Northwest Journal of Medical Sciences (NJMS) ISSN: 2413-8010 (Print) 2414-8229 (Online) is the official biomedical journal of Northwest School of Medicine. NJMS is a quarterly, peer-reviewed open-access journal. It has been recognized by Higher Education Commission, Pakistan (Category Y), Pakistan Medical & Dental Council , accredited by College of Physicians and Surgeons, Pakistan and indexed in the Directory of Open Access Journals (DOAJ) . NJMS follows a strict peer-review policy with national and international experts on the editorial board. The journal accepts various articles, including original research, meta-analysis, clinical trials, reviews, audits, case series, case reports, short communications, letters to the editor, and comments on published articles. Our diamond open-access policy ensures barrier-free visibility of valuable scholarly work to a global audience, resulting in a higher impact.
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BURN INJURIES IN PAKISTAN: A TWO-DECADE EPIDEMIOLOGICAL REVIEW AND A CALL FOR INTEGRATED ACTION
Abstract: A 20 year Global Burden of Disease analysis reveals that Pakistan’s estimated burns prevalence and incidence, both have increased by 51% and 39% respectively. At the same time the age-standardized prevalence and incidence rates (per 100,000 population) have decreased significantly, along with a 20% drop in mortality rates, despite an increase in absolute mortality. These numbers show a paradox, indicating that Pakistan is becoming relatively safer per capita but more people are getting burnt and surviving with the disabilities. This warrants more rigorous action. Keywords: Burns, Pakistan, Mortality, Disability, Epidemiology Between 2001 and 2021, Pakistan’s estimated burns prevalence rose from roughly 0.56 million to 0.85 million (around 51% increase), while the age-standardized prevalence rate fell from about 396 to 360 per 100,000 population. Over the same period, annual incident cases increased from around 75,800 to 105,00 (around 39% rise), yet the age-standardized rate declined from about 53 to 45 per 100,000 and the age-standardized mortality rate dropped by about 20% (2.6 to 2.1 per 100,000) despite deaths increasing in absolute terms from around 3700 to nearly 5000 at peak. These numbers capture a dangerous paradox: Pakistan is becoming relatively safer per capita, but more people than ever are being burned, surviving and living with long-term disability. 1 This pattern mirrors global trends where burn incidence and mortality have declined in many regions, but progress lags in low and middle income countries (LMICs), which still account for the vast majority of burn deaths. A GBD 2017 analysis of injuries from fire, heat, and hot substances showed substantial reductions in age-standardized disability-adjusted life year (DALY) rates worldwide, yet much slower gains in low sociodemographic index settings, including South Asia. Pakistan’s rising absolute burden against falling rates is therefore consistent with regional demographic expansion coupled with incomplete prevention and uneven access to timely, specialized care. 2,3 Local clinical data underscores how these national trends translate at the bedside. A recent national burn centre cohort from Islamabad reported more than 14,000 burn visits and 613 admissions in a single year, with most injuries occurring at home, high proportions of flame burns, and substantial sepsis and wound-infection complications, despite an in-hospital mortality under 10%. A systematic review of Pakistani burn studies found mean total body surface area involvement near 30% and an average mortality around 26%, reflecting the severity of cases reaching hospitals and the limited reach of specialized care. 4,5 Taking together these data indicate that Pakistan has likely made genuine gains in acute survival through more burn units, better resuscitation, and improved critical care, while failing to reduce exposure to underlying risks or to provide comprehensive long-term support. The rising prevalence of survivors with burn sequelae implies growing need for reconstructive surgery, rehabilitation, mental health care, and social reintegration that are largely unmet in service models. Without a strategic shift, the health system will continue to inherit a steadily growing cohort of individuals with contractures, disfigurement, chronic pain, and psychosocial distress. 6 This warrants more rigorous action. First, Pakistan needs to build a national burns surveillance and registry platform that links emergency departments, burn centers and other facilities to generate real-time data. Such data are essential to not only document and adjust response but to also identify population at risk and deploy effective targeted preventive measures. Prevention must move upstream into housing, energy, occupational policies like safer LPG and electrical infrastructure, enforcement of industrial safety standards and safe homes/kitchens programs targeted to poor, crowded urban and rural settings. Burns should also be integrated into universal health coverage and government sponsored Sehat Card program, under which appropriate medical, surgical and psychological support must be provided, so that survival doesn’t mean lifelong disability. 7 Finally, sustained research is needed to close persistent evidence gaps, especially sex and age stratified analyses, provincial disparities, and the long term quality of life outcomes of survivors. The GBD based trends provide a powerful national narrative: the imperative now is to translate that narrative into policy, infrastructure and practice that bend both the rates and the absolute numbers of burn injuries, death =s, and disabilities downward over the coming decades
Copyright (c) 2025 Bashir Ahmad https://creativecommons.org/licenses/by-nc/4.0
HEALTHCARE WASTE MANAGEMENT SYSTEM AT BASIC HEALTH UNITS. A STUDY FROM DISTRICT SWABI, KHYBER PAKHTUNKHWA.
Objectives: To assess the healthcare waste management systems at Basic Health units using a pre-validated Questionnaire check list developed by World Health Organization. Methodology: This was a cross-sectional study carried out in the district Swabi. Overall, 30 Basic health care units were included in the study. Data was collected using self-administered questionnaire. A validated questionnaire by World Health Organization was used to collect data from Incharge Medical Officers of BHUs. Results: Specific containers for healthcare waste were available in 56.7% of Basic Health Units, while proper containers for infectious waste were present in only 26.7%. Disposable gloves and surgical masks were available in 73.3% and 66.7%, respectively; however, complete personal protective equipment (PPE) was used in only 36.6% of facilities. Compliance with the standard color-coding system for biomedical waste management was observed in just 6.7%. Nearly half of the Primary health care centers (46.7%) lacked designated storage areas for biomedical waste. Pit disposal was the most commonly reported method of healthcare waste disposal, practiced by 73.3% of BHUs. Conclusion: The present study showed that majority of healthcare waste management in Swabi is inadequate. Government intervention and policy implementation are urgently needed.
Copyright (c) 2025 Nazim Hameed, Kashif Ur Rehman Khalil, Muhammad jawad Khalil, Khalid Rehman Khalil, Syed Azhar Ali Shah, Baber Awan https://creativecommons.org/licenses/by-nc/4.0
COMPARATIVE ANALYSIS OF GABAPENTSAL AND GABAPENTIN INDUCED HISTOLOGICAL CHANGES IN LIVER AND KIDNEY TISSUES OF A MURINE EXPERIMENTAL MODEL
ABSTRACT Objectives Gabapentin is widely used in the treatment of neuropathic diseases. Gabapentsal, a Schiff-based derivative of gabapentin, has diverse biological activities and a lower toxicity profile. This study aims to evaluate and compare the histological effects of gabapentsal and gabapentin on the liver and kidneys in a murine model. Material and Methods Thirty mice were divided into five groups, with six animals in each group. Group I (the control group) received normal saline. Groups II and III were treated with Gabapentin (2.5mg/kg and 5mg/kg respectively), while Groups IV and V were given Gabapentsal (2.5mg/kg and 5mg/kg respectively) via oral gavage for up to eight weeks. After the animals were anesthetized with chloral hydrate, liver and kidney tissues were collected for histological examination using H&E stain. Results Liver tissue from gabapentin-treated groups showed lobular cellular infiltration, dilatation of the central vein, severe inflammation in the portal/periportal area, hemorrhage, and distortion of hepatic architecture compared to the normal group. In contrast, the gabapentin-treated groups showed intact hepatic architecture, no changes in sinusoids or central vein but mild lobular and portal/periportal inflammation. The kidney tissue of the Gabapentin-treated groups showed severe dilatation of the glomeruli and blood vessels, and inflammatory cell infiltration, while the kidney tissue of Gabapentsal-treated mice showed mild architectural damage, dilated glomeruli and blood vessels, and inflammatory cell infiltration compared to the normal tissues. Conclusion Gabapentsal produces fewer toxic effects on kidney and liver tissue compared to Gabapentin-treated animals.
