Pakistan Journal of Medical Sciences最新文献

{"title":"Impact of a Mobile Health Application on Medication Adherence, Thyroid Function, and Quality of Life in Patients with Hypothyroidism: A Prospective Comparative Study.","authors":"Saima Askari, Eraj Abbas, Azra Shaheen, Mahwish Bano","doi":"10.12669/pjms.42.9.14616","DOIUrl":"https://doi.org/10.12669/pjms.42.9.14616","url":null,"abstract":"<p><strong>Background & objective: </strong>Effective hypothyroidism management requires consistent daily levothyroxine therapy; poor adherence causes fluctuating Thyroid Stimulating Hormone (TSH), persistent symptoms, and long-term complications. To evaluate the impact of a mobile application on symptom improvement and clinical outcomes through improved treatment adherence among patients with hypothyroidism.</p><p><strong>Methodology: </strong>The study was conducted at the Outpatient Department of Diabetes & Endocrine center, Karachi over a duration of 10 months from 1^st January 2025 to 31^st October 2025. A total of 60 participants were included and divided into two groups: Group-1 (Control), did not use the mobile application, and Group-2 (Test), which used the mobile application. Patients aged 18 to 60 years with a confirmed diagnosis of hypothyroidism requiring ongoing levothyroxine therapy were included. Patients with hyperthyroidism, thyroid cancer, thyroid nodules or severe comorbidities were excluded. Symptoms (weight gain, cold intolerance, increased sleepiness, menstrual irregularity), TSH levels and Quality of Life Scale (WHOQOL), were assessed at baseline, after two and six months in both groups.</p><p><strong>Results: </strong>Mobile app users showed lower mean TSH levels (4.0 ± 2.10 mIU/L) than non-users (6.78 ± 2.78 mIU/L; p < 0.001) and higher quality-of-life scores (82.43 ± 18.25 vs. 72.10 ± 21.64; p<0.01) at six months. The symptoms improvements were more pronounced in application users as compared to non- users especially in menstrual irregularity (40.0% vs. 70.0%; p < 0.001), fatigue (50.0% vs. 66.6%; p = 0.01) and weight gain (16.6% vs. 60%, p<0.01).</p><p><strong>Conclusion: </strong>The study revealed that integrating mobile health applications into routine hypothyroidism care can substantially enhance treatment outcomes and provide a simple and effective strategy for medication adherence.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2403-2409"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113421","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":"Hepatitis-B virus reactivation during Immunosuppressive therapy: Clinical observations from a tertiary care center.","authors":"Bekir Tunca, Nevin İnce, Şengül Cangür","doi":"10.12669/pjms.42.9.15213","DOIUrl":"https://doi.org/10.12669/pjms.42.9.15213","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluated the incidence of hepatitis-B virus reactivation (HBVr) in patients receiving immunosuppressive therapy and examined the association between anti-HBs titers and reactivation risk in routine clinical practice.</p><p><strong>Methodology: </strong>This retrospective study was conducted at Duzce University Faculty of Medicine Hospital between 2017 and 2020. Adult patients (≥18 years) receiving immunosuppressive therapy and monitored for HBVr were included. A total of 166 patients who were either HBsAg (+) or HBsAg (-) with anti-HBc positivity were analyzed. Demographic and clinical characteristics, type of immunosuppressive therapy, antiviral prophylaxis use, HBV serological markers, HBV DNA levels, and HBVr episodes were obtained from medical records. Patients were categorized into three groups based on their serological status and prophylaxis use: HBsAg (-) / anti-HBc (+) patients not receiving antiviral prophylaxis constituted Group-1 (n=104), HBsAg (-) / anti-HBc (+) patients receiving antiviral prophylaxis constituted Group-2 (n=46), and HBsAg (+) patients receiving antiviral prophylaxis constituted Group-3 (n=16). Statistical analyses were performed using SPSS version 22.0, with p < 0.05 considered statistically significant.</p><p><strong>Results: </strong>The mean age of the cohort was 54 ± 12.7 years, and 42.1% were male. Most patients were HBsAg (-) / anti-HBc (+) (90.4%), while 9.6% were HBsAg (+). Antiviral prophylaxis was administered to 37.3% of patients. HBVr occurred in 17.3% of HBsAg (-) / anti-HBc (+) patients without prophylaxis and was significantly more frequent in those with anti-HBs titers <100 mIU/mL than in those with titers ≥100 mIU/mL (p = 0.049). Among HBsAg (-) / anti-HBc (+) patients receiving prophylaxis, HBVr was observed in 8.7%. Only one HBVr episode occurred among HBsAg (+) patients receiving prophylaxis.