Journal of Health, Wellness and Community Research
Journal of Health, Wellness and Community Research (JHWCR) ISSN: 3007-0570 | DOI Prefix: 10.61919 JHWCR is dedicated to advancing global health and community well-being by publishing high-quality, peer-reviewed, open-access research. We actively encourage submissions from early-career researchers and support interdisciplinary work across the health sciences, rehabilitation, allied health, public and behavioral health, epidemiology, biostatistics, chronic and infectious diseases, environmental and global health, healthcare innovations, and basic or allied sciences with human health implications. All manuscripts undergo double-blind peer review and strict ethical screening in line with the guidelines of the Committee on Publication Ethics (COPE) and ICMJE. Frequency: Biweekly Indexing: HEC Pakistan (Y Category), Google Scholar, EuroPub, PakMediNet, Afro-Asian Research Index, CrossRef Open Access: Creative Commons Attribution 4.0 (CC BY 4.0) Publication Fee: PKR 18,000 or equivalent in USD.
Link Medical Interface, Lahore, Pakistan
Comparative Usefulness of CRP and ESR in Patients With Rheumatoid Arthritis
Background: Disease activity monitoring in rheumatoid arthritis (RA) commonly relies on Disease Activity Score-28 (DAS28) calculated with either erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), yet these indices may not be interchangeable and can influence treat-to-target decisions. Objective: To compare the usefulness of CRP and ESR by assessing agreement and discordance between DAS28-ESR and DAS28-CRP in patients with established RA. Methods: This cross-sectional observational study was conducted at the Department of Medicine, Combined Military Hospital, Multan (October 2024–March 2025). Adults aged 30–65 years with RA duration ≥1 year receiving non-biologic DMARDs with or without low-dose corticosteroids and without major comorbid confounders were enrolled consecutively. DAS28 was calculated using paired same-day joint counts, patient global assessment, and laboratory ESR and CRP. Agreement between DAS28-ESR and DAS28-CRP categories (remission/low/moderate/high) was evaluated using Cohen’s kappa, with discordance proportions and McNemar testing for high disease activity (HDA) versus non-HDA; ESR–CRP correlation was assessed by Spearman’s rho. Results: Ninety-two patients were analyzed (median age 51.0 years; 71.7% female). DAS28-ESR classified more patients as HDA than DAS28-CRP (27.2% vs 12.0%). Overall categorical agreement was 46.7% with fair concordance (κ=0.265; 95% CI 0.12–0.41), and discordance occurred in 53.3%, predominantly ESR-higher/CRP-lower. Agreement for HDA versus non-HDA was moderate (κ=0.47) with significant paired discordance (McNemar p=0.001). ESR and CRP correlated strongly (ρ=0.871; p<0.001). Conclusion: Despite strong ESR–CRP correlation, DAS28-ESR and DAS28-CRP show only fair categorical agreement, with DAS28-ESR more frequently classifying high disease activity; the indices are not interchangeable and discordant cases require clinical correlation.
C-reactive protein; Erythrocyte sedimentation rate; DAS28; Rheumatoid arthritis; Disease activity; Visual analogue scale.
Copyright (c) 2025 Muhammad Umer Rashid, Aasim Ali Sajid, Muhammad Ashraf, Ahtasham Ul Hassan, Fahd Farooq Ashraf, Muhammad Haseeb Lodhi (Author) https://creativecommons.org/licenses/by/4.0
Correlation of Prolonged Sitting with Low Back Pain and Level of Function Among University Students
Background: Low back pain (LBP) is increasingly prevalent among university students and may contribute to functional limitation and reduced academic performance, with prolonged sitting proposed as a modifiable risk factor. Objective: To assess the association between prolonged sitting duration and low back pain intensity and to evaluate its relationship with functional disability among university students. Methods: An analytical cross-sectional observational study was conducted at the University of Management and Technology, Lahore, using convenience sampling. A total of 120 students aged 20–30 years with acute or chronic LBP were assessed using the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI). Sitting duration was categorized as 5–6, 7–8, and 8–9 hours/day. Descriptive statistics were reported as frequencies and percentages, and Pearson correlation was used to test associations between sitting duration and NPRS and ODI outcomes (p < 0.05). Results: Participants were predominantly female (85.8%), aged 20–25 years (98.3%), and of normal BMI (62.5%). Moderate-to-severe pain was reported by 81.6% of students. Minimal disability was observed in 53.3%, while 46.7% reported ODI ≥21%. Sitting duration showed negligible and non-significant correlations with NPRS (r = 0.014, p = 0.881) and ODI (r = −0.012, p = 0.900). Conclusion: Sitting duration was not significantly associated with pain intensity or disability; however, LBP and disability burden was substantial, suggesting multifactorial determinants beyond sitting duration alone.
prolonged sitting, low back pain, Oswestry Disability Index, Numeric Pain Rating Scale, university students, functional disability
Copyright (c) 2025 Alveena Arif, Azka Maryam, Aimen Khurram, Sadia Riaz, Huma Aslam (Author) https://creativecommons.org/licenses/by/4.0
Burden and Severity Profile of Low Back Pain and Functional Disability Among University Students with Prolonged Sitting: A Cross-Sectional Study
Background: Low back pain (LBP) is increasingly reported among university students and may result in functional limitation. Prolonged sitting is common in academic settings, yet symptom severity profiles among prolonged sitters are underreported in local student cohorts. Objective: To determine the burden and severity distribution of low back pain intensity and functional disability among university students with prolonged sitting, and to explore whether sitting duration is associated with pain or disability severity. Methods: A cross-sectional observational study was conducted at the University of Management and Technology, Lahore, using convenience sampling. A total of 120 students aged 20–30 years with acute or chronic LBP were assessed using the Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI). Sitting duration was categorized as 5–6, 7–8, and 8–9 hours/day. Data were summarized using frequencies and percentages, and Pearson correlation was used to explore associations between sitting duration and NPRS and ODI outcomes. Results: Participants were predominantly female (85.8%) and aged 20–25 years (98.3%). Moderate-to-severe pain (NPRS 4–10) was reported by 81.6% of students, and 46.7% demonstrated ODI ≥21%. Sitting duration showed negligible correlations with NPRS (r = 0.014, p = 0.881) and ODI (r = −0.012, p = 0.900). Conclusion: University students with prolonged sitting demonstrated high pain and disability burden, but sitting duration alone was not associated with symptom severity, indicating the likely influence of multifactorial determinants beyond sitting time alone.
low back pain, prolonged sitting, Oswestry Disability Index, Numeric Pain Rating Scale, university students, disability
Copyright (c) 2025 Aniqa Aslam, Sana Hafeez (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Progressive Pressure Release Technique in Patients With Mechanical Neck Pain Associated With Myofascial Trigger Points
Background: Mechanical neck pain is a common musculoskeletal condition frequently associated with myofascial trigger points in cervical musculature, contributing to high pain intensity and functional limitation. Progressive Pressure Release Technique (PPRT) is a trigger point–directed manual therapy intended to reduce nociceptive sensitivity and improve function through gradual, tolerable pressure application. Objective: To evaluate within-participant changes in pain intensity and neck-related disability following a three-week PPRT program in adults with mechanical neck pain associated with myofascial trigger points. Methods: A quasi-experimental single-group pre–post study was conducted in the outpatient physiotherapy department of Nishtar Hospital, Multan, Pakistan, enrolling 30 adults aged 20–45 years with mechanical neck pain for ≥4 weeks and active trigger points in the upper trapezius, levator scapulae, and/or suboccipital muscles. Participants received PPRT three sessions/week for three weeks (20–30 minutes/session), alongside standardized ergonomic advice and home isometric exercises. Outcomes were assessed at baseline and week 3 using the Numeric Pain Rating Scale (NPRS) and Neck Disability Index (NDI). Normality was tested with Shapiro–Wilk; Wilcoxon signed-rank and paired t-tests were applied accordingly. Results: Pain decreased significantly (median NPRS 8.0 [IQR 1.25] to 3.0 [IQR 1.0]; p<0.001), with a large effect (r=0.87). Disability improved substantially (NDI mean 26.83±3.52 to 11.86±2.37; mean difference 14.96; 95% CI 13.65–16.27; p<0.001; Cohen’s d=4.18). Conclusion: A three-week PPRT program was associated with large, clinically meaningful improvements in pain and disability in adults with mechanical neck pain and myofascial trigger points; controlled trials are warranted to confirm effectiveness and isolate treatment-specific effects.
