Journal of Gandhara Medical and Dental Science

Continuum of Maternal Care from Pregnancy to Postpartum Period: A Systematic Review

Rabiya masood — 2026-06-30

ABSTRACT

Background: Continuum of maternal care, encompassing antenatal care, skilled birth attendance, institutional delivery, and postnatal care, is essential for improving maternal and neonatal outcomes. However, continuity across these stages remains suboptimal in many low- and middle-income countries.

Objective: To systematically review the utilization, determinants, and outcomes associated with the continuum of maternal care from pregnancy to the postpartum period.

Methods: A systematic review was conducted following PRISMA 2020 guidelines. Electronic databases including PubMed, Web of Science, and Scopus were searched for studies published between January 2020 and December 2025. Original research studies conducted on women of reproductive age (15–49 years) and reporting at least one component of maternal care were included. A total of 617 records were identified, of which 15 studies met the inclusion criteria. Data were extracted and analyzed using a narrative synthesis approach.

Results: Antenatal care utilization ranged from 60% to 76%, while skilled birth attendance and institutional delivery showed moderate coverage. Postnatal care remained the least utilized component. Overall completion of the continuum of care ranged between 30% and 50%. Key determinants included maternal education, socioeconomic status, and residence. Accessibility barriers, health system limitations, and cultural factors contributed to discontinuity of care. Completion of the continuum was associated with improved maternal and neonatal outcomes.

Conclusion: The continuum of maternal care remains fragmented, particularly at the postnatal stage. Strengthening healthcare systems, improving accessibility, and addressing socioeconomic and cultural barriers are essential to enhance continuity of care and improve maternal and neonatal health outcomes.

Keywords: Continuum of care, maternal health, antenatal care, postnatal care, skilled birth attendance, systematic review

Effects of Vitamin D on Respiratory Function and Immune Status for Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review

Sikandar Ali Khan — 2026-06-30

ABSTRACT

OBJECTIVES

To systematically review recent evidence on the effects of vitamin D on respiratory function and immune status in patients with COPD.

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent airflow limitation, recurrent exacerbations, systemic inflammation, and impaired quality of life. Vitamin D has immunomodulatory and anti-inflammatory effects and has been investigated for its possible role in COPD progression and clinical outcomes.

METHODOLOGY

Eligible studies were identified through searches of PubMed, Web of Science, and Scopus. Search terms included vitamin D, COPD, respiratory function, inflammation, and immune status. Original human studies published between 2020 and 2025 were included. Eligible study designs included randomized controlled trials, cohort studies, case-control studies, longitudinal studies, and cross-sectional studies. Reviews, meta-analyses, pilot studies, case reports, case series, editorials, conference abstracts, and animal studies were excluded. Study selection was conducted according to PRISMA 2020 guidelines. Data were extracted narratively, and methodological quality was assessed using the Cochrane Risk of Bias 2 tool and Joanna Briggs Institute appraisal checklists.

RESULTS
A total of 512 records were identified, of which 18 original studies met the eligibility criteria for qualitative synthesis. Most studies showed that low serum 25-hydroxyvitamin D levels were associated with poorer lung function, greater symptom burden, increased risk of acute exacerbations, and higher inflammatory activity in COPD. Evidence from supplementation trials was inconsistent. Some studies reported improvement in exacerbation frequency and symptom scores, whereas others found no significant overall benefit.

CONCLUSION

Low vitamin D status appears to be associated with adverse respiratory and immune-inflammatory outcomes in patients with COPD. Current evidence does not support universal vitamin D supplementation for all COPD patients; however, assessment and correction of deficiency may be useful in selected high-risk or deficient patients. Further large, well-designed trials are needed to clarify the clinical relevance of vitamin D in COPD

Leadership or Control? A Barrier to Student-Centred Learning in Pakistan’s Health Professions Education

Muhammad Abdullah Qazi — 2026-06-30

Health Professions Education has evolved substantially over the past three to four decades, particularly following the introduction of the SPICES Model (1984) by Ronald Harden (see figure 1).¹ This marked a major shift from teacher-centered approaches to student-centered learning, with an increased emphasis on the student’s abilities, needs, learning styles, and interests rather than those of the teacher.² On the other hand, the teachers’ role is not limited to just an “information provider”, but also a facilitator, a role model, a planner, an assessor, and a resource developer.² The successful implementation of student-centered educational frameworks depends not only on curriculum design, but also on leadership practices that shape educational culture.

Figure 1: SPICES Model by Harden (1984)¹

Health professions education is undergoing another significant transformation with the integration of global Artificial Intelligence (AI). Emerging AI applications in health professions education across learning and teaching, clinical practice, research, and educational leadership are reshaping institutional expectations and educational roles.³ The integration of AI further challenges traditional leadership styles, as effective use of AI in education requires adaptability, trust, experimentation, and learner autonomy. The culture of health professions education in Pakistan is predominantly characterized by authoritarian practices.⁴ However, the country appears to be in a transitory phase, with health professions leaders, educationists, and educators demonstrating a spectrum of leadership styles ranging from authoritarian to transformational, often exhibiting hybrid characteristics.^4,5 The problem with the predominant authoritarian leadership style is its fundamental incompatibility with student-centered learning, which relies on psychological safety, collaboration, and learner autonomy.^2,6 What exactly is at stake if authoritarian leadership persists? Learner autonomy, psychological safety, faculty engagement, and the sustainability of student-centered educational reform. Authoritarian leadership relies on compliance and hierarchy to manage educational environments, emphasizing centralized authority and control and often limiting autonomy and participation.⁵ In educational settings, authoritarian practices tend to produce passive learners and foster a fear of making mistakes. Persistent authoritarian leadership can limit educational reform, learner development, innovation, and faculty engagement. In contrast, transformational leadership emphasizes facilitation, collaboration, critical thinking, and partnership. Transformational leadership supports the development of active and reflective learners by empowering, inspiring, and intellectually stimulating them, encouraging them to work towards shared educational goals. Transformational leadership can help promote student-centered learning environments and foster collaboration.^5,6

