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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).
Comparing Early vs Delayed Mobilization After Coronary Artery Bypass Grafting (CABG) and Its Impact on Functional Recovery
Background: Delayed functional recovery and postoperative complications remain common challenges following coronary artery bypass grafting (CABG), often prolonging hospitalization and impairing patient independence. Postoperative immobility contributes to muscle deconditioning, pulmonary complications, and reduced exercise tolerance. Early mobilization has been proposed as a strategy to enhance recovery; however, its benefits compared with conventional delayed mobilization remain inconsistently applied in routine cardiac surgical care. Objective: To evaluate whether early postoperative mobilization accelerates functional recovery and reduces complications compared with delayed mobilization in patients undergoing CABG. Methods: A single-center randomized controlled trial was conducted in a tertiary cardiac care setting. Sixty adult patients undergoing elective, first-time isolated CABG were randomly allocated to early mobilization (initiation within 24 hours postoperatively) or delayed mobilization (initiation after 72 hours). Functional recovery was assessed at discharge using the Six-Minute Walk Test, Barthel Index, and Modified Borg Scale. Postoperative complications and length of hospital stay were recorded from clinical records. Between-group comparisons were performed using appropriate parametric statistical tests, with significance set at p < 0.05. Results: Patients in the early mobilization group demonstrated significantly greater walking capacity (312.6 ± 48.9 m vs. 248.3 ± 52.1 m, p < 0.001) and higher independence in activities of daily living (Barthel Index: 87.4 ± 8.6 vs. 74.9 ± 10.2, p < 0.001) compared with the delayed group. Perceived exertion was lower among early mobilized patients (p = 0.002). Pulmonary complications, particularly atelectasis, were less frequent in the early mobilization group, and hospital stay was significantly shorter (6.2 ± 1.1 vs. 7.8 ± 1.4 days, p < 0.001). Conclusion: Early postoperative mobilization after CABG was associated with improved functional recovery, fewer complications, and reduced hospital stay, supporting its integration into standard postoperative rehabilitation protocols.
Activities of Daily Living; Coronary Artery Bypass; Early Ambulation; Hospitalization; Postoperative Complications; Rehabilitation; Six-Minute Walk Test
Copyright (c) 2025 Akshy Kumar, Hassaan Mehdi, Muhammad Adeel, Prerna Rani, Ravi Kumar, Sajid Khan (Author) https://creativecommons.org/licenses/by/4.0
Investigating Genetic, Cognitive, and Therapeutic Approaches for Enhancing Quality of Life in Individuals With Down Syndrome
Background: Down syndrome (DS) is associated with substantial heterogeneity in cognition, adaptive functioning, and behavior, influenced by cytogenetic subtype and modifiable rehabilitative exposures, yet integrated regional evidence from South Punjab remains limited. Objective: To evaluate associations between cytogenetic subtype, therapy dose and modality, and standardized cognitive, adaptive, and behavioral outcomes among individuals with DS. Methods: A cross-sectional observational study was conducted in South Punjab (January–March 2025) including 60 individuals with cytogenetically confirmed DS aged 6–35 years. Cognitive performance was assessed using WISC-IV/WAIS-IV, adaptive functioning via VABS-II, and behavioral symptoms via the Aberrant Behavior Checklist. Therapy exposure over the preceding 6 months was operationalized as weekly minutes and categorized by intensity; modality was classified as single-modality versus multidisciplinary. Analyses used correlations, group comparisons, and multivariable linear regression (SPSS v26; α=0.05). Results: Full trisomy 21 occurred in 88.3%, mosaicism in 8.3%, and translocation in 3.4%. Mean Full-Scale IQ was 48.3±9.7, higher in mosaicism than trisomy 21 (56.2±6.4 vs 47.5±8.9; p=0.03). VABS-II composite averaged 62.8±11.3 and correlated with IQ (r=0.56; p<0.001). Multidisciplinary therapy was associated with higher VABS-II scores than single-modality therapy (67.2±9.8 vs 58.9±10.4; p=0.001; d=0.89). In regression, therapy intensity (β=0.42; p=0.002) and IQ (β=0.38; p=0.005) independently predicted adaptive functioning (adjusted R²=0.44). Conclusion: Adaptive outcomes in DS are more strongly associated with therapy intensity and multidisciplinary rehabilitation than cytogenetic subtype alone, supporting scalable integrated intervention models in resource-constrained settings.
Down syndrome; Trisomy 21; Mosaicism; Adaptive functioning; Vineland; Cognitive assessment; Multidisciplinary therapy; Rehabilitation; Behavioral symptoms; South Punjab
Copyright (c) 2025 Tooba Khanum, Zobia Ali Hussain, Muhammad Adeel Manzoor, Muhammad Haseeb Khan, Jabeen Haider Asad, Arish Noor, Laiba Mushtaq (Author) https://creativecommons.org/licenses/by/4.0
Systematic Review on the Application of Molecular Biology Techniques in Early Detection and Targeted Therapy of Human Diseases
Background: The integration of molecular biology techniques into clinical medicine represents a paradigm shift towards precision healthcare. While these methods hold immense promise for the early detection of disease and the guidance of targeted therapies, the evidence remains fragmented across various specialties and technological platforms, necessitating a consolidated, critical appraisal. Objective This systematic review aimed to evaluate the role of molecular biology methods in improving diagnostic accuracy and therapeutic strategies for human diseases, focusing on their application in early detection and targeted therapy. Methods A systematic review was conducted following PRISMA guidelines. Comprehensive searches of PubMed, Scopus, Web of Science, and the Cochrane Library were performed for studies published between 2014 and 2023. Inclusion criteria encompassed primary studies (randomized controlled trials, cohort studies, diagnostic accuracy studies) evaluating molecular techniques for early detection or therapy guidance in human diseases. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment using standardized tools. Results Eight studies were included in the qualitative synthesis. The findings demonstrate that molecular techniques, such as circulating tumor DNA analysis and next-generation sequencing, can detect cancer recurrence with a lead time of several months before clinical relapse and significantly improve patient outcomes when used to guide targeted therapies. For instance, molecular stratification for PD-L1 expression in non-small cell lung cancer and for homologous recombination deficiency in ovarian cancer was associated with significantly improved survival (Hazard Ratios of 0.69 and 0.33, respectively). Conclusion Molecular biology techniques provide a substantial advantage for early disease detection and personalized treatment selection, directly translating to improved clinical outcomes. However, evidence heterogeneity and potential publication bias highlight the need for standardized, large-scale prospective studies to confirm efficacy across diverse populations and healthcare settings, and to establish cost-effectiveness.
