Frontier in Medical & Health Research {FMHR} | ISSN (E) 3007-1607 (P) 3007-1593 | is a HEC & CPSP approved journal. FMHR is an open-access, quarterly, and double-blind peer-reviewed journal covering all areas of medical and health sciences from basic research to clinical and experimental work. The FMHR is committed to completing the double-blind peer-review process within one month and informing the author(s) accordingly. The FMHR is published by the Institute for Excellence in Education and Research (IEER), duly registered with the Securities and Exchange Commission of Pakistan (SECP) under registration number 0224595.
Institute for Excellence in Education & Research
PREVALENCE OF HEPATITIS C VIRUS INFECTION AND ASSOCIATED RISK FACTORS AMONG HEMODIALYSIS PATIENTS IN DISTRICT SWAT, PAKISTAN
Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease worldwide, and patients undergoing maintenance hemodialysis (HD) are recognized as a high-risk group due to repeated vascular access, shared dialysis equipment, and frequent blood product exposure. Objective(s): To determine the prevalence of HCV infection among hemodialysis patients in District Swat and to identify its association with demographic and clinical risk factors, including gender, age, marital status, education, living status, blood transfusion history, surgical history, diabetes, and smoking. Methodology: A cross-sectional study was conducted at the Dialysis Unit of Nawaz Sharif Kidney Hospital, Sangota, Swat, over a period from 23 May 2018 to 10 December 2018. A total of 149 patients undergoing hemodialysis were enrolled. Demographic and clinical data were collected through a structured questionnaire, and 5 ml of venous blood was drawn from each participant into an EDTA tube. Serum was screened for anti-HCV antibodies using a rapid immunochromatographic cassette (Healgen Scientific LLC). Data were coded in Microsoft Excel and analyzed using SPSS, with chi-square tests applied to assess associations (p < 0.05). Results: Of the 149 patients studied, 86 (57.7%) were male and 63 (42.3%) were female; overall HCV seroprevalence was 41.6% (62/149). Seropositivity was higher in females (47.6%) than males (37.2%). The highest infection rate occurred in the 41–50-year age group (51.4%), while no positive cases were recorded above 70 years. HCV positivity was higher among married patients (42.5% vs. 36.3% unmarried), smokers (60% vs. 40.2% non-smokers), and patients from rural areas (42.4% vs. 41.3% urban). A history of blood transfusion showed a statistically significant association with HCV positivity (87% of positive cases had a transfusion history; p = 0.00). No significant associations were found with gender, marital status, surgical history, diabetes, or living status (p > 0.05 for each). Conclusion: The study demonstrates a high prevalence of HCV infection among hemodialysis patients in District Swat, with blood transfusion history emerging as the principal significant risk factor. Strengthening infection control practices, donor blood screening, and patient awareness in dialysis settings is warranted to curb nosocomial transmission.
Hepatitis C Virus, Hemodialysis, Prevalence, Risk Factors, Swat
MULTIPLE EXTENSIVE COMPLEX ODONTOMAS OF THE JAWS
Odontomas are odontogenic tumors found within the oral cavity and consist of dental components such as enamel, dentin, cementum, and pulp. Because they are benign and usually asymptomatic, they are most often detected incidentally during routine radiographic examinations. Reports of odontomas erupting into the oral cavity are relatively uncommon. A review of the English-language literature identified only ten documented cases of erupted compound odontomas. The present report describes an unusual case involving multiple, symptomatic, erupted complex odontomas of exceptionally large size affecting both jaws and extending into the maxillary sinuses in a 22-year-old female. Clinical assessment and radiological investigations, including conventional imaging and CT scanning, demonstrated a markedly large radiopaque mass with a density comparable to enamel or bone, occupying both jaws and both maxillary sinuses. A provisional diagnosis of odontoma was established and later confirmed through histopathological examination. The lesion, along with the associated sinus lining, was completely surgically removed. The postoperative recovery was smooth, and no recurrence has been observed.
jaw, mandible, maxilla, maxillary sinus, multiple complex odontomas
ASSESSMENT OF CT ANGIOGRAPHY IN EARLY DIAGNOSIS AND TREATMENT IN STROKE PATIENTS: A RETROSPECTIVE STUDY
Objective: To evaluate whether earlier CTA assessment is associated with favorable clinical outcomes and reduced in-hospital mortality. Materials & Methods: A retrospective study of 163 acute ischemic stroke patients was conducted at the University Of Lahore Teaching Hospital Care Center from April 2025 to July 2026. All patients underwent CT angiography within 24 hours of symptom onset to assess vascular abnormalities, particularly large-vessel occlusion and collateral circulation. CTA images were reviewed by two experienced neuroradiologists. Clinical outcomes were assessed using the modified Rankin Scale (mRS). Data were analyzed using appropriate statistical tests, with p < 0.05 considered statistically significant. The study evaluated the usefulness of early CTA for diagnosis, treatment planning, and prediction of clinical outcomes in acute ischemic stroke. Results: Among 163 patients, the mean age was 63.5 ± 8.5 years, with males predominating (59.50%) over females (40.49%). Hypertension (75.46%) was the most common risk factor, followed by diabetes mellitus (36.19%) and dyslipidemia (25.15%). The mean time to CTA was 5.1 hours. CTA identified large-vessel occlusion in 80 patients (49.07%). Collateral circulation was mild in 24.53%, moderate in 45.39%, and severe in 30.06%, with 74.85% demonstrating moderate-to-severe collateral circulation. Incidental vascular anomalies were found in 10.42% of patients. Clinically, 53.37% achieved favorable outcomes, while 14.72% died during hospitalization. Overall, the findings highlight the importance of early CTA for detecting large-vessel occlusion and assessing collateral circulation in acute ischemic stroke. Conclusion: CT angiography is a valuable imaging modality for early stroke diagnosis, enabling rapid detection of large-vessel occlusion and collateral circulation. Early CTA supports timely treatment decisions and may improve clinical outcomes.
Computed Tomography, Angiography, Stroke
COMPARISON OF TAILORED-ENHANCED RECOVERY AFTER SURGERY VERSUS CONVENTIONAL CARE IN PATIENTS WITH DUODENAL ULCER PERFORATION
Background: Perforated duodenal ulcer (PDU) is a potentially life-threatening surgical emergency, there is significant morbidity and generally long term hospitalisation. There is a relative scarcity of evidence for use of Enhanced Recovery After Surgery (ERAS) pathways in emergency abdominal surgery, when compared to elective surgery. Objective: To comparepost-surgical outcomes of tailored-enhanced recovery versus conventional care in patients with duodenal ulcer perforation. Methods: This was a Randomized Controlled trial that was carried out at Department of Surgery, Nishtar Hospital Multan from June 2024 to December 2024. 60 patients, aged 18-60 years were randomized evenly to both t-ERAS and conventional-care groups. The t-ERAS protocol included early mobilization, early oral feeding, multimodal non-opioid analgesia and early tube, drain and urinary catheter removal. Primary and secondary outcomes measured were hospital length of stay (LOS), need for additional analgesia, occurrence of an organ-space surgical-site infection (SSI) with leakage, and 30-day readmission. Results: The mean hospital stay in the t-ERAS group was significantly reduced compared to that of the conventional-care group (6.12 ± 1.98 days vs 9.45 ± 4.12 days; p < 0.001). Extra analgesia was required by 3 (10.0%) versus 9 (30.0%) patients, respectively (p = 0.050). There were no differences between groups with regard to organ-space SSI with leakage or 30-day readmission. Conclusion: A personalized ERAS pathway is safe and improves recovery after emergency Graham's patch repair and minimizes hospitalization and requirement for rescue analgesics without increasing postoperative complications.
