Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University
type: channel
description: The Annals of Pakistan Institute of Medical Sciences (APIMS) is the official quarterly and open access journal of Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Pakistan. Previously, two separate medical journals of this institute were being published, namely, JPIMS started in 1990 and the Journal of Surgery in 1991. They were officially merged into one journal, APIMS, in 2005. The Annals of PIMS is recognized by the Pakistan Medical and Dental Council (PMDC), the Higher Education Commission of Pakistan ( Y category), and the CPSP (https://www.cpsp.edu.pk/files/news_notifications/cpsp-sec-2020-338.pdf) It is indexed in WHO-IMEMR, EBSCO Host & Base from Germany.
publisher: Shaheed Zulfiqar Ali Bhutto Medical University
language: en-US
publication name: Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University
issn: 1815-2287
copyright: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons. org/licenses/by-nc/4.0/.) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
items: Physics Forceps Versus Conventional Forceps in Dental Extractions – A Split Mouth Comparison
items: Bedside Diaphragmatic Ultrasonography as a Predictor of Successful Weaning from Mechanical Ventilation
items: Comparison Between Primary and Secondary Implant Stability of Hybrid Versus Resorbable Blast Media (RBM) Surfaces Using Resonance Frequency Analysis
items: Changes in Central Corneal Thickness & Intraocular Pressure after Phacoemulsification
items: Doppler Evaluation of Middle Cerebral Artery and Umbilical Artery Pulsatility Index in the Diagnosis of IUGR Taking Clinical IUGR at Birth as Gold Standard
items: Response Evaluation with Definitive Chemoradiotherapy in Carcinoma of the Esophagus
items: Role of Probiotics as Adjunct Therapy Along with Standard Care in Decreasing Hospital Stay and Improving Symptoms in Pediatric Patients Admitted with Severe Pneumonia
items: Efficacy of Melatonin in Treatment of Infantile Colic in Infants Presenting to CMH Quetta OPD
items: Effect of Dexamethasone Intraligament Injection on Post-Endodontic Pain in Patients with Symptomatic Irreversible Pulpitis
items: Comparison of Stent Patency, Biochemical and Clinical Improvement in Plastic Versus Metallic Biliary Stent for Palliation in Malignant Biliary Obstruction in a Developing Country Tertiary Hospital
items: Role of Diclofenac Suppositories in Pain Relief During the Postpartum Period
items: Hypothyroidism in Patients with Non Alcoholic Fatty Liver Disease (NAFLD)
items: Assessment of Malnutrition Among Critically Ill Adults Admitted in the ICU of a Tertiary Care Hospital at Rawalpindi, Pakistan
items: Role of Bedside Leukoreduction Filters in Mitigating Febrile Non-Hemolytic Transfusion Reactions in Thalassaemia Major Patients
items: Umbilical Cord PRP Is Better in Relieving Pain in Patients of Knee Osteoarthritis as Compared to Autologous Venous PRP
items: Effects of Graded Dose of Sodium Benzoate on Ovaries of Adult Female Albino Wistar Rats
items: Comparing the Effectiveness of Bite Wafers and Ibuprofen in Pain Management After Initial Orthodontic Arch-wire Placement
items: Perinatal Outcomes in Women with Pre-eclampsia Having Raised Serum Uric Acid Levels
items: Frequency and Characteristics of Hypothyroidism in Neonatal Intensive Care Unit Patients in a Tertiary Care Hospital
items: Revolutionizing Reproductive Health: A Narrative Review on the Role of AI in Transforming Infertility Care in Pakistan
items: Bone Marrow Involvement In Hodgkin’s lymphoma: Case Report
items: Doctor as a Role Model- Obstacles in its Way

Physics Forceps Versus Conventional Forceps in Dental Extractions – A Split Mouth Comparison
type: item
description: Objective: To compare the outcomes of physics forceps with traditional forceps during dental extractions for orthodontic treatment. Methodology: After obtaining from the Institutional Review Board (IRB) of the Dental Section, Islamabad Medical &amp; Dental College vide letter No. IMDC/DS/IRB/220 dated 30-11-2022, participants were recruited from the OPD who met inclusion criteria, after taking informed written consents. Group A, the experimental group, had teeth extracted utilizing physics forceps, whereas Group B, the control group, had teeth extracted using standard methods. Results: The study involved 70 extractions from 35 participants, with tooth numbers 14 and 24 extracted from each, representing 50% of the sample for each tooth. Both groups were statistically comparable at baseline (p-value > 0.05). The mean extraction time in Group A was 108.51±93.30 seconds, while Group B's was 127.29±117.09 seconds. Alveolar fractures occurred in 1 case (2.9%) in Group A and 8 cases (22.9%) in Group B. Tooth fractures were 4 cases (11.4%) in Group A and 3 cases (8.6%) in Group B. Soft tissue injuries were 4 cases (11.4%) in Group A and 10 cases (28.6%) in Group B. Conclusion: The study found similar operational times between the groups. However, Group A had fewer alveolar fractures and soft tissue injuries. Both groups had similar tooth fracture rates, but Group A had lower complications and better comfort.
creator: Sana Riaz
creator: Khalid Mahmood Siddiqi
rights: Copyright (c) 2025 Sana Riaz, Khalid Mahmood Siddiqi https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 509
ending page: 514
doi: 10.48036/apims.v21i3.1454

