Journal of Gandhara Medical and Dental Science

Facial Chromoblastomycosis with Visceral Involvement in Form of Extensive Abdominal Lymphadenopathy – A Case Report and Literature review.

Aliena Badshah — 2026-10-01

OBJECTIVES

Chromoblastomycosis is a chronic granulomatous infection caused by a group of dematiaceous fungi and most commonly affects the lower extremities of individuals exposed to colonised mud or wood, such as agriculturists and ecotourists. It is most commonly limited to the skin and subcutaneous tissue but can be locally aggressive, leading to local lymphadenopathy, osteomyelitis and lytic bony lesions. Treatment modalities include surgical excision of the chromoblastomycosis lesion, oral antifungal agents or physical therapy, with the decision depending upon the size and severity of the lesion.

CASE

A 19-year-old male farmer presented to us with an erythematous plaque on his right cheek along with generalised jaundice and pruritus. The skin lesion was diagnosed as a chromoblastomycosis lesion on histopathological evaluation. Workup of his jaundice revealed extensive abdominal lymphadenopathy causing a compressive effect on the common hepatic duct. Histopathology of the lymph node taken from the porta hepatis confirmed systemic extension of fungal infection. He was treated with oral antifungals in combination with debulking abdominal surgery for his extensive abdominal lymphadenopathy causing obstructive jaundice. The patient responded well, with his liver function tests improving, and abdominal lymphadenopathy and facial lesion decreasing in size on follow-up.

CONCLUSION

The key learning points of this case report are that chromoblastomycosis, in addition to local invasion and lymphadenopathy, can cause visceral involvement as well, even though it is rare. In these cases, spread can be via lymphatic or hematogenous routes. In cases like ours, where visceral involvement was evident in the form of extensive abdominal lymphadenopathy, debulking surgery for symptomatic relief can be considered as part of the treatment regimen. Even in cases of chromoblastomycosis with visceral involvement, the role of oral antifungals remains justified, as both the chromoblastomycosis lesion and visceral features responded to antifungal therapy in our case.

Patterns of Diabetes-Related Complications and Clinical Outcomes in General Medicine Settings: A Systematic Review Withour Meta Analysis

Shumaila Ali Nasir — 2026-10-01

OBJECTIVES

To systematically synthesise recent observational evidence on patterns of diabetes-related complications, clinical outcomes, glycemic-control findings, and factors associated with adverse outcomes in general medicine and related routine-care settings.

METHODOLOGY

PubMed, Web of Science, and Scopus were searched for original studies published from 2020 through 2025. Eligible studies included observational cross-sectional, cohort, retrospective, prospective, multicenter, hospital-based, and community-based studies reporting microvascular or macrovascular complications, glycemic control, multimorbidity, or related clinical outcomes among people with diabetes. Review articles, case reports/series, pilot studies, editorials, opinion articles, and reports with insufficient outcome data were excluded. Owing to substantial heterogeneity in populations, designs, definitions, and outcome reporting, findings were synthesised narratively without statistical pooling. Methodological limitations were appraised across selection, exposure/risk-factor measurement, outcome assessment, confounding, and data-completeness domains.

RESULTS
Twenty studies were included after screening 613 records. The evidence base was predominantly cross-sectional, although large retrospective and prospective cohorts were also represented. Microvascular complications, particularly nephropathy/chronic kidney disease, neuropathy, and retinopathy, were reported more consistently than macrovascular outcomes. Studies that directly assessed both complication categories generally documented an appreciable burden of both small- and large-vessel disease. Across studies, poor glycemic control, longer diabetes duration, hypertension, obesity, dyslipidemia, older age, suboptimal adherence, and irregular follow-up were repeatedly associated with greater complication burden. Most studies were judged to have low-to-moderate methodological concerns, driven mainly by cross-sectional designs, restricted recruitment settings, and incomplete control of confounding.

CONCLUSION

Recent observational evidence indicates a substantial and heterogeneous burden of diabetes-related complications in routine clinical settings. The findings support integrated surveillance of renal, retinal, neurologic, cardiovascular, peripheral vascular, and foot complications alongside sustained glycemic and cardiovascular risk-factor management. Because the included studies were methodologically heterogeneous, the review supports clinical pattern recognition rather than a single pooled prevalence estimate.

Physiological and Biochemical Effects of Intermittent Fasting on Insulin Sensitivity and Glucose Metabolism: A Systematic Review

Hina Hakim — 2026-10-01

OBJECTIVES

This study aimed to review the physiological and biochemical effects of intermittent fasting on insulin sensitivity and glucose metabolism in human studies published between 2019 and 2025.

METHODOLOGY

A literature search was conducted in electronic databases, such as PubMed, Google Scholar, ScienceDirect, SpringerLink, Wiley Online Library and Cochrane Library, for original human studies from January 2019 to December 2025. The studies included in the analysis were randomised controlled trials, randomised clinical trials, open-label randomised trials, randomised crossover trials and prospective interventional trials of intermittent fasting or time-restricted eating. There were no reviews, meta-analyses, narrative articles, case reports, animal or in vitro studies, nor pilot studies. The following data were collected for study characteristics, insulin sensitivity, glucose metabolism, physiological outcomes, biochemical markers, and risk of bias.

RESULTS
Twenty-one original studies were included. Most studies reported favourable effects of intermittent fasting on glucose regulation, fasting insulin, HOMA-IR, HbA1c, continuous glucose monitoring outcomes, body weight, waist circumference, lipid profile, and cardiometabolic markers. Benefits were more consistent among adults with obesity, metabolic syndrome, type 2 diabetes, polycystic ovary syndrome, and increased diabetes risk. Early time-restricted eating and 8–10-hour eating windows showed more promising metabolic effects than less structured fasting patterns. However, the magnitude of benefit varied across studies.

CONCLUSION

Intermittent fasting may improve insulin sensitivity, glucose metabolism, and related physiological and biochemical outcomes, especially in metabolically high-risk adults. However, heterogeneity in fasting schedules, intervention duration, population characteristics, and outcome measures limits direct comparison. Larger long-term randomised trials are needed to identify the safest and most effective fasting protocols.

From Adoption to Account Ability: Governing Artificial Intelligence (AI) and its Subsets in Medical and Dental Education

Shehzad Akbar Khan — 2026-10-01

The rapid integration of artificial intelligence (AI) into medical and dental education marks a transformative shift in how knowledge is produced, delivered, and assessed. From adaptive learning systems to generative tools, AI is reshaping medical and dental learning environments globally. This adoption is accelerating, affecting governance frameworks.¹ This growing imbalance raises a fundamental question for medical and dental governance. How can medical and dental institutions ensure the responsible and ethical use of AI while maintaining professional standards?

