Link Medical Journal of Health and Community Research (LMJHCR) is a bi-annual, open-access journal published by Link Medical Interface, focused on original research in medical sciences, clinical disciplines, rehabilitation, allied health, and biomedical fields. The journal also considers submissions in healthcare management, disease prevention, and public health (including community medicine). LMJHCR supports clinicians and practitioners with editorial and research mentorship throughout the publication process. Frequency: Bi-Annual ISSN: 3007-3448 Publisher: Link Medical Interface HEC Recognized (page 65) Indexing: Google Scholar, CrossRef, and others Open Access: CC BY 4.0 APC: None Publication Fee: 40,000 PKR (post-acceptance) Submit your research to LMJHCR and join a platform committed to advancing evidence-based medical practice.
Link Medical Interface, Lahore, Pakistan
© 2025 The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Assessing postoperative physiotherapy adherence and functional recovery among tibial plateau fracture patients in Punjab
Background: Tibial plateau fractures are complex intra-articular injuries that require surgical stabilisation and structured rehabilitation to restore optimal knee function. Postoperative physiotherapy adherence is a key determinant of functional recovery, yet evidence from South Asian populations remains limited. Objective: To evaluate the relationship between physiotherapy adherence and functional recovery among patients with surgically treated tibial plateau fractures at tertiary care hospitals in Punjab. Methods: A cross-sectional study was conducted over six months among 120 adult patients who underwent open reduction and internal fixation for tibial plateau fractures. Physiotherapy adherence was assessed using a structured adherence checklist, categorising patients as high, moderate, or low adherence. Functional outcomes were measured with the Lysholm Knee Scoring Scale and goniometric knee range of motion (ROM). Data were analysed using one-way ANOVA and Pearson’s correlation to determine associations between adherence and recovery outcomes. Results: The mean age of participants was 40.7 ± 9.3 years, with 51.7% males. High, moderate, and low physiotherapy adherence were recorded in 40.0%, 38.3%, and 21.7% of patients, respectively. The overall mean Lysholm score was 83.6 ± 10.6, and mean knee ROM was 120.1 ± 15.2 degrees. Patients with higher adherence demonstrated slightly greater ROM (p=0.08) and stable Lysholm scores across groups. A modest positive correlation was observed between adherence and ROM (r=0.19, p=0.03). Conclusion: Consistent physiotherapy adherence was associated with improved knee mobility and maintained functional stability following surgical fixation of tibial plateau fractures. Enhancing access to rehabilitation and patient engagement may optimise recovery outcomes in similar healthcare settings.
Adherence, Knee Injuries, Orthopedic Rehabilitation, Patient Compliance, Physiotherapy, Range of Motion, Tibial Fractures
Copyright (c) 2025 Zarina Naz, Arsalan Rasool, Abdul Rehman Usama, Rafia Siddique, Hassan Raza, Muhammad Bilal Yasin (Author) https://creativecommons.org/licenses/by/4.0
Impact of Lumbar Stabilization Exercises on Pain and Functional Disability in Patients With Chronic Lumbosacral Strain
Background: Chronic lumbosacral strain is a prevalent musculoskeletal condition characterized by persistent lower back pain and functional limitations, adversely affecting daily activities and quality of life. Conventional therapies often provide limited long-term benefits, highlighting the need for targeted interventions that restore spinal stability and improve functional outcomes. Objective: To assess the effectiveness of a structured lumbar stabilization exercise program on pain intensity and functional disability in adults with chronic lumbosacral strain. Methods: A randomized controlled trial was conducted in outpatient physiotherapy clinics in South Punjab over twelve weeks. Eighty participants aged 25–55 years with persistent lumbosacral discomfort were randomly assigned to an intervention group (n=40) receiving progressive lumbar stabilization exercises or a control group (n=40) receiving conventional physiotherapy and educational guidance. Pain was measured using the Visual Analogue Scale (VAS), and functional disability was assessed with the Oswestry Disability Index (ODI). Data were analyzed using paired and independent t-tests, with p<0.05 considered statistically significant. Results: Participants in the intervention group demonstrated significant reductions in VAS scores (mean change: -3.8 ± 1.2) compared with the control group (-1.4 ± 0.9, p<0.001). Functional disability improved substantially in the intervention group, with ODI scores decreasing by 28.5% ± 7.6%, versus 9.2% ± 5.3% in controls (p<0.001). No adverse events were reported, and adherence rates were high across supervised sessions. Conclusion: Structured lumbar stabilization exercises significantly reduced pain and improved functional capacity in adults with chronic lumbosacral strain. These findings support the integration of targeted, progressive exercise interventions into rehabilitation programs as a safe, effective, and practical strategy for managing chronic lower back disorders.
Chronic low back pain, Functional disability, Lumbar exercises, Muscle stabilization, Pain management, Rehabilitation, Randomized controlled trial
Copyright (c) 2025 Muhammad Asif, Haseeb Muhammad Khna, Muhammad Zubair, Waheed Zaman, Muhammad Muaz, Ayesha Khalid (Author) https://creativecommons.org/licenses/by/4.0
Diagnostic Accuracy of AI-Driven Wearable Sensors for Early Detection of Bruxism
Background: Bruxism, characterized by repetitive jaw-muscle activity involving clenching or grinding, often goes undetected until significant dental or muscular complications arise. Conventional diagnostic approaches—including clinical examination and patient self-reports—frequently miss early or nocturnal episodes. With the emergence of artificial intelligence (AI) and wearable biosensors, continuous and objective monitoring may enhance early detection. Objective: To assess the diagnostic accuracy of AI-integrated wearable jaw-movement sensors compared with standardized clinical examination for early bruxism detection. Methods: A cross-sectional study of 120 adults aged 18–50 years was conducted in Lahore over four months. Participants underwent simultaneous bruxism evaluation using AI-driven wearable jaw-movement sensors and clinical assessment based on international diagnostic criteria. The supervised AI algorithm analyzed sensor-recorded jaw-movement patterns to distinguish bruxism events from normal motion. Diagnostic accuracy parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROC-AUC were computed using SPSS version 26. Results: The AI-enabled wearable device demonstrated a sensitivity of 96.6%, specificity of 89.3%, overall accuracy of 93.1%, PPV of 91.7%, and NPV of 95.2%. ROC analysis indicated excellent performance (AUC = 0.95). A strong correlation (r = 0.86, p < 0.001) was found between AI-detected and clinically diagnosed bruxism cases. Conclusion: AI-driven wearable jaw-movement sensors exhibit high diagnostic precision and strong agreement with clinical evaluation, supporting their utility as reliable, noninvasive tools for early bruxism detection and personalized dental care.
