Journal of Ayub Medical College Abbottabad
J Ayub Med Coll Abbottabad, the printed and online Journal of Ayub Medical College Abbottabad Pakistan, is an indexed journal, recognised by Pakistan Medical and Dental Council (PM&DC) as a Standard Medical Journal and by Higher Education Commission (HEC) of Pakistan. It is registered with Serial Data System of France (pISSN 1025-9589 and eISSN 1819-2718) and indexed with PubMed, Medline, PakMediNet, and Tehqeeqat. It is the second journal from Pakistan to achieve this status, and the first journal of any medical college of Pakistan to be internationally indexed and the first Pakistani Medical Journal available Full Text with Illustrations FREE online. JAMC is also indexed in the Master List of Index Copernicus. The journal is published quarterly and contains articles of medical research interest having basic, applied or clinical research content.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board. USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access. AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
MPOX IN PAKISTAN: A CALL FOR VIGILANCE AND GLOBAL HEALTH SOLIDARITY
Background With 11 cases and one death in 2024, the Mpox virus was by and large under control in Pakistan as the country followed the screening and surveillance guidelines when Mpox was declared a global emergency. The screening of suspected patients is being done across the country, and those showing symptoms are being sent to isolation wards in hospitals to avoid local transmission of the virus. A recent report published on community-based Mpox and sexually transmitted disease surveillance using discarded condoms in the global south presents an innovative approach to disease monitoring that has significant implications for global health security.[i] This new discovery presents another urgency for Pakistan to deal with in a population which has several high-risk groups involved in unsafe sexual practices. The urgency to integrate such surveillance methods into our health system becomes increasingly evident.[ii] This brief narrative explains how Pakistan’s response to Mpox can align with global health security frameworks emphasizing surveillance, capacity building, stigma reduction, and enhanced border vigilance. Wannigama DL, Amarasiri M, Phattharapornjaroen P, Hurst C, Modchang C, Besa JJ, et al. Community-based mpox and sexually transmitted disease surveillance using discarded condoms in the global south. Lancet Infect Dis. 2024 Aug 21; Online First. doi: 10.1016/S1473-3099(24)00514-0. Rauf SA, Aftab A, Hussain T, Hussain R, Dave T, Shah HH. First case of monkeypox in Pakistan: WHO’s response and steps to prevent an outbreak. IJS Glob Health. 2024 Jan 1;7(1): e0381.
Copyright (c) 2026 Babar Tasneem Shaikh, Muhammad Ahmed Abdullah, Muhammad Wasif Malik, Muhammad Salman https://creativecommons.org/licenses/by-nd/4.0
INTEGRATING ARTIFICIAL INTELLIGENCE INTO MEDICAL EDUCATION IN PAKISTAN: AN URGENT REFORM AGENDA
Although AI has become integral to medical training internationally, its uptake within Pakistan’s medical-education system is minimal. Few institutions offer structured AI exposure, leaving graduates underprepared for data-driven clinical practice. Integrating AI literacy, ethical principles, and governance into undergraduate curricula is now essential to modern clinical competence.Integrating these components would enhance diagnostic reasoning, safeguard patient safety and align Pakistan’s medical training with global standards.
Copyright (c) 2026 Abdul Wahab Yousafzai, Fatima Saeed Khan, Shawaf Naeem https://creativecommons.org/licenses/by-nd/4.0
RETROPERITONEAL LYMPH NODE DISSECTION: CASE SERIES AND CONTEMPORARY LITERATURE PERSPECTIVES
Purpose: Retroperitoneal lymph node dissection (RPLND) remains a part of the management of men with metastatic germ cell tumours and is infrequently performed. The purpose of this study was to review clinical outcomes and complications of RPLND performed at Pakistan Kidney and Liver Institute & Research Center (PKLI & RC), Lahore, using data of patients who underwent the procedure between August 15, 2022, and July 16, 2024, as well as compared the results with the previous studies. Materials and Methods: This study is a retrospective case series analysis of all patients who had RPLND at PKLI & RC in the given time frame. Patients' demographics and medical history, surgical details, postoperative course, and follow-up data were recorded on a structured questionnaire. Results: Five patients who were treated by RPLND were enrolled in the study. The average age was 30. 40 ± 3. 98 years on average, and the average length of stay in surgery was 256. 00 ± 85. 47 minutes. A postoperative complication was intraoperative blood loss which required transfusion in one case. Epidural analgesia was the main approach that was utilized in managing pain. The mean time spent on hospital visits was 7. 20 ± 1. 48 days. Several pathologies were seen including the mature cystic teratoma, teratoma and the mixed germ cell tumor. Conclusion: It was observed that RPLND at PKLI & RC usually yielded good results with manageable complications after surgery. In view of the above findings, this study provides useful information on the procedural aspects and the postoperative management of RPLND in order to enhance patient care in the future. For these reasons, it is recommended that subsequent research be conducted with larger sample sizes as a means of cross-checking these findings and enhancing understanding of potential long-term effects.
Copyright (c) 2026 Nadeem Bin Nusrat, Assad ur Rehman, Shujah Muhammad, Nauman Zafar, Asadullah Aslam, Hassan Arshad, Yasir Khan, Sarmad Imtiaz, Moin Arshad, Aadil Chaudhary, Saira Imtiaz https://creativecommons.org/licenses/by-nd/4.0
GENDER BASED COMPARATIVE STUDY OF THE QUALITY OF LIFE OF PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS (PLHIV) ON ANTIRETROVIRAL THERAPY (ART)
Background: Quality of life of people living with HIV is considered important component of HIV care particularly in settings like Pakistan where treatment access and gender disparities continue to determine the health outcomes despite advancements in treatment regimens. This study aims to compare Health Related-QoL (HR-QOL) among male, female, and transgender individuals living with HIV on ART. Methods: A cross-sectional study was conducted at the HIV/AIDS treatment center of Mayo Hospital, Lahore, between February and July 2024. A sample of 384 participants (221 males, 151 females, and 12 transgender individuals) was selected using non-probability consecutive sampling. Data were collected using the HIV/AIDS-Targeted Quality of Life (HAT-QOL) and SF-36 surveys. Statistical analysis included Chi-square tests for categorical variables and ANOVA for continuous variables, with significance set at p < 0.05. Results: Out of 384 participants, 57.55% were male, 39.32% female, and 3.13% transgender. A significant difference in social status was observed across gender groups (p = 0.020). HRQoL domains differed significantly by gender; transgender individuals reported better overall function (76.11 ± 23.78) compared to females (69.47 ± 22.62) and males (74.1± 23.5), p = 0.001. Multivariate regression showed that health worries had the strongest association with HRQoL among transgender individuals (standardized β = 0.567, 95% CI: 0.09–0.30), compared to males (β = 0.432) and females (β = 0.527), emphasizing the differential impact on quality of life. Conclusion: Gender-specific differences in HRQOL among PLHIV needs considerations for gender-sensitive healthcare approaches to improve overall well-being and quality of life for all individuals living with HIV.
