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Link Medical Interface, Lahore, Pakistan
© The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Effects of Latissimus Dorsi–Fascia Stretching, Lower Trapezius Strengthening, and Sham Control on Pain and Function in Thoracolumbar Dysfunction: A Randomized Clinical Trial
Background: Chronic mechanical low back pain is commonly associated with pain, disability, restricted lumbar mobility, and thoracolumbar dysfunction. Altered thoracolumbar fascia mobility, posterior-chain restriction, and impaired postural muscle control may contribute to persistent symptoms, supporting the need for targeted rehabilitation strategies. Objective: To compare the effects of latissimus dorsi–thoracolumbar fascia stretching, lower trapezius strengthening, and sham control on pain intensity, functional disability, and lumbar range of motion in adults with chronic mechanical low back pain associated with thoracolumbar dysfunction. Methods: This three-arm randomized clinical trial included 198 participants allocated equally into latissimus dorsi–thoracolumbar fascia stretching, lower trapezius strengthening, and sham control groups, with 66 participants in each group. Pain intensity, Oswestry Disability Index, and lumbar range of motion were assessed at baseline and after intervention. Between-group differences were analyzed using inferential statistics, with significance set at p < 0.05. Results: Pain decreased most in the latissimus dorsi–thoracolumbar fascia stretching group, from 7.42 ± 0.63 to 3.91 ± 0.84, compared with 7.43 ± 0.71 to 4.53 ± 0.91 in the lower trapezius strengthening group and 7.41 ± 0.64 to 6.43 ± 0.74 in the sham control group. Oswestry Disability Index improved from 53.66 ± 6.38 to 35.14 ± 7.12, 53.31 ± 6.61 to 39.23 ± 7.03, and 54.25 ± 6.22 to 48.59 ± 6.77, respectively. Lumbar range of motion increased from 41.22 ± 6.61 to 55.83 ± 7.39, 42.05 ± 6.04 to 53.94 ± 6.08, and 41.45 ± 5.69 to 45.73 ± 5.91, respectively. Between-group differences were significant for all outcomes (p < 0.001). Conclusion: Latissimus dorsi–thoracolumbar fascia stretching produced the greatest improvement in pain, disability, and lumbar mobility, followed by lower trapezius strengthening, while sham control showed limited benefit. Targeted thoracolumbar rehabilitation may be clinically useful for chronic mechanical low back pain associated with thoracolumbar dysfunction
Chronic Mechanical Low Back Pain; Thoracolumbar Dysfunction; Latissimus Dorsi; Thoracolumbar Fascia; Lower Trapezius; Oswestry Disability Index; Randomized Clinical Trial.
Copyright (c) 2025 Muhammad Tahir Akram, Fatima Zehra, Sehrish Aslam, Mahrukh Siddiqui, Ashok kumar, Bharoz Shakeel, Umar Ali (Author) https://creativecommons.org/licenses/by/4.0
Effect of a Proprioceptive Neuromuscular Facilitation-Based Physiotherapy Program on Nerve Function and Disability in Leprosy Patients with Peripheral Neuropathy: A Randomized Controlled Trial
Background: Leprosy-related peripheral neuropathy can persist after multidrug therapy and may result in sensory loss, muscle weakness, neuropathic pain, deformity, disability, and reduced functional independence. Proprioceptive Neuromuscular Facilitation (PNF) may enhance neuromuscular recruitment and functional movement control, but evidence in leprosy-related neuropathy remains limited. Objective: To evaluate the effect of a PNF-based physiotherapy program on nerve function, disability, and pain in patients with leprosy-related peripheral neuropathy. Methods: A multi-center, single-blinded, parallel-group randomized controlled trial was conducted in specialized leprosy and rehabilitation centers in Karachi, Pakistan. Eighty adults with leprosy-related peripheral neuropathy were randomized into a PNF-based physiotherapy group (n=40) or conventional physiotherapy group (n=40). The intervention was delivered for 12 weeks. Outcomes included motor strength using the Medical Research Council scale, disability using the SALSA scale, and pain using the Visual Analogue Scale. Results: At 12 weeks, the PNF group showed significantly better motor strength than controls (3.91 ± 0.74 vs 3.56 ± 0.53; mean difference 0.35; p=0.018), lower disability scores (32.75 ± 5.54 vs 41.44 ± 4.31; mean difference −8.69; p<0.001), and lower pain intensity (1.98 ± 0.62 vs 4.05 ± 0.69; mean difference −2.07; p<0.001). Conclusion: PNF-based physiotherapy produced superior improvements in motor strength, disability, and pain compared with conventional physiotherapy and may be integrated into leprosy rehabilitation protocols.
Leprosy; Peripheral Neuropathy; Proprioceptive Neuromuscular Facilitation; Physiotherapy; Disability; Pain
Copyright (c) 2025 Muhammad Tahir Akram, Fakher ud din, Rimsha taimuri, Dr. M Shahmir khan, Eraj Fatima, Israr Ali Haider, Dr. Umar Ali (Author) https://creativecommons.org/licenses/by/4.0
Azadirachta indica -Mediated Synthesis of Iron Oxide Nanozymes with Superior Peroxidase-Like Catalytic Efficiency
Background: Metal-based nanomaterials with natural enzyme-like activity, nanozymes are gaining popularity as alternatives to biological enzymes due to their superior stability and cost-effectiveness. The catalytic efficacy of iron oxide nanozymes may be diminished by aggregation during chemical production. Objective: This study aimed to synthesize iron oxide nanozymes using Azadirachta indica leaf extract and compare their structural composition and OPD–H₂O₂ peroxidase-like catalytic activity with chemically synthesized nanozymes. Methods: Iron oxide nanozymes were synthesized using chemical co-precipitation and Azadirachta indica-mediated green synthesis. The synthesized materials were characterized by scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Peroxidase-like activity was evaluated using oxidation of o-phenylenediamine (OPD) in the presence of hydrogen peroxide(H2O2). Kinetic parameters were estimated using Michaelis–Menten analysis. Results: Green-synthesized nanozymes showed comparatively reduced aggregation and lower residual chlorine signal than chemically synthesized nanozymes. Azadirachta indica-mediated nanozymes generated the maximum absorbance at 451 nm in the OPD–H2O₂ assay, suggesting more peroxidase-like activity. Kinetic analysis revealed that green-synthesized nanozymes had a higher Vmax and a roughly 5.4-fold higher Vmax/Km-based catalytic effectiveness than chemically synthesized nanozymes. Conclusion: Iron oxide nanozymes with enhanced catalytic performance were generated by Azadirachta indica-mediated synthesis, most likely as a result of phytochemical-assisted stabilization and surface modification. Before biosensing or environmental usage, additional phase characterization, replicate-based validation, and application-specific testing are needed
Green synthesis; Azadirachta indica; iron oxide nanozymes; peroxidase-like activity; OPD oxidation; catalytic efficiency
Copyright (c) 2025 Zahid H Shar, Muqadus Abbasi, Nusrat N Memon, Anoosha Maryam, Pawan Kumar, Pirah Ismail, Pirah Zahir (Author) https://creativecommons.org/licenses/by/4.0
Barriers to Spinal Cord Injury Rehabilitation in Low-Resource Settings: A Critical Narrative Review and Conceptual Synthesis
