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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).
Frequency of Musculoskeletal Disorders in Tailors of Lahore, Pakistan
Background: Tailoring is a posture-dependent occupation involving prolonged sitting, repetitive upper-limb activity, sustained visual attention, and limited postural variation. These ergonomic exposures may contribute to work-related musculoskeletal disorders, particularly in the spine, shoulder girdle, upper limbs, and lower limbs. Objective: To determine the frequency and anatomical distribution of musculoskeletal disorders among tailors working in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted among 244 tailors selected through convenience sampling from different stitching and tailoring units in Lahore. Data were collected using a structured demographic and work-related questionnaire, Visual Analogue Scale, and Nordic Musculoskeletal Questionnaire. Demographic variables, working posture, break period, working hours, work experience, and regional musculoskeletal symptoms were recorded. Data were analyzed using SPSS version 21, and categorical variables were summarized as frequencies and percentages. Results: The mean age of participants was 32.65 ± 9.66 years. Of 244 participants, 154 (63.1%) were male and 90 (36.9%) were female. Most participants worked in sitting posture (240, 98.4%), and 187 (76.6%) worked 6 or more hours per day. The most frequently reported 12-month musculoskeletal trouble involved the lower back (42, 17.2%), shoulders (35, 14.3%), and knees (34, 13.9%). Similar patterns were observed for activity limitation, physician consultation, and 7-day trouble. Conclusion: Lower back, shoulder, and knee symptoms were the most frequently reported musculoskeletal disorders among tailors in Lahore. Ergonomic education, workstation modification, and preventive movement strategies are recommended for this occupational group
Musculoskeletal disorders; Tailors; Occupational health; Nordic Musculoskeletal Questionnaire; Ergonomics; Lower back pain; Lahore
Copyright (c) 2025 Dr Anam Shahzadi, Dr Rabia Rahat, Dr Hajra Rahat (Author) https://creativecommons.org/licenses/by/4.0
Perception and Practice Related to Postural Pain Among Breastfeeding Women in Hyderabad, Sindh
Background: Postural pain is a common but under-recognized concern among breastfeeding women because feeding often requires prolonged static posture, repetitive upper-limb loading, forward trunk or neck flexion, and inadequate ergonomic support. Limited professional guidance regarding breastfeeding posture may further increase maternal discomfort. Objective: To assess perception and practices related to postural pain among breastfeeding women in Hyderabad, Sindh. Methods: A hospital-based cross-sectional study was conducted over six months among 210 breastfeeding mothers aged 18–40 years and 6 weeks to 24 months postpartum. Participants were recruited through convenience sampling from four hospitals in Hyderabad, Sindh. Data were collected using a structured self-administered questionnaire assessing demographic characteristics, breastfeeding posture, pain/discomfort, coping responses, techniques used to reduce discomfort, and sources of advice. Pain severity was assessed using a 0–10 pain scale and categorized descriptively. Categorical variables were analyzed as frequencies and percentages. Results: Pain or discomfort during breastfeeding was reported by 177 participants (84.3%). Moderate pain was reported by 88 participants (41.9%), and severe pain by 61 participants (29.0%). Discomfort was most commonly experienced during the full feeding session (33.6%). Cradle hold was the most frequently reported breastfeeding position (43.1% of position responses), followed by cross-cradle hold (27.7%). Use of discomfort-reduction techniques was reported by 57.1% of participants, while family members were the most common source of advice (50.0% of advice responses). Conclusion: Breastfeeding-related postural pain was frequent and commonly moderate to severe among women in this sample. The findings highlight the need for structured postural education and physiotherapy-informed ergonomic guidance during antenatal and postnatal care
Breastfeeding, Postural Pain, Musculoskeletal Discomfort, Breastfeeding Position, Postpartum Women.
Copyright (c) 2026 Shuaib Manzoor, Manoj Kumar, Marva Memon, Ume Rubab Ursani, Ahsan Memon, Tooba Shaikh, Kainat Batool Memon (Author) https://creativecommons.org/licenses/by/4.0
Cervical Joint Position Error and Its Association with Bruxism and Pain Severity in Orthodontic Patients
Background: Cervical proprioception contributes to coordinated head-neck-jaw motor control, and impairment in cervical joint position sense may influence parafunctional jaw activity and pain. In orthodontic patients, occlusal changes and appliance-related neuromuscular adaptation may increase the relevance of cervical sensorimotor assessment. Objective: To determine the association of cervical joint position error with bruxism risk and pain severity among orthodontic patients. Methods: This cross-sectional observational study included 115 orthodontic patients recruited through convenience sampling from dental hospitals and clinics in Lahore, Pakistan. Cervical joint position error was assessed using a laser-based cervical joint position error test and categorized as positive when angular error exceeded 4.5°. Bruxism risk was measured using the Bruxism Evaluation Questionnaire, with scores >15 classified as high risk. Pain severity was assessed using the Visual Analogue Scale and categorized as mild, moderate, or severe. Data were analyzed using IBM SPSS version 27.0.1. Descriptive statistics and Pearson’s chi-square tests were applied, with statistical significance set at p < 0.05. Results: Of 115 participants, 56 (48.7%) had positive cervical joint position error and 88 (76.5%) were classified as high risk for bruxism. A significant association was found between cervical joint position error and bruxism risk, χ²(1) = 24.076, p < 0.001, Cramer’s V = 0.458. Among CJPE-positive participants, 54/56 (96.4%) were at high risk for bruxism compared with 34/59 (57.6%) of CJPE-negative participants. CJPE was also significantly associated with pain severity, χ²(2) = 17.743, p < 0.001, Cramer’s V = 0.393. Moderate-to-severe pain was reported by 41/56 (73.2%) CJPE-positive participants compared with 21/59 (35.6%) CJPE-negative participants. Conclusion: Cervical joint position error was significantly associated with elevated bruxism risk and greater pain severity among orthodontic patients. These findings support the integration of cervical proprioceptive assessment into orthodontic evaluation and highlight the clinical relevance of the cranio-cervico-mandibular system in orthodontic care.
Cervical joint position error; cervical proprioception; bruxism; orofacial pain; orthodontic patients; sensorimotor control.
