Biological and Clinical Sciences Research Journal

Comparison of Functional Outcome After 2 Weeks Immobilization Versus No Immobilization After Reduction of Acute Shoulder Dislocation

Mishkat Ullah — 2025-05-31

Acute anterior shoulder dislocation is an injury that happens mostly in people who are active and younger. After reducing the dislocation, immobilizing the joint is an accepted treatment, but the ideal time for removal is argued, since some studies report that early movement may help you recover faster. Objective: To analyze whether resting the shoulder is better than moving it after a closed reduction for first-time anterior shoulder dislocation. Methods: The study was carried out in the Orthopedic Surgery Department of CMH Rawalpindi between 15 June 2024 to 14 Feb 2025. The study grouped sixty patients into two groups. Group A was repaired and then confined to bed for two weeks; Group B was not immobilized and was encouraged to move as soon as possible. Constant-Murley and DASH scores were used to measure function at 2, 6, and 12 weeks after reducing the fracture. Results: Group B consistently had better mean scores for Constant-Murley and DASH at 6 and 12 weeks, with p < 0.01 (statistical significance). No differences in rates of redislocation were noticed between the groups. Conclusion: Early mobilization without immobilization after anterior shoulder dislocation results in superior short-term functional outcomes and may be a viable alternative to traditional immobilization.

Impact of Excessive Use of Mobile Phone on Academic Performance of Students of Mohtarma Benazir Bhutto Shaheed Medical College

Youmnah Ali — 2025-05-31

Mobile phone usage has become deeply embedded in student life, offering both educational utility and considerable distraction. Among medical students, excessive screen time may impair concentration, study habits, and health, ultimately affecting academic outcomes. Objectives: To assess the impact of excessive mobile phone usage on the study patterns and academic performance of medical students and to compare academic outcomes between frequent mobile phone users and those who use mobile phones only when necessary. Methods: A cross-sectional study was conducted from April 2018 September 2018 within the premises of Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, AJK. A structured questionnaire was administered to students residing in both the college and hostel. Variables included mobile phone usage frequency, study disruptions, social media activity, and self-reported health complaints. Descriptive statistics were used to summarize data, and comparative analysis was applied between high and low phone usage groups. Results: Of the respondents, 46% reported experiencing attention deficits while studying. WhatsApp was the most frequently cited distraction, with 96% of students admitting to using it during study time, followed by Facebook/Instagram (39%). Furthermore, 71% reported using mobile phones for more than two hours during study periods. Health effects included hearing and vision-related issues in 60% of the students. High-frequency users demonstrated poorer academic concentration and greater interference in study routines compared to low-frequency users. Conclusion: Excessive mobile phone usage has a significant negative impact on the academic behavior and health of medical students. It contributes to reduced concentration, study time mismanagement, and increased risk of sensory complaints. To support academic success and student well-being, institutional awareness programs promoting responsible digital habits should be implemented.

Accuracy of Combined Neutrophil to Lymphocyte Ratio and C-Reactive Protein for Diagnosis of Spontaneous Bacterial Peritonitis Among Cirrhotic Patients

Asif Ali — 2025-05-31

Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis associated with high morbidity and mortality. While ascitic fluid analysis remains the diagnostic gold standard, it is invasive and not always feasible. There is a need for simple, non-invasive, and cost-effective alternatives to diagnose SBP early, especially in resource-limited settings. Objective: To determine the diagnostic accuracy of combined neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels in diagnosing SBP among cirrhotic patients, using ascitic fluid PMN count as the gold standard. Methods: This descriptive cross-sectional study was conducted over six months from April 2024 to September 2024, at the Department of Medicine, Ibn-e-Siena Hospital, Multan. A total of 131 cirrhotic patients with ascites were included through non-probability consecutive sampling. All patients underwent diagnostic paracentesis. SBP was confirmed if PMN count in ascitic fluid was ≥250/mm³. NLR and CRP were assessed using venous blood samples. A cut-off of NLR ≥2.9 and CRP >11.3 mg/dL was used to define SBP positivity. Diagnostic indices were calculated using 2×2 contingency tables. Results: Out of 131 patients, 91 (69.5%) were confirmed to have SBP by ascitic fluid analysis. The combination of NLR and CRP showed a sensitivity of 94.5%, specificity of 85.0%, positive predictive value of 93.5%, negative predictive value of 87.2%, and overall diagnostic accuracy of 91.6%. Stratified analysis revealed consistent diagnostic performance across gender and duration of liver disease. Conclusion: Combined NLR and CRP are accurate, readily available, and non-invasive diagnostic markers for SBP in cirrhotic patients. Their application may complement or, in selected cases, substitute ascitic fluid analysis, improving early detection and outcomes in resource-limited settings such as Pakistan.

Effectiveness of Structural Teaching Program on Knowledge, Attitude and Practice (KAP) Regarding Breast Cancer and Breast Self-Examination (BSE) Among Undergraduate Nursing Students

