ZU Journal System (Ziauddin University)
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Exploring Antimicrobial Peptides in Preventive Dentistry: A Novel Approach to Oral Microbiome Management
No full textBackground: The oral microbiome plays a major role in maintaining oral health. Antimicrobial peptides like AMPs provide strong antifungal and antimicrobial properties. This study evaluated the expression levels of these genes in response to antimicrobial interventions for managing the oral microbiome.
Methods: This cross-sectional study (June 2022 to December 2022) contained 60 subjects: healthy subjects (n = 20) and gingivitis patients (n = 40). OpenEpi 3.0.0. was used for sample size calculation. It was conducted at Baqai Medical University and analyzed at Liaquat College of Medicine and ISRA University Karachi. Total RNA was extracted and converted to cDNA for qRT-PCR analysis. The gene expression levels of HTN1 and HTN3, normalized to GAPDH, were analyzed. ANOVA and t-tests were used to assess statistical significance (p < 0.05). SPSS v20 was utilized to perform these tests.
Results: Demographic variables like age, gender, smoking, and index did not differ significantly. qPCR revealed that chlorhexidine administration resulted in a 2.5 ± 0.31–fold and a 1.9 ± 0.27–fold increase in HTN1 and HTN3 expressions, respectively (p < 0.001). Application of fluoride resulted in a 1.8–fold increase in HTN1 (p < 0.01) and a 1.6–fold increase in HTN3 (p < 0.01), and LL-37 mimetics caused a 2.1–fold rise in HTN1 expression (p < 0.01) and a 1.7–fold elevation in HTN3 gene expression (p < 0.01).
Conclusion: The administration of antimicrobial agents modifies HTN1 and HTN3 gene activity for potential use in managing oral diseases
Advancing Anesthesia Care and Challenges by Artificial Intelligence: A Prospective Study based on Systematic Review and Meta-Analysis
No full textBackground: AI technologies remain essential in modern perioperative care, where they improve clinical decision outcomes and delivery of anesthesia. Health professionals need additional validation testing to determine the practical implementation of these systems for regular medical practice. This study aimed to evaluate the clinical effectiveness and diagnostic accuracy of AI-based tools in anesthesia and perioperative care.
Methods: This PRISMA-2020 based review included studies published till May 2025 on AI use in anesthesia and perioperative care with clinical outcomes. Two reviewers independently extracted data and assessed bias (Cochrane for RCTs, NOS for observational). Meta-analysis was done using RevMan 5.4.1 under a random-effects inverse-variance model. Results were reported as SMDs for clinical effectiveness and ORs for diagnostic accuracy. Heterogeneity (I²), subgroup, and sensitivity analyses were also performed.
Results: Seven research studies (5 as randomized controlled trials, 2 as observational ones) with 1,821 patients were found on inclusion. Anesthesia was implemented with the use of AI in the prediction of the diagnosis, monitoring of sedation, and facilitation of recovery. There were no significant differences in the outcomes of recovery (SMD: -0.36, 95% CI: -1.20 to 0.49). More diagnostic accuracy was achieved under the influence of AI (OR: 2.12; 95% CI: 1.05 to 4.27). The risk of bias was moderate or low.
Discussion: New evidence indicates that AI will transform perioperative care through automated decision support functions and outcome prediction solutions; however, a key limitation is the small number of eligible studies and high variability across clinical settings. Thus, standard evaluation standards and multicenter testing activities are necessary for this potential to become realizable
Closed K-Wire Fixation for the Treatment of Peri-Lunate Dislocation – A Case Series
No full textPerilunate dislocations and trans-scaphoid perilunate fracture dislocations are serious wrist injuries with the potential for lasting dysfunction if not treated appropriately. This case series presents three male patients with perilunate injuries treated using closed Kirschner wire fixation techniques in 2024. Each case involved varying levels of complexity and timing of presentation. One patient presented three weeks post-injury with a high palmar dislocation and underwent volar open reduction with ligament repair and K-wire stabilization. Another patient arrived within hours of a traffic accident and received closed reduction and percutaneous pinning within 24 hours. The third case involved a combined radial styloid and scaphoid fracture with lunate dislocation, managed using a dual surgical approach with internal fixation and ligamentous repair. These cases highlight the importance of timely diagnosis, injury-specific surgical planning, and the utility of K-wire fixation as a stabilizing method. Early intervention and tailored surgical techniques contribute to favorable outcomes in managing complex wrist injuries
Cognitive Behavioral Therapy Versus Antidepressant Medication in Generalized Anxiety Disorder: A Prospective Schematic & Meta-Analysis Approach
No full textBackground: Generalized Anxiety Disorder (GAD) is a common mental disorder, which is usually treated by cognitive behavioral therapy (CBT) or antidepressant medications (ADMs). Nevertheless, a significant number of patients do not respond well to monotherapy, resulting in complete remission. The present review focuses on the main comparison of CBT and ADM outcomes in GAD. Cases of combination therapy (CBT + ADM) were reviewed secondarily in those studies that reported it.
