BMC Journal of Medical Sciences

HISTOPATHOLOGICAL SPECTRUM OF CHOLECYSTECTOMY SPECIMENS: A RETROSPECTIVE CROSS-SECTIONAL STUDY

2026-06-29T06:58:49+00:00

Background: Cholecystectomy is one of the most frequently performed abdominal surgical procedure worldwide. Although routine Histopathological examination of cholecystectomy specimens is standard practice, its diagnostic utility in identifying incidental pathologies, particularly premalignant and malignant lesions, remains clinically significant.

Objective: This study aimed to investigate the histomorphological patterns in 1036 cholecystectomy specimens and emphasize the utility of routine Histopathological examination for precise diagnosis.

Material and Methods: A retrospective analysis of 1036 cholecystectomy specimens was conducted from January 2017 to December 2019 at Liaquat National Hospital, Karachi. Standard Histopathological processing and examination techniques were employed. Patient demographics and Histopathological diagnoses were analyzed using descriptive statistics.

All consecutive cholecystectomy specimens received during the study period were included irrespective of age or gender. Specimens with inadequate fixation, and incomplete clinic pathological data were excluded. Data were analyzed using SPSS software version 20.0 with frequency distributions and percentages calculated for all variables.

Results: Chronic cholecystitis was identified in 421 cases (40.6%), followed by acute cholecystitis in 208 cases (20.1%). These two entities accounted for 60.7% of all specimens examined. Intestinal metaplasia in chronic cholecystitis occurred in 50 cases (4.82%). Dysplasia was detected in 6 cases (0.57%), representing a significant pre-malignant finding. Invasive gallbladder carcinoma was identified in 8 specimens (0.77%). A marked female predominance was observed across major diagnostic categories.

Conclusion: Routine histopathological examination of cholecystectomy specimens is essential for detecting diverse gallbladder pathologies and identifying incidental pre-malignant and malignant lesions. Detection of dysplasia in 0.57% and carcinoma in 0.77% of specimens underscores the clinical importance of routine histological evaluation.

KNOWLEDGE AND PRACTICES OF CAFFEINATED ENERGY DRINK CONSUMPTION AMONG UNDERGRADUATE MEDICAL STUDENTS IN KARACHI: A CROSS-SECTIONAL STUDY

2026-06-29T08:04:12+00:00

Background: A significant increase in consumption of caffeinated energy drink ( CED) despite its negative health risks has become a growing public health concern. The aggressive marketing of caffeinated energy drinks toward youth to enhance performance stems from a lack of regulatory oversight and surveillance.

Objective: This study aimed to assess the practices and knowledge regarding adverse health effects of Caffeinated energy drink among undergraduate medical students.

Material and Methods A cross-sectional study was carried out at Fazaia Ruth Pfau Medical College (FRPMC) from Feb 2024 to August 2024.Systematic random sampling method was employed. The sample size was determined to be 366 estimated through OpenEpi software. Data were collected using a validated, structured questionnaire administered via online Google Forms platforms. Data were entered, processed and analyzed using SPSS version 25.0. A p-value of < 0.05 was considered statistically significant for analyses. Consumption, practices, level of knowledge, sources of information, and perceived adverse effects were assessed. Chi square test was applied to assess the significance among study variables. A multivariate logistic regression was applied to demonstrates the association between demographic characteristics and the practice of reading health warning labels on caffeinated energy drinks among participants.

Results: Among the 366 student, less than half of medical students 46.72% (n= 171/366) were ignorant about the adverse consequences of CED reported consumption of CED. Sixty one 61% (n= 226/366) of medical students do not read the health warning present on CED. A significant association was observed between ethnicity (p=0.022) and knowledge regarding the awareness of health warning on CED.

Conclusion: Since the knowledge regarding negative health consequences of CED among undergraduate medical students of Karachi during 2024 was found to be quite high. However the researcher wants to add that further longitudinal studies on this subject is needed to explore the practices regarding exact health consequences of CED. Further to this, there is still a need for implementation of policies at Federal, Provisional and local level to control the incorrect practices regarding excessive consumption of CED as the users do not need the health warning present on CED.

MULTIDISCIPLINARY CARE TEAM APPROACH AND OUTCOMES IN BREAST CANCER PATIENTS: A PROSPECTIVE COMPARATIVE STUDY

2026-06-29T06:44:24+00:00

Background: The role of the multidisciplinary care team (MDCT) has been emphasized in providing optimal treatment for breast cancer. Although previous studies have shown limited benefits in terms of certain metrics, whole system effectiveness is currently unknown and must be evaluated through interdepartmental trials.

Objective: To evaluate the impact of a structured multidisciplinary team-based care pathway on clinical outcomes, patient-reported outcomes, quality of life, and healthcare utilization among newly diagnosed breast cancer patients compared with routine standard care without formal MDT coordination.

