Pakistan Journal of Health Sciences

In recent years, the healthcare industry has witnessed a revolutionary shift driven by advances in artificial intelligence (AI) and machine learning (ML) technologies. These groundbreaking tools are transforming the way we deliver care, enhance patient outcomes, and optimize healthcare systems. The role of AI and ML in healthcare has become increasingly prominent, opening up new avenues for innovation, precision medicine, and improved decision-making. As we embark on this transformative journey, it is crucial to explore the potential, challenges, and ethical implications of integrating AI and ML into healthcare. One of the key areas where AI and ML have shown immense promise is in the realm of diagnostics. By analyzing vast amounts of medical data, these technologies can quickly and accurately detect patterns, identify anomalies, and assist in diagnosing diseases. AI-powered algorithms can analyze medical images, such as X-rays and MRIs, with remarkable accuracy, enabling early detection of diseases like cancer and improving patient outcomes. ML algorithms can also assist healthcare professionals in predicting disease progression, guiding treatment plans, and offering personalized medicine approaches, leading to more targeted and effective interventions. Moreover, AI and ML have the potential to revolutionize healthcare delivery and management. Intelligent systems can optimize hospital operations, streamline administrative tasks, and enhance resource allocation. From scheduling appointments and managing electronic health records to predicting patient flow and optimizing bed occupancy, these technologies can help healthcare organizations work more efficiently, reduce costs, and improve patient experiences. Furthermore, AI-powered chatbots and virtual assistants can provide personalized health advice, answer patient queries, and offer triage support, enhancing accessibility and patient engagement. However, as we embrace the potential of AI and ML in healthcare, it is essential to address several challenges and ethical considerations. Data privacy and security, algorithmic biases, and the potential for AI to replace human judgment are critical concerns. Striking the right balance between human expertise and machine assistance is crucial to ensure that patient-centric care remains at the forefront. Rigorous validation, robust regulatory frameworks, and ongoing monitoring are necessary to ensure the safety, efficacy, and ethical use of AI and ML in healthcare. In conclusion, the role of artificial intelligence and machine learning in healthcare is transformative, promising significant advancements in diagnostics, healthcare delivery, and patient outcomes. These technologies have the potential to revolutionize how we approach healthcare, enhance decision-making, and improve resource allocation. However, it is vital to navigate the challenges and ethical considerations associated with AI and ML adoption. By embracing a collaborative approach that combines human expertise with intelligent systems, we can harness the full potential of these technologies and create a future where AI and ML empower healthcare professionals, improve patient experiences, and contribute to healthier communities

Phenomenology is the qualitative research inquiry that explores the lived experiences of the individual. This paper discusses phenomenology as a qualitative research methodology and its roots, characteristics, and steps to conduct the study. The relevant literature was searched using the database library, including PubMed, Google Scholar, PakMediNet, Medline, and Cumulative Index to Nursing and Allied Health Literature CINAHL. Literature was searched using keywords including phenomenology, qualitative inquiry, roots of phenomenology, steps of phenomenology, and characters of phenomenology. The essential essence of phenomenology is to understand the lived experiences of individuals. The participants truly share the lived experiences which they witnessed. It is concluded that phenomenology is a qualitative inquiry that addresses the real-life experiences of individuals.

Rheumatoid Arthritis (RA) is a persistent inflammatory and autoimmune affliction, which results in significant impairment of mobility and a decline in the overall standard of living. The present therapeutic strategies for the management of RA are frequently associated with adverse reactions of notable severity. Medicinal plants containing Phytochemicals such as Campesterol, Crocetin, Nigella Sativa, and Ginkgolic Acid have been recognized as significant alternatives for the treatment of RA. This review article provides an overview of the bioactive constituent campesterol, which exhibits the capacity to regulate interleukins and immune modulation in vitro and in vivo experimental models. The current study aimed to obtain relevant academic literature about the utilization of natural products in the treatment of arthritic conditions. A systematic search strategy was employed, involving both electronic and manual efforts, to query prominent scholarly databases including PubMed, Embase, Scopus, and Web of Science. 76 publications were identified through this review, with 30 being deemed eligible for inclusion. Four researchers have reported their discoveries on the efficacy of natural constituents in the management of RA through investigations In Vitro & In Vivo. Scholarly reports investigated the role of bioactive constituents of phytochemicals for RA treatment, while 15 studies In Vivo evaluated the effectiveness of Campesterol, in alleviating arthritis symptoms through their inflammatory responses and modulation of interleukin production. This review presents notable findings suggesting that Campesterol appears to be particularly effective in the expression of pro-inflammatory modulation of cytokines, and anti-inflammatory cytokines, hence posing therapeutic potential in RA management.

