Journal of Health, Wellness and Community Research
Journal of Health, Wellness and Community Research (JHWCR) ISSN (Electronic): 3007-0570 DOI Prefix: 10.61919 Publisher: Link Medical Interface (Private) Limited Publication Frequency: Biweekly — two issues per month (from April 2025) License: Creative Commons Attribution 4.0 International (CC BY 4.0) About the Journal The Journal of Health, Wellness and Community Research (JHWCR) is a peer-reviewed, open-access journal published biweekly by Link Medical Interface (Private) Limited, Lahore, Pakistan. The journal is dedicated to publishing high-quality interdisciplinary research that advances health, wellness, and community well-being across the health sciences, allied health, social sciences, and humanities. JHWCR strongly encourages submissions from early-career and young researchers, supporting the next generation of scholars in global health. Frequency History: January 2023 – March 2025: Biannual April 2025 onwards: Biweekly (two issues per month) Open Access Policy JHWCR is committed to immediate, unrestricted, and free open access to scholarly research. All articles are made freely available online upon publication with no embargo period. Readers may read, download, copy, distribute, print, search, or link to the full text of any article without registration, payment, or prior permission, provided appropriate attribution is maintained. All content is published under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits sharing and adaptation for any purpose, including commercial use, provided the original work is properly cited. No subscription fees are charged to readers or institutions. → Read Full Open Access Policy Aims and Scope JHWCR invites original research, reviews, and clinical studies across the following disciplines: Epidemiology & Biostatistics — population health, statistical methods, disease burden Public & Behavioral Health — health promotion, behavioral interventions, community health Rehabilitation Sciences — physical, occupational, and allied health rehabilitation Chronic & Infectious Diseases — prevention, management, and outcomes research Environmental & Global Health — environmental determinants, global health equity Healthcare Innovations & Allied Health — emerging technologies, allied health practice Basic and Allied Sciences — biomedical and applied sciences with human healthcare implications Article types accepted: Original Research, Systematic and Narrative Reviews, Case Reports, Short Communications, Commentaries, and Letters. 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Stage-by-stage timeline: Stage Duration Initial administrative screening — plagiarism check, scope fit, documentation 0–3 days Editor-in-Chief assessment — suitability, originality, desk rejection if warranted 3–7 days Reviewer selection and invitation — minimum two independent experts 7–14 days Double-blind peer review — full scientific evaluation by each reviewer 21–30 days Editorial decision — Accept / Minor Revision / Major Revision / Reject 5–7 days Minor revision turnaround by authors Up to 14 days Major revision turnaround by authors 4–6 weeks Re-review and final decision after revision 7–14 days Copyediting, typesetting, proof approval, and publication Following acceptance Total time from submission to first decision: typically 5 to 9 weeks, depending on reviewer availability and manuscript complexity. JHWCR does not offer expedited or fast-track review. All manuscripts follow the same process regardless of author affiliation, nationality, or APC status. All manuscripts undergo plagiarism screening via Turnitin prior to peer review. Manuscripts with overall similarity exceeding 15%, or more than 5% from a single source, are returned to authors before proceeding to review. Where two reviewers reach substantially divergent conclusions, a third independent reviewer is invited before an editorial decision is issued. All special issue articles are subject to the same double-blind peer review process as regular submissions. Guest editor manuscripts are handled through an independent editorial pathway with no involvement of the guest editor in any aspect of their own manuscript's review. → Read Full Peer Review Policy Publication Ethics JHWCR adheres to internationally recognized standards for authorship, data integrity, conflict of interest, plagiarism prevention, and post-publication corrections. The journal follows COPE and ICMJE guidelines across all editorial decisions. 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All complaints are acknowledged within three working days and a full response provided within two to four weeks. → Read Full Complaints & Appeals Policy Editorial Team Chief Editor Dr. Maryam Shabbir — Associate Professor, Doctorate, Physical Therapy The University of Lahore, Pakistan Editor Dr. Umair Ahmed — Associate Professor, Doctorate, Neuro-Physical Therapy The University of Lahore, Pakistan Managing Editor Dr. Muhammad Tahir — Consultant, MS, Neuro-Physical Therapy Therapy Plus Clinics, Pakistan Editorial Board Name Designation Specialization Institution Country Dr. Ahmed Hassan Senior Medical Officer FCPS – ENT Mansorah Hospital Pakistan Dr. Namra Yousaf Assistant Professor FCPS – Microbiology Fatima Memorial Hospital Pakistan Dr. Sabiha Abbas Assistant Professor Food Technology University of Okara Pakistan Dr. Fatirah Aziz Senior Demonstrator Hematology Fatima Memorial Hospital Pakistan Dr. Khurram Malik Senior Registrar Ophthalmology Fatima Memorial Hospital Pakistan Dr. Muhammad Abbas Khan Senior Registrar FCPS – General Medicine Muhammad Teaching Hospital Peshawar Pakistan Dr. Eman Fayed Assistant Professor Physical Therapy University of St. Augustine for Health Sciences USA Dr. Usman Janjua Professor Rehabilitation Elite College of Management Sciences Pakistan Dr. Ayesha Kamal Butt Senior Lecturer Educational Management Manchester Metropolitan University UK Dr. Kashif Iqbal Sahibzada Postdoctoral Fellow Biochemistry Henan University of Technology China Dr. Saqlain Raza Assistant Professor Applied Statistics Imam Abdulrahman bin Faisal University Saudi Arabia Advisory Board Name Designation Specialization Institution Country Dr. Ghazal Usman Senior Demonstrator FCPS Fatima Memorial Hospital Pakistan Dr. Hafiz Ahmed Haroon Dermatologist & Cosmetologist FCPS – Dermatology Novimed Specialist Clinic Pakistan Dr. Saima Akhtar Chattha Assistant Professor English Linguistics COMSATS University Islamabad (Lahore Campus) Pakistan Dr. Rabbiya Sarwar Lecturer Public Health University of Health Sciences Pakistan Dr. Aisha Ansari Lecturer Cardiopulmonary Physical Therapy University of Hai'l Saudi Arabia Dr. Ajediran Idowu Bello Associate Professor Physical Therapy University of Ghana Ghana Dr. Francisco Arroyo Professor Sports Medicine Sport Med Medical Centre, Guadalajara Mexico Dr. Mohamed Khallaf Associate Professor Physical Therapy University of St. Augustine for Health Sciences USA Dr. Muhammad Shahid Lecturer Cardiopulmonary Physical Therapy University of Hail Saudi Arabia → Editorial Endogeny & Self-Publication Policy Author Guidelines & Submission Full submission requirements, article types, formatting standards, reporting guidelines, and ethical documentation requirements are detailed in the Author Guidelines. → View Full Author Guidelines & Submission Instructions Submission Email: editor@jhwcr.com Publisher Information Publisher: Link Medical Interface (Private) Limited Address: 8 Commercial, Sunny Park, Lahore 54000, Pakistan Website: https://lmi.education/ Editorial Contact: editor@jhwcr.com → Ownership & Management Disclosure Archiving & Preservation JHWCR ensures permanent long-term preservation of all published content through: PKP Preservation Network (PKP PN) — distributed digital preservation via the Keepers Registry LOCKSS — distributed preservation through participating library networks CLOCKSS — dark archive ensuring long-term access in the event of journal discontinuation → Read Full Archiving Policy Self-Archiving Policy Authors may deposit any version of their manuscript (preprint, accepted manuscript, or published PDF) in any institutional or subject repository, preprint server, or personal website at any time. No embargo applies to any version. All self-archived versions must include a complete citation to the published JHWCR article and a link to the CC BY 4.0 license. → Read Full Self-Archiving Policy Indexing JHWCR is indexed and registered with Google Scholar, CrossRef (DOI prefix 10.61919), EuroPub, PakMediNet, and Afro-Asian Research Index. All content published in JHWCR is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Authors retain full copyright. © Link Medical Interface (Private) Limited, Lahore, Pakistan
Link Medical Interface, Lahore, Pakistan
Frequency and Clinical Patterns of Placental Abruption and Placenta Previa in Pregnant Women at Tertiary Care Hospital Quetta
Background: Antepartum hemorrhage remains a major cause of maternal and perinatal morbidity in low-resource obstetric settings, particularly where hypertensive disorders, grand multiparity, delayed referral, and inadequate antenatal screening coexist. Placental abruption and placenta previa are the two principal causes, but their frequency and clinical patterns vary across populations. Objective: To determine the frequency and clinical patterns of placental abruption and placenta previa and to compare their maternal and fetal outcomes among pregnant women presenting to a tertiary care hospital in Quetta. Methods: This cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Bolan Medical College/Hospital, Quetta, from May to August 2025. A total of 154 pregnant women beyond 28 weeks of gestation with antepartum hemorrhage due to placental abruption or placenta previa were enrolled consecutively. Diagnosis was based on clinical assessment supported by ultrasonography. Data were analyzed using SPSS version 26.0 with descriptive statistics and chi-square-based comparisons. Results: Placental abruption accounted for 95 cases (61.7%) and placenta previa for 59 cases (38.3%). Hypertension was significantly more common in placental abruption (61.1% vs 15.3%; OR 8.71, 95% CI 3.83–19.79). Blood transfusion requirement (86.3% vs 67.8%), fetal distress or bradycardia (65.3% vs 20.3%), and intrauterine death (18.9% vs 3.4%) were substantially higher in abruption. All previa cases required cesarean delivery, whereas 74.7% of abruption cases underwent cesarean section. Overall maternal mortality was 1.3%. Conclusion: Placental abruption was more frequent than placenta previa in this tertiary care cohort and was associated with markedly greater maternal and fetal compromise. Strengthening antenatal hypertension surveillance, early placental localization, and timely referral may reduce preventable adverse outcomes.
