Pakistan Postgraduate Medical Journal

FOSTERING A CONDUCIVE TEACHING ENVIRONMENT FOR POSTGRADUATE MEDICAL TRAINING IN PAKISTAN

Prof. Nudrat Sohail — Wed, 01 Jul 2026 05:53:36 +0000

On job training for postgraduate medical students remains a testing task, whereas on one hand the acquisition of knowledge, skills and attitudes remains the priority. On the other hand, they face the real challenges of practical life where they encounter patients, their attendants & most important their senior peers and teachers. The environment in which this training takes place becomes big and complex. The general consensus remains that the onus to keep environment conducive is the responsibility of instructors and the teaching faculty^1,2,3. However, the challenge of keeping the trainees focused on healthy, enthusiastic and keen is difficult.

The training of clinicians to become consultants, researchers and future teachers is studied with challenges like long service hours, patient load and less than adequate mentorship resulting in production of specialists who may not be aptly trained.

Within the context of Pakistan which is the 5^th most populous country touching a figure of 255 million people, has critical inflection with growing burden of both communicable & non communicable diseases in a resource limited country becomes difficult.

The service training imbalance across the public sector teaching hospitals with both emergency and clinical duties compromise the protected academic time of the trainees; many a time, learning becomes incidental rather than planned.

In the present competency based, universal postgraduate training curricula where evidence-based appraisal, simulation, reflective practices and audit are essential components in the making of a good clinician are omitted.

A conducive training environment³can be achieved through a planned strategy making use of following.

Scheduling and timetabling for teaching rounds, case-based discussion, journal clubs and skill demonstrations.
These activities empower the trainees not only to learn correctly under guided supervision but make them confident.
The supervisors must own trainees and should guide them aptly through the entire training program. They can act as their mentors for carrier guidance and help them gain links both at national and international levels to give them bigger opportunities.
Burnout and poor physical and mental health among trainees are a well-researched area. Flexibility in rosters when needed with rest periods and trainee wellbeing must be sought.⁴
Institutions must develop facilities within the approach of trainees like, skill labs, internet and journal subscriptions.⁵

No training can be completed if the regulatory bodies fail to focus on the evaluation of the training centers. This calls upon looking after supervisor-to-trainee ratio, trainee and supervisor feedback.⁶ Today within the Pakistan context, we observe that the supervisor to trainee ratio in public sector hospital; is inadequate.

The number of trainees must be allocated according to vacant slots with supervisors in an institute and must also include patient workload in that particular training facility. So that neither the training slots remain vacant, nor the number of trainees exceed the required number per supervisor. This practically calls upon developing robust induction policies to cater for the national postgraduate training needs.⁷

In recent times AI has emerged as an added nuance to the learning environment with promise to make the learning personalized, more detailed and more helpful ^9,10,11 but at the same time, unexpected and undesired outcomes are plausible which needs proper ethical review, guard rails and regulation of AI.¹² All this may ensure a real training advantageous setting. To conclude, the learning environment to be conducive and fruitful all the stake holders the policy makers, the institutional heads, the trainers, the trainees, the patients and the society must all play their roles understanding that quality of future specialists will be determined today by the environment we create together.

QUALITY OF LIFE IN CAREGIVERS OF INDIVIDUALS WITH INTELLECTUAL DISABILITY IN A TERTIARY CARE HOSPITAL OF LAHORE, PAKISTAN.

Wed, 01 Jul 2026 00:00:00 +0000

Background: Caring about an intellectually disabled (ID) person can significantly transform the emotional, physical, and social life of the caregiver as it is a life-long obligation. ID diagnosis at birth or later in life is likely to alter family dynamics and bring about grieving responses in addition to generating the ongoing financial and emotional strain.

Objectives: To measure the quality of life (QoL) among caregivers of individuals with intellectual disability (ID) and to identify sociodemographic factors that may aeffect caregiver well-being.

Methods: It is cross-sectional study conducted at Outpatient and Inpatient Psychiatry Departments, Services Hospital, Lahore, from June-2025 to November-2025. Sixty primary caregivers of individuals diagnosed with intellectual disability according to DSM-5 criteria were recruited using non-probability consecutive sampling. Data was collected using a structured socio demographic questionnaire and the Urdu version of the World Health Organization Quality of Life-BREF (WHOQOL-BREF), which identifies physical, psychological, social, and environmental domains. Descriptive statistics were calculated and Chi-square test was used to examine associations between QoL and sociodemographic variables. Independent t tests, oneway ANOVA, and multiple linear regression were applied to find out potential predictors of overall QoL.