Clinical placement is the setting of the physical environment and personnel teaching for healthcare workers, including nurses and nursing students. A clinical placement offers hands-on learning opportunities that can enhance your understanding of healthcare practices and procedures. Moreover, clinical placement could also provide networking opportunities and connections with healthcare professionals, which could help build their professional network. Objective: To measure the satisfaction of nursing students toward their clinical placement and association with their academic year at private Nursing College Karachi Pakistan. Methods: A cross-sectional analytical study was conducted in the Horizon School of Nursing and Health Sciences Karachi, Pakistan, from June 2022-September 2022. A total of 62 participants were part of the study; 3rd year and 4th-year students were enrolled. Moreover, a Convenient sampling technique was used for the data collection. Data were collected through a valid and reliable tool that was self-administered. Results: The study results show that. 12.9% of participants had a low level of satisfaction regarding their clinical placement, 51.6.% had a moderate level, and 35.5% had a high level of satisfaction. There was no significant difference between the satisfaction of nursing students toward their clinical placement with their academic year p-value (.193). Conclusions: Most students were satisfied with their clinical environment. But some still have poor satisfaction; it is essential to listen to nursing students' feedback regarding their clinical placement and take steps to address their concerns

Self-esteem is an individual attitude about his personality and the gratitude of his worth. It signifies an honest, suitable, steady appreciation of one’s value. Objectives: To find out anxiety, depressive symptoms and socio-demographic factors associated with self-esteem among male nursing students. Methods: A cross-sectional research design was selected and conducted with 155 undergraduate students of nursing students at College of Nursing and Midwifery, Sindh Government Hospital, Liaquatabad, Karachi. The Urdu version of the Aga Khan University Anxiety and Depression Scale (AKUADS) and Rosenberg Self-Esteem Scale (RSES) validated questionnaires were used to collect data. Results: The study findings showed that 137 students (88.39%) had normal self-esteem levels, and 18 students (11.61%) had low self-esteem. Analysis of Self-esteem about socio-demographic variables revealed an insignificant association with age, gender, marital status, family type, socioeconomic levels, family income, residence, substance use, and education program. The only statistically significant association was found between the current degree year and self-esteem levels (p = 0.046). There was a weak statistically significant negative relationship between self-esteem and anxiety depressive symptoms ((r = -0.221; p < 0.01). Conclusions: The current research study concluded that nursing students with normal self-esteem levels were also suffering from anxiety and depression. The junior students were found to have more anxiety and depression symptoms and low self-esteem levels. Socio-demographic variables have no significant effect on the self-esteem of nursing students.

Methanol poisoning is a severe public health issue that causes disease and death, particularly in developing countries. Exposure can occur intentionally or unintentionally through several industrial products such as cleansers, solvents, antifreeze, perfumes, and paints. The toxic dose of methanol is approximately 1g/kg, emphasizing its potent toxicity. Methanol intoxication is chiefly caused by the harmful metabolites which are formed during its breakdown. These metabolites encourage metabolic acidosis. Formic acid, a methanol breakdown product, troubles mitochondria, distressing cytochrome oxidase and ATP production. Methanol-related problems include neurological disorders, vision problems, liver impact, Alzheimer’s, and Parkinson's. Key lab tests, including osmolality and anionic gap, aid in recognizing alcohol harm. Furthermore, detecting a faint smell of methanol in the breath, observing visual disturbances, and altered sensory neurons, seeing a history of abdominal pain, and conducting routine checkups support the early diagnosis of methanol poisoning. Treatment using prompt gastric lavage, sodium bicarbonate given intravenously, management with ethanol, folate-dependent folate systems suggest, dialysis, competent ADH inhibitor “pyrazole”, specific antidote “Fomepizole” can be used to treat methanol poisoning. Regular toxicologist check-ups are critical in such cases. Definite symptoms like basal ganglia issues and eye problems require consultations with neurologists and ophthalmologists. For cases needing hemodialysis or liver tissue recovery, consulting a nephrologist is essential. It is suggested to immediately act to prevent harm, especially for industrial workers, rural alcohol sellers, those with alcoholism, and vulnerable youth vulnerable to methanol poisoning.