Mechanical neck pain; Myofascial trigger points; Progressive Pressure Release Technique; Upper trapezius; Levator scapulae; Suboccipital muscles; Numeric Pain Rating Scale; Neck Disability Index
Copyright (c) 2026 Aqsa Samreen, Areeba Shahid, Aqsa Ambreen, Attia Fatima, Tahir Mehmood Buzdar, Haider Zaman Khan, Tehmina Ashraf, Muhammad Awais (Author) https://creativecommons.org/licenses/by/4.0
A Comprehensive Study On Hair As An Investigative Approach In Forensic Science
Background: Human hair is a durable keratinized matrix frequently encountered in forensic casework and capable of retaining morphological, genetic, toxicological, and isotopic information over extended periods, yet its evidentiary value depends on validated interpretation beyond conventional microscopy. Objective: To evaluate hair as an investigative substrate using an integrated analytical framework combining morphology, nuclear and mitochondrial DNA profiling, toxicology, and stable isotope analysis, and to quantify key associations relevant to forensic interpretation. Methods: A cross-sectional observational study analyzed 120 scalp-hair samples from adult participants using light microscopy/SEM for morphological features, STR profiling from hair roots for nuclear DNA, mtDNA sequencing from hair shafts, chromatographic mass spectrometry for toxicological detection, and IRMS for δ¹³C/δ¹⁵N variability; blinded assessments, replicate testing, and inter-analyst agreement were implemented. Results: Hair roots were present in 56/120 (46.7%) samples; complete STR profiles were obtained in 49/56 (87.5%), with anagen phase strongly predicting STR success (OR 4.62, 95% CI 1.71–12.49; p=0.002). mtDNA sequencing succeeded in 110/120 (91.7%). Illicit drugs/metabolites were detected in 26/120 (21.7%) and therapeutic drugs in 17/120 (14.2%); cosmetic treatment was associated with lower detected concentrations (mean difference −18.6 pg./mg, 95% CI −29.4 to −7.8; p=0.001). Mobile participants showed higher intra-hair δ¹³C variability than sedentary participants (0.71±0.26 vs 0.42±0.18‰; p=0.004). Conclusion: Multimodal hair analysis provides robust forensic intelligence when morphology is constrained to screening and molecular/chemical methods are applied with validated protocols, bias controls, and transparent reporting of limitations.
Forensic science; hair analysis; microscopy; STR; mitochondrial DNA; GC-MS/LC-MS/MS; IRMS; isotopes; toxicology; ethics.
Copyright (c) 2026 Muhammad Ali Anjum, Abdul Mohiz, Ghulam Abbas Haral, Sameer Yaqub Nasik, Saeeda Soha, Muhammad Asif Ali, Abdullah Manzar, Ume Kalsoom, Amna Arooj, Muhammad Naveed (Author) https://creativecommons.org/licenses/by/4.0
Populations and the Rising Need for Geriatric Rehabilitation
Copyright (c) 2025 Ujala Bashir, Syed Assadullah Arslan (Author) https://creativecommons.org/licenses/by/4.0
Administrative Bottlenecks in U.S. Hospital Management: Lessons from Post-Pandemic Workforce Shortages and Bureaucratic Overload
Background: U.S. healthcare delivery is characterized by high administrative complexity, which intensified during and after COVID-19 and may differentially burden patients and healthcare-facing roles through appointment coordination, information seeking, paperwork, and billing/insurance problems. Objective: To quantify post-pandemic administrative burden and assess associations with demographic, socioeconomic, role, and insurance characteristics among U.S. adults with continuous coverage. Methods: A cross-sectional analysis used the Health Reform Monitoring Survey (HRMS) administered via Ipsos Knowledge Panel, drawing a nationally representative sample of adults aged 18–64 years with continuous health insurance; the final analytic sample included 4,155 respondents (January 2024–March 2025 fielding window with 12-month recall). Survey-weighted logistic regression estimated adjusted odds ratios (ORs) and predicted probabilities for four administrative domains. Results: Females had higher adjusted odds of frequent appointment coordination (OR 1.85, 95% CI 1.55–2.21) and information gathering (OR 1.42, 95% CI 1.18–1.71). Younger adults had lower odds of appointment coordination versus ages 50–64 (18–34: OR 0.60, 95% CI 0.48–0.75). Higher income was associated with lower information gathering (≥$75,000: OR 0.60, 95% CI 0.48–0.75) and a marked reduction in billing/insurance issues (predicted probability 28.0% vs 45.0% for <$25,000). Public insurance was associated with higher billing/insurance burden (OR 1.55, 95% CI 1.25–1.92). Conclusion: Post-pandemic administrative burden remains substantial and socially patterned, with pronounced inequities by sex, income, and insurance; streamlining administrative processes and reducing billing/coverage friction may yield clinically meaningful improvements in access and system efficiency.
Administrative burden; hospital management; billing; insurance; workforce shortages; COVID-19; health services research; inequities
Copyright (c) 2026 Abid Yaseen, Izhar Khan, Muhammad Hamza Javed, Ali Nawaz (Author) https://creativecommons.org/licenses/by/4.0
Exploring the Influence of Clinical Placement Quality and Metacognitive Awareness on Clinical Competence in Nursing Students Through the Mediation of Learning Agility
Background: Clinical competence is a core outcome of nursing education, yet students often experience a theory–practice gap driven by variability in clinical placements and differences in reflective self-regulation and adaptability. Objective: To examine the influence of clinical placement quality and metacognitive awareness on clinical competence in nursing students and to test learning agility as a mediating mechanism. Methods: A quantitative cross-sectional observational study was conducted among undergraduate nursing students at the University of Science and Technology, Lahore. Participants completed a structured Likert-scale questionnaire assessing clinical placement quality, metacognitive awareness, learning agility, and clinical competence. Analyses included descriptive statistics, reliability testing, Pearson correlations, multiple linear regression, and mediation analysis using PROCESS Model 4 with bootstrapped confidence intervals. Results: Data from 348 students were analyzed. All constructs demonstrated excellent internal consistency (Cronbach’s α range 0.93–0.96). Clinical placement quality, metacognitive awareness, and learning agility were positively associated with clinical competence (r = 0.469, 0.605, and 0.625, respectively; all p < 0.001). In multivariable regression, clinical placement quality (β = 0.238, p < 0.001) and metacognitive awareness (β = 0.531, p < 0.001) predicted competence (R² = 0.509). Learning agility strongly predicted competence (β = 0.728, p < 0.001) and partially mediated the effects of clinical placement quality (indirect β = 0.180, 95% CI 0.090–0.275) and metacognitive awareness (indirect β = 0.150, 95% CI 0.074–0.229). Conclusion: Clinical placement quality and metacognitive awareness enhance nursing students’ clinical competence both directly and through learning agility, supporting curricular strategies that strengthen reflective self-regulation and adaptive learning alongside high-quality clinical supervision.
