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
EFFECTS OF MUSCLE ENERGY TECHNIQUE WITH AND WITHOUT SACROILIAC BELT ON PAIN, MUSCLE STRENGTH AND QUALITY OF LIFE IN PATIENTS WITH SACROILIAC JOINT DYSFUNCTION A RANDOMIZED CLINICAL TRIAL
Background: Low back pain is reported to be the most common problem in the domain of musculoskeletal problems, although it’s a common problem but its etiology is still not known in most of the cases which is eventually called as non-specific back pain and in almost near to half of the cases this back pain is arising from the sacroiliac joint giving it a name as sacroiliac joint dysfunction. Objective(s): To check the effects of muscle energy technique with and without sacroiliac belt on pain, muscle strength and quality of life in patients with sacroiliac joint dysfunction. Methodology: A Randomized clinical trial was conducted with sample size of 48 through convenient sampling technique. Participants were allocated into two groups i.e., Experimental and Control groups. Group A MET with SI Belt and Group B received only MET. SF-36, NPRS and MMT used for Quality of life, Pain and MMT for Muscle strength. Assessment was performed Pre and Post Treatment in both Group. Independent Sample T test and Repeated ANOVA tests were used to compare between group and within group differences with P value <0.05. Results: No significant difference was seen with p value >0.05 in between group and within comparison of both the groups pre and post treatment as per independent samples test but there was significant difference noted among between subject and within subject’s comparison as per Repeated ANOVA with p value <0.05. Conclusion: The present study concluded that both the groups (Group A = MET with SI Belt) and (Group B= MET without SI Belt) showed significant difference in Quality of Life, Pain, and Muscle strength
LEVEL OF DEPRESSION AND QUALITY OF LIFE AMONG PATIENTS WITH BELL’S PALSY IN PESHAWAR; A CROSS-SECTIONAL STUDY
Objectives: To determine the prevalence and severity of depression, assess quality of life, and examine the relationship between depression and quality of life among patients with Bell's Palsy. Method: A cross-sectional study was conducted using non-probability convenience sampling to recruit 139 patients with Bell's Palsy from tertiary care hospitals in Peshawar. The Patient Health Questionnaire-9 (PHQ-9) and WHO Quality of Life-BREF (WHOQOL-BREF) instruments were administered to assess depression severity and quality of life across physical, psychological, social, and environmental domains. Data were analysed using SPSS version 22, employing descriptive statistics, chi-square tests, and Fisher’s Exact Test with Monte Carlo simulation, with significance set at p < 0.05. Results: Out of the respondents, 93.5 percent had clinically significant depressive symptoms with only 6.5 percent indicating minimal or none. The quality of life was significantly affected in all the domains with the lowest scores recorded in the environmental domain. The chi-square and Fisher Exact tests showed that the degree of depression was statistically significant with the general quality of life, especially with the social relationships part (p < 0.001) showing that social functioning was worse with greater levels of depression. There were no significant differences in severity of depression and gender (p = 0.115), past Bell's Palsy episodes (p = 0.978), or length of illness (p = 0.749), although clinical trends indicated that, in this case, depression was most likely to increase within the range of 1–3 months. Conclusion: Depression is very common in patients with Palsy, and it is linked to poor quality of life particularly in social functioning. The results to this end demonstrate the necessity of combined psychological evaluation and treatment in the treatment of Bell's Palsy, especially of those with moderate-severe depressive symptoms.
Bell Palsy, Palsy, depression, PHQ-9, psychosocial impact, Quality of life, WHOQOL-BREF
COMPARISON OF INTER-APPOINTMENT PAIN REDUCTION DURING ROOT CANAL TREATMENT IN SYMPTOMATIC APICAL PERIODONTITIS BY USING CONVENTIONAL IRRIGATION AND ENDOACTIVATOR IRRIGATION SYSTEM: A RANDOMIZED CONTROLLED TRIAL
Objective: To compare inter-appointment pain reduction during root canal treatment in symptomatic apical periodontitis by using conventional irrigation and EndoActivator irrigation system. Methodology: This randomized controlled trial enrolled 156 patients diagnosed with symptomatic apical periodontitis involving permanent mature single-rooted teeth that were randomly allocated into two equal groups at Department of Operative Dentistry and Endodontics, Isra University Hospital, Hyderabad, over one year following synopsis approval. Group A underwent conventional syringe irrigation, while Group B received EndoActivator irrigation. Pain intensity was recorded using the Visual Analog Scale preoperatively and postoperatively at 24 and 48 hours. Percentage inter-appointment pain reduction was calculated and compared between groups using independent samples t-test. Stratification by age, gender, and tooth type was performed, followed by post-stratification analysis. SPSS version 22 was used to analyse the data. A p-value of ≤0.05 was considered statistically significant. Results: A total of 156 patients were included, with 78 participants in each group. The EndoActivator irrigation group demonstrated significantly greater percentage pain reduction than the conventional irrigation group at both 24 hours (82.01 ± 14.91 vs. 49.49 ± 12.22; p<0.001) and 48 hours (99.17 ± 4.22 vs. 82.64 ± 13.37; p<0.001). Statistically significant differences remained after stratification for age, gender, and most tooth types. In canine teeth, the difference remained statistically significant at 24 hours but not at 48 hours. Conclusion: EndoActivator irrigation was associated with significantly greater inter-appointment pain reduction compared with conventional syringe irrigation during root canal treatment.
EndoActivator, Conventional irrigation, Root canal treatment, Symptomatic apical periodontitis, Inter-appointment pain
SYNTHESIS, CHARACTERIZATION AND ANTIFUNGAL ACTIVITY OF METAL DOPPED CuO-MCM-41 NANOCOMPOSITES
Nanomaterials made from metal oxides such as CuO, Fe2O3, and ZnO demonstrate a wide range of pharmacological characteristics, including antibacterial, anti-inflammatory, anti-cancer, wound healing, and anti-diabetic properties. In particular, Copper Oxide nanomaterials have become increasingly important due to their growing applications in diverse areas such as heterogeneous catalysis, antimicrobial agents, antioxidants, imaging agents, cancer therapy, and drug delivery systems. The CuO-MCM-41 nanomaterials were synthesized through a hydrothermal method. The combination of the produced nanomaterials was achieved using a solution dispersion technique. Specifically, 0.5 g of the synthesized nanomaterials was dissolved in 50 ml of water and sonicated for 10 minutes. EDX analysis confirmed the presence of oxygen, copper, and silicon in the created nanocomposites. SEM images of the produced copper oxide nanocomposites showed irregular shapes with some aggregation, particularly at higher concentrations of MCM-41. The antifungal effectiveness was evaluated using the disc diffusion approach, revealing inhibition zones of 21 mm against Aspergillus niger and 22 mm against Candida albicans, thus confirming the strong antifungal properties of the synthesized nanocomposites.