Antepartum hemorrhage, placental abruption, placenta previa, hypertension, maternal outcome, fetal outcome, Quetta.
Copyright (c) 2025 Amna Khan, Sumaira Hamza, Zoofishan Suleman, Farzana Gul, Khalida Rehmat, Farah Fatima (Author) https://creativecommons.org/licenses/by/4.0
Assessment of Immunization Coverage Among Different Age Groups of Students in Peri-Urban Setting in Lahore
Background: Immunization is one of the most effective public health interventions for reducing morbidity and mortality from vaccine-preventable diseases, yet disparities in vaccine uptake persist in peri-urban and underserved populations. Objective: To assess complete Expanded Programme on Immunization coverage among students aged 5-23 years in a peri-urban area of Lahore and to examine its association with age group, gender, parental education, sibling number, and distance from the nearest vaccination center. Methods: This analytical cross-sectional study was conducted from February to July 2025 in Mustafa Abad, Lahore, among 350 students enrolled in government educational institutions. Data were collected using a semi-structured questionnaire, vaccination cards where available, and caregiver verification when needed. Immunization status was classified as complete or incomplete age-appropriate EPI history. Data were analyzed in SPSS version 25 using descriptive statistics and Pearson’s chi-square test. Results: Overall, 327 of 350 students were completely immunized, giving a coverage of 93.43%. The highest coverage was observed among students aged 5-10 years (96.72%), followed by those aged 16-18 years (93.18%), 11-15 years (93.02%), and 19-23 years (91.67%). Gender, parental education, and sibling number showed descriptive variation but no statistically significant association with immunization status. Distance from the nearest vaccination center was significantly associated with complete immunization (χ² = 22.24, p < 0.001), with coverage declining to 76.74% among students living more than 10 km away. Conclusion: Immunization coverage in this peri-urban student population was high overall, but physical access to vaccination services remained a key determinant of complete vaccine uptake.
Immunization, vaccination, Expanded Programme on Immunization, peri-urban population, vaccine coverage, Pakistan
Copyright (c) 2026 Tazeem Shahbaz, Rabbiya Sarwar, Neelam Raheel, Asma Kanwal, Syma Arshad, Nida Asif, Aneesa Mahreen (Author) https://creativecommons.org/licenses/by/4.0
Comparison Of QRISK3 And Framingham Risk Scores For Estimating 10-Year CVD Risk In Patients With CKD
Background: Chronic kidney disease (CKD) is strongly associated with increased cardiovascular morbidity and mortality, yet conventional cardiovascular risk prediction models may underestimate risk in this population because they do not account for CKD-specific determinants of vascular disease. Objective: To compare the cardiovascular risk stratification performance of QRISK3 and the Framingham Risk Score (FRS) and evaluate the clinical implications of risk reclassification among patients with CKD stages 3–5. Methods: A prospective cohort study was conducted at Pak Emirates Military Hospital, Rawalpindi, between January and December 2023. Two hundred fifty adults with CKD stages 3–5 underwent baseline cardiovascular risk estimation using both QRISK3 and the 2008 Framingham Risk Score. Participants were categorized into low (<10%), moderate (10–19%), and high (≥20%) risk groups. Risk reclassification was assessed using net reclassification improvement (NRI). Patients were followed for 12 months to document major adverse cardiovascular events (MACE). Discriminatory performance was evaluated using receiver operating characteristic curves. Results: QRISK3 classified significantly more patients as high risk compared with FRS (62.8% vs 32.4%, p < 0.001). Risk category changes occurred in 48.0% of participants, predominantly upward. MACE developed in 43.6% of patients during follow-up. Event rates were higher among individuals reclassified upward by QRISK3 (52.3% vs 31.5%, p = 0.002). The AUROC for predicting MACE was higher for QRISK3 than FRS (0.74 vs 0.66, p = 0.008), with an NRI of 0.18 (95% CI: 0.08–0.28). Conclusion: QRISK3 demonstrated superior cardiovascular risk stratification compared with the Framingham Risk Score in patients with CKD, identifying a greater proportion of individuals at high cardiovascular risk and showing improved predictive discrimination for adverse cardiovascular outcomes.
Chronic kidney disease; Cardiovascular risk prediction; QRISK3; Framingham risk score; Risk reclassification; Major adverse cardiovascular events.
Copyright (c) 2025 Mutahar Abbas, Waleed Ur Rehman, Nauman Karim, Muhammad Iqbal, Mumtaz Ali, Zeeshan Asghar Jathol (Author) https://creativecommons.org/licenses/by/4.0
Measurement of IL-6 as an Inflammatory Biomarker in Early Detection of Sepsis Among Trauma ICU Patients
Background: Sepsis is a life-threatening complication among trauma patients admitted to intensive care units, and early diagnosis remains challenging due to overlap between post-traumatic systemic inflammation and infection-related immune responses. Interleukin-6 (IL-6), a pro-inflammatory cytokine released rapidly after tissue injury or infection, has been proposed as a potential early biomarker for identifying sepsis in critically injured patients. Objective: To evaluate the diagnostic performance of serum IL-6 measured within 24 hours of ICU admission for early identification of sepsis among trauma ICU patients. Methods: A prospective observational diagnostic accuracy study was conducted in a tertiary care trauma ICU between March and December 2025. A total of 150 adult trauma patients were enrolled using consecutive sampling. Serum IL-6 levels were measured within 24 hours of admission using chemiluminescent immunoassay. Sepsis diagnosis was established according to Sepsis-3 criteria using clinical evaluation, microbiological findings, and organ dysfunction assessment. Receiver operating characteristic analysis was performed to determine the optimal IL-6 threshold and diagnostic accuracy parameters. Results: Among the 150 patients, 144 (96.0%) exhibited elevated IL-6 levels (>50 pg/mL), with a mean concentration of 125 ± 40 pg/mL. ROC analysis demonstrated excellent discriminative ability with an area under the curve of 0.91 (95% CI: 0.85–0.96). The optimal IL-6 cut-off value of 52 pg/mL yielded sensitivity of 93.2%, specificity of 81.4%, positive predictive value of 89.6%, and negative predictive value of 87.5%. Elevated IL-6 levels were consistently observed across age groups and genders. Conclusion: Serum IL-6 measured early after ICU admission demonstrates high diagnostic accuracy for identifying sepsis in trauma patients and may serve as a valuable biomarker for early detection and clinical decision-making in trauma ICU settings. Keywords: Interleukin-6, Sepsis, Trauma ICU, Biomarker, Inflammation, Early detection, ROC analysis.
Interleukin-6, Sepsis, Trauma ICU, Biomarker, Inflammation, Early detection, ROC analysis.
Copyright (c) 2026 Ayesha Kashif, Asma Tariq, Isra Saeed, Uzma Shahzadi, Sidra Jabeen, Muhammad Umar, Prof. Dr. Muhammad Iqbal Ch (Author) https://creativecommons.org/licenses/by/4.0
Incidence of Drug-Induced Liver Injury in Patients Taking Antituberculosis Therapy
Background: Tuberculosis remains a major global health challenge, particularly in high-burden countries where treatment-related complications can compromise outcomes. Drug-induced liver injury (DILI) is the most common and clinically significant adverse effect associated with first-line antituberculosis therapy, potentially leading to treatment interruption, morbidity, and prolonged disease transmission. Objective: To determine the incidence of drug-induced liver injury among patients receiving first-line antituberculosis therapy and to compare baseline clinical and biochemical characteristics between patients who developed DILI and those who did not. Methods: A prospective observational cohort study was conducted at the Department of Pulmonology, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from July to December 2023. Adult patients with newly diagnosed pulmonary or extrapulmonary tuberculosis initiating standard four-drug antituberculosis therapy were enrolled consecutively. Baseline demographic, clinical, and biochemical data were recorded, and participants were monitored during the intensive treatment phase for development of DILI according to standard biochemical criteria. Statistical analysis was performed using SPSS version 26, with comparisons conducted using independent sample t-tests and chi-square tests. Results: Among 173 patients, 18 developed drug-induced liver injury, yielding an incidence of 10.4% (95% CI: 6.3–15.9). The mean time to onset was 9.61 ± 3.11 days, with 50% of cases occurring between days 11 and 14 of therapy. Higher baseline alanine aminotransferase levels were observed among patients who developed DILI (p=0.035), while most affected patients recovered with appropriate management (83.3%). Conclusion: Drug-induced liver injury occurred in approximately one in ten patients receiving antituberculosis therapy and typically developed early during treatment. Baseline liver function abnormalities may help identify patients requiring closer monitoring during the intensive phase of therapy.
Tuberculosis, Antituberculosis Therapy, Drug-Induced Liver Injury, Hepatotoxicity, Liver Function Tests, Pulmonary Medicine.