Clinical placement quality; Metacognitive awareness; Learning agility; Clinical competence; Nursing students; Clinical learning environment; Reflective practice; Experiential learning
Copyright (c) 2026 Atia Siddiq, Nimra Fatima, Rashida Nasreen, Sadaf Rasheed, Sania Usman, Iqra Shahzadi (Author) https://creativecommons.org/licenses/by/4.0
Skeletogenesis and Disproportionate Short Stature: Genotypic Determinants and Phenotypic Variability in Achondroplasia
Background: Endochondral ossification governs longitudinal bone growth and is tightly regulated by fibroblast growth factor receptor signaling, particularly FGFR3, such that gain-of-function variants can disrupt growth-plate dynamics and produce disproportionate short stature as observed in achondroplasia and related skeletal dysplasias. Objective: To delineate molecular mechanisms underlying disproportionate short stature and clarify genotype–phenotype correlations, emphasizing FGFR3-mediated pathophysiology, phenotypic variability, and lifetime complications in achondroplasia within the broader framework of skeletal dysplasia diagnostics. Methods: A cross-sectional observational study was conducted at tertiary-care clinics and affiliated genetic laboratories (January 2019–December 2024) using consecutive recruitment of individuals aged ≥1 year with clinically and radiologically confirmed disproportionate short stature due to skeletal dysplasia. Standardized anthropometry and skeletal survey review (dual-reader, blinded) were performed, and pathogenic/likely pathogenic variants were identified via targeted panels and/or next-generation sequencing with ACMG classification. Genotype was the primary exposure; phenotypic disproportionality indices, height SDS, radiographic severity markers, and system-specific complications were outcomes. Multivariable regression adjusted for a priori confounders; missing data were addressed using multiple imputation. Results: FGFR3-related dysplasia’s, predominantly achondroplasia, demonstrated consistent disproportion patterns with clinically meaningful inter-individual variability in complication burden, including neurological, orthopedic, and otologic manifestations, supporting heterogeneity beyond a single-variant model. Genotype category and variant type were associated with phenotypic severity after adjustment for age and sex. Conclusion: Integrating standardized phenotyping with molecular diagnostics enables robust genotype–phenotype mapping in disproportionate short stature, supporting pathway-oriented evaluation and precision surveillance in achondroplasia and related dysplasia.
endochondral ossification; skeletal dysplasia; disproportionate short stature; achondroplasia; FGFR3; genotype–phenotype correlation; next-generation sequencing; growth plate; complications surveillance
Copyright (c) 2026 Iqra Shahid, Salman Latif, Fatima Saeed, Hadia Wajid, Saira Farooqui (Author) https://creativecommons.org/licenses/by/4.0
Postoperative Complications Related to Intraoperative Hypothermia in General Surgery Patients
Background: Inadvertent intraoperative hypothermia (IIH; core temperature <36.0 °C) is a frequent complication of general anesthesia and is associated with impaired wound healing and delayed postoperative recovery. Objective: To determine the incidence of IIH and evaluate its association with early postoperative complications in adult general surgery patients. Methods: This observational cross-sectional study included 75 adults (18–65 years) undergoing elective or emergency surgery under general anesthesia at a tertiary-care hospital. Core temperature was monitored from induction to end of surgery. Patients were classified as hypothermic if temperature fell below 36.0 °C at any intraoperative time point. Early postoperative outcomes (hemodynamic abnormalities, postoperative temperature status, gastrointestinal recovery indicators, nausea/vomiting, and wound condition) were assessed in the immediate recovery period. Group comparisons used chi-square/Fisher’s exact tests and effect sizes were expressed as odds ratios (OR) with 95% confidence intervals (CI). Results: IIH occurred in 46/75 patients (61.3%), and postoperative hypothermia occurred in 41/75 (54.7%). Compared with normothermic patients, IIH was associated with higher odds of postoperative nausea (22/46 vs 7/29; OR 2.88, 95% CI 1.03–8.06; p=0.040) and delayed evacuation (40/46 vs 5/29; OR 31.0, 95% CI 8.7–110.4; p<0.001). Wound abnormalities (hyperemia or secretion) occurred in 18/46 (39.1%) hypothermic patients and 0/29 normothermic patients (p=0.001). Conclusion: IIH is common and is strongly associated with impaired wound integrity and delayed gastrointestinal recovery, supporting strict perioperative normothermia as a key quality measure.
intraoperative hypothermia; normothermia; general anesthesia; postoperative complications; wound healing; gastrointestinal recovery; nausea
Copyright (c) 2026 Aleeza Rana, Shiza Ijaz, Awais Akhtar, Syed Zamin Raza Shah, Taimoor Riaz Ullah, Saqib Hussain Dar, Inam Ullah, Sumbal Shahbaz (Author) https://creativecommons.org/licenses/by/4.0
Impact of General Anesthesia on Post Operative Respiratory Complications in Obese Patients Undergoing Intra-Abdominal Surgeries
Background: Obesity predisposes surgical patients to postoperative pulmonary complications (PPCs) through impaired respiratory mechanics, reduced functional residual capacity, and anesthesia-related atelectasis, with risk potentially amplified during intra-abdominal surgery under general anesthesia. Objective: To determine the incidence of early PPCs and identify associated risk factors in obese adults undergoing elective intra-abdominal surgery under general anesthesia. Methods: A cross-sectional observational study was conducted from January to June 2025 among adults (≥18 years) with BMI ≥30 kg/m² scheduled for elective intra-abdominal surgery under general anesthesia. Consecutively recruited participants were followed in the post-anesthesia care unit and for 48 hours postoperatively. PPCs (hypoxemia, atelectasis, bronchospasm, pneumonia, or reintubation) were recorded using standardized clinical documentation. Associations were evaluated using chi-square testing and multivariable logistic regression (SPSS v27). Results: Among 200 patients, 45 developed PPCs (22.5%). Hypoxemia was most frequent (12.5%), followed by atelectasis (7.5%), pneumonia (3.0%), bronchospasm (2.5%), and reintubation (2.0%). PPC incidence was higher with surgical duration >2 hours (35.0% vs 12.0%; p=0.007) and in patients with obstructive sleep apnea (31.0% vs 18.1%; p=0.012). In adjusted analysis, surgical duration >2 hours (aOR 3.92; 95% CI 1.78–8.63; p=0.001), obstructive sleep apnea (aOR 2.14; 95% CI 1.05–4.35; p=0.036), and residual neuromuscular blockade (aOR 2.67; 95% CI 1.21–5.89; p=0.015) independently predicted PPCs. Conclusion: Early PPCs are common after elective intra-abdominal surgery under general anesthesia in obese patients, with prolonged operative time, obstructive sleep apnea, and residual neuromuscular blockade conferring increased risk.
