Pakistan Journal of Medical & Cardiological Review
The Pakistan Journal of Medical & Cardiological Review (ISSN-P3007-2379 ,ISSN-E 3007-2387) is a peer-reviewed, open-access medical journal dedicated to the advancement of health sciences and clinical practice. It serves as a platform for the dissemination of high-quality, evidence-based research, clinical innovations, and expert commentary across all areas of medicine. The journal publishes original research articles, systematic reviews, meta-analyses, case reports, and editorials that contribute to improving patient care, public health, and medical education. Committed to scientific rigor, ethical standards, and global accessibility, the Pakistan Journal of Medical & Cardiological Review welcomes submissions from researchers, clinicians, and healthcare professionals worldwide. The journal aims to bridge the gap between research and practice by promoting interdisciplinary dialogue and fostering collaboration among professionals from diverse healthcare backgrounds.
Forum for Education, Knowledge and Reform (FEKR)
Uterine Artery Ligation in Postpartum Haemorrhage
Background. Postpartum haemorrhage (PPH) is still the single biggest reason women die in childbirth. About a quarter of maternal deaths in the world are caused by it, and almost all of these deaths happen in poor and middle-income countries. When uterotonics, tranexamic acid and balloon tamponade fail to stop the bleeding, the surgeon has to act quickly. Uterine artery ligation (UAL), first described by O'Leary in 1966, is one of the oldest yet most useful surgical options available in such an emergency. Objective. This review looks at the role of uterine artery ligation in the modern management of PPH. The technique, indications, success rates, complications and long-term reproductive outcome are discussed, along with a comparison against internal iliac artery ligation and uterine artery embolization. Methods. A narrative review was carried out using PubMed, Google Scholar and the Cochrane Library. Articles published in English from 2000 onwards were screened. Guidelines from FIGO, WHO, RCOG and ACOG were also reviewed. Cohort studies, case series of more than ten patients, systematic reviews and meta-analyses were considered. Results. The success rate of bilateral UAL in stopping intractable PPH lies between 80 and 96 percent in most published series. Stepwise devascularization, in which ligation is extended in stages, raises this figure even further. Complications are rare. Doppler studies have shown that the ligated arteries recanalize within a few weeks and menstruation and fertility return to normal. Compared with internal iliac artery ligation, UAL is easier, faster and more effective. Conclusion. UAL deserves a clear place as the first surgical step in PPH that does not respond to medical treatment, especially in centres where interventional radiology is not available. Training young obstetricians in this simple procedure can lower the rate of peripartum hysterectomy and save lives. Keywords. Postpartum haemorrhage; uterine artery ligation; O'Leary suture; uterine devascularization; maternal mortality.
Copyright (c) 2025 Dr. Mumtaz Begum*, Dr. Saima Shaikh, Dr. Abida Kanwal, Dr. Sumera Khan, Prof: Farah Deeba, Prof: Raishem (Author)
EVALUATE THE PREVALENCE AND ASSOCIATED RISK FACTORS OF GASTRITIS AT DERA ISMAIL KHAN
Background: In 1728, German physician Georg Ernst Stahl first coined the term "gastritis". Italian anatomical pathologist Giovanni Battista Morgagni further described the qualities of gastric irritation. In 1859, British physician, William Brinton first describe regarding acute, subacute, and chronic gastritis. Gastritis is a health situation that means to irritation within the stomach. It creates when the gastric lining gets into narrow or damaged and it comes in get in touch with with hydrochloric acid secreted by the stomach. Objective: To determine the prevalence of gastritis and its associated risk factors in population of Dera Ismail Khan At District head quarter (DHQ) D I Khan. Method: An observational Cross-Sectional Study. The study comprised 148 victims of gastritis presenting to the hospital like Hayat medical and surgical complex. Demographic information, the mechanism of injury, the mode of transportation, pre-hospital treatment, the clinical state upon arrival, emergency management, and patient outcomes were all gathered. The collected data was analyzed by using the logistic regression, Pearson correlation, and descriptive statistics. Results: Over the course of the six-month research, 148 patients in total were examined. There were 45 patients aged between 18 to 28years accounting 30.4% of the total. In 29 to 39years age group, there were 30 patients, which accounting for 20.2%. The 40 to 50yeras age group were 38 patients, accounting for 25.6%. Those aged 51 to 60years are 20 patients, or 13.5%. Finally, 15 patients are over 60 years old, making up 10% of the total. The survey asked patient they smoked. The total 148 patients, 46 (31%) said "Yes," while 102 (69%) said "No. Most patients did not smoke, and only about one-third was smokers. Conclusion: The most dominant patients were observed at the age group 8-28 years (30.4%) indicating a younger demographic is affected by gastritis. According to gender distribution the cases were found more in female 87 [58.70%] as compared to male 61 [41.20%]. According to marital status the cases were found more in [91] 61.4% of patients were married. According to education basis the cases were found more in 90 (60.8%) were educated. Keywords: Risk factor, gastritis, lymphoma, H-pylori, amoxicillin, Smoking, PPI.
Copyright (c) 2026 NaveedUllah Khan*, Muddasir Khan, AsadUllah, Amna Rauf, Arbab Haroon, Muhammad Usman, Azeem Ullah, Saqib Nawaz (Author)
Awareness Regarding Postmenopausal Health among Women of Low Socioeconomic Class
Background. Menopause is a natural phase in a woman's life, but in poor settings it is often surrounded by silence, fear and wrong beliefs. Pakistan has one of the youngest mean ages at menopause in the world, and a large number of postmenopausal women live in households earning less than the minimum wage. Despite these conditions, the extent of women's awareness about their changing bodies, the associated long-term health risks due to estrogen deficiency and the available treatment options is still unknown. Very few studies have been conducted in Pakistan, all consistently indicating poor knowledge; however, data on women belonging to the lower socioeconomic class is not available. Objective. This study aimed to determine the knowledge, attitude and health-seeking behaviour of low socioeconomic class postmenopausal women regarding menopausal changes and to identify the factors associated with poor awareness among this group. Methods. This was a hospital based descriptive cross sectional study carried out in the gynaecology outpatient department of advance teaching hospital in Pakistan over a period of six months. A total of 240 postmenopausal women aged 45 to 65 years, belonging to the low socioeconomic class (defined as a monthly household income of less than PKR 40,000 or roughly USD 140), were enrolled using non-probability consecutive sampling. Women with surgical menopause, known psychiatric illness, or those unwilling to participate were excluded. Data were collected through face-to-face interviews with a pre-tested, structured questionnaire translated and back-translated into Urdu. Socio-demographic characteristics, knowledge of menopause (definition, age, symptoms, long-term complications, and treatment options), attitudes towards menopause, and care-seeking behaviour were inquired about. The knowledge score was calculated on 15 items and divided into three categories: poor (<6) average (6-10) and good (>10). Data was entered and analysed in SPSS version 26. Descriptive statistics were computed for the variables of interest. The Chi-square test was used to observe an association between the knowledge level and socio-demographic variables. Results. The mean age of the participants was 53.4 ± 5.6 years, and the mean age at menopause was 47.2 ± 3.8 years. Most of the women were illiterate (59.2%) and worked as housewives (77.5%). Only 34.2% knew the correct definition of menopause, and 40.0% knew the average age at which it usually occurs. Hot flushes were the most