Objective: To determine role of lung Ultrasound in Early Diagnosis of ILD in Patients with RA. Study Design: Observational Prospective study. Setting: Madina Teaching Hospital (MTH), University Medical and Dental College Faisalabad (UMDC). Period: July 2022 to December 2022. Methods: Adults with a diagnosis of RA and signs and symptoms of ILD in RA who were included. Lung function testing and diagnostic imaging were carried out. Results: The research comprised a total of 141 participants, consisting of 55 (39%) males and 86 (61%) females, with an average age of 51.92±12.15 years. The majority of the participants were positive for Rh factor, namely 112 out of 79% of the individuals examined. Mean duration of rheumatoid arthritis was 15.8 ± 10.4 years. Analysis of the patients' medical records revealed that 51.1% individuals had a documented history of smoking. Of all the patients, 60 people (42.6%) were using glucocorticoids. ILD was detected by HRCT in 108 of the 141 patients in the study group, representing a 76.6% prevalence. The LUS detected symptoms of ILD in 101 out of 141 individuals, representing a percentage of 71.6%. Concordance among LUS and HRCT was 66.7%. The sensitivity for LUS was 75%, while the specificity was 39.39%. Conclusion: The results show that LUS is a valuable method for identifying ILD in RA patients and is capable of accurately predicting the occurrence of ILD in these patients. Larger cohorts, the test's cost-efficiency, and the usefulness of LUS in the follow-up of patients who have already been diagnosed with ILD should all be assessed in future research.
Objective: To compare mean postoperative pain with and without rectus sheath block in patients undergoing midline laparotomy. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: April’24 to September’24. Methods: We enrolled 84 patients aged 13–60 years undergoing elective or emergency midline laparotomy who were randomly assigned to two groups: Group A (RSB group) and Group B (non-RSB group). RSB was performed using a landmark-based technique with 0.25% bupivacaine. Pain intensity was measured at 1, 4, 12, and 24 hours following surgery using the Visual Analogue Scale (VAS).Rescue analgesic requirements were also recorded. Results: The RSB group showed significantly lower VAS scores at 1 hour (2.46 ± 0.73 vs. 4.56 ± 0.69, p = 0.000) and 24 hours (4.51 ± 0.62 vs. 4.82 ± 0.74, p = 0.041). Mean rescue analgesic doses were also significantly lower in the RSB group (1.12 ± 0.77 vs. 2.74 ± 1.13, p = 0.000). Demographics were comparable across groups, with 63.1% males and 50% ASA I status. Findings align with 12 supporting studies, suggesting consistent benefit of RSB in terms of pain control and opioid-sparing effects. Conclusion: Landmark-guided rectus sheath block significantly reduces postoperative pain and opioid use in midline laparotomy. Its efficacy is comparable to ultrasound-guided methods and may be enhanced through preoperative timing and adjuvant use. RSB is a valuable tool, especially in settings lacking advanced imaging.
Objective: To evaluate the incidence of surgical site infections (SSI) with and without the use of suprafascial intrawound vancomycin powder in instrumented posterior spinal fusion. Study Design: Randomized Controlled Trial. Setting: Department of Neurosurgery, Allied Hospital-I, Faisalabad. Period: 01-01-2026 to 30-06-2026. Methods: We randomly assigned 74 patients from each group to undergo posterior spinal instrumentation; the patients' ages ranged from 18 to 65. In addition to the usual prophylactic intravenous antibiotics, Group A also got intrawound vancomycin powder. In contrast, Group B only received intravenous antibiotics. Over the course of three months, patients were monitored for the occurrence of SSI, as defined by the CDC. A chi-square test was used to compare the SSI rates between the groups, and the data were analyzed using SPSS version 25.0. Results: The overall frequency of SSI was 13.5% (20/148). Group A showed a significantly lower rate of SSI (6.8%) compared to Group B (20.3%) (p = 0.016). Among infections, 8.8% were superficial and 4.7% were deep. Stratified analysis demonstrated a consistent reduction in SSI in the vancomycin group across most subgroups. Conclusion: Suprafascial intrawound application of vancomycin powder significantly reduces postoperative SSI in instrumented posterior spinal fusion and may be considered an effective, safe, and cost-efficient adjunct to standard antibiotic prophylaxis.
