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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).
Beyond the Initial Appeal: A Qualitative Study of Sustained Engagement with Virtual Reality and Wearable-Supported Rehabilitation After Stroke
Background: Multimorbidity is often managed through disease-specific services, requiring patients to coordinate information, Background: Artificial intelligence (AI) is increasingly being incorporated into diagnostic, prognostic, and treatment-support processes in oncology, raising concerns regarding patient autonomy, trust, informed consent, explainability, and professional accountability. Objective: To explore how adults with current or previous oncology-care experience perceived autonomy, trust, informed consent, explainability, and clinician responsibility when considering hypothetical scenarios in which AI contributed to cancer-related diagnosis, prognosis, or treatment recommendations. Methods: A qualitative interpretive design was used. Fourteen adults with oncology-care experience were purposively recruited to provide variation in cancer experience and familiarity with digital health. Semi-structured interviews incorporated hypothetical scenarios involving AI-supported image analysis, individualized recurrence estimation, treatment recommendations, clinician–algorithm disagreement, and AI use without prior discussion. Data were analysed using reflexive thematic analysis. Results: Five interconnected themes were identified: conditional trust rather than technological trust; consent as an ongoing conversation; human accountability as the boundary of acceptable automation; explainability as practical meaning; and algorithmic pressure on autonomy. Participants generally perceived AI as acceptable when it augmented rather than replaced clinical reasoning, clinicians remained responsible for interpreting its outputs, and patients retained opportunities to question recommendations and consider alternatives. Participants also anticipated that AI-labelled recommendations could appear unusually objective and therefore become more difficult to reject, particularly when uncertainty and alternative options were not clearly communicated. Conclusion: Participants perceived AI-supported oncology decision-making as most compatible with autonomy when AI remained subordinate to accountable clinical judgment, disclosure was proportionate to its influence on the decision, explanations were clinically meaningful, and patients retained genuine opportunities to question or refuse recommendations. Because the study examined hypothetical scenarios rather than observed AI-supported consultations, the findings represent anticipated perceptions rather than demonstrated effects on clinical behaviour or autonomy
artificial intelligence; oncology; patient autonomy; trust; informed consent; shared decision-making; qualitative research
Copyright (c) 2026 Yu Shihui, Inda Kania Meilani, Ica Yulianti Pulungan (Author) https://creativecommons.org/licenses/by/4.0
Beyond the Clinic Door: Designing Compassionate Digital Support After Early Pregnancy Loss Through the Experiences of Patients, Partners and Maternity Professionals
Background: Early pregnancy loss can generate substantial emotional, informational, and relational needs that persist beyond acute clinical management, while digital support may provide continuity of care if it remains sensitive, clinically credible, and connected to professional services. Objective: To explore how patients, partners, and maternity professionals conceptualized compassionate digital support following early pregnancy loss and to identify stakeholder-informed requirements for an appropriate digital support pathway. Methods: A qualitative descriptive design informed by an interpretive orientation was used. The analytic dataset comprised 15 participant profiles, including seven patients, four partners, and four maternity professionals. Data were analyzed using reflexive thematic analysis with deliberate comparison across stakeholder groups. Results: Four interrelated themes were developed: recognition before information; staged, clinically anchored guidance; inclusion of partners without displacing the patient; and human connection, choice, and escalation as safety functions. Participants did not consider a fully automated application or static information portal sufficient. They favored a digitally enabled pathway that acknowledged the loss before providing information, adapted content to different stages of recovery, allowed control over notifications and potentially triggering material, provided separate support for partners without compromising patient privacy, and maintained clear routes to professional assistance when physical or psychological concerns escalated. Conclusion: Compassionate digital support following early pregnancy loss should be conceptualized as a relational extension of existing maternity and follow-up care rather than a substitute for healthcare professionals. Future co-design and feasibility studies should evaluate the acceptability, usability, emotional safety, accessibility, and clinical governance of stakeholder-informed digital support pathways
early pregnancy loss; miscarriage; digital health; compassionate care; maternity care; partners; qualitative research
Copyright (c) 2026 Yu Jiaoyang, M. Fauzi Nasution, Qori Fadillah (Author) https://creativecommons.org/licenses/by/4.0
When Algorithms Join the Consultation: A Qualitative Study of Patient Autonomy, Trust and Informed Consent in AI-Supported Oncology Decision-Making
Copyright (c) 2026 Qiu Huixu, Linda Chiuman, Ali Napiah Nasution (Author) https://creativecommons.org/licenses/by/4.0
The Hidden Labour of Making Multimorbidity Care Coherent: A Qualitative Study of Patients Navigating Fragmented Internal Medicine Pathways in Indonesia
Background: Multimorbidity is often managed through disease-specific services, requiring patients to coordinate information, appointments, medicines, referrals, and competing clinical priorities across fragmented pathways. This study explored the largely invisible coordination work undertaken by adults with multimorbidity navigating internal medicine care in Indonesia. Methods: A qualitative descriptive design was used with analytic material comprising 14 adult participant profiles representing diverse combinations of chronic conditions. Semi-structured accounts addressed movement between primary and specialist care, appointment management, information transfer, medication changes, conflicting recommendations, and family involvement. Data were analysed using reflexive thematic analysis informed by treatment-burden and cumulative-complexity perspectives. Results: Five interrelated themes were identified: becoming the courier of one's own medical history; appointment choreography and time poverty; reconciling contradictory clinical plans; family members as shadow coordinators; and continuity as a scarce clinical resource. Participants described substantial cognitive, administrative, temporal, and interpretive work required to maintain continuity across services. Medication-related uncertainty and unclear responsibility for reconciling competing recommendations created circumstances with potential safety implications, while family support and relational continuity increased patients' capacity to navigate fragmented care. Conclusion: Fragmented multimorbidity care can transfer substantial coordination work to patients and families. Strengthening informational and relational continuity, clarifying responsibility for cross-condition reconciliation, coordinating transitions, and providing targeted navigation support may reduce avoidable treatment burden and improve patient-centred care
multimorbidity; qualitative research; care coordination; treatment burden; continuity of care; internal medicine; Indonesia
Copyright (c) 2026 Tan Liwei, Celvin Angkasa, Dewi Asih (Author) https://creativecommons.org/licenses/by/4.0
Patient Experiences of AI-Assisted Diabetic Retinopathy Screening: Trust, Consent and Understanding of Results