Copyright (c) 2026 Iqra Hamid Khan, Jayasree S Kanathasan, Sreemoy Kanti Das, Awais Gohar https://creativecommons.org/licenses/by-nd/4.0
FOSTERING DIGITAL HEALTH IN PAKISTAN: AN INTERVENTIONAL STUDY REGARDING AWARENESS OF TELEMEDICINE AMONG PATIENTS OF DIVERSE HEALTHCARE SETUPS IN ISLAMABAD
ABSTRACT Introduction Telemedicine is the provision of healthcare services at a distance. With the rapidly increasing population in Pakistan and a chronic shortage of doctors in peri-urban and rural areas, telemedicine has become the need of the time. This research was conducted to create general awareness of telemedicine using video and assess the difference between pre-and post-interventional awareness with the aim of providing suggestions for making telemedicine more accessible and thus reducing the burden of the health care system. Methodology We conducted a pre and post-interventional study in various health care setups, on adults aged 18 and above who have been residents of Islamabad for over 6 months. Convenient sampling was done with a sample size of 98. Both pre-and post-interventional information was collected from the sample population through a self-developed questionnaire filled out through interviews. For intervention, an awareness session was conducted using a self-made video. Results Our pre & post-interventional grand mean scores were 6.89 and 9.48 respectively and this difference was highly significant statistically as p value was <0.001. The knowledge of telemedicine increased from 18 percent to 31.8 percent following the awareness session and 88 percent of people after learning about telemedicine services agreed that they were more accessible than looking for a doctor. Conclusion We conclude that the majority of the participants hold a favorable attitude toward telemedicine services. They have the means to access telemedicine but are unable to do so due to a lack of awareness; hence, there is a need for education and awareness through government-supported programs to encourage the utilization of telemedicine services. Keywords: Telemedicine, Awareness of telemedicine, Willingness to use Telemedicine
Copyright (c) 2026 Shehbano Syed, Minal Zaman, Aiza Anwar, Muhammad Junaid Hussain, Muhammad Imad Naeem, Elyzae Rizwan, Asifa Afzal, Arshia Bilal https://creativecommons.org/licenses/by-nd/4.0
ANTERO POSTERIOR POSITION OF MAXILLARY CENTRAL INCISORS IN RELATION TO THE FOREHEAD IN PAKISTANI POPULATION
Abstract Objective To determine the anteroposterior (AP) position of maxillary central incisors in relation to the forehead and examine the potential correlation between the AP positioning of maxillary central incisors and the inclination of the forehead in a cohort representing the Pakistani population. Materials and Methods A total of 100 orthodontic patients aged 13 years and older, without regard to gender of Pakistani descent, were enrolled in the study. Exclusions comprised individuals with absent or impacted maxillary central incisors, history of orthodontic treatment, craniofacial trauma, prior cosmetic dental procedures, or anterior prostheses/restorations. Participants' demographic data including age and gender were recorded. Forehead inclination and position of maxillary central incisor were assessed from smiling photographs. Pearson's correlation coefficient was used to evaluate the correlation between the anteroposterior (AP) positioning of maxillary central incisors and the angle of forehead inclination. Differences in the AP positioning of maxillary central incisors based on age and gender were analyzed using t-tests and ANOVA. Results The males were 44 (44%) and females were 56 (56%). The mean age was 26.47 ± 6.46 years. The mean value of incisor position in males (2.86 ± 1.73 mm) was a little higher than in females (2.55 ± 2.03 mm) but not statistically significant (p = 0.416). The correlation between incisor position and forehead inclination was moderately high (r = 0.672), and it was very highly statistically significant (p < 0.001). Conclusions The average values for maxillary incisor sagittal position and forehead inclination were determined. A moderately strong and highly statistically significant correlation was observed between incisor position and forehead inclination. No gender differences were identified, although variations were noted among different age groups. Keywords: Anteroposterior; Forehead; Incisor; Orthodontics
Copyright (c) 2026 Mazhar Hussain, Faiza Malik, Muhammad Noman, Munawar Manzoor Ali, Gulsana Hashmi, Saba Sikandar https://creativecommons.org/licenses/by-nd/4.0
UNSTIMULATED SALIVARY FLOW RATE VARIATIONSDURING EARLY MIXED, LATE MIXED, AND PERMANENT DENTITION AND ITS ASSOCIATION WITH AGE, GENDER, & SOCIOECONOMIC CLASS AMONG HEALTHY CHILDREN-A CROSS SECTIONAL STUDY
1) Roblegg E, Coughran A, Sirjani D. Saliva: An all-rounder of our body. Eur J Pharm Biopharm. 2019 Sep; 142:133-141. doi: 10.1016/j.ejpb.2019.06.016. Epub 2019 Jun 18. 2) Dawes C, Pedersen AL, Villa A, Ekström J, Proctor GB, Vissink A, Aframian D, McGowan R, Aliko A, Narayana N, Sia YW. The functions of human saliva: A review sponsored by the World Workshop on Oral Medicine VI. Arch. Oral Biol. 2015 Jun 1;60(6):863-74. 3) Ekström J, Khosravani N, Castagnola M, Messana I. Saliva and the control of its secretion. In Dysphagia 2017 (pp. 21-57). Springer, Cham.
Copyright (c) 2026 Asma Saher Ansari, Imtiaz Ahmed, Masood Anwar Qureshi, Zairah Muqaddas, Abdur Rehman https://creativecommons.org/licenses/by-nd/4.0
OUTCOME OF MODIFIED STOPPA TECHNIQUE FOR THE MANAGEMENT OF ACETABULAR FRACTURES
Objective: To evaluate outcome in terms of radiological and clinical outcome of modified Stoppa technique for the management of acetabular fractures. Methodology: This descriptive study was conducted at Orthopedic & Spine Unit, Hayatabad Medical Complex, Peshawar from January 2023 to January 2024. Fifty three patients with acetabular fractures were managed with modified Stoppa technique. Outcome such as radiological and clinical were assessed after 8 months of the procedure. Numerical data was assessed with mean and standard deviation while categorical with frequency and percentage. Chi Square test was used for association keeping P value significant at < 0.05. Results: The mean age of participants was 44.62±11.69 years, with higher frequency of male patients. The mean operative time recorded was approximately 155.45±34.28 minutes, and the mean blood loss was 741.43±107.28 ml. Anatomical reduction was achieved in 39 (73.6%) of cases on the basis of Matta's criteria for radiological assessment, while clinical outcome were rated as excellent in 16 (30.2%) patients, good 29 (54.7%) patients, fair 6 (11.3%) patients while poor in 2 (3.8%) on the basis of Harris Hip Score. Conclusion: Modified Stoppa Approach is a safe and potent procedure for the management of acetabular fractures exhibiting radiological and clinical outcome up to the mark. Keywords: Acetabular fractures, Modified Stoppa Approach, Radiological outcome, Clinical outcome
Copyright (c) 2026 Muhammad Saeed, Abdul Sattar, Muhammad Inam, Zeeshan Khan, Shafi Ul Haq https://creativecommons.org/licenses/by-nd/4.0
EFFECT OF CONTINUOUS ENHANCED VAGAL TONE ON DUAL ATRIOVENTRICULAR NODE AND ACCESSORY PATHWAYS
Background: Continuous increased vagotonus effect on dual atrioventricular (AV) node and accessory pathway requires a flexible concept in the field of cardiac electrophysiology. The AV node has a critical function in regulation of the heart´s electrical conduction and accessory pathways are abnormal alternate routes to which an impulse can be transmitted across, circumventing these checkpoints–causing arrhythmias such as atrioventricular re-entrant tachycardia (AVRT) or Wolff-Parkinson-White Syndrome (WPW). Objective was to evaluate the effect of continuous enhanced vagal tone on dual AV node physiology and accessory pathways, focusing on conduction properties, arrhythmia induction, and the success of catheter ablation. Methods: A prospective observational study was conducted in the Department of Cardiology, Hayatabad Medical Complex, Peshawar, between April 2023 and April 2024. The study included 250 patients with dual AV node physiology or accessory pathways, undergoing electrophysiological studies and catheter ablation. Continuous vagal stimulation was applied during these procedures to assess its impact on conduction delays, refractory periods, and arrhythmia induction. Statistical analysis was performed using Chi-square and logistic regression, with a significance level of p<0.05. Results: The mean PR interval delay during vagal stimulation was 202 ms, and the mean refractory period was 250 ms. Arrhythmias were induced in 35% of the patients. Catheter ablation was successful in 85% of cases, though 30% experienced recurrence of arrhythmia within one year. The results showed a significant association between continuous vagal tone and arrhythmia induction, as well as a protective effect of longer refractory periods against recurrence. Conclusion: Continuous enhanced vagal tone significantly influences the conduction properties of dual AV nodes and accessory pathways, increasing the likelihood of arrhythmias. While catheter ablation remains effective, these findings suggest that vagal modulation could be explored as a potential adjunct to improve long-term outcomes in patients with complex arrhythmias.
