Pakistan Postgraduate Medical Journal

TIME TO REWRITE THE MBBS CURRICULUM: WHY DOES IT NEEDS URGENT REFORM?

2026-10-08T05:51:14+00:00

The curriculum for MBBS poses responsibility on the designer to equip the students with knowledge, skills and attitudes to treat the patients and contribute effectively to the society being served¹ with safeguarding patient safety.² Is the curriculum serving the purpose of preparing the doctors to face the health challenges of tomorrow?

Medical education remains extensive and if not effectively organized content wise exhausts the students leading to student burnout.³ The teacher and student involved in dispersing the content is always anxious to complete the course content within the timeline provided. The foremost reason being the details included in all the subjects in the curriculum. The syllabus of both basic and clinical subjects includes topics in unnecessary details; it seems if all the students would become biochemists after studying biochemistry and similarly all students would become physicians after studying medicine.⁴ Attempts to integrate curricula horizontally and vertically improved the understanding of the subject in relevance to disease and segregating content into modules which gave ease of completion of course in a stipulated time.⁵ Even these changes over a period of time did not make the student take interest in lectures or clinical work.

What is wrong with our curriculum?

The learning outcomes are extensive to address theoretical knowledge and fall short in defining skills and attitudes required for a medical graduate. More and more content is being added each year with no emphasis on skills and attitudes. A student memorizes 200 drugs but will fail to counsel about hand hygiene to public or break sad news with empathy.
The content allocated in modules is not aligned with assessment marks, students leave important content when they realize that it will not affect total scores. For example, if the module carries only 2 MCQs from neuro anatomy, the student will skip entire neuroanatomy and study easy content.
Community oriented diseases and preventive medicine are not given due weightage in course content. A student memorizes Krebs cycle or Wilson’s disease but fails to realize importance of population management and prevention of iron deficiency anemia.
The assessment tests memory and not competence. The exams are designed to reward rote learners and not give credit to students who attended the wards and respected the patients.
There is lack of alignment between learning outcomes and tools used for assessment. The learning outcomes designed for dispersing theory are assessed on MCQS.

So, in the light of the above, what can be done to bring a change in the curriculum? In my opinion, few suggestions are:

It is time to move from content based to competency-based curriculum for the MBBS Course, in a manner which is similar to that that is already adopted in the post graduate curricula. It is the only solution where students take responsibility to acquire the competencies, and the teacher is responsible to ensure the transfer of competencies aptly to each student.
Appropriate number of competencies can be designed for every module, assessment of competencies to assessor satisfaction and a provision of remedial must be present.
Ethics, professionalism, communication skills and research must be adequately addressed as competencies. The purpose must be to equip students with the ability to become lifelong learners and be able to develop their competencies throughout life.
Mandatory interaction of students with patients in hospitals, so learning remains contextual and relevant. Interaction should start from first year. Mandatory visits to basic healthcare units, Rural health care centers and district hospitals. Keeping medical students in big tertiary care hospitals without ever visiting BHU/RHC deprives the doctor of understanding what the real problems related to population explosion are safe drinking water and malnourishment.
Assessment needs change. In my opinion, semester system in medical education will take away the syllabus pressure off the students, motivating them to be regular in class attendance and daily study habits. Annual assessment makes the student delay serious studying until the final months before examination, which creates intense mental, physical and psychological pressure on majority of the students. Assessments are meant to evaluate application of knowledge not the memory or recall alone. Effective communicators with digital skills would help shape up future medical professionals.⁶

Medical education universally finds itself at a crossroads leading to young doctors facing diluted professional identity.⁷ The onus lies on PMDC, Universities and representatives of stakeholders involved in medical education to show courage and take the responsibility to change the MBBS curriculum to competency based and ensure producing medical graduates who are clinically competent, ethical, humane and add value to providing clinical services to the nation.

PREVALENCE AND ANTIMICROBIAL RESISTANCE PATTERN OF E.COLI CAUSING UTI AMONG PATIENTS

2026-10-08T05:51:14+00:00

ABSTRACT

Background: Urinary tract infections (UTI) are one of the most common bacterial infections, with Escherichia coli (E.coli) being the predominant causative agent in both community and hospital settings. The increasing antimicrobial resistance among uropathogenic E.coli poses a significant challenge to effective treatment.