Current evidence indicates that AI is a core component of medical and dental education, moving beyond its earlier role as a supporting tool.^2,3 It is increasingly used for simulation-based training, clinical decision support, and automated assessment. A recent analysis underlines that generative AI, a subset of AI, has significant potential to enhance personalized learning and clinical training, but it also raises critical concerns about accuracy, ethical use, and reliability.^4,5 These concerns are relevant to medical and dental education and health professions education, where compromised learning or inconsistent assessment may eventually affect patient safety. In Pakistan, the regulatory landscape is changing to address these challenges, with regulatory bodies recently strengthening their educational and ethical frameworks, including updated accreditation standards, competencies, and codes of conduct for medical and dental institutions.⁶ The updated ethics code emphasizes accountability, integrity, and patient safety, requiring institutions to provide high standards in teaching and professional conduct. These structures do not clearly address AI, but they can provide a strong regulatory foundation for AI governance. Pakistan’s National Artificial Intelligence Policy 2025 signals a strategic national commitment to AI integration.⁷ The policy emphasizes ethical AI distribution, data protection, and the development of a secure and inclusive AI network, along with inspiring objectives for capacity building and workforce development.^8,9

These initiatives are accompanied by growing recognition within medical and dental institutes that AI literacy and governance must become integral to medical and dental training and continuing professional development.^10,11 Despite these advances, a critical implementation gap remains. Policies and frameworks provide direction, but institutions often lack operational clarity on how to govern AI in routine academic practice. Uncertainty remains around the appropriate use of AI in assessments, writing, and research, and many faculty members lack adequate training to use these tools effectively. Evidence suggests that although healthcare professionals have positive attitudes toward AI, effective implementation requires structured training and institutional support.¹² Moreover, administrative policies should focus on specific steps, such as establishing a clear policy for AI use, ensuring fair assessments, and incorporating AI literacy into the curriculum, so that governance is context-sensitive. In Pakistan, where access to technology and digital resources is uneven, AI may benefit some learners more than others if not carefully managed. Building trust is essential in this transition. AI integration in medical and dental education requires transparency, accountability, and ongoing evaluation. Medical and dental professionals should initiate the development of inclusive, adaptable frameworks aligned with national and global priorities. AI policies in Pakistan mark important progress, where the focus must now shift to sensible implementation. Moving from adoption to accountability is essential to ensure that AI strengthens learning, preserves professional integrity, and improves healthcare outcomes.

Outcome of Open Reduction and Internal Fixation of Isolated Talus Neck Fractures Versus Fixation of Talus Neck Fractures with Concomitant Ipsilateral Foot and Ankle Fractures

Faaiz Ali Shah — 2026-10-01

ABSTRACT

OBJECTIVES

This study aimed to compare the radiological and functional outcomes of open reduction and internal fixation of isolated Talus neck fractures with Talus neck ipsilateral foot and ankle fractures.

METHODOLOGY

This retrospective study was conducted in the Orthopaedics Division, Lady Reading Hospital, Peshawar. The medical records of Talus neck fractures fulfilling the inclusion criteria and operated on in the last five years were reviewed. Patients were divided into group A (isolated Talus neck fractures) and group B (Talus neck fracture with concomitant ipsilateral foot and ankle fractures). Postoperative radiological fracture union, osteoarthritis, avascular necrosis (AVN) and functional outcome using the American Orthopaedic Foot and Ankle Society (AOFAS) were assessed and compared in both groups.

RESULTS
34 patients, with 18 (52.94%) patients in group A and 16 (47.05%) in group B. The mean AOFAS score at one year was 95.34±3.3 in group A and 74.11±2.2 in group B (P=0.001). Non-union was noted in 1(6.25%) patient in group B and none in group A. AVN Talus was documented in 02(11.11%) patients in group A and 07(43.75%) in group B(P=0.02). Postoperative osteoarthritis was noted in 3(16.66%) patients in group A and 5(31.25%) in group B. Multivariate regression analysis revealed that smoking, concomitant ipsilateral foot and ankle fractures, fracture classification and quality of postoperative fracture reduction were significant predictors of increased postoperative AVN of the Talus.

CONCLUSION

Open reduction and internal fixation of isolated Talus neck fractures have significantly better radiological and functional outcomes than fixation of Talus fractures with concomitant ipsilateral foot and ankle fractures.

Comparison of Tooth Length Measured with Conventional Periapical Versus Cone-Beam Computed Tomography

Ijaz Ul Haq — 2026-10-01

ABSTRACT

OBJECTIVES

To compare tooth length measurements obtained using intraoral periapical radiographs (IOPA) and CBCT in extracted single-rooted premolars.

METHODOLOGY

This cross-sectional comparative study was conducted at the Operative Dentistry Department, Riphah International Dental Hospital, Islamabad. Forty extracted single-rooted premolars from Pakistani patients aged 12-50 years were included. Teeth with incomplete root development, structural defects, metallic restorations, or severe attrition were excluded. After extraction, teeth were cleaned, disinfected, and mounted in a dry human mandible with modelling wax to simulate soft tissue. Tooth lengths were measured using IOPA with the paralleling technique and CBCT in the sagittal plane. Measurements were compared using paired t-tests, with stratification by age and gender.

RESULTS
The mean tooth length measured on IOPA was 19.78 mm (SD 1.44), while CBCT measurements were shorter at 18.18 mm (SD 1.37) (p < 0.001). This difference was consistent across all age and gender groups. Females had CBCT lengths of 17.98 mm versus 19.64 mm on IOPA, and males had 18.44 mm versus 19.96 mm. Participants aged 13–30 years had CBCT lengths of 17.91 mm versus 19.94 mm on IOPA, and those aged 31–50 years had 18.37 mm versus 19.66 mm.

CONCLUSION

CBCT consistently produced shorter tooth length measurements than IOPA, suggesting that periapical radiographs may overestimate tooth length. Its three-dimensional imaging allows precise localisation of the root apex, making it a reliable modality for endodontic measurement and treatment planning.

Diagnostic Accuracy of Barium Swallow Study for Differentiating Benign and Malignant Esophageal Strictures Using Endoscopy with Biopsy as Gold Standard

Hira Syed — 2026-10-01

ABSTRACT

OBJECTIVES

This study aimed to determine the diagnostic accuracy of barium swallow for differentiating malignant from benign oesophageal strictures using endoscopy with biopsy as the reference standard.

METHODOLOGY

This cross-sectional validation study included 88 consecutively selected adults with dysphagia at Rehman Medical Institute from 1 March 2023 to 1 August 2025. Barium swallow and endoscopic biopsy were performed within two weeks. Malignancy was the positive condition. Diagnostic indices, likelihood ratios, Cohen’s kappa and the area under the receiver operating characteristic curve (AUC) were calculated with 95% confidence intervals (CIs).

