Indus Journal of Bioscience Research (IJBR) is a peer-reviewed, open-access journal devoted to the publication of original research in all areas of bioscience. The journal is published Monthly and provides an international forum for the dissemination of high-quality research results in the fields of biochemistry, molecular biology, genetics, physiology, microbiology, immunology, bioinformatics, biotechnology, and medical science related disciplines that are relevant to the advancement of bioscience. The Indus Journal of Bioscience Research (IJBR) Impact Factor 1.20
Outcome of 3D Reconstructed Acrylic Cranioplasty
Background: Cranioplasty is required for post-craniectomy rehabilitation. Its outcomes depend on multiple factors; this study aims to evaluate the impact of size and the anatomic location of cranial defect on patient satisfaction. Methods: A prospective observational study was conducted on 70 patients who underwent cranioplasty. A defect size ranging from 12cm2 to 168cm2 was included in the study and was categorized into four anatomic groups (Frontotemporal, Trauma flap, Occipital, and Bifrontal). A 10-point Likert scale was used to assess patient satisfaction scores. A One-way ANOVA test, a Kruskal-Wallis’s test, and a Logistic Regression were performed to evaluate these defect characteristics and their effect on the cosmetic satisfaction. Results: Among the participants, 90% were satisfied with the cosmetic outcome following cranioplasty. The study found no significant association between the defect size and patient satisfaction (P-value 0.309 and Exb (B)= 1.014). Also, no significant impact of anatomical location was observed on patient satisfaction (Anova: F (3, 3) = 1.41, P-value 0.249). Conclusion: The study found no significant effect of the cranial defect sizes or their anatomical location on the overall patient cosmetic satisfaction.
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Frequency of Acute Kidney Injury and Its Short Term Effects after Acute Myocardial Infarction
Objective: To determine the frequency of acute kidney injury (AKI) in patients with acute myocardial infarction (AMI) and compare the short-term outcomes between AKI and non-AKI patients. Methodology: The study was conducted at Hayatabad Medical Complex, Peshawar, from October 20, 2024 to April 21, 2025, involving 134 AMI patients. Data were collected on demographics, comorbidities, AKI status, and short-term outcomes, including ventricular tachycardia, atrial fibrillation (AF), and in-hospital mortality (VT). AKI was defined as a serum creatinine increase of 0.5 mg/dL or more within 24 hours of admission. Results: The results showed that 25.4% (34 patients) developed AKI. In comparison to the non-AKI group, the AKI group exhibited a higher in-hospital mortality rate (28.07 %) (1.79 %). The frequency of AF was 33.8% in AKI patients and 17.5% in non-AKI patients, while VT was observed in 18.5% of AKI patients and 7.5% of non-AKI patients. The statistical study did not uncover any significant connection between AKI and in-hospital mortality, AF, or VT (p-values of 0.775, 0.429, and 0.488, respectively). Conclusion: AKI is prevalent in AMI patients, with higher mortality and arrhythmia rates in the AKI group. However, no statistically significant correlation was found between AKI and short-term outcomes. Future studies should focus on multicentre data, long-term follow-up, and the role of biomarkers in predicting AKI outcomes.
Effects of Moringa Oleifera Mouthwash on Plaque Index in Patients Having Fixed Orthodontic Appliances
Background: With increasing trend towards improved facial esthetics, larger number of people are getting orthodontic treatments. Maintenance of adequate oral hygiene become difficult with fixed orthodontic appliances because tooth brushes can’t reach all the surfaces due to hindrance provided by fixed appliances. Thus, in order to prevent deleterious effects of braces adjunctive oral care measures like flossing and use of an efficient mouthwash is advised by orthodontists. Commercially available chemical mouthwashes especially Chlorhexidine Gluconate is very effective in preventing plaque accumulation, gingivitis and other gum health problems, but it is associated with wide variety of side effects. So, the interest is being shifted to herbal alternatives that are equally effective but have minimal to zero side effects. In the recent history Moringa Oleifera has emerged as a miracle tree and studies have shown that it has numerous health benefits and medicinal advantages as well. It also has anti-inflammatory a property. Objective: The objective of this study was to find out the efficacy of Moringa Oleifera mouthwash in preventing plaque development over the period of five months in patients undergoing orthodontic treatment with fixed appliances. Materials and Method: This parallel arm, triple blinded, randomized controlled trial was done at Islamic International Dental Hospital. Total 60 participants who were starting orthodontic treatment with fixed appliances were included in the study; they were randomly allocated to two groups, Moringa Group and Control group. Plaque Index was recorded before the fixed appliances i.e. T0. One month after that i.e. at T1, PI was recorded again and then a one litter bottle of mouthwash was given to the participants with the detailed instructions on how to use that. Placebo mouthwash was given to control group and Moringa Oleifera mouthwash was given to Moringa group. PI was recorded again after one month i.e. at T2 and then on monthly intervals i.e. T3, T4 and T5. Jamovi and Phyton was used to analyze the results, the difference between PI scores at T0, T1, T2, T3 and T4 was assessed using the Wilcoxon Signed-rank test. P value was set at ≤ 0.05 and was considered significant. Mann Whitney U test was applied to compare the plaque index scores between control and Moringa group. Results: The results showed significant increase in plaque index score in both the groups over time from T0 to T4. But it increases more in the control group as compared to the Moringa group. At T4 there is significant difference in plaque index scores between the two groups, control groups have higher score than the Moringa group. Conclusion: The Moringa Oleifera mouthwash efficiently reduces the plaque accumulation in patients undergoing orthodontic treatment with fixed appliances. Thus, it can be used as an adjunctive oral care measure to prevent gingivitis and other deleterious effects of fixed orthodontic appliances instead of chemical mouthwashes.
Functional Outcome of Transosseous Krackow Suture Repair for Lower Pole Patella Fracture
Lower pole patella fractures, though relatively uncommon, present significant management challenges due to their impact on the extensor mechanism and the small, often comminuted nature of the fracture fragment. Traditional fixation methods such as tension band wiring and partial patellectomy have shown limitations, including implant-related complications and compromised functional outcomes. This prospective observational study aimed to evaluate the short-term functional and radiological outcomes of transosseous Krackow suture repair in lower pole patella fractures at a tertiary care center in Islamabad. Study was conducted at Combined Military Hospital (CMH), Rawalpindi, from January 2021- June 2023. A total of 105 patients (mean age 39.4 ± 12.6 years; 68.6% male) were treated surgically using non-metallic transosseous Krackow sutures. Patients were assessed at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively for union rates, range of motion, Lysholm knee scores, and complications. Radiological union was achieved in 96.2% of cases within an average of 10.3 weeks. The mean Lysholm score at six months was 88.6 ± 7.9, with 92.3% of patients regaining flexion >120° and 95.2% achieving full extension. Complications were minimal (7.6%), including superficial infections, reoperations due to suture failure, and hardware irritation. These findings indicate that transosseous Krackow suture repair is a safe, effective, and minimally invasive technique for lower pole patellar fractures. It provides reliable fixation with excellent functional outcomes and a low complication profile, making it a viable alternative to traditional fixation methods, particularly in resource-limited settings.
Evaluation of Utility of Modified Early Obstetric Warning Score (Meows) Chart on Reducing Incidence of Peurpural Sepsis in Tertiary Care Setting
Background: Puerperal sepsis is a leading cause of maternal morbidity and mortality, particularly in low- and middle-income countries. The Modified Early Obstetric Warning Score (MEOWS) chart is a clinical tool designed to facilitate early detection of deterioration in obstetric patients through structured monitoring of physiological parameters. Objective: To evaluate the utility of the MEOWS chart in reducing the incidence of puerperal sepsis among postpartum women in a tertiary care hospital. Methods: This prospective interventional study was conducted at Shaikh Zaid Women Hospital, Larkana, from January 2025 to April 2025. A total of 185 postpartum patients were enrolled in the study using a non-probability consecutive sampling technique. Patient data were collected using a structured clinical proforma. The study was divided into two equal phases. In the first (pre-intervention) phase, standard postpartum monitoring protocols were followed without the use of the MEOWS chart. In the second (post-intervention) phase, the MEOWS chart was implemented for routine monitoring. Results: The incidence of puerperal sepsis significantly decreased from 20.0% in the pre-intervention group to 6.3% in the post-intervention group (p = 0.006). The mean time to diagnosis was reduced from 14.6 ± 5.2 hours to 6.3 ± 2.8 hours (p < 0.001), and time to antibiotic initiation decreased from 16.2 ± 6.0 hours to 7.4 ± 3.1 hours (p < 0.001). ICU admissions dropped from 5.6% to 1.1% (p = 0.098), and the average hospital stay was shorter in the MEOWS group (4.9 ± 1.3 days vs. 5.6 ± 1.5 days; p = 0.014). Conclusion: The MEOWS chart is a practical and effective tool for early detection of puerperal sepsis. Its implementation significantly reduced sepsis rates and improved response times in postpartum patients. Routine use of MEOWS in obstetric wards can enhance maternal safety, particularly in resource-limited settings.