Material and Methods: This prospective study was conducted at Department of General Surgery, Hayatabad Medical Complex, Peshawar between May 2021 to April 2022 and prospectively followed until April 2024, consisted of 73 female patients newly diagnosed with breast cancer. Personalized oncologic treatment plans were developed in collaboration of multidisciplinary cancer teams (MDCTs) which include medical oncologist, surgeons and radiation oncologists. Clinical outcomes, patient reported outcomes (estimated by EORTC QLQ-C30 and SF-36) and healthcare utilization metrics were collected at baseline and at 6, 12, 18, and 24 months of follow-up.

Results: Patients managed by multidisciplinary cancer teams had a significantly higher 2-year disease-free survival 62(85% )vs. 53( 72%) and overall survival rates 67 (92%) vs.58 (80%). MDCTs significantly dropped recurrence rates 9 (12%) vs. 18(25%) and complications 6 (8%) vs. 9(13%), significant reduction in length of hospital stay (5.6 vs 10.2 days), and number of outpatient visits(12 vs 18 visits).

Conclusion: MDCT improves clinical outcomes, patient-reported outcomes and healthcare efficiency in breast cancer management. These results highlight the need to further incorporate MDCTs into clinical practice in order to optimize patient care and outcomes across diverse healthcare environments.

THE EVALUATION OF ORAL HEALTH STATUS BASED ON DMFT INDEX IN MEDICAL AND DENTAL COLLEGE STUDENTS OF KOHAT

2026-06-29T07:11:03+00:00

Background: The Decayed, Missing, and Filled Teeth (DMFT) index is a useful tool for measuring and tracking dental health in a population. keeping this in mind, the present study was initiated to investigate the oral health status and related characteristics among students studying at Medical and Dental College Kohat using the DMFT index

Objective: To assess the oral health status of medical and dentistry students in Kohat, Khyber Pakhtunkhwa, using the DMFT index and identify the contributing factors influencing their oral health.

Material and Methods This cross-sectional descriptive analytical study was conducted at Khyber Medical University, Institute of Medical Sciences (KMU-IMS) and Institute of Dental Sciences (KMU-IDS), Kohat, from November 2023 to November 2024, conducted on 250 students, aged 19-26 years old. Using a questionnaire, data were collected by three trained dental students. The dependent variable was the DMFT index. Data were analyzed using SPSS-26 for T-test, ANOVA and multiple regressions.

Results: In all, 250 persons between the ages of 19 and 26 participated in the study, 150 of them were between the ages of 19 and 22 and 100 were between the ages of 23 and 26. The mean (±SD) values of DT, MT, and FT indices in the partakers were 2.66±0.6, 1.09±1.5, and 2.5±2.4, respectively. The mean (±SD) value of total DMFT index was 6.25±2.4 in all the subjects, 5.8±2.7 in students aged 19-22 years old, and 6.7±2.1 in students aged 23-26years old.

Conclusion: A relatively high DMFT score was observed among the participants. However, owing to the cross-sectional nature of the study and the absence of direct assessment of stress and other potential confounding factors, no causal relationship can be established. The findings suggest that oral hygiene behaviors were associated with oral health status among the study population . Changing behavioural routines (such brushing, mouthwash, and tooth floss) and raising parental and individual education levels can enhance oral and dental health.

CHARACTERISTICS AND OUTCOME OF PREGNANCY-RELATED ACUTE KIDNEY INJURY IN A TEACHING HOSPITAL IN A LOW RESOURCE SETTING, DERA ISMAIL KHAN, PAKISTAN

2026-06-29T07:20:19+00:00

Background: Acute Kidney Injury (AKI) is frequently caused by pregnancy-related acute kidney damage (PRAKI), which has a pooled incidence of 2% worldwide.

Objective: To determine the clinical characteristics, associated risk factors, and maternal renal outcomes of pregnancy-related acute kidney injury in patients managed at a low-resource setting in Dera Ismail Khan,Pakistan.

Material and Methods: This cross-sectional study was conducted in the Nephrology Unit of District Headquarter Teaching Hospital, Dera Ismail Khan, Pakistan, from May to September 2025. Using a non-probability consecutive sampling technique, all eligible pregnant or postpartum women diagnosed with acute kidney injury according to KDIGO criteria were enrolled during the study period. Data were analyzed by using IBM SPSS Statistics version 23. Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were presented as frequencies and percentages, n (%). The Chi-square test and Fisher’s exact test were used to assess associations between variables. A p-value <0.05 was considered statistically significant.

Results: A total of 48 postpartum patients with acute kidney injury were included in the study. Multiparous women accounted for 28 (58.3%) cases, while 40 (83.3%) patients were uncooked. Spontaneous vaginal delivery was the most common mode of delivery, occurring in 32 (66.7%) patients. Postpartum haemorrhage was observed in 36 (75%) patients, followed by eclampsia in 20 (41.7%), sepsis in 11 (22.9%), gestational diabetes mellitus in 12 (25%), and hypertensive disorders of pregnancy in 8 (16.7%) patients. Overall, 18 (37.5%) patients achieved renal recovery, whereas 30(62.5%) had poor outcomes. Maternal mortality occurred in 4 (8.3%) patients. Postpartum haemorrhage, sepsis, and eclampsia were significantly associated with poor outcomes.

