https://jrmi.pk/ <p><strong>ISSN(Print): </strong>2708-8367 <strong>ISSN(</strong><strong>Online): </strong>2708-8375</p> <p><strong>DOI PREFIX:</strong> 10.52442</p> <p>Journal of Rehman Medical Institute (JRMI; J Rehman Med Inst.) is an initiative to introduce a high quality standard publication that highlights important research output from medical professionals of the country and around the world.</p> <p>This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.</p> <p>JRMI follows international guidelines for peer-reviewed journals as provided by the International Committee of Medical Journal Editors (ICMJE; <a href="http://www.icmje.org/">http://www.icmje.org</a>) and the Committee on Publication Ethics (COPE; <a href="http://publicationethics.org/">http://publicationethics.org/</a>)</p> <p>The journal accepts Original Articles, Short Communications, Case Reports, Review Articles, Conference Reports, Letters to the Editor, and General Articles of medical interest. It is open to all biomedical professionals whose work has a bearing on human health and disease.</p> Rehman Medical Institute en-US Journal of Rehman Medical Institute 2708-8367 <p>This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial License (<a href="https://creativecommons.org/licenses/by-nc/4.0">http://creativecommons.org/licenses/by-nc/4.0</a>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> https://jrmi.pk/article/view/1126 <p>The role of Enterobius Vermicularis in triggering appendicitis remains controversial as&nbsp;an&nbsp;incidental&nbsp;finding or&nbsp;actual etiology. We report an 11-year-old boy presented with right lower quadrant abdominal pain and perianal itching. Examination found positive guarding&nbsp;and tenderness. Biochemical markers&nbsp;were&nbsp;normal. Abdominal ultrasound suggested&nbsp;parasitic infestations in the appendiceal lumen. Open appendectomy&nbsp;revealed an inflamed tissue&nbsp;with&nbsp;lumen&nbsp;obstructed&nbsp;by&nbsp;helminths. Post operative standard antibiotic cover with albendazole was administered. This case emphasizes E. vermicularis as an etiology of atypical acute appendicitis, and&nbsp;highlights&nbsp;the need of early recognition and management.</p> Dr Maryam Saqib Copyright (c) 12 1 https://jrmi.pk/article/view/1125 <p><strong>Objectives: </strong>To compare the shear bond strength (SBS) of graphene-modified, bioactive glass-modified, and conventional orthodontic composites before and after artificial aging and to evaluate their adhesive remnant index (ARI).</p> <p><strong>Methodology: </strong>This in-vitro experimental study was conducted using 60 extracted human premolars, randomly assigned to three groups (10 per group). Brackets were bonded using graphene-modified composite, bioactive glass-modified composite, and conventional composite resin. All samples underwent SBS testing using Universal Testing Machine before and after thermocycling (5°C–55°C, 5000 cycles). Failure patterns were assessed under stereomicroscopy using the ARI. Data was analyzed using SPSS version 25, normality was assessed using Shapiro-Wilk test, comparisons were made using one-way ANOVA, Tukey’s post hoc, paired t-tests, and chi-square tests (p&lt;0.05).</p> <p><strong>Results: </strong>Before aging, mean SBS values (MPa) were highest in the graphene-modified composite (15.84±0.54), followed by the bioactive glass-modified (12.80±1.09) and conventional composite (10.66±0.85) (p&lt;0.001). After aging, SBS decreased in all groups i.e., graphene-modified (14.01±0.47), bioactive glass-modified (11.60±1.38), and conventional (9.40±1.04) (p&lt;0.001). The reduction in SBS after thermocycling was significant in all groups (p&lt;0.001). No significant difference was observed in ARI distributions across groups (p=0.423).</p> <p><strong>Conclusion: </strong>Graphene-modified composites showed highest bond strength and aging resistance compared to bioactive glass-modified and conventional adhesives. Their greater shear bond strength and stable adhesive interface suggest potential for long-term clinical orthodontic use.</p> Fatima Zahra Ali Hammad Hassan Hira Asghar Rabia Anjum Lubbabah Ibrahim Amna Younas Copyright (c) 12 1 https://jrmi.pk/article/view/1124 <p><strong>ABSTRACT:</strong></p> <p>&nbsp;<strong>Objective:</strong></p> <p>To identify the incidence of metabolic acidosis in infants with early-onset sepsis and to assess the arterial blood gas and biochemical profile of metabolic acidosis.