Obesity; General anesthesia; Postoperative pulmonary complications; Intra-abdominal surgery; Obstructive sleep apnea; Atelectasis; Hypoxemia
Copyright (c) 2026 Ravish Gull, Inam Ullah, Saqib Hussain Dar, Taimoor Riaz Ullah, Awais Akhtar, Sumbal Shahbaz (Author) https://creativecommons.org/licenses/by/4.0
Impact of Early Patient Mobilization Post-Surgery on Hospital Stay Length and Recovery Outcomes
Background: Prolonged postoperative immobility is associated with preventable complications and delayed functional recovery, contributing to extended hospital length of stay and increased healthcare utilization. Early mobilization within 24 hours of surgery is increasingly incorporated into enhanced recovery pathways, yet its combined impact on clinical, functional, and patient-reported outcomes across elective surgical populations requires further evaluation. Objective: To assess the association between early postoperative mobilization and hospital length of stay, postoperative complications, mobility at discharge, 30-day readmission, and patient satisfaction among elective surgery patients. Methods: A cross-sectional observational comparative study was conducted among 200 adults undergoing elective surgery at a tertiary-care hospital. Patients were categorized into an early mobilization group (mobilized within 24 hours post-surgery; n = 100) and a standard care group (mobilized after 24 hours; n = 100) based on routine postoperative documentation. Outcomes included length of stay, in-hospital complications (deep vein thrombosis, pneumonia, pressure ulcers), discharge mobility score (10-point scale), 30-day readmission, and discharge satisfaction score (10-point scale). Group comparisons used t-tests and chi-square tests, with effect estimates reported as mean differences and odds ratios. Results: Early mobilization was associated with shorter length of stay (5.4 ± 1.2 vs 7.2 ± 1.5 days; mean difference −1.8 days; p = 0.02), lower complication rates (deep vein thrombosis: 2.5% vs 7.0%, OR 0.34; pneumonia: 1.0% vs 5.0%, OR 0.19; pressure ulcers: 1.5% vs 6.5%, OR 0.22; all p ≤ 0.03), higher mobility scores (8.4 ± 1.3 vs 6.2 ± 1.8; mean difference 2.2; p = 0.001), reduced 30-day readmission (3.0% vs 7.5%, OR 0.38; p = 0.04), and higher satisfaction (9.0 ± 0.9 vs 7.2 ± 1.1; mean difference 1.8; p = 0.002). Conclusion: Early mobilization within 24 hours after elective surgery was associated with improved postoperative outcomes, including shorter hospitalization, fewer complications, better functional recovery, lower readmission, and higher patient satisfaction, supporting its integration into routine postoperative care pathways.
Early mobilization; postoperative recovery; elective surgery; length of stay; postoperative complications; mobility; readmission; patient satisfaction
Copyright (c) 2026 Muhammad Husnain, Sumaira Nawaz, Uzma Javed, Gule Fatima Syeda, Kaneez Fatima, Amna Abbas (Author) https://creativecommons.org/licenses/by/4.0
Predicting Difficult Intubation in Elective Surgery Patients Through Preoperative Airway Assessment
Background: Unanticipated difficult laryngoscopy during elective surgery can lead to hypoxaemia, airway trauma, and perioperative complications; however, no single bedside airway test consistently provides high diagnostic accuracy for preoperative risk stratification. Objective: To evaluate and compare the diagnostic performance of commonly used preoperative airway assessment tests for predicting difficult laryngoscopy in adult elective surgical patients. Methods: A cross-sectional observational study was conducted at the University of Lahore Teaching Hospital among 133 patients aged 18–65 years (ASA I–III) scheduled for elective surgery under general anaesthesia with planned orotracheal intubation. Preoperative assessment included the Modified Mallampati Test (MMT), thyromental distance (TMD), inter-incisor gap (IIG), upper lip bite test (ULBT), LEMON assessment, and atlanto-occipital extension (AOE). Direct laryngoscopy findings were graded using the Cormack–Lehane (CL) system; difficult laryngoscopy was defined as CL grade III–IV. Results: Difficult laryngoscopy occurred in 15/133 patients (11.3%). MMT demonstrated the highest sensitivity (66.7%), while LEMON showed the highest specificity (77.0%). AOE yielded the highest overall accuracy (86.0%) and the strongest association with difficult laryngoscopy (restricted AOE grade III–IV: 12/15 vs 1/118; p<0.001). TMD, IIG, and ULBT showed moderate predictive performance. Conclusion: No single bedside test optimally predicts difficult laryngoscopy; combining complementary assessments, particularly sensitivity-oriented screening with specificity-oriented confirmation and neck mobility evaluation, provides a more reliable preoperative approach.
difficult laryngoscopy; Cormack–Lehane; Modified Mallampati Test; thyromental distance; inter-incisor gap; upper lip bite test; LEMON; atlanto-occipital extension
Copyright (c) 2026 Muhammad Sheharyar Khan, Akbar Ali, Awais Akhtar, Saqib Hussain Dar, Taimoor Riaz Ullah, Inam Ullah, Sumbal Shahbaz (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Spontaneous Bacterial Peritonitis in Chronic Liver Disease at BMC SPH, Quetta
Background: Spontaneous bacterial peritonitis (SBP) is a frequent and life-threatening infection of ascitic fluid in chronic liver disease (CLD), contributing substantially to in-hospital morbidity and mortality. Local epidemiologic and microbiologic data are essential to guide early diagnostic vigilance and empiric antimicrobial therapy in hospitalized patients with cirrhosis and ascites. Objective: To determine the frequency of SBP among hospitalized CLD patients with ascites at Sendeman Provincial Hospital/BMC Quetta and to describe ascitic fluid culture yield and bacterial spectrum. Methods: A cross-sectional observational study was conducted in the Department of General Medicine, Unit IV, Sendeman Provincial Hospital/BMC Quetta from 06 January 2025 to 06 June 2025. Consecutive patients aged >15 years with CLD and ascites underwent diagnostic paracentesis within 24 hours of admission. Ascitic fluid (50 mL) was obtained under aseptic technique; 10 mL was inoculated directly into blood culture bottles and the remainder was analyzed for cell count/differential. SBP was diagnosed using standard criteria (ascitic polymorphonuclear leukocytes ≥250 cells/mm³) and infections were categorized by PMN count and culture status. Results: Among 139 patients (mean age 35.67±12.79 years; 61.0% male), SBP was present in 56 (40.3%). Ascitic fluid culture was positive in 80 (57.6%). Among culture-positive infections (n=80), classical SBP accounted for 52 (65.0%), bacterascites for 18 (22.5%), and culture-negative neutrocytic ascites for 10 (12.5%). Escherichia coli was the most common isolate (30/80, 37.5%), followed by Klebsiella species (15/80, 18.8%). Conclusion: SBP occurred in approximately two-fifths of hospitalized CLD patients with ascites, with predominance of classical SBP and enteric gram-negative pathogens, supporting routine early paracentesis and locally informed empiric management.
spontaneous bacterial peritonitis; ascitic fluid; chronic liver disease; cirrhosis; bacterascites; culture-negative neutrocytic ascites; Escherichia coli; Klebsiella.
Copyright (c) 2025 Sultan Shah, Jehanzeb, Mohib Ullah, Abbaseen Khan, Muhibullah Khan (Author) https://creativecommons.org/licenses/by/4.0
Frequency of Risk Factor in Peripheral Arterial Disease in Diabetes
Background: Peripheral arterial disease (PAD) is a common yet frequently under-recognized macrovascular complication of type 2 diabetes mellitus (T2DM) that increases risk of lower-limb morbidity and adverse cardiovascular outcomes. Objective, reproducible screening using the ankle–brachial index (ABI) can identify PAD, including asymptomatic disease, and may facilitate targeted risk-factor modification. Objective: To determine the prevalence of ABI-defined PAD and evaluate the frequency and association of key risk factors among adults with T2DM. Methods: This cross-sectional observational study was conducted in the Department of Medicine, Sandeman Provincial Hospital, Quetta, from January 6 to June 6, 2025. Adults (≥18 years) with T2DM of ≥6 months’ duration were enrolled. ABI was measured using a handheld Doppler ultrasound device; PAD was defined as ABI ≤0.9. Demographic and clinical variables including BMI, HbA1c, hypertension, smoking history, and family history of diabetes were recorded. Associations with PAD were tested using chi-square and t-tests, with crude odds ratios (ORs) and 95% confidence intervals (CIs) calculated; Pearson correlation assessed relationships with ABI. Results: Among 897 participants (56.5% female), mean age was 50.68±11.65 years and mean BMI 26.29±5.49 kg/m²; 68.7% had BMI ≥23 kg/m², 27.9% had hypertension, and 7.7% reported smoking. Mean ABI was 1.11±0.17 and PAD prevalence was 10.0% (90/897). PAD was associated with BMI ≥23 kg/m² (OR 2.68, 95% CI 1.49–4.83; p=0.001), hypertension (OR 1.85, 95% CI 1.18–2.90; p=0.007), and smoking (OR 3.08, 95% CI 1.68–5.66; p<0.001). HbA1c showed a weak inverse correlation with ABI (r=−0.070; p=0.036). Conclusion: ABI-defined PAD affected one in ten adults with T2DM and was strongly associated with obesity, hypertension, and smoking, supporting targeted ABI screening and aggressive risk-factor control in high-risk subgroups.
ankle–brachial index; hypertension; peripheral arterial disease; smoking; type 2 diabetes mellitus.
