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Background: Percutaneous coronary intervention (PCI) is a primary treatment modality for coronary artery disease, particularly in complex cases involving multivessel disease, chronic total occlusions, or bifurcation lesions. The choice of vascular access site—radial versus femoral—can significantly impact patient outcomes and the incidence of vascular complications. Recent trends favor radial access due to its potential advantages in safety and recovery. Objective: To evaluate the impact of radial versus femoral access on vascular complications and patient outcomes in complex PCI. Methods: This randomized control trial was conducted at the Chaudhary Pervaiz Elahi Institute of Cardiology, Wazirabad, Pakistan, over a six-month period from September 2023 to February 2024. A total of 350 patients undergoing complex PCI were enrolled, with 210 assigned to radial access and 140 to femoral access. Baseline characteristics, including age, BMI, and prevalent comorbidities (dyslipidemia, hypertension, and diabetes mellitus), were recorded. Major outcomes measured included periprocedural myocardial infarction, in-hospital mortality, and stent thrombosis. Statistical analysis was performed using SPSS Version 26. Results: The mean age of participants was 52.90 ± 8.07 years. No significant differences were found in BMI and comorbid conditions between the groups. In-hospital mortality was 1.4% in the radial group compared to 4.3% in the femoral group (P=0.05). Rates of periprocedural myocardial infarction were similar between groups (0.5% radial vs 0.7% femoral, P=0.77). Stent thrombosis was observed in 0.5% of the radial group and was absent in the femoral group. Conclusion: Radial access in complex PCI was associated with lower in-hospital mortality compared to femoral access, with similar rates of myocardial infarction and stent thrombosis. These findings suggest that radial access may provide a safer alternative, supporting its increasing use in clinical practice.

Background: Benign breast diseases (BBD) are a frequent cause of mastalgia, both worldwide and in Pakistan. Hence recognition of BBD using clinical signs and sonographic breast imaging is important to reduce the number of unnecessary radiation exposure in the form of mammography and invasive biopsies and consequently avoid delay in the diagnosis. Thus, this study was conducted to assess the prevalence of the subtypes of BBD in the local population presenting with mastalgia. Patients and Methods: It was a cross sectional study conducted in Radiology Department of Lahore General Hospital, Lahore from 1st January till 30th June, 2022. Total 301 females fulfilling inclusion criteria referred from Surgery OPD and were enrolled after taking informed consent. Patients were clinically examined to assess and exclude any palpable lumps and to validate mastalgia. Sonographic evaluation of the breast was performed by three independent Consultant Radiologists following updated guidelines. The probe frequency was between 4.5MHz - 9MHz. Other technical parameters were adjusted accordingly. Colour Doppler and spectral Doppler techniques were used to further assess the lesion and categorize into the BBD lesions. Data was analysed by using SPSS version 20. Results: The mean age of enrolled patient was 31.47 (+10.59) years. The mean duration of symptoms was 5 months. Out of 301 females, the imaging was normal in 89 (29.6%), while 92 (30.6%) patients had findings in right breast, 74 (24.6%) in left and 46 (15.3%) in bilateral breast. Overall, ductal dilatation was most common cause for mastalgia (9.8%). Fibroadenoma being the second most common finding (8.8%). Other causes being non-puerperal mastitis (8.6%), abscess (6.3%) and benign cyst (5.6%). Conclusion: BBD are the most common cause of mastalgia in our population with duct ectasia being the most common type in second and third decade followed by fibroadenoma.

Desquamative interstitial pneumonia (DIP) is a rare form of interstitial lung disease (ILD) in children that can be idiopathic but is usually associated with an inborn error of surfactant metabolism. We reported DIP in a 13-year-old girl who was referred to our outpatient clinic because of worsening dyspnea. High-resolution computed tomography showed ground-glass attenuation with honeycombing and intralobular, interstitial septal thickening, suggestive of an ILD. Transbronchial lung biopsy was performed, and histopathology findings were consistent with DIP. The patient was started on steroid therapy with oxygen support. Unfortunately, she died a month after being diagnosed due to disease progression.

