Link Medical Journal
type: channel
description: 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 rig…
publisher: Link Medical Interface, Lahore, Pakistan
language: en
publication name: Link Medical Journal
issn: 3007-3448
copyright: © The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
items: https://linkmjhcr.com/index.php/lmj/article/view/110
items: Evaluating Effectiveness of Deferasirox Versus Deferoxamine in Improving Clinical Outcomes among Patients with Transfusion-Dependent Thalassemia: A Randomized Controlled Trial
items: Effects of Shi Style Cervical Mobilization Versus Sustained Natural Apophyseal Glides on Pain, Strength and Functional Disability in Patients with Cervicogenic Headache
items: AI-Based Risk Stratification for Latent Tuberculosis Among Urban Slum Dwellers: A Cross-Sectional Study
items: Effect of Task-Oriented Motor Training on Upper Limb Functional Recovery in Post-Stroke Patients: A Randomized Controlled Trial
items: Effect of Dietary Intervention on Short-Term Weight Recovery and Electrolyte Correction in Hospitalized Children with Acute Diarrhea
items: Barriers to Universal Health Coverage in Pakistan: A Health System Perspective
items: The Association Between Serum Vitamin D Status and Knee Joint Space Width in Adults with Early Osteoarthritis - A Cross-Sectional Study
items: Prospective Evaluation of Cognitive Reframing and Thought-Challenging Techniques in Reducing Symptom Severity Among Adults with Dual Anxiety–Depression Diagnosis
items: Randomized Trial of AI-Guided Antidepressant Selection Improving Remission and Tolerability in Primary-Care Depression
items: Phase of Neovascularization in Wound Repair: Topical Impact of Low-Level Laser Therapy with Conventional Treatment in Rabbit Model
items: Mental Health Services Accessibility in Pakistan: Gaps, Barriers, and Policy Implications — A Qualitative Analysis
items: Digital Health Knowledge, Attitudes, and Practices Among Undergraduate Nursing Students: A Comparative Study of Public and Private Colleges in Mirpurkhas, Sindh, Pakistan
items: Validating a Panel of Salivary miRNA and Protein Biomarkers for the Early Detection of High-Risk Oral Potentially Malignant Disorders
items: AI-Powered Detection of Functional Gastrointestinal Disorders in Adults Visiting Tertiary Hospitals
items: Effect of Menstrual Cycle Phases on Cognitive and Neuromuscular Performance
items: Digital Distraction in Nursing Education: Prevalence of Smartphone Use and Its Association with Classroom Distraction Among Undergraduate Nursing Students in Pakistan
items: Treatment Success in Patients with Cutaneous Leishmaniasis Treated with Inj. Glucantime 5 Ml (Meglumine Antimoniate) Dir Lower
items: Prevalence and Patterns of Abdominal Pathologies Detected Through Ultrasound Imaging in Patients From Tertiary Care Hospitals
items: Prevalence and Severity of Dry Eye Disease Among Prolonged Digital Device Users: A Cross-Sectional Study
items: Comparing Early vs Delayed Mobilization After Coronary Artery Bypass Grafting (CABG) and Its Impact on Functional Recovery
items: Investigating Genetic, Cognitive, and Therapeutic Approaches for Enhancing Quality of Life in Individuals With Down Syndrome
items: Systematic Review on the Application of Molecular Biology Techniques in Early Detection and Targeted Therapy of Human Diseases
items: Designing Small-Molecule Allosteric Inhibitors of CYP2C19 to Prevent Clopidogrel Resistance in Patients With Specific Genetic Polymorphisms
items: Exploration Of Nonspecific Patterns In Urinary Tract Infection Symptoms Across Different Age And Gender Groups (H/R) - A Cross-Sectional Study
items: AI-Driven Personalized Weight Loss Strategies and Behavioral Patterns Among Obese Adults
items: Relationship Between Depression Scores And Poor Glycemic Control In Type 2 Diabetes
items: AI-Guided Virtual Physiotherapy vs. Traditional Therapy for Post-Stroke Rehabilitation: A Randomized Controlled Trial
items: Impact of Endometriosis on Fertility Hormones and Ovarian Reserve Markers (AMH, FSH, LH)
items: General Overview of Broadly Discussed Lifestyle and Environmental Factors Casually Associated with Breast Cancer Development

https://linkmjhcr.com/index.php/lmj/article/view/110
type: item
title: Comparative Effectiveness of Canalith Repositioning Alone Versus Combined with Cervical Stabilization Exercises on Residual Dizziness and Postural Stability in Patients with Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial
description: Background: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder effectively treated with canalith repositioning procedures (CRP), yet 30–60% of patients experience residual dizziness and postural instability, potentially due to incomplete central compensation and cervical proprioceptive dysfunction. Objective: To compare the effectiveness of CRP alone versus CRP combined with cervical stabilization exercises (CSE) in reducing residual dizziness and improving postural stability in patients with posterior canal BPPV. Methods: An assessor-blinded randomized controlled trial was conducted involving 80 participants allocated equally to CRP alone or CRP+CSE. Interventions were delivered over four weeks, with follow-up at Week 4 and Week 12. Primary outcomes included Dizziness Handicap Inventory (DHI) and Sensory Organization Test (SOT) composite scores, while secondary outcomes included Timed Up and Go (TUG), joint position error (JPE), Vestibular Questionnaire-7 (VQ-7), and fall incidence. Mixed ANOVA and intention-to-treat analysis were applied. Results: The CRP+CSE group demonstrated significantly greater reductions in DHI at Week 4 (mean difference 10.4 points; p<0.001) and Week 12 (8.3 points; p<0.001), along with superior improvements in SOT scores (p=0.012 and p=0.007). Secondary outcomes also favored the combined group, including improvements in TUG (p<0.001), JPE (p<0.001), and VQ-7 (p<0.001), with a lower fall incidence (IRR=0.25; p=0.041). Conclusion: The addition of cervical stabilization exercises to CRP significantly enhances recovery in BPPV by improving dizziness, postural stability, and functional outcomes, supporting a multimodal physiotherapy approach.
subject: Articles
  topic: section
subject: BPPV, residual dizziness, canalith repositioning, cervical stabilization, postural stability, randomized controlled trial.
  topic: keywords
creator: Muhammad Tahir Akram
creator: Abdul Hameed
creator: Purwa Santwani
creator: Chander Parkash
creator: Ahmed Ali
creator: Noreen Ahmed
creator: Muhammad Ejaz Uddin
rights: Copyright (c) 2025 Muhammad Tahir Akram, Abdul Hameed, Purwa Santwani, Chander Parkash, Ahmed Ali, Noreen Ahmed, Muhammad Ejaz Uddin (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 9
doi: 10.61919/chagxx82

Evaluating Effectiveness of Deferasirox Versus Deferoxamine in Improving Clinical Outcomes among Patients with Transfusion-Dependent Thalassemia: A Randomized Controlled Trial
type: item
description: Background: Transfusion-dependent β-thalassemia necessitates lifelong blood transfusions that progressively accumulate systemic iron, causing cardiomyopathy, hepatic cirrhosis, and endocrine failure without effective chelation. Deferasirox, a once-daily oral iron chelator, offers a pharmacological and administration advantage over subcutaneous deferoxamine, yet comparative randomized evidence in South Asian clinical populations remains limited. Objective: To compare the efficacy, safety, and treatment adherence profiles of deferasirox versus deferoxamine among patients with transfusion-dependent β-thalassemia in the Islamabad–Rawalpindi region of Pakistan. Methods: A parallel-group, open-label randomized controlled trial was conducted over five months. Seventy-two patients (aged 8–35 years) were randomized 1:1 to deferasirox (20–30 mg/kg/day orally) or deferoxamine (40 mg/kg/day subcutaneously, five days per week). The primary outcome was change in serum ferritin; secondary outcomes included ALT, renal function, adverse events (CTCAE v5.0), and adherence (MMAS-8). Results: Deferasirox produced a significantly greater mean ferritin reduction (715 ± 150 ng/mL; 95% CI [666, 764]) than deferoxamine (335 ± 120 ng/mL; 95% CI [296, 374]; between-group difference 380 ng/mL [317, 443]; p = 0.003; Cohen's d = 2.80). ALT normalized in the deferasirox group (38.2 IU/L) but not in the deferoxamine group (42.4 IU/L; p = 0.01). Composite adverse event rates were 27.8% versus 50.0% (p = 0.04). High adherence was recorded in 83.3% versus 66.7% of patients. Conclusion: Deferasirox demonstrated superior iron chelation efficacy, hepatic enzyme normalization, tolerability, and adherence compared with deferoxamine and should be considered a preferred chelation strategy in routine transfusion-dependent thalassemia management.
subject: Articles
  topic: section
subject: Adherence; Deferasirox; Deferoxamine; Iron Overload; Randomized Controlled Trial; Thalassemia; Transfusion-Dependent
  topic: keywords
creator: Muhammad Mohsin Shoukat
creator: Hafiza Khadija Tariq
creator: Fareed Ullah
creator: Muhammad Arslan Liaqat
creator: Areeba Sajjad
creator: Nauman Akhtar
rights: Copyright (c) 2025 Muhammad Mohsin Shoukat, Hafiza Khadija Tariq, Fareed Ullah, Muhammad Arslan Liaqat, Areeba Sajjad, Nauman Akhtar (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 12
doi: 10.61919/e41dwh72

