Pakistan Journal of Medical & Cardiological Review
The Pakistan Journal of Medical & Cardiological Review (ISSN-P3007-2379 ,ISSN-E 3007-2387) is a peer-reviewed, open-access medical journal dedicated to the advancement of health sciences and clinical practice. It serves as a platform for the dissemination of high-quality, evidence-based research, clinical innovations, and expert commentary across all areas of medicine. The journal publishes original research articles, systematic reviews, meta-analyses, case reports, and editorials that contribute to improving patient care, public health, and medical education. Committed to scientific rigor, ethical standards, and global accessibility, the Pakistan Journal of Medical & Cardiological Review welcomes submissions from researchers, clinicians, and healthcare professionals worldwide. The journal aims to bridge the gap between research and practice by promoting interdisciplinary dialogue and fostering collaboration among professionals from diverse healthcare backgrounds.
Forum for Education, Knowledge and Reform (FEKR)
ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT VENTRICULAR EJECTION FRACTION IN HYPERTENSIVE AND DIABETIC PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY
Background: Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease and frequently lead to left ventricular hypertrophy (LVH). Persistent pressure overload and metabolic abnormalities may impair left ventricular systolic function, making assessment of left ventricular ejection fraction (LVEF) essential for early detection of cardiac dysfunction. Echocardiography is the preferred non-invasive modality for evaluating LVEF and LVH in these patients. Objective: To assess left ventricular ejection fraction using echocardiography in hypertensive and diabetic patients with left ventricular hypertrophy and determine its association with demographic and clinical characteristics. Methods: A retrospective cross-sectional analytical study was conducted at Rehman Medical Institute (RMI), Peshawar, over a period of six months. A total of 90 adult patients with hypertension, type 2 diabetes mellitus, and echocardiographically confirmed LVH were included using consecutive sampling. Demographic and clinical data were obtained from hospital records. Transthoracic echocardiography was used to evaluate LVEF and classify LVH. Data were analyzed using SPSS version 26. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Chi-square test, independent t-test, and ANOVA were used where appropriate, with a p-value <0.05 considered statistically significant. Results: The mean age of participants was 59.01 ± 14.12 years, and 51.1% were male. Hypertension was present in 85.6% of patients, while 91.1% had diabetes mellitus. Concentric hypertrophy was the most common LVH pattern (45.6%), followed by eccentric hypertrophy (30.0%) and concentric remodeling (24.4%). Mildly impaired LVEF was the most frequent finding (31.1%). A statistically significant association was observed between hypertension and LVEF (χ² = 14.145, p = 0.003). However, no significant associations were found between LVEF and diabetes mellitus (p = 0.614), LVH type (p = 0.550), gender (p = 0.085), or age (p = 0.194). Conclusion: Hypertension was significantly associated with reduced left ventricular ejection fraction in patients with left ventricular hypertrophy, whereas diabetes mellitus, age, gender, and LVH geometry showed no significant association. Routine echocardiographic assessment of LVEF in hypertensive patients with LVH may facilitate early detection of systolic dysfunction and improve clinical management. Keywords: Left ventricular ejection fraction, echocardiography, hypertension, diabetes mellitus, left ventricular hypertrophy, systolic function.
Copyright (c) 2026 Ajmal Khan, Muhammad Farooq Shah, Badeegha Jamal, Muhammad Waqas , Adnan Khadim, Dr. Laiba Ajmal* (Author)
IMPACT OF FENTANYL ON HOSPITAL STAY IN PATIENTS UNDERGOING CARDIAC SURGERY AT REHMAN MEDICAL INSTITUE (RMI), PESHAWAR
Background: Perioperative and postoperative pain management in cardiac surgery is an application of fentanyl that is commonly used due to its fast onset of action, potent effect for pain, and cardiovascular stability. Although it has therapeutic benefits, it can also cause side effects including respiratory depression, drowsiness, nausea, vomiting and delirium, all of which can delay recovery and early mobility. These issues in patients undergoing cardiac surgery can lead to a longer time spent on mechanical ventilation, longer time spent in the intensive care unit and more time spent in the hospital. Objectives: The impact of Fentanyl on Post-Operative Recovery time and discharge. To Identify the influence of patients Characteristics (age, gender, comorbidities) on Fentanyl requirement and hospital stay. Materials and Methods: Prospective observational research was carried out over a four-month period at Rehman Medical Institute in Peshawar. The 143 adult patients with heart surgery and peri-operative fentanyl were selected using non-probability purposive sampling. After obtaining ethical approval and institutional permission, data was collected by using a standardized questionnaire and analyzed with SPSS and presented by tables, percentages and graphs. Results: The number of heart surgery patients was 143 and the male patients accounted for 59.4% of the sample. The majority of patients were ASA III (80.4%) and CABG was the most prevalent procedure (53.8%). Hypertension (31.5%) and diabetes (23.1%) were the most common comorbidities. Fentanyl was utilized in 99.3% of patients, all through the intravenous method, with 49.7% getting it for one day. ICU stay was mainly one day (46.9%) or not required (42.7%) with a majority of hospital stay being four days (49.0%). Postoperative complications occurred in many patients, such as nausea/vomiting (30.8%) and respiratory depression (30.1%); however, the majority of patients (88.1%) were discharged in stable condition. Conclusion: Use of fentanyl was common in heart surgery and was generally effective in producing a more stable postoperative period with short ICU and hospital stay, and that postoperative problems were still prevalent. Keywords: Fentanyl, Cardiac surgery, Hospital stay, ICU stay, Postoperative complications, Respiratory depression, Analgesia, ASA classification, Perioperative care, Length of stay.
Copyright (c) 2026 Muhammad Kashif , Ihtisham Ul Haq , Javeria Usman , Quaid Latif , Afrasiyab , Asfand Yar* (Author)
FREQUENCY, SEVERITY, AND RISK FACTORS OF CONTRAST-INDUCED ADVERSE REACTIONS AMONG PATIENTS UNDERGOING CONTRAST-ENHANCED CT EXAMINATIONS AT THE RADIOLOGY DEPARTMENT, LADY READING HOSPITAL, PESHAWAR
Background: Contrast-enhanced computed tomography (CT) is widely used for diagnosis and disease evaluation. Although modern non-ionic iodinated contrast media are considered relatively safe, adverse reactions may occasionally occur, ranging from mild symptoms to rare, severe, life-threatening events.To determine the frequency, severity, clinical pattern, and associated risk factors of contrast-induced adverse reactions among patients undergoing contrast-enhanced CT at the Radiology Department, Lady Reading Hospital, Peshawar. Methods: A hospital-based descriptive cross-sectional study was conducted on 1,000 consecutive patients undergoing contrast-enhanced CT, enrolled by non-probability consecutive sampling. Data on demographics, examination type, contrast agent, comorbidities, allergy history, and reaction occurrence/severity were recorded on a structured proforma and analysed using SPSS. Results: The study population had a mean age of 62.4 ± 17.6 years (range 23–95 years); 566 (56.6%) were male and 434 (43.4%) female. Iohexol (256, 25.6%) and iopamidol (210, 21.0%) were the most frequently used agents. Comorbidities were present in 312 (31.2%) patients, most commonly hypertension (75, 7.5%) and diabetes mellitus (64, 6.4%). An adverse reaction occurred in 4 of 1,000 patients (0.4%; 95% CI 0.16–1.02%): 3 (0.3%) mild and 1 (0.1%) moderate, with no severe or fatal reactions. Reactions occurred within 1–8 minutes of injection, most commonly with iopamidol, and all resolved fully with observation and/or symptomatic treatment (antihistamines, corticosteroid, and intravenous fluids in the moderate case). Conclusion: Contrast-induced adverse reactions were uncommon (0.4%) in this cohort and were predominantly mild and self-limiting, consistent with international literature. These findings support the overall safety of non-ionic contrast media in local practice while underscoring the continued need for vigilant monitoring and emergency preparedness during contrast-enhanced CT. Keywords: Computed tomography; iodinated contrast media; adverse reactions; contrast-induced reactions; radiology; patient safety; Peshawar.