Copper oxide, Silver nitrate, Nanocomposites, Antifungal Activities
COMPARISON OF LIVER ENZYMES DERANGEMENT IN DENGUE FEVER, DENGUE HEMORRHAGIC FEVER AND DENGUE SHOCK SYNDROME
Objective: To determine the prevalence of hepatic dysfunction in adults with dengue fever and to compare liver parameters in patients with dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. Methods: This descriptive cross-sectional study was conducted in the Department of Medicine, Nishtar Hospital, Multan, from August 2024 to January 2025. We included 193 patients aged 18-65 years, of either gender, admitted with a diagnosis of dengue fever. Baseline characteristics, including age, gender, and duration of illness was recorded. Grading of illness (DF/DHF/DSS) was determined by the attending consultant on admission. Enzymatic assays (ALT, AST, bilirubin, alkaline phosphatase, and LDH) using an ultraviolet spectrophotometer and PT / INR were performed. Results: The study participants' baseline characteristics were as followed: The average age was 36.5±11.7 years. Regarding gender, 118 participants (61.1%) were male, and 75 (38.9%) were female. The mean illness duration was 4.9±1.7 days. In terms of illness severity, 110 individuals (59.9%) were diagnosed with Dengue Fever (DF), 66 (34.2%) with Dengue Hemorrhagic Fever (DHF), and 17 (8.8%) with Dengue Shock Syndrome (DSS). The occurrence of hepatic dysfunction increased with disease severity: affecting 15.5% of DF, 27.3% of DHF, and 41.1% of DSS patients (P = 0.02). Conclusion: Hepatic dysfunction frequently occurs in patients with dengue infection. Therefore, these patients should be closely monitored and managed to prevent and identify any complications early.
Dengue fever, Dengue hemorrhagic fever, dengue shock syndrome, Hepatic dysfunction
BALANCING PUBLIC HEALTH PRIORITIES: ADDRESSING COMMUNICABLE AND NON-COMMUNICABLE DISEASES IN MODERN GLOBAL HEALTH SYSTEMS
The growing coexistence of communicable diseases (CDs) and non-communicable diseases (NCDs) presents a significant challenge for modern global health systems. This study examines how health systems balance competing public health priorities while addressing the dual burden of disease across low-, middle-, and high-income countries. A mixed-methods approach was employed, combining quantitative data from structured questionnaires with qualitative insights from semi-structured interviews involving healthcare professionals, policymakers, and practitioners. The findings reveal that high-income countries primarily prioritize NCDs, while low-income countries continue to focus on communicable diseases, often supported by external funding. Middle-income countries face the greatest challenge, managing both burdens simultaneously. Key issues identified include unequal resource allocation, limited health system capacity, fragmented service delivery, and disparities in healthcare access. The study also highlights the importance of integrated healthcare systems and preventive strategies in addressing both disease categories effectively. In conclusion, balancing CDs and NCDs requires comprehensive, context-specific approaches that emphasize equity, system strengthening, and long-term policy planning.
Objective: To determine the frequency, pattern, and associated risk factors of calcium imbalance following thyroid surgery. Methodology: This prospective observational study was conducted at a tertiary care hospital over a period of 6 months. A total of 150 patients undergoing thyroid surgery were included through non-probability consecutive sampling. Serum calcium levels were measured preoperatively and postoperatively at 24, 48, and 72 hours. Hypocalcemia was defined as serum calcium <8.5 mg/dL. Data were analyzed using SPSS version26. Quantitative variables were expressed as mean ± standard deviation, while qualitative variables were presented as frequencies and percentages. Associations between risk factors and hypocalcemia were assessed using Chi-square/Fisher’s exact test. A p-value ≤ 0.05 was considered statistically significant. Frequencies were reported with 95% confidence intervals. Results: Out of 150 patients, 42 (28%; 95% CI: 21.0–35.8%) developed postoperative calcium imbalance. Transient hypocalcemia was observed in 36 (24%) patients, while permanent hypocalcemia occurred in 6 (4%). A significantly higher incidence of hypocalcemia was observed in patients undergoing total thyroidectomy compared to subtotal thyroidectomy (37.5% vs 17.1%, p=0.002). Parathyroid gland injury (57%, p=0.001), vitamin D deficiency (41%, p=0.004), and female gender (33%, p=0.03) were also significantly associated with postoperative hypocalcemia. Conclusion: Calcium imbalance is a common complication following thyroid surgery. Total thyroidectomy, parathyroid injury, and vitamin D deficiency are significant risk factors. Careful surgical technique and preoperative assessment can help reduce its incidence.
Calcium imbalance, Hypocalcemia, Thyroidectomy, Parathyroid injury, Postoperative complications
EARLY EXPERIENCE WITH THE WHIPPLE PROCEDURE IN A NEWLY ESTABLISHED HEPATOBILIARY UNIT: A RETROSPECTIVE COHORT STUDY
Objective: To determine the early clinical outcome, postoperative morbidity and mortality of pancreaticoduodenectomy (Whipple procedure) in a newly established hepatobiliary unit. Study Design: Retrospective cohort study. Place and Duration of Study: The study was done in the Department of General Surgery, Unit-I, Ward-3, Jinnah Postgraduate medical Centre(JPMC), Karachi, between January 2023 and February 2026. Methodology: Retrospectively, medical records of patients who underwent pancreaticoduodenectomy were reviewed within the study period. The demographics, clinical presentation, operative, ICU stay, postoperative complications and mortality were data collected. All procedure was done with open method by the classical Whipple technique. Results: A total of 29 patients were included, with 24 (82.8%) males and 5 (17.2%) females. The mean age was 55 ± 10 years. Obstructive jaundice was the most common presenting symptom, and periampullary carcinoma was the most frequent indication (55.2%). All patients required ICU admission postoperatively, with a mean ICU stay of 2–3 days. Postoperative complications occurred in 7 patients (24.1%), including hepaticojejunostomy leak in 2 (6.9%), gastrojejunostomy leak in 1 (3.4%), and surgical site infection in 4 (13.8%). The overall postoperative mortality rate was 13.8% (n = 4). Conclusion: Pancreaticoduodenectomy is safely performed in new hepatobiliary units with an acceptable morbidity and mortality, when there is proper surgical expertise and postoperative care are available.
