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CURRENT ISSUE
JULY 2026 – SEPTEMBER 2026
VOL. 24, ISSUE NO. 3
https://doi.org/10.59058/jaimc.2026
EDITORIAL
Guarding the Record: The Widening Burden on the Medical Journal Editor
Kokab Jabeen
https://doi.org/10.59058/jaimc.202
ORIGINAL ARTICLES
Dengue Awareness Among Medical Students Of Public Sector Colleges,
Lahore; A Comparative Cross-Sectional Study.
Rozina Shahadat Khan, Fariha Salman, Bilal Khan, Danish Shafiq,
Wazir Ashter, Waleed Waheed
https://doi.org/10.59058/jaimc.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 percentage of high level of awareness amongst different institute’s emphasis need for more comprehensive sharing of information. KEY WORDS: Dengue, Students, Medical, Practice, Disease Vectors, Health Education.
Prevalence of AmpC β-Lactamase Production and Antimicrobial Resistance
Patterns among Proteus spp. at a Tertiary Care Hospital in Lahore
Qurrat ul Ain, Rukhsana Tumrani, Maryam Sheikh, Afsheen Nigar,
Maryam Afzal, Zainab Awais
https://doi.org/10.59058/jaimc.2026
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.
Sociodemographic and Clinical Characteristics of Tuberculosis Positivity
and Rifampicin Resistance among Presumptive Patients in Southern
Punjab, Pakistan: A Cross-Sectional Study
Rashda Shabbir, Sumera Malik, Javairia Saeed, Saadia Latif,
Qurat Ul Ain Ayaz, Arifa zia Hashmi
https://doi.org/10.59058/jaimc.2026
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 as increasing susceptibility to tuberculosis, was noted in a notable proportion of patients, underscoring the need for early identification, targeted screening and integrated care management strategies. KEY WORDS: Tuberculosis, Multidrug-Resistant, Mycobacterium tuberculosis, Risk Factors, Socioeconomic Factors, Diagnostic Tests, Routine, Pakistan
Clinical And Biochemical Correlates Of Continuous Glucose
Monitoring-derived Glycemic Metrics In Children And Adults With
Type 1 Diabetes Mellitus (T1DM): A Pilot ObservationalStudy From
Lahore, Pakistan
Atif Munir, Sidra Anwar, Saniya Umer Draz, Aijaz Zeeshan Khan Chachar, Najeeb Ullah, Asma Afzal Khan
https://doi.org/10.59058/jaimc.2026
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. KEY WORDS: Type 1 diabetes mellitus; Continuous glucose monitoring; Time in range
Low-Dose Silodosin for Premature Ejaculation: A Clinical Evaluation
Sajid Mahmood Khan, Asif Imran, Muhammad Shafi Ghori,
Asif Shehzad, Irfan Ul Haq
https://doi.org/10.59058/jaimc.2026
BACKGROUND & OBJECTIVE: Premature ejaculation (PE) is one of the most common male sexual disorders and may occur alone or in association with erectile dysfunction. Various psychological, behavioral, local, and pharmacological treatment 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 B comprised 60 patients who received a placebo capsule. The study period was six months, with patients followed for three 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 also documented. 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%) patients had lifelong PE and 6 (10%) had acquired PE, whereas in Group B, 52 (86.6%) patients had lifelong PE and 8 (13.3%) had acquired PE. In Group A, IELT increased significantly from less than one minute at baseline to 8.2 minutes after treatment with silodosin 4 mg. Significant improvement was also observed in PEP and CGIC scores among patients receiving 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 therapeutic option for PE. KEY WORDS: Premature ejaculation; Silodosin; Intravaginal ejaculation latency time; Premature Ejaculation Profile; Clinical Global Impression of Change; Alpha-1Ablocker
Depression Severity Across Clinical Subtypes of Psoriasis in a Pakistani
Tertiary Care Hospital
Sadia Yasir, Ibrahim Mamond, Arooj Fatima, Zona Tahir, Shawana Sharif
https://doi.org/10.59058/jaimc.2026
BACKGROUND & OBJECTIVE: Depression is common in psoriasis, but subtype-specific differences in depressive severity are less well characterised, particularly in South Asian populations. We assessed depression across clinical psoriasis subtypes and examined its relationship with psoriasis severity. METHODOLOGY: We conducted a cross-sectional study of 155 adults with dermatologist-confirmed psoriasis recruited consecutively 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 severity was accompanied by greater proportions of moderately severe or severe depression on both measures. PASI severity was associated with sex (p=0.029), whereas sex was not associated with PHQ-9 (p=0.127) or BDI-II (p=0.086) depression severity. CONCLUSION: Depression was common across clinical psoriasis subtypes, with moderate symptoms particularly prominent in erythrodermic psoriasis. Greater psoriasis severity was also accompanied by more severe depressive symptoms. Routine depression screening should be considered in dermatology care, especially for patients with extensive or severe psoriasis. KEY WORDS: Psoriasis; Depression; Patient Health Questionnaire; Severity of Illness Index; Cross-Sectional Studies
Acute Tubular Necrosis in Patients with Acute Gastroenteritis Associated 39
Acute Kidney Injury: Incidence, Risk Factors, and Clinical Outcomes
A Prospective Observational Study
Kamran Amir Khan, Sameed Ullah Qureshi, Hamza Ahmad