Delayed gastric perforations; Enhanced Recovery After Surgery (ERAS); Tailored ERAS; Graham's Patch Repair; Emergency Laparotomy; Hospital Stay; Postoperative Recovery; Surgical Site Infection (SSI).
PREVALENCE AND FACTORS ASSOCIATED WITH LATE OR NON-UTILIZATION OF ANTENATAL CARE SERVICES AMONG PREGNANT WOMEN: A CROSS-SECTIONAL STUDY
Background: Timely initiation of antenatal care (ANC) within the first trimester is vital for early risk screening, baseline maternal health assessment, and nutritional supplementation. In many resource-limited settings, maternal health metrics prioritize crude contact numbers over gestational timing, obscuring significant delays in care initiation. Objective: This study evaluated the prevalence of late or non-utilization of ANC services and identified independent sociodemographic, structural, and behavioral predictors associated with delayed or absent care. Methods: A descriptive analytical cross-sectional investigation was conducted utilizing an analytically modeled dataset of 220 pregnant women across urban, peri-urban, and rural strata. Early initiation was defined as first contact by 12 completed weeks of gestation, late initiation as first contact after 12 completed weeks, and non-utilization as zero contact during the index pregnancy. Predictors of composite late/non-utilization were analyzed using multivariable binary logistic regression to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results: Early ANC initiation was documented in 43.2% (n = 95) of respondents, late initiation in 41.8% (n = 92), and complete non-utilization in 15.0% (n = 33), yielding a pooled late/non-utilization prevalence of 56.8% (95% CI: 50.3%–63.4%). Multivariable logistic regression revealed that rural residence was the strongest independent risk factor for late or absent booking (AOR = 4.11; 95% CI: 2.03–8.30; p < 0.001). Inadequate knowledge of ANC timing (AOR = 2.09; 95% CI: 1.11–3.93; p = 0.022) and unplanned pregnancy (AOR = 1.92; 95% CI: 1.02–3.60; p = 0.042) were also statistically significant predictors. Lack of reliable transport showed a strong trend toward increased risk (AOR = 1.91; 95% CI: 0.99–3.65; p = 0.052). Conclusion: More than half of the surveyed women experienced delayed or absent antenatal entry, primarily driven by geographic disparity, lack of timing awareness, and logistical constraints. Maternal health initiatives and frontline nursing programs must pivot from tracking overall registration to auditing first-trimester booking, coupling clinic intake protocols with community outreach and transport planning.
Antenatal care; early booking; maternal health; primary health care; health services accessibility; nursing practice.
DECODING THE ROLE OF PROBIOTICS IN INFANT HEALTH: INSIGHTS FROM CLINICAL AND EXPERIMENTAL EVIDENCE
Infancy is a critical time for the inception of gut microbiota, which is essential for long- term development, immunological maturation, and infant health. Probiotic therapies have been clinically proven to promote digestive health and defense against dysbiosis-related illnesses by regulating microbial composition, elevating microbial diversity, and lowering possibly pathogenic bacteria, particularly with strains like bifidobacterium and lactobacillus. Probiotics can strengthen gastrointestinal function, ease constipation, minimize the risk of infections, and reduce the frequency of acute necrotizing enterocolitics (NEC) in premature newborns, based on clinical findings. Additionally, probiotics, prebiotics, and synbiotics have been related to reduce prevalence of atopic dermatitis, and allergic sensitization during pregnancy and early life period, emphasizing their role in immunological programming. Despite outcomes in human, are still inconclusive, emerging findings also highlight potential gains on cognitive and neurodevelopmental results via regulation of gut-brain exist. In conclusion, additionally probiotics, synbiotics, or human milk oligosaccharides (HMOs) to baby formulae has confirmed potential for encouraging balanced gut colonization and partially mimicking the protective advantages of breastfeeding. Overall, these outcomes emphasize the diverse effects of probiotics across early life stages, covering gut health, immunology, prevention of allergic conditions, cognitive maturation, and nutritional support, establishing them crucial tactic for enhancing early-life health outcomes.
Human milk oligosaccharides (HMOs), probiotics, prebiotics, gut microbiota, infant health.
FINANCIAL TOXICITY AND ADVERSE MENTAL-HEALTH OUTCOMES AMONG FAMILY CAREGIVERS OF CANCER PATIENTS UNDERGOING CHEMOTHERAPY: ROLE OF RESILIENCE
Family caregivers of patients undergoing cancer chemotherapy often experience substantial financial and psychological challenges. However, resilience may serve as a protective psychological resource that reduces the adverse mental-health consequences associated with financial toxicity. The present study examined the relationship between financial toxicity and psychological distress among family caregivers of cancer patients undergoing chemotherapy and investigated the mediating role of resilience. A correlational research design was employed with a quantitative survey approach. A purposive sample of 107 family caregivers was recruited from Combined Military Hospital (CMH), Multan, and MINAR Cancer Hospital, Multan. Data were collected using the Comprehensive Score for Financial Toxicity (COST-FACIT), Kessler Psychological Distress Scale (K10), and Connor-Davidson Resilience Scale (CD-RISC). Pearson correlation and mediation analyses were conducted to examine associations among the study variables. Financial toxicity was significantly positively associated with psychological distress (r = .53, p < .01) and negatively associated with resilience (r = −.39, p < .01). Resilience demonstrated a strong negative association with psychological distress (r = −.69, p < .01). Moreover, resilience partially mediates the relationship of financial toxicity and adverse mental- health outcomes. Financial toxicity is associated with greater psychological distress among family caregivers of cancer patients undergoing chemotherapy, whereas resilience appears to function as a significant protective factor. Interventions aimed at strengthening resilience alongside addressing caregivers’ financial concerns may help reduce psychological distress and improve caregiver well-being.
Financial toxicity, psychological distress, resilience, family caregivers, cancer, chemotherapy
PREVALENCE & PATTERN OF DYSLIPIDEMIA IN TYPE 2 DIABETES MELLITUS IN QUETTA, PAKISTAN.
Background: Dyslipidemia is a risk factor for cardiovascular disease (CVD) in individuals with Type 2 Diabetes Mellitus (T2DM). It is linked to insulin resistance in individuals with T2DM. Its prevalence in Pakistani T2DM patients remains unknown, despite being a common consequence of Type 2 Diabetes Mellitus. Objective: To find out if dyslipidemia is conjoint in masses with T2DM in Quetta, Pakistan. Materials and Methods: From July 2021 to June 2022, researchers conducted a cross-sectional study. The study enrolled 272 people with T2DM using a convenience sample technique. A standardized questionnaire was used to gather information on socio-demographics, behavior and clinical variables. We took measurements of things like blood pressure, weight and height. SPSS sort 23 was used to examine the data. A P-level 0.05 was judged scientifically noteworthy for the pearson correlation test. Results: Dyslipidemia was found in 64.3 % of the research participants. A total of 30.9 % of patients had isolated dyslipidemia, 47.4 % had combined dyslipidemia and 21.7 % had mixed dyslipidemia. 71 % of individuals had hypertriglyceridemia as an isolated lipid profile abnormality, 47.4 % of them had hypercholesterolemia, 62.5% had an extreme value of low-density lipoprotein (LDL-C), and 72 % had a less than normal value of HDL-C. Physical dormancy, fatness, hypertension and extreme blood glucose level remained linked to dyslipidemia in people under the age of 35. Conclusion: People with T2DM are more likely to suffer from dyslipidemia, according to a new study. Involvement of methods for the recognised risk issue and screening, treatment and prevention programs for dyslipidemia should be taken into account because of this study's findings.
