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Link Medical Interface, Lahore, Pakistan
© The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Barriers to Universal Health Coverage in Pakistan: A Health System Perspective
Background: Universal Health Coverage (UHC) aims to ensure equitable access to essential health services without financial hardship; however, progress in Pakistan remains constrained by systemic challenges. Qualitative inquiry is needed to understand how these barriers are experienced and interpreted within the health system. Objective: To explore stakeholder perceptions of structural barriers to UHC in Pakistan from a health systems perspective. Methods: A qualitative descriptive study was conducted between January and March 2025 using semi-structured interviews with 25 stakeholders, including policymakers, public health experts, physicians, and hospital administrators. Participants were selected through purposive sampling. Data were analyzed using Braun and Clarke’s reflexive thematic analysis. Results: Five major themes were identified: insufficient health financing, workforce shortages and maldistribution, weak governance and policy implementation, inequitable healthcare access, and high out-of-pocket expenditure. Participants described these barriers as interconnected, with financing and governance influencing workforce distribution and service accessibility, while financial burden directly affected healthcare utilization. Conclusion: Achieving UHC in Pakistan requires integrated health system reforms focusing on financing, governance, workforce distribution, and financial protection. Strengthening implementation mechanisms and addressing contextual barriers will be critical for improving equitable healthcare access.
Universal Health Coverage, Pakistan, Health Systems, Qualitative Research, Healthcare Access, Health Policy
Copyright (c) 2025 Muhammad Hamza Muzammil, Muhammad Uzair, Faiza Iqrar, Muhammad Talha, Sara Alam, Aatqa Khan, Sehrish Muhammad, Arsalan Khan, Kainat Ashraf, Noor Fatima (Author) https://creativecommons.org/licenses/by/4.0
The Association Between Serum Vitamin D Status and Knee Joint Space Width in Adults with Early Osteoarthritis - A Cross-Sectional Study
Background: Knee osteoarthritis (OA) is a progressive degenerative joint disease in which early cartilage loss determines long-term functional trajectory. Vitamin D, beyond its classical skeletal role, modulates chondrocyte metabolism and joint inflammatory signaling through vitamin D receptor pathways; however, its cross-sectional association with radiographic cartilage preservation in early knee OA remains incompletely characterized. Objective: To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] sufficiency and medial tibiofemoral joint space width (JSW) as a radiographic marker of cartilage integrity in adults with early knee osteoarthritis. Methods: A cross-sectional study was conducted over eight months at a tertiary care hospital in Lahore, Pakistan, enrolling 135 adults aged 40–65 years with Kellgren–Lawrence grade I–II knee OA. Serum 25(OH)D was measured by chemiluminescent immunoassay and categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL) per Endocrine Society guidelines. Standardized weight-bearing JSW was measured digitally by two blinded musculoskeletal radiologists (ICC = 0.91). WOMAC pain and function subscales provided secondary clinical outcomes. ANOVA with Tukey post-hoc testing, Pearson correlation with 95% CIs, and multivariable linear regression adjusting for age, sex, BMI, and symptom duration were applied. Results: Mean serum 25(OH)D was 26.7 ± 8.4 ng/mL. Sufficient participants demonstrated significantly greater JSW than deficient individuals (3.89 ± 0.57 mm vs. 3.11 ± 0.54 mm; mean difference 0.78 mm, 95% CI 0.51–1.05, p < 0.001). Serum 25(OH)D correlated positively with JSW (r = 0.41, 95% CI 0.26–0.54, p < 0.001) and inversely with WOMAC pain (r = -0.36, p = 0.002) and function (r = -0.33, p = 0.004). Associations remained significant after confounder adjustment (β = 0.023 mm/ng/mL, 95% CI 0.011–0.035, p < 0.001). Conclusion: Vitamin D sufficiency was independently associated with greater radiographic joint space width and reduced symptomatic burden in early knee OA, supporting its evaluation as a modifiable nutritional target in early OA prevention.
25-Hydroxyvitamin D; joint space width; Kellgren–Lawrence grade; knee osteoarthritis; nutritional status; radiography; WOMAC
Copyright (c) 2025 Namra Urooj, Sumera Kanwal, Malak Mustaqeem Khan, Saima Ashraf, Nauman Akhtar, Aqil ur Rehman, Muhammad Faizan Ali (Author) https://creativecommons.org/licenses/by/4.0
Prospective Evaluation of Cognitive Reframing and Thought-Challenging Techniques in Reducing Symptom Severity Among Adults with Dual Anxiety–Depression Diagnosis
Background: Anxiety and depression frequently co-occur, creating compounded symptom burden and reduced responsiveness to conventional pharmacotherapy. Cognitive reframing and thought-challenging, core components of cognitive-behavioral therapy, target the shared maladaptive cognitive processes that maintain both conditions, yet their effectiveness as an isolated structured intervention in adults with confirmed dual diagnoses of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in low-to-middle-income settings remains inadequately characterized. Objective: To evaluate the effectiveness of a structured 12-week cognitive reframing and thought-challenging intervention in reducing anxiety and depressive symptom severity, improving cognitive emotion regulation, and enhancing quality of life among adults with comorbid GAD and MDD over a 24-week prospective follow-up. Methods: A prospective single-arm interventional study was conducted among 80 adults with DSM-5-confirmed comorbid GAD and MDD at three tertiary care hospitals in Lahore, Pakistan. Participants received 12 weekly individual sessions derived from validated CBT manuals, culturally adapted for local context. Primary outcomes were assessed using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) at baseline, week 12, and week 24. Secondary outcomes included the Cognitive Emotion Regulation Questionnaire (CERQ) and WHOQOL-BREF. Repeated measures ANOVA with Bonferroni-corrected post-hoc comparisons and ANCOVA adjusting for medication class were performed. Results: Per-protocol retention was 93.75% (n = 75). BAI scores declined from 28.4 ± 7.1 to 14.9 ± 5.8 (Δ = −13.5; 95% CI: −16.0 to −11.0; Cohen's d = 1.34; p < 0.001) and BDI-II from 30.6 ± 8.2 to 16.1 ± 6.4 (Δ = −14.5; 95% CI: −16.9 to −12.1; d = 1.34; p < 0.001) by week 24. CERQ adaptive composite scores increased by +16.7 points and WHOQOL-BREF total scores by +17.8 points at week 24 (both p < 0.001). ANCOVA confirmed independence of effects from medication class. Conclusion: Structured cognitive reframing and thought-challenging were associated with large, sustained reductions in anxiety and depressive symptoms and improvements in cognitive regulation and quality of life among Pakistani adults with comorbid GAD and MDD. Randomized controlled trials are warranted to confirm efficacy against active comparators.
Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Cognitive Reframing; Comorbidity; Depression; Pakistan; Prospective Studies; Thought-Challenging; Treatment Outcome.
Copyright (c) 2025 Muhammad Numair Kashif, Eisha Maryam, Harmain Fatima, Seema Habib Bhutto, Bushra Waheed, Najma Syed Ghulam (Author) https://creativecommons.org/licenses/by/4.0
Randomized Trial of AI-Guided Antidepressant Selection Improving Remission and Tolerability in Primary-Care Depression
Background: Depressive disorders represent a leading cause of disability in primary-care settings globally, yet conventional antidepressant prescribing relies predominantly on trial-and-error approaches that delay remission and increase adverse-effect exposure. Artificial intelligence (AI)-based decision-support systems offer a mechanism for personalising medication selection by integrating patient-specific clinical data, but randomised evidence from real-world primary-care settings, particularly in low- and middle-income countries, remains absent. Objective: To compare AI-guided antidepressant selection with usual clinician-directed care on remission rates, adverse-effect burden, and time-to-clinical response among adults with depressive disorders in primary care. Methods: A prospective, parallel-group randomised controlled trial was conducted in primary-care clinics across South Punjab, Pakistan. Eighty-four adults (aged 18–65 years) with PHQ-9 scores ≥ 10 initiating or switching antidepressant therapy were randomised 1:1 to AI-guided medication selection (n = 42) or usual care (n = 42). The AI tool integrated baseline symptom profiles, comorbidity data, and prior treatment history to generate individualised first-line antidepressant recommendations. Depressive severity was assessed using the PHQ-9 at baseline and at weeks 2, 4, 6, and 8; remission was defined as PHQ-9 ≤ 4; clinical response as ≥ 50% PHQ-9 reduction from baseline; and adverse effects were measured using the FIBSER scale. Outcomes were analysed using independent-samples t-tests, chi-square tests, repeated-measures ANOVA, and effect sizes reported as Cohen's d. Results: At week eight, mean PHQ-9 score was significantly lower in the AI-guided group (6.16 ± 2.4 vs 8.47 ± 2.9; mean difference 2.31, 95% CI: 1.23–3.39; p < 0.001; d = 0.88). Remission was achieved by 61.9% of AI-guided participants versus 38.1% in usual care (RR = 1.63, 95% CI: 1.04–2.54; p = 0.029). Mean time to clinical response was 3.14 ± 0.9 versus 4.86 ± 1.1 weeks (difference 1.72 weeks, 95% CI: 1.29–2.15; p < 0.001; d = 1.73). Adverse-effect burden was significantly lower in the AI-guided arm (FIBSER: 3.16 ± 1.2 vs 4.80 ± 1.4; p < 0.001; d = 1.25). No serious adverse events were recorded in either group. Conclusion: AI-guided antidepressant selection improved remission rates reduced adverse-effect burden, and accelerated clinical response compared with usual care, with consistently large effect sizes across all outcome domains. These findings support integration of AI-based decision-support tools to enhance personalised depression treatment in resource-limited primary-care settings.
Algorithms; Antidepressive agents; Artificial intelligence; Clinical decision support; Depression; Patient Health Questionnaire-9; Primary health care; Randomised controlled trial; Treatment outcome.
Copyright (c) 2025 Fatima Hassan, Fareeha F Khan, Anina Qureshi, Bushra Waheed, Eisha Maryam, Shaikh Khalid Muhammad (Author) https://creativecommons.org/licenses/by/4.0
Phase of Neovascularization in Wound Repair: Topical Impact of Low-Level Laser Therapy with Conventional Treatment in Rabbit Model
Background: Neovascularization is the rate-limiting event in the proliferative phase of wound repair, and its accelerated induction represents a key therapeutic target in surgical wound management. Low-level laser therapy (LLLT), a non-invasive photobiomodulatory modality, has demonstrated pro-angiogenic properties through cytochrome c oxidase-mediated bioenergetic stimulation and growth factor upregulation, yet direct histomorphometric comparisons with conventional topical agents such as normal saline and Edinburgh University Solution of Lime (Eusol) remain insufficiently characterised. Objective: To evaluate and compare the effect of topical LLLT, normal saline, and Eusol dressing on the neovascularization phase of full-thickness surgical wound repair using quantitative vascular density assessment across discrete healing time points in an experimental rabbit model. Methods: Fifteen male albino rabbits (200–350 g) were randomly allocated to three groups (n = 5/group): Group A (normal saline, daily), Group B (LLLT, 10 J/cm², 830 nm, THOR DD II device, daily), and Group C (Eusol dressing, daily). Full-thickness excisional wounds (2.5 × 2.5 cm²) were created on the dorsal surface under ketamine–xylazine anaesthesia. Wound tissue biopsies were collected at Days 3, 7, and 14, processed for haematoxylin and eosin staining, and mean vascular counts were enumerated per 0.196 mm² field at 400× magnification by a blinded histologist. Data were analysed using one-way ANOVA with post hoc Tukey's HSD test (p < 0.05). Results: Group B demonstrated significantly superior mean vascular counts at all time points: Day 3 (6.65 ± 1.80 versus 2.31 ± 1.20 and 3.54 ± 0.41), Day 7 (10.47 ± 0.11 versus 3.21 ± 0.32 and 5.68 ± 1.74), and Day 14 (8.88 ± 0.63 versus 4.45 ± 0.71 and 5.97 ± 1.57) for Groups A and C respectively (p = 0.040–0.001; η² = 0.721–0.916). A biphasic trajectory with peak neovascularization at Day 7 was observed exclusively in Group B. Conclusion: LLLT significantly accelerates surgical wound neovascularization compared with normal saline and Eusol, supporting its integration as an adjunctive modality in evidence-based wound management protocols.
