Journal of Rehman Medical Institute

Conceptual Pillars of Clinical Outcomes of Treatment: A Unified Framework for Medical, Surgical, and Psychological Disorders

2026-09-07T10:20:14+00:00

In Hospital Outcomes of STEMI Patients Presenting with and without Standard Modifiable Cardiovascular Risk Factors (SMuRF)

2026-08-25T19:38:20+00:00

Objectives: This study aims to compare differences in outcomes between ST -Elevation Myocardial Infarction (STEMI) patients based on the presence or absence of Standard Modifiable Cardiovascular Risk Factors (SMuRFs).

Materials and Methods: This cross-sectional study was conducted in the Cardiology Department of a tertiary care hospital in Pakistan. Study participants were divided into two groups based on STEMI classification: SMuRF vs. SMuRF-less. Patient characteristics, ECG, angiographic, and echocardiographic data were collected. In-hospital outcomes and mortality within a 3-day hospital stay were evaluated. Statistical Package for Social Sciences (SPSS) was used to compare the prognosis of SMuRF vs. SMuRF-less patients.

Results: 150 patients were enrolled, with 113 (75.3%) in the SMuRF group and 37 (24.6%) in the SMuRF-less group. Younger patients (18–25 years) were more prevalent in the SMuRF-less group (66%). Inferior wall MI was more commonly associated with four risk factors than anterior wall MI (12.5% vs. 2.7%, p=0.021). In-hospital outcomes showed no significant differences between SMuRF and SMuRF-less patients, including heart failure (OR 0.973, 95% CI: 0.447–2.119), mitral regurgitation (OR 1.158, 95% CI: 0.291–4.613), heart block (OR 0.757, 95% CI: 0.082–6.99), recurrent infarction (OR 0.323, 95% CI: 0.071–1.469), and renal failure (OR 0.600, 95% CI: 0.068–5.307). No deaths were reported in either group.

Conclusion: Our study highlighted the trend of patients without SMuRF and its association with a younger age group. IWMI was more commonly associated with four risk factors, and there was no difference in in-hospital outcomes between SMuRF and SMuRF-less patients.

Short term Metabolic Outcomes Following Bariatric Surgery in a Tertiary Care Centre in Pakistan: A Retrospective Cohort Study

2026-08-06T11:32:42+00:00

Introduction

Bariatric surgery is increasingly being optimized for metabolic comorbidities globally and in Pakistan aswell, however its outcome are less frequently reported in Pakistani population.

Objective:
The objective of this study was to evaluate the impact of bariatric surgery on weight parameters along with metabolic comorbidities in patients presenting at a tertiary care hospital setting in Pakistan.

Materials and Methods:
This retrospective cohort study was conducted from January 2023 to December 2023. Preoperative and postoperative data of patients who had consecutively undergone bariatric surgery, were collected from hospital records. Remission of comorbidities was assessed using McNemar’s exact test. A p-value of <0.05 was considered statistically significant.

Results:
A total of 50 patients with mean age of 37.46 ± 8.37 years, encompassing mostly females (66%) were included. The mean preoperative weight and BMI recorded were 127.28 ± 23.43 kg and 49.06 ± 9.93 kg/m², which significantly decreased to 98.29 ± 23.88 kg and 39.11 ± 12.15 kg/m² postoperatively (p < 0.001) at 6 months of follow-up. Percentage weight loss and excess weight loss were 24.22 ± 10.60% and 51.63 ± 28.26%, respectively. Medication-free status consistent with clinical remission rate of hypertension and type 2 diabetes mellitus was 97.4% and 88.9% (p < 0.001). Discontinuation of lipid-lowering medication was documented in all patients previously receiving treatment leading to remission rate of 100%.

Conclusion:
Bariatric surgery is an effective therapeutic option for controlling metabolic diseases in obese patients in the Pakistani population.

MOLECULAR IDENTIFICATION AND ANTIMICROBIAL SUSCEPTIBILITY TESTING (AST) PROFILING OF ENTEROCOCCS SPECIES ISOLATED FROM URINARY TRACT INFECTIONS

2026-07-29T06:06:43+00:00

ABSTRACT

Background of study: Gram-positive cocci that have emerged as clinically important nosocomial pathogens, particularly in immunocompromised patients and those with underlying comorbidities. Their intrinsic and acquired resistance to multiple antibiotics poses a serious therapeutic challenge in hospital settings.

