Students' Supplement of Journal of Rawalpindi Medical College

The Role of Activated Charcoal in Mitigating Lead-Induced Нераtоtоxicity In Albino Wistar Rats

2025-09-14

Background: Lead is a pervasive environmental toxin with severe effects on human health, particularly the liver. Through oxidative stress—an imbalance between reactive oxygen species (ROS) and antioxidant defenses—lead induces hepatocellular damage via lipid peroxidation, protein oxidation, DNA injury, and inflammation.

Objective: To evaluate the hepatoprotective effects of activated charcoal against lead-induced hepatotoxicity in albino Wistar rats.

Methods: A quasi-experimental study was conducted from February to August 2024 on 36 male albino Wistar rats, divided into three groups (n = 12 each): Group A (control), Group B (lead-acetate), and Group C (lead-acetate + activated charcoal). Blood samples and liver tissues were collected for biochemical and histological analysis.

Results: Group B showed significant increases in AST (79.31 ± 9.79 U/L), ALT (38.28 ± 2.29 U/L), ALP (209.09 ± 8.49 U/L), and bilirubin (0.98 ± 0.43 mg/dL), along with reductions in albumin (2.88 ± 0.28 g/dL) and total proteins (6.92 ± 0.22 g/dL) (p < 0.05). Group C displayed intermediate values between Groups A and B. Antioxidant enzymes—glutathione peroxidase and superoxide dismutase—were highest in Group A, lowest in Group B, and intermediate in Group C (p < 0.05). Histology revealed marked vacuolar degeneration and lymphocyte infiltration in Group B, while Group C exhibited milder changes with fewer infiltrates.

Conclusion: Activated charcoal significantly mitigates lead-induced hepatotoxicity in albino Wistar rats, demonstrated by improved biochemical markers and reduced histological damage.

Keywords: Activated Charcoal; Lead; Oxidative Stress; Lead-Acetate; Heavy Metals

Comparative Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin for Stroke Prevention and Major Bleeding in Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Mian Zahid Jan Kakakhel — 2025-09-14

Background: Atrial fibrillation (AF) is one of the most common arrhythmias, affecting over 52 million people worldwide. Direct-acting oral anticoagulants (DOACs) are proposed as add-on therapy to prevent ischemic stroke in AF.
Purpose: To assess the safety of various DOAC regimens compared with warfarin in AF patients.
Methods: A literature search across four databases (inception–January 2025) identified randomized trials comparing DOACs and warfarin. Outcomes included stroke, intracranial haemorrhage (ICH), all-cause mortality, major bleeding, and non-ICH mortality. Risk ratios (RR) with 95% credible intervals (CrI) were estimated. Surface under the cumulative ranking curve (SUCRA) indicated lowest event risk. Analyses used the Bugsnet package in R with a common-effects model and deviance information criterion.
Results: Eighteen studies with 89,985 patients and nine treatment arms were analyzed. Rivaroxaban 15 mg once daily (OD) showed the lowest stroke risk (RR 0.45; 95% CrI 0.20–0.92; SUCRA 83.15%), followed by dabigatran 150 mg twice daily (BD) (RR 0.68; 95% CrI 0.55–0.84) and apixaban 5 mg BD (RR 0.74; 95% CrI 0.62–0.89). Major bleeding risk was lowest but not significant with apixaban 2.5 mg (SUCRA 86.68%); significant reduction occurred with apixaban 5 mg BD versus warfarin (RR 0.70; 95% CrI 0.62–0.91). Rivaroxaban 15/20 mg OD carried the highest major-bleeding risk, exceeding that of dabigatran 110 mg BD and apixaban 5 mg BD. For ICH, dabigatran 110 mg BD had the lowest risk (SUCRA 92.81%), significantly lower than apixaban 5 mg BD, rivaroxaban 15/20 mg OD, and warfarin. Mortality unrelated to ICH was lowest with endoxaban 60 mg OD, followed by dabigatran 150 mg BD and apixaban 5 mg BD; all DOACs outperformed warfarin. All-cause mortality was least with endoxaban 60 mg OD, then apixaban 5 mg BD and dabigatran 150 mg BD.
Conclusion: Apixaban 5 mg provides the best overall safety, combining low major-bleeding risk with favorable stroke and mortality outcomes. Rivaroxaban 15 mg offers the greatest stroke protection. Overall, all DOACs were safer and at least as effective as warfarin.

Optimizing Survival Prediction in Neurotrauma: Comparative Performance of Age, ISS, RTS, and TRISS Using Advanced Regression Models

Muhammad Usman, Ali Abdul Basit — 2025-09-14

Background: Neurotrauma presents a critical burden in emergency care, where early and accurate survival prediction is essential for timely interventions and optimal resource allocation. While established scores such as the Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) are widely used, their relative performance—especially when enhanced with modern statistical models—requires further exploration.

Objectives: To evaluate and compare the predictive accuracy of Age, ISS, RTS, and TRISS in forecasting survival among neurotrauma patients using traditional and spline-based logistic regression.

Materials and Methods: This retrospective study was conducted at a tertiary care hospital between February and June 2022. Trauma patients with head and/or spinal injuries were included. Exclusion criteria were age <12 years, non-trauma admissions, or incomplete records. Data were extracted from electronic records and analyzed using R. One-, two-, three-, and four-predictor models were constructed using Age, ISS, RTS, and TRISS. Model performance was assessed using AUC, Brier score, calibration plots, and nomograms. Sensitivity analyses and internal validation ensured robustness.

Results: TRISS demonstrated the highest predictive performance (AUC: 0.95), followed by RTS (AUC: 0.91), ISS (AUC: 0.87), and Age (AUC: 0.76). Two-predictor models combining TRISS with Age or RTS improved discrimination. Three- and four-predictor models offered marginal improvement, suggesting TRISS-based models are most efficient.

Conclusion: TRISS remains the most reliable tool for survival prediction in neurotrauma. Its predictive power can be enhanced by incorporating Age and applying flexible modeling techniques. These findings support the use of refined prediction tools in acute neurotrauma management.

Keywords: Neurotrauma, TRISS, Survival Prediction, Logistic Regression, Trauma Scoring Systems.

An Assessment of the Association Between Respiratory Health and Duration of Exposure to Traffic-Related Air Pollution Among Taxi Drivers of Rawalpindi: A Cross-Sectional Study

Muhammad Talha Farrukh, Sohaib Mushtaq, Ayan Habib, Ehtisham Khan — 2025-09-14

Introduction:
Traffic-related air pollution is a major public health hazard, causing millions of deaths annually. Workers with prolonged exposure are more prone to respiratory symptoms, yet research on drivers—especially the link between exposure duration and respiratory health—is limited. Rapid urbanisation and growing traffic highlight this gap.

Methods:
This cross-sectional study was approved by the ethics committee. Using OpenEpi and a total driver population of 300, a sample size of 115 was calculated. Data were collected via a standardized respiratory health questionnaire and peak flow measurements, using non-random convenience sampling. Taxi drivers who worked part-time, smoked, or had chronic respiratory disorders were excluded. SPSS 21 was used for analysis.

Results:
Among 115 taxi drivers, mean age was 39.1 ± 12.34 years, mean expiratory flow rate 433.5 L/min, and average respiratory symptom score 3.17. Fifty-five (48%) reported at least one symptom. Hours spent driving per day showed a borderline correlation with symptoms (r = 0.181, p = 0.053), while tenure showed no overall association (r = 0.110, p = 0.247). Linear regression confirmed these findings. In the subgroup aged <40 years (n = 58), however, occupational tenure significantly predicted symptoms (p = 0.009), with each additional year increasing the score by β = 0.341.

Conclusions:
In taxi drivers younger than 40, respiratory symptoms rise with longer occupational tenure, whereas no linear relationship exists in older drivers.

Keywords:
Occupational exposure, traffic-related air pollution, taxi drivers.

Exploring Panic Attack Prevalence, Symptoms, Risk Factors, and Impact Among Medical Students of Islamabad; a Cross-Sectional Study

2025-09-14

INTRODUCTION: Panic attacks are episodes of intense fear that may reflect a state of severe distress and become a risk for depression. People who experience panic attacks have impaired physical and emotional health. In medical students, these episodes interfere with their academic performance and eventually lead to burnout and decreased productivity.

OBJECTIVES: To determine the prevalence of panic attacks, their relationship with associated risk factors among medical students, and to assess panic attacks’ impact on their health.

METHODS: A quantitative cross-sectional study was conducted over six months among medical students enrolled at a medical college in Islamabad. The sample size was calculated to be 255 using OpenEpi. Data were collected from medical students, whereas non-medical students were excluded from the study. Data collection was mediated through a questionnaire, after obtaining approval from the ERC, containing questions related to panic attack symptoms, duration, risk factors, and impact on health. All descriptive statistics, such as chi-square tests, were applied using SPSS 31, with p<0.05 considered significant for all measures.

RESULTS: The sample consisted of medical students from all five years of MBBS. Of the participants, 74.2% (n=190) had experienced the symptoms of a panic attack. Among them, 54.7% (n=140) had a panic attack for the first time after entering medical college. In addition, 44.1% (n=113) experienced panic episodes during exams or while giving a presentation. A total of 84% (n=215) considered panic attacks in some way harmful to their physical or mental health. Moreover, 45.3% (n=116) reported occasional fear and avoided places because of fear of having a panic attack. A statistically significant result was observed in the responses of the students about the impact of panic attacks on their academic and clinical performance (p<0.05).

CONCLUSION: Our study reveals that panic attacks are common among medical students, with a majority experiencing onset after entering medical college. Most students perceive panic attacks as harmful to their health and note a significant impact on their academic and clinical performance, highlighting the need for targeted mental health support along with the curriculum.

KEYWORDS: Panic, Prevalence, Medical Students

Assessing Quality of Life Post-Myocardial Infarction: A Study of Physical Activity And Emotional Well-Being in Patients

Hamza Chaudhary, Ariba Waheed — 2025-09-14

Introduction: Studying changes in quality of life post-myocardial infarction is crucial as it informs patient-centered care, rehabilitation strategies, and predicts long-term outcomes. These assessments also guide healthcare resource allocation and quality improvement initiatives to optimize recovery and overall well-being for individuals affected by myocardial infarction. The objective of this study is to assess and quantify the changes in quality of life experienced by individuals following myocardial infarction, informing strategies for enhanced patient care and rehabilitation outcomes.