Bedside Diaphragmatic Ultrasonography as a Predictor of Successful Weaning from Mechanical Ventilation
type: item
description: Objective: To assess the predictive value of diaphragmatic ultrasound for successful weaning from mechanical ventilation. Methodology: This cross-sectional validation study was conducted in the ICU at PIMS from November 2023 to April 2024, on mechanically ventilated patients aged 16–60 years with a pre-illness frailty score of <3 who met weaning criteria. After a successful 1-hour spontaneous breathing trial (SBT), the Rapid Shallow Breathing Index (RSBI) was recorded, and diaphragm ultrasound was performed by an independent anesthetist to measure diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF). Ultrasound assessments were done using curvilinear and linear probes in a semi-recumbent position. Maintaining the spontaneous breathing for 48 hours post-extubation was defined as successful weaning, while failure was defined as needing re-intubation within 48 hours. Data were analyzed using SPSS version 26. Results: Overall average age of patients was 37.82 years. There were 19 (28.8%) females and 47(71.2%) males. Mean days on mechanical ventilator was 5.48 days. The outcomes of weaning showed that 59 participants (89.4%) were successfully weaned, while 7 participants (10.6%) experienced failure in the weaning process. Further analysis of outcomes of weaning showed insignificant association with the gender and (P>0.05). Conclusion: Diaphragmatic ultrasound provided a comprehensive assessment of diaphragmatic function and its role in predicting weaning outcomes. The high success rate suggests that diaphragmatic ultrasound could be a valuable tool in clinical practice for identifying patients who are likely to be successfully weaned from mechanical ventilation, thereby improving patient management and outcomes.
creator: Farah Naz
creator: Qudsia Rasool
creator: Syed Muneeb Ali
creator: Rana Imran Sikander
creator: Jaweria Khan
creator: Suresh Kumar
rights: Copyright (c) 2025 Farah Naz, Qudsia Rasool, Syed Muneeb Ali, Rana Imran Sikander, Jaweria Khan, Suresh Kumar https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 515
ending page: 520
doi: 10.48036/apims.v21i3.1556

Comparison Between Primary and Secondary Implant Stability of Hybrid Versus Resorbable Blast Media (RBM) Surfaces Using Resonance Frequency Analysis
type: item
description: Objective: To compared the primary and secondary stability of implant surfaces made of Resorbable Blast Media (RBM) and Hybrid, sandblasted & acid etched (SBA). Methodology: This randomized controlled trial (registration number NCT06620315) was conducted in the Department of Prosthodontics at the Institute of Dentistry, CMH Lahore Medical College from June to December 2023. A total of 60 patients were randomly assigned to two groups using the lottery method: Group 1 received Hybrid-SBA implants, and Group 2 received RBM implants. Primary implant stability was measured using resonance frequency analysis (Osstell Mentor) at the time of implant placement, and secondary stability was assessed 12 weeks postoperatively. All implants were placed using a non-submerged technique. A chi-square test was applied to compare RFA scores for primary and secondary implant stability between the two implant types. Results: Results indicated that Hybrid-SBA implants had higher primary (74.33 ± 3.51) and secondary (75.03 ± 3.00) stability compared to RBM implants (primary: 69.20 ± 4.44, secondary: 71.07 ± 3.98). The mean age of patients in the SBA group was 30.7 years (SD = 6.75), while in the RBM group, the mean age was 31.2 years (SD = 6.23). Although statistically significant differences were not found overall, secondary stability was significantly higher in females with Hybrid-SBA implants. Conclusion: The findings suggest that Hybrid-SBA implants may offer superior stability, likely due to their rougher surface enhancing osseointegration. This study provided insights into the potential long-term success of different implant surfaces, emphasizing the importance of surface treatment in dental Implantology.
creator: Maila Habib Piracha
creator: Abdul Mueed Zaigham
creator: Afaq Habib Piracha
creator: Miraat Anser
creator: Rana Muhammad Ahmed Khan
rights: Copyright (c) 2025 Miraat Anser, Maila Habib Piracha, Abdul Mueed Zaigham, Afaq Habib Piracha, Rana Muhammad Ahmed Khan https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 521
ending page: 526
doi: 10.48036/apims.v21i3.1534

Changes in Central Corneal Thickness & Intraocular Pressure after Phacoemulsification
type: item
description: Objective: To determine the deviations in central corneal thickness (CCT) and intraocular pressure (IOP) after phacoemulsification. Methodology: A descriptive observational study performed at the Institute of Ophthalmology, Liaquat University Medical & Health Science (LUMHS) Jamshoro from March to September 2022. Patients aged 45 years and above, of either gender, diagnosed with senile cataract and undergoing phacoemulsification with intraocular lens (IOL) implantation were included. Surgeries were carried out under local anesthesia using the phacoemulsification technique, followed by IOL implantation. CCT and IOP were measured before and after surgery using a pachymeter and Goldmann applanation tonometer, respectively. Postoperative follow-up were assessed on day 1, week 1, 4th week and at 6th week. All collected data were entered and analyzed using SPSS version 22. Results: Results shows that there is 7.42% enhancement occurred in CCT on first day of surgery as compared to pre-operative mean reading, which also impacted on IOP readings that increased by 6.42% from pre-operative day. But these readings adjusted gradually. The results and findings of the research study exposed that there is not significant change occurred after surgery in CCT and IOP. Only at 1st day of surgery CCT increased due to surgical intervention due to which IOP reading is also found high and it must not be preserved until the central corneal thickness is also considered. Conclusion: Both CCT and IOP temporarily increase after phacoemulsification, showing the most pronounced rise on the first postoperative day, but gradually stabilize with significant improvement by the first week and near-complete return to baseline by the sixth week.
creator: Zain-Ul-Abden Bilal Ahmed
creator: Mariya Nazish Memon
creator: Ghazi Khan Maree
creator: Azfar Ahmed Mirza
creator: Imtiaz Ahmed Gilal
creator: Ghulam Hyder Sahito
rights: Copyright (c) 2025 Zain-Ul-Abden Bilal Ahmed, Mariya Nazish Memon, Ghazi Khan Maree, Azfar Ahmed Mirza, Imtiaz Ahmed Gilal, Ghulam Hyder Sahito https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 527
ending page: 531

