Biological and Clinical Sciences Research Journal

Assessment of Emotional Distress Among Hepatitis C Patients Undergoing Antiviral Therapy

Samerna Aftab Gill — 2025-06-30

Hepatitis C virus (HCV) infection is a major global health concern with significant physical and psychological implications. In Pakistan, where HCV prevalence is among the highest in the world, limited attention is paid to the emotional distress and self-efficacy of patients undergoing antiviral therapy. Psychological distress may hinder treatment adherence and adversely impact health outcomes. Objective: To assess the prevalence of emotional distress and levels of self-efficacy among patients with Hepatitis C undergoing antiviral therapy at a tertiary care hospital in Pakistan. Methods: This descriptive cross-sectional study was conducted over three months (January–March 2024) at a Tertiary care hospital in Lahore. A total of 117 adult patients diagnosed with Hepatitis C and receiving antiviral treatment were recruited using convenience sampling. Data were collected through a structured, pre-validated, Urdu-translated questionnaire that consisted of demographic variables, emotional distress (adapted from the Hospital Anxiety and Depression Scale, HADS), and self-efficacy items (based on the General Self-Efficacy Scale, GSES). Descriptive statistics and inferential tests (Chi-square, t-test, Mann–Whitney U) were performed using SPSS version 26. A p-value of <0.05 was considered statistically significant. Results: Of the 117 patients, 51.3% were female, and the majority (43.6%) were aged between 31 and 35 years. A high prevalence of emotional distress was observed, with 47.0% of participants reporting frequent anxiety and 41.9% experiencing persistent worrying thoughts. Fear and loss of enjoyment were also commonly reported. Self-efficacy was notably low; 46.2% of patients were not at all confident in discussing their illness with a physician, and only 3.4% consistently managed physical discomfort effectively. Emotional distress was more prevalent in female participants, whereas younger patients demonstrated relatively higher self-efficacy. Conclusion: Hepatitis C patients in Pakistan exhibit considerable emotional distress and poor self-efficacy during antiviral therapy. These findings underscore the pressing need for integrated psychosocial interventions, enhanced patient-provider communication, and culturally tailored education programs to promote psychological resilience and treatment adherence.

Postpartum Depression in Mothers of Infants with Very Low Birth Weight

Misbah Khan — 2025-06-30

Postpartum depression (PPD) remains a significant public health concern, particularly among mothers of infants with very low birth weight (VLBW). Despite advancements in neonatal intensive care improving survival outcomes, maternal psychological health is often overlooked. The present study explores the association between infant birth weight and maternal depression severity. Methods: A cross-sectional analytical study was conducted at Ward 8 of Jinnah Postgraduate Medical Centre, Karachi, from January 2024 to January 2025. A total of 110 postpartum mothers were recruited using non-probability sampling. The participants were categorized into two groups: mothers of infants with birth weights <2500g and ≥2500g. Data were collected using a structured questionnaire comprising demographic details and the Edinburgh Postnatal Depression Scale (EPDS). Statistical analyses included Pearson correlation, chi-square test, and multinomial logistic regression using SPSS version 17.0. Results: The mean EPDS scores were significantly higher among mothers of infants with birth weight <2500g (16.29±3.14) compared to those with normal birth weight (13.38±2.78) (p<0.001). Regression analysis indicated a strong association between low birth weight and elevated PPD risk, even after controlling for confounders such as maternal age, education, parity, and family support. Additionally, unplanned pregnancies, cesarean deliveries, and longer neonatal intensive care unit (NICU) stays were linked to higher depression scores. Conclusion: Very low birth weight is a significant predictor of postpartum depression. Early identification of high-risk mothers, especially those with limited family support and VLBW infants, is crucial. Routine psychological screening and integrated postpartum care are recommended to mitigate adverse maternal and infant outcomes.

Clinical Presentation and Fetomaternal Consequences of Placental Abruption: A Multi-Center Study

Noor ul Ayin — 2025-06-30

Placental abruption is a major obstetric morbidity described by early detachment of the placenta from the uterine wall. It is dangerous to the mother and fetus in cases of haemorrhage, fetal insufficiency, and perinatal mortality. The crucial issue in upgrading clinical management and minimizing adverse outcomes related to this condition is understanding the fetomaternal outcomes related to the condition. Objective: To evaluate the fetomaternal outcome of patients admitted with a placental abruption in a multi-centre environment. Methods: This was a cross-sectional study; the study was performed at Central Park Teaching Hospital, Lahore, from December 2022 to June 2023. Two hundred patients with ill conditions of placental abruption, and no earlier history of placental pathology development, were accepted. Departmental ultrasonographic scans and structured questionnaires were used in the collection of data. Maternal age, gestational age, kinds of abruption, heart rate of the baby, maternal complications, type of delivery, and neonatal outcome were reviewed utilising the SPSS program, version 25. Assessment of statistical significance was done using chi-square and independent t-tests. Results: The average age of the mothers was 29.4 +/- 5.7 years, and the average gestational age at which the mothers went to hospital was 34.2 +/- 3.1 weeks. Syndesmotic OGD presenting symptom was the most widespread, vaginal bleeding (78%), followed by abdominal pains (64%). Bad maternal conditions involved postpartum hemorrhage (32), hypovolemic shock (18), and emergency cesarean section (41). Fetal outcomes were intrauterine fetal death (22%), low birth weight (38%), and NICU hospitalisations (45%). A statistically strong linkage was identified amid heavy abruption and poor neonatal outcomes (p < 0.01). Conclusion: There is a high fetomaternal morbidity associated with pregnancy abruption. Fast identification of obstetric emergencies and urgent obstetric treatment are important to enhance maternal and fetal survival. The burden of this obstetric emergency can be decreased by means of multi-center surveillance and prescribed management protocols.