Copyright (c) 2026 Sawera Sahar, Hafsa Hayye, Masud Ul Haq, Sadiq Amin*, Inam Ullah (Author)
Assessment of Nalbuphine on Postoperative Extubation Time in Elective General Surgery Patients at Rehman Medical Institute
Background: Since delayed extubation could increase the risk of complications and limit operating room access for other patients, postoperative extubation time was considered a crucial indicator of recovery following general anesthesia. Opioids used for intraoperative analgesia were known to affect the recovery profiles of patients, including extubation time and respiratory function, and can cause pulmonary complications in the postoperative phase, which might need reintubation of those patients. Nalbuphine, a mixed opioid agonist-antagonist, provided effective analgesia with a potentially lower risk of respiratory depression compared to conventional opioids. However, its effect on postoperative extubation time in patients undergoing elective general surgery remained unclear. Therefore, this study was conducted to evaluate the effect of nalbuphine on extubation time, which is important for recovery. Objectives: To assess how much time general surgery patients will require for extubation without sacrificing patient safety in order to observe the effect of nalbuphine. Materials and Methods: This study was a prospective observational study, which was conducted over four months in the General OT of RMI. We used the convenience sampling technique to recruit 160 patients of adult age who were scheduled for elective surgery. A tested datasheet was used to assess patients’ responses to the Nalbuphine drug, extubation time, and any complications related to our concern about the opioid. We were using SPSS 2025 for statistical analysis of data and OpenEpi to calculate the sample size. Results: The mean extubation time was 8.13 minutes (SD ± 2.86). Eighty percent of patients achieved smooth extubation. Chi-square analysis showed no statistically significant association between demographic or clinical variables and extubation response or side effects. Sex, age group, and ASA physical status were not significantly associated with extubation response or side effects (p > 0.05 for all comparisons). Additionally, no significant relationship was observed between sex and ASA status (χ² = 0.673, p = .412). These findings indicate that extubation outcomes and adverse effects were comparable across all patient groups. Conclusion: Nalbuphine is an effective and safe agent for attenuating the extubation response in general surgery patients. Its dose-dependent effect on emergence timing and favourable safety profile support its routine perioperative use. Keywords: General anesthesia, Extubation time, delayed extubation, Postoperative pulmonary complications (PPCs), Opioid-induced repiratory depression, Nalbuphine Recovery profile.
Copyright (c) 2026 Muhammad Kashif, Aleeza Arooj, Muneeb Akhtar, Shayan Amir, Iqra Khan* (Author)
ESTIMATION OF TOTAL SALT CONSUMPTION FROM DIETARY SODIUM INTAKE AND ITS ASSOCIATION WITH BLOOD PRESSURE AMONG ADULTS OF MARDAN
Background: Excessive dietary salt intake is a major modifiable risk factor for hypertension and cardiovascular disease, particularly in developing countries where dietary habits are changing rapidly. This study estimated total dietary salt intake from sodium consumption among adults of District Mardan and examined its association with blood pressure. Methods: In this cross-sectional study, data were collected from 200 adults aged 20–65 years using a 24-hour dietary recall and a food frequency questionnaire (FFQ). Anthropometric measurements and blood pressure were also recorded, and nutrient intake was analyzed using NutriSurvey software. Statistical analysis, including multivariate general linear modeling, was performed in SPSS version 20. Results: The mean dietary sodium intake was 2079 ± 685.94 mg/day, corresponding to an estimated salt intake of 4.91 ± 1.39 g/day; 55% of participants exceeded the WHO-recommended limit of 5 g/day. Nearly half of the respondents (46.0%) were classified as likely hypertensive. Salt intake was positively associated with systolic blood pressure (β = 0.74, p < 0.05), whereas potassium intake was inversely associated with both systolic and diastolic blood pressure. Likely-hypertensive individuals also showed higher body weight, BMI, waist circumference, and energy intake, alongside lower intake of fiber, potassium, calcium, magnesium, and vitamins D, B9, and B12. Age, gender, salt intake, and potassium intake emerged as significant independent predictors of blood pressure. Conclusion: Elevated blood pressure among adults of Mardan is driven largely by excessive salt intake and poor overall diet quality, underscoring the need for community-based salt-reduction and dietary-quality interventions. Keywords: Dietary salt; Sodium intake; Blood pressure; Hypertension; Sodium–potassium ratio; Mardan
Copyright (c) 2026 Uzma Gul, Maisam Ali, Nazaka Ali Shah, Humaira Jamal*, Saba Ali, Zia Ud Din (Author)
Targeted Nano-Encapsulated Ceftriaxone: Ligand–Receptor Interactions and Strategies to Overcome Efflux Pump-Mediated Resistance
The issue of antimicrobial resistance is a serious health problem on the international level, which makes traditional antibiotics like ceftriaxone less effective. The mechanisms that limit the accumulation of intracellular drugs and impair the therapeutic outcomes include efflux pumps, enzymatic degradation, and reduced membrane permeability. One of the promising solutions to these challenges involves nanotechnology-based drug delivery system, which entails encasing the antibiotics into nanoscale systems, which not only stabilizes the drug, but also prevents degradation of the drug, but also allows the controlled and targeted release. Nano-encapsulation enhances conditions of ligand-receptor of ceftriaxone and bacterial targets, elevating local drug concentration, improving binding of penicillin-binding proteins, and improving residence time in the vicinity of bacterial membrane. Nanocarriers also resolve the resistance due to efflux by circumventing the traditional recognition pathways, sustained release of drugs, and co-delivery of ceftriaxone and efflux pump inhibitors. All these measures further compound the intracellular accumulation of the antibiotics, which guarantees constant exposure and overloading of the bacterial defences. Surface plasmon resonance, isothermal titration calorimetry, and fluorescence spectroscopy are experimental biophysical methods that can offer important information regarding the binding dynamics and efficacy of nano-encapsulated antibiotics, whereas molecular docking and molecular dynamics simulations are the two computational methods that present vital information on the binding dynamics and efficacy of nano-encapsulated antibiotics. The quality and performance of formulations and drug release are guaranteed by the dynamic light scattering, transmission electron microscopy and drug release analysis characterization of nanoparticles. Keywords: Nanoparticles, Antibiotic resistance, Efflux Pump.
Copyright (c) 2026 Zoha Ghazanfar, Eeman Fatima*, Abu Sulman, Muhammad Yawar Saeed, Mudassar Majid, Romaan Fatima, Rafay Munir, Waleed Feyyaz, Muhammad Ali, Muhammad Qasim, Muhammad Saad Naeem* (Author)
Computational Modeling and Optimization of Lipase Production by Bacillus Species: An In Silico Study
Microbial lipases are among the most industrially versatile biocatalysts, with extensive applications in detergent formulation, food processing, and biodiesel synthesis, and members of the genus Bacillus are among their most widely studied bacterial producers. This study presents a literature-derived, fully reproducible computational analysis of Bacilluslipase production, constructed entirely from peer-reviewed experimental data compiled from five independent published studies spanning four species/strains (Bacillus subtilis TTP-06 and NS8, Bacillus aryabhattai SE3-PB, Bacillus amyloliquefaciens, and Bacillus holotolerans VSH09). A structured dataset of 21 data points was assembled across six physicochemical variables — temperature, pH, incubation time, carbon-source concentration, nitrogen-source concentration, and agitation speed — with unreported values retained explicitly as "Not Reported" rather than estimated or imputed. Correlation analysis across the pooled dataset identified agitation speed (r = 0.573, p = 0.013) and pH (r = 0.518, p = 0.023) as the strongest determinants of reported lipase activity, while Principal Component Analysis revealed that the dataset's structure was heavily shaped by a single dominant source study. Within the only subset supporting full multivariate modeling (n = 15, from a Box–Behnken design), Multiple Linear Regression, Response Surface Methodology, Random Forest Regression, Support Vector Regression, and an Artificial Neural Network were compared under leave-one-out cross-validation; Random Forest achieved the best performance (R² = 0.261, RMSE = 3.554 U/mL), while quadratic Response Surface Methodology identified a statistically significant, concave carbon-source effect and an optimum of 2.74% molasses and 1.40% peptone, yielding 27.86 U/mL. These findings support carbon-source concentration as a priority optimization target for Bacillus lipase production while highlighting the current scarcity of harmonized, multi-variable literature data needed for broadly generalizable computational optimization models.
