ISSN: 1819-7973 EISSN: 1997-2067 Gomal Journal of Medical Sciences (GJMS) is the official journal of Gomal Medical College, Dera Ismail Khan (D.I.Khan), Pakistan. It is published since 2003. It is fully open access. The work published here is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License. The authors retain the copyrights. GJMS is double-blind peer-review multi-disciplinary medical journal and is published quarterly. All articles submitted for publication are required to conform to the "Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals" as described by the International Committee of Medical Journal Editors (ICMJE). Indexed in ESCI (Emerging Sources Citation Index) of Web of Science (Clarivate) since August 2016 Included in JCR (Journal Citation Report) since 2020 JCI (Journal Citation Indicator) 0.22 for 2021, 0.17 for 2022, 0.14 for 2023 and 0.08 for 2024 JIF (Journal Impact Factor) 0.5 for 2022, 0.5 for 2023 and 0.1 for 2024 Indexed in Scopus since 2022, with CiteScore 1.0, SJR 0.187 & SNIP 0.514 for 2022, CiteScore 0.6, SJR 0.113 & SNIP 0.041 for 2023 and CiteScore 0.4, SJR 0.118 & SNIP 0.09 for 2024 Recognized by HEC (Higher Education Commission) in category Y since 2020-2021 and in category X since 01-10-2024
Gomal Medical College, D.I.Khan, Pakistan
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FOREIGN BODIES IN THE EAR, NOSE, AND THROAT: CLINICAL CHALLENGES AND MANAGEMENT
A foreign body is defined as any object or substance present in a part of the body where it does not normally belong. Foreign bodies involving the ear, nose, and throat (ENT) constitute one of the most frequent emergencies encountered in otorhinolaryngology outpatient clinics and emergency departments worldwide. Despite advances in healthcare delivery and increased public awareness, these cases continue to pose a significant clinical challenge, accounting for nearly 11% of all ENT emergencies. Children, particularly those under three years of age, are the most affected population and experience the highest rates of morbidity and mortality. Foreign bodies may be lodged in natural orifices such as the external auditory canal, nasal cavity, pharynx, or aerodigestive tract, or may penetrate the soft tissues of the maxillofacial region.
Copyright (c) 2026. Nawazish Ali, Muneeba Attique https://creativecommons.org/licenses/by-nc/4.0
EFFECT OF REMDESIVIR TREATMENT ON CLINICAL OUTCOME IN HOSPITALIZED PATIENTS WITH COVID-19 IN KIRKUK CITY
Background: One of the greatest pandemic illnesses of the century, Coronavirus Disease 2019 (COVID-19), is an infectious disease brought on by the SARS-CoV-2 virus, which causes severe acute respiratory syndrome. Currently, Remdesivir (RDV) is thought to be the only antiviral medication that has received complete approval for treating COVID-19 in hospitalized patients who are 12 years of age or older. The objective of the study was to evaluate RDV’s effectiveness in reducing death and length of stay in patients admitted with Covid-19. Materials & methods: This prospective cohort study was conducted among 341 hospitalized COVID-19 patients admitted to the isolation units at Azadi Teaching Hospital and Rizgari Hospital in Kirkuk City between February and August 2021. Participants were divided into two groups: the remdesivir group comprising 120 patients who received remdesivir plus standard treatment, and the control group consisting of 221 patients who received standard management without remdesivir. All patients were followed until discharge, ICU admission, or death, and clinical outcomes were compared between the two groups. Results: After initiation of RDV there were significant reduction in deaths among RDV group in comparison to control group (p=0.0001). there was significant lower mean time to discharge from hospital among RDV group (15 days) in comparison to control group (17 days) (p=0.0001). Conclusions: Receiving RDV plus standard regimen is effective in reducing mortality and duration of hospitalization among patient with COVID-19 in comparison to standard regimen without RDV.