Optimizing Primary Care, The Role of Early Diagnostic Interventions in General Medicine
A large percentage of diagnostic interventions used in the primary care practice constitute diagnostic interventions that have been proven to be very basic in the primary care practice and outcome since diseases can be diagnosed and treated before they cause complications. It was quantitative, and it was used in the research of the effects of early diagnostic interventions on patient outcomes, efficiency, and cost-effectiveness in general medicine. The target population was the population of the general medicine patients in the primary healthcare centers in Punjab, Pakistan, and the study design was descriptive cross-sectional. Where there was simple random sampling, 250 patients who had previously used the early diagnostic services within the past year were subjected to the structured patient records and the standardized questionnaire in an attempt to acquire the information. Data analysis was done using SPSS version 27. The demographic and clinical characteristics were provided along with the descriptive statistics. To deal with the objectives, the independent samples t-test had demonstrated the statistically essential difference between the patient outcomes in favor of those who have passed the early diagnostics successfully (p < 0.01). The chi-square test showed that the reduction in the number of hospitalization instances was highly associated with the early diagnostic treatments (χ² = 15.62, p = 0.000). ANOVA = 8.47 and p = 0.01 or less displayed that the difference between the healthcare costs according to the time of diagnosis was significant (F = 8.47, p = 0.01 or less), and the costs of treatment were lower in the cases of early intervention groups. The characters explain the clinical and economical benefit of the special interest in the first flow of the diagnostics in the health care institutions of the low resource.
Efficacy of High Flow Nasal Cannula Versus Noninvasive Ventilation in Acute Exacerbation of COPD
Introduction: COPD is a familiar treatable disorder, Despite the availability of various treatment options, there is limited local evidence to guide the most effective and accessible treatment strategies in resource-constrained settings, Non-Invasive Ventilation (NIV) has been widely used as the standard of care for managing AECOPD; however, recent advancements, such as High-Flow Nasal Cannula (HFNC), offer a promising alternative. Materials & Methods: There were 200 patients with acute exacerbations of COPD, both male and female, ranging in age from 20 to 70. Individuals suffering from systemic illnesses such as chronic liver disease, heart failure, renal failure, hematological disorders, bronchiectasis, pneumonia, life-threatening hypoxemia, agitation, confusion, bowel obstruction, vomiting, upper gastrointestinal surgery, hemodynamic instability requiring pressors or inotropes, trauma, facial burns, or recent upper airway or facial surgery were not included. Group A received non-invasive ventilation (NIV). Group B received high flow nasal oxygen treatment. The following parameters were used to determine the frequency of treatment success: pH >7.35, a decrease in PaCO2 of >15–20% with SaO2 (with or without oxygen) of >90%, and a decrease in respiratory rate of >20% compared with spontaneous breathing. All patients were monitored for 24 hours. Results: The study's age range was 20 to 70 years old, with a mean age of 57.79 ± 4.93 years. Patients in group A were 57.69 ± 5.01 years old on average, while those in the group B were 57.84 ± 4.91 years old. Out of 200 patients, 132 (66.0%) were males and 68 (34.0%) were females with male to female ratio of 1.9:1. At the end of 24 hours of treatment, 73 patients (73.0%) in group A (noninvasive ventilation) and 89 patients (89.0%) in group B (nasal high-flow oxygen) showed successful with 0.0039 significant p-value. Conclusion: This study demonstrated the efficacy of nasal high-flow oxygen is better than noninvasive ventilation in acute exacerbation of COPD.
Prevalence of ESBL Producing and Carbapenem-resistant E. Coli in Urinary Tract Infection from Tertiary Care Hospital
Background: Urinary tract infections are the most common kind of nosocomial infection. E. coli is the leading cause of UTIs and show resistance to carbapenem. Objective: The aim of this study was to determine the Prevalence of ESBL Producing and carbapenem-resistant E. coli in urinary tract infection from tertiary care hospital. Material and Method: The present cross sectional study was conducted at the d Institute of Kidney Diseases Hayatabad Peshawar after taking permission from the ethical board of the institute. A total of 324 mid-stream urine samples were collected in sterile, closed containers from patients presenting with UTI complications. Culturing was done on standard laboratory techniques. Gram staining, microscopy, and biochemical testing were used to identify and confirm the presence of Escherichia coli. The Kirby-Bauer disc diffusion technique was used on Mueller-Hinton agar to determine antibiotic susceptibility. For screening purposes of ESBL generation, E. coli isolates were tested for resistance to cephalosporin and/or aztreonam. A crucial hole or shoulder zone formed by the combination of amoxicillin, clavulanic acid, and one of the surrounding cephalosporin or azitreonam was identified as an ESBL producer. E. coli strains resistant to imipenem, meropenem, or both were designated carbapenem-resistant. Data was analyzed using SPSS version 21 and presented in the tables and figures. Results: A total of 324 urine samples were processed out of which 260 (80.2%) showed bacterial growth. UTIs were most common in female 140(53.8%) as compared to male 120(46.1%) . Out of the total culture positive, the most prevalent uropathogen was E.coli 150(57.6%) followed by Klebsiella 60(23%, Proteus 26(10%) and Pseudomonas species 24(9.2%) correspondingly The E.coli isolates were sensitive to Meropenum 95%,Imepenem 94%,amikacin 89% , Fosfomycine 88% and Nitrofurantoin 72% while exhibited the highest resistance to ampicillin (88%), followed by ofloxacin 70%, ciprofloxacin 65%, ceftriaxone 65%, and co-trimoxazole 64% . Out of the total 150 E.coli bacteria 100(66.6%) were extended spectrum β - lactamases producers and 50(33.3%) were not producers. Among ESBL isolates 10(6.6%) were carbapenem resistant and 4(2.6%) were carbapenem-resistant but not ESBL producers. Conclusion: The current study reported high prevalence of ESBL-producing E. coli, but carbapenem-resistant E. coli was less prevalent in urinary tract infections.
Prevalence of Portopulmonary Hypertension in Patients with Hepatic Cirrhosis
Objective: “To determine the frequency of portopulmonary hypertension in patients with hepatic cirrhosis.” Study Place and Duration: Department of Medicine, Ghurki Trust Teaching Hospital, Lahore for 05 months from 7th Feb 2025 to 8th June 2025. Methodology: After meeting the selection criteria, 130 patients were and underwent portal vein Doppler ultrasound and echocardiography. Portopulmonary hypertension was diagnosed if the patient had a tricuspid regurgitation velocity ≥2.8 m/s, an estimated pulmonary artery systolic pressure >35 mmHg on echocardiography, pulmonary arterial pressure >20 mmHg, pulmonary artery wedge pressure ≤15 mmHg, and pulmonary vascular resistance ≥3 Wood units. All findings were documented in a structured proforma and analysed in SPSS. Results: The mean age of participants was 55.40 ± 9.76 years. Among them, 71 (54.6%) were male and 59 (45.4%) were female. In this study, porto-pulmonary hypertension was observed in 14 patients (10.77%) with hepatic cirrhosis. Among males, 4 (5.6%) had portopulmonary hypertension, compared to 10 (16.9%) females (p = 0.038*). Conclusion: Based on the findings of this study, it can be concluded that portopulmonary hypertension was present in 10.77% of patients with hepatic cirrhosis, with a higher prevalence observed among females.
Effectiveness of Contraceptive Counseling in Perinatal Period
Background: Contraceptive counseling during the perinatal period plays a crucial role in reducing unintended pregnancies, particularly in women with higher parity. However, the efficacy of contraceptive counseling remains under investigation, with varying success across different demographic groups. Objective: To determine the efficacy of contraceptive counseling in perinatal period at AIMS hospital Azad Jammu and Kashmir. Study Design: Descriptive study. Duration and Place of Study: The study was conducted from May 2024 to May 2025 at the Department of Obstetrics and Gynaecology, AIMS Hospital, Muzaffarabad, AJK. Methodology: A total of 196 women aged 20–40 years, married, with a parity of ≥4, and in the perinatal period were included in the study. Participants were counseled on one of the following contraceptive methods: male condoms, emergency contraceptive pills, oral contraceptive pills, injectable contraceptives, or IUCD. After 12 months, the efficacy, defined as no unintended pregnancies, was evaluated. Results: The mean age of participants was 31.2 ± 4.6 years, with a mean parity of 5.6 ± 1.1. Among participants, 67.9% reported contraceptive counseling efficacy, while 32.1% did not. Stratified analysis revealed that efficacy was significantly associated with the perinatal period, socioeconomic status, parents' education, residential status, and contraceptive method type. Postpartum women and those from higher socioeconomic classes had higher efficacy. IUCD users reported 100% efficacy, while injectable contraceptive users had an efficacy of 91.7%. Conclusion: Contraceptive counseling during the perinatal period is effective in preventing unintended pregnancies, with efficacy varying across different demographic factors and contraceptive methods.