Bacillus; Lipase Production; Response Surface Methodology; Machine Learning; Artificial Neural Network; Random Forest Regression; Bioprocess Optimization; In Silico Modeling.
Copyright (c) 2026 Kaynaat Akbar, Muhammad Yaqoob , Sadaf Naz , Muhammad Khurram (Author)
Frequency Of Staphylococcus Aureus In Wound Infections Among Patients In District Okara
A study to investigate the frequency of Staphylococcus aureus in Okara conducted at the Central laboratory of Mayo Hospital. The information provided here includes both their age, gender and their antibiotic resistance, and the most ideal Medicine for individuals around Okara. As such: Research objective, to investigate the Frequency of Staphylococcus aureus among wound infected cases in District Okara, Punjab, Pakistan. This was a retrospective cross sectional study that used a total of 50 cases conducted at a prestigious institute between January 2026 and April 2026. Samples taken are wound swab and pus in normal saline from cases and put in tube & then moved to laboratory, all taken under aseptic conditions and the isolation is confirmed onthe bases of culture and biochemical test and antibiotic susceptibilities were tested by standard criteria disc diffusion and also results confirmed by CLSI (2019),results taken through SPSS 20.16. Total results is about; Staphylococcus aureus infection occurs among, the thirty two cases of which about 32% out of the 50 have this result indicating Staphylococcus aureus to be present in the patient to a total population of 64% in the entire study about wound infected infection at District Okara. Patients aged younger are infected more than others and that age at risk seems like, so with regards to gender there was greater number of people suffering in to make a decision of the antibiotic and it turned out to be Vancomycin in this study for thirty two (32) out of the fifty (50) in each case but there was more male individuals with infection than female and it was proved by this, The research that has come to close have come up with the finding that S.aureus can be held a cause to prevalent for many injuries among locals in Okara.
Staphylococcus aureus , frequency , wound samples , infection
Copyright (c) 2026 Unaiza Maryam, Ali Mudassar, Mahnoor, Iram Shahzadi, Qandeel Fatima, Ayesha, Ayesha Ghulam Nabi, Muskan Sehar (Author)
The effect of preoperative anxiety on post-operative pain in patients undergoing elective surgery
Objective: To evaluate the effect of preoperative anxiety on postoperative pain scores, and postoperative analgesic requirements in adult surgical patients. Methods: This prospective cohort study included 370 patients undergoing elective surgery, equally divided into low and high preoperative anxiety groups (n = 185 each) based on standardized anxiety assessment. Demographic characteristics, clinical variables, type of surgery, anesthesia technique, intraoperative opioid consumption, duration of surgery, postoperative Numerical Rating Scale (NRS) pain scores at 2, 4, 6, 12, and 24 hours, and total 24-hour postoperative tramadol consumption were recorded. Comparisons between groups were performed using independent t-tests and chi-square tests, with p < 0.05 considered statistically significant. Results: The mean age was comparable between the low and high anxiety groups (41.78 ± 9.48 vs 40.50 ± 9.40 years; p = 0.191), with no significant differences in gender distribution or educational status. A significantly higher proportion of rural patients (p = 0.048) and ASA III status (p = 0.042) was observed in the high anxiety group. General anesthesia was used more frequently in patients with high anxiety (67.0% vs 56.8%; p = 0.042). Mean intraoperative opioid consumption was significantly higher in the high anxiety group (105.71 ± 17.44 mg vs 95.79 ± 15.38 mg; p < 0.001). Postoperative NRS pain scores were significantly higher in the high anxiety group at all time points (2–24 h; all p < 0.001). Total 24-hour postoperative tramadol consumption was also significantly greater in patients with high preoperative anxiety (159.86 ± 15.88 mg vs 135.04 ± 23.44 mg; p < 0.001). Conclusion: High preoperative anxiety is associated with increased intraoperative opioid use, higher postoperative pain scores, and greater postoperative analgesic requirements. Routine assessment and management of preoperative anxiety may improve postoperative pain outcomes and optimize perioperative analgesic strategies.
Preoperative anxiety; postoperative pain; opioid consumption; tramadol; numerical rating scale; anesthesia
Copyright (c) 2025 Wajeeha, Fahd Mudassar Hameed , Anas Nadeem Khan , Abdul Rafeh, Azwa Ali (Author)
Effectiveness of vitamin E and Primrose oil versus NSAIDS for treatment of cyclical mastalgia
Objective: This study aimed to evaluate the effectiveness and safety of vitamin E combined with Primrose oil versus NSAIDs in the treatment of cyclical mastalgia. Methods: A prospective,cohort study was done in Department of General surgery, PAF Hospital, Islamabad, on 130 patients with a diagnosis of cyclical mastalgia. Patients were allocated into Group A (vitamin E + Primrose oil, n=65) or Group B (NSAIDs, n=65). Demographic and clinical data (age, BMI, the severity of pains, the type of pain) were identified as the baseline data. The interventions were done in three menstrual cycles. The severity of pain was measured by Visual Analogue Scale (VAS) at baseline, 1 month and 3 months. The secondary outcomes were the overall clinical response and adverse events. Results: The mean age was 40.4 ± 5.8 years in Group A and 38.5 ± 6.2 years in Group B (p=0.356). BMI was comparable between groups (28.4 vs 27.9, p=0.424), although obesity (BMI ≥30) was higher in Group A (35.4% vs 12.3%, p=0.002). Most patients experienced diffuse pain (81.5% vs 80%), with no significant difference in pain laterality (p=0.211). Pain scores decreased in both groups over three months. Baseline VAS scores were 5.7 vs 5.3 (p=0.267). At 3 months, Group A had slightly lower pain scores than Group B (3.5 vs 4.2, p=0.046). Overall clinical response was similar at study end (3.4 vs 3.3, p=0.785). Adverse events were mild and comparable between groups. Conclusion: Vitamin E + Primrose oil is equal to NSAIDs in decreasing pain related to cyclical mastalgia and with the same safety profile. These results justify its use as a safe substitute in a long-term management of cyclical mastalgia.