Effects of Shi Style Cervical Mobilization Versus Sustained Natural Apophyseal Glides on Pain, Strength and Functional Disability in Patients with Cervicogenic Headache
type: item
description: Background: Cervicogenic headache is a secondary headache disorder originating from cervical spine dysfunction, commonly associated with pain, reduced mobility, dizziness, and functional disability, with manual therapy representing a key conservative management strategy. Objective: To compare the effectiveness of Shi-style cervical mobilization and Sustained Natural Apophyseal Glides (SNAGs) on pain intensity, cervical muscle strength, dizziness-related disability, functional disability, and quality of life in patients with cervicogenic headache. Methods: A randomized controlled trial was conducted on 40 participants allocated equally into two groups receiving either Shi-style cervical mobilization or SNAGs over a two-week period, alongside standardized physiotherapy. Outcomes including Numeric Pain Rating Scale (NPRS), pressure biofeedback, Dizziness Handicap Inventory (DHI), Neck Disability Index (NDI), and SF-36 were assessed at baseline and post-intervention. Non-parametric statistical tests were applied with significance set at p < 0.05. Results: Both groups demonstrated statistically significant improvements across all outcomes (p < 0.001). However, Shi-style mobilization resulted in greater reductions in pain (median 6.0 to 2.0 vs 3.0), disability (NDI: 32.0 to 7.0 vs 17.0), and dizziness (DHI: 53.0 to 21.0 vs 23.5), with moderate to large effect sizes (r = 0.42–0.79). Conclusion: Both interventions are effective, but Shi-style cervical mobilization demonstrates superior clinical outcomes and may be considered a more effective treatment approach for cervicogenic headache.
subject: Articles
  topic: section
subject: Cervicogenic headache, manual therapy, SNAGs, cervical mobilization, randomized controlled trial, pain, disability.
  topic: keywords
creator: Ayesha Khalid Malik
creator: Ayesha Habib
creator: Ayyaz Ahmad
creator: Hafiza Aroosa Syed
creator: Huma Khan
creator: Muhammad Haris
rights: Copyright (c) 2025 Ayesha Khalid Malik, Ayesha Habib, Ayyaz Ahmad, Hafiza Aroosa Syed, Huma Khan, Muhammad Haris (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 9
doi: 10.61919/n8wffa20

AI-Based Risk Stratification for Latent Tuberculosis Among Urban Slum Dwellers: A Cross-Sectional Study
type: item
description: Background: Latent tuberculosis infection (LTBI) poses a critical public health challenge in urban informal settlements, where structural deprivation, household overcrowding, and limited healthcare access sustain high transmission risk. Traditional screening methods fail to reach the most vulnerable individuals, underscoring the need for targeted, data-driven approaches. Objective: This study aimed to evaluate the predictive performance of AI-assisted machine learning models for LTBI risk stratification among adults in urban informal settlements in Lahore, Pakistan. Methods: A cross-sectional analytical study enrolled 150 adult participants from densely populated slum communities. Data were collected via structured questionnaires, clinical assessments, and tuberculin skin testing (TST; ≥10 mm threshold). Three supervised machine learning algorithms, logistic regression, random forest, and gradient-boosted decision trees, were developed using a stratified 70:30 train-test split with 10-fold cross-validation. Model performance was assessed using accuracy, sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) with 95% bootstrap confidence intervals. Variable importance was evaluated using normalised feature gain scores. Results: TST positivity was 42.0% (n=63). The gradient-boosted model achieved the highest performance (AUC 0.91, sensitivity 90.5%, specificity 88.5%), followed by random forest (AUC 0.88) and logistic regression (AUC 0.82). Prior TB contact history, household crowding, and poor ventilation were the strongest predictors. Overall classification accuracy was 89.3% (95% CI 83.3–93.7%). Conclusion: AI-assisted risk stratification using community-collectible sociodemographic and environmental variables can effectively identify individuals at elevated LTBI risk in urban slum settings, supporting targeted screening and preventive intervention strategies.
subject: Articles
  topic: section
subject: Artificial intelligence; community health; latent tuberculosis; machine learning; risk stratification; tuberculin skin test; urban slums
  topic: keywords
creator: Ali Dost
creator: Afeera Bint-e-Tanveer
creator: Ajmal Khan
creator: Kamran Ali
creator: Sajjad Ahmad
creator: Zubia Shahid
rights: Copyright (c) 2026 Ali Dost, Afeera Bint-e-Tanveer, Ajmal Khan, Kamran Ali, Sajjad Ahmad, Zubia Shahid (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 12
doi: 10.61919/m227h628

Effect of Task-Oriented Motor Training on Upper Limb Functional Recovery in Post-Stroke Patients: A Randomized Controlled Trial
type: item
description: Background: Upper limb motor impairment affects approximately 70–80% of stroke survivors and constitutes a primary determinant of functional independence and quality of life. Task-oriented motor training (TOT) engages neuroplastic recovery through repetitive, goal-directed functional practice, yet evidence from low- and middle-income country (LMIC) rehabilitation settings remains limited. Objective: To evaluate the efficacy of structured task-oriented motor training on upper limb motor recovery, arm function, motor performance efficiency, and functional independence compared to conventional physiotherapy in subacute post-stroke patients. Methods: A single-blind, parallel-group randomized controlled trial was conducted at a tertiary care neurorehabilitation centre in Khyber Pakhtunkhwa, Pakistan. One hundred and two subacute stroke patients (2–6 months post-ictus) were allocated by computer-generated randomization to TOT (n = 51) or conventional physiotherapy (n = 51), each receiving 45–60 minutes of supervised therapy five sessions per week for six weeks. Primary outcome was the Fugl-Meyer Assessment–Upper Extremity (FMA-UE); secondary outcomes included the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and Barthel Index. Intention-to-treat analysis with multiple imputation was applied; Bonferroni correction controlled for multiple comparisons. Results: Ninety-five participants completed post-intervention assessment (TOT: n = 48; control: n = 47). The TOT group demonstrated significantly greater improvements across all outcomes: FMA-UE (MD = +3.9, 95% CI: 2.5–5.3; d = 0.58), ARAT (MD = +4.4, 95% CI: 2.7–6.1; d = 0.52), WMFT (MD = −2.1 s, 95% CI: −3.2 to −1.0; d = 0.46), and Barthel Index (MD = +5.4, 95% CI: 3.2–7.6; d = 0.49); all p < 0.0125 after Bonferroni correction. TOT group improvements exceeded established minimal clinically important difference thresholds for all outcomes. Conclusion: Structured task-oriented motor training yields clinical…
subject: Articles
  topic: section
subject: stroke; upper limb recovery; task-oriented training; motor function; neurorehabilitation; LMIC; functional independence; neuroplasticity; randomized controlled trial
  topic: keywords
creator: Hamna Khurshid
creator: Urooj Khan
creator: Kiran Ishaq
creator: Amna Rafique
creator: Mehr Un Nisa
creator: Warda Khan
creator: Kiran Hassan
creator: Etisam Wahid
creator: Shahzad Ahmad
creator: Ayesha Nisar
rights: Copyright (c) 2025 Hamna Khurshid, Shahzad Ahmad, Etisam Wahid, Kiran Hassan, Warda Khan, Mehr Un Nisa, Amna Rafique, Kiran Ishaq, Urooj Khan, Ayesha Nisar (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 13
doi: 10.61919/vpgb9798

Effect of Dietary Intervention on Short-Term Weight Recovery and Electrolyte Correction in Hospitalized Children with Acute Diarrhea
type: item
description: Background: Acute diarrhea remains a leading cause of malnutrition and electrolyte derangement among children under five years of age in low- and middle-income countries, yet evidence on the short-term impact of structured inpatient dietary interventions on anthropometric and biochemical recovery in Pakistani pediatric populations remains limited. Objective: To evaluate the effect of a structured dietary intervention on short-term weight recovery and serum electrolyte correction in children hospitalized with acute diarrhea. Methods: A single-arm, pre-post interventional study was conducted among 100 children aged 1–59 months admitted with acute diarrhea to a tertiary care pediatric ward in Peshawar, Pakistan. The dietary intervention comprised locally available semi-solid foods (mashed banana, rice-lentil preparation, yogurt) administered alongside standard rehydration and zinc supplementation. Body weight and serum sodium, potassium, chloride, and hemoglobin levels were measured at admission and discharge. Paired-samples t-tests with 95% confidence intervals and Cohen's d effect sizes were computed. Results: Mean body weight increased from 7.14 ± 1.22 kg to 7.39 ± 1.18 kg (mean difference 0.25 kg; 95% CI: 0.19–0.31; p < 0.001; d = 0.81). Serum potassium rose from 3.20 ± 0.50 to 3.99 ± 0.41 mEq/L (p < 0.001; d = 1.73), chloride from 98.5 ± 4.2 to 102.3 ± 3.1 mEq/L (p < 0.001; d = 1.03), and sodium from 135.2 ± 3.8 to 138.7 ± 2.9 mEq/L (p = 0.031; d = 1.03). Hemoglobin remained unchanged (p = 0.42). Conclusion: The structured dietary intervention, combined with standard rehydration and zinc supplementation, was associated with significant short-term weight recovery and electrolyte normalization; however, the absence of a control group limits causal inference, and randomized controlled trials with extended follow-up are warranted
subject: Articles
  topic: section
subject: acute diarrhea; dietary intervention; children under five; electrolyte correction; nutritional status; Pakistan
  topic: keywords
creator: Mahnoor Nadeem
creator: Burhan Ahmad
creator: Adnan Habib
creator: Maisam Ali
creator: Muhammad Ibrar
creator: Humaira Jamal
creator: Hiba Zehra
creator: Saira
creator: Muhammad Wasif Jamal
rights: Copyright (c) 2025 Mahnoor Nadeem, Burhan Ahmad, Adnan Habib, Maisam Ali, Muhammad Ibrar, Humaira Jamal, Hiba Zehra, Saira, Muhammad Wasif Jamal (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 10
doi: 10.61919/2f3mmk23