Steps can be taken on multiple levels to reshape educational environments within health professions education in Pakistan. At a macro level, regulatory authorities need to align national policies with student-centered educational values. At the institutional level, health professions education institutes should offer periodic leadership development programs focused on reflective practice, communication, effective feedback, facilitation, and change management.^5,7 Leadership appointments and promotions should be guided by educational leadership competencies rather than years of service alone. Institutions should also strengthen mentorship processes, promote shared decision-making, foster role modeling, support leadership research, and amplify faculty voices.^2,6 At an individual level, this paper calls on educational leaders, educationists, educators, and learners to critically reflect on their own leadership styles and actively develop characteristics conducive to student-centered approaches. Promoting transformational leadership and student-centered approaches is not solely the responsibility of those in key leadership roles. Every leader, educationist, educator, and learner has a role in creating an environment that fosters collaboration, shared decision-making, student-centered approaches, psychological safety, trust, and learner autonomy. Re-examining current leadership practices is key to achieving student-centered educational reform in Pakistan.

The Comparison of Outcomes of Partial Turbinectomy Versus Mucosal Diathermy in Patients with Inferior Turbinate Hypertrophy

Muhammad Zeeshan Ashraf — 2026-06-30

ABSTRACT

OBJECTIVES

To compare the outcomes of partial turbinectomy versus mucosal diathermy in patients with inferior turbinate hypertrophy.

METHODOLOGY

The ENT Department at Sheik Zayed Hospital, Lahore, conducted this single-center, non-randomized, controlled study. Sixty adults aged 18-60 years with clinically and radiologically confirmed inferior turbinate hypertrophy were selected and sequentially assigned to two equal groups upon screening and informed consent. Group A had partial inferior turbinectomy (PIT), whereas Group B had submucosal diathermy (SMD). Comparison of the groups with the baselines was conducted. Variability in operators was minimized using a standardized operative protocol. The pain after the operation was measured using a 10-point Visual Analog Scale (VAS), nasal obstruction was measured on a 0-3 scale, nasal crusting was graded using the Lund and Kennedy system, and endoscopic assessment assessed tissue healing. The three-month follow-up was made.

RESULTS
There was similarity between groups in baseline demographic and clinical variables. Mean postoperative pain was significantly lower in the SMD group than in the PIT group on day 1 (mean difference 2.67; 95% CI 2.14-3.20; Cohen's d=2.61; p=0.0001) and at one month (mean difference 1.83; 95% CI 1.43-2.23; Cohen's d=2.36; p=0.0001). Nasal obstruction, crusting, and bleeding outcomes in the nasal passages were numerically predisposed to SMD, although a majority of between-group comparisons were non-significant. The SMD group exhibited a statistically significantly higher (0.003) good tissue healing at three months (76.67%) compared with the PIT group (33.33%).

CONCLUSION

SMD, in this non-randomized study, was associated with less postoperative pain and faster tissue healing at 3 months compared to PIT. Other clinical outcomes showed positive trends in SMD but should be used with caution due to small sample sizes, non-random subject allocation, and limited follow-up.

Frequency of Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Mellitus Patients With Non-Alcoholic Fatty Liver Disease

Muhammad Saad — 2026-06-30

ABSTRACT

OBJECTIVES

The study aimed to determine the frequency of left ventricular diastolic dysfunction (LVDD) in type 2 diabetes mellitus (DM) patients with non-alcoholic fatty liver disease (NAFLD).

METHODOLOGY

This cross-sectional study was conducted in the Department of Medicine at Hayatabad Medical Complex, Peshawar, Pakistan, between 01.03.2025 and 10.09.2025. The study participants were patients with type 2 DM and concomitant NAFLD. Patients with a history of hypertension, ischemic heart disease, and chronic kidney disease were excluded. All patients underwent echocardiography, and LVDD was diagnosed based on the E/A ratio reversal. The association between LVDD and its risk factors (age, gender, body mass index, smoking status) was determined using univariate and multivariable analyses.

RESULTS
Of the 252 participants, 51 patients (20.2%) were diagnosed with LVDD. It was more frequent in males (22.4% vs 18.4%), individuals over 60 years of age (24.6% vs 16.4%), obese patients (21.9% vs 19%), and smokers (30.1% vs 15.4%). Nevertheless, univariate and multivariable regression analyses indicated that age, gender, and obesity were not statistically significant or independent predictors of LVDD. Conversely, smoking was identified as a significant independent risk factor in both univariate (p = 0.006) and multivariable regression analyses (AOR: 3.865; 95% CI: 1.384–10.793; p = 0.010).

CONCLUSION

A significant number of patients with type 2 DM and NAFLD showed LVDD. Smoking is independently linked to LVDD, highlighting the importance of quitting smoking and performing early cardiovascular screenings to prevent progression to overt heart failure in this high-risk group.

Evaluation of Mid Palatal Suture Maturation and its Correlation with Maxillary Second Molar Mineralization in Growing Individuals

Salka Urooj — 2026-06-30

ABSTRACT

OBJECTIVES

This study aimed to evaluate and correlate, using CBCT, the maturation stages of the mid-palatal suture (MPS) and the mineralization stages of the maxillary second molars in subjects to determine whether molar mineralization can predict MPS maturation.

METHODOLOGY

This study (cross-sectional) was conducted on 33 participants (aged 10-18 years). MPS maturation was assessed according to Angelieri et al., and second molar mineralization was evaluated using the Demirjian index from CBCTs. Spearman's correlation was used to assess the relationship between MPS maturation and second molar mineralization. Furthermore, partial correlation analysis was conducted to assess the relationship between these variables while controlling for age. Intra-examiner reliability was calculated utilizing intraclass correlation coefficients (ICC).

RESULTS
Intra-examiner reliability was high (ICC = 0.86). A significant moderate positive correlation was found between MPS maturation stages and second molar mineralization (ρ = 0.479, p = 0.005). When analyzed by gender, females showed a significant moderate correlation (ρ = 0.522, p = 0.018), whereas males showed a positive but non-significant correlation (ρ = 0.402, p = 0.173). Partial correlation analysis revealed a diminishing correlation between MPS maturation and molar mineralization (ρ = 0.282, p = 0.117).