Type 2 Diabetes Mellitus, Dyslipidemia, lifestyle modification
TO CORRELATE THE ROLE OF SERUM FERRITIN AND D-DIMER AS A PROGNOSTIC BIOMARKER IN COVID-19 DISEASE.
Introduction Covid 19 pandemic is still a threat to public health. According to WHO, since the start of this pandemic, about 260 million cases with more than 5 million deaths reported globally. Including Pakistan, more than 200 countries have been affected so far. It is highly contagious disease, commonly spreads between people who are in close contact to each other. According to studies, hyper-inflammation followed by systemic inflammatory response, wide spread endothelial damage and hypercoagulable state are the main cause of this disease. Therefore, evaluation of inflammatory state using biomarkers will be helpful in screening and early detection of severe disease. Objective To assess the severity of covid-19 by correlating serum ferritin and D-dimer levels with the clinical outcome of the disease. Materials and method: It is a descriptive cross-sectional study, conducted in the department of clinical pathology, JPMC, with collaboration of Ziauddin Medical university hospital, during a period of six months with the approval of IRB. A total of 384 covid PCR positive patients were selected from covid wards and ICU and categorized into mild, moderate and severe disease group on the basis of WHO covid-19 disease severity classification. Serum ferritin and D-dimer levels was done at admission and repeated after 1 week of hospitalization, on automated clinical analyzer using principle of immuno-turbidimetry. All the patients were followed throughout the course of their disease. Results were analyzed and corelated with the clinical progression and outcomes of the disease. Results: Our study has shown, male dominance in mild, moderate and severe disease group i.e. we found 54.5% (n=12) males in mild disease group, 54.8% males in moderate disease group and 53.6% males in severe disease group. The mean age of patients with mild to moderate disease was less than 50 years whereas, patients with severe disease had a mean age of more than 50years. In mild disease group, mean serum ferritin level was 80.74 ng/ml and mean serum D-dimer level was 444.06 ng/ml, during first week of hospitalization with an average of 7 days of stay in hospital, no oxygen requirement and 100% survival rate, whereas in moderate disease group, we observe that mean serum ferritin level was 150.42 ng/ml and D-dimer level was 2676.5 ng/ml during first week of hospitalization. About 84.2% (n=166) patients with moderate disease got survived and discharged, but unfortunately 15.7% (n=31) of patients, progresses to severe disease with complications and high oxygen requirement, their mean serum ferritin level was more than 220 ng/ml and D-dimer levels was more than 2000 ng/ml. In severe disease group, mean serum ferritin level was 333.6 ng/ml and mean D-dimer level was 6810.5 ng/ml during first week of hospitalization, with an average of 18 days of stay in hospital, with very high oxygen requirement, complications and only 6 % (n=8) survival rate. Conclusion: Our study showed the importance of serum ferritin and D-dimer levels as the primary biomarker which can help in early detection of severity of the disease, enabling the clinicians to make strategic planning and disease management. These steps would definitely decrease the mortality index and hospital stay
THE CHALLENGES FACED BY NURSING STUDENTS IN CLASS ROOM TEACHING AND CLINICAL ROTATION
Background: Nursing education combines classroom teaching with clinical training to prepare students for safe and competent professional practice. Nursing students may face academic, psychological, interpersonal, and clinical challenges that can affect learning, confidence, and skill development. Aim: The study aimed to assess the challenges faced by undergraduate nursing students during classroom teaching and clinical rotations. Methods: A descriptive cross-sectional research design was used at the College of Nursing, Superior University, Lahore. The accessible population was 500 undergraduate nursing students, and a sample of 218 students was selected using a probability sampling technique. Data were collected through a structured questionnaire and analyzed using SPSS Version 27. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used. Results: The findings showed that students experienced challenges in both classroom and clinical settings. Difficulty connecting theory with practice, heavy academic workload, and understanding complex concepts were major classroom challenges. Fear of making mistakes, stress during patient care, lack of confidence, and difficulty applying theoretical knowledge were prominent clinical challenges. Clinical rotations were perceived as more challenging than classroom teaching. Conclusion: Nursing students experience substantial academic and clinical challenges. Improved supervision, supportive teaching strategies, adequate clinical exposure, and stronger integration of theory with practice are recommended.
Nursing students, classroom teaching, clinical rotation, challenges, nursing education, clinical learning.
COMPARATIVE EFFECTIVENESS OF NANO-HYDROXYAPATITE AND FLUORIDE-BASED INTERVENTIONS FOR THE MANAGEMENT OF DENTIN HYPERSENSITIVITY: A SYSTEMATIC REVIEW
Background: Dentin hypersensitivity is a common oral health condition characterized by short, sharp pain arising from exposed dentin in response to thermal, tactile, or evaporative stimuli. Fluoride-based products are widely used for its management, while nano-hydroxyapatite (n-HAP) has emerged as a biomimetic alternative with potential dentinal tubule-occluding and remineralizing properties. Objective: To systematically evaluate the comparative effectiveness of nano-hydroxyapatite and fluoride-based interventions for the management of dentin hypersensitivity. Methods: This systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Embase, Cochrane Library, and Web of Science were searched, along with reference-list screening. Eligible studies evaluated hydroxyapatite-containing toothpaste or dentifrice against fluoride-based interventions and reported clinical outcomes related to dentin hypersensitivity or remineralization. Study characteristics and clinical outcomes were extracted, and risk of bias was assessed using the Cochrane RoB 2 tool. Results: Four randomized clinical trials met the eligibility criteria. Across the included studies, both nano-hydroxyapatite and fluoride-based interventions demonstrated reductions in dentin hypersensitivity. Hydroxyapatite-containing formulations produced clinically meaningful improvements in sensitivity assessed through tactile and air-blast stimulation and patient-reported sensitivity measures. In comparative evaluations, hydroxyapatite demonstrated effects comparable to, and in some outcomes favorable to, fluoride-based interventions. However, differences in hydroxyapatite concentration, formulation, comparator products, assessment methods, and follow-up duration limited direct quantitative comparison. Overall, three studies were judged to have low risk of bias, while one had some concerns related primarily to missing outcome data. Conclusion: Nano-hydroxyapatite appears to be a promising alternative to fluoride-based interventions for reducing dentin hypersensitivity. However, the limited number of studies and methodological heterogeneity highlight the need for larger, well-designed trials with standardized outcome measures and longer follow-up.
Nano-hydroxyapatite; Fluoride; Dentin hypersensitivity; Remineralization; Desensitizing toothpaste; Systematic review.
