Annals of Punjab Medical College

Association of Sociodemographic Factors with Oral Health Literacy in Patients Presenting to Dental Teaching Hospital

2025-07-11T08:25:47+00:00

Background: Oral health literacy is associated with improved oral health outcomes and can aid in formulation of health education materials catered to population's comprehension level. Objective: The study aims to evaluate oral health literacy among dental patients and its association with sociodemographic factors. Study Design: Cross-sectional study. Settings: Dental teaching hospital of University of Lahore, Lahore Pakistan. Duration: June to September 2019. Methods: The study employing an Urdu-translated HeLD-14 questionnaire to assess oral health literacy. Data was collected from patients presenting to the outpatient department of a dental teaching hospital in Lahore. The questionnaire measured seven domains of oral health literacy on a five-point Likert scale along with demographic variables. The association of demographic variables with items of the domain was assessed through Chi-squared and Kruskal-Wallis statistical tests. Results: 250 patients had a mean HeLD score of 41.24 ± 12.36. About 52.8% of participants could read dental information without effort. Only 34.8% could ask for support with a dental appointment and 34.6% could look for a second opinion without difficulty. Approximately 39.6% could pay for a dental visit and 37.9% could attend to their dental health needs without difficulty. Significant associations for age, gender, education, and occupation were obtained for different items in domains of access, understanding, utilization, communication, and economic barriers. Conclusion: Participants reported moderate oral health literacy. Notably, females showed better comprehension of dental information and higher education was associated with better utilization of dental services and decision-making capabilities. These findings highlight the need for tailored oral health literacy interventions to enhance oral health related quality of life.

Neurosurgical Approaches and Visual Outcomes in Pituitary Adenoma Surgery

2025-07-11T08:59:16+00:00

Objective: To evaluate the visual outcomes of patients undergoing pituitary adenoma surgery using transsphenoidal and transcranial approaches at Hayatabad Medical Complex, Peshawar. The study focused on identifying factors influencing visual recovery and comparing the effectiveness of both surgical methods. Study Design: retrospective study. Settings: Department of Neurosurgery, Hayatabad Medical Complex, Peshawar Pakistan. Duration: from January 2023 to December 2023. Methods: 100 patients divided into two groups: transsphenoidal (n = 50) and transcranial (n = 50). Patient demographics, tumour characteristics, and visual outcomes were analysed. Statistical analysis included chi-square tests, independent t-tests, and logistic regression, with a significance level of p<0.05. Results: The mean age of patients was 45.2 ± 13.4 years (transsphenoidal) and 47.6 ± 14.3 years (transcranial) (p = 0.421). Preoperative visual acuity was 20/200 ± 70 in the transsphenoidal group and 20/180 ± 65 in the transcranial group (p=0.325). Postoperatively, visual acuity improved to 20/50 ± 30 (transsphenoidal) and 20/100 ± 55 (transcranial) (p=0.005). Optic chiasm involvement was significantly higher in the transcranial group (80% vs. 10%, p<0.001). Logistic regression analysis identified the surgical approach as a significant predictor of visual improvement (OR: 2.13, 95% CI: 1.10-4.12, p = 0.028). Conclusion: Transsphenoidal surgery resulted in better visual outcomes than transcranial surgery. Tumour size and optic chiasm involvement significantly influenced recovery. Future research should focus on long-term outcomes and the development of patient selection criteria.

Epidemiological Analysis of Uterine and Ovarian Pathologies: A Cross-sectional Study

