Ziauddin University

We reviewed with interest the recent publication by Ko et al., which demonstrated that a higher baseline albumin–bilirubin (ALBI) grade (≥ 2) independently predicts poorer long-term survival in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE), including those with preserved liver function classified as Child–Pugh A [1]. The extended follow-up duration and comprehensive multivariate analyses strengthen the authors' conclusion that ALBI serves as an objective and clinically relevant prognostic indicator in this population. The prognostic relevance of baseline ALBI grade in TACE-treated HCC has been consistently supported by evidence from large cohorts. A meta-analysis including over 6500 patients confirmed that higher pretreatment ALBI grades are significantly associated with reduced overall survival, reinforcing its value as a standardized marker of hepatic functional reserve [2]. In contrast to the Child–Pugh classification, ALBI is based exclusively on serum albumin and bilirubin, thereby minimizing interobserver variability. Although baseline ALBI allows effective pretreatment risk stratification, liver function is dynamic and may change substantially following TACE. Increasing evidence suggests that the deterioration of ALBI grade after the initial TACE session is associated with earlier recurrence and reduced recurrence-free survival, reflecting treatment-related hepatic injury and declining liver reserve [3]. Furthermore, the progressive worsening of ALBI grade with repeated TACE procedures has been linked to reduced survival outcomes, underscoring the limitations of relying exclusively on single baseline measurements [4]. These findings demonstrate that serial assessment of ALBI may offer additional prognostic value beyond pretreatment evaluation alone. Integration of ALBI with established clinical staging systems may further improve risk stratification. Treatment decision-making in HCC frequently integrates liver function assessment alongside the Barcelona Clinic Liver Cancer (BCLC) staging system. Several studies have demonstrated that prognostic models combining ALBI with tumor burden and performance status outperform either parameter alone in predicting outcomes following TACE [5]. Additionally, the recently proposed simplified ALBI score (EZ-ALBI) has shown effective prognostic discrimination in intermediate-stage HCC, with performance comparable to or exceeding that of conventional scoring indices [6]. Prospective validation of ALBI-integrated staging models may enhance individualized treatment selection and inform optimal timing of therapeutic transitions. Methodological limitations should be acknowledged. Most studies assessing ALBI, including the analysis by Ko et al. [1], are retrospective and therefore subject to selection bias, heterogeneity in TACE techniques, and variability in post-treatment management. Prospective, multicenter studies are needed to validate optimal ALBI thresholds, standardize definitions of dynamic ALBI change, and confirm applicability across diverse clinical settings. Beyond its prognostic role, an important unresolved issue is whether ALBI can be used to actively guide treatment sequencing. Early identification of patients exhibiting post-TACE deterioration in ALBI grade may allow a timely transition to systemic therapies, potentially preserving hepatic function and improving outcomes. Prospective interventional trials evaluating ALBI-guided therapeutic strategies are therefore necessary to clarify its role in clinical decision-making and guideline development. In conclusion, although the baseline ALBI grade is a robust and objective prognostic marker for patients with HCC undergoing TACE, the integration of dynamic ALBI changes, incorporation with established staging systems, and validation of these approaches prospectively may further enhance its clinical utility and support more personalized management strategies. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. No new data were generated for this research.

Intracranial meningiomas are vascular tumors often causing significant intraoperative blood loss. Preoperative embolization (POE) aims to reduce vascularity and improve outcomes, though its efficacy is debated. This systematic review and meta-analysis evaluate the impact of POE on operative and postoperative outcomes in intracranial meningioma surgery. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a literature search from 2017 to 2025 identified 13 English-language, non-randomized studies comparing POE to no embolization. Outcomes included intraoperative blood loss, operative time, extent of resection, complications, and tumor recurrence. Due to heterogeneity, a meta-analysis was performed where possible, supplemented by a narrative synthesis. Risk of bias assessment was performed. Meta-analysis revealed that POE significantly reduced complications (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.53-0.88) and increased the likelihood of achieving gross total resection (GTR) (pooled OR 0.61, 95% CI 0.46-0.80). In contrast, findings on intraoperative blood loss and operative time were highly inconsistent with extreme heterogeneity. Tumor recurrence data were extremely limited, reported in only on study, precluding synthesis on long-term outcomes. Significant methodological variability was identified. POE consistently improves the likelihood of achieving GTR in intracranial meningiomas. However, its benefits in reducing intraoperative blood loss and operative time remain inconsistent. Neurosurgeons should consider POE when maximal resection is the primary surgical goal, especially for highly vascular tumors. Future research requires robust designs, such as matched-cohort studies or randomized controlled trials, to definitively establish its precise role.