Background: Artificial intelligence (AI)-assisted diabetic retinopathy screening can increase the speed and accessibility of retinal image interpretation, particularly in primary-care and underserved settings. However, diagnostic performance alone does not establish whether patients understand AI involvement, provide meaningful consent, trust automated decisions, or successfully navigate care after screening. Patient-centred evidence remains fragmented across studies of acceptance, satisfaction, trust, consent, data governance, communication, and referral. Objective: This critical integrative review synthesized patient-focused evidence on AI-assisted diabetic retinopathy screening to examine how patients develop or withhold trust in AI-supported screening, whether disclosure and consent processes support meaningful understanding and choice, and how patients comprehend results and navigate subsequent clinical care. Methods: Peer-reviewed literature published between January 2016 and July 2026 was identified using structured combinations of terms related to diabetic retinopathy, retinal screening, artificial intelligence, patient experience, trust, consent, privacy, understanding, communication, and referral, supplemented by citation chaining. Twenty publications informed the conceptual and theoretical context, while a separate corpus of 15 primary studies published between 2021 and 2026 informed the findings. Heterogeneous evidence from surveys, implementation studies, experiments, and patient-experience assessments was synthesized thematically, with design-sensitive critical appraisal. Results: Three interrelated themes emerged. Trust was conditional on visible human oversight and accountability, with patients generally preferring AI as an adjunct rather than an autonomous substitute for clinicians. Evidence concerning consent was substantially less developed than evidence concerning acceptance; disclosure did not necessarily establish comprehension, voluntariness, or permission for secondary data use. Speed, local access, and immediate results were valued, but favourable screening experiences did not consistently translate into referral completion or understanding of subsequent actions. Conclusion: Patient-centred AI-assisted diabetic retinopathy screening requires more than technical accuracy or high satisfaction. Sustainable implementation depends on identifiable human accountability, intelligible consent, practical explanation of results, transparent data governance, meaningful choice, and a navigable pathway from screening to follow-up care
Copyright (c) 2026 Zhang Shuixin, Ali Napiah Nasution, Clarisa Lister (Author) https://creativecommons.org/licenses/by/4.0
Green-Synthesized Zinc Oxide Nanoparticles From Indigenous Medicinal Plants for Multidrug-Resistant Bacterial Infections
Background: When we get infections from bacteria that're resistant to many medicines it is really hard to treat them with the usual medicines. This is why we need to find ways to treat these infections. We think that tiny particles of zinc oxide that are made in a way could help to fight bacteria and heal wounds. Objective: We wanted to see how well a special cream made with these zinc oxide particles worked compared to another medicine called mupirocin. We used this cream on people with skin infections that were resistant to medicines. We also wanted to see if the size of the particles made a difference in how well they fought the bacteria. Methods: We did a study in Karachi, Pakistan from May 2025 to January 2026. We had 84 people in the study. We divided them into two groups. One group used the cream with zinc oxide particles and the other group used mupirocin. They used these medicines twice a day for four weeks. We looked at how many bacteria were on the skin how big the wound. If the wound was completely healed. Results: After four weeks we found that the people who used the cream with zinc oxide particles had bacteria on their skin. The wounds of the people who used the cream with zinc oxide particles were also more likely to be healed. We found that the smaller the zinc oxide particles were, the better they were at killing the bacteria. Our study showed that the cream made with zinc oxide particles worked better than mupirocin at fighting bacteria and healing wounds. This is a sign and we think that we should do more studies, with more people to see if this cream really works
Azadirachta indica; Antimicrobial Resistance; Multidrug-Resistant Bacteria; Mupirocin; Nanoparticles; Wound Healing; Zinc Oxide
Copyright (c) 2026 Ayesha Zubair, Mohammad Shaiq Mahmood, Aqsa Ashraf, Taiba Ahmad, Raja Kamran Afzal (Author) https://creativecommons.org/licenses/by/4.0
A Cross-Sectional Study on AI-Assisted Versus Conventional Surgical Planning for Musculoskeletal Conditions and Postoperative Functional Recovery
Background: Artificial intelligence is being used more and more in the field of brain cancer treatment. It is used for scans predicting outcomes figuring out risks and planning operations. Whether people accept it in the clinic depends not on how well it works but also on how people understand if it is reliable how it talks to them what it is unsure about and who is responsible. Objective: The goal was to find out how patients the people who speak for them and brain surgeons saw the reliability of intelligence how it communicates, what it is unsure about who is responsible how the family is involved and how confident they are in decisions made with the help of AI during brain tumour surgery. Methods: A study was done where people were interviewed in places in Indonesia that treat brain cancer and brain tumour problems. Twenty-five people took part: ten patients, eight people who speak for them and seven brain surgeons. The interviews were not fixed but covered topics like how reliable they thought AI was whether doctors agreed or disagreed with it how sure they were, how the family was involved how confident they. What kinds of safety measures were acceptable. The interviews were between 45 and 75 minutes long. They were recorded, written down exactly as said, checked and made anonymous. The data were looked at using a method called thematic analysis. This included looking at each group comparing between groups and checking for cases that didn't fit. Results: Five main ideas came up. AI was seen as an opinion, not something that makes decisions on its own. Communication was about turning chances into results. People were confident even when they knew there was some uncertainty. Responsibility was something that involved patients their families and doctors. Conditions for control included how the AI works in the area if it is fair if people are accountable if it can be checked and if doctors can change what AI says. Trust was not complete. Depended on clear reasons for disagreement, between doctors and AI. Artificial intelligence was seen best when it helped doctors not when it took over. Trust depended on communication understanding uncertainty respecting the values of the patient working together with the family checking the AI and making sure people are responsible
intelligence; brain tumour surgery; qualitative research; shared decision-making; uncertainty; trust; family surrogates
Copyright (c) 2026 Muhammad Hassam Mehdi, Ahmad Waqar, Muhammad Hafeez Malik, Komal Kumari, Saad Sultan Qureshi, Tayyaba Fatima (Author) https://creativecommons.org/licenses/by/4.0
Beyond the Step Count: A Qualitative Study of Patient and Clinician Experiences with Wearable-Supported Rehabilitation After Major Orthopedic Surgery
Background: Wearable technologies can make recovery after major lower-limb orthopedic surgery more visible, but their clinical value depends on how patients and clinicians interpret and act on the data they produce. Qualitative inquiry is needed to understand motivation, reassurance, anxiety, clinical meaning, workload, and digital exclusion. Objective: To explore patient and clinician experiences of wearable-supported rehabilitation and identify conditions under which wearable data are perceived as supportive, clinically meaningful, and feasible. Methods: An interpretive qualitative descriptive interview study included 14 purposively selected participants: nine postoperative patients and five clinicians involved in orthopedic rehabilitation. Semi-structured interviews were analyzed using reflexive thematic analysis. Results: Four themes were developed: numbers as reassurance and momentum; quantified recovery as pressure; data requiring clinical context; and remote visibility creating new work and inequities. Personal trends could make progress tangible, whereas inflexible targets could be experienced as judgment. Clinicians interpreted longitudinal patterns alongside symptoms, function, and circumstances. Remote monitoring was perceived as useful only when review responsibilities, escalation pathways, technical support, and non-digital alternatives were clear. Conclusion: Participants perceived wearables as most acceptable when they supported conversation rather than replaced it. Personalized goals, contextualized feedback, defined monitoring responsibilities, and equitable access are important sustainability conditions
wearable technology; orthopedic rehabilitation; total knee arthroplasty; total hip arthroplasty; qualitative research; remote monitoring.
