Journal of Shalamar Medical & Dental College - JSHMDC

The Right to Decide: Navigating Autonomy and Cultural Blindness in Critical Care (A short commentary)

2026-06-25T03:37:15+00:00

This commentary article highlights an ethical dilemma in critical care in which patient autonomy was disregarded in favor of family decision-making. It examines the impact of cultural insensitivity on end-of-life care, emphasizes the importance of respecting patients’ choices, and advocates for advance directives and supportive policy frameworks to promote equitable, patient-centred care. The paper concludes that advocating for patient autonomy within culturally sensitive care requires balancing ethical obligations with compassion, fostering shared decision-making, and establishing institutional frameworks that safeguard patients’ voices throughout the care process

Comparative in-vitro evaluation of antimicrobial efficacy of herbal extracts versus chlorhexidine against oral Staphylococcus aureus isolates in smokers

2026-06-25T03:36:29+00:00

Background: Staphylococcus aureus is an opportunistic oral pathogen that can colonize in smokers due to alterations in the oral microbiome.

Objective: To assess and compare the antimicrobial effectiveness of herbal extracts (Azadirachta indica (neem), Syzygium aromaticum (clove oil), Ocimum tenuiflorum (Tulsi), and Camellia sinensis (green tea)) versus chlorhexidine against Staphylococcus aureus in smokers.

Methods: This in vitro experimental study was conducted at Azra Naheed Medical and Dental College from December 2025 to March 2026 on 100 adult smokers. Dental plaque samples were collected from 100 adult smokers, from which Staphylococcus aureus isolates were obtained and tested. Herbal extracts of Azadirachta indica (neem), Syzygium aromaticum (clove oil), Ocimum tenuiflorum (Tulsi), and Camellia sinensis (green tea) were prepared using ethanol extraction and compared for antimicrobial activity using the agar well diffusion method. Chlorhexidine (0.2%) was used as a control. Mean inhibition zones were compared with one-way-ANOVA.

Results: Chlorhexidine showed the largest inhibition zone (24.70±3.57), followed by clove oil (19.40±4.11), green tea (14.10±3.92), Tulsi (15.30±3.25), and Neem showed the smallest zone (12.01±2.58mm) (p<0.001). There was a significant difference in mean inhibition zones between chlorhexidine and clove (p<0.001), whereas no significant difference was observed between green tea and Tulsi (p=0.116). An inverse correlation was observed between the number of cigarettes smoked per day and the zone of inhibition for green tea (r=−0.213, p=0.033), but no significant correlation was observed with chlorhexidine (r=0.029, p=0.778).

Conclusion: Chlorhexidine demonstrated the greatest antimicrobial efficacy against oral S. aureus isolates from smokers, followed by clove oil, green tea, Tulsi, and neem. Further optimization of herbal agent concentrations may enhance their clinical applicability.

Postoperative wound infection after elective abdominal gynecological procedures: Incidence, risk factors, and treatment outcomes

2026-06-25T03:36:37+00:00

Background: Postoperative wound infections are a significant complication of elective abdominal gynecological surgery, contributing to prolonged hospital stay, increased costs, and additional interventions.

Objectives: To determine the incidence of postoperative wound infections, identify associated risk factors, and evaluate treatment outcomes among women undergoing elective abdominal gynecological procedures.

Methods: This prospective observational study was conducted at Avicenna Medical College Hospital in Lahore from April to November 2025. Of 138 consecutively enrolled women, 23 were lost to follow-up, leaving 115 for final analysis. Risk factors were recorded, and all patients were followed for 30 days. Fisher's exact test and relative risk (RR) with 95% confidence intervals (CI) were calculated for statistical analysis.

Results: Cumulative incidence of postoperative wound infection was 12.17% (14/115), with 92.86% of cases detected after hospital discharge. Significant risk factors were duration of surgery >120 minutes (RR 4.26, p=0.013), intraoperative blood loss >500 ml (RR 4.05, p=0.018), and antibiotic administration <60 minutes before incision (RR 4.66, p=0.011). Antibiotic prophylaxis significantly reduced the risk of infection (RR 0.29, 95% CI 0.12–0.73, p=0.012). Elevated BMI, anemia, and diabetes showed increased risk but did not reach statistical significance. Infected patients had a longer hospital stay (4.4 days vs 2.0 days), corresponding to an excess of 2.4 days. Of 14 infected patients, 9 (64.3%) were managed conservatively, while 5 (35.7%) required surgical re-intervention. 50% required readmission for management.