low-level laser therapy; photobiomodulation; neovascularization; angiogenesis; surgical wound healing; Eusol; rabbit model
Copyright (c) 2025 Muhammad Asif, Satheesh Babu Natarajan, Muhammad Ahmed Azmi (Author) https://creativecommons.org/licenses/by/4.0
Mental Health Services Accessibility in Pakistan: Gaps, Barriers, and Policy Implications — A Qualitative Analysis
Background: Mental health disorders are a major public health concern in Pakistan, yet access to mental health services remains limited. Existing evidence has described workforce shortages, stigma, and weak policy implementation, but less is known about how these barriers are experienced across different stakeholder groups. A qualitative approach is necessary to explore the social, cultural, financial, and system-level factors that shape access to care in real-world settings. Objective: To explore perceptions of mental health service accessibility in Pakistan, identify major barriers and enabling factors influencing access to care, and examine the policy implications of these findings. Methods: This qualitative study used semi-structured interviews with key stakeholders, including psychiatrists, psychologists, patients, caregivers, and health policy experts. Relevant literature from PubMed, Scopus, and Web of Science was used to contextualize the findings. Interview data were analyzed thematically following the Braun and Clarke framework. Results: Four major themes were identified: structural barriers, sociocultural barriers, financial barriers, and policy and governance barriers. Participants highlighted shortage and urban concentration of services, stigma and negative social perceptions, reliance on non-medical explanatory models, unaffordable treatment pathways, and weak implementation of mental health policies. Accessibility was shaped by overlapping mechanisms involving trust, perceived acceptability, cost, and system responsiveness. Conclusion: Mental health service accessibility in Pakistan is constrained by interconnected structural, social, financial, and governance barriers. Improving access requires primary-care integration, workforce strengthening, community-sensitive stigma reduction, and stronger policy implementation.
Mental health, accessibility, Pakistan, stigma, healthcare policy, qualitative research.
Copyright (c) 2025 Muhammad Uzair, Eiman Imtiaz, Mibra Asjad, Syed Saqib Hussain Shah, Sibghat Ullah, Qurat Ul Ain Hingoro, Rabiya Hanif, Fizza Khalil, Hassan Raza Ali, Talat Yasmin (Author) https://creativecommons.org/licenses/by/4.0
Digital Health Knowledge, Attitudes, and Practices Among Undergraduate Nursing Students: A Comparative Study of Public and Private Colleges in Mirpurkhas, Sindh, Pakistan
Background: Digital health technologies are increasingly transforming healthcare delivery, requiring healthcare professionals to possess adequate digital competencies. Nursing students, as future healthcare providers, must develop sufficient knowledge, positive attitudes, and effective practices related to digital health technologies to ensure safe and efficient patient care in technology-driven healthcare systems. However, limited evidence exists regarding digital health readiness among nursing students in developing regions such as Pakistan. Objective: This study aimed to evaluate the levels of digital health knowledge, attitudes, and practices among undergraduate nursing students and to examine differences between public and private institutions as well as across academic years. Methods: A comparative cross-sectional study was conducted among 254 undergraduate nursing students enrolled in selected public and private nursing colleges in Mirpurkhas, Sindh, Pakistan. Data were collected using a structured self-administered questionnaire based on a five-point Likert scale and analyzed using IBM SPSS version 27. Descriptive statistics were used to summarize variables, while independent samples t-tests and one-way ANOVA were used to compare group differences. Pearson correlation analysis was performed to assess relationships among knowledge, attitudes, and practices. Results: The mean scores for knowledge (3.30 ± 0.75), attitudes (3.26 ± 0.56), and practices (3.46 ± 0.86) indicated moderate levels across all domains. Significant differences were observed between public and private institutions in knowledge (p = 0.031) and attitudes (p = 0.024), while practices showed no significant difference (p = 0.189). Significant variations were also found across academic years for knowledge (p = 0.028) and attitudes (p = 0.003). Strong positive correlations were identified between knowledge and attitudes (r = 0.754), knowledge and practices (r = 0.688), and attitudes and practices (r = 0.698), all statistically significant (p < 0.001). Conclusion: Undergraduate nursing students demonstrated moderate digital health knowledge, attitudes, and practices. Strengthening digital health literacy and informatics education within nursing curricula may enhance students’ preparedness for technology-driven healthcare systems.