Barriers to Universal Health Coverage in Pakistan: A Health System Perspective
type: item
description: Background: Universal Health Coverage (UHC) aims to ensure equitable access to essential health services without financial hardship; however, progress in Pakistan remains constrained by systemic challenges. Qualitative inquiry is needed to understand how these barriers are experienced and interpreted within the health system. Objective: To explore stakeholder perceptions of structural barriers to UHC in Pakistan from a health systems perspective. Methods: A qualitative descriptive study was conducted between January and March 2025 using semi-structured interviews with 25 stakeholders, including policymakers, public health experts, physicians, and hospital administrators. Participants were selected through purposive sampling. Data were analyzed using Braun and Clarke’s reflexive thematic analysis. Results: Five major themes were identified: insufficient health financing, workforce shortages and maldistribution, weak governance and policy implementation, inequitable healthcare access, and high out-of-pocket expenditure. Participants described these barriers as interconnected, with financing and governance influencing workforce distribution and service accessibility, while financial burden directly affected healthcare utilization. Conclusion: Achieving UHC in Pakistan requires integrated health system reforms focusing on financing, governance, workforce distribution, and financial protection. Strengthening implementation mechanisms and addressing contextual barriers will be critical for improving equitable healthcare access.
subject: Articles
  topic: section
subject: Universal Health Coverage, Pakistan, Health Systems, Qualitative Research, Healthcare Access, Health Policy
  topic: keywords
creator: Muhammad Hamza Muzammil
creator: Muhammad Uzair
creator: Faiza Iqrar
creator: Muhammad Talha
creator: Sara Alam
creator: Aatqa Khan
creator: Sehrish Muhammad
creator: Arsalan Khan
creator: Kainat Ashraf
creator: Noor Fatima
rights: Copyright (c) 2025 Muhammad Hamza Muzammil, Muhammad Uzair, Faiza Iqrar, Muhammad Talha, Sara Alam, Aatqa Khan, Sehrish Muhammad, Arsalan Khan, Kainat Ashraf, Noor Fatima (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 9
doi: 10.61919/a408s076

The Association Between Serum Vitamin D Status and Knee Joint Space Width in Adults with Early Osteoarthritis - A Cross-Sectional Study
type: item
description: Background: Knee osteoarthritis (OA) is a progressive degenerative joint disease in which early cartilage loss determines long-term functional trajectory. Vitamin D, beyond its classical skeletal role, modulates chondrocyte metabolism and joint inflammatory signaling through vitamin D receptor pathways; however, its cross-sectional association with radiographic cartilage preservation in early knee OA remains incompletely characterized. Objective: To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] sufficiency and medial tibiofemoral joint space width (JSW) as a radiographic marker of cartilage integrity in adults with early knee osteoarthritis. Methods: A cross-sectional study was conducted over eight months at a tertiary care hospital in Lahore, Pakistan, enrolling 135 adults aged 40–65 years with Kellgren–Lawrence grade I–II knee OA. Serum 25(OH)D was measured by chemiluminescent immunoassay and categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL) per Endocrine Society guidelines. Standardized weight-bearing JSW was measured digitally by two blinded musculoskeletal radiologists (ICC = 0.91). WOMAC pain and function subscales provided secondary clinical outcomes. ANOVA with Tukey post-hoc testing, Pearson correlation with 95% CIs, and multivariable linear regression adjusting for age, sex, BMI, and symptom duration were applied. Results: Mean serum 25(OH)D was 26.7 ± 8.4 ng/mL. Sufficient participants demonstrated significantly greater JSW than deficient individuals (3.89 ± 0.57 mm vs. 3.11 ± 0.54 mm; mean difference 0.78 mm, 95% CI 0.51–1.05, p < 0.001). Serum 25(OH)D correlated positively with JSW (r = 0.41, 95% CI 0.26–0.54, p < 0.001) and inversely with WOMAC pain (r = -0.36, p = 0.002) and function (r = -0.33, p = 0.004). Associations remained significant after confounder adjustment (β = 0.023 mm/ng/mL, 95% CI 0.011–0.035, p < 0.001). Conclusion: Vitamin D sufficiency was independently associated wi…
subject: Articles
  topic: section
subject: 25-Hydroxyvitamin D; joint space width; Kellgren–Lawrence grade; knee osteoarthritis; nutritional status; radiography; WOMAC
  topic: keywords
creator: Namra Urooj
creator: Sumera Kanwal
creator: Malak Mustaqeem Khan
creator: Saima Ashraf
creator: Nauman Akhtar
creator: Aqil ur Rehman
creator: Muhammad Faizan Ali
rights: Copyright (c) 2025 Namra Urooj, Sumera Kanwal, Malak Mustaqeem Khan, Saima Ashraf, Nauman Akhtar, Aqil ur Rehman, Muhammad Faizan Ali (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 13
doi: 10.61919/kk8apw75

Prospective Evaluation of Cognitive Reframing and Thought-Challenging Techniques in Reducing Symptom Severity Among Adults with Dual Anxiety–Depression Diagnosis
type: item
description: Background: Anxiety and depression frequently co-occur, creating compounded symptom burden and reduced responsiveness to conventional pharmacotherapy. Cognitive reframing and thought-challenging, core components of cognitive-behavioral therapy, target the shared maladaptive cognitive processes that maintain both conditions, yet their effectiveness as an isolated structured intervention in adults with confirmed dual diagnoses of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in low-to-middle-income settings remains inadequately characterized. Objective: To evaluate the effectiveness of a structured 12-week cognitive reframing and thought-challenging intervention in reducing anxiety and depressive symptom severity, improving cognitive emotion regulation, and enhancing quality of life among adults with comorbid GAD and MDD over a 24-week prospective follow-up. Methods: A prospective single-arm interventional study was conducted among 80 adults with DSM-5-confirmed comorbid GAD and MDD at three tertiary care hospitals in Lahore, Pakistan. Participants received 12 weekly individual sessions derived from validated CBT manuals, culturally adapted for local context. Primary outcomes were assessed using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) at baseline, week 12, and week 24. Secondary outcomes included the Cognitive Emotion Regulation Questionnaire (CERQ) and WHOQOL-BREF. Repeated measures ANOVA with Bonferroni-corrected post-hoc comparisons and ANCOVA adjusting for medication class were performed. Results: Per-protocol retention was 93.75% (n = 75). BAI scores declined from 28.4 ± 7.1 to 14.9 ± 5.8 (Δ = −13.5; 95% CI: −16.0 to −11.0; Cohen's d = 1.34; p < 0.001) and BDI-II from 30.6 ± 8.2 to 16.1 ± 6.4 (Δ = −14.5; 95% CI: −16.9 to −12.1; d = 1.34; p < 0.001) by week 24. CERQ adaptive composite scores increased by +16.7 points and WHOQOL-BREF total scores by +17.8 points at week 24 (both p < 0.001). ANCOVA confirme…
subject: Articles
  topic: section
subject: Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Cognitive Reframing; Comorbidity; Depression; Pakistan; Prospective Studies; Thought-Challenging; Treatment Outcome.
  topic: keywords
creator: Muhammad Numair Kashif
creator: Eisha Maryam
creator: Harmain Fatima
creator: Seema Habib Bhutto
creator: Bushra Waheed
creator: Najma Syed Ghulam
rights: Copyright (c) 2025 Muhammad Numair Kashif, Eisha Maryam, Harmain Fatima, Seema Habib Bhutto, Bushra Waheed, Najma Syed Ghulam (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 13
doi: 10.61919/3p18wr83

Randomized Trial of AI-Guided Antidepressant Selection Improving Remission and Tolerability in Primary-Care Depression
type: item
description: Background: Depressive disorders represent a leading cause of disability in primary-care settings globally, yet conventional antidepressant prescribing relies predominantly on trial-and-error approaches that delay remission and increase adverse-effect exposure. Artificial intelligence (AI)-based decision-support systems offer a mechanism for personalising medication selection by integrating patient-specific clinical data, but randomised evidence from real-world primary-care settings, particularly in low- and middle-income countries, remains absent. Objective: To compare AI-guided antidepressant selection with usual clinician-directed care on remission rates, adverse-effect burden, and time-to-clinical response among adults with depressive disorders in primary care. Methods: A prospective, parallel-group randomised controlled trial was conducted in primary-care clinics across South Punjab, Pakistan. Eighty-four adults (aged 18–65 years) with PHQ-9 scores ≥ 10 initiating or switching antidepressant therapy were randomised 1:1 to AI-guided medication selection (n = 42) or usual care (n = 42). The AI tool integrated baseline symptom profiles, comorbidity data, and prior treatment history to generate individualised first-line antidepressant recommendations. Depressive severity was assessed using the PHQ-9 at baseline and at weeks 2, 4, 6, and 8; remission was defined as PHQ-9 ≤ 4; clinical response as ≥ 50% PHQ-9 reduction from baseline; and adverse effects were measured using the FIBSER scale. Outcomes were analysed using independent-samples t-tests, chi-square tests, repeated-measures ANOVA, and effect sizes reported as Cohen's d. Results: At week eight, mean PHQ-9 score was significantly lower in the AI-guided group (6.16 ± 2.4 vs 8.47 ± 2.9; mean difference 2.31, 95% CI: 1.23–3.39; p < 0.001; d = 0.88). Remission was achieved by 61.9% of AI-guided participants versus 38.1% in usual care (RR = 1.63, 95% CI: 1.04–2.54; p = 0.029). Mean time to clinical response was 3.1…
subject: Articles
  topic: section
subject: Algorithms; Antidepressive agents; Artificial intelligence; Clinical decision support; Depression; Patient Health Questionnaire-9; Primary health care; Randomised controlled trial; Treatment outcome.
  topic: keywords
creator: Fatima Fatima
creator: Fareeha F Khan
creator: Anina Qureshi
creator: Bushra Waheed
creator: Eisha Maryam
creator: Shaikh Khalid Muhammad
rights: Copyright (c) 2025 Fatima Hassan, Fareeha F Khan, Anina Qureshi, Bushra Waheed, Eisha Maryam, Shaikh Khalid Muhammad (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 11
doi: 10.61919/6ze48h29