Copyright (c) 2026. Assad Mubarak Jabbar, Abdulla Kamil Abdulla https://creativecommons.org/licenses/by-nc/4.0
EFFECT OF NURSES TRAINING IN ESSENTIAL NEWBORN CARE ON REDUCING ASPHYXIA AND NEONATAL MORTALITY: A QUASI EXPERIMENTAL STUDY
Background: Asphyxia and mortality remain significant concerns in developing countries, emphasizing the need for quality essential newborn care (ENC) at birth. Therefore, this study aimed to evaluate the effect of training nurses in Essential Newborn Care (ENC) on reducing neonatal asphyxia and mortality. Materials & Methods: A quasi-experimental study design was conducted in the Obstetrics Department of a public teaching hospital in Lahore School of Nursing, The University of Lahore, Punjab, Pakistan. over a period of nine months. A total of 42 nurses were selected through census sampling and received an 8-week ENC training program focused on immediate newborn care and neonatal resuscitation. The prevalence of asphyxia and neonatal mortality among NICU admissions was assessed before and after the training. A validated questionnaire was used to evaluate nurses’ knowledge, practices, and neonatal outcomes. Data were analyzed using SPSS version 23. Results: A review of 698 NICU admissions showed a slight decrease in asphyxia prevalence from 37.0% to 33.7%, with improvement in severity levels. Early neonatal mortality also showed a downward trend from 10.5% to 8.1%, though this change was not statistically significant. Secondary analysis Wilcoxon Signed-Rank test revealed significant improvements in nurses’ knowledge and practice scores post-training (p < 0.001), with median differences of 10.0 and 12.5, respectively. Conclusion: The findings suggest that ENC training can contributes to improved neonatal outcomes. However, to achieve a significant reduction in asphyxia and mortality, additional factors influencing patient outcomes must be addressed.
Copyright (c) 2026. Noreena Begum, Madiha Mukhtar, Azeem Kaleem https://creativecommons.org/licenses/by-nc/4.0
FUNCTIONAL OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION VIA THE ANTERIOR APPROACH FOR CAPITELLUM FRACTURES IN ADULT PATIENTS
Background: Capitellum fractures are rare intra-articular injuries of the distal humerus that require anatomical reduction and stable fixation for optimal functional recovery. The anterior approach to the elbow allows direct visualization of the articular surface and may facilitate early mobilization with minimal soft-tissue disruption. The purpose of the present study was to evaluate the clinical and functional outcomes of patients undergoing ORIF of capitellum fractures using headless Herbert screws via the anterior approach at a tertiary care center. Materials & Methods: This prospective case series study was conducted in the Department of Orthopaedic Surgery, MTI-Khyber Teaching Hospital, Peshawar, from June 2023 to October 2024, involving 29 adult patients (17 male, 12 female) with isolated capitellum fractures. All patients underwent open reduction and internal fixation using headless Herbert screws via the anterior approach. Patients were followed for 6 months. Functional outcome was assessed using the Mayo Elbow Performance Index (MEPI). Data were analyzed using SPSS version 26.0. Results: The mean age of patients was 33.48 ± 8.58 years. The mean time to radiological union was 11.90 ± 1.29 weeks. The mean flexion-extension arc was 142.77 ± 3.03 degrees, and the mean supination-pronation arc was 165.27 ± 2.03 degrees. The mean MEPI score was 85.24 ± 10.68. According to the MEPI score, 16 (55.2%) patients achieved excellent results, 7 (24.1%) good, 4 (13.8%) fair, and 2 (6.9%) poor outcomes. No cases of avascular necrosis, implant failure, or deep infection were observed. Conclusion: Open reduction and internal fixation of isolated capitellum fractures using headless Herbert screws via the anterior approach provides excellent to good functional outcomes in the majority of patients with a low complication rate in the short term. This technique is a safe and effective surgical option for adult patients.
Copyright (c) 2026. Muhammad Siraj, Manzoor Ilahi, Adnan Khan, Waseem Khan, Abbas Ali, Shahab Ur Rehman https://creativecommons.org/licenses/by-nc/4.0
MULTIMODAL RADIOLOGICAL DIAGNOSIS OF UTEROVAGINAL MULLERIAN DUCT ANOMALIES; A THREE-YEAR EXPERIENCE IN TERTIARY CARE HOSPITAL, PESHAWAR
Background: Müllerian duct anomalies (MDAs) are congenital uterovaginal malformations with significant reproductive and gynecological implications. Early and accurate diagnosis is essential for effective management. This study aimed to determine the frequency and spectrum of uterovaginal Müllerian duct anomalies in a tertiary care hospital and to assess the role of multimodal imaging using the ASRM MAC 2021 classification Materials & Methods: This retrospective cross-sectional study was conducted at the Radiology Department of Lady Reading Hospital, Peshawar, using HMIS data from January 2022 to December 2024. Patients aged ≥12 years with radiologically confirmed uterovaginal anomalies were included (n=150). Ultrasound and pelvic MRI were used for evaluation, and anomalies were classified according to the ASRM Müllerian Anomaly Classification (MAC) 2021. Data were analyzed using SPSS v26. Descriptive statistics were reported; an independent-samples t-test compared uterine bud dimensions between infantile and prepubertal uterus. A total of 150 patients aged ≥12 years with radiologically confirmed uterovaginal anomalies were included. Imaging modalities used were ultrasound & MRI. Anomalies were classified per ASRM MAC 2021 criteria. Results: Mean age was significantly lower in patients presenting with primary amenorrhea (16.8±4.07 years) compared with other presentations (27.22±9.58 years; p<0.01). The most frequent anomaly was dysplastic/infantile uterus (34.4%), followed by bicornuate uterus (24.0%) and transverse vaginal septum (13.9%). Ultrasound was the primary imaging modality (124/150), while MRI was used for problem-solving (26/150). Craniocaudal uterine bud length differed significantly between infantile and prepubertal uterus (p=0.007). Conclusion: Uterovaginal MDAs constitute a substantial diagnostic workload in tertiary care. A structured multimodal imaging approach guided by ASRM MAC 2021 improves characterization and communication with gynecology teams, supporting appropriate clinical management.
