Objective: To compare the procedural success between symptomatic and asymptomatic patients who underwent carotid angioplasty in a tertiary care center. Methodology: This cross-sectional analytical study was conducted at the Rawalpindi Institute of Cardiology, Rawalpindi after taking ethical approval. Data was collected from March 2023 to March 2026. Following written informed consent, 170 patients aged ≥18 years with severe carotid artery stenosis who underwent carotid angioplasty were included using non-probability consecutive sampling. The patients were divided into symptomatic and asymptomatic groups. All cases of carotid angioplasty with stenting were performed electively by the team of interventional cardiologists in the catheterization lab using aseptic protocols. Procedural success was defined as residual stenosis of <30% after stent placement with no major adverse cardiac and cerebrovascular events (MACCEs). Patients were followed up at 30 days and 6 months. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 26. Results: One hundred and forty one (82.9%) patients had a history of stroke, and were symptomatic, whereas, 29(17.1%) patients were asymptomatic, with either no symptom (6%) or planned for coronary artery bypass grafting (16.5%). The technical success was 100%, with <30% residual stenosis. Out of 170 patients, 2(1.2%) patients died, 3(1.8%) patients developed stroke and 1(0.6%) patient had myocardial infarction at 6 months. The overall procedural success was 96.5%. The procedural succcess was not significantly different between symptomatic and asymptomatic patients (p-value = 1.00). Conclusion: Carotid angioplasty showed excellent procedural success in symptomatic as well as asymptomatic patients in a tertiary care center.
Objective: To determine the frequency and antimicrobial resistance (AMR) pattern of bacterial isolates among intensive care unit (ICU) patients in a tertiary care hospital. Methodology: This cross-sectional descriptive study was carried out in the Microbiology Laboratory of Provincial Headquarter Hospital, Gilgit, from October 2025 to March 2026 after ethical approval. After taking informed consent, 150 culture specimens received from ICU patients were tested by non-probability consecutive sampling. Each specimen was inoculated onto the appropriate culture media, then incubated and carefully identified based on colony morphology, Gram stain, and biochemical tests. The antimicrobial sensitivity testing (AST) was performed by the Kirby-Bauer disc diffusion method. The antibiotic zone diameters were reported following the Clinical and Laboratory Standards Institute (CLSI) guidelines 2025. The statistical analysis was done by the Statistical Package for the Social Sciences (SPSS) version 27. Results: The most common pathogen isolated was Staphylococcus (31.6%), succeeded by Escherichia coli (17.3%), Klebsiella pneumoniae (15.3%), Pseudomonas aeruginosa (13.3%), Acinetobacter baumannii (10.2%), Enterococcus species (9.2%), and Proteus species (3.1%). Staphylococcus aureus, Coagulase-negative Staphylococcus species (CoNS) and Enterococcus species were sensitive to vancomycin and linezolid. Staphylococcus aureus and CoNS showed less resistance to gentamicin (35.7% versus 23.5%) and doxycycline (28.6% and 17.6%). Carbapenems showed 100% susceptibility in all Gram-negative isolates. Piperacillin-tazobactam, amikacin and nitrofurantoin showed better sensitivities as compared to other antibiotics. Escherichia coli, Klebsiella pneumoniae, Proteus and Pseudomonas showed 29.4%, 33.3%, 0% & 38.5% resistance to piperacillin-tazobactam and 17.6%, 20%, 33.3% & 46.1% to amikacin. Resistance to nitrofurantoin was 27.3% for E. coli, 0% for Klebsiella pneumoniae, and Proteus species. Acinetobacter baumannii exhibited higher antibiotic resistance. Conclusion: Gram-negative bacteria constituted 59.2%, whereas Gram-positive bacteria made up 40.8% of the isolates. Around 71.4% isolates of Staphylococcus aureus were methicillin-resistant and 70.6% Escherichia coli & 73.3% Klebsiella pneumoniae were extended-spectrum beta-lactamase (ESBL) producers. A higher antimicrobial resistance was seen in the isolates.