Digital health; digital health literacy; nursing students; knowledge attitude practices; telemedicine; health informatics.
Copyright (c) 2025 Inshal Anwar Arain, Irfan Ali Chandio, Areeba Zulfiqar Rajput, Nimra Rasheed Gill, Sheela Davi Malhi, Dileep Kumar Malhi (Author) https://creativecommons.org/licenses/by/4.0
Validating a Panel of Salivary miRNA and Protein Biomarkers for the Early Detection of High-Risk Oral Potentially Malignant Disorders
Background: Oral potentially malignant disorders (OPMDs) are precancerous oral lesions with variable risk of progression to oral squamous cell carcinoma, yet current assessment depends largely on biopsy-based histopathology, which is invasive and not ideal for repeated screening. Salivary molecular diagnostics offer a non-invasive alternative capable of detecting early biological changes associated with malignant potential. Objective: To assess the diagnostic performance of a combined salivary biomarker panel comprising miR-21, miR-31, miR-184, IL-8, and MMP-9 for differentiating patients with high-risk OPMDs from healthy controls. Methods: In this cross-sectional observational study, 84 participants were enrolled, including 44 patients with clinically and histopathologically confirmed OPMDs and 40 healthy controls. Unstimulated saliva samples were analyzed for miR-21, miR-31, and miR-184 expression by quantitative real-time polymerase chain reaction and for IL-8 and MMP-9 concentrations by enzyme-linked immunosorbent assay. Group comparisons, correlations, and receiver operating characteristic analyses were performed. Results: All three microRNAs and both proteins were significantly elevated in OPMD cases compared with controls (p < 0.001 for all). The strongest correlations were observed between miR-21 and IL-8 (r = 0.72) and between miR-31 and MMP-9 (r = 0.68). Individual biomarker AUCs ranged from 0.81 to 0.89, while the combined panel achieved an AUC of 0.94 (95% CI: 0.89-0.98), with sensitivity of 91.2% and specificity of 88.7%. Conclusion: The combined salivary biomarker panel demonstrated strong diagnostic accuracy for identifying high-risk OPMDs and supports the potential of saliva-based molecular profiling as a practical non-invasive adjunct for early oral precancer detection.
Oral potentially malignant disorders; saliva; microRNA; IL-8; MMP-9; biomarkers; early detection
Copyright (c) 2025 Ranya Khan, Saqba Alam, Durr e Sameen, Seemab Naz, Asia Rahman Khan Lodhi, Arshad Ahmad (Author) https://creativecommons.org/licenses/by/4.0
AI-Powered Detection of Functional Gastrointestinal Disorders in Adults Visiting Tertiary Hospitals
Background: Functional gastrointestinal disorders are common in tertiary gastroenterology practice and remain difficult to diagnose because they are defined largely by symptom patterns rather than structural or biochemical abnormalities. In busy referral settings, overlap among irritable bowel syndrome, functional dyspepsia, functional constipation, and non-functional gastrointestinal conditions can reduce diagnostic consistency. Artificial intelligence offers a potential solution by integrating structured clinical variables with free-text symptom narratives to support more standardized classification. Objective: To evaluate the diagnostic accuracy of an artificial intelligence–based system for detecting functional gastrointestinal disorders among adults attending tertiary hospitals. Methods: This multicenter cross-sectional diagnostic accuracy study was conducted over eight months in three tertiary hospitals in Lahore, Pakistan. A total of 420 adults aged 18–65 years presenting with gastrointestinal symptoms were enrolled through consecutive sampling. After exclusion of relevant organic pathology, Rome IV–based clinician diagnosis served as the reference standard. The artificial intelligence system analyzed structured clinical variables and unstructured consultation notes using supervised machine learning and natural language processing to classify irritable bowel syndrome, functional dyspepsia, functional constipation, and non-functional gastrointestinal disorder status. Diagnostic performance was assessed using sensitivity, specificity, predictive values, area under the receiver operating characteristic curve, and Cohen’s kappa. Results: The mean age was 37.4 ± 10.8 years, and 54.8% of participants were male. Clinically, 33.3% had irritable bowel syndrome, 23.8% functional dyspepsia, 14.3% functional constipation, and 28.6% non-functional gastrointestinal disorders. The artificial intelligence model achieved a sensitivity of 88.2%, specificity of 84.5%, positive predictive value of 86.9%, negative predictive value of 86.0%, overall accuracy of 87.1%, and an overall area under the curve of 0.912. Agreement with clinician diagnosis was strong (κ = 0.83, p < 0.001). Conclusion: The artificial intelligence system showed high diagnostic performance and strong concordance with Rome IV–based clinical diagnosis, supporting its potential role as an adjunctive decision-support tool for functional gastrointestinal disorder classification in tertiary care.