Objective: To visualize the factors causing issues in patients for their better lives.

Materials and Methods: A survey was used as a tool to collect data from post-MI patients. It is a cross-sectional study conducted at the Punjab Rangers Teaching Hospital, Lahore, for 2 months. The sample size is 150. A questionnaire/survey was filled out by patients. Medically confirmed cases with a diagnosis of myocardial infarction (MI) based on clinical records or diagnostic tests (e.g., ECG, cardiac enzymes) were included in the study. A simple random sampling technique was used. Data were analyzed using SPSS version 25. IRB approval from the hospital IRB committee was obtained. Descriptive analysis was performed on each question of the survey.

Results: A total of 150 individuals with diagnosed MI participated in the survey. Thirty-two (21.33%) individuals reported being restless most of the time. Thirty-one (20.67%) individuals reported being tearful or emotional most of the time. Thirty-four (22.67%) reported being extremely limited in sports and other physical activity. Fifty-five (36.67%) reported being very limited in sports and other physical activity.

Conclusion: The results revealed a negative impact on the quality of life of patients after myocardial infarction. The quality is affected in terms of physical activity as well as emotionally. Guidelines should be established to provide psychiatric, emotional, and physiotherapy-related interventions to ensure a better quality of life for patients after suffering from myocardial infarction.

Keywords: Rehabilitation, Healthcare.

Conception Timing and Autism Spectrum Disorder: Unraveling the Connection

Hamza Chaudhary, Ariba Waheed — 2025-09-14

Introduction: The purpose of this research is to determine whether the age of conception and the frequency of autism are correlated. This research is important because it will assist parents in making healthy family planning decisions and reduce the huge financial burden associated with the health and education of these children.

Objectives: To check the association of paternal and maternal factors with autism.

Materials and Methods: It is a comparative cross-sectional study conducted in the Mayo Hospital Psychiatry Ward of patients with autism from ages 4 to 11. The duration of the study was 1.5 months after the approval of the synopsis. Ethical approval was taken from the IRB of KEMU. The calculation yielded a sample size of 300. A preformed questionnaire proforma was given to parents/guardians to obtain data on demographic information, pregnancy, delivery, delivery intervals, and ASD according to the ADI-R International Questionnaire. SPSS version 25 was used. The chi-square test was applied to determine the association between childbirth, demographic and other gestational factors, and ASD measured with the ADI-R scale. Children with any severity of ASD and normal school-going children were included in this study. Children with severe neurocognitive disorders were excluded.

Results: A significant association between maternal age at conception and ASD was reported (p = 0.000). A significant association between paternal age at conception and ASD was also reported (p = 0.000). All other childbirth factors also had a significant association with ASD. No significant association between the birth weight of the child and ASD was reported (p = 0.064).

Conclusion: The results showed a significant association of ASD with prenatal and postnatal factors and other gynaecological and obstetric factors, including the mother’s and father’s age at conception. We suggest the implementation of our findings in the clinical guidelines, family planning, and prenatal and postnatal care of the mother and the child.

Keywords: Autism Spectrum Disorder, prenatal factors, postnatal factors.

Nephroprotective Effects of Equisetum ramosissimum L. Ethanolic Extract Against Cisplatin-Induced Nephrotoxicity in Albino Rats: A Quasi-Experimental Study

Mariyam Bachani — 2025-09-14

Background: Cisplatin, a widely used chemotherapeutic agent, is associated with significant nephrotoxicity, limiting its clinical utility. Medicinal plants like Equisetum ramosissimum L. have been explored for their antioxidant and nephroprotective properties. This study aimed to evaluate the protective effects of E. ramosissimum ethanolic extract on cisplatin-induced renal damage in albino rats.

Methods: A quasi-experimental study was conducted at Isra University, Hyderabad, from February to July 2025, using 30 adult albino Wistar rats randomly divided into three equal groups. Group A served as the control. Group B received a single intraperitoneal dose of cisplatin (20 mg/kg). Group C received cisplatin followed by E. ramosissimum ethanolic extract (300 mg/kg/day orally) for seven days. Renal function was assessed via serum creatinine, blood urea nitrogen (BUN), and histopathological examination of renal tissue.

Results: Group B exhibited significantly elevated serum creatinine (2.5 ± 0.3 mg/dL) and BUN (45 ± 5.2 mg/dL) compared to Group A (0.7 ± 0.1 mg/dL and 22 ± 3.4 mg/dL, respectively; p < 0.001). In contrast, Group C showed substantial improvement in renal markers (creatinine: 1.1 ± 0.2 mg/dL; BUN: 28 ± 4.1 mg/dL; p < 0.01 vs. Group B). Histological analysis confirmed reduced tubular necrosis and glomerular damage in Group C compared to Group B.

Conclusion: Equisetum ramosissimum ethanolic extract demonstrated significant nephroprotective effects against cisplatin-induced nephrotoxicity in albino rats. These findings support its potential as an adjunctive therapy to mitigate cisplatin-associated renal injury.

Keywords: Equisetum ramosissimum, nephrotoxicity, cisplatin, nephroprotection, herbal extract, albino rats.

Moral Injury in Medical Students Witnessing Unethical Practices: Insights From A Cross-Sectional Survey

2025-09-14

Background: Moral distress arises when an individual recognizes the ethically appropriate action but feels powerless to act due to institutional or psychological barriers. Though first described in palliative care, it now affects all medical fields. This study evaluates the impact of witnessing unethical practices on medical students’ resilience, burnout, and career intentions.

Objectives: To identify the unethical practices encountered by medical students during clinical rotations, assess the severity of moral injury from such experiences, and examine its relationship with burnout and concerns about future careers.

Method: A nationwide, convenience-based cross-sectional survey was conducted in July 2025 among undergraduate medical students who had completed clinical rotations and provided informed consent. A pretested electronic questionnaire collected demographic data and used the Moral Injury Outcome Scale (MIOS), along with measures of coping, burnout, and career impact. The MIOS includes shame-related and trust-violation subscales (scores 0–56), with severity classified as mild (14–28), moderate (29–42), or severe (43–56). Pearson’s chi-square test evaluated associations between variables. Ethical approval was obtained.

Results: Of 78 responses, 67 were analyzed (mean age 22.0 ± 0.1 years; 94% female; 74.6% fourth-year students). Age positively correlated with the number of departments worked in (r = 0.36, p = 0.003). Reported unethical practices included disrespect toward patients (55.2%), discrimination (29.9%), lack of consent (19.4%), breaches of confidentiality (26.9%), aggression or care delays (38.8%), and record falsification (7.5%). Severe moral discomfort was noted in 38.8%, yet only 34.3% reported incidents. Mean shame and trust scores were 20.0 ± 8.8 and 24.0 ± 9.5, respectively; mean MIOS total score was 43.0 ± 18.3. Mild and moderate moral injury occurred in 52.2% and 16.4% of students. Witnessing unethical behavior was significantly associated with moral injury severity (χ² = 12.7, p = 0.005; Fisher’s p = 0.007), burnout (χ² = 8.95, p = 0.030), and future career concerns (r = 0.48, p < 0.001).

Conclusion: These findings highlight the urgent need for reforms in clinical training environments to reduce unethical practices and protect the moral integrity of future healthcare professionals.

Keywords: Moral Injury, Burnout, Medical Students

Machine Learning Deconvolution of the Blood Brain Barrier Immune Fibrosis in the Pathogenesis of Neurodegenerative Diseases

Husna Irfan Thalib — 2025-09-14

Background and Objectives: Neurodegenerative disorders such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) involve blood–brain barrier (BBB) dysfunction and immune-driven fibrosis, which contribute to neuronal injury and cognitive decline. This study used machine-learning (ML) deconvolution to examine immune and fibrotic signatures at the BBB, aiming to identify biomarkers and therapeutic targets for neurodegeneration.

Methods: Transcriptomic data from brain endothelial cells, cerebrospinal fluid, and peripheral blood of AD and PD patients were analyzed using ML deconvolution algorithms (CIBERSORTx and single-cell RNA sequencing). Immune subsets and fibrotic gene expression were quantified and integrated with clinical profiles. Clustering and predictive modelling identified immune-fibrotic subtypes, and biomarker findings were validated in external datasets with pathway-enrichment analyses.

Results: ML analysis revealed increased macrophages and activated endothelial cells expressing TGF-β, collagen I, and fibronectin at the BBB in both AD and PD. Peripheral monocytes migrated into the CNS, promoting fibrosis. High TGF-β signaling correlated with greater cognitive decline. Two subtypes emerged: (1) an inflammation-dominant subtype with elevated IL-6, TNF-α, marked BBB disruption, and rapid disease progression; and (2) a fibrosis-dominant subtype characterized by excessive collagen deposition, reduced BBB permeability, slower progression, and higher treatment resistance.

Conclusion: Machine-learning deconvolution highlights distinct immune and fibrotic alterations at the BBB in AD and PD. The inflammation-dominant subtype shows accelerated BBB breakdown and cognitive decline, whereas the fibrosis-dominant subtype exhibits slower progression but greater therapy resistance. These findings support the development of personalized, subtype-specific treatment strategies for neurodegenerative diseases.

Disparities and Determinants of Hypertensive Renal Disease Mortality in the United States: A Nationwide Retrospective Study (1999–2020)

2025-09-14

Introduction: Hypertensive renal disease (HRD), coded as ICD-10 I12, is a severe complication of chronic, uncontrolled hypertension that lies at the intersection of cardiovascular and renal pathology. Despite improved hypertension management, HRD-related mortality in the United States continues to rise, disproportionately affecting older adults, racial and ethnic minorities, and people in underserved areas. Prior studies have focused mainly on hypertension or chronic kidney disease overall, often neglecting HRD-specific trends and key demographic or regional vulnerabilities.