Pancreaticoduodenectomy, Whipple surgery, hepatobiliary surgery, periampullar tumors, surgical outcome
GREEN SYNTHESIS OF METAL NANOPARTICLES USING FRUIT EXTRACTS: EVALUATION OF ANTIOXIDANT AND ANTIMICROBIAL PROPERTIES
The increased need to obtain sustainable and environmentally friendly approaches to the fabrication of nanomaterial has stimulated studies on biogenic synthesis pathways. The current paper presents the green synthesis of silver nanoparticles (AgNPs) by using fruit extract of Punica granatum (pomegranate) as a natural reducing and capping agent in aqueous solutions. The best synthesis was done at pH 9, 60 C, and extract-salt ratio of 1:5 which was confirmed by a typical surface plasmon resonance (SPR) peak at 432 nm. X-ray diffraction (XRD) showed face-centred cubic (FCC) crystalline AgNPs with an average crystallite size of 18.4 ± 2.1 nm, which is in line with the transmission electron microscopy (TEM) measurements (mean diameter 20.3 ± 3.6 nm). Fourier-transform infrared spectroscopy (FTIR) was used to identify the phenolic hydroxyl (O -H, -3310 cm) and carbonyl (C -O, -1635 cm) stretches as the main functional groups that were the cause of reduction and stabilization. Colloidal stability was confirmed using dynamic light scattering (DLS) which gave a zeta potential of -31.4 mV. The produced AgNPs exhibited a high antioxidant activity (DPPH IC50 = 28.6 + 1.4 -1mL; ABTS IC50 = 24.1 + 1.2 -1mL), which is much higher than the crude extract itself. Agar well diffusion and broth microdilution assays of antimicrobials against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans demonstrated minimum inhibitory concentration (MIC) values of 12.550 µg/mL, with Gram-positive bacteria being more susceptible. These results make pomegranate-mediated AgNPs a scalable, non-toxic nanomaterial with potential biomedical uses.
Green Synthesis; Silver Nanoparticles; Pomegranate; Punica Granatum; Antioxidant; Antimicrobial; Dpph; Surface Plasmon Resonance
IMPACT OF URBANIZATION ON BIRD MIGRATION: HOW URBAN SPRAWL AND LIGHT POLLUTION ARE ALTERING THE MIGRATORY PATTERNS OF BIRDS
Undoubtedly, urban sprawl and light pollution pose great threats to the migratory patterns of birds all over the world. This study aims to compile all the literature available on the effects of urbanization and light pollution on bird migration. A comprehensive search of several academic databases resulted in the identification of relevant studies, which were systematically reviewed. The outcomes of this study shows that urbanization causes habitat loss, fragmentation, and disruption of migratory corridors. In addition to light pollution, altered migratory routes, causing structural collisions with birds, and changing the times of migration. Changes in both urban sprawl and light pollution will alter migratory behaviors, change migratory routes, and increase collisions with buildings and other anthropogenic structures in birds. The current context submits that conservation strategies are greatly needed in mitigating urbanization and light pollution regarding bird migration patterns. Many studies focused only on avian ecology, but there are still only a few studies that examine both urban growth and light pollution together and how they disturb migratory birds. Future direction includes more research designs and practical implication of these research results to protect birds from the adverse effects of urban sprawl and light pollution. These designs include making bird-friendly conurbations, using smart lights, and making more strict international policies for the conservation of the bird species.
Migration, Urbanization, Light Pollution, Conservation, Habitat, Mitigation
PLATELET–NEUTROPHIL CROSSTALK IN LEUKEMIA: MECHANISMS, IMMUNOTHROMBOSIS AND THERAPEUTIC IMPLICATIONS – A REVIEW
Background: Leukemia is a complicated blood cancer that is characterized by immune dysfunction and thrombo-inflammation. The cross-linkage of platelet neutrophils, especially with the help of NETs and adhesion cues, promotes disease development, thrombosis, immune surveillance, and treatment resistance. Objective: To establish the platelet neutrophil interaction in the pathophysiology and progression of leukemia. Methodology: A structured-literature review was performed, which is a systematic-search procedure in the form of narrative. Peer-reviewed articles published between January 2020 and December 2025. Original research papers, systematic reviews, and high-quality narrative reviews were captured and conference abstracts without the full text and irrelevant editorials were not. Results: The activation of platelets facilitates neutrophil recruitment and neutrophil NET through PSGL-1 and P-selectin. High NETs cause immunothrombosis, endothelial injury and leukemic progression. Platelet-derived factors also increase the survival, chemoresistance of leukemic cells, and are associated with poor clinical outcomes. Conclusion: Platelet-neutrophil cross talk leads to inflammation, coagulation and leukemia development. Overproduction of platelet activation and NET release produces an immunosuppressive, prothrombotic environment that is disease sustaining. This pathway should be targeted to enhance the results in leukemia.
Platelets, Tumor Microenvironment, Immunothrombosis, Leukemia, NETosis
DIAGNOSTIC ACCURACY OF MAGNETIC RESONANCE IMAGING IN CHARACTERIZING INTRA-AXIAL BRAIN GLIOMAS, TAKING HISTOPATHOLOGY AS THE GOLD STANDARD
Background: Intra-axial brain gliomas are among the most common primary central nervous system tumors, with variable prognosis depending on their histopathological grade. Objective: To determine the diagnostic accuracy of magnetic resonance imaging in characterizing intra-axial brain gliomas, taking histopathology as the gold standard. Methods: This cross-sectional validation study was conducted at the Department of Radiology, Shaukat Khanum Memorial Cancer Hospital, Lahore, from January 2025 to May 2025. A total of 127 patients aged 20–70 years with suspected intra-axial gliomas were included using consecutive sampling. All patients underwent MRI using a 1.5 Tesla scanner, and findings were interpreted by an experienced radiologist. Subsequently, histopathological examination was performed following biopsy. Results: MRI diagnosed 72 (56.7%) cases as malignant, while histopathology confirmed 68 (53.5%) malignant cases. MRI showed a sensitivity of 88.2%, specificity of 79.7%, PPV of 83.3%, and NPV of 85.5%. The overall diagnostic accuracy of MRI was 84.3%. ROC curve analysis demonstrated good diagnostic performance with an area under the curve (AUC) of 0.86. Conclusion: MRI is a reliable non-invasive imaging modality with high diagnostic accuracy in characterizing intra-axial brain gliomas. However, histopathology remains the gold standard for definitive diagnosis and tumor grading.
