Pakistan Armed Forces Medical Journal (PAFMJ) is bi - monthly medical journal published by Army Medical College, Rawalpindi, Pakistan. The Pakistan Armed Forces Medical Journal follows "CC BY NC creative commons" licensing https://creativecommons. org/licenses/by-nc/4.0/. PAFMJ is an open access journal and is included in Directory of Open Access Journals (DOAJ). Online ISSN : 2411-8842 Print ISSN : 0030-9648 The journal is recognised by Higher Education Commission (HEC) and PM&DC of Pakistan and is Indexed and abstracted in Scopus. Covered by: Google Scholar
WATER DRINKING TEST: AN OUTDATED MODALITY OR STILL A USEFUL TEST WHILE MANAGING PATIENTS OF GLAUCOMA
Objective: To compare the mean rise in intraocular pressure in patients with primary open angle glaucoma following water drinking test, with healthy individuals. Study Design: Quasé-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi from September 2011 to March 2012. Patients and Methods: One hundred and twenty eyes that fulfilled the laid down criteria were enrolled and the intra-ocular pressure was measured before and 45 minutes after the water drinking test (WDT). Difference in IOP before and after WDT was calculated in both cases (of glaucoma) and controls and mean difference in IOP was compared in both the groups. A difference of 6 mm Hg before and after water drinking test was considered significant. Results: After WDT, IOP was increased significantly in cases as well as the controls but the increase in IOP was significantly higher in cases than the controls. Conclusion: It is concluded from this study that the comparison of difference between mean baseline intraocular pressure and mean intra-ocular pressure after 45 minutes of water drinking test between cases and controls was statistically significant.
Copyright (c) 2015 https://creativecommons.org/licenses/by-nc/4.0
Seventy-Five Years of Academic Excellence: Commemorating the Legacy and Future Vision of the Pakistan Armed Forces Medical Journal (PAFMJ)
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc/4.0
Ethics before Evidence: The Essential Role of IERB Approval in Research Integrity
In medical research, where new ideas and discoveries enhance our understanding of life, ethical principles must come before evidence. The Institutional Ethical Review Board (IERB) upholds ethical standards, ensuring that the pursuit of knowledge never compromises human dignity and moral responsibility. Every researcher must first seek the approval of IERB, not as a formality, but as an essential step toward responsible and credible research.1 The idea of ethical review boards is not new. Its roots traced back to the mid-20th century, when the world was confronted with the horrifying violations of human rights during unethical experiments in medicine and science. The Nuremberg Code in 1947 and later the Declaration of Helsinki in 1964 marked the beginning of global awareness about the need to protect research participants.2 Over time, countries and institutions developed their own frameworks to ensure ethical oversight, and the concept of IERB was created as an institutional mechanism to protect participants, promote ethical standards, and uphold research credibility.
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc/4.0
From Foundation to Future: 75 Years of PAFMJ and Its Global Aspirations
The PAFMJ is one of the few South Asian biomedical journals that was created within the original framework of military and civilian collaboration within the medical field.1 The first volume of the PAFMJ was published with very few resources and personnel; however, it laid the foundation for a strong future. By the time it completed its first decade of publication (1950-1965), the PAFMJ had already published over one hundred scientific papers in a wide variety of newly emerging areas of medicine, such as pathology, virology, and tropical medicine.2 These early contributions were made by a small group of people, usually done on typewriters, and demonstrated an enormous amount of perseverance and curiosity that has led to the success of the PAFMJ today. Between the years 1970 to 2000, PAFMJ transitioned from an institutional newsletter to an organized, nationally recognized medical journal. The establishment of the Army Medical College and Department of Basic Medical Sciences in the late 1970s created the foundation for the journal’s institutionalization. In addition, the 1990s witnessed dramatic changes that significantly improved the quality and credibility of PAFMJ. These changes included the establishment of an Editorial Advisory Board, under the direction of Surg Gen DGMS(IS), and adherence to best practices for medical journals (e.g., adoption of Vancouver style for references and implementation of a strict policy of double-blind peerreviewed evaluations to eliminate bias in manuscript evaluations. In keeping with these changes, PAFMJ expanded its publication cycle to a regular quarterly format, whereas, before this, it was published sporadically. Thus, by 2005, PAFMJ had become a regular, and therefore a mainstay, scientific journal in the biomedical sciences of Pakistan with four issues published each year by following the ICMJE and COPE standards for editorial processes.3
From Relief to Resilience: Strengthening Disaster Preparedness for Health and Education Sectors
The destruction caused by recent calamities shows one of the long-standing global failures: excessive dependence on short-term aid and insufficient investment in preparedness and strength. Health and education, both vital in a crisis, are particularly prone to disruption. The transition to proactive resilience instead of reactive relief is not only essential but also possible, as there is increasing evidence to support this notion. Health systems are the first line of defense during emergencies. A 2025 study has developed a practical Emergency Preparedness and Health System Resilience Assessment Tool that allows governments to identify gaps and take resilience-building actions first.1 Conceptually, resilience is now more clearly defined: a recent analysis clarifies qualities, including absorptive, adaptive, and transformative capacities that collectively define the way systems withstand shocks.2 However, despite conceptual advances, operational issues remain.
