ZU Journal System (Ziauddin University)
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Postoperative Recovery in Thyroid Surgery: Evaluating Pain, Scar Quality, and Operative Efficiency with and without Platysma Suturing
No full textBackground: Often, thyroid surgery requires a layered closure, involving the suturing of the platysma muscle. But, this procedure can increase the length of the surgery and the pain a patient feels afterward without obvious benefits. It is important to think about the need for this surgery to help achieve better results and better patient recovery. The intention of this study is to review the postoperative pain, appearance of the scar and the amount of time needed for wound closure when using or not using platysma suturing in thyroidectomy.
Methods: At Mayo Hospital Lahore, researchers recruited 72 patients going through thyroid surgery to take part in a randomized controlled trial January to July 2022. The patients were assigned to one of the following two groups: Group A patients had no platysma suturing, whereas Group B had it. The pain level was checked 6, 24 and 48 hours postoperatively using the Visual Analogue Scale (VAS). At the 6-month mark, the quality of scars was appraised with the Patient and Observer Scar Assessment Scale (POSAS). We also collected data about when surgery was completed and whether any pain relief medicines were given.
Results: There were much lower pain scores for Group A throughout the procedure (p < 0.001) and a faster time to close the wound (3.86 vs. 5.86 minutes; p < 0.001). The POSAS scores did not differ significantly among the two groups (p = 0.078). It was observed that less patients from Group A asked for additional pain relief (p = 0.032).
Conclusion: Not sewing the platysma during thyroid surgery lowers the time needed for closure, reduces pain after surgery and results in comparable scarring, showing that it is a suitable simple method.
Thymoquinone as a Natural Anti-Angiogenic Agent: Experimental Pharmacology insights into Schematic and Meta-Analysis of Ocular Neovascularization and Retinal Pathology
No full textBackground: Thymoquinone is seen to combat angiogenesis, reduce inflammation, and act as an antioxidant. This systematic review and meta-analysis aimed to assess the role of thymoquinone in angiogenesis, damage involving reactive oxygen species, and preservation of the retina in different preclinical models.
Methods: This study followed the PRISMA approach, and PubMed, Scopus, Web of Science, and Cochrane Library were searched to identify studies published by 2025. This study included in vivo and in vitro studies examining how thymoquinone influences the growth of new blood vessels in different cell lines and animal models. Excluded studies were reviews, case studies, reports, and studies in a non-English language. For quality assessment, the OHAT risk of bias assessment tool was used, and effect sizes were measured to determine the therapeutic role of thymoquinone on eye diseases. GRADE framework was employed to assess the certainty of evidence.
Results: Ten preclinical articles were reviewed to assess the impacts of thymoquinone on ocular angiogenesis. Meta-analysis demonstrated an in vivo and in vitro pooled effective concentration of 32.31 and 7.37 μM, respectively. Effect sizes were in constant support of the antioxidant and anti-inflammatory properties of thymoquinone. Bias across studies was low, and on GRADE assessment, it had moderate certainty, having therapeutic potential in neovascular retinal disorders. Discussion: Overall, thymoquinone appears useful in reducing the formation of new blood vessels and reducing oxidative damage in diseases affecting the eyes. Because it seems promising in the role of a treatment supplement, more research through clinical studies should be carried out
Evaluation of Salivary Proteomic and Genomic Biomarkers as Non-Invasive Diagnostic Tools for Early Detection of Alzheimer\u27s and Parkinson\u27s Diseases: A Schematic Assessment and Meta-Analysis
No full textBackground: Salivary biomarkers are non-invasive molecules that indicate neurodegenerative illnesses, especially Alzheimer disease (AD) and Parkinson disease (PD).this study was conducted to determine the diagnostic precision of salivary proteomic and genomic biomarkers in terms of early AD and PD detection.