Compliance of Anesthesia Personnel Towards Regional Anesthesia Checklist

Aneeqa Zia — 2025-06-30

Ensuring adherence to institutional protocols is crucial for minimising complications and enhancing patient safety during regional anaesthesia. Standardised checklists are endorsed globally to improve procedural compliance and promote uniformity in anaesthesia practice. Objective: To assess the compliance of anaesthetists with institutional standard practice protocols for regional anaesthesia at a tertiary care hospital. Methods: A cross-sectional study was conducted in the Anaesthesia Department of National Hospital and Medical Centre, Lahore, from August 2024 to February 2025. A total of 83 anaesthetists were enrolled, including both consultants and postgraduate residents. A standardized pre-procedure checklist comprising 9 items was used to evaluate compliance, based on guidelines provided by the American Society of Regional Anesthesia (ASRA) and the WHO pre-block checklist. Data were analysed using SPSS version 25. Descriptive statistics were computed, and the chi-square test was applied to determine associations between compliance and variables such as designation and type of surgical procedure. A p-value <0.05 was considered statistically significant. Results: Overall compliance with regional anaesthesia protocols was 86%. The highest compliance rates were observed for equipment readiness (97.59%), drug labelling (95.18%), and obtaining surgical consent (93.98%). Compliance during the "time-out" phase was slightly lower at 92.77%. Consultants demonstrated a marginally higher compliance rate (88.5%) compared to postgraduate residents (84.2%). No statistically significant differences in compliance were observed based on anaesthetist designation or type of surgical procedure (p>0.05). Conclusion: High compliance with regional anaesthesia protocols was observed, particularly in equipment preparation, drug labelling, and consent verification. While consultants showed marginally better adherence than residents, overall compliance remained commendable across all practitioner levels. Continued emphasis on checklist implementation and periodic audits can further reinforce adherence to protocol.

Comparison Between Two Different Doses of Oral Pregabalin Given Pre-Emptively on Duration of Spinal Anesthesia and Postoperative Pain in Lower Limb Surgeries

Abubakar Obaid — 2025-06-30

Optimal management of postoperative pain following lower limb surgeries remains a clinical challenge in resource-limited settings. Pregabalin, a gabapentinoid, has emerged as an effective adjunct for enhancing spinal anesthesia and reducing opioid requirements. This study aimed to compare the effects of 75 mg versus 150 mg of oral pregabalin administered preemptively on the duration of spinal anesthesia and postoperative pain control. Methods: This prospective comparative study was conducted at Aziz Bhatti Shaheed Hospital, Gujrat, from November 2022 to September 2023. Ninety adult patients scheduled for elective lower limb surgery under spinal anesthesia were randomized into two groups: Group A received 75 mg and Group B received 150 mg of oral pregabalin one hour before surgery. Duration of sensory and motor block, postoperative Visual Analogue Scale (VAS) pain scores, time to first rescue analgesia, and total 24-hour tramadol consumption were recorded. Results: The 150 mg pregabalin group demonstrated a significantly longer duration of sensory block (196.2 ± 19.4 min vs. 172.5 ± 15.8 min; p<0.001) and motor block (187.6 ± 18.9 min vs. 162.4 ± 14.7 min; p<0.001) than the 75 mg group. Postoperative VAS scores were consistently lower at all intervals in the 150 mg group (p<0.05). Time to first rescue analgesia was significantly delayed (224.8 ± 30.2 min vs. 174.3 ± 25.6 min; p<0.001), and total 24-hour tramadol requirement was significantly reduced (84.5 ± 13.7 mg vs. 107.8 ± 15.3 mg; p<0.001) in the higher dose group. Conclusion: Preemptive administration of 150 mg oral pregabalin significantly prolongs spinal block duration, reduces postoperative pain scores, and minimizes opioid consumption compared to 75 mg. It presents a viable strategy for enhanced perioperative analgesia in lower limb surgeries within the Pakistani population.