Students face challenges while selecting a career in Pakistan is very common. 99% students lack career counselling services in schools, colleges and universities. In the current study career decision-making difficulties faced by students in Peshawar was investigated when they plan to apply in a school, college and university and to evaluate what kind of assistance they need in their career choices related to their personality. Objective: To see how personality affect the decision-making of careers in students at high schools, colleges, and universities. Methods: The influence of personality traits (Extraversion and Neuroticism) on the decision-making of career difficulties was investigated using a causal-comparative study methodology. In Pakistan, 99 percent of pupils still need career guidance. As a result, three hundred and seventy-six (N=376) students were chosen from Peshawar's various schools, colleges, and universities. Two questionnaires were used to gauge the participants' responses: The career decision-making difficulties Questionnaire and Big Five Personality Inventory. Results: Findings suggest that most students needed help with professional decision-making and that a small percentage of students were satisfied with their selected disciplines. Conclusions: Students with high neuroticism and low extroversion had difficulty making professional decisions.

Patient satisfaction is critical to healthcare quality and significantly impacts patient outcomes and healthcare delivery. Objectives: To explore patient satisfaction with nursing care and its association with gender at a tertiary care Hospital in Karachi, Pakistan. Methods: This cross-sectional Analytical study was conducted at a tertiary care Hospital in Karachi from September 2022 to December 2022. Sixty participants were recruited through a convenient sampling technique from the medical ward. Data were collected through a pretested questionnaire which was reliable. Results: The study found that out of the 60 participants, 3% had a low level of satisfaction, 50% had a moderate level, and 47% had a high level of satisfaction regarding nursing care. Moreover, the study revealed no evidence of an association between gender and level of satisfaction. Conclusions: Based on the findings majority of the participants had a moderate to high level of satisfaction, with only a small percentage reporting low satisfaction. There was no evidence of a relationship between gender and satisfaction level. However, generalizing these findings to a larger population requires more investigation due to the small sample size.

Autism spectrum disorder (ASD) is a neurological condition that affects characterized with limitations the occurrence of specific interests and recurrent behaviors in social interaction. This article explains factors that may influence prevalence rates, such as recent changes to the diagnostic criteria, in light of current concerns about increased prevalence. To observe the development of literature regarding autism spectrum disorder in light of recent researches. The data was collected from data bases such as google scholar, Pubmed, HEC library and Scopus. The researches from only national scholars was considered. The data was vetted by a self appointed committee of expert peer reviewer to ensure maximum quality. Based on our analysis of published works, it can be claimed that there is a lack of academically sound published material from Pakistan, making it challenging to quantify the burden of ASD in this community, identify risk factors, or even create efficient intervention methods.

Nursing education is the combination of clinical skills and theoretical knowledge. The nursing institutes prepare students for the future as part of the workforce or leaders where they will represent their college or university in clinical practice or in teaching. Objective: To identify the factors that affect the performance of nursing students of KPK. Methods: The study was conducted in the public and private nursing institutes of KPK Pakistan from June 2022 to July 2022 having a sample size of 120 using a cross-sectional descriptive design and a non-probability sampling technique through adopted questionnaire. Results: The male participants of the study were higher (72%) than female (28%) participants. The mean and standard deviation score among all the categories the score of teacher related issues were high (3.26 ± 0.70), followed by the mean and standard deviation score of institute related issues (3.00 ± 0.82), study related issues (2.97 ± 0.76), while home related issues were (2.94 ± 0.67), and personal related issues (2.86 ± 0.96). Conclusions: The study concluded based on the finding that out of the basic 5 factors, teachers-related factors including the teacher's subject-matter expertise, the use of audiovisuals inappropriately and the number of topics covered in a single class have the greatest impact on students' performance.

