Anas Jahangir

Background: Barium swallow is an accessible, non-invasive test for dysphagia, especially in areas where endoscopy and manometry are less available, but the results are influenced by local factors like corrosive ingestion, and the data from South Punjab, Pakistan is limited. Objective: To describe the spectrum of barium swallow findings in dysphagia at a tertiary-care hospital and evaluate their association with corrosive ingestion. Methods: The study was retrospective cross sectional study, in which 120 consecutive patients aged ≥12 years who were referred for barium swallow for dysphagia were analysed from the electronic radiology reports from January to March 2026 at Nishtar Hospital Multan. Proportions are given with 95% Wilson confidence intervals (CI); associations were tested with Fisher’s exact test. Results: Most patients were female (66.7%) and aged ≤45 years (84.2%). Studies were normal in 46 (38.3%; 95% CI 30.1–47.3), showed a definite radiological abnormality in 65 (54.2%; 45.3–62.8) and were inconclusive in 9 (7.5%). The most frequent findings were extrinsic compression by cervical osteophytes (12.5%), caustic oesophageal stricture (12.5%), gastric outlet obstruction (10.0%), oesophageal web (6.7%), non-caustic stricture (5.0%) and suspected neoplastic lesion (5.0%) and suspected motility disorder (2.5%). None of the 24 patients with corrosive ingestion had a normal study (versus 47.9% without; p=2.2×10⁻⁶). Oesophageal stricture was seen in 12/12 patients following ingestion of bleach, and gastric outlet obstruction in 9/12 patients following ingestion of acid (p=0.0003). Endoscopy was recommended in 46.7%. Conclusion: Barium swallow revealed a definite radiological abnormality in more than half of the patients, mainly corrosive injury and compression of the cervical osteophytes, in this predominantly young group. Normal studies do not exclude disease, and further evaluation with endoscopy, with manometry if indicated, is important.

Background: Environmental decontamination is essential for infection prevention in operating theatres (OTs), yet terminology, evidence and implementation practices vary considerably. Objective: To review the efficacy, safety and implementation of traditional fumigation and contemporary no-touch decontamination technologies. Methods: A structured narrative search of PubMed/MEDLINE, Scopus and Google Scholar prioritised systematic reviews and OT-specific studies. Formal risk-of-bias and GRADE assessments were not performed. Results: Formaldehyde demonstrates broad-spectrum antimicrobial activity but presents substantial occupational health risks and prolonged environmental persistence. Vaporized hydrogen peroxide and aerosolized hydrogen peroxide are distinct technologies, with vaporized hydrogen peroxide having the strongest evidence base among gaseous approaches, although clinical findings remain variable. Ozone and chlorine dioxide demonstrate antimicrobial efficacy under laboratory conditions, but clinical evidence is limited and stringent safety measures are required. Ultraviolet-C has moderate supporting evidence as an adjunct to manual cleaning. Plasma air treatment and far-UVC require further evaluation, while photocatalytic coatings remain investigational. Clinical trials have not established a clear benefit for plasma air treatment. Conclusion: No single technology suits all OT settings. Selection should consider efficacy, safety, cost and institutional capacity, with manual cleaning remaining fundamental and automated technologies serving as adjuncts. Keywords: Fumigation, Operating Rooms, Communicable Disease Control, Hydrogen Peroxide, Decontamination, Ultraviolet Rays, Review

Background: Spinal anesthesia is widely used in lower limb, lower abdominal, and obstetric surgery due to its rapid onset, extensive sensory and motor blockade, and good analgesic effect. The most frequent complication associated with this method is intraoperative hypotension, which occurs due to sympathetic vasomotor blockade, venous pooling, decreased venous return, and compromised cardiac compensatory response. Obstetric patients may experience decreased organ perfusion during hypotensive episodes. Objective: The purpose of this narrative review is to present the causes, risk factors, manifestations, and interventions that have been shown to prevent and treat hypotension following spinal anesthesia. Methods: Articles were identified through a literature search of PubMed, Scopus, and Google Scholar for the years 2015 to 2026. Keywords used were spinal anesthesia, hypotension, prevention, and management. A total of 87 articles were screened, of which 45 articles were selected for inclusion in the review. Results: Factors associated with hypotension following spinal anesthesia can be grouped into patient-, procedure-, and drug-related factors. Patient factors include pregnancy, age, intravascular volume, and cardiac disease. Procedural factors include block height, local anesthetic dose, speed of injection, and positioning. Drug-related factors include the type of local anesthetic, vasoconstrictors, and adjuncts. Controlled crystalloid (electrolyte) fluid co-loading and early use of vasopressors, particularly phenylephrine or norepinephrine, are effective strategies for prevention. Continuous non-invasive hemodynamic monitoring can facilitate early identification of hemodynamic disturbances and support an appropriate response. The effects of spinal anesthesia-induced hypotension may be greatly reduced through appropriate management. Conclusion: Spinal anesthesia may cause hypotension primarily due to sympathetic blockade. Recognition of relevant patient-, procedural-, and drug-related factors, together with appropriate fluid management, early vasopressor use, and hemodynamic monitoring, can support its prevention and management. Keywords: Anesthesia, Spinal; Hypotension; Blood Pressure; Perioperative Care; Bradycardia; Hemodynamics; Patient Positioning; Fluid Therapy

