Annals of King Edward Medical University
Annals of KEMU is a biomedical research journal that is devoted to publishing the recent advances in all areas of biomedical research for physicians, surgeons, post-graduate trainees, and undergraduate students with special emphasis on clarity of presentation and accuracy of the presented data. Articles published in the Annals of KEMU cover a wide range of fields from basic medical sciences, clinical specialties, and super-specialty areas. Articles describing original clinical or laboratory investigations, case reports, and public health-related studies and surveys are always considered for publication. As a multi-disciplinary journal published by the most renowned and oldest medical institute in Pakistan, Annals of KEMU publishes the most relevant original research articles that form the foundations of tomorrow's medicine in Pakistan and around the globe. Links: 1) Tutorial on how to Upload your Submission 2) HEC Ranking
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Underused Handheld Ultrasound in General Practice: A Pakistani Demand for Change
We wish to highlight a critical gap in Pakistan’s clinical practice—the underutilisation of handheld point-of-care ultrasound (POCUS) devices, such as the Butterfly iQ, particularly in outpatient settings managed by general practitioners (GPs). Globally, including in the United States, United Kingdom, Germany, and parts of Asia, handheld ultrasound devices are increasingly crucial to general practice. These compact, high-resolution instruments are transforming frontline care by allowing real-time assessment of common conditions—abdominal pain, urinary retention, pleural effusion, soft tissue injuries, and early pregnancy viability—often eliminating the need immediate radiology referrals.¹⁻²
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Sensitivity Pattern of Staphylococcus Aureus in a Tertiary Care Hospital in Lahore; Implications and Recommendations
Introduction: Staphylococcus aureus is becoming a major concern worldwide due to its increasing resistance to antibiotics, particularly Methicillin Resistant S. aureus (MRSA). We aimed to investigate the prevalence and antibiotic sensitivity pattern of S.aureus in clinical specimens and to highlight the importance of an Antimicrobial Stewardship Program. Methods: Two years' data from a tertiary care hospital was analyzed. All S. aureus isolates were tested for their sensitivity by Kirby-Bauer disc diffusion method. Result: A total of 207 S. aureus isolates were identified, with a high prevalence of MRSA (82.7%). Variable resistance was observed for Ampicillin (97.5%), Ciprofloxacin (85.5%), Cloxacillin (82.7%), and Erythromycin (77.7%), while 100% sensitivity was observed for Linezolid, Vancomycin, and Teicoplanin making them the antibiotics of choice. Conclusions: Training of doctors on the appropriate use of antibiotics and the restrictions on the sale of antibiotics can be a way forward. Governmental support and legislation can help to overcome the problem.
Knowledge and Awareness among Healthcare Professionals regarding Sterilization of Instruments at Shalamar Hospital of Lahore: A Cross Sectional Study
Background: In the medical field, sterilizing instruments is an essential step in any surgical process. Healthcare workers must have a fundamental understanding of how to effectively sterilize and disinfect medical equipment and supplies. Objective: The goal of the study was to assess healthcare staff’s knowledge and awareness regarding the sterilization of instruments. Materials and Methods: The study employed a cross-sectional design, and participants were recruited using a convenience sampling technique. A questionnaire was created to evaluate the knowledge and awareness levels of different healthcare professionals. Participants answered all of the questions and submitted their responses via an online connection. During the six-month study, there were 30 questions included, 15 of which assessed knowledge and the other half assessed awareness. Data were analyzed using descriptive statistics in SPSS. Results: The study included 65 participants, Of the total, 23 individuals (35.4%) are men, while 42 individuals (64.6%) are women. Participants ranged in age from 19 to 46. The results show that a significant majority of healthcare professionals showed sufficient awareness (71.49%) and knowledge (65.84%) about Instruments sterilization. Conclusion: This study demonstrates a thorough comprehension of instruments sterilization. On the other hand, continuing education and workshops can help people better grasp sterilization methods, which will improve infection control and increase patient safety in surgical settings.
