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
Wings of Hope:: Drone Technology for Medical Aid in High Risk Operational Zones
In today’s conflict zones, getting medical supplies to casualities can be nearly impossible. Healthcare delivery can be completely transformed by the use of drones for medical missions in operational areas and during wars. Drones can provide rapid and effective solutions to a number of major issues that medical teams encounter in these settings, such as challenging terrain, continuing hostilities, and remote locations. When it comes to delivering supplies to hazardous and inaccessible locations, unmanned aerial vehicles offer a significant advantage over other delivery methods. Conventional transit is unable to do so because of security risks, damaged infrastructure, or time constraints. Drones can be used to deliver medical supplies, such as blood products, vaccines, and selfimportant medications, directly to areas affected by natural disasters or conflicts. When every minute counts, this technology will save lives by ensuring that those in need receive much-needed supplies on time.1
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc/4.0
WATER DRINKING TEST: AN OUTDATED MODALITY OR STILL A USEFUL TEST WHILE MANAGING PATIENTS OF GLAUCOMA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)
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
Incidence of Neuralgia in Post-Thoracotomy Patients at the Department of Thoracic Surgery of a Tertiary Care Hospital: A Cross-Sectional Study
Objective: To determine the incidence, characteristics, and associated factors of Post-thoracotomy neuralgia (PTN). Study Design: Cross-Sectional Study. Place and Duration of study: Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2024 to Sep 2025. Methodology: A total of 336 consecutive adult patients undergoing thoracotomy were evaluated at 1-, 3-, and 6-month post-procedure. The primary outcome measured was Post-thoracotomy neuralgia (PTN). Parametric and multivariable logistic regression analyses was used to analyze the data. Results: Among 336 patients (mean age 39.2±15.4 years; 248(73.8%) male), PTN was observed in 234(69.6%) patients. Pricking pain subtype was reported in 168 PTN patients (71.8%). Severity improved over time: no pain was reported by 100(42.9%) patients at 3 months and 159(67.9%) patients at 6 months; severe pain was absent at both 3 and 6 months. Post-operative altered sensation was reported by 155(66.1%); predominantly hypoesthesia 129(83.3%), mainly at the anterior lower chest 97(75.0%). Conclusions: We found that PTN occurs in a significant proportion of patients following thoracotomy. Female gender and larger incisions were identified as independent factors associated with a higher risk of PTN.
Chronic Pain, Neuralgia, Pain Management, Thoracotomy, Treatment Outcome
Copyright (c) 2026 Ali Zaman Khan, Farhan Ahmed Majeed, Adeel Wyne, Muhib Ullah, Adnan Younis Panni, Fazila Khan https://creativecommons.org/licenses/by-nc/4.0
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
Exploring Obstructive and Restrictive Patterns of Pulmonary Function in Post-Tuberculosis Patients at Secondary Care Hospital in Kohat
Objective: To determine the patterns of pulmonary function impairment among patients with previously treated pulmonary tuberculosis (TB) at a secondary care hospital in Kohat, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine, Divisional Headquarters Teaching Hospital, Kohat, Khyber Pakhtunkhwa, Pakistan, from Aug 2024 to Jan 2025. Methodology: A total of 139 post-tuberculosis patients who had completed the full course of anti-TB therapy with microbiological cure were included. Pulmonary function was assessed using a portable MiniSpir S spirometer, and results were categorized as normal, obstructive, restrictive, or mixed ventilatory patterns according to American Thoracic Society (ATS) and European Respiratory Society (ERS) guidelines. Data were analyzed using IBM SPSS Statistics version 27. Results: The mean age of participants was 52.9±13.5 years, with females comprising 54% of the sample. Most participants (74.8%) belonged to the middle-income group, and none were smokers. Spirometry revealed 56.8% normal, 33.8% restrictive, 8.6% obstructive, and 0.7% mixed ventilatory patterns. Shortness of breath was reported by 39.6% of participants and showed a significant association with both obstructive and restrictive patterns (p<0.001). A positive family history of tuberculosis was also significantly associated with pulmonary dysfunction (p = 0.04). Conclusion: A substantial proportion of post-TB patients exhibited persistent pulmonary function impairment, predominantly of the restrictive type. These findings highlight the need for routine post-treatment pulmonary evaluation and the development of context-specific rehabilitation guidelines for tuberculosis survivors in resource-limited healthcare settings.
