Objective: To evaluate the association between serum magnesium concentration and clinically significant arrhythmias in patients with heart failure with reduced ejection fraction. Study Design: Analytical Cross Sectional. Setting: Department of Biochemistry, Shahida Islam Medical and Dental College, Lodhran. Period: October 2025 to February 2026. Methods: Total of 185 adults with confirmed systolic dysfunction (left ventricular ejection fraction ≤40%). Hypomagnesemia was defined as fasting serum magnesium <0.70 mmol/L. Arrhythmia burden was ascertained using standardized electrocardiography and ambulatory rhythm monitoring. Multivariable logistic regression quantified independent associations after rigorous adjustment for demographic, renal, electrolyte, and guideline-directed pharmacological confounders. Statistical significance was considered at p value <0.05. Results: Hypomagnesemia affected 15.7% of participants, while 36.8% exhibited clinically significant arrhythmias, predominantly atrial fibrillation and frequent ventricular ectopy. Unadjusted analysis revealed markedly elevated arrhythmia prevalence (odds ratio: 2.89; p=0.009). Following comprehensive covariate adjustment, low serum magnesium remained independently associated with arrhythmia occurrence (adjusted odds ratio: 2.14; 95% confidence interval: 1.03–4.45; p=0.041). Concomitant reductions in estimated glomerular filtration rate and serum potassium emerged as additional independent predictors. Model diagnostics demonstrated acceptable discriminatory capacity and calibration. Subgroup evaluations confirmed consistent effect modification across renal and diuretic exposure categories. Conclusion: Hypomagnesemia independently predicts a substantially higher arrhythmia burden in systolic heart failure. Systematic magnesium surveillance and targeted repletion constitute pragmatic, cost-effective strategies for arrhythmia risk mitigation.
Objective: To determine the distribution spectrum and frequency of testicular and para-testicular lesions, including both neoplastic and non-neoplastic types from one of the diagnostic centres of Pakistan. Study Design: Cross-sectional study. Setting: Chughtai Institute of Pathology, Lahore. Period: August 2025 to February 2026. Methods: A total of 396 cases of testicular and paratesticular lesions, including 204 orchidectomy specimens and 192 testicular biopsies received over a period of 1 year were studied retrospectively. Results: Overall, non-neoplastic conditions were predominant. The most frequent non-neoplastic diagnosis was non-granulomatous epididymo-orchitis (40 cases, 19.60%), followed closely by atrophic testes (34 cases, 16.66%). Undescended testis (cryptorchidism) was identified in 12 specimens (5.88%). Among the neoplastic lesions from the 204 surgical cases, mixed germ cell tumors were the most common tumor type (35 cases, 17.15%), followed by seminoma (21 cases, 10.29%). Yolk sac tumors were observed in 9 cases (4.41%), predominantly in the pediatric age group (6 cases in the 0-10-year age bracket). Histopathological findings of the 192 testicular biopsies varied from normal spermatogenesis and maturation arrest to Sertoli-cell-only syndrome and hyposermatogenesis, providing critical diagnostic information for managing male infertility. Conclusion: The study shows that the non-neoplastic lesions predominate among the testicular and para-testicular pathologies with epididymo-orchitis and testicular atrophy being the most common findings. Within the malignant lesions, germ cell tumors are most frequently followed by mixed germ cell tumors and seminoma.
