Objective: To assess the functional performance of the ipsilateral upper limb in breast cancer patients after axillary lymph node dissection (ALND) at a tertiary care hospital in Karachi, Pakistan. Methods: A prospective cohort study was conducted at the Department of Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan, from May 2025 to March 2026. Female breast cancer patients undergoing unilateral ALND were enrolled. Functional performance was assessed using Disabilities of the Arm, Shoulder, and Hand (DASH) score, shoulder flexion, extension, abduction, external rotation, internal rotation, horizontal abduction, and horizontal adduction measured through digital goniometry, along with inter-limb volume difference measured through circumferential arm measurements. Higher DASH scores indicated poorer function, while higher range of motion values reflected better recovery. Inter-limb volume difference was categorized as normal (<5%), subclinical (5–9.9%), or clinical lymphedema (≥10%). Assessments were performed at baseline, 3 months, and 6 months postoperatively. Results: Among 60 patients, the median age was 51.5 years (IQR: 39.2–59.7). DASH scores increased postoperatively with maximum impairment at 3 months followed by partial recovery at 6 months (p-value <0.001). Shoulder flexion, abduction, horizontal adduction, horizontal abduction, and inter-limb volume difference also showed significant interval changes over time (all p-values <0.05). At 3 months, 9 (15.0%) patients developed subclinical lymphedema without any clinical cases; however, by 6 months, 37 (61.7%) progressed to subclinical lymphedema and 6 (10.0%) developed clinical lymphedema. Conclusion: ALND was associated with significant deterioration in ipsilateral upper limb functional performance, with progressive increase in subclinical and clinical lymphedema during postoperative follow-up.
Objective: To evaluate the efficacy and safety of suprachoroidal triamcinolone acetonide (SCTA) injection in patients with refractory diabetic macular edema (DME). Methods: This prospective observational cohort study was carried out at the Department of Ophthalmology, LRBT Eye Hospital, Karachi, from December 2024 to May 2025. Patients aged 30–60 years presenting with type II diabetes mellitus and refractory diabetic macular edema managed with SCTA were consecutively monitored. Standardized baseline and post-injection data were extracted at 1 week, 1 month, and 3 months. Key endpoints included functional efficacy ≥0.3 logMAR improvement in best corrected visual activity (BCVA), anatomical efficacy (≥150µm reduction in CMT on SD-OCT), and safety (incidence of ocular hypertension, defined as intraocular pressure (IOP) >21 mmHg). Results: Of a total 85 patients, the mean age was 51.7 ±7.4 years. Following SCTA injection, a significant improvement in median BCVA from 0.7 to 0.4 and a marked reduction in CMT from 468.1 µm to 311.0 µm were observed at 3 months (both p-values <0.001). In contrast, median IOP showed a mild but significant increase from 15.2 mmHg to 18.4 mmHg (p-value <0.001). Functional efficacy was achieved in 43 (50.6%) patients and anatomical efficacy in 44 (51.8%), with an overall therapeutic success rate of 65 (76.5%). Regarding safety, 73 (85.9%) maintained normal IOP, while 12 (14.1%) developed raised IOP (>21 mmHg). Conclusion: SCTA demonstrated significant improvement in BCVA and CMT with a generally favorable safety profile.
Environmental-Occupational Health & Climate Change section, Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi-74800, Pakistan. Correspondence to: Prof. Zafar Fatmi, Email: zafar.fatmi@aku.edu, ORCID ID: 0000-0001-7212-6858 Air pollution constitutes an important public health threat in Pakistan. While its impacts are most apparent in the form of winter smog, it remains an ongoing problem, affecting children, older individuals, outdoor workers, pregnant women, individuals suffering from chronic ailments, and those residing close to roads, industries, brick kilns and waste burn sites. Apart from being an environmental issue, air pollution is a health issue, a climate issue, and an urban governance issue, in addition to being an economic development concern.