Molecular Diagnostics; Early Detection of Disease; Precision Medicine; Targeted Therapy; Systematic Review.
Copyright (c) 2025 Grannaz Mengal, Sadia Mengal, Hafiz Muhammad Jawad, Ayesha bibi, Muhammad Zian Shakir, Shaikh Khalid Muhammad (Author) https://creativecommons.org/licenses/by/4.0
Designing Small-Molecule Allosteric Inhibitors of CYP2C19 to Prevent Clopidogrel Resistance in Patients With Specific Genetic Polymorphisms
Background: Clopidogrel resistance due to CYP2C19 polymorphisms presents a major barrier in achieving effective antiplatelet therapy, particularly in genetically predisposed populations. Current solutions often involve switching to alternative medications, which may be cost-prohibitive or contraindicated. A pharmacological strategy aimed at correcting enzyme dysfunction, rather than altering therapy, offers a novel approach to personalized treatment. Objective: To develop and evaluate a small-molecule allosteric inhibitor of CYP2C19 that enhances clopidogrel activation in individuals with reduced-function genetic variants. Methods: A descriptive study was conducted using computational modeling and pharmacokinetic simulation over eight months in South Punjab. A sample of 384 genotype-simulated participants was generated. Molecular docking and virtual screening techniques were used to identify candidate allosteric inhibitors targeting polymorphic CYP2C19 isoforms. A population-based pharmacokinetic model simulated active clopidogrel metabolite concentrations before and after co-therapy. Statistical analysis was performed using SPSS 26, with paired t-tests and ANOVA applied to normally distributed data. Results: Significant increases in active clopidogrel metabolite concentrations were observed post-intervention in all variant genotypes. Mean improvements were highest in *3/*3 (111.7%) and *2/*2 (79.4%) groups. Paired t-tests confirmed statistical significance in all mutant genotypes (p < 0.001). The intervention demonstrated robust potential to correct metabolic inefficiencies without altering standard antiplatelet therapy. Conclusion: The proposed co-therapy offers a promising solution to genetically driven clopidogrel resistance through targeted CYP2C19 modulation. This strategy could enable personalized, cost-effective, and clinically adaptable antiplatelet treatment in genetically diverse populations.
Allosteric regulation, Antiplatelet therapy, Clopidogrel, CYP2C19, Drug resistance, Enzyme modulation, Pharmacogenetics
Copyright (c) 2025 Marriam Abid, Qasim Mehmood, Naila Abdullah, Maqsood Razzaq, Noor Ihsan, Muhammad Talha Safder, Shahid Ullah (Author) https://creativecommons.org/licenses/by/4.0
Exploration Of Nonspecific Patterns In Urinary Tract Infection Symptoms Across Different Age And Gender Groups (H/R) - A Cross-Sectional Study
Background: Urinary tract infections (UTIs) remain among the most prevalent bacterial infections worldwide, yet their clinical presentation varies widely across demographic groups. Recognizing nonspecific symptom patterns in different populations is crucial for timely diagnosis and management, particularly among vulnerable age groups where symptoms may be atypical. Objective: This study aimed to examine the distribution of specific and nonspecific urinary tract infection symptoms across age and gender groups, identifying demographic patterns and their implications for clinical practice. Methods: A cross-sectional study was conducted over eight months at a tertiary care hospital in Lahore, Pakistan, including 260 participants aged one year and above with clinically suspected or laboratory-confirmed UTI. Data were collected using structured questionnaires, physical examinations, and laboratory analyses including urinalysis and urine culture. Statistical analyses were performed using SPSS version 26. Descriptive statistics summarized demographic and clinical data, while chi-square and ANOVA tests evaluated group differences. Binary logistic regression identified predictors of nonspecific symptom presentation, with p < 0.05 considered statistically significant. Ethical approval was obtained from the institutional review board of the relevant institute. Results: Of 260 participants, 62.3% were female and the mean age was 36.4 ± 21.8 years. Specific symptoms were reported in 55.8% of cases, while 44.2% presented nonspecific features such as fever, malaise, and weakness. Nonspecific symptoms predominated among children (57.9%) and the elderly (66.7%), whereas specific symptoms were more frequent in adults (64.5%) (p < 0.001). Logistic regression identified age ≥ 60 years (OR 2.54, 95% CI 1.42–4.51), comorbidities (OR 1.91, 95% CI 1.07–3.39), and female gender (OR 1.48, 95% CI 1.03–2.12) as independent predictors of nonspecific presentations. Conclusion: Nonspecific urinary tract infection symptoms are common among pediatric and elderly populations, posing diagnostic challenges. Awareness of demographic symptom variability may improve diagnostic accuracy and ensure timely management across diverse patient groups.