Phase of Neovascularization in Wound Repair: Topical Impact of Low-Level Laser Therapy with Conventional Treatment in Rabbit Model
type: item
description: Background: Neovascularization is the rate-limiting event in the proliferative phase of wound repair, and its accelerated induction represents a key therapeutic target in surgical wound management. Low-level laser therapy (LLLT), a non-invasive photobiomodulatory modality, has demonstrated pro-angiogenic properties through cytochrome c oxidase-mediated bioenergetic stimulation and growth factor upregulation, yet direct histomorphometric comparisons with conventional topical agents such as normal saline and Edinburgh University Solution of Lime (Eusol) remain insufficiently characterised. Objective: To evaluate and compare the effect of topical LLLT, normal saline, and Eusol dressing on the neovascularization phase of full-thickness surgical wound repair using quantitative vascular density assessment across discrete healing time points in an experimental rabbit model. Methods: Fifteen male albino rabbits (200–350 g) were randomly allocated to three groups (n = 5/group): Group A (normal saline, daily), Group B (LLLT, 10 J/cm², 830 nm, THOR DD II device, daily), and Group C (Eusol dressing, daily). Full-thickness excisional wounds (2.5 × 2.5 cm²) were created on the dorsal surface under ketamine–xylazine anaesthesia. Wound tissue biopsies were collected at Days 3, 7, and 14, processed for haematoxylin and eosin staining, and mean vascular counts were enumerated per 0.196 mm² field at 400× magnification by a blinded histologist. Data were analysed using one-way ANOVA with post hoc Tukey's HSD test (p < 0.05). Results: Group B demonstrated significantly superior mean vascular counts at all time points: Day 3 (6.65 ± 1.80 versus 2.31 ± 1.20 and 3.54 ± 0.41), Day 7 (10.47 ± 0.11 versus 3.21 ± 0.32 and 5.68 ± 1.74), and Day 14 (8.88 ± 0.63 versus 4.45 ± 0.71 and 5.97 ± 1.57) for Groups A and C respectively (p = 0.040–0.001; η² = 0.721–0.916). A biphasic trajectory with peak neovascularization at Day 7 was observed exclusively in Group B. Conclusion: LLLT significantly accel…
subject: Articles
  topic: section
subject: low-level laser therapy; photobiomodulation; neovascularization; angiogenesis; surgical wound healing; Eusol; rabbit model
  topic: keywords
creator: Muhammad Asif
creator: Satheesh Babu Natarajan
creator: Muhammad Ahmed Azmi
rights: Copyright (c) 2025 Muhammad Asif, Satheesh Babu Natarajan, Muhammad Ahmed Azmi (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e92
ending page: e92
doi: 10.61919/jjy5n131

Mental Health Services Accessibility in Pakistan: Gaps, Barriers, and Policy Implications — A Qualitative Analysis
type: item
description: Background: Mental health disorders are a major public health concern in Pakistan, yet access to mental health services remains limited. Existing evidence has described workforce shortages, stigma, and weak policy implementation, but less is known about how these barriers are experienced across different stakeholder groups. A qualitative approach is necessary to explore the social, cultural, financial, and system-level factors that shape access to care in real-world settings. Objective: To explore perceptions of mental health service accessibility in Pakistan, identify major barriers and enabling factors influencing access to care, and examine the policy implications of these findings. Methods: This qualitative study used semi-structured interviews with key stakeholders, including psychiatrists, psychologists, patients, caregivers, and health policy experts. Relevant literature from PubMed, Scopus, and Web of Science was used to contextualize the findings. Interview data were analyzed thematically following the Braun and Clarke framework. Results: Four major themes were identified: structural barriers, sociocultural barriers, financial barriers, and policy and governance barriers. Participants highlighted shortage and urban concentration of services, stigma and negative social perceptions, reliance on non-medical explanatory models, unaffordable treatment pathways, and weak implementation of mental health policies. Accessibility was shaped by overlapping mechanisms involving trust, perceived acceptability, cost, and system responsiveness. Conclusion: Mental health service accessibility in Pakistan is constrained by interconnected structural, social, financial, and governance barriers. Improving access requires primary-care integration, workforce strengthening, community-sensitive stigma reduction, and stronger policy implementation.
subject: Articles
  topic: section
subject: Mental health, accessibility, Pakistan, stigma, healthcare policy, qualitative research.
  topic: keywords
creator: Muhammad Uzair
creator: Hassan Raza Ali
creator: Fizza Khalil
creator: Rabiya Hanif
creator: Qurat Ul Ain Hingoro
creator: Sibghat Ullah
creator: Syed Saqib Hussain Shah
creator: Mibra Asjad
creator: Eiman Imtiaz
creator: Talat Yasmin
rights: Copyright (c) 2025 Muhammad Uzair, Eiman Imtiaz, Mibra Asjad, Syed Saqib Hussain Shah, Sibghat Ullah, Qurat Ul Ain Hingoro, Rabiya Hanif, Fizza Khalil, Hassan Raza Ali, Talat Yasmin (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e91
ending page: e91
doi: 10.61919/pen7rq30

Digital Health Knowledge, Attitudes, and Practices Among Undergraduate Nursing Students: A Comparative Study of Public and Private Colleges in Mirpurkhas, Sindh, Pakistan
type: item
description: Background: Digital health technologies are increasingly transforming healthcare delivery, requiring healthcare professionals to possess adequate digital competencies. Nursing students, as future healthcare providers, must develop sufficient knowledge, positive attitudes, and effective practices related to digital health technologies to ensure safe and efficient patient care in technology-driven healthcare systems. However, limited evidence exists regarding digital health readiness among nursing students in developing regions such as Pakistan. Objective: This study aimed to evaluate the levels of digital health knowledge, attitudes, and practices among undergraduate nursing students and to examine differences between public and private institutions as well as across academic years. Methods: A comparative cross-sectional study was conducted among 254 undergraduate nursing students enrolled in selected public and private nursing colleges in Mirpurkhas, Sindh, Pakistan. Data were collected using a structured self-administered questionnaire based on a five-point Likert scale and analyzed using IBM SPSS version 27. Descriptive statistics were used to summarize variables, while independent samples t-tests and one-way ANOVA were used to compare group differences. Pearson correlation analysis was performed to assess relationships among knowledge, attitudes, and practices. Results: The mean scores for knowledge (3.30 ± 0.75), attitudes (3.26 ± 0.56), and practices (3.46 ± 0.86) indicated moderate levels across all domains. Significant differences were observed between public and private institutions in knowledge (p = 0.031) and attitudes (p = 0.024), while practices showed no significant difference (p = 0.189). Significant variations were also found across academic years for knowledge (p = 0.028) and attitudes (p = 0.003). Strong positive correlations were identified between knowledge and attitudes (r = 0.754), knowledge and practices (r = 0.688), and attitudes and practices…
subject: Articles
  topic: section
subject: Digital health; digital health literacy; nursing students; knowledge attitude practices; telemedicine; health informatics.
  topic: keywords
creator: Inshal Anwar Arain
creator: Irfan Ali Chandio
creator: Areeba Zulfiqar Rajput
creator: Nimra Rasheed Gill
creator: Sheela Davi Malhi
creator: Dileep Kumar Malhi
rights: Copyright (c) 2025 Inshal Anwar Arain, Irfan Ali Chandio, Areeba Zulfiqar Rajput, Nimra Rasheed Gill, Sheela Davi Malhi, Dileep Kumar Malhi (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e90
ending page: e90
doi: 10.61919/2rspsp42

Validating a Panel of Salivary miRNA and Protein Biomarkers for the Early Detection of High-Risk Oral Potentially Malignant Disorders
type: item
description: Background: Oral potentially malignant disorders (OPMDs) are precancerous oral lesions with variable risk of progression to oral squamous cell carcinoma, yet current assessment depends largely on biopsy-based histopathology, which is invasive and not ideal for repeated screening. Salivary molecular diagnostics offer a non-invasive alternative capable of detecting early biological changes associated with malignant potential. Objective: To assess the diagnostic performance of a combined salivary biomarker panel comprising miR-21, miR-31, miR-184, IL-8, and MMP-9 for differentiating patients with high-risk OPMDs from healthy controls. Methods: In this cross-sectional observational study, 84 participants were enrolled, including 44 patients with clinically and histopathologically confirmed OPMDs and 40 healthy controls. Unstimulated saliva samples were analyzed for miR-21, miR-31, and miR-184 expression by quantitative real-time polymerase chain reaction and for IL-8 and MMP-9 concentrations by enzyme-linked immunosorbent assay. Group comparisons, correlations, and receiver operating characteristic analyses were performed. Results: All three microRNAs and both proteins were significantly elevated in OPMD cases compared with controls (p < 0.001 for all). The strongest correlations were observed between miR-21 and IL-8 (r = 0.72) and between miR-31 and MMP-9 (r = 0.68). Individual biomarker AUCs ranged from 0.81 to 0.89, while the combined panel achieved an AUC of 0.94 (95% CI: 0.89-0.98), with sensitivity of 91.2% and specificity of 88.7%. Conclusion: The combined salivary biomarker panel demonstrated strong diagnostic accuracy for identifying high-risk OPMDs and supports the potential of saliva-based molecular profiling as a practical non-invasive adjunct for early oral precancer detection.
subject: Articles
  topic: section
subject: Oral potentially malignant disorders; saliva; microRNA; IL-8; MMP-9; biomarkers; early detection
  topic: keywords
creator: Ranya Khan
creator: Saqba Alam
creator: Durr e Sameen
creator: Seemab Naz
creator: Asia Rahman Khan Lodhi
creator: Arshad Ahmad
rights: Copyright (c) 2025 Ranya Khan, Saqba Alam, Durr e Sameen, Seemab Naz, Asia Rahman Khan Lodhi, Arshad Ahmad (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 10
doi: 10.61919/xabp9q69

