Journal of the College of Physicians and Surgeons--Pakistan : JCPSP最新文献

{"title":"Preoperative Prediction of Impacted Ureteric Stones Using the Impacted Stone Formula.","authors":"Muhammad Hummam Siddique, Syed Muhammad Nazim, Ramna Nadeem, Noor Ul Ain Zehra","doi":"10.29271/jcpsp.2026.09.1175","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.09.1175","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic performance of the Impacted Stone Formula (ISF) in a South Asian cohort undergoing semirigid ureteroscopy (URS).</p><p><strong>Study design: </strong>An analytical study. Place and Duration of the Study: Department of Urology, Aga Khan University Hospital, Karachi, Pakistan, from March to September 2025.</p><p><strong>Methodology: </strong>This study included 120 adult patients who underwent semirigid URS for a single, unilateral, radio-opaque ureteric stone at Aga Khan University Hospital, Karachi, Pakistan. Preoperative non-contrast computed tomography (NCCT) parameters, including stone characteristics, ureteric wall thickness (UWT), hydronephrosis grade, and Hounsfield unit (HU) measurements proximal and distal to the stone, were recorded and analysed using SPSS. ISF was calculated using the validated formula: ISF = UWT × (HU below/HU above) × (1 + hydronephrosis grade). Stone impaction was confirmed intraoperatively by failure to pass a guidewire beyond the stone during initial ureteral catheterisation. The cut-off value for ISF was determined using the Youden Index. Receiver operating characteristic (ROC) analysis and multivariable logistic regression were performed to assess predictive accuracy.</p><p><strong>Results: </strong>Among 120 patients, 57 (47.5%) had impacted stones. Impacted stones were associated with significantly higher UWT, hydronephrosis grades, stone density, and ISF values. ROC analysis demonstrated excellent discriminatory performance of the ISF with an area under the curve of 0.96. At a cut-off value of 15.5, ISF showed 75% sensitivity and 93.7% specificity. Impacted stones were associated with longer operative times, increased intraoperative bleeding, longer length of stay, and higher postoperative stent placement rates.</p><p><strong>Conclusion: </strong>The ISF is a reliable and practical preoperative predictor of ureteric stone impaction. Incorporation of ISF in routine practice, along with NCCT assessment, may improve surgical planning, risk stratification, and patient counselling before the procedure.</p><p><strong>Key words: </strong>Urolithiasis, Stone impaction, Ureteroscopy, Ureteral wall thickness, Prognostic factor, Validation.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1175-1180"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning-Based Evaluation of Impacted Third Molars with Open and Closed Apices on CBCT.","authors":"Suay Yagmur Unal, Gaye Keser, Filiz Namdar Pekiner","doi":"10.29271/jcpsp.2026.09.1114","DOIUrl":"10.29271/jcpsp.2026.09.1114","url":null,"abstract":"<p><strong>Objective: </strong>To develop and evaluate a deep learning approach for the automated segmentation of impacted third molars on cone-beam computed tomography (CBCT) images and the classification of each tooth's root apex as open or closed.</p><p><strong>Study design: </strong>An observational study. Place and Duration of the Study: Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkiye, from December 2022 to December 2024.</p><p><strong>Methodology: </strong>Three hundred CBCT scans containing impacted third molars were retrospectively collected. Experts categorised teeth as having an open apex (incomplete root development) or closed apex (fully formed roots). A 3D nnU-Net convolutional neural network was trained using manual segmentations of the molars (270 scans for training and 30 for testing), with the network output distinguishing between teeth with open and closed apices. Model performance was evaluated on the independent test set using segmentation overlap metrics (Dice similarity coefficient and Jaccard index) and classification metrics derived from confusion matrix components [accuracy, sensitivity, precision, and area under the ROC curve (AUC)]. All performance metrics were automatically computed within the nnU-Net v2 framework and further verified using Python.</p><p><strong>Results: </strong>The model demonstrated high performance in segmenting closed-apex molars, achieving a Dice similarity coefficient of 0.85, a Jaccard index of 0.78, sensitivity of 0.90, precision of 0.85, and an AUC of 0.95. However, for open-apex molars, performance was substantially lower (Dice: 0.37; Jaccard: 0.30; sensitivity: 0.31; precision: 0.71; AUC: 0.65), primarily attributable to severe class imbalance in the training dataset.