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
LIVED EXPERIENCES OF PATIENTS WITH TYPE 2 DIABETES MELLITUS: A QUALITATIVE SYSTEMATIC REVIEW AND META-SYNTHESIS IN GLOBAL AND LMIC CONTEXTS
Background: Type 2 diabetes mellitus (T2DM) is a major global and LMIC health challenge with profound psychosocial and health-system consequences. Qualitative research explains how patients interpret and live with T2DM, but findings are dispersed across settings. Objective: To systematically review and meta-synthesize qualitative evidence on adults lived experiences of T2DM, highlighting common themes and LMIC-specific constraints. Methods: We conducted a qualitative systematic review and thematic meta-synthesis. We searched PubMed/MEDLINE, CINAHL, Scopus, Web of Science and Google Scholar (January 2005–October 2025) for English-language qualitative studies involving adults with T2DM. Study quality was appraised using the CASP checklist. Findings were synthesised using inductive coding and thematic synthesis informed by Braun and Clarke. Results: Twenty-five studies met inclusion criteria. Seven analytical themes were generated: (1) emotional and psychological impact; (2) cultural beliefs, knowledge and misconceptions; (3) social support, stigma and relationships; (4) physical and functional burden; (5) self-management challenges and coping strategies; (6) financial constraints; and (7) healthcare system experiences. Across contexts, fear of complications, treatment fatigue and difficulty sustaining lifestyle change were pervasive. In LMICs, these were amplified by cost, misinformation, limited access to monitoring, and system constraints such as overcrowding and stock-outs. Conclusion: T2DM is lived as a long-term biopsychosocial condition. Diabetes services should incorporate psychosocial care, culturally tailored education, family-inclusive strategies, and health-system strengthening to reduce structural barriers in LMIC settings.
ASSESSING PARENTAL AWARENESS, KNOWLEDGE, AND PERCEPTIONS OF IONIZING RADIATION RISKS IN PEDIATRIC MEDICAL IMAGING IN THE HOSPITAL OF KARACHI
With the advancement in medical imaging, radiological applications in the pediatric population have also increased. Children, generally more radiosensitive, have a higher risk of developing certain malignancies. Therefore, this may result in uneasiness among parents and caretakers when their children need to undergo a medical imaging examination. Hence, the study aims to evaluate parental knowledge regarding medical radiation and associated risks in pediatric medical imaging. A descriptive cross-sectional quantitative research design was employed. The research was carried out within the radiology units of a chosen hospital, among parents or guardians of children who are undergoing imaging tests that utilize radiation (e.g., X-rays or computer tomography scans). A convenience sampling method was used with a sample size of 150. Information was gathered through a structured, validated questionnaire which was pre-tested. Ethical approval was obtained from the IRB. Data were examined using SPSS, employing both descriptive and inferential statistics. Results show most parents showed limited awareness and understanding of the risks of ionizing radiation in pediatric medical imaging. While some had basic knowledge, many underestimated potential harms. Communication from healthcare providers was present but often unclear, leaving gaps in parental understanding. Overall, the findings highlight the need for improved education and clearer explanations to help parents make informed decisions. In conclusion, results will help improve communication between doctors and parents, raise awareness, and support safer imaging practices for children. It will also guide hospitals and policymakers in Pakistan to create better educational tools and safety guidelines, ultimately benefiting children, families, and healthcare workers.
DATA-DRIVEN DECISION SUPPORT SYSTEMS IN PERVASIVE HEALTHCARE: BALANCING INNOVATION, PRIVACY, AND SUSTAINABILITY: A COMMENTARY
This commentary systematically explores how Data‑Driven Decision Support Systems (DSS) in pervasive healthcare reconcile innovation with privacy and sustainability. It highlights technical approaches—such as cross-source data fusion using enhanced Dempster–Shafer theory, federated learning, and homomorphic encryption—while analyzing specific case studies in ophthalmology (e.g., retinal disease detection models), MRI, and CT imaging that demonstrate real-world implementation strategies. The paper also reviews solutions to core issues like data cleaning, encryption optimization, algorithmic explainability, and ecological footprint mitigation. The commentary concludes that successful DSS adoption depends on integrative technical frameworks supported by cross-disciplinary collaboration and transparent governance.
IMMUNOTHERAPY COMBINATIONS IN STAGE IV CANCER: SYNERGISTIC EFFECTS AND CLINICAL OUTCOMES
Objective: The research aimed to evaluate the synergistic effects of combining various immunotherapies for treating stage IV cancer. Specifically, the study sought to determine whether combination therapies could improve clinical outcomes, slow tumor progression, and increase overall survival rates in advanced cancer patients. Methods: A prospective, randomized controlled trial was conducted at a tertiary care hospital in Pakistan, involving 100 patients diagnosed with stage IV cancer. The patients were randomly assigned into two groups: Group A (combination therapy) receiving Pembrolizumab (200 mg every 3 weeks) and Ipilimumab (3 mg/kg every 3 weeks), and Group B (monotherapy) receiving Pembrolizumab alone (200 mg every 3 weeks). Tumor response was assessed using RECIST 1.1 criteria, while progression-free survival (PFS) and overall survival (OS) were evaluated as primary and secondary endpoints, respectively. Adverse events were monitored using the CTCAE scale, and quality of life (QoL) was assessed using the EORTC QLQ-C30 questionnaire. Data were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards models. Results: The results revealed that combination immunotherapies significantly reduced tumor progression and improved survival rates compared to single-agent treatments. Patients receiving combination therapies exhibited a better response rate, with 45% showing a complete or partial response to the treatment, compared to 30% in the monotherapy group. Conclusion: The study concluded that combining immunotherapies in stage IV cancer patients resulted in a synergistic effect, enhancing clinical outcomes and improving overall survival rates. The findings support the potential of combination therapies as a viable treatment option for advanced cancers, warranting further investigation.