Magnetic resonance imaging, glioma, diagnostic accuracy, histopathology, brain tumors, sensitivity, specificity
OVARIAN STROMAL AND UTERINE ARTERY BLOOD FLOW PATTERN IN HYPERTENSIVE PATIENTS DIAGNOSED ON ULTRASOUND
Background: Hypertension is the most common systemic vascular disorder that can adversely affect microvascular circulation in multiple organs, including the female reproductive system. While the impact of hypertension on major organs is well documented, its effect on uterine artery and ovarian stromal blood flow in non-pregnant women remains underexplored. Objective: To compare ovarian stromal and uterine artery blood flow patterns in hypertensive and normotensive women using Doppler ultrasound. Methodology: This comparative cross-sectional study was conducted at Faizan Medical and Surgical Hospital, Lahore, over a period of nine months. A total of 46 women aged 18–45 years were included and divided equally into hypertensive (n=23) and normotensive (n=23) groups. Transabdominal ultrasound was performed to assess pelvic anatomy, followed by Doppler evaluation of bilateral uterine arteries and ovarian stromal vessels. Resistance index (RI) and pulsatility index (PI) were measured. Data were analyzed using SPSS version 25, and independent sample t-tests were applied, with a p-value <0.05 considered statistically significant. Results: Hypertensive women demonstrated significantly higher RI and PI values in both right and left uterine arteries and ovarian stromal vessels compared to normotensive controls (p<0.05). In contrast, grayscale parameters such as uterine size, ovarian dimensions, endometrial thickness, and uterine morphology showed no significant differences between the groups. Conclusion: Hypertension is associated with increased vascular resistance in uterine and ovarian circulation despite normal pelvic anatomy. Doppler ultrasound is a sensitive tool for detecting early pelvic vascular changes in hypertensive women and may have clinical value in reproductive health assessment.
ULTRASOUND-GUIDED REGIONAL BLOCKS VS. OPIOID ANALGESIA IN POSTOPERATIVE PAIN CONTROL: A COMPARATIVE STUDY
Background Postoperative pain remains a major clinical concern following surgical procedures. Although opioids are commonly used for pain control, their use is associated with significant side effects such as nausea, sedation, respiratory depression, and delayed recovery. In recent years, ultrasound-guided regional nerve blocks have emerged as an effective opioid-sparing alternative. However, local data comparing these two approaches in tertiary care settings in Pakistan remain limited. Objective: To compare effectiveness, safety, and recovery outcomes between ultrasound-guided nerve blocks and standard opioid-based analgesia in postoperative patients. The goal is to establish safer, opioid-sparing pain management approaches. Methods This prospective cohort study was conducted over a 12-month period and included 220 adult patients undergoing elective surgical procedures. Participants were divided into two groups: Group A (n = 110) received ultrasound-guided regional nerve blocks, while Group B (n = 110) received conventional intravenous opioid-based analgesia. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 6, 12, 24, and 48 hours after surgery. Total opioid consumption during the first 48 hours was recorded. Secondary outcomes included incidence of opioid-related side effects, time to first mobilization, and length of hospital stay. Data were analyzed using appropriate statistical tests, with p < 0.05 considered statistically significant. Results Patients receiving ultrasound-guided regional blocks demonstrated significantly lower pain scores at all time intervals compared to the opioid group (p < 0.001). The mean total opioid consumption in the first 48 hours was substantially lower in the regional block group (8.5 ± 3.2 mg) compared to the opioid group (22.4 ± 5.6 mg) (p < 0.001). The incidence of nausea and vomiting (12% vs 38%), respiratory depression (2% vs 10%), and sedation (8% vs 29%) was significantly higher in the opioid group. Furthermore, patients in the regional block group mobilized earlier (14 ± 4.2 hours vs 22 ± 5.6 hours) and had a shorter average hospital stay (3.1 ± 0.9 days vs 4.6 ± 1.2 days). Conclusion Ultrasound-guided regional nerve blocks provide superior postoperative pain control with significantly reduced opioid requirements and fewer systemic side effects compared to standard opioid-based analgesia. Additionally, regional anesthesia supports earlier mobilization and shorter hospital stay. These findings strongly support the adoption of opioid-sparing, ultrasound-guided regional anesthesia techniques in tertiary healthcare settings to improve patient outcomes and enhance recovery after surgery.
A COMPARATIVE STUDY OF HEALTHCARE MANAGEMENT PRACTICES BETWEEN THE UK AND PAKISTAN
Background: The success, efficiency, and equity of health service delivery in the world depends on the practices of healthcare management. This comparative paper will focus on healthcare management in the United Kingdom and Pakistan, the country with very different economic resources, government systems, and health systems legacies. Purpose: The study is intended to compare healthcare management practices on five main areas namely governance and leadership, financial management, human resource management, quality assurance and professionalism and health information systems. Methods: The qualitative comparative case study approach was used, and the analysis of documents, reviews of policies and secondary data based on the peer-reviewed literature, governmental reports, and international healthcare databases were utilized. Findings: The findings show that there are considerable differences in the two systems. Standardized, resource-consuming management, strong regulatory oversight, but workforce shortages and financial pressures are some of the weaknesses affecting the UK National Health Service which has a standardized management practice. The disjointed healthcare system in Pakistan demonstrates the adaptive management strategies in resource-constrained environments, high degree of public-privacy disconnects, new community health worker programmes and new digital health projects. The two systems have shared problems such as migration of workforce, lack of quality assurance and the necessity to have integrated disease surveillance. Conclusion: Although the UK provides a course on the standardized quality assurance, the measurement of professionalism and the integrated care systems, Pakistan provides the innovative solutions to the core health services packaging, and the management of the partnership between the population and the business. The research proposes context-based hybrid management frameworks of strengthening health systems.