Comparative Study of Efficacy and Adverse Effects of Metformin Plus Empagliflozin Versus Metformin Plus Sitagliptin in Diabetes Mellitus Type II Patients
Introduction: This study aims to compare the efficacy and adverse effects of metformin combined with empagliflozin versus metformin combined with sitagliptin in Type II DM patients in Pakistan. Given the rising prevalence of diabetes in Pakistan, evaluating these widely used combination therapies in a local population is essential for optimizing treatment strategies. This research will provide valuable insights into glycemic control and safety profiles in a population with unique genetic, dietary, and lifestyle factors, which are often underrepresented in global studies. Materials and Procedures: This single-blinded RCT enrolled 112 patients aged 35–65 with HbA1c 7–9%, diabetes >1 year. Patients were randomized into two groups: Group A received Metformin plus Empagliflozin, and Group B received Metformin plus Sitagliptin. Exclusions included irregular medication, prior hypoglycemic use, high creatinine, or glucose-altering drugs. HbA1c was measured monthly; compliance and side effects were monitored. Results: In my research, patients treated with metformin + empagliflozin had a higher likelihood of being in the metformin + empagliflozin group than those treated with metformin + sitagliptin (48.21% vs. 26.79%, respectively) if their HbA1c was under 7%. Side effects with empagliflozin are less than sitagliptin i.e. diarrhea (3.57% vs 8.93%), rash (0.0% vs 5.36%), hypoglycemia (12.50% vs 16.07%), UTI (0.0% vs 7.14%) and increased urination (19.64% vs 10.71%) respectively. Conclusion: When used in conjunction with metformin, SGLT-2 inhibitors are just as safe, effective, and well-tolerated in individuals with Type 2 diabetes mellitus as DPP4 inhibitors.
Frequency of Anatomical Variations of Osteomeatal Complex among Patients with Chronic Rhinosinusitis
Objectives: To determine the frequency of anatomical variations of osteomeatal complex in patients presenting with chronic rhinosinusitis. Study design: Descriptive cross-sectional study. Date and place of study: Department of Diagnostic Radiology, Combined Military Hospital, Multan, from Nov, 2024 to Apr, 2025. Methods: A total of 125 patients aged 18–65 years, clinically diagnosed with chronic rhinosinusitis (persistent symptoms lasting at least 12 weeks despite medication), and referred for CT scans of the paranasal sinuses were included in this study. A consultant radiologist identified anatomical variations of the osteomeatal complex. Descriptive statistics was applied to present the frequency and types of these variations. Results: The mean age of patients was 35.4 ± 11.2 years (range: 18–65 years). There were 59% males and 41% females. Anatomical variations of the osteomeatal complex were found in 112 (89.6%) patients. Most frequent variations were deviated nasal septum 82 (65.6%), concha bullosa 71 (56.8%), agger nasi cells 49 (39.2%), haller cells 34 (27.2%), pneumatized uncinate process 28 (22.4%), uncinate process deviation 25 (20%) and paradoxical middle turbinate 15 (12%). Conclusion: Anatomical variations of the osteomeatal complex are highly prevalent in patients diagnosed with chronic rhinosinusitis, with deviated nasal septum and concha bullosa being the most frequent variations observed in our population.
Glycated Hemoglobin as A Marker for Predicting Outcomes of Patients with Hemorrhagic Stroke
Background: A severe cerebrovascular event with a high morbidity and fatality rate is hemorrhagic stroke (HS). Finding trustworthy prognostic indicators is essential to enhancing clinical results. Glycated hemoglobin (HbA1c), which has been connected to vascular dysfunction and the risk of stroke, is a measure of long-term glycemic management. Its predictive usefulness for hemorrhagic stroke outcomes is still unknown, though. Objective: This study aims to evaluate the role of HbA1c as a predictive biomarker for clinical outcomes in patients with hemorrhagic stroke, focusing on stroke severity, functional recovery, and mortality. Methods: At Quetta's Bolan Medical Complex Hospital, 300 patients with hemorrhagic stroke were the subjects of a prospective observational study. Based on their HbA1c readings, patients were divided into three groups: <5.7%, 5.7%–6.4%, and >6.5%. The Glasgow Coma Scale (GCS) and NIH Stroke Scale (NIHSS) were used to measure clinical severity. The modified Rankin Scale (mRS) was used to assess functional outcomes both at discharge and ninety days after the stroke. Independent predictors of unfavorable outcomes were found using logistic regression analysis. Results: Significantly negative outcomes were seen by patients with HbA1c >6.5%, including higher mean blood pressure (160/95 mmHg ± 14, p=0.001), higher NIHSS scores (14.7 ± 5.2, p=0.002), and lower GCS scores (8.9 ± 3.2, p=0.001). This group had the lowest functional independence (18.2%, p=0.001) and the highest mortality (36.4%, p=0.002). Along with age >60 years, hypertension, and high NIHSS scores, logistic regression verified that HbA1c >6.5% was an independent predictor of poor functional recovery (OR: 2.9, p=0.001). Conclusion: In hemorrhagic stroke patients, elevated HbA1c levels are linked to worse functional recovery, higher mortality, and more severe stroke. A major independent predictor of unfavorable outcomes is a HbA1c >6.5%. These results imply that regular HbA1c testing could help patients with hemorrhagic stroke with risk assessment and clinical decision-making.
Climate Change Awareness and Perceived Health Impacts: A Cross-Sectional Study among Nursing Students in Sindh, Pakistan
Background: Climate change poses significant threats to global health, particularly in low- and middle-income countries. Nurses, as frontline healthcare providers, must be equipped with climate-health literacy to address climate-sensitive conditions. This study assessed the awareness and perceived health impacts of climate change among nursing students in Sindh, Pakistan. Methods: A cross-sectional survey was conducted over three months (from March – May of 2025) among 292 second-year Bachelor of Science in Nursing students from public and private colleges in Sindh. Participants were selected using cluster sampling. Data were collected through a validated self-administered questionnaire and analyzed using SPSS v27. Descriptive statistics summarized awareness levels, and chi-square tests examined associations between demographic variables and climate change awareness. Results: Most participants (91.4%) were familiar with the term “climate change” and 87.3% acknowledged its health impacts. Key causes identified included deforestation (66.4%) and air pollution (10.6%), while fewer recognized industrial emissions (1.7%). Respiratory diseases (82.5%), infectious diseases (80.8%), and malnutrition (68.2%) were commonly perceived health outcomes. Gender and age showed significant associations with awareness indicators (p<0.05). However, only 43.5% of students reported personal action against climate change, and 66.1% were unaware of governmental climate policies. Conclusion: Although nursing students demonstrated high general awareness of climate change, gaps in understanding specific causes, health impacts, and policies were evident. Integrating climate-health education into nursing curricula is critical for developing a climate-resilient healthcare workforce.
Frequency of Iron Deficiency in Females having Normal Haemoglobin level Complaining of Fatigue
Background: Iron deficiency is the most widespread nutritional disorder globally and often occurs without anemia, especially in women of reproductive age. Conventional screening practices that rely solely on hemoglobin levels may miss a significant number of cases. Aim: To determine the frequency of iron deficiency in non-pregnant females having normal hemoglobin levels, and to identify associated risk factors based on clinical, demographic, dietary, and reproductive variables. Methodology: A cross-sectional study was conducted at the Department of Medicine, Services Hospital Lahore, over a period of six months. A total of 100 non-pregnant females aged 16–45 years with hemoglobin >11 g/dL were enrolled using non-probability consecutive sampling. Data on sociodemographic, clinical, dietary, and reproductive factors were collected. Laboratory evaluation included hemoglobin, serum ferritin, and serum iron. Iron deficiency was defined as serum ferritin <15 µg/L and serum iron <10 µmol/L. Data were analyzed using SPSS v25, and associations were tested using Chi-square test and odds ratios; p < 0.05 was considered statistically significant. Results: Iron deficiency was found in 41% of participants despite normal hemoglobin levels. Significant associations were observed between iron deficiency and underweight BMI (OR = 7.11, p = 0.002), history of anemia (OR = 6.30, p = 0.001), hypertension (OR = 3.84, p = 0.012), ≥2 deliveries (OR = 3.10, p = 0.012), breastfeeding (OR = 2.50, p = 0.045), sedentary lifestyle (OR = 2.41, p = 0.049), no supplement use (OR = 2.80, p = 0.034), and low meat intake (OR = 3.06, p = 0.016). The strongest predictors were low serum ferritin (OR = 9.47, p < 0.001) and low serum iron (OR = 5.54, p < 0.001). Conclusion: A considerable proportion of non-pregnant females with normal hemoglobin levels were found to be iron deficient, highlighting the inadequacy of hemoglobin-based screening. Risk factors were multifactorial, involving nutritional, reproductive, and behavioral dimensions. Routine biochemical screening and broader nutritional interventions are recommended to detect and manage iron deficiency in at-risk non-pregnant females, even in the absence of anemia.
