Objective: To identify the knowledge and perceptions of participants regarding the poppy seeds (khash-khash) consumption and false-positive opioid urine test results and related consequences Study Design: Cross-sectional studyPlace and Duration of Study: This study was carried out in major urban cities of Pakistan from August to November 2025. Methods: A structured questionnaire based at Google Forms was shared with 384 participants. The questionnaire contained 3 sections that measured demographic variables, knowledge and perceptions of participants regarding poppy seed (khash-khash) consumption, false-positive opioid urine test and related consequences. Subsequently, twenty participants of different age groups were selected who regularly consumed poppy seeds provided urine samples at 6 and 24 hours after ingestion. Samples were first screened for opioids using enzyme immunoassay (EIA). Results: The results demonstrate that (89.84%) participants reported widespread consumption of poppy seeds. Nonetheless, awareness of the risk of false-positive results was extremely low. A large proportion of the respondents (77.6%) lacked the awareness that poppy seeds lead to a false positive urine test for opioids. Moreover, 51.2% of the participants felt that the current urine drug tests are not adequate to distinguish between the use of opiates and consumption of poppy seeds. Majority of the participants were of the opinion that this false positive opioid drug can result in dismissal, emotional distress, legal actions and loss of reputation. All participants who regularly consumed poppy seeds were confirmed to have false positive urine test for opioids Urine tests of opioids were detected to be false positive using enzyme immunoassay (EIA) with a cutoff of 300 ng/mL, and positive results were confirmed using LC-MS/MS. Conclusion: This study confirms a significant awareness gap and validates poppy seed–induced false-positive opiate tests. Targeted education and policy-level improvements in drug testing protocols are urgently needed to ensure fairness and accuracy.

Objective: To observe the type 2 diabetes mellitus in combination with obesity levels affects diabetic neuropathy occurrence. Study Design: Cross-sectional studyPlace and Duration of Study: This study was conducted at the Department of Biochemistry of Al-Rafai Education Hospital in Dhi Qar Iraq from 31st December 2024 to 31st March 2025. Methods: A total of 90 participants assigned to three separate groups consisting of healthy control patients and participants with type 2 diabetes mellitus without neuropathy as well as type 2 diabetes mellitus patients with confirmed diabetic neuropathy. Researchers took blood samples which they used to measure fasting blood sugar and haemoglobin A1c and hemoglobin and ferritin along with the lipid profile. Results: Diabetic patients especially those with neuropathy experienced a marked increase in fasting blood sugar and haemoglobin A1c and body mass index levels when tested. The diabetic neuropathy patient group demonstrated elevated ferritin compared to other participant groups. A high relationship emerged between haemoglobin A1c measurements and both fasting blood sugar levels and body mass index values as well as ferritin levels. Conclusion: Both type 2 diabetes mellitus duration extending in years and obesity condition increase the susceptibility to neuropathic complications.

Objective: To compare the characteristics of ovarian stimulation, oocyte maturation, embryo development, and transfer-related parameters between the gonadotropin-releasing hormone agonist long protocol and the gonadotropin-releasing hormone antagonist protocol in infertile couples having intracytoplasmic sperm injection. Study Design: Retrospective comparison analysisPlace and Duration of Study: This study was conducted at the Department of Gynecology & Obstetrics, Collage of Pharmacy, University of Duhok from 20th August 2024 to 28th February 2025. Methods: This retrospective comparison analysis was performed on 200 Intracytoplasmic sperm injection cycles utilising either a gonadotropin-releasing hormone agonist or gonadotropin-releasing hormone antagonist regimen. We looked at the length of stimulation, the amount of gonadotropin used, the reaction of the ovaries, the age of the oocytes, the success of fertilisation, the quality of the embryos, the thickness of the endometrium, and the day of embryo transfer. Results: The gonadotropin-releasing hormone antagonist protocol correlated with markedly reduced stimulation days (p=0.003) and diminished gonadotropin requirements (p<0.001). The ovarian response was more effective in antagonist cycles, with increased quantities of metaphase II oocytes (p=0.001) and fertilised oocytes (p=0.010). Thequality of embryos varied considerably among procedures (p < 0.001), with antagonist cycles yielding a greater percentage of high-grade blastocysts and more frequent day-5 embryo transfers (p<0.001). The endometrialthickness on the day of embryo transfer was considerably higher in antagonist cycles (p=0.032). Conclusion: Gonadotropin-releasing hormone antagonist programs exhibit enhanced stimulation efficacy and embryological outcomes relative to gonadotropin-releasing hormone agonist protocols. These data indicate that biological and treatment-related benefits linked to antagonist regimens may enhance reproductive outcomes.