Adults, Age distribution, Bacteriuria, Cross-sectional studies, Gender differences, Pediatric infections, Urinary tract infections, Urine culture
Copyright (c) 2025 Zarina Naz, Areej Areej, Muhammad Mobeen, Seemal Fatima, Muhammad Abdullah Mirza, Arish Noor (Author) https://creativecommons.org/licenses/by/4.0
AI-Driven Personalized Weight Loss Strategies and Behavioral Patterns Among Obese Adults
Background: Obesity is a multifactorial chronic disease in which conventional lifestyle programs often produce heterogeneous outcomes due to limited personalization and suboptimal adherence. Artificial intelligence (AI)–enabled platforms can adapt dietary, activity, and behavioral recommendations using continuous user data, potentially improving engagement and clinical response. Objective: To evaluate the effectiveness of an AI-driven personalized weight management intervention versus standard counseling-based weight management in improving weight loss and adherence-related behaviors among obese adults in South Punjab, Pakistan. Methods: In this parallel-group randomized controlled trial, 180 adults aged 25–55 years with BMI 30.0–39.9 kg/m² were randomized 1:1 to an AI-assisted mobile program integrating self-monitoring inputs and wearable-derived activity/sleep metrics or to standard biweekly counseling without algorithmic personalization. Assessments at baseline, 8 weeks, and 16 weeks included anthropometry and validated behavioral measures (IPAQ; WELQ). Analyses followed intention-to-treat principles with repeated-measures testing and effect size estimation. Results: The AI group achieved greater mean weight loss than controls (−8.9 kg [95% CI −9.6 to −8.2] vs −4.2 kg [−4.9 to −3.5]), with a between-group difference of −4.7 kg (−5.6 to −3.8; p<0.001; d=1.59). BMI reduction was larger in the AI group (−3.2 vs −1.6 kg/m²; p<0.001), and waist circumference declined more (−8.4 vs −4.1 cm; p<0.001). The AI group showed higher physical activity (2860±520 vs 2210±480 MET-min/week), dietary adherence (84.5±6.1% vs 69.8±8.0%), and self-monitoring (5.6±1.0 vs 3.1±1.2 days/week) (all p<0.001). Conclusion: AI-driven personalized lifestyle intervention produced clinically and statistically superior short-term weight loss and adherence-related behavioral improvements compared with standard counseling, supporting its potential as a scalable adjunct for obesity management in resource-constrained settings.
Adherence; Artificial Intelligence; Behavior Modification; Body Mass Index; Digital Health; Machine Learning; Obesity; Randomized Controlled Trial; Weight Loss.
Copyright (c) 2025 Mohammad Alruwaili, Faisal Sajda Owad Almutairi, Zarina Naz, Muhammad Zia Iqbal, Uzair Ahmad, Noor Un Nisa, Mahmoud Awad (Author) https://creativecommons.org/licenses/by/4.0
Relationship Between Depression Scores And Poor Glycemic Control In Type 2 Diabetes
Background: Depression and diabetes frequently coexist, forming a bidirectional relationship that worsens metabolic outcomes and quality of life. Poor glycemic control among patients with type 2 diabetes mellitus (T2DM) is often influenced by psychological distress, reduced medication adherence, and unhealthy lifestyle behaviors. Understanding this association is critical for developing integrated care models that address both metabolic and mental health needs. Objective: This study aimed to evaluate the association between depression severity and glycated hemoglobin (HbA1c) levels in patients with T2DM, while examining medication adherence, clinic attendance, and lifestyle behaviors as potential mediators of this relationship. Methods: A cross-sectional study was conducted over eight months among 240 adults with T2DM attending tertiary hospitals in Lahore, Pakistan. Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9), medication adherence with the Morisky Medication Adherence Scale (MMAS-8), and lifestyle behaviors with the Summary of Diabetes Self-Care Activities (SDSCA). Clinical data, including HbA1c levels, were obtained from medical records. Pearson correlation and multiple linear regression analyses were performed to identify predictors of glycemic control, assuming normal data distribution. Ethical approval was obtained from the Institutional Review Board of the relevant institute. Results: The mean HbA1c was 8.3 ± 1.4%, and mean PHQ-9 score was 10.2 ± 5.3. Depression scores were significantly correlated with HbA1c (r = 0.41, p < 0.001). Medication adherence (r = -0.36, p < 0.001) and lifestyle behaviors (r = -0.32, p < 0.001) were inversely associated with HbA1c. Regression analysis identified depression (β = 0.38, p < 0.001), medication adherence (β = -0.25, p < 0.001), and lifestyle behaviors (β = -0.22, p = 0.003) as independent predictors of HbA1c. Medication adherence partially mediated the depression–HbA1c relationship. Conclusion: Depression significantly contributes to poor glycemic control in T2DM, partly through its adverse effects on adherence and self-care. Integrating mental health screening into diabetes management may enhance both psychological and metabolic outcomes.
Adherence, Depression, Diabetes Mellitus Type 2, Glycated Hemoglobin A, Lifestyle, Mental Health, Self-Care, South Asia
Copyright (c) 2025 Naheed Shah, Asma Iqbal, Naeem Asghar, Sadaf Moeez, Erum Fatima, Shaikh Khalid Muhammad (Author) https://creativecommons.org/licenses/by/4.0
AI-Guided Virtual Physiotherapy vs. Traditional Therapy for Post-Stroke Rehabilitation: A Randomized Controlled Trial
Background: Stroke remains a leading cause of long-term disability, with motor and functional impairments requiring intensive rehabilitation. Conventional physiotherapy is effective but limited by accessibility and adherence. The integration of artificial intelligence (AI) into remote rehabilitation platforms offers an innovative approach to optimize recovery while addressing barriers of traditional therapy. Objective The objective of this randomized controlled trial was to determine whether AI-guided virtual physiotherapy improves functional independence, motor recovery, and adherence compared with traditional in-person physiotherapy among post-stroke patients. Methods A total of 100 patients with ischemic or hemorrhagic stroke were randomized into AI-guided virtual physiotherapy (n=50) and traditional therapy (n=50) groups. Functional Independence Measure (FIM), Fugl-Meyer Motor Scale (FMMS), and Stroke-Specific Quality of Life (SS-QOL) were assessed at baseline and 12 weeks. Adherence rates were also recorded. Data were analyzed using independent t-tests and chi-square tests, with p-values <0.05 considered statistically significant. Results Patients in the AI-guided group showed significantly greater improvements in functional independence (mean improvement in FIM: 28.6 vs. 21.4, p=0.01) and motor recovery (mean improvement in FMMS: 19.8 vs. 15.2, p=0.02). Quality of life improved more in the AI-guided group (24% vs. 16%, p=0.03). Adherence was higher in the AI group, with 88% achieving ≥85% adherence compared with 72% in the traditional group (p=0.04). Conclusion AI-guided virtual physiotherapy demonstrated superior functional, motor, and quality-of-life outcomes with higher adherence compared to traditional therapy, highlighting its potential as an effective and scalable post-stroke rehabilitation strategy.
