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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).
Prevalence of Musculoskeletal Pain and Its Association With Upper Limb Function Among Textile Designers in Lahore
Background: Textile designers are exposed to prolonged static postures, sustained cervical flexion, repetitive upper-limb activity, and extended seated work, which may increase the risk of work-related musculoskeletal pain and functional limitation. Objective: To determine the prevalence of musculoskeletal pain in different body regions and assess its association with upper-limb function among textile designers in Lahore. Methods: This observational cross-sectional study included 188 textile designers aged 18–60 years working in selected textile and fashion-design settings in Lahore. Musculoskeletal pain was assessed across the neck, shoulder, upper back, elbow, wrist, lower back, hip, knee, and ankle regions using the Standardized Nordic Musculoskeletal Questionnaire. Upper-limb function was evaluated using the Upper Limb Functional Scale and categorized into score ranges of 8–20, 21–40, 41–60, and 61–80. Descriptive statistics summarized participant characteristics and pain prevalence, while chi-square tests assessed associations between regional pain and upper-limb functional categories. Results: Pain was most prevalent in the upper back (60.1%), shoulder (59.6%), and neck (56.4%), followed by elbow (41.5%) and wrist (35.6%). Lower-body symptoms were less frequent, including knee (21.3%), hip (17.6%), lower back (14.4%), and ankle pain (13.3%). Most participants had minimal to mild upper-limb functional limitation, with 37.8% scoring 8–20 and 47.3% scoring 21–40. Elbow pain was significantly associated with upper-limb function (χ² = 13.275, p = 0.004), as was lower-back pain (χ² = 9.292, p = 0.026). Neck, shoulder, upper-back, wrist, hip, knee, and ankle pain showed no statistically significant association with upper-limb functional categories. Conclusion: Musculoskeletal pain was highly prevalent among textile designers, particularly in the upper back, shoulder, and neck regions. Elbow and lower-back pain showed significant associations with upper-limb functional status, highlighting the need for ergonomic assessment, posture education, rest breaks, and targeted preventive rehabilitation strategies in this occupational group.
Musculoskeletal pain; Textile designers; Upper-limb function; Nordic Musculoskeletal Questionnaire; Occupational health; Ergonomics
Copyright (c) 2025 Rabia Munawar, Mahnoor Shafi, Hira Javed, Maida Mushtaq, Usman Ejaz, Ifra Zulqarnain Awan (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Musculoskeletal Pain and Discomfort and Its Association With Gender Among Clinical Physiotherapists of Lahore
Background: Musculoskeletal pain and discomfort are common occupational health concerns among clinical physiotherapists because their work involves prolonged standing, repetitive movements, manual therapy, patient handling, and sustained non-neutral postures. Objective: To determine the prevalence of musculoskeletal pain and discomfort among clinical physiotherapists in Lahore and assess its association with gender. Methods: A cross-sectional observational study was conducted among 140 clinical physiotherapists from hospitals and certified physiotherapy clinics in Lahore. Participants included 70 females and 70 males with at least two years of clinical experience and a minimum of six working hours per day. Musculoskeletal pain and discomfort were assessed across nine anatomical regions using the Standardized Nordic Musculoskeletal Questionnaire, while pain severity was measured using the Numeric Pain Rating Scale. Data were analyzed using SPSS version 24. Frequencies and percentages were calculated, and gender-wise associations were assessed using chi-square or Fisher’s exact test, with p < 0.05 considered statistically significant. Results: Lower back pain was the most prevalent complaint, affecting 55 participants (39.3%), followed by neck pain in 52 participants (37.1%). Female physiotherapists reported significantly higher neck pain than males (51.4% vs 22.9%; OR = 3.57, 95% CI: 1.72–7.41; p = 0.001) and lower back pain (51.4% vs 27.1%; OR = 2.84, 95% CI: 1.40–5.75; p = 0.005). Moderate-to-severe pain was also more frequent among females (71.4% vs 48.6%; OR = 2.65, 95% CI: 1.32–5.33; p = 0.009). Conclusion: Musculoskeletal pain and discomfort were common among clinical physiotherapists in Lahore, particularly in the lower back and neck regions. Female physiotherapists showed a higher burden of neck pain, lower back pain, and moderate-to-severe pain, highlighting the need for gender-sensitive ergonomic and preventive workplace strategies.
Musculoskeletal pain, physiotherapists, gender, lower back pain, neck pain, Nordic questionnaire, occupational health.
Copyright (c) 2025 Ansa Majeed, Mahnoor Shafi, Mamoona Anwar, Saddiqa Qamar, Tamknat Ilyas, Ambreen Safique (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Neck Pain and Functional Disability and Its Association With Working Hours Among Aestheticians
Background: Neck pain is a common occupational musculoskeletal problem among aestheticians because their work frequently involves sustained neck flexion, forward head posture, repetitive upper-limb activity, prolonged static positioning, and extended working hours. These exposures may contribute not only to pain but also to functional limitations affecting daily and professional activities. Objective: To determine the prevalence of neck pain and functional disability among aestheticians and to examine their association with daily working hours. Methods: A cross-sectional observational study was conducted among 103 aestheticians working in aesthetic clinics, salons, and beauty-related settings in Lahore, Pakistan. Participants were recruited using non-probability convenience sampling. Demographic and occupational data were collected using a structured questionnaire. Neck pain severity was assessed using the Numerical Pain Rating Scale, and functional disability was assessed using the Neck Disability Index. Associations between working-hour categories and neck pain severity and functional disability were analyzed using Pearson’s chi-square test in SPSS version 26, with p < 0.05 considered statistically significant. Results: Moderate neck pain was reported by 61 participants (59.2%), severe neck pain by 32 (31.1%), and mild neck pain by 10 (9.7%). Functional disability was mild in 17 participants (16.5%), moderate in 32 (31.1%), severe in 32 (31.1%), and complete in 22 (21.4%). Daily working hours were significantly associated with neck pain severity, χ²(4) = 36.525, p < 0.001, Cramer’s V = 0.421, and functional disability, χ²(6) = 49.283, p < 0.001, Cramer’s V = 0.489. Conclusion: Neck pain and functional disability were highly prevalent among aestheticians, with longer working hours associated with greater pain severity and disability. Ergonomic education, posture correction, scheduled breaks, and workplace modifications may help reduce the occupational burden of neck-related symptoms.
