Baqai Medical University

Anxiety is a common observation that warrants attention especially for patients scheduled for surgical tooth extraction. A quasi-experimental study was carried out that included sixty (60) patients, booked for surgical extraction at Baqai Dental College, Karachi, Pakistan. Baseline respiratory rate (RR), and blood pressure (BP) were recorded before the administration of the 7.5mg Midazolam (test group). The subjects waited for one hour before the commencement of the dental extraction. The BP and RR were checked again, and the level of anxiety was registered on the modified dental anxiety scale. A significant reduction in the systolic BP, diastolic BP, and RR were observed amongst the participants who were administered pre-procedure Midazolam (p-value <0.001). However, compared to controls, only diastolic BP (p=0.003) and RR (<0.001) reduced significantly in the test group with no notable change in the systolic BP (pvalue= 0.119).

Abstract Introduction: E. faecalis is a Gram-positive, facultative anaerobe from the phylum Bacillota. While part of the normal gastrointestinal flora, it can become opportunistic, causing urinary tract infections, endocarditis, and other conditions. It shows resistance to a wide range of antibiotics and tolerates extreme conditions, making it a significant nosocomial pathogen. Objectives: This study aimed to determine the effectiveness of commonly used antibiotics, identify emerging resistance trends, and analyze antimicrobial susceptibility patterns of Enterococcus faecalis isolates over an eight-year period at Fauji Foundation Hospital to inform treatment strategies and antibiotic stewardship. Material and Method: Samples were collected from multiple wards. Cysteine, Lactose, and Electrolyte Deficient (CLED) agar was used to culture specimens, incubated for 24 hours at 37°C. Antibiotic susceptibility testing was performed according to standard protocols, and results were analyzed using Microsoft Excel. Results: A total of 1916 isolates were assessed. Most were from urine cultures (1008), followed by pus and HVS cultures. Vancomycin showed 100% effectiveness, followed by linezolid (98.02%), fusidic acid (81.25%), and nitrofurantoin (79.23%). Ciprofloxacin and gentamicin showed concerning resistance. Ampicillin sensitivity was 61.17%, with resistance rising over time. Erythromycin (76.53%) and norfloxacin (95.45%) demonstrated high resistance, suggesting misuse. Augmentin showed moderate effectiveness. Conclusion: This 8-year study revealed a rise in antimicrobial resistance among E. faecalis isolates in a Pakistani tertiary care hospital. Vancomycin and linezolid remained effective, but increasing resistance to ciprofloxacin, gentamicin, erythromycin, and norfloxacin indicated misuse and shrinking options. Findings highlight the urgent need for antibiotic stewardship, regular surveillance, and tailored treatment guidelines to preserve last-resort antibiotics.

Background. Oral cancer is the eighth leading cause of cancer-related mortality worldwide, particularly prevalent in regions with high tobacco and betel nut consumption. The associated high mortality and morbidity rates could be reduced through early detection, prompting researchers to focus on identifying early markers of carcinogenesis. Methods. This systematic review evaluated the effectiveness of oxidative stress markers as diagnostic tools. An electronic search was conducted in PubMed and Google Scholar to identify case‒control studies published between January 2000 and June 2024 that explored the use of oxidative stress markers as diagnostic biomarkers. A manual search was also performed in relevant journals, including oral oncology and oral diseases. Initially, 38 studies were screened, and after applying the inclusion criteria, only nine studies were included. The Newcastle-Ottawa Scale (NOS) tool was used to assess the risk of bias. Results. Eight studies were conducted in India, while one was from Saudi Arabia. These studies analyzed oxidative stress markers in oral squamous cell carcinoma (OSCC), oral submucous fibrosis (OSMF), and leukoplakia. Control groups were matched based on age and sex, with only two studies also considering socioeconomic status. A significant difference (P<0.05) in oxidative stress marker levels was observed between cases and controls, particularly in patients with OSCC and OSMF.Conclusion. Oxidative stress markers show promise as diagnostic and prognostic indicators. Standardized methodologies and therapeutic approaches targeting oxidative stress could enhance early detection and treatment, especially in resource-limited settings. However, the findings must be interpreted with caution due to methodological limitations, geographic bias, and the lack of inclusion of grey literature.

Chronic use of proton pump inhibitors (PPIs), although effective for acid-related disorders, has raised concerns regarding their association with various long-term adverse health outcomes. This systematic review aimed to synthesize evidence from observational studies and meta-analyses evaluating the potential risks linked to prolonged PPI exposure, including cognitive decline, chronic kidney disease, bone fractures, and cardiovascular events. A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Embase, focusing on studies involving adult human populations and reporting adjusted risk estimates. Eight studies met the inclusion criteria, encompassing prospective cohorts, cross-sectional analyses, and systematic reviews. A narrative synthesis approach was adopted due to the heterogeneity of study designs and outcome measures. While findings across studies varied, several demonstrated statistically significant associations between long-term PPI use and increased risks of adverse outcomes, particularly in elderly or comorbid populations. However, many studies were limited by confounding, bias, and the inability to establish causality. The evidence underscores the need for cautious and judicious prescribing of PPIs, with periodic reassessment of the indication and consideration of deprescribing in low-risk patients. Further high-quality prospective studies and randomized trials are warranted to clarify these associations and guide clinical decision-making.