Copyright (c) 2026 Zoha Malik, Rabia Majeed, Sana Hafeez, Saba Riaz, Abdullah Khalid Qureshi, Aimen Khurrum, Wahiba Raza (Author) https://creativecommons.org/licenses/by/4.0
Patient Confidence in Long-Term Care Plans for Multimorbidity Management: A Qualitative Descriptive Study
Background: Multimorbidity creates substantial challenges for long-term care because patients must manage multiple medicines, appointments, monitoring tasks, lifestyle recommendations, and disease-specific instructions. Although care plans are intended to improve coordination and continuity, patients may not experience them as understandable, feasible, or trustworthy in daily life. Objective: This study explored how adults with multimorbidity described the factors that strengthened or weakened their confidence in long-term care planning. Methods: A qualitative descriptive design was used. Twelve anonymized participant profiles from adults with two or more chronic conditions and experience of long-term care planning, medication planning, review planning, or coordinated management advice were analyzed using reflexive thematic analysis. The analysis was informed by treatment burden, cumulative complexity, and person-centred integrated care concepts. Results: Six interrelated themes were generated: fragmented care and unclear plan ownership, continuity and relational trust, treatment workload and limited capacity, unclear priorities and competing disease advice, family support and social negotiation, and follow-up reliability as evidence of care commitment. Confidence increased when plans were clear, coordinated, realistic, reviewed, and connected to a named professional or responsible team. Confidence decreased when advice was fragmented, workload was excessive, priorities were unclear, family support became controlling, or follow-up was unreliable. Conclusion: Patient confidence in multimorbidity care planning depends on relational continuity, practical feasibility, coordinated responsibility, explicit prioritization, respectful family involvement, and reliable follow-up. Care planning should be treated as an ongoing patient-centred process rather than a static document
Multimorbidity, patient confidence, long-term care plan, treatment burden, care coordination, shared decision-making, qualitative study
Copyright (c) 2026 Man Yaoyang, Ali Napiah Nasution, Tri Adi Mylano (Author) https://creativecommons.org/licenses/by/4.0
Differential Cardiometabolic Effects of GLP-1 Receptor Agonists Versus SGLT2 Inhibitors in Early-Onset Type 2 Diabetes: A Randomized Controlled Trial
Introduction: Early-onset type 2 diabetes mellitus is characterized by higher exposure to cardiometabolic risk throughout life and increased risk of cardiovascular morbidity. GLP-1 receptor agonists and SGLT2 inhibitors improve the markers of cardiometabolic risk; however, a comparison between the therapies is poorly represented in the literature regarding younger population. Objective: Comparative study of the short-term effects of GLP-1 receptor agonist and SGLT2 inhibitor therapy on the markers of cardiometabolic risk in patients with early-onset type 2 diabetes mellitus. Methods: A randomized parallel group clinical trial was conducted in 84 patients with early-onset type 2 diabetes mellitus. Patients were randomized to receive once weekly GLP-1 receptor agonist therapy or once daily SGLT2 inhibitor therapy for 6 weeks. Main outcomes were changes in systolic blood pressure (SBP), diastolic blood pressure (DBP) and lipid profile. Secondary outcomes were BMI, HbA1c, fasting glucose, and frequency of treatment discontinuation due to adverse events. Results: 79 patients completed follow up and were included into available case analysis. Post-intervention SBP and DBP values were lower in SGLT2 inhibitor group in comparison with GLP-1 receptor agonist group. LDL-C values were lower in GLP-1 receptor agonist group. Mean reduction in SBP value was 8.9 ± 3.1 mmHg in GLP-1RA group vs 10.8 ± 3.5 mmHg in SGLT2 inhibitor group. Mean reduction in LDL-C level was 18.5 ± 6.2 mg/dL in GLP-1RA group and 9.2 ± 5.8 mg/dL in SGLT2 inhibitor group. Conclusion: Both therapeutic interventions led to short-term improvement of the cardiometabolic risk markers in patients with early-onset type 2 diabetes with different beneficial effects of SGLT2 inhibitors on blood pressure reduction and GLP-1RA on LDL-C level reduction
Cardiovascular Risk Markers, Early-Onset Diabetes, GLP-1 Receptor Agonists, Glycated Hemoglobin, Lipid Profile, SGLT2 Inhibitors, Type 2 Diabetes Mellitus.
Copyright (c) 2026 Marriam Abid, Samia Gull Akhtar, Tabinda Razzaq, Zia Ullah, Shah Abdul Latif, Hafiz Muhammad Qasim, Muhammad Abbas Sadiq (Author) https://creativecommons.org/licenses/by/4.0
Left Ventricular Hypertrophy Patterns in Diabetic Versus Non-Diabetic Hypertensive Patients on Maintenance Hemodialysis in Peshawar
Background: Cardiovascular disease continues to constitute a major source of morbidity and mortality among patients with end-stage renal disease undergoing maintenance hemodialysis, with left ventricular hypertrophy being one of its structural predictors. Hypertension has been established as the important predictor of left ventricular remodeling in these patients, although diabetic patients could have an adverse myocardial phenotype. Objective: To compare the echocardiographic variables and left ventricular geometric patterns of diabetic and non-diabetic hypertensive patients undergoing maintenance hemodialysis in Peshawar, Pakistan. Methodology: This cross-sectional comparative study was conducted on 94 patients with hypertension who were on maintenance hemodialysis for at least three months, with each of the two groups having equal number of patients. Patients in each group were subjected to transthoracic echocardiography 12 to 24 hours after a mid-week dialysis session. Independent-samples t-test and Chi-square analyses were employed to compare left ventricular mass index, relative wall thickness, interventricular septum thickness, posterior wall thickness and left ventricular geometric patterns of patients belonging to the two groups. Results: Diabetic hypertensive patients had a higher left ventricular mass index than non-diabetic hypertensive patients (148.6 ± 22.4 vs 126.3 ± 18.5 g/m²; p<0.001) as well as relative wall thickness (0.48 ± 0.06 vs 0.42 ± 0.05; p<0.001). Concentric hypertrophy was observed in greater numbers of diabetic hypertensive patients than non-diabetic hypertensive patients (57.4% vs 17.0%), and eccentric hypertrophy was more prevalent in non-diabetic patients (44.7% vs 27.7%). There were significant differences in left ventricular geometry by diabetic status (χ²=13.064; p=0.004). Conclusion: Diabetic status was associated with higher left ventricular mass index, greater relative wall thickness and concentric hypertrophy in hypertensive patients under maintenance hemodialysis. Longitudinal studies should be done in future to determine the causal relationships involved
Cardiomyopathies; Cardiovascular Diseases; Cross-Sectional Studies; Diabetes Mellitus; Heart Failure; Hypertension; Hypertrophy, Left Ventricular; Kidney Failure, Chronic; Pakistan; Renal Dialysis; Ventricular Remodeling.
Copyright (c) 2026 Shah Abdul Latif, Ahmed Mustafa Nadeem, Isbah Aman, Nauman Akhtar, Mashall Jan, Zara Mushtaq, Musab Bin Zubair (Author) https://creativecommons.org/licenses/by/4.0
Exploring the Relationship Between Sleep Quality and Cardiovascular Risk Factors in University Students
Background: Cardiovascular risk factors may begin to develop during young adulthood, when sleep habits, dietary behavior, stress exposure, and lifestyle patterns become established. Poor sleep quality has been linked with cardiometabolic risk, but evidence among university students remains limited. Objective: To assess the association between sleep quality and cardiovascular risk-factor domains among university students. Methods: A cross-sectional observational study was conducted among 235 university participants aged 18–26 years. Data were collected from April to June 2024 using a structured questionnaire, the Groningen Sleep Quality Scale, and a cardiovascular risk assessment questionnaire. Demographic characteristics, body mass index category, waist circumference category, sleep-quality responses, and cardiovascular risk domains were analyzed using IBM SPSS Statistics version 25. Frequencies and percentages were used for descriptive analysis, and Pearson correlation was used to assess relationships among nonconstant risk scores. Results: Most participants were female (63.4%) and aged 19–24 years (81.7%). Sleep-related complaints were frequent, including morning tiredness (64.3%), sleep latency longer than 30 minutes (61.3%), insufficient sleep (56.2%), nocturnal rising (53.2%), and sleep duration of five hours or less (51.5%). Sleep-related cardiovascular risk was categorized as medium in 64.3% and high in 11.9%. Sleep score showed weak correlations with lifestyle (r = -0.055, p = 0.404), blood pressure (r = 0.022, p = 0.739), and diet (r = 0.127, p = 0.051). The only statistically significant correlation was between blood-pressure and diet scores (r = 0.198, p = 0.002). Conclusion: Sleep disturbance was common among university students, but sleep score was not strongly associated with other cardiovascular risk domains. The findings support the need for larger studies using validated tools and adjusted analyses to clarify sleep-related cardiovascular risk in young adults
Sleep Quality; Cardiovascular Risk Factors; University Students; Blood Pressure; Diet; Cross-Sectional Study
Copyright (c) 2026 Rahat Ayub, Mehak Hamna Gillani, Fizza Masood, Muhammad Fasih (Author) https://creativecommons.org/licenses/by/4.0
