Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University
The Annals of Pakistan Institute of Medical Sciences (APIMS) is the official quarterly and open access journal of Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Pakistan. Previously, two separate medical journals of this institute were being published, namely, JPIMS started in 1990 and the Journal of Surgery in 1991. They were officially merged into one journal, APIMS, in 2005. The Annals of PIMS is recognized by the Pakistan Medical and Dental Council (PMDC), the Higher Education Commission of Pakistan ( Y category), and the CPSP (https://www.cpsp.edu.pk/files/news_notifications/cpsp-sec-2020-338.pdf) It is indexed in WHO-IMEMR, & Base from Germany.
Shaheed Zulfiqar Ali Bhutto Medical University
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons. org/licenses/by-nc/4.0/.) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Bridging the Regulatory Gap in Pakistan’s Stem Cell Landscape
Copyright (c) 2026 Nazia Abdul Rehman, Ramla Shahid https://creativecommons.org/licenses/by-nc/4.0
Outcome of Chewing Gum versus Intravenous Fluids in Prevention of Postoperative Ileus after Stoma Reversal
Objective: This study compared the effectiveness of postoperative chewing gum with standard IV-fluid-based care in preventing POI after stoma reversal. Methodology: This randomized controlled trial study was conducted in Department of General Surgery, PIMS, Islamabad from 01/03/25 to 30/09/2025 on 60 patients who were in a condition to undergo stoma reversal and randomly divided into two groups: Group A received three times of sugar-free chewing gum three days after surgery and Group B received only IV-fluid as a postoperative treatment. The time to first flatus and hospital stay were the primary outcomes. The secondary outcomes were the incidence of POI, the scores of postoperative pain, and patient satisfaction. Data was analyzed on SPSS version 27 and the p value of less than 0.05 was regarded as statistically significant. Results: First flatus occurred before patients in the chewing-gum group (54.3 ± 7.9 hours) than in the control group (78.6 ± 10.4 hours). Group A also had shorter hospital stay (6.8 ± 1.1 days) as compared to Group B (9.1 ± 1.4 days). The chewing-gum group had less POI incidence, lower pain scores and increased satisfaction. Conclusion: Chewing gum is a safe, inexpensive, and effective adjunct that enhances postoperative bowel recovery after stoma reversal. Incorporating it into routine postoperative care may help reduce POI and improve patient outcomes.
Copyright (c) 2026 Mohibah Khaliq, S H Waqar, Fahad Akhtar, Kanza Farukh, Muhammad Fahad Ali https://creativecommons.org/licenses/by-nc/4.0
Comparative Analysis of Refractive Error in Children with Unilateral and Bilateral congenital Nasolacrimal duct Obstruction
Objectives: To determine and compare the frequency of various refractive errors in children with unilateral and bilateral congenial nasolacrimal duct obstruction. Methodology: This comparative observational study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi from January-2025 to June-2025. A total of 220 children with congenital nasolacrimal duct obstruction (both unilateral and bilateral types) were included and were assessed for refractive errors. Comparison of refractive error types was performed using Chi-square test. Data was analyzed using SPSS version 22. Results: Among 220 children, 160 (72.70%) patients had unilateral while 60 (27.30%) patients had bilateral disease. The median age was 5.00 (2.00) years. There were 139 (63.20%) male and 81 (36.80%) female patients. In patients with unilateral disease (n = 160), frequency of anisometropia was observed in 113 (70.63%) patients, while in patients with bilateral disease (n = 60), it was 5 (8.33%), (p < 0.001). In patients with unilateral disease (n = 160), most common type of refractive errors was myopia observed in 47 (29.38%) patients followed by hypermetropia in 44 (27.50%) patients and astigmatism in 24 (15.00%) patients while in patients with bilateral disease (n = 60), most common type of refractive errors was myopia observed in 13 (21.67%) patients followed by astigmatism in 7 (11.67%) patients and hypermetropia in 6 (10.00%) patients, (p = 0.001). Conclusion: Refractive errors, particularly anisometropia, are much higher in patients with unilateral rather than bilateral congenital nasolacrimal duct obstruction.
Copyright (c) 2026 Adila Anwar, Hanif Malik, Rabeeah Zafar, Summaya Anjum; Nusrat Sharif, Shafaq Najmi https://creativecommons.org/licenses/by-nc/4.0
Cytoprotective Role of Co-Enzyme Q10 on the Spleen of Immunosuppressed Female Albino Wistar Rats
Objective: To assess the effects of Co-enzyme Q10 supplementation on the histology of the spleen in immunocompromised female Albino Wistar rats. Methodology: A quasi-experimental study was conducted between July 2021 and December 2021 at the Anatomy Department of Isra University Hyderabad. Forty female adult Albino Wistar rats (n=10/group) were included in the present study, divided into 4 groups where A was kept as vehicle control, B as experimental group, C as pre-treatment group, and D was kept as post-treatment. All drugs were administered through the intraperitoneal route. On Day 09, animals were sacrificed through cervical dislocation and dissected. Spleen was carefully dissected from each animal and washed thoroughly with distilled water, and tissue was fixed in 10% formalin and processed for light microscopy. Results: On the histopathological findings, the moderate and severe white pulp atrophy was significantly higher in group B (p-0.001). All the animals of control group A were without haemorrhagic findings, while mild haemorrhage was seen in 3 animals of group b, 3 animals in group C and 3 animals of group D. Moderate haemorrhage was seen in 5 animals of group B and 2 animals of group D, while severe haemorrhage was seen only in 2 animals of group B. The moderate and severe haemorrhage was significantly higher in group B (p-0.001). Furthermore, the moderate and severe necrosis was significantly higher in group B (p-0.001). Conclusion: The histological changes, including white pulp atrophy, haemorrhage, and necrosis, were most frequently observed in the spleens of immunosuppressed female rats treated with cyclophosphamide. A significant cytoprotective effect of Coenzyme Q10 was noted in these rats, as spleen histology showed marked improvement in those treated with Coenzyme Q10 alongside cyclophosphamide, regardless of whether Coenzyme Q10 was administered before or after the start of cyclophosphamide treatment.