Conclusion: Postoperative wound infection occurred in 12% of women, with 92.86% detected after discharge. Duration of surgery, blood loss, and delayed antibiotic administration were significant risk factors, whereas prophylaxis was protective. Most infections responded to conservative management, though 50% required readmission and 35.7% required re-intervention, underscoring the need for structured post-discharge surveillance.

Nitrofurantoin or Fosfomycin: The better choice for lower urinary tract infection?

2026-06-25T03:37:23+00:00

Background: Almost 50%-60% of women have at least one episode of urinary tract infection (UTI) during their lifetime.

Objective: To determine and compare the effectiveness of oral Fosfomycin and nitrofurantoin in women of reproductive age with lower UTIs.

Methods: A quasi-experimental study was conducted in the urogynaecology department of Shalamar Hospital, Lahore, Pakistan, from 4^th September 2024 to 4^th March 2025. A total of 392 females presenting with symptoms of lower urinary tract infection were included. Participants received empirical treatment with either nitrofurantoin (Group A) or Fosfomycin (Group B) orally after providing a baseline urine sample for culture and sensitivity testing. The primary outcome was the assessment of clinical resolution at the first follow-up visit on day 7. The second follow-up visit on day 14 was conducted to assess bacterial eradication. Data were analyzed using SPSS version 21.

Results: Nitrofurantoin use was associated with higher clinical improvement (82% vs. 71%, p=0.016) and bacteriological resolution (91% vs. 84%, p=0.020) compared with Fosfomycin. Diarrhea was the predominant adverse effect reported more frequently with Fosfomycin use (12.7% vs 6.1%, p=0.02). Nitrofurantoin users achieved faster recovery of symptoms when compared with Fosfomycin e.g., dysuria relief in 2.4 vs 3.1 days (p=0.003), urinary frequency decreased in 3.1 vs 4 days (p=0.005), suprapubic pain settled in 2.9 vs 3.5 days (p=0.04), better post-treatment quality of life in 8.8 vs 8.2 days (p=0.009), and greater willingness to reuse the drug in 89% vs 78% (p=0.008).

Conclusion: Nitrofurantoin demonstrated superior clinical and bacteriological efficacy over Fosfomycin, with faster symptom resolution and greater patient satisfaction, supporting its use as the preferred first-line agent for uncomplicated lower UTIs. Fosfomycin remains a viable alternative where adherence is a concern.

Perceptions and Preferences of Medical Students Regarding Contemporary Pedagogical Tools

2026-06-25T03:36:59+00:00

Background: Contemporary pedagogical tools in medical education encompass modern, student-centered teaching strategies that move beyond traditional lectures.

Objective: To explore perceptions and preferences regarding the use of contemporary pedagogical tools among medical students.

Methods: A descriptive cross-sectional study was conducted at Liaquat National Medical College, Karachi, from 1st July to 30th September 2024. Using a census approach, 500 MBBS students from all five academic years completed a validated online questionnaire assessing their preferences for five active learning strategies (Clinical Rotations, Problem-Based Learning, Practical Sessions, Team-Based Learning, Flipped Classroom) and three didactic learning strategies (PowerPoint Presentations, Lectures, and Videos). Data were analyzed using SPSS version 24.0 with descriptive and inferential statistics.

Results: Clinical rotations were the most preferred teaching method, showing the highest levels of engagement (83.8%), comprehension (74.2%), critical thinking (70.6%), conceptual clarity (61.4%), and individual learning fit (67.45%). Problem-based learning also performed strongly, particularly for critical thinking (71.0%), while videos ranked similarly for conceptual clarity and learning fit (~60%). The flipped classroom was the least preferred across all domains, with engagement as low as 23.1%. Clinical rotations significantly outperformed the flipped classroom in all domains (p < 0.001; rank-biserial r = 0.58–0.63), while problem-based learning and videos also showed significant advantages (p = 0.002–0.004; r = 0.30–0.35).

Conclusion: Medical students demonstrated a clear preference for Clinical rotations, problem-based learning, and videos over passive lectures or flipped classrooms. To prepare competent, practice-ready physicians, programs should blend structured teaching with these highly engaging, real-world instructional methods.

Post-cessation corneal topographic changes in refractive and non-refractive soft contact lens users

2026-06-25T03:37:07+00:00

Background: The use of soft contact lenses (SCLs) can alter corneal thickness, curvature, and surface regularity. Understanding these effects is important for optimizing lens use and preventing long-term corneal complications.

