https://www.pjmhsonline.com/index.php/pjmhs/issue/feedPakistan Journal of Medical & Health Sciences2025-05-14T20:48:37+00:00PROF. ABDUL MAJEED CHAUDHRYnayyar@pjmhsonline.comOpen Journal Systems<p><strong><span style="color: #000080;"><span style="color: #0000ff;">PJMHS is a Double blind Peer-reviewed , open Access Monthly Journal </span></span></strong></p> <p><strong><span style="color: #000080;">ISSN (Online): 2957-899X <span style="color: #b8c6c7;">|</span> ISSN (Print): 1996-7195 </span></strong></p> <p>The <strong>Pakistan Journal of Medical & Health Sciences (PJMHS)</strong> is a monthly journal that publishes scholarly material (original paper, reviews, case reports, short communication, letter to editors, and editorial) based on the author's opinion and does not reflect official policy. All rights reserved. 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In case of doubt, a copy of the published material should be included with a manuscript to help the editors decide how to deal with the matter.</p> <p style="box-sizing: border-box; line-height: 1.785rem; margin: 1.43rem 0px 0px; color: rgba(0, 0, 0, 0.87); font-family: 'Noto Sans', -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen-Sans, Ubuntu, Cantarell, 'Helvetica Neue', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"><strong>Pakistan Journal of Medical & Health Sciences</strong> is published monthly from Basement Barkat Center, Royal Park, Lahore Pakistan</p>https://www.pjmhsonline.com/index.php/pjmhs/article/view/6153A Lesson to Scientists from the Prophet Ibrahim’s (Alayhi As-Salam) Miracle of “The fire that does not burn” 2025-05-07T22:03:11+00:00HÜSEYIN ÇAKSENhuseyincaksen@hotmail.com<p>Death by burning (also known as immolation) is an execution, murder, or suicide method involving combustion or exposure to extreme heat. It has a long history as a form of public capital punishment, and many societies have employed it as a punishment for and warning against crimes such as treason, heresy, and witchcraft. The best-known execution of this type is burning at the stake, where the condemned is bound to a large wooden stake and a fire lit beneath<sup>1</sup>. Burning at the stake practiced in Babylonia and ancient Israel and later adopted in Europe and North America. In England, the burning of heretics ended in 1612 with the death of Edward Wightman; the country’s last execution for heresy (by hanging) occurred in 1697. Burning at the stake for crimes other than heresy continued into the 18th century<sup>2</sup>.</p> <p> Currently, although self-immolation is seen in many parts around the world<sup>3-5</sup>, immolation is particularly common in India<sup>6</sup>. According to the World Health Organization, around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles<sup>7</sup>.</p> <p> The Prophet Ibrahim (Alayhi As-Salam [AS]) is accepted as the greatest ancestor by Judaism, Christianity and Islam. Ibrahim (AS) invited his tribe and the Babylonian ruler Nemrud to the religion of Allah, but they did not accept this invitation. He argued with Nemrud, who claimed divinity, but Nemrud was defeated by the evidence presented by Ibrahim (AS). Then, Ibrahim (AS) was thrown into a fire burning so big and so strong with a catapult by Nemrud. However, he miraculously survived the fire. The fire did not burn Ibrahim (AS) as a miracle, with Allah's permission, and the place where he fell turned into a rose garden<sup>8</sup>. Here, we discuss the Prophet Ibrahim’s (AS), miracle of “the fire that does not burn,” which contains some lessons for today's people including scientists, to draw attention to the importance of the prophets’ stories in the Quran.