Objective: The aim of the narrative review is to compare the incidence of the malignant transformation of oral lichen planus (OLP) and oral lichenoid lesions (OLL) in patients. Place and Duration of Study: The literature review was undertaken at the Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, Qassim University, Saudi Arabia from January 2025 to May 2025. Methods: The review of literature was undertaken with the help of electronic data bases, including Web of Science, PubMed, Google Scholar, Scopus, Medline, Embase, NCBI, Elsevier. The following keywords were used to search for the present study: oral lichen planus, oral lichenoid lesions, malignant transformation, and diagnostic challenges: 2014, May 2024. Results: The reported rates of malignant transformation of OLP and OLL ranged from 0 to 5.4. The incidence of malignant transformation in OLP is uncertain due to overlap with OLL and with early-stage oral squamous cell carcinoma (OSCC) and lichenoid lesions. Conclusion: Malignant transformation risk in OLP and OLL is variable with a low average risk. However, a combination of clinical and histological features complicates risks assessment and there is a need to put more emphasis on follow-up and consistent diagnosis.

Objective: To explain the epidemiology and sociodemographic details of Crimean-Congo hemorrhagic fever in ThiQar, Southern Iraq. Study Design: Cross-sectional studyPlace and Duration of Study: This study was conducted at the using data from the Department of Public Health, Province of Thi Qar from 15th September 2024 to 31st December 2024. Methods: A total of 44 cases of Crimean-Congo hemorrhagic fever were identified during the period by reverse transcription polymerase chain reaction or enzyme-linked immunosorbent assay. Results: The mean age of the patient was 42.05±12.72 years. The majority of patients get the infection during May (N=7, 16%) and June (N=10, 23%). 57% of patients reported having interaction with animals, and slaughter by14% and contact with raw meat 43%. The majority of patients (N=21, 48%) were housewives. Livestock breeders represent (N=8, 18%), and Butcher represent (N=6, 14%). They lived in both rural (46.01%) and urban (33.88%) areas. Death represents (N=6, 13.7%) and patients get complete cure represent (N= 38, 86.3%). The outcome of hemorrhagic fever patients was significantly correlated with the year of infection (P<0.001). Conclusion: Crimean-Congo hemorrhagic fever is a hazardous illness that can lead to major health issues. Iraq is currently considered to be a country with a high prevalence of Crimean-Congo hemorrhagic fever

Objective: To compare the LIFT and traditional fistulotomy on the management of fistula-in-Ano with particular emphasis on the healing, recurrence of fistula, post-surgical pain, and anal sphincter functionality. Study Design: Retrospective studyPlace and Duration of Study: This study was conducted at the General Surgery Department, Sandeman Provincial Hospital / Bolan Medical Complex Hospital, Quetta from June 2025 to October 2025. Methods: The retrospective study was done in a sample of 100 patients with fistula-in-ano who underwent either LIFT (n=50) or traditional fistulotomy (n=50) at a tertiary care hospital. The demographic information, fistula type, complications, postoperative pain ratings, and recurrences were recorded. The follow-up was done at 3, 6, and 12 months to measure the healing, recurrence, and preservation of the sphincter. SPSS was used to conduct statistical analysis, and p-values were used to evaluate the significance. Results: The mean age of the patients was 38.2 ± 9.5 years. The LIFT group showed a healing rate of 90% with a 10% complication rate (mild infection). In contrast, the fistulotomy group had a 75% healing rate, with 25%experiencing recurrence and incontinence. Postoperative pain was significantly lower in the LIFT group (mean score 3.2 ± 1.1) compared to fistulotomy (mean score 6.1 ± 2.4, p < 0.05). The recurrence rate was significantly lower in the LIFT group (10%) compared to the fistulotomy group (25%, p = 0.02). Conclusion: The LIFT method had better results than the traditional fistulotomy on the treatment of fistula-in-ano, recurrence, postoperative pain, and sphincter preservation. A complex or high anal fistula is advised to undergo the LIFT procedure, and fistulotomy is effective in a simple one. The outcomes favor LIFT as a safer treatment and more effective.

Objective: To compare periilioinguinal nerve block with subcutaneous wound infiltration in below umbilical surgeries in pediatric surgical patients. Study Design: Randomised control trial study Place and Duration of Study: This study was conducted at the department of Anaesthesiology, ICU and Pain medicine at Mohiuddin Islamic Medical College teaching hospital, Mirpur, AJK from 12th May till November, 2025. Methods: This study included fifty ASA I and II elective surgical pediatric patients in a teaching tertiary care hospital. Patients were randomized into group P (Periilioinguinal block) and group S (Subcutaneous infiltration). Endotracheal tube was inserted after general anesthesia induction with ketamine and propofol. Results: Fifty elective surgery patients were randomly assigned in two groups, group P (Periilioinguinal) and group S (Subcutaneous infiltration). The minimum age in group P and S was 10 months and maximum in group P is 9 years and group S is 8 years. There were 24 males in group P and 21 males in group S while 1 females in group P and 4 females in group S. Using FLACC score, no pain noted in thirteen patients in P group vs 5 in S group which was statistically significant at 1st hour postoperatively (p<0.005). Using NRS score, no pain noted in 13 patients in P group while 5 in S group which was statistically significant at 1st hour postoperatively (p<0.005). At 6th and 12 hours, more pain noted in S than P group but not statistically significant. (p 0.345). Conclusion: Periilioinguinal nerve block improves the pain management of pediatric surgical patients compared to subcutaneous wound infiltration with bupivavaine technique making it a valuable choice in multimodal analgesia in low income countries for elective and emergency surgeries pediatric anaesthesia.