CONCLUSION

Percutaneous nephrostomy was associated with higher short-term treatment effectiveness than double-J stenting in obstructive uropathy. Clinical context and underlying etiology should guide treatment selection.

Comparison of Xylocaine Addition to Propofol vs Local Tapping for Alleviating Injection Pain

Aamir Waseem — 2026-06-30

ABSTRACT

OBJECTIVES

To evaluate and compare the efficacy of xylocaine–propofol admixture and local tapping in reducing the incidence and severity of propofol injection pain.

METHODOLOGY

This quasi-experimental comparative study was conducted at Shalamar Hospital, Lahore, from August 2025 to December 2025, involving 120 adult patients undergoing elective surgery under general anesthesia. Group A received propofol mixed with 0.5 ml of 2% xylocaine, while Group B received standardized local tapping for five seconds before propofol administration. Pain severity was assessed using a four-point verbal rating scale after the first 5 ml of propofol.

RESULTS
Pain incidence and severity were significantly lower in the xylocaine group. No pain was reported by 63.3% of patients in Group A compared to 20.0% in Group B, while severe pain occurred in only 1.7% versus 16.7%, respectively (p < 0.001). The mean pain score was significantly lower in Group A (0.50 ± 0.73) than in Group B (1.47 ± 1.04) (p < 0.001). Hemodynamic changes were also smaller in the xylocaine group, with heart rate and systolic blood pressure increasing by +2.7 bpm and +2.1 mmHg, compared to +6.7 bpm and +6.2 mmHg in the tapping group (p < 0.05). Adverse events were minimal, with only one mild irritation case in Group A. Patient satisfaction was higher in Group A, with 66.7% reporting being very satisfied compared to 30.0% in Group B.

CONCLUSION

It is concluded that xylocaine admixture is significantly more effective than local tapping in reducing propofol injection pain, stabilizing hemodynamic responses, and improving patient satisfaction. Local tapping may offer partial benefit but should not replace xylocaine as the preferred technique for minimizing discomfort during propofol administration.

Frequency of Sexual Dysfunction among Patients Receiving Selective Serotonin Reuptake Inhibitors

Amir Wahab — 2026-06-30

ABSTRACT

OBJECTIVES

This study aims to determine the frequency of sexual dysfunction among patients undergoing SSRI treatment.

METHODOLOGY

A cross-sectional study was conducted at the Department of Psychiatry, MTI Lady Reading Hospital, Peshawar, from December 2023 to June 2024. Using non-probability consecutive sampling, 288 patients aged 20-40 years receiving SSRIs for at least 12 weeks for various psychiatric disorders were enrolled. Patients with severe medical illnesses, substance dependence, or pre-existing sexual dysfunction were excluded. Sexual dysfunction was assessed using the Arizona Sexual Experience Scale (ASEX). Data were analyzed using SPSS version 26. Chi-square test was applied, and p≤0.05 was considered statistically significant.

RESULTS
The mean age of the patients was 27.20±5.40 years. The mean duration of SSRI use was 2.61±1.12years. The p-value >.05 indicated that there is no statistically significant correlation between SSRI duration (1-3 years vs. >3 years) and sexual dysfunction. Among the participants who had sexual dysfunction, 56 (62.2%) were male, while 34 (37.8%) were female and aged 2-30 years, but the association was not statistically significant (χ² = 1.34, p = 0.246, φ = 0.07). The chi-square result shows no statistically significant difference between demographic and clinical variables and sexual dysfunction, and the effect size shows a very small association.

CONCLUSION

A substantial proportion of patients receiving SSRIs experienced sexual dysfunction, highlighting the need for routine screening and counseling in psychiatric practice.

Comparison of SNAPPS and Traditional Bedside Teaching in Enhancing Clinical Reasoning Skills Among 4th Year MBBS Students in Obstetrics and Gynecology

Ansa Islam — 2026-06-30

ABSTRACT

OBJECTIVES

To compare the effectiveness of the SNAPPS model versus traditional bedside teaching in enhancing clinical reasoning and learning experiences among 4th-year MBBS students during Obstetrics and Gynecology ward rotations.

METHODOLOGY

A crossover comparative (within-subjects) study was conducted over six months among 43 fourth-year MBBS students at Ayub Medical Teaching Institute, Abbottabad. Each student experienced both traditional and SNAPPS-based bedside teaching. Student perceptions were gathered using a structured questionnaire, and ward test scores (out of 10) were analyzed. Data were processed using SPSS, and paired t-tests were used; p < 0.05 was considered significant.

RESULTS
SNAPPS-based teaching produced significantly higher mean scores in case summarization (p = 0.001), differential diagnosis (p = 0.001), management planning (p = 0.001), and total scores (p = 0.001), though no difference was observed in history/examination (p = 0.937). Student feedback showed strong agreement that SNAPPS improved clinical reasoning, confidence, and active participation, with higher overall satisfaction (39.14 ± 3.97 vs. 25.86 ± 4.15; p = 0.001).

CONCLUSION

The SNAPPS model significantly outperformed traditional bedside teaching in promoting clinical reasoning, analytical thinking, and student engagement among Obstetrics and Gynecology undergraduates. Its integration into ward teaching is recommended to foster reflective, learner-centered clinical education.

Frequency, Pattern and Management of Dentoalveolar Trauma in Pediatric Patients

Fareeha Fatima — 2026-06-30

ABSTRACT

OBJECTIVES

This study aimed to determine the frequency, pattern, and management of dentoalveolar trauma in pediatric patients.

METHODOLOGY

This descriptive cross-sectional study was conducted at the Oral and Maxillofacial Surgery department of Saidu Dental Hospital, Swat. A total of 166 pediatric patients aged 2 to 12 years with maxillofacial trauma were included through non-probability consecutive sampling. Patients with jaw fractures, epilepsy, mental disabilities, or delayed presentation beyond 12 hours were excluded. Clinical and radiographic assessments confirmed dentoalveolar trauma. Data on trauma patterns and management strategies were collected and stratified by age and gender. Post-stratification chi-square tests were used to assess associations.