Shahla Pardhan — 2025-05-31

Globally, breast cancer is primary cause of morbidity and mortality, reducing life by over 18.5 years. Annually, 1,384,155 cases were diagnosed globally. Therefore, Breast Self-Examination (BSE) is cost-free & non-invasive, and private method for women to identify potential breast health issues. Objective: To assess and evaluate the Knowledge, Attitude and Practices (KAP) amongst undergraduate nursing student’s about Breast Self-Examination. Methods: A Quasi Experimental Study was conducted in two public and one Private Nursing Colleges which were residing in Karachi, Pakistan, where data collected amongst 383 female undergraduate Nursing students, from June, 2024 to January, 2025 to assess the KAP amongst them. Results: The majority of participants were aged 18–20 years (54.6%), single (88.8%), and lived in urban areas (64%). Most were first-year students (55.6%) and Mothers’ education levels varied, with (36%) having no formal education. Only (10.2%) reported a family history of breast cancer. Awareness and knowledge of BSE improved significantly after the intervention. Awareness rose from (60.8% to 91.6%) (p = 0.001). Correct knowledge about starting BSE at age 20 increased from (17% to 82.2%), and monthly practice rose from (29.5% to 81.7%) (Both p < 0.001). More participants correctly identified the ideal time for BSE as a week after menstruation (19.3% to 85.6%, p < 0.001), though the intervention significantly improved attitudes toward BSE rose from (30% to 77.5%) (p = 0.001), fear of seeing a doctor decreased (p = 0.016), family and community support for BSE increased from (7.8% to 54.8%) (p = 0.011). Similarly, the intervention significantly improved participants' practice of BSE rose from (23% to 73.1%) (p = 0.011), while ignorance as a reason for not practicing dropped from (81.8% to 11.7%) (p = 0.021), Fear of finding a lump increased post-intervention (2.6% to 75.7%), showing heightened awareness, and Knowledge of correct techniques improved notably: inspecting in front of a mirror (26.1% to 93.2%), using middle three fingers (30.8% to 77.5%), and the opposite hand (83.8%). Understanding of examining the armpit and identifying nipple discharge errors also improved, and correct rejection of the triangular method increased from (23.2% to 87.7%) (p = 0.011) respectively. Conclusion: The intervention significantly enhanced Positive attitudes towards BSE increased with a higher percentage of participants recognized its importance, Fear of discovering a lump decreased, although perceptions regarding discomfort also showed minimal change.

Comparison of Results of Standard Versus Accelerated Casting Method for Relapsed Club Foot Deformity

Muhammad Hassan Zafar — 2025-05-31

Relapsed idiopathic clubfoot remains a significant clinical challenge in pediatric orthopedics, particularly in low-resource countries like Pakistan. While the standard Ponseti method with weekly casting is well-established, the accelerated casting method, requiring more frequent cast changes, offers potential advantages in reducing treatment time without compromising outcomes. Objective: To compare the effectiveness, complication rates, recurrence, and parental satisfaction between standard weekly casting and accelerated bi-weekly casting methods for relapsed clubfoot deformity in a tertiary care hospital in Pakistan. Methods: A prospective comparative study was conducted at the Department of Orthopedics, Benazir Bhutto Hospital, Rawalpindi, from September 15, 2024, to March 15, 2025. A total of 80 children with relapsed idiopathic clubfoot were divided into two equal groups: 40 treated with the standard Ponseti method and 40 with the accelerated method. Outcomes included a number of casts, treatment duration, Pirani score improvement, complication rates, recurrence at 6-month follow-up, and parental satisfaction using a 5-point Likert scale. Data were analyzed using SPSS v25.0, with independent t-tests and chi-square tests applied where appropriate. Results: Both groups achieved comparable deformity correction as reflected by similar final Pirani scores (0.7 ± 0.4 in standard vs. 0.6 ± 0.3 in accelerated, p = 0.312). The accelerated group required significantly fewer casts (5.1 ± 0.9 vs. 6.9 ± 1.1, p < 0.001) and shorter treatment duration (2.6 ± 0.5 weeks vs. 6.9 ± 1.1 weeks, p < 0.001). Complication and recurrence rates were low and statistically similar in both groups. Parental satisfaction was significantly higher in the accelerated group (mean score 4.4 ± 0.5 vs. 3.8 ± 0.7, p = 0.002). Conclusion: The accelerated Ponseti method is a safe and effective alternative to standard casting for relapsed clubfoot, offering faster correction and higher caregiver satisfaction without increasing complications or recurrence. Its adoption may enhance compliance and reduce treatment burden in the Pakistani healthcare setting.

Outcomes of Balloon Dilatation in Isolated vs. Risk-Associated Pulmonary Stenosis: A Comparative Study

Saba Mumtaz — 2025-05-31

Pulmonary valve stenosis (PVS) is a common congenital heart defect, with balloon pulmonary valvuloplasty (BPV) being the standard intervention. However, outcomes can vary significantly between isolated cases and those associated with additional risk factors, such as dysplastic valves or right ventricular hypoplasia. Objective: T.o compare the outcomes of balloon dilatation in isolated versus risk-associated pulmonary stenosis (PS). Methodology: This cross-sectional study was conducted from January to December 2024 at the Pediatric Cardiology Department of NICVD, Karachi. Patients of any age and gender with echocardiographicaly confirmed pulmonary valve stenosis (PVS) undergoing balloon pulmonary valvuloplasty (BPV) were included. Isolated PS was defined as severe doming valves without additional risk factors; risk-associated PS included dysplastic valves, critical PS, multilevel obstruction, or RV/valvular hypoplasia. Pre- and post-procedural clinical, echocardiographic, and hemodynamic data were recorded. Follow-up echocardiography was performed on day one and at one month. Data were analyzed using IBM-SPSS Statistics. For all inferential statics, p<0.05 was considered statistically significant. Results: Of 61 patients, 36 (59%) had isolated, and 25 (41%) had risk-associated pulmonary stenosis. Risk-associated cases had lower median age (1.5 vs 7.0 years; p=0.015), smaller annulus diameter (8.0 vs 15.0 mm; p<0.001), and higher cyanosis (64.0% vs 19.4%; p<0.001). Day-1 RVSP was higher (74.0 vs 65.5 mmHg; p =0.016), and cardiac arrest occurred only in the risk group (16.0%; p=0.013). By day-30, restenosis occurred exclusively in risk-associated cases (21.1% vs 0%; p=0.010). At day-30, mortality occurred in 2 cases ( risk-associated PS). Conclusion: Balloon pulmonary valvuloplasty remains an effective therapeutic option for pulmonary stenosis. Patients with risk-associated features are more likely to experience higher residual RV pressures, greater regurgitant lesions, increased risk of cardiac arrest, and early restenosis.