Prelabor rupture of membranes (PROM) is a significant obstetric complication predisposing a woman to chorioamnionitis, neonatal sepsis, and placental abruption. The optimal timing of labour induction, particularly in late preterm pregnancies, remains a clinical challenge requiring a balance between infectious risk and prematurity-related morbidity. Objectives: To evaluate the association between early versus late induction of labour and maternal and neonatal outcomes in women with term and late preterm PROM. Methods: This prospective study was conducted at the Combined Military Hospital, Malir, from October 2023 to September 2024. A total of 111 women with singleton pregnancies ≥34 weeks with confirmed PROM were grouped as term (≥37 weeks) or late preterm (34–36+6 weeks) and stratified by induction timing: early (6–12 hours) or late (>12 hours). Maternal and neonatal outcomes were analyzed using SPSS version 27.0, with Chi-square and Fisher’s exact tests applied; p<0.05 was considered significant. Results: Of 111 participants, term PROM was present in 59 (53.2%) and late preterm PROM in 52 (46.8%); 61 (55.0%) underwent early and 50 (45.0%) late induction. Spontaneous vaginal delivery was the predominant mode (63.1%). Late preterm PROM was associated with significantly worse neonatal outcomes than term PROM across all parameters, while induction timing had no significant effect on any maternal or neonatal outcome. Conclusions: Gestational age at membrane rupture is a stronger determinant of neonatal morbidity than induction timing. Thus, we cannot claim that early induction is definitively 'safe'—only that it was not associated with worse outcomes in this specific cohort.

Intestinal parasitic infections are one of the primary determinants of morbidity and mortality in people with HIV, especially in resource-limited environments. Objective: To determine the prevalence of intestinal parasitic infections in HIV-positive patients presenting with acute diarrhoea. Methods: This cross-sectional study was conducted at Allama Iqbal Teaching Hospital, Dera Ghazi Khan, from October 2025 to February 2026. A total of 153 HIV-seropositive patients (18–60 years) with acute diarrhoea and CD4 count <200 cells/mm³ were enrolled, and their stool specimens were examined by direct wet-mount microscopy with normal saline and Lugol’s iodine, modified acid-fast (Kinyoun) staining for coccidian parasites, and formal-ether concentration. Data were analysed using SPSS version 25.0. Results: Of 153 patients (mean age 34.8±9.6 years; 74.5% male), intestinal parasitic infection was detected in 68 (44.4%; 95% CI 36.8–52.4). Cryptosporidium spp. was the most prevalent organism (30.1%), followed by Entamoeba histolytica (13.1%), Cystoisospora belli (11.8%) and Blastocystis spp. (9.8%). Infection rates were significantly higher in patients with CD4 <50 cells/mm³ (100%) versus 101–200 cells/mm³ (31.8%) (χ²=19.94, p<0.001), and in WHO clinical Stage IV (75.6%) versus Stage I (14.3%) (χ²=30.57, p<0.001). In multivariable logistic regression, each one-cell/mm³ increase in CD4 count was associated with lower odds of infection (aOR 0.968, 95% CI 0.955–0.982, p<0.001). Conclusions: Intestinal parasitic infections are frequent in HIV-positive patients with acute diarrhoea, with Cryptosporidium species being the most common. Lower CD4 count and advanced WHO clinical stage were the only variables independently associated with infection.