Methods: The articles were identified through systematic searches of PubMed and Google Scholar that were carried out to determine randomized controlled trials published between 2011 and 2025. The inclusion criteria included studies that used adults with standardized measurement of GAD diagnosis and post-therapeutic outcomes of anxiety measures CBT, and/or ADM. Combination data were identified where available. The mean anxiety scores were pooled in a random-effects meta-analysis and risk of bias was evaluated according to the Cochrane method.
Results: The number of included studies was eight randomized controlled trials with 259 participants. In the main analysis, CBT resulted in slightly improved post-treatment anxiety results (mean = 20.46, 95% CI: 5.9534.96) than pharmacotherapy alone (mean = 22.75, 95% CI: 4.6940.80). The lowest pooled score (mean = 17.72, 95% CI: 10.83 24.62) was observed in those studies that reported combination therapy. Nonetheless, because of great heterogeneity among the studies (I2 > 95%), the findings were viewed with caution. The overall direction of effect was supported by subgroup and sensitivity analyses.
Discussion: CBT can be slightly more effective than antidepressant drugs in alleviating anxiety symptoms in GAD. Combination therapy also demonstrated good outcomes in a few studies, but this was not the key aspect of this analysis. Future studies are needed on standardizing outcome measures and examining individual predictors of treatment responsiveness in order to conduct personalized care
Frequency of Recurrent Laryngeal Nerve Palsy with Routine Nerve Identification in Benign Thyroid Surgeries
No full textBackground: Goiter is a global health issue. A small goiter with normal thyroid function tests does not require treatment. The size of a large euthyroid goiter may be reduced by thyroxine suppressive therapy. The study aimed to determine the frequency of recurrent laryngeal nerve (RLN) injury through routine visual identification during thyroidectomy and to provide a foundation for developing advanced identification methods.
Methods: This cross-sectional survey was conducted at the General Surgery Department of Fauji Foundation Rawalpindi from July 2022 to June 2023. The study included 241 patients with benign thyroid disorders requiring thyroidectomy. Non-probability consecutive technique was used for sampling. All patients underwent fiber-optic direct laryngoscopy (FODL) before surgery to assess the preoperative RLN status. Patients showing improvement on follow-up laryngoscopy were classified as having transient recurrent laryngeal nerve palsy, while those with persistent abnormal vocal cord mobility even after 6 months were classified as having permanent RLN palsy. Data was analyzed using SPSS version 25. Qualitative and quantitative variables were expressed as percentages/frequencies and mean±SD. Effect modifiers were controlled by stratification and p value <0.05 considered as significant.
Results: The average age of the patients was 50.67±9.06 years. There were 73 (30.29%) males and 168 (69.71%) females. After 24 hours post-surgery, the RLN injury rate in endoscopic thyroidectomy was 1.2%. At 3 months, the injury rate increased to 3.7%, and after 6 months, it was 2.1%. Stratification analysis reflected that among all the study confounders, statistically significant association (p<0.05) for was noted for size of goiter only.
Conclusion: In this study, RLNP during thyroidectomy was identified in 1.2% of patients after 24 hours, 3.7% at 3 months, and 2.1% after 6 months. This comprehensive analysis of RLN injury can inform discussions during informed consent and assist surgeons in identifying candidates at higher risk for injury.
Outcome Idiopathic Intracranial Hypertension in Terms of Papilledema Improvement Following Lumboperitoneal Shunt: Experience at Khyber Teaching Hospital
No full textBackground: Background: Idiopathic intracranial hypertension or pseudotumor cerebri is a clinical entity characterized by symptoms and signs of elevated intracranial pressure, cerebrospinal fluid opening pressure >25 cm H₂O, normal cerebrospinal fluid composition, and absence of radiological evidence of causative lesions on magnetic resonance imaging or computed tomography. Treatment options vary from conservative to surgical. The use of Lumboperitoneal Shunt has been well documented as treatment modality for patient with idiopathic intracranial hypertension.