</p> <p><strong>Study Design:</strong></p> <p>Cross-sectional study.</p> <p><strong>Methodology:</strong></p> <p>A cross-sectional study (November 2023-April 2024) of 241 neonates ([?]7 days) with early-onset sepsis at Imran Idrees Teaching Hospital, Sialkot, was conducted. The parameters of arterial blood gas and serum lactate were measured at the beginning of the treatment and analyzed by independent sample t-test where p &lt; 0.05 was set as the significant value.</p> <p><strong>Results:</strong></p> <p>Metabolic acidosis was identified in 64 (26.6%) neonates with early-onset sepsis. Neonates with metabolic acidosis demonstrated significantly lower arterial pH (7.26 ± 0.07 vs 7.38 ± 0.05; p &lt;0.001) and bicarbonate levels (17.9 ± 2.8 vs 24.1 ± 2.5 mmol/L; p &lt;0.001) compared to those without acidosis. Base deficit (−8.4 ± 3.2 vs −2.3 ± 1.8 mmol/L; p &lt;0.001) and serum lactate levels (4.0 ± 1.2 vs 2.1 ± 0.7 mmol/L; p &lt;0.001) were significantly higher in acidotic neonates, while PaCO₂ levels did not differ significantly between groups (p = 0.094).</p> <p><strong>Conclusion:</strong></p> <p>Early-onset sepsis complicates the neonate with metabolic acidosis, which is a prevalent biochemical abnormality. Early biochemical evaluation of arterial blood is necessary to detect and treat at-risk septic infants in time.</p> <p><strong>Keywords</strong></p> <p><em>Metabolic acidosis, neonatal sepsis, arterial blood gas, early-onset sepsis.</em></p> Dr sana saleem Dr. Samreen Iqbal Dr Allah Bakhsh Dr Sadia Rehman Dr Rida Ali Aakash Kumar Copyright (c) 12 1 https://jrmi.pk/article/view/1120 <p><strong>ABSTRACT</strong></p> <p>Mixed phenotype acute leukemia (MPAL) with both B and T cell features is incredibly rare and tough to pin down. In this form of acute leukemia, the cancerous cells carry markers from more than one blood cell type. MPAL makes up less than 5% of all acute leukemia cases, but it’s more aggressive than the usual types. It often shrugs off standard chemo, which makes things even harder for patients.</p> <p>Here’s the case: a 77-year-old man came in feeling weak, and his white blood cell count wouldn’t come down. When doctors checked his bone marrow, they found two separate groups of abnormal cells—one with B-cell markers, the other with T-cell markers. Molecular tests showed he had the BCR-ABL1 p190 fusion transcript.</p> <p>This case really shows why it’s so important to use detailed cell marker testing and molecular analysis for MPAL. Without that, it’s easy to miss or misdiagnose. Getting the diagnosis right matters—it’s the only way to pick the right, targeted treatment for patients facing this rare and stubborn leukemia.</p> Shayan Ashfaq Copyright (c) 12 1 https://jrmi.pk/article/view/1119 <p><strong>ABSTRACT</strong></p> <p>The glyoxylate pathway is impacted by primary hyperoxaluria (PH), a rare genetic metabolic disorder that causes an excess of oxalate to be produced. This oxalate builds up in different organs as calcium oxalate.&nbsp; Later on, the crystals may also deposit in non-renal tissues like bone marrow, but the kidneys are usually the first and most severely affected, resulting in progressive kidney damage and recurrent kidney stones.&nbsp; We describe a case of a male patient, age 22, who had end-stage renal disease (ESRD), was receiving twice-weekly hemodialysis, and was the subject of a kidney transplant evaluation.&nbsp; He had had two nephrolithotomy surgeries in the past and had a history of kidney stones that started to occur frequently in early childhood. He eventually developed ESRD that required dialysis as his renal function steadily deteriorated. Unknown cytopenia during his transplant evaluation led to a bone-marrow test. The biopsy showed needle-shaped birefringent crystals encircled by foreign-body giant cells, focal fibrosis, and marrow that was normocellular to mildly hypercellular, with many osteoblasts and osteoclasts along bony trabeculae—findings typical of calcium-oxalate deposition (bone-marrow oxalosis). By connecting these histologic characteristics to the patient's lifetime history of renal failure and nephrolithiasis, the diagnosis of Primary Hyperoxaluria with bone-marrow oxalosis was validated. In patients with ESRD and unexplained cytopenias, this case demonstrates a rare manifestation of PH and the diagnostic utility of bone-marrow evaluation, especially when early-onset nephrolithiasis has been a feature of the patient's clinical trajectory.