Effectiveness of Polyethylene Glycol vs Lactulose in the Management of Functional Constipation in Children

Faiza Qayyum — 2025-06-30

Functional constipation is a prevalent gastrointestinal disorder in children, often leading to discomfort and reduced quality of life. Effective management is essential for timely symptom resolution and improved patient outcomes. Among the various therapeutic agents, polyethylene glycol (PEG) and lactulose are commonly used, yet comparative data on their efficacy remain limited in pediatric populations. Objectives: To compare the effectiveness of polyethylene glycol versus lactulose in the management of functional constipation in children. Methods: This quasi-experimental study was conducted at Pediatrics department of Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2025 to May 2025. A total of 118 children with functional constipation were included, who were divided into Group-P (polyethylene glycol) and Group-L (lactulose), each containing 59 children. Diagnosis of the functional constipation in children was based on the well-validated tool named the Rome IV criteria along with the decreased number of stools (two or fewer) in a week being set as the essential criteria for making a diagnosis. Baseline characteristic including age, gender, duration of constipation, and number of stools passed each week were documented and compared between groups. Therapy was continued for a period of twelve weeks and the final assessment for the effectiveness was made after twelve weeks of therapy. The effectiveness of both these drugs was assessed based on the achievement of therapeutic success at 12-weeks and the comparison was performed between groups using the Chi-square test. Analysis of data was performed through the Statistical Package for Social Sciences (SPSS) software version 22. Results: Median age was 7.00 (5.00) years. There were 75 (63.60%) male and 43 (36.40%) female patients. Median weight was 22.00 (10.00) kg. Median duration of constipation was 2.00 (1.00) weeks. Median number of stools per week was 1.00 (1.00). Frequency of achievement of therapeutic success in Group-P (n = 59) at twelve weeks follow up was 54 (91.53%) while in Group-L (n = 59), it was 31 (52.54%), (p < 0.001). Conclusion: Polyethylene glycol is a better therapeutic option for the management of functional constipation in children as compared to lactulose.

Frequency of Errors in Inhaler Technique among Patients Using Metered-Dose Inhalers (MDIs) in a Tertiary Care Hospital

Aziz Ur Rehman — 2025-06-30

Proper use of metered-dose inhalers (MDIs) is essential for optimal drug delivery and management of respiratory conditions such as asthma and COPD. However, incorrect inhaler technique remains a common issue, particularly among patients who do not use spacer devices. Identifying and addressing these errors is crucial to ensure therapeutic efficacy. Objective: This study aims to assess the frequency of errors in inhaler technique among patients using metered-dose inhalers (MDIs) without spacer devices in a tertiary care hospital. Methods: This cross-sectional study was conducted at the Department of Pulmonology, Sheikh Zayed Hospital, Rahim Yar Khan, from November 30, 2020, to May 29, 2021. A total of 96 patients aged 15 to 65 years who used MDIs without spacers for more than three months were included. Patients with physical limitations, newly diagnosed cases, and those using spacers were excluded. Inhaler technique was assessed using a standardised checklist based on handling and inhalational errors, including steps such as shaking the inhaler, maintaining an upright posture, and proper breathing coordination. Results: The mean age of participants was 40.13 ± 7.77 years, with 59.4% males and 40.6% females. Errors in inhaler technique were observed in 39 (40.6%) patients. Handling errors were more common (22.9%) than inhalational errors (17.7%). Common errors included failure to exhale fully before inhalation (6.3%) and not holding breath for at least 10 seconds after inhalation (6.3%). Conclusion: The frequency of errors in inhaler technique among MDI users is high, emphasising the need for patient education and structured training programs to improve inhaler use and disease management outcomes.

Early Metoprolol Administration before Primary Percutaneous Coronary Intervention (PCI) in ST-Segment Elevation Myocardial Infarction: Impact on Left Ventricular Ejection Fraction

Muhammad Amin — 2025-06-30

Ischemic heart disease is the main cause of death globally, with STEMI being its most severe sign. Beta-blocker lower systemic blood pressure, heart rate, decreases ischemia damage when given before PPCI, particularly when metoprolol is used. Objective: the aim of this study was to find out the effect of early metoprolol administration before Primary Percutaneous Coronary Intervention (PCI) in STEMI. Methods: The current Randomized Controlled Trial was carried out at the Department of Cardiology, Lady Reading Hospital, Peshawar from 1st February 2025 to 31st April after taking permission from the ethical committee of the institute. A total of 60 participants were included and divided in to two groups and each group had 30 individuals. All collected data was entered into a computerized database, and SPSS version 25.0 was used for data analysis. To compare the effectiveness of early metoprolol administration before PCI in ST-segment elevation myocardial infarction on LVEF, an independent sample t-test was used to compare the mean LVEF values between the treatment group and the control group. A p-value of <0.05 were considered statistically significant. Results: Over all 60 individuals participated in the current study. The LVEF of metoprolol group was substantially higher than the control group at one week, three months, and 6 months following PCI (P <0.05). Before starting therapy, the two groups' LVEFs did not differ significantly (P >0.05). The intravenous metoprolol group's LVEF was considerably greater than the control group's at one week, three months, and six months following PCI. The Intravenous Metoprolol group's 6 months overall incidence of MACE was noticeably lower than the control groups. Conclusion: The current study concluded that in individuals with ST-Segment Elevation Myocardial Infarction early metoprolol administration before Primary Percutaneous Coronary Intervention (PCI) in ST-Segment Elevation Myocardial Infarction increase left ventricular ejection, can improve heart rate regulation, lessen myocardial damage, and enhance cardiac function and lower the risk of serious adverse cardiac events.