2025-07-11T11:32:04+00:00

Background: With disorders like endometritis affecting up to 11% of women of reproductive age and leading to infertility, women's uterine and ovarian health concerns have a substantial influence on reproductive health. Objective: To ascertain the frequency of ovarian and uterine infections and pathologies across different districts of Khyber Pakhtunkhwa, with an emphasis on finding trends in the conditions' distribution. Study Design: A retrospective cross-sectional study. Settings: Hayatabad Medical Complex, Peshawar Pakistan. Duration: September 2023 to September 2024. Methods: 389 female patients who presented with gynecological complaints were enrolled in the study. Age, district, and diagnostic results were obtained from medical records. With a significance level of p<0.05, statistical analysis, including chi-square tests, was performed using SPSS version 22. Results: The study examined 389 individuals and found that with majority of participants (n=256, 65.8%) were in the 36–50 age group. With n=306 (78.7%) participants from Peshawar. According to statistical analysis, there was no significant geographic variation by age p=0.924. According to diagnostic results, 25.4% of patients had benign diseases upon presentation, and 71.5% of patients had no substantial pathology. Moreover, n=2 (0.5%) of the patients were diagnosed with endometrioid carcinoma (Grade 1), signifying a minor yet clinically important incidence of cancer within this cohort. Conclusion: The study highlights the need for decentralized gynecological services to alleviate healthcare strain in Peshawar and improve access in rural areas.

Successful Induction of Labour at 40+ and 41+ Weeks in Primigravida Women

2025-07-11T11:43:25+00:00

Background: Induction initiates labour before it starts naturally, often used between 40–41 weeks in complicated pregnancies to reduce risks. Objective: The aim of the study to find the frequency of successful induction of labour at 40+ and 41+ weeks in primigravida and to compare the frequency of successful induction at these gestational ages. Study Design: descriptive cross-sectional study. Settings: Obstetrics & Gynecology Department of MTI-LRH, Peshawar Pakistan. Duration: July 2022 to January 2023. Methods: 120 primigravida women who were 40+ and 41+ weeks along in their gestation were included in the study. The data was analysed using SPSS version 16. Results: In this study, the primigravida women who were at 40+ and 41+ weeks were measured for the results of induction of labour. 40 weeks (SD ±1.0) was the average gestational age, while the average mother age was 33.5 years (SD ±4.5). 18.33 percent had caesarean section births, while vaginal birth accounted for 81.66 percent; of the deliveries within 48 hours of attempted induction, the rate was a 66.66 percent; the outcomes among those induced were better at 40+ compared to 41+. Conclusion: Inducing labour at 40+ and 41+ weeks is a safe and effective way to reduce caesarean sections and improve newborn outcomes. The prevalence of vaginal deliveries was higher at 40+ weeks than at 41+ weeks, highlighting the need of good patient selection and close monitoring during labour induction.

Does Obesity Negatively Impact Semen Quality? A Cross-Sectional study in population of Rahim Yar Khan

2025-07-11T12:18:53+00:00

Background: The prevalence of obesity has been much increased over last few years among males of reproductive age which is consistent with increase in male infertility. Obesity has been found to have detrimental effects on sperm parameters by affecting the sperm DNA. Objective: To determine the correlation of high BMI (Body mass index) kg/m²with semen parameters among infertile males. Study Design: Observational cross-sectional. Setting: Urology department, Sheikh Zayed Hospital, Rahim Yar khan. Duration: From February 2022 to January 2024. Methods: Study conducted after ethical clearance from institutional review board. Males aged between 20 to 45 years visiting outdoor clinic for workup of infertility with BMI ≥25kg/m² were included. Males with BMI <25kg/m², seropositive for HIV, with history of chronic medical conditions like uncontrolled hypertension or diabetes, on medications like steroids or immunosuppressants that may affect spermatogenesis or cause erectile dysfunction, having history of genital infections, previously undergone groin or scrotal surgery, or had refused to give consent were all excluded. Semen reference limits has been used provided by WHO. Data entered and analyzed using SPSS version 25. P value<0.05 deemed as significant. Results: Of the total 147 study subjects, mean age was 31.25±8.234years. Statistically significant (P value: 0.004) negative correlation(r=-0.801) of sperm concentration (millions/ml) has been found with respect to BMI (kg/m²). Low sperm concentration <15millions/ml has been found in 31(21.08%) study subjects with BMI ≤30 kg/m²and in 61(41.49%) study subjects with BMI >30kg/m². While 42(28.57%) were having sperm concentration >15millions/ml in subgroup BMI ≤30kg/m2 and 13(8.84%) subjects with high BMI >30kg/m2 were having sperm concentration >15millions/ml. Conclusion: On the basis of our study, it has been concluded that high BMI negatively correlate with sperm concentration. No correlation has been found between high BMI and other semen parameters such as total sperm number, morphology, motility and vitality.