Objective: This study aimed to determine the prevalence and antimicrobial resistance pattern of E.coli isolated from urinary tract infection patients at Sheikh Zayed Hospital, Lahore.

Methods: A cross-sectional observational study was conducted from January 2025 to June 2025. A total of 224 midstream urine samples were collected and processed through standard microbiological techniques for the isolation and identification of E.coli. Antimicrobial susceptibility testing was performed using the disc diffusion method according to Clinical Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was conducted using SPSS version 26.

Results: Out of 224 urine samples, females (57%) were more frequently affected compared to males (43%), with the most infections observed in the age group of 40–65 years. Most commonly isolated pathogen was E.coli 75 (34%). E.coli isolates exhibited greatest susceptibility to Amikacin (94%), Imipenem (93%), Meropenem (92%), urinary antiseptics Nitrofurantoin and Fosfomycin (82%) and (81%), and Gentamicin (72%). Highest rates of resistance were seen among Ciprofloxacin (18%) and Levofloxacin (14%). The chi-square test indicated a significant association between gender and UTI occurrence (p-value < 0.05).

Conclusion: The study shows a high prevalence of UTI especially among female patients. The most commonly isolated pathogen remains to be E.coli. Aminoglycosides, Carbapenems, and and urinary antiseptics remain to be the most effective treatment option against resistant uropathgenic E.coli. However, owing to the increased antimicrobial resistance, it is extremely important to undergo routine culture and sensitivity testing before commencing antibiotic therapy.

Keywords: E.coli, Antimicrobial Resistance, UPEC, UTI, Carbapenems

PROPHYLACTIC ROLE OF CURCUMIN IN PROTECTING DISTAL CONVOLUTED TUBULE DIAMETER AGAINST ASPIRIN-INDUCED NEPHROTOXICITY IN ALBINO RATS

2026-10-08T05:51:15+00:00

Background: Aspirin is one of the widely used anti-inflammatory nonsteroidal drug worldwide, that can cause nephrotoxic effects by inhibiting prostaglandin synthesis. Curcumin, an active component of turmeric, has been shown to possess antioxidant and anti-inflammatory properties that help to protect renal tubules.
Objective: To determine the protective role of curcumin in preserving the diameter of distal convoluted tubules (DCT) after aspirin-induced renal toxicity in adult female albino rats.
Methods: A total of sixty albino rats were randomly selected and divided into four groups. Group A was the control group and were given distilled water Group B received aspirin alone, and Groups C and D received aspirin along with low and high doses of curcumin, respectively. Renal tissues were taken out for histological evaluation and for morphometric measurement of DCT diameter. ANOVA followed by Tukey's test was used for the analysis of data.
Results: The largest diameter of DCT was observed in Group A (56.7 ± 2.4 µm). Administration of aspirin significantly decreased DCT diameter in Groups B and C. While Group D showed significant preservation of diameter when compared to Group C and Group B and it was statistically significant with a p value of p=0.007.
Conclusion: Curcumin showed a dose-dependent protective effect on distal tubular structures to counteract against aspirin-induced nephrotoxicity.
Keywords: Curcumin, Aspirin, Distal Convoluted Tubule, Nephrotoxicity, Albino Rats

PATTERN OF ANTIBACTERIAL RESISTANCE IN URINARY TRACT INFECTIONS

2026-10-08T05:51:15+00:00

INTRODUCTION:
Urinary Tract Infections (UTIs) represent one of the most prevalent bacterial infections encountered in clinical practice worldwide, affecting individuals of all ages and demographics 1. Despite advancements in science and healthcare, the management of UTIs continues to pose substantial challenges, primarily due to the emergence and proliferation of antibiotic-resistant strains of bacteria. The rise in antimicrobial resistance (AMR) not only compromises the efficacy of traditional treatment regimens but also underscores the urgent need for a deeper understanding of the evolving patterns of antibacterial resistance in UTIs 2.
The misuse and overuse of antibiotics have facilitated the proliferation of resistant bacterial strains, rendering once-effective treatment options ineffective 3. Understanding the specific patterns of antibacterial resistance in UTIs is paramount for guiding clinical decision-making and formulating effective therapeutic strategies. Analysis of surveillance data reveals varying resistance profiles across different geographical regions and patient populations4,5, highlighting the dynamic nature of antimicrobial resistance and the importance of tailored treatment approaches.
Moreover, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains poses a grave threat to public health6,7, limiting treatment options and increasing the risk of treatment failure and disease complications8,9. A study done by Mortazavi et al1 showed that the most common pathogens causing UTIs were E. coli, Klebsiella, Staphylococcus, and Streptococcus with a frequency of 62%, 13%, 12%, and 11%. Other bacteria such as Citrobacter and Pseudomonas had a marginal role in UTI with a combined frequency of 2%.
The rationale of this study is to determine bacterial etiologic agents responsible for urinary tract infection and to evaluate their in vitro susceptibility pattern to commonly used antimicrobial agents. This study is important for clinicians to facilitate the effective treatment and management of patients with symptoms of urinary tract infection and to avoid unnecessary judicious use of these drugs to preserve their efficacies. Development of unusual resistance among such strains could easily be detected, and thus, will help in better treatment and management of those infected by these pathogens.

