Vol. 24 No. 3 (2026)

BACKGROUND & OBJECTIVE: Dengue is one of the most rapidly spreading viral disease transmitted by mosquito bite to human. In Pakistan, where dengue outbreaks have been a concern, increasing dengue awareness among medical students is vital. The objective of this study was to assess the current level of awareness about dengue, focusing related knowledge and practices.METHODOLOGY: This cross-sectional comparative study was conducted among 222 fourth year medical students selected through convenient sampling from six public sector medical colleges of Lahore. All those who were present at the time of data collection and were willing to participate were included but participants with incomplete responses were excluded from study. Data entry and analysis was done using SPSS version 27. A Pearson chi-square test of independence was conducted to evaluate the relationship between gender and dengue awareness scores. An independent-samples t-test was conducted to determine whether overall dengue knowledge scores differed significantly between day scholars and hostelite. A one-way analysis of variance (ANOVA) was conducted to evaluate differences in dengue awareness scores across six medical institutions in Lahore. A p-value of less than 0.05 was considered statistically significant scoring system was developed using all of the 27 questions of our online questionnaire, giving each correct question 1 score and incorrect as 0 score. ≥75% score considered as High level of awareness.RESULTS: Descriptive analysis of the 27-point dengue awareness scale showed almost identical awareness scores among male and female students. The scores in both groups ranged from 13.50 to 27.00, with an interquartile range of 4.50. For residential status, day scholars had a mean awareness score of 21.98 ± 2.81 and Hostelite had a mean score of 21.96 ± 3.26. No statistically significant association was found between gender and dengue awareness; similarly residential status was not significantly associated with dengue awareness. Although the mean awareness scores varied between institutions, ranging from 20.39 ± 4.01 at Fatima Jinnah Medical University to 23.18 ± 2.41 at Shaikh Khalifa Bin Zayed Medical and Dental College, this difference did not reach statistical significance.CONCLUSION: This multi-center study demonstrated high baseline dengue awareness among undergraduate medical students across public medical colleges in Lahore. Knowledge levels were uniform across demographic subgroups, showing no statistically significant differences by gender, or residential status. Although the mean awareness scores varied between institutions, this difference did not reach statistical significance. The difference of highest percentageof high level of awareness amongst different institute's emphasis need for more comprehensive sharing of information

BACKGROUND & OBJECTIVE: AmpC beta-lactamase production among Gram-negative bacteria is an emerging therapeutic challenge due to resistance to several beta-lactam antibiotics. Limited local data are available on AmpC production among Proteus species. The main objective of this study was to determine AmpC beta-lactamase production in Proteus species using phenotypic methods and assess their antibiotic resistance patterns. METHODOLOGY: This cross-sectional study was conducted at the Microbiology Laboratory, Department of Pathology, King Edward Medical University/Mayo Hospital, Lahore, Pakistan, during 01-02-2025 to 31-10-2025. Sixty nonduplicate clinical isolates of Proteus spp. were included. Identification was based on Gram staining, colony morphology, swarming motility, and biochemical testing. Antimicrobial susceptibility was determined by Kirby–Bauer disc diffusion according to CLSI guidelines (M100, 35th edition, 2025). Isolates with a cefoxitin zone <18 mm were screened for AmpC production and further evaluated using the AmpC disc test and Modified Hodge Test. Data were analyzed using SPSS version 27. RESULTS: Of 60 isolates, 41 (68.3%) were from males and 19 (31.7%) from females. AmpC production was detected in 7 (11.7%) isolates by the AmpC disc test and 6 (10.0%) by the Modified Hodge Test. Highest resistance was observed to amoxicillin-clavulanate (93.3%), cefotaxime (83.3%), ceftriaxone (85%), and ciprofloxacin (68.3%). Resistance to meropenem and piperacillin-tazobactam was 6.7% and 10.0%, respectively. CONCLUSION: A significant number of AmpC beta lactamase proteus was found, which also showed MDR. Regular diagnostic labs should have no trouble incorporating these phenotypic detection techniques. KEY WORDS: AmpC Beta- lactamase, Antibiotic resistance, Cefoxitin Hodge test, Enterobacteriaceae, MDR, Proteus species.  