Results: The average age of caregivers in this study was 41.23 ± 11.35 years, and on average, they had been providing care for about 7–8 years (89.68 ± 50.63 months). Overall, caregivers reported a moderate level of quality of life, with a mean score of 57.52 ± 6.19. When looking at different areas of life, scores were fairly similar: physical health (58.46 ± 9.08), psychological well-being (57.96 ± 11.32), social relationships (56.11 ± 11.95), and environmental factors (57.56 ± 10.36), though social well-being appeared slightly lower than the others. Most of the caregivers were women (71.7%), and more than half were mothers of individuals with intellectual disability (55.0%), highlighting the central caregiving role of mothers in our setting.

Conclusion: Overall caregivers of individuals with intellectual disability were found to have a moderate quality of life with relatively lower satisfaction in social and environmental aspects. These findings suggest a need to shift greater attention toward caregiver support, particularly through psychosocial interventions and community based programs, to improve their overall well-being.

IN VITRO ASSESSMENT OF MEROPENEM–VABORBACTAM AGAINST CARBAPENEM-RESISTANT ESCHERICHIA COLI IN A TERTIARY CARE SETTING

Wed, 01 Jul 2026 00:00:00 +0000

ABSTRACT

Background: Carbapenem-resistant Escherichia coli is an ongoing problem in healthcare settings, especially in the less developed parts of the world where antibiotics are misused and overused. Even though new combinations like meropenem–vaborbactam are introduced, the effectiveness is still determined by the local resistance patterns.

Objectives: To assess the in-vitro activity of meropenem–vaborbactam against carbapenem-resistant E. coli isolates from clinical specimens in a tertiary care hospital in Lahore.

Methods: A total of 94 non-duplicate carbapenem-resistant E. coli isolates were collected over a six-month period for this cross-sectional study. Microbiological methods and VITEK-2 system were used for the identification of isolates. Testing of antimicrobial susceptibility was done by disc diffusion and MIC methods according to CLSI 2023–2024 guidelines. The analyzed data was processed with SPSS version 26.0.

Results: The isolates were found to be all resistant to the carbapenems, third- and fourth-generation cephalosporins, ciprofloxacin, and piperacillin–tazobactam. Resistance was also detected at high levels against aminoglycosides and other non-β-lactam agents. Activity for meropenem–vaborbactam was limited to 10% of isolates being susceptible.

Conclusion: Multidrug resistance is widespread among the carbapenem-resistant E. coli isolates, and the in-vitro effectiveness of meropenem–vaborbactam is low in this region. The monitoring of antibiotic resistance at the local level, along with the development of the right strategies for the use of antimicrobials, is necessary for establishing the right treatment.

COMPARATIVE FREQUENCY OF NECROTIZING ENTEROCOLITIS IN PRETERM NEONATES ON PROBIOTICS VS STANDARD CARE ALONE

Wed, 01 Jul 2026 00:00:00 +0000

ABSTRACT

Background: Preterm infants show increased pathogenic microbes and reduced normal flora, raising their risk of Necrotizing Enterocolitis (NEC). Probiotics, as non-pathogenic microbes, help prevent NEC and sepsis by enhancing intestinal barriers and modulating host response.

Objectives: To compare frequency of NEC in preterm neonates on probiotics versus standard care only.

Methods: It is Randomized Clinical trial conducted at Department of Neonatology, Children Hospital Multan from 25th April 2022 to 24th October 2022. A total of 188 (94 in each group) preterm infants of gestational age ≤35 weeks were included. Patients with congenital anomalies, requiring inotropic support, respiratory distress needing oxygen support within 72 hours of life and severe perinatal asphyxia were excluded. Group A (Probiotic group) - was given Immutec - Lactobacillus rhamnosus and Bifidobacterium BB-12 species 2.5×109 cfu (colony forming units) per day

with feed. Group B (standard care group) – received enteral feeding and the remaining standard care (thermo neutral environment, fluid electrolyte balance, antibiotics when indicated). During this period the infant was investigated for NEC (blood counts, abdominal radiograph and stool for blood).

Results: Necrotizing enterocolitis was found in 05 (5.32%) in group A (probiotics group) and 21 (22.34%) in group B (standard care only group) with p-value of 0.0007.

Conclusion: This study concluded that probiotics are better in terms of preventing necrotizing enterocolitis in preterm neonates than standard care only.

