Pakistan Institute of Medical Sciences

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.

Excessive crying is one of the most common problems in the first three months of life, accounting for nearly 20% of pediatric consultations. Objectives: To evaluate the effectiveness of Lactobacillus reuteri in infants with infantile colic compared with standard care alone. Methods: A prospective quasi-experimental study was used to enroll 172 infants (<13 weeks of age) with clinically diagnosed infantile colic who were enrolled. Group A received probiotic L. reuteri in addition to standard care, while Group B received standard care alone. Outcomes included mean daily crying time, crying episodes/week, and daily sleep duration, measured at baseline, days 7, 14, 21, and 28. Between-group comparisons were performed using the Mann–Whitney U test, and within-group changes were analyzed using the Friedman test. Results: Over 28 days, Group A showed greater improvement than Group B in reducing crying and increasing sleep. Daily crying decreased by −3.53 ± 1.05 hours in Group A vs. −1.79 ± 1.19 hours in Group B (p<0.001), weekly crying episodes by −3.60 ± 0.69 vs. −3.36 ± 0.97 (p=0.041), and daily sleep increased by 5.38 ± 2.08 hours vs. 2.80 ± 3.52 hours (p<0.001). Conclusions: L. reuteri supplementation in addition to standard care significantly reduced crying time and episodes, and improved sleep-in infants with colic compared to standard care alone.

Objective: To evaluate the association between different age groups and body mass index (BMI) and the incidence of breast cancer (BC) among clinically suspected women. Methodology: A retrospective cross-sectional study was conducted at the Department of Radiology, Liaquat National Hospital, Karachi, based primarily on hospital records, with a few cases assessed cross-sectionally from May to October 2024. The study included all female patients aged 18 years or older who were clinically diagnosed with breast cancer and had histopathological confirmation, along with complete clinical records, including age, height, weight (for BMI calculation), menopausal status, and cancer stage. All patients and their medical records were assessed according to the inclusion criteria. Data were entered and analyzed using SPSS version 26. Results: The overall mean age of the patients was 44.3 ± 14.8 years, and the mean BMI was 25.9 ± 4.7 kg/m². The most common breast condition was fibrocystic changes (30.0%), followed by breast cancer (25.6%), benign lumps (20.0%), mastitis (15.6%), and intraductal papilloma (8.9%). Analysis revealed a significant association between breast cancer and women aged >40 years, with an odds ratio (OR) of 0.26 (95% CI: 0.08–0.85; p = 0.019). Similarly, BMI showed a significant association, with an odds ratio of 0.12 for overweight/obese women (95% CI: 0.03–0.45; p = 0.001). Conclusion: This study revealed that older age and higher BMI are significantly associated with an increased risk of breast cancer among women presenting with different breast conditions.

This case series presents the successful management of three complex uterine rupture cases with high morbidity at a tertiary care center, emphasizing the challenges and outcomes. Patients who consented were analyzed for clinical presentation, intraoperative findings, and postoperative outcomes. Case 1 involved a 32-year-old woman (G11, P7+3) with spontaneous uterine rupture at 35 weeks gestation, extending to a broad ligament hematoma, necessitating total abdominal hysterectomy, internal iliac ligation, broad ligament exploration. Case 2 described a 35-year-old woman (P3+1) with a history of three cesarean sections, who experienced uterine rupture following dilation and curettage for a cesarean scar ectopic pregnancy, requiring cesarean hysterectomy and bladder repair. Case 3 involved a 28-year-old woman (G5, P4) with uterine rupture and hand prolapse, successfully managed with uterine repair and conservation. These cases underscore the critical importance of prompt recognition, timely surgical intervention, and a multidisciplinary approach in managing uterine rupture. Individualized strategies tailored to patient conditions are essential for optimizing outcomes, particularly in high-risk obstetric patients.