Copyright (c) 2025 Zeeshan Asghar Jathol, Attia Khaliq, Waleed Ur Rehman, Mutahar Abbas, Mumtaz Ali, Sheraz Ahmed (Author) https://creativecommons.org/licenses/by/4.0
Multidimensional Diagnostic Criteria for Chronic Non-Specific Low Back Pain Patients: A Narrative Review
Background: Chronic non-specific low back pain (CNSLBP) is one of the most prevalent musculoskeletal disorders worldwide and a major cause of long-term disability. Despite its high burden, diagnosis remains challenging because most patients do not present with a single clearly identifiable pathological cause. Conventional diagnostic approaches based mainly on structural findings and imaging are often insufficient to explain symptom persistence, functional limitation, and variation in clinical presentation. This has increased interest in multidimensional diagnostic models that integrate physical, psychosocial, functional, and neurobiological domains. Objective: To synthesize the literature on multidimensional diagnostic criteria and assessment domains relevant to patients with chronic non-specific low back pain through a narrative review. Methods: A narrative review of the literature was conducted using major electronic databases, including PubMed, Scopus, and Google Scholar. Relevant studies and reviews were identified using terms related to chronic non-specific low back pain, diagnostic criteria, multidimensional assessment, biopsychosocial factors, functional evaluation, psychosocial screening, and pain mechanisms. The evidence was synthesized thematically around key diagnostic domains, including core criteria, common clinical features, psychiatric and medical comorbidities, psychosocial and functional consequences, and putative neurobiological mechanisms. Results: The reviewed literature showed that effective diagnosis of CNSLBP requires more than exclusion of specific spinal pathology. Core diagnostic criteria include pain located between the lower rib margin and gluteal folds, symptom duration exceeding 12 weeks, and absence of a clear specific pathological source. The evidence further demonstrated that physical examination, functional assessment, psychosocial screening, and movement-based evaluation are essential components of diagnosis. Common clinical features include diffuse axial pain, activity-related aggravation, and variable functional limitation, whereas psychiatric and medical comorbidities such as anxiety, depression, insomnia, hypertension, diabetes, and osteoarthritis frequently coexist. Psychosocial factors, particularly fear-avoidance, catastrophizing, reduced work participation, and disability, emerged as major contributors to symptom persistence. In addition, neurobiological mechanisms such as central sensitization and altered pain modulation were identified as important explanatory domains in a subgroup of patients. Overall, the findings support the use of multidimensional diagnostic frameworks, including biopsychosocial and movement-based classification models, to improve clinical reasoning and patient stratification. Conclusion: Chronic non-specific low back pain should be diagnosed using a multidimensional framework that extends beyond structural assessment to include functional, psychosocial, and neurobiological domains. Adoption of such an approach may improve diagnostic precision, enhance individualized rehabilitation planning, and support better clinical outcomes.
chronic non-specific low back pain; diagnosis; multidimensional assessment; biopsychosocial model; functional evaluation; psychosocial factors; central sensitization; narrative review
Copyright (c) 2026 Samrood Akram, Saleh Shah, Muhammad Naveed Babur, Amna Zia, Anam Zafar (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Post-Burn Contractures and Their Impact on Functional Activities among Burn Survivors: A Cross-Sectional Study
Background: Burn injuries frequently result in long-term complications that impair functional recovery, with post-burn contractures representing one of the most disabling sequelae. Contractures cause restriction of joint range of motion and can substantially limit activities of daily living and overall quality of life among burn survivors. Objective: To determine the prevalence of post-burn contractures and evaluate their association with functional activities among adult burn survivors attending a tertiary burn rehabilitation center. Methods: A cross-sectional study was conducted among 100 adult burn survivors aged 18–50 years with healed burns sustained at least six months prior. Contractures were assessed using goniometric measurement of passive joint range of motion and classified as mild (<25% ROM loss), moderate (25–50%), or severe (>50%). Functional status was evaluated using the Burn Specific Health Scale–Brief (BSHS-B). Descriptive statistics summarized clinical characteristics, and associations between contracture severity and functional outcomes were analyzed using Spearman correlation. Results: Post-burn contractures were identified in 65% of participants. Upper limbs were the most frequently affected region (45%), followed by lower limbs (30%), neck (20%), and trunk (10%). Functional scores progressively decreased with increasing contracture severity: none (78 ± 5.2), mild (70 ± 6.0), moderate (62 ± 5.5), and severe (52 ± 6.3). A significant negative correlation was observed between contracture severity and BSHS-B score (r = –0.62, p < 0.001). Conclusion: Post-burn contractures are common among burn survivors and are strongly associated with functional impairment. Early identification and targeted rehabilitation strategies are essential to reduce disability and improve long-term outcomes.
Post-burn contractures, burn rehabilitation, functional impairment, range of motion, activities of daily living, burn survivors.
Copyright (c) 2026 Huma khan, Pirtik Rai, Rafia Nazar, Jahanzeb Ahmed, Mansoor Ahmed, Salman Khan (Author) https://creativecommons.org/licenses/by/4.0
Descriptive Study of Non-Pharmacological Strategies Actually Used by Patients with Resistant Hypertension in Daily Life
Background: Resistant hypertension remains a major clinical challenge because many patients continue to have uncontrolled blood pressure despite multidrug therapy, and little is known about how they use non-pharmacological and complementary strategies in routine life. Objective: To document the types, frequency, and self-perceived effectiveness of lifestyle and complementary non-pharmacological strategies used by adults with resistant hypertension in an urban Pakistani setting. Methods: A descriptive cross-sectional study was conducted over four months in the Islamabad–Rawalpindi region among 72 adults aged 30-70 years with resistant hypertension. Participants were recruited from outpatient clinics, community pharmacies, and patient support settings. Data were collected through face-to-face interviews using a structured questionnaire assessing dietary practices, physical activity, sleep hygiene, herbal therapies, and relaxation or meditation practices. Self-perceived effectiveness was rated on a 5-point Likert scale, and recent blood pressure readings were extracted from patient-held records. Continuous and categorical data were summarized descriptively, and correlations and group comparisons were examined using Pearson correlation and independent-samples t-tests. Results: DASH-style dietary modification was the most commonly used strategy (61.1%), while relaxation or meditation had the highest mean perceived effectiveness score (3.9 ± 0.8). The number of strategies used was positively correlated with overall perceived effectiveness (r = 0.34, p = 0.004), and physical activity was inversely correlated with systolic blood pressure (r = -0.29, p = 0.017). Physically active participants reported higher effectiveness scores than inactive participants (3.8 ± 0.7 vs 3.2 ± 0.9; p = 0.012). Conclusion: Adults with resistant hypertension commonly adopt multiple self-management strategies beyond medication, with relaxation-based approaches and physical activity showing particularly favorable perceived benefit. Integrating patient-reported lifestyle and complementary practices into routine care may support more patient-centered hypertension management.
resistant hypertension; self-management; lifestyle modification; complementary therapies; physical activity; DASH diet; perceived effectiveness; Pakistan
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
Re-Epithelization: Impact of Topical Agents in Wound Care
Background: Wound re-epithelization is a critical determinant of healing quality, yet the comparative efficacy of available topical agents in promoting epidermal restoration remains incompletely characterised in controlled experimental models. Low-level laser therapy (LLLT) has emerged as a non-thermal, photobiomodulatory modality with proposed pro-regenerative mechanisms, but its superiority over conventional agents such as Eusol and normal saline has not been systematically quantified using concurrent macroscopic and histomorphometric outcomes in a standardised rabbit excisional wound model. Objective: To compare the effects of topical LLLT, Eusol, and normal saline on wound surface area reduction and epidermal thickness restoration at Days 3, 7, and 14 in male albino rabbits. Methods: Twelve adult male albino rabbits (250–400 g) were randomly assigned to three equal groups: Group A (normal saline, once daily), Group B (LLLT, 10 J/30 seconds, once daily), and Group C (Eusol, once daily), each for 14 days. Full-thickness excisional wounds of 2.5 × 2.5 cm² were created on the dorsal surface under ketamine-xylazine anaesthesia. Wound surface area was measured on Days 3, 7, and 14, and epidermal thickness was assessed by ocular micrometry on H&E-stained sections at 400× magnification on Day 14. Data were analysed using one-way ANOVA with post-hoc Tukey's HSD test (p ≤ 0.05). Results: LLLT achieved significantly greater wound contraction at all time points (Day 14: 0.24 ± 0.19 cm²) versus saline (1.45 ± 0.43 cm²) and Eusol (1.12 ± 0.36 cm²), with p = 0.001 and p = 0.002 respectively (η² = 0.87). Epidermal thickness on Day 14 was greatest in the LLLT group (1.98 ± 0.52 µm) compared with Eusol (1.54 ± 0.44 µm; p = 0.002) and saline (0.24 ± 0.18 µm; p = 0.001; η² = 0.83). Conclusion: LLLT produced significantly superior wound re-epithelization and epidermal restoration compared with conventional topical agents, supporting its integration into evidence-based wound management protocols.
wound healing, re-epithelization, low-level laser therapy, photobiomodulation, Eusol, epidermal thickness, rabbit model, oxidative stress.
