Journal of Shalamar Medical & Dental College - JSHMDC
Journal of Shalamar Medical & Dental College (JSHMDC) is the official journal of the Shalamar Medical and Dental College, Lahore, Pakistan. JSHMDC is an OPEN ACCESS, peer-reviewed, multidisciplinary medical journal that publishes biannually. It publishes scholarly work from Medical Sciences and Allied Health Sciences. It is recognized by the Pakistan Medical & Dental Council (PMDC), the Higher Education Commission (HEC) of Pakistan, and the College of Physicians & Surgeons of Pakistan (CPSP). JSHMDC is indexed in the Directory of Open Access Journals (DOAJ), Index Medicus East Mediterranean Region (IMEMR), Google Scholar, Pakmedinet, Tehqeeqat, and the Asian Research Index.
Shalamar Medical & Dental College, Lahore
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Nitrofurantoin or Fosfomycin: The better choice for lower urinary tract infection?
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 4th September 2024 to 4th 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. .
Copyright (c) 2025 Sheema Yousuf, Nazli Hameed https://creativecommons.org/licenses/by-nc/4.0
The Right to Decide: Navigating Autonomy and Cultural Blindness in Critical Care (A short commentary)
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
Copyright (c) 2026 Imran Uddin, Anum Gujrati https://creativecommons.org/licenses/by-nc/4.0
Post-cessation corneal topographic changes in refractive and non-refractive soft contact lens users
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.
Copyright (c) 2026 Maheen Faizan, Muhammad Shaheer, Muhammad Anwar Awan, Amarah Rasheed https://creativecommons.org/licenses/by-nc/4.0
Perceptions and Preferences of Medical Students Regarding Contemporary Pedagogical Tools
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.
Copyright (c) 2026 Sadia Abdul Qayyum https://creativecommons.org/licenses/by-nc/4.0
Association of salivary flow rate and pH with salivary alkaline phosphatase in smokers and non-smokers with periodontitis
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.
Copyright (c) 2026 Ayesha Akram, Sofia Amjad, Hafiz Muhammad Majid Jehangir https://creativecommons.org/licenses/by-nc/4.0
Postoperative wound infection after elective abdominal gynecological procedures: Incidence, risk factors, and treatment outcomes
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.
Copyright (c) 2026 Sehrish Razzaq, Nadia Zahid, Gulfreen Waheed, Robina Kauser https://creativecommons.org/licenses/by-nc/4.0
Comparative in-vitro evaluation of antimicrobial efficacy of herbal extracts versus chlorhexidine against oral Staphylococcus aureus isolates in smokers
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.
Copyright (c) 2026 Saad Shahid, Muhammad Munir, Mirza Ameer Faizan Ali, Nida Javed, Hammad Hassan https://creativecommons.org/licenses/by-nc/4.0
Rethinking academic leadership in medical education: From seniority to scholarship and capacity building
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.
Copyright (c) 2026 Dr.Noor-i-Kiran Naeem, Dr.Gohar Wajid https://creativecommons.org/licenses/by-nc/4.0
Vaping trap: A fading breath beneath the flavors
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.
Copyright (c) 2026 Sadaf Saleem Uppal, Dr Adeela Shahid https://creativecommons.org/licenses/by-nc/4.0
Problematic mobile phone use and sleep quality in medical students: A cross-sectional study
Background: Mobile phone usage has increased significantly, with estimates of more than 1.5 billion users worldwide. Objective: To assess the level of problematic mobile phone use and its association with sleep quality among medical students. Methods: It was a cross-sectional study conducted at Lahore Medical and Dental College, Lahore, from August 2021 to February 2022. Medical students in the MBBS program who were using a mobile (smart) phone between 21 and 23 years of age, male or female and involved in clinical rotations were included in the study. A convenience sampling technique was used. A structured questionnaire was administered, comprising demographic data, the Problematic Use of Mobile Phones (PUMP) scale, and the Pittsburgh Sleep Quality Index (PSQI). Data was analyzed using SPSS 21. The Chi-square test was used to examine the associations between PUMP and PSQI. Results: Out of the 256 participants, 181 (71%) scored <62 on the PUMP scale, indicating non-problematic mobile phone use. In contrast, 75 students (29.3%) had PUMP scores ≥62 and were classified as problematic mobile phone users with a statistically significant difference in PUMP scores between problematic and non-problematic users (p < 0.001). Regarding sleep quality, 163 participants (63.6%) had a PSQI score above 5, reflecting poor sleep quality, whereas 93 (36.3%) demonstrated good sleep quality. Problematic mobile phone use did not differ significantly across demographic groups, while sleep quality differed significantly by residence, with poorer sleep quality observed among hostel residents (p = 0.037). The association between PUMP and PSQI was statistically non-significant (p = 0.134). Conclusion: It was concluded that problematic mobile phone use was not associated with poor sleep quality among medical students.