Objective: To isolate, identify Enterococcus species using molecular techniques and AST profile in patients clinically diagnosed with urinary tract infection.

Methods: Total 200 urine samples were collected over six months. Standard microbiological methods were employed for culture, isolation, and identification. Molecular identification was done using PCR. Antimicrobial susceptibility testing (AST) was performed using the Kirby-Bauer disc diffusion method following CLSI 2023 breakpoint guidelines and were Interpreted as sensitive (S) or resistant (R). VRE, VSE AND MDR cases were identified. All the data was analyzed using SPSS version 23.0. Descriptive statistics was used to calculate mean ±SD, frequencies & percentages. Chi-square test was done to Check association between the categorical variables and clinical factors. A P value less than 0.05 was considered statistical significant.

Results: out of 200 urine samples were processed ,76 % were positive isolates followed by no growth (24%), 4.6% were the enterococcal isolates.22% isolation were of gram positive pathogen while 77% were of gram negative pathogens. Demographical characteristics were varied. The mean age was 41.3 ± 19.6 years. Females 64% were more prevalent. The In-patients/ IPD admitted) were 59% patients and accounted for the highest proportion of urine samples. Enterococcal isolates were 4.6%, the most frequently isolated pathogen was E. coli followed by K. Pneumoniae 24% staph. Aureus 7.2%, Pseudomonas ( 7.8%) , proteus (9.2%), and CONS were 10.5%. All 7 Enterococcus isolates were subjected to phenotypic identification using conventional biochemical tests i.e. all enterococcus isolates were negative for catalase reaction, all were positive 100% for Bile Aesculin hydrolysis Test and Growth in 6.5% NaCl Broth. 5 isolates showed hemolysis on blood agar while 2 were negative for hemolysis. All 7 Enterococcus isolates were subjected to phenotypic identification using conventional biochemical tests i.e. all enterococcus isolates were negative for catalase reaction, all were positive 100% for Bile Aesculin hydrolysis Test and Growth in 6.5% NaCl Broth. All were non –hemolytic and non motile. Enterococcus faecalis was the most frequently identified species n=6 ,( 85 %), followed by E. faecium n=1, (14 %) on PCR assay. E. faecalis demonstrated significantly higher sensitivity to ampicillin, penicillin and nitrofurantoin (86.1% vs 42.1%, p<0.001) compared to E. faecium. 71 % cases were vancomycin sensitive while 28% cases were vancomycin resistant. Vancomycin (84%), Linezolid (93.5%) and teicoplanin (80.6%) and Nitrofurantoin (90%) showed highest sensitivity. Tetracycline was most resistant (76%). Cephalosporin had 100% resistance rate while glycopeptides had varied sensitivity.84 % cases were sensitive to VAN and 16% shows resistance. The highest resistance was observed among the cephalosporins group followed by tetracyclines 91% ,CIP 88% and beta- lactams 50%.57% of Enterococcus isolates were multi-drug resistant (MDR) while 42% were non MDR . prior hospitalization within six months (p=0.004), and catheter-associated UTI (p=0.012) were significantly associated with both MDR and VRE phenotypes. recurrent UTI showed a trend toward higher resistance rates, but were not statistical significant.

Conclusion: Enterococcus spp. constitute a clinically relevant proportion of urine isolates at Saleem memorial Hospital, Lahore, demonstrating alarming resistance to commonly used antibiotics. Vancomycin, Teicoplanin and Linezolid remain the most effective agents. Strengthening infection control protocols, antimicrobial stewardship programs, and routine surveillance is instantly necessary.

Keywords: Enterococcus, antimicrobial resistance, urinary tract infection, nosocomial pathogen, urine culture, Vancomycin., VRE, MDR

OUTCOME OF A PATIENT WITH SINONASAL TERATOCARCINOSARCOMA TREATED WITH INDUCTION CHEMOTHERAPY FOLLOWED BY RADICAL CONCURRENT CHEMORADIATION: A CASE REPORT

2026-07-27T07:16:50+00:00

Outcome of a Patient with Sinonasal Teratocarcinosarcoma Treated with Induction Chemotherapy Followed by Radical Concurrent Chemoradiation: A Case Report

Dr Asmat Ullah, Dr Jawad Latif, Dr Simra Qureshi, Dr Yasir Inam, Dr Fawad Ul Qamar ,Dr Irfan Haider.