</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility of a deep learning approach for automatically evaluating impacted third molars on CBCT, including tooth segmentation and root maturity assessment. The model's strong performance suggests that such AI tools could assist clinicians in assessing impactions and planning extractions.</p><p><strong>Key words: </strong>Impacted third molar, Cone-beam computed tomography, Deep learning, Tooth segmentation, Root apex closure, nnU-Net.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1114-1119"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Pulmonary Fibrosis and Emphysema: Clinicoradiological Parameters Associated with Fibrosis Patterns.","authors":"Huseyin Alper Kiziloglu, Halil Ibrahim Yakar","doi":"10.29271/jcpsp.2026.09.1120","DOIUrl":"10.29271/jcpsp.2026.09.1120","url":null,"abstract":"<p><strong>Objective: </strong>To determine the relative frequency of conditions causing different types of fibrosis [usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP)] in combined pulmonary fibrosis and emphysema (CPFE), a newly defined disease.</p><p><strong>Study design: </strong>A cross-sectional observational study. Place and Duration of the Study: Department of Radiology, Tokat Gaziosmanpasa University, Tokat, Turkiye, from January 2023 to January 2025.</p><p><strong>Methodology: </strong>Based on HRCT images, the visualised fibrosis types were divided into two groups:  UIP (n = 48) and NSIP (n = 46). Demographic data included age, gender, smoking history, and occupational history. The Charlson Comorbidity Index (CCI) score was calculated for each patient. The Kolmogorov-Smirnov test was used to assess the distribution of variables in the analyses. Categorical data were compared using the chi-square test and numerical data by Student's t-test.</p><p><strong>Results: </strong>CPFE patients were divided into two groups: UIP pattern (n = 48) and NSIP pattern (n = 46). No significant differences were found between the groups in terms of age, gender, smoking, CCI, and high-risk occupation. When examining the relationship between pulmonary hypertension and demographic data in patients with CPFE, the mean age and CCI were significantly higher in the group with systolic pulmonary artery pressure (sPAP) ≥25 mmHg, as measured by echocardiography. Furthermore, in those with sPAP ≥25, haemoglobin and haematocrit levels were significantly lower, and urea levels were significantly higher. Similarly, in those with sPAP ≥25, diffusing capacity of the lungs for carbon monoxide levels were significantly lower.</p><p><strong>Conclusion: </strong>Although comorbidities were found to be significantly higher in the UIP pattern compared to the NSIP pattern, the CCI was similar. As more than half of patients with CPFE had elevated sPAP, pulmonary hypertension should also be considered when evaluating these patients.</p><p><strong>Key words: </strong>Pulmonary fibrosis, Emphysema, Usual interstitial pneumonia, Carbon monoxide, Diffusion test, Pulmonary artery pressure.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1120-1125"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency and Safety of Torsional IP Mode and Combined Torsional-Longitudinal Mode for the Management of Grade 5 Cataract.","authors":"Suleyman Gokhan Kerci, Berna Sahan","doi":"10.29271/jcpsp.2026.09.1160","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.09.1160","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficiency and safety of torsional Intelligent Phaco (IP) mode with those of the combined torsional- longitudinal mode for the treatment of Grade 5 cataracts.</p><p><strong>Study design: </strong> A descriptive study. Place and Duration of the Study: Department of Ophthalmology, Medicana International Izmir Hospital, Turkiye, from January 2020 to July 2025.</p><p><strong>Methodology: </strong>Patients with Grade 5 cataracts who underwent torsional IP mode and combined torsional-longitudinal mode were retrospectively analysed. Age, gender, operation time, ultrasound time, cumulative dissipated energy (CDE), longitudinal power, torsional amplitude, and total estimated fluid were recorded. Preoperative and postoperative best-corrected visual acuity (BCVA) and central corneal thickness were noted.</p><p><strong>Results: </strong>A total of 68 patients were included. Ultrasound time was significantly shorter in the combined torsional-longitudinal US mode group than in the torsional IP mode group (76.1s vs. 67.9s, p = 0.008). The mean CDE (22.1 vs. 18.9, p = 0.001) and torsional amplitude (60.0 vs. 55.8, p = 0.003) were significantly higher in the torsional IP mode group. Single and multiple occlusions were detected in 9 and 13 patients in the IP torsional mode group, and 6 patients and 2 patients in the combined torsional-longitudinal US mode group, respectively.  Conclusion: The present study demonstrated that both torsional IP mode and combined torsional-longitudinal US mode are effective and safe techniques for the management of Grade 5 cataracts. However, the combined mode was associated with shorter ultrasound time, lower CDE, lower torsional amplitude, and fewer intraoperative occlusions.  