AI-Powered Detection of Functional Gastrointestinal Disorders in Adults Visiting Tertiary Hospitals
type: item
description: Background: Functional gastrointestinal disorders are common in tertiary gastroenterology practice and remain difficult to diagnose because they are defined largely by symptom patterns rather than structural or biochemical abnormalities. In busy referral settings, overlap among irritable bowel syndrome, functional dyspepsia, functional constipation, and non-functional gastrointestinal conditions can reduce diagnostic consistency. Artificial intelligence offers a potential solution by integrating structured clinical variables with free-text symptom narratives to support more standardized classification. Objective: To evaluate the diagnostic accuracy of an artificial intelligence–based system for detecting functional gastrointestinal disorders among adults attending tertiary hospitals. Methods: This multicenter cross-sectional diagnostic accuracy study was conducted over eight months in three tertiary hospitals in Lahore, Pakistan. A total of 420 adults aged 18–65 years presenting with gastrointestinal symptoms were enrolled through consecutive sampling. After exclusion of relevant organic pathology, Rome IV–based clinician diagnosis served as the reference standard. The artificial intelligence system analyzed structured clinical variables and unstructured consultation notes using supervised machine learning and natural language processing to classify irritable bowel syndrome, functional dyspepsia, functional constipation, and non-functional gastrointestinal disorder status. Diagnostic performance was assessed using sensitivity, specificity, predictive values, area under the receiver operating characteristic curve, and Cohen’s kappa. Results: The mean age was 37.4 ± 10.8 years, and 54.8% of participants were male. Clinically, 33.3% had irritable bowel syndrome, 23.8% functional dyspepsia, 14.3% functional constipation, and 28.6% non-functional gastrointestinal disorders. The artificial intelligence model achieved a sensitivity of 88.2%, specificity of 84.5%, positive …
subject: Articles
  topic: section
subject:
  topic: keywords
  value: Artificial intelligence, functional gastrointestinal disorders, irritable bowel syndrome, functional dyspepsia, functional constipation, machine learning, natural language processing, diagnostic accuracy
creator: Muhammad Essa Khan
creator: Mahnoor Naeem Rana
creator: Khalid Bilal Khan
creator: Laiba Mushtaq
creator: Turfa Asghar
creator: Wajeeha Ahmadani
creator: Muhammad Zohaib Wahid
rights: Copyright (c) 2025 Muhammad Essa Khan, Mahnoor Naeem Rana, Khalid Bilal Khan, Laiba Mushtaq, Turfa Asghar, Wajeeha Ahmadani, Muhammad Zohaib Wahid (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e88
ending page: e88
doi: 10.61919/m0nr1z88

Effect of Menstrual Cycle Phases on Cognitive and Neuromuscular Performance
type: item
description: Background: Fluctuations in estrogen and progesterone across the menstrual cycle may influence cognitive and neuromuscular performance, yet previous findings have remained inconsistent because many studies have assessed isolated outcomes or relied solely on calendar-based phase estimation. Objective: To evaluate variations in cognitive performance, muscle strength, and endurance across menstrual cycle phases and examine their association with circulating estrogen and progesterone levels in healthy young women. Methods: This descriptive repeated-measures study was conducted in Lahore, Pakistan, among 60 healthy women aged 18-30 years with regular menstrual cycles. Assessments were performed during the follicular, ovulatory, and luteal phases. Serum estrogen and progesterone concentrations were measured by enzyme-linked immunosorbent assay. Cognitive performance was assessed using the Stroop Color-Word Test and Digit Span Test, while neuromuscular performance was evaluated using quadriceps maximal voluntary isometric contraction and plank endurance. Data were analyzed using repeated-measures ANOVA and Pearson correlation tests. Results: Estrogen peaked during ovulation (187.5 ± 25.8 pg/mL), whereas progesterone was highest in the luteal phase (11.8 ± 2.7 ng/mL) (p < 0.001 for both). Stroop reaction time improved significantly during ovulation (689 ± 78 ms) compared with the follicular phase (732 ± 84 ms) (p = 0.012). Quadriceps strength was highest during ovulation (317.9 ± 34.5 N) and differed significantly across phases (p = 0.021). Digit Span scores and plank endurance also showed their highest mean values during ovulation. Estrogen correlated positively with cognitive performance (r = 0.42, p < 0.05), while progesterone correlated positively with muscular endurance (r = 0.39, p < 0.05). Conclusion: Cognitive and neuromuscular performance varied across menstrual cycle phases, with the most favorable overall outcomes observed during ovulation. These findings support…
subject: Articles
  topic: section
subject: Menstrual cycle, estrogen, progesterone, cognitive function, muscle strength, endurance, reaction time, women’s health
  topic: keywords
creator: Isma Ishaq
creator: Bilal Safdar
creator: Seerat Husnain
creator: Rawaal Amin
creator: Aqsa Khan
creator: Mahnoor Zia
rights: Copyright (c) 2025 Isma Ishaq, Bilal Safdar, Seerat Husnain, Rawaal Amin, Aqsa Khan, Mahnoor Zia (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 10
doi: 10.61919/jr0rb844

Digital Distraction in Nursing Education: Prevalence of Smartphone Use and Its Association with Classroom Distraction Among Undergraduate Nursing Students in Pakistan
type: item
description: Background: The widespread adoption of smartphones among university students has transformed educational environments by providing immediate access to digital resources and communication platforms. However, frequent smartphone use during classroom sessions may contribute to digital distraction, reduced attention, and diminished academic engagement, particularly in professional disciplines such as nursing where sustained concentration is essential for learning complex theoretical concepts. Objective: To determine the prevalence of smartphone use during lectures and examine its association with classroom distraction among undergraduate nursing students in Mirpurkhas, Pakistan. Methods: A cross-sectional analytical study was conducted among 272 undergraduate nursing students from three nursing institutes in Mirpurkhas, Sindh. Data were collected using a structured self-administered questionnaire assessing demographic characteristics, frequency of smartphone use during lectures, percentage of class time spent using mobile devices, and levels of classroom distraction measured on a five-point Likert scale. Descriptive statistics were used to summarize frequencies and percentages. Chi-square test, Spearman rank correlation, and binary logistic regression were performed using SPSS version 26 to examine the relationship between smartphone use and classroom distraction, with a significance level set at p < 0.05. Results: Smartphone use during lectures was highly prevalent, with 43.0% of students reporting using their phones 1–10 times per class and 28.3% reporting more than 30 uses per session. A significant association was found between smartphone use frequency and classroom distraction (χ² = 27.11, p = 0.007). Spearman correlation indicated a positive but weak relationship between phone use and distraction levels (r = 0.231, p < 0.001). Logistic regression analysis demonstrated that increased smartphone use significantly predicted higher classroom distraction (OR = 1.37, 95…
subject: Articles
  topic: section
subject: Smartphone use; classroom distraction; nursing students; digital distraction; learning engagement; nursing education.
  topic: keywords
creator: Urooj Mari Baloch
creator: Ameet Kumar
creator: Lachman Das Malhi
creator: Nazish Chandio
creator: Sahban Jarwar
creator: Vijash Kumar
rights: Copyright (c) 2025 Urooj Mari Baloch, Ameet Kumar, Lachman Das Malhi, Nazish Chandio, Sahban Jarwar, Vijash Kumar (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e85
ending page: e85
doi: 10.61919/tgsjft83

Treatment Success in Patients with Cutaneous Leishmaniasis Treated with Inj. Glucantime 5 Ml (Meglumine Antimoniate) Dir Lower
type: item
description: Background: The dogma of Leishmania parasites is a widespread parasitic disease in tropical and subtropical areas, transmitted through the bite of sandflies, which is known as the cutaneous leishmaniasis (CL). This condition causes skin lesions that are either ulcerative, nodular or papular and in most cases causes great morbidity since disfigurement as well as functional impairment results. Meglumine antimoniate (Glucantime (meglumine antimoniate) is a common first-line drug but its effect on the treatment depends on the type of lesions, route of administration and demographics of the patient. Objective: The purpose of the study was to estimate predictors of the success of treatment in the patients with cutaneous leishmaniasis treated using Glucantime (meglumine antimoniate, with regard to the characteristics of the lesions, the route of administration, and the demographics of the patient. Methods: The study was done through a prospective, observational study over six treatment centers in District Dir Lower, Pakistan, in the 2022-2024 period. There was a total of 1,231 patients with cutaneous leishmaniasis, who were diagnosed by either PCR or microscopy. Glucantime (meglumine antimoniate as per the national guidelines) was used in intradermal or intramuscular form on patients. Successful treatment outcomes were those cases where lesions healed without relapses or even complications. Their effects included gender, age, number, size, and morphology of the lesion analyzed to determine their influence on treatment success. The analysis of data was performed based on descriptive statistics, chi-square tests, and logistic regression, with a level of significance of p < 0.05. Results: The overall results of the treatment were 66.9, and the failure was 33.1. Successful treatment among females (74.5) was higher when compared to male (58.4) (p = 0.002). The success rate of 72.8 in patients with single lesions and that of 52.1 with multiple lesions were a significant differen…
subject: Articles
  topic: section
subject: Cutaneous leishmaniasis, Glucantime (meglumine antimoniate, treatment success, intradermal administration, lesion characteristics, demographic factors, treatment outcomes, route of administration
  topic: keywords
creator: Fawad Khan
creator: Tariq Hassan
creator: Muhammad Qasim khan
creator: Sania Mehreen
creator: Qamar Niaz
creator: Ali Shaan
creator: Kashif Nawaz
creator: Muhammad Kamal Khan
creator: Siyab Ur Rahman
creator: Muhammad Ajmal Khan
creator: Shehreyar Javed
creator: Mohammad Imran younas
creator: Muhammad Younas
rights: Copyright (c) 2025 Fawad Khan, Tariq Hassan, Muhammad Qasim khan, Sania Mehreen, Qamar Niaz, Ali Shaan, Kashif Nawaz, Muhammad Kamal Khan, Siyab Ur Rahman, Muhammad Ajmal Khan, Shehreyar Javed, Mohammad Imran youns, Muhammad Youns (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e84
ending page: e84
doi: 10.61919/98a90157

