Journal of Rehman Medical Institute

A Comparison of Excision With and Without Flap Closure for Pilonidal Sinus Disease

2025-11-10T11:12:17+00:00

Objective: To compare the results from surgeries where a flap was used during the excision and without using the surgical flap for chronic pilonidal sinus disease in terms of complications after the surgery, the length of hospitalization, and the rate of the disease recurrence.

Study Design: Retrospective observational comparative study.

Place and Duration of Study: Department of General Surgery, Hayatabad Medical Complex, Peshawar, from March 2024 to November 2025.

Methodology: A total of 47 patients with chronic pilonidal sinus disease were identified by reviewing the medical and surgical records from the department of General Surgery, Hayatabad Medical Complex, between March 2024 and November 2025. They were divided into two groups: Group A (n = 24) had excision without flap closure, while Group B (n = 23) had excision with flap closure using either the Karydakis or Limberg technique. We excluded all patients who had recurrent pilonidal sinuses after multiple surgeries, sacral osteomyelitis, or other chronic infections. We evaluated postoperative outcomes for pain, infection, dehiscence, hospital stay, healing time, and recurrence. We analyzed the data using SPSS v25.0, applying Chi-square and independent t-tests, with p < 0.05 seen as significant.

Results: Out of the 47 patients, 42 (89.4%) were men and 5 (10.6%) women, whose mean age was 27.3 ± 4.2 years, respectively. Postoperative pain was considerably greater in the open group (70.8%) than in the flap group (26.1%, p = 0.012). Wound infection happened in 6 patients (25%) of Group A and 2 patients (8.7%) of Group B (p = 0.045). Open group stayed in the hospital for an average of 5.4 ± 1.8 days and the flap group only for 3.1 ± 1.2 days (p < 0.001). Recurrence was experienced in 4 patients (16.7%) of Group A and 1 patient (4.3%) of Group B (p = 0.04).

Conclusion: Flap closure after excision of pilonidal sinus significantly reduces postoperative complications, hospital stay, and recurrence rate compared to excision without flap.

Keywords: Pilonidal sinus disease; Flap closure; Karydakis flap; Limberg flap; Recurrence; Postoperative complications.

S Beyond Phishing: Detecting MFA Fatigue and Adversary-in-the-Middle at Scale

2025-11-09T19:01:14+00:00

This study proposes a defender-centric strategy to detect and contain two fast-rising attack patterns—MFA fatigue and Adversary-in-the-Middle (AiTM)—without relying on expensive tooling. We introduce a lightweight pipeline that fuses identity telemetry (push frequency anomalies, impossible travel), web gateway indicators (suspicious reverse-proxy domains), and endpoint signals (token theft heuristics) into actionable detections. Evaluated across 15 small-to-medium organizations, the approach reduced median time-to-detect by 63% and cut successful account takeovers by 41% over eight weeks. We document failure modes (e.g., noisy travel baselines), provide hardening tips (phishing-resistant MFA, conditional access, token binding), and publish query patterns that can be adapted to common SIEM/XDR platforms. The results indicate that defenders can meaningfully blunt modern phishing and session-hijacking campaigns with modest engineering effort and targeted telemetry enrichment.

PREVALENCE AND IMPACT OF NIGHT SLEEP DEPRIVATION AND ACADEMIC STRESS ON PHYSICAL AND MENTAL HEALTH AMONG MEDICAL STUDENT OF KARACHI

2025-11-08T05:01:26+00:00

Background: Medical students globally face significant academic pressures that often lead to sleep deprivation and elevated stress levels, with potential consequences for their physical and mental health. Limited research exists on these issues regarding medical students in Karachi, Pakistan.

Objective: To assess the prevalence of night sleep deprivation and academic stress among medical students in Karachi and analyze their impact on physical and mental health outcomes.

Methods: A cross-sectional observational study was carried out among 350 medical students (aged 18-25 years) enrolled in the MBBS program at Jinnah Sindh Medical University (JSMU) in Karachi. Participants were recruited from all academic year levels. Data collection was performed using a comprehensive online survey instrument that included: participant demographics, sleep quality assessment via the Pittsburgh Sleep Quality Index (PSQI), stress levels measured using the 10-item Perceived Stress Scale (PSS-10), and overall health status determined by the 12-item Short Form Health Survey (SF-12). Ordinal logistic regression analysis was employed to determine factors predictive of health outcomes.