recognised symptom (45.8%), followed by mood changes (36.7%). Regarding long-term complications, only 15.8% were aware of an increased risk of osteoporosis, and 12.5% were aware of an increased risk of cardiovascular disease. Only 7.5% had heard of hormone replacement therapy. Attitudinally, 59.2% of the women felt that menopausal symptoms should be silently endured, 40.0% felt that a woman loses her femininity after menopause, and 24.2% felt that a husband can marry another woman after his wife becomes menopausal. Only 44.2% had ever consulted a doctor for menopausal complaints. Overall knowledge was poor in 67.1% of women, average in 24.2% and good in only 8.7%. A statistically significant association was found between knowledge score and educational level (p<0.001) and monthly income (p<0.01). Conclusion. Knowledge of postmenopausal changes and long-term health risks is limited among Pakistani women of low socioeconomic status. Negative attitudes and silent suffering remain common. Education and family income are the main determinants of awareness. Thus, targeted health education at the primary care level, employing female community health workers, and incorporating menopausal counselling into routine gynaecology and family medicine clinics are essential to improving the quality of life of this neglected population. Keywords. Postmenopause; awareness; knowledge; attitude; low socioeconomic class; Pakistan; women's health
Copyright (c) 2025 Dr. Mumtaz Begum, Dr. Saima Shaikh Kamal, Dr. Abida Kanwal Kamal, Dr. Sumera Khan, Prof: Farah Deeba, Prof: Raishem (Author)
“Mutational Analysis Of Mitochondrial Trna Proline Gene In Myoclonal Epileptic Patients From North Waziristan”
The term "epilepsy" refers to a group of neurological diseases and syndromes that are characterized by recurring, spontaneous, paroxysmal seizure activity. Juvenile myoclonic epilepsy is a comparatively benign form of idiopathic generalized epilepsy. Genetics appears to have a major role in the genesis of epilepsy. The mitochondrion is the only organelle in the cell that has its own DNA that codes for 13 proteins. The mt-DNA circular genome is 16154bp in length. Mt-DNA mutations cause multisystem mitochondrial disorders having a diverse set of clinical signs and symptoms. More than 20-heteroplasmic point mutations has been linked to Myoclonic epilepsy with ragged red fibers, demonstrating the genetic variability of mitochondrial disorders. In Mt- DNA the most common mutation (m.8344A>G) is observed in tRNA lys (MT-TK) gene, which accounts for 80% of Myoclonic epilepsy ragged red fibers cases. The current study was designed to identify the mutation in Proline (MT-TP) gene of mt-DNA. This cross-sectional study was conducted in North Waziristan. Non-probability convenient sampling technique was adopted. After taking informed consent questioner was filled and 3mL of blood sample was collected in EDTA tube. A total of 38 samples were collected from 10 families using sample size calculation formula n=p(1-p2) z2/d2. The samples size was calculated by using p(prevalence)=4% (0.04), d (margins of error) =5% (0.05), z; confidence level=95% (1.96) which provided a sample size of (n=38). Thermo Scientific Gene-JET Genomic DNA Purification Kit was used for mt-DNA extraction. DNA quantity was confirmed by nano drop and agarose gel electrophoresis. Specific primers were designed for 394 bp target of proline gene and the extracted DNA was used as a template for the PCR amplification. The specific amplified region of proline-gene was confirmed through gel electrophoreses. The amplified PCR product bands were carefully removed, purified and cleaned through gene clean process. The amplified product was sequenced in BGI Hongkong for nucleotide. Out of total 14 epilepsy sample population, 10 (71.4%) were males and 4 (28.6%) were females. In the current study, no mutation was found in the (MT-TP) Proline-tRNA gene ranged from 16008-15956 bp of studied specimens. The results of over study suggest that mutation may be found in other region of MT-TP gene or MT-TK gene. The current study also recommends conducting the research on a wider scale to rule out the other mutation in different genes of mitochondrial genome of epileptic families in Pakistani population.
Copyright (c) 2025 Muhammad Riaz Khan, Kaleem Ullah , Tahir Ullah, Mansoor Badshah , Noor ul Nisa, Shaukat Aman Kamal, Anas Bacha Shaheen, Musadiq Khan (Author)
Prevalence And Severity Of Mitral Regurgitation Following Acute Myocardial Infarction Admitted To Tertiary Care Hospital In Peshawar
Background: Mitral regurgitation (MR) is a frequent mechanical complication of acute myocardial infarction (AMI) and contributes significantly to morbidity and mortality. Early detection of MR following AMI is essential for timely management and improved clinical outcomes.Objective: To determine the prevalence and severity of mitral regurgitation among patients admitted with acute myocardial infarction at a tertiary care hospital in Peshawar. Methodology: A descriptive cross-sectional study was conducted at the Cardiology Department and Coronary Care Unit of Lady Reading Hospital, Peshawar. Data were collected retrospectively from medical records and echocardiography reports of 252 patients diagnosed with AMI. Demographic characteristics, AMI types, risk factors, left ventricular ejection fraction (LVEF), prevalence and severity of MR, and associated complications were analyzed using SPSS version 25. Results: Of the 252 patients, 69% were male and 31% were female. The majority of patients (43.3%) were aged 50–59 years. Anterior wall myocardial infarction was the most common AMI type (53.6%). Hypertension (61.9%) and diabetes mellitus (36.5%) were the leading risk factors. Mitral regurgitation was identified in 234 (92.9%) patients. Regarding severity, mild MR was observed in 53.4%, moderate MR in 36.8%, and severe MR in 9.8% of patients. Heart failure was the most common complication (10.3%), followed by cardiogenic shock and arrhythmias (5.6% each). Conclusion: Mitral regurgitation is highly prevalent among patients following acute myocardial infarction, with mild MR being the most frequently observed severity grade. Routine echocardiographic evaluation after AMI is recommended to facilitate early diagnosis, risk assessment, and appropriate management of MR, thereby improving patient outcomes. Keywords- Acute Myocardial Infarction (AMI), Mitral Regurgitation (MR), Echocardiography, Prevalence, Severity, Left Ventricular Ejection Fraction (LVEF), Heart Failure
Copyright (c) 2026 Muzamil Hussain, Sahiba Shoaib, Naeem Ullah , Wasif Khan , Adnan Khadim, Roheela Hikmat, Wasif Khan (Author)
PREVELANCE OF DE-QUERVAIN’S TENOSYNOVITIS IN PREGNANT AND POSTPARTUM WOMEN OF FAISALABAD
Background: An inflammatory disorder called De Quervain's Tenosynovitis affects the sheath that surrounds tendons and is most frequently seen in the hands and wrists. In this study, the prevalence of De-Quervain's Tenosynovitis is examined in pregnant and postpartum women who are especially susceptible because of the physiological and bio-mechanical pressures that come with these conditions. Aim of the study: The aim of this research was to determine the prevalence of De-Quervain’s Tenosynovitis in pregnant and postpartum women in Faisalabad by using DASH, PRWE score and Finkelstein test. Material and Methods: 132 subjects are selected according to the inclusion and exclusion criteria. A written informed consent is taken from the subjects in the language best understood by them. The study subjects is explained about the procedure. The test is performed on both hands. A positive test is indicated by pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist and is indicative of a Para tendonitis of these two tendons. The data is collected and statistically analyzed. Results are analyzed through Microsoft Excel and Statistical package for social sciences (SPSS) version 27. Results: This study shows that the prevalence of De-Quervain ’ s tenosynovitis by performing Finkelstein test was positive in 46.7% of pregnant participants and 40.4% of postpartum participants. While the prevalence appeared slightly higher during pregnancy, the difference was not statistically significant (χ²(1) = 0.524, p = 0.469), indicating that the maternal status (being pregnant or not) alone does not have a significant association with the condition.