Blood Pressure and Risk of Bleeding During Permcath Insertion
Background: The tunnelled double-lumen cuffed catheter (TDLCC) is commonest route of vascular access with risk of bleeding from its insertion site. Objective: To assess the effect of blood pressure on the risk of bleeding during tunnelled double-lumen catheter placement for haemodialysis. Methods: This study was carried out on patients who were ≥ 18 years old and required vascular access for haemodialysis. Patients having patent arteriovenous fistula, coagulopathy, and thrombocytopenia were excluded. All the patients were observed for haemodynamic instability and bleeding from the site of TDLCC insertion. Results: There were one hundred and forty (n=140) individuals, including 97 (69.29%) males, with a mean age of 56.21±14.86 years. The bleeding during TDLCC insertion was observed in 24 (17.14%) patients. The mean systolic blood pressure was 138.69±19.09 mmHg, while the mean diastolic BP was 85.89±12.31 mmHg. The receiver operating curve analysis of systolic blood pressure for the risk of bleeding showed the area under curve 0.792(95% confidence interval 0.697 - 0.886, p<0.001) and for diastolic blood pressure, the area under curve came out to be 0.767(95% confidence interval 0.662 - 0.871, p<0.001). The area under curve for serum creatinine was 0.654(95% confidence interval 0.536 – 0.772, p=0.017). The best cut-off values for systolic and diastolic blood pressure and serum creatinine for predicting bleeding risk were 142.50 mmHg, 92.50 mmHg, and 691.50 µmol/L, respectively. Conclusion: The blood pressure has a significant effect on the risk of bleeding during the insertion of a tunnelled double-lumen catheter in haemodialysis patients.
Retrospective Analysis of the Indications and Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP), Experience at Tertiary Care Center
Background: As the population ages, the number of biliary tract diseases also increase leading to increased demand of endoscopic retrograde cholangiopancreatography which is currently has been used more for therapeutic purposes than as diagnostic modality. Objective: The aim of the study was to analyze the characteristics, indications and outcomes of endoscopic retrograde cholangiopancreatography retrospectively. Methods: This cross sectional study was conducted in the Medicine and Gastroenterology department of Pakistan Railway Hospital, Rawalpindi from 1st Jan 2022 to 31st Dec 2022 retrospectively. Ethical approval was granted by the hospital ethical committee. The study included data of patients who had undergone elective ERCP procedures. Data was collected from electronic record of hospital and endoscopy room data. Results: Out of 111 ERCPs performed, 50(45.04%) patients were male and 61(54.95%) were female. The mean age of the patients at presentation was 54.42 ± 14.71 years. The most common indication for ERCP was choledocholithiasis 39 (35.1%), followed by benign biliary stricture 23 (20.7%), and cholecystodocholithiasis 20 (18%). The most common complication was acute pancreatitis 6 (5.4%). Cholangitis occurred in 3 (2.7%) while bleeding and duodenal perforation occurred in only one patient (0.9%) respectively. Mortality was reported in only 1 patient (0.9%). Conclusion: Our study has revealed that the most common indication was for ERCP is choledocholithias and most common complication is pancreatitis. The indications and outcomes are comparable to local and international studies.
Effect of Hypothermia During Cardiopulmonary Bypass on Neurocognition After Cardiac Surgery in Adults
Background: The use of Hypothermia during Cardiopulmonary bypass (CPB) is a beneficial approach regarding neurocognitive protection to the patients, but at the same time, the added effects of hypothermia also carry some potential adverse outcomes. Objective: To compare the effects of mild and moderate hypothermia during cardiopulmonary bypass on post-operative neurocognitive function in patients undergoing elective cardiac surgeries. Methods: Patients undergoing on-pump Cardiac Surgery were assigned to the two groups according to the degree of hypothermia they received. The two groups, namely, mild hypothermia (31 °C to 35 °C) and moderate hypothermia (25 °C to 30 °C). Each group has thirty patients. The Mini-Mental State Examination (MMSE) is a standardized 30-point cognitive assessment tool, selected for this study due to its validated reliability in detecting post-operative neurocognitive decline, and was administered both pre-operatively and post-operatively. Results: A total of 72 patients were received for Cardiac Surgery, out of which 60 (83.3%) patients met our inclusion criteria and underwent elective cardiac surgery using CPB by the same surgeon, and other team members. The study found no significant difference in post-operative neurocognitive decline between the mild and moderate hypothermia groups when comparing their post-operative MMSE scores. We found no significant difference in blood loss, hours of ventilation and inotropic support. However, the adrenaline infusion rate with the mild hypothermia group exhibited a slightly higher value while the ICU stay with moderate hypothermia was longer compared to those with mild hypothermia group (p-value of 0.045). Conclusion: Our study demonstrates that the use of either mild or moderate hypothermia during CPB resulted in no significant difference in postoperative neurocognitive function. However, the duration of stay in the ICU and inotropic support in terms of adrenaline infusion rate varied among the groups, indicating that patients may recover differently depending on whether they received mild or moderate hypothermia during CPB.
