Open Access Statement LMJHCR is a fully open-access journal. All published articles are made available online immediately upon publication, without subscription or access barriers. Readers may read, download, copy, share, distribute, print, search, and link to the full text of articles and may use the content for any lawful purpose, provided appropriate attribution is given to the original author(s) and source. Journal Identity Link Medical Journal of Health and Community Research (LMJHCR) is a peer-reviewed, open-access journal published by Link Medical Interface. The journal advances multidisciplinary scholarship across medical sciences, clinical specialties, rehabilitation and allied health, biomedical sciences, and public and community health, with emphasis on clinically relevant and community-informed research. Journal Title: Link Medical Journal of Health and Community Research (LMJHCR) Publisher: Link Medical Interface Publication Frequency: Biannual (two issues per year) Online ISSN: 3007-3448 ISSN Portal Record: https://portal.issn.org/resource/ISSN-L/3007-3448 Digital Object Identifiers (DOIs): All published articles are assigned DOIs. Scholarly Visibility: Articles are discoverable through major scholarly search platforms (including Google Scholar) and through structured metadata and DOI-based linking. Recognition: HEC Recognized (as per latest official listing) Aims and Objectives LMJHCR is committed to advancing evidence-based scholarship in medical sciences, public health, and community-based research. Our primary aim is to foster innovative, ethically sound contributions that address pressing health challenges, promote equity in healthcare delivery, and enhance community well-being, with particular relevance to resource-limited settings and underrepresented populations globally. The journal also encourages early-career researchers and novice contributors by providing clear editorial guidance and constructive peer-review feedback, while maintaining rigorous scientific and ethical standards. All submissions undergo editorial screening and double-blind peer review and must meet the journal’s ethical, transparency, and reporting requirements. The journal’s objectives are to: • Disseminate high-quality original research, reviews, and perspectives that bridge clinical practice, epidemiological insights, and socio-cultural determinants of health. • Support interdisciplinary collaboration among researchers, clinicians, policymakers, and community stakeholders to translate findings into actionable health interventions. • Prioritize rigorous methodologies that contribute to sustainable health improvements and inform health policy and practice. • Expand scholarly exchange through cross-cultural knowledge sharing and inclusive publishing practices. Scope LMJHCR welcomes submissions across clinical medicine, rehabilitation sciences, public and community health, epidemiology, and innovations in diagnostics and therapy. Areas of interest include (but are not limited to): • Neurological and musculoskeletal rehabilitation (e.g., stroke recovery, chronic pain, physical therapy interventions). • Chronic disease epidemiology and management (e.g., diabetes, kidney disease, metabolic disorders). • Community health dynamics (health-seeking behavior, cultural influences, nutrition, women’s health, preventive strategies in low- and middle-income contexts). • Emerging tools and technologies for early detection and personalized care (including AI-enabled decision support where appropriate). • Infectious disease stewardship, antimicrobial resistance, and screening programs. • Socio-economic and environmental determinants of health, including rural–urban disparities. We encourage diverse methodologies—cross-sectional surveys, interventional trials, diagnostic accuracy studies, and qualitative research—provided they demonstrate real-world relevance, methodological robustness, and ethical compliance. Journal Policies and Transparency Licensing and Copyright All articles are published under Creative Commons Attribution 4.0 International (CC BY 4.0), and authors retain copyright with a non-exclusive license to publish. Licensing Policy: https://linkmjhcr.com/index.php/lmj/licensingpolicy Copyright Policy: https://linkmjhcr.com/index.php/lmj/copyrightpolicy Peer Review LMJHCR uses a double-blind peer review process with documented workflow, timelines, and responsibilities for authors, reviewers, and editors. Peer Review Policy: https://linkmjhcr.com/index.php/lmj/peerreviewpolicy Publication Ethics The journal applies documented ethics procedures for plagiarism screening, authorship integrity, corrections/retractions, and misconduct handling. Publication Ethics & Malpractice Statement: https://linkmjhcr.com/index.php/lmj/publicationethicsmalpracticestatement Complaints and Appeals Authors and readers may submit complaints or appeals through a fair, confidential, and structured process with defined timelines. Complaints & Appeals Policy: https://linkmjhcr.com/index.php/lmj/complaintsappealspolicy Publication Fee Publication fee information (including what it covers and waiver provisions, where applicable) is provided transparently in the policy. Author Charges / Publication Fee Policy: https://linkmjhcr.com/index.php/lmj/authorchargespublicationfeepolicy