Copyright (c) 2024 Rida Qureshi, Zaheer Ahmed Memon, Syna Pervaiz Sangha, Lal Bakash Khaskheli, Shamshad Bano, Kahaf Naz https://creativecommons.org/licenses/by-nc/4.0
Integrating Clinical, MRI and Arthroscopic Findings for Accurate Diagnosis of Meniscal Tears.
Objective: To compare the diagnostic efficacy of clinical examination (joint line tenderness and McMurray test) versus MRI for detection of medial and lateral meniscal tears, by utilizing arthroscopy as the gold standard. Methodology: This retrospective cross-sectional study was carried out at Shifa International Hospital Islamabad from Sep 2024 to August 2025. Clinical data of 200 patients with suspected meniscus tears subjected to clinical evaluation, MRI, and arthroscopy were included. Clinical examinations including joint line tenderness and McMurray test, MRI and arthroscopic findings were documented. Diagnostic indicator including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated Results: The clinical examination for medial meniscus tear (n=154 confirmed by arthroscopy) yielded 84.4% sensitivity, 84.8% specificity, 94.9% PPV, 61.9% NPV, and 84.5% accuracy. The sensitivity of MRI was found to be 99.4%, its specificity was 82.6%, its PPV was 95.0%, its NPV was 97.4%, and its accuracy was 95.5%. For lateral meniscal tears (n=57 confirmed on arthroscopy), sensitivity was 73.7%, specificity was 98.6%, and accuracy was 91.5% on physical examination, whereas sensitivity was 91.2%, specificity was 95.8%, and accuracy was 94.5% on MRI. MRI had markedly higher negative predictive value (97.4% medial; 96.5% lateral), while clinical examination showed higher specificity for lateral tears. Conclusion: MRI proved to be most valid and accurate non-invasive diagnostic tool before arthroscopy for both medial and lateral tears owing to its higher sensitivity, negative predictive value and overall precision in comparison with clinical findings. Clinical assessment is quite facilitative, but it cannot be substituted for MRI as a single diagnostic modality.
Copyright (c) 2026 Dr. Syed Talha Tariq, Dr. Sajjad Hassan Orakzai, Dr. Abdul Aziz, Dr. Hasnain Ali, Dr. Luqman Shahid, Syed Ali Turab https://creativecommons.org/licenses/by-nc/4.0
Effectiveness of Various Concentrations of Benzocaine and Polyethylene Glycol Gel in Patients with Acute Tooth ache
Objective: To find out the reduction in pain in one hour, upon application of topical Benzocaine gels, with 10% and 20% concentrations, for toothache due to irreversible pulpitis. Methodology: This comparative study was conducted in Department of Operative Dentistry, Pakistan Institute of Medical Sciences Islamabad from Dec 2018 to Feb 2020. Sample of 200 in each group, 10% Benzocaine group, 20% Benzocaine group and polyethylene glycol gel group was achieved via stratified random sampling. Patients without any systemic disease, 15 years or older reported with toothache due to irreversible pulpitis in one permanent maxillary or mandibular tooth with an open cavity were included. The intensity of endodontic pain was evaluated by the Visual Analogue Scale (VAS). The ethical committee of PIMS/SZABMU approved the study and the informed consent was taken from participants after a diagnosis of irreversible pulpitis was made with cold test. Results: Out of 600 patients, males were 254 and females were 346. Patients with moderate severity of pain upon arrival for dental treatment were 404, while 196 had severe pain. Chi-square test revealed that there was a significant difference between the levels of pain after one hour among the three groups (P=< 0.001). Similarly, chi-square revealed that there was a significant difference between the levels of pain relief among the three groups after one hour (P=<0.001). Conclusion: Benzocaine gel (20%) showed more effective results as compared to the 10% benzocaine gel in patients with tooth ache. Benzocaine, in both concentrations, is more effective than Polyethylene Glycol.
Copyright (c) 2026 Faizan Hussain, Namrah Ayaz, Amina Ghaffar, Altaf Hussain, Saniah Qureshi, Usman Mahmood, Junaid Israr Ahmed Khan https://creativecommons.org/licenses/by-nc/4.0
Role of Education in Developing Awareness Among Dental Health Care Workers pertaining Cross Infection Control in Clinical Settings
Background: There are certain methods used to prevent the cross infection in the health care delivery systems and their personnel including immunization, routine precaution, and personal protective equipment (PPE). This study aimed to evaluate the role of education in developing awareness among Dental health care workers pertaining cross infection control in clinical settings. Methods: A total of ninety-eight (98) dental surgery assistants working in Dental hospitals of Multan were recruited from 1st April 2022 to 31st July 2022. The procedure of Data collection was done by using structured, self-administered four sectioned questionnaire via simple random sampling. The Dental assistants working for over 01 year were included in the study. The statistical analysis of the collected data was then conducted with SPSS. The Results were displayed in graphs and tables by keeping the significance level at P<0.05. Results: Out of 98 participants, females were 21.4% (21) whereas males were 78.6% (77). Majority 75 (76.53%) participants received higher secondary education from school. Chi square test depicted a significant association between knowledge and educational level of the participants (p-value = 0.016). There was an insignificant association of attitude with educational level (p-value = 0.292) and gender (p-value= 0.285). There was also an insignificant association of practice revealed with educational level (p-value = 0.073) and gender (p-value = 0.103). Conclusion: The current study concluded significant association between knowledge and educational level of dental assistants. There exists a strong association between knowledge, practice and usage of PPE for controlling the cross infection among dental assistants.