Aestheticians, Neck Pain, Functional Disability, Working Hours, Neck Disability Index, Occupational Health, Musculoskeletal Disorders.
Copyright (c) 2025 Usama Javed, Mahnoor Shafi, Rahat Ayub, Maida Mushtaq, Amtullah Ansari, Ambreen Shafique (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Neck Pain and Disability Among Cashiers in Traditional Versus Digital Banking Settings in Lahore, Pakistan
Background: Neck pain is a common work-related musculoskeletal problem among banking professionals, particularly in occupations involving prolonged sitting, repetitive computer use, sustained neck posture, and limited postural variation. Cashiers working in traditional and digital banking settings may experience different ergonomic exposures, but comparative evidence from local banking environments remains limited. Objective: This study aimed to compare the prevalence of neck pain and neck-related functional disability among cashiers working in traditional versus digital banking settings in Lahore, Pakistan. Methods: A cross-sectional observational study was conducted among 104 bank cashiers, including 52 participants from traditional banking settings and 52 from digital banking settings. Participants aged 20–60 years with at least six months of cashier work experience and a minimum work exposure of 30 hours per week were included. Neck pain severity was assessed using the Numeric Pain Rating Scale, while functional disability was measured using the Neck Disability Index. Data were analyzed using descriptive statistics and group comparisons. Results: Neck pain was reported by 84.6% of traditional banking cashiers and 94.2% of digital banking cashiers. Moderate-to-severe pain was present in 63.5% of traditional banking cashiers and 67.3% of digital banking cashiers. Any neck-related disability was reported by 67.3% of traditional banking cashiers and 73.1% of digital banking cashiers, while moderate-to-complete disability was higher among digital banking cashiers than traditional banking cashiers, 26.9% versus 13.5%, respectively. Conclusion: Neck pain and disability were frequent among cashiers in both banking settings, with a consistently higher observed burden among digital banking cashiers. These findings highlight the need for ergonomic workplace modification, scheduled breaks, posture education, and physiotherapy-led preventive strategies in banking environments.
Neck pain, neck disability, bank cashiers, digital banking, traditional banking, ergonomics, occupational health.
Copyright (c) 2025 Mahnoor Shahid, Amna Shahbaz, Nimra Arshad, Sana Mehmood, Anam Abbas (Author) https://creativecommons.org/licenses/by/4.0
Exploring Ultrasonography Reliability and Affordability for NAFLD Grading: Insights From Liver Biomarker’s Correlation in Pakistan
Background: Non-alcoholic fatty liver disease (NAFLD) is a common metabolic liver disorder associated with diabetes mellitus, hypertension, dyslipidemia, obesity, sedentary lifestyle, and unhealthy dietary patterns. In resource-limited settings, abdominal ultrasonography and routine liver function tests may provide a practical approach for early assessment and monitoring of NAFLD. Objective: This study aimed to evaluate the relationship between ultrasound-based NAFLD grading and selected biochemical liver parameters among adults in Pakistan. Methods: This retrospective cross-sectional analytical study included 190 adults aged 18–70 years who underwent abdominal ultrasonography and liver function testing at selected hospitals and laboratories in Punjab, Pakistan. Patients with hepatitis B or C, alcoholic fatty liver disease, chronic liver disease, or drug-related liver disease were excluded. NAFLD was graded on ultrasound as Grade I, II, or III. Biochemical parameters included alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, and serum albumin. Descriptive statistics and correlation analysis were performed using SPSS. Results: Of 190 participants, 96 (50.5%) were female and 94 (49.5%) were male, with a mean age of 40.84 ± 13.79 years. Grade I NAFLD was most frequent, affecting 115 participants (60.5%), followed by Grade II in 56 (29.5%) and Grade III in 19 (10.0%). ALT showed the strongest positive correlation with NAFLD grade (r = 0.494, p < 0.05), while AST (r = 0.055) and ALP (r = 0.109) showed weaker positive associations. Albumin showed a weak negative correlation (r = −0.181, p = 0.013), whereas bilirubin was not significantly correlated (r = 0.136, p = 0.138). Conclusion: Ultrasound-based NAFLD severity was associated with selected liver biochemical changes, particularly ALT elevation. Combining abdominal ultrasonography with routine liver function tests may support practical early assessment and monitoring of NAFLD in resource-limited clinical settings.
Non-alcoholic fatty liver disease, ultrasonography, liver enzymes, alanine aminotransferase, metabolic syndrome, Pakistan.