Relationship of Serum Hepcidin, Ferritin and Iron in Chronic Hepatitis C Patients of District Hyderabad.

2025-07-06T22:05:34+00:00

Introduction: Hepatitis C Virus (HCV) is the 2nd largest infection in Pakistan. Roughly 20% of individuals with hepetitis C virus eventually develop liver scarring and cancer. The primary cause of the advancement of the disease is iron overload, with subsequent decreased levels of hepcidin. Objectives: The study aimed to determine the correlation of hepcidin, and ferritin levels with disease progression in chronic hepatitis C (CHC) patients. Methodology: A cross-sectional study was carried out in the Physiology department of L UM H S, in collaboration with clinical wards (Medicine ward, medicine outpatient department, gastroenterology ward, gastroenterology outpatient department) and D-R Lab, LUMHS. The study was conducted from 22^nd February 2022 to 22^nd September 2022. Diagnosed male and female patients aged between 20-45 years visiting the medicine and gastro outpatient department or admitted to the medicine and gastro ward at LUMHS Jamshoro were included in this study. A Self-structured questionnaire was used to collect data and blood samples were drawn from participants for serum hepcidin, and ferritin. SPSS 23.0. Results: The study involved 116 volunteer participants. Of these, 48 (41.3%) were male, and 68 (58.6%) were female, the mean age of the participants was 47.7 years. The serum hepcidin was negatively and non-significantly related to ferritin levels, at an R-value of 0.069 and a P-value of 0.459, and substantially negatively correlated at iron (R-value= 0.497) and (P value= < 0.0001). Conclusion: This study concludes that for the participants with hepatitis, low hepcidin levels are often observed as a result of excessive iron in the body. Our research suggested hepcidin as a predictive marker for monitoring iron load in patients of CHC, iron overload in CHC is the core reason for disease progression to cirrhosis. Hepcidin transcription is down-regulated by HCV-induced reactive oxygen species, increasing duodenum iron intake and macrophage release.

Comparison Of Outcome in Single Incision Laparoscopic Cholecystectomy and Conventional Laparoscopic Cholecystectomy in Tertiary Care Hospital, Faisalabad, Pakistan

2025-07-06T22:06:12+00:00

Objectives: The study aimed to compare the outcomes of Single-Incision Laparoscopic Cholecystectomy (SILC) and Conventional Multi-Port Laparoscopic Cholecystectomy (CLC) Study Settings: This quasi-experimental study was conducted at Allied hospital/FMU Faisalabad, recruiting patients undergoing elective laparoscopic cholecystectomy. Duration of Study: February 01, 2025 to May 30, 2025. Data Collection: A total of 74 patients were divided into two groups: 37 undergoing SILC and 37 undergoing CLC. Postoperative pain was assessed using the Visual Analog Scale (VAS) at different time points, wound infection was categorized according to CDC criteria, return to work was recorded in days, and cosmetic outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS). Results: SILC patients experienced significantly lower pain scores at 6, 24, 48 hours, and 7 days postoperatively (p<0.001). The incidence of superficial SSIs was lower in the SILC group (2.7%) compared to the CLC group (29.7%), (p=0.012). SILC patients returned to work significantly earlier (62.1% within 4-7 days, p<0.001), and a higher percentage rated their cosmetic outcome as excellent (43.2% vs. 18.9% in CLC, p=0.005). Conclusion: SILC provides superior postoperative pain relief, lower SSI rates, faster return to work, and better cosmetic outcomes compared to CLC. However, challenges such as increased operative time and a steeper learning curve remain.

Hematological Findings in Epilepsy: Associations with Seizure Type

2025-07-06T22:06:51+00:00

Background: Evidently relating systemic inflammation and blood disorders to inflammatory pathogenesis, epilepsy occurs as a chronic neurological disorder. This study aimed to evaluate the comparative relationship of complete blood count (CBC) with epilepsy in epileptic patients and healthy control.

