Journal of Ayub Medical College Abbottabad
type: channel
description: 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.
publisher: Ayub Medical College, Abbottabad.
language: en-US
publication name: Journal of Ayub Medical College Abbottabad
issn: 1025-9589
copyright: 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.
items: INTEGRATING ARTIFICIAL INTELLIGENCE INTO MEDICAL EDUCATION IN PAKISTAN: AN URGENT REFORM AGENDA
items: GENDER BASED COMPARATIVE STUDY OF THE QUALITY OF LIFE OF PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS (PLHIV) ON ANTIRETROVIRAL THERAPY (ART)
items: FOSTERING DIGITAL HEALTH IN PAKISTAN: AN INTERVENTIONAL STUDY REGARDING AWARENESS OF TELEMEDICINE AMONG PATIENTS OF DIVERSE HEALTHCARE SETUPS IN ISLAMABAD
items: ANTERO POSTERIOR POSITION OF MAXILLARY CENTRAL INCISORS IN RELATION TO THE FOREHEAD IN PAKISTANI POPULATION
items: https://demo.ayubmed.edu.pk/index.php/jamc/article/view/13766
items: OUTCOME OF MODIFIED STOPPA TECHNIQUE FOR THE MANAGEMENT OF ACETABULAR FRACTURES
items: EFFECT OF CONTINUOUS ENHANCED VAGAL TONE ON DUAL ATRIOVENTRICULAR NODE AND ACCESSORY PATHWAYS
items: COMPARISON OF SINGLE BOLUS NOREPINEPHRINE WITH PHENYLEPINEPHRINE FOR PREVENTION OF HYPOTENSION DURING CESAREAN SECTION UNDER SPINAL ANESTHESIA
items: DIAGNOSTIC ACCURACY OF ULTRASOUND FOR MORBIDLY ADHERENT PLACENTA
items: A PREEMPTIVE REGIMEN REDUCED NOCICEPTIVE C-FOS EXPRESSION IN THE SOMATOSENSORY CORTEX OF SURGICAL PAIN PARADIGM.
items: THE ROLE OF BARIATRIC SURGERY IN NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) MANAGEMENT: A PROSPECTIVE STUDY AT AFRIDI MEDICAL COMPLEX, PESHAWAR
items: THE INCIDENCE AND CLINICAL CORRELATION OF DACRYOCYSTITIS WITH NASAL PATHOLOGY IN A TERTIARY CARE HOSPITAL.
items: MITCHELL-BANKS’ VS. FERGUSON AND GROSS HERNIOTOMY IN BOYS OVER TWO: A PROSPECTIVE COMPARISON OF POSTOPERATIVE OUTCOMES
items: MOLECULAR CHARACTERIZATION OF BETA THALASSEMIA MAJOR IN PUNJAB, PAKISTAN
items: URINARY INCONTINENCE IN ANTENATAL WOMEN AND ITS IMPACT ON QUALITY OF LIFE
items: A PHENOMENOLOGICAL STUDY OF OBSTETRICIANS’ LIVED EXPERIENCES IN MANAGING HIGH-RISK OBSTETRIC CASES
items: EFFICACY OF INTRALESIONAL ACYCLOVIR VERSUS CRYOTHERAPY FOR TREATMENT OF PLANTAR WARTS
items: POST-AMI: A STUDY OF PLANNED OUTPATIENT ANGIOGRAPHY AFTER SUCCESSFUL THROMBOLYSIS IN STEMI PATIENTS.
items: EXPLORING THE USE OF MIND MAPPING FOR LEARNING ANATOMY IN UNDERGRADUATE MEDICAL STUDENTS: A MIXED METHODS STUDY
items: “AI-ASSISTED RENAL TUMOR MANAGEMENT: A COMPARATIVE EVALUATION OF CHATGPT AND MULTIDISCIPLINARY TEAM DECISIONS”
items: EFFECTIVENESS OF FRACTIONAL CARBONDIOXIDE LASER WITH TOPICAL METHOTREXATE VS TOPICAL PUVASOL IN TREATEMENT OF VITILIGO
items: PREDICTORS AND OUTCOMES OF FAILED RECANALIZATION OF CHRONIC TOTAL OCCLUSIONS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE AT A TERTIARY CARE CARDIAC CENTER
items: A COCAINE INHALATION LEADING TO SPONTANEOUS PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA: A CASE REPORT AND REVIEW OF MECHANISMS
items: HIGH-DOSE ORAL VITAMIN C WITH MINIMAL TOPICAL BETAMETHASONE IN THE MANAGEMENT OF MILD POMPHOLYX ECZEMA: A CASE REPORT
items: 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
items: SYSTEMIC LUPUS ERYTHEMATOSUS COMPLICATED WITH CASTLEMAN DISEASE : A CASE REPORT
items: ABDOMINAL COCOON SYNDROME: A CASE REPORT
items: RETROPERITONEAL LYMPH NODE DISSECTION: CASE SERIES AND CONTEMPORARY LITERATURE PERSPECTIVES
items: MPOX IN PAKISTAN: A CALL FOR VIGILANCE AND GLOBAL HEALTH SOLIDARITY

