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Background and objectives Oral mucosal variations, though significant in the aging population, remain under-researched regarding their prevalence and characteristics in local Pakistani population. This study aimed to investigate the prevalence of normal oral mucosal variations in the elderly population, providing insights to aid clinicians and researchers. Methodology This cross-sectional, observational, descriptive study was conducted over four months, from December 2023 to March 2024, in the Department of Oral Medicine at HITEC Institute of Medical Sciences (IMS) Dental College, Taxila, Pakistan. A total of 385 male and female patients over 60 years of age were examined. Of these, 250 patients met the inclusion criteria. All patients underwent extraoral and intraoral examinations by a consultant in dental medicine with five years of clinical experience. Diagnoses were made following the World Health Organization's Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases. Results Among the N = 143 female patients, approximately 33% (n = 47) exhibited age-related oral mucosal variations, while 23.4% (n = 25) of the N = 107 male patients showed such variations. The most prevalent variation was a coated tongue, found in 8.3% (n = 12) of females and 5% (n = 6) of males, followed by depapillated n = 6 (4.2%) and fissured tongues n = 3 (2.8%) respectively. Sublingual varices were the least common, occurring in 1.4% (n = 2) of females and 1.8% (n = 2) of males. Conclusion This study highlights the prevalence of normal age-related mucosal alterations and their gender predispositions, which can facilitate the development of future health strategies to improve oral health and promote informed care practices., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Review Committee at HITEC Institute of Medical Sciences (IMS) Dental College, Taxila, Pakistan issued approval Dental/HITEC/IRB/64. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Malik et al.)

Background: Cardiovascular diseases (CVDs), especially coronary artery disease (CAD), are a major health burden, and their incidence is rising in countries like Pakistan., Objective: The objective of this research was to assess the prevalence and association of cardiovascular risk factors with CAD in Pakistani adults., Methodology: The research was carried out from January 2023 to December 2023 at the Pakistan Institute of Medical Sciences (PIMS) Islamabad and Shifa International Hospital Islamabad, Pakistan, using a cross-sectional design. Based on predefined criteria, 320 individuals who were Pakistani nationals and over the age of 18 years old were included. Those having a history of congenital heart disease, pregnancy, significant comorbidities, coronary artery bypass grafting (CABG), or percutaneous coronary intervention (PCI) were excluded. Medical, lifestyle, and demographic data were collected, and clinical evaluations were carried out by qualified healthcare workers. The data was analyzed using descriptive statistics and relevant statistical tests. A p<0.05 was statistically significant., Results: The study investigated cardiovascular risk factors and demographic traits in 320 adult Pakistanis. The majority of participants (n=181; 56.56%) were male and aged between 18 and 45. University education was predominant (n=170; 53.13%). Specifically, 147 participants (45.94%) had dyslipidemia, 74 (23.12%) had diabetes mellitus, and 112 (35.0%) had hypertension. Diabetes mellitus (OR: 9.60, 95% CI: 4.52-20.38, p<0.001), dyslipidemia (OR: 1.88, 95% CI: 1.29-2.75, p=0.001), and hypertension (OR: 2.67, 95% CI: 1.72-4.15, p<0.001) showed significant correlations with CAD. Poor socioeconomic status (OR: 3.00, 95% CI: 1.31-6.89, p=0.009) and genetic propensity (OR: 2.00, 95% CI: 1.02-3.92, p=0.040) were also significantly associated with CAD., Conclusion: Our study highlights diabetes as strongly linked to CAD in Pakistani adults, while socioeconomic status emerges as a significant predictor., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board and Ethics Committee of Shifa International Hospital and Hospital Ethics Committee of Pakistan Institute of Medical Sciences issued approval 028-22 and ECPIMS/22/13. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khan et al.)