Objective: To evaluate the outcome of idiopathic intracranial hypertension in terms of improvement in papilledema following lumboperitoneal shunt placement and to analyze predictive factors for treatment success.
Methodology: This cross-sectional descriptive study was conducted at Khyber Teaching hospital Peshawar from June 2023 to June 2025 among 32 patients. Study design was non-probability purposive. Informed consent was obtained from all patients. Female patients with age range from 18 to 45 years with diagnosed cases of IIH were included. Statistical analysis included chi-square tests, paired t-tests, Fisher\u27s exact test, and correlation analysis using SPSS version 28.
Results: Among 32 female participants (mean age: 32.8±2.1 years), pre-surgical fundoscopic examination revealed grade 1 papilledema in 18 cases (56.2%) and grade 2 in 14 cases (43.8%). Mean cerebrospinal fluid opening pressure measured 38.2±4.5 cm H₂O (range: 28-48). Following lumboperitoneal shunt insertion, optic disc swelling resolved in 29 patients (90.6%), while cephalgia subsided in 26 cases (81.3%). Surgical intervention within six months of symptom onset demonstrated superior therapeutic efficacy compared to delayed procedures (100% vs 76.9% papilledema resolution; OR=4.44,95% CI [1.12-17.62], p=0.032). Post-surgical CSF pressure reduction proved statistically robust (mean decrease: 20.7±5.4 cm H₂O; t=21.760, p<0.001).
Conclusion: Lumboperitoneal shunt demonstrates excellent efficacy for papilledema improvement in IIH with 90.6% success rate. Early intervention before advanced papilledema develops is crucial for optimal outcomes. The procedure has acceptable complication rates and should be considered in medically refractory cases
Epidemiology and Burden of Infectious Diseases in a Tertiary Care Hospital
No full textBackground: Infectious diseases remain a significant cause of morbidity and mortality, particularly in low- and middle-income countries. Tertiary care hospitals face increasing challenges from antimicrobial resistance and healthcare-associated infections, necessitating localized epidemiological data for effective management. The study aimed to determine the epidemiology and clinical burden of infectious diseases at Bakhtawar Amin Hospital, Multan, Pakistan, identifying high-risk populations, seasonal trends, and predictors of mortality.
Methods: A cross-sectional analytical study was conducted from January 2023 to December 2024. A total of 334 adult inpatients with confirmed infectious diseases were included. Data were extracted from medical records using ICD-10 codes. Variables included demographics, diagnosis, seasonality, antimicrobial use and outcomes. Statistical analysis was performed using SPSS version 26.0.
Results: The mean age was 48.6 ± 16.4 years; 54.8% were male. Respiratory tract infections (34.4%) were most common, followed by urinary tract (18.6%) and gastrointestinal infections (13.2%). Summer saw the highest admissions (31.1%), while winter showed peak respiratory illness (42.6%). Nosocomial infections accounted for 21.3% of cases. Antimicrobial use was high, with 22.5% of isolates being multidrug-resistant. Mortality was 16.2%, with age >60 years and diabetes as independent predictors of death.
Conclusion: Infectious diseases significantly burden tertiary care services, especially among older adults and diabetics. Targeted infection control, antimicrobial stewardship, and surveillance are critical to mitigating this burden
Etiological Spectrum of Intestinal Obstruction in Adults Having Virgin Abdomen
No full textBackground: Intestinal obstruction is a common surgical emergency with significant morbidity and mortality, but postoperative adhesions are its most frequent cause. Patients with a virgin abdomen—those without any prior abdominal surgery—pose diagnostic challenges; this study explored the etiological spectrum, clinical features, and outcomes of such cases in a tertiary care hospital in Pakistan.
Methods: A six-month prospective observational study at Lady Reading Hospital, Peshawar, enrolled 73 eligible adult patients, categorizing them into Group 1 (surgical management for mechanical causes such as hernias, tumors, or volvulus) and Group 2 (conservative management for functional or self-resolving causes). Data collected encompassed demographics, presenting symptoms, vital signs, symptom duration, and etiological factors, supplemented by relevant laboratory investigations and imaging studies. Statistical analysis was performed using SPSS version 26, with continuous variables summarized as mean ± standard deviation and compared using the independent t-test, categorical variables presented as frequencies and percentages and analyzed using the Chi-square or Fisher’s exact test, and a p-value of <0.05 considered statistically significant.