Artificial Intelligence; Bruxism; Diagnostic Accuracy; Jaw Movements; Machine Learning; Sensitivity and Specificity; Wearable Electronic Devices
Copyright (c) 2025 Ayesha Ikram Malik, Amna Javed, Changaiz Khan, Sahaab Alvi, Saba Batool, Muhammad Nadeem Khan (Author) https://creativecommons.org/licenses/by/4.0
Microbial Nanofactories in Cancer Nanomedicine: Harnessing Bacillus subtilis for Green Synthesis of Silver Nanoparticles in Cancer Therapy
The global pursuit of sustainable nanomedicine has accelerated interest in microbial systems as eco-friendly nanofactories capable of producing biologically compatible metal nanoparticles. This review critically explores the role of Bacillus subtilis in the green synthesis of silver nanoparticles (AgNPs) and their therapeutic applications in hepatocellular carcinoma (HCC). Literature from 2010–2025 was systematically screened across PubMed, Scopus, and Web of Science using predefined inclusion criteria focused on B. subtilis–mediated AgNP synthesis and anticancer efficacy. The evidence demonstrates that B. subtilis extracellular enzymes, particularly nitrate reductases and oxidoreductases, facilitate the reduction of Ag⁺ ions to Ag⁰, producing nanoparticles with high stability, spherical morphology (10–50 nm), and a strong negative surface charge. These biologically capped AgNPs exert selective cytotoxicity in hepatic cancer models (HepG2, Huh7) through enhanced reactive oxygen species (ROS) generation, mitochondrial depolarization, caspase-3/9 activation, and apoptosis, while maintaining minimal toxicity to normal hepatocytes. Mechanistic studies reveal modulation of NF-κB, COX-2, mTOR, and AMPK pathways, underpinning their multifaceted anticancer effects. Compared with chemically synthesized nanoparticles, B. subtilis–derived AgNPs exhibit superior biocompatibility, reduced aggregation, and environmental sustainability. Despite promising preclinical findings, translational challenges persist, including synthesis variability, incomplete toxicological profiling, and limited in vivo validation. Clinically, Bacillus subtilis–based biogenic AgNPs offer a novel, sustainable approach to liver cancer nanotherapy with potential for integration into targeted drug delivery and redox-modulating treatment strategies. Future research should focus on genetic optimization of microbial strains, process standardization, and comprehensive pharmacokinetic studies to enable safe clinical translation of microbial nanomedicine for hepatic oncology
Bacillus subtilis, green synthesis, silver nanoparticles, hepatocellular carcinoma, apoptosis, ROS, nanomedicine
Copyright (c) 2025 Azka Razzaq, Nadeem Anwar, Muhammad Waqas, Muhammad Saqlain, Faraz Nadeem, Shiza Shahzadi (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Gallstones in Patients Undergoing Abdominal Ultrasonography at Hayatabad Medical Complex, Peshawar
Background: Gallstone disease is a prevalent hepatobiliary disorder with considerable clinical and economic implications, influenced by demographic, metabolic, and regional factors. Despite its burden, regional epidemiological data from Khyber Pakhtunkhwa remain limited, particularly among patients undergoing routine ultrasonography. Objective: To estimate the prevalence and sonographic characteristics of gallstones and to analyze their association with age, sex, and clinical symptoms among patients undergoing abdominal ultrasonography at Hayatabad Medical Complex, Peshawar. Methods: A descriptive cross-sectional study was conducted on 245 consecutive patients of all ages referred for abdominal ultrasonography. Standardized fasting ultrasonography was performed using a 3–5 MHz curvilinear probe to assess gallstones, their number, location, and gallbladder size. Data were analyzed using SPSS 22, applying chi-square tests and odds ratios with 95% confidence intervals; significance was set at p < 0.05. Results: Gallstones were identified in 82 patients (33.5%), with slightly higher prevalence in females (35.5%) than males (30.8%) (p = 0.442). Prevalence rose significantly with age (p < 0.001), peaking at 50.0% in the 41–50 year group. Most stones were multiple (89.0%) and located within the gallbladder lumen (85.4%), while gallbladder enlargement showed no significant association with stone presence (p = 0.989). Conclusion: Gallstones were common among patients undergoing ultrasonography, predominantly affecting middle-aged adults and characterized by multiple intraluminal stones. These findings highlight the importance of age-targeted evaluation, structured ultrasound reporting, and further analytical studies to refine risk assessment and management strategies for gallstone disease.
Gallstones; Ultrasonography; Prevalence; Age distribution; Pakistan; Hayatabad Medical Complex
Copyright (c) 2025 Wisal Hayat, Irfan Ullah, Munir Khan, Aqib Zeb (Author) https://creativecommons.org/licenses/by/4.0
How Do Language Domains Recover? A Domain-Specific Response Profile to Constraint-Induced Language Therapy in Chronic Post-Stroke Aphasia
Background: Global aphasia scores, such as the Western Aphasia Battery (WAB) Aphasia Quotient (AQ), often obscure heterogeneous domain-specific responses to therapy, limiting tailored speech-language therapy (SLT) planning for chronic post-stroke aphasia (PSA). Understanding differential improvements in spontaneous speech, naming and reading, repetition and writing, and comprehension can optimize session design and goal prioritization, particularly in high-burden regions like Pakistan. Objective: To characterize domain-level changes in language function following Constraint-Induced Language Therapy (CILT) in chronic PSA to inform SLT micro-planning. Methods: A prospective pre-post cohort study enrolled 80 adults with chronic PSA from five Sialkot, Pakistan, centers. Participants received CILT (3 sessions/week, 60–90 minutes) for two months, involving graded verbal tasks constraining non-verbal strategies. WAB domain composites (spontaneous speech, naming and reading, repetition and writing, comprehension) and AQ were assessed pre- and post-therapy. Paired t-tests evaluated mean changes and percent-of-scale gains; AQ changes were modeled with paired correlations. Results: Spontaneous speech improved most (+12.60/20, 63%, p<0.001, d=4.12), followed by naming and reading (+10.04/20, 50.2%, p<0.001, d=3.45), repetition and writing (+9.88/20, 49.4%, p<0.001, d=3.38), and comprehension (+4.50/10, 45%, p<0.001, d=2.35). AQ rose from 24.51±5.92 to 77.38±8.48 (p<0.001, d=5.71), shifting all participants from severe/very severe to moderate/mild categories. Conclusion: CILT preferentially enhances expressive domains, particularly spontaneous speech, while yielding robust comprehension gains, guiding SLT to prioritize verbal output tasks for rapid recovery in chronic PSA.
Post-stroke aphasia, Constraint-Induced Language Therapy, language domains, speech-language therapy, cognitive rehabilitation
Copyright (c) 2025 Saima Ashraf, Sadia Ashraf, Manahal Sughra, Urwa Tul Esha, Abida Shehzadi, Rabia Afzal (Author) https://creativecommons.org/licenses/by/4.0
Determinants of Post-Stroke Cognitive Impairment in a Hospital-Based Sialkot Cohort
Background: Post-stroke cognitive impairment (PSCI) is one of the most disabling sequelae of stroke, contributing to functional dependence, poor rehabilitation outcomes, and reduced quality of life. Despite a rising burden of stroke in Pakistan, there remains limited evidence on the prevalence and determinants of PSCI in secondary-care hospital settings. Objective: To assess the frequency and predictors of post-stroke cognitive impairment among survivors in Sialkot hospitals and to identify the independent socio-demographic and clinical factors influencing cognitive outcomes. Methods: An analytical cross-sectional study was conducted among 100 stroke survivors and 100 healthy controls recruited from four major hospitals in Sialkot between January and June 2024. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), stroke severity by the National Institutes of Health Stroke Scale (NIHSS), and functional status by the Barthel Index. Data were analyzed using SPSS v25, applying t-tests, ANOVA, correlation, and multiple linear regression to determine independent predictors of MoCA scores. Results: Cognitive impairment (MoCA <26) was observed in 78% of stroke survivors versus 12% of controls (p<0.001). Lower MoCA scores correlated significantly with older age (r=-0.47), higher NIHSS (r=-0.59), and lower Barthel Index (r=+0.63). Education, stroke severity, and functional independence independently predicted cognitive performance (adjusted R²=0.61). Conclusion: Post-stroke cognitive impairment is highly prevalent among stroke survivors in Sialkot and is primarily influenced by age, education, and neurological severity. Routine cognitive screening and integrated rehabilitation strategies are recommended to enhance recovery and independence.