Conclusion: Pregnancy-related acute kidney injury remains a significant contributor to maternal morbidity in low-resource settings, Poor renal outcome was observed in 30(62.5%) of patients, while 18(37.5%) showed renal recovery. Postpartum hemorrhage (p=0.02), sepsis (p=0.026), and eclampsia (p=0.035) were significantly associated with adverse outcomes.

THE DENTAL WAITING-ROOM ENVIRONMENT AND ITS ASSOCIATION WITH DENTAL ANXIETY IN PRIVATE DENTAL CLINICS AND HOSPITAL DENTAL DEPARTMENTS

2026-06-29T07:39:27+00:00

Background: Dental anxiety is a major barrier to oral health care. Waiting room conditions may influence pre-treatment anxiety, but evidence from private dental settings in Lahore is limited.

Objective: To assess the association between patient-perceived waiting room environmental and organizational factors and dental anxiety among adult patients attending private dental clinics and private hospital dental departments in Lahore, Pakistan.

Material and Methods: This cross-sectional study was conducted in the waiting rooms of 4 private dental clinics and 2 private hospitals in Lahore from Jan to Nov 2025, after approval from the IRB of Azra Naheed Dental College. Adults aged 18 years and above attending scheduled non-emergency dental care and able to understand English or Urdu were recruited through consecutive sampling. Data was collected using a questionnaire covering demographics, the Modified-Dental-Anxiety-Scale (MDAS), and a literature-informed checklist of patient-perceived waiting-room factors. Chi-square tests compared clinics and hospitals, while multinomial logistic regression identified predictors of MDAS anxiety categories.

Results: Out of 700 patients approached, 651 completed the questionnaire, with a response rate of (651)93%. The mean age was 33.2±13.7 years; 313 (48.1%) were male and 338 (51.9%) female. The mean MDAS score was 13.19±4.62. Low, moderate, and high anxieties were reported by 293( 31.2%), 360 (55.3%), and 13.5% of participants, respectively. Mean MDAS scores did not differ significantly between clinics and hospitals (p=0.115). In multivariable analysis, perceived cleanliness and minimized waiting time were independently associated with lower anxiety categories

Conclusion: Patient-perceived cleanliness and shorter waiting time were associated with lower dental anxiety in private dental settings in Lahore.

FREQUENCY OF HYPOCALCEMIA IN NEONATES WITH PERINATAL ASPHYXIA

2026-06-29T07:49:46+00:00

Background: Asphyxia in a basic term used when birth occurs and newborn's spontaneous respiration is delayed after delivery. More specifically, hypoxia, hypercapnia, and acidosis that cause systemic problems in the infant is known as birth asphyxia. Because of the possible consequences of hypocalcaemia, the relationship between it and fetal hypoxia is a crucial factor to take into account.

Objective: To determine the frequency of hypocalcaemia in neonates with perinatal asphyxia

Material and Methods: This cross-sectional study was conducted at the Department of Pediatric Medicine, Khalifa Gul Nawaz Teaching Hospital, Bannu, from July to December 2025. All newborns of both genders with perinatal asphyxia were included. Excluded were infants with sepsis, inborn metabolic errors, Rh incompatibility, and clinical suspicion of hematological conditions. SPSS version 25.0 was used for statistical analysis. p value <0.05 were considered statistically significant.

Results: In this study, the average gestational age was 38.03 ± 1.06 weeks. Of the 100 patients, 40 (40.0%) were male and 60 (60.0%) were female, with a male to female ratio of 1:1.5. The average weight in our sample was 3.09 ± 1.53 kg. The average serum calcium level was 2.14 ± 0.18 mg/dl. Hypocalcaemia was found in 27 (27.0%) newborns with perinatal asphyxia in our study.

Conclusion: According to our research, newborns that suffer from birth asphyxia go on to develop hypocalcaemia. When a newborn experiences hypoxia, prompt detection and effective treatment of hypocalcaemia lowers the chance of death and removes detrimental effects on neurological development.

A HOSPITAL-BASED STUDY ON THE INFLUENCE OF SYSTEMIC RISK FACTORS IN THE DEVELOPMENT OF CENTER-INVOLVING MACULAR EDEMA IN PATIENTS WITH DIABETIC RETINOPATHY

2026-06-29T08:17:11+00:00

Background: Diabetic retinopathy and center-involving diabetic macular edema are the major causes of vision loss in working age individuals, with macular edema resulting from fluid accumulation in the macula leading to increased retinal thickness and visual deterioration.

Objective: To determine the frequency of center-involving diabetic macular edema (Ci-DME) and evaluate its association with glycemic control and serum lipid profile among patients with diabetic retinopathy.