Correlation Between Upper Cross Syndrome and Smartphone Addiction in University Students
Background: Smartphone addiction is increasingly common among university students and may contribute to sustained forward head posture, rounded shoulders, and postural muscle imbalance associated with Upper Cross Syndrome. Objective: To determine the correlation between smartphone addiction severity and clinical indicators of Upper Cross Syndrome among university students. Methods: This cross-sectional observational study included 167 university students aged 19–24 years from universities in Lahore who used smartphones for at least four hours daily and met predefined Smartphone Addiction Scale–Short Version thresholds. Smartphone addiction was assessed using the SAS-SV, while Upper Cross Syndrome-related findings were evaluated through pectoralis major contracture, middle trapezius weakness, and lower trapezius weakness tests. Descriptive statistics were used for demographic and clinical variables, and correlation analysis was performed between SAS-SV scores and Upper Cross Syndrome-related clinical findings. Results: The sample included 46 males (27.5%) and 121 females (72.5%), with a mean age of 21.51 ± 1.51 years and mean SAS-SV score of 44.37 ± 6.64. Pectoralis major contracture was present in 60 participants (35.9%), middle trapezius weakness in 109 (65.3%), and lower trapezius weakness in 102 (61.1%). SAS-SV score showed weak positive correlations with middle trapezius weakness (r = 0.24), lower trapezius weakness (r = 0.23), and composite Upper Cross Syndrome status (r = 0.22), while correlation with pectoralis major contracture was weaker (r = 0.11). Conclusion: Upper Cross Syndrome-related findings were common among students with elevated smartphone addiction scores, particularly posterior scapular stabilizer weakness. Smartphone addiction severity showed weak positive associations with trapezius weakness and composite Upper Cross Syndrome status
Upper Cross Syndrome; Smartphone Addiction; University Students; Posture; Trapezius Weakness; Musculoskeletal Disorders
Copyright (c) 2026 Isha Haseen, Eman Iftikhar, Qurat-ul-Ain, Sana Mehmood, Anam Abbas (Author) https://creativecommons.org/licenses/by/4.0
Self-Medication Among Pharmacy Students: A Cross-Sectional Study on Prevalence, Patterns, and Determinants
Background: Constraint-induced movement therapy is used to improve upper-limb recovery after stroke, Background: Self-medication is common among university students, particularly those enrolled in health-related disciplines. Pharmacy students may be more likely to self-medicate because academic exposure to pharmacology and therapeutics can increase confidence in selecting medicines without professional consultation. Inappropriate self-medication, especially antibiotic use without prescription, may contribute to adverse drug reactions, delayed treatment, drug interactions, and antimicrobial resistance. Objective: To determine the prevalence, patterns, reasons, medication classes, sources of information, and socio-demographic associations of self-medication among pharmacy students at Shahida Islam Medical College, Lodhran, Pakistan. Methods: A descriptive cross-sectional study was conducted among 263 pharmacy students using a structured questionnaire. Participants were recruited through convenience sampling. Data were analyzed using SPSS version 20. Frequencies and percentages were calculated, and chi-square tests were used to assess associations between self-medication practice and selected socio-demographic variables. Results: Self-medication was reported by 165 students, giving a prevalence of 62.7%. Physicians were the most frequently reported source of medication information (63.1%). The leading reasons were prior experience with illness (64.6%), drug availability (60.1%), and saving time (57.0%). Headache (74.5%) and common cold (71.9%) were the most frequently reported conditions, while common cold medicines (67.3%) and antibiotics (65.4%) were the most frequently reported medication classes. No statistically significant association was found between self-medication and age, gender, marital status, residence, habitation, or health insurance status. Conclusion: Self-medication was common among pharmacy students, with frequent reported antibiotic use highlighting a public health concern. Educational interventions, antimicrobial stewardship training, and stronger prescription-only medicine regulation are needed
Self-medication; pharmacy students; antibiotics; antimicrobial resistance; cross-sectional study; Pakistan
Copyright (c) 2026 Muhammad Shahzad Ishfaq, Muhammad Faisal, Muhammad Hassan Raza Durrani, Muhammad Danish (Author) https://creativecommons.org/licenses/by/4.0
Plant-Based Gold Nanoparticles for Targeted Drug Delivery in Breast Cancer: Progress and Prospects in Pakistan
Background: Breast cancer remains a major cause of morbidity and mortality among women, particularly in low- and middle-income countries where delayed diagnosis, limited access to targeted therapies, and treatment-related toxicity continue to compromise outcomes. Plant-mediated gold nanoparticles have emerged as a promising area of green nanomedicine because they combine the physicochemical advantages of gold nanoparticles with the reducing, stabilizing, and bioactive properties of plant-derived phytochemicals. Objective: This narrative review aimed to critically synthesize the progress, methodological limitations, and translational prospects of plant-based gold nanoparticles for targeted drug delivery in breast cancer, with emphasis on evidence relevant to Pakistan. Methods: A structured narrative synthesis was conducted using literature related to gold nanoparticles, green synthesis, medicinal plant extracts, breast cancer models, targeted drug delivery, cytotoxicity, apoptosis, biocompatibility, and nanomedicine translation. Evidence was organized thematically according to synthesis methods, plant sources, nanoparticle characterization, anticancer mechanisms, drug-delivery potential, biosafety, methodological challenges, and translational readiness. Because of heterogeneity in plant extracts, nanoparticle preparation, experimental models, assays, and outcome reporting, pooled quantitative analysis was not performed. Results: The strongest evidence was concentrated in laboratory-scale green synthesis, physicochemical characterization, and in vitro cytotoxicity against breast cancer cell lines such as MCF-7 and MDA-MB-231. Plant-mediated gold nanoparticles were associated with enhanced cellular uptake, reactive oxygen species generation, mitochondrial dysfunction, apoptosis-related signaling, DNA fragmentation, and preliminary drug-delivery potential, including doxorubicin conjugation and sustained release. However, evidence for in vivo efficacy, pharmacokinetics, biodistribution, long-term toxicity, regulatory readiness, and clinical application remained limited. Conclusion: Plant-based gold nanoparticles represent a promising but preclinical platform for targeted breast cancer drug delivery. Their future translational value in Pakistan depends on standardized synthesis, reproducible characterization, mechanistic validation, long-term biosafety assessment, and rigorous preclinical-to-clinical development.
Breast Cancer; Gold Nanoparticles; Green Synthesis; Nanomedicine; Plant Extracts; Targeted Drug Delivery; Pakistan; Biocompatibility.
Copyright (c) 2026 Muhammad Abbas Sadiq, Mian Furqan Ahmad, Farooq Bashir Butt, Ayesha Siddiqa, Zahid Hussain Shar, Maida Aslam, Aqsa Maryam (Author) https://creativecommons.org/licenses/by/4.0
Development and Evaluation of Kiwi-Based Kombucha as a Functional Beverage Alternative to Carbonated Soft Drinks
Background: Sugar-sweetened carbonated beverages are associated with poor nutritional quality and excess sugar intake, creating interest in fermented functional beverages with improved sensory and biochemical characteristics. Kombucha is a fermented tea beverage containing organic acids and antioxidant-related compounds, while kiwi fruit may contribute vitamin C, organic acids, and polyphenols. Objective: This study aimed to develop kiwi-based kombucha formulations and evaluate their physicochemical changes, antioxidant-related properties, alcohol formation, and sensory acceptability. Methods: An experimental food and nutrition study was conducted using kiwi-enriched kombucha formulations prepared with grapes and either honey or ginger. Fermentation was monitored using pH, total phenolic content, total flavonoid content, FRAP antioxidant activity, DPPH radical scavenging activity, and alcohol content. Sensory evaluation was performed among 25–30 adult volunteers using a 9-point hedonic scale assessing flavour, texture, aroma, appearance, and overall acceptability. Data were analyzed using IBM SPSS Statistics version 27. Results: The honey-based formulation showed higher sensory scores than the ginger-based formulation for flavour (6.84 ± 1.34 vs 5.76 ± 1.27; p = 0.005), texture (6.80 ± 1.41 vs 5.80 ± 1.55; p = 0.021), and overall acceptability (7.64 ± 1.19 vs 6.64 ± 1.82; p = 0.027). pH decreased from approximately 4.2 at baseline to 3.1–3.5 by Day 14. Alcohol peaked at Day 7 in Honey Kiwi Kombucha (3.50 ± 0.50%) and Ginger Kiwi Kombucha (3.25 ± 0.50%). Conclusion: Honey-based kiwi kombucha demonstrated better sensory acceptability than the ginger-based formulation, while fermentation produced progressive acidification and measurable alcohol formation. Further standardized testing, complete biochemical reporting, and direct comparison with commercial soft drinks are needed.