Obstructive ventilatory pattern; Pakistan, Pulmonary Tuberculosis; Pulmonary function impairment; Restrictive ventilatory pattern; Spirometry; Tuberculosis sequelae
Copyright (c) 2026 Zakir Ullah, Akhtar Sherin, Syed Fahim Shah, Muhammad Atif Tauseef 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
Comparison of Intrauterine versus Per-Rectal Misoprostol in Prevention of Postpartum Hemorrhage in Women undergoing Caesarean Section: A Quasi-Experimental Study
Objective: to compare the efficacy of the intrauterine vs. Rectal Misoprostol in preventing PPH among women undergoing caesarean section. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Gynecology and Obstetrics, Avicenna Hospital, Lahore Pakistan, from May to Oct 2023. Methodology: Participants were allocated into two groups: Group A received 800 μg intrauterine misoprostol, while Group B received 800 μg rectal misoprostol immediately after delivery. The primary outcome was the occurrence of PPH. Secondary outcomes included approximate blood loss, hospital stay, maternal complications, adverse effects, and additional uterotonic requirement. Results: The intrauterine group showed significantly lower mean blood loss (370.94±120.14 mL) compared to the rectal group (500.32±140.86 mL, p<0.001). The PPH incident was clearly reduced (13.1% vs. 52.0%, p<0.001). The stay in the hospital was reduced in the intrauterine group (2.23(0.63) days vs. 3.14(0.85) days, p<0.001). Fewer women require additional uterotonic (10.7% vs. 39.8%, p<0.001). The adverse effects were less frequent in the intrauterine group. Conclusions: The intrauterine misoprostol is better than rectal misoprostol during the Caesarean section with low complications
Caesarean Section, Misoprostol, Postpartum Hemorrhage, Uterotonic
Copyright (c) 2026 Zara Gul, Gulfreen Waheed https://creativecommons.org/licenses/by-nc/4.0
Success Rate of Combined Transcanalicular Diode Laser and Endoscopic Dacryocystorhinostomy in Patients of Nasolacrimal Duct Obstruction
Objective: To determine the success rate of combined Endoscopic Dacryocystorhinostomy (DCR) and Transcanalicular Diode Laser DCR in patients with nasolacrimal duct obstruction. Study Design: Analytical cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from March 2024 to Mar 2025. Methodology: Patients presenting with epiphora and a positive regurgitation-on-pressure test were enrolled through convenience sampling. Pre-sac patency was assessed using lacrimal syringing, which confirmed complete nasolacrimal duct obstruction. All patients underwent combined Transcanalicular Diode Laser DCR and Endoscopic DCR performed as a simultaneous procedure. Outcomes were evaluated at a 6-month postoperative follow-up, assessing overall, anatomical, and functional success. Results: A total of 150 patients were included, with a mean age of 54.9±9.8 years (range: 28–76 years). The overall success rate was 92.0%, while anatomical and functional success rates were 96.0% and 91.3%, respectively (p=0.016). Functional pathology was the leading cause of failure, and lid laxity (22.7%) was significantly associated with functional failure (23.5% vs 4.3%, p<0.01). Conclusion: Combined Transcanalicular Diode Laser–Endoscopic DCR yielded high overall, anatomical, and functional success rates. Functional failure remained more common in patients with associated lid laxity.