EFFECTS OF ACUTE EXERCISE ON CARDIOVASCULAR FUNCTION IN YOUNG ADULTS: A CROSS-SECTIONAL STUDY
Objective: This cross-sectional study examines the acute effects of different types of exercise on cardiovascular function in young adults. By analyzing heart rate, blood pressure, and vascular response before and after exercise, the study aims to explore how various forms of physical activity (aerobic, resistance, and flexibility exercises) influence cardiovascular health in the short term. The findings could contribute to optimizing exercise prescriptions for enhancing cardiovascular health. Methods: The study was carried out at a tertiary care center in Sindh, Pakistan, involving healthy young adults aged 18–30 years. Participants were stratified into three groups based on exercise modality: aerobic exercise, resistance training, and flexibility-based exercise. Baseline cardiovascular parameters, including resting heart rate, systolic and diastolic blood pressure, and vascular responsiveness, were measured prior to exercise. Post-exercise measurements were recorded immediately and after a standardized recovery period. Statistical analysis was performed to compare pre- and post-exercise cardiovascular responses across exercise types. Results: Acute aerobic exercise produced a significant increase in heart rate and systolic blood pressure immediately post-exercise, followed by a rapid recovery phase. Resistance exercise resulted in higher transient elevations in both systolic and diastolic blood pressure compared to other modalities. Flexibility exercises demonstrated minimal cardiovascular stress, with modest improvements in vascular responsiveness. Statistically significant differences were observed among exercise modalities in terms of cardiovascular load and recovery dynamics (p < 0.05). Conclusion: The findings indicated that different forms of acute exercise elicited distinct cardiovascular responses in young adults. Aerobic exercise primarily enhanced heart rate dynamics and vascular function, resistance training induced greater blood pressure fluctuations, and flexibility exercise offered cardiovascular benefits with minimal hemodynamic strain. These results supported the importance of exercise-specific prescriptions for optimizing short-term cardiovascular health in young adults
THE PSYCHOLOGICAL BURDEN OF LOWER LIMB AMPUTATION IN DIABETES: EXPLORING LEVELS OF DEPRESSION AND ANXIETY
Background: This study aimed to determine the prevalence of depression and anxiety among diabetic patients with lower limb amputation in various areas of District Swabi. Beck’s Depression Inventory (BDI) and the Generalized Anxiety Disorder-7 (GAD-7) scale were used for assessment. Methodology: A simple quantitative cross-sectional design was used. The study was conducted in different regions of District Swabi using a convenient sampling technique. A total of 169 diabetic patients were included, with the sample size calculated through the Raosoft calculator. Patients who had undergone lower limb amputation more than two months prior were eligible, while those with amputations less than two months, ICU patients, and individuals with systemic diseases were excluded. Data was collected using validated questionnaires and analyzed through SPSS version 23. Results: Out of 169 participants, 137 were male (81.1%) and 32 were female (18.9%). The most common amputation level was ankle disarticulation (79 participants; 46.7%), followed by transtibial (56; 33.1%) and knee disarticulation (34; 20.1%). Severe depression was reported by 96 participants (56.8%) on the BDI scale, while 79 participants (46.7%) had severe anxiety on the GAD-7 scale. Mean age was 3.14 ± 0.76, BDI mean score was 4.5 ± 0.61, and GAD mean score was 3.31 ± 0.72. Conclusion: Most diabetic amputees in this study had ankle disarticulation and demonstrated severe levels of depression and anxiety on standardized scales.
amputation, diabetes, depression, anxiety
THE EFFECTS OF REGULAR EXERCISE ON MENTAL HEALTH AND DEVELOPMENT OF KPK UNIVERSITY STUDENTS
Background: Mental disorders represent a major public health concern, affecting a significant proportion of the global population and contributing to substantial healthcare costs and disability. Physical activity has been recognized as a critical factor in promoting mental and physical well-being. University students are particularly vulnerable to stress and mental health challenges, and their physical activity patterns can influence both mental health outcomes and overall life satisfaction. Objective: This study aimed to examine the relationship between regular physical activity, sedentary behavior, and indicators of mental health, quality of life, and life satisfaction among university students. Methods: A descriptive study was conducted with 352 students from various private universities in Khyber Pakhtunkhwa, Pakistan. The International Physical Activity Questionnaire (IPAQ) assessed physical activity across multiple domains, including leisure, transport, domestic, and work-related activities, along with sedentary behavior. Quality of life was measured using the Comprehensive Quality of Life Scale Adult (ComQol-A5), which assesses seven domains: material well-being, health, productivity, intimacy, safety, place in community and emotional well-being. Demographic data included age, gender and type of education. Data were analyzed using SPSS, with descriptive statistics, correlation analyses and regression models to explore associations between physical activity and mental health outcomes. Results: Most participants reported moderate to high levels of physical activity, with average weekly energy expenditure of 1,750 ± 520 MET-min/week. Life satisfaction and overall quality of life scores were significantly higher among participants engaging in higher levels of recreational and transport-related physical activity (p < 0.05). Sedentary behavior during weekends was negatively correlated with mental health indicators (r = -0.43, p = 0.03). Regression analysis revealed that recreational physical activity predicted 28% of the variance in life satisfaction, controlling gender and type of education (β = 0.53, p = 0.01). Conclusion: Regular engagement in physical activity, particularly recreational and transport-related activities, is positively associated with improved mental health, quality of life, and life satisfaction in university students. Strategies to reduce sedentary behavior and promote active lifestyles in university settings are warranted to enhance student development.
Physical activity, mental health, university students, quality of life, life satisfaction, sedentary behavior.
ASSESSMENT OF ANTIOXIDANTS ACTIVITY IN SEVEN WHEAT GENOTYPES GROWN UNDER NACL SALINITY
Salinity, drought, temperature variation, nutrient disproportion, chemical toxicity and oxidative stress are the very important environmental problems that effect crop productivity in the whole world. A sand culture experiment was carried out in a wire house of old Botanical Garden, University of Agriculture, Faisalabad. Seven genotypes of wheat were collected from Ayub Agricultural Research Institute, Faisalabad that was Parwaz 94, Faisalabad-83, Punjab-96, Iqbal 2000, SH- 2002, AS- 2002 and Lasani- 08. Seeds were sown in plastic pots containing 10 kg of thoroughly washed sand and irrigated with full strength Hoagland’s nutrient solution. The experiment was laid out in completely randomized design (CRD) factorial with 3 replications. Two salt levels i.e. 0 and 150 mM L-1 were applied to establish salt stress conditions. After germination, the seedlings were treated with salinity. Antioxidants are the substances that counteract oxidative stress in plants subjected to some abiotic menace due to up regulation of reactive oxygen species. Antioxidants slow down lipid per-oxidation processes and thus shield biological membranes. It is believed that plants with high antioxidant levels have better confrontation to reactive oxygen species. In present studies we checked the effect of salinity on production of antioxidant species in wheat. The main objective of this study was to check the activity of antioxidants under NaCl stress. In current study the antioxidant (SOD, POD, CAT) activity was enhanced under NaCl stress.