Comparison of the Outcomes of Open Haemorrhoidectomy Versus Procedure for Prolapse and Haemorrhoids (PPH) in the Treatment of Grades III and IV Haemorrhoids

Hafiz Muhammad Zafarullah — 2025-06-30

Haemorrhoidal disease is common in Pakistan, with grades III and IV often requiring surgical intervention. While open haemorrhoidectomy has long been the standard, PPH is gaining popularity due to its minimally invasive nature. This study compares outcomes between these two surgical techniques. Objective: To compare operative time, intraoperative blood loss, postoperative pain, and healing time between open haemorrhoidectomy and PPH in patients with grade III and IV haemorrhoids. Methods: A randomized controlled trial was conducted at the Department of Surgery, Bahawal Victoria Hospital, Bahawalpur, from 16 January 2025 to 16 April 2025. Sixty patients with grade III or IV haemorrhoids were randomly assigned to undergo either PPH (Group A, n=30) or open haemorrhoidectomy (Group B, n=30). Outcomes were assessed using intraoperative and postoperative measures, including operative time, blood loss, pain (VAS), and wound healing. Data were analyzed using SPSS v25, with p ≤ 0.05 considered significant. Results: The mean operative time was significantly lower in the PPH group (15.1 ± 4.2 min) than in the open group (28.4 ± 5.9 min; p<0.001). Blood loss was also lower in the PPH group (76.3 ± 20.8 ml vs. 97.6 ± 31.1 ml; p<0.001). Postoperative pain scores were reduced (VAS: 2.9 ± 1.1 vs. 6.3 ± 1.4; p<0.001), and healing was faster (8.1 ± 2.4 vs. 14.8 ± 4.7 days; p<0.001). Stratified analysis showed these benefits were consistent across gender, BMI, and comorbidities. Conclusion: PPH provides superior outcomes compared to open haemorrhoidectomy in terms of operative efficiency and postoperative recovery. It is a safe and effective alternative for the surgical management of advanced haemorrhoids in the Pakistani population.

Frequency of Malignancy in Clinically Benign Breast Lump

Shaista Sindhu — 2025-06-30

Breast lumps are among the most common presentations in surgical clinics, and while many are benign, a significant proportion may harbor malignancy. Clinical assessment alone may not reliably differentiate benign from malignant lesions, necessitating histopathological confirmation to guide appropriate management. Objective: To determine the frequency of malignancy in clinically benign breast lumps. Study design: Cross-sectional study. Place and duration: Department of General Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, for 6 months, i.e., from September 2024 to February 2025. Methods: A total of 143 patients who fulfilled the selection criteria were included. At baseline, the demographic profile, clinical history, and physical examination of all patients were carried out, and findings were not noted down on a predesigned proforma by the researcher herself. Risk factors for malignancy were assessed in all patients. All patients were then subjected to core needle biopsy of the breast lump. Specimens were sent for histopathological evaluation, and findings were noted down and subjected to statistical analysis. Results: The median (IQR) age of the patients was 52 (16) years. The median (IQR) BMI was 25.4 (4.8) kg/m2. The median (IQR) duration of BBL was 4 (2) months. Among patients with BLL, malignancy was reportedly present in 28 (19.6%) patients. Conclusion: In patients with benign breast lesions, malignancy was reported in 28 (19.6%) patients.

Comparison of Outcomes Following Severe TBI Between Pediatric and Adult Patients With Similar GCS and Pupil Parameters

Ramsha Nasir Obaid — 2025-06-30

Severe traumatic brain injury (TBI) remains a leading cause of mortality and long-term disability across all age groups. Pediatric patients are often thought to have superior neuroplasticity, potentially yielding better outcomes compared to adults. However, limited data exist directly comparing age-stratified outcomes when initial injury severity is matched. Objective: To evaluate and compare outcomes following severe TBI between pediatric and adult patients with similar initial neurological severity, as defined by Glasgow Coma Scale (GCS) scores and pupil reactivity. Methods: This cross-sectional study was conducted at the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from February 2025 to May 2025 after receiving ethical approval from the institutional review board. A total of 300 patients aged 0 to 55 years with severe TBI (GCS score 3–8 and Abbreviated Injury Scale [AIS] head score >3) were enrolled using consecutive non-probability sampling. Participants were stratified into pediatric (0–17 years) and adult (18–55 years) groups. Outcome categories included good recovery, moderate disability, severe disability, vegetative state, and death. Comparative analysis was performed using the chi-square test, with p<0.05 considered statistically significant. Results: Outcome distributions did not significantly differ between groups (p = 0.527). Among adults, 20% had good recovery, 23% moderate disability, 18% severe disability, 17% were vegetative, and 23% died. In the pediatric group, 24% achieved good recovery, 13% had moderate disability, 24% severe disability, 22% were vegetative, and 17% died. Imaging and recovery pattern variations were observed but did not affect overall outcome parity. Conclusion: When initial injury severity is controlled, pediatric and adult patients with severe TBI exhibit comparable short-term outcomes. These findings emphasize the need for standardized, age-inclusive neurocritical care protocols and challenge assumptions of age-dependent prognostication.