Copyright (c) 2026 Muhammad Mohsin Javaid, Syed Midhat Batool , Muhammad Ahmad , Hina Nasim, Ezza Mansoor, Efrah Mansoor, Rizwan zafar langrial, Afsheen Mansoor https://creativecommons.org/licenses/by-nc/4.0
Assessment of Self-Reported Metabolic Parameters Among Pakistani Doctors
Objective: To determine the frequency of self-reported metabolic syndrome (MetS) and its components in Pakistani. Methodology: This cross-sectional, descriptive study was conducted at Shifa International Hospital, Islamabad from August to November 2025. 360 licensed doctors (house officers, post graduate trainees, medical officers, and consultants) aged between 25 to 65 years of age completed a self-reported questionnaire on anthropometric measurements, blood pressure, fasting glucose, lipid profile, and lifestyle factors; cut-off values provided by the AHA/NHLBI for the definition of MetS were applied using ethnic and age-specific cut-off values for the Asian population. Descriptive statistics and chi-square tests were performed to evaluate associations. Results: The participants had a mean age of 28.9±5.4 years, and 60.6% of the participants were male. The mean BMI for the sample was 27.3±4.2 kg/m²; 66.1% of the participants were classified as overweight, and 7.8% were classified as obese according to BMI. From the total sample, 26.1% of the participants self-reported having MetS;the percentage of males (29.4%) was higher than that of females (21.1%);Poor physical activity levels (33% vs. 18.1%) and current smoking status (34.2% vs. 23.9%) were both associated with a greater incidence of MetS. Conclusion: Many Pakistani doctors having self-reported metabolic syndrome and its associated components. The MetS is typified by central obesity, dyslipidemia, and hypertension. The prevalence of lifestyle variables and the risk of developing metabolic diseases (lack of exercise and smoking) highlight the importance of screening and prevention among this cohort.
Copyright (c) 2026 Hazar Khan, Muslim Attiq, Aliza Ijaz, Mohammad Salih, Maliha, Maaz Bin Badshah, Rida Inam https://creativecommons.org/licenses/by-nc/4.0
Role of tranexamic acid in terms of reducing perioperative blood loss and post operative transfusion requirement in fractures of proximal femur
Objectives: To assess the effect of perioperative intravenous tranexamic acid (TXA) on the amount of blood lost postoperatively, as well as the requirement of blood transfusions in patients who underwent surgery for proximal femur fractures. Methodology: A comparative study was conducted at the Department of Orthopedics, Pakistan Air Force (PAF) Hospital, Islamabad, from November 2025 to January 2026. A total of 180 patients aged 18 to 65 years with proximal femur fractures (ASA I to II classification) were included in this study, divided into control and TXA groups. The control group (n = 90) patients who received no TXA, and the TXA group (n = 90) patients who received intravenous TXA perioperatively. Blood loss was measured based on hemoglobin drop and 24-hour drain output. Blood transfusion requirements were recorded according to institutional guidelines. The statistical analysis of the results was performed using SPSS version 25. Results: The mean postoperative drain output in the TXA group was significantly less than that in the control group (312 ± 74 mL vs. 468 ± 96 mL; p < 0.001). Patients receiving TXA also had a lower mean postoperative hemoglobin drop (1.2 ± 0.5 g/dL vs. 2.1 ± 0.6 g/dL; p < 0.001). The TXA group had a significantly lower mean number of transfused units per patient (0.38 ± 0.72 vs. 0.89 ± 1.03; p = 0.001) and fewer patients needed postoperative blood transfusions (18.9% vs. 38.9%; p = 0.004). Thromboembolic or wound-related complications did not differ significantly. Conclusion: The routine use of perioperative intravenous TXA in clinical practice is supported by the fact that it successfully lowers postoperative blood loss and transfusion requirements in proximal femur fracture surgery without increasing adverse events.