Copyright (c) 2026 Wang Haoyu, Alexander Angkasa, Linda Chiuman (Author) https://creativecommons.org/licenses/by/4.0
Living Through the Data: A Qualitative Study of Wearable Symptom Tracking, Self-Management and Family Participation During Chemotherapy
Background: Artificial intelligence is increasingly capable of contributing to information processing, risk estimation, and clinical decision support in oncology, but its acceptability depends not only on technological performance but also on how patients and families understand its role within clinical relationships. Qualitative inquiry is needed to examine how trust, disclosure, accountability, explainability, and autonomy are experienced when algorithmic recommendations enter preference-sensitive treatment decisions. Objective: To explore how adults with cancer and family caregivers perceive artificial intelligence in oncology decision-making and to identify conditions under which AI is viewed as supporting or constraining informed participation and patient autonomy.Methods: An interpretive qualitative study was conducted with 14 purposively sampled participants, comprising 10 oncology patients and four family caregivers. Semi-structured interviews used clinical scenarios addressing AI-supported recommendations, disclosure, clinician–algorithm disagreement, responsibility, and treatment choice. Data were analysed using reflexive thematic analysis. Results: Five interrelated themes were developed: conditional trust rather than technological trust; consent as an ongoing conversation; human accountability as the boundary of automation; explainability as practical meaning; and algorithmic pressure on autonomy. Participants generally accepted AI as an additional source of information when clinicians remained visibly responsible for interpretation and decision-making. Meaningful disclosure was considered increasingly important when AI materially influenced consequential treatment choices. Participants preferred practical explanations of relevance, uncertainty, and alternatives over technical descriptions. Algorithmic recommendations could facilitate deliberation by clarifying options but could also make disagreement appear irrational when presented as objectively definitive. Conclusion: Participants perceived AI as most acceptable when it augmented rather than displaced clinical judgement, preserved opportunities to question recommendations, and maintained identifiable human accountability. Implementation should prioritise proportionate disclosure, clinically meaningful explanations, explicit responsibility, and protection of patient choice
Artificial intelligence; oncology; patient autonomy; shared decision-making; informed consent; qualitative research; family caregivers
Copyright (c) 2026 Wang Lei, Liena, Linda Chiuman (Author) https://creativecommons.org/licenses/by/4.0
Conditional Trust and Shared Responsibility in AI-Assisted Brain Tumour Surgery: A Qualitative Study of Patients, Family Surrogates, and Neurosurgeons
Background: Artificial intelligence (AI) is increasingly applied in neuro-oncology for imaging, prognostic modelling, functional-risk estimation, and surgical planning. Its clinical acceptability depends not only on predictive performance but also on how stakeholders interpret reliability, uncertainty, communication, and responsibility. Objective: To explore how patients, family surrogates, and neurosurgeons understood AI reliability, communication, uncertainty, responsibility, family involvement, and decision-making confidence in AI-assisted brain tumour surgery. Methods: A qualitative interview study was conducted in tertiary neurosurgical and neuro-oncology settings in Indonesia. Maximum-variation purposive sampling included 25 participants: 10 patients, 8 family surrogates, and 7 neurosurgeons. Semi-structured interviews explored perceived AI reliability, clinician–AI agreement or disagreement, uncertainty, family involvement, confidence, and acceptable safeguards. Interviews lasted 45–75 minutes, were audio-recorded, transcribed verbatim, checked, and de-identified. Data were analysed using reflexive thematic analysis with within-group, cross-group, and negative-case comparison. Results: Five themes emerged: AI as a second opinion rather than an autonomous authority; communication as translation of probabilities into meaningful consequences; confidence despite acknowledged uncertainty; relational responsibility involving patients, families, and clinicians; and governance conditions including local applicability, fairness, accountability, auditability, and clinician override. Trust was conditional rather than absolute, and transparently explained clinician disagreement with AI could strengthen confidence. Conclusion: AI-assisted brain tumour surgery was considered most acceptable when AI supplemented rather than replaced human judgement. Trust depended on understandable communication, acknowledged uncertainty, patient values, negotiated family involvement, clinician scrutiny, and visible accountability
artificial intelligence; brain tumour surgery; qualitative research; shared decision-making; uncertainty; trust; family surrogates
Copyright (c) 2026 Hua Feng, Linda Chiuman, Dewi Sartika (Author) https://creativecommons.org/licenses/by/4.0
Visualising a Possible Postoperative Body: Patient Experiences of 3D and AI-Generated Simulations in Reconstructive Plastic Surgery
Background: Three-dimensional (3D) and artificial intelligence (AI)-generated visualisations are increasingly used to communicate possible reconstructive surgical outcomes. Although visual representations may improve anatomical understanding, photorealistic imagery can imply greater predictive certainty than reconstructive surgery permits. Qualitative evidence is limited regarding how patients interpret these representations in relation to expectations, identity, trust, and decision-making. Objective: To explore how adults with reconstructive surgery experience interpret anatomy-based 3D and synthetic AI-generated visualisations and to identify conditions influencing their perceived usefulness and ethical acceptability. Methods: An interpretive qualitative study using semi-structured interviews and visual elicitation was conducted in Medan, Indonesia, from January to May 2026. Twelve adults aged 24–62 years with experience of considering, planning, revising, or undergoing reconstructive surgery were purposively sampled for maximum variation. Participants viewed an anatomy-based 3D representation and a synthetic, illustrative, non-predictive AI-generated image. Interviews were analysed using reflexive thematic analysis. Results: Six themes were generated: movement from abstraction to an imaginable body; hope that could become a visual promise; recognition, estrangement, and embodied fit; trust borrowed from the surgeon; unequal redistribution of agency; and ethical acceptability through boundaries. Participants generally regarded 3D visualisation as a provisional anatomical aid, whereas photorealistic AI imagery was more readily interpreted as a possible outcome and was more susceptible to expectation anchoring. Trust increased when uncertainty, provenance, clinician responsibility, privacy, and patient control were explicit. Conclusion: Patient-facing visualisation should prioritise bounded, transparent communication rather than photorealism. Clinician accountability, explicit uncertainty, representational fit, privacy safeguards, and patient control over viewing and reuse are central to ethically acceptable implementation
reconstructive plastic surgery; three-dimensional simulation; artificial intelligence; body image; shared decision-making; qualitative research
Copyright (c) 2026 Nie Man, Celvin Angkasa, Tri Lidya Anggraini (Author) https://creativecommons.org/licenses/by/4.0
Distributed Digital Care Work in Remote Patient Monitoring: A Qualitative Study of Older Adults with Multimorbidity, Family Caregivers and Clinicians in Indonesia
Background: Remote patient monitoring is increasingly incorporated into chronic-disease care, but its usefulness for older adults with multimorbidity depends on the practical, cognitive, relational, and professional work required to generate, interpret, and respond to remotely collected information. How this work is distributed among patients, family caregivers, and clinicians remains insufficiently understood. Objective: To explore how older adults with multimorbidity, unpaid family caregivers, and clinicians experienced, organised, and negotiated digital care work associated with remote patient monitoring in Medan, Indonesia. Methods: A qualitative descriptive study with an interpretive orientation was conducted between January and May 2026. Twelve participants—six older adults, three family caregivers, and three clinicians—were purposively recruited using maximum-variation sampling. Semi-structured individual interviews were analysed using reflexive thematic analysis, with Normalisation Process Theory and burden of treatment theory used as sensitising perspectives after initial coding. Results: Six interrelated themes were developed: reassurance through data but not certainty; monitoring as an additional treatment regimen; caregivers as digital intermediaries and moral safety nets; clinical visibility constrained by workflow and fragmented responsibility; relational negotiation of autonomy, surveillance, and trust; and the need for adaptive, human-supported care. Monitoring was perceived as valuable when data were interpretable and connected to credible clinical responses, whereas rigid routines, hidden caregiver labour, technological problems, and unclear responsibility increased burden. Conclusion: Remote monitoring redistributed rather than eliminated care work. Person-centred implementation requires adaptable monitoring demands, negotiated caregiver involvement, clear clinical accountability, continuing human support, and accessible non-digital alternatives
