Physical Education, Health and Social Sciences

Comparative Analysis of the Modified Atlanta Classification and CT Severity Index in Assessing Acute Gallstone Pancreatitis: A Study at PIMS Hospital, Islamabad

Dr Uzma Qayyum — 2025-05-17

Background: Acute gallstone pancreatitis (AGP) is a significant gastrointestinal emergency with variable degrees of severity. Exact classification is important for guiding clinical management and predicting patient outcomes. The Modified Atlanta Classification (MAC) and the Computed Tomography Severity Index (CTSI) are widely used for severity assessment, but their comparative effectiveness remains a subject of debate.
Aim: Our Current research intended to assess the efficiency of the Modified Atlanta Classification and the Computed Tomography Severity Index in assessing disease severity and predicting clinical outcomes in patients with acute gallstone pancreatitis.
Methods: A cross-sectional study was led at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, from August 2024 to January 2025. A total of 130 patients diagnosed with acute gallstone pancreatitis were included. Severity classification was performed using both the Modified Atlanta Classification and the Computed Tomography Severity Index. Clinical outcomes, including length of hospital stay, need for intensive care unit (ICU) admission, complications, and mortality, were analyzed and compared between the two classification methods. Statistical analysis was conducted using SPSS, with p-values <0.05 considered significant.
Results: The study included 130 patients diagnosed with AGP at PIMS Islamabad. The Modified Atlanta Classification categorized 42% of cases as mild, 36% as moderately severe, and 22% as severe, while the CTSI classified 38% as mild, 40% as moderate, and 22% as severe. The MAC showed a stronger correlation with ICU admissions (p < 0.05) and organ failure, whereas the CTSI was more predictive of local complications. The length of hospital stay was significantly longer in patients classified as severe by either system (p < 0.001). Both classification methods demonstrated high predictive accuracy, but the CTSI was slightly more effective in identifying patients requiring intensive care.
Conclusion: Both the Modified Atlanta Classification and the Computed Tomography Severity Index were effective in assessing acute gallstone pancreatitis severity. The Modified Atlanta Classification showed superior predictive value for ICU admission and mortality, whereas the Computed Tomography Severity Index was more closely associated with local pancreatic complications. A combined approach may enhance the accuracy of severity assessment and patient management in acute gallstone pancreatitis.

Predicting Heart Disease Risk Using Machine Learning Models and Feature Selection Techniques

Sohaib Latif — 2025-04-01

Heart disease is one of the leading causes of death worldwide, making early detection essential for improving patient outcomes. With advancements in machine learning (ML), predictive models now offer a powerful way to assist doctors in diagnosing heart disease more accurately and efficiently. This study explores various ML algorithms, including Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), Decision Tree (DT), Naïve Bayes (NB), and K-Nearest Neighbors (KNN), to identify the most effective approach for heart disease prediction. Using the Cleveland Heart Disease Dataset, which contains 1,025 patient records with 14 medical attributes, we preprocessed the data, selected key features, and optimized model parameters. After evaluating the models with 10-fold cross-validation, the Random Forest model achieved the highest accuracy (98%), followed by Decision Tree (97%). These results highlight the potential of ML-based tools in clinical decision-making, helping doctors detect heart disease at an earlier stage and make informed treatment plans.

Neonatal Thrombocytopenia as a Consequence of Pregnancy Induced Hypertensive Mother

Dr Muhammad Zain Ul Abideen Roy — 2025-04-03

Objective: To determine the frequency of Neonatal thrombocytopenia as a consequences of Pregnancy induced Hypertensive Mother
Methods: After the ethical approval from the institutional review board, this crossectional study was conducted at Department of Paediatrics, Sialkot Medical College, Sialkot from 05/September/2024 to 05/January/2025. Through non-probability consecutive sampling 140 neonates age l-24 hours, both genders, delivered after 32-weeks of gestation, females with pregnancy induced hypertension were included in the present study
Results: Thrombocytopenia was observed in 49% (n=69) of neonates. Gender showed a highly significant association (p<0.0001), with all thrombocytopenic cases occurring in males (n=63). Similarly, gestational age was strongly associated (p<0.0001); all cases of thrombocytopenia occurred in neonates born before 37 weeks of gestation. Apgar scores were also significant (p<0.0001), as all neonates with scores under 5 had thrombocytopenia.
Conclusion: In conclusion, neonatal thrombocytopenia has direct relationship with maternal PIH especially when the baby is preterm, male or born with low Apgar scores

Levels of Burnout and Resilience Among Nursing Staff at a Public Sector Tertiary Hospital in Swat.

Nasar Mian — 2025-04-03

Background: Burnout refers to a state of physical, emotional, and psychological fatigue resulting from over time exposure to stress, particularly in demanding domains such as health care. While coping builds the ability to withstand stress and cope with pressure, resilience is the ability to bounce back to normal wellbeing after a stressful period easily. In its simplest terms, nurses—counted among the fundamental members of the health care system offer crucial patient care in sometimes testing circumstances.
Aim: The study aimed to assess burnout and resilience among nurses working in a public-sector tertiary care hospital in District Swat.
Methods: The study employed an analytical cross-sectional design to assess burnout and resilience among nurses in a tertiary care hospital in Swat. A convenient sampling technique selected 84 nurses, meeting specific inclusion and exclusion criteria. Data were collected using the Maslach Burnout Inventory (MBI) and Connor-Davidson Resilience Scale (CD-RISC) over two weeks and analyzed via SPSS (version 26). Descriptive statistics and Chi-square tests examined burnout, resilience, and their associations.
Results: The study assessed burnout and resilience among 84 nurses in a tertiary care hospital. Most participants were young females with moderate levels of burnout and resilience. The most prevalent burnout dimensions were emotional exhaustion, depersonalization, and reduced personal accomplishment. Significant associations were found between resilience and all burnout dimensions, highlighting the importance of resilience in reducing burnout.
Conclusion: The study found moderate levels of burnout among nurses, especially in emotional exhaustion and personal accomplishment. Most nurses demonstrated moderate resilience, but a significant portion showed low resilience. A strong association between burnout and resilience suggests that improving resilience could help reduce burnout and enhance nurses' wellbeing in high-stress environments.