Objective: To determine the incidence of malignancy in patients undergoing Functional Endoscopic Sinus Surgery (FESS) for nasal polyps and to identify clinical and endoscopic factors associated with underlying malignant disease. Methods: This prospective study included 91 patients presenting with nasal polyps who underwent FESS at a Fauji Foundation Hospital, Rawalpindi, Pakistan, from February 2024 to September 2025. Preoperative evaluation included demographic profiling, symptom duration, smoking status, prior steroid use, and CT-based Lund–Mackay scoring. Intraoperative findings, extent of surgery, and the need for additional biopsies were documented. All surgical specimens were sent for histopathological examination. Patients were subsequently categorized into malignant and non-malignant groups based on final pathology. Results: Malignancy was identified in 7 (7.7%) patients. Histological types included squamous cell carcinoma in 3 (42.9%) patients, adenocarcinoma in 2 (28.6%), and lymphoma and inverted papilloma with dysplasia in 1 patient each (14.3%). Patients with malignant pathology were significantly older compared to those with benign disease (60.57 ± 9.14 vs. 43.51 ± 11.35 years; p<0.001). Current smoking was strongly associated with malignancy (p<0.001). Endoscopic appearance suggestive of atypical or unilateral lesions (p=0.019), intraoperative suspicion requiring further assessment (p=0.003), need for additional biopsies (p<0.001), and a more limited extent of surgery (p=0.027) were also significantly associated with malignant outcomes. Conclusion: The incidence of malignancy among patients undergoing FESS for nasal polyps was 7.7%, with squamous cell carcinoma being the most common malignancy. Older age, smoking, atypical endoscopic features, and intraoperative suspicion were key predictors of malignancy.
Objective: To determine the outcome of platelet-rich plasma (PRP) in patients with moderate osteoarthritis of the knee joints presenting to a tertiary care hospital. Methods: This prospective observational study was conducted at the Sindh Institute of Physical Medicine & Rehabilitation from May 2025 to January 2026. Sixty patients aged 40-80 years of either gender with Kellgren–Lawrence grade II and III knee osteoarthritis for ≥6 months duration were included. Primary outcomes were assessed at baseline and 6 weeks. Pain intensity was measured via Visual Numerical Scale (VNS) (0–10 scale; 0=no pain, 10=worst pain), while functional health was evaluated using five Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales (0–100 scale; 100=no symptoms/problems). Improvement was defined as a reduction in VNS and an increase in KOOS scores. Results: The median age of the patients was 52 years (IQR: 48–60). At 6 weeks, VNS pain median scores significantly decreased from 7 (IQR: 6-8) to 1 (IQR: 0-3) at 6 weeks, p-value <0.001). All five subscales of the KOOS demonstrated statistically significant improvement (all p-values <0.001). Median changes were greatest in pain 27 (IQR: 26-28), followed by symptoms 27 (IQR: 26-27), Activities of Daily Living (ADL) 27 (IQR: 6-28), Sport/Recreation 26 (IQR: 4-26), and Quality of Life (QOL) 25 (IQR: 5-26). Spearman correlation analysis showed significant positive correlations among improvements in KOOS subscales, with the strongest association between ADL and Sport/Rec (ρ = 0.849, p-value <0.001). Conclusion: PRP resulted in significant short-term reductions in pain and meaningful improvements in knee-related function and QOL.