Clinical and Radiation department in Shaukat khanum memorial cancer Hospital and research centre

Abstract

Background: Sinonasal teratocarcinosarcoma (SNTCS) is an extremely rare and highly aggressive malignancy of the sinonasal tract characterized by histological heterogeneity and poor prognosis. Due to its rarity, optimal management remains undefined.

Case Presentation: We report a 43-year-old male who presented with headache and recurrent epistaxis. Imaging revealed a locally advanced mass involving the right nasal cavity and paranasal sinuses without intracranial extension. Histopathology confirmed SNTCS with loss of SMARCA4 expression. The patient was treated with induction chemotherapy (cisplatin and docetaxel) followed by radical concurrent chemoradiation (66 Gy in 33 fractions with concurrent cisplatin). He achieved significant tumor regression and remains clinically stable two years post-treatment with no locoregional or distant metastasis.

Conclusion: This case highlights the chemosensitive and radiosensitive nature of SNTCS and supports a multimodality treatment approach in achieving durable local control.

Keywords: Sinonasal teratocarcinosarcoma, induction chemotherapy, chemoradiation, SMARCA4, rare sinonasal tumor

Introduction

Sinonasal teratocarcinosarcoma (SNTCS) is a rare and highly aggressive malignant neoplasm arising predominantly in the nasal cavity and paranasal sinuses.¹ First described by Heffner and Hyams in 1984,⁴ it demonstrates triphasic histology comprising epithelial, mesenchymal, and neuroepithelial elements.³

SNTCS most commonly originates in the ethmoid and maxillary sinuses and typically presents with nasal obstruction and epistaxis.⁴ The tumor exhibits a strong male predominance and primarily affects adults.²⁸ Due to rapid growth and a high tendency for local invasion, recurrence, and distant metastasis, prognosis remains poor, with median survival reported at less than two years.¹²

Given the rarity of this tumor, standardized treatment guidelines are lacking. Surgery followed by adjuvant radiotherapy has traditionally been considered the standard approach.⁶ However, emerging evidence suggests that multimodality treatment incorporating chemotherapy may improve outcomes.⁶

We present a case of locally advanced SNTCS successfully treated with induction chemotherapy followed by definitive concurrent chemoradiation, with durable disease control at two-year follow-up.

Case Report

A 43-year-old male presented with a one-month history of right-sided headache and recurrent epistaxis. Clinical examination revealed a polypoid mass occupying the right nasal cavity, displacing the nasal septum toward the left, with associated soft palate mass effect.

Histopathology

Biopsy yielded four formalin-fixed tissue fragments measuring 20 × 12 × 4 mm. Microscopic examination demonstrated a malignant neoplasm composed of:

Primitive neuroepithelial elements
Atypical squamous nests
Atypical spindle cells with myxoid stromal change

Immunohistochemistry showed:

Loss of SMARCA4 expression
Synaptophysin positivity in neuroepithelial components
p63 positivity in squamous components

Based on morphology and immunoprofile, a diagnosis of sinonasal teratocarcinosarcoma was established. (Figure 1 a,b ).

Figure 1 a, b

Low and high power sections which reveal a malignant neoplasm composed of primitive neuroepithelial elements, atypical squamous nests and atypical spindled cells with areas of myxoid change.

Radiological Findings

Contrast-enhanced computed tomography (CT) revealed a heterogeneously enhancing mass centered in the right nasal cavity and ethmoid sinus, extending into:

Right maxillary sinus
Sphenoid sinus
Nasopharynx
Left nasal cavity

There was no evidence of intracranial extension. (Figure 2).

Figure 2

CT image (axial and coronal views) showing mass in right nasal cavity extending into right ethmoid sinus, maxillary sinus, and sphenoid sinus with extension into right nasopharynx

Treatment

The case was discussed in a multidisciplinary tumor board. Given the locally advanced disease and anticipated surgical morbidity, the patient was planned for induction chemotherapy followed by definitive chemoradiation.