Results: The study revealed alarming rates of stress and poor sleep quality among participants. Regarding stress levels, 40.0% of students reported high stress, 33.7% experienced extreme stress, and 17.1% reported very high stress. Sleep quality assessment showed that 50.3% of participants had very poor sleep quality, while 35.7% experienced severe sleep problems. For health outcomes, 66.6% reported moderate health problems and 28.3% reported severe health issues. Ordinal logistic regression analysis identified very poor sleep quality as the only significant predictor of worse health status (OR = 1.82, 95% CI [1.11, 2.97], p = .017). Perceived stress levels, gender, age, and academic year were not significantly associated with health outcomes.

Conclusions: The study demonstrates a high prevalence of sleep deprivation and academic stress among medical students in Karachi, with sleep quality being a significant predictor of self-reported health status. These findings highlight the critical need for interventions focusing on sleep hygiene and stress management in medical education curricula. The results suggest that addressing sleep quality may be more impactful than stress reduction alone in improving student health outcomes.

Keywords: Medical students, sleep deprivation, academic stress, health outcomes, Karachi, Pakistan.

The Double-Edged Sword of AI in Research: Growth Driver or Learning Threat?

2025-11-03T08:01:32+00:00

Prevalence of Hair fall and Association of its Risk factors Among Medical Students of KP

2025-10-31T09:54:48+00:00

Introduction:

Alopecia or hairloss, is a common issue that affects people of all ages and genders and frequently results in psychological distress and a lower quality of life. Hair loss is caused by a variety of reasons, such as lifestyle choices, stress, genetics, and hair care habits. Despite the fact that numerous research have examined its prevalence worldwide, little is known about medical students in Khyber Pakhtunkhwa(KPK), Pakistan.

Objective

To establish the frequency of hair loss among KPK medical students as well as the demographic, genetic, lifestyle, and psychosocial risk factors that are linked to it.

Methods

A descriptive cross-sectional study was carried out throughout KPK's medical colleges. Sample size of 280 was calculated by open EPI keeping 95% confidence interval, 5% margin of error, and anticipated prevalence of 76.2%.Convenience sampling was used. Data was gathered via a self-administered questionnaire. SPSS version 27 was used to analyze the data.

Results

238 (85%) of the 280 participants—reported having hair loss. Compared to men, women had a greater effect (90.2% vs. 76.4%, p < 0.001). The most prevalent pattern of hair loss was diffuse thinning (n = 133, p = 0.030). A family history of hair loss, especially when both parents and siblings were impacted, and a positive hair pull test are major indicators. Hair loss is also substantially correlated with stress- related variables, including nervousness (p<0.001), incapacity to manage anger (p=0.001), and incapacity to cope (p=0.013). Smoking was the lifestyle factor most strongly linked to hair loss (p = 0.001), while regular exercise was linked to decreased hair loss (p = 0.013). Another significant effect (p = 0.001) was the frequency of hair washing, with less frequent washing being associated with higher hair loss. No significant associations were observed with diet, hydration, or socioeconomic status

Conclusion

In KPK, hair loss is very common among medical students, especially in females. Genetic predisposition, stress, smoking, and poor hair care are important risk factors. on the other hand, consistent exercise and good scalp hygiene seem to be protective.

SLEEP DEPRIVATION AND ITS CAUSES, EFFECTS AND COMPARISON IN DIFFERENT SOCIODEMOGRAPHIC STUDENTS OF MEDICAL COLLEGES OF KPK

2025-10-31T09:41:16+00:00

Introduction

Sleep deprivation occurs when an individual fails to obtain less than five to seven hours sleep at night chronically. Medical students are more likely than other students to suffer from sleep deprivation, which is mostly caused by a demanding course load, stress, and unhealthy lifestyle choices. Sleep deprivation affects psychological health, academic performance, and cognitive function. With sociodemographic variations, this study investigated the frequency, causes, and consequences of sleep deprivation among medical students in Khyber Pakhtunkhwa (KPK), Pakistan.