Artificial intelligence, functional gastrointestinal disorders, irritable bowel syndrome, functional dyspepsia, functional constipation, machine learning, natural language processing, diagnostic accuracy
Copyright (c) 2025 Muhammad Essa Khan, Mahnoor Naeem Rana, Khalid Bilal Khan, Laiba Mushtaq, Turfa Asghar, Wajeeha Ahmadani, Muhammad Zohaib Wahid (Author) https://creativecommons.org/licenses/by/4.0
Effect of Menstrual Cycle Phases on Cognitive and Neuromuscular Performance
Background: Fluctuations in estrogen and progesterone across the menstrual cycle may influence cognitive and neuromuscular performance, yet previous findings have remained inconsistent because many studies have assessed isolated outcomes or relied solely on calendar-based phase estimation. Objective: To evaluate variations in cognitive performance, muscle strength, and endurance across menstrual cycle phases and examine their association with circulating estrogen and progesterone levels in healthy young women. Methods: This descriptive repeated-measures study was conducted in Lahore, Pakistan, among 60 healthy women aged 18-30 years with regular menstrual cycles. Assessments were performed during the follicular, ovulatory, and luteal phases. Serum estrogen and progesterone concentrations were measured by enzyme-linked immunosorbent assay. Cognitive performance was assessed using the Stroop Color-Word Test and Digit Span Test, while neuromuscular performance was evaluated using quadriceps maximal voluntary isometric contraction and plank endurance. Data were analyzed using repeated-measures ANOVA and Pearson correlation tests. Results: Estrogen peaked during ovulation (187.5 ± 25.8 pg/mL), whereas progesterone was highest in the luteal phase (11.8 ± 2.7 ng/mL) (p < 0.001 for both). Stroop reaction time improved significantly during ovulation (689 ± 78 ms) compared with the follicular phase (732 ± 84 ms) (p = 0.012). Quadriceps strength was highest during ovulation (317.9 ± 34.5 N) and differed significantly across phases (p = 0.021). Digit Span scores and plank endurance also showed their highest mean values during ovulation. Estrogen correlated positively with cognitive performance (r = 0.42, p < 0.05), while progesterone correlated positively with muscular endurance (r = 0.39, p < 0.05). Conclusion: Cognitive and neuromuscular performance varied across menstrual cycle phases, with the most favorable overall outcomes observed during ovulation. These findings support consideration of menstrual physiology as a relevant biological variable in female performance research and individualized training or workload planning.
Menstrual cycle, estrogen, progesterone, cognitive function, muscle strength, endurance, reaction time, women’s health
Copyright (c) 2025 Isma Ishaq, Bilal Safdar, Seerat Husnain, Rawaal Amin, Aqsa Khan, Mahnoor Zia (Author) https://creativecommons.org/licenses/by/4.0
Digital Distraction in Nursing Education: Prevalence of Smartphone Use and Its Association with Classroom Distraction Among Undergraduate Nursing Students in Pakistan
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% CI: 1.11–1.69, p = 0.003). Conclusion: Smartphone use during classroom sessions is common among nursing students and is significantly associated with increased classroom distraction. Implementing structured institutional policies and promoting responsible smartphone use may help reduce digital distractions and improve student engagement in nursing education.
Smartphone use; classroom distraction; nursing students; digital distraction; learning engagement; nursing education.
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
Treatment Success in Patients with Cutaneous Leishmaniasis Treated with Inj. Glucantime 5 Ml (Meglumine Antimoniate) Dir Lower
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 difference (p < 0.001). The morphology of lesions also impacted the results with vesicular lesions reporting the best success rate (81.3) and ulcerative lesions reporting the lowest (59.2). By way of the administration route, the intradermal route was more successful (88.6) versus the intramuscular route which was 45.9 (p < 0.001). The success rate of the treatment remained insignificantly high throughout the years of the study, with an increase of 65.8 in 2022 to 68.5 in 2024. Conclusion: The research has determined some of the critical predictors of success of treatment in cutaneous leishmaniasis. There was increased treatment success in female gender, single lesions, and intradermal administration of Glucantime (meglumine antimoniate. The results imply that there should be treatment measures that consider these factors to achieve the best results in the patients with cutaneous leishmaniasis. More studies are still required in the investigation of other factors like immune response and genetic tendencies to enhance treatment regimes
Cutaneous leishmaniasis, Glucantime (meglumine antimoniate, treatment success, intradermal administration, lesion characteristics, demographic factors, treatment outcomes, route of administration
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
Prevalence and Patterns of Abdominal Pathologies Detected Through Ultrasound Imaging in Patients From Tertiary Care Hospitals
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 significantly across age groups, with hepatobiliary abnormalities more frequent in adults over 40 years. Sex-based variations were minimal. Conclusion Ultrasound imaging identified a high proportion of abdominal abnormalities, with hepatobiliary and renal pathologies representing the dominant trends in the studied population. These findings underscore the continuing value of ultrasound as a primary diagnostic tool and highlight the need for targeted preventive strategies, particularly in high-risk age groups.
Abdominal Pain; Abdominal Ultrasound; Cross-Sectional Studies; Diagnostic Imaging; Hepatobiliary System; Prevalence; Ultrasonography
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
Prevalence and Severity of Dry Eye Disease Among Prolonged Digital Device Users: A Cross-Sectional Study
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.
Cross-sectional studies, dry eye syndromes, ocular surface, prevalence, risk factors, screen time, visual display terminals.
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
Comparing Early vs Delayed Mobilization After Coronary Artery Bypass Grafting (CABG) and Its Impact on Functional Recovery
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 associated with improved functional recovery, fewer complications, and reduced hospital stay, supporting its integration into standard postoperative rehabilitation protocols.
Activities of Daily Living; Coronary Artery Bypass; Early Ambulation; Hospitalization; Postoperative Complications; Rehabilitation; Six-Minute Walk Test
Copyright (c) 2025 Akshy Kumar, Hassaan Mehdi, Muhammad Adeel, Prerna Rani, Ravi Kumar, Sajid Khan (Author) https://creativecommons.org/licenses/by/4.0
Investigating Genetic, Cognitive, and Therapeutic Approaches for Enhancing Quality of Life in Individuals With Down Syndrome
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.
Down syndrome; Trisomy 21; Mosaicism; Adaptive functioning; Vineland; Cognitive assessment; Multidisciplinary therapy; Rehabilitation; Behavioral symptoms; South Punjab
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
Systematic Review on the Application of Molecular Biology Techniques in Early Detection and Targeted Therapy of Human Diseases
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, evidence heterogeneity and potential publication bias highlight the need for standardized, large-scale prospective studies to confirm efficacy across diverse populations and healthcare settings, and to establish cost-effectiveness.