Wheat, salinity, hoagland’s solution, antioxidants, stress, environmental toxicity
PREVALENCE AND ASSOCIATED RISK FACTORS OF VIRAL HEPATITIS IN THE KHAIRPUR REGION, PAKISTAN
Viral hepatitis remains a serious public health concern in Pakistan, particularly in the Sindh province where unsafe medical practices and insufficient awareness contribute to high infection rates. This cross-sectional study was conducted to investigate the prevalence and associated risk factors of viral hepatitis among diagnosed patients in the Khairpur region. Purposive sampling was used to choose 500 confirmed hepatitis patients from university and different hospitals of Khairpur Mir's. A standardized questionnaire covering demographics, exposure history, clinical symptoms, and type of hepatitis was used to gather data. The results showed that males accounted for 79% of the cases, with teens and young adults having the highest prevalence. The most prevalent form was found to be Hepatitis C, which was followed by Hepatitis B. Several major risk factors were identified, including previous blood transfusions (44%), family contact with sick patients (50%), and inadequate understanding regarding transmission channels. Despite most participants having access to safe drinking water (66%), a majority lacked basic knowledge of hepatitis prevention (66%). Fever (30%), weariness (22%), abdominal discomfort (15%), Jaundice (10%), and joint pain (8%) were the most commonly reported symptoms. In order to stop the development of hepatitis in Khairpur, the study emphasizes the critical need for better awareness campaigns, safer medical procedures, and regular screening. Reducing community transmission requires increasing vaccination rates and enforcing stringent sanitation procedures in medical facilities. Further study with bigger sample sizes is recommended to explore changing epidemiological trends and increase public health interventions.
Hepatitis, Prevalence, Risk factors, Healthcare practices, public health
IDENTIFICATION OF PROGNOSTIC MARKERS AND SEVERITY PREDICTORS IN ORGANOPHOSPHORUS POISONING: EVIDENCE FROM TERTIARY CARE HOSPITALS IN PESHAWAR
Background: In areas where pesticides are widely used, such as agriculture, organophosphate poisoning is still a major public health risk. If not treated quickly and efficiently, it is linked to high rates of morbidity and mortality. Objective: This study aims to identify clinical and laboratory prognostic markers in patients with organophosphorus (OP) poisoning and to assess their association with key outcomes, including hospital stay, ICU admission, and mortality. The findings are intended to guide the development of evidence-based recommendations for early risk assessment and triage in OP poisoning cases. Method: A total of 109 patients who had been diagnosed with organophosphate toxicity participated in prospective observational research. Descriptive and inferential statistics were used to gather and analyze data on outcome, clinical presentation, exposure intent, treatment methods, and demographics. Results: This study examined 109 poisoning cases in all. All of the instances were reported from Peshawar, and the patients were mostly young and female. Students and housewives were the occupational groups most impacted, and the majority of exposures were purposeful (suicidal). In the majority of instances, prompt hospitalization and adherence to prescribed treatment plans had positive short-term clinical results. Treatment: The cornerstone of treatment was standardized atropine and pralidoxime administration, which was complemented by supportive care, such as ventilator support when necessary, and produced positive results.
Organophosphate poisoning, atropine, pralidoxime, pesticide exposure, GCS Score, POP Score, Pupil Size.
ASSESSING THE KNOWLEDGE AND ATTITUDES OF ICU HEALTHCARE PROVIDERS TOWARDS VAP PREVENTION AND MANAGEMENT AT TERTIARY CARE HOSPITALS PESHAWAR
Ventilator-associated pneumonia (VAP) is a well-recognized and prophylactic disease in intensive care units (ICUs), which leads to bad patient outcome and cost to health care. Prevention of this is based on the attitudes and knowledge of the healthcare providers in ICU. Intermittent infection control policies and staff training in resource-strained environments, such as Pakistan, help to perpetuate excessive VAP. Knowledge about the awareness and views of ICU staffs is also necessary in promoting care and minimizing the infection rates. Methods: An observational study or a cross-sectional study was carried out on 109 sample size in ICU health workers like doctors, nurses, and respiratory therapists working in tertiary care hospitals across the city of Peshawar. Information was obtained with the help of a structured questionnaire and analyzed in SPSS version 25. Objectives: To identify knowledge and beliefs of ICU healthcare provider concerning the prevention, and management of Ventilator-Associated Pneumonia (VAP). Results: Although 70.6 percent of them knew when VAP occurred, or when a patient contracted it, i.e., after 48 hours of intubation, 56 of them did not know the right frequency of oral care, and 68.8 of them did not understand that regular antibiotics use was incorporated in the VAP bundle. It is worth noting that only 54.1 percent were never trained in VAP formally. Attitudinally, 63.3% were motivated to adhere to the protocols however the support and training given by the institutions differ widely. Conclusion: Even though ICU staff has a partial understanding of VAP, there are knowledge gaps that result to ineffective prevention as well as training lacking consistency. The organization and educational support through appropriate resources and policies will also play an important role in enhancing compliance and lowering the incidence of VAP in ICUs.
Pneumonia, associative ventilator, staffs of ICU, infection control, attitude to health care, stop VAP, tertiary hospitals, Pakistan.
COMPARISON OF GENERAL ANESTHESIA WITH SPINAL ANESTHESIA ON THE QUALITY OF RECOVERY WITH CHANGE IN HEMODYNAMICS OF PATIENTS WITH ABDOMINAL HYSTERECTOMY
Background: The choice between general anaesthesia (GA) and spinal anaesthesia (SA) during abdominal hysterectomy remains clinically significant, as each technique has distinct physiologic effects that may influence intraoperative stability and postoperative recovery. Existing evidence remains heterogeneous, and clarity is particularly needed in low-resource settings where open hysterectomy is common and anaesthetic decisions directly affect patient outcomes. Objective: To compare the effects of GA and SA on perioperative hemodynamic and early postoperative recovery among women undergoing elective abdominal hysterectomy. Methods: A comparative cross-sectional study including 30 women (15 GA, 15 SA) was conducted at DHQ Hospital Mianwali, Pakistan. Eligible participants were ASA class I–II and aged 35–70 years. Heart rate, systolic and diastolic blood pressure, and oxygen saturation were recorded at recovery entry, recovery exit, and during recovery. Data were analysed using SPSS v27.0.1, with p < 0.05 considered statistically significant. Results: Baseline demographics, including age and BMI, were comparable between groups. Hemodynamic parameters demonstrated similar patterns in GA and SA across all timepoints. Heart rate remained <120 bpm in 56.7% at entry and 70.0% at exit, with no group differences (p = 0.70–1.00). Systolic blood pressure exceeded 80 mmHg in 73.3% at entry and exit, and in 80.0% during recovery, again without significant differences (p = 0.68–1.00). Diastolic pressure and oxygen saturation also showed no significant intergroup variation, with SpO₂ >92% increasing from 80.0% at entry to 93.3% at exit. Across all parameters, GA and SA yielded statistically equivalent recovery-phase stability. Conclusion: General and spinal anaesthesia produced comparable hemodynamic stability and early recovery profiles in ASA I–II women undergoing abdominal hysterectomy. These findings suggest that, under standardized perioperative care, anaesthetic technique may not independently determine early physiological recovery. Anaesthetic choice should therefore be individualized, considering patient characteristics, surgical requirements, and resource context. Larger multicentre studies with extended follow-up are warranted to confirm long-term and patient-reported outcomes.
