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
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.
Copyright (c) 2025 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
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
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
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
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
Barriers to Continuing Medical Education Among Doctors in Tertiary Care Hospitals of Pakistan: a Descriptive Cross-Sectional Study
Objective: To assess the barriers to Continuing Medical Education (CME) among doctors in tertiary care hospitals of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Public and private tertiary care hospitals of Rawalpindi and Islamabad, Pakistan, from Feb 2025 to Apr 2025. Methodology: This study was conducted on doctors working in tertiary care hospitals of Rawalpindi and Islamabad using a structured, self-administered questionnaire. A total of 417 responses were collected through online and paper-based surveys. Results: Out of 417 respondents, only 43.2% had attended a CME activity in the past year. The primary barriers identified were lack of time due to heavy workload (63%), high cost of participation (34%), and limited local access to CME programs (26%). To address time constraints, the most preferred solution was integrating CME into work hours (42.9%), followed by shorter or flexible sessions (29%) and online programs (25.4%). For financial barriers, employer-sponsored programs (33.3%), lower registration fees (27.6%), and free online options (27.3%) were the top recommendations. Workshops and hands-on training were the most favored CME formats (59%), and opinions on mandatory CME for license renewal were nearly evenly split. Conclusion: CME participation among doctors is hindered primarily by time and financial constraints. Institutional support through work-integrated CME, financial assistance, and flexible delivery formats can significantly enhance participation. Policy-level interventions are needed to ensure equitable access and sustained professional development.
Continuing, Education, Medical, Physicians
Copyright (c) 2025 Amna Ahmed, Mehwish Abbas, Saba Khurshid https://creativecommons.org/licenses/by-nc/4.0
The Scalpel and the Algorithm: Navigating the Ethical Landscape of AI in Medical Writing
The rapid advancement of artificial intelligence (AI), particularly large language models (LLMs) like ChatGPT, has sparked excitement and apprehension within the medical community. While the allure of automated medical writing is undeniable, we must proceed cautiously, acknowledging the ethical implications of integrating these powerful tools into our practice. LLMs offer enticing possibilities, from streamlining literature reviews to drafting manuscripts, but their limitations and potential pitfalls demand careful consideration. As Fingerhut and Winter aptly warn, "AI in medical writing has limitations and dangers. The medical community must be aware of them."1 One of the most significant concerns is the potential erosion of critical thinking. LLMs, trained on vast datasets, excel at mimicking human language and generating seemingly coherent text. However, they lack the nuanced understanding and contextual awareness crucial for scientific reasoning. As Sharma et al. points out, "AI tools cannot understand new information, generate insights, or perform deep analysis, which are essential for meaningful scientific discourse."2 Over-reliance on these tools can lead to cognitive offloading, where individuals delegate critical thinking tasks to the algorithm, potentially hindering the development of essential analytical skills.4 This is particularly concerning for trainees and early-career professionals, who may become overly dependent on AI, bypassing the rigorous process of independent learning and critical evaluation.1-3
Frequency of Parafunctional Habits and Malocclusion in Patients with Temporomandibular Disorders in Public Dental Hospital
Objective: To correlate the frequency of parafunctional habits and dental malocclusion in patients presenting with and without temporomandibular joint disorders. Study Design: Correlational study. Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from Feb to Jul 2024. Methodology: A total of 150 patients with parafunctional habits and dental malocclusion issues were assessed for presence or absence of temporomandibular joint (TMJ) disorders. The assessment for presence or absence of TMJ disorders was done according to standard guidelines furnished by the American Academy of Orofacial Pain, which included TMJ pain, muscle stiffness, and joint noises. Primary variables studied were the frequency of parafunctional habits and malocclusion between patients with and without TMJ disorders. Results: Bruxism was reported in 47(51.1%) versus 12(20.7%) patients (p<0.001), nail biting was reported in 23(25.0%) versus 07(12.1%) patients, (p=0.054), lip biting was reported in 09(9.8%) versus 04(6.9%) patients (p=0.541) holding objects in the mouth was reported in 18(19.6%) versus 05(8.6%) patients (p=0.070) and leaning the face on both arms was seen in 20(21.7%) versus 06(10.3%) patients (p=0.073). Class-I Occlusion was seen in 06(6.5%) versus 36(62.1%) patients, Class-II malocclusion in 55(59.8%) versus 22(37.9%) patients and Class-III malocclusion was seen in 31(33.7%) versus 00(0%) between both groups (p<0.001) Conclusion: We conclude that parafunctional habits and malocclusion are major and important risk factors leading to TMJ disorders in patients.