Copyright (c) 2026. Nasreen Aman, Muhammad Imran Khan, Fatima Sultan Ahmad, Shehzadi Saima Hussain, Fariha Afzal, Laila Khan https://creativecommons.org/licenses/by-nc/4.0
PIRIBEDIL, A DOPAMINE AGONIST MODULATE GLYCEMIC CONTROL IN DIABETIC RAT MODEL
Background: Diabetes mellitus is a metabolic syndrome presenting with multiple pathologies. Numerous regimens of antidiabetic drugs are in practice. Bromocriptine, a dopamine agonist, is approved by the FDA for the management of hyperglycemia. Piribedil is a piperazine derivative. It has been authorized by the European Union for the treatment of depression, Parkinson’s disease, and restless leg syndrome. The objectives of this study were to investigate piribedil for treatment of hyperglycemia in diabetic rat model. Materials & Methods: This in-vivo experimental study was duly approved by the Faculty Research Board and was conducted in Pharmacology Department, Azra Naheed Medical College, Lahore. Diabetes was induced by alloxan (150 mg/kg) intraperitoneal injection in Sprague–Dawley rats. The animals were divided into normal control, diseased control, positive control (glimepiride 0.1 mg/kg), piribedil low dose (25 mg/kg), piribedil medium dose (50 mg/kg), and piribedil high dose (75 mg/kg). Treatment was given for 2 weeks. The body weights, and fasting blood glucose levels were monitored weekly. The animals were euthanized, and blood samples were drawn through cardiac puncture. Plasma insulin levels were determined using rat ELISA kits. Results: Piribedil significantly reduced blood glucose levels as compared to the diabetic group in a dose dependent manner. Additionally, serum insulin levels were significantly increased in all treatment groups (P<0.05). All treatment groups experienced a post-treatment reduction in HOMA-IR with glimepiride (3.52 ± 0.41) and high-dose piribedil (3.60 ± 0.27), showing the most substantial improvement. High dose piribedil and glimepiride groups demonstrated QUICKI values (0.316 ± 0.003) & (0.317 ± 0.005) respectively, comparable to the normal control (0.326 ± 0.003), indicating improved insulin sensitivity. Conclusion: Piribedil operates by reducing fasting blood glucose levels and enhancing insulin production. These findings imply that piribedil may play a role in combating hyperglycemia.
Copyright (c) 2026. Tehreem Saif, Naseem Saud Ahmad, Asma Inam, Muhammad Zeeshan Alam Khan, Basma Shakeel, Rubina Kashif. https://creativecommons.org/licenses/by-nc/4.0
ASSESSING THE EFFECTIVENESS OF CONTINUOUS GLUCOSE MONITORING (CGM) IN ICU SETTINGS
Background: Effective glycemic rheostat in censoriously ill affected people is associated with improved clinical outcomes. Traditional point-of-care (POC) glucose monitoring has limitations in detecting rapid glucose fluctuations. This study evaluated the effectiveness and medical utility of Continuous Glucose Monitoring (CGM) in ICU settings compared to standard POC testing. Materials & Methods: A prospective observational study was conducted involving 100 ICU patients randomized into two clusters: CGM (n=50) and POC (n=50). Key outcomes included accuracy metrics (MARD, Clarke Error Grid), period in glucose series (70–180 mg/dL), incidence of hypo/hyperglycemic events, insulin adjustment frequency, and ICU outcomes (length of stay, mortality). Results: CGM demonstrated high accuracy (MARD 10.2%) with 96.5% of readings in clinically acceptable zones. Time in range was pointedly higher in the CGM group (78.6% vs. 65.2%, p < 0.001), with fewer hypoglycemic events (0.4 vs. 1.1 per patient-day, p = 0.002) and hyperglycemic episodes (1.2 vs. 2.8 per patient, p = 0.01). CGM enabled more frequent insulin titration (4.5 vs. 2.7 adjustments/day, p < 0.001). No noteworthy differences were experiential in ICU length of stay or mortality. Conclusion: CGM is a safe and accurate tool for glycemic management in ICU patients.
