Abstract Background Soft tissue defects of the distal forearm and hand resulting from high-energy trauma frequently involve exposed tendons or bone and require reliable reconstruction to restore function and prevent long-term morbidity. The dorsal ulnar artery perforator (DUAP) flap preserves major vascular axes and provides thin, pliable coverage; however, its clinical outcomes remain under-reported, particularly in South Asian populations. Objectives To evaluate the clinical outcomes of the dorsal ulnar artery perforator flap for soft tissue coverage of defects in the distal forearm and hand. Methodology This descriptive longitudinal study included 90 patients aged 15–60 years with non-healing soft tissue defects of the distal forearm and hand persisting for more than four weeks. All patients underwent reconstruction using a dorsal ulnar artery perforator flap. Flap outcomes were assessed at three months and classified as complete survival, partial necrosis, or total necrosis based on predefined clinical criteria. Demographic and clinical variables were recorded prospectively. Statistical analysis was performed using SPSS version 25. Continuous variables were summarized as medians with interquartile ranges, while categorical variables were expressed as frequencies and percentages. Associations between flap survival and potential effect modifiers were analyzed using the chi-square test. Results The median age was 40.5 years, and 67.8% of patients were male. Complete flap survival was observed in 75 patients (83.3%), partial necrosis in 13 patients (14.4%), and total necrosis in 2 patients (2.2%). All cases of partial necrosis were managed conservatively or with split-thickness skin grafting. No statistically significant association was found between flap survival and patient- or defect-related variables (p > 0.05). Conclusion The dorsal ulnar artery perforator flap is a reliable and effective option for soft tissue reconstruction of distal forearm and hand defects, demonstrating high survival rates and low complication rates across diverse patient subgroups.
BACKGROUND: Postoperative atrial fibrillation (POAF) is a common complications after the CABG) which sometime leads to morbidity and prolonged hospital stay. Structural remodelling of left atrium, reflected by the increased left atrial size is identified as vital substrate for atrial fibrillation. Enlarged left atrial dimensions are linked to altered electrical conduction and intensify arrhythmogenic potential. Assessing left atrial size preoperatively may assist as a simple and valuable predictor for development of new onset atrial fibrillation following CABG. OBJECTIVE: To determine the diagnostic accuracy of left atrial size in predicting new-onset postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, using postoperative ECC findings as the gold standard. METHODOLOGY: This Cross-sectional validation study was conducted on 224 patients undergoing elective on-pump coronary artery bypass grafting from 25-09-2025—25-02-2026 at Armed Forces Institute of Cardiology (AFIC), Rawalpindi, Pakistan Patients with prior arrhythmias, previous cardiac surgery or pacemaker implantation, taking preoperative anti-arrhythmic therapy and patients with valvular pathologies and pulmonary hypertension were excluded. Preoperative transthoracic echocardiography was performed to measure left atrial diameter, left atrial area, left atrial volume index, and left ventricular ejection fraction. All patients underwent continuous telemetry monitoring for at least 72 hours postoperatively to detect new-onset atrial fibrillation. Left atrial diameter > 41mm was considered the cutoff point for diagnosing new-onset atrial fibrillation. Diagnostic accuracy was measured using 2x2 contingency table. ROC curve was analyzed. Chi square test was used for assessing associations with significance set at 5%. RESULTS: Postoperative atrial fibrillation occurred in 124 (55.4%) patients. At a cut-off value of > 41 mm, sensitivity was 62.90%, specificity 63.0%, and negative predictive value was 57.80%, with diagnostic accuracy was 62.95%. Receiver operating characteristic curve analysis showed an area under the curve of 0.66 (95% confidence interval 0.59 to 0.73, p<0.001). Independent predictors included hypertension (p<0.001), body mass index (p<0.001), and left atrial diameter (p=0.001). CONCLUSION: Left atrial diameter was a significant independent predictor of new-onset atrial fibrillation after coronary artery bypass grafting, with modest diagnostic accuracy 62.95%.
ABSTRACT Background: Detecting ankylosing spondylitis (AS) at initial stage is challenging due to standard X-rays having limited sensitivity. Magnetic reaonance imaging (MRI) is highly sensitive in detecting early inflammation but it is price-intensive and its limited availability impedes its use in resource-limited settings. This study was conducted to observe the diagnostic accuracy of spinal X-ray in capturing ankylosing spondylitis (AS), with MRI serving as the gold-standard. Methodology: At the Department of Radiology, Hayatabad Medical Complex, a cross-sectional study was carried out including a total of 110 patients aged 17-45 years with clinical suspicion of ankylosing spondylitis (AS). All participants had under gone both spinal X-ray and magnetic resonance imagining (MRI). Diagnostic performance measures which include sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. MRI was used as Gold standard. Results: The participants had a mean age of 32.4±7.8 years. The male-to-female ratio was 2.3:1. Spinal X-ray showed a sensitivity of 64.2%, specificity of 82.5%, positive predictive value (PPV) of 76.8%, negative predictive value (NPV) of 71.4%. Among the radiographic features, vertebral squaring and syndesmophytes demonstrated the highest specificity (85.7% and 88.2%, respectively) whereas Romanus lesions had the lowest sensitivity (31.3%). Conclusion: The diagnostic accuracy of X-ray is moderate as compared to MRI for ankylosing spondylitis (AS) with specificity higher than sensitivity to especially in early disease. X-ray remains a useful imaging tool for initial detection especially in a resource-limited area like ours. However, MRI should be kept in mind when clinical suspicion remains even if X-ray is negative.
The integrated curriculum in medical education aims to produce clinically competent, patient-centered graduates through interdisciplinary learning. However, its implementation in Pakistani medical colleges faces significant barriers. This editorial identifies key challenges, including faculty resistance, lack of training, poor interdepartmental coordination, inadequate infrastructure, flawed assessment systems, and student disengagement. We argue that without structured faculty development, aligned assessment strategies, and institutional support, the potential benefits of integration remain unrealized.
BACKGROUND: Measles, also known as rubeola, is a highly contagious, acute febrile viral illness that can be prevented through vaccination. It remains a significant cause of global mortality and morbidity, particularly in regions such as Africa and South Asia. OBJECTIVE: To determine the frequency and associated demographic factors of complications among children hospitalized with measles. METHODOLOGY: A cross-sectional study was conducted at Pediatrics Department, Northwest General Hospital, Peshawar, from 20-10-2023, to 30-08-2025. A total of 330 children, of both genders, diagnosed with measles were included in the study. Measles complications, including pneumonia, encephalitis, acute watery diarrhea, otitis media, and febrile fits, were evaluated in all patients. RESULTS: This study includes 330 measles children, with a mean age of 16.2±5.1 months, predominantly male (63.9%). Pneumonia was the most common complication (49.1%), followed by encephalitis (27.0%), otitis media (10.3%), acute watery diarrhea (9.4%), and febrile fits (5.2%). Children aged<18 months had significantly higher odds of developing pneumonia (54.4% vs. 35.2%; OR: 2.20, 95% CI: 1.34–3.61; p=0.002) and encephalitis (30.5% vs. 17.6%; OR: 1.91, 95% CI: 1.06–3.45; p=0.010) compared with older children. No significant association was observed between age and acute watery diarrhea, otitis media, or febrile fits (p>0.05). Similarly, gender was not significantly associated with any of the measured complications (p>0.05). CONCLUSION: Pneumonia and encephalitis were the most common measles complications, with children younger than 18 months at significantly higher risk, highlighting the importance of early recognition and timely management to reduce morbidity.