RESULTS
Biopsy identified 26 malignant and 62 benign strictures. There were eight true positives, 20 false positives, 18 false negatives and 42 true negatives. Sensitivity was 30.8% (95% CI 14.3–51.8), specificity 67.7% (54.7–79.1), positive predictive value 28.6% (13.2–48.7), negative predictive value 70.0% (56.8–81.2) and accuracy 56.8% (45.8–67.3). Positive and negative likelihood ratios were 0.95 (0.48–1.88) and 1.02 (0.75–1.39), respectively. Kappa was −0.015 (−0.222 to 0.193), and binary-score AUC was 0.493 (0.385–0.600). Malignancy remained present in 18/60 benign-appearing examinations (30.0%; 18.8–43.2).

CONCLUSION

Barium classification provided little discrimination and missed most biopsy-confirmed malignancies. A benign-appearing examination should not be used to exclude malignancy or defer indicated endoscopy with biopsy: the small cohort and incomplete masking documentation limit generalisability.

Occlusal Assessment of Porcelain-Fused-To-Metal (PFM) Crowns during try-in Appointment in the Prosthodontics Department, Saidu College Of Dentistry

Sadiq Ullah — 2026-10-01

ABSTRACT

OBJECTIVES

To assess the quality of occlusal contacts in PFM crowns during try-in appointments using modified FDI criteria at the Prosthodontics Department, Saidu College of Dentistry.

METHODOLOGY

This cross-sectional observational study involved 193 patients receiving PFM crowns. Occlusal contacts were assessed using 12-µm and 100-µm articulating papers. Contacts were categorised as excellent, good, satisfactory, or unsatisfactory. Demographic and clinical data were analysed using SPSS v25, and associations were evaluated via chi-square tests (p ≤ 0.05).

RESULTS
Among 193 patients (54.9% female, mean age: 41.2 years), 35.2% had excellent, 29.0% good, 22.3% satisfactory, and 13.5% unsatisfactory occlusal contacts. Age was significantly associated with occlusal outcomes (p = 0.038), with older patients more likely to exhibit unsatisfactory contacts. No significant differences were observed by gender or tooth location.

CONCLUSION

Most PFM crowns exhibited acceptable occlusal contacts during try-in. Age influenced occlusal quality, emphasising the need for heightened clinical scrutiny in older patients. Articulating papers of varying thickness effectively detected contact discrepancies, reinforcing their role in ensuring optimal prosthetic fit and function prior to cementation.

Diagnostic Accuracy of Dynamic Contrast-Enhanced MRI for Breast Lesions Using Histopathology as the Gold Standard

Mian Waheed Ahmad — 2026-10-01

OBJECTIVES

This study aimed to determine the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for differentiating benign and malignant breast lesions, using histopathology as the reference standard.

METHODOLOGY

This cross-sectional diagnostic-accuracy study was conducted at DHQ Hospital, Gujranwala, Pakistan, from November 2023 to April 2024. Ninety-six patients with clinically suspected breast lesions were enrolled by non-probability consecutive sampling. DCE-MRI was performed before histopathological examination by biopsy or surgical excision. Sensitivity, specificity, predictive values, overall accuracy, and the association between MRI and histopathological diagnosis were analyzed using SPSS version 26.

RESULTS
The mean age of participants was 45.52 ± 12.73 years, and histopathology confirmed malignancy in 54/96 (56.3%) lesions. DCE-MRI showed a sensitivity of 90.7%, specificity of 83.3%, positive predictive value of 87.5%, negative predictive value of 87.5%, and overall accuracy of 87.5%. MRI diagnosis was strongly associated with histopathology (χ² = 53.33, p < 0.001; Cramer's V = 0.745).

CONCLUSION

DCE-MRI demonstrated high diagnostic accuracy for differentiating benign and malignant breast lesions and may serve as a valuable adjunct in the evaluation of suspicious lesions.

Frequency of Positive Blood Cultures and Pathogen Distribution among Febrile Patients Admitted to Northwest General Hospital, Peshawar

Gul Rukhsar — 2026-10-01

OBJECTIVES

To determine the frequency of positive blood cultures, describe the distribution of clinically significant pathogens, and compare selected clinical outcomes according to blood-culture status among febrile adult inpatients at Northwest General Hospital, Peshawar.

METHODOLOGY

This prospective observational cohort study enrolled 129 consecutive febrile patients aged 18-90 years admitted to the Department of General Medicine from January to June 2025. Two blood-culture sets were collected using aseptic technique and processed in an automated culture system. Positive bottles underwent Gram staining, subculture, and organism identification by matrix-assisted laser desorption ionisation time-of-flight mass spectrometry. Patients were followed until discharge or in-hospital death. Data were analysed using SPSS version 25, with appropriate non-parametric and exact tests; p<0.05 was considered significant.

RESULTS
Blood cultures were positive in 50/129 patients (38.8%). Enterobacteriaceae accounted for 48.0% of positive cultures, Gram-positive cocci for 40.0%, and non-fermenting Gram-negative rods for 12.0%. Staphylococcus aureus was the most frequent species (22.0%). Carbapenems (31.0%) and cephalosporins (27.9%) were the most frequently prescribed antimicrobial classes. Culture-positive patients were less often male (48.0% vs 70.9%; p=0.015), had lower median diastolic blood pressure (70 vs 80 mmHg; p=0.004), and longer median hospital stay (4 vs 3 days; p=0.043). Mortality was higher among culture-positive patients (20.0% vs 10.1%), although not statistically significant(p=0.126).
CONCLUSION
Bloodstream infection was frequent among febrile inpatients, with substantial Gram-negative and Gram-positive pathogen burdens. The findings support timely blood-culture sampling, careful interpretation, and strengthened antimicrobial stewardship. Local surveillance of pathogen distribution and resistance should guide empiric therapy and institutional antibiotic prescribing in this hospital population.

Diagnostic Accuracy of the Modified CT Severity Index for Severe Acute Pancreatitis Using the Revised Atlanta Classification as Reference Standard

Syeda Najia Hussain — 2026-10-01

OBJECTIVES

This study aimed to determine the diagnostic accuracy of the Modified Computed Tomography Severity Index (mCTSI) for identifying severe acute pancreatitis using the Revised Atlanta Classification as the reference standard.

METHODOLOGY

This cross-sectional validation study included 155 adults aged 20–60 years with acute pancreatitis who underwent contrast-enhanced computed tomography at Fauji Foundation Hospital, Rawalpindi, from 22 February to 22 May 2025. mCTSI was calculated from computed tomography performed after 48 hours of admission, while severe disease, by Revised Atlanta Classification, was defined by persistent organ failure for more than 48 hours using the Modified Marshall score. Diagnostic performance was evaluated using a 2×2 table and reported as sensitivity, specificity, predictive values, and overall accuracy.

