Background: To determine the frequency of diabetic retinopathy (DR) and its association with age, gender, duration of illness and type of anti diabetic treatment in type 2 diabetic patients. Methods: In this cross sectional study 225 type 2 diabetes mellitus patients underwent detailed fundus examination for presence or absence of DR. If DR was noted, it was classified into background retinopathy, pre-proliferative retinopathy, proliferative retinopathy, and maculopathy. Comparison of patients with and without DR was done in terms of mean age, gender, duration of diabetes mellitus, and predominant mode of treatment (insulin or oral hypoglycemic agents) employing t test or Chi2 test wherever appropriate. Duration of diabetic illness and type of DR were also correlated similarly. Results: Mean patient age was 57.52±9.77 years. Diabetic retinopathy was seen in 52.4%. Majority (74.7%) were on oral hypoglycemics and 25.3% were on insulin. In 29.3% patients duration of diabetic illness was 5-10 years, while in the rest it was >10 years. Non-proliferative retinopathy was seen in 37.3%, 31.4% had pre-proliferative retinopathy, 10.2% had proliferative retinopathy and 21.2% had maculopathy. Longer duration of diabetes had statistically significant association with presence of DR and type of DR (p <0.05). Insulin therapy also correlated with presence of DR (p <0.05). Conclusion: Frequency of DR in our type 2 DM patients was 52.4%. Duration of diabetic illness, and insulin therapy correlate with presence of DR. Key Words: Diabetes Mellitus, Retinopathy.
Objective: To assess the mental health and associated factors among healthcare professionals working in high workload departments of Sheikh Zayed Hospital, Rahim Yar Khan. Methods: This analytical cross-sectional study was conducted from April to July at the Sheikh Zayed Hospital, Rahim Yar Khan. 260 participants (aged 30-65 years, >6 months experience) were recruited via non-probability convenience sampling. Data were collected using a structured questionnaire, including the General Health Questionnaire-28 (GHQ-28), where a score above 16 indicated poor mental health. SPSS version 27 was used for analysis. Chi-square tests identified associations that were then entered into a multi-logistic regression model to control for confounders and identify independent predictors. Statistical significance in regression was set at p<0.05. Results: A mean GHQ-28 total score of 34.85 (SD=12.29) indicated that 72.3% of participants had poor mental health. The subscales measuring physical symptoms and anxiety/insomnia had the highest mean values. Multivariate logistic regression showed that high job stress was the sole significant predictor of poor mental health, despite bivariate analysis showing significant relationships with high workload (p = 0.015) and dissatisfaction with work-life balance (p = 0.001). Conclusion: A significant percentage of healthcare professionals in departments with heavy workloads experience mental health issues, which are mostly caused by excessive workloads and a lack of work-life balance. In order to protect healthcare professionals' well-being and improve patient care outcomes, targeted interventions—such as mental health support programs, task redistribution, and institutional support mechanisms—are desperately needed. Keywords: Allied Health Personnel, Emergency Service, Health Personnel, Hospital, Intensive Care Units, Mental Health, Pakistan, Psychological Stress, Workload
Cartilage injuries remain a major challenge due to the avascular nature of cartilage and its limited regenerative capacity. Emerging evidence suggests that recent advances in mRNA-based therapeutics allow localized and transient expression of proteins relevant to cartilage repair. This literature review synthesizes current knowledge on mRNA delivery platforms, highlights key molecular targets such as SOX9 and FGF18 demonstrated in preclinical models, and summarizes emerging translational insights. While preclinical studies indicate meaningful potential for mRNA-based approaches in enhancing cartilage regeneration, substantial challenges—including delivery efficiency, stability within the joint environment, and regulatory complexity—must be addressed to ensure clinical applicability. Keywords: Messenger RNA, Osteoarthritis, Lipid Nanoparticles, Regenerative Medicine, Drug Delivery Systems, Cytokines.