General anaesthesia, spinal anaesthesia, abdominal hysterectomy, hemodynamic stability, postoperative recovery, perioperative care.
BACTERIAL CONTAMINATION IN STORED BLOOD PRODUCTS AT HEMATOLOGY LAB OF HAYATABAD MEDICAL COMPLEX PESHAWAR
BURNOUT, RESILIENCE AND LIFE SATISFACTION AMONG DOCTORS WORKING WITH HIGH-RISK PATIENTS
Burnout has become a major problem among doctors that negatively affects not only the individual and the patients, but also the healthcare systems. Burned-out doctors show an increased likelihood of generating errors and poor decision-making. Doctors who possess resilience, along with life satisfaction, are less prone to stressors, thus preventing them from burnout. This study aimed to analyze the correlations between burnout, resilience, and life satisfaction among doctors (N = 151, Mage = 26.32; SD = 2.864) dealing with high-risk patients in the Medicine and Surgery departments of Allied Hospitals 1 and 2, Faisalabad, Pakistan. The data were collected using validated self-report questionnaires, including the Copenhagen Burnout Inventory (CBI), the Brief Resilience Scale, and the Satisfaction with Life Scale. Data was analyzed using both the Pearson Correlation Coefficient and hierarchical regression techniques. The results reveal a positive and significant relationship between resilience and life satisfaction (r = 0.42, p<0.001), while it also reports a significant negative relationship between resilience and burnout (r = -0.18, p<0.05). Similarly, results also showed a negative association between burnout and life satisfaction (r = -0.36, p<0.001). Overall results also showed that both resilience (β = 0.39, p < 0.001) and personal burnout (β = -0.32, p < 0.001) significantly predicted life satisfaction. These findings have implications for doctors and healthcare administrators in enhancing and enforcing programs that train doctors on resilience skills.
Burnout, Resilience, Life satisfaction, Doctors, High Risk Patients, Medicine and Surgery Department
COMPARISON BETWEEN THE USE OF ENDOTRACHEAL TUBE AND LARYNGEAL MASK AIRWAY IN PATIENTS WITH UPPER RESPIRATORY TRACT INFECTIONS
Background: The issue of airway management in patients with upper respiratory tract infections (URTI) continues to be a clinical problem, as it is associated with high-airway hyperirritability alongside the possibility of complications that may include laryngospasm and bronchospasm. This paper sought to provide a comparison between the efficacy and efficiency of Endotracheal Tube (ETT) and the Laryngeal Mask Airway (LMA) in patients with URTI undergoing anesthesia. Methods: 120 patients were enrolled and split evenly in two groups; ETT (n=60) and LMA (n=60). The information was gathered about demographic data, number of attempts to make the insertion, ease of making the insertion, sufficiency of ventilating, manipulating the airways, and the complications during the perioperative period. The hemodynamic variables such as heart beats, blood pressure and oxygen saturation were noted at baseline, during insertion and post-insertion. Findings: The study proposes that most patients were aged 2535 years (38.2) and males (72.4). LMA (90%): ETT (71.6%): The probability of successful airway insertion at the first attempt was significantly higher with LMA than it was with ETT. Ease of insertion was easy in 91.7 percent of LMA and 56.7 percent ETT. Sufficient ventilation was obtained in every instance. LMA did not necessitate the manipulation of airways in any patient, just like ETT. Nevertheless, both laryngospasm and bronchospasm were found to be much greater in ETT group (28.3 and 31.6) than in the LMA group (0.0% and 1.6). The LMA group had a higher hemodynamic stability with all the patients reporting regular Heart rate and Blood pressure readings right after insertion, as opposed to ETT insertion, which was characterized with short-term changes in heart rate and blood pressure. Conclusion: The research demonstrated that the Laryngeal Mask Airway demonstrated better performance over the Endotracheal Tube in regards of ease of insertion, reduced airway complications, and improved hemodynamic stability in patients with upper respiratory tract infections. LMA can be considered a less harmful and more effective substitute for airway patency in such cases. Recommendations: The results of this study suggests that the use Laryngeal mask airway should be more frequent in Upper respiratory tract infections Patients because of its better efficacy. Except the surgeries in which Laryngeal mask airway is contraindicated due to other reasons.
Laryngeal Mask Airway, Endotracheal Tube, Upper Respiratory Tract Infections
THE ROLE OF MOTIVATION IN MITIGATING PERCEIVED STRESS AND BURNOUT AMONG HEALTH CARE WORKER IN ISLAMABAD
Healthcare professionals experience high levels of perceived stress and burnout as a result of demanding nature of their job, which can have greater impact on their job performance and well-being. Perceived stress and burnout among healthcare professionals is common issue in the world, including Pakistan. Exploring factors that mitigate perceived stress and burnout is important for improving well-being and job performance of the healthcare professionals. The purpose of this study is to investigate the role of motivation in mitigating perceived stress and burnout among health care workers in Capital Hospital Islamabad, Pakistan. By studying the relationship between motivation and perceived stress and burnout, the study aims to identify interventions and strategies that can improve motivation among healthcare workers, resulting in reduced levels of stress and burnout. The study employed a quantitative cross-sectional research design to determine the relationships between motivation, perceived stress, and burnout among healthcare workers in Islamabad, Pakistan. Data was collected from about 250 regular healthcare workers at Capital Hospital Islamabad using purposive sampling. The study used Work Extrinsic and Intrinsic Motivation Scale (WEIMS) to measure motivation, Perceived Stress Scale (PSS) to assess perceived stress, and the Sherom-Mellmend Burnout Scale (SMBO) to determine burnout, aiming to understand psychological well-being of the healthcare workers in clinical and hospital contexts through detailed data collection. Statistical analysis such as descriptive statistics, correlation analysis, and regression analysis using SPSS version 21.0, is carried out explore the relationships between variables, identify predictors of perceived stress and burnout. Ethical considerations involve seeking informed consent, ensuring confidentiality and privacy, minimizing risks, and obtaining approvals. The findings showed that higher levels intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation was related to lower levels of stress and burnout. Regression analysis showed that both perceived stress and burnout significantly affected motivation, with burnout exerting a greater impact. These findings emphasize the need to mitigate stressors and enhancing motivation to improve well-being and productivity of healthcare workers. Targeted interventions and measures focusing on motivation, perceived stress management, and burnout prevention are important for creating a supportive work environment in Islamabad, Pakistan.