Copyright (c) 2026 Aamar Munir, Saad Mubeen Khalid, Nadeem Ahmed Shaikh, Syed Tayyab Hasan Naqvi, Rana Shahbaz Ahmad https://creativecommons.org/licenses/by-nc/4.0
How Do Doctoral Scholars In Health Professions Education Construct and Negotiate Their Professional Identity During Their PhD Journey: A Qualitative Study Design
Objective: To explore how doctoral scholars in Health Professions Education construct and navigate their professional identity during the PhD journey, including the challenges and their future aspirations. Methodology: In order to investigate how doctoral researchers in health professions education create and manage their professional identities during their PhD journey, this study used a qualitative research approach. Because professional identity construction is a complex and socially created process that best retains significance through participants' lived experiences and interpretations, a qualitative method was selected. An in-depth analysis of how PhD researchers interpret their evolving roles, values, and professional identities in academic and clinical settings was made possible by this design. The six PhD participants completed a five-point open-ended questionnaire, and themes and subthemes were derived from the written responses. Results: Five analytic themes emerged: (1) Multiple Facets of HPE Professionals (2) Achieving Credibility as HPE Professional (3) Practical Barriers to Progress (4) Shaping the Future of PhD in HPE (5) Expanding Horizons in HPE. Senior leaders highlighted systemic innovations and institutional legacies, while early-career professionals expressed hopes for advancement and recognition. In order to gain a reputation and make a significant contribution to HPE, all participants had similar goals. Their goals go beyond personal achievement; taken as a whole, they want "HPE ecosystem" and a "transformed PhD landscape" that is adaptable, organized, and contextually relevant. In this way, their stories blend individual aspirations with more general reformist goals, presenting the PhD in HPE as a "catalyst for individual growth as well as systemic change" rather than just an academic endeavor. Conclusions: Both macro (financing, organized PhD curriculum, official career pathways, international evaluation) and micro (mentorship, protected research time, faculty development) initiatives are needed to strengthen PhD-HPE in Pakistan.
Copyright (c) 2026 Zeeshan Ahmed Rehman, Afreenish Malik, Ambreen Shabbir, Fouzia Sultana, Gul Shaikh, Shazia Irum, Ayesha Junaid, Junaid Sarfraz Khan https://creativecommons.org/licenses/by-nc/4.0
Time to Calculate the Vasoactive Inotropic Score as a Predictor of Mortality and Morbidity in Cardiac Surgery
Objective: To determine the ideal time for calculating vasoactive inotropic score (VIS) as a reliable predictor of morbidity and mortality in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: The study was a prospective and cross-sectional study that took place in the Department of Anesthesia and cardiac surgery of Choudhary Pervez Ellahi Institute cardiology in Multan on 346 patients undergoing cardiac surgery with cardiopulmonary bypass. The demographic and perioperative information was taken, such as the type of surgery, cardiopulmonary bypass, and cross-clamp time. VIS was also measured at different points of the postoperative period, and the patients were observed on the clinical outcomes such as in-hospital mortality, length of mechanical ventilation, length of stay in the ICU, and renal failure, as well as low cardiac output syndrome. Results: The mean age of patients was 56.91 ± 10.89 years, with 61.8% males. CABG was the most common procedure (57.2%). Mean cardiopulmonary bypass and aortic cross-clamp times were 112.42 ± 27.51 minutes and 73.22 ± 18.98 minutes, respectively. VIS increased over the first 24 hours postoperatively, from 9.75 ± 6.54 at ICU admission to a peak VIS of 22.64 ± 6.30. Mean ICU and hospital stays were 4.12 ± 2.21 days and 10.04 ± 4.38 days, respectively. In-hospital mortality was 9.2%, while the composite outcome of death or major morbidity occurred in 34.1% of patients. X2 Conclusion: The vasoactive inotropic score is a useful forecast of postoperative outcome in cardiac surgery and the 24-hour postoperative VIS showed the greatest predictability of mortality or morbidity. Regular VIS evaluation at this time can enhance risk classification and implement interventions on time.
Copyright (c) 2026 Aamir Furqan, Syed Aushtar Abbas Naqvi, Shumaila Ali, Ahmad Adnan https://creativecommons.org/licenses/by-nc/4.0
Fetomaternal Outcome with Active versus Expectant Management of Pre Labour Rupture of Membranes at Term; A randomized controlled trial.
Objective: To compare fetomaternal outcome with immediate/active versus expectant management in pregnancies complicated with pre labour rupture of membranes at term. Methodology: A randomized prospective controlled trial conducted in Obstertics & Gynaecology department of Benazir Bhutto Hospital, Rawalpindi. All women presenting with PROM at term and fulfilling the inclusion criteria were recruited and randomized equally to Group-A and Group-B for Active versus Expectant management. The latency period for onset of labour, mode of delivery, maternal and fetal complications were compared in two groups. Results: During study period, 190 women were recruited. The mean maternal age was 26.16 years. Out of total, 45% were primigravidas, 40% multigravidas and 15% were grand multiparas. Mode of delivery was comparable in both groups (p-value >0.05). The latency period was significantly prolonged (>24 hours) in 57.9 % of the patients with expectant management (p-value <0.05). The rate of PPH and chorioamnionitis was higher in expectant group while neonatal complications were comparable in both groups. Conclusion: The active management of PROM is the preferred management option due to a shorter latency period, lesser maternal complications, without any significant increase in the rate of operative delivery.