</p> <p>One-hundred and twenty-four thousand prophets came from the first Prophet Adam (AS), the first man, to the last Prophet Muhammad (Sallallahu Alayhi Wa Sallam)<sup>9</sup>. Historical events and lives of the prophets have been described through stories in the Holy Books so that people take lessons. There are more than one hundred stories in the Quran. One of the stories is about the Prophet Ibrahim (AS). The miracle of Ibrahim’s (AS) “the fire that does not burn” is described in detail in Surah <a href="https://www.theholyquran.org/?x=s_main&y=s_middle&kid=33&sid=21">Al-Anbiya</a> of the Quran<sup>10</sup>. Bediüzzaman Said Nursi<sup>11</sup>, the author of the Risale-i Nur Collection<sup>12</sup>, noted three subtle indications in the ayat 69 of surah Al-Anbiya (We said: “O fire! Be cool and a means of safety for Ibrahim), which is about Ibrahim’s (AS) miracle as follows: The first: Like other natural causes, fire does not act according to its own wishes and nature, blindly, but performs a duty under a command. Thus it did not burn Ibrahim (AS), because it was commanded not to burn him<sup>13</sup>.</p> <p><strong>The second:</strong> There is a degree of heat which burns through its coldness. That is, it has an effect like burning. Through the word, Be cool!, (One Quranic commentary [tafsir] states: If He had not said: Be cool!, it would have burnt him with its coldness) Almighty Allah is saying to the coldness: “Do not burn him with your coldness, the same as your heat!” That is to say, through its coldness, fire at that degree has an effect like burning. It is both fire and cold. In fact, in natural science there is a degree of fire, the state of “white heat,” the heat of which does not spread to its surroundings. It attracts the heat around it to itself and with this cold, freezes surrounding liquids such as water, in effect burning them through its cold. Thus, intense cold is a category of fire which burns through its cold. In which case, this intense cold is surely a part of Hell, for it contains all the degrees and sorts of fire<sup>13</sup>.</p> <p> The third: Just as there is an immaterial substance like belief which counters the effects of Hell-fire and affords protection against it, the armor of Islam, so there is a physical substance which protects against the effects of worldly fire. For as is required by the Name of All-Wise, this world is the abode of wisdom, and Almighty Allah carries out His works under the veil of causes. Therefore, the fire burnt neither Ibrahim’s body, nor his garments; He imbued them with a state which resisted fire. Thus, by this allusion, the ayat is in effect saying: “O nation of Ibrahim! Resemble Ibrahim, so that your garments may be your armor against fire, your greatest enemy both here and there. Clothe your spirit in belief in Allah, and it will be your armor against Hell-fire. Moreover, there are certain substances which Almighty Allah has hidden in the earth for you which will protect you from the evils of fire. Search for them, extract them, and clothe yourselves in them!” Thus, one of man’s important discoveries and a step in his progress was his finding a substance which fire does not burn; and he clothed himself in garments resistant to fire. So see how elevated, subtle, and fine a garment this ayat weaves on the loom of Hanifan Musliman, which will not be rent in all eternity<sup>13</sup>.</p> <p> Nomex is an inherently flame-retardant fabric having a meta-aramid chemistry and is predominantly used in military clothing systems to provide protection from intense heat and flame. Nomex has good thermal stability and does not melt with the fiber decomposing between 370-430 °C. When exposed to high heat fluxes, the Nomex fiber consolidates and thickens thus preventing exposure of skin to the incident heat flux and hence second and third degree skin burns<sup>14</sup>. DuPont was introduced commercially as papers and fibers in 1961. The trademark Nomex nylon was adopted in 1963<sup>15</sup>. Also, polybenzimidazole fibers offer improved flame resistance and retain its strength and flexibility after exposure to flame<sup>16</sup>. Recently, it was found that the blend of Nomex and carbon fibers showed the best flame resistance performance having a minor char length, minimum weight loss and no after-glow time<sup>17</sup>.