BEYOND THE OPERATING ROOM: A PHENOMENOLOGICAL STUDY OF THE EMOTIONAL, COGNITIVE, AND PROFESSIONAL IMPACT OF SURGICAL COMPLICATIONS ON NEUROSURGERY RESIDENTS
Background: Surgical complications are an unavoidable part of neurosurgical training and can have serious effects on both patients and doctors. While much research focuses on clinical outcomes, less attention has been given to how these events affect residents emotionally, mentally, and professionally, especially in low- and middle-income countries. Objective: This study aims to explore the emotional, cognitive, and professional impact of surgical complications on neurosurgery residents. Methods: A qualitative phenomenological approach was used to understand the lived experiences of neurosurgery residents. Participants were selected through purposive sampling. Data were collected using in-depth, semi-structured interviews and analyzed using Colaizzi’s method to identify key themes. Results: Residents reported strong emotional responses such as guilt, anxiety, and fear after complications. They also described changes in thinking, including deep reflection, increased caution, and sometimes defensive practice. These experiences affected their professional identity, leading to both growth and ongoing stress. Support from supervisors and a positive institutional culture helped residents cope better, while lack of support increased distress. Conclusion: Surgical complications have a deep and lasting impact on neurosurgery residents beyond technical training. Addressing emotional and professional challenges through structured support and open discussion can improve both resident well-being and the quality of surgical training
DETERMINANTS OF NUTRITIONAL AWARENESS AMONG DIABETIC PATIENTS; TERTIARY CARE HOSPITAL LAHORE, PAKISTAN A STUDY OF 2017
Objectives The objectives of this study were to determine the awareness (i.e. nutritional knowledge, attitudes and practices) of diabetic patients and identify the factors associated with it. Methods A cross sectional survey was conducted to determine the awareness of diabetic patients and identify the factors associated with nutritional knowledge, attitude and practices of diabetic patients. A standardized pre-tested structured questionnaire was developed in order to interview the participants. Simple random sampling technique was used for the selection of study participants., the sample size was 403 after 5% lost to follow-up. Data analyses was done on SPSS version 20.0 and MS excel was also used for tables and graphs. Results Diabetes was more prevalent among people of 26-45-year age. Most of the patients were less educated, only few of them were graduates (18.7%). Most of the patients had positive family history of Diabetes (51%). Most of the patients had inadequate knowledge about disease (51%), poor attitude about disease (58.1%) and poor practices about disease (52.1%). Conclusions There is lack of knowledge and awareness about diabetes. The study indicates that there is need to organize awareness programs related life style modification of diabetic patients and for the management of diabetes. Prevalence of diabetes has been increasing in Pakistan.
As per International Diabetes Federation (IDF) Atlas – 2015 report, Diabetes was one of the worst centurial global health hazards. Its prevalence among people aged 20-79 years at 8.8% in 2015 was estimated to rise to 10.4% in 2040 (Sreedharan, J. (2016).). Another report reveals that about five million people are enduring with Diabetes universally and the number is expected to expand to 51% by 2045, due to rising obesity, growing unhealthy lifestyles, and the aging population. Furthermore, half of the populace living with Diabetes is not even aware that he/she has Diabetes (Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., & IDF Diabetes Atlas Committee. (2019)). With extensive public health ailments, Diabetes Mellitus merits a disease for establishing a registry, and maintaining a data about the health conditions of patients and the treatment received over a period. Registries would be highly beneficial in achieving insight by gathering large-scale data and making knowledgeable decisions. These are extremely useful instruments capable of judging the value of therapies in the clinical practices for Diabetic patients, conducting trials, and conceding areas where better results can be attained.
COMPARATIVE EVALUATION OF TRIGONELLA FOENUM-GRAECUM AS A FUNCTIONAL AQUAFEED ADDITIVE ON GROWTH, BLOOD PARAMETERS AND PHYSIOLOGICAL HEALTH OF CYPRINIDS
The present study was conducted to evaluate the effects of dietary fenugreek (Trigonella foenum-graecum) as a functional feed additive on growth performance, hematological parameters, and antioxidant defense system of selected cyprinid fishes, including Labeo rohita, Catla catla, Ctenopharyngodon idella, and Labeo calbasu. Experimental diets were formulated with graded levels of fenugreek supplementation (0%, 1%, 2%, and 3%) and fed to fish under controlled laboratory conditions. Results indicated that fenugreek supplementation significantly improved growth performance, with the highest weight gain and specific growth rate (SGR) observed at 2% inclusion level (T2) across all species. Hematological parameters, including red blood cells (RBC), white blood cells (WBC), hemoglobin (Hb), and packed cell volume (PCV), were also significantly enhanced in fenugreek-treated groups, indicating improved physiological and immune status. Furthermore, antioxidant enzyme activities such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were significantly increased, while malondialdehyde (MDA) levels were reduced, suggesting improved antioxidant defense and reduced oxidative stress. However, at the highest inclusion level (3%), a slight decline or plateau in some parameters was observed, indicating that excessive supplementation may reduce biological efficiency. This study concludes that fenugreek is an effective natural feed additive for enhancing growth, hematology, and antioxidant status in cyprinid fishes, with an optimal dietary inclusion level of approximately 2%.
ROLE OF FEAR OF NEGATIVE EVALUATION AND ACADEMIC SELF-EFFICACY AMONG YOUNG ADULTS
The present study was aimed to identify the relationship between fear of negative evaluation and academic self-efficacy among young adults. It was hypothesized that females are more vulnerable to fear of negative evaluation as compared to males and that they have more tendency to have affected academic self-efficacy as compared to males because of the dread of being negatively evaluated. It is a quantitative research in which a correlational research design was used and non-probability sampling technique was preferred to gather data. A total sample of 89 participants in which 45 were females and 44 were males were recruited through convenient sampling technique. To find out the correlation between the defined variables two scales were added to the questionnaire. These scales are Fear of Negative Evaluation scale and Academic Self-Efficacy scale. It was used to assess the level of fear of negative evaluation among young adults. The academic self-efficacy scale was used to assess the level of academic self-efficacy among young adults. As this study was quantitative in nature SPSS software was used to analyse the data collected from the participants. Independent sample t-test was run on SPSS software and spearman correlation was applied to check if there’s relationship between fear of negative evaluation and academic self-efficacy. It was found that females scored high on fear of negative evaluation scale and low on academic self-efficacy scale as compared to males. It was inferred that females are more vulnerable to fear of negative evaluation and have poor academic self-efficacy as compared to males.