Background: Spinal cord injury is associated with long-term disability, secondary complications, reduced participation, and substantial dependence on rehabilitation services. In low- and middle-income countries, rehabilitation access remains constrained by fragmented service delivery, limited workforce capacity, financial barriers, weak referral systems, and poor community-based support. Although previous literature has described individual barriers to rehabilitation, less attention has been given to how these barriers interact across the continuum of care. Objective: To critically synthesize evidence on barriers to spinal cord injury rehabilitation in low-resource settings and develop a conceptual framework explaining how multi-level barriers influence access, continuity, participation, and outcomes. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and CINAHL. Literature published between January 2010 and March 2026 was considered. Eligible sources examined spinal cord injury rehabilitation or directly relevant disability rehabilitation services in low- and middle-income countries, with focus on access, service delivery, continuity, barriers, or outcomes. Evidence was synthesized thematically across system-level, service-level, socioeconomic, and patient-level domains, with particular attention to transition points across the rehabilitation pathway. Results: Twenty-two studies/sources were included in the narrative synthesis. The evidence consistently showed that rehabilitation barriers operate cumulatively rather than independently. System-level constraints, including policy gaps, limited financing, and workforce shortages, contributed to restricted service availability and weak referral pathways. Service fragmentation, high out-of-pocket costs, transport barriers, limited community-based rehabilitation, low awareness, stigma, and poor adherence further disrupted continuity of care, especially during transitions from acute care to rehabilitation and from institutional rehabilitation to community reintegration. Conclusion: Spinal cord injury rehabilitation in low-resource settings is best understood as a pathway-level systems challenge. Effective reform requires integrated rehabilitation planning, structured referral and discharge systems, community-based rehabilitation expansion, financial protection, and context-specific strategies to reduce geographic and social inequities
Spinal cord injury; rehabilitation; low-resource settings; low- and middle-income countries; access to care; neurorehabilitation; health systems; community reintegration
Copyright (c) 2025 Sidra-Tul-Muntaha, Mansoor Ahmad, Muhammad Adnan, Iqra Javed, Muqaddas Yaqoob, Areesha Tanveer, Warda Khan, Etisam Wahid, Shahzad Ahmad, Ayesha Nisar (Author) https://creativecommons.org/licenses/by/4.0
Sonographic Findings of Myocardial Infarction in Obese Hypertensive and Obese Non-Hypertensive Patients on Echocardiography
Background: Obesity and hypertension are major cardiovascular risk factors that may worsen myocardial remodeling and functional impairment after myocardial infarction. Echocardiography provides a non-invasive method for assessing structural and functional cardiac abnormalities in high-risk patients. Objective: To compare echocardiographic findings between obese hypertensive and obese non-hypertensive patients with myocardial infarction. Methods: This cross-sectional observational study included 103 obese patients with myocardial infarction who underwent echocardiographic assessment at Combined Military Hospital, Lahore. Participants were categorized as hypertensive or non-hypertensive, and echocardiographic abnormalities were analyzed across hypertension status, age group, and gender using frequency distributions, cross-tabulation, chi-square tests, and effect-size estimates. Results: Of 103 participants, 54 (52.4%) were hypertensive and 49 (47.6%) were non-hypertensive; 69 (67.0%) were male and 34 (33.0%) were female. The most frequent echocardiographic findings were left ventricular hypertrophy in 17 participants (16.5%), mitral regurgitation in 16 (15.5%), and increased left ventricular wall thickness in 12 (11.7%). The overall distribution of echocardiographic findings did not differ significantly by hypertension status, χ²(11) = 16.550, p = 0.122, or gender, p = 0.662. Age group was significantly associated with gender distribution, p = 0.018. Conclusion: Obese patients with myocardial infarction demonstrated a notable burden of echocardiographic abnormalities, particularly left ventricular hypertrophy, mitral regurgitation, and increased left ventricular wall thickness. Hypertensive patients showed selected numerical differences, but overall echocardiographic patterns were not statistically different from non-hypertensive patients.
obesity, hypertension, myocardial infarction, echocardiography, left ventricular hypertrophy, cardiac remodeling
Copyright (c) 2025 Arifa Mobeen, Amtullah Ansari, Minahil Kiran, Minahil Shabbir, Areesha, Pakeeza Nadeem, Shanza Shahid, Wajiha Zafar (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Postural Awareness Session in Reducing Neck Pain Among Allied Health Sciences Students
Background: Neck pain is a prevalent musculoskeletal disorder among university students, particularly in Allied Health Sciences, due to prolonged study hours, poor posture, and extensive digital device use. Educational interventions focusing on postural awareness have shown potential in reducing musculoskeletal symptoms, but evidence in this specific population remains limited. Objective: To evaluate the effectiveness of a structured postural awareness session in reducing neck pain and associated symptoms among undergraduate Allied Health Sciences students. Methods: A quasi-experimental pre–post interventional study was conducted among 45 students aged 18–25 years with neck pain. Participants underwent baseline assessment using the Numeric Pain Rating Scale (NPRS) and a structured questionnaire evaluating posture-related behaviors and symptoms. A standardized 30–40 minute postural awareness session was delivered, and outcomes were reassessed after two weeks. Paired sample t-tests were used to compare pre- and post-intervention scores, with p < 0.05 considered statistically significant. Results: Mean NPRS scores significantly decreased from 5.89 ± 2.09 to 3.04 ± 1.59 (p < 0.001), with a mean difference of −2.85 and a large effect size (d = 1.52). Significant reductions were also observed in pain after prolonged sitting, neck stiffness, headache frequency, and mobile-related pain (p < 0.001). Awareness of proper posture improved significantly (p = 0.001), while behavioral and ergonomic changes were not statistically significant (p > 0.05). Conclusion: A single postural awareness session significantly reduced neck pain and improved awareness among Allied Health Sciences students; however, sustained behavioral change may require longer-term, multifaceted interventions
Neck pain, postural awareness, ergonomics, students, musculoskeletal disorders, NPRS.
Copyright (c) 2025 Nasir Mehmood, Tooba Rafique, Asma Arshad, Sawera Rafiq, Muneeba Shahzad, Laiba Ali (Author) https://creativecommons.org/licenses/by/4.0
A Community-Based Randomized Controlled Trial on Weekly Vitamin D₃ Supplementation for Prevention of Seasonal Respiratory Illness in Transit Workers
Background: Seasonal respiratory illnesses contribute substantially to morbidity, absenteeism, and reduced productivity among transit workers because of their repeated exposure to commuters in crowded occupational environments. Vitamin D has immunomodulatory effects that may reduce respiratory infection susceptibility, but evidence from pragmatic high-exposure occupational settings remains limited. Objective: To evaluate the effect of weekly high-dose vitamin D₃ supplementation on the incidence, frequency, duration, and severity of seasonal respiratory illness among transit workers. Methods: A community-based randomized placebo-controlled trial was conducted over four months in Industrial and Urban Core Punjab. Seventy-two transit workers were randomized to weekly oral vitamin D₃ 50,000 IU or matching placebo, and 68 completed follow-up. Baseline serum 25-hydroxyvitamin D was measured, and participants were followed weekly using symptom diaries and structured interviews. Respiratory illness incidence, number of episodes, illness duration, and WURSS-21 severity scores were compared between groups. Results: Respiratory illness occurred in 14/34 participants receiving vitamin D₃ and 25/34 receiving placebo (41.2% vs 73.5%; RR=0.56; 95% CI: 0.36–0.88; p=0.01). Vitamin D₃ also reduced mean episode frequency (0.62 ± 0.70 vs 1.18 ± 0.90; p=0.02), duration (3.4 ± 1.2 vs 5.1 ± 1.6 days; p<0.001), and WURSS-21 severity score (28.6 ± 8.9 vs 41.3 ± 10.5; p<0.001). Conclusion: Weekly vitamin D₃ supplementation significantly reduced respiratory illness burden among transit workers and may serve as a practical adjunctive preventive strategy in high-exposure occupational settings
Cholecalciferol; Occupational Health; Respiratory Tract Infections; Supplementation; Transit Workers; Vitamin D Deficiency; Workplace Exposure.