Objective: This study aimed to determine the prevalence of asymptomatic bacteriuria among pregnant women and to ascertain the associated risk factors. Methods: This cross-sectional study was conducted in Rawal Institute of Health Sciences, Gynae /Obs department from 1st Sept 2024 till 31st July 2025. A total of 300 pregnant women of any gestational age, attending their first antenatal visit, asymptomatic for urinary tract infection, were included. Patients with symptoms of acute urinary tract infection, on antibiotics for at least 72 hrs for any infection, acute or chronic kidney disease, or urinary stent were excluded. Midstream clean-catch sample collected for analysis and culture. Information on maternal demographics, obstetric history, and potential determinants of asymptomatic bacteriuria was systematically recorded. SPSS VS 25 was used for data analysis. Results: Prevalence of ASB in our study was 22%. Regarding socio-demographic factors of patients (300), the maximum number of cases, 48% presented between 26-32 years with a mean age of 28 years. Urban residents 77%, 48% matriculate, 71 % from the middle class, 68% had parity from 1-4, 52% presented in the 3rd trimester. The predominant pathogen isolated was E. coli in 78%. The principal maternal complication was preterm labor (11%), 14% developed p-pyrexia. Multivariate logistic regression confirmed significant associations of ASB with low socioeconomic status, low education, rural residence, parity >4, and recurrent UTI with a statistically significant p value<0.05. Conclusion: This study highlights a notable prevalence of ASB in pregnancy and underscores the importance of targeted screening for women with identifiable risk factors. Keywords: Asymptomatic bacteriuria, Infectious, Pregnancy Complications, Risk factors
Being a graduate of Rawalpindi Medical College and settled as an oncologist in Australia for quite a while, I felt both honoured and humbled when I was requested to write this editorial. I have vivid recollection of my early days as a doctor, when the energy, vigour, and enthusiasm were running through my veins, thinking I could treat all ailments, alleviate the sufferings of humanity, cure disease, and ‘fix everything’. Perhaps, I needed that to drive my ambition to do something bigger, to make a difference, and that journey took me from one pole to another, from academic teaching to acquiring clinical expertise, to research and development and drug discovery, to clinical research and practicing medical oncology. I also remember that those early years as a doctor, it was never easy to accept ‘defeat’, to encounter failure, to see the complications of disease and treatments, and accept death also as an outcome. With time came maturity to understand that as a doctor, I have to make the best effort to heal, use my best learnings, knowledge, and skills, and strive to get the best possible outcome for each patient, but also know when not to interfere and when to give up. Death is not a defeat for the doctor; it is a reality that is expected and has to be accepted, after all possible realistic avenues have been exhausted. Hence, the question, How Long Do I Have Doc!, that I need to be prepared to answer every day in my practice. I don’t have the crystal ball to look into the future, nor do I have any special powers to make predictions; oncology has indeed taught me the science and the art of prognostication. I have seen oncology being practiced in its very early development phase in Pakistan (as in the 90’s), and then moving to Australia to be a part of state-of-the-art cancer clinics and witness the tremendous advancements in science and continued improvement in outcomes. Just in the last 25 yrs the overall survival for all cancers has improved by 25%.1 This change is so dramatic that what was then considered a ‘curse’ (lack of effective treatments and relatively short survival in advanced cancers) is now talked about as a manageable and (potentially) curable disease. How, then, does someone prepare to answer the question on prognosis? The Cambridge defines prognosis as a judgment or the act of making a judgment about what is likely to happen in the future. When we apply this to the development of a disease or a disease-related outcome, this translates into a systematic, calculated, and knowledgeable expression statement that makes a clear prediction or estimation of how things will turn out. In oncology, overall survival (OS) remains the most persuasive and universally acceptable evidence that a treatment works. It is measured as the length of time a patient is alive after a certain diagnosis or treatment. OS is one of the most fundamental and clinically meaningful endpoints used in oncology clinical trials. It remains the benchmark for definitive clinical benefit and is often referred to as the gold standard. It provides an unambiguous, objective measure of treatment benefit. While OS is ideal, it is also one of the most difficult endpoints to improve in modern oncology. The challenges include longer duration of study timelines, a larger number needed to treat, confounding factors like multiple lines of therapy, crossover design, and many others. There has not been a universal consensus on any other outcome of interest; many surrogate endpoints have successfully been looked at, like progression-free survival (PFS), objective response rate (ORR), quality of life (QoL), etc. Real-world datasets and meta-analyses are performed frequently, which also rely heavily on OS, as this remains one of the strongest and most favoured endpoints looked at by regulators, payers, and clinicians while making treatment-related decisions. Let’s take an example of Lung Cancer and see what the outlook for stage IV non-small cell lung cancer (NSCLC) was at the turn of the century and compare it with today. In 2000, the expected 5-year relative survival rate typically hovered between 12% and 16%, while median survival (MS) in stage IV was remarkably short, often recorded at just 6.6 to 8.5 months. In 2026, the expected overall 5-year relative survival rate for lung cancer is approximately 28% to 30%. This outcome remains highly dependent on how early the cancer is detected, e.g., for localized (Stage I), its approx. 