Association of SNP rs533864137 with Severe and Early Diabetic Nephropathy in the Pakistani Population
Objective: To explore the association between SNP rs533864137 and diabetic nephropathy in a Pakistani cohort using tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Study Design: Case-Control study. Place and Duration of Study: Center for Research in Experimental and Applied Medicine (CREAM), within the Department of Biochemistry & Molecular Biology, Army Medical College, Rawalpindi, Pakistan from Nov 2020 to Aug 2024. Methodology: A total of 213 participants, comprising 113 DN Patients and 100 Controls with diabetes but without nephropathy, were included. Genomic DNA was extracted from blood samples, biochemical analysis was performed to ascertain cases and Controls, and SNP rs533864137 was genotyped using ARMS-PCR. Statistical analyses evaluated the distribution of genotypes and alleles between the Groups and assessed the SNP's association with DN. Results: Among Controls, 97(97%) individuals had the GG genotype, and 3(3%) had the GA genotype. In the DN Group, 100(99.1%) exhibited the GG genotype, while 1(0.9%) was homozygous for the AA genotype. No significant differences in genotype distribution were observed between Groups (p=0.310). Statistical analysis confirmed that rs533864137 was not significantly associated with DN (p>0.05). Conclusion: SNP rs533864137 does not appear to be associated with DN in this population. These findings suggest that rs533864137 may not serve as a reliable genetic marker for assessing DN risk in the studied cohort.
Diabetic Nephropathy, SNP rs533864137, Tetra Primer-ARMS-PCR, CBR1 Gene.
Copyright (c) 2025 Syed Zubair Hussain Shah https://creativecommons.org/licenses/by-nc/4.0
We deeply regret to announce that Prof. Brig. Munir Ahmed Cheema passed away in Rawalpindi due to heart failure. Born in Punjab, Prof. Cheema earned his MBBS from King Edward Medical College, Lahore. He completed a house job in Surgery at Mayo Hospital, then pursued postgraduate and Fellowship training in Orthopaedic Surgery in the UK, followed by advanced training in the USA. Upon his return to Pakistan, Prof. Cheema joined the Pakistan Armed Forces Medical Services on 22nd June 1967. He served as an Orthopaedic Surgeon at various Army and Air Force hospitals. He developed Orthopaedic Departments at several Military Hospitals across the country and significantly advanced orthopaedic care within the Armed Forces.
Student-Centered Assessment - Contentions, Reticence and the Way Forward
There is probably more bad practice and ignorance of significant issues in the area of assessment than in any other aspect of higher education. This would not be so bad if it were not for the fact that the effects of bad practice are far more potent than they are for any aspect of teaching. Students can, with difficulty, escape from the effects of poor teaching, they cannot (by definition if they want to graduate) escape the effects of poor assessment”. 1 The last hundred years have witnessed milestone developments in the domain of curriculum development and teaching - learning in medical education The focus of medical education has shifted from the teacher-centeredness to student-centeredness. However, this focus has yet to include assessment practices. Assessment has always been and will remain to be the most critical component of medical education in terms of its impact on the student, the system of education and the regulatory requirements. Learning, being the central outcome of any educational programme, is the main purpose of all educational interventions. Assessment not only authenticates, quantifies and certifies learning but it also evaluates the teachers, educational programme, the systems that are designed to actualize learning and the impact of learning. Therefore, if assessment is not focused on learning it loses its purpose. There is no doubt that assessment drives learning but if it does not follow the purpose for which it was designed, it can disrupt learning with lifelong consequences for the student, the system and the end-user of health care– the patient. 2
Role of Programmed Ventricular Extrastimulation in Differentiating Atrioventricular Nodal Re-entrant and Atrioventricular Re-entrant Tachycardias in Supraventricular Tachycardias
Objective: To evaluate the diagnostic effectiveness of Programmed Ventricular Extrastimulus (PVE) during supraventricular tachycardia (SVT) in differentiating atrioventricular nodal re-entrant tachycardia (AVNRT) from atrioventricular re-entrant tachycardia (AVRT). Study Design: Analytical Cross-Sectional Study Place and Duration of Study: Electrophysiology Department, Armed Institute of Cardiology/National Institute of Heart Disease, Rawalpindi, Pakistan, from Mar to Aug 2025 Methodology: A total of 180 adult patients (aged ≥18 years) of either gender with suspected or documented supraventricular tachycardia (SVT) or inducible tachycardia during an electrophysiology (EPS) study were enrolled. Both ventricular entrainment and PVE (V2) pacing techniques were applied to record electrophysiological parameters, including stimulus-to-atrial minus ventriculoatrial (SA-VA) time and post-pacing interval minus tachycardia cycle length (PPI–TCL). Based on EPS findings, patients were classified into two groups: AVNRT (n=90) and AVRT (n=90). Results: Among 180 patients, the AVNRT group included 53 males (58.9%), and the AVRT group had 64 males (71.1%). The mean age was 45.50 ± 15.31 years in the AVNRT group and 34.29 ± 11.78 years in the AVRT group (p<0.001). AVNRT patients exhibited significantly longer PR intervals (168.59 ± 9.81 ms) and shorter VA intervals during SVT (53.47 ± 7.94 ms) compared to AVRT patients (145.33 ± 12.58 ms and 166.1 ± 9.91 ms, respectively; p<0.001). Using the V2 technique, an SA–VA interval cutoff of 92.00 ms achieved 100% sensitivity and specificity for differentiating AVNRT from AVRT, with an AUC of 1.00 (95% CI: 1.00–1.00, p<0.001).. Conclusion: PVE from the right ventricle (V2) shows excellent diagnostic accuracy in differentiating AVNRT from AVRT..