PREVELANCE OF DE-QUERVAIN’S TENOSYNOVITIS IN PREGNANT
FREQUENCY AND ULTRASONOGRAPHIC FINDINGS OF POLYCYSTIC KIDNEY DISEASE AMONG PATIENTS UNDERGOING ABDOMINAL ULTRASONOGRAPHY: A DESCRIPTIVE CROSS-SECTIONAL STUDY
Background: Polycystic kidney disease (PKD) is a common inherited renal disorder causing progressive cystic enlargement and renal dysfunction. Ultrasonography is a practical, non-invasive tool for its early detection, monitoring, and differentiation from other cystic kidney diseases.To determine the frequency of PKD and evaluate its ultrasonographic findings among patients undergoing abdominal ultrasound examinations. Methods: This descriptive cross-sectional study was conducted over four months at Lady Reading Hospital, Peshawar. Ninety-three patients undergoing abdominal ultrasonography were enrolled through convenient sampling. Data were collected using a structured questionnaire together with ultrasonographic findings. Patients with indeterminate PKD, kidney transplant, or prior kidney surgery were excluded. Data were analyzed using SPSS version 22, and results were expressed as frequencies and percentages. Results: Of 93 participants, 72 (77.4%) were diagnosed with PKD on ultrasonography, while 21 (22.6%) had normal findings. Bilateral renal involvement was the most common pattern (24.7%), followed by right-sided (40.9%) and left-sided (14.0%) involvement. A positive family history of kidney disease was reported more frequently among hypertensive participants than non-hypertensive participants. Conclusion: PKD was identified in a substantial proportion of patients undergoing abdominal ultrasonography, with bilateral renal involvement predominating. Family history and hypertension were important associated factors. Ultrasonography remains an effective, accessible tool for the early detection of PKD. Keywords: Polycystic Kidney Disease; Autosomal Dominant Polycystic Kidney Disease; Ultrasonography; Abdominal Ultrasound; Renal Cysts; Renal Imaging.
Copyright (c) 2026 Mehmood Khan , Dr. Muhammad Arshad, Tuba Arif , Aman Ullah, Asad Ullah, Athar Salahuddin, Aliza Shameen, Sharifullah* (Author)
Knowledge and Practice Gaps in the use of Personal Protective Equipment among Nurses in Islamabad: A Cross-Sectional Study
Background: Personal protective equipment (PPE) is an essential component of standard precautions and is central to reducing occupational exposure and healthcare-associated infection risks in clinical settings. Nurses are frequently exposed to blood, body fluids, respiratory secretions, and invasive procedures; therefore, their knowledge and consistent use of PPE directly affect patient and staff safety. Objective: To assess nurses' knowledge and reported practices regarding the use of PPE in clinical practice in the Cardiology Ward of Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. Methods: A descriptive cross-sectional study was conducted from October 2023 to January 2024 among charge nurses and student nurses in the Cardiology Ward of PIMS Islamabad. A convenience sample of 30 participants completed a structured closed-ended questionnaire covering demographic variables and 17 items related to PPE training, use, indications, hand hygiene, mask use, gloves, gowns, donning and doffing, and workplace policy. Data were summarized using descriptive statistics. Results: Of the 30 participants, 16 (53.3%) were aged 20-25 years and 14 (46.7%) were older than 25 years. Most participants were BSN students or nurses (n=18, 60.0%), followed by Post RN (n=9, 30.0%) and General Nursing (n=3, 10.0%). Only 33% reported formal PPE training, while 67% had not received training. Appropriate PPE use in moderate-risk situations was reported by 37%, and 47% identified PPE as a preventive measure against hospital-acquired infection. Hand hygiene before mask use and correct mask removal were each reported by 40%. Perceptions and practices related to gloves, gowns, and compulsory PPE use were inconsistent. Conclusion: The findings indicate important knowledge and practice gaps regarding PPE among nurses in a tertiary-care cardiology ward. Structured training, clear institutional PPE policies, supervised practice, and continuous monitoring are recommended to improve adherence and strengthen infection prevention.
Personal Protective Equipment; Nurses; Knowledge; Practice; Infection Prevention; Hospital-Acquired Infection; Cardiology Ward
Copyright (c) 2026 Naila Habib, Um e Farwa, Sameera Shehzadi, Shameen Ayub, Allah Ditta Shah, Safi Ullah, Wajid Ullah, Fatima Nawaz (Author)
Obstetrical Complications in Grand Multipara at Shaikh Zaid Women Hospital, Larkana
Grand multiparity, commonly defined as parity of five or more, remains a significant obstetric concern in developing countries, including Pakistan. It is often associated with increased maternal and neonatal morbidity due to biological, socioeconomic, and healthcare-related factors. To determine the frequency and pattern of obstetrical complications among grand multiparous women at Shaikh Zaid Women Hospital, Larkana. This hospital-based cross-sectional study was conducted at Shaikh Zaid Women Hospital, Larkana. Pregnant women identified as grand multipara were enrolled using a non-probability sampling technique. Data were collected through a structured proforma including demographic characteristics, obstetrical history, and maternal and neonatal outcomes. Common complications assessed included anemia, pregnancy-induced hypertension, postpartum hemorrhage, cesarean section rate, preterm delivery, and low birth weight. Statistical analysis was performed using SPSS, with results presented as frequencies, percentages, and appropriate inferential statistics. A high frequency of obstetrical complications was observed among grand multiparous women. Maternal complications such as anemia, postpartum hemorrhage, and hypertensive disorders were prominent. Grand multiparity is associated with an increased risk of adverse obstetrical outcomes in the studied population. Early antenatal care, effective family planning, and targeted clinical management are essential to reduce complications and improve maternal and neonatal health outcomes
Grand multiparity; Obstetrical complications; Maternal outcomes; Neonatal outcomes; Postpartum hemorrhage; Cesarean section; Pakistan; Larkana
OMEGA-3 FATTY ACIDS AND CARDIOVASCULAR HEALTH: A NARRATIVE REVIEW
Omega-3 polyunsaturated fatty acids (PUFAs) have attracted considerable attention because of their protective effects against cardiovascular disease (CVD), one of the leading causes of morbidity and mortality worldwide. This narrative review provides a comprehensive overview of the role of omega-3 fatty acids in cardiovascular health, with particular emphasis on alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Relevant literature was retrieved from PubMed, Google Scholar, and Sci-Hub to summarize current evidence regarding dietary sources, physiological mechanisms, clinical outcomes, and therapeutic recommendations. ALA is primarily obtained from plant-based foods such as flaxseed, chia seeds, walnuts, soybean, and canola oil, whereas EPA and DHA are mainly derived from fatty fish, seafood, fish oil, breast milk, and marine microorganisms. Evidence indicates that omega-3 PUFAs exert cardioprotective effects through multiple mechanisms, including anti-inflammatory, antithrombotic, antiarrhythmic, triglyceride-lowering, and endothelial function-enhancing activities, as well as modulation of gene expression and membrane fluidity. Clinical studies demonstrate that increased intake of EPA and DHA is associated with reduced risks of myocardial infarction, major adverse cardiovascular events (MACE), coronary heart disease, and cardiovascular mortality. High-dose EPA therapy, particularly 4 g/day, has shown significant reductions in cardiovascular events among high-risk individuals. Studies recommend regular consumption of fatty fish and appropriate omega-3 supplementation, particularly for individuals with hypertriglyceridemia or elevated cardiovascular risk. Nevertheless, inconsistencies regarding optimal dosage, formulation, duration of supplementation, and comparative efficacy of EPA alone versus EPA plus DHA remain. Further large-scale, well-designed clinical trials are needed to establish standardized recommendations and clarify the long-term cardiovascular benefits of omega-3 fatty acids across diverse populations
Omega-3 fatty acids; Cardiovascular disease; Eicosapentaenoic acid (EPA); Docosahexaenoic acid (DHA);
Metagenomic Profiling of Hospital Microbiomes for Surveillance of Multidrug-Resistant Pathogens Using High-Throughput Sequencing Techniques
Antimicrobial resistance (AMR) poses an escalating global health emergency, with hospitals acting as primary reservoirs for multidrug-resistant (MDR) pathogens. Traditional culture-based surveillance methods face significant limitations, such as culture biases and a restricted diagnostic scope. To address these gaps, high-throughput whole metagenome shotgun sequencing has emerged as a powerful, culture-independent approach for population-level environmental and clinical monitoring. This review systematically evaluates the technical capabilities, error profiles, and performance metrics of second-generation (Illumina) and third-generation (Oxford Nanopore Technologies and Pacific Biosciences) sequencing modalities in resistome tracking. While short-read platforms excel in single-nucleotide accuracy, long-read technologies enable the resolution of complex repetitive structures and mobile genetic elements (MGEs) essential for tracking horizontal gene transfer. Furthermore, this paper benchmarks sample preparation protocols designed to mitigate the bottleneck of overwhelming host DNA contamination in low-biomass environments using selective cell lysis and enzymatic depletion. It also examines the computational trade-offs between read-based mapping and assembly-based bioinformatic architectures using specialized profiling tools. Finally, we analyze the structural organization and curation strategies of prominent antimicrobial resistance databases including CARD, ResFinder, ResFinderFG, and MEGARes which facilitate ecological population modeling and the identification of novel or divergent resistance genes.