Dental, Malocclusion, Parafunctional, Temporomandibular
Copyright (c) 2025 , Shafi Ullah Khan, Adnan Babar, Sana Somair, Anis Ur Rehman, Ayesha Imran https://creativecommons.org/licenses/by-nc/4.0
Efficacy of Progressive Muscle Relaxation in Reducing Psychological Distress and Improving Quality of Life Among Nursing Students: A Feasibility Trial from Pakistan
Objective: To assess the level of psychological distress and evaluate the efficacy of Progressive Muscle Relaxation on psychological distress (stress, depression, anxiety) and quality of life among nursing students. Study Design: Mixed-methods Study. Place and Duration of Study: College of Nursing, Armed Forces Post Graduate Medical Institute, Rawalpindi Pakistan, from Jun to Aug 2024. Methodology: Phase I of the study includes the assessment of psychological distress, in which a total of 28 nursing students reported significant psychological distress based on the Depression Anxiety Stress Scale (DASS-21) and participated in testing the efficacy of PMR intervention. In phase II, a single session of PMR was used along with pre- and post-testing for study variables through DASS21, the World Health Organization Quality of Life Scale (WHOQOL-BREF), and a Demographic Information sheet (DIS) in a group setting. Result: We present initial evidence of the intervention's fidelity, with good inter-rater reliability (r=0.80), high acceptability through qualitative feedback analysis, and the feasibility of running a randomized controlled trial. Further, results revealed that after the intervention, depression scores significantly reduced with a moderate effect size (Cohen’s d=0.314). Qualitative assessment from acceptability feedback interviews complemented the findings. Conclusions: We support using PMR intervention to manage psychological distress and enhance the quality of life among nursing students in Pakistan.
Anxiety, Depression, Mental Health, Nursing Students, Progressive Muscle Relaxation
Copyright (c) 2025 Shakeel Ahmed , Nazia Mustafa, Abid Aftab, Sophia Rashid Khan https://creativecommons.org/licenses/by-nc/4.0
Saphenous Vein Graft vs. Radial Artery Graft: Searching for the Best Second Conduit in Coronary Artery Bypass Grafting
Objective: To compare early in hospital outcomes between Radial Artery (RA) graft and saphenous vein grafts (SVG) in patients undergoing Coronary Artery Bypass Graft (CABG) surgery. Study Design: Quasi Experimental study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Oct 2021-Nov 2024. Methodology: Three hundred and ninety-one patients with over age of 18 years, regardless of gender who underwent isolated On-pump CABG were recruited through non probability consecutive sampling. Patients were non-randomly allocated into two groups; Group-A (LIMA+VG) and Group-B (LIMA+RA+VG). Data on demographic, preoperative, intraoperative, and postoperative characteristics was collected using a structured proforma from adult cardiac surgery database. In-hospital outcomes and post-operative complications were compared between the study groups. Results: Out of 391 patients, 76(19.4%) were females and 315(80.6%) were males with median age of 59.00(52.00-65.01) years. Group-A and Group-B had 182(46.5%) and 209(53.5%) patients respectively. Group-A had longer ICU stay duration compared to Group-B [45.50(22.00-91.00) vs. 29.00(21.00-61.00) hours; p<0.01]. In patients receiving three grafts, Group-A showed significantly higher chest tube drainage than Group-B [550.00(380.00-990.00ml) vs. 400.00(250.00-650.00ml); p=0.013]. The OR for type of graft was 2.03 (95% CI: 0.98-4.19; p=0.05), manifesting the borderline but significant impact on the postoperative complications. Conclusion: RA grafts showed potential advantages over SVG as the second conduit in CABG surgery, especially in improving early in-hospital outcomes. Our findings emphasize the potential of RA graft use and support its frequent adoption in clinical practice particularly in younger population.