To Determine the Frequency of Preterm Birth with Oral Progesterone in Female Presenting with Risk of Preterm Delivery
Background: Preterm Birth (PTB) is the foremost reason of morbidity and mortality in newborns. Intramuscular 17-hydroxyprogesterone has been demonstrated to lower the risk of subsequent premature delivery. The potential of oral natural progesterone to prevent repeated preterm births has not been well investigated. Objective: To determine the frequency of preterm birth (<37 weeks) among pregnant women at risk of preterm birth receiving oral progesterone from 28-34 weeks gestation over a period of 6 months. Methodology: The Department of Obstetrics and Gynecology at Madina Teaching Hospital Faisalabad conducted this Descriptive case series. The study comprised 100 pregnant women presented in Gynae OPD & Emergency of Madina Teaching Hospital who satisfied the selection criteria. Patients were given oral progesterone twice daily till 36-37 weeks of gestation or delivery whichever occurs first. During follow-up, females were advised to present in situation of active labor and primary outcome measure is documented that is Frequency of preterm delivery <37 weeks of gestation. Results: The patients average age was 28.61 + 3.72 years. Frequency of PTB with oral progesterone in female presenting with risk of PTB shows that 14% had preterm birth whereas 86% had Term birth. Distribution of cases by gestation age shows that 57% were between 28-30 weeks whereas 43% (n=43) were between 31-34 weeks of gestation, mean Gestational age was 30.46+2.11 weeks. Mean BMI of the patients was calculated as 30.49+2.01kg/m2. Conclusion: Oral progesterone administration in females at risk of preterm delivery significantly reduces the frequency of preterm birth and may serve as an effective preventive strategy in high-risk pregnancies.
Improvement in Daily Life as Well as Working of Health Professionals with Body Postural Correction at Workplace: A Multicentre Study
Background: Good body posture plays vital role in our daily life. Habitual mal-postural patterns are associated with musculoskeletal pain. Adaptation of bad postures disturb our life patterns. Objectives: The objective of this study was to find out the role of postural correction in maladapted health professionals and design guidelines for prevention of maladaptive postures at workplace. Methods: Postures of health professionals were observed during work in this prospective cohort study at three leading Plastic surgery centers of Punjab, Pakistan from October 2023 to September 2024. Consistently maladapts were identified and individually contacted. After informed consent, mal-adaptive posture/s were noted and post work stiffness, pain, lethargy, irritability and socialization and eagerness to get back to work next day was scored. Postural correction instructed by the Physiotherapist and monitored for three months after which rescoring was done. Results: Mean age of the subjects was 29.90±13.04 years the maximum 50 years and minimum 23 years of which 55% were females. Among them 37 were surgeons, 17 physicians, 21 Nurses. 4 dispensers, 8 OT technicians and 5 dressers. Most of the subjects (52%) were ectomorphic and shoulder droop, kyphosis, feet eversion, pelvic posterior tilt and feet broad base were the bad posture mainly observed. Pre and post intervention mean scoring about post work muscle stiffness, body aches, lethargy, irritability, socialization and eagerness to get back to work next day were found out. Eagerness to get back to work was having mean score 4±1.7 which improved to 6±2.3 after following postural instruction by the participants. Conclusion: Correct body posture is one of the key factors for better performance at workplace among health professional.