Exploring the Incidence and Anatomical Distribution of Spermatic Cord Lipoma During Hernia Repair: A Ward-Based Study
Background: Spermatic cord lipomas, often overlooked during inguinal hernia repair, can mimic or accompany indirect hernias, potentially leading to postoperative complications if not identified and managed intraoperatively. This study aimed to evaluate the incidence and anatomical distribution of spermatic cord lipomas across different surgical modalities in a ward-based setting. Methods: A prospective observational study was conducted over 12 months (May 2024–April 2025) at Jinnah Postgraduate Medical Center, Karachi. A total of 140 male patients undergoing elective inguinal hernia repair were included. Surgical approaches comprised open repair (n=98), laparoscopic TAPP (n=22), and robotic TAPP (n=20). Intraoperative identification and localization of lipomas were recorded, categorized anatomically as precordial, midcordial, or proximal. Results: Spermatic cord lipomas were detected in 53 of 140 patients (37.9%). Incidence varied by surgical technique: robotic TAPP (50.0%), laparoscopic TAPP (45.5%), and open repair (33.7%). Midcordial location was most frequent (39.6%), followed by precordial (34.0%) and proximal (26.4%). Unilateral lipomas predominated (90.6%), while bilateral cases (9.4%) were exclusively identified via laparoscopic and robotic methods. No intraoperative complications related to lipoma dissection were reported. However, in cases where lipomas were missed or incompletely excised, postoperative complications such as recurrence, bulging, and persistent discomfort were noted during follow-up. Conclusion: Spermatic cord lipomas are a common intraoperative finding during inguinal hernia repair, especially in minimally invasive procedures where improved visualization enhances detection. Midcordial involvement is most prevalent, and bilateral cases may go unnoticed in open repairs. Standardized intraoperative evaluation of the spermatic cord is crucial to mitigate the risk of recurrence, postoperative bulging, and patient discomfort, thereby improving long-term outcomes.
Impact of Obstructive Sleep Apnea on Neurological Recovery after Ischemic Stroke: A Prospective Study
Objectives: In this investigation, the prevalence, clinical features, and impact of obstructive sleep apnea (OSA) on the prognosis of acute ischemic stroke patients were examined. Study design: Prospective Study. Settings: Department of Neurology, Shifa International Hospital, Islamabad. Study Duration: February 2025 to April 2025. Methods: Forty-nine patients with acute ischemic stroke were included. Lab findings, demographic data, and PSG features were collected. The modified Rankin Scale (mRS) was used to quantify the functional result, and the National Institutes of Health Stroke Scale (NIHSS) was utilized to gauge the extent of the initial neurologic loss. An poor prognosis was defined as an mRS ≥3 three months after the onset of acute ischemic stroke. Multivariate logistic regression was employed to assess the correlation between OSA severity and functional outcome. Results: OSA [apnea-hypopnea index (AHI)≥5/h] was present in 43 (87.8%) of the 49 patients who suffered an acute ischemic stroke. Of the patients, 13 (26.5%) had severe OSA, 16 (32.7%) had moderate OSA, and 14 (28.6%) had mild OSA. OSA-related factors, such as oxygen desaturation index (ODI) and AHI, were linked to poor clinical outcomes three months after stroke (mRS ≥3), according to univariate logistic regression. After controlling for age and initial NIHSS, multivariate logistic regression analysis showed that a rise in AHI and ODI was linked to a poor functional outcome three months following a stroke. Conclusions: Poor functional outcomes are linked to OSA in patients who have had an acute ischemic stroke.
Patterns and Trends of Antibiotic Prescribing in Primary Care: A Cross-Sectional Analysis
A cross-sectional descriptive study was conducted to clarify the trends of antibiotic prescriptive practice in primary care and determinants of inappropriate use by primary care physicians in the Multan district. Simple random sampling was applied to recruit a total of 270 physicians in government health centers, private clinics, and community health centers. The data was collected using a structured, self-administered questionnaire, and where prescription records were available, they were reviewed. Most of them were males (59.3%), and their age was 30–39 years with 5–10 years of clinical practice, and 40.7 percent of consultations were carried out in telemedicine. Descriptive analysis depicted that the mean number of antibiotic prescriptions was 18.25 per week and the inappropriate prescribing rate was 42.36%. The proportion of all prescriptions that constituted broad-spectrum antibiotics was 68 percent. The chi-square test revealed that the age of patients and the type of antibiotic prescribed had a significant relationship (p = 0.021). An independent sample t-test revealed that less experienced physicians exhibited worse appreciation of appropriate prescription (p = 0.034). The key predictors of irrational prescribing were also identified as the physician's experience, patient pressure, and telemedicine use with the help of binary logistic regression. Data analysis was done using SPSS version 27.0. These findings support the relevance of particular antimicrobial stewardship measures and lifelong medical education in primary care. Improving prescription audits, distribution of guidelines, and clinical decision-support systems can also promote reasonable use of antibiotics.
Micro RNA-Mediated Epigenetic Regulation in Hormonal Pathways: Insights into Thyroid Cancer Progression
Thyroid cancer is the most prevalent endocrine malignancy, and its prevalence is continuously increasing globally. Thyroid cancer is a complicated disease that is impacted by environmental, genetic, and epigenetic factors. Among these, epigenetics, which are heritable variations in gene expression that do not include changes in the DNA sequence, has drawn much interest. The physiology and pathology of the thyroid gland depend heavily on hormonal pathways, especially those involving thyroid hormones. It has been demonstrated that their dysregulation promotes the development of tumors and the progression of cancer. MicroRNAs (miRNA or miRNAs) are key regulators of these epigenetic modifications. They modulate gene expression through chromatin remodeling, DNA methylation, and histone modifications, thereby influencing hormonal signaling pathways critical to thyroid physiology and pathology. Dysregulation of miRNA can disrupt thyroid hormone signaling, affect the expression of hormone-responsive genes and receptors, and contribute to tumor initiation, progression, and metastasis. Recent studies highlight the interplay between thyroid hormone signaling and miRNA-mediated epigenetic regulation in thyroid cancer. Understanding these molecular mechanisms is crucial for the development of novel diagnostic biomarkers and targeted therapeutic strategies.
Spectrum of Laboratory Errors Encountered in the Total Testing Process of a Tertiary Care Teaching Hospital Laboratory
Background: Monitoring laboratory performance continuously is critical for recognizing errors and promoting further improvements in laboratory. This study aimed to review the laboratory errors in the preanalytical, analytical and post analytical phases of testing in a clinical laboratory. Materials and Methods: A retrospective and descriptive study was carried out at our clinical chemistry, hematology, immunoassay and coagulation laboratories in CHK - Central laboratory Dr. Ruth K.M Pfau Civil Hospital, Karachi, over a period of 1-year period, from November 2022 to November 2023 and the findings of pre-analytical, analytical and post-analytical errors were analyzed of 413631 samples. Results: Errors were detected in 281467 samples out of 413631 samples with total error rate of 68%. Results of the study showed that Preanalytical errors were most common with a frequency of 97.25%, followed by post analytical errors 2.5% and analytical errors 0.25% respectively. Conclusions: The study concludes that pre-analytical, analytical, and post analytical errors arising in laboratory not only lead to wrong diagnosis and treatment of patient they also effect the cost, inventory and human resource as well. The results of our study suggest that more efforts are to be made for training of phlebotomy, sample collection and transport of specimens.