Copyright (c) 2026 Aisha Ishtiaq, Shazia Syed, Hina Gul, Unsa Malik, Sumaira Mubasher, Ismat Batool https://creativecommons.org/licenses/by-nc/4.0
Effect of intravenous analgesia versus intraoperative pectoral block for postoperative pain management in patients undergoing modified radical mastectomy
Objective: To evaluate the efficacy of intravenous analgesia versus intraoperative pectoral nerve block (PECs block) for postoperative pain management in patients having modified radical mastectomy (MRM). Methods: This randomized controlled trial was conducted at Akbar Niazi Teaching Hospital, Islamabad, from July to December 2025 (NCT07257874). PECs block (Group A, n=30) and intravenous analgesia (Group B, n=30) were the two groups into which 60 adult female patients (18–65 years) undergoing elective unilateral MRM were randomly assigned. Ten milliliters of 0.5% bupivacaine split between two fascial planes were used to administer PECs block. The Numeric Pain Rating Scale (NPRS) was used to measure postoperative pain intensity at 0, 6, 12, and 24 hours. Postoperative nausea and vomiting (PONV), time to first rescue analgesia, total opioid consumption within 24 hours, and patient satisfaction were secondary outcomes. Results: At every time point, Group A—NPRS scores were significantly lower than Group B (0 h: 2.1±0.8 vs. 3.4±1.1; 6 h: 2.6±0.9 vs. 4.1±1.2; 12 h: 2.9±0.8 vs. 4.0±1.0; 24 h: 2.4±0.7 vs. 3.5±0.9; p<0.001). Group B consumed more opioids overall (28.7±6.2 mg) than Group A (mean 18.3±4.5 mg; p<0.001). The PECs group experienced a significantly longer time to first rescue analgesia (412±85 minutes vs. 263±74 minutes; p<0.001). PONV incidence was reduced in Group A (10%) versus Group B (33%). No block-related complications were observed. Group A had higher patient satisfaction scores (p<0.01). Conclusion: When compared to intravenous analgesia alone, PECs block improves recovery profiles, reduces the need for opioids, and offers better postoperative analgesia in MRM patients. It ought to be incorporated into standard perioperative pain management techniques.
Copyright (c) 2026 Atiq ur Rehman, Sohaib Haider, Rizwan Aziz, Zarnab Fatima Aftab, Munazzah Aziz, Taimoor Ahmed https://creativecommons.org/licenses/by-nc/4.0
Physical Activity, Body Mass Index and Generalized Anxiety Disorder: Unraveling the Multifaceted relationships among University students
Objective: The objective of this study was to evaluate the association between body mass index, score for generalized anxiety disorder and international physical activity status among university students. Methodology: Cross-sectional design was used to collect data from 385 students in Lahore, Pakistan from May 2025 to Aug 2025. GAD-7, and IPAQ questionnaires were used to assess anxiety and physical activity levels. Participants were recruited through random sampling. Inclusion Criteria was Participants must be between 18 and 24 years old and currently enrolled in a university in Lahore with no diagnosed mental disorders. While Participants with any diagnosed medical or psychiatric conditions were excluded from study. Data was analyzed using IBM SPSS to examine correlations between anxiety, BMI and physical activity. Results: With a near-equal gender distribution, 40.78% were overweight and 6.23% obese. Most had minimal anxiety (68.57%) and low physical activity (98.18%). There was a statistical significant association of generalized anxiety disorder (GAD) status with BMI and gender (p = 0.000), whereas insignificant association with physical activity (p = 0.224). Conclusion: The study emphasizes the importance of targeted interventions to improve mental health and promote physical activity among young adults, considering the observed associations between anxiety, BMI, and eating behaviors. Keywords: BMI, Generalized anxiety disorder (GAD), International Physical Activity Questionnaire, Physical activity
Copyright (c) 2026 Muhammad Hasnat Agha, Saima Bairam , Tabassum Nawaz, Gul Mehar Javaid Bukhari, Nida Badar, Alina shaukat, Abdul Baqi Khan, Mudassar Mushtaq Jawad Abbasi https://creativecommons.org/licenses/by-nc/4.0
Comparison of Intravenous Paracetamol Infusion Versus Intramuscular Tramadol as an Intrapartum Analgesic
Objective: To compare the mean intrapartum pain score between intravenous paracetamol infusion and intramuscular tramadol. Methodology: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Indus Hospital, Muzaffargarh, from August 2023 to February 2024, included women with full-term pregnancy, aged 20–40 years, carrying a single fetus, and having a spontaneous onset of labor in the active phase. Participants were equally divided into two groups: Group A received intravenous paracetamol, while Group B received intramuscular tramadol. Pain scores were recorded before drug administration and at 1 and 3 hours post-administration. The mode of delivery and duration of labor were also documented. Results: The mean age of the participants was 27.7 ± 4.2 years. The mean duration of labor was significantly shorter in the paracetamol group (4.6 ± 0.8 hours) compared to the tramadol group (5.9 ± 0.8 hours) (p = 0.001). Furthermore, the mean pain score at three hours after treatment was significantly lower in the paracetamol group compared to the tramadol group (mean VAS = 6.8 ± 0.8 vs. 7.8 ± 0.7, respectively) (p = 0.001). Conclusion: Intravenous paracetamol was found to be more effective in providing labor analgesia and in reducing the duration of labor compared to intramuscular tramadol. Additionally, it is an easy, affordable, and practical option for use in low-resource settings where access to advanced healthcare facilities is limited.