multimorbidity; older adults; remote patient monitoring; digital care work; family caregivers; qualitative research
Copyright (c) 2026 Liu Zhanyuan, Linda Chiuman, Muhammad Faridz Syahrian (Author) https://creativecommons.org/licenses/by/4.0
Calibrating Patient Trust Through Dentist Communication in AI-Assisted Dental Imaging: A Qualitative Study
Background: Artificial intelligence is increasingly used to support interpretation of dental radiographic images, but diagnostic performance alone does not determine whether patients consider AI-supported recommendations trustworthy. Trust may depend on how visual outputs, uncertainty, professional accountability, privacy, and treatment consequences are communicated. Qualitative investigation is needed to understand how patients interpret these factors during AI-assisted dental care. Objective: To explore how adults perceive trust in AI-assisted dental imaging, how dentist communication shapes confidence and willingness to act, and which contextual factors influence acceptable reliance on AI-supported recommendations. Methods: An interpretive qualitative study informed by a constructivist orientation was conducted in an urban dental-care setting in Medan, Indonesia, between January and May 2026. Twelve adults aged 24–58 years with previous experience of AI-assisted dental imaging participated in semi-structured individual interviews. Purposive variation sampling sought diversity in gender, education, AI awareness, imaging experience, and dental anxiety. Data were examined using reflexive thematic analysis. Results: Three interconnected themes were developed: seeing strengthens belief but does not prove correctness; the dentist remains the trusted interpreter; and trust is conditional on accountability, privacy, and consequence. AI-supported visualization helped participants understand where to focus but did not replace clinical explanation. Trust increased when dentists contextualized findings, acknowledged uncertainty, invited questions, discussed alternatives, and retained responsibility for recommendations. Privacy, fairness, commercial motives, and treatment reversibility also influenced acceptable reliance, with participants seeking stronger human verification before irreversible care. Conclusion: Patient trust in AI-assisted dental imaging was conditional rather than automatic. Appropriate implementation should emphasize transparent clinician interpretation, uncertainty communication, professional accountability, patient choice, and proportionate human verification for higher-consequence decisions
artificial intelligence, dental imaging, patient trust, dentist communication, explainability, qualitative research
Copyright (c) 2026 Li Songjian, Cindy Denhara Wijaya, Shieny (Author) https://creativecommons.org/licenses/by/4.0
Living With Digital Monitoring in Early Psychosis: Service Users’ Experiences of Privacy, Stigma and Therapeutic Trust
Digital monitoring is increasingly incorporated into psychosis care through smartphone symptom monitoring, passive sensing, digitally mediated therapy, supported self-management, and algorithm-based relapse prediction. Its clinical and ethical value, however, depends not only on technical performance but also on how service users experience data collection, interpretation, stigma, autonomy, and therapeutic relationships. This qualitative evidence synthesis examined service-user experiences of privacy, stigma, and therapeutic trust in early psychosis and broader psychosis-spectrum care. PubMed/MEDLINE, PsycINFO, Scopus, and Web of Science were searched for literature published from January 2016 through April 2026, supplemented by citation chaining. Contextual literature was separated from the primary empirical evidence used for thematic synthesis. Sixteen primary studies published between 2021 and 2026 contributed to the findings and encompassed active symptom monitoring, passive smartphone sensing, digitally mediated therapy, supported self-management, digital access and engagement, and algorithm-based relapse prediction. Reflexive thematic synthesis identified three interconnected themes. First, consent functioned as an ongoing negotiation of data type, purpose, access, interpretation, and continued participation rather than as a single authorization event. Second, digital care could reduce visible contact with mental health services while simultaneously reproducing stigma through digital exclusion, disclosure of psychiatric identity, persistent records, and decontextualized interpretation of ordinary behaviour as risk. Third, therapeutic trust depended on reciprocity, human interpretation, transparency about responsibility, contestability of automated outputs, and evidence that monitoring produced meaningful and timely benefit. Experiences differed according to monitoring modality and whether participants described actual or anticipated technology use. Digital monitoring in psychosis care is therefore most defensible when data collection is proportionate, users retain meaningful control, automated interpretations remain contestable, and monitoring supports rather than substitutes therapeutic relationships. The heterogeneity of digital modalities, study designs, psychosis stages, and predominantly high-income settings limits the transferability of the synthesis and warrants longitudinal research examining lived experience during routine clinical implementation
early psychosis; digital monitoring; digital phenotyping; privacy; stigma; therapeutic trust; qualitative evidence synthesis
Copyright (c) 2026 Ding li, Liena, Fioni (Author) https://creativecommons.org/licenses/by/4.0
Algorithmic Smile Ideals: How Short-Video Dentistry Shapes Expectations, Appearance Anxiety, and Consent Among Young Adults
Background: Short-video platforms increasingly present cosmetic dentistry through highly visual transformations that combine clinical information, advertising, testimonials, and appearance ideals. Although social-media exposure has been associated with dental aesthetic perceptions and interest in cosmetic procedures, less is known about how young adults interpret such content and incorporate it into appearance evaluation, consultations, and treatment decisions. Objective: To explore how short-video dental content shapes young adults’ perceptions of ideal smiles, appearance-related comparison and self-surveillance, use of visual references during dental consultations, and deliberation about cosmetic dental treatment and informed consent. Methods: An interpretivist qualitative study was conducted in Medan, North Sumatra, Indonesia, from February to May 2026. Twelve purposively sampled adults aged 18–29 years who regularly used TikTok, Instagram Reels, or YouTube Shorts and had undergone, sought, or seriously considered cosmetic dental treatment participated in semi-structured interviews lasting approximately 45–60 minutes. Data were analysed using reflexive thematic analysis. Results: Four interrelated themes were developed: the algorithmic ideal smile, from inspiration to self-surveillance, screenshot-led consultation, and consent under aesthetic momentum. Repeated exposure contributed to perceptions of whiteness, alignment, symmetry, and apparent naturalness as desirable norms. Content could reduce embarrassment and improve treatment awareness while also encouraging repeated comparison and appearance checking. Nine participants had shown or intended to show screenshots during consultations, which facilitated communication but could also become implicit benchmarks for expected change. Participants further described how accumulated emotional, visual, social, and practical investment in an anticipated outcome could make benefits more salient than uncertainty, maintenance, irreversibility, alternatives, or no treatment. Conclusion: Short-video dental content formed part of the broader relational context in which participants interpreted cosmetic expectations and treatment choices. Clinician engagement with visual references, biological limitations, conservative alternatives, and meaningful decision time may support more reflective and informed cosmetic dental decision-making
short-video dentistry; cosmetic dentistry; ideal smile; appearance anxiety; informed consent.
