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
ASSOCIATION BETWEEN INSULIN RESISTANCE AND AESTHETIC TREATMENT OUTCOMES IN ACNE, MELASMA, AND SKIN AGING IN THE UAE POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Background: IR has been widely accepted to be an important metabolic component affecting the onset and progression of many dermatological diseases. However, there is limited information available regarding the effects of IR on aesthetic outcomes in patients suffering from acne vulgaris, melasma, and skin aging. This is especially true for the UAE population. Methods: This study employed a systematic review and meta-analysis based on PRISMA 2020 principles. The electronic databases such as PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar were searched for articles published from January 2000 to December 2025, which examined the correlation of insulin resistance with the clinical outcomes following aesthetic dermatology procedures. Results: Twenty-four studies including 6,842 participants fulfilled the inclusion criteria, out of which 18 studies were included in the meta-analysis. Patients suffering from insulin resistance had shown worse therapeutic outcomes in terms of acne vulgaris (OR = 1.82; 95% CI: 1.39-2.38), melasma (SMD = -0.63; 95% CI: -0.89 to -0.37), and skin aging (SMD = -0.51; 95% CI: -0.78 to -0.24) as compared to the patients who did not suffer from insulin resistance. Moreover, there were increased recurrence rates in the patients suffering from insulin resistance, while they had poorer outcomes as well. Conclusion: In cases of acne, melasma, and skin aging, there exists an association between insulin resistance and lower effectiveness of aesthetic treatments. The integration of metabolic evaluations into everyday aesthetics dermatology practice may lead to improved patient care through better selection of treatments and prevention of recurrences, especially in regions where metabolic diseases are common like the UAE
Insulin resistance; Aesthetic dermatology; Acne vulgaris; Melasma.
ASSESSMENT OF KNOWLEDGE AMONG NURSES REGARDING SPREAD OF NOSOCOMIAL INFECTION AT LIAQUAT MEDICAL HOSPITAL JAMSHORO HYD
Background: Nosocomial infections (NIs) are hospital-acquired infections that emerge within 48 hours of patient’s admission, posing serious risks to the patient’s safety. Nurses play a key role in infection prevention, yet their knowledge may vary based on clinical experience, education, and departmental placement. This study aims to assess how these factors influence nurses’ infection control knowledge. Objective: This study aimed to assess the knowledge among registered nurses regarding the prevention and transmission of nosocomial infections at Liaquat Medical Hospital (LUH), Hyderabad/Jamshoro. Methodology: Descriptive cross-sectional study was conducted on 103 registered nurses using a a pre-performed questionnaire. The tool assessed knowledge related to infection transmission, hand hygiene, personal protective equipment, and standard infection control protocols. Data was analyzed through (SPSS version. 27 software) Results: Out of total 103 registered nurses, 33% had high levels of knowledge related to Noso common infection, 35% had moderate knowledge while remaining 32% exhibited low awareness regarding the prevention and spread of nosocomial infection at LUH Hyderabad/Jamshoro. I this study the educational status of participants significantly associated with nosocomial infection are also known as hospital acquired infection with p-value (0.00), Furthermore, a considerable number of nurses reported not receiving any refresher training in infection prevention. Conclusion: The study highlights the need for continuous refresher training at Hospitals to enhance nurses’ knowledge regarding infection control and prevention. Addressing existing knowledge gaps is essential to minimize the risk of hospital acquired infection and ensure safe healthcare practice
Nosocomial Infections, Hospital-Acquired Infections (HAIs), Infection Control, Nurses' Knowledge, Healthcare-Associated Infection Prevention, Hand Hygiene
ANALYSIS OF SOME HEAVY METAL CONCENTRATION IN COMMON CARP (FISH) COLLECTED FROM KALPANI RIVER
Heavy metal concentrations were analyzed in water sediments and different tissue samples of fish collected from Kalpani stream. Least concentration was shown in water and different tissue samples of fish. The results of the present research work revealed that most of the metals are particulate bound and least bioaccumulation occurred in fish. Thus metal accumulation in Common carp is within the permissible limits of FAO, WHO and U.S Recommended daily allowance (1989) which reflects low metal load in Kalpani Stream.
Heavy metal, carp (fish) And Kalpani River
EFFECTIVENESS OF DELNIDO V/S CONVENTIONAL CARDIOPLEGIA ON POSTOPERATIVE OUTCOMES IN PATIENTS OF CARDIAC SURGERY
Background: Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, resulting in an increasing demand for effective myocardial protection strategies during cardiac surgery. Cardioplegia plays a crucial role in minimizing ischemia-reperfusion injury during cardiopulmonary bypass. Del Nido cardioplegia, originally developed for pediatric cardiac surgery, has gained increasing acceptance in adult cardiac procedures because of its prolonged myocardial protective effects. This study aimed to compare the effectiveness of Del Nido cardioplegia with conventional cardioplegia in adult patients undergoing coronary artery bypass grafting and valvular heart surgery. Methodology: A retrospective comparative study was conducted at a tertiary cardiac care hospital. A total of 136 adult patients were included, comprising 68 patients who received Del Nido cardioplegia and 68 patients who received conventional cardioplegia. Demographic characteristics, intraoperative variables, postoperative biochemical markers, intensive care unit stay, inotropic support requirements, postoperative blood loss, major complications, and renal and hepatic biochemical parameters were obtained from hospital medical records. Statistical analysis was performed using SPSS version 26.0, with a p-value of <0.05 considered statistically significant. Results: Patients receiving Del Nido cardioplegia demonstrated significantly shorter aortic cross-clamp time (69 vs. 74 minutes; p = 0.041) and cardiopulmonary bypass duration (121 vs. 129 minutes; p = 0.032) compared with the conventional cardioplegia group. Del Nido cardioplegia was associated with a significantly shorter ICU stay (5 vs. 6 days; p = 0.002), lower postoperative Troponin-T (228 vs. 392 ng/L; p < 0.001) and CK-MB (15 vs. 24 U/L; p < 0.001) levels, reduced inotropic support, decreased postoperative blood loss, fewer major postoperative complications, and improved postoperative renal and hepatic biochemical profiles. Conclusion: Del Nido cardioplegia demonstrated superior myocardial protection and improved early postoperative outcomes compared with conventional cardioplegia in adult patients undergoing CABG and valvular heart surgery. Its use was associated with improved operative efficiency, reduced myocardial injury, enhanced postoperative recovery, and lower complication rates. These findings support Del Nido cardioplegia as a safe and effective myocardial protection strategy in adult cardiac surgery. Further large-scale prospective multicenter studies are recommended to validate these findings and evaluate long-term clinical outcomes.