Objective: To determine the prevalence of thyroid dysfunction and evaluate its relationship with body mass index (BMI) among Algerian adults. Methods: This observational cross-sectional study was conducted at the diabetic care center of Sidi Bel Abbes, Algeria, from January to May 2025. Algerian adults aged ≥18 years who underwent BMI and thyroid function assessment were included. Demographic, metabolic, and thyroid-related parameters including thyroid peroxidase antibodies (TPOAb) were recorded. The primary outcome was thyroid dysfunction, assessed using serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels and categorized as euthyroidism, subclinical hypothyroidism, overt hypothyroidism, or hyperthyroidism according to laboratory reference ranges. The relationship between thyroid dysfunction and BMI was evaluated as the secondary outcome. Results: Among 107 Algerian adults, the median age was 52.0 years (IQR: 44.0–59.0). Subclinical hypothyroidism was the most prevalent thyroid dysfunction 63 (58.9%), followed by overt hypothyroidism 23 (21.5%). The median BMI was 26.8 kg/m² (IQR: 24.0–29.3), and participants with overt hypothyroidism demonstrated significantly higher BMI values (p-value <0.001). Furthermore, BMI showed significant positive correlations with TSH (ρ = 0.217, p-value = 0.025) and TPOAb levels (ρ = 0.210, p-value = 0.030), while significant negative correlations were observed with FT3 (ρ = −0.193, p-value = 0.047) and FT4 levels (ρ = −0.323, p-value <0.001). Conclusion: Subclinical hypothyroidism was the most prevalent thyroid dysfunction, while overt hypothyroidism demonstrated significantly higher BMI values among Algerian adults
Objective: To evaluate the predictive accuracy of the Surgical Apgar Score (SAS) in determining 30-day postoperative morbidity and mortality among adult patients undergoing laparotomy in a tertiary care setting in Karachi, Pakistan. Methods: This prospective observational study was conducted at Jinnah Postgraduate Medical Centre from July to December 2025. A total of 105 patients aged eighteen years or older undergoing elective or emergency laparotomy were enrolled using non-probability consecutive sampling. The SAS (range 0–10) was calculated immediately after surgery using the lowest intraoperative heart rate, lowest mean arterial pressure, and estimated blood loss. Patients were categorized into low-risk (7–10), moderate-risk (5–6), and high-risk (≤4) groups. Postoperative outcomes, including morbidity and 30-day mortality, were analyzed using Chi-square/Fisher Exact and Kruskal-Wallis tests. Results: Of total 105 patients, the median age was 47.0 years (40.5-55.5). Most patients were classified as moderate risk 66 (62.9%) based on the SAS, followed by low 21 (20.0%) and high risk 18 (17.1%). Postoperative complications occurred in 37 (35.2%) patients, with a 30-day mortality of 12 (11.4%). Surgical site infection (p-value < 0.001), overall complications (p-value = 0.041), and 30-day mortality (p-value = 0.005) were significantly higher in patients with moderate to higher SAS risk levels. ROC curve analysis demonstrated a fair predictive ability of SAS for 30-day mortality, with an AUC of 0.702. Conclusion: The SAS was significantly associated with postoperative morbidity and 30-day mortality, with higher risk levels showing increased adverse outcomes, and demonstrated fair predictive ability.
Objective: To evaluate the clinical outcomes of percutaneous peritoneal drainage (PPD) in high-risk patients with peritonitis secondary to hollow viscus perforation. Methods: A prospective cross-sectional study was conducted in the surgical wards of Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from December 2024 to May 2025. Patients aged 15 years and above presenting high-risk peritonitis secondary to hollow viscus perforation who underwent percutaneous PPD were enrolled. High-risk status included diffuse peritonitis with acute kidney injury, septic shock, immunocompromised state, malignancy, age >70 years, or treatment delay >24 hours. Demographic, clinical, laboratory, and procedural data were collected using a structured proforma. Outcomes assessed were discharge, need for subsequent laparotomy, mortality, and procedure-related complications. Results: Of 82 patients, the mean age was 63.02 ±14.21 years. The overall mortality was observed in 17 (20.7%) patients, while 57 (69.5%) required subsequent laparotomy and 8 (9.8%) were discharged with clinical improvement. Procedure-related complications included persistent sepsis in 9 (36.0%), drain blockage in 3 (12.0%), and worsening peritonitis in 13 (52.0%) patients. The comparison of outcomes showed that immunocompromised state (p-value 0.033), acute kidney injury (p-value 0.036), septic shock (p-value 0.011), delay in treatment for 24 hours (p-value <0.001), and malignancy (p-value <0.001), and type of perforation (p-value <0.001) were found to be significantly associated with the poor outcomes. Conclusion: PPD showed limited success, with considerable mortality and frequent need for subsequent laparotomy. Immunocompromised status, acute kidney injury, septic shock, delayed treatment, malignancy, and perforation type were significantly associated with poor outcomes.