Objective: To evaluate the effect of strict institutional donor selection criteria on short term safety outcomes among living liver donors undergoing hepatectomy. Methodology: This retrospective cross-sectional study on 140 living liver donor records was conducted in the Department of Hepatopancreatobiliary (HPB) and Liver Transplant Surgery at Bahria International Hospital, Orchard, Lahore. The study was carried out from January to March 2026 after obtaining institutional ethical approval. Donors were evaluated by a multidisciplinary team and selected through a structured protocol that included clinical, biochemical, radiological, and psychosocial evaluations. Acceptable graft parameters included graft-to-recipient weight ratio (GRWR) ≥0.8 and future liver remnant (FLR) ≥30%. Those with significant comorbidities, fatty liver, abnormal liver function tests, and fibrosis were not selected for donation. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 29. Results: The mean age of donors was 27.0±4.7 years with a mean body mass index (BMI) of 24.0±2.4 kg/m². The mean length of hospital stay was 5.0±0.7 days. Overall, early postoperative complications occurred in 3(2.1%) donors, including bile leak in 2(1.4%) cases and wound infection in 1(0.7%) case. No donor mortality was observed. Donors who developed early complications had a significantly longer hospital stay compared with those without complications (6.67±0.58 days vs 4.98±0.62 days, p <0.001). Conclusion: The use of a meticulous donor selection protocol, combined with a multidisciplinary assessment, was associated with low complication rates, shorter hospital stays, and no donor mortality.
Objective: To compare the efficacy and safety of oral itraconazole alone versus oral itraconazole in combination with oral isotretinoin in the treatment of chronic recurrent dermatophytosis. Methodology: This quasi-experimental study was conducted in the Department of Dermatology, Services Hospital, Lahore, over a duration of one year from January to December, 2025, after institutional ethical approval. Written informed consent was obtained, and a total of 125 patients with recurrent tinea cruris and/or tinea corporis were enrolled using a non-probability consecutive sampling technique. Patients were allocated into two groups: group A (n=61) received oral itraconazole alone, while group B (n=64) received oral itraconazole in combination with oral isotretinoin for one month. Patients were followed weekly during the treatment period to assess clinical cure and adverse effects. Mycological cure was assessed at the end of one month of treatment, and patients were then followed monthly for three months posttreatment to evaluate relapse. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 26. Results: The mean age of our study participants was 33.95±7.59 years. This study found no statistically significant difference in clinical and mycological cure at treatment completion between the groups (p=0.06). However, relapse was significantly more frequent in group A (55.7%) compared to the group B (34.4%) (p=0.013). Group B experienced a significantly higher frequency of adverse effects, particularly cheilitis and lip dryness (p <0.001). Conclusion: There was no significant difference in initial clinical or mycological cure rates between the groups. However, group B receiving combination therapy significantly reduced relapse rates but was associated with a higher frequency of adverse effects in the treatment of chronic recurrent dermatophytosis.
Objective: To determine the association between key perception constructs measured using the technology acceptance model (TAM) questionnaire and attitude towards adoption of artificial intelligence (AI) as a teaching tool among medical students in Pakistan. Methodology: This cross-sectional analytical study was conducted at Allama Iqbal Medical College, Lahore, from September 2025 to February 2026 after ethical approval. Two hundred and eighty five MBBS students aged ≥18 years of any gender were included using a non-probability convenience sampling technique after obtaining informed written consent. Students with prior AI experience or enrollment in AI programs were excluded. A predesigned TAM questionnaire was used to collect data. The data was entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 21. The key perception constructs, perceived usefulness (PU) and perceived ease of use (PEU), were compared with the main dependent outcome, i.e., attitude towards AI use. Results: The mean age of the participants was 21.5±1.5 years. Most students were females [156(54.7%)] and majority of the students belong to 4th year MBBS [105(36.8%)]. Multivariable regression showed that perceived usefulness had a significantly positive association with attitude towards AI adoption (p-value=0.001) whereas perceived ease of use demonstrated a weak but significant negative association with attitude (p=0.005). Conclusion: Perceived usefulness is found to be a primary driver of AI adoption among medical students. However, perceived ease of use demonstrated a small but significant negative association with attitude, suggesting that its role may be secondary when usefulness is accounted for in the model.