COMPARISON OF INTRAVENOUS LIGNOCAINE VERSUS INTRAVENOUS DEXMEDETOMIDINE FOR ATTENUATION OF HEMODYNAMIC RESPONSE DURING GENERAL ANESTHESIA
BACKGROUND The hemodynamic responses of tachycardia and hypertension, which are associated with Laryngoscopy and endotracheal intubation, are potentially detrimental, especially in high-risk patients. This response has been suppressed with a number of pharmacological agents. The study aimed to compare the effectiveness of intravenous lignocaine and intravenous dexmedetomidine in the attenuation of the hemodynamic response to general anesthesia. METHODOLOGY It is a randomized controlled trial, which was carried out in the Department of Anesthesia, LMDC/Ghurki Trust Hospital, Lahore, from February 2025 to May 2025. Seventy-six patients within the age range of 18-60 years, ASA I-II, undergoing elective laparoscopic and gynecological surgery were selected and randomly split into 2 groups (n= 38 patients assigned to each group). Group A was given intravenous lignocaine (1.5mg/kg), and Group B was given intravenous dexmedetomidine (1 ug/kg). All patients were given general anesthesia. Observance of hemodynamic parameters, such as heart rate and mean arterial pressure, was done at the baseline and 5 minutes following intubation. RESULTS There was equal baseline characteristics in the two groups. At 5 minutes of the intubation, the dexmedetomidine group showed better attenuated hemodynamic response, most patients were in the 60-80 bpm range (65.8%), the others in the lignocaine group were mostly in the 100-120 (52.6%), and 120 or higher range. On the same note, mean arterial pressure was tighter in the dexmedetomidine group, with the majority of the patients being within the range of 70-110 mmHg, whereas in the lignocaine group, 44.7% were within the range of 110-130 mmHg, and the rest 42.1% were above 130 mmHg. CONCLUSION The intravenous dexmedetomidine is more effective in the attenuation of hemodynamic response to laryngoscopy and endotracheal intubation. It offers better regulation of heart rate and mean arterial pressure and is a more consistent method of maintaining hemodynamic stability in the process of induction of general anesthesia.
Dexmedetomidine; Lignocaine; Hemodynamic response; Laryngoscopy; Endotracheal intubation; General anesthesia
ASSESSING THE IMPACT OF NUTRITIONAL INTERVENTIONS, INCLUDING SUPPLEMENTATION WITH VITAMIN B12 AND FOLATE, IN MANAGING MACROCYTIC ANEMIAS.
Background: Macrocytic anemia is often linked with vitamin B12 and folate deficiencies, which results in the inhibition of erythropoiesis and the abnormal development of red blood cells. Correction of these deficiencies and enhancement of hematological outcomes require nutritional interventions. Objective: To determine the effect of supplementation of vitamin B 12 and folate on the treatment of macrocytic anemia. Methods: The cross-sectional research was carried out in Ward VI Unit II of the Jinnah Postgraduate Medical Centre (JPMC) in a period of six months. An initial sample of 323 patients aged between 18 and 65 years who had laboratory-confirmed macrocytic anemia was selected using constant sampling. Baseline demographic, clinical, and hematological data (hemoglobin, mean corpuscular volume (MCV), serum vitamin B12, folate levels, and the number of reticulocytes), were taken. The SPSS version 25 was used as the analyzer of the data; paired t-tests were used; p<0.05 was regarded as significant. Results: The average age was 41.2 ± 12.6 years and 55.1% were of the male gender. Large gains were achieved following supplementation. Mean hemoglobin went up to 8.9 ± 1.4 g/dL to 11.8 ± 1.2 g/dL, and MCV decreased to 108.5 ± 6.2 fL to 94.3 ± 4.8 fL (p<0.001). The level of serum vitamin B12 and folate were highly elevated and reticulocyte count was elevated (p<0.001). The highest complete response rate (78.7%) was with combined supplementation. Conclusion: B12 and folate supplementation have a significant effect on the blood parameters of macrocytic anemia, and the combined treatment proves more effective.
Folate, Hematological parameters, Macrocytic anemia, Supplementation, Vitamin B12
PATTERN OF BLUNT FORCE MECHANICAL INJURIES AMONG MEDICO-LEGAL CASES IN HYDERABAD
Background: Mechanical trauma of the blunt force type is one of the most frequent types of trauma that are met in the medico-legal practice and take up one of the largest shares of the cases that are studied in the emergency departments and police surgeon units. Such injuries are often linked with physical attacks, interpersonal violence, domestic conflicts, road accidents, workplace accidents and falls. Due to easy access to blunt objects in the environment, including sticks, iron rods, bricks, stones, and wooden objects, blunt trauma is a major public health and forensic issue because this technique is frequently applied in violent confrontations.In forensic medicine, the nature, mechanism, severity and the weapon that could be used to cause blunt force injury all depend on the accurate documentation and interpretation of such injuries. Some of the typical modes of common injury are abrasions, contusions, lacerations, fractures and mixed patterns of injury which have significant medico-legal implications. This pattern, distribution, and age of these injuries can assist in reconstructing the chain of events, distinguishing between accidental and intentional injuries, and matching the words said by victims with the physical evidence.Blunt force injuries are a significant problem in urban medico-legal centers like Police Surgeon Hyderabad, and Liaquat University Hospital because of the increased violence, traffic accidents, and workplace trauma. The forensic profile and epidemiological data of such injuries may be studied to offer useful local evidence on enhancing trauma management, medico-legal reporting and violence prevention measures. Objective: The aim of the study is to examine the trend, frequency and forensic importance of blunt force injuries in medicolegal cases in Hyderabad. Methods: The study involved a retrospective cross-sectional study of 246 medicolegal cases that were reported in 2024 between January and December. The descriptive statistics were used to analyze the data on age, gender, injury type, and anatomical site. Findings: The majority of the cases were female (83.7%), and male (16.3). The most affected age group was 18–35 years (68.3%). The most frequent type of injury was contusions (39.8%), then lacerations (30.1) and abrasions (21.1). The most common anatomical parts were the head and face (45.5%), upper limbs (27.6%). Conclusion: Blunt force trauma affects young females most of the time and is likely to involve the face and head. These results indicate the significance of forensic records and specific prevention measures
CHANGE IN CORNEAL ASTIGMATISM AFTER PTERYGIUM EXCISION USING BARE SCLERA TECHNIQUE
Objective: This study aimed to evaluate and compare the changes in corneal astigmatism following pterygium excision using the bare sclera and conjunctival autograft techniques. Methods: The study was conducted as a prospective comparative study carried out at the Combined Military Hospital in Gujranwala in the period between March and September 2024. A total of ninety patients (45 per group) with primary nasal pterygium, were randomly divided into two groups where they were expected to undergo excision with the bare sclera approach or conjunctival autograft method. Uncorrected and best-corrected visual acuity, keratometry values with the Topcon RM 8000B autorefractometer, and slit-lamp test were used as pre- and postoperative measures. Results: The two groups of surgical individuals showed a significant improvement in corneal astigmatism postoperative (p < 0.05). The range of the mean change of the astigmatism in the bare sclera group (3.28 with 1.01 SD to 1.17 with 0.88 SD) was higher than the conjunctival autograft group (3.34 with 1.07 SD to 1.74 with 1.01 SD). There was a positive significant correlation (r = 0.712, p < 0.001) between the size of preoperative pterygium and the level of astigmatism. Conclusion: The bare sclera technique was shown to have better refractive results compared with the conjunctival autograft procedure with a stronger and quicker reduction in corneal astigmatism in the first three months after surgery. The bare sclera method has low cost, shorter operation time and is very easy to perform, thus it has been found to be still a useful surgery in ophthalmic centres with limited resources and high volume, especially when used together with proper patient selection and good follow-up methods in order to check recurrence