RESILIENCE AS A PROTECTIVE FACTOR IN THE RELATIONSHIP BETWEEN FINANCIAL TOXICITY AND PSYCHOLOGICAL DISTRESS AMONG FAMILY CAREGIVERS OF CANCER PATIENTS UNDERGOING CHEMOTHERAPY
Financial toxicity is an important concern for family caregivers of cancer patients and may contribute to psychological distress during chemotherapy. Resilience may serve as a protective factor by helping caregivers cope with financial and emotional challenges. This study examined the relationship between financial toxicity and psychological distress and investigated the mediating role of resilience among family caregivers of cancer patients undergoing chemotherapy. A quantitative, cross-sectional, correlational design was used. A purposive sample of 139 family caregivers was recruited from MINAR Hospital, Multan, Pakistan. Data were collected using the Comprehensive Score for Financial Toxicity (COST-FACIT), Kessler Psychological Distress Scale (K10), and Connor-Davidson Resilience Scale (CD-RISC-10). Pearson correlation and mediation analysis with 5,000 bootstrap samples were performed. Financial toxicity was positively associated with psychological distress (r = .48, p < .001) and negatively associated with resilience (r = −.36, p < .001). Resilience was negatively associated with psychological distress (r = −.52, p < .001). Financial toxicity significantly predicted lower resilience (β = −.36, p < .001), while resilience significantly predicted lower psychological distress (β = −.40, p < .001). The indirect effect through resilience was significant (B = 0.15, 95% CI [0.06, 0.26]), while the direct effect remained significant (β = .31, p < .001), indicating partial mediation. Financial toxicity is significantly associated with psychological distress among family caregivers, while resilience may partially buffer this relationship. Strengthening resilience and addressing caregivers’ financial difficulties may help reduce psychological distress during cancer treatment.
Financial Toxicity, Psychological Distress, Resilience
RELATIONSHIP BETWEEN PSYCHOLOGICAL SAFETY, INTERPROFESSIONAL COLLABORATION, AND PATIENT-SAFETY CULTURE AMONG REGISTERED NURSES
Background Psychological safety and interprofessional collaboration are important organizational factors that may influence patient-safety culture. Registered nurses frequently communicate safety concerns, coordinate care, and collaborate with multidisciplinary healthcare teams. A supportive work environment may encourage nurses to speak up and participate in patient-safety activities. Aim To determine the relationship between psychological safety, interprofessional collaboration, and patient-safety culture among registered nurses. Methods A quantitative, descriptive cross-sectional design was used among 235 registered nurses at Jinnah Hospital, Lahore. Participants were recruited through convenience sampling. Data were collected using a structured self-administered questionnaire assessing demographic characteristics, psychological safety, interprofessional collaboration, and patient-safety culture. Data were analyzed using SPSS Version 27. Descriptive statistics and Pearson's correlation coefficient were used, with statistical significance set at p < 0.05. Results The findings showed that 48.1% of nurses had moderate psychological safety, 51.5% reported moderate interprofessional collaboration, and 50.6% perceived a moderate patient-safety culture. Psychological safety was significantly positively correlated with interprofessional collaboration (r = .582, p < .001) and patient-safety culture (r = .641, p < .001). Interprofessional collaboration demonstrated the strongest association with patient-safety culture (r = .683, p < .001). Conclusion Psychological safety and interprofessional collaboration were significantly associated with patient-safety culture. Strengthening supportive communication, teamwork, speaking-up behaviors, and collaborative practice may contribute to improving patient safety.
Psychological safety; Interprofessional collaboration; Patient-safety culture; Registered nurses; Patient safety; Nursing; Healthcare.
SENSITIVITY OF TRIGLYCERIDE GLUCOSE (TyG) INDEX FOR DIAGNOSIS OF NAFLD IN OVERWEIGHT INDIVIDUALS
Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide and is closely linked to obesity and insulin resistance. Liver biopsy and advanced imaging remain limited by cost, invasiveness, and availability, particularly in resource-limited settings. The triglyceride-glucose (TyG) index, derived from routine fasting glucose and triglyceride measurements, has been proposed as an inexpensive surrogate marker of insulin resistance and hepatic steatosis. This study aimed to evaluate the diagnostic performance of the TyG index for detecting ultrasonography-confirmed NAFLD among overweight adults at a resource-limited tertiary care hospital in Pakistan. Materials and Methods: This cross-sectional study was conducted in the adult medical outpatient and inpatient population at Federal Government Polyclinic Hospital, Islamabad, enrolling 200 consecutive overweight adults (body mass index ≥ 23.0 kg/m² per the World Health Organization Asian classification). Demographic, anthropometric, and biochemical variables were recorded, and the TyG index was calculated as ln[fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. Abdominal ultrasonography, performed by a radiologist blinded to biochemical results, served as the reference standard for NAFLD. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) curve analysis. All data were entered and analyzed using SPSS version 23.0. The statistical significance was set at p ≤ 0.05. Results: NAFLD was diagnosed by ultrasonography in 88 of 200 participants (44.0%). Participants with NAFLD had significantly higher body mass index, waist circumference, fasting glucose, serum triglycerides, and liver enzymes than those without NAFLD (p<0.001 for all). The mean TyG index was significantly higher in the NAFLD group than in the non-NAFLD group (9.03 ± 0.43 vs 8.49 ± 0.43; p<0.001). At the optimal cutoff of 8.70, the TyG index yielded a sensitivity of 79.5%, specificity of 70.5%, positive predictive value of 68.0%, negative predictive value of 81.5%, and an overall diagnostic accuracy of 74.5%, with an area under the ROC curve of 0.81 (95% CI 0.75–0.87). Conclusion: The TyG index demonstrates good diagnostic performance for identifying NAFLD among overweight individuals and represents a practical, inexpensive, and readily available screening tool, particularly valuable in resource-limited healthcare settings where advanced imaging modalities are not routinely accessible.
Insulin Resistance; Non-Alcoholic Fatty Liver Disease; Triglycerides; Blood Glucose; Ultrasonography
MACHINE LEARNING–BASED EARLY PREDICTION OF SEVERE PREECLAMPSIA USING ELECTRONIC MATERNAL HEALTH RECORDS IN PAKISTAN
Preeclampsia is a major pregnancy-related complication that can rapidly progress to severe maternal and fetal outcomes, particularly where timely risk identification and referral are limited. This study examined the potential of machine learning (ML) to predict severe preeclampsia using routinely available electronic maternal health records in Pakistan. A retrospective quantitative design was proposed using demographic, obstetric, clinical, and laboratory variables, including maternal age, BMI, previous preeclampsia, hypertension, diabetes, gestational age, and blood-pressure measurements. A dataset of 1,000 maternal records was used to demonstrate model development and evaluation. Logistic Regression, Random Forest, Support Vector Machine, and XGBoost were compared using AUC, accuracy, sensitivity, specificity, and F1-score. In the analysis, XGBoost achieved the highest predictive performance (AUC = 0.91), followed by Random Forest (AUC = 0.89), SVM (AUC = 0.86), and Logistic Regression (AUC = 0.82). Blood pressure, previous preeclampsia, BMI, chronic hypertension, and diabetes emerged as important predictors. The findings suggest that ML may support early risk stratification and clinical decision-making for severe preeclampsia. However, the reported results are based on synthetic data; therefore, they do not represent actual clinical outcomes from Pakistani patients. Future research should validate the proposed framework using large, multicenter Pakistani datasets and prospective clinical studies.
Machine Learning; Severe Preeclampsia; Electronic Health Records; Maternal Health; Predictive Analytics; Pakistan.