65%, regional (Stage II/III), it's around 37%, and for metastatic (Stage IV), it’s at 10% (a five-fold increase from the 2% reported two decades ago). While the figures still look relatively dismal, this remarkable feat has only been made possible due to earlier and better diagnostics, improved surgical and radiation outcomes, and a marked understanding of the molecular profiling and use of targeted systemic and immune therapies. To showcase the impact on OS in this difficult-to-treat population, I will briefly mention 2 examples. Lorlatinib, an anaplastic lymphoma kinase (ALK) inhibitor, has shown ( in a randomised phase 3 - CROWN Study),2 that for patients with advanced ALK+ NSCLC, treated with lorlatinib, 60% remained disease-free at 5 years, 63% were progression-free, and 76% of patients were alive at 5 years. Similarly, pembrolizumab, an immune therapy agent and a PD-1 Inhibitor, has shown (in Keynote 024 study),3 that a durable, clinically meaningful long-term OS benefit was achieved in first-line metastatic NSCLC with a PD-L1 tumour proportion score of at least 50%. Kaplan-Meier (KM) estimates of the 5-year OS rate was 31.9% -pembrolizumab group vs 16.3% - chemotherapy group. Multidisciplinary care is the standard of care in oncology management these days, and patient preferences and choice are also better understood and appreciated by the clinicians. What may look like a statistically significant outcome from a well-designed study may not necessarily be interpreted as clinically meaningful by patients. It is therefore a common practice to include quality of life (QoL) validated tools to evaluate the impact of an interventional study to holistically capture the statistical and clinical benefits. Decisions about various treatments, including chemotherapy, are not straightforward and often include trade-offs between their benefits, harms, and inconveniences. I had undertaken a review, with my co-authors,4 to find, evaluate and summarise studies quantifying the survival benefits that cancer patients judged sufficient to make chemotherapy for NSCLC worthwhile, and reported that most cancer patients (>50%) judged moderate survival benefits sufficient to make chemotherapy worthwhile, for example, absolute increases of 10% in survival rates or 6 months in life expectancies. Individual patients' preferences varied widely: benefits judged sufficient ranged from very small (e.g., survival rate of 1%) to very large (e.g., survival rate of 50%). Knowing that OS remains the goal in Oncology, and with appreciation for how this goalpost has changed over time, it is also true that no 2 patients are going to be the same. They may present with a similar-looking clinical picture, but the actual outcome, even from the same intervention, can be very different. Apart from the many known pathologic and clinical prognostic markers, many genomic and biomarker indicators and tools have been looked at and are available in many situations, to aid the conversations on the likely benefit to be expected from a certain intervention and help formulate a prognosis on outcomes. I have published (with my coauthors),5 a model on how to interpret clinical data, what to take from the KM survival curves, and how to formulate this scientific data into a meaningful conversation around prognosis. We searched for randomized first-line chemotherapy trials published from January 2000 to April 2008. We recorded median time to progression (TTP) and median overall survival and extracted the following percentiles (represented scenario) from each OS curve: 90th (worst-case), 75th (lower-typical), 25th (upper-typical), and 10th (best-case). For each OS curve, we divided these percentiles (scenarios) in turn by the median to determine if a simple relationship existed between each scenario and the median. We concluded that simple multiples of an OS curve's median provided accurate estimates of typical (half to double the median), best-case (triple the median), and worst-case (one quarter of the median) life expectancy scenarios for patients starting chemotherapy for advanced NSCLC. Now coming back to the original question, how long do I have doc!, the answer is not going to be straightforward, simple, or similar from one patient to another. This has to be carefully crafted, knowing that this information is quite critical for decision-making and future planning for the patients and their families. It must be backed by scientific evidence, should avoid point estimates, and should always be tailored across certain scenarios, providing ranges and ballpark estimates. This can often be challenging and daunting to bring up at times, as there may be prohibitions and inhibitions that need to be overcome. At the same time, it has been shown that the majority of patients and families want to know and appreciate the truthful information to be provided, and also such conversations have shown to improve the QoL of patients and carers. While I have illustrated some examples here, prognosis of various tumours will widely vary, depending upon the stage at presentation, interventions received and various disease related (eg., size, grade, invasion, nodal or distant spread, biomarkers, genetic factors, targetable mutations and many others), as well as patient factors (like age, performance status, comorbidities, organ dysfunction and fitness to undergo various procedures and interventions etc). Many cancers, like testicular and breast, when treated early (stage 1), have a 5-yr survival close to 100%. Overall survival for breast cancer in Australia is 93%, and for prostate cancer it's 95-97%. This contrasts with some others, like pancreas or high-grade gliomas, where less than 1 in 5 is alive 5 yrs from diagnosis. Any prognostic discussions with these patients and their families would have been so unique and individualised. When I convey prognosis, I continually remind myself of the nuances of any such discussion, prepare myself for the tangible outcomes, and convey the information in an empathic and sympathetic manner, giving hope where it's needed, keeping a realistic attitude, hoping for the best, and preparing for the unknowns and unexpected. It is indeed an art to convey prognosis, and this art of knowing what the patient wants, how much, and what to say, timing of such discussions, and anticipating the emotional impact will carefully need to be balanced with a reasonably well-worded scientific rationale based on good evidence.