RESULTS
The mean age of participants was 7.47 years (SD ± 2.95), with 57 females (34.34%) and 109 males (65.66%). Dentoalveolar trauma was observed in 50% of cases. Luxation was the most common injury (25.9%), followed by crown infraction (10.2%) and avulsion (9.0%). The most frequent management approach was splinting (31.3%), followed by conservative management (9.6%). Closed and open reduction with fixation were less common. There was no significant difference in trauma type or treatment method between genders (p=0.66 and p=0.98, respectively) or age groups (p=0.81 and p=0.63, respectively).
CONCLUSION
Half of the pediatric patients with facial trauma presented with dentoalveolar injuries. Luxation was the most common injury pattern, and splinting was the most commonly used treatment. No significant gender- or age-based differences were found in trauma patterns or management approaches.

Bacteriological Pattern of Urinary Tract Infection in Children Presenting to Pediatric Department of Mardan Medical Complex

Pakiza Naeem — 2026-06-30

ABSTRACT

OBJECTIVES

This study aimed to determine the bacteriological profile and antibiotic susceptibility of culture-confirmed urinary tract infections among children presenting to the Pediatric Department of Mardan Medical Complex.

METHODOLOGY

This hospital-based cross-sectional study was conducted from April 2025 to October 2025. A total of 109 children aged 1 month to 12 years with clinically suspected urinary tract infection were enrolled through consecutive sampling. Urine microscopy, nitrite testing, culture, bacterial identification, and Kirby-Bauer disc diffusion susceptibility testing were performed. Data were analyzed using SPSS version 25. Frequencies, percentages, 95% confidence intervals, Chi-square/Fisher-Freeman-Halton exact test, Cramer's V, and binary logistic regression were applied.

RESULTS
The mean age was 6.72 ± 3.43 years, and 67 children (61.5%) were female. Urine culture was positive in 53 cases (48.6%; 95% CI: 39.4-57.9%). Among culture-positive isolates, Staphylococcus spp. was most frequent, 11 (20.8%; 95% CI: 12.0-33.5%), followed by Enterococcus spp., 10 (18.9%), Proteus spp., 9 (17.0%), Escherichia coli, 8 (15.1%), Klebsiella spp., 8 (15.1%), and Pseudomonas spp. 7 (13.2%). Cefixime showed the highest sensitivity (30; 56.6%). Amoxicillin and co-amoxiclav showed the highest resistance, 31 (58.5%) each. No independent predictor of culture positivity was identified on logistic regression.

CONCLUSION

Culture confirmation remains essential in suspected pediatric UTI. The predominance of Staphylococcus spp. should be interpreted cautiously due to possible contamination and lack of species-level confirmation. Organism-wise susceptibility surveillance is recommended.

Comparison of Efficacy Between Linear Versus Purse String Skin Closure at Loop Ileostomy Reversal

Naseeb Ali — 2026-06-30

ABSTRACT

OBJECTIVES

This study aimed to compare postoperative surgical site infection (SSI) rates and LOS between linear and purse-string skin closure during loop ileostomy reversal.

METHODOLOGY

This randomized controlled trial was conducted in the Department of General Surgery at MTI-HMC Peshawar from Jun 22 2020, to Jul 1 2025. patients fulfilling the inclusion criteria, undergoing stoma reversal, were enrolled to either linear (Group A) or PS (Group B) wound closure groups, while 63 patients with stoma site infection (TLC >11,000/L with fever) were excluded from the sample size (Figure 1: CONSORT Flow Diagram). Length of hospital stay was recorded, and patients were followed for 30 days to assess for SSI. This trial was registered in Clinical Trials with NCT # NCT07573423.

RESULTS
A total of 252 patients were randomized equally into two groups (126 per group). SSI occurred in 47 (37.3%) in Group A (Linear Skin Closure - LSC), compared with 9 (7.14%) in Group B (Purse String Closure - PS) (p<0.001). Mean hospital stay was significantly shorter in group B (4.1±1.1) compared to group A (4.5±1.6) (p<0.001)

CONCLUSION

Purse-string skin closure following loop ileostomy reversal was significantly associated with a lower rate of SSI compared with linear skin closure. In addition, the LOS was shorter with purse-string closure, suggesting that it is a safe and recommended technique for routine use to reduce post-operative wound complications.

Clinical Comparison between Ischemic and Hemorrhagic Stroke

Faisal Khan — 2026-06-30

Background:
Stroke is a significant cause of death and disability in the global population. It is categorized as ischemic and hemorrhagic, with clinical features, risk factors, and outcomes of each. Awareness of the difference between these two types of strokes is necessary in order to enhance the diagnosis, management and prevention interventions.

Objective:
To compare the demographic characteristics, risk factors, clinical presentation, radiological findings, and clinical outcomes of patients with ischemic and hemorrhagic stroke.

Methodology:
This is a cross-sectional analytical research carried out at the Department of Neurology and Emergency Medicine, Capital Hospital, Capital Development Authority (CDA), Islamabad in during six months. A non-probability consecutive sampling was used to enroll 106 patients who had known stroke. Diagnosis of stroke was done via clinical examination and brain neuroimaging (CT/MRI). A structured proforma was used to gather data on demographics, risk factors, clinical presentation, lesion location and outcome. The analysis was done statistically using SPSS 26.0. Continuous variables were included in the mean and standard deviation format and categorical variables were provided in the form of frequencies and percentages. Independent sample t-test and Chi-square test were used to establish relationships between variables and p 0.05 was taken as a statistically significant level.

Results:
Among the 106 patients, 68 (64.2%) had ischemic stroke and 38 (35.8%) had hemorrhagic stroke. The mean age was 53.99 ± 16.93 years in ischemic stroke patients and 57.71 ± 15.42 years in hemorrhagic stroke patients (p = 0.265). Common risk factors included hypertension, diabetes mellitus, smoking, hyperlipidemia, and previous stroke; however, none showed a statistically significant association with stroke type. Hemiparesis and speech difficulty were the most frequent clinical presentations. Radiological findings showed parietal lobe involvement as the most common lesion location in ischemic stroke. Clinical outcomes indicated that partial recovery was the most common outcome, followed by persistent disability and death. No statistically significant association was found between stroke type and patient outcomes (p = 0.560).