Objective: To evaluate the frequency and nature of complications associated with ultrasound-guided omental biopsies and to assess the effectiveness of immediate on-table management strategies using a co-axial biopsy technique. Study Design: Prospective Observational Clinical Cohort study. Setting: Department of Interventional Radiology, Tertiary Care Hospital, Lady Reading Hospital, Peshawar. Period: June 2025 to June 2026. Methods: Included 115 consecutive patients undergoing ultrasound-guided omental biopsy using a co-axial core biopsy system. Demographic data, lesion characteristics, procedural details, complication rates, bleeding severity, and management strategies were recorded prospectively. Minor bleeding was managed using autologous clotted blood injection through the same c o-axial tract, whereas major bleeding was treated using Gel Foam slurry embolization followed by manual compression. Post-procedural ultrasound follow-up was performed to assess residual hematoma formation and delayed complications. Results: Among the 115 patients included in the study, 81 (70.4%) were female and 34 (29.6%) were male. Bleeding complications occurred in 12 patients (10.4%). Minor bleeding occurred in 9 patients (7.8%) and was successfully managed with autologous clot injection through the existing co-axial needle tract. Major bleeding occurred in 3 patients (2.6%) and was managed successfully using Gel Foam slurry embolization through the same tract followed by manual compression for 15 minutes. Technical success of hemostasis was achieved in 100% of complicated cases. No patient required surgical intervention, angiographic embolization, blood transfusion, or intensive care admission. Follow-up ultrasound demonstrated no residual hematoma or delayed bleeding complications. Conclusion: Ultrasound-guided omental biopsy using the co-axial technique is a safe, effective, and minimally invasive diagnostic procedure. Immediate management of bleeding complications through the same access tract significantly enhances procedural safety, minimizes patient morbidity, reduces resource utilization, and eliminates the need for additional invasive interventions.
Objective: To compare the AIMS65 score with the pre-endoscopy Rockall score among patients presenting with upper gastrointestinal bleeding for the prediction of in-hospital mortality. Study Design: Analytical Cross-sectional study. Setting: Medical Unit III, Sahiwal Teaching Hospital. Period: August 2025 to March 2026. Methods: 123 patients who presented with upper GI bleeding in the emergency department were enrolled. For each patient AIMS 65 and Pre-endoscopy Rockall score was calculated. Data analysis was performed using SPSS. Area under the Curve (AUC) was determined for both scores using Receiver Operating Characteristic (ROC) analysis. A p-value of <0.05 was considered statistically significant. Results: The mean age of the patients was 55.90 ± 14.7 years. Male patients were 56.1% in proportion. The total mortality rate in the hospital was found out to be 24.4%. AUC for AIMS65 and pre-endoscopy Rockall scores was 0.844 (95% CI: 0.772–0.917; p<0.001) and 0.834 (95% CI: 0.766–0.903; p<0.001), respectively. Both scores showed good predictive performance for in-hospital mortality. The difference between the two was minimal (0.010) and not statistically significant. Conclusion: AIMS 65 and Pre-endoscopy Rockall score are both equally effective for the prediction of in-hospital mortality among UGIB patients.
Objective: To identify and quantify the factors associated with reduced attention span during lectures among medical students at Nishtar Medical University, focusing on students, pedagogy, teaching methods and determinants related to environment. Study Design: Cross-sectional Survey. Setting: Nishtar Medical University, Multan. Period: March 2026 to October 2026. Methods: A structured questionnaire was used, we assessed eleven factors affecting attention span. Students also rated their perceived concentration over the course of a typical lecture. Descriptive statistics characterized the prevalence of these distractors; multivariate logistic regression was used to examine associations between these factors and self-reported attention decline during lectures. Results: A large proportion among the respondents reported declining attention during lectures which is by the various distractors which we have studied. Key student-related factors significantly associated with concentration loss included psychological factors such as lack of personal interest and post lunch meal status and peer distraction. Negative emotional background is also correlated with reduced focus. Regarding pedagogical variables, insignificant use of audiovisual aids and passive lecturing style and teaching methodologies were linked to lower sustained attention. Environmental factors, particularly noise pollution and poor lighting or ventilation, were also significant predictors of concentration decline. In regression analysis, for example, students who reported distractions from noise pollution had greater attention decline as compared to those who did not, controlling for various other variables. In our study of 219 medical students, attention-span difficulties were highly prevalent, with major contributors including impaired concentration (89.04%), emotional impact (86.76%), environmental noise (83.56%), diet (81.28%), lack of interest (73.06%), teaching method (72.15%), study material (61.64%), and prior knowledge (54.79%). Conclusion: Our study indicates that a multifactorial “attention span crisis” affects medical students during lectures, encompassing individual environmental, and pedagogical contributors. To mitigate or eradicate this decline, medical educators should consider more interactive teaching, improvements needed in teaching styles, optimized classroom environments, and scheduling considerations (e.g., meal timing) to maintain and improve student engagement.