Copyright (c) 2026 Hameed Ullah, Muhammad Idrees Khan, Asif Mehmood, Yasir Hayat , Talia Mansoor, Romana https://creativecommons.org/licenses/by-nd/4.0
COMPARISON OF SINGLE BOLUS NOREPINEPHRINE WITH PHENYLEPINEPHRINE FOR PREVENTION OF HYPOTENSION DURING CESAREAN SECTION UNDER SPINAL ANESTHESIA
Background: Hypotension remains the main concern following spinal anesthesia in patients planned for cesarean section. A no of pharmacological agents has been used prophylactically to prevent hypotension in past. Norepinephrine and phenylepinephrine are the two most commonly used agents. Aim of this study was to evaluate the effectiveness of these two agents used as single bolus for prevention of hypotension during cesarean section under spinal anesthesia. Methodology: This Quasi-experimental study was conducted in Department of anesthesia, Pak Rangers Teaching Hospital Lahore. A total of 180 patients (90 in each group) fulfilling the inclusion criteria were included in this study. Patients were divided into two groups by using lottery method. Group-A (PE group) received phenylepinephrine bolus while Group-B (NE group) received norepinephrine bolus under spinal anesthesia. Blood pressure (primary outcome) and heart rate (secondary outcome) was recorded for 20 minutes at five-minute interval. Incidence of hypotension and bradycardia was recorded in both groups. Presence of hypotension alone or with bradycardia in both groups was treated with intravenous crystalloid bolus @ 10ml per kg body weight. Persistent hypotension with bradycardia despite crystalloid bolus treated with a rescue bolus of intravenous atropine 0.6 mg was considered the endpoint. Results: 33.3% (n=30) in PE Group while 18.9% (n=17) in NE Group developed hypotension with p value of 0.04. Similarly, 20% (n=18) in PE Group as compared to 4.4% (n=4) in NE Group had bradycardia showing statistically significant difference between the two groups with p value of 0.02. Regarding need of rescue atropine bolus, n=5 (5.5%) in PE Group while n=1 (1.1%) in NE Group required it with calculated p value of 0.09. Conclusion: We concluded that prophylactic bolus of norepinephrine was more effective than phenylepinephrine in prevention of post spinal hypotension and bradycardia during cesarean section with better maintenance of systolic blood pressure and heart rate. Keywords: Hypotension, Norepinephrine, Phenylepinephrine, Spinal anesthesia.
Copyright (c) 2026 Mishal Pervaiz, Raja Mushtaq Hussain, Muhammad Mudasir Saleem https://creativecommons.org/licenses/by-nd/4.0
DIAGNOSTIC ACCURACY OF ULTRASOUND FOR MORBIDLY ADHERENT PLACENTA
Background: Morbidly adherent placenta (MAP), including placenta accreta, increta, and percreta, is a serious obstetric condition associated with significant maternal morbidity and mortality. The aim of this cross-sectional validation study was to assess the diagnostic accuracy of ultrasound, using the Placenta Accreta Index (PAI), in detecting morbidly adherent placenta (MAP) in a tertiary care hospital in Pakistan. Methods: A total of 81 pregnant women in the third trimester, at risk of developing MAP due to a history of two or more cesarean sections, placenta previa, or prior myomectomy independent of cesarean sections, were included in this cross-sectional Validation study. Gray scale and Doppler ultrasound were performed, and the PAI was calculated. Per-operative findings were considered as the gold standard and compared with ultrasound results. Sensitivity, specificity, and diagnostic accuracy were calculated using a 2x2 contingency table. Results: Among the included women, 25 (30.86%) had confirmed MAP based on perioperative findings, with varying degrees of placenta accreta (percreta, increta, and accreta). The ROC curve analysis revealed a PAI cutoff value of 4.37, yielding a sensitivity of 84.00%, specificity of 85.71%, and diagnostic accuracy of 85.19%. Lacunae, bridging vessels, and placenta previa were found to be associated with increased risk of MAP, while decreased myometrial thickness correlated with higher PAI values. Conclusion: This study demonstrates that ultrasound, utilizing the PAI, exhibits promising diagnostic accuracy for detecting morbidly adherent placenta in women at risk. The findings support the role of ultrasound as a valuable tool in the diagnosis of MAP, aiding in appropriate management and intervention.
Copyright (c) 2026 Aliya Ahmed, Ayesha Isani Majeed, Ramish Riaz, Hamna Abid, Bilal Asif, Ummehabiba malik https://creativecommons.org/licenses/by-nd/4.0
A PREEMPTIVE REGIMEN REDUCED NOCICEPTIVE C-FOS EXPRESSION IN THE SOMATOSENSORY CORTEX OF SURGICAL PAIN PARADIGM.
Background: Preemptive analgesia effectively diminishes postsurgical pain with fewer side effects, although its effectiveness and mechanism of action to reduced pain is still debatable. This study assessed the effectiveness of the preemptive regime in terms of neuronal c-fos expression on the somatosensory cerebral cortex (pain perception area of the spinothalamic tract) in both somatic and visceral pain models. Methods: Lab-base experimental investigation was carried out for almost two years (January 2022 to December 2023) at Khyber Medical University Peshawar. Eight to ten weeks old, eighteen Sprague-Dawley rats weighing between 150 and 250g were divided into: a) Somatic (skin incision only) (SG; n = 9); b) Visceral pain groups (uterine incision was given and then closed) (DG; n = 9). Each group was further categorised into Buprenorphine, Tramadol, and Saline subgroups; in addition, 2% lidocaine (7 mg/kg) was given along with preemptive analgesia preoperatively under general anaesthesia (isoflurane). c-fos mean cell count (MCC) and optical density (OD) were calculated on immunohistochemical slides two hours postoperatively. Data was analysed using MS Excel, SSPS version 25, Graph Pad Prism, and the Fiji Image J analyser. Results: In comparison to the saline group, buprenorphine and tramadol were significantly more effective in reducing the mean cell count and optical density of c-fos-expressing neuronal cells in the cortex (p ‰¤ 0.05) in both the somatic and visceral pain groups [superficial (somatic) and deep (visceral/uterine) surgical pain models]. Conclusion: The study concluded that a sufficient preemptive regimen is a practical way to avoid post-operative discomfort and pain following a surgical procedure.