Copyright (c) 2025 Marwa Parveen, Hamna Aleem, Qurat ul Ain, Aimen Javed, Alishba Asghar, Durre Nayyab, Maisoon Khawar, Sidra Aslam (Author) https://creativecommons.org/licenses/by/4.0
Early Biomarker Trajectories After Biologic Initiation as Predictors of Remission in Severe Asthma
Background: Severe asthma remains difficult to control in a substantial proportion of patients despite biologic therapy, and clinicians lack validated early indicators of long-term remission. Objective biomarker trajectories may provide earlier prognostic information than symptom response alone. Objective: To determine whether early changes in blood eosinophils, fractional exhaled nitric oxide, and asthma symptom scores during the first 12 weeks after biologic initiation predict 12-month clinical remission in adults with severe asthma. Methods: This retrospective cohort study included 102 adults with severe asthma who initiated first-line biologic therapy between January 2021 and December 2022 at a tertiary care hospital in the Islamabad-Rawalpindi region, with follow-up reviewed through December 2023. Early biomarker and symptom trajectories were assessed at weeks 4, 8, and 12. Clinical remission at 12 months was defined as no exacerbations, no maintenance oral corticosteroid use, and controlled symptoms. Multivariable logistic regression adjusted for age, sex, baseline biomarker values, biologic type, and baseline oral corticosteroid use. Results: Clinical remission was achieved by 38 patients (37.3%). Week 8 FeNO reduction was the strongest independent predictor of remission (aOR 1.92 per 10% reduction, 95% CI 1.41–2.61, p<0.001), followed by week 4 eosinophil reduction (aOR 1.41 per 10% reduction, 95% CI 1.18–1.68, p=0.002). Week 8 symptom-score improvement did not remain independently significant after biomarker adjustment (p=0.21). The combined biomarker model showed good discrimination (c-statistic 0.84, 95% CI 0.76–0.92). Conclusion: Early FeNO and eosinophil reductions were independently associated with 12-month remission after biologic initiation in severe asthma. These findings support early biomarker-based prognostic assessment but require prospective validation before use in treatment-switching decisions
asthma; biological products; biomarkers; eosinophils; fractional exhaled nitric oxide; remission induction; retrospective studies.
Copyright (c) 2025 Muhammad Hassan Raza, Fnu Neha, Ekta Bai, Ravi Kumar, Akshy Kumar, Shaikh Khalid Muhammad (Author) https://creativecommons.org/licenses/by/4.0
A Randomized Trial of a Nurse-Led Symptom Monitoring App for Reducing Unplanned Hospital Admissions in Older Adults Receiving Chemotherapy
Background: Older adults receiving chemotherapy are vulnerable to treatment-related toxicities that may progress rapidly when symptoms are reported late, increasing emergency department visits, unplanned hospital admissions, and treatment disruption. Objective: To evaluate whether a nurse-led mobile symptom-monitoring application improves timely symptom reporting, reduces acute healthcare utilization, and enhances chemotherapy completion among older adults undergoing outpatient chemotherapy. Methods: A parallel-group randomized controlled trial was conducted in the Islamabad–Rawalpindi region over five months. Eighty-four adults aged ≥60 years receiving outpatient chemotherapy for solid malignancies were randomized equally to a nurse-led symptom-monitoring intervention or standard oncology care. The intervention group used a PRO-CTCAE-based mobile application for daily symptom reporting, with nurse review, telephone follow-up within 24 hours for moderate-to-severe symptoms, standardized guidance, escalation when required, and weekly virtual check-ins. The control group received routine oncology care without structured digital monitoring. Outcomes included unplanned hospital admissions, emergency department visits, symptom-reporting delay, ESAS symptom burden, and chemotherapy completion over six weeks. Results: Seventy-five participants completed follow-up, including 38 in the intervention group and 37 in the control group. The intervention group had fewer unplanned hospital admissions than controls (1.21 ± 0.74 vs 2.08 ± 0.91, p<0.001) and fewer emergency department visits (0.89 ± 0.63 vs 1.67 ± 0.88, p<0.001). Symptom-reporting delay decreased from 3.6 ± 1.2 to 1.4 ± 0.6 days in the intervention group, compared with 3.5 ± 1.1 to 3.2 ± 1.0 days in controls. ESAS scores improved more substantially in the intervention group, and chemotherapy completion was higher with nurse-led monitoring (86.8% vs 70.3%, p=0.04). Conclusion: Nurse-led digital symptom monitoring improved early symptom communication, reduced acute healthcare utilization, lowered symptom burden, and supported chemotherapy completion among older adults receiving chemotherapy.
Older adults; chemotherapy; nurse-led intervention; symptom monitoring; mobile application; PRO-CTCAE; emergency department visits; hospital admissions
Copyright (c) 2025 Fauzia Latif, Amna Aziz, Zarina Naz, Kashfa Sana (Author) https://creativecommons.org/licenses/by/4.0
Retained Wisdom Tooth Root Fragment Versus Complete Extraction for Preventing Inferior Alveolar Nerve Injury in High-Risk Patients
Background: Inferior alveolar nerve disturbance remains an important complication of mandibular third molar surgery, particularly when preoperative imaging shows close proximity between the roots and mandibular canal. Coronectomy, involving removal of the crown while retaining a healthy apical root fragment, may reduce nerve trauma by avoiding apical manipulation in high-risk cases. Objective: To compare coronectomy with complete surgical extraction for reducing short-term inferior alveolar nerve disturbance in patients with radiographically high-risk mandibular third molars. Methods: A parallel-group randomized controlled trial was conducted in the Islamabad–Rawalpindi region over five months. Seventy-two adults aged 18–40 years with impacted mandibular third molars showing radiographic proximity to the inferior alveolar canal were randomized equally to coronectomy or complete extraction. Neurosensory function was assessed using light-touch and two-point discrimination testing at baseline, 1 week, 4 weeks, and 8 weeks. Pain, facial swelling, and infection were also recorded. Results: Sixty-seven participants completed follow-up, including 33 in the coronectomy group and 34 in the complete extraction group. At 8 weeks, inferior alveolar nerve disturbance was lower after coronectomy than complete extraction, 6.1% versus 23.5% (p=0.041). Two-point discrimination was also better after coronectomy, 5.2 ± 1.1 mm versus 6.8 ± 1.5 mm (p<0.001). Early postoperative pain and swelling were significantly lower in the coronectomy group, while infection rates did not differ significantly. Conclusion: Coronectomy reduced short-term inferior alveolar nerve disturbance and improved early postoperative recovery compared with complete extraction in selected high-risk mandibular third molars.