Copyright (c) 2026 Liu Yulan, Florenly, Shieny (Author) https://creativecommons.org/licenses/by/4.0
From Scrolling to Surgical Decisions: Social-Media-Shaped Expectations, Informed Consent, and Surgeon Communication in Aesthetic Plastic Surgery
Background: Social media increasingly shapes the appearance ideals, treatment information, professional portfolios, and postoperative images encountered by prospective aesthetic-surgery patients before consultation. Although quantitative studies associate social-media exposure, filter use, and appearance-focused engagement with greater consideration of cosmetic procedures, less is known about how digitally shaped preferences become personally meaningful expectations and how those expectations subsequently interact with risk perception and clinical communication. Objective: To explore how social-media-shaped expectations influenced aesthetic-surgery decision-making, risk perception, informed-consent experiences, and communication with surgeons. Methods: A qualitative descriptive study with an interpretivist orientation was conducted between January and April 2026. Twelve adults who had considered or undergone aesthetic plastic surgery and had used social media during decision-making were purposively sampled. Semi-structured interviews explored memorable digital content, filtered or edited images, anticipated physical and psychosocial benefits, surgeon selection, risk and recovery perceptions, reference photographs, consultation experiences, and decision revision. Data were analysed using reflexive thematic analysis, incorporating both semantic and latent interpretation and attention to divergent cases. Results: Three interrelated themes were developed. From Scrolling to Wanting described cumulative visual exposure, personalised comparison, and filtered self-representations through which aesthetic preferences became more salient. Seeing the Result, Discounting the Uncertainty captured the greater psychological salience of visible desired outcomes compared with complications, uncertain recovery, and individual anatomical limitations. The Consultation as a Corrective Conversation described how exploration of reference images, anatomical explanation, communication of uncertainty, psychosocial questioning, and opportunities for reflection could reinforce, modify, postpone, or reverse treatment intentions. Conclusion: Social-media influence was experienced as a cumulative and context-dependent process rather than a uniform determinant of aesthetic surgery. Participants described consultation as most meaningful when digitally shaped expectations were explored, individualised, and related to realistic anatomical and psychosocial possibilities. These findings support treating expectation management as an ongoing process extending from digital exposure through consultation and deliberation
social media; aesthetic plastic surgery; patient expectations; informed consent; shared decision-making; reflexive thematic analysis; qualitative research
Copyright (c) 2026 Lan Bin, Sulaiman Delrizal, Ali Napiah Nasution (Author) https://creativecommons.org/licenses/by/4.0
A Descriptive Observation of Brain Region Involvement During Unclear Stress Responses Across Heterogeneous Populations
Background: Stress experienced without a clearly identifiable precipitating event may involve altered engagement of neural circuits responsible for emotional salience, cognitive regulation, and physiological stress processing. Objective: To characterize regional brain activation during an ambiguous stress condition and examine its associations with perceived stress and salivary cortisol in adults. Methods: This cross-sectional task-based functional magnetic resonance imaging study included 60 adults aged 18–50 years from the Islamabad–Rawalpindi region. Perceived stress was assessed using the PSS-10, anxiety and depressive symptoms using HADS, and physiological assessment included resting heart rate and morning salivary cortisol. Participants underwent 3-Tesla functional magnetic resonance imaging during an ambiguous stress-induction task incorporating social-evaluative uncertainty and cognitive interference. Regional BOLD responses were evaluated in the amygdala, anterior cingulate cortex (ACC), prefrontal cortex, hippocampus, and insula. Pearson correlations and independent-samples t-tests were applied. Results: Mean ACC activation was 0.91 ± 0.25%, followed by amygdala activation at 0.84 ± 0.22%. PSS-10 scores correlated positively with amygdala activation (r=0.46, p=0.001) and ACC activation (r=0.41, p=0.002) and inversely with prefrontal activation (r=−0.31, p=0.017). Cortisol correlated positively with ACC activation (r=0.39, p=0.003). Females demonstrated higher amygdala activation than males (0.92 ± 0.20% vs 0.78 ± 0.21%; p=0.014). Conclusion: Perceived stress under uncertain conditions was associated with differential engagement of limbic, cingulate, and prefrontal regions, with convergent associations across subjective, biochemical, and neural measures. These findings represent cross-sectional neural correlates and should not be interpreted as causal or predictive biomarkers
Anterior Cingulate Cortex; Amygdala; Cortisol; Functional Magnetic Resonance Imaging; Perceived Stress; Prefrontal Cortex; Stress Response.
Copyright (c) 2026 Asfand Yar Wali Khan, Muhammad Zia Iqbal, Farhan Ali, Sumera Kanwal, Iraj Siddiqui, Khan Deen, Sundas Farhat (Author) https://creativecommons.org/licenses/by/4.0
Effect of Vestibular Rehabilitation Combined with Cervical Manual Therapy in Patients with Cervicogenic Dizziness: A Randomized Controlled Trial
Background: Cervicogenic dizziness is associated with cervical dysfunction and disturbed integration of cervical proprioceptive, vestibular, and visual information. Evidence regarding rehabilitation programs simultaneously addressing cervical and vestibular impairments remains limited. Objective: To compare vestibular rehabilitation combined with cervical manual therapy and cervical exercises with vestibular rehabilitation alone in patients with cervicogenic dizziness. Methods: This multicenter randomized controlled trial included 60 participants allocated equally to experimental and control groups. Both groups received vestibular rehabilitation three times weekly for six weeks; the experimental group additionally received cervical manual therapy and cervical home exercises. Dizziness Handicap Inventory (DHI), Visual Analogue Scale, Neck Disability Index, Berg Balance Scale, cervical Joint Position Error, and cervical range of motion were assessed at baseline, Week 6, and Week 12. Outcomes were analyzed using mixed repeated-measures ANOVA with Bonferroni-adjusted comparisons. Results: DHI decreased from 55.4 ± 8.3 to 17.2 ± 4.4 in the experimental group and from 55.9 ± 8.5 to 32.0 ± 6.3 in controls. At Week 12, the between-group DHI difference was −14.8 points. Significant group × time interactions occurred for all outcomes (partial η² = 0.30–0.41; p < 0.001), with greater improvements in pain, disability, balance, proprioception, and cervical mobility in the experimental group. Conclusion: A multimodal cervical-plus-vestibular rehabilitation program produced greater short-term improvement than vestibular rehabilitation alone in patients with cervicogenic dizziness
Cervicogenic dizziness; Vestibular rehabilitation; Cervical manual therapy; Dizziness Handicap Inventory; Randomized controlled trial; Physiotherapy
Copyright (c) 2026 Nida Pervaiz, Muhammad Baqir, Muhammad Usman, Syeda Maria Nazir, Ismail khan, Sara Tariq (Author) https://creativecommons.org/licenses/by/4.0
Network Pharmacology and Bioinformatics Perspectives on Quercetin from Moringa Oleifera in Cancer Therapy
Background: Quercetin is a naturally occurring flavonol present in Moringa oleifera and several dietary plant sources and has attracted considerable interest because of its reported multitarget anticancer activity. Network pharmacology and bioinformatics provide systems-level approaches for interpreting the diverse molecular pathways potentially influenced by quercetin and for prioritizing cancer-associated targets for experimental investigation. Objective: This integrative narrative review aimed to synthesize current evidence on the phytochemical and pharmacological characteristics of quercetin in the context of Moringa oleifera, evaluate published network-pharmacology and bioinformatics findings concerning its cancer-associated targets and pathways, and examine its potential roles in tumor biology, combination therapy, and translational oncology. Methods: Published evidence was synthesized across predefined thematic domains, including quercetin phytochemistry and pharmacology, network pharmacology, protein–protein interaction networks, functional and pathway-enrichment analyses, molecular docking and molecular-dynamics studies, cancer-specific mechanisms, tumor-microenvironment modulation, combination-treatment strategies, pharmacokinetic limitations, formulation approaches, and translational challenges. Computational findings were interpreted separately from biochemical, cellular, animal, and clinical evidence, and studies of purified quercetin were distinguished from investigations involving multicomponent M. oleifera preparations. Results: Across the reviewed literature, quercetin-associated targets repeatedly converged on pathways regulating proliferation, apoptosis, oxidative and inflammatory signaling, angiogenesis, metastatic behavior, and treatment resistance. Network-based studies frequently identified cancer-associated proteins including TP53, AKT1, VEGFA, CCND1, and regulators of cell-cycle and survival signaling as highly connected candidate nodes. Reported cancer-related pathways included PI3K/AKT/mTOR, MAPK, NF-κB, JAK/STAT, p53, hormone-receptor, and EGFR-associated signaling. Preclinical evidence further suggested potential effects on tumor-associated macrophages, cytokine signaling, efferocytosis, and PD-1/PD-L1-related mechanisms. Molecular docking and molecular-dynamics studies provided structural hypotheses for several quercetin–protein interactions, while combination studies described potential enhancement of chemotherapy, radiotherapy, targeted therapy, and immune-checkpoint approaches. However, the strength of evidence varied substantially across computational, experimental, and translational levels. Conclusion: Quercetin represents a biologically plausible multitarget anticancer candidate with potential relevance to several interconnected cancer-associated pathways. Nevertheless, computational predictions and preclinical findings do not establish clinical efficacy. Translation remains limited by formulation-dependent bioavailability, extensive metabolism, variability among M. oleifera preparations, incomplete experimental validation of predicted molecular targets, and limited clinical evidence. Standardized formulations, pharmacologically relevant experimental models, direct target-engagement studies, rigorous evaluation of combination strategies, and carefully designed clinical investigations are required before quercetin can be established as an adjunctive cancer therapy.