Doppler Evaluation of Middle Cerebral Artery and Umbilical Artery Pulsatility Index in the Diagnosis of IUGR Taking Clinical IUGR at Birth as Gold Standard
type: item
description: doppler indices as the fetal Middle cerebral artery and the umbilical artery pulsatility index for their diagnostic accuracy and preserve clinically significant IUGR at birth as the gold standard. Methodology: This descriptive, cross-sectional study was performed at AFIRI, PEMH Rawalpindi from March 30, 2020, to September 29, 2020, AFIRI. There were 123 patients diagnosed with IUGR ranging in age at gestation: 31–40 weeks and ages 31 to 40 years old. Enrollment of all patients in the study was based on inclusion criteria. A 3.5–5 MHz convex array transducer was used to measure doppler indices once fetal biometry was completed. During each examination, each series of measurements was made three times, and the outcomes were averaged. Results: Following a doppler ultrasonography on all patients, it was discovered that 60 (48.7%) were true positives and 9 (7.3%) were false positives. Of the 54 individuals who tested negative for Doppler, 7 (5.6%) were false negatives, meaning that a clinical examination revealed fetal IUGR after birth, and 47 (38.2%) were true negatives (p=0.0001). In order to diagnose IUGR pregnancies, the Doppler indices overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 89.55%, 83.93%, 86.96%, 87.04%, and 86.99%, respectively, for the fetal MCA and umbilical artery pulse index.
creator: Hina Hanif Mughal
creator: Humaira Riaz
creator: Madiha Maryum Azam
creator: Sana Alvi Assistant
creator: Irum Haq
creator: Tehreem Shan .
rights: Copyright (c) 2025 Hina Hanif Mughal, Humaira Riaz, Madiha Maryum Azam, Sana Alvi Assistant, Irum Haq, Tehreem Shan . https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 532
ending page: 536
doi: 10.48036/apims.v21i3.1210

Response Evaluation with Definitive Chemoradiotherapy in Carcinoma of the Esophagus
type: item
description: Objective: i) To evaluate the treatment outcomes of patients with carcinoma of the esophagus receiving definitive chemoradiation using IMRT with concurrent chemotherapy and ii) To assess patient demographics and disease characteristics in relation to treatment response and patterns at a single tertiary care center. Methodology: This prospective cohort study was conducted in the Department of Radiation Oncology at Shifa International Hospital from June 2024 to November 2024. A total of 133 patients with biopsy-proven esophageal carcinoma, aged 16 to 65 years, were enrolled using non-probability consecutive sampling. All patients received definitive chemoradiation, consisting of either 5040 cGy in 28 fractions or 5400 cGy in 30 fractions delivered via intensity-modulated radiation therapy (IMRT), along with concurrent chemotherapy. Chemotherapy regimens included either weekly carboplatin (AUC 2) and paclitaxel (50 mg/m²) for five weeks, or cisplatin (75 mg/m² on day 1) combined with continuous infusion of fluorouracil (1000 mg/m²/day for 96 hours) during weeks 1 and 5 of external beam radiotherapy. Results: Out of 133 patients, 78 (63%) were males and 55 (37%) were females. Most patients (n = 79, 59%) had stage II disease, while 46 (34%) had stage III disease. An objective complete response was achieved in 66 patients (61%), while partial response was observed in 67 patients (38%). The majority of patients achieving complete response had squamous cell carcinoma histology (66%). No patients died or experienced disease progression during treatment. Grade 3 mucositis occurred in 7 patients (5%), grade 3 dysphagia in 9 patients (7.5%), and grade 3 myelosuppression in 3 patients (2.2%). Conclusions: Patients treated with definitive concurrent chemoradiotherapy (CCRT) for non-metastatic carcinoma of the esophagus demonstrated promising outcomes, with a complete remission rate of 66%. Complete response was more frequently observed in patients with squamous histology. A signi…
creator: Maryam Noor Awan
creator: Asif Masood
creator: Hiba Khalid
creator: Maira Zafar
creator: Furqan Ul Haq
rights: Copyright (c) 2025 Maryam Noor Awan, Asif Masood, Hiba Khalid, Maira Zafar, Furqan Ul Haq https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 537
ending page: 542
doi: 10.48036/apims.v21i3.1339

Role of Probiotics as Adjunct Therapy Along with Standard Care in Decreasing Hospital Stay and Improving Symptoms in Pediatric Patients Admitted with Severe Pneumonia
type: item
description: Objective: To determine if probiotics have any role as adjunct therapy along with standard care in decreasing hospital stay and duration of symptoms in patients admitted with severe pneumonia. Methodology: A randomized controlled trial was conducted at the Children’s Hospital, Pakistan Institute of Medical Sciences (PIMS), from March 2022 to September 2022. A total of 60 patients aged 2 to 24 months, admitted with severe pneumonia, were enrolled over a period of six months using non-probability consecutive sampling. The participants were randomly assigned into two groups using the lottery method: Group 1 (probiotic group) and Group 2 (placebo group). Group 1 received probiotics mixed in milk daily for three consecutive days, while Group 2 received plain milk as a placebo. The primary outcomes measured were the duration of hospital stay, time to resolution of cough, and time to resolution of fever. Results: Both probiotics and placebo group participants had similar baseline characteristics. Duration of hospital stay, cough and fever all decreased in probiotic group. The average length of hospital stay did not decrease significantly in the probiotic group vs placebo group (6.5 ± 2.74-day vs 7.18 ± 2.23 days, p value=0.314). The average fever duration for probiotic group was 5.93 ± 2.71 days and for placebo group was 7.82 ± 5.15 days with p-value of 0.091 suggesting no statistically significant difference in both groups. The average cough duration was significantly less in probiotics group vs placebo group (9.46 ± 4.34 days vs 12.36 ± 5.63 days, p-value of 0.036). Conclusion: Probiotics have potential to be beneficial in terms of reducing cough duration when added to standard care of pneumonia but further studies with larger sample size are required to elaborate on the hypothesis
creator: Rashiqa Saadat
creator: Nighat Haider
creator: Mazhar Ahmed
creator: Iradat Ahmad Khokhar
creator: Tehmina Zahid
creator: Huda Abdur Rahman
rights: Copyright (c) 2025 Rashiqa Saadat, Dr Nighat, Dr Mazhar, Dr Iradat, Dr Tehmina, Dr Huda https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 543
ending page: 548
doi: 10.48036/apims.v21i3.1200