<strong>Introduction: </strong>The concept of being infected with Sexually Transmitted Infections (STIs) is culturally sensitive in Saudi Arabia. Considering the impact and cost-effectiveness of early diagnosis and treatment, studying the care-seeking behaviors of the Saudi population towards STIs is essential. Therefore, this research aimed to evaluate care-seeking behaviors towards STIs and associated factors in Saudi Arabia. <strong>Methods:</strong> A cross-sectional study was conducted in 2022, including 420 adults aged 18-60, male and female, Native Arabicspeakers, and living in Saudi Arabia. A self-administered, community-based, and computerized questionnairewas constructed by the researchers and distributed via social media. Data analysis was managed using the Statistical Packagefor SocialSciences (SPSS) version 27. <strong>Results:</strong> A total of 420 participants were included in this study. 77% of respondents were willing to seek care once they suspect having STIs. All socioeconomic factors and perceived barriers were introduced into a logistic regression model that included different variables such as religion, workinghours, income, fear of legal issues, condom protection knowledge, STIs symptomsknowledge,and transmission routesknowledge had significant relationship with willingness to seek healthcare.Furthermore,more than 52% had no obstaclesto report STIs, while the remaining respondents had some obstacles. The three most prominent obstacles werefear of breaching confidentiality (~30%), fear of stigma (~21%), and fear of partnerresponse (~20%). <strong>Conclusions:</strong> The study showed good-seeking behavior as the majority of the respondents were willing to seek healthcare. However, several factors and obstacleswere foundsuch as religion, workinghours, income, fear of legal issues, condom protection knowledge, STI symptoms knowledge,transmission route knowledge, fear of breaching confidentiality, fear of stigma, and fear of partner and family responses.

Purpose: Many infectious and congenital diseases caused by bacteria and viruses affect the health of both mother and fetus. Today, an epidemic with the common name TORCH affects women during pregnancy, especially during the first trimester. Method: The current study investigates the pathogens and routes of transmission and the percentage of antibodies in the blood against toxoplasma, rubella and cytomegalovirus. The first 20 weeks usually develop in pregnant women and can be fatal if the infection is passed on to the fetus. Although these infectious diseases cannot be adequately treated, several vaccines are being introduced into the pharmaceutical industry to treat pregnant women during pregnancy and prevent fetal death. Results: Data were collected from the Liaquat Jamshoro School of Medicine and Department of Public Health Pathology in affected women and summarized as follows. Transmission of cytomegalovirus and rubella is most common compared to toxoplasma. A CMIA test (chemiluminescent micro particle immunoassay) was performed to obtain highly accurate data on the responsible IgG and IgM antibodies in the blood of pregnant women. In this case, CMIA is considered very reliable. Conclusion: Throughout the study, it was observed that these viruses can cause fetal malformations or ultimately death if left untreated in pregnant women. It is said to spread knowledge about the treatment and struggle of disease. Keywords: CMV; CMIA; Rubella; TORCH; Toxoplasma;

Background: Celiac disease (CD) is an immune mediated enteropathy that is caused by intolerance to gluten storage protein of wheat bartey and rice. Early diagnosis of celiac disease is highly imperative to institute early intervention in order to prevent profound macronutrient deficiencies as well as long term complications. Diagnostic investigation for celiac disease, the matter of controversy, with endoscopic duodenal biopsy remaining the gold standard but invasive, costly, painful, needing expertise and carrying risks of endoscopy, while serologic tests although noninvasive, cheap, easily available but with disputed specificity and sensitivity. Objective: To find the accuracy and importance of anti-tissue transglutaminase IgA antibody in celiac disease diagnosis and determination in pediatric patients. Place and Duration of Study: Department of Pediatrics, GMMMC Hospital Sukkur from 1st June 2019 to 30th November 2019. Methodology: One hundred and fifty children were suspected celiac diseases were enrolled. Demographic data including age, gender was noted. Duodenal biopsy and upper GI endoscopy of all patients with positive anti-tTG was performed. At least 6 biopsy specimens were taken from first and second part of duodenum and duodenal bulb. Results: Mean age of the children was 8.72±1.92 years. Sensitivity, specificity, PPV and NPV of tTG-IgA in evaluating celiac disease was 86.9%, 84.8%, 88%, 83.6% and 86% respectively. Conclusion: Tissue transglutamianse (TTG) is an excellent screening test for celiac disease in high risk Paediatric population having diagnostic accuracy of 86%. Therefore, it can be safely recommended that patients having even fewer clinical features should be screened by TTG to detect celiac disease patients with minimal signs and symptoms. Keywords: Celiac disease, IgA anti-tissue transglutaminase, Gastrointestinal endoscopy