Copyright (c) 2025 Rabia Rasheed, Umbreen Navied, Humayun Mirza, Hina Ali, Ayesha Mansoor, Bensih Ziasahi https://creativecommons.org/licenses/by-nc/4.0
Association of hand grip strength and laboratory markers with frailty in patients on maintenance hemodialysis
Background: Frailty is a common yet under-recognised problem in end-stage renal disease. Objective: To assess the association between frailty and hand grip strength and to evaluate laboratory parameters as predictors of frailty in patients on maintenance hemodialysis. Methods: This study was conducted at Combined Military Hospital, Lahore, from January to February 2025, among adolescent and adult patients with end-stage renal disease undergoing maintenance haemodialysis. Key exclusion criteria included physical disabilities, poor functional status, acute kidney injury, and unwillingness. Before the start of the mid-week haemodialysis session, hand grip strength was tested on both sides three times using a handheld digital dynamometer, and the best value was recorded. The Short Physical Performance Battery (SPPB) was also administered to all patients, with scores <10 indicating frailty. Blood samples were also collected to check haemoglobin, serum calcium, phosphate, albumin, creatinine, potassium, C-reactive protein, and bicarbonate levels. Statistical analyses were performed using Spearman's rank correlation test, binary logistic regression, and receiver Operating Characteristic (ROC) curve analysis. Results: A total of 105 patients with a mean age of 55.00 ± 14.96 years were included. The mean hand grip strength was 14.32 ± 6.80 kg, below the normal reference values (>28 kg for males and >18 kg for females). Mean hand grip strength was 15.11 ± 6.95 kg on the right side and 13.52 ± 6.96 kg on the left side. The median (IQR) SPPB score was 8.00 (4.50–10.00). SPPB score showed a significant correlation with hand grip strength (r² = 0.311; p < 0.001). A hand grip strength cutoff of ≥16.95 kg demonstrated a sensitivity of 65.71% and specificity of 81.43% for discriminating non-frail status (SPPB ≥10) (AUC = 0.781; p < 0.001). None of the laboratory parameters were independent predictors of frailty (p > 0.05). Conclusion: Hand grip strength is associated with frailty and can discriminate non-frail status, while laboratory parameters are not independent predictors of frailty.
Copyright (c) 2025 Ayesha Munaf, Abdul Rehman Arshad, Aniqa Mushtaq, Rizwan Yusuf https://creativecommons.org/licenses/by-nc/4.0
Unseen struggles: The psychosocial toll of raising a child with functional neurological disorder
Background: Functional neurological disorder (FND) is characterized by neurological symptoms that are inconsistent with structural or known pathophysiological causes. Objective: To explore the psychosocial experiences of parents raising a child with FND, focusing on emotional distress, social challenges, and financial burdens. Methods: The phenomenological approach to exploratory qualitative research was used, with a nonprobability purposive sampling strategy to collect the data. The parents of children (n=12) having FND were recruited from a private hospital in Lahore, Pakistan. A demographic sheet and semi-structured interview guide were used to collect data. Braun & Clarke's (2009) 6-step approach to thematic analysis was used for data analysis in NVivo. Results: There were six fathers and six mothers of children with FND, varying between 25 and 45 years of age, with a mean age of 35±2 years, from Lahore. The themes that emerged from the thematic analysis were psychological stressors and socioeconomic and caregiving burdens. The subthemes were emotional stressors, anxiousness and depression, lack of social support, financial burdens, difficulties in time management, and social isolation and stigma. Conclusion: Having special children can affect parental interpersonal connections and psychological well-being. Healthcare leaders and authorities need to consider the special needs of affected parents.
Copyright (c) 2025 Waheed Ahmad, Moafia Dastagir, Iqbal Ahmad Azhar, Shabbir Ahmad, Saima Batool https://creativecommons.org/licenses/by-nc/4.0
Medical student syndrome: Health anxiety in medical and allied health sciences students
Background: Medical Student Syndrome (MSS) is a phenomenon in which medical students develop fears and symptoms related to the diseases they are studying, compromising their mental health and clinical performance. Objective: To compare the presence of medical student syndrome among the students of medical sciences (MBBS and BDS) and Allied health sciences (Pharm-D and DPT). Methods: A cross-sectional study was conducted at Islam Medical and Dental College, Sialkot, Pakistan, from September to November 2024. The study population comprised first- to final-year medical sciences (MBBS and BDS) and Allied health sciences (Pharm-D and DPT) students, excluding those with a history of psychological or endocrinological disorders. MSS was assessed using the Short Health Anxiety Inventory (SHAI), a validated tool evaluating health-related anxiety specifically measuring components of hypochondriasis (excessive preoccupation with illness) and nosophobia (fear of developing serious diseases). A printed questionnaire was used to collect data. Data were analysed using SPSS version 21. Results: Among 625 students, medical sciences students had significantly higher total SHAI and hypochondriasis scores compared to allied health sciences students (p = 0.031 and p = 0.046, respectively), with MBBS students having the highest scores (overall discipline effect: p = 0.006). The frequency of MSS was 20% and was not associated with socio-demographic variables, although students with MSS had significantly higher hypochondriasis and nosophobia scores (p < 0.001). Year of study showed contrasting trends: a non-significant negative association among medical sciences students and a significant positive correlation among allied health sciences students for SHAI total, hypochondriasis, and nosophobia scores (p ≤ 0.01). Conclusions: Both medical and allied health sciences students demonstrated a comparable frequency of MSS. However, medical sciences students, particularly males, exhibited higher levels of hypochondriasis, while progression with year of study was more pronounced for health anxiety among allied health sciences students.