Efficacy of Melatonin in Treatment of Infantile Colic in Infants Presenting to CMH Quetta OPD
type: item
description: Objective: To determine the efficacy of melatonin in treatment of infantile colic presenting to a tertiary care hospital or CMH Quetta. Methodology: This prospective single group interventional study was conducted at Pediatrics department of Combined Military Hospital, Quetta, Pakistan from October 2024 to April 2025 after taking parental informed consent and ethical approval from institution. A total of 146 infants with colic were included, selected through non-probability consecutive sampling technique. All the infants were given oral melatonin for five days and one week after completion of therapy infants were assessed for improvement in the colic severity. Efficacy was considered to be established in case of achievement of complete resolution of colic. Analysis of data was performed through SPSS version 22. Results: In this study, 146 infants were included. Median age was 4.00 (2.00) months. There were 77 (52.70%) male and 69 (47.30%) female infants. Median weight was 9.00 (3.00) kg. A total of 65 (44.50%) infants were receiving breast feeding, 52 (35.60%) infants were receiving formula milk feeding and 29 (19.90%) infants were receiving cow milk. Complete improvement/efficacy was achieved in 80 (54.80%) infants, partial improvement was observed in 43 (29.50%) infants while 23 (15.80%) infants had no improvement. Conclusion: Melatonin is an effective intervention in the management of infantile colic. It resulted in complete recovery in 54.80% of the infants and partial improvement in 29.50% of the infants with colic.
creator: Nidda Arshad Waraich
creator: Muhammad Omer Tufail
creator: Zainab Akmal Abbasi
creator: Muhammad Umer Farooq
rights: Copyright (c) 2025 Nidda Arshad Waraich, Muhammad Omer Tufail, Zainab Akmal Abbasi, Muhammad Umer Farooq https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 549
ending page: 553
doi: 10.48036/apims.v21i3.1519

Effect of Dexamethasone Intraligament Injection on Post-Endodontic Pain in Patients with Symptomatic Irreversible Pulpitis
type: item
description: Objective: This study aimed to evaluate the efficacy of intraligamentary dexamethasone injection in reducing post-endodontic pain among patients with symptomatic irreversible pulpitis. Methodology: A descriptive case series was conducted at the Department of Dentistry, Ibn-e-Siena Hospital, Multan, from October 2023 to April 2024. A total of 155 patients aged 18–65 years, presenting with irreversible pulpitis of less than seven days’ duration, were enrolled using non-probability consecutive sampling. After informed consent, all patients received a pre-operative intraligamentary injection of dexamethasone (0.4 mL) using a pressure syringe following standard anesthesia. Single-visit pulpectomy was performed 30 minutes post-injection by an experienced endodontist. Postoperative pain was assessed at six hours using a Visual Analogue Scale (VAS). Treatment success was defined as VAS < 3. Data were analyzed using SPSS v23, and chi-square test was applied to assess associations; p < 0.05 was considered significant. Results: Of the 155 patients, 72 (46.5%) were male and 83 (53.5%) were female, with a mean age of 38.6 ± 10.4 years. Successful pain control was achieved in 109 (70.3%) patients, while 46 (29.7%) experienced persistent pain (VAS ? 3). No statistically significant association was observed between treatment success and gender (p = 0.404), laterality (p = 0.928), or tooth location (p = 0.411). Conclusion: Preoperative intraligamentary injection of dexamethasone significantly reduced post-endodontic pain in patients with symptomatic irreversible pulpitis, with a success rate of 70%. Incorporating this approach into routine endodontic practice can enhance patient comfort and improve clinical outcomes.
creator: Sharina Naz
creator: Assad Jamil
creator: Saria Riaz
creator: Usman Mahmood
creator: Amara Nazir
creator: Amira Shahid
creator: Mustafa Sajid
rights: Copyright (c) 2025 Sharina Naz, Assad Jamil, Saria Riaz, Usman Mahmood, Amara Nazir, Amira Shahid, Afsheen Mansoor, Mustafa Sajid https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 554
ending page: 559
doi: 10.48036/apims.v21i3.1218

Comparison of Stent Patency, Biochemical and Clinical Improvement in Plastic Versus Metallic Biliary Stent for Palliation in Malignant Biliary Obstruction in a Developing Country Tertiary Hospital
type: item
description: Objective: To compare stent patency, biochemical, and clinical outcomes between partially covered self-expandable metal stents (SEMS) and plastic stents (PS) in patients with malignant biliary obstruction. Methodology: A prospective observational study was conducted at Faisalabad Teaching Hospital from January to June 2024. Sixty patients with malignant biliary obstruction confirmed by imaging and elevated bilirubin (?1.75 mg/dL) were included. Patients were allocated to PS or SEMS groups based on clinical judgment. ERCP was performed by experienced gastroenterologists. Outcomes assessed included stent patency, biochemical improvement, complications, and reintervention rates. Data were analyzed using SPSS v20 with t-test and Chi-square; p < 0.05 was considered significant. Results: The PS group included 30 patients (60% male; mean age 57.9 ± 7.9 years), and the SEMS group included 30 patients (66.7% male; mean age 55.7 ± 6.9 years). Pancreatic cancer was the most frequent diagnosis, followed by gallbladder cancer and cholangiocarcinoma. Post-procedural cholangitis was significantly higher in the PS group (80.0%) compared to SEMS (43.3%; p = 0.003). Stent dysfunction occurred in 63.3% of PS versus 33.3% of SEMS (p = 0.021). Mean stent patency was significantly longer with SEMS (190.5 ± 98.7 days) than PS (128.7 ± 54.3 days; p = 0.004). Biochemical improvement and symptom relief were superior in the SEMS group, with fewer reinterventions and shorter hospital stays. Conclusion: SEMS demonstrated better patency, lower complication rates, and improved clinical outcomes compared to PS, supporting their use as a more effective palliative option in malignant biliary obstruction, especially for patients with longer life expectancy.
creator: Uzair Muhammad
creator: Mughees Ather
creator: Hussain Tariq chattha
creator: Inam ul Haq
creator: Eraj Mehdi
rights: Copyright (c) 2025 Uzair Muhammad, Mughees Ather, Hussain Tariq chattha, Inam ul Haq, Eraj Mehdi https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 560
ending page: 564
doi: 10.48036/apims.v21i3.1414