Objective: To determine the reliability of C-reactive protein (CRP) as an early diagnostic biomarker for neonatal sepsis by assessing its correlation with clinical features, and potential perinatal risk factors, in order to support its use as a rapid and accessible tool for early diagnosis and management. Methodology: A descriptive cross-sectional study was conducted at the Neonatology Unit of Combined Military Hospital (CMH), Malir, over a period of six months, from July 2021 to November 2021. All neonates aged ≤28 days, of either gender, presenting with signs and symptoms suggestive of sepsis such as lethargy, poor feeding, temperature instability, respiratory distress, or convulsions were included. A total of 2 to 3 mL of venous blood was drawn aseptically from each neonate for CRP testing. A CRP level greater than 10 mg/L was considered positive and indicative of infection, serving as a key marker in assessing the likelihood of neonatal sepsis. All data were entered and analyzed using SPSS version 25. Results: A total of 101 neonates were assessed, with 51.5% being male and 48.5% female. Among them, 96% had a positive CRP level. The most common clinical features observed were lethargy (72.3%), reluctance to feed (51.5%), and persistent vomiting (46.5%). CRP levels were predominantly in the range of 6–30 mg/L (51.5%) and 31–50 mg/L (40.6%). There was a statistically significant association between CRP status and both mode of delivery (p = 0.020) and type of feeding (p = 0.042), while no significant association was found with age, gender, PROM, meconium-stained liquor, or maternal fever (p=>0.05). Conclusion: C-reactive protein observed to be a reliable and accessible biomarker for the early diagnosis of neonatal sepsis, with its positivity rate of 96% among clinically suspected cases and strong alignment with key clinical features such as lethargy and feeding difficulties, CRP proves to be a valuable diagnostic aid in neonatal care.

Penelitian ini bertujuan untuk mengungkap narasi disfungsi keluarga dalam lirik lagu Family Line karya Conan Gray melalui pendekatan analisis isi kualitatif dengan perspektif psikologi keluarga. Lirik lagu dipandang sebagai teks budaya populer yang merepresentasikan pengalaman emosional individu dalam konteks relasi keluarga. Data penelitian berupa kata, frasa, dan kalimat dalam lirik lagu yang mengandung makna terkait dinamika keluarga dan pengalaman psikologis. Analisis dilakukan melalui tahapan pengumpulan data, reduksi, pengkodean, kategorisasi tematik, serta interpretasi berdasarkan konsep disfungsi keluarga dan dampak psikologisnya. Hasil penelitian menunjukkan tiga tema utama. Pertama, konflik orang tua direpresentasikan sebagai sumber ketidakamanan emosional anak, yang memunculkan perasaan takut, sedih, dan tidak berdaya. Kedua, ketidakhadiran dukungan emosional dalam keluarga tergambar melalui narasi pengabaian afektif, yang berpotensi menghambat pembentukan kelekatan aman (secure attachment) dan menimbulkan kesepian psikologis. Ketiga, pengalaman disfungsi keluarga terinternalisasi menjadi luka emosional jangka panjang yang memengaruhi harga diri, regulasi emosi, dan pola relasi interpersonal individu hingga dewasa. Penelitian ini menegaskan bahwa lirik lagu dapat menjadi medium representasi psikologis yang reflektif dan relevan dalam kajian psikologi keluarga. Secara metodologis, studi ini memperluas pendekatan penelitian psikologi keluarga dengan memanfaatkan analisis teks budaya populer sebagai sumber pemahaman mengenai pengalaman emosional individu dalam konteks keluarga.

ABSTRACTObjectives:To assess the clinical and functional outcome of Tibialis Anterior Tendon Transfer in Recurrent Relapsed Idiopathic Clubfoot Deformity associated with peroneal nerve dysfunction.Methodology:This observational study included 16 (2.11%) of 756 Idiopathic Clubfoot Deformity (CFD) patients with recurrent and relapse deformity following Ponseti management, treated during January 1, 2011 to December 31, 2023 at Ziauddin Hospital Clifton, Karachi, Pakistan. Included patients had evertors and toe extensors weakness associated with concomitant Peroneal Neuropathy. Following an initial Ponseti re-casting, Extended Posterior Release (EPR) and Tibialis Anterior Tendon Transfer (TATT) was performed. Clinical and functional outcomes were assessed on Nogueira and Songs satisfaction protocols.Results:All 16 patients had bilateral idiopathic Clubfoot deformity at initial treatment, who developed Iatrogenic Complex Clubfoot deformity with concomitant Peroneal nerve dysfunction, four of these had recurrent relapse on left side only. Their muscle charting revealed peroneal and toe extensor muscles weakness, while Tibialis Anterior strength was grade IV. Five patients had flexible deformity, while 11 patients had fixed severe deformities. Thirteen patients underwent EPR and TATT, while three had Posterio-Medial Release and TATT. At 3-10 years of follow-up, six patients improved from Nogueira Poor to good Nogueira outcome and Satisfied on Song’s Scale. While three patients achieved Nogueira’s “Poor” and “Very dissatisfied” on Song’s criteria.Conclusion:A small and rare sub-set of iatrogenic complex clubfoot deformity with peroneal nerve dysfunction, is undoubtedly difficult to treat. Early diagnosis and treatment prevents extensive surgical interventions, which is required mostly in late presenting, rigid deformities. The association between peroneal neuropathy and preserved tibialis anterior muscle strength in these patients remains poorly understood.