Molecular Diagnostics; Early Detection of Disease; Precision Medicine; Targeted Therapy; Systematic Review.
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
Designing Small-Molecule Allosteric Inhibitors of CYP2C19 to Prevent Clopidogrel Resistance in Patients With Specific Genetic Polymorphisms
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.
Allosteric regulation, Antiplatelet therapy, Clopidogrel, CYP2C19, Drug resistance, Enzyme modulation, Pharmacogenetics
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
Exploration Of Nonspecific Patterns In Urinary Tract Infection Symptoms Across Different Age And Gender Groups (H/R) - A Cross-Sectional Study
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 tract infection symptoms are common among pediatric and elderly populations, posing diagnostic challenges. Awareness of demographic symptom variability may improve diagnostic accuracy and ensure timely management across diverse patient groups.
Adults, Age distribution, Bacteriuria, Cross-sectional studies, Gender differences, Pediatric infections, Urinary tract infections, Urine culture
Copyright (c) 2025 Zarina Naz, Areej Areej, Muhammad Mobeen, Seemal Fatima, Muhammad Abdullah Mirza, Arish Noor (Author) https://creativecommons.org/licenses/by/4.0
AI-Driven Personalized Weight Loss Strategies and Behavioral Patterns Among Obese Adults
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 resource-constrained settings.
Adherence; Artificial Intelligence; Behavior Modification; Body Mass Index; Digital Health; Machine Learning; Obesity; Randomized Controlled Trial; Weight Loss.
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
Relationship Between Depression Scores And Poor Glycemic Control In Type 2 Diabetes
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. Conclusion: Depression significantly contributes to poor glycemic control in T2DM, partly through its adverse effects on adherence and self-care. Integrating mental health screening into diabetes management may enhance both psychological and metabolic outcomes.
Adherence, Depression, Diabetes Mellitus Type 2, Glycated Hemoglobin A, Lifestyle, Mental Health, Self-Care, South Asia
Copyright (c) 2025 Naheed Shah, Asma Iqbal, Naeem Asghar, Sadaf Moeez, Erum Fatima, Shaikh Khalid Muhammad (Author) https://creativecommons.org/licenses/by/4.0
AI-Guided Virtual Physiotherapy vs. Traditional Therapy for Post-Stroke Rehabilitation: A Randomized Controlled Trial
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.
Adherence, Artificial Intelligence, Motor Recovery, Physiotherapy, Post-Stroke Rehabilitation, Quality of Life, Randomized Controlled Trial
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
Impact of Endometriosis on Fertility Hormones and Ovarian Reserve Markers (AMH, FSH, LH)
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 follicle-stimulating hormone levels. These findings emphasized the value of early hormonal assessment in women with endometriosis to support informed fertility counseling and reproductive planning.
Anti-Mullerian Hormone; Endometriosis; Fertility; Follicle Stimulating Hormone; Luteinizing Hormone; Ovarian Reserve; Women
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
General Overview of Broadly Discussed Lifestyle and Environmental Factors Casually Associated with Breast Cancer Development
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.
Breast Cancer; Lifestyle Factors; Environmental Exposure; Risk Factors; Narrative Review; Prevention
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
Combined Effect of Respiratory Muscle Stretching and Active Cycle of Breathing Technique on Kinesiophobia, Functional Capacity and Anxiety among Chronic Obstructive Pulmonary Disease Patients
Background: COPD causes chronic airflow limitation and dyspnea, reducing function and quality of life. Objective: To evaluate the combined effect of the Active cycle Breathing Technique (ACBT) with Respiratory Muscle Stretching (RMS) on kinesiophobia, functional capacity and anxiety among Chronic Obstructive Pulmonary Disease (COPD) patients. Methods: This randomized controlled trial was conducted at Arif Memorial Teaching Hospital in Lahore. Forty Patients with COPD moderate to severe were randomly assigned into group A and group B (n=20 each). Group A received active cycle breathing technique (ACBT), alone and Active cycle Breathing Technique with Respiratory Muscle Stretching (RMS) was received by Group B. The Tampa kinesiophobia scale Questionnaire was used to evaluate kinesiophobia. The functional capacity was assessed by 6-minute walk test, and hospital anxiety and depression were used to assess anxiety. Results: Both groups showed significant with-in group improvements in kinesiophobia, functional capacity and anxiety with p-value < 0.05. Between group analysis showed that there is greater improvement in ACBT combined with RMS compared to ACBT alone with p-value < 0.05. Conclusion: This trial concluded that the combination of ACBT and respiratory muscle stretching could be a promising intervention for COPD patients, offering a potential solution to the challenges of kinesiophobia, reduced functional capacity, and anxiety.