Objective: To assess the educational environment, strengths, weaknesses, and interdisciplinary differences in postgraduate clinical training in Quetta using Postgraduate Hospital Educational Environment Measure (PHEEM). Methods: This cross-sectional study was conducted from May to November 2023 in two public sector tertiary care teaching hospitals in Quetta, Pakistan. Postgraduate clinical trainees with at least one year of training were included. The educational environment was assessed using total and domain PHEEM scores (range 0–160) with predefined categories. Strengths and weaknesses were identified based on item-wise mean scores, where higher values reflected favorable perceptions and lower values indicated areas requiring improvement. Differences across specialties and hospitals were evaluated using inferential statistical tests. Results: Of total 358 participants 182 (50.8%) belong to hospital A and 176 (49.2%) belong to hospital B. The overall mean PHEEM score was 98.16 ±22.72, with 233 (65.1%) reported an environment with room for improvement, while 74 (20.6%) reported several problems and 50 (14.0%) rated it as excellent. Based on item-wise mean scores, higher scores were observed for teamwork (2.91 ±0.92), appropriate responsibility (2.88 ±0.88), and qualified instructors (3.16 ±0.88), whereas lower scores were noted for orientation (2.36 ±1.09), inappropriate warning (2.13 ±1.23), feedback (2.33 ±1.18), and institutional support. No significant differences in PHEEM scores were observed across specialties (p-value 0.350); however, residents from Hospital A reported significantly higher overall and domain PHEEM scores compared to Hospital B (p-value <0.05). Conclusion: The educational environment was moderately positive; however, gaps in orientation, feedback, and institutional support highlight the need for targeted improvements.
Objective: To determine the frequency of vitamin B12 deficiency and its associated factors among patients with hypothyroidism. Methods: This descriptive cross-sectional study was conducted at the Department of Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan from April to October 2025. Vitamin B12 deficiency was defined as serum levels <200 ng/mL. Demographic and clinical information including age, gender, smoking status, diabetes mellitus, residential status, educational status, body mass index (BMI), and duration of hypothyroidism were recorded using a structured data collection form. Serum thyroid stimulating hormone (TSH), free thyroxine (FT4), vitamin B12, and anti-thyroid peroxidase (Anti-TPO) levels were measured using chemiluminescence immunoassay. Results: Of total 140 patients, the median age was 46.5 years (IQR: 29.0–57.0). There were 53 (37.9%) males and 87 (62.1%) females. Vitamin B12 deficiency was observed in 54 (38.6%) patients. Vitamin B12 deficiency was significantly higher in patients aged >40 years (p-value =0.004), diabetes mellitus (p-value<0.001), higher BMI (p=0.010), and elevated Anti-TPO levels (p-value <0.001). In multivariable logistic regression analysis, diabetes mellitus (aOR 4.20; 95% CI: 1.60–11.10; p-value =0.003) and higher Anti-TPO levels (aOR 1.06; 95% CI: 1.03–1.08; p-value <0.001) were associated with increased odds of vitamin B12 deficiency. Conversely, age ≤40 years was associated with lower odds of deficiency (aOR 0.16; 95% CI: 0.04–0.57; p-value =0.004). Conclusion: Vitamin B12 deficiency affects more than one-third of hypothyroid patients and is significantly associated with diabetes mellitus, elevated Anti-TPO, and age >40 years.
Objective: To determine the frequency of surgical site infection (SSI) in patients undergoing ileostomy reversal and to compare their clinical characteristics between wound closure techniques. Methods: This descriptive cross-sectional study was conducted at the Department of General Surgery, Indus Hospital Karachi, from April 2024 to February 2025. Patients aged 18-75 years undergoing ileostomy reversal were included. Clinical characteristics including body mass index, comorbidities (diabetes and hypertension), preoperative laboratory parameters (serum albumin and hemoglobin), and indication for initial stoma formation were recorded. Operative details such as anastomosis technique, level of contamination, wound closure method, and duration of surgery were documented. SSI was defined using standard clinical criteria, including erythema, tenderness, purulent discharge, or positive microbial culture. Results: A total of 120 patients, the median age was 36.0 (22.2-47.7) years. The overall incidence of SSI was 4 (3.3%). Among the SSI cases, 2 (50.0%) were classified as Grade III and 2 (50.0%) as Grade V infections. Primary wound closure was performed in 40 (33.3%) patients, whereas 80 (66.7%) underwent secondary closure. SSI occurred in 3 (7.5%) patients in the primary closure group and 1 (1.3%) patient in the secondary closure group; however, this association was not statistically significant (p-values= 0.072). Diabetes was significantly more prevalent among patients receiving primary closure (p-value =0.010), while other demographic and clinical variables showed no significant associations with closure type (all p-values >0.05). Conclusion: SSI following ileostomy reversal was found low in our cohort, indicating favorable postoperative outcomes within this setting.