Copyright (c) 2025 Muhammad Asif, Satheesh Babu Natarajan, Muhammad Ahmed Azmi (Author) https://creativecommons.org/licenses/by/4.0
Comparative Clinical Efficacy of Ceftriaxone Sodium and Cefoperazone–Sulbactam in the Management of Diabetic Foot Infections: A Prospective Cohort Study
Background: Diabetic foot infections (DFIs) represent a major complication of diabetes mellitus, contributing substantially to hospitalization rates, amputation risk, and healthcare costs, particularly in resource-limited settings where broad-spectrum intravenous antibiotics are prescribed empirically without microbiological confirmation. Objective: To compare the clinical wound-healing efficacy and non-response rates of intravenous ceftriaxone sodium versus intravenous cefoperazone–sulbactam in adult patients with diabetic foot infections in Peshawar, Khyber Pakhtunkhwa, Pakistan, and to characterize the spectrum of presenting foot complications in this cohort. Methods: A prospective comparative cohort study was conducted at the SS Diabetic and Medical Care Center, Peshawar. Eighty patients aged ≥30 years with established diabetes mellitus and active diabetic foot infections were enrolled and allocated to receive either intravenous ceftriaxone sodium 2 g twice daily (Group 1; n = 40) or intravenous cefoperazone–sulbactam 2 g twice daily (Group 2; n = 40) for seven consecutive days. Wound healing was assessed at day 7 using a validated six-point ordinal scale (0%–100%). The primary outcome, clinical response rate, was compared between groups using Fisher's exact test, with 95% confidence intervals calculated by the Wilson score method. Results: Clinical response rates were 85.4% (95% CI: 71.3%–93.2%) for ceftriaxone sodium and 89.4% (95% CI: 76.2%–95.7%) for cefoperazone–sulbactam; the 4.0 percentage-point difference was not statistically significant (p = 0.499; OR for non-response 1.53, 95% CI: 0.42–5.54). Diabetic foot ulcer was the most prevalent complication (53%), followed by cellulitis (31%) and skin gangrene (15%). Conclusion: Both regimens demonstrated clinically acceptable wound-healing efficacy as cost-effective empiric options for diabetic foot infections in resource-limited settings, though future adequately powered, randomised trials incorporating microbiological confirmation are required to establish definitive comparative evidence.
Cephalosporins; ceftriaxone; cefoperazone–sulbactam; diabetic foot infection; diabetic foot ulcer; clinical efficacy; beta-lactamase inhibitor; antibiotic stewardship; Khyber Pakhtunkhwa; Pakistan.
Copyright (c) 2026 Muhammad Shafeeq, Hafiz Sajid Akbar, Dareen Ihsan, Muhammad Ikram, Muhammad Faheem, Ali Khan, Muhammad Sohail Anwar, Adil Khaliq, Haleema Hidayat, Saqib Jahan, Abdul Mateen, Maryam Zulfat, Haroon Badshah, Atta Ullah Shah (Author) https://creativecommons.org/licenses/by/4.0
Sleep Deprivation and Its Effects on Nurses Working at the Night Shift at Critical Care Units of Services Hospital Lahore
Background: Sleep deprivation among nurses working night shifts in critical care units remains a major occupational health concern, influencing cognitive performance, emotional stability, and overall well-being. Night-shift nurses often experience disrupted circadian rhythms and poor sleep quality, leading to fatigue, errors, and reduced job performance. Understanding the extent and consequences of sleep deprivation is essential for developing effective strategies to promote nurse well-being and ensure patient safety. Objective: This study aimed to evaluate the impact of sleep deprivation on night-shift nurses working in critical care units at Services Hospital, Lahore. It specifically assessed sleep quality, cognitive functioning, job performance, and physical and mental health using the Pittsburgh Sleep Quality Index (PSQI) and the Non-Restorative Sleep Scale (NRSS). Methods: A descriptive cross-sectional study was conducted among 76 nurses (13 males, 63 females) aged 19–38 years. Data were collected through Google Forms containing validated instruments—the PSQI and NRSS—and analyzed using JASP software. Descriptive statistics, Spearman’s correlation, t-tests, and Exploratory Factor Analysis (EFA) were employed. Participants were categorized as good (N=12) or poor sleepers (N=64) based on PSQI global scores (>5 threshold). Results: Poor sleepers had significantly higher mean PSQI scores (Mean = 8.95, SD = 2.08) than good sleepers (Mean = 4.00, SD = 0.74), indicating poorer sleep quality. Significant differences were found in sleep latency (Mean = 1.59 vs. 0.50; t = -4.955, p < .001) and overall sleep quality (t = -8.111, p < .001). Strong positive correlations were observed between PSQI and sleep duration, latency, and disturbances (p < .001). NRSS results revealed decreased daytime energy (Mean = 3.58), lower alertness (Mean = 3.50), and higher irritability (Mean = 2.60) among poor sleepers. EFA of NRSS identified four key domains—Cognitive Performance, Physical Symptoms, Emotional Well-being, and Sleep Quality Perception—explaining 54.7% of total variance. Conclusion: The study demonstrated that sleep deprivation severely impairs cognitive function, emotional health, and job performance among night-shift nurses in critical care units. Targeted interventions, including optimized shift scheduling, rest breaks, and sleep hygiene education, are essential to enhance nurse well-being and improve patient care quality
Cognitive performance, critical care nursing, job performance, mental health, night-shift work, sleep deprivation, sleep quality
Copyright (c) 2026 Ammara Zainab, Zartasha Kanwal, Sadia Batool, Amber Fatima, Iqra Mumtaz (Author) https://creativecommons.org/licenses/by/4.0
Association Between Clinically-Assessed Scapular Dyskinesia and Neck Disability and Functional Performance Among Gym-Goers: A Cross-Sectional Study
Background: Scapular dyskinesia is characterized by abnormal scapular movement and impaired neuromuscular control of the scapulothoracic joint. Altered scapular biomechanics can influence shoulder stability, pain perception, and cervical spine mechanics, potentially contributing to neck disability and reduced functional performance. Recreational gym-goers frequently perform repetitive upper-limb resistance exercises, which may increase mechanical stress on the scapular stabilizing musculature; however, limited evidence exists regarding the relationship between scapular dyskinesia, neck disability, and functional performance in this population. Objective: To determine the association between clinically assessed scapular dyskinesia, neck disability, pain intensity, and functional performance among gym-goers. Methods: A cross-sectional observational study was conducted among 187 gym-goers aged 18–35 years recruited from commercial gyms. Scapular dyskinesia was assessed using the Scapular Assistance Test (SAT). Pain intensity was measured using the Numeric Rating Scale (NRS), neck disability using the Neck Disability Index (NDI), and shoulder-related functional performance using the Shoulder Pain and Disability Index (SPADI). Associations between variables were analyzed using the chi-square test with statistical significance set at p < 0.05. Results: Positive SAT findings were observed in 118 participants (63.1%), indicating a high prevalence of scapular dyskinesia. Significant associations were found between SAT results and SPADI functional performance scores (p = 0.002), pain intensity (p < 0.001), and neck disability (p = 0.013). Participants with scapular dyskinesia demonstrated higher frequencies of severe pain and greater levels of functional disability compared with those without dyskinesia. Conclusion: Scapular dyskinesia was significantly associated with increased pain intensity, neck disability, and reduced shoulder-related functional performance among gym-goers. These findings highlight the importance of evaluating scapular mechanics in physically active individuals and support the integration of scapular stabilization strategies within rehabilitation and training programs.
Scapular dyskinesia, neck disability, shoulder pain, functional performance, gym-goers, shoulder biomechanics.
Copyright (c) 2026 Wajeeha Hameed, Ghulam Fatima, Momina Arif, Hoorab Hameed, Mishal Jamal, Ahmad Faraz (Author) https://creativecommons.org/licenses/by/4.0
From Stigma to Early Detection: A Call to a National Breast Cancer Screening Program in Pakistan
Breast Neoplasms; Early Detection of Cancer; Mass Screening; Mammography; Health Policy; Social Stigma; Pakistan
Copyright (c) 2026 Samrood Akram, Saleh Shah (Author) https://creativecommons.org/licenses/by/4.0
A Systematic Review on the Development of High-Tech Mobile Applications in Urdu, Punjabi, and Sindhi for Children with Autism Spectrum Disorder and Social Communication Disorder
Background: Children with Autism Spectrum Disorder (ASD) and Social Communication Disorder (SCD) face persistent impairments in language acquisition, social communication, and daily functioning. High-technology mobile applications have demonstrated efficacy in supporting communication and language development in these populations; however, the overwhelming majority of validated applications are developed in English and culturally oriented toward Western contexts. No prior systematic review has examined the development or effectiveness of mobile applications specifically designed in Urdu, Punjabi, or Sindhi — the three primary regional languages of Pakistan and South Asia — for children with ASD or SCD. Objective: To systematically identify, characterise, and appraise the methodological quality and effectiveness of high-technology mobile applications incorporating Urdu, Punjabi, or Sindhi language support for children (aged 0–18 years) with ASD or SCD. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Five electronic databases — PubMed/MEDLINE, IEEE Xplore, Scopus, Web of Science, and Google Scholar — were searched in January 2025 from inception to search date. Two independent reviewers conducted dual screening at title/abstract and full-text stages; disagreements were resolved by consensus. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT), JBI Quasi-Experimental Checklist, and CASP Quantitative Checklist, as appropriate to study design. Narrative synthesis was conducted using the SWiM framework. Results: Of 847 records identified, 28 studies met eligibility criteria after removal of 156 duplicates and staged screening. Seven studies constituted the core evidence base directly aligned with the review's South Asian regional language focus. Five studies incorporated Urdu as a primary application language; one study addressed Sindhi-language digital learning; no standalone study was identified for Punjabi. The only study covering all three target languages simultaneously (Hassan et al., 2025) demonstrated measurable speech production gains and significantly improved compliance. Quality scores ranged from 5 to 9 out of 10; three studies were rated High quality, one Moderate–High, two Moderate, and one Moderate–Low. The direction of reported effect was uniformly positive across all core studies, though only two employed validated, standardised outcome instruments in controlled designs. Conclusion: Urdu-language mobile applications for ASD and SCD children in Pakistan demonstrate feasibility and positive usability but lack controlled efficacy evidence. Punjabi represents a critical and entirely unaddressed evidence gap despite representing the primary language of Pakistan's largest population. Prioritised development and rigorous evaluation of Punjabi- and Sindhi-language mobile ASD applications are urgently needed to meet international inclusive education mandates and ensure linguistically equitable intervention access.
