Pakistan Journal of Medical Sciences最新文献

{"title":"Diagnostic accuracy of non-invasive tools to detect esophageal varices keeping esophagogastroduodenoscopy as gold standard in patients with compensated chronic liver disease.","authors":"Nayab Munib, Iqbal Haider, Mahnoor Khattak","doi":"10.12669/pjms.42.9.16288","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16288","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the diagnostic accuracy of Aspartate Aminotransferase to Platelet Ratio Index (APRI) and Platelet Count to Spleen Diameter Ratio (PC/SD) having upper esophagogastroduodenoscopy findings as the reference standard for predicting esophageal varices in patients with compensated chronic liver disease.</p><p><strong>Methodology: </strong>This prospective cross-sectional validation study was carried out at the Department of Medicine, Khyber Teaching Hospital (KTH) Peshawar from August 2025 to January 2026. A total of 161 consecutive patients aged 20 to 70 years with compensated chronic liver disease (CLD) who fulfilled the eligibility criteria were enrolled using non probability consecutive sampling technique. Patients with peptic ulcer disease, contraindications to upper gastrointestinal endoscopy, hepatocellular carcinoma or altered upper gastrointestinal anatomy were excluded. APRI and PC/SD ratio were calculated for all participants and upper gastrointestinal endoscopy was performed as the reference standard. Diagnostic performance was evaluated by calculating sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy.</p><p><strong>Results: </strong>A total of 161 patients with CLD were included, of whom 101 (62.7%) had esophageal varices (EVs) on upper gastrointestinal endoscopy. The APRI score demonstrated 100% sensitivity, 65.0% specificity and an overall diagnostic accuracy of 87.0%, whereas the PC/SD ratio showed 51.5% sensitivity, 100% specificity, and 69.6% accuracy. Both markers demonstrated excellent discriminatory performance, with AUCs of 0.943 for APRI and 0.939 for the PC/SD ratio (p = 0.315). APRI was significantly more sensitive, while the PC/SD ratio was significantly more specific for detecting EVs (both p < 0.001). Increasing APRI values and decreasing PC/SD ratio values were significantly associated with higher grades of EVs (p < 0.001).</p><p><strong>Conclusion: </strong>Both the APRI and PC/SD ratio demonstrated acceptable diagnostic performance for identifying EVs in patients with CLD. These inexpensive and readily available biomarkers may assist in risk stratification and prioritizing patients for endoscopic evaluation particularly in resource limited settings. However, upper gastrointestinal endoscopy remains the reference standard for the diagnosis of EVs.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2519-2525"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Cognitive Behavior Therapy, Pelvic Floor Therapy, Integrated Therapy, and Pharmacotherapy in the Treatment of Chronic Pelvic Pain in Women: A Randomized Controlled Trial.","authors":"Bushra Akram, Ahmad Bilal","doi":"10.12669/pjms.42.9.16890","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16890","url":null,"abstract":"<p><strong>Objective: </strong>The objective of the current study was to determine the efficacy of Cognitive Behavior Therapy (CBT-cp), Pelvic Floor Therapy (PFT), Integrated Therapy (Combination of CBT-cp and PFT), and Pharmacotherapy in the Treatment of Chronic Pelvic Pain in women, compared with the placebo group.</p><p><strong>Methodology: </strong>A five-arm (four intervention arms and one placebo arm), Randomized Controlled Trial (RCT) was conducted, to examine the effectiveness of CBT-cp, PFT, and Pharmacotherapy in the treatment of Chronic Pelvic Pain in women, compared with the placebo group. The sample comprised 175 female patients with CPP; 141 patients completed the study. They were presented to the Outpatient Department of the Department of Obstetrics & Gynecology, and the Department of Physiotherapy at Nishtar Hospital, Multan, Pakistan, from April to June, 2025. The Impact of Female Chronic Pelvic Pain Questionnaire (IF-CPPQ), Urdu version was used as primary outcome measure. The intervention lasted three months.</p><p><strong>Results: </strong>Results showed that the mean CPP scores significantly decreased at the Posttest (<i>p</i> < 0.001) on IF-CPPQ, although they did not maintain at follow-up. It demonstrated that posttest and follow-up scores were significantly different from pretest scores in all the intervention groups. The Integrated therapy group differed considerably from the CBT-cp, PFT, Pharmacotherapy, and Placebo groups in CPP reduction.</p><p><strong>Conclusion: </strong>The Integrated therapy is the most effective and statistically significant in reducing CPP compared with CBT-cp, PFT, Pharmacotherapy, and Placebo. <b><i>Registration No.:</i></b> ClinicalTrials.gov (Identifier: NCT07042555).