Copyright (c) 2025 Fatima Khan, Munkishey Ali, Farkhunda Naz, Sohail Afsar Awan, Tanzeel u Rehman, Shazia Ilyas (Author) https://creativecommons.org/licenses/by/4.0
Role of Chronic Psychological Stress Biomarkers in Triple-Negative Breast Cancer Progression
Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with limited therapeutic targets and variable disease progression. Emerging evidence suggests that chronic psychological stress and its biological correlates, particularly cortisol and inflammatory markers, may influence tumor behavior through psychoneuroimmunological pathways. Objective: To evaluate the association between chronic psychological stress, serum cortisol, C-reactive protein (CRP), and disease severity in patients with TNBC. Methods: A cross-sectional study was conducted over four months in the Islamabad–Rawalpindi region, including 72 histopathologically confirmed TNBC patients. Participants were categorized into early-stage (I–II) and advanced-stage (III–IV) groups. Serum cortisol was measured using enzyme-linked immunosorbent assay, and CRP levels were assessed via high-sensitivity assays. Psychological stress was evaluated using the Perceived Stress Scale (PSS-10). Statistical analysis included independent t-tests and Pearson correlation, with significance set at p < 0.05. Results: The mean age of participants was 48.6 ± 10.2 years. Advanced-stage patients exhibited significantly higher cortisol (21.3 ± 5.2 µg/dL vs. 15.4 ± 4.1 µg/dL, p < 0.001) and CRP levels (8.2 ± 2.9 mg/L vs. 5.1 ± 2.4 mg/L, p < 0.001) compared to early-stage patients. Psychological stress scores were also elevated in advanced disease (24.1 ± 5.7 vs. 17.9 ± 4.8, p < 0.001). Positive correlations were observed between stress scores and cortisol (r = 0.52, p < 0.001), stress scores and CRP (r = 0.47, p < 0.001), and cortisol with CRP (r = 0.44, p < 0.01). Conclusion: Chronic psychological stress and its associated biomarkers were significantly associated with advanced TNBC, suggesting a potential role of psychoneuroimmunological mechanisms in disease progression. Integrating stress assessment into cancer care may provide additional clinical value
Breast Neoplasms; C-Reactive Protein; Cortisol; Disease Progression; Psychoneuroimmunology; Stress, Psychological; Triple Negative Breast Neoplasms
Copyright (c) 2025 Sajida Memon, Fareeha F Khan, Zainab Tanveer, Ayesha Khalid, Asad Hassnain, Amir Ali, Dua Jabbar (Author) https://creativecommons.org/licenses/by/4.0
Ultrasound-Tuned Antimicrobial Hydrogel–Coated Urinary Catheters Reduce Catheter-Associated Urinary Tract Infection: A Randomized Controlled Trial
Background: Catheter-associated urinary tract infection remains a frequent healthcare-associated infection, largely driven by microbial adhesion and biofilm formation on catheter surfaces. Conventional antimicrobial coatings have shown inconsistent effectiveness because of passive release kinetics and declining activity over time. Objective: To compare catheter-associated urinary tract infection rates between ultrasound-tuned antimicrobial hydrogel–coated urinary catheters and standard uncoated silicone catheters. Methods: This prospective parallel-group randomized controlled trial enrolled 60 hospitalized adults requiring indwelling urinary catheterization for at least 72 hours. Participants were allocated equally to an ultrasound-tuned antimicrobial hydrogel–coated catheter group or a standard catheter group. The intervention group received daily low-intensity ultrasound activation, while both groups received standardized catheter care. The primary outcome was clinically assessed and microbiologically confirmed catheter-associated urinary tract infection. Secondary outcomes included urine colony count, time to infection onset, symptomatic infection, and adverse events. Results: Catheter-associated urinary tract infection occurred in 1/30 participants (3.3%) in the ultrasound-tuned hydrogel group and 5/30 participants (16.7%) in the standard catheter group, representing an absolute risk reduction of 13.4 percentage points and an estimated relative risk of 0.20. Mean urine colony count was lower in the intervention group (2.1 × 10⁴ ± 0.8 × 10⁴ CFU/mL) than in the control group (6.7 × 10⁴ ± 1.9 × 10⁴ CFU/mL; p = 0.01). No catheter-related or ultrasound-associated complications were reported. Conclusion: Ultrasound-tuned antimicrobial hydrogel–coated catheters were associated with reduced infection risk and bacterial burden during short-term inpatient catheterization.
Antimicrobial Coatings; Catheter-Associated Urinary Tract Infection; Hydrogels; Ultrasound Therapy; Urinary Catheters; Randomized Controlled Trial.
Copyright (c) 2025 Danial Aziz, Zarina Naz, Muhammad Ishaque Mujeeb Rehman, Muhammad Zakria, Muhammad Rizwan, Akif Saeed Ch, Syeda Hadia Qudrat (Author) https://creativecommons.org/licenses/by/4.0
Effect of Long-Term Soft Contact Lens Wear on Corneal and RNFL Parameters Assessed by Optical Coherence Tomography
Background: Long-term soft contact lens wear is associated with ocular surface alterations and corneal changes; however, its relationship with posterior segment parameters, particularly retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography, remains insufficiently understood. Objective: To evaluate the impact of long-term soft contact lens wear on ocular surface parameters, central corneal thickness, and OCT-derived RNFL measurements, and to assess potential associations between RNFL thickness and clinical variables. Methods: This comparative cross-sectional study included 200 myopic adults divided into 100 long-term contact lens users and 100 non-wearers. All participants underwent tear break-up time, Schirmer test, and Ocular Surface Disease Index assessment, along with OCT measurement of central corneal thickness and RNFL thickness. Group comparisons were performed using independent t-tests, while Pearson correlation and multiple linear regression analyses assessed associations. Results: Contact lens users demonstrated significantly reduced tear break-up time (7.28 ± 2.18 vs 11.00 ± 2.14 seconds), lower Schirmer scores (13.06 ± 4.12 vs 18.08 ± 5.17 mm), and higher OSDI scores (29.38 ± 10.10 vs 14.40 ± 6.99) (all p < 0.001). Central corneal thickness was also lower (518.11 ± 20.15 vs 536.49 ± 17.77 µm, p < 0.001). Average RNFL thickness was reduced in contact lens users (95.85 ± 7.85 vs 100.01 ± 8.18 µm, p < 0.001), with similar reductions across all quadrants. No significant correlations were observed between RNFL thickness and duration of lens wear or ocular surface parameters. Conclusion: Long-term soft contact lens wear is associated with significant ocular surface compromise and corneal thinning, alongside modest reductions in OCT-derived RNFL measurements that are not explained by exposure duration or surface parameters, suggesting potential influence of confounding factors.
Contact lenses; Optical coherence tomography; RNFL thickness; Corneal thickness; Dry eye; Ocular surface.
Copyright (c) 2025 Asad Ullah, Eisha Fiaz, Mariam Sana Ullah, Amber Saeed, Muhammad Ishfaq, Sana Sharif, Aqsa Batool (Author) https://creativecommons.org/licenses/by/4.0
Exploring The Lived Experiences of Patients with Chronic Obstructive Pulmonary Disease (COPD) In Managing Daily Life and Treatment Adherence
Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that disrupts physical functioning, emotional well-being, social participation, and treatment adherence. Although COPD care is often evaluated through clinical outcomes, less is known about how patients experience daily disease management and integrate long-term treatment into routine life. Objective: To explore the lived experiences of adults with COPD, focusing on daily activity limitation, emotional burden, treatment adherence, coping strategies, healthcare communication, and contextual influences. Methods: A qualitative phenomenological study was conducted among 20 adults with clinically diagnosed COPD recruited through purposive sampling from outpatient and community healthcare settings. Data were collected using semi-structured, in-depth interviews and analyzed through inductive thematic analysis following Braun and Clarke’s framework. Trustworthiness was supported through field notes, reflexive journaling, independent coding, audit trail documentation, and member checking. Results: Five themes emerged: physical disruption of daily life, emotional burden and uncertainty, treatment adherence challenges, coping and social support, and healthcare communication within environmental and cultural contexts. Breathlessness and fatigue restricted independence, while fear of exacerbation contributed to anxiety and social withdrawal. Adherence was shaped by medication cost, complex regimens, limited inhaler understanding, and clinician communication. Family support, activity pacing, breathing exercises, and clear explanations facilitated coping and treatment continuity. Conclusion: COPD care should address physical symptoms, psychological distress, treatment literacy, affordability, social support, and environmental barriers through holistic patient-centered strategies.
Chronic Obstructive Pulmonary Disease, Qualitative Research, Phenomenology, Patient Experience, Treatment Adherence, Thematic Analysis
Copyright (c) 2025 Fareed Ullah, Tanzeel u Rehman, Naveen Kumar Motwani, Sohail Afsar Awan, Zeeshah Nadeem, Humna Ijaz (Author) https://creativecommons.org/licenses/by/4.0
Comparative Effectiveness of Canalith Repositioning Alone Versus Combined with Cervical Stabilization Exercises on Residual Dizziness and Postural Stability in Patients with Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial
Background: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder effectively treated with canalith repositioning procedures (CRP), yet 30–60% of patients experience residual dizziness and postural instability, potentially due to incomplete central compensation and cervical proprioceptive dysfunction. Objective: To compare the effectiveness of CRP alone versus CRP combined with cervical stabilization exercises (CSE) in reducing residual dizziness and improving postural stability in patients with posterior canal BPPV. Methods: An assessor-blinded randomized controlled trial was conducted involving 80 participants allocated equally to CRP alone or CRP+CSE. Interventions were delivered over four weeks, with follow-up at Week 4 and Week 12. Primary outcomes included Dizziness Handicap Inventory (DHI) and Sensory Organization Test (SOT) composite scores, while secondary outcomes included Timed Up and Go (TUG), joint position error (JPE), Vestibular Questionnaire-7 (VQ-7), and fall incidence. Mixed ANOVA and intention-to-treat analysis were applied. Results: The CRP+CSE group demonstrated significantly greater reductions in DHI at Week 4 (mean difference 10.4 points; p<0.001) and Week 12 (8.3 points; p<0.001), along with superior improvements in SOT scores (p=0.012 and p=0.007). Secondary outcomes also favored the combined group, including improvements in TUG (p<0.001), JPE (p<0.001), and VQ-7 (p<0.001), with a lower fall incidence (IRR=0.25; p=0.041). Conclusion: The addition of cervical stabilization exercises to CRP significantly enhances recovery in BPPV by improving dizziness, postural stability, and functional outcomes, supporting a multimodal physiotherapy approach.