Frequency of Extra-Intestinal Manifestations of Ulcerative Colitis in Patients Presenting in A Tertiary Care Hospital

Maria Hussain — 2025-06-30

Ulcerative Colitis (UC) is a chronic inflammatory bowel disease primarily affecting the colon and rectum. However, a significant proportion of patients also experience extra-intestinal manifestations (EIMs), which may involve the musculoskeletal, dermatological, ocular, and hepatobiliary systems. These manifestations can complicate the clinical course and significantly impact the patient's quality of life. Objective: To determine the frequency and distribution of extra-intestinal manifestations in patients with UC presenting at a tertiary care hospital and assess associations with demographic and clinical factors. Methods: This cross-sectional study was conducted over three months from January to March 2025, at the Department of Medicine, Shalamar Hospital, Lahore. A total of 125 patients with a confirmed diagnosis of UC were enrolled using non-probability consecutive sampling. Data were collected through a structured proforma, with confirmation of EIMs by relevant specialists. Statistical analysis was performed using SPSS version 23. Chi-square and t-tests were applied to assess associations, with a p-value < 0.05 considered significant. Results: Out of 125 patients, 47 (37.6%) exhibited extra-intestinal manifestations. Musculoskeletal involvement was the most common (25.6%), followed by dermatological (12.0%), hepatobiliary (11.2%), and ocular (10.4%) manifestations. A statistically significant association was observed between longer disease duration and the presence of EIMs (mean duration: 8.2 ± 2.4 years vs. 5.6 ± 2.1 years, p = 0.0004). No significant gender difference was found, although musculoskeletal symptoms were more common in males and dermatological conditions were more frequent in females. Conclusion: EIMs are a common and clinically significant aspect of UC, affecting over one-third of patients in this study. The findings highlight the importance of early recognition and multidisciplinary management of EIMs, particularly in patients with longer disease duration. Routine screening and inter-specialty coordination can facilitate timely diagnosis and enhance patient outcomes. Further multicenter longitudinal studies are warranted to explore the long-term impact and progression of EIMs in diverse populations.

Comparison of Clinical Outcomes of Short-Course vs Long-Course Antibiotic Treatment in Children With Pyelonephritis

Warda Zahid — 2025-06-30

To evaluate the comparative effectiveness of short-course vs long-course antibiotic treatment for clinical outcomes of children with pyelonephritis. Methodology: A retrospective observational study was conducted in the Pediatrics Department of PIMS Hospital, Islamabad, between May 2024 and May 2025. A total of 200 children aged from 6 months to 18 years presenting in the outpatient department with urine culture showing the presence of Escherichia coli, Klebsiella species, or Proteus mirabilis were selected for the study. Children were divided into two treatment groups by physicians; Group A included 100 patients who were administered the short-course antibiotic treatment for 6-9 days, and Group B included 100 patients treated for 10 or more days. The primary endpoint was treatment failure, shown by the occurrence of one or more composite outcomes in 1 month following treatment. Results: The odds ratio of achieving the composite outcomes at follow-up between both groups was 1.19 (95% CI: 0.81-2.02). There was no significant difference between outcomes concerning age between both groups however between the age groups, children aged 4-13 years had a significantly higher frequency of treatment failure (14.7%) as compared to other age groups (9 vs 8.2%) irrespective of treatment (OR: 1.68, 95% CI: 1.12-2.81, p<0.01). 40% patients in Group A and 65% in Group B had a recurrence with an increasingly resistant organism at follow-up (OR: 0.40, 95% CI: 0.11-1.48). Conclusion: The effect of short-course and long-course antibiotic treatment is similar in children with pyelonephritis. However, short-course therapy is superior for reducing the risks of drug-resistant infection recurrence.

Frequency of Urethrocutaneous Fistula After Use of Autologous Platelet-Rich Plasma

Waqar Hameed Ghazi — 2025-06-30

Hypospadias is one of the most prevalent congenital anomalies of the male genitalia, and urethrocutaneous fistula (UCF) represents the most common postoperative complication following surgical correction. Platelet-rich fibrin (PRF), an autologous biomaterial rich in growth factors, has recently gained attention as a potential biological barrier to promote tissue regeneration and minimize surgical complications. Objective: To determine the frequency of urethrocutaneous fistula following hypospadias repair using autologous platelet-rich fibrin membrane. Methods: This descriptive case series was conducted at the Department of Pediatric Surgery, Services Hospital, Lahore, from 20th June 2019 to 19th December 2019. A total of 139 male patients aged 1 to 12 years undergoing primary hypospadias repair were included through non-probability consecutive sampling. Patients with prior hypospadias surgeries or other genitourinary anomalies were excluded. Intraoperatively, autologous PRF membranes were prepared from each patient’s venous blood and applied as an intermediate layer over the neourethra following urethroplasty. Patients were followed for three months to assess the development of urethrocutaneous fistula. Data were analyzed using SPSS version 20.0. Post-stratification chi-square test was applied to evaluate associations, with a p-value ≤ 0.05 considered statistically significant. Results: The mean age of patients was 6.59 ± 2.15 years. Distal penile hypospadias was the predominant type (66.91%), and tubularized incised plate (TIP) urethroplasty was the most frequently performed procedure (73.38%). Urethrocutaneous fistula developed in 11 patients, resulting in a complication rate of 7.91%. Conclusion: The use of autologous platelet-rich fibrin membrane as an adjunct in hypospadias repair is associated with a low incidence of urethrocutaneous fistula. PRF may serve as a beneficial, cost-effective biological scaffold to enhance wound healing and reduce postoperative complications.