Objective: To determine the frequency and efficacy of empirical antibiotic therapy used for treatment of pediatric typhoid fever in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, Fatima Memorial Hospital Lahore. Period: 12 September 2025 to 12 March 2026. Methods: A total of 140 children aged 1-15 years, diagnosed with typhoid fever confirmed by blood culture, were included. Data on demographics, clinical features, and empirical antibiotic prescriptions were collected. Antibiotic sensitivity was assessed for the prescribed empirical antibiotics. Results: The study included 140 children with a mean age of 8.0 years; 51.4% were male. The most commonly prescribed empirical antibiotic was ceftriaxone (52.9%), followed by cefixime and ciprofloxacin (19.3%). Imipenem and azithromycin were prescribed to 4.3% of patients. Sensitivity rates were 70% for ciprofloxacin, 28% for ceftriaxone, 62% for cefixime, 50% for azithromycin, and 100% for imipenem. Only 43% of patients were sensitive to the empiric antibiotic prescribed. Conclusion: The study highlights dependence on ceftriaxone in the treatment of treating pediatric typhoid fever, despite moderate sensitivity rates. The findings demonstrate that there is a need for antibiotic stewardship program that guide appropriate empirical therapy and can also counter the increase of antibiotic resistance in pediatric populations.
Objective: To find out the outcomes of mechanical thrombectomy (MT) for acute ischemic stroke and risk factors associated with mortality. Study Design: Retrospective study. Setting: Department of Neurology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: October 2022 till January 2025. Methods: A total of 136 acute stroke patients management unit started functioning to caters patients requiring ntravenous thrombolysis (IVT) and MT. All patients who underwent MT for LVO from October 2022 till January 2025 were included. Inclusion criteria for MT was age >18 years, National Institutes of Health Stroke Scale (NIHSS) >6, ischemic cerebral signs on computed tomography (CT) scan by using Alberta Stroke Program Early CT Score (ASPECT) >6 and time from onset < 8 hours were included. Baseline demographics, risk factors, type of stroke, endovascular procedure and outcome were noted. Primary aim was to evaluate outcome (mortality and functional recovery). Secondary aim was predictors of mortality. Results: There were 136 patients who underwent MT, and baseline modified Rankin scale (MRS) and NIHSS were 4 and 14 respectively. Overall, 77.2% patients did achieve successful recanalization and we observed in hospital mortality of around 30.1%. Factors leading to poor recanalization were older age and high MRS score. Predictors of mortality were higher baseline MRS score, failed to achieve recanalization, procedural complication and reocclusion. Conclusion: This study demonstrates the important role of mechanical thrombectomy in the treatment of acute ischemic stroke. Older age, high MRS and ASPECT score remain factors associated with poor recanalization resulting in higher mortality.
Objective: To investigate the relation of Hb to Red cell distribution width (RDW). Study Design: Cross-sectional study. Setting: Department of Physiology, Sahiwal Medical College, Sahiwal. Period: 20 April 2025 to 20 July 2025. Methods: A total of 62 patients with upper gastro intestinal bleed were included in study. The Hb to RDW ratio was calculated for each participant. Data were entered and analyzed using SPSS version 26. Results: It was shown that a total of 62 participants were included out of which 34 were females, and people living in urban areas participated more in this disease (46.8%). In addition to this, our results showed that the mean value of Hb was 9.62, RDW was 17.2, and of Hb to RDW was calculated as 0.617. Furthermore, the Hb to RDW ratio was found to be significant with area-wise distribution (0.023). At the same time, it was found to be nonsignificant with marital status. Gender and area distribution were also measured by Fischer’s exact test but the statistical significance was not Conclusion: The primary study objective to establish a direct association between the Hb/RDW ratio and the incidence or severity of upper GI bleeding was not supported by a statistically significant link.