https://doi.org/10.59058/jaimc.2026
BACKGROUND & OBJECTIVE: Gastroenteritis is a common cause of community acquired AKI in South Asia. Often, the condition progresses to ATN as the result of protracted hypovolemia. A prospective study was conducted to assess the frequency, 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 General Hospital and Research Center, Peshawar, were enrolled. The diagnosis of ATN was based on clinical picture, laboratory parameters, microscopic examination of urinary sediment and the BUN:Serum Cr ratio. Gastroenteritis was the presenting 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 patients with ATN were much worse in terms of longer hospital stay (9.2±4.1 vs. 4.6±2.3 days, P<0.001), renal replacement therapy (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 cases and predicts bad prognosis. Implementation of early risk stratification based on biochemical indicators and appropriate hydration strategies is urgent. KEY WORDS: Acute tubular necrosis; acute kidney injury; acute gastroenteritis; dehydration; blood urea nitrogen-tocreatinine ratio; Pakistan
Diagnostic Accuracy of Pleural Fluid Cholesterol in Differentiating 45
Between Exudative and Transudative Pleural Effusion in Pediatric
Patients: A Simple Alternative to Conventional Criteria
Mehvish Sana, Ayesha Fayyaz, Zille Rubab, Sara Rubab,
Muhammad Shahid Nawaz, Shoaib Liaquat
https://doi.org/10.59058/jaimc.2026
BACKGROUND & OBJECTIVE: Differentiation of exudative from transudative pleural effusions is crucial in determining the etiology and guiding appropriate management in pediatric patients. This study aims to determine diagnostic accuracy of pleural fluid cholesterol in differentiating exudative from transudative pleural effusion in pediatric patients. METHODOLOGY: This cross-sectional study was conducted in the Pathology and Pediatric Medicine Department of Children Hospital and Institute of Child Health, Multan from July 2025 to January 2026. Patients aged 1-14 years with definite clinical and radiological evidence of pleural effusion were included in the study. Effusions were classified according to Light's criteria which served as gold standard. Pleural fluid cholesterol 45mg/dl was used as cut off to identify exudative pleural effusion. The diagnostic performance of pleural fluid cholesterol was analyzed using sensitivity, 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 was significantly 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 exudative from transudative pleural effusion with overall diagnostic accuracy of 92.8%. CONCLUSION: Pleural fluid cholesterol is a simple, cost-effective, and reliable biomarker for differentiating exudative from transudative pleural effusions in children and it correlates well with Light's criteria. KEY WORDS: Cholesterol, Exudates, Lactate dehydrogenase, Pleural effusion, Transudates
Association of Blood Pressure with Mild Cognitive Impairment in Patients 50
with Type 2 Diabetes Mellitus: A Multicenter Cross-Sectional Study
Ameena Nasir, M. Suliman Sajid, M. Adil Abid,M. Haris,
Muhammad Auns, Shazia Sukhera
https://doi.org/10.59058/jaimc.2026
BACKGROUND & OBJECTIVE: 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. METHODOLOGY: 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. KEY WORDS: Mild Cognitive Impairment, Type 2 Diabetes Mellitus, Blood Pressure, Hypertension, MoCA, Cognitive Decline, Cross-Sectional Study
A Comparison of Internal Jugular Vein (DV) Cannulation by Usg and
Anatomical Landmark Technique in Emergency Setting
Muhammad Omer Ajmal, Muhammad Aslam Khan, Zuraira Mujahid, Rashid
Minhas, Aakif Yousaf, Hafiz Muhammad Amjad
https://doi.org/10.59058/jaimc.2026.
BACKGROUND & OBJECTIVE: In recent times, using ultrasonography either in pre-insertion or in real time is accepted as remedy to reduce failure and malposition rate. It has been suggested that ultrasound guidance could improve the success rate, reduce the number of needle passes, and decrease complications. The objective of this study was to compare the technique for internal jugular vein cannulation by landmark (LM) and ultrasound guided (UG) in Emergency 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. Skin inflammation 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 therapy were 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 was confirmed by a chest radiograph at the end of the procedure. The real-time USG-guided technique was performed with a 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 of attempts 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 is better (less number of attempts and access time) than landmark (LM) technique in Emergency department patients. KEY WORDS: Internal jugular vein cannulation, Landmark (LM) technique, Ultrasound guided.
CASE REPORT
Bilateral Lumbar L3 Pars Defect Secured with Pedicle Screw Fixation and 67
Interbody Fusion: A Case Report with Literature Review
Muhammad Rizwan Ali, Muhammad Jawad Saleem, Ali Shahid,
Muhammad Auns, Ali Imran Hashm
https://doi.org/10.59058/jaimc.2026
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. KEY WORDS: Spondylolysis, Pars Interarticularis Defect, L3 Vertebra, Pedicle Screw Fixation, Interbody Fusion, Radiculopathy, Case report
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