Pakistan Armed Forces Medical Journal

Objective: To compare post-operative sensitivity after placement of composite restoration in Class I cavity using total etch adhesive and self-etch adhesive. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Operative Dentistry, Armed Forces Institute of Dentistry (AFID), Rawalpindi Pakistan, from Jul to Dec 2019. Methodology: Total 80 patients were chosen with Class-I cavities present on premolars and molars of both maxillary and mandibular arch. They were divided into two groups. 40 patients each in Group-A (Self etch adhesive) and in Group-B (Total etch adhesive). Composite restorations were sited in both groups and evaluated for post-operative sensitivit y after 24 hours and after one week. Data was recorded by using Visual Analog Score in response to air stimulus. Results: The mean VAS scores for the Self Etch Group, group was lower than the Total Etch group at the 1-day (0.525 and 0.850 respectively), and 1-week (0.050 and 0.10 respectively) evaluation periods with a statistically significant difference after 24 hours only. Conclusion: Significantly less post-operative sensitivity observed with Self Etch adhesive as compared to total etch following 24 hours of restoration placement. Sensitivity faded over the period of one week.

Objective: To study the perception of COVID-19 and its prevention in the general public. Study Design: Cross-sectional study conducted using convenient sampling technique. Place and Duration of Study: In Islamic Republic of Pakistan, from 1st Apr to 12th Apr 2020. Methodology: An online questionnaire was made on Google Forms Inc. It was modified from an online ques-tionnaire available free on the internet. The sample size was 1042. Frequencies and percentages were calculated for categorical variables. Mean and standard deviation was calculated for continuous data and chi-square and t-test were applied for statistical significance between healthcare providers and non-healthcare providers. Results: A total of 97% people thought that older adults were more likely to develop complications. Most of the participants thought that use of face mask (91%), washing hands (99.4%), avoiding close contact with sick people (97.8%) and not touching the face with unwashed hands (98.7%) should be used as a preventive measure. Majority were aware of the common symptoms of the disease. Statistically significant difference between some perceptions of healthcare providers and non-health care providers was observed with myths prevailing more in the health care providers, these are; rinsing mouth and nose with saline for prevention (59.9%) and skin rash (8.9%) and watery diarrhea (47.8%) as common symptoms. 85.2% of the participants believed that “kalonji” and 81.6% believed that antimalarials may be effective in prevention or treatment of the disease. Conclusions: The participants showed a high level of knowledge regarding the pandemic but certain myths are also prevalent.

Artificial Intelligence (AI) is transforming healthcare globally, including in Pakistan. This research journal paper provides an overview of the role and significance of AI in healthcare, ethical considerations, regulatory frameworks, challenges faced byAI healthcare startups, and the current landscape of AI adoption in Pakistan's healthcare system. AI has the potential to revolutionize disease prevention, diagnosis, and treatment by leveraging large healthcare datasets, advanced computational power, and machine learning algorithms. It improves patient outcomes, enhances clinical decision-making, and optimizes healthcare delivery. Globally, AI applications in healthcare encompass medical imaging, clinical decision support, drug discovery, genomics, and remote patient monitoring. AI algorithms accurately diagnose various medical conditions, predict treatment responses, and identify therapeutic targets. Successful AI implementations include combating antimicrobial resistance and improving pediatric healthcare. Ethical considerations in AI healthcare involve bias mitigation, privacy, transparency, and the role of healthcare professionals in shared decision-making. Regulatory frameworks and guidelines are being developed worldwide to ensure safe and responsible AI implementation. Quality criteria for AI-based prediction models focus on performance, interpretability, generalizability, and robustness. Legal and ethical considerations encompass liability, accountability, and the principles of beneficence, autonomy, and justice. In Pakistan, the integration of AI in healthcare can address challenges like limited resources and uneven distribution of healthcare facilities. AI technologies can analyze medical data, diagnose disease outcomes, and personalize treatment plans.

Objective: To find out the predictive relationship between resilience, emotional intelligence and psychological well being in medical students. Study Design: Cross sectional correlational study. Place and Duration of Study: Study was conducted at the department of Psychology, University of Gujrat, Sialkot Sub-campus, from Mar 2017 to Dec 2018. Methodology: A total of 200 medical students were recruited from different private and government medical colleges of Sialkot, Pakistan. The students of first professional year to final professional year between age ranges 19 years to 27 years were selected for the study. Cannor Devidson Resilience Scale, Trait Emotional Intelligence, Questionnaire-Short Form and psychological wellbeing scale-CPI, were used to find out the predictive relationship between resilience, emotional intelligence and psychological well-being in medical students. Results: Linear regression analysis was determined by using SPSS-21. Results showed significant predictive relationship between resilience and psychological well-being (R=0.315; R2=09; p<0.001), and resilience and emotional intelligence with psychological well-being of medical students (R=0.224; R2=05; p<0.001). Conclusion: The current research maintained the predictive relationship between resilience and emotional intelligence with psychological well-being in medical students. This study will provide the vital information about the role of positive growth and psychological health of the medical students in their healthy professional development.

