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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PAKISTAN'S DUAL BURDEN OF DIABETES AND HYPERTENSION: AN APPEAL FOR INTEGRATED PUBLIC HEALTH INTERVENTIONS
Abstract Background: Among the most common cardiovascular risk factors in the world, diabetes mellitus and hypertension often co-occur as part of the cardiometabolic or cardiorenal metabolic syndrome. This "syndemic" is a serious public health issue with significant economic ramifications, fueled by rising obesity and inactive lifestyle rates. Intensive blood pressure (BP) control, aiming for a systolic BP of less than 120 mm Hg, can significantly reduce major cardiovascular events in diabetic patients, according to international research like the BPROAD study. However, putting such strategies into practice in settings with limited resources is still a difficult task. Discussion: Among the most common cardiovascular risk factors in the world, diabetes mellitus and hypertension often co-occur as part of the cardiometabolic or cardiorenal metabolic syndrome. This "syndemic" is a serious public health issue with significant economic ramifications, fueled by rising obesity and inactive lifestyle rates. Intensive blood pressure (BP) control, aiming for a systolic BP of less than 120 mm Hg, can significantly reduce major cardiovascular events in diabetic patients, according to international research like the BPROAD study. However, putting such strategies into practice in settings with limited resources is still a difficult task. Conclusion: Among the most common cardiovascular risk factors in the world, diabetes mellitus and hypertension often co-occur as part of the cardiometabolic or cardiorenal metabolic syndrome. This "syndemic" is a serious public health issue with significant economic ramifications, fueled by rising obesity and inactive lifestyle rates. Intensive blood pressure (BP) control, aiming for a systolic BP of less than 120 mm Hg, can significantly reduce major cardiovascular events in diabetic patients, according to international research like the BPROAD study. However, putting such strategies into practice in settings with limited resources is still a difficult task.
Copyright (c) 2026 Muhammad Mehr Ali, Imad Khan, Abdul Muqeet Ahmad (Author) https://creativecommons.org/licenses/by-nc/4.0
FREQUENCY AND HISTOPATHOLOGICAL TYPES OF GALL BLADDER CARCINOMA AND ITS ASSOCIATION WITH DEMOGRAPHIC FACTORS AND COMORBIDITIES IN PATIENTS UNDERGOING SURGERY FOR CHOLELITHIASIS AT A TERTIARY CARE HOSPITAL
BACKGROUND: Gall bladder carcinoma (GBC) is an aggressive malignancy with a poor prognosis, commonly identified at an advanced stage. Cholelithiasis is identified as a key risk factor for the development of gall bladder cancer in regions with a high prevalence of gallstones. Several cases of gall bladder carcinoma are incidentally detected during or following the surgery for presumed benign gallstone disease. Early diagnosis in patients undergoing cholecystectomy could improve the outcomes. OBJECTIVE: To determine the frequency, histopathological types of gallbladder carcinoma, and association of demographic factors (age, gender, BMI) and comorbidities (diabetes mellitus, hypertension) with GBC among patients undergoing surgery for cholelithiasis at a tertiary care hospital. METHODOLOGY: This cross-sectional study was conducted on 189 patients undergoing surgery for cholelithiasis in the age range of 18 to 65 years, with either gender at the General Surgery department of Ayub Teaching Hospital MTI, Abbottabad, from 24 May 2024 to 24 November 2024. All the patients underwent gross examination, where characteristic features such as a firm /tan-white to yellow-gray cut surface and the presence of exophytic or polypoid friable mucosal lesions were noted, and confirmation was made with histopathological assessment for the diagnosis of carcinoma. The collected data were then analyzed with SPSS 27 Results: The mean age in our study was 40.03 ± 11.86 years. Gender distribution showed that 102 (54.0%) were females and 87 (46.0%) were males. Gallbladder carcinoma was observed in 7 (3.7%) patients. A significant association was found between gallbladder carcinoma and diabetes (p=0.009) and age (p=0.05). No significant associations were observed with gender, BMI, and hypertension (p > 0.05 for all). The recorded mean age in gallbladder carcinoma patients was 52.43+13.697 years (p=0.005). The recorded mean duration of symptoms was 15.43+1.90 months (p<0.001). CONCLUSION: The frequency of gall bladder carcinoma among patients undergoing surgery for cholelithiasis was 3.7%. Diabetes, older age, and prolonged duration of symptoms were associated with GBC.