Copyright (c) 2025 Hajra Ayub, Walayat Shah, Ikramullah, Hafiz Abdul Salam, Muhammad Ikram, Muhammad Saleh Faisal https://creativecommons.org/licenses/by-nc/4.0
PERSPECTIVES OF FIRST & SECOND-YEAR MEDICAL STUDENTS ABOUT INNOVATIVE INSTRUCTIONAL STRATEGIES VERSUS TRADITIONAL CLASSROOM-BASED TEACHING AT REHMAN MEDICAL COLLEGE, PESHAWAR: A CROSS-SECTIONAL STUDY
BACKGROUND: Innovative instructional strategies such as Problem-Based Learning (PBL), Case-Based Learning (CBL), and seminars are increasingly being adopted in medical education to promote active learning, self-directed learning, critical thinking, and clinical reasoning. OBJECTIVE: To explore and compare the perspectives of first and second year medical students regarding innovative instructional strategies (PBL, CBL, and seminars) versus traditional classroom based teaching at Rehman Medical College, Peshawar. METHODOLOGY: A total of 181 first and second-year medical students were purposively selected for this cross-sectional study. A 19-item questionnaire was used to collect data about students' perception of innovative instructional strategies, including problem-based learning, case-based learning, and seminars. The age range was between 18 and 20, and they had experience with PBL, CBL, and seminars. RESULTS: Out of the 181 participant students 49.1% (n=88) were male and 51%(n=92) were female with a mean age range of 19.8+/-1.0. Most of the participants agreed with benefits of (CBL, PBL), (mean=1.69 – 2.67). Highest agreement (mean=1.69) for inclusion of PBL/CBL, and neutral to slight disagreement (mean=2.67) for classroom teaching was observed. Female students (mean=2.69) were more inclined towards innovative teaching than male students (mean=2.95). Positive correlation between CBL/PBL and communication skills, retention of knowledge (r = 0.519, p < 0.01), self-study skills (r = 0.547, p < 0.01) & critical thinking (r = 0.304, p < 0.01), participation (r = 0.524, p < 0.01) and improvement in confidence levels (r = 0.244, p < 0.01) were observed. Negative correlation was observed between traditional teaching and cognitive thinking (r = -0.315, p < 0.01) and correlation of knowledge to practice (r = -0.292, p < 0.01) CONCLUSION: CBL/PBL/seminars were considered effective for critical thinking, participation, application & retention of knowledge, enhanced student confidence, and communication skills. Better organization of PBL/CBL was recommended.
Copyright (c) 2025 Mahrukh Ikram Shah, NOWSHAD ASIM, Muhammad Zarghama Khan, Asna Kulsoom, Talha Mir https://creativecommons.org/licenses/by-nc/4.0
CLINICAL OUTCOMES OF PRIMARY VALVE ABLATION VERSUS URINARY DIVERSION IN INFANTS WITH POSTERIOR URETHRAL VALVES: A PROSPECTIVE COHORT STUDY
Background: Posterior urethral valves (PUV) are a congenital condition affecting the male urinary tract and characterised by membranous folds in the posterior urethra, presenting as the most common cause of lower urinary tract obstruction in paediatric patients. Primary valve Ablation (PVA) and urinary diversion (UD) are the treatment choices depending on the patient's condition and the surgeon's understanding. Objective: The current study aimed to evaluate the clinical outcomes of PVA versus UD in male children under the age of one year. Methods: The prospective cohort study included 110 patients, with 55 in each of the PVA and UD intervention groups. After three months of follow-up the outcomes, voiding dysfunction, urine dribbling, straining, slow stream, recurrent Urinary Tract Infections (UTIs), predictors of chronic kidney disease (CKD), as albumin excretion and Glomerular filtration rate (GFR), were evaluated. Results: Mean age was 6.89±3.07 months, albumin excretion 24.50±10.13 mg/day, and GFR 76.46±18.34/ml/min/1.73m2 in participants. Duration of surgery in PVA was 25.40±5.47 minutes and 129.94±18.44 minutes in UD. Recurrent UTIs were reported in 19.1%, urine dribbling in 38.2%, urine straining in 19.1%, and a slow stream of urine in 28.2% participants. No significant difference was reported in urine dribbling P=0.578, urine slow stream P=0.289, and urine straining P=0.089. Recurrent UTIs, P=0.04, were significant with OR=2.22 in the UD group as compared to PVA. Albumin excretion P=0.776 and GFR P=0.487 were insignificant. Age of the child had a significant negative association with Albumin excretion r= -0.288, P=0.002 and a moderate negative association with GFR r=-0.346, P<0.001. Conclusion: There was no significant difference in clinical outcomes of PVA versus UD at three-month follow-up, in terms of CKD and voiding dysfunction, except recurrent UTIs reported two times higher in the UD group. The study limitation was short followup, a single centre investigation and lower sample size.
Copyright (c) 2025 Aboozar Khan, Hazrat Ullah, Tariq Ahmad, Murad Ali, Mohammad Anees Iqbal, Abdul Jabbar https://creativecommons.org/licenses/by-nc/4.0
COMPARISON OF THE THERAPEUTIC POTENTIAL OF METHYLDOPA AND LABETALOL IN PREGNANCY-INDUCED HYPERTENSION: A QUASI-EXPERIMENTAL STUDY
Background: Pregnancy-induced hypertension (PIH) affects around 10% pregnancies, leading to maternal and fetal morbidity and mortality. Objectives: This study explores the efficacy of methyldopa and labetalol in the management of PIH. Methodology: This study was conducted in the department of obstetrics and gynecology, Health Ways Hospital, Kohat, from September 2024 to April 2025. After ethical approval, 200 PIH patients (100 in each group), aged between 20-35 years with gestational age >20 weeks and blood pressure ≥140/90mmHg were enrolled. The methyldopa group was prescribed methyldopa 250 mg thrice daily, while the labetalol group received Labetalol 100 mg thrice daily. Data was analyzed using SPSS version 26.0. A paired sample t-test was employed to find the mean difference in blood pressure between each group. Independent sample t-test was used to find the statistical differences between systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both groups Results: There were significant reductions in both SBP and DBP at the 1st and 2nd follow-ups in both methyldopa and labetalol group with p-values <0.001. The independent sample t-test shows that the SBP at 1st follow-up and 2nd follow-up in the labetalol group was significantly reduced compared to the methyldopa group, with p-values of 0.03 at the first follow-up and < 0.001 at the second follow-up. Regarding, the DBP reduction, while no significant differences were evident between groups at the first follow-up, the labetalol group showed a significant reduction in DBP at the second follow-up, with a p-value of 0.01 Conclusion: Both methyldopa and labetalol significantly reduce both SBP and DBP in PIH. However, in comparison, labetalol reduction in blood pressure is significantly higher as compared of methyldopa.
Copyright (c) 2025 Waheed Iqbal, Syed Hasnain Ali Shah, Naimat Ullah Khan, Heema, Kiran Ijaz, Faheela Faizi Aamir https://creativecommons.org/licenses/by-nc/4.0
EFFECTIVENESS OF ZINC AS AN ADJUNCT TO ANTIBIOTICS IN THE MANAGEMENT OF SEVERE CHILDHOOD PNEUMONIA: A PROSPECTIVE COMPARATIVE STUDY
Abstract Background: Pneumonia remains a leading cause of morbidity and mortality in children under five, particularly in low-resource settings. Zinc, an essential micronutrient with immunomodulatory properties, may enhance recovery when used alongside standard antibiotic therapy. However, evidence regarding its therapeutic efficacy remains inconclusive. Objective: To assess the effectiveness of adjunctive zinc supplementation in reducing symptom resolution time and improving treatment outcomes in children aged 6–59 months with severe pneumonia. Methodology: This prospective comparative observational study was conducted at the Federal Government Polyclinic Hospital, Islamabad, over seven months. A total of 160 children diagnosed with WHO-defined severe pneumonia were divided into two groups: Group I received standard antibiotics plus oral zinc (2 mg/kg twice daily for 7 days), and Group II received antibiotics alone. Clinical parameters were monitored, and the primary outcome was time to symptom resolution. Secondary outcomes included treatment success rate and duration of hospital stay. Results: Children in Group I showed significantly faster symptom resolution (23.3 ± 10.1 hours vs. 43.2 ± 10.1 hours; p < 0.001) and higher treatment success (93.8% vs. 68.8%). Subgroup analysis by gender, age, nutritional status, and vaccination history consistently favored the zinc group (p < 0.001). Conclusion: Adjunctive zinc supplementation significantly enhances recovery and treatment success in children with severe pneumonia. Its use may reduce healthcare burden in resource-limited settings. Further large-scale randomized controlled trials are recommended to validate these findings and explore pathogen-specific responses.