Key Words: Cataract, Torsional-longitudinal mode, Torsional IP mode, Phacoemulsification.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1160-1163"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brugada Syndrome in Pakistan: A Context-Adapted Screen-Refer-Treat-Collaborate Framework Based on the Re-evaluation of a 2015 JCPSP Case.","authors":"Ning Wang","doi":"10.29271/jcpsp.2026.09.1223","DOIUrl":"10.29271/jcpsp.2026.09.1223","url":null,"abstract":"<p><p></p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1223-1224"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restrictive Lung Pattern in End-Stage Renal Disease: Beyond Uraemia and Fluid Overload?","authors":"Amna Khan","doi":"10.29271/jcpsp.2026.09.1227","DOIUrl":"10.29271/jcpsp.2026.09.1227","url":null,"abstract":"<p><p></p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1227-1228"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Comprehensive Geriatric Assessment and Heart Failure with Preserved Ejection Fraction in Elderly Patients.","authors":"Yijian Yu, Zhe Xue","doi":"10.29271/jcpsp.2026.09.1107","DOIUrl":"10.29271/jcpsp.2026.09.1107","url":null,"abstract":"<p><strong>Objective: </strong>To explore the association between comprehensive geriatric assessment (CGA)-related projects and indicators of heart failure with preserved ejection fraction (HFpEF) in hospitalised older adults, and to evaluate their predictive value for HFpEF risk.</p><p><strong>Study design: </strong>An observational study. Place and Duration of the Study: Department of Geriatrics, Mindong Hospital Affiliated to Fujian Medical University, Mindong, China, from July to December 2024.</p><p><strong>Methodology: </strong>A total of 134 patients aged ≥60 years who received standard CGA were included in the single-centre cross-sectional analysis. The CGA protocol was used to evaluate frailty using the FRAIL scale, sarcopenia risk using the SARC-CalF score, nutritional status, cognitive function, basic activities of daily living, and fall risk. Patients were divided into the HFpEF group (n = 50) and the heart failure without preserved ejection fraction (non-HFpEF) group (n = 84) according to clinical diagnosis. Statistical methods included initial univariate screening, variable selection using Least Absolute Shrinkage and Selection Operator (LASSO) regression, followed by multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis to evaluate diagnostic performance.</p><p><strong>Results: </strong>Patients with HFpEF were older, had a higher burden of polypharmacy, and had higher FRAIL scores than those in the non-HFpEF group (all p <0.05). In the adjusted multivariate analysis, both FRAIL and SARC-CalF scores were independently associated with HFpEF. The odds ratio for the FRAIL score was 3.68 (95% CI, 1.83-8.39), while the odds ratio for the SARC-CalF score was 1.47 (95% CI, 1.21-1.86). ROC analysis shows that the prediction utility of the two tools is relatively strong. The AUC for the FRAIL scale is 0.88, whereas the AUC for the SARC-CalF scale is 0.89. The optimal diagnostic thresholds are 1.5 points (indicating pre-frailty) and 11 points.</p><p><strong>Conclusion: </strong>The SARC-CalF and FRAIL scales are sensitive for identifying high-risk older adults with HFpEF. Their combined use improves predictive specificity and accuracy compared with either scale alone. This dual-scale approach may provide a practical and efficient preliminary screening tool for HFpEF in geriatric care.</p><p><strong>Key words: </strong>HFpEF, Comprehensive geriatric assessment, Aged, Frailty, Pre-frailty, Sarcopenia.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1107-1113"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation-Based Training in the Limberg Flap Technique for Pilonidal Sinus Disease.","authors":"Rubab Nafees, Rabia Aftab, Komal Faheem, Madeeha Shahid, Aun Ali","doi":"10.29271/jcpsp.2026.08.1090","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.08.1090","url":null,"abstract":"<p><p>Intergluteal pilonidal sinus is a common disease among adults, especially males and is related to high morbidity. The rhomboid flap reconstruction for pilonidal sinus is a transposition flap designed to close a 60° rhombus-shaped defect. This rhomboid flap is basically a chain of connecting equilateral triangles with 60° angles. The planning, outlining, and implementation of the rhombus-shaped flap are very challenging and require technical and cognitive skills to avoid any discrepancies and structural problems in flap raising and reconstruction. This can be achieved by introducing a realistic, simulation-based model of pilonidal sinus disease that allows trainees to practise and become familiar with flap measurements and marking, followed by flap elevation and mobilisation. For this research, a prospective design was adopted to evaluate the effect of simulation-based training on surgical performance in Limberg flap reconstruction for pilonidal sinus disease on real patients. The study aimed to determine the effectiveness of simulation-based training in the Limberg flap technique for pilonidal sinus disease using a task trainer. Key Words: Limberg flap, Pilonidal sinus disease, Simulation, Reconstruction, Rhombus.