Pakistan Journal of Medical Sciences最新文献

{"title":"Beyond Bilateralism: Regional and Global Health Governance Implications of China-Pakistan Health Cooperation under the CPEC.","authors":"Gao Jian, Xu Ziheng, Qu Qiumei","doi":"10.12669/pjms.42.8.20095","DOIUrl":"10.12669/pjms.42.8.20095","url":null,"abstract":"<p><p>Global health governance faces challenges due to differences in philosophy, the complexity and political nature of the governance domain, and the uncertainty of funding sources. As an emerging economy, China will participate in global health governance through \"South-South cooperation\" and the \"Belt and Road\" Initiative. The China-Pakistan Economic Corridor (CPEC) serves as the hub and flagship project of the \"Belt and Road\" Initiative, while the China-Pakistan Health Corridor represents a specialized collaboration and extension of CPEC in the healthcare sector. Focusing on pharmaceuticals, disease prevention and control, and medical technology, it aims to improve the livelihoods of the Pakistani people and jointly advance the deepening of the All-Weather Strategic Partnership. This study is part of the research project entitled \"General Project of Philosophy and Social Sciences in Heilongjiang Province \"A Study on the Pragmatic Motivation and Mechanism of 'Sub-Prototypical Category Fuzzy Expressions' in Modern Chinese\" (22YYB250)\"and \"2022 Heilongjiang Province Postdoctoral Funding Project: Research on the Value of Marxist View of Literature and Art in the New Era(LBH-Z22205)\".</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"2174-2177"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857167","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":"Minimally invasive approach to Dunbar Syndrome.","authors":"Sajida Qureshi, Mohammad Fahad Tariq Barlas, Fahad Memon, Sadia Jamal","doi":"10.12669/pjms.42.8.12313","DOIUrl":"10.12669/pjms.42.8.12313","url":null,"abstract":"<p><p>Median arcuate ligament syndrome (MALS) is a rare vascular condition, more commonly observed in females and typically considered a diagnosis of exclusion. Its clinical presentation often mimics chronic mesenteric ischemia, making diagnosis challenging. We report an interestingly rare case of a young male presenting with chronic postprandial abdominal pain, nausea, and significant weight loss. Following an extensive diagnostic workup and exclusion of other potential etiologies, a diagnosis of MALS was established. The patient underwent successful laparoscopic decompression of the celiac artery with division of the median arcuate ligament, resulting in complete symptom resolution.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"2185-2188"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857658","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 Bromhexine hydrochloride combined with bronchoalveolar lavage under fiberoptic bronchoscopy in the treatment of mild to moderate community-acquired pneumonia.","authors":"Feiyan Hu, Li Lin, Feijing Lv, Yanan Xu, Zhihui Dai","doi":"10.12669/pjms.42.8.19507","DOIUrl":"10.12669/pjms.42.8.19507","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy of bromhexine hydrochloride (BRH) combined with fiberoptic bronchoalveolar lavage (BAL) under fiberoptic bronchoscopy (FOB) in the treatment of patients with community-acquired pneumonia (CAP).</p><p><strong>Methodology: </strong>This retrospective cohort study included clinical data from 126 patients with mild-to-moderate CAP treated at Yongkang First People's Hospital from March 2023 to March 2025. Of them, patients treated with BRH alone (BRH group, n=63) were matched 1:1 to a cohort treated with BRH combined with fiberoptic bronchoscopic BAL under FOB (BRH & BAL group, n=63). The primary outcome was clinical efficacy. Secondary outcomes included clinical symptoms, levels of inflammatory factors, and incidence of adverse reactions.</p><p><strong>Results: </strong>After treatment, the efficacy of the BRH & BAL group (95.2%) was significantly higher than that of the BRH group (84.1%) (P<0.05). Post-treatment duration of fever, time to cough relief, time to resolution of pulmonary rales, and hospital length of stay in the BRH & BAL group were all shorter than those in the BRH group (P<0.05). After treatment, the levels of IL-6, CRP, and PCT in both groups were considerably lower than pre-treatment and significantly lower in the BRH & BAL group than in the BRH group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05).</p><p><strong>Conclusion: </strong>BRH combined with BAL under FOB for the treatment of mild-to-moderate CAP is associated with improved therapeutic efficacy, alleviation of clinical symptoms, reduction of the inflammatory response, and good safety.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"2019-2025"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857211","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 outcomes in patients with diabetic foot ulcers based on initial assessment at admission.","authors":"Sadaqat Ali, Tahir Ghaffar, Syed Hilal Badshah","doi":"10.12669/pjms.42.8.15773","DOIUrl":"10.12669/pjms.42.8.15773","url":null,"abstract":"<p><strong>Objective: </strong>To determine the outcomes of diabetic foot ulcers in hospitalized patients based on initial evaluation.