Comparison of Biochemical and Hematological Profile in Pulmonary and Extrapulmonary Tuberculosis at Gulab Devi Teaching Hospital
Introduction: Tuberculosis (TB) remains a significant cause of morbidity among children in developing countries. Differentiating between pulmonary TB (PTB) and extrapulmonary TB (EPTB) based on laboratory parameters can aid in timely diagnosis and management. This study aimed to compare the biochemical and hematological profiles of pediatric patients diagnosed with PTB and EPTB at Gulab Devi Teaching Hospital. Methodology: This descriptive case series included 120 pediatric patients under 14 years of age diagnosed with TB over a three-month period. Patients were divided into PTB and EPTB groups. Biochemical and hematological parameters including Hb, RBCs, WBCs, TLC, PLT, ESR, CRP, and differential counts were analyzed. Radiological and clinical features such as TST positivity, chest X-ray findings, lymphadenopathy, cavity lesions, and miliary TB were also compared between groups. Data were analyzed using SPSS v25.0 with p ≤ 0.05 considered statistically significant. Results: Out of 120 patients, 74 (61.7%) had PTB and 46 (38.3%) had EPTB. Mean age was 7.01 ± 4.31 years, with a nearly equal gender distribution. PTB patients had significantly higher TLC (11.49 ± 1.95 vs. 8.30 ± 1.57; p=0.001) and WBC counts (11.10 ± 1.77 vs. 9.86 ± 1.58; p=0.001) compared to EPTB. Other hematological and biochemical parameters showed no significant differences. TST positivity was more frequent in EPTB (95.7% vs. 78.4%; p=0.010). Conclusion: While most biochemical and hematological markers were comparable between PTB and EPTB, significantly higher leukocyte counts in PTB suggest a more pronounced inflammatory response. Radiological findings and TST also differed notably, which can aid in clinical differentiation and early diagnosis.
The Spectrum of Haemoglobinopathies: A Tertiary Care Hospital Experience
Background: A scientist, Csaba Harvath first described high-performance chromatography (HPLC). HPLC method is beneficial for detecting different types of hemoglobinopathies, including both quantitative and qualitative disorders of globin chains.This study aimed to explore the significance of HPLC technique in the diagnosis of various hemoglobinopathies. Methods: This cross-sectional retrospective study was conducted in the Central Laboratory of Civil Hospital Karachi from 1st Jan 2021 to 31 Dec 2023. A total of 1464 patients were included who came with low hemoglobin levels. Analysis of blood for complete blood count was done on an XN 1000 analyzer and then HPLC was performed on an Arkray analyzer in samples received in our laboratory. Hemoglobinopathies were diagnosed by the more sensitive method, High-Performance Liquid Chromatography (HPLC) on the analyzer ADAMS A1C Model No. HA-8180T Arkray/Japan. Results: Out of 1464 cases, 1022 (69.8%) were normal, and 442 (30.1%) cases had abnormal haemoglobin pattern. 688(46.9%) were males and 776 (53.0%) were females. Out of 1022 cases of Anemia, 557 (54.5%) were microcytic hypochromic, 45(4.4%) macrocytic, and the rest 421(41.1%) had a normocytic normochromic picture. Of the total cases, 442 (30.1%) showed abnormal Hb fractions. The major abnormality observed was high HbA2. Other hemoglobinopathies in descending order of frequency were Hb D Disease at 40 (9.0%), sickle cell disease at 29 (6.5%), Hb E at 18(4.0%), Sickle/beta-thalassemia in 06 (1.3%), and Hb C 01 (0.2%). Conclusion: Our study revealed a higher frequency of the Beta Thalassaemia trait. It is suggested that detection of HbA2 should be carried out in all the high-risk groups with anaemia. Further larger studies are needed to screen our population to detect thalassaemia carrier state and Iron deficiency Anaemia.
Incidence of Ischemic Stroke among Patients Recently Initiated on Direct Oral Anticoagulants for Atrial Fibrillation
Background: Ischemic strokes are a leading source of disability and death globally, particularly due to atrial fibrillation (AF), which is a significant risk factor. While prescribing anticoagulation DOACs to patients with AF for cardioembolism stroke prevention, real-world scenarios show persistent stroke events, which connote suboptimal functioning of the controlled interventions. To establish the rate of ischemic stroke among patients with newly prescribed DOACs for atrial fibrillation (AF)and to evaluate the relevant demographic, clinical, and laboratory features. Methods: A descriptive cross-sectional study was conducted in the Emergency Department of Lady Reading Hospital, Peshawar from May 2024 to May 2025. A total of 184 patients aged 30–60 years, presenting with acute ischemic stroke and recently started on DOACs, were enrolled using consecutive non-probability sampling. Data were collected through structured clinical evaluation, ECG confirmation of AF, neuroimaging, and relevant laboratory tests. Statistical analysis was performed using SPSS version 21.0, with p-values ≤ 0.05 considered significant. Results: The mean age of patients was 51.3 ± 7.6 years, with females comprising 51.6% of the sample. Ischemic stroke occurred in 20.1% of patients despite recent initiation of DOACs. Atrial fibrillation was present in 60.3% of cases, but no significant association with stroke outcome was observed. In contrast, male gender showed a statistically significant link with stroke occurrence (p = 0.0191). Most patients had normal liver and renal function, though abnormalities in serum electrolytes and glucose levels were common. Conclusion: A notable proportion of patients developed ischemic stroke despite DOAC use, suggesting that anticoagulation alone may not be sufficient in high-risk cases. Male gender appeared to be a significant risk factor, whereas family history and documented AF were not. These findings highlight the need for comprehensive stroke prevention strategies beyond anticoagulation, including close monitoring and metabolic risk control.
Feeding Pattern of Children Under 2 Years of Age with Severe Malnutrition Presenting in Hayatabad Medical Complex
Background: To determine the frequency and distribution of various feeding patterns among children under two years of age diagnosed with severe malnutrition presenting at Hayatabad Medical Complex, Peshawar. Methods: A cross-sectional study was conducted over a period of six months (16 September, 2024 to 15 March, 2025) in the Department of Pediatrics, MTI-Hayatabad Medical Complex, Peshawar, Pakistan. A total of 118 malnourished children aged 2 to 12 months were enrolled using non-probability consecutive sampling. Data on age, gender, vaccination status, residence, and feeding practices were collected through caregiver interviews and clinical assessments. Feeding patterns were categorized as exclusive breastfeeding, predominant breastfeeding, formula feeding, or fresh cow’s milk feeding. Data were analyzed using SPSS version 22.0. Chi-square tests were applied to assess associations, with p ≤ 0.05 considered significant. Results: Exclusive breastfeeding was reported in 32.2% of participants, while 28.0% received formula, and 22.0% were fed fresh cow’s milk. Age group, vaccination status, and duration of malnutrition were significantly associated with feeding practices. Younger infants, vaccinated children, and those with shorter durations of malnutrition were more likely to be exclusively breastfed. Conclusion: The study highlights low rates of exclusive breastfeeding among malnourished infants and emphasizes the need for improved maternal education and support programs to encourage optimal feeding practices. Integration of nutritional counseling into routine immunization and child health services may offer a practical strategy for reducing malnutrition.
Risk Factors and Status of Unplanned Readmission of Neonates within Thirty Days of Discharge from NICU at Tertiary Care Hospital of Low Resource Country
Background: 12% out of all neonates born alive, require admission to health care facility mainly NICU (4). Neonate that requires readmissions to NICU poses a universal health concern, with frequency as much as 10.1% outside the USA, creating load on health care facilities and parents. Objective: To investigate the risk factors associated with unplanned readmissions of newborns after discharge from the Neonatal Intensive Care Unit (NICU). Methods: A total of 572 neonates who were readmitted to the NICU throughout the study period were also included in this retrospective observational analysis. Data on these readmitted neonates, including gestational age, birth weight, diagnosis, and other factors, were retrieved and evaluated. The chi-square test was applied to see whether there was a relationship between problems and hospital status and newborn demographics. To calculate adjusted odds ratios (ORs) and their 95% confidence intervals (CI), the logistic regression technique using univariate and multivariate data was applied. Result: Out Of 572 study participants, 317(55.4) were male and 255(44.6) were female. The median age of the sample was 1 day (inter-quartile range [IQR]: 0-5 days) with their median length of the NICU stay was 3.00 (2.00 -5.00) days. 78 percent of participants were in born and 22 percent were out born. Most of the newborns during this study were admitted only once (n=496,86.7%) in comparison readmission status was (n=76,13.3%). Among these participants 45 percent were normal birth weight,39 percent were LBW, 10percent ere VLBW and around 6 percent were ELBW. Univariate logistic regression showed that younger age (OR: 1.07, 95% CI: 1.05-1.09) patients who had lesser length of NICU stay were at increased risk of readmission (OR: 0.73, 95% CI: 0.62-0.87). Newborns with very low and low birth weight were had increased odds of NICU readmission in contrast to those whose weight is normal (OR: 4.03, 95% CI: 1.92-8.44, (OR: 2.22, 95% CI: 1.25-3.92). Conclusion: Newborns discharged from NICU are at high risk of readmission, especially in settings with weak community care like Pakistan. Strengthening discharge protocols, caregiver education, and post-discharge follow-ups can reduce readmissions and improve outcomes.