Coronectomy; Inferior Alveolar Nerve; Mandibular Third Molar; Nerve Injury; Oral Surgery; Randomized Controlled Trial; Tooth Extraction.
Copyright (c) 2025 Sumblina Amin, Aqsa Amin, Alkesh Kammal, Haadia Arooj, Farheen Khan, Hafsa Liaqat, Ghazal Rahu (Author) https://creativecommons.org/licenses/by/4.0
A Comparative Analysis of Point-of-Care Dipstick Testing with Culture for Detection of Urinary Tract Infection
Background: Urinary tract infections are among the most frequent bacterial infections encountered in clinical practice and require timely diagnosis to guide appropriate patient management. Although urine culture remains the reference standard for confirming infection, its longer turnaround time may delay early clinical decision-making. Point-of-care urine dipstick testing provides a rapid and low-cost screening option by detecting leukocyte esterase and nitrite, which serve as indirect markers of urinary inflammation and bacteriuria. Objective: This study aimed to evaluate the diagnostic accuracy of combined leukocyte esterase and/or nitrite urine dipstick testing compared with urine culture for the detection of urinary tract infection. Methods: A comparative cross-sectional diagnostic accuracy study was conducted on 100 urine samples collected from clinically suspected urinary tract infection cases. Each sample was analyzed using urine dipstick testing and standard urine culture. Dipstick results were considered positive when leukocyte esterase and/or nitrite showed positivity. Urine culture was used as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy were calculated. Results: Urine culture was positive in 60 samples and negative in 40 samples. Dipstick testing identified 68 positive and 32 negative samples. Compared with culture, dipstick testing produced 48 true-positive, 20 false-positive, 20 true-negative, and 12 false-negative results. Sensitivity was 80.0%, specificity 50.0%, positive predictive value 70.6%, negative predictive value 62.5%, and diagnostic accuracy 68.0%. Conclusion: Combined leukocyte esterase and/or nitrite dipstick testing is useful as a rapid initial screening method for suspected urinary tract infection, but urine culture remains essential for definitive diagnosis and antimicrobial guidance.
Urinary Tract Infection; Urine Dipstick Test; Urine Culture; Leukocyte Esterase; Nitrite; Diagnostic Accuracy
Copyright (c) 2025 Aqsa Ashiq, Hifsa Mobeen, Wajiha Zafar, Tayyaba Ghafoor, Ahmad Salih, Tehreem Fatima, Asma Fatima (Author) https://creativecommons.org/licenses/by/4.0
Descriptive Assessment Of General Patterns Of Multidrug Resistance Observed In Various Dermatological Conditions Across Patient Groups
Background: Multidrug resistance (MDR) in dermatological infections is an increasing clinical and public health concern, particularly in settings where empirical antimicrobial prescribing, self-medication, and limited routine culture testing may contribute to resistant disease. Objective: To determine the prevalence and distribution of MDR among microbiologically confirmed dermatological infections across patient groups in South Punjab. Methods: A descriptive cross-sectional study was conducted over four months in outpatient dermatology clinics and tertiary healthcare facilities across South Punjab. A total of 384 patients with confirmed microbial skin infections were enrolled. Demographic and clinical data were collected using a structured proforma, and skin swabs, scrapings, or biopsy specimens were processed using standard microbiological methods. Antimicrobial susceptibility was assessed using the Kirby-Bauer disk diffusion method, and MDR was defined as resistance to at least one agent in three or more antimicrobial classes. Data were analyzed using SPSS version 26. Results: The mean age was 38.6 ± 15.2 years, with equal male and female representation. Rural residents accounted for 62.0% of participants. Overall, MDR was identified in 196 of 384 patients (51.0%). Mixed infections showed the highest MDR proportion (58.8%), followed by bacterial (55.8%), parasitic (47.4%), and fungal infections (44.3%). Adults aged 18–40 years contributed the largest number of MDR cases (82/146; 56.2%). Staphylococcus aureus showed the highest pathogen-specific MDR rate (68/104; 65.4%), followed by Pseudomonas aeruginosa (42/68; 61.8%). Conclusion: MDR was frequent among dermatological infections in South Punjab, particularly in mixed and bacterial infections and among common bacterial pathogens. Culture-guided therapy, rational antimicrobial use, and regional resistance surveillance are essential to improve dermatological infection management.