Objective: To compare corneal topographic changes between refractive and non-refractive cosmetic soft contact lens users and to assess recovery after a two-week cessation period.

Methods: A quasi-experimental study was conducted after approval by the Ethical Review Board of the College of Ophthalmology & Allied Vision Sciences (COAVS), King Edward Medical University, Lahore, Pakistan, from 1st May, 2024 to 30th July, 2025 A total of 56 participants (28 refractive and 28 non-refractive SCL users), aged 18–35 years, who had used SCLs for at least 6 months (10 hours/week), were included in the study. Corneal topography was performed immediately after lens removal and two weeks after cessation of SCL use. Quantitative variables were summarized as mean ± SD. Paired and independent t-tests were performed using SPSS 25; p ≤0.05 was considered significant.

Results: Following a two-week cessation of soft contact lens wear, both refractive and non-refractive lens users demonstrated statistically significant increases in corneal thickness. In refractive users, the thinnest corneal thickness and central corneal thickness increased by 14.18 µm and 14.34 µm, respectively (both p<0.001). However, comparison of mean changes between refractive and non-refractive users revealed no statistically significant differences for any corneal parameter (all p>0.05).

Conclusion: Reversible changes in corneal topography are observed in refractive and non-refractive soft contact lens users. A two-week cessation period appears sufficient to allow corneal recovery.

Association of salivary flow rate and pH with salivary alkaline phosphatase in smokers and non-smokers with periodontitis

2026-06-25T03:36:46+00:00

Background: Changes in salivary flow rate, pH, and salivary alkaline phosphatase (S-ALP) may reflect periodontal disease activity in smokers.

Objective: To determine the association of salivary flow rate and salivary pH with salivary alkaline phosphatase in smokers and non-smokers with periodontitis.

Methods: This cross-sectional study was conducted at Azra Naheed Medical & Dental College from February to December 2025. A total of 200 adults (100 smokers with ≥5 pack-years and 100 non-smokers) aged 18-40 years with clinically diagnosed periodontitis were recruited by consecutive sampling. Unstimulated whole saliva was collected by passive drool for 5 minutes. Salivary pH was measured with a calibrated pH meter, and S-ALP was measured by spectrophotometry. Data was analyzed using SPSS version-25.

Results: There was a significant difference in salivary pH (5.64±0.514 vs. 7.02±0.12, p<0.001) and S-ALP (59.67±34.28 vs. 31.73±18.86, p<0.001) between smokers and non-smokers, respectively, while the difference in salivary flow rate was non-significant (Smokers:0.648±0.136 vs. Non-smokers:0.652±0.257 mL/min; p=0.880). There is a negative correlation of salivary flow rate (r=-0.651, p<0.001) and salivary pH (r=-0.450, p<0.001) with S-ALP among smokers; in non-smokers, only salivary flow rate (r=-0.560, p<0.001) showed a negative correlation with S-ALP. Among smokers, salivary pH showed a significant association with elevated S-ALP levels (p-value < 0.001), and among those with acidic salivary pH, 77.4% had elevated S-ALP levels compared with 22.6% with normal levels.

Conclusion: Smokers with periodontitis show significantly lower salivary pH and higher S-ALP than non-smokers. Since salivary pH is associated with elevated S-ALP among smokers, pH can serve as a useful marker for monitoring smoking-related periodontal biochemical changes.

Rethinking academic leadership in medical education: From seniority to scholarship and capacity building

2026-06-25T03:36:20+00:00

Despite the evolving expectations of academic leadership in health professions educaiton, leadership appointments in many low- and middle-income countries, continue to rely predominantly on years of service rather than demonstrated leadership competencies. This editorial disucsses the limitations of seniority-based leadership and throws lights on a holistic framework encompassing scholarship, educational expertise and leadership potential. In addition, importance of faculty development, leadership training, and transparent governance processes in preparing future academic leaders is highlighted.

Vaping trap: A fading breath beneath the flavors

2026-06-25T03:36:12+00:00

Electronic cigarettes, commonly called vapes, have become very popular especially among young people in recent years. Many users believe that vaping is a safe or less harmful choice compared to traditional cigarettes, but this thinking is not fully supported by the available evidence. The appealing flavors, colorful packaging, and social media promotion have played a big role in attracting adolescents and even children toward these products. Emerging research is now showing that vaping can cause serious damage to the lungs, heart, and other body systems, and nicotine addiction can begin very quickly. There is a strong need for better public awareness, stricter regulations, and more research to protect especially the younger generation from falling into this trap.