Dacryocystorhinostomy, Endoscopy, Nasolacrimal Duct Obstruction
Copyright (c) 2026 Ammarah Ashraf Awan, Syeda Alishba Zahra Naqvi, Aisha Rafique, Ubaid Ullah Yasin, Waqas Rahim Butt, Syed Abid Hassan Naqvi https://creativecommons.org/licenses/by-nc/4.0
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
Comparison of Function Outcome of External Fixation with Orthofix Versus External Fixation with Orthifix Supplemented by K-Wires in Distal Radius Intra-Articular Comminuted Fractures (23c3)
Objective: To compare functional and anatomical outcomes of closed reduction external fixation with Orthofix alone versus Orthofix supplemented by K-wires in distal radius comminuted intra-articular fractures. Study Design: Quasi experimental study. Place and Duration of Study: Department of Orthopedic Surgery, Sahiwal Teaching Hospital, Sahiwal, Pakistan from Jan 2025 to Apr 2025. Methodology: Total 62 patients with closed distal radius comminuted intra-articular fractures (AO type 23-C3) were allocated into two groups with treating physician choice; Group-A external fixator plus K-wires, and Group-B external fixator alone. Functional outcome was assessed using Modified Mayo Wrist Score, while anatomical outcome was measured by radial length, radial angle, and volar tilt at 12 weeks postoperatively. Data were analyzed using SPSS 24. Independent sample t-test and Chi-square/Fisher’s exact test were applied, with p-value <0.05 considered significant. Results: The mean MMWS at 12 weeks was significantly higher in Group-A (86.77±4.97) vs Group-B (83.54±7.34; p=0.047). At 6th-week postoperative assessment, volar tilt was significantly better in Group-A (11.80 ± 0.80°) versus Group-B (10.99 ± 0.86°; p<0.001), while no significant differences were observed in radial length (p=0.248) and radial angle (p=0.083). Functional outcomes were also more favorable in Group-A across most age groups, among females and in fall or sports-related injuries, though differences in RTA-related injuries were less marked. Conclusion: The addition of K-wires to external fixation provides superior functional recovery and improved anatomical alignment particularly in terms of volar tilt, compared to external fixation alone in the management of distal radius comminuted intra-articular fractures.
Comminuted; Fracture Fixation, External; Intra-Articular; Kirschner Wires; Orthopedic Fixation Devices, Radius Fractures.
Copyright (c) 2026 Ali Raza, Muhammad Rashid , Majid Rashid, Rana Danish Iftikhar https://creativecommons.org/licenses/by-nc/4.0
Predictors of Negative Sentinel Lymph Node Biopsy Results in Early Breast Cancer: a Retrospective Cohort Study
Objective: To identify clinicopathologic predictors of negative sentinel lymph node biopsy (SLNBx) in clinically node-negative breast cancer patients at a tertiary center in Pakistan. Study Design: Retrospective cohort study. Place and Duration of Study: Breast Surgery Department, Combined Military Hospital Rawalpindi, Pakistan, from Jan to Dec 2024. Methodology: Women with early-stage, clinically node-negative invasive breast cancer undergoing SLNBx were included. Data on tumor size, grade, receptor profile, Ki-67, comorbidities, and family history were analyzed. Chi square test was applied and p-value of ≤ 0.05 was considered as statistically significant. Results: Of 186 patients, 142 had complete data; 120 (84.5%) had negative SLNBx. There was a statistically significant association found between SLN and Menopause (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), family history (p= 0.026), tumor grade (p < 0.001) and histology (p = 0.005). . Conclusion: A negative family history was the only independent predictor of SLNBx outcome. The high rate of pathologic node negativity supports selective de-escalation of axillary surgery in this subgroup.
Ki-67 Antigen, Neoplasm, Sentinel Lymph Node Biopsy, Tumor Receptor Status
Copyright (c) 2026 Saman Naz, Ayesha Javed, Syeda Rifaat Naqvi, Aqsa Saleema, Zohra Jabeen, Syeda Saima Qamar Naqvi https://creativecommons.org/licenses/by-nc/4.0
Spectrum of Interstitial Lung Disease Patterns in Connective Tissue Diseases and their Outcomes: a Retrospective Analysis
Objective: To evaluate patterns of connective tissue disease-associated interstitial lung disease and to evaluate disease outcomes across various CTD subtypes in a tertiary care setting in Lahore, Pakistan. Study Design: Observational Retrospective Study Place and Duration of the Study: Rheumatology Department, Central Park Teaching Hospital, and its affiliated Clinics, Lahore, Pakistan, from 2021 to 2025. Methodology: The data of 174 patients diagnosed with CTD-ILD was reviewed. Inclusion criteria included adult patients with a confirmed CTD diagnosis (as per ACR/EULAR criteria) and HRCT-confirmed ILD. Data on demographics, serology, HRCT patterns, and pulmonary function tests (PFTs), and outcomes were analyzed using SPSS v27. The statistical significance was set at p ≤ 0.05. Results: Among 174 patients, 93.7% were female, with a mean age of 49.4 ± 13.7 years. The most common CTD was systemic sclerosis (30.5%), followed by rheumatoid arthritis (21.8%) and mixed connective tissue disease (MCTD) (19.5%). NSIP was the predominant HRCT pattern (61.5%), followed by UIP (23.0%). Disease activity varied, with active disease most common in SLE (62.5%) and systemic sclerosis (47.2%). PFTs showed moderate to severe restriction in a majority of patients, particularly those with myositis, systemic sclerosis, and SLE (p < 0.001). Conclusion: CTD-ILD presents with heterogeneous clinical, serological, and radiological profiles. NSIP is the most frequent ILD pattern across CTDs. Timely identification of ILD patterns and targeted immunosuppressive therapy may improve patient outcomes.