OBJECTIVE:
1. To determine the frequency of the most common gram-positive and gram-negative organisms causing urinary tract infections
2. To measure the frequency of their sensitivity/resistance to different antibiotics in patients admitted through OPD/Emergency.

MATERIAL AND METHODS
STUDY DESIGN: Cross-sectional study

SETTING: Department of Medicine, Railway Hospital, Rawalpindi

DURATION OF STUDY: Six months after approval of synopsis.

SAMPLE SIZE:
● The WHO Sample Size Calculator was used to calculate the sample size.

● A study done by Mortazavi et al 1 was taken as a reference

● Absolute precision = 6%

● Confidence level = 95%

● The sample size comes out to be = 105 patients

SAMPLING TECHNIQUE: Non-probability, consecutive sampling

SAMPLE SELECTION:

Inclusion criteria:

1)Patients with UTI proven by positive growth of microorganisms on urine culture.
2)Patients between 12-75 years of age.

Exclusion criteria: All potential factors behaving as confounders will be included in the exclusion criteria

1)Patients with tubo-ovarian disorders, sexually transmitted diseases, appendicitis, prostatitis, and epididymitis.
2)Patients already taking antibiotics before hospital presentation.
3)Pregnant patients

DATA ANALYSIS:
Data will be entered and analyzed using SPSS v22.0. Frequency and percentage will be presented for qualitative variables like sex, co-morbids, type of organisms, urine R/E and antibiotics to which these organisms are sensitive/resistant. Mean ± SD will be calculated for age and BMI. Data will be stratified for age, BMI and gender to control effect modifiers. Post-stratification, the chi-square test will be applied. A p-value of ≤0.05 will be considered significant.

RESULTS & CONCLUSIONS: This study demonstrates high rates of fluoroquinolone and third-generation cephalosporin resistance among uropathogens in our setting, with preserved susceptibility to aminoglycosides, carbapenems, fosfomycin, and nitrofurantoin. These findings underscore the urgent need for antimicrobial stewardship, routine susceptibility surveillance, and adherence to evidence-based treatment guidelines. Future research should focus on molecular epidemiology of resistance, longitudinal resistance trends, and evaluation of stewardship interventions to preserve the efficacy of available antimicrobials.

REFERENCES:

1. Mortazavi-Tabatabaei SAR, Ghaderkhani J, Nazari A, Sayehmiri K, Sayehmiri F, Pakzad I. Pattern of Antibacterial Resistance in Urinary Tract Infections: A Systematic Review and Meta-analysis. Int J Prev Med. 2019;10:169.
2. Khademi F, Sahebkar A. A systematic review and meta-analysis on the prevalence of antibiotic-resistant Listeria species in food, animal and human specimens in Iran. J Food Sci Technol. 2019;56(12):5167-5183.
3. Tchesnokova V, Larson L, Basova I, Sledneva Y, Choudhury D, Solyanik T et al. Increase in the community circulation of ciprofloxacin-resistant Escherichia coli despite reduction in antibiotic prescriptions. Commun Med. 2023;3(1):110.
4. Ali SA, Mandal S, Georgalas A, Gilani SAD. A Pattern of Antibiotic Resistance in Gram-Negative Rods Causing Urinary Tract Infection in Adults. Cureus. 2021;13(1):e12977.
5. Vazouras K, Velali K, Tassiou I, Anastasiou-Katsiardani A, Athanasopoulou K, Barbouni A et al. Antibiotic treatment and antimicrobial resistance in children with urinary tract infections. J Glob Antimicrob Resist. 2020;20:4-10.
6. Bakhtiari S, Mahmoudi H, Seftjani SK, Amirzargar MA, Ghiasvand S, Ghaffari ME et al. Antibiotic resistance pattern and phylogenetic groups of the uropathogenic Escherichia coli isolates from urinary tract infections in Hamedan, west of Iran. Iran J Microbiol. 2020;12(5):388-394.
7. Alshaikh SA, El-Banna T, Sonbol F, Farghali MH. Correlation between antimicrobial resistance, biofilm formation, and virulence determinants in uropathogenic Escherichia coli from Egyptian hospital. Ann Clin Microbiol Antimicrob. 2024;23(1):20.
8. Pałka A, Kujawska A, Hareza DA, Gajda M, Wordliczek J, Jachowicz-Matczak E et al. Secondary bacterial infections & extensively drug-resistant bacteria among COVID-19 hospitalized patients at the University Hospital in Kraków. Ann Clin Microbiol Antimicrob. 2023;22(1):77.
9. Kaza P, Xavier BB, Mahindroo J, Singh N, Baker S, Nguyen TNT et al. Extensively Drug-Resistant Klebsiella pneumoniae Associated with Complicated Urinary Tract Infection in Northern India. Jpn J Infect Dis. 2024;77(1):7-15.

DIVERSITY OF HEMATOLOGICAL DISORDERS UNCOVERED IN BONE MARROW EVALUATION

2026-10-08T05:51:15+00:00

Background: Bone marrow examination is a significant diagnostic tool for assessing a wide range of hematological and certain non-hematological disorders. The spectrum of disorders varies with patient population and referral patterns, and local trend data remain limited. This retrospective study was conducted to evaluate the distribution and trends of hematological and non-hematological disorders diagnosed on bone marrow examination. The results aim to highlight the relative frequencies of various conditions diagnosed on routine bone marrow examination.

Methodology: This cross-sectional study was conducted in the hematology department of Chughtai Institute of Pathology between January 2022 and December 2023. The study comprised all bone marrow biopsies performed at Chughtai Institute of Pathology as well as biopsy specimens received for reporting from various centers. One thousand nine hundred and seventy-one bone marrow biopsies in all were documented. Relevant clinical data were obtained and statistically analyzed, including patient demographics, presenting symptoms, laboratory results, imaging tests, bone marrow morphology, immunophenotypic profiles, and diagnosis. The mean and standard deviation for age was determined. Qualitative variables such as gender and diagnosis were expressed as frequencies and percentages.

Results: Most prevalent hematological condition in the current study group, with 289 cases and a frequency of 14.6%, was precursor B-acute lymphoblastic leukemia. Acute myeloid leukemia (9.02%), aplastic anemia (6.18%), chronic myeloid leukemia (6.33%), and were the next most prevalent disorders. 4% patients had megaloblastic anemia, whereas 10.44% of the patients had normal morphology.

Conclusion: Bone marrow examination remains a vital diagnostic tool for a wide range of hematological and non-hematological conditions. This retrospective study determines the major conditions encountered and reveals trends in their relative frequencies, providing clinicians with valued insight into local disease patterns and supporting in targeted diagnostic evaluation.

Keywords: bone marrow examination, hematological disorders, leukemia.

PROSPECTIVE STUDY OF CLINICAL PRESENTATION, DIAGNOSTIC PROCESS, TREATMENT AND INDUCTION OUTCOME; ONE YEAR EXPERIENCE IN PAEDIATRIC ACUTE MYELOID LEUKEMIA (AML).

2026-10-08T05:51:15+00:00

Introduction: Leukemias constitute one third of all paediatric cancers with myeloid neoplasms constituting about 20% of childhood leukemias.

Objective: To study the clinical features of pediatric Acute Myeloid Leukemia (AML) at presentation and to evaluate impact of these features on outcome.

Methods: It was a Cross-Sectional study conducted at The Children’s Hospital, Lahore from January 2022 to December 2023. The participants included 103 cases of AML diagnosed on bone marrow biopsy and flowcytometry, selected through consecutive convenience sampling. Data was analyzed through SPSS version 20.