PREDICTIVE ACCURACY OF CRIB-II AND SNAPPE-II SCORES FOR MORTALITY RISK IN PRETERM NEONATES: A CROSS-SECTIONAL VALIDATION STUDY AT BENAZIR BHUTTO HOSPITAL, RAWALPINDI

Muhammad Usman Ali, Mahnoor Fatima — Wed, 01 Jul 2026 00:00:00 +0000

Background: Preterm birth is a major contributor to neonatal mortality and long-term neurodevelopmental complications globally, largely due to the immaturity of essential organ systems such as the lungs, brain, gastrointestinal tract, and immune system.

Objectives: To compare the diagnostic performance of the CRIB-II and SNAPPE-II scoring systems in predicting mortality among preterm neonates.

Methods: It is Cross-sectional validation study conducted at Department of Paediatrics, Benazir Bhutto Hospital, Rawalpindi, from 15th February to 15th May 2025. This study included preterm neonates with a gestational age of less than 32 weeks and a birth weight below 1500 grams, selected through non-probability consecutive sampling. Both CRIB-II and SNAPPE-II scores were calculated within 12 hours of admission according to standard criteria. Mortality risk was classified using cutoffs of ≥8.5 for the CRIB-II and ≥27.5 for the SNAPPE-II. Neonatal outcomes were monitored for 28 days. Diagnostic indicators, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, and the area under the receiver operating characteristic curve (AUC), were determined.

Results: Of the 122 neonates enrolled, 15 (12.3%) did not survive. The CRIB-II scores correctly identified 11 deaths, with a sensitivity of 73.33%, specificity of 79.44%, PPV of 33.33%, NPV of 95.51%, accuracy of 78.69%, and an AUC of 0.925. SNAPPE-II identified 12 deaths, demonstrating a sensitivity of 80.00%, specificity of 84.11%, PPV of 41.38%, NPV of 96.77%, accuracy of 83.61%, and an AUC of 0.952.

Conclusion: Both scoring systems demonstrated reliable diagnostic value for early mortality prediction in preterm neonates. In this cohort, SNAPPE-II exhibited superior overall performance.

HEFOT HEPATOPROTECTIVE EFFECT OF FLAXSEEDS (LINUM USITATISSIMUM L.) ON TRIAZOPHOS INDUCED STEATOSIS AND HEPATIC ENZYMES IN MALE WISTAR RATS.

Wed, 01 Jul 2026 00:00:00 +0000

Background: Inappropriate handling and use of pesticides, i.e. triazophos without any plan in agriculture have caused hepatotoxicity. The need for pesticide products for agricultural efficiency is clear, but the volume of production indicates that the occurrence of accidental exposure and as a result life threatening incidents are great.

Objective: To determine the effects of Flaxseeds on hepatic enzymes and steatosis in hepatocytes induced by Triazophos pesticide.

Methods: In this study 24 Wistar albino rats of age: 6-8 weeks and weight 150-200gms were segregated into four groups comprising six rats each (Random number Generator). Group A was labelled as control group. Groups B, C and D were labelled as experimental. All groups were given standard rat feed and water ad libitum. Group B was given powdered flaxseeds (800mg/kg b.w.) once daily for 21 consecutive days, Group C was given triazophos (8.2mg/kg b.w.) once daily for 21 consecutive days and Group D was given triazophos (8.2mg/kg b.w.) and flaxseeds (800mg/kg b.w.) once daily for 21 consecutive days. Livers of Albino rats were dissected out and their frozen sections were stained with Sudan ш to evaluate steatosis. Blood samples were collected from the tail of rats for biochemical evaluation of liver enzymes including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP), which were assessed for biochemical changes on 1^st ,7^th,14^th and 21^st day. On day 22, 24 hours after administration of last dose, rats of control as well as of experimental groups were sacrificed under deep anesthesia.

Results: A statistically significant notable increase with a p value of 0.001, was observed in the hepatic enzymes and steatosis in livers of adult male albino rats. Additionally, Flaxseeds have significant ability to ameliorate the effects of Triazophos pesticide.

Conclusion: Use of Flaxseeds in our daily routine can decrease the drastic effects of pesticides on the liver.

COMPARATIVE ANALYSIS OF STONE-FREE RATES IN LOWER POLE RENAL STONES (<1.5 CM): ESWL VS. RIRS

Wed, 01 Jul 2026 00:00:00 +0000

Background: Treating stones in the lower pole of the kidney is often difficult because certain anatomical features—such as an acute infundibulopelvic angle, elongated calyx, and narrow infundibular width—reduce the likelihood of effective drainage of fragments. Extracorporeal shock wave lithotripsy (ESWL) is widely used for small renal stones due to its non-invasive nature; however, its success rate for lower-pole calculi is often suboptimal. In contrast, retrograde intrarenal surgery (RIRS), facilitated by advances in flexible ureteroscopy and laser technology, has demonstrated improved stone clearance outcomes.