Copyright (c) 2025 Sidra Nisar, Aisha Khalid Asadullah Khan, Shiza Rizwan Qazi, Shahzad Munir, Naveed Ashraf https://creativecommons.org/licenses/by-nc/4.0
PREVALENCE OF CULTURE-PROVEN URINARY TRACT INFECTIONS IN PEDIATRIC PATIENTS WITH LOWER URINARY TRACT SYMPTOMS
Background: Urinary tract infections (UTIs) are among the most common bacterial infections in children. If untreated or mismanaged, they can lead to renal scarring, hypertension, and chronic kidney disease. Culture confirmation is essential to ensure accurate diagnosis and guide antibiotic selection, especially in the context of increasing antimicrobial resistance. Objective: To determine the prevalence of culture-proven urinary tract infection among children presenting with lower urinary tract symptoms (LUTS) at a tertiary care center in Peshawar, Pakistan. Methods: A cross-sectional study was conducted from May to November 2024 conducted in the Department of Urology, Khyber Teaching Hospital, Peshawar, Pakistan, from May 2024 to November 2024. A total of 195 children aged ≤15 years with LUTS were enrolled. Midstream urine samples were collected and processed for culture and susceptibility testing in the hospital microbiology laboratory. A positive urine culture was defined as growth of a single recognized uropathogen at or above 10^5 CFU per mL in a clean-catch midstream urine sample. Results: Out of 195 children (mean age 8.7 ± 5.0 years), 172 (88.2%) had positive urine cultures. Culture positivity was significantly higher in females than males (92.7% vs. 82.4%, p=0.026) and showed a strong inverse relationship with age, with the highest rate in children ≤5 years (96.7%). Conclusion: In this tertiary-care urology clinic, 88.2% of children presenting with LUTS had a positive urine culture. This reflects diagnostic yield in a referral setting. Routine urine culture should be integrated into diagnostic practice to improve accuracy and guide appropriate antibiotic use.
Copyright (c) 2025 Tariq Ahmad, Adil Muhammad, Murad Ali, Imdad Ullah https://creativecommons.org/licenses/by-nc/4.0
MUCORMYCOSIS OUTCOMES IN THE COVID 19 ERA: A RETROSPECTIVE COHORT STUDY
ABSTRACT Objective: To evaluate the survival outcomes and prognostic factors of patients with mucormycosis during the COVID-19 pandemic and assess treatment strategies. STUDY DESIGN: Retrospective cohort study PLACE AND DURATION: Department of ENT, Northwest General Hospital and Research Centre Peshawar, Pakistan, from January 2020 to December 2023. Methodology: A cohort of 30 mucormycosis patients with comprehensive records over a three-year period was identified and extracted from the hospital's HMIS database. Clinical, radiological, and surgical data were meticulously collected. All patients underwent functional endoscopic sinus surgery (FESS) and surgical debridement, and the data were analyzed using SPSS. Results: The mean age was 50.31±1.911 years, with 21(70%) males and 12(40%) COVID-19 positive. Disease extent included paranasal sinus (PNS) involvement 9(30%), PNS + orbital (OR)9 (30%), and PNS + OR + intracranial (IC) 11(37%). Mortality was higher in patients with extensive disease (PNS + OR + IC) at 6(54.5%) (p=0.02). COVID-positive patients had a mortality rate of 6(50%). FESS alone was performed in 18(60%) of patients, while 12(40%) required more extensive surgeries such as exenteration or external approaches with more extensive surgeries linked to worse outcomes (p=0.025). Conclusion: Advanced age, COVID-19 positivity, and extensive disease involving the paranasal sinuses, orbit, and intracranial regions were linked to higher mortality. Patients treated solely with functional endoscopic sinus surgery (FESS) demonstrated better survival outcomes compared to those requiring more invasive procedures. While corticosteroid use and COVID-19 status correlated with disease severity, they did not significantly influence surgical outcomes. Early diagnosis, timely surgical intervention, and antifungal therapy are essential for improving survival in mucormycosis cases.
Copyright (c) 2025 Shehzad Saeedullah Saeedullah, Imran Mohib khan, Sylvia Motlalepule Mosito, Samuele Frasconi, Hamid Mukhtar, Zeshma Ijaz Khan https://creativecommons.org/licenses/by-nc/4.0
AVAILABILITY AND READINESS OF MATERNAL AND NEONATAL HEALTH SERVICES IN THE NEWLY MERGED DISTRICTS OF KHYBER PAKHTUNKHWA. A CROSS-SECTIONAL STUDY
BACKGROUND: Maternal and newborn mortality and morbidity are major concerns in rural areas of KPK. One of the major causes of this is the lack of quality services. OBJECTIVE: The study aims to evaluate MNCH services in health care facilities within the newly merged districts of KPK and to compare those services across different Health Care Centers with the Minimum Initial Service Delivery Package METHODOLOGY: A cross-sectional study was conducted from June 2023 to December 2023. Primary health facilities were randomly selected, while secondary health facilities were chosen on a census basis. 10 facilities from each district will be selected, including Basic Health Units (BHUs), Rural Health Centers (RHCs), Tehsil Headquarters Hospitals (THQs), and District Headquarters Hospitals (DHQs). Data were collected using a pre-validated questionnaire developed by the World Health Organization, known as the SARA tool, which includes various variables for assessing service availability and readiness. RESULTS: The majority of hospitals, 85.7%, are situated in urban areas, while only 14.3% are located in rural regions. Alarmingly, 66% of these facilities provide poor health services, with just 33% categorized as average and a mere 1% deemed good. There is a distinct difference in mean health service scores based on facility type; however, there is no significant difference (P = 0.567) in health care services between rural and urban facilities. CONCLUSION:The present study showed that the health facilities in the merged districts are below the standards. Government should take measure to improve these facilities. KEYWORDS: Maternal, Neonatal, Services, Newly Merged Districts, Khyber Pakhtunkhwa.