Chronic Obstructive Pulmonary Disease, Active Cycle of Breathing Technique, Respiratory muscle stretching, Tampa Scale Kinesiophobia, Functional Capacity
Copyright (c) 2025 Fareeha Faisal, Aleena Waheed, Rehana Niazi, Nazeer Ahmad, Tahir Mahmood (Author) https://creativecommons.org/licenses/by/4.0
Descriptive Analysis of Common Ophthalmic Disorders and Their Management Approaches among Patients Visiting Tertiary Care Hospitals in South Punjab, Pakistan
Background: Ophthalmic disorders are a major cause of avoidable visual impairment in low- and middle-income countries, where delayed presentation and limited screening capacity often shift the burden to tertiary hospitals. Objective: To describe the prevalence, clinical patterns, and management strategies of common ophthalmic disorders among patients attending tertiary care hospitals in South Punjab, Pakistan. Methods: This descriptive cross-sectional study was conducted over eight months in ophthalmology outpatient departments of selected tertiary hospitals in South Punjab. A total of 384 patients aged ≥10 years were enrolled through consecutive sampling. Standard ophthalmic assessment was performed using visual acuity testing, slit-lamp biomicroscopy, ophthalmoscopy, and intraocular pressure measurement. Diagnoses and primary management modality were recorded using a structured proforma. Descriptive statistics were reported with 95% confidence intervals (CIs), and age-patterning of major disorders was tested using chi-square analysis. Results: The mean age was 46.2 ± 16.4 years, and 51.0% were female. Refractive errors were most prevalent (34.9%; 95% CI: 30.3–39.8), followed by cataract (24.0%; 95% CI: 20.0–28.5), conjunctivitis (12.5%), and glaucoma (9.4%). Pharmacological therapy (41.1%) and surgical intervention (27.1%) were the dominant management approaches. Age distribution differed significantly across refractive error, cataract, and glaucoma (χ²(6)=153.61; p<0.001). Conclusion: Tertiary care workload in South Punjab is dominated by treatable disorders, supporting targeted refraction services for younger patients and strengthened cataract, glaucoma, and diabetic retinopathy screening pathways for older adults. Keywords: Cataract, Conjunctivitis, Glaucoma, Ophthalmic diseases, Refractive errors, South Punjab, Tertiary care.
Cataract, Conjunctivitis, Glaucoma, Ophthalmic diseases, Refractive errors, South Punjab, Tertiary care.
Copyright (c) 2025 Muhammad Israr, Rida Fatima Aslam, Muhammad Zia Iqbal, Muhammad Waseem, Saira Gulzar, Javed Rasul (Author) https://creativecommons.org/licenses/by/4.0
Comprehensive Assessment of Hormonal Disruption in Primary Amenorrhea
Background: Primary amenorrhea is a heterogeneous condition reflecting disorders of hypothalamic–pituitary–ovarian function or reproductive tract development, and delayed presentation is common in resource-variable settings. Objective: To determine hormonal patterns and etiological distribution of primary amenorrhea among females presenting to tertiary care hospitals in South Punjab, Pakistan. Methods: This observational cross-sectional study enrolled 58 females with primary amenorrhea over two months. Clinical evaluation included demographics, BMI, Tanner breast staging, and pelvic ultrasonography. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, and thyroid-stimulating hormone (TSH) were measured using chemiluminescent immunoassays. Participants were stratified by FSH into hypogonadotropic (<3 mIU/mL), eugonadotropic (3–10 mIU/mL), and hypergonadotropic (>40 mIU/mL) categories. Etiology was determined using integrated clinical, biochemical, and imaging findings. Results: Mean age was 17.4 ± 2.1 years. Eugonadotropic amenorrhea was most common (44.8%), followed by hypogonadotropic (31.0%) and hypergonadotropic amenorrhea (24.1%). Outflow tract anomalies were the leading etiology (36.2%), followed by ovarian disorders (24.1%), hypothalamic–pituitary dysfunction (20.7%), and PCOS (12.1%). Eugonadotropic patients had the highest mean estradiol, while hypergonadotropic cases had markedly reduced estradiol. Conclusion: Structural and ovarian etiologies predominated, and hormonal stratification combined with ultrasonography supported pragmatic etiological triage and management planning.
Primary amenorrhea; Estradiol; Follicle-stimulating hormone; Gonadotropins; Hypogonadism; Outflow tract anomalies; Ovarian disorders; Polycystic ovary syndrome
Copyright (c) 2025 Naheed Shah, Samia Saliha, Sheeba Jan, Zarina Naz, Zainab Tahir, Hira Arshad (Author) https://creativecommons.org/licenses/by/4.0
Investigating the Therapeutic Impact of Moringa Oleifera Consumption on Human Health: A Comprehensive Review of Evidence-Based Studies
Background: Moringa oleifera is widely consumed as a nutrient-dense functional food and has attracted scientific interest for potential metabolic and anti-inflammatory benefits relevant to chronic disease prevention and management. Objective: To synthesize and critically appraise evidence on the therapeutic and nutritional effects of Moringa oleifera consumption on human health, with emphasis on glycemic control, lipid profile, blood pressure-related outcomes, antioxidant status, inflammation, and nutritional indices. Methods: This narrative review synthesized evidence from peer-reviewed literature identified through structured searches of major biomedical and academic sources and reference-list screening. Human interventional and observational studies evaluating Moringa oleifera preparations (leaf powder, extracts, capsules, and related formulations) were prioritized, while mechanistic and experimental literature was included to contextualize biological plausibility. Evidence was synthesized thematically and appraised qualitatively based on study design, intervention characterization, duration, and outcome reporting. Results: Across the reviewed literature, Moringa oleifera consumption demonstrated a generally favorable direction of effect on glycemic outcomes and lipid parameters in several studies, supported by mechanistic evidence indicating antioxidant and anti-inflammatory activity. Nutritional applications were supported by compositional data and evidence suggesting utility for micronutrient supplementation. However, findings were limited by heterogeneity in formulations and dosing, small samples, short follow-up periods, and inconsistent control of lifestyle confounders, which collectively reduced certainty. Conclusion: Moringa oleifera shows promise as a complementary dietary and nutraceutical strategy for metabolic and nutritional support, but current human evidence is insufficient to support definitive clinical recommendations. Rigorous, longer-term randomized controlled trials using standardized preparations are required.