Factors Associated with Suicidal Behavior in Patients Coming to the Emergency of Services Hospital, Lahore
Background: Suicidal behavior is a serious public health problem and is commonly seen in Emergency Department (ED) patients, where early detection is very important. It is influenced by psychological, social, and environmental factors. In Pakistan, mental health services are limited, and there is not enough data on suicidal behavior in ED patients. Objective: To determine the factors associated with suicidal behavior in adult patients attending the emergency department (ED) of the Services Hospital, Lahore. Methods: This cross-sectional study was conducted over three months in the ED of Services Hospital, Lahore. A total of 227 adults were included using convenience sampling. Data were collected through a pretested questionnaire after ethical approval. SPSS version 27 was used for analysis. Chi-square test was applied, and p < 0.05 was considered significant. Results: Out of 227 patients, 29.1% reported suicidal intent. Most participants (73.1%) were between 21–40 years of age, and 68.7% were single. Anxiety (18.5%) and depression (17.2%) were common diagnoses, while 51.1% had no previous psychiatric history. Substance use was denied by 60.4%, but others reported use of drugs, alcohol, sheesha, smoking, or vaping. Financial stress was strongly linked with suicidal behavior. Poor family relationships (49.3%), pessimism (46.3%), introversion (36.1%), and recent life stressors were also important factors. Substance use and gender showed a significant association, and family relations were also linked with suicidal ideation (p < 0.05). Conclusion: Suicidal behavior in emergency patients was mainly linked with young age, marital status, poor family relationships, personality traits like introversion and pessimism, substance use, and recent stressful events. This study highlights the importance of paying attention to mental health in emergency settings. Simple screening for stress, substance use, and family issues can help identify at-risk patients early. Strengthening family support and providing brief counseling in EDs may reduce future risk.
Impact of Malnutrition and Inflammation on Mortality in Hemodialysis Patients: A Prospective Study
Background: Malnutrition and inflammation are common conditions in patients undergoing hemodialysis (HD) that contribute to poor health outcomes, although their impact on mortality among South Asian populations is limited. This paper discusses how these factors interact and how they affect patient survival. Objective: To examine the relationship between malnutrition, inflammation and mortality in HD patients, the relationship between these three variables, as well as their impact on clinical outcomes. Methods: This is a prospective cohort study, which was carried out at the department of Nephrology, Mayo hospital Lahore between September 2023 and October 2024. The sample consisted of 134 patients who were over 18 years old and on maintenance hemodialysis (MHD) for at least three months. Nutritional status was identified using the Malnutrition-Inflammation Score (MIS) and CRP, and ferritin was used to identify inflammation. Anthropometric and biochemical data were recorded at the beginning of the research. Patients were followed for a year, and Kaplan-Meier curves and Cox regression were used as survival outcomes to analyse the results. Results: Among the 134 patients, 82.8% of the patients were malnourished and 38.8% were classified as severely malnutrition (MIS>9). During the one year follow-up period, 17 patients (12.8%) died. Mortality was strongly associated with higher MIS scores and elevated CRP levels (p<0.001). Compared to survivors, deceased patients had lower MAMC, hemoglobin, and albumin, but higher ferritin levels (p<0.05). Conclusion: Malnutrition and inflammation are strongly linked to higher mortality in HD patients. Key indicators are severe malnutrition, elevated CRP and ferritin, and low albumin levels. Regular nutrition screening, effective management of inflammation and early dietary interventions can help reduce mortality risk.