</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2487-2496"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of mitral valve parameters with gender and age in the Pakistani population: A 2-dimensional echocardiographic study.","authors":"Mahail Khan, Aisha Qamar, Sabha Bhatti, Aneel Ahmed","doi":"10.12669/pjms.42.9.13469","DOIUrl":"https://doi.org/10.12669/pjms.42.9.13469","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess variations in mitral valve echocardiographic parameters in relation to gender and age using transthoracic 2-dimensional echocardiography in a subset of the Pakistani population.</p><p><strong>Methodology: </strong>This cross-sectional study was conducted over six months (March-August 2024) at the National Institute of Cardiovascular Diseases (NICVD), Karachi, enrolling 385 individuals who fulfilled the inclusion criteria. Mitral valve echocardiographic parameters were measured using transthoracic 2D echocardiography and recorded on subject evaluation forms. Variations across gender and four age groups (18-30, 31-45, 46-65, and >65 years) were analyzed using the Kolmogorov-Smirnov test, Shapiro-Wilk test, Mann-Whitney U test, and Kruskal-Wallis test.</p><p><strong>Results: </strong>Among 385 participants, 182 males and 203 females were examined. Posterior leaflet length was significantly greater in males than in females (p = 0.012), while all other parameters - annular diameter, annular area, anterior leaflet length and thickness, and posterior leaflet thickness - showed no statistically significant difference between genders. No parameter showed a statistically significant difference across age groups; posterior leaflet thickness did not reach statistical significance across age groups (p = 0.069).</p><p><strong>Conclusion: </strong>In the Pakistani population, posterior leaflet length is significantly greater in males than in females. No statistically significant age-related differences were observed across any mitral valve parameter. These findings indicate a need for gender-specific reference values in echocardiographic assessment of the mitral valve in this population.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2305-2311"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Serum ALB, IL-18, and NGAL Levels and Individualized Nutritional Nursing in Patients with Hematopoietic Stem Cell Transplantation and Myelosuppression.","authors":"Yu Wu, Lei Geng","doi":"10.12669/pjms.42.9.16306","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16306","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical associations of serum albumin (ALB), interleukin-18 (IL-18), and neutrophil gelatinase-associated lipocalin (NGAL) and individualized nutritional nursing on the recovery of patients in the myelosuppression stage of the conditioning regimen of hematopoietic stem cell transplantation (HSCT).</p><p><strong>Methodology: </strong>Retrospectively selecting clinical data of 118 patients undergoing hematopoietic stem cell transplantation First Affiliated Hospital of Soochow University, Department of Hematology, from January 2024 to September 2025, 56 patients receiving routine care from January 2024 to November 2024 were selected as the control group, and 62 patients receiving personalized nutritional nursing from December 2024 to September 2025 were selected as the study group. Dynamics of serum ALB, IL-18, and NGAL were tested. Statistics on hematopoietic function reconstruction, serological indicators, complications, and hospitalization-related indicators during the bone marrow suppression period in two groups.</p><p><strong>Results: </strong>The study group had lower neutrophil implantation time, platelet implantation time, red blood cell transfusion volume, and platelet transfusion volume compared to the control group (P<0.05). Serum levels of ALB in the study group were enhanced, while serum levels of IL-18 and NGAL were reduced compared with those in the control group (P<0.05). The incidence of complications in the study group (9.68%) was lower than that in the control group (21.43%), but there was no significant difference between the groups (P>0.05). The duration of bone marrow suppression and total hospitalization time in the study group were shorter than those in the control group, but there was no significant difference between the groups (P>0.05).</p><p><strong>Conclusion: </strong>Individualized nutritional nursing can accelerate the reconstruction of bone marrow hematopoietic function and may reduce the incidence of complications, and shorten the length of hospital stay, potentially through modulation of serum ALB, IL-18, and NGAL levels during the conditioning regimen of HSCT.