Copyright (c) 2026 Anam Laraib https://creativecommons.org/licenses/by-nc/4.0
Assessment of Resting Tongue Position in Patients with Partial and Complete Edentulism
Objective: To determine the frequency of different tongue positions in partially dentate and completely edentulous patients. Methodology: A cross-sectional descriptive study was conducted in the Department of Prosthodontics, Institute of Dentistry, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, from August 2023 to January 2024. All partially and completely edentulous patients aged 18–65 years of either gender were included. An intraoral examination was conducted to assess the resting tongue position, with five observations made per participant to ensure accuracy. Tongue position was evaluated based on the visibility of the floor of the mouth, the lateral borders in relation to the mandibular ridge or teeth, and the apex position relative to the anterior ridge. Each tongue position was then classified as normal upper, normal lower, abnormal upper, or abnormal lower. Results: Overall, 91 patients with edentulism were studied, with a mean age of 58.36 ± 7.53 years. Complete edentulism was most prevalent (73.6%). Abnormal upper tongue positioning was the most common finding (62.6%), followed by 28.6% with a normal upper position, 5.5% with a normal lower position, and only 3.3% with an abnormal lower position. Moreover, significant associations were found between tongue position and age of the patients (p = 0.006), gender (p = 0.028), and duration of edentulism (p = 0.001), indicating that prolonged edentulism, female gender, and older age are associated with abnormal tongue position. Conclusion: Irregular tongue positions, particularly the abnormal upper posture, were more prevalent in completely edentulous and older populations with prolonged duration of edentulism. This highlights the importance of assessing tongue posture during prosthodontic treatment planning to improve denture fit and function.
Copyright (c) 2026 Sakina, Aamir Mehmood Butt, Sana Kashif, Almas Rahoojo, Sanam, Hamshad Bano https://creativecommons.org/licenses/by-nc/4.0
Diagnostic Accuracy of Contrast-Enhanced Computed Tomography in Small Renal Cell Carcinoma
Objective: To determine the diagnostic accuracy of contrast-enhanced computed tomography (CECT) in the diagnosis of small renal cell carcinoma (RCC), using histopathology as the reference gold standard. Methodology: This cross-sectional study was conducted in the Department of Radiology, Civil Hospital, Karachi, from September 2020 to March 2021. All clinically suspected patients with small RCC, of either gender, were included. Contrast-enhanced CT of the abdomen was performed using intravenous contrast material. Imaging was acquired in the axial plane with multiplanar reformations in sagittal and coronal planes, with the patient in the supine position. A diagnosis of small RCC was made based on CT findings, and histopathology results were collected. Sensitivity, specificity, and diagnostic accuracy of contrast-enhanced CT of the abdomen were calculated using histopathology as the gold standard. Results: Of the participants, 68.2% were male and 31.8% were female. The mean age was 56.54 ± 9.45 years. The mean duration of symptoms was 7.88 ± 2.31 weeks. The mean renal mass diameter was 2.54 ± 0.92 cm. Overall, 45.5% of patients were diagnosed with RCC on CT scan, while 52.7% were confirmed by histopathology. CECT demonstrated a sensitivity of 82.76%, specificity of 96.15%, positive predictive value (PPV) of 96%, negative predictive value (NPV) of 86.33%, and an overall diagnostic accuracy of 89.09% for diagnosing small RCC. Conclusion: Contrast-enhanced CT offers high sensitivity and specificity for the accurate diagnosis of small renal mass
Copyright (c) 2026 Ravi Kumar, Parkash, Rakesh Kumar, Nazia Azeem https://creativecommons.org/licenses/by-nc/4.0
Frequency of Atrial Fibrillation in Patients of Heart Failure with Reduced Ejection Fraction
Background: A comprehensive review of the literature indicates that there is a dearth of information about AF in heart failure in the local community, with most of the information coming from research conducted internationally, the results of which cannot be generalized due to demographic and clinical variations. Therefore this study was planned to determine the frequency of atrial fibrillation in patients of heart failure with reduced ejection fraction(HFrEF). Methodology: This cross sectional study was carried out at the department of cardiology, PIMS hospital, Islamabad from 19 Sep 2025 till 19 March 2026 . A total of 258 male and female patients in the age range 20 to 80 years diagnosed with heart failure with ejection fraction less than 40.0% were enrolled. The patients were evaluated for the presence of atrial fibrillation through clinical examination and ECG findings. Data analysis was carried out using SPSS v. 26. Results: The mean age of the participants was 48.85±12.16 years. Participants aging more than 50 years were 122 (47.3%) while 214 patients (82.9%) were male. Diabetes mellitus was present in 46 patients (17.8%) while NYHA class IV was recorded in 202 patients (78.3%). Atrial fibrillation was recorded in 29 patients (11.2%). No statistically significant association was recorded between atrial fibrillation and baseline clinico-demographic parameters (p value >0.05). Conclusion: The frequency of atrial fibrillation in this cohort of HFrEF patients was lower than that reported in global studies, probably due to younger age distribution of the study population. These results highlight the variability in the association between atrial fibrillation and HFrEF and emphasize the importance of regional data for accurate assessment and treatment strategies. Key words: Atrial Fibrillation, Heart Failure, Reduced Ejection Fraction
Copyright (c) 2026 Shayan Khan, Fazlul Aziz Mian, Shahab Saidullah, Ayesha Tariq https://creativecommons.org/licenses/by-nc/4.0
Patterns of Liver Function Test Derangement in Dengue Fever and Dengue Hemorrhagic Fever Among Patients Admitted at Jinnah Hospital, Lahore
Objective: To identify and contrast the patterns of liver function test abnormalities in patients admitted to a tertiary care hospital with dengue fever (DF) and dengue hemorrhagic fever (DHF), a cross-sectional research was carried out. Methodology: This observational cross-section study was conducted at Jinnah Hospital, Lahore, from March to August 2025. The study included 100 individuals with confirmed dengue infection (NS1 antigen or IgM positive). Both clinical characteristics and laboratory results were documented, such as total bilirubin levels, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Data were analyzed using SPSS version 27. The association between liver function abnormalities and dengue fever and dengue hemorrhagic fever was assessed using chi-square tests. Results: Elevated ALT levels were observed in 28% of patients with dengue fever (DF), 11% of patients with DF with hemorrhage, and 61% of patients with dengue hemorrhagic fever (DHF). A significant correlation was found between disease severity and elevated AST levels, which were observed in 26%, 11%, and 63% of patients, respectively. Elevated total bilirubin levels were noted in 8% of DF patients, 17% of DF with hemorrhage patients, and 75% of DHF patients. Painful hepatomegaly was present in 22% of patients, while 32% experienced active vomiting. A statistically significant association was observed between disease severity and elevated ALT, AST, and bilirubin levels (p = 0.001). Conclusion: Dengue infection frequently results in impaired liver function, especially in DHF. AST elevation may be a helpful indicator of hepatic involvement and was substantially correlated with the severity of the illness. The majority of abnormalities were minor and reversible, highlighting the significance of regular monitoring of liver function in dengue patients.