The dental profession is an important segment of human health care services all over the world. Dental schools in Europe and United States have evolved their curriculum to keep abreast with advances in dentistry; like connective tissue biophysics and molecular engineering through an objectively structured and clinically oriented curriculum. However, dental education in our country is still mostly traditional. This article examines the new approaches to teaching and learning in dental schools/colleges that are shaping dental curriculum globally. Articles relating to curricular trends in dental education and advancement in the dental profession published between 2010-2020 were searched in medical search engines. However, few relevant articles published before this period were also consulted. The current trends in dental curricula show new teaching, learning, and assessment methods like small group discussions, case-based learning, competency-based learning, Inquiry-based teaching-learning, and peer-assisted learning. The curricular format is integrated and new innovative assessment techniques like the assessment of multiple systematic reviews (AMSTAR) are being employed. Virtual reality, interdisciplinary teaching, and distributed community models in dental education are being implemented. The emergence of COVID-19 has also affected dental education and as a result, e-learning formats and assessment techniques have become increasingly popular. Dental schools abroad have revamped their curriculum with the advances in newer technologies and research related to dentistry. There is a need to immediately update and redesign the present dental curriculum in our country as well.

Objective: To determine association between maternal anemia and poor perinatal outcome. Study Design: Cohort study. Place and Duration of Study: Department of Gynaecology and Obstetrics, PNS Shifa Karachi, from Apr 2017 to Sep 2017. Material and Methods: A total of 643 women fulfilled the inclusion criteria. Of these, 342 women were anaemic (haemoglobin <11g/dl in labor and on two previous occasions in current pregnancy) and were labeled as group A. A total of 301 women had haemoglobin >11g/dl at all times during pregnancy and were labeled as non-anaemic group B. Perinatal outcomes included preterm delivery, low birth weight (LBW) at delivery, intrauterine growth restriction, APGAR score at 1 and 5 min, intrauterine fetal death (IUD) were calculated and compared among the two groups. Results: There were 229 (66.9%) cases of preterm delivery in group A compared to 44 (14.66%) in group B. Low birth weight (LBW) was observed in 124 (36.2%) cases in anaemic group and in 44 (14.6%) cases in non-anemic group B. There were 5 (1.4%) cases of stillbirth in anemic group as compared to 2 (0.66%) in non anemic women. In group A, new born of 109 (31.8%) cases showed Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score <5 at 1 minute compared to 14 (4.6%) cases in other group. Similarly, the score <7 at 5 minutes was observed in 70 (20.4%) deliveries in group A and 12 (3.98%) in group B. Conclusion: Low maternal haemoglobin levels are associated with increased risk of preterm delivery, LBW babies, APGAR score <5 at 1 min and IUD.

Hypertension is a risk factor that can cause hypertension leading to cardiovascular diseases. A high or persistent blood pressure level of 140/90mmHg is known as hypertension which is divided into further stages. Blood pressure is the pushing force with which the heart pumps blood against the walls of arteries. High blood pressure is a serious medical condition in which the force of blood against wall of an artery is elevated than the normal which is called as hypertension. Recent guidelines of ICD-11 categorizes blood pressure into four levels. In a clinical setting, an average of blood pressure measurements is usually taken by healthcare providers. These categories are labeled as normal blood pressure, elevated blood pressure, stage 1 hypertension and stage 2 hypertension according the blood pressure measurements. Hypertension is associated with cardiovascular diseases which results in significant morbidity and mortality. Hypertension for a long-term or chronic elevation of blood pressure causes organ damage, eventually. It can be divided into primary or essential hypertension which occurs in 95% of cases whereas; secondary hypertension occurs in 5% of the cases. There are several possible and interrelated factors that are involved in development of hypertension. Intake of sodium in diet, insulin resistance, genetics, and obesity are some of the non-modifiable risk factors for hypertension. Whereas; renin-angiotensin-aldosterone system, cardiac output, peripheral resistance are also implicated in hypertension development. It is a wide known considered risk factor not only for cardiovascular diseases but for renal diseases as well. In this review article.....