</p> Shayan Ashfaq Copyright (c) 12 1 https://jrmi.pk/article/view/1118 <p><strong>ABSTRACT</strong><br>The dimorphic fungus Histoplasma capsulatum causes histoplasmosis, an infection that can manifest as anything from a simple, self-limiting illness to a serious, widely spread illness. Fungal culture is still the gold standard for confirmation, but diagnosis is sometimes delayed by its slow development. Bone marrow analysis can offer a quick and accurate diagnostic substitute in these situations. We describe a male immunocompetent patient, age 21, who has had a persistent fever and malaise for three months that have not improved with empirical treatment. Repeated blood cultures and serologic testing came out negative, but laboratory studies showed cytopenias. Grocott-Gomori methenamine silver and periodic acid-Schiff stains, on the other hand, revealed intracellular and extracellular yeast-like organisms in bone marrow aspirate and trephine biopsy that were morphologically consistent with Histoplasma capsulatum.</p> Shayan Ashfaq Copyright (c) 12 1 https://jrmi.pk/article/view/1117 <p>NA</p> <p>An abstract is normally not required for an editorial; a pictorial abstract have been attached in the main document.</p> Munawar Hussain Soomro Mansoor Magsi Salma Memon Copyright (c) 12 1 https://jrmi.pk/article/view/1116 <p><strong>Background: </strong>A common and dangerous side effect of liver cirrhosis, hepatic encephalopathy (HE) dramatically raises hospitalization, morbidity, and mortality. There is little local data from low-resource environments. Among hospitalized patients with cirrhosis at Mardan Medical Complex, Mardan, the goal is to ascertain the prevalence, grade distribution, precipitating events, and independent predictors of early HE (within 48 hours).</p> <p><strong>Methods</strong>: <strong>&nbsp;</strong>Between January and August of 2025, a prospective cross-sectional study was carried out. Adults who had cirrhosis and were consecutive were enrolled. At admission and 48 hours later, HE was evaluated using the West Haven criteria. Clinical and analytical parameters were gathered, and precipitating factors were screened methodically. Using multivariable logistic regression with bootstrap validation, independent predictors were found. AUC and calibration measures were used to assess the model's performance, and a bedside nomogram was produced.</p> <p><strong>Results</strong>: 256 patients (mean age 54.3 ± 11.8 years; 59.8% male) were included out of 281 screened. 39.5 percent (95 percent CI 33.7–45.6) had HE, and 81.2% had Grade I–II. The most common precipitants were hyponatremia (29.7%) and infection (36.6%). AOR 2.41 (95 % CI 1.34–4.33), infection (2.09; 1.28–3.43), sodium (per 3 mmol/L decrease: 1.35; 1.16–1.57), creatinine (per 0.5 mg/dL increase: 1.28; 1.04–1.58), bilirubin (per 1 mg/dL increase: 1.06; 1.02–1.10), INR (per 0.5 increase: 1.31; 1.06–1.62), constipation (1.68; 1.02–2.77), and exposure to psychoactive drugs (1.95; 1.06–3.57) were all independent predictors. The model demonstrated high calibration and strong discrimination (AUC 0.83).</p> <p><strong>Conclusion</strong>: Modifiable factors play a major role in the prevalence of early HE in cirrhosis. In environments with limited resources, the validated bedside nomogram may facilitate early triage and focused interventions.</p> <p><strong>Keywords:</strong>&nbsp;Hepatic Encephalopathy; Liver Cirrhosis; Risk Factors; Logistic Models; Cross-Sectional Studies; Hyponatremia; Renal Insufficiency; Infection; Nomograms; Hospitalization; Prognosis; Pakistan</p> Farman Ullah Shah Sardar Alam Sardar Alam Raees Ahmad Khan Rehman Ud Din Nadeem Akhtar Copyright (c) 12 1 https://jrmi.pk/article/view/1115 <p><strong>Background:</strong> Sciatica is a common neuropathic pain condition caused by lumbar disc herniation, leading to radiating leg pain, sensory disturbances, and functional disability. Lumbar discectomy is widely performed when conservative treatment fails, with evidence showing substantial postoperative improvement.