Atrioventricular Nodal Re-entry. Re-entrant, Sensitivity and Specificity, Stimulus, Supraventricular tachycardia
Copyright (c) 2025 Momina Najam, , Qurban Khan, Atif Rauf, Waheed Ur Rehman https://creativecommons.org/licenses/by-nc/4.0
Comparison of Methylene Blue versus Patent Blue Dyes in Sentinel Lymph Node Biopsy: A Prospective Study at A Tertiary Care Hospital
Objective: To compare the diagnostic accuracy of Methylene blue versus patent blue dyes in the identification of sentinel lymph node (SLN) on biopsy, and compare clinical patient outcomes, including adverse effects and local tissue effects. Study Design: Quasi-Experimental study. Place and Duration of Study: Department of Breast Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2025. Methodology: A total 240 were divided to identify sentinel lymph node using Methylene blue (n=120) versus patent blue dyes (n=120). Primary variable studied was the diagnostic accuracy of both dyes in detection of sentinel lymph node compared with the actual histopathology report. Secondary variables studied were incidence and frequency of adverse effects between both groups. Results: Diagnostic comparison of Methylene blue compared to actual histopathology results showed a diagnostic accuracy of 90.0% while comparison of patent blue dye showed a diagnostic accuracy of 95.8%. Frequency of adverse effects showed that hypersensitivity was seen in 05(4.2%) versus 07(5.8%) patients (p=0.769), skin rash was seen in 04(3.3%) versus 08(6.7%) patients, bronchospasm was seen in 00(0%) versus 02(1.7%) patients (p=0.498), confusion was seen in 01(0.8%) versus 03(2.5%) patients (p=0.622), dizziness was seen in 02(1.7%) versus 05(4.2%) patients (p=0.446) and nausea was seen in 02(1.7%) versus 04(3.3%) patients (p=0.684). Conclusion: The study concludes that, combined with the radioisotope, both methods show comparable detection rates for sentinel lymph nodes with a favorable and comparable adverse effects profile.
Breast, Biopsy, Blue, Dye, Lymph, Methylene, Node, Sentinel
Copyright (c) 2025 Ayesha Javed, Saman Naz, Syeda Rifaat Qamar Naqvi, Aqsa Saleema, Zohra Akram, Syeda Saima Qamar Naqvi https://creativecommons.org/licenses/by-nc/4.0
Post-Flood Mental Health Crisis:: Neglected Consequences of Natural Disasters
Floods are often put into perspective within the frame of visible destruction, such as houses and agricultural lands ruined, and damaged infrastructure. Still, the psychological damage that they cause to the victims is no less terrible and is left in them even when the water subsides. Research conducted globally has indicated that floods cause recovery booms of depression, anxiety, and post-traumatic stress disorder (PTSD) in societies that are already poor and have weak health systems. Psychological consequences of natural disasters are a crisis to be considered and be included in the disaster preparedness and disaster recovery policies. The systematic review of the consequences of flooding found a linear association with large levels of depression and PTSD particularly among individuals who were displaced or had their means of livelihood destroyed.1 Greater evidence exists on natural disasters confirming the same trends: exposure to natural disasters is a major risk of mood and anxiety disorders and the impact of disasters on mental health is also likely to be long-term over the years.2 Longitudinal support of this image includes one study, which monitored participants both prior to and following floods, and found sharp rises in distress, anxiety, and PTSD symptoms during the post-disaster period.3 It was found that the exposure to disasters enhances prevalence rates of common mental disorders across all settings, but the extent and duration of the impact varies with vulnerability factors.4 However, interventions remain a few. A meta-analysis of prevention strategies found very little evidence of support of psychosocial interventions in the aftermath of natural hazards and stated that there was much to be desired on scalable mental health responses to the flood-affected population.5
Pioneers of Medical Profession in Pakistan: Contributions of Armed Forces Doctors
It is nice to remember the pioneers of the medical profession in Pakistan. In the Civil setup, the Armed Forces personnel are generally not well known, and their contributions are often overlooked in published articles. In this article, the contributions of the Armed Forces doctors as pioneers and their role in developing the medical profession in the early period of Pakistan are described. At independence, the Pakistan Armed Forces inherited well-developed psychiatric units at major Military Hospitals with both indoor and outdoor facilities. Military Hospital Rawalpindi had a major psychiatric unit, which also trained postgraduates. Maj M. Shoaib (later Maj Gen) was the Head of the unit. He was trained in psychiatry before the partition and was the first to acquire D.P.M. (Lond) from Pakistan (at that time, it was the major qualification in psychiatry). CMH Lahore had a well-known psychiatrist, Maj Thaker Das. Later, Major General Ishrat Hussain and Brigadier Fazle-Haq made contributions. In the civil institutions, psychiatric units emerged decades later.