Copyright (c) 2026. Sarwat Saif, Khushroo Minhas, Umair Ashfaq, Sohaib Haider, Adnan Saeed Shakir, Amna Riaz, Zobia Zafar https://creativecommons.org/licenses/by-nc/4.0
CLINICAL OUTCOMES AND SURGICAL MANAGEMENT OF DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH): A SINGLE-CENTER EXPERIENCE WITH DEGA OSTEOTOMY
Background: Developmental Dysplasia of the Hip (DDH) is a significant pediatric orthopedic condition with long-term implications for hip function and mobility. This study aimed to evaluate the clinical outcomes and effectiveness of surgical management, focusing on the Dega osteotomy technique. Materials & Methods: This retrospective single-center study included 35 patients (49 operated hips) who underwent Dega osteotomy for DDH between January 2020 and December 2024. Demographic, clinical, and surgical data were collected, and functional outcomes were assessed using standardized measures. Results: The mean age at diagnosis was 1.84 years (±1.2). Dega osteotomy was the most frequently performed procedure (62.9%), often combined with other interventions. Postoperative outcomes were favorable, with 82.9% of patients reporting no or minor pain. Functional outcomes showed that 97.1% of patients did not require mobility support, 77.1% exhibited no limp, and 85.7% could walk unlimited distances. Statistically significant associations were observed between the number of surgeries and hip involvement (p = 0.000), type of harness used (p = 0.032), type of operation (p = 0.016), pain levels (p = 0.042), and walking distance (p = 0.041). Conclusions: The Dega osteotomy, often combined with other procedures, demonstrated effective surgical management of DDH in this single-center experience. Favorable functional outcomes, including improved mobility and reduced pain, were achieved in the majority of patients. These findings underscore the importance of early diagnosis and tailored interventions to optimize long-term outcomes for DDH patients.
Copyright (c) 2026. Mudir Khan, Abbas Ali, Sikandar Hayat, Rao Erbaz khan, Jawad Ali, Zeeshan khan, Hamza Haroon https://creativecommons.org/licenses/by-nc/4.0
THE PRACTICE OF BREASTFEEDING AMONG WOMEN: CHALLENGES AND MOTIVATIONS
Background: The decision to breastfeed is shaped by a mix of motivations and challenges. While the health, emotional, and economic benefits are strong motivators, women often face significant barriers—physical discomfort, societal stigma, workplace limitations, and lack of support. Strengthening healthcare guidance, creating supportive environments at work and in public spaces, and promoting awareness can help mothers sustain breastfeeding practices and maximize benefits for both mother and child. The aim of this study was to explore the breastfeeding practice among mothers and to identify the motivators and barriers influencing the initiation and duration of breastfeeding. Materials & Methods: A cross-sectional study was conducted from February the 1st 2025 till April the 30th 2025, study setting was in the gynecology and obstetrics hospital and pediatric hospital, during a period of 6 months by interviewing among mothers attending in pediatric hospital and obstetric hospital for variable reasons using a constructed questionnaire of demography, practice barriers, motivators and duration of breastfeeding. Results: Among 188 women of age 20-40 years half of them were college graduates, mostly housewives of middle income, two thirds of them were of nuclear families, two thirds of them were exclusively breastfeeding their infants, initiating within the 1st hour postdelivery in nearly half of them till one year, the main motivation was the nutritional benefits to their infant, the main physical challenge was painful nipple followed by decreased milk production, although nearly one third of working women complain from insufficient maternity leave, this was not significantly associated with duration of breast feeding. Conclusion: Most of the participant mothers were exclusively breast feeding their infants , initiating the feeding within the 1st hour of delivery, mainly motivated by breast milk nutritional benefit, regardless the employment status they continued breastfeeding till one year.
Copyright (c) 2026. Mayasah A.Sadiq, Alaa A.Salih, Najlaa Fawzi Jamil https://creativecommons.org/licenses/by-nc/4.0
OUTCOMES OF DELAYED TOTAL HIP ARTHROPLASTY; POST-ACETABULAR FRACTURE FIXATION
Background: Despite advances in the treatment of acetabular fractures, traumatic osteoarthritis rate is very high & accounts for 13-40% of all hip osteoarthritis cases. Arthroplasty in the context of an acetabular fracture is a complicated procedure whether done as part of the acute therapy (ORIF acute THA) or in the delayed setting (ORIF delayed THA). The objective of this study was to determine the functional outcomes of delayed total hip arthroplasty post-acetabular fracture fixation. Materials & Methods: This Descriptive was conducted in the department of orthopedics & spine, Hayatabad Medical Complex, Peshawar from February1st 2022 to Oct 31st 2025. Function outcomes of all patients were assessed post-operatively using Harris Hip score. Higher scores indicate better outcomes. Results: Out of 30 patients included in our study two patients were having Harris Hip score between 90 & 100(Excellent outcome), 21 were having Harris hip score between 80 & 90(Good outcome) while three patients were having Harris hip score between 70 & 80(Fair outcome). Paired t-test was used to compare pre & post-operative outcomes of patients & the results were statistically significant. Conclusion: Despite the technically challenging procedure, delayed cementless acetabular total hip arthroplasty (THA) is an effective procedure for patients who have had prior unsuccessful acetabular fracture treatment.