Objective: To evaluate postgraduate residents’ satisfaction with Mini-CEX as a formative assessment tool, and to use their feedback to guide improvements in its implementation at Rawalpindi Medical University. Methods- A structured and validated questionnaire comprising 18 closed-ended items was distributed using a five-point Likert scale. It assessed trainees’ understanding of Mini-CEX, perceptions of its educational value, facilitator involvement, and its impact on personal, professional, and clinical development. It also collected trainee-driven feedback to inform future improvements in Mini-CEX sessions. Results- Among 135 eligible trainees, 116 completed the questionnaire, resulting in a response rate of 85.9%. Most trainees expressed satisfaction with Mini-CEX, noting improvements in clinical skills, personal development, and professional growth. The mean satisfaction score across all domains was 3.6. However, several respondents reported gaps in orientation, unclear format, and inconsistent feedback and facilitator engagement. Conclusion- These findings highlight the need for clearer orientation regarding Mini-CEX objectives and practical strategies to improve time management during assessments. To address concerns about facilitator engagement, establishing a formal feedback channel between trainees and instructors could improve the quality of interactions. Strengthening communication and aligning expectations will enhance the educational value of Mini-CEX in postgraduate training. Keywords: Clinical Competence, Education, Medical, Graduate, Educational Measurement, Professional Satisfaction, Workplace
Objective: To compare the therapeutic effects of Coenzyme Q10 & L-Carnitine on remyelination of Anterior Commissure in Cuprizone-induced rat model of Multiple Sclerosis. Methods: Forty male Sprague Dawley rats were randomly divided into four groups. Group 1 was given a normal diet, and the remaining three groups were Multiple Sclerosis models and given 0.2% Cuprizone for 12 weeks. After 4 weeks, Group 3 received 150 mg/kg/day CoQ10, Group 4 was given 100 mg/kg/day L-Carnitine, while Cuprizone poisoning continued till 12 weeks. Rats were then dissected, and their brains were removed. Coronal sections were stained with Luxol Fast Blue stain to demonstrate the remyelination. Results: CoQ10 was found to promote remyelination more effectively than L-Carnitine, as evidenced by significantly reduced areas of demyelination. Conclusion: CoQ10 demonstrates greater effectiveness in promoting remyelination compared to L-Carnitine. Keywords: Coenzyme Q10, Carnitine, Multiple Sclerosis, Remyelination
Objective: To assess the association between serum ferritin levels and glycated haemoglobin (HbA1c) levels in patients diagnosed with type 2 diabetes mellitus presenting to Benazir Bhutto Hospital. Methods: A descriptive cross-sectional study was undertaken at Benazir Bhutto Hospital, Rawalpindi. One hundred and forty patients with the diagnosis of type 2 diabetes mellitus between the ages of 35 and 70 years were enrolled using consecutive sampling. Patients with other conditions that are known to affect serum ferritin levels were excluded. Values of serum ferritin levels and HbA1c were determined in blood samples. Data were analyzed using SPSS v25. Group comparisons were performed using an independent samples t-test. Results: Among 140 participants, 58.6% exhibited poor glycaemic control (HbA1c >7%). Serum ferritin levels and HbA1c were found to have a positive association, with participants having HbA1c >10.5% showing higher serum ferritin levels (108.27 μg/L) compared to those with HbA1c 6-7.49% (71.46 μg/L). Serum ferritin levels in people with well-controlled and poorly-controlled diabetes differed significantly, according to an independent t-test. (p=0.019). Conclusion: The study demonstrates that serum ferritin levels were higher among participants with poor glycaemic control in patients diagnosed with type 2 diabetes mellitus, suggesting that ferritin may serve as a supportive biomarker alongside routine glycaemic assessment. Keywords: Diabetes Mellitus, Type 2; Haemoglobin A, Glycosylated; Ferritins; Glycaemic Control.