Autism Spectrum Disorder; Social Communication Disorder; mobile application; augmentative and alternative communication; Urdu; Punjabi; Sindhi; assistive technology; systematic review; South Asia
Copyright (c) 2026 Rabia Azmat, Zohaib Shahid, Syed Asadullah Arslan (Author) https://creativecommons.org/licenses/by/4.0
Association of Gait Speed with Physical Activity, BMI and Arch Height in Postmenopausal Women
Background: Menopause is associated with hormonal and musculoskeletal changes that may adversely affect mobility, balance, and functional independence. Gait speed is a clinically important indicator of overall functional health and may be influenced by modifiable factors such as body mass index, physical activity, and foot arch characteristics. Objective: To determine the association of gait speed with physical activity, body mass index, and foot arch height in postmenopausal women. Methods: This descriptive cross-sectional observational study was conducted in Lahore, Pakistan, from April to June 2025 among 187 postmenopausal women aged 45-65 years. Participants were recruited through non-probability purposive sampling from community centers and hospital settings. Gait speed was measured using the 10-meter walk test, physical activity with the International Physical Activity Questionnaire-Short Form, body mass index from measured height and weight, and foot arch height using the navicular drop test. Data were analyzed using SPSS version 24. Pearson correlation and chi-square-based trend analyses were applied with p < 0.05 considered significant. Results: Mean age was 60.4 ± 4.4 years, mean body mass index was 27.8 ± 3.0 kg/m², and mean gait speed was 1.08 ± 0.18 m/s. Gait speed showed a significant negative correlation with body mass index (r = -0.169, p = 0.021) and significant positive correlations with foot arch height (r = 0.238, p = 0.001) and physical activity (r = 0.255, p < 0.001). Conclusion: Gait speed in postmenopausal women is significantly associated with body mass index, physical activity, and foot arch height. Routine assessment of these modifiable factors may support early identification of women at risk of reduced mobility and inform targeted preventive strategies.
gait speed; body mass index; physical activity; arch height; postmenopausal women
Copyright (c) 2026 Amna, Maria Mustafa, Siddiqa Qamar, Asma Niaz, Javeria Akhlaq, Shafaq Shahid (Author) https://creativecommons.org/licenses/by/4.0
The Hummingbird Effect: Unpacking Their Ecological Significance
Background: Hummingbirds are among the most specialized avian pollinators and play an important ecological role in sustaining flowering plant reproduction across the Americas. Their interactions with plants are shaped by nectar dependence, bill–flower trait matching, and ecological specialization, making them a valuable model for understanding mutualism, biodiversity maintenance, and ecosystem functioning. Objective: To synthesize current knowledge on the ecological significance of hummingbirds, with emphasis on their roles in pollination, plant reproduction, biodiversity conservation, habitat stability, and responses to environmental change. Methods: This narrative review integrates published literature on hummingbird diversity, plant–hummingbird interactions, ecological networks, specialization, coevolution, and conservation threats. Evidence was examined thematically to evaluate how hummingbirds influence floral reproduction, genetic exchange, and ecosystem resilience. Results: The reviewed evidence indicates that hummingbirds contribute substantially to pollen transfer, cross-pollination, and reproductive success in numerous ornithophilous plant species. Their interactions also support genetic diversity, maintain plant community structure, and strengthen ecological networks within forests and other habitats. Trait matching between bill morphology and floral structure frequently shapes specialization, although strict coevolution remains difficult to confirm. Habitat loss, fragmentation, climate change, urbanization, and invasive plants were identified as major threats affecting hummingbird populations and their pollination services. Conclusion: Hummingbirds are ecologically significant pollinators whose conservation is essential for maintaining plant reproduction, biodiversity, and ecosystem stability. Future research should further clarify interaction effectiveness, environmental sensitivity, and conservation priorities within plant–hummingbird mutualistic systems.
Hummingbirds, pollination, mutualism, nectar, biodiversity, plant–hummingbird interactions, conservation, ecological networks
Copyright (c) 2026 Shahid Mahmood, Anzalna Tahir, Meerab Fatima, Fatima Azhar, Hifza Zafar, Mamoona Kanwal (Author) https://creativecommons.org/licenses/by/4.0
Evaluation of Day-to-Day Variation in Platelet Count and pH of Platelet Single Unit Stored at 20-24◦C at Al-Nafees Medical College and Hospital, Islamabad
Background: Platelet concentrates are highly sensitive blood components whose quality progressively declines during storage because of metabolic and structural alterations collectively described as platelet storage lesions. Serial monitoring of simple laboratory indicators such as platelet count and pH may help assess product viability during routine blood bank storage. Objective: To evaluate day-to-day changes in platelet count and pH in platelet concentrate units stored at 20–24°C with continuous agitation over five days. Methods: This prospective in-vitro repeated-measures laboratory study was conducted from September to December 2025 at Al-Nafees Medical College and Hospital, Islamabad. Eighty platelet concentrate units derived from individual whole-blood donations and prepared by the platelet-rich plasma method were included. Units meeting predefined storage and quality criteria were monitored daily from Day 1 to Day 5. Platelet count was measured using an automated hematology analyzer and pH was assessed using a calibrated digital pH meter. Data were analyzed in SPSS version 27 using repeated-measures analysis, with p < 0.05 considered statistically significant. Results: Mean pH declined from 7.29 on Day 1 to 7.07 on Day 5, while mean platelet count decreased from 7.34 × 10¹⁰ to 4.88 × 10¹⁰ per unit over the same period. Both parameters showed statistically significant time-dependent decline. pH remained within acceptable viability limits throughout storage, whereas platelet count showed a steeper reduction, with accelerated quantitative loss after Day 3. Conclusion: Platelet concentrate units stored at 20–24°C undergo significant day-wise deterioration over five days, with platelet count showing greater sensitivity to prolonged storage than pH. Serial monitoring may support quality assurance and guide timely utilization of stored platelet products.
Platelet concentrate; platelet storage lesion; platelet count; pH; storage quality; blood bank; transfusion medicine; room-temperature storage; platelet viability; quality control.
Copyright (c) 2026 Isma Kiyani, Hassan Rafique, Waleed Ahmed, Maryam Khalid, Shahzeera Begum (Author) https://creativecommons.org/licenses/by/4.0
Medical Brain Drain from Pakistan: A Qualitative Study of Push–Pull Factors and the Professional and Personal Experiences of Migrated Physicians
Background: Medical brain drain represents one of the most consequential challenges facing Pakistan's healthcare system. Despite producing substantial numbers of medical graduates annually, Pakistan experiences persistent physician shortages attributable in significant part to the sustained emigration of trained doctors to high-income destination countries. Existing evidence is predominantly quantitative, leaving the subjective motivations, professional experiences, and post-migration orientations of migrating physicians largely unexplored. Objective: To generate an in-depth, participant-centred qualitative account of the factors motivating Pakistani physicians to migrate, their professional and personal experiences within foreign healthcare systems, and their reflections on Pakistan's healthcare sector and the conditions under which return might be considered. Methods: A qualitative descriptive design situated within a constructivist-interpretivist epistemological framework was employed. Thirty Pakistani-trained physicians practising in the United Kingdom, Canada, Saudi Arabia, and the United Arab Emirates were recruited through purposive and snowball sampling. Individual semi-structured interviews were conducted online, audio-recorded, and transcribed verbatim. Data were analysed using Braun and Clarke's six-phase reflexive thematic analysis framework. Trustworthiness was established through prolonged engagement, peer debriefing, reflexive memo-writing, and audit trail maintenance. The study was conducted in accordance with COREQ reporting guidelines. Results: Six themes were identified: economic disenfranchisement experienced as existential mismatch; institutional neglect and erosion of professional agency; the architecture of professional promise abroad; dignity, regulation, and the experience of being professionally valued; the price of migration including licensing barriers and cultural dislocation; and moral residue and the weight of leaving, encompassing persistent homeland conscience and conditional orientation toward return. Conclusion: Pakistani medical migration is driven by cumulative institutional failure rather than financial incentive alone. Diaspora physicians retain conditional return orientations amenable to policy intervention. Comprehensive structural reform — spanning remuneration, infrastructure, meritocracy, and diaspora engagement — is essential to address this phenomenon.