Methods: A systematic literature search was conducted in PubMed, web of science and Google Scholar, and studies included from 2016 to 2025. Research that examined salivary biomarkers in AD and PD was eligible. The data were analyzed with a random-effects model and odds ratios (OR), standard mean differences (SMD), and 95% confidence interval (CI) was estimated. Also, subgroup and sensitivity analysis were performed. To assess the risk of bias, the Newcastle-Ottawa Scale (NOS) was applied for included observational studies.
Results: A total of 11 eligible studies concerning proteomic biomarkers, including amyloid-β (Aβ42, Aβ40) and alpha-synuclein total (α-synTotal) and alpha-synuclein Oligomer (α-synOligo), and genomic biomarkers like different salivary microRNAs were included. Meta-analysis indicated that Aβ42 (OR=0.70; 95% CI: 0.41 to 1.1) and Aβ40 (OR=1.01; 95% CI: 0.97 to 1.06) had significant discriminatory potential in AD patients; but α-synOligo (SMD = 2.90; 95% CI: -0.59–6.39) and α-synTotal (SMD = 0.44; 95% CI: -3.14 to 4.02) was higher in PD patients as compared with controls. Genomic biomarkers demonstrated inconsistent findings (SMD = -0.18; 95% CI: -1.79–1.42) because of difference in microRNA types. Heterogeneity was high (I2 > 90%), which is caused by alterations in study design and in the methods to measure biomarkers.
Discussion: Salivary biomarkers were found to be an insignificant yet exceptional method of early examination of AD and PD. Nonetheless, the inconsistency of different studies points to develop standardized protocols
Role of Demographic Factors in Stone-Free Rates After Extracorporeal Shockwave Lithotripsy: A Multicentric Study from JPMC Karachi and IKD Peshawar
No full textBackground: Extracorporeal shock wave lithotripsy (ESWL) is a well-established, non-invasive treatment for renal stones, but stone-free rates (SFR) can differ based on stone size, location, and patient demographics. This study aimed to evaluate the SFR after ESWL in relation to demographic and geographic factors across two major centers in Pakistan.
Methods: A prospective, multicentric cohort study was carried out from February to April 2022 at the Department of Urology and Transplantation, JPMC Karachi, and the Institute of Kidney Diseases, Hayatabad Peshawar. A total of 300 patients of either gender were enrolled using non-probability consecutive sampling. Prophylactic antibiotics were administered to all participants, and ketorolac 30 mg IV was given as analgesia before the procedure. Data were analyzed using SPSS software. Means were reported for continuous variables and frequencies for categorical variables.
Results: Of the 300 patients, 150 were treated at JPMC and 150 at IKD. The mean age was 39 years in the JPMC group and 34 years in the IKD group. Males constituted 62.66% (n=94) of the JPMC group and 73.33% (n=110) of the IKD group. Mean stone size was 15.3 mm at JPMC and 14.7 mm at IKD (p>0.05). Mean stone density was 690 ± 120 HU at JPMC and 750 ± 105 HU at IKD, with no significant difference. At six weeks, complete stone clearance was seen in 229 patients (76.3%) with an average of 1.5 ESWL sessions. The SFR was significantly higher at IKD (82%, n=124) compared to JPMC (70%, n=105) (p<0.05). Better fragmentation was observed in patients from areas supplied by the Indus River system. Gender did not influence fragmentation rates. Partial clearance after three sessions was recorded in 71 patients.
Conclusion: ESWL achieved complete stone clearance in 76% of patients across both centers. Outcomes were better among patients from urban populations with Indus River water supply. Lower calyceal stones were an independent risk factor for partial clearance
Cross-sectional Evaluation of Mycobacterial Associations with Lung Disease and Its Associated Factors
No full textBackground: Nontuberculous mycobacteria (NTM), a diverse group of environmental organisms rapidly proliferating in water, soil, and dust, are becoming a common cause of clinical disease. This study analyzed patient data from two major hospitals in Faisalabad, Pakistan, to improve early detection of NTM lung disease and to guide clinical practice in seeking earlier and quicker intervention.
Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2021, using the records of 294 tuberculosis patients at Allied Hospital and DHQ Hospital, Faisalabad. Non-probability convenience sampling was used for sample collection and sample size was collected using OpenEpi 3.0.0. Data from patients with NTM lung disease were checked. The diagnosis was based on criteria defined by the ATS/IDSA (a clinical, radiological and microbiological evidence). Testing of specimens (sputum, BAL fluid, puncture fluid) was conducted using AFB smear, culture (MGIT 960) and species identification by molecular techniques. Chi-square, Wilcoxon tests and logistic regression were performed using SPSS version 26.0.p<0.05 was considered as significant.
Results: There were 294 patients (147 males; 147 females); median age 61 years, 77.2% had bronchiectasis. The most frequently identified species was the Mycobacterium avium-intracellulare complex (MAC 56.1%) followed by M. kansasii (19%) and M. abscessus (15.3%). Sputum cultures had the highest positivity rate (87.4%), outperforming BAL fluid (80.3%) and puncture fluid (61.5%).
Conclusion: The M. avium-intracellulare complex is the most common NTM species found in patients in these hospitals. The signs of expectoration, gender and bronchiectasis increased likelihood of BAL culture positivity, which aids in diagnosis
Hepatoprotective Effects of Curcumin and Thymoquinone Against Chemically Induced Liver Injury: A Schematic Study with Meta-Analysis of Antioxidant and Anti-inflammatory Outcomes
No full textBackground: Curcumin and thymoquinone are phytochemicals that have shown the ability to protect the liver in previous studies, with involvement of their antioxidant and anti-inflammatory activity. This study aimed to examine the effective concentrations of curcumin and thymoquinone at which liver injury could be mitigated by evaluating liver enzymes and markers of liver damage. Methods: According to PRISMA 2020, this review and the diagram were created. Studies published up to 2025 were found in a thorough search of PubMed, Scopus, Web of Science, and the Cochrane Library. Included studies were experiments using animals that examined how curcumin and/or thymoquinone affected liver injury and led to changes in liver enzyme levels. Studies that were excluded were editorials, reviews, articles in languages other than English, conference abstracts, and those without any quantitative results. The OHAT Risk of Bias Rating Tool (Version January 2015) was used, and Odds ratios were used in a meta-analysis for the primary outcome, lowering of liver enzymes.
Results: Eleven studies were sampled. Meta-pooled analysis revealed that at a mean dose of 194.56 mg/kg (95% CI: 16.31-372.81), curcumin decreased liver enzymes at a significant level, whereas thymoquinone exhibited a significant effect at 27.99 mg/kg (95% CI: -7.6 to 63.59). Even though heterogeneity was high (I2 > 99%), sensitivity analysis was performed to show the robustness. The risk of bias was low to moderate, and evidence certainty was rated moderate as per GRADE.
Discussion: Liver damage is greatly reduced by curcumin and thymoquinone, mainly by lowering markers related to damaged cells in the liver. Nevertheless, restricted study designs and inconsistency of models indicated that future research should include standardized dosing as well as extended human studies
Efficacy Between Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery For Renal Stones
No full textBackground:
Renal stones, particularly those between 2 cm and 3.5 cm in size, present a significant challenge in urology. Despite the availability of modern techniques, the optimal treatment for stones within this size range remains a contentious issue. Percutaneous Nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) are two popular minimally invasive procedures used to treat renal stones. However, there is limited consensus on the superiority of one over the other in terms of clinical outcomes, complications, and patient satisfaction.
Objective:
To compare the clinical outcomes of PCNL and RIRS in the treatment of renal stones sized between 2 cm and 3.5 cm, specifically focusing on stone-free rate (SFR), complications, hospital stay, blood loss, the need for repeat procedures, and patient satisfaction.
Method:
This was a prospective, randomized study conducted from June 2024 TO December 2024 at CMH nephrology and urology department district peshawer, with 150 patients presenting with renal stones between 2 cm and 3.5 cm. The patients were randomly assigned to either the PCNL group (n = 75) or the RIRS group (n = 75). Preoperative imaging (CT or ultrasound) confirmed stone size. Patients with bilateral kidney stones, a history of previous kidney surgeries, or significant comorbidities were excluded. Clinical outcomes, including SFR, hospital stay, complications (postoperative fever, infection, stent-related symptoms), blood loss, and the need for repeat procedures, were analyzed. Patient satisfaction was also evaluated using a 1-10 scale.