Cyclical mastalgia, Vitamin E, Evening primrose oil, NSAIDs, Pain management, cohort study
Copyright (c) 2025 Wajeeha, Fahd Mudassar Hameed , Anas Nadeem Khan , Abdul Rafeh , Azwa Ali , Muhammad Hamza (Author)
Ultrasound-Based Assessment of Placental Characteristics and Fetal Well-Being in Second and Third Trimester Pregnancies: A Hospital-Based Cross-Sectional Study in Faisalabad
Background: Ultrasonography is a vital non-invasive imaging modality for assessing the placental morphology and fetal well-being during the period of pregnancy. Sonographic assessment of placental location, placental maturity, placental grade, amniotic fluid, fetal growth, fetal presentation and fetal cardiac activity provide important information for identifying pregnancy requiring closer antenatal surveillance. This research observed the sonographic characteristics of the placenta and selected fetal well-being indicators among pregnant females attending a tertiary-care hospital in Faisalabad. Objective: The present study aims at describing the sonographic characteristics of the placenta and assess selected maternal and fetal parameters among women in the second and third trimesters of pregnancy. Methodology: The study employed an observational cross-sectional method at Madinah Teaching Hospital, Faisalabad over a period of four months. A sample of 80 pregnant women was selected using convenient sampling technique and women in the second and third trimesters were included whereas multiple pregnancies and women with previous pregnancy complications were excluded from the study. A standardized data collection proforma and obstetric ultrasonography were used for data collection. Moreover, placental location, placental grade according to the Grannum classification, placental maturity according to gestational age, amniotic fluid index (AFI), fetal growth pattern, fetal presentation and fetal heart activities were recorded. The collected information was analyzed on SPSS version 26.0 through descriptive statistics and chi-square test. Results: 60.0% respondents age group was 21–30 years and multigravida women constituted 60.0% of the sample whereas 40.0% respondents were primigravida. 76.3 % participants reported regular antenatal care. Anterior placentation was the most frequent placental location as reported by 33.8% respondents which were followed by posterior and fundal locations 30.0% each. Moreover, the Grade I placenta was frequently observed sonographic grade as reported by 36.3% respondents. 90.0% women reported Placental maturity as appropriate for gestational age while Normal AFI was observed in 90.0% pregnancies. The Fetal growth was appropriate for gestational age in 86.3%pregnancies while Cephalic presentation was observed in 77.5% cases. Normal fetal heart activity was documented in 93.8%. Hypertension was the most frequently reported pregnancy-related complication 40.0% followed by gestational diabetes 26.3% and anemia 15.0%. Conclusion: The study highlighted predominantly normal sonographic placental and fetal findings among inspected second and third-trimester pregnancies. Grade I placenta and maturity appropriate for gestational age were the most common placental findings while most fetuses reported normal growth, AFI, presentation and cardiac activity. Moreover, the hypertension, gestational diabetes, premature placental maturation, oligohydramnios, small-for-gestational-age growth and abnormal fetal cardiac activity were explored in a proportion of participants despite these generally favorable findings. Therefore, routine obstetric ultrasonography may contribute early identification and monitoring of pregnancies demanding increased clinical attention.
obstetric ultrasonography; placental maturity; fetal well-being; amniotic fluid index; fetal growth; Faisalabad; pregnancy
Copyright (c) 2026 Iqra Abdul Razzaq , Aliza Zulfiqar , Zoha Abbas , Noor ul Huda , Ayesha Wali , Uswa Jamil , Fatima Azhar , Maleeka Iftikhar (Author)
Prevalence of Goiter and Household Salt Iodine Status Among Women in Tehsil Katlang, District Mardan, Pakistan: A Community-Based Cross-Sectional Study
Background: Iodine deficiency disorders (IDDs), of which goiter is the most common manifestation, remain an important public health problem in Pakistan, particularly among women.To determine the prevalence of goiter among women of Tehsil Katlang, District Mardan, and to assess the iodine status of salt at the household level. Methods: A community-based cross-sectional study was conducted from February to April 2022 among 200 women in Tehsil Katlang using a pre-tested structured questionnaire. Goiter was assessed by physical examination performed by a trained observer, and household salt samples were tested for iodine content using a rapid spot-testing kit. Data were entered and analyzed in Microsoft Excel to generate frequencies and percentages. Results: Visible goiter was identified in 18 women (9%), of whom 8 (4%) had a positive family history of goiter and only 33 (16.5%) had adequate knowledge of goiter prevention. A higher proportion of respondents (n=127, 63.5%) consumed goitrogenic foods. Uneducated respondents (n=142, 71%) lacked information about iodized salt, and 145 (72.5%) could not differentiate iodized from non-iodized salt. Salt was left uncovered in 105 households (52.5%), and 144 salt samples (72%) tested negative for iodine. Conclusion: Goiter and inadequate household salt iodization are prevalent among women in Tehsil Katlang and are strongly associated with poor awareness, goitrogenic food consumption, and improper salt storage practices. Community-level education and stricter regulation of salt iodization are recommended. Keywords: Goiter; Iodine deficiency; Iodine deficiency disorders; Goitrogenic foods; Salt iodization; Rapid testing kit
Copyright (c) 2026 Humaira Jamal, Maisam Ali*, Uzma Gul, Inam Ullah, Sharif Ullah (Author)
Prevalence, Antimicrobial Resistance Profiles, and Virulence Determinants of Staphylococcus aureus Isolated from Hospitalized Patients
Background: Staphylococcus aureus is an important bacterial pathogen associated with both community- and healthcare-associated infections. The increasing occurrence of methicillin-resistant S. aureus (MRSA), multidrug resistance, and virulence-associated determinants creates substantial challenges for antimicrobial therapy and infection-control programs. Conventional prevalence estimates provide point estimates but may not adequately represent uncertainty associated with heterogeneous hospital populations and variable resistance and virulence patterns. Objective: This study aimed to develop a Monte Carlo simulation model to estimate the prevalence of S. aureus, predict the proportion of MRSA, characterize antimicrobial resistance profiles, estimate multidrug resistance, and model the distribution of selected virulence determinants among hospitalized patients. Methods: A literature-informed probabilistic Monte Carlo model was developed for a hypothetical cohort of 500 hospitalized patients. Beta distributions were assigned to uncertain prevalence and resistance parameters, and 100,000 simulation iterations were performed. The model incorporated S. aureus prevalence, MRSA/MSSA classification, antimicrobial resistance, multidrug resistance, and selected resistance and virulence determinants, including mecA, mecC, pvl, hla, icaA, fnbA, sea, and tst. Results: The simulation estimated an overall S. aureus prevalence of 30.8%, corresponding to approximately 154 isolates per 500 hospitalized patients. MRSA represented 51.3% of simulated S. aureus isolates. Penicillin showed the highest modeled resistance, whereas vancomycin and linezolid showed comparatively low resistance. Approximately 49.7% of simulated S. aureus isolates were classified as multidrug resistant, with a higher proportion among MRSA. Among the modeled virulence determinants, hla and icaA showed relatively high frequencies, whereas mecC and tst were less frequent. Conclusion: The Monte Carlo model predicted a substantial burden of S. aureus, MRSA, antimicrobial resistance, multidrug resistance, and virulence-associated determinants among hospitalized patients. Probabilistic simulation provides a useful framework for representing uncertainty in hospital microbiological surveillance. The numerical findings represent modeled predictions and should not be interpreted as observations from a laboratory-based clinical study.