Methods

321 students from KPK's public and private medical colleges participated in a descriptive cross-sectional study. A standardized, self-administered questionnaire was used to gather data. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to measure sleep quality and daytime sleepiness. Statistical analysis was carried out using SPSS v27.

Results

The mean age of participants was 21.05 ± 1.47 years, with 52.3% of them being male and 47.7% being female. Overall, 30.5% of respondents reported mild to severe daytime sleepiness, whereas 58.3% of respondents indicated poor sleep quality based on PSQ1. Screen usage (34.4%), ineffective time management (25.7%), academic pressure (21.3%), and stress or worry (13.7%) were the main contributors to sleep deprivation. Compared to female students, male students' sleep quality was noticeably worse (p = 0.039). Poor sleep was significantly correlated with stress and anxiety (p = 0.002), but not with socioeconomic status or place of residence. There was a strong correlation between daytime tiredness and using electronic devices before bed (p = 0.014). Significantly, 85% of respondents said that getting too little sleep has a noticeable impact on their academic performance.

Conclusion

Due to psychological and academic stressors, the majority of medical students in KPK have insufficient and poor-quality sleep. In order to improve their academic performance and sleep hygiene, these findings highlight the critical need for awareness campaigns, mental health services, and interventions such time management training and counseling.

Prevalence of Cyberchondria Among Medical students in Khyber Pakhtunkhwa, Pakistan; The Role of Obsessive-Compulsive Disorder and Sociodemographic Correlates (A Cross-sectional Study)

2025-10-31T09:19:59+00:00

Background:

Cyberchondria means extensive use of Internet for self- diagnoses leading to psychopathologies and may negatively affect mental health. Its relationship with obsessive–compulsive disorder (OCD) among medical students remains underexplored.

Objective:

To determine the prevalence of cyberchondria and its association with OCD and sociodemographic factors among medical students in Khyber Pakhtunkhwa, Pakistan.

Methods:

This cross-sectional study was conducted in all public-sector medical colleges affiliated with Khyber Medical University. A total of 291 MBBS students were selected after ethical approval from ERB of NMC. Data were collected using the Cyberchondria Severity Scale–Short Form (CSS-15), the Obsessive-Compulsive Inventory–Revised (OCI-R), and a sociodemographic questionnaire. Statistical analysis was performed in SPSS version 26, applying chi-square tests and ordinal regression.

Results:

Of 291 participants (mean age 21.35 ± 1.77 years; 66% male), 85.9% demonstrated low cyberchondria severity, 6.5% moderate, and 7.6% severe. OCD positivity was significantly higher in moderate (78.9%) and severe (72.7%) groups compared with the low group (53.2%) (p = 0.025). Frequent health-related internet searching (p = 0.002) and reliance on online symptom checkers (p < 0.001) were strong independent predictors of higher cyberchondria severity. Ordinal regression indicated OCD-positive students had 1.742 times higher odds of falling into greater severity categories (p = 0.028). No significant associations were found with sociodemographic variables including age, gender, residence, marital status, or academic performance.

Conclusion:

Cyberchondria severity among medical students in Khyber Pakhtunkhwa was generally low, possibly due to protective effects of health literacy. However, its strong association with OCD highlights the need for awareness and targeted interventions to address compulsive health information-seeking behaviors

Research Capacity and Culture among Undergraduate MBBS Students in Medical Colleges of Rawalpindi

2025-10-30T10:48:16+00:00

ABSTRACT

Introduction: Involvement in research among medical students is a vital parameter in academic skills development and medical knowledge development. Nevertheless, institutional support, mentorship, and access to resources are among several factors that can have a large influence on the engagement of students in research activities.

Objective: To assess the factors influencing research involvement among medical students, focusing on institutional support, faculty mentorship, access to resources, and barriers to research participation.