Synovial chondromatosis and osteochondroma rarely present concurrently in the elbow. We report a 19-year-old male football goalkeeper with an 8 month history of progressive right elbow pain and restricted range of motion (flexion 90°, extension 30°) likely related to repetitive microtrauma. Imaging revealed multiple intraarticular small, loose bodies; known as rice bodies consistent with synovial chondromatosis and a distal humeral osteochondroma measuring >2.5 cm. In the first stage, arthroscopic synovectomy with excision of rice bodies was performed, while the osteochondroma was left for a planned second stage open resection. This case highlights the importance of staged surgical management and rehabilitation in restoring function in a young patient with concurrent benign elbow pathologies.
Objective: To assess the clinical presentation, laboratory abnormalities, and antimicrobial response patterns among children diagnosed with enteric fever. Methodology: This cross-sectional analytical study was conducted at the Department of Pediatrics, Ittefaq Hospital (Trust), Lahore from January to June 2025. Ethical approval was obtained from the Institutional Review Committee. Informed written consent was sought from parents/guardians of study participants. A sample size of 131 was calculated and children suspected of enteric fever were enrolled using non-probability consecutive sampling technique. Demographic and clinical data was documented. Blood samples were obtained aseptically before antimicrobial therapy and processed for Salmonella typhi identification and antimicrobial susceptibility. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: The median age of 131 children was 7.0 years [inter-quartile range (IQR) 3.0-9.0]. Blood culture was positive for Salmonella typhi in 75(57.3%) cases including 42(32.1%) multidrug-resistant (MDR) and 33(25.2%) extensively drug-resistant (XDR) strains. Abdominal pain (p=0.004) and constipation (p=0.010) were more frequent in XDR cases. Leukopenia occurred only in XDR cases (p=0.009), and raised C-reactive protein (CRP) was more common in MDR (85.7%) and XDR (90.9%) samples compared to no growth samples (p <0.001). Conclusion: Salmonella typhi was identified in over half of the cases with a high proportion of MDR and XDR strains. Abdominal pain, constipation, and leukopenia were significantly more common among XDR patients compared to MDR patients. C-reactive protein was significantly elevated in both MDR and XDR cases, while erythrocyte sedimentation rate (ESR) showed no association. Multidrug-resistant strains showed sensitivity to ceftriaxone and XDR strains to azithromycin & carbapenems.
Artificial Intelligence (AI) has rapidly evolved into an essential component of modern healthcare and medical education, supporting clinical decision-making, documentation, research, and personalized learning. AI-based tools enhance medical training by generating clinical scenarios, simplifying complex concepts, providing instant feedback, and facilitating self-directed learning. In resource-limited settings such as Pakistan, AI offers opportunities to address gaps in faculty availability and clinical exposure. In clinical practice, AI is increasingly utilized in specialties including radiology, dermatology, pathology, and cardiology for diagnostic assistance, risk prediction, image interpretation, and administrative support, thereby improving efficiency and expanding access to healthcare services. Despite its benefits, AI presents significant challenges related to reliability, algorithmic bias, transparency, accountability, patient privacy, and data security. Excessive dependence on AI may undermine critical thinking, clinical reasoning, and professional judgment among healthcare professionals and trainees. Ethical concerns remain central, as empathy, compassion, communication, and patient trust cannot be replicated by algorithms. The successful integration of AI into healthcare and medical education requires appropriate governance, AI literacy, institutional support, and responsible implementation. The future of medicine lies not in replacing physicians with AI, but in combining technological innovation with human expertise, ethical responsibility, and compassionate patient care.