Antenatal Care Paradox: Exploring the Gap between Antenatal Care Utilization and Pregnancy Outcome
Background: Antenatal care is the care given to the pregnant women from conception till birth. It is a structured program of observation, education and medical management of pregnant lady aimed at making pregnancy and birth a positive experience. Objective: To find out the association of antenatal care utilization with pregnancy outcomes. Methods: A descriptive cross sectional study was done in Obstetrics and Gynaecology department, Nishtar Hospital and Tertiary Care Hospital Nishtar- II, Multan. A sample of 362 women was included using non-probability convenient sampling technique. A questionnaire which included mother’s demographic data, antenatal care utilization data, antepartum complications, postpartum complications and data related to pregnancy outcomes was administered. Results: Among 362 women, mean age was 28.9 ±6.5 % women was among 25-34 years of age. Regarding antenatal care utilization, 136 (37.5%) women had 7 to 10 antenatal visits. 302(83.2%) women had adequate iron and calcium intake. Among 362 women, 87.1 % (316) delivered via cesarean section 12.9% (47) women delivered via spontaneous vaginal delivery. Around 10.7% (39) babies were still born and 324 (89.3%) women delivered alive baby. The variables that impacted the pregnancy outcome (alive or dead) were; number of ANC visits (p<0.001), age of mother (p=0.03) and level of education (p=0.004) and tetanus vaccination (p<0.001) while occupation, area of residency and socioeconomic status have no impact (p>0.05) on pregnancy outcome. Conclusion: Health education about the value of prenatal care, along with the improvement of health facilities particularly in remote areas, will lead to frequent prenatal visits, leading to healthier pregnancy outcomes.
The Effect of Faculty Development Program on Students’ Success: A concurrent mixed method Study
Background: Faculty Development Programs (FDPs) are the pillars of teaching and learning in any institution. FDPs play crucial role in advancing quality teaching and learning for successful students’ outcome in medical education. FDPs can indirectly improve students’ academic performance and learning experiences through faculty enhancement of pedagogical, assessment, and mentoring skills. Objective: To evaluate the effect of a faculty development program on students’ academic success and learning experiences. Methods: A Concurrent mixed, methods research was done at the University of Lahore from August 2024 to January 2025 after approval by the Ethical Review Committee (ERC/40/24/07). A self-administered, validated questionnaire was distributed among second, third, and fourth, year MBBS students (n = 400). Quantitative data were analyzed on SPSS version 24. Six FGDs were done with purposively selected high, and low, achieving students. Qualitative data were analyzed thematically. Results: Over 70% of students agreed that FDP, led initiatives were beneficial for clarity of learning, enhancing teaching styles and assessment feedback. The mean (± SD) scores across categories of teaching and assessment were between 3.6 (± 0.75) and 4.1(± 0.66) on the five, point Likert scale. Only 54.8% of students believed mentoring caused an improvement. Key themes from free text responses included improvement in teaching style, feedback from assessment and student confidence; whereas there were difficulties around consistency of mentoring and cognitive load. Conclusion: Faculty development programs positively influence student learning experiences and perceived academic success. Robust mentoring systems and clinical application of improved teaching styles could be encouraged to further achieve heightened student satisfaction.
Pesticide-Induced Genotoxicity in Farmers of Southern Punjab as Indicated by Frequency of Micronuclei
Background: Farmers have an increased risk of pesticide-induced DNA damage which can be detected by the presence of micronuclei (MN) in buccal cells. Smoking may further amplify this genotoxic effect, making MN a valuable biomarker for assessing both occupational and lifestyle related DNA damage. Objective: To determine the frequency of micronuclei as a biomarker of DNA damage in buccal mucosal cells of pesticide exposed farmers, with and without smoking. Methods: A comparative analytical cross sectional study was conducted from May to November 2021 on farmers in Moza Durana Nigana, Tehsil & District Multan. A total of 135 participants aged 21–60 years were divided into three groups of 45 each: Group I – nonsmokers and non-farmers (control); Group II –pesticide exposed farmers, who were nonsmokers or smoked fewer than five cigarettes per day; Group III – pesticide exposed farmers who smoked 15–20 cigarettes per day. Buccal smears were collected and stained using the Papanicolaou technique. Slide preparation and analysis were performed in the Departments of Anatomy and Pathology, King Edward Medical University, Lahore, to detect micronuclei (MN) as an indicator of DNA damage. Results: Pesticide exposed farmers showed a significantly higher frequency of micronuclei (MN), averaging 30.79 ± 9.65 per 1000 cells as compared to the control group, which had a frequency of 1.15 ± 0.38 per 1000 cells (p < 0.05). Among the exposed groups, Group III exhibited the highest MN frequency, indicating a synergistic genotoxic effect of pesticide exposure and smoking. Conclusion: Pesticide exposure in farmers demonstrated a significant increase in DNA damage which is further amplified in those who smoke.