Objectives: This study aimed to (1) quantify national trends in age-adjusted mortality rates (AAMRs) from HRD in the U.S. from 1999 to 2020, (2) identify disparities by gender, race/ethnicity, and urban–rural status, and (3) detect inflection points in mortality trends using Joinpoint regression.

Materials and Methods: A retrospective, population-based analysis used CDC WONDER Multiple Cause of Death data. All adult deaths (≥18 years) with ICD-10 code I12 from 1999–2020 were included. AAMRs per 100,000 were standardized to the 2000 U.S. population. Joinpoint regression calculated annual percent changes (APCs) and identified significant trend shifts. Subgroup analyses examined gender, race/ethnicity, and urban–rural categories. Only publicly available, de-identified data were used, adhering to STROBE guidelines.

Results: From 1999 to 2020, 618,157 HRD deaths were recorded. National AAMR rose from 5.28 to 29.6 per 100,000 (APC: 9.65%; 95% CI: 7.48–11.48). Males consistently had higher AAMRs than females (15.59 vs. 11.12). Non-Hispanic Black individuals showed the highest AAMRs (29.55) but the lowest APC (5.25%), indicating persistently high mortality. Non-Hispanic Whites had the fastest rise (APC: 11.25%). Urban–rural disparities were evident, with the highest AAMRs in Large Central Metros and the lowest in Large Fringe Metros.

Conclusion: HRD mortality increased sharply in the U.S. from 1999 to 2020, with marked and evolving disparities across racial, gender, and geographic lines. Equity-focused public health strategies are urgently needed to address these widening gaps.

Keywords: Hypertension, Renal Insufficiency, Mortality, Health Disparities, Epidemiology

Comparative Analysis of Etiological Factors, Clinical Presentation, and Complications of Cholelithiasis in Adult and Pediatric Patients: A Multicenter Study in Hyderabad, Pakistan

Muhammad Rizwan — 2025-09-14

Background: Cholelithiasis presents differently in adults and children because of distinct etiologies, physiology, and risk factors. While well-documented in adults, its rising incidence in pediatric patients warrants further study. This research compared etiological factors, clinical symptoms, and complications of cholelithiasis between adult and pediatric cohorts.

Methods: A cross-sectional observational study was conducted from January to June 2025 across three tertiary care centers in Hyderabad: Isra Hospital, Civil Hospital, and Khidmat-e-Khalq Foundation Hospital. Using non-probability consecutive sampling, 240 ultrasonography-confirmed patients were enrolled—180 adults (>18 years) and 60 children (<18 years). Data on demographics, risk factors (obesity, hemolytic disorders, family history, diet), clinical symptoms, and complications (cholecystitis, pancreatitis, obstructive jaundice) were collected and analyzed using SPSS v26.

Results: Obesity (65%) and sedentary lifestyle (58%) were predominant risk factors in adults, whereas hemolytic disorders (40%) and family history (33%) were more frequent in children (p < 0.001). Abdominal pain was the most common symptom in both groups (90% adults vs. 83% children). Pediatric patients showed a higher rate of asymptomatic cases (18% vs. 4%, p = 0.003). Adults experienced significantly more complications, especially acute cholecystitis (32% vs. 12%, p = 0.005).

Conclusion: Pediatric cholelithiasis is being diagnosed more often and exhibits distinct etiological patterns with fewer complications than adult disease. Early detection and age-specific prevention strategies are essential to reduce long-term morbidity.

Keywords: Cholelithiasis; Gallstones; Pediatrics; Adults; Risk Factors; Complications; Abdominal Pain

Efficacy of Bioresorbable Vascular Scaffold vs Drug- Eluting Stents After PCI : A GRADE-Assessed Systematic Review and Meta-Analysis of Randomised Controlled Trials

2025-09-14

Background: Drug-eluting stents (DES) are widely used in percutaneous coronary intervention (PCI), but their permanent metallic structure can impair long-term vascular function. The DynamX bioadaptor, a sirolimus-eluting scaffold with bioresorbable links, is designed to restore vessel motion after six months, potentially improving outcomes.
Objectives: To compare clinical outcomes of bioadaptive stents with DES in PCI patients by analysing recent randomized controlled trials (RCTs).
Methods: This meta-analysis followed PRISMA and Cochrane guidelines. RCTs comparing bioadaptive stents with DES in PCI patients were included. Primary outcomes were cardiac death, myocardial infarction (MI), and revascularization. A random-effects model was applied in Review Manager 5.4.1. Certainty of evidence was assessed using GRADE, and publication bias was evaluated with funnel plots and Egger’s test.
Results: Twenty-two RCTs involving 5,068 patients were analyzed. No significant differences emerged between stent types for cardiac death (RR = 0.93; 95% CI: 0.71–1.21), all-cause mortality (RR = 0.92; 95% CI: 0.78–1.10), or target vessel MI (RR = 1.38; 95% CI: 1.18–1.63). Secondary outcomes—including target lesion revascularization (TLR), target vessel revascularization (TVR), and all MI—were likewise not significantly different. Heterogeneity was low (I² = 0%), and evidence certainty ranged from moderate to high.
Conclusions: Although bioadaptive stents are designed to improve vessel healing and motion, current evidence shows no superiority over DES. Earlier bioresorbable vascular scaffolds (BVS) carried higher risks of MI and TLR due to design limitations. Longer follow-up and improved scaffold designs are needed to clarify potential long-term benefits.

Blue Screen Blue Mood: Investigating the Association of Daily Screen Time with Sleep Quality and Mental Distress in Students

2025-09-14

Introduction: The widespread use of technology and prolonged screen exposure have significant implications for sleep quality and mental health, especially among students.

Objectives: To measure daily screen time among students from different academic fields and assess its association with demographic variables, sleep quality, and mental health symptoms.

Materials & Methods: This cross-sectional study was conducted at Isra University, Hyderabad, from August 2023 to February 2024 among undergraduate students. A total of 152 participants who provided informed consent were included, while those with diagnosed psychiatric conditions or sleep disorders were excluded. Data on demographics, daily screen time, sleep quality, and mental distress were collected using self-administered questionnaires. Standardized tools included the Pittsburgh Sleep Quality Index (PSQI) for sleep quality and the Depression Anxiety Stress Scale (DASS-42) for mental distress. Statistical analysis was performed in SPSS v22, assessing correlations between screen time, PSQI, and DASS scores (p ≤ 0.05, 95% confidence).

Results: Participants had a mean age of 20.59 ± 2.16 years; most were urban residents (87.5%) and day scholars (74.34%). Mean daily screen time was 5.85 ± 1.14 hours. Mean scores were: depression 13.34 ± 12.01, anxiety 11.17 ± 9.41, stress 15.32 ± 11.09, and PSQI 6.45 ± 3.48. Screen time showed significant positive correlations with depression (r = 0.81, p < 0.01), anxiety (r = 0.78, p < 0.01), stress (r = 0.83, p < 0.01), and PSQI (r = 0.75, p < 0.01).

Conclusion: Longer daily screen time is strongly associated with poorer sleep quality and higher levels of depression, anxiety, and stress in undergraduate students.

Keywords: Screen Time; Mental Health; Sleep Quality; Depression; Anxiety

Prevalence of Undiagnosed ADHD: A Cross-Sectional Study Among the Adult Population in Peshawar

Zarar Khan, Beenish Riaz, Maham, Hadiqa Murad, Saaim Sikandar — 2025-09-14

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental condition that impairs academic, occupational, and social functioning. Frequently undiagnosed in adults, especially in Pakistan, it remains understudied among university students. This study investigates the prevalence and functional impact of undiagnosed ADHD in Peshawar to guide screening, raise awareness, and inform local interventions.

Objectives: To determine the prevalence of undiagnosed ADHD among undergraduate students and adults in Peshawar and evaluate associated functional impairments and socio-academic triggers.

Methods: A cross-sectional study was conducted in urban Peshawar from February to June 2025 after ethics approval (No. 175/RC/NWSM/2024) from the Northwest School of Medicine IRB. Verbal consent was obtained, and anonymity maintained. A total of 349 adults aged 20–40 years were recruited using convenience sampling. Participants completed a modified WHO Adult Self-Report Scale (ASRS v1.1) with an added section on functional difficulties in daily life, social interaction, emotional regulation, and task performance. Data were analyzed using SPSS v25 with descriptive statistics and chi-square tests.

Results: ADHD symptoms were common: 176 participants (50.4%) were classified as borderline ADHD and 16 (4.6%) as moderate ADHD. Significant associations were found between ADHD symptoms and educational level (χ² = 0.025) and occupation (χ² = 0.026), with medical professionals reporting higher symptom burden. Functional impairments were markedly more frequent in those with borderline or moderate ADHD (p < 0.001), particularly in emotional regulation (94.1% of the moderate ADHD group). No significant associations emerged with gender or age.

Conclusion: A considerable proportion of adults in Peshawar, notably within medical and academic settings, exhibit undiagnosed ADHD symptoms linked to substantial emotional and functional impairment. Targeted screening, culturally sensitive awareness campaigns, and early intervention strategies are urgently needed to address this overlooked mental health issue.

Keywords: Attention-Deficit/Hyperactivity Disorder; Functional Impairment; Medical Students

A Cross-Sectional Study of Prevalence of Gastro-Oesophageal Reflux Disease and Associated Risk Factors Among Medical Students of Pakistan

Easha Masood ,Sana Fatima,Rumman Ashraf,Fatima tul Zahra,Mishaal Zarar — 2025-09-14

Introduction: Gastroesophageal reflux disease (GERD) is a common disorder in which stomach contents flow backward into the esophagus, causing heartburn and regurgitation. If left untreated, it may progress to complications such as Barrett’s esophagus and esophageal cancer. Key risk factors include stress, obesity, poor diet, smoking, and NSAID use. GERD affects about 13.98% of the global population and up to 24% in Pakistan. Medical students are particularly vulnerable due to academic stress, sedentary routines, and irregular meals, yet data on this group remain limited. This study aimed to determine the prevalence of GERD, identify risk factors, and assess its impact on medical students’ daily lives.