Methods: A retrospective case-control study was performed in Peshawar, Pakistan on 284 patients with epilepsy and 100 control subjects. The CBC including white blood cells (WBC), red blood cells (RBC), hemoglobin concentration (HGB), platelets (PLT) and different leukocyte fractions were performed. The independent t-tests and multivariate logistic regression models at *p* <0.05 significance level was performed.

Results: Patients with epilepsy showed markedly elevated WBC counts (12.34 ± 5.45 vs. 8.26 ± 2.05 ×10³/µL, *p* < 0.001) and had lower RBC counts (4.37 ± 0.77 vs. 4.75 ± 0.62 ×10⁶/µL, *p* < 0.001) alongside HGB levels of 11.19 ± 2.13 g/dL (*p* < 0.001) which is significantly lower than the control group’s 13.25 ± 1.94 g/dL. Cytometry revealed a statistically significant elevation in PLT count (350.99 ± 175.96 vs 289.73 ± 77.93 ×10³/µL, *p* = 0.001). The most common seizure type observed was generalized tonic-clonic seizures (76.76%), with considerable hematologic findings suggestive of inflammation and anemia.

Conclusion: The research underscores specific CBC anomalies in epilepsy which confirm inflammatory and hematological pathways relevant to the disease’s mechanisms. These results are consistent with previous studies, but also incorporate new findings which indicate more research is needed for the investigation of CBC-based biomarkers for epilepsy treatment.

Student-Centered Assessment: The Impact of Learner Involvement on Educational Outcomes

2025-07-06T22:08:10+00:00

Objectives:

To devise a method of learning that enhances deep learning by retaining knowledge, encouraging team building, increasing accountability of what students learn, and acquiring skills to assess their peers.

Methods:

50 final-year MD students were involved in the study, conducted over four months between October 2019 and January 2020. They were divided into three groups A, B, and C, and were given the autonomy to be innovative in constructing MCQs and OSCEs based on subject relevance and coming up with answers based on their extensive research. Their perception of the learning tool was assessed using a feedback questionnaire.

Results:

Results of the feedback demonstrated a positive outlook towards a student-centred curriculum. 76% of students felt empowered by their assessment and learning. Around 60% of students considered it to be an effective tool for adult learning as it made them more inquisitive and enhanced their problem-solving skills. The major barrier to this study was time constraints.

Conclusions:

A shift to student-centred learning may be the future of medical education.

HPLC in Characterization of Hemoglobin Profile in Thalassemia Syndrome and Hemoglobinopathies: An Experience in Pediatric Tertiary Care Hospital

2025-07-07T06:52:33+00:00

ABSTRACT

Background: Hemoglobinopathies constitute an increasing global health burden as they are the most common genetic disorders across the globe. Identification of these disorders are important for epidemiologic purpose and for prevention of Thalassemias and clinically severe hemoglobinopathies. Objective: To characterize the hemoglobin profiles of patients with thalassemia and hemoglobinopathy using cation exchange HPLC. Study Design: Cross-sectional study. Place and Duration of study: Department of Hematology and Transfusion Medicine, University of Child Health Sciences and Children’s Hospital, Lahore from August 2024 to November 2024. Material and Methods: Samples were analyzed on the BIO-RAD VARIANT II for the HPLC and CBC were performed on automated cell counter BECKMAN COULTER(US). Statistical Analysis: Data was analyzed with chi-Square test with IBM SPSS Statistics 23 software. Continuous variables were expressed as mean ±SD and Categorical variables as frequencies and percentages. Result: A total of 105 individuals were studied, normal cases were 62 showing normal hemoglobin profile and the most common diagnosis obtained on chromatograph by HPLC was thalassemia trait (21.9%) followed by beta-thalassemia major (10.5%) having abnormal hemoglobin profile. However, only one case of Hb-S trait, Hb-D trait, Hb D disease and Hetero Hb-E were found. Mean RDW-CV is raised in all Thalassemias. Conclusion: This study confirms the diagnostic utility of cation exchange HPLC as a reliable and sensitive tool for identifying thalassemia and hemoglobinopathies in pediatric populations and underscore the importance of HPLC in distinguishing these conditions through distinct hemoglobin fraction patterns.