Objective: To evaluate the educational environment for interns during their internship rotations and identify strengths and weaknesses across three domains: role of autonomy, teaching and social support, using the Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire in Peshawar. Study Design: Cross-sectional study. Setting: Northwest General Hospital and Research Center, Peshawar. Period: July 2025 to December 2025. Setting: Among 204 medical interns at a tertiary care teaching hospital using the Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire. Data were collected from all major clinical departments. Reliability was assessed using Cronbach’s alpha. Comparisons were made by gender using an independent samples t-test and across departments using one-way ANOVA. Statistical significance was set at p < 0.05. Results: This PHEEM-based study found that the overall educational environment for house officers at Northwest General Hospital & Research Centre, Peshawar, was perceived as more positive than negative (mean total PHEEM score = 103.81 ± 26.73 out of 160). The highest-rated domain was Perception of Teaching (39.77 ± 11.78), followed by Role Autonomy (36.38 ± 8.92), while Perception of Social Support scored the lowest (27.67 ± 7.42). One-way ANOVA revealed statistically significant differences across departments in total PHEEM score (p = 0.021), Role Autonomy (p = 0.029), and Social Support (p = 0.010), with Medicine Allied and Surgery Allied departments consistently showing the highest scores and Obstetrics & Gynecology recording the lowest. Conclusion: The PHEEM-based study at Northwest General Hospital, Peshawar, revealed an excellent educational environment for medical interns. Surgery and Allied Medicine excelled, while Obstetrics and Gynaecology scored lowest, likely due to high workloads. Minor improvements in workload management and support facilities could further enhance the internship experience.
Objective: To examine the relationship between childhood trauma severity and borderline personality disorder (BPD) symptom severity among adult patients, and to explore the role of dissociation and attachment anxiety in this association. Study Design: Cross-sectional study. Setting: Psychiatric Outpatient Department, Allama Iqbal Teaching Hospital, Dera Ghazi Khan. Period: 11-08-2025 to 10 -02-2026. Methods: A purposive sample of 150 adults (18–45 years) diagnosed with BPD was included. Data were collected using a structured proforma assessing demographic variables, childhood trauma (types and severity), BPD symptom severity (DSM-5 criteria), dissociation, and attachment anxiety. Data were analyzed using SPSS version 26. Descriptive statistics, Pearson correlation, multiple regression, and logistic regression analyses were performed. Results: Most participants reported at least one form of childhood trauma, with emotional neglect and witnessing domestic violence being most common. Trauma severity showed a strong positive correlation with BPD symptom severity (r = 0.58, p < 0.001). Dissociation and attachment anxiety were also significantly correlated with trauma and symptom severity. Regression analysis indicated trauma severity as a significant predictor of BPD symptoms, with partial mediation by dissociation and attachment anxiety. Logistic regression showed trauma severity and sexual abuse significantly predicted self-harm behavior. Conclusion: Childhood trauma significantly contributes to the severity of BPD symptoms. Dissociation and attachment anxiety partially mediate this relationship. Trauma-informed and culturally sensitive interventions are essential for improving clinical outcomes in resource-limited settings.
Objective: To explore medical students’ perceptions of VIL, focusing on perceived benefits, barriers, and suggestions for improvement. Study Design: Qualitative study. Setting: Chandka Medical College, a Constituent College of Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan. Period: September 2025 to December 2025. Methods: Fifty MBBS students from all academic years, including both genders, participated. Data were collected using an open-ended questionnaire through printed forms and Google Forms, according to student preference and availability. Participation was voluntary, and responses were confidential. Data were analyzed using NVivo software (version 15), following Braun & Clarke’s thematic analysis framework, including familiarization, coding, theme identification, triangulation, member checking, and iterative refinement to ensure credibility and trustworthiness. Results: Thematic analysis identified six major themes: (1) Overall experience of VIL, (2) Integration of basic and clinical sciences, (3) Improvement in learning style and clinical reasoning, (4) Perceived benefits, (5) Barriers, and (6) Suggestions for improvement. Students reported positive experiences, highlighting enhanced understanding, better subject correlation, early clinical exposure, and improved correlation between subjects. Barriers included heavy workload, limited opportunities for clinical practice, inconsistent integration across departments, and time management difficulties. Suggestions included increasing clinical exposure, structured case-based sessions, and improved coordination between departments. Conclusion: Medical students perceive VIL positively, particularly for linking theory with practice, enhancing clinical reasoning, and fostering early clinical exposure. Effective implementation, however, requires careful curriculum planning, structured integration, and coordinated departmental support. These insights can inform curriculum development and policy decisions in Pakistan and similar educational contexts.