RESULTS
Mean age was 42.8 ± 11.6 years, and 94 (60.6%) patients were male. Severe acute pancreatitis was classified in 46 (29.7%) patients by mCTSI and in 41 (26.5%) by Revised Atlanta criteria. There were 37 true-positive, 105 true-negative, nine false-positive, and four false-negative results. mCTSI demonstrated sensitivity of 90.2%, specificity of 92.1%, positive predictive value of 80.4%, negative predictive value of 96.3%, and overall diagnostic accuracy of 91.6%. Performance remained broadly consistent across age, sex, and symptom-duration strata.

CONCLUSION

CTSI showed high diagnostic accuracy for severe acute pancreatitis compared with the Revised Atlanta Classification. Its high negative predictive value supports its usefulness for radiological risk stratification when interpreted alongside clinical assessment and serial organ-failure evaluation and may support timely escalation of monitoring and supportive clinical care decisions.

Interpreting Complexity: How Senior Clinical Fellows Approach Challenging Cardiothoracic Imaging Cases - A Qualitative Study

Khalid Shakeel Babar — 2026-10-01

OBJECTIVES

To explore how senior clinical fellows in cardiothoracic radiology approach complex imaging cases in routine clinical practice, with secondary objectives of understanding how they manage diagnostic uncertainty, the factors influencing their decision-making, and the development of confidence and independence during fellowship.

METHODOLOGY

A qualitative descriptive study was conducted involving seven senior clinical fellows in cardiothoracic radiology at Liverpool Heart and Chest Hospital, Liverpool, UK, between January 2026 and March 2026. Participants were selected using purposive sampling based on relevant clinical experience. Data were collected through face-to-face interviews using a structured questionnaire containing open-ended and Likert-scale questions. Qualitative interview data were analysed using Braun and Clarke’s six-phase thematic analysis framework.

RESULTS
Five major themes emerged, including supportive environment in decision-making, importance of clinical details, diagnostic uncertainty, decision-making under stress, and experiential learning. Fellows reported that consultant supervision, support and multidisciplinary discussions were essential for managing uncertainty. Limited clinical information and ambiguous imaging findings increased diagnostic difficulty. Clinical demands, particularly in unstable patients, influenced decision-making. Furthermore, experience and literature review improved confidence over time.

CONCLUSION

Decision-making in complex cardiothoracic imaging involves managing uncertainty through senior Consultant support, mentorship, adequate clinical information, and experience, which together improve confidence in interpretation and patient care.

Understanding Bacterial Profiles and Antimicrobial Sensitivity in Pregnant Women with Urinary Tract Infections: A Study from THQ Swabi

Nilofar — 2026-10-01

Background: UTI is a frequent disorder of pregnancy and if not treated properly, could result in complications in both mother and baby. Local knowledge of the bacterial isolates and the antimicrobial sensitivity of the bacteria is crucial in the selection of appropriate and safe antibiotic in patients during their antenatal period.

Objective: To determine the bacterial profile and antimicrobial sensitivity pattern among pregnant women presenting with urinary tract infections at THQ Swabi.

Methodology: The descriptive cross sectional study was carried out at Tehsil Headquarters Hospital, Swabi with the Department of Pathology from May 2023 to November 2023. A non-probability consecutive sampling was used for the enrolment of the pregnant women suspected of having UTI, a total of 102 pregnant women were enrolled. Clean-catch urine samples were collected and processed for bacteriological culturing, identification, and antimicrobial susceptibility. The data were analyzed using the SPSS version 26.

Results: The mean age was 28.10 ± 6.00 years. Significant bacterial growth was found in 78 (76.5%) samples. Escherichia coli was the most common isolate 36 (46.2%), followed by Klebsiella pneumoniae 17 (21.8%) and Staphylococcus saprophyticus 8 (10.3%). Fosfomycin showed the highest sensitivity 70 (89.7%), followed by nitrofurantoin and amikacin 67 (85.9%) each. The highest resistance was observed against ampicillin 65 (83.3%) and cotrimoxazole 54 (69.2%). After multivariable adjustment, pus cells >5/HPF remained the only significant independent predictor of culture-positive UTI (AOR = 3.262, 95% CI: 1.073–9.916, p = 0.037).

Conclusion: Culture-positive UTI was frequent among pregnant women at THQ Swabi. E. coli was the leading bacterial isolate, while fosfomycin and nitrofurantoin showed favorable sensitivity. High resistance to ampicillin and cotrimoxazole supports the need for culture-guided therapy and regular local antibiogram surveillance.

Keywords: Pregnancy, urinary tract infection, bacterial profile, antimicrobial sensitivity, Escherichia coli, fosfomycin, nitrofurantoin.

Diagnostic Accuracy of Ultrasound in Diagnosing Craniosynostosis in Infants Using CT as the Gold Standard

Kiran Zafar — 2026-10-01

OBJECTIVE

This study aimed to determine the diagnostic accuracy of cranial ultrasound in detecting craniosynostosis in infants using computed tomography (CT) as the reference standard.

METHODOLOGY

This cross-sectional validation study was conducted in the Department of Radiology, MTI–Hayatabad Medical Complex, Peshawar. A total of 125 infants aged 2–6 months with clinical suspicion of craniosynostosis were enrolled through non-probability consecutive sampling. All infants underwent cranial ultrasound followed by CT scan. Ultrasound findings were compared with CT results, which were taken as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated.

RESULTS
The mean age of infants was 4.02 ± 1.40 months. CT confirmed craniosynostosis in 120 (96.0%) cases. Ultrasound demonstrated a sensitivity of 79.17% (95% CI: 71.05–85.47%), specificity of 80.00% (95% CI: 37.55–96.38%), PPV of 98.96% (95% CI: 94.33–99.82%), NPV of 13.79% (95% CI: 5.50–30.56%), and overall diagnostic accuracy of 79.20% (95% CI: 71.27–85.39%).

CONCLUSION

Cranial ultrasound shows acceptable diagnostic accuracy with very high PPV, supporting its use as a useful adjunct first-line imaging tool for craniosynostosis in settings with a high pre-test probability of disease, particularly in resource-limited settings; however, its low NPV in this high-prevalence referral cohort means a negative ultrasound cannot reliably exclude the diagnosis, and CT remains essential for equivocal cases and surgical planning.

Long-Term Outcomes of Translumbar Haemodialysis Catheters as Salvage Vascular Access in Patients with Exhausted Conventional Access Options

Shuah Ullah — 2026-10-01

OBJECTIVES

This study evaluated the technical success, catheter function, patency, complications, and predictors of failure of translumbar haemodialysis catheters used as salvage vascular access in patients with exhausted conventional access options.

METHODOLOGY

This record-based cohort study included 103 patients with end-stage kidney disease who underwent attempted translumbar catheter placement at the Sindh Institute of Urology and Transplantation, Karachi, from March 2025 to March 2026. We assessed consecutive eligible cases for procedural success, dialysis performance, immediate and long-term complications, catheter disposition, and access survival. We estimated patency using Kaplan–Meier analysis. Multivariable binary logistic regression identified independent predictors of catheter failure.