Copyright (c) 2026 Saima Mumtaz , Najma Baseer, Syed Hamid Habib, Saima Saleem, Sana Malik https://creativecommons.org/licenses/by-nd/4.0
THE ROLE OF BARIATRIC SURGERY IN NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) MANAGEMENT: A PROSPECTIVE STUDY AT AFRIDI MEDICAL COMPLEX, PESHAWAR
Abstract: Background: The prevalence of non-alcoholic fatty liver disease (NAFLD) has significantly increased due to the obesity pandemic.Reducing body weight by 5 to 10% in obese patients can improve all aspects of NAFLD. This study aimed to determine the Role of Bariatric Surgery in Non-Alcoholic Fatty Liver Disease (NAFLD). Methods: Over the course of one year, this prospective study was carried out from August 2021-august 2022.Patients undergoing laparoscopic sleeve gastrectomy (LSG) with a diagnosis of non-alcoholic fatty liver disease (NAFLD) were included.Preoperative data including demoraphics and Laboratory tests included HbA1c, lipid profile, fasting glucose, and liver function tests (ALT, AST, and GGT). The BARD score, NAFLD fibrosis score and De Ritis ratio (AST/ALT), , and the AST to platelet ratio index (APRI) were among the serum marker scores that were evaluated post-surgery at different follow ups of 3, 6, and 12 and 18 months. Results:. A total of 461 (50%) of the 922 patients had non-alcoholic steatohepatitis (NASH). A total of 382 (83%) patients showed continued improvement in steatosis at eighteen months post-surgery while 51 (37%) patients with F2 fibrosis and 165 (60%) of those with F1 fibrosis demonstrated lower fibrosis stage at 1 year following surgery. Conclusion: The degree of fibrosis, hepatic inflammation, and steatosis in obese people is found to be decreased after bariatric surgery and is a safe and successful surgical procedure in the management of non-alcoholic fatty liver disease. Keywords: Bariatric Surgery, Management, Non-Alcoholic Fatty Liver Disease (NAFLD), Sleeve gastrectomy
Copyright (c) 2026 Mushtaq Ahmad, Maria Alamgir, Waqar Ahmad, Abdul Haseeb Sahibzada https://creativecommons.org/licenses/by-nd/4.0
THE INCIDENCE AND CLINICAL CORRELATION OF DACRYOCYSTITIS WITH NASAL PATHOLOGY IN A TERTIARY CARE HOSPITAL.
Dacryocystitis is an inflammation or infection of the lacrimal sac. This condition frequently occurs secondary to the nasolacrimal duct blockage, causing tear stasis and ultimately infection. Objective: To identify the relationship between chronic dacryocystitis and different nasal pathologies for accurate diagnosis, management, and preventing relapse in a cohort of 320 patients. Methods: This descriptive cross-sectional study was conducted at the ENT and Eye Departments of Ayub Teaching Hospital, Abbottabad from 1st April 2024 to 31st January 2025. The study enrolled 320 patients of age 18 years and above, irrespective of gender with clinically and or radiologically diagnosed Dacryocystitis. Collected data was analyzed to determine the prevalence of nasal pathologies. Data analysis was done using SPSS version 28.Results: The study highlights that 32.8% cases of chronic dacryocystitis had underlying nasal pathologies with deviated nasal septum in 15%, hypertrophied inferior turbinate 6.9%, nasal polyps 5.9%, rhinolithiasis 1.6 %, nasal tumors 3.4% and no pathology was found in 67.2% of cases. Conclusion: This study demonstrates an important correlation between chronic dacryocystitis and nasal abnormalities and thus highlights the importance of interdisciplinary strategy for the diagnosis and management of chronic dacryocystitis.
Copyright (c) 2026 Muhammad Imran Shah, Zara Sajid, Bushra Aaqil, Hasan Sajid Kazmi, Tahira Sajid, Usman Ameen https://creativecommons.org/licenses/by-nd/4.0
MITCHELL-BANKS’ VS. FERGUSON AND GROSS HERNIOTOMY IN BOYS OVER TWO: A PROSPECTIVE COMPARISON OF POSTOPERATIVE OUTCOMES
Background: Inguinal hernia repair in boys traditionally employs Ferguson and Gross Herniotomy (FGH) for older children and Mitchell-Banks’ Herniotomy (MBH) for younger ones, though this age-based distinction is increasingly debated. Objective: To compare postoperative outcomes—primarily scrotal edema—between MBH and FGH in boys over two years of age. Methods: In this prospective cohort study, 136 boys older than two years underwent primary inguinal herniotomy from January 2022 to December 2024 (MBH: 62; FGH: 74). Scrotal edema was assessed clinically on postoperative days 1 and 7. Secondary outcomes included operative time, six-month recurrence, testicular atrophy, and surgical site infection. A p-value <0.05 was considered statistically significant. Results: MBH was associated with a significantly higher incidence of scrotal edema on day 1 (40.3% vs. 5.4%) and day 7 (16.1% vs. 2.7%) (both p<0.05). However, MBH showed shorter operative duration (17.3 ± 3.5 vs. 20.4 ± 4.6 minutes, p<0.001) and lower recurrence rates (1.6% vs. 6.8%, p=0.038). Rates of testicular atrophy and surgical site infection were low and comparable between groups. Conclusion: Despite a higher rate of transient scrotal edema, MBH offers advantages in operative efficiency and recurrence reduction, suggesting it may be a suitable option in older children. Further randomized studies are recommended to confirm these findings.