Evaluation of Maxillary Molar Root Canal Morphology in a Tertiary Care Setting in Lahore, Pakistan

2025-07-06T22:10:22+00:00

Background:

Successful endodontic procedures depend on a detailed understanding of tooth anatomy and meticulous canal preparation, cleaning, and filling. Despite generally high success rates for root canal treatment (RCT), failures can occur due to missed canals and complex canal morphology.

Objective: This study aimed to evaluate the root and canal morphology of maxillary molars in a Pakistani population using cone beam computed tomography (CBCT).

Study Design: Retrospective cross-sectional study

Settings: Rashid Latif Dental College/ Rashid Latif Medical Complex

Duration: Six months from June 2022 to January 2023

Materials and Methods:

This study included 206 CBCT images of maxillary molars from 55 patients. The images were analyzed for root number, canal number, and configurations.

Results:

Maxillary first molars typically had three roots and four canals (66.7%), while second molars had three roots and three canals (72.5%). Maxillary third molars exhibited variable root forms. Type I and IV configurations were common in the mesiobuccal (MB) roots of second and first molars, respectively. Palatal roots mostly showed Type I configuration, though the first molars displayed more variation. The incidence of C-shaped canals was low (1.8%). These findings are consistent with previous studies from various populations, confirming the prevalence of three roots in maxillary molars.

Conclusion:

CBCT imaging's detailed analysis of root canal morphology can improve RCT outcomes by providing a comprehensive understanding of complex anatomy, particularly in cases with variations like C-shaped canals in Pakistani population.

Visual Outcomes Following Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenoma

2025-07-06T22:11:33+00:00

Abstract

Objective: To evaluate the visual outcomes following EETS for pituitary adenomas, focusing on factors influencing postoperative visual recovery and identifying predictors of visual improvement.

Methodology: A retrospective study was conducted, involving 100 patients who underwent EETS at Hayatabad Medical Complex, Peshawar. Data were collected on patient demographics, tumour size, adenoma type, preoperative visual impairment, surgical outcomes, and postoperative complications. Chi-square tests were used to analyse the association between tumour size and visual outcomes, with a significance threshold set at p-value < 0.05.

Results: Out of 100 patients, 58% were male, and 42% were female, with a mean age of 45.2 years. Tumour size distribution showed 30% micro adenomas and 70% macro adenomas. Post-surgery, 60% of patients experienced visual improvement, while 30% maintained their preoperative visual status, and 10% worsened. The p-value for the association between tumour size and visual outcome was 0.01, indicating significant correlation. Complications were low, with 10% transient diabetes insipidus and 5% CSF leaks.

Conclusion: The study concludes that EETS is an effective surgical approach for improving visual outcomes, particularly in patients with macro adenomas and non-functioning adenomas. Early surgical intervention significantly contributes to visual recovery, highlighting EETS as a safe and minimally invasive procedure for managing pituitary adenomas.

Efficacy of Topical Intranasal Steroid Spray in Improving Post-Covid Anosmia at a Tertiary Care Hospital

2025-07-06T22:12:08+00:00

Objective EFFICACY OF TOPICAL INTRANASAL STEROID SPRAY Fluticasone furoate nasal spray in improving anosmia in patients recovered from COVID-19 infection. Material and Methods; These patients were divided in two groups; Group A and group B having 91 patients each based upon lottery method. Group A having 91 post COVID anosmia were given topical corticosteroid nasal spray Fluticasone furoate in appropriate dose of 2 puff in each nostril (100 μg once daily) besides olfactory training while group B also having 91 patients did not receive topical corticosteroid nasal spray but only olfactory training. As regards the assessment of smell, all these patients were assessed for their smell sensation employing known materials such as jar of coffee, a branch of mint and garlic having specific odor were used. The patient reported the degree of anosmia on visual analogue scale (VAS) marked 0 – 10 after 1 week, 2 weeks and 3 weeks. Data was analyzed using SPSS version 25 for descriptive and comparative statistics. Results; A total of 182 patients meeting inclusion criteria of our study were recruited, of which 87 (47.8%) were male and 95 (52.2 %) were females (in group A male patients were 48.4 % versus 47.3 % in group B, P = 0.882). Mean age of these patients was 39.23 ± 10.07 years (range; 23 – 63 years), Mean age in group A was 40.00 ± 9.96 years versus 38.45 ± 10.17 years (P = 0.301) and 152 (83.5%) were aged up to 50 years. Of these 182 study cases, 102 (56.0 %) were from urban areas and 130 (71.4%) were from middle income families. History of diabetes was noted in 53 (29.1%), hypertension in 67 (36.8%) and mean body mass index was 25.21 ± 1.18 and 25 (13.7%) were obese. Efficacy was noted to be 103 (56.6%), in group A efficacy was 62.6% versus 50.5% in group B (P = 0.101). Conclusion; Although use of corticosteroids showed little higher efficacy; however our study results do not support use of corticosteroid nasal spray in post COVID anosmia patients as efficacy was not significantly higher as compared with control group. Owing to the inconsistency in available literature, it is suggested that further large scale studies from different population subsets be conducted to create data based evidence on this topic.