Objective: To determine the efficacy of honey in preventing radiation induced mucositis (RIM) in patients with head and neck cancers.Design: Randomized controlled trial.Setting: Oncology Department of Combined Military Hospital Rawalpindi, from July 2011 to September 2012.Patients and Methods: Sixty patients diagnosed with head and neck cancer requiring radiotherapy to the oropharyngeal mucosa were randomized into two groups to receive either radiation alone or radiation and natural honey. Patients were treated using 6-MV X-ray beams from linear accelerator at a dose rate of 2 Gy per day five times a week up to a dose of 66 Gy. In the treatment group, patients were advised to take 20 ml of pure honey 15 minutes before, 15 minutes after and 6 hours after radiotherapy. Patients were evaluated every week for the development of RIM using the WHO oral mucositis grading system.Results: In treatment group, out of 30 patients, 4(13%) developed grade 3 RIM and none developed grade 4 RIM. In control group, out of 30 patients, 12 (40%) developed grade 3 or 4 RIM (p=0.039). Four patients (13%) in treatment group lost more than 5 Kg weight during the course of radiotherapy compared to 16 patients (53%) in control group (p=0.002).Conclusion: The results of our study have shown that honey is a simple and cost effective treatment to prevent RIM. Large scale randomized trials are needed to confirm the results of our study.

Objective: To determine frequency of post-traumatic stress among undergraduate medical students in Pakistan due to COVID-19. Study Design: Web based cross-sectional survey. Place and Duration of Study: Sahiwal Medical College Sahiwal, from 1st May 2020 to 31st May 2020. Methodology: Post-traumatic stress due to COVID-19 was assessed by using Impact of Event scale revised version (IES-R). Questionnaire was distributed with use of Whatsapp messenger to 450 students. Results: Out of total, 410 responded so response rate of our study was 91.11%. Major percentage of our study population was female (74.9%). All are aged between 18-23. Majority belong to 4th year MBBS (153-37.3%). Third year was second on the list on the basis of percentage (98-23.9%). Severe cases of post-traumatic stress were 72 (17.60%) out of 410 study participants and moderate category included 150 (36.50%) participants. The frequency rate of severe cases of post-traumatic stress in female medical undergraduates was found to be higher (77.80%). Our study found statistically significant result when frequency rate of post-traumatic stress was associated with institution (p=0.031). The frequency rate of severe and moderate post-traumatic cases was higher in other institutions (59.73% and 51.34% respectively). Conclusion: The severity of post-traumatic stress is quite evident in all the MBBS students generally while in female students specifically in our study.

Objective: To determine the relationship between ABO blood groups and the COVID-19 susceptibility. Study Design: Cross-sectional analytical study. Place and Duration of the Study: Department of Pathology, Army Medical College, in collaboration with Pak Emirates Military Hospital, Rawalpindi, from March to May 2020. Methodology: The sample comprised of 326 patients. Non-purposive consecutive sampling technique was used with inclusion criteria of COVID-19 patients confirmed by real-time reverse transcriptase polymerase-chain-reaction test (RT-PCR) of sub acute respiratory syndrome corona virus-2 (SARS-CoV-2) of all age groups. ABO blood grouping was done by test tube method. The results were compared with recent surveys of ABO blood group distribution in general population of Pakistan. Results: The ABO blood group distribution of normal population was compared with COVID-19 patients. The blood group A was found to be 122 (37.4%) having significant association with COVID infection and mortality but blood group O had least prevalence 71 (21.8%) with COVID-19 infection. The p-value was calculated using Chi-square test which was p 0.04. Conclusion: Blood group A had a significant association where as people with blood group O had a least association for COVID-19 infection and severity. The findings of the present study can be used in clinical management of the COVID-19 and that blood group A population is more susceptible to acquire COVID-19 infection, further more can develop complications with high mortality rate. Clinicians should be more vigilant in treating patients with blood group A.