Background: Benign idiopathic intracranial hypertension (BIIH) is characterized by raised intracranial pressure without an identifiable intracranial pathology and commonly presents with headache. However, atypical presentations without headache may delay diagnosis and increase the risk of irreversible visual loss. Empty sella syndrome is a radiological finding that may be associated with raised intracranial pressure and pituitary dysfunction, though hormonal abnormalities are often under-recognized. Case Presentation: We report the case of a 38-year-old obese woman who presented with progressive visual impairment and asymmetric bilateral papilledema in the absence of headache, nausea, or vomiting. Visual acuity was preserved in the right eye but markedly reduced in the left eye. Neuroimaging revealed an empty sella with flattening of the pituitary gland, while cerebrospinal fluid opening pressure was markedly elevated. Hormonal evaluation demonstrated isolated gonadotropin insufficiency with low follicle-stimulating hormone levels. The patient was diagnosed with benign idiopathic intracranial hypertension associated with empty sella syndrome. Management included therapeutic lumbar puncture, oral acetazolamide, and combined estrogen–progesterone hormone replacement therapy initiated after endocrinology consultation. Gradual improvement in visual function was observed over a six-month follow-up period. Conclusion: This case highlights an atypical, headache-free presentation of benign idiopathic intracranial hypertension associated with empty sella syndrome and gonadotropin insufficiency. It underscores the importance of considering BIIH in patients presenting primarily with visual symptoms and emphasizes the role of comprehensive hormonal evaluation and multidisciplinary management in optimizing visual outcomes. Keywords: Idiopathic Intracranial Hypertension; Empty Sella Syndrome; Papilledema; Gonadotropin Deficiency; Visual Impairment.
Objective: To investigate different clinical and demographic parameters among COVID-19 patients admitted to the intensive care unit and to correlate these parameters with survival outcome. Methods: This cross-sectional study was conducted at the COVID-19 Intensive Care Unit of Pakistan Air Force Hospital, Islamabad, Pakistan, from January 2021 to December 2022. Ethical review was obtained. Calculated sample size was 340. Covid-19 diagnosed patients > 18 years of age admitted to the ICU were enrolled. Data related to socio-demography, HRCT chest score, need for mechanical ventilation, duration of ICU stay, and survival outcome were collected. The data were collected, entered, and analyzed using SPSS version 22.0. A p-value of <0.05 was taken as significant. Results: This study includes 186 males and 154 females. Mean age was 55.8 ± 14.5. 82.6 % patients were RT-PCR positive. 59.7 % had >15 HRCT chest score. 77.9% needed mechanical ventilation. 50.9% had 4-7 days of ICU stay. 40.6% patients had co-morbidities. Mortality was 62.9 %. Conclusion: This study concludes that old age, HRCT score>15, need for mechanical ventilation, prolonged ICU stay, and presence of co-morbidities were associated with increased mortality among COVID-19 ICU-admitted patients. Keywords: COVID-19, Mortality, Intensive care units, Mechanical Ventilation
Objective: This study sought to determine the association between metformin therapy, vitamin B12 and folate deficiencies, and peripheral neuropathy in adults diagnosed with Type 2 Diabetes Mellitus (T2DM). Methods: A cross-sectional study was carried out at the Department of Medicine, Tertiary Care Hospital, Rawalpindi, from November 2023 to April 2024. The study included 224 patients with T2DM based on distinct inclusion and exclusion criteria, with informed consent obtained from all participants. Data collection involved assessing diabetes duration, metformin usage, dosage, and the presence of peripheral neuropathy. Serum levels of vitamin B12, folate, and homocysteine were calculated during the evaluation. Results: Individuals taking metformin tend to have lower Serum vitamin B12 levels compared to those not using the medication. Among metformin users, 27 (69.2%) were found to have vitamin B12 deficiency, compared to 12 (30.8%) in the non-user group, indicating a significant association p=0.00. However, no significant difference in folate levels could be determined between the groups (p = 0.55). Among participants with hyperhomocysteinemia, vitamin B12 deficiency was identified in 20 (71.4%) individuals versus 8 (28.6%), with a significant p-value of 0.02. While VPT and DN4 scores were comparable between groups, the DNS score showed statistical significance, being higher in metformin users (p = 0.03). Conclusion: This study highlights the high incidence of vitamin B12 deficiency, a preventable condition, among metformin users in the evaluated population and its link to neuropathy. Future studies are warranted to evaluate the efficacy of oral vitamin B12 supplementation in managing peripheral neuropathy in this group. Patients with T2DM on metformin for more than 2 years should therefore be screened for vitamin B12 deficiency regularly. Keywords: Metformin, Peripheral Neuropathy, Diabetes Mellitus type 2, Vitamin B12