RESULTS
Technical success was achieved in 101/103 patients (98.1%), and 93 (90.3%) completed the first dialysis session successfully. Immediate complications occurred in 10 (9.7%) patients, without major organ injury or procedure-related mortality. Primary patency was 85.3% at three months, 75.5% at six months, and 57.6% at twelve months. Median assisted primary and secondary patency were 15.60 and 17.50 months, respectively. Catheter dysfunction occurred in 29/101 (28.7%), catheter-related bloodstream infection in 23 (22.8%), and thrombosis or occlusion in 20 (19.8%). Bloodstream infection and initial blood-flow rate below 300 mL/min independently predicted catheter failure.

CONCLUSION

Translumbar catheterisation provided high technical success and clinically meaningful patency in patients with severely limited vascular access. Rigorous infection prevention and early correction of inadequate catheter flow may improve durability and reduce access failure. These findings support translumbar access as a practical last-resort dialysis strategy.

Ultrasound Strain Elastography in Diagnosis of Breast Lesions

Tabassum Begum — 2026-10-01

OBJECTIVES

To determine the diagnostic performance of ultrasound strain elastography for differentiating benign and malignant breast lesions, using histopathology as the reference standard.

METHODOLOGY

This prospective diagnostic-accuracy study was conducted in the Department of Radiology, Bacha Khan Medical College and Mardan Medical Complex, Mardan, from January to March 2026. Ninety-seven patients with suspected breast lesions were enrolled by non-probability consecutive sampling. Conventional ultrasonography followed by strain elastography was performed in all patients. BI-RADS category, elasticity score, and strain ratio (cut-off 3.5) were compared with histopathology. Data were analyzed using IBM SPSS Statistics version 25.

RESULTS
Strain elastography showed a sensitivity of 94.9%, specificity of 86.2%, positive predictive value of 82.2%, negative predictive value of 96.2%, and overall accuracy of 89.7%. Elastography findings were strongly associated with histopathological diagnosis (p < 0.001). BI-RADS category, elasticity score, and strain ratio also showed strong to very strong correlations with histopathology.

CONCLUSION

Ultrasound strain elastography demonstrated high diagnostic performance in differentiating benign from malignant breast lesions. Used as an adjunct to conventional ultrasonography and BI-RADS assessment, it may improve diagnostic confidence and help reduce unnecessary biopsy.

Comparison of Functional and Morphological Outcomes of Open Versus Laparoscopic Pyeloplasty in Infants with Ureteropelvic Junction Obstruction

Younas khan — 2026-10-01

OBJECTIVES

The aim of the study was to compare functional, morphological, perioperative, and short-term surgical outcomes of open and laparoscopic pyeloplasty in infants with unilateral ureteropelvic junction obstruction.

METHODOLOGY

This prospective quasi-experimental study enrolled 116 infants aged 12 months or younger at Khyber Teaching Hospital, Peshawar, between June and November 2025, with six-month postoperative follow-up. Fifty-eight infants underwent open Anderson-Hynes pyeloplasty and 58 underwent transperitoneal laparoscopic pyeloplasty; allocation was based on surgeon expertise and parental preference. Estimated glomerular filtration rate (eGFR), renal pelvic anteroposterior diameter, and renal parenchymal thickness were assessed before surgery and at six months. Operative time, hospital stay, complications, and surgical success were also compared.

RESULTS
Baseline characteristics and preoperative eGFR were comparable between groups. At six months, mean eGFR increased by 5.3 mL/min/1.73 m² after open pyeloplasty and 6.1 mL/min/1.73 m² after laparoscopic pyeloplasty (p=0.016). Reduction in anteroposterior diameter was greater after laparoscopy (18.4±3.1 vs 15.8±2.9 mm; p<0.0001), as was improvement in parenchymal thickness (4.0±0.7 vs 3.0±0.7 mm; p=0.001). Laparoscopy required longer operative time (165±25 vs 90±12 minutes; p=0.001) but shorter hospitalisation (5.0±1.5 vs 6.5±2.0 days; p=0.002). Surgical success was similar (94.8% vs 93.1%; p=0.65), with low complication rates.

CONCLUSION

Both approaches produced high success and acceptable morbidity. Laparoscopy showed modestly greater functional and morphological improvement and shorter hospitalisation, but the non-randomised design limits causal interpretation. eGFR was calculated with age-appropriate creatinine-based equations, ultrasound was interpreted by a radiologist blinded to surgical approach, and complications were classified according to the Clavien-Dindo system. Longer follow-up is required to determine whether these differences persist in this infant population.

Immunization Status and Determinants of Vaccine Hesitancy among Children Under Five Years of Age

Ali Maalik — 2026-10-01

OBJECTIVES

This study aimed to determine immunisation status and identify demographic, socioeconomic, access-related, and caregiver factors associated with incomplete immunisation among children under five years.

METHODOLOGY

This descriptive cross-sectional study enrolled 345 children who presented to the Department of Paediatrics, Ayub Teaching Hospital, Abbottabad, from October 2025 to April 2026 using non-probability consecutive sampling. Parents or guardians completed a pre-tested structured questionnaire, and immunisation status was verified from Expanded Programme on Immunisation records when available and supplemented with caregiver recall. Children were categorised as fully, partially, or not immunised. We assessed associations using chi-square tests and Cramer's V, followed by binary logistic regression for incomplete immunisation.

RESULTS
The mean child age was 28.15 ± 17.19 months. Overall, 212 (61.4%) children were fully immunised, 103 (29.9%) partially immunised, and 30 (8.7%) non-immunised. Frequently reported barriers were fear of side effects (49.0%), lack of schedule knowledge (42.6%), and unawareness of the need for immunisation (41.2%). Immunisation status was significantly associated with residence, socioeconomic status, parental education, and parental occupation. After adjustment, low socioeconomic status, unawareness of follow-up doses, misconceptions about contraindications, lack of a nearby vaccination facility, concern about lost wages, and poor schedule knowledge independently predicted incomplete immunisation.

CONCLUSION

More than one-third of children had incomplete immunisation. Improving completion requires caregiver education, clear counselling about contraindications and adverse effects, reliable reminders for subsequent doses, and practical service-delivery measures that reduce geographic and economic barriers for vulnerable families. Targeted outreach should consistently prioritise rural and socioeconomically disadvantaged households.

Influence of Active Cigarette Smoking on Postoperative Outcomes after Elective General Surgery: A Prospective Cohort Study

Muhammad Imran — 2026-10-01

OBJECTIVES

This study aimed to assess the association between active cigarette smoking and postoperative morbidity and hospital stay among adults undergoing elective non-cardiac general surgery at a tertiary-care hospital in Pakistan.