Abstract Objectives The study aims to predict the association between oral hyperpigmentation and pregnancy in women between 18 and 45 years using machine learning (ML) algorithms. Directed acyclic graphs (DAGs) were constructed to explore the association between oral hyperpigmentation and demographic factors such as age, occupation, ethnicity, and number of pregnancies. Methods This cross-sectional study involved pregnant and non-pregnant participants aged between 18 and 45. The study was conducted at one public and one private sector hospital. DAGs were used to represent relationships between different variables. Three ML models, including Logistic Regression (LR), Random Forest (RF) and Gradient Boosting Machine (GBM) algorithms, were used to predict the association between oral hyperpigmentation and pregnancy based upon relevant theoretically backed predictors. Results The results show that labial mucosa and hard palate hyperpigmentation had a positive correlation with the number of pregnancies, with p-values of 0.003 and 0.018, respectively. All three ML models demonstrated excellent predictive power. However, the LR model with an accuracy rate of 96.67% was particularly effective in predicting the association between oral hyperpigmentation and pregnancy. Conclusions This study highlighted the effectiveness of LR, supported by DAGs, in predicting oral hyperpigmentation among women aged 18–45. Key factors such as the number of pregnancies, age, ethnicity, and occupation significantly influenced site-specific hyperpigmentation. The findings support the integration of ML into maternal oral healthcare for early detection and culturally tailored interventions. Simpler ML models proved most accurate in moderate-sized datasets with fewer covariates.

A notable number of patients with diabetes suffer from painful diabetic neuropathy (PDN), which is a debilitating complication of diabetes mellitus. Prolonged hyperglycaemia and metabolic dysregulation lead to PDN, a condition characterised by chronic pain, sensory dysfunction, and reduced quality of life. Although various treatment options are available, clinical management is challenging due to the complex and multifactorial nature of PDN pathophysiology. N-methyl-D-aspartate receptors (NMDARs), particularly the NR2B subtype (NMDAR-2B), have emerged as a key player in the pathophysiology of chronic pain states, including PDN. This review highlights the mechanistic NMDAR-2B involvement in the pathophysiology of PDN, focusing on its upregulation role in pain-processing regions, interaction with inflammatory mediators, glia-derived mediators, and oxidative stress mechanisms. Advancements in targeting NMDAR-2B as a mechanistically driven approach to PDN management also offer potential in enhancing the therapeutic efficacy of NMDAR-2B. Consequently, this review provides a novel perspective on understanding the role of NMDAR-2B in PDN for the future development of effective treatment strategies for managing the condition.

Objective: To quantify the therapeutic and diagnostic delays among patients with CIRDs in Pakistan. Study Design and Setting: Cross sectional study. PIMS Hospital Islamabad Rheumatology OPD. Duration 8th June 2025 to 8th September 2025. Methodology: This cross-sectional study comprised 220 patients. Informed consent was obtained; demographic details like age and sex were noted. All Patients previously diagnosed with conditions such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or similar diseases were selected from various rheumatology clinics and departments over six months. Data collection was done using a structured face-to-face interview which included data on demographic information, age of symptom onset, consultation times, and treatment commencement, dividing delays into diagnostic and therapeutic categories. For the analysis in SPSS v21, Shapiro–Wilk, Chi-square, and Fisher’s Exact Test were performed, and the results were presented as the median for continuous variables and percentages for categorical data. A p-value = 0.05 was taken as statistically significant. Results: A total of 220 participants were included in this study. Among the 220 patients, 40.5% had diagnostic delay exceeded 18 months with only 6.4% diagnosed within 6 months. Patients who visited homeopaths had the highest delay rate (56.1%). Psoriatic arthritis (71.4%) and ankylosing spondylitis (53.8%) had longest delays. Joint pain led to early referral in 54.6%, whereas atypical symptoms caused prolonged delays. Conclusions: The findings of this study revealed that both diagnostic and therapeutic delays are common in CIRDs in Pakistan, often caused by multiple reasons before reaching a rheumatologist and referral system inefficiencies