Investigate the Mortality, Morbidity and Factors Associate in Thalassemia Patients in Faisalabad, Pakistan
Introduction: Thalassemia represents a genetic blood disorder that people obtain from their parents through hereditary materials since their bodies produce abnormal types of hemoglobin. The red blood cell destruction occurs in high numbers because of this disorder thus producing anemia.It is a prevalent disease, and in our society, its prevalence is 75%, with 35% of cases in females and 40% in males. Most of the cases are of beta thalassemia major. Objective: We are conducting this research so that in the future, we can correlate the disease with comorbidity in order to reduce the prevalence and so to improve treatment. Method: The study design of this research was retrospective cross-sectional study. We made a questionnaire provided to participants for gathering data.This was followed by a peripheral blood smear to assess cell morphology. Iron deficiency tests were then conducted to rule out other causes of anemia. The questionnaire was carefully designed to gather detailed information on patient and family history, lifestyle, awareness levels, and genetic background Patients were monitored through a follow-up process. Result: The study found that 75% of participants were affected by thalassemia, with 40% males and 35% females, and most cases were beta thalassemia major. Blood tests like CBC confirmed genetic anemia, not due to iron deficiency. The majority of participants lacked awareness about the disease and its hereditary nature, highlighting the need for screening and education programs. Conclusion: In this review we will discuss about Investigate the Mortality, Morbidity and factors associate on Thalassemia patients in Faisalabad 2025Pakistan. Its prevalence rate is high about 75% which is 35% females and 40% males related to our research. Future Perspective: This study's findings will inform evidence-based healthcare policies and interventions to reduce mortality and morbidity in thalassemia patients in Faisalabad, Pakistan, ultimately improving patient outcomes and quality of life. The insights gained will also contribute to the development of targeted prevention strategies and optimized management protocols for thalassemia care in resource-constrained settings. Future research can build upon these findings to explore innovative solutions and best practices for thalassemia management in Pakistan.
Role of Chewing Gum in Reducing Post-Operative Ileus and Enhancing Recovery Following Colorectal Surgery – A Study at CMH Lahore
Objectives: To determine impact of chewing gum in immediate postoperative period on the outcomes of colorectal surgery. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital, Lahore from February 07, 2025 to May 07, 2025. Methodology: In this study, 62 patients who underwent elective colorectal surgery were included. They were divided into Group-G (advised to chew gum in addition to standard post-operative care) and Group-S (managed through standard post-operative care). Patients in both the groups were assessed for outcomes including duration to recover from physiologic postoperative ileus and the occurrence of pathologic postoperative ileus and their comparison was performed between groups. Data was analyzed using SPSS version 22.00. Results: In this study, 62 patients divided into two groups were included. Median age was 68.00 (7.00) years. There were 33 (53.20%) male and 29 (46.80%) female patients. In Group-G, median duration to pass first postoperative flatus was 37.00 (5.00) hours while in Group-S it was 58.00 (19.00) hours, (p < 0.001). In Group-G, median duration to pass first postoperative feces was 58.00 (5.00) hours while in Group-S it was 78.00 (5.00) hours, (p < 0.001). In Group-G (n = 31), pathological postoperative ileus occurred only in 1 (3.23%) patient while in Group-S (n = 31), it occurred in 8 (25.81%) patients, (p = 0.012). Conclusion: Addition of gum chewing to standard postoperative care after colorectal surgery can effectively reduce postoperative ileus rate and recovery time.
Correlation between Body Image and Depression in Pregnant Women
Introduction: Pregnancy-related body image dissatisfaction is linked to psychiatric conditions like depression. This study examines the relationship between depression and body image in pregnant women and emphasizes the importance of taking mental health into account throughout pregnancy. Objectives: The purpose of the study was to establish the correlation between body image and depression in pregnant women. Materials and Methods: This cross-sectional study was conducted in Dr Ziauddin Hospital in Karachi from January 2025 to May 2025. Participants were selected through convenience sampling and 100 pregnant women agreed to participate in the study. Socio-demographic details were also gathered. The correlation between body image dissatisfaction and depression was tested using Spearman’s correlation coefficient. Results: Body image dissatisfaction have a significantly moderate negative relation with depression, with a coefficient of determination of -0.62 and a p-value of 0.001. A correlation was observed between body image satisfaction and depressive symptoms, with women with lower levels of body image satisfaction being higher in depressive symptoms. Conclusion: Depression in pregnant women is associated with body image perception. Addressing body image concerns may contribute to improved maternal mental health.
Exploring the Relationship Between Antimicrobial Stewardship and the Rise of Multi-Drug Resistant Pathogens in Healthcare Settings
The aim of this study was to examine the relationship between the antimicrobial stewardship (AMS) programs and the relationship between these programs and the incidence of multi-drug resistant (MDR) pathogens within a healthcare facility, and how healthcare practitioners are provoked in administering an AMS program. Multi-drug resistance has been a serious health concern of late with the infections more susceptible to healing and patients are at a higher risk. It was a descriptive cross-sectional research performed in a few out of the total number of the governmental and regional hospitals in the province of Punjab in Pakistan during the period between March 1, 2025 and May 15, 2025. A sample of 250 healthcare professionals, was chosen by simple random sampling. A structured questionnaire with self-report was used to carry the observation and measurements. Frequencies and percentages were used to report categorical data whereas the means and standard deviation (SD) were used to report numerical data. Associations and Comparing of Means were performed on chi-square and Independent Samples t-tests. The results showed a high correlation in use of AMS and the incidences of MDR (p = 0.003) with few MDR cases per hospital having AMS implemented to practice. The knowledge of AMS was significantly higher in the case of the public hospitals when compared to those in a private hospital (p = 0.014). There were higher scores of challenges in AMS implementation among nurses and the pharmacists. The results indicate that there is a need to enhance AMS programs.
Efficacy of Platelet-Rich Plasma (PRP) in wound Healing in Superficial Partial Thickness Burn Wounds
Objectives: To determine the efficacy of Platelet-Rich Plasma (PRP) and conventional dressing among patients with Superficial Partial Thickness Burns. Study Design: Randomized controlled trial. Study Duration: March 2025 to May 2025. Place of Study: Allied Burn and Reconstructive Surgery Centre, Allied Hospital, Faisalabad. Materials & Methods: Total 60 patients between the ages of 16 and 65 years with superficial partial thickness burn area of 35% were included. People with full-thickness burns, which damage the entire dermis, chemical, electrical, or friction burns, a history of bleeding disorders, those currently on anticoagulant therapy, or those who are hypersensitive to PRP components, uncontrolled diabetes with a hbA1c level greater than 6, other injuries, or who are already anemic were not allowed to participate. People in group A had PRP done. Thirty patients in Group B were chosen to get treated with standard dressing therapy. We also looked for evidence of epithelialization on the wound surface, such the presence of fresh, pink epithelial tissue, and on the borders of the incision, like the creation of an epithelial "lip. Results: Patients in group A were 37.10 ± 7.81 years old on average, while those in the group B were 37.37 ± 7.63 years old. With a male to female ratio of 2.2:1, 41 (68.33%) of the 60 patients were men and 19 (31.67%) were women. At the end of 9 days of treatment, 18 patients (60.0%) in group A (Platelet-Rich Plasma (PRP)) and 01 patients (3.33%) in group B (conventional dressing) showed efficacy. 0.0001 is the statistically significant p-value. Conclusion: Our research shows that autologous platelet-rich plasma (PRP) is substantially better at healing wounds than standard dressings.