Copyright (c) 2026. Asif Nawaz, Muhammad Aamir, Waleed Salman, Saeed Anwar, Javeria Shah, Faiza Imrad, Israr Ahmad https://creativecommons.org/licenses/by-nc/4.0
EFFECT OF RAMADAN FASTING ON PREGNANT WOMEN ON THE WEIGHT AND OTHER DEMOGRAPHICS OF NEWBORNS
Background: Literature suggests that the environment during pregnancy has a significant influence on the physical and mental health of newborns. The study aimed to determine the effect of Ramadan fasting on pregnant women on the weight and size of newborn babies, as well as on their sleeping patterns. Materials & Methods: This prospective cohort study was conducted in three private (Raazi Hospital, Rawalpindi; Raazi Hospital, Islamabad; and Shifa International Hospital, Islamabad) and two government hospitals (Holy Family Hospital, Rawalpindi; and Benazir Bhutto Hospital, Rawalpindi) in Holy Family Hospital, Rawalpindi; and Benazir Bhutto Hospital, Rawalpindi. All pregnant women visiting the prenatal clinics during Ramadan were enrolled in the study. The pre-designed questionnaire collected participants’ demographic information, diet and sleep patterns, knowledge, and perceptions regarding Ramadan fasting. The information about the newborns was collected after the delivery of the enrolled participants. Results: Six hundred and eight (608) pregnant women were followed up to the delivery. The weight, height, head-circumference, and mid-arm circumference of the newborns were not statistically significant in terms of the number of days of fasting, and trimester during the Ramadan between fasting and non-fasting mothers. However, the mean weight of newborns from mothers in middle socio-economic groups was significantly higher than that of newborns from mothers in lower socio-economic groups. Seventy percent of women include Roti or Paratha in Sahoor, and almost all the women were consuming the fruits in Iftar. There was also no significant association between newborns’ gender. However, APGAR score showed significantly higher mean value for fasting mothers. Conclusions: The study concludes that Ramadan fasting in pregnant women does not have any effect on the weight, height, or gender of newborns.
Copyright (c) 2026. Nazeer Khan, Muhammad Iqbal Khan, Shazia Fakhar, Jawveria Gulzar, Muhammad Kumail Baloch, Ayesha Saif https://creativecommons.org/licenses/by-nc/4.0
CLINICAL, DERMATOLOGICAL, AND HORMONAL CORRELATES OF POLYCYSTIC OVARY SYNDROME: A CASE-CONTROL STUDY IN SOUTHERN PUNJAB, PAKISTAN
Background: Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder. This study aimed to assess the clinical, menstrual, obstetric, and endocrine profiles of women with PCOS in comparison to healthy controls ascertained from Southern Punjab, Pakistan. Materials & Methods: In a cross-sectional case-control study design, 204 PCOS patients and 150 controls were recruited from tertiary care hospitals. PCOS was diagnosed per Rotterdam criteria. Descriptive statistics was employed. Results: Dermatological manifestations were significantly more prevalent among PCOS cases: hirsutism (Odd ratios, OR: 60.4), acne (OR: 11.2), alopecia (OR: 23.4), seborrhea (OR: 11.7), and acanthosis nigricans (OR: 58.8). Menstrual irregularities like oligomenorrhea and amenorrhea cases were significantly more common among PCOS cases. Abortions and miscarriages were slightly more common among cases, though not statistically significant. Endocrine profiling showed significantly lower FSH levels and higher LH, testosterone, and estradiol levels in PCOS cases. Serum leptin and insulin levels were also significantly elevated, indicating metabolic disturbances. Hirsutism correlated positively with serum testosterone levels in both groups, emphasizing the role of androgen excess in PCOS. Age-stratified analyses of PCOS individuals revealed significant association between waist-and-hip circumference and FSH and LH levels in older age patients. Conclusions: This study highlights the multifaceted clinical and hormonal disturbances in PCOS and underscores the diagnostic value of dermatological features and endocrine markers. These findings also suggest that PCOS manifestations and hormonal imbalances vary with age, emphasizing the need for age-specific diagnostic and management approaches.