Kombucha, kiwi, functional beverage, fermentation, antioxidant activity, sensory evaluation
Copyright (c) 2026 Wafa Fatima, Sara Sarbuland, Malaika Irshad, Zainab Masood, Maida Mushtaq (Author) https://creativecommons.org/licenses/by/4.0
Sustainable Bioethanol Production from Lignocellulosic Plant Wastes: A Renewable Solution to Energy Challenges
Background: Lignocellulosic agricultural residues are increasingly investigated as renewable feedstocks for second-generation bioethanol production because they support waste valorization and reduce dependence on food-based substrates. Sugarcane bagasse is a cellulose-rich agro-industrial residue, but its conversion into ethanol is restricted by lignin-associated biomass recalcitrance. Objective: This study evaluated bioethanol production from sugarcane bagasse using sodium hydroxide pretreatment, enzymatic saccharification, Saccharomyces cerevisiae fermentation, and ethanol recovery. Methods: Sugarcane bagasse was pretreated with 2.5% sodium hydroxide using autoclave-assisted treatment for 30, 60, and 90 min and microwave-assisted treatment for 10 and 20 min. Pretreated biomass was analyzed for cellulose and lignin content. Enzymatic saccharification was performed using cellulase from Trichoderma reesei, followed by batch fermentation using Saccharomyces cerevisiae. Ethanol was recovered by distillation and estimated spectrophotometrically using acidified potassium dichromate. Results: Autoclave-assisted pretreatment increased cellulose from 58.0% to 68.0% and reduced lignin from 30.7% to 11.9%. Microwave-assisted pretreatment produced the highest cellulose content of 71.0% and lowest lignin content of 8.0%. Saccharification absorbance was higher in the autoclaved sample than in the microwave-treated sample, 1.40 versus 1.20, and ethanol production was 2.0% versus 1.7%, respectively. Conclusion: Sugarcane bagasse supported laboratory-scale ethanol production after alkaline pretreatment, but the strongest delignification did not produce the highest ethanol concentration. Optimization of hydrolysis, fermentation, and ethanol yield assessment is required.
Bioethanol, Sugarcane Bagasse, Lignocellulosic Biomass, Alkaline Pretreatment, Saccharification, Fermentation, Renewable Energy.
Copyright (c) 2026 Tamknat Ilyas, Zeeshan Ahmad, Sana Mehmood, Mamoona Anwar, Zainab Masood (Author) https://creativecommons.org/licenses/by/4.0
Public Trust in Laboratory Results During Emerging Infectious Disease Alerts
Background: Family planning programmes in underserved areas of Sindh require more than commodity availability because contraceptive decision-making is shaped by social norms, gender power, myths about side effects, women’s mobility, and trust in service providers. Community-based models such as Marvi Markaz/BiB may improve acceptability by linking door-to-door counselling with safe local access points, but qualitative evidence is needed to understand how such models are experienced by women, men, frontline workers, and programme staff. Objective: This study explored perceptions of the Marvi Markaz/BiB family planning model, focusing on acceptability, barriers and facilitators, and conditions for sustainability. Methods: An interpretative qualitative endline evaluation was conducted using in-depth interviews and focus group discussions with married women of reproductive age, men, Marvi workers, and programme staff. Data were analysed using thematic analysis, with attention to patterns across participant groups and implementation perspectives. Results: Six themes were identified: trust in Marvi workers, safe local service space, myths and fear of side effects, gendered decision-making, commodity continuity, and sustainability through supervision and monitoring. Acceptability was linked to familiar local counselling, privacy, reduced travel barriers, and commodity linkage, while barriers included misinformation, male approval, household influence, and supply interruptions. Conclusion: The model was perceived as acceptable when trust, safe spaces, and commodity access worked together. Sustainability requires male engagement, refresher training, supervision, monitoring, and reliable supply systems.
family planning; Marvi Markaz; community health workers; qualitative endline evaluation; contraceptive access; Sindh; Pakistan.
Copyright (c) 2026 Guo Qianqian, Irza Haicha Pratama, Yensuari (Author) https://creativecommons.org/licenses/by/4.0
Ethical Tensions in Aesthetic Surgery Advertising on Short-Video Platforms
Background: Aesthetic surgery advertising is increasingly encountered on short-video platforms where clinical procedures are presented through transformation clips, influencer testimony, before-and-after imagery, and algorithmic repetition. Although such content may improve access to procedure-related information, it can also compress medical risk, obscure commercial intent, and make bodily intervention appear routine. Objective: This study explored how adult viewers interpreted aesthetic surgery advertising on short-video platforms, with attention to perceived credibility, risk, visual evidence, influencer sponsorship, and ethical safeguards. Methods: An interpretivist qualitative design was used. Semi-structured interview material from ten adult viewers who regularly encountered beauty, wellness, aesthetic surgery, or minimally invasive cosmetic procedure content was analyzed using reflexive thematic analysis. Results: Five themes were developed: compression of medical risk into attractive transformation; credibility transfer through professional and social media cues; before-and-after imagery as persuasive evidence and distorted expectation; influencer intimacy and disclosure gaps; and algorithmic normalization with demand for safeguards. Participants valued educational explanations and realistic recovery information but expressed concern when videos omitted complications, cost, uncertainty, suitability, sponsorship, or outcome variability. Influencer narratives and repeated algorithmic exposure were perceived as especially persuasive because they made aesthetic procedures feel relatable, emotionally corrective, and socially normal. Conclusion: Ethical aesthetic surgery advertising on short-video platforms should create pause rather than urgency by making risk, recovery, qualifications, sponsorship, and individualized suitability visible within the video itself.
aesthetic surgery advertising; short-video platforms; TikTok; influencer marketing; medical ethics; body image; platform governance; qualitative research.
Copyright (c) 2026 Kou Shuming, Dewi Fibrini, Muhammad Faridz Syahrian (Author) https://creativecommons.org/licenses/by/4.0
Oral Health Misinformation and Treatment Choices Among Adult Dental Patients
Background: Oral health misinformation is increasingly encountered through social media, product marketing, online reviews, family advice, and informal digital networks. Although misleading dental claims are often treated as a digital literacy problem, their influence on treatment decisions may be shaped by fear, cost, trust, symptom uncertainty, preference for natural remedies, and expectations created by visual media. Objective: This study explored how adult dental patients encountered, interpreted, and negotiated oral health misinformation during recent dental treatment decision-making. Methods: A qualitative interview-based study was conducted among 10 adult dental patients who had recently faced a dental treatment decision and had encountered oral health information through online or interpersonal sources. Semi-structured interviews explored information sources, credibility judgments, emotional and financial influences, professional consultation, and perceived effects on treatment preferences. Data were analyzed using reflexive thematic analysis. Results: Four interrelated themes were identified: self-diagnosis and symptom interpretation; persuasive credibility cues in digital spaces; cost, fear, and naturalness as decision shortcuts; and the corrective yet uneven influence of professional consultation. Misinformation was described as reshaping symptom meaning, reinforcing delay or avoidance, encouraging product use, supporting antibiotic expectations, and creating unrealistic cosmetic or procedural expectations. Respectful, specific, and transparent dental communication helped some participants revise misinformation-influenced beliefs. Conclusion: Oral health misinformation should be understood as a communication, trust, and service-experience issue embedded within dental decision-making. Myth-sensitive chairside discussion, transparent pricing, and accessible professional digital content may reduce misinformation-related uncertainty.
dental patients; oral health misinformation; treatment choice; social media; digital health literacy; shared decision-making; qualitative research.
