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Pakistan Journal of Medical Sciences

Publisher:
—
ISSN:
1682-024X
Category:
MEDICINE, GENERAL & INTERNAL
Impact factor:
1.2
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15 parsed articles

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Latest articles

Pre-donation deferral patterns in blood donor recruitment in a tertiary care hospital

2026-03-25

Poonam Devi, Neelum Mansoor, Saba Jamal

Objectives: This study analyzes pre-donation deferral patterns in blood donor recruitment at a tertiary care hospital in Pakistan to improve blood supply management. Methodology: A cross-sectional analysis was conducted on 6,039 potential blood donors aged 18–60 years at the Indus Hospital Blood Center, Karachi, from April-June 2023. Physical examinations and clinical evaluations determined the donor’s eligibility. Deferral rates and reasons were analyzed using descriptive statistics. Results: The average deferral rate was 27.4%, with 97.7% temporary and 2.3% permanent deferral. Majority donors were first-time (92.3%) and male (93.3%). Common temporary deferral reasons were anemia (29.0%), ill-feeling (21.9%), and antibiotic intake (9.8%), while Hepatitis C (23.7%) and Hepatitis B (21.1%), and chronic respiratory disease (18.4%) were permanent. Conclusion: The study reveals challenges in blood donor recruitment, including high first-time donors and gender disparity. Targeted measures may help address risk factors and improve donor retention, strengthening blood transfusion services in resource-poor settings, impacting public health in Pakistan and other low- and middle-income countries (LMICs).

Efficacy of membrane sweeping at term pregnancy to promote spontaneous labor: A comparative study

2026-03-25

Moatter Asmat, Samina Mumtaz, Samiea Perveen

Background & Objective: Membrane sweeping is done to promote spontaneous initiation of labor at term to avoid post-date pregnancy which is associated with perinatal morbidity and mortality. Post-date pregnancy occurs in 4–18% cases. This study will help in reducing rates of cesarean sections and post-term pregnancies and its associated complications. Our objective was to determine frequency of initiation of labor by membrane sweeping in low-risk pregnant women at term as compared to initiation of labor in pregnant women having expectant management till 40 weeks Methodology: A comparative study was done in outpatients visiting Obstetrics and Gynecology department in Recep Tayyip Erdogan Hospital, Muzaffargarh between June 1, 2024 to December 31, 2024. One hundred and eighteen uncomplicated pregnant patients, randomly allocated at 37 weeks into study and control groups, Group-A membrane sweeping (n=59), Group-B without membrane sweeping (n-59). In Group-A, membrane sweeping done on weekly antenatal visit starting at 37 week and control group received standard care with no membrane sweeping. Primary outcome measures are frequency of patients going into spontaneous labor and gestational age at labor onset. Results: Frequency of women going into spontaneous labor was significantly higher in membrane sweeping group compared to no membrane sweeping (91.5% vs. 71.2%, p-value=0.005). The mean gestational age at delivery was significantly lower in membrane sweeping group compared to no sweeping group (38.2±0.5 vs. 39.8±1.2 weeks, p<0.001). Conclusion: Sweeping of the membranes at term increases the chance of women for going into spontaneous labor before 41 weeks and reduces the incidence of post-date gestation.

A randomized controlled comparison of sublay and onlay mesh techniques in ventral abdominal wall hernia repair

2026-03-25

Sana Ehsan Ullah, Muhammad Irshad Hussain, Irfan Javed

Objective: To compare wound infection, seroma formation, and hernia recurrence rates between onlay and sublay mesh repair for ventral abdominal wall hernias. Methodology: This prospective, randomized controlled trial was conducted at Recep Tayyip Erdogan Hospital, Muzaffargarh, Pakistan, from February 2022 to August 2023. Ninety-six patients aged 18–60 years with ventral hernias (defect size 40–100 mm) were randomly assigned to onlay or sublay mesh repair (48 per group). Outcomes—wound infection, seroma, and recurrence—were evaluated during hospitalization and at two week and six month follow-ups. Data were analyzed using SPSS v26.0; p ≤ 0.05 was considered significant. Results: The mean age was 43.4 ± 8.8 years in the onlay group and 44.5 ± 11.2 years in the sublay group (p = 0.592). Wound infections occurred in 22.9% of onlay versus 8.3% of sublay patients (p = 0.049). Seroma formation occurred in 8.3% versus 4.2% (p = 0.678), and recurrence in 0% versus 2.1% (p = 0.495), respectively. In defects 5.1–10 cm, infection was significantly higher in onlay repairs (37.5% vs 12%; p = 0.03). Conclusion: Sublay mesh repair significantly reduced wound infections compared with onlay repair, with comparable seroma and recurrence rates, supporting its preference in resource-limited settings. Registration No.: ClinicalTrials.gov (NCT07140471).