Genomics and Molecular Services in Developing Economies: a Suggested Road Map to Incorporate Technology in Parallel to the Emerging Landscape of Genetic Service Provision AI AI-Driven Arena
1. Science has never stayed static but has been evolving, revolutionizing, and opening out in 360 degrees. From the prehistoric invention of the wheel to the development of the “James Webb Telescope,” it was all hard work, allowing headway towards the envisioned redefinition of scientific discovery, which has led to the current day scientific boom. What we learn over time is that ‘change’ is the only constant in any human development and discovery. Recent landmark innovations of biotechnology and ambitious exploration of the human genome have allowed mining of the intricate ‘cellular life’ to enlighten our species with DNA and RNA world illuminating us with a tsunami of newer diagnostics and possibly therapeutics.1 Molecular sciences and genomics over recent decades to replace the conventional in clinical science with the potential to emerge as definitive medical tools for diagnostics. It can be an easy deduction to foresee that the genomics era has ushered in fast with more robustness to muscle much-needed depth now needed in clinical diagnostic care.2 The swarming growth of diagnostic markers has steadily entered the clinical corridors, necessitating a nationwide need for ‘standard of care in Molecular Pathology. 3
Comparison of 3-D Plates and Conventional Miniplates in the Management of Symphysis and Parasymphysis Fracture of the Mandible: A Single-Blinded Randomized Controlled Trial
Objective: To compare the surgical outcome and postoperative complications of symphysis and parasymphysis fractures in 3-D and conventional miniplating systems. Study Design: Randomized Controlled Trial. Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Combined Military Hospital, Peshawar Pakistan, from Aug 2023 to Sep 2024. Methodology: According to the inclusion criteria, 33 patients were eligible who were then divided into two groups. The anterior mandible fractures in Group A (n=17) were treated with 3-D mini plates, and those in Group B (n=16) were treated with conventional mini plates. Results: Demographic characteristics were compared but none were found to be statistically significant. Out of enrolled 33(58.0%) patients, were randomized into two groups: 17(27.4%) in Group A (3-D plating) and 16(25.8%) in Group B (conventional miniplates). The results observed were not statistically significant for stability, pain, and wound dehiscence in three consecutive follow-up visits (p-value>0.05). However, malocclusion, evident on the first postoperative day in 4(25.0%) patients of Group B, was found to be statistically significant (0.027). Conclusion: Better surgical outcomes and minimal postoperative complications were noted among patients offered 3-D plates compared to conventional miniplates and appreciable results were noted, especially in achieving satisfactory occlusion.
Mandibular Fractures, Maxillofacial Injuries, Open Fracture Reduction, Oral Surgical Procedures
Copyright (c) 2025 Aminah Khan, Chaudry Muhammad Usman, Muhammad Afzal, Hafiz Abubakar Ghufran, Muhammad Wasi Ullah Khan, Maliha Lateef https://creativecommons.org/licenses/by-nc/4.0
Ultrasonographic Measurement of Optic Nerve Sheath Diameter for Detection of Raised Intracranial Pressure in Critically Ill Patients; A Novell, Non-Invasive and Point of Care Test
Objective: To determine the diagnostic accuracy of bedside Ultrasonographic measurement of Optic Nerve Sheath Diameter for detection of raised Intracranial Pressure in critically ill patients in comparison with CT scan brain. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Anesthesia and Critical Care Medicine, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University Islamabad, Pakistan from Jun to Nov 2019. Methodology: Patients with clinical suspicion of raised ICP underwent Ultrasonographic measurement of ONSD by Principal Investigator within one hour prior to shifting of the patients to Radiology suite for CT scan brain to prevent diagnosis bias. The Ultrasonographic measured ONSD value of 5.0 mm was the cutoff limit for detecting raised ICP in our study. The CT scan brain reports were considered positive if findings suggested radiological features of raised ICP like Cerebral edema/effacement of ventricle or cisterns, midline shift or sub arachnoid haemorrhage. The diagnostic accuracy of Ultrasonographic measurement of ONSD for detection of raised ICP was then determined by comparing the results with radiological diagnosis of raised ICP by CT scan brain. Results: We enrolled total 120 patients in this study. The patients included in our study were suffering from different diseases like Traumatic Brain Injury (TBI), Meningitis, Encephalitis, Space Occupying Lesions (SOLs), Eclampsia, Stroke and Metabolic encephalopathy with different percentages. The ultrasonographic measured ONSD value range was from minimum 4.7 to maximum 6.9 with mean value of 6.1 mm. The sensitivity was 95.5%, specificity 91.3%, positive predictive value 93.2%, negative predictive value 98.5% where ultrasonographic measured ONSD value of 5.0 mm was taken as a cutoff limit. In our study ultrasonographic measured ONSD values showed good diagnostic accuracy for raised ICP detection in comparison with CT scan brain. Conclusion: We found that ONSD measured through bedside ultrasound is very useful for diagnosis and risk stratification of incipient intracranial hypertension in pregnant patients with pre-eclampsia and eclampsia where invasive monitoring is hazardous due to deranged coagulation profile.
New Dimensions of Pelviperineology:: Integral Theory and Nattive Tissue Repair in Pelvic Floor Disorders
Pelviperineology is evolving rapidly, propelled by ground breaking conceptual frameworks and innovative surgical techniques that reshape our understanding and management of pelvic floor disorders. Among these, the Integral Theory— pioneered by Professor Peter Petros—stands out as a transformative paradigm that offers a comprehensive, biomechanical explanation for conditions like anterior and posterior vaginal prolapse, as well as urinary incontinence.1 The Integral Theory fundamentally redefines pelvic floor dysfunction as a consequence of ligamentous and fascial laxity, disrupting the intricate balance of forces required for normal pelvic organ support and function.1,2 The ligament-based system offers a new way forward. It is a different way of thinking. In contrast to previous thinking; the ligament-based system aims primarily to treat the pelvic symptoms even if prolapse is minimal. This is because even a slightly altered anatomy can cause severe symptoms.
Factors Affecting Health-Related Quality of Life in Tuberculosis Patients: A Systematic Review
Objective: To systematically review and synthesize published evidence on the physical, psychosocial, and socioeconomic factors influencing health-related quality of life (HRQoL) among patients with tuberculosis (TB). Data Sources: This study used four primary databases (PubMed, Scopus, Medline, and Web of Science). MeSH terms and keywords (“TB”, “QoL”, “HRQoL”, “PROMs”, “patient reported outcomes”) with Boolean operators to identify global peer-reviewed studies on TB about HRQoL and sociodemographic variables. Study Selection: English-language, open-access articles (2012-2024) on adult TB patients’ HRQoL using quantitative or qualitative methods were included. Studies on pediatric, extrapulmonary TB populations or specific comorbidities, and non-original articles were excluded. Screening was performed by two independent reviewers, with arbitration as needed. Data Extraction: Using a standardized PRISMA-guided approach data was summarized for study characteristics and HRQoL domains (physical, psychological, and socioeconomic). Meta-analysis was not conducted due to heterogeneity in study designs, measurement tools, and outcomes. Data Synthesis: Twenty-nine studies revealed that TB significantly impairs HRQoL, persistent physical symptoms, early psychological distress (e.g., depression, anxiety), and socioeconomic hardship were common. Stigma and low social support further reduced the adherence and well-being. Peer and nutritional support showed positive effects but underutilized. Conclusion: This review underscores the broad impact of TB on HRQoL, with persistent physical symptoms, psychological distress, stigma-related isolation and socioeconomic hardship. Findings emphasize the need for community-based support and integrated policies to enhance recovery and reintegration beyond medical treatment.