</p> <p> Although Nomex was found in the 20<sup>th</sup> century, the Quran pointed out over 1,400 years ago that there is a non-combustible and protective substance against fire. The limit drawn and the target indicated of the ayat are much broader and higher than the current technology. The ayat encourages scientists to discover fabric that are resistant to temperature of up to 1,000 °C and even higher, because maximum flame temperature (in air, diffusion flame) of a wood-fired in which Ibrahim (AS) was thrown is 1,027 °C<sup>18</sup>.</p> <p> Furthermore, although Ibrahim (AS) was thrown from the catapult set up on a very high hill, he had no traumatic brain injury, injury to the abdominal or thoracic cavities, fractures or complex soft tissue injury with Allah's protection. So the ayat also encourages scientists to discover a fabric that has protective properties against both flame and high-energy trauma.</p> <p> In conclusion, the prophets’ lives have been described through stories in the Holy Books so that people including scientists take lessons. The Quran orders people to be like Ibrahim (AS): Put on the fireproof material shirt and clothe your soul with faith. They protect you from the evil of your greatest enemy, fire, both in this world and in the hereafter. Second, the Quran pointed out over 1,400 years ago that there is a non-combustible and protective substance against fire with the miracle of Ibrahim’s (AS) “the fire that does not burn.” Moreover, the Quran shows scientists goals that are more advanced than today's technology and encourages them to do scientific studies.</p>2025-04-05T00:00:00+00:00Copyright (c) 2025 HÜSEYIN ÇAKSENhttps://www.pjmhsonline.com/index.php/pjmhs/article/view/6154Pharmacological Strategies for Enhanced Recovery after General Surgery, Assessing the Efficacy and Safety of NSAIDs, Opioids, and Adjuncts2025-05-07T22:08:38+00:00MUHAMMAD RASHIDmohammad_rasheed@hotmail.comMUHAMMAD TAIMOOR SHAHno@no.comwqSALMA KAUSARno@no.comwq<p><strong>Background: </strong>Enhanced Recovery after Surgery (ERAS) protocols implement multimodal strategies aiming to improve the postoperative outcomes and to reduce the complications. Pharmacological pain management with NSAIDs, opioids and adjunctive agents is a major component, but comparative data on efficacy and safety are lacking for the most part in general surgical settings.</p> <p><strong>Aim: </strong>To assess and compare the efficacy and safety of NSAIDs, opioids and adjunct analgesics on improving postoperative recovery in patients undergoing general surgical procedures.</p> <p><strong>Methodology: </strong>It was a prospective comparative study on 79 patients who were undergoing elective general surgery. The patients were grouped into three groups based on the postoperative analgesia given: Group A (n=27 with NSAIDs, Group B (n=26 with opioids) and Group C (n=26 with adjuncts, such as paracetamol and gabapentinoids). Outcomes measured included pain scores (Visual Analog Scale), time to first ambulation, return of bowel function, length of hospital stay and adverse events such as nausea, renal impairment, respiratory depression, or gastrointestinal bleeding.</p> <p><strong>Result: </strong>NSAIDs provided good pain control and early bowel recovery with shorter hospital stay but had mild renal function alteration in 2 patients. The highest analgesia was noted in opioid recipients but there was a significantly higher frequency of nausea (23.1%) and delayed ambulation. The fewest side effects and moderate pain relief were seen with adjunct therapy, and good patient satisfaction, especially when used in a multimodal approach.