</p><p><strong>Methodology: </strong>A cross-sectional study was conducted in the Endocrinology department, Hayatabad Medical Complex Peshawar, Pakistan, from June 26, 2025 to December 26, 2025. Consecutive sampling was used to cover 108 individuals who had been admitted with DFU. Clinical, laboratory, and demographic information was gathered, including the duration of diabetes, Wagner grade, peripheral pulses, HbA1c, total leukocyte count (TLC), X-ray foot findings and vascular assessment. Clinical outcomes were divided into four categories: below-knee amputation (BKA), forefoot/ mid foot amputation, toe amputation, and conservative care. Data were analyzed by using Chi-square tests and multinomial logistic regression (p ≤ 0.05).</p><p><strong>Results: </strong>Most patients were male (63%) and aged 41-70 years (85.2%). Diabetes duration >10 years was present in 63.9% and poor glycemic control (HbA1c >7.5%) was observed in 90.8% of patients. Wagner grade and X-ray evidence of osteomyelitis was significantly associated with poorer outcomes (p <0.001 and p=0.027 respectively). Multinomial regression identified Wagner grade had the strongest association with the amputation (BKA: OR 6.50; TOE: OR 3.12). X-ray findings were independently related to toe amputation (OR 0.33).</p><p><strong>Conclusion: </strong>Initial ulcer severity and bone involvement on X-ray strongly predict amputation in hospitalized patients. Timely identification and aggressive treatment of severe ulcers may reduce limb loss.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"2014-2018"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857308","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":"Ureaplasma parvum meningitis in neonates: A retrospective case study and literature review.","authors":"Fang Yan, Meifang Lin, Qinqin Fu, Yi Gao, Yeting Hu, Minfen Zhou","doi":"10.12669/pjms.42.8.16496","DOIUrl":"10.12669/pjms.42.8.16496","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical characteristics and advances in diagnosis and treatment of neonatal <i>Ureaplasma parvum</i> (<i>U. parvum</i>) meningitis.</p><p><strong>Methodology: </strong>Clinical manifestations, diagnosis, treatment, and follow-up data of a neonate with persistent fever, normal blood routine, but persistently abnormal cerebrospinal fluid (CSF) results due to <i>U. parvum</i> meningitis were retrospectively analyzed. A literature review was conducted to identify relevant studies reporting on neonatal <i>U. parvum</i> meningitis published until May 2025.</p><p><strong>Results: </strong>A male infant born at 35+2 weeks of gestation with eight hours of premature rupture of membranes (PROM) was admitted at 17 days of age with persistent fever. The routine blood test was normal, while the CSF suggested purulent meningitis. Empirical treatment was ineffective, and metagenomic next-generation sequencing (mNGS) of CSF confirmed <i>U. parvum</i> meningitis. The infant recovered after three weeks of azithromycin treatment, but a language delay was found at two-year follow-up. The literature review identified 16 previously reported cases of <i>U. parvum</i> meningitis, which were combined with the current case, totaling 17 cases. Main manifestations included fever and convulsions, or initial circulatory and respiratory symptoms. CSF in the included studies showed leukocytosis, decreased glucose, and elevated protein. Diagnosis was mainly based on mNGS, and the predominant treatment consisted of macrolides, sometimes combined with quinolones, for 3-10 weeks. Two patients relapsed after drug withdrawal, and one had elevated liver enzymes. Major neurological complications included lateral ventricular dilatation and hydrocephalus, cerebral hemorrhage, infarction, malacia, and herniation. Most cases had a favorable prognosis, with rare developmental delay.</p><p><strong>Conclusion: </strong>Clinical manifestations of neonatal <i>U. parvum</i> meningitis are nonspecific. Some patients present with normal blood routine but purulent CSF. <i>U. parvum</i> meningitis should be suspected in patients with poor response to empirical antibiotics and confirmed by CSF mNGS. Macrolides are biologically rational and commonly used for neonatal <i>U. parvum</i> meningitis; however, the optimal regimen and duration remain unclear due to limited and heterogeneous case-based evidence.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"2178-2184"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857729","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":"Visual Field Indices or Retinal Nerve Fiber Layer? Predictors of Relative Afferent Pupillary Defect Severity in Asymmetric Glaucoma.","authors":"Yousaf Jamal Mahsood, Alina Raza Khan, Anam Khan, Hafsah Aman, Saima Farooq, Rashid Zia","doi":"10.12669/pjms.42.8.14773","DOIUrl":"10.12669/pjms.42.8.14773","url":null,"abstract":"<p><strong>Objective: </strong>To determine the association of visual field indices like mean deviation (MD) and visual field index (VFI) and retinal nerve fiber layer (RNFL) thickness with relative afferent pupillary defect (RAPD) in asymmetric glaucoma and to quantify the amount of inter-eye differences in these parameters required to predict severity of RAPD grades.