Efficacy of Corticosteroid-Augmented Arthrocentesis in the Management of Temporomandibular Joint Disorders
Background: Temporomandibular joint disorders (TMDs are a common cause of chronic orofacial pain and functional limitation, and a subset of patients remains symptomatic despite conservative management. Arthrocentesis is an established minimally invasive intervention, and adjunctive intra-articular corticosteroids may enhance its anti-inflammatory and clinical effects, though evidence from well-characterized prospective studies remains limited. Objective: To evaluate the short-term clinical effectiveness of corticosteroid-augmented arthrocentesis in reducing pain, improving mandibular mobility, and decreasing joint sounds in patients with refractory TMDs. Methods: A quasi-experimental, single-arm pre–post study was conducted on 52 adults with imaging-confirmed TMJ internal derangement unresponsive to conservative therapy. All patients underwent standardized arthrocentesis of the superior joint space followed by intra-articular injection of triamcinolone acetonide. Pain intensity (Visual Analog Scale), maximum interincisal opening, joint clicking, and patient satisfaction were assessed at baseline and at 1 week, 1 month, and 3 months post-intervention. Repeated-measures statistical analyses were applied. Results: Mean pain scores decreased significantly from 7.6 ± 1.2 at baseline to 1.2 ± 0.7 at 3 months (p < 0.001), while maximum mouth opening improved from 28.4 ± 4.6 mm to 43.7 ± 3.1 mm (p < 0.001). Joint clicking prevalence declined from 92.3% to 7.7% (p < 0.001), and 88.5% of patients reported high satisfaction. No serious adverse events were observed. Conclusion: Corticosteroid-augmented arthrocentesis is a safe and effective minimally invasive intervention for refractory TMDs, producing significant short-term improvements in pain, function, and joint stability.
Temporomandibular joint disorders; arthrocentesis; corticosteroids; triamcinolone acetonide; pain management; mandibular mobility.
Copyright (c) 2026 Mariam Haroon, Saima Khan, Marjan Alam, Kashaf Ilyas, Azhar Atta Muhammad, Momal Kharo (Author) https://creativecommons.org/licenses/by/4.0
Systematic Review of Lipid Nanoparticle Efficacy for Delivering Antifungal Agents in Invasive Pulmonary Aspergillosis
Background: Invasive pulmonary aspergillosis (IPA) remains a lethal infection in immunocompromised hosts, with treatment limited by the poor pharmacokinetics and toxicity of conventional antifungals. Lipid nanoparticles (LNPs) offer a promising delivery platform to overcome these barriers, yet a synthesis of pre-clinical evidence is lacking. Objective: This systematic review aimed to synthesize pre-clinical evidence on the therapeutic potential of LNP-based systems for delivering antifungal agents in the treatment of IPA. Methods: Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted for studies published from 2014-2024. Included were pre-clinical studies evaluating LNP-encapsulated antifungals in models of IPA, compared to conventional formulations. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using the SYRCLE tool. Results: Eight studies met the inclusion criteria. All reported that LNP formulations (of amphotericin B, voriconazole, itraconazole, or posaconazole) significantly reduced lung fungal burden and/or improved survival compared to free drug controls (p<0.05). LNPs consistently enhanced drug deposition in lung tissue and, for amphotericin B, demonstrated a reduced nephrotoxic profile. Methodological quality was variable, with frequent unclear risks of bias related to blinding. Conclusion: Pre-clinical evidence robustly indicates that LNP encapsulation enhances the efficacy and safety of antifungal drugs in IPA models. These findings justify accelerated translational research to standardize formulations and advance the most promising candidates toward clinical trials for this high-mortality infection.
Invasive pulmonary aspergillosis; lipid nanoparticles; antifungal therapy; drug delivery; systematic review; pre-clinical
Copyright (c) 2026 Hina Ali Ahmed, Syed Muhammad Razi Kazim Naqvi, Aqsa Sharif, Shaikh Khalid Muhammad, Nimra Zahoor, Mustafa Rahim Abro, Z. H. Shar (Author) https://creativecommons.org/licenses/by/4.0
Effect of Smartphone Addiction on Sleep Quality Among Medical and Non-Medical Students
Background: Problematic smartphone use is increasingly recognized as a behavioral addiction in young adults and has been linked to sleep disruption, yet discipline-specific differences between medical and non-medical students remain underexplored. Objective: To compare smartphone addiction and sleep quality between medical and non-medical university students and to evaluate smartphone addiction as a predictor of sleep quality. Methods: A cross-sectional observational study was conducted from March to September 2025 across multiple universities in Sialkot, Pakistan, enrolling undergraduate students aged 18–25 years (N=378) with equal representation from medical and non-medical programs (n=189 each). Data were collected using a demographic questionnaire, the Smartphone Addiction Scale–Short Version (SAS-SV; range 10–60), and the Sleep Quality Scale (SQS; higher scores indicate poorer sleep). Group differences were assessed using Mann–Whitney U tests with effect sizes, and linear regression evaluated the association between SAS-SV and SQS. Results: Non-medical students reported significantly higher smartphone addiction than medical students (40.11±8.44 vs 28.08±8.65; p<0.001; r=0.58) and poorer sleep quality (32.82±11.74 vs 28.62±10.27; p<0.001; r=0.19). Smartphone addiction significantly predicted poorer sleep quality (B=0.26, 95% CI 0.16–0.36; β=0.26; R²=0.067; F(1,376)=27.21; p<0.001). Conclusion: Higher smartphone addiction was associated with poorer sleep quality among university students, with non-medical students demonstrating a higher-risk profile. Targeted digital well-being and sleep-hygiene interventions may help reduce sleep disturbance in student populations.
Smartphone addiction; Sleep quality; University students; Medical students; Non-medical students; SAS-SV; Sleep Quality Scale
Copyright (c) 2026 Alisha Batool, Asifa Qurat Ul Ain, Hashim Shahbaz, Khadija Zahid, Sehar Salman, Raveena Rajput (Author) https://creativecommons.org/licenses/by/4.0
In-Hospital Cardiac Arrest Management: A Retrospective Study in the Emergency Department
Background: In-hospital cardiac arrest (IHCA) in the emergency department (ED) remains a high-mortality event, and locally generated outcome data from low- and middle-income settings are limited. Objective: To describe the characteristics, management, and outcomes of ED-based IHCA in a tertiary-care hospital and to evaluate differences in outcomes by initial cardiac arrest rhythm. Methods: This retrospective observational study was conducted in the Emergency Department of Lady Reading Hospital, Peshawar, from June 2025 to December 2025. Adult patients (≥18 years) who developed cardiac arrest in the ED after arrival and received cardiopulmonary resuscitation were included; out-of-hospital cardiac arrest and documented do-not-resuscitation cases were excluded. Data were extracted from ED records and CPR logs using standardized definitions. The primary outcome was return of spontaneous circulation (ROSC); secondary outcomes were survival to ED disposition and survival to hospital discharge. Results: Eighty-six patients were included (mean age 58.4 ± 15.2 years; 60.5% male). Initial rhythms were pulseless electrical activity in 44.2%, asystole in 37.2%, and shockable rhythms in 18.6%. ROSC occurred in 31/86 (36.0%), survival to ED disposition in 18/86 (20.9%), and survival to hospital discharge in 9/86 (10.5%). Shockable rhythms were associated with higher ROSC than non-shockable rhythms (62.5% vs 30.0%; OR 3.89, 95% CI 1.25–12.10; p=0.018). Conclusion: ED-based IHCA was associated with low survival to hospital discharge, with non-shockable rhythms predominating and conferring poorer outcomes. Strengthening early recognition, high-quality resuscitation, and optimized post-arrest care may improve survival.
