Foundation University Medical Journal

Bridging the gap in hepatocellular carcinoma detection: evaluating LI-RADS with MRI

2025-05-14T16:40:57+00:00

Objectives: This study aimed to determine diagnostic accuracy of the LI-RADS (Liver Imaging Reporting and Data System) using magnetic resonance imaging (MRI) for detecting Hepatocellular carcinoma (HCC) in cases of liver cirrhosis diagnosed to have hepatic nodules≤20 mm, using histopathology as the reference.

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Department of Radiology, Holy Family Hospital, Rawalpindi. Study duration was from 25-03-2024 till 24-01-2025

Patients and Methods: After ethical approval, 170 consecutive eligible patients underwent multiphasic gadoliniumenhanced abdominal MRI on a 1.5 Tesla system "(33 mT/m gradient)", with LI-RADS interpretation by a consultant radiologist. All patients also underwent ultrasound-guided percutaneous fine needle biopsy, and histopathology served as the gold standard. Data were analyzed using SPSS 20, with diagnostic performance assessed via a 2×2 contingency table, and stratification applied to evaluate the impact of effect modifiers on diagnostic accuracy.

Results: A total of 170 patients (53% males, 47% females) were included, with mean age 45.28±11.67 years, BMI 30.38±2.33 kg/m², cirrhosis duration 7.93±2.46 months, and nodule size 11.25±5.25 mm; HCC was identified in 60% by LI-RADS. Diagnostic performance showed sensitivity 60.78%, specificity 95.58%, PPV 95.38%, NPPV 61.90%, and accuracy 74.70%.

Stratified accuracy was similar by age (<40: 75.38%, >40: 73.53%) and sex (males 74.44%, females 75%), but higher with BMI >27 kg/m² (76.69% vs. 71.64%) and cirrhosis duration >10 months (83% vs. 70.94%); accuracy was 77.02% for nodules <10 mm and 72.91% for >10 mm. Overall, LI-RADS shows high specificity but moderate sensitivity, with better performance in higher BMI and longer cirrhosis duration.

Conclusion: This study demonstrates Li-RADS with MRI to have high diagnostic accuracy for detection of hepatocellular carcinoma. Standardization of reports of CT and MRI with LI-RADS improves consistency, reduces errors, and enhances patient management. It also supports nationwide data collection, enabling future research and AI-driven analysis in HCC diagnostics

Facilitators and barriers to evidence-based practice among nurses working in Sheikh Zayed Hospital, Rahim Yar Khan

2025-09-25T05:05:50+00:00

Objective: The objective of this study was to identify and explore the facilitators and barriers influencing the adoption and implementation of Evidence-Based Practice among nurses working at Sheikh Zayed Hospital in Rahim Yar Khan.
Study Design: Observational cross-sectional study
Place and duration of study: This study was conducted from 23 November 2024 to 30 May 2025 at Sheikh Zayed Hospital, Rahim Yar Khan.
Patients and Methods: This study included non-probability convenient sampling technique to recruit 300 registered nurses with over one year of experience. Data were collected via a structured questionnaire adapted from an Evidence-Based Practice competency tool, approved by the Institutional Review Board. Quantitative data were analyzed using mean and standard deviation, while qualitative variables were analyzed using frequency and percentage in SPSS-27, ensuring informed consent and participant confidentiality.
Results: This study primarily surveyed female (94.7%) and married (68.7%) Registered Nurses (85%) with diverse educational backgrounds. A large proportion of nurses valued Evidence-Based Practice, with 73.7% believing it improves patient care decisions, 65.7% that it leads to better outcomes, and 68% willing to implement it. While nurses perceived strong organizational support (86.7%), significant barriers to implementation were identified, including a lack of confidence in research evaluation (44%), limited time (66.7%), inadequate access to published research (77%), and concerns about research reliability (95.7%).
Conclusion: Nurses perceive organizational support and have a good appreciation for Evidence-Based Practice, yet there are still many practical obstacles to overcome.
Addressing the lack of confidence in research evaluation, time constraints, and limited access to reliable research is crucial to fully integrate EBP into nursing practice and improve patient outcomes.

Frequency and outcomes of acute kidney injury in patients presenting with acute heart failure at a cardiac centre in Karachi

2025-09-18T08:59:56+00:00

Objectives: To determine the frequency of acute kidney injury (AKI) in patients with acute heart failure (AHF) and evaluate its association with in-hospital mortality.

Patients and Methods: This cross-sectional study was conducted over six months at Tabba Heart Institute, Karachi. A total of 121 consecutive patients aged 40–80 years admitted with AHF were enrolled. Patients with acute coronary syndromes, sepsis, arrhythmias, or major non-cardiac comorbidities were excluded. AKI was defined as a ≥0.3 mg/dL increase in serum creatinine within 48 hours of admission. Demographic, clinical, and socioeconomic variables were recorded. Primary outcomes were the frequency of AKI and in-hospital mortality.

