ZU Journal System (Ziauddin University)
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Specialized Workforce Development in Rehabilitation the Prerequisite of Future Health Care Need
No full textThe bionetwork of healthcare in Pakistan is foreseeing a storm of noncommunicable diseases in the coming future loaded especially diabetes, stroke and cardiovascular which will be leading to further rise in mental health disorders across the life and expediting the disability adjusted life years of the population. This threat will not only collapse the health care system but also social economical block of Pakistan demographic. The scarcity of specialized rehabilitation and lack of infrastructure of service integration in health care system is one of the major challenges.
From Silence To Seizures: Benzodiazepine-Induced Neonatal Abstinence Syndrome In A Preterm Newborn– A Rare Case From Darul Sehat Hospital.
No full textThis case report delves into the clinical presentation, examination and management of a neonate from Pakistan, diagnosed with NEONATAL ABSTINENCE SYNDROME(NAS) at DarulSehat. It’s a withdrawal condition affecting infants with opioids or other Central Nervous System depressants exposure in utero. The subject, born at 33 weeks via emergency C-section to a mother with history of opioid use exhibited classical symptoms of NAS including high pitched cry, hyperirritability, seizures, tachypnea, tremors-within 24 hours postpartum. Thorough clinical evaluation supported by laboratory and imaging findings led to diagnosis of NAS secondary to maternal benzodiazepine abuse during pregnancy. A Finnegan Neonatal Abstinence Scoring System was used to monitor the severity of withdrawal symptoms and guide treatment. This case accentuates importance of early identification, standardized assessment protocols and multidisciplinary approach of NAS to improve short and long term outcomes. It also emphasizes the ongoing need for support systems for families affected by this disorder
Comparison Of One-Year Outcome After Elective Percutaneous Coronary Intervention: Single Vs Multiple Inflations Of Drug-Eluting Balloons
No full textBackground: Drug-eluting balloons (DEBs) are increasingly used in percutaneous coronary intervention (PCI), particularly for patients with small vessel disease or those unsuitable for stent implantation. However, the optimal inflation strategy for DEBs remains unclear. The aim of this research was to compare one-year outcomes of single versus multiple inflations of the same DEB during elective PCI
Methods: This prospective study was conducted at Ch Pervaiz Elahi Institute of Cardiology, Multan, from 4th April 2024 to 4th April 2025. A total of 86 patients aged 40-75 years of both genders with de novo coronary lesions received either single (Group A) or multiple (Group B) inflations of the same DEB. All patients underwent lesion preparation with pre-dilatation, followed by DEB-only angioplasty. The main outcome was late lumen loss (LLL) at one year. Secondary endpoints included target lesion revascularization, binary restenosis, and major adverse cardiovascular events.
Results: Group B (multiple inflations) showed significantly lower LLL (0.21 ± 0.09 mm) as compared to Group A(0.35 ± 0.12 mm)(p=0.01). TLR and binary restenosis rates were numerically lower in Group B (4.7% vs. 13.9% and 2.3% vs. 11.6%, respectively), though not statistically significant. No differences in MACE were observed. Procedural success was 100% in both groups. Multiple inflations were associated with significantly lower late lumen loss at one year (0.21 mm) as compared to single inflations (0.35 mm) (p = 0.01). A trend toward lower TLR and binary restenosis was observed in the multiple-inflation group (p>0.05).
Conclusion: Multiple inflations of the same DEB result in significantly lower late lumen loss and favourable trends in restenosis and revascularization compared to single inflation. This simple modification may enhance DEB efficacy and should be considered in routine PCI practice, especially in resource-limited settings
Risk-Profiling and Early Wound Complications following Lower-Limb Amputation with Primary Stump Closure at Mayo Hospital, Lahore
No full textBackground: Surgical site infection (SSI) is known to complicate the outcome of below-knee amputation (BKA), negatively impacting recovery. To enhance outcomes, it is critical to identify risk factors of SSI. The aim of the study was to determine the frequency, contributing factors and independent predictors of SSI in patients who underwent BKA using primary stump closure.
Methods: A prospective descriptive case series was done in the East Surgical Ward at the Mayo Hospital Lahore, a tertiary teaching hospital, over a period of six months (from May 2025 to November 2025). Consecutive enrollment of 77 patients aged 18-70 years with peripheral arterial disease and wet gangrene necessitating BKA was enrolled. All amputations were done through the long-posterior flap technique under spinal anesthesia. The duration of monitoring postoperative SSI was seven days. The data were examined through descriptive statistics, Chi-square, and logistic regression; a p-value below 0.05 was found to be significant.