Quercetin; Moringa oleifera; network pharmacology; bioinformatics; cancer therapy; molecular docking; molecular dynamics; tumor microenvironment; immunomodulation; precision oncology
Copyright (c) 2026 Mehak Nimra, Faseeha Nadeem, Laiba Wadood, Norin Memon, Zara Ijaz, Amna Noor, Syed Adil Hussain Shah, Sofia Fiaz, Zeeshan Dahri, Hamid Nawaz (Author) https://creativecommons.org/licenses/by/4.0
Hypoglycorrhachia as a Central Diagnostic Feature inTuberculous Meningitis: Investigating its Relationshipwith Patient Age and Sex
Background: Hypoglycorrhachia is a common cerebrospinal fluid biochemical abnormality in tuberculous meningitis, but variation in CSF glucose concentration according to patient demographic characteristics remains insufficiently characterized. Objective: To examine the association of patient age and sex with CSF glucose concentration among patients with confirmed tuberculous meningitis. Methods: A hospital-based cross-sectional study was conducted in the Neurology Department of General Hospital, Lahore, Pakistan, from January to April 2025. A total of 120 patients with confirmed TBM were included in the final analysis. CSF glucose concentrations were compared according to sex and predefined age categories of 16–35, 36–50, and 51–80 years. Independent samples t-test, one-way analysis of variance with post-hoc comparisons, and multiple linear regression were used as applicable. Results: Mean CSF glucose concentration was 41.2 ± 12.1 mg/dL. Female participants had lower mean CSF glucose concentrations than male participants (34.1 ± 8.9 vs 47.3 ± 11.2 mg/dL; p < 0.001). Mean CSF glucose also decreased across age groups, from 45.1 ± 10.8 mg/dL among participants aged 16–35 years to 41.9 ± 11.5 mg/dL among those aged 36–50 years and 36.8 ± 9.5 mg/dL among those aged 51–80 years (ANOVA p = 0.002). Increasing age remained associated with lower CSF glucose in multivariable analysis (B = −0.21 mg/dL per year, 95% CI: −0.36 to −0.06; p = 0.008). A significant adjusted association with sex was also reported. Conclusion: CSF glucose concentration among patients with confirmed TBM was associated with age and sex, with lower concentrations observed among female and older participants. These findings demonstrate demographic variation within confirmed TBM cases but do not establish demographic-specific diagnostic thresholds. Further multicenter diagnostic and observational studies are required to determine the clinical significance of these associations
Tuberculous Meningitis; Hypoglycorrhachia; Cerebrospinal Fluid; Glucose; Age Factors; Sex Factors.
Copyright (c) 2026 Danial Hassan Adil, Yaye Aby Lo, Marwa Liaqat Ali, Asim Patrick, Aqsa Batool, Qandeel Abbas Soomro, Irfan Ali, Nouman Aslam (Author) https://creativecommons.org/licenses/by/4.0
Certificate of Editorial Service and Appreciation
This certificate is issued to Dr. Muhammad Nadeem Chohan, Assistant Professor of English at Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, in recognition of his valuable editorial services to the Link Medical Journal of Health and Community Research (LMJHCR) from July 2024 to Present. Certificate ID: LMJCR-213
Copyright (c) 2026 Dr. Muhammad Nadeem Chohan (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Mirror Therapy Combined with Task-Oriented Training versus Task-Oriented Training Alone on Upper Limb Function in Chronic Stroke Patients: A Randomized Controlled Trial
Background: Persistent upper-limb impairment after stroke restricts independence and participation in daily activities. Mirror therapy provides augmented visual feedback that may enhance task-oriented motor practice. Objective: To compare mirror therapy combined with task-oriented training with task-oriented training alone for improving upper-limb motor function and functional performance in adults with chronic stroke. Methods: This assessor-blinded, two-arm randomized controlled trial was conducted at Therapy Plus Clinic, Lahore, Pakistan. Twenty-eight adults with chronic stroke were allocated equally to mirror therapy plus task-oriented training or task-oriented training alone. Outcomes were assessed at baseline and immediately after treatment. The primary outcome was the Fugl-Meyer Assessment–Upper Extremity, and the secondary outcome was the Action Research Arm Test. Within-group changes were examined using paired-samples t tests, and change scores were compared between groups using independent-samples t tests. Results: Fugl-Meyer scores improved by 14.2 ± 5.0 points in the combined group and 7.3 ± 4.4 points in the comparison group, producing a between-group difference of 6.9 points (95% CI, 3.24–10.56; p = 0.001; Cohen’s d = 1.47). Action Research Arm Test scores improved by 14.8 ± 5.7 and 7.1 ± 4.9 points, respectively, with a between-group difference of 7.7 points (95% CI, 3.57–11.83; p = 0.001; Cohen’s d = 1.45). Conclusion: Mirror therapy combined with task-oriented training produced greater immediate improvement in upper-limb motor impairment and structured functional performance than task-oriented training alone
chronic stroke; mirror therapy; task-oriented training; upper limb; motor recovery; Fugl-Meyer Assessment; Action Research Arm Test
Copyright (c) 2026 Hafsa Zahid, Rahila Suleman, Zarqa Sharif , Hanan Azfar , Bisma Shakil, Sufyan Nawaz, Umar Farooq Nazir, Muhammad Tahir (Author) https://creativecommons.org/licenses/by/4.0
A Cross-Sectional Comparative Study of Academic, Clinical, and Social Stress Among Undergraduate Nursing Students in Public and Private Institutions in Swat
Background: Undergraduate nursing students encounter academic, clinical, and social demands that may affect their well-being and educational performance, but evidence comparing stress across public and private institutions in Swat is limited. Objective: To determine academic, clinical, and social stress among undergraduate nursing students and compare stress-level distributions according to institutional sector, gender, and year of study. Methods: A multicentre comparative cross-sectional study included 237 second-, third-, and fourth-year nursing students from two public and two private institutions in Swat, Pakistan. Participants were recruited through convenience sampling and completed the 43-item Stress in Nursing Students questionnaire. Stress was classified as low, moderate, or severe. Data were analysed using descriptive statistics, Pearson’s chi-square tests, Cramér’s V, and unadjusted odds ratios with 95% confidence intervals. Results: Moderate academic, clinical, and social stress was reported by 62.0%, 59.9%, and 49.4% of participants, respectively. Severe stress was most frequent in the clinical domain (7.2%). Clinical stress differed by institutional sector (p=0.043), and public-sector students had higher odds of moderate or severe clinical stress than private-sector students (OR=1.83, 95% CI 1.06–3.17). Academic and social stress did not differ significantly by sector. Clinical stress varied by year of study (p=0.033), while academic and social stress were associated with gender (p=0.042 and p<0.001, respectively). Conclusion: Moderate stress was common across all domains, with the clearest institutional difference observed for clinical stress. Structured clinical preparation and student-support strategies are warranted, although adjusted and longitudinal studies are needed.