PLASMA LIPIDOMIC PROFILES AND THEIR ASSOCIATION WITH EARLY CARDIOVASCULAR DYSFUNCTION IN YOUNG ADULTS WITH METABOLIC SYNDROME
Background: Metabolic syndrome is becoming a common problem in young adults with a high predictive value for future cardiovascular disease. Evidence is slowly emerging that negative lipidomic and metabolic changes could play a role in initial cardiovascular dysfunction, even though the clinical disease has not yet manifested. Nevertheless, there is limited information that examines these relationships among young adults. Objective: To determine the relationship between early cardiovascular dysfunction and plasma lipidomic profiles in young people with metabolic syndrome. Methods: It was a cross-sectional observational study that involved young adults between the ages of 18 and 35 years who were diagnosed with metabolic syndrome using ATP criteria of III. The demographic, anthropometric, lifestyle, and clinical information were gathered on a structured questionnaire. Routine biochemical analysis and lipidomic profiling. Plasma Lipidomic profiling Fasting blood samples were collected. Early R-Cardiovascular dysfunction was measured by non-invasive measurements, such as the stiffness indices of the arteries and echocardiographic values. Normality, reliability, and validity of the data had been established before analysis. Independent Samples t-test, One-way ANOVA, Kruskal-Wallis test, and Chi-square test were used to make comparisons between groups. Pearson correlation and multiple linear regression were used to assess the relationships between lipidomic parameters and cardiovascular dysfunction. Results: Continuous variables had an ideal normal distribution, showing a high level of reliability and reasonable construct validity. There was a considerable variation according to demographic and metabolic populations. Pearson correlation analysis showed a positive correlation between metabolic parameters and lipid variables, and the independent variable with early cardiovascular dysfunction. Multilinear regression analysis found body mass index, systolic blood pressure, fasting blood glucose, triglycerides, and HDL-cholesterol as positive independent predictors of early cardiovascular dysfunction. The regression model attributed a significant variation in cardiovascular disease to the regression model. Conclusion: Early cardiovascular dysfunction in young adults with metabolic syndrome is strongly related to plasma lipidomic and metabolic abnormalities. The findings highlight the necessity to identify and treat early metabolic and lipid abnormalities and to prevent cardiovascular disease in the future among this high-risk group of individuals.
ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF NURSING STUDENTS REGARDING DISASTER PREPAREDNESS IN PUBLIC AND PRIVATE NURSING COLLEGES OF ISLAMABAD
Introduction: Nations are increasingly vulnerable to crises, making the management of healthcare systems and healthcare professionals more challenging. Nursing staff and student nurses play a vital role in disaster response, and therefore, having adequate knowledge and competence in disaster preparedness is essential. The aim of the present study was to assess the knowledge, attitude, and practice (KAP) of nursing students regarding disaster preparedness. Methodology: A descriptive cross-sectional quantitative study was conducted among 197 nursing students from four nursing institutions: Bashir Institute of Health Sciences (BIHS), Pakistan Institute of Medical Sciences (PIMS) School of Nursing, Federal Government Nursing College (FGPC), and Rawal Nursing College (RNC) in Islamabad. A structured questionnaire assessing knowledge, attitudes, and practices related to disaster preparedness was administered to undergraduate students from all academic years. Results: The findings revealed that most participants had adequate knowledge (72%) and a positive attitude (75%) toward disaster preparedness. However, a majority demonstrated inadequate practice (65%). Conclusion: Although the participating nursing students showed sufficient knowledge and a positive attitude toward disaster preparedness, their practical skills were lacking. Continuous education, hands-on training, and regular drills are essential to strengthen their competencies and prepare them to effectively manage potential emergencies or disasters. The outcomes of this study can help guide the development of educational policies and training programs aimed at improving disaster preparedness among nursing students
IMPACT OF PHACOEMULSIFICATION AND FEMTOSECOND LASER-ASSISTED CATARACT SURGERY ON INTRAOCULAR PRESSURE: A COMPARATIVE STUDY
Purpose: The relationship between IOP and Cataract surgery involves both long-term and immediate effects. Extracting the cloudy lens and replacing it with an artificial intraocular lens can cause a short-term increase in IOP immediately after the procedure due to fluid shift and the use of viscoelastic substances. Long-term cataract surgery often leads to a reduction in IOP, which is particularly beneficial for patients with conditions like glaucoma. For glaucoma patients, temporary OP spikes can pose risks, so surgeons follow techniques and medication to manage the pressure during and after surgery. Objective: To compare the effects of Femtosecond laser-assisted cataract surgery (FLACS) and conventional Phacoemulsification cataract surgery on intraocular pressure after surgery in cataract patients. Methodology. This comparative cross-sectional study reviewed 140 cataract patients who underwent FEMTOSECOD LASER-ASSISTED and PHACOEMULSIFICATION cataract surgery. The data was collected from both femto and phaco groups with all clinical and medical records by a self-made Performa after obtaining consent at UOL Teaching Hospital, Lahore, and Amanat Eye Hospital, Rawalpindi, from 30 July 2024 to Nov- 2024. An air puff tonometer was used to measure Pre-op and Post-op IOP. Post-op IOP was measured on the 1st and 3rd week. Results. In the phaco and femto group, the mean difference of pre-op and post-op IOP measured was 1.95± 0.97 mmHg and 1.19 ±2.60 mmHg, respectively (p=0.309). However, the Phaco group measures IOP 0.77 mmHg less than the femto group. In the femto group, the mean of Pre-Op and post-Op IOP at 1st and 2nd weeks was 16.08 ± 3.36 mmHg, 15.26 ± 3.13 mmHg and 14.13 ± 2.95mmHg respectively (p<0.001). Likewise, in the phaco group, the mean of Pre-Op and post-Op IOP at 1st and 2nd week was 14.4 ± 3.146 mmHg, 13.7 ± 2.82 mmHg, and 13.21 ± 2.76 mmHg respectively (p<0.001). Conclusion. The study concluded that there is no significant difference between mean post-operative IOP in FLACS and phacoemulsification postoperative IOP. However, in the phaco group, there is less increase of IOP recorded as compared to the femto group. Conclusion. This study demonstrated, there was a significant change in intraocular pressure (IOP) before and after phacoemulsification 14.4 ± 3.146 mmHg, 13.7 ± 2.82 mmHg, and 13.21 ± 2.76 mmHg and FLACS 16.08 ± 3.36 mmHg, 15.26 ± 3.13 mmHg, and 14.13 ± 2.95mmHg. The IOP slightly decreases after both surgical procedures. Statistically comparing the mean pre- and post-IOP values of both procedures shows no significant changes as the mean difference is 0.77 and p = 0. 309 (Table 4).