Result:
The study found that PCNL had a significantly higher stone-free rate (95%) compared to RIRS (82%). The mean hospital stay for RIRS was shorter (1.56 ± 0.4 days) compared to PCNL (6.5 ± 1.2 days). While the incidence of postoperative postoperative infection was higher in the RIRS group (44% vs. 2.7%), blood loss was greater in the PCNL group (12% vs. 4%). The need for additional procedures was higher in the RIRS group, with 44% requiring further sessions, compared to just 2.7% in the PCNL group. Patient satisfaction was higher in the PCNL group (94.7%) compared to RIRS (77.3%).
The treatment of renal stones larger than 2 cm and smaller than 3.5 cm remains controversial, and Percutaneous Nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) are two popular treatment options. This study compares these two techniques in terms of clinical outcomes, including stone-free rate (SFR), complications, hospital stay, and patient satisfaction. This prospective study was conducted June 2024 TO December 2024 at CMH neprology and urology department district peshawer involving 150 patients with renal stones who were randomized into two treatment arms, PCNL and RIRS, with 75 patients in each arm. They critically evaluated the following parameters: SFR, duration of hospital stay, blood loss during surgery, complications, requirement for re-procedures, and patient satisfaction. The puncture access of the PCNL group was decided according to the Guy\u27s Score classification. The stone-free rate was significantly higher in the PCNL group (95%) compared to the group treated with other methods (82%). The mean hospitalization time was shorter for RIRS (6.5 ± 1.2 vs. 1.56 ± 0.4 days). PostoperativePostoperative infective complications were seen more in the RIRS group (44%) along with the stent -related symptoms (34.6%) but had the least postoperative morbidity in the PCNL group (2.7% infection). Blood loss was greater for the PCNL group (12%) compared to the RIRS group (4%), but both groups had low requirements for blood transfusions (2.7% for PCNL and 1.3% for RIRS). Furthermore, RIRS required a greater proportion of repeat sessions (44%) for total stone clearance, especially in cases involving larger stones or increased stone density, whereas PCNL required fewer repeat procedures (2.7%). The patient satisfaction was excellent in the PCNL group (94.7%) and was slightly higher than in the RIRS group (77.3%).
Conclusion:
Both PCNL and RIRS are effective treatments for renal stones between 2 and 3.5 cm, with PCNL offering superior stone-free rates and greater patient satisfaction, particularly for stones with favorable anatomy. RIRS is a less invasive approach but may require multiple sessions for complete stone clearance and is associated with a higher incidence of postoperative postoperative complications. The choice of procedure should be individualized based on patient characteristics, stone features, and treatment preferences
Performance of Serum Biomarkers (AFP, DCP) Combined with Imaging Modalities in Early HCC Detection: A Prospective Study
No full textBackground
Early detection of hepatocellular carcinoma (HCC) is crucial for curative management, yet current surveillance methods remain suboptimal, particularly in high-burden, resource-limited settings. While serum alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) have shown promise as biomarkers, their combined value with imaging modalities for early HCC detection requires validation in real-world, South Asian populations.
Methods
We conducted a prospective, observational cohort study at Hayatabad Medical Complex, Peshawar, from May 2024 to May 2025. Adults with chronic liver disease, free of known HCC at enrollment, underwent six-monthly assessments with serum AFP and DCP, ultrasonography, and, where indicated, multiphase MRI. Diagnostic performance metrics—sensitivity, specificity, positive and negative predictive values (PPV, NPV), and area under the receiver operating characteristic curve (AUC)—were calculated for each modality and their combinations. Early HCC was defined by international criteria. Analyses were performed using R (v4.3.1), with missing data addressed by multiple imputation.