ASSESSMENT OF FACTORS ASSOCIATED WITH BURNOUT LEVELS AMONG NURSING STAFF IN TERTIARY CARE HOSPITAL. A CROSS-SECTIONAL STUDY
Background: There is a global trend of occupational burnout among clinical nurses, which is negatively impacting on their retention, mental health and the quality of patient care. Acute care nurses in developing nations like Pakistan are given increased workloads due to the lack of resources in the health care system. Objectives: The purpose of this study was to evaluate the prevalence and important organizational factors of Burnout, Job Satisfaction and turnover among the nursing personnel of a semi-government tertiary care hospital Karachi, Pakistan. Methods: A descriptive, cross-sectional study method was used involving 175 active bedside nurses, purposively sampled. A structured questionnaire was used to gather the data on the demographic and occupational factors, burnout indicators, aspects of job satisfaction and job turn-over history. SPSS version 26 software was used for both descriptive and inferential statistics. Results: The respondents were mostly females (60.6%), single (84.6%), BSN educated (85.1), working in acute care units (77.1). The most common signs of burnout were physical depletion (48.6%), general fatigue (45.1%), awareness of becoming more susceptible to illness (41.7%) and emotional depletion (36.6%). There was a strong dissatisfaction amongst the respondents towards salary (51.0%), career growth (46.0%) and work atmosphere (42.0%), while 68.0% were satisfied with the working/peer relationships. Importantly, 71.1% said that a lack of staffing had a negative effect on their mental health and 53.9% said they had given up nursing jobs because of burnout. Conclusion: Overall, the causes of nurse burnout and attrition in this context are mainly structural issues of the workplace, including unsafe staffing, low pay, and lack of career advancement opportunities. While peer support is an important social lubricant, it can't compensate for organizational stressors. Structural changes to ensure nurse-to-patient staffing ratios, to promote competitive nurse compensation packages and to create promotion pathways are critical to protect clinician health and to foster workforce stability at the health system level.
Nurse Burnout, Occupational Stress, Job Satisfaction, Nurse Turnover, Staffing Ratios, Tertiary Care Hospital, Pakistan.
KNOWLEDGE, ATTITUDE AND PRACTICE OF ICU NURSES REGARDING POST-EXTUBATION DYSPHAGIA IN TRACHEAL INTUBATION PATIENTS
Background: Artificial intelligence (AI) is increasingly being integrated into healthcare, nursing education, clinical decision-making, patient monitoring, documentation, and research. Nursing students require adequate knowledge and positive attitudes to use AI safely, ethically, and effectively in future practice. Aim: To assess the knowledge and attitude of undergraduate nursing students regarding artificial intelligence. Methods: A descriptive cross-sectional research design was used among 218 undergraduate nursing students at the College of Nursing, Superior University, Lahore. Participants were selected from an accessible population of 500 students using a probability sampling technique. Data were collected through a structured questionnaire assessing demographic characteristics, knowledge, and attitudes regarding AI. Data were analyzed using SPSS Version 27. Frequencies, percentages, means, and standard deviations were calculated, while inferential tests were used to examine associations. Statistical significance was set at p < .05. Results: Most participants (72.0%) reported previous exposure to AI. Regarding knowledge, 47.2% demonstrated moderate knowledge, 26.1% demonstrated good knowledge, and 26.6% demonstrated poor knowledge. More than half of the participants (54.1%) had a positive attitude toward AI, while 28.0% had a neutral and 17.9% had a negative attitude. Previous AI exposure, training, and use were significantly associated with knowledge and attitude. Conclusion: Nursing students demonstrated predominantly moderate knowledge and generally positive attitudes toward AI. Structured AI education and training are recommended to strengthen AI literacy, ethical understanding, critical evaluation, and responsible use among future nurses.
Artificial intelligence, nursing students, knowledge, attitude, AI literacy, nursing education, healthcare technology
GREEN-SYNTHESIZED SILVER NANOPARTICLES FROM MORINGA OLEIFERA FOR THE TREATMENT OF LEISHMANIA MAJOR: ANTILEISHMANIAL ACTIVITY, CYTOTOXICITY, AND MECHANISTIC INSIGHTS
Treatment of CL (caused by L. major) presents a serious challenge due to the toxicity, long-term use, inconsistent efficacy and resistance of available drugs. Silver nanoparticles (AgNPs) which are synthesized using green methods are a promising alternative because of their antimicrobial properties and the bioactive compounds of medicinal plants. In this study, antileishmanial activity, cytotoxicity, and the possible mechanisms of action of Moringa oleifera-mediated AgNPs against L. major were evaluated. Various process parameters such as precursor concentration, extract concentration, pH, temperature, and reaction time were optimized to produce AgNPs with the leaf extract of M. oleifera. The obtained nanoparticles were characterized by the various techniques like UV-Visible spectroscopy, FTIR, XRD, SEM/TEM, EDX, DLS and zeta potential. The antileishmanial activity was measured against promastigotes and intracellular amastigotes, and the mammalian-cell cytotoxicity and hemocompatibility were evaluated to determine selectivity. The effects of oxidative stress, mitochondrial dysfunction, integrity of membranes, ultrastructural changes, apoptosis-like responses and expression of selected stress and cell death-associated genes were examined. The optimized AgNPs exhibited a characteristic SPR peak at 420 nm, mostly spherical shape, mean TEM particle size of 18.6 ± 6.4 nm, hydrodynamic diameter of 22.8 nm, PDI of 0.184 and zeta potential of −28.7 mV. AgNPs were found to inhibit the promastigote stage of L. major at an IC₅₀ of 44.7 µg/mL and the intracellular amastigote stage at an IC₅₀ of 12.1 µg/mL. The mammalian-cell CC₅₀ was 231.8µg/mL with selectivity indices of 5.2 and 19.2 (CC₅₀ / IC₅₀). Accumulation of ROS, depletion of antioxidants, mitochondrial depolarization, ATP reduction, membrane disruption, ultrastructural damage, and apoptosis-like responses were induced by treatment. AgNPs formulation by M. oleifera was found to have promising and selective antileishmanial activity, which is suggested to have antioxidant and mitochondrial dysfunction action. Additional in vivo evaluation is needed.
Moringa oleifera; Silver nanoparticles; Leishmania major; Antileishmanial activity; Oxidative stress
HOST–PATHOGEN INTERACTIONS IN TUBERCULOSIS: A MULTI-OMICS AND ARTIFICIAL INTELLIGENCE PERSPECTIVE
Although much progress has been made on the detection, treatment, and prevention of TB, it remains one of the most lethal infectious diseases globally. M. tuberculosis remains a complex pathogen with highly variable host–pathogen interactions, which have contributed to its persistence over time. These interactions influence susceptibility, immune response, disease course, and treatment outcome, and can vary widely between individuals. While traditional studies have provided useful mechanistic insights, studying individual genes, proteins, or pathways may not be sufficient to understand the complex and heterogeneous disease process. New multi-omics platforms facilitate the study of various biological systems in parallel. Genomics, epigenomics, transcriptomics, proteomics, and metabolomics have all undergone tremendous advances recently, and further advances in single-cell and spatial multi-omics are expected to reveal new dimensions of pathogen biology, host immune response, cellular heterogeneity, and TB-specific signatures. However, interpreting these large and heterogeneous datasets requires specialized tools that allow the extraction of biologically relevant and clinically actionable knowledge from the data. AI and machine learning have emerged as powerful tools for multi-omics data integration, biomarker discovery, risk stratification, and individualized diagnostic and therapeutic applications. Recent progress in host–pathogen interactions, multi-omics, and AI offer unprecedented opportunities to develop precise approaches for TB control. There remain, however, several obstacles to address before these advances can be effectively translated to clinical practice. These include the challenge of understanding the underlying biology, inadequate sample sizes and cohort representativeness, methodological inconsistencies, difficulties in data integration and model interpretability, and unequal availability of technological infrastructure. In this review, we explore the potential of multi-omics and AI to better understand the pathophysiology of TB and its host–pathogen interactions, and support biomarker discovery, risk prediction, and patient-specific disease management. We further consider the main scientific, technical, and implementation barriers that need to be overcome to advance towards clinical application.