A Study of Factors Affecting Treatment Compliance among Tuberculosis Patients Visiting Tertiary Care Hospital Bahawalpur
Background: Pulmonary tuberculosis is a leading cause of mortality, particularly in lower-middle-income countries like Pakistan. The adherence to treatment is crucial for its effectiveness. Various factors affect treatment compliance among tuberculosis patients including knowledge, monthly income, level of education, side effects of medications, treatment duration, social support. However, treatment compliance can be improved by developing effective strategies. Objective: To determine various factors that affect treatment compliance among tuberculosis patients of Pulmonology ward and outpatient department, Bahawal Victoria Hospital, Bahawalpur. Methods: A descriptive cross-sectional study was conducted during May -September 2024 in pulmonology ward and OPD, BVH, Bahawalpur. The sample size 162, calculated by using Raosoft sample size calculator was recruited by Non-probability convenient sampling. The data was collected through a preformed questionnaire having three sections including questions regarding demographic details and the status of patient’s compliance to the treatment and different factors that affect treatment compliance. The data was analyzed using SPSS software, version 26. Chi square test of significance was applied. Results: Out of the sample of 162 respondents, 34.3% were illiterate and 27.1% had received primary education. About 39.8% had monthly income of >40k, 38% had 20-40k and 22.3% had less than 20k. About 82.5% patients were taking their TB medication regularly while 15.7% were noncompliant. Whereas 58% patients were convinced that anti-TB drugs had serious adverse effects while 42% patients negated it. Conclusion: Patients with higher level of education and greater family support tend to follow their treatment better. Factors like good socioeconomic status and gender did not show a statistically significant relationship with treatment compliance. However, social stigma present challenges to treatment compliance. Addressing these issues through education, family involvement, and better management of social stigma can improve treatment outcomes.
Comparison of Heart Failure Etiology and Management in Pediatric and Adult Patients with Congenital Heart Diseases
Background: Heart failure is a serious complication of congenital heart disease (CHD) in both pediatric and adult populations. Understanding differences in etiology, clinical presentation, and treatment strategies is essential for improving outcomes and guiding targeted management across age groups. Objective: To compare the etiology, clinical features, and management of heart failure in pediatric and adult patients with congenital heart disease (CHD). Methodology: This Comparative analytical study was carried out at Department of Cardiology, Cardiac Centre, Bahawal Victoria Hospital, Bahawalpur, from September 2023 to September 2024. A total of 200 patients were included, comprising 100 in the study group (50 pediatric and 50 adult CHD patients with heart failure) and 100 in the control group (50 pediatric and 50 adult CHD patients without heart failure). Data were analyzed for demographics, types of CHD, clinical features, management strategies, and outcomes. Ejection fraction (<55%) and elevated BNP levels were used to classify heart failure. Statistical analysis was performed using SPSS, with p-values <0.05 considered significant. Results: This paper will compare the etiology, presentation, and treatment of pediatric heart failure as compared to the presentation and treatment in patients with congenital heart disease (CHD). They included 200 patients, 100 heart failure, and 100 no heart failure, 50 pediatric and 50 adult patients in each group. Complex CHD was more prevalent in the study group with a lower ejection fraction (72% vs. 12% p<0.001), and higher BNP (84=7210, p<0.001). The study group received medications like diuretics (88%) and ACE inhibitors (72%). The study group (45), versus the control group (70); surgical processes were less invasive in the former compared to the latter. Conclusion:Risk factors such as impaired coronary arteries, late presentation and high complication rates are linked to CHD. The burden of heart failure in patients with CHD can be greatly minimized by early detection and management.