</p><p><strong>Methodology: </strong>This study was conducted at glaucoma clinic of ophthalmology department of Hayatabad Medical Complex, Peshawar, Pakistan from July 2024 to March 2025. Patients diagnosed with asymmetric glaucoma (all types) and clinically detectable RAPD were included in this study. RAPD was recorded using clinical plus grading. The RNFL thickness, mean deviation (MD), visual field index (VFI), and their inter-eye differences were calculated. Ordinal logistic regression assessed the relationship between RAPD grades and the inter-eye differences in these parameters. A p-value<0.05 was set for statistical significance.</p><p><strong>Results: </strong>In 126 participants recruited, the mean age was 52.48 ± 14.63 years and 97 (77%) were males. The inter-eye differences in OCT-RNFL (global or sectoral), MD and VFI were statistically significant (p<0.001). Inter-eye difference in MD was the only significant predictor of RAPD grade (OR=1.225, 95% CI=1.009-1.489, p=0.04), suggesting that greater differences in MD are associated with higher RAPD severity. The association between the glaucoma stage of the worse eye and RAPD grades were found statistically insignificant (p=0.345).</p><p><strong>Conclusions: </strong>Inter-eye differences in RNFL thickness, MD, and VFI were significantly associated with RAPD severity. Visual field asymmetry (MD difference) emerged as the strongest predictor of RAPD grade, while glaucoma stage showed no association with RAPD severity.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"2107-2115"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857706","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":"Pattern of blood utilization and blood wastage at blood bank of a tertiary care hospital in Lahore.","authors":"Asma Akhtar, Naureen Saeed, Ahsen Muzaffar, Zunairah Mughal","doi":"10.12669/pjms.42.8.13958","DOIUrl":"10.12669/pjms.42.8.13958","url":null,"abstract":"<p><strong>Objective: </strong>To analyze pattern of blood component utilisation and determine the extent and causes of blood wastage in the blood bank of a tertiary care hospital in Lahore.</p><p><strong>Methodology: </strong>A retrospective observational study was conducted at the Blood Bank of Shalamar Hospital, Lahore, from January 1, 2022 and December 31, 2023.Board. Data on the number and type of blood components prepared, issued, and discarded were retrieved from blood bank record. Causes of blood wastage, including expiry, transfusion reactions, delayed return after issuance, broken bags or seals, and haemolysed or clotted units, were reviewed. Data were analyzed using SPSS version 24, and results were expressed as frequencies and percentages.</p><p><strong>Results: </strong>A total of 9,406 blood donations were collected. Of these, 8129 units were issued to clinical departments, while 1,277 units were discarded, resulting in wastage rate of 13.5%. Whole blood (41.8%) and red cell concentrates (36.8%) were most frequently utilized. The Intensive Care Unit (21.4%), Gynecology and Obstetrics (19.9%), and Medical units (16.7%) were the leading end users. Expired units accounted for 96% of blood wastage, with fresh frozen plasma forming the largest proportion (45%).</p><p><strong>Conclusion: </strong>Whole blood and red cell concentrates were the most commonly used components. Blood wastage exceeded international benchmarks, with expiry as the predominant cause. Regular audits, rational ordering, and adherence to transfusion guidelines are essential to optimize utilization and minimize losses.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"1987-1992"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857668","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":"Comparison of the effectiveness of oral lactase enzyme and lactose-free formula in the management of secondary lactose intolerance in persistent and severe persistent diarrhea.","authors":"Fatima Ghayas Siddiqi, Heena Rais, Tayyaba Anwar, Aizaz Ali Khan","doi":"10.12669/pjms.42.8.12258","DOIUrl":"10.12669/pjms.42.8.12258","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness of oral lactase enzyme versus lactose-free formula in the management of secondary lactose intolerance in persistent and severe persistent diarrhea.</p><p><strong>Methods: </strong>This randomized controlled trial was conducted at the pediatric unit of Ziauddin University Hospital, Kemari, Karachi, Pakistan, from June, 2023 to July,2024. A total of 50 children were included in this study following the inclusion criteria of both genders aged 6-24 months and presented with persistent or severe persistent diarrhea due to secondary lactose intolerance. In Group-A, five drops of lactase enzyme (200 units lactase/drop)/ounce of milk were added 5-30 minutes before feeding, while in Group-B, lactose-free formula milk/diet was advised. They were monitored from day one through day five and assessed for outcome measures, comprising clinical (on day five) and laboratory assessments (stool pH and reducing substances on day six), success or failure, and duration of hospital stay (less or more than five days).