</p> <p><strong>Conclusions: </strong>NSAIDs and adjunct analgesics were favorable to opioids in recovery and safety among 79 surgical patients. These agents could be incorporated into a balanced multimodal regimen to optimize recovery in general surgical patients without increasing opioid related complications. These findings are further validated by further large scale trials.</p>2025-04-05T00:00:00+00:00Copyright (c) 2025 MUHAMMAD https://www.pjmhsonline.com/index.php/pjmhs/article/view/6155Effect of Propolis on the Isolated Bacterial Infection on Covid-19 patient in Erbil City-Iraq2025-05-07T22:13:46+00:00SHLER QASIM HUSSIENshler.husien@epu.edu.iq<p><strong>Background:</strong> Propolis, a resin-like substance collected by honeybees, has long been known for its antimicrobial capabilities.</p> <p><strong>Aim: </strong>To explore the antibacterial potential of ethanolic propolis extracts (EEP) against bacterial isolates obtained from COVID-19-infected patients in Erbil, Iraq.</p> <p><strong>Methods:</strong> Clinical samples were obtained from 50 confirmed COVID-19 patients admitted to the Emergency Management Center (EMC) in Erbil. Standard microbiological methods were used for bacterial isolation and identification. Propolis extracts at a concentration of 1500 µg/mL were applied in wells on culture plates, and antibacterial activity was assessed by measuring zones of inhibition.</p> <p><strong>Results: </strong>Out of 50 samples, 39 yielded positive bacterial cultures while 11 showed no bacterial growth. Among the isolates, 7 were Gram-positive and 23 were Gram-negative. Klebsiella species were the most frequently isolated Gram-negative pathogens, followed by E. coli and Pseudomonas spp. Staphylococcus aureus was the dominant Gram-positive isolate. No methicillin-resistant S. aureus (MRSA) strains were detected. The study demonstrated variable inhibition zones in response to different EEP concentrations.</p> <p><strong>Conclusion:</strong> The ethanolic extract of propolis exhibited significant antibacterial effects against both Gram-positive and Gram-negative bacteria isolated from COVID-19 patients. The inhibition varied depending on bacterial species and EEP concentration.</p>2025-04-05T00:00:00+00:00Copyright (c) 2025 SHLER QASIM HUSSIENhttps://www.pjmhsonline.com/index.php/pjmhs/article/view/6156Blood Pressure Trends and Their Association with Cardiovascular Risk Factors in a Tertiary Care Population2025-05-07T22:19:39+00:00AMNA FAISALamnafaisal599@outlook.comFATIMA GHAFFARamnafaisal599@outlook.comHIRA AHMEDamnafaisal599@outlook.comKHADEEJA ASIFamnafaisal599@outlook.comHANAF BATOOL VIRKamnafaisal599@outlook.com<p><strong>Background:</strong> Cardiovascular disease is a major global problem due to hypertension, and this is especially true in low and middle-income countries. This is important as it helps identify its association with modifiable risk factors so that early interventions and prevention are possible.</p> <p><strong>Objective:</strong> In order to assess blood pressure trends and their relation with cardiovascular risk factors in a tertiary care population in Pakistan.</p> <p><strong>Methods:</strong> This was a cross-sectional study conducted at the University of Lahore Teaching Hospital during July 2023 to July 2024. Sixty adult patients were enrolled. AHA 2017 guidelines were followed for categorization of blood pressure. Demographics, BMI, diabetes status, lipid profile, smoking, and family history of CVD were collected. SPSS v25 was used for statistical analysis, including multivariate logistic regression.</p> <p><strong>Results:</strong> Hypertension was present in 60% of 60 subjects (mean age 51.3 ± 12.6 years). Hypertension was significantly associated with obesity (p=0.011), diabetes (p=0.042), smoking (p=0.045), and elevated LDL (p=0.004). Obesity (OR=2.74, p=0.024) and diabetes (OR=2.58, p=0.048) were found to be independent predictors by multivariate analysis.