Objectives: This study is designed to evaluate and compare stone-free rates after ESWL and RIRS in patients with lower-pole renal stones measuring less than 1.5 cm.

Methods: A randomized controlled trial was conducted at PGMI/Lahore General Hospital involving 150 patients with confirmed lower-pole stones (<1.5 cm). Participants were randomly assigned to either the ESWL group or the RIRS group. Post-treatment outcomes were evaluated using a non-contrast CT KUB performed one week after the procedure. The primary outcome measure was the stone-free rate.

Results: Among the 150 patients, the RIRS group demonstrated a higher stone-free rate of 53.9% compared to 46.1% in the ESWL group. The difference was statistically significant (p = 0.036), indicating a favorable outcome with RIRS in this patient population.

Conclusion: RIRS showed superior efficacy compared with ESWL for treating lower-pole kidney stones measuring 1.5 cm or less. These findings support considering RIRS as a preferred option in selected cases, particularly when anatomical factors may limit ESWL success.

CLINICAL PRESENTATION OF COVID-19 AND ITS ASSOCIATION WITH BLOOD GROUPS AND GENDER AMONG MEDICAL STUDENTS DURING DIFFERENT WAVES OF PANDEMIC

Thu, 02 Jul 2026 00:00:00 +0000

Background: Covid-19 is a heterogenous viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), surfaced in December 2019 and enveloped the whole world since then. It affects people of all ages with wide range of symptoms. Inconsistent relationship between Covid-19 with ABO/Rh blood groups and female gender has been reported so far.

Objectives: To determine clinical presentation of Covid-19 and its association with blood groups and gender among medical students during different waves of pandemic.

Methods: This retrospective observational study was conducted at Rashid Latif Medical Complex Lahore from May-2023 to August-2023. The study included volunteer students from the medical, dental, and physiotherapy departments, aged 16–26 years. Participants were divided into two groups: those previously diagnosed with Covid-19 who had successfully recovered (Covid-positive group) and those without a history of Covid-19 infection (Covid-negative group). Mean ± SD were given for quantitative variables and frequencies and percentages for non-quantitative variables. The association between susceptibility of Covid 19 infection with ABO/Rh blood groups and gender was determined by Chi square test and odds ratio which was reported with 95% confidence intervals. The p-value < 0.05 was considered as significant.

Results: Out of total 428 students, 99 (23%) experienced Covid-19-like symptoms and 56 confirmed positive by reverse transcription polymerase chain reaction test (RT-PCR) out of them were selected. Median age of the infected individuals was 21 years (20.00-21.25) and 61.4% were females and 38.6 % were males. Common symptoms were cough and fever, flu, headache, sore throat, and smell & taste. Symptoms of majority of Covid-19 infected individuals i.e. of 73% subjects lasted less than 10 days. Only 6.8% of the Covid-19 infected subjects were hospitalized. Higher frequencies of blood group A and AB were found in Covid-positive group in comparison to Covid-negative but Chi square test showed no significant association between Covid-19 disease susceptibility and ABO/Rh blood groups.

Conclusion: Young individuals were primarily affected in the second and third waves of the Covid-19 pandemic, experienced short duration of infection and rapid recovery. Blood groups and gender are not found related with the risk of getting Covid-19 infection.

DETERMINATION OF HEPATIC HISTOTOPROTECTIVE EFFECT OF COMBINATION OF SM/ SILYMARIN AND ZNSO4/ ZINC SULFATE AGAINST DAMAGE BY RIF/ RIFAMPICIN AND INH/ ISONIAZID IN ALBINO RATS.

Wardah Siddique, Hannah Pirzada , Javaria Fatima, Ayela Eman Zia — Thu, 02 Jul 2026 00:00:00 +0000

Background: To induce hepatotoxicity with RIF and INH in albino rats, to estimate histoprotective effect of combination of ZnSO4 and Silymarin.

Objective: To evaluate the hepatic histoprotective activity of zinc sulfate in combination with silymarin against rifampicin- and isoniazid-induced hepatic damage in albino rats.

Methods: The study was conducted at the Department of Pharmacology, King Edward Medical University Lahore and UVAS, Lahore after approval from IRB committee vide no. 18/ PEC/RC/KEMU. The 'Animal Experimental Study' was carried out of 14 days’ duration. A sample size of 28 healthy albino wistar rats was taken and divided into four equal groups. GA was normal control group and given water once a day orally. GB was toxic control group and was given inducing agents RIF and INH (100 and 50 mg/kg/day) orally for 14 days. Whereas, rats in GC and GD received inducing agents along with combination of ZnSO4 + SM (3.5 + 100 mg /kg/day) and (7 + 200 mg /kg/day) respectively once daily for 14 days. Histoprotective effects evaluated by various histopathological parameters.