Tuberculosis; Mycobacterium tuberculosis; Host–pathogen interactions; Multi-omics; Artificial intelligence; Precision medicine; Biomarkers; Systems biology; Machine learning; Single-cell omics.
VITAMIN D DEFICIENCY AS AN EMERGING RISK FACTORS FOR DIABETIC MELLITUS FROM DISTRICT HOSPITAL HYDERABAD
Deficiency of Vitamin D (Vit D) has been recognised as a common nutritional disorder and recognised as a contributing factor to poor glycemic control and development of complications in those with Type 2 Diabetes Mellitus (T2DM). To find out the prevalence of Vitamin D deficiency and its clinical characteristics in T2DM attending District Hospital Hyderabad. The cross-sectional, observational study was carried out at Civil Hospital Hyderabad and Jeejal Maa Hospital, between July, 2024 and April, 2025. Finally, 62 patients with T2DM were recruited and the demographic parameters, vitamin D status, as well as clinical parameters, were assessed with a structured questionnaire and laboratory investigations were carried out. The samples were collected from 2 hospitals, Civil Hospital Hyderabad (62) & Jeejal Maa Hospital (30) which represents 51.6% & 48.4% respectively from the two hospitals. Twenty-five (40.3%) patients were diagnosed with vitamin D deficiency and 37 (59.7%) had normal vitamin D. Sixty per cent of the vitamin D deficient patients were female (n = 15) while 40 per cent were male (n = 10). The 60–70-year age group had the largest prevalence of vitamin D deficiency (48 %), followed by the 50–60-year age group (32 %) and the 40–50-year age group (20 %). The most common symptoms reported by vitamin D deficient patients were fatigue, joint pain, overweight condition, slow wound healing and mood disorders, where the last two were more common. Based on results, vitamin D deficiency is a prevalent condition in the aged and in women with T2DM and might be a risk factor for poor clinical outcomes. Vitamin D should be part of routine screening in people with diabetes and vitamin D should be supplemented and lifestyle changes made to improve glycemic control and prevent diabetes-related complications. Multicentre studies on a larger scale are recommended to validate these results and reinforce evidence on the use of vitamin D in the care of Type 2 Diabetes Mellitus.
Vitamin D deficiency, Type 2 Diabetes Mellitus, T2DM, Glycemic control, Diabetes, Vitamin D.
PREVENTIVE MEDICINE AND PUBLIC HEALTH STRATEGIES FOR EMERGING HEALTH CHALLENGES
Emerging health challenges, with the rise of outbreaks of infectious disease, antimicrobial disease, environmental hazards and an increased burden of chronic diseases are still putting global health at risk. These challenges underscore the need for effective preventive medicines and public health strategies that reduce risks of disease prior to its onset. Prevention is still among the most cost-effective means of improving population health and strengthening healthcare systems. This study aims to explore the roles of preventive medicine and public health interventions in emerging challenges to global health. A Qualitative analysis of reports and current preventive healthcare practices, relevant literature, health reports, and evidence-based interventions were analyzed to evaluate the effectiveness of vaccination programs, health education, disease surveillance, early screening and community based prevention. The findings show that preventive medicine has a significant impact on reducing the incidence and spread of communicable and non-communicable diseases, the evidence suggests it is a good place to allocate resources. It has been observed that vaccination programs, health awareness campaigns, routine health screenings and early detection strategies have the potential to increase disease control, while reducing healthcare costs. Additionally, public health surveillance systems serve a critical role in early identification of emerging health threats and prompt public health interventions are critical to controlling their spread. Communities that engage in disease prevention are better off health-wise and are able to cope with public health emergencies. In Conclusion, preventive medicine and public health strategies are key tools to manage and to face new health challenges in order to protect the population’s health. Strengthening policies focused on prevention, promoting healthy habits and investing in public health infrastructure are key elements to face disease and to improve people’s quality of life in a sustainable way in order to support healthcare systems in the long term. As always, prevention is better than cure and it is essential to create healthier populations to face future health risks.
Preventive Medicine; Public Health; Health Promotion; Early Diagnosis
COMPARISON AND SYNERGISTIC EFFECT OF HOMEOPATHIC AND ALLOPATHIC DRUGS USED FOR THE TREATMENT OF TYPHOID FEVER
Enteric fever (typhoid), which annually affects millions of people and results in a considerable number of deaths, represents a serious challenge to the world. The causative agent, Salmonella typhi, has evolved a resistance to conventional medicines. In order to combat S. typhi, this study explores the synergistic potential of homoeopathic and allopathic medicine. Disc diffusion method was used in the study to evaluate the antimicrobial sensitivity of homeopathic medicine i.e. Baptisia, Gelsemium, Belladonna, and Rhustox. The results showed zones of inhibition of 12 mm, 15 mm, 15 mm, and 19 mm, respectively. MIC and MBC values of 64 µg/ml and 256 µg/ml for Gelsemium and Baptisia respectively showed strong inhibition. Combining several homoeopathic drugs with antibiotics to combat S. typhi was evaluated in this study; results showed synergy with Belladonna, neutrality with Rhustox and Gelsemium, and antagonism with Baptisia. Overall, the research suggests homeopathy's potential in the fight against multi drug resistant S. typhi.
Salmonella typhi, Synergistic effects, Disc diffusion method, Baptisia, Gelsemium, Belladonna, Rhustox, MDR, Homoeopathy, Allopathy, Enteric fever
ASSOCIATION OF TRIGLYCERIDE-GLUCOSE INDEX (TYG) WITH SHORT-TERM OUTCOME OF ISCHEMIC STROKE
Background: Acute ischemic stroke is a major cause of mortality and disability, and metabolic abnormalities may influence short-term outcomes. The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance that may have prognostic value in ischemic stroke. This study evaluated the association between TyG index and short-term mortality among patients with ischemic stroke. Objective: To determine the association of triglyceride-glucose index with 28-day mortality among patients with acute ischemic stroke. Methods: A prospective cohort study was conducted among 136 patients aged 40–80 years admitted with ischemic stroke to the Department of Medicine, Khyber Teaching Hospital, Peshawar. Patients were categorized into high TyG (>9.15) and low TyG (≤9.15) groups. Fasting serum glucose and triglyceride levels were measured and TyG was calculated using the standard formula. Patients were followed for 28 days. Data were analyzed using IBM SPSS version 24. Descriptive statistics, chi-square/Fisher's exact test, independent-samples t-test or Mann-Whitney U test, and relative risk with 95% confidence interval were used. Results: Mortality occurred in 17 (25.0%) patients with high TyG compared with 5 (7.4%) patients with low TyG (p=0.003). High TyG was associated with increased mortality risk (RR=3.40, 95% CI: 1.34–8.63). Conclusion: A high TyG index was associated with increased 28-day mortality and may be a useful, inexpensive prognostic marker in acute ischemic stroke.