Post-Stroke Cognitive Impairment, Stroke Severity, Montreal Cognitive Assessment, Functional Independence, Predictors, Pakistan
Copyright (c) 2025 Sadia Ashraf, Saima Ashraf, Manahal Sughra, Urwa Tul Esha, Abida Shehzadi (Author) https://creativecommons.org/licenses/by/4.0
Fatigue, Social Reintegration, and Quality of Life after Stroke in Sialkot: Beyond Mobility
Background: Post-stroke fatigue is a pervasive and disabling symptom that significantly affects quality of life (QoL) and social reintegration, yet it often remains underrecognized in rehabilitation programs focused primarily on physical recovery. Its impact may be particularly profound in low-resource settings where structured post-stroke care is limited. Objective: This study aimed to examine the relationship between fatigue severity and reintegration to normal living among stroke survivors in Sialkot, Pakistan, while assessing whether this association is independent of gait performance measures. Methods: A cross-sectional study was conducted among 100 post-stroke survivors and 100 age- and sex-matched community controls recruited from five tertiary hospitals. Fatigue was assessed using the Fatigue Severity Scale (FSS), reintegration using the Reintegration to Normal Living Index (RNLI), and gait performance using the Timed Up and Go (TUG) test, gait speed, and cadence. Data were analyzed using Pearson correlation and multivariate regression to identify independent predictors of reintegration, with adjustments for demographic and clinical confounders. Results: Stroke survivors exhibited significantly higher fatigue (FSS 5.78 ± 1.28 vs. 3.58 ± 0.95; p < 0.001) and lower reintegration (RNLI 28.35 ± 16.39 vs. 75.73 ± 11.88; p < 0.001). Fatigue severity independently predicted poorer reintegration (β = −0.29, p = 0.003) after adjusting for mobility and socioeconomic factors. Conclusion: Fatigue exerts a substantial, independent influence on post-stroke reintegration and QoL, underscoring the need for fatigue-focused rehabilitation strategies that extend beyond gait recovery.
Stroke, Fatigue Severity, Reintegration, Quality of Life, Gait, Rehabilitation, Pakistan
Copyright (c) 2025 Saima Ashraf, Urwa Tul Esha, Sadia Ashraf, Abida Shehzadi, Manahal Sughra, Nosheen Fatima (Author) https://creativecommons.org/licenses/by/4.0
Cadence Rules Mobility: Gait Determinants of Functional Performance in Post-Stroke Survivors from Sialkot
Background: Post-stroke mobility impairments significantly hinder independence and quality of life (QoL), particularly in low-resource regions like District Sialkot, Pakistan, where rehabilitation access is limited. While gait speed is often emphasized, cadence may be a more modifiable target for improving functional mobility in such settings, yet its independent role remains underexplored. Objective: To identify the primary gait parameter predicting functional mobility, measured by the Timed Up and Go (TUG) test, among post-stroke survivors in Sialkot, with fatigue and QoL as contextual covariates. Methods: A cross-sectional study recruited 100 post-stroke survivors (86% ischemic) and 100 non-stroke controls from five Sialkot hospitals (September–November 2024). Gait speed (m/s), cadence (steps/min), TUG (s), Fatigue Severity Scale (FSS), and Reintegration to Normal Living Index (RNLI) were assessed. Multiple linear regression predicted TUG from gait speed, cadence, FSS, and RNLI, adjusting for demographics. Results: Stroke survivors exhibited slower TUG (23.95±1.73 vs. 13.29±0.97 s, p<0.001) and gait speed (0.13±0.008 vs. 0.11±0.016 m/s, p<0.001) but higher cadence (59.44±2.72 vs. 52.50±4.12 steps/min, p<0.001) than controls. TUG strongly correlated with cadence (r=-0.956, p<0.001) and speed (r=-0.927, p<0.001); regression (R²=0.916) identified cadence as the sole significant predictor (β=-0.539, p<0.001). Conclusion: Cadence is the dominant determinant of functional mobility in post-stroke survivors, offering a scalable target for low-cost interventions like metronome cueing to enhance recovery in resource-limited settings.
cadence, TUG, gait speed, stroke, functional mobility, Sialkot
Copyright (c) 2025 Urwa Tul Esha, Saima Ashraf, Sadia Ashraf, Abida Shehzadi, Manahal Sughra (Author) https://creativecommons.org/licenses/by/4.0
Cognition and Independence Drive Health-Related Quality of Life in Stroke Survivors: A Predictive Model from District Narowal
Background: Stroke imposes profound physical, cognitive, and psychosocial burdens, leading to sustained reductions in health-related quality of life (QOL). Understanding how cognition and functional independence jointly influence QOL is critical for improving rehabilitation outcomes, especially in low-resource settings where rapid clinical assessment tools are essential. Objective: To quantify the independent and combined effects of cognitive function and functional independence on domain-specific QOL among stroke survivors and to evaluate whether age contributes incremental predictive value. Methods: A cross-sectional predictive study was conducted among 100 stroke survivors at District Headquarter Hospital, Narowal. Health-related QOL was assessed using the WHOQOL-BREF, cognition using the Montreal Cognitive Assessment (MOCA), and functional independence using the Barthel Index (BI). Hierarchical linear regressions examined associations between MOCA, BI, age, and the four QOL domains. Model validity was tested through 10-fold cross-validation. Results: BI and MOCA showed strong positive correlations with all QOL domains (r = 0.41–0.74, p < 0.001). BI independently explained 46–55% of variance in QOL domains, while the addition of MOCA improved explained variance up to 61% (ΔR² = 0.06, p = 0.002). Age had a minor, nonsignificant effect. Cross-validation confirmed model stability (R² = 0.40–0.59). Conclusion: Functional independence and cognition are key determinants of post-stroke QOL, highlighting the value of integrating BI and MOCA into rehabilitation planning to enhance multidimensional recovery in resource-limited healthcare settings.
Stroke, Cognition, Functional Independence, Quality of Life, Barthel Index, Montreal Cognitive Assessment, Rehabilitation
Copyright (c) 2025 Saima Ashraf, Abida Shehzadi, Manahal Sughra, Sadia Ashraf, Urwa Tul Esha (Author) https://creativecommons.org/licenses/by/4.0
Domain-Specific Recovery Patterns Following Constraint-Induced Language Therapy in Chronic Post-Stroke Aphasia
Background: Post-stroke aphasia (PSA) affects approximately one-third of stroke survivors, leading to enduring communication deficits that vary across language domains. While global measures such as the Western Aphasia Battery Aphasia Quotient (WAB-AQ) capture overall severity, they obscure domain-specific responsiveness crucial for tailoring therapy. Constraint-Induced Language Therapy (CILT), founded on use-dependent neuroplasticity, compels verbal output and has shown substantial global efficacy, but its domain-level effects remain underexplored, particularly in chronic cases within resource-limited settings. Objective: To characterize the differential recovery profiles of Spontaneous Speech, Naming+Reading, Repetition+Writing, and Comprehension following a two-month standardized CILT program in adults with chronic PSA. Methods: A prospective pre–post cohort of 80 adults with chronic PSA received thrice-weekly CILT sessions over eight weeks. WAB domain scores were measured before and after intervention. Paired t-tests quantified mean changes, proportional gains, and effect sizes, while correlations assessed domain contributions to overall improvement. Results: Significant gains occurred across all domains (p<0.001). Spontaneous Speech showed the highest improvement (+12.6, 63%), followed by Naming+Reading (+10.0, 50%), Repetition+Writing (+9.9, 49%), and Comprehension (+4.5, 45%). Expressive domains correlated most strongly with global AQ change (r=0.81–0.76). No subgroup differences were observed. Conclusion: CILT elicited robust, domain-specific improvements, with expressive functions demonstrating the greatest responsiveness yet accompanied by meaningful receptive gains. This expressive-forward recovery profile supports prioritizing speech initiation and lexical retrieval in therapy design while sustaining comprehension and repetition tasks for consolidation. Keywords: post-stroke aphasia, constraint-induced language therapy, domain-specific recovery, neuroplasticity, speech-language rehabilitation.