METHODOLOGY

This prospective observational cohort study enrolled 280 adults aged 18–60 years undergoing elective general surgical procedures at Services Institute of Medical Sciences/Services Hospital, Lahore, from November 2024 to December 2025. Participants comprised 180 active smokers and 100 non-active smokers. Smoking exposure was quantified in pack-years. Patients received standard perioperative care and were followed through 30 days after discharge. Outcomes included pulmonary complications, surgical-site or wound-related complications, postoperative fever, cardiovascular events, and total hospital stay. Associations were assessed using chi-square testing, logistic regression for overall complications, and independent-samples testing for length of stay.

RESULTS
Overall postoperative complications occurred in 67/180 smokers (37.2%) and 13/100 non-smokers (13.0%), corresponding to an odds ratio of 3.96 (95% CI 2.0–7.7; p<0.001). Pulmonary complications were the most frequently reported adverse event among smokers. Among smokers with more than 11 pack-years, 55/121 (45.5%) developed at least one complication. Mean total hospital stay was 14.90 days in smokers and 7.58 days in non-smokers (reported p<0.001).

CONCLUSION

Active smoking was associated with substantially greater postoperative morbidity and longer hospitalisation after elective general surgery. Routine preoperative tobacco assessment, pack-year documentation, and structured cessation support should be incorporated into elective surgical pathways.

Effectiveness Of Low Vision Aids As Rehabilitative Services Given To Low Vision Patients At Khyber Teaching Hospital, Peshawar, Pakistan

Natasha Junaid — 2026-10-01

OBJECTIVES

This study aims to determine the effectiveness of various low vision aids provided to low vision patients and to observe their impact on quality of life.

METHODOLOGY

A cross-sectional study was conducted to collect data from low vision patients visiting the Eye OPD, Khyber Teaching Hospital, Peshawar, using a well-structured questionnaire. We estimated a total sample size of 100 using a formula and collected data through non-probability convenience sampling. Informed consent was obtained. We analyzed the data using SPSS version 20.

RESULTS
Of the 100 participants, 74% were male, and 26% were female. 36% of participants were aged 5-15 years, whereas 64% were 16-80 years old. 98% already used low vision aids, and 2% did not. Of these, 66% used telescopes, 16% used magnifiers, and 18% used both. After the use of low vision aids, 40% of participants had a visual acuity in the range of 6/6 and 6/9, 24% had between 6/18 and 6/12, 21% between 6/24 and 6/18, 11% had between 6/60 and 6/36, 3% had between 1/60 and 3/60 and 1% between 4/60 and 5/60. Of 100 participants, 51% had average effectiveness, 38% poor effectiveness, and 11% excellent effectiveness. Participants' quality of life improved significantly. 40% of participants had slightly improved quality of life, 38% had moderately improved quality of life, and 22% had significantly improved quality of life.

CONCLUSION

Use of low vision aids has significantly improved vision and quality of life in low vision patients. The dependency on others to perform various daily tasks has greatly decreased for a vast majority of patients. Hence, our study concludes that low vision aids have proved to be really effective as a visual rehabilitative service for low vision patients.

Infraorbital Nerve Injury in Zygomaticomaxillary Complex Fractures in Patients Presenting to Ayub Teaching Hospital, Abbottabad

Aqsa Munir — 2026-10-01

OBJECTIVES

This study aimed to analyse the frequency and trends of infraorbital nerve (ION) damage in zygomaticomaxillary complex (ZMC) fractures.

METHODOLOGY

We conducted a cross-sectional analytical study at the Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad, from January 2025 to June 2025. We recruited 132 ZMC fracture patients through non-probability consecutive sampling. Information on age, gender, aetiology and mechanism of trauma, fracture side, and ION injury presence and type was obtained. We assessed infraorbital nerve injury using neurosensory testing and graded it as paraesthesia, anaesthesia, or hypoesthesia. Data were analysed using SPSS, with p < 0.05 considered significant.

RESULTS
Of the 132 patients, 68 (51.52%) were male, and 64 (48.48%) were female. ION injury was seen in 88 (66.67%) patients, with paraesthesia being the most prevalent type (34.09%), followed by anaesthesia (23.48%) and hypoesthesia (9.09%). There was a statistically significant relationship between gender and ION injury (p < 0.001), and between fracture laterality and ION injury, with 97.5% of bilateral fractures having nerve involvement (p < 0.001). However, the aetiology of trauma was not significantly correlated with ION injury (p = 0.191).

CONCLUSION

ION injury is a common sequel of ZMC fractures, paraesthesia being the most frequent presentation. Male gender and bilateral fractures were correlated with increased injury rates, underlining the necessity of early neurosensory evaluation.

Empirical Antibacterial Therapy for Culture-Negative Pyogenic Spondylodiscitis: Functional and Radiological Outcomes and the Role of Tissue Diagnosis

Abdul Satar — 2026-10-01

OBJECTIVES

This study aimed to determine the efficacy of empirical antibacterial treatment of culture-negative pyogenic spondylodiscitis in terms of functional and radiological outcomes, with secondary assessment of pain, inflammatory response, treatment failure, recurrence, and requirement for surgery.

METHODOLOGY

A prospective observational cohort design was used at the Department of Orthopaedics and Spine Surgery, Hayatabad Medical Complex, Peshawar. Adults with clinical, biochemical, and magnetic resonance imaging findings compatible with native pyogenic spondylodiscitis, negative blood cultures, and no immediate indication for surgery were included. Patients with suspected tuberculosis, brucellosis, postoperative infection, malignancy, hemodynamic instability, or progressive neurological compromise were excluded. Empirical therapy was selected to cover staphylococci, streptococci, and aerobic Gram-negative bacilli. Functional status was measured using the Oswestry Disability Index (ODI), pain with the Visual Analogue Scale (VAS), and inflammatory response using C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Assessments were performed at baseline, 6 weeks, 3 months, and 6 months. Two readers independently classified the six-month MRI. Longitudinal outcomes were analysed using linear mixed-effects models.

RESULTS
Sixty-four patients entered the empirical-treatment cohort, and 61 completed 6-month follow-up. Mean age was 50.3 ± 12.0 years, and 39 patients (60.9%) were male. Mean ODI decreased from 62.7 ± 9.7 at baseline to 25.2 ± 13.4 at 6 months; the adjusted mean reduction was 37.38 points (95% CI 35.46–39.29; p<0.001). Mean VAS decreased from 7.62 ± 0.62 to 2.23 ± 1.20, corresponding to an adjusted reduction of 5.39 points (95% CI 5.17–5.61; p<0.001). Median CRP declined from 70.4 mg/L to 5.7 mg/L, while mean ESR decreased from 75.8 ± 16.2 to 26.0 ± 17.2 mm/hour. Favorable MRI response was observed in 54/61 patients (88.5%; 95% CI 78.2–94.3), and overall treatment success was achieved in 56/61 (91.8%; 95% CI 82.2–96.4).