Prevalence and Associated Risk Factors of Forward Head Posture in Early Adolescence

Dr. Zain Ali — 2025-04-03

People who spend a lot of time sitting and reading or using a computer frequently develop forward head posture. The weight of the head is kept in front of gravity in a forward head position, shortening the sub occipital muscles and lengthening the pre- vertebral muscles, which increases the flexion moment of the spine. Increased neck discomfort, headaches, temporomandibular (jaw) joint dysfunction, and limited neck mobility are all linked to forward head position. The objective of this study is to evaluate the prevalence of forward head posture in students and young adults and to assess the risk factors of forward head posture. The craniovertebral angle is the most widely used measurement for assessing forward head posture. Subjects are included and excluded according to the criteria developed. Measurement of the craniovertebral angle is usually performed with the help of photometric way and with the help of goniometer. A self-made questionnaire is formed to identify the risk factors. Forward head posture and the magnitude of the craniovertebral angle are inversely related. Data showed that out of 370 participants 267 students have forward head posture while the remaining 103 have not. Those who have forward head posture also find in the activity like reading books in abnormal posture, playing electronic gadgets while bending their head and carrying a heavy bag pack. Prevalence of forward head posture is found to be 72.2% among the students with the age between 12-16. Forward Head Posture is found more prevalent in boys than girls.

Comparative Effects of Semont Liberatory Maneuver and Cawthorne Cooksey Exercises in Benign Paroxysmal Positional Vertigo (Bppv)

Dr. Anbreena Rasool — 2025-04-04

Dizziness is an impression of turning or spinning. The patient feels or thinks motion as a result of the vestibular system's dysfunction. It is associated with vertigo, nausea, and difficulty standing and walking. The most common cause of vertigo is BPPV, impacts between 20% and 40% of patients with peripheral vestibular disease affecting the PC. This study's objective was to determine the comparative effects of SLM and CCE in PC BPPV. This is quasi experimental study in which we collected data from Allied Hospital and National hospital Faisalabad. Twenty-eight patients with BPPV participate among two groups. Group A got SLM and group B got CCE in this study. The intervention was performed three times per week for 3 weeks. Liberatory maneuver depends on the theory of cupulolisthiasis. It includes quickly guiding the sufferer through resistance intended to remove the debris from cupula. CCE was utilized to energize and rush the rebuilding of equilibrium to diminish episodes of lightheadedness. Patients were made to lie in prostrate if patient can't sit up. In any case, the patients were made to sit in any situation without arm rest. The patients were included on the basis of criteria for inclusion and exclusion. SPSS version 20 was utilized for the analysis of the data.

Effectiveness of Holding Breath After a Deep Inhalation in Reducing Pain Intensity During an Injection.

Asaf Shah — 2025-04-08

Background
Pain during injections is a common experience for patients, often leading to discomfort and anxiety. Non-pharmacological techniques, such as breath-holding after deep inhalation, have been explored as potential methods to reduce pain intensity. This study aimed to evaluate the effectiveness of this intervention in minimizing pain during injections.
Objective
The primary objective was to determine the effectiveness of holding one's breath after deep inhalation in reducing pain during injections.
Methods
A quasi-experimental study was conducted at the emergency department of Saidu Group of Teaching Hospitals, Swat. The study included 80 participants (40 in each group) aged 20–50. The intervention group was instructed to hold their breath after deep inhalation during injection, while the control group received no intervention. Pain intensity was measured objectively (researcher observation) and subjectively (patient self-report) using a numerical pain scale (0–10). Data were analyzed using SPSS version 26, with independent t-tests to compare groups.
Results
The mean objective pain intensity was significantly lower in the intervention group (2.70 ± 1.09) compared to the control group (4.20 ± 1.57; p = 0.000). Similarly, the mean subjective pain intensity was lower in the intervention group (2.63 ± 1.21) than in the control group (4.45 ± 1.63; p = 0.000). A higher proportion of participants in the intervention group reported less pain than in previous injections (67.5% vs. 5.0% in the control group).
Conclusion
Holding breath after deep inhalation effectively reduces pain intensity during injections. This simple, non-pharmacological technique can enhance patient comfort and improve the injection experience. Further research is recommended to validate these findings in diverse populations and settings.