Copyright (c) 2025 Saima Ashraf, Manahal Sughra, Urwa Tul Esha, Abida Shehzadi, Sadia Ashraf (Author) https://creativecommons.org/licenses/by/4.0
Quality of Life Profiles in Brain Stroke Survivors Versus Community Controls: A Case–Control Study from an Under-Resourced District Hospital
Background: Brain stroke is a leading cause of disability and mortality globally, profoundly impacting quality of life (QOL), particularly in under-resourced settings like rural Pakistan where rehabilitation access is limited. Few studies provide case-control comparisons of QOL, cognitive function, and functional independence in district-level hospitals, leaving gaps in understanding localized deficits and screening strategies. Objective: To compare QOL, cognitive function, and functional independence between stroke survivors and community controls at a district hospital in Narowal, Pakistan, and identify simple screening thresholds for low QOL. Methods: In a case-control study from September to November 2023 at District Head Quarter Hospital Narowal, 100 stroke survivors and 100 community controls were assessed using the WHOQOL-BREF, Montreal Cognitive Assessment (MoCA), and Barthel Index (BI). Independent t-tests, two-way ANOVA for age-stratified effects, and ROC analyses were conducted to compare groups and derive cut-offs for low QOL (≤25th percentile of control scores). Results: Stroke survivors showed significantly lower scores across all WHOQOL-BREF domains (p<0.01, Cohen’s d=1.57–3.02), MoCA (mean=15.35 vs. 29.15, p<0.001), and BI (mean=44.90 vs. 98.55, p<0.001), with older survivors (age >65) exhibiting steeper QOL declines (p<0.05). MoCA cut-offs (15–18) and BI cut-offs (45–55) achieved AUCs of 0.75–0.87 for detecting low QOL. Conclusion: Stroke survivors in rural Pakistan face substantial QOL, cognitive, and functional deficits, accentuated by age, necessitating accessible screening and targeted rehabilitation to improve outcomes. Keywords: Stroke, Quality of Life, Cognitive Impairment, Functional Independence, Case-Control Study, Pakistan
Copyright (c) 2024 Abida Shehzadi, Saima Ashraf, Manahal Sughra, Sadia Ashraf, Urwa Tul Esha (Author) https://creativecommons.org/licenses/by/4.0
Constraint-Induced Language Therapy for Chronic Post-Stroke Aphasia: A District-Wide Pre–Post Effectiveness Study from Sialkot
Background: Aphasia remains a major cause of long-term communication disability after stroke, substantially impairing participation, psychosocial wellbeing, and quality of life. Evidence supports intensive behavioral therapies for promoting neuroplasticity, yet real-world data on Constraint-Induced Language Therapy (CILT) in chronic post-stroke aphasia (PSA) from low- and middle-income settings remain scarce. Objective: To evaluate the district-level effectiveness of a standardized two-month CILT program in improving language outcomes among adults with chronic PSA in Sialkot, Pakistan. Methods: A prospective pre–post cohort study was conducted across five rehabilitation centers. Adults ≥1 month post-stroke with limited verbal output received CILT (three sessions/week, 60–90 minutes) for eight weeks. Primary outcome was change in Western Aphasia Battery Aphasia Quotient (WAB-AQ); secondary outcomes included domain scores for Spontaneous Speech, Naming+Reading, Repetition+Writing, and Comprehension. Paired t-tests and effect sizes (Cohen’s dz) quantified change. Results: Eighty participants (mean age 56.8±15.0 years; 55% male) completed therapy. Mean WAB-AQ improved from 24.51±5.92 to 77.38±8.48 (Δ=+52.86, 95% CI 50.80–54.92, t=51.02, dz=5.71, p<0.001). All domain scores showed significant gains (p<0.001). Aphasia severity migrated from 48 very severe and 32 severe cases pre-therapy to 36 moderate and 44 mild post-therapy. Conclusion: Intensive, short-cycle CILT yielded transformative improvements in chronic PSA, supporting its integration into district-level speech-language rehabilitation pathways.
Aphasia, Constraint-Induced Language Therapy, Stroke Rehabilitation, Neuroplasticity, Speech Therapy, Low-Resource Settings
Copyright (c) 2025 Manahal Sughra, Saima Ashraf, Urwa Tul Esha, Abida Shehzadi, Sadia Ashraf (Author) https://creativecommons.org/licenses/by/4.0
Evaluation of Renal Cyst Pattern on Clinical Sonography at Institute of Kidney Diseases, Peshawar
Background: Renal cysts are common sonographic findings, often incidental but occasionally associated with significant pathology. Differentiating simple from complex cysts is essential to guide monitoring and management. Objective: To evaluate the sonographic patterns, laterality, and associated pathologies of renal cysts in patients undergoing ultrasound examination at the Institute of Kidney Diseases, Peshawar. Methods: A descriptive cross-sectional study was conducted on 110 patients with renal cysts identified by ultrasonography between January and June 2024. Scans were performed using a Toshiba Aplio 500 ultrasound system (3–5 MHz curvilinear probe) in supine and decubitus positions. Cysts were classified using ultrasound-adapted Bosniak criteria and autosomal dominant polycystic kidney disease (ADPKD) was defined according to Pei et al. (2009) thresholds. Data were analyzed in SPSS v23 using chi-square tests and multivariable logistic regression, reporting adjusted odds ratios (ORs) with 95 % confidence intervals (CIs). Results: The mean participant age was 52.6 ± 14.9 years; 59.1 % were male. Solitary cysts were most frequent (48.2 %), followed by two cysts (21.8 %) and multiple cysts (30.0 %). Laterality was unilateral in 59.1 % and bilateral in 40.9 %. Simple cysts constituted 82.7 % and complex cysts 17.3 %. Renal stones were observed in 30.0 %, hydronephrosis in 7.3 %, and cyst wall calcification in 10.9 %. Participants aged > 45 years had higher odds of multiple or complex cysts (OR = 2.42, 95 % CI 1.05–5.55, p = 0.03). Complex cysts independently predicted nephrolithiasis (OR = 2.96, 95 % CI 1.04–8.40) and hydronephrosis (OR = 3.75, 95 % CI 1.01–13.89). Conclusion: Renal cysts are predominantly simple and unilateral, increasing in complexity with age. Ultrasound remains a reliable first-line tool for detection and risk stratification, with Bosniak-aligned reporting enabling identification of patients requiring advanced imaging or nephrology referral.