The Robson Ten-Group Classification System (TGCS) uses basic obstetric characteristics to categorize birthing women into ten different groups. The World Health Organization (WHO) recommended TGCS in its 2015 Executive Statement as a standard tool for monitoring and evaluating cesarean section rates at health facilities and national levels. Objectives: To determine the frequency of cesarean section according to Robson’s criteria in the Tertiary care hospital of Lahore. Methods: This descriptive cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Services Hospital, Lahore, from July 2023 to December 2023. A total of 135 women aged 18- 40 years undergoing delivery were selected, and those with major obstetric complications were excluded. Data were collected by non-probability, consecutive sampling. Patients were assessed for Robson classification by the researcher herself, and cesarean section was recorded for each group. Data were analyzed by computer software SPSS version 25.0. Results: Most of the patients, 81 (60.0%), were between 18 and 30 years of age. The frequency of cesarean section was found in 53 (39.3%) patients. Cesarean section rate in different groups (1-10) according to Robson’s classification was found to be 18.2%, 29.2%, 52.9%, 27.3%, 60.0%, 80.0%, 30.0%, 37.5%, 60.0%, and 100.0%, respectively. Conclusions: Robson Groups 3 and 5 were primary contributors to cesarean section rates, followed by Groups 6 and 2. These results underline the importance of the minimization of primary cesarean sections and the encouragement of normal delivery.

Surgical site infections (SSIs) and periprosthetic joint infections (PJIs) are among the major complications seen after an arthroplasty procedure; they lead to morbidity, surgical revisions, and medical cost escalation. The operating time has been shown as one of the risk factors for these infections, and hence can be modified by proper intervention. Objective: To determine the rate of surgical site infection in arthroplasty and evaluate its association with operative duration among patients undergoing primary total knee arthroplasty. Methods: From January to June of 2025, this prospective observational cohort study was carried out at the Department of Orthopaedics & Spine Centre, GTTH, Lahore. Included were 94 patients having elective primary total knee arthroplasty. Clinical, perioperative, and demographic information was documented. Using CDC criteria, patients were monitored for ninety days to determine whether surgical site infections had occurred. SPSS version 27.0 was used for statistical analysis. Results: In total, surgical site infections occurred in 8 out of 94 patients (9%). 12% of patients who had surgery for more than 120 minutes had SSI (p=0.07), whereas those who had surgery for less than 120 minutes had no infections. Logistic regression analysis revealed a not statistically significant correlation between an elevated risk of SSI and an operative duration of ≥120 minutes (OR=3.80, p=0.03). Conclusions: After a primary total knee replacement, a longer operating time is linked to a higher risk of surgical site infection. There was a greater chance of postoperative infection in patients whose operations took longer than 120 minutes.

Apnea of prematurity (AOP) is common in preterm neonates, and the optimal caffeine citrate dose remains uncertain. Objective: To compare outcomes of high-dose versus low-dose caffeine citrate for AOP. Methods: This open-label randomized clinical trial (NCT06905496) was conducted at Nishtar Hospital, Multan, from January to October 2025 after approval (7028) and written consent. Preterm neonates 32 to less than 37 weeks’ gestation with AOP were randomized 1:1. High-dose caffeine citrate comprised a 40 mg/kg loading dose followed by 20 mg/kg/day for 7 days; low-dose comprised 20 mg/kg then 10 mg/kg/day for 7 days. The primary outcome was extubation failure within 48 hours; secondary outcomes were apnea episode frequency, need and duration of mechanical ventilation, duration of oxygen therapy, and in-hospital mortality. Statistical Package for the Social Sciences version 26.0 was used with a probability value (p) < 0.05. Results: One hundred fourteen neonates were allocated (57 per group). Baseline characteristics were similar except for sex distribution (p=0.036). Apnea episodes were lower with high-dose therapy (10.74 ± 2.91 vs 12.89 ± 2.20), mean difference −2.16 (95% confidence interval −3.12 to −1.20; p<0.001). Mechanical ventilation requirement was similar (38.6% vs 43.9%; p=0.568). In ventilated neonates (47), extubation failure was reduced (27.3% vs 56.0%; p=0.047) and ventilation duration was shorter (median 2 vs 4 days; p=0.027). Oxygen therapy duration (median 10 vs 11 days; p=0.555) and mortality (5.3% vs 8.8%; p=0.463) did not differ. Conclusion: In conclusion, high-dose caffeine reduced apnea burden and improved extubation outcomes without differences in oxygen days or in-hospital mortality.