Antimicrobial Resistance (AMR); Shotgun Metagenomics; High-Throughput Sequencing; Host DNA Depletion; Resistome Databases; Bioinformatic Profiling.
Copyright (c) 2026 Afra, Zil E Huma, Talha (Author)
Nutritional Transition, Ultra-Processed Food Consumption, and Metabolic Syndrome Risk Among Adolescents in Urban Pakistan
Adolescence represents a critical developmental period characterized by elevated nutritional demands and heightened vulnerability to dietary transitions. In urban Pakistan, approximately 40 million adolescents are experiencing a rapid nutritional shift driven by urbanization, aggressive digital food marketing, and poorly regulated school food environments. Traditional diets are increasingly being replaced by ultra-processed foods (UPFs), while sedentary lifestyles further exacerbate the rising burden of overnutrition. This review examines the double burden of malnutrition (DBM), the mechanistic links between UPF consumption and metabolic syndrome (MetS), and the limitations of current diagnostic frameworks in capturing cardiometabolic risk in South Asian adolescents. This narrative review synthesizes evidence on dietary patterns among Pakistani youth, obesogenic school environments, and the biological mechanisms underlying UPF-induced metabolic dysfunction. It also evaluates existing pediatric MetS diagnostic criteria in relation to the South Asian phenotype. Evidence indicates a simultaneous rise in overweight, obesity, and persistent undernutrition among urban adolescents in Pakistan. A substantial proportion of schoolchildren rely on school canteens where energy-dense, nutrient-poor foods are widely available, contributing to increased UPF consumption. Mechanistically, UPFs promote metabolic dysregulation through glycemic instability, hyperinsulinemia, and ectopic fat accumulation. They also disrupt gut microbiota composition by reducing dietary fiber intake and depleting short-chain fatty acid production, while food additives may compromise intestinal barrier integrity, contributing to systemic inflammation and metabolic endotoxemia. Genetically mediated susceptibility, including high rates of consanguinity and a distinct South Asian phenotype, predisposes Pakistani youth to insulin resistance and visceral adiposity at lower BMI thresholds. Consequently, conventional diagnostic criteria, such as those proposed by the IDF, may underestimate true risk, whereas alternative measures (modified NCEP-ATP III and waist-to-height ratio) indicate substantially higher prevalence of MetS in adolescents.
Adolescents; Pakistan; Ultra-processed foods; Metabolic syndrome; Double burden of malnutrition; Insulin resistance; Gut microbiota; South Asian phenotype; Obesity; Public health nutrition.
RELATIONSHIP BETWEEN URINARY STONES AND GRADE OF HYDRONEPHROSIS USING CT
Background: Urinary stone disease (urolithiasis) is a common global health problem and a major cause of urinary tract obstruction leading to hydronephrosis. Hydronephrosis occurs as a result of obstruction caused by urinary stones and may lead to renal damage if untreated. The severity of hydronephrosis varies depending on several factors, including stone size, location, and number. Understanding this relationship is essential for early diagnosis and proper management. Objectives: To evaluate urinary stone characteristics (size, location, and number) using CT-KUB. To determine the relationship between urinary stones and grades of hydronephrosis. Methodology: An analytical cross-sectional study was conducted in the Radiology Department of RYK Hospitals over a duration of 4 months. A total of 150 patients with confirmed urinary stones on non-contrast CT-KUB were included using consecutive sampling. Data regarding stone size, location, number, and hydronephrosis grade were collected and analyzed using SPSS. Statistical tests including regression analysis were applied, with p < 0.05 considered significant. Results: The mean stone size was 13.3 ± 9.2 mm. Hydronephrosis was present in 76.7% of patients out of 150, with Grade 1 being the most frequent. A statistically significant positive relationship was observed between stone size and hydronephrosis grade (p < 0.001). Stone location also showed a strong association, with pelvico-ureteric junction (PUJ) stones predominantly causing severe hydronephrosis (Grades 3 and 4). In contrast, the number of stones did not demonstrate a significant relationship with hydronephrosis severity (p = 0.487). Conclusion: CT-KUB is an effective modality for evaluating urinary stones and associated hydronephrosis. Stone size and location are significant predictors of hydronephrosis severity, whereas stone number is not. These findings can assist in early diagnosis and better clinical management of patients with urolithiasis.
Urolithiasis, Hydronephrosis, CT-KUB, Urinary Stones, Stone Size and Stone Location.
Copyright (c) 2026 Elsa Maryam , Noor Fatima, Rohan Ali (Author)
Grand multiparity, commonly defined as parity of five or more, remains a significant obstetric concern in developing countries, including Pakistan. It is often associated with increased maternal and neonatal morbidity due to biological, socioeconomic, and healthcare-related factors. To determine the frequency and pattern of obstetrical complications among grand multiparous women at Shaikh Zaid Women Hospital, Larkana. This hospital-based cross-sectional study was conducted at Shaikh Zaid Women Hospital, Larkana. Pregnant women identified as grand multipara were enrolled using a non-probability sampling technique. Data were collected through a structured proforma including demographic characteristics, obstetrical history, and maternal and neonatal outcomes. Common complications assessed included anemia, pregnancy-induced hypertension, postpartum hemorrhage, cesarean section rate, preterm delivery, and low birth weight. Statistical analysis was performed using SPSS, with results presented as frequencies, percentages, and appropriate inferential statistics. A high frequency of obstetrical complications was observed among grand multiparous women. Maternal complications such as anemia, postpartum hemorrhage, and hypertensive disorders were prominent. Grand multiparity is associated with an increased risk of adverse obstetrical outcomes in the studied population. Early antenatal care, effective family planning, and targeted clinical management are essential to reduce complications and improve maternal and neonatal health outcomes.
The Impact of ISO 15189 Laboratory Accreditation on Diagnostic Quality and Patient Care Outcomes: A Systematic Review
Background: The medical laboratory produces information that is the basis for the vast majority of clinical decisions, but the laboratory testing process can be flawed at every stage. The international standard for quality and competence in medical laboratories, ISO 15189, has emerged as the world's main laboratory accreditation standard. Despite ISO 15189 accreditation being broadly used, the empirical evidence of measurable improvements in diagnostic quality and patient outcomes is fragmented in heterogeneous literature from high-, middle- and low-income settings. Objective: To gather existing evidence of the relationship between ISO 15189 accreditation and patient care results, as well as diagnostic accuracy and error reduction. Methods: A narrative systematic review of peer-reviewed literature on the ISO 15189 accreditation, external quality assessment, total testing process errors and laboratory process improvement methodologies. 21 sources were included that fulfilled the relevance and verifiability criteria, and they were synthesized thematically. Results: Accreditation and the elements of accreditation, external quality assessment, structured error monitoring, and continuous improvement systems were consistently linked to enhanced analytical reliability, lower pre-analytical error rates, and better organizational quality culture in the various contexts, but the evidence on direct, causally attributable improvements in patient-level clinical outcomes was comparatively limited and methodologically heterogeneous. Conclusion: ISO 15189 accreditation is a legitimate structural proxy for laboratory quality, but it is not the accreditation itself that directly affects patient outcomes, but rather implementation fidelity, resource context, and associated quality systems. Keywords: ISO 15189 accreditation, Medical laboratory quality, Lab accreditation, Diagnostic accuracy, Quality management systems.