Archiving and Preservation LMJHCR ensures long-term access to published content through documented preservation and archiving arrangements. Archiving & Digital Preservation Policy: https://linkmjhcr.com/index.php/lmj/archivingdigitalpreservationpolicy Self-Archiving Authors may self-archive preprints, accepted manuscripts, and published PDFs without embargo, with proper citation and licensing. Self-Archiving Policy: https://linkmjhcr.com/index.php/lmj/selfarchivinggreenopenaccesspolicy Privacy and Data Protection Personal data is handled under a defined privacy, consent, and data protection framework; reviewer anonymity is protected under the review model. Privacy / Data Protection Policy: https://linkmjhcr.com/index.php/lmj/privacypolicydataprotectionconsentpolicy Competing Interests (Conflict of Interest) Authors, reviewers, and editors must disclose any financial or non-financial competing interests; recusal is applied where conflicts exist. Conflict of Interest Policy: https://linkmjhcr.com/index.php/lmj/conflictofinterestpolicy Full Policies Hub All journal policies are available here (Open access, licensing, copyright, ethics, review, governance, archiving, transparency, and more): https://linkmjhcr.com/index.php/lmj/policies
Link Medical Interface, Lahore, Pakistan
© The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Influence of Selective Caries Removal on Post-Operative Sensitivity in Permanent Molars
Background: Post-operative sensitivity after restoration of deep carious lesions is a common patient-centered concern that may reduce comfort and satisfaction after dental treatment. Complete caries excavation can increase pulpal irritation in deep lesions, whereas selective caries removal preserves affected dentin near the pulp and may reduce early discomfort. Objective: To compare short-term post-operative sensitivity after selective caries removal versus complete excavation in permanent molars with deep carious lesions. Methods: This randomized controlled trial enrolled 60 adults aged 18–45 years with deep occlusal or occlusoproximal caries in permanent molars. Participants were allocated equally to selective caries removal or complete excavation. All cavities were restored immediately using resin-modified glass ionomer cement under standardized clinical protocols. Post-operative sensitivity was assessed using a visual analogue scale at 24 hours, 72 hours, and 7 days. Biting sensitivity and the association between cavity depth and VAS scores were also evaluated. Results: Selective caries removal produced lower VAS scores than complete excavation at 24 hours (2.1 ± 0.9 vs. 3.8 ± 1.1), 72 hours (1.4 ± 0.7 vs. 2.6 ± 0.9), and 7 days (0.6 ± 0.4 vs. 1.2 ± 0.6). Biting sensitivity was also less frequent after selective removal at 24 hours and 72 hours. Cavity depth showed stronger positive correlations with sensitivity after complete excavation. Conclusion: Selective caries removal reduced early post-operative sensitivity compared with complete excavation in permanent molars, supporting conservative excavation for short-term patient comfort.
Caries, Dental; Dental Pulp; Postoperative Complications; Randomized Controlled Trial; Resin-Modified Glass Ionomer; Sensitivity, Dental; Tooth, Permanent
Copyright (c) 2026 Fawad Ali Shah, Aimon Khan, Zoya Nawaz, Makkia Sumbal, Syed Ahmed Omer, Waleed Ajmal (Author) https://creativecommons.org/licenses/by/4.0
Nurse-Led Microclimate Adjustments in Patient Rooms and Their Physiological Impact on Sleep Quality Recovery
Background: Sleep disturbance is common among hospitalized adults and may impair physiological recovery, increase fatigue, and reduce patient comfort. Environmental factors such as room temperature, light exposure, noise, airflow, and bedding comfort are potentially modifiable contributors to inpatient sleep disruption. Objective: To evaluate the effect of nurse-led environmental microclimate adjustment on sleep quality and physiological sleep-recovery markers among hospitalized adults. Methods: A parallel-group randomized controlled trial was conducted in medical and post-surgical recovery wards of a tertiary care hospital in Central Punjab, Pakistan, from August 2025 to January 2026. Seventy-two adults with baseline sleep disturbance were randomized to structured nurse-led microclimate adjustment or routine ward care. The intervention targeted nighttime temperature, lighting, noise, airflow, and bedding comfort over 14 nights. Baseline characteristics were analyzed in all randomized participants, while post-intervention outcomes were analyzed among 65 participants with complete outcome data. Results: Post-intervention PSQI scores were lower in the intervention group than controls (5.9 ± 1.7 vs 8.8 ± 2.0; mean difference −2.9; 95% CI −3.8 to −2.0; p<0.001). The intervention group also showed fewer nighttime awakenings, higher oxygen saturation, greater heart rate variability, lower fatigue severity, and higher comfort scores. Comfort was inversely correlated with PSQI score (r=−0.61; p<0.001). Conclusion: Nurse-led microclimate adjustment was associated with improved sleep quality, comfort, fatigue, and physiological sleep-recovery markers in hospitalized adults. Larger multicenter trials with objective sleep monitoring and adjusted analyses are recommended.