Assessment of Patients Satisfaction and Anesthesia Related Discomfort Between Spinal Anesthesia and General Anesthesia for Cesarean Section

Faiqa Hashmi — 2025-06-30

Cesarean section is a commonly performed obstetric procedure, and the choice of anesthesia—general or spinal—plays a crucial role in determining maternal comfort and satisfaction. Evaluating the differences in anesthesia-related discomfort and overall patient satisfaction between the two techniques is essential for optimizing perioperative care. Objective: To determine the frequency of general anesthesia (GA) and spinal anesthesia (SA) use in elective cesarean sections and to compare patient satisfaction and anesthesia-related discomfort between the two techniques. Methods: This quasi-experimental study was conducted at the Anaesthesia Department of National Hospital and Medical Centre, Lahore, Pakistan, from August 2024 to February 2025. A total of 127 women scheduled for elective cesarean section were enrolled and divided into two groups based on the planned anesthesia technique: Group A (GA) and Group B (SA). Patient satisfaction and anesthesia-related discomfort were evaluated 12 hours postoperatively using the Bauer Patient Satisfaction Questionnaire, which includes five Likert-scale questions. Data were collected at discharge and analyzed using SPSS version 25. Independent sample t-tests were used to compare mean scores, with p < 0.05 considered statistically significant. Results: Out of 127 participants, 63% underwent spinal anesthesia and 37% received general anesthesia. The mean discomfort score was significantly higher in the GA group compared to the SA group (4.26 ± 0.71 vs. 3.05 ± 0.82; p<0.001), while the mean satisfaction score was significantly lower in the GA group compared to the SA group (14.19 ± 1.58 vs. 15.26 ± 1.29; p<0.001). Conclusion: Spinal anesthesia was more frequently utilized and yielded significantly higher satisfaction and lower anesthesia-related discomfort compared to general anesthesia in women undergoing elective cesarean section. These findings support the preference for spinal anesthesia to enhance patient-centered outcomes in obstetric care.

Development of Gluten-free Baked Nachos Using Watermelon Rind Powder for Assessment of Physicochemical and Sensory Attributes

Mubeen Bashir — 2025-06-30

Watermelon (Citrullus lanatus) is a widely cultivated fruit, primarily consumed for its sweet, nutrient-rich flesh. However, the rind, which constitutes a significant portion of the fruit, is commonly discarded as agricultural waste despite its emerging potential as a value-added food ingredient. Recent research suggests that watermelon rind is rich in bioactive compounds and dietary fiber, making it a promising candidate for functional food development, especially in gluten-free applications. Objective: This study aimed to develop gluten-free baked nachos incorporating watermelon rind powder (WRP) and to evaluate their physicochemical properties, functional characteristics, sensory acceptability, and storage stability. Methods: A laboratory-based experimental study was conducted from January to April 2025. Three treatment formulations were prepared: T₀ (100% corn flour), T₁ (85% corn flour + 15% WRP), and T₂ (80% corn flour + 20% WRP). Watermelon rind powder was prepared using a modified method based on Ogo et al. (2021), while nachos were formulated following a modified protocol from Dubey et al. (2021). Functional properties of the powder blends (swelling capacity, water absorption, and oil absorption) were assessed. Physicochemical analyses of nachos were conducted on days 0, 7, and 14, evaluating moisture content, ash, fat, crude fiber, crude protein, and color using a handheld spectrocolorimeter (Lovibond LC-400). Texture analysis was performed using a TA.XT Plus Texture Analyzer. Microbiological assessment for bacterial and mold counts was conducted to determine shelf stability. Sensory evaluation was carried out by a trained panel (n=10) using a 9-point hedonic scale. Data were analyzed using Statistix 8.1 software, with statistical significance set at p < 0.05. Results: Incorporation of WRP significantly improved the fiber content in T₁ and T₂ compared to the control (T₀). T₂ showed the highest crude fiber and water absorption capacity but slightly reduced sensory acceptability in terms of taste and texture. T₁ achieved the most favorable balance between nutrition and sensory properties. Over the 14-day storage period, all samples remained microbiologically safe, though T₂ exhibited slightly higher moisture retention and texture changes. Color and texture were moderately affected by increasing WRP levels, while functional properties like oil and water absorption improved. Conclusion: Watermelon rind powder is a viable functional ingredient for developing gluten-free snacks such as baked nachos. A 15% substitution level (T₁) demonstrated the most promising results in terms of nutritional enhancement, sensory acceptability, and storage stability. This study supports the valorization of fruit by-products in sustainable food systems and contributes to the development of health-oriented gluten-free products.