Cardioplegia, Delnido Cardioplegia, Conventional Cardioplegia, Cardiac Surgery, Myocardial Protection
EFFECT OF NUTRITION EDUCATION ON NUTRITIONAL STATUS OF MALNOURISHED CHILDREN
Objective: The objective of this study is to determine the effect of nutrition educational intervention on malnourished children’s nutritional status of age 6 months- 8 years in twin cities of Pakistan. Study Design: The present study interventional study involving moderately malnourished children of age 6 months to 8 years. Study samples were selected randomly from outpatient pediatric department of tertiary hospital. Methods: Total 150 children of both genders were included in this study from Islamabad and Rawalpindi region. 94 study samples were from age group 6 months – 5 years and 56 study samples were from age group 5 years – 8 years. Data were collected through interview-based questionnaire from mothers/caregivers to find out socio-demographic status, to evaluate height- for- age (stunting), weight- for- height (wasting) and weight- for- age (underweight) of children before and after intervention. Results: Results proved improvement in underweight, wasting, mid-upper arm circumference and calorie intake amongst children after nutritional education intervention. The improvement level at the end of study varied significantly for weight (13.5 ± 3.6, 15.5 ± 4.1: p = 0.00), underweight (-1.762 ± 0.434, -0.662 ± 0.65; p=0.00), stunting (-0.827 ± 0.635, -0.712 ± 0.542; p=0.004) and wasting (-1.899 ± 0.616, -0.3490 ± 0.916; p=0.00) of children before intervention. Conclusion: Results of this study provide suggested that nutrition education is an effective and inexpensive approach to reduce the frequency of child malnutrition
Nutrition education, malnutrition, children
ENDOMETRIAL HISTOPATHOLOGY IN ABNORMAL UTERINE BLEEDING IN RELATION WITH ENDOMETRIAL THICKNESS ON ULTRASONOGRAPHY
Background: Abnormal uterine bleeding (AUB) is a common gynecological presentation with a wide spectrum of underlying etiologies. Transvaginal ultrasound is a non-invasive procedure, while histopathological examination is considered the gold standard for evaluating endometrial pathologies. This study correlated endometrial thickness observed on transvaginal ultrasound with histopathological findings in patients with AUB. Methods: The present study was a hospital-based prospective, cross-sectional study conducted in the Department of Pathology, Lahore General Hospital, Lahore, over 12 months from May 2024 to April 2025. Transvaginal ultrasonography and endometrial biopsy were performed in 70 women presenting with AUB. Endometrial thickness was categorized into five groups (<4 mm, 4-10 mm, 11-15 mm, 16-20 mm, and >20 mm), and histopathological outcomes were classified into eight diagnostic categories. Chi-square tests, ANOVA, and Pearson correlation were used for analysis. Results: The most common diagnoses were endometrial hyperplasia (21.4%), endometrial polyp (20.0%), and secretory endometrium (17.1%), while endometrioid adenocarcinoma was found in 11.4% of patients. A significant association was observed between endometrial thickness category and histopathological diagnosis (p < 0.001). All cases with thickness >20 mm were diagnosed with endometrioid adenocarcinoma. Mean thickness values were significantly higher in hyperplastic and malignant cases (p < 0.001). Pearson correlation analysis showed a weak but statistically significant positive relationship between endometrial thickness and histopathological severity (r = 0.275, p < 0.05). Conclusion: Endometrial thickness measured by transvaginal ultrasonography demonstrates a reliable correlation with underlying histopathological patterns in AUB. Thickness >11 mm, and particularly >20 mm, should undergo histological evaluation as they have high suspicion of hyperplasia or malignancy
Endometrial hyperplasia; Endometrial adenocarcinoma; Endometrial sampling; Abnormal uterine bleeding; Transvaginal ultrasound
DETERMINANTS OF EARLY BREASTFEEDING INITIATION AMONG POSTNATAL MOTHERS IN A TERTIARY CARE HOSPITAL, BAJAUR, PAKISTAN: A CROSS-SECTIONAL STUDY
Early initiation of breastfeeding (EIBF) refers to the initiation of breastfeeding within the first hour after delivery, and is a key intervention for enhancing neonatal survival and maternal and child health. The World Health Organization (WHO) has recommended that all babies be breastfed within one hour of birth and this is not the practice in many developing countries, including Pakistan, where there is a high prevalence of delayed initiation of breastfeeding. The objective of the study was to find out the prevalence of EIBF and factors associated with timely initiation of breastfeeding among the postnatal mothers visiting the tertiary care hospitals of Bajaur District of KP, Pakistan. Structured interviewer-administered questionnaires were used to carry out a cross-sectional analytical study of 288 postnatal mothers. Data pertaining to socio-demographic aspects, obstetric history, breastfeeding practices, counseling, myths and support systems was gathered and analyzed with SPSS version (28). Descriptive statistics were used and Chi-square tests were used to test associations between independent variables and EIBF. The study revealed that 77.8% of the mothers started breasts-feeding within one hour after birth of their child. The mean age of participants was 28.23 ± 5.46 years, while the mean parity was 2.48 ± 1.75. Significant associations with EIBF were observed for maternal education (p=0.001), socioeconomic status (p=0.015), normal vaginal delivery (p=0.007), timing of breastfeeding education (p=0.005), reasons for failure of antenatal breastfeeding education (p=0.026), hospital-related barriers to breastfeeding initiation (p<0.001), prelacteal feeding practices (p=0.002), postnatal practical assistance (p<0.001), and indicators of adequate milk consumption (p<0.001). But, maternal antenatal breastfeeding education and the breastfeeding education provider were not significantly associated with early initiation. A number of breastfeeding myths were found, most notably lack of milk and that babies need water after birth. The results indicate that there is a great deal of variation in breastfeeding initiation practices, maternal support, and cultural beliefs. Improvements in early breastfeeding initiation through strengthening breastfeeding support in the postnatal period, discouraging prelacteal feeding, correcting common misconceptions about breastfeeding and encouraging breastfeeding friendly hospital practices may further enhance early breastfeeding initiation and help to ensure better neonatal health outcomes in this under-served population
early initiation of breastfeeding, postnatal mothers, determinants, breastfeeding practices, prelacteal feeding, Bajaur, Pakistan
IMPACT OF ORGANIZATIONAL SUPPORT ON BURNOUT AND PATIENT SAFETY: EVIDENCE FROM TERTIARY HEALTHCARE SETTINGS IN KARACHI
Background: The safety of patients is one of the core indicators of health care service quality, especially in situations where there is insufficient health care resource availability. Healthcare provider burnout is an important predictor of patient safety outcomes. Perceived organizational support may be instrumental in promoting patient safety culture by minimizing the effects of burnout. Objectives: To determine the association between perceived organizational support, burnout, and patient safety culture and evaluate the role of burnout as a mediator in tertiary health care institutions in Karachi, Pakistan. Methodology: A cross-sectional analytical study was carried out among 110 health care providers, consisting of physicians, nurses, and allied health personnel in tertiary health care facilities in Karachi, Pakistan, using a convenience sampling method. Data were collected using standardized instruments, which include the Survey of Perceived Organizational Support, Maslach Burnout Inventory, and Hospital Survey on Patient Safety Culture scales. Descriptive statistics, Pearson correlation, multiple linear regression, and mediation analysis with Hayes' PROCESS macro (Model 4) using 5,000 bootstrap samples were used for data analysis. Results: Respondents perceived moderate organizational support (3.99 ± 0.61), burnout (3.21 ± 0.68), and patient safety culture (3.67 ± 0.57). The organizational support scale exhibited a negative relationship with the burnout scale (r = –0.52, p < 0.01), while a positive relationship with the patient safety culture scale (r = 0.61, p < 0.01) was found. Moreover, the burnout scale correlated negatively with the patient safety scale (r = –0.58, p < 0.01). Organizational support (β = 0.43, p < 0.001) and burnout (β = –0.39, p < 0.001) were significant predictors of patient safety culture (R² = 0.50). Mediation analysis confirmed partial mediation of burnout in the association between organizational support and patient safety culture. Conclusion: Organizational support perceptions have a significant impact on patient safety culture both directly and indirectly through burnout
Organizational support; burnout; patient safety culture.