Evaluating the Impact of Problem-Based Learning on Critical Thinking Skills in Undergraduate Nursing Students

Ayesha Liaqat — 2025-05-31

Critical thinking is an essential competency for nursing professionals, enabling them to make informed clinical decisions and ensure patient safety. In Pakistan, traditional lecture-based pedagogies dominate nursing education, often limiting the development of higher-order cognitive skills. Problem-based learning (PBL) has emerged as an effective student-centered strategy to enhance critical thinking, but its application in Pakistani nursing curricula remains limited. Objective: To evaluate the effectiveness of problem-based learning in improving critical thinking skills among undergraduate nursing students in a tertiary care teaching hospital in Pakistan. Methods: A quasi-experimental pre- and post-intervention study was conducted from April to September 2024 at the NMC Multan. A total of 86 undergraduate nursing students were recruited through non-probability convenience sampling. Participants underwent six weeks of structured PBL sessions integrated into their curriculum. Critical thinking skills were assessed before and after the intervention using a validated critical thinking disposition inventory. Data were analyzed using SPSS version 25, employing paired t-tests and ANOVA to determine statistical significance, with a p-value ≤ 0.05 considered significant. Results: Post-intervention analysis revealed significant improvements in all domains of critical thinking: interpretation (p = 0.000), analysis (p = 0.000), evaluation (p = 0.000), inference (p = 0.000), and explanation (p = 0.000). The overall mean critical thinking score increased from 15.6 ± 3.5 to 20.5 ± 2.9 (p < 0.001). Senior students (3rd and 4th year) demonstrated greater improvements compared to juniors (p = 0.034), while no significant gender-based differences were observed (p = 0.210). Conclusion: Problem-based learning significantly enhances critical thinking skills among undergraduate nursing students and should be integrated into nursing curricula in Pakistan to promote clinical competence and professional readiness.

Challenging Ableism: Sexual and Reproductive Health Barriers for Women with Differently Abled Bodies

Syeda Abeeha Zahra — 2025-05-31

Women with physical disabilities experience compounded marginalization due to ableism, gender inequality, and entrenched socio-cultural norms. These intersecting barriers severely limit their autonomy and access to sexual and reproductive health (SRH) services, particularly in low- and middle-income settings like Pakistan. Objective: To explore the lived experiences and challenges in accessing SRH services among married women with physical disabilities in Lahore, Pakistan. Methods: A qualitative phenomenological study was conducted from January to June 2024 in Lahore, Pakistan. Purposive sampling was used to recruit 15 married women aged 18–40 years with physical disabilities. In-depth semi-structured interviews were conducted in Urdu, audio-recorded, transcribed verbatim, and translated into English. Thematic analysis was performed using NVivo software, following Colaizzi’s seven-step method. The study was grounded in the theoretical frameworks of social constructivism and intersectionality to examine how structural and attitudinal factors shape SRH experiences. Results: Participants reported numerous barriers to accessing SRH services, including negative societal attitudes, discriminatory healthcare practices, inaccessible facilities, and inadequate SRH education. The internalization of stigma, invisibility in SRH discourse, and lack of provider sensitization further marginalized these women. Many participants expressed that health systems neither addressed their specific SRH needs nor considered their lived realities. Conclusion: The study underscores the urgent need to integrate disability-sensitive approaches into SRH policies in Pakistan. Addressing structural ableism, gender discrimination, and socio-cultural bias is critical to ensuring equitable access to SRH services for women with disabilities. A more inclusive health policy framework, provider training, and community awareness are essential to improve SRH outcomes for this underserved population.

Awareness and Knowledge of Liver Diseases in Relation to Demographic Variables in the General Population of Pakistan

Saira Ashraf — 2025-05-31

Liver diseases are a growing public health concern worldwide, yet public awareness and understanding of these conditions remain inadequate. Objectives: To assess the level of awareness and knowledge regarding liver diseases among patients and examine how these vary according to demographic factors such as age, gender, education, and residence. Methods: This cross-sectional, observational study was conducted at the Gastroenterology Outpatient and Indoor departments at Combined Military Hospital Lahore from 1^st February 2025 till 30^th April 2025. All patients meeting the inclusion criteria will be asked to fill out a standard questionnaire, the regional liver index study, and some questions from previously done research assessing the patients' knowledge, attitude, and practice regarding chronic liver disease. Data were collected using a structured questionnaire. Results: Out of 200 participants, 75% reported general awareness of liver diseases, with hepatitis being the most recognized condition (60%). However, only 19% of respondents demonstrated good knowledge, while 43% and 38% had moderate and poor knowledge. Knowledge levels were significantly associated with education level (p < 0.001) and place of residence (p = 0.03), but not with gender (p = 0.22). Only 28% were aware of the hepatitis B vaccine. Traditional media and the internet were the most cited sources of information. Conclusion: It is concluded that although awareness of liver diseases exists among the population, specific knowledge remains limited, particularly among individuals with lower educational levels and those in rural areas. Targeted educational initiatives are needed to bridge this knowledge gap and improve liver health outcomes.

Etiological Profile of Hyperbilirubinemia in Full Term Neonates Requiring Exchange Transfusion

Muhammad Faizullah Khan — 2025-05-31

Neonatal hyperbilirubinemia, characterized by elevated serum bilirubin, is common in full-term neonates, with severe cases requiring exchange transfusion to prevent complications like kernicterus. This study explores the etiological factors necessitating this intervention at Ayub Teaching Hospital, Abbottabad. Objective: To identify and analyze etiological factors of hyperbilirubinemia requiring exchange transfusion in full-term neonates. Methods: A descriptive cross-sectional study was conducted at Neonatology Unit, Ayub Teaching Hospital, Abbottabad, from 2 December 06 May 2025, enrolling 385 full-term neonates (gestational age 37–42 weeks) with serum bilirubin >19.5 mg/dL. Data on demographics, clinical profiles, and etiologies were collected and analyzed using SPSS version 22. Results: ABO incompatibility (36.1%) was the leading cause, followed by Rh incompatibility (24.2%), G6PD deficiency (11.7%), sepsis (10.6%), and intracranial bleeding (3.4%). Unidentified causes accounted for 14.0%. Most neonates (93.8%) were discharged stable post-transfusion. Conclusion: ABO and Rh incompatibilities predominate, highlighting the need for enhanced antenatal screening and early neonatal surveillance to reduce exchange transfusion necessity.