Antimicrobial resistance, dermatological infections, multidrug resistance, skin infections, Staphylococcus aureus, Pseudomonas aeruginosa, South Punjab
Copyright (c) 2025 Abdul Rehman, Babu Shah Mohammed, Areeba Sajjad, Sidrah Hafeez, Sajjad Ahmad, Muhammad Jawad, Badeea Farrukh (Author) https://creativecommons.org/licenses/by/4.0
Clinical Efficacy of Rifampicin Nanoparticle Local Delivery in Post-Surgical Wound Infections Caused by Resistant Bacteria
Background: Post-surgical wound infections caused by resistant bacteria remain difficult to manage because conventional antimicrobial strategies may provide inadequate local drug exposure, delayed bacterial clearance, frequent dressing requirements, and prolonged wound healing. Nanoparticle-based local antibiotic delivery may improve wound-site drug retention while reducing treatment burden. Objective: To evaluate the clinical efficacy and local tolerability of rifampicin nanoparticle dressing in adults with culture-confirmed resistant post-surgical wound infections. Methods: A parallel-group randomized controlled trial was conducted in a tertiary care surgical unit in Central Punjab, Pakistan, from September 2025 to January 2026. Seventy-two adults aged 18–65 years were randomized equally to receive either localized rifampicin nanoparticle dressing or conventional antimicrobial dressing for four weeks. Primary outcomes were percentage wound area reduction and quantitative bacterial load. Secondary outcomes included dressing frequency, pain, comfort score, and local adverse effects. Results: Sixty-three participants completed follow-up and were included in the final post-intervention analysis. The rifampicin nanoparticle group showed greater wound area reduction than controls (68.5 ± 12.4% vs 49.2 ± 11.8%; p<0.001) and lower bacterial load (2.1 ± 0.6 vs 3.4 ± 0.7 log CFU/ml; p<0.001). The intervention group also had fewer dressing changes, lower pain scores, and higher comfort scores, while local adverse effects were comparable between groups. Conclusion: Localized rifampicin nanoparticle delivery significantly improved wound healing, bacterial clearance, and patient-centered outcomes in resistant post-surgical wound infections, supporting its potential as an adjunctive wound-care strategy.
Antibacterial Agents; Drug Delivery Systems; Nanoparticles; Postoperative Wound Infection; Rifampicin; Randomized Controlled Trial; Wound Healing
Copyright (c) 2025 Bushra Rasool, Hijab Zahra, Aramish Iqbal, Muhammad Azhar, Sana Ahmed, Rafia Arshad (Author) https://creativecommons.org/licenses/by/4.0
Effect of Sedentary Behavior on the Nutritional Status of Children (Age Between 6 to 12 Years)
Background: Sedentary behavior, prolonged screen exposure, inadequate physical activity, and unhealthy dietary practices are increasingly associated with abnormal nutritional status among school-aged children. In urban settings such as Karachi, these behaviors may contribute to both excess body weight and broader nutritional imbalance. Objective: To assess the association between sedentary behavior and nutritional status among children aged 6–12 years in Karachi, Pakistan. Methods: This school-based cross-sectional study included 380 children aged 6–12 years from selected public and private schools in Karachi. Data were collected using a structured parent-completed questionnaire assessing sociodemographic characteristics, dietary behaviors, physical activity, sedentary behavior, screen time, sports participation, and transport mode. Height and weight were measured using standardized procedures, and nutritional status was classified using WHO BMI-for-age Z-score categories. Data were analyzed using SPSS version 23. Frequencies and percentages were calculated, and chi-square tests were used to assess associations between categorical variables and BMI-based nutritional status. Results: Of 380 children, 201 were male and 179 were female. Overall, 43 children were underweight, 124 had normal weight, 79 were overweight, and 134 were obese. Combined overweight/obesity was present in 213 children. Weekday sedentary behavior, recreational screen time >2 hours/day, physical activity category, breakfast frequency, dinner frequency, fast-food and snack intake, delayed meal pattern, and transport mode were significantly associated with BMI-based nutritional status. Screen time >2 hours/day showed the clearest association with overweight/obesity, as 170 of 195 children in this category were overweight or obese compared with 43 of 185 children with screen time ≤2 hours/day. Conclusion: Sedentary behavior, prolonged recreational screen time, dietary patterns, and physical activity category were significantly associated with nutritional status among children aged 6–12 years in Karachi. Because of the cross-sectional design, the findings should be interpreted as associations rather than causal effects. School- and family-based interventions should prioritize reducing recreational screen exposure, promoting regular physical activity, and improving dietary routines.
Sedentary behavior; nutritional status; obesity; overweight; physical activity; screen time; children; BMI-for-age
Copyright (c) 2025 Aqsa Javed, Fatima Jawaid, Rida Ahmed, Sana Khalid, Amna Javed, Eisha Khaliq, Dr. Fareeha (Author) https://creativecommons.org/licenses/by/4.0
Impact of Low Back Pain on Musculoskeletal Health in Prime Gravida Women With or Without Spinal Anesthesia
Background: Postpartum musculoskeletal symptoms may affect maternal mobility, self-care, physical activity, and return to daily routine, particularly among primigravida women recovering after delivery. Spinal anesthesia is commonly used in obstetric practice, yet its association with postpartum musculoskeletal health remains clinically relevant and insufficiently defined. Objective: To determine the association between spinal anesthesia exposure and postpartum musculoskeletal health among primigravida women. Methods: A cross-sectional observational study was conducted among 266 primigravida women assessed eight weeks after delivery. Participants were divided equally into women who received spinal anesthesia before delivery (n = 133) and women who did not (n = 133). Data were collected using a structured form and the Musculoskeletal Health Questionnaire, assessing pain intensity, joint or muscle stiffness, walking interference, washing or dressing difficulty, physical activity limitation, disruption of daily routine, and overall musculoskeletal health score. Descriptive statistics and Pearson correlation analysis were performed using SPSS version 25. Results: Pain intensity was comparable between groups, with moderate-to-severe pain reported by 16.5% of women in the spinal anesthesia group and 15.0% in the non-spinal anesthesia group. However, severe functional interference was more frequent among women exposed to spinal anesthesia, particularly daily routine disruption (27.8% vs 12.8%), daytime pain or stiffness (24.1% vs 11.3%), and walking interference (24.1% vs 11.3%). Spinal anesthesia status showed a significant weak-to-modest negative correlation with Musculoskeletal Health Questionnaire score (r = −0.231, p < 0.001). Conclusion: Spinal anesthesia exposure was associated with poorer postpartum musculoskeletal health among primigravida women, mainly through greater stiffness and functional interference rather than pain intensity alone. These findings support routine postpartum musculoskeletal screening and early rehabilitative guidance.