Objectives: This study aimed to evaluate the prevalence of gastroesophageal reflux disease (GERD) among medical students in Pakistan, assess the key risk factors and the impact of GERD on their daily lives, and recommend appropriate lifestyle modifications to help reduce GERD symptoms.

Methods: A nationwide cross-sectional study was conducted among undergraduate medical students in May 2024. Using Cochran’s formula, the required sample size was 220 (95% CI, 5% error). Non-random convenience sampling was applied, and an electronic pretested questionnaire was distributed across multiple medical institutes. The survey collected demographic data, risk factors, GERD questionnaire responses, and 10-item Cohen Perceived Stress Scale (PSS) scores. IBM SPSS v27 was used for analysis. GERD was defined by a cut-off score ≥8. Perceived stress was categorized as low (0–13), moderate (14–26), or high (27–40). Associations between categorical variables were assessed using Pearson’s chi-square test. Ethical approval was obtained from the Rawalpindi Medical University Review Committee, and informed consent was secured.

Results: A total of 249 responses were analyzed; most participants were female (85.1%), and 75.9% had a healthy BMI (18–25 kg/m²). GERD prevalence was 20.5% (n=51). Moderate and high stress were reported by 71.5% and 12.4% of students, respectively. GERD showed significant associations with midnight snacking (p=0.007), type of exercise (p=0.034), and perceived stress (p=0.025).

Conclusion: GERD is common among medical students and is linked to stress and unhealthy lifestyle habits. Despite potential recall bias and absence of formal clinical diagnosis, this study highlights the need for targeted awareness and preventive strategies to reduce disease burden in future healthcare professionals.

Keywords: Gastroesophageal Reflux; Gastric Acid; Esophagitis; Epidemiology

Phenotypes, Predictors and Outcome of Hypertension in the Inpatient Setting

Mohammad Mujtaba Khokhar — 2025-09-14

Background: Hypertension (HTN) is a leading preventable cause of cardiovascular disease and mortality worldwide and remains a major health burden in Pakistan. The National Diabetes Survey of Pakistan (2016–2017), which included 10,834 participants, reported an overall age-adjusted, weighted HTN prevalence of 46.2%. However, data on hypertension management among hospitalized non-cardiac patients are limited. Understanding patterns of inpatient management in this group is crucial for improving outcomes and guiding treatment protocols. This study aimed to evaluate the prevalence, treatment patterns, and outcomes of hypertension in non-cardiac inpatients, focusing on complications, medication adherence, and discharge planning.

Methods: A cross-sectional study was conducted over five months (November 2024–March 2025) at Shalamar Hospital, Lahore. Adult patients (≥18 years) admitted with known or newly diagnosed hypertension were enrolled. Demographics, clinical characteristics, inpatient blood pressure trends, treatment modalities, and outcomes were collected through structured questionnaires and medical-record review. Statistical analyses were performed using SPSS v27.

Results: Among 151 hypertensive inpatients (mean age 58.2 ± 12.8 years; 68.9% female), 77.5% had a prior HTN diagnosis and 67.5% reported treatment adherence before admission. Diabetes (81.9%) and chronic kidney disease (13.8%) were the most common comorbidities. Hypertension was actively managed in 78.2% of patients, yet 18.5% received no treatment during admission. Oral antihypertensives were administered to 72.1%, with 37.7% receiving monotherapy. Complications included hypertensive emergencies (5.3%), renal failure (8.0%), and myocardial infarction (2.6%). Only 29.1% had a documented follow-up plan at discharge. Poor blood-pressure control was significantly associated with renal dysfunction, inadequate medication use, and lack of specialist referrals (p < 0.05).

Conclusion: Despite a high prevalence of hypertension among hospitalized non-cardiac patients, significant gaps exist in management, including suboptimal treatment, limited follow-up planning, and high complication rates. These findings highlight the need for standardized inpatient hypertension protocols in Pakistan to improve outcomes and reduce healthcare burden.

Who Manages the Pressure? Gaps, Challenges and Policy Needs in Inpatient Hypertension Care

Mohammad Mujtaba Khokhar — 2025-09-14

Background: Elevated blood pressure (BP) during hospitalization affects 50–70% of adults, yet no formal international guidelines exist for its management. Such elevations may indicate true hypertension, transient stress responses, or measurement inaccuracies. This study evaluated the management of hypertension in clinically stable hospitalized patients at a tertiary care center.

Methods: A prospective, observational cross-sectional study was conducted at Shalamar Hospital, Lahore, Pakistan, from November 2024 to March 2025. Adult inpatients (≥18 years) with a prior or new diagnosis of hypertension were enrolled consecutively. Data were collected at a single time point using structured questionnaires and medical record review. Statistical analysis was performed with JMP Version 13 (SAS), with p < 0.05 considered significant.

Results: Among 151 hypertensive patients (mean age 58.2 ± 12.8 years; 68.9% female), 90.7% had pre-existing hypertension and 83% were receiving treatment. Common comorbidities included type 2 diabetes (81.9%) and chronic kidney disease (13.8%). Half of the patients maintained BP < 140/90 mmHg during hospitalization, yet adverse events occurred: hypertensive urgency (5.3%), creatinine elevation (23%), and myocardial infarction (2.6%). Inpatient prescribing patterns showed significant declines in angiotensin receptor blocker use (44.4% → 36.4%, p < 0.01) and beta-blockers (19.9% → 13.2%, p < 0.05), alongside increased calcium channel blocker (38.4% → 47.7%, p < 0.01) and diuretic (7.3% → 11%, p = 0.06) use. Despite these adjustments, 25% had uncontrolled BP at discharge; 70% lacked documented outpatient follow-up, and only 19% were referred to specialist care.

Conclusion: Hypertension management during hospitalization remains challenging amid multimorbidity, acute illness, and shifting treatment priorities. The absence of formal guidelines, limited prescribing oversight, and inadequate discharge planning contribute to suboptimal control and follow-up. These findings underscore the need for clear institutional protocols, stronger inpatient–outpatient integration, and enhanced clinical support to ensure safe, consistent, evidence-based management of hospitalized patients with hypertension.

Demographic and Regional Mortality Trends in Adult Epilepsy-Related Mortality in the United States (1999–2020)

Syeda Fadak Zahra Hujjat — 2025-09-14

Introduction: This study used CDC WONDER data to examine U.S. adult epilepsy-related mortality trends from 1999–2020, focusing on demographic and geographic patterns to inform health policy and guide targeted interventions.

Objective: To evaluate epilepsy-related mortality trends among U.S. adults by age, sex, race/ethnicity, and geography.

Materials and Methods: A retrospective observational analysis of CDC WONDER mortality data (ICD-10 G40–G41) was conducted for adults ≥25 years. Crude death rates (CDR) and age-adjusted mortality rates (AAMR) per 100,000 were calculated with 95% confidence intervals and stratified by age group, sex, race/ethnicity, and U.S. region. Joinpoint regression identified significant trend changes over time.

Results: Nationally, the CDR nearly doubled from 0.6 to 1.1 per 100,000, while AAMR accelerated after 2011 (annual percent change +9.56%, p < 0.001). Males consistently had higher mortality than females (AAMR 10.5 vs. 6.0 in 2020). Black individuals bore the greatest burden (AAMR 13.0/100,000 in 2020). The steepest rise occurred in adults aged 25–34 years, whose AAMR increased from 3.0 to over 14.0. Geographic disparities were evident, with the highest state-level AAMRs in Michigan (1,113.26), California (746.46), and Florida (518.55). Several Central and Northwestern states had suppressed data because of low counts.

Conclusion: Epilepsy-related mortality in U.S. adults rose sharply from 1999–2020, with disproportionate increases among young adults, males, Black populations, and residents of certain states. The post-2011 inflection suggests changing risk factors or care gaps. Targeted strategies addressing structural inequities and improving regional resources are urgently needed.

Keywords: Epilepsy/mortality; Health Status Disparities; United States/epidemiology; Retrospective Studies; Population Surveillance

Factors Causing Delay to Surgical Treatment In Geriatric Neck of Femur Fracture Patients: A Case-Control Study

Hamza Chaudhary, Ariba Waheed — 2025-09-14

Introduction: Neck of femur fracture is a frequent orthopedic condition treated surgically, with global incidence projected to reach 6.26 million cases annually by 2050. Delays in operative management can influence outcomes, yet the specific factors contributing to such delays require clarification.

Objectives: To identify key factors causing surgical delay beyond 36 hours in neck of femur fractures and evaluate their impact on hospital stay and mortality.

Materials and Methods: A retrospective case–control review of 300 patient records was conducted at a General Hospital in Dudley, West Midlands, UK. Adults undergoing surgical treatment for intracapsular or extracapsular hip fractures were included. Patients operated within 36 hours formed the control group; those with surgery delayed beyond 36 hours formed the case group. Associations between time to surgery (TTS) and clinical outcomes were analyzed using chi-square tests, with p < 0.05 considered significant. Hospital permission was obtained; no IRB approval or data collection tools were required.

Results: A significant association was found between TTS and length of hospital stay (p = 0.036), with delayed surgery linked to hospitalization exceeding two weeks. No significant relationship was observed between TTS and mortality (p = 0.924). Among potential causes of delay, only gender showed a significant association with prolonged TTS (p = 0.001).

Conclusion: Surgery delayed beyond 36 hours increases hospital stay but does not significantly affect mortality. While timely intervention remains important, individualized pre-operative assessments—such as cardiovascular evaluation and hemoglobin optimization—may be prioritized without adversely impacting survival.

Keywords: Hip fracture; Neck of femur; Time to surgery; Mortality; Hospital stay

Frequency of Normal Findings in Brain CT Accompanied by Headache and Potential Risk of Unnecessary Exposure: A Cross-Sectional Study

Ali Rashid, Abid Ali, Taiba Zulfiqar, Ahmed Rashid — 2025-09-14

Introduction: Computed tomography (CT) has greatly enhanced diagnostic accuracy in medicine. However, its liberal use raises concerns regarding radiation exposure, incidental findings, and unnecessary follow-up testing. CT is often ordered for patients with minor symptoms, including headaches, even when the results may not meaningfully influence management. This pattern suggests potential overuse with minimal diagnostic benefit.