Copyright (c) 2025 Yusra Khan, Anam Ali, Fateen Khan, Muhammad Azhar Sherkheli, Aamir Shazad, Nauman Akhtar (Author) https://creativecommons.org/licenses/by/4.0
Investigating Pre-Vaccination Mucosal Microbiota Composition as a Predictor of Humoral and Cellular Immune Response to the Seasonal Influenza Vaccine
Background: Variability in immune responsiveness to seasonal influenza vaccination remains a persistent public health challenge, as a substantial subset of vaccinated individuals fails to mount adequate humoral and cellular protection. Increasing evidence suggests that mucosal microbiota composition modulates immune priming at the respiratory interface, yet its predictive value for influenza vaccine outcomes remains insufficiently characterized. Objective: To investigate whether pre-vaccination upper respiratory mucosal microbiota composition predicts humoral and cellular immune responses to the seasonal influenza vaccine and to identify microbial biomarkers associated with suboptimal responsiveness. Methods: A prospective observational cohort study was conducted over five months in Lahore, enrolling 220 adults (18–65 years) receiving a trivalent inactivated influenza vaccine. Pre-vaccination nasopharyngeal and oropharyngeal swabs underwent 16S rRNA sequencing. Humoral immunity was assessed using hemagglutination inhibition assays at baseline and 28 days post-vaccination, and cellular immunity was evaluated using IFN-γ ELISpot and flow cytometric quantification of CD4⁺ and CD8⁺ T-cell activation. Multivariable regression, PERMANOVA, and random forest classification were applied with adjustment for key covariates. Results: Complete data were available for 212 participants, of whom 132 (62.3%) achieved seroconversion. Responders exhibited higher microbial diversity (Shannon index 3.9 ± 0.6 vs 3.4 ± 0.5, p = 0.002; Simpson index 0.87 ± 0.04 vs 0.81 ± 0.05, p < 0.001) and distinct beta diversity clustering (PERMANOVA p = 0.001). Responders demonstrated higher antibody fold-rise (5.7 ± 2.4 vs 2.1 ± 1.2, p < 0.001) and higher IFN-γ ELISpot responses (142 ± 38 vs 87 ± 29 SFU/10⁶ PBMCs, p < 0.001) with greater CD4⁺ (14.6% vs 9.2%, p < 0.001) and CD8⁺ (12.3% vs 8.5%, p < 0.01) activation. Higher Faecalibacterium abundance predicted seroconversion (adjusted OR 1.42, 95% CI 1.15–1.76, p < 0.001), whereas Streptococcus abundance was inversely associated (adjusted OR 0.63, 95% CI 0.48–0.82, p < 0.01); random forest classification achieved AUC 0.87 (95% CI 0.82–0.91). Conclusion: Pre-vaccination mucosal microbiota diversity and specific microbial signatures predict both humoral and cellular influenza vaccine responses, supporting the potential utility of microbial biomarkers for identifying suboptimal responders and informing microbiota-directed strategies to improve vaccine effectiveness.
Influenza Vaccines; Microbiota; Mucosal Immunity; Hemagglutination Inhibition; Cellular Immunity; ELISpot; Predictive Biomarkers; Vaccine Response.
Copyright (c) 2025 Ali Basim, Hira Rasool, Muhammad Azhar Sherkheli, Sajjad Ahmad, Fatima Ayub (Author) https://creativecommons.org/licenses/by/4.0
Investigating Nutritional Deficiencies and Lifestyle Factors Contributing to Rising Incidence of Rickets among Children in Developing Regions
Background: Nutritional rickets persists in many low- and middle-income countries despite abundant sunlight, driven by a complex interplay of inadequate dietary intake, limited effective sunlight exposure, and evolving lifestyle patterns among children. Objective: To examine the association between dietary calcium and vitamin D intake, sunlight exposure, lifestyle behaviours, and rickets-related outcomes among children in urban and semi-urban settings in Pakistan. Methods: A cross-sectional study was conducted over four months among 410 children aged 1–12 years selected through multistage sampling from healthcare facilities and schools. Data were collected using an interviewer-administered questionnaire, semi-quantitative food frequency questionnaire, 24-hour dietary recall, and a Sunlight Exposure Index. Anthropometry and standardised clinical assessment for rickets were performed, and available biochemical data were extracted from records. Descriptive statistics, t-tests, ANOVA, Pearson’s correlation, and multiple linear regression were applied using SPSS version 26. Results: Mean daily calcium and vitamin D intakes were 528 ± 211 mg and 3.8 ± 1.9 µg, respectively, with fewer than 21% of children meeting age-specific recommendations. Overall, 16.8% had clinical or radiographic features consistent with rickets. Lower calcium intake, reduced daily sunlight exposure, lower Sunlight Exposure Index scores, and shorter outdoor play time were significantly associated with rickets indicators. In multivariable models, inadequate calcium intake and limited sunlight exposure remained the strongest independent predictors. Conclusion: Inadequate intakes of calcium and vitamin D, combined with limited effective sunlight exposure and sedentary lifestyles, are major determinants of rickets-related outcomes among children in this setting, highlighting the need for integrated nutritional and behavioural interventions.
nutritional rickets; vitamin D deficiency; calcium intake; sunlight exposure; child health; Pakistan.
Copyright (c) 2025 Shabahat Arain, Muhammad Azeem, Tehniat Shoukat, Serish Fatima, Babar Hilal Ahmad Abbasi, Rida Ali, Farzaan Bashir Ahmed, Komal Mushtaq (Author) https://creativecommons.org/licenses/by/4.0