Spinal anesthesia, primigravida, postpartum, musculoskeletal health, low back pain, stiffness, MSK-HQ.
Copyright (c) 2025 Layba Khalid Janjua, Moeen Ahmad Khan, Harum Fatima, Ayesha Zaheer, Armeen Shahid, Anam Abbas (Author) https://creativecommons.org/licenses/by/4.0
Comparison of Neck Pain and Disability With and Without Helmet in Commercial Bikers
Background: Neck pain is a common musculoskeletal complaint among commercial bike riders because of prolonged riding duration, sustained cervical posture, repetitive road vibration, occupational workload, and possible helmet-related biomechanical loading. Although helmets are essential for head-injury prevention, their relationship with neck pain and neck-related disability remains clinically debated. Objective: To compare the prevalence and severity of neck pain and neck-related disability among commercial bike riders with and without helmet use. Methods: This observational cross-sectional study was conducted among 231 male commercial bike riders in Lahore, Pakistan. Participants were selected through non-probability convenience sampling and categorized into helmet users (n = 115) and non-helmet users (n = 116). Data were collected using a self-structured questionnaire, Numeric Pain Rating Scale, and Neck Disability Index. Descriptive statistics and chi-square tests were applied using IBM SPSS Statistics version 25, with p < 0.05 considered statistically significant. Results: Neck pain was reported by 67 helmet users (58.3%) and 85 non-helmet users (73.3%). Non-helmet users had higher crude odds of neck pain than helmet users (OR = 1.96; 95% CI: 1.13–3.42; p = 0.016). Severe-to-complete disability was more frequent among non-helmet users than helmet users (15.5% vs 6.1%), whereas moderate disability was higher among helmet users (24.3% vs 16.4%). Neck pain was significantly associated with Neck Disability Index category within both helmet users and non-helmet users (p < 0.001). Conclusion: Neck pain and disability were common among commercial bike riders, with greater neck-pain prevalence and severe-disability burden among non-helmet users. These findings suggest that cervical symptoms in commercial riders are multifactorial and should be addressed through helmet safety, ergonomic correction, posture education, and preventive neck-care strategies.
Neck Pain; Neck Disability Index; Helmet Use; Commercial Bike Riders; Numeric Pain Rating Scale; Occupational Health.
Copyright (c) 2025 Muhammad Asad Naeem, Rubab Nadeem, Muhammad Abrar Khan, Aamna Binte Ali, Samra Naeem, Muhammad Zain ul Abedin (Author) https://creativecommons.org/licenses/by/4.0
Association Between Sleep Quality and Postpartum Depression in Primigravida
Background: Postpartum depression and poor sleep quality are common concerns among first-time mothers and may negatively affect maternal recovery, emotional well-being, infant care, and mother–infant bonding. Sleep disturbance during the postpartum period may arise from infant-care demands, physical discomfort, fragmented nighttime rest, and psychosocial adjustment, while depressive symptoms may further worsen perceived sleep quality. Objective: To assess the association between sleep quality and postpartum depression among primigravida women and to compare sleep quality and depressive symptoms between vaginal and cesarean delivery groups. Methods: A cross-sectional observational study was conducted among 142 primigravida postpartum women, including 71 women after vaginal delivery and 71 after cesarean delivery. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and postpartum depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Data were analyzed using descriptive statistics, independent-samples t-tests, Pearson’s correlation, and Spearman’s correlation, with statistical significance set at p < 0.05. Results: Cesarean-delivery mothers had higher mean EPDS scores than vaginal-delivery mothers (15.96 ± 5.82 vs 10.65 ± 5.74) and higher mean PSQI scores (10.65 ± 3.77 vs 6.25 ± 4.26). Poorer sleep quality was moderately and positively associated with higher depressive symptom severity (Pearson’s r = 0.591, p < 0.001; Spearman’s rho = 0.615, p < 0.001). Pain during sleep showed the largest delivery-mode difference. Conclusion: Poor sleep quality was significantly associated with higher postpartum depressive symptoms among primigravida women, with cesarean-delivery mothers showing greater sleep and depression burden. Routine postpartum assessment of sleep disturbance, pain-related sleep disruption, and depressive symptoms may support early identification and timely maternal mental health care.