He received three cycles of:

Cisplatin
Docetaxel

Response assessment imaging demonstrated significant reduction in tumor volume.

Subsequently, he underwent radical concurrent chemoradiation using intensity-modulated radiotherapy (IMRT):

66 Gy in 33 fractions to gross tumor volume (GTV/high-risk CTV)
54 Gy to bilateral level II–IV cervical lymph nodes
Concurrent cisplatin 75 mg/m² on days 1 and 22

(Figure 4).

Figure 4

CT image (axial and coronal views) showing good treatment response with shrinkage of the primary sinonasal mass lesion

Response and Follow-Up

Post-treatment CT demonstrated further tumor reduction to 25 × 12 mm from a prior 38 × 18 mm.

Six-month follow-up imaging showed continued regression. Figure 5

At two years post-treatment (February 2026): Figure 6

Stable residual lesion in right nasal cavity
No locoregional lymphadenopathy
No pulmonary or bony metastasis

The patient remains clinically well with only occasional headache and mild flu-like symptoms. He continues on three-monthly surveillance.

Figure 5

Response assessment CT images showing further reduction in the size of right sinonasal mass. measuring about 2.5 x 1.8 x 1.3 cm in CC x AP x TR dimensions against the previous size of about 2.8 x 2.5 x 1.3 cm in CC x AP x TR dimensions.

Figure 6

CT neck and chest follow up scan post two years of treatment Conclusion of the scan done February 2026 which is exactly two years post chemo radiation completion shows Stable tumor in the right nasal cavity. No evidence of locoregional lymphadenopathy or pulmonary & bony metastasis.

Discussion

SNTCS remains a diagnostic and therapeutic challenge due to its rarity and histological complexity.⁷ Histologically, these tumors demonstrate diverse differentiation patterns including squamous carcinoma, adenocarcinoma, neuroectodermal tissue, and mesenchymal elements such as chondrosarcoma or osteoid tissue.¹⁰ Immunohistochemistry assists in confirming the biphasic or triphasic nature of the tumor.¹¹

SNTCS is characterized by aggressive local invasion with frequent recurrence and metastasis.¹² Historical data report median survival of less than two years, with recurrence typically occurring within three years.¹²

A systematic review of 86 cases across 49 articles demonstrated improved survival with trimodality therapy (surgery + radiotherapy + chemotherapy) compared to surgery and radiotherapy alone (88.8% vs. 56.5%).⁶ Only two cases in that review were treated with definitive chemoradiotherapy alone, highlighting the scarcity of data supporting nonsurgical approaches.

Another recent case report described rapid progression with pulmonary and hepatic metastases despite surgery and palliative radiotherapy, emphasizing the aggressive nature of this tumor and the need for multimodal therapy.¹³

In our case, induction chemotherapy followed by definitive concurrent chemoradiation achieved durable local control without surgical resection. This suggests:

Significant chemosensitivity
Favorable radiosensitivity
Potential role for organ-preserving strategies in selected cases

The observed long-term disease stability at two years exceeds the historically reported median survival, supporting the potential benefit of aggressive multimodal therapy.

Conclusion

Sinonasal teratocarcinosarcoma is a rare and highly aggressive malignancy with historically poor outcomes. This case demonstrates excellent local control with induction chemotherapy followed by radical concurrent chemoradiation, without surgical resection.

Our findings support:

Early multidisciplinary evaluation
Consideration of multimodal therapy
Inclusion of systemic chemotherapy in treatment planning
Close long-term surveillance

Further multicenter studies and pooled analyses are required to establish standardized treatment guidelines for this rare entity.

References:

Ferna´ndez PL, Cardesa A, Alos L, Pinto J, Traserra J. Sinonasal teratocarcinosarcoma: an unusual neoplasm. Pathol Res Pract. 1995;191(2):166–171
Barnes L, Eveson JW, Reichart P, Sidransky D. 3rd ed. Lyon: International Agency for Research on Cancer; 2005. World Health Organization Classification of Tumours: Pathology and Genetics of Head and Neck Tumours; pp. 76–7.
Sable M, Kakkar A, Garg K, Suri V. Sinonasal teratocarcinosarcoma: an underdiagnosed entity posing diagnostic challenges. Turk Neurosurg. 2017;27(3):468–471
Heffner DK, Hyams VJ. Teratocarcinosarcoma (malignant teratoma?) of the nasal cavity and paranasal sinuses a clinicopathologic study of 20 cases. Cancer. 1984;53:2140–54. doi: 10.1002/1097-0142(19840515)53:10<2140::aid-cncr2820531025>3.0.co;2-y.
Wei S, Carroll W, Lazenby A, Bell W, Lopez R, Said-Al-Naief N. Sinonasal teratocarcinosarcoma: Report of a case with review of literature and treatment outcome. Ann Diagn Pathol. 2008;12:415–25. doi: 10.1016/j.anndiagpath.2007.05.003.
Misra P, et al, Management of Sinonasal Teratocarcinosarcoma: a systematic review, Am J Otolaryngol–Head and Neck Med and Surg (2013)
Heffner DK, Hyams VJ. Teratocarcinosarcoma (malignant teratoma?) of the nasal cavity and paranasal sinuses a clinicopathologic study of 20 cases. Cancer. 1984;53:2140–54. doi: 10.1002/1097-0142(19840515)53:10<2140::aid-cncr2820531025>3.0.co;2-y.
Agrawal N, Chintagumpala M, Hicks J, Eldin K, Paulino AC. Sinonasal teratocarcinosarcoma in an adolescent male. J Pediatr Hematol Oncol. 2012;34:e304–7.
Barnes L, Eveson JW, Reichart P, Sidransky D. 3rd ed. Lyon: International Agency for Research on Cancer; 2005. World Health Organization Classification of Tumours: Pathology and Genetics of Head and Neck Tumours; pp. 76–7
Fletcher CD. 4th ed. Philadelphia: Elsevier Saunders; 2013. Diagnostic Histopathology of Tumors; pp. 143–4.
Pai SA, Naresh KN, Masih K, Ramarao C, Borges AM. Teratocarcinosarcoma of the paranasal sinuses: A clinicopathologic and immunohistochemical study. Hum Pathol. 1998;29:718–22. doi: 10.1016/s0046-8177(98)90281-7.
Wei S, Carroll W, Lazenby A, Bell W, Lopez R, Said-Al-Naief N. Sinonasal teratocarcinosarcoma: Report of a case with review of literature and treatment outcome. Ann Diagn Pathol. 2008;12:415–25. doi: 10.1016/j.anndiagpath.2007.05.003.
Hanif H, Misbah D, Maqsood S, Iftikhar S, Inam Y. Sinonasal Teratocarcinosarcoma: A Rare and Highly Aggressive Neoplasm. Cureus. 2023 Jul 5;15(7):e41396. doi: 10.7759/cureus.41396. PMID: 37546103; PMCID: PMC10401896.

Role of Alprazolam in management of post-endodontic pain after single visit root canal treatment

2026-07-26T10:03:24+00:00

Objective:
To compare mean pain score between two group of participants undergoing post operative pain management after single visit root canal treatment: one group receiving NSAIDs alone and the other receiving a combination of NSAIDs and an anxiolytic medication i.e alprazolam.

Study Design:
Randomized controlled trial (NCT07388368).

Place and Duration of the Study:
Department of Operative Dentistry and Endodontics, Armed Forces Institute of Dentistry (AFID), Rawalpindi, Pakistan from June 2025 to December 2025.

Methodology:

A total of 110 patients with diagnosed symptomatic irreversible pulpitis were randomly grouped based on different medication used. After obturation and temporary restoration, the patients were randomly allocated into one of the two groups with Group 1 receiving ibuprofen 400mg (Abbot Brufen) and Group 2 receiving ibuprofen 400mg (Abbot Brufen) + alprazolam 0.5 mg (Hilton pharma Alp). The root canal treatment was done in a single-visit. Pain intensity was recorded using VAS scale and measured at 6 hours, 12 hours, and 24 hours postoperatively. SPSS version 23 was used for data analysis and p value of 0.05 was considered statistically significant.

Results:

The combination group showed significantly lower pain scores at 6 and 12 hours postoperatively (p < 0.05). At 24 hours, the difference was not statistically significant (p > 0.05). Both groups demonstrated a significant reduction in pain over time (p < 0.001).