FREQUENCY OF CONGENITAL HEART DISEASES IN INFANTS OF DIABETIC MOTHERS ATTENDING IN A TERTIARY CARE HOSPITAL
Background: Congenital heart diseases (CHDs) are among the most common congenital anomalies and represent a major cause of infant morbidity and mortality. Maternal diabetes, including pre-existing and gestational diabetes mellitus, has been consistently associated with an increased risk of fetal cardiac malformations. However, local data regarding the frequency of CHDs among infants born to diabetic mothers remain limited, highlighting the need for regional epidemiological evidence to support early diagnosis and preventive strategies. Objective: To determine the frequency of congenital heart diseases among infants born to diabetic mothers attending a tertiary care hospital and to evaluate the demographic and clinical factors associated with these cardiac anomalies. Methods: A descriptive cross-sectional study will be conducted over six months at the Department of Pediatrics, Bacha Khan Medical Complex/Gajju Khan Medical College, Swabi, Pakistan. A total of 360 infants aged 0–12 months born to mothers with either gestational or pre-existing diabetes mellitus will be recruited using convenience sampling. Data will be collected through a structured questionnaire, medical record review, clinical examination, and echocardiography to confirm CHDs. Demographic and clinical characteristics, including maternal age, diabetes type, and glycemic control, will be recorded. Statistical analysis will be performed using SPSS version 27. Descriptive statistics will summarize the prevalence of CHDs, while Chi-square or Fisher's exact tests will assess associations between categorical variables, with statistical significance set at p < 0.05. Expected Outcomes: The study is expected to establish the prevalence of congenital heart diseases among infants of diabetic mothers and identify associated maternal and neonatal factors. The findings will provide baseline regional data to support targeted screening, optimize prenatal counseling, and improve the clinical management of diabetic pregnancies
Congenital heart disease; diabetic mothers; gestational diabetes mellitus; infant; echocardiography; prevalence; Pakistan
GREEN SYNTHESIS OF SILVER NANOPARTICLES USING METHANOLIC EXTRACT OF MICROMERIA BIFLORA AND THEIR CONCENTRATION-DEPENDENT EFFECTS ON TOMATO (SOLANUM LYCOPERSICUM) GROWTH AND FUSARIUM WILT MANAGEMENT
Background: The rising concern over chemical fungicide residues in food crops has pushed researchers to look for safer, greener alternatives. Silver nanoparticles (AgNPs) prepared through plant-based routes have gained particular attention owing to their documented antimicrobial properties and relatively low production costs. Tomato (Solanum lycopersicum) is among the most widely grown vegetable crops worldwide, yet its productivity in Pakistan remains constrained by soil-borne diseases, most notably Fusarium wilt. In this study, we synthesized AgNPs using a methanolic extract of Micromeria biflora (Lamiaceae) and evaluated their effects on early tomato growth and Fusarium wilt incidence under pot conditions. Methods: The methanolic extract of shade-dried M. biflora aerial parts was reacted with silver nitrate solution at room temperature. Formation of AgNPs was confirmed through a visible colour shift and subsequently verified by UV-Vis spectroscopy, which showed a surface plasmon resonance peak at approximately 432 nm. A pot experiment involving five treatments — distilled water (negative control), crude M. biflora extract, AgNPs at 20 ppm, AgNPs at 40 ppm, and triadimefon (chemical fungicide, positive control) — was established with three replicates per treatment. Nine morphological parameters along with biomass and disease endpoints were recorded one week after treatment application. Results: A clear dose-dependent response was observed. Plants receiving 20 ppm AgNPs exhibited the strongest overall growth, outperforming all other treatments across eight of nine morphological outcomes. Flower number increased by 82.5%, stem width by 31.2%, and leaf length by 22.5% over the water control. Fresh biomass at 20 ppm reached 91.0 ± 3.0 g compared to 68.0 ± 2.0 g in the control. Fusarium wilt disease severity was reduced to 14.0 ± 3.0% at 20 ppm versus 72.0 ± 4.0% in untreated plants, a reduction comparable to triadimefon (18.0 ± 3.0%). In contrast, the 40 ppm treatment showed inhibitory effects on six of nine growth parameters, suggesting phytotoxicity at higher concentrations. Conclusions: Green-synthesized AgNPs from M. biflora enhanced tomato growth and suppressed Fusarium wilt in a concentration-dependent fashion, with 20 ppm emerging as the optimal dose. These results position biosynthesized AgNPs as a promising, eco-friendly tool for integrated disease management in tomato cultivation, though field-scale validation remains necessary.
Silver nanoparticles; Green synthesis; Micromeria biflora; Solanum lycopersicum; Fusarium wilt; Dose response; Plant growth promotion; Sustainable agriculture
PAIN INTENSITY, FUNCTIONAL DISABILITY, AND QUALITY OF LIFE IN ADULTS WITH CHRONIC NON-SPECIFIC LOW BACK PAIN ATTENDING OUTPATIENT PHYSIOTHERAPY CLINICS: A CROSS-SECTIONAL STUDY
Background: Chronic non-specific low back pain (CNSLBP) is a leading cause of disability worldwide, yet comprehensive data examining the interplay of pain, functional limitation, psychosocial factors, and health-related quality of life in South Asian populations remain scarce. This cross-sectional study investigated the relationships among pain intensity, functional disability, and quality of life, while identifying key physical and psychological predictors in adults with CNSLBP attending outpatient physiotherapy clinics. Methods: A total of 130 adults (65 male, 65 female) aged 22-68 years with CNSLBP exceeding 12 weeks were recruited from outpatient physiotherapy clinics. Pain intensity was measured using the Numeric Pain Rating Scale (NPRS), functional disability using the Oswestry Disability Index (ODI), and health-related quality of life using the SF-36. Secondary measures included the Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), body mass index (BMI), lumbar range of motion (ROM), and the Sorensen trunk endurance test. Descriptive statistics, Pearson correlations, independent samples t-tests, ANOVA, and multiple linear regression analyses were performed (alpha = 0.05). Results: The mean pain intensity was 6.43 +/- 1.71 (NPRS), mean ODI was 54.11 +/- 14.60, and mean SF-36 score was 40.76 +/- 13.94. The majority of participants (85.4%) demonstrated moderate-to-severe disability, and all participants reported at least moderate pain. Pain intensity demonstrated strong positive correlations with ODI (r = 0.866, p < 0.001) and strong negative correlations with SF-36 (r = -0.923, p < 0.001). In the multiple regression model for ODI, pain intensity (beta = 0.414, p < 0.001) and BMI (beta = 0.292, p < 0.001) were the strongest significant predictors, collectively explaining 84.9% of variance. Pain and ODI were the only significant predictors of quality of life (R-squared = 0.883). Conclusions: Pain intensity and BMI are the dominant independent predictors of functional disability in CNSLBP, while pain and disability together predominantly determine quality of life. These findings underscore the importance of multidimensional assessment incorporating both physical and psychosocial dimensions, and support early targeted interventions addressing pain management and weight optimization in this population
chronic non-specific low back pain, pain intensity, functional disability, quality of life, fear-avoidance, catastrophizing, biopsychosocial model, cross-sectional study
IMPACT OF DEATH ANXIETY ON HEALTH-RELATED QUALITY OF LIFE AMONG HEALTHCARE PROFESSIONALS: MODERATING EFFECT OF SELF-EFFICACY
Background: Death anxiety is a common psychological concern among healthcare professionals because of frequent exposure to critically ill patients, terminal illnesses, and patient deaths. Persistent death anxiety may adversely affect health-related quality of life (HRQoL). Self-efficacy has been recognized as a psychological resource that may improve coping with occupational stress and enhance overall well-being. Aim: To determine the impact of death anxiety on health-related quality of life among healthcare professionals and to examine the moderating effect of self-efficacy. Methods: A quantitative descriptive cross-sectional study was conducted among 250 healthcare professionals working in selected tertiary care hospitals. Participants were recruited using a convenience sampling technique. Data were collected using a structured questionnaire comprising demographic information, the Death Anxiety Scale, the General Self-Efficacy Scale, and a Health-Related Quality of Life scale. Data were analyzed using SPSS version 27. Descriptive statistics, Pearson's correlation, linear regression, and PROCESS macro moderation analysis were performed. Statistical significance was set at p < .05. Results: Participants reported moderate levels of death anxiety and moderate to high levels of self-efficacy and health-related quality of life. Death anxiety significantly predicted health-related quality of life (R² = .454, β = .674, p < .001). Self-efficacy showed a significant direct association with health-related quality of life. The interaction between death anxiety and self-efficacy was not statistically significant (β = −.232, p = .221), indicating that self-efficacy did not moderate the relationship. Conclusion: Death anxiety significantly influenced health-related quality of life among healthcare professionals. Self-efficacy improved health-related quality of life directly but did not moderate the relationship between death anxiety and health-related quality of life. Healthcare organizations should implement psychological support and resilience-building interventions to promote healthcare professionals' well-being
Death anxiety, health-related quality of life, self-efficacy, healthcare professionals, moderation, psychological well-being, cross-sectional study.