Health Education Awareness: A Silent Catalyst for Restful Sleep, Mental Resilience, and Holistic Well-Being

Ali Umar * — 2025-04-08

Health education awareness plays a critical role in shaping individual health behaviors, including sleep patterns, mental resilience, and overall well-being. However, the extent of its influence on these aspects remains underexplored. This study examines the impact of health education awareness on sleep quality, stress management, mental health, and preventive healthcare behaviors. A comparative analysis was conducted among individuals with and without health education awareness. Data were collected through structured questionnaires assessing key areas, including sleep hygiene, mental well-being, stress management techniques, preventive healthcare engagement, and lifestyle behaviors. Mean scores and standard deviations were analyzed to evaluate differences between the two groups. The findings reveal a strong correlation between health education awareness and improved health outcomes. Participants with health education awareness reported significantly better sleep hygiene, with more consistent sleep schedules and fewer disturbances. They also exhibited higher mental resilience, actively engaging in stress management techniques such as mindfulness, exercise, and social support. Additionally, they demonstrated greater engagement in preventive healthcare measures, such as regular medical check-ups and health monitoring. In contrast, those lacking health education awareness displayed poorer sleep quality, higher stress levels, and lower adherence to preventive health practices. Health education awareness serves as a silent but powerful catalyst for improved sleep, enhanced mental resilience, and overall well-being. By fostering knowledge about health-promoting behaviors, it empowers individuals to adopt proactive healthcare measures, leading to long-term health benefits. These findings highlight the urgent need for widespread health education initiatives to bridge knowledge gaps and promote healthier lifestyles across populations.

Prevalence of St-Elevation Myocardial Infarction in End Stage Renal Disease Patients Admitted with Acute Coronary Syndrome at Shifa International Hospital Islamabad

Arsala Khan Kakar — 2025-04-09

Background: End-stage renal disease (ESRD) is associated with a significantly increased risk of cardiovascular morbidity and mortality, with ST-elevation myocardial infarction (STEMI) representing one of the most serious cardiac complications. Due to the unique pathophysiological changes in ESRD, traditional cardiovascular risk factors may not fully predict STEMI in this population.
Objective: To determine the prevalence of ST-elevation myocardial infarction (STEMI) among ESRD patients admitted with acute coronary syndrome (ACS) and to assess its association with baseline patient characteristics.
Material and Methods: This descriptive cross-sectional study was conducted at the Inpatient Department of Shifa International Hospital, Islamabad, over a six-month period from November 2024 to April 2025. A total of 71 ESRD patients aged 30–60 years on maintenance hemodialysis for at least three months and admitted with ACS were included. Data were collected on demographics, comorbidities, and laboratory parameters. STEMI was diagnosed based on ECG changes and elevated troponin levels. Associations with baseline variables were assessed using the chi-square test.
Results: Among 71 patients, the mean age was 46.72 ± 8.88 years, with a mean BMI of 25.43 ± 4.84. STEMI was diagnosed in 14 patients, yielding a prevalence of 19.7%. STEMI was more frequently observed in patients aged 30–40 years (28.6%), females (20.9%), obese individuals (27.3%), and non-smokers (22.2%); however, no association with age, gender, obesity, smoking, diabetes, or hyperlipidemia was statistically significant.
Conclusion: STEMI is a common cardiac event in ESRD patients admitted with ACS. Traditional cardiovascular risk factors did not significantly predict STEMI in this cohort, suggesting the need to explore uremia-specific contributors.

Preventing Needle Phobia in Children: The Efficacy of Distraction Techniques

Naheed Akhtar — 2025-04-09

Background: Needle phobia exists in almost 50% of children despite being a condition that produces significant discomfort regarding necessary medical treatments. Virtual reality (VR) bubble blowing and tablet games demonstrate the potential to decrease both procedural pain and fear in children, but established standard operating procedures are currently absent.
Aim: This study evaluated the effectiveness of structured distraction interventions compared to standard care in reducing pain, fear, and distress during pediatric needle procedures while assessing procedural success and parent satisfaction.
Methods: A quasi-experimental research study included 60 children aged 3-12 years who received randomized grouping into either structured distraction intervention (VR, bubbles, or tablets) or standard care conditions at Saidu Teaching Hospital. The outcomes addressed pain using FPS-R/FLACC scales and fear through CFS measurements, success rate figures for the first attempt procedures, assessment of duration and parent satisfaction levels, and documentation of distress behaviors. The SPSS v28 program with p<0.05 significance level analyzed the data using independent t-tests and chi-square tests.
Results: First-attempt success proved higher, along with decreased pain (2.1±1.4 vs. 4.7±1.8) and fear (1.8±0.9 vs. 3.9±1.2) among subjects receiving structured distraction methods (p<0.001). VR provided the most significant success rate along with the least amount of pain (1.7±1.1) among all intervention methods, yet bubbles (2.0±1.3) and tablets (2.6±1.6) showed intermediate outcomes. Twenty-four seconds shortened the procedural time (p=0.002), and parent satisfaction rates increased to 83.3% while remaining at 40% in the control group (p<0.001).
Conclusion:The adoption of structured distraction techniques leads to better procedural findings and improved patient experience outcomes. Research has demonstrated virtual reality as the best approach, although cost-effective bubble techniques could also deliver successful results. Medical staff should adopt this intervention into their practice for improved care of pediatric patients.

