Military Hospital

To evaluate the efficacy and safety of conservative (oxygen saturation [Sp o2 ] 88-94% or Pa o2 < 80 mm Hg) vs. liberal oxygen targets (Sp o2 ≥ 94% or Pa o2 ≥ 90 mm Hg) in mechanically ventilated critically ill adults. PubMed, Cochrane CENTRAL, Embase, and ClinicalTrials.gov . We conducted the OXY-BREATHES, a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing conservative vs. liberal oxygen targets in mechanically ventilated ICU patients. Primary outcomes were 90-day mortality and ICU length of stay. Secondary outcomes included ventilator- and vasopressor-free days, renal replacement therapy, nosocomial pneumonia, and cardiac or cerebral ischemic events. Subgroup analyses included patients with sepsis/septic shock and post-cardiac arrest. Data were collected according to study selection criteria. Certainty of evidence was appraised with Grading of Recommendations, Assessment, Development, and Evaluation, and risk of bias with the Cochrane tool. Data were analyzed using a random-effects model. Nine RCTs enrolling 20,447 patients were included. Conservative and liberal targets showed no substantial differences in 90-day (risk ratio [RR], 1.01; 95% CI, 0.94-1.09) or ICU length of stay (mean difference [MD], -0.17; 95% CI, -0.41 to 0.06). Secondary outcomes, including organ support-free days and the incidence of adverse events, were comparable between groups. In subgroup analyses, conservative targets yielded more vasopressor-free days in septic patients (MD, 2.0; p = 0.008) and a potential survival benefit in post-cardiac arrest patients (RR, 0.89; p = 0.05). Certainty of evidence was rated moderate for 90-day mortality, ICU length of stay, vasopressor-free days, and ventilator-free days; low for renal replacement therapy and nosocomial pneumonia; and very low for cerebral and cardiac ischemia due to imprecision and open-label trial designs. Conservative oxygenation is comparable to liberal oxygen targets in mechanically ventilated critically ill patients, with possible advantages in sepsis and post-cardiac arrest. Future condition-specific RCTs are warranted to define optimal ICU oxygen strategies.

Abstract Aims Free tissue transfer is a common plastic surgical procedure with a wide array of applications. There is limited consensus on how free flap ischaemia time impacts flap survival. This systematic review aims to evaluate the association between free flap ischaemia time and acute flap failure rate. Methods A systematic review and meta-analysis in compliance with PRISMA statement standards was conducted following registration on the PROSPERO Register (CRD420251052841). A search strategy was developed and the search conducted in September 2024. Studies eligible for inclusion reported length of ischaemia time for free flap surgery and acute flap failure rate. 78 articles were eligible for inclusion and were published between 1997 and 2024. Study populations ranged from 7 to 3926 patients, with a pooled total of 26 374 free flaps in 23 615 patients. The meta-analysis showed overall risk of flap failure was 3.5% (95% c.i. 3%–4.1%). Meta-regression using ischaemia time as a continuous variable showed an increasing risk of acute flap failure from 3% (2.3%–3.9%) at 30 min ischaemia time to 7.5% (4.4%–12.5%) at 240 min. The variables study type, flap type, indication and risk of bias did not account for between study heterogeneity which was substantial. Conclusions This study has systematically assessed existing literature to show a significant association between prolonged ischaemia time and acute free flap loss. This association can guide microsurgical training as carrying out microsurgery in a time efficient manner has a positive impact on free flap survival.

Abstract: Background: The dengue fever has remained a significant health in Pakistan due to its endemic outbreaks. NS1 glycoprotein is an important serological biomarker play an important role in disease progression. Its early identification can optimize the diagnostic testing and result interpretation in suspected dengue patients. Objective: To associate NS1 antigen positivity with day of illness in suspected dengue patients. Materials and Methods: This hospital based retrospective cross-sectional study was conducted from 1st June 2025 to 30th November 2025, at Pakistan Institute of Medical Sciences, Islamabad after obtaining ethical approval from the ethical review committee of PIMS under ERC# F-5-2/2024 (ERRC) PIMS, dated: 15-11-2025. A hospital record of total 364 suspected dengue patients was collected and analyzed. The association between NS1 antigen positivity and day of illness were evaluated by using Chi-square. Age was presented as mean ± S.D while frequency was observed for gender distribution. Result: Among 364 suspected dengue cases, 31.9% tested positive for NS1 antigen, with a higher prevalence in males (67.3%) and a mean age of 36.75 years. NS1 positivity was highest in patients presenting on days 5–7 of illness (33.7%) and reached 100% in those presenting on day 8 or later. Platelet counts showed no significant variation across different days of illness (p = 0.475). Conclusion: NS1 antigen testing is a valuable early diagnostic tool for dengue, and its accuracy may improve when combined with serological and hematological markers. Future longitudinal studies are needed to better understand NS1 dynamics throughout the illness. Keywords: Dengue, NS1 antigen, Serological markers, Disease progression, Epidemiology.