Copyright (c) 2026 Aysha Ghayyur, Shazia Siddique, Amina Umer, Saima Nouman Khan, Sher Afgan, Saman Shahid https://creativecommons.org/licenses/by-nc/4.0
Assessing the Efficacy of Local Flap Reconstruction for Scalp Defects: A Review of Techniques and Outcomes
Background: Scalp reconstruction presents unique challenges due to limited tissue elasticity, aesthetic importance, and the need to protect underlying structures. Among various reconstructive options, local flaps remain a cornerstone technique, offering vascular reliability and tissue compatibility. This study aimed to assess the efficacy and outcomes of local flap reconstruction for scalp defects compared with other reconstructive methods. Methods: A prospective observational comparative study was conducted on 100 patients presenting with scalp defects of varying etiology, including post-traumatic, post-oncologic, and infective causes. Participants were treated using either local flaps or other reconstructive techniques. Data were analyzed using SPSS version 26, with normality assessed by the Shapiro–Wilk test. The Mann–Whitney U test and Chi-square test were applied for group comparisons, while Spearman’s correlation evaluated associations between defect size and postoperative outcomes. Results: Local flaps were used in 45 (45%) cases, regional flaps in 24 (24%), and free flaps in 31 (31%) cases. The overall flap viability was 80 (80%), with 4 (4%) cases of complete failure. Postoperative complications included infection in 23 (23%) patients, wound dehiscence in 16 (16%), and hematoma in 4 (4%) . Conclusion: Local flap reconstruction remains a safe, efficient, and aesthetically favorable technique for scalp defect repair, providing outcomes comparable to more complex methods while minimizing operative time and morbidity. Keywords: Scalp reconstruction, local flap, aesthetic outcome, wound healing, reconstructive surgery
Copyright (c) 2026 Rida Siddiqui, Abdul Khaliq, Hajirah Khalid, Tayyaba Sohail, Zarish Daniel, Irfan Ali https://creativecommons.org/licenses/by-nc/4.0
Association of Normal Values of Nasolabial Angle and Lip Length with Incisal Display at Rest Position of Lips
Objective: To determine correlation between values of nasolabial angle and lip length with incisal display at rest position of lips. Methods: This descriptive cross-sectional study was conducted at Institute of Dentistry LUMHS. Individuals aged between 18 to 40 years visiting for prosthesis of posterior teeth, both genders, with fully erupted anterior maxillary teeth and well aligned teeth and with intact upper central incisors, with no significant wear, fractures, or discoloration were included. A photogrammetric approach was employed to analyze the nasolabial angle, and two photographs with frontal and lateral views were taken for each participant, with the camera placed 1.5 meters away at the participant&#39;s head height to ensure standardization, which were digitally analyzed, with the nasolabial angle measured in degrees and the lip length and incisal display measured in millimeters. Vernier caliper was used for measurement of the lip length from the base of the nose to the lowest point of the upper lip, and these measurements were cross-referenced with digital measurements to ensure accuracy. A correlation analysis was assessing the relationship of nasolabial angle and lip length, with incisal display.
Copyright (c) 2026 Hira Huma https://creativecommons.org/licenses/by-nc/4.0
Comparison of Intraoperative Bleeding During Excision of Benign Soft Tissue Oral Lesions Using Scalpel and Diode Laser.