OP, Cataract, Healthy Subjects, Phacoemulsification, FLACS
AN INTEGRATED ARTIFICIAL INTELLIGENCE FRAMEWORK FOR PREDICTING POSTOPERATIVE SEPSIS AND WOUND INFECTIONS IN DIABETIC PATIENTS USING RANDOM FOREST ALGORITHM
Patients with type 2 diabetes have higher risk of post operative complications i.e. surgical wound infections and sepsis. If not treated with proper treatment that may lead to prolonged hospitalization and also increase morbidity rate. Identification of high risk patients diabetic patients can improve surgical outcomes and optimize clinical management. This study aim to design and develop a model based on random forest algorithm to predict the high risk patients with post operstive complications. A retrospective analysis was conducted using the dataset collected from local hospitals of hyderabad. The dataset developed included demographic information, labortory indicators and surgical characteristics i.e. procedure specialty, operative duration and anesthesia type. The dataset was divided into 80/20 ratio in which 80% was for training set and 20% was reserved for testing to evaluate the model performance. This study presents the development and evaluation of a predictive model for identifying postoperative complications, specifically wound infection and sepsis. The model’s performance was assessed using standard classification metrics, including accuracy, precision, recall, F1-score, and receiver operating characteristic (ROC) analysis. The results demonstrate strong predictive capability, with accuracy values of 93.8% for wound infection and 94% for sepsis, indicating a high rate of correct classifications. Precision scores of 89.2% and 87.1% for wound infection and sepsis, respectively, reflect the model’s effectiveness in producing reliable positive predictions while minimizing false positives. Similarly, recall values of 90.1% for wound infection and 89.6% for sepsis highlight the model’s ability to correctly identify the majority of actual positive cases. The F1-scores, recorded at 90.5% for wound infection and 89.1% for sepsis, further confirm a balanced performance between precision and recall. The findings highlight the effectiveness of accurate prdiction of postoperative complications using random forest approach.
DIABETIC PATIENTS USING RANDOM FOREST ALGORITHM
A NATIONWIDE SURVEY ON BIOMEDICAL WASTE MANAGEMENT PRACTICES AND CHALLENGES IN MEDICAL INSTITUTIONS
Background: Biomedical waste management (BMWM) is a critical component of infection control and environmental safety in healthcare systems. Despite the existence of regulatory frameworks, compliance remains inconsistent, particularly in resource-limited settings. This national survey was intended to identify the existing practice, the extent of compliance, and also issues of biomedical waste management in various forms of medical establishments. Objectives: This study aimed to assess adherence to biomedical waste management guidelines across medical institutions, identify key operational challenges, and evaluate the impact of training, internal audits, and resource availability on compliance. Additionally, a composite compliance score was developed to compare performance across different types of healthcare facilities. Methods: A nationwide cross-sectional descriptive survey was used, and 288 medical institutions were sampled through stratified random sampling in different regions, ownerships, and levels of care. The data were collected with the help of a structured questionnaire and observation checklist that was built based on segregation, storage, documentation, and PPE use practices. Some of the statistical tests that were conducted on SPSS and Excel software on the normality of the response involved t-tests, ANOVA, Kruskal-Wallis, Chi-square, correlation, and multiple regression. Results: The normality of the proposed quantitative variables (p > 0.05) was met, and justified the use of parametric tests. There was good instrument reliability (Cronbach's Alpha = 0.91) and the validity tests indicated that the sampling is adequate (KMO = 0.812, p < 0.001). There were strong statistically significant differences between training status, type of institution, and level of care in compliance (p < 0.05). The correlation helped to realize that compliance and training (r = 0.63), internal audit (r = 0.59), and PPE availability (r = 0.55) are strongly and positively associated. The multiple regression analysis showed that all of them were important predictors of compliance (Adjusted R² = 0.57, p < 0.001), which indicates that both the competence of staff and institutional systems jointly increase the BMWM performance. Conclusion: The study concludes that the waste management process in medical institutions is considerably influenced by the staff training and the internal control, along with the provision of safety measures. The level of compliance between the government and the tertiary hospitals is greater compared to the primary-level and the private hospitals. Compliance in the country can be greatly improved through making the training more effective and performing regular audits, and the regular provision of PPE. The findings outline the importance of human resource growth and system departmental intervention as one of the steps towards sustainable biomedical waste management.
EPIDEMIOLOGY AND CLINICAL BURDEN OF SKIN CANCER IN PAKISTAN: A REVIEW
Skin cancer is the fifth most prevalent cancer worldwide. The skin acts as a barrier against UV rays and toxins; however, skin cancer is a significant issue that has been largely overlooked in Pakistan. Data regarding skin cancer is mostly unavailable. Skin cancer is a chronic disease, with the melanoma type being particularly dangerous as it can potentially lead to death. The symptoms of skin cancer vary and may include changes in the size, shape, and color of moles or growths, as well as bleeding and oozing. Various environmental, genetic, and kidney transplants can contribute to its development. Treatment options include traditional, conventional, and advanced techniques within the field of dermato-oncology. Data suggests that Pakistan is particularly vulnerable to skin cancer, making it essential for the government to take serious action against this growing concern. This can be achieved by recruiting highly trained experts, enhancing research networks, educating the public, and adopting innovations to address skin carcinogens. Indirect risk factors include obesity and age. Preventive measures and public awareness regarding skin cancer should be prioritized to help control and reduce its incidence.
NMSC, BCC, SCC, UV, PAHs, VOCs, Nox, O3, PM, HPVs, NPs and RT