Frequency of Placenta Previa Among Pregnant Patients With Scarred and Unscarred Uterus

Sana Aslam — 2025-05-31

Placenta previa is a serious obstetric condition typically observed during the second and third trimesters of pregnancy. It poses a significant risk for maternal and fetal morbidity and mortality, particularly when associated with prior uterine surgical interventions such as cesarean sections. A history of uterine scarring is a recognized risk factor for placenta previa and its more severe variant, placenta accreta. Objective: To determine the prevalence of placenta previa in pregnant women with and without previous uterine scarring presenting to a tertiary care hospital. Methods: A cross- sectional study was conducted in the Department of Obstetrics & Gynecology at Divisional Headquarter Hospital, Mirpur, from July 1, 2024, to December 31, 2024. A total of 150 pregnant women aged 15–45 years, with gestational age’s ≥28 weeks and singleton pregnancies, were enrolled using a non-probability consecutive sampling technique. Participants were categorized based on the presence or absence of uterine scarring. Women with second-trimester bleeding or primigravida status were excluded. Relevant obstetric history, including parity, gravidity, and gestational age, was documented. Data were analyzed using SPSS version 24. Descriptive statistics were used to summarize demographic and clinical characteristics. Categorical data were presented as frequencies and percentages; continuous data were reported as means ± standard deviations. Results: The mean age of participants was 34.23 ± 12.34 years, with the majority (45.7%) between 26–30 years of age. Regarding gestational age, 13.8% were between 28–32 weeks, 20.83% between 31–35 weeks, and 65.2% between 36–40 weeks. A total of 100 women (66.66%) had previously scarred uteri, while 5 (31.95%) had unscarred uteri. Vaginal delivery history was noted in 46 women. In terms of gravidity, 110 (73.3%) were G2–G4, 35 (23.33%) were G5– G7, and above. Placenta previa was significantly more prevalent among women with a history of uterine scarring. Conclusion: The findings indicate a higher prevalence of placenta previa among women with prior uterine scarring compared to those without. This underscores the need for vigilant prenatal screening and risk stratification in women with a history of cesarean sections or uterine surgeries.

Frequency of Depression in Young Patients with Diabetes Mellitus

. Abdullah — 2025-05-31

Diabetes mellitus (DM) is a chronic metabolic disorder associated with numerous physical and psychological complications. Depression is a common comorbidity in diabetic patients, significantly impacting self-care, glycemic control, and quality of life. Objective: To determine the frequency of depression in young patients with diabetes mellitus aged 15–45 years. Methods: This descriptive cross-sectional study was conducted at the Department of Medicine, PAEC General Hospital Islamabad from October 2024 till March 2025. A total of 122 diabetic patients aged 15–45 years, with a duration of diabetes over six months, were enrolled through non-probability consecutive sampling. Sociodemographic and clinical data were collected using a structured proforma. Results: Among 122 patients, 49 (40.2%) were diagnosed with depression. Depression was more common among females (45.3%) than males (34.5%). It was more prevalent in patients with lower income (<25,000 PKR/month: 57.9%), illiterate individuals (72.2%), and those with longer diabetes duration (>10 years: 52%). Higher rates were also observed among smokers (54.8%) and those with hypertension (50%). Depression severity ranged from mild (15.6%) to moderate (14.8%) and severe (9.8%). Significant associations were found between depression and income (p=0.01), education level (p=0.003), smoking (p=0.04), and hypertension (p=0.05). Conclusion: Depression is highly prevalent among young patients with diabetes, particularly those with lower socioeconomic status, poor education, and longer disease duration. Routine mental health screening and integrated psychological support should be incorporated into diabetes management to improve overall outcomes.

Comparison of Bolster Versus Quilting Techniques on Outcome of Graft Take for Free Fibula Donor Site

Nida Sehar — 2025-05-31

Donor site management following free fibula flap harvest is crucial to optimize healing and minimize morbidity. While bolstering and quilting are both commonly employed to enhance graft adherence, their relative efficacy in donor site graft take and complication rates remains uncertain, particularly in head and neck oncologic reconstruction. Objective: This study aims to directly compare the outcomes of quilt and bolster when applied specifically to the free fibula flap donor site, in regard to graft take. Methods: After the ethical approval from the institutional review board, this Single center, parallel, open labelled, randomized control trial was conducted at Plastic Surgery Department at Aga Khan University Hospital from 01/July/2024 to 31/dec/2024. Through non-probability consecutive sampling, 48 patients aged 18-70 years, both gender, who underwent free fibula flap for reconstruction of head and neck tumors at were included in this study. Patients with prior history of limb trauma, peripheral vascular disease, underwent free fibula for other illnesses, such as osteoradionecrosis or trauma or extremity tumors were excluded from the present study. Results: The average flap donor site defect size was 93.5 ± 27.7 cm² in the bolster group and 90.4 ± 23.8 cm² in the quilting group (p = 0.649). The majority of split-thickness skin grafts (STSGs) in both groups were harvested from the contralateral leg—92% in the bolster group and 100% in the quilting group—while only 8% of STSGs in the bolster group were taken from the same leg (p = 0.162). The mean percentage of graft take was 86.2% ± 5.9 in the bolster group and 85.8% ± 7.5 in the quilting group, showing no significant difference (p = 0.812). Donor site complications were observed in 13% of patients in each group (p = 0.98), indicating comparable complication rates between the two techniques. Conclusion: Both bolstering and quilting techniques yield comparable outcomes in terms of graft take and complication rates at the free fibula donor site.