Objective: To determine the efficacy of melatonin as an adjunct to first-line antiepileptic therapy in reducing seizure severity, seizure frequency, and electroencephalographic (EEG) abnormalities in pediatric patients with generalized epilepsy. Study Design: Quasi-experimental Comparative study. Setting: Department of Pediatrics, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Period: July 2025 to Dec 2025. Methods: A total of 60 children aged 2–12 years with generalized epilepsy and suboptimal seizure control despite first-line antiepileptic therapy were enrolled using consecutive sampling. Patients were allocated into two groups: the treatment group (n=30) received melatonin as an adjunct to first-line therapy, while the control group (n=30) received placebo with first-line therapy. Melatonin was administered at bedtime for 12 weeks (1 mg for children <5 years and 2 mg for ≥5 years). Seizure severity was assessed using the Chalfont-National Hospital Seizure Severity Scale (NHS-3), while seizure frequency over a three-month period and EEG findings were recorded at baseline and follow-up. Data were analyzed using SPSS version 25.0, and a p-value of less than 0.05 was considered statistically significant. Results: The two groups showed no significant differences in baseline demographic and clinical characteristics. At 12 weeks, seizure severity scores were significantly reduced in the melatonin group compared to the placebo group (10.7 ± 2.4 vs. 17.9 ± 4.3; p < 0.001), with a mean reduction of 7.9 ± 3.1 versus 1.5 ± 1.6, respectively. Seizure frequency also showed a significant reduction in the melatonin group compared to placebo (mean reduction: 3.1 ± 1.1 vs. 0.4 ± 0.9; p < 0.001). 50% of patients in the melatonin group showed significant EEG normalizationin contrast to 26% in the placebo group (p = .03). Conclusion: Adjunctive use of melatonin with first-line antiepileptic therapy results in significant improvement in seizure severity, seizure frequency, and EEG findings in pediatric patients with generalized epilepsy, supporting its safety and effectiveness as an additional treatment option in children with inadequate seizure control.
Objective: To compare the hemodynamic stress response between video laryngoscopy and conventional direct laryngoscopy in patients undergoing general anesthesia. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Fauji Foundation Hospital, Rawalpindi. Period: Oct-2025 to Dec-2025. Methods: A total of 192 patients aged 18–50 years, belonging to ASA class I–II and undergoing elective surgery under general anesthesia were randomized into two equal groups. Patients in Group VL underwent video laryngoscopy while patients in Group DL underwent conventional direct laryngoscopy. The primary outcomes were hemodynamic parameters recorded at baseline (T0), during laryngoscopy (T1), at intubation (T2), and at one minute post-intubation (T3). These outcomes were compared between the two groups by applying independent t-test, where a p-value < 0.05 was considered significant. Results: Mean age of patients was 40±7.57 years, ranging from 18 to 50 years with a slightly higher number of male patients (53.13%) compared to the females (46.88%). The results showed an expected increase in HR and BP during laryngoscopy and intubation in both groups; however, analysis of the primary outcomes confirmed that the magnitude of the increase was significantly lower in the VL group compared to the DL group at T1, T2, and T3. Specifically heart rate, systolic blood pressure, diastolic blood pressure and MAP were significantly lower in the video laryngoscopy group at T2 (p< 0.0001). Conclusion: Video laryngoscopy provides a significantly reduced stress response regarding hemodynamic changes compared to conventional laryngoscopy in patients undergoing general anesthesia.