Results: SSI was present in 53 (68.8%) patients. The average age was 63 years old, and the majority of them were male (59, 76.6%). The frequent comorbidities were anemia (71, 92.2%), poor glycemic control (53, 68.8%), leukocytosis (45, 58.4%), renal failure (25, 32.5%), and peripheral arterial disease (40, 51.9%). The multivariate analysis presented a positive relationship between male gender and decreased risk of SSI (OR = 0.116, 95% CI: 0.014-0.973, p = 0.047).
Conclusion: SSI occurs frequently in BKA using primary stump closure. Male gender lowers the risk of SSI, whereas other comorbidities and poor glycemic control do not have significant relationships
A Review of Emerging Innovations in Dentistry --- Bridging Science, Technology, and Patient Care
No full textDentistry has entered a transformative era where the convergence ofscience and technology is redefining the boundaries of oral health care.What was once limited to restorative and preventive practices is nowexpanding into a domain where digital solutions, biomaterials, andprecision medicine stand at the forefront. The review on EmergingInnovations in Dentistry is both timely and significant, highlighting theaccelerating pace of change and its profound implications forpractitioners and patients alike.Digital dentistry, particularly through computer-aided design andmanufacturing (CAD/CAM), intraoral scanners, and 3D printing, hasrevolutionized clinical workflows. These tools not only enhanceaccuracy and efficiency but also improve patient experience byreducing chair time and delivering personalized care. Alongside,regenerative approaches—such as stem-cell-based therapies andbioengineered scaffolds—offer a glimpse into a future where naturaltooth structures may be restored, rather than replaced, marking aparadigm shift in treatment philosophy.Artificial intelligence (AI) and machine learning are also beginning toreshape diagnostic and predictive capabilities. By analyzingradiographs, intraoral images, and patient histories withunprecedented precision, AI holds the potential to assist clinicians inearly disease detection and tailored treatment planning. Thesetechnologies, however, must be integrated with a human-centered
approach, ensuring that the essence of patient care remains rooted inempathy and trust.What makes these innovations most compelling is their role in bridgingscience with patient-centered outcomes. Beyond technicalsophistication, the true measure of innovation lies in accessibility,affordability, and its ability to close gaps in oral health disparities. Theintegration of tele-dentistry, mobile health applications, and minimallyinvasive techniques underscores a broader commitment to inclusivecare that extends beyond the dental chair.As we reflect on these advancements, the responsibility lies inbalancing enthusiasm for new technologies with a criticalunderstanding of their limitations and ethical implications. The futureof dentistry must not only be innovative but also equitable, sustainable,and evidence-based.This review serves as a reminder that dentistry today is no longerconfined to drills and fillings—it is a dynamic discipline bridging science,technology, and compassionate care. By embracing innovationresponsibly, the dental community can ensure that progress translatesinto healthier smiles and improved quality of life for patientsworldwide
Comparison Of Port Site (Epigastric Versus Umbilical) Infection Following Gall Bladder Retrieval In Patient Undergoing Laparoscopic Cholycystectomy
No full textBackground: Laparoscopic cholecystectomy is a common surgical procedure for removing the gallbladder. While it\u27s minimally invasive, there\u27s still a risk of port site infection. This study was conducted to compare the frequency of port site infection and postoperative pain between umbilical and epigastric port retrieval.
Methods: A prospective observational study was conducted at department of Surgery, Ghulam Muhammad Mahar Medical College, Sukkur, between September 2024 to April 2025. A total of 114 patients undergoing elective laparoscopic cholecystectomy were consecutively enrolled and divided into two equal groups: umbilical and epigastric. Pain levels were recorded using the Visual Analogue Scale at 1, 6-, 12-, 24-, and 36-hours following surgery. Port site infection was monitored for 30 days postoperatively. Statistical analysis was performed in SPSS version 27, applying Mann–Whitney U test, Chi-square/Fisher’s Exact test, and multivariable logistic regression (significance threshold: p≤0.05).
Results: Port site infection occurred in 17 (14.9%) patients, with significantly more cases in the epigastric group (n = 13, 76.5%) than the umbilical group (n = 4, 23.5%) (p < 0.001). Retrieval via the umbilical port significantly lowered infection risk (adjusted odds ratio [aOR] = 0.18; 95% CI: 0.04–0.78; p = 0.021). Non-diabetic patients also showed a substantially reduced likelihood of infection (aOR = 0.02; p < 0.001). At all assessed time intervals except the 6-hour mark, postoperative pain scores were significantly lower for the umbilical group.
Conclusion: Umbilical port retrieval during laparoscopic cholecystectomy is associated with significantly lower rates of port site infection and postoperative pain
Evaluating the Impact of Enhanced Recovery After Surgery (ERAS) Protocols on Postoperative Morbidity and Hospital Stay
No full textBackground: Enhanced Recovery after Surgery (ERAS) protocols are the scientifically-supported perioperative guidelines aimed at optimizing the recovery, minimizing the complications, as well as the hospitalization. The objective of this study was to determine the impact of ERAS measures on postoperative outcome, such as complications, hospital stay, pain management, and functional recovery, in comparison to the traditional methods of perioperative care.