Objective: To assess levels of hemoglobin, serum copper (Cu), zinc (Zn), iron (Fe), and superoxide dismutase (SOD) levels in individuals with depressive disorder and to evaluate their diagnostic utility as biomarkers using receiver operating characteristic (ROC) curve analysis. Methodology: This cross-sectional comparative study was conducted at the University of Health Sciences, Lahore from September 2025 to March 2026 and serum samples were collected from Combined Military Hospital, Muzaffarabad. After obtaining institutional ethical approval, 30 healthy controls and 60 patients with depressive disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria were included. Study participants were recruited using non-probability consecutive sampling technique. After obtaining informed written consent, blood samples were analyzed for hemoglobin, copper, zinc, iron, and SOD levels using standard laboratory methods. Statistical Package for the Social Sciences (SPSS) version 25.0 was used for data analysis and a p-value <0.05 was considered statistically significant. Results: Patients with depression had significantly higher serum copper levels (129.31±45.81 vs. 101.32±14.14 µg/dL, p=0.001) and Cu/Zn ratio (1.71±1.05 vs. 1.15±0.44, p=0.001), but lower hemoglobin levels (10.89±0.92 vs. 11.35±1.01 g/dL, p=0.040) and SOD activity (54.14±44.66 vs. 84.02±28.72 U/mL, p=0.001) compared to healthy controls. In the depression group, serum copper showed significant inverse correlations with zinc (r=-0.38, p=0.004) and SOD activity (r=-0.41, p=0.002). Regarding diagnostic performance, serum copper demonstrated fair discriminatory ability [area under the curve (AUC)=0.70, 95% confidence interval (CI):0.58-0.82], while a combined model of serum copper and Cu/Zn ratio showed improved performance (AUC=0.82, 95% CI:0.71-0.90), indicating good discriminatory ability. Conclusion: The depression group showed significantly elevated serum copper, increased Cu/Zn ratio, reduced SOD activity, and lower hemoglobin levels as compared to healthy controls. Serum copper was inversely correlated with zinc and SOD in the depression group. Serum copper and the Cu/Zn ratio combined showed good diagnostic performance on ROC analysis. Serum zinc and iron levels were not significantly different between groups.
Objective: To compare the efficacy and safety of CAPOX versus FOLFOX6 in patients with metastatic colorectal carcinoma in terms of disease progression, mortality, and treatment-related toxicities. Methodology: This randomized controlled trial was conducted at the Department of Oncology, Jinnah Hospital, Lahore, from September 2025 to February 2026, following ethical approval from the institutional review board. Patients aged 20 to 80 years with metastatic colorectal carcinoma planned for postoperative chemotherapy were recruited using a non-probability consecutive sampling technique after obtaining informed written consent. A total of 248 patients were screened, of whom 216 eligible patients were randomized to either CAPOX or FOLFOX6 treatment groups. During follow-up, 15 patients in the CAPOX group and 22 patients in the FOLFOX6 group were lost to follow-up; therefore, the final analysis was performed on 179 patients, including 93 in the CAPOX group and 86 in the FOLFOX6 group. Outcomes included disease progression, dose reduction, hepatotoxicity, diarrhea, neuropathy, treatment discontinuation, and mortality. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 26. Results: Baseline demographic and clinical characteristics were comparable between the two groups (p >0.05). Disease progression occurred in 25(26.9%) patients in the CAPOX group and 32(37.2%) patients in the FOLFOX6 group [odd ratio (OR) 0.62, 95% confidence interval (CI):0.33-1.17; p=0.138]. Neuropathy was significantly less frequent in the CAPOX group compared with the FOLFOX6 group (24.7% vs. 47.7%; p=0.001). Hepatotoxicity was less frequent in the CAPOX group than in the FOLFOX6 group (5.4% vs. 14.0%); however, this difference did not reach statistical significance (p=0.051). Mortality, dose reduction, treatment discontinuation, and diarrhea did not differ significantly between the groups (p >0.05). Conclusion: In patients with metastatic colorectal carcinoma, CAPOX was associated with a significantly lower frequency of neuropathy compared with FOLFOX6. CAPOX and FOLFOX6 treatment groups showed no statistically significant difference in disease progression, mortality, dose reduction, hepatotoxicity, diarrhea, and treatment discontinuation.