A Review of Neurological Symptoms and Complication of Covid 19

Mehwish Wazir — 2025-04-09

The first case was identified in December 2019, the Human coronavirus disease 2019 (HCOV-19), caused by the severe acute respiratory syndrome coronavirus 2, spread quickly, resulting in a global pandemic. As of early 2025, the virus infected over 200 countries, with over 3.5 million cases and an estimated 165,000 to 243,000 fatalities. Largely characterized by respiratory and cardiovascular complications, recent studies highlight the wide-ranging effect of the virus on the nervous system. The neurological presentations range from mild manifestations, such as headache (in about 10–20% of patients), dizziness, and hyposmia—the most frequent peripheral nervous system symptom—to severe complications, such as encephalopathy, acute cerebrovascular disease (e.g., ischemic stroke and intracerebral hemorrhage), Guillain-Barré syndrome, and sporadic cases of acute transverse myelitis or encephalitis. Importantly, neurological deficits may occur prior to the onset of characteristic respiratory symptoms (such as fever and cough) in 20–30% of cases, making early diagnosis challenging and allowing for transmission risks in the healthcare setting.
Pathophysiologic mechanisms remain to be explored but are likely to include direct viral neuroinvasion through angiotensin-converting enzyme 2 receptors, cytokine storm induction due to systemic inflammation, and hypercoagulability with subsequent thrombotic events. Delirium and encephalopathy are more common in critically ill patients and may be due to hypoxia or multiorgan failure. Chronic neurological sequelae like cognitive impairment and postexertional fatigue are increasingly observed in "long COVID" patients, and this suggests that monitoring in the long term may be necessary.
This review consolidates current situation of the neurological spectrum of HCOV-19 and the need for early detection and multidisciplinary management. Frontline doctors and neurologists need to remain in increased suspicion of SARS-CoV-2 infection in patients with acute neurological syndromes, regardless of respiratory symptoms, to facilitate early isolation and treatment. Research is necessary to unravel the neurotropic capacity of the virus, maximize therapeutic intervention, and prevent long-term disability burden.

Effectiveness of Simulation-Based Training on Clinical Decision-Making Skills Among Nursing Students

Naveela Kausar — 2025-04-10

Background: Simulation-based training (SBT) is increasingly recognized as an effective teaching method for developing clinical decision-making skills (CDMS) in nursing education. Traditional classroom methods often fail to bridge the gap between theoretical knowledge and clinical application, creating challenges for students in real-life healthcare settings.
Aim: This study aimed to evaluate the effectiveness of simulation-based training on enhancing clinical decision-making skills among final-year nursing students.
Methods: A quasi-experimental pre- and post-test design was conducted involving 60 final-year nursing students from various colleges in Swat, Pakistan. Participants underwent six simulation sessions over two weeks. Clinical decision-making skills were assessed using a validated tool before and after the intervention. Paired sample t-tests and chi-square tests were employed to analyze the data.
Results: The mean post-test score (25.75 ± 3.90) was significantly higher than the pre-test score (18.40 ± 4.25), with a mean difference of 7.35 (p < 0.001), indicating a substantial improvement. No significant associations were found between demographic variables (gender and age) and post-test scores (p > 0.05), suggesting that simulation training is practical across different groups.
Conclusion: Simulation-based training significantly improves clinical decision-making skills among nursing students, even those without simulation experience. It is an inclusive and impactful educational approach that can enhance learning outcomes regardless of demographic background. These findings support integrating simulation-based strategies into nursing curricula to better prepare students for real-world clinical practice.

A Comparative Study of Nursing Students’ Perceptions of Clinical Learning Environments in Urban and Semi-Urban Regions of Pakistan

Zeeshan Ahmed — 2025-04-11

Background: Clinical learning environments (CLEs) are pivotal in shaping nursing competencies. In Pakistan, disparities in mentorship, infrastructure, and resource allocation across regions influence student perceptions significantly.
Objective: This study compares nursing students’ perceptions of CLEs between urban (Karachi) and semi-urban/rural hospitals (Hyderabad, Khairpur, Larkana) and explores the factors underpinning these differences.
Methods: A cross-sectional survey using the Clinical Learning Environment Inventory (CLEI) was administered to 120 BScN students. Both quantitative (independent t-tests, ANOVA via SPSS v26) and qualitative methods (thematic analysis) were employed.
Results: Karachi students reported notably higher satisfaction regarding mentorship (mean = 3.5 vs. 2.9, p = 0.02), resource availability (3.8 vs. 2.6, p < 0.01), and peer collaboration (4.0 vs. 3.2, p = 0.03). Graphical representations reveal distinct clusters for urban and semi-urban responses. Qualitative findings highlighted themes such as the need for better supervision and reduced non-academic workload in semi-urban areas.
Conclusion: Urban CLEs currently outperform semi-urban settings, largely due to superior infrastructure and structured mentorship. Policy reforms focusing on faculty training, resource allocation, and workload management are recommended to standardize educational outcomes across regions.

Chronic Neutrophilic Leukocytosis and Elevated Liver Enzymes with Persistent Body Ache: A Diagnostic Challenge

Zeeshan Ahmed — 2025-04-11

A 20-year-old nursing student reported experiencing intense body pains for the last two years, which worsened at night but showed some relief during the day. He also had elevated liver enzymes (SGPT: 216 U/L), and neutrophilic leukocytosis. Despite undergoing multiple tests, including bone marrow biopsy, genetic analysis (NGS panel of BCR-ABL, JAK2, and myeloid genes, and an autoimmune profile, a definitive diagnosis could not be reached. The patient developed body rashes, weight gain, high blood pressure, and mood swings, likely due to prolonged use of multiple antibiotics and, more recently corticosteroids. The patient’s body aches and rashes have persisted as chronic symptoms. The challenges highlight the challenges in the diagnosis of individuals with unexplained neutrophilic leukocytosis and underscore the need for further studies on the etiology, including lymph node involvement.