Copyright (c) 2026 Naveed Ahmad, Ulas Khan, Tallat Shahzad, Mudassar Sajjad, Hamza Ashraf, Maryam Imran, Aneeq Iqbal https://creativecommons.org/licenses/by-nd/4.0
MOLECULAR CHARACTERIZATION OF BETA THALASSEMIA MAJOR IN PUNJAB, PAKISTAN
Abstract Background: β-Thalassemia major is among the most prevalent hereditary blood disorders in Pakistan. A person develops β-Thalassemia major when they inherit two mutated alleles for the HBB gene. This study aimed to identify the profile of mutations that are found in the population of Punjab, Pakistan, to develop a mutation-targeted diagnostic panel for the detection and better control of the disease. Settings and Method: The study was conducted at the Sundas Foundation. A cross-sectional approach was adopted for this study, and a non-probability consecutive sampling technique was employed to recruit data from 133 patients between January 2023 and December 2024. Blood samples from the patients were collected and tested using Multiplex ARMS-PCR for common and rare HBB mutations in Punjab. Results: Our findings revealed that homozygosity was found in 70.9 % of the cases and compound heterozygosity in the remaining 20.4%. Among the 13 mutations involved in our study: IVS1-5 (G>C) (33.8%), Fr8-9 (+G) (28.6%), Fr41-42 (-CTTT) (15%), IVS1-1 (G>A) (7.1%). These four mutations were common and accounted for 77.5% of the cases. Less commonly encountered mutations involved Codon5 (-CT), Codon15 (A>T), Codon30 (G>C), Cap+1 (A>C), Del619, Fr16 (-C). Three hemoglobin variants- HbE Cd-26, HbS Cd-6, and HbC Cd-6 were also investigated in this study. Conclusion: The most frequently found mutation in our study population is IVS1-5 (G>C). Many additional mutations, such as IVS1-1 (G>A), Fr8-9 (+G), and Fr41-42 (-CTTT), contributed significantly to the disease burden
Copyright (c) 2026 Muhammad Irtza Tanveer; Sadaf Farzand, Areeba Manzoor, Ambereen Anwar, Saima Farhan, Saira Moin https://creativecommons.org/licenses/by-nd/4.0
URINARY INCONTINENCE IN ANTENATAL WOMEN AND ITS IMPACT ON QUALITY OF LIFE
Background: The involuntary leakage of urine is key feature of urinary incontinence (UI), and is prevalent but underreported condition among pregnant women. Despite being benign, UI significantly affects physical, emotional, and social well-being, particularly in low-resource environments where continence care is often overlooked. Methods: A prospective cross-sectional study was done over six months in the Gynaecology C Unit at Ayub Teaching Hospital, Abbottabad. A total of 388 women with singleton pregnancies beyond 37 weeks were enrolled using a non-probability, sequential sampling technique. Data was collected using standardized tools, including International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7), and the SF-12v2 Health Survey. Variables assessed included symptom type, severity, impact on daily activities, and overall HRQoL. Results: UI symptoms were reported by majority of participants, with frequent urination (70.1%) and urinary incontinence (51.0%) being the most common. Stress incontinence was suggested by leakage triggered by coughing or sneezing (59%). Around 13.6% experienced severe to very severe symptoms. UI had a considerable impact on daily life, notably on household tasks (55.4%), emotional health (44.8%), and physical activities (48.5%). General health and quality of life were also negatively impacted, with 43% expressing continuous weariness and 32.5% ranking their health as fair or poor. Conclusion: UI is a common and disruptive condition during pregnancy, affecting many aspects of quality of life. Early identification, education, and incorporation of pelvic floor health into antenatal care are essential to improving maternal well-being and reducing postpartum complications.
Copyright (c) 2026 Ayesha Ismail, Zahida Parveen, Ruqqia Sultana, Hajira Iqbal, Sobia Zeb, Anaheeta Israr https://creativecommons.org/licenses/by-nd/4.0
A PHENOMENOLOGICAL STUDY OF OBSTETRICIANS’ LIVED EXPERIENCES IN MANAGING HIGH-RISK OBSTETRIC CASES
Background: This phenomenological study examines the experiences of obstetricians handling high-risk cases, such as postpartum hemorrhage, antepartum hemorrhage, uterine rupture, and sepsis, in a resource-limited tertiary care hospital in Pakistan. Method: Through questionnaires (open ended questions) with 10 obstetricians, the study identifies four key themes: emotional challenges and psychological stress, systemic resource shortages, professional resilience and coping strategies, and recommendations for institutional support. Results: Obstetricians reported a heavy emotional burden, worsened by their frequent encounters with maternal and neonatal deaths, and a lack of access to mental health services. Systemic issues, such as delays in lab tests, not enough ICU beds, bureaucratic obstacles, and inadequate blood bank support, often delayed care and increased clinical risks. Despite these difficulties, clinicians used informal coping methods like peer support, teamwork, and following protocols. Participants highlighted the need for non-punitive feedback systems, regular emergency drills, decentralizing low-risk deliveries, and integrating mental health services for staff. Conclusion: The study employs Colaizzi’s method to analyze the narratives, showing the complex, emotional, and systemic aspects of maternal care that are often missed in quantitative research. The findings stress the urgent need to make healthcare systems more compassionate by recognizing provider stress and implementing structural, psychological, and procedural changes. This research deepens the understanding of obstetric practices in low-resource settings and provides insights for policies aimed at improving maternal outcomes and clinician well-being. While the study is limited by being conducted at one site, it sets the stage for further exploration into healthcare professionals’ experiences in low-to-middle-income countries.
Copyright (c) 2026 Humaira Jadoon, Attiya bibi Khan, Ansa Islam, Salar Ahmed Khan, Maria Khan, Junaid Sarfaraz https://creativecommons.org/licenses/by-nd/4.0
EFFICACY OF INTRALESIONAL ACYCLOVIR VS CRYOTHERAPY FOR TREATMENT OF PLANTAR WARTS: A QUASI-EXPERIMENTAL STUDY
Background: Warts, benign proliferation of skin and mucosa caused by human papilloma virus (HPV), are treated by different modalities among which cryotherapy remains the most common. The objective of this study was to assess comparative efficacy of Intralesional acyclovir versus cryotherapy for plantar warts. Methods: This quasi-experimental study was conducted on eighty-four patients of plantar warts (1–10 in number) enrolled after obtaining ethical approval and written informed consent. Patients were divided into group A and B. Group A patients received intralesional Acyclovir in a dose of 0.1ml (70 mg/ml) at the base of each wart while Group B patients had cryotherapy for two freeze and thaw cycles with each cycle of 10 seconds duration. Lesion size and clinical photographs were recorded at baseline and at follow-up visits scheduled every 2 weeks (maximum 5 sessions) and followed for further 4 months. Response was considered as complete (100% resolution), partial (resolution 50-99%) or no response (resolution <50%). Results: A total of 84 patients with 42 (79% Males and 21% females) in group A and 42 (55% males and 45% females) in group B, having mean age 27.79±4.36 and 26.74±6.03 years, mean wart size 0.43±0.09 and 0.49±0.09 cm and mean number of warts 1.61±1.06 and 1.67±1.12 in each group respectively. 83% achieved complete response, 10% lost to follow-up and 7% refused treatment in Group A whereas 48% achieved complete and partial responses respectively and 4% had no response in Group B (p<0.001). Conclusion: Acyclovir is an effective treatment modality of cutaneous warts with better results in males presenting with single plantar wart.
Copyright (c) 2026 Faisal Ahmad, Natasha Shahid Janjua, Muneeza Rizwan https://creativecommons.org/licenses/by-nd/4.0
POST-AMI: A STUDY OF PLANNED OUTPATIENT ANGIOGRAPHY AFTER SUCCESSFUL THROMBOLYSIS IN STEMI PATIENTS.