INTEGRATING ARTIFICIAL INTELLIGENCE INTO MEDICAL EDUCATION IN PAKISTAN: AN URGENT REFORM AGENDA
type: item
description: 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.
creator: Abdul Wahab Yousafzai
creator: Fatima Saeed Khan
creator: Shawaf Naeem
rights: Copyright (c) 2026 Abdul Wahab Yousafzai, Fatima Saeed Khan, Shawaf Naeem https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 271
ending page: 272
doi: 10.55519/JAMC-03-15005

GENDER BASED COMPARATIVE STUDY OF THE QUALITY OF LIFE OF PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS (PLHIV) ON ANTIRETROVIRAL THERAPY (ART)
type: item
description: 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.
creator: Iqra Hamid Khan
creator: Jayasree S Kanathasan
creator: Sreemoy Kanti Das
creator: Awais Gohar
rights: Copyright (c) 2026 Iqra Hamid Khan, Jayasree S Kanathasan, Sreemoy Kanti Das, Awais Gohar https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 273
ending page: 279

FOSTERING DIGITAL HEALTH IN PAKISTAN: AN INTERVENTIONAL STUDY REGARDING AWARENESS OF TELEMEDICINE AMONG PATIENTS OF DIVERSE HEALTHCARE SETUPS IN ISLAMABAD
type: item
description: 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
creator: Shehbano Syed
creator: Minal Zaman
creator: Aiza Anwar
creator: Muhammad Junaid Hussain
creator: Muhammad Imad Naeem
creator: Elyzae Rizwan
creator: Asifa Afzal
creator: Arshia Bilal
rights: 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
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 280
ending page: 285

ANTERO POSTERIOR POSITION OF MAXILLARY CENTRAL INCISORS IN RELATION TO THE FOREHEAD IN PAKISTANI POPULATION
type: item
description: 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
creator: Mazhar Hussain
creator: Faiza Malik
creator: Muhammad Noman
creator: Munawar Manzoor Ali
creator: Gulsana Hashmi
creator: Saba Sikandar
rights: Copyright (c) 2026 Mazhar Hussain, Faiza Malik, Muhammad Noman, Munawar Manzoor Ali, Gulsana Hashmi, Saba Sikandar https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 286
ending page: 290

https://demo.ayubmed.edu.pk/index.php/jamc/article/view/13766
type: item
title: 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
description: 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.
creator: Asma Saher Ansari
creator: Imtiaz Ahmed
creator: Masood Anwar Qureshi
creator: Zairah Muqaddas
creator: Abdur Rehman
rights: Copyright (c) 2026 Asma Saher Ansari, Imtiaz Ahmed, Masood Anwar Qureshi, Zairah Muqaddas, Abdur Rehman https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 291
ending page: 296

OUTCOME OF MODIFIED STOPPA TECHNIQUE FOR THE MANAGEMENT OF ACETABULAR FRACTURES
type: item
description: 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
creator: Muhammad Saeed
creator: Abdul Sattar
creator: Muhammad Inam
creator: Zeeshan Khan
creator: Shafi Ul Haq
rights: Copyright (c) 2026 Muhammad Saeed, Abdul Sattar, Muhammad Inam, Zeeshan Khan, Shafi Ul Haq https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 297
ending page: 300

EFFECT OF CONTINUOUS ENHANCED VAGAL TONE ON DUAL ATRIOVENTRICULAR NODE AND ACCESSORY PATHWAYS
type: item
description: 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 findin…
creator: Hameed Ullah
creator: Muhammad Idrees Khan
creator: Asif Mehmood
creator: Yasir Hayat
creator: Talia Mansoor
creator: Romana
rights: Copyright (c) 2026 Hameed Ullah, Muhammad Idrees Khan, Asif Mehmood, Yasir Hayat , Talia Mansoor, Romana https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 301
ending page: 305