BACKGROUND & OBJECTIVE: In Pakistan, drug-resistant forms of tuberculosis (TB) continue to be a significant public health concern. Targeted control techniques depend on the identification of clinical and sociodemographic factors of TB and rifampicin resistance.The objective of this study was to describe the clinical and sociodemographic characteristics of presumptive tuberculosis patients and to characterise the pattern of TB positivity and rifampicin resistance among them.METHODOLOGY: The Provincial Reference TB Laboratory at Nishtar Medical University in Multan was the site of this cross-sectional analytical investigation. A total of 210 suspected TB patients were enrolled using a non-probability convenience sampling technique. Data regarding demographic characteristics, comorbidities, and laboratory findings were collected. Rifampicin resistance and Mycobacterium tuberculosis were detected using the GeneXpert MTB/RIF assay. SPSS version 25 was used to analyse the data, and the findings were displayed as frequencies, percentages, and mean ± standard deviation.RESULTS: The mean age of 210 patients was 36.81±16.22 years, with 53.8% of them being men and 46.2% being women. The age group of 18 to 24 years old had the largest percentage (30%). A majority of patients (81%) were illiterate. Diabetes mellitus was present in 11% of cases. Of the 210 suspected patients, 194 (92.4%) were positive for Mycobacterium tuberculosis on GeneXpert MTB/RIF assay; among these MTB-positive patients, 21 (10.8%) showed rifampicin resistance. Most samples were taken from the lungs (95.2%).CONCLUSION: In this study, tuberculosis positivity was most frequently observed among young adults and individuals with low educational attainment, a pattern consistent with the known sociodemographic distribution of tuberculosis in similar settings. The proportion of rifampicin resistance identified among MTB-positive patients also indicates an emerging drug-resistance problem in this population. Diabetes mellitus, a comorbidity recognised in the literature asincreasing susceptibility to tuberculosis, was noted in a notable proportion of patients, underscoring the need for early identification, targeted screening and integrated care management strategies. 

BACKGROUND & OBJECTIVE: Continuous glucose monitoring (CGM) provides clinically useful glycaemic information beyond HbA1c, but local data from Pakistan in type 1 diabetes remain limited. The main objective of this study was to assess the relationship between HbA1c and CGM-derived diabetes metrics in children, adolescents and adults with type 1 diabetes attending a specialist endocrinology clinic in Lahore, Pakistan. METHODOLOGY: This pilot observational analytical study retrospectively reviewed routine clinical and CGM data from 13 individuals with type 1 diabetes who had approximately 14 days of CGM monitoring. Clinical variables included age, sex, insulin regimen and HbA1c. CGM outcomes included time in range, time above range, time below range, hypoglycaemic and hyperglycaemic episodes, and coefficient of variation. Continuous data were summarised as median and interquartile range. Spearman correlation and Mann-Whitney U testing were used for exploratory analyses. RESULTS: Median age was 14 years, 69.2% were male, and all participants used basal-bolus insulin. Median HbA1c was 8.5%. Median time in range was low at 31.2%, while median time above range was 60.9% and time below range was 2.0%. Hyperglycaemia was frequent, with a median of 19 episodes, whereas hypoglycaemia was uncommon. Median coefficient of variation was 38.8%. HbA1c was not significantly correlated with CGM metrics. Older age correlated with higher time in range and lower time above range. CONCLUSION: This pilot study demonstrates substantial hyperglycaemic exposure and increased glycaemic variability despite basal-bolus therapy, supporting CGM use alongside HbA1c in the diabetes care for people in Pakistan living type 1 diabetes care along with structured education in resource-constrained clinical settings for improved glycaemic control and clinical outcomes.