Postpartum depression; sleep quality; primigravida; Pittsburgh Sleep Quality Index; Edinburgh Postnatal Depression Scale; cesarean section; vaginal delivery
Copyright (c) 2025 Rimsha Akhtar, Moeen Ahmad Khan, Samra Younas, Nasrullah, Zarmina Fatima, Kalsoom Sakhi Ullah (Author) https://creativecommons.org/licenses/by/4.0
Frequency of Heel Pain and Its Association with Quality of Life Among Hair Dressers in Lahore
Background: Heel pain is a common occupational musculoskeletal complaint among workers who spend prolonged periods standing, including hairdressers, and may negatively affect physical functioning, psychological wellbeing, work performance, and overall quality of life. Objective: To determine the frequency of heel pain and assess its association with quality of life among hairdressers in Lahore. Methods: This cross-sectional observational study included 279 male and female hairdressers aged 18–35 years who had been practicing professionally for at least two years and worked 7–8 hours per day. Participants were recruited from salons in Lahore using convenience sampling. Heel pain intensity was assessed using the Numeric Pain Rating Scale and categorized as no pain, mild pain, moderate pain, or severe pain. Quality of life was assessed using domain-based questionnaire responses covering general health, physical health, psychological health, social relationships, and environmental health. Data were analyzed using descriptive statistics and tests of association, with statistical significance set at p < 0.05. Results: Most participants were male (61.6%). Heel pain was reported by 65 participants (23.3%), while 214 participants (76.7%) reported no pain. Mild pain was present in 21 participants (7.5%), moderate pain in 33 participants (11.8%), and severe pain in 11 participants (3.9%). Heel pain intensity showed a statistically significant association with poorer quality-of-life outcomes across general, physical, psychological, social, and environmental domains (p < 0.001). Conclusion: Heel pain affected nearly one-fourth of hairdressers and was significantly associated with reduced quality of life, particularly in physical and psychological domains. Early screening, ergonomic education, supportive footwear, rest breaks, and preventive workplace strategies may help reduce heel pain burden and improve wellbeing among hairdressers
Heel pain; hairdressers; quality of life; occupational health; Numeric Pain Rating Scale; musculoskeletal pain; Lahore.
Copyright (c) 2025 Maliha Arshad, Rubab Nadeem, Fariha Arshad, Moeen Ahmad Khan, Laraib Gul, Ahmad Raza (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Hamstring and Iliotibial Band Tightness Associated with Low Back Pain and Disability Among Traffic Wardens
Background: Low back pain is a common occupational health problem that may impair physical function and work performance, particularly in traffic wardens exposed to prolonged standing, repetitive walking, and sustained postural loading. Reduced hamstring and iliotibial band flexibility may alter lumbopelvic mechanics and contribute to pain-related disability. Objective: To determine the prevalence of hamstring and iliotibial band tightness and assess their association with low back pain intensity and disability among traffic wardens. Methods: A cross-sectional observational study was conducted among 212 traffic wardens aged 30–50 years in Lahore, Pakistan. Hamstring tightness was assessed using the 90–90 straight leg raise test, iliotibial band tightness using Ober’s test, pain intensity using the Numeric Pain Rating Scale, and disability using the Oswestry Disability Index. Data were analyzed using descriptive statistics and chi-square tests, with odds ratios calculated for clinically relevant associations. Results: Hamstring tightness was present in 136 participants (64.2%), while iliotibial band tightness was present in 84 participants (39.6%). Moderate pain was reported by 146 participants (68.9%) and severe pain by 46 (21.7%). Moderate disability was observed in 94 participants (44.3%), severe disability in 80 (37.7%), and complete disability in 12 (5.7%). Pain intensity was significantly associated with hamstring tightness (χ² = 12.67, p = 0.005), iliotibial band tightness (χ² = 13.66, p = 0.003), and Oswestry disability category (χ² = 41.76, p < 0.001). Participants with severe pain had higher odds of severe-to-complete disability (OR = 4.60, 95% CI: 2.25–9.42). Conclusion: Hamstring tightness was highly prevalent and iliotibial band tightness was moderately prevalent among traffic wardens with low back pain. Greater pain intensity was significantly associated with lower-limb tightness and higher disability, supporting the need for routine flexibility screening and targeted occupational rehabilitation
Low back pain; hamstring tightness; iliotibial band tightness; traffic wardens; Oswestry Disability Index; occupational health.
Copyright (c) 2025 Shahzad Anjum, Rubab Nadeem, Zahid Ali, Eeman Rauf, Bilal Ahmad, Muhammad Faisal (Author) https://creativecommons.org/licenses/by/4.0
Correlation of Restless Leg Syndrome and Sarcopenia with Function and Sleep Quality in Older Adults
Background: Restless legs syndrome and sarcopenia-related functional limitation are common geriatric concerns that may adversely affect sleep quality, physical activity, mobility, and independence among older adults. Sleep disturbance in this population may coexist with reduced lower-extremity performance, but evidence from South Asian older adults remains limited. Objective: To determine the correlation of restless legs syndrome and suspected sarcopenia-related functional limitation with lower-extremity function and sleep quality among older adults. Methods: This observational cross-sectional study included 175 older adults recruited from tertiary care hospitals, geriatric outpatient departments, and community elderly centers in Lahore, Pakistan. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and lower-extremity function was measured using the Lower Extremity Functional Scale. Demographic and clinical variables were summarized using descriptive statistics, and Pearson correlation analysis was applied to assess associations between sleep-quality index and selected variables. Results: The mean age of participants was 67.54 ± 7.50 years, and females comprised 59.4% of the sample. Poor sleep quality was observed in 149 participants (85.1%), while 148 participants (84.6%) had moderate lower-extremity functional limitation. Mean PSQI score was 8.18 ± 2.79, mean LEFS score was 53.97 ± 5.69, and mean sleep duration was 6.55 ± 1.19 hours. Sleep-quality index showed strong positive correlations with sleep duration (r = 0.715, p < 0.001) and physical activity level (r = 0.709, p < 0.001), and a moderate inverse correlation with lower-extremity functional performance (r = −0.540, p < 0.001). Conclusion: Poor sleep quality and moderate lower-extremity functional limitation were highly prevalent among older adults with restless legs syndrome and suspected sarcopenia-related impairment. Sleep quality, sleep duration, physical activity, and lower-extremity function were closely interrelated, supporting the need for integrated geriatric assessment of sleep and mobility