BPPV, residual dizziness, canalith repositioning, cervical stabilization, postural stability, randomized controlled trial.
Copyright (c) 2025 Muhammad Tahir Akram, Abdul Hameed, Purwa Santwani, Chander Parkash, Ahmed Ali, Noreen Ahmed, Muhammad Ejaz Uddin (Author) https://creativecommons.org/licenses/by/4.0
Developing a Fused AI Model That Integrates 3D Radiomic Data From CBCT With Whole-Slide Images of Oral Biopsies
Background: Oral squamous cell carcinoma grading remains clinically important for prognostic stratification and treatment planning, but conventional diagnostic workflows often evaluate radiological and histopathological data separately. Objective: To develop and evaluate a fused artificial intelligence model integrating three-dimensional CBCT radiomic features with whole-slide image–derived computational pathology features for improving OSCC grading accuracy. Methods: This cross-sectional diagnostic model-development study included 36 patients with histopathologically confirmed OSCC who had complete pre-treatment CBCT imaging and analyzable digitized biopsy slides. Radiomic features were extracted from segmented CBCT tumor volumes, while computational pathology features were derived from whole-slide hematoxylin and eosin images. Radiomics-only, whole-slide image–only, and fused feature-level machine learning models were evaluated using grading accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve. Results: The CBCT radiomics–only model achieved 69.4% accuracy and an AUC of 0.74, while the whole-slide image model achieved 77.8% accuracy and an AUC of 0.81. The fused AI model demonstrated the highest performance, with 86.1% accuracy and an AUC of 0.89. Fusion significantly improved accuracy compared with CBCT radiomics alone (p = 0.012) and whole-slide imaging alone (p = 0.031). Conclusion: Multimodal fusion of CBCT radiomics and whole-slide image analysis improved OSCC grading performance and may support more objective diagnostic decision-making.
Artificial Intelligence; Cone-Beam Computed Tomography; Oral Squamous Cell Carcinoma; Computational Pathology; Radiomics; Whole-Slide Imaging.
Copyright (c) 2025 Mariam Imdad, Uzma Zareef, Laiba Sohail, Amna Shakeel, Muhammad Hamza, Ahmad Hassan, Laiba Sheikh (Author) https://creativecommons.org/licenses/by/4.0
Evaluating Effectiveness of Deferasirox Versus Deferoxamine in Improving Clinical Outcomes among Patients with Transfusion-Dependent Thalassemia: A Randomized Controlled Trial
Background: Transfusion-dependent β-thalassemia necessitates lifelong blood transfusions that progressively accumulate systemic iron, causing cardiomyopathy, hepatic cirrhosis, and endocrine failure without effective chelation. Deferasirox, a once-daily oral iron chelator, offers a pharmacological and administration advantage over subcutaneous deferoxamine, yet comparative randomized evidence in South Asian clinical populations remains limited. Objective: To compare the efficacy, safety, and treatment adherence profiles of deferasirox versus deferoxamine among patients with transfusion-dependent β-thalassemia in the Islamabad–Rawalpindi region of Pakistan. Methods: A parallel-group, open-label randomized controlled trial was conducted over five months. Seventy-two patients (aged 8–35 years) were randomized 1:1 to deferasirox (20–30 mg/kg/day orally) or deferoxamine (40 mg/kg/day subcutaneously, five days per week). The primary outcome was change in serum ferritin; secondary outcomes included ALT, renal function, adverse events (CTCAE v5.0), and adherence (MMAS-8). Results: Deferasirox produced a significantly greater mean ferritin reduction (715 ± 150 ng/mL; 95% CI [666, 764]) than deferoxamine (335 ± 120 ng/mL; 95% CI [296, 374]; between-group difference 380 ng/mL [317, 443]; p = 0.003; Cohen's d = 2.80). ALT normalized in the deferasirox group (38.2 IU/L) but not in the deferoxamine group (42.4 IU/L; p = 0.01). Composite adverse event rates were 27.8% versus 50.0% (p = 0.04). High adherence was recorded in 83.3% versus 66.7% of patients. Conclusion: Deferasirox demonstrated superior iron chelation efficacy, hepatic enzyme normalization, tolerability, and adherence compared with deferoxamine and should be considered a preferred chelation strategy in routine transfusion-dependent thalassemia management.
Adherence; Deferasirox; Deferoxamine; Iron Overload; Randomized Controlled Trial; Thalassemia; Transfusion-Dependent
Copyright (c) 2025 Muhammad Mohsin Shoukat, Hafiza Khadija Tariq, Fareed Ullah, Muhammad Arslan Liaqat, Areeba Sajjad, Nauman Akhtar (Author) https://creativecommons.org/licenses/by/4.0
Effect of Platelet-Rich Fibrin on Alveolar Osteitis and Early Recovery After Mandibular Third Molar Surgery: A Randomized Controlled Trial
Background: Alveolar osteitis is a painful complication after impacted mandibular third molar surgery and is associated with clot disintegration, delayed healing, repeated clinical visits, and increased analgesic use. Platelet-rich fibrin is an autologous fibrin matrix that may enhance clot stability and early tissue repair. Objective: To evaluate the effectiveness of platelet-rich fibrin in reducing alveolar osteitis and improving early recovery after impacted mandibular third molar extraction. Methods: This randomized controlled clinical trial included 60 adults requiring surgical removal of a single impacted mandibular third molar. Participants were allocated to a platelet-rich fibrin group or a conventional socket management group. The primary outcome was alveolar osteitis. Secondary outcomes included pain measured by Visual Analog Scale, facial swelling, Landry Wound Healing Index score, and analgesic consumption during the first post-operative week. Results: Alveolar osteitis occurred in 2 patients in the platelet-rich fibrin group and 8 patients in the control group (6.7% vs 26.7%; p = 0.038). Platelet-rich fibrin was associated with lower pain scores on days 1, 3, and 7, reduced facial swelling on days 3 and 7, better day-7 healing scores, and lower analgesic consumption. Conclusion: Platelet-rich fibrin reduced dry socket incidence and improved early post-operative recovery after mandibular third molar surgery.
Alveolar Osteitis; Platelet-Rich Fibrin; Third Molar; Tooth Extraction; Postoperative Pain; Wound Healing.
Copyright (c) 2025 Mussarat Hayat Sheikh, Zainab Hayat, Changaiz Khan, Aisha Shaikh, Fiza Waheed Pirzada, Sharmeen Saqib (Author) https://creativecommons.org/licenses/by/4.0
Effects of Shi Style Cervical Mobilization Versus Sustained Natural Apophyseal Glides on Pain, Strength and Functional Disability in Patients with Cervicogenic Headache
Background: Cervicogenic headache is a secondary headache disorder originating from cervical spine dysfunction, commonly associated with pain, reduced mobility, dizziness, and functional disability, with manual therapy representing a key conservative management strategy. Objective: To compare the effectiveness of Shi-style cervical mobilization and Sustained Natural Apophyseal Glides (SNAGs) on pain intensity, cervical muscle strength, dizziness-related disability, functional disability, and quality of life in patients with cervicogenic headache. Methods: A randomized controlled trial was conducted on 40 participants allocated equally into two groups receiving either Shi-style cervical mobilization or SNAGs over a two-week period, alongside standardized physiotherapy. Outcomes including Numeric Pain Rating Scale (NPRS), pressure biofeedback, Dizziness Handicap Inventory (DHI), Neck Disability Index (NDI), and SF-36 were assessed at baseline and post-intervention. Non-parametric statistical tests were applied with significance set at p < 0.05. Results: Both groups demonstrated statistically significant improvements across all outcomes (p < 0.001). However, Shi-style mobilization resulted in greater reductions in pain (median 6.0 to 2.0 vs 3.0), disability (NDI: 32.0 to 7.0 vs 17.0), and dizziness (DHI: 53.0 to 21.0 vs 23.5), with moderate to large effect sizes (r = 0.42–0.79). Conclusion: Both interventions are effective, but Shi-style cervical mobilization demonstrates superior clinical outcomes and may be considered a more effective treatment approach for cervicogenic headache.
