Pakistan Postgraduate Medical Journal

THE JOY OF DISCOVERY: WHY MEDICAL COLLEGES MUST ENCOURAGE STUDENT RESEARCH

Muhammad Farooq Afzal — Thu, 01 Jan 2026 07:15:37 +0000

Research lies at the heart of medical education. It is not an optional pursuit but the very spirit of inquiry that transforms information into knowledge and knowledge into discovery. The joy of research is not confined to large, well-funded laboratories; it begins with curiosity, a well-formed question, and the courage to seek answers. For medical students, even modest project,a case report, a clinical audit, or a literature review can provide the first spark of discovery and a sense of contribution to the wider body of medicine. Medical colleges bear a responsibility far greater than the transmission of facts. As Iqbal reminded us, education must nurture 'the spirit of inquiry and the search for truth.¹ Without fostering research, our institutions risk producing technicians rather than thinkers. The father of nation emphasized that the youth of Pakistan must build character and knowledge in service of the nation.² Encouraging student research is thus both an academic and moral imperative. It elevates the reputation of colleges, enhances clinical outcomes³, and most importantly, aligns education with the real health needs of our communities.⁴ For students, research is transformative. It sharpens critical thinking, problem-solving, and resilience while offering a competitive edge in postgraduate training and global opportunities.⁵More profoundly, it instills the joy of contribution. In countries like Pakistan, where disease burdens and healthcare realities differ from the West, generating local evidence is crucial.⁶ Without it, we remain consumers of global science; with it, we become producers and policy shapers. The call, therefore, is clear. Our medical colleges must integrate research as a core mission, and our students must embrace it as part of their professional identity. In doing so, we honor the vision of Iqbal and Jinnah, and ensure that medical education becomes not just a path to practice, but a gateway to discovery.

A FUNCTIONAL AND SURGICAL OUTCOMES OF DELAYED EARLY VERSUS LATE REPAIR OF OBSTETRIC ANAL SPHINCTER INJURIES, A RETROSPECTIVE COHORT STUDY

Saeeda Bano, Farooq Ahmad, Afia Riaz — Fri, 02 Jan 2026 04:15:31 +0000

Background: Obstetric anal sphincter injuries (OASIS) remain a significant cause of postpartum anal incontinence and impaired quality of life among women. Standard management involves immediate primary repair; however, missed or inadequately repaired injuries often necessitate secondary reconstruction. Current practice varies between delayed-early repair (within 2–21 days after delivery) and late repair (≥3 months postpartum), yet evidence on comparative outcomes remains limited.

Objective: This study aims to compare functional outcomes (continence, quality of life) and surgical outcomes (wound complications, dehiscence, rupture, and fistula formation) between delayed-early and late anal sphincter repair in women with obstetric anal sphincter injuries.

Methods: This single-centre retrospective cohort study at Sahiwal Teaching Hospital (2014–2024) reviewed women undergoing delayed early and late anal sphincter repair by the same surgeon for ten year time period. All patients received standardized postoperative care.

Results: Sixty women were analyzed (29 delayed early repair; 31 late repair). Mean blood loss, Wexner scores, postoperative pain, and quality-of-life measures (daily life interference, pad use, constipation medication, and urgency) were comparable between groups, with no statistically significant differences (p > 0.05). Both approaches achieved similar short-term clinical and functional outcomes.

Conclusion: our study suggests that both delayed early and late repairs can be effective and safe when performed by experienced surgeons with standardized postoperative protocols. Delayed early repair may offer the advantage of faster recovery and reduced risk of dyspareunia or fistula, though these trends require validation in larger studies

EFFECT OF COTTON PAD PLACEMENT REINFORCED WITH AN ELASTIC CREPE BANDAGE IN EARLY RESOLUTION OF INFANTILE UMBILICAL HERNIA

Fri, 02 Jan 2026 04:18:02 +0000

Background: Umbilical hernia (UH) in infants is typically identified as a bulge in umbilical region in early couple of months, appearing after the shedding off the umbilical cord. It occurs when a sac lined by peritoneum protrudes from umbilical ring, due to its incomplete closure.¹This failure of the umbilical ring to close properly contributes to the formation of an umbilical hernia.

Objectives: To evaluate the effectiveness of a conservative approach using a cotton pad reinforced with a crepe bandage (Ammannaya’s technique) in promoting the resolution of infantile umbilical hernia.