Quercetin and curcumin are strong natural antibacterial and antioxidant compounds. However, their topical use is restricted due to their low stability, poor solubility, and insufficient skin penetration. The purpose of this study was to develop nanoethosomes loaded with curcumin and quercetin and assess their antibacterial efficacy, antioxidant activity, and physicochemical characteristics for topical administration. The ethanolic injection method was used to create the nanoethosomes, which were then characterized for entrapment efficiency, zeta potential, particle size, and polydispersity index (PDI). The DPPH assay was used to measure antioxidant activity, while zone of inhibition, MIC, and MBC studies were used to measure antibacterial efficacy against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. The findings indicated that the nanoethosomes loaded with quercetin had particle size of 128.7 ± 16.4 nm, PDI of 0.545 ± 0.05, and zeta potential of −34.8 ± 0.6 mV, whereas those loaded with curcumin measured 155.3 ± 1.2 nm, PDI 0.186 ± 0.07, and zeta potential −42.2 ± 0.3 mV. Curcumin's entrapment efficiency was 92.1 ± 2.1%, whereas quercetin's was 84.6 ± 1.8%. The curcumin-loaded nanoethosomes exhibited antibacterial activity against S. aureus, P. aeruginosa, and E. coli, with inhibition zones of 21.5 ± 1.1, 20.1 ± 0.9, and 22.3 ± 0.8 mm, respectively. Similarly, at 50 µg/mL, both formulations showed 65 and 54% inhibition of BSA protein denaturation, respectively. These results demonstrated strong antioxidant activity, high stability, excellent drug loading, and broad-spectrum antibacterial activity, underscoring their promise as secure and efficient topical delivery methods for natural medicines.

The gastrointestinal nematode Haemonchus contortus is a major economic and pathogenic challenge to livestock productivity worldwide. Extensive use of synthetic drugs like albendazole and ivermectin, the mainstays for controlling these infections, has resulted in the emergence and spread of anthelmintic resistance in gut nematodes. Hence, there is growing interest in plant-based alternatives that utilize secondary metabolites to disrupt parasite physiology. The present study was conducted to evaluate the anthelmintic activity of an acetone extract of Coriandrum sativum L. seeds against different developmental stages of H. contortus. The extract was characterized for chemical composition using high-performance liquid chromatography (HPLC). In vitro assays were conducted to evaluate the effects of the extract on adult worms, larvae, and eggs at concentrations of 0.5%, 1%, 2%, and 4%. Adult worm motility and mortality, larval migration and mortality, and egg hatchability were determined and compared with albendazole as positive control and distilled water as negative control. HPLC analysis revealed the presence of phenolic and related metabolites in the extract with quercetin identified at the highest concentration of 38.89 mg/g. The extract showed a significant dose- and time-dependent anthelmintic activity in all the parameters studied. The motility of adult worms at highest concentration (4%) was reduced to 6.33% after 12 hours and mortality was 100% within 48 hours. Similarly, larval migration was inhibited by 93.33% and larval mortality was 96.33% after 48 hours. Furthermore, egg hatchability was completely inhibited (0%) after 72 h of exposure to the 4% concentration. The effect of the extract at 4% was almost comparable to the commercial drug albendazole. The acetone seed extract of C. sativum displayed a potent natural anthelmintic activity against different developmental stages of H. contortus. These inhibitory effects may be related to the phenolic compounds identified in the extract. These findings suggest that further investigations should be conducted on the economic feasibility, sustainability, and scalability of C. sativum seed extract as a sustainable and cost-effective alternative for parasite management in livestock.