renal cyst, ultrasonography, Bosniak classification, hydronephrosis, nephrolithiasis, ADPKD
Copyright (c) 2025 Shahab Ahmad, Muhammad Faraan Khan, Sadaf, Aiman Akhtar, Hira Tariq, Rizwan Ullah (Author) https://creativecommons.org/licenses/by/4.0
Assessing the Knowledge and Practices of Diabetes Mellitus Type 2 Patients Regarding Self-Care Management at a Tertiary-Care Hospital, Rawalakot: An Analytical Cross-Sectional Study
Background: Type 2 diabetes mellitus (T2DM) requires sustained self-care, yet the translation of knowledge into effective daily management remains inconsistent in low-resource settings. Objective: This study assessed the knowledge and self-care practices of adults with T2DM and examined their relationship in a tertiary-care hospital in Rawalakot, Azad Jammu and Kashmir. Methods: An analytical cross-sectional design was employed among 315 patients aged ≥30 years selected by simple random sampling. Data were collected using validated instruments: the 14-item Diabetes Knowledge Questionnaire (DKQ) and 15-item Diabetes Self-Management Questionnaire (DSMQ), each scored on a five-point Likert scale. Reliability was confirmed (α = 0.761 and 0.752). Descriptive, correlation, and linear-regression analyses were performed using SPSS v25, with p < 0.05 considered significant. Results: Participants demonstrated moderate knowledge (mean DKQ = 2.15 ± 0.98) and mixed adherence to self-care (mean DSMQ = 2.84 ± 0.91). Medication compliance was highest (81%), whereas structured glucose recording and risk-screening practices were weakest. Knowledge correlated positively but weakly with self-care (r = 0.157, p = 0.005), explaining 2.5% of behavioural variance. Conclusion: Diabetes knowledge contributes modestly to self-care behaviours in Rawalakot. Strengthening diabetes self-management education with behavioural support, literacy-adapted materials, and regular follow-up could narrow the observed knowledge-practice gap.
Diabetes mellitus, self-care, knowledge, practices, Type 2 diabetes, Rawalakot.
Copyright (c) 2025 Rubab Tariq, Fozia Fatima, Shahida Anwar, Safia Noreen, Tanvir Kausar (Author) https://creativecommons.org/licenses/by/4.0
Evaluation of Drug-Related Problems in Non-Dialysis Chronic Kidney Disease at Northwest General Hospital Peshawar: A Cross-Sectional Study
Background: Chronic kidney disease (CKD) is a progressive condition associated with substantial morbidity, polypharmacy, and altered drug pharmacokinetics, placing patients at high risk of drug-related problems (DRPs). Non-dialysis CKD (ND-CKD) patients, in particular, face increased vulnerability to adverse drug events and drug–drug interactions (DDIs), necessitating proactive pharmaceutical care. Objective: This study aimed to evaluate the prevalence, causes, and clinical outcomes of DRPs in ND-CKD patients, assess the nature and acceptance of pharmacist-led interventions, and identify associations between Pharmaceutical Care Network Europe (PCNE) domains and DRP outcomes. Methods: A cross-sectional study was conducted among 157 ND-CKD inpatients at Northwest General Hospital, Peshawar. DRPs were identified and classified using PCNE version 9.1, and DDIs were analyzed via Lexicomp®. Data were analyzed using descriptive statistics and multivariate logistic regression. Results: A total of 254 DRPs were identified, predominantly due to inappropriate drug selection (42.91%) and patient-related factors (26.77%). Lexicomp® detected 157 DDIs, with Category C interactions most common (68.8%). Of 278 pharmacist interventions, 80.21% were accepted, and 44.96% of DRPs were completely resolved. Significant associations were found between DRP causes, intervention acceptance, and outcomes (p<0.05). Conclusion: DRPs are frequent in ND-CKD and predominantly preventable. Pharmacist-led interventions significantly improve therapeutic safety, highlighting the need for their integration into renal care.
Chronic Kidney Disease, Drug-Related Problems, Non-Dialysis, Pharmacist Interventions, Drug–Drug Interactions, PCNE Classification
Copyright (c) 2025 Aizaz Ahmed, Fawad Ali, Farmanullah, Sajid Khan Sadozai, Sajid Hussain, Uzifa Shinwari, Abdul Saboor Pirzada, Muhammad Ikram, Muhammad Sohail Anwar, Uzma Mumtaz (Author) https://creativecommons.org/licenses/by/4.0
Clinical Association of Allergic Rhinitis with Sleep Impairment in Pediatric and Adult Patients in Pakistan
Background: Allergic rhinitis (AR) is a prevalent chronic inflammatory condition affecting both pediatric and adult populations, significantly impairing sleep quality through nasal obstruction, airway resistance, and systemic inflammation. Sleep disturbances such as insomnia, hypersomnia, and obstructive sleep apnea (OSA) exacerbate morbidity, reduce quality of life, and increase the risk of cardiometabolic and neurocognitive complications. Despite substantial global research, data from South Asia remain limited, necessitating population-specific evidence. Objective: This study aimed to investigate the prevalence, patterns, and predictors of sleep disturbances among pediatric and adult patients with AR in Pakistan, and to examine associations between AR severity, demographic factors, and sleep-disordered breathing. Methods: A cross-sectional study was conducted on 156 patients with clinically diagnosed AR. Demographic, clinical, and sleep-related data were collected using validated questionnaires, and statistical analyses included chi-square tests, t-tests, and logistic regression to identify significant predictors. Results: Insomnia (59%) and hypersomnia (38.6%) were highly prevalent, while OSA occurred in 2.4% of cases. Moderate–severe AR, male sex, older age, and excessive daytime sleepiness were significant predictors of snoring and sleep-disordered breathing. Conclusion: Sleep disturbances are common and clinically significant comorbidities in AR, highlighting the need for integrated allergy and sleep assessment and management strategies. Keywords: Allergic rhinitis, sleep disorders, insomnia, hypersomnia, obstructive sleep apnea, airway inflammation, Pakistan.
artificial intelligence, cancer survivors, physical activity, digital health, randomized controlled trial, survivorship care
Copyright (c) 2024 Syed Hssan Raza Rizvi (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Robotic-Assisted Gait Training in Enhancing Functional Mobility in Post-Stroke Patients: A Randomized Controlled Trial
Background: Gait impairment is among the most disabling sequelae of stroke, limiting independence and quality of life. Conventional gait rehabilitation, while effective, is restricted by variability in intensity, therapist burden, and limited task-specific repetition. Robotic-assisted gait training (RAGT) has emerged as a technology-driven intervention that enables high-intensity, repetitive, and controlled gait cycles, potentially enhancing neuroplasticity and recovery outcomes in post-stroke patients. Objective: This study evaluated the effectiveness of RAGT compared with conventional gait training (CGT) in improving gait speed, balance, and activities of daily living (ADL) in patients recovering from stroke. Methods: A randomized controlled trial was conducted involving 50 post-stroke patients assigned to RAGT or CGT groups. Each group received 30-minute sessions, five days per week, for four weeks. Primary outcomes included gait speed, Berg Balance Scale scores, and Functional Independence Measure (FIM). Assessments were performed at baseline, post-intervention, and four-week follow-up. Data was analyzed using repeated-measures ANOVA and independent t-tests with significance set at p<0.05. Results: RAGT produced significantly greater improvements in gait speed (+0.28 m/s vs. +0.16 m/s, p<0.001), balance (+10.4 vs. +6.2 points, p<0.001), and ADL performance (+12.4 vs. +7.5 FIM points, p<0.01) compared to CGT, with benefits sustained at follow-up. No serious adverse events were observed. Conclusion: RAGT significantly enhances gait speed, balance, and functional independence compared with CGT, supporting its clinical integration as an effective intervention in post-stroke rehabilitation. Future studies should investigate long-term outcomes and cost-effectiveness.