KNOWLEDGE, PERCEPTIONS, AND BEHAVIORAL RESPONSES TO GESTATIONAL HAEMORRHOIDS AMONG PREGNANT FEMALES FROM GUJRAT , PAKISTAN
Background: Haemorrhoids are the most prevalent anorectal illness during pregnancy, and they might cause symptoms in some women. Objective:​ To assess the Knowledge, Perceptions, and Behavioral Responses to Gestational Haemorrhoids among pregnant females aged ≥20-≤40 years from a tertiary care hospital Method: ​A descriptive cross-sectional study of 300 women was performed in August 2025-december 2025, via a closed-ended, structured 29-question questionnaire. Interviews were conducted in Umer Bashir Hospital in District Gujrat. Volunteer patients were contacted after approval from the hospital's higher authorities. The questionnaire is primarily based on 3 domains. ​Socio-demographic information regarding age, education level, and occupation was obtained from. The rest of the questionnaire contained information about the current trimester of pregnancy, the history of pregnancies. Questions about the cause of haemorrhoids during pregnancy, number of surgeries during pregnancy were asked. Knowledge, perception, and behaviour towards haemorrhoids were evaluated through different questions. Data was analyzed using GraphPad 10.2. prism. Results:​ Among the total 300 pregnant female participants who were interviewed, 47 were aged (<20 years), 114 participants were in the age group 20–29 years, the largest of all 3 groups, were 130 participants, present in the age group 30–39 years, while 09 participants (The smallest group) were in the age group (≥40 years). Highly Significant Variations were seen in age groups like 30–39 vs. 40 years (Mean Diff: 49, p-value 0.0083). A highly significant difference in participant volume was also observed in age group 20–29 vs. 40 years (Mean Diff 50, p-value 0.0069). Most disturbing and triggering factors among female participants were constipation and anatomical pressure from the baby/uterus, which are the most prominent, particularly in the prime childbearing age group (20–39years). Chi-square Test and Šídák’s Multiple Comparisons test were applied to evaluate women who experienced haemorrhoids for specific variables. Analyzed data shed light on gaps in prenatal education, psychosocial obstacles, and symptom literacy from questions Q9-Q18. Responses of partcipants regrading use of topical creams, herbal treatments, sitz bath, and stool softeners were also analyzed. Conclusion: Analysis of the distribution of responses from questions 19–29 revealed varying degrees of dietary and lifestyle changes; participants had embraced behavioral and medical interventions. Most of the participants reported consistently engaging in preventive behavior
COMPARISON OF IN-HOSPITAL STAY DURATION AMONG VIRAL PNEUMONIA PATIENTS TREATED WITH AND WITHOUT OSELTAMIVIR IN A PRIVATE TERTIARY CARE HOSPITAL, LAHORE
Background: Oseltamivir (Tamiflu) is a neuraminidase inhibitor widely prescribed in viral pneumonia, particularly influenza. However, evidence regarding its impact on in-hospital length of stay (LOS) in real-world tertiary care settings in Pakistan remains limited. Objective: To compare the total in-hospital length of stay between viral pneumonia patients treated with and without oseltamivir at a private tertiary care hospital in Lahore, and to evaluate associated clinical outcomes including clinical improvement, ICU admission, oxygen therapy requirements, complications, and in-hospital mortality. Methods: A retrospective observational study was conducted using data collected from 57 patients admitted with viral pneumonia. Patients were classified into two groups: those who received oseltamivir (n=33) and those who did not (n=20). Key outcomes including total LOS, clinical improvement at 72 hours, ICU admission rates, complications, in-hospital mortality, and 30-day readmission were analyzed and compared between the two groups. Results: The mean LOS was significantly longer in the oseltamivir group (7.2 ± 2.8 days) compared to the non-oseltamivir group (4.4 ± 1.0 days). Despite this, clinical improvement within 72 hours was higher in the oseltamivir group (81.8% vs 60.0%). ICU admission was more frequent in the oseltamivir group (27.3% vs 5.0%), reflecting greater baseline disease severity. In-hospital mortality was zero in both groups. Seventy-five percent of oseltamivir-treated patients received the drug more than 72 hours after symptom onset. Conclusion: The longer LOS observed in the oseltamivir group likely reflects greater initial disease severity rather than a detrimental drug effect. Delayed initiation of oseltamivir was common, which may have impacted outcomes. Early initiation of antiviral therapy in appropriately selected patients remains important. These findings highlight the need for prospective controlled studies to better delineate the true impact of oseltamivir on hospital stay in Pakistani tertiary care settings
Oseltamivir, viral pneumonia, influenza, length of hospital stay, antiviral therapy, tertiary care, Lahore, Pakistan
ASSESSMENT OF HEALTH CARE PRACTICES FOR PEDIATRIC IRON DEFICIENCY ANEMIA (IDA) IN AZAD JAMMU AND KASHMIR: A MULTICENTER STUDY OF DIAGNOSIS, TREATMENT, AND OUTCOMES
Background- Iron deficiency anemia (IDA) remained the most prevalent nutritional disorder in children worldwide, with significant consequences for growth, cognition, and development. Despite widespread awareness, gaps identified in diagnosis and management, particularly in district Azad Jammu & Kashmir (AJK), Pakistan. This study evaluated the diagnostic practices, treatment patterns, and clinical outcomes of IDA in children of three districts of AJK. Aim / Objectives- The study aimed to assess the diagnosis and treatment patterns of IDA in children aged 6 months to 14 years, to identify associated risk factors and clinical manifestations leading to IDA.Design/Methods- A descriptive cross-sectional study design using self-structured questionnaire consisted of demographics, clinical symptoms, diagnostic tests, and treatment modalities based on WHO anemia classification was conducted at four hospitals in District Mirpur, Bhimber, and Kotli. Where 160 children with IDA were approached conveniently. Data were analyzed using SPSS version 20, applying descriptive and inferential statistics for significant associations.- Results The study was comprised of 160 children having IDA among which 56.3% were males and 43.8% were females. Majority respondents (56.3%) aged 6–59 months. Low birth weight (35%) and urban residence (86.9%) were prevalent. Fatigue (93.8%), pallor (65%), tachycardia (59.4%), and poor appetite (65.6%) were common. Severe IDA (Hb <7 g/dL) affected 23.8%. Serum ferritin was low in 97.5%, however TIBC, transferrin saturation rarely performed. 76.3% received oral ferrous fumarate, 25.6%), yet 98.8% of caregivers were unaware of the correct dosage. IV iron sucrose was given to 31.9%, with 91.3% receiving adjunct Vitamin C. Poor diet (49.4%), malabsorption (40.6%), and low birth weight (33.1%) were significant contributors Conclusion- IDA remained a major public health concern in AJK, driven by improper diagnosis and treatment. Despite oral iron being first-line therapy, poor monitoring and inconsistent dosing highlighted the need for implementing protocols, healthcare worker training, and community awareness