Clinical Profile, Echo, and Outcome of Congenital Heart Disease in First Two Years of Life

Noor Ul Haram Khattak — 2025-05-31

Due to the lack of high-quality echocardiography in developing countries mostly neonates with CHD die each year. Objective: The aim of the study was to find out the Clinical profile, echo, and outcome of congenital heart disease in first two years of life. Method: The current study was carried out in neonatal intensive care unit Bacha Khan Medical Complex/Gajju khan Medical college Swabi from July 2023 to December 2023 after taking permission from the ethical board of the institute. A total of 54 children of day zero to two years presented to the NICU with congenital heart diseases were enrolled in this study. Echo-machine was used to perform transthoracic echocardiography (TTE).Throughout the research period, the study population was evaluated in order to determine the outcome of congenital cardiac disease. A pre-tested, semi-structured questionnaire was used to record all pertinent data in a prepared datasheet Microsoft Excel was used to analyze the data, which were then shown as tables and figures. Results: A total of 54 children with congenital heart defect were included in this study. Of these, 38.1% of cases were identified between the ages of 13 - 24 months, while 61% of cases were diagnosed between the ages of 0-12 months. Out of 54 individuals, 15 (27%) had cyanotic heart lesions and 36 (66.6%) had a cyanotic heart lesions. VSD was the most common structural defect, Complaints of children with CHD showed cough in most cases (82%), dyspnea in 80%, poor weight gain in 70%, breathing difficulty in 68% and fever in 58% cases. Among children with congenital heart disease, murmur was the most prevalent presenting symptom (85%). In both age groups, 57.4% of the participants had a history of over two respiratory symptom episodes. Out of the total participants 66% Advice for Surgery or conservative treatment and 9 % of individuals died. Conclusion: This study concluded that echocardiography play a major role in the diagnosis and management of congenital heart disease in first two years of life .the death rate was recorded 9% in this study which further revealed that early management of CHD is crucial.

Efficacy of Vaginal Prostaglandin E2 Versus Oxytocin for Induction of Labour in Patients with Premature Rupture of Membranes

Zainab Noor — 2025-05-31

Prelabour rupture of membranes (PROM) at term is a common obstetric complication that necessitates timely labor induction to reduce maternal and neonatal morbidity. While both oxytocin and prostaglandin E2 (PGE2) are used for induction, their comparative efficacy remains under-investigated in low-resource settings such as Pakistan. Objective: To compare the efficacy of vaginal prostaglandin E2 versus intravenous oxytocin for labor induction in patients with term PROM in terms of timely vaginal delivery and reduction in cesarean rates. Methods: A randomized controlled trial was conducted over six months from April 2024 to September 2024 at the Department of Obstetrics & Gynaecology, Ibn-e-Siena Hospital, Multan. A total of 120 women with singleton term pregnancies (37–42 weeks) presenting with PROM of <6 hours duration were randomly assigned to receive either intravenous oxytocin (Group A, n = 60) or vaginal PGE2 (Group B, n = 60). Primary outcome was vaginal delivery within 24 hours. Secondary outcomes included induction-to-delivery interval, cesarean section rate, and failure of induction. Data were analyzed using SPSS version 23, with significance set at p ≤ 0.05. Results: Vaginal delivery within 24 hours was achieved in 73.3% of women in the PGE2 group versus 50.0% in the oxytocin group (p = 0.010). The mean induction-to-delivery interval was significantly shorter in the PGE2 group (7.2 ± 2.1 hours) compared to the oxytocin group (9.4 ± 2.3 hours; p < 0.001). Cesarean section rates were also significantly lower in the PGE2 group (20.0%) versus the oxytocin group (40.0%; p = 0.020). No serious adverse events were reported in either group. Conclusion: Vaginal PGE2 is more effective than intravenous oxytocin for labor induction in term PROM, with a higher likelihood of timely vaginal delivery and reduced cesarean risk. These findings support the inclusion of PGE2 in national labor induction guidelines, especially in high-volume, resource-limited healthcare settings in Pakistan.

Antepartum Hemorrhage in Obstetrics Is Still a Maternal/Fetal Killer

Fozia Shaikh — 2025-05-31

Antepartum hemorrhage (APH), defined as bleeding from the genital tract after 20 weeks of gestation but before the birth of the baby, remains a significant cause of maternal and perinatal morbidity and mortality, especially in low-resource settings. Early identification and prevention strategies are crucial for improving outcomes. Objective: To determine the frequency and associated risk factors of antepartum hemorrhage among women who delivered between January 2020 and December 2024 at a tertiary care hospital in Larkana, Pakistan. Methods: This retrospective descriptive study was conducted at the Gynecological Unit of Shaikh Zayad Women's Hospital, affiliated with Shah Abdul Latif University, Khairpur. Data from 672 pregnant women aged 21 to 49 years who presented with antepartum hemorrhage were included. The study population included both primigravida and multigravida women at preterm (20–36+6 weeks) and term (37–42 weeks) gestation. Continuous variables were expressed as mean ± standard deviation (SD), and categorical variables were presented as frequencies and percentages. The chi-square test was employed to evaluate categorical associations, while independent t-tests compared continuous variables between anemic and non-anemic women with APH. A p-value < 0.05 was considered statistically significant. Data analysis was conducted using SPSS version 20. Results: Results showed that women aged 33–47 years had significantly higher odds of experiencing APH compared to those aged 16–32 years (p < 0.05). A previous history of abortion was associated with a twofold increase in APH risk, while women with a history of cesarean section had a 5.7 times higher likelihood of developing APH compared to those without such a history. Additional associated factors included anemia, multiparity, malnutrition, and previous episodes of APH. Conclusion: This study highlights key risk factors for antepartum hemorrhage, including advanced maternal age, multiparity, anemia, malnutrition, prior abortion, previous cesarean delivery, and history of APH. Public health efforts should focus on reducing preventable risk factors such as unnecessary cesarean sections and unsafe abortions while improving antenatal care to mitigate APH-related complications.