Copyright (c) 2026. Amna Mushtaq, Asia Bibi, Muhammad Asim Iqbal Qureshi, Faheem Riaz, Sajid Malik, Nahid Kausar https://creativecommons.org/licenses/by-nc/4.0
T1W HYPERINTENSE SIGNAL ON MRI OF POSTERIOR PITUITARY GLAND – NORMAL DIMENSIONS IN OUR POPULATION
Background: Pituitary gland is one of the most important gland of the body. The posterior part of pituitary gland depicts a bright spot, seen on T1W sequence. Studies show that the presence of vasopressin and T1 shortening effect, bright spot is depicted in posterior pituitary. Less commonly but absent or ectopic pituitary can also be observed. The aim of this study was to assess normal craniocaudal and anteroposterior dimensions of the posterior pituitary bright spot on magnetic resonance imaging (MRI). Materials & Methods: It was retrospective study conducted in Radiology Department of Fauji Foundation Hospital, Rawalpindi. Duration is from January, 2022 to September, 2022. Total 499 patients with normal pituitary MRI studies were selected for the study. The dimensions of posterior pituitary bright spot were assessed on non-contrast sagittal T1WI. Anteroposterior and craniocaudal dimensions were noted. Results: Posterior pituitary bright spot (PBBS) was identified in 98.4 % of the patients with normal pituitary glands. In 1.6 % of patients (n=8) there was absence of posterior pituitary bright spot. Mean (±SD) dimensions of PBS size in craniocaudal dimension were 5.17 ±1.20 mm (range 1.7 – 8.4 mm). Mean (±SD) dimensions in anteroposterior dimension were 2.21±0.59 mm (range 0.5 – 4.4 mm). There is a direct relation in craniocaudal dimension and anterior posterior dimension of posterior pituitary bright spot. Concluson: Pituitary bright spot is a normal finding in brain MRI. By identifying the normal range, it is hoped that pathology of the pituitary gland can be more easily recognized. In case of its absence, ectopic or pathological pituitary gland must be identified.
Copyright (c) 2026. Kamran Burki, Khalil Hussain, Aasma Nudrat Zafar, Faryal Asmat, Kiran Fatima Farooq, Najia Hussain Rizvi https://creativecommons.org/licenses/by-nc/4.0
COMPARATIVE STUDY: N-ACETYLCYSTEINE AND METFORMIN ON ATHEROGENIC INDEX IN DIABETIC RATS
Background: Diabetes Mellitus (DM) is a global health issue with severe systemic health effects. A key driver of these complications is prolonged high blood sugar, which enhances the lipolysis and leads to dyslipidemia. Atherogenic index plasma (AIP) significantly heightens the risk of cardiovascular diseases (CVS) in diabetic patients. The objectives of this study were to check the novel use of N- acetylcysteine (NAC) in diabetic rats and to evaluate the comparative effects of NAC and Met on diabetes induced rats. Materials & Methods: This randomized control trial study was undertaken at the Department of Pharmacology & Therapeutics, Army Medical College Rawalpindi in association with the National Institute of Health (NIH) Islamabad from August 2021 to October 2021. There was a total of twenty-five rats, with five in each group randomized. An intraperitoneal (IP) injection of Streptozotocin (STZ) (35 mg/kg) was given to induce a diabetic condition in the animals. Rats with blood sugar levels in excess of 300 mg/dl after 48 hours were considered to be diabetic. The rats with Diabetes were used as a diabetic control group in one group while the remaining DM rats in three groups were treated with N-acetylcysteine (NAC), Metformin (Met), and Metformin plus N-acetylcysteine (Met + NAC) respectively. The treatment lasted for four weeks. The Atherogenic Index plasma (AIP) of the groups was compared at the end of the trial period. In the statistical analysis, the whole data array was handled with the SPSS 25.0 statistical software package. The Analysis of Variance (ANOVA Test), which compares the variations within all the groups, has been employed, followed by post hoc Tukey test. Results: There was a total of twenty-five rats, with five in each group randomized. There was a marked improvement in the Atherogenic index plasma (AIP) for the N-acetylcysteine (NAC) group, as well as for the Metformin + N- acetylcysteine (Met + NAC) group having a p value <0.001in these groups. Conclusion: The use of antioxidants, including N-acetylcysteine, caused a significant decrease in the Atherogenic Index Plasma in a diabetes-induced model produced by Streptozotocin.