Iron deficiency anemia, pediatric anemia, diagnosis and management, treatment patterns, clinical Practice
STRATEGIES FOR MITIGATING ENVIRONMENTAL IMPACTS AND ASPECTS: FROM REGULATION TO GREEN SUPPLY CHAINS, DIGITAL MONITORING AND URBAN NATURE-BASED SOLUTIONS
Background: Industrial and urban development intensifies emissions, energy use, water consumption, waste generation and residual exposure, requiring mitigation approaches that move beyond isolated compliance. Aim: This study evaluates how environmental regulation, green supply-chain governance, digital monitoring and nature-based solutions can reduce environmental aspects and impacts when applied separately and as an integrated portfolio. Methodology: A qualitative integrative review was combined with a coded evidence matrix of 150 industrial and urban-interface observations across five regions, eight sectors and five mitigation bundles. Outcomes were assessed through emissions, energy, water and waste reductions, payback period and composite environmental performance. Results: Across all observations, emissions fell by 22.0%, energy use by 22.8%, water use by 15.2% and waste by 21.6%. Integrated strategies produced the strongest results, achieving 31.8% mean emissions reduction, 31.4% energy reduction, 29.7% waste reduction, a 98.7 performance score and a short 1.21-year payback. Digital maturity and sensor coverage strengthened performance, while procurement and supplier audits extended mitigation upstream. Conclusion: Environmental impacts are mitigated most reliably when regulation, procurement, digital evidence and urban ecological buffering operate together as one evidence-driven management system. The findings support portfolio-based policy and management, reducing impact shifting while improving operational, financial and environmental outcomes across diverse sectors.
strategies , mitigating environmental impacts, aspects, egulation , green supply chains, digital monitoring, urban nature-based
SYNERGISTIC NEUROPROTECTIVE EFFECTS OF FLAVONOIDS AND MICRONUTRIENTS ON OXIDATIVE STRESS AND NEUROINFLAMMATION
Neurodegenerative diseases are also being perceived as one of the major health challenges in the world, where the degeneration of neurons, their cognitive abilities and their dysfunctional nervous systems are associated with the disease. Oxidative stress and chronic neuroinflammation are two key processes that cause these disorders, and are both involved in interrupting cellular homeostasis and increasing neuronal death rate. Recent studies have begun pointing to the possibility of moderating these pathological processes through the action of nutritional compounds, flavonoids and micronutrients to some extent. Flavonoids are polyphenols of diverse chemical structure but originally found in plants and were associated with potent antioxidant and anti-inflammatory actions contributing to the regulation of cellular signal transduction of neuronal defense. Micronutrients such as essential vitamins and trace minerals have major roles in the preservation of neuronal metabolism and antioxidant defense systems as well as in the preservation of mitochondrial functions. The combined effect of different flavonoids and micronutrients is beginning to be investigated as a potential synergistic approach to stimulating neuroprotective effects and improving their ability to mitigate oxidative free radicals as well as adjust inflammatory processes in the central nervous system. These synergistic responses have the potential to enhance neuronal capacity and quality in aging and provide cognitive health. This review investigates the biological pathways of the oxidative stress and neuroinflammation in neurodegenerative disorders and attempts to analyze the complementary effects of flavonoids and micronutrients in neuroprotection. The knowledge of these interactions can be useful in devising dietary ways and nutraceutical interventions that could prevent or delay the onset of the neurodegenerative diseases.
flavonoids, micronutrients, neuroprotection, oxidative stress, neuroinflammation, neurodegenerative diseases, antioxidants, brain health
MAPPING THE SEVEN FACES OF TENSION: AN INTERPRETATIVE PHENOMENOLOGICAL STUDY OF HYPER-AROUSAL SUBTYPES, CULTURAL CONTEXT, AND LIVED EXPERIENCE IN PAKISTAN
Hyper-arousal is a multidimensional psychological phenomenon characterized by persistent physiological, emotional, cognitive, and behavioral activation that disrupts daily functioning and well-being. Although hyper-arousal has been extensively examined in relation to trauma, anxiety disorders, and post-traumatic stress disorder, limited research has explored how individuals themselves experience different manifestations of chronic tension within their sociocultural environments. In Pakistan, where emotional expression is often influenced by cultural expectations, family obligations, and religious beliefs, understanding the lived experience of hyper-arousal requires an approach that acknowledges both psychological and cultural realities. The present study aimed to explore the lived experiences of individuals experiencing chronic hyper-arousal and to identify the different phenomenological "faces" of tension within the Pakistani cultural context. A qualitative research design based on Interpretative Phenomenological Analysis (IPA) was employed. Fifteen participants experiencing persistent psychological tension and hyper-arousal symptoms were recruited through purposive sampling. Semi-structured interviews explored emotional, cognitive, behavioral, physical, interpersonal, and cultural experiences of chronic tension. Data were analyzed following Smith, Flowers, and Larkin's six-stage IPA framework. Analysis generated seven interconnected experiential themes representing the "Seven Faces of Tension": Living in Constant Alertness; The Restless Body; Emotional Storms beneath Silence; Trapped between Expectations and Identity; Relationships under Invisible Pressure; Cultural Silence and Religious Meaning-Making; and Rediscovering Hope through Acceptance and Healing. Participants described hyper-arousal as an all-encompassing experience affecting thoughts, emotions, bodily sensations, social relationships, occupational functioning, and spiritual life. Cultural norms simultaneously intensified distress through emotional suppression while offering resilience through collective support and religious coping. Hyper-arousal extends beyond physiological activation and represents a deeply personal and culturally embedded experience. Findings emphasize the importance of culturally informed psychological interventions integrating emotional regulation, trauma-informed care, family psycho education, and culturally sensitive therapeutic practices within Pakistan. The study contributes to the growing phenomenological literature by demonstrating that chronic tension is experienced as a dynamic interaction between mind, body, relationships, and sociocultural meaning systems.