brain drain; doctor migration; healthcare workforce; Pakistan; push-pull factors; qualitative research; reflexive thematic analysis; lived experience; physician retention; diaspora engagement
Copyright (c) 2026 Muhammad Hamza Muzammil, Muhammad Uzair, Izatullah, Hassan Raza Ali, Faiza Iqrar, Muhammad Talha (Author) https://creativecommons.org/licenses/by/4.0
Accuracy and Clinical Pitfalls of Cone-Beam CT for Planning Zygomatic Implant Placement: A Systematic Review
Background: Zygomatic implants have become an important treatment option for the rehabilitation of patients with severely atrophic maxillae, offering an alternative to extensive bone grafting procedures. Accurate preoperative planning is essential due to the complex anatomical trajectory and proximity to critical structures such as the maxillary sinus and orbit. Cone-beam computed tomography (CBCT) has gained widespread use in implant dentistry because of its ability to provide three-dimensional visualization of craniofacial structures. However, concerns remain regarding the diagnostic accuracy and potential clinical limitations of CBCT imaging in planning zygomatic implant placement. Objective This systematic review aimed to evaluate the accuracy and clinical pitfalls associated with CBCT imaging in the surgical planning of zygomatic implants and to assess its reliability in guiding complex implant procedures. Methods A systematic review was conducted following PRISMA guidelines. Electronic databases including PubMed, Scopus, Web of Science, and the Cochrane Library were searched to identify relevant studies. Eligible studies included clinical and observational research evaluating the use of CBCT in preoperative planning for zygomatic implants. Non-clinical studies, case reports, and non-English publications were excluded. Study selection was performed through a structured screening process, and data were extracted using standardized forms. Methodological quality and risk of bias were assessed using established evaluation tools. A qualitative synthesis of findings was performed due to methodological variability among studies. Results Eight studies met the inclusion criteria and were included in the final analysis. The findings consistently indicated that CBCT imaging provides accurate three-dimensional assessment of anatomical structures relevant to zygomatic implant placement. Measurement deviations between planned and intraoperative findings were generally minimal, often within clinically acceptable ranges. CBCT was shown to improve visualization of implant trajectory and anatomical landmarks; however, certain limitations such as imaging artifacts, variability in voxel resolution, and interpretive challenges were reported in some studies. Conclusion CBCT imaging appears to be a reliable and valuable tool for planning zygomatic implant placement, offering improved visualization and enhanced surgical planning capabilities. Nevertheless, awareness of potential imaging limitations and careful interpretation remain essential. Further large-scale clinical studies are recommended to strengthen the current evidence and refine imaging protocols for complex implant rehabilitation.
Cone-Beam Computed Tomography, Zygomatic Implants, Digital Implant Planning, Maxillary Atrophy, Systematic Review, Implant Dentistry
Copyright (c) 2026 Gul Afshan Syed, Harum Fatima, Sidra Ahsan, Iqra Shah Muhammad, Musharraf Ahmed, Muhammad Umair, Muhammad Haris Zia (Author) https://creativecommons.org/licenses/by/4.0
A Randomized Trial Measuring Gingival Inflammation and Plaque Levels During Treatment With Clear Aligners Versus Self-Ligating Braces
Background: Orthodontic appliances can interfere with routine oral hygiene and promote plaque retention, leading to gingival inflammation during active treatment. While self-ligating fixed appliances were introduced to reduce plaque accumulation compared with conventional braces, clear aligner therapy has gained popularity due to its removable design and perceived periodontal advantages. Evidence directly comparing the periodontal impact of these two appliance systems under randomized clinical conditions remains limited. Objective: To compare changes in plaque accumulation and gingival inflammation in patients undergoing orthodontic treatment with clear aligners versus self-ligating fixed appliances during the early phase of active treatment. Methods: A parallel-arm randomized controlled trial was conducted over four months in the Islamabad–Rawalpindi region. Sixty orthodontic patients aged 18–30 years were randomly allocated to receive either clear aligners or self-ligating braces. Periodontal status was assessed at baseline, two months, and four months using the Silness and Löe Plaque Index and the Löe and Silness Gingival Index. Data were analyzed using independent t-tests, repeated measures ANOVA, and Pearson correlation analysis, with statistical significance set at p < 0.05. Results: Fifty-eight participants completed the study. Both groups showed increases in plaque and gingival index scores over time; however, these increases were significantly greater in the self-ligating brace group. At four months, mean plaque index scores were 1.02 ± 0.26 in the clear aligner group and 1.38 ± 0.31 in the self-ligating group (p < 0.001). Mean gingival index scores were 0.94 ± 0.23 and 1.31 ± 0.28, respectively (p < 0.001). A strong positive correlation was observed between plaque accumulation and gingival inflammation (r = 0.68, p < 0.001). Conclusion: Clear aligner therapy was associated with more favorable periodontal outcomes than self-ligating fixed appliances during early orthodontic treatment. Appliance removability appeared to support better plaque control, underscoring the importance of appliance selection and oral hygiene reinforcement in orthodontic care.
Dental Plaque; Gingivitis; Orthodontic Appliances; Orthodontic Brackets; Periodontal Health; Randomized Controlled Trial; Tooth Movement
Multi-Target Hepatoprotective Mechanisms of Glycyrrhiza glabra: Molecular Pathways, Experimental Evidence, and Clinical Translation
Background: Liver diseases including non-alcoholic fatty liver disease, viral hepatitis, drug-induced liver injury, cholestatic injury, and fibrosis are driven by interconnected mechanisms such as oxidative stress, inflammation, apoptosis, mitochondrial dysfunction, and dysregulated lipid metabolism. Glycyrrhiza glabra has long been used in traditional medicine and contains multiple bioactive compounds with potential hepatoprotective activity. Objective: To critically synthesize the phytochemical basis, molecular pathways, experimental evidence, and clinical translational relevance of Glycyrrhiza glabra in liver protection. Methods: A structured narrative review was conducted using literature from major biomedical databases and reference screening, with emphasis on liver-specific studies evaluating extracts, isolated constituents, and derivatives of Glycyrrhiza glabra. Evidence was organized by phytochemistry, molecular mechanisms, preclinical hepatoprotective models, and clinical relevance. Results: The strongest evidence supports antioxidant and anti-inflammatory effects mediated through Nrf2 activation, NF-κB suppression, modulation of Bax/Bcl-2 and caspase signaling, inhibition of CYP2E1-related toxic bioactivation, and partial attenuation of TGF-β1-associated fibrogenesis. Glycyrrhizin, 18β-glycyrrhetinic acid, glabridin, liquiritigenin, isoliquiritigenin, and magnesium isoglycyrrhizinate were the principal compounds linked to hepatoprotection. Experimental studies consistently reported reductions in ALT, AST, ALP, malondialdehyde, and inflammatory cytokines with restoration of endogenous antioxidant defenses and histological improvement. Clinical evidence suggests biochemical benefit in selected liver disorders, but remains heterogeneous. Conclusion: Glycyrrhiza glabra is a promising multi-target hepatoprotective agent, although clinical translation requires standardized formulations, pharmacokinetic optimization, safety monitoring, and well-designed randomized trials.
Glycyrrhiza glabra; glycyrrhizin; hepatoprotection; oxidative stress; inflammation; NAFLD; drug-induced liver injury
Copyright (c) 2026 Aliza Rashid, Alishba, Asia Umer, Mariam Bashir, Ayesha Awan, Waleed Maqbool, Nasrullah Khalid, Maria Altaf, Hafiz Aamir Ali Kharl (Author) https://creativecommons.org/licenses/by/4.0
Systematic Review on Diagnostic Approaches and Management Strategies for Benign Urological Tumors in Adult Populations
Background: Benign urological lesions in adults are frequently encountered in clinical practice and include renal angiomyolipoma, benign renal masses, and selected symptomatic benign proliferative conditions managed within urology. Although these lesions are non-malignant, they may still cause hemorrhage, pain, obstructive symptoms, diagnostic uncertainty, and treatment-related loss of organ function. Contemporary management has shifted toward more selective intervention and greater emphasis on nephron preservation, but the evidence remains fragmented across lesion types and treatment pathways. Objective: To systematically evaluate current diagnostic approaches and management strategies for benign urological lesions in adults, with emphasis on diagnostic utility, symptom outcomes, complications, lesion progression, recurrence, and preservation of organ function. Methods: A systematic review with qualitative synthesis was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, Cochrane CENTRAL, and Web of Science were searched for studies published between January 2014 and March 2024. Eligible studies included adults with radiologically characterized or histologically confirmed benign urological lesions and reported diagnostic or management outcomes. Two reviewers independently screened studies, extracted data, and assessed methodological quality using RoB 2 for randomized trials and the Newcastle-Ottawa Scale for observational studies. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively. Results: Eight studies involving 1,427 adults were included. Five studies evaluated renal angiomyolipoma, two examined benign small renal masses, and one assessed symptomatic benign prostatic proliferative disease. Active surveillance was safe for most small asymptomatic angiomyolipomas, with 94% showing no clinically meaningful growth over 36 months in one prospective cohort and 60% of tuberous sclerosis complex-associated cases remaining intervention-free over 5 years. For larger or symptomatic angiomyolipomas, selective arterial embolization preserved renal function better than partial nephrectomy, with a smaller decline in estimated glomerular filtration rate at 12 months (-3.2 vs -11.5 mL/min/1.73 m²; p<0.01), although post-embolization syndrome was more frequent. Percutaneous biopsy for indeterminate small renal masses showed 88% sensitivity, 100% specificity, and a 15% non-diagnostic rate. Conclusion: Current evidence supports surveillance for selected small asymptomatic renal angiomyolipomas and selective arterial embolization as an effective kidney-preserving option for larger or symptomatic lesions. However, the evidence base is predominantly observational and heavily renal-focused, underscoring the need for higher-quality prospective comparative studies across the broader spectrum of benign urological lesions.