cardiac arrest; emergency department; cardiopulmonary resuscitation; return of spontaneous circulation; shockable rhythm
Copyright (c) 2026 Muhammad Abas Khan, Muhammad Kamal Khattak, Umair Shafqat, Eisha Adnan, Abubakar Shaid, Sana Shakeel, Erum Fatima (Author) https://creativecommons.org/licenses/by/4.0
The Role of Cardiopulmonary Physical Therapy in Promoting Healthy Aging and Preventing Age-Related Respiratory Problems: A Systematic Review
Background: Population aging is associated with progressive declines in cardiopulmonary function and an increased burden of chronic respiratory conditions, underscoring the need for effective strategies that support healthy aging and functional independence. Objective: To systematically synthesize current evidence on the role of cardiopulmonary physical therapy (CPT) in promoting healthy aging and preventing age-related respiratory problems in older adults. Methods: A systematic review with narrative synthesis was conducted in accordance with established systematic review principles. PubMed, Scopus, Web of Science, and CINAHL were searched for English-language studies published between January 2019 and December 2024. Eligible studies included adults aged ≥60 years who received CPT or pulmonary rehabilitation interventions, with outcomes related to respiratory function, exercise capacity, quality of life, or functional independence. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Results: Ten studies involving at least 4,296 participants met the inclusion criteria, comprising randomized and non-randomized interventional studies, observational studies, and secondary evidence syntheses. CPT interventions were consistently associated with improvements in exercise capacity and health-related quality of life, while effects on respiratory function and preventive outcomes were mixed and dependent on intervention specificity. Overall certainty of evidence ranged from low to moderate, reflecting heterogeneity in study designs and predominantly moderate risk of bias. Conclusion: CPT appears to be a beneficial component of care for older adults, particularly for enhancing functional capacity and quality of life; however, evidence supporting direct preventive effects on age-related respiratory decline remains limited. Higher-quality, long-term studies are required to clarify the preventive role of CPT in healthy aging.
cardiopulmonary physical therapy, pulmonary rehabilitation, healthy aging, elderly, respiratory function.
Copyright (c) 2026 Salman Latif, Saima Riaz, Sobia Maqbool, Mariam Javaid, Jurat Ali, Hassan Bin Akram, Saira Farooqui (Author) https://creativecommons.org/licenses/by/4.0
Impact of Shoulder–Hand Syndrome on Upper Extremity–Related Functional Independence Among Chronic Stroke Patients
Background: Shoulder–hand syndrome (SHS), commonly conceptualized within post-stroke complex regional pain syndrome type I, is a disabling complication that may exacerbate dependence in chronic stroke survivors by limiting functional use of the affected upper limb. Objective: To determine the association between SHS pain intensity and activities-of-daily-living (ADL) functional independence among chronic stroke patients. Methods: A cross-sectional observational study was conducted over six months at PSRD Hospital and Lahore General Hospital. Using non-probability convenience sampling, 164 chronic ischemic supratentorial stroke patients (>6 months post-stroke) meeting Budapest criteria for SHS were enrolled. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS; 0–10), and functional independence was evaluated using the Barthel Index. Pearson correlation was applied to examine the association between NPRS and Barthel total score (SPSS v25; two-tailed α=0.05). Results: Participants had a mean age of 59.35±9.52 years; 152 (92.7%) were male. Mean NPRS pain intensity was 2.48±2.03, and mean Barthel total score was 63.4±18.9. Greater pain intensity was associated with lower ADL independence (r=−0.414; 95% CI −0.54 to −0.27; p<0.001). Dependency was most pronounced in stair negotiation (42.7% unable) and transfers (56.1% requiring assistance). Conclusion: In chronic stroke patients with SHS, higher pain intensity is significantly associated with poorer functional independence, supporting the clinical importance of targeted pain management within long-term stroke rehabilitation.
Shoulder–hand syndrome; complex regional pain syndrome; chronic stroke; pain intensity; Barthel Index; functional independence
Copyright (c) 2025 Asma Malik, Aneela Amjad, Khadija Tariq, Rubab Rehman, Warda Eman, Muhammad Ammaz Naveed (Author) https://creativecommons.org/licenses/by/4.0
The Association of Pes Planus and Calf Muscle Tightness Among School-Age Children
Background: Pes planus is a common pediatric foot posture variant characterized by medial longitudinal arch collapse during weight bearing and has been linked to altered lower-limb biomechanics, including restricted ankle dorsiflexion leading to compensatory pronation. Objective: To determine the association of pes planus and calf muscle tightness (gastrocnemius and soleus) among school-age children. Methods: A cross-sectional observational study was conducted over six months at PSRD Hospital Lahore and PSRD High School Lahore using convenience sampling. Children aged 6–12 years were classified as pes planus or normal foot posture using Jack’s test. Ankle dorsiflexion was measured bilaterally with a goniometer in knee extension (gastrocnemius) and knee flexion (soleus) and categorized into severity bands. Associations were tested using Pearson’s chi-square with effect sizes (Cramér’s V). Results: Among 142 children (mean age 9.16 ± 2.04 years; 54.2% male), 86 (60.6%) had pes planus. Pes planus was strongly associated with gastrocnemius tightness bilaterally (χ²=118.52, df=2, p<0.001; Cramér’s V=0.65), with severe tightness present in ~65% of the pes planus group versus ~11% without pes planus. Soleus tightness was also associated with pes planus (right: χ²=62.01, df=2, p<0.001; V=0.47; left: χ²=44.31, df=1, p<0.001; V=0.40). Conclusion: School-age children with pes planus demonstrate significantly higher prevalence of calf muscle tightness, particularly gastrocnemius restriction, supporting routine dorsiflexion assessment in pediatric flatfoot evaluation.
Pes planus; flatfoot; calf muscle tightness; gastrocnemius; soleus; ankle dorsiflexion; children.
Copyright (c) 2025 Rubab Rehman, Faryal Arshad, Karan Parkash, Asma Malik, Warda Eman, Maria Farooq (Author) https://creativecommons.org/licenses/by/4.0
Evaluating Diagnostic Accuracy and Treatment Outcomes of Emerging Clinical Protocols in Managing Complex Internal Medicine Disorders
Background: Complex internal medicine admissions are prone to diagnostic discordance and variable treatment outcomes, particularly in high-volume tertiary settings, motivating the adoption of structured, technology-assisted clinical protocols to standardize diagnostic and therapeutic pathways. Objective: To evaluate whether emerging protocol-based care is associated with improved diagnostic concordance and better inpatient and short-term post-discharge outcomes compared with conventional care among adults with complex internal medicine disorders. Methods: A retrospective observational cohort study was conducted across tertiary care teaching hospitals in Lahore, Pakistan, over a 12-month period. Adult inpatients (n=300) managed under internal medicine services were classified by documented care pathway into emerging protocol-based care (n=152) or conventional care (n=148). Primary diagnostic performance was assessed as diagnostic concordance between the initial working diagnosis within 24 hours and the final adjudicated discharge diagnosis. Outcomes included clinical improvement at discharge (CGI-I ≤3), length of stay, in-hospital complications, and 30-day readmission. Multivariable logistic regression adjusted for age, sex, comorbidity burden, disease category, and baseline severity. Results: Diagnostic concordance was higher with emerging protocols (90.8% vs 81.1%; risk difference 9.7%, 95% CI 2.8–16.6; p=0.006). Clinical improvement was more frequent (84.2% vs 69.6%; OR 2.34, 95% CI 1.36–4.03; p=0.002), length of stay was shorter (5.8±1.9 vs 8.4±2.3 days; mean difference −2.6, 95% CI −3.1 to −2.1; p<0.001), and 30-day readmissions were lower (7.9% vs 14.9%; OR 0.49, 95% CI 0.23–0.99; p=0.046). Protocol-based care independently predicted favorable outcomes (adjusted OR 2.47, 95% CI 1.44–4.22; p=0.001). Conclusion: Emerging protocol-based care was associated with improved diagnostic concordance and clinically meaningful gains in efficiency and short-term outcomes in complex internal medicine admissions.