Conclusion:
Ischemic stroke was the most common subtype among patients in this study. Although several clinical patterns were observed between ischemic and hemorrhagic stroke, no statistically significant differences were identified. Early diagnosis and effective management of modifiable risk factors remain essential for reducing the burden of stroke.

Keywords:
Stroke, Ischemic Stroke, Hemorrhagic Stroke, Risk Factors, Clinical Presentation, Neuroimaging

Diagnostic Accuracy of Color Doppler Ultrasonography in Differentiating Benign and Malignant Cervical Lymph Nodes Keeping Histopathology as Gold Standard

Jawad Ali — 2026-06-30

ABSTRACT
OBJECTIVE

This study aimed to assess the diagnostic accuracy of Color Doppler Ultrasonography (CDUS) for differentiating benign from malignant cervical lymph nodes, with histopathological correlation.

METHODOLOGY

A prospective cross-sectional study was conducted at the Department of Radiology, MTI–Hayatabad Medical Complex, Peshawar. A total of 235 consecutive patients with clinically suspected cervical lymphadenopathy underwent Color Doppler ultrasonography followed by histopathological confirmation, where clinically indicated. Diagnostic performance measures, including sensitivity, specificity, PPV, NPV, and diagnostic accuracy, along with their 95% confidence intervals, were calculated.

RESULTS
CDUS classified 87 (37.0%) lymph nodes as malignant and 148 (63.0%) as benign. The histopathological results showed 94 (40.0%) malignant and 141 (60.0%) benign lymph nodes. The diagnostic performance of CDUS showed 87.2% sensitivity, 96.5% specificity, 94.3% PPV, 91.9% NPV, and 92.8% diagnostic accuracy. The participants' mean age was 44.40 ± 15.65 years, with a female predominance (54.0%). Exploratory stratified analysis demonstrated numerically comparable diagnostic performance across age and gender categories; these observations were descriptive and not formally compared statistically.

CONCLUSION

CDUS demonstrated high diagnostic performance and may serve as a useful first-line imaging modality for evaluation of cervical lymphadenopathy, particularly in resource-limited settings; however, histopathological confirmation remains necessary in equivocal cases.

Comparative Efficacy of Meropenem Versus Meropenem Combined with Azithromycin in Treating Extensively Drug-Resistant Uncomplicated Typhoid Fever

Fawad Ahmad — 2026-06-30

ABSTRACT

OBJECTIVES

To compare the effectiveness of treating children with meropenem monotherapy vs meropenem plus azithromycin for cases of unexplained typhoid fever that have developed resistance to other drugs.

METHODOLOGY

This study aimed to compare the clinical efficacy and safety of meropenem alone versus meropenem combined with azithromycin in treating pediatric patients with XDR uncomplicated typhoid fever in a randomised controlled trial (ClinicalTrials.gov Identifier: NCT07445282). Over 6 months, a randomised controlled trial was conducted at the Department of Pediatric Medicine at Sheikh Zayed Hospital in Rahim Yar Khan. Ninety children, aged six months to under five years, with blood-culture–confirmed XDR S. Typhi were included and randomly divided into two groups. Group A received meropenem IV (20–40 mg/kg every 8 hours), and Group B received meropenem and azithromycin by mouth (20 mg/kg/day). The main goal was the average time it took for the fever to go down. We used SPSS version 25.0 to analyse the data, setting the p-value to 0.05.

RESULTS
The mean time to defervescence was significantly shorter in the combination group (5.4 ± 2.1 days) than in the meropenem group (6.5 ± 2.8 days; p = 0.02). In the combination group, 93.3% of patients saw clinical improvement, while in the monotherapy group, only 82.2% did (p = 0.04). The dual regimen significantly reduced the mean time to ovulation and the frequency of clinical alterations, without a significant increase in adverse events, compared with the monotherapy or the combination therapy in young children with severe drug-resistant (XDR) straightforward fever.

CONCLUSION

This study provides substantial evidence for optimising antibiotic therapy in pediatric XDR tachycardia by systematically assessing the clinical outcomes of two therapeutic regimens. The results are anticipated to enhance clinical practice, inform antibiotic stewardship initiatives, and support the global effort to mitigate antimicrobial resistance.

Factors Affecting Adherence to Iron Chelation Therapy in Thalassemia Major Patients

Ghazala — 2026-06-30

ABSTRACT

OBJECTIVES

This study aimed to determine the factors affecting adherence to iron chelation therapy among patients with thalassemia major.

METHODOLOGY

This is a cross-sectional analytical study conducted at a tertiary care hospital. 97 patients with 97 cases of 2 thalassemia major were recruited using a non-probability, consecutive sampling method. The structured questionnaire and medical record review were used to collect data. Compliance was classified as good, moderate, and poor. SPSS version 25 was used to analyze the data. Associations were tested using the chi-square test, and p-values of 0.05 or less were considered statistically significant..

RESULTS
The mean age of participants was 15.6 ± 7.0 years. Good adherence was observed in 46.4% of patients, while 53.6% showed suboptimal adherence. No statistically significant association was found between adherence and demographic or clinical variables (p > 0.05). The most common reasons for non-adherence were forgetfulness (28.8%) and painful injections (25.0%), followed by high cost of therapy (19.2%) and side effects (17.3%).

CONCLUSION

Adherence to iron chelation therapy is suboptimal among thalassemia patients and is mainly influenced by behavioral and treatment-related factors. Strategies focusing on patient education, adherence support, and simplified treatment regimens are essential to improve compliance and clinical outcomes.

Coincidence of Maxillary Dental Midline with the Ala-Canthus Intersection Point Among Dental Students

Sara Farid — 2026-06-30

ABSTRACT

OBJECTIVES

This study aimed to determine the frequency of dental midline coincidence with the ala–canthus intersection point.