Hyper-arousal, Chronic Tension, Interpretative Phenomenological Analysis, Lived Experience, Pakistan, Qualitative Research, Cultural Psychology, Emotional Regulation
DYSPHAGIA IN DEMENTIA: INTERVENTIONS TO REDUCE ASPIRATION PNEUMONIA
This narrative review summarizes interventions used to reduce aspiration and aspiration pneumonia among older adults with dementia-related dysphagia, describes their reported effectiveness, and highlights gaps and limitations in the evidence base (Baijens et al., 2016; Wirth et al., 2016). Commonly reported approaches include diet and texture modification, feeding assistance and posture adjustments, swallowing rehabilitation, oral-care protocols, pharmacological agents, and stimulation therapies; multi-disciplinary and person-centered programs showed the most promise, but high-quality, long-term evidence remains scarce (Beck et al., 2018; O’Keeffe, 2018; Painter et al., 2017; Rofes et al., 2011). The review emphasizes the limited availability of speech and language therapy in many nursing-home settings and the need for interventions adapted to people with cognitive impairment and to low- and middle-income contexts (Levenson & Walker, 2019; Wirth et al., 2016).
FREQUENCY AND PATTERN OF INJURIES AMONG CHILDREN: A HOSPITAL BASED CROSS-SECTIONAL STUDY IN PAKISTAN
Background: Childhood injuries remain a major public health issue, particularly in low- and middle-income countries (LMICs). In Pakistan, updated hospital-based evidence is scarce, limiting effective injury prevention and trauma service planning. This study aimed to describe patterns of childhood injuries and identify factors associated with hospital disposition. Methods: A descriptive cross-sectional study was conducted among 533 injured children presenting to the Paediatrics Emergency Department of a tertiary care hospital in Karachi, Pakistan (May 2020–April 2021). Data on demographics, mechanism and place of injury, body site affected, clinical features at presentation, and final disposition were collected using a structured electronic case report form. Descriptive statistics summarized injury patterns, and binary logistic regression identified factors independently associated with admission or referral. Results: The mean age of participants was 6.3 ± 3.7 years, and 68.7% were male. Nearly half of injuries occurred at home (48.9%). Falls were the most common mechanism (28.4%), followed by road traffic accidents (22.2%). In multivariable analysis, moderate pain (aOR 1.9, 95% CI 1.3–2.8) and severe pain (aOR 8.0, 95% CI 4.5–14.0) were strongly associated with admission or referral. Complications (aOR 2.2, 95% CI 1.4–3.4), burn injuries (aOR 6.5, 95% CI 2.1–20.2), and presence of inflammation or swelling (aOR 1.4, 95% CI 1.0–2.1) were also independently associated with admission. Conclusion: Childhood injuries in this tertiary care setting were common among young boys and frequently occurred at home, with falls being the leading mechanism. However, hospital admission was primarily determined by clinical severity pain intensity, complications, burns, and swelling rather than demographic factors or location of injury. These findings underscore the need for preventive interventions in domestic environments and highlight the importance of early clinical assessment in pediatric emergency care
Paediatric injury; hospital admissions; injury patterns; trauma epidemiology; Pakistan
A LITERATURE REVIEW OF THE CORRELATION BETWEEN HBA1C AND LIPID PROFILE IN TYPE 2 DIABETIC PATIENTS
The hallmarks of type 2 diabetes mellitus (T2DM) include chronic hyperglycaemia, insulin resistance and deranged lipid metabolism and represent a global pandemic disorder which results in a heightened risk of cardiovascular disease. Glycated haemoglobin (HbA1c) is a very important indicator of the long-term glycaemic control and has a tendency to grant the development of diabetes dyslipidaemia with resultant abnormalities of the lipid profile that include raised triglycerides, low HDL-C concentrations, and LDL-C. Critical review of 11 articles of 2013-2024 shows that poor glycaemic control (high HbA1c) is still linked to unfavourable lipid patterns. The evidence proves that in those settings where it is difficult to measure cholesterol, HbA1c has the potential to become an indirectly expressed evidence of lipids issues. The study underlines the importance of management of type 2 diabetes, which balances markers of lipids and glycol at once in an effort to mitigate cardiovascular impact. To understand such relations, it is proposed to conduct additional studies.
Dyslipidemia, Glycemic Control, HbA1c, Lipid Profile, Type 2 Diabetes Mellitus (T2DM
PREVALENCE OF MYOCARDIAL INFARACTION AT TERITARY CARE HOSPITAL (SGTH)
In our study we explore patient history, current illness and symptom intertwined together to point a view picture of health condition in the admitted patient myocardial infarction (MI) is a term used for an event of heart attack which is due to formation of plaques in the interior walls of the arteries resulting in reduced blood flow to the heart and injuring heart muscles because of lack of oxygen supply. The symptoms of MI include chest pain, which travels from left arm to neck, shortness of breath, sweating, nausea, vomiting, abnormal heart beating, anxiety, fatigue, weakness, stress, depression, and other factors. The immediate treatment of MI includes, taking aspirin, which prevents blood from clotting, and nitro-glycerin to treat chest pain and oxygen. The heart attack can be prevented by taking an earlier action to lower those risks by controlling diet, fat, cholesterol, salt, smoking, nicotine, alcohol, drugs, monitoring of blood pressure every week, doing exercise every day, and loosing body weight. The treatment of MI includes, aspirin tablets, and to dissolve arterial blockage injection of thrombolytic or clot dissolving drugs such as tissue plasminogen activator, streptokinase or urokinase in blood within 3 h of the onset of a heart attack. The painkillers such as morphine or meperidine can be administered to relieve pain. Nitroglycerin and antihypertensive drugs such as beta-blockers, ACE inhibitors or calcium channel blockers may also be used to lower blood pressure and to improve the oxygen demand of heart. The ECG, coronary angiography and X-ray of heart and blood vessels can be performed to observe the narrowing of coronary arteries. In this article the causes, symptoms and treatments of MI are described. Cardiovascular mortality differs across Asian American subgroups, but myocardial infarction (MI) hospitalization outcomes or quality of care have not been reported in these populations. MI quality and outcomes differ among Asian Americans, with worse outcomes compared with non-Hispanic White (NHW) adults
EFFECTS OF GLP-1 RECEPTOR AGONISTS ON PERIODONTAL HEALTH, ORAL WOUND HEALING, AND PERIODONTAL REGENERATION: A SYSTEMATIC REVIEW OF PRECLINICAL EVIDENCE
Background: Periodontitis is a chronic inflammatory disease characterized by progressive destruction of the tooth-supporting tissues and is strongly associated with metabolic disorders such as type 2 diabetes mellitus. Glucagon-like peptide-1 receptor agonists (GLP-1Ras) have demonstrated anti-inflammatory, osteoprotective, and regenerative properties beyond glycemic control, suggesting potential applications in periodontal therapy. This systematic review aimed to evaluate the available preclinical evidence regarding the effects of GLP-1Ras on periodontal health, oral wound healing, and periodontal regeneration. Methods: A systematic review was conducted according to the PRISMA 2020 guidelines. PubMed, ScienceDirect, and the Cochrane Library were searched from inception to June 2026. Experimental animal and in vitro studies evaluating GLP-1Ras on periodontal inflammation, oral wound healing, alveolar bone preservation, and periodontal regeneration were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Results: Three preclinical studies met the eligibility criteria, including one animal study and two in vitro investigations. Liraglutide and exendin-4 consistently reduced periodontal inflammation, suppressed pro-inflammatory cytokines, decreased osteoclast activity, preserved alveolar bone, enhanced osteogenic differentiation, promoted periodontal ligament cell proliferation and migration, and activated regenerative signaling pathways, including MAPK and Wnt signaling. All included studies demonstrated satisfactory methodological quality. Conclusion: Current preclinical evidence suggests that GLP-1Ras possess significant anti-inflammatory, osteoprotective, and regenerative properties that may improve periodontal health and oral wound healing. However, the evidence is limited to experimental studies, and well-designed clinical trials are required to establish their efficacy and safety before routine application in periodontal practice
GLP-1 receptor agonists; periodontitis; periodontal regeneration; oral wound healing; alveolar bone; liraglutide; exendin-4; systematic review.