Prevalence and Patterns of Abdominal Pathologies Detected Through Ultrasound Imaging in Patients From Tertiary Care Hospitals
type: item
description: Background: Abdominal pathologies remain a major diagnostic concern in clinical practice due to their diverse etiologies and varying presentations. Ultrasound imaging is widely used as a first-line, non-invasive modality for evaluating abdominal structures, yet its diagnostic patterns within local populations require continuous documentation to support clinical decision-making. Understanding the distribution of common abdominal abnormalities helps strengthen diagnostic accuracy, highlights population-specific trends, and informs resource allocation in radiology departments. Objective To evaluate the prevalence and distribution of abdominal pathologies identified through ultrasound imaging among patients presenting to a radiology department in Peshawar. Methods A cross-sectional study was conducted over a defined period, using a simulated sample of 180 patients who underwent abdominal ultrasound for diagnostic purposes. Patients were selected through convenience sampling, with exclusions applied to incomplete records and repeat imaging for the same complaint. Ultrasound examinations were performed using standardized imaging protocols, and findings were categorized into hepatobiliary, renal, pancreatic, splenic, gastrointestinal, and vascular pathologies. Data were analyzed using descriptive statistics, including means, standard deviations, and frequency distributions. Group comparisons were conducted using independent t-tests and chi-square tests where relevant. All analyses assumed normally distributed data. Results Of the 180 patients included, 54.4% were female and the mean age was 42.7 ± 16.3 years. Abnormal findings were documented in 69.4% of examinations. Hepatobiliary pathologies were the most prevalent (32.2%), followed by renal abnormalities (23.3%), while pancreatic and splenic findings remained comparatively infrequent. Fatty liver, cholelithiasis, and renal calculi constituted the leading individual diagnoses. The distribution of pathologies differed sig…
subject: Articles
  topic: section
subject: Abdominal Pain; Abdominal Ultrasound; Cross-Sectional Studies; Diagnostic Imaging; Hepatobiliary System; Prevalence; Ultrasonography
  topic: keywords
creator: Muhammad Fahad Khan
creator: Niamat Ali Khan
creator: Tauqeer Ullah
creator: Rabia Khattak
creator: Noor Fatima
creator: Muhammad Hamza
creator: Rohail Ahmed Khan
rights: Copyright (c) 2025 Muhammad Fahad Khan, Niamat Ali Khan, Tauqeer Ullah, Rabia Khattak, Noor Fatima, Muhammad Hamza, Rohail Ahmed Khan (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e83
ending page: e83
doi: 10.61919/hdz1ty56

Prevalence and Severity of Dry Eye Disease Among Prolonged Digital Device Users: A Cross-Sectional Study
type: item
description: Background: Dry eye disease has become an increasingly important ocular surface disorder in the era of widespread digital device use, with prolonged screen exposure contributing to altered blinking, tear film instability, and visual discomfort. Objective: To determine the prevalence and severity of dry eye disease and evaluate its association with prolonged daily screen time among digital device users in Peshawar, Pakistan. Methods: This cross-sectional study was conducted from March to October 2025 among 422 adults aged 18-45 years who used digital devices for at least 2 hours daily. Participants were assessed using the Ocular Surface Disease Index and SPEED questionnaires, followed by Tear Break-Up Time and Schirmer’s I testing. Mean differences in symptom severity across screen-time categories were evaluated using one-way ANOVA, and associations were assessed using Pearson’s correlation and logistic regression. Results: The mean age was 27.8 ± 6.1 years, and 55.5% of participants were female. The prevalence of dry eye disease based on OSDI was 80.1% (95% CI: 76.3%-83.9%), with 31.3% showing severe symptoms. TBUT below 10 seconds was observed in 63.5%, Schirmer’s I below 10 mm/5 min in 46.4%, and both abnormalities in 36.5%. Mean OSDI scores increased progressively across screen-time categories, reaching 45.7 ± 10.3 in participants with more than 6 hours of daily exposure. Screen time was strongly correlated with OSDI score (r = 0.71, p < 0.001), and users with more than 6 hours of exposure had 3.8-fold higher odds of moderate-to-severe dry eye. Conclusion: Dry eye disease was highly prevalent among prolonged digital device users, and its severity increased significantly with greater daily screen exposure. Regular screening, digital hygiene counseling, and public awareness measures may help reduce the burden of screen-associated ocular surface disease.
subject: Articles
  topic: section
subject: Cross-sectional studies, dry eye syndromes, ocular surface, prevalence, risk factors, screen time, visual display terminals.
  topic: keywords
creator: Muhammad Israr
creator: Noor-e-eman
creator: Malaika Sardar
creator: Um E Farwa
creator: Hina Ali Ahmed
creator: Ayesha Rahman
rights: Copyright (c) 2025 Muhammad Israr, Noor-e-eman, Malaika Sardar, Um E Farwa, Hina Ali Ahmed, Ayesha Rahman (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 1
ending page: 10
doi: 10.61919/y49t2459

Comparing Early vs Delayed Mobilization After Coronary Artery Bypass Grafting (CABG) and Its Impact on Functional Recovery
type: item
description: Background: Delayed functional recovery and postoperative complications remain common challenges following coronary artery bypass grafting (CABG), often prolonging hospitalization and impairing patient independence. Postoperative immobility contributes to muscle deconditioning, pulmonary complications, and reduced exercise tolerance. Early mobilization has been proposed as a strategy to enhance recovery; however, its benefits compared with conventional delayed mobilization remain inconsistently applied in routine cardiac surgical care. Objective: To evaluate whether early postoperative mobilization accelerates functional recovery and reduces complications compared with delayed mobilization in patients undergoing CABG. Methods: A single-center randomized controlled trial was conducted in a tertiary cardiac care setting. Sixty adult patients undergoing elective, first-time isolated CABG were randomly allocated to early mobilization (initiation within 24 hours postoperatively) or delayed mobilization (initiation after 72 hours). Functional recovery was assessed at discharge using the Six-Minute Walk Test, Barthel Index, and Modified Borg Scale. Postoperative complications and length of hospital stay were recorded from clinical records. Between-group comparisons were performed using appropriate parametric statistical tests, with significance set at p < 0.05. Results: Patients in the early mobilization group demonstrated significantly greater walking capacity (312.6 ± 48.9 m vs. 248.3 ± 52.1 m, p < 0.001) and higher independence in activities of daily living (Barthel Index: 87.4 ± 8.6 vs. 74.9 ± 10.2, p < 0.001) compared with the delayed group. Perceived exertion was lower among early mobilized patients (p = 0.002). Pulmonary complications, particularly atelectasis, were less frequent in the early mobilization group, and hospital stay was significantly shorter (6.2 ± 1.1 vs. 7.8 ± 1.4 days, p < 0.001). Conclusion: Early postoperative mobilization after CABG was associate…
subject: Articles
  topic: section
subject: Activities of Daily Living; Coronary Artery Bypass; Early Ambulation; Hospitalization; Postoperative Complications; Rehabilitation; Six-Minute Walk Test
  topic: keywords
creator: Akshy Kumar
creator: Hassaan Mehdi
creator: Muhammad Adeel
creator: Prerna Rani
creator: Ravi Kumar
creator: Sajid Khan
rights: Copyright (c) 2025 Akshy Kumar, Hassaan Mehdi, Muhammad Adeel, Prerna Rani, Ravi Kumar, Sajid Khan (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e79
ending page: e79
doi: 10.61919/pmz7z441

Investigating Genetic, Cognitive, and Therapeutic Approaches for Enhancing Quality of Life in Individuals With Down Syndrome
type: item
description: Background: Down syndrome (DS) is associated with substantial heterogeneity in cognition, adaptive functioning, and behavior, influenced by cytogenetic subtype and modifiable rehabilitative exposures, yet integrated regional evidence from South Punjab remains limited. Objective: To evaluate associations between cytogenetic subtype, therapy dose and modality, and standardized cognitive, adaptive, and behavioral outcomes among individuals with DS. Methods: A cross-sectional observational study was conducted in South Punjab (January–March 2025) including 60 individuals with cytogenetically confirmed DS aged 6–35 years. Cognitive performance was assessed using WISC-IV/WAIS-IV, adaptive functioning via VABS-II, and behavioral symptoms via the Aberrant Behavior Checklist. Therapy exposure over the preceding 6 months was operationalized as weekly minutes and categorized by intensity; modality was classified as single-modality versus multidisciplinary. Analyses used correlations, group comparisons, and multivariable linear regression (SPSS v26; α=0.05). Results: Full trisomy 21 occurred in 88.3%, mosaicism in 8.3%, and translocation in 3.4%. Mean Full-Scale IQ was 48.3±9.7, higher in mosaicism than trisomy 21 (56.2±6.4 vs 47.5±8.9; p=0.03). VABS-II composite averaged 62.8±11.3 and correlated with IQ (r=0.56; p<0.001). Multidisciplinary therapy was associated with higher VABS-II scores than single-modality therapy (67.2±9.8 vs 58.9±10.4; p=0.001; d=0.89). In regression, therapy intensity (β=0.42; p=0.002) and IQ (β=0.38; p=0.005) independently predicted adaptive functioning (adjusted R²=0.44). Conclusion: Adaptive outcomes in DS are more strongly associated with therapy intensity and multidisciplinary rehabilitation than cytogenetic subtype alone, supporting scalable integrated intervention models in resource-constrained settings.
subject: Articles
  topic: section
subject: Down syndrome; Trisomy 21; Mosaicism; Adaptive functioning; Vineland; Cognitive assessment; Multidisciplinary therapy; Rehabilitation; Behavioral symptoms; South Punjab
  topic: keywords
creator: Tooba Khanum
creator: Zobia Ali Hussain
creator: Muhammad Adeel Manzoor
creator: Muhammad Haseeb Khan
creator: Jabeen Haider Asad
creator: Arish Noor
creator: Laiba Mushtaq
rights: Copyright (c) 2025 Tooba Khanum, Zobia Ali Hussain, Muhammad Adeel Manzoor, Muhammad Haseeb Khan, Jabeen Haider Asad, Arish Noor, Laiba Mushtaq (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e78
ending page: e78
doi: 10.61919/rx80pr05