Risk Factors of Postpartum Urinary Retention After Vaginal Delivery: A Case-Control Study

Mahrukh Saif — 2025-05-31

PPUR is a common yet underdiagnosed complication of vaginal delivery, especially in low-resource settings. Objective: This study aimed to identify maternal and intrapartum risk factors associated with PPUR. Methods: A case-control study was conducted at Ibn-e-Siena Hospital, Multan, over three months from 22 January 2025 to 22 April 2025. A total of 142 women (71 with PPUR, 71 controls) were assessed for maternal characteristics and intrapartum variables. Statistical analysis included logistic regression to identify independent risk factors. Results: Significant independent risk factors for PPUR included episiotomy (OR 3.90), epidural analgesia (OR 3.88), obesity (OR 2.54), gestational diabetes (OR 3.39), macrosomia (OR 4.75), and longer labor duration (p = 0.003) were noted in this study. Conclusion: Targeted monitoring for women with identified risk factors may reduce the incidence and complications of PPUR. These findings support the integration of routine bladder care into postpartum protocols in Pakistani healthcare settings.

Effectiveness of Structured Diabetes Education Programs in Improving HbA1c and Treatment Adherence Among Newly Diagnosed Patients in Pakistan

Khizer Iqbal Mufti — 2025-05-31

Diabetes mellitus is a major public health challenge in Pakistan, with poor glycemic control and suboptimal treatment adherence contributing to high morbidity. Structured diabetes self-management education (DSME) programs have demonstrated significant benefits globally but remain underutilized in the Pakistani healthcare system. Objective: To evaluate the effectiveness of a structured diabetes education program on HbA1c reduction and treatment adherence among newly diagnosed type 2 diabetes patients in a tertiary care setting in Pakistan. Methods: A quasi-experimental study was conducted at a tertiary care hospital from April to September 2024. A total of 86 newly diagnosed type 2 diabetes patients were divided into two groups: the intervention group received a structured education program (4 sessions over 4 weeks), and the control group received routine care. HbA1c levels and medication adherence (assessed by MMAS-8) were recorded at baseline and 12 weeks post-intervention. Data were analyzed using paired and independent sample t-tests. Results: Participants in the intervention group showed a significant reduction in HbA1c (mean change: –1.6%, p < 0.001) compared to the control group (mean change: –0.3%, p = 0.084). Treatment adherence improved markedly in the intervention group (+2.3 points, p < 0.001) versus minimal change in the control group (+0.5 points, p = 0.067). Patient satisfaction and perceived knowledge also significantly improved in the intervention group (p < 0.001). Conclusion: Structured diabetes education significantly improves glycemic control and medication adherence in newly diagnosed patients. Integration of such programs into routine care is essential to address the diabetes epidemic in Pakistan.

Clinical Outcome of Conservative Management of Acute Appendicitis

Syeda Midhat Fatima Bukhari — 2025-05-31

Conservative management of uncomplicated acute appendicitis using antibiotics has gained global interest as a safe alternative to surgery. This approach is especially relevant in resource-limited healthcare systems like Pakistan, where surgical capacity and accessibility remain constrained. This study aimed to evaluate the clinical outcomes of non-operative management in patients with uncomplicated acute appendicitis in a Pakistani tertiary care setting. Methods: This prospective observational study was conducted at a PIMS hospital in Islamabad from 9 November 2024 to 9 February 2025. Patients were treated conservatively with intravenous antibiotics followed by oral antibiotics. Primary outcomes included symptom resolution, recurrence within six months, and the need for delayed appendectomy. Secondary outcomes included hospital stay duration, complications, and readmission rates. Data were analyzed using SPSS version 26.0. Results: Symptom resolution was achieved in 86.2% of patients within 48 hours. During initial admission, 94.3% were successfully managed without surgery. At six-month follow-up, 80.5% remained symptom-free. In 13.8% of patients, recurrence occurred, while 11.5% required delayed appendectomy. Complication and readmission rates were low (3.4% and 6.9%, respectively), and the mean hospital stay was 3.8 days. Conclusion: Conservative management of uncomplicated acute appendicitis is a safe and effective alternative to surgery in selected patients. This approach may reduce hospital burden, lower healthcare costs, and minimize surgical risks in the Pakistani healthcare context.

Frequency and Severity of Head Injury Among Motorcycle Riders With and Without Helmet Use

Mubashara Waheed Siddiqui — 2025-05-31

Related injuries are a growing public health concern worldwide, particularly head injuries, which are a leading cause of death and long-term disability among riders. Despite strong evidence supporting the protective benefits of helmets, helmet usage remains inconsistent, especially in low- and middle-income countries. Understanding the frequency and severity of head injuries in riders with and without helmets is essential for guiding safety regulations, promoting helmet use, and reducing the burden of traumatic brain injuries due to motorcycle accidents. Objective: The main objective of the current study was to determine the frequency and severity of head injury among motorcycle riders with and without helmet use presenting at the emergency ward of a tertiary care hospital. Methods: This cross-sectional study was conducted from November 15, 2024, to February 28, 2025, in the Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi. Participants of both genders, aged between 18-60 years, who were motorcycle riders or pillion riders presenting at the emergency ward with road accidents were included in this study. Mentally disabled patients and cases in which obtaining consent was not possible because unconsciousness of patients and the absence of their attendants were excluded from the current research study; the data were analyzed by using SPSS version 27. Results: A total of 195 motorcycle drivers injured in road accidents were included in the study; the mean age (years) of all patients was 33.24±15.73, and 80.5% (n=157) were male. Motorcycle male drivers with and without helmets presented as 88(89.8%) & 69(71.1%) compared with the female drivers as 10(10.2%) and 28(28.9%), p-value of 0.001. Glasgow Coma Scale (GCS) scores showed that motorcycle drivers with and without helmets were more often in mild (GCS-15) as 66 (67.3%) versus 27 (27.8%), p-value < 0.000. The moderate (GCS Score 9-12) severity of head injury was 4 (4.1%) versus 12(12.4%), respectively. Severe (GCS Scores 3-8) were observed as 8 (8.2%) compared to 24 (24.7%) with a statistically significant p-value < 0.005. Conclusion: The study shows that helmet use among motorcycle drivers significantly reduces the severity of head injuries. Riders who used helmets had a higher rate of mild Glasgow Coma Scale (GCS) scores and a lower number of severe injuries compared to those without helmets.