KNOWLEDGE, ATTITUDES, AND PRACTICES RELATED TO ANEMIA PREVENTION AND MANAGEMENT AMONG PREGNANT WOMEN IN A TERTIARY CARE SETTING LAHORE
Background: Anemia during pregnancy remains a major public health problem and is associated with increased maternal and neonatal morbidity and mortality, particularly in low- and middle-income countries. Adequate knowledge, positive attitudes, and appropriate preventive practices among pregnant women are essential for reducing the burden of anemia and improving pregnancy outcomes. Assessing these factors provides evidence for developing effective maternal health education and nutrition interventions. Aim: To assess the knowledge, attitudes, and practices related to anemia prevention and management among pregnant women attending a tertiary care hospital. Methods: A quantitative descriptive cross-sectional study was conducted among 150 pregnant women attending the antenatal clinic of a tertiary care hospital. Participants were selected using a convenience sampling technique. Data were collected using a structured, pretested questionnaire comprising demographic characteristics and knowledge, attitude, and practice domains. Data were analyzed using IBM SPSS version 29. Descriptive statistics, Pearson's correlation, and multiple linear regression analyses were performed. Statistical significance was set at p < .05. Results: The findings showed that participants had good knowledge (M = 3.97 ± 0.67), positive attitudes (M = 3.99 ± 0.47), and satisfactory practices (M = 3.98 ± 0.61) regarding anemia prevention and management. Most participants recognized the importance of iron-rich diets, iron and folic acid supplementation, and regular antenatal care. Lower practice scores were observed for avoiding tea and coffee after meals, indicating an area requiring additional health education. Conclusion: Pregnant women demonstrated satisfactory knowledge, positive attitudes, and appropriate practices regarding anemia prevention and management. Continuous antenatal education, nutritional counseling, and community awareness programs are recommended to address remaining knowledge gaps and strengthen preventive behaviors, ultimately improving maternal and neonatal health outcomes.
Anemia, Pregnancy, Knowledge, Attitude, Practice, Anemia Prevention, Pregnant Women, Maternal Health, Antenatal Care, Tertiary Care Hospital.
ASSESSMENT OF EARLY MOBILITY PROTOCOLS ON PRESSURE ULCER INCIDENCE IN POST-SURGICAL PATIENTS OF TERTIARY CARE HOSPITAL
Background: Pressure ulcers represent a frequent and serious complication among post-surgical patients, primarily driven by prolonged immobility. While early mobility protocols are recognized as a key preventive strategy, their consistent implementation and definitive impact in clinical settings require further evaluation. Aim: This study aimed to determine the impact of early mobility protocols on the incidence of pressure ulcers in post-surgical patients. Methods: A quantitative, cross-sectional study was conducted at a tertiary care hospital with a sample of 108 post-surgical patients. Data were collected using an observation checklist and chart reviews to assess mobility adherence and pressure ulcer incidence. Statistical analysis was performed using SPSS version 27, employing descriptive statistics and chi-square tests. Results: The study found a statistically significant association (*p* = 0.001) between high adherence to early mobility protocols (≥3 activities) and a reduced incidence of pressure ulcers. Only 3% of patients in the high-adherence group developed ulcers, compared to 33% in the low-adherence group. While 77.8% of patients were assisted to sit within 24 hours, ambulation within 72 hours was achieved by only 64.8%. Key barriers to mobility included postoperative pain (62.0%) and fear of wound disruption (38.9%). Conclusion: Early mobility protocols are a highly effective intervention for preventing pressure ulcers in post-surgical patients. However, full compliance is hindered by patient-related and systemic barriers. A multidisciplinary approach addressing pain management, patient education, and staffing resources is essential for successful implementation.
Early Mobility, Pressure Ulcer, Post-Surgical Care, Nursing Protocols, Patient Safety
FREQUENCY OF FINDINGS IN CASE OF CERVICAL SPONDYLOSIS ON X-RAY
Introduction: Cervical spondylosis is a degenerative skeletal disorder that is becoming more prevalent all over the world with time. Poor neck posture puts excessive strain on the cervical spine which leads to significant morbidity. The disease presents on X-ray films in the form of various radiological patterns creating diagnostic difficulty among clinicians. Identifying the patterns prevalent in our society along with their age and sex distribution can help clinicians to diagnose cervical spondylosis early to start prompt treatment and decrease the morbidity associated with the disease. Method: It was a prospective cross-sectional study conducted at Surraya Azeem Waqf Teaching Hospital Chuburji, Lahore. X-rays of 252 patients diagnosed with cervical spondylosis on radiology during the duration of our study were included in the study. Age, Gender, Clinical history, and radiological findings on Anteroposterior or lateral cervical spine X-rays were documented. Data was analyzed using Med-CALC. The chi-square test was used to explore the p-value of significance for various radiological parameters among females and males. Results: Of these 252 patients, 48% patients had a moderate degree of cervical spondylosis, and 37.7% had straightening of the cervical spine. All the patients had anterior marginal osteophytes. The most frequently observed level of anterior marginal osteophytes was C5 (96.4%). The most frequently affected cervical intervertebral disc space was C5-C6 (81.7%). Bilateral cervical ribs were present in 1.5% of patients. The degree of cervical spondylosis showed a significant association with the age of patients (p<0.001) while there was no significant difference in frequency of cervical curvature abnormalities, anterior marginal osteophytes, presence of disc-space reduction, and degree of cervical spondylosis between males and females (p>0.05). Conclusion: Cervical curvature abnormality was equally prevalent in both genders suffering from cervical spondylosis but the severity of cervical spondylosis was more in elder patients. The most frequently involved vertebra in cervical spondylosis was C5 and the least affected vertebra was C3.