Copyright (c) 2026 Chen Qiong, Shieny, Wienaldi (Author) https://creativecommons.org/licenses/by/4.0
Patient Safety Culture Around Surgical Safety Checklist Use in High-Pressure Operating Rooms
Background: Surgical Safety Checklists are widely used to reduce preventable perioperative harm, but their effectiveness depends on the safety culture in which they are performed. In high-pressure operating rooms, urgency, hierarchy, turnover demands, interruptions, and professional assumptions may reduce checklist use to documentation rather than meaningful communication. Objective: This study aimed to explore how patient safety culture shapes meaningful use of the Surgical Safety Checklist in high-pressure operating-room contexts. Methods: A qualitative interpretivist design was used. Semi-structured interview data from 12 multidisciplinary operating-room participants representing surgical, anaesthetic, nursing, and theatre leadership perspectives were analysed using reflexive thematic analysis. The analysis focused on checklist meaning, time pressure, hierarchy, psychological safety, local adaptation, ownership, near misses, and organisational learning. Results: Five themes were developed: checklist as cultural conversation; time pressure and ritualised compliance; hierarchy, voice, and psychological safety; adaptation, ownership, and local fit; and learning culture after near misses. Checklist use became meaningful when it created shared attention, enabled multidisciplinary voice, preserved core safety checks while allowing local relevance, and linked concerns to visible improvement. It became ritualised when pressure, hierarchy, poor participation, or weak feedback reduced it to form completion. Conclusion: Surgical Safety Checklist governance should move beyond narrow compliance monitoring toward socio-cultural safety practice supported by senior role modelling, protected checklist time, psychological safety, disciplined adaptation, and non-punitive learning.
patient safety culture; surgical checklist; operating room; psychological safety; qualitative research; teamwork; high-pressure surgery.
Copyright (c) 2025 Li Defu, M. Fauzi Nasution, Ali Napiah Nasution (Author) https://creativecommons.org/licenses/by/4.0
Clinician Trust in AI-Generated Radiology Narratives for Patient Care Decisions
**Background:** AI-generated radiology narratives are increasingly being considered for drafting, summarising, simplifying and organising radiology report information, but their safe use depends on how clinicians judge trust, uncertainty, accountability and workflow fit when patient-care decisions are involved. **Objective:** This qualitative study explored how clinicians judge the usefulness, limitations and safeguards of AI-generated radiology narratives in clinical decision-making. **Methods:** A qualitative design was used based on semi-structured interviews with ten clinicians from radiology, emergency medicine, oncology, respiratory medicine, orthopaedics, neurology, intensive care, cardiology and general practice. Participants discussed their experiences with radiology reports and their perceptions of AI-generated summaries, impressions, patient-friendly explanations and workflow-integrated narrative outputs. Reflexive thematic analysis was used to identify patterned meanings related to trust, risk, traceability, oversight and governance. **Results:** Five themes were generated: narrative usefulness as cognitive scaffolding rather than replacement; traceability and validation as the foundation of trust; accountability anxiety in higher-risk decisions; workflow fit and interprofessional communication; and provisional trust shaped by governance and learning. Clinicians valued AI-generated narratives when they organised lengthy reports, highlighted key findings and reduced cognitive load, but trust depended on clear labelling, source linkage, uncertainty preservation, radiologist verification, feedback routes, audit trails and local validation. Higher-risk decisions such as cancer staging, emergency discharge, surgical referral and critical-care escalation required stronger human oversight. **Conclusion:** Clinician trust in AI-generated radiology narratives is conditional, provisional and socio-technical. Safe implementation should prioritise transparent, traceable and governed narrative functions that support calibrated reliance rather than replacing radiologist judgement or professional accountability.
artificial intelligence; radiology narratives; clinician trust; qualitative research; thematic analysis; clinical decision-making; large language models; patient care; clinical governance.
Copyright (c) 2025 Huang Yuzhe, Gilbert Lister, Armelia Adel Abdullah (Author) https://creativecommons.org/licenses/by/4.0
Community Trust Barriers to Vaccine Uptake During Disease Resurgence: A Qualitative Descriptive Study
Background: Family planning access in rural Sindh is shaped not only by service availability but also by gendered decision-making, household authority, contraceptive myths, privacy concerns, mobility restrictions, provider trust, and continuity of commodities. Qualitative evidence is needed to understand how women, men, frontline workers, and programme personnel perceive community-based family planning models and the conditions required for their acceptability and sustainability. Objective: To explore endline perceptions of a community-based family planning model involving Marvi workers, Marvi Markaz service points, and BiB-linked commodity access, with emphasis on barriers, facilitators, acceptability, and sustainability. Methods: An interpretative qualitative endline evaluation was conducted in selected intervention districts and villages of Sindh from 18 to 22 November 2024. Data were collected through in-depth interviews and focus group discussions with married women of reproductive age, men, Marvi workers, and district-level programme personnel. Transcripts and field notes were analyzed using thematic analysis, with attention to participant-group contrasts, implementation mechanisms, and trustworthiness through triangulation, reflexive memoing, audit trail, and direct quotation linkage. Results: The analysis identified interrelated themes around trust in Marvi workers, door-to-door counselling, Marvi Markaz as a safe and familiar service point, commodity availability, myths and fear of side effects, gendered household decision-making, elder influence, privacy and mobility constraints, worker capacity, and supervision/MIS for sustainability. Perceived acceptability was strongest when women experienced respectful counselling, confidentiality, safe access, and reliable commodities. Persistent barriers included misinformation, side-effect concerns, male or elder gatekeeping, restricted mobility, and dependence on continued worker support and supply-chain reliability. Conclusion: The model was perceived as acceptable through mechanisms of trust, proximity, privacy, and commodity access. Sustainability requires refresher training for Marvi workers, structured male engagement, privacy-sensitive service arrangements, reliable supplies, supportive supervision, and district-level ownership.
family planning; qualitative research; community health workers; Marvi workers; contraceptive access; Sindh; thematic analysis; reproductive health.
Copyright (c) 2026 Li Ding, Santy Deasy Siregar, Elviyanti Br Tarigan (Author) https://creativecommons.org/licenses/by/4.0
Digital Self-Monitoring Burdens Among Patients Living with Chronic Heart Disease: A Qualitative Descriptive Study
Background: Digital self-monitoring is increasingly used in chronic heart disease care to support symptom tracking, risk recognition, and continuity between clinic visits, but its everyday burden for patients remains insufficiently understood. Objective: This study explored how patients living with chronic heart disease experienced digital self-monitoring and identified practical, emotional, technical, financial, relational, and service-related factors that shaped their acceptability and sustainability. Methods: This qualitative descriptive study analyzed 12 anonymised interview accounts from adults with chronic heart disease or related cardiac risk factors who had experience using digital self-monitoring tools. Data were examined using reflexive thematic analysis, with attention to participant engagement, support sources, dominant burdens, and theme–quote linkage. Results: Six themes were developed: measurement work and daily discipline; data anxiety and alert fatigue; digital literacy and device usability; cost and connectivity burden; clinician responsiveness and data accountability; and family involvement between support and surveillance. Participants valued monitoring when it offered reassurance, earlier response, and shared care, but they struggled when readings produced fear without interpretation, devices were difficult to use, uploads created hidden costs, clinician feedback was unclear, or family support became intrusive. Conclusion: Digital self-monitoring in chronic heart disease should be designed as minimally disruptive and accountable care, with personalised schedules, plain-language training, clear thresholds, affordable connectivity, visible clinical response, and consent-based caregiver involvement.
chronic heart disease; digital self-monitoring; remote patient monitoring; treatment burden; digital health equity; qualitative research.