Conclusion:

The addition of alprazolam to ibuprofen significantly improves early postoperative pain control following single-visit root canal treatment.

Supervisor-Contested AI Use in Postgraduate Medical Training: A Qualitative Study from Pakistan

2026-07-25T15:51:29+00:00

Background:

The use of Generative AI tools by MBBS qualified post-graduate medical trainees in Pakistan is rapidly expanding, but neither the Pakistan Medical and Dental Council (PMDC) nor the College of Physicians and Surgeons Pakistan (CPSP) has provided regulatory guidance on AI disclosure, supervision, or assessment in post-graduate training at the time of data collection for this study (June 2025). While the published literature has explored AI attitudes and learning outcomes in medical education, none of the studies identified in our search of relevant health professions education and medical education databases examined the supervisor-contested AI incident as the primary unit of analysis, or the consequences for entrustment and professional identity formation that ensued. This study filled this gap in a postgraduate training environment across two cities, 14 specialties and various institutional sectors in Pakistan. The related literatures focus on academic integrity, trust in the workplace, and supervisory conflict and digital professionalism; but none has explored the supervisor-contested AI incident as a unit of analysis and its impact on trust and professional identity in the context of postgraduate medical training.

Methods:

A qualitative design drawing on narrative inquiry principles was employed. Data were collected from 45 MBBS-qualified postgraduate trainees recruited through purposive sampling with maximum variation from training hospitals in Peshawar and Islamabad. In Peshawar, data were collected face-to-face by the principal investigator at Khyber Teaching Hospital (KTH) and Northwest General Hospital (NWGH); in Islamabad, data were collected by a co-investigator at the Pakistan Institute of Medical Sciences (PIMS) and Shifa International Hospital. Each trainee completed a structured open-ended narrative proforma describing a supervisor-contested AI incident. Thematic analysis was applied in a narrative-informed manner, guided by an integrated theoretical framework of entrustment decision-making theory and professional identity formation (PIF) theory. Five themes were generated through inductive coding and iterative team analysis. Trustworthiness was established through Lincoln and Guba's four criteria, member checking with eight trainees, and structured team reflexivity. The study was conducted and reported in accordance with the Standards for Reporting Qualitative Research (SRQR) checklist. The three lenses of PIF theory — identity challenge, moral identity negotiation, and professional socialisation — were incorporated into each of the five themes.

Results:

Five themes emerged: (1) purposive AI adoption driven by identifiable structural deficiencies in the training environment; (2) three distinct supervisory trigger patterns through which AI-assisted work disrupted the evidential basis for entrustment decisions; (3) three trainee navigation strategies — demonstration, disclosure, or strategic silence — each with different consequences for supervisory trust; (4) identity-level responses including shame, ethical dissonance, and dependency anxiety, with an equity dimension absent from existing frameworks; and (5) behavioural recalibration, supervisory relationship outcomes, and operationally specific governance recommendations generated from direct incident experience in a regulatory void. Across all specialties, the contested AI incident disrupted the evidential chain on which entrustment depends and produced identity consequences consistent with PIF theory.

Conclusions:

The supervisor-contested AI incident is a structurally predictable educational event in postgraduate medical training, with identifiable triggers, distinct trainee navigation strategies, and substantive consequences for both entrustment and professional identity formation. PMDC, CPSP, and postgraduate training hospitals are called upon to develop tiered, specialty-sensitive AI governance frameworks incorporating active trainee input. Without institutional action, generative AI use in postgraduate training is likely to expand as a hidden, ungoverned practice with avoidable consequences for academic integrity, patient safety, and the supervisory relationships through which clinical competence develops. This was a cross-sectional qualitative study, so the results should be seen as an account of what trainees report experiencing during a single moment in time; further studies are required that utilize both trainee and supervisor perspectives over time to assess the lasting effects of these consequences over the course of the trainee's career through training.

Keywords:

generative artificial intelligence; postgraduate medical education; clinical supervision; entrustment; professional identity formation; Pakistan; narrative inquiry; qualitative research; AI governance; low- and middle-income countries

ASSESSING USAGE PATTERNS AND DETERMINANTS OF CONTRACEPTION AMONGST FEMALES VISITING A TERTIARY CARE HOSPITAL LAHORE 2024

2026-07-16T12:34:45+00:00

Background: Regardless of presence of different types of Contraceptive agents such as Long-Acting, Hormonal Methods, Barrier Methods and Permanent Methods estimated 257 million reproductive age group females lack access to appropriate family planning methods due to availability, accessibility factors and socio-cultural constraints.