Role of Diclofenac Suppositories in Pain Relief During the Postpartum Period
type: item
description: Objective: To compare the efficacy of rectal diclofenac suppositories and oral mefenamic acid in relieving pain during the postpartum period. Methodology: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Shifa International Hospital, Islamabad, from October 2024 to March 2025. A total of 170 postpartum women meeting inclusion criteria were randomly allocated to receive either rectal diclofenac (100 mg every 8 hours) or oral mefenamic acid (500 mg every 8 hours). Pain levels were assessed using the Visual Analog Scale (VAS) at baseline and 8 hours post-analgesic administration. Pain scores were compared among the two-group using independent sample t-test. A p-value of < 0.05 was considered statistically significant. Results: The results demonstrated significantly lower mean pain scores in the rectal diclofenac group (2.5 ± 1.1) compared to the oral mefenamic acid group (4.0 ± 1.5; p = 0.004). Both groups exhibited comparable baseline characteristics, including age, BMI, gestational age, and parity. No significant differences were observed in perineal trauma severity, labor duration, or mode of delivery. Conclusions: The rectal diclofenac has superior analgesic efficacy over oral mefenamic acid in the relief of postpartum pain. Given its effectiveness, safety, and ease of administration, rectal diclofenac is a promising option for managing postpartum pain, particularly when oral analgesics are less effective or poorly tolerated.
creator: Shaawana Ejaz
creator: Shazia Fakhar
creator: Manahil Jaffer
creator: Shama Munir Kayani
creator: Misbah Hanif
creator: Qurrat-ul-Ain
rights: Copyright (c) 2025 Shaawana Ejaz, Shazia Fakhar, Manahil Jaffer, Shama Munir Kayani https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 565
ending page: 570
doi: 10.48036/apims.v21i3.1478

Hypothyroidism in Patients with Non Alcoholic Fatty Liver Disease (NAFLD)
type: item
description: Objective: To determine the frequency of hypothyroidism in patients diagnosed with Non-alcoholic fatty liver disease (NAFLD) presenting at Liaquat University Hospital, Hyderabad. Methodology: A descriptive cross-sectional study was conducted over six months, from January to July 2023, in the Department of Medicine, Liaquat University Hospital, Hyderabad. Patients aged 20 to 60 years of either gender with a clinical diagnosis of NAFLD for at least three months were included. Each patient was evaluated for hypothyroidism through laboratory analysis of a 2cc venous blood sample, and relevant data were recorded using a predesigned proforma. Post-stratification associations were analyzed using chi-square test taking a p-value ? 0.05 as statistically significant. Results: An overall mean age of the patients was 39.56 ± 10.45 years, comprising 54.7% males and 45.3% females. Overall hypothyroidism was detected in 93 individuals (38.0%). Additionally post-stratification analysis showed that hypothyroidism was significantly more common among females (57.9%), rural residents (54.4%), patients with longer disease duration, hypertension, obesity and smokers (p-0.001), while no significant difference was found across different age groups (p = 0.93). Conclusion: A high frequency of hypothyroidism was observed among patients with NAFLD, suggesting a potential link between thyroid dysfunction and fatty liver disease.
creator: Sanober
creator: Abdul Ghani Rahimoon
creator: Kashif Shaikh
creator: Muhammad Nouman Shaikh
creator: Kuldeep Kumar
creator: Rizwan Channa
rights: Copyright (c) 2025 Sanober, Abdul Ghani Rahimoon, Kashif Shaikh, Muhammad Nouman Shaikh, Kuldeep Kumar, Rizwan Channa https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 571
ending page: 576
doi: 10.48036/apims.v21i3.1303