Abstract Objective: The objective of this study was to compare the grade of intraoperative bleeding during excision of benign soft tissue oral lesions using scalpel and diode lasers according to Boezart et al bleeding scale. Methodology: A single blinded randomized comparative trial was conducted over a span of one year at department of Oral and Maxillofacial Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS Islamabad. A total of 128 patients with benign oral soft tissue lesions were selected and randomly divided into two groups Group A Scalpel and Group B Diode laser. Relevant history and clinical examination were carried out and recorded. Excision was carried out under Local anesthesia using diode laser and scalpel. The intraoperative bleeding grades were recorded in accordance with the criteria defined by Boezaart et al attached as Annexure A. Results: Conclusion: It was concluded that diode laser effectively reduces intraoperative bleeding during excision of benign oral soft tissue lesions. Key words: Diode Lasers, Hemorrhage, Bleeding, Surgery, Oral
Copyright (c) 2026 Dr. Waqas Javied Malik, Dr. Qurat Ul Ain Zafar, Dr. Varqa Faraid https://creativecommons.org/licenses/by-nc/4.0
Prevalence of Dental Anxiety Among Edentulous Patients Receiving Complete Denture Prosthesis
Objective: To determine the dental anxiety in edentulous patients receiving complete dental prosthesis using questionnaire. Materials and Methods: This prospective cross-sectional study was done at department of Prosthodontics, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro. Patients with edentulous and aged between 30 years to 70 years of either gender were included. The dental anxiety, denture-related fears, impression-related discomfort, and treatment barriers were assessing. Anxiety was quantified on a 0–10 visual analogue scale. House classification was assessed clinically by the operating dentist. Edentulous duration, demographic data, and prior denture experience were also recorded. Data were analyzed using SPSS v.25. Results: There were 49 females and 38 males, with mean edentulous duration of 6.8 ± 4.3 years. Dental anxiety prevalence was 64.4% (n=56), with a mean anxiety score of 5.9 ± 2.3. Females reported significantly higher anxiety scores (6.4 ± 2.1) compared to males (5.2 ± 2.4; p=0.012). Anxiety scores showed a significant positive correlation with edentulous duration (r=0.41, p&lt;0.001). Among anxiety triggers, fear of loose denture was most prevalent (38.0%), followed by swallowing impression material (31.0%), fullness of mouth (24.0%), and breathlessness (18.4%). Sight of instruments caused discomfort in 34.5% of patients. Cost was the primary barrier to treatment (42.5%). However, 78.2% of patients reported greater comfort when treatment procedure was explained beforehand (p=0.004), and prior denture experience was associated with lower anxiety scores (4.9 ± 2.1 vs. 6.8 ± 2.3; p=0.003). Conclusion: Dental anxiety was highly prevalent among edentulous patients undergoing complete denture treatment, particularly among females, first-time denture wearers, and patients classified as hysterical under the House classification. Fear of loose dentures, impression- related discomfort, and financial barriers were the most commonly identified concerns. Keywords: Dental anxiety, edentulous, complete denture prosthesis, treatment, dental fear, prevalence, Comfort,
Copyright (c) 2026 Asma Yasmeen https://creativecommons.org/licenses/by-nc/4.0
Prevalence, Diagnosis, and Management of Adnexal Mass in Reproductive Age Group
Objective: To determine the prevalence of adnexal mass and its management outcomes in patients of reproductive age group. Methodology: This cross-sectional descriptive study was conducted on 102 women of reproductive age (15–49 years) presenting with adnexal mass to the gynecological outpatient and inpatient departments. Detailed history including age, parity, menstrual history, presenting complaints, and duration of symptoms was recorded. Diagnosis was established through transvaginal or transabdominal ultrasound, tumor markers (CA-125, AFP, LDH, Beta-hCG), and histopathological examination where applicable. Management modalities including conservative, medical, and surgical interventions were documented. Statistical analysis was performed using SPSS version 26. Results: Mean patient age was 31.6 ± 8.4 years, with peak prevalence in the 26–35-year group (38.2%). Ovarian cysts were most common (52.9%), followed by endometriomas (17.6%), tubo- ovarian abscess (12.7%), ectopic pregnancy (9.8%), and malignancy (6.9%). Pelvic pain (68.6%) was the leading complaint. CA-125 was elevated in 38.2%, strongly correlating with malignancy (p&lt;0.001). Surgical intervention was required in 50% of cases, predominantly laparoscopic cystectomy. Mass size &gt;8 cm (OR=4.2; p&lt;0.001) and elevated CA-125 (OR=3.6; p=0.002) were independent malignancy indicator. Conclusion: Ovarian cysts constitute the most prevalent adnexal pathology in reproductive-age women. Ultrasound with CA-125 provides reliable diagnostic accuracy, while laparoscopic cystectomy remains the predominant surgical approach. Early diagnosis and timely referral are critical for favorable outcomes, particularly in differentiating benign from malignant masses. Keywords: Adnexal mass, ovarian cyst, reproductive age, CA-125, ultrasonography, laparoscopy, malignancy
Copyright (c) 2026 Bakhtawar https://creativecommons.org/licenses/by-nc/4.0
Interparietal Hernia Presenting as Acute Intestinal Obstruction: A Case Report
Interparietal hernias are a few and infrequent type of abdominal wall hernias where the herniated viscera is located between the musculoaponeurotic layers of the anterior abdominal wall. The hidden anatomic location commonly causes time loss in diagnosis, and the presentation also is commonly complicated by the scenario of intestinal obstruction. The present report discusses a 67-year-old woman who came to the clinic with acute pain and distension in the abdomen, vomiting, and no bowel movements. Contrast enhanced computed tomography showed loops of the small bowel hernias through an inferior midline abdominal wall defect above the pubic symphysis. Emergency exploratory laparotomy was made to establish an interparietal hernia which was located below the arcuate line, and the distal jejunal and ileal loops were incarcerated. It was a viable bowel that was successfully reduced and a mesh repair of the bowel was done to seal the defect. The follow-up postoperative period was complication-free and the patient did not suffer any symptoms. This case emphasizes the significance of the consideration of interparietal hernia in patients with unexplained intestinal obstruction and a history of abdominal surgery, and the significance of computed tomography in the diagnosis of the condition preoperative diagnosis. Diagnosis and treatment are easy on realization.
Copyright (c) 2026 Seemab, Arsalan, Qurat Ul Ain, Tahira Malik, Tanwir Khaliq https://creativecommons.org/licenses/by-nc/4.0