Interstitial lung disease, Mixed connective tissue disease, Pakistan, Retrospective study
Copyright (c) 2026 Amar Lal, Muhammad Ahmed Saeed, Muhammad Rafaqat Hameed, Maryam Aamer, Umbreen Arshad, Hiba Shariq https://creativecommons.org/licenses/by-nc/4.0
Evaluation of Oral Stereognostic Ability in Completely Edentulous Patients
Objective: To determine the mean oral stereognostic ability (OSA) score in fully edentulous patients. Study Design: Cross-sectional Study. Place and Duration of the Study: Department of Prosthodontics, Foundation University College of Dentistry & Hospital, Islamabad, Pakistan, from Sep 2024 to Feb 2025. Methodology: A total of 145 patients aged 45 to 75 participated in the study. Four unfamiliar testing tools of different shapes were used to assess OSA, with patients manipulating them intraorally to select corresponding analogues on a table. Each tool was scored from 0 to 3 based on the time taken to recognize it. The study analyzed the relationship between OSA scores and various clinical and demographic characteristics using statistical modeling. Results: The mean age was 59.28±8.19 years, of which 64(44.14%) were men, 81(55.86%), were women, and 87(60%) had experience with dentures. The mean stereognostic tool scores varied from 1.78±0.9 to 1.98±0.7. There were no significant differences in OSA scores according to gender or denture experience (p>0.05). A statistically significant difference was seen between age of the patient and total stereognostic score (p<0.001). A strong negative correlation was observed between OSA scores and period of edentulism (p<0.001). Conclusion: OSA decreases with age and longer periods of edentulism, underscoring the value of early prosthetic rehabilitation. Gender and previous denture experience did not have a significant impact on OSA scores.
Complete Dentures, Proprioception, Stereognosis
Copyright (c) 2026 Fatima Rafiq, Salman Ahmad, Shoaib Rahim, Huda Khalid, Ayesha Mehak, Sana Afzal https://creativecommons.org/licenses/by-nc/4.0
Predictors of Short and Long-Term Success of Electrical Cardioversion in Persistent Atrial Fibrillation
Objective: To determine the predictors of short-term and long-term success of electrical cardioversion in persistent atrial fibrillation. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Cardiology, Electrophysiology Division, Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi Pakistan, from Sep 2024 to Apr 2025. Methodology: A total of 119 male and female patients aged 20 to 90 years diagnosed with persistent atrial fibrillation. Patients with valvular heart disease, prior history of electrical cardioversion, paroxysmal atrial fibrillation, and left atrial clot were excluded. Electrical cardioversion was performed, and short-term (sinus rhythm restoration after a week) and long-term (sinus rhythm restoration after three months) success was noted. Data analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 26. Results: The mean age of the participants was 55.95±11.46 years, and the mean Atrial Fibrillation (AF) duration was 12.63±3.72 days. Patients aged more than 50 years were 77(64.7%), and 72(60.5%) patients were male. Successful cardioversion was recorded in 104 patients (87.4%). Short-term and long-term success was recorded in 92(77.3%) and 80(67.2%) patients, respectively. Acute successful cardioversion was more frequent when performed by a consultant with more than 12 years of experience (91.0% versus 76.7%, p-value 0.041). Conclusion: Electrical cardioversion was shown to be an effective and successful therapy for persistent atrial fibrillation. Although success rates inevitably declined over time, the promising early outcomes demonstrate that electrical cardioversion is a dependable first-line technique for restoring sinus rhythm.
Atrial Fibrillation, Electrocardiography, Electrical Cardioversion, Sinus Rhythm, Treatment Outcome.