Clinical protocols; Diagnostic concordance; Clinical decision support; Internal medicine; Length of stay; Readmission; Retrospective cohort
Copyright (c) 2026 Mon Yee Htet Paing, Muhammad Numair Kashif, Lal Shehbaz, Shaikh Khalid Muhammad, Muhammad Haseeb Shaikh, Shazia Ilyas (Author) https://creativecommons.org/licenses/by/4.0
Investigating the Efficacy and Safety of Newly Developed Drug Therapies for Managing Chronic and Life-Threatening Human Diseases
Background: Chronic diseases require sustained pharmacotherapy, yet conventional regimens may be limited by incomplete symptom control, tolerability concerns, and variable patient-reported outcomes, prompting increasing clinical adoption of recently introduced mechanism-based therapies. Objective: To evaluate the short-term effectiveness, safety profile, and quality-of-life outcomes associated with newly developed drug therapies among adults with chronic diseases receiving routine clinical care. Methods: A prospective observational pre–post study was conducted over two months in a tertiary clinical setting in Lahore, Pakistan, enrolling 60 adults (≥18 years) with chronic diseases receiving recently introduced drug therapies. Effectiveness was assessed by within-patient change in symptom severity scores, patient-reported outcomes by change in quality-of-life scores, and safety by frequency and severity of adverse events. Paired-sample t-tests were applied with 95% confidence intervals and effect sizes. Results: Mean symptom severity decreased from 7.87 ± 1.09 at baseline to 4.97 ± 1.52 at follow-up (mean change −2.90; 95% CI −3.33 to −2.47; p < 0.001; Cohen’s d = 2.03). Quality-of-life scores improved from 53.12 ± 7.04 to 68.19 ± 7.63 (mean change +15.07; 95% CI 12.96 to 17.18; p < 0.001; Cohen’s d = 2.06). Adverse events were none in 40.0%, mild in 41.7%, moderate in 18.3%, and severe in 0.0%. Conclusion: Newly developed drug therapies were associated with large short-term improvements in symptom burden and quality of life, with an acceptable tolerability profile and no severe adverse events observed.
Chronic Disease; Drug Safety; Emerging Therapies; Observational Study; Patient-Reported Outcomes; Quality of Life; Therapeutic Effectiveness.
Copyright (c) 2026 Muhammad Azhar Sherkheli, Amna Saeed, Muneer Akhtar, Shaikh Khalid Muhammad, Adeel Zain, Amina Mansab (Author) https://creativecommons.org/licenses/by/4.0
Evaluating the Efficacy of Adjunctive Non-Pharmacological Interventions in Reducing Seizure Frequency among Patients with Epilepsy.
Background: Epilepsy is a chronic neurological disorder that often requires long-term treatment to achieve adequate seizure control. Although antiepileptic drugs remain the primary therapy, a considerable proportion of patients continue to experience recurrent seizures despite stable pharmacological management. Growing attention has been directed toward non-pharmacological strategies that target modifiable lifestyle and behavioral factors contributing to seizure occurrence. However, evidence from controlled studies evaluating their additive benefit alongside standard therapy remains limited. Objective: To compare the effectiveness of adjunctive non-pharmacological interventions versus standard therapy alone in reducing seizure frequency among patients with epilepsy. Methods: A randomized controlled study was conducted in a clinical setting in South Punjab. Sixty adult patients with epilepsy and persistent seizures despite stable antiepileptic therapy were randomly allocated into two equal groups. The control group received standard pharmacological treatment, while the intervention group received standard therapy combined with structured non-pharmacological interventions, including stress management, sleep hygiene counseling, lifestyle modification, and guided physical activity. Seizure frequency was recorded using patient-maintained seizure diaries at baseline and during follow-up. Data were analyzed using parametric statistical tests, with comparisons made within and between groups. Results: Baseline seizure frequency was comparable between groups. Following the intervention period, the intervention group demonstrated a marked reduction in mean monthly seizure frequency compared with the control group. Within-group analysis showed a statistically significant reduction in seizure frequency in the intervention group, while the control group exhibited a smaller reduction. No intervention-related adverse events were reported. Conclusion: Adjunctive non-pharmacological interventions, when combined with standard antiepileptic therapy, were associated with a greater reduction in seizure frequency. These findings support the integration of structured non-pharmacological strategies into comprehensive epilepsy management.
Behavior Therapy, Epilepsy, Lifestyle Modification, Physical Activity, Seizure Frequency, Sleep Hygiene, Stress Management
Copyright (c) 2025 Shah Nawaz, Muhammad Numair Kashif, Amna Saeed, Najia Ijaz, Hamna Riaz, Amina Khalid Zaman (Author) https://creativecommons.org/licenses/by/4.0
Evaluating the Current State of Esthetic Dentistry Knowledge and Training Among Dental Students and Dentist in Pakistan
Background: Esthetic dentistry has gained increasing importance due to heightened patient awareness of smile aesthetics and its psychosocial impact, placing greater demands on dental professionals to deliver predictable and high-quality esthetic outcomes. Objective: To evaluate the level of knowledge, perception, and training needs related to esthetic dentistry among dental students and general dental practitioners in Pakistan. Methods: A cross-sectional quantitative survey was conducted among 385 dental students and general dentists using a validated, self-administered questionnaire. Data were analyzed using descriptive statistics and inferential tests including chi-square, ANOVA, correlation analysis, and logistic regression, with significance set at p<0.05. Results: A total of 235 responses were analyzed. Most participants recognized the impact of dental esthetics on appearance (97.9%) and social interaction (96.6%). Awareness of basic esthetic concepts was high; however, familiarity with advanced principles such as the golden proportion was limited (32.3%). Interest in further esthetic dentistry training was reported by 94% of respondents. Years of clinical experience showed a positive correlation with knowledge of esthetic terminology (r=0.41, p<0.01). Conclusion: Although dental professionals in Pakistan demonstrate strong awareness of the importance of esthetics, significant gaps exist in advanced esthetic knowledge and clinical application, underscoring the need for structured educational and continuing professional development programs.