Background: The third trimester of pregnancy is associated with increased physiological and emotional stress, which often manifests as heightened anxiety and sleep disturbances. These conditions can adversely affect maternal health and fetal outcomes if left unaddressed. Objective: To assess the prevalence and severity of anxiety and sleep disturbances among women in their third trimester of pregnancy and explore associated sociodemographic and obstetric factors. Methods: A cross-sectional study was conducted over eight months at tertiary care hospitals and maternity clinics in Lahore, Pakistan. A total of 355 pregnant women in their third trimester were recruited through consecutive sampling. Data were collected using a structured questionnaire that included the Generalized Anxiety Disorder-7 (GAD-7) scale and the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics, t-tests, ANOVA, Pearson correlation, and multivariable linear regression were applied using SPSS version 26. Results: Moderate to severe anxiety was observed in 44.8% of participants, while 72.7% reported poor sleep quality. Significant associations were found between higher anxiety scores and unemployment (p = 0.003), lower education levels (p = 0.021), and primigravida status (p = 0.047). Poor sleep quality also correlated positively with anxiety levels (r = 0.41, p &lt; 0.001). Multivariable analysis confirmed employment status, education level, and parity as independent predictors of anxiety severity. Conclusion: Anxiety and sleep disturbances are highly prevalent in the third trimester of pregnancy and are influenced by key sociodemographic and obstetric factors. Early identification and targeted interventions are essential for improving maternal mental health and ensuring better pregnancy outcomes.

Statin therapy effectively reduces low-density lipoprotein (LDL) cholesterol, thereby lowering the risk of atherosclerosis and cardiovascular (CV) events. This systematic review and meta-analysis assessed its impact on all-cause mortality, CV mortality, major adverse cardiovascular events (MACE), such as heart attack, stroke, coronary revascularization, and CV hospitalization in adults with CV risk factors or established cardiovascular disease (CVD). A systematic search of PubMed, Google Scholar, and Cochrane Central (2013-2024) included randomized controlled trials, prospective cohorts, and retrospective studies. Primary outcomes were all-cause mortality, CV mortality, MACE, and CV hospitalization. A random-effects model was employed, with heterogeneity assessed using the I² statistic. Seven studies, comprising 506,813 patients (118,491 statin users and 388,322 non-users), with a mean follow-up of 3.7 years, were included. Statin therapy significantly reduced all-cause mortality (relative risk (RR) 0.60, 95% confidence interval (CI): 0.43-0.83, p<0.00001, I²=91%), and MACE (RR 0.75, 95% CI: 0.70-0.82, p<0.00001, I²=0%). The high heterogeneity observed in mortality outcomes likely reflects differences in study populations, statin types, and baseline risk profiles. A non-significant trend was observed toward CV mortality (RR 0.74, 95% CI: 0.53-1.02, p<0.00001, I²=90%). Additionally, no significant reduction in CV hospitalizations was observed (RR 0.97, 95% CI: 0.83-1.13, p=0.58, I²=0%). Statin therapy significantly lowers all-cause mortality and MACE, reinforcing its role in CV risk management. However, its effect on CV mortality and CV hospitalization remains uncertain, warranting further investigation into complementary strategies for reducing hospital admissions.

Cornus macrophylla has been traditionally recognized for its medicinal properties, particularly in managing inflammatory conditions. However, a scientific understanding of its bioactive constituents and mechanisms remains underexplored. This study aimed to isolate and characterize bioactive compounds from the bark of C. macrophylla and evaluate their anti-inflammatory potential through in silico and in vitro analyses. A total of ten compounds, including an ellagic acid derivative and nine steroids and triterpenes, were isolated. Comprehensive analyses integrating molecular docking, ADMET profiling, and density functional theory (DFT) calculations were conducted to elucidate the molecular and anti-inflammatory properties. Experimental validation was performed to confirm the findings. 1,2,3-trimethoxychromeno[5,4,3-cde][1,3]dioxolo[4,5-h]chromene-5,11-dione (1) emerged as the most active compound among those tested, demonstrating moderate inhibition of lipoxygenase (LOX), exhibiting an IC50 value of 78.1 ± 0.03µM. It also exhibited measurable suppression of respiratory burst activity in human neutrophils, achieving an IC50 of 298.21 ± 0.037µM, comparable to the benchmark anti-inflammatory agent, Indomethacin (IC50: 271.14 ± 0.032µM). Molecular docking studies revealed that compound 1, strongly interacts with 15-LOX, demonstrating a binding affinity of -7.038kcal/mol and forming stable interactions with key active site residues. ADMET profiling and DFT analysis indicated its favourable drug-like properties, reinforcing its potential as a therapeutic candidate. The findings highlight compound (1) as a potent natural inhibitor of LOX, with significant anti-inflammatory activity validated through both experimental and computational approaches. Its efficacy and drug-likeness underscore its therapeutic potential for developing novel anti-inflammatory agents. Further studies are warranted to explore its clinical applicability.

Pharmacogenomics has transformed the way we approach the treatment of the most common diseases worldwide, especially cardiovascular. In this article, we highlight the main categories of drugs involved in major cardiovascular diseases (CVD), related genetic variability and their effects on metabolism in each case of contrastive operability. This not only explains disparities in treatment outcomes but also unfolds customised management based on genomic studies to improve efficiency and limit side effects. Genetic variations have been identified that impact the efficacy, safety, and adverse effects of drugs commonly used in the treatment of CVD, such as Angiotensin converting Enzyme Inhibitor (ACEI), Angiotensin Receptor Blocker (ARBs), calcium channel blockers, antiplatelet agents, diuretics, statins, beta-blockers, and anticoagulants. It discusses the impact of genetic polymorphisms on drug metabolism, efficacy, and adverse reactions, highlighting the importance of genetic testing in optimizing treatment outcomes. Pharmacogenomics holds immense potential for revolutionizing the management of CVD by enabling personalized medicine approaches tailored to individual genetic profiles. However, challenges such as clinical implementation, cost-effectiveness, and ethical considerations need to be addressed to completely incorporate pharmacogenomic testing into standard clinical practice. Continued research and clinical diligence are required for the utilization of pharmacogenomics to improve therapeutic outcomes and reduce the burden of CVD globally.