Staphylococcus aureus; MRSA; antimicrobial resistance; virulence determinants; Monte Carlo simulation; multidrug resistance; hospitalized patients; predictive modeling
Copyright (c) 2026 Eman Farrukh, Laiba Amjad Malik, Moiza Noor, Aneesa Ajmal, Hina Ali Ahmed, Dr. Afroz Rais, Muhammad Abdullah Butt (Author)
Comparison Of Oral Vitamin C Supplementation Versus Control For Management Of Bronchopneumonia In Children Presenting In Allied Hospital Faisalabad
Background: Childhood pneumonia remains the major contributor of child mortality globally and bronchopneumonia is a major cause of morbidity and mortality during childhood in resource poor settings like Pakistan. It has been proposed that vitamin C a strong antioxidant and immune potentiating supplement may be beneficial and a cheap adjuvant to standard antibiotics and that it can decrease the severity and length of hospital stay in patients with bronchopneumonia. Objective: To evaluate the impact of oral Vitamin C supplementation in comparison with a control group in managing bronchopneumonia in children admitted at Allied Hospital Faisalabad in terms of mean hospital stay. Study design: Randomized Controlled Trial. Place and duration: Department of Paediatrics, Allied Hospital, Faisalabad, from September 2024 to January 2025. Methodology: Seventy-two children aged 2 months to 5 years with bronchopneumonia were included and randomized into two groups, each consisting of 36 patients. Group A received routine antibiotics along with oral Vitamin C while Group B received only routine antibiotics. Quantitative parameters i.e. Age, weight, respiratory rate, oxygen saturation, duration of symptoms and duration of stay in the hospital were compared using mean and standard deviation. P value of 0.05 was considered significant. Both male and female patients between 2 months to 5 years age group admitted to ward with a clinical diagnosis of bronchopneumonia supported by findings on X-Ray and laboratory investigations was enrolled and patients with Asthma/ reactive airway disease, Congenital heart diseases, Immuno- deficiency syndromes, cystic fibrosis, Moderate to Severe malnourished children, patients with Sepsis/Diarrhea, active Measles Virus Infection, Patients with vitamin/micronutrient supplementation or treated elsewhere had been excluded. Results: Mean age of participants was 29.89+16.74 months. There was statistically significant less hospital stay in the Vitamin C group as compared to control group (4.19+1.27 Vs 5.88+1.16 days, p<0.001).Male gender dominated the study with 59.7% and the radiological infiltrates were seen in 47.2% patients whereas crepitations were present in 50.0% patients. Fever resolution was statistically significant more rapid in Vitamin C group as compared to control group (1.8+0.7 Vs 2.9+1.1 days, p=0.002). Conclusion: Oral Vitamin C supplementation may significantly reduce the duration of hospitalization among children admitted for bronchopneumonia and can be considered as an effective adjunct to the routine antibiotic therapy for pediatric pneumonia.
Bronchopneumonia, Vitamin C, Children, Hospital stay, Pneumonia, Pediatric respiratory infection
Copyright (c) 2025 Muhammad Sajjad, Ali Asghar Taseer, Sumaira Hassan, Sadia Zafar, Sumbla Fayyaz (Author)
Nursing Students' Understanding of Neonatal Sepsis Early Warning Signs in Clinical Settings, Lahore
Neonatal sepsis remains a leading and largely preventable cause of neonatal mortality in low- and middle-income countries, and the early recognition of its warning signs is a core nursing competency upon which newborn survival frequently depends. This study examined nursing students' understanding of neonatal sepsis early warning signs in clinical settings in Lahore, Pakistan, and the pathways through which knowledge and observational competence translate into clinical action. Grounded in a positivist, quantitative paradigm and informed by Benner's Novice to Expert model, Kolb's Experiential Learning Theory, and Bandura's Social Cognitive Theory, a cross-sectional survey was conducted among 352 Post-RN and BSN nursing students undertaking clinical rotations at Jinnah Hospital and Gulab Devi Hospital. Data were collected using a structured, five-point Likert questionnaire measuring four constructs: Neonatal Sepsis Knowledge (NSK), Clinical Observation Skills (COS), Early Warning Recognition (EWR), and Clinical Response Behavior (CRB). Data were analysed in SPSS version 25 using descriptive statistics, Cronbach's alpha reliability analysis, Pearson correlation, linear regression, and mediation analysis using Hayes' PROCESS macro (Model 4) with 5,000 bootstrap samples. All scales demonstrated strong internal consistency (α = 0.879–0.934). Participants reported moderate-to-high scores across the four constructs, and all study variables were significantly and positively correlated. Regression analyses supported all direct hypotheses, while mediation analyses confirmed that Early Warning Recognition partially mediated both the NSK→CRB and COS→CRB pathways. The findings indicate that theoretical knowledge and observational skill are necessary but insufficient for competent clinical response unless operationalised through accurate recognition of sepsis warning signs. The study recommends the integration of dedicated neonatal sepsis modules, structured early warning scoring systems, and simulation-based experiential learning into nursing curricula in Lahore.
Copyright (c) 2026 Amtul Inayat, Muqaddas Tasneem*, Nazia Parveen, Muhammad Sufyan Ali (Author)
Immunochromatographic and Demographic Based Evaluation of Plasmodium Species in Reported Data to Various Clinical Setups in Distract Karak, Pakistan
Malaria is a serious public health problem, mainly in the ecological and socioeconomically determined regions. Presently, the area is affected by the occurrence of the disease, though the level of infection in specific tehsils and different age-distribution groups remains elusive. The current research aimed to determine the frequency of malaria-positive cases, identify the prevalent species of Plasmodium, and establish the correlation of infection with the tehsils, age, and sex in District Karak. The cross-sectional study was conducted in the tertiary care hospitals of Karak, Takht-e-Nasrati, and Banda Daud Shah, which are type-C Tehsil Headquarters. In total, 53,767 patient records were assessed, and rapid diagnostic tests for malaria were conducted using immunochromatographic analysis. The data were analyzed using R software, applying the descriptive statistical procedure. Out of 53,767 patients, 7,983 were diagnosed with malaria. The highest number of positive cases was reported in Tehsil Karak (4,442), followed by Banda Daud Shah (2,005) and Takht-e-Nasrati (1,536). Moreover, P. vivax was the prevalent species of Plasmodium in all three tehsils, whereas P. falciparum and mixed infections were rare. In addition, more positive cases were detected among the male population than among the female population. The majority of infected patients were aged 21–40, while those aged 61–70 was the least affected. Malaria causes a significant health burden in District Karak, with the highest number of cases reported in Tehsil Karak, whereas P. vivax is the prevalent malaria parasite species. Notably, people aged 21–40 years and the male population are at higher risk of malaria infection. Thus, it is essential to implement proper monitoring and surveillance mechanisms and provide timely treatment for patients. In addition, it is vital to organize the relevant health and administrative authorities to launch the appropriate malaria prevention and control strategies. Keywords: Malaria; Plasmodium vivax; Plasmodium falciparum; Rapid diagnostic test
Copyright (c) 2026 Muhammad Mustafa Khan, Kaleem Ullah*, Muhammad Haris (Author)
In Vitro Multi-Target Enzyme Inhibitory Potential of a Novel Trisamine Derivative against Acetylcholinesterase, Butyrylcholinesterase, Monoamine Oxidase-B and β-Secretase-1
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and multiple pathological mechanisms involving cholinergic dysfunction, oxidative stress, abnormal monoamine metabolism and amyloid-β accumulation. The development of multi-target-directed ligands capable of simultaneously modulating several disease-associated enzymes represents an attractive strategy in contemporary neuropharmacological research. The present study investigated the hypothetical in-vitro multi-target enzyme inhibitory potential of a novel trisamine derivative, designated SA-1, against acetylcholinesterase (AChE), butyrylcholinesterase (BChE), monoamine oxidase-B (MAO-B), and β-secretase-1 (BACE-1). The compound SA-1, previously characterized as a nitrogen-rich trisamine derivative with molecular formula C₂₄H₄₅N₇S₆ and molecular mass 624.03, was considered for enzyme-inhibition evaluation. Enzyme inhibition was expressed as percentage inhibition and IC₅₀ values. For research-planning purposes, hypothetical results suggested concentration-dependent inhibition against all four targets. SA-1 showed a stronger predicted inhibitory response toward MAO-B and AChE than toward BChE and BACE-1. The hypothetical IC₅₀ values were 18.42 ± 0.86 µM for AChE, 27.65 ± 1.12 µM for BChE, 12.74 ± 0.61 µM for MAO-B and 21.38 ± 0.94 µM for BACE-1. These illustrative findings suggest that trisamine scaffolds may provide a useful starting point for the development of multi-target neuroprotective agents. However, the presented numerical values are simulated for research and manuscript-development purposes and require experimental validation. Keywords: Trisamine derivative; SA-1; acetylcholinesterase; butyrylcholinesterase; MAO-B; BACE-1; Alzheimer’s disease; multi-target inhibitor.
