Bacteriological and Hematological Profile of Neonatal Sepsis: Rural-Urban Comparison in a Tertiary Care Setting

Objectives: To determine the frequency of blood culture-proven neonatal sepsis (NNS) and to compare the bacteriological and hematological profiles of culture-positive cases between rural and urban neonates. Methodology: This descriptive, cross-sectional study was conducted at the Department of Pediatric Unit 1, Bahawal Victoria Hospital, Bahawalpur, over a period of seven months from January 2023 to July 2023 and enrolled 111 neonates with suspected sepsis. Preterm neonates, as well as those with a ruptured meningomyelocele or a history of prior hospitalization, were excluded from the study. For each participant, demographic and clinical details were recorded, and hematological parameters, including white blood cell count, hemoglobin, and platelet count, were assessed. Blood cultures were also performed to identify Gram-positive and Gram-negative organisms, and the resulting findings were compared between rural and urban cases. Results: Blood culture-proven sepsis was found in 27 neonates (24.32%). Gram-negative organisms predominated, accounting for 58.82% of rural and 70% of urban cases. Gram-positive organisms accounted for 41.18% of rural and 30% of urban cases. Thrombocytopenia and leukopenia were significantly more common in Gram-negative infections and among rural neonates (p < 0.05). Low birth weight and early-onset sepsis were significantly associated with sepsis (p<0.05). Conclusion: Blood culture-proven NNS was found in nearly one-fourth of suspected cases. Gram-negative organisms predominated. Hematological abnormalities were common. Thrombocytopenia and leukopenia were more frequent in Gram-negative and rural cases, suggesting severe disease. Early pathogen identification, local bacteriological surveillance, and monitoring hematological markers are key to guide therapy and improve outcomes. Keywords: Blood culture, Gram-positive bacteria, Gram-negative bacteria, Leukopenia, NICU Neonatal infections, Neonatal sepsis, Rural-urban differences, Thrombocytopenia

Frequency of Thyroid Dysfunction in Patients with Non-Alcoholic Fatty Liver Disease

Objectives: To determine the frequency of thyroid dysfunction in patients with non-alcoholic fatty liver disease. Methodology: This cross-sectional study was conducted at Rawal Institute of Health Sciences, Medicine Department, Islamabad, Pakistan, from August 2025 to February 2026. A total of 370 patients with non-alcoholic fatty liver disease were included; they were screened for the presence of any abnormality in the thyroid function (overt/subclinical hypothyroidism and hyperthyroidism). Thyroid dysfunction stratification was done based on confounding variables. Post-stratification analysis was done using the chi-square test. Results: Median age was 54.00 (22.00) years. There were 197 (53.20%) male and 173 (46.80%) female patients. Median BMI was 30.46 (8.15) kg/m². History of smoking, diabetes, and hypertension was positive in 274 (74.10%), 186 (50.30%), and 187 (50.50%), respectively. Among non-alcoholic fatty liver disease patients, the frequency of thyroid dysfunction was 92 (24.90%). A total of 46 (12.43%) patients had subclinical hypothyroidism, 29 (7.84%) had overt hypothyroidism, and 17 (4.59%) had hyperthyroidism. Conclusion: Thyroid dysfunction was found in 24.9% of the patients suffering from non-alcoholic fatty liver disease, with subclinical hypothyroidism being the most common type of dysfunction. Keywords: Hyperthyroidism, Hypothyroidism, Non-Alcoholic Fatty Liver Disease

Evaluation of GeneXpert MTB/RIF for the Detection of Mycobacterium Tuberculosis in a Tertiary Care Hospital, Pakistan

Objectives: To evaluate the diagnostic concert of GeneXpert MTB/RIF assay for the analysis of pulmonarytuberculosis and detection of Rifampicin resistance using sputum samples.Methodology: The retrospective descriptive cross-sectional study was conducted at the department of microbiology.Federal Government Polyclinic (FGPC), Islamabad, Pakistan, from August 2023 to July 2024. A total of 771 participants,referred by their physicians as TB suspects, were consecutively enrolled in the study from various wards of FGPC andother healthcare facilities in Islamabad, Pakistan. Sputum samples were collected from these participants andexamined using light microscopy following Ziehl-Neelsen (ZN) staining. All samples were processed using theGeneXpert MTB/RIF Assay.Results: Out of the 771 sputum samples, Mycobacterium tuberculosis was detected in 89 (11.54%) cases using theGeneXpert MTB/RIF assay. Rifampicin-resistant M. tuberculosis was found in 8 out of these 89 cases (8.98 %). Maleand female ratio of the patients was almost equal. Males were found to be 406 (57.4%) while 365 (42.5%) werefemales. The data were expressed as mean, median, and mode, and analyzed using the Statistical Package for SocialSciences (SPSS) version 25.0. Simple descriptive statistics (frequencies and percentages) were calculated for eachcategorical variable. The diagnostic accuracy, i.e., sensitivity, specificity, positive predictive value (PPV), and negativepredictive value (NPV) of the GeneXpert MTB/RIF assay compared to traditional methods was calculated.Conclusion: The GeneXpert MTB/RIF has higher sensitivity and specificity to conventional ZN smear microscopy. It isa simple, rapid, and accurate test for detecting Mycobacterium tuberculosis in sputum specimens.Keywords: GeneXpert MTB/RIF; Pakistan; Pulmonary tuberculosis; Rifampicin resistance