Frequency of Atrioventricular Block in Patients with Acute ST Segment Elevation Myocardial Infarction

Asad Ali Khan — 2025-06-30

Atrioventricular (AV) block is a recognized complication of acute ST-segment elevation myocardial infarction (STEMI), associated with adverse clinical outcomes. The timely identification of conduction abnormalities can assist in risk stratification and management of affected patients.. Objective: To determine the frequency of atrioventricular block in patients with acute ST-segment elevation myocardial infarction. Methodology: We conducted this cross-sectional study on 104 patients aged 35 to 75 years of either gender presenting with acute STEMI (based on symptoms and ECG criteria). We determined the frequency of atrioventricular block in these patients. AV block was diagnosed through ECG (PR interval >0.20 seconds). Results: Mean age was 57.34±10.86 years. Fifty-eight (55.8%) were male and 46 (44.2%) were female. Nineteen (18.3%) patients had diabetes. Twenty-five (24.0%) had hypertension. Smoking was reported in 16 (15.4%) patients. The frequency of atrioventricular block in our study was 7 (6.7%). Conclusion: The frequency of atrioventricular block in patients with acute ST-segment elevation myocardial infarction in our study was 7 (6.7%).

Comparative Analysis of Effectiveness of Intercostal Nerve Block Versus Intravenous Analgesics in Chest Trauma Victims Over First 72-Hour Time Period

Mamoon Ali — 2025-06-30

Chest trauma is a common emergency in Pakistan, frequently leading to significant pain and respiratory complications. Conventional intravenous (IV) analgesics may be inadequate or cause systemic side effects. Intercostal nerve block (ICNB) offers a regional technique with potential benefits, but its comparative efficacy in local trauma settings remains under-evaluated. Objective: To compare the analgesic effectiveness of ICNB versus IV analgesics in chest trauma victims over a 72-hour period. Methods: This case-control study was conducted at Aziz Bhatti Shaheed Teaching Hospital, Gujrat from 3 February to 3 May 2025. A total of 142 patients with AAST Grade I or II chest trauma were enrolled and randomly assigned to receive either ICNB (Group A) or IV ketorolac (Group B). Pain was assessed using the Visual Analog Scale (VAS) at 12, 24, and 72 hours post-intervention. Adverse effects and the need for rescue analgesia were also recorded. Data were analyzed using SPSS v22. Independent t-tests and stratification were applied with p ≤ 0.05 considered statistically significant. Results: Group A (ICNB) showed significantly lower mean VAS scores compared to Group B (IV) at 12 hours (5.01 ± 2.40 vs. 6.16 ± 2.25, p=0.001), 24 hours (3.75 ± 1.85 vs. 5.04 ± 2.50, p=0.000), and 72 hours (2.89 ± 1.54 vs. 3.65 ± 1.89, p=0.012). ICNB was also associated with fewer adverse events (nausea/vomiting: 4.2% vs. 14.1%, p=0.042) and a lower rate of rescue analgesia (5.6% vs. 19.7%, p=0.013). Stratified analysis confirmed consistent efficacy across gender and injury grades. Conclusion: ICNB offers superior pain control, fewer side effects, and better overall outcomes compared to IV analgesics in chest trauma patients. Its adoption should be considered as part of standard pain management protocols in Pakistani trauma care settings.

Frequency of Anemia in Patients With Preterm Labour at Tertiary Care Hospital Quetta

Hira Yousaf — 2025-06-30

Preterm labour is a major cause of neonatal morbidity and mortality, particularly in low-resource settings. Anemia, especially iron deficiency anemia, has been suggested as a modifiable risk factor contributing to preterm birth. Objective: To assess the frequency of anemia and its association with demographic and clinical variables in pregnant women with preterm labour. Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Sandeman Provincial Hospital, Quetta, over a period of six months following ethical approval. A total of 146 pregnant women aged 18–40 years with preterm labour were enrolled using non-probability consecutive sampling. Data were collected using a structured proforma, including demographics, clinical findings, and hemoglobin levels. Anemia was defined as hemoglobin <11 g/dL. Results: Out of 146 participants, 90 women (61.6%) were found to be anemic. Severe anemia was noted in 6 cases (4.1%). Anemia was significantly more common in women aged <25 years (p = 0.03), those from rural areas (p = 0.04), those with lower socioeconomic status (p = 0.01), and those with limited education (p = 0.02). No significant association was found with parity (p = 0.16) or BMI (p = 0.09). Conclusion: It is concluded that anemia is a common finding in patients presenting with preterm labour, especially among socially and economically disadvantaged groups. Early detection and management of anemia during pregnancy can play a vital role in reducing the risk of preterm birth. Strengthening antenatal care services with a focus on nutritional support and community education is essential.

Comparative Study of Clinical Profile in Patients With Solitary vs Multiple Gallstones