Benign urological lesions; renal angiomyolipoma; active surveillance; selective arterial embolization; renal mass biopsy; nephron-sparing management; systematic review
Copyright (c) 2026 Hafiza Khadija Tariq, Saima Ashraf, Mariam Azam Warya, Adeen Rehman, Muhammad Hussain, Isma Sheraz, Nimra Azhar (Author) https://creativecommons.org/licenses/by/4.0
Clinical Efficacy of Nanoparticle-Based Antibiotic Delivery Systems in Drug-Resistant Bacterial Infections: A Systematic Review
Background: Antimicrobial resistance has substantially reduced the effectiveness of conventional antibiotics against multidrug-resistant bacterial pathogens, creating an urgent need for strategies that improve antimicrobial delivery, efficacy, and tolerability. Nanoparticle-based delivery systems have emerged as a promising approach, but recent translational evidence remains fragmented across preclinical and early clinical studies. Objective: To systematically review recent preclinical and clinical evidence on the efficacy and safety of nanoparticle-based antimicrobial delivery systems in drug-resistant bacterial infections. Methods: A systematic review with narrative synthesis was conducted in accordance with PRISMA 2020. PubMed, Scopus, Web of Science, and CENTRAL were searched for studies published from January 2019 to December 2024. Eligible studies included controlled in vivo animal studies and clinical trials evaluating antimicrobial agents encapsulated, conjugated, or otherwise delivered through nanoparticle systems against drug-resistant bacterial infections. Two reviewers independently screened studies, extracted data, and assessed risk of bias using SYRCLE for animal studies and RoB 2 for randomized trials. Owing to heterogeneity in pathogens, models, formulations, and outcomes, meta-analysis was not performed. Results: Seven studies met the final eligibility criteria, including six murine infection-model studies and one randomized clinical trial. Across the preclinical studies, nanoparticle formulations consistently improved antibacterial efficacy, with bacterial burden reductions ranging from approximately 2 to 4.5 log CFU beyond conventional comparators and survival gains of 20 to 50 percentage points in severe infection models. Liposomal vancomycin, polymeric colistin, solid lipid mupirocin, chitosan-tigecycline, silver nanoparticle-ampicillin conjugates, and liposomal linezolid all showed favorable results. The single clinical trial demonstrated that inhaled liposomal ciprofloxacin significantly prolonged time to first pulmonary exacerbation in adults with chronic Pseudomonas aeruginosa infection (hazard ratio 0.53, 95% confidence interval 0.32-0.88; p=0.01) with acceptable tolerability. Risk of bias was low in the clinical trial but frequently unclear in the preclinical literature because of incomplete reporting. Conclusion: Nanoparticle-based antimicrobial delivery systems demonstrate consistent preclinical efficacy and early clinical promise in resistant bacterial infection, particularly for liposomal platforms. However, the current evidence remains predominantly preclinical, and larger, rigorously designed clinical trials are required before routine clinical adoption can be justified.
Antimicrobial resistance; nanoparticles; liposomes; antibiotic delivery systems; multidrug-resistant bacteria; nanomedicine; systematic review
Copyright (c) 2026 Aamnah Aslam, Sahaab Alvi, Anina Qureshi, Adeel Zain, Hina Ali Ahmed, Muhammad Umar (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Neck Pain Attributable to Poor Posture During Study Sessions among Students Across Various Universities in Karachi
Background: Neck pain is a common musculoskeletal complaint among university students and is frequently associated with prolonged study duration, poor posture, and extended use of electronic devices. Sustained non-neutral cervical postures during academic activities can increase mechanical stress on cervical structures, potentially leading to discomfort, reduced productivity, and impaired quality of life. Despite increasing recognition of posture-related neck pain globally, limited epidemiological data are available describing its prevalence and associated study behaviors among university students in Karachi, Pakistan. Objective: To determine the prevalence of neck pain attributable to study posture and to describe associated behavioral and ergonomic factors among university students in Karachi. Methods: A descriptive cross-sectional study was conducted among university students aged 18–30 years from multiple universities in Karachi. A total of 300 questionnaires were distributed using a non-probability convenience sampling approach, of which 288 eligible responses were included in the analysis. Data were collected using a structured questionnaire assessing demographic characteristics, study posture, study duration, break patterns, physical activity, ergonomic device use, and neck pain intensity measured using the Visual Analogue Scale (VAS). Statistical analysis was performed using SPSS version 27 with descriptive statistics and chi-square testing. Results: Among the 288 participants, 96.5% reported experiencing some degree of neck pain, with moderate pain being the most common intensity level (50.3%). Poor desk positioning during study was reported by 57.3% of students. Prolonged study duration was common, with 44.1% studying 4–6 hours daily. A majority of students (71.2%) reported not taking breaks during study sessions, while 62.5% did not use ergonomic devices. Longer study duration, lack of breaks, physical inactivity, and poor ergonomic practices were significantly associated with higher neck pain prevalence. Conclusion: Neck pain is highly prevalent among university students in Karachi and appears to be associated with modifiable study behaviors and ergonomic factors. Promoting ergonomic awareness, regular study breaks, and physical activity may help reduce posture-related neck pain among students.
Neck pain, posture, university students, study duration, forward head posture, musculoskeletal pain, ergonomics.
Copyright (c) 2026 Umed Ali, Muhammad Talha, Muhammad Tahir Akram, Raja Muhammad Usama Ali, Hurair Qureshi, Sumbal Rani (Author) https://creativecommons.org/licenses/by/4.0
Cross Cultural Competence Among Health Care Professionals at District Headquarters Hospital Mirpurkhas: Assessing Preparedness and Impact on Quality of Care
Background: Increasing cultural diversity within healthcare systems requires nurses to possess cross-cultural competence in order to deliver culturally congruent and patient-centered care. In multicultural societies such as Pakistan, differences in language, ethnicity, and cultural health beliefs can influence communication, treatment adherence, and overall healthcare outcomes. Despite the importance of culturally responsive care, empirical evidence assessing cultural competence among nurses in district-level healthcare facilities remains limited. Objective: To assess the level of cross-cultural competence among nurses working at District Headquarters Hospital Mirpurkhas, Sindh, Pakistan. Methods: A quantitative cross-sectional study was conducted among 95 nurses selected through non-probability convenience sampling. Data were collected using a structured questionnaire consisting of demographic variables and the Ethiopian Health Workers’ Cultural Competence Scale (EHWCCS), which measures four domains: cultural health skills, cultural health awareness, cultural health desire, and cultural health knowledge. Responses were recorded on a five-point Likert scale. Data were analyzed using SPSS version 20, and descriptive statistics including frequencies, percentages, means, and standard deviations were calculated. Results: The overall level of cross-cultural competence among nurses was moderate, with a mean score of 3.38 ± 1.29. Cultural health knowledge demonstrated the highest mean score (3.57 ± 1.18), followed by cultural health awareness (3.48 ± 1.34) and cultural health desire (3.45 ± 1.33). Cultural health skills recorded the lowest mean score (3.03 ± 1.29), indicating limited practical application of cultural competence in clinical practice. Conclusion: Nurses demonstrated moderate cross-cultural competence, with stronger knowledge and awareness than practical skills. Strengthening transcultural nursing education, communication training, and institutional support programs is essential to enhance culturally responsive healthcare delivery in diverse clinical settings.
Cross-cultural competence, Nurses, Cultural competence, Multicultural healthcare, Quality of care, Pakistan.
Copyright (c) 2026 Maheen Ashraf, Aftab Ahmed, Lachman Das Malhi, Muskan Atta Memon, Nazia M Hassan, Hina Eijaz (Author) https://creativecommons.org/licenses/by/4.0
Variants Specific Clinical Characteristics of SARS-CoV-2: A Cross-Sectional Study in Khyber Pakhtunkhwa, Pakistan
Background: SARS-CoV-2 has evolved into multiple variants with potential differences in transmissibility, pathogenicity, and clinical presentation. Understanding variant-specific symptom profiles is essential for improving surveillance, diagnosis, and clinical management, particularly in resource-limited settings where genomic sequencing is limited. Objective: To compare the clinical characteristics associated with Alpha, Beta, Gamma, and Delta SARS-CoV-2 variants among PCR-confirmed COVID-19 cases in Khyber Pakhtunkhwa, Pakistan. Methods: A cross-sectional observational study was conducted at the Public Health Reference Laboratory, Khyber Medical University, using PCR-confirmed COVID-19 cases recorded between 2020 and 2023. SARS-CoV-2 variants were identified using mutation-specific PCR assays. Clinical and demographic data were collected through structured telephone interviews based on the World Health Organization COVID-19 case report form. Descriptive statistics and inferential analyses including chi-square and Fisher–Freeman–Halton tests were performed using SPSS version 25, with statistical significance set at p<0.05. Results: Among 416 participants, the Delta variant accounted for the majority of infections (310; 74.5%), followed by Gamma (60; 14.4%), Alpha (36; 8.7%), and Beta (10; 2.4%). Delta infections were strongly associated with fever, cough, sore throat, body aches, and loss of smell and taste, each exceeding 94% prevalence. Gamma infections demonstrated high rates of fatigue, rigors, chills, rhinorrhea, and shortness of breath (>90%), whereas Beta infections showed prominent gastrointestinal symptoms including nausea and vomiting (70%). Alpha infections had the highest proportion of asymptomatic cases (27.8%). Conclusion: SARS-CoV-2 variants exhibited distinct clinical phenotypes in this population, with Delta characterized by respiratory and sensory symptoms, Gamma by systemic inflammatory manifestations, and Beta by gastrointestinal involvement. Recognition of variant-specific symptom clusters may support improved clinical detection and epidemiological surveillance in settings with limited genomic sequencing capacity.