Cervical vertebrae, Spondylosis, BMI, myeloradiculopathy, osteophytes
ASSESSMENT OF KNOWLEDGE AND PRACTICE REGARDING NASOGASTRIC TUBE PLACEMENT AMONG NURSES WORKING IN A TERTIARY CARE HOSPITAL, LAHORE, PAKISTAN
BACKGROUND: Nasogastric (NG) tube insertion is a routine yet critical nursing procedure, widely used for providing nutrition, administering medication, and decompressing the stomach in patients who are unable to eat orally. Nevertheless, if not inserted properly, it may cause severe complications, which include aspiration pneumonia, respiratory distress, or death. OBJECTIVE: This study was conducted to evaluate nurses' knowledge and practices related to NG tube insertion in a pediatric tertiary care setting in Lahore, Pakistan. METHODOLOGY: The study was conducted during a period of six months at the Children's Hospital, Lahore, using a descriptive, cross-sectional design. Using a simple random sampling method, data were collected from 268 registered nurses who met the inclusion criteria. In order to measure the presence of theoretical knowledge and practical skills, a structured questionnaire and an integrated checklist based on the validated instruments were adopted. The data was being analyzed through descriptive statistical methods in SPSS 26. RESULTS: Findings showed that while most nurses (84.7%) were aware of general guidelines and 87% could identify clinical indications for NG tube insertion, only 63% recognized contraindications, and 25% lacked awareness of possible complications. Practical implementation also revealed shortcomings—only 23.9% confirmed tube placement using recommended techniques such as aspiration or pH testing. Additionally, over half of the participants (58.6%) had never received formal training in NG tube placement. CONCLUSION: The study highlights a clear disconnect between knowledge and practice, pointing to the urgent need for structured and evidence-based training. Regular skill-building sessions, simulation-based learning, and reinforcement of standardized protocols are essential to ensure safe and effective NG tube management, particularly in pediatric care, where precision is vital to patient outcomes
EFFECTS OF MICROPLASTIC EXPOSURE ON PHYSIOLOGICAL AND ANTIOXIDANT RESPONSES OF REEF-BUILDING CORAL POCILLOPORA DAMICORNIS
Microplastic pollution has emerged as a major environmental concern in marine ecosystems due to its persistence, widespread distribution, and potential harmful effects on aquatic organisms. Coral reefs are particularly vulnerable to environmental stressors, yet limited information is available regarding the physiological and antioxidant responses of reef-building corals to microplastic exposure. Therefore, the present study was conducted to evaluate the effects of microplastics on the physiological and antioxidant responses of Pocillopora damicornis under controlled laboratory conditions. Healthy coral fragments of Pocillopora damicornis were obtained from a commercial marine aquarium supplier and acclimatized prior to experimentation. Corals were exposed to different concentrations of polyethylene microplastics, including 0 mg/L (control), 10 mg/L, 50 mg/L, and 100 mg/L for a period of six weeks. Physiological parameters such as growth performance, polyp activity, bleaching response, and chlorophyll content were evaluated. Antioxidant and oxidative stress biomarkers including reactive oxygen species (ROS), superoxide dismutase (SOD), and catalase (CAT) activities were also analyzed. The results demonstrated that increasing concentrations of microplastics negatively affected coral physiology. Coral fragments exposed to higher microplastic concentrations exhibited reduced growth, decreased polyp extension, mild bleaching, and lower chlorophyll content compared with the control group. Furthermore, ROS production significantly increased in treated groups, indicating elevated oxidative stress. Antioxidant enzyme activities, including SOD and CAT, also increased progressively with increasing microplastic concentrations, suggesting activation of cellular defense mechanisms against oxidative damage. Although complete coral mortality was not observed during the experimental period, the findings indicated that continuous exposure to microplastics may gradually impair coral health and physiological stability. The present study concluded that microplastic pollution poses a significant threat to reef-building corals by inducing physiological disturbances and oxidative stress responses. This study provides preliminary baseline information regarding the effects of microplastics on corals and highlights the importance of reducing plastic pollution to protect coral reef ecosystems and marine biodiversity
Microplastics, coral reefs, oxidative stress, antioxidant enzymes, chlorophyll, Pocillopora damicornis, marine pollution
ASSESSMENT OF NURSES’ KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARDS OXYGEN THERAPY ADMINISTRATION IN CRITICALLY ILL PATIENTS AT A TERTIARY CARE HOSPITAL
Background Oxygen therapy is an essential intervention in the management of critically ill patients and plays a vital role in preventing hypoxemia and improving tissue oxygenation. Nurses are primarily responsible for administering and monitoring oxygen therapy; therefore, adequate knowledge, a positive attitude, and appropriate clinical practice are necessary to ensure safe and effective patient care. Aim The study aimed to assess the knowledge, attitude, and practice of nurses regarding the administration of oxygen therapy to critically ill patients at Jinnah Hospital Lahore. Methods A descriptive cross-sectional study was conducted over a period of nine months among 157 registered nurses selected through purposive sampling. Data were collected using an adapted structured questionnaire assessing knowledge, attitude, and practice regarding oxygen therapy. The collected data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22. Descriptive statistics, including frequencies and percentages, were used to summarize the findings. Results The findings showed that 49.7% of nurses had moderate knowledge, 45.2% had poor knowledge, and only 5.1% had good knowledge. Regarding attitude, 51.0% demonstrated a positive attitude, while 49.0% had a negative attitude. In terms of practice, 58.6% of participants had poor practice, 31.8% had moderate practice, and only 9.6% demonstrated good practice regarding oxygen therapy administration. Conclusion The study concluded that although nurses generally demonstrated a positive attitude toward oxygen therapy, their knowledge and clinical practice require significant improvement. Continuous professional education, competency-based training, and adherence to evidence-based guidelines are recommended to enhance safe oxygen therapy administration and improve patient outcomes
Oxygen therapy, Knowledge, Attitude, Practice, Nurses, Critically ill patients, Critical care, Intensive Care Unit, Emergency Department.
EFFECTIVENESS OF A STRUCTURED COMPETENCY-BASED TRAINING INTERVENTION IN ENHANCING NURSES’ DIABETIC FOOT WOUND MANAGEMENT PRACTICES: A QUASI-EXPERIMENTAL STUDY
Background: Diabetic foot ulcers are among the most serious complications of diabetes mellitus and contribute significantly to morbidity, hospitalization, lower-limb amputation, and healthcare costs. Nurses play a pivotal role in diabetic foot wound management, making competency-based training essential for improving evidence-based clinical practice. Aim: To evaluate the effectiveness of a structured competency-based training intervention in enhancing nurses' diabetic foot wound management practices at a tertiary care hospital in Lahore, Pakistan. Methods: A quasi-experimental one-group pre-test and post-test study was conducted among 54 registered nurses selected through convenience sampling. The sample size was calculated using the G*Power calculator. Baseline practice was assessed using a structured competency checklist before the intervention. Participants then received a structured competency-based training program comprising lectures, demonstrations, hands-on practice, and competency assessment. Post-intervention practice was evaluated using the same checklist. Data were analyzed using SPSS version 26.0. Descriptive statistics summarized participant characteristics, while a paired-samples t-test compared pre-test and post-test practice scores. Statistical significance was set at p < .05. Results: The mean practice score increased significantly from 19.18 ± 4.35 before the intervention to 31.42 ± 3.28 after the intervention. The paired-samples t-test demonstrated a statistically significant improvement in nurses' diabetic foot wound management practices (t = 19.86, p < .001). The proportion of nurses with good practice increased from 11.1% to 75.9% following the training. Conclusion: The structured competency-based training intervention significantly improved nurses' diabetic foot wound management practices. Regular competency-based educational programs should be integrated into continuing nursing education to strengthen evidence-based practice and improve patient outcomes.
Competency-based training, diabetic foot ulcer, wound management, nurses, nursing practice, quasi-experimental study, diabetes mellitus.