Evaluating the Impact of Clinical Supervision on the Development of Core Clinical Competencies in Undergraduate Nursing Students: A Mixed-Methods Study

Rizwan Ullah — 2025-04-11

Background:
Integrating theoretical education and applied nursing skills relies fundamentally on clinical supervision during education programs. Adequate supervision produces qualitative assessments that help students develop core competencies, including communication and critical thinking skills and practical abilities for delivering safe patient care. However, the development of competencies faces barriers due to minimal available resources, large class sizes, and inconsistent supervisory methods, specifically in the under-resourced environments of Pakistan.
Aim: This study examined how clinical supervision methods affect the development of core clinical competencies for medical nursing students in Swat.
Methodology: A convergent parallel mixed-methods design integrated quantitative data sets with qualitative measurements to conduct the research. One hundred eighty undergraduate nursing students participated in the study as part of the stratified random sampling process from years 2 to 4. Survey data were collected through the Clinical Competency Self-Assessment Scale (CCSAS) and Clinical Supervision Evaluation Tool (CSET), and interviews were conducted with twelve students. Descriptive statistics, Pearson correlation, Chi-square tests, and thematic analysis methods were utilized for data analysis.
Results: The research data showed that clinical supervision positively affects competency development (r = 0.61, p < 0.001). Fourth-year students achieved the highest scores in competency tests (mean = 3.8) as their academic level increased. Educational staff highlighted the significance of supervisor assistance and meaningful feedback within a positive learning context yet faced challenges from inadequate staffing and insufficient allocated time.
Conclusion: Proper clinical supervision effectively improves nursing students' clinical competencies. Supervisors should receive training as an essential part of their job, while sufficient resources and periodic evaluations of teaching quality will enhance nursing education results.

Comparative Study of Total Cholesterol and Triglyceride in Obese and Non-Obese Subject

Bushra Zainab — 2025-04-14

Objective: To assess the possible effects on cardiovascular health by comparing the levels of triglycerides and total cholesterol in obese and non-obese people.
Methodology: At Ghurki Hospital in Lahore, a comparative cross-sectional study was carried out. One hundred participants in all were classified as either non-obesity (BMI < 30) or obese (BMI > 30). Following an 8–12 hours fast, blood samples were drawn, and enzymatic colorimetric tests were used to determine the levels of total cholesterol and triglycerides. SPSS software was used to statistically analyze the data.
Results: The results showed a strong correlation between changed lipid profiles and obesity. The levels of triglycerides and total cholesterol were considerably greater in fat people than in non-obese people. Obesity and hyper-cholesterolemia were shown to be strongly correlated (p = 0.000), with 44% of the study population having high cholesterol levels (≥200 mg/dL). Likewise, hyper-triglyceridemia and obesity were statistically significantly correlated (p = 0.000), with 62% of subjects having increased triglyceride levels (≥150 mg/dL).
Conclusion: Increased levels of triglycerides and total cholesterol are closely linked to obesity, which may raise the risk of cardiovascular disorders. These results emphasize the necessity of early screening and focused interventions, such as dietary and lifestyle changes, to control lipid abnormalities linked to obesity and avoid related health issues.

Prevalence of Methicillin Resistant Staphylococcus Aureus in Pus Sample

Areej Imran — 2025-04-14

Methicillin-Resistant Staphylococcus aureus (MRSA) has become a significant problem worldwide, causing infections in both hospitals and the wider community. In Pakistan, MRSA is a serious public health issue, especially when it involves skin and wound infections. This study looked at how common MRSA is in pus samples and examined how it resists common medications. The aim of this research is to find out how frequently MRSA occurs in pus samples drawn from clinical sources. A descriptive cross-sectional study was conducted in selected healthcare facilities in Lahore. A total of 250 pus samples were collected from patients presenting with wound or skin infections. The samples were processed for the isolation and identification of Staphylococcus aureus using blood and MacConkey AGAR. Methicillin resistance was determined by antimicrobial susceptibility testing performed using the Disk diffusion method on Muller Hinton agar according to guideline of CLSI. Out of 250 clinical samples analyzed, 49% tested positive for Methicillin-Resistant Staphylococcus aureus (MRSA). Antibiotic susceptibility testing was performed on 55% of the samples. Among the tested isolates, resistance was observed to Vancomycin (31%), Methicillin (24%), and Ceftriaxone (22%). The highest resistance was noted for Vancomycin. Gender-wise distribution showed a slightly higher infection rate in males (54%) compared to females (46%). The increasing number of MRSA cases found in Staphylococcus aureus is a serious health issue that we need to address. This situation indicates that crucial medicines like methicillin and vancomycin are becoming less effective against these infections. Therefore, it is vital to conduct regular tests and be cautious with the use of antibiotics. Additionally, there is a need to enhance laboratory testing methods since not all samples are being examined. To combat the spread of MRSA, we must focus on improving infection control practices, using antibiotics wisely, and continuously monitoring the situation. By taking these steps, we can better manage and reduce the risks associated with MRSA.