Adherence, Artificial Intelligence, Motor Recovery, Physiotherapy, Post-Stroke Rehabilitation, Quality of Life, Randomized Controlled Trial
Copyright (c) 2025 Zarina Naz, Arsalan Rasool, Namra Urooj, Baseer Ahmad, Nayab Khan, Aqsa Iqbal, Zainab Arshad (Author) https://creativecommons.org/licenses/by/4.0
Impact of Endometriosis on Fertility Hormones and Ovarian Reserve Markers (AMH, FSH, LH)
Background: Endometriosis is a chronic gynecological condition commonly affecting women of reproductive age and is frequently associated with infertility. Beyond mechanical and inflammatory factors, endocrine alterations may contribute to impaired fertility by affecting ovarian reserve. Hormonal markers such as anti-Müllerian hormone, follicle-stimulating hormone, and luteinizing hormone are widely used to assess ovarian reserve and reproductive potential, yet their patterns in women with endometriosis remain variably reported, particularly in routine clinical settings. Objective: To compare ovarian reserve markers, specifically anti-Müllerian hormone, follicle-stimulating hormone, and luteinizing hormone, between women with endometriosis and healthy controls. Methods: This descriptive comparative study was conducted in Islamabad over three months and included women aged 20–40 years attending gynecology clinics. Participants were divided into two equal groups: women with clinically confirmed endometriosis and age-matched healthy controls. Demographic and clinical data were recorded, and venous blood samples were obtained during the early follicular phase of the menstrual cycle. Serum anti-Müllerian hormone, follicle-stimulating hormone, and luteinizing hormone levels were measured using standardized laboratory assays. Data were analyzed using appropriate parametric statistical tests, with significance set at p < 0.05. Results: Women with endometriosis demonstrated significantly lower mean anti-Müllerian hormone levels compared with healthy controls, indicating reduced ovarian reserve. Follicle-stimulating hormone levels were significantly higher in the endometriosis group, while luteinizing hormone levels showed a modest but statistically significant increase. Baseline demographic characteristics were comparable between groups. Conclusion: Endometriosis was associated with altered ovarian reserve markers, particularly reduced anti-Müllerian hormone and elevated follicle-stimulating hormone levels. These findings emphasized the value of early hormonal assessment in women with endometriosis to support informed fertility counseling and reproductive planning.
Anti-Mullerian Hormone; Endometriosis; Fertility; Follicle Stimulating Hormone; Luteinizing Hormone; Ovarian Reserve; Women
Copyright (c) 2025 Ambreen Ibrahim, Naheed Shah, Lubna Malik, Rawaal Amin, Syeda Khalida Naeem, Hina Ali Ahmed (Author) https://creativecommons.org/licenses/by/4.0
General Overview of Broadly Discussed Lifestyle and Environmental Factors Casually Associated with Breast Cancer Development
Background: breast cancer represents a significant global health burden, with a complex etiology extending beyond genetic predisposition to encompass modifiable lifestyle and environmental exposures. A myriad of these factors are frequently discussed in both scientific and public domains, yet the evidence supporting these associations varies widely in strength and consistency. Objective: This narrative review aims to broadly survey and synthesize the lifestyle and environmental factors that are casually mentioned in relation to breast cancer development, providing a panoramic overview of these superficial associations without delving into deep mechanistic analysis. Main Discussion Points: The review thematically explores factors including dietary patterns, alcohol and tobacco use, physical activity, body composition, exogenous hormones, environmental chemical exposures, circadian disruption, and socioeconomic influences. It highlights well-established causal links, such as those for alcohol and postmenopausal obesity, while also presenting the more ambiguous and inconsistently supported associations for elements like specific dietary components and endocrine-disrupting chemicals. Critical analysis underscores the methodological limitations inherent in the observational evidence base. Conclusion: The evidence for casually mentioned risk factors exists on a spectrum, with clear public health priorities emerging for risk reduction. Clinicians and policymakers should focus on advocating for interventions related to the most robustly evidence-based factors. The review calls for future research employing more rigorous, integrative study designs to clarify unresolved associations and advance primary prevention strategies.