Results: Nineteen patients (15.7%) developed AKI. Patients with AKI had a higher prevalence of urban residence (100% vs 80.4%, p=0.035), dyslipidemia (73.7% vs 44.1%, p=0.018), and reported lower family income (73.7% vs 34.3%, p=0.001) compared to non-AKI patients. In-hospital mortality was higher in the AKI group (42.1% vs 20.6%, p=0.044). Univariate logistic regression showed an odds ratio (OR) for mortality with AKI of 3.05 (95% CI 1.03–9.05, p=0.044). After adjustment, the adjusted OR was 3.21 (95% CI 0.73–14.18, p=0.124)

Conclusion: AKI occurred in approximately one-sixth of patients hospitalized with AHF and was associated with higher unadjusted in-hospital mortality. Socioeconomic factors, particularly low income and urban residence, were linked to AKI risk, underscoring the need for targeted preventive strategies in high-risk subgroups.

Intra-operative instillation of steroids injections (Dexamethasone) during caesarean section to reduce early and late post-operative morbidity

2025-10-23T04:50:02+00:00

Objective: To evaluate whether intra-operative intra-peritoneal instillation of dexamethasone reduces immediate and late post-operative morbidity following caesarean section.

Study Type: Interventional comparative study

Place and Duration of Study: Tertiary care hospital in Pakistan from 12 January 2020 to 22 December 2022.

Patients & Methods: A total of 400 women undergoing elective caesarean section were recruited, divided equally into four categories: primigravida and those with 1, 2, or 3 previous caesarean sections. Within each group, 50 patients received intra-peritoneal dexamethasone (3 ml), and 50 served as controls. Post-operative pain was assessed at 6–12 hours, 12–24 hours, and on the first post-operative day. Early mobilization, oral intake, and overall well-being were also recorded. A subgroup of 41 women returning for repeat caesarean section one year later were evaluated for intra-operative adhesions.

Results: Patients who received dexamethasone reported fewer pain complaints and required less additional analgesia compared with controls. On the first post-operative day, additional pain relief was needed in 30–40% of controls versus 12–16% of those receiving dexamethasone. Early mobilization was achieved by 66–76% of the dexamethasone group versus 36–44% of controls. Oral intake and overall well-being were also better in the dexamethasone group. At follow-up, more patients in the intervention group were comfortable at home, and fewer adhesions were noted in women who had received dexamethasone during prior surgery.

Conclusion: Intra-peritoneal instillation of dexamethasone during caesarean section is associated with reduced post-operative pain, earlier recovery, and less morbidity.

Beyond the pandemic: how Covid-19 still shapes doctors' job stress and performance

2025-09-05T04:35:44+00:00

Objective: To investigate the relationship between job stress and job performance among doctors and analyze whether this relationship is moderated by COVID-19.

Study Design: Cross sectional analytical study

Place and duration of study: Gujranwala Teaching Hospital and Gujranwala Medical College Teaching Hospital, conducted from 1 Nov 2024 to 31 Mar 2025.

Patients and methods: A structured online questionnaire was distributed among 212 doctors working in OPDs and Emergency departments, via google forms and personal emails. Convenience sampling was used and ethical approval was obtained (IRB.43/GMC). Validated scale developed by Tessema, M., and Soeters, J was used for measuring job performance, for job stress, scale from Parker and Decotiis and perceived threat of COVID-19 was measured using a modified version of scale from Sinclair and LoCicero. Data were analyzed using SPSS version 24 for descriptives, correlation and moderation effects.

Results: The mean stress score in doctors came out to be 3.48±0.82, mean job performance score 3.78±0.48 and perceived threat of COVID score, 3.13±0.65 all out of 5.00, the high stress score is at lower limit of severe stress level. Job stress showed a negative correlation with job performance and the perceived threat of COVID 19 as a moderator significantly strengthened the negative association.

Conclusion: Job stress negatively affects doctor performance, further intensified by perceived threat of COVID-19. Stress management interventions are vital to maintain healthcare performance during pandemics.

Frequency and indications of caesarean-section in females undergoing induction of labor

2025-12-30T07:20:34+00:00

Objective: To determine the frequency of caesarean section and to identify the common indications leading to caesarean delivery in females undergoing induction of labor.

Study Design: A descriptive cohort study

Place and Duration of Study :This study was conducted at Hameed Latif Hospital from 05 June 2024 to 20 December 2024.

Patients and Methods: Five hundred pregnant women admitted for induction, selected via convenient sampling. Descriptive statistics were applied to analyze both qualitative and quantitative variables, with stratification for effect modifiers such as age and BMI, followed by post-stratification chi-square test.