Copyright (c) 2026 Hira Ahmad, Muhammad Shabbir , Huma Mushtaq, Shahid Mukarram, Tehreem Fahd, Syed Sajidain Syed https://creativecommons.org/licenses/by-nc/4.0
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
Effect of Technology-Assisted Teaching on Student Engagement in Undergraduate Medical Education- a Quasi Experimental Study
Objective: To evaluate the effect of technology-assisted teaching on student engagement in undergraduate medical students. Study design: Quasi-experimental study. Place and Duration of Study: Mohi-ud-Din Islamic Medical College, Mirpur, Azad Jammu and Kashmir, Pakistan, from Jun to Sep 2024. Methodology: An experimental study was carried out, using technology-assisted teaching as the intervention among 100 third-year medical students. For the intervention, the class was divided into two halves by non-random sampling technique. Group-A (control) was taught with traditional teaching and Group-B (experimental) was additionally assisted by technology. For measuring engagement, a validated student engagement questionnaire was used. Results: Results showed that students in the technology-assisted teaching group (Group-B) showed higher mean engagement scores, (65.34±7.537) as compared to the traditional teaching group (Group-A), (61.14±11.421). The means between two groups were compared, which showed a significant difference between both groups (p< 0.05). Conclusion: The study provided statistical evidence that students who received technology-assisted teaching showed increased engagement in their classes than those who were taught by traditional teaching methods.
Medical Education, Student Engagement, Technology-Assisted Teaching
Copyright (c) 2026 Saira Zafar, Asiya Zahoor, Asma Mahmood, Rabia Ashraf https://creativecommons.org/licenses/by-nc/4.0
Management of Mandibular Angle Fractures Using One Miniplate Versus Two Miniplate Fixation System
Objective: To compare postoperative complication rates in patients with non-comminuted, favourable mandibular angle fractures treated using either single miniplate fixation (Champy’s technique) or a two-miniplate approach. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry Rawalpindi, Pakistan from Dec 2024 to May 2025. Methodology: Sixty patients with favourable mandibular angle fractures were non-randomly allocated by alternate assignment into two equal groups. Group-A underwent fixation with a single miniplate at the superior border, while Group-B received two miniplates at the superior and inferior borders. Postoperative complications, including wound infection, neurosensory disturbance, malocclusion, wound dehiscence, pseudoarthrosis, hardware failure, and scarring, were evaluated on Day 1 and Weeks 1, 2, and 4. Data were analysed using SPSS version 23. Chi-square test was applied to compare complication rates between the two groups, with significance set at p≤0.05. Results: Wound infection occurred in 6.7% of patients in Group-A and 33.3% of patients in Group-B (p=0.010). Statistically significant differences were also noted in neurosensory dysfunction (0.0% vs. 16.7%, p=0.020), wound dehiscence (6.7% vs. 26.7%, p=0.038), hardware failure (6.7% vs. 26.7%, p=0.038), and scarring (3.3% vs. 23.3%, p=0.023), respectively. Malocclusion showed no significant difference (10.0% vs. 13.3%, p=0.688), and pseudoarthrosis was absent in both groups. Overall, 26.7% of Group-A and 73.3% of Group-B experienced at least one complication (p<0.001). Conclusion: Single miniplate fixation resulted in fewer postoperative complications and is preferable for favourable mandibular angle fractures.
Champy’s Technique, Internal Fixators, Mandibular Fractures, Maxillofacial Injuries, Open Fracture Reduction, Postoperative Complications
Copyright (c) 2026 Shahrukh Zafar, Shahid Iqbal Khan, Muhammad Junaid, Syed Junaid Hussain Bukhari, Sana Somair, Ayesha Imran https://creativecommons.org/licenses/by-nc/4.0
Clinical Characteristics and Short-Term Outcomes of Pediatric Mediastinal Mass-Prospective Experience from a Tertiary Care Center in Karachi, Pakistan
Objective: To evaluate the clinical and demographic characteristics, diagnostic approaches and management outcomes of pediatric patients presenting with mediastinal mass. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Pediatric Oncology, The Indus Hospital and Health Network from Dec 2021 to Jan 2023. Methodology: One hundred pediatric patients under 17 years of age, all with radiologically confirmed mediastinal widening (defined as a mediastinum-to-chest ratio greater than 0.25) were enrolled. The clinical presentations, radiologic and laboratory diagnostic findings, sedation practices, steroids or chemotherapy use and short-term outcomes were recorded. Data were analyzed using SPSS version 21, with p<0.05 considered statistically significant. Results: The median age of the patients was 9.5 years (IQR 6), with 76% being male. The most prevalent symptoms were fever (78%), lymphadenopathy (52%), and cough and dyspnea (27% each). Among the 97 patients with confirmed diagnoses, 94.8% had malignant tumors, primarily T-lymphoblastic leukemia/lymphoma (40.5%) and Hodgkin lymphoma (26.8%). A total of the 80% of the patients were discharged, 14% died, and 4% left against medical advice. No significant association was found between short-term outcomes and factors such as age, gender, sedation type or the use of steroids or chemotherapy (p>0.05). Conclusion: Age, gender, type of sedation and steroid or chemotherapy use did not influence short-term management outcomes. The study helps categorize risk and formulate personalized treatment plans for patients with mediastinal masses Additional CONCLUSION: The study helps categorize risk and formulate personalized treatment plans for patients with mediastinal masses. Age, gender, sedative type, ...