Complication, Conduit, In-hospital outcome, Radial artery, Graft patency.
Copyright (c) 2025 Imtiaz Ahmed Chaudhry, Naser Ali Khan https://creativecommons.org/licenses/by-nc/4.0
The High Cost of a Medicalized Death: Are We Heading in the Right Direction or Is It Time for a Change?
The medicalization of death refers to the process by which dying is increasingly viewed and treated as a medical issue, often leading to interventions that may not align with patients' desires or values.1 This phenomenon has been shaped by historical, cultural, and systemic factors, resulting in a healthcare model that prioritizes hospital-based care at the end of life.2,3 Every year, millions of people spend their final days in hospitals, hooked to machines and surrounded by strangers, rather than at home with loved ones. This is the reality of medicalized death—a phenomenon that prioritizes aggressive interventions over patient autonomy and dignity. Some people have argued that medicalization can provide necessary support and pain management for patients at the end of life, ensuring comfort and dignity. This perspective emphasizes the role of medical professionals in facilitating a "good death" through appropriate interventions.4 This editorial highlight the issue of medicalization in context of a developing country like Pakistan with limited resources and some possible solutions.
Factors Affecting Adherence to Iron-Folic Acid Supplementation During Pregnancy in Rawalpindi
Objectives: To determine frequency of adherence to Iron Folic Acid supplementation (IFAS) and to identify determinants of adherence to IFAS in pregnant women of Rawalpindi. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynecology and Obstetrics, Fauji Foundation Hospital, Rawalpindi, Pakistan, from Oct 2021 to Mar 2022. Methodology: Three hundred and ninety-nine pregnant women in their second and third trimesters of pregnancy meeting our inclusion criteria were recruited. A pre-validated, open-access questionnaire, including informed consent, demographic information, and items related to IFAS adherence, including reasons for non-adherence, counselling by healthcare provider, polypharmacy, family support, and whether or not the pregnancy was planned, was administered. Results: Forgetfulness (23.7%), abdominal pain (13.4%), nausea (14.4%), and unpleasant taste (11.3%) were main reasons reported for non-adherence. There was a significant association between education (p=0.001), monthly income (p=0.03), area of residence (p=0.001), planned pregnancy (p=0.001), husband’s support (p< 0.001), counseling by healthcare provider regarding the importance of IFAS (p=0.003), availability (p< 0.001), accessibility (p< 0.001) and affordability (p< 0.001) of IFAS supplements and adherence. Conclusion: The majority of women reported adherence to the prescribed IFAS supplementation. Higher education, planned pregnancy, urban residence, husband’s support, counselling by healthcare provider, affordability, availability and accessibility were associated with adherence. For those who reported non-adherence, forgetfulness and side effects were main reasons reported for non-adherence. Training of healthcare professionals to provide better counseling to women and their husbands during Antenatal care is recommended.
Folic Acid, Iron-deficiency Anemia, Medication Adherence, Pregnancy.
Copyright (c) 2025 Fatima Ali Raza Mughal, Naila Azam, Raima Asif, Najam us Saqib Khan, Mehwish Riaz https://creativecommons.org/licenses/by-nc/4.0
The Outcome of Pregnancy in Women with Normal V/S High Salt Intake Presenting in a Hospital of Northern Region of Pakistan
Objective: To compare the outcome of pregnancy in women with normal versus high salt intake presenting in a hospital of northern region Pakistan. study design: quasi experimental study. Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital, Gilgit Pakistan, from Feb 2023 to Feb 2024. Methodology: This study was conducted on the pregnant women attending the department for antenatal checkup in these study dates. Daily salt intake was calculated with the help of dietician by calculating the overall consumption of sodium chloride in different forms during the day. Women were divided into two groups on this basis as having normal or high salt intake. Both the groups were followed up till the time of delivery for any maternal or fetal complications. Results: A total of 1000 pregnant women were included in the final analysis who were followed up till delivery. Mean age of the study participants was 26.66±5.15 years. Out of the babies born, 527(52.7%) were males and 473(47.3%) were females. Out of 1000 women, 450(45%) were classed as having normal salt intake while 550(55%) were classed as having high salt intake. Statistical analysis showed that intrauterine growth retardation, oligohydramnios, pregnancy induced hypertension and preeclampsia were found significantly more in women who had high salt intake (p-value<0.01). Conclusion: A significant number of pregnant women in Gilgit and surrounding areas were having high salt intake. Both maternal and fetal complications studies were found significantly more in women with high salt intake as compared to women with ...