Objective: The objective of this study was to compare the efficacy of topical xylometazoline and topical tranexamic acid in achieving bleeding control in patients presenting with anterior epistaxis in the emergency department. Method: After getting approval from the ethical review board, this RCT was conducted at Rawalpindi Teaching Hospital from 2nd February 2024 to 1st February 2025. A total of 80 patients (more than 18 years of age) with spontaneous anterior epistaxis were included in the study using non-probability consecutive sampling. They were randomly assigned to two equal groups (n = 40 each). One group received topical xylometazoline (0.1%), which was put on a cotton pledget and inserted into the affected nostril, while the other group received topical tranexamic acid (500 mg in 5 mL) using the same technique. The pledgets remained in place for 10 minutes. The primary outcome was to note the time to achieve haemostasis, which was categorised into 4 intervals: 5-10 minutes, 11-20 minutes, 21-30 minutes, or more than 30 minutes. If the bleeding had not stopped within 30 minutes, it would mean treatment failure, and the patient would be managed via cautery or nasal packing. The secondary outcome was to note the incidence of rebleeding within 48 hours. Results: In the tranexamic acid group, 45% of patients achieved haemostasis within 5–10 minutes, while only 23% of patients achieved haemostasis in the xylometazoline group in the same period, indicating a statistically significant difference (p = 0.019). An additional 45% of the patients in the tranexamic acid group achieved haemostasis within 11–20 minutes, whereas only 18% in the xylometazoline group stopped bleeding within the same timeframe. In the 21–30-minute category, 15% of the patients treated with tranexamic acid achieved haemostasis compared to 25% in the xylometazoline group. For the secondary outcome of rebleeding within 8 hours,43% of patients in the tranexamic acid group experienced recurrence of bleeding, compared to 50% in the xylometazoline group (p = 0.23). Conclusion: These findings suggest that Topical tranexamic acid is significantly more effective in achieving rapid haemostasis compared to xylometazoline and is associated with a lower failure rate. However, both agents exhibit similar rebleeding rates within 48 hours. Keywords: Epistaxis; Tranexamic acid; Administration, Topical; Hemostasis; Vasoconstrictor agents; Antifibrinolytic agents
Cyclosporine is associated with several well-known adverse effects; however, autonomic insufficiency related to the drug is rarely described in the literature. We report the case of a 72-year-old male pediatrician from Karachi, Pakistan, who was receiving cyclosporine for pure red-cell aplasia. He presented with dizziness, recurrent falls, tremulousness, and urinary incontinence. Examination revealed a significant postural drop in systolic blood pressure and fine resting tremors. Although specific autonomic testing was unavailable, the clinical picture and supporting investigations strongly suggested the presence of autonomic dysfunction. His cyclosporine level was markedly elevated (947.1 ng/mL). Discontinuation of cyclosporine, along with supportive management, led to rapid improvement in blood pressure, tremors, and urinary symptoms. The medication was later restarted at a lower dose with close therapeutic drug monitoring. This case highlights a rare presentation of autonomic neuropathy secondary to acute cyclosporine toxicity and underscores the need for vigilant monitoring, prompt recognition, and further research into this uncommon complication. Keywords: Cyclosporine; Drug Toxicity; Autonomic Nervous System Diseases; Orthostatic Hypotension; Tremor; Urinary Incontinence; Pure Red-Cell Aplasia
Objective: To investigate the effect of levo-carnosine co-administration on portal inflammation and fibrotic alterations caused by cisplatin in the BALB/c mice liver. Methods: The study was carried out from December 2020 to April 2022 at the Department of Anatomy in collaboration with the Department of Physiology, Army Medical College in Rawalpindi. The study included 90 adult BALB/c mice; three groups of 30 mice each. Group A (Control) was not given any medication. Group B (Cisplatin) received intraperitoneal cisplatin 8mg/kg body weight as a single weekly dose for four weeks, whereas Group C (Carnosine + Cisplatin) administered similar cisplatin treatment along with levo-carnosine 300mg/kg body weight every day by oral lavage. Mice were then euthanized, a 2 ml of terminal blood sample was obtained by intracardiac puncture for biochemical analysis, and then the liver was dissected out, processed, and stained with Hematoxylin and Eosin (H&E) and Masson’s trichrome stains to study portal inflammation and fibrosis, respectively. Results: Absence of portal inflammation was observed in 86.7% of mice in group A, moderate to severe portal inflammation was seen in 66.7% specimens in group B, whereas mild portal inflammation was observed in 43.3% of specimens in group C. Group B shows significantly (p<0.001) raised portal inflammation among the three groups. Similarly, liver fibrosis was not seen in 93.3% of mice in group A, mild to moderate fibrosis was seen in 83.3% specimens in group B, whereas mild fibrosis was noted in 26.7% of mice in group C. Group-C shows significantly (p<0.001) high liver fibrosis among the three groups. The serum albumin mean was 2.36±0.12 g/dl, 1.71±0.12 g/dl, and 2.16±0.26 g/dl in group A, group B, and group C, respectively. A significant (p<0.001) decrease in serum albumin was observed in group B when associated with group A and group C. Conclusion: Cisplatin administration caused portal inflammation and fibrosis in the liver of mice. Levo-carnosine, when administered along with cisplatin, reduced the toxic effect of cisplatin on the mice's liver. Keywords: Antioxidants, Carnosine; Cisplatin; Inflammation; Liver disease.