Robotic-assisted gait training, stroke rehabilitation, gait speed, balance, Functional Independence Measure, randomized controlled trial.
Copyright (c) 2024 Umar Farooq, Muhammad Tahir (Author) https://creativecommons.org/licenses/by/4.0
Evaluation of Incidence and Diagnosis of Upper-Limb Mononeuropathy Using Neurodiagnostic Procedures in Khyber Pakhtunkhwa
Background: Upper-limb mononeuropathies are frequent focal nerve disorders that impair motor and sensory function, often secondary to repetitive mechanical stress or entrapment. Despite advances in neurodiagnostic techniques, regional data from South Asia remain limited. Objective: To determine the incidence, distribution, and severity of upper-limb mononeuropathies diagnosed by standardized nerve-conduction studies (NCS) among patients in Khyber Pakhtunkhwa, Pakistan. Methods: A descriptive cross-sectional study was conducted at Lady Reading Hospital, Peshawar (September 2024–March 2025). A total of 170 adult patients with clinically suspected mononeuropathy underwent NCS using AANEM-aligned protocols. Data on age, sex, occupation, and neurophysiologic parameters were analysed with descriptive statistics, χ² tests, and one-way ANOVA (p < 0.05). Results: Median-nerve mononeuropathy predominated (80.6 %), followed by ulnar (10 %) and radial (9.4 %) lesions. Females comprised 68 % of cases, and the 26–60-year age range accounted for 73 %. Occupational analysis showed highest prevalence among housewives (65.9 %) and labourers (20.6 %). Moderate-grade involvement was most frequent (52.4 %), while ulnar and radial neuropathies displayed greater severe-grade proportions (p < 0.001). Conclusion: Median-nerve mononeuropathy is the dominant form of upper-limb entrapment in this regional cohort, with severity linked to occupational and gender-specific exposures. Early electrodiagnostic screening and ergonomic interventions are recommended to prevent progression and reduce disability.
Upper limb mononeuropathy; nerve conduction study; median nerve; ulnar nerve; radial neuropathy; ergonomic risk.
Copyright (c) 2025 Zar Jamil Khan, Aman Binte Aamir, Muhammad Osamo, Sohni Khan, Awais Qarni, Rizwan Ullah, Awal Mir (Author) https://creativecommons.org/licenses/by/4.0
Correlation Between C-Reactive Protein and Syphilis Titers in Blood Donors at Hayatabad Medical Complex, Peshawar
Background: Syphilis, caused by Treponema pallidum, remains a major public-health challenge in low- and middle-income countries despite effective antibiotic therapy. C-reactive protein (CRP), an acute-phase reactant synthesized by hepatocytes in response to pro-inflammatory cytokines, may reflect the systemic inflammatory response during infection, but its clinical correlation with syphilis remains poorly understood. Objective: To determine the association between serum CRP levels and syphilis titters among blood donors at Hayatabad Medical Complex, Peshawar. Methods: A descriptive analytical cross-sectional study was conducted from July to December 2024 on 90 syphilis-positive blood donors aged 18–60 years. Syphilis titers were measured using the Abbott Architect Syphilis TP chemiluminescent immunoassay, and CRP was quantified via the Roche Cobas 6000 immunoturbidimetric analyzer (> 0.5 mg/dL positive threshold). Hematological parameters were analyzed on a Sysmex XN-1000 system. Statistical analyses used Pearson’s correlation and independent t-tests with significance at p < 0.05. Results: Thirty-five donors (38.9 %) showed elevated CRP. A weak but significant positive correlation was found between CRP and syphilis titers (r = 0.336, 95 % CI 0.14–0.51, p = 0.001). Eosinophil counts were significantly reduced (p = 0.019) compared with reference values. Conclusion: Elevated CRP reflects low-grade systemic inflammation in syphilis-positive donors. Although non-specific, CRP may serve as a supplementary biomarker for monitoring inflammatory activity and guiding disease management.
Syphilis; Treponema pallidum; C-reactive protein; Blood donors; Inflammatory biomarkers
Copyright (c) 2025 Muhammad Talha, Saqib Ullah, Salman Shah, Muhammad Afaq, Waseem Ullah, Raheem Ullah, Rizwan Ullah, Abdur Rehman (Author) https://creativecommons.org/licenses/by/4.0
Impacts of Violence on Nurses: Stress and Productivity Effects
Background: Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are chronic inflammatory disorders with overlapping clinical consequences but distinct pathophysiological mechanisms. Both impair health-related quality of life (HRQoL), yet direct comparative evidence is scarce, particularly in low-resource settings. Objective: To compare HRQoL outcomes in patients with PsA and RA, focusing on physical functioning, disability, and mental health. Methods: We conducted a cross-sectional study of 256 outpatients with clinically confirmed PsA (n=128) or RA (n=128) recruited through stratified random sampling. HRQoL was assessed using the Short Form-36 (SF-36) and Health Assessment Questionnaire (HAQ), alongside clinical measures of grip strength, effusion count, and erythrocyte sedimentation rate. Multivariable linear regression adjusted for age, sex, and disease duration. Results: Compared with RA, PsA patients demonstrated significantly higher physical functioning (mean difference 21.7, 95% CI 14.7–28.7, p<0.001), fewer role limitations due to physical health (28.9, 95% CI 14.3–43.5, p<0.001), and greater vitality (13.5, 95% CI 5.0–22.0, p=0.002). Disability was lower in PsA (HAQ difference –0.53, 95% CI –0.73 to –0.33, p<0.001). No differences were observed in mental health outcomes. Conclusion: PsA patients experience less disability and better physical performance compared with RA, although both groups share a comparable psychological burden. These findings highlight the need for targeted physical rehabilitation in RA and emphasize integrating psychosocial support into the care of both populations.
Workplace violence; nurse productivity; psychological stress; healthcare safety; occupational health; Pakistan.
Copyright (c) 2023 Gulshan Ambreen, Chanda Jabeen, Surrya Parveen (Author) https://creativecommons.org/licenses/by/4.0
The Essential Role of Multidisciplinary Teamwork in Addressing Emerging Health Challenges
Collaboration is essential, not optional: Interprofessional teamwork is a necessity for safe and humane healthcare. Call to action: Investment in communication, leadership, and structural reform is urgent—incremental fixes are not enough.
Multidisciplinary, Teamwork, Emerging Health Challenges
Copyright (c) 2023 Syed Imtiaz Hussain Shah (Author) https://creativecommons.org/licenses/by/4.0
Reproducibility of Digital Photography for Assessing Anterior Pelvic Tilt Using MicroDicom Among Patients with Non-Specific Low Back Pain: A Test–Retest Reliability Study
Background: Non-specific low back pain (NSLBP) is frequently associated with anterior pelvic tilt (APT), a postural deviation linked to altered spinal mechanics and musculoskeletal dysfunction. Reliable and accessible tools for quantifying APT are essential for effective rehabilitation practice, particularly in settings where radiographic imaging is impractical. Objective: To evaluate the test–retest reliability of digital photography for measuring APT in individuals with NSLBP using MicroDicom software. Methods: A test–retest reliability study was conducted at the Department of Rehabilitation, National Orthopedic Hospital, Bahawalpur, Pakistan. Forty participants aged 20–40 years with NSLBP were recruited. Standardized lateral-view digital photographs were obtained using a tripod-mounted smartphone camera. The anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) were palpated and marked, and APT angles were measured in MicroDicom software across three testing sessions. Reliability was evaluated using the intraclass correlation coefficient (ICC[2,1], two-way random effects, absolute agreement), standard error of measurement (SEM), coefficient of variation (CV), and Bland–Altman analysis. Results: The mean APT angles were 16.57° ± 1.51, 15.99° ± 1.54, and 15.97° ± 1.45 across the three sessions. Test–retest reliability was good (ICC[2,1] = 0.872, 95% CI: 0.705–0.939, p < 0.001). The SEM was 0.54°, CV was 9.3%, and percentage SEM was 3.3%. Bland–Altman analysis showed a negligible mean bias (0.03°) and narrow 95% limits of agreement (–1.30° to +1.36°), indicating minimal systematic error. Conclusion: Standardized digital photography analyzed with MicroDicom software provides a reliable, non-invasive, and cost-effective method for monitoring APT in adults with NSLBP. While not a substitute for radiographic imaging, it offers a clinically practical tool for postural evaluation in rehabilitation settings.