Objective: To determine the prevalence and etiological factors of thrombocytopenia among pregnant women living in remote area of Pakistan. Methods: This descriptive cross-sectional study was conducted at the Department of Obstetrics & Gynecology, Gambat Institute of Medical Sciences, from June 2024 to September 2025. Pregnant women in any trimester with measured platelet counts and who provided informed consent were included. Venous blood samples were analyzed using an automated hematology analyzer. Thrombocytopenia was defined as a platelet count <150,000/& micro;L and classified as mild, moderate, or severe. Affected participants underwent further evaluation to determine underlying causes, including gestational thrombocytopenia, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, immune thrombocytopenia (ITP), infections, and nutritional deficiencies, supported by relevant laboratory investigations. Sociodemographic, obstetric, and medical histories were recorded using a structured questionnaire. Results: Of total 287 pregnant women, the mean age was 30.77 +/- 8.18 years. Thrombocytopenia was observed in 85 (29.6%) patients, of which 51 (60.0%) were mild, 26 (30.6%) moderate, and 8 (9.4%) severe. Gestational thrombocytopenia was the most common etiology 45 (52.9%), followed by HELLP syndrome 20 (23.5%), infectious causes 14 (16.5%), nutritional disorders 7 (8.2%), and ITP 4 (4.7%). A significant association between etiology and the severity of thrombocytopenia was observed only for ITP (p-value = 0.013), while no significant association was found for other etiological factors (p-value >0.05). Conclusion: Thrombocytopenia affected nearly one-third of pregnant women, with gestational thrombocytopenia being the most common cause. Severe cases were rare and mainly associated with ITP.
Pharmaceutical chemistry has always depended on a balance between testing things out in the real world and building models based on theory. As pharmacological molecules get more complex, the difference between what can be measured practically and what can be simulated in theory is continuously growing. Classical computational models, including molecular docking and density functional theory (DFT), have enhanced our comprehension of molecular interactions, however, they are still computationally constrained in their ability to characterize quantum effects and multi-electron processes critical for precise predictions of chemical behavior. Quantum computing is going to fill this gap. Quantum computers use qubits, which are quantum bits that can be in more than one state at the same time. This is different from classical computers, which use binary bits to process information. This basic distinction lets quantum computers look at a huge number of different molecule configurations at the same time, which greatly improves the speed, accuracy, and precision of calculations. This means that pharmaceutical research may now model the quantum nature of drug molecules, simulate how reactions happen, and compare what is predicted by theory with what is seen experimentally.
Objective: To compare the mean keratometric values obtained from the intraocular lens (IOL) Master and Pentacam in patients undergoing refractive evaluation. Methods: This cross-sectional analytical study was conducted at the department of ophthalmology, Liaquat National Hospital and Medical College, Karachi, from November 2024 to April 2025. A total of 45 patients (90 eyes) aged 18-70 years undergoing keratometric evaluation without prior corneal surgery or ocular disease were consecutively enrolled. Demographic data and relevant history were recorded, followed by a complete ophthalmic examination. Keratometric measurements were obtained using the IOL Master and Pentacam under standardized conditions. Device order was alternated to reduce measurement bias, and the examiner was masked to previous readings. Steep and flat keratometric (k), and mean keratometric values were recorded, with mean keratometry as the primary outcome. Results:The median age was 28 years (25.0–33.0), with 18 (40%) males and 27 (60%) females. Flat (K1), steep (K2), and mean keratometric values were slightly higher when measured with the IOL Master compared to the Pentacam in both eyes (all p-values < 0.001). Strong correlations were observed for all keratometric parameters between the IOL Master and Pentacam (ρ = 0.955 to 0.992; all p-values < 0.001), with excellent agreement demonstrated by intraclass correlation coefficients ranging from 0.97 to 0.99. Conclusion: The IOL Master and Pentacam showed excellent agreement and strong correlation, indicating both devices are reliable for clinical use.