Assessing Climate Change Worry among Undergraduate Nursing Students in Sindh, Pakistan: A Cross-sectional Study
Background: Climate change is increasingly recognized as a significant threat to mental health globally. This study investigates the prevalence and nature of climate-related worry among undergraduate nursing students in Sindh, Pakistan, and explores differences between public and private institutions. Methods: A cross-sectional survey was conducted from March to May 2025 across public and private nursing colleges in Sindh. A total of 291 students participated, completing a 10-item Climate Change Worry Scale (CCWS) alongside demographic questions. Descriptive statistics characterized the sample and mean CCWS scores. A one-sample t-test determined whether the mean worry score was significantly above the neutral midpoint (score = 3.0). Mann–Whitney U tests compared item-level responses between public and private college students. Results: Participants (75.3% male; 72.5% aged 21–30; 60.1% rural; 78% Sindhi) exhibited a mean CCWS score of 3.25 (SD = 0.65), significantly above neutral (t(290) = 5.24, p < 0.001). Many frequently worried about the future (54.6%), loved ones (62.1%), and felt “paralyzed” by their concern (48.1%). Public vs. private institution comparisons revealed significant differences in worry intensity and proactive engagement for four items: self-comparative worry (p = 0.001); future-oriented anxiety (p = 0.006); personal impact (p = 0.025); and suggesting solutions (p = 0.004). Conclusions: Climate-related worry is significantly present among nursing students in Sindh, particularly when considering emotional impact and engagement. Differences between institutional groups suggest the influence of educational or contextual factors. Results underscore the need to integrate climate-related mental health content into nursing education and to develop longitudinal and interventional research to support adaptive coping and resilience in future healthcare professionals.
Frequency and Outcomes of Inferior Wall Myocardial Infarction without Left Dominant System
Background: Inferior wall myocardial infarction (IWMI) is a common type of ST-elevation myocardial infarction (STEMI), usually resulting from right coronary artery (RCA) occlusion in patients with a right-dominant coronary system. Objective: To determine the frequency and in-hospital outcomes of inferior wall myocardial infarction (IWMI) in patients with a non-left dominant coronary artery system. Methodology: This Descriptive observational study was conducted at National Institute of Cardiovascular Diseases (NICVD), Karachi, from 25th February 2025 to 1st June 2025. A total of 171 patients aged 18–70 years with acute IWMI and a non-left dominant coronary system were included through non-probability convenient sampling. Patients with prior myocardial infarction, cardiac revascularization, chronic kidney disease, or other major exclusions were omitted. Data were collected using a structured proforma. Results: Out of 171 patients, 138 (80.7%) presented with STEMI and RCA was the culprit vessel in 164 (95.9%). The most common lesion location was proximal RCA (51.5%) and Killip Class I was seen in 61.4% of patients. Right ventricular infarction occurred in 32.7%, complete heart block in 18.1%, advanced heart failure in 11.7%, and in-hospital mortality in 7.6% of cases. RV infarction was significantly associated with proximal RCA occlusion (p = 0.02) and CHB (p = 0.01). Patients with LVEF <30% had significantly higher mortality (p = 0.004). Conclusion: Patients with IWMI and non-left dominant systems predominantly have RCA involvement and carry substantial risk of conduction abnormalities and RV dysfunction. Early recognition and aggressive management are crucial to prevent adverse outcomes. Coronary dominance assessment should be a routine part of diagnostic angiography for better risk stratification.
Comparative Study on Growth Performance and Proximate Composition of Meat and Internal Organs of Farmed and Wild Cirrhinus mrigala
Fish play an enormous role in the diet of humans and are a great source of essential nutrients. Simple techniques determined growth performance. The tape foot was used to determine the length, and the weighing balance was used to calculate the weight. Proximate composition is the measurement of the percentage of proteins, fats, carbohydrates, ash percentage and moisture content. The present-day study was helpful in analyzing the accurate difference in body composition as well as the difference in growth rate of wild and farmed Cirrhinus mrigala. Twenty-one farmed and wild Cirrhinus mrigala in three (3) weight groups, such as W1 (250-500g), W2 (501-1000g) and W3 (1001-1500g) were taken from Satyana Road Fish Farm, Faisalabad and Trimu headworks Jhang Sadar, respectively. Each of the fish was fed on three types of treatments T1 (25% CP or 250g protein in 1kg) T2 (30% CP 300g in 1kg) and T3(35% CP 350g in 1kg) according to weight categories. At the end of the experimental trial, each fish was weighed individually (W1) and weighed after dressing loss (W2). Micro Kjeldahl method was used to determine the protein percentage and Crude fat was determined by using ether extract extraction method in the Soxhlet system. Total ash percentage was calculated by burning the sample in the muffle furnace. To determine the moisture contents, one gram of the samples of fish organs was placed in weighed Petri dishes and was dried in the oven at 105Celsius for twelve hours. The samples were taken to vacuum desiccators for five minutes and weight was recorded continuing this drying practice. For one to two hours the samples were again kept in oven until they achieve their invariable weight. Data was subjected to statistical analysis. Analysis of variance was performed to compare means.
Maternal and Fetal outcomes in Premature Rupture of Membranes
Objective: This study aimed to evaluate the maternal and fetal outcomes associated with term premature rupture of membranes (PROM), with a focus on identifying clinical and laboratory factors that contribute to adverse outcomes. The goal was to determine the impact of PROM-to-delivery interval, infection markers, and delivery mode on neonatal and maternal complications. Methodology: This descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, over six months (November 02, 2023 to May 01, 2024). A total of 50 women with confirmed term PROM were enrolled using non-probability purposive sampling. The Inclusion criteria were singleton pregnancies at ≥37 weeks of gestation with spontaneous rupture of membranes before the onset of labor. Exclusion criteria included multiple gestation, known fetal anomalies, and preterm PROM. Data was collected using a structured proforma and analyzed using SPSS. Descriptive and inferential statistics were used to explore trends and test associations between variables, with p<0.05 considered statistically significant. Results: The mean age of participants was 28.36 ± 4.59 years, with most being multigravida. The average gestational age was 38.86 weeks. Spontaneous vaginal delivery occurred in 76% of cases, while cesarean section was performed in 24%, primarily due to fetal distress. A prolonged PROM-to-delivery interval (>18 hours) was significantly associated with maternal complications, including chorioamnionitis (30%) and postpartum endometritis (48%) (p<0.05), as well as neonatal sepsis (64%) and stillbirth (22%). CRP positivity (26%) and leukocytosis (36%) were strong predictors of infectious morbidity. Discolored liquor was significantly associated with fetal distress and NICU admissions. Statistical analysis revealed PROM duration, positive inflammatory markers, and abnormal liquor as significant predictors of adverse outcomes (p<0.05). Conclusion: PROM, even at term, presents a substantial risk for maternal and neonatal morbidity when not managed promptly. The findings underscore the importance of early hospital presentation, timely induction of labor, and routine screening for infection using CRP and leukocyte count. Public health initiatives should focus on educating pregnant women about the signs and risks of PROM. Institutional protocols must be strengthened to standardize the management of PROM, particularly in low-resource settings. Further multi-center research with larger sample sizes is needed to explore microbiological factors, optimize intervention timing, and reduce preventable maternal and neonatal complications.
A Comparison of Effectiveness of Dry Needling and Cross-Fiber Massage on Pain and Functional Mobility in Individuals with Chronic Lateral Epicondylitis
Background: Lateral epicondylitis (LE), or tennis elbow, is a prevalent musculoskeletal condition characterized by lateral elbow pain and reduced function; primarily affecting adults aged 40–59. Although various conservative treatments exist, including dry needling (DN) and cross-fiber massage (CFM), limited evidence directly compares their effectiveness in chronic LE. Objective: To compare the effectiveness of DN and CFM on pain intensity, functional disability, and grip strength in individuals with chronic LE. Methods: A single-blind randomized clinical trial was conducted involving 60 participants aged 30–60 years diagnosed with chronic LE. Participants were randomly assigned to DN (n=30) or CFM (n=30) groups. Interventions were administered twice weekly for four weeks. Pain, disability, and grip strength were assessed using the Visual Analog Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and a handheld dynamometer, respectively, at baseline and post-intervention. Results: Both groups showed significant within-group improvements in VAS, PRTEE, and grip strength scores (p<0.05). Between-group comparison revealed that the CFM group had significantly lower post-treatment VAS scores (p=0.007), while no statistically significant differences were observed between groups for PRTEE (p=0.55) or grip strength (p=0.819). Conclusion: Both DN and CFM are effective in managing chronic LE. However, CFM provided superior pain reduction, likely due to its mechanical effects on fibrotic tendon tissue. Clinicians should consider patient-specific factors when selecting between these interventions. Further studies with long-term follow-up and imaging-based evaluation are recommended.