Anterior pelvic tilt; non-specific low back pain; reliability; digital photography; MicroDicom.
Copyright (c) 2025 Mahtab Ahmed Mukhtar Patafi, Suriyakala Perumal Chandran, Mazhar Ali Bhutto, Nasir Mehmood, Muhammad Shahzaib Alam, Rumaisa Asad (Author) https://creativecommons.org/licenses/by/4.0
Prevalence Rates for Constipation and Fecal and Urinary Incontinence Among Pediatric Populations
Background: Constipation, fecal incontinence, and urinary incontinence are common in pediatric populations and often coexist, leading to significant physical and psychosocial impacts. Data from South Asia remain limited, particularly regarding age-specific prevalence and associations across developmental stages. Objective: To estimate the prevalence of constipation, fecal incontinence, and urinary incontinence among children and to examine their associations across pediatric age groups. Methods: A cross-sectional study was conducted at a tertiary pediatric hospital in Lahore, Pakistan, between February and December 2022. Children aged 0–17 years were consecutively enrolled, excluding those with congenital anomalies, neurological impairments, or prior incontinence surgery. Data were collected using a validated, structured questionnaire with medical record verification. Constipation was defined using Rome IV criteria; outcomes were analyzed with χ² tests and logistic regression. Results: Of 582 children (mean age 7.6 years), 22.7% had constipation, peaking at 25.7% in ages 2–3 years. Fecal incontinence occurred in 18.3% of children with constipation versus 0.3% without (p<0.001). Urinary incontinence was more frequent in constipated children (21.8% vs. 7.3%, p<0.001), with the strongest association observed for nocturnal symptoms. Conclusion: Constipation is common in South Asian children and is strongly associated with both fecal and urinary incontinence. Integrated screening and early intervention during early childhood may improve outcomes.
pediatric constipation; fecal incontinence; urinary incontinence; prevalence; South Asia; child health.
Copyright (c) 2023 Muhammed Azeem Subhani (Author) https://creativecommons.org/licenses/by/4.0
Infection Risk in Patients with Biopsy-Proven Fatty Liver Disease: A Cohort Study
Background: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver condition worldwide and is increasingly recognized as a systemic disorder associated with metabolic comorbidities. Whether NAFLD independently increases susceptibility to severe infections remains uncertain, particularly across histological stages of disease. Objective: To determine the incidence and hazard of severe infections among patients with biopsy-confirmed NAFLD compared with matched population controls. Methods: This population-based cohort study included 133 adults with biopsy-proven NAFLD and 629 age- and sex-matched comparators from 1995 to 2017 in Lahore, Pakistan. Patients were stratified by histological severity (simple steatosis, NASH without fibrosis, non-cirrhotic fibrosis, cirrhosis). Severe infections, defined as hospital-diagnosed events requiring systemic therapy or admission, were ascertained through electronic health records. Incidence rates per 1000 person-years were calculated, and Cox proportional hazards models adjusted for demographic and metabolic covariates were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Patients with NAFLD had higher infection rates than controls (17.9 vs 11.3 per 1000 person-years). Adjusted hazards were elevated across infection types, including sepsis (HR 2.16, 95% CI 1.95–2.39), respiratory (HR 1.52, 95% CI 1.42–1.62), and urinary tract infections (HR 1.63, 95% CI 1.51–1.75). Risk increased with histological severity, reaching its highest in cirrhosis (HR 1.37, 95% CI 1.21–1.55). Conclusion: NAFLD was associated with an increased hazard of severe infections, with risk rising across disease stages. Preventive measures and closer surveillance may benefit this population.
Nonalcoholic fatty liver disease; infections; cohort study; epidemiology; cirrhosis; metabolic syndrome.
Copyright (c) 2023 Arfa Hamid, Hafiza Tooba Aftab, Shawal Mir (Author) https://creativecommons.org/licenses/by/4.0
Comparative Effects of Supervised Exercise Regime, Education and Self-Management Techniques on Clinical Outcomes in Fibromyalgia
Background: Fibromyalgia (FM) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, poor sleep, and psychological distress. Pharmacological therapies offer limited benefit, making non-pharmacological approaches such as exercise, education, and self-management essential in multimodal care. Objective: To compare the effects of supervised exercise versus education and self-management techniques on clinical outcomes in women with fibromyalgia. Methods: A randomized controlled trial was conducted at the University of Lahore Teaching Hospital from March to December 2024. Fifty-two women aged 20–45 years meeting ACR 2016 criteria for FM were randomized into supervised exercise (Group A, n=26) or education/self-management (Group B, n=26). Interventions lasted four weeks. Primary outcome was fibromyalgia impact (FIQ). Secondary outcomes included pain intensity (VAS), sleep quality (SQS), and patient satisfaction (PSQ-18). Data were analyzed using Wilcoxon signed-rank tests for within-group changes and ANCOVA/Mann–Whitney U tests for between-group comparisons. Effect sizes (r) and 95% confidence intervals (CI) were calculated. Results: Both groups improved significantly in FIQ and VAS. In Group A, FIQ decreased from 63 to 50 (Δ –13, Z=–4.21, p<0.001, r=0.65), and VAS from 7.1 to 5.4 (Δ –1.7, Z=–4.48, p<0.001, r=0.70). In Group B, FIQ decreased from 65 to 54 (Δ –11, Z=–3.92, p<0.001, r=0.60), and VAS from 7.3 to 5.6 (Δ –1.7, Z=–3.55, p=0.001, r=0.62). Sleep quality did not significantly change in either group (Group A: Δ –1, p=0.41; Group B: Δ –4, p=0.08). Patient satisfaction improved significantly in Group B (2.7→3.2, Δ +0.5, Z=–4.61, p<0.001, r=0.68) but not in Group A (2.8→3.0, p=0.06). Between-group comparisons showed no significant differences in FIQ (–2.1, 95% CI –6.0 to +1.8, p=0.28) or VAS (–0.3, 95% CI –0.7 to +0.2, p=0.23), but patient satisfaction favored Group B (–0.3, 95% CI –0.5 to –0.1, p=0.01). Adherence exceeded 85% in both groups with no adverse events. Conclusion: Both supervised exercise and education/self-management significantly improved pain and disease impact, but only education/self-management enhanced patient satisfaction. Integrating both approaches may provide optimal, patient-centered fibromyalgia care.