Objective: To evaluate the feasibility, safety, and short-term outcomes of Transnasal Percutaneous Endoscopic Gastrostomy (T-PEG) placement in patients with head and neck cancer. Methods: This retrospective observational study was conducted at Naimat Begum Hamdard University Hospital, Karachi, Pakistan, from January 2019 to January 2022. Adult patients (>= 18 years) with head and neck cancer undergoing T-PEG due to anatomical obstruction or trismus were included. Data on demographics, tumor characteristics based on the Tumor-Node-Metastasis staging system, prior oncologic treatments, and baseline laboratory parameters were retrieved from medical records. T-PEG was performed using an ultrathin gastroscopy under conscious sedation. The primary outcome was procedural safety, defined as successful T-PEG placement without immediate life-threatening complications. Secondary outcomes included procedure duration and the occurrence of short-term complications within 7 days of PEG placement. Results: Of total 42 patients, the mean age was 49.3 +/- 7.6 years. There were 30.0 (71.4%) males and 12 (28.6%) females. The most common tumor sites were cheek 18 (42.9%) and tongue 13 (31.0%). Trismus or upper aero digestive obstruction was present in 36 (85.7%) of patients. All 42 procedures (100%) were technically successful. No procedure-related mortality occurred during the 7-day follow-up period. With respect to complications, 2 (4.8%) developed T-PEG site infections and were managed conservatively with intravenous antibiotics. Conclusion: T-PEG was technically successful in all patients, with minimal complications, demonstrating it as a safe and effective alternative for enteral feeding in head and neck cancer patients with obstructive anatomy.
Objective: To determine liver enzymes (Alanine Transaminase: ALT and Aspartate Transaminase: AST) abnormalities in β-thalassemia major patients with multiple blood transfusions and to correlate these enzymes with serum ferritin. Methods: This cross-sectional study was conducted at the Pathology Department of The Children’s Hospital and Institute of Child Health, Multan, from December 2024 to February 2025. Children aged 2–14 years with β-thalassemia major, receiving regular transfusions, on chelation therapy, and with serum ferritin >1000 ng/mL were included. Demographic data, transfusion frequency, chelation compliance, and laboratory results were recorded using a structured proforma. Liver enzyme abnormalities were defined as ALT >35 U/L and AST >45 U/L. Patients were categorized into three groups based on serum ferritin levels: 1000–2000 ng/mL, 2001–3000 ng/mL, and >3000 ng/mL to assess their correlation with liver enzyme abnormalities. Results: A total of 107 patients, the median age was 6.0 years (4.0-9.0). There were 70 (65.4%) males and 37 (34.6%) females. Abnormal liver enzymes were observed in 94 patients (87.9%). Liver enzyme abnormality was significantly associated with higher serum ferritin levels (p-value = 0.005) and poor compliance to chelation therapy (p-value <0.001). A significant increase in liver enzymes (ALT and AST) was observed across ferritin categories (both p-values <0.001). Correlation analysis showed a positive correlation between serum ferritin and liver enzymes (for ALT ρ = 0.663, p-value <0.001, for AST ρ = 0.662, p-value <0.001)
Objective: To compare the effectiveness of intravenous (IV) versus oral iron therapy in improving hematologic parameters in chronic kidney disease (CKD) patients. Methods: This prospective cohort study was conducted in the Nephrology Department of Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from June to September 2025. Adults aged 18-60 years with CKD were enrolled and equally divided into two groups. Participants received either IV iron sucrose (200 mg infused over 60-90 minutes) or oral iron (325 mg thrice daily) as determined by the treating clinician's judgment and routine care practice. Baseline and post-treatment measurements of hemoglobin, serum iron, ferritin, transferrin, and total iron-binding capacity (TIBC) were compared between groups. Results: Of the total 120 patients, the median age was 41 years (28-53). All laboratory parameters showed significant improvement after four weeks of iron therapy in both groups (all p-values < 0.001). Within-group analysis showed significant increases in hemoglobin, serum iron, ferritin, transferrin, and TIBC for both IV and oral therapy (all p-values < 0.001). Post-treatment comparison showed that hemoglobin (p-value = 0.013), serum iron, ferritin, transferrin, and TIBC (all p-values < 0.001) were significantly higher in the IV group compared to the oral group. Adverse events were reported in 66 (55.0%) participants, with 35 (53.0%) in the IV group and 31 (47.0%) in the oral group. Conclusion: IV and oral iron both improved hematologic parameters in CKD patients, with greater improvement observed in the IV group; adverse events were almost similar between groups.