BACKGROUND: The current recommendations regarding STEMI patients who are treated with thrombolysis in non-PCI centers are to transfer such patients to a facility capable of angiography as soon as possible. However, many emerging PCI-capable centers thrombolyse patients in acute settings because they have not yet achieved primary PCI capability. Could successfully thrombolysed patients undergo nonurgent angiography in such settings without the risk of major complications? In the setting of limited resources, where urgent angiographies could be reserved for rescue or other urgent indications, demonstrating the safety of non-urgent outpatient angiography in successfully thrombolysed patients would be useful. METHODS: One hundred consecutive patients presenting within 12 hours of symptoms for their first STEMI and meeting our inclusion criteria were given 1.5 MU of Streptokinase and guideline-directed medical treatment. Successfully thrombolysed patients were scheduled to undergo angiography within 72 hours of discharge. The primary outcome was event-free survival up to angiography or unscheduled admissions for recurrent angina or re-infarction or death while waiting for angiography. RESULTS: All patients were accounted for. About 80% of patients were males. ST-segment resolution of ≥70% was associated with TIMI III flow at angiography in 90% of patients. TIMI 0 was found in only 8%. All patients survived to have their outpatient angiographies within 72 hours. There were no unscheduled admissions for recurrent angina or re-infarction while waiting for angiography. CONCLUSION: ST-segment resolution of ≥70% is a sensitive marker of good short-term prognosis and a patent infarct-related artery on angiography. Routine outpatient angiography within 72 hours of discharge can be safely undertaken in patients who show resolution of chest pain with 70% or more ST-segment resolution at 90 minutes post-thrombolysis.
Copyright (c) 2026 Zia Ullah Khan, Rukhshanda Afsar, Mohammad Imran Khan, Saad Shams, Aftab Ahmad, Mohsin Iqbal https://creativecommons.org/licenses/by-nd/4.0
EXPLORING THE USE OF MIND MAPPING FOR LEARNING ANATOMY IN UNDERGRADUATE MEDICAL STUDENTS: A MIXED METHODS STUDY
Background: Anatomy is an important preclinical subject often taught through didactic lectures to undergraduate medical students. To improve learning outcomes, mind mapping presents a promising alternative by visually organizing information and promoting active learning. The objectives of the study were to compare the effectiveness of mind mapping versus didactic lectures in improving anatomy learning and explore the experiences of undergraduate medical students with using mind mapping. Methods: A mixed-methods study was conducted involving first-year medical students at a private medical college. In the quantitative phase, test scores of first year medical students in anatomy were compared following teaching interventions involving mind mapping and didactic lectures. An independent sample t-test was used for this comparison. The qualitative phase involved three focus group discussions to explore students' experiences with using mind mapping to learn anatomy. Data were analyze inductively using Braun and Clarke's thematic analysis method. Results: The students who learned anatomy through mind mapping scored higher than those who were taught through didactic lectures. For topic 1 and 2, the p- values were 0.02 and 0.01 respectively, indicating a statistically significant difference in scores between the mind mapping and didactic lecture groups. The qualitative phase revealed five themes: Initial perceptions and expectations, Advantages of mind mapping, Limitations and improvement areas, Mind mapping versus traditional learning methods, and Recommendations. Conclusion: This study highlights mind mapping as an effective tool for improving academic performance, engagement, and collaboration in anatomy education. It demonstrates that mind mapping offers advantages over traditional teaching methods. Incorporating mind mapping into teaching practices can improve understanding of anatomical concepts and learning outcomes in medical students. Keywords: Mind mapping; Anatomy; Didactic lectures; Undergraduate medical students
Copyright (c) 2026 Anam Zahra, Zain Gulzar, Hina Sohail, Nimrah Fahim, Momina Gul https://creativecommons.org/licenses/by-nd/4.0
“AI-ASSISTED RENAL TUMOR MANAGEMENT: A COMPARATIVE EVALUATION OF CHATGPT AND MULTIDISCIPLINARY TEAM DECISIONS”
Abstract Background: Renal tumors, including renal cell carcinoma (RCC), often require complex and personalized decision-making processes, typically achieved through multidisciplinary team (MDT) discussions. With advancements in artificial intelligence (AI), tools like ChatGPT have the potential to aid decision-making. This study evaluates ChatGPT’s ability to align its recommendations with MDT decisions in renal tumor management. Methods: This retrospective study analyzed 13 renal tumor cases discussed by MDTs. Tumor classifications were based on the TNM staging system, including T1a, T1b, T2, T3/T4, and metastatic RCC. Treatment recommendations—partial nephrectomy, radical nephrectomy, systemic therapy, and surveillance—were generated by ChatGPT using the European Association of Urology (EAU) guidelines. Concordance with MDT decisions was assessed. Results: Localized RCC (T1-T2) accounted for 61.5% of cases, advanced RCC (T3/T4) for 15.4%, and metastatic RCC for 23.1%. Treatment recommendations included partial nephrectomy (23.1%), radical nephrectomy (46.2%), systemic therapy (23.1%), and surveillance (7.7%). ChatGPT demonstrated 100% concordance with MDT decisions across all cases. Conclusion: ChatGPT’s ability to align with MDT decisions underscores its potential as a supplementary tool in renal tumor management. However, human oversight is essential to account for patient-specific and contextual factors. Larger studies are required to validate these findings and refine AI integration into clinical workflows.
Copyright (c) 2026 Jawad khan, Malik Furqan Mahmood, Muhammad Saleem, Mudassar Abbas, Saddam Hussain, Syed Muhammad Ali Hasnu, Abdul Basit Khan, Hifza Jadoon, Mezhgan Kiwan https://creativecommons.org/licenses/by-nd/4.0
EFFECTIVENESS OF FRACTIONAL CARBONDIOXIDE LASER WITH TOPICAL METHOTREXATE VS TOPICAL PUVASOL IN TREATEMENT OF VITILIGO
Background: Vitiligo is an autoimmune disease characterized by patches of depigmentation on the skin. As skin is the major contributor to one’s social image and appearance, this disease impairs one’s quality of life to a significant extent. Dermatologists are continuously trying to find more and better treatment options, in addition to steroids, calcineurin inhibitors, immunomodulators and phototherapy. The aim of our study was to compare the effectiveness of topical methotrexate in combination with fractional carbon dioxide laser with topical psoralen with solar UVA (PUVASOL). Our hypothesis was that the Carbon dioxide laser-Topical Methotrexate combination is better than topical PUVASOL. It was a double blinded randomized Control Trial carried out in the Dermatology OPD of a tertiary care hospital in Rawalpindi over a period of 06 months i.e., 20.01.24 to 20.07.24. Methods 36 patients meeting the inclusion criteria were included in the study after taking informed consent. Sampling was done by non-probability randomized sampling using lottery method. Half of them were treated with Fractional CO-2 laser followed by topical methotrexate12.5mg/ml application. Weekly sessions were done for 4 months. In the other group topical PUVASOL was used on alternate days for 04 months. 01 patient from each group was dropped. An independent observer noted the clinical improvement. Patient satisfaction and complications were also recorded. Results Statistically significant difference in results of Group A as compared to Group B, regarding clinical improvement and patient satisfaction were noted i.e., p= 0.039 and 0.002 respectively. There was no significant difference in the side-effect profile of both groups (p=0.59), with 44.1% patients having no side effect at all. Conclusion: Fractional Carbon dioxide laser combined with topical methotrexate is better than topical PUVASOL in the treatment of vitiligo. Keywords Fractional carbon dioxide laser, Topical methotrexate, Topical PUVASOL, Vitiligo