Cervicogenic headache, manual therapy, SNAGs, cervical mobilization, randomized controlled trial, pain, disability.
Copyright (c) 2025 Ayesha Khalid Malik, Ayesha Habib, Ayyaz Ahmad, Hafiza Aroosa Syed, Huma Khan, Muhammad Haris (Author) https://creativecommons.org/licenses/by/4.0
AI-Based Risk Stratification for Latent Tuberculosis Among Urban Slum Dwellers: A Cross-Sectional Study
Background: Latent tuberculosis infection (LTBI) poses a critical public health challenge in urban informal settlements, where structural deprivation, household overcrowding, and limited healthcare access sustain high transmission risk. Traditional screening methods fail to reach the most vulnerable individuals, underscoring the need for targeted, data-driven approaches. Objective: This study aimed to evaluate the predictive performance of AI-assisted machine learning models for LTBI risk stratification among adults in urban informal settlements in Lahore, Pakistan. Methods: A cross-sectional analytical study enrolled 150 adult participants from densely populated slum communities. Data were collected via structured questionnaires, clinical assessments, and tuberculin skin testing (TST; ≥10 mm threshold). Three supervised machine learning algorithms, logistic regression, random forest, and gradient-boosted decision trees, were developed using a stratified 70:30 train-test split with 10-fold cross-validation. Model performance was assessed using accuracy, sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) with 95% bootstrap confidence intervals. Variable importance was evaluated using normalised feature gain scores. Results: TST positivity was 42.0% (n=63). The gradient-boosted model achieved the highest performance (AUC 0.91, sensitivity 90.5%, specificity 88.5%), followed by random forest (AUC 0.88) and logistic regression (AUC 0.82). Prior TB contact history, household crowding, and poor ventilation were the strongest predictors. Overall classification accuracy was 89.3% (95% CI 83.3–93.7%). Conclusion: AI-assisted risk stratification using community-collectible sociodemographic and environmental variables can effectively identify individuals at elevated LTBI risk in urban slum settings, supporting targeted screening and preventive intervention strategies.
Artificial intelligence; community health; latent tuberculosis; machine learning; risk stratification; tuberculin skin test; urban slums
Copyright (c) 2026 Ali Dost, Afeera Bint-e-Tanveer, Ajmal Khan, Kamran Ali, Sajjad Ahmad, Zubia Shahid (Author) https://creativecommons.org/licenses/by/4.0
Effect of Task-Oriented Motor Training on Upper Limb Functional Recovery in Post-Stroke Patients: A Randomized Controlled Trial
Background: Upper limb motor impairment affects approximately 70–80% of stroke survivors and constitutes a primary determinant of functional independence and quality of life. Task-oriented motor training (TOT) engages neuroplastic recovery through repetitive, goal-directed functional practice, yet evidence from low- and middle-income country (LMIC) rehabilitation settings remains limited. Objective: To evaluate the efficacy of structured task-oriented motor training on upper limb motor recovery, arm function, motor performance efficiency, and functional independence compared to conventional physiotherapy in subacute post-stroke patients. Methods: A single-blind, parallel-group randomized controlled trial was conducted at a tertiary care neurorehabilitation centre in Khyber Pakhtunkhwa, Pakistan. One hundred and two subacute stroke patients (2–6 months post-ictus) were allocated by computer-generated randomization to TOT (n = 51) or conventional physiotherapy (n = 51), each receiving 45–60 minutes of supervised therapy five sessions per week for six weeks. Primary outcome was the Fugl-Meyer Assessment–Upper Extremity (FMA-UE); secondary outcomes included the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and Barthel Index. Intention-to-treat analysis with multiple imputation was applied; Bonferroni correction controlled for multiple comparisons. Results: Ninety-five participants completed post-intervention assessment (TOT: n = 48; control: n = 47). The TOT group demonstrated significantly greater improvements across all outcomes: FMA-UE (MD = +3.9, 95% CI: 2.5–5.3; d = 0.58), ARAT (MD = +4.4, 95% CI: 2.7–6.1; d = 0.52), WMFT (MD = −2.1 s, 95% CI: −3.2 to −1.0; d = 0.46), and Barthel Index (MD = +5.4, 95% CI: 3.2–7.6; d = 0.49); all p < 0.0125 after Bonferroni correction. TOT group improvements exceeded established minimal clinically important difference thresholds for all outcomes. Conclusion: Structured task-oriented motor training yields clinically meaningful, statistically robust improvements in upper limb motor recovery and functional independence following stroke, and represents an effective, low-resource-compatible rehabilitation strategy for LMIC clinical settings.
stroke; upper limb recovery; task-oriented training; motor function; neurorehabilitation; LMIC; functional independence; neuroplasticity; randomized controlled trial
Copyright (c) 2025 Hamna Khurshid, Shahzad Ahmad, Etisam Wahid, Kiran Hassan, Warda Khan, Mehr Un Nisa, Amna Rafique, Kiran Ishaq, Urooj Khan, Ayesha Nisar (Author) https://creativecommons.org/licenses/by/4.0
A Systematic Review of Marine Omega-3 Fatty Acids for the Reduction of Neuroinflammation in Major Depressive Disorder
Background: Major depressive disorder is increasingly linked with immune-inflammatory dysregulation, and elevated inflammatory biomarkers may contribute to symptom persistence and treatment resistance in selected patients. Marine omega-3 fatty acids, particularly eicosapentaenoic acid and docosahexaenoic acid, have been proposed as adjunctive modulators of inflammatory pathways, but evidence remains inconsistent. Objective: This systematic review evaluated whether marine-derived omega-3 fatty acid supplementation is associated with modulation of inflammatory biomarkers in adults with major depressive disorder. Methods: A systematic review without meta-analysis was conducted using studies identified from PubMed, Scopus, Web of Science, and the Cochrane Library. Eligible studies included randomized controlled trials and observational studies involving adults with major depressive disorder receiving EPA, DHA, or combined marine omega-3 supplementation and reporting inflammatory biomarker outcomes. Risk of bias was assessed according to study design, and findings were synthesized qualitatively because of heterogeneity in interventions, comparators, and outcome reporting. Results: Eight studies comprising 525 participants were included. Five were randomized controlled trials, two were cohort studies, and one was case-control. Omega-3 supplementation showed a consistent qualitative trend toward reductions in IL-6, CRP, and TNF-α, particularly in EPA-containing interventions. However, exact biomarker values, confidence intervals, and effect sizes were incompletely reported. Conclusion: Marine omega-3 fatty acids may modestly improve inflammatory biomarker profiles in major depressive disorder, but current evidence remains suggestive rather than definitive. Larger standardized trials are required.
Major Depressive Disorder; Omega-3 Fatty Acids; Eicosapentaenoic Acid; Docosahexaenoic Acid; Inflammatory Biomarkers; Systematic Review.