</p><p><strong>Conclusion: </strong>HBVr risk during immunosuppressive therapy is shaped by HBsAg status, antiviral prophylaxis, and anti-HBs titers. Prophylaxis markedly reduces risk, while anti-HBs titers ≥100 mIU/mL provide additional protection and may guide individualized prophylaxis strategies.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2297-2304"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113465","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":"Multidisciplinary management of Whipple's disease complicated with rectal stenosis from multidisciplinary nursing management: A case study.","authors":"Fang Ding, Lili Dong, Yahong He, Wenli Wu, Rong Xu","doi":"10.12669/pjms.42.9.16422","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16422","url":null,"abstract":"<p><p>Whipple's disease (WD) is a rare, chronic systemic disorder caused by Tropheryma whipplei (<i>T. whipplei</i>), a bacterium belonging to the Actinobacteria phylum. Clinical manifestations of WD include weight loss, diarrhea, and arthralgia. To date, no cases of rectal stenosis caused by <i>T. whipplei</i> infection have been reported in the literature. This paper presents a case of rectal stenosis associated with <i>T. whipplei</i> infection, evaluates the effectiveness of comprehensive, multidisciplinary management, and provides guidelines for optimizing disease management. A 40-year-old male patient presented with a one-year history of constipation and weight loss. He reported the passage of narrow-calibre stools, approximately the width of a little finger, and a 10-kilogram weight loss over the past year. A diagnosis of WD was indicated by bronchoalveolar lavage (BAL) fluid analysis, but no microbiological evidence of rectal <i>T. whipplei</i> infection was found at that time. The patient received 14 days of intravenous antibiotic therapy, followed by a one-year course of oral cotrimoxazole, combined with a comprehensive management plan that included structured medication adherence education, targeted intestinal nursing care, nutritional support, psychological intervention, and multidisciplinary follow-up. After five months of treatment, the patient showed significant improvement, including four-kilogram weight gain, a return to normal bowel movements, and resolution of pulmonary inflammation. This case highlights the importance of early recognition of atypical WD manifestations and demonstrates that a multidisciplinary model integrating standardized antimicrobial therapy with structured nursing management may significantly improve patient outcomes in rare systemic infections.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2478-2484"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113419","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":"Consumption of isoflurane and recovery time in low-flow anaesthesia versus high-flow anaesthesia.","authors":"Aaisha Hanif, Syed Asadullah Jafri, Amjad Nadeem, Maryyam Hanif","doi":"10.12669/pjms.42.9.15941","DOIUrl":"https://doi.org/10.12669/pjms.42.9.15941","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effects of low-flow versus high-flow Isoflurane anesthesia on volatile anesthetic consumption, recovery characteristics, postoperative inflammatory response, and patient clinical outcomes in elective laparoscopic cholecystectomy.</p><p><strong>Methodology: </strong>This quasi-experimental study was conducted at Department of Anesthesia, Combined Military Hospital, Malir Cantt, Karachi, Pakistan from October 2022-March 2023. A total of 280 consecutive eligible patients fulfilling the inclusion criteria were recruited using non-probability convenience sampling and assigned into Group-A (Low-flow anesthesia) (n=140) and Group-B (High-flow anesthesia) (n=140). Primary variables were the mean intraoperative isoflurane consumption, and the neutrophil-to-lymphocyte ratio (NLR) at 24 hours postoperatively. Secondary variables were patient outcomes and anesthesia adverse effect profile.</p><p><strong>Results: </strong>Mean isoflurane consumption was significantly lower in Group-A at 12.04 ± 3.00 mL, compared with 16.18 ± 3.79 mL in Group-B (p<0.001). Median baseline NLR values were nearly the same: 2.27 (0.87) in Group-A and 2.30 (0.89) in Group-B (p=0.972). However, postoperative NLR at 24 hours showed a clear rise in Group-B, recorded as 4.46 (2.01), compared with 3.45 (1.54) in Group-A (p<0.001). Low-flow anesthesia was associated with shorter time to extubation while time to Aldrete score ≥ 9, postoperative pain score, rescue analgesia requirements, postoperative nausea and vomiting, shivering, hypothermia, delayed emergence, dizziness and HDU admissions were comparable between groups.