Once-weekly dipeptidyl peptidase-4 inhibition represents a potential strategy to reduce dosing burden while maintaining glycaemic efficacy in type 2 diabetes mellitus. Objectives: To compare once-weekly trelagliptin with once-daily vildagliptin in adults receiving background metformin, using change in glycated hemoglobin and attainment of glycated hemoglobin below 7%, with secondary assessment of body weight and body mass index. Methods: A randomized, open-label, parallel-group clinical trial was conducted at a tertiary care hospital. Adults aged 30 to 60 years with type 2 diabetes mellitus, glycated hemoglobin 7.5% to 9.5% on metformin, were randomized by lottery to trelagliptin 100 mg once weekly or vildagliptin 50 mg once daily for 12 weeks. Independent-samples t testing and chi-square or Fisher's exact testing were applied as appropriate. Prespecified stratified analyses were performed for the efficacy endpoint. Results: A total of 102 participants were randomized, and 93 completed follow-ups. Baseline characteristics were comparable. Glycated hemoglobin change was −1.24±0.78% with trelagliptin and −1.52±0.67% with vildagliptin, mean difference 0.28% (95% CI −0.02 to 0.58), p=0.068. Target attainment was 53.2% versus 63.0%, p=0.336. Weight and body mass index changes did not differ significantly, and stratified analyses showed no significant subgroup effects. Conclusions: No statistically significant difference was detected between once-weekly trelagliptin and once-daily vildagliptin in glycaemic improvement over 12 weeks in patients. Short-term changes in body weight and body mass index were also not significantly different between the two treatment groups.

Severe acute malnutrition (SAM) is a major public health problem in children, contributing to high morbidity, mortality, and impaired neurodevelopment. While nutritional rehabilitation improves survival and physical growth, its effect on cognitive, motor, language, and social development remains inadequately explored. Objective: To evaluate the impact of nutritional rehabilitation on neurodevelopmental outcomes in children aged 1–6 years with SAM. Methods: This prospective observational study was conducted over six months in the Department of Paediatrics of Khairpur Medical College, Sindh. A total of 150 children aged 1–6 years diagnosed with SAM (according to WHO criteria: weight-for-height Z-score < −3 SD or mid-upper arm circumference < 11.5 cm) were enrolled. Participants received eight weeks of standardized nutritional rehabilitation, including therapeutic feeding and micronutrient supplementation, along with management of associated complications. Anthropometric parameters and neurodevelopmental domains (cognitive, motor, language, and social) were assessed at baseline and post-intervention. Data were analysed using SPSS version 23, applying paired t-tests and chi-square tests, with p<0.05 considered significant. Results: Significant improvements were observed in weight (7.3 ± 1.4 vs. 9.2 ± 1.6 kg), MUAC (10.4 ± 0.9 vs. 12.5 ± 1.1 cm), and weight-for-height Z-score (−3.42 ± 0.51 vs. −2.18 ± 0.47) (p < 0.001). Neurodevelopmental scores improved significantly across all domains (p < 0.001). The proportion of children with normal development increased from 20.0% to 53.3%, while moderate developmental delay decreased from 33.3% to 14.7%. Conclusions: Nutritional rehabilitation significantly improves both growth and neurodevelopment in children with SAM. Early identification and timely intervention are crucial for optimal developmental recovery.