Copyright (c) 2025 Shah Nawaz, Bilal Safdar, Sana Ahmed, Arooj Fatima Awan, Muhammad Uzair Mazhar, Farkhunda Naz (Author) https://creativecommons.org/licenses/by/4.0
Effect of Dietary Intervention on Short-Term Weight Recovery and Electrolyte Correction in Hospitalized Children with Acute Diarrhea
Background: Acute diarrhea remains a leading cause of malnutrition and electrolyte derangement among children under five years of age in low- and middle-income countries, yet evidence on the short-term impact of structured inpatient dietary interventions on anthropometric and biochemical recovery in Pakistani pediatric populations remains limited. Objective: To evaluate the effect of a structured dietary intervention on short-term weight recovery and serum electrolyte correction in children hospitalized with acute diarrhea. Methods: A single-arm, pre-post interventional study was conducted among 100 children aged 1–59 months admitted with acute diarrhea to a tertiary care pediatric ward in Peshawar, Pakistan. The dietary intervention comprised locally available semi-solid foods (mashed banana, rice-lentil preparation, yogurt) administered alongside standard rehydration and zinc supplementation. Body weight and serum sodium, potassium, chloride, and hemoglobin levels were measured at admission and discharge. Paired-samples t-tests with 95% confidence intervals and Cohen's d effect sizes were computed. Results: Mean body weight increased from 7.14 ± 1.22 kg to 7.39 ± 1.18 kg (mean difference 0.25 kg; 95% CI: 0.19–0.31; p < 0.001; d = 0.81). Serum potassium rose from 3.20 ± 0.50 to 3.99 ± 0.41 mEq/L (p < 0.001; d = 1.73), chloride from 98.5 ± 4.2 to 102.3 ± 3.1 mEq/L (p < 0.001; d = 1.03), and sodium from 135.2 ± 3.8 to 138.7 ± 2.9 mEq/L (p = 0.031; d = 1.03). Hemoglobin remained unchanged (p = 0.42). Conclusion: The structured dietary intervention, combined with standard rehydration and zinc supplementation, was associated with significant short-term weight recovery and electrolyte normalization; however, the absence of a control group limits causal inference, and randomized controlled trials with extended follow-up are warranted
acute diarrhea; dietary intervention; children under five; electrolyte correction; nutritional status; Pakistan
Copyright (c) 2025 Mahnoor Nadeem, Burhan Ahmad, Adnan Habib, Maisam Ali, Muhammad Ibrar, Humaira Jamal, Hiba Zehra, Saira, Muhammad Wasif Jamal (Author) https://creativecommons.org/licenses/by/4.0
Barriers to Universal Health Coverage in Pakistan: A Health System Perspective
Background: Universal Health Coverage (UHC) aims to ensure equitable access to essential health services without financial hardship; however, progress in Pakistan remains constrained by systemic challenges. Qualitative inquiry is needed to understand how these barriers are experienced and interpreted within the health system. Objective: To explore stakeholder perceptions of structural barriers to UHC in Pakistan from a health systems perspective. Methods: A qualitative descriptive study was conducted between January and March 2025 using semi-structured interviews with 25 stakeholders, including policymakers, public health experts, physicians, and hospital administrators. Participants were selected through purposive sampling. Data were analyzed using Braun and Clarke’s reflexive thematic analysis. Results: Five major themes were identified: insufficient health financing, workforce shortages and maldistribution, weak governance and policy implementation, inequitable healthcare access, and high out-of-pocket expenditure. Participants described these barriers as interconnected, with financing and governance influencing workforce distribution and service accessibility, while financial burden directly affected healthcare utilization. Conclusion: Achieving UHC in Pakistan requires integrated health system reforms focusing on financing, governance, workforce distribution, and financial protection. Strengthening implementation mechanisms and addressing contextual barriers will be critical for improving equitable healthcare access.
Universal Health Coverage, Pakistan, Health Systems, Qualitative Research, Healthcare Access, Health Policy
Copyright (c) 2025 Muhammad Hamza Muzammil, Muhammad Uzair, Faiza Iqrar, Muhammad Talha, Sara Alam, Aatqa Khan, Sehrish Muhammad, Arsalan Khan, Kainat Ashraf, Noor Fatima (Author) https://creativecommons.org/licenses/by/4.0
The Association Between Serum Vitamin D Status and Knee Joint Space Width in Adults with Early Osteoarthritis - A Cross-Sectional Study
Background: Knee osteoarthritis (OA) is a progressive degenerative joint disease in which early cartilage loss determines long-term functional trajectory. Vitamin D, beyond its classical skeletal role, modulates chondrocyte metabolism and joint inflammatory signaling through vitamin D receptor pathways; however, its cross-sectional association with radiographic cartilage preservation in early knee OA remains incompletely characterized. Objective: To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] sufficiency and medial tibiofemoral joint space width (JSW) as a radiographic marker of cartilage integrity in adults with early knee osteoarthritis. Methods: A cross-sectional study was conducted over eight months at a tertiary care hospital in Lahore, Pakistan, enrolling 135 adults aged 40–65 years with Kellgren–Lawrence grade I–II knee OA. Serum 25(OH)D was measured by chemiluminescent immunoassay and categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL) per Endocrine Society guidelines. Standardized weight-bearing JSW was measured digitally by two blinded musculoskeletal radiologists (ICC = 0.91). WOMAC pain and function subscales provided secondary clinical outcomes. ANOVA with Tukey post-hoc testing, Pearson correlation with 95% CIs, and multivariable linear regression adjusting for age, sex, BMI, and symptom duration were applied. Results: Mean serum 25(OH)D was 26.7 ± 8.4 ng/mL. Sufficient participants demonstrated significantly greater JSW than deficient individuals (3.89 ± 0.57 mm vs. 3.11 ± 0.54 mm; mean difference 0.78 mm, 95% CI 0.51–1.05, p < 0.001). Serum 25(OH)D correlated positively with JSW (r = 0.41, 95% CI 0.26–0.54, p < 0.001) and inversely with WOMAC pain (r = -0.36, p = 0.002) and function (r = -0.33, p = 0.004). Associations remained significant after confounder adjustment (β = 0.023 mm/ng/mL, 95% CI 0.011–0.035, p < 0.001). Conclusion: Vitamin D sufficiency was independently associated with greater radiographic joint space width and reduced symptomatic burden in early knee OA, supporting its evaluation as a modifiable nutritional target in early OA prevention.
25-Hydroxyvitamin D; joint space width; Kellgren–Lawrence grade; knee osteoarthritis; nutritional status; radiography; WOMAC
Copyright (c) 2025 Namra Urooj, Sumera Kanwal, Malak Mustaqeem Khan, Saima Ashraf, Nauman Akhtar, Aqil ur Rehman, Muhammad Faizan Ali (Author) https://creativecommons.org/licenses/by/4.0
Prospective Evaluation of Cognitive Reframing and Thought-Challenging Techniques in Reducing Symptom Severity Among Adults with Dual Anxiety–Depression Diagnosis
Background: Anxiety and depression frequently co-occur, creating compounded symptom burden and reduced responsiveness to conventional pharmacotherapy. Cognitive reframing and thought-challenging, core components of cognitive-behavioral therapy, target the shared maladaptive cognitive processes that maintain both conditions, yet their effectiveness as an isolated structured intervention in adults with confirmed dual diagnoses of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in low-to-middle-income settings remains inadequately characterized. Objective: To evaluate the effectiveness of a structured 12-week cognitive reframing and thought-challenging intervention in reducing anxiety and depressive symptom severity, improving cognitive emotion regulation, and enhancing quality of life among adults with comorbid GAD and MDD over a 24-week prospective follow-up. Methods: A prospective single-arm interventional study was conducted among 80 adults with DSM-5-confirmed comorbid GAD and MDD at three tertiary care hospitals in Lahore, Pakistan. Participants received 12 weekly individual sessions derived from validated CBT manuals, culturally adapted for local context. Primary outcomes were assessed using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) at baseline, week 12, and week 24. Secondary outcomes included the Cognitive Emotion Regulation Questionnaire (CERQ) and WHOQOL-BREF. Repeated measures ANOVA with Bonferroni-corrected post-hoc comparisons and ANCOVA adjusting for medication class were performed. Results: Per-protocol retention was 93.75% (n = 75). BAI scores declined from 28.4 ± 7.1 to 14.9 ± 5.8 (Δ = −13.5; 95% CI: −16.0 to −11.0; Cohen's d = 1.34; p < 0.001) and BDI-II from 30.6 ± 8.2 to 16.1 ± 6.4 (Δ = −14.5; 95% CI: −16.9 to −12.1; d = 1.34; p < 0.001) by week 24. CERQ adaptive composite scores increased by +16.7 points and WHOQOL-BREF total scores by +17.8 points at week 24 (both p < 0.001). ANCOVA confirmed independence of effects from medication class. Conclusion: Structured cognitive reframing and thought-challenging were associated with large, sustained reductions in anxiety and depressive symptoms and improvements in cognitive regulation and quality of life among Pakistani adults with comorbid GAD and MDD. Randomized controlled trials are warranted to confirm efficacy against active comparators.
Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Cognitive Reframing; Comorbidity; Depression; Pakistan; Prospective Studies; Thought-Challenging; Treatment Outcome.