Breast Cancer; Lifestyle Factors; Environmental Exposure; Risk Factors; Narrative Review; Prevention
Copyright (c) 2025 Shabahat Arain, Marriam Abid, S Batool Zehra Naqvi, Sardar Momen, Noshaba Zaheer Khan, Wajahat Ullah, Rimsha Faisal (Author) https://creativecommons.org/licenses/by/4.0
Combined Effect of Respiratory Muscle Stretching and Active Cycle of Breathing Technique on Kinesiophobia, Functional Capacity and Anxiety among Chronic Obstructive Pulmonary Disease Patients
Background: COPD causes chronic airflow limitation and dyspnea, reducing function and quality of life. Objective: To evaluate the combined effect of the Active cycle Breathing Technique (ACBT) with Respiratory Muscle Stretching (RMS) on kinesiophobia, functional capacity and anxiety among Chronic Obstructive Pulmonary Disease (COPD) patients. Methods: This randomized controlled trial was conducted at Arif Memorial Teaching Hospital in Lahore. Forty Patients with COPD moderate to severe were randomly assigned into group A and group B (n=20 each). Group A received active cycle breathing technique (ACBT), alone and Active cycle Breathing Technique with Respiratory Muscle Stretching (RMS) was received by Group B. The Tampa kinesiophobia scale Questionnaire was used to evaluate kinesiophobia. The functional capacity was assessed by 6-minute walk test, and hospital anxiety and depression were used to assess anxiety. Results: Both groups showed significant with-in group improvements in kinesiophobia, functional capacity and anxiety with p-value < 0.05. Between group analysis showed that there is greater improvement in ACBT combined with RMS compared to ACBT alone with p-value < 0.05. Conclusion: This trial concluded that the combination of ACBT and respiratory muscle stretching could be a promising intervention for COPD patients, offering a potential solution to the challenges of kinesiophobia, reduced functional capacity, and anxiety.
Chronic Obstructive Pulmonary Disease, Active Cycle of Breathing Technique, Respiratory muscle stretching, Tampa Scale Kinesiophobia, Functional Capacity
Copyright (c) 2025 Fareeha Faisal, Aleena Waheed, Rehana Niazi, Nazeer Ahmad, Tahir Mahmood (Author) https://creativecommons.org/licenses/by/4.0
Descriptive Analysis of Common Ophthalmic Disorders and Their Management Approaches among Patients Visiting Tertiary Care Hospitals in South Punjab, Pakistan
Background: Ophthalmic disorders are a major cause of avoidable visual impairment in low- and middle-income countries, where delayed presentation and limited screening capacity often shift the burden to tertiary hospitals. Objective: To describe the prevalence, clinical patterns, and management strategies of common ophthalmic disorders among patients attending tertiary care hospitals in South Punjab, Pakistan. Methods: This descriptive cross-sectional study was conducted over eight months in ophthalmology outpatient departments of selected tertiary hospitals in South Punjab. A total of 384 patients aged ≥10 years were enrolled through consecutive sampling. Standard ophthalmic assessment was performed using visual acuity testing, slit-lamp biomicroscopy, ophthalmoscopy, and intraocular pressure measurement. Diagnoses and primary management modality were recorded using a structured proforma. Descriptive statistics were reported with 95% confidence intervals (CIs), and age-patterning of major disorders was tested using chi-square analysis. Results: The mean age was 46.2 ± 16.4 years, and 51.0% were female. Refractive errors were most prevalent (34.9%; 95% CI: 30.3–39.8), followed by cataract (24.0%; 95% CI: 20.0–28.5), conjunctivitis (12.5%), and glaucoma (9.4%). Pharmacological therapy (41.1%) and surgical intervention (27.1%) were the dominant management approaches. Age distribution differed significantly across refractive error, cataract, and glaucoma (χ²(6)=153.61; p<0.001). Conclusion: Tertiary care workload in South Punjab is dominated by treatable disorders, supporting targeted refraction services for younger patients and strengthened cataract, glaucoma, and diabetic retinopathy screening pathways for older adults. Keywords: Cataract, Conjunctivitis, Glaucoma, Ophthalmic diseases, Refractive errors, South Punjab, Tertiary care.
Cataract, Conjunctivitis, Glaucoma, Ophthalmic diseases, Refractive errors, South Punjab, Tertiary care.
Copyright (c) 2025 Muhammad Israr, Rida Fatima Aslam, Muhammad Zia Iqbal, Muhammad Waseem, Saira Gulzar, Javed Rasul (Author) https://creativecommons.org/licenses/by/4.0
Comprehensive Assessment of Hormonal Disruption in Primary Amenorrhea
Background: Primary amenorrhea is a heterogeneous condition reflecting disorders of hypothalamic–pituitary–ovarian function or reproductive tract development, and delayed presentation is common in resource-variable settings. Objective: To determine hormonal patterns and etiological distribution of primary amenorrhea among females presenting to tertiary care hospitals in South Punjab, Pakistan. Methods: This observational cross-sectional study enrolled 58 females with primary amenorrhea over two months. Clinical evaluation included demographics, BMI, Tanner breast staging, and pelvic ultrasonography. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, and thyroid-stimulating hormone (TSH) were measured using chemiluminescent immunoassays. Participants were stratified by FSH into hypogonadotropic (<3 mIU/mL), eugonadotropic (3–10 mIU/mL), and hypergonadotropic (>40 mIU/mL) categories. Etiology was determined using integrated clinical, biochemical, and imaging findings. Results: Mean age was 17.4 ± 2.1 years. Eugonadotropic amenorrhea was most common (44.8%), followed by hypogonadotropic (31.0%) and hypergonadotropic amenorrhea (24.1%). Outflow tract anomalies were the leading etiology (36.2%), followed by ovarian disorders (24.1%), hypothalamic–pituitary dysfunction (20.7%), and PCOS (12.1%). Eugonadotropic patients had the highest mean estradiol, while hypergonadotropic cases had markedly reduced estradiol. Conclusion: Structural and ovarian etiologies predominated, and hormonal stratification combined with ultrasonography supported pragmatic etiological triage and management planning.