Bilateral femur osteomyelitis: A rare case with successful outcome

2026-03-25

Shahzad Ahmed Mengal, Syed Ali Anwar Jilani, Nazir Alam

Chronic femoral osteomyelitis with segmental bone loss remains a complex reconstructive challenge, particularly in the setting of failed prior fixation and multidrug-resistant infection. Bilateral femoral involvement is extremely rare and lacks a standardized management algorithm. This report aims to describe a staged, limb-salvage strategy employing different reconstruction techniques for each femur based on defect size, biological potential, and infection status. Case Presentation: A 28 years old male presented with bilateral thigh pain and inability to ambulate three years after bilateral femoral shaft fractures complicated by recurrent surgical site infections and multiple revision surgeries. Clinical, laboratory, and radiological evaluation confirmed chronic bilateral femoral osteomyelitis with significant segmental bone defects, more severe on the right side. Management and Outcome: The left femur was managed with aggressive debridement and single-stage stabilization using an antibiotic-coated intramedullary SIGN nail, followed by culture-directed antimicrobial therapy for multidrug-resistant organisms, resulting in radiological union at six months. The right femur required staged reconstruction with debridement and Ilizarov-based distraction osteogenesis. Poor regenerate formation necessitated adjunctive teriparatide therapy, followed by definitive fixation using intramedullary nailing and augmentation with a non-vascularized fibular strut graft. At one-year follow-up, the patient was ambulating independently with bilateral radiological union and no evidence of recurrent infection. Conclusion: This case illustrates that individualized, staged reconstruction combining infection eradication, mechanical stability, and biological augmentation can achieve successful limb salvage in rare and complex cases of bilateral femoral chronic osteomyelitis.

Health Literacy and its associated factors: A cross-sectional study among youth in Karachi

2026-03-25

Nourina, Aiesha Ishaque, Abdul Rehman

Objectives: To determine the level of health literacy among youth in Karachi, Pakistan, and to explore key factors influencing their ability to access, understand, and use health information. Methods: An analytical cross-sectional study was conducted among youth aged 15–24 years enrolled in vocational training programs at The Hunar Foundation, Karachi, from June 2023 to June 2024. Participants were selected through consecutive non-probability sampling. Health literacy was assessed using the 12 items Short-Form Health Literacy Questionnaire (HLS-SF12). Sociodemographic variables, parental education, socioeconomic status, and digital literacy indicators were collected using a structured questionnaire. Data were analyzed using STATA 17. Associations were examined using chi-square and Kruskal–Wallis tests, followed by multivariable ordinal logistic regression after confirming the proportional odds assumption. Results: Among 375 participants, 6.1% had poor, 74.2% satisfactory, and 19.7% good health literacy. In multivariable analysis, higher participant education (Graduation: AOR = 7.62; Matric: AOR = 5.26), maternal literacy (AOR = 5.85), and active online health information seeking (AOR = 12.30) were independently associated with better health literacy. Gender, ethnicity, and socioeconomic status were not significant after adjustment. Conclusion: Among Pakistani youth, higher health literacy is strongly influenced by educational attainment, parental literacy, particularly maternal literacy, and active online health information seeking. These findings highlight the need for educational and digital health interventions to improve youth health literacy and support long-term health outcomes.