Material and Methods: In this hospital-based analytical cross-sectional study, 200 eyes of 100 diabetic patients were investigated from March 2023 to October 2023 in KGN TH eye department Bannu, Pakistan. The patients were placed into two groups: (1) Ci-DME (DR and Ci-DME coexisting in one or both of the eyes) and group (2) Non-Ci-DME (DR present with or without DME but no Ci-DME in any of the eyes present).The levels of urine albumin, glycosylated hemoglobin (HbA1C) (0.326), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and serum total cholesterol have been measured in both groups(>0.272).

Results: 40 (40%) of the 100 diabetic patients were diagnosed with ci-DME, of which 27 (67.27%) were male and 13(32.73%) were female in which high cholesterol level and insufficient glycemic control were significantly correlated. Additionally patients with ci-DME had lower levels of HDL (0.91p) and TG (0.93P), both of which are known risk factors for cardiovascular disease. Despite these distinctions, the differences in lipid levels between the two groups were not statistically significant in this investigation except low density lipoproteins.

Conclusion: Ci-DME is associated significantly with higher level of total cholesterol and poor glycemic control.

TERTIARY CARE HOSPITAL REALITY CHECK: HEMOGLOBIN CHANGE AFTER TRANSFUSING 1 UNIT OF FRESH WHOLE BLOOD IN A CROSS-SECTIONAL STUDY

2026-06-29T08:33:07+00:00

Background: Anemia is a typical clinical disorder which often necessitates blood transfusion, especially in hospitalized patients. Even though it is usually believed that the transfusion of a unit of blood raises the hemoglobin levels about 1 g/dL, the response of hemoglobin can differ according to the patient traits and clinical conditions. However, limited evidence exists regarding the real-world hemoglobin increment after transfusion of fresh whole blood in tertiary care settings and the influence of comorbidities on this response.

Objective: To determine the change in hemoglobin level following transfusion of one unit of fresh whole blood (450 mL) in anemic patients and to assess whether comorbid conditions influence the hemoglobin response.

Material and Methods: This cross-sectional study was conducted in the Department of Medicine, Benazir Bhutto Shaheed Teaching Hospital (DHQ), Abbottabad, Pakistan, from 15 April 2024 to 14 April 2025. A total of 159 hemodynamically stable anemic patients (hemoglobin <11 g/dL) receiving one unit of fresh whole blood were included after informed consent. Pre-transfusion (HBBT) and 24-hour post-transfusion (HBAT) hemoglobin levels were measured using the Sahli method. Data on demographics, anemia type, comorbidities, and clinical features were collected. Analysis included descriptive statistics, subgroup comparisons, and multivariable linear regression (SPSS v22).

Results: Mean age was 42.23 ±19.74 years; 62.9% were female. Microcytic anemia was most common (???)54.1%. The mean increase in hemoglobin was 1.65 ± 0.70 g/dL (mean percentage change: 32.29 ± 25.80%), which was a statistically significant improvement after transfusion of fresh whole blood. Females showed greater increase than males. Patients with vague bleeding had lower increment (1.49±0.63 g/dL vs 1.71±0.71 g/dL in non-bleeding). Regression analysis identified female gender as a positive predictor (B = 0.24, p = 0.047) and vague bleeding as a negative predictor (B= −0.29, p = 0.024) of hemoglobin change.

Conclusion: One unit of fresh whole blood transfusion produced a clinically meaningful hemoglobin rise of approximately 1.65 g/dL in anemic patients. Female gender enhanced response, while vague bleeding attenuated it. Comorbidities like hypertension, diabetes, and chronic kidney disease showed no significant impact.

MRI IMAGE QUALITY AND DIAGNOSTIC CONFIDENCE IN BRAIN TUMOR EVALUATION

2026-06-29T08:49:10+00:00

Background: MRI is the preferred imaging modality for brain tumor evaluation, and image quality significantly affects diagnostic accuracy. Quantitative measures such as Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) may influence radiologists’ diagnostic confidence and clinical decision-making.

Objective: To assess MRI image quality using quantitative measures including Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) along with qualitative assessment, and to evaluate their association with diagnostic confidence in brain tumor diagnosis.

Material and Methods: Retrospective cross-sectional study was conducted at Department of Radiology, Liaquat University of Medical & Health Sciences (LUMHS) and Advanced Diagnostic Centre, Jamshoro and Hyderabad, from 1st July, 2025 to 30th November, 2025. A sample of 250 adult patients (≥18 years) was selected using non-probability consecutive sampling. Sample Size and Statistical Justification. All scans were performed on a 3.0 Tesla scanner. Image quality was analyzed quantitatively via Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR), and qualitatively via a 5-point Likert scale. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0.