Kapil Dev — 2025-06-30

Gallstones are a common biliary pathology, posing a significant global health burden. The worldwide prevalence of gallstones is approximately 10-15% among adults, with higher rates reported in developed countries due to dietary habits and lifestyle factors1. In developing nations, including Pakistan, the prevalence of gallstone disease ranges between 15% and 20% with a higher occurrence in females compared to males. Objective: To compare the clinical profiles of patients with solitary gallstones versus those with multiple gallstones in a Pakistani population. Study design: Prospective observational study. Place and duration: Department of General Surgery, Combined Military Hospital, Hyderabad, for 6 months, i.e., from Oct/2024 till March/2025. Methods: A total of 141 patients who fulfilled the selection criteria were included. Patients were divided into two groups based on the number of stones in the gallbladder as revealed on ultrasonography, i.e., Group A (solitary gallstones; n=71) and Group B (multiple gallstones; n=70). All patients underwent laparoscopic cholecystectomy, and outcomes were assessed and subjected to statistical analysis. Results: The median (IQR) age of patients in Group A was 45 (13) years, and in Group B was 42 (13) years (p=0.601). The median (IQR) intraoperative duration in Group A was 42 (4) minutes and in Group B was 41 (7) minutes (p=0.016). The median (IQR) duration of stay at the hospital was 6 (2) days in Group A and 4 (1) days in Group B (p=0.000). Pain was the commonest symptom in both groups, and there was no significant difference in terms of clinical presentation between the two. Conclusion: In patients with gallstones, there was no significant difference in the clinical presentations of multiple versus solitary gallstones; however, there was a significant difference in terms of intraoperative duration, intraoperative findings, and duration of hospitalization.

Prognostic Power of Cerebroplacental Ratio for Adverse Fetal Outcomes in Women with High-Risk Pregnancies

Saima Batool — 2025-06-30

High-risk pregnancies are associated with increased risk of adverse fetal outcomes, including perinatal mortality and morbidity. The cerebroplacental ratio (CPR), derived from Doppler assessment of fetal umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs), has been proposed as a non-invasive predictor of such outcomes. However, its predictive accuracy remains variable in clinical practice. Objective: To evaluate the predictive ability of cerebroplacental ratio for adverse fetal outcomes in women with high-risk pregnancies. Methods: This retrospective study was conducted in the Department of Obstetrics and Gynaecology at Nishtar Hospital, Multan, from February 2024 to February 2025. A total of 100 pregnant women with singleton pregnancies between 32 and 40+6 weeks of gestation were included. All participants underwent Doppler ultrasonography to assess UA-PI, MCA-PI and to calculate the CPR. The primary outcome was the incidence of perinatal adverse outcomes such as stillbirth, neonatal death, low 5-minute Apgar score, seizures, and grade II or III neonatal encephalopathy. Secondary outcomes included the incidence of small-for-gestational-age (SGA) fetuses among live births, SGA fetuses with morbidity, and morbidity in appropriate-for-gestational-age (AGA) fetuses. Data were analyzed using receiver operating characteristic (ROC) curves, and area under the curve (AUC) values were compared. Results: UA-PI, MCA-PI, and CPR were all poor predictors of perinatal mortality, with AUCs of 0.61, 0.55, and 0.58, respectively, showing no significant difference in accuracy. For the prediction of SGA fetuses, CPR demonstrated a significantly higher z-score (0.75) compared to MCA-PI (0.71) and UA-PI (0.72). CPR and MCA-PI both had moderate predictive value for morbidity in AGA fetuses (AUC: 0.65), outperforming UA-PI (AUC: 0.58). For morbidity prediction in SGA fetuses, CPR (AUC: 0.76) and MCA-PI (AUC: 0.75) exhibited similar prognostic accuracy, both superior to UA-PI (AUC: 0.65). Conclusion: While Doppler indices including CPR, MCA-PI, and UA-PI demonstrated limited utility in predicting perinatal mortality, CPR and MCA-PI were relatively better predictors of neonatal morbidity, particularly in small-for-gestational-age fetuses. These findings support the clinical value of CPR and MCA-PI in fetal surveillance during high-risk pregnancies.

Optimizing On-The-Job Training in Obstetrics and Gynecology Fellowship: A Learning Theory-Based Framework for Competency Development

Qudsia Nawaz — 2025-06-30

In Pakistan, the current on-the-job training (OJT) model for Obstetrics and Gynecology (Ob-Gyn) fellowship programs primarily follows an apprenticeship-based framework. While this model offers experiential benefits, it presents notable challenges in standardized competency development, structured mentorship, and consistent feedback, thereby affecting training quality and skill acquisition. Objective: To evaluate the effectiveness of the existing OJT model in Ob-Gyn fellowship training in Pakistan using established learning theories and to propose a structured framework for optimizing training outcomes. Methods: A qualitative literature review was conducted to assess the existing OJT model through the lens of competency-based medical education, experiential learning theory (Kolb), and social learning theory (Bandura). Sources included peer-reviewed journals, academic reports, and international training guidelines. The analysis focused on identifying strengths and gaps within the current system. A framework for training enhancement was subsequently developed, incorporating principles of structured mentorship, simulation-based education, standardized rotations, and objective assessment tools. Results: The review revealed that while the current OJT model aligns well with experiential and social learning theories, it suffers from critical gaps. These include non-uniform case exposure, limited use of simulation technologies, inconsistent formative feedback, and lack of standardized evaluation metrics. The proposed framework includes structured mentorship programs, integration of simulation-based modules, objective assessment criteria (e.g., DOPS, OSATS), and technology-assisted learning platforms, all aimed at enhancing trainee competence and aligning with international best practices. Conclusion: The OJT model in Ob-Gyn fellowship training in Pakistan can be significantly strengthened by adopting a hybrid approach. Integrating simulation-based education, structured feedback systems, standardized competency assessments, and enhanced mentorship will bridge existing gaps and elevate the training program to meet global standards.