Results: The study revealed that 45.2% of participants underwent caesarean section, while 54.8% achieved vaginal delivery. Prolonged labor was the most prevalent indication for caesarean section (40.1%), followed by fetal distress (29.9%), failed labor (19.8%), and patient refusal of further induction (10.2%). The caesarean section rate was notably elevated in the 31-35 years age group (42.4%) and in women with higher BMI (49.2%).

Conclusion: Induction of labor is associated with a moderate risk of caesarean section, particularly in primigravida women and those with an unfavorable cervix. The most common indications for caesarean section include failed induction, fetal distress, and failure to progress. Careful selection of patients and proper monitoring during induction can help reduce the rate of unnecessary caesarean deliveries.

Helicobacter pylori infection and anemia in dyspeptic patients – a cross sectional study

2026-02-12T04:19:59+00:00

Objective: To determine the association between Helicobacter pylori infection and anemia.

Study Design: Analytical cross sectional study

Place and Duration of Study: Combined Military Hospital Rawalpindi for 6 months from 02 Jan 2025 to 10 Jun 2025.
Materials and Methods: After informed consent, demographic and clinical information was obtained in 285 patients. Four cc blood was drawn for complete blood count. Anemia was defined as hemoglobin level < 12 g/dl in women and < 13 g/dl in men. The Helicobacter pylori rapid antigen test was done on stool samples. Saline stool preparation was checked for the presence of parasites. Bivariate regression analysis and Chi square tests were conducted to find association amongst variables. P value of < 0.05 was considered statistically significant.

Results: Of 285 participants, 113 (39.6%) were male and 172 (60.4%) were female. The H. pylori infection was present in 44.9% (128/285) patients and anemia was present in 25.3% (72/285). Among anemic patients, 48/72 (66.7%) were H. pylori-positive compared to 80/213 (37.5%) non-anemic patients. H. pylori infection was significantly associated with anemia (P < 0.001), older age, smoking, and type of water source.

Conclusion: H. pylori infection was significantly associated with anemia in dyspeptic patients. Older age, smoking, and unsafe water sources were also significantly associated with the infection.

Screen time and physical activity patterns among medical students: a comparative analysis of private and public institutions

2025-07-11T07:18:59+00:00

Objectives: This study aimed to compare academic and recreational screen time, as well as physical activity levels, among medical students enrolled in public and private institutions in Pakistan. Furthermore, it explored the association between screen exposure and physical activity patterns within this population.

Study Design: Cross-sectional study.

Place and Duration of Study: The study was carried out at two institutes, Liaquat National Medical College and Nishtar Medical University from 10th January 2025 till 30th April 2025.

Patients and Methods: A total of 374 MBBS students, 187 from each institution from first to final year were recruited using stratified random sampling. Data were collected through a structured questionnaire .Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ). Statistical analyses were performed using SPSS version 27, with Binary Logistic regression employed to examine associations.

Results: This study showed the difference in screen time between private and public institution students is statistically significant based on the study's findings (p < 0.001 for related screen time comparisons). Most (65%) exhibited low physical activity, with males, older (>20 years), and married students more active; barriers were motivation (47.9%) and academics (35.6%). Academic screen time strongly reduced physical activity (p < 0.001), recreational screen time moderately (OR = 0.385, p = 0.002). Recreational screen use impacted academic performance negatively for 59.9%, linked to burnout. Interventions are critical to curb screen time and promote activity, especially in private colleges.

Conclusions: Medical students, particularly those in private colleges exhibit excessive screen time and low physical activity levels (65%), posing significant health risks. Academic screen use was strongly linked to reduced physical activity, with key barriers including lack of motivation (47.9%) and academic pressure (35.6%). These findings highlight the urgent need for targeted interventions, such as institutional screen-time guidelines, motivational workshops, and accessible fitness programs, to foster healthier digital habits and active lifestyles.

Assessment of outcomes in donor site closure of anterolateral thigh flap with keystone flap

2026-01-29T08:35:20+00:00

Background: After harvesting an anterolateral thigh (ALT) flap, closing the donor site too tightly can lead to problems or require skin grafting, which can impact both the structural and cosmetic results. The Keystone Perforator Island Flap (KPIF) is a reliable alternative to tension-free closure that preserves contour and reduces morbidity.

Objective: To look at the KPIF method for closing the donor site after harvesting a free ALT flap and see how safe, reliable, and attractive it is, as well as its results and problems.