Copyright (c) 2025 Minal Akbar, Momina Jilani, Hamza Shafique, Muhammad Daniyal Chaudhary, Minahil Shahzad, Mehwish Qamar https://creativecommons.org/licenses/by-nc/4.0
COVID-19 as a catalyst for change: Challenges and innovations in medical education
This study details the challenges faced by medical schools in Pakistan during the pandemic, including training faculty in online teaching and assessment, ensuring practical and clinical training, and proctoring online assessments. Opportunities that arise from it include the use of digital technology platforms such as LMS, webinars, Google Meet, and SurveyMonkey, as well as their integration into the curriculum. The use of virtual training tools and simulations has become an integral part of undergraduate clinical training. The study suggests investing in digital technology and artificial intelligence, faculty training, the introduction of calculus and physics, and curricular flexibility and diversity to prepare doctors for 21st-century needs.
Copyright (c) 2025 Anila Jaleel , Ghulam Farid https://creativecommons.org/licenses/by-nc/4.0
Protective role of omega-3 fatty acids against energy drink–induced structural changes in the testes of adult albino Wistar rats
Background: Energy drinks (EDs) are widely consumed beverages that enhance alertness and performance but may cause adverse histological and structural testicular changes in males. Omega-3 fatty acids (omega-3 FA) possess antioxidant and anti-inflammatory properties that may protect against such tissue damage. Objective: To evaluate the protective role of omega-3 FA against energy drink-induced histological and morphological changes in the testes of adult male albino Wistar rats. Methods: This experimental study was conducted at the University of Health Sciences (UHS), Lahore, and Postgraduate Medical Institute (PGMI), Lahore, Pakistan, for 12 weeks from June 1 to August 31, 2020. Thirty male Wistar rats were divided into three groups (n=10 each). Group A (Control) received distilled water, Group B (ED) received ED (120 mg/kg body weight), and Group C (ED+ Omega-3 FA) received ED (120 mg/kg) plus omega-3 FA (300 mg/kg) orally for 40 days simultaneously. On day 41, rats were sacrificed, and testes were dissected, fixed, and stained with hematoxylin and eosin (H&E) and Masson’s trichrome for histological evaluation. Data were analyzed using Fisher’s exact test using SPSS version 25, with a p-value ≤ 0.05 considered statistically significant. Results: Sertoli cell vacuolization was observed in 70% of animals in Group B (ED), 20% in Group C (ED + Omega-3 FA), and was absent in the control group (Group A) (p = 0.002). Interstitial fibrosis occurred in 70% of Group B and 30% of Group C, with no cases in Group A (p = 0.004). Abnormal sperm head morphology was most frequent in Group B (80%), compared to 30% in Group C and 10% in Group A (p = 0.008). These findings indicate that omega-3 FA supplementation substantially reduces ED-induced testicular damage. Conclusion: Omega-3 FA significantly protected against energy drink-induced histological and morphological changes in the testis.
Copyright (c) 2025 Qanbar Abbas Naqvi, Syeda Abeer Fatima, Areiba Haider https://creativecommons.org/licenses/by-nc/4.0
Aligning with global standards requires a 5-year dental curriculum in Pakistan
The practice of dentistry is rapidly evolving, with continuous advancements in technology, materials, and clinical techniques. In Pakistan, the existing four-year Bachelor of Dental Surgery (BDS) curriculum has remained largely unchanged for decades and is increasingly unable to accommodate the expanding scope of dental education. Limited time within the current program restricts the inclusion of contemporary courses such as dental implants, lasers in dentistry, digital dentistry, forensic odontology, and emerging research methodologies. Consequently, graduates often face challenges in meeting international standards and adapting to modern patient care requirements. A five-year dental curriculum is urgently needed to address these gaps by offering a more comprehensive educational framework. The additional year would allow integration of advanced clinical training, evidence-based practice, inter-professional education, and research opportunities without compromising foundational knowledge. It would also reduce student stress from overloaded schedules and enhance competency-based learning. Aligning with global trends, a five-year curriculum would ensure Pakistani dental graduates are better equipped to provide high-quality care, contribute to research, and compete in the international healthcare arena. Thus, extending the BDS program to five years is a critical step towards strengthening dental education and safeguarding the future of dentistry in Pakistan.