Assessment of Malnutrition Among Critically Ill Adults Admitted in the ICU of a Tertiary Care Hospital at Rawalpindi, Pakistan
type: item
description: Objective: To determine the prevalence and clinical implications of nutritional risk among critically ill adults admitted to the ICU at Fauji Foundation Hospital, Rawalpindi, Pakistan. Methodology: This prospective observational study enrolled 250 adult ICU patients admitted for 7–60 days between January 2023 and July 2023. Nutritional risk was assessed at admission and discharge using validated NRS-2002 and mNUTRIC scores, and MUAC was measured as an anthropometric indicator. Multivariate logistic regression analysis was performed to evaluate the association between nutritional risk markers and clinical outcomes, including mortality and length of stay (LOS). Results: Most patients (62.8%) were older than 40 years, with a majority being female (74%). A high prevalence of nutritional risk was observed at admission (62.4% by NRS-2002 and 27.2% by mNUTRIC), which increased to 69.6% and 88%, respectively, at discharge or death. MUAC showed a significant decline from admission to discharge (?2.10 cm in males and ?1.70 cm in females). The ICU mortality rate was 43%. Higher NRS-2002 scores (OR: 1.42; 95% CI: 1.13–1.77; p = 0.002) and mNUTRIC scores (OR: 2.85; 95% CI: 2.09–3.90; p < 0.001) at admission were independently associated with increased mortality. A decline in MUAC was also linked to higher mortality (OR: 1.26; 95% CI: 1.10–1.70; p = 0.007) and prolonged LOS (OR: 1.19; 95% CI: 1.01–1.40; p = 0.034). Conclusion: This study reveals a high prevalence of malnutrition (62.4%–69.6%) among ICU patients, which is strongly associated with adverse clinical outcomes. These findings underscore the need for routine nutritional screening using validated tools such as NRS-2002 and mNUTRIC, particularly in resource-limited settings, to enable early detection and timely interventions that can improve patient outcomes.
creator: Ayesha Nasir
creator: Mir Muhammad Hassan Bullo
creator: Abdul Samad Wadho
creator: Asma Afreen
creator: Saira Kanwal
creator: Syed Mujahid Gilani
rights: Copyright (c) 2025 Ayesha Nasir, .Mir Muhammad Hassan Bullo, Abdul Samad , Asma Afreen, Saira Kanwal, Syed Mujahid Gilani https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 577
ending page: 582
doi: 10.48036/apims.v21i3.1496

Role of Bedside Leukoreduction Filters in Mitigating Febrile Non-Hemolytic Transfusion Reactions in Thalassaemia Major Patients
type: item
description: Objective: To evaluate the clinical effectiveness of bedside leukoreduction filters in reducing the occurrence of febrile non-hemolytic transfusion reactions (FNHTRs) among patients with beta-thalassemia major, by comparing their frequency in patients receiving blood through a filter versus those without a filter. Methodology: A retrospective cross-sectional comparative study was conducted at the Thalassemia Centre in collaboration with the Blood Bank, Pakistan Institute of Medical Sciences, from January to March 2024. A total of 1,000 multi-transfused beta-thalassemia major patients with a history of FNHTRs were included and divided into two groups: 500 patients received blood through bedside leukoreduction filters, while 500 received non-filtered blood. Transfused red cell concentrates ranged in storage age from 2 to 14 days. Data were analyzed using SPSS Version 20, and the chi-square test was applied to compare the incidence of FNHTRs between the two groups. A p-value of <0.05 was considered statistically significant. Results: Among the 500 patients receiving bedside leukoreduced blood, 7 (1.4%) experienced FNHTRs during transfusion, presenting with symptoms such as fever, chills, cold extremities, abdominal pain, and facial flushing. In contrast, 49 (9.8%) patients receiving non-filtered blood developed FNHTRs (p < 0.001). Conclusion: The incidence of FNHTRs was significantly reduced with the use of bedside leukoreduction filters compared to non-leukoreduced blood. Implementing this simple and cost-effective strategy in resource-limited settings can help prevent transfusion reactions, improve patient and staff satisfaction, and reduce the risk of transfusion discontinuation, prolonged hospitalization, and extensive laboratory investigations.
creator: Sundas Ali
creator: Maha Tariq Kiani
creator: Amna Imtiaz
creator: Farwa Sijjeel
creator: Tazeen Anwar
creator: Farah Hanif
rights: Copyright (c) 2025 Sundas Ali, Maha Tariq Kiani, Amna Imtiaz, Farwa Sijjeel, Tazeen Anwar, Farah Hanif https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 583
ending page: 588
doi: 10.48036/apims.v21i3.1153

Umbilical Cord PRP Is Better in Relieving Pain in Patients of Knee Osteoarthritis as Compared to Autologous Venous PRP
type: item
description: Objective: To evaluate the effectiveness of umbilical cord blood platelet-rich plasma (CB-PRP) and autologous venous platelet-rich plasma (A-PRP) in the pain relief and knee functional improvement for patients with early-stage knee osteoarthritis (OA). Methodology: This observational study carried out in the Anesthesia Department of a CDA Hospital , a tertiary care hospital in Islamabad. Sixty patients with Kellgren-Lawrence Grade 1–2 knee OA were randomized into 2 groups with 30 patients in each group, in the CB-PRP and A-PRP group. Aseptically injected PRP into the joint. Outcomes included the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline, 4 weeks, 12 weeks, and 24 weeks. The analysis was done by SPSS statistical software (version 26). We considered p-value < 0.05 as statistically significant. Results: CB-PRP displayed significant improvement on VAS scores at all follow-ups compared with A-PRP (weeks 4: 3.69 ± 0.87 vs. 6.31 ±1.03 p < 0.001). KOOS scores at 24 weeks were also greater in the CB-PRP compared to the placebo group (75.12 ± 6.76 vs. 62.34 ± 7.12; p < 0.001). There was a steady improvement in WOMAC scores in both groups of patients, and a significant difference in favor of CB-PRP was found at 24 weeks (2.44 ± 0.73 vs 3.00 ± 0.71, p = 0.040). There were no significant adverse events. Conclusion: CB-PRP was more effective than A-PRP in pain reduction and functional improvement total scores in early knee OA.
creator: Muhammad Umer
creator: Muhammad Abdullah
creator: Liaqat Ali
creator: Khaleel Ahmad
creator: Komal Mumtaz
creator: Gul e Zahra
rights: Copyright (c) 2025 Muhammad Umer, Muhammad Abdullah, Liaqat Ali, Khaleel Ahmad, Komal Mumtaz, Syeda Gul e zahra https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 589
ending page: 594
doi: 10.48036/apims.v21i3.1506