Systematic Review on the Application of Molecular Biology Techniques in Early Detection and Targeted Therapy of Human Diseases
type: item
description: Background: The integration of molecular biology techniques into clinical medicine represents a paradigm shift towards precision healthcare. While these methods hold immense promise for the early detection of disease and the guidance of targeted therapies, the evidence remains fragmented across various specialties and technological platforms, necessitating a consolidated, critical appraisal. Objective This systematic review aimed to evaluate the role of molecular biology methods in improving diagnostic accuracy and therapeutic strategies for human diseases, focusing on their application in early detection and targeted therapy. Methods A systematic review was conducted following PRISMA guidelines. Comprehensive searches of PubMed, Scopus, Web of Science, and the Cochrane Library were performed for studies published between 2014 and 2023. Inclusion criteria encompassed primary studies (randomized controlled trials, cohort studies, diagnostic accuracy studies) evaluating molecular techniques for early detection or therapy guidance in human diseases. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment using standardized tools. Results Eight studies were included in the qualitative synthesis. The findings demonstrate that molecular techniques, such as circulating tumor DNA analysis and next-generation sequencing, can detect cancer recurrence with a lead time of several months before clinical relapse and significantly improve patient outcomes when used to guide targeted therapies. For instance, molecular stratification for PD-L1 expression in non-small cell lung cancer and for homologous recombination deficiency in ovarian cancer was associated with significantly improved survival (Hazard Ratios of 0.69 and 0.33, respectively). Conclusion Molecular biology techniques provide a substantial advantage for early disease detection and personalized treatment selection, directly translating to improved clinical outcomes. However, evi…
subject: Articles
  topic: section
subject: Molecular Diagnostics; Early Detection of Disease; Precision Medicine; Targeted Therapy; Systematic Review.
  topic: keywords
creator: Grannaz Mengal
creator: Sadia Mengal
creator: Hafiz Muhammad Jawad
creator: Ayesha bibi
creator: Muhammad Zian Shakir
creator: Shaikh Khalid Muhammad
rights: Copyright (c) 2025 Grannaz Mengal, Sadia Mengal, Hafiz Muhammad Jawad, Ayesha bibi, Muhammad Zian Shakir, Shaikh Khalid Muhammad (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e77
ending page: e77
doi: 10.61919/kvjjme88

Designing Small-Molecule Allosteric Inhibitors of CYP2C19 to Prevent Clopidogrel Resistance in Patients With Specific Genetic Polymorphisms
type: item
description: Background: Clopidogrel resistance due to CYP2C19 polymorphisms presents a major barrier in achieving effective antiplatelet therapy, particularly in genetically predisposed populations. Current solutions often involve switching to alternative medications, which may be cost-prohibitive or contraindicated. A pharmacological strategy aimed at correcting enzyme dysfunction, rather than altering therapy, offers a novel approach to personalized treatment. Objective: To develop and evaluate a small-molecule allosteric inhibitor of CYP2C19 that enhances clopidogrel activation in individuals with reduced-function genetic variants. Methods: A descriptive study was conducted using computational modeling and pharmacokinetic simulation over eight months in South Punjab. A sample of 384 genotype-simulated participants was generated. Molecular docking and virtual screening techniques were used to identify candidate allosteric inhibitors targeting polymorphic CYP2C19 isoforms. A population-based pharmacokinetic model simulated active clopidogrel metabolite concentrations before and after co-therapy. Statistical analysis was performed using SPSS 26, with paired t-tests and ANOVA applied to normally distributed data. Results: Significant increases in active clopidogrel metabolite concentrations were observed post-intervention in all variant genotypes. Mean improvements were highest in *3/*3 (111.7%) and *2/*2 (79.4%) groups. Paired t-tests confirmed statistical significance in all mutant genotypes (p < 0.001). The intervention demonstrated robust potential to correct metabolic inefficiencies without altering standard antiplatelet therapy. Conclusion: The proposed co-therapy offers a promising solution to genetically driven clopidogrel resistance through targeted CYP2C19 modulation. This strategy could enable personalized, cost-effective, and clinically adaptable antiplatelet treatment in genetically diverse populations.
subject: Articles
  topic: section
subject: Allosteric regulation, Antiplatelet therapy, Clopidogrel, CYP2C19, Drug resistance, Enzyme modulation, Pharmacogenetics
  topic: keywords
creator: Marriam Abid
creator: Qasim Mehmood
creator: Naila Abdullah
creator: Maqsood Razzaq
creator: Noor Ihsan
creator: Muhammad Talha Safder
creator: Shahid Ullah
rights: Copyright (c) 2025 Marriam Abid, Qasim Mehmood, Naila Abdullah, Maqsood Razzaq, Noor Ihsan, Muhammad Talha Safder, Shahid Ullah (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e76
ending page: e76
doi: 10.61919/gsj6hy59

Exploration Of Nonspecific Patterns In Urinary Tract Infection Symptoms Across Different Age And Gender Groups (H/R) - A Cross-Sectional Study
type: item
description: Background: Urinary tract infections (UTIs) remain among the most prevalent bacterial infections worldwide, yet their clinical presentation varies widely across demographic groups. Recognizing nonspecific symptom patterns in different populations is crucial for timely diagnosis and management, particularly among vulnerable age groups where symptoms may be atypical. Objective: This study aimed to examine the distribution of specific and nonspecific urinary tract infection symptoms across age and gender groups, identifying demographic patterns and their implications for clinical practice. Methods: A cross-sectional study was conducted over eight months at a tertiary care hospital in Lahore, Pakistan, including 260 participants aged one year and above with clinically suspected or laboratory-confirmed UTI. Data were collected using structured questionnaires, physical examinations, and laboratory analyses including urinalysis and urine culture. Statistical analyses were performed using SPSS version 26. Descriptive statistics summarized demographic and clinical data, while chi-square and ANOVA tests evaluated group differences. Binary logistic regression identified predictors of nonspecific symptom presentation, with p < 0.05 considered statistically significant. Ethical approval was obtained from the institutional review board of the relevant institute. Results: Of 260 participants, 62.3% were female and the mean age was 36.4 ± 21.8 years. Specific symptoms were reported in 55.8% of cases, while 44.2% presented nonspecific features such as fever, malaise, and weakness. Nonspecific symptoms predominated among children (57.9%) and the elderly (66.7%), whereas specific symptoms were more frequent in adults (64.5%) (p < 0.001). Logistic regression identified age ≥ 60 years (OR 2.54, 95% CI 1.42–4.51), comorbidities (OR 1.91, 95% CI 1.07–3.39), and female gender (OR 1.48, 95% CI 1.03–2.12) as independent predictors of nonspecific presentations. Conclusion: Nonspecific urinary…
subject: Articles
  topic: section
subject: Adults, Age distribution, Bacteriuria, Cross-sectional studies, Gender differences, Pediatric infections, Urinary tract infections, Urine culture
  topic: keywords
creator: Zarina Naz
creator: Areej Areej
creator: Muhammad Mobeen
creator: Seemal Fatima
creator: Muhammad Abdullah Mirza
creator: Arish Noor
rights: Copyright (c) 2025 Zarina Naz, Areej Areej, Muhammad Mobeen, Seemal Fatima, Muhammad Abdullah Mirza, Arish Noor (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e75
ending page: e75
doi: 10.61919/xp8cg223

AI-Driven Personalized Weight Loss Strategies and Behavioral Patterns Among Obese Adults
type: item
description: Background: Obesity is a multifactorial chronic disease in which conventional lifestyle programs often produce heterogeneous outcomes due to limited personalization and suboptimal adherence. Artificial intelligence (AI)–enabled platforms can adapt dietary, activity, and behavioral recommendations using continuous user data, potentially improving engagement and clinical response. Objective: To evaluate the effectiveness of an AI-driven personalized weight management intervention versus standard counseling-based weight management in improving weight loss and adherence-related behaviors among obese adults in South Punjab, Pakistan. Methods: In this parallel-group randomized controlled trial, 180 adults aged 25–55 years with BMI 30.0–39.9 kg/m² were randomized 1:1 to an AI-assisted mobile program integrating self-monitoring inputs and wearable-derived activity/sleep metrics or to standard biweekly counseling without algorithmic personalization. Assessments at baseline, 8 weeks, and 16 weeks included anthropometry and validated behavioral measures (IPAQ; WELQ). Analyses followed intention-to-treat principles with repeated-measures testing and effect size estimation. Results: The AI group achieved greater mean weight loss than controls (−8.9 kg [95% CI −9.6 to −8.2] vs −4.2 kg [−4.9 to −3.5]), with a between-group difference of −4.7 kg (−5.6 to −3.8; p<0.001; d=1.59). BMI reduction was larger in the AI group (−3.2 vs −1.6 kg/m²; p<0.001), and waist circumference declined more (−8.4 vs −4.1 cm; p<0.001). The AI group showed higher physical activity (2860±520 vs 2210±480 MET-min/week), dietary adherence (84.5±6.1% vs 69.8±8.0%), and self-monitoring (5.6±1.0 vs 3.1±1.2 days/week) (all p<0.001). Conclusion: AI-driven personalized lifestyle intervention produced clinically and statistically superior short-term weight loss and adherence-related behavioral improvements compared with standard counseling, supporting its potential as a scalable adjunct for obesity management in res…
subject: Articles
  topic: section
subject: Adherence; Artificial Intelligence; Behavior Modification; Body Mass Index; Digital Health; Machine Learning; Obesity; Randomized Controlled Trial; Weight Loss.
  topic: keywords
creator: Mohammad Alruwaili
creator: Faisal Sajda Owad Almutairi
creator: Zarina Naz
creator: Muhammad Zia Iqbal
creator: Uzair Ahmad
creator: Noor Un Nisa
creator: Mahmoud Awad
rights: Copyright (c) 2025 Mohammad Alruwaili, Faisal Sajda Owad Almutairi, Zarina Naz, Muhammad Zia Iqbal, Uzair Ahmad, Noor Un Nisa, Mahmoud Awad (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e74
ending page: e74
doi: 10.61919/m88k6g05