Comparison of Time to Fracture Union and Functional Outcome by Minimally Invasive Plate Osteosynthesis vs Shortened Intramedullary Nailing in Extra-Articular Distal Tibia Fractures

Muhammad Saad Farooq — 2025-05-31

Extra-articular distal tibial fractures pose significant management challenges due to the bone's subcutaneous nature and limited soft tissue envelope, increasing the risk of complications. Minimally invasive plate osteosynthesis (MIPO) and shortened intramedullary nailing (IMN) are two commonly employed fixation methods; however, their comparative effectiveness in fracture healing and functional recovery remains uncertain. Objective: To compare the time to radiographic union and functional outcomes between shortened intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) in treating extra-articular distal tibial fractures. Methods: A single-center, prospective, randomized controlled trial was conducted from January to December 2024. Sixty skeletally mature patients (aged 20–60 years) with AO classification 43A1–A3 extra-articular distal tibia fractures were randomly assigned to receive either shortened IMN (n=30) or MIPO (n=30). Radiographic healing was assessed using the Radiographic Union Score for Tibial fractures (RUST) at 2 weeks and 3, 4, 5, and 6 months postoperatively. Functional outcome was evaluated using the Olerud-Molander Ankle Score (OMAS) at the final follow-up. Time to union and OMAS grades were compared using chi-square tests, with significance set at p<0.05. Results: A significantly higher proportion of patients in the IMN group achieved union within 12 weeks (66.7%) compared to the MIPO group (26.7%) (p=0.017). Conversely, delayed union beyond 20 weeks was more prevalent in the MIPO group (50.0% vs. 20.0%). Excellent OMAS outcomes were reported in 70.0% of IMN patients versus 20.0% in the MIPO group (p=0.001). The incidence of angular deformity was comparable between groups (IMN: 23.3%, MIPO: 16.7%; p>0.05). Conclusion: Shortened intramedullary nailing leads to earlier radiographic union and superior functional recovery compared to minimally invasive plate osteosynthesis for extra-articular fractures.

Effect of Zinc Supplementation in Acute Watery Diarrhea in Children 6 Months to 5 Years

Sahrish Khan — 2025-05-31

AWD is the third most common cause of childhood morbidity and mortality in the developing world today. Iron deficiency anemia, and more commonly zinc deficiency, remain rife, especially among children in these areas, thus exposing them to a weakened immune system. It was known from the report that Zinc is said to have been recommended by the World Health Organization (WHO) as a means to shorten the duration and lessen the severity of diarrhea. Objectives: to determine the role that zinc supplementation has on the duration, severity, and frequency of acute watery diarrhoea among children of 6 months to 5 years of age. A quasi-experimental study. Methods: The study was conducted in the Pediatric A ward, Ayub Medical Complex, Abbottabad in the duration from 27 September 2024 to 27 March 2025. A total of 150 children between 6 months and 5 years of age presented with acute watery diarrhea. The patients were divided into two groups: 75 accepted zinc supplementation (20 mg/day for 10 days) and 75 children received no additional zinc. More specifically, the number of diarrheal stools per day, as well as the total number of diarrheal stools and days, were obtained. The level of statistical significance was determined by p-value and standard deviation (SD). Results: out of 150 patients, prophylactic effect in children receiving zinc supplementation was experienced diarrhea for a shorter time in terms of the mean duration: 3.5±1.2 against 5.1±1.8 in the control group, p < 0.05. In the same way, the frequency of stools was lower in the zinc group compared to the placebo group. The zinc group had a standard deviation of 1.2 for the duration of diarrhea, and the control group had a standard deviation of 1.8, and the p-value = 0.01, which shows that our findings are significantly different. There were no clinically significant adverse effects in either study group. Conclusions: The present study shows that zinc supplementation clearly shortens the duration and mitigates the severity of acute watery diarrhea among children aged between 6 months to 5 years. This enhances the process of extending the traditional course of zinc support during diarrhea management to enhance course favorable results as well as minimize the load on the health care systems.

Frequency of Coronary Artery Anomalies Among Adult Patients Undergoing Primary Percutaneous Coronary Intervention

Muhammad Jawad — 2025-05-31

Coronary artery anomalies (CAAs) are congenital variations in coronary anatomy that may be encountered during primary percutaneous coronary intervention (PCI). Early recognition is critical to avoid procedural complications, especially during emergent interventions. Objective: To determine the frequency and types of CAAs in adult patients undergoing primary PCI in a tertiary care hospital in Pakistan. Methods: This descriptive cross-sectional study was conducted over six months at the Department of Cardiology, Bahawal Victoria Hospital (BVH), Bahawalpur, from 3^rd October 2024 to 3^rd April 2025. One hundred sixty-two adult patients undergoing primary PCI were included using non-probability consecutive sampling. Demographic, clinical, and angiographic data were recorded. Coronary angiograms were assessed for anomalies by two experienced interventional cardiologists. Data were analyzed using SPSS v25. Chi-square tests were applied to evaluate associations between CAAs and cardiovascular risk factors. Results: Among the 162 patients, the mean age was 58.4 ± 10.2 years, with 74.7% being male. The overall frequency of CAAs was 9.3% (n = 15). The most common anomaly was the right coronary artery (RCA) originating from the left coronary sinus (3.1%), followed by absence of the left main trunk with separate origins of the LAD and LCx arteries (2.5%). No statistically significant association was found between CAAs and hypertension (p = 0.43), diabetes mellitus (p = 0.39), smoking (p = 0.36), age > 60 years (p = 0.85), or male gender (p = 0.68). Conclusion: The frequency of CAAs in patients undergoing primary PCI in this Pakistani tertiary care setting was relatively high at 9.3%. The most frequently observed anomalies were RCA from the left coronary sinus and absence of the left main trunk. While no significant correlation was observed with traditional cardiovascular risk factors, the recognition of CAAs remains essential during emergency PCI to guide catheter selection, prevent procedural delays, and ensure patient safety.