</p><p><strong>Conclusion: </strong>The study supports low flow anaesthesia as an effective technique that reduces anesthetic use, shortens the extubation time and attenuated the postoperative inflammatory response without increasing perioperative adverse events related to anesthesia or delaying recovery.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2551-2557"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113595","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":"Radiologically measured optic nerve sheath diameter as a predictor of mortality and functional outcomes in stroke patients: A systematic review and meta-analysis.","authors":"Wenyan Chen, Jiayuan Zhu","doi":"10.12669/pjms.42.9.16989","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16989","url":null,"abstract":"<p><strong>Objective: </strong>Optic nerve sheath diameter (ONSD) has emerged as a non-invasive marker of intracranial pressure and may provide prognostic information in patients with acute stroke. However, studies evaluating its association with mortality and functional outcomes have reported inconsistent findings. This systematic review and meta-analysis aimed to evaluate the prognostic value of radiologically measured ONSD in stroke patients.</p><p><strong>Methodology: </strong>A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted from database inception to March 10, 2026. Observational studies evaluating ONSD measured by computed tomography or ocular ultrasonography in adult stroke patients were included. Random-effects meta-analysis was performed to pool mean differences (MD) in ONSD between outcome groups and odds ratios (OR) for mortality associated with elevated ONSD.</p><p><strong>Results: </strong>Sixteen studies were included in the review. Seven studies reported ONSD values for mortality analysis, demonstrating significantly larger ONSD in patients who died compared with survivors (MD 0.50 mm, 95% CI 0.15-0.85; I²=86%). Five studies evaluating functional outcomes showed significantly greater ONSD in patients with poor outcomes (MD 0.60 mm, 95% CI 0.26-0.93; I²≈89%). Three studies reporting risk estimates indicated that elevated ONSD was associated with a higher risk of mortality (OR 5.87, 95% CI 3.11-11.09; I²=64%). Sensitivity analyses and subgroup analyses confirmed the robustness of these findings.</p><p><strong>Conclusions: </strong>Enlarged ONSD may be associated with increased mortality and poorer functional outcomes in stroke patients. ONSD measurement may serve as a simple, non-invasive adjunct for early prognostic assessment, although further standardised prospective studies are needed. <b><i>Registration No:</i></b> PROSPERO (CRD420261344376).</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2459-2468"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113602","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":"Spectrum and clinical profile of disorders of sex development: A 10 year experience at a tertiary care center.","authors":"Nida Aslam, Sommayya Aftab, Bushra Naseer Khan, Noor-E-Hira","doi":"10.12669/pjms.42.9.15195","DOIUrl":"https://doi.org/10.12669/pjms.42.9.15195","url":null,"abstract":"<p><strong>Background & objective: </strong>Disorders of Sex Development is a group of congenital conditions characterized by atypical development of chromosomal, gonadal, or anatomical sex. These conditions present diverse clinical challenges and require individualized, multidisciplinary management throughout life. This study aimed to determine the clinical spectrum of children and adolescents with Disorders of Sex Development (DSD) at a tertiary care center over the last decade.</p><p><strong>Methodology: </strong>In this retrospective observational study, 815 children and adolescents (0-18 years) diagnosed with Disorders of Sex Development (DSD) were evaluated at the Department of Pediatrics Endocrinology and Diabetes, University of Child Health Sciences, The Children's Hospital, Lahore from January 2015 to December 2024. Data regarding demographic characteristics, clinical presentation, karyotype, and final diagnosis were collected and analyzed. Statistical analysis was performed to assess the association between karyotype and subtype distribution, with significance set at p < 0.05.</p><p><strong>Results: </strong>The mean age of presentation was 7.5 ± 5 years, with 62% raised as male and 38% as female. The most common presentation was microphallus (41%), followed by ambiguous genitalia (21.6%) and delayed puberty/primary amenorrhea (20%). Based on karyotype, 46,XY DSD was most common (60.7%), predominantly due to androgen insensitivity and 5α-reductase deficiency (82.4%). 