Copyright (c) 2026 Mehak Rashid, Muhammad Talha, Shamail Ali Butt, Muhammad Sooban, Tatheer-Ul-Hassan, Esha Nawal*, Atif Munir (Author)
Effect of Mercury Contaminated Diet on Hematology and Histology of Liver, Kidney and Gills in Nile Tilapia (Oreochromis Niloticus)
The present study was designed to assess the impact of mercury contaminated diets on hematological parameters and histopathological alterations in vital organs of Nile tilapia. Nile tilapia is a widely cultivated freshwater species known for its rapid growth and high adaptability; however, its exposure to toxic heavy metals, especially mercury, can lead to significant physiological and structural damage. A total of 300 healthy fingerlings were randomly assigned to four treatment groups: T0 (control), T1 (0.5 mg/kg methylmercury), T2 (5 mg/kg), and T3 (10 mg/kg), with three replicates each. The feeding trial was conducted over a period of 105 days under controlled laboratory conditions. Water quality parameters were regularly monitored to assess the environmental impact of mercury exposure. In T3, significant increases were observed in ammonia, nitrite, phosphorus and iron indicating a deterioration in water quality and increased metabolic stress on the fish. Hematological parameters showed pronounced dose-dependent alterations. Hemoglobin levels declined significantly along with reductions in RBC count, mean corpuscular volume and mean corpuscular hemoglobin concentration. White blood cell counts were suppressed showing immune suppression induced by mercury toxicity. it is concluded that Mercury severely affected hematological and physiological organ system. Its contamination resulted in significant alterations in hematological parameters, including anemia and immune dysfunction, alongside severe histopathological damage in key organs such as the liver, kidneys, and gills. it is suggested to implement and enforce strict environmental policies to limit industrial and agricultural mercury discharge into water bodies. Keywords; Nile tilapia, heavy metals, methylmercury, water quality, immune suppression, anemia
Copyright (c) 2026 Altaf Hussain*, Dr. Majid Hussain Soomro, Dr. Shaista, Muhammad Ramzan, Dr. Sajid Siyal , Ali Asghar Baloch (Author)
GENDER-BASED INCIDENCE OF MECHANICAL COMPLICATIONS AFTER ACUTE MYOCARDIAL INFARCTION AT A TERTIARY CARE HOSPITAL
Background: Mechanical complications of acute myocardial infarction (AMI), including ventricular septal rupture (VSR), papillary muscle rupture (PMR) causing acute severe mitral regurgitation, and left ventricular free wall rupture (LVFWR), are among the most catastrophic consequences of transmural myocardial necrosis. Although their incidence has declined in high-income countries with the widespread adoption of primary percutaneous coronary intervention (PCI), these complications remain associated with extremely high short-term mortality. In low-and middle-income countries (LMICs), such as Pakistan, where reperfusion therapy may be delayed or unavailable, the burden of mechanical complications may be substantially higher. Sex differences in AMI presentation, management, and outcomes are well recognized; however, data on sex-based differences in mechanical complications from South Asian populations remain scarce. This study aimed to determine the sex-based incidence of mechanical complications among patients admitted with AMI at Lady Reading Hospital (LRH), Peshawar, a major tertiary care center in Khyber Pakhtunkhwa, Pakistan. Methods: A descriptive cross-sectional study was conducted on 140 adult patients admitted with AMI (STEMI or NSTEMI) to the cardiology department of LRH during the data collection period. Patients aged ≥ 18 years with a confirmed AMI diagnosis based on clinical features, electrocardiographic changes, and elevated cardiac biomarkers, and with complete clinical and echocardiographic records, were included. Patients with pre-existing structural heart disease were excluded. Data were collected using a structured proforma encompassing demographic characteristics, cardiovascular risk factors, AMI type, echocardiographic findings, laboratory values, management strategies, and in-hospital outcomes. Mechanical complications were defined as new-onset VSR, PMR causing acute severe mitral regurgitation, or LVFWR occurring during the index hospitalization. Data were entered and analyzed using SPSS version 27. Descriptive statistics were used to summarize the baseline characteristics. Chi-square tests and two-proportion Z tests were used to assess the associations between categorical variables. A p-value of less than 0.05 was considered statistically significant. Results: The study population comprised 86 men (61.4%) and 54 women (38.6%), with a mean age of 56.5 ± 11.2 years. STEMI was diagnosed in 72 patients (51.4%) and NSTEMI in 68 patients (48.6%). The most prevalent cardiovascular risk factors were hypertension (62.1%), diabetes mellitus (48.6%), and smoking (41.4%). Mechanical complications were documented in 48 patients (34.3%): papillary muscle rupture in 20 patients (41.7% of complicated cases), ventricular septal rupture in 16 patients (33.3%), and left ventricular free wall rupture in 12 patients (25.0%). Sex was not significantly associated with the occurrence of mechanical complications (χ² = 0.130, p = 0.718; Z = −0.544, p = 0.587). AMI type, diabetes, smoking, hyperlipidemia, and a family history of ischemic heart disease were also not significantly associated with mechanical complications. However, there was a strong and statistically significant association between mechanical complications and in-hospital outcomes (χ² = 25.746, p < 0.001), with substantially higher mortality among patients who developed complications. Conclusion: The reported incidence of mechanical complications in this study (34.3%) is markedly higher than contemporary international benchmarks (<1% in the reperfusion era), potentially reflecting delayed hospital presentation, limited reperfusion access, and a high-risk case mix at a major tertiary referral center. No statistically significant sex-based difference in mechanical complication incidence was observed; however, this finding should be interpreted cautiously given the sample size and absence of multivariable adjustment. Mechanical complications were strongly associated with in-hospital mortality, underscoring their catastrophic clinical significance. These findings highlight the urgent need for early AMI recognition, rapid reperfusion therapy, routine echocardiographic surveillance, and strengthened cardiac surgical capacity at tertiary care centers in Pakistan. Future multicenter prospective studies with standardized diagnostic protocols and comprehensive reperfusion data are essential to validate these findings and inform healthcare policy.
Acute myocardial infarction, mechanical complications, ventricular septal rupture, papillary muscle rupture, free wall rupture, gender differences, Pakistan, tertiary care
From Service Burden to Burnout: The Protective Role of Supervisory Support Among Internal Medicine Postgraduate Residents in Punjab Teaching Hospitals A Cross-Sectional Survey Running head: Service burden, supervisory support, and burnout in Punjab Intern
Background: Internal Medicine postgraduate residents in teaching hospitals carry a dual responsibility: providing frontline clinical care and engaging in structured postgraduate training. Prolonged working hours, frequent night duties, and limited supervisory support may raise burnout risk, particularly in high-volume public-sector hospitals. Local evidence from Punjab on burnout in Internal Medicine residents, viewed through the lens of service burden and supervision, remains limited. Objective: To determine the association between service burden and burnout among Internal Medicine postgraduate residents in Punjab teaching hospitals, and to assess whether perceived supervisory support plays a protective role. Method: A Google Forms-based cross-sectional survey was conducted among 340 Internal Medicine postgraduate residents in Punjab teaching hospitals. The questionnaire gathered demographic, training, and workload data and measured supervisory support and burnout using Likert-type items (six items for supervisory support, nine for burnout). Descriptive statistics, reliability analysis, Pearson correlation, and multivariable linear regression were performed. Weekly working hours and monthly night duties served as service burden indicators. Results: Mean age was 30.05 (±2.52) years; 53.2% were male and 77.6% worked in government teaching hospitals. Mean weekly working hours were 78.56 (±10.89) and mean monthly night duties were 6.56 (±1.74). Mean burnout score was 3.03 (±0.84), with high burnout observed in 32.6% of residents. Mean supervisory support score was 2.90 (±0.62). Weekly working hours showed a positive correlation with burnout (r = 0.23, P < .001). Supervisory support showed a moderate-to-strong negative correlation (r = −0.55, P < .001). In adjusted regression, longer working hours, government hospital placement, and lower supervisory support were significant independent predictors of burnout. The service burden-by-supervisory support interaction was not statistically significant. Conclusions: Burnout was common among Internal Medicine postgraduate residents in Punjab teaching hospitals. Longer working hours and public-sector placement were associated with higher burnout, while stronger supervisory support was consistently associated with lower burnout. Improving resident well-being requires both workload review and strengthened supervision in Internal Medicine training programmes.