Objective: To assess usage patterns and identify the determinants of contraceptive use amongst ever married Reproductive age group females of the study setting.

Methods: Cross-sectional analytical study was conducted in the Gynae OPD of Lahore General Hospital from June-September 2024 amongst 377 conveniently selected ever married reproductive age group females. Structured questionnaire was used for data collection. Data entry and analysis done using SPSS version 23. Logistic regression was applied to identify factors associated with contraceptive use (p < 0.05).

Results: Out of the 377 participants, 95.65% were married, 30.7% had completed primary education, 75.8%were unemployed, and 70.2% resided in urban areas. The majority (37.6%) belonged to the 25-34-year age group and 51.2% had three or more children. Overall, 39.4% of the women reported using some form of contraception out of which 12.1% were using Intrauterine devices, 10.6% opted tubal ligation followed by 8.7% using condoms. Several factors were identified by participants that influence their choice of contraceptive methods, including cost (5.59%), convenience (30.4%), potential Side effects (2.2%), cultural beliefs (1.24%), partner preference (7.45%), religious beliefs (0.62%) and health care provider recommendation (6.83%). Logistic regression analysis revealed three significant predictors of contraceptive use. Perceived convenience had a strong positive association, with women who considered contraception convenient being far more likely to use it (OR=1277.78, 95% CI: 186.40-8759.41, p<0.001). Healthcare provider recommendation significantly increased the likelihood of contraceptive use (OR =333.94, 95% CI: 32.53-3428.22, p<0.001). Similarly advancing age was significantly associated with increased odds of contraceptive use (OR=287, 95% CI: 1.16-7.12, p=0.023). Similarly, Conclusion: Contraceptive uptake remains suboptimal despite urban residency and education. Increasing age, health care provider recommendation and perceived convenience influence contraceptive use. Improved counseling and understanding barriers may enhance contraceptive uptake.

PULMONARY HEMORRHAGE IN NEONATES AT A TERTIARY CARE NICU IN ISLAMABAD: A CROSS-SECTIONAL STUDY OF PREVALENCE, RISK FACTORS, AND OUTCOMES

2026-07-16T11:26:14+00:00

Introduction: Pulmonary hemorrhage (PH) is a catastrophic neonatal emergency associated with high mortality, but data from Pakistani neonatal intensive care units (NICUs) are scarce.

Objective(s): To determine the prevalence, risk factors, and clinical outcomes of pulmonary hemorrhage among neonates admitted to a tertiary care NICU in Islamabad.

Materials & Methods: A cross-sectional analytical study was conducted in the NICU of Shifa International Hospital, Islamabad, from January to March 2026. A total of 164 consecutively sampled neonates admitted within 72 hours of birth were enrolled, excluding those with major congenital heart defects or pre-existing PH. PH was defined as bloody endotracheal fluid accompanied by acute clinical deterioration. Univariate and multivariable logistic regression were used to identify independent risk factors.

Results: PH occurred in 13 of 164 neonates (prevalence 7.9%; 95% CI: 4.3-13.1%), rising to 14.2% among extremely low birth weight infants. Delivery room intubation (adjusted OR 5.8; 95% CI 2.1-16.4; p = 0.001) and blood product transfusion within six hours (adjusted OR 4.5; 95% CI 1.6-12.9; p = 0.004) were independent predictors. In-hospital mortality was higher in the PH group (61.5% versus 19.2%; adjusted OR 6.9; p < 0.001), as were prolonged mechanical ventilation and oxygen dependence at 36 weeks corrected age.

Conclusions: Pulmonary hemorrhage is common and highly lethal in this tertiary NICU. Delivery room intubation and blood product transfusion are modifiable risk factors; gentler resuscitation and restrictive transfusion practices may help reduce its burden.