Copyright (c) 2026 Sajjad Ahmad, Muhammad Ayaz, Aftab Ahmad Khan, Anam Saleem, Syed Hamza Lateef, Dr. Ashfaq Ahmad* (Author)
Investigating Increased Monocyte counts as A Biomarker In Pancreatic Cancer, Exploring Its Link To Tumor-Associated Inflammation
Background: Pancreatic cancer remains a highly lethal malignancy with a 5-year survival rate below 12%, driven by late diagnosis and intense desmoplasia. Chronic inflammation is a hallmark of pancreatic carcinogenesis, and circulating monocytes, precursors of tumour-associated macrophages, are key mediators of tumour-promoting inflammation. Their peripheral blood count may reflect tumour burden and inflammatory activity, yet its diagnostic value alongside established inflammatory markers is incompletely defined. Methodology: We analyzed venous blood samples from 25 pancreatic cancer patients, 25 patients with benign pancreatic disease, and 25 healthy controls. Absolute monocyte count was obtained via complete blood count; serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α) were measured as inflammatory indices. Comparisons, correlation analyses, and logistic regression were performed using SPSS v26. Results & findings: Mean monocyte count was significantly higher in pancreatic cancer patients (0.96 ± 0.14 × 10⁹/L) than in benign disease (0.69 ± 0.11 × 10⁹/L) and healthy controls (0.46 ± 0.08 × 10⁹/L) (p < 0.001). CRP, IL-6, and TNF-α were similarly elevated in the cancer group (p < 0.001). Monocyte counts correlated strongly with CRP (r = 0.73), IL-6 (r = 0.78), and TNF-α (r = 0.71) and rose with advancing tumour stage. In multivariable logistic regression, monocyte count independently predicted pancreatic cancer diagnosis (OR 4.82, p < 0.001). Conclusion: Peripheral blood monocyte counts are elevated in pancreatic cancer, closely linked to tumour-associated inflammation, and increase with disease severity. As an inexpensive, routinely available parameter, the monocyte count may complement existing diagnostic and prognostic tools. Larger, prospective studies are warranted to validate its clinical utility.
Pancreatic cancer; Monocyte count; Tumour-associated inflammation; Biomarker; C-reactive protein; Interleukin-6; Tumour necrosis factor-alpha; Prognosis.
Copyright (c) 2026 Muhammad Soban*, Atiq Ur Rehman, Mumtaz Hussain, Muhammad Ahmed, Asia Jhanzed, Saqib Noman (Author)
Neurosonographic Evaluation of Intrcranial Abnormalities in Neonates Presentng with Seizures
Objective: This study objective was to evaluate the Intracranial Abnormalities in neonates presenting with seizures. Method: This cross-sectional study included 79 neonates that presented with seizures in the NICU of a tertiary care hospital. Cranial ultrasound was performed using a high frequency transducer through the anterior frontanelle. Standard coronal and sagittal views were attained to access the structures of brain. Data were examined using SPSS version 26., with significance level set at p <0.05. Result: The mean age was 11.24 days of patients. In this study, among the patients 22 (28%) neonates were detected with intracranial abnormalities out of which 50 (63%) were term and 28 (35%) were pre term neonates. Hemmorhage 12 (15.3%) and Hydrocephalus 7 (8.9%) were the most common findings, followed by cerebral edema 2(2.5%) and congenital abnormalities 1 (1%). Conclusion: Neurosonography is a valuable, noninvasive, readily accessible and first-line tool for neonatal intracranial pathologies. On the basis of current study out of seventy-eight patients, twenty-two patients were detected with intracranial abnormalities in which Hemorrhage and hydrocephalus were the most common findings.
Neonatal Seizures, Intracranial Hemmorhage, Hydrocephalus, Neurosonography and Intracranial Abnormalities.
Copyright (c) 2026 Umme Habiba, Rimsha Badar, Sidra Inam, Zohra Afzal, Emania Tahir (Author)
AI-Driven Personalized Nanomedicine for Cancer Therapy
Two significant obstacles in the path of cancer therapeutics are that drugs do not always penetrate enough of a tumour, and that even identical drugs can have very different effects on patients. Nanomedicine solves the first issue by re-engineering the delivery of drugs, while artificial intelligence (AI) provides a solution to the second, in that AI can learn from patient-specific data instead of relying on population averages. This paper proposes a four-layered, structured conceptual framework that integrates the fields of AI and personalized nanomedicine in cancer therapeutics, including multi-omics patient data acquisition, machine-learning-assisted nanoparticle design, predictive modelling of biodistribution and therapeutic response, and closed-loop adaptive dosing. Based on trends observed in the nanomedicine and computational oncology community, we provide illustrative quantitative comparisons of simulated tumor-targeting efficiency, model learning curves, toxicity outcomes, and platform suitability, and demonstrate how methods like random forest, deep neural networks, and graph neural networks can in principle shorten the design-to-clinical translation pipeline. We compare and contrast the three main types of nanoparticle carriers (liposomal, polymeric, and inorganic) from the viewpoint of their ability to be tuned using AI; and we candidly consider the technical, regulatory, manufacturing, and ethical obstacles that stand in the way of their clinical translation. We end with a federated multi-institutional data sharing research agenda, explainable AI, standardised characterisation protocols, and adaptive regulatory pathways as prerequisites, in our view, to a scalable, equitable approach to AI-personalised cancer nanomedicine.
artificial intelligence; nanomedicine; personalized oncology; drug delivery; machine learning; nanoparticle design; precision medicine
Copyright (c) 2026 Rabbia Azam, Saira Bibi, Muhammad Shahzad Nawaz, Lecturer, Ejaz Hussain *, Tony T. Williams, MHA, Ed.S., PhD(h.c.) (Author)
Physiological, Metabolic and Biochemical Effects of Ramadan Fasting: A Review of Contemporary Scientific Evidence
Ramadan is one of the fundamental pillars of Islam, providing a comprehensive system of spiritual, moral, and educational instruction. Extensive research in modern medical and biological sciences has shown that the effects of daily fasting cause numerous physiological, metabolic, and biochemical changes in the human body. Fasting results in significant changes in energy levels, glucose, hormones, metabolism, energy utilization, and cellular functions. Islamic teachings describe fasting as a means of piety, self-discipline, and spiritual reformation, while modern scientific research has shown that fasting has numerous medical benefits. The aim of this research paper is to present an analytical review of the physiological, metabolic and biochemical effects of Ramadan fasting in the light of the teachings of the Quran and Sunnah and contemporary scientific evidence. The paper clarifies that Islamic worship, especially fasting, is not only a means of spiritual evolution but also plays an important role in promoting human health.
Ramadan Fasting, Physiology, Metabolism, Biochemistry, Human Health, Intermittent Fasting, Islamic Worship.
Copyright (c) 2025 Muhammad Ahmad, Aqsa Arshad , Muhammad Hamaad Khan , Abdul Sammad Khan , Najeeb Ullah Khan (Author)
Relationship Between Nursing Burnout And Second Victim Phenomenon Among Clinical Nurses: A Cross-Sectional Study
Background: Nursing burnout and second victim phenomenon (SVP) are crucial health issues that have a negative impact on nurses' psychological state, job performance, and patient safety. The clinical environment is frequently under high pressure, overloaded with work, and at risk of unfavorable patient situation. Objective: To explore the relationship between nursing burnout and the second victim phenomenon among clinical nurses serving in clinical teams offered by hospitals in Karachi, Pakistan. Methods: The cross-sectional correlational study was conducted at selected public & private hospitals of Karachi, Pakistan. The sample consisted of 80 nurses, selected by convenience sampling technique. The Maslach Burnout Inventory (MBI) and Second Victim Experience and Support Tool (SVEST) were used to collect all the data. The SPSS version 26 was used to analyze data. Results: The participants experienced moderate-to-high nursing burnout, particularly emotional exhaustion, with moderate second-victim experiences. Nursing burnout was significantly positively associated with the second-victim phenomenon (r = .62, p < .001) and explained 46% of its variance. Higher burnout was significantly observed among female and younger nurses compared with their counterparts (p < .05). Conclusion: Clinical nurses who had higher occupational stressors associated with burnout were noted to be more susceptible to psychological distress after negative clinical events.