burnout, Internal Medicine, postgraduate residents, Punjab, supervisory support, service burden, working hours, teaching hospitals, cross-sectional survey
Gastrointestinal Tract Lesion Classification Using Deep Involution Neural Networks
Classification of gastrointestinal (GI) tract lesions from endoscopic images is one of the challenging medical image analysis. Conventionally, the automation techniques that leverage very large and complex deep learning methods, that are very difficult to be deployed. This study proposes a lightweight four-layer Deep Involution Neural Network for automated classification of GI tract lesions into four classes: Normal, Ulcerative Colitis, Polyps, and Esophagitis. The proposed model uses involution operations to efficiently extract essential features while reducing computational complexity. The model has been evaluated on a publicly available dataset that consists of 6000 endoscopic images. After training the model on the dataset, it achieves an overall accuracy of 91.13%. These results validate that the proposed model is an effective and computationally efficient approach for computer-aided GI tract lesion classification.
Gastrointestinal lesions, Endoscopy, Deep involution network, Deep learning, Medical image classification.
Frequency of Cholelithiasis and Associated Factors Among Patients Undergoing Abdominal Ultrasonography: A Cross-Sectional Study
Background: Cholelithiasis is a common gastrointestinal disorder and an important cause of morbidity worldwide. Despite its increasing burden, evidence regarding its frequency and associated risk factors in Pakistan remains limited. Objective: To determine the frequency of cholelithiasis and identify its associated risk factors among patients undergoing abdominal ultrasonography at a tertiary care hospital in Mardan, Pakistan. Methods: A descriptive cross-sectional study was conducted among 141 patients aged 20–70 years undergoing abdominal ultrasonography at the Department of Radiology, Mardan Medical Complex, Pakistan. Patients with a previous history of cholelithiasis or cholecystectomy were excluded. Demographic, clinical, and lifestyle data were collected using a structured questionnaire. Cholelithiasis was diagnosed by abdominal ultrasonography. Associations between cholelithiasis and potential risk factors were evaluated using the Chi-square test, with a p-value <0.05 considered statistically significant. Results: The mean age of the participants was 39.9 ± 11.35 years, and 53.2% were females. Cholelithiasis was detected in 87 (61.7%) participants. Females had a significantly higher frequency of cholelithiasis than males (71.3% vs. 28.7%; p<0.001). A positive family history of cholelithiasis (p=0.02) and elevated liver function tests (p=0.03) were significantly associated with gallstone disease. No significant associations were observed between cholelithiasis and age group (p=0.13), body mass index (p=0.73), serum cholesterol level (p=0.41), or physical activity (p=0.16). Conclusion: Cholelithiasis was frequently detected among patients undergoing abdominal ultrasonography. Female gender, a positive family history of cholelithiasis, and elevated liver function tests were significant factors associated with gallstone disease. These findings support the use of abdominal ultrasonography for early diagnosis in high-risk individuals and highlight the need for larger multicenter prospective studies to validate these findings and inform preventive strategies.
Cholelithiasis, Gallstones, Abdominal Ultrasonography, Risk Factors, Gallbladder Disease
Copyright (c) 2026 Khushmala Khattak, Madina Tahir , Hasnain Kamal , Kiran Zeb, Kiran Zeb, Aqsa Siddique , Abid Ullah Shah , Aisha Muhammad Saleh , Uzma Ali Khan (Author)
SOLUBLE KLOTHO AND FGF23/FGFR4-DRP1 MITOCHONDRIAL FISSION IN CKD CARDIOMYOPATHY
Background: Chronic kidney disease (CKD) is strongly associated with excess cardiovascular mortality that cannot be fully explained by loss of renal filtration alone. Uremic cardiomyopathy in CKD is characterized by left ventricular hypertrophy, interstitial fibrosis, mitochondrial dysfunction, and impaired energetic capacity, occurring in parallel with disturbances in mineral metabolism. Elevated fibroblast growth factor 23 (FGF23) and reduced Klotho levels have been implicated in the CKD–mineral bone disorder axis, with emerging evidence suggesting direct cardiac effects of FGF23 via FGFR4-mediated signaling pathways leading to mitochondrial fission through Drp1 activation. Objective: This study aimed to determine whether CKD-associated elevations in FGF23 contribute to cardiac remodeling through FGFR4-dependent signaling and whether mitochondrial fission via Drp1 acts as a downstream effector mechanism in uremic cardiomyopathy. Methods: A randomized, controlled, blinded preclinical study was conducted at the Toxicology Laboratory, University of Veterinary and Animal Sciences (UVAS), Lahore, Pakistan, from February 2024 to July 2025. The study employed a male Sprague–Dawley rat 5/6 nephrectomy (PNx) model, complemented by a human iPSC-derived cardiomyocyte system. Animals were randomized after CKD confirmation and allocated to five groups: Sham + vehicle, PNx + vehicle (CKD control), PNx + recombinant Klotho (rescue arm), PNx + FGFR4 blockade (mechanistic inhibition), and PNx + anti-FGF23 antibody (ligand neutralization). Cardiac structure and function were assessed using echocardiography at baseline, pre-randomization, and terminal stages. Renal and mineral metabolism profiles included serum creatinine, BUN, phosphate, calcium, PTH, FGF23, and soluble Klotho. Cardiac tissue was analyzed for fibrosis, hypertrophy, and mitochondrial structure using transmission electron microscopy (TEM). Mechanistic evaluation of Drp1 phosphorylation (Ser616/Ser637) and FGFR4–PLCγ–calcineurin–NFAT signaling was performed via Western blotting. Mitochondrial morphology and function were further validated in iPSC-derived cardiomyocytes exposed to FGF23 with or without pathway modulation. Results: CKD was confirmed 2-4 weeks post-5/6 nephrectomy, with significantly elevated serum creatinine (1.2-1.8 mg/dL vs. 0.5-0.7 mg/dL in sham, p<0.05), BUN (45-65 mg/dL vs. 15-20 mg/dL, p<0.01), phosphate (7.0-9.5 mg/dL vs. 4.5-5.5 mg/dL, p<0.05), PTH (200-400 pg/mL vs. 50-100 pg/mL, p<0.01), and FGF23 (800-2000 pg/mL vs. 50-150 pg/mL, p<0.001), while soluble Klotho was significantly reduced (100-200 pg/mL vs. 300-500 pg/mL, p<0.01). Echocardiography demonstrated progressive LV hypertrophy and dysfunction, with fractional shortening decreasing from 45-55% at baseline to 25-35% (p<0.001) by week 7-10. TEM analysis revealed significant mitochondrial fragmentation in CKD hearts, with mitochondrial length reduced from 2.5-3.5 μm to 1.0-1.8 μm (p<0.001) and mitochondrial damage increasing from <5% to 35-55% (p<0.001). Western blot analysis showed marked activation of Drp1 Ser616 phosphorylation (p-Drp1 Ser616/Total Drp1: 1.2-1.8 vs. 0.2-0.4 in sham, p<0.001) and downregulation of fusion proteins MFN1, MFN2, and OPA1. Recombinant Klotho treatment and FGFR4 blockade significantly attenuated these mitochondrial abnormalities, with mitochondrial length recovering to 2.0-2.8 μm (p<0.01) and p-Drp1 Ser616 decreasing to 0.5-0.8 (p<0.01), despite