Circadian Rhythm; Heart Rate Variability; Hospitalization; Nursing Care; Patient Comfort; Sleep Quality; Temperature Comfort
Copyright (c) 2026 Abrar Hussain, Sadia Iqbal, Anum Rehman, Syed Maaz Hussain, Abdullah Khan, Ayesha Rehman (Author) https://creativecommons.org/licenses/by/4.0
Effects of Instrument-Assisted Soft Tissue Mobilization Versus Active Release Technique for Tight Upper Trapezius Among Bikers of Gujranwala
Background: Upper trapezius tightness is a frequent musculoskeletal problem among bike riders because prolonged riding posture, vibration exposure, and sustained shoulder-neck loading may contribute to pain, restricted cervical mobility, and functional disability. Objective: This study aimed to compare the effects of Instrument-Assisted Soft Tissue Mobilization and Active Release Technique on pain intensity, cervical range of motion, and neck-related disability among bike riders with upper trapezius tightness. Methods: A randomized clinical trial was conducted in Gujranwala district over six months. A total of 126 individuals were screened, and 110 eligible bike riders aged 18–45 years were randomized into two equal groups. Group A received IASTM and Group B received ART; both groups also received standard physical therapy consisting of TENS, moist heat, and stretching. Treatment was delivered twice weekly for four weeks. Outcomes were assessed at baseline and after four weeks using the Numeric Pain Rating Scale, goniometric cervical range of motion, and Neck Disability Index. Results: Both groups showed significant within-group improvement after treatment. NPRS decreased from 6.71 ± 0.874 to 2.09 ± 1.191 in the IASTM group and from 6.94 ± 0.943 to 3.65 ± 1.493 in the ART group. IASTM showed greater post-treatment benefit for NPRS, flexion, extension, right side bending, and bilateral rotation, while NDI improved substantially in both groups without a statistically significant post-treatment between-group difference. Conclusion: IASTM was more effective than ART for reducing pain and improving most cervical mobility outcomes, while both interventions improved neck-related disability.
Active Release Technique; Bike Riders; Cervical Range of Motion; Instrument-Assisted Soft Tissue Mobilization; Neck Disability Index; Numeric Pain Rating Scale; Upper Trapezius Tightness.
Copyright (c) 2026 Noha Arshad, Shaphan Jonathan, Fatima, Noor ul Nisa, Nayab Kanwal, Arooba Tariq, Ayesha Fakhir, Muhammad Ahmad (Author) https://creativecommons.org/licenses/by/4.0
Maternal Decision-Making around Digital Birth Preparedness in Resource-Limited Settings: A Narrative Review
Background: Digital birth preparedness is increasingly promoted to improve maternal knowledge, antenatal engagement, and complication readiness in resource-limited settings, yet its influence on maternal decision-making depends on autonomy, household negotiation, phone access, privacy, trust, and health-system responsiveness. Objective: This narrative review synthesized recent evidence on how digital birth-preparedness interventions influence maternal decision-making, care-seeking, equity, privacy, and implementation in low-resource contexts. Methods: Literature published between January 2016 and May 2026 was reviewed from PubMed/MEDLINE, Scopus, Google Scholar, and institutional sources including the World Health Organization, UNFPA, UNICEF, International Telecommunication Union, GSMA, and the World Bank. Evidence from systematic reviews, intervention studies, qualitative research, implementation evaluations, and policy reports was synthesized thematically. Results: Digital interventions, including SMS reminders, voice messages, helplines, mobile applications, community health worker tools, electronic registers, and digital referral systems, can improve maternal knowledge, appointment recall, antenatal contact, and selected service-use behaviours. However, evidence is stronger for intermediate outcomes than for emergency referral completion, maternal mortality reduction, or sustained decision agency. Their impact is moderated by women’s control over phones, literacy, language, household authority, transport, cost, perceived quality of care, privacy safeguards, and facility readiness. Conclusion: Digital birth preparedness should be understood as health-system-integrated decision support rather than a stand-alone messaging strategy. Programmes are most likely to improve maternal decision-making when they combine timely information with community health worker support, respectful maternity care, emergency referral capacity, equity-sensitive design, and privacy-protective governance.