Objective: To determine mean epicardial adipose tissue (EAT) thickness using cardiac MRI in individuals with coronary artery disease (CAD) compared to controls. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, Pakistan; from July to September 2025. Methodology: Eighty-four adults were recruited through consecutive sampling and allocated equally to CAD-Group (n = 42) and non-CAD-Group (n = 42). Greater than 50% luminal stenosis was used to identify CAD on CT coronary angiography (CTCA). Inclusion criteria included adults aged 25–55 years with either CTCA-confirmed CAD or normal coronary anatomy. Exclusion criteria comprised MRI contraindications (such as pacemakers, cochlear implants, or severe claustrophobia), nondiagnostic CMR images, prior PCI or CABG, previous valve surgery, known cardiomyopathies, eGFR <30 mL/min/1.73m², and active malignancy or recent chemotherapy or radiotherapy. All participants underwent non-contrast 3.0T cardiac MRI, and EAT thickness was measured at the left atrioventricular groove during end-diastole. Results: Mean EAT thickness was significantly higher in CAD participants (13.24±3.32 mm) than in controls (11.49±2.15 mm) (p-value=0.005). Logistic regression demonstrated that each 1 mm increase in EAT thickness was independently associated with CAD (adjusted OR 1.256; 95% CI 1.061–1.487; p-value = 0.008). Conclusion: EAT thickness assessed on non-contrast CMR was significantly elevated in CAD patients and independently associated with disease presence, supporting its potential as a noninvasive imaging biomarker for CAD risk assessment.

Objective: To compare abdominal pain experienced by patients with and without a subhepatic drain placed after uncomplicated laparoscopic cholecystectomy. Study Design: Prospective comparative study. Place and Duration of Study: General Surgery Department of Combined Military Hospital Rawalpindi, Pakistan from Aug 2023 to Feb 2024. Methodology: One hundred and eighty-two patients who underwent uncomplicated elective laparoscopic cholecystectomy for symptomatic gallstones were included in the study, and split into two equal groups of 91 patients each. In Group-A, the subhepatic drain was placed during the surgery, and in Group-B, no drain was placed. Assessment of intra-abdominal pain in both groups was done with the help of Visual Analogue Scale (VAS). Results: The mean age of 182 patients was 47.88±9.5 years. Seventy-five (41.2%) were male, and 107 (58.8%) were female. Twenty-four hours after the surgery, significant abdominal pain was present in 22(24.1%) patients with subhepatic drain and only 4(4.3%) patients without drain. Median intra-abdominal pain in Group-A was 3(1), and in Group-B, it was 2(1). No significant difference was observed between the two groups regarding the development of nausea/vomiting, fever, perihepatic collection, and surgical site infection (SSI) in the postoperative period. Conclusion: After performing uncomplicated elective laparoscopic cholecystectomy, subhepatic drain is associated with increased intra-abdominal pain without offering any significant advantage.

Objective: To compare the efficacy of infrared heat therapy with cryotherapy as an adjunct to Meglumine Antimoniate in the treatment of cutaneous leishmaniasis Study Design: Quasi-experimental study Place and duration of study: Combined Military Hospital, Quetta, Pakistan, from Jan to Jun 2024. Methodology: Eligible participants were aged 18 years or older with confirmed cutaneous leishmaniasis. Participants were assigned to three treatment arms: cryotherapy with meglumine, meglumine alone, and infrared heat therapy with meglumine. The primary outcome was clinical cure after 2 months of therapy. Results: The mean age of the participants was 28.6±9.2years. Most of the participants were male, comprising 87.5% of the patients. The duration of the disease among the participants was 3.6 months on average. On average, each participant had 4.7 lesions. 28 participants (87.5%)achieved a clinical cure in the group treated with cryotherapy and meglumine. 26 participants(81.2%)achieved a clinical cure in the group treated with infrared heat therapy and meglumine. Among those treated with meglumine alone,22 participants(68.7%)achieved a clinical cure. The p-value indicates a statistically significant difference in clinical cure rates among the treatment groups, with a value less than 0.05. Conclusion: Combination therapy of meglumine with infrared heat and cryotherapy achieved better clinical cure when compared to meglumine alone.

Objective: To compare response to first line chemotherapy Bortezomib, Lenalidomide and Dexamethasone (VDR) and Bortezomib, Cyclophosphamide and Dexamethasone (VCD) in diagnosed cases of multiple myeloma at CMH Rawalpindi. Study Design: Prospective comparative study. Place and Duration of Study: Medical Oncology Department, Combined Military Hospital Rawalpindi, Pakistan Aug 2023 to Feb 2024. Methodology: This study was carried out on a cohort of 100 multiple myeloma patients classified as high-risk candidates based on the International Scoring System (ISS) with a score of III. Upon diagnosis, the patients were stratified into two Groups. Group-I received a combination of Bortezomib, Lenalidomide and Dexamethasone, (VDR), whereas Group-II recieved Bortezomib, Cyclophosphamide and Dexamethasone (VCD). The efficacy of treatment response and the occurrence of treatment-related adverse effects were evaluated and compared between the two Groups after minimum of four-month treatment period. Results: The final analysis included 100 multiple myeloma patients, with a median age of 37.50 and range 41 years. Among these patients, 63 (63%) were male, and 37 (37%) were female. Number of patients in Group I, which underwent VDR was 51(51%, while in Group II 49 (49%) received VCD treatment. Statistically significant difference was observed in the treatment response, with a notably superior response in VDR treatment compared to those receiving VCD treatment (p-value<0.001). Conclusion: Patients receiving treatment with Bortezomib, Dexamethasone, and Lenalidomide (VDR) exhibited superior treatment response as compared to Bortezomib, Cyclophosphamide and Dexamethasone(VCD). However, adverse effects did not show a significant difference between the two treatment Groups.