Copyright (c) 2026 Saifullah, Babar Sultan Khaghan (Author) https://creativecommons.org/licenses/by-nc/4.0
ATTITUDE OF DOCTORS IN SCREENING & MANAGEMENT OF PRE-DIABETES IN ADULTS IN PESHAWAR
Background: Prediabetes, a reversible high-risk state for type 2 diabetes, remains significantly underdiagnosed, hindering timely intervention. With Pakistan ranking third globally in diabetes prevalence, understanding physician practices is critical for prevention. This study assesses the attitudes of doctors towards the screening and management of prediabetes in adults at tertiary care hospitals in Peshawar. Objective: This study aims to assess the attitudes of doctors towards the screening and management of prediabetes in adults. Methodology: A cross-sectional questionnaire-based study was conducted from 26th March 2025 to 26th September 2025. A total of 106 doctors were recruited via convenience sampling technique. Exploratory Factor Analysis (EFA), t-tests, ANOVA, and regression analyses were used to determine the strengths of association with demographics, with p-value of < 0.05 was considered statistically significant. Results: In current study majority of the doctors have positive attitudes: 63.2% supported universal screening, 75.5% favored WHO/ADA guidelines, and 74.5% agreed evidence-based practice is effective. Nonetheless, psychological effects were perceived differently, and 35.8% of respondents believed that diagnosis might have adverse effects on mental health. Additionally, this study demonstrates that male doctors adhered more to guidelines than females (p = 0.04), and TMOs had more positive attitudes toward screening than registrars (p = 0.03). Higher qualifications were linked with concern about psychological impact of the diagnosis (p = 0.02). Conclusion: Doctors in Peshawar tended to have positive attitudes towards prediabetes screening, and management. Nevertheless, health systems, skills-based training, and localized guidelines should be enhanced to channel positive attitudes into effective preventive practice
Copyright (c) 2026 Faiza Akbar, Bushra Iftikhar, Muhammad Abbas Khan, Muhammad Zafar Khan, Rabia Akbar (Author) https://creativecommons.org/licenses/by-nc/4.0
PATTERN AND FREQUENCY OF CONDYLAR FRACTURES IN CHILDREN: A CROSS-SECTIONAL STUDY AT KHYBER COLLEGE OF DENTISTRY, PESHAWAR
Background: Condylar fractures are among the most common mandibular fractures, accounting for a high proportion of injuries found in facial trauma cases. Their management is particularly challenging considering the variety of changes in the mandible as a child grows and the long term functional and aesthetic complications associated with it. Objective: To assess the frequency and pattern of condylar fractures in children presenting with mandibular trauma to S1 OPD in Khyber College of Dentistry. Methods: An observational cross-section study was conducted on patients from the age of birth to 18 years diagnosed with condylar fracture between January 2023 and December 2024. Data was collected using a structured proforma including patient demographics and pattern of the fracture. Descriptive and inferential statistics were applied to analyze the association between demographics and pattern of fracture. Results: Among 118 patients of mandibular trauma over, 50% of fractures involved the condyle, majority of those being extracapsular fractures. There was a higher percentage seen in males at a ratio of 3.4:1 in the age group of 4-7 years. Majority of fractures were unilateral and about 28.3% of the cases presented with displacement of the condyle and about 6.7% of the cases presented with total dislocation from the joint.