Esthetic dentistry, Smile design, Dental education, Cosmetic dentistry, Pakistan
Copyright (c) 2025 Muhammad Farrukh, Mariam Younus Paracha, Muhammad Anas, Jawad Ahmed Shahok, Nisha Prem Kumar, Kumail Ali (Author) https://creativecommons.org/licenses/by/4.0
Evaluation of the Association Between Axial Length and Cup-to-Disc Ratio Among Non-Glaucomatous Hypertensive Patients
Background: Cup-to-disc ratio (CDR) is a key clinical parameter for optic nerve head assessment, yet physiological variation may be influenced by ocular biometry and systemic factors such as hypertension. Axial length (AL) can modify optic disc morphology and may complicate interpretation of CDR during glaucoma screening in hypertensive patients without glaucoma. Objective: To determine the association between axial length and cup-to-disc ratio among non-glaucomatous hypertensive patients. Methods: An observational cross-sectional study was conducted on 94 hypertensive patients aged 18–70 years at Al-Shifa Eye Clinic, Ali Pur Chatha. Eligible participants had normal intraocular pressure (<21 mmHg) and AL between 21–26 mm. Blood pressure was assessed using a calibrated sphygmomanometer, AL was measured using A-scan ultrasonography, and vertical CDR was assessed by slit-lamp biomicroscopy with a +90D lens after dilation. Non-normality was assessed using the Kolmogorov–Smirnov test, and associations were evaluated using Spearman’s correlation with multivariable linear regression adjusting for age. Results: The cohort included 64 males (68.1%) and 30 females (31.9%), with mean age 42.19±15.71 years. Spearman’s correlation showed no significant association between AL and CDR (OD: r=0.029, p=0.778; OS: r=0.135, p=0.195). In regression models, AL did not significantly predict CDR in either eye (OD: B=0.000, p=0.963; OS: B=0.011, p=0.097). Conclusion: Axial length was not significantly associated with cup-to-disc ratio in non-glaucomatous hypertensive patients within the studied biometric range
Hypertension; Cup-to-disc ratio; Axial length; Optic nerve head; Optic disc
Copyright (c) 2026 Safira khalid, Sahar Aslam, Sibgha Naseem, Sufiyan Ali Bin Ishtiaq, Ayesha Sajid (Author) https://creativecommons.org/licenses/by/4.0
Association Between Habitual Caffeine Intake and Delayed Onset Muscle Soreness Among Recreationally Active Females
Background: Delayed onset muscle soreness (DOMS) is a common, self-limiting pain syndrome following unfamiliar or intense exercise and may influence training adherence in recreationally active females; caffeine is widely consumed and may modulate post-exercise pain perception through adenosine receptor antagonism. Objective: To determine the association between habitual caffeine intake and DOMS severity and to evaluate the relationship between physical activity level and DOMS severity among recreationally active females. Methods: A cross-sectional observational study was conducted among 126 females (18–25 years) recruited from three fitness facilities in Lahore, Pakistan. Habitual caffeine intake was assessed using the Caffeine Consumption Questionnaire and categorized as low (<100 mg/day) or moderate (100–300 mg/day). DOMS severity was measured using a Likert-type muscle soreness scale (no, mild, moderate, severe). Physical activity level was classified using the International Physical Activity Questionnaire (low, moderate, high). Associations were tested using chi-square analyses (α = 0.05), with effect sizes reported as Cramér’s V. Results: Mean age was 21.02 ± 2.02 years. DOMS was reported by 82/126 (65.1%), most commonly moderate (27.8%) and mild (23.0%). Caffeine intake was significantly associated with DOMS severity (χ² = 18.47, df = 3, p = 0.001; Cramér’s V = 0.38), with severe soreness more frequent in low versus moderate caffeine consumers (24.6% vs 4.6%). Physical activity level was associated with DOMS severity (χ² = 13.21, df = 6, p = 0.038; Cramér’s V = 0.23). Conclusion: Moderate habitual caffeine intake and higher physical activity levels were associated with lower DOMS severity in recreationally active females.
habitual caffeine intake; delayed onset muscle soreness; physical activity; females; recreational exercise; IPAQ; CCQ
Copyright (c) 2025 Shaleem Maqsood, Faiza Amjad, Laiba Qamar (Author) https://creativecommons.org/licenses/by/4.0
Comparative Assessment of Clinical and Radiographic Parameters in Periodontal and Peri-Implant Tissues
Background: Periodontal and peri-implant tissues are vulnerable to biofilm-associated inflammation, yet peri-implant tissues may exhibit greater destructive changes because of distinct structural and vascular characteristics. Objective: To compare clinical and radiographic parameters of inflammation in periodontitis and peri-implantitis and to evaluate associations with oral hygiene practices and dental attendance patterns among adult dental attendees in Karachi, Pakistan. Methods: A cross-sectional comparative study was conducted among 300 adults attending tertiary dental hospitals. Periodontal assessment included probing pocket depth, clinical attachment loss, bleeding on probing, and plaque status, while peri-implant assessment included peri-implant probing depth, bleeding on probing, and standardized radiographic marginal bone loss. Oral hygiene practices and dental attendance patterns were recorded using structured questionnaires. Group comparisons and multivariable logistic regression were performed in SPSS (version 25) to identify independent predictors of destructive inflammatory breakdown. Results: Periodontitis-only was present in 162/300 (54.0%), peri-implantitis-only in 58/300 (19.3%), and both conditions in 46/300 (15.3%). Peri-implantitis-only demonstrated greater probing depth (5.1 ± 1.1 vs 4.2 ± 0.9 mm; p < 0.01), higher bleeding on probing (62.1% vs 46.7%; p < 0.01), and greater marginal bone loss (2.4 ± 0.9 vs 1.6 ± 0.7 mm; p < 0.001). Poor oral hygiene (adjusted OR 2.64; 95% CI 1.58–4.42) and irregular dental visits (adjusted OR 1.89; 95% CI 1.12–3.17) independently predicted inflammatory tissue breakdown. Conclusion: Peri-implantitis is associated with more severe inflammatory and radiographic compromise than periodontitis, and modifiable behaviors—plaque control and regular maintenance attendance—remain central targets for prevention.
Periodontitis; Peri-implantitis; Probing depth; Marginal bone loss; Bleeding on probing; Dental attendance.
Copyright (c) 2025 Muhammad Nadeem, Iram Nasir, Irfan Qureshi (Author) https://creativecommons.org/licenses/by/4.0
Imparting Awareness Among Health Care Professionals About The Role Of Speech And Language Pathologists In Treating Dysphagia
Background: Dysphagia is a high-burden swallowing disorder associated with aspiration pneumonia, malnutrition, dehydration, and increased morbidity and mortality when not recognized and managed promptly. Effective care depends on multidisciplinary collaboration, yet limited awareness among healthcare professionals regarding the role of speech-language pathologists (SLPs) may delay appropriate referral and intervention. Objective: To determine whether a brief educational intervention improves healthcare professionals’ awareness of dysphagia management and the role of SLPs. Methods: A quasi-experimental pre–post study was conducted at two tertiary-care facilities in Lahore, Pakistan (June 2024–June 2025). Using purposive sampling, 150 practicing healthcare professionals from multiple disciplines completed a validated questionnaire (Cronbach’s α = 0.85) immediately before and after a standardized 40-minute awareness lecture on dysphagia and SLP-led assessment and management. The primary outcome was the within-participant change in total awareness score; paired-samples t-testing was performed using SPSS v27, with subgroup exploration by clinical experience. Results: Participants were predominantly female (58.7%) and aged <30 years (86.0%); 95.3% held at least a graduate qualification, and 62.0% reported no prior clinical experience. Awareness scores improved significantly post-intervention (mean increase 3.71 points; 95% CI 0.07–7.34; t(149)=2.02; p=0.046), with a small effect size (Cohen’s d=0.16). Change did not differ significantly by experience (p=0.214). Conclusion: A brief, structured lecture was associated with a statistically significant, modest improvement in dysphagia and SLP-role awareness, supporting targeted education as a feasible strategy to strengthen multidisciplinary dysphagia care pathways.
Dysphagia; Speech-language pathology; Awareness; Swallowing disorders; Aspiration pneumonia; Interdisciplinary collaboration; Education intervention; Diet modification
Copyright (c) 2025 Sadia Afzal, M. Sikander Ghayas Khan (Author) https://creativecommons.org/licenses/by/4.0