Digital Birth Preparedness; Maternal Decision-Making; mHealth; Birth Preparedness and Complication Readiness; Antenatal Care; Skilled Birth Attendance; Emergency Obstetric Referral; Resource-Limited Settings.
Copyright (c) 2025 Wang Chunxiang, Ali Napiah Nasution, Liena (Author) https://creativecommons.org/licenses/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
Knowledge, Attitude and the Acceptance of the COVID-19 Vaccine Among Undergraduate Students of Air University Islamabad
Background: COVID-19 vaccination remains an important public health measure for reducing severe disease and supporting community protection; however, vaccine uptake is influenced by knowledge, safety perceptions, trust, misinformation, affordability, and accessibility. University students are a relevant group for vaccine-confidence research because they are highly exposed to digital information and may influence family and peer health decisions. Objective: To assess knowledge, attitudes, and acceptance of COVID-19 vaccination among undergraduate students of Air University Islamabad. Methods: A descriptive cross-sectional study was conducted among 302 undergraduate students from different departments of Air University Islamabad, including Fazaia Medical College. Data were collected using an online structured questionnaire covering socio-demographic characteristics, COVID-19 information exposure, vaccine-related knowledge, attitudes, and acceptance factors. Data were analyzed using SPSS and summarized as frequencies, percentages, means, and standard deviations. Results: The mean age of participants was 21.04 ± 1.70 years; 161 students (53.3%) were female and 141 (46.7%) were male. Social media was the leading source of COVID-19 information (60.3%). The mean knowledge score was 5.11 ± 1.64, with 55.0% classified as having good knowledge. Most participants believed that COVID-19 vaccines were effective in preventing infection (90.4%) and that vaccination was necessary for Pakistan’s population (87.4%). Overall, 79.8% had a positive attitude, 88.1% would encourage family and friends to be vaccinated, and 91.7% would accept vaccination if recommended by doctors. Free provision (96.0%), convenience (85.1%), and price (64.6%) were important decision factors. Conclusion: Undergraduate students demonstrated good knowledge, positive attitudes, and high conditional acceptance of COVID-19 vaccination, especially under doctor recommendation. Physician-led education, transparent safety communication, social media-based myth correction, and free, convenient vaccination services may strengthen vaccine confidence among university students
COVID-19; vaccine acceptance; vaccine attitude; vaccine knowledge; undergraduate students; Pakistan; university students.
Copyright (c) 2026 Nadia Iqbal, Muhammad Farhan Chattha, Zoila Shah (Author) https://creativecommons.org/licenses/by/4.0
Biomechanical Links Between Knee Posture, Strength, and Low Back Pain: A Narrative Review
Background: Low back pain is a major cause of disability worldwide and is increasingly understood as a multifactorial condition influenced by interactions among the lumbar spine, pelvis, hips, knees, and distal lower limbs. Although traditionally managed as a spinal disorder, biomechanical alterations in knee posture, knee range of motion, muscle strength, and neuromuscular control may affect lumbopelvic alignment, spinal loading, gait mechanics, and functional movement. Objective: This narrative review aimed to synthesize current biomechanical and clinical evidence on the relationship between knee posture, knee muscle strength, lumbopelvic alignment, and low back pain, with emphasis on kinetic-chain mechanisms and implications for assessment and rehabilitation. Methods: Relevant literature was identified through searches of PubMed, Scopus, Web of Science, Google Scholar, and ScienceDirect using terms related to low back pain, knee alignment, knee osteoarthritis, knee extension limitation, quadriceps strength, hamstring strength, lumbopelvic alignment, sagittal balance, kinetic chain, gait, lifting, neuromuscular control, and rehabilitation. Evidence from biomechanical studies, observational studies, systematic reviews, clinical trials, gait analyses, and rehabilitation literature was synthesized narratively using a kinetic-chain framework. Results: The strongest evidence supports an association between restricted knee extension, knee flexion contracture, knee osteoarthritis, sagittal imbalance, and increased lumbar loading. Biomechanical studies indicate that knee extension limitation can increase lumbar extension moments, paraspinal activation, and lumbar or thoracolumbar compressive forces during gait. Moderate evidence suggests that quadriceps and hamstring weakness may impair shock absorption and alter force transmission to the pelvis and lumbar spine. Emerging evidence supports neuromuscular and myofascial pathways linking knee dysfunction with altered trunk control, proprioception, and movement compensation. Conclusion: Knee posture, mobility, strength, and neuromuscular control are clinically relevant contributors to lumbopelvic biomechanics and low back pain. Integrated assessment and rehabilitation should address knee alignment, knee range of motion, lower-limb strength, gait mechanics, and trunk–pelvis–knee coordination
Low Back Pain; Knee Joint; Biomechanics; Posture; Muscle Strength; Lumbopelvic Alignment; Kinetic Chain; Rehabilitation.