PERIOPERATIVE MANAGEMENT OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A MULTIDISCIPLINARY APPROACH
Objective: This study aims to examine the perioperative challenges faced by patients with obstructive sleep apnea (OSA). The research focuses on developing a multidisciplinary care model that integrates anesthesiologists, pulmonologists, and surgeons to enhance patient safety and improve postoperative recovery. Methods: The study was conducted retrospectively and prospectively over a defined study period at a tertiary care teaching hospital in KPK. Adult patients with clinically suspected or previously diagnosed OSA who underwent surgical procedures under general or regional anesthesia were included. Data were collected on demographic variables, comorbidities, perioperative risk stratification, anesthetic techniques, airway management, postoperative complications, length of hospital stay, and intensive care unit (ICU) admissions. A multidisciplinary perioperative pathway was implemented and outcomes were compared before and after its structured adoption. Descriptive and inferential statistical analyses were performed to assess perioperative outcomes and complication rates. Research Type: Observational Research Results: Patients with OSA demonstrated a significantly higher incidence of perioperative respiratory complications, difficult airway management, postoperative hypoxemia, and prolonged hospital stay compared to non-OSA surgical patients. Implementation of the multidisciplinary care model was associated with improved preoperative screening, reduced unplanned ICU admissions, better postoperative respiratory monitoring, and a measurable decline in adverse respiratory events. Enhanced communication among perioperative teams contributed to improved clinical decision-making and patient-centered care. Conclusion: The findings indicated that patients with OSA represented a high-risk surgical population requiring tailored perioperative management. A multidisciplinary approach significantly improved perioperative safety and postoperative recovery. Early identification of OSA, coordinated anesthetic planning, optimized postoperative monitoring, and interdepartmental collaboration were essential in reducing morbidity. Adoption of structured multidisciplinary perioperative protocols was recommended, particularly in resource-limited tertiary care settings.
Obstructive sleep apnea; perioperative management; multidisciplinary care; anesthesia risk; postoperative complications; airway management; tertiary care hospital; Pakistan; observational study; respiratory complications; surgical outcomes; anesthesiology; pulmonology; perioperative safety
EVALUATING THE EFFICACY OF VITAMIN D SUPPLEMENTATION IN PREVENTING KIDNEY STONE FORMATION IN PATIENTS WITH HYPERPARATHYROIDISM
Objective: To assess the effect of vitamin D supplementation in preventing the formation of kidney stones in patients with secondary hyperparathyroidism, exploring its potential as a preventive treatment. Methods: A prospective clinical trial was conducted at multiple tertiary care hospitals in Lahore. A total of 180 adult patients with biochemically confirmed secondary hyperparathyroidism were enrolled and allocated into two groups: a vitamin D supplementation group (n = 90) and a control group receiving standard care (n = 90). Patients in the intervention group received oral cholecalciferol with dose adjustments guided by biochemical monitoring. Participants were followed for a mean duration of 18 ± 4 months. The primary outcome was the incidence of kidney stone formation, while secondary outcomes included changes in serum 25-hydroxyvitamin D, parathyroid hormone levels, urinary calcium excretion, and adverse events. Results: Vitamin D supplementation resulted in a significant increase in serum 25-hydroxyvitamin D levels and a marked reduction in parathyroid hormone concentrations. Mean vitamin D levels increased from 14.8 ± 4.2 ng/mL to 33.9 ± 6.8 ng/mL, while parathyroid hormone levels decreased from 312 ± 88 pg/mL to 214 ± 67 pg/mL (p < 0.001). Kidney stone formation occurred in 9 patients (10.0%) in the vitamin D group compared with 18 patients (20.0%) in the control group, representing a significant reduction in stone incidence. A modest increase in urinary calcium excretion was observed in the supplementation group; however, sustained hypercalciuria occurred in fewer than 10% of patients and was managed with dose adjustment. No serious adverse events or vitamin D toxicity were reported. Conclusion: Vitamin D supplementation, when administered with careful biochemical surveillance, was associated with a reduced incidence of kidney stone formation in patients with secondary hyperparathyroidism. The findings supported the safe and effective use of vitamin D as part of comprehensive management strategies for secondary hyperparathyroidism in tertiary care settings, particularly in regions with a high prevalence of vitamin D deficiency.
Vitamin D supplementation; secondary hyperparathyroidism; nephrolithiasis; urolithiasis; chronic kidney disease–mineral bone disorder; hypercalciuria; hypercalcemia; calcium oxalate stones; parathyroid hormone; 25-hydroxyvitamin D; tertiary care; Pakistan
MRI EVALUATION OF ROTATOR CUFF BETWEEN DIABETIC AND NON-DIABETIC PATIENTS WITH SHOULDER PAIN
Background: The rotator cuff is a group of muscles and tendons that stabilize the shoulder joint and enable its movement. Rotator cuff disorders, including tendon tears, degeneration, and fatty infiltration, are common causes of shoulder pain, particularly among diabetic individuals. Diabetes mellitus (DM) is a key risk factor, as chronic hyperglycemia and metabolic dysfunction can accelerate tendon degeneration and impair healing. The rising prevalence of DM and its impact on musculoskeletal health underscores the need for early detection and targeted interventions. Objective: To evaluate the structural differences of the rotator cuff on MRI between diabetic and non-diabetic patients with shoulder pain and to assess the prevalence and severity of tendon pathology. Methodology: This cross-sectional comparative study was conducted at [Obaid Noor Hospital, Mianwali. A total of 52 participants with shoulder pain were enrolled using convenient sampling. After obtaining informed consent, demographic data, clinical history, and risk factors were recorded. MRI of the affected shoulder was performed using standard protocols. Images were analyzed by two experienced radiologists to assess tendon tears, tendon degeneration, muscle atrophy, and fatty infiltration. Data were analyzed using SPSS version 21. Results: The study included 80 participants, with a majority being male (63.7%) and middle- aged (51–60 years, 42.5%). Most participants were diabetic (63.7%) and experienced right-shoulder pain (65.0%), with pain duration commonly lasting four months (25.0%). MRI findings were abnormal in 65.0% of participants, with 65.0% showing rotator cufftears, predominantly partial tears, and Grades II and IV being most frequent. Associated findings were present in 53.8%, highlighting the overall high prevalence of shoulder pathology in the study population. Conclusion: The study concludes that diabetes significantly increases the prevalence and severity of rotator cuff pathology. Early screening using MRI, along with targeted preventive and therapeutic strategies, is essential to reduce functional impairment and improve shoulder outcomes in diabetic patients.