Results: Significant change (p-value 0.05) between positive control and hepatoprotective groups was observed for parameters like hepatic cell enlargement, lobular lymphocytic infiltrate, portal lymphocytic infiltrate, kuppfer cells, sinusoidal distention, lobular and portal plasma cellular infiltrate, steatosis, neutrophils, inflamed portal area, congestion and mast cells. Comparing GC and GD significant improvement was seen in parameters like lymphocytic lobular infiltrate, steatosis, hepatocytes enlargement and portal inflammation.

Conclusion: The current study has shown hepatoprotection of ZnSO4, SM and their combination in different doses as evidenced by improvement in histological parameters

CYCLOPHOSPHAMIDE RELATED HEPATOTOXICITY AND PROTECTION BY THYMOQUINONE, A HISTOLOGICAL VIEW

Thu, 02 Jul 2026 00:00:00 +0000

Background: Cyclophosphamide (CP), used to cure cancer, causes hepatotoxicity. Hepatoprotection, brought by thymoquinone (TQ) found in kalonji. Study was performed to prove it.

Objectives: To observe thymoquinone restorative effect on the hepatic toxicity by cyclophosphamide.

Methods: It is Experimental randomized control trial. Adult albino rats were 24, put in 3 groups, each having 8. control Group A, given 2 ml Phosphate Buffer Saline (PBS) for a week by gastric gavage, 2 intraperitoneal injection (i.p) 2 days apart, gastric gavage for 1 week again. Experimental Group B, two i.p doses of CP as 200 mg/kg, on day 1, 4. Group C, given TQ (10 mg/kg/day) by gastric gavage for 1 week, 2 doses of CP, given on day 8 and 10, again TQ for 1 week. 24 hours after the experiment, livers were isolated from rats after dissection and processed. Gross and histopathological changes were observed.

Results: Weight of rats of both experimental groups (B, C) was decreased in comparison to A group (p-value <0.001), reduced from (190.4 g-136.9 g) for group B, (177 g-147g) for group C rats, weight increased in group A rats (184.9 g-223.1g). RTWI, more in both groups (4.38 in B and 3.55 in C) in comparison to control (2.59), B versus A (p-value <0.001), B versus C (p-value 0.012) and C versus A (p-value 0.004). Hepatic lobules shape difference was statistically significant in experimental groups when compared to the control (p-value <0.001).

Conclusion: Study proved hepatotoxic impact of CP on liver histology, shows ameliorative effect of TQ.

ANTIOXIDANT EFFICACY OF VITAMIN E IN ATTENUATING BISPHENOL A–INDUCED FUNCTIONAL TESTICULAR IMPAIRMENT: A HISTOMORPHOLOGICAL AND MORPHOMETRIC RAT MODEL STUDY

Sadia Saqib, Nadia Haq, Raafea Tafweez, Ahmed Fawad Syami, Irfan Ali — Thu, 02 Jul 2026 00:00:00 +0000

Background: Bisphenol A (BPA) is a pervasive environmental contaminant associated with male reproductive dysfunction.

Objectives: To investigate the functional and histomorphological restoration of testicular integrity following co-treatment with vitamin E in BPA-exposed Wistar rats.

Methods: Ninety adult male rats were randomly divided into three groups (n=30 each): Group I (control), Group II (BPA 20 mg/kg), and Group III (BPA 20 mg/kg + vitamin E 100 mg/kg). Treatment lasted for six weeks via oral gavage.

Results: Morphometric analysis demonstrated significant differences among groups: seminiferous tubule diameter was reduced in BPA group (316.0 ± 22.2 µm) and restored in vitamin E group (346.3 ± 44.1 µm, p=0.003). Epithelial height also significantly improved from 51.0 ± 3.2 µm in Group II to 74.4 ± 14.6 µm in Group III (p<0.001). Testis-to-body-weight index was significantly higher in the co-treatment group (0.0151) compared to BPA-only rats (0.0149).

Conclusion: Leydig cell counts remained unchanged across groups (p=0.535), yet epithelial recovery indicated improved spermatogenic potential. These findings provide statistically validated evidence that vitamin E significantly mitigates BPA-induced structural testicular damage and supports its application in counteracting environmental toxicant exposure. The novel integration of morphometric and functional indicators reinforces the relevance of antioxidant therapy in reproductive health research.