Fibromyalgia, supervised exercise, self-management, education, pain, quality of life
Copyright (c) 2025 Ayesha Alam, Muhammad Yousaf Sani, Fatima, Sara Khatoon, Sana Saghir, Muhammad Usama, Hafiza Aimen Hameed, Sameen Asif (Author) https://creativecommons.org/licenses/by/4.0
Society and Culture: Factors Associated with the Health Seeking Behaviour Among the Rural Women of District Tando Muhammad Khan
Background: Health-seeking behavior among rural women is shaped by complex sociocultural, economic, and gender-based dynamics that influence access to timely and appropriate healthcare. In rural Pakistan, entrenched patriarchal norms, cultural taboos, and financial barriers contribute to healthcare delays and adverse outcomes, disproportionately affecting women’s health and survival. Objective: To assess the patterns of health-seeking behavior among rural women in District Tando Muhammad Khan and to identify the sociocultural and social factors associated with delayed healthcare and related negative outcomes. Methods: A descriptive cross-sectional study was conducted from 15th November 2024 to 15th May 2025, involving 329 women aged ≥18 years from five randomly selected union councils. Data were collected using a structured, pre-tested questionnaire addressing demographic, social, and cultural determinants of healthcare utilization. Descriptive statistics, Pearson’s correlation, and logistic regression were performed using SPSS version 29, with p < 0.05 considered significant. Results: A total of 71.1% of participants always required family head permission to seek care, 78.7% reported consulting male doctors as socially unacceptable, and 64.4% identified consultation costs as a barrier. Cultural belief decisions (r = 0.40) and cultural restrictions (r = 0.37) showed moderate positive correlations with death due to delayed care. Male dominance (OR = 2.48) and the male doctor taboo (OR = 2.71) significantly increased the odds of adverse outcomes. Conclusion: Sociocultural norms, gendered authority, and economic barriers substantially limit rural women’s healthcare access. Interventions must integrate cultural sensitivity, community engagement, and women’s empowerment to reduce care delays and improve health equity.
Health-seeking behavior, cultural barriers, rural women, gender norms, delayed healthcare, Pakistan
Copyright (c) 2025 Nayab Gul, Muhammad Ilyas Siddiqui, Rafaina Shah, Misbah, Haji Muhammad Shaikh, Moiz Muhammad Shaikh (Author) https://creativecommons.org/licenses/by/4.0
Association Between Total and Indirect Bilirubin Levels and Metabolic Syndrome in Adults From Lahore, Pakistan
Background: Metabolic syndrome is a cluster of metabolic abnormalities that increases the risk of cardiovascular disease and type 2 diabetes. Emerging evidence suggests that bilirubin, particularly its unconjugated fraction, may have antioxidant properties relevant to metabolic health. However, data from South Asian populations remain limited. Objective: To investigate the association between serum total, indirect, and direct bilirubin concentrations and the presence of metabolic syndrome among adults in Lahore, Pakistan. Methods: A cross-sectional study was conducted among 546 adults (273 men, 273 women) recruited through stratified random sampling in Lahore. Participants with chronic liver disease, prior cholecystectomy, or use of hepatotoxic medications were excluded. Clinical, anthropometric, and biochemical data were collected after a 12-hour fast. Metabolic syndrome was defined using International Diabetes Federation criteria. Logistic regression models estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs) across bilirubin quartiles, controlling for age, sex, BMI, smoking, and alcohol use. Results: Mean age was 40.3 years (SD 11.9). Higher total and indirect bilirubin quartiles were inversely associated with metabolic syndrome. Compared with the lowest quartile, the highest quartile showed adjusted ORs of 0.38 (95% CI 0.21–0.68, p<0.001) for total bilirubin and 0.36 (95% CI 0.20–0.65, p<0.001) for indirect bilirubin. No consistent association was observed for direct bilirubin. Conclusion: In this South Asian population, higher serum total and indirect bilirubin concentrations were associated with lower odds of metabolic syndrome. These findings support further longitudinal and mechanistic research to clarify temporality and clinical utility
Bilirubin; metabolic syndrome; Lahore; antioxidant; cardiovascular risk.
Copyright (c) 2023 Hafiza Tooba Aftab, Fatima Javed, Fatima Rehman, Ariba Saleem, Rimsha Murad, Shiza Wajid (Author) https://creativecommons.org/licenses/by/4.0
Association Between Metabolic Dysfunction–Associated Fatty Liver Disease and Gastrointestinal Infections: A Retrospective Observational Study
Background: Metabolic dysfunction–associated fatty liver disease (MAFLD) is the most prevalent chronic liver disorder worldwide and is closely linked with metabolic comorbidities. Disruption of the gut–liver axis may increase susceptibility to gastrointestinal (GI) infections, but evidence from large hospital-based cohorts remains limited. Objective: To examine the association between MAFLD and GI infections and to identify demographic and clinical factors that modify this relationship. Methods: We conducted a retrospective observational study of 550 adult inpatients with a confirmed diagnosis of MAFLD at a tertiary hospital in Pakistan between 2020 and 2022. Patients were stratified by presence or absence of GI infection, and demographic, socioeconomic, and comorbidity data were extracted. Associations were assessed using multivariable logistic regression, adjusting for prespecified covariates. Results: GI infections were more common in patients aged >65 years (57.1% vs. 43.8%, OR 1.62, 95% CI 1.30–2.02, p<0.001) and in those who were self-paying (53.5% vs. 46.6%, OR 1.28, 95% CI 1.03–1.61, p=0.028). Diabetes and hypertension were also associated with higher infection risk (ORs 1.30 and 1.70, respectively). Inflammatory bowel disease conferred the strongest association (OR 5.20, 95% CI 2.00–13.48, p<0.001). Conclusion: MAFLD patients with advanced age, metabolic comorbidities, and socioeconomic disadvantage are at increased risk of GI infections. Targeted screening and integrated care may help reduce this burden, but prospective studies are needed to confirm these associations.
Metabolic Dysfunction-Associated Fatty Liver Disease
Copyright (c) 2023 Fatima Hussain, Gohar Kaleem (Author) https://creativecommons.org/licenses/by/4.0
Comparative Health-Related Quality of Life of Patients with Psoriatic Versus Rheumatoid Arthritis
Background: Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are chronic inflammatory diseases with distinct pathophysiology but overlapping impacts on patients’ quality of life. While both impair physical, social, and psychological wellbeing, comparative evidence on health-related quality of life (HRQoL) across the two conditions remains limited. Objective: To compare HRQoL outcomes in patients with PsA and RA, focusing on physical functioning, pain, and mental health. Methods: We conducted a cross-sectional study of 256 adult outpatients with clinically confirmed PsA (n=128) or RA (n=128) recruited through stratified random sampling. HRQoL was measured using the Short Form-36 (SF-36) Health Survey and the Health Assessment Questionnaire (HAQ). Clinical measures included grip strength, effusion count, and erythrocyte sedimentation rate. Associations between disease group and outcomes were assessed using multivariable regression adjusting for age, sex, and disease duration. Results: Compared with RA, PsA patients reported higher physical functioning (mean difference 21.7, 95% CI 14.7 to 28.7, p<0.001), fewer role limitations due to physical health (28.9, 95% CI 14.3 to 43.5, p<0.001), and greater vitality (13.5, 95% CI 5.0 to 22.0, p=0.002). Disability was lower in PsA (HAQ difference –0.53, 95% CI –0.73 to –0.33, p<0.001). Mental health outcomes did not differ significantly. Conclusion: PsA patients experience less physical disability and better functional outcomes than those with RA, though both groups share a comparable psychological burden. Tailored treatment strategies should combine physical rehabilitation with enhanced psychosocial support.
Copyright (c) 2023 Shadab Arshad, Syed Naeem Abbas (Author) https://creativecommons.org/licenses/by/4.0