Results: Out of 250 scans, 200 (80%) exhibited high quantitative quality. High qualitative diagnostic confidence was recorded in 210 (84%) cases, while 225 (90%) scans were clinically usable. Inter-rater agreement was 230 (92%). Although artifacts were present in 70 (28%) scans, they impacted clinical decision-making in only 45 (18%) cases. Tumor types included Gliomas (n=100, 40%), Meningioma’s (n=75, 30%), and Metastases (n=50, 20%); contrast was administered in 200 (80%) patients.

Conclusion: Objective SNR and CNR metrics strongly correlate with radiologist confidence. Standardizing these parameters is vital for accurate tumor characterization and personalized neuro-oncology care.

ORAL HYGIENE PRACTICE AND DENTAL CARIES STATUS AMONG FEMALE MEDICAL STUDENTS RESIDING IN HOSTELS AT KMU-IMS KOHAT: A CROSS-SECTIONAL ANALYSIS

2026-06-29T08:58:11+00:00

Background: Poor oral hygiene and dental caries are frequently encountered issues yet often neglected, especially among young adults. Medical students in spite of their future roles in healthcare may often adopt unhealthy oral hygiene practices

Objective: The study aimed to determine the oral hygiene status and dental caries prevalence among hostellite female medical students at KMU-IMS, Kohat, KPK, Pakistan, and to identify the associated factors influencing their dental health.

Material and Methods: A cross-sectional study was conducted from April to June 2023 in KMU Institute of Medical Sciences, Kohat. Census sampling was employed, and all 203 eligible female hostelite students were considered for inclusion; 190 students consented to participate. Data were collected using a structured questionnaire and oral examinations. Oral health status was assessed using the Oral Hygiene Index Simplified (OHI-S) and the DMFT (Decayed, Missing, Filled Teeth) index. The examination was conducted by trained researchers under the supervision of dentists. Data were analyzed using SPSS version 22, using descriptive and chi-square test for inferential analysis to assess associations between oral hygiene, caries status, and related factors.

Results: The mean age of the participants was 21.91 ± 1.78 years. The average OHI-S score was 2.11 ± 1.14, indicating that 118 (62.1%) participants had fair oral hygiene. The mean DMFT score was 0.89 ± 1.35. Associations between oral hygiene status and related factors were assessed using the chi-square test. Significant factors associated with poor oral hygiene included brushing once a day, lack of use of dental floss or mouthwash, and frequent consumption of carbonated drinks (all p < 0.001).

Conclusion: Although the prevalence of dental caries was low, the majority of participants had fair oral hygiene. The findings highlight the need for improved oral health education focused on promoting better habits to enhance overall oral hygiene and prevent dental caries.

EVALUATION OF MECHANICAL AND ANTIMICROBIAL PROPERTIES OF ALKALI TREATED MORINGA POWDER REINFORCED POLY METHYL METHACRYLATE ACRYLIC RESIN: AN IN-VITRO EXPERIMENTAL LABORATORY STUDY

2026-06-29T09:05:57+00:00

Background: poly methyl methacrylate (PMMA) denture base resin is widely used in Prosthodontics but has limitations such as low fracture resistance and absence of antimicrobial activity. Natural fillers like Moringa oleifera powder are being explored to improve its mechanical strength and antimicrobial properties.

Objective: To evaluate the effect of incorporating different concentrations of Moringa powder (5%, 10%, and 15%) as a reinforcement in PMMA (polymethyl methacrylate) denture base resin on mechanical and antimicrobial properties..

Material and Methods: This in-vitro experimental laboratory-based study was conducted after the approval of the IRB of Azra Naheed Dental College, from Mar to Dec 25on PMMA resin reinforced with Moringa powder at 5%, 10%, and 15% by weight. The samples were prepared in accordance with ISO 178 and ISO 179-2 standards for mechanical testing. Flexural strength was evaluated using a universal testing machine (three-point bending test). Impact strength was tested using the Izod method. Antimicrobial activity was assessed using the disc diffusion method, and zones of inhibition were measured and averaged across all tested microorganisms. Data was analyzed using one-way ANOVA and post-hoc Tukey tests. SPSS v24 was used for analysis. p-value less than or equal to 0.05 was taken as significant.

Results: There were significant improvements in impact strength (p=0.002), flexural strength (p=0.044) and antimicrobial properties (p=0.001) with the incorporation of moringa powder. The 10% moringa group reported the highest flexural strength (89.83±3.54 MPa) and impact strength (10.13±0.68 J). The 15% Moringa group exhibited the largest antimicrobial activity, with the highest zone of inhibition (12.17±1.60 mm).

Conclusion: Incorporating moringa oleifera powder into PMMA denture base resin significantly improved both mechanical and antimicrobial properties, with the 10% concentration providing the best outcomes. Moringa powder shows potential as a natural reinforcement for improving the performance of PMMA dental materials.

FREQUENCY OF ACUTE MYOCARDIAL INJURY AMONG PATIENTS PRESENTING WITH UPPER GASTROINTESTINAL BLEEDING: A CROSS-SECTIONAL STUDY FROM PESHAWAR, PAKISTAN

2026-06-29T09:54:16+00:00

Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency with significant morbidity and mortality. Acute myocardial injury may occur in UGIB due to hemodynamic compromise and is commonly identified using elevated cardiac troponin levels.