Assessing Quality of Life in Thalassemia Patients and their Caregivers in Larkana: A Cross-sectional Study
This study assesses the health-related quality of life (HRQoL) among transfusion-dependent thalassemia patients and their caregivers in Larkana, Sindh, Pakistan, a region with limited healthcare infrastructure. Conducted between December 2024 and May 2025 at the Fatimid Foundation Center, the cross-sectional study involved 57 patients aged 8 years and older and their primary caregivers. Using the validated TranQoL questionnaire, data were collected on physical health, emotional well-being, family support, and school functioning for patients, and additional domains like financial strain for caregivers. Results showed patients had a mean QoL Summary Score of 50.29 (SD=15.44), higher than caregivers’ 35.03 (SD=16.88), indicating a greater burden on caregivers, particularly in emotional and physical health domains. Urban children reported significantly better family health (mean=55.33) than rural children (mean=45.33, p=0.010), highlighting resource disparities. No significant gender differences were found in physical (t=-0.254, p=0.801) or emotional health (t=-0.936, p=0.882) for children. A positive correlation existed between children’s physical and emotional health (r=0.464, p<0.01). Caregivers’ low scores underscore chronic stress and potential depression, exacerbated by socio-economic challenges and caregiving demands. The study highlights the need for integrated interventions addressing medical, psychological, and social needs, particularly in under-resourced settings like Larkana. Limitations include a small sample size and lack of clinical indicators like hemoglobin levels. These findings contribute to understanding thalassemia’s multidimensional impact, advocating for targeted support to improve QoL for patients and caregivers.
Use of Different Agrochemicals and Neem Oil to Control Whitefly (Bemisia tabaci) in Cotton Under Different Field Conditions
Cotton, the white gold, is an important fiber crop that is grown as a commercial crop all over the world. Among the several factors contributing to the low yield of cotton, biotic constraints appear to be very important that are ravages caused by insect pests assume greater importance. Sucking the cell sap caused by whitefly gives a great reaction, which transfers viral diseases to the cotton after secreting the honeydew. For this, a trial was conducted Ayub Agricultural Research Institute (AARI) and a local farmer’s field during 2023-2024 cotton season to check the efficacy of different insecticides against the critical cotton insect pest, whitefly (Bemisia tabaci). In this study, Dufire 70% WDG, Crunch Super 75% WDG, Ulala 50%, Oshin 20% SG, and neem oil were applied in the cotton field and the data of the whitefly population were recorded the day after application, 72 hrs., and 7 days after application of insecticides. The data was taken accordingly, and it was seen that each insecticide significantly reduced the population to a certain level, but Oshin and Ulala proved to be the best chemicals to decrease the whitefly population in field conditions. The population of whitefly in treated areas of Ayub Agricultural Research Institute was always maximum in control conditions after the pesticides were applied and the least value was observed in neem oil and control-treated plots.
The Role of Smart Pharmacy Automation in Improving Medication Safety: A Systematic Review
Background: Medication errors pose significant risks to patient safety, contributing to 5–6% of hospital admissions globally. Traditional pharmacy systems, reliant on manual processes, are prone to errors due to human factors, inefficient workflows, and inadequate technology integration. Smart Pharmacy Automation Systems (SPAS), leveraging IoT, AI, and cloud-based analytics, offer a transformative solution to mitigate these challenges. Objective: This systematic review evaluates the efficacy of SPAS in reducing medication errors, optimizing workflows, and enhancing patient safety by synthesizing evidence from 48 studies (2020–2025). Methods: Following PRISMA guidelines, PubMed and Google Scholar were searched for peer-reviewed studies on SPAS implementation. Inclusion criteria focused on IoT-enabled automation, error reduction, and integration with Electronic Health Records (EHRs). Quality assessment was conducted using PRISMA standards. Results: SPAS demonstrated significant improvements: (1) Error Reduction: Automated dispensing reduced prescription errors by 42.2% and eliminated dispensing errors; (2) Efficiency: Real-time IoT monitoring cut medication expiration rates by ≤0.3% and audit times by 50%; (3) Safety: Integration with EHRs minimized dosing errors and adverse drug interactions. Challenges included interoperability gaps (23% of studies) and cybersecurity risks (18%). Conclusion: SPAS enhances medication safety and operational efficiency but requires standardized protocols, staff training, and robust cybersecurity measures. Future research should address cost-benefit analyses and scalability in low-resource settings.
Association Between Gut Microbiota Composition and Statin Responsiveness in Hyperlipidemic Patients: A Meta-Analysis
Background: Statin therapy remains a cornerstone in the management of hyperlipidemia and prevention of cardiovascular events. However, interindividual variability in statin response poses a major clinical challenge. Emerging evidence suggests that the gut microbiota may influence lipid-lowering efficacy by modulating drug metabolism, bile acid composition, and systemic lipid pathways. This meta-analysis aims to evaluate the association between gut microbiota composition and responsiveness to statin therapy among hyperlipidemic patients. Methods: A systematic search of PubMed, Scopus, Embase, and Cochrane CENTRAL databases was conducted through May 2019. Studies were included if they assessed lipid outcomes (LDL-C, total cholesterol, HDL-C, triglycerides) in statin-treated patients, with or without gut microbiota analysis. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Risk of bias was assessed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Publication bias was evaluated via funnel plot inspection. Results: Three studies (n = 884 participants) met the inclusion criteria. Pooled analysis showed that rosuvastatin significantly reduced LDL-C (SMD = -0.62; 95% CI: -1.00, -0.23; p = 0.002) and total cholesterol (SMD = -0.36; 95% CI: -0.60, -0.13; p = 0.003) compared to control groups. No significant differences were observed in HDL-C or triglyceride levels. One included study demonstrated that statin responders had distinct gut microbiota profiles, including reduced alpha diversity and increased abundance of Blautia species. Conclusion: This meta-analysis supports the superior lipid-lowering efficacy of rosuvastatin and highlights the potential role of gut microbiota in modulating statin response. Integration of microbiome profiling into lipid management strategies may advance personalized therapy for hyperlipidemia. Further large-scale studies are needed to validate these findings and explore microbiota-targeted interventions.
A Review on Pharmaceutical Jelly Formulations: New Frontier in Oral Drug Delivery
Pharmaceutical jelly-based formulations represent a novel, emerging and patient-friendly approach in oral and mucosal drug delivery, contributing a palatable, semi-solid alternative to traditional tablets and capsules. Particularly advantageous for patient populations experiencing dysphagia, including pediatric and geriatric populations. Functioning at the intersection of liquid and solid dosage forms, these semi-solid systems facilitate enhanced palatability, ease of administration, and improved physicochemical stability of active pharmaceutical ingredients. This review critically explained the enriching research studies of jelly formulations, offering a systematic classification based on administration routes, therapeutic objectives, and compositional attributes. It further elucidates formulation strategies, excipient rationalization, and recent technological advancements supporting the development of fast-dissolving, sustained-release, and nutraceutical variants. Regulatory developments, formulation challenges, and emerging trends such as precision dosing and stimuli-responsive jellies are also addressed. Despite certain physicochemical properties and storage constraints, jelly systems exhibit considerable promise in improving medication adherence and optimizing therapeutic performance in contemporary pharmaceutics. Future directions indicate the development of advanced delivery systems utilizing nanotechnology, mucoadhesive polymers, and personalized medicine approaches. With increasing regulatory interest and market expansion, jelly formulations are poised to become a vital component of modern drug delivery systems.
Adherence to Protocols for Pleural Fluid Aspiration (Thoracentesis): An Audit Report
Background: Thoracentesis is a routinely performed diagnostic and therapeutic procedure for pleural effusions. Adherence to standardized procedural protocols is essential to minimize complications, ensure diagnostic accuracy, and optimize patient outcomes. However, compliance with established guidelines is often suboptimal in busy clinical settings, particularly in low-resource environments. Objective: This audit aimed to evaluate the adherence of healthcare professionals to standard thoracentesis protocols in the Pulmonology Department of Gujranwala Medical College Teaching Hospital and to assess the impact of an educational intervention on improving compliance. Methods: A prospective clinical audit was conducted over a one-week period in April 2024. A total of 30 thoracentesis procedures performed by post-graduate residents and house officers were observed using a structured proforma based on British Thoracic Society and Whittington Health NHS guidelines. Parameters assessed included clotting profile documentation, informed consent, aseptic measures, imaging guidance, correct technique, and post-procedural monitoring. Following the initial audit, a departmental educational intervention was implemented. A re-audit was conducted two weeks later using the same methodology. Results: The initial audit revealed that only 74.9% of procedures met the required standards. Key areas of non-compliance included documentation of clotting profiles and post-procedural chest X-rays. After the intervention, adherence improved to 86.3%, with notable gains in aseptic technique, proper needle selection, and informed consent. Conclusion: The audit demonstrates that protocol adherence in thoracentesis can be significantly improved through structured feedback and targeted educational interventions. Regular clinical audits and reinforcement of procedural standards are vital for enhancing patient safety and maintaining high-quality care.