Copyright (c) 2026 Abdullah Faleh Alhumayani, Lamiaa K. Elsayyad, Chua Siew Kuan (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
Association Between Family Structure and Speech and Language Delay in Children
Background: Speech and language development in early childhood is strongly influenced by environmental and familial factors, particularly caregiver interaction, socioeconomic context, and household composition. Family structure may shape the quantity and quality of linguistic exposure through caregiver availability, supervision patterns, and communication practices. However, limited evidence exists from urban Pakistani clinical settings examining how family structure and related environmental factors coexist among children presenting with speech delay. Objective: To determine the association between family structure and speech and language delay among children attending tertiary care hospitals in Lahore, Pakistan, and to explore related caregiving and environmental characteristics. Methods: A cross-sectional observational study was conducted from July to December 2025 at Sehat Medical Complex and the University of Lahore Teaching Hospital. Sixty-eight children aged 3–9 years with clinically confirmed speech delay were recruited using purposive sampling. Data were collected through a structured questionnaire assessing family structure, parental education, household income, caregiver type, daily parent–child interaction time, storytelling frequency, and screen exposure. Descriptive statistics were generated using SPSS version 25. Results: Moderate speech delay was most prevalent (50.0%), followed by severe (26.5%) and mild (23.5%). Joint families constituted 52.9% of cases, nuclear families 38.2%, and single-parent households 8.8%. Male children represented 60.3% of participants. Low household income was reported in 79.4% of families. Limited daily interaction (≤2 hours) was observed in 77.9% of cases, while 83.8% engaged only occasionally or rarely in storytelling activities. Screen exposure ≥1 hour daily was reported in 77.9% of children. Conclusion: Children with speech delay in this clinical sample commonly resided in joint or non-nuclear family systems and experienced limited structured verbal interaction alongside considerable screen exposure. Household composition appears to interact with caregiving practices and socioeconomic factors, underscoring the importance of family-centered early intervention strategies.
Speech delay; Language delay; Family structure; Caregiver interaction; Screen exposure; Children.
Copyright (c) 2025 Marwa, Muhammad Sikander Ghayas Khan (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Hearing Loss in Children: A Systematic Review
Background: Hearing loss in childhood is a significant public health concern because it may affect speech perception, language development, classroom participation, academic achievement, and psychosocial wellbeing. School-based screening provides an important opportunity for early detection, particularly in settings where routine audiological services are limited. Objective: To synthesize evidence on the prevalence, types, and commonly reported otological contributors of hearing loss among school-going children. Methods: A systematic review with narrative synthesis was conducted using PubMed/MEDLINE, Scopus, and Google Scholar, supplemented by reference-list searching. Observational studies reporting hearing-loss prevalence among school-going children were included. Clinical subgroup studies were interpreted separately from general school-screening populations. Due to heterogeneity in audiometric thresholds, screening procedures, and case definitions, meta-analysis was not performed. Results: Eleven studies were included in the qualitative synthesis. Reported prevalence among general school-screening populations ranged from 2.4% to 21%, with most estimates clustering between approximately 5% and 12%. Conductive hearing loss was the predominant type where classification was reported. In Nepal, conductive hearing loss accounted for 70.47% of identified cases, while sensorineural and mixed hearing loss accounted for 25% and 3.84%, respectively. Commonly reported contributors included cerumen impaction, otitis media, chronic suppurative otitis media, and tympanic membrane abnormalities. Conclusion: Hearing loss among school-going children remains clinically important and is frequently associated with preventable or treatable conductive causes. Standardized school-based screening protocols, clear threshold reporting, diagnostic confirmation, and timely referral pathways are needed to reduce avoidable educational and social consequences.
Hearing loss; hearing impairment; school children; conductive hearing loss; otitis media; hearing screening; prevalence.
Copyright (c) 2025 Fatima Tahir, Muhammad Sikander Ghayas Khan, Muhammad Ahmed, Amina Iqbal, Arshed Mahmood Naz, Rabia Azmat, Anita Batool (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