Comprehensive Interventions, Economic Burdens, Health-Related Quality of Life, Social Support, Stigma
Copyright (c) 2025 Ruhamah Yousaf, Asita Elengoe, Muhammad Riaz , Abid Hussain Shah https://creativecommons.org/licenses/by-nc/4.0
Comparison of Learning Styles and E-Health Literacy among Undergraduate Medical Students
Objective: To assess the learning styles and eHealth literacy among undergraduate medical students and to compare eHealth literacy scores across gender and different learning style domains (Visual, Auditory, kinesthetic and Read/write). Study Design: Analytical cross-sectional study. Place and Duration of study: Department of Medical Education, Fazaia Medical College Islamabad, Pakistan from Jan to Feb 2025. Methodology: Data was collected using pre-validated Visual, Aural (auditory), Read/Write, and Kinesthetic (VARK) and e-Health Literacy Scale (eHEALS) from 152 students of first and second-year MBBS using convenience sampling. After excluding two participants with multiple missing values, data was analyzed. Descriptive statistics, reliability, independent t-test, ANOVA and Pearson’s correlation were used for data exploration and analysis. Results: With response-rate of 76.0% and male: female ratio of 1:1.27, this study shows that in unimodal category Kinesthetic 70 (46.7%) is most predominantly prevalent style while Visual 06(4.0%) and Read/Write 04(2.7%) are least preferred learning styles. Multimodal style was observed in 22(14.7%) individuals. This pattern was replicated across genders as well. eHEALS shows mean score of 27.44+5.83 with 86(57.3%) students in developing, 42(28.0%) in high and (n=20;13.3%) in low e-health category. No significant relationship was found between e-Health literacy and learning styles or gender. There was significant strong negative relationship between different learning styles (p<0.05). Conclusion: Medical students' digital health literacy is not related to learning styles or gender. Students may have single or multimodal learning styles but this does not impact their e-Health literacy.
Digital Health Competence, eHealth literacy, Medical Education, Undergraduate Medical Education, VARK model.
Copyright (c) 2025 Marium Sohail, Nadia Amanat https://creativecommons.org/licenses/by-nc/4.0
Outcome of Distal Humeral Fractures: An Experience to Evolve
Objective: To evaluate the functional outcomes of distal humerus fracture fixation using locking plates and screws, focusing on fracture reduction, fixation stability, and post-operative recovery as measured by the Mayo Elbow Performance Score (MEPS). Study Design: Cross sectional study. Place and Duration of Study: Pakistan Navy Station Shifa Hospital, Karachi Pakistan, from Jan 2019 to 30 Jun 2021. Methodology: A total of 19 patients aged 18-65 with closed distal humerus fractures were included in the study. All patients underwent open reduction and internal fixation (ORIF) using locking plates. The primary outcome was functional recovery assessed using the Mayo Elbow Performance Score (MEPS) at 3 and 6 months post-operatively. Secondary outcomes included complication rates, time to union, and patient adherence to post-operative rehabilitation. Results: At 6 months, the mean MEPS score was 72.37±8.39, with significant improvement from the 3-month follow-up. Males showed better recovery than females (p=0.032). Two patients (10.5%) experienced mild surgical site infections, and one patient (5.3%) had delayed union. Notably, 89.5% of patients missed regular rehabilitation sessions, which negatively impacted their functional outcomes. Fracture union occurred in an average of 20 weeks. Conclusion: Locking plate fixation provides stable fracture fixation and satisfactory functional outcomes for distal humerus fractures. Gender and compliance with rehabilitation were significant factors influencing the outcomes in this study.
Elbow Joint, Fracture Fixation, Humeral Fractures, Outcome Assessment.
Copyright (c) 2025 Syed Faraz Anwar, Syed Sheheryar Anwar, Shahid Iqbal, Syeda Lyba Onaiz https://creativecommons.org/licenses/by-nc/4.0
Thirty-Day Mortality Frequency in Acute Coronary Syndrome Patients with Varying Hematocrit Levels
Objective: To find the frequency of various hematocrit levels in patients of acute coronary syndrome (ACS) and to compare the frequency of 30-day mortality in patients of ACS with varying hematocrit levels. Study Design: Prospective longitudinal study. Place and Duration of Study: Emergency department, Punjab Institute of Cardiology, Lahore, Pakistan, from Dec 2024 to May 2025. Methodology: A total of 150 patients with ACS were taken into consideration for the study. Five ml of blood were taken for assessment of hematocrit and hemoglobin levels at baseline and compared with reference ranges. Patients were called after 30 days for follow-up. If patients died during the first 30 days, their mortality was recorded. Results: The mean age of patients was 55.27±10.56 years. Out of 150 patients, 109 (72.67%) were males. Normal, low, and high hematocrit levels were noted in 90(60%), 50(33.33%), and 10(6.67%) patients, respectively. In patients having low hematocrit levels, mortality occurred in 8(16%) patients, and in patients having high hematocrit levels, mortality occurred in 9(90%) patients (p-value <0.001) Conclusion: The frequencies of normal, low, and high hematocrit levels were 60%, 33.3% and 6.67%, respectively. Furthermore, it is concluded that hematocrit levels are significantly associated with mortality within 30 days of ACS.