Copyright (c) 2025 Asaad Javaid Mirza https://creativecommons.org/licenses/by-nc/4.0
Estimating stature from hand and foot anthropometry: A pilot study
Background: Stature estimation is a critical component of forensic identification, particularly when dealing with incomplete human remains. While global anthropometric models exist, population-specific data for Pakistan remain scarce. Objective: To determine the correlation of hand and foot length with stature in medical students and to derive sex-specific regression equations for stature prediction, using hand and foot lengths. Methods: A pilot cross-sectional study was conducted from August 21 to September 20, 2025, in the Forensic Department of Shalamar Medical & Dental College, Lahore, Pakistan. Both male and female MBBS students (n=100), aged 20 to 25 years from a medical college, were included in the study. Standardized anthropometric techniques were used to measure hand and foot lengths and stature. Pearson's correlation test and multiple linear regression were employed to develop predictive models. Results: Significant positive correlations were found between stature and both hand and foot lengths of both sides (r = 0.688–0.773, p < 0.001), with left foot length showing the strongest correlation (p<0.001). Gender-specific regression analyses revealed that, for males, the model with left-hand and foot length explained 36.0% of the variance in stature, with foot length as the significant predictor. For females, the similar model explained 33.2% of variance, with both hand and foot length as significant predictors. Conclusion: Stature was significantly correlated with hand and foot lengths, with left foot length showing the strongest association. Sex-specific regression analyses indicated that left foot length was the main predictor in males, while left hand and left foot lengths significantly predicted stature in females.
Copyright (c) 2025 Muhammad Maqsood, Muhammad Kashif Butt, Laiba Saher, Samiullah Asif https://creativecommons.org/licenses/by-nc/4.0
Towards a culture of ethical engagement of artificial intelligence in research
Artificial intelligence (AI) is transforming the research process by reshaping how knowledge is generated, analyzed, and communicated. While AI enhances efficiency and opens new possibilities, it also introduces ethical challenges of authorship, accountability, bias, and trust. This paper emphasizes the need to move beyond compliance with policies toward building a culture of ethical engagement. Such a culture integrates ethics within scholarly identity and institutional practices through awareness, reflexivity, transparency, and inclusivity. Researchers must disclose and reflect on their use of AI tools, while institutions, journals, and funders share responsibility for ensuring literacy, fairness, and accountability. Embedding ethical reflection into training, peer review, and reward systems can help shift behavior from rule-following to genuine commitment. Developing a culture of ethical engagement ensures that the use of AI in research remains grounded in human integrity, critical judgment, and social responsibility.
Copyright (c) 2025 Noor-i-Kiran Naeem https://creativecommons.org/licenses/by-nc/4.0
Community dental visits as a catalyst for understanding oral health disparities in undergraduate dental students
Background: Oral health disparities remain a critical public health issue, highlighting the need for experiential learning in dental education Objective: To evaluate the impact of community dental visits on undergraduate dental students’ awareness, understanding, and attitudes toward oral health disparities in underserved populations. Methods: A descriptive cross-sectional study was conducted on 150 dental students (2nd to 4th year at Rehman College of Dentistry, Peshawar, Pakistan, from 1st March to 30th June 2023. Purposive sampling was done, and students participating in community dental visits were included. A newly developed questionnaire based on 04 major themes: awareness of students on oral health inequalities, role of community visits in raising awareness, socioeconomic factors underlying oral health disparities, and recommendations by students for dental curriculum modifications was used. SPSS version 22 was used for data analysis. Chi-square test and t-test were applied to compare responses. Results: A response rate of 49% (73/150) was obtained with a female-to-male ratio of 45:28. Most of the dental students in 2nd, 3rd, and 4th year (82.6%, 83.3% & 95%, respectively) agreed on the lack of oral health prioritization in primary healthcare Undergraduate dental students of the 2nd year (78-95.6%), 3rd year (76.7-93.3%) & 4th year (85-95%) recommended to increase the integration of community-based dental education in BDS. Across all years, 82–90% of the participants reported heightened motivation to address dental health disparities following community visits. There was a significant difference between responses of dental students of different years regarding awareness of oral health disparities concerning socioeconomic status (p<0.05). A greater proportion of fourth-year students (80%) agreed on the relevance of socio-economic status compared to third-year (40%) and second-year (43.4%) dental students. Conclusion: Community dental visits are an effective educational strategy for enhancing undergraduate dental students’ awareness and understanding of oral health disparities. Increasing their frequency may further strengthen students’ attitudes toward addressing these disparities in underserved communities.