Copyright (c) 2026 Samina, Sakina Sadiq Malik, Ahmed Naveed Malik, Aayesha Rehman, Sajjad Ahmed, Ahsan Tameez-Ud-Din https://creativecommons.org/licenses/by-nd/4.0
A COCAINE INHALATION LEADING TO SPONTANEOUS PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA: A CASE REPORT AND REVIEW OF MECHANISMS
Abstract Background: Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SE) are rare clinical entities, typically resulting from trauma, invasive procedures, or underlying pulmonary pathology. However, recreational drug use—particularly cocaine inhalation—has emerged as a less common but important non-traumatic cause due to its barotrauma-inducing effects. Case Presentation: We present the case of an 18-year-old male with no known comorbidities who presented with progressive facial, neck, and chest swelling, pleuritic chest pain, and dyspnea. Physical examination revealed subcutaneous crepitus and altered voice resonance. Imaging via chest radiography and computed tomography (CT) confirmed extensive pneumomediastinum and subcutaneous emphysema. No pneumothorax or esophageal perforation was identified. A fluoroscopic contrast swallow excluded esophageal injury. Upon further evaluation, the patient admitted to recent inhalational cocaine use. He was managed conservatively with oxygen, analgesia, and clinical observation, resulting in full clinical and radiological resolution within two weeks. Conclusion: This case highlights the diagnostic challenge and clinical relevance of cocaine-induced SPM in young adults presenting with acute chest symptoms. It underscores the importance of a high index of suspicion, appropriate imaging, and the effectiveness of conservative management in stable patients. Increased awareness of this etiology is essential to avoid unnecessary interventions and support early identification. Further research is warranted to explore long-term outcomes and recurrence risk associated with drug-induced pulmonary barotrauma. Keywords: Pneumomediastinum, Subcutaneous Emphysema, Cocaine, Barotrauma, Spontaneous, Conservative Management Introduction Pneumomediastinum is defined as the presence of free air in the mediastinum, while subcutaneous emphysema refers to air trapped within the subcutaneous tissues, most often observed in the neck or chest wall. While both are uncommon findings, their spontaneous occurrence in young individuals, especially secondary to illicit drug use, remains underreported. Inhaled cocaine use is increasingly recognized as a cause of barotrauma due to increased intrathoracic pressure, leading to alveolar rupture and air dissection along the bronchovascular sheath into the mediastinum and soft tissues [1,2]. Early recognition and exclusion of life-threatening conditions such as esophageal perforation are critical [3]. Case Presentation An 18-year-old male presented to the Emergency Department with a three-day history of facial, neck, and chest swelling associated with pleuritic chest pain and mild shortness of breath. The patient denied any history of trauma or known recreational drug use at presentation. He had no significant medical or family history. On examination, vital signs were stable (HR 67 bpm, BP 125/80 mmHg, SpO₂ 95% on room air). Tactile crepitus was noted in the supraclavicular region, with bilateral wheezing on auscultation. His voice was high-pitched and hyponasal, suggesting air tracking into the soft tissues of the upper airway. There were no clinical signs of airway compromise. Investigations Figure 1: Chest X-ray (Initial Presentation). Chest radiograph (PA view) showing radiolucent streaks of air in the cervical and thoracic subcutaneous tissues, consistent with extensive surgical emphysema and pneumomediastinum. This image demonstrates subcutaneous emphysema along the neck and chest wall and air outlining the mediastinum, confirming pneumomediastinum without associated pneumothorax. Further imaging via CT Thorax (Figure 2) confirmed the presence of extensive subcutaneous emphysema in the neck and anterior chest wall, along with free gas in the superior mediastinum. Fluoroscopy using Omnipaque 300 contrast showing normal contrast progression without evidence of extravasation. The study ruled out esophageal perforation. There was no leak of contrast and no extravasation into the mediastinum during early or delayed imaging sequences. No pneumothorax or focal pulmonary lesion was identified. The findings were suggestive of spontaneous pneumomediastinum, potentially due to an airway leak, though no definitive site was identified. A B Figure 2: Fluoroscopic Swallow Study. Figure A: Axial CT thorax image showing extensive subcutaneous emphysema in the neck and anterior chest wall, with free gas visible in the superior mediastinum, consistent with pneumomediastinum. No pneumothorax or focal pulmonary lesion is noted. Figure B: Axial CT thorax image (different window setting) demonstrating the same findings of subcutaneous emphysema and free mediastinal gas. There is no evidence of esophageal contrast extravasation or mediastinal fluid collection. Fluoroscopic evaluation using Omnipaque contrast demonstrated normal esophageal contrast progression without evidence of leak or extravasation, effectively ruling out esophageal perforation. Both anteroposterior and lateral views confirmed intact esophageal integrity, and delayed imaging showed no contrast collection in the mediastinum (Figure 3A-3C). These findings supported the diagnosis of spontaneous pneumomediastinum, likely secondary to barotrauma from recent inhalational cocaine use, and justified the conservative management approach. A B C Figure 3: Fluoroscopic view. Figure A. Anteroposterior fluoroscopic view showing normal contrast progression through the esophagus without evidence of extravasation. Figure B. Lateral fluoroscopic view further confirming normal contrast flow with no leak or collection in the mediastinum. Figure C. Delayed imaging sequence showing no contrast extravasation into the mediastinum, ruling out esophageal perforation. Following a multidisciplinary review, the patient admitted to recent inhalational cocaine use, which likely contributed to alveolar rupture from barotrauma. Conservative management was adopted, including oxygen therapy, analgesia, and clinical observation. The patient was monitored over 48 hours, during which his symptoms improved without complications. He was discharged with outpatient follow-up. Figure 4: Follow-Up Chest X-ray (Two Weeks Post-Discharge). Resolution of previous subcutaneous emphysema and pneumomediastinum on follow-up imaging. The radiograph confirms complete resolution of the previously observed emphysematous changes, validating the effectiveness of conservative management. Therapeutic Intervention The patient was managed conservatively with close inpatient monitoring, supplemental oxygen, and analgesia. Antibiotics were not initiated as there was no clinical or imaging evidence of infection or esophageal perforation. He was admitted to the medical ward with daily assessments and chest auscultation to monitor for progression. No surgical intervention was required. Follow-Up and Outcome At 48 hours, the patient's symptoms had improved markedly. He remained hemodynamically stable, with no signs of airway compromise. A follow-up chest X-ray after two weeks confirmed complete resolution of subcutaneous emphysema and pneumomediastinum. The patient was advised on the risks of recreational drug use and referred to outpatient addiction services. Discussion SPM and SE, particularly in the absence of trauma, represent uncommon but clinically important entities. The classic triad of chest pain, dyspnea, and neck swelling—first described by Hamman and later elaborated by Lintz [4]—was observed in our patient, reinforcing the consistency of clinical features across case reports. However, the etiology in our case—cocaine-induced barotrauma—remains an infrequent and underdiagnosed cause. In a comprehensive review by Kouritas et al. [1], most cases of pneumomediastinum were linked to iatrogenic or traumatic