Comparison of Efficacy of Oral Tranexamic Acid Versus Glycolic Acid Peels in the Treatment of Melasma

Objective: To compare the efficacy of oral tranexamic acid versus glycolic acid peels in the treatment of epidermaland mixed-pattern melasma.Methodology: A total of 88 patients, aged 20 to 50 years, diagnosed with epidermal or mixed-pattern melasma, wereassigned to two treatment groups based on their treatment choice or eligibility criteria. Group A received oraltranexamic acid (250 mg twice daily), and Group B underwent 50% glycolic acid peels every two weeks for 12 weeks.MASI scores were recorded at baseline and at 12 weeks to assess the extent of improvement, and side effects weremonitored.Results: The baseline MASI score for all patients was 14.74 (SD = 3.09). At 12 weeks, the mean MASI score significantlydecreased to 2.45 (SD = 1.70). Both groups showed substantial improvements in MASI scores. Group A had a meanMASI score of 15.5 at baseline, which reduced to 3.2, while Group B showed a mean reduction from 14.9 to 4.8.Statistical analysis revealed no significant difference in efficacy between the two treatments (p-value =0.05).Conclusion: Both oral tranexamic acid and glycolic acid peels are effective in treating melasma, with comparableresults. Future studies with larger sample sizes and longer follow-up are recommended to assess long-term outcomes and potential combination therapies.Keywords: Glycolic acid peels; MASI score; Melasma; Oral tranexamic acid; Treatment efficac

CXR Patterns & Outcomes in MDR-TB - Saidu Teaching Hospital, Retrospective Cross-Sectional Single Centre Study

  Objective: To determine the association between baseline chest X-ray patterns and treatment outcomes in MDR-TB patients at Saidu Teaching Hospital, Swat. Specifically, it sought to explore the relationship between radiological features and treatment success or failure, with a focus on gender as a potential predictor of unfavourable outcomes. Methodology: A retrospective cross-sectional study was conducted involving 350 microbiologically confirmed MDR-TB patients, with data collected from June 2014 to December 2024. Chest X-ray findings, including cavitation, bilateral involvement, and extent of disease, were compared with treatment outcomes categorized as favourable or unfavourable. Descriptive statistics, chi-square tests, and logistic regression were used for data analysis. Results: The study found that 261 (74.6%) patients had favourable outcomes, while 89 (25.4%) had unfavourable outcomes. Gender was significantly associated with treatment outcomes (Chi-square = 13.17, p-value = 0.0218), with male patients having higher odds of unfavourable outcomes (OR = 1.25, p = 0.007). Age did not significantly predict treatment outcomes. Radiological features such as cavitation and bilateral involvement were common but did not show a direct statistical correlation with unfavourable outcomes. Conclusion: The study highlights the importance of gender as a significant predictor of MDR-TB treatment outcomes, emphasizing the need for gender-specific interventions. Future research should involve multicentre prospective studies to further validate these findings and explore the impact of radiological features in diverse settings. Keywords: Chest X-ray; Gender; Logistic Regression; Multidrug-Resistant Tuberculosis; Treatment Outcome

Rare Presentation of Crossed Fused Ectopia with Single Ureter and Ureteropelvic Junction Obstruction: A Case Report

Crossed fused renal ectopia (CFRE) is a congenital anomaly in which one kidney is ectopically located on the opposite side of the midline and fused with its contralateral counterpart. However, CFRE with a single ureter draining both renal moieties is an exceptionally rare variant. We report on the case of a 12-year-old boy who presented with recurrent episodes of right flank pain. Ultrasonography and subsequent contrast-enhanced CT revealed that the left kidney was located on the right side, fused with the right kidney. Both renal pelvises were fused, forming a single pelvicalyceal system that drained through a solitary ureter entering the urinary bladder on the right side. This case highlights the characteristic imaging features of this unusual congenital anomaly, emphasizing the crucial role of CT in its accurate diagnosis and preoperative evaluation

The Impact of AI-Powered Clinical Decision Support Systems on Clinical Decision-Making and Treatment Quality: A Systematic Review