Copyright (c) 2025 Dr Huma, Mahrukh Shah, Aaman Eltahmash Israr, Aslam Qamar, Haris Sardar, Sajid Ahmad https://creativecommons.org/licenses/by-nc/4.0
Etiology, clinical features, and outcomes in acute-on-chronic liver failure patients in the intensive care unit of a quaternary care center
Background: Multi-organ failure and a sharp decline in liver function are hallmarks of acute-on-chronic liver failure (ACLF), carrying high mortality. Objective: To determine the etiology, clinical presentations, and the mortality outcome in patients with acute-on-chronic liver disease. Methods: In this retrospective study, medical records of 109 patients admitted to the Intensive Care Unit (ICU) of Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan, from 1st January 2022 to 31st August 2023 with ACLF were included after ethical approval (PKLI-IRB/AP/149). Data regarding demographics, clinical features, comorbidities, Child-Turcotte-Pugh (CTP) score, Chronic Liver Failure Consortium (CLIF-C score), Model for End-stage Liver Disease-Na (MELD-Na), and ACLF grades were recorded, and their outcome in terms of mortality was noted. Results: The mean age was 47.4 ± 10.5. The primary cause of cirrhosis was hepatitis C virus (HCV) infection (52.3%), followed by cryptogenic cirrhosis (14.7%). According to the CTP score, 95.4% of the patients had Child-Pugh class C cirrhosis, and 52.3% were classified as grade 3 ACLF. Out of 109 patients, only 31 survived, with a mortality rate of 71.6%. Acute decompensation was mainly secondary to hepatic encephalopathy precipitated by infections and variceal bleeding. The non-survivors had significantly higher INR=3.4 ± 1.8 vs 2.6 ± 1.1 (p=0.002) and ammonia levels =230.1 ± 241.7 µg/dL vs 125.7 ± 65.7 µg/dL (p=0.002) on ICU admission compared to those who survived. The mean MELD-Na score at hospital admission was 32.9 ± 6.5, and in ICU admission was 34.7 ± 6.7 (p<0.001), but was not significant regarding survival (p=0.195). The CLIF-C score increased from 50.4±10.1 (in ward) to 56.1 ±10.2 (ICU transfer) (p<0.001) and was also higher in non-survivors compared to survivors (p<0.001). It is observed that increasing CLIF-C scores is a sign of poor prognosis. Conclusion: HCV infection was the most common cause of cirrhosis, and hepatic encephalopathy was the common trigger for ACLF. A high INR, hyperammonia, advanced ACLF grade, and an increase in CLIF-C score lead to poor outcomes in terms of survival, while worsening of CLIF-C scores may additionally predict short-term mortality.
Copyright (c) 2025 Saleem Sharieff, Fariha Khan, Wajid Ali Rafai, Arslan Saleem Chughtai, Burhan Ahmed, Umar Farooq https://creativecommons.org/licenses/by-nc/4.0
AI in healthcare: Weighing innovation with trust, ethics, and human touch
Artificial Intelligence (AI) is a game-changing phenomenon that has the potential to change how we communicate, work, and live completely. This is particularly true for the healthcare industry, where artificial intelligence (AI) has been applied to a wide range of fields, including medical education and training, diagnostic medicine, creating individualized treatment plans, and medical research, which has produced advances in essential fields like pharmacology and genomics.1 But as AI technology develops and becomes increasingly integrated into our daily lives, it is essential to comprehend how it affects society's socioeconomic elements and the moral and societal conundrums raised by its broad use.
Copyright (c) 2025 Professor Dr. Talat Waseem, Dr. Haseeb Arif https://creativecommons.org/licenses/by-nc/4.0
Quality of life of mothers having children with Down syndrome
Background: A mother's Quality of life (QoL) is essential not only for her own well-being but also for providing better care to her child. Objective: To assess the QoL of mothers having children with Down syndrome. Methods: A cross-sectional analytical study was conducted in ten special needs schools catering to intellectual disabilities from September 2023 to March 2024 after Institutional ethical approval (IRB Ref letter # M-22/82/-CM). The study population was mothers of children with Down syndrome. A sample size of 37 was calculated on the WHO sample size calculator, doubled to 74, and the questionnaire was administered to 100 mothers. We included mothers of children diagnosed with DS, willing biological mothers who have one child with Down syndrome, and all other normal children. Whereas, single mothers, mothers having a child with Down syndrome who also suffered from another dual diagnosis, and mothers having another chronically sick or disabled child were excluded. A convenient sampling technique was applied. Data was collected using a standardized, validated WHOQOL-BREF instrument. Results: The total QoL mean score for mothers was 84.45±14.33. Higher maternal education (p=0.007) and having a child older than 10 years (p<0.001) were significantly associated with increased mean QoL scores. Gender of the child and household income showed no statistically significant (p>0.05) associations. Conclusion: Mothers with a higher education level, a child with Down syndrome of >10 years, and a better family socio-economic status had a higher quality of Life.