Acute Coronary Syndrome, Anemia, Hemoglobin, Hematocrit, Mortality
Copyright (c) 2025 Sakha Muqeet, Salman Ijaz, Asma Razzaq, Badr Mansoor, Salman Munir, Masood Ali Akbar https://creativecommons.org/licenses/by-nc/4.0
Frequency of Left Ventricular Function Decline in Patients Undergoing Primary Percutaneous Coronary Intervention (PCI) for St Segment Elevation Myocardial Infarction (STEMI)
Objective: To determine the frequency of left ventricular function decline in patients undergoing primary PCI for STEMI. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Cardiology, Punjab Institute of Cardiology, Lahore Pakistan, from Dec 2024 to Jun 2025. Methodology: This study was done after taking ethical approval from IRB of Punjab Institute of Cardiology, Lahore. This study was done on 66 patients diagnosed with acute STEMI undergoing primary PCI after taking informed consent. Data collection was done using pre-designed proforma. >5% decrease in ejection fraction as compared to pre PCI at follow up (48 hours post PCI and 4 weeks) was defined as decline in LV function. Data analysis was performed using SPSS version 26, with p-value <0.05 considered significant. Results: LV function decline was observed in 28.8% participants, with significantly higher frequency was observed in those who presented late and had multiple vessel disease p= 0.047 and 0.001, respectively. The LVEF before PCI (53.27±3.67%), after PCI (52.10±3.91%), and at four weeks follow-up (51.66±4.32%), indicating gradual decline in LVEF over time. Conclusion: This study highlights that significant proportion of patient’s experience decline in left ventricular function following primary PCI for STEMI. The findings underscore the critical impact of delayed presentation and presence of multivessel coronary artery disease on post-procedural LV performance. These results emphasize the importance of early intervention and comprehensive assessment of coronary anatomy to optimize long-term cardiac function and outcomes in STEMI patients undergoing PCI.
Left Ventricular Function, Primary PCI, STEMI
Copyright (c) 2025 Syed Jalal ud Din, Sajjad Ahmad, Adeel Arif, Saim Ali Cheema, Fahim Ahmad Danish, Muhammad Taha https://creativecommons.org/licenses/by-nc/4.0
Clairvoyance in the Perspective of Modern Science
Man has been fascinated by the phenomenon of “Clairvoyance” since ages. Whether one believes in its reality or not, one is still attracted to the possibility of seeing beyond the physical senses and obtaining help from unconventional and supernatural powers. The term “clairvoyance” comes from a combination of two French words; “Clair” meaning clear and “voyant” meaning vision. In other words, it refers to one’s ability to sense information without using any known sensory medium, hence the terms extrasensory perception (ESP), “sixth sense” etc. Clairvoyance or “Paranormal beliefs” relate to experiences that have not been scientifically analyzed or proven.1 A poll conducted in 2005 in United States of America, having a sample size of 1002, found that 55% subjects had faith in spiritual healing of the body through mind, 41% believed in ESP and 31% believed in the existence of mental telepathy.2
A Participatory Approach to Develop Ethical Guidelines for Generative Artificial Intelligence
Objective: To explore the perceptions of supervisors and postgraduate students on the ethical use of Artificial Intelligence (AI) in thesis writing. Study Design: Qualitative Exploratory Study. Place and Duration of Study: Riphah International University Rawalpindi, Pakistan from Jan to Jun 2024. Methodology: Focus group discussions were employed to gather data from 20 participants, consisting of university supervisors and postgraduate students. Thematic analysis was performed using ATLAS.ti 9 to identify recurring themes related to the ethical use of AI in thesis writing. Results: Five key themes emerged from the analysis: transparency, academic integrity, personal development, data privacy, and supervision. Both students and supervisors expressed concerns about the ethical use of AI, particularly around issues like plagiarism, over-reliance, and data security. Supervisors also emphasized the need for institutional policies to regulate AI usage, while students perceived AI as a tool for enhancing their academic skills. Conclusion: There is a critical need for comprehensive ethical guidelines to govern the use of AI in academic research, particularly in thesis writing. Engagement of key stakeholder including academic supervisors, students, and institutional authorities in the formulation of these guidelines provided a balanced approach in identifying the benefits of AI while addressing concerns related to academic integrity, transparency, and data privacy.