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 8","pages":"1090-1092"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of On-Axis Incision on Surgically Induced Astigmatism Following Phacoemulsification Cataract Surgery.","authors":"Sadia Humayun, Amna Tariq, Samar Fatima, Muhammad Shahid","doi":"10.29271/jcpsp.2026.08.1023","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.08.1023","url":null,"abstract":"<p><strong>Objective: </strong>To estimate surgically induced astigmatism (SIA) and the flattening effect produced by an on-axis incision in patients undergoing phacoemulsification cataract surgery.</p><p><strong>Study design: </strong>A quasi-experimental study. Place and Duration of the Study: Department of Eye, Combined Military Hospital, Lahore, Pakistan, from May to September 2024.</p><p><strong>Methodology: </strong>A total of 142 eyes underwent phacoemulsification with a 2.75-mm limbal incision placed on the steep axis. Keratometric (K) readings, including flat K (K1) and its axis, steep K (K2) and its axis, and astigmatism and its axis, were measured by the same technician before surgery and again 6 weeks postoperatively using an optical biometer (Tomey AL 100). Uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) were recorded for all patients preoperatively and postoperatively. SIA was calculated using the ASSORT online calculator, and changes in astigmatism, UCVA, and CDVA were analysed using the Wilcoxon signed-rank test (SPSS version 26), with statistical significance set at p < 0.05.</p><p><strong>Results: </strong>The mean age of participants was 62.9 ± 6.9 years, with 60.6% males. Preoperative astigmatism averaged 0.88 ± 0.52 dioptres (D) and decreased to 0.65 ± 0.48 D postoperatively, representing a mean reduction of 0.23 ± 0.30 D (p < 0.001). The mean SIA was 0.58 ± 0.50 D, and target-induced astigmatism was 0.45 ± 0.45 D. Both UCVA and CDVA improved significantly (p <0.001). Nearly 70% of eyes gained three or more Snellen lines of corrected vision.</p><p><strong>Conclusion: </strong>A 2.75-mm on-axis limbal incision during phacoemulsification produces low and predictable SIA, a statistically significant reduction in corneal astigmatism and substantial improvement in visual acuity. This approach provides a practical, cost-neutral option for astigmatism management in cataract surgery.</p><p><strong>Key words: </strong>Phacoemulsification, Astigmatism, Cataract extraction, Cornea/surgery, Visual acuity.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 8","pages":"1023-1027"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility of Ultrasound-Guided Midline Catheters in the Cardiovascular Intensive Care Unit.","authors":"Fen Xu, Tao Xiang, Liang Hui Zhang, Ling Liang, Feng Liu, Xiongfei Xu","doi":"10.29271/jcpsp.2026.08.1088","DOIUrl":"10.29271/jcpsp.2026.08.1088","url":null,"abstract":"<p><p>This observational study evaluated the clinical utility of ultrasound-guided midline catheters (MCs) for the delivery of cardiovascular medications in the cardiovascular intensive care unit (CICU). Conducted at a tertiary hospital in China between 2020 and 2022, 387 critically ill CICU patients (median age 78 years) requiring multi-drug infusions were analysed. MCs demonstrated a median dwell time of 9 days (IQR: 6-13 days), successfully administering 13 cardiovascular medications, including vasopressors and antiarrhythmics. Complication rates were remarkably low (1.3%), with two lumen occlusions, two haemorrhages, and one phlebitis. No central line-associated bloodstream infections (CLABSIs) or symptomatic thromboses occurred. Compared to central venous catheters (CVCs), MCs reduced insertion complexity and infection risk while maintaining efficacy for prolonged therapy. The findings support MCs as a safe alternative to traditional CVCs in CICU settings, particularly for elderly patients with complex comorbidities. Nurses performed most insertions (78%), highlighting procedural accessibility. This study underscores the value of ultrasound-guided MCs in optimising vascular access strategies for critical cardiovascular care. Key Words: Midline catheter, Central venous catheter, Peripherally inserted central catheter, Cardiovascular intensive care unit.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 8","pages":"1088-1089"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}