Impact of Different BMIs on Fetomaternal Outcome as Compared to Control Group BMIs

Mounazza Rehman — 2025-05-31

Maternal body mass index (BMI) plays a pivotal role in determining fetomaternal outcomes. Deviations from the normal BMI range—whether underweight, overweight, or obese—are associated with adverse maternal and neonatal complications. As the global prevalence of abnormal BMI among women of reproductive age continues to rise, it is imperative to understand its impact on pregnancy outcomes to optimize prenatal care strategies. Objective: To evaluate and compare the fetomaternal outcomes across different maternal BMI categories—underweight, overweight, and obese—using women with normal BMI as the reference group, with a focus on maternal complications (e.g., pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), postpartum hemorrhage (PPH)) and neonatal indicators (e.g., birth weight, NICU admission). Methods: This cross-sectional observational study was conducted over six months at the Combined Military Hospital (CMH), Quetta from July 2023 to January 2024. A total of 200 third-trimester pregnant women with singleton pregnancies were selected via purposive sampling and stratified equally into four BMI categories—underweight, normal (control), overweight, and obese—based on World Health Organization (WHO) BMI criteria. Data on mode of delivery, maternal complications, and neonatal outcomes were collected using clinical records and semi-structured interviews. Statistical analysis involved the use of frequencies, percentages, and thematic content analysis to assess psychological factors. Results: Obese women exhibited the highest rates of cesarean delivery (48%), GDM (30%), PIH (24%), macrosomia (20%), and NICU admissions (28%). Overweight women also demonstrated increased risks across these categories, though to a slightly lesser degree. Underweight mothers had the highest incidence of low birth weight (36%), notable NICU admissions (12%), and assisted vaginal delivery (8%). Women with normal BMI consistently showed the most favorable outcomes across all variables. Thematic analysis revealed psychological distress related to body image, fear of surgical interventions, and reduced emotional support, especially among underweight and obese participants. Conclusion: Abnormal maternal BMI is significantly associated with poor fetomaternal outcomes. Underweight status predisposes to intrauterine growth restriction and neonatal morbidity, while obesity increases the risk of metabolic, hypertensive, and delivery-related complications. Optimal pregnancy outcomes are most consistently observed in women with normal BMI. These findings highlight the need for BMI-based prenatal risk stratification, targeted counseling, and integrated psychosocial support to improve maternal and neonatal health.

Frequency of Helicobacter Pylori Infection Among Patients With Dyspepsia

Sassi Manzoor Hassan — 2025-05-31

Helicobacter pylori (H. pylori) is a globally prevalent pathogen, infecting nearly half of the world’s population. It is strongly associated with a spectrum of gastrointestinal disorders, including chronic gastritis, peptic ulcer disease, and gastric malignancies. Early detection of H. pylori infection, particularly among dyspeptic individuals, is essential for prompt treatment and prevention of complications. Objective: To determine the frequency of Helicobacter pylori infection among patients presenting with dyspepsia at tertiary care hospitals in Quetta and Turbat, Pakistan. Methods: This descriptive cross-sectional study was conducted at the Department of Internal Medicine, Sandeman Provincial Hospital, Quetta, and the Department of Medicine, Teaching Hospital, Turbat from January 2023 to December 2023. A total of 145 adult patients presenting with clinical features of dyspepsia and fulfilling the inclusion criteria were enrolled after obtaining informed written consent. Detailed history and clinical examination were performed. Stool samples were collected from all participants and tested for Helicobacter pylori stool antigen (HPSA) using enzyme immunoassay. Data were analyzed to determine the frequency of H. pylori infection. Results: Out of 145 patients with dyspepsia, 93 (64.1%) were males and 52 (35.9%) were females. The mean age of the study population was 29.95 ± 4.71 years. H. pylori infection was detected in 99 patients, representing a prevalence of 68.3%. Infection was more common among males and individuals residing in urban areas. Conclusion: The prevalence of Helicobacter pylori infection among dyspeptic patients in this study was notably high, especially in young males and those from urban settings. These findings highlight the need for routine screening and early eradication therapy in symptomatic individuals to reduce gastrointestinal morbidity.

Comparison Study Of Minimally Invasive Plate Osteosynthesis (MIPO) Vs Open Reduction And Internal Fixation (ORIF) For Comminuted Distal Tibia Fracture

Mishkat Ullah — 2025-05-31

Comminuted distal tibia fractures are complex injuries that require precise management due to limited soft tissue coverage and high risk of complications. Two commonly used fixation techniques are minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF). Each method has distinct biomechanical and biological implications that influence healing outcomes. Objective: To compare the functional and radiological outcomes of MIPO versus ORIF in the treatment of comminuted distal tibia fractures. Methods: This prospective comparative study was conducted at the Department of Orthopedic Surgery, CMH Rawalpindi, from 15 June 2024 to 14 Feb 2025. A total of 60 patients were divided into two groups of 30 each, treated with either MIPO or ORIF. Functional outcomes were measured using the AOFAS score, and radiological union was assessed through serial X-rays. Results: The MIPO group showed significantly higher mean AOFAS scores (88.5 vs. 80.9), faster union times (15.2 vs. 17.6 weeks), and fewer complications compared to the ORIF group. Conclusion: MIPO is a superior technique for comminuted distal tibia fractures, offering better outcomes with fewer complications.