Kartagner syndrome is a rare congenital autosomal recessive disorder of ciliary movement, characterized by triad of chronic sinusitis, situs inversus and bronchiectasis leading to recurrent chest and sinuses infections. The primary objectives of this case report is to highlight the presentation of this rare disorder, its surgical challenge with minimally invasive procedures, and contribute to literature of this rare syndrome in pediatric patient of 9-year-old female presented with a complaint of high grade fever and productive cough for 3 days. The X-ray findings showed Dextrocardia and right sided stomach gas, suggesting Situs inversus. The chest computerized tomography revealed right side apex beat, aortic arch on right side and right lower lobe bronchiectasis. Considering these clinical signs and radiological examination, the patient was diagnosed with Kartagener's syndrome. During Hospitalization, along with conservative treatment, the patient had undergone successful thoracoscopic right lower lobectomy for bronchiectasis secondary to Kartagener's syndrome. This case report presents a rare disorder, highlights the importance of considering Kartagener's syndrome as a differential diagnosis in patients with recurrent respiratory infection and atypical radiological findings such as situs inversus. Surgical management such as thoracoscopic right lower lung lobectomy requires expertise due to atypical anatomical arrangement. This case contributes to the existing literature of Kartagener's syndrome in pediatric patients and provides its effective comprehension of surgical management and emphasizes the need for timely intervention by experienced surgeons.

Digital nerve injuries are the most prevalent form of peripheral nerve injuries. We aimed to conduct a systematic review and Bayesian network meta-analysis to determine the optimal technique for sensory restoration in patients undergoing digital nerve repair. An electronic search was conducted from inception to September 2025. Thirteen studies were included comparing neurorrhaphy, allograft, autograft, and conduit. Outcomes analyzed included static 2-point discrimination (S2PD) and moving 2-point discrimination (M2PD), presented as mean difference (MD) with 95% confidence intervals (CIs) or as surface under the cumulative ranking curve (SUCRA) scores and mean rank estimates. Sensitivity analyses were also performed by excluding neurorrhaphy. A P value <0.05 was considered statistically significant. The pooled analysis demonstrated that allograft was the best technique for S2PD (SUCRA: 70.39, mean rank: 1.89), whereas neurorrhaphy ranked highest for M2PD (SUCRA: 70.71, mean rank: 1.88). Traditional meta-analysis also confirmed allograft's superiority for S2PD (MD = -1.44, 95% CI: -2.57 to -0.32; P = 0.01) and neurorrhaphy for M2PD (MD = -0.50, 95% CI: -0.87 to -0.13; P = 0.007). However, sensitivity analyses excluding neurorrhaphy demonstrated that allograft also ranked highest for M2PD (SUCRA: 69.91, mean rank: 1.60). Conduit repair was significantly worse than other techniques for both outcomes (S2PD : P = 0.002; M2PD : P = 0.004). These findings highlight allograft as the most effective techniques for optimizing sensory recovery in digital nerve injuries, especially in cases where neurorrhaphy is not feasible.

Background: Foot complications are a major cause of morbidity in Type 2 Diabetes Mellitus (T2DM), which often leads to ulcers, infections, and amputations. Despite the fact that most of the diabetic foot complications are preventable, gaps in patient understanding, awareness and education lead to suboptimal practices in foot care. This study investigated the knowledge and education-related predictors of foot care practices among patients with T2DM. Methodology: A multicenter cross-sectional study was conducted on 328 individuals with T2DM, attending tertiary care hospitals in Karachi. The data collection involved a self-administered structured questionnaire, aimed at assessing demographics, educational exposure, diabetes knowledge, foot care knowledge and self-reported foot care practices. Random Forest algorithms were employed to select variables for ordinal regression to assess predictors for foot care practices. Results: A total of 328 participants were included in the study. Better practices were predicted by older age (OR = 1.03; 95% CI: 1.01-1.05). Participants who had a monthly income of PKR 100,000 - 250,000 were less likely to have better practices as opposed to those with monthly income of PKR &lt;100,000 (OR = 0.43; 95% CI: 0.20-0.93). Received formal foot care education was significantly associated with improved foot care practices (OR = 3.73; 95% CI: 1.24-11.13), as was community foot care education (OR = 2.90; 95% CI: 1.29-6.50). The knowledge of diabetes (OR = 4.51; 95% CI: 2.09-9.74), and foot care knowledge (OR = 7.54; 95% CI: 3.47-16.39) were the strongest predictors of improved foot care practices. Conclusion: This study demonstrates that diabetes and foot care knowledge along with formal and community-based education are highly significant predictors of foot care practices in patients with T2DM showing the significance of targeted educational interventions to enhance preventive practices. Keywords: Attitudes, Self-Care, Foot Care, Health Knowledge, Practice, Type 2 Diabetes Mellitus