Copyright (c) 2026 Sufyan Ammar Khan, Haseeba Younas, Atta ur Rehman (Author) https://creativecommons.org/licenses/by-nc/4.0
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
PROSPECTIVE EVALUATION OF A RISK-STRATIFIED, SYMPTOM-GUIDED POSTPARTUM TRIAL WITHOUT CATHETER (TWOC) PROTOCOL AND ITS IMPACT ON BLADDER RECOVERY, MATERNAL COMFORT, AND HEALTHCARE UTILIZATION
Background: Postpartum urinary retention (PPUR) is a common but neglected complication of parturition. This leads to overdistension of the bladder, urinary tract infections, and long-term voiding dysfunction. Despite this evident complication, standardized postpartum bladder management protocols are lacking in many maternity units in Pakistan; therefore, this study aims to establish a postpartum trial without a urinary catheter, as recommended by developed countries. Objective: To evaluate the effectiveness, safety, and feasibility of a risk-stratified, symptom-guided postpartum Trial Without Catheter (TWOC) protocol. Methods: A prospective observational study was conducted on 220 women in the tertiary care maternity unit of Bahawal Victoria Hospital from June 2024 to September 2025. Postpartum women at risk of PPUR underwent a structured TWOC protocol incorporating timed voiding, Voiding Efficiency Screening & Symptom Inquiry (VESSI), and post-void residual volume measurement. TWOC success, need for re-catheterization, bladder overdistension, urinary tract infection, and patient-reported satisfaction were the outcomes of the study. Results: Successful TWOC on first attempt was in 70.0%. Overdistension (>700 ml) was in only 5%, and the median time to spontaneous voiding was 5.2 hours (IQR 4.1–6.0). Increasing post-void residual volume and higher VESSI scores were associated with progressively poorer TWOC outcomes (χ² = 55.25, df = 2, p < 0.001). On multivariable analysis, residual volume ≥250 ml (adjusted OR 3.4, 95% CI 2.1–5.6), high VESSI score (≥5) (adjusted OR 2.9, 95% CI 1.8–4.7), and instrumental delivery (adjusted OR 2.2, 95% CI 1.3–3.9) independently predicted TWOC failure (all p ≤ 0.004). Patient-reported outcomes were favorable, with over 80% reporting reduced anxiety and willingness to recommend the protocol. Conclusion: The TWOC protocol is safe, effective, and associated with high patient satisfaction, supporting its integration into routine postpartum care.
Copyright (c) 2026 Khudija sundas, Shakila Yasmin, Sana Usman (Author) https://creativecommons.org/licenses/by-nc/4.0
FREQUENCY OF HUMAN IMMUNODEFICIENCY VIRUS IN DIAGNOSED CASES OF PULMONARY TUBERCULOSIS
Background: Pulmonary tuberculosis remains a major public health concern, particularly in resource-limited settings, and co-infection with HIV worsens disease outcomes. In Peshawar, where TB is common and HIV risk is increasing, local data on TB–HIV co-infection are limited, underscoring the need to determine HIV prevalence among TB patients to inform integrated management strategies. Objective: To determine the frequency of human immunodeficiency virus in diagnosed cases of pulmonary tuberculosis. Methodology: This descriptive cross sectional study was conducted at the Pulmonology Department, Northwest General Hospital Peshawar from July 2025 to December 2025, including a total of 110 patients with confirmed pulmonary tuberculosis. Blood samples were analyzed for HIV ribonucleic acid, and demographic, clinical, and socioeconomic data were collected. Statistical associations between HIV positivity and demographics variables were assessed using Fisher’s exact test. Results: The mean age of the patients was 37.2±8.7 years and mean BMI of 21.0±2.8 kg/m². Most participants were male (62.7%), resided in rural areas (65.5%), and belonged to a low socioeconomic status (71.8%). HIV infection was detected in 10 patients, yielding a prevalence of 9.1% (95% CI: 3.7–14.5%). Stratified analysis showed that male gender was significantly associated with HIV infection (OR = 14.65; 95% CI: 0.84–254.6; p = 0.013), whereas age, duration of tuberculosis, BMI, residence, education level, and socioeconomic status were not significantly associated (p>0.05).. Conclusion: HIV co-infection is present in a notable proportion of pulmonary tuberculosis patients, particularly among males.