Restless Legs Syndrome; Sarcopenia; Sleep Quality; Lower Extremity Function; Older Adults; Physical Activity
Copyright (c) 2025 Maryam Allah Rakha, Hafiza Sana Ashraf, Muhammad Noman Tasawer, Sarah Irshad, Syeda Tayyaba Saeed, Misbah Tariq (Author) https://creativecommons.org/licenses/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
Design and Implementation of a Competency-Based Training Framework for Home Health Aides in Community Settings
Background: Home health aides provide essential support to patients receiving care in community and home-based settings, yet their training often varies across institutions and may lack structured competency validation. Competency-based training may improve practical performance, but implementation evidence in home health aide education remains limited. Objective: This study aimed to design and implement a competency-based training framework for home health aide trainees and evaluate its implementation outcomes, including adoption, feasibility, acceptability, fidelity, maintenance, and cost, alongside secondary caregiver and patient-related outcomes. Methods: A cluster-based hybrid effectiveness–implementation study was conducted across six healthcare training institutes in the United States. Three institutes implemented an 8-week competency-based training framework organized into basic, intermediate, and advanced skill levels, while three comparison institutes continued traditional training. The RE-AIM framework guided implementation evaluation. Outcomes included caregiver competency scores, patient satisfaction, infection incidence, medication errors, fall rates, readmissions, SF-36 quality-of-life scores, adoption, acceptability, fidelity, maintenance, and preliminary cost-offset estimates. Results: A total of 180 trainees participated, including 92 in the intervention group and 88 in the comparison group. Program completion was higher in the intervention group than in the comparison group (93.4% vs 81.8%). Fidelity was 91.0%, and 87.0% of trainees reported that the competency-based program was more useful than traditional training. Competency scores improved from 58.2 to 84.6 post-training in the intervention group and from 59.1 to 68.3 in the comparison group. At 6 months, scores remained higher in the intervention group than in the comparison group (78.9 vs 63.4). Patient-related indicators favored the intervention group, including satisfaction (88.5% vs 74.2%), infection incidence (6.8% vs 11.9%), medication errors (4.1 vs 9.3 per 100 cases), falls (5.7 vs 10.6 per 100 patients), readmissions (12.3% vs 18.8%), and SF-36 score (72.4 vs 61.7). The average training cost was USD 420 per caregiver, with an estimated annual cost offset of USD 950 per patient. Conclusion: The competency-based training framework was feasible, acceptable, adoptable, and deliverable with high reported fidelity across participating institutes. The findings suggest favorable early maintenance of caregiver competency and improved patient-related indicators, but larger cluster-adjusted studies with complete statistical and economic evaluation are needed before definitive effectiveness or cost-effectiveness conclusions can be made
implementation science; competency-based training; home health aides; RE-AIM framework; feasibility; acceptability; adoption; fidelity; sustainability; home healthcare.
Copyright (c) 2025 Saira 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
Comparison of AMH and LH/FSH Ratio for Predicting Anovulation in PCOS
Background: Polycystic ovary syndrome is a common endocrine disorder and a major cause of anovulatory infertility. Although LH/FSH ratio is traditionally used as a supportive hormonal marker in PCOS, its predictive value is inconsistent and may be influenced by BMI and cycle-related variability. Anti-Müllerian hormone reflects small antral follicle burden and may offer a more stable biomarker for ovulatory dysfunction. Objective: To compare the predictive performance of AMH and LH/FSH ratio for anovulation in women with PCOS and to develop a simple clinical scoring tool incorporating hormonal and clinical predictors. Methods: This cross-sectional predictive study included 250 women aged 18–35 years diagnosed with PCOS according to Rotterdam criteria at a tertiary hospital in Quetta, Pakistan. Clinical assessment, BMI categorization, serum AMH, LH, FSH, LH/FSH ratio, and pelvic ultrasonography were evaluated. Correlation analysis, ROC curve analysis, BMI-stratified subgroup analysis, and multivariable logistic regression were performed. Results: AMH showed stronger predictive accuracy for anovulation than LH/FSH ratio, with AUC values of 0.88 (95% CI: 0.83–0.93) and 0.74 (95% CI: 0.67–0.81), respectively. AMH ≥8 ng/mL demonstrated 85% sensitivity and 80% specificity, while LH/FSH ratio ≥2.0 showed 70% sensitivity and 65% specificity. AMH correlated strongly with follicle count (r = 0.72, p < 0.001), whereas LH/FSH ratio showed a moderate correlation (r = 0.41, p = 0.020). AMH retained high predictive performance across BMI categories, while LH/FSH ratio declined in obese women. AMH ≥8 ng/mL was the strongest independent predictor of anovulation (OR = 4.5, 95% CI: 2.7–7.6, p < 0.001), and the proposed scoring tool achieved 82% preliminary accuracy. Conclusion: AMH is a superior and more BMI-stable predictor of anovulation than LH/FSH ratio in women with PCOS. Integrating AMH into a simple scoring model may improve outpatient risk stratification and fertility counseling.
PCOS, anti-Müllerian hormone, AMH, LH/FSH ratio, anovulation, ovarian follicles, BMI, infertility, predictive biomarker.
Copyright (c) 2025 Rawaal Amin, Aneen Akbar, Sadaf Zulfiqar, Mehak Memon, Shafquat Ara, Haleema Shehnaz Bhatti, Naseem Fatima (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