Pakistan BioMedical Journal

Diagnostic Accuracy of Contrast-Enhanced FLAIR MRI in the Diagnosis of Meningitis, Keeping CSF Analysis as the Gold Standard

2026-10-09T10:59:15+00:00

Meningitis is a potentially life-threatening inflammation of the meninges that requires prompt diagnosis to reduce neurological complications and mortality. Cerebrospinal fluid (CSF) analysis remains the reference standard, but contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging (CE-FLAIR MRI) may improve detection of meningeal enhancement and complement CSF assessment. Objective: To determine the diagnostic accuracy of CE-FLAIR MRI for meningitis using CSF analysis as the reference standard. Methods: This cross-sectional diagnostic accuracy study included 103 patients with suspected meningitis at MTI/Hayatabad Medical Complex, Peshawar, from May to November 2022. All participants underwent CE-FLAIR MRI and CSF analysis. Diagnostic performance was assessed using a 2 × 2 contingency table, and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated with 95% confidence intervals. Results: Among 103 patients, 61 were CSF-positive, and 42 were CSF-negative. CE-FLAIR MRI identified 55 true-positive, 34 true-negative, 8 false-positive, and 6 false-negative cases. Sensitivity was 90.2% (95% CI: 80.2–95.4), specificity 81.0% (66.7–90.0), PPV 87.3% (76.9–93.4), NPV 85.0% (70.9–92.9), and overall accuracy 86.4% (78.5–91.7). CE-FLAIR MRI showed a strong association with CSF-confirmed meningitis (Cramer’s V = 0.717, p<0.001). Conclusions: CE-FLAIR MRI showed good diagnostic performance and may serve as a useful non-invasive adjunct to CSF analysis in suspected meningitis; however, it should not replace CSF assessment where lumbar puncture is feasible.

Comparison of Propofol Dexmedetomidine with Propofol Ketamine for Anesthesia during Endoscopic Retrograde Cholangiopancreatography

2026-10-13T15:09:05+00:00

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a complex endoscopic procedure. The combination of Propofol with dexmedetomidine or ketamine is commonly used, but the comparative efficacy and safety of these combinations remain a topic of debate. Objective: To compare the effects of propofol-dexmedetomidine versus propofol-ketamine for anesthesia in patients undergoing ERCP. Methods: This prospective cohort study was conducted at Fatima Memorial Hospital from 20 December 2025 to 20 June 2026. Consecutive sampling was used to select 150 ERCP patients, who were further allocated to two groups: propofol-dexmedetomidine (n=75) and propofol-ketamine (n=75). Baseline characteristics, hemodynamic parameters, total propofol dose, recovery time, adverse events, and satisfaction scores were measured. Data were analyzed using SPSS version 26.0, and the p-value ≤0.05 was regarded as significant. Results: Propofol-dexmedetomidine achieved greater reductions in intra-procedural heart rate and BP (all p<0.001), shorter recovery time (p<0.001), and higher endoscopist and patient satisfaction (p=0.006 and p=0.018). A higher incidence of bradycardia (p=0.005) and hypotension (p=0.016) was seen with dexmedetomidine, while more propofol was used with propofol-ketamine (p<0.001) and more excessive secretions (p=0.031) and agitation/emergence reactions (p=0.034). There was no significant difference in crude incidence of ≥1 MAE (p=0.051). Conclusions: Propofol-dexmedetomidine allowed for better procedural conditions and satisfaction, and propofol-ketamine allowed for better hemodynamic stability. Each patient should be assessed based on their risk profile and the requirements for their procedure.

Role of Triphasic Computed Tomography in Evaluation of Hepatic Lesions: Comparative Cross-Sectional Study

2026-10-14T15:09:23+00:00

Focal hepatic lesions may be benign or malignant and can be difficult to characterize with ultrasound alone. Multiphase contrast-enhanced computed tomography provides dynamic information about lesion vascularity and enhancement, which can improve lesion characterization and guide further management. Objectives: To determine the diagnostic accuracy of triphasic computed tomography (TPCT) in differentiating benign from malignant hepatic lesions using fine-needle aspiration cytology (FNAC) as the reference standard. Methods: A comparative cross-sectional study was conducted among 136 patients with focal hepatic lesions. All patients underwent triphasic computed tomography (TPCT), and fine-needle aspiration cytology (FNAC) was used as the reference standard. TPCT findings were compared with FNAC results to determine sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy. Results: Out of 140 enrolled patients, 136 had complete data available for the final analysis. TPCT classified 31 (22.8%) lesions as benign and 105 (77.2%) as malignant, whereas FNAC classified 29 (21.3%) as benign and 107 (78.7%) as malignant. The contingency table showed 104 true positives, 28 true negatives, 1 false positive, and 3 false negatives. Overall diagnostic accuracy was 97.1%. Conclusions: In this single-centre cohort, TPCT demonstrated high diagnostic accuracy for distinguishing benign from malignant focal hepatic lesions. Its high sensitivity and specificity support its value as a non-invasive diagnostic modality, although findings should be validated in larger multi-centre studies.