Unanticipated difficult laryngoscopy is a significant problem in airway management and is linked to higher morbidity. Objectives: To determine the diagnostic accuracy of upper airway angle and glottic height to predict unanticipated difficult endotracheal intubation, taking Cormack–Lehane classification as the gold standard. Methods: This study was a cross-sectional research work conducted at Sindh Institute of Urology and Transplantation, Karachi, during the period of six months from 7 August, 2025 to 31st January, 2026. A sample size of 150 patients aged between 18 and 80 years, subjected to general anesthesia with direct laryngoscopy, was included. The 2 x 2 contingency tables were used to calculate the diagnostic accuracy indices, and the effect modifiers were stratified; an independent t-test was used, where p≤0.05 was regarded as significant. Results: UAA showed a sensitivity of 73.7%, a specificity of 85.7%, a PPV of 63.6%, an NPV of 90.6%, and a total accuracy of 82.7%. The sensitivity of GH was 78.9%, specificity was 78.5%, PPV was 55.6%, NPV was 91.7%, and accuracy was 78.7%. Conclusions: UAA and GH are non-invasive and easy to use and predict difficult laryngoscopy, especially because they show high negative predictive values. These measurements of the anatomy should be considered in the standard airway evaluation to improve preoperative prediction and patient safety.

One of the main causes of conductive hearing loss is still chronic otitis media with tympanic membrane perforation. Surgical repair aims to restore hearing and membrane integrity. Objective: To compare the postoperative anatomical and functional outcomes of interlay versus underlay tympanoplasty techniques in patients with chronic otitis media. Methods: This randomized controlled trial was carried out at the Department of Otorhinolaryngology, Shaikh Zayed Medical Complex, Lahore, from January to June 2025 after approval by the institutional ethical review board. Consecutive Sampling of Patients with Chronic Otitis Media and Large Central Tympanic Membrane Perforations. At the conclusion of the trial period, 78 patients who had both substantial central tympanic membrane perforation and chronic otitis media were included. Post-enrolment, participants were randomly assigned to either underlay or interlay tympanoplasty using simple randomization to minimize allocation bias. Standardized endoscopic procedures using temporalis fascia grafts were performed under general anesthesia. Outcomes were assessed at 12 weeks, and 62 patients completed follow-up and were analyzed. Results: Analysis was done on 62 patients in total. The baseline features of the groups were similar (p>0.05). The mean air-bone gap was 25.08 ± 4.07 dB before surgery, compared to 26.27 ± 4.03 dB (p=0.254). At 12 weeks, postoperative air–bone gap improved to 15.95 ± 4.03 dB versus 11.79 ± 3.70 dB (p < 0.001), with greater mean hearing gain in the interlay group (14.48 ± 4.48 dB vs 9.14 ± 3.12 dB; p<0.001). Conclusions: Interlay tympanoplasty resulted in significantly greater hearing improvement than the underlay technique, with comparable anatomical success.

Sepsis persists as a major cause of in-hospital mortality, with the highest burden in low- and middle-income countries. Early lactate clearance is proposed as a dynamic, low-cost biomarker of tissue perfusion, yet locally generated evidence from Pakistan is scarce. Objectives: To evaluate the frequency of early lactate clearance and its association with 30-day all-cause mortality and multiorgan failure in adults admitted with sepsis. Methods: This prospective cohort study with a 30-day follow-up was conducted in the Department of General Medicine, Jinnah Postgraduate Medical Centre, Karachi (14 October 2025 and 14 January 2026) after ethical approval. A total of 195 adults aged 18–65 years with Sepsis-3-defined sepsis and admission venous lactate >4 mmol/L were enrolled by consecutive sampling. Early lactate clearance was defined as a ≥10% reduction in venous lactate at 6 hours. Outcomes were SOFA-defined multiorgan failure and 30-day mortality. Continuous variables were summarized as median (IQR) after Shapiro-Wilk testing; binary logistic regression & survival analysis were performed. Results: Early lactate clearance occurred in 106/195 (54.4%) patients. Thirty-day mortality was significantly lower with clearance than without (12.3% vs 24.7%; OR 0.43, 95% CI 0.20–0.91; p=0.024), persisting after adjustment (aOR 0.43, 95% CI 0.20–0.94; p=0.035). Multiorgan failure did not differ significantly (17.0% vs 22.5%; OR 0.71, 95% CI 0.35–1.44; p=0.335). Conclusions: Early lactate clearance was associated with significantly lower 30-day mortality in this underpowered exploratory analysis; however, these findings require confirmation in larger adequately powered studies.