SARS-CoV-2, COVID-19, clinical characteristics, variants, Delta variant, Pakistan.
Copyright (c) 2026 Aliya Ayub, Muhammad Usman Sharif, Arif Ullah Khan, Zaboor Khan Burki, Fida Muhammad, Muhammad Bilal Khattak, Khalid Rehman (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Early Antibiotic Administration on Outcomes in Pneumonia Patients in Emergency Department
Background: Pneumonia remains a major cause of morbidity and mortality worldwide and frequently presents to emergency departments. Early initiation of antibiotic therapy has been proposed as an important factor influencing clinical outcomes in patients with pneumonia; however, delays in treatment remain common in busy emergency care settings, particularly in resource-limited healthcare systems. Objective: To evaluate the association between early antibiotic administration and clinical outcomes among adult patients presenting with pneumonia to the emergency department of a tertiary care hospital. Methods: This prospective observational study was conducted in the emergency department of Lady Reading Hospital–Medical Teaching Institution, Peshawar, Pakistan, from 1 March to 31 July 2025. Adult patients aged ≥18 years presenting with clinically and radiologically confirmed pneumonia were consecutively enrolled. The primary exposure variable was time from emergency department registration to first intravenous antibiotic administration. Patients were categorized into early (≤3 hours) and delayed (>3 hours) antibiotic groups. Outcomes assessed included length of hospital stay, intensive care unit (ICU) admission, and in-hospital mortality. Data were analyzed using SPSS version 26 with appropriate comparative and multivariable statistical methods. Results: A total of 120 patients were included (mean age 56.8 ± 17.4 years; 60% male). Early antibiotic administration occurred in 68 (56.7%) patients. Patients receiving early antibiotics had significantly shorter hospital stays (5.1 ± 2.3 vs 7.4 ± 3.1 days; p=0.01) and lower ICU admission rates (11.8% vs 26.9%; p=0.03). In-hospital mortality was lower in the early antibiotic group (4.4% vs 13.5%), although this difference did not reach statistical significance (p=0.06). Conclusion: Early administration of antibiotics within three hours of emergency department presentation was associated with shorter hospitalization and reduced ICU admission among pneumonia patients. These findings support the importance of timely antimicrobial therapy in emergency department management of pneumonia.
Pneumonia; Anti-Bacterial Agents; Emergency Service, Hospital; Time-to-Treatment; Treatment Outcome; Community-Acquired Infections.
Copyright (c) 2026 Tirza Israr Ullah Khan, Muhammad Abas Khan, Sabeen Sajjad, Khadim Hussain Kaleri, Arslan Zahid, Tayyaba Hanif, Abdul Hameed (Author) https://creativecommons.org/licenses/by/4.0
An Empirical Investigation of the Effects of Supportive Organizational Climate on Psychological Well-Being by Using Job Satisfaction as Mediator and Person-Job Fit as Moderator in Higher Educational Systems
Background: Employee psychological well-being is increasingly recognized as a critical determinant of organizational effectiveness, particularly in higher education institutions where academic staff face complex professional demands, performance pressures, and evolving institutional expectations. Supportive organizational climates may provide psychosocial resources that improve employee attitudes and mental health outcomes, yet the mechanisms linking workplace climate to psychological well-being remain insufficiently explored within academic environments. Objective: This study examined the relationship between supportive organizational climate and psychological well-being among employees in higher education institutions, while evaluating the mediating role of job satisfaction and the moderating role of person–job fit. Methods: A cross-sectional observational study was conducted among 200 employees working in higher education institutions in Rawalpindi, Pakistan. Data were collected using a structured questionnaire measuring supportive organizational climate, job satisfaction, person–job fit, and psychological well-being on five-point Likert scales. Descriptive statistics, Pearson correlation analysis, and regression-based mediation and moderation analyses were performed using the PROCESS macro in SPSS (version 28) with bootstrapped confidence intervals based on 5,000 resamples. Results: Supportive organizational climate was positively associated with psychological well-being (β = 0.271, p < 0.001) and job satisfaction (β = 0.709, p < 0.001). Job satisfaction was strongly associated with psychological well-being (β = 0.711, p < 0.001) and significantly mediated the relationship between supportive organizational climate and psychological well-being (indirect effect β = 0.631, 95% CI: 0.504–0.756). Person–job fit demonstrated positive associations with job satisfaction and psychological well-being but did not significantly moderate the relationship between supportive organizational climate and job satisfaction (β = −0.013, p = 0.302). Conclusion: Supportive organizational climates contribute to improved psychological well-being among higher education employees primarily through enhanced job satisfaction, highlighting the importance of supportive institutional practices for promoting employee mental health and positive workplace experiences.
supportive organizational climate, psychological well-being, job satisfaction, person–job fit, higher education, employee well-being, workplace environment, mediation analysis, moderation analysis.
Copyright (c) 2026 Ayesha Azmat, Zohra Hakim, Isra Saeed, Musa Raza (Author) https://creativecommons.org/licenses/by/4.0
Factors Associated with Poor Compliance in Type 2 Diabetic Patients Presenting to Ayub Teaching Hospital
Background: Type 2 diabetes mellitus (T2DM) requires sustained adherence to pharmacological therapy, dietary modification, and regular follow-up to achieve optimal glycemic control. However, poor treatment adherence remains a major barrier to effective diabetes management, particularly in low- and middle-income countries where socioeconomic, educational, geographic, and psychological factors may influence patient behavior and access to healthcare services. Objective: To determine the prevalence of poor treatment adherence and identify factors associated with poor adherence among patients with type 2 diabetes mellitus presenting to Ayub Teaching Hospital, Abbottabad, Pakistan. Methods: A hospital-based cross-sectional analytical study was conducted from July to December 2024 including 213 adults aged ≥30 years with diagnosed T2DM receiving oral hypoglycemic agents and/or insulin therapy. Participants were recruited using consecutive sampling. Data were collected through structured interviews and medical record review, capturing demographic, clinical, socioeconomic, educational, geographic, and psychological variables. Poor adherence was defined as failure to follow prescribed medication, dietary, or follow-up recommendations. Associations between adherence status and independent variables were evaluated using chi-square tests and logistic regression analysis, with p<0.05 considered statistically significant. Results: Poor adherence was observed in 34.7% of participants. Higher prevalence of poor adherence was associated with increasing age, insulin-based or combination therapy, lower socioeconomic status, lower educational attainment, remote residence, and fear of insulin injections (p<0.05). Gender was not significantly associated with adherence status. Conclusion: Poor adherence affects approximately one-third of patients with T2DM and is strongly influenced by socioeconomic disadvantage, limited education, geographic barriers, treatment complexity, and psychological resistance to insulin therapy. Targeted educational, socioeconomic, and accessibility-based interventions are essential to improve adherence and long-term diabetes outcomes.
Type 2 diabetes mellitus, treatment adherence, socioeconomic status, education, insulin fear, Pakistan.
Copyright (c) 2025 Nayab Ihsan, Syed Yasir Hussain Gilani, Nizakat Hussain, Zia Ul Haq, Atiq Ullah, Ashraf Khan (Author) https://creativecommons.org/licenses/by/4.0
Correlation of Forward Head Posture with Refractive Error Among Undergraduate Students of Allied Health Sciences in Sarhad University of Science and Information Technology, Peshawar
Background: Forward head posture is a common postural deviation among university students and may be influenced by prolonged near-work, poor ergonomics, and visual impairment. Refractive error may contribute to compensatory head-neck positioning adopted to improve visual clarity during academic activities. Objective: To determine the relationship between forward head posture and refractive error among undergraduate students of Allied Health Sciences at Sarhad University of Science and Information Technology, Peshawar. Methods: A descriptive cross-sectional study was conducted among 332 undergraduate students selected through convenience sampling. Demographic data and visual status were recorded using a structured questionnaire, and forward head posture was assessed through craniovertebral angle measurement using a goniometer. Postural status was categorized as normal, mild forward head posture, or moderate/severe forward head posture. Data were analyzed in SPSS version 20 using descriptive statistics, cross-tabulation, chi-square testing, odds ratio estimation, and correlation analysis. Results: Forward head posture was identified in 210 students (63.3%), while refractive error was present in 186 students (56.0%). Among students with refractive error, 73.1% demonstrated forward head posture compared with 50.7% among those without refractive error. A significant association was observed between refractive error and forward head posture (chi-square = 17.71, p < 0.001), and students with refractive error had higher odds of postural deviation (OR = 2.65, 95% CI: 1.67-4.19). Craniovertebral angle showed a significant negative correlation with refractive error (r = -0.312, p = 0.001). Conclusion: Refractive error was significantly associated with greater forward head posture among undergraduate students. Combined vision screening, ergonomic education, and postural interventions may help reduce musculoskeletal risk in this population.
forward head posture, refractive error, craniovertebral angle, university students, posture, ergonomics
Copyright (c) 2026 Tirza Johnson, Hira Majid, Hazrat Amin, Huma Khan, Hina Khan, Qazi Farhan Ullah (Author) https://creativecommons.org/licenses/by/4.0