CONCLUSION

A structured antibacterial pathway improved patient outcome, supporting a non-biopsy approach when diagnosis is clear, blood cultures are negative, other serious conditions are excluded, and multidisciplinary monitoring is present. However, tissue diagnosis remains crucial for diagnostic uncertainty or empirical treatment failure.

Diagnostic Performance and Radiocytological Correlation of ACR TI-RADS in Thyroid Nodules Using Bethesda-Reported FNAC as the Reference Standard

Shanza Khan — 2026-10-01

OBJECTIVES

This study aimed to evaluate the diagnostic performance and radiocytological concordance of American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) categories for thyroid nodules, using fine-needle aspiration cytology (FNAC) reported according to the Bethesda System as the reference standard.

METHODOLOGY

This cross-sectional study included 134 adults aged 18–80 years presenting with clinically suspected thyroid nodules to the Department of Radiology, FC Teaching Hospital, Peshawar. High-resolution ultrasound was performed with a high-frequency linear transducer, and nodules were scored for composition, echogenicity, shape, margins, and echogenic foci. Two radiologists independently reviewed ultrasound findings while blinded to cytology. Ultrasound-guided FNAC was subsequently performed and categorised by the Bethesda System. For the submitted analysis, Bethesda IV–VI constituted the cytologically high-risk reference category and ACR TI-RADS TR4–TR5 constituted a positive ultrasound test. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated.

RESULTS
Mean participant age was 44.8 ± 12.6 years, and 102 (76.1%) were female. Thirty-eight nodules (28.4%) were classified as Bethesda IV–VI. ACR TI-RADS demonstrated 89.5% sensitivity, 85.4% specificity, 70.8% positive predictive value, 95.3% negative predictive value, and 86.6% overall accuracy. Higher TI-RADS categories were significantly associated with higher-risk Bethesda cytology (p<0.001).

CONCLUSION

ACR TI-RADS showed strong diagnostic discrimination and a particularly high negative predictive value against Bethesda-reported FNAC. Structured ultrasound risk stratification may support biopsy selection and reduce avoidable procedures, although indeterminate Bethesda categories should not be interpreted as histologically proven malignancy in this clinical cohort.

Assessment of Postural Stability in Pediatric Population with Juvenile Idiopathic Arthritis: A Cross-Sectional Study

Amina Ashfaq — 2026-10-01

OBJECTIVES

The study aimed to determine the postural stability of children with Juvenile Idiopathic Arthritis (JIA).

METHODOLOGY

A cross-sectional study was conducted from June 2024 to January 2025 at Children's Hospital Lahore. Seventy children aged 6- 15 years with JIA and active joint involvement were recruited through convenience sampling. The Pediatric Balance Scale (PBS) was used to evaluate postural stability, and the Childhood Health Assessment Questionnaire (CHAQ) was used to assess functional status. We used SPSS version 26 to analyse the data. Chi-square tests and descriptive statistics were applied.

RESULTS
The mean age was 11.6 (± 2.8) years, with 41 females (58.6%) and 29 males (41.4%). PBS scores showed 42 children (60%) with poor balance (score 0 20), 16 (22.9%) with moderate balance (21- 40), and 12 (17.1%) with good balance (41- 56). According to the CHAQ, 50 children (71.5%) reported much difficulty or were unable to perform everyday activities, while a further 9 (12.9%) reported some difficulty. A significant association was found between CHAQ functional level and PBS balance category (χ² = 15.42, p = 0.017), and a moderate negative correlation was observed between CHAQ and PBS total scores (r = -0.41, p < 0.001). No significant association was found between age and balance (p = 0.087).

CONCLUSION

A substantial proportion of children with JIA scored in the lower ranges of the PBS, and poorer balance was moderately correlated with greater functional disability. These findings support integrating balance assessment into routine clinical evaluation in pediatric JIA.

Exploring Tutors' Perspectives on Tutor Preparedness for Student Support and the Challenges Faced in Medical Education

Ayesha Bibi — 2026-10-01

OBJECTIVES

This study examined the tutors’ perspectives about the student support programs and the problems faced in providing effective student assistance at their dental institutions.

METHODOLOGY

This qualitative study was conducted in three dental institutions in Abbottabad, Pakistan. Four focus group discussions (FGDs) with six participants each were conducted to gather perceptions from 24 tutors. Participants with at least one year of teaching experience were chosen by purposive sampling. FGDs were guided by a semi-structured discussion proforma, and the conversations were audio-recorded and transcribed verbatim. Thematic analysis was conducted to find repeating patterns and major themes in the data, to appropriately represent the perspectives of the tutors. Conformability and dependability were ensured by maintaining data trail. The researchers ensured reflexivity by explicitly expressing and intentionally keeping aside own views during data analysis, to ensure methodological rigor.

RESULTS
Four major themes emerged, tutor preparedness and training deficiencies, difficulties in reconciling clinical and teaching duties, support and developmental requirements, and adaptability to technology advancements. Tutors understood well their academic role, but many expressed a need for more training in professionalism, provision of emotional support, and mentorship of students. They found it difficult to maintain a balance between hectic clinical duties with the multifaceted tutoring role, and with the use of digital technologies in teaching due to lack of training and institutions support.

CONCLUSION

Though tutors had subject expertise but defficiency in the tutor preparedness for mentorship, emotional support of students, and the challenges of managing workload were, partly attributed to lack of institutional support. This necessitates need for faculty development initiatives by institutions.

Diagnostic Accuracy of Non-Invasive Parameters for Detecting Esophageal Varices in Cirrhotic Patients in a Resource-Limited Setting

Zainab Abbasi — 2026-10-01

OBJECTIVES

This study evaluates the ability of selected non-invasive markers—portal vein diameter (>13 mm), aspartate aminotransferase (AST), AST-to-platelet ratio index (APRI), platelet-to-spleen diameter ratio, spleen size, and INR to detect oesophageal varices in cirrhotic patients accurately. The goal is to reduce reliance on invasive procedures and lower healthcare costs, particularly in resource-limited settings.

METHODOLOGY

This cross-sectional, prospective study included 165 patients undergoing screening endoscopy, ultrasonography, and laboratory investigations (selected via a non-probability, consecutive sampling technique). The study was conducted at Aga Khan University Hospital, Karachi, from 1^st April 2024 to 30^th September 2024. Factors associated with oesophageal varices were first analysed using univariable logistic regression analyses. The predictive performance of the final model was evaluated using sensitivity, specificity, positive and negative predictive values, and overall accuracy. Statistical significance was set at p < 0.05.

RESULTS
Spleen size remained significantly associated with oesophageal varices (p-value = 0.025). Other variables, including age, gender, PVD >13 mm, Ascites, AST, APRI, platelet-to-splenic diameter ratio, and INR, were not independently associated. The model achieved an overall accuracy of 80%, sensitivity of 84%, specificity of 67%, and positive predictive value of 90%, while the negative predictive value was 55% in predicting oesophageal varices.