Objective: To determine the frequency of normal and abnormal head CT findings in patients presenting with headache and to assess the risk of unnecessary radiation exposure.

Methods: This cross-sectional study was conducted in the Radiology Department of Gondal Medical Complex, Gujranwala, from November 2023 to February 2024. After institutional ethics approval, CT head scan reports of 132 consecutive patients presenting primarily with headache were retrospectively reviewed. Data were analyzed using SPSS version 20, with descriptive statistics applied to calculate frequencies and percentages.

Results: Of the 132 patients, 68 (51.5%) were female and 64 (48.5%) male, with a mean age of 41 ± 16.4 years. The largest subgroup was aged 30–39 years (25%, n=33). Headache was the sole complaint in 116 patients (87.9%), while 16 patients (12.1%) reported additional symptoms such as vertigo or hypertension. Overall, 113 scans (85.6%) were normal. Nineteen scans (14.4%) revealed abnormalities, of which only 12 (9.6% of the total) were clinically significant; the remainder showed minor changes such as brain atrophy.

Conclusion: The high proportion of normal head CT scans among patients with headache suggests potential overuse of imaging. More judicious selection of patients is warranted to limit unnecessary radiation exposure and reduce the workload on radiology services, emphasizing the importance of careful clinical assessment before ordering CT imaging.

Keywords: Computed tomography; Headache; Overuse; Normal findings

Assessing the Psychological and Functional Impact of Low Vision in a Developing Country: Congenital vs. Acquired Cases

Rabia Faheem, Muhammad Saad, Saad Tariq — 2025-09-14

Introduction: Low vision profoundly influences mental health, with individuals who develop vision loss later in life often experiencing greater psychological distress than those born with the condition. Despite this impact, mental health needs in patients with low vision are frequently overlooked.

Objective: To assess how the age of onset of low vision—congenital versus acquired—affects vision-related quality of life (VR-QoL) and mental health, while accounting for educational and socioeconomic factors.

Methods: A cross-sectional study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, including 225 participants: 75 with congenital low vision (CLV), 75 with acquired low vision (ALV), and 75 controls with normal vision. VR-QoL was evaluated using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Mental health was measured with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Educational level and socioeconomic status were documented. Independent t-tests and chi-square tests were applied for group comparisons.

Results: Patients with ALV had lower NEI VFQ-25 subscale and composite scores compared with those with CLV, though differences were not statistically significant. BDI and BAI scores were significantly higher in the ALV group (BDI: 13.42 ± 12.21 vs. 8.91 ± 9.78, P = 0.017; BAI: 10.23 ± 11.04 vs. 6.24 ± 7.62, P = 0.025). A greater proportion of ALV patients required professional evaluation for depression (P = 0.008). Lower education and socioeconomic status were associated with poorer VR-QoL and higher depression and anxiety scores (P < 0.05), particularly among ALV patients.

Conclusion: Acquired low vision is linked to significantly higher levels of depression and anxiety than congenital low vision. Socioeconomic disadvantage and limited education further worsen mental health and quality-of-life outcomes, especially in those with later-onset vision loss. Because congenital cases often develop coping mechanisms early, ALV represents a sudden life disruption that intensifies psychological burden. Routine mental health screening and integrated psychosocial support should be central to low-vision rehabilitation to address both visual and psychological needs.

Keywords: Low vision; Mental health; Anxiety; Depression; Rehabilitation

Trends in Hypertensive Renal Disease with Renal Failure-Related Mortality Among Gender Ethnicity and Census Regions in the United States from 1999-2000

Faiza Ikram — 2025-09-14

Background: Hypertensive renal disease affects roughly 753 million people worldwide each year. In the United States, the age-adjusted mortality rate (AAMR) for hypertension-related end-stage renal disease (ESRD) increased from 9.7 to 43.7 per 100,000 between 1999 and 2020. This study evaluates national mortality trends in hypertensive renal disease over this period, highlighting disparities by gender, race, and urbanization to inform targeted interventions and improve outcomes.

Methods: Mortality data for hypertensive renal disease with renal-failure–related deaths from 1999 to 2020 were extracted from the CDC WONDER database. Age-adjusted mortality rates with 95% confidence intervals (CIs) were calculated to assess national and demographic trends.

Results: Men consistently demonstrated higher AAMRs than women (148.92; 95% CI: 148.37–149.48 vs. 106.11; 95% CI: 105.73–106.49). African American individuals had the highest overall AAMR at 286.29 (95% CI: 284.68–287.90), rising from 186.23 in 1999 (95% CI: 179.34–193.13) to 529.72 in 2020 (annual percent change [APC] 5.27). Metropolitan areas saw AAMRs climb from 197.57 (95% CI: 187.88–207.26) to 1,112.12 (APC 10.00), while non-metropolitan areas increased from 97.35 (95% CI: 90.63–104.08) to 643.06 (APC 11.81). State-level AAMRs ranged from 61.23 (95% CI: 59.29–63.16) in Connecticut to 225.06 (95% CI: 214.96–235.16) in the District of Columbia.

Conclusion: From 1999 to 2020, hypertensive renal disease mortality rose sharply, with the greatest burden among men, African Americans, and residents of non-metropolitan areas. These findings underscore the need for multifaceted public-health strategies emphasizing early detection, equitable access to care, and targeted interventions to reduce mortality.

Keywords: Hypertensive renal disease; Chronic kidney disease; Kidney damage; Mortality trends

Histopathological Spectrum and Pain Severity in Oral Lesions: A Cross-Sectional Study from a Tertiary Care Center in Pakistan

Faiz un Nisa, Eman Fatima — 2025-09-14

Introduction: Oral lesions, ranging from benign hyperplasia to malignant neoplasms, represent a significant public health concern. Pain is often the first clinical symptom but is underutilized in diagnostic assessment.

Objectives: To evaluate the histopathological spectrum of oral lesions and assess the prevalence, severity, and predictors of pain among patients with biopsy-confirmed oral lesions.

Material and Methods: This cross-sectional study was conducted at the Pathology Department, Isra University, Hyderabad, with the Nuclear Institute of Medical Radiotherapy (NIMRA), Jamshoro, and included 338 patients with biopsy-proven oral lesions. Sample size was calculated using OpenEpi at 95% confidence, 5% margin of error, and 66.8% expected pain prevalence. Patients of all ages and genders were enrolled; those with recurrent lesions, incomplete data, or systemic pain-modifying conditions were excluded. Pain was rated on a 0–10 numeric scale following the Brief Pain Inventory and MD Anderson Symptom Inventory, and histopathology, lesion site, tumor size, and TNM stage were recorded. Data were analyzed in SPSS v21 using chi-square and logistic regression, with p < 0.05 considered significant.

Results: The mean age was 52.3 ± 12.7 years, with 63.9% males. Malignant neoplasms constituted 39.3% of cases. Pain was reported by 68.3% of patients; 12.1% experienced severe pain. Pain severity was significantly associated with histopathological type, lesion location, and TNM stage (p<0.001). Tongue lesions (OR 2.45), tumor size >4 cm (OR 1.75), and limited mouth opening (OR 3.12) were independent predictors of pain. TNM Stage I tumors were inversely associated (OR 0.32, p=0.003).

Conclusion: Pain is a frequent and diagnostically relevant symptom in oral lesions, particularly in malignancies. Pain assessment should be routinely integrated into clinical evaluation to facilitate early intervention.

Keywords: Oral lesions, histopathology, pain severity, TNM staging

Machine Learning-Based Deconvolution of Immune Infiltrates in Cardiac Fibrosis

Husna Irfan Thalib — 2025-09-14

Background and Objectives: Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by myocardial fibrosis and diastolic dysfunction, with limited effective therapies. Immune-mediated mechanisms are increasingly recognized as key contributors to HFpEF pathogenesis. This study focuses on using machine learning (ML)-based immune deconvolution to identify specific immune cell populations and their interplay with fibrotic pathways to provide important insights regarding HFpEF mechanisms and potential therapeutic targets.
Methods: RNA sequencing datasets from myocardial tissues of HFpEF patients and healthy controls were analyzed using machine learning deconvolution algorithms (CIBERSORTx and xCell). Immune cell proportions were correlated with fibrotic gene expression, including collagen I, fibronectin, and TGF-β1. Clustering analysis identified immune-fibrotic phenotypes. Predictive models were developed to assess the role of specific immune infiltrates in fibrosis
severity and clinical outcomes.
Results: Machine learning identified increased infiltration of M2 macrophages and regulatory T cells (Tregs) in fibrotic myocardial regions of HFpEF patients, alongside reduced cytotoxic NK cell activity. M2 macrophage abundance strongly correlated with collagen I and fibronectin expression (r = 0.89, p < 0.01), suggesting a pivotal role in driving myocardial fibrosis. Tregs were associated with enhanced TGF-β1 signaling, further promoting fibrotic remodeling. Clustering analysis revealed two distinct immune-fibrotic subtypes: Inflammatory-dominant subtype: Marked by elevated pro-inflammatory cytokines (IL-6, TNF-α) and moderate fibrosis, associated with early-stage HFpEF and Fibrosis-dominant subtype: Characterized by excessive ECM deposition, advanced myocardial stiffness, and poor diastolic function, correlating with worse clinical outcomes.
Conclusion: This study highlights the role of M2 macrophages, Tregs, and TGF-β1 signaling in HFpEF-associated myocardial fibrosis, identifying distinct immune-fibrotic phenotypes with potential diagnostic and therapeutic relevance. Targeting macrophage polarization and fibrotic signaling pathways could potentially be identified as a new treatment strategy to prevent HFpEF progression.

Digital Health: Opportunity or Overload for Young Doctors

Aayet Zulfiqar — 2025-09-13

Predictors of infodemic and misinformation against Covid–19 among general public of Rawalpindi

Muhammad Ali Riaz — 2025-09-13

Objective:

This study aimed to identify predictors of infodemic and misinformation related to COVID-19 among Rawalpindi's general public by analyzing their behavioral attributes and assessing their reliance on different types of evidence regarding the pandemic.