Primary amenorrhea; Estradiol; Follicle-stimulating hormone; Gonadotropins; Hypogonadism; Outflow tract anomalies; Ovarian disorders; Polycystic ovary syndrome
Copyright (c) 2025 Naheed Shah, Samia Saliha, Sheeba Jan, Zarina Naz, Zainab Tahir, Hira Arshad (Author) https://creativecommons.org/licenses/by/4.0
Investigating the Therapeutic Impact of Moringa Oleifera Consumption on Human Health: A Comprehensive Review of Evidence-Based Studies
Background: Moringa oleifera is widely consumed as a nutrient-dense functional food and has attracted scientific interest for potential metabolic and anti-inflammatory benefits relevant to chronic disease prevention and management. Objective: To synthesize and critically appraise evidence on the therapeutic and nutritional effects of Moringa oleifera consumption on human health, with emphasis on glycemic control, lipid profile, blood pressure-related outcomes, antioxidant status, inflammation, and nutritional indices. Methods: This narrative review synthesized evidence from peer-reviewed literature identified through structured searches of major biomedical and academic sources and reference-list screening. Human interventional and observational studies evaluating Moringa oleifera preparations (leaf powder, extracts, capsules, and related formulations) were prioritized, while mechanistic and experimental literature was included to contextualize biological plausibility. Evidence was synthesized thematically and appraised qualitatively based on study design, intervention characterization, duration, and outcome reporting. Results: Across the reviewed literature, Moringa oleifera consumption demonstrated a generally favorable direction of effect on glycemic outcomes and lipid parameters in several studies, supported by mechanistic evidence indicating antioxidant and anti-inflammatory activity. Nutritional applications were supported by compositional data and evidence suggesting utility for micronutrient supplementation. However, findings were limited by heterogeneity in formulations and dosing, small samples, short follow-up periods, and inconsistent control of lifestyle confounders, which collectively reduced certainty. Conclusion: Moringa oleifera shows promise as a complementary dietary and nutraceutical strategy for metabolic and nutritional support, but current human evidence is insufficient to support definitive clinical recommendations. Rigorous, longer-term randomized controlled trials using standardized preparations are required.
Copyright (c) 2025 Yusra Khan, Anam Ali, Fateen Khan, Muhammad Azhar Sherkheli, Aamir Shazad, Nauman Akhtar (Author) https://creativecommons.org/licenses/by/4.0
Investigating Pre-Vaccination Mucosal Microbiota Composition as a Predictor of Humoral and Cellular Immune Response to the Seasonal Influenza Vaccine
Background: Variability in immune responsiveness to seasonal influenza vaccination remains a persistent public health challenge, as a substantial subset of vaccinated individuals fails to mount adequate humoral and cellular protection. Increasing evidence suggests that mucosal microbiota composition modulates immune priming at the respiratory interface, yet its predictive value for influenza vaccine outcomes remains insufficiently characterized. Objective: To investigate whether pre-vaccination upper respiratory mucosal microbiota composition predicts humoral and cellular immune responses to the seasonal influenza vaccine and to identify microbial biomarkers associated with suboptimal responsiveness. Methods: A prospective observational cohort study was conducted over five months in Lahore, enrolling 220 adults (18–65 years) receiving a trivalent inactivated influenza vaccine. Pre-vaccination nasopharyngeal and oropharyngeal swabs underwent 16S rRNA sequencing. Humoral immunity was assessed using hemagglutination inhibition assays at baseline and 28 days post-vaccination, and cellular immunity was evaluated using IFN-γ ELISpot and flow cytometric quantification of CD4⁺ and CD8⁺ T-cell activation. Multivariable regression, PERMANOVA, and random forest classification were applied with adjustment for key covariates. Results: Complete data were available for 212 participants, of whom 132 (62.3%) achieved seroconversion. Responders exhibited higher microbial diversity (Shannon index 3.9 ± 0.6 vs 3.4 ± 0.5, p = 0.002; Simpson index 0.87 ± 0.04 vs 0.81 ± 0.05, p < 0.001) and distinct beta diversity clustering (PERMANOVA p = 0.001). Responders demonstrated higher antibody fold-rise (5.7 ± 2.4 vs 2.1 ± 1.2, p < 0.001) and higher IFN-γ ELISpot responses (142 ± 38 vs 87 ± 29 SFU/10⁶ PBMCs, p < 0.001) with greater CD4⁺ (14.6% vs 9.2%, p < 0.001) and CD8⁺ (12.3% vs 8.5%, p < 0.01) activation. Higher Faecalibacterium abundance predicted seroconversion (adjusted OR 1.42, 95% CI 1.15–1.76, p < 0.001), whereas Streptococcus abundance was inversely associated (adjusted OR 0.63, 95% CI 0.48–0.82, p < 0.01); random forest classification achieved AUC 0.87 (95% CI 0.82–0.91). Conclusion: Pre-vaccination mucosal microbiota diversity and specific microbial signatures predict both humoral and cellular influenza vaccine responses, supporting the potential utility of microbial biomarkers for identifying suboptimal responders and informing microbiota-directed strategies to improve vaccine effectiveness.
Influenza Vaccines; Microbiota; Mucosal Immunity; Hemagglutination Inhibition; Cellular Immunity; ELISpot; Predictive Biomarkers; Vaccine Response.
Copyright (c) 2025 Ali Basim, Hira Rasool, Muhammad Azhar Sherkheli, Sajjad Ahmad, Fatima Ayub (Author) https://creativecommons.org/licenses/by/4.0
Investigating Nutritional Deficiencies and Lifestyle Factors Contributing to Rising Incidence of Rickets among Children in Developing Regions
Background: Nutritional rickets persists in many low- and middle-income countries despite abundant sunlight, driven by a complex interplay of inadequate dietary intake, limited effective sunlight exposure, and evolving lifestyle patterns among children. Objective: To examine the association between dietary calcium and vitamin D intake, sunlight exposure, lifestyle behaviours, and rickets-related outcomes among children in urban and semi-urban settings in Pakistan. Methods: A cross-sectional study was conducted over four months among 410 children aged 1–12 years selected through multistage sampling from healthcare facilities and schools. Data were collected using an interviewer-administered questionnaire, semi-quantitative food frequency questionnaire, 24-hour dietary recall, and a Sunlight Exposure Index. Anthropometry and standardised clinical assessment for rickets were performed, and available biochemical data were extracted from records. Descriptive statistics, t-tests, ANOVA, Pearson’s correlation, and multiple linear regression were applied using SPSS version 26. Results: Mean daily calcium and vitamin D intakes were 528 ± 211 mg and 3.8 ± 1.9 µg, respectively, with fewer than 21% of children meeting age-specific recommendations. Overall, 16.8% had clinical or radiographic features consistent with rickets. Lower calcium intake, reduced daily sunlight exposure, lower Sunlight Exposure Index scores, and shorter outdoor play time were significantly associated with rickets indicators. In multivariable models, inadequate calcium intake and limited sunlight exposure remained the strongest independent predictors. Conclusion: Inadequate intakes of calcium and vitamin D, combined with limited effective sunlight exposure and sedentary lifestyles, are major determinants of rickets-related outcomes among children in this setting, highlighting the need for integrated nutritional and behavioural interventions.