BACKGROUND & OBJECTIVE: Premature ejaculation (PE) is one of the most common male sexual disorders and mayoccur alone or in association with erectile dysfunction. Various psychological, behavioral, local, and pharmacologicaltreatment options are available; however, an ideal and universally accepted treatment regimen remains unavailable.This study aimed to evaluate the efficacy of silodosin 4 mg in the management of premature ejaculation.METHODOLOGY: This comparative study included 120 patients with PE, who were equally divided into two groups.Group A comprised 60 patients who received silodosin 4 mg two hours before sexual intercourse, while Group Bcomprised 60 patients who received a placebo capsule. The study period was six months, with patients followed forthree months. Pre- and post-treatment intravaginal ejaculation latency time (IELT), Premature Ejaculation Profile(PEP), and Clinical Global Impression of Change (CGIC) were recorded. Treatment-related adverse effects were alsodocumented. Informed consent was obtained, and ethical considerations were observed.RESULTS: The mean age was 29.6 ± 4.8 years in Group A and 29.8 ± 2.44 years in Group B. In Group A, 54 (90%) patientshad lifelong PE and 6 (10%) had acquired PE, whereas in Group B, 52 (86.6%) patients had lifelong PE and 8 (13.3%) hadacquired PE. In Group A, IELT increased significantly from less than one minute at baseline to 8.2 minutes aftertreatment with silodosin 4 mg. Significant improvement was also observed in PEP and CGIC scores among patientsreceiving silodosin.CONCLUSION: Silodosin 4 mg appears to be an effective treatment option for patients with premature ejaculation,with negligible side effects. Its safety, affordability, and availability may make it a useful alternative therapeuticoption for PE.

BACKGROUND & OBJECTIVE: Depression is common in psoriasis, but subtype-specific differences in depressiveseverity are less well characterised, particularly in South Asian populations. We assessed depression across clinicalpsoriasis subtypes and examined its relationship with psoriasis severity.METHODOLOGY: We conducted a cross-sectional study of 155 adults with dermatologist-confirmed psoriasis recruitedconsecutively from the dermatology outpatient and inpatient departments of a tertiary-care hospital in Rawalpindi,Pakistan, between October 2023 and March 2025. Depression was assessed using the Patient Health Questionnaire-9(PHQ-9) and Beck Depression Inventory-II (BDI-II), and psoriasis severity using the Psoriasis Area and Severity Index(PASI).RESULTS: Plaque psoriasis was the predominant subtype (64.5%), followed by erythrodermic (19.4%), guttate (9.7%),and pustular (6.5%). Overall, moderate depression was the most frequent PHQ-9 category (44.5%). In the subtypespecific manual analysis, mild, moderate, and severe depression were 26%, 42%, and 32% in plaque; 15%, 56%, and 29%in erythrodermic; 38%, 40%, and 22% in guttate; and 36%, 40%, and 24% in pustular psoriasis. Increasing PASI severitywas accompanied by greater proportions of moderately severe or severe depression on both measures. PASI severitywas associated with sex (p=0.029), whereas sex was not associated with PHQ-9 (p=0.127) or BDI-II (p=0.086) depressionseverity.CONCLUSION: Depression was common across clinical psoriasis subtypes, with moderate symptoms particularlyprominent in erythrodermic psoriasis. Greater psoriasis severity was also accompanied by more severe depressivesymptoms. Routine depression screening should be considered in dermatology care, especially for patients withextensive or severe psoriasis.