Introduction: Artificial intelligence (AI) is revolutionizing clinical decision-making processes by leveraging vast data generated from health records and delivery systems. This enhances safety and quality of care decisions, making Clinical Decision Support Systems (CDSS) essential tools in healthcare, thereby improving clinicians' decisions and patient outcomes. Methodology: A systematic review was conducted across PubMed, Google Scholar and Cochrane Library, that assessed the use of AI-powered CDSS. Following title and abstract screening, full-text articles were evaluated for methodological quality and compliance to the inclusion criteria. The data extraction process concentrated on study design, AI technologies used, reported outcomes, and proof of AI-CDSS impact on patient and clinical outcomes. A total of 32 studies were included after the screening of the articles, encompassing various study designs and healthcare applications. The analysis focused on evaluating the type of AI technologies employed, their effects on clinical decision-making and treatment quality, and the challenges faced during implementation. Results: The review found that ML algorithms, including Convolutional Neural Networks (CNNs) and Support Vector Machines (SVMs), were predominant among the included studies. Significant improvements were noted in the diagnostic accuracy (reported in 18 studies) and timely medical interventions (12 studies). Personalized treatment recommendations were facilitated in 10 studies, further optimizing treatment protocols in 08 studies. However, challenges such as data privacy concerns and the need for clinician training were highlighted in 10 studies, while ethical considerations were reported in 05 studies. Conclusion: This systematic review underscores the potential of AI-powered CDSS to significantly enhance clinical decision-making and treatment quality. While AI technologies improve diagnostic and therapeutic processes, their successful integration into clinical practice requires addressing ethical concerns, clinical training, and data management challenges. Future research should focus on long-term impacts, real-world applications, and strategies for overcoming barriers to AI adoption in healthcare settings. Key words: Artificial Intelligence, Machine Learning, Clinical Decision Support Systems, CDSS, healthcare

Mandibular Adenomatoid Odontogenic Tumor: A Rare Entity

An adenomatoid odontogenic tumor (AOT) is a very rare epithelial tumor that makes upto 3% of odontogenic tumors. The mandibular region accounts for 35% of cases, while the maxilla accounts for around 65% of cases. This case report aims to report a case of adenomatoid odontogenic tumor in the anterior mandible in a male patient who was treated with surgical marsupialization and posterior enucleation. Auxiliary therapeutic techniques can be used effectively to reduce the lesion, and accurate histological diagnosis is mandatory to avoid unnecessary aggressive surgery. This case study also covered the need for a thorough description that distinguishes AOT from other odontogenic tumors, of which dentigerous cysts are the most frequent misdiagnosis

Prevalence and Antibiotics Susceptibility of MRSA at Federal Burn Care Centre, Pakistan

Objectives: 1) To assess the prevalence of MRSA among patients with burn wounds. 2) To explore the susceptibility of MRSA to antibiotics in patients with burn wounds. Methodology: An observational descriptive study was conducted in the Burn Care Centre (BCC), PIMS, SZAB Medical University, Islamabad, from July 2023 to April 2024. Patients of all age groups, genders, and burn varieties were included in our study.  Results: A total of 274 swab cultures were collected from patients who showed signs of infection. Out of the total, 122 (44.5%) were male patients and 152 (45.4%) were females. About 39.7% (109) patients were children younger than 12 years of age. Among 274 samples, 50 (18.2%) samples revealed no growth. The most common bacteria cultured was Pseudomonas aeruginosa with 113 (41.2%) swab cultures, followed by Klebsiella pneumoniae with 71 (25.9%) samples and MRSA with 40 (14.6%) cultures. MRSA showed 100% sensitivity to vancomycin and 92.5% sensitivity to linezolid. Chloramphenicol was 60% sensitive. Penicillin, ceftriaxone, ceftazidime, oxacillin, piperacillin, and tazobactam showed no sensitivity to MRSA.  Conclusion: Our study shows less prevalence of MRSA in the BCC unit with no vancomycin and almost no linezolid resistance as compared to other mentioned studies. We achieved low prevalence of MRSA and antibiotic resistance due to judicial use of antibiotics, maintenance of antibiograms, and following aseptic technique. Keywords: Antibiotic susceptibility, Burn, Pakistan, Methicillin-resistant Staphylococcus aureus, Wound cultur

The Emerging Significance of Magnetic Resonance Spectroscopy in Diverse Intracranial Pathologies – Pictorial Review

This study aimed to outline the role of magnetic resonance spectroscopy (MRS) in diagnosing various intracranialpathologies in Pakistan by evaluating patients who underwent MRI with MRS on Siemens 3-Tesla or Toshiba Titan1.5-Tesla scanners, with interpretations by consultant radiologists and correlation with histopathological diagnoses,alongside a supporting literature review. The findings highlight the broad clinical utility of MRS in assessing braintumors as well as neurological and mental disorders, enabling differentiation among multiple diagnostic possibilities.Overall, MRS emerges as a versatile technique for investigating cerebral metabolic processes and contributessignificantly to tumor identification, localization, staging, assessment of aggressiveness, and evaluation of treatmentresponse, thereby enhancing patient care.Keywords: Magnetic Resonance Spectroscopy; Brain; Neurology; Radiology