Objective: To determine the diagnostic performance of ultrasound pixel density in differentiating exudative from transudative pleural effusions, using Light’s criteria as the gold standard. Methodology: This cross-sectional validation study was conducted at the Pulmonology Department of Pak Emirates Military Hospital, Rawalpindi from January to April 2026, after institutional ethical approval. One hundred and ten patients with pleural effusions confirmed by ultrasound and scheduled for diagnostic thoracentesis were enrolled using a non-probability consecutive sampling technique. Written informed consent was obtained from all patients. A curvilinear ultrasound probe (3-5 MHz) was used with standardized depth (8 cm) and gain (60 dB) settings. Three frozen B-mode images were obtained per patient, and pixel density was quantified within a 1 cm² region of interest using ImageJ software. Ultrasonographic pixel density ≥9.5 was classified as exudative. Light’s criteria were applied to pleural fluid biochemistry as the gold standard. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 27.0. Results: Among 110 patients (mean age 42.29±9.09 years; 61.8% males), 66(60%) were classified as having exudative and 44(40%) as having transudative pleural effusion according to Light’s criteria. At the 9.5 cut-off value, pixel density demonstrated a sensitivity of 25.76%, specificity of 95.45%, positive predictive value (PPV) of 89.47%, negative predictive value (NPV) of 46.15%, and an overall diagnostic accuracy of 53.64%. Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.75 (p <0.001). Median pixel density was significantly higher in exudative effusions (3.35) compared with transudative effusions (1.50) (p <0.001). Conclusion: Pixel density on ultrasound at a cut-off value of 9.5 demonstrated high specificity with low sensitivity for differentiating exudative from transudative pleural effusion. The ROC analysis showed fair diagnostic accuracy of ultrasound pixel density. This technique may serve as a useful adjunct in the evaluation of pleural effusion; however, it cannot be used as the only diagnostic test instead of thoracentesis.
Objective: To determine the association between high-altitude residence and the risk of prostate cancer based on prostate-specific antigen density (PSAD) among residents of Gilgit-Baltistan. Methodology: This cross-sectional analytical study was conducted at Misgar, Gilgit Baltistan, by Sharif Institute of Urology & Renal Transplant (SIURT), Sharif Medical City Hospital, Lahore, from July to December 2025, following ethical approval from the institutional review board. After meeting the selection criteria, 96 male residents of high altitude, having age ≥40 years, were enrolled using a non-probability consecutive sampling technique, irrespective of digital rectal examination (DRE) or ultrasound findings. The patients then underwent clinical evaluation, and blood samples were collected to measure their prostate-specific antigen (PSA) levels. Prostate size (ml) was measured using abdomino-pelvic ultrasound by a consultant radiologist in the nearest health facility, and PSAD was calculated. Based on PSA density, patients were categorized as having low, intermediate, and high risk of cancer. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 26. Results: The mean age of the patients was 59.38±11.12 years. Among patients residing at high altitude for ≥10 years, a high risk of prostate cancer based on PSA density was observed in 4(4.2%) cases, whereas among those living at high altitude for <10 years, high risk was not found in any of the patients (p <0.001). Most of the smokers, hypertensives, diabetics, and those with positive family history of prostate cancer had intermediate or high risk of prostate cancer (p <0.05). However, alcohol use showed no such association (p-value=0.18). Conclusion: Residents living at high altitude for more than 10 years had a significantly higher risk of developing prostate cancer compared to those residing at high altitude for less than 10 years.