</p><p><strong>Results: </strong>In a total of 50 children, the median age was 11 (9-15.3) months. There were 30 (60.0%) children who presented with vomiting, while 14 (28.0%) had severe dehydration. At day five, lactase enzyme children showed significantly less episodes of diarrhea versus lactose free formula (20.0% vs. 48.0%, p=0.037), while all other complaints were statistically similar (p>0.05). The duration of hospital stay was significantly less among children in lactase enzyme group versus lactose free formula group (p=0.001).</p><p><strong>Conclusion: </strong>The effectiveness of lactase enzyme supplementation was better than lactose-free formula in children with persistent diarrhea due to secondary lactose intolerance.Clinical Trial Registration: NCT06827405 (https://clinicaltrials.gov).</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"2123-2128"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857257","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":"The impact of nursing risk management on quality of life, complications, nursing care satisfaction in patients undergoing percutaneous coronary intervention.","authors":"Ying Zhang, Zhi Chen, Mengying Gao","doi":"10.12669/pjms.42.8.16632","DOIUrl":"10.12669/pjms.42.8.16632","url":null,"abstract":"<p><strong>Objective: </strong>To explore the impact of nursing risk management on quality of life (QoL), complications and nursing care satisfaction in patients undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methodology: </strong>A retrospective analysis was conducted of 156 patients with coronary heart disease (CHD) who underwent PCI at the Second Hospital of Hebei Medical University from September 2024 to October 2025. Among them, 78 patients receiving nursing risk management were matched 1:1 with the cohort receiving routine nursing care. QoL, length of hospital stay (LOS), incidence of complications, and nursing care satisfaction were compared between the two groups.</p><p><strong>Results: </strong>The QoL score of the observation group was significantly higher than that of the control group (P<0.05). The LOS in the observation group was shorter, and the incidence rates of MACE, abdominal distension, irritability, and insomnia were significantly lower in the observation group than in the control group (P<0.05). The nursing care satisfaction rate of the observation group (91.0%) was significantly higher than that of the control group (78.2%) (P<0.05).</p><p><strong>Conclusion: </strong>Implementing nursing risk management in CHD patients undergoing PCI is associated with improved postoperative QoL, shortened LOS, reduced incidence of postoperative complications, and enhanced nursing care satisfaction.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"2100-2106"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857701","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":"975 nm Diode Laser-Mediated Dentin Surface Modification Enhances Bio-ceramic Sealer Retention: Comparative Study with Er: YAG Photoacoustic Irrigation.","authors":"Amer M Alanazi, Azmat Ali Khan","doi":"10.12669/pjms.42.8.16385","DOIUrl":"10.12669/pjms.42.8.16385","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate different irrigation protocols, Photon-Induced Photoacoustic Streaming (PIPs) using Sodium hypochlorite (NaOCl) and NaOCl with EDTA and diode laser (DL) compared to syringe irrigated (SI)-NaOCl+EDTA (control) on smear layer (SL) and dislocation resistance of Bioceramic (BC) sealers to canal dentin.</p><p><strong>Methodology: </strong>This in vitro experimental study was approved by the institutional review board, King Saud University CDRC# FC-58-41-2026. The duration of the study was three months, January 1, 2026 - March 1, 2026. Seventy five central incisors were included. The prepared specimens were randomly divided into three experimental groups according to the disinfection protocol. <i>Group-1:</i> SI-NaOCl+EDTA (Control), <i>Group-2:</i> PIPS-NaOCl+EDTA, and <i>Group-3:</i> NaOCl+ EDTA+DL. On five specimens from each category, SL removal was assessed using a scanning electron microscope (SEM). Ten specimens from each category were obturated with premixed Endosequence BC sealer (EBCS), and another 10 were bonded with two-component BioRoot RCS (BRS). The Universal Testing Machine was used to assess dislocation resistance. The failure type was evaluated using a stereomicroscope. ANOVA with post hoc comparisons of SL elimination and dislocation resistance among the tested categories.</p><p><strong>Results: </strong>Group-3 NaOCl+EDTA+DL specimens displayed the highest SL removal and maximum scores of dislocation resistance. Group-1 SI-NaOCl+EDTA-treated canals showed the lowest SL removal and the lowest dislocation resistance.</p><p><strong>Conclusion: </strong>DL as an adjunctive therapy after conventional syringe irrigation utilizing NaOCl and EDTA displayed the most satisfactory performance in terms of removing SL and improving the dislocation resistance of different bioceramic sealers.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 8","pages":"2038-2044"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857638","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}