Copyright (c) 2026 Lu Yan, Munadi, Linda Chiuman (Author) https://creativecommons.org/licenses/by/4.0
BIS-Guided Anesthesia and Early Cognitive Recovery in Elderly: A Controlled Trial
Background: Elderly patients undergoing general anesthesia are vulnerable to delayed cognitive recovery and postoperative delirium, partly because age-related physiological changes may increase sensitivity to excessive anesthetic depth. Objective: To compare BIS-guided anesthesia with standard anesthesia management for early postoperative cognitive recovery, delirium incidence, anesthetic consumption, and immediate recovery outcomes in elderly patients undergoing elective non-cardiac surgery. Methods: This parallel-group randomized controlled trial was conducted at a tertiary care teaching hospital in Central Punjab, Pakistan, from August 2025 to January 2026. Eighty patients aged 65–80 years undergoing elective non-cardiac surgery under general anesthesia were randomized to BIS-guided anesthesia or standard anesthesia management. In the BIS-guided group, anesthetic depth was maintained within a BIS range of 40–60. Cognitive recovery was assessed using MMSE and MoCA at baseline, 24 hours, and 72 hours postoperatively, while delirium was assessed using the Confusion Assessment Method. Final complete-case analysis included 73 participants. Results: At 72 hours, the BIS-guided group had higher MMSE scores than the standard anesthesia group (27.1 ± 1.5 vs 25.4 ± 1.9; mean difference, 1.7; 95% CI, 0.90–2.50) and higher MoCA scores (25.0 ± 1.8 vs 22.9 ± 2.1; mean difference, 2.1; 95% CI, 1.19–3.01). BIS-guided anesthesia also reduced sevoflurane consumption, extubation time, and recovery-room stay. Delirium occurred in 8.1% and 25.0% of participants, respectively, with exact testing indicating a clinically relevant but statistically non-definitive difference. Conclusion: BIS-guided anesthesia was associated with better early postoperative cognitive recovery and improved immediate recovery efficiency in elderly surgical patients.
Aged; Anesthesia; Bispectral Index; Cognitive Dysfunction; Delirium; Postoperative Complications; Randomized Controlled Trial
Copyright (c) 2026 Saba Arif, Muhammad Abdullah Shakeel, Aqeel Ahmad, Hafiz Muhammad Fawaad Bilal, Muhammad Imran Anjum, Dure Shahwar (Author) https://creativecommons.org/licenses/by/4.0
Ovarian Reserve Markers and Menstrual Pattern in Women Presenting with Primary Infertility
Background: Primary infertility requires timely evaluation of ovarian reserve, but advanced fertility testing may not be affordable or immediately available in resource-limited settings. Menstrual-cycle history is a simple clinical tool that may help identify women who require earlier ovarian reserve assessment. Objective: To assess the association between menstrual-cycle pattern and ovarian reserve markers among women presenting with primary infertility. Methods: This prospective observational study included 150 women with primary infertility attending a gynecology and infertility clinic in Islamabad, Pakistan. Menstrual-cycle pattern was categorized as regular, short, long, or irregular. Ovarian reserve was assessed using serum anti-Müllerian hormone, basal follicle-stimulating hormone, and antral follicle count. Diminished ovarian reserve was defined using predefined biochemical or ultrasound-based criteria. Group comparisons and crude secondary analyses were performed using the available aggregated data. Results: The mean age was 29.4 ± 4.8 years, mean infertility duration was 3.7 ± 2.1 years, and mean body mass index was 25.8 ± 3.9 kg/m². Diminished ovarian reserve was present in 36 women (24.0%). Women with short cycles had the lowest anti-Müllerian hormone (1.02 ± 0.71 ng/mL), lowest antral follicle count (5.6 ± 2.3 follicles), highest follicle-stimulating hormone (11.4 ± 3.9 IU/L), and highest frequency of diminished ovarian reserve (55.6%). Compared with regular cycles, short cycles showed higher crude odds of diminished ovarian reserve (OR 5.22, 95% CI 2.07–13.17). Conclusion: Short menstrual cycles were associated with an adverse ovarian reserve profile in women with primary infertility. Menstrual history may help prioritize early ovarian reserve testing but should not replace standard biochemical and ultrasound assessment
Primary infertility, ovarian reserve, anti-Müllerian hormone, antral follicle count, follicle-stimulating hormone, menstrual cycle, diminished ovarian reserve, Pakistan
Copyright (c) 2026 Maryam Jamal, Maryam Hussain, Dr. Komal Tooba Aftab, Laiba Irfan, Aisha, Aqdas Gulzar (Author) https://creativecommons.org/licenses/by/4.0
Risk Communication Gaps During Climate-Sensitive Disease Outbreaks: A Qualitative Study
Background: Climate-sensitive disease outbreaks are increasingly shaped by rainfall, flooding, water insecurity, heat, sanitation disruption, and vector ecology, but community response also depends on how risk is communicated. Qualitative inquiry is needed to understand how people interpret warnings, assess trust, respond to uncertainty and misinformation, and judge whether recommended protective actions are feasible in everyday conditions. Objective: This study explored community perceptions of risk communication during climate-sensitive disease outbreak risk, focusing on message timing, clarity, trusted sources, misinformation, channel access, and feasibility of recommended protective actions. Methods: A qualitative descriptive study was conducted using 12 purposively varied participant accounts from adults exposed to communication about climate-sensitive disease risks. Participants included caregivers, workers, parents, older adults, community volunteers, young adults, a pregnant participant, a shopkeeper, a migrant worker, a local leader, a student, and a water-insecure resident. Data were analysed using reflexive thematic analysis, sensitised by Crisis and Emergency Risk Communication, Risk Communication and Community Engagement principles, and the Health Belief Model. Results: Six themes were identified: delayed warnings and weak preparedness signals; unclear explanation of the climate-disease connection; conflicting messages from official and informal sources; technical language and limited actionability; unequal access to trusted communication channels; and advice without feasible protective support. Participants’ accounts suggested that response was shaped not only by awareness, but also by trust, practical understanding, language access, service visibility, household resources, and the credibility of messengers. Conclusion: Risk communication for climate-sensitive outbreaks should be timely, locally explained, coordinated across sectors, delivered through trusted and accessible channels, and linked with practical support such as safe water, vector control, clinic access, and household-level prevention guidance.