Leukemia, Lymphoma, Mediastinal mass, Outcome, Pediatric Oncology
Copyright (c) 2026 Naila Rafiq, Muhammad Rahil Khan, Anushe Mohsin Feroze, Ghulam Qadir Pathan , Muhammad Rafie Raza, Muhammad Shamvil Ashraf https://creativecommons.org/licenses/by-nc/4.0
Association of Polycystic Ovarian Syndrome with Mental Stress in Women of Reproductive Age Group
Objective: To determine the association of polycystic ovarian syndrome with stress in women of reproductive age group. Study Design: Case control study. Place and Duration of Study: Department of Obstetrics & Gynecology, Sughra Shafi Hospital, Narowal Pakistan, from Feb to Jul 2025. Methodology: Five hundred and thirty women were included in the study from OPD and were divided in two groups i.e. cases were those who were diagnosed with PCOS and controls were those who did not have PCOS. Then women were examined for perceived stress score and if score If >13, then stress was labeled. Results: In this study, the mean age of women in case group was 30.30±8.57 years and in control group was 31.26±8.80 years. The stress was observed in 175(66.0%) women in case group while in 82(30.9%) women in control groups with the OR =4.339 (95% CI: 3.016, 6.245). Conclusion: There is significant association of stress with PCOS among women of reproductive age group.
Perceived Stress Score, Polycystic Ovarian Syndrome, Reproductive Age Group, Stress
Copyright (c) 2026 Amina Zulfiqar, Malahat Mansoor, Munawar Afzal, Faraz Bakht, Marriam Sarfraz, Sajida Karamat https://creativecommons.org/licenses/by-nc/4.0
When Health Becomes Security: Theorizing Infectious Disease Securitization Beyond the Biomedical Frame – A Scoping Review
Objective: The Securitization Theory by the Copenhagen School frames the unchecked spread of infectious diseases as an existential security threat, broadening traditional militarized security concepts to include public health. This review enhances understanding of the securitization of infectious diseases and its implications for interpreting contemporary “existential” security threats. Data Sources: Using Prisma guidelines, two independent researchers identified relevant literature using the PubMed, Science Direct, Google Scholar, and Medline databases. Study Selection: The search strategy focused on articles published in the past 15 years in English. Boolean Operators and key terms used include: “emerging infectious diseases” AND “securitization theory” OR “securitization,” “security–public health nexus,” “infectious diseases” AND “health security,” and “securitization of COVID-19” AND “securitization theory.” Concept papers, peer-reviewed articles, books, and policy analyses (policy briefs) were included. Non-English publications, editorials, or conference abstracts, and any other literature lacking clear relevance to the securitization of infectious diseases were excluded. Data Extraction and Synthesis: The data collection took four months, resulting in 137 citations from database searches and 31 from supplementary sources. After removing duplicates, 61 citations were included, with three non-English papers excluded. Conclusions: The in-depth deliberation on the securitization of infectious diseases presented in this article offers a modern pragmatic worldview of utilizing securitization theory as a practical security analysis tool while reconciling with critics of the theory to facilitate policies and public health responses for pre-emptive global health security, governance, and regulation.
Securitization Theory, Security-Public Health Nexus, Emerging Infectious Diseases, Global Health Security, National Security, One Health.
Copyright (c) 2026 Sanaa Aslam, Maidah Hanif, Muhammad Omar Niaz, Maryam Naseem https://creativecommons.org/licenses/by-nc/4.0
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.