Results: Among 103 patients, ninety-three received treatment. The mean age of presentation was 6.9 ±4.5 years and 72.1% were males. The common presenting feature was fever (92%) followed by pallor (64%). Majority of the patients (46%) had initial WBC count of 50,000-100,000/µl. The mean hemoglobin was 6g/dl and the mean platelet count was 14x10⁹/L. Signs and symptoms involving central nervous system were observed in five patients and all were found to have hyperleukocytosis at presentation. The most common FAB subtype was M2(36%) followed by M4(15.5%), M5(12%) and M7(6.8%). Induction mortality rate was 53% and most common cause of death was septic shock. Among rest of the patients, remission rate after first induction was 74%.

Conclusion: Pediatric AML presented with fever, cytopenias, and hyperleukocytosis, with FAB M2 being the most prevalent subtype. While a substantial proportion of patients achieved remission after initial induction, the considerable induction-related mortality, largely attributable to sepsis, emphasizes the need to enhance supportive management and infection prevention strategies to improve survival outcomes.

A FUNCTIONAL OUTCOME OF KNEE JOINT AFTER ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2026-10-08T05:51:15+00:00

ABSTRACT:

BACKGROUND:

Anterior cruciate ligament (ACL) is a common ligamentous injury of knee joint. Graft selection for ACL is a controversial subject. Despite of clinical outcomes with Patellar tendon bone graft (PTB), donor site morbidity and patellar fractures are of great concern with this technique. Peroneus Longus tendon is an alternative technique with promising results. It has greater tensile strength as compared to Patellar tendon (PTB) and quadriceps tendon graft and has a potential with minimal or no donor site morbidity.

METHODS:

After approval from Ethical Review Board of Jinnah hospital Lahore affiliated with Allama Iqbal medical college, this prospective observational study was carried out at Department of Orthopedic Surgery Jinnah Hospital, Lahore from Aug 2024 to Dec 2025. A total number of 24 patients with age between 20-60 years having isolated ACL tear were enrolled in the study after clinical and MRI evaluation. All patients underwent ACL reconstruction with double bundle Peroneus Longus tendon graft. We assessed the knee function preoperatively & postoperatively with Tegner-Lysholm and International Knee Documentation Committee (IKDC Score) score. Similarly, ankle joint functional status was assessed with American Orthopedic Foot and Ankle society score (AOFAS) and foot and ankle disability index (FADI) Score preoperatively and postoperatively after 03 months,06 months and at the end of final follow up of one year after the surgery.

RESULTS:

There was a significant difference between preoperative and post-operative IKDC and Tegner-Lysholm score after ACL reconstruction with Peroneus Longus tendon graft. There was also no donor site morbidity and AOFAS Score and FADI Score were almost equal at the ankle joint preoperatively and postoperatively.

CONCLUSION:

Peroneus Longus tendon is most advantageous for ACL reconstruction in terms of graft harvesting technique, large graft diameter, adequate graft length and lower rate of complication at the donor site. Moreover, ankle function is not deteriorated if proper graft harvesting technique is used. It has a greater tensile strength with minimal or no donor site morbidity.

A COMPARATIVE STUDY OF LOCAL INFILTRATION OF WOUNDS WITH BUPIVACAINE AND INTRAVENOUS PARACETAMOL AT THE TIME OF INDUCTION FOR POST-OPERATIVE PAIN RELIEF IN PEDIATRIC INGUINAL HERNIOTOMY SURGERIES

2026-10-08T05:51:15+00:00

Background and Objective:

Effective postoperative pain control in children is essential to reduce distress, enhance recovery, and prevent complications. We aim to compare the efficacy of local wound infiltration with bupivacaine versus intravenous (IV) paracetamol for early postoperative pain management in children undergoing inguinal herniotomy.

Methods:

This double-blind randomized controlled trial included 98 children aged 5–12 years undergoing elective inguinal herniotomy. Participants were randomly assigned into two groups (n=49 each). In the bupivacaine group, 0.25% bupivacaine (prepared by diluting 0.5% solution) was infiltrated into the surgical wound at induction. In the paracetamol group, IV paracetamol was administered at induction. Postoperative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at 30 minutes and hourly for 6 hours. Rescue analgesia was administered for FLACC scores ≥4. Data were analyzed using appropriate statistical tests, with p≤0.05 considered significant.