Copyright (c) 2026 Hamid Akhtar, Mohammad Asim, Muhammad Asif Zia, Tariq Aziz, Muhammad Aqif Khan Wazir, Muhammd Arsalan (Author) https://creativecommons.org/licenses/by-nc/4.0
FUNCTIONAL OUTCOME OF TITANIUM ELASTIC NAILING IN THE TREATMENT OF FEMORAL SHAFT FRACTURES AMONG CHILDREN LESS THAN 8 YEAR
BACKGROUND: Femoral shaft fractures are one of the most common in young children which often necessitate operative stabilization to warrant proper alignment and early mobilization. Titanium elastic nailing has gained acceptance in pediatric orthopedics due to its minimally invasive nature and ability to provide stable fixation. This method provides the benefit of rapid fracture healing and reduced complication rates. OBJECTIVE: To determine the functional outcome of Titanium Elastic Nailing in the treatment of femoral shaft fractures among children under 8 years of age. METHODOLOGY: This descriptive study was conducted on 128 children aged 01-07 years with femoral shaft fractures from 25-May-2025—25-November-2025 at department of orthopaedic surgery of Lady Reading Hospital, Peshawar. All the patients underwent surgical fixation with titanium elastic nails. Functional outcomes were assessed at 12th week using Flynn's criteria and categorised as excellent, good, fair, and poor. Functional outcomes were stratified with time to surgery, malunion, limb length deficiency (LLD), infection, and nail irritation using chi square test, P value ≤ 0.05 was considered significant. RESULTS: Mean age of the 128 patients was 4.98±1.46 years. Male patients were 84 (65.6%). Functional outcomes were excellent in 65.6% (n = 84) cases and good in 22.7% (n = 29). A statistically significant association was found between shorter time to surgery and excellent outcomes (p < 0.001). Early weight bearing was associated with excellent outcomes (p < 0.001). All patients with a poor outcome had malunion (p < 0.001) and infection (p < 0.001). LLD (>2 cm) was associated with poor outcomes (p < 0.001). CONCLUSION: Titanium elastic nailing demonstrated excellent and good functional outcomes in majority of the children. Excellent functional outcomes were significantly associated with early surgical intervention, early post-operative weight bearing, and the absence of complications such as malunion, infection, and limb length discrepancy.
Copyright (c) 2026 Dr. Shahid Akbar, Dr. Naeem Ullah (Author) 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
DISTRIBUTION OF MAJOR JOINT DISORDERS AND ASSOCIATED FACTORS AMONG ADULTS IN TERTIARY CARE SETTINGS OF PESHAWAR: A CROSS SECTIONAL STUDY
BACKGROUND: Joint disorders are a major yet under-recognized public health challenge, contributing substantially to disability, reduced quality of life, and long-term healthcare costs. In low-resource countries like Pakistan, their impact is magnified by a high burden of comorbidities. Detailed information on their patterns, especially in busy tertiary care settings, remains limited here. The lack of local evidence makes it difficult to design effective prevention and care strategies. OBJECTIVE: To determine the distribution of major joint disorders and associated factors among adults attending tertiary care hospitals in Peshawar, Pakistan, and to assess the comorbidity burden in this population. METHODOLOGY: It was a cross-sectional study conducted from June to November 2022 in four tertiary care hospitals of Peshawar. A sample of 400 patients aged ≥18 years diagnosed with joint disorders was recruited by non-probability convenience sampling. Data were collected using a structured questionnaire covering demographics, lifestyle factors, clinical diagnosis, and comorbidities. Data analysis was performed using SPSS-26, with results presented in tables as frequencies and percentages. RESULTS: The mean age of the sample was 54±13.06 years, with 54.5% males and 45.5% females. Osteoarthritis was the most common disorder (35%), followed by gout (27.5%) and rheumatoid arthritis (24.5%). Gout was predominant in males (37%), while osteoarthritis was more frequent in females (45%). Most of the subjects were married (75%), non-smokers (68%) and belonged to middle-income category (58.5%). Majority of them did not have family history of joint disorder (76%) or history of prior trauma (66%). A high comorbidity burden was observed and 92% of the participants reported comorbidities, most common being hypertension (54%) and diabetes mellitus (22.5%). CONCLUSION: There is a high burden of osteoarthritis and gout among adults in tertiary care settings in Peshawar, compounded by a very high rate of comorbidities. These findings underscore the need for integrated, preventive public health strategies and multidisciplinary care models for joint disorders in Pakistan.