Materials and Methods:

This descriptive cross-sectional study was conducted in Rawalpindi, Punjab, Pakistan from April to June 2024. The study assessed perceived information gathering capacity and risk perception related to COVID-19 among individuals aged 18 and above. A sample size of 377 was calculated. Convenience non-random sampling was used. The questionnaire covered demographics, information gathering capacity, and risk perception. Ethical approval was obtained from the Institutional Review Board of Rawalpindi Medical University, and data analysis was performed using SPSS version 26 applying descriptive statistics and Spearman’s rank correlation analysis to explore relationships between variables.

Results:

The study surveyed 394 individuals, with 55.3% males and 44.7% females. Most participants were in the 18-24 age group with varying educational backgrounds. Findings showed confidence in gathering information about COVID-19, distinguishing facts from rumors, and awareness of information sources. Perceptions of COVID-19 severity and susceptibility varied, with mixed emotions towards the pandemic and trust levels in information sources. Positive correlations were found between information gathering capacity, judgment frequency, and preventive behaviors against COVID-19.

Conclusion:

Relying on statistical, experimental evidence, and preventive measures enhances information gathering capacity. However, there is no direct link between reliance on scientific evidence and the ability to differentiate rumors from facts. The study also highlights public dissatisfaction with the Pakistani government's pandemic response and distrust in official information sources.

Reported Self-care Practices in Pregnancy and Their Relationship With Birth Outcomes in Women Presented to Allied Hospitals of Rawalpindi Medical University

2025-09-14

Introduction

Self-care is crucial for promoting health, preventing disease, and maintaining health during pregnancy. Understanding specific healthcare behaviors adopted by women is necessary to improve maternal healthcare delivery and birth outcomes.

Objectives

This study aimed to assess self-care practices during pregnancy and analyse the relationship between mother self-care and birth outcomes.

Materials and Methods

A descriptive cross-sectional study was conducted in postnatal wards of gynaecology departments of Allied hospitals of Rawalpindi Medical University from March 2024 to June 2024. Our study population included post-partum primigravida and multigravida women, excluding those having a previous history of comorbidities. For sample size calculation, we used Epi info sample size calculator. Data was collected using a validated self-structured questionnaire. Statistical analysis of data was done using SPSS version 27.

Results

The study found that 48% of participants had moderately healthy lifestyles, followed by 31.4% with healthy lifestyles, and 20.57% with least healthy lifestyles. Similarly, 57.14% had moderately healthy behaviours, 29.14% had healthy behaviours, and 13.71% had unhealthy behaviours. The relationship between healthy lifestyles and number of pregnancies was significant. PCOS prevalence was higher in participants with moderately healthy or healthy lifestyles. Stillbirths were more prevalent in participants with unhealthy lifestyles. The relationship between pregnancy-induced hypertension, pregnancy-induced diabetes, and healthy behaviours was significant.

Conclusion

The study suggests that education regarding childbirth is needed, especially for first-time mothers. Healthy lifestyles lead to better birth outcomes.

Association between Antenatal Care Utilization and Maternal Anemia in Pregnant Women: A Cross-sectional study in RMU & Allied Hospitals

2025-09-13

Background: Antenatal care (ANC) is important for preventing maternal complications and improving health outcomes. In Pakistan, although many women contact ANC, there are still significant issues with timing, quality, and fairness in access.
Objectives: This study looks at the relationship between ANC use and maternal complication of anemia, at RMU & Allied Hospitals.
Materials and Methods: We carried out a retrospective cross-sectional study using hospital records of 385 women who were admitted for delivery between January 2024 and March 2025. We gathered data on sociodemographic, ANC details, maternal complications, and delivery outcomes. We used R software for statistical analyses, applying chi-square, Fisher’s exact, and Wilcoxon rank sum tests to find significant associations.
Results: Anemia was present in 15.3% of the participants. It was notably more common among women from rural areas (22.1%), those with low education (27.9% among those with only primary education), and those from low-income backgrounds (17.1%) (all p < 0.05). Even though 98.06% of women had at least one ANC visit, those who started care later (after three weeks) and had more visits (a median of 6 for anemic women compared to 4 for non-anemic women, p = 0.010) were paradoxically linked to anemia, suggesting that they sought care after complications developed. Anemic women were more likely to arrive in poor condition, be in advanced labor, and have complications such as bleeding after 28 weeks and threatened miscarriage.
Conclusion: Inadequate and delayed ANC was strongly tied to negative maternal outcomes, particularly anemia. Factors like living in rural areas, low education, and poverty increased the risks. These findings stress the need for early, fair, and effective antenatal care to enhance maternal health in Pakistan.
Keywords:
Antenatal care, anemia, Pregnancy complications, Healthcare Disparities, Pakistan, Rural health

Clot Formation Within Tracheostomy Tube in Surgical Unit 1 of HFH Hospital Rawalpindi; a Quality Improvement Project

Abdul Hafeez Soomroo, Shanza Nazih, Ahsan Hameed, Rai Asghar, Aayet Zulfiqar — 2025-09-13

Clotting inside tracheostomy tubes is a major problem that can block the airway and trigger breathing problems, more especially among critical care patients. This clinical audit is a full report of the Tracheostomy Care Practice in the Surgical Intensive Care Unit (ICU) of Holy Family Hospital (HFH) Rawalpindi, where we evaluated the current situation, identified risk factors for clot formation, and made recommendations for improvement. It was a combined retrospective and prospective review, and it was from January to February 2025, the period when 50 patients who underwent tracheostomy and remained in the ICU for more than 48 hours were involved. The data were primarily based on patient’s medical records, clinical documentation, and incident reports. The study found out that the incidence rate of clot formation was 20% because of the lack of enough humidification (50%), infrequent suctioning (30%), and airway trauma (20%) as the most significant risk factors. The support of recommended measures was still ineffective with 60% of the oxygen that was only humidified and suctioning being done at appropriate intervals was in 70% of cases. The outcomes contained in the research impress the significance of standard tracheostomy care protocols, better-equipped staff, and frequent audits so that the patients’ safety is improved and the obstructions of the airways risk is minimized. The implementation of these measures is the key to obtaining better results for the ICU patients undergoing tracheostomy surgery.

Factors Affecting Healthy Lifestyle among Medical Students in Rawalpindi Medical University, a Cross Sectional Study

Ali Abdul Basit — 2025-09-13

University is a critical time where students are more prone to engage in risky health behaviors known to negatively affect well-being, such as physical inactivity, stress, and poor dietary habits. A health promoting lifestyle is an important determinant of health status and is recognized as a major factor for the maintenance and improvement of health. This study was designed to assess the health-promoting lifestyle of students in Health University in Rawalpindi, Pakistan.

Methodology:

A total of 375 students participated in this descriptive cross-sectional study. Data gathering was conducted at Rawalpindi Medical University. Participating students completed a self-reported questionnaire that included questions regarding their demographic characteristics and their health-promoting behaviors.

66℅females and 33%males were included in this study. 74% of the participants were of normal weight and 7.9% were overweight. The analysis showed that there was a significant association between gender wise and year of study wise comparison with regards to the factor of health responsibility. Students were found to have an inadequate level of adherence to recommendations regarding physical activity and healthy eating habits. The analysis also found that majority of the students do not attend educational programs on health care. The model shows that gender, type of college, year in school, and family structure were significant predictors of the health lifestyle of students in Pakistan.

Conclusion:

The results of the current study indicate that university students are leading unhealthy lives, where the majority of them have unhealthy eating habits and poor physical activity level. Universities are ideal settings for implementing health promotion programs. Therefore, planning and implementing programs to motivate students to be more responsible for their own health, to engage more in physical activity, and to practice healthy eating habits and other forms of wellness are of paramount importance.

Evaluation of Knowledge, Attitude and Vaccination Status among Pre Clinical Medical Students of Rawalpindi Medical University

Amna Idrees — 2025-09-13

Abstract

Introduction

Hepatitis refers to viral liver inflammation leading to acute and chronic illness. In Pakistan its prevalence is 4.9% for hepatitis C and 2.5%. Reuse of contaminated needles, syringes, or sharp objects in healthcare settings causes the spread of this virus. Vaccination is an effective tool for its prevention but unfortunately a low vaccination rate is observed in developing countries. Healthcare workers, because of negligence and non-vaccination are severely exposed to it. In medical practice, medical students are more prone to hepatitis because of lack of awareness, vaccination and high prevalence of needle stick injuries. Thus, proper knowledge and outlook is important for safety. Working on medical students' apprehension is significant for hepatitis control in future as they can raise consciousness regarding disease in themselves and their patients.

Methodology

We conducted a cross-sectional study using an online questionnaire-based survey recording the demographic details, knowledge, attitude, practice and vaccination status of non clinical year medical students. Total data of 249 students was collected through convenience sampling. Statistical analysis was performed.

Results

Out of 266 participants, ranging from age 17 to 27, the majority were females 202 (75.9%). Among these, 66.5% strongly agreed that hepatitis was caused by a virus whereas, hepatitis causes liver inflammation was also supported by majority (43.2% strongly agree, 41% agree). Regarding attitude, only 38% considered healthcare workers to be at an increased risk for hepatitis B but 52.6% believed in the efficacy of Hepatitis B vaccination. Assessment of vaccination status showed 92 (34.6%) people not being vaccinated while 174 (65.4%) were vaccinated.

Conclusion

A mixed response was achieved from pre-clinical year students about their knowledge in regards to Hepatitis B. Majority students were found vaccinated, showing a positive attitude towards vaccination.

Association of Blood Clotting Time with Gender and Blood Group among Young Healthy Individuals

2025-09-13

Introduction:

Blood clotting is a crucial homeostatic process that prevents excessive bleeding after injury. This study investigates the influence of physiological parameters like blood type and gender on Clotting Time. While previous studies suggest potential associations between pathologic conditions and Blood Clotting Time, the evidence remains inconclusive for such an association between physiologic conditions like blood group and gender, and Blood Clotting Time. Additionally, regional variations in Clotting Time are understudied. This study aimed to investigate the relationship between clotting time, blood type, and gender in a Pakistani population.