Copyright (c) 2025 Saadia Shahzad, Iram Manzoor https://creativecommons.org/licenses/by-nc/4.0
Evaluation of serum Cystatin C as a predictor of eGFR in type 2 diabetic patients with nephropathy
Background: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease (CKD) worldwide. Objective: To evaluate serum Cystatin C as a predictor of eGFR in type 2 diabetic patients with nephropathy. Methods: A cross-sectional analytical study was conducted at the Department of Nephrology, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan, from 10th March to 9th September 2023. Patients with type 2 diabetes (T2D) for more than five years, both males and females, 30 to 65 years of age, and with nephropathy for the last 2 years were included in the study. Serum creatinine, serum Cystatin C (Cys-C), fasting blood sugar (FBS), glycated hemoglobin A1c (HbA1c), total protein, and albumin were measured. A spot urine sample was collected to analyze total urinary protein, albumin, and creatinine levels. The estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration (CKD-EPI) equation. One-way ANOVA, Pearson correlation test, and Linear regression analysis were done to analyze the data. Results: A total of 113 patients were analyzed, with a mean age of 55.5±6.1 years. The mean duration of T2D was 12.0±5.3 years. The mean HbA1c level was 9.1±1.3%. Based on Cys-C levels, the mean eGFR was 71.33±24.8 mL/min/1.73m². Among the participants, 43(38.1%), were suffering from Stage II, 32(28.3%) from Stage I, 32(28.3%) from Stage III, and 6(5.3%) from Stage IV CKD. A majority of 50(44.2%) of study participants had microalbuminuria. A statistically significant (p<0.001) negative correlation between eGFR and Cys-C level was observed among the study participants. Serum Cystatin C is a significant (<0.05) predictor of eGFR. Conclusion: Serum Cystatin C was a significant predictor of eGFR in type 2 diabetic patients with nephropathy. The strong negative relationship between Cystatin C and eGFR supports its potential role as a valuable marker for assessing renal function in diabetic patients.
Copyright (c) 2025 Aqsa Fatima, Pooran Mal, Zoheb Rafique Memon, Mukesh Kumar, Haseeb Jameel Memon, , Misbah Fatima https://creativecommons.org/licenses/by-nc/4.0
Metoclopramide-induced acute dystonic reaction: A case report
Metoclopramide, a common antiemetic, is associated with extrapyramidal side effects. This case report describes a 19-year-old male with dengue fever who developed involuntary muscle contractions and respiratory distress two hours after receiving intravenous metoclopramide for nausea. Despite the rare incidence (0.2% of users), the patient exhibited severe extrapyramidal symptoms, which were managed with procyclidine. The case emphasizes the need for vigilance in monitoring patients receiving metoclopramide, as early recognition and treatment of such reactions are critical to prevent complications. Clinicians should be aware of these potential side effects when prescribing metoclopramide, especially in vulnerable populations.
Copyright (c) 2025 Shafiq Ur Rahman, Rozina Roshan, Faheem Shaikh https://creativecommons.org/licenses/by-nc/4.0
Frequency and risk factors of restless leg syndrome in pregnant women
Background: Restless leg syndrome (RLS) is a prevalent neurological condition in pregnancy, and is associated with poor maternal and fetal outcomes Objective: To determine the frequency and the risk factors leading to restless leg syndrome in pregnant women. Methods: A cross-sectional descriptive study was conducted from 3rd December 2023 to 2nd June 2024, at the Obstetrics & Gynecology department of Bilawal Medical College and affiliated Countess of Dufferin Fund Hospital, Jamshoro, Pakistan. Pregnant women from all trimesters, aged 20–40 years, were recruited using non-probability consecutive sampling after obtaining informed consent. Pregnant women having painful legs, peripheral neuropathy, akathisia, nocturnal leg cramps, peripheral vascular disease, pre-gestational diabetes, renal failure, and varicose veins were excluded. RLS was diagnosed based on the 2012 revised International RLS Study Group (IRLSSG) criteria. 5 mL of blood was collected for complete blood count (CBC) and iron studies. Data analysis was performed using SPSS Version 22. Results: A Total of 204 participants were included. The mean age of the pregnant women was 24.83±4.41 years. RLS was observed in 97 participants (47.5%), with the remaining 107 (52.5%) unaffected. RLS was most prevalent in the third trimester, accounting for 22.5% of cases. Most women were multiparous (152, 74.5%), while 52 (25.5%) were nulliparous. Iron deficiency anemia was identified as a significant risk factor for restless leg syndrome, with an odds ratio of 7.839 (p < 0.001). Additionally, gestational hypertension (OR=2.679, p=0.041) and chronic hypertension (OR=9.418, p=0.003) were significantly associated with an increased risk of RLS. Conclusion: Restless leg syndrome affected nearly half of the pregnant women studied, with the highest prevalence observed in the third trimester. Iron deficiency anemia, gestational hypertension, and chronic hypertension were found to be significant risk factors for RLS, highlighting the need for early identification and management of these conditions during pregnancy.