Copyright (c) 2026 Mirza Mabroor Ahmad, Dr. Khadija Nowaira Abdullah, Dr. Bibi Aliya, Shahab Ud Din Awan, Aqsa Qasim, Amina Khursheed (Author) 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
FEEDING PRACTICES AND RISK OF PROLONGED DIARRHOEA AMONG INFANTS PRESENTING WITH ACUTE DIARRHOEA: A CROSS-SECTIONAL STUDY AT HAYATABAD MEDICAL COMPLEX, PESHAWAR
BACKGROUND: Suboptimal infant feeding practices adopted by caregivers are important contributors to infectious diseases, including diarrhoeal illnesses, among infants in low- and middle-income countries. OBJECTIVE: To describe feeding practices among infants presenting with diarrhoeal symptoms and examine their association with household hygiene practices and the risk of prolonged diarrhoea. METHODOLOGY: This cross-sectional study was conducted from December 2024 to June 2025 in the Department of Paediatrics at Hayatabad Medical Complex, Peshawar. A total of 161 infants presenting with diarrhoeal symptoms were enrolled. Data were collected from primary caregivers using a structured questionnaire assessing feeding practices and household hygiene conditions. Statistical analysis was performed using SPSS version 27. Associations between feeding practices and prolonged diarrhoea (>7 days) were examined using chi-square tests and binary logistic regression. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS: The mean age of the infants was 6.73 ± 3.27 months; 53.4% were female and 46.6% were male. Among the participants, 55.9% had diarrhoeal symptoms lasting <7 days, while 44.1% experienced symptom prolonged symptoms (>7 days)s (>7 days). Infants younger than six months showed significantly higher rates of prolonged diarrhoea (p < 0.001). Risk factors associated with prolonged diarrhoea included formula feeding (OR = 2.37; 95% CI: 1.31–3.14), consumption of home-cooked food or cow’s milk (OR = 4.02; 95% CI: 2.17–7.08), and lack of vaccination (OR = 2.05; 95% CI: 1.30–3.20). Protective factors included current breastfeeding (OR = 0.05; 95% CI: 0.01–0.26) and bottle feeding (OR = 0.11; 95% CI: 0.02–0.42). Additional significant factors included non-exclusive breastfeeding, unimproved household water sources, feeding unwashed or uncooked food, use of unwashed feeding utensils, and feeding stored food (p < 0.05). CONCLUSION: Community-based education for caregivers, especially mothers, on feeding practices, combined with improved access to safe water and sanitation, is essential to prevent diarrhoea and its complications in Peshawar and comparable settings in Pakistan.