Objective: This study aimed to evaluate histopathological and biochemical alterations caused by Piperine on the ovaries of adult female Wistar albino rats. Methods: Thirty rats (3–4 months old, 200–250 g) were divided into three groups (n=10 each). Group A (control) received normal saline, Group B received Piperine at 5 mg/kg, and Group C received Piperine at 10 mg/kg body weight daily for 30 days. Serum estrogen and progesterone were measured using ELISA. Histology of ovarian tissues was done, and estrous cycle changes were monitored. Results: Piperine exposure produced a dose-dependent increase in secondary follicle diameter (Group A: 210.4 ± 15.2 µm; Group B: 285.7 ± 18.9 µm; Group C: 342.1 ± 22.7 µm; p < 0.001). Serum estrogen was significantly elevated in Groups B and C (62.7 ± 5.3 pg/ml and 75.4 ± 6.1 pg/ml) compared to controls (48.2 ± 4.5 pg/ml), while progesterone declined (Group A: 1.45 ± 0.35 ng/ml; Group B: 1.01 ± 0.33 ng/ml; Group C: 0.41 ± 0.12 ng/ml; p < 0.001). Conclusion: Piperine caused dose-dependent enlargement of secondary follicles with elevated estrogen and reduced progesterone, leading to arrest of the ovarian cycle at the proestrus stage. These findings suggest potential reproductive toxicity of piperine in females of reproductive age. Keywords: Piperine, Secondary Follicles, Estrogen, Progesterone, Estrous cycle.
Objective: To determine the frequency of fungal infection among patients, as well as its characteristics and features, in patients with nasal polyps presenting at tertiary care hospitals. Methods: A Cross-Sectional Study was conducted for 6 months after the project's approval, from September 18, 2023, to March 18, 2024. After setting the inclusion criteria, patients were enrolled, and informed written consent was obtained after explaining the study's aims, benefits, and risks. Demographic details, including age, gender, and address, were recorded, and participants underwent physical and medical assessments. Those diagnosed with nasal polyps were tested for fungal infections through histopathology, using biopsy specimens to identify fungal growth, hyphae, and branching patterns. All observations were documented on pre-defined proformas. Results: out of 195 patients, the mean age was 42.30 ± 11.05 years. Participants were distributed across age groups as follows: 10.3% (18-30 years), 36.4% (31-40 years), 30.3% (41-50 years), and 23.1% (>50 years). Of the total, 41.5% were male, 58.5% were female, 66.7% were employed, and 33.3% were unemployed. Most had unilateral (55.4%) rather than bilateral (44.6%) nasal polyps. Fungal infection was present in 45.6% of patients. The mean weight, height, and BMI were 38.66 kg, 1.437 meters, and 18.43, respectively. Stratification by age, gender, employment status, polyp type, and BMI revealed no significant associations with fungal infection, as indicated by p-values above 0.05 in all categories. Conclusion: Patients showed a high frequency of fungal infection after nasal polyps Keywords: Body Mass Index, Fungal Sinusitis, Nasal Polyps.
Objective: To investigate the Quality of Life (QoL) of adolescents living with hemophilia and analyze the impact of sociodemographic factors like socioeconomic status, parents' qualification, and clinical factors like disease severity and type on their physical and psychosocial health. Methods: It was a descriptive observational study with association analysis. Fifty adolescents with either hemophilia A or B were recruited from the Hemophilia Treatment Center (HTC), managed by Hemophilia Patients Welfare Society. The Pediatric Quality of Life Inventory (PedsQL) was used to quantify QoL. Statistical analyses, including one-way ANOVA and correlations, were performed to identify associations between QoL scores and baseline factors. Results: The Majority of adolescents had compromised physical and psychosocial health. Mean Physical Health Functioning scores and Psychosocial Health Functioning scores were (44.03 ± 25.80) and (57.24 ± 18.03), respectively, which showed that both physical and psychosocial quality of life are compromised, but physical health is more affected than psychosocial health. Analysis of the association between sociodemographic variables with physical and psychosocial health yielded statistically significant results for parents' qualification to physical and social functioning; however, the impact of clinical factors like disease severity and type did not yield statistically significant results. Conclusion: The QoL of most adolescents with hemophilia is compromised, regardless of disease severity or type. Parents' qualification plays a positive role in adolescents' physical and social functioning. We suggest incorporating regular psychological evaluations and parents' psychoeducation into management plans to improve the quality of care and QoL. Keywords: Hemophilia; Adolescents; Quality of Life.