Objective: To determine the frequency of acute myocardial injury among patients presenting with UGIB and its association with demographic and clinical variables.

Material and Methods: A cross-sectional study was conducted in the Department of Medicine at Khyber Teaching Hospital, Peshawar, from 11 January 2024 to 11 July 2024. A total of 163 patients aged 20–80 years presenting with UGIB were enrolled using consecutive non-probability sampling. Patients with pre-existing cardiac disease were excluded. Cardiac troponin I levels were measured twice, 12 hours apart, and acute myocardial injury was defined as troponin I >0.2 ng/mL. Data were analyzed using SPSS version 23. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. The Chi-square test was used to assess associations, with p ≤0.05 considered statistically significant.

Results: The mean age of patients was 58 ± 11.5 years. Among the 163 patients, 108 (66%) were male and 55 (34%) were female. Acute myocardial injury was observed in 13 patients (8%), while 150 patients (92%) had normal troponin I levels. No statistically significant association were identified between myocardial injury and age (p = 0.6878) or gender (p = 0.8131).

Conclusion: Acute myocardial injury was identified in 8% of patients presenting with upper gastrointestinal bleeding. Although no statistically significant association was observed with age or gender, myocardial injury remains a clinically important consideration in UGIB. Selective

FREQUENCY AND RISK FACTORS OF PERSISTENT CORNEAL EPITHELIAL DEFECT IN DIABETIC PATIENTS UNDERGOING PARS PLANA VITRECTOMY

2026-06-29T10:03:13+00:00

Background: Persistent corneal epithelial defect (PCED) is a significant postoperative complication that can occur after pars plana vitrectomy (PPV), particularly in diabetic patients. It may delay corneal healing, impair visual recovery, and increase the risk of ocular morbidity.

Objective: To estimate the frequency and risk factors of persistent corneal epithelial defects (PCED) among diabetic patients undergoing pars plana vitrectomy (PPV).

Material and Methods: This Retrospective study was carried out in the outpatient department of ophthalmology at Hayatabad HMC Peshawar Medical Complex from January 2017 to December 2018. The sample of 437 (511 eyes) that underwent PPV from 2017 to 2018 was studied. If the patient had epithelial defects in cornea, edematous cornea or superficial punctuate keratopathy within first week after PPV, was labeled as complications of the cornea. However, if the complications of the cornea persist for more than 14 days after conservative treatment, the patient was labeled as a persistent corneal epithelial defect (PCED). The diabetic patients were grouped in two i.e. PCED and non-PCED. The sociodemographic and clinical/ surgical data were analyzed and outcomes were assessed. For statistical analysis, SPSS version 24 was used. P value was calculated and considered significant if it was less than 0.05.

Results: After PPV corneal complications were developed among 114 eyes of 437 subjects (22%), while PCED was developed among 38 eyes out of 114 eyes (33%).The chi square P value of PCED, SPK and Corneal Edema were (0.032), (0.003) and (0.936) respectively. Among those eyes that developed complications, 22 eyes progressed to PCED. Poor visual acuity was observed among eyes with PCED with (P = 0.035). After most suitable statistic tests applied to the data, the results showed that among the risk factors of PCED after PPV, diabetes mellitus has significant association.

Conclusion: There was an association of diabetes and PCED with p value of (p=0.03). Diabetes mellitus, perfluoropropane intravitreal tamponade, and assistance of first-year resident were among the risk factors. Poor visual acuity was observed among these patients. Initially aggressive treatment is required for patients with corneal epithelial defects after surgery to avoid unfavorable results.

BETA-THALASSEMIA MUTATIONS IN PUNJAB, PAKISTAN (2016- 2022), HIGHLIGHTING RARE VARIANTS DURING COVID-19 (2019- 2020)

2026-06-29T10:14:50+00:00

Background: Beta-thalassemia is one of the most common inherited hemoglobin disorders in Pakistan, with a heterogeneous mutation spectrum that varies across different geographic regions, making region-specific mutation data essential for accurate prenatal diagnosis and genetic counseling.

Objective: This study evaluated the frequency, regional diversity, and rare beta-thalassemia mutations in Punjab, Pakistan, during 2016–2022, emphasizing implications for prenatal diagnosis, genetic counseling, and possible COVID-19-related temporal variations.

Material and Methods: A retrospective study was performed from 2016–2022 at Nishtar Hospital Multan. Chorionic villus samples from 1000 pregnant women with gestational ages of 12–14 weeks undergoing prenatal diagnosis for beta-thalassemia were collected along with parental blood samples. Samples were analyzed at the Punjab Thalassemia and Other Genetic Disorders Prevention and Research Institute, Lahore, for 17 beta-thalassemia mutations using PCR-based molecular techniques. Genomic DNA extraction and beta-globin gene amplification were performed. Descriptive statistics and chi-square analysis were applied to compare mutation frequencies across years and demographic groups.