persistent renal dysfunction. FGFR4 blockade and rKlotho treatment preserved LV function (ejection fraction: 65-70% vs. 45-55% in CKD, p<0.01) and reduced fibrosis. Human iPSC-derived cardiomyocytes exposed to FGF23 (100 ng/mL) recapitulated the mitochondrial fission phenotype, with reduced mitochondrial length (0.8-1.5 μm vs. 2.0-3.0 μm in control, p<0.001), increased p-Drp1 Ser616 (1.5-2.5 vs. 0.3-0.5, p<0.001), and decreased mitochondrial membrane potential (55-65% vs. 100%, p<0.001). Co-treatment with rKlotho or FGFR4 blockade prevented these effects. Anti-FGF23 neutralization showed beneficial cardiac effects but was associated with hyperphosphatemia and increased vascular calcification risk. Conclusion: This integrated multi-system approach demonstrates that CKD-associated elevations in FGF23 contribute to cardiac remodeling through FGFR4-dependent signaling, with mitochondrial fission via Drp1 Ser616 phosphorylation acting as a critical downstream effector mechanism in uremic cardiomyopathy. Recombinant soluble Klotho attenuates cardiac mitochondrial injury and Drp1 activation even when renal parenchymal injury persists, suggesting a primarily cardioprotective role independent of renal recovery. These findings position the FGF23–Klotho–FGFR4–Drp1 axis as a potential therapeutic target for mitigating cardiovascular complications in CKD. Keywords: Chronic kidney disease; Uremic cardiomyopathy; Fibroblast growth factor 23; Soluble Klotho; Mitochondrial fission; Drp1; FGFR4; 5/6 nephrectomy
Copyright (c) 2026 Sayyed Hanif Ullah, Azhar Uddin, Shaukat Khan, Naveed ul Hassan, Saddam Hussain, Naseem Khan⃰ (Author)
INCIDENCE OF HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND INTUBATION UNDER GENERAL ANESTHESIA
During laryngoscopy and intubation, 41% of my 100 patients had their heart rate or blood pressure increase. This was higher among males (49.2%) than females (29.3%) and was statistically significant. A higher number of events was seen in ASA II patients (57.1%) as compared to ASA I patients (13.5%). This is not unusual, as individuals who have slight health problems are more likely to be affected by stress. There was also a clear age effect – just 8.7% of the youngest group experienced events, but 55.6% of the oldest group did. The figure of 14% needing a rescue drug only tells me that most events were mild and went away all by themselves. Patients who had an event had a slightly longer laryngoscopy time (16.6 seconds) compared to those without an event (14.0 seconds). However, the event rate was greater for the patients requiring two attempts to tube insertion compared to those inserting the tube on the first attempt (47.6% vs. 39.2%). The most prevalent pattern was for the patient to have both fast heart rate and high blood pressure. Overall, the ASA II status, male sex and age are important risk factors that should be taken into special consideration during intubation.
Hemodynamic reaction, Laryngoscopy, Intubation, Tachycardia, high blood pressure, widespread Anesthesia, ASA reputation, Age organizations, and Rescue drug
RELATIONSHIP OF FATTY LIVER GRADING ALONG WITH THE LIVER ENZYMES
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is the most common chronic liver disease worldwide. Although liver enzymes are routinely used to assess hepatic injury, their relationship with imaging-based fatty liver grading remains inconsistent. This systematic review aimed to evaluate the association between fatty liver grading and serum liver enzyme levels. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Electronic databases including PubMed/MEDLINE, Scopus, Web of Science, Embase, Google Scholar, and the Cochrane Library were searched for studies published between January 2018 and December 2026. Studies evaluating the relationship between imaging-based fatty liver grading and liver enzyme levels were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Newcastle–Ottawa Scale and the Cochrane Risk of Bias tool. Data were synthesized qualitatively. Results: A total of 102 records were identified, of which 20 studies met the inclusion criteria. Most studies demonstrated a positive association between increasing fatty liver grade and elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Several intervention studies reported significant reductions in liver enzyme levels following improvements in hepatic steatosis through lifestyle modification, pharmacological therapy, probiotic supplementation, glucose-lowering agents, or bariatric surgery. However, several studies also reported normal liver enzyme values despite moderate-to-severe hepatic steatosis. Elevated gamma-glutamyl transferase (GGT) levels and higher AST/ALT ratios were more frequently associated with advanced liver disease and adverse clinical outcomes. Conclusion: Liver enzyme abnormalities generally increase with worsening fatty liver grade; however, liver enzymes alone cannot reliably determine the severity of hepatic steatosis. Combining imaging-based fatty liver grading with biochemical liver enzyme assessment provides a more accurate approach for diagnosis, disease monitoring, and prognostic evaluation in patients with fatty liver disease.
Fatty liver disease; Hepatic steatosis; Fatty liver grading; Liver enzymes; Alanine aminotransferase; Aspartate aminotransferase; Gamma-glutamyl transferase; MASLD
ASSESSMENT OF KNOWLEDGE ATTITUDE AND PRACTICE REGARDING RISK FACTORS OF CATHETER ASSOCIATED URINARY TRACT INFECTION IN CRITICAL CARE SETTING IN GENERAL HOSPITAL, LAHORE.
Objective: To assess the knowledge and attitudes of healthcare professionals working in critical care settings regarding the risk factors of catheter-associated urinary tract infections (CAUTIs). Study Design: Descriptive cross -sectional study. Place and Duration of Study: The study was conducted among personnel, including physicians, nurses, and technicians, at General Hospital and University of Health Sciences, Lahore, Pakistan, from September 2025 to April 2026. Methodology: A standardized questionnaire was used to assess participants’ knowledge of CAUTI causes, risk factors, and preventive measures, as well as their attitudes and adherence to recommended prevention practices. Data were analysed to identify knowledge gaps and opportunities for improvement. Results: A total of 122 participants were included in the study. Most participants were female (91.8%), and 83.6% were aged 23–28 years. Regarding educational qualifications, 54.1% held a General Nursing diploma, while 42.6% were BSN graduates. Participants demonstrated good knowledge of CAUTI prevention, with a mean knowledge score of 15.91. The mean attitude score was 22.54, reflecting a positive perception of infection prevention. Furthermore, 79.5% disagreed that CAUTIs are unavoidable, and 72.1% strongly disagreed that CAUTIs are non-serious infections. The mean practice score was 10.54, indicating strong compliance with recommended infection-control measures. Conclusion: Operating theatre staff demonstrated high levels of knowledge, positive attitudes, and satisfactory preventive practices regarding CAUTI prevention. The findings highlight a well-informed workforce committed to reducing catheter-associated infections through adherence to evidence-based infection prevention measures.