Rotator cuff, MRI, Diabetes mellitus, Shoulder pain, Tendon tear, Fatty infiltration
COMPARISON OF FINDINGS OF HEPATOCELLULAR CARCINOMA VASCULARITY ON CT TRIPHASIC AND DOPPLER ULTRASOUND IN ADULTS
Background: One of the most common liver cancers is Hepatocellular carcinoma (HCC), and its early diagnosis, treatment, and prognosis relies on proper evaluation of lesions and vascularity. Triphasic CT and Doppler USG are complementary non-invasive methods of imaging of lesions, assessment of vascular patterns and measurement of hemodynamics. Objective: To compare triphasic CT and Doppler USG in terms of vascularity assessment of HCC and evaluate the capacity of each of the modalities to identify lesions, characterize the vascular patterns and the Resistive Index (RI). Methods: The study was an observational, comparative, cross-sectional study at the Liver Clinic, New Muslim Town, Lahore, in a period of three months. The convenience sampling was used to select seventy-three patients. The inclusion criteria were that a patient had to be having at least one liver lesion 1cm in both CT and Doppler USG in the last four weeks. The exclusion criteria were age below 18 years, missing imaging data, non-diagnostic images, previous liver procedures, pregnancy or critical illness. The features of the lesions, vascularity, involvement of portal and hepatic veins, and size and RI were evaluated and compared. Results: Out of 73 participants, the number of women and men was 52.1 percent and 47.9 percent respectively. Lesions were detected by CT in 43.8 percent and Doppler USG in 52.1 percent of subjects. Lesions were primarily small to medium (0.63 -3.9 cm). Preponderance was on isoenhancing and hypovascular patterns with significant numbers of lesions being Not Visible. The involvement of portal and hepatic veins was 53.4% and 56.2, respectively. The values of RI were relatively medium with very few high values, which means that the lesion population is heterogeneous.
Morphology Hepatocellular carcinoma, Triphasic CT, Doppler ultrasound, vascularity, Resistive Index, liver lesions.
BIOCHEMICAL MARKERS OF METABOLIC DISORDERS: AN AGE-SPECIFIC APPROACH TO REDUCING TYPE 2 DIABETES AND CARDIOVASCULAR DISEASE RISK
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Metabolic syndrome, Dyslipidemia, Glycemic control, Cardiovascular risk, Lifestyle factors, Early prevention
Copyright (c) 2025 Frontier in Medical and Health Research
COMPARISON OF OUTCOME OF PEDIATRIC TIBIAL DIAPHYSEAL FRACTURES TREATED WITH TITANIUM ELASTIC NAILING SYSTEM VERSUS CONSERVATIVE MANAGEMENT
Background: Pediatric tibial diaphyseal fractures are common long bone injuries, often managed either conservatively with casting or operatively with Titanium Elastic Nailing System. This study aimed to compare the clinical and radiological outcomes of TENS versus conservative management in children. Methods: This prospective observational study was conducted in the Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi from August 2024 to February 2025. A total of 82 children aged 5–11 years with tibial diaphyseal fractures were enrolled, with 41 managed by the TENS and 41 by conservative casting. Patients were followed at scheduled intervals until radiological union was confirmed. Time to partial and full weight bearing along with duration of hospital stay and complication rates were noted. Results: Excellent and acceptable functional outcomes were significantly more frequent with TENS (53.7% vs. 24.4%, p = 0.022; and 97.6% vs. 75.6%, p = 0.004, respectively). The TENS group demonstrated earlier mobilization, with shorter mean time to partial (2.85 ±0.76 vs. 5.94 ±1.13 weeks, p <0.001) and full weight bearing (8.05 ±1.35 vs. 11.88 ±1.93 weeks, p <0.001). Hospital stay was longer in the TENS group (4.07 ±0.96 vs. 2.07 ±0.91 days, p <0.001). Delayed union occurred more frequently in the conservative group (p =0.007), while rates of malunion, infection, limb-length discrepancy, and re-fracture were comparable between groups. Conclusion: TENS demonstrated superior outcomes in terms of earlier mobilization and reduced incidence of delayed union compared to conservative management, though at the cost of a slightly longer hospital stay.
Tibial Fractures, Fracture Fixation, Intramedullary, Elastic Nails, Cast Immobilization, Treatment Outcome
HISTOPATHOLOGICAL PATTERN OF ENDOMETRIAL SAMPLING PERFORMED FOR ABNORMAL UTERINE BLEEDING
Background: Abnormal uterine bleeding (AUB) is one of the most frequent gynecological complaints and often reflects a wide spectrum of underlying endometrial pathology. Objective: This study aimed to determine the histopathological patterns of endometrial samples obtained from women presenting with AUB in a tertiary care hospital in Pakistan. Methods: This cross-sectional study was conducted in the Department of Pathology in collaboration with the Department of Obstetrics & Gynecology at Sir Ganga Ram Hospital, Lahore from March 2025 to June 2025. A total of 145 women aged 20–75 years presenting with AUB and undergoing dilatation and curettage were included using non-probability consecutive sampling. Endometrial tissues were processed, stained with H&E, and examined by a consultant histopathologist. Results: The mean age of participants was 45.8 ± 10.6 years. Proliferative endometrium was the most frequent finding (38.6%), followed by secretory endometrium (18.6%). Inflammatory endometrium, including acute and chronic endometritis, accounted for 12.4%, while endometrial tuberculosis was diagnosed in 2.0% of cases. Endometrial hyperplasia was seen in 15.8% of samples, with both atypical and non-atypical forms identified. Benign lesions such as polyps and leiomyomas were found in 9.6% and 4.1% of cases, respectively. Conclusion: AUB is associated with diverse histopathological patterns ranging from normal physiological endometrium to premalignant and malignant conditions. Endometrial sampling remains an essential diagnostic tool, particularly for detecting hyperplasia and malignancy in high-risk women.