Objectives:

The objectives of our study were to investigate the association between blood group ( ABO and Rh) and Clotting Time in a healthy young adult population from Pakistan and to determine if there are significant differences in Clotting Time of males and females.

Material and Methods:

A Cross-sectional, observational study was conducted on 208 healthy subjects, 108 males and 100 females. Blood groups were self-reported by participants while Blood Clotting Time was measured by the Capillary Tube Method. The Association of Clotting Time with gender and blood group was checked.

Results:

Clotting Time was highest in the O blood group and lowest in AB and this relation was significant (p value=0.001). Among Rh blood groups, Rh negative had higher Clotting Time than Rh positive, but this relation was not significant (p value=0.564). Females had higher Clotting Time than males with high significance ( p value=0.00).

Conclusion:

Females and O blood group individuals are more susceptible to abnormal bleeding in cases of trauma or surgery, therefore necessary measures should be taken before undergoing invasive procedures. Studies with a larger number of participants need to be done to determine risk groups more accurately.

Knowledge about First Aid among Medical, Nursing and Allied Health Sciences Students of Rawalpindi Medical University, Pakistan.

Tayyab Rasool — 2025-09-13

Background: First aid is an important life-saving skill that can make a profound impact in emergency situations. It involves giving rapid medical care at the site of the accident. Medical and nursing students often get training inside controlled hospital environments. However, the scope of first aid education entails effectively responding to many emergency situations outside the hospital. Objectives: The objective of this study is to assess the knowledge of undergraduate students in the fields of MBBS, Nursing, and Allied Health Sciences (AHS) with regards to first aid. Materials and Method: A cross-sectional questionnaire-based study was conducted from April 2023 to August 2023 at Rawalpindi Medical University. A validated, self-structured 16 items questionnaire regarding first aid was used to assess the knowledge of the students. Data analysis was done using Microsoft Excel and SPSS version 26. Results: The study included a total of 309 individuals enrolled in the MBBS, AHS, and Nursing programs. The mean knowledge score among all students was 8.72 ± 1.878. Only 10 (3.23%) students had High knowledge, 216 (69.9%) students had Moderate knowledge, and 83 (26.8%) students had Low knowledge of first aid. Significant differences were observed in knowledge scores among degree programs, with MBBS students (M = 9.02, SD = 1.61) scoring significantly higher than AHS (M = 8.0, SD = 2.33) and Nursing students (M = 8.06, SD = 2.11). However, no significant difference was found between AHS and Nursing students. A positive correlation was identified between academic year and knowledge scores, indicating increasing proficiency with each academic year.

Conclusion: This study sheds light on the current state of first aid knowledge among undergraduate healthcare students and underscores the need for tailored educational strategies to equip them with the essential knowledge for effective emergency response.

Awareness of Breast Cancer in Patients at a Tertiary Care Hospital in Pakistan; a Cross-sectional Study

Rameen Khalid — 2025-09-13

The Knowledge, Attitude and Practice about cervical cancer among women of reproductive age living in Rawalpindi, Pakistan: A Cross-sectional study

Fatima Nazir — 2025-09-13

Abstract

Background: Cervical cancer is a malignant epithelial tumor caused by Human papilloma virus. It is a gradually progressive disease. Since it is a prevalent health problem and can be prevented, it is necessary that women are aware of the disease and its prevention. This cross-sectional survey aimed to evaluate the knowledge, attitudes, and practices regarding cervical cancer among women of reproductive age group in Rawalpindi, Pakistan.

Objectives: To assess knowledge, practice, and attitude of women of Rawalpindi regarding cervical cancer and to determine the association between knowledge, attitude and practices regarding cervical cancer and demographic factors

Methods: A self-structured questionnaire was developed from a previous study (1). Random women of reproductive age (15-49) visiting Holy family Hospital, Rawalpindi were interviewed, and data was collected after informed consent in the time span of 3 months. Data was analyzed using SPSS (Statistical Package for Social Sciences) version 26. To find the association between independent variables (demographic characteristics) and dependent variables (Knowledge score, attitude score, practice score) an independent t test was used. Also, Pearson correlation was used to find association between knowledge score , attitude score and practice score .

Results: Overall study showed that 152(66.6%) women had adequate level of knowledge, 119(52.1%) women showed adequate level of attitude towards cervical cancer and 204(89.4%) women showed adequate level of practice. Among these women majority of women were younger, unmarried, literate, and nulliparous. On using independent t test significant (p<0.05) association was found between marital status, parity, age, and knowledge score also, significant (p<0.05) association between parity and attitude score was found. And significant (p<0.05) association was found between age, marital status, parity, and practice score. Pearson correlation showed signification relation between knowledge score and attitude score , knowledge score and practice score .

Conclusion: There is a dire need to increase awareness among women regarding cervical cancer to decrease the incidence of cervical cancer and to decrease mortality.

Keywords: Cancer of Cervix , Cancer of the Uterine Cervix , Pap Smear , HPV

Effectiveness of Soft Arch Insoles in the Management of Pediatric Pes Planus: A Descriptive Observational Study

Muqadas Mazhar — 2025-09-13

Abstract:
Objective

To evaluate the effectiveness of foot insoles in improving foot alignment, enhancing arch formation,
reducing pain and discomfort, and improving functional capacity in the pediatric population with pes planus
(flatfoot).
Study Design

A Descriptive Observational Study
Place & Duration of Study: This study took place at Benazir Bhutto Hospital Rawalpindi and lasted six months,
from May 1st, 2023 to November 31st, 2023.
Material and Methods

This study, conducted at Benazir Bhutto Hospital (BBH) Rawalpindi, examined the effects
of shoe insoles on 50 children aged 6 to 12 years with flexible pes planus who selected using nonprobability
consecutive sampling after providing informed consent. Children with flexible pes planus and no additional deformities were included, while those with rigid pes planus or noncompliance with insole use were excluded. A standardized questionnaire was used to gather data at baseline, 3 months, and 6 months, which included demographic information, the Foot Function Index (FFI), and the Visual Analog Scale (VAS). Statistical analysis was carried out using SPSS version 25.0, with descriptive statistics and paired sample t-tests used to analyze changes in VAS and PFFI scores
over time and the effectiveness of the intervention.
Results

The study comprised 50 pediatric patients with flexible pes planus, ranging in age from 8.94 ± 1.69 years.
There were 44% boys and 56% girls, with 68% coming from urban and 32% from rural areas. In 60% of
participants, the disease affected the right side, whereas 40% affected the left. Foot pain VAS scores dropped
significantly, from 5.2 ± 1.1 at baseline to 3.1 ± 0.9 at 3 months and 2.3 ± 0.8 at 6 months (p < 0.01). The Pediatric
Foot Function Index (PFFI) scores improved considerably from 72.5 ± 10.3 at baseline to 50.3 ± 8.7 at 6 months (p < 0.01). There were no major side effects observed, while 15% of individuals experienced moderate discomfort that resolved within a few weeks. P-values < 0.05 were considered significant.
Conclusion

The study found that using shoe insoles in children with flexible pes planus significantly reduced foot
discomfort and improved foot function over a 6month period. Foot pain VAS scores dropped significantly, from 5.2
± 1.1 at baseline to 3.1 ± 0.9 at 3 months and 2.3 ± 0.8 at 6 months (p < 0.01). The Pediatric Foot Function Index
(PFFI) scores improved considerably from 72.5 ± 10.3 at baseline to 50.3 ± 8.7 at 6 months (p < 0.01). There were
no major side effects observed, while 15% of individuals experienced moderate discomfort that resolved within a few weeks. P-values < 0.05 were considered significant.
Conclusion: The study found that using shoe insoles in children with flexible pes planus significantly reduced foot
discomfort and improved foot function over 6 months.
Keywords

foot insoles, pediatric pes planus, flat foot, medial longitudinal arch

Complementary Feeding: Is it Healthy and Adequate? Attitudes, Knowledge and Practices of Families of Rawalpindi

Shehzadi Shehar Bano — 2025-09-13

Background: This study examines the factors contributing to inappropriate complementary feeding practices for infants and young children, which can lead to impaired growth, delayed motor and cognitive development, stunting, malnutrition and other nutritional deficiencies.
Objectives: The objectives of this study are to assess the knowledge, attitudes and practices of complementary feeding habits in families of Rawalpindi, to determine demographic variables and child characteristics that influence complementary feeding, and to determine whether child feeding practices are adequate concerning a child's overall health or not.
Materials and Methods: This cross-sectional study was conducted from March to August 2023 in allied hospitals of Rawalpindi Medical University and a total of 308 mothers with index children between the ages of 4 months and 1 year participated. Convenience sampling was used to enroll eligible mothers. Data was collected through a verified self-administered questionnaire or interview-based approach as all mothers were not able to read and understand English. The data was analyzed through SPSS version 25.
Results: Among 308 study participants, majority of mothers (86.4%) were housewives and only 13.6% were working women. About two-thirds of the study population, i.e. 211 participants (68.5%) correctly stated the recommended time to initiate breastfeeding and nearly two-thirds of the mothers, 198(64.3%) knew the recommended duration for exclusive breastfeeding. Only half of the study population 170(55%) correctly answered the recommended time to initiate complementary feeding. The difference in knowledge between the housewives and working women was statistically significant (p<0.016) at the 0.05 significance level.
Conclusion: The current knowledge and practices of complementary feeding are insufficient. To develop a more positive attitude towards complementary feeding it is advisable to organize health education and awareness campaigns.
Keywords: Complementary feeding, Impaired Growth, Delay motor development, Malnutrition, Nutritional deficiencies.

Quality of life index in patient with scabies

Maryam Sadiq — 2025-09-13

Title; Quality of Life index in patient with scabies

Introduction; Scabies is an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. It places a psychological and emotional toll on patients similar to any other disease. Quality of life index helps to make an estimate about the physical, psychological, emotional and social impact of a disease for the patient.

Objectives;

• To assess QoL impairment in scabies patients and its variability with gender.