Diagnostic Accuracy of Strain Elastography in Thyroid Nodule Assessment Using Histopathology as Reference Standard
Background: Ultrasound elastography functions on the property of soft tissues that deform readily than harder ones under compression. This technique is beneficial in differentiating malignant and benign lesions in different organs i.e. breast, lymph nodes, prostate and pancreas. Recent years have seen significant research in differential diagnosis using this method. Objectives: The study aims to find diagnostic accuracy of ultrasound elastography (USE) in thyroid nodule assessment using histopathology results as reference standard. Methods: This study employed a prospective observational design to find diagnostic accuracy of USE in identification of thyroid nodules to be benign or malignant. A comprehensive review of existing literature on USE and thyroid nodule characterization was conducted. The study included 175 patients aged between 18 and 80 years, presenting with one or more solid nodules in the thyroid lobe. Patients aged 18-80 years with solid nodules in the thyroid lobe identified by conventional ultrasound were included. Ultrasound elastography was performed, and strain ratios were calculated from the strain elastography color-coded images. These strain ratios were compared with histopathology reports to determine diagnostic accuracy and find correlation between ultrasound elastography findings and histopathology results. Institutional Review Board approval was obtained to ensure adherence to ethical guidelines and hence, written agreement was made with all participants of study. Results: The results obtained through this comparative study of using strain elastography and histopathology to differentiate benign and malignant thyroid nodules were very convincing and consistent to previous studies. Statistical analysis results came out to be as sensitivity 94.38%, specificity 90.70%, PPV 91.30%, NPV 93.98% and diagnostic accuracy 92.57%. Conclusion: The research findings indicate that strain ultrasound elastography is key imaging technique in detection of malignant thyroid nodules. Non-invasiveness and high diagnostic accuracy compels to use the method for identifying malignant thyroid nodules.
Potential Risk Factors and Physical Functioning of Women with Knee Osteoarthritis
Background: Knee osteoarthritis is a common musculoskeletal condition that has a severe effect on physical functioning, especially in women that are above the age of 40, causing chronic pain, stiffness in the joints, loss of mobility, which worsens overall quality of life, resulting in many individuals being incapable of performing normal daily tasks, among other ways and increased dependency. Objectives: The study aims to identify frequency and possible risk factors of Knee osteoarthritis and Physical Functioning of women aged 40 years and over. Methods: The study is a cross-sectional analytical study that was carried out at the University of Lahore Teaching Hospital on 350 women aged 40 years and above using non-probability convenience sampling. A structured questionnaire was used to gather data through the collection of demographic data, risk factors, and Western Ontario and McMaster Universities osteoarthritis index (WOMAC-34) to measure physical functioning. The research time was between August 2024 and January 2025. The statistical analysis was conducted in SPSS Version 25.0 with the help of chi square to access the association of different risk factors and t-tests to determine the physical functioning of the two groups. The p-value of less than 0.05 was deemed to be significant. Results: The findings revealed that knee osteoarthritis was diagnosed in 30.3 percent of the study participants with significant correlations between knee osteoarthritis and age greater than 40 years (p=0.015), hand osteoarthritis (p=0.033), and estrogen deficiency (p=0.004), BMI, and strenuousness of work (p=0.001). Knee OA women had a higher score on WOMAC which indicated more pain, stiffness and less physical functionality. Also, a high value (p=0.001) was found between knee OA and the physical activity levels, where the low level of physical activity was associated with the high prevalence of OA. Conclusion: The study identifies increased age and modifiable risk factors like high BMI, estrogen deficiency, hand osteoarthritis, and physically demanding work as significant risk factors for knee OA in women. An increased physical activity to enhance functional outcome in knee oa women can be achieved by promoting regular and joint-friendly physical activity that has the potential to considerably better pain, stiffness, and overall physical functioning in affected women.
Diagnostic Accuracy of Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) for Skeletal Metastasis in Patients of Breast CA in Comparison with Bone Scan
Background: Breast carcinoma (CA) is one of the most prevalent cancers in women all across the globe. In current clinical practice, bone scan is main method for determining metastasis. However, use of various other imaging such as whole body magnetic resonance imaging (WB-MRI), enhanced with diffusion weighted protocol, can provide with a significant alternative method in early detection and assessment of various treatment options. Objective: To evaluate diagnostic accuracy of diffusion weighted MRI (DW-MRI) for skeletal metastasis in patients of breast CA taking bone scan as a gold standard. Methods: It was a cross sectional study, carried out at Department of Radiology, Mayo Hospital Lahore. 106 patients were enrolled and sent to the department of nuclear medicine for bone scan as part of their routine bone metastatic work-up. MRI including conventional sequences as well as DW sequence was then performed in all patients. Results: Mean age of patients was 51.2±11.7 years. On bones scan, metastasis were identified in 86 (81.1%) patients, while it was negative in 20 (18.2 %) patients. On DWI, metastatic disease was found in 73 (68.8%) patients, while it was absent in 33(31.1%) patients. Sensitivity, specificity, PPV and NPV of DWI-MRI were 80.1%, 80.0%, 94.5% and 48.4%, respectively. Conclusion: Sensitivity and specificity values of DWI are satisfactorily high in detecting metastatic disease in patients of breast CA. It can be a reliable and noninvasive alternate in detection of early disease.