Methods: This prospective cohort study (September 2023 to February 2024) included 140 adult patients undergoing general surgical practice was recruited with 70 of the population treated according to an ERAS protocol and 70 treated according to conventional care. Demographic and clinical baseline data were taken. Postoperative complications, hospital stay, and pain scores, ambulation time, postoperative site infections, and postoperative nausea and vomiting, as well as 30-day readmission, were recorded. T-tests were used to analyze the continuous variables and chi-square to test the categorical variables, p < 0.05 was considered significant.
Results: The 13 (18%) patients in the ERAS group had much fewer postoperative problems (p=0.012) and shorter hospitalization (3.8 ±1.2) compared to the Standard Care group (6.2 ±1.5). The pain scores at 24 and 48 hours were lower, and the ambulation was earlier in the ERAS group (p<0.001). Postoperative nausea/vomiting and 30-day readmission rates were also equal, and surgical site infections (SSI) were less frequent as 4(5.7%, p=0.04).
Conclusion: ERAS protocols are effective in general surgical patients by decreasing complications, length of stay, pain management, and mobilization in both general and surgical patients
Outcomes Of Infant Acute Lymphoblastic Leukaemia; An Experience From Low Middle Income Country
No full textBackground: Acute Lymphoblastic Leukaemia (ALL) is the most common pediatric malignancy. This study was done to describe the prognostic factors and course of infant ALL in Pakistan.
Methods: This retrospective observational study was performed at the department of Paediatric Oncology/Haematology, CMH Hospital Rawalpindi, Pakistan, from January 2012 to December 2023. Data of infants with confirmed diagnosis of ALL by immunophenotyping and treated as per Interfant 06 protocol were analyzed. Non-probability consecutive sampling technique was adopted. Disease risk stratification was done based on clinical and laboratory markers. Prognostic factors, overall survival (OS), and disease-free survival (DFS) were documented. Statistical analysis was performed using IBM-SPSS Statistics, Version 26.0.
Results: In a total of 47 infants, there were 25 (53.2%) male, and the median age was 9.00 (6.00-10.00) months. Age (p<0.001), and MLL rearrangement (p<0.001) had significant association with disease risk group. During the evaluation period, relapse was noted among 17 (36.2%) cases. Mortality was reported among 33 (70.2%) cases. The median DFS, and OS were 6.90 (1.90-27.3) months, and 9.6 (2.90-29.0) months, respectively. ALL disease risk categorization was found to have significant association with overall survival (p=0.016). Evaluation of laboratory parameters revealed that mortality was significantly associated with higher leukocytes count (p=0.027), and lower platelets count (p=0.010).
Conclusion: The overall mortality in ALL is high. These findings highlight the critical role of risk group stratification, elevated WBC count, and low platelet count in predicting survival outcomes in infant ALL
Transcription Factor 7/Like2 (TCF7/L2) Gene Associated With Metabolic Syndrome In The Type 2 Diabetes
No full textBackground: Diabetic retinopathy (DR) is a chronic complication of diabetes mellitus which can be due to micro vascular changes occurring in retina due to hyperglycemia. Polymorphism in gene TCF7L2 rs7903146 has been shown to increase susceptibility to developing diabetes mellitus.
Aim: Association between Diabetic retinopathy (DR) and polymorphism of TCF7L2 expression and alteration in VEGF expression level has also been found in Type2 DM.
Method: A comparative research was carried out in the Department of Biochemistry, with 148 volunteers aged 18 to 50 recruited from the Baqai Institute of Diabetology and Endocrinology (BIDE). Clinical data, anthropometric measures, and biochemical markers such FBS, OGTT, HbA1c, and lipid profile were obtained. Genomic DNA was collected, and the TCF7L2 gene polymorphism (rs7903146) was examined by Sanger sequencing.
Results: The study analyzed 148 Type 2 Diabetes mellitus (T2DM) patients with and without retinopathy, with a mean age of 43.27±9.45 years. Results showed significant differences in blood pressure, fasting blood glucose, HbA1c, triglycerides, and cholesterol levels between groups. The TT genotype was more abundant in group B, while the CT genotype was higher in group A. The majority of T2DM patients with retinopathy had complications like retinal hemorrhages, microdot, and blindness.
Conclusion: Overall, the homozygous TT genotype of TCF7L2 rs7903146 polymorphism was found dominant in T2DM subjects with retinopathy as compared with T2DM without retinopathy, and CT genotype was found higher in T2DM subjects without retinopathy and healthy individuals. We also found mutant T allele was predominantly higher in T2DM subjects with and without retinopathy