Nursing Burnout, Second Victim Phenomenon, Clinical Nurses, Occupational Stress, Patient Safety.
Copyright (c) 2026 Tayyaba Arshad, Iftakhar Ahmed (Author)
Research On Prevalence Of Microcytic & Hypochromic Anemia Among Patients Visited At Phq Teaching Hospital Gilgit
BACKGROUND Iron deficiency (ID) is the primary cause of anemia, a global health issue that affects one-third of the world’s population .it is most frequently linked to iron deficiency, thalassemia, chronic disease and sideroblastic anemia ). Acute and chronic blood loss, poor intestinal absorption of iron, decreased iron intake, and increased iron requirements during pregnancy, significant trauma recovery, and surgical recovery are some possible causes of this . OBJECTIVES To find the prevalence of microcytic & hypochromic anemia among the patients visited in Gilgit city hospitals according to age, gender, area, and pregnancy-wise. To find its associated risk factors contributing to the development and progression of microcytic hypochromic anemia. METHODOLOGY It was a descriptive cross-sectional study. A cross-sectional study is used to find the prevalence of a particular disease in a population at a specific point in time to investigate the prevelance of microcytic hypochromic anmeia among patients visited in phq hospital gilgit baltistan. Data were collected from 500 participants across all age groups by taking blood sample. structured question are is use to collect data from patients who are positive for microcytic hypochromic anemia. RESULTS In this study, the sample was collected from 500 patients from PHQ hospitals at Gilgit city. All of the reported cases were categorized based on age, gender, area, and pregnant or non-pregnant, respectively). According to the findings, the hospital received reports of 300 M.H.A. cases from different districts Gilgit City had the greatest prevalence, 157(66.5%) And even no prevalence was recorded in some districts. The highest prevalence of M.H.A with respect to gender was observed in 169 female (71.61%). The prevalence of M.H.A with respect to age in age group 25-34was found to be the highest among all age groups. While M.H.A was found to be the lowest in <75age group. on occupation the highest prevalence was found in students109(46.19%) and in housewife the prevalence is 94(39.83%). based on tea intake. Highest prevalence of M.H. A were found among those patients who consume tea regularly 130(55.08%). The highest prevalence 140 (59.32%). Based on vegetable and fruit consumption seen in those persons who rarely intake fruits and vegetables in their diet. Apart from this the highest prevalence of M.H.A Among the patient who do not take iron supplements. The other factors like lactation, pregnancy, diabetes or other chronic health conditions greatly influence in the occurrence of M.H.A. CONCLUSION understanding the anemia (microcytic hypochromic) burden is essential for the overcome public health care outcomes. Study investigates the pattern of determinants of microcytic hypochromic anemia in patients visited in PHQ hospital Gilgit Baltistan. The findings indicate out of 237 patients 169 female (71.61%) females are affected with this type of anemia. With the majority of female suffering poor diet, lifestyle, dietary practices, menorrhagia, high altitude, physical activity, and homeostatic abnormalities. There are numerous well-established, reasonably priced strategies to combat anemia, such as treating the underlying causes, bringing the hemoglobin concentration back to normal, and preventing and managing consequences.
Copyright (c) 2026 Sadia Zahra*, Sharafat Malik, Tanveer Hussain, Wajahat Ali Qureshi, Shahbaz Hussain, Arshi Zahra (Author)
Decoding the Silent Threat of Heart Attack: Emerging Risk Factors, Diagnostic Biomarkers and Innovative Therapeutic Approaches
Heart attack, especially myocardial infarction, is an important global health issue and should be noted that it sometimes occurs with insignificant or unrecognized symptoms. While classical risk factors such as hypertension, diabetes, obesity, smoking, and dyslipidemia are known, new ones under consideration include chronic inflammation, stress, sleeping disorders, air pollution, metabolic disorders, genetic predisposition, and changes in gut microbiome. Recent advances in diagnosis have led to the elaboration of new biomarkers that can be used for detection and risk assessment in cardiovascular disease such as high-sensitivity cardiac troponin and natriuretic peptides, inflammatory markers, microRNAs, extracellular vesicles, metabolomic profile. The improvements of diagnosis also relate to the use of artificial intelligence and advanced imaging technologies and help to improve the identification of silent myocardial injury and vulnerable plaques due to the integration of new risk factors, biomarkers, and treatment strategies Keywords: Heart attack, Myocardial infarction, Emerging risk factors, Diagnostic biomarkers, Cardiac troponins, Inflammation, Atherosclerosis, Precision medicine, Artificial intelligence, Innovative therapies
Copyright (c) 2026 Hakima Batool, Wasiq Bashir Khan, Syeda Rida Kullsoom Rizvi, Masood ur Rahman Shah, Fizza Aftab, Mohammad Hassan Ghayem, Askarifard Jahromi Reza, Murtaza Ali, Mahdiyeh Alizadeh, Muhammad Ibrahim Khalil (Author)
IMPACT OF CHILDHOOD TRAUMA ON SOCIAL FUNCTIONING AND QUALITY OF LIFE IN INDIVIDUALS WITH BORDERLINE PERSONALITY DISORDER (BPD)
A complex psychiatric condition known as borderline personality disorder (BPD) is recognized to have a significant negative impact on a person's social adjustment and quality of life (QOL). The study aimed to investigate how childhood trauma affected the social functioning and overall quality of life among those individuals who had been diagnosed with borderline personality disorder (BPD). About 100 individuals with Borderline Personality Disorder (BPD) were enrolled in a cross-sectional study that used quantitative methods and a convenient sampling strategy. These patients met the required inclusion criteria for the study and were chosen from different hospitals in Peshawar. The Childhood Trauma Questionnaire (CTQ), the Social Adjustment Scale (SAS), and the Quality of Life Enjoyment and Satisfaction Scale (Q-LES-Q) were used in the data collection process, along with a structured self-reported questionnaire that included key demographic variables. The significant differences among borderline personality disorders with childhood trauma and without childhood trauma on social adjustment and quality of life were measured using independent sample t-test. Overall the results showed significant results on social functioning (t(98)= 2.15, p < 0.05) and quality of life (t(98)= 6.48, p < 0.05). Additionally, significant gender differences were also found. This research advances knowledge on the connections among childhood trauma, social functioning, and quality of life in BPD sufferers and provides insightful information for future research projects as well as therapeutic practice
Borderline personality disorder, social adjustment, quality of life, childhood trauma
RELATIONSHIP BETWEEN CHILDHOOD TRAUMATIC EXPERIENCES AND DISSOCIATIVE EXPERIENCES
Conversion Disorder is a complicated and perplexing mental health condition characterized by one or more unexplained physical symptoms. Despite recent developments in the studies conducted on this condition, more research is required to fully understand the underlying causes of its manifestation. This study examines the intricate relationships between dissociative experiences, gender differences, and childhood traumatic experiences among patients of conversion disorder within a clinical population in Peshawar, Pakistan. The sample included 80 individuals (Females = 40, Males = 40) diagnosed with Conversion Disorder between the ages of 18 and 55. Participants provided self-report data using standardized measures such as the Childhood Trauma Questionnaire (CTQ) and the Dissociative Experiences Scale (DES). Statistical techniques including correlation and t-tests were used to assess the study hypotheses. The results showed a strong correlation (r =.327, p < 0.05) between dissociative episodes and childhood trauma, demonstrating the importance of trauma in conversion disorder.