Objective: To compare the efficacy of inhaler corticosteroids and oral montelukast in children with reactive airways disease. Study Design: Randomized Controlled Trial. Setting: Department of Pediatrics, Lady Reading Hospital, Peshawar. Period: 20 July 2025 to 20 January 2026. Methods: A total of 60 children aged 1 to 5 year with reactive airway disease for more than 3 months were enrolled using a 95% confidence level and 80% power calculation. Participant were randomized into two equal groups of 30 each. Group A received inhaler corticosteroids at 200 microgram per day and Group B received oral montelukast at 4 mg once daily in children below 1 year and 5 mg once daily in children above 1 year. Efficacy was defined as complete absence of symptom after 3 months of treatment. Chi-square test and Fischer exact test were applied to compare efficacy between groups and across stratified variables. Results: Inhaler corticosteroids showed efficacy in 73.3% patients compared to 33.3% with oral montelukast (p=0.002). Age-stratified analysis showed significant efficacy in children aged 3 years or less (77.8% versus 40.0%, p=0.041). Female gender demonstrated superior response to inhaler corticosteroids (84.6% versus 35.3%, p=0.012). Urban residents showed better efficacy with inhaler corticosteroids (76.5% versus 31.3%, p=0.007). Conclusion: Inhaler corticosteroids are significantly more effective than oral montelukast in managing reactive airways disease in children.
Objective: To determine the frequency of VAP and its outcome in children admitted to the pediatric intensive care unit (PICU) of a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Intensive Care, Children Hospital Multan, Pakistan. Period: February 2024 to July 2024. Methods: A total of 139 patients of both genders, ages 6 months to 12 years, admitted to the ICU for MV were included. All of the relevant information was noted, and the patients were followed until the final outcome, which included discharge from ICU or expiry. Results: In a total of 139 children, 87 (62.6%) were male. The mean age was 5.94±2.47 years. The development of VAP was observed in 45 (33.1%) patients. Age between 7 to 12 years (p=0.0158), and weight > 20kg (p=0.0053) were having significant association with the development of VAP. Age between 7-12 years (p<0.0001), female gender (p=0.0491), and weight > 20kg (<0.0001) were having significant association with mortality. Mortality was significantly associated with VAP (67.7% vs. 26.4%, p<0.0001), duration of MV > 7 days (p<0.0001), and duration of PICU stay > 10 days (p<0.0001). Conclusion: This study found a relatively high incidence of VAP in the PICU, with significant associations between VAP and age, weight, and mortality.
Objective: To evaluate the effect of obesity on operative duration and the rate of conversion to open surgery among patients undergoing laparoscopic cholecystectomy. Study Design: Analytical Cross-sectional study. Setting: Department of Surgery. Period: 25 November 2025 to 24 May 2026. Methods: Recruitment was concluded after the required sample size of 194 patients had been achieved. A total of 194 patients scheduled for laparoscopic cholecystectomy were included and categorized into two equal groups: obese (n=97) and non-obese (n=97). The sample size was determined using the WHO sample size calculator with a confidence level of 95% and study power of 90%. Patients aged between 18 and 60 years, of either gender, were selected through simple random sampling. Baseline demographic and clinical characteristics including age, sex, body mass index (BMI), ASA classification, associated comorbidities, and history of prior abdominal surgery were documented. All procedures were performed by consultant surgeons having a minimum of three years’ post-fellowship experience. The primary outcomes assessed were operative time and frequency of conversion to open cholecystectomy. Statistical analysis was carried out using SPSS version 25. Independent sample t-test and Chi-square test were used for comparison, with p≤0.05 taken as statistically significant. Results: Obese patients demonstrated a longer mean operative time compared to non-obese patients (97.43 ± 35.04 minutes vs. 87.45 ± 35.75 minutes); however, this difference did not reach statistical significance (p=0.051). The rate of conversion to open cholecystectomy was significantly greater in the obese group than in the non-obese group (14.4% vs. 3.1%; p=0.005). Subgroup analysis further revealed increased conversion rates among obese individuals in several categories, particularly females, younger patients, those with higher ASA grades, and patients with diabetes mellitus or hypertension. Conclusion: Obesity appears to increase the likelihood of conversion from laparoscopic to open cholecystectomy and may also contribute to prolonged operative duration. Thorough preoperative evaluation, appropriate patient counseling, and experienced surgical management are important factors in achieving favorable outcomes in obese patients undergoing laparoscopic cholecystectomy.