Relationship Between Depression Scores And Poor Glycemic Control In Type 2 Diabetes
type: item
description: Background: Depression and diabetes frequently coexist, forming a bidirectional relationship that worsens metabolic outcomes and quality of life. Poor glycemic control among patients with type 2 diabetes mellitus (T2DM) is often influenced by psychological distress, reduced medication adherence, and unhealthy lifestyle behaviors. Understanding this association is critical for developing integrated care models that address both metabolic and mental health needs. Objective: This study aimed to evaluate the association between depression severity and glycated hemoglobin (HbA1c) levels in patients with T2DM, while examining medication adherence, clinic attendance, and lifestyle behaviors as potential mediators of this relationship. Methods: A cross-sectional study was conducted over eight months among 240 adults with T2DM attending tertiary hospitals in Lahore, Pakistan. Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9), medication adherence with the Morisky Medication Adherence Scale (MMAS-8), and lifestyle behaviors with the Summary of Diabetes Self-Care Activities (SDSCA). Clinical data, including HbA1c levels, were obtained from medical records. Pearson correlation and multiple linear regression analyses were performed to identify predictors of glycemic control, assuming normal data distribution. Ethical approval was obtained from the Institutional Review Board of the relevant institute. Results: The mean HbA1c was 8.3 ± 1.4%, and mean PHQ-9 score was 10.2 ± 5.3. Depression scores were significantly correlated with HbA1c (r = 0.41, p < 0.001). Medication adherence (r = -0.36, p < 0.001) and lifestyle behaviors (r = -0.32, p < 0.001) were inversely associated with HbA1c. Regression analysis identified depression (β = 0.38, p < 0.001), medication adherence (β = -0.25, p < 0.001), and lifestyle behaviors (β = -0.22, p = 0.003) as independent predictors of HbA1c. Medication adherence partially mediated the depression–HbA1c relationship. C…
subject: Articles
  topic: section
subject: Adherence, Depression, Diabetes Mellitus Type 2, Glycated Hemoglobin A, Lifestyle, Mental Health, Self-Care, South Asia
  topic: keywords
creator: Naheed Shah
creator: Asma Iqbal
creator: Naeem Asghar
creator: Sadaf Moeez
creator: Erum Fatima
creator: Shaikh Khalid Muhammad
rights: Copyright (c) 2025 Naheed Shah, Asma Iqbal, Naeem Asghar, Sadaf Moeez, Erum Fatima, Shaikh Khalid Muhammad (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e73
ending page: e73
doi: 10.61919/hwzp2v55

AI-Guided Virtual Physiotherapy vs. Traditional Therapy for Post-Stroke Rehabilitation: A Randomized Controlled Trial
type: item
description: Background: Stroke remains a leading cause of long-term disability, with motor and functional impairments requiring intensive rehabilitation. Conventional physiotherapy is effective but limited by accessibility and adherence. The integration of artificial intelligence (AI) into remote rehabilitation platforms offers an innovative approach to optimize recovery while addressing barriers of traditional therapy. Objective The objective of this randomized controlled trial was to determine whether AI-guided virtual physiotherapy improves functional independence, motor recovery, and adherence compared with traditional in-person physiotherapy among post-stroke patients. Methods A total of 100 patients with ischemic or hemorrhagic stroke were randomized into AI-guided virtual physiotherapy (n=50) and traditional therapy (n=50) groups. Functional Independence Measure (FIM), Fugl-Meyer Motor Scale (FMMS), and Stroke-Specific Quality of Life (SS-QOL) were assessed at baseline and 12 weeks. Adherence rates were also recorded. Data were analyzed using independent t-tests and chi-square tests, with p-values <0.05 considered statistically significant. Results Patients in the AI-guided group showed significantly greater improvements in functional independence (mean improvement in FIM: 28.6 vs. 21.4, p=0.01) and motor recovery (mean improvement in FMMS: 19.8 vs. 15.2, p=0.02). Quality of life improved more in the AI-guided group (24% vs. 16%, p=0.03). Adherence was higher in the AI group, with 88% achieving ≥85% adherence compared with 72% in the traditional group (p=0.04). Conclusion AI-guided virtual physiotherapy demonstrated superior functional, motor, and quality-of-life outcomes with higher adherence compared to traditional therapy, highlighting its potential as an effective and scalable post-stroke rehabilitation strategy.
subject: Articles
  topic: section
subject: Adherence, Artificial Intelligence, Motor Recovery, Physiotherapy, Post-Stroke Rehabilitation, Quality of Life, Randomized Controlled Trial
  topic: keywords
creator: Zarina Naz
creator: Arsalan Rasool
creator: Namra Urooj
creator: Baseer Ahmad
creator: Nayab Khan
creator: Aqsa Iqbal
creator: Zainab Arshad
rights: Copyright (c) 2025 Zarina Naz, Arsalan Rasool, Namra Urooj, Baseer Ahmad, Nayab Khan, Aqsa Iqbal, Zainab Arshad (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e72
ending page: e72
doi: 10.61919/94tgwn21

Impact of Endometriosis on Fertility Hormones and Ovarian Reserve Markers (AMH, FSH, LH)
type: item
description: Background: Endometriosis is a chronic gynecological condition commonly affecting women of reproductive age and is frequently associated with infertility. Beyond mechanical and inflammatory factors, endocrine alterations may contribute to impaired fertility by affecting ovarian reserve. Hormonal markers such as anti-Müllerian hormone, follicle-stimulating hormone, and luteinizing hormone are widely used to assess ovarian reserve and reproductive potential, yet their patterns in women with endometriosis remain variably reported, particularly in routine clinical settings. Objective: To compare ovarian reserve markers, specifically anti-Müllerian hormone, follicle-stimulating hormone, and luteinizing hormone, between women with endometriosis and healthy controls. Methods: This descriptive comparative study was conducted in Islamabad over three months and included women aged 20–40 years attending gynecology clinics. Participants were divided into two equal groups: women with clinically confirmed endometriosis and age-matched healthy controls. Demographic and clinical data were recorded, and venous blood samples were obtained during the early follicular phase of the menstrual cycle. Serum anti-Müllerian hormone, follicle-stimulating hormone, and luteinizing hormone levels were measured using standardized laboratory assays. Data were analyzed using appropriate parametric statistical tests, with significance set at p < 0.05. Results: Women with endometriosis demonstrated significantly lower mean anti-Müllerian hormone levels compared with healthy controls, indicating reduced ovarian reserve. Follicle-stimulating hormone levels were significantly higher in the endometriosis group, while luteinizing hormone levels showed a modest but statistically significant increase. Baseline demographic characteristics were comparable between groups. Conclusion: Endometriosis was associated with altered ovarian reserve markers, particularly reduced anti-Müllerian hormone and elevated foll…
subject: Articles
  topic: section
subject: Anti-Mullerian Hormone; Endometriosis; Fertility; Follicle Stimulating Hormone; Luteinizing Hormone; Ovarian Reserve; Women
  topic: keywords
creator: Ambreen Ibrahim
creator: Naheed Shah
creator: Lubna Malik
creator: Rawaal Amin
creator: Syeda Khalida Naeem
creator: Hina Ali Ahmed
rights: Copyright (c) 2025 Ambreen Ibrahim, Naheed Shah, Lubna Malik, Rawaal Amin, Syeda Khalida Naeem, Hina Ali Ahmed (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e71
ending page: e71
doi: 10.61919/bvvmr151

General Overview of Broadly Discussed Lifestyle and Environmental Factors Casually Associated with Breast Cancer Development
type: item
description: Background: breast cancer represents a significant global health burden, with a complex etiology extending beyond genetic predisposition to encompass modifiable lifestyle and environmental exposures. A myriad of these factors are frequently discussed in both scientific and public domains, yet the evidence supporting these associations varies widely in strength and consistency. Objective: This narrative review aims to broadly survey and synthesize the lifestyle and environmental factors that are casually mentioned in relation to breast cancer development, providing a panoramic overview of these superficial associations without delving into deep mechanistic analysis. Main Discussion Points: The review thematically explores factors including dietary patterns, alcohol and tobacco use, physical activity, body composition, exogenous hormones, environmental chemical exposures, circadian disruption, and socioeconomic influences. It highlights well-established causal links, such as those for alcohol and postmenopausal obesity, while also presenting the more ambiguous and inconsistently supported associations for elements like specific dietary components and endocrine-disrupting chemicals. Critical analysis underscores the methodological limitations inherent in the observational evidence base. Conclusion: The evidence for casually mentioned risk factors exists on a spectrum, with clear public health priorities emerging for risk reduction. Clinicians and policymakers should focus on advocating for interventions related to the most robustly evidence-based factors. The review calls for future research employing more rigorous, integrative study designs to clarify unresolved associations and advance primary prevention strategies.
subject: Review Articles
  topic: section
subject: Breast Cancer; Lifestyle Factors; Environmental Exposure; Risk Factors; Narrative Review; Prevention
  topic: keywords
creator: Shabahat Arain
creator: Marriam Abid
creator: S Batool Zehra Naqvi
creator: Sardar Momen
creator: Noshaba Zaheer Khan
creator: Wajahat Ullah
creator: Rimsha Faisal
rights: Copyright (c) 2025 Shabahat Arain, Marriam Abid, S Batool Zehra Naqvi, Sardar Momen, Noshaba Zaheer Khan, Wajahat Ullah, Rimsha Faisal (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: e70
ending page: e70
doi: 10.61919/m28rrs70