Sociodemographic determinants of multimorbidity in asthma: Insights from a retrospective cross-sectional study of the Obstructive Lung Disease program, Pakistan

2026-03-25

Madiha Siddiqui, Sheikh Hina Sadiq, Shumaila Zeeshan, Saima Saeed

Background & Objective: Multimorbidity (MM) or the presence of additional chronic conditions in asthma, worsens disease control and increases healthcare use, but its prevalence and sociodemographic links in Pakistan are unclear. Our objectives were to assess the prevalence and patterns of MM in asthma and examine associations with key social and demographic factors. Methodology: This observational cross sectional retrospective study was carried out at nine primary care sites of Indus Hospital & Health Network (IHHN), Pakistan. Obstructive Lung Disease (OLD) program data from January 2021 to March, 2025 of 5,802 physician confirmed asthma patients aged 12 years and above were analyzed using Statistical Package for Social Sciences (SPSS). Frequencies, percentages and logistic regression assessed prevalence, patterns, and associations of MM with age, gender, location, employment in asthma. Results: Amongst 5,802 patients, 19% had MM, most commonly hypertension and diabetes mellitus. Prevalence was highest in middle-aged (22.5%) and older adults (31.2%), while 6.2% of adolescents and young adults were also affected. After adjusting for age, gender, geographical location, and employment status, the odds of having MM were significantly higher among middle-aged and older adults compared with adolescents and young adults (p < 0.001). Male sex, rural residence, and non-employment were also associated with MM (p < 0.05). Having >1 comorbidity was more likely in older (AOR = 15.72) and middle-aged (AOR = 9.63) adults than in younger groups, and in females versus males (AOR = 1.85; all p < 0.001). Conclusion: Asthma patients in Pakistan face a substantial MM burden influenced by sociodemographic factors, highlighting the need for patient-centered care.

Early-onset blount’s disease in a two-year-old child

2026-03-25

Nida Asad, Nida Ilyas Shamsi

Blount’s disease is an acquired growth disorder involving the medial aspect of the proximal tibial physis, epiphysis, and metaphysis. Infantile Blount’s disease, one of its variants, commonly presents with progressive lower limb bowing and limb length discrepancy. Because physiological bowing and nutritional rickets are far more common in this age group, early-onset Blount’s disease is frequently overlooked in primary care settings. Early diagnosis is crucial, as timely intervention can halt disease progression, prevent worsening deformity, and reduce the need for surgical correction, whereas delayed recognition may lead to irreversible growth disturbances. This case is noteworthy because it highlights the importance of early clinical suspicion and radiological evaluation of pathological bowing in a toddler presenting first to a family medicine clinic. We report the case of a two years old girl with bilateral lower limb bowing, normal biochemical findings, and radiological features like bilateral medial tibial metaphyseal beaking (spur formation) with genu varum deformity and preserved bone density, findings consistent with early-onset Blount’s disease.

Type-IV intestinal atresia: A challenging congenital anomaly with successful management

2026-03-25

Syeda Rawash Mehdi, Anum Liaquat

Intestinal atresia is one of the most common and complex congenital deformity of neonatal life causing intestinal obstruction. It has four sub-types based on the anatomy of the atresia. Among these four types, Type-IV, which involves multiple atresia segments, is the most severe and rare with high mortality. The biggest surgical challenge is to save enough gut length to prevent long-term complications like short gut syndrome. Early diagnosis and surgical intervention with the right procedure choice is key for survival. Additionally, postoperative neonatal care, parenteral nutrition, and early feeds are crucial for a successful outcome. We present a case report of a newborn with Type-IV intestinal atresia who underwent successful surgical management, highlighting the importance of early diagnosis and prompt intervention with the choice of primary anastomosis.

Diagnostic profile of Pediatric T-Lymphoblastic Leukemia and its correlation with post-induction disease status

2026-03-25

Zeenat Amna Azhar, Neelum Mansoor, Saba Jamal

Objective: To determine the diagnostic profile of T-ALL in pediatric patients and correlate the association of the clinical characteristics with early disease outcome determined through minimal/measurable residual disease (MRD) status, tested after the induction phase of chemotherapy at day-35. Methodology: This retrospective cohort study was conducted at the Hematology Department of Indus Hospital and Health Network, Karachi, (IHHN) from October 2023 to December 2024 including 75 newly diagnosed T-ALL patients aged 1-16 years, who presented to our facility and were under treatment in Pediatric Oncology services. Results: Median age of patients was 9.52 years, with male to female ratio of 4:1. Most frequent presenting complaint was fever 92%. Mediastinal mass was present at 34.7% and CNS involvement in 4%. Immunophenotypic profile showed aberrant CD13 and CD79a expression in 1.3%. Following early treatment, 81.3% were steroid good responders; 1.3% expired before day 8, 2.7% expired before day=35. After induction of chemotherapy, 92% achieved morphological remission whereas 74.6% were MRD negative. Conclusion: In LMICs like Pakistan, pediatric T-ALL patients usually presents with advanced disease. However, risk stratification employing clinical features and early treatment outcome leading to intensified multi-agent chemotherapy administration ultimately achieved disease remission in majority of the patients, similar in comparison to local and international data.