Background: Liver transplantation (LT) is a definitive treatment for end-stage liver disease, acute liver failure, liver tumors, and some metabolic diseases. Re-exploration after surgery is associated with poor clinical outcomes and is considered a quality of care measure. Objective: to determine the frequency and risk factors of reoperation (early relaparotomy) after donor hepatectomy in postoperative LDLT donors. Materials & Methods: A cross-sectional analytical study was conducted at Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, from December 2023 to May 2024. The study included 672 LDLT donors aged over 18 years. Data on donor age, gender, blood group, operation time, and re-exploration were collected. Primary endpoints were the frequency and causes of re-exploration, and secondary endpoints included the association of re-exploration with clinical outcomes. Statistical analyses were performed using SPSS 25.0, with a significance level set at p < 0.05. Results: The frequency of re-exploration was 2.8%. Among those requiring re-exploration, 42.1% were aged 21-28 years. The difference in re-exploration rate between male and female patients was found to be statistically significant (p<0.001). Blood group analysis revealed 57.9% of re-explored donors had blood group B+. Bleeding was the primary cause of re-exploration in 73.7% of cases. The majority (57.9%) of re-explorations occurred in patients with operation times between 451-550 minutes. Conclusion: This study highlights a relatively low frequency of re-exploration (2.8%) among LDLT donors. However, the significant gender disparity and the high incidence of bleeding as a cause for re-exploration underscore the need for improved postoperative care.

The methoxy substituted phenylacetic acid (MeOPhA) and chloro substituted phenoxyacetic acid (ClPhA) were used to synthesized eight new Cd(II) based complexes. The nitrogen donor 2,2′- bipyridine (MeOPhA2, ClPhA2) and 1,10-phenanthroline (MeOPhA3, ClPhA3) were used as auxiliary ligands for the synthesis of mixed ligand complexes. These complexes were characterized by FT-IR and multinuclear NMR (1H and 13C-NMR) spectroscopic techniques. The FT-IR spectra of the complexes showed characteristic COO- asymmetric and COO- symmetric vibrational bands indicating metal coordination through oxygen. Moreover, their difference, i.e., Δν reveal that the selected ligands are coordinated to the Cd(II) center in a bidentate manner. The 1H-NMR and 13C-NMR data recorded in deuterated solvents also supported successful synthesis in pure forma as well as metal coordination through carboxylate group. The nature of the complex–DNA interaction was examined, and the impact of hetero ligand attachment on binding strength and reactivity was assessed using UV–visible spectroscopy. The obtained data confirmed the effective binding ability through partial intercalation and groove binding through spontaneous process for all the complexes.

Background: Obstructive sleep apnea (OSA) is frequently underdiagnosed and may influence perioperative outcomes. Postoperative nausea and vomiting (PONV) are common adverse effects following laparoscopic surgery. The purpose of this study was to determine the relationship between PONV and the risk or predisposition of OSA based upon STOP-Bang criteria in laparoscopic surgery patients.Methods: This is a prospective cohort study conducted in government and private hospitals in Lahore from January to July 2025. The sample consisted of 200 patients who underwent elective laparoscopic surgery under general anesthesia, recruited via convenience sampling. The OSA risk was categorised using the STOP-Bang questionnaire, whereas PONV was measured by the Apfel simplified risk score and the visual analogue scale (VAS). Statistical analyses were performed using SPSS v.26, including descriptive statistics, Spearman correlations, Mann-Whitney U tests, Kruskal-Wallis tests, chi-square tests, and multiple linear regression analyses, while controlling for age, gender, medication use, surgical history, and anesthesia history.Results: Among the 200 participants, 152 (76%) were female, and 48 (24%) were male. The most common age ranges were 56-60 years (73 participants, 36%) and 46-55 years (54 participants, 27%). The relationships among the Apfel, VAS, and STOP-Bang scores showed moderately positive correlations (r = 0.23, p < 0.01; r = 0.19, p < 0.01). Regression analysis showed that STOP-Bang scores (beta = 0.152, p = 0.003), nausea severity (beta = 0.176, p = 0.003), female gender (beta = 0.125, p = 0.008), and medication use (beta = 0.142, p = 0.003) were associated with higher Apfel scores. Younger age was associated with higher PONV scores (χ² = 21.77, p = 0.001). Female patients scored significantly higher on the STOP-Bang, Apfel, and VAS than males (p < 0.05).Conclusion: STOP-Bang-defined OSA risk has a significant association with PONV in laparoscopic surgery patients. Female gender and younger age increased susceptibility to PONV, whereas OSA risk was augmented in older people. These results illustrate the clinical utility of integrating STOP-Bang screening into preoperative evaluation to optimise perioperative care and individualise preventive measures against PONV. These findings support integrating STOP-Bang screening into preoperative risk assessment to improve postoperative outcomes.