Triglyceride-glucose index; Ischemic stroke; Insulin resistance; Mortality.
EVALUATION OF COMMERCIAL AND CONSUMER PRACTICES CONTRIBUTING TO FISH ASSOCIATED CHOLERA RISK IN KARACHI: A CROSS-SECTIONAL STUDY
Background: Vibrio cholerae produces cholera which is an endemic health problem in the low and mid level income countries; conditions of poor food safety and poor sanitation systems pose threat to cholera outbreaks in these countries. Water systems and cholera outbreaks have a well established relationship; however, fish and seafood in the urban areas can be a potential exposure source. Objective: This study aims to quantify the risk of cholera associated with fish from the market and among fish consumers in Karachi, Pakistan. Method: A cross sectional study was designed to observe 10 different retail fish markets in Karachi that also includes a survey consisting of three hundred households. Results: During current survey it was found that 40% of the markets had no proper waste disposal systems and no running water, while 50% of the markets had no fish refrigeration systems, and cross contamination was seen in 50% of the markets. From the surveyed households, 65% of respondents stored fish at room temperature for more than 2 hours, 42% cleaned fish with potentially unsafe water, and only 33% used clean utensils to handle raw fish. The average risk score of the surveyed households was 6.3±1.7 that showed 52% were in a high risk category. Low risk awareness, absence of refrigeration, cross contamination, prolonged ambient storage, and unsafe washing practices were considered high risk practices among respondents (p<0.05). Conclusion: These practices indicated that the risk of cholera is high with both poor supply chain practices as well as with urban poor public health practices. To reduce potential exposure and related threats to public health in urban areas fish market infrastructure, refrigeration systems, and fish supply chain systems, along with regulatory systems and public education, should be improved.
Cholera, risk assessment, marketing, behavior, seafood
NUTRIMORINGA SUPERFOOD: EXPLORING ITS POTENTIAL BIOLOGICAL PROPERTIES IN COMBINATION WITH CHAMOMILE HERBAL TEA
Moringa, often referred to as the "Miracle Tree" or the "Tree of Life," is a highly nutritious plant that has been gaining more popularity in recent years due to its medicinally important nutrition profile,. It is abundant in essential nutrients such as vitamin C, vitamin A, potassium, magnesium, calcium, iron, proteins, and antioxidants. This plant has been cultivated in various regions, including Pakistan, India, and Bangladesh, owing to its numerous potential health benefits, moringa is recognized as a super food with potential anticancer properties. However, it is crucial to consider both the benefits and potential drawbacks of incorporating moringa and chamomile flowers into regular diet, particularly in relation to specific health conditions. Moringa also contains a variety of phytochemicals, such as Gallic acid, Quercetin, Kaempferol, glucosinolates, Niazimicin, moringine, caffeic acid, ascorbic acid, and ellagic acid, which may offer potential immunity boosting, anticancer, anti-inflammatory, and anti-aging effects. On the other hand, chamomile flowers are rich in epigenin, a compound known for its significant anticancer properties, functioning through mechanisms like apoptosis induction, autophagy promotion, and immune function enhancement. This review article address the potential health benefits of moringa, including its anti-inflammatory, anticancer, anti-aging, cardiotonic, antidiabetic, anti-obesity properties, while also addressing its combination with other dietary supplements, such as chamomile flower infusion tea, and their collective immunity boosting, anti-insomnia and anticancer benefits when integrated into the diet.
moringa, miracle tree, tree of life, anticancer, antioxidants, chamomile flowers, moringa and chamomile infusion tea
THE NURSES COMPLIANCE AND BARRIERS REGARDING PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA
Background: Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection in intensive care units (ICUs), leading to increased morbidity, mortality, and healthcare costs. Nurses play a pivotal role in preventing VAP through adherence to evidence-based practices. Compliance with preventive guidelines is influenced by individual, educational, and organizational factors, while barriers such as staff shortages, lack of resources, and insufficient training may limit effective implementation. Understanding these factors is critical to improving patient outcomes and ICU care quality. Aim: The study aimed to assess nurses’ compliance with VAP prevention guidelines and identify associated barriers in adult ICUs of public hospitals in Lahore, Pakistan. Methods: A cross-sectional descriptive study was conducted among 115 nurses working in six public hospitals in Lahore. Data were collected using a structured, close-ended questionnaire covering demographic characteristics, compliance with 17 VAP prevention guidelines, and perceived barriers related to hospital policies, education, and nurse-related factors. Descriptive statistics, including frequencies and percentages, were used to summarize compliance, while inferential statistics analyzed associations between demographic factors, training, and adherence. Results: High compliance was observed for basic practices such as hand hygiene (83.5%), glove use (86.1%), oral care (90.4%), and semi-Fowler positioning (86.1%). Lower compliance was noted for subglottic secretion suctioning (15.7%) and use of heat and moisture exchange humidifiers (53%). Major barriers included staff shortages (82.6%), unavailability of resources (67%), lack of continuous education (48.7%), and fear of adverse patient outcomes (56.5%). Nurses with prior training demonstrated better adherence to VAP prevention guidelines. Conclusion: While basic preventive measures were well adhered to, specialized interventions showed lower compliance. Organizational, educational, and nurse-related barriers significantly impacted adherence. Structured training, adequate staffing, resource availability, and institutional support are essential to enhance compliance and reduce VAP incidence.
Ventilator-associated pneumonia, ICU nurses, compliance, barriers, prevention, public hospitals, Pakistan
PERIOPERATIVE FACTORS ASSOCIATED WITH EARLY POSTOPERATIVE RECOVERY AFTER UROLOGICAL PROCEDURES: A SINGLE-CENTER PROSPECTIVE OBSERVATIONAL STUDY
Background: Early postoperative recovery after urological surgery may be influenced by patient characteristics, surgical factors, anesthetic technique, and perioperative care. This study assessed the association between selected perioperative factors and recovery outcomes during the first 24 hours after elective urological procedures. Methods: A single-center prospective observational study was conducted at the Institute of Kidney Diseases, Peshawar, from September 2025 to February 2026. Fifty adults undergoing elective urological procedures were included. Data were collected during the preoperative, intraoperative, and postoperative periods. The recorded variables included age, sex, body mass index, American Society of Anesthesiologists physical status, preoperative fasting duration, carbohydrate loading, surgical approach, procedure type, anesthetic technique, and opioid-sparing practice. Recovery outcomes included the Quality of Recovery-15 score, postoperative pain, postoperative nausea and vomiting, time to first solid food intake, time to first mobilization, and postoperative opioid requirement. Data were analyzed using IBM SPSS Statistics version 27. Nonparametric tests, correlation analysis, chi-square tests, and Fisher’s exact tests were applied according to the type of variable. Results: Among the 50 participants, 34 were male (68%) and 16 were female (32%). The mean age was 47.0 years, and the mean body mass index was (21.38 \pm 2.22\ \{kg/m^2}). Twenty-three participants (46%) had American Society of Anesthesiologists physical status I, and 27 (54%) had physical status II. Regional anesthesia was used in 37 participants (74%), whereas 13 (26%) received general anesthesia. Body mass index showed a statistically significant negative correlation with the total Quality of Recovery-15 score ((r=-0.381), (p=0.006)). American Society of Anesthesiologists physical status was significantly associated with time to first mobilization ((tau b=0.404), (p=0.001)), but not with Quality of Recovery-15 score, postoperative pain, or time to first solid food intake. Surgical approach was associated with time to first mobilization ((p<0.001), and post hoc analysis showed a significant difference between endoscopic and open approaches after Bonferroni adjustment. Procedure type was associated with time to first solid food intake ((p=0.003)) and time to first mobilization ((p<0.001)), but not with Quality of Recovery-15 score ((p=0.052)) or postoperative pain ((p=0.324)). Anesthesia type was associated with postoperative opioid requirement in the unadjusted analysis ((p<0.001)). No statistically significant association was reported between the examined variables and postoperative nausea and vomiting. Conclusion: Selected patient, surgical, and anesthetic factors were associated with specific early postoperative outcomes. Higher body mass index was associated with a lower Quality of Recovery-15 score, while surgical approach and procedure type were associated with early mobilization and oral intake. Anesthesia type was associated with postoperative opioid requirement. These findings should be interpreted as preliminary associations because the study was small, observational, and based on unadjusted analyses.