Copyright (c) 2025 Zainab Memon, Nusrat Nisar, Bakhtawar, Rabia, Ghazala, Sidra https://creativecommons.org/licenses/by-nc/4.0
Correlation between computed tomography findings and liver function parameters in chronic liver disease
Background: Chronic liver disease (CLD) leads to cirrhosis, hepatocellular carcinoma (HCC), and liver failure. Non-invasive assessment tools are crucial for the early detection and management of these complications of CLD. Objective: To determine the correlation between computed tomography findings and liver function parameters in patients with chronic liver disease. Methods: This retrospective study was conducted in the Department of Radiology, Lady Reading Hospital, Peshawar, Pakistan from December 2024 to January 2025 after obtaining the Institutional ethical approval (Ref. No. 569 MTI/LRH). Medical records of 276 patients with CLD from 1st October 2023 to 30th September 2024 were reviewed. Data were retrieved from the radiology department and laboratory information systems. Data of adult patients were included if they had undergone a contrast-enhanced computed tomography (CT) and liver function tests (LFTs) and hematological tests done within seven days of the CT scan. CT reports were assessed for cirrhosis, ascites, splenomegaly, portal vein thrombosis (PVT), and hepatocellular carcinoma. LFTs and hematological tests included ALT, AST, bilirubin, albumin, INR, and platelet count. Statistical analysis involved Pearson’s correlation and multivariate logistic regression. Results: Cirrhosis was present in 96.7%, ascites in 64.1%, splenomegaly in 47.8%, PVT in 40.2%, and HCC in 73.9%. There was a significant negative correlation (r= –0.81, p<0.001) between cirrhosis and serum albumin levels. The severity of ascites correlated positively (r=0.70, p=0.008) with serum bilirubin levels and INR (r=0.60, p=0.010), indicating worsening of hepatic function. Splenomegaly was significantly correlated with reduced platelet counts (r = –0.75, p< 0.001). Conclusion: CT findings in chronic liver disease showed significant correlations with liver function parameters. Cirrhosis correlated with low albumin, ascites severity with elevated bilirubin and INR, and splenomegaly with thrombocytopenia. These findings highlight the complementary role of CT imaging and biochemical markers in assessing disease severity and hepatic dysfunction.
Copyright (c) 2025 Moeen ud din Khan Khalil, Syed Kazim Shah Bukhari, Syed Murtaza Shah Bukhari, Mian Zia Shah, Mian Raza Shah https://creativecommons.org/licenses/by-nc/4.0
Assessment of metacognition levels: A cross-sectional study among dental professionals in Pakistan
Background: Metacognition plays a pivotal role in learning, particularly in dentistry, enabling individuals to effectively manage their cognitive processes and identify areas for improvement. Objective: To evaluate the degree of metacognition among dental professionals at various phases of their careers. Methods: A cross-sectional study was conducted, using a non-probability sampling technique in private dental hospitals of Lahore from April to June 2024. A total of 320 dental professionals consented to participate. Data collection involved a semi-structured questionnaire and the Metacognitive Assessment Inventory (MAI), comprising two overarching domains – knowledge about cognition and regulation of cognition, each with three and five subdomains, respectively. Data were analysed using SPSS version 25. Descriptive statistics were computed, and one-way ANOVA and post hoc analysis were used to evaluate group differences. A p-value of <0.05 was considered statistically significant. Results: Consultants demonstrated significantly higher total cognitive knowledge scores than house officers (16.4 versus 8.5, respectively). This trend extended across subdomains, including procedural, conditional, and declarative knowledge. Similarly, consultants outperformed other participants in cognitive regulation (32.9 versus 17.6, respectively), particularly in planning and evaluation. Subdomains such as information management, communication, and debugging strategies were significantly higher in consultants than in graduate dentists, house officers, and postgraduates. General dentists had the highest cognition score among all the others (p<0.05). Conclusion: The metacognition level of consultants and general dentists was highest among dental professionals. It underscores the importance of fostering self-learning among dental professionals, particularly through developing their metacognitive abilities.