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2289-2296"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Value of ANA Titer, Anti-ds-DNA, Anti-nRNPSm, and Sm Antibodies in Early Atypical Systemic Lupus Erythematosus.","authors":"Jianqiao Zhang, Meichen Liu, Qing Liu, Dong Chen, Meng Zhang","doi":"10.12669/pjms.42.9.14966","DOIUrl":"https://doi.org/10.12669/pjms.42.9.14966","url":null,"abstract":"<p><strong>Objective: </strong>To explore the diagnostic value of antinuclear antibody(ANA) titer, anti-double-stranded DNA(anti-ds-DNA) antibody, anti-nuclear ribonucleoprotein/Smith(anti-nRNPSm) antibody, and Smith (Sm) antibody for early atypical systemic lupus erythematosus(SLE).</p><p><strong>Methodology: </strong>This was a retrospective study. Forty-nine patients diagnosed with early atypical SLE admitted to Affiliated Hospital of Hebei University between January 2023 to June 2025 were assigned to Group-A, and 66 patients with other autoimmune diseases admitted during the same period were enrolled in Group-B. Compared the results of ANA, anti-ds-DNA, anti-nRNPSm and Sm antibody tests between the two groups, and analyzed the diagnostic value of the individual indicators and their combined detection for early atypical SLE.</p><p><strong>Results: </strong>There were statistically significant differences in the results of ANA, anti-ds-DNA, anti-nRNPSm and Sm antibodies between the two groups(P<0.05). Multivariate Logistic regression analysis confirmed that ANA, anti-ds-DNA, anti-nRNPSm and Sm were independent influencing factors for early atypical SLE (<i>P</i><0.05). ROC curve analysis showed that the AUC of combined diagnosis was 0.856, with a predictive sensitivity of 87.8%, a specificity of 71.2%, and a predictive probability of 0.79. Significant differences in AUC were observed between ANA and anti-ds-DNA antibody, Sm antibody, or the four-antibody combination(<i>P</i><0.05); between anti-ds-DNA antibody and the four-antibody combination(<i>P</i><0.05); and between anti-nRNPSm antibody, Sm antibody and the four-antibody combination(<i>P</i><0.05).</p><p><strong>Conclusion: </strong>ANA, anti-ds-DNA, anti-nRNPSm and Sm antibodies are major independent influencing factors for early atypical SLE. Combined detection of these indicators may effectively improve the diagnostic value for this disease.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2318-2323"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progression of myopia among undergraduate students of Fatima Jinnah Medical University, Lahore.","authors":"Huma Kayani Saigol, Maham Javed, Hamza Riaz, Abdul Rahman Alvi","doi":"10.12669/pjms.42.9.16073","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16073","url":null,"abstract":"<p><strong>Background and objective: </strong>The global rise in myopia has become a significant public health concern, with a projected prevalence affecting nearly half of the world's population by 2050. Despite increasing prevalence in low- and middle-income countries (LMICs), longitudinal data on myopia progression, especially in high-risk academic cohorts, remain limited. This study investigates the five-year progression of myopia and its behavioral correlates among undergraduate female medical students in Pakistan.</p><p><strong>Methodology: </strong>A longitudinal prospective study was conducted at Fatima Jinnah Medical University, Lahore, including 304 students enrolled in the 2020 MBBS batch. Annual measurements of spherical equivalent refraction (SER), self-reported screen time, and study time were collected over five academic years, from January 2020 to December 2025. Descriptive statistics summarized SER progression and behavioral exposure. Linear mixed-effects models (LMM) assessed SER changes across time. Multivariable linear regression evaluated predictors of SER progression (ΔSER). Spearman's correlation and subgroup analyses examined associations with behavioral and demographic variables.</p><p><strong>Results: </strong>Of the 304 students, 48 had complete longitudinal SER data. The mean SER progressed from -1.66 D (SD ±2.41) at baseline to -2.73 D (SD ±1.78) after five years, with a mean ΔSER of -1.07 D (SD ±2.85). Baseline SER was a significant predictor of progression (β = -0.96; 95% CI: -1.20 to -0.73; p < 0.001). No significant associations were found between ΔSER and screen or study time. Subgroup analysis showed no difference in progression by family history of myopia.</p><p><strong>Conclusion: </strong>This study adds to the existing Pakistani literature on myopia among medical students by providing longitudinal data on refractive change over a period of five-year. Findings highlight baseline refractive error as the strongest determinant of progression, emphasizing the need for early detection and targeted surveillance in LMIC academic populations.