METHODOLOGY

A cross-sectional study was conducted at the department of Prosthodontics, Khyber College of Dentistry, Peshawar, from January to June 2025. A total of 86 dental students, both male and female, were included in the study. Facial portrait photographs were taken with a DSLR camera while smiling. Photoshop software CC 2019 version 20.0 was used to analyze the coincidence of the dental midline with the intersection point of ala-canthus lines. Data were analyzed using SPSS version 22.0. Associations between categorical variables were assessed using the Chi-square test or Fisher’s exact test, where appropriate. A p-value < 0.05 was considered statistically significant.

RESULTS
The coincidence of the maxillary dental midline with the ala–canthus intersection point was observed in 33.72% (29/86) of participants.

CONCLUSION

Maxillary dental midline coincidence was observed in only one-third of participants. The dental midlines were coincident with the intersection point of ala-canthus lines in less than half of the sample.

Comparative Evaluation of Analgesic Outcomes of Intraperitoneal Versus Subcutaneous Administration of Bupivacaine for Laparoscopic Cholecystectomy Patients

Nimrah Iqbal — 2026-06-30

ABSTRACT

OBJECTIVES

This study aimed to compare the analgesic efficacy and recovery outcomes of intraperitoneal versus subcutaneous administration of bupivacaine in patients undergoing laparoscopic cholecystectomy.

METHODOLOGY

This was a comparative clinical study conducted at the Department of Anesthesiology, Rawalpindi Medical University, and at Allied Hospitals. A total of 86 ASA class I patients undergoing elective laparoscopic cholecystectomy were divided into two groups: intraperitoneal bupivacaine (n=43) and subcutaneous port-site infiltration (n=43). Post-operative pain was assessed using the Visual Analog Scale (VAS) at 1, 2, 4, 6, 12, and 24 hours. Time to first rescue analgesia, total analgesic consumption, number of rescue doses, recovery parameters, and complications were recorded. Repeated measures ANOVA, independent sample t-test, and chi-square test were applied, with p ≤ 0.05 considered statistically significant.

RESULTS
Intraperitoneal bupivacaine significantly reduced post-operative VAS scores at all time intervals (p < 0.001). Repeated-measures ANOVA demonstrated significant effects of time (p < 0.001) and group (p < 0.001), indicating consistently lower pain scores in the intraperitoneal group. Time to first rescue analgesia was longer (211.1±44.1 vs 120.0±44.9 min), and total analgesic consumption was lower (82.7±24.4 vs 125.4±21.1 mg) compared with subcutaneous infiltration (p < 0.001). Patients demonstrated earlier ambulation, earlier oral intake, shorter hospital stay, and higher satisfaction (p < 0.001). Shoulder tip pain was significantly reduced (11.6% vs 46.5%), while other complications were comparable between groups.

CONCLUSION

Intraperitoneal bupivacaine was associated with improved post-operative analgesia, an enhanced recovery profile, and reduced shoulder tip pain, without increasing complications, compared with subcutaneous infiltration; however, these findings should be interpreted cautiously due to the non-randomized study design.

Transvaginal Ultrasonography in Detecting Endometrial Hyperplasia in Post-Menopausal Women

Tabassum Begum — 2026-06-30

ABSTRACT

OBJECTIVES

This study aimed to determine the diagnostic accuracy of transvaginal ultrasonography in detecting histopathologically confirmed endometrial pathology in post-menopausal women, using histopathological examination as the reference standard.

METHODOLOGY

This descriptive cross-sectional diagnostic accuracy study was conducted at MTI Bacha Khan Medical College and Mardan Medical Complex, Mardan. A total of 93 post-menopausal women were enrolled through consecutive sampling. TVS assessed endometrial thickness and associated ultrasound findings. Histopathological examination of the endometrial sample was used as the reference standard. Data were analyzed using SPSS version 25. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and 95% confidence intervals were calculated. Receiver operating characteristic curve analysis was performed, and the optimal cutoff was determined using the Youden index.

RESULTS
The mean age of participants was 58.8 ± 8.8 years, and the mean endometrial thickness was 8.45 ± 3.67 mm. Histopathology showed normal endometrium in 31 (33.3%) cases, endometrial hyperplasia in 52 (55.9%), and endometrial carcinoma in 10 (10.8%). Using a predefined cutoff of >10 mm, TVS showed sensitivity of 58.1% (95% CI: 45.7-69.5), specificity of 100.0% (95% CI: 89.0–100.0), positive predictive value of 100.0% (95% CI: 90.4–100.0), negative predictive value of 54.4% (95% CI: 41.6–66.6), and diagnostic accuracy of 72.0% (95% CI: 62.2–80.1). ROC analysis showed an area under the curve of 0.935 (95% CI: 0.887–0.984; p < 0.001). The optimal cutoff by the Youden index was ≥5.65 mm, with a sensitivity of 93.5% and a specificity of 77.4%.

CONCLUSION

Transvaginal ultrasonography is a useful initial, non-invasive tool for evaluating endometrial pathology in post-menopausal women. The >10 mm cutoff showed excellent specificity but moderate sensitivity, indicating that it is more useful for ruling in disease than for ruling it out. A lower ROC-derived cutoff may improve screening sensitivity, but histopathological confirmation remains essential for definitive diagnosis.

Sensitivity Pattern of Cefixime against Uropathogens Causing Urinary Tract Infection in Pregnant Women

Syeda Maria Shah — 2026-06-30

ABSTRACT

OBJECTIVES

This study aimed to determine the susceptibility pattern of cefixime against uropathogens causing urinary tract infections among pregnant women attending a tertiary care hospital in Peshawar, Pakistan.