Copyright (c) 2025 Natasha Junaid, Sadaf Bilal, Kashif Ur Rehman Khalil, Areeba Junaid, Syed Azhar Ali shah, Guleena Junaid https://creativecommons.org/licenses/by-nc/4.0
COMPARATIVE OUTCOMES OF DEFINITIVE RADIOACTIVE IODINE THERAPY VERSUS ANTITHYROID DRUG THERAPY WITH METHIMAZOLE IN GRAVES' DISEASE: A CROSS-SECTIONAL STUDY
BACKGROUND: Graves’ disease, a common cause of hyperthyroidism, is treated with radioactive iodine (RAI) or antithyroid drugs like methimazole, but comparative outcomes guide optimal therapy. OBJECTIVE: To compare efficacy and safety of RAI versus methimazole in patients with Graves’ disease, focusing on remission, hypothyroidism, treatment failure, and symptom improvement. METHODOLOGY: This retrospective study (January 2022–July 22, 2025) included 153 patients with Graves’ disease, confirmed by thyroid scan, suppressed TSH, and elevated free T4, presenting to the internal medicine clinic at Northwest General Hospital & Research Centre, Peshawar. Eighty patients received RAI, and 73 received methimazole (10–30 mg/day). Outcomes at six months included remission, hypothyroidism, and treatment failure, time to remission, relapse, and symptom improvement. Chi-square tests, t-tests, and Kaplan-Meier analysis were used. RESULTS: RAI achieved treatment success in 80.0% of patients (64/80), though the majority of these (48/80, 60.0%) developed hypothyroidism, a known consequence of ablative therapy, versus 65.8% for methimazole (48/73; all euthyroid) (P=0.04). Hypothyroidism occurred in 60.0% of RAI patients (48/80) but none in the methimazole group (P<0.001). Treatment failure was lower with RAI (10.0%) than methimazole (34.2%) (P<0.01). RAI had shorter mean time to treatment success (2.8 months) versus methimazole (4.1 months) (P<0.01). Symptom improvement was higher with RAI (85.0%) than methimazole (70.0%) (P=0.03). CONCLUSIONS: RAI offers early relief in symptoms and biochemical euthyroidism but carries a higher hypothyroidism risk. Methimazole preserves thyroid function but has higher failure rates. Treatment should be individualized. KEYWORDS: graves’ disease, radioactive Iodine, hyperthyroidism, methimazole, remission
Copyright (c) 2025 Kamran Amir Khan, Sameed Qureshi https://creativecommons.org/licenses/by-nc/4.0
PREVALENCE, DEMOGRAPHIC FACTORS AND SEASONAL VARIATIONS OF POISONING CASES REPORTED TO A FORENSIC MEDICINE DEPARTMENT IN PESHAWAR: A CROSS- SECTIONAL STUDY
Background: Poisoning remains a critical public health issue worldwide, with significant morbidity and mortality. In Khyber Pakhtunkhwa, particularly in Peshawar poisoning cases have shown an upward trend, often influenced by socio-demographic and seasonal factors. The identification of these trends is essential to guide targeted prevention strategies and inform forensic and public health responses. To determine the prevalence of poisoning cases and their associated demographic profiles reported to the Department of Forensic Medicine, Peshawar and to analyze the seasonal variations among them. Methodology: This descriptive cross-sectional study was conducted in department of forensic medicine and toxicology Khyber Medical College, Peshawar from January 1st to December 31st, 2024. All suspected poisoning cases presented for forensic examination during this period, excluding cases with incomplete documentation or unwilling participation. Both dead and living cases were included. Data were collected via proforma and analyzed using SPSS v25. Descriptive statistics were used for demographic variables and chi-square tests assessed seasonal associations.Among 960 subjects, the mean age was 29.5 ± 14.4 years (range 7–86 years), with males comprising 649(67.6%) and females 311 (32.4%). Most cases 727 (75.7%) were from urban areas, predominantly from Peshawar 456 (47.5%). The majority of poison samples were drawn from blood 505 samples (52.6%) and stomach contents 345 samples (35.9%). Toxicological analysis revealed that 384 individuals ( 40.1%) had identifiable poisons—30.9% with single and 9.2% with multiple poisons. Results were being tested in Gas Chromatography-Mass Spectrometry. Phosphine (10.7%), benzodiazepines (9.7%), tricyclic antidepressants (8.6%), and methamphetamines (6.7%) were the most common poisons. Significant seasonal variations were observed for phosphine (p<0.001) particularly in June, amphetamines (pand benzodiazepines (p<0.001) in January month. Conclusion: This study highlights distinct demographic and seasonal patterns in poisoning cases in Peshawar, with young urban males affected most. Phosphine emerged as the most prevalent toxic agent, likely reflecting agricultural pesticide use. Keywords: Poisoning, Demographic factors, Seasonal variation, Forensic Toxicology
Copyright (c) 2025 hakim khan afridi, muhammad asghar khattak, muhammad wasif, Muhammad Ishaq, Watan Yar, Mahnoor Ali https://creativecommons.org/licenses/by-nc/4.0
FROM THEORY TO BEDSIDE: UNVEILING NURSES’ PERCEPTIONS OF THE PRACTICE GAP; A QUALITATIVE STUDY FROM PESHAWAR PAKISTAN
BACKGROUND: The difference between what is learned in the classroom and what is implemented in real scenarios during clinical practice is known as the theory-practice gap. It is observed that implementing standard theoretical knowledge into practice has a positive influence on patients' health outcomes. OBJECTIVE: This study aims to assess nurses' perceptions regarding the theory-practice gap. METHODOLOGY: A descriptive qualitative study design was employed for this investigation. Using purposive sampling, 12 in-depth interviews were conducted with nurses working in tertiary care hospitals and analyzed through thematic analysis. RESULTS: Nine sub-themes emerged. Nurses understood the TPG as the disconnect between academic learning and clinical application. Hospital management factors such as inadequate staffing, insufficient resources, weak supervision, and misallocation of duties further widened it. Educational institutions played a critical role; lack of skilled instructors, limited engagement in clinical teaching, and poorly equipped skills laboratories contributed to the gap. System-level weaknesses in Pakistan's healthcare infrastructure, sociocultural barriers (especially gender norms), staff shortages, and varying levels of expertise also reinforced the TPG. CONCLUSION: Nurses are aware of the theory-practice gap and perceive that it reciprocally affects patient outcomes. Therefore, it should be addressed through multi-dimensional approaches.
factors leading to the theory-practice gap;
impact of the theory-practice gap on patient outcomes;
strategies for bridging the theory-practice gap.
Copyright (c) 2025 Aurang Zeb, Yasmeen Afzal, Hina Afzal, Hurriyat Riaz, Ume-e-Aiman, Saiqa Khan Afridi https://creativecommons.org/licenses/by-nc/4.0
A PROSPECTIVE COHORT STUDY COMPARING TAILORED AND CONVENTIONAL LATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURES
BACKGROUND: Anal fissure is defined as a superficial tear in the skin distal to the dentate line and is one of the leading causes of hospitalization among proctologic disorders. Anal fissures are initially managed by conservative treatments, but have limited efficacy and may need surgical interventions. OBJECTIVE: The current study aimed to compare the effectiveness of Conventional lateral internal Sphincterotomy (LIS) versus tailored LIS in terms of pain, bleeding and recurrent symptoms as outcomes. METHODOLOGY: The prospective cohort study was carried out at Muhammad Teaching Hospital, Peshawar, including n=196 participants, diagnosed with Chronic anal fissures, over the age of 18 years, through informed consent. Patients were assessed for pain, bleeding, and recurrent symptoms pre-operatively and post-operatively at one-month intervals of follow-up. RESULTS: The Mean age of the participants was 34.50±11.18 years, including 52 (26.5%) males and 144 (73.5%), operated with Conventional LIS 94 (48%), and tailored LIS 102 (52%). Post-operative pain was significantly reduced, P<0.001 in both groups, with no difference P=0.182, between interventions. For flatus incontinence Significant difference by Fisher’s exact test P=0.028 reported between interventions, with a relative risk RR= 0.204 (CI 0.045-0.923), 0.039 for tailored LIS. For faecal incontinence, Fisher's exact test P=0.011 was significant between groups, and RR=0.070 (CI 0.004-1.242), P=0.070 was insignificant. Faecal soiling P=0.108, recurrent symptoms P=0.152, post-operative constipation P=0.124, and pruritus P=0.030 did not report significant differences among treatment groups when conventional LIS was compared with tailored LIS. CONCLUSION: Conventional LIS and tailored LIS were both effective in post-operative pain and bleeding reduction. Tailored LIS helped reduce post-operative flatus and faecal incontinence. The study was limited by a short follow-up duration and insufficient consideration of patients’ medical histories and comorbidities. KEYWORDS: Anal fissures, Conventional lateral internal Sphincterotomy, Tailored lateral internal Sphincterotomy, LIS, faecal incontinence, flatus incontinence.