Antimicrobial resistance is a growing global and national public health crisis that threatens the effectiveness of modern medicine and increases mortality, healthcare costs, and treatment failure. According to global estimates, antimicrobial resistance caused 1.27 million deaths worldwide in 2019, with projections indicating a substantial rise by 2050 if urgent action is not taken. In Pakistan, antimicrobial resistance ranks among the leading causes of death, driven by widespread antibiotic misuse, over-the-counter availability, inadequate diagnostics, poor infection control, and antibiotic use in agriculture. Resistant pathogens such as Mycobacterium tuberculosis, Staphylococcus aureus, and Enterobacterales are increasingly common, leading to prolonged hospital stays, limited treatment options, and higher mortality. Addressing this challenge requires a coordinated One Health approach that strengthens surveillance, promotes antimicrobial stewardship, improves diagnostic capacity, enforces infection prevention measures, and supports antibiotic innovation. Immediate collective action by healthcare providers, policymakers, and communities is essential to preserve antibiotic effectiveness and prevent a future where common infections become life-threatening.
Objective: To determine the association of Hemoglobin A1c (HbA1c) levels with the complexity of coronary artery disease (CAD) in diabetic patients presenting with acute coronary syndrome (ACS), in terms of higher synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score measured during coronary angiography. Methodology: This cross-sectional comparative study was conducted at Fauji Foundation Hospital, Rawalpindi from July to September 2025 after approval from the ethical committee of the institution. Patients were divided into two groups. Those with HbA1c ≤7% were labeled as group 1 and group 2 had patients with HbA1c >7%. After informed written consent, 122 confirmed diabetic patients who presented with ACS and underwent coronary angiography were included using non-probability convenience sampling. The SYNTAX score was estimated to determine angiographic disease complexity. The patients with scores of 0-22 were labeled as low risk, 23-32 as intermediate, and >32 as high-risk CAD. The blood samples of patients were taken and sent for HbA1c levels and fasting lipid profile. Data analysis was carried out with the Statistical Package for the Social Sciences (SPSS) version 26. Results: When CAD risk categories were compared with HbA1c groups, the majority of the patients in group 1 (34.4%) and group 2 (24.6%) had low risk and intermediate risk CAD, respectively. There was a significant and moderate positive correlation (r=0.528) between HbA1c and SYNTAX scores (p-value=0.001). Only the lipid profile showed a significant relationship with CAD risk categories. Conclusion: The majority of patients with HbA1c ≤7% had low-risk CAD, while patients with HbA1c >7% had intermediate-risk CAD. The SYNTAX score significantly increased with increasing HbA1c levels. In addition, the patients with intermediate and high-risk CAD also had dyslipidemia.
Objective: To compare the efficacy of lacosamide versus placebo in patients with diabetic neuropathy in terms of reduction of the mean pain score. Methodology: This randomized controlled trial (RCT) was conducted at the Department of Medicine, Nishtar Hospital, Multan from April to August 2025. After informed written consent, 60 patients with diabetic neuropathy were included and their baseline pain levels at recruitment were assessed using the visual analogue scale (VAS). The patients were enrolled using non-probability convenience sampling technique and subsequently randomized equally through a lottery method. Randomization was used to assign patients to either group A (lacosamide) or group B (placebo). Participants were administered either lacosamide (LCM; brand name atcomid) or a placebo that contained microcrystalline cellulose, which was commercially available and widely used in clinical trials involving diabetics. Both placebo & lacosamide were started at 100 mg daily and escalated to 400 mg/day over four weeks. Both were maintained at 400 mg for 12 weeks. The VAS was used to measure baseline and post-treatment pain scores. The variables of age, gender, duration of diabetes, obesity (body mass index ≥30 kg/m2), and diabetes control were documented. Statistical Package for the Social Sciences (SPSS) version 26 was used for the analysis of the data. Results: The age distribution of the study population was statistically similar in the two groups (46.67±9.66 years vs. 49.30±8.38 years; p=0.264). Majority of the participants were males in both groups (66.7% vs. 56.7%). The baseline VAS values were almost similar across the groups (group A: 7.40±1.96 vs. group B: 6.87±2.01; p=0.31). The lacosamide group showed a notable decrease in post-treatment pain scores as compared to placebo (3.90±1.92 vs. 6.73±1.72; p <0.001). Conclusion: Lacosamide provided a statistically and clinically significant reduction in pain intensity among patients with diabetic neuropathy compared to placebo. The marked decrease in post-treatment VAS scores highlighted its potential as an effective adjunctive option for managing neuropathic pain in this population.