Insights into Artificial Intelligence & Ethical Readiness of Undergraduate Medical Students in Digital Era: A Cross-Sectional Snapshot Study

2026-07-16T10:00:37+00:00

Introduction: Artificial Intelligence (AI) is rapidly modifying the healthcare system by entering the medical education field and healthcare practice, yet the existing undergraduate medical education curriculum does not offer formal coverage of AI-related topics. Hence, medical students’ understanding, perception, and ethical awareness of AI in education and healthcare remains poorly explored.

Objective: To evaluate medical students’ understanding, perception, and ethical awareness regarding Artificial Intelligence in education and healthcare.

Material and Methods: A cross-sectional descriptive study was conducted in April 2024, involving medical students at Fazaia Ruth Pfau Medical College, a constituent medical college of the Air University. Through non-probability convenience sampling 351 MBBS students first to final year were assessed for understanding, attitude, and ethical awareness of Artificial Intelligence. Data was collected using a structured questionnaire and analyzed with SPSS version 26.

Results: Data showed a moderate level of understanding of AI, although familiarity with advanced concepts such as generative AI and prompt-related terminology was limited. The majority supported the inclusion of AI in the undergraduate curriculum and practical, hands-on training was favored. Students also indicated awareness of ethical concerns, particularly issues related to data privacy, confidentiality, and responsible use of AI systems. Senior students demonstrated slightly higher awareness compared to junior students.

Conclusion: Suggests foundational understanding of medical students for Artificial Intelligence along with positive attitudes and reasonable ethical awareness. Incorporating structured and practical Artificial Intelligence training into the undergraduate medical curriculum can enhance preparedness for the expanding role of AI in healthcare.

Frequency of hypocalcemia and vocal cord dysfunction following total thyroidectomy

2026-07-16T07:24:48+00:00

Background: Thyroidectomy remains the main source of iatrogenic recurrent laryngeal nerve (RLN) paralysis and the most common complication after total thyroidectomy is still hypocalcemia with varied reported incidences for both transient and permanent hypocalcemia. These injuries induce significant post-operative morbidities from hoarseness to more serious complications including aspiration and dyspnea which are potentially life threatening.

Objective: To determine the frequency of hypocalcemia and vocal cord dysfunction (recurrent laryngeal nerve injury) in patients undergoing total thyroidectomy.

Methods: This was a descriptive cross-sectional study conducted at the Department of Surgery (ward-21), at Jinnah Postgraduate Medical Center (JPMC), Karachi, during the period of three months from February, 2026 to April 2026. All patients (sample size = 81) who met the diagnostic criteria were included. Demographic data was presented as frequency and percentages. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification chi square test was applied taking p-value of ≤0.05 as significant.

Results: total of 81 patients who met the inclusion and exclusion criteria were included in this study. Mean age, serum calcium, BMI, height and weight in our study was 49.69±10.78 years, 3.72±1.24 mmol/L, 28.68±5.11 kg/m2, 153±10.36 cm and 71.7±9.87 kg. Out of 81 patients, 14.8% and 4.9% patients developed hypocalcemia and recurrent laryngeal nerve injury.

Conclusion: Hypocalcemia and recurrent laryngeal nerve injury continues to be a serious complication of thyroid surgery. Therefore, close monitoring of patients must be done in all patients with regular follow-up.

The

2026-07-15T14:22:51+00:00

Introduction: Blood transfusion is a crucial and highly specialised nursing skill in healthcare. It saves the lives of patients; however, if blood is not transfused according to established protocols, complications and adverse reactions can lead to fatal consequences. Aim: To evaluate the effects of educational interventions on blood transfusion among nurses and to assess the association between knowledge levels and various demographic variables. Methodology: A pre- and post-design quasi-experimental study was conducted at the Divisional Headquarters Teaching Hospital, Mirpur, AJK. A total of 58 nurses were included using the census method. A nurse researcher delivered the intervention, and data were collected using an adopted questionnaire. Results: Prior to the intervention, half of the nurses (50%) demonstrated average knowledge regarding blood transfusion, while 38% had poor knowledge, and only 12% exhibited good knowledge. Following the intervention, there was a notable improvement in knowledge levels. Most nurses (79%) demonstrated good knowledge, 12% maintained an average level, while only 9% had poor knowledge regarding blood transfusion. Conclusion: The study's findings concluded that educational interventions enhance nurses' knowledge of blood transfusion.

Keywords: Knowledge, Nurses, Educational Interventions, blood transfusion