Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis.

Background: For decades, poor treatment options and low-quality evidence plagued care for patients with rifampin-resistant tuberculosis. The advent of new drugs to treat tuberculosis and enhanced funding now permit randomized, controlled trials of shortened-duration, all-oral treatments for rifampin-resistant tuberculosis.

Methods: We conducted a phase 3, multinational, open-label, randomized, controlled noninferiority trial to compare standard therapy for treatment of fluoroquinolone-susceptible, rifampin-resistant tuberculosis with five 9-month oral regimens that included various combinations of bedaquiline (B), delamanid (D), linezolid (L), levofloxacin (Lfx) or moxifloxacin (M), clofazimine (C), and pyrazinamide (Z).

Diagnostic accuracy and safety of ultrasound-guided percutaneous core needle biopsy among children with extra cranial solid masses at a tertiary care hospital in Karachi, Pakistan.

Objective: To determine the diagnostic accuracy and procedure safety of ultrasound-guided core needle biopsy of extra cranial solid masses in the pediatric population.

Method: A cross-sectional survey was conducted by the Department of Pediatric Hematology /Oncology and Radiology at Indus Hospital and Health Network Karachi from August 2022 to April 2023. A total of 118 pediatric patients, from age one month to 18 years, with extra cranial solid masses were studied.

Tendon evaluation with ultrashort Echo Time (UTE) MRI: A Systematic Review.

Tendon disease ranks among the leading reasons patients consult their general practitioners, comprising approximately one-third of musculoskeletal appointments. Magnetic resonance imaging (MRI) is regarded as the gold standard for assessing tendons. Due to their short transverse relaxation time (T2), Tendons show up as a signal void in conventional MRI scans, which employ sequences with echo times (TEs) around several milliseconds.

Effectiveness of Abdominal Breathing Exercise to Control Gastroesophageal Reflux Disease, a Randomized Controlled Trial.

Objectives: To determine the effect of actively training the crura of diaphragm which is a part of lower esophageal sphincter using abdominal breathing exercises to treat gastroesophageal reflux disease.

Methodology: With a randomized controlled study design, a total of 22 (11 in each group) clinically diagnosed patients of GERD presenting to the gastroenterology outpatient department at Holy Family Hospital in Pakistan were assessed using GERD related "quality of life index (QoLI)" questionnaire and their on-demand proton pump inhibitors (PPI) usage. Single blinding technique will be used.

Outcomes of Reconstructive Surgery Using Vacuum-Assisted Closure in Patients With Complex Wounds.

This study aimed to assess the results of reconstructive surgery with vacuum-assisted closure (VAC) therapy in patients with complex wounds. The sample included 60 patients with a mean age of 53.03 years.

Correlation Between Ki-67 Expression and Tumor Grade in Breast Cancer: A Cross-Sectional Study.

Introduction Ki-67 is a proliferation marker that may correlate with tumor grade in breast cancer. This study explores the association between Ki-67 expression levels and tumor grade in breast cancer patients. Materials and methods This cross-sectional study analyzed Ki-67 expression in tumor samples from 280 breast cancer patients.

Immunohistochemical Analysis of the p53 Protein in Colorectal Cancer: A Clinicopathological Study.

The role of p53 expression in colorectal cancer (CRC) was investigated in this immunohistochemical analysis of 110 CRC patients. The study aimed to explore the relationship between p53 expression and clinicopathological features, such as tumor grade, size, lymph node involvement, and molecular subtypes. The mean age of patients was 52.

Medulloblastoma Molecular Subgrouping and Outcomes Data of a Single Center From a Low- and Middle-Income Country.

Introduction: Medulloblastoma (MB) is the most common malignant childhood brain tumor. Molecular subgrouping of MB has become a major determinant of management in high-income countries. Subgrouping is still very limited in low- and middle-income countries (LMICs), and its relevance to management with the incorporation of risk stratification (low risk, standard risk, high risk, and very high risk) has yet to be evaluated in this setting.

Challenges in practice and training structure of residents in obstetric anaesthesia: A perspective from teaching hospitals in Sindh province of Pakistan.

Objectives: To document information on the available obstetric anaesthesia services and structure of resident training in a Pakistani setting.

Methods: The survey was conducted from June to September 2018 across the Sindh province of Pakitan after approval from the ethics reiew committee of the Pakistan Society of Anaesthesiology, and covered all teaching hospitals in both public and private sectors recognised for residents' training for fellowship in Anaesthesiology by the College of Physician and Surgeons of Pakistan. A standardised questionnaire was filled by either the department chairperson or a senior designated faculty member in each institution regarding obstetric anaesthesia services and structure of resident training.

Evaluating the Effectiveness of Shockwave Lithotripsy vs Ureteroscopic Lithotripsy for Treatment of Renal Stones: A Prospective Cohort Study.

Background: Renal stones are a prevalent condition requiring effective treatment strategies. This study evaluates the comparative effectiveness of shockwave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) in treating renal stones in a Pakistani cohort, focusing on stone clearance, recurrence, and complications.

Methods: This prospective cohort study involved 250 patients aged 18-55 diagnosed with renal stones.

Type and physical intensity of occupations at pulmonary TB diagnosis.

Background: Pulmonary TB (PTB) predominantly affects individuals of working age. We sought to characterise the occupations of people newly diagnosed with PTB in Karachi, Pakistan, by type and physical intensity.