Copyright (c) 2025 Muhammad Numair Kashif, Eisha Maryam, Harmain Fatima, Seema Habib Bhutto, Bushra Waheed, Najma Syed Ghulam (Author) https://creativecommons.org/licenses/by/4.0
Randomized Trial of AI-Guided Antidepressant Selection Improving Remission and Tolerability in Primary-Care Depression
Background: Depressive disorders represent a leading cause of disability in primary-care settings globally, yet conventional antidepressant prescribing relies predominantly on trial-and-error approaches that delay remission and increase adverse-effect exposure. Artificial intelligence (AI)-based decision-support systems offer a mechanism for personalising medication selection by integrating patient-specific clinical data, but randomised evidence from real-world primary-care settings, particularly in low- and middle-income countries, remains absent. Objective: To compare AI-guided antidepressant selection with usual clinician-directed care on remission rates, adverse-effect burden, and time-to-clinical response among adults with depressive disorders in primary care. Methods: A prospective, parallel-group randomised controlled trial was conducted in primary-care clinics across South Punjab, Pakistan. Eighty-four adults (aged 18–65 years) with PHQ-9 scores ≥ 10 initiating or switching antidepressant therapy were randomised 1:1 to AI-guided medication selection (n = 42) or usual care (n = 42). The AI tool integrated baseline symptom profiles, comorbidity data, and prior treatment history to generate individualised first-line antidepressant recommendations. Depressive severity was assessed using the PHQ-9 at baseline and at weeks 2, 4, 6, and 8; remission was defined as PHQ-9 ≤ 4; clinical response as ≥ 50% PHQ-9 reduction from baseline; and adverse effects were measured using the FIBSER scale. Outcomes were analysed using independent-samples t-tests, chi-square tests, repeated-measures ANOVA, and effect sizes reported as Cohen's d. Results: At week eight, mean PHQ-9 score was significantly lower in the AI-guided group (6.16 ± 2.4 vs 8.47 ± 2.9; mean difference 2.31, 95% CI: 1.23–3.39; p < 0.001; d = 0.88). Remission was achieved by 61.9% of AI-guided participants versus 38.1% in usual care (RR = 1.63, 95% CI: 1.04–2.54; p = 0.029). Mean time to clinical response was 3.14 ± 0.9 versus 4.86 ± 1.1 weeks (difference 1.72 weeks, 95% CI: 1.29–2.15; p < 0.001; d = 1.73). Adverse-effect burden was significantly lower in the AI-guided arm (FIBSER: 3.16 ± 1.2 vs 4.80 ± 1.4; p < 0.001; d = 1.25). No serious adverse events were recorded in either group. Conclusion: AI-guided antidepressant selection improved remission rates reduced adverse-effect burden, and accelerated clinical response compared with usual care, with consistently large effect sizes across all outcome domains. These findings support integration of AI-based decision-support tools to enhance personalised depression treatment in resource-limited primary-care settings.
Algorithms; Antidepressive agents; Artificial intelligence; Clinical decision support; Depression; Patient Health Questionnaire-9; Primary health care; Randomised controlled trial; Treatment outcome.
Copyright (c) 2025 Fatima Hassan, Fareeha F Khan, Anina Qureshi, Bushra Waheed, Eisha Maryam, Shaikh Khalid Muhammad (Author) https://creativecommons.org/licenses/by/4.0
Phase of Neovascularization in Wound Repair: Topical Impact of Low-Level Laser Therapy with Conventional Treatment in Rabbit Model
Background: Neovascularization is the rate-limiting event in the proliferative phase of wound repair, and its accelerated induction represents a key therapeutic target in surgical wound management. Low-level laser therapy (LLLT), a non-invasive photobiomodulatory modality, has demonstrated pro-angiogenic properties through cytochrome c oxidase-mediated bioenergetic stimulation and growth factor upregulation, yet direct histomorphometric comparisons with conventional topical agents such as normal saline and Edinburgh University Solution of Lime (Eusol) remain insufficiently characterised. Objective: To evaluate and compare the effect of topical LLLT, normal saline, and Eusol dressing on the neovascularization phase of full-thickness surgical wound repair using quantitative vascular density assessment across discrete healing time points in an experimental rabbit model. Methods: Fifteen male albino rabbits (200–350 g) were randomly allocated to three groups (n = 5/group): Group A (normal saline, daily), Group B (LLLT, 10 J/cm², 830 nm, THOR DD II device, daily), and Group C (Eusol dressing, daily). Full-thickness excisional wounds (2.5 × 2.5 cm²) were created on the dorsal surface under ketamine–xylazine anaesthesia. Wound tissue biopsies were collected at Days 3, 7, and 14, processed for haematoxylin and eosin staining, and mean vascular counts were enumerated per 0.196 mm² field at 400× magnification by a blinded histologist. Data were analysed using one-way ANOVA with post hoc Tukey's HSD test (p < 0.05). Results: Group B demonstrated significantly superior mean vascular counts at all time points: Day 3 (6.65 ± 1.80 versus 2.31 ± 1.20 and 3.54 ± 0.41), Day 7 (10.47 ± 0.11 versus 3.21 ± 0.32 and 5.68 ± 1.74), and Day 14 (8.88 ± 0.63 versus 4.45 ± 0.71 and 5.97 ± 1.57) for Groups A and C respectively (p = 0.040–0.001; η² = 0.721–0.916). A biphasic trajectory with peak neovascularization at Day 7 was observed exclusively in Group B. Conclusion: LLLT significantly accelerates surgical wound neovascularization compared with normal saline and Eusol, supporting its integration as an adjunctive modality in evidence-based wound management protocols.
low-level laser therapy; photobiomodulation; neovascularization; angiogenesis; surgical wound healing; Eusol; rabbit model
Copyright (c) 2025 Muhammad Asif, Satheesh Babu Natarajan, Muhammad Ahmed Azmi (Author) https://creativecommons.org/licenses/by/4.0
Mental Health Services Accessibility in Pakistan: Gaps, Barriers, and Policy Implications — A Qualitative Analysis
Background: Mental health disorders are a major public health concern in Pakistan, yet access to mental health services remains limited. Existing evidence has described workforce shortages, stigma, and weak policy implementation, but less is known about how these barriers are experienced across different stakeholder groups. A qualitative approach is necessary to explore the social, cultural, financial, and system-level factors that shape access to care in real-world settings. Objective: To explore perceptions of mental health service accessibility in Pakistan, identify major barriers and enabling factors influencing access to care, and examine the policy implications of these findings. Methods: This qualitative study used semi-structured interviews with key stakeholders, including psychiatrists, psychologists, patients, caregivers, and health policy experts. Relevant literature from PubMed, Scopus, and Web of Science was used to contextualize the findings. Interview data were analyzed thematically following the Braun and Clarke framework. Results: Four major themes were identified: structural barriers, sociocultural barriers, financial barriers, and policy and governance barriers. Participants highlighted shortage and urban concentration of services, stigma and negative social perceptions, reliance on non-medical explanatory models, unaffordable treatment pathways, and weak implementation of mental health policies. Accessibility was shaped by overlapping mechanisms involving trust, perceived acceptability, cost, and system responsiveness. Conclusion: Mental health service accessibility in Pakistan is constrained by interconnected structural, social, financial, and governance barriers. Improving access requires primary-care integration, workforce strengthening, community-sensitive stigma reduction, and stronger policy implementation.
Mental health, accessibility, Pakistan, stigma, healthcare policy, qualitative research.
Copyright (c) 2025 Muhammad Uzair, Eiman Imtiaz, Mibra Asjad, Syed Saqib Hussain Shah, Sibghat Ullah, Qurat Ul Ain Hingoro, Rabiya Hanif, Fizza Khalil, Hassan Raza Ali, Talat Yasmin (Author) https://creativecommons.org/licenses/by/4.0
Digital Health Knowledge, Attitudes, and Practices Among Undergraduate Nursing Students: A Comparative Study of Public and Private Colleges in Mirpurkhas, Sindh, Pakistan
Background: Digital health technologies are increasingly transforming healthcare delivery, requiring healthcare professionals to possess adequate digital competencies. Nursing students, as future healthcare providers, must develop sufficient knowledge, positive attitudes, and effective practices related to digital health technologies to ensure safe and efficient patient care in technology-driven healthcare systems. However, limited evidence exists regarding digital health readiness among nursing students in developing regions such as Pakistan. Objective: This study aimed to evaluate the levels of digital health knowledge, attitudes, and practices among undergraduate nursing students and to examine differences between public and private institutions as well as across academic years. Methods: A comparative cross-sectional study was conducted among 254 undergraduate nursing students enrolled in selected public and private nursing colleges in Mirpurkhas, Sindh, Pakistan. Data were collected using a structured self-administered questionnaire based on a five-point Likert scale and analyzed using IBM SPSS version 27. Descriptive statistics were used to summarize variables, while independent samples t-tests and one-way ANOVA were used to compare group differences. Pearson correlation analysis was performed to assess relationships among knowledge, attitudes, and practices. Results: The mean scores for knowledge (3.30 ± 0.75), attitudes (3.26 ± 0.56), and practices (3.46 ± 0.86) indicated moderate levels across all domains. Significant differences were observed between public and private institutions in knowledge (p = 0.031) and attitudes (p = 0.024), while practices showed no significant difference (p = 0.189). Significant variations were also found across academic years for knowledge (p = 0.028) and attitudes (p = 0.003). Strong positive correlations were identified between knowledge and attitudes (r = 0.754), knowledge and practices (r = 0.688), and attitudes and practices (r = 0.698), all statistically significant (p < 0.001). Conclusion: Undergraduate nursing students demonstrated moderate digital health knowledge, attitudes, and practices. Strengthening digital health literacy and informatics education within nursing curricula may enhance students’ preparedness for technology-driven healthcare systems.