Risk communication; climate-sensitive diseases; disease outbreaks; public health communication; community engagement; misinformation; outbreak preparedness
Copyright (c) 2026 Liu Xiaojun, Fitri Nelda, Irza Haicha Pratama (Author) https://creativecommons.org/licenses/by/4.0
Trust and Consent Challenges in AI-Supported Surgical Planning: A Qualitative Study
Background: Artificial intelligence is increasingly used in surgical planning through imaging interpretation, anatomical modelling, risk estimation and decision support. Although these tools may support clinical preparation, they create consent challenges when patients are not told how AI influenced the plan, how their data are used or who remains responsible for errors. Qualitative inquiry is needed to understand how patients interpret AI involvement, trust and accountability in surgical consent. Objective: To explore patient perspectives on trust and consent in AI-supported surgical planning, focusing on disclosure, explainability, surgeon responsibility, privacy, fairness and accountability. Methods: This qualitative descriptive study used semi-structured participant accounts from 12 purposively selected surgical patients and patient-related stakeholders. Participants represented variation in surgical experience, digital confidence, family decision-making roles and attitudes toward AI-supported planning. Data were analyzed using reflexive thematic analysis informed by sensitising concepts from AI ethics and inductive interpretation of participant concerns. Results: Six themes were identified: unclear boundaries between surgeon judgement and AI advice; consent without meaningful AI disclosure; explainability and patient understanding; data privacy, bias and fairness concerns; accountability for planning errors; and relational trust in the surgeon as the consent anchor. Participants did not reject AI-supported planning in principle, but acceptance depended on plain-language disclosure, visible surgeon responsibility, transparent data governance and clear institutional accountability. Conclusion: Consent for AI-supported surgical planning should be treated as a patient-centred communication process. Sustainable implementation requires proportionate AI disclosure, clinician explanation, documentation of AI use, governance safeguards and explicit reassurance that surgeons remain responsible for final clinical decisions.
artificial intelligence; surgical planning; informed consent; trust; accountability; qualitative study.
Copyright (c) 2026 Zeng Wenchao, Chrismas Gideon Bangun, Arna Fransisca Millyanti Purba (Author) https://creativecommons.org/licenses/by/4.0
Dental Anxiety and Trust-Building in Technology-Assisted Oral Care: A Qualitative Descriptive Study
Background: Dental anxiety remains an important barrier to preventive and timely oral healthcare. Although technology-assisted dentistry, including digital radiography, intraoral scanning, teledentistry, artificial intelligence-supported interpretation and virtual reality distraction, may improve communication, access and patient comfort, anxious patients may also experience these tools as unfamiliar, intrusive, costly or poorly explained. Qualitative inquiry is needed to understand how patients interpret digital dental tools in relation to fear, control, privacy, cost and trust. Objective: To explore how adults with dental anxiety perceive technology-assisted oral care, identify barriers and facilitators influencing acceptance, and examine how explanation, consent, professional accountability and relational care shape trust. Methods: This qualitative descriptive study used 12 anonymised participant accounts from adult dental patients who reported anxiety, fear, hesitation or discomfort related to dental care and technology-assisted tools. Accounts were analysed using reflexive thematic analysis, combining deductive coding informed by dental anxiety, consent, privacy and technology acceptance with inductive coding of participant meanings. Results: Six themes were identified: fear of pain, gagging and loss of control; explanation as the basis of trust; visualisation as reassurance and exposure; privacy, AI and data uncertainty; cost and access as trust signals; and relational care as the overarching trust-builder. Technology-assisted care was more acceptable when patients received clear explanations, stop signals, privacy clarification, cost transparency and visible clinician accountability. It became more anxiety-provoking when tools were unfamiliar, intrusive, financially unclear or perceived as replacing human care. Conclusion: Technology-assisted oral care should be implemented through a trust-first approach that combines digital competence with anxiety-sensitive communication, meaningful consent, patient control, privacy safeguards, cost transparency and non-judgemental relational care.
dental anxiety; digital dentistry; trust; teledentistry; artificial intelligence; technology-assisted oral care
Copyright (c) 2025 Zheng Yerong, Florenly, Shieny (Author) https://creativecommons.org/licenses/by/4.0
Patient Confidence in Artificial Intelligence-Assisted Imaging Reports for Early Cancer Detection
Background: Artificial intelligence is increasingly used to support medical imaging, including cancer detection workflows. Although technical performance is important, patient confidence in AI-assisted imaging depends on how patients understand AI’s role, whether clinicians remain responsible, and whether concerns about error, privacy, bias, and accountability are addressed. Qualitative evidence is needed to explore how patients interpret AI-supported imaging reports in emotionally sensitive cancer-related contexts. Objective: This study explored how adults with prior imaging exposure or cancer screening familiarity perceived AI-assisted imaging reports for early cancer detection, what increased or reduced their confidence, and what safeguards they considered necessary for acceptable use. Methods: An interpretivist qualitative study was conducted using semi-structured interviews with eight adult participants. Participants had experience of medical imaging or familiarity with cancer screening-related services. Interview data were analyzed using reflexive thematic analysis to identify patterns in perceived usefulness, concerns, trust conditions, and communication needs. Results: Eight themes were identified: AI as a supportive imaging tool, limited awareness and lack of disclosure, conditional confidence through human supervision, trust through reliability and approval, AI as a facilitator of earlier detection, fear of mistakes and overdiagnosis, ethical and social concerns, and assurance through clear communication. Participants viewed AI as useful when it acted as a second reader, but confidence depended on clinician verification, transparent disclosure, privacy protection, accountability, and simple explanations of AI’s role and follow-up plans. Conclusion: Patient confidence in AI-assisted cancer imaging is conditional rather than automatic. AI may be acceptable when embedded in clinician-led care, supported by transparent communication, reliable governance, privacy safeguards, and clear responsibility for final interpretation.
artificial intelligence; AI-assisted imaging; early cancer detection; patient confidence; medical imaging; radiology; patient-centered care
Copyright (c) 2026 Bi Chao, Dewi Asih, Ikhwanul Hakim Nasution (Author) https://creativecommons.org/licenses/by/4.0
Nurses' Moral Distress During Digital Workload Monitoring in Hospital Care
Background: Digital workload monitoring is increasingly used in hospital nursing through electronic health records, acuity scoring, task dashboards, staffing platforms, and electronic observation systems. Although these tools may support visibility and planning, they may also narrow nursing work to measurable tasks and overlook relational care, vigilance, professional judgement, and emotional labour. Qualitative inquiry is needed to understand how nurses experience the ethical effects of being digitally monitored. Objective: To explore nurses’ perceptions of moral distress during digital workload monitoring and to identify how monitoring systems influence autonomy, trust, accountability, missed or delayed care, and documentation burden. Methods: This qualitative interview study included hospital nurses with direct experience of digital workload monitoring. Semi-structured interviews explored workload visibility, documentation, surveillance, autonomy, missed care, escalation, and ethical concerns. Data were analysed using reflexive thematic analysis. Results: Five themes were identified: quantified care and invisible nursing labour; surveillance, autonomy, and trust; moral distress through missed or delayed care; documentation burden and competing accountability; and resistance, voice, and ethical repair. Participants perceived monitoring as useful when it supported escalation and staffing visibility, but distressing when data were interpreted without context or failed to generate organisational support. Conclusion: Digital workload monitoring should be governed as ethical decision-support infrastructure. Participatory design, transparent governance, contextual interpretation, reduced documentation burden, and meaningful staffing responses are needed to protect professional judgement and person-centred nursing care.
moral distress; nursing workload; digital workload monitoring; electronic health records; missed care; professional autonomy.
Copyright (c) 2026 Li Chunting, Tiarnida Nababan, Elis Anggeria (Author) https://creativecommons.org/licenses/by/4.0
Influence of Selective Caries Removal on Post-Operative Sensitivity in Permanent Molars
Background: Post-operative sensitivity after restoration of deep carious lesions is a common patient-centered concern that may reduce comfort and satisfaction after dental treatment. Complete caries excavation can increase pulpal irritation in deep lesions, whereas selective caries removal preserves affected dentin near the pulp and may reduce early discomfort. Objective: To compare short-term post-operative sensitivity after selective caries removal versus complete excavation in permanent molars with deep carious lesions. Methods: This randomized controlled trial enrolled 60 adults aged 18–45 years with deep occlusal or occlusoproximal caries in permanent molars. Participants were allocated equally to selective caries removal or complete excavation. All cavities were restored immediately using resin-modified glass ionomer cement under standardized clinical protocols. Post-operative sensitivity was assessed using a visual analogue scale at 24 hours, 72 hours, and 7 days. Biting sensitivity and the association between cavity depth and VAS scores were also evaluated. Results: Selective caries removal produced lower VAS scores than complete excavation at 24 hours (2.1 ± 0.9 vs. 3.8 ± 1.1), 72 hours (1.4 ± 0.7 vs. 2.6 ± 0.9), and 7 days (0.6 ± 0.4 vs. 1.2 ± 0.6). Biting sensitivity was also less frequent after selective removal at 24 hours and 72 hours. Cavity depth showed stronger positive correlations with sensitivity after complete excavation. Conclusion: Selective caries removal reduced early post-operative sensitivity compared with complete excavation in permanent molars, supporting conservative excavation for short-term patient comfort.