Methods: This RCT was conducted at The Children’s Hospital, Lahore. Ethical approval from institutional review board obtained and trails was also registered to Thai Clinical Trials Registry. A total of 108 infants (≤3 years) with umbilical hernia were enrolled and randomly allocated into an intervention group (cotton pad with crepe bandage) and a control group (observation only), with 54 patients in each arm. Patients were followed at 4 and 8 weeks, and chi-square test was used for comparison of resolution rates.

Results: Of these 108 patients, 65 (60.2%) were male and 43 (39.8%) female, with most infants younger than 6 months (77.8% intervention vs. 87.0% control). At 4 weeks, resolution found in 25.9% of the intervention group whereas occurred in 9.3% of the control group (p = 0.023). By 8 weeks, cumulative resolution was found to be higher in the intervention group (59.2%) in comparison with the control group (37.1%) (p = 0.029). Closure was more common in infants <6 months, whereas resolution was rare in older infants irrespective of management. No complications were observed with the intervention.

Conclusion: Application of a cotton pad with crepe bandage accelerates and increases the resolution rate of infantile umbilical hernia compared with observation alone. This low-cost, safe, and practical technique may serve as an effective conservative alternative, particularly in resource-limited settings

COMPARISON OF LUNG EXPANSION AFTER UNIPORTAL AND MULTIPORTAL VIDEO ASSISTED THORACIC SURGERY FOR STAGE II POST-PNEUMONIC BACTERIAL EMPYEMA THORACIS

Zeeshan Sarwar, Hassan Iftikhar, Muhammad Shoaib Nabi — Fri, 02 Jan 2026 04:22:21 +0000

Background and Objectives:

Background: Empyema is a condition that thoracic surgeons encounter in daily practice. Traditionally, the surgical approach was open thoracotomy; then the multiportal VATS approach became more common. Recently, more surgeons are adopting the uniportal VATS approach, which has become a powerful surgical tool for managing stage II empyema.

Objectives: To evacuate the pus and fibrin deposits in the thoracic cavity for complete lung expansion.

Methods: It was a parallel-armed randomized control study in which 160 patients admitted to the (Department name), (Hospital name), Lahore were included. The patients were divided into two equal groups (80 in each group). (Uniportal group) Group-A patients underwent uniportal VATS, while (Multiportal group) Group B patients were treated with multiportal VATS. Simple consecutive sampling was carried out. Expansion of lung was evaluated postoperatively at the 1^st, 3^rd, 7^thand 15^th postoperative day by chest radiograph after uniportal and multiportal VATS.

Results: The age of patients ranged from 20 to 73 years, with a mean age of 35.73 ± 10.67 years. The mean operative time was 211.08 ± 12.92 minutes in group A and 226.94 ± 9.75 minutes in group B. Mean intraoperative blood loss was also 47.73 ± 11.11 ml in group A and 97.49 ± 15.67 ml in group B. Lung re-expansion was observed in 76 (95%) patients in group A and 75 (93.75%) patients in group B. Postoperative pain scores on the visual analogue scale in group A were 3.48 ± 0.75 on day 1, 2.63 ± 0.40 on day 3, and 2.22 ± 0.53 on day 7. In group B, postoperative pain scores were 3.95 ± 0.87, 3.05 ± 0.81, and 2.53 ± 0.67 on days 1, 3, and 7, respectively.

Conclusion: Uniportal and multiportal VATS are feasible treatment options in all patients with pleural empyema requiring surgery. In our study, we observed comparable postoperative success rates, no need for conversion, and successful completion of decortication via both multiportal and uniportal approaches. The transition to a single-incision technique was associated with fewer chest tubes, minimal surgical trauma, and no compromise in clinical outcomes.

BROAD-SPECTRUM CEPHALOSPORIN CEFTAROLINE: A NEW OPTION AGAINST METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS

Fri, 02 Jan 2026 04:24:54 +0000

Background: Methicillin-resistant Staphylococcus aureus (MRSA) can cause variety of hospital-acquired and community-associated infections with limited treatment options. Ceftaroline belong to cephalosporin class showed effective bactericidal activity against MRSA and several other ESBL producing gram-negative rods.

Objectives: To check the activity of ceftaroline against MRSA

Methods: This was a cross-sectional study design and was done in Pathology department of AIMC over the period of two years. MRSA isolated from different clinical samples was confirmed phenotypically and sensitivity testing for different antimicrobials was done on Mueller-Hinton agar. MIC determination of MRSA was done by E-strip method.

Results: Total 282 MRSA isolates was collected along with maximum number was isolated from pus samples (49.2%), followed by wound swabs (18.7%). MRSA isolates showed 100% sensitivity against ceftaroline and vancomycin. MIC range was 0.25 to 4 µg/mL against MRSA isolates. While maximum number of isolates of MRSA showed inhibition at 1 µg/mL.