Fetal growth retardation; Infant; Pregnancy; Sodium Chloride; Preeclampsia; Oligohydramnios
Copyright (c) 2025 Reema Gul, Ayisha Raja, Munnaza Andleeb, Faria Memon, Fareeha Zaheer, Umber Imtiaz Khan https://creativecommons.org/licenses/by-nc/4.0
Opportunistic Infection in HIV Patients at Tertiary Care Hospital in Rawalpindi
Objective: To determine the spectrum of opportunistic infection in human immunodeficiency virus patients at tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Infectious Diseases, Pak Emirates Military Hospital, Rawalpindi, Pakistan from Jan 2024 to Sep 2024. Methodology: The confirmed cases of human immunodeficiency virus infection of both genders between the age of 18-65 years were included. Patients having any infection before the diagnosis of human immunodeficiency virus infection were excluded from the study. Moreover, those who were not willing to participate and unable to comprehend questions were also excluded. All participants willing to participate were interviewed for demographic details and the clinical examination was done afterwards. Laboratory investigations for the suspected opportunistic infections were done. Results: Of these eighty-one (n=81) patients 74(91.36%) were males and 7(8.64%) were females with a median age of 29.00 (44.00-35.00) years. The median HIV RNA PCR value was 33000.00 (1529.00 - 903341.00) IU/ml while median CD4 counts were 213.00 (71.00-381.00) cell/mm3. The most common opportunistic infection was pulmonary tuberculosis 20(24.69%) followed by Cytomegalovirus infection 18(22.22%) and Toxoplasmosis 17(20.99%). Syphilis was seen in 7(8.64%) while Cryptococcal Meningitis was seen in 3(3.70%). The least common infections were hepatitis B and Ebstein Bar virus infection having a frequency of 1(1.23%). Conclusion: Pulmonary tuberculosis, cytomegalovirus infection and toxoplasmosis were the most common infections observed in individuals with human immunodeficiency virus infection.
Autoimmune deficiency Syndrome, Human immunodeficiency infection, Opportunistic Infection, Tuberculosis.
Copyright (c) 2025 Mirza Waseem Javed, Shazia Nisar, Ejaz Ahmad, Muhammad Iqbal, Muhammad Anwar, Syed Yasir Abbas https://creativecommons.org/licenses/by-nc/4.0
Workplace Challenges and their Impact on Quality of Life Among Women in Midlife and Beyond
Objective: To identify workplace challenges experienced by women in midlife and beyond and determine the impact of these challenges on their Quality of Life. Study Design: Analytical cross-sectional study. Place and Duration of Study: Islamabad, Pakistan, from March to December 2023. Methodology: This study included working women between the ages of 45 to 65 years, who were invited to participate in an online survey hosted on Google Forms. The survey was a structed and validated questionnaire, comprising demographic details and questions related to time utilization, job satisfaction and facing workplace challenges. Results: The researchers enrolled 282 female participants from Islamabad, Pakistan, majority (160, 56.7%) of whom were between the ages of 45-50 years and reported having full-time employment (162, 57.4%). While most participants felt that they did not face organizational discrimination in their workplace (192, 68.1%), a lot of participants also responded that they had faced employment rejection due to being in midlife (176, 62.4%) and had taken extra efforts to maintain their appearance (149, 52.8%). Statistical tests were applied where p-value ≤0.05 was considered significant. Conclusion: Majority women reported no organizational discrimination at work, experienced no economic challenges and feared no age-related job threats. Participants who reported occasionally taking time off work for themselves and spent time frequently with family and friends felt no need to take early retirement indicating high job satisfaction.
Job Satisfaction, Occupational Stress, Quality of Life, Working Women, Work-Life Balance.
Copyright (c) 2025 Nabia Tariq, Anum Shahid, Asmara Ahmed Malik, Najm us Saqib Khan https://creativecommons.org/licenses/by-nc/4.0