Objective: To compare postoperative outcomes, including surgical site infection (SSI), burst abdomen, and wound care quality, between continuous and interrupted closure techniques in emergency midline laparotomy. Methods: This prospective cohort study was conducted in the Department of Surgery at Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from January to July 2025. Patients aged ≥18 years undergoing emergency midline laparotomy were grouped into continuous and interrupted closure cohorts. Demographic, clinical, intraoperative, and postoperative data were collected using a structured proforma. The primary outcome was a burst abdomen during the index hospital admission or within 30 days of surgery. Secondary outcomes included SSI (Centers for Disease Control and Prevention criteria), reoperation, in-hospital mortality, and wound care quality (classified as poor, average, or good). Results: A total of 312 patients, the mean age was 52.0 ±19.0 years. There were 175 (56.1%) males and 137 (43.9%) females. Postoperative outcomes showed an insignificantly higher rate in the continuous closure group compared to the interrupted closure group for good wound care quality (57 [36.5%] vs 42 [26.9%], p-value = 0.102), SSI (85 [54.5%] vs 77 [49.4%], p-value = 0.365), in-hospital mortality (8 [5.1%] vs 7 [4.5%], p-value = 0.791), reoperation (88 [56.4%] vs 78 [50.0%], p-value = 0.257), and burst abdomen within 30 days of surgery (79 [50.6%] vs 65 [41.7%], p-value = 0.112). Conclusion: Continuous closure had better rates of good wound care quality, SSI, in-hospital mortality, reoperation, and burst abdomen within 30 days of surgery compared to interrupted closure, with no significant association between groups.
Objective: To evaluate and compare serum vitamin D levels between eclamptic and normotensive pregnant women. Methods: This case-control study was carried out in the Department of Obstetrics and Gynecology, Liaquat University of Medical and Health Sciences Jamshoro, Pakistan, from May to August 2025. A total of 120 pregnant women were enrolled, including 60 with eclampsia and 60 normotensive controls. Women aged 20-40 years with singleton pregnancies beyond 20 weeks were included. Demographic, clinical, and anthropometric data were collected. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured using chemiluminescent immunoassay and categorized as deficient (<20 ng/mL), insufficient (20-30 ng/mL), or sufficient (>30 ng/mL). Results: The median age of participants was 28.4 years (26.4-31.3). Women with eclampsia had significantly higher parity, weight, body mass index, and blood pressure readings compared with normotensive controls (all p-values <0.001). The overall median serum 25(OH)D concentration was 21.8 ng/mL (17.5-25.5). Vitamin D concentrations were significantly lower in the eclampsia group than in the control group 19.6 ng/mL (14.1-22.9) vs. 24.2 ng/mL (19.9-27.1), (p-value <0.001) respectively. A significant association was also observed in the distribution of vitamin D categories (p-value <0.001), with deficiency present in 33 (55.0%) of women with eclampsia compared to 15 (25.0%) among controls, whereas sufficiency was noted in only 1 (1.7%) of cases and 7 (11.7%) of controls. Conclusion: Pregnant women with eclampsia exhibited considerably lower serum vitamin D levels compared with normotensive counterparts, with a higher frequency of vitamin D deficiency.
Intrauterine devices are rare but known to cause uterine perforation and extrauterine migration, which is especially uncommon in bladder migration. Our patient is a 54-year-old female who had an Intrauterine devices (IUDs) placed 40 days after delivery. The device was not seen on followEdikta Edikta-up exams despite several clinical interactions. She had two pregnancies, laparoscopy, and hysteroscopy after that. The patient reported more than twenty years later with suprapubic pain and dysuria, and imaging showed an intravesical IUD and a vesical calculus. Cystoscopic lithotripsy was able to remove encrusted devices. Though the IUD was removed successfully and the patient recovered well, this case highlights the increased risk of perforation during the postpartum period of IUD insertion and the effects of not being able to confirm the location of the devices. It is necessary to investigate in time when the IUD strings were not visualized so that long-term complications are avoided.