Copyright (c) 2026. Novera Sohail Bajwa, Zoobia Irum, Mehtab Munir, Syed Muzaffar Ali, Mushayada Irshad, Qurra-Tul- Ain Haider. https://creativecommons.org/licenses/by-nc/4.0
THE VALUE OF ULTRASOUND AND MAGNETIC RESONANCE IMAGING IN DIAGNOSIS OF PLACENTA PREVIA AND ABNORMAL PLACENTATION
Background: Maternal morbidity and mortality are significantly increased in cases with placenta accreta spectrum (PAS), a severe obstetric disease. Accurate antenatal diagnosis is essential for optimal peripartum planning and management. Using intraoperative and histological findings as the gold standard, this study aimed to evaluate and compare the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound in detecting PAS. Materials & Methods: From the 1st of March, 2023 to the 1st of August, 2025, Radiology, Obstetrics & Gynaecology, a validational cross-sectional study was conducted at Rehman Medical Institute and Hayatabad Medical Complex. We conducted a study on 146 pregnant women with 28 weeks soaring pregnancy age and history of abnormal placentation using non-probability consecutive sampling technique. MRI and USG values were standardised in all the subjects. The calculated sensitivity, specificity, positive predictive value, negative predictive value and accuracy were used for the assessment. The SPSS ver 26.0 analyzed the information statistically, and p0.05 is significant. Results: On average, participants were 32.47 ± 6.66 years old and 32.79 ± 3.28 weeks pregnant. A clinical diagnosis of PAS was confirmed in 99 (67.8%) cases. The diagnostic accuracy of ultrasound for probable infective pyelonephritis and UTI was found to be 82.19%. The results of the MRI analysis improved. Conclusion: When it came to recognizing the placenta accreta spectrum, MRI proved to be more accurate than ultrasound. In high-risk pregnancies, magnetic resonance imaging (MRI) is a useful adjunct to ultrasound for enhancing diagnostic certainty and facilitating right surgical planning, while ultrasound is still the gold standard.
Copyright (c) 2026. Sara Khattak, Ummara Siddique, Zara Khattak, Wadana Khattak, Ghulam Ghaus, Hammad Ur Rehman, Hira Syed, Muhammad Hasnat. https://creativecommons.org/licenses/by-nc/4.0
PREVALENCE, PATTERNS, AND SELF-REPORTED HEALTH CONSEQUENCES OF SODA DRINK CONSUMPTION AMONG MEDICAL STUDENTS: A CROSS-SECTIONAL STUDY
Background: Soda drinks are widely consumed worldwide despite strong evidence linking them to adverse health outcomes such as obesity, diabetes, elevated blood pressure, dyslipidemia, and cardiovascular disease. The objectives of this study were to determine the prevalence of soda drink consumption among medical students and assess self-reported health consequences. Materials & Methods: A cross-sectional study was conducted among students from all academic years at Rehman Medical College Peshawer (n = 138). A structured online questionnaire assessed soda consumption frequency, duration, perceived health effects, and demographic information. BMI was calculated for participants with available height and weight data. Statistical analyses included descriptive statistics, Mann–Whitney U tests, Spearman correlations, and logistic regression for adjusted associations. Results: Of 138 respondents, 91 (65.9%) reported regular consumption and 33 (23.9%) reported daily consumption. Most frequently cited health effects included weight gain and dental problems. BMI did not differ significantly between consumers and non-consumers (median ≈ 21.9; p = 0.827), nor did years of consumption correlate with BMI (ρ =−0.022, p = 0.814). Adjusted analysis indicated a borderline significant association between daily consumption and dental problems (p ≈ 0.05). Conclusion: Soda consumption remains highly prevalent among medical students, despite awareness of associated risks. Strategies targeting behavioral change and supportive policy measures are recommended.
Copyright (c) 2026. Zayyan Khan, Muhammad Aliyan, Muhammad Kashan, Muhammad Hamza, Mahrukh Azmat. https://creativecommons.org/licenses/by-nc/4.0
QUANTITATIVE LIGHT-INDUCED FLUORESCENCE IN THE DIAGNOSIS OF WHITE SPOT LESIONS: PRINCIPLES, APPLICATIONS, AND CLINICAL RELEVANCE
White spot lesions (WSLs) are early signs of dental caries and are characterized by demineralization of the enamel surface. Timely detection and monitoring of WSLs are crucial for effective preventive and therapeutic interventions to halt their progression. Quantitative Light-induced Fluorescence (QLF) has emerged as a promising diagnostic tool for the early detection and quantitative assessment of WSLs. This review aims to provide a comprehensive overview of the principles, methodologies, and clinical applications of QLF in diagnosing WSLs. The underlying principles of QLF, including its interaction with dental tissues and the fluorescence properties of demineralized enamel, and methodological aspects, such as image acquisition protocols, software analysis, and interpretation criteria, are critically evaluated. Furthermore, the diagnostic accuracy, reliability, and reproducibility of QLF in detecting WSLs were systematically reviewed based on the available literature. The challenges and limitations associated with QLF, including its reliance on operator proficiency, calibration procedures, and potential confounding factors, have been identified. This review highlights the significance of QLF in enhancing the early detection and management of WSLs, thereby contributing to optimal oral health.
