National University of Medical Sciences

Background: Low-grade squamous intraepithelial lesions (LSIL) are commonly associated with persistent human papillomavirus infection and are frequently managed through conservative surveillance due to their potential for spontaneous regression. Emerging evidence suggests that disruption of the cervicovaginal microbiome, particularly depletion of Lactobacillus species, may contribute to lesion persistence. Microbiome-modulating therapies have therefore gained attention as low-risk adjuncts in cervical disease prevention. Objective: To determine whether topical cervical application of Lactobacillus probiotics increases regression rates of LSIL to normal cytology. Methods: A randomized controlled trial was conducted over 12 months in tertiary care gynecology clinics in the Lahore region of Pakistan. Women aged 21–45 years with cytologically confirmed LSIL were randomized to receive either topical cervical Lactobacillus probiotic therapy alongside standard surveillance or standard care alone. Cervical cytology was assessed at baseline, six months, and twelve months. The primary outcome was regression to normal cytology at 12 months. Data were analyzed using parametric statistical tests, with significance set at p < 0.05. Results: At 12 months, regression to normal cytology was observed in 71.9% of women in the probiotic group compared with 50.5% in the control group, representing a statistically significant difference. Persistence of LSIL was lower in the intervention group, while progression to higher-grade lesions was infrequent in both groups. Probiotic therapy was well tolerated, with no serious adverse events reported. Conclusion: Topical cervical Lactobacillus probiotic therapy significantly enhanced LSIL regression and reduced lesion persistence without added safety concerns. These findings support microbiome modulation as a practical and non-invasive adjunct to conservative LSIL management and cervical cancer prevention strategies. Keywords: Cervical Intraepithelial Neoplasia; Lactobacillus; Papillomavirus Infections; Probiotics; Randomized Controlled Trial; Uterine Cervical Dysplasia; Vaginal Microbiome

Background: Benign urological lesions in adults are frequently encountered in clinical practice and include renal angiomyolipoma, benign renal masses, and selected symptomatic benign proliferative conditions managed within urology. Although these lesions are non-malignant, they may still cause hemorrhage, pain, obstructive symptoms, diagnostic uncertainty, and treatment-related loss of organ function. Contemporary management has shifted toward more selective intervention and greater emphasis on nephron preservation, but the evidence remains fragmented across lesion types and treatment pathways. Objective: To systematically evaluate current diagnostic approaches and management strategies for benign urological lesions in adults, with emphasis on diagnostic utility, symptom outcomes, complications, lesion progression, recurrence, and preservation of organ function. Methods: A systematic review with qualitative synthesis was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, Cochrane CENTRAL, and Web of Science were searched for studies published between January 2014 and March 2024. Eligible studies included adults with radiologically characterized or histologically confirmed benign urological lesions and reported diagnostic or management outcomes. Two reviewers independently screened studies, extracted data, and assessed methodological quality using RoB 2 for randomized trials and the Newcastle-Ottawa Scale for observational studies. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively. Results: Eight studies involving 1,427 adults were included. Five studies evaluated renal angiomyolipoma, two examined benign small renal masses, and one assessed symptomatic benign prostatic proliferative disease. Active surveillance was safe for most small asymptomatic angiomyolipomas, with 94% showing no clinically meaningful growth over 36 months in one prospective cohort and 60% of tuberous sclerosis complex-associated cases remaining intervention-free over 5 years. For larger or symptomatic angiomyolipomas, selective arterial embolization preserved renal function better than partial nephrectomy, with a smaller decline in estimated glomerular filtration rate at 12 months (-3.2 vs -11.5 mL/min/1.73 m²; p<0.01), although post-embolization syndrome was more frequent. Percutaneous biopsy for indeterminate small renal masses showed 88% sensitivity, 100% specificity, and a 15% non-diagnostic rate. Conclusion: Current evidence supports surveillance for selected small asymptomatic renal angiomyolipomas and selective arterial embolization as an effective kidney-preserving option for larger or symptomatic lesions. However, the evidence base is predominantly observational and heavily renal-focused, underscoring the need for higher-quality prospective comparative studies across the broader spectrum of benign urological lesions.