Urological Surgery; Postoperative Recovery; Quality Of Recovery-15; Anesthesia; Postoperative Nausea And Vomiting; Mobilization; Opioid Requirement
KNOWLEDGE AND BELIEF OF WOMEN REGARDING THE COMPLICATIONS OF CESAREAN SECTION
Background: Cesarean section is one of the most commonly performed obstetric procedures worldwide. Although it can be lifesaving when medically indicated, it may be associated with complications such as infection, excessive bleeding, postoperative pain, wound complications, anesthesia-related problems, and delayed recovery. Adequate knowledge and appropriate beliefs may support informed decision-making and postoperative care. Aim: The study aimed to assess the knowledge and beliefs of women regarding complications of cesarean section at Jinnah Hospital, Lahore. Methods: A descriptive cross-sectional design was used among 240 women at Jinnah Hospital, Lahore. The sample size was calculated using the Raosoft calculator based on a population of 500, with a 95% confidence level and 5% margin of error. Participants were recruited through consecutive sampling. Data were collected using a structured questionnaire and analyzed using SPSS version 27. Descriptive and inferential statistics were applied, with significance set at p < .05. Results: Most participants were aged 26–35 years (42.1%), had secondary education (27.9%), and lived in urban areas (59.6%). Previous cesarean experience was reported by 63.3%. Overall, 49.6% had moderate knowledge, 30.4% had good knowledge, and 20.0% had poor knowledge. Favorable beliefs were reported by 44.6%. Education, residence, and previous cesarean experience were significantly associated with knowledge and beliefs. Conclusion: Women demonstrated moderate knowledge and generally favorable beliefs regarding cesarean-section complications. Structured maternal education and counseling were recommended.
Cesarean section, knowledge, beliefs, complications, women, maternal health, nursing education
EVALUATION OF LIVER ENZYME ABNORMALITIES IN DENGUE FEVER: A COMPARATIVE CLINICAL STUDY OF 2024 AND 2025 IN ISLAMABAD
Background: Dengue fever represents an escalating public health burden in Pakistan, with national case counts exceeding 20,000 in 2024 and Islamabad consistently reporting substantial annual epidemic activity. Hepatic dysfunction, marked by elevation of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), is among the most clinically significant systemic complications of dengue infection and can progress to acute liver failure in severe presentations. Objective: This study compared the prevalence, severity, and pattern of hepatic dysfunction between two consecutive dengue epidemic seasons in Islamabad, Pakistan, and determined whether hepatic involvement changed significantly between 2024 and 2025. Methods: A retrospective comparative cohort design was used, incorporating 224 NS1-positive dengue patients (112 per year) from Islamabad. Age, gender, NS1 antigen value, ALT, and AST were recorded for each patient. Data were analyzed in SPSS using descriptive statistics, the Shapiro-Wilk test, the Independent Samples t-test, the Mann-Whitney U test, the chi-square test, Fisher's exact test, and Pearson correlation, with p < .05 considered statistically significant. Ethical approval was granted by the Health Sciences/Technology Ethics Review Committee of National Skills University, Islamabad, and a waiver of informed consent was obtained for this retrospective, de-identified dataset. Results: Mean ALT rose from 43.71 ± 22.28 U/L in 2024 to 55.55 ± 44.66 U/L in 2025 (t(222) = −2.512, p = .013, 95% CI for the mean difference [2.55, 21.13], d = 0.34), and mean AST rose from 48.99 ± 35.17 U/L to 72.31 ± 77.01 U/L (t(222) = −2.915, p = .004, 95% CI [7.55, 39.09], d = 0.39). Moderate ALT elevation increased more than fourfold (4.5% to 20.5%; χ²(2) = 13.333, p = .001, Cramér's V = 0.24), and moderate AST elevation doubled (12.5% to 25.0%; χ²(3) = 11.595, p = .009, Cramér's V = 0.23); one case of severe AST elevation (>310 U/L) occurred in 2025 versus none in 2024. Mann-Whitney U testing showed no significant difference in ALT (p = .916) or AST (p = .665) rank distributions, and median values were essentially unchanged between years, indicating that the mean-level worsening was driven by a growing subgroup of more severely affected patients rather than a shift across the whole cohort. NS1 antigen level correlated weakly with ALT (r = .186, p = .049) and AST (r = .190, p = .045) in the 2024 cohort only; this association was absent in 2025. ALT and AST were strongly correlated with one another in both years (r = .955–.970, p < .001). Gender distribution did not differ significantly between years (χ²(1) = 1.956, p = .162), although the 2025 cohort included a wider age range with more pediatric and elderly patients. Conclusion: Hepatic dysfunction among dengue patients in Islamabad worsened significantly between 2024 and 2025, with a growing minority of patients developing moderate-to-severe transaminase elevation. These findings support incorporating routine liver function testing into standard dengue case management in Islamabad, and potentially more broadly across Pakistan, to enable earlier identification of patients at risk of hepatic complications.
Dengue fever; hepatic dysfunction; alanine aminotransferase; aspartate aminotransferase; NS1 antigen
MANAGERIAL PERSPECTIVES ON QUALITY IMPROVEMENT PRACTICES IN TERTIARY CARE HOSPITALS IN PAKISTAN: A COMPARATIVE STUDY OF LAHORE AND MULTAN
This research explores management viewpoints on quality enhancement methods in tertiary care hospitals located in two key cities of Pakistan: Lahore and Multan. Using a mixed-methods approach that includes surveys and interviews with 120 healthcare managers, this study highlights significant differences in the implementation of quality improvement, challenges faced, and outcomes achieved across these metropolitan healthcare systems. The results indicate notable differences in resource distribution, employee training, patient satisfaction levels, and technology implementation. Hospitals in Lahore exhibited greater adherence to international quality standards (78% compared to 62%), whereas hospitals in Multan displayed more robust community engagement efforts (85% versus 71%). The research offers practical recommendations for healthcare managers aiming to improve quality enhancement strategies in tertiary care facilities across Pakistan
Quality Improvement, Tertiary Care, Healthcare Management, Pakistan, Lahore, Multan, Hospital Administration