Results:

Of the 98 children, 69.4% were male and 30.6% female, with a mean age of 7.19±1.63 years. The bupivacaine group demonstrated significantly lower FLACC scores at 2, 3, 4, 5, and 6 hours postoperatively (p<0.05). Additional analgesia was required in 6.1% of patients in the bupivacaine group compared to 22.4% in the paracetamol group (p=0.021).

Conclusion:

Local wound infiltration with bupivacaine provides superior and prolonged postoperative analgesia compared to IV paracetamol in pediatric inguinal herniotomy, with reduced need for rescue analgesia.

MATRIX METALLOPROTEINASE-2 GENE POLYMORPHISM AND SUSCEPTIBILITY TO MYOCARDIAL INFARCTION

2026-10-08T05:51:15+00:00

Background: Myocardial infarction (MI) is a major cause of death in Pakistan. In pathogenesis of MI, Matrix Metalloproteinases-2 (MMP-2) acts as a major contributor by causing extracellular matrix degradation and atherosclerotic plaque rupture. MMP-2 -1306 C/T polymorphism (rs243865) is a variation in MMP-2 gene that increase the risk of MI.

Objectives: The objective of this study was to find out the association of the MMP-2 -1306 C/T polymorphism with development of MI in the Pakistani population.

Materials: It was a case-control study with 36 acute MI patients and 36 matched healthy controls. MMP-2 gene was augmented by Polymerase Chain Reaction and genotype was found out by Restriction Fragment Length Polymorphism (PCR-RFLP). SPSS 26.0 was used to perform statistical analysis.

Results: The heterozygous CT genotype was significantly higher in MI cases (27.8%) than in controls (5.6%; p = 0.01), with an odds ratio of 6.53 (95% CI 1.3–32.4). The T allele was also significantly linked with MI (p = 0.016). No significantly substantial association was determined between this polymorphism and traditional clinical risk factors, serum MMP-2 levels, or cardiac biomarkers (p > 0.05).

Conclusion: The CT genotype and T allele of the MMP-2 -1306 C/T polymorphism are significantly associated with development of MI. This polymorphism may act as an independent genetic risk marker in the Pakistani population.

EFFICACY OF POST-OPERATIVE VORICONAZOLE IN MANAGEMENT OF CHRONIC INVASIVE FUNGAL RHINOSINUSITIS

2026-10-08T05:51:15+00:00

Background and Objective: Chronic invasive fungal rhinosinusitis (CIFRS) is a gradually progressive disease requiring surgical debridement followed by systemic antifungal therapy. There is limited evidence regarding the use of standardized postoperative voriconazole treatment. The primary objective is to assess short-term clinical, endoscopic, radiological and safety outcomes of voriconazole after functional endoscopic sinus surgery (FESS).

Methods: This prospective single-arm interventional case series included 60 patients. Following surgical debridement, participants received oral voriconazole 400 mg every 12 hours for the first 24 hours and 200 mg every 12 hours for two months. Outcomes were assessed over 12 weeks through symptom evaluation, nasal endoscopy, Lund–Mackay scoring, and laboratory monitoring.

Results: Disease control was observed in 48/60 patients (80.0%; 95% CI: 68.2%–88.2%). Resolution occurred in 52/60 patients with nasal obstruction, 42/48 with facial pain, 40/45 with headache, and 43/50 with rhinorrhea. At 12 weeks, 44/60 patients had no visible polyposis. Mean Lund–Mackay score decreased from 16.5 ± 3.2 to 5.8 ± 2.6. Visual disturbance, elevated liver enzymes, and skin reactions occurred in 8.3%, 6.7%, and 5.0%, respectively.

Conclusion: Combined surgery and postoperative voriconazole were associated with favourable short-term outcomes and predominantly mild adverse effects, although voriconazole-specific efficacy could not be established without a comparator.

CLINICAL OUTCOMES OF ACUTE VIRAL HEPATITIS WITH AND WITHOUT URSODEOXYCHOLIC ACID THERAPY

2026-10-08T05:51:15+00:00

Objective:

To assess the efficacy of Ursodeoxycholic Acid (UDCA) as adjuvant therapy to fasten the resolution of hepatic inflammation and cholestasis in patients presenting with Acute viral hepatitis (AVH).