Objective: To determine the frequency of sexual dysfunction among married women with untreated Major Depressive Disorder (MDD). Study Design: Analytical Cross sectional study. Period: June 2025 to December 2025. Setting: Outpatient department of Psychiatry and Behavioral Sciences, DHQ Hospital, Faisalabad Medical University. Methods: Total 193 married women aged 18–45 years, diagnosed with MDD per DSM-5 criteria and not on antidepressants, were enrolled using non-probability consecutive sampling. Sexual function was assessed using Female Sexual Function Index (FSFI), with a total score ≤26 indicating dysfunction. Data were analyzed using SPSS version 23.0; chi-square tests were applied to examine associations, with p ≤ 0.05 considered significant. Results: The mean age of participants was 31.4 ± 6.2 years. Sexual dysfunction was present in 137 women (71.0%), with the lowest FSFI domain scores in desire (2.8 ± 1.1) and arousal (3.1 ± 1.3). Significant associations were found between sexual dysfunction and older age (p = 0.021), longer marriage duration (p = 0.008), higher parity (p = 0.014), and cesarean delivery (p = 0.032). Employment status showed no significant association (p = 0.217). Conclusion: Female sexual dysfunction was frequent in women with untreated depression, particularly affecting desire and arousal, and is significantly influenced by reproductive and demographic factors.
Objective: To compare the clinical efficacy of adjunctive zinc supplementation combined with standard lactulose and rifaximin therapy against lactulose and rifaximin alone in patients presenting with hepatic encephalopathy. Study Design: Analytical Cross-sectional Investigation. Setting: Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. Period: June to December 2025. Methods: One hundred eight adult patients diagnosed with hepatic encephalopathy (West Haven grades I–IV) were enrolled via consecutive sampling and allocated into two therapeutic arms. The intervention cohort received oral lactulose, rifaximin, and a zinc-carnosine formulation, whereas the control arm received standard dual therapy. Clinical efficacy was defined as a ≥1-grade improvement on the West Haven scale following seven days of continuous treatment. Data were analyzed using SPSS version 23.0, with Chi-square tests determining statistical significance. Results: Baseline demographic and clinical profiles were comparable between groups. Following the intervention period, 53.7% (n=29) of patients receiving zinc achieved substantial clinical improvement compared to 25.9% (n=14) in the standard therapy group (χ²=8.94, p=0.003). The calculated number needed to treat was 3.6. Both regimens exhibited comparable tolerability, reporting only mild gastrointestinal disturbances without serious adverse events. Conclusion: Supplementing conventional pharmacological management with zinc significantly accelerates short-term neurological recovery in hepatic encephalopathy. Integrating this affordable micronutrient adjunct into acute care protocols represents a highly effective strategy for optimizing clinical outcomes in cirrhotic populations.
Ewing sarcoma (ES) is a highly malignant, poorly differentiated neuroectodermal neoplasm that predominantly arises within the medullary cavity of long bones in children and adolescents. Extraosseous Ewing sarcoma (EES) affecting the head and neck region is exceedingly rare, accounting for only 1% to 4% of all cases, with primary sinonasal tract localization representing a severe diagnostic and therapeutic challenge.