Copyright (c) 2025 Tayyaba Nayab, Kaynat Jahangir, Ammara Chaudhry, Annam Imtiaz, Tooba Saeed, Malik Adeel Anwar https://creativecommons.org/licenses/by-nc/4.0
Forensic investigation of electrocution: Examining electrical injury profiles in Hyderabad, Pakistan
Background: Electrocution-related deaths in Pakistan are a significant public health concern, demonstrating the interplay of electrical safety, infrastructural issues, and socioeconomic status. Objective: To investigate the forensic characteristics of electrical injuries. Methods: This cross-sectional study examined 175 electrocution death cases that were autopsied at the Civil Hospital, Hyderabad, Pakistan, mortuary in one year from November 2023 to December 2024. We gathered and examined information on burn patterns, anatomical distribution of injuries, voltage levels, wound sites, injury types, cause of mortality, and gender differences. Information was obtained from eyewitness statements, police inquest documents, and autopsy results using a structured information proforma and checklist. Results: Out of 175 dead bodies examined, the majority were males (90.3%), and 34.8% were between 21 and 30 years of age. The results indicate a predominance of upper limb injuries (37.8%) and a high incidence of low-voltage injuries (78.3%). Cardiac arrest has emerged as the leading cause of mortality (41.7%), underscoring the critical role of infection in post-injury complications. The gender wise differences of injury location, degree of burns, and mortality cause were found statistically significant (p<0.05). Conclusion: Electrical injuries, particularly those involving low-voltage sources, have a significant impact on specific body areas, notably the upper limbs, and are linked with a high risk of septic complications that can ultimately lead to death.
Copyright (c) 2025 Qadri Naveed Ali, Nahyoon Waheed Ali , Dr. Mukkaram Ali, Dr. Sadia Abdul Qayyum, Dr. Alia Sarfaraz https://creativecommons.org/licenses/by-nc/4.0
Exploring burning mouth syndrome: Diagnosis and management of an unusual presentation: A case report
Burning Mouth Syndrome (BMS) is a chronic pain condition of the oral mucosa without visible lesions and may be linked to systemic disorders. A 45-year-old male with anemia, gastroesophageal reflux disease (GERD), and suspected Crohn’s disease presented with a persistent burning sensation, primarily on the tongue. Clinical findings included mucosal atrophy, gingival pigmentation, cobblestoning, and generalized chronic periodontitis. He was diagnosed with BMS Type 1, and systemic symptoms prompted further evaluation, raising suspicion for Crohn’s disease. A multidisciplinary approach was initiated. This case highlights the rare association between BMS and Crohn’s disease and emphasizes the role of oral signs in identifying systemic illness.
Copyright (c) 2025 Dr. Maarij Zubair, Dr. Muhammad Dawood, Dr. Nida https://creativecommons.org/licenses/by-nc/4.0
Comparative outcomes of Piperacillin-Tazobactam versus Ceftriaxone in managing spontaneous bacterial peritonitis in cirrhotic patients: An observational study
Background: Spontaneous bacterial peritonitis (SBP), a serious complication of liver cirrhosis, demands prompt antibiotic treatment, but rising resistance to ceftriaxone has spurred interest in alternative therapies. Objective: To compare the treatment outcomes of Piperacillin-Tazobactam versus ceftriaxone in spontaneous bacterial peritonitis among cirrhotic patients. Methods: This comparative observational study was conducted from 1st January to 1st July 2023 at the Services Institute of Medical Sciences, Lahore, Pakistan. A total of 218 cirrhotic patients, 18-60 years of age, diagnosed with SBP based on an ascitic fluid polymorphonuclear (PMN) count >250/μL, were enrolled using non-probability consecutive sampling. On the physician’s discretion, patients receiving Piperacillin-Tazobactam (4.5 g IV every 8 hours) were allocated to Group A (n=109) and those receiving Ceftriaxone (2 g/day) were allocated to Group B (n=109). Treatment response was observed on day five by assessing clinical improvement and repeat ascitic fluid analysis. A Chi-square test was conducted using SPSS version 22 for statistical analysis. Results: The mean age of the study population was 35.7 ± 6.5 years, with 61.93% male patients. A higher proportion of patients treated with Piperacillin-Tazobactam (75.2%) showed resolution of SBP by day 5 compared to those receiving Ceftriaxone (62.4%). Although there was a difference in the response to the treatments (χ²=3.61, p=0.0574), it was statistically not significant. Across stratified subgroups, age, gender, symptom duration, Child-Pugh score, and PMN count for the Piperacillin-Tazobactam (group A) showed higher, though statistically insignificant, treatment response rates compared to Ceftriaxone (group B). Conclusion: Piperacillin-Tazobactam showed a higher, though statistically insignificant, resolution rate of SBP compared to Ceftriaxone. This trend was consistent across age groups, gender, symptom duration, Chil-Pugh score, and PMN count, suggesting a potential clinical advantage.
Copyright (c) 2025 Azhar Hussain , Muhammad Umer Sheikh, Ambreen Tauseef, Hafiz Ghulam Mohayudin, Hira Sadaqat, Waqar Ahmed Siddiqui https://creativecommons.org/licenses/by-nc/4.0