nutritional rickets; vitamin D deficiency; calcium intake; sunlight exposure; child health; Pakistan.
Copyright (c) 2025 Shabahat Arain, Muhammad Azeem, Tehniat Shoukat, Serish Fatima, Babar Hilal Ahmad Abbasi, Rida Ali, Farzaan Bashir Ahmed, Komal Mushtaq (Author) https://creativecommons.org/licenses/by/4.0
Cultural Beliefs and Delayed Health-Seeking Behavior in Women with Abnormal Uterine Bleeding
Background: Abnormal uterine bleeding (AUB) is a common gynecological condition affecting reproductive-aged women, often leading to delayed health-seeking due to cultural stigma and normalization of symptoms in conservative settings like urban Pakistan. Objective: To determine the prevalence of AUB and identify sociocultural factors associated with delayed health-seeking behavior among women attending gynecology clinics in Pakistan. Methods: This cross-sectional observational study enrolled 450 reproductive-aged women from outpatient gynecology clinics in Karachi and Lahore using consecutive sampling. Data were collected via structured interviews incorporating FIGO criteria for AUB assessment and modules on health-seeking and cultural beliefs. Descriptive statistics, chi-square tests, and multivariable logistic regression were performed to examine associations. Results: The prevalence of AUB was 32.4% (142/438), with 68.3% of affected women reporting delays >6 months in seeking care. Lower education, cultural normalization, high stigma, and reliance on traditional advice were significantly associated with delays (adjusted odds ratios >2, p<0.05), explaining substantial variance alongside socioeconomic factors. Conclusion: Sociocultural barriers significantly contribute to delayed care for AUB, necessitating culturally sensitive education and community interventions to promote timely utilization and reduce morbidity.
Abnormal uterine bleeding, health-seeking behavior, menstrual stigma, cultural norms, prevalence, Pakistan, women's health
Copyright (c) 2025 Rimal Rashid, Mishal Tayyab, Zarina Naz, Sheeza Kainat, Tajwer Shahana, Zainab Tahir (Author) https://creativecommons.org/licenses/by/4.0
Evaluating the Effectiveness of Non-Pharmacological Interventions in Reducing Labor Pain among Women during Vaginal Delivery
Background: Labour pain is a profound physical and emotional stressor, and while pharmacological analgesia is effective, it carries risks and is not universally available, particularly in low-resource settings. Non-pharmacological interventions may offer safe, low-cost alternatives that enhance women’s coping and satisfaction. Objective: To evaluate the effectiveness of a structured bundle of non-pharmacological interventions, compared with standard care, in reducing labour pain intensity and improving maternal satisfaction among women undergoing vaginal delivery. Methods: In this parallel-group randomized controlled trial, 120 low-risk women in active labour (4–6 cm cervical dilatation) at term were allocated to either an intervention group (n = 60) receiving guided breathing, maternal position changes, warm lumbar compresses, and continuous intrapartum support, or a control group (n = 60) receiving standard obstetric care. Pain intensity was measured using a 10-cm visual analogue scale at 4–6 cm, 7–9 cm, and during the second stage of labour. Maternal satisfaction was assessed within 24 hours postpartum using a five-point Likert scale. Data were analysed with independent-sample t-tests; mean differences, 95% confidence intervals, and effect sizes were reported. Results: Mean VAS scores were significantly lower in the intervention group at 4–6 cm (5.1 ± 1.2 vs 6.2 ± 1.3; mean difference −1.1; p = 0.001), 7–9 cm (6.3 ± 1.5 vs 7.8 ± 1.6; mean difference −1.5; p = 0.002), and during the second stage (7.4 ± 1.6 vs 8.9 ± 1.7; mean difference −1.5; p = 0.001). Maternal satisfaction was higher with the intervention (4.3 ± 0.7 vs 3.5 ± 0.8; mean difference 0.8; p < 0.001). Conclusion: A multimodal non-pharmacological intervention bundle significantly reduced labour pain and enhanced maternal satisfaction compared with standard care, supporting its integration into routine intrapartum practice in resource-limited settings.
labour pain; non-pharmacological interventions; visual analogue scale; continuous support; maternal satisfaction; randomized controlled trial.