Nursing Students; Psychological Stress; Clinical Education; Academic Stress; Social Stress; Public Institutions; Private Institutions; Pakistan.
Copyright (c) 2026 Zafar Iqbal, Hassan Ali, Maimon Khan, Shahid Khan, Noman Khan, Sadaat Khan, Iqdar Ali (Author) https://creativecommons.org/licenses/by/4.0
Knowledge and Practicing Attitude for Diagnostic Approaches to Non-Healing Oral Ulcers Among Dental Practitioners in Pakistan: A Cross-Sectional Study
Background: Persistent oral ulcers may represent traumatic, inflammatory, infectious, potentially malignant, or malignant conditions and require timely assessment. Dental practitioners play an important role in early recognition, biopsy selection, and referral. Objective: To evaluate dental practitioners’ knowledge, attitudes, self-reported confidence, diagnostic practices, referral behaviour, and perceived barriers regarding non-healing oral ulcers in Pakistan. Methods: A cross-sectional questionnaire-based survey was conducted among 227 dental practitioners recruited through professional and academic networks. Information was collected on professional characteristics, recognition of suspicious features, biopsy awareness, initial management, referral practices, and diagnostic barriers. Data were analysed descriptively using frequencies and percentages. Results: Fair or good knowledge was reported by 207 participants (91.2%). A 14-day persistence threshold was identified by 158 (69.6%), while 179 (78.9%) recognized induration and rolled margins as suspicious. Biopsy was considered the diagnostic gold standard by 211 (93.0%), but only 54 (23.8%) selected biopsy as their first approach. Removal of local irritants followed by review was selected by 105 (46.3%), and 114 (50.2%) deferred referral until initial treatment failed. Inadequate training was the leading barrier (36.1%). Conclusion: Respondents demonstrated favourable awareness but reported less consistent implementation of timely biopsy and referral. Practical training and standardized referral pathways may help reduce this knowledge–practice gap
non-healing oral ulcer; oral cancer; biopsy; dental practitioners; diagnostic practice; Pakistan
Copyright (c) 2026 Komal Malik, Maira Izhar, Muhammad Ibrahim, Noor ul ain waheed, Muhammad Farrukh, Hafsa Shahid (Author) https://creativecommons.org/licenses/by/4.0
Impact of Physiotherapy on Kinesiophobia and Knee Pain After Knee Replacements
Background: Pain and fear of movement may restrict participation in rehabilitation after total knee replacement. Evidence regarding their relationship with routine physiotherapy attendance in Pakistan remains limited. Objective: To determine the association of physiotherapy-session exposure with kinesiophobia and knee-pain intensity after total knee replacement. Methods: This analytical cross-sectional study included 144 patients aged 40–60 years who were assessed one to three months after total knee replacement at hospitals and private physiotherapy clinics in Lahore. Participants were classified as having higher exposure if they had completed five or more physiotherapy sessions and lower exposure if they had completed fewer than five sessions. Pain was assessed using the Numeric Pain Rating Scale, and kinesiophobia was assessed using the 11-item Tampa Scale for Kinesiophobia. Associations were examined using Pearson’s chi-square test. Results: Each exposure group included 72 participants. Kinesiophobia was present in 12 (16.7%) participants in the higher-exposure group and 55 (76.4%) in the lower-exposure group (χ²(1)=51.61, p<0.001). The crude risk ratio was 0.22 (95% CI 0.13–0.37). No or mild pain was reported by 75.0% of the higher-exposure group compared with 12.5% of the lower-exposure group, whereas moderate or severe pain was reported by 25.0% and 87.5%, respectively (χ²(3)=59.05, p<0.001). Conclusion: Greater physiotherapy-session exposure was associated with lower kinesiophobia and less severe knee pain; however, the cross-sectional design did not establish causality
Total Knee Replacement; Kinesiophobia; Physiotherapy; Postoperative Rehabilitation; Knee Pain; Tampa Scale for Kinesiophobia.
Copyright (c) 2026 Ayesha Izhar, Maham Naeem, Eisha-Tur Raazia, Mehwish Shahzadi, Hafiza Ramal, Anam Abbas (Author) https://creativecommons.org/licenses/by/4.0
Geographic and Socioeconomic Predictors of Postpartum Depression Identified Through Machine Learning Analysis of Pakistani Health Data
Background: Postpartum depressive symptoms are frequently under-recognised in resource-constrained settings, and their geographic and socioeconomic distribution within Pakistani hospital populations remains insufficiently characterised. Objective: To identify hospital-city and socioeconomic predictors of postpartum depressive symptom severity using conventional regression and random forest analysis. Methods: This multicentre retrospective record-based analytical study included 336 postpartum women aged 18–45 years receiving care at tertiary hospitals in Karachi, Lahore, and Rawalpindi between January 2021 and December 2023. The primary outcome was the continuous Edinburgh Postnatal Depression Scale score. Geographic and socioeconomic predictors were examined using analysis of variance, multivariable linear regression, and random forest regression. Results: The mean EPDS score was 11.2 ± 5.8, and 187 women (55.7%) screened positive at an EPDS threshold of ≥10. Mean scores were highest in Rawalpindi (13.4 ± 5.9), followed by Lahore (11.1 ± 5.6) and Karachi (9.1 ± 5.2). Compared with the respective reference categories, Rawalpindi hospital-city site was associated with a 3.9-point higher score, household income below PKR 30,000 with a 5.8-point increase, no formal education with a 4.9-point increase, and overcrowding with a 3.2-point increase. The random forest model achieved a test-set R² of 0.51. Conclusion: Socioeconomic disadvantage and hospital-city context were associated with greater postpartum depressive symptom severity. Targeted screening may be warranted among women from low-income, poorly educated, and overcrowded households
Edinburgh Postnatal Depression Scale; geographic variation; household income; machine learning; maternal education; overcrowding; Pakistan; postpartum depression
Copyright (c) 2026 Sabira Feroz, Sidra Irfan, Fariha Muhammad Iqbal, Noorulain Tariq Siddiqui, Zubia Shahid, Saeed Wali, Iraj Siddiqui (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Wilbarger Protocol on Tactile Defensiveness in Children with Autism Spectrum Disorder
Background: Tactile defensiveness may restrict self-care, play, social interaction, and participation among children with autism spectrum disorder. Evidence supporting the Wilbarger Deep Pressure and Proprioceptive Technique remains limited. Objective: To evaluate short-term changes in tactile-response classification following a three-week Wilbarger Protocol intervention. Methods: This single-group quasi-experimental pretest–posttest study included 16 children aged 3–14 years with autism spectrum disorder and tactile defensiveness recruited from two clinical settings in Lahore, Pakistan. Caregivers administered firm-pressure brushing followed by joint compressions four times daily for three weeks after therapist training. Tactile responses were assessed before and after intervention using the relevant Sensory Profile-2 classification. Changes were summarized as category transitions and analyzed using an exact two-sided sign test. Results: All participants were classified as having tactile responses “much more than others” at baseline. After intervention, five children (31.3%) moved to “just like the majority of others,” five (31.3%) moved to “more than others,” and six (37.5%) remained unchanged. Overall, 10 children (62.5%) improved by at least one classification level, while none worsened. The directional change was statistically significant (p = 0.002). Conclusion: Short-term improvement in tactile-response classification was observed among some participants, but the uncontrolled design, small sample, and ordinal caregiver-reported outcome prevent causal conclusions
Autism spectrum disorder; tactile defensiveness; sensory over-responsivity; Wilbarger Protocol; deep pressure; occupational therapy; Sensory Profile-2.