Conclusion: Ceftaroline showed excellent bactericidal activity against MRSA and can be used effectively to treat (cSSTI). It is considered safe to use because it is well-tolerated with minimum adverse reactions.

PREVENTIVE ROLE OF OCIMUM BASILICUM AGAINST CYCLOPHOSPHAMIDE INDUCED PRIMORDIAL FOLLICULAR ATROPHY IN ADULT FEMALE ALBINO RATS

Saba Saleem, Hadia Zulfiqar; Arooj Nawaz; Mehak Shafiq; Noor Ijaz, Kanwal Sharif — Fri, 02 Jan 2026 04:27:31 +0000

Background: Cyclophosphamide, the alkylating chemotherapeutic drug is commonly used in treatment against wide variety of carcinomas. This drug has known antifertility effects on gonads of young female patients. A natural herb known as Ocimum Basilicum has been found rich in polyphenols and is known to significantly improve fertility because its strong antioxidant potential.

Objectives: To assess the preventive ability of the natural herb, Ocimum basilicum extract against atrophic changes induced by cyclophosphamide in primordial follicles.

Methods: Total number of female albino rats used was 45. All were evenly distributed into three groups: Group A was control, group B and group C were experimental. There were 15 rats present in each one of these groups. On the 8th day of the experiment, rats in group A were administered a single intraperitoneal injection of normal saline (150 mg/kg). Group B rats were administered, on day 8 of experiment, a single intraperitoneal injection of cyclophosphamide (150 mg/kg). Rats in group C were fed with methanolic extract of basil seeds for 7 days. After that, rats were injected with a single intraperitoneal dose (150 mg/kg) of cyclophosphamide on day 8. The rats were euthanized and dissected after 48 hours of administration of cyclophosphamide.

Results: Results showed the significant improvement in state of primordial follicles between groups B and C (p-value 0.003), in terms of number of rats showing atrophic primordial follicles i.e., 11 rats (80%) in experimental group B and only 4 (26.7%) in experimental group C.

MODULATORY EFFECTS OF HYALURONIC ACID AND PIROXICAM ON SYNOVIAL IL-6 AND MMP-13 IN RAT MODEL OF OSTEOARTHRITIS

Fri, 02 Jan 2026 04:30:05 +0000

Background: Osteoarthritis, a degenerative joint disorder, is characterized by synovial inflammation, cartilage degradation, and elevated proinflammatory mediators including interleukin-6 (IL-6) and matrix metalloproteinase-13 (MMP-13). This study evaluates and compares the modulatory effects of intra-articular hyaluronic acid (HA) and piroxicam (PIRO) on IL-6 and MMP-13 levels in a rat model of OA.

Methods: OA was surgically induced in 24 Sprague Dawley rats and animals were randomly assigned to three groups (control, HA, and PIRO) with 08 rats in each group. saline water, hyaluronic acid and piroxicam were administered intra-articularly once weekly for four weeks. Synovial lavage samples were collected post-treatment and analyzed for IL-6 and MMP-13 levels. Data was analyzed using SPSS, (p≤0.05) was considered statistically significant.

Results: Both HA and PIRO significantly reduced synovial IL-6 (p=0.001) and MMP-13 (p=0.003) and (p<0.00 l) respectively when compared to control group. No significant difference was found between HA and PIRO groups (p>0.05), suggesting comparable anti-inflammatory efficacy.

Conclusion: Both hyaluronic acid and piroxicam equally reduce IL-6 and MMP-13 levels in the synovial lavage fluid of a rat model of osteoarthritis.

COMPARISON OF ALL ARTHROSCOPIC VS MINI OPEN ROTATOR CUFF REPAIR: A RETROSPECTIVE ANALYSIS OF TWO TECHNIQUES

Fri, 02 Jan 2026 04:32:39 +0000

Background: Shoulder pain is a common presenting complaint in orthopedic clinic and among the causes of pain, Rotator cuff (RC) tears is a major contributing factor. Many studies have looked at numbers and in the United States alone, up to 250,000 Rotator Cuff Repairs (RCRs) are done annually. Regarding surgical management of RC tears, tradition open repair, mini-open repair and arthroscopic repair have been used by surgeons.

Methods: Once institutional review board approval was received, a retrospective study was performed. Convenience sampling technique was applied. After excluding the patients not meeting our study criteria, a final sample of 115 patients was analyzed: 60 combined arthroscopically assisted mini-open RCR (cRCR), and 55 all-arthroscopic RCR (aRCR).