METHODOLOGY

A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Khyber Teaching Hospital, Peshawar, with approval from the Institutional Ethical Review Committee. The study was carried out over six months (June 30 2024, to December 31 2024). A total of 197 pregnant women with culture-confirmed UTI were enrolled through consecutive non-probability sampling. Midstream urine specimens were collected aseptically and processed for routine examination, culture, and antibiotic susceptibility testing. Culture and sensitivity testing were performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines (the latest available hospital-level laboratory protocol). Cefixime susceptibility was reported as sensitive or resistant according to the standard zone interpretation used in the institutional microbiology laboratory. Data were analysed using SPSS version 20. Quantitative variables were summarised as means ± standard deviations. The chi-square test was used for subgroup analysis, and binary logistic regression was used to identify predictors of cefixime sensitivity. A p-value ≤ 0.05 was considered statistically significant. Odds ratios (OR) with 95% confidence intervals (CI) were reported.

RESULTS
Among 197 pregnant women with culture-confirmed UTIs, Escherichia coli was the most common uropathogen (83.8%). Overall, 36.5% of isolates were sensitive to cefixime, while 63.5% were resistant. Chi-square analysis demonstrated no significant association between cefixime sensitivity and age, BMI, education, residence, or uropathogen type. Binary logistic regression identified education as the only significant predictor of cefixime sensitivity (OR = 1.89, 95% CI: 1.16-3.08, p = 0.010).

CONCLUSION

A high level of cefixime resistance was observed among uropathogens, particularly E. coli. These findings highlight the importance of urine culture and susceptibility testing before antibiotic selection. However, broader multicenter studies with multiple antibiotics and additional clinical variables are needed before changing empirical treatment policies.

Quantification of Liver Fat and Fibrosis with Ultrasound: The Expanding Role of Elastography

Zubair Janan Orakzai — 2026-06-30

ABSTRACT

OBJECTIVES

To assess ultrasound-detected fatty liver grade and elastography-based fibrosis stage among adults undergoing liver ultrasound evaluation and to determine their association with selected clinical and metabolic risk factors.

METHODOLOGY

This descriptive cross-sectional observational study was conducted at the Department of Radiology, MTI Bacha Khan Medical College and Mardan Medical Complex, Mardan, from February 2026 to April 2026. A total of 83 adults undergoing liver ultrasound evaluation were recruited through non-probability consecutive sampling. Demographic, clinical, laboratory, ultrasound, and elastography findings were recorded. Significant fibrosis was defined as fibrosis stage ≥F2. Data were analyzed using SPSS version 25. The chi-square test and Cramér’s V were used to assess unadjusted associations, while binary logistic regression was used to identify independent factors associated with significant fibrosis.

RESULTS
The mean age of participants was 42.1 ± 13.8 years, and 45 (54.2%) were male. Overweight and obesity were observed in 38 (45.8%) and 22 (26.5%) participants, respectively. Grade II fatty liver was the most common ultrasound finding, observed in 39 (47.0%) participants. Significant fibrosis ≥F2 was present in 51 (61.4%) participants. On unadjusted analysis, BMI category, ALT category, and fatty liver grade were significantly associated with significant fibrosis. On multivariate logistic regression, elevated ALT was associated with higher odds of significant fibrosis (AOR = 5.85, 95% CI: 1.12-30.30, p = 0.036). Fatty liver grade was also independently associated with significant fibrosis (AOR = 15.87, 95% CI: 3.47-72.64, p < 0.001). BMI, diabetes mellitus, age group, and gender were not significant after adjustment.

CONCLUSION

Significant fibrosis was common in this hospital-based sample. Elevated ALT and higher fatty liver grade were independently associated with significant fibrosis ≥F2. Ultrasound-detected fatty liver grade and elastography-based fibrosis staging may support non-invasive risk stratification in patients undergoing liver evaluation.

Comparative Efficacy of Topical Oxiconazole Cream (1%) Versus Topical Clotrimazole Cream (1%) in the Treatment of Tinea Cruris

Fahad Khan — 2026-06-30

ABSTRACT

OBJECTIVES

To compare the clinical efficacy of topical Oxiconazole 1% cream with topical clotrimazole 1% cream in patients with KOH-confirmed tinea cruris.

METHODOLOGY

The study was conducted in the Department of Dermatology, MTI-Hayatabad Medical Complex, Peshawar, from 12 May, 2025 to 12 Nov, 2025. A total of 386 patients aged 18–60 years with clinically diagnosed tinea cruris confirmed by potassium hydroxide mount were consecutively recruited and randomly allocated into two equal treatment groups. Group A received topical Clotrimazole 1% cream, while Group B received topical Oxiconazole 1% cream, applied twice daily for four weeks. Clinical severity was assessed at baseline and at Week 4 using a composite symptom score comprising pruritus, erythema, vesicles, and desquamation, each graded from 0 to 3. Clinical response was defined as ≥50% reduction in total symptom score at Week 4. The primary analysis was performed according to the randomized groups. Mean differences with 95% confidence intervals were calculated for symptom scores, and the risk difference with 95% confidence interval was calculated for clinical response. Data were analyzed using IBM SPSS version 25, with p≤0.05 considered statistically significant.

RESULTS
All 386 randomized patients were included in the Week-4 analysis, with 193 patients in each group. Baseline symptom scores were comparable between the groups. At Week 4, pruritus score was significantly lower in the oxiconazole group than in the clotrimazole group (0.74±0.63 vs. 0.93±0.58; mean difference -0.19, 95% CI -0.31 to -0.07; p=0.003). Week-4 erythema, vesicles, and desquamation scores did not differ significantly between the groups. Overall clinical response was achieved in 165/193 patients (85.5%) in the oxiconazole group and 157/193 patients (81.3%) in the clotrimazole group, with a risk difference of 4.1% (95% CI -3.3% to 11.6%; p=0.274). Clinical response remained comparable across gender strata.

CONCLUSION

Topical Oxiconazole 1% and Clotrimazole 1% creams showed comparable overall clinical response in KOH-confirmed tinea cruris after four weeks of treatment. Oxiconazole produced a statistically greater reduction in pruritus; however, the magnitude of difference was small. As Week-4 mycological cure, antifungal susceptibility, quality-of-life assessment, adverse-event profile, and recurrence after treatment were not assessed in the available dataset, the findings should be interpreted as short-term clinical response rather than confirmed microbiological eradication.