causes, with spontaneous cases being relatively rare and primarily occurring in young males. Our patient's demographics fit this profile, but his initial denial of drug use underscores the diagnostic challenge in cases with a concealed etiology. As Caceres et al. [2] highlighted, spontaneous cases must be meticulously evaluated to rule out life-threatening causes such as esophageal perforation or bronchial injury. Our case mirrors the clinical natural history described by Panacek et al. [5], in which the majority of patients with SPM were stable and responded well to conservative treatment. This supports the growing consensus that invasive interventions are unnecessary in hemodynamically stable individuals without evidence of complications. In contrast, Kassem and Wallen [3] emphasized the potential risk of misdiagnosing Boerhaave syndrome, which can present similarly. The use of fluoroscopic contrast swallow in our case effectively ruled out esophageal injury, highlighting the importance of imaging in early work-up. Drug-induced SPM is even more unusual and often underreported. Cocaine, a known vasoconstrictor, can induce alveolar rupture by increasing intrathoracic pressure during forceful inhalation or valsalva maneuvers [6]. Weissman [6] and Mégarbane et al. [7] provided detailed pathophysiologic mechanisms, showing how cocaine damages alveolar epithelium and disrupts the pulmonary interstitium, increasing susceptibility to rupture. Terra Filho et al. [8] added that repeated use of cocaine may lead to structural lung changes, predisposing to recurrent episodes. Compared to previously reported cases, our case is distinct in the following ways. It occurred in an 18-year-old with no significant medical history, reinforcing that cocaine-induced barotrauma can be the first and only presentation. There was no pneumothorax or pneumopericardium, which are often associated features [2,7]. Diagnosis was complicated by initial concealment of drug use, making imaging and multidisciplinary evaluation critical. The patient fully recovered on conservative management, echoing the outcomes in most benign SPM cases [5]. This case strengthens the body of evidence indicating that spontaneous pneumomediastinum in young, otherwise healthy individuals should raise suspicion for inhaled drug use—even in the absence of initial admission—and that non-invasive management is both safe and effective when serious pathology is excluded. Conclusion This case report presents a rare instance of cocaine-induced spontaneous pneumomediastinum and subcutaneous emphysema in a young male with no prior health issues. The diagnosis was supported by imaging, and serious causes such as esophageal perforation. The patient improved with conservative treatment alone. Cocaine inhalation is a significant, often under-recognized cause of barotrauma. Spontaneous pneumomediastinum, while rare, typically has a benign course in stable patients. A high index of suspicion and thorough diagnostic evaluation are crucial, especially when the history is initially unclear. Early identification and appropriate imaging are essential to avoid unnecessary interventions. Clinicians should routinely consider recreational drug use in differential diagnoses of young adults with acute chest symptoms, even when history is non-contributory. Furthermore, this case highlights the need for increased awareness and possibly routine toxicology screening in similar presentations. Research into the long-term pulmonary sequelae of cocaine use remains limited and warrants further study.
Copyright (c) 2026 Mehr Ali Khan, Ayaz Muhammad, Rabeea Komal, Ijaz ul Haq, Hafiz Hassan, Yusaf Hakim Vapra https://creativecommons.org/licenses/by-nd/4.0
HIGH-DOSE ORAL VITAMIN C WITH MINIMAL TOPICAL BETAMETHASONE IN THE MANAGEMENT OF MILD POMPHOLYX ECZEMA: A CASE REPORT
Background: Pompholyx eczema presents as vesicular skin eruptions in hands and feet and follows a chronic and relapsing disease course. While topical corticosteroids are routinely used for treatment, long-term use remains a major concern. Vitamin C is known for its role in immunity and wound healing. However, it has not been widely investigated in pompholyx eczema. Case Presentation: We report the clinical case of a 45-year-old Pakistani male with a 22-year history of mild pompholyx eczema. Eczematous flares in this patient are associated with the use of medicated soaps, dishwash detergents and dryness induced by water. Interestingly, during the COVID-19 pandemic, he began taking high-dose oral vitamin C (2000 mg/day). This coincided with a significant reduction in symptoms. The patient was inspired by this improvement and designed a self-directed observational trial in consultation with a dermatologist. He started with one self-inflicted active lesion after using dishwash detergent. He started using 2000 mg/day vitamin C for 8 days and only single nightly dose of topical 0.1% betamethasone on day 6 and 7. This led to complete resolution of the lesion on day 9 and the patient documented the healing process photographically. Conclusion: The adjunctive role of vitamin C has the potential to reduce corticosteroid dependence in Pompholyx eczema management. However, further clinical research is warranted to explore the clinical efficacy of vitamin C in eczema.
Copyright (c) 2026 Asif Ali https://creativecommons.org/licenses/by-nd/4.0
A A CASE OF CENTRAL NERVOUS SYSTEM INVASIVE ASPERGILLOSIS MIMICKING ORBITAL CELLULITIS IN A PATIENT WITH UNCONTROLLED TYPE 2 DIABETES MELLITUS AND END-STAGE RENAL DISEASE
Central nervous system aspergillosis is a rare and often fatal complication seen in immunocompromised individuals. Here, we present the case of a 60-year-old female with uncontrolled type 2 diabetes mellitus and end-stage renal disease (ESRD) who was ultimately diagnosed with CNS aspergillosis. This case underscores the diagnostic challenge and delays posed by fungal infections in patients with predisposing conditions, necessitating a multidisciplinary approach for timely diagnosis and management.
Copyright (c) 2026 Zomer Sardar, Azhar Nasim, Mohammad Faisal, Mariam Danish Iqbal https://creativecommons.org/licenses/by-nd/4.0
SYSTEMIC LUPUS ERYTHEMATOSUS COMPLICATED WITH CASTLEMAN DISEASE : A CASE REPORT
Castleman disease is a rare nonclonal heterogeneous group of diseases involving lymphoid tissue. It often simulates other inflammatory conditions and malignancies. Systemic lupus erythematosus, being a multisystem inflammatory disorder, shares many features with Castleman disease. Here, we report a similar case of a middle age female who was initially diagnosed as SLE with lupus nephritis, for which she was put on steroids and immunosuppressants. After commencing treatment, her symptoms resolved and she remained in remission for some period. However, her condition was complicated with Castleman disease later on. For diagnostic and therapeutic purpose, she underwent lymph node resection and to our surprise, her condition improved.
Copyright (c) 2026 Ahsan Khurshid, Anum Abbas, Suhail Iqbal, Raheel Khan https://creativecommons.org/licenses/by-nd/4.0
ABDOMINAL COCOON SYNDROME: A CASE REPORT
Abstract INTRODUCTION: Abdominal cocoon syndrome is an unusual cause of small bowel obstruction characterized by encasement of the bowel by a fibrous and/or collagenous membrane. PRESENTATION OF CASE: A 38-year-old male, with no comorbidities, presented with signs and symptoms of sub-acute intestinal obstruction for the last one and a half months. He had two episodes of similar symptoms in the past year. DISCUSSION: It is a rare disease. Patients usually present with symptoms of recurrent obstruction of the small bowel, usually without any obvious cause. The preferred imaging modality is a CT scan however diagnosis is usually made intra-operatively. Surgical excision of membranes carries a good prognosis. CONCLUSION: Abdominal cocoon syndrome is a rare cause of obstruction of the small bowel where preoperative diagnosis usually is difficult. Treatment of choice is meticulous surgical excision of the membranes.
Copyright (c) 2026 Khizar Hayat Khanzada, Mariya Rizwan Butt, Komal Khalid, Husnain Ahmad https://creativecommons.org/licenses/by-nd/4.0