Objective: To evaluate the efficacy and safety of metronomic capecitabine in patients with metastatic TNBC (mTNBC), with progression free survival (PFS) as primary end point and toxicity profile as secondary endpoint. Study Design: Retrospective study. Setting: Department of Radiotherapy, Quaid e Azam Medical College, Bahawalpur, Pakistan. Period: 1st January 2022 to 30th October 2025. Methods: The study included patients with mTNBC of any age who were metastatic at presentation. All patients received first-line chemotherapy, or subsequently went on to receive the second-line chemotherapy. Capecitabine at a dose of 500 mg twice daily was administered to patients with stable disease after initial chemotherapy. Patients were asked to follow up every 4 weeks and thorough clinical examination was performed at each follow up. Results: Out of 643 breast cancer patients, 117 (18.2%) had stage IV disease, with 47 (40.1%) having mTNBC. The median age was 44 years. There were 33 (70.2%) patients who achieved stable disease and started metronomic capecitabine following initial chemotherapy. Among these 33 patients, 24 (72.7%) had stable disease while remaining 9 (27.3%) experienced disease progression. The most common toxicities were mild nausea and vomiting, noted in 9 (27.2%), grade 1 diarrhea 4 (12%), grade 1 mucositis 3 (9.1%), and grade 1 myelosuppression 4 (12.4%). Conclusion: Metronomic capecitabine was an effective and well-tolerated treatment option for patients with mTNBC, particularly in the short term.
Objective: To assess the relationship of vitamin D3 on the timing of sternebrae fusion in females aged 18 to 25. Study Design: Cross-sectional study. Setting: Azra Naheed Medical and Dental College, Lahore. Period: Aug 2023 to Jan 2024. Methods: A total of 400 females, aged 18-25, were categorized into four age groups within this cross-sectional study. Investigative modalities included serum vitamin d3 levels and lateral chest x-rays to determine the fusion status of sternebrae 2nd-3rd, 3rd-4th, 4th-5th. Statistical analysis, such as chi-square tests and regression models, were carried out to determine link between Vitamin D3 levels, age, and fusion status. Results: While vitamin D3 was deficient in 60.2% of the participants, fusion of the sternebrae was nearly complete in all age groups (97.5% to 99.2%). Besides this, statistical analysis revealed no significant association between vitamin D3 status and the fusion of any sternebrae segment (p > 0.05). Furthermore, regression analysis also showed no predictive value of vitamin D3 levels on the age of fusion. Conclusion: Vitamin D3 seems to have no significant influence on the fusion rate of the sternebrae; complete fusion occurred by 18 years of age in the majority of females. While Vitamin D3 itself remains an important nutrient, further research is necessary to determine what other systemic factors have a role in the timeline of sternebrae fusion.
Objective: To determine the frequency of atrial fibrillation (AF) and its associated clinical factors among patients presenting with acute ischemic stroke at a tertiary care hospital. Study Design: Cross-sectional Observational study. Setting: Ayub Medical Teaching Institute, Abbottabad, a Tertiary Care Hospital. Period: January 20, 2026, to April 22, 2026. Methods: A total of 167 consecutive adults aged ≥18 years with CT- or MRI-confirmed acute ischemic stroke presenting within 7 days of symptom onset were enrolled. Patients with hemorrhagic stroke, transient ischemic attack, non-vascular causes, incomplete records, or those who declined consent were excluded. AF was identified through documented medical history and admission 12-lead electrocardiography. Demographic and cardiovascular risk factor data were collected via a structured proforma. Statistical analysis was performed using SPSS version 26, with associations assessed by the Chi-square test. Results: +AF was detected in 38 patients (23%). The overall cohort had a mean age of 65.2 ± 12.4 years, and 58.7% were male. Patients with AF were significantly older (70.1 ± 13.2 vs. 63.8 ± 11.9 years; age >65 years: 68.4% vs. 48.1%, p=0.031). Significant associations with AF were found for diabetes mellitus (52.6% vs. 34.9%, p=0.038) and obesity (34.2% vs. 17.1%, p=0.029). Hypertension was more common in AF patients but did not reach statistical significance (78.9% vs. 63.6%, p=0.082). Sex, smoking, dyslipidemia, and prior stroke showed no significant associations. Conclusion: Nearly one in four ischemic stroke patients in this cohort had AF, with older age and metabolic risk factors such as diabetes and obesity showing strong associations. These findings underscore the importance of targeted cardiac screening to guide anticoagulation and improve secondary stroke prevention.