Evaluating the effect of cultural competency training in Nursing Education: A Mixed-Methods Approach

Naveela Kausar — 2025-04-16

Background: The education of nurses requires essential cultural competency training because it provides students with the abilities needed to give fair services to patients from different cultural backgrounds in diverse healthcare environments. The recognized significance of culture competency training shows substantial variations when implemented throughout nursing programs, specifically in lower and middle-income countries, including Pakistan.
Aim: This research examined how students in their third and fourth year of nursing education at Swat, Pakistan, developed cultural competence through a structured educational program.
Methodology: The study utilized a mixed-methods research design that included pre-and post-training quantitative CCAT assessment protocols and post-training qualitative FGDs and interview assessments. This study enrolled 185 Bachelor of Science in Nursing students, 81.1% male and 18.9% female, in their third and fourth year. The research used convenience sampling as the enrollment method. The training period spanned six weeks and delivered content about cultural awareness, bias mitigation techniques, communication methods, and case-based simulation practices.
Results: All CCAT domains experienced marked positive changes based on group statistical analysis results (p < 0.0001 with mean score differences of knowledge 1.07, skills 1.12, and attitudes 0.95). Female nursing students obtained slightly better improvements compared to their male counterparts. Research participants indicated better empathetic abilities and communication skills during their training while they pointed to difficulties accessing support resources and few hands-on learning opportunities as fundamental barriers.
Conclusion: Nursing students acquire better readiness to provide patient care across diverse backgrounds through cultural competency training programs. To successfully implement cultural competency training, curriculum integration must be sustained while institutions offer support and practical learning opportunities.

Factors Affecting Academic Performance of Undergraduate Nursing Students at Pak Swiss Nursing College and Hassan College of Nursing Swat

Asaf Shah — 2025-04-16

Background: The educational outcomes of nursing undergraduate students stem from individual characteristics, institutional practices, and external environmental elements. Knowledge of these determinants is essential for achieving better educational results and lowering nursing program attrition.
Aim: This study examined which elements impact academic achievement rates for BSN nursing students enrolled at Pak-Swiss Nursing College and Hassan College of Nursing Swat in Pakistan.
Methods: Between July and November 2024, researchers conducted a quantitative cross-sectional survey that selected 185 nursing students randomly. Subjects responded to self-administered structured questionnaires that examined demographic information, study habits, financial constraints, clinical stress, and institutional support. SPSS software version 26.0 was used to run statistical analyses that included descriptive statistics, independent t-tests, and Pearson correlation methods.
Results: Research participants mainly consisted of male subjects (95.1%) within the age range of 20–24 years (95.1%) who reported being unmarried (95.1%). Key findings included the following: Students who studied with their peers ranked highest as those who significantly benefited from positive influences (75.1%), followed by peer collaboration (73.5%). Students' performance suffered due to clinical stress (67.5%) and financial limitations (45.9%). Test results showed that individual study time contributed significantly more to GPA scoring (r = 0.42, p < 0.001) than working together with fellow peers.
Conclusion: The attainment of academic success among nursing students depends on their study routines, their institution's backing, and their ability to manage stress. To boost student performance, specific interventions should be combined with study skills workshops, financial assistance programs, and faculty training efforts.

Association Between Social Media Addiction and Academic Achievement in Undergraduate Nursing Students.

Sohni — 2025-04-18

Background: Social media integration into the life cycle occurs quickly, which has a considerable impact on the academic context, especially for nursing students. With networking benefits, the availability of information resources, and company presence, the social networks have adverse effects by distracting and causing organizational time management and increased academic performance to decline. The present study aims to assess the level of social media addiction of nursing students and its relation to the educational performance of the students to implement corrective measures.
Aim: The study aimed to explore the relationship between social media addiction and the academic performance of nursing students.
Methods: A quantitative, cross-sectional study was conducted among 232 nursing students in Swat using self-administered questionnaires. Participants were selected through convenience sampling, and data were analyzed using descriptive and inferential statistics. Chi-square tests assessed the associations between demographic variables and social media usage patterns.
Results: According to the study, 94% of the respondents said social media addiction was undesirable for their academic performance. Other platforms used include WhatsApp and Twitter as necessary in group learning and subject collaboration. In contrast, the excessive use of social media was said to endanger study time, performance, and clinical practice. Gender, age, marital status, and year of study were statistically significant determinants of social media usage. Hypothesis 3 was also supported; the non-academic activities detected on SNS were more frequent among male and younger students, although older students exhibited diminished interest.
Conclusion: Social media's dual role as a learning tool and a source of distraction highlights the need for effective management strategies. Educators should focus on promoting responsible usage and supporting students, enabling them to balance their academic responsibilities with social media activities.

Prevalence and Risk Factors of Gestational Diabetes Mellitus Among Pregnant Women

Minahil Shafiq — 2025-04-16

Background: Pregnant women worldwide are impacted by gestational diabetes mellitus, a serious public health issue. macrosomia, pre-eclampsia, and a higher chance of type 2 diabetes.One of the detrimental effects it is associated with in both mothers and fetuses is diabetes. Understanding the prevalence and related risk factors is crucial for early diagnosis and treatment.
Objective: The primary objective of this study is to evaluate the prevalence of GDM among pregnant women and identify key risk factors contributing to its development.
Methodology: Over the course of four months, this cross-sectional study was conducted at Ghurki Hospital in Lahore. A glucose challenge test (GCT) was used to screen 100 pregnant women in total, and those with abnormal results were then screened using an OGTT. SPSS software was used to gather and analyze data on lifestyle, clinical, and demographic factors.
Results: Of the study participants, 56% had GDM. Obesity (BMI > 30 kg/m2), hypertension, a history of prior GDM, and advanced maternal age (>35 years) were identified as key risk factors. Women with GDM were more likely to experience maternal complications like preeclampsia (20%) and hypertension (21%). GDM was also substantially linked to fetal complications, such as preterm birth (22%), and macrosomia (29%).
Conclusion: In conclusion, the high incidence of GDM emphasizes the necessity of lifestyle changes, early screening, and focused interventions to reduce related risks. To lower the prevalence of GDM and enhance pregnancy outcomes, public health programs emphasizing nutritional counseling and maternal education are advised.