COMPARISON OF SINGLE BOLUS NOREPINEPHRINE WITH PHENYLEPINEPHRINE FOR PREVENTION OF HYPOTENSION DURING CESAREAN SECTION UNDER SPINAL ANESTHESIA
type: item
description: 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 mai…
creator: Mishal Pervaiz
creator: Raja Mushtaq Hussain
creator: Muhammad Mudasir Saleem
rights: Copyright (c) 2026 Mishal Pervaiz, Raja Mushtaq Hussain, Muhammad Mudasir Saleem https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 306
ending page: 310

DIAGNOSTIC ACCURACY OF ULTRASOUND FOR MORBIDLY ADHERENT PLACENTA
type: item
description: 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.
creator: Aliya Ahmed
creator: Ayesha Isani Majeed
creator: Ramish Riaz
creator: Hamna Abid
creator: Bilal Asif
creator: Ummehabiba malik
rights: Copyright (c) 2026 Aliya Ahmed, Ayesha Isani Majeed, Ramish Riaz, Hamna Abid, Bilal Asif, Ummehabiba malik https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 311
ending page: 314

A PREEMPTIVE REGIMEN REDUCED NOCICEPTIVE C-FOS EXPRESSION IN THE SOMATOSENSORY CORTEX OF SURGICAL PAIN PARADIGM.
type: item
description: 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.
creator: Saima Mumtaz
creator: Najma Baseer
creator: Syed Hamid Habib
creator: Saima Saleem
creator: Sana Malik
rights: Copyright (c) 2026 Saima Mumtaz , Najma Baseer, Syed Hamid Habib, Saima Saleem, Sana Malik https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 315
ending page: 320

THE ROLE OF BARIATRIC SURGERY IN NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) MANAGEMENT: A PROSPECTIVE STUDY AT AFRIDI MEDICAL COMPLEX, PESHAWAR
type: item
description: 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
creator: Mushtaq Ahmad
creator: Maria Alamgir
creator: Waqar Ahmad
creator: Abdul Haseeb Sahibzada
rights: Copyright (c) 2026 Mushtaq Ahmad, Maria Alamgir, Waqar Ahmad, Abdul Haseeb Sahibzada https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 321
ending page: 325

THE INCIDENCE AND CLINICAL CORRELATION OF DACRYOCYSTITIS WITH NASAL PATHOLOGY IN A TERTIARY CARE HOSPITAL.
type: item
description: 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.
creator: Muhammad Imran Shah
creator: Zara Sajid
creator: Bushra Aaqil
creator: Hasan Sajid Kazmi
creator: Tahira Sajid
creator: Usman Ameen
rights: 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
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 326
ending page: 329

MITCHELL-BANKS’ VS. FERGUSON AND GROSS HERNIOTOMY IN BOYS OVER TWO: A PROSPECTIVE COMPARISON OF POSTOPERATIVE OUTCOMES
type: item
description: 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.
creator: Naveed Ahmad
creator: Ulas Khan
creator: Tallat Shahzad
creator: Mudassar Sajjad
creator: Hamza Ashraf
creator: Maryum Imran
creator: Aneeq Iqbal
rights: 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
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 330
ending page: 333

MOLECULAR CHARACTERIZATION OF BETA THALASSEMIA MAJOR IN PUNJAB, PAKISTAN
type: item
description: 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
creator: Muhammad Irtza Tanveer
creator: Sadaf Farzand
creator: Areeba Manzoor
creator: Ambereen Anwar
creator: Saima Farhan
creator: Saira Moin
rights: Copyright (c) 2026 Muhammad Irtza Tanveer; Sadaf Farzand, Areeba Manzoor, Ambereen Anwar, Saima Farhan, Saira Moin https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 334
ending page: 338

URINARY INCONTINENCE IN ANTENATAL WOMEN AND ITS IMPACT ON QUALITY OF LIFE
type: item
description: 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.
creator: Ayesha Ismail
creator: Zahida Parveen
creator: Ruqqia Sultana
creator: Hajira Iqbal
creator: Sobia Zeb
creator: Anaheeta Israr
rights: Copyright (c) 2026 Ayesha Ismail, Zahida Parveen, Ruqqia Sultana, Hajira Iqbal, Sobia Zeb, Anaheeta Israr https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 339
ending page: 345
doi: 10.55519/JAMC-02-14606