Conventional lateral internal Sphincterotomy
Tailored lateral internal Sphincterotomy
Copyright (c) 2025 Mir Wais Mir Wais, Shahana Rehman, Ghulam Younas Khan https://creativecommons.org/licenses/by-nc/4.0
CARDIOPROTECTIVE POTENTIAL OF CONVOLVULUS ARVENSIS AGAINST ISOPROTERENOL-INDUCED CARDIOTOXICITY
BACKGROUND: Myocardial infarction is largely driven by oxidative stress-mediated cellular and mitochondrial dysfunction. Isoproterenol-based experimental models closely mimic these pathological mechanisms, while plant-derived antioxidants have gained recognition as potential cardioprotective agents against oxidative injury. OBJECTIVE: This study aimed to investigate the cardioprotective effects of methanolic extract from Convolvulus arvensis against Isoproterenol-induced cardiotoxicity in rats, focusing on myocyte injury markers and histopathological changes. METHODOLOGY: The experimental study was carried out in the Department of Pharmacology at Khyber Medical College and Khyber Medical University, Peshawar, Pakistan, between August 2022 and April 2023. Female Sprague Dawley rats were randomly allocated into three main groups: a positive control, a negative control, and treatment groups receiving Convolvulus arvensis extract at doses of 50 mg/kg, 150 mg/kg, and 300 mg/kg orally for 14 days. Myocardial infarction was induced in rats by administering Isoproterenol (100mg/kg SC) on the 13th and 14th days. Biochemical and histopathological assessments were conducted on the 15th day. RESULTS: Administration of Isoproterenol led to changes in serum levels of cardiac injury markers (CK-MB and LDH) and histopathological alterations. Pre-treatment with Convolvulus arvensis extract prevented all parameters of Isoproterenol-induced myocardial infarction in rats, as confirmed by histopathological examination. The study findings suggest that Convolvulus arvensis exerts significant protective effects on the heart against Isoproterenol-induced myocardial infarction by maintaining endogenous antioxidant enzyme activities. CONCLUSION: Convolvulus arvensis extract significantly lowered serum CK-MB levels and mitigated histopathological damage in isoproterenol-treated rats, refelecting its potential as a cardioprotective agent. KEYWORDS: Cardiotoxicity, Cardioprotection, Convolvulus arvensis, Isoproterenol, Myocardial infarction, Oxidative stress
Copyright (c) 2025 Muazzam Ahmad, Niaz Ali, Muhammad Saleh Faisal, Muhammad Nabi, Shafiq Ahmad, Baber Awan https://creativecommons.org/licenses/by-nc/4.0
RISK FACTORS ASSOCIATED WITH OSTEOARTHRITIS AMONG THE PATIENTS VISITING TERTIARY CARE HOSPITALS OF PESHAWAR, PAKISTAN
BACKGROUND: Osteoarthritis (OA) is a degenerative joint disorder that significantly impairs daily functioning, in all age groups. Different factors contribute to the development of Osteoarthritis including genetics, age, physical activity, Joint injury and occupation. OBJECTIVE: The primary objective of this study was to identify and analyze the modifiable and non-modifiable risk factors associated with osteoarthritis (OA). Additionally, the study aimed to examine the strength of association between various risk factors and the development or progression of OA in affected individuals. METHODOLOGY: A descriptive cross-sectional study was conducted from 1st February to 30th April 2025, involving 358 diagnosed OA patients from Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC). Non-probability sampling was used, and data was collected via a self-administered questionnaire. Statistical analysis was performed using SPSS, with results presented in tables and percentages. RESULTS: This cross-sectional study of 358 OA patients in Peshawar identified significant associations between modifiable (BMI, physical activity, joint injury) and non-modifiable (age, gender,) risk factors. Mean age of the patients was 55.39 years, a higher prevalence of knee OA (71.5%), and a higher BMI was statistically significant (p<0.001). Laborers (15.9%) and agricultural workers (9.8%) who engaged in vigorous activities exhibited significantly higher occupational injury rates (63.2% and 60.0%) as compared to the rest. Hypertension (23.7%, p=0.004) and diabetes (7.5%, p=0.001) showed a significant association with Osteoarthritis, while family history (34.4%, p=0.734) was non-significant. CONCLUSION: This study showed that osteoarthritis is substantially related to age, gender, elevated body mass index, history of joint injury, occupational exposure, and physical activity. The results underscore the need for targeted interventions, such as weight management programs, occupational health initiatives, and genetic screening to explore familial predispositions. KEY WORDS: Osteoarthritis, Risk Factors, Tertiary care hospitals, occupation, BMI, Trauma
Copyright (c) 2025 Komal Khan, Fayzhan, Sara Khan, Adeela Mustafa, Nasreen Khan, Rabia Noor https://creativecommons.org/licenses/by-nc/4.0
DETERMINANTS OF DELAY IN BREAST CANCER DIAGNOSIS AND TREATMENT: A CROSS-SECTIONAL STUDY AT LADY READING HOSPITAL, PESHAWAR
BACKGROUND: Delayed diagnosis and treatment of breast cancer significantly impact patient outcomes and survival rates. In developing countries, healthcare system challenges and patient-related factors contribute to diagnostic delays, leading to advanced disease presentation and poor prognosis. OBJECTIVE: To assess the extent of delays in breast cancer diagnosis and treatment among patients presenting to Lady Reading Hospital and identify associated factors contributing to these delays. METHODOLOGY: A cross-sectional study was conducted among 384 newly diagnosed breast cancer patients from 1st January 2024 to 30th December 2024. Data were collected through structured interviews and medical record reviews. Delays were categorised into patient delay, provider delay, and treatment delay. RESULTS: The median patient delay was 12 weeks (IQR: 6-20), provider delay was 8 weeks (IQR: 4-14), and treatment delay was 6 weeks (IQR: 3-10). About 68.5% of patients presented with Stage III/IV disease. Significant associations were found between longer delays and rural residence (p<0.001), lower education levels (p=0.002), and financial constraints (p<0.001). CONCLUSION: Substantial delays in breast cancer diagnosis and treatment result in advanced disease presentation. Immediate implementation of better healthcare access, patient education, and an efficient system is essential for better breast cancer outcomes in resource-constrained settings. KEYWORDS: Breast Neoplasms, Diagnostic Delay, Time-to-Treatment, Health Services Accessibility, Cross-Sectional Studies
Copyright (c) 2025 Muhammad Attaullah Khan, Muhammad Daud, Ihtisham Ul Haq, Waseem Ullah, Qurat Ul Ain, Monica Jan https://creativecommons.org/licenses/by-nc/4.0
DIAGNOSTIC ACCURACY OF THE T2/FLAIR MISMATCH SIGN IN PREDICTING ISOCITRATE DEHYDROGENASE MUTATION IN LOW-GRADE GLIOMAS
BACKGROUND: Gliomas represent a significant global health burden due to their high morbidity, infiltrative nature and often limited therapeutic options. MRI is pivotal in their diagnosis, providing detailed structural and functional assessments that refines tumor characterization. Accurate MRI driven evaluation carries strong prognostic implications, guiding personalized treatment and improving outcome prediction. OBJECTIVES: To evaluate diagnostic accuracy of T2/FLAIR mismatch sign in predicting IDH mutations in low grade gliomas. METHODOLOGY: This cross-sectional study analyzed 52 histologically confirmed glioma patients from 2022 to 2024 at AKUH. Preoperative 1.5T (GE) and 3T (Toshiba) MRI were reviewed by two neuroradiologists for T2/FLAIR mismatch and additional imaging features and compared with molecular profiling i.e. IDH1/2 following WHO 2021 criteria. Statistical analysis was done with Fisher’s exact test. RESULTS: IDH mutant gliomas exhibited frequent T2/FLAIR mismatch i.e. 58.3% vs 10.7% in wildtype, which highlights the utility of conventional MRI techniques as a reliable, non-invasive tool for predicting IDH status. CONCLUSIONS: T2/FLAIR mismatch sign along with conventional MRI features, may serve as a useful non-invasive adjunct, particularly where molecular testing is unavailable.