46,XX DSD accounted for 33.4%, mainly congenital adrenal hyperplasia (91.6%), while sex chromosome DSD comprised 6.6%, with Turner Syndrome variants being the most frequent subtype. A statistically significant association was observed between karyotype and subtype distribution (χ² = 167.42, p < 0.0001).</p><p><strong>Conclusion: </strong>DSD presents a broad range of clinical challenges underscoring the need for early accurate diagnosis and appropriate gender assignment. A multidisciplinary approach, improved diagnostic tools, and better education are essential for achieving optimal patient outcomes and reducing the long-term psychological impact of DSD.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2497-2502"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113556","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":"Childhood sigmoid volvulus.","authors":"Mesud Fakirullahoglu, Metin Yildiz, Rifat Peksoz, Esra Disci, Sabri Selcuk Atamanalp","doi":"10.12669/pjms.42.9.19557","DOIUrl":"https://doi.org/10.12669/pjms.42.9.19557","url":null,"abstract":"<p><strong>Objectives: </strong>Childhood sigmoid volvulus (SV) is a comparatively rare illness. The objective of this study was to examine the recent advances in childhood SV.</p><p><strong>Methodology: </strong>In clinical review conducted at Ataturk University, Turkey, we used combined retrospective (from June 1966 to July 1986) and prospective (from July 1986 to July 2026) evaluation.</p><p><strong>Results: </strong>Fourteen children constituted 1.3% of total 1,101 SV cases. Mean age was 10.3 years (range: 10 weeks-17 years) and male/female ratio was 12/2 (85.7%/14.3%). Previous SV attack was present in two patients (14.3%). Mean admission period was 60.9 hours (range: 24-96 hours). Main clinical features were abdominal pain/tenderness (12 cases, 85.7%), distention (ten cases, 71.4%), abnormal bowel sound (nine cases, 64.3%), vomiting (seven cases, 50.0%), obstipation and muscular rigidity/rebound tenderness (six cases, 42.9% for each), hypokinetic/akinetic bowel sound and shock (four cases, 28.6% for each), and gangrenous stool (two cases, 14.3%). SV was diagnosed by abdominal X-ray radiography in seven patients (50.0%), at laparotomy in five cases (35.7%), and by computed tomography in two patients (14.3%). Emergency surgery was required in 12 cases (85.7%), while endoscopic detorsion was recently performed in two cases (14.3%) and elective surgery was added in one (7.1%). Mortality and morbidity were seen in four cases (28.6%) for each.</p><p><strong>Conclusion: </strong>Although childhood SV is rare, it is still a critical area due to its relatively poor anamnestic inability, diagnostic difficulty, and prognostic outcome. However, diagnostic efficacy of CT, therapeutic contribution of endoscopic detorsion, and recurrence-preventive effect of elective laparoscopic surgery are important advances during the recent years.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2370-2374"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113561","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":"Operative hysteroscopy intravascular absorption (OHIA) syndrome presenting with severe hypoxemia and abnormal carboxyhemoglobin elevation.","authors":"Dongmiao Cai, Haizhen Wang, Bin Yang, Zhihong Xu","doi":"10.12669/pjms.42.9.13717","DOIUrl":"https://doi.org/10.12669/pjms.42.9.13717","url":null,"abstract":"<p><p>A 40 years old woman undergoing elective hysteroscopic myomectomy under general anesthesia developed progressive hypoxemia and severe metabolic acidosis. The primary etiology was Operative Hysteroscopy Intravascular Absorption (OHIA) syndrome, resulting from massive normal saline irrigation (approximately 18 L used) leading to dilutional hyperchloremic metabolic acidosis and pulmonary edema. Intraoperatively, a sudden drop in end-tidal carbon dioxide (EtCO₂) and an incidental elevation in carboxyhemoglobin (COHb) of 15.7% were noted. This COHb elevation was suspected to be due to spectrophotometric interference by dissolved hydrogen gas generated during bipolar electrosurgery, which might have indirectly suggested a concurrent, transient venous gas embolism. However, OHIA remained the principal driver of hypoxemia and clinical deterioration. Management included fluid restriction, diuretics, steroids, and supportive ventilation. The patient recovered uneventfully. This case highlights the dominant role of OHIA in prolonged high-pressure hysteroscopy, with artifactual COHb elevation serving as a potential (though non-definitive) ancillary clue to intravascular gas entry.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2474-2477"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113513","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":"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}