Effects of Graded Dose of Sodium Benzoate on Ovaries of Adult Female Albino Wistar Rats
type: item
description: Objective: To determine the gross effects of graded dose dependent affects Sodium Benzoate on ovaries in adult female albino Wistar rats Methodology: This quasi-experimental study was conducted at the Animal House of Sindh Agriculture University, Tando Jam, using 30 adult female albino Wistar rats (150–200g), randomly divided into three groups: A (control), B, and C. Group A received a regular lab chow diet, while Groups B and C were fed chow mixed with sodium benzoate at doses of 300 mg/kg and 600 mg/kg body weight, respectively. Initial and final body weights were recorded. After the experiment, rats were anesthetized with chloroform and sacrificed using cervical dislocation. Ovaries were extracted, weighed, and preserved in 10% formalin for histological analysis using Hematoxylin and Eosin staining. Data were analyzed using SPSS version 26.0. Results: Ovarian weight was higher in the control group (0.065g) compared to group B (0.039g) and group C, (p > 0.05). Though, group C showed a significantly higher incidence of blood congestion (66.7%) than group B (25.0%) and the control group (8.3%) (p < 0.004). Cellular hypertrophy rat was significantly higher in group C (70.0%) compared to group B (30.0%) and the control group (0%) (p < 0.001). Oocyte degeneration was also significantly more common in group C (69.2%) than in group B (23.1%) and the control (7.7%) (p < 0.001). Additionally, vacuolation was observed in 61.5% of group C, 30.8% of group B, and only 7.7% of the control group (p < 0.001). Conclusion: Histological analysis indicated that sodium benzoate may have contributed to increased blood congestion, cellular hypertrophy, and vacuole formation within the ovarian tissue specifically at higher dose.
creator: Mansoor Mukhtar
creator: Zaheer Ahmed Memon
creator: Amir Derick Isaac
creator: Syna Pervaiz Singha
creator: Salahuddin Shaikh
creator: Farheen M
rights: Copyright (c) 2025 Mansoor Mukhtar, Zaheer Ahmed Memon, Amir Derick Isaac, Syna Pervaiz Singha, Salahuddin Shaikh, Farheen M https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 595
ending page: 601
doi: 10.48036/apims.v21i3.1484

Comparing the Effectiveness of Bite Wafers and Ibuprofen in Pain Management After Initial Orthodontic Arch-wire Placement
type: item
description: Objective: This study compares the effectiveness of ibuprofen and bite wafer use on pain reduction after initial archwire placement. Methodology: This study was conducted at the Department of Orthodontics, School of Dentistry, SZABMU, Islamabad. From October 2024 to March 2025. A total of 80 patients make up the sample (40 in each group). This comparative study involved patients who were placed under an arch wire and were randomly allocated by lottery method into two groups i.e. Ibuprofen Group (IBG) and Bite Wafer Group (BWG). Patients were given a bite wafer to chew on to relieve pain, or a 400 mg ibuprofen tablet to chew on at 8-hour intervals, for at least a week if pain persisted, after following all the study protocols. The pain intensity was assessed using a VAS questionnaire at home, and the results were analyzed at the end of the week. Results: Out of 80 patients, 40 were males & 40 were females aged between 14 and 25 years. An independent sample t test revealed that ibuprofen initially worked better than bite wafers at 2 and 24 hours (P=0.01). However, at the end of the week, or on the seventh day, the results were not statistically significant (P=0.477). However, both the groups were satisfied with the treatment offered. Conclusion: Bite-wafers showed similar reduction in pain score after initial arch-wire placement as compared to ibuprofen over the 7 days period. Thus, offering bite wafers as an alternative to analgesics may be a reasonable solution for patients experiencing pain during orthodontic treatment.
creator: Gulsanga Hassan Khan
creator: Najam Ul Hassan
creator: Zubair Ahmed
creator: Sundus Wahid
creator: Saad Saud
creator: Usman Mahmood
creator: Ghazanfar Gul
creator: Afsheen Mansoor
rights: Copyright (c) 2025 Gulsanga Hassan Khan, Najam Ul Hassan, Zubair Ahmed, Sundus Wahid, Saad Saud, Usman Mahmood, Ghazanfar Gul, Afsheen Mansoor https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 602
ending page: 607
doi: 10.48036/apims.v21i3.1521

Perinatal Outcomes in Women with Pre-eclampsia Having Raised Serum Uric Acid Levels
type: item
description: eclampsia who had elevated serum uric acid levels. Methodology: This descriptive study was conducted at the Department of Obstetrics and Gynecology, PAF Hospital Islamabad, Sarfraz Rafiqui Complex from Jan 2025 to Mar 2025. The study population was determined using the WHO calculator, considering the prevalence of pre-eclampsia in pregnancy as 25.9% in the local population, with a 95% confidence interval and a 0.08% margin of error. The calculated minimum sample size was 116. Participants were selected through consecutive non-random sampling. Data were collected on maternal demographics, serum uric acid levels, and perinatal outcomes. Statistical analysis was performed by means of SPSS version 23. Results: Among 116 women detected through pre-eclampsia, those through elevated serum uric acid levels had a higher incidence of adverse perinatal outcomes, including preterm birth, low birth weight, neonatal intensive care unit (NICU) admissions, and perinatal mortality. A statistically significant correlation was observed between raised serum uric acid levels and poor perinatal outcomes (p < 0.05). Conclusion: Elevated serum uric acid levels in females having pre-eclampsia were related through adverse perinatal results, including preterm birth, low birth weight, and increased NICU admissions. Routine monitoring of serum uric acid levels in pre-eclamptic pregnancies may help in early identification of high-risk cases, allowing for timely intervention to improve perinatal outcomes. Keywords: Pre-eclampsia, Serum Uric Acid, Perinatal Outcomes, Pregnancy, Hypertensive Disorders of Pregnancy, Maternal Health.
creator: Ayesha Nadar
creator: Mamoona Kauser
creator: Ramlah Ghazanfar
creator: Fatima Habib
creator: Rakhshanda Aslam
creator: Anam Saleem
rights: Copyright (c) 2025 Ayesha Nadar, Mamoona Kauser, Ramlah Ghazanfar, Fatima Habib, Rakhshanda Aslam, Anam Saleem https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 608
ending page: 612
doi: 10.48036/apims.v21i1.1525