Objective: Association of coronary artery disease in peripheral artery disease patients. Study Design: Retrospective observational studyPlace and Duration of Study: This study was conducted at the Iraqi Center of Heart Disease, Iraq from 1st April 2024 to 31 March 2025. Methods: This is a retrospective observational study, with 300 peripheral arterial disease patients with computerized tomography angiography and/or peripheral angiography at the Iraqi Center of Heart Disease, Iraq and none of them had any previous symptoms and/or had ever experienced coronary artery disease. Asymptomatic coronary artery disease was detected by means of comprehensive checks, such as electrocardiogram, echocardiography, and coronary angiography. Results: The silent coronary artery disease was high with 72% of patients having peripheral arterial disease. Diabetes mellitus was also significantly correlated as 77.4% patients with coronary artery disease were asymptomatic (p= 0.008). Another highly predictive factor was reduced ejection fraction; 84.7% of ejection fraction less than 50% individuals had coronary artery disease (p=0.0001). Patients with coronary artery disease were more likely to develop lower limb peripheral arterial disease (83.2, p=0.0001). The age factor also predisposed the possibility of identifying asymptomatic coronary artery disease, and the risk was also elevating at a steady rate, 0.0512/year. Conclusion: A significant load of asymptomatic coronary artery disease in peripheral arterial disease patients, including older people, diabetics and low-ejection-fraction. Cardiovascular screening should be a routine in this high-risk group in order to prevent the emergence of complications i the future and better the clinical outcomes.

Objective: To find correlation of thigh length with adult human stature.Study Design: Cross sectional correlational studyPlace and Duration of Study: This study was conducted at the Department of Forensic Medicine and Toxicology, King Edward Medical University, Lahore from 24 May 2024 to 24 August 2024. Methods: Sixty medical students (30 males and 30 females) were enrolled, with informed consent obtained after explaining the study's purpose. Biodata, including name, age, gender, and city, was collected. Stature, inter anterior superior iliac spinal distance, and thigh length were measured per Krogman's procedures, with the measurement team trained to minimize observer bias. Results: The mean age of participants was 20.48 years (SD 1.19), with 30 males and 30 females. Those under 20 years comprised 45% (n=27), while those over 20 made up 55% (n=33). The mean thigh length was 46.18 cm (SD 2.02) and mean stature was 169.48 cm (SD 8.35). The overall correlation between thigh length and stature was 0.203 (p=0.12). In males, it was -0.106 (p=0.579) and in females, 0.099 (p=0.60). For participants under 20, the correlation was 0.167 (p=0.40), while for those over 20, it was 0.252 (p=0.158). Conclusions: This study evaluated thigh length as a predictor of adult stature, finding a weak to moderate correlation that varied by gender and age. Although it shows some potential, correlation is not strong enough to recommend it as a standalone measurement.

Objective: The objective of this study was to determine whether the Platelet-Albumin-Bilirubin (PALBI) score outperformed the traditional Child-Pugh classification in predicting outcomes, such as deaths in hospitals andsubsequent bleeding, in cirrhotic patients presenting with an acute variceal bleed.Study Design: A cross-sectional studyPlace and Duration of Study: This study was conducted at the Gastroenterology Department, Holy Family Hospital, Rawalpindi from 1 July to 31 December 2021. Methods: 68 cirrhosis patients who were admitted due to acute variceal bleeding were among them. Serum albumin, bilirubin, and platelet count were used to compute the PALBI score, and the Child-Pugh classification was also evaluated. The two main outcomes were re bleeding within four weeks and in-hospital death. Each scoring system's predictive accuracy was calculated using the Area Under the Receiver Operating Characteristic Curve (AUC). Results: A total of 68 patients were enrolled in the study, with mean age 54.32 years. 63.2% (43) were male and 36.8% (25) were female. According to Child–Pugh classification, 5.9% were Class A, 27.9% Class B, and 66.2%Class C. while 14.7% were Grade 1, 38.2% Grade 2, and 47.1% Grade 3 PALBI score. Overall, in-hospital mortality was 16.17%, occurring only in Child–Pugh Classes B (5.26%) and C (22.22%), and in PALBI Grades 2 (7.69%) and3 (28.13%). No deaths were observed in Child–Pugh A or PALBI Grade 1. Rebleeding occurred in 5.26% of Class B and 57.78% of Class C patients, and in 15.38% of PALBI Grade 2 and 71.88% of Grade 3 patients; no rebleedingoccurred in Class A or PALBI Grade 1. PALBI grade showed a strong association with both mortality and rebleeding (p < 0.001). For predicting rebleeding, PALBI demonstrated high sensitivity (85.19%) and specificity(100%), with an excellent AUC of 0.926. Although not statistically superior to Child–Pugh (AUC difference 0.0944; p = 0.0722), PALBI showed better overall performance. Conclusion: When predicting rebleeding and early mortality in individuals with acute variceal hemorrhage, the PALBI score is a trustworthy method.