Materials and Methods: The study was a descriptive cross-sectional study done at Rawalpindi Medical University, Pakistan between January to June 2025. A questionnaire that participants self-administered was issued to 260 undergraduate medical students. The demographic information was gathered using the questionnaire, perceptions on the institutional support, mentorship, research barriers, and motivation towards research. The SPSS version 22 was used in analyzing the responses.

Results: The response rate was 85.6% and the mean age was 22.1 ± 2.3 years. Research involvement in personal faculty support (p < 0.001) and access to resources (p < 0.001) was found to significantly predict research involvement. Research engagement was also positively correlated with mentorship (p < 0.05). The constraint of time and financial aspects was discovered as a hindrance to the research participation. Students who felt better institutional support in their perception were more likely to have been engaged in research.

Conclusion: The research demonstrated that faculty support and resource availability are crucial for promoting research participation, yet challenges such as time constraints and funding issues persist, suggesting the need for medical schools to implement policies that address these barriers and enhance mentorship.

Keywords: Research Involvement; Medical Students; Mentorship; Institutional Support; Research Barriers

Artificial Intelligence in Prosthodontics: A Systematic Review of Historical Progression, Contemporary Applications, and Future Directions

2025-10-27T07:14:31+00:00

Introduction:
Artificial intelligence (AI) has increasingly gained attention in healthcare for its potential to improve and transform different aspects of healthcare , including Prosthodontics . This systematic review aims to explore the historical progression, current applications, and future directions of AI in prosthodontics .
Objectives:
To investigate, gather and present a comprehensive review regarding the use of AI in prosthodontics, its role in diagnosis, treatment planning, prosthesis design, and workflow optimization.

Materials & Methods:
A structured literature search was conducted in PubMed, Scopus, and Google Scholar to find studies published from 2019 to 2023. A total of 365 articles were identified, after screening those articles based on present inclusion/exclusion criteria a final 80 studies were selected for this review.

Results:
The current five key domains of AI applications in prosthodontics are : diagnostic imaging, treatment planning, prosthesis design/fabrication, dental implants, and smile design. While a generous amount of studies evidently shows improvements in diagnostic accuracy, treatment efficiency, and patient-specific outcomes, certain limitations like small sample sizes and lack of standardized clinical protocols still exist.

Conclusion:
AI applications holds significant potential to revolutionize prosthodontic practice through increased patient personalization, treatment accuracy, and efficiency. continued research is essential to establish standardized guidelines to ensure ethical integration of AI technologies in dental practice.

MR Hepatitis A and E, seroprevalence, liver function tests, pediatric infection, and vaccination strategy

2025-10-22T18:07:41+00:00

Hepatitis A and E, seroprevalence, liver function tests, pediatric infection, and vaccination strategy

Background: Hepatitis A virus (HAV) and hepatitis E virus (HEV) are endemic in many regions of Pakistan, including Balochistan, where sanitation challenges and limited vaccination coverage contribute to disease burden. This study aimed to assess the seroprevalence of HAV and HEV and evaluate liver function abnormalities in a registry of patients from Balochistan.

Methods: A retrospective registry-based analysis was conducted on 441 patients aged 4–53 years. Serological markers (Anti-HAV IgM, Anti-HAV IgG, Anti-HEV IgM, Anti-HEV IgG) and liver function tests (ALT, AST, bilirubin fractions, ALP, GGT, albumin) were evaluated. Patients were stratified by age and sex, and diagnostic prevalence was calculated.

Results: Acute HAV infection (Anti-HAV IgM reactive) was identified in 142 patients (32.2%), predominantly among children under 12 years. Past HAV exposure (Anti-HAV IgG reactive, IgM non-reactive) was observed in 98 cases (22.2%), increasing with age. HEV exposure was rare, with 17 cases (3.9%) showing reactive Anti-HEV IgG and no active HEV infections detected. Severe liver injury (ALT >1000 U/L, AST >2000 U/L, direct bilirubin >3.5 mg/dL, elevated ALP and GGT) was documented in 38 cases (8.6%), all associated with acute HAV infection.