Methodology: This study was conducted from 01 June 2024 to 30 November 2025 (18 months), at the Plastic Surgery Department of Fauji Foundation Hospital, Rawalpindi. This was a prospective descriptive cohort study. The study comprised consecutive patients undergoing donor-site closure for KPIF. In the first two weeks after surgery, the attributes such as demographic information, surgery details, and early postoperative problems were recorded. These problems included seroma, hematoma, epidermolysis, wound dehiscence, flap necrosis, and compartment syndrome. As part of a standard follow-up after three and six months of surgery, patients filled out structured questionnaires and underwent clinical examination. The examination comprised of checking for contour deformity, sensory symptoms like tingling or numbness, differences in thigh circumference compared to the other leg, and evaluating the quality of the scar using the Vancouver Scar Scale.

Results: Our study included 28 patients, with an average age of 41±15 years, an average BMI of 20±1.2 kg/m², and 57.1% of them were women. In all cases, closure without any major complications was achieved. In 14.3% of cases, minor complications were seen and were managed conservatively. Measurements of thigh circumference showed no significant difference compared to the other limb, and most people said they had mild sensory problems. At three months, 85.7% rated the cosmetic results as good or excellent, and 42.9% of the patients as per the structured questionnaire, showed a contour deformity.

Conclusion: Closing the ALT donor site with KPIF is safe, effective, and looks good. It keeps the structure of the site intact and lowers the risk of problems.

Evaluation of knowledge of postgraduate trainees in transfusion medicine: a cross–sectional survey

2025-06-18T07:07:28+00:00

Objective: The objective of study was to assess postgraduate trainees' knowledge of transfusion medicine.

Study Design: It was a descriptive, quantitative cross-sectional study

Place and Duration of study: The study was conducted at Fauji Foundation Hospital Rawalpindi in department of Hematology. Duration of study was from 15 Sep 2023 to 15 Nov 2023.

Participants and Methods: Total 177 postgraduate trainees of different departments of a Fauji Foundation Hospital, Rawalpindi, in different years of training were included in study. The sampling technique used was a Non probability Convenience sampling technique .Trainees were evaluated by a questionnaire. A data collection sheet that was peer-reviewed was used to score the final performance.

Results: Of 177 participants, 173 participants responded to the online questionnaire survey. Overall, 52.46% of participants across all specialties and training years correctly answered the questions. The mean score for the Medicine (M =.59, SD =.15) specialty group was statistically different from Medicine and Allied (M =.49, SD =.16, P =<.001), Surgery and Allied (M =.50, SD =.13, P =.008), and Surgery (M =.48, SD =.12, P =.032).

Conclusions: Significant gaps in knowledge were observed in transfusion medicine. Medical colleges and training institutes might be more likely to contribute to transfusion medicine teaching if the study's findings could be replicated at other training facilities.

Isolation of Streptococcus pyogenes from pleural fluid in a critically ill patient: a case report with a rare occurrence

2025-10-22T07:15:55+00:00

Transudative or exudative pleural effusion has a diverse etiology including bacteria that differ depending upon hospital or community acquired infections. Most bacterial organisms isolated from pleural fluid include Gram positive bacteria including Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus viridans followed by Gram negative bacteria. The Isolation of Streptococcus pyogenes (Group A Lancefield Group) from pleural fluid is unusual as this bacterium is responsible for causing skin and throat infections which range from asymptomatic cases to full blown symptomatic toxic shock syndrome. Patients with various comorbidities may have the worst prognosis and severe complications from asymptomatic or confirmed infections.
We report a case study of a patient with isolation of Streptococcus pyogenes from pleural fluid, This is a rare finding, but may happen owing to dysbiosis associated with systemic insufficiencies. To our understanding this is the first reported case in Pakistan of Streptococcus pyogenes isolation from pleural fluid.

Novel approaches to combat antimicrobial resistance in developing countries

2026-05-22T05:13:04+00:00

Antimicrobial resistance (AMR) is an emerging public health crisis whose threat to present-day antimicrobial efficacy and global progress in the control of infectious diseases has rapidly escalated. It presents as an even graver situation in developing countries, whose underdeveloped healthcare infrastructure, limited laboratory capacity, weak regulation in antimicrobial prescription and consumption, as well as restricted access to novel antimicrobials accelerates selection and proliferation of multidrug resistant organisms. Traditional methods such as the use of surveillance systems, infection prevention and control, and antimicrobial stewardship are vital but are insufficient by themselves. We must advance beyond incremental changes to the problem of the increasing AMR crisis, instead committing to the use of novel and locally appropriate solutions. This change is enabled by quick and low-cost diagnostics that circumvent poor laboratory infrastructure which leads to empirical wide-spectrum antibiotic prescription. Rapid and cost-effective diagnostics such as loop-mediated isothermal amplification (LAMP), lateral flow immunoassays and low cost molecular platforms can all be deployed to facilitate identification of the target pathogen as well as its susceptibility pattern at the bedside.