Study Design:

Parallel group, randomized open label controlled trial.

Place and Duration of Study:

The study was conducted at gastroenterology departments, for a period of 28 days for each individual participant.

Methodology:

One hundred and fifty adult patients with an average age of 18-65 years with diagnosis of AVH (ALT >5x ULN) within 14 days of the onset of symptoms were collected. Participants were randomized in a 1:1 ratio to the UDCA group who received UDCA (13-15mg/kg/day plus standard supportive care) in the form of iv fluids anti ematics and control group (standard supportive care only). The primary outcome measured was the mean decrease in serum ALT level on Day 14. Subsequent effects of treatments Time to resolution of jaundice, and pruritus were secondary outcomes.

Results:

A total of 150 participants were analyzed, 75 were in each group. The baseline characteristics were similar between groups. By Day 14 significant reduction in ALT level (185+-40 unit/L) was also shown in the UDCA group compared with the control (310+- 60 U/L; p < 0.001). The mean time for resolution of jaundice was shorter in the UDCA arm (mean 14.2 days compared to the control arm, mean 21.5 days). Mild diarrhea was reported in 5.3 of the UDCA group and no serious adverse events reported.

Conclusion:

UDCA is a safe and effective adjunctive therapy which significantly improves biochemical recovery and clinical resolution of jaundice in patients with acute viral hepatitis.

ASSOCIATION BETWEEN VITAMIN D DEFICIENCY IN PREGNANCY AND LOW BIRTH WEIGHT NEONATES

2026-10-08T05:51:15+00:00

ABSTRACT:

Background and Objective:

Vitamin D deficiency and low birth weight (LBW) are both very common in Pakistan. Therefore, the aim of this study was to determine the association between low birth weight (LBW) and maternal vitamin intake. D deficiency.

Methods:

This prospective cohort study was conducted in the department of obstetrics and gynecology of Lady Aitchison Hospital Lahore from April-2026 to June-2026. We included 60 pregnant patients who delivered their babies in the hospital at gestational age ≥36 weeks. At 32 to 34 weeks of gestation, venous blood samples were obtained and sent for vitamin d level measurements. We included 30 women who were vit. D-deficient and 30 women who were having adequate vitamin. D levels. All patients were followed till delivery, and after delivery, the neonatal birth weight was measured.

Results:

The mean ages of mothers were 27.62 ± 4.31 and 28.06 ± 4.71 years (p=0.67). Mean gestational age was 38.1 ± 0.99 and 38.06 ± 1.11 weeks (p=0.90). Among the exposed group (N=30), 10 patients (33.3%) had low birth weight (LBW) infants, whereas in the unexposed group (N=30), only 3 patients (10.0%) had LBW infants [RR 1.80 (CI 1.16 to 2.8)] (p=0.02).

Conclusion:

Vitamin D deficiency during pregnancy is significantly associated with a higher risk of giving birth to LBW babies. Therefore, there is a need to check vitamin D levels in early pregnancy and vitamin. D supplementation should be advised to mothers having vitamin. D deficiency.

IRON DEFICIENCY ANEMIA IN CHILDREN WITH FEBRILE FITS

2026-10-08T05:51:16+00:00

ABSTRACT:

Background:

Febrile seizures are common seizures often observed in children aged 6 months to 5 years. Some studies have have explored the potential link between IDA and FS in young children.

Objective:

To determine the association of iron deficiency anemia (IDA) with febrile fits in children.

Methodology:

This case-control study was conducted in Dr. Faisal Masood Teaching Hospital, Sargodha, from May 2025 to December 2025. In this study, the cases were the children who were admitted with febrile seizures, while the controls were those who presented with any other complaint in the hospital. The blood samples were drawn using a 5 cc BD syringe for evaluation of serum HB, MCV, Hct, and ferritin levels. Frequency of IDA was determined. Odds ratio was calculated to found out the association between IDA and febrile fits. OR>1 was considered statistically significant.

Results:

The mean age was 24.9 (SD: 12.5) years. Among the participants, 127 (63.5%) were male and 73 (36.5%) were female. Cases exhibited a lower mean hemoglobin (HB) level (9.3 ± 1.1 g/dL) compared to controls (10.4 ± 1.2 g/dL; P < 0.001). Serum ferritin levels were substantially reduced in the case group (46.8 ± 25.2) versus the control group (82.4 ± 18.7; P < 0.001). The frequency of IDA was 33% among cases and 19% among controls, with odds ratio of 2.09 (1.09 to 4.02), demonstrating that cases had more than twice the odds of IDA compared to controls (p-value 0.02).