Copyright (c) 2025 Sheheryar Ahmed, Dr Aisha Memon, Dr Fatima Mubarak https://creativecommons.org/licenses/by-nc/4.0
INTRADISCAL CONDOLIASE INJECTIONS: A NEW FRONTIER IN NON-SURGICAL DISC HERNIATION THERAPY
The intradiscal condoliase injection stands out as the most biologically targeted and non surgical intervention currently available for lumbar disc herniation. It bridges a crucial therapeutic gap between conservative care and invasive surgery, offering durable pain relief with a single outpatient based treatment. Its mechanism is precise selectively degrading glycosaminoglycans in the nucleus pulposus and minimizing risk to the surrounding tissue. Beyonds symptoms control condoliase impact on quality of life, reduce recovery time and its cost-effectiveness make it especially promising in healthcare system seeking value based care. With consistent success rates of 70-78% in real world and clinical trial settings it presents an excellent option for well-selected patients. Nonetheless, long-term outcome data and broader internation adoption remain necessary to confirm its full therapeutic scope. As research advances and patient selection protocols improve, condoliase may reshape how clinicians approach intervertebral disc disorders and transforming pain management into precision enzymatic therapy.
Copyright (c) 2025 Wasif Ullah Khan, Mehr Un Nisa https://creativecommons.org/licenses/by-nc/4.0
THE FREQUENCY OF WOUND DEHISCENCE IN ADULTS UNDERGOING MIDLINE EXPLORATORY LAPAROTOMY IN A TERTIARY CARE HOSPITAL IN PESHAWAR
BACKGROUND: Abdominal wound dehiscence is a serious postoperative complication characterized by the partial or complete disruption of a surgical incision. Despite advancements in surgical techniques and perioperative care, its occurrence remains a challenge, particularly in emergency settings and among high-risk patient groups. Limited local data exists on its frequency and risk factors in the population of Peshawar, Pakistan. OBJECTIVE: To determine the frequency and associated risk factors of wound dehiscence among adult patients undergoing midline exploratory laparotomy in a tertiary care hospital in Peshawar. METHODOLOGY: This cross-sectional study was conducted in the Department of General Surgery, Hayatabad Medical Complex, Peshawar, from June 24, 2021, to December 24, 2021. A total of 193 patients aged 15–70 years who underwent elective or emergency midline exploratory laparotomy were recruited through consecutive non-probability sampling. Data on demographics, clinical variables, and wound outcomes were collected using a structured proforma. Wound dehiscence was classified as partial or complete. Data were analyzed using SPSS version 20. Chi-square tests were applied to determine statistical significance, with a p-value <0.05 considered significant. RESULTS: Among the 193 patients, 57 (29.5%) developed wound dehiscence; 36 (63.2%) had partial and 21 (36.8%) had complete dehiscence. The mean age was 37.5 ± 10.4 years. A significant association was observed between wound dehiscence and increasing age (p = 0.000), higher BMI (p = 0.045), and type of surgery (emergency vs. elective). Longer hospital stay leads to less wound dehiscence (p = 0.000), with earlier discharges more commonly associated with this complication. CONCLUSION: Wound dehiscence was found to be a prevalent complication following midline exploratory laparotomy, particularly in older and overweight patients and those undergoing emergency surgery. KEYWORDS: Wound dehiscence, exploratory laparotomy, midline incision, surgical complication, BMI.
Copyright (c) 2025 Ishrat Alam, Sheema Amin, Sidra Iqbal, Maryam Samad, Rizmi Tahir https://creativecommons.org/licenses/by-nc/4.0
REPRODUCIBILITY CRISIS: CAN SCIENCE IN PAKISTAN AFFORD INACCURACY?
The pace of global scientific advancement is particularly pronounced in the field of biomedical research. With the proliferation of sophisticated computational tools and widespread access to high-speed internet, researchers now operate in an ecosystem primed for rapid idea development and dissemination.Understanding Reproducibility Reproducibility, a fundamental principle of the scientific method, refers to the ability to obtain consistent results by independent researchers using the same experimental methodologyPakistan, too, is not immune to this crisis. A 2024 study published in BMC Medical Ethics surveyed 654 medical and dental faculty across the country. Alarmingly, every respondent admitted to engaging in at least one questionable research practice, including data fabrication, selective reporting, and honorary authorship. These behaviors were strongly linked to institutional pressures and insufficient training in research ethics.
Copyright (c) 2025 Adeela Mustafa https://creativecommons.org/licenses/by-nc/4.0
COMPARATIVE OUTCOMES OF MICROSCOPIC VERSUS NON MICROSCOPIC OPEN SUBINGUINAL VARICOCELECTOMY ON SPERM PARAMETERS: A QUASI EXPERIMENTAL STUDY FROM PESHAWAR
BACKGROUND: Varicocele, common cause of male infertility, negatively affects semen parameters like sperm count and motility. Surgical intervention, specifically varicocelectomy, remains a key treatment strategy, with laparoscopic, open and microscopic sub-inguinal techniques widely practiced. However, comparative data specific to open techniques, traditional and microscopic to the Peshawar region remains limited. OBJECTIVE: This study aimed to compare the impact of microscopic versus non microscopic open sub-inguinal varicocelectomy on sperm parameters, evaluating postoperative improvements and complication rates among patients in a tertiary care setting. METHODOLOGY: A quasi-experimental study was conducted at Northwest General Hospital, Peshawar, enrolling 220 male patients with clinically diagnosed varicocele. Patients were divided into two groups: Group A underwent microscopic sub-inguinal varicocelectomy (n=110), and Group B received the non-microscopic open subinguinal varicocelectomy technique (n=110). Pre- and postoperative semen analyses were performed, and data were statistically analyzed using SPSS v22. RESULTS: Group A showed significantly greater improvements in sperm count (from 14 ± 0.68 to 39 ± 7.4 million/mL) and motility (from 23 ± 3.75% to 58 ± 12.32%) compared to Group B (count: 12 ± 2.28 to 30 ± 5.7 million/mL; motility: 21 ± 5.34% to 53 ± 8.73%). ≥50% improvement in semen parameters was achieved in 53.63% of Group A, versus 39.09% in Group B (p = 0.0426). Although statistically non-significant, postoperative complications were fewer in the microscopic group. CONCLUSION: Microscopic varicocelectomy provided superior improvement in semen parameters and fewer complications than the non-microscopic open subinguinal varicocelectomy technique. The findings support broader adoption of microsurgical approaches in fertility management, particularly in resource-limited settings. KEY-WORDS: Varicocelectomy, Microscopic Surgery, Sperm Parameters, Male Infertility, Sub-Inguinal Approach.