Comparison of Early Outcome of Arteriovenous Fistula for Dialysis Access among Diabetic and Non-Diabetic Patients: A Comparative Prospective Observational Study

2026-10-14T15:09:16+00:00

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, but early maturation failure and postoperative complications remain important concerns. Diabetes mellitus may affect vascular remodeling and has been considered a potential risk factor for adverse AVF outcomes, though evidence remains inconsistent. Objective: To compare the early outcomes of AVF creation for hemodialysis access among diabetic and non-diabetic patients. Methods: This comparative prospective observational study was conducted at the Department of Cardiovascular Surgery, Ayub Teaching Hospital, from April 2025 to March 2026. A total of 254 patients undergoing AVF creation were included through non-probability consecutive sampling. Patients were grouped according to diabetic status. Early outcomes assessed included AVF maturation, thrombosis, infection, hematoma formation, and AVF failure. Data were analyzed using the chi-square test and independent-samples t-test, with p≤0.050 considered significant. Results: Mean age was 48.3 ± 17.8 years; 117 (46.1%) patients were diabetic, and 137 (53.9%) were non-diabetic. Early maturation occurred in 56.4% of diabetic and 54.7% of non-diabetic patients (p=0.742). Thrombosis (45.3% vs 44.5%, p=0.881), infection (49.6% vs 53.3%, p=0.571), and AVF failure (46.2% vs 46.7%, p=0.932) were comparable between groups. Hypertension, smoking, and radiocephalic fistula type showed significant association with AVF failure. Conclusions: Early AVF outcomes were comparable between diabetic and non-diabetic patients. Diabetes was not significantly associated with poorer early AVF outcomes in this cohort.

Preterm Birth Frequency among Women with Risk Factors Presenting at 28–34 Weeks and Receiving Oral Micronized Progesterone: A Prospective Single-Arm Study

2026-10-14T05:43:24+00:00

Preterm birth (PTB) remains a major cause of neonatal morbidity and mortality. Evidence regarding oral progesterone in women presenting with risk factors later in gestation remains limited. Objectives: To determine the frequency of PTB before 37 completed weeks among women presenting at 28–34 weeks with risk factors for PTB and receiving oral micronized progesterone. Methods: This prospective single-arm study included 100 women aged 18–40 years with singleton pregnancies at 28–34 weeks and a previous spontaneous PTB, cervical length <25 mm, or both. Oral micronized progesterone 100 mg was given twice daily until 36+6 weeks or delivery. Participants were followed until delivery. Data were analyzed using IBM SPSS Statistics version 26.0. Quantitative variables were summarized as median and interquartile range. Categorical variables were reported as frequencies and percentages. Mann–Whitney U and Fisher exact tests were used where appropriate. Results: Median age was 30.0 years and median cervical length was 23.4 mm. PTB occurred in 15 (15.0%) women (95% CI: 8.6–23.5), while 85 (85.0%) delivered at term. Five (5.0%) delivered before 34 weeks and 10 (10.0%) at 34 to <37 weeks. Median gestational age at delivery was 38.2 weeks. Compliance was good in 93 (93.0%) women. Twenty women reported adverse effects, with one recorded adverse effect per affected participant. Conclusion: PTB occurred in 15.0% of women receiving oral micronized progesterone, while 85.0% reached term gestation.

Role of Academia and Research Institutions in Advancing Indigenous Vaccine Development

2026-10-09T10:59:14+00:00

Research and academic institutions play a vital role in advancing the development of indigenous vaccines. The self-driven research and production of vaccines that suit national or regional public health needs reduces reliance on imports and enhances self-reliance, which is particularly important for developing countries [1].

These institutions contribute at many stages of the development of vaccines. Their work includes pathogen isolation and characterization, antigen discovery, and the development of platform technologies, including inactivated, recombinant, and subunit approaches. Their involvement may extend to early-stage clinical trials and immunological data that support vaccine research. Collaboration with industry provides another way by which vaccine research can progress from laboratory development to large-scale manufacturing [2].

Training of candidates for vaccine research encompasses skills development with a focus on affordable biopharmaceuticals and vaccines. Universities and research institutions can contribute in terms of discovery, clinical trial infrastructure, and specialized scientific expertise. Collaboration between academia, industry, and government can further support the movement of research towards product development [1].

Comparable roles for public research institutions can be seen in other countries. In Brazil, institutions such as Fiocruz (Bio-Manguinhos), together with partnerships involving universities, have supported technology transfer, local production of COVID-19 vaccines, and efforts to develop indigenous vaccine platforms, including mRNA approaches. These activities have also been linked to wider efforts to reduce dependence on external vaccine supply. In other low- and middle-income countries, research institutions contribute to vaccine research, scientific training, and collaborations intended to address pathogen strains and logistical needs relevant to their own settings [3].

For Pakistan, strengthening domestic vaccine production is particularly relevant because of the country’s heavy dependence on imported vaccines. Approximately 90–95% of the vaccines used in the national immunization program are reported to be imported. Such dependence may increase exposure to global supply disruptions, higher procurement costs, and potential vaccine shortages during pandemics or other emergencies [4].

Overall, academic and research institutions are particularly important during the early stages of vaccine development, when evidence must be generated for subsequent regulatory and policy decisions, including those made through bodies such as India’s NTAGI. Academic and research institutions also contribute to training the next generation of vaccinologists and to maintaining the scientific capacity needed to respond to emerging infectious threats. Academic research alone, however, is not sufficient. Its contribution to indigenous vaccine development depends on continued funding, supportive policy, and effective links with industry. Together, these factors can strengthen domestic vaccine capacity, improve access to vaccines, and support preparedness for future public health emergencies.