AUB, Patients, Histopathology, Malignancy, Risk factors, Diagnosis, Inflammation.
LETTER TO EDITOR: DISCUSSING THE TEMPORAL INCONSISTENCY IN AN ENVIRONMENTAL HEALTH FIELD STUDY
This critique of Rathore et al. (2025) challenges the causal link between water quality and the gastrointestinal crisis following the 2022 Pakistan floods. Key concerns include: (1) significant temporal lag between the disease surge and environmental sampling; (2) a reductionist focus on water contamination that overlooks human-to-human transmission in displacement camps; and (3) the use of "synthetic" visualizations instead of raw laboratory data. While acknowledging the importance of climate-resilient infrastructure, this letter argues that the study’s methodological inconsistencies undermine its conclusions, highlighting the need for real-time environmental sampling in future disaster research.
FREQUENCY OF CORONARY ARTERY DISEASE IN TYPE 2 DIABETES MELLITUS PATIENTS
Objective: The objective of this study was to determine the frequency of coronary artery disease in patients with type 2 diabetes mellitus and to compare its frequency between patients with controlled and uncontrolled diabetes. Study Design: Descriptive cross-sectional study. Place and Duration of Study: This study was conducted in the Department of Medicine, Provincial Headquarter Hospital Gilgit, from 22th Feb 2025 to 15th June 2025. Methodology: A total of 83 patients with type 2 diabetes mellitus aged between 30 and 70 years who presented with chest pain were included in the study. Patients were selected by non-probability consecutive sampling. Glycemic control was assessed using HbA1c levels and patients were classified as controlled or uncontrolled diabetes. Coronary artery disease was diagnosed on the basis of clinical presentation, electrocardiographic changes and raised cardiac troponin I levels. All data were recorded on a predesigned proforma. Data entry and analysis was done using SPSS version 25. Mean and standard deviation were calculated for quantitative variables while frequencies and percentages were calculated for categorical variables. Comparison of coronary artery disease between controlled and uncontrolled diabetes was done using chi square test and a p value of less than or equal to 0.05 was taken as statistically significant. Results: Out of 83 patients, coronary artery disease was found in 29 patients which makes a frequency of 34.9 percent. Coronary artery disease was more commonly observed in patients with uncontrolled type 2 diabetes mellitus as compared to those with controlled diabetes. Among uncontrolled patients, 45.2 percent had coronary artery disease while only 18.2 percent of controlled patients were affected and this difference was statistically significant. Increasing age, longer duration of diabetes, presence of hypertension, smoking history and positive family history of coronary artery disease were also found to be significantly associated with coronary artery disease. Conclusion: coronary artery disease is frequently seen in patients with type 2 diabetes mellitus especially in those with poor glycemic control. Early identification of high risk patients and better control of blood sugar levels may help in reducing cardiovascular complications and related mortality.
Type 2 diabetes mellitus, coronary artery disease, glycemic control, chest pain.
THE ASSOCIATION BETWEEN ACADEMIC SITTING POSTURES AND PIRIFORMIS SYNDROME IN ALLIED HEALTH SCIENCES STUDENTS: A CROSS-SECTIONAL STUDY IN PESHAWAR
Background: Piriformis syndrome (PS) is a neuromuscular condition caused by compression or irritation of the sciatic nerve by the piriformis muscle. It is an important yet underdiagnosed cause of low back and buttock pain, especially in populations exposed to prolonged sitting and poor postural habits. University students, particularly those in health sciences, are at increased risk due to extended academic sitting hours and inadequate ergonomic facilities. Objective: To determine the prevalence of piriformis syndrome and its association with prolonged sitting and cross-legged sitting among allied health sciences students in Peshawar, Pakistan. Methodology: A cross-sectional study was conducted from May to November 2023 among 198 allied health sciences students selected through random sampling. Data were collected using a self-structured questionnaire (Cronbach’s alpha = 0.72), Visual Analogue Scale (VAS), and the FAIR test for piriformis syndrome diagnosis. Data were analyzed using SPSS version 25. Results: The overall prevalence of piriformis syndrome was 61.61%. Females showed a higher prevalence (32.92%) compared to males (18.68%). Cross-legged sitting aggravated pain in 80.8% of participants. Nearly half (47.97%) of the students could not sit for more than 30 minutes, and 47.47% used wooden chairs. Moderate to severe pain (VAS 6–10) was reported by 77.77% of affected students. Pain interfered with daily activities in 30.30% of participants. Conclusion: Piriformis syndrome is highly prevalent among allied health sciences students in Peshawar. Prolonged sitting, cross-legged posture, and poor seating ergonomics are strongly associated with PS. Preventive strategies, ergonomic interventions, and awareness programs are urgently required.
Piriformis syndrome, prolonged sitting, cross-legged sitting, low back pain, students, ergonomics
MEDICO LEGAL PATTERN ANALYSIS OF MECHANICAL INJURY CASES INVESTIGATED BY THE POLICE SURGEON OFFICE HYDERABAD FROM JANUARY TO DECEMBER 2024
Background: Mechanical injuries caused by assault, accidents, interpersonal violence are a substantial percentage of medico-legal cases investigated by the police surgeons. Such injuries have to be systematically documented and analyzed, which are necessary to be interpreted in law, prevent injuries, and plan the health of people. Materials and Methods: A retrospective descriptive study was carried out with the help of medico-legal examination reports of the cases of mechanical injuries received by the Police Surgeon, Hyderabad. Such variables as age, gender, date of examination, anatomic site of injury, and description of injury were analyzed. The injuries were classified based on the type (abrasion, contusion, laceration, incised wound, punctured/firearm injury, swelling) and the body area. Findings: Both male and female victims were involved in the study that was conducted over an extensive age range (2-85 years). The proportion of females was higher in cases, and most of them were seen to be young adults. The head and face were the most frequently affected anatomical regions then, upper limbs and lower limbs. The commonest types of injuries were abrasions, contusions and lacerations. Fewer cases were associated with grievous injuries, including bone-deep lacerations and puncture wounds of a gun with entry and exit features. Conclusion: Mechanical injuries in medico-legal practice are most often associated with young adults, and injuries of the head and face prevail. The most common is blunt force trauma, but sharp force and gunshot wounds are of great medico-legal relevance. The proper records of the nature of injuries are essential in court litigation.
