Journal of Sheikh Zayed Medical College (JSZMC)

Coagulation Profile in Patients with Liver Disease: A Cross-Sectional Study from a Tertiary Care Hospital

Faiza Sarwar — 2025-08-11

Background: Liver disease is a major public health issue globally, and it significantly impacts coagulation due to the liver’s role in synthesizing clotting factors. Coagulopathy in liver disease increases the risk of bleeding and thrombosis, complicating clinical management. Despite its importance, data on coagulation profiles among patients with liver diseases are limited in Pakistan. Objective: To assess the frequency and severity of coagulopathy in patients with liver diseases presenting to Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, and to determine its association with disease severity. Methodology: A cross-sectional study was conducted from January to June 2024 at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. A total of 100 adult patients (≥25 years) diagnosed with various liver diseases were enrolled. Complete blood count (CBC), prothrombin time (PT), and activated partial thromboplastin time (aPTT) were assessed. Disease severity was evaluated using the Child–Pugh classification. Data were analyzed using SPSS version 25. Results: Of the 100 participants, 58% were male and 42% female. Thrombocytopenia was observed in 70% of patients, prolonged PT in 59%, and prolonged aPTT in 42%. Coagulopathy was more frequent in patients with higher Child–Pugh scores. Severe thrombocytopenia (<50,000/µL) was present in 34% of patients, while 26% had PT >18 seconds. Significant associations were found between coagulation abnormalities and disease severity (p < 0.05). Conclusion: This study demonstrates a high prevalence of coagulopathy in patients with liver diseases, especially in those with advanced liver dysfunction. Routine assessment of coagulation parameters should be integrated into the management of liver disease patients to guide clinical decision-making and improve outcomes.

Assessment of Personal Protective Equipment usage and Compliance to prevent Infectious Disease spread in a Tertiary Care Hospital setting

Sabir Hussain — 2025-08-19

Background: Healthcare workers (HCWs) face occupational infection risks, especially in high-risk environments, necessitating strict adherence to personal protective equipment (PPE) protocols to prevent transmission. Objective: To assess the usage and compliance with Personal Protective Equipment among healthcare workers in a tertiary care hospital. Methodology: This cross-sectional study enrolled 310 HCWs (doctors, nurses, allied health, and janitorial staff) via stratified sampling. Inclusion criteria: HCWs ≥18 years old, employed for≥6 months in clinical/support roles. Data collection included KAP surveys, direct observation of PPE practices, and compliance metrics. Independent variables were PPE type, frequency, and protocol adherence; compliance scores served as dependent variables. Statistical analysis used chi-square tests and logistic regression. SPSS version 26.0 was used for data analysis. Results: PPE compliance rates for masks were 255 (82.3%), gloves 242 (78.1%) and gowns 203 (65.5%). Doctors demonstrated the highest compliance at 80 (80%). Availability of PPE was also strongly associated with compliance (p<0.001). PPE availability significantly boosted compliance (adjusted OR 4.2; 95% CI 2.8–6.3), alongside training (OR 3.1; 95% CI 1.9–5.1) and high-risk departments (OR 2.5; 95% CI 1.6–3.9). High workload inversely related (OR 0.6; 95% CI 0.4–0.9). Barriers were discomfort/poor fit (45.2%), shortages (38.1%), inadequate training (28.1%), and low-risk perception (21.9%). Conclusion: PPE compliance among HCWs is suboptimal, influenced by resource availability, training, workload, and departmental risk. Prioritizing consistent PPE supply, training, and workload management is critical to reducing preventable infections and protecting HCWs.

Role of Narcissism, Mattering, and Social Support on Psychological Well-Being Of Medical Students

Ghulam Mujtaba Nasir — 2025-08-25

Background: Medical students often experience a peak in intellectual and emotional stress, which can greatly affect their psychological well-being (PWB).

Objective: To determine the impact of narcissism, social support, and a sense of belonging on psychological well-being in medical students.