BACKGROUND & OBJECTIVE: Gastroenteritis is a common cause of community acquired AKI in South Asia. Often, thecondition progresses to ATN as the result of protracted hypovolemia. A prospective study was conducted to assess thefrequency, risk factors and short- and mid-term outcomes of ATN in a mixed ward-ICU population.METHODOLOGY: 712 consecutive adult patients with acute gastroenteritis and AKI admitted at the Northwest GeneralHospital and Research Center, Peshawar, were enrolled. The diagnosis of ATN was based on clinical picture, laboratoryparameters, microscopic examination of urinary sediment and the BUN:Serum Cr ratio. Gastroenteritis was thepresenting feature in 83% of cases.RESULTS: ATN was diagnosed in 236 patients (33.1%). Patients with ATN had higher rates of severe dehydration,electrolyte imbalance, delayed presentation and elevated BUN:Serum Cr ratio (P<0.001). Outcomes of the patientswith ATN were much worse in terms of longer hospital stay (9.2±4.1 vs. 4.6±2.3 days, P<0.001), renal replacementtherapy (11.4% vs. 1.3%, P<0.001), lower rate of renal recovery at 90 days (64.8% vs. 93.1%, P<0.001) and higher inhospital mortality (8.5% vs. 1.5%, P<0.001).CONCLUSION: In this region of a high disease burden, ATN develops in one third of gastroenteritis-induced AKI casesand predicts bad prognosis. Implementation of early risk stratification based on biochemical indicators andappropriate hydration strategies is urgent.

BACKGROUND & OBJECTIVE: Differentiation of exudative from transudative pleural effusions is crucial in determiningthe etiology and guiding appropriate management in pediatric patients. This study aims to determine diagnosticaccuracy of pleural fluid cholesterol in differentiating exudative from transudative pleural effusion in pediatricpatients.METHODOLOGY: This cross-sectional study was conducted in the Pathology and Pediatric Medicine Department ofChildren Hospital and Institute of Child Health, Multan from July 2025 to January 2026. Patients aged 1-14 years withdefinite clinical and radiological evidence of pleural effusion were included in the study. Effusions were classifiedaccording to Light's criteria which served as gold standard. Pleural fluid cholesterol 45mg/dl was used as cut off toidentify exudative pleural effusion. The diagnostic performance of pleural fluid cholesterol was analyzed usingsensitivity, specificity, positive and negative predictive values, likelihood ratios, and overall accuracy.RESULTS: Among 97 patients there were 58 (59.8%) males and 39 (40.2%) females. Median pleural fluid cholesterol wassignificantly higher in exudative effusions 71(63-83.5) as compared to transudative effusions 34(22.75-38) p < 0.0001.Pleural fluid cholesterol was found to have sensitivity of 95.1% and specificity of 88.9% in differentiating exudativefrom transudative pleural effusion with overall diagnostic accuracy of 92.8%.CONCLUSION: Pleural fluid cholesterol is a simple, cost-effective, and reliable biomarker for differentiatingexudative from transudative pleural effusions in children and it correlates well with Light's criteria.

Background Type 2 diabetes mellitus (T2DM) and hypertension frequently coexist and independently elevate the risk of cognitive decline. Although blood pressure (BP) dysregulation is hypothesized to accelerate neurovascular damage, its independent association with mild cognitive impairment (MCI) among individuals with T2DM remains insufficiently characterized in real-world multicenter cohorts. Methods This multicenter cross-sectional study evaluated 489 adult patients with T2DM recruited from tertiary outpatient clinics. Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA, including MoCA-Basic for low-literacy participants), with MCI defined as a score < 26. Resting blood pressure was measured using standardized protocols. Statistical analyses included Pearson and Spearman correlations, multiple linear and binary logistic regression, independent samples t-tests, ROC analyses, and age-stratified subgroup assessments. Results Overall, 79.8% (n = 390) of the participants met the criteria for MCI, with a sample MoCA score of 21.40 ± 5.35. In multivariable models, cognitive performance was independently predicted by: Education: Higher formal education was protective and associated with higher MoCA scores (B = 0.70, p < 0.001; aOR = 0.93, 95% CI: 0.86–1.00). Age: Advancing age independently increased the odds of impairment (B = -0.08, p < 0.001; OR = 1.03, 95% CI: 1.00–1.05). Sex: Female sex was associated with lower cognitive scores and elevated MCI risk (B = -1.71, p < 0.001; OR = 2.02, 95% CI: 1.21–3.37). In contrast, systolic BP, diastolic BP, pulse pressure, and hypertension status showed no significant independent associations with cognitive scores or MCI risk after multivariable adjustment (all p > 0.05). Blood pressure parameters demonstrated negligible discriminative accuracy for MCI (AUC range: 0.52–0.53), and MoCA scores did not significantly differ between normotensive and hypertensive patients (21.64 vs. 20.94, p = 0.175). Conclusion Mild cognitive impairment affects nearly four in five diabetic patients in this population. Poorer cognitive performance is primarily driven by demographic and socioeconomic determinants—specifically older age, female sex, and limited education—rather than clinic blood pressure indices. These findings highlight the critical need for routine cognitive screening protocols tailored to high-risk demographic profiles within diabetes management pathways.