Copyright (c) 2026 Qazi Yousaf Ali, Rahida Karim, Muhammad Fayaz, Shehr Bano Raza, Asad Kamal, Sanat Ullah (Author) https://creativecommons.org/licenses/by-nc/4.0
RISK FACTORS FOR FEVER AND SEPSIS AFTER PERCUTANEOUS NEPHROLITHOTOMY: A SINGLE-CENTER STUDY IN PAKISTAN
BACKGROUND: Percutaneous nephrolithotomy (PCNL) is a preferred treatment option for large and complex renal calculi. However, infectious complications such as postoperative fever and sepsis remain clinically significant. The pathogenesis is multifactorial, that involves patient, stone, and operative factors. Reported rates differ widely, and local data from Pakistan is limited. Identifying risk factors could improve perioperative management and reduces the morbidity. OBJECTIVE: To determine the frequency of postoperative fever and sepsis after percutaneous nephrolithotomy (PCNL) and to identify associated preoperative and intraoperative risk factors. METHODOLOGY: This study was conducted at the Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan, from January 15 to September 30, 2025. A total of 110 adult patients undergoing PCNL were enrolled. Data was collected and analysed using SPSS version 23. A p-value <0.05 was considered statistically significant. RESULTS: The median age of the study participants was 38 years (IQR: 20), with 58.2% being male and 41.8% female. Postoperative fever (temperature ≥38°C within 7 days) occurred in 38 patients (34.5%), while sepsis defined according to SIRS criteria was observed in 6 patients (5.5%). On forward-stepwise multivariable analysis, staghorn calculi (aOR 8.95; 95% CI 1.64–48.88; p=0.011) and partial staghorn calculi (aOR 4.64; 95% CI 1.16–18.52; p=0.030) remained independent predictors of postoperative fever. Obesity was also associated with fever (aOR 44.4; 95% CI 1.70–1164; p=0.023); however, the wide confidence interval reflects imprecision due to small number of obese patients and should be interpreted cautiously. Longer operative time was significantly associated with both fever (p=0.034) and sepsis (p=0.002) on univariate analysis. CONCLUSION: Staghorn and partial staghorn calculi were independent predictors of postoperative fever following PCNL. Although obesity showed statistical significance, the estimate lacked precision due to the small number of obese patients and should be interpreted cautiously. Prolonged operative time correlates with both fever and sepsis on univariate analysis. Recognizing risk factors allows clinicians to tailor perioperative care and enhance postoperative monitoring, and hence potentially reducing the complications.
Copyright (c) 2026 Muhammad Waqas, Akhtar Nawaz, Siddiq Akbar, Muhammad Saad Hamid, Shabeer Ahmad, Sulaiman Shah (Author) 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
RISK OF OBSTRUCTIVE SLEEP APNEA AND ITS ASSOCIATION WITH QUALITY OF LIFE AMONG PATIENTS IN KHYBER PAKHTUNKHWA: A CROSS-SECTIONAL STUDY
Background: Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed sleep disorder associated with significant morbidity, including reduced quality of life and increased cardiovascular risk, particularly in underserved regions like Khyber Pakhtunkhwa, Pakistan, where diagnostic access is limited. Objectives: To determine the prevalence of obstructive sleep apnea among primary care patients in Khyber Pakhtunkhwa, assess its impact on quality of life and associated clinical factors, and evaluate the effectiveness of CPAP therapy. Methodology: This was a cross-sectional study with prospective follow-up for CPAP-treated subsets. Participants were recruited from primary care clinics in Peshawar, with home-based assessments conducted across Khyber Pakhtunkhwa, Pakistan, between January 2020 and July 2025. A total of 500 adults were screened using the STOP-BANG questionnaire and Mallampati score. Obstructive sleep apnea was confirmed by home-based polysomnography (PSG), defined as an Apnea–Hypopnea Index (AHI) ≥ 5 events per hour. Quality of life was assessed using the Epworth Sleepiness Scale (ESS). Baseline sleep study parameters—including AHI, Apnea Index (AI), Oxygen Desaturation Index (ODI), Respiratory Disturbance Index (RDI), and sleep efficiency—were recorded, along with clinical measures such as blood pressure, weight, neck circumference, and associated comorbidities. Among patients diagnosed with OSA and initiated on continuous positive airway pressure (CPAP) therapy, a subset was followed prospectively for six months to evaluate treatment adherence and clinical outcomes. Conclusion: A large number of primary care patients in Khyber Pakhtunkhwa have undiagnosed obstructive sleep apnea, which negatively affects their quality of life and sleep-related parameters. Patients who used CPAP therapy regularly showed clear improvement in clinical and sleep outcomes.
Copyright (c) 2026 Kamran Amir Khan, Sameed Qureshi, Zuhra Naheed Khan (Author) 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