Results: IVS 1-5 (G-C) was the most prevalent mutation (39.06%), followed by Fr 8-9 (+G) (30.94%) and Cd-15 (G-A) (6.6%). Rare mutations included IVS1-1 (G-T) (2.8%), Exon mutation (1.1%), and Cap+1 (A-C) (0.8%). Rare variants including HbS, HbD, Cd-16, and Exon mutations appeared intermittently during 2016–2020. Exon mutation frequency increased during late 2019–2020, coinciding temporally with the COVID-19 pandemic period; however, no causal association could be established. Mutations were most common in women aged 25–29 years and gravida three or more.

Conclusion: The study revealed significant regional variation in common and rare beta-thalassemia mutations in South Punjab, supporting improved prenatal diagnosis, targeted mutation screening, and genetic counseling, while further multicenter studies are needed to explore possible COVID-19-related associations.

ASSOCIATION BETWEEN BILIARY DISEASE, INCLUDING ACUTE CHOLECYSTITIS,AND DIPEPTIDYL PEPTIDASE 4 INHIBITORS USE IN PATIENTS WITH TYPE 2 DIABETES MELITTUS

2026-06-29T10:25:40+00:00

Background: Type 2 diabetes mellitus (T2DM) is a global health challenge associated with multiple significant complications. Recent studies suggest that use of dipeptidyl peptidase 4 (DPP-4) inhibitors, may be linked to acute cholecystitis and biliary dysfunction. Understanding this association is important, as biliary complications may adversely affect patient outcomes.

Objective: To explore the association between biliary disease, including acute cholecystitis, in patients with type 2 diabetes mellitus treated with DPP-4 inhibitors.

Material and Methods: This cross-sectional study was conducted between Nov 2022 to August 2024 at PAF Hospital, Islamabad. The study population had two qual groups of 350 patients each comprising type 2 diabetic patients receiving DPP-4 inhibitors and those receiving other ant diabetic medications. The data regarding demographic characteristics and biliary outcomes were collected from their medical records using a structured questionnaire and analyzed using SPSS version 25 to find the association between biliary disease and use of DPP4 inhibitors.

Results: Patients receiving DPP-4 inhibitors showed a significantly higher frequency of acute cholecystitis compared to those receiving other antidiabetic medications (16.0% vs 10.0%, p=0.027; OR=1.71, 95% CI: 1.09–2.68). There were also higher frequencies of gallstones (22.0% vs 16.0%, p=0.153; OR=1.48, 95% CI: 0.99–2.20)and biliary sludge (24.0% vs 18.3%, p=0.076; OR=1.41, 95% CI: 0.97–2.05)in the DPP-4 inhibitor group; however, these differences were not statistically significant.

Conclusion: Our findings suggests an association between use of DPP-4 inhibitors and a higher frequency of acute cholecystitis and biliary disease in patients with type 2 diabetes mellitus, warranting careful monitoring in clinical practice.

MANUAL VACUUM ASPIRATION (MVA): A SAFER AND MORE EFFICIENT ALTERNATIVE TO CONVENTIONAL CURETTAGE IN FIRST TRIMESTER MISCARRIAGE

2026-06-29T10:33:15+00:00

Background: Miscarriage, also known as spontaneous abortion, is a common issue during early pregnancy. In Pakistan, the miscarriage rate is about 29 per 1,000 women aged 15 to 49 years. Dilation and curettage (D&C) is a common surgical procedure, which is effective but can also be risky.

Objective: This study aimed to compare the safety and effectiveness of Manual Vacuum Aspiration (MVA) with traditional curettage in managing first-trimester miscarriages.

Material and Methods: A randomized trial was carried out at the Department of Gynecology and obstetrics, Bolan Medical complex, Quetta. The study included 274 women aged 18-35 who had miscarriages during the first trimester and were randomly divided into two groups of equal numbers: Group A receiving MVA and Group B Undergoing D& C.

Results: MVA achieved full evacuation in 113 (95.6 %) and D&C in 117(85.8 %) (significant difference, p 0.05). The MVA procedure took an average of 6.9 minutes, about half as much as 13.7 minutes per D&C. Only 0.6% of MVA patients had serious bleeding (>= 100mL) as compared to 2.4% in the D&C group. In both groups, no uterine perforations or serious infections were noted.

Conclusion: MVA is a safe, effective and efficient alternative to traditional curettage of first-trimester miscarriages. It has a greater success rate, less procedure time, less risk of complications and improved patient satisfaction, which is evidence to expand the use of MVA in everyday gynecological practice.

THE ASSOCIATION BETWEEN GENDER WITH THE SHAPE OF MANDIBULAR CONDYLE IN YOUNG ADULTS OF PESHAWAR

2026-06-29T10:38:00+00:00

Background: The morphology of the condyles changes with age, gender, face type, occlusal force, functional load, malocclusion type, and the right and left sides. To diagnose temporomandibular disorders and to plan orthodontic and Prosthodontics therapies, it is imperative to evaluate these variances.