Frequency and Characteristics of Hypothyroidism in Neonatal Intensive Care Unit Patients in a Tertiary Care Hospital
type: item
description: Objective: To Investigate frequency, clinical and laboratory profiles of hypothyroidism in neonates admitted to the Neonatal Intensive Care Unit (NICU) in a tertiary care hospital. Methodology: This Prospective, cross-sectional study Neonatology Department, Fatima Memorial Hospital, Lahore, from July 2024 to December 2024. A total of 200 neonates admitted in NICU were included using consecutive non-random sampling. Thyroid function was assessed through serum free T4 and TSH levels, with hypothyroidism diagnosed based on low free T4 or elevated TSH levels and clinical symptoms. Data were analyzed using SPSS 25.0, with statistical significance set at p < 0.05. Results: Among 200 neonates, 23 (11.5%) were diagnosed with congenital hypothyroidism (CH), while 33 (16.5%) exhibited subclinical hypothyroidism. Low free T4 levels were observed in 21 (10.5%) neonates, and high TSH levels in 36 (18%). Feeding intolerance was the most common clinical symptom noted in 52.5% of cases. Significant maternal factors associated with CH included gestational illness (p = 0.008), antenatal steroid use (p = 0.003), and multiple gestations (p = 0.027). Predominant neonatal risk factors were preterm birth (p < 0.001), cesarean delivery (p = 0.016), and intrauterine growth restriction (IUGR) (p = 0.044). The prevalence of hypothyroidism was higher in preterm (p <0.001) and low-birth-weight neonates (p = 0.191), highlighting the vulnerability of this subgroup. Conclusion: Congenital hypothyroidism is prevalent in NICU patients, particularly those born preterm or with low birth weight. Maternal and neonatal factors significantly influence the risk.
creator: Samiya Mehak
creator: Naila Kanwal
creator: Zahid Anwar
creator: Faiza Yasin
creator: Muhammad Usman
creator: Irshad Hussain
rights: Copyright (c) 2025 Samiya Mehak, Naila Kanwal, Tuhaira Haroon, Zahid Anwar, Faiza Yasin, Muhammad Usman, Irshad Hussain https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 613
ending page: 619
doi: 10.48036/apims.v21i3.1425

Revolutionizing Reproductive Health: A Narrative Review on the Role of AI in Transforming Infertility Care in Pakistan
type: item
description: The integration of artificial intelligence (AI) into infertility care is transforming the field of gynaecology, providing new solutions that improve diagnosis and treatment. AI technology is being used to increase the accuracy of fertility tests, personalized treatment plans, and more accurately predict outcomes. Intelligent models can measure important information such as hormone levels and ultrasound scans. This review explores how AI transforms patient treatment by decreasing diagnostic time and improving patient care and decision-making efficiency. Since there is a disconnect between male infertility, taken care of by urologists, and female infertility managed by gynaecologists, we want to bridge this gap through the use of AI in treatment. This article looks at the institutional and cultural constraints that frequently keep husbands from going to infertility consultations with their wives. Infertility is typically viewed as a woman&#39;s problem in our conservative settings, which means that she must endure years of treatment. Women continue to receive hormonal treatments until the male element is brought to light because there is an unwillingness on the part of men to get tested. AI can be used to develop treatment regimens that equally incorporate both parties. Current applications, challenges, and future directions of AI in Pakistan and low-resource settings highlight promising opportunities for alleviating the disparity between male and female infertility care. This descriptive review aims to explore the application of AI to improve medical care, provide personalized counseling, and increase diagnostic accuracy. However, the use of AI in infertility care also raises ethical, regulatory, and accessibility issues that must be addressed to ensure that AI is responsible and equitable.
creator: Samina Naeem Khalid
creator: Mohammad Abdullah Naveed
creator: Sabine Khan
creator: Areeba Memon
creator: Muhammad Mohsin Javaid
creator: Muhammad Rashid Ahmed
creator: Muhammad Farooq Umer
rights: Copyright (c) 2025 Samina Naeem Khalid, Mohammad Abdullah Naveed, Sabine Khan, Areeba Memon, Mansoor Kazi, Muhammad Mohsin Javaid, Muhammad Rashid Ahmed, Muhammad Farooq Umer https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 620
ending page: 627
doi: 10.48036/apims.v21i3.1486

Bone Marrow Involvement In Hodgkin’s lymphoma: Case Report
type: item
description: Hodgkin’s lymphoma is a malignant lymphoid neoplasm showing specific neoplastic cells and background of reactive non-neoplastic cells. Classical Hodgkin’s lymphoma involves germinal or post germinal center B-cells which are positive for CD15 and CD 30 immunophenotypically. Mixed cellularity classical Hodgkin’s lymphoma occurs in old age and is mostly seen in males. Extra nodal involvement is rare. Bone marrow involvement is considered as stage IV disease and it has poor prognosis. Here we present a unique case of CHL mixed cellularity with bone marrow infiltration showing three different patterns of infiltration.
creator: Hina Bilal
creator: Farva Raza
creator: Naseer Ahmed
rights: Copyright (c) 2024 Hina Bilal https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: 628
ending page: 630
doi: 10.48036/apims.v21i3.779

Doctor as a Role Model- Obstacles in its Way
type: item
creator: Nadeem Ikram
rights: Copyright (c) 2025 Nadeem Ikram https://creativecommons.org/licenses/by-nc/4.0
license: https://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-01
publication date: 2025-07-01
volume: 21
number: 3
starting page: i
ending page: ii
doi: 10.48036/apims.v21i3.1561