Objective: To explore experiences and perceptions of early clinical exposure (ECE) in undergraduate medical students under a modular curriculum through a mixed-methods approach. Methodology: This cross-sectional mixed-methods study was conducted at Rashid Latif Khan University Medical College, Lahore from July to September 2025, following a recently introduced modular curriculum after ethical approval. The participants were second-year MBBS students who had completed at least one year of learning under the modular system with early clinical exposure components. After obtaining written, informed consent, 100 students were included using non-probability convenience sampling technique. Quantitative data was collected through a structured questionnaire using 5-point Likert scale assessing integration of basic and clinical sciences, motivation to learn, communication with patients, and overall satisfaction. Qualitative perceptions were obtained through focus group discussions (FGDs), transcribed verbatim and analyzed thematically using NVivo software. Quantitative data was analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Results: The majority of the students were of the opinion that ECE resulted in enhanced incorporation of basic and clinical sciences (mean Likert score 4.3/5), it also improved the motivation to learn (4.5/5), and better-quality communication skills with patients (4.2/5). Qualitative data analysis with thematic analysis discovered four major themes, i.e. (1) Linking theory and practice; students recognized the significance of learning in a specific context (2) Motivation through realistic exposure - clinical learning environment stimulated them for enhanced learning (3) Professionalism and communication - students felt an improvement in their self-confidence, communication skills and empathy with the patients; and (4) Challenges and barriers - despite major positive outcomes overcrowding, lack of time, and inconsistent faculty input posed difficulties. Conclusion: The majority of the students perceived early clinical exposure within modular curricula positively. It enhanced students' motivation, understanding, and communication skills. Fixing the logistical and faculty training challenges can maximize the impact.
Objective: To compare the effectiveness of diclofenac suppositories and injection diclofenac in pain relief after abdominal surgeries. Methodology: This quasi-experimental study was conducted at the West Surgical Ward, Mayo Hospital, Lahore from June 2022 to January 2023 after taking approval from ethical committee. Total 136 patients undergoing elective and emergency abdominal surgeries were enrolled in the study via non-probability convenience sampling technique. Informed written consent was taken from all the patients. The patients were divided into two groups (group A & B). Group A was given diclofenac suppositories and group B was given injection diclofenac via the intramuscular (I/M) route. The pain scores were recorded by using visual analogue scale (VAS) at 0, 8, 16, and 24 hours. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 26. Results: There was a significant decrease in mean pain scores at 0, 8, 16, and 24 hours post-operatively in group A as compared to group B. The maximum difference in the means was observed at 16 hours post-operatively (p <0.001). Only 15(11.1%) patients in group A required rescue analgesia, while more than half the patients in group B required rescue analgesia for effective pain relief (p=0.001). The proportion of patients experiencing adverse effects of the drug in group A was significantly smaller (8.1%) as compared to group B (25.7%) (p=0.001). Conclusion: Rectal suppositories of diclofenac were significantly more effective for post-operative pain relief among patients undergoing abdominal surgeries as compared to diclofenac intramuscular injection.
Objective: To detect the frequency and species distribution of intestinal parasites among children and young adolescents visiting a provincial Headquarter Hospital in Gilgit, Pakistan and determine their association with socio-demographic and environmental factors Methodology: This descriptive, cross-sectional study was done among patients visiting the Provincial Headquarter Hospital in Gilgit-Baltistan, Pakistan after ethical approval. The study duration was 6 months from August 2024 to January 2025. After taking informed consent, 227 children and young adolescents with ages ranging from 1 to 18 years were included using non-probability convenience sampling technique. Data was collected using a structured questionnaire including demographic factors, hygiene practices, healthcare access, and other relevant factors. Specimen bottles labeled with participant names and identification numbers were provided to parents and they were guided for stool sample collection. The collected specimens were processed in the Pathology Department of a healthcare facility for stool routine analysis. The data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: Intestinal parasitic infections (IPIs) were present in 74(32.6%) children and young adolescents. Ascaris lumbricoides (46%) and Giardia lamblia (29.7%) were the most prevalent intestinal parasites. Access to clean drinking water and hygienic conditions had a significant relation with IPIs (p-value=0.001). No significant association was seen with other variables such as gender, age, education level, and family income. Conclusion: Intestinal parasitic infections were prevalent in 32.6% children and young adolescents. Ascaris lumbricoides and Giardia lamblia were the most common parasites. There was a statistically significant influence of environmental factors, particularly access to clean drinking water and poor personal hygienic conditions, on the frequency of these infections.