Objective: To assess the knowledge, practice, and attitude of MBBS doctors regarding ear hygiene and analyse the statistical association with their clinical speciality and duration of professional experience. Methods: This cross-sectional-analytical study was conducted at the Department of Otorhinolaryngology, Niazi Welfare Foundation Teaching Hospital, from October 2024 to March 2025, after obtaining ethical committee approval. A structured questionnaire was distributed among 520 MBBS doctors, recruited through convenience sampling. Data were analysed using SPSS version 23. Descriptive analysis was conducted for all variables, and one-way ANOVA was used to explore statistical associations between the Knowledge, Attitude, and Practices (KAP) of MBBS doctors and their clinical speciality and experience. Results: Among the 520 study participants (mean age: 33.2 ± 9.9 years; 59.2% female), 77.7% correctly recalled the ear canal's curved anatomy, but only 52.7% acknowledged cerumen’s immunological function. More than half (56.9%) of study participants confessed to using cotton buds, with 51.5% cleaning their ears more than twice a week. Itching was identified as the most common (38.5%) stimulant for inserting objects in the ear canal, and 12.3% had a history of self-inflicted ear injury. Only 47.7% referred to ENT specialists for ear problems. Clinical speciality showed a significant positive association with KPA (p < 0.05), except for the influence of parental habits (p = 0.66). Conclusion: A significant knowledge gap was identified among many MBBS doctors, reflecting their unsafe ear cleaning practices. Educational corroboration is prudent to promote knowledge of ear hygiene and evidence-based counselling in clinical practice. Keywords: Cerumen, External Ear, Health behaviour, IgA, Physicians.
Background: To note patient characteristics, risk factors, use of streptokinase, complications, and mortality in subjects presenting with acute myocardial infarction. Methods: This prospective, observational, case study was conducted at DHQ Teaching Hospital, Rawalpindi, from January 2001 to January 2002. All 95 patients who were admitted with a diagnosis of acute myocardial infarction during this period were included. Patients were managed in the standard way, initially in CCU and then in the medical ward. Data obtained was statistically examined using Epi Info 2000. Results: Of the 95 patients, 70 (73.7%) were male and 25 (26.3%) female. Mean patient age was $57\pm12.54$ years. Anterior wall was involved commonly (38.9% patients). Forty-nine (51.6%) patients received thrombolysis with streptokinase. Arrythmias (57.9% patients) and cardiac failure (53.6% patients) were the commonest complications of acute myocardial infarction. Mean hospital stay was 8 days. 11.5% $(n=11)$ patients died during hospital stay, of these 27.2% $(n=3)$ received streptokinase. Age, sex, smoking, and sedentary life styles were common (>50%) risk factors for myocardial infarction. Conclusion: Acute myocardial infarction is common in males and over the age of 50 years. Majority of these patients are candidates for thrombolytic therapy with streptokinase. Myocardial infarction related in-hospital mortality, even in a tertiary care setting, may be 11.5%
Background: To study etiology of upper gastro-intestinal [GI] haemorrhage with flexible upper GI endoscopy. Methods: 2484 patients who were endoscoped at DHQ Teaching Hospital, Rawalpindi, from October to December 2003, for evaluation of upper GI haemorrhage were included. Record of these patients that included patient characteristics, endoscopic diagnosis etc was analyzed using statistical program, SPSS version 8. Results: Of the 2484 patients, 68% were female and 32% male. Mean patient age was 38.8 ± 12.6 years. Erosive gastritis [15.6%], esophago/gastro/duodenitis [15.3%], duodenitis [14.7%], varices [12.9%], and peptic ulcer disease [8.3%] were commonest endoscopic diagnosis. 24% patients had normal upper GI endoscopy. Conclusion: Erosive gastritis, esophago/gastro/duodenitis, duodenitis, varices, and peptic ulcer disease are common causes of upper GI haemorrhage in our patients.