Copyright (c) 2025 Irfan Ullah Khan, Muhammad Uzair, Ayesha Ali Khan, Noor Sardar Afridi, Sultan Zeb, Ameer Hamza Khan https://creativecommons.org/licenses/by-nc/4.0
RELATION OF HIGH SENSITIVITY C-REACTIVE PROTEIN WITH ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH AND WITHOUT TYPE-2 DIABETES MELLITUS
BACKGROUND: Coronary artery disease (CAD) is a major contributor to cardiac morbidity and mortality. Type 2 diabetes mellitus (T2DM) accelerates atherosclerosis through chronic low-grade inflammation, increasing the risk of CAD and its sequelae. High-sensitivity CRP (Hs-CRP) serves as an independent marker of this inflammation, aiding in risk assessment. This biomarker's significance extends beyond clinical settings into forensic medicine, where it can offer insights into the inflammatory status of individuals prior to death, aiding in the determination of cause of death. METHODOLOGY: This cross-sectional study conducted from January 2021 to January 2022 employed non-probability consecutive sampling. Ninety acute myocardial infarction (MI) patients of both genders presenting in tertiary care hospitals of Peshawar were included in the study. They were categorized into two groups: Group 1 (T2DM with acute MI) and Group 2 (acute MI without T2DM). Hs-CRP levels were measured using the immunoturbidimetric method. Independent t-test compared mean age and BMI, Chi-square tested gender distribution, and Mann-Whitney U assessed Hs-CRP differences across the groups. RESULTS: Male subjects had a higher mean age than females. Group 1 patients were significantly older (59.18 ± 8.45 years) than Group 2 (54.82 ± 14.48 years). Median Hs-CRP levels were significantly higher in diabetic MI patients (Group 1: 2.20 mg/L, IQR 7.85) compared to non-diabetic MI patients (Group 2: 0.60 mg/L, IQR 1.35) (p=0.007). Among 90 MI patients, 38 developed complications, Hs-CRP levels were significantly higher in those with complications (p=0.01) and in diabetics with complications as compared to non-diabetics with complications (p=0.03). CONCLUSION: T2DM patients with MI exhibited elevated Hs-CRP, indicating greater inflammatory burden and higher complication risk. Hs-CRP may aid in risk stratification and includes forensic relevance in assessing pre-mortem inflammation as well. KEYWORDS: Coronary artery disease, Type 2 diabetes mellitus, Hs-CRP, atherosclerosis, chronic low-grade inflammation
Copyright (c) 2025 Munir Hussain, Sonia Aziz, Anwar Ul Haq, Naheed Siddiqui, Ghulam Muhayudin, Arshad Parvez https://creativecommons.org/licenses/by-nc/4.0
ANTIOXIDANT AND ANTI-BACTERIAL ACTIVITY OF ETHANOLIC EXTRACT OF AESCULUS INDICA
BACKGROUND: Oxidative stress and bacterial infections have been identified as the root cause of the development and progression of several diseases. Despite many medicinal plants being reported to have antioxidant and antibacterial potentials, only a few are investigated. Medicinal plants exerting these properties can be used alone or in combination with other drugs for the treatment of various disorders. OBJECTIVE: To determine the antioxidant and anti-bacterial activity of ethanolic extract of Aesculus Indica. METHODOLOGY: This experimental, lab-based study was carried out at the Pharmacy department of Bahauddin Zakariya University Multan, from September 2022 to March 2023. The ethanolic extract of Aesculus indica was evaluated for its antioxidant and antibacterial activity. The stable 1,1-diphenyl -2-picrylhydrazyl radical was used to evaluate the antioxidant activity. Quercetin was used as standard antioxidant. Antibacterial activity of Aesculus indica was evaluated by paper disc diffusion method against the bacterial cultures of Staphylococcus epidermidis, and Bacillus atrophaeus at the dose of 100mg/ml and 200mg/ml. Ciprofloxacin (40μg/ml) was used as a standard antibacterial drug for Staphylococcus epidermidis. RESULTS: The mean of Aesculus Indica extract for 1,1-diphenyl -2-picrylhydrazyl radical scavenging activity was 83.76±0.76 while that of standard drug quercetin was 93.21±0.97. Statistically significant difference was found between the two. Ethanolic extract of Aesculus Indica showed significant (p<0.05) antibacterial activity in comparison to ciprofloxacin against Staphylococcus epidermidis and Bacillus atrophaeus. CONCLUSION: Ethanolic extract of the Aesculus Indica showed significant antioxidant and anti-bacterial properties. KEY WORDS: Aesculus indica, Antioxidant, Antibacterial, Quercetin, Ciprofloxacin.
Copyright (c) 2025 naseer, Aamna Khokhar, Iram Kamal, Rizwan Faisal, Attia aAnwar, Afeefah Sattar https://creativecommons.org/licenses/by-nc/4.0
IMPLEMENTING FORMATIVE ASSESSMENT: TEACHERS’ PERCEPTIONS AND CHALLENGES IN MEDICAL COLLEGES OF PESHAWAR, PAKISTAN; A QUALITATIVE STUDY
BACKGROUND: Formative assessments (FA) play an important role in medical education as they provide immediate feedback, assist students in recognizing deficiencies in their comprehension, and enhance their clinical competencies. Teacher awareness, motivation, resource accessibility, and continuous support are various aspects for the successful implementation of these initiatives. OBJECTIVE: The objective of the study was to investigate the teachers’ perceptions and challenges faced in the implementation of formative assessment at medical colleges in Peshawar, Pakistan. METHODOLOGY: A qualitative study was applied by utilizing semi-structured interviews with a purposive sample of a total of twelve participants from medical colleges of Peshawar. Thematic analysis was employed to identify recurring themes of awareness, motivation, and the resources necessary for FA implementation. RESULTS: Based on the teacher's perception, two major themes were identified: the challenges in implementing formative assessment, and the second is suggested solutions. The major challenges were time restrictions, which frequently hindered the regular and comprehensive assessments, while insufficient resources and inadequate training restricted their ability to deliver complete feedback. The absence of clear guidelines and acknowledgment for new techniques, along with restricted chances for feedback, further hindered the implementation of formative assessments. Resource allocation and staff training were the main recommendations. CONCLUSION: The effective adoption of formative assessments necessitates not only awareness and motivation but also an effective support system. Institutions must confront issues such as time limitations, resource inadequacies, and insufficient training via focused professional development and pragmatic workshops. Equipping the teachers with assessment tools, protocols, and technology can mitigate resource constraints. KEYWORDS: Formative assessment, Teacher, Medical college, Assessment, Implementation, Challenges, Qualitative study, Professional development
Copyright (c) 2025 syeda shamal, Brekhna Jamil, sahar mufti, Summaya Wajid, haider ali https://creativecommons.org/licenses/by-nc/4.0
FREQUENCY OF URINARY TRACT INFECTION (UTI) IN PATIENTS UNDERWENT TRANSURETHRAL RESECTION OF PROSTATE (TURP) AND CHARACTERIZATION OF CAUSATIVE AGENT
OBJECTIVE: To determine the frequency of urinary tract infection and identification of causative agent after transurethral resection of prostate in patients at Institute of Kidney Diseases, Peshawar. METHODOLOGY: This study was conducted at Department of Urology, Institute of Kidney Diseases, Hayatabad, Peshawar from the period of six months (29/1/2024 to 29/6/2024). Study design was cross sectional in which a total of 103 patients were observed. All the patients undergoing transurethral resection of prostate, with negative urine culture, in age between 45 to 70 years were included. A detailed history, physical examination; investigations including Urine R/E & Urine Culture and Ultrasound Kidney Ureter Bladder were performed and the selected patients were subjected to Operation Theatre for transurethral resection of prostate. Followed up after 24 hours, 3rd and 7th post operative day for the . Data was then entered and analyzed in statistical software (SPSS) version 23.0. RESULTS: In this study 103 patients were observed; mean age was 60.30 years ± 6.776. The frequency of Urinary Tract Infection was 19(18%) in which 13(69%) patients had Eschericia coli, 3(16%) patients had Enterococcus, 2(12%) patients had Klebsiella, 1(3%) patient had Proteus.