Mechanical injuries, anatomical distribution, Police Surgeon Hyderabad, violence and morbidity.
COMPARISON OF THE EFFICACY OF 0.2% TOPICAL GLYCERYL TRINITRATE VERSUS PLACEBO IN PAIN MANAGEMENT IN PATIENTS UNDERGOING MILLIGAN-MORGAN HEMORRHOIDECTOMY AT TERTIARY CARE HOSPITAL, KARACHI
Objective: The research examines whether 0.2% topical glyceryl trinitrate (GTN) works better than placebo for avoiding postoperative pain and infection in patients who receive Milligan-Morgan hemorrhoidectomy at a tertiary care hospital. Study Design: Randomized Controlled Trial. Place and Duration of Study: A six months study took place at the Department of Surgery within Jinnah Postgraduate Medical Centre (JPMC) Karachi after receiving CPSP approval. Methodology: A total of 60 patients who fit the criteria of Grade III hemorrhoids with an ASA I or II rating between 20 and 70 years old received random distribution through a sealed opaque envelope technique into two groups. The research subjects receiving 0.2% GTN ointment followed by placebo treatment thrice daily for twelve consecutive days after surgery made up the two study groups. Two weeks following surgery Healthcare professionals examined patients for post operative pain and infection by clinical assessment and bacteriological culture testing. The research analysis occurred through SPSS version 20. Chi-square analysis served as the statistical method for determination of significance where p-values below 0.05 became significant. Results: Postoperative pain and infection occurred in 4 patients of the GTN group (13.3%) but affected 12 patients of the placebo group (40%) (p < 0.05). The treatment effect from GTN maintained similar results regardless of patient characteristics related to diabetes, hypertension, obesity or past smoking behavior. The only Side Effects found in this study were brief temporary headaches which patients using GTN experienced. Conclusion: Doctors should consider using topical 0.2% glyceryl trinitrate because it successfully reduces postoperative pain and infections after performing Milligan-Morgan hemorrhoidectomies. The application of GTN stands as a safe achievement-enhancing practical secondary therapy suitable for improving surgical outcomes following hemorrhoid surgery
The study used glyceryl trinitrate and hemorrhoidectomy with wound pain managementas variables along with Milligan-Morgan methods and postoperative care through a randomized controlled trial
PARENTAL PERSPECTIVES ON ADOLESCENT GIRLS’ HEALTH KNOWLEDGE: AWARENESS, BARRIERS, AND RESPONSIBILITY
Background: Adolescent girls in urban Pakistan often lack adequate health knowledge due to limited parent-daughter communication, despite parents recognizing their responsibility for guidance on puberty, nutrition, and sexual/reproductive health. Objective: To examine parental awareness, barriers, and predictors of regular health discussions with adolescent daughters in Karachi using a sequential explanatory mixed-methods design. Methods: A cross-sectional survey of 320 parents was followed by five focus group discussions (FGDs). Quantitative data underwent descriptive analysis, chi-square tests, and binary logistic regression (outcome: regular discussion yes/no). Qualitative data were thematically analyzed to explain quantitative findings. Results: Although 71% of parents reported high awareness of daughters' health needs, only 38% engaged in regular discussions. Cultural taboo was the primary barrier (55%), followed by lack of knowledge (27%). Logistic regression showed high awareness (adjusted OR 2.87, 95% CI 1.72–4.79, p<0.001) and health program exposure (OR 2.14, 95% CI 1.28–3.58, p=0.004) independently predicted regular discussions, while strong cultural taboo perception suppressed them (OR 0.48, 95% CI 0.28–0.82, p=0.007). FGDs revealed parental SRH discussion anxiety, e-Health confidence gains, and support for school/mosque-based interventions. Conclusion: Parents demonstrate awareness but face cultural barriers limiting health communication. Targeted school- and community-based programs can bridge this gap by enhancing skills and reducing stigma, with potential to substantially improve adolescent girls' health knowledge in Karachi.​
MARFAN SYNDROME: INSIGHTS INTO PATHOPHYSIOLOGY, DIAGNOSIS, AND TREATMENT STRATEGIES
Marfan Syndrome is a single-gene dominant connective tissue problem mostly from harmful changes in the FBN1 gene, affecting the structure of fibers outside cells and proper elastic fiber function. These gene changes affect the TGF-β pathway, causing unusual tissue structure changes and increasing over time heart, eye, and bone problems. Population studies show that Marfan syndrome happens in about one in five thousand to one in ten thousand people worldwide, with nearly one-third of cases caused by new gene changes, showing variable gene effects and lots of differences in features. Visible traits go from mild bone problems to serious heart and blood vessel issues like bigger aorta base, artery bulge, and artery tear, which are still the main signs of sickness and risk of dying. Latest progress in detailed gene sequencing has increased the range of FBN1 gene changes, like hidden gene areas and mutations that change gene processing, helping update mutation categories and the link between genes and features. These findings show a move away from only watching blood vessels to complete heart muscle monitoring in Marfan syndrome care. Treatment plans have developed past beta-blocker drugs and ARB medicines, along with current studies on TGF-β blocking drugs, DNA-changing methods, and medicines affecting tissue structure. Some types of FBN1 gene changes affect the chance and speed of enlargement of the aorta base. Marfan disorder also has heart valve problems, like tricuspid and mitral valve bulge, and the mitral valve problem can be an early sign of serious childhood heart disease. Not related to heart valve problems, recent studies also show internal heart muscle problems and a higher chance of irregular heartbeats in the lower heart chambers. Heart ultrasound is done to find the disease, and new methods like the aorta base measurement help check children early. To see mitral valve separation and heart muscle scarring, heart MRI is very important. Because of the close connection between genes and features, DNA testing helps in finding high-risk cases and confirms the disease. Preventive aorta surgery using set limits, beta-blocker or ARB medicine, and monitoring for life are all included in treatment. This article shows that to improve results and well-being for people with Marfan disorder, complete heart treatment needs teamwork from different specialists and careful monitoring for all types of heart and blood vessel problems