Objective: To compare the preoperative computerized tomography of petromastoid region with intraoperative finding in cases with chronic suppurative otitis media (CSOM). Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Otorhinolaryngology, Combined Military Hospital Gujranwala, Pakistan, from Jul to Dec 2024. Results: High-Resolution Computed Tomography (HRCT) findings were compared with intraoperative results in 70 patients. Ossicular erosion was detected in 37 cases by HRCT, with 33 confirmed (sensitivity 64.7%, specificity 78.9%, p=0.001). Bone erosion was noted in 40 cases, with 28 true positives (sensitivity 84.8%, specificity 67.6%). Tegmen erosion had 100% sensitivity but 0% specificity. Detection accuracy for scutum, facial canal, and sinus plate erosion varied (sensitivity 44%–50%, specificity 42.9%–100%). Conclusion: Retraction pockets seen on otoscopy are the most common sign of potentially dangerous CSOM (primary acquired cholesteatoma). HRCT has enhanced the preoperative detection of advanced disease and complications. However, it remains imperfect, with both false-positive and false-negative findings limiting its reliability.

Communication is an important element in all professions. In journalism, one survives or fades away depending on his ability to use the right words for his writings to have the right impact. This is equally true of the professions of healing. Words can be taken as the commonest Medicine used by a physician. In health care, the words used by the doctor have a profound effect on the well-being of a patient. These can inspire hope in the patient or plunge him in despair. Words can make all the difference between rapid recovery of the patient or prolongation and aggravation of his ailment. The right words can potentiate a patient, mobilise his will to live and set the stage for a heroic response from him. Wrong words can induce despair and defeat or impair the usefulness of whatever treatment is prescribed. The practice of medicine is both a science and an art, the oldest is art. Being able to diagnose correctly is a good test of medical competence; being able to tell the patient just what is good for him or her to know is a good test of medical artistry. In short, a physician should adopt a psychological approach in dealing with his patients. It should be realised that proper communication is one of the most difficult undertakings. Patients can get frightened, confused or immobilised as a result of faulty communication with their doctors. Sloppy communication often impairs patient-physician relationship. 1

Objective: To investigate the frequency of coronary artery disease in patients younger than 45 years presenting with stable chest pain and then to compare the uric acid to HDL ratio in patients with and without coronary artery disease. Study Design: Cross-sectional survey. Place and Duration of Study: Armed Forces Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi, Pakistan, from Jul to Nov 2025. Methodology: After meeting the selection criteria, a total of 200 patients were enrolled. Patients underwent coronary angiography. Based on the findings, they were categorized into two groups: with coronary artery disease or without coronary artery disease. The angiographic procedure was performed by a single team of cardiologists with assistance from the researcher, under local anesthesia. Blood samples were collected using a 3 cc disposable syringe to assess the uric acid-to-HDL ratio. Results: In this study, 143(71.5%) were male, 163(81.5%) were hypertensive, and 75(37.5%) were diabetic. Regarding the outcome variable, CAD was detected in 125(62.5%) patients. The median uric acid to HDL ratio was 0.34 (IQR: 0.16) in patients with CAD, compared to 0.08 (IQR: 0.03) in those without CAD (p<0.001). Conclusion: It can be concluded that the frequency of coronary artery disease was 62.5% among patients younger than 45 years presenting with stable chest pain, and the uric acid to HDL ratio showed a significant association with coronary artery disease.