Design/methods: We did a secondary analysis of data from a study evaluating the diagnostic accuracy of artificial intelligence-based chest X-ray (CXR) analysis software, where individuals had been evaluated for active PTB using sputum cultures and had provided information on occupation.

Clinical characteristics of dengue virus infections in Karachi from 2019 to 2023: a cross-sectional study.

Dengue fever is a vector-borne, acute, febrile, and self-limiting systemic viral infection that affects tropical and subtropical regions, including Pakistan. Karachi has a significant burden of Aedes aegypti and Aedes albopictus due to suitable breeding sites, weather, and rapid and unplanned urbanization of squatter areas. The country has limited surveillance studies on circulating serotypes of the dengue virus and the patient's clinical features evolving over temporal changes.

Exploring medical educators' perspectives on teaching effectiveness and student learning.

Background: Medical education in resource-constrained settings such as Pakistan faces significant challenges, including large class sizes, limited resources, and reliance on traditional teacher-centered pedagogies. These factors hinder effective learning and fail to equip students with the critical thinking and practical skills essential for modern medical practice. Educators play a fundamental role in shaping student experiences but often struggle to adopt student-centred methodologies due to insufficient training, resource limitations, and institutional constraints.

Novel technique for achieving the under-correction of native tibial varus in calipered restricted kinematically aligned total knee arthroplasty - A validation study.

Purpose: Restricted kinematic alignment (rKA) TKA is relatively newer technique for achieving an overall under-corrected limb alignment. The present study aims to provide an easy and reproducible technique for achieving calipered rKA-TKA (crKA-TKA) using routine instrumentation.

Method: A prospective study was conducted including 30 patients (30 knees).

The Frequency and Incidence of QT Prolongation with Extended Use of Bedaquiline or Delamanid in a Large, Multi-Country MDR/RR-TB Cohort.

Background: The 2022 WHO guidelines on multi-drug/rifampicin resistant tuberculosis (MDR/RR-TB) recommend six months of bedaquiline (Bdq) in the all-oral 9-month shorter regimen and six months or longer for Bdq and delamanid (Dlm) in the 18-20-month longer regimen. However, lack of evidence on extended treatment using Bdq or Dlm has limited their use to six months. We examine the frequency and incidence of QT prolongation based on duration of Bdq and/or Dlm use in longer regimens.

Filling the Gaps: Vitamin D Status in Diffuse Hair Fall Among Pakistanis.

Introduction: Hair loss can happen for various reasons, including emotional stress, physical strain, certain medical issues, and nutritional gaps. When it comes to nutrition, a lack of vitamin D3 could be linked to diffuse hair loss.

Objectives: The aim was to look for the frequency of vitamin D3 deficiency with diffuse hair fall, especially in the Pakistani population.

Efficacy of Different Beta Blockers in Reducing Mortality in Heart-Failure Patients.

This study evaluated the comparative efficacy of different beta blockers bisoprolol, carvedilol, and metoprolol in reducing mortality and hospitalizations among 120 heart-failure (HF) patients. The sample had an equal gender distribution (50% male, 50% female) with a mean age of 69.28 years.

HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS - A PRESENTATION OF ACCELERATED PHASE OF CHEDIAK HIGASHI SYNDROME; CASE REPORT AND CLINICOPATHOLOGICAL REVIEW.

Abstract: Chediak Higashi syndrome (CHS), a rare form of autosomal recessive disorder has been reported globally in less than 500 cases over the past two decades. It clinically manifests as repeated episodes of infection, haemorrhagic sequelae, partial albinism, photosensitivity and late neurological signs (neuropathy, cognitive impairment etc). The pathognomonic morphological finding is the presence of abnormally large intra-cytoplasmic granules, particularly in leucocytes.

Insights into Mitochondrial Rearrangements and Selection in Accipitrid Mitogenomes, with New Data on and .

Background/objectives: Accipitridae mitogenomes exhibit unique structural variations, including duplicated control regions (CRs) that undergo gradual degeneration into pseudo-CRs, revealing a complex evolutionary landscape. However, annotation of this characteristic in a subset of accipitrid genomes is lacking. Due to the taxonomic diversity of Accipitridae and the presence of understudied species, comprehensive mitogenomic studies are essential.

Genetics of C-Peptide and Age at Diagnosis in Type 1 Diabetes.

Identified genetic loci for C-peptide and type 1 diabetes (T1D) age at diagnosis (AAD) explain only a small proportion of their variation. We aimed to identify additional genetic loci associated with C-peptide and AAD. Some HLA allele/haplotypes associated with T1D also contributed to variability of C-peptide and AAD, whereas outside the HLA region, T1D loci were mostly not associated with C-peptide or AAD.

Combined Fluorescein and Methylene Blue Dye for Sentinel Lymph Node Biopsy in Patients of Early Carcinoma Breast: A Promising Technique.

Sentinel lymph node biopsy is currently the gold standard for clinically node-negative patients of carcinoma breast. Fluorescein is a safe, low-cost agent, and easily available. Fluorescein has shown a promising role in sentinel lymph node evaluation in carcinoma breast in combination with methylene blue dye with a detection rate of more than 90% and a false-negative rate of less than 10% in previous studies.