Background: Laparoscopic cholecystectomy has progressively replaced traditional open surgery due to its minimally invasive nature, reduced postoperative pain, faster functional recovery, and lower risk of surgical site infections. As surgical site infections continue to pose a significant burden on patient outcomes and healthcare systems, understanding how operative techniques influence infection rates remains clinically important. This study evaluates and compares infection-related outcomes associated with laparoscopic and open cholecystectomy, with the aim of strengthening evidence for surgical decision-making and improving postoperative care standards. Objective: To compare the frequency of surgical site infections and associated postoperative complications between laparoscopic and open cholecystectomy. Methods: A comparative cross-sectional study was conducted at Arif Memorial Teaching Hospital over four months. A total of 250 patients were enrolled, including 125 who underwent open cholecystectomy (Group A) and 125 who underwent laparoscopic cholecystectomy (Group B). Patients were followed for four weeks postoperatively and assessed weekly for superficial incisional, deep incisional, and organ-space infections using standardized clinical criteria. Data were analyzed using SPSS 2023, with frequencies, percentages, means, and standard deviations used to describe outcomes. Inferential statistical tests, including chi-square analysis, were applied to compare infection rates between groups. Results: Surgical site infections occurred in 10 patients in Group A and 6 patients in Group B. Incisional infections were identified in 6 patients in Group A compared with 3 patients in Group B. Organ-space infections were reported equally across groups, affecting 3 patients each. Male-to-female distribution was 60:65 in Group A and 50:75 in Group B. Mean ages were 38 ± 11.55 years in Group A and 37.5 ± 10.1 years in Group B. Conclusion: Laparoscopic cholecystectomy demonstrated a lower overall risk of surgical site and incisional infections compared with the open approach, while organ-space infections remained similar across both groups. These findings support the preference for laparoscopy when feasible, although open surgery remains essential in selected clinical situations.

Background: Diabetes mellitus is strongly linked with accelerated atherosclerosis, subclinical myocardial injury, and a high burden of cardiovascular complications. Individuals with Type 2 Diabetes Mellitus frequently present with atypical or silent ischemic symptoms, making timely diagnosis challenging and increasing the risk of delayed treatment. Electrocardiography and cardiac biomarkers offer valuable insight for early detection of myocardial stress, particularly in patients with poor metabolic control. Determining the relationship between glycemic status, ECG abnormalities, and troponin elevation is therefore essential for effective cardiovascular risk assessment in this high-risk population. Objective: This study aimed to determine the association between glycemic control (HbA1c), ECG abnormalities, and elevated troponin I levels in diabetic patients presenting with chest discomfort, and to evaluate whether poor glycemic regulation predicts myocardial ischemia or injury identifiable through ECG or cardiac biomarkers. Methods: A six-month cross-sectional analytical study was conducted in the Cardiology Department of CMARTH, enrolling 255 adults (≥18 years) with confirmed Type 2 Diabetes Mellitus presenting with chest pain. Patients with CKD stage ≥3, structural heart disease, non-diabetic status, or incomplete records were excluded. Data collection included 12-lead ECG interpreted independently by two physicians, HbA1c measurement categorized according to ADA criteria, and serum troponin I testing. Statistical analysis using SPSS version 23 involved descriptive statistics, Pearson correlation, and cross-tabulation to evaluate associations between glycemic status, ECG abnormalities, and troponin levels. Results: The mean age of participants was 63.03 ± 11.24 years, with female predominance (69.01%). ST depression was present in 26.7%, ST elevation in 22%, T-wave inversion in 24.3%, arrhythmias in 11.8%, and non-specific changes in 15.3%. Most patients (73.72%) had uncontrolled diabetes (HbA1c ≥ 6.5%). Elevated troponin I levels showed a significant positive correlation with poor glycemic control, indicating increased myocardial injury in metabolically uncontrolled individuals. Conclusion: Poor glycemic control was significantly associated with both elevated troponin I and ECG abnormalities in diabetic patients with chest pain, underscoring the need for routine cardiac screening and strict metabolic management to reduce cardiovascular complications.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare- and community-acquired infections worldwide, posing a significant challenge to effective treatment due to its multidrug-resistant nature. It commonly causes skin, wound, and bloodstream infections, and its rapid spread through direct contact or contaminated surfaces complicates infection control. The increasing antibiotic resistance of MRSA highlights the urgent need for ongoing surveillance and the rational use of effective antimicrobials such as vancomycin to limit morbidity and mortality associated with these infections. Objective: To determine the frequency and antimicrobial susceptibility pattern of MRSA isolated from various clinical specimens collected in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted at the Microbiology Laboratory of Arif Memorial Teaching Hospital, Lahore, from August 2024 to January 2025. A total of 149 clinical samples, including pus, blood, urine, and wound swabs, were collected using a convenient sampling technique after obtaining informed consent. Bacterial identification was performed through standard microbiological techniques, including Gram staining, catalase, and tube coagulase tests. Antimicrobial susceptibility testing was carried out using the Kirby–Bauer disc diffusion method following CLSI 2018 guidelines. MRSA detection was based on cefoxitin (30 µg) disc diffusion, with isolates showing a zone of inhibition ≤21 mm considered resistant. Data were analyzed using SPSS version 25. Results: Out of 149 patients, 75 (50.3%) were males and 74 (49.7%) were females. Positive bacterial growth was observed in 105 samples, yielding a culture positivity rate of 70.5%. S. aureus was the most frequent isolate (70.5%), predominantly from pus (43%) and blood (28.2%) specimens. All isolates exhibited complete resistance to penicillin (100%), while significant resistance was noted against levofloxacin (54.4%) and septran (53.7%). Conversely, maximum sensitivity was observed to vancomycin (100%), cefoxitin (57.7%), and linezolid (28.2%). The overall frequency of MRSA was recorded as 2.7%. Conclusion: The study confirms S. aureus as the leading pathogen in clinical infections, exhibiting widespread resistance to commonly used antibiotics but retaining high sensitivity to vancomycin. These findings emphasize the urgent need for rational antibiotic prescribing, regular resistance monitoring, and strict infection control measures to mitigate the rising threat of MRSA in healthcare settings.