Knowledge, attitude, practices, CAUTI, urinary tract infection, infection prevention
TO DETERMINE THE FREQUENCY OF KIDNEY STONE ON ULTRASONOGRAPHY AT TERTIARY CARE HOSPITAL (RMI)
Background: kidney stones are solid salt and mineral deposits. Renal calculi and nephrolithiasis are other names for them. Kidney stone presents as intense flank or stomach torment with queasiness and spewing. The stone affects the kidney by forming cysts and cause hydronephrosis and may also lead to kidney failure. Kidney stones were 10% common in US in 2013 and 2014. The frequency of kidney stone was determined in Pakistan including some places of Gilgit and Chitral. Objective: The purpose of our study is to evaluate frequency of kidney stones on ultrasonography. Design, setting and participants: The study was conducted in Rehman Medical Institute. A cross-sectional based study with a non-probability convenient sampling technique was selected. The sample size was 139. Duration of research project was 4-6 months. Results: from the results of the study it was examined that there is slightly raise in the frequency of male individuals with the presence of kidney stone in their body as compared to the female individuals. The ratio include 72 male and 67 females. We divided our study population into age groups in which age group between (21-40) have higher percentage of kidney stone about 48.2%. The common type of kidney stone among the individuals the most common were concretions with ratio of 80 and calculus with 59. Conclusion: As the data collected from the sample population who visit to the radiology department of Rehman Medical Institute for ultrasound it is concluded that the frequency of kidney stone occur higher in male as compared to female.
nephrolithiasis, urinary tract infection, kidney stones, urinary calculi, concretions stone
Assessing Clinical Competency Among Nursing Students AccordingTo their Academic Level At Aligarh College Of Nursing And AlliedHealth Sciences, Lahore
Background: Clinical competency is an essential component of nursing education. Throughout academic levels,nursing students must have adequate clinical knowledge, practical skills as well as professional attitude.Clinical competency varies according to academic level. Objective: To determine the relationship between academic level and clinical competency among nursing students. Methods: A cross-sectional study was conducted among 109 nursing students from BSN 4 year, BSN 3 year, and BSN 4 semester.A Likert-scale questionnaire consisting of four competency domains was used to collect data. SPSS version 26 was used for data analysis. Descriptive statistics,one-way ANOVA and Tukey post hoc tests were used. Results: The findings suggest that nursing students showed moderate to high levels of clinical competency.BSN 4th year students showed the higher mean competency scores (43.20 ± 2.39),compared to BSN 4th semester students (29.31 ± 3.91).Academic level disparities statistically significant (p<0.001) according to one-way ANOVA.Tukey Post hoc test showed 4th year BSN nursing students (118.03) demonstrated higher clinical competency scores than BSN 4th semester nursing students (74.50). Conclusion: Nursing students showed moderate to high levels of clinical competency, increasing according to academic level.BSN 4th year students achieved highest competency, showing importance of academic progression in clinical competency.
BSN education, academic level, clinical competency, nursing students, and one-way ANOVA
Copyright (c) 2026 Obaid Alyas, Irshad Ali , Irshad Ali , Usama Seikhu , Ameer Hamza , Muhammad Tayyab (Author)
Assessment Of Knee Joint Pathologies On Mri Among Different Age Groups
Background: Among body joints, the most complex and most intricate is knee joint essential for enabling movement and sustaining body weight. Magnetic Resonance Imaging (MRI) is a modality that is non- intrusive approach for the diagnosis of knee abnormalities. Objective: To assess and evaluate the prevalence of the knee joint pathologies on MRI among different age groups. Material and Methods: Convenient sampling was used to gather data of 87 patients with a history of chronic knee pain. Data was collected prospectively from multicenters in Lahore and analyzed using SPSS version 23. Knee pathologies frequencies were assessed across three age groups, from 19 to 80 years old comprising 55 (63.2%) patients in 19-40, 26 (29.9%) in 41-60 and only 6 (6.9%) in 61-80 age group. Results: Among total of 87 patients undergoing knee MRI, Gender distribution showed 67 males (77.01%) with highest frequency in 19-40 age group (87.3%) and 20 females (22.99%) with highest frequency 38.5% in 41-60 age group. 39 patients had an ACL tear with highest frequency of 49.1% in 19–40 age group. 3 patients suffered from MCL tear with highest frequency of 3.6% in 19-40 age group, 5 patients had PCL tear with highest frequency 5.5% in 19-40, 4 patients had LCL tears with highest frequency 7.7% in 41-60 age group. Joint effusion highest frequency was 61.9% in 19-40 age group. Conclusion: MRI can be brought into play as a screening tool for affected individuals with persistent knee pain symptoms who are anxious to resume their usual lifestyle, therefore prompt diagnosis of their condition based on their age will shorten the recovery period. They can also choose therapeutic techniques through MRI screening.
MRI, Knee Joint, Arthroscopy, Soft Tissues, Ligaments, Menisci, Knee Joint Pathologies
Copyright (c) 2026 Ayesha Tehreem, Ateeqa Qurban, Anmol Khadija , Aiman Azhar, Saira Afzal, Sadaf Abdul Qadir (Author)
Inflammaging As A Central Driver Of Age-Related Atherosclerosis: Mechanisms, Lifestyle Determinants, And Therapeutic Perspectives
Aging is a key risk factor for atherosclerosis & cardiac diseases, subject to continued structural & physiological fluctuations in the walls of arteries. With growing age, vascular ossification, endothelial dysfunction & lipid accumulation form a pro-inflammatory environment that is more augmented by ongoing, substandard sensitivity known as inflammaging. This review analyzes the biological & curative links between aging, atherosclerosis & inflammaging, traumatized causal molecular mechanisms & their implications for cardiovascular health. Pivotal pathogenic processes under discussion include immunological dysregulation, oxidative stress, cellular senescence, and altered lipid metabolism, all of which contribute to the initiation and progression of atherosclerotic lesions. This review analyzes impact of routine factors—such as regime, bodily activity, smoking, use of alcohol, sleep patterns, and social anxiety—on inflammatory problem and vascular aging. Emerging studies on restorative approaches directing inflammaging with anti-inflammatory mediators, digestive tract microbiota variation, caloric constraint, and Seno-lytic interpositions, is also studied. Studying the interaction between age-linked irritation, life determining factors & vascular pathology may offer opportunities for initial anticipation and tailored supervision of age-linked atherosclerosis, eventually refining cardiovascular consequences in the aged people.
Inflammaging Atherosclerosis, Aging, Chronic inflammation, Vascular aging, cardiovascular disease, Lifestyle factors.
Copyright (c) 2026 Bakhtawar Malik, Muhammad Bader-e-Tefoor, Mahnoor Ashraf, Rimsha Shahid, Aasia Nazar (Author)
FREQUENCY OF ATRIAL FIBRILLATION IN PATIENTS WITH DILATED CARDIOMYOPATHY AT A TERTIARY CARE HOSPITAL, PESHAWAR
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with dilated cardiomyopathy (DCM) and is associated with worsening heart failure, thromboembolic events, and increased mortality. This study aimed to determine the frequency of AF and evaluate its association with demographic and echocardiographic characteristics in patients with DCM. Methods: This cross-sectional study was conducted in the Department of Cardiology, Lady Reading Hospital, Peshawar, from February to June 2026. A total of 113 patients with echocardiographically confirmed DCM were enrolled using a non-probability convenience sampling technique. Demographic and clinical data were collected using a structured questionnaire. Atrial fibrillation was diagnosed using a standard 12-lead electrocardiogram (ECG). Data was analyzed using R software (version 4.3), and a p-value <0.05 was considered statistically significant. Results: Among the 113 patients, 20 (17.7%) had AF, while 93 (82.3%) were in sinus rhythm. The mean age of the participants was 55.9 ± 9.2 years, and 78 (69.0%) were male. No significant association was observed between AF and age (p = 0.20) or gender (p = 0.13). However, AF was significantly associated with the severity of mitral regurgitation (p = 0.011). Patients with AF also demonstrated a higher prevalence of severe left ventricular systolic dysfunction, with borderline statistical significance for left ventricular ejection fraction <30% (p = 0.074). Conclusion: Atrial fibrillation was present in nearly one-fifth of patients with DCM and was significantly associated with mitral regurgitation and severe left ventricular systolic dysfunction. Early recognition of AF and echocardiographic abnormalities may improve risk stratification and clinical management in patients with DCM.
Atrial fibrillation; Dilated cardiomyopathy; Electrocardiography; Echocardiography; Mitral regurgitation; Left ventricular ejection fraction.