Objective: To compare the efficacy of Vaginal Dinoprostone and Cervical Foley’s Catheter for Induction of Labour In Women With One Previous Caesarean Section. Study Design: Quasi-Experimental Study Setting and Duration of Study: Department of Gynecology and Obstetrics, PAF Hospital Mushaf, Sargodha, Pakistan, from Mar to Nov 2023. Methodology: A total of 120 women having a previous cesarean section undergoing the induction of labor with a gestational age of 37-41 weeks were included. Patients with multiple pregnancies, preterm labor, rupture of membranes, intrauterine fetal death, polyhydramnios, placenta previa, PIH, and GDM were excluded. All the included participants were randomly divided into two equal groups, i.e., Group-B (transcervical Foley’s catheter) & Group-A (vaginal Dinoprostone), by using the lottery method (randomization process). In both groups, the efficacy was noted. Results: The study included individuals aged between 20 and 45 years, with an average age of 27.53 ± 4.31 years. Group-A women had an average age of 27.60 ± 5.12 years, while Group-B women had 27.40 ± 3.99 years. 20 to 30 years was the common age among most of the patients, 78 (65.0%). In this study, vaginal delivery within 24 hours was significantly higher in Group-A (Dinoprostone group) (96.67% vs. 76.67%, p = 0.0013) as compared to Group-B (Intracervical Foley’s catheter group). Conclusion: This study concluded that the efficacy (in terms of vaginal delivery) of vaginal Dinoprostone is higher as compared to intracervical Foley’s catheter for the initiation of labor in prior one-scar pregnancies.

Objective: To evaluate the efficacy and safety of primary repair augmented by Witzel feeding jejunostomy for managing duodenal and proximal jejunal injuries in penetrating abdominal polytrauma at a tertiary trauma center in Pakistan. Study Design: Prospective analytical study. Place and Duration of the Study: Combined Military Hospital, Quetta, Pakistan from Aug 2023 to Jun 2025. Methodology: Patients with penetrating duodenal and/or proximal jejunal injuries were enrolled. Primary repair was performed with adjunctive feeding jejunostomy, nasogastric decompression and drain placement. Data on demographics, injury details, vital signs, surgical procedures, and outcomes were collected from records of patient. Results: Of 27 patients, 15(55.6%) had duodenal injuries (18.5% first part, 37.0% fourth part), and 19 (70.4%) had proximal jejunal injuries, with 8(29.6%) having concurrent duodenal injuries. All patients presented after sustaining firearm injuries. Mean operation time was 110.1±38.9 minutes. Surgical site infections occurred in 04 patients, with no anastomotic leaks or reoperations. The most common AAST grade in duodenal injury was grade II in 12(80%) patients. Significant associations included ventilatory support with higher injury count (p<0.001) and longer hospital stay (p=0.005), spleen injury with increased surgical site infection risk (p=0.049) and prolonged stay (p=0.030), and shock index on arrival with stoma formation (p=0.002). No mortality was recorded and there was no anastamotic leak in patients. Conclusion: Primary repair with Witzel feeding jejunostomy is safe and effective for penetrating duodenal and proximal jejunal injuries, with low complication rates in a resource-limited setting.

Objective: To identify recent susceptibility patterns of Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and Paratyphi A in a government hospital in Taxila Cantt and to determine the frequency of Multi-Drug Resistant (MDR) and Extensively Drug-Resistant (XDR) S. Typhi. Study Design: Cross-sectional study. Place and Duration of Study: Pathology Department, HIT Hospital, Taxila Cantt, Pakistan, from Jan 24 to Jan 25. Methodology: Samples of blood cultures from patients suspected of having enteric fever were received in the microbiology section, HIT Laboratory, Taxila Cantt. Isolates of Salmonella Typhi and Paratyphi A from positive blood cultures were included in the study. Antibiotic susceptibility was tested based on CLSI guidelines (2024). Descriptive statistics were shown as Mean ±SD. Results: In this study, out of the 64 positive blood cultures for Typhoidal Salmonella from patients (median age 20), 95.3% were Salmonella Typhi (61) and 4.7% were Salmonella Paratyphi A (03). In 71.9% of cases, CRP was positive. After using appropriate antimicrobials, fever took around five days to settle. Out of the total Salmonella isolated from blood culture, including both species of Salmonella Typhi and Paratyphi A, Azithromycin and Meropenem showed 100% susceptibility, as compared to first-line antibiotics with % resistance of 92, 90.6, and 87.5 for Ampicillin, co-trimoxazole, and chloramphenicol, respectively. Ciprofloxacin and Ceftriaxone demonstrated substantial resistance rates of 97% and 76.6%, respectively. Conclusions: This study showed significant antimicrobial resistance to multiple antibiotics in both Salmonella Typhi and Paratyphi A isolates, with an alarmingly high number of MDR and XDR strains of