Critical insights: Exploring the timeliness and consistency of critical results reporting in hematology section of a specialized healthcare clinical laboratory

2026-03-25

Sahrish Haji, Arrosa Rahim, M. Umar Saddique, Safdar Hussain

Background & Objective: A critical laboratory value refers to a test result that falls within a dangerous abnormal range, indicating a potentially life-threatening condition. Delays in reporting such results can jeopardize patient well-being. Therefore, assessing the timely reporting of critical result is key factor for identifying areas of improvement and ensuring efficient dissemination of crucial information to healthcare providers. This proactive approach enhances patient care, expedites clinical decisions, and reduces morbidity and mortality. This study aimed to assess the timeliness and consistency of critical result reporting in hematology section of pathology department in a specialized healthcare facility. Methodology: A retrospective cross-sectional study was conducted at the Multan Institute of Kidney Diseases from Jan 2022 till June 2025. The sample of CBC, PT, APTT, Reticulocyte count, MP-ICT meeting sample acceptance criteria were included. Results: During the study period total 2 52, 034 million tests were requested by clinicians in the hematology section of pathology department. The requisition data shows that CBC accounts for 181750 of the total, followed by PT - 34367, APTT - 34145, Reticulocytes -1182 and ICT Malaria - 590. A total of 6,152 hematology tests yielded critical results, of which 6,130 (99.82%) were reported within the established critical reporting benchmark. Only 11 cases (0.18%) experienced delays in notification due to various influencing factors. This reflects a high compliance rate in the timely reporting of critical alerts, demonstrating exceptional operational efficiency and adherence to patient safety protocols. Conclusion: Ensuring rapid and reliable delivery of critical haematology values is essential for timely clinical intervention and improved patient outcomes. Implementation of targeted strategies such as staff training, automated alert systems, and continuous performance monitoring can significantly enhance the accuracy and efficiency of critical result management.

Spectrum of constitutional chromosomal disorders: A five-year retrospective analysis from a tertiary care center in Karachi

2026-03-25

Saba Aman, Mustajab Mujtaba, Maliha Naz, Neelum Mansoor

Objective: Cytogenetic analysis plays a crucial role in the assessment of genetic disorders. Our study aimed to provide an overview of the prevalence of constitutional chromosomal abnormalities, enabling the recognition of common presentations and frequencies, which would assist us in identifying the disease burden and establishing better diagnostic services for cytogenetic studies. Methodology: This is a retrospective study conducted at the department of Cytogenetics, Clinical Laboratories of Indus Hospital and Health Network, Karachi, from January 2020 to May 2025. All cases, irrespective of age and gender, were included in the study. Conventional karyotyping is performed on peripheral blood using G-banding. Patients’ demographics and clinical parameters were retrieved from electronic medical records of the hospital after IRB approval (IHHN-IRB NUMBER: IHHN_IRB_023_05_003). Results: Total 348 cases were received for cytogenetic analysis with suspected constitutional disorder. Median age of the patients was 10 months(one day-55years) with male to female ratio of 0.7. The most common indication was suspected Down syndrome (DS), with suspected Turner syndrome and ambiguous genitalia being among other indications. The most commonly diagnosed disorder was also Down syndrome. Conclusion: Constitutional chromosomal disorders were found to be relatively frequent in our population, with numerical abnormalities occurring more often than structural abnormalities. Trisomy 21 is the most frequent disorder found in our cohort. Overall findings highlight the diverse spectrum of constitutional chromosomal disorders in Pakistan and underscore the need to strengthen cytogenetic diagnostic services to improve early recognition and patient care.