Results: Our final study population was 115 patients which underwent either mini-open or arthroscopic RCR at our hospital. . First cRCR( combined arthroscopic and mini-open) groups had 60 patients, 60%(n=36) male and 40%(n=24) female patients. In the three month post operative period there were total 2 complications, 4 re-do surgeries and 1 re-hospitalization.

Conclusion: Our study has clearly demonstrated that both techniques for RC repairs, cRCR and aRCR have comparable clinical outcomes Patients in aRCR group had higher cost of surgery and more time spent in theatre.

Key words: rotator cuff repair, arthroscopy, mini-open technique

HISTOPROTECTIVE EFFECTS OF COQ10 AGAINST VITAMIN D3 INDUCED CARDIOTOXICITY IN ALBINO RATS

Fri, 02 Jan 2026 04:35:34 +0000

Background: Vitamin D₃ toxicity is increasing due to its easy availability and unprescribed use of vitamin D₃ supplements. With the increasing awareness about vitamin D₃ deficiency and increase in number of prescriptions by physician without proper laboratory investigation may leads to increased risk of vitamin D₃ toxicity.

Objectives: To determine the toxic effects of Vitamin D₃ on cardiac muscles and to evaluate the cardioprotective effects of Coenzyme Q₁₀ on Vitamin D₃ induced cardiotoxicity in albino rats.

Methodology: Animals were randomly divided into four groups with 10 animals in each group. Group I (Control), Group II (Vitamin D₃ at 2 mg/kg/day for 4 weeks), Group III (Vitamin D₃ + CoQ₁₀ 10mg/kg/day simultaneously for 4 weeks) and Group IV (Vitamin D₃ for 2 weeks followed by CoQ₁₀ 10mg/kg/day for 2 weeks). Histological features such as nuclear status, branching pattern, mononuclear infiltrates, calcium deposition and fibrosis in cardiomyocytes using hematoxylin-eosin, Masson's trichrome, and Von Kossa staining were studied.

Results: Group II showed significantly deranged cardiomyocyte architecture, fibrosis and calcification. Group III showed normal cardiomyocyte architecture. Group IV showed partial histological recovery, suggesting reduced efficacy with delayed intervention.

Conclusion: Combined use of Coenzyme Q₁₀ and Vitamin D₃ prevented myocardial tissue injury, and ultimately maintaining proper functioning of cardiac tissue

Key words: cholecalciferol, cardioprotective, cardiotoxicity, Coenzyme Q10, Fibrosis, Calcification.

THE AMELIORATIVE EFFECT OF FOENICULUM VULGARE (FENNEL/SAUNF) ON BLOOD OVALBUMIN-INDUCED ALLERGIC AIRWAY INFLAMMATION

Fri, 02 Jan 2026 00:00:00 +0000

Background: Allergic asthma is a chronic inflammatory disorder driven by Th2-type immune responses. Current treatments include corticosteroids and bronchodilators, which are effective but often associated with systemic side effects. This study investigates the anti-inflammatory effect of Foeniculum vulgare methanolic seed extract (FME) in an ovalbumin (OVA)-induced allergic airway inflammation model in BALB/c mice.

Methods: Forty mice were randomly divided into five groups (n=8): normal control, disease control (OVA-sensitized), standard treatment (OVA + dexamethasone), and two test groups treated with 200 mg/kg and 300 mg/kg FME. All treatments were given orally for 7 days prior to final OVA challenge. Blood was collected to assess total leukocyte count (TLC), eosinophil, lymphocyte, and neutrophil percentages. Data were analyzed via one-way ANOVA followed by Tukey’s post-hoc test (p<0.05).

Results: Disease control group exhibited significantly elevated TLC and eosinophils (p<0.001). Both FME-treated groups showed significant reduction in TLC and eosinophil count. Lymphocyte levels also declined, while neutrophils remained statistically unchanged. Effects were comparable to dexamethasone.

Conclusions: FME demonstrated potent anti-inflammatory activity, particularly in reducing eosinophilia and total leukocytes, highlighting its potential as a safe plant-based alternative in asthma management.

Keywords: Foeniculum vulgare, asthma, eosinophils, ovalbumin, inflammation, BALB/c mice

HISTOPROTECTIVE EFFECTS OF VITAMIN E ON ALENDRONATE INDUCED GASTRIC ULCERS IN ALBINO RATS

Fri, 02 Jan 2026 04:40:45 +0000

Background: Gastric ulcer is a serious precancerous disease. The pathogenesis of gastric ulcer is due to the imbalance of shielding factors and risk factors. Oxidative damage also plays an important part in its pathogenesis. Alendronate is the main bisphosphonate used for Osteoporosis but affects GIT badly. Vitamin E is the main antioxidant which prevents the oxidative damage.