Artificial Intelligence, Ethical Guidelines, Supervisors' Perceptions, Students' Perceptions
Copyright (c) 2025 Fatima Shaukat, Zainab Kamal, Rehan Ahmed Khan, Madiha Sajjad, Irum Tassaduq, Salma Ambreen https://creativecommons.org/licenses/by-nc/4.0
Innovative Surgical Strategies for Morbidly Adherent Placenta: Optimizing Outcomes and Minimizing Maternal Morbidity
Objective: To analyze maternal outcomes associated with different surgical approaches during cesarean section for morbidly adherent placenta. Study Design: Prospective longitudinal study. Place and Duration of Study: Obstetrics & Gynecology Departments of Combined Military Hospital Sialkot, Quetta, Kharian, Rawalpindi, Pakistan from Jan 2015 to Dec 2024. Methodology: This study analyzed 252 women. Patients underwent five types of surgical intervention at time of cesarean section: bilateral internal iliac artery ligation followed by hysterectomy, hysterectomy followed by bilateral internal iliac ligation, hysterectomy alone, placenta left in situ followed by Injection Methotrexate and bilateral internal iliac ligation followed by myometrial resection. Outcomes assessed included the operative time, number of transfusions, duration of hospital stay, incidence of re-laparotomy and postoperative sepsis. Results: A total of 252 patients were included. Age group ranged between 26 to 40 years (Mean 34.4±3.3), the gestational age was between 34 to 37 weeks (Mean 35.6±0.94) and the mean BMI was 29.6 Kg/m2±1.9. Bilateral internal iliac ligation followed by hysterectomy was done in 138(54.8%), hysterectomy followed by Bilateral internal iliac ligation in 71(28.2%), hysterectomy in 27(10.7%), placenta left in situ in 2(0.8%) and myometrial resection in 14(5.6%) patients. The median hospital stay was 5 days, patients who did not undergo internal iliac ligation required more transfusions as compared to other surgical approaches (p<0.001) Conclusion: There is variability in clinical outcomes with different surgical approaches for morbidly adherent placenta during cesarean section. The surgical procedures incorporating bilateral internal iliac artery ligation were associated with reduced intraoperative blood loss and improved outcomes.
Blood transfusion, Hysterectomy, Hemorrhage, Morbidly adherent placenta
Copyright (c) 2025 Saira Saeed, Uzma Gul, Uzma Urooj, Sumaira Khan https://creativecommons.org/licenses/by-nc/4.0
Relationship Between Leadership Styles And Emotional Intelligence Level Among Medical Educationists In Medical Institutions of Punjab
Objective: To explore the relationship of leadership styles with the emotional intelligence level of medical educationists working in medical institutes of Punjab. Study Design: Cross-sectional study. Place and Duration of the Study: Medical colleges and universities in Punjab, Pakistan, from May 2024 to Sep 2024. Methodology: A cross-sectional study was carried out through universal sampling involving 30 medical educationists in leadership roles across various medical institutions in Punjab. The Genos Emotional Intelligence Inventory (Concise), with 31 items, and the Multifactor Leadership Questionnaire by Avolio and Bass, with 45 items, were used to determine the relationship of their leadership style with their emotional intelligence level. Results: The analysis yielded a significant positive correlation between emotional intelligence and transformational leadership (r=0.887) with p-value of <0.001, suggesting that elevated levels of emotional intelligence are associated with a greater prevalence of transformational leadership behaviors. Conversely, a negative correlation was identified between emotional intelligence and transactional leadership (r=-0.702), indicating that higher emotional intelligence correlates with a diminished reliance on transactional leadership styles. No significant correlation was established between emotional intelligence and laissez-faire leadership (r=-0.281). Conclusion: The study highlights the importance of emotional intelligence in effective leadership within medical education, recommending tailored development programs to cultivate this skill among educationists. Strengthening emotional intelligence could foster supportive learning environments and enhance outcomes for students and faculty alike.
Emotional Intelligence, Transactional Leadership, Laissez-faire leadership, Medical Educationists, Transformational Leadership.
Copyright (c) 2025 Asma Mahmood, Naushaba Sadiq https://creativecommons.org/licenses/by-nc/4.0
Assessment of the Relationship Between Anthropometric Measurements of Index Finger with Occlusal Vertical Dimension in Dentate Subject
Objective: To assess the correlation of anthropometric measurement of length of index finger with occlusal vertical dimension in dentate subjects. Study Design: Analytical cross-sectional study. Place and Duration of Study: Department of Prosthodontics, Foundation University College of Dentistry and Hospital, Islamabad, from Mar to Aug 2024. Methodology: A total of 100 participants (50 males and 50 females) were included using non-probability convenient sampling. All participants exhibited bilateral occlusal stops on natural posterior teeth, as per the selection criteria. Measurements of Occlusal Vertical Dimension (OVD) and Length of Index Finger (LIF) were obtained using Digital Vernier Calliper, with data recorded on a Performa. Results: The study sample included equal number of males and females with an average age of 32.86±8.64 years. The mean OVD of the study population was found to be 68.57±4.89 mm, while the mean LIF was 74.02±6.04 mm. Analysis of finger length measurement revealed a significant correlation with both occlusal vertical dimension and gender (p<0.01). Correlation of LIF with OVD in females (r=0.562, p-value<0.001) suggested a moderate positive correlation, while a weak positive correlation was observed in males (r = 0.302, p-value <0.033). Conclusion: Length of Index Finger shows a moderate correlation with Occlusal Vertical Dimension, particularly in females, and may serve as a simple, non-invasive adjunctive method for Occlusal Vertical Dimension estimation
Anthropometric, Facial landmarks, Index finger length, Occlusal vertical dimension
Copyright (c) 2025 Huda Khalid, Salman Ahmad, Fatima Rafiq, Ayesha Mehak Saeed, Sana Afzal, Mehtab Gohar https://creativecommons.org/licenses/by-nc/4.0
Outcomes of Concurrent Surgery for Prolapse Repair and Stress Urinary Incontinence: A Pilot Observational Study
Objective: To compare the effectiveness of combined surgery versus isolated prolapse surgery in alleviating urinary leakage symptoms. Study Design: Quasi-experimental study. Place and Duration of Study: Urogynecology unit of Shalamar Hospital, Lahore, Pakistan, from Sep 2024 to May 2025. Methodology: A total of 17 participants presenting with overt urinary leakage along with prolapse of pelvic viscera, scheduled for surgery, were included in the study. The primary outcome was the resolution of stress urinary incontinence (SUI). Negative cough stress test conducted at six months was considered an objective cure. Mean±SD was used for continuous variables, while categorical variables were presented as frequencies and percentages. Statistical significance was considered at a p-value of less than 0.05. Results: Out of the 17 patients, 9(52%) underwent exclusive prolapse repair, while 8(47%) received both prolapse repair and anti-incontinence surgery. At six months, women in the combined surgery group were more likely to report the absence of stress urinary incontinence (SUI) compared to those in the prolapse surgery-only group, with 75% versus 33%, respectively. Additionally, two women (25%) in the combined group required further treatment for SUI (all physiotherapy), compared to six women (66%) in the control group, who also received physiotherapy. Conclusions: Women are less prone to have incontinence after combined surgery compared with isolated POP surgery and are less likely to undergo additional treatment for SUI.