Compliance with Medical Advice and Safety in High-Risk Diabetis Patients During Ramadan

Javeria Javed — 2026-06-30

ABSTRACT

OBJECTIVES

This study was designed to evaluate compliance with medical recommendations and safety outcomes among high-risk diabetic patients during Ramadan in Peshawar, Pakistan.

METHODOLOGY

This descriptive study encompassed 246 high-risk diabetic patients (type 2 DM, risk score >6, aged 40-75 years) at Khyber Teaching Hospital, observed over six months, including Ramadan. Data were gathered via structured questionnaires, baseline and follow-up evaluations, and telephone interviews conducted after Ramadan. Compliance was assessed based on adherence to medical recommendations. The complications were compared between groups that followed the rules and those that did not. SPSS version 27 was used for statistical analysis.

RESULTS

A total of 246 individuals participated in the study, with a mean age, HbA1c, and average weight of 56.17 years, 9.4%, and 63 kg. 44.7% of the individuals who took part attempted to fast during Ramadan. Only 16.2% of individuals fasted for all 30 days, and 55.3% of individuals did not fast at all. Overall, 35.4% of individuals reported having hypoglycemia, with 68.1% of fasting individuals having at least one episode compared to 8.8% of the non-fasting group (p < 0.001). Patients who were fasting experienced more hyperglycemia and dehydration (p < 0.001). Regular self-monitoring of blood glucose was not very satisfactory, with only 31.7% of people following the recommended steps. Of 221 high-risk diabetic patients, the majority had type 2 diabetes and were on insulin therapy; however, only one-third frequently monitored their blood glucose levels.

CONCLUSION

Despite medical advice, many high-risk individuals with diabetes continue to observe fasting during Ramadan. This renders them more likely to develop hypoglycemia, hyperglycemia, and dehydration. For this highly susceptible population to be safer, it is important to improve patient education, offer tailored counseling, and follow risk-based guidelines.

Optical Coherence Tomography Biomarkers in Acute Central Serous Chorioretinopathy: Relationship Between Subretinal Fluid Height and Logmar Visual Acuity

Sadiqullah Khan — 2026-06-30

ABSTRACT

OBJECTIVES

To evaluate the clinical significance of specific spectral-domain optical coherence tomography (SD-OCT) features, specifically subretinal fluid (SRF) height and retinal pigment epithelial (RPE) alterations, in predicting visual acuity (VA) outcomes in patients presenting with acute central serous chorioretinopathy (CSCR).

METHODOLOGY

This cross-sectional study, conducted at the Department of Ophthalmology, Hayatabad Medical Complex, Peshawar, evaluated 50 consecutive patients with acute CSCR. The sample size was statistically powered to detect a moderate-to-strong correlation (r ≥ 0.39). Maximum subretinal fluid (SRF) height was measured quantitatively. Qualitative parameters included the frequency and location of pigment epithelial detachments (PEDs) and retinal pigment epithelium (RPE) bumps. Snellen VA was converted to continuous LogMAR units for parametric analysis. Relationships were evaluated using Pearson correlation coefficients (r).

RESULTS
The study population comprised 50 male patients with a mean age of 36.50 ± 7.42 years (SD) (range: 25-50 years). A strong, statistically significant positive correlation was observed between maximum SRF height and degraded visual acuity (r = 0.907, P < 0.001). Patients with minimal SRF height (0–200 µ, n=29, 58%) maintained baseline LogMAR vision between 0.00 and 0.30, whereas the maximum recorded SRF height (933 µ) corresponded to a severe visual reduction (LogMAR > 1.30). Concurrently, PEDs were identified in 40% (n=20) of the cohort (28% single, 12% multiple; 14% subfoveal, 26% extrafoveal), and RPE bumps were noted in 64% (n=32). No statistically significant correlation was identified between visual impairment and the presence (r = 0.063, P = 0.666), frequency (r = 0.074, P = 0.608), anatomical site (r = 0.074, P = 0.607) of PEDs, or the presence of RPE bumps (r = 0.024, P = 0.807).

CONCLUSION

In acute CSCR, visual acuity degradation is primarily driven by the physical height of subretinal fluid accumulation beneath the fovea. Secondary microstructural modifications of the RPE such as isolated pigment epithelial detachments or fine RPE contour irregularities show no immediate statistical correlation with baseline visual acuity within this cohort size.

Theoretical Frameworks in Medical Education: A Comparative Review of Behaviourism and Cognitive Load Theory

Saman Baseer — 2026-06-30

ABSTRACT

OBJECTIVES

This narrative review analyses the conceptual underpinnings of Behaviourism and Cognitive Load Theory (CLT) to appraise their distinct roles in instructional design and to synthesise a unified pedagogical paradigm that addresses both external behavioural management and internal memory architecture in healthcare training..

METHODOLOGY

A comprehensive narrative literature synthesis was executed across the PubMed, Google Scholar, and Cochrane Library databases utilising Medical Subject Headings (MeSH) terms including "Behaviourism", "Models, Educational", and "Memory, Short-Term". A total of 32 peer-reviewed articles matching the inclusion criteria (English language, focus on undergraduate/postgraduate medical education, publication years 1988–2026) were extracted, critically appraised for methodological relevance, and qualitatively synthesised.

RESULTS
Behaviourism relies heavily on observable operant mechanisms and positive reinforcement to guide classroom dynamics, establish procedural obedience, and motivate learners through direct external stimuli. Conversely, CLT isolates human cognitive boundaries, focusing on the processing constraints of working memory (7±2 informational elements). CLT advocates instructional designs (such as worked examples and task sequencing) that minimise non-essential extraneous load while maximising productive germane load.

CONCLUSION

While Behaviorism remains an essential mechanism for basic behavioral modification and repetitive clinical skill habituation, CLT provides a superior, non-reductive framework for mastering advanced clinical reasoning and diagnostic problem-solving. Medical educators should adopt an integrated, dual-framework model to structure highly structured, cognitively optimised, and behaviorally disciplined learning environments.