Methodology: In this cross-sectional study, we included a total of 368 medical students from different Medical Colleges in South Punjab, Pakistan, from September 2024 to February 2025. The research used the General Mattering Scale (GMS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Ryff Scale of Psychological Well-being (PWB) scale, and the Narcissistic Personality Inventory (NPI) scale. Multiple regression analysis, together with correlation studies, served as statistical methods for evaluating PWB predictors. SPSS-26 was used for data analysis.

Results: Descriptive analysis revealed mean scores for PWB (87.92, SD = 11.40), NPI (5.03, SD = 2.90), MSPSS (4.75, SD = 1.17), and GMS (12.71, SD = 2.92). Correlation analysis indicated significant positive relationships between PWB and MSPSS (r = 0.401, p < 0.001), as well as GMS (r = 0.351, p < 0.001). Regression analysis showed MSPSS (β = 0.319, p < 0.001) and GMS (β = 0.268, p < 0.001) as significant predictors of PWB, while NPI was not significant (β = -0.076, p = 0.104).

Conclusion: The study data demonstrate that medical students achieve superior psychological well-being when they receive social support and feelings of belonging. Research experts suggest selected techniques to enhance social relationships and promote social attachment among people.

Frequency of Undiagnosed Gestational Diabetes Mellitus and its association with Maternal age and Parity

Sadia Shakir — 2025-08-11

Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder during pregnancy that poses significant risks to both mother and fetus if left undiagnosed. Despite known risk factors, routine screening practices remain inconsistent in many healthcare settings, particularly in low-resource areas. Objective: To determine the frequency of undiagnosed gestational diabetes mellitus among pregnant women consulting for antenatal care and to assess its association with maternal age and parity. Methodology: This cross-sectional study was conducted at the Gynecology & Obstetrics Outpatient Department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from June to December 2024. A total of 196 pregnant women between 24 and 28 weeks of gestation, with no prior diagnosis of diabetes, were enrolled using a consecutive non-probability sampling technique. GDM was diagnosed using the 75g oral glucose tolerance test (OGTT) and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Data on maternal age, parity, and BMI were collected and analyzed using SPSS. Chi-square tests and logistic regression were performed to determine associations, with p < 0.05 considered statistically significant. Results: The frequency of undiagnosed GDM was 29 (14.8%). Maternal age >30 years (p = 0.016; aOR = 2.0) and BMI ≥25 kg/m² (p = 0.031; aOR = 1.9) were significantly associated with GDM. Parity showed no statistically significant association (p = 0.140). Conclusion: Undiagnosed GDM is prevalent among pregnant women, with advanced maternal age and elevated BMI identified as significant independent risk factors. Targeted screening of high-risk groups is essential for early diagnosis and prevention of complications.

Association between antenatal care visits and birth preparedness among pregnant women

Rubina Atta — 2025-08-08

Background: Maternal mortality remains a significant public health concern, particularly in low- and middle-income countries. Antenatal care (ANC) plays a vital role in reducing maternal and perinatal morbidity and mortality by promoting birth preparedness and complication readiness. Despite the availability of services, many women still do not attend the recommended number of ANC visits or make adequate preparations for childbirth. Objective: To determine the association between antenatal care visits and birth preparedness among pregnant women and to identify socio-demographic factors influencing birth preparedness. Methodology: A cross-sectional analytical study was conducted at Bahawal Victoria Hospital, Bahawalpur, from January 2024 to December 2024. A total of 259 pregnant women with gestational age ≥28 weeks were enrolled using non-probability consecutive sampling. Data were collected through face-to-face interviews using a pre-tested structured questionnaire. Birth preparedness was assessed using the WHO BPCR module. Descriptive statistics and chi-square tests were used for analysis. Results: The mean age of participants was 26.7 ± 4.8 years. About 62.2% attended four or more ANC visits, and 64.5% had adequate birth preparedness. Women who attended ≥4 ANC visits were significantly more likely to be adequately prepared compared to those with fewer visits (82.0% vs. 35.7%, p < 0.001). Early initiation of ANC and higher maternal education were also significantly associated with better birth preparedness. Conclusion: Regular antenatal care attendance is strongly associated with improved birth preparedness. Efforts should focus on increasing ANC uptake and integrating birth planning education into routine maternal health services, especially for less educated and rural women.