Digital health; digital health literacy; nursing students; knowledge attitude practices; telemedicine; health informatics.
Copyright (c) 2025 Inshal Anwar Arain, Irfan Ali Chandio, Areeba Zulfiqar Rajput, Nimra Rasheed Gill, Sheela Davi Malhi, Dileep Kumar Malhi (Author) https://creativecommons.org/licenses/by/4.0
Validating a Panel of Salivary miRNA and Protein Biomarkers for the Early Detection of High-Risk Oral Potentially Malignant Disorders
Background: Oral potentially malignant disorders (OPMDs) are precancerous oral lesions with variable risk of progression to oral squamous cell carcinoma, yet current assessment depends largely on biopsy-based histopathology, which is invasive and not ideal for repeated screening. Salivary molecular diagnostics offer a non-invasive alternative capable of detecting early biological changes associated with malignant potential. Objective: To assess the diagnostic performance of a combined salivary biomarker panel comprising miR-21, miR-31, miR-184, IL-8, and MMP-9 for differentiating patients with high-risk OPMDs from healthy controls. Methods: In this cross-sectional observational study, 84 participants were enrolled, including 44 patients with clinically and histopathologically confirmed OPMDs and 40 healthy controls. Unstimulated saliva samples were analyzed for miR-21, miR-31, and miR-184 expression by quantitative real-time polymerase chain reaction and for IL-8 and MMP-9 concentrations by enzyme-linked immunosorbent assay. Group comparisons, correlations, and receiver operating characteristic analyses were performed. Results: All three microRNAs and both proteins were significantly elevated in OPMD cases compared with controls (p < 0.001 for all). The strongest correlations were observed between miR-21 and IL-8 (r = 0.72) and between miR-31 and MMP-9 (r = 0.68). Individual biomarker AUCs ranged from 0.81 to 0.89, while the combined panel achieved an AUC of 0.94 (95% CI: 0.89-0.98), with sensitivity of 91.2% and specificity of 88.7%. Conclusion: The combined salivary biomarker panel demonstrated strong diagnostic accuracy for identifying high-risk OPMDs and supports the potential of saliva-based molecular profiling as a practical non-invasive adjunct for early oral precancer detection.
Oral potentially malignant disorders; saliva; microRNA; IL-8; MMP-9; biomarkers; early detection
Copyright (c) 2025 Ranya Khan, Saqba Alam, Durr e Sameen, Seemab Naz, Asia Rahman Khan Lodhi, Arshad Ahmad (Author) https://creativecommons.org/licenses/by/4.0
AI-Powered Detection of Functional Gastrointestinal Disorders in Adults Visiting Tertiary Hospitals
Background: Functional gastrointestinal disorders are common in tertiary gastroenterology practice and remain difficult to diagnose because they are defined largely by symptom patterns rather than structural or biochemical abnormalities. In busy referral settings, overlap among irritable bowel syndrome, functional dyspepsia, functional constipation, and non-functional gastrointestinal conditions can reduce diagnostic consistency. Artificial intelligence offers a potential solution by integrating structured clinical variables with free-text symptom narratives to support more standardized classification. Objective: To evaluate the diagnostic accuracy of an artificial intelligence–based system for detecting functional gastrointestinal disorders among adults attending tertiary hospitals. Methods: This multicenter cross-sectional diagnostic accuracy study was conducted over eight months in three tertiary hospitals in Lahore, Pakistan. A total of 420 adults aged 18–65 years presenting with gastrointestinal symptoms were enrolled through consecutive sampling. After exclusion of relevant organic pathology, Rome IV–based clinician diagnosis served as the reference standard. The artificial intelligence system analyzed structured clinical variables and unstructured consultation notes using supervised machine learning and natural language processing to classify irritable bowel syndrome, functional dyspepsia, functional constipation, and non-functional gastrointestinal disorder status. Diagnostic performance was assessed using sensitivity, specificity, predictive values, area under the receiver operating characteristic curve, and Cohen’s kappa. Results: The mean age was 37.4 ± 10.8 years, and 54.8% of participants were male. Clinically, 33.3% had irritable bowel syndrome, 23.8% functional dyspepsia, 14.3% functional constipation, and 28.6% non-functional gastrointestinal disorders. The artificial intelligence model achieved a sensitivity of 88.2%, specificity of 84.5%, positive predictive value of 86.9%, negative predictive value of 86.0%, overall accuracy of 87.1%, and an overall area under the curve of 0.912. Agreement with clinician diagnosis was strong (κ = 0.83, p < 0.001). Conclusion: The artificial intelligence system showed high diagnostic performance and strong concordance with Rome IV–based clinical diagnosis, supporting its potential role as an adjunctive decision-support tool for functional gastrointestinal disorder classification in tertiary care.
Artificial intelligence, functional gastrointestinal disorders, irritable bowel syndrome, functional dyspepsia, functional constipation, machine learning, natural language processing, diagnostic accuracy
Copyright (c) 2025 Muhammad Essa Khan, Mahnoor Naeem Rana, Khalid Bilal Khan, Laiba Mushtaq, Turfa Asghar, Wajeeha Ahmadani, Muhammad Zohaib Wahid (Author) https://creativecommons.org/licenses/by/4.0
Effect of Menstrual Cycle Phases on Cognitive and Neuromuscular Performance
Background: Fluctuations in estrogen and progesterone across the menstrual cycle may influence cognitive and neuromuscular performance, yet previous findings have remained inconsistent because many studies have assessed isolated outcomes or relied solely on calendar-based phase estimation. Objective: To evaluate variations in cognitive performance, muscle strength, and endurance across menstrual cycle phases and examine their association with circulating estrogen and progesterone levels in healthy young women. Methods: This descriptive repeated-measures study was conducted in Lahore, Pakistan, among 60 healthy women aged 18-30 years with regular menstrual cycles. Assessments were performed during the follicular, ovulatory, and luteal phases. Serum estrogen and progesterone concentrations were measured by enzyme-linked immunosorbent assay. Cognitive performance was assessed using the Stroop Color-Word Test and Digit Span Test, while neuromuscular performance was evaluated using quadriceps maximal voluntary isometric contraction and plank endurance. Data were analyzed using repeated-measures ANOVA and Pearson correlation tests. Results: Estrogen peaked during ovulation (187.5 ± 25.8 pg/mL), whereas progesterone was highest in the luteal phase (11.8 ± 2.7 ng/mL) (p < 0.001 for both). Stroop reaction time improved significantly during ovulation (689 ± 78 ms) compared with the follicular phase (732 ± 84 ms) (p = 0.012). Quadriceps strength was highest during ovulation (317.9 ± 34.5 N) and differed significantly across phases (p = 0.021). Digit Span scores and plank endurance also showed their highest mean values during ovulation. Estrogen correlated positively with cognitive performance (r = 0.42, p < 0.05), while progesterone correlated positively with muscular endurance (r = 0.39, p < 0.05). Conclusion: Cognitive and neuromuscular performance varied across menstrual cycle phases, with the most favorable overall outcomes observed during ovulation. These findings support consideration of menstrual physiology as a relevant biological variable in female performance research and individualized training or workload planning.
Menstrual cycle, estrogen, progesterone, cognitive function, muscle strength, endurance, reaction time, women’s health
Copyright (c) 2025 Isma Ishaq, Bilal Safdar, Seerat Husnain, Rawaal Amin, Aqsa Khan, Mahnoor Zia (Author) https://creativecommons.org/licenses/by/4.0