CONCLUSION

Among the evaluated non-invasive parameters, spleen size demonstrated the most consistent association with the presence of oesophageal varices, remaining an independent predictor on multivariable analysis. The predictive model incorporating non-invasive markers achieved good overall accuracy with high sensitivity, indicating its usefulness in identifying patients at high risk for oesophageal varices, although specificity and negative predictive value were moderate.

Functional Outcomes after Multiligament Knee Reconstruction at a Tertiary Care Hospital

Jawad Farooq — 2026-10-01

OBJECTIVES

The study aimed to determine short-term functional outcomes after multiligament knee reconstruction and identify factors associated with satisfactory recovery.

METHODOLOGY

This observational study with three-month follow-up included 142 patients aged 20-70 years with magnetic resonance imaging-confirmed injury to at least two major knee ligaments at Khyber Teaching Hospital, Peshawar, from October 2025 to April 2026. Patients underwent surgical repair and/or reconstruction according to injury pattern, followed by departmental rehabilitation. We assessed functional outcome at three months using the Lysholm knee score and categorised it as excellent, good, fair, or poor. We examined associations using chi-square or exact tests, and used binary logistic regression to identify independent predictors of excellent/good outcome.

RESULTS
Mean age was 36.17 ± 12.37 years, and 104 (73.2%) patients were male. Road traffic accidents accounted for 74 (52.1%) injuries. The mean three-month Lysholm score was 81.56 ± 11.89. Outcomes were excellent in 29 (20.4%), good in 48 (33.8%), fair in 50 (35.2%), and poor in 15 (10.6%) patients; 77 (54.2%) therefore achieved a satisfactory outcome. Functional outcome was associated with age, body mass index, timing of surgery, number of ligaments involved, and meniscal injury. Delayed surgery beyond 14 days, greater ligament involvement, increasing age, and higher body mass index independently reduced the odds of satisfactory recovery.

CONCLUSION

Multiligament knee reconstruction produced satisfactory short-term function in more than half of patients. Earlier management, careful assessment of injury complexity, weight optimisation, and structured rehabilitation may improve recovery, although longer-term multicentre evaluation is required.

Kidney Transplantation in Patients with a Previous History of Femoral Lines: Surgical Challenges and Outcomes

Muhammad Izhar — 2026-10-01

OBJECTIVES

To assess surgical complexity, early complications, and short-term graft outcomes in kidney transplant recipients with a history of femoral lines.

METHODOLOGY

This prospective cohort study included 47 adult renal transplant recipients with prior femoral catheterisation who underwent living donor transplantation at the Institute of Kidney Diseases, Peshawar, Pakistan. Data on demographics, intraoperative events, and postoperative outcomes were analysed using SPSS (p < 0.05). Complications were classified by the Clavien–Dindo system.

RESULTS
Recipients had a mean age of 39.8 ± 10.7 years, and 80.9% were male. Hypertension (76.6%) and diabetes (25.5%) were common. All transplants were performed in the right iliac fossa, using the external iliac vessels in most cases. Difficult venous exposure occurred in 19.1%, and venous injury in 6.4%. Delayed graft function developed in 19.1%, while 6-month graft and patient survival were 91.5% and 97.9%, respectively. Patients with venous abnormalities had longer operative times and greater blood loss (p < 0.05) but similar graft survival

CONCLUSION

Kidney transplantation in patients with prior femoral lines is feasible and yields favourable early outcomes. Pre-operative vascular imaging, meticulous surgical technique, and multidisciplinary coordination are essential to mitigate intraoperative risks and optimise graft success.

Frequency of Common Causes of Bleeding Per Rectum among Patients Presenting to Surgical OPD at A Tertiary Care Hospital

Aurangzeb Ahmad — 2026-10-01

OBJECTIVES

This study aimed to estimate the frequency and 95% confidence intervals of harmonised, clinician-recorded etiological categories among adults presenting with bleeding per rectum to the surgical outpatient department of a tertiary-care hospital.

METHODOLOGY

This descriptive cross-sectional study was conducted at Hayatabad Medical Complex, Peshawar, from September 2022 to March 2024. The patients were consecutively sampled during a fixed period of six months, with an age range of 20-60 years (all patients within the age range were included in the study, n = 164). Laboratory testing and imaging were used selectively. Since inflammatory bowel disease, ulcerative colitis and colitis are conceptually similar, post hoc (after the data were collected), these three mutually exclusive source codes were pooled together into inflammatory colitis.

RESULTS
The mean age was 38.7 ± 12.8 years; 107 (65.2%) patients were male. Inflammatory colitis was recorded in 83 patients (50.6%; 95% CI, 43.0%-58.2%), hemorrhoids in 54 (32.9%; 95% CI, 26.2%-40.4%), abdominal tuberculosis in 17 (10.4%; 95% CI, 6.6%-16.0%), and diverticular disease in 10 (6.1%; 95% CI, 3.3%-10.9%). Etiological distribution was not significantly different in the various age groups (Monte Carlo exact p = 0.695; Cramer's V = 0.116). Complete colon evaluation was not always done, and colorectal carcinoma was not detected via the selective diagnostic pathway.

CONCLUSION

The most common categories were inflammatory colitis and hemorrhoids. The combined inflammatory estimate should not be interpreted as the prevalence of confirmed inflammatory bowel disease, and the selective diagnostic pathway does not exclude undetected proximal colonic disease.

Factors Associated With Treatment Adherence and Symptom Burden among Patients Receiving Maintenance Hemodialysis in Pakistan: A Cross-Sectional Study

Muhammad Mamoon — 2026-10-01

OBJECTIVES

This study aimed to assess treatment adherence, symptom burden, and factors associated with adherence among adults receiving maintenance hemodialysis in Pakistan.

METHODOLOGY

A cross-sectional study was conducted from January to July 2026 in the Dialysis Unit of District Headquarters Hospital, Kohat, Pakistan. A total of 141 adults receiving maintenance hemodialysis were recruited consecutively. Data were collected using a structured questionnaire, the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), and the Dialysis Symptom Index (DSI). Descriptive statistics were used to summarise participant characteristics and adherence-related behaviours.

RESULTS
The mean age was 44.01 ± 14.40 years, and 55.3% of participants were male. Self-rated overall treatment compliance was excellent in 69.5%, very good in 21.3%, and good in 9.2%. No dialysis session was missed by 74.5% of participants during the reported period. Difficulties were reported with medication-taking (44.0%), fluid restriction (68.8%), and dietary recommendations (58.9%).

CONCLUSION

Most participants reported high overall treatment compliance; however, clinically relevant difficulties with medication use, fluid restriction, and dietary adherence remained common. Structured education, individualised counselling, and practical support for treatment barriers should be integrated into routine dialysis care. Validated DSI results and appropriately reanalysed association models are required before conclusions regarding symptom burden and independent predictors can be finalised.