Heart failure with preserved ejection fraction (HFpEF) a major cause of morbidity may be under-diagnosed in primary care, particularly among elderly patients with non-specific complaints. This case describes a 70-year-old hypertensive and obese female patient referred for progressive exertional dyspnea during the previous six months. On presentation, her BNP level was 210 pg/mL, and transthoracic echocardiography demonstrated preserved left ventricular ejection fraction of 60% with diastolic dysfunction consistent with HFpEF. The use of an aggressive multidisciplinary approach to management including diet and lifestyle modification as well as pharmacologic therapy, altogether yielding significant symptomatic improvement and sustained reduction in cardiac biomarkers was noted at 1 year. Ultimately, the patient became asymptomatic with BNP improved significantly and echocardiographic status stabilized. This case demonstrates the need for a low threshold for suspicion of HFpEF in high risk patients and the role of early identification and structured follow up in primary care.

Background: Cortisol is a key hormone of the hypothalamic-pituitary-adrenal (HPA) axis and plays an essential role in the stress response. In physically active individuals, exercise-induced cortisol elevations are common; however, cortisol testing is often used in the evaluation of Overtraining Syndrome (OTS) despite uncertain diagnostic value and potential for misinterpretation in clinical practice. Material and methods: A structured literature search of PubMed and Google Scholar (1998–2025) was conducted using terms related to cortisol, exercise, overtraining, hypercortisolism and HPA-axis function. Human studies, systematic reviews, meta-analyses and major endocrine guidelines were included. Results: Cortisol responses to exercise are highly variable and influenced by training load, intensity, duration and individual factors. In athletes with suspected OTS, resting and dynamic cortisol measurements show inconsistent results with significant overlap compared to healthy athletes and non-athletic controls. Diagnostic accuracy is further limited by methodological heterogeneity, diurnal variation and biological variability. Numerous non-training factors, including sleep disturbance, psychological stress, illness, medications and endocrine disorders, can elevate cortisol to levels similar to exercise-related responses, increasing diagnostic uncertainty. Conclusions: Cortisol lacks sufficient specificity and sensitivity to serve as an independent diagnostic marker of OTS. Elevated cortisol in athletes should be interpreted within a comprehensive clinical context. Cortisol testing may provide supportive information but should not be used in isolation to diagnose overtraining or guide clinical or training-related decisions.

Background. Attention-deficit/hyperactivity disorder (ADHD) is a condition that affects how a person focuses, regulates behavior, and manages impulses. As a result, individuals with ADHD often experience difficulties in everyday life, including at school, at work, and in social relationships. It is characterized by persistent attention deficit, hyperactivity, and impulsivity. Aim. This literature review evaluates current treatments for ADHD, including both medication and non-medication options, and discusses their effectiveness. Materials and Methods. This review summarizes current evidence on medication and psychosocial treatments for attention-deficit/hyperactivity disorder (ADHD). The review included original studies and reviews from the Cochrane, PubMed, and Google Scholar databases. The article selection process ended in February 2026. Results. Medicines that stimulate the brain are the best treatment for ADHD for people of all ages. Non-stimulant medications show moderate effectiveness and may be particularly useful in patients with contraindications to stimulants or comorbid conditions. Pharmacotherapy tends to produce larger effect sizes in children than in adults, although it is effective in both populations. Conclusions. The current evidence shows that a multimodal approach is the best way to treat ADHD. Stimulants are still the best type of drug for this, but doctors need to plan treatments for each patient that take into account their mental and social well-being, any other health problems, their age, and how well they can handle the medication to ensure the best possible care.