Results
Of 192 participants (median age 53 years, 61.5% male), 21 developed incident early-stage HCC (10.9%; 95% CI 7.2–16.1%) during follow-up. Sensitivity for early HCC detection was 61.9% (AFP alone), 71.4% (DCP alone), 57.1% (ultrasound alone), and 85.7% for combined AFP+DCP. The AFP+DCP+ultrasound strategy yielded the highest sensitivity (90.5%; 95% CI 69.6–98.8), with an AUC of 0.90. MRI confirmed all cases with indeterminate initial findings. No significant differences were observed in diagnostic accuracy by age, sex, or CLD etiology. No major adverse events were reported.
Conclusions
In this real-world South Asian cohort, the combination of serum AFP and DCP with ultrasonography substantially improved early HCC detection compared to any single modality. These findings support integration of multimodal surveillance strategies—including DCP—into local and regional screening programs, with potential to inform policy and reduce liver cancer mortality in high-risk populations
Accuracy of Ultrasonography and Color Doppler in the Diagnosis of Ovarian Masses and Their Correlation with Histopathological Findings
No full textBackground: Ovarian masses are very common gynecological concern in women so, this study is comparing the ultrasonographic and color Doppler findings of ovarian masses with their histopathological diagnosis.
Methods: This prospective study evaluated patients diagnosed with an ovarian mass who visited the obstetrics and gynecology and radiology department of Bakhtawar Amin Medical and Dental College, Multan, between March 2024 and February 2025. The eligible patients were divided into two groups: Group A included patients who underwent abdominal and vaginal ultrasound to assess the morphology of the pelvic mass. In contrast, Group B included patients whose ovarian masses were evaluated using color Doppler in addition to transabdominal ultrasound to examine vascularization as well as morphology.
Results: Morphology scoring of transabdominal and transvaginal ultrasound showed high accuracy of 98.4%, specificity 96.8%, and NPV 98.0%, while Doppler had lower sensitivity (54.3%) but reasonable specificity (94.2%). The combined approach achieved perfect sensitivity and NPV (100%) with high accuracy (98.4%), enhancing diagnostic performance without losing specificity.
Conclusion: Combining color Doppler with morphological ultrasound improves the accuracy of diagnosing pelvic tumors, enhancing malignancy detection and boosting confidence in benign diagnoses, making it a valuable tool for early disease diagnosis
Menstrual Irregularities and Lifestyle Factors in Young Women: A Cross-Sectional Analysis
No full textBackground: Menstrual irregularities are common among young women and are affected by modifiable lifestyle factors, including diet, physical activity, stress, and sleep quality. These disorders can indicate underlying endocrine dysregulation and affect reproductive and overall health. The purpose of this study was to estimate the prevalence of menstrual irregularities and their association with important lifestyle factors in young women. Materials and Methods: In this cross-sectional study (January and June 2022) stratified random sampling was used to recruit 400 female students. Menstrual irregularity was a cycle length of <21 days, >35 days, or >7 days change in the preceding six months. Sociodemographic, menstrual history, eating patterns, physical activity, sleep, and perceived stress data were recorded through a validated structured questionnaire. Independent t-test, chi-square, and multivariate logistic regression were used for data analysis. P< 0.05 was considered statistically significant. Results: Menstrual irregularities were observed at the rate of 146 (36.5%). Disrupted cycles had a significant relation with increased stress (68 (46.6%) vs. 62 (24.4%), p < 0.001; AOR = 2.16, CI: 1.46-3.19), lack of physical activity (85 (58.2%) vs. 98 (38.6%), p < 0.001; AOR = 1.73, CI: 1.16-2.58), and inadequate sleep (72 (49.3%) vs. 89 (35.0%), p = 0.006; AOR = 1.61, CI:1.07-2.43). There was no significant association of breakfast skipping, fast-food intake, BMI, and chronic illness. Conclusion: Menstrual irregularities are common in young women and are linked to stress, physical inactivity, and sleep disturbances. Addressing these factors may improve menstrual and reproductive outcomes