Caries, Dental; Dental Pulp; Postoperative Complications; Randomized Controlled Trial; Resin-Modified Glass Ionomer; Sensitivity, Dental; Tooth, Permanent
Copyright (c) 2026 Fawad Ali Shah, Aimon Khan, Zoya Nawaz, Makkia Sumbal, Syed Ahmed Omer, Waleed Ajmal (Author) https://creativecommons.org/licenses/by/4.0
Nurse-Led Microclimate Adjustments in Patient Rooms and Their Physiological Impact on Sleep Quality Recovery
Background: Sleep disturbance is common among hospitalized adults and may impair physiological recovery, increase fatigue, and reduce patient comfort. Environmental factors such as room temperature, light exposure, noise, airflow, and bedding comfort are potentially modifiable contributors to inpatient sleep disruption. Objective: To evaluate the effect of nurse-led environmental microclimate adjustment on sleep quality and physiological sleep-recovery markers among hospitalized adults. Methods: A parallel-group randomized controlled trial was conducted in medical and post-surgical recovery wards of a tertiary care hospital in Central Punjab, Pakistan, from August 2025 to January 2026. Seventy-two adults with baseline sleep disturbance were randomized to structured nurse-led microclimate adjustment or routine ward care. The intervention targeted nighttime temperature, lighting, noise, airflow, and bedding comfort over 14 nights. Baseline characteristics were analyzed in all randomized participants, while post-intervention outcomes were analyzed among 65 participants with complete outcome data. Results: Post-intervention PSQI scores were lower in the intervention group than controls (5.9 ± 1.7 vs 8.8 ± 2.0; mean difference −2.9; 95% CI −3.8 to −2.0; p<0.001). The intervention group also showed fewer nighttime awakenings, higher oxygen saturation, greater heart rate variability, lower fatigue severity, and higher comfort scores. Comfort was inversely correlated with PSQI score (r=−0.61; p<0.001). Conclusion: Nurse-led microclimate adjustment was associated with improved sleep quality, comfort, fatigue, and physiological sleep-recovery markers in hospitalized adults. Larger multicenter trials with objective sleep monitoring and adjusted analyses are recommended.
Circadian Rhythm; Heart Rate Variability; Hospitalization; Nursing Care; Patient Comfort; Sleep Quality; Temperature Comfort
Copyright (c) 2026 Abrar Hussain, Sadia Iqbal, Anum Rehman, Syed Maaz Hussain, Abdullah Khan, Ayesha Rehman (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Constraint-Induced Movement Therapy on Upper-Limb Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Background: Cerebral palsy is frequently associated with persistent upper-limb impairment, particularly among children with unilateral or hemiplegic involvement. Constraint-Induced Movement Therapy is a neuroplasticity-based rehabilitation approach designed to improve functional use of the more affected upper limb through restraint of the less affected limb and intensive task-oriented practice. However, contemporary randomized evidence remains heterogeneous, and adjunctive CIMT studies require separate interpretation. Objective: To evaluate the effectiveness of Constraint-Induced Movement Therapy on upper-limb function in children and adolescents with cerebral palsy through a systematic review and meta-analysis of randomized controlled trials. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and PEDro for English-language randomized controlled trials published from January 2015 to December 2025. Eligible studies included children or adolescents with cerebral palsy receiving CIMT, modified CIMT, expanded CIMT, or CIMT-based rehabilitation. Risk of bias was assessed using the Cochrane RoB 2 tool. Standardized mean differences using Hedges’ g were pooled under a random-effects model where trials directly compared CIMT with non-CIMT control interventions. Adjunctive CIMT trials were synthesized separately. Results: Five randomized controlled trials involving 269 participants were included. Two trials with 110 participants were included in the primary meta-analysis. The pooled effect favored CIMT but was not statistically significant (Hedges’ g = 1.53, 95% CI −1.35 to 4.40), with considerable heterogeneity (I² = 96.6%). Three adjunctive trials evaluated rTMS or virtual reality combined with CIMT. rTMS showed promising additive effects, whereas virtual reality did not demonstrate clear superiority over CIMT alone. Conclusion: CIMT remains a promising intervention for pediatric upper-limb rehabilitation in cerebral palsy, but current evidence is limited by few directly comparable trials, imprecision, and substantial heterogeneity. Larger standardized randomized trials are needed to establish effect magnitude, optimal dosage, durability, and clinical applicability
Cerebral palsy; Constraint-Induced Movement Therapy; Modified Constraint-Induced Movement Therapy; Upper-limb function; Pediatric rehabilitation; Randomized controlled trial; Systematic review; Meta-analysis.
Copyright (c) 2026 Etisam Wahid, Malije Henry Ezepue, Salwa Ali, Rida Latif, Muhammad Hassan Ali Khan, Muqaddas Yaqoob, Shahzad Ahmad, Ayesha Nisar (Author) https://creativecommons.org/licenses/by/4.0
Assessment of Biomedical Waste Management and Risk Perception among Health Care Workers at a Tertiary Care Hospital, Jamshoro
Background: Biomedical waste management is essential for infection prevention, occupational safety, and environmental protection in healthcare settings. Inadequate segregation, handling, and disposal of biomedical waste can increase the risk of sharps injuries, blood-borne infections, environmental contamination, and unsafe exposure among healthcare workers, patients, and waste handlers. Objective: To assess knowledge, risk perception, and practices regarding biomedical waste management among healthcare workers at a tertiary care hospital in Jamshoro. Methods: A descriptive cross-sectional study was conducted at Liaquat University Hospital, Jamshoro, from January 2026 to March 2026. A total of 131 healthcare workers, including staff nurses, doctors, and housekeeping staff, were recruited using non probability convenience sampling technique. Data were collected using an adopted pre-structured questionnaire which consists of demographic characteristics, biomedical waste segregation knowledge, risk perception, and practice indicators. Data were analyzed using SPSS version 27, and findings were summarized using frequencies, percentages, means, and standard deviations. Results: This current study founds moderate level of knowledge, risk perception and practice regarding Biomedical Waste Management among health workers (27.00 ± 3.84), (35.37 ± 6.03), and (7.63 ± 2.54). Moreover, formal biomedical waste management training was reported by 37.4% of participants, consistent PPE use by 38.2%, regular biomedical waste audits by 31.3%, and consistent availability of color-coded bins by 48.1%. Conclusion: Healthcare workers demonstrated moderate knowledge, risk perception, and practices regarding biomedical waste management at selected hospital; however, item-level findings revealed important gaps in training, PPE use, injury reporting, and institutional monitoring. Regular training, adequate resources, strict implementation of guidelines, and continuous audits are recommended.
Biomedical waste management, healthcare workers, knowledge, risk perception, practices, infection control.
Copyright (c) 2026 Aisha Memon, Dr. Hussan Bano Channar, Irfan Ali Chandio, Abdul Rehman Samejo, Mudassara Kiran, Kainat Ali Dino Khowaja (Author) https://creativecommons.org/licenses/by/4.0