Sexual and Gender-based Violence: Need for an Integrated and Holistic Healthcare Response & Curriculum
Sexual and gender-based violence (SGBV) has been recognized as a violation of human rights and a significant pervasive public health crisis with legal, social, cultural, economic and psychological dimensions. It transcends across age, race, ethnicity, religion, and geography, especially when seen in the context of its extensive psychological, physical, sexual and reproductive-health related sequelae.1 World Health Organization statistics reveals that globally nearly one in three women experience physical or sexual violence in their lifetime, with risks increasing in fragile and low-resource settings.2 Furthermore, men particularly boys in humanitarian settings and otherwise also experience SGBV.3 South Asian estimates suggest that GBV rates are 35% higher than the global average especially among women.4 49.2% of the world’s population is the female gender, translating loosely into half of its potential. Gender equality is a fundamental human right. Sustainable Development Goal 5 aims to achieve gender equality which empowers women and girls.5 This is critical to promote health, education and general well-being of girls and boys. Violence affects women and children disproportionately, more so if marginalized. SDG-5 has 9 key targets and 14 indicators focused on eliminating violence in all its forms (including trafficking & sexual exploitation), discrimination, harmful practices (early child/forced marriages, female genital cutting/mutilation) and gender gaps in leadership and economic resources. SDG-5 seeks to ensure universal access to sexual and reproductive health and rights.6 A comprehensive and holistic healthcare response to violence is central to achieving this goal.
Public Mental Health: A Way Forward for Health Delivery Systems
Mental well-being is the state of mental health that allows people to cope with the stresses of life. Mental well-being also improves individual’s capabilities by adding remarkable value to day-to-day functioning. General health depends on good physical health, but mental health is also necessary to enhance life quality and the ability to handle life's ups and downs. Good mental health plays a significant part in improving physical wellbeing, enhancing social equalities and promoting healthy lifestyles. It is a pity that despite progress in understanding the impacts & consequences, and required service patterns for mental disorder, mental illnesses are still presenting an alarming challenge to global health. The WHO's 2022 report emphasizes how much importance people, communities, and governments should place on mental health and how all stakeholders in all sectors must match that value with dedication, participation, and investment.1 Although mental health conditions contribute to millions of disability-adjusted life years (DALYs),2,3 these get less attention from health systems getting approximately two percent or even less spending on healthcare by governments around the world. Mental well-being provides safeguards against unhealthy lifestyle choices and inequality in society. Nowadays, there are a lot of evidence-based strategies for managing mental illness and fostering mental wellness through prevention. Promoting mental wellbeing is an important social objective since it helps equitable society and healthy lifestyles. There is a consensus that mental health conditions contribute to the global burden of diseases, but the interventions to treat and prevent such conditions are not given due attention. The full scope of these issues must be brought to the attention of policymakers in order to increase funding for promotion & prevention of mental health disorders as a crucial part of health policies and professional training.
Uterine Papillary Serous Carcinoma (UPSC): A Rare Case Report
Uterine papillary serous carcinoma (UPSC) accounts for 5-10% endometrial cancers, although they account for majority of endometrial cancer mortality. This case report discusses a 58-year-old female menopausal for fifteen years presented with vaginal discharge for two months, post-menopausal bleeding for 20 days, and lower abdominal pain after 20 days. Bloating, vomiting, constipation, increased urine frequency, and abnormal uterine bleeding were eventually diagnosed as Uterine Papillary Serous Carcinoma (UPSC).The case emphasizes the limitations of early identification, the significance of histological confirmation, and the therapeutic choices for controlling this aggressive tumor.