Conclusion:

IDA is significantly associated with febrile seizures. Screening all children experiencing a first febrile seizure for iron deficiency is recommended. Early detection and iron supplementation may help prevent recurrence.

A A STUDY ON RISK OF DEVELOPMENT OF GESTATIONAL DIABETES MELLITUS IN PREGNANT PATIENTS WITH OVER & SUBCLINICAL HYPOTHYROIDISM

2026-10-08T05:51:16+00:00

ABSTRACT:

OBJECTIVE: To calculate the prevalence of overt and subclinical hypothyroidism and gestational diabetes mellitus among pregnant females and to find out if there is an association between these two pathologies.

STUDY DESIGN & SETTING: It is a cross-sectional descriptive case series carried out over a period of 08 months from November 1st 2025 to July 1st 2026 at Department of Obstetrics & Gynecology, Sheikh Zayed Hospital, Lahore, which is a tertiary care hospital in Lahore, Pakistan.

METHODOLOGY: 300 pregnant females of age 18-40 years with single viable fetus were included in this study. Thyroid function tests (serum TSH, free T3 and free T4) were done at 16-20 weeks followed by oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Data was analysed by SPSS version 29.0 using Chi square test. P value equal to or less than 0.05 was considered statistically significant.

RESULTS: The odds of developing gestational diabetes mellitus (GDM) were approximately 10 times higher among women with hypothyroidism (OR = 10.24, 95% CI: 4.32–24.28) & this association was statistically significant (p = 0.001)

CONCLUSION: Presence of hypothyroidism was significantly associated with an increased likelihood of development of gestational diabetes mellitus (GDM) in the study population.

KEY WORDS: Subclinical hypothyroidism, overt hypothyroidism, gestational diabetes mellitus (GDM).

BODY DYSMORPHIC DISORDER SCREENING IN AESTHETIC PRACTICE AND THE ROLE OF ARTIFICIAL INTELLIGENCE

2026-10-08T05:51:16+00:00

Background

Body dysmorphic disorder (BDD) is a psychiatric disorder characterized by a persistent preoccupation with perceived defects in physical appearance that are minimal or not observable to others. It is particularly relevant in aesthetic medicine, where prevalence appears higher than in the general population. Patients with BDD often seek cosmetic interventions; however, aesthetic treatment rarely addresses the underlying psychopathology and may worsen dissatisfaction, reinforce distorted self-perception, and increase requests for repeated procedures. Early recognition is therefore essential for patient safety and ethical practice.

Objective

To review the literature on the screening of BDD in aesthetic practice and to examine the emerging role of artificial intelligence (AI) as a supportive tool for early detection.

Methodology

A structured literature review was conducted using PubMed, Embase, Scopus, and Google Scholar. Studies published in English between January 2000 and March 2026 were considered. Search terms included body dysmorphic disorder, BDD, aesthetic medicine, cosmetic surgery, psychological screening, artificial intelligence, machine learning, and deep learning. A Best Evidence Topic (BestBETs) approach was used to evaluate the literature.

Results

The reviewed literature supports the use of validated screening tools, including the Body Dysmorphic Disorder Questionnaire (BDDQ), BDDQ-Dermatology Version (BDDQ-DV), Dysmorphic Concern Questionnaire (DCQ), and Cosmetic Procedure Screening Questionnaire (COPS), for identifying patients at risk of BDD in aesthetic settings. However, screening tools alone are insufficient for diagnosis, and a clinical interview by a mental health professional remains essential. Emerging AI-based approaches, including machine learning, natural language processing, digital phenotyping, and computer vision, show potential as adjunctive methods for identifying behavioral, linguistic, and visual patterns associated with dysmorphic concern. Current evidence is promising but limited by small sample sizes, heterogeneity of methods, and lack of large-scale clinical validation.

Conclusion

Conventional screening tools remain the cornerstone of BDD detection in aesthetic practice. AI may serve as a useful decision-support tool for early recognition, but it should complement rather than replace clinical judgment and psychiatric evaluation. Future