Copyright (c) 2025 Samreen Iqbal, Muhammad Konain Azhar, Zarkaish Asmatullah, Rabiya Inayat, Safia Mehboob, Aamna Shah (Author) https://creativecommons.org/licenses/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
Effectiveness of Clear Aligners Versus Fixed Appliances in Correcting Mild to Moderate Crowding
Background: Fixed orthodontic appliances are widely regarded as the standard of care for managing dental crowding, yet their use is often limited by discomfort, aesthetic concerns, and oral hygiene challenges. Clear aligners have emerged as a patient-centered alternative, but high-quality comparative evidence in adults with mild to moderate crowding remains limited. Objective: To compare the effectiveness, treatment duration, pain experience, and patient satisfaction of clear aligners versus fixed appliances in adults with mild to moderate mandibular anterior crowding. Methods: In this parallel-group randomized controlled trial, 120 adults (18–35 years) with baseline Little’s Irregularity Index (LII) of 3–7 mm were allocated to clear aligner therapy or fixed pre-adjusted edgewise appliances. Standardized non-extraction protocols were used in both groups. Primary outcome was change in LII from baseline to treatment completion. Secondary outcomes included treatment duration, pain at 14 days (10-cm visual analogue scale, VAS), overall satisfaction at completion (10-item VAS composite), and early complications, including enamel decalcification and 3-month relapse. Data were analyzed using independent-samples t-tests and chi-square or Fisher’s exact tests with 95% confidence intervals. Results: Mean LII reduction was similar between clear aligners and fixed appliances (4.30 ± 0.88 vs 4.39 ± 0.91 mm; mean difference −0.09 mm, 95% CI −0.40 to 0.22; p = 0.56). Treatment duration was significantly shorter with aligners (8.4 ± 1.7 vs 12.1 ± 2.3 months; mean difference −3.7 months, 95% CI −4.42 to −2.98; p < 0.001). Pain at 14 days was lower (3.4 ± 1.2 vs 6.2 ± 1.8; p < 0.001), and satisfaction higher (9.1 ± 0.7 vs 7.4 ± 0.8; p < 0.001) in the aligner group. Enamel decalcification occurred in 0% of aligner patients and 8.3% of fixed appliance patients (p = 0.02), while early relapse rates were low and comparable. Conclusion: In adults with mild to moderate crowding, clear aligners achieved alignment comparable to fixed appliances but with shorter treatment duration, less early pain, higher satisfaction, and fewer enamel decalcification events, supporting their use as a patient-centered alternative in appropriately selected cases.
clear aligners; fixed appliances; dental crowding; Little’s Irregularity Index; treatment duration; patient satisfaction; enamel decalcification.
Copyright (c) 2025 Ayesha Ikram Malik, Lateef Ullah, Ayesha Latif, Tanzeel Sajid, Syeda Tooba Sajjad, Muhammad Amir Sher Khan (Author) https://creativecommons.org/licenses/by/4.0
Diagnostic Accuracy of AI in Radiographic Detection of Dental Caries and Periapical Lesions
Background: Accurate detection of dental caries and periapical lesions is critical for timely intervention and preservation of tooth structure, yet conventional radiographic interpretation is limited by observer variability and diagnostic fatigue. Recent advances in artificial intelligence (AI) offer automated image analysis with the potential to enhance diagnostic consistency and sensitivity in dental radiology. Objective: To compare the diagnostic accuracy of an AI-based radiographic tool with conventional clinical and radiographic examination for detecting dental caries and periapical lesions in adult dental patients. Methods: In this prospective diagnostic accuracy study, 240 adults undergoing intraoral periapical and bitewing radiography at a tertiary dental hospital in Lahore were consecutively enrolled. Two calibrated dentists performed conventional examinations using ICDAS II and PAI, blinded to AI outputs. A deep learning–based AI software analyzed all radiographs. Expert consensus by a radiologist and endodontist served as reference standard. Sensitivity, specificity, predictive values, accuracy, and area under the ROC curve (AUC) were calculated; McNemar’s and DeLong’s tests compared methods. Results: For caries detection, AI achieved sensitivity 91.7%, specificity 89.2%, and AUC 0.94, versus 83.4%, 81.6%, and 0.87 for conventional examination (all p ≤ 0.001). For periapical lesions, AI sensitivity, specificity, and AUC were 93.5%, 88.9%, and 0.96, compared with 84.8%, 80.2%, and 0.85 for conventional methods (all p ≤ 0.002). Conclusion: AI-based radiographic analysis demonstrated significantly superior diagnostic accuracy to conventional examination for both dental caries and periapical lesions, supporting its use as an adjunctive tool in routine dental diagnostics.
artificial intelligence; dental caries; periapical lesions; diagnostic accuracy; deep learning; intraoral radiography; sensitivity; specificity
Copyright (c) 2025 Saher Ahmed, Rabia Masood, Ifrah Rashid, Amna Jamil Haq, Rehmeen Asif, Syeda Tooba Sajjad, Nahel Tasnim (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
Prevalence of Pes Planus and Foot Health-Related Quality of Life Among University Students
Background: Pes planus (flat foot) is a common deformity whose prevalence and functional consequences in young adults, particularly university students, remain incompletely characterised. Objective: To determine the prevalence of pes planus using the Navicular Drop Test, examine associations with gender and body mass index, and compare foot-health-related quality of life between students with and without pes planus. Methods: A cross-sectional observational study enrolled 126 university students (18–27 years) in Karachi, Pakistan, in 2023. Navicular Drop Test (≥10 mm defined pes planus) and Foot Health Status Questionnaire data were collected. Associations were tested with chi-square and effect sizes; quality-of-life domains were compared by one-way ANOVA. Results: Pes planus prevalence was 17.5% (95% CI 11.2–23.8%) in the right foot and 11.1% (95% CI 5.7–16.5%) in the left foot. Higher body mass index was significantly associated with right-foot pes planus (χ²=7.98, p=0.047, Cramer's V=0.22; OR 2.8, 95% CI 1.1–7.2). Foot Health Status Questionnaire scores showed mild pain and minor functional limitation overall, with no significant differences across arch types (pain p=0.292, function p=0.378, footwear p=0.329). Conclusion: Pes planus is common among university students and linked to elevated body mass index, yet it does not substantially impair foot-related quality of life in this age group. Attention to footwear fit and weight management may offer preventive benefits.
pes planus, flat foot, Navicular Drop Test, Foot Health Status Questionnaire, body mass index, university students, quality of life
Copyright (c) 2025 Mehwish Khan, Taiba Abdul-Sattar, Faryal Waheed, Filza Siddiqui, Hafsa Saeed, Winza Tabassum, Iqra Khan, Sawera Ali, Jawaria Ismail (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