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2364-2369"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histiocytic necrotizing lymphadenitis with central nervous system involvement in children: An analysis of clinical features.","authors":"Xiaoyuan Wu, Fang Guo, Yanhong Jia, Wenjun Luan, Chunxia Yang","doi":"10.12669/pjms.42.9.16518","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16518","url":null,"abstract":"<p><strong>Objectives: </strong>To summarize the clinical features of histiocytic necrotizing lymphadenitis (HNL) with central nervous system (CNS) involvement in children.</p><p><strong>Methodology: </strong>A retrospective analysis was conducted on the clinical data of HNL-CNS children diagnosed and treated in Hebei Children's Hospital from January 2015 to January 2025.</p><p><strong>Results: </strong>A total of 22 HNL-CNS children were enrolled (17 boys, five girls; age 9.2 ± 3.5 years). Fever and lymphadenopathy occurred in all cases. Neurological manifestations included headache/vomiting (77.3%), convulsions (27.3%), and consciousness disorders (18.2%). Eight children presented with neurological symptoms before lymphadenopathy. Peripheral blood leukopenia was found in 68.2%. Cerebrospinal fluid (CSF) showed elevated pressure (81.8%), elevated white blood cell count (86.4%, mainly monocytes), and elevated protein (50.0%). Cranial MRI abnormalities were observed in 68.2%, predominantly in frontal/occipital lobes, with leptomeningeal enhancement in 13.6%. Anti-Mycoplasma pneumoniae antibody titers ≥1:160 were found in 50.0%. Antiviral therapy with acyclovir was given to 19 (86.4%) children, antibiotics were used in 17 (77.3%) children, intravenous corticosteroid (CS) therapy was provided to 19 (86.4%) children, and Cs combined with intravenous immunoglobulin (IVIG) was adopted in 8 (36.4%). Two out of three children who did not use Cs experienced recurrences.</p><p><strong>Conclusion: </strong>HNL-CNS occurs predominantly in school-age boys. Neurological symptoms may precede lymphadenopathy. CSF findings are characterized by elevated pressure and mononuclear pleocytosis. MRI lesions commonly involve frontal and occipital lobes. Corticosteroid therapy yields favorable clinical outcomes and a low recurrence risk.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2375-2380"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in implementing integrated undergraduate medical curricula across low- and middle-income countries: A scoping review.","authors":"Nadeem Razaq, Mohamad Nurman Yaman, Mohd Nasri Awang Besar, Suhaila Sanip","doi":"10.12669/pjms.42.9.16442","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16442","url":null,"abstract":"<p><strong>Objectives: </strong>Integrated curricula have become a core element of undergraduate medical education (UGME) reforms worldwide, including low- and middle-income countries (LMICs). LMICs, which are often characterized as resource-constrained settings, encounter challenges in integrated curricula implementation. However, these challenges are reported fragmentarily. This review mapped the literature on the implementation of integrated curricula in LMICs, with attention to reported challenges, contextual variation and gaps in the evidence base.</p><p><strong>Methodology: </strong>Electronic searches were conducted between August 2025 and January 2026 at the Department of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia following the frameworks of Arksey and O'Malley and Levac et al. The literature published between January 2010 and December 2025 within LMIC medical schools was searched through PubMed, Scopus, Web of Science, EBSCO MEDLINE Complete and ERIC databases. Original peer-reviewed studies in English reporting the functional enactment of integrated undergraduate medical curricula were eligible for inclusion.</p><p><strong>Results: </strong>From 925 records identified, thirteen studies met the inclusion criteria. Six broad themes (with sub-themes) were identified: resources and infrastructure constraints (faculty shortages, lack of skills labs), governance and organizational barriers (policy-practice gaps, limited departmental autonomy), faculty development needs (role-transition resistance), assessment misalignment (exit exams undermining delivery), curriculum integration issues (content overload) and training settings constraints (rural supervision shortages). The findings indicated that while structural reforms are widespread, a deficiency in reporting on implementation outcomes remains a critical evidence gap.</p><p><strong>Conclusion: </strong>The findings suggest that the implementation of integrated UGME curricula in LMICs depends not only on curriculum design but also on the strength of institutional system and contextual readiness to support reforms into practice.