Objective: This descriptive cross-sectional study aimed to identify the variations in the shape of mandibular condyles as evaluated through Orthopantomogram (OPG) among young adults of both genders.

Material and Methods: The study was carried out by postgraduate Oral Biology students in collaboration with the Maxillofacial Surgery (OMF) department at Peshawar Dental College (PDC), Peshawar. The individuals who visited the outpatient department of the PDC, Peshawar during the period from December 2023 to November 2024 were included.

Employing inclusion and exclusion criteria, the research involved 250 participants (Male 120 and female 130) within the age range of 18 to 26.The OPGs were examined utilizing a Digital Villa Rot graph EVO 3D. The print was examined on a single LED X Ray View box screen. Condyles were classified into four types: rounded, angled, flattened & mixed. Statistical techniques were employed to ascertain the percentage and p value.

Results: The majority of individuals exhibited a round-shaped left mandibular condyle 114 (45.6 %), followed by a mixed 54 (21.6 %) and a flattened shape 43 (17.2 %), while the angled shape was the least frequently 39 (15.6 %) observed. Similarly, most individuals also displayed a round-shaped right mandibular condyle 120 (48.0 %), followed by a mixed 54 (21.6 %), flattened 42 (16.8 %) and angled shapes 34 (13.6 %). No significant difference in the shape of mandibular condyle was observed between the two genders on both left and right sides(P >0.05).

Conclusion: The mandibular condyle's structure on both the right and left sides in early adults was found to be the same in both genders. The round shape condyles were most prevalent among both genders. Further work with larger populations from diverse communities is needed to verify the described results.

CHRONIC KIDNEY DISEASE AND DIAGNOSTIC ACCURACY OF HIGH-SENSITIVITY TROPONIN I IN ACUTE CORONARY SYNDROME

2026-06-29T10:43:54+00:00

Background: Acute coronary syndrome (ACS) is a major cause of heart-related illness and death. In patients with chronic kidney disease (CKD), it is hard to interpret high-sensitivity troponin I (hs-TnI) results because baseline levels may be consistently high.

Objective: To determine how the stage of CKD impacts the diagnostic accuracy of hs-TnI in patients being checked for ACS.

Material and Methods: This cross-sectional study took place in the Cardiology Department of Rehman Medical Institute, Peshawar, from January to April 2025. Out of 558 cardiac patients screened, 145 adults with CKD and symptoms of ACS were included. We recorded clinical symptoms, 12-lead electrocardiography, estimated glomerular filtration rate (eGFR), CKD stage, dialysis status, other health conditions, and hs-TnI levels. Data were analysed using SPSS version 27. Normality of age, eGFR, SBP, DBP, pulse pressure, and hs-TnI was assessed using the Shapiro-Wilk test and Q-Q plots. Means and standard deviations were calculated for normally distributed variables. Independent-samples t-test, one-way ANOVA, Pearson correlation, chi-square test, receiver operating characteristic analysis, and regression models were used as appropriate. A P value <0.05 was considered statistically significant.

Results: The average age of the patients was 59.48 ± 13.81 years. Among them, 91 (62.8%) were male and 54 (37.2%) were female. Patients with advanced CKD were older and had higher systolic blood pressure, diastolic blood pressure, pulse pressure, and ST-segment depression. hs-TnI levels varied across CKD stages according to one-way ANOVA (F = 5.126, P < 0.001), with the highest readings in stage 6. The area under the receiver operating characteristic curve was 0.594, showing weak ability to distinguish ACS in this CKD group..

Conclusion: hs-TnI levels increase with worsening CKD, so they should be interpreted carefully in this group. Diagnosing ACS in CKD patients should rely on the overall clinical situation, electrocardiographic results, and changes in biomarkers over time, rather than just one hs-TnI value.

THE CRUCIBLE OF ANTIMICROBIAL RESISTANCE AND ENDEMIC PATHOGENS: A STRATEGIC BLUEPRINT FOR SOUTHERN KHYBER PAKHTUNKHWA

2026-06-29T10:47:56+00:00

The practice of clinical medicine within the global South is being profoundly redefined by a silent, structural crisis. While international healthcare frameworks focus heavily on pandemic preparedness and novel viral pathogens, regional tertiary care networks in Pakistan face a more immediate, daily existential threat: the compounding convergence of deeply entrenched endemic infections and rapidly accelerating antimicrobial resistance (AMR).

As we present the latest volume of the BMC Journal of Medical Sciences, it is time to look closely at our local epidemiological footprint. For the clinicians, academicians, and researchers representing Bannu Medical College and our allied teaching hospitals, this transition marks a pivotal shift. We must move past the era of reactive, empirical prescribing and step firmly into an era of rigorous, data-driven antimicrobial stewardship.