Copyright (c) 2026. Namrata Gaur, Raghunath Nagasundara Rao, Jyothikiran Hurkadle, Vidya Gowdappa Doddawad. https://creativecommons.org/licenses/by-nc/4.0
TOWARD PRECISION HEPATOLOGY: GENOMIC AND IMMUNOLOGIC DETERMINANTS OF DISEASE PROGRESSION IN CHRONIC HBV AND HCV INFECTION
Hepatitis B and C remain significant causes of cirrhosis and hepatocellular carcinoma, especially in the Middle East, where HBV genotype D and HCV genotype 4 are predominant. Despite the expansion of vaccination programs and new direct-acting antivirals, many patients still progress to advanced liver disease due to complex host–virus interactions involving genetic, epigenetic, and immune system balance. This study compiles recent research on viral genotypes, host immunogenetic polymorphisms, and multi-omics advances to capture long-term profiles of liver injury. Key viral factors include the pathogenic roles of DNA integration and immune-escape mutations in HBV, as well as NS5A resistance variants in HCV. Host factors involve HLA allele diversity, interferon-lambda and cytokine gene polymorphisms, and immune checkpoint regulation. Multi-omics technologies, analyzing genomics, transcriptomics, proteomics, metabolomics, and immunomics, are shaping the era of precision hepatology by enabling detailed molecular profiling of tissues and responses to fibrosis stages. To maximize the benefits of precision hepatology in the Middle Eastern population, integrating with national genomic databases and linking to multi-omics data is crucial for identifying population-specific biomarkers. Additionally, translating detection into treatment through local biorepositories and omics collaboration is essential to improve national models, support Saudi Vision 2030, and achieve global hepatitis elimination goals.
Copyright (c) 2026. Shuaibu Abdullahi Hudu, Abdulgafar Olayiwola Jimoh. https://creativecommons.org/licenses/by-nc/4.0
WILSON’S DISEASE PRESENTING WITH NEUROPSYCHIATRIC SYMPTOMS AND KAYSER–FLEISCHER RING COMPLICATED BY URETERIC CALCULUS AND UTI
Background: Wilson’s disease is an autosomal recessive disorder of copper metabolism leading to toxic accumulation in multiple organs, most prominently the liver, brain, and cornea. While neuropsychiatric manifestations and Kayser–Fleischer (KF) rings are well-established diagnostic hallmarks, renal complications such as nephrolithiasis and secondary urinary tract infection (UTI) are less frequently recognised, despite their potential to significantly alter clinical outcomes. Case Presentation: We report the case of a 25-year-old male with known Wilson’s disease who presented with progressive memory impairment, behavioural dullness, tremors, and bradykinesia over several months. Slit-lamp examination revealed a distinct KF ring, indicating ongoing systemic copper deposition, corroborated by markedly reduced ceruloplasmin levels. Following a transient neurological exacerbation, the patient later developed acute flank pain, low-grade fever, and anorexia. Ultrasound imaging identified a lower calyceal renal calculus and a distal ureteric calculus causing mild hydroureteronephrosis. Urinalysis demonstrated early features of UTI. He was managed conservatively with intravenous antibiotics, hydration, analgesics, and continuation of chelation and dopaminergic therapy, resulting in rapid symptom resolution and stable renal and neurological status. Conclusion: This case highlights the multisystemic nature of Wilson’s disease, emphasising the need for vigilance regarding renal complications, particularly when new-onset pain or fever emerges in patients presenting primarily with neurological involvement.
Copyright (c) 2026. Hepzibah Rani Gidla, Pavan Kumar Yanamadala, Vijay Kumar Nakka. https://creativecommons.org/licenses/by-nc/4.0
ANALYSİS OF INTERNET SEARCH TRENDS FOR BASİC ANESTHESİA PRACTİCES: TURKEY AND THE WORLD
The Internet has become a cornerstone of patient self-education, serving as a primary resource for individuals to address their health concerns prior to clinical consultations. In the field of anesthesiology, understanding public interest is of critical importance, as patients often make decisions regarding labor analgesia and types of anesthesia long before meeting a specialist. In this letter, we evaluated anesthesia-related search trends using Google Trends (GT) data both in Turkey and globally between 2023 and 2024.
Copyright (c) 2026. Mehmet Sahap, Sumeyye Demirhan, Ezgi Erkılıç, Handan Gulec. https://creativecommons.org/licenses/by-nc/4.0