BACKGROUND & OBJECTIVE: In recent times, using ultrasonography either in pre-insertion or in real time is acceptedas remedy to reduce failure and malposition rate. It has been suggested that ultrasound guidance could improve thesuccess rate, reduce the number of needle passes, and decrease complications. The objective of this study was tocompare the technique for internal jugular vein cannulation by landmark (LM) and ultrasound guided (UG) inEmergency department patients.METHODOLOGY: It was comparative study conducted at the Department of Anesthesiology, Sahiwal Teaching Hospital,nd st Sahiwal from 22 March 2023 to 21 September 2023.A total of 130 patients of ≥18 years of age of either gender posted emergency surgeries were included. Skininflammation or burn at insertion site, altered coagulation profile (platelet count<50,000 per cu mm, INR > 1.5),known bleeding disorders, prior catheterization, subcutaneous emphysema and patients undergoing radiation therapywere excluded. In group A, Ultrasonography-guided (UG) technique was applied. In group B, Anatomical landmark (LM)technique was applied. Standard triple lumen CVC was used for cannulation in all patients. The position of the CVC wasconfirmed by a chest radiograph at the end of the procedure. The real-time USG-guided technique was performed witha single dedicated USG machine and a 6-13 MHz linear probe for the entire duration of the study.RESULTS: In this study, average number of attempts 1.79 ± 0.71 in land mark group (LM) and average number ofattempts 1.32 ± 0.47 in Ultrasound guided group (UG). Access time was 164.51 ± 9.14 seconds in LM group and 87.32 ±8.54 seconds in US group.CONCLUSION: This study concluded that ultrasound guided (UG) technique for internal jugular vein cannulation isbetter (less number of attempts and access time) than landmark (LM) technique in Emergency department patients.

Background: Spondylolysis is a defect of the pars interarticularis, which most often affects the 5th lumbar vertebra and less frequently the 4th lumbar vertebra. The involvement of L3 is rare and bilateral traumatic pars defects at this level is even less reported. We report a case of acute bilateral L3 pars defect subsequent to trauma associated with left L3 radiculopathy which was successfully treated with pedicle screw fixation and interbody fusion.   Case Presentation: A 34-year-old woman fell off of a ladder and complained of low back pain that spread down her left leg, and over the front of her thigh and inside of her leg. This finding was confirmed by computed tomography (CT) which revealed a bilateral pars defect at L3, but not at L4 or L5; most pars defects are found lower in the spine. The MRI revealed mild bone marrow edema over the defect with irritation of the nerve root of L3 and no significant disc herniation or canal stenosis. Neurological examination found that there was sensory loss in the left L3 dermatome and positive straight leg raise, but there was no motor weakness or abnormal reflexes. She then did not get any relief from her pain with conservative treatment and had to have bilateral pedicle screw fixation with interbody fusion performed at L3. She had marked resolution of back and leg pain post surgery, with progressive improvement in the sensory deficit and follow up imaging revealed a good hardware position with early signs of fusion. Conclusion: Bilateral L3 pars defects, though rare, should be taken into consideration in patients with low back pain following trauma especially if imaging does not conform with the typical appearance of lower lumbar spondylolysis. A complete neurological examination is still necessary as it may be possible to identify a radicular cause of instability despite the fact that the bony defect is the most important. In patients who have failed conservative therapy, pedicle screw fixation with interbody fusion can be an effective procedure