Results: The mean age of Group 1 was significantly higher (55.73 ± 4.86 years) than Group 2 (44.13 ± 6.32 years, p < 0.001). Tumors were the most common cause (24.7%), followed by hernias (20.5%) and volvulus (13.7%). Group 1 had longer hospital stays (12.45 ± 2.94 days vs. 7.76 ± 2.03 days, p < 0.001) and higher clinical severity. Complications and mortality rates were low and comparable between groups, with effective management in both cohorts.
Conclusion: The cause of intestinal obstruction differs in patients with a virgin abdomen of which has a vast clinical impact. It demands early diagnosis and proper treatment plans to enhance the quality of life and reduce mortality. Further investigations of patient follow-up with focus on discharge and ways of minimizing the number of days patients spend in the hospital are important
Low Tidal Ventilation During Bypass in Coronary Artery Bypass Reducing Post Operative Atelectasis and Pneumonia
No full textBackground: Postoperative pulmonary complications are frequent after coronary artery bypass grafting (CABG), and the contribution of low tidal volume ventilation during cardiopulmonary bypass (CPB) to pneumonia and atelectasis prevention is still unclear. The main objective is to determine the rates of postoperative pneumonia and atelectasis in patients during the CABG surgery and LTV ventilation during CPB, and to determine their relationships with the demographic and intraoperative parameters.
Methods: This descriptive observational study was carried out at the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi. A consecutive non-probability method was used to include 185 patients aged between 30 and 75 years due to an urgent need of CABG. LTV in CPB was 3-4ml/kg ideal body weight and respiratory rate was 10breaths/minute. Based on standardized clinical and radiological criteria there was postoperative pneumonia and atelectasis. SPSS version 26 was used to analyze the data and p-value was set at 0.05.
Results: The average age was 54.43 ± 6.51years and 136 (73.5 %) were men. There were 15 patients (8.1%) with pneumonia and 31 patients (16.75%) with atelectasis. No statistically significant correlations of these complications with the demographic features, comorbidities or intraoperative parameters of ventilation were found.
Conclusion: Pneumonia and atelectasis were identified in CABG patients ventilated with LTV during CPB, however none of the perioperative factors were found to relate significantly to pneumonia or atelectasis occurrence
Evaluating Neurotherapeutic Potential of Myricetin by In-Vivo research models
No full textBackground: Oxidative stress, neuroinflammation, and poor neurotrophic signaling are associated with neurological diseases. Myricetin is a bioflavonoid present in berries, vegetables, and medicinal herbs, with strong anti-inflammatory, antioxidant, and neurotrophic properties in animal studies. The objective of the present in-vivo research was to assess the neuroprotective potential of myricetin on nerve growth factor (NGF) expression and neuroinflammation in chemically induced neural injury. Materials and Methods: Thirty healthy male adult Wistar rats (180-220g, 8 weeks old) were randomly divided into five groups (n=6 per group). Group I was used as a control, with no intervention. Groups II to V were exposed to a standard propionic acid (PPA) to induce neuroinflammation. Groups III-V were induced and subsequently administered with oral myricetin of 50 mg/kg, 100 mg/kg, and 200 mg/kg for 28 days. Serum levels of NGF were measured with Enzyme-linked Immunosorbent assay (ELISA). One-way ANOVA was performed for statistical analysis using SPSS. Results: PPA decreased NGF to 4.3 ± 0.5 pg/ml (p< 0.001). Myricetin restored NGF to 9.3, 7.6, and 9.8 pg/mL via 50, 100, and 200 mg/kg doses, respectively. At 200 mg/kg, C-reactive protein (CRP), tumor necrosis factor (TNF), and malondialdehyde (MDA) were decreased to 1.7 ± 0.2 mg/L, 26 ± 3 pg/mL, and 2.9 ± 0.3 nmol/mg, compared to 4.9 ± 0.4, 58 ± 4, and 6.7 ± 0.4. (p < 0.001). Conclusion: Myricetin exhibits promising neurotherapeutic potential, evidenced by its ability to upregulate NGF and mitigate neuroinflammatory damage, making it a potential therapeutic option for the treatment of neurological disorders