</p> <p><strong>Conclusion:</strong> Obesity and diabetes are closely associated with the high burden of hypertension in this population. Reduction of long-term morbidity is dependent on early identification and integrated cardiovascular risk management. The tertiary care and community health settings should prioritize a preventive strategy based on lifestyle modification.</p>2025-04-05T00:00:00+00:00Copyright (c) 2025 AMNA FAISAL, FATIMA GHAFFAR, HIRA AHMED, KHADEEJA ASIF, HANAF BATOOL VIRKhttps://www.pjmhsonline.com/index.php/pjmhs/article/view/6157Mortality Outcomes and Predictors of Failed Thrombolysis following STEMI Thrombolysis in a Non-PCI Capable Tertiary Hospital2025-05-07T22:38:06+00:00ADEEL AHMEDaadeel93@hotmail.comRIMSHA ALIrimshale97@gmail.comGHULAM FARIDcss_bcs@yahoo.comAHMAD SAQIBAhmadsaqib2014@outlook.comMUHAMMAD ALIMuhammadali8971@gmail.comMUHAMMAD MUNEEBMuhammed.muneeb@gmail.comZOHAIB AKRAMZohaib_akram86@hotmail.com<p><strong>Background:</strong> Thrombolysis is an essential treatment for ST elevation myocardial infarction (STEMI) in situations where primary percutaneous coronary intervention (PCI) is unavailable. This research examines mortality outcomes and determines predictors of unsuccessful thrombolysis in a tertiary hospital lacking PCI capabilities.</p> <p><strong>Methods:</strong> A retrospective analysis was conducted on 550 patients who received thrombolysis following STEMI at a non-PCI capable tertiary hospital from 2018 to 2023. Patient data, including demographics, clinical presentation, treatment protocols, and outcomes, were reviewed. Failed thrombolysis was defined as the absence of >50% resolution of ST-segment elevation within 90 minutes post-thrombolysis. Multivariate logistic regression analysis was used to identify predictors of failed thrombolysis.</p> <p><strong>Results:</strong> The mean age of the patients was 60 ± 10 years, with 70% being male. Thrombolysis was successful in 75% of cases, while 25% (138 patients) experienced failed thrombolysis. The in-hospital mortality rate was 12% for the overall cohort, but significantly higher at 30% among those with failed thrombolysis. Predictors of failed thrombolysis included advanced age (>65 years), delayed presentation (>6 hours from symptom onset), anterior infarction, and higher Killip class at presentation (III-IV). Multivariate analysis identified delayed presentation (OR 2.5, 95% CI 1.7-3.7) and anterior infarction (OR 3.1, 95% CI 2.1-4.5) as the strongest predictors of failed thrombolysis.</p> <p><strong>Conclusion:</strong> Failed thrombolysis following STEMI is associated with significantly higher mortality in a non-PCI capable tertiary hospital setting. Delayed presentation and anterior infarction are key predictors of thrombolysis failure, highlighting the need for early intervention and potential transfer to PCI-capable centers.</p>2025-04-05T00:00:00+00:00Copyright (c) 2025 ADEEL AHMED, RIMSHA ALI, GHULAM FARID, AHMAD SAQIB, MUHAMMAD ALI, MUHAMMAD MUNEEB, ZOHAIB AKRAMhttps://www.pjmhsonline.com/index.php/pjmhs/article/view/6178Audit of Inpatient Monitoring and Management of Hypoglycemia in Diabetic Patients Compared to National Guidelines2025-05-14T20:38:14+00:00ZEESHAN UMARsafdarsundas16@gmail.comHAFSA WAQARsafdarsundas16@gmail.comSYED HASSNAIN SHAHsafdarsundas16@gmail.comSALIHA WAZIRsafdarsundas16@gmail.comHAZRAT ULLAHsafdarsundas16@gmail.comSANA MUKHTIARno@no.comSAFI ULLAHno@no.comeJAMIL AHMADno@no.comKAINAT KHANno@no.comeHANIF ULLAH HANFIno@no.comSundas Safdarsafdarsundas16@gmail.comNAQEEB ULLAHno@no.come<p><strong>Background: </strong>Hypoglycemia is a serious and preventable complication in hospitalized diabetic patients, often resulting from treatment with insulin or insulin secretagogues. Effective inpatient monitoring and timely intervention are crucial for minimizing adverse outcomes.