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2449-2458"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical-radiological comparative evaluation of the BISAP and Computed tomography severity index scores as predictors of severity in acute pancreatitis.","authors":"Nasreen Aman, Nosheen Noor, Muhammad Hamza, Hamna Khalid","doi":"10.12669/pjms.42.9.15523","DOIUrl":"https://doi.org/10.12669/pjms.42.9.15523","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the clinical and radiological performance of the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the Computed Tomography Severity Index (CTSI) in predicting disease severity and mortality in patients with acute pancreatitis, providing locally relevant evidence from a tertiary care setting in Pakistan.</p><p><strong>Methodology: </strong>This retrospective cross-sectional study was conducted at the Department of Radiology, Lady Reading Hospital-MTI, Peshawar, from January to December 2024. Data from 99 adult patients diagnosed with acute pancreatitis according to the Revised Atlanta Criteria (2012) were analyzed. BISAP scores were calculated using clinical and laboratory parameters recorded within 24 hours of admission, while CTSI was derived from contrast-enhanced CT findings. Disease severity was dichotomized into severe and non-severe categories for receiver operating characteristic (ROC) curve analysis. Diagnostic accuracy, optimal cut-off values, and predictive performance of BISAP and CTSI for severity and in-hospital mortality were assessed.</p><p><strong>Results: </strong>Out of 99 patients, severe acute pancreatitis was identified in 35.4% by CTSI and 20.2% by BISAP scores. ROC analysis demonstrated superior predictive performance of BISAP scores for severe acute pancreatitis with an area under the curve (AUC) of 0.667 (95% CI: 0.559-0.775; p = 0.006), compared to CTSI scores with an AUC of 0.571 (95% CI: 0.456-0.686; p = 0.239). For mortality prediction, BISAP scores showed better discrimination (AUC 0.846; 95% CI: 0.677-1.000; p = 0.021) with 100% sensitivity at the optimal cut-off, whereas CTSI scores demonstrated poor predictive ability (AUC 0.528; p = 0.852).</p><p><strong>Conclusion: </strong>BISAP demonstrated better predictive performance than CTSI in this cohort and may be a useful bedside tool for early risk stratification. CTSI remains valuable for assessing local pancreatic complications but has limited prognostic utility when used alone.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2416-2421"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical efficacy of bladder hydrodistension combined with oral mirabegron and intravesical instillation in the treatment of interstitial cystitis.","authors":"Lei Du, Ziyue Ma, Wenyong Xue, Wei Li","doi":"10.12669/pjms.42.9.16265","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16265","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the therapeutic efficacy of bladder hydrodistension combined with oral mirabegron and intravesical instillation in patients with interstitial cystitis(IC).</p><p><strong>Methodology: </strong>This was a retrospective study. Ninety patients diagnosed with IC at The Second Hospital of Hebei Medical University between October 2023 to October 2025 were retrospectively enrolled and randomized into two groups(<i>n=</i>45 each). All participants underwent cystoscopic examination followed by bladder hydrodistension. Patients in the control group received oral mirabegron sustained-release tablets in conjunction with hydrodistension. In addition to the same regimen, patients in the study group were administered sodium hyaluronate via intravesical instillation. The treatment duration for both groups was six months. Clinical symptom improvement and clinical efficacy were assessed at the end of treatment.</p><p><strong>Results: </strong>After six months of treatment, scores on the Pelvic Pain and Urgency/Frequency Patient Symptom Scale, Interstitial Cystitis Symptom Index, and Interstitial Cystitis Problem Index were significantly lower in the study group than in the control group(<i>p=</i> 0.00, respectively). The overall response rate was higher in the study group compared with the control group(<i>p=</i> 0.03). Patients receiving the triple therapy exhibited a greater reduction in both daytime voiding frequency and nocturia episodes(<i>p=</i> 0.00, respectively), together with a significantly increased maximum bladder capacity(<i>p=</i> 0.00).</p><p><strong>Conclusion: </strong>The combination of bladder hydrodistension, oral mirabegron, and intravesical instillation demonstrates superior clinical benefit in patients with IC. This regimen can enhance symptom relief, decrease urinary frequency, expand bladder capacity, and reduce urinary levels of EGF, NGF, and IGF-1 without a significant increase in adverse events.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2358-2363"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}