Copyright (c) 2025 Muhammad Afnan, MOHAMMAD ASAD SHAMSHER, MUHAMMAD SAAD HAMID, IMMAD AHMED, khizer zaman, NAUMAN UL MULK https://creativecommons.org/licenses/by-nc/4.0
THE SAFETY AND EFFICACY OF IRON POLYMALTOSE COMPLEX VERSUS FERROUS SULPHATE IN THE TREATMENT OF IRON DEFICIENCY ANEMIA IN PREGNANCY
BACKGROUND: Iron deficiency anemia is a widespread disease affecting pregnant women around the world and contributes significantly to maternal and fetal complications, work-related risks, and negative birth outcomes. OBJECTIVE: The purpose of this study is to assess the efficacy and safety of Iron Polymaltose Complex compared to Ferrous Sulfate in the treatment of IDA during pregnancy. METHODOLOGY: This quasi-experimental study was conducted in Health Ways hospital Kohat Pakistan that enrolled 120 pregnant women diagnosed with IDA (hemoglobin (Hb) levels of 7–9.9g/dL). After ethical approval and proper consent, participants were divided into two groups A and B. Group A was given Ferrous Sulfate while group B were prescribed Iron Polymaltose Complex. Each group followed a standardized regimen with follow-up visits every month for 2 months to determine the improvement in hematological parameters along with any adverse drug reaction encounter. All the data was analyzed using SPSS version 22.0. RESULTS: The baseline parameters in both groups were same and statistically not significant. Both group A Ferrous Sulfate and group B Iron Polymaltose Complex showed increment in Hemoglobin b and ferritin levels at each follow-up visit. However, the Iron Polymaltose Complex group shows statistically significant difference in both Hemoglobin levels and ferritin levels after 2 months follow-up with p-values <0.001. Furthermore, the Ferrous Sulfate group shows higher frequency of adverse events as compared to Iron Polymaltose Complex group. CONCLUSION: These results support the use of Iron Polymaltose Complex as an effective and better-tolerated option for the treatment of Iron Deficiency Anemia during pregnancy. Its excellent safety profile and improved patient compatibility highlight the clinical benefits over traditional iron salts like Ferrous Sulfate. KEY WORDS: Adverse Drug Reactions, Anemia, Iron Deficiency Anemia, Pregnant Women
Copyright (c) 2025 Heema, Naimat Ullah Khan, Tariq Mahfooz Khawaja, Syed Hasnain Ali Shah, Zainab Irshad, Saif Ullah Khan Khalil https://creativecommons.org/licenses/by-nc/4.0
PERIOPERATIVE MANAGEMENT IN CRANIOTOMY PATIENTS ON ANTIPLATELET AND ANTICOAGULANT THERAPY: A CROSS-SECTIONAL STUDY AT A TERTIARY CARE HOSPITAL IN PAKISTAN
BACKGROUND: The perioperative period, comprises the time before and after surgery, with a range from one week before surgery to four weeks following it. The five weeks are marked by occurrences during which most thrombotic and bleeding complications associated with perioperative antithrombotic management take place. Management of these risks presents a clinical challenge, particularly in neurosurgical procedures such as craniotomy due to high hemorrhagic potential of the procedure. OBJECTIVE: To evaluate perioperative management strategies and associated complications in patients undergoing craniotomy while receiving antiplatelet and anticoagulant therapy. METHODOLOGY: This is a cross-sectional study, conducted on 300 craniotomy patients over two years from 1st February 2022 till 1st January 2024 at the Irfan General Hospital, Peshawar. Patients aged 20 years and older receiving antiplatelet (aspirin, clopidogrel) or anticoagulant therapy (VKA, DOACs, and LMWH) were included. Data collection focused on patients’ demographics, perioperative management strategies, and post-op complications. SPSS software was used to analyze the data. RESULTS: Among 300 patients, 195 (65%) received AP therapy, while 105(35%) were on AC therapy. Aspirin (36.7%) and clopidogrel (28.3%) were commonly used AP drugs. Whereas, VKA (18.3%) was primarily an AC drug. Perioperative management strategies varied, with 35% of patients temporarily discontinuing anticoagulants, 25% receiving bridging therapy with heparin, and 10% switching to LMWH. In AP therapy, minimal bleeding was observed in most patients (96, 49.2%), while in AC therapy, moderate bleeding was noticed at a greater rate of 38, 35.2%) indicating a significant difference in bleeding severity (p < 0.01). CONCLUSION: This study highlights the prevalence of antithrombotic therapy among craniotomy patients and enhances the importance of individualized perioperative management to minimize complications. Temporary discontinuation and bridging strategies are some of the perioperative techniques commonly used. KEYWORDS: Antiplatelet, Anticoagulants, Craniotomy, Perioperative.
Copyright (c) 2025 Amina Sultan, Lubna Naz, Haseena sabir, Rahida, Mushafa https://creativecommons.org/licenses/by-nc/4.0
ASSOCIATION BETWEEN POLYHYDRAMNIOS AND FETAL CONGENITAL ANOMALIES IN PREGNANT WOMEN PRESENTING TO TERTIARY CARE HOSPITALS IN PESHAWAR, KHYBER PAKHTUNKHWA
BACKGROUND: Polyhydramnios is the excess of amniotic fluid in the uterine cavity. It is defined as Abnormal Fluid Index (AFI) which is more than 25 centimeters or a pocket of amniotic fluid more than or equal to 8 centimeters on ultrasonography. Polyhydramnios may be transient or persistent. It is responsible for 1-3% of complicated pregnancies. In about 50–60% of cases polyhydramnios is idiopathic. Polyhydramnios may be secondarily attributed to fetal, maternal or placental abnormalities. OBJECTIVE: To determine the frequency of common fetal anomalies among women with polyhydramnios presenting to a tertiary care hospital of Peshawar. METHODOLOGY: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Hayatabad Medical Complex and Northwest General Hospital, Peshawar from January 2024 to June 2024. A total of 139 patients with polyhydramnios were included in the study by non-probability consecutive sampling technique. All women were subjected to detail ultrasonography for diagnosis of polyhydramnios. All were followed through ultrasonography till delivery of the baby to determine the common fetal anomalies like gastrointestinal, CNS, cardiovascular and musculoskeletal. RESULTS: In this study, the mean age of patients was 31.25 ± 7.62 years. A total of 14 (10%) fetuses were found to have congenital anomalies. Among these 14 newborns with anomalies, 28.6% had central nervous system anomalies, 21% had gastrointestinal tract anomalies, 21% had musculoskeletal anomalies, 14% had cardiovascular anomalies, and 14% had mixed anomalies involving multiple systems. CONCLUSION: Polyhydramnios is associated with congenital fetal anomalies of nervous, gastrointestinal, cardiovascular and musculoskeletal systems. KEYWORDS: Polyhydramnios, congenital anomalies, central nervous system, musculoskeletal systems
Copyright (c) 2025 Saima Ayub, Dr. Nudrat, Rukhsana Karim, Sidra Jehangir, Basharat, MeherUn Nisa https://creativecommons.org/licenses/by-nc/4.0
PERCEIVED EFFECTIVENESS OF PEER LEARNING AMONG UNDERGRADUATE NURSING STUDENTS, PESHAWAR.
BACKGROUND: Traditionally, learning in nursing education was teacher-centered, but now with the advancement in teaching-learning methodologies, peer learning has gained popularity and acceptance in nursing education. It is a two-way learning process that provides joint benefits to all learners involved. It also brings positive effects such as autonomy, self-confidence, critical-thinking skills, deeper understanding, and leadership abilities which support the learners in their academic and professional sphere. Despite its importance, scarce literature is available on the subject particularly in the context of undergraduate nursing students, Peshawar. OBJECTIVE: This study aims to measure the perceived effectiveness of peer learning among undergraduate nursing students, Peshawar. METHODOLOGY: A descriptive cross-sectional study was conducted in three nursing institutes in Peshawar. Using convenience sampling technique, 228 students were included in the study. A questionnaire was adopted and modified for the context. Cronbach’s alpha was calculated to be 0.81 after conducting a pilot study. Data was analyzed on SPSS version 20. RESULTS: The study indicated that a significant percentage of undergraduate students (67.11%) perceived peer learning as highly effective, whereas 32.02% considered it as moderately effective while an exceedingly small percentage (0.87%) saw it as ineffective. Chi-square test was applied to find out any significant association between the demographic variables and peer learning, it was significant (p<0.001) between the institute where the students were enrolled in and peer learning. CONCLUSION: Overall, the study proved that peer learning is a highly effective teaching-learning strategy among nursing students and has remarkable benefits. KEYWORDS: Peer Learning, Perceived Effectiveness, Undergraduate Nursing Students.
Copyright (c) 2025 Dr. Aurang Zeb, Michelle, Manahil Rehman, Mujeeb Ur Rahman, Muhammad Zakir Khan, Abdul Wahab https://creativecommons.org/licenses/by-nc/4.0