Fetomaternal Outcome in Patients with Placenta Previa: One-Year Review at Allied Hospital, Faisalabad

2025-07-10T08:04:59+00:00

Objectives: To determine the frequency of maternal and fetal outcomes in women with placenta previa. Study Design: Descriptive study. Settings: Department of Gynecology, Allied Hospital, Faisalabad, Pakistan. Duration: from 1^st February 2023 to 31^st January 2024. Methods: All women booked or unbooked presented to Allied Hospital with placenta previa were included. Patients who were managed outside the hospital and later referred to Allied Hospital for monitoring or ICU care were excluded. Results: A total of 412 women presented with placenta previa. Elective surgery was done in 216 cases and emergency surgery in 196. Peripartum hysterectomy was done in 59 (27.31%) cases in elective C-section and 43 (21.91%) in emergency C-section. Uterine compression sutures were applied in 20 (9.25%) elective C-sections and 13(6.63%) in emergency C-sections. Maternal mortality tool placed in 2 (0.48%) cases. 16 (7.40%) babies were admitted to NICU in elective surgery and 41 (20.92%) in emergency surgery. Neonatal mortality was 10 (4.63%) in elective surgery and 31 (15.81%) in emergency surgery. Conclusion: Placenta previa is associated with increased maternal and perinatal morbidity. However, regular antenatal care, proper counselling of the patient, arrangement of blood, and a multidisciplinary approach can reduce both maternal and fetal morbidity and mortality.

Is High White Blood Cell Count an Adverse Drug Reaction of PD-1 Or Paraneoplastic Syndrome? A Case of Adenocarcinoma of the Lung

2025-07-06T22:12:46+00:00

Paraneoplastic syndromes are tumour-associated indirectly related clinical disorders. Here, we present a 58-year-old woman with impaired glucose tolerance and a gradual increase in white blood cell count. In May 2019, the patient was diagnosed with adenocarcinoma of the lung and engaged in a series of chemotherapy followed by PD-1 therapy at last. About a month following her last PD-1 cycle, she indicated some clinical disorders. Haematological studies on and after admission revealed a white blood cell count that progressively increased up to 84.69×109/L. CT scan of the abdomen unveiled the presence of a cyst and a tumour connected. Repeated blood cultures, as well as bacterial genetic testing of the cyst drainage were all negative. Bone marrow biopsy exhibited a normal pathological appearance, and bone marrow liquid examination by flow cytometry was regular. Diagnosis of an adverse drug reaction of PD-1 therapy or a paraneoplastic syndrome was accepted. Following the patient's tumour progress, the patient was treated with a combination of Albumin paclitaxel and Endostar chemotherapy. After the treatment, a progressive restoration of the patient's condition, blood cell counts, and vital signs were observed. Three days after the treatment, the patient's platelet count significantly dropped, and she was given rhIL-11, which restored this number by day 8. The white blood cell count dropped on day 3 post-chemotherapy as well, but without any treatment, re-increased to 10.89×109/L on day 6 and more by day 7: 39.8×109/L, and up to 44.3×109/L by day 8.