</p> <p><strong>Objective:</strong> To determine the neurological and functional outcomes among patients of sciatica undergoing lumbar discectomy</p> <p><strong>Methodology:</strong> This retrospective cohort study was conducted on 349 patients who underwent lumbar discectomy. Demographic data, clinical presentation, imaging, surgical details, and pre and postoperative neurological examinations were reviewed. Pain was assessed using the Visual Analogue Scale (VAS) and disability using the Oswestry Disability Index (ODI). Statistical analysis was performed using paired t-test and McNemar’s test, with significance set at p &lt; 0.05.</p> <p><strong>Results:</strong> The mean age was 47.9±10.8 years, with 209(60%) males. Most patients 185(53%) had symptoms &lt;6 months. Postoperative VAS leg pain significantly improved from 7.78±1.22 to 2.97±1.12 (p&lt;0.001), and VAS back pain from 5.52±1.23 to 3.11±1.24 (p&lt;0.001). Motor deficits decreased from 58(32.6%) to 12(6.7%), sensory deficits from 87(48.9%) to 24(13.5%), and reflex loss from 70(39.3%) to 22(12.4%), all with p&lt;0.001. ODI scores shifted markedly, with minimal disability increasing from 0% to 99(28.4%) and severe disability decreasing from 222(63.6%) to 41(11.7%). Complications included wound infection 9(2.6%) and reoperation for recurrence 7(2.0%).</p> <p><strong>Conclusion:</strong> Lumbar discectomy provides significant pain reduction, neurological recovery, and functional improvement with low complication rates, supporting its effectiveness for sciatica due to lumbar disc herniation.</p> <p><strong>Keywords:</strong> Sciatica, Diskectomy, Functional Outcome</p> Aziz Ur Rehman Sulaiman Khan Muhammad Faizan Qadir Wadood Khan Zulfiqar Ali Shah Armoghan Khattak Copyright (c) 12 1 https://jrmi.pk/article/view/1114 <p><strong>Objective:</strong> To determine meropenem efficacy and resistance patterns among culture-proven neonatal sepsis cases and evaluate associated clinical outcomes.</p> <p><strong>Study Design and Duration: </strong>This was a retrospective cohort study conducted from April 2024 to 2025 at Neonatal Intensive Care Unit, Northwest General Hospital and Research Centre, Peshawar.</p> <p><strong>Methodology:</strong> The study includes 132 neonates patients data, extracted from hospital electronic record system. The Neonate presented with culture-proven sepsis and who received meropenem and have complete medical record was included in the study population. The total patients during this time was 132. Clinical variables like bacterial isolates, meropenem sensitivity, mortality, and hospital stay were recorded in a predesigned proforma. Data was analyzed through SPSS 25. Chi-square test assessed associations (p≤0.05 significant).</p> <p><strong>Results:</strong> A total of 132 neonates were included, predominantly male 100 (75.8%), with a median age of 10 days. Most of the patients was presented within the first 10 days of life 99 (75.0%). Almost 70 (53.0%) isolates were resistant, 57 (43.2%) sensitive, and 5 (3.8%) intermediate. Gram-negative non-fermenters showed highest resistance (77.1%), Gram-positive cocci showed 60.9% sensitivity. Meropenem sensitivity was higher in preterm (49.2%) vs term (38.0%) neonates (p=0.435). Significant association found between organism type and meropenem sensitivity (p=0.021). Mortality was 15.9%.</p> <p><strong>Conclusion:</strong> High meropenem resistance in neonatal sepsis highlights urgent need for antimicrobial stewardship.</p> <p><strong>Keywords:</strong> Neonatal Sepsis, Meropenem, Drug Resistance, NICU, Gram-Negative Bacteria, Antibiotic Stewardship.</p> Aizaz Raheem Wasim Akram Amjad khan Huma Iftikhar Aziz Ur Rehman Aizaz Ahmad Copyright (c) 12 1 https://jrmi.pk/article/view/1113 <p><strong>Introduction:</strong></p> <p>Empyema thoracis in deformed patients with complex and bronchopleural fistula is hard to treat, especially when it is not possible to perform major surgery. At these instances, Claggett window thoracostomy could be used as an alternative to effective drainage and infection control.</p> <p><strong>Objective:</strong></p> <p>To determine the results of Claggett window thoracostomy in patients with complicated empyema thoracis.