A Review Article on Innovative Strategies for Thalassemia

Muhammad Taha Shahzad — 2025-04-15

Thalassemia, a genetic blood disorder characterized by abnormal hemoglobin synthesis, poses a significant global health challenge. With a higher prevalence in the Mediterranean, Middle East, Asia, and parts of Africa, thalassemia has profound implications for affected individuals and healthcare systems. Public health initiatives, including awareness campaigns, genetic screening programs, and advancements in treatment, play a crucial role in mitigating the impact of this hereditary condition. However, economic disparities, inadequate healthcare infrastructure, and cultural barriers hinder effective management and prevention strategies. This study aims to explore the current state of thalassemia management, highlighting the obstacles to optimal care while recommending evidence-based public health strategies to enhance treatment outcomes and prevention measures. Public health initiatives addressing thalassemia encompass a range of strategies, including education campaigns, genetic screening, and improved access to treatment. Educational programs inform communities and healthcare professionals about the disorder, inheritance patterns, and the importance of genetic counseling. Additionally, specialized treatment centers and research collaborations enhance the accessibility and quality of care for thalassemia patients. Studies in various regions, including Cambodia, Pakistan, and other high-prevalence areas, indicate that while awareness and screening acceptance are increasing, gaps remain in healthcare accessibility and policy implementation. Despite advancements in thalassemia management, persistent challenges necessitate more comprehensive and inclusive public health strategies. Addressing socioeconomic disparities, improving healthcare infrastructure, and fostering culturally sensitive genetic counseling are essential for effective prevention and treatment.

Emerging Strategies and Rules for T-Cell Receptor Derived Therapy (A review)

Fakhru Nisa — 2025-04-16

TCR-based therapies represent a groundbreaking step forward in cancer immunotherapy, leveraging the immune system's ability to identify and kill cancer cells. This review explores the latest strategies and regulation updates influencing TCR-targeted therapies, presenting an integrated picture of their scientific rationale, recent developments, and prospective future
directions. The review first describes the fundamental mechanisms of TCR-derived therapy, highlighting how TCRs recognize intracellular tumor-associated antigens presented by major histocompatibility complex (MHC) molecules. The review then discusses some of the main challenges of the field, including antigen specificity, TCR affinity, off-target toxicity, and tumor
heterogeneity, which hinder the discovery of safe and effective therapies. New technologies like gene editing, synthetic biology, and high-throughput screening are revolutionizing TCR design and delivery to target more precisely and with improved safety profiles. At the same time, regulatory mechanisms are being reformatted to address the challenges of engineered T-cell therapies through revised guidelines and oversight. Clinical trials have also produced promising outcomes, especially in hematologic malignancies and a few solid tumors, demonstrating the therapeutic potential of TCR-based therapies. Results from case studies identify successes and limitations, giving useful insights to maximize treatment effectiveness. In the future, the review underlines the need to create predictive models, investigate combination treatments, and provide more widespread access to personalized immunotherapies. With ongoing advances in research and development, TCR-derived therapy has the potential to become the cornerstone of future cancer treatment—subject to scientific, clinical, and regulatory matters being resolved in harmony.

Comparative Analysis of Renal Parameters in Diabetic Vs Non-Diabetic Patients

Ujala Zafar — 2025-04-18

Objective: To find out comparative analysis of renal parameters in diabetic vs. non-diabetic patients.
Methodology: The present study was conducted by reviewing the medical records of 140 renal patients who affected with and without diabetes at AL Noor Lab & digital X-Ray center from October 2024 to March 2025. Biochemical tests will include renal function tests (serum creatinine and blood urea) and glucose test (fasting, random and HbA1c) conducted to provide a comprehensive biochemical profile for each participant.
Results: This research examined 126 blood samples for blood glucose, urea, and serum creatinine levels by employing standard biochemical techniques. The study population consisted of 51.6% males and 48.4% females in three age groups: 18-33, 34-49 and 50+ years. Statical analysis did not show any significant difference between normal and abnormal values of these parameters (p> 0.05).” Thus, hypothesis was rejected, which means the values were statistically insignificant.
Conclusion: This research points out that diabetes negatively impacts renal functions, with creatinine levels deviating more than urea. Screening and glycemic control are essential in controlling diabetic nephropathy.