Copyright (c) 2026 Maryam Ashraf, Sikander Ghayas Khan, Ifrah Kaleem, Jazib Haider (Author) https://creativecommons.org/licenses/by/4.0
Neuromodulatory Impact of Low-Intensity Focused Ultrasound on Early Cognitive Decline
Background: A mild neurocognitive disorder causes problems with memory, attention and thinking skills.. There are not many good ways to treat this that do not need surgery. Objective: To see how active low-intensity focused ultrasound and fake ultrasound affect memory, attention and brain connections in people with neurocognitive disorder. Methods: This study had 76 people, aged 55 to 80. They were split into two groups. One group got ultrasound that targeted parts of the brain related to thinking and memory. The other group got a treatment. They tested the brain functions of the people before the treatment one week after and two months after. Sixty-eight people finished the study. Results: One week after the treatment people who got ultrasound had better memory than those who got the fake treatment. The difference was still there two months later. People who got ultrasound also did better on a test of attention. Their brain connections between the part of the brain and the hippocampus were stronger, than those who got the fake treatment. No serious problems happened. low-intensity focused ultrasound seems to help with memory and attention and makes brain connections stronger.. More studies are needed to be sure
Attention; Cognitive Dysfunction; Double-Blind Method; Functional Connectivity; Memory; Mild Neurocognitive Disorder; Non-Invasive Brain Stimulation; Randomized Controlled Trial; Ultrasonic Waves.
Copyright (c) 2026 Abdul Rehman Naeem, Mahwish Haque, Saima Kanwal Attique, Maqsooda Akram Butt, Syeda Qaima Abbas, Sameea Areeb (Author) https://creativecommons.org/licenses/by/4.0
Exosomal MicroRNA-21 Expression Changes During Neoadjuvant Chemotherapy in Breast Cancer Patients
Background: Variability in breast cancer response to neoadjuvant chemotherapy highlights the need for minimally invasive biomarkers capable of reflecting treatment effectiveness during therapy. Circulating exosomal microRNA-21 may provide dynamic molecular information because of its stability and association with tumor progression and treatment response. Objective: To evaluate longitudinal changes in circulating exosomal miR-21 during neoadjuvant chemotherapy and examine their association with tumor response. Methods: This parallel-group randomized controlled trial enrolled 72 women with stage II–III breast cancer at a tertiary-care oncology center in Punjab, Pakistan. Participants were allocated equally to protocolized exosome-guided monitoring or routine clinical monitoring. Blood was collected at baseline and before chemotherapy cycles for exosomal miR-21 quantification using quantitative reverse-transcription polymerase chain reaction. Final outcomes were available for 67 participants. Analyses included t-tests, repeated-measures analysis of variance, risk ratios, and Pearson correlation. Results: Post-treatment miR-21 expression was lower in the intervention group than in the control group (1.42±0.39 versus 2.11±0.53; mean difference=−0.69; 95% CI: −0.92 to −0.46; p<0.001). Tumor shrinkage was greater by 15.50 percentage points (95% CI: 6.80–24.20; p<0.001). RECIST response was 84.8% versus 64.7% (p=0.058), and pathological complete response was 39.4% versus 23.5% (p=0.162). miR-21 reduction correlated with tumor shrinkage (r=0.62; 95% CI: 0.45–0.75; p<0.001). Conclusion: Serial exosomal miR-21 measurement reflected treatment-associated molecular changes and was associated with radiological tumor reduction, but larger standardized trials are required before clinical implementation
Biomarkers; Breast Neoplasms; Exosomes; MicroRNAs; Neoadjuvant Therapy; Precision Medicine; Treatment Outcome.
Copyright (c) 2026 Rameen Khalid, Samira Khaliq, Taram Nayab, Muhammad Naveed, Sehrish Siddiqui, Muhammad Abbas Sadiq, Nimra Sikander (Author) https://creativecommons.org/licenses/by/4.0
Low-Level Laser Therapy Versus Occlusal Splint for Myofascial Pain Reduction in Chronic TMJ Disorder Patients
Background: Chronic myofascial temporomandibular disorders cause persistent orofacial pain, restricted mandibular movement, and functional limitation. Photobiomodulation may provide a non-invasive alternative to occlusal appliances. Objective: To compare 810 nm diode laser photobiomodulation with custom-fabricated occlusal splint therapy for reducing pain and improving jaw function. Methods: This parallel-group randomized controlled trial enrolled 72 adults with chronic myofascial temporomandibular disorders at a tertiary dental care centre in Southern Punjab, Pakistan. Participants were allocated equally to 12 laser sessions over four weeks or nighttime occlusal splint use. Outcomes were assessed by a blinded examiner at baseline and four weeks. Between-group comparisons, paired tests, repeated-measures analysis of variance, and correlation analysis were performed. Results: Sixty-seven participants completed follow-up: 34 in the laser group and 33 in the splint group. Post-intervention VAS pain scores were lower with laser therapy than with splint therapy (2.6 ± 1.1 versus 3.8 ± 1.4; mean difference −1.2, 95% CI −1.8 to −0.6; p<0.001). Jaw Functional Limitation Scale scores were also lower (16.4 ± 5.2 versus 20.7 ± 6.1; p=0.003). Maximum mouth opening and lateral mandibular movement favoured laser therapy. The VAS time × group interaction was significant (F=12.9; p<0.001). Conclusion: Photobiomodulation produced greater short-term improvements in pain and mandibular function than occlusal splint therapy
Jaw Functional Limitation; Low-Level Light Therapy; Myofascial Pain; Occlusal Splints; Photobiomodulation; Temporomandibular Disorders
Copyright (c) 2026 Mishka Amanullah, Sabir Ali, Uzma Zareef, Areeba Zubair, Sana M. Ashraf, Arshad Ahmad (Author) https://creativecommons.org/licenses/by/4.0