Background: Community-acquired pneumonia (CAP) poses a significant global health challenge, even more so for children less than five years old. Nutritional interventions, such as zinc and vitamin A supplementation, are gaining attention for their therapeutic potential in enhancing recovery and minimizing pneumonia severity in pediatric patients., Objective: To assess the therapeutic benefits of zinc and vitamin A supplementation in pediatric CAP patients under five years old and to advocate for their use in clinical settings., Methodology: Three groups were formed in a randomized controlled trial conducted from October 2022 to September 2023, to address zinc and vitamin A supplementation in pediatric patients under five years old in the intensive care unit with severe pneumonia. Group 1 received zinc supplementation, group 2 received vitamin A supplementation, and group 3 served as the control group, receiving antibiotic treatment exclusively for pneumonia. This treatment comprised either a β-lactam (amoxicillin-clavulanate, commonly referred to as Augmentin) administered orally at 500 mg/125 mg three times a day, Augmentin 875 mg/125 mg orally twice daily, or Augmentin 2000 mg/125 mg orally once daily. Additionally, the control group received a macrolide (azithromycin or clarithromycin) or doxycycline at a dosage of 100 mg orally twice daily.   Linear regression analysis identified statistically significant decreases in both length of hospital stay and active pneumonic effusion., Results: The study encompassed 90 pediatric pneumonia patients with an age range of six to 55 months. Multiple linear regression analysis showed that both vitamin A and zinc led to a significant decrease in hospitalization length by 2.39 days (p < 0.01, 95% CI: 4.19-0.47) and 3.17 days (p < 0.01, 95% CI: 5.19-1.31), respectively. In comparison to the control group, both the vitamin A and zinc supplementation groups were linked to a shorter pneumonic effusion duration (p < 0.001)., Conclusion: Both interventions significantly reduced the duration of hospitalization (2.39 days for vitamin A and 3.17 days for zinc) and pneumonic effusion compared to the control group. These findings highlight the potential of zinc and vitamin A as valuable additions to standard CAP treatment regimens, potentially leading to improved clinical outcomes and reduced healthcare burdens., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Atta et al.)

Background: Extended-spectrum β-lactamase (ESBL) producing organisms are resistant to a wide range of broad-spectrum antibiotics, and their emergence is a significant driving force of antibiotic resistance. Most South-Asian countries have become hotspots for antibiotic resistance, so specifics of ESBL data are critical to tackling antibiotic resistance. We present the temporal changes in ESBL-producing organisms cultured in our tertiary care referral centre., Methods: Over a year, a historical cohort analysis was carried out at our tertiary care referral centre in Southeast Asia. Samples from patients presenting with acute surgical conditions were sent for culture and sensitivity. The phenotype of all specimens was checked using the combination disc method. Antimicrobial susceptibilities to various antibiotics were also checked as per CLSI (Clinical and Laboratory Standard Institute) guidelines., Results: Specimens from 170 patients were analysed. The mean age was 44.73±19.89 years, and there was a female predominance of 62%. The most common organisms were Escherichia coli (70%), Klebsiella pneumoniae (18%), and Pseudomonas aeruginosa (16%). The percentage of ESBL-producing organisms was 54.7%, which is significantly higher than in previous reports. Widespread resistance was found against commonly used antibiotics, including co-amoxiclav (81.9%), ceftriaxone (75%), ciprofloxacin (47%), and levofloxacin (35.7%). Sensitivities to combination antibiotics like piperacillin-tazobactam (79.2% sensitive), cefoperazone-sulbactam (84.3% sensitive), and imipenem-cilastatin (91.1% sensitive) were also noted to be falling., Conclusion: The incidence of ESBL-producing organisms continues to increase at an alarming rate, which mandates strict antibiotic stewardship and amendments to local guidelines., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Zahid et al.)

Background:  In adults, lymph nodes are not normally palpable. A number of patients with asymptomatic lymphadenopathy never visit physicians for the condition, and thus, this important sign is often missed by the medical practitioner if it is not the presenting complaint. The incidence of lymphadenopathy is suggested to be increasing. While lymphadenopathy is benign and self-limiting in most patients, the underlying disease may range from treatable infectious etiology to malignant neoplasms. In most cases clinical examination and history guide towards the cause of lymphadenopathy. In recent years, fine needle aspiration cytology (FNAC) has become an easy clinical tool (with or without the assistance of CT, MRI, and ultrasound) for the diagnosis of the underlying cause of lymphadenopathy., Aims and Objectives:  To find out the cytomorphological pattern in superficial lymphadenopathy with the help of FNAC., Materials and Methods:  This descriptive cross-sectional study was conducted at HBS General Hospital, Islamabad from January 2017 to June 2019. Patients presenting with superficial lymphadenopathy were included in the study. FNAC was performed by the pathologist, histopathological reports were examined and analyzed using Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY).  Results: Six hundred and thirty-two patients underwent FNAC. Tuberculous lymphadenitis was the most common diagnosis (56.1%) followed by reactive hyperplasia (28.29%). The sample showed metastatic malignancy 3.36% and lymphoma 2.05%. Cervical lymphadenopathy was the most common site for TB (49.36%). Metastatic cancer observed in cervical lymph nodes was 3.16% and lymphoma was 1.74%., Conclusion:  FNAC is recognized as a simple and safe diagnostic technique that can diagnose cases of superficial and deep lymphadenopathy easily. The most common cause of superficial lymphadenopathy in our study was tuberculosis with cervical lymph nodes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Islam Sheikh et al.)