Stress Urinary Incontinence, Pelvic Organ Prolapse, Concomitant Surgery, Cough Stress Test
Copyright (c) 2025 Sheema Yousuf, Nazli Hameed https://creativecommons.org/licenses/by-nc/4.0
Comparison of Pulmonary Vascular Resistance Measurements by Echocardiography and Cardiac Catheterization
Objective: To compare Pulmonary Vascular Resistance (PVR) measurements by echocardiography and cardiac catheterization. Study Design: Analytical cross-sectional study Place and Duration of Study: Department of Paediatric Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi Pakistan from Jun to Nov 2024. Methodology: Consecutive sampling was used to recruit thirty-one patients. Included patients were between the ages of 2 and 60, who were having cardiac catheterization for suspected pulmonary vascular disease or PH. A detailed echocardiographic assessment was performed within 24 hours, including tricuspid regurgitation velocity (TRV) and the velocity-time integral of the right ventricular outflow tract (VTIRVOT). These characteristics were then compared to PVR measurements obtained using catheterization. Results: Out of 31 cases, 16(51.6%) were males and 15(48.38%) were females with median age of 6.90(22.00-3.00) years. A moderate positive correlation was observed between PVR measured by echocardiography and cardiac catheterization in Wood units (WU) (r=0.41; p=0.02). This r-value reflects moderate consistency between non-invasive and invasive measurements of PVR. Bland- Strong agreement between the PVR measured by catheterization and echocardiography was demonstrated by Altman analysis. The 78.6% sensitivity and 82.4% specificity were observed for a PVR of >2 WU with a TRV/VTIRVOT threshold of 0.179 (AUC: 0.752, 95% CI: 0.55 to 0.94; p=0.001). Conclusion: Echocardiography can provide a simple, reliable, noninvasive and potentially cost-effective alternative to determine PVR. The strong correlation and agreement between echocardiography-derived and catheterization-based PVR measurements show its potential as a valuable diagnostic tool, reducing the need for invasive testing.
Cardiac catheterization, Echocardiography, Pulmonary hypertension, Pulmonary vascular resistance
Copyright (c) 2025 Maimoona Saeed, Khurram Akhtar, AbuBakar Sadiq, Madeeha Ikram, Kaleem Ahmad, Saima Rafique https://creativecommons.org/licenses/by-nc/4.0
Telecardiology and Digital Health Innovations for Cardiovascular Care
Cardiovascular disease remains the leading global health concern,1 with remote populations often facing barriers to timely and specialized cardiac care.2 Every 36 seconds, a life is lost to cardiovascular disease (CVD)—yet for more than 6 billion people, accessing specialized cardiac care remains a distant hope. Telecardiology, a transformative technology, integrates telemedicine with wearable sensors and Al analytics to remotely diagnose and manage heart conditions.3 This approach aims to enhance medical excellence and operational readiness within cardiovascular healthcare systems.
Unlocking Potentials: Exploring Awareness, Utilization, and Perceptions related to Benefits and Challenges of Artificial Intelligence in Research - A Study amongst Aspiring Healthcare Professionals of Islamabad
Objective: To assess level of awareness, utilization pattern, and perceptions regarding benefits and challenges of artificial intelligence in research among aspiring healthcare professionals in Islamabad. Study Design: Cross Sectional Analytical study Place and Duration of Study: Foundation University School of Health Sciences (FUSH), Islamabad from 25th May to 25th September 2024 Methodology: A stratified random sample of 355 students was surveyed after ethical approval using structured Google Form. After informed consent, data were collected on demographics, AI awareness, utilization, benefits, challenges and training needs, and analyzed using SPSS v25. Chi-square, t-tests, correlation, and regression were applied (p ≤ 0.05). Results: Of 355, 327 responded, among these, 236 (72.2%) were generally aware of AI in research, though 209 (88.5%) had no formal AI training. The mean awareness score 10.44±3.19, with 174 (73.7%) showing adequate awareness. However, only 75 (31.8%) showed sufficient AI tool utilization (mean score 6.4±4.29). Popular AI platforms included ChatGPT, Grammarly, and Mendeley. A majority (68.2%) agreed that AI improves research efficiency. Key barriers included lack of training (54.6%), limited technological access (46.2%), 93.6% expressed willingness to use AI in future research. Significant associations were found between awareness, utilization, and demographic variables. Conclusion: Aspiring healthcare professionals in Islamabad showed high AI awareness but low utilization, with limited formal training. Positive perceptions prevailed despite concerns over plagiarism, data security, and technical understanding. Formal AI training remains essential for developing responsible, effective, and ethical use of AI in research
Artificial Intelligence, Awareness, Challenges, Research, Utilization.
Copyright (c) 2025 Tahira Amjad, Owais Mahmood Ikram, Murtaza Akif, Hafza Sajid, Rikza Sadiq https://creativecommons.org/licenses/by-nc/4.0