Background: Surgical site infections (SSIs) continue to be a major postoperative complication, particularly in resource-limited healthcare settings. These infections significantly prolong hospitalization, increase morbidity, and escalate healthcare costs. Both Gram-positive and Gram-negative bacteria are implicated, and the rise of antimicrobial resistance has further complicated management. Accurate identification of pathogens and their resistance patterns is essential to guide empirical therapy and strengthen infection control practices. Objective: To identify Gram-positive and Gram-negative bacteria isolated from post-surgical patients and to evaluate their antimicrobial susceptibility patterns. Methods: A descriptive cross-sectional study was conducted in the Department of Microbiology, Arif Memorial Teaching Hospital, Lahore, from August 2024 to January 2025. A total of 104 clinical specimens, including pus, wound swabs, and blood samples, were collected using convenient sampling. Standard microbiological procedures such as Gram staining, colony morphology, catalase, coagulase, and biochemical assays were employed for bacterial identification. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method in accordance with CLSI 2018 guidelines. Data were analyzed using SPSS version 25, with frequencies and percentages calculated for isolates and resistance profiles. Results: Out of 104 collected specimens, 63 (60.6%) were culture-positive, while 41 (39.4%) showed no growth. Staphylococcus aureus was the predominant pathogen (23.1%), followed by Escherichia coli (19.2%), Enterobacter species (7.7%), Staphylococcus species (3.8%), Pseudomonas (1.9%), Proteus vulgaris (1.9%), and Klebsiella species (1.9%). Gram-positive isolates showed complete resistance to penicillin and ampicillin (100%) but full sensitivity to vancomycin (100%) and high sensitivity to linezolid (81.8%). Gram-negative isolates exhibited marked resistance to ceftazidime (96.0%), ciprofloxacin (82.4%), and levofloxacin (82.5%), whereas carbapenems such as imipenem (80.0%) and meropenem (74.3%) retained considerable efficacy. Conclusion: The findings highlight the coexistence of Gram-positive and Gram-negative organisms as major contributors to SSIs, with alarmingly high resistance to first-line antibiotics. Vancomycin, linezolid, and carbapenems remain effective therapeutic options. The results emphasize the urgent need for continuous surveillance, rational antimicrobial use, and stronger infection control strategies to reduce SSI-related morbidity.

Inflammatory Bowel Disease (IBD), which includes Crohn’s Disease (CD) and Ulcerative Colitis (UC), is a long-term condition caused by abnormal immune responses that lead to ongoing inflammation in the gut. Its roots are complex, involving a mix of genetics, environmental triggers, gut bacteria, and immune system issues. In recent years, the way we treat IBD has changed dramatically. We’ve moved beyond just managing symptoms with anti-inflammatory and immunosuppressive drugs. Now, we use biologic therapies—advanced treatments made from living cells that target specific parts of the immune system responsible for inflammation. A major breakthrough came with TNF-α inhibitors like infliximab and adalimumab. These drugs help many patients achieve remission, heal their intestinal lining, and feel significantly better overall. For those who don’t respond to these first-line options, newer treatments like vedolizumab (which targets integrins) and ustekinumab (which blocks interleukins IL-12 and IL-23) offer promising alternatives. Still, not everything is perfect. Some patients don’t respond to treatment right away, and others may stop responding over time, often due to their immune systems producing antibodies against the medication. When that happens, doctors might adjust the dose, switch to a different drug, or combine treatments to improve results. While many biologics affect the whole immune system, gut-specific drugs like vedolizumab offer a safer option for long-term use. Cost is another challenge, but biosimilars affordable versions of biologic drugs are making these treatments more accessible, especially in countries with limited healthcare resources. Even so, outcomes can differ from person to person based on how severe their disease is and how well they stick to their treatment plan. Looking ahead, the future of IBD treatment is all about personalized medicine. Scientists are working on finding biomarkers that can help predict which treatment will work best for each individual. New drugs, including small molecule therapies and more targeted biologics, are also on the horizon. Combining therapies may even become a strategy to improve results while minimizing side effects. In short, biologics have transformed the way we manage IBD, offering better disease control and improved quality of life. But research and innovation remain key to helping more people achieve lasting remission with fewer complications.