Objective: To determine the relationship between elevated blood uric acid levels and short-term in-hospital mortality in myocardial infarction with ST-elevation. Study Design: Quasi-experimental. Place and Duration of Study: Combined Military Hospital (CMH), Hyderabad, Pakistan from Aug to Dec 2023. Methodology: A total of 378 (189 in each group) patients were enrolled, and serum uric acid sample was sent for analysis, patients were monitored for seven days after admission. Patients were split into two groups based on their serum uric acid levels: Group A (exposed) and Group B (non-exposed), identical treatment was given to both groups. Baseline investigations were carried out on admission including ECG, blood complete picture, coagulation profile, cardiac enzymes, lipid profile, chest X-ray, renal and liver function tests and troponins. Results: Group A (high serum uric acid, 10%) had a greater mortality rate than Group B (low serum uric acid, 3%) and significant categories with higher death rates were patients with history of smoking (75.0%, p = 0.029), hypertension (77.8%, p = 0.010), BMI ≤ 25 kg/m² (78.6%, p = 0.033), and men (76.5%, p = 0.026). Results point to serum uric acid as a prognostic biomarker, highlighting its function in risk assessment for treatment of ST-Segment Elevation Myocardial Infarction (STEMI). Conclusions: Elevated serum uric acid level was noted to be linked to a higher in-hospital death rate among patients with ST elevation myocardial infarction.

Objective: To study the effect of Testosterone replacement therapy in improving the level of anemia and quality of life in males undergoing hemodialysis due to chronic renal failure (CRF). Study Design: Randomized controlled trial (ANZCTR Trial ID ACTRN12624001137583). Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi, Pakistan from Jan 2024 to Jun 2024. Methodology: 160 patients were randomized into two groups, one to receive Testosterone supplementation therapy (Group A) (n=80) and one to receive placebo (Group B) (n=80). Primary variables studied were improvement in Aging Males Symptoms (AMS) scores and Hb levels. Secondary variables were changes in Testosterone levels (free and total serum levels). Results: 160 patients were randomized into two groups, one to receive Testosterone supplementation therapy (Group A) (n=80) and one to receive placebo (Group B) (n=80). Mean hemoglobin levels between both groups were 8.38±1.12 versus 8.34±1.12 g/dl before therapy (p=0.834), 8.13±1.12 versus 8.10±1.16 g/dl at 3 months of therapy (p=0.891) and 8.10±1.10 versus 8.09±1.17 g/dl at 6 months of therapy (p=0.945). Median (IQR) values for total AMS scores between both groups were 36.00 (3.00) versus 36.00 (2.00) before therapy (p=0.954), 34.00 (2.00) versus 36.00 (4.00) at 3 months of therapy (p<0.001) and 31.00 (3.00) versus 36.00 (4.00) at 6 months of therapy (p<0.001). Conclusion: We conclude that phycological and somato-vegetative variables in patients were considerably improved with no improvement in sexual dysfunction and levels of hemoglobin in these patients.

Objective: To assess efficacy and safety of Duloxetine for pain in adult patients diagnosed with fibromyalgia in our tertiary care hospital. Study Design: Quasi-experimental study. Place and Duration of Study: Medicine and Rheumatology Department, Pak Emirates Military Hospital Rawalpindi, Pakistan from Oct 2021 to Jun 2022. Methodology: 500 patients of fibromyalgia diagnosed by consultant medical specialist or rheumatologist were included in the study. They were divided into two Groups. Group A received routine analgesics as per local protocol while Group B received Duloxetine in standard dose. Patients were evaluated with Brief pain inventory at the time of diagnosis and at end of two week of treatment for resolution of pain symptoms. Adverse effects experienced by patients were also recorded with in these two weeks. Results Out of five hundred patients randomized into two Groups, 257(51.4%) were categorized into Group A (routine analgesics) and 253(48.6%) were categorized into Group B (Duloxetine). 390(78.0%) were female while 110(22.0%) were male. Mean age of patients put who were diagnosed with fibromyalgia in our study was 39.84 ±7.96 years. Patients who received Duloxetine had better response in pain symptoms as compared to those who took routine analgesics (p-value-0.001). No significant difference was observed in adverse effects in both the Groups (p-value>0.005). Conclusion Patients of fibromyalgia who were managed with Duloxetine had better response to pain symptoms after two weeks as compared to patients managed with routine analgesics. No significant difference was found in adverse effect profile of patients in both the Groups.