</p> <p><strong>Aims: </strong>To evaluate current inpatient practices for monitoring and managing hypoglycemia in diabetic patients at Lady Reading Hospital, Peshawar, and to compare these practices with National Guidelines for Management of Hypoglycemia in Hospitalized Patients.</p> <p><strong>Methods: </strong>A clinical audit was conducted from July to December 2024, reviewing 150 diabetic patient records with at least one hypoglycemic episode (blood glucose <70mg/dL). Data were collected using a structured proforma aligned with national standards and analyzed using SPSS v25.0. Parameters assessed included monitoring frequency, timeliness of treatment, reassessment, documentation, and preventive strategies.</p> <p><strong>Results: </strong>A total of 212 hypoglycemic episodes were recorded. While blood glucose rechecking within 30 minutes post-treatment showed 81.1% compliance, timely treatment initiation within 15 minutes was noted in only 33.5% of cases. Preventive measures and care escalation were documented in just 42% and 29.3% of cases, respectively.</p> <p><strong>Conclusion: </strong>Although some aspects of hypoglycemia management at LRH show acceptable adherence to guidelines, significant gaps remain, particularly in early intervention and documentation of preventive strategies.</p>2025-04-05T00:00:00+00:00Copyright (c) 2025 Sundas Safdar, ZEESHAN UMAR, HAFSA WAQAR, SYED HASSNAIN SHAH, SALIHA WAZIR, HAZRAT ULLAHhttps://www.pjmhsonline.com/index.php/pjmhs/article/view/6179A Clinical Audit on Appropriateness of Intravenous Fluid Prescribing Practices in Hospitalized Adult Inpatients: Evaluating Compliance with National Guidelines2025-05-14T20:48:37+00:00NAQEEB ULLAHtamanna.n.96@gmail.comZEESHAN UMARtamanna.n.96@gmail.comSYED HUSSAINI SHAHtamanna.n.96@gmail.comSYED HASSNAIN SHAHtamanna.n.96@gmail.comWAJID ALItamanna.n.96@gmail.comSANA MUKHTIARno@no.com SAJID NAWAZno@no.comTamanna Nazirtamanna.n.96@gmail.comHANIF ULLAH HANFIno@no.comeSHEEMA IQBALno@no.comZUBAIR AHMADno@no.come<p><strong>Background:</strong> Intravenous (IV) fluid therapy is a routine yet critical aspect of inpatient care, essential for maintaining fluid and electrolyte balance. However, inappropriate prescribing can result in significant morbidity.</p> <p><strong>Aim:</strong> To assess appropriateness of IV fluid prescribing practices among adult inpatients at Lady Reading Hospital, Peshawar & evaluate compliance with NICE CG174 guidelines.</p> <p><strong>Methods:</strong> A retrospective audit was conducted over six months (January–June 2024). Data were collected from 200 randomly selected patient records across general medicine, surgery, and orthopedics departments. A structured tool based on NICE guidelines was used to evaluate key parameters such as initial fluid assessment, documentation, reassessment, and fluid type. Data were analyzed using SPSS version 25.</p> <p><strong>Results:</strong> Only 48% of IV fluid prescriptions were fully compliant with NICE guidelines; 35% were partially compliant, and 17% were non-compliant. Documentation of initial assessment occurred in 70% of cases, while ongoing reassessment was documented in just 49%. General Medicine showed the highest compliance (55%), and Orthopedics the lowest (38%). Normal Saline was the most frequently prescribed fluid (65%).</p> <p><strong>Conclusion:</strong> The audit reveals suboptimal adherence to national guidelines, with notable interdepartmental variation. Targeted interventions, including staff training and standardized protocols, are recommended to enhance safe and effective fluid prescribing practices.</p>2025-04-05T00:00:00+00:00Copyright (c) 2025 NAQEEB ULLAH, ZEESHAN UMAR, SYED HUSSAINI SHAH, SYED HASSNAIN SHAH, WAJID ALI, SANA MUKHTIAR, SAJID NAWAZ, TAMANNA NAZIR, HANIF ULLAH HANFI, SHEEMA IQBAL, ZUBAIR AHMAD