A PHENOMENOLOGICAL STUDY OF OBSTETRICIANS’ LIVED EXPERIENCES IN MANAGING HIGH-RISK OBSTETRIC CASES
type: item
description: 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.
creator: Humaira Jadoon
creator: Attiya bibi Khan
creator: Ansa Islam
creator: Salar Ahmed Khan
creator: Maria Khan
creator: Junaid Sarfaraz
rights: 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
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 346
ending page: 351

EFFICACY OF INTRALESIONAL ACYCLOVIR VERSUS CRYOTHERAPY FOR TREATMENT OF PLANTAR WARTS
type: item
description: 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.
creator: Faisal Ahmad
creator: Natasha Shahid Janjua
creator: Muneeza Rizwan
rights: Copyright (c) 2026 Faisal Ahmad, Natasha Shahid Janjua, Muneeza Rizwan https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 352
ending page: 355

POST-AMI: A STUDY OF PLANNED OUTPATIENT ANGIOGRAPHY AFTER SUCCESSFUL THROMBOLYSIS IN STEMI PATIENTS.
type: item
description: 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.
creator: Zia Ullah Khan
creator: Rukhshanda Afsar
creator: Mohammad Imran Khan
creator: Saad Shams
creator: Aftab Ahmad
creator: Mohsin Iqbal
rights: 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
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 356
ending page: 360

EXPLORING THE USE OF MIND MAPPING FOR LEARNING ANATOMY IN UNDERGRADUATE MEDICAL STUDENTS: A MIXED METHODS STUDY
type: item
description: 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;…
creator: Anam Zahra
creator: Zain Gulzar
creator: Hina Sohail
creator: Nimrah Fahim
creator: Momina Gul
rights: Copyright (c) 2026 Anam Zahra, Zain Gulzar, Hina Sohail, Nimrah Fahim, Momina Gul https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-09
publication date: 2026-01-09
volume: 37
number: 3
starting page: 361
ending page: 367

“AI-ASSISTED RENAL TUMOR MANAGEMENT: A COMPARATIVE EVALUATION OF CHATGPT AND MULTIDISCIPLINARY TEAM DECISIONS”
type: item
description: 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.
creator: Jawad khan
creator: Malik Furqan Mahmood
creator: Muhammad Saleem
creator: Mudassar Abbas
creator: Saddam Hussain
creator: Syed Muhammad Ali Hasnu
creator: Abdul Basit Khan
creator: Hifza Jadoon
creator: Mezhgan Kiwan
rights: 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
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 368
ending page: 370

EFFECTIVENESS OF FRACTIONAL CARBONDIOXIDE LASER WITH TOPICAL METHOTREXATE VS TOPICAL PUVASOL IN TREATEMENT OF VITILIGO
type: item
description: 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 PUVAS…
creator: Samina
creator: Sakina Sadiq Malik
creator: Ahmed Naveed Malik
creator: Aayesha Rehman
creator: Sajjad Ahmed
creator: Ahsan Tameez-Ud-Din
rights: 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
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 371
ending page: 377

PREDICTORS AND OUTCOMES OF FAILED RECANALIZATION OF CHRONIC TOTAL OCCLUSIONS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE AT A TERTIARY CARE CARDIAC CENTER
type: item
description: Background: Chronic Total Occlusions (CTOs) are a challenging subset of coronary artery disease (CAD), often necessitating complex percutaneous coronary intervention (PCI). Despite advancements in tools and techniques, failure to recanalize CTOs remains a significant clinical concern, particularly in stable CAD patients. This study aimed to identify predictors and evaluate outcomes of failed CTO recanalization in a tertiary care cardiac center.Methods: A retrospective analysis was conducted on patients with stable CAD who underwent attempted CTO-PCI between January and July 2024. Clinical, angiographic, and procedural data were collected and analyzed. Primary outcome was CTO recanalization failure. Secondary outcomes included procedural complications, major adverse cardiac events (MACE), need for repeat revascularization, and mortality. Results: Among the studied cohort, key predictors of CTO-PCI failure included lesion length >20 mm (OR 3.2; 95% CI 2.2–4.6), severe calcification (OR 2.5; 95% CI 1.8–3.4), blunt stump morphology (OR 2.0; 95% CI 1.3–3.1), prior coronary artery bypass grafting (CABG) (OR 2.8; 95% CI 1.9–4.2), and proximal tortuosity (OR 1.7; 95% CI 1.2–2.7). Failed recanalization was associated with higher rates of perforation, MACE (66.7% vs. 13.3%), repeat revascularization, and mortality (8 vs. 4 cases) compared to successful recanalization. Conclusion: Specific anatomical and historical factors significantly predict CTO recanalization failure. These findings underscore the importance of comprehensive pre-procedural assessment and individualized procedural strategies. Failed CTO-PCI is associated with worse in-hospital and long-term outcomes, highlighting the need for continued refinement in techniques and patient selection to improve success rates and clinical prognosis
creator: Muhammad Fasih Ullah Khan
creator: Muhammad Hasnain Iqbal
creator: Naveed Yaqoob
creator: Fahad Khalid
creator: Muhammad Fareed Khan
creator: Wahab Anwar
rights: Copyright (c) 2025 Muhammad Fasih Ullah Khan, MuhammadHasnain Iqbal, Naveed Yaqoob, Fahad Khalid, Muhammad Fareed Khan, Wahab Anwar https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2025-06-20
publication date: 2025-06-20
volume: 37
number: 3
starting page: 378
ending page: 381
doi: 10.55519/JAMC-01-14375