Semaglutide Evolving Role: A Call for Broader Clinical Research in Pakistan

Mazhar Hussain — 2025-09-03

Diabetes mellitus is a chronic metabolic disorder and a growing global public health challenge, linked to numerous complications. According to the International Diabetes Federation (IDF) Diabetes Atlas, approximately 10.5% of adults (537 million people) were living with diabetes in 2021. This number is projected to increase to 11.3% (643 million) by 2030 and 12.2% (783 million) by 2045.^1,2 Pakistan ranks third globally in diabetes prevalence, with 33 million cases reported in 2022 and projections reaching up to 70 million by 2045. The country also holds the highest global comparative diabetes prevalence at 30.8% (IDF, 2021).³With rising obesity (BMI >25 kg/m²), the risk of type 2 diabetes increases sharply, and obesity-related diabetes is expected to affect 300 million people worldwide by 2025, highlighting the need for dual-targeted treatments.⁴

GLP-1 receptor agonists are a novel class of antidiabetic drugs that enhance insulin secretion, suppress glucagon, delay gastric emptying, and reduce appetite. They not only improve glycemic control and aid in weight loss but also show benefits for cardiovascular, renal, and metabolic health, with emerging potential in neurodegenerative diseases and certain cancers.⁵

Semaglutide was initially approved by the FDA for glycemic control in adults with type 2 diabetes mellitus (T2DM). Its notable weight reduction properties later led to a second FDA-approved indication for chronic weight management in both adults and adolescents.⁶ Following evidence of cardiovascular benefits, semaglutide received a third indication for reducing major adverse cardiovascular events (MACE) in adults with T2DM and established cardiovascular disease (CVD).⁷ More recently, the FDA approved semaglutide for slowing the progression of chronic kidney disease (CKD) and reducing cardiovascular death in patients with T2DM and CKD.⁸Additionally, semaglutide has now been approved for the treatment of metabolic dysfunction-associated steatohepatitis (MASH) in patients with stage F2–F3 fibrosis.⁹

The efficacy of semaglutide in diabetes management, particularly in reducing body weight, HbA1c levels, and MACE, has been well established through the SUSTAIN and PIONEER clinical trials.¹⁰ Additionally, the STEP trial demonstrated that a 20% reduction in body weight achieved with semaglutide led to significant improvements in diabetes-related comorbidities.¹¹ The FOCUS trial further highlighted the potential of semaglutide in addressing microvascular complications associated with diabetes.¹² Similarly, the FLOW trial showed that semaglutide significantly reduced the risk of heart failure events and cardiovascular death in patients with T2DM and CKD.¹³ Beyond diabetic populations, findings from the SELECT trial indicated that semaglutide improved kidney function and reduced microalbuminuria in overweight or obese individuals without diabetes.¹⁴

In addition, emerging studies support the potential role of semaglutide in the management of several non-metabolic and metabolic conditions, including Non-alcoholic Fatty Liver Disease (NAFLD), Heart Failure, Polycystic Ovary Syndrome (PCOS), Obstructive Sleep Apnea (OSA), Alcohol Use Disorder (AUD), Alzheimer’s disease, Acute Ischemic Stroke, Non-diabetic Chronic Kidney Disease, and Obesity-related asthma.¹⁵

In Pakistan, semaglutide is primarily recognized for its dual role as an antidiabetic and anti-obesity agent. However, data regarding its broader therapeutic potential both in diabetes management and in other comorbid conditions remains limited and underexplored. Research on its efficacy and safety profile is scarce, largely due to the high cost of the drug in the past. With the recent availability of both oral and subcutaneous formulations, and the introduction of new generic brands leading to a price reduction of over 70%, semaglutide has become more accessible. This presents a timely opportunity to initiate local studies evaluating both forms of semaglutide and to explore its multifaceted clinical benefits in the Pakistani population.