Methodology; With cross-sectional study design, a total of 297 diagnosed patients of scabies presenting in Benazir Bhutto Hospital, Rawalpindi were assessed using DLQI questionnaire defined by World Health Organization with a maximum score of 30 and cut-off values of 1,5,10 and 20. Patients of scabies with other skin diseases, underlying neuropsychiatric illnesses, functional disability and pregnancy were excluded. Data was stored and analyzed using SPSS version 27. Descriptive analysis was used for describing the study variables. Independent t-test was used for comparison between males and females, p value of <0.05 was taken as significant.

Results; Out of total 297 participants, number of males were 156 and females were 141. Out of total, 1.7% had no effect,22.2% had small effect, 36% had moderate effect, 30% had very large effect and 9.4% had extremely large effect on their quality-of-life due scabies disease. The p-value was found to be significant i.e., p-value<0.01.

Conclusion; Scabies has a significant negative impact on the lives of affected individuals. Anxiety, depression and significant psychological consequences are binding in these patients. Assessment of quality of life enables the treating physician to devise the best possible management plan individually.

Key words;

Quality of life; Quality of life is defined by World Health Organization as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.

Scabies; A contagious cutaneous inflammation caused by the bite of the mite SARCOPTES SCABIEI

Assessment of Awareness Regarding Hepatitis B and C among the Urban Community of Rawalpindi

2025-09-13

OBJECTIVE: Hepatitis B and C can cause lethal liver infections leading to permanent liver tissue damage.Globally, two billion individuals have encountered the Hepatitis B virus and 100 million individuals have encountered the Hepatitis C virus.The objective of this study was to evaluate knowledge,attitudes and practices of urban community in Rawalpindi towards Hepatitis B and C.
METHODS: A descriptive cross-sectional study was conducted in July 2023 among 277 participants. Data was collected through a questionnaire assessing knowledge, attitudes, and practices related to Hepatitis B and C. The responses to the questionnaire were recorded in SPSS version 25. Responses of participants were compared on the basis of both gender and educational level through Chi square test. Responses were also compared on the basis of age via Kruskal- Wallis H test. P-value<0.05 was considered statistically significant.
RESULTS: Among the participants, 135 (48.7%) were male, and 142 (51.3%) were female, with a mean age of 38.13 years ±12.76 years. The majority had not received Hepatitis B vaccination (61%), and only 27.1% had undergone screening. Participants from the secondary education level demonstrated higher knowledge levels in various aspects of Hepatitis B and C. There was no significant difference between genders, except for female participants being more informed about the potential lifelong persistence of the diseases.
CONCLUSION: This study provides valuable insights into the knowledge, attitudes, and practices regarding Hepatitis B and C within the urban community of Rawalpindi. The results indicate a need for enhanced vaccination coverage and screening accessibility. Tailored educational initiatives can significantly contribute to improved public health outcomes in this context.
KEYWORDS: Hepatitis B, Hepatitis C, Health Knowledge, Attitudes, Practices, Urban population.

Estimation of mean scores of blood pressure and knowledge of health risks associated with high blood pressure among medical students of RMU

2025-09-13

Introduction:

Hypertension is a problem faced by many people in our society. This study examines the mean scores of blood pressure and knowledge of health risks associated with hypertension among 1st year medical students at Rawalpindi medical university.

Objectives:

The objectives of this study are to measure the mean scores of blood pressure, and assess the risk factors associated with high blood pressure.

Materials and Methods:

The descriptive cross-sectional survey was conducted in April-June ,2024 at Rawalpindi Medical University, Rawalpindi, Pakistan. A total of 70 medical students responded to this survey. Data was analyzed using IBM SPSS statistics version 27. Inferential statistics was done and threshold for statistical significance was set at p value less than 0.05.

Results:

More than half of the population whose data is obtained are females. Approximately 3/4 of the people had their blood pressure checked by professionals. More than 50% had normal blood pressure and only less than 1% were on blood pressure medications.

Conclusion:

The study demonstrated that blood pressure scores were mostly normal among the students. Moreover, students had a significant knowledge regarding health risks associated with high blood pressure

Keywords:

Blood Pressure, Systolic Blood Pressure, Diastolic Blood Pressure, Sphygmomanometer.

Determination of Mean Bleeding Time and Knowledge of Conditions Associated with Variations in Mean Bleeding Time

2025-09-13

Bleeding time is a vital haemostatic parameter used to assess the platelet function and the overall blood coagulation. Bleeding time is defined as the average time taken by incision to stop bleeding.

This study aimed to evaluate mean bleeding time, conditions that might cause the fluctuation in the mean bleeding time and how early indication of such conditions might help elevate the medicine sector.

The population of the study were the universities students of first year MBBS of Rawalpindi Medical University involving the standard age group of 18 to 22 years. The Duke’s method was used to assess bleeding time. This method involves pricking participants’ earlobe or finger with a special needle or lancet, and the bleeding time is measured using a stopwatch.

To observe the several factors affecting the main bleeding time, a specifically designed questionnaire keeping in view the principles of ethics including confidentiality, autonomy and beneficence was developed which assess the participant’s lifestyle: including their physical activities, habits, medications, and addictions of drugs (if any). The family history, genetic disorders, and the health problems such as anaemia would be taken into the account. These factors would be analysed and their role in fluctuating the mean bleeding time would be linked.

The data collected contributed to understanding bleeding time variations and optimizing treatment strategies for early intervention, ultimately improving patient’s outcomes.

Assessment of Mental Health among Medical Students of RMU Rawalpindi

2025-09-13

ABSTRACT

Introduction

Mental health is an essential part of our general health. Students, especially those studying in medical colleges, are more prone to disturbed mental health, which can further affect the performance of medical students when they enter professional practice.

Objectives

The objective of this study is to assess the mental health and psychosocial well-being of MBBS students studying at Rawalpindi Medical University and to analyse factors affecting it.

Methods and Materials

In this cross-sectional study, a total of 315 students were enrolled across five medical years of study using consecutive sampling. Data was collected in a 3-part questionnaire; Demographics data, General Health Questionnaire-28 (GHQ-28) and a self-structured Factors Affecting Mental Health (FAMH) Questionnaire with 14 items was used. Likert Scoring was used for GHQ (cutoff=24).

Descriptive Statistics of mean, median, frequency, and percentage were applied to further describe the data. Chi-Square, T-test (Mann-Whitney U test and Kruskal-Wallis H test) on FAMH, and Binary Logistic Regression analysis, were applied to the data to find the association of GHQ score with the demographics of the students and FAMH.

Results

A total of 315 students participated with 34% (107) male and 66% (208) female. Mean age was 21.1 years (SD=2.65). 72.1% (227) non-boarders and 27.6% (87) boarders were included.

A significant difference was observed in year of study, where 50.7% basic years students and 35.2% clinical years students showed GHQ scores less than 24 (p=0.006). Only 34.5% of boarders and 46.2% of non-boarders had GHQ scores below 24 (p=0.060).

Physical appearance (p<0.001), preference in choosing MBBS (p=0.002), fear of failure of exams (p=0.003), support from staff (p=0.001), social habits (p=0.030), sports (p=0.001), physical health, financial issues, and chronic illnesses (p<0.001 respectively), were the factors that affected mental health with a clear statistical significance. Family structure (p=0.064), demand of studies (p=0.078), some foreign exam (p=0.096), family support (p=0.556), substance abuse (p=0.465), had no statistical significance on mental health.

Conclusion

Clinical year students are at higher risk of mental health issues. Physical appearance, fear of failure of exams, financial stress, and social habits affect mental health adversely. Moreover, stress of medical education and lack of awareness also affects mental health.

Keywords

Mental health, GHQ, Factors affecting mental health, medical students, university.

Metastatic Papillary Thyroid Microcarcinoma Mimicking Brachial Cleft Cyst: A Case Report

Rabia Mahmood — 2025-09-13

INTRODUCTION:

Papillary thyroid carcinoma (PTC) is the most common and well-differentiated type of thyroid cancer, with tumors ≤10 mm classified as papillary thyroid microcarcinoma (PTMC) by the World Health Organization. This case highlights a BCC initially diagnosed as benign but later found to harbor metastatic PTC. It emphasizes the need for careful evaluation of atypical neck masses to avoid delayed diagnosis and treatment.

CASE PRESENTATION

This case involves a 35-year-old woman with a three-year history of right-sided neck swelling and breathing difficulty, initially presumed to have a branchial cleft cyst (BCC) based on clinical findings and FNAC. Surgical removal of the cystic mass confirmed a type 2 BCC. However, continued symptoms led to further imaging and thyroid evaluation, which revealed a small nodule. Histopathology confirmed a unifocal papillary thyroid microcarcinoma (PTMC) in the right lobe. The case underscores the importance of considering hidden malignancy in seemingly benign lateral neck masses.

DISCUSSION

Although PTMC typically follows an indolent course, cystic lymph node metastases may signal aggressive behavior. Misdiagnosis as benign neck cysts can delay appropriate treatment. This case emphasizes the need for thorough evaluation of adult-onset lateral neck masses and supports early surgical intervention for accurate diagnosis and optimal management.

KEYWORDS :

Papillary Thyroid Microcarcinoma (C563277 ) , Metastasis ( D009362 ) , Branchial Cleft Cyst (D001935 ), Thyroidectomy (D013965)

Comparison of efficacy and adverse effects of Triptans and Gepants – Anti-migraine drugs

Pakeezah Tabasum — 2025-09-13

Migraine, the 2nd largest cause of Years Lived in disabilities (YLD) in 195 countries of world with a prevalence rate of 1040 Million. It is unilateral neurological disorder of head. 75% of patient of migraine are female who are in their reproductive stage. Most probably, the accepted cause behind pathophysiology of migraine is dilation of cephalic and intracranial arteries. By decades, the commonest used drugs for acute treatment of migraine are Triptans, 5-HT 1B and 5-HT1D receptor antagonist. Triptans for the treatment of migraine, cause relief from pain and other symptoms of migraine such as, nausea, vomiting, photophobia and photophobia within 2 hours. However, newly approved Drugs: Zavegepant and Rimegepant cause greater adverse effect than Triptans. Hence, rarely used for the treatment of migraine due its greater complications.