Background: Antimicrobial resistance (AMR) continues to be a serious issue among hospitalized bacterial infections. This systematic review and meta-analysis aimed to review evidence-based practices in the rational utilization of antibiotics in the clinical setting and identify strategies that can help reduce inappropriate use, improve patient outcomes, and overcome antimicrobial resistance. Methods: In May 2025, a search of PubMed, Scopus, Web of Science, and Google Scholar was conducted to find 10 eligible studies. The meta-analyses were performed with RevMan 5.4.1 based on the random-effects models, pooled odds ratios (ORs), and 95% confidence intervals (CIs). Cochrane's Risk of Bias tool, and the Newcastle-Ottawa Scale was used to identify risk of bias in studies. Heterogeneity was assessed using an I2 statistic, and the quality of evidence was assessed overall using GRADE. Results: The combined effect of five studies that assessed mortality showed a pooled OR of 1.43 [95% CI: 0.78 - 2.63], which was not significant between the intervention and control groups. Heterogeneity was high (I² = 90%). In the case of AMR, there were five studies with a pooled OR of 1.12 [95% CI: 0.63 - 2.00] without any significant effect (I2 = 82%). The results were stable over sensitivity analyses, but heterogeneity was large. Risk of bias was moderate or low. Conclusion: There is no existing evidence that the interventions studied show meaningful mortality or AMR reductions. Well-designed, multicenter, standardized-protocol, and outcome-definition studies are necessary in the future to develop comprehensive strategies to reduce mortality and antimicrobial resistance among patients in the hospital.
Intrauterine contraceptive devices (IUCDs) are effective long‑acting reversible contraceptives but may rarely perforate the uterus and migrate to adjacent viscera, sometimes remaining asymptomatic for years. A 33‑year‑old woman at 26 weeks’ gestation presented with right iliac fossa pain, fever, and tachycardia for 1 day. Intraoperative findings revealed a transmigrated Copper‑T device within the caecum, causing dual perforations of the caecum requiring ileocecal resection and end-to-end ileocolic anastomosis. Maternal recovery was uneventful, and fetal viability was preserved throughout the entire hospital stay. The patient was discharged on the 5th postoperative day. Long‑standing retained IUCDs can cause serious gastrointestinal complications and contraceptive failure; prompt surgical management yields favorable outcomes.
Background: Oral squamous cell carcinoma (OSCC) is observed to account for most of the malignancies in the oral cavity. This systematic review and meta-analysis aimed to assess whether p53 and Ki-67 expression form a prognostic marker in oral squamous cell carcinoma (OSCC), and its relationships to the lymph node metastasis (LNM) and tumor aggressiveness. Methodology: PubMed, Scopus, Web of Science, and Google Scholar were searched up to the month November 2025. The studies that were included were observational cohort and cross-sectional studies that assessed p53 or Ki-67 expression in immunohistochemistry (IHC) and provided extractable counts of high/low expression and LNM. Titles, abstracts, and full texts were screened by two reviewers, and disagreements were settled by a third reviewer. The risk of bias was also determined based on the Newcastle–Ottawa Scale (NOS) and the certainty of evidence was determined based on a GRADE methodology. Results: There was no statistically significant correlation between the p53 expression and LNM (OR = 6.56; 95% CI: 0.28-155.9; I2 = 89%), indicating that the heterogeneity was high. On the contrary, Ki-67 overexpression was much related to LNM (OR = 5.67; 95% CI: 2.22-14.51; I2 = 35%), and this effect was reported in all studies. The stability of the Ki-67 pooled estimate was validated by the sensitivity analysis, but the results of p53 were sensitive to the elimination of specific studies. Conclusion: Ki-67 overexpression can serve as a predictable prognostic biomarker of metastasis to the lymph node, and p53 outcomes are inconclusive due to the heterogeneity of the methodology.
Background: The educational environment significantly influences students’ learning and professional development. The Dundee Ready Education Environment Measure (DREEM) is a validated tool to assess these perceptions in medical education. A cross-sectional quantitative study was conducted to assess students’ perceptions of the educational environment using the DREEM questionnaire Methods: The study was conducted at four dental institutions in Islamabad: Dental College HITEC-IMS, Islamic International Medical College School of Dentistry, PIMS, and Shifa College of Dentistry from 31st May 2023 till 30th Nov 2023. The data collection was done using the Dundee Ready Educational Environment Measure (DREEM) questionnaire, which was completed by 318 dental students from four colleges. The Kolmogorov-Smirnov test assessed normality, Cronbach’s alpha evaluated internal reliability, and the Mann-Whitney U test compared preclinical (n=189) and clinical (n=129) students’ perceptions. Likert responses are presented as median (IQR). Results: According to Mann-Whitney U = 10507.0, p = 0.028, clinical-phase students had a significantly worse perception of the learning environment than preclinical students, who consistently reported higher satisfaction in the domains of learning, teacher support, confidence building, and stress support. Conclusions: As students move from preclinical to clinical training, their opinions of the classroom dramatically deteriorate. These results show that in order to facilitate the transition and enrich the clinical learning experience, specific curricular reforms, improved faculty support, and organized student support structures are required
Background: Chronic kidney disease (CKD) is a major global health challenge. This study was done to identify the clinical, haemodialysis-related, and laboratory factors associated with intra-dialytic hypotension (IDH) in patients undergoing maintenance haemodialysis. Methods: This prospective observational case–control study was conducted at the Kidney Center, Karachi, from September 2024 to February 2025. Patients (n=60) on maintenance haemodialysis (>3 months) were enrolled, including 30 with IDH, and 30 without IDH. Non-probability consecutive sampling technique was adopted. Demographics, comorbidities, haemodialysis prescription, interdialytic weight gain, dialysate parameters, medication history, water and food intake, urine output, and laboratory values were recorded. Blood pressure was measured pre-, intra-, and post-dialysis. Data were analysed using SPSS v26 with appropriate parametric and non-parametric tests taking p<0.05 as significant. Results: In a total of 60 patients, the mean age was 50.9±14.1 years, and 32 (53.3%) patients females. Hypertension was present in 58 (96.7%), and diabetes mellitus in 22 (36.7%) patients. Patients with IDH had longer dialysis vintage (5.5±4.5 vs 3.3±3.9 years, p=0.010). Interdialytic weight gain (2.3±0.8 vs 1.8±0.7 kg, p=0.007) and daily water intake (1.1±0.5 vs 0.8±0.4 L, p=0.023) were higher in IDH. Intradialytic systolic and diastolic BP were significantly lower (88.0±5.8/53.1±6.3 vs 138.4±20.6/82.6±12.8 mmHg, both p<0.001). Serum sodium was reduced in IDH (133.6±4.6 vs 135.9±5.3 mEq/L, p=0.041). Conclusion: Patients with IDH undergoing maintenance haemodialysis were characterized by longer dialysis duration, greater interdialytic weight gain, higher daily fluid intake, lower pre-dialysis diastolic pressure, significantly reduced intradialytic blood pressure values, and lower serum sodium levels compared with those without IDH.