Objective: To assess the association of radial artery spasm (RAS) with radial artery diameter and other factors in patients undergoing transradial cardiac catheterization. Methodology: This descriptive, cross-sectional study was conducted at the Fauji Foundation Hospital, Rawalpindi from June to September 2025 after ethical approval. After taking informed written consent, 150 patients who underwent coronary angiography or percutaneous coronary intervention using transradial approach were included. Prior to the procedure, radial artery diameter was assessed by the linear probe of Xario 100g Ultrasound machine. Radial artery spasm was assessed clinically by the operator and radial artery angiograms. Patients were divided into two groups: group I with no RAS and group II with RAS. The association of RAS with the radial artery diameter and other variables were determined. Statistical Package for the Social Sciences (SPSS) version 26 was used for data analysis. Results: Radial artery spasm occurred in 35(23.3%) patients. The time to vascular access was significantly higher (150.60±49.77 seconds) in patients with RAS as compared to those without spasm (43.69±29.61 seconds) (p=0.001). The number of procedure attempts, episodes of vasovagal syncope (3.3% versus 0%) and access site crossover (6% versus 0%) were also significantly higher in patients with RAS. The radial artery spasm had a significant positive association with radial artery diameter, ejection fraction, angiographic findings, and treatment plan. The ROC curve showed an area under the curve of 0.876, showing the excellent ability of radial artery diameter to predict RAS. Conclusion: Radial artery spasm affects a significant proportion of patients (23.3%) undergoing transradial cardiac catheterization. The radial artery diameter, vascular access time, need for ultrasound assistance to secure vascular assistance, additional vasodilator & glide wire, vasovagal syncope, and access site crossover were significantly higher in patients with RAS.
Objective: To compare the effects of ticagrelor and clopidogrel on major adverse cardiovascular events (MACE), 30 day mortality, and stent thrombosis in patients with ST-elevation myocardial infarction (STEMI) undergoing complex percutaneous coronary intervention (PCI). Methodology: This quasi-experimental study was conducted at the Rawalpindi Institute of Cardiology, Rawalpindi in 3 months from June to August 2025 after ethical approval. After obtaining informed written consent, 376 patients with STEMI treated with complex PCI were included by non-probability convenience sampling technique. The patients were assigned to two groups: Group A received aspirin & clopidogrel, whereas group B received aspirin and ticagrelor. The outcomes assessed were MACE, 30 day mortality, and stent thrombosis. Follow-up was done till 1 month. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: Bifurcation stenting was present in 80(42.6%) patients in clopidogrel group, while it was seen in 46(24.5%) patients in ticagrelor group. The left main PCI was also more prevalent in the ticagrelor group [81(43.1%)]. The thrombolysis in myocardial infarction (TIMI) 3 flow was restored in 53.7% versus 30.3% of the patients taking ticagrelor and clopidogrel, respectively. Stent thrombosis and MACE were significantly higher in the clopidogrel group (8.5% versus 2.7%) and (19.1% versus 11.2%), respectively. In contrast, no substantial difference was noted regarding 30 day mortality (9% vs. 8%) between the two groups. Conclusion: Ticagrelor is associated with improved post-PCI TIMI flow, lower incidence of MACE and stent thrombosis in STEMI patients who underwent complex PCI as compared to clopidogrel. However, 30 day mortality is not significantly different in the two groups.