A COCAINE INHALATION LEADING TO SPONTANEOUS PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA: A CASE REPORT AND REVIEW OF MECHANISMS
type: item
description: 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 c…
creator: Mehr Ali Khan
creator: Ayaz Muhammad
creator: Rabeea Komal
creator: Ijaz ul Haq
creator: Hafiz Hassan
creator: Yusaf Hakim Vapra
rights: 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
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 387
ending page: 390

HIGH-DOSE ORAL VITAMIN C WITH MINIMAL TOPICAL BETAMETHASONE IN THE MANAGEMENT OF MILD POMPHOLYX ECZEMA: A CASE REPORT
type: item
description: 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.
creator: Asif Ali
rights: Copyright (c) 2026 Asif Ali https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 391
ending page: 393

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
type: item
description: 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.
creator: Zomer Sardar
creator: Azhar Nasim
creator: Mohammad Faisal
creator: Mariam Danish Iqbal
rights: Copyright (c) 2026 Zomer Sardar, Azhar Nasim, Mohammad Faisal, Mariam Danish Iqbal https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 394
ending page: 397

SYSTEMIC LUPUS ERYTHEMATOSUS COMPLICATED WITH CASTLEMAN DISEASE : A CASE REPORT
type: item
description: 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.
creator: Ahsan Khurshid
creator: Anum Abbas
creator: Suhail Iqbal
creator: Raheel Khan
rights: Copyright (c) 2026 Ahsan Khurshid, Anum Abbas, Suhail Iqbal, Raheel Khan https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 398
ending page: 400

ABDOMINAL COCOON SYNDROME: A CASE REPORT
type: item
description: 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.
creator: Khizar Hayat Khanzada
creator: Mariya Rizwan Butt
creator: Komal Khalid
creator: Husnain Ahmad
rights: Copyright (c) 2026 Khizar Hayat Khanzada, Mariya Rizwan Butt, Komal Khalid, Husnain Ahmad https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 401
ending page: 403

RETROPERITONEAL LYMPH NODE DISSECTION: CASE SERIES AND CONTEMPORARY LITERATURE PERSPECTIVES
type: item
description: 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.
creator: Nadeem Bin Nusrat
creator: Assad ur Rehman
creator: Shujah Muhammad
creator: Nauman Zafar
creator: Asadullah Aslam
creator: Hassan Arshad
creator: Yasir Khan
creator: Sarmad Imtiaz
creator: Moin Arshad
creator: Aadil Chaudhary
creator: Saira Imtiaz
rights: 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
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 382
ending page: 386

MPOX IN PAKISTAN: A CALL FOR VIGILANCE AND GLOBAL HEALTH SOLIDARITY
type: item
description: 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.
creator: Babar Tasneem Shaikh
creator: Muhammad Ahmed Abdullah
creator: Muhammad Wasif Malik
creator: Muhammad Salman
rights: Copyright (c) 2026 Babar Tasneem Shaikh, Muhammad Ahmed Abdullah, Muhammad Wasif Malik, Muhammad Salman https://creativecommons.org/licenses/by-nd/4.0
license: https://creativecommons.org/licenses/by-nd/4.0
date: 2026-01-14
publication date: 2026-01-14
volume: 37
number: 3
starting page: 404
ending page: 406