Objectives: To assess the knowledge, practices and barriers of family planning in child bearing age women.Methodology: This cross-sectional study was conducted at Department of Obstet-rics and Gynecology unit II Dr. Ruth K.M Pfau civil hospital Karachi from April 2019 to June 2019. During this period 399 women after being discharged from hospital were assessed for knowledge, practices of contraception and presumed barriers for using contraception. The responses were documented on self-designed question-naire.Results: Mean age of candidates was 29.72 ±4.72 years. 66% women were not for-mally educated. 88.7% of women had knowledge about family planning methods and the major source of information was friends and relatives (42%). Only 40.6% women were practicing contraception and majority of them were using barrier method (24.6%). Any method was not used by 59.4% of women due to multiple reasons. The major barrier was fear of side effects (27.6%).Conclusion: Our study population was well aware about contraceptive methods but underutilized due to family pressures .Women education and counseling along with husband and mother in law can improve family planning measures. The government and media should do active measures in spreading information about various availa-ble methods of contraception and their side effects.&#x0D; Keywords: Knowledge, Practices, Barriers, Contraception

Objectives:In this study we determine the modifiable factors related to bleeding and transfusion in post-cardiac surgery patients who underwent open heart surgery.Methods:This is a retrospective study that include two hundred patients who had undergone open heart surgery (OHS) at Northwest General Hospital and Research Center from December 2018 to July 2021. Platelet count and hemoglobin level were measured in the pre-operative period.Results:This study included both male and female patients. Postoperative platelets were counted as follow: 50-100 x109 L in 3.0% cases, 101-150 x109 L seen in 27.5% cases, and >150 x 109 L in 69.5% cases which required transfusion. We have also reported the increased requirement of transfusion of blood and blood products in patients with pre-operative hemoglobin (Hb) < 10 g/dl.Conclusion:Correction of pre-op Hb, post-op platelet count and total bypass time are the significant and preventable parameters in patients undergoing cardiac surgery if proper pre-op assessment of the patient is performed.

Background: Iron deficiency anaemia (IDA) and rest leg syndrome (RLS) are two common medical conditions in our population. There is etiologic association between the two pathologies which however; has not been investigated in our local population. Objective: To determine the frequency of iron deficiency anemia among patients of restless leg syndrome. Study Design: Cross sectional study. Place and Duration of Study: Department of Neurology, Khairpur Medical College- Khairpur Mir’s from December 2020 to March 2021. Methodology: Three hundred and thirty nine patients having RLS, of either gender, age 18-60 years, were included after taking a valid informed/written consent. Pregnant women or having menorrhagia, blood dyscrasias, iron supplements or steroids, any neurological comorbid or comatose patients were excluded. Results: The mean age was 39.12±10.79 years. The mean duration of RLS was 8.42±4.01 years while mean haemoglobin was 12.06±2.36 g/dL. The prevalence of IDA among RLS patients was 133 (39.2%). The stratified analysis significantly revealed that elder age, female gender, positive family history, and higher BMI were associated with increased frequency and severity of IDA among RLS patients (P=0.996, 0.007, 0.372 &amp;0.738). Conclusion: Iron deficiency anaemia is quite frequent in patients of Restless leg syndrome and healthcare providers should increase awareness among population regarding its treatment. Key words: Restless leg syndrome, Iron deficiency, Anaemia, Haemoglobin, Sleep disturbance

Objective: To compare the efficacy of manual vacuum aspiration with dilatation and curettage in first trimester miscarriages. Study Design: Randomized control trial. Place and Duration of Study: Department of Obstetrics and Gynecology Unit “A”, Lady Reading Hospital, Peshawar. Patients were received through OPD and Emergency during the six months i.e from 1st Jan, 2015 till 30th June, 2015. Methodology: Women admitted in the department of Obstetrics and Gynecology Unit “A”, Lady Reading Hospital, Peshawar, who meet the inclusion and exclusion criteria, were included in the study by consecutive non probability sampling with random allocation by dividing them into two groups through lottery method. Patients in group A were treated by dilatation and curettage while the patients in group B were evacuated by manual vacuum aspiration. After the randomly allocated method of evacuation, the efficacy of the procedure was determined in terms of need for the evacuation by presence of retained products of conception on ultrasound done by specialist. Results: No substantial difference was found between patients subjected to D&amp;C and to those subjected to MVA. Conclusion: MVA is as effective as D&amp;C for the treatment of miscarriage. Keywords: Miscarriage, Abortion, Dilatation &amp; Curettage, Manual Vacuum Aspiration, Retained products of conception.