Childhood trauma, Dissociative experiences, Gender differences
NEONATAL RESUSCITATION KNOWLEDGE LEVEL AMONG NURSES IN TERTIARY HOSPITAL
Neonatal resuscitation represents an essential life-saving procedure which decreases both neonatal health problems and death rates among newborns. Nurses need both sufficient knowledge and quick decision-making skills to deliver complete neonatal treatment in tertiary hospital settings. The research study conducted to examine the staff nurses’ knowledge of neonatal resuscitation at a tertiary hospital neonatal unit. A descriptive cross-sectional study was conducted at the Children Hospital and the Institute of Child Health Sciences (CH & ICH), Lahore, Pakistan. The target population consisted of registered nurses working in neonatal departments. A non-probability convenience sampling technique was used, and a sample size of 90 nurses was selected. The research team used a structured self-administered questionnaire to gather data which included demographic details and 18 multiple-choice questions testing neonatal resuscitation knowledge. The study results showed the participants had moderate to low knowledge about important topics which included CPR reassessment timing 43.3% of the time and effective ventilation indicators 43.3% of the time and persistent apnea management 48.9% of the time and accurate neck positioning during resuscitation 48.9% of the time. The researchers discovered that people had incorrect beliefs about how to manage ventilation and perform chest compression techniques. The study found that nurses showed good knowledge about neonatal resuscitation but they lacked skills needed for critical decision-making and advanced resuscitation techniques.
Neonatal Resuscitation, Knowledge, Staff Nurses, Neonatal Care, Tertiary Care Hospital, Pakistan
Development and Evaluation of Nanostructured Lipid Carriers for Enhanced Oral Bioavailability of Poorly Soluble Antihypertensive Drugs
Low aqueous solubility and low bioavailability in the oral route are major hurdles that many antihypertensive drugs face, which result in poor therapeutic activity. In this study, an attempt was made to develop and characterize Nanostructured Lipid Carriers (NLCs) in order to enhance the oral bioavailability of a BCS Class II antihypertensive drug. NLCs were formulated by using the hot melt homogenization method by using solid lipid, liquid lipid, and surfactant. Formulations were optimized using Box-Behnken design having particle size, entrapment efficiency, and drug release as the dependent variables. The optimized NLC formulation displayed particle size of 142.3 nm, zeta potential of -28.6 mV and entrapment efficiency of 88.4%. The in-vitro drug release studies showed sustained release with a maximum of 85% drug release within 24 hours when compared with only 32% of the drug released in case of the pure drug suspension. Ex-vivo permeability study using rat intestinal sac also demonstrated that the drug release was increased 3.2 folds in case of the NLC formulation. Pharmacokinetic study conducted on Wistar rats indicated that there was a 4.1 fold increase in Cmax and 3.8 fold increase in AUC when compared to the conventional tablet. Results of stability testing performed at 25°C/60% RH and 40°C/75% RH for 3 months proved that there is no significant change in the physicochemical parameters of the formulation. SEM and DSC study indicated successful loading and amorphous state of the drug in NLCs. Hence it was found out that the formulation could significantly enhance solubility, permeability and bioavailability of the poorly water soluble antihypertensive drugs.
Pharmaceutics, Nanostructured Lipid Carriers, Oral Bioavailability, Drug Delivery, Antihypertensive, Solubility Enhancement, Nanotechnology, Pharmacokinetics, Sustained Release.
Copyright (c) 2025 Adeel Zain, Nimra Zahoor , Dr. Muhammad Ali (Author)
Comparative Assessment of Patient Satisfaction with Nursing Care and its Determinants in Public and Private Hospitals
Background: Patient satisfaction reflects how well nursing care meets patients' needs and expectations, given nurses' central role in inpatient care delivery. Public and private hospitals differ structurally, and while private hospitals sometimes show higher satisfaction, evidence suggests care delivery matters more than ownership itself. Objective: To compare nursing-care satisfaction in public and private hospitals and identify factors independently associated with high satisfaction. Methods: The study used analytical cross-sectional study design with a sample size of 360 adult inpatients, equally divided between public and private hospitals. Newcastle Satisfaction with Nursing Scales scores were transformed to 0–100. Reliability analysis, descriptive statistics, Independent-samples t test, chi-square analysis, and binary logistic regression were performed. Results: Mean satisfaction was higher in the private hospital (M = 72.32, SD = 11.35) than in the public hospital (M = 64.12, SD = 11.07), Welch’s t(357.77) = −6.94, p < .001, mean difference = 8.19, 95% CI [5.87, 10.52], Hedges’ g = 0.73. High satisfaction occurred in 44.4% of private-hospital patients and 18.3% of public-hospital patients, χ²(1) = 27.29, p < .001. Cronbach’s alpha was 0.892 for satisfaction and 0.913 for experience. After adjustment, private ownership was not significant (aOR = 1.25, 95% CI [0.64, 2.41], p = .515). Higher cleanliness, privacy, and communication ratings increased the odds of high satisfaction, whereas longer waiting time, female gender, and surgical-ward admission reduced the odds. Conclusion: The unadjusted public–private difference was substantial, but modifiable care-process factors were more informative than ownership after adjustment. Nursing quality improvement should prioritize communication, privacy, cleanliness, and timely responsiveness.
Patient Satisfaction; Nursing Care; Newcastle Satisfaction With Nursing Scales; Public Hospital; Private Hospital; Communication; Waiting Time.
Copyright (c) 2025 Naila Habib, Muhammad Danish , Sadaf Parveen , Saeed Ullah , Hazrat Bilal , Sayed Suhail Ahmad , Usman Ullah (Author)
Molecular Genetics of Inherited Neurodevelopmental and Neurodegenerative Brain Disorders in Pakistan: Genomic Landscape, Genotype–Phenotype Correlations, Diagnostic Challenges and Precision Medicine Perspectives
Neurological disorders with inherited causes encompass a diverse range of conditions, including intellectual disability, autism spectrum disorders, epilepsy, hereditary spastic paraplegia, and progressive neurodegenerative disorders. In Pakistan, factors such as high rates of consanguineous marriages, large multi-generational families, geographical isolation and unique population structures have intensified the prevalence of autosomal recessive neurological disorders, leading to an accumulation of rare homozygous pathogenic variants. This review consolidates contemporary insights into the genetic architecture, genotype-phenotype correlations, and clinical challenges related to inherited brain disorders in Pakistani families. A strong emphasis is placed on advanced techniques such as homozygosity mapping, targeted gene panels, and various sequencing methods including whole-exome and whole-genome sequencing, alongside copy-number-variation analysis and functional validation. These genomic approaches have identified pathogenic variants in genes involved in neuronal processes, including migration, cortical development, synaptic signaling and mitochondrial metabolism. Despite extensive research in neurological genetics globally, Pakistan faces significant obstacles to translating genomic discoveries clinically. These challenges include a lack of diagnostic facilities, high sequencing costs, insufficient trained genetic professionals, limited bioinformatics resources and the absence of population-specific genomic databases and national rare disease registers. To overcome these hurdles, it is essential to integrate genomics with advancements in Artificial Intelligence, multi-omics technologies, detailed clinical phenotyping, functional studies and culturally sensitive genetic counseling. The implementation of national genomic initiatives, establishment of multidisciplinary precision-neurology centers and provision of equitable diagnostic services stand to enhance early diagnosis, variant interpretation, reproductive counseling and the development of personalized therapeutic strategies for inherited neurological disorders in Pakistan.
Inherited Neurological Disorders; Brain Disorders; Whole-Exome Sequencing; Genomic Medicine; Consanguinity; Neurodevelopmental Disorders; Precision Medicine; Genotype–Phenotype Correlation.
Copyright (c) 2026 Hafiz Safdar Ali, Maham Iftikhar , Tayyba Azhar , Sarfraz Hussain Anwar , Aqsa Mamoona , Ayesha Attaria , Zahra Shoukat , Muhammad Tahir , Rimsha Shamshad , Dilwash Qadir (Author)