Objectives: To evaluate the gastro protective effects of Vitamin E on gastric mucosal injury produced by Alendronate.

Methods: Twenty-one adult albino rats were divided into three groups. Group I was the control group, group II was given Alendronate 3mg/kg for 28 days and group III was given Vitamin E 400IU/100gm followed by Alendronate 3mg/kg after 1 hour, for 28 days. On 29^th day, all rats were sacrificed and specimens of stomach were preserved for tissue processing and sectioning. H&E staining was used to see epithelial integrity, extent of ulcer, inflammatory infiltrates and hemorrhage.

Results: The epithelial integrity was disrupted in Group II (Alendronate) while Group I (Control) and Group III (Vitamin E and Alendronate) had intact epithelium. Most of the ulcers were extended up to epithelium of Group II (Alendronate). Neutrophil infiltrate and microscopic hemorrhages were also seen in Group II (Alendronate) but not in Group III (Vitamin E and Alendronate).

Conclusion: The study showed that Vitamin E had provided gastro protection against Alendronate induced gastric ulcer in rats. There was reduction in gastric mucosal erosion in the Group III which was given Vitamin E along with Alendronate.

CLINICAL EVALUATION OF 1% OXICONAZOLE CREAM FOR DERMATOPHYTOSIS: EFFICACY AND TOLERABILITY

Fri, 02 Jan 2026 04:43:39 +0000

Background: Dermatophytosis, also known as ring worm is a common fungal infection that affects a significant portion of the global population. In Pakistan, Tinea corporis, Tinea cruris, Tinea Pedis are most common fungal infections. Oxiconazole has recently been introduced in Pakistan for treatment of dermatophytosis.

Objectives: To evaluate clinical efficacy of 1% oxiconazole cream once daily for treatment of tinea corporis, tinea cruris and tinea pedis and to estimate its side effects.

Methods: A clinical trial was carried out in the outpatient department of Dermatology, Akhtar Saeed Trust Hospital, EME, Lahore.110 patients of Dermatophytosis were selected and were instructed to apply 1% oxiconazole cream once daily for 6 weeks with clinical assessment made fortnightly during treatment period.

Results: The mean age of patients were 40.5 years. Numbers of male patients were 48 and female patients were 62. Among 110 patients, tinea corporis were found in 58 (52.7%), tinea cruris in 29 (26.3%) and tinea pedis in 23 (20.9%) patients. Mean clinical assessment score declined from 8.2 + 1.5 at baseline to 4.1+1.2 at week 2, 1.5 +1.3 at week 4 and 0.6+ 1.1 at week 6. Reduction of clinical assessment from baseline at end of the treatment period was statically significant (p < 0.001). Improvement of clinical score from baseline was 50.1% at week 2, 92.6% at week 4, 95.2% at week 6. Global response was clear in 77(70%), good in 32(29%) patients and fair in 1 (1%). Side effects like pruritus, erythema and burning were not reported in any patient.

Conclusion: Once daily application of 1% oxiconazole cream is highly effective, affordable and tolerable treatment for dermatophytosis.

THE ROLE OF CALCITONIN GENE-RELATED PEPTIDE AND PENTRAXIN-3 IN MIGRAINE PATHOPHYSIOLOGY AND DIAGNOSIS

Fri, 02 Jan 2026 04:46:59 +0000

Background: Migraine is a prevalent neurological disorder characterized by neurovascular dysregulation and inflammation. Biomarkers such as calcitonin gene-related peptide (CGRP) and pentraxin-3 (PTX3) may play a key role in migraine pathophysiology.

Objective: To evaluate serum CGRP and PTX3 levels in migraine patients compared with healthy controls and explore their clinical associations.

Methods: A cross-sectional study was conducted including migraine patients (n=40) and age-matched controls (n=40). Demographic, clinical, and triggering factors were recorded. Hematological parameters, CGRP, and PTX3 levels were analyzed. Data were assessed using Mann-Whitney U and t-tests with significance set at p<0.05.

Results: Migraine patients showed significantly higher CGRP (99.6 vs. 14.8 ng/L) and PTX3 (100.5 vs. 31.1 pg/L) levels compared with controls (p<0.001). Neutrophils were elevated while lymphocytes were reduced in migraineurs. Stress, skipping meals, and photophobia were the most frequent triggers.

Conclusion: Elevated CGRP and PTX3 levels indicate their involvement in migraine pathogenesis and potential as biomarkers for diagnosis and prophylactic therapy development.