Conclusion: This registry analysis from Balochistan reveals a high burden of acute HAV infection in pediatric populations, often accompanied by severe liver dysfunction. Past HAV exposure increases with age, while HEV exposure remains minimal. These findings underscore the urgent need for targeted HAV vaccination, improved sanitation infrastructure, and routine liver function monitoring in endemic regions like Balochistan.

Documentation Completeness of In-patient Medical Records: An Audit at a Teaching Hospital in Lahore Pakistan

2025-10-22T09:07:39+00:00

Objective: Clinical audits are a well-established tool for ensuring adherence to standards and driving improvements in healthcare delivery. To recognize deficiencies in our documentation practices, we undertook a clinical audit to evaluate the completeness of in-patient medical record documentation at a teaching hospital in Lahore, Pakistan.

Methods: A standardized checklist, based on Islamabad Healthcare Regulatory Authority, Punjab Healthcare Commission and Royal College of Physicians guidelines, was used after ethical approval from Azra Naheed Medical College. All medical records from the Department of Medicine from April to June 2025 were reviewed. Out of 141 retrieved files, 122 were analyzed (19 excluded due to damage/missing data). Data analysis was conducted using SPSS v23.

Results: Basic demographics (name, age, gender, registration number) were fully documented. Address and contact number were noted in 90.9% and 84.4% of records, respectively. Occupation (18.8%) and weight (19.6%) were poorly recorded. Presenting complaints (98.3%) and history of present illness (94.2%) were well documented; systemic and past medical history were complete (100%). Medication and family histories appeared in 78.6% and 93.4%. Psychiatric (6.5%), sexual (21.3%), and gynecological (10.6%) histories were rarely recorded. Dietary/appetite history (86%), travel (19.6%), and vaccination (28.6%) were inconsistently noted. Vitals and focused examinations were complete, while other systems exams were documented in 86.8%. All required tests and results were included, but flow charts were present in only 35.2%. Admission summaries (92.6%), provisional diagnoses (100%), problem lists (95.9%), and final diagnoses (98.3%) were mostly complete. Medications and follow-up plans were consistently documented; procedures/interventions appeared in 87.7%.

Conclusion: While documentation was strong in several areas, key gaps remain in patient history and auxiliary data, requiring ongoing efforts to improve clinical record-keeping standards.

HEALTHCARE PROFESSIONALS’ KNOWLEDGE AND ATTITUDES TOWARD PAIN MANAGEMENT AND OPIOID THERAPY CONCERNS IN HOSPITALS AFFILIATED WITH ARMY MEDICAL COLLEGE

2025-10-20T16:00:36+00:00

Background

Despite pharmacological advancements, effective chronic pain management remains a challenge worldwide due to healthcare providers’ limited knowledge and negative attitudes toward management with opioid analgesics. Growing concerns about opioid misuse, dependence, and adverse effects often result in the under-treatment of pain.

Objectives

This study aimed to explore the healthcare professionals’ (HCPs) knowledge and attitudes about pain assessment and management. The study also aimed to examine HCPs’ concerns regarding opioid therapy for patients with chronic pain and to assess the associations between demographic variables, KASRP scores, providers’ concerns, and identify predictors of KASRP scores.

Methods

A descriptive, cross-sectional study was conducted among 236 HCPs (doctors and nurses) using the Knowledge and Attitude Survey Regarding Pain (KASRP), and a 6-point Likert scale for concerns regarding opioid use. Descriptive statistics were used for demographic variables, KASRP scores, and Likert scale responses. Additionally, inferential analysis tested associations and predictors of KASRP scores.

Results

The results showed a mean KASRP score of 54.66% ± 13.45, indicating deficient knowledge and negative attitudes toward pain management, and high concerns regarding opioid prescription. KASRP scores showed a significant association with professionals’ personal pain history (p = 0.019) but no demographic variable predicted KASRP scores. Chi-square analysis revealed some significant associations between opioid concerns and demographic characteristics (p < 0.05), though most were not significant.

Conclusions

All healthcare professionals need improvement in their knowledge of pain assessment and management, especially regarding the use of opioid analgesics.

Keywords

Health personnel; Chronic pain; Pain management; Analgesics, Opioid/misuse; Knowledge, Attitudes, Practice; Pakistan.