</p> <p><strong>Materials &amp; Methods:</strong></p> <p>This was a retrospective single centre research undertaken at Rehman Medical Institute, Peshawar, between the years 2017 and 2022. Claggett window thoracostomy was performed on 51 cachectic patients who had unilateral diseased lungs and were not fit to undergo major surgery and also failed in the previous interventions performed on them under local anesthesia and sedation. Analysed pre- and postoperative C-reactive protein (CRP) and forced expiratory volume in one second (FEV1).</p> <p><strong>Results:</strong></p> <p>The average age was 47.2/13.3 years, 49/51 percent male and female respectively. Eighty-four point three percent of patients had tuberculous empyema and 66.7% of patients had bronchopleural fistula. In 76.4% of patients after the operation, the CRP levels decreased, and the FEV1 increased in 64.7% of patients. Spontaneous closure of the thoracostomy window was noted in all patients without any additional operation. The results were much superior in tuberculous than non-tuberculous empyema (p &lt; 0.05).</p> <p><strong>Conclusions:</strong></p> <p>Claggett window thoracostomy is a simple and safe technique of dealing with complex empyema in high-risk patients with reliable infection control, functional improvement, and spontaneous closure of the chest wall.</p> Baha -ud-din Khan Hussain Shah Sajid Khan Shahzad Khan Aitizaz Ahsan Azam Jan Copyright (c) 12 1 https://jrmi.pk/article/view/1112 <p><strong>Abstract </strong></p> <p><strong>Introduction:</strong> Type 2 diabetes mellitus is a multifactorial metabolic disorder that is frequently accompanied by altered platelet function and increased thrombotic risk. Recent interest has focused on platelet-derived parameters, including immature platelet fraction, as potential indicators of disease severity and vascular complications. This study was conducted to explore the association between glycemic control, platelet indices, and the development of complications in patients with type 2 diabetes mellitus.</p> <p><strong>Objective:</strong> To determine the relationship between immature platelet fraction (IPF) and glycemic control (HbA1c) and to assess their associations with the development of complications in patients with type 2 diabetes mellitus.</p> <p><strong>Methodology:</strong> This cross-sectional study was conducted at the Department of Pathology, King Edward Medical University in association with the diabetic clinic at Mayo Hospital, Lahore, from June 2021 to January 2022. A total of sixty patients aged forty to sixty-five years of both genders diagnosed with type 2 diabetes and with HbA1c measured within the previous three months were enrolled. Exclusion criteria included type 1 diabetes, major cardiovascular events (stroke, angina, or myocardial infarction), and refusal to participate. After institutional ethical approval and informed consent, venous blood was collected in EDTA vials and analyzed on a Sysmex XN-100 hematology analyzer for platelet indices. IPF was measured using combined flow cytometry and impedance techniques within two hours of sample collection. Clinical history, comorbidities, medication compliance, and complications during one-year follow-up were recorded. Data were analyzed using SPSS v26. Descriptive statistics were used for continuous variables. Associations were tested with chi-square test and Pearson correlation where appropriate; P values ≤ 0.05 were considered significant.</p> <p><strong>Results:</strong> A total of sixty patients were included (thirty-four male, twenty-six female). The mean age was 43.12 ± 6.42 years. Mean HbA1c was 7.34 ± 0.86 and mean IPF was 3.91 ± 1.55. Patients with higher HbA1c and IPF were more likely to develop complications during follow-up (P = 0.004 and P &lt; 0.01, respectively). HbA1c correlated positively with mean platelet volume (MPV), platelet distribution width (PDW), and platelet count. IPF did not correlate significantly with HbA1c (P = 0.708).</p> <p><strong>Conclusions:</strong> HbA1c and IPF are not correlated and should be considered independent markers for monitoring disease progression and risk stratification in type 2 diabetic patients. Larger studies are recommended to confirm these findings.</p> <p><strong>Keywords:</strong> Diabetes Mellitus, Type 2; HbA1c; Immature Platelet Fraction; Platelet Indices; Glycemic Control</p> Afsheen Nigar Zunairah Mughal Hira Babar Sobia Ashraf Samreen Asghar Samina Qamar Copyright (c) 12 1