Suggested Treatment of Advanced Cancer Patients

Hafiz Umair Altaf — 2025-04-18

More than one million women are diagnosed with breast cancer every year, making it the leading cause of death among women all over the world. It is estimated that one out of every nine Pakistani women will acquire breast cancer, making it the most prevalent type of the disease in the country. The prevalence in Pakistan is two and a half times higher than that in nations such as Iran and India. These include a woman's age and her family's history, an early menarche, combined oestrogen and progestin menopausal hormone intake, alcohol use, inactivity, a low socioeconomic position, and a lack of knowledge about breast cancer. Another risk factor is not having enough information about breast cancer. This review article's objective is to to suggest the advanced treatment for cancer patients . Breast cancer, the disease that affects the most women overall and is a serious concern for public health, strikes one in every eight women in the United States. Immunotherapies that target the specific pathophysiology of breast tumours have recently been developed as a result of recent advances in molecular biology and immunotherapy. Following the start of therapy, it's important to pay attention to the formation of treatment resistance mechanisms, which need to be clarified quickly. In breast cancer targeted therapy, are there any novel molecular resistance mechanisms? And if so, what are the best strategies to overcome this huge obstacle? One of its main goals is to update the public on latest findings in the field, as well as investigate into the possibility of preventing resistance processes in order to lengthen life expectancy for those who suffer from this condition Breast cancer is more likely in women who have certain risk factors. Any relevant risk factors must be evaluated in order to enhance the likelihood of developing an illness. One such risk factor that can be avoided is alcohol consumption. There are, however, some risk factors that cannot be avoided (like a history of breast cancer in the female line of descent). Breast cancer is not a foregone conclusion for women who have risk factors. Breast cancer does not impact all women who have risk factors for the diseas

Incidence of Surgical Site Infections and Associated Risk Factors in General/Surgical Wards in Peshawar

Muzamil Khan — 2025-04-19

Surgical site infections (SSIs) remain a major cause of postoperative complications, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. This study examines multiple risk factors contributing to SSIs, including patient demographics, surgical history, postoperative care, infection indicators, healthcare provider practices, antibiotic resistance patterns, environmental influences, surgical team compliance, and nutritional status. A total of 138 patients undergoing various surgical procedures were analyzed. Data were collected on demographic characteristics, type of surgery, duration of hospital stay, wound care practices, presence of infections, antibiotic use, and compliance with infection control measures. Microbiological analysis identified common bacterial pathogens and their antibiotic resistance patterns. Environmental conditions and healthcare provider adherence to infection prevention protocols were also assessed. Statistical analysis was performed to determine significant associations between these factors and SSI incidence. SSIs were confirmed in 23.2% of patients, with Staphylococcus aureus (34.4%), Escherichia coli (28.1%), and Pseudomonas aeruginosa (21.9%) being the most common pathogens. Methicillin-resistant S. aureus (MRSA) was identified in 41.2% of cases, while fluoroquinolone and carbapenem resistance were prevalent among E. coli and Klebsiella pneumoniae. Key risk factors for SSIs included emergency surgeries (34.8%), prolonged surgical duration (>2 hours, 23.9%), inadequate postoperative wound care, and poor nutritional status. Environmental conditions, including high patient density and inadequate ventilation, were also linked to higher SSI rates. Compliance with infection control protocols varied, with only 36.2% of suspected infection cases involving patient isolation. Malnourished patients had a significantly higher SSI incidence (28.6%) and longer recovery times compared to well-nourished individuals. The findings emphasize the need for a multifaceted approach to SSI prevention, incorporating strict infection control measures, antibiotic stewardship, environmental optimization, and perioperative nutritional support. Strengthening surgical team compliance, improving postoperative wound care, and addressing modifiable patient risk factors can significantly reduce SSIs and enhance patient outcomes. Future research should focus on long-term strategies to mitigate antimicrobial resistance and develop advanced infection prevention protocols.

The Role of Artificial Intelligence in Enhancing Nursing Decision-Making

Arshad Hussain — 2025-04-20

Introduction: Artificial intelligence (AI) is revolutionizing nursing by enhancing clinical decision-making. AI-driven tools assist nurses in analyzing patient data, predicting outcomes, and improving care quality. This study explores AI’s role in nursing, highlighting its benefits, challenges, and impact on decision-making to enhance efficiency, accuracy, and patient safety in healthcare settings. Methodology: This quantitative study employed a cross-sectional design to assess the role of AI in nursing decision-making. A sample of 146 nurses was selected using a stratified random sampling technique. Data were collected through a structured questionnaire measuring AI-assisted decision-making efficiency, accuracy, and usability. Descriptive and inferential statistics were used for data analysis, including mean, standard deviation, and regression analysis. Ethical approval was obtained, and participant confidentiality was ensured throughout the study. Results: The study analyzed responses from 146 nurses, revealing that 78% found AI-assisted decision-making improved efficiency, while 82% reported enhanced accuracy in clinical judgments. AI integration reduced decision-making time by an average of 30%. Regression analysis showed a significant positive correlation between AI usage and decision accuracy (p < 0.05). However, 40% of participants expressed concerns about AI dependency. The findings suggest that AI positively impacts nursing decision-making, improving patient care while highlighting the need for proper training and integration strategies. Conclusion: The findings of this study support existing literature, emphasizing the positive impact of AI in nursing decision-making. However, concerns regarding AI’s reliability in complex cases and the need for structured AI training programs highlight areas requiring further exploration. Future research should focus on improving AI reliability and integrating AI-specific education into nursing curricula to enhance clinical decision-making and patient safety.

Assessing The Efficiency of Automated Vs Manual Blood Typing Methods.

Rizwan Ashraf — 2025-04-21

Accurate blood typing is critical in transfusion medicine to prevent life-threatening complications. This review systematically compares the efficiency of automated and manual blood typing methods, evaluating analytical accuracy, operational throughput, cost-effectiveness, and scalability. A literature search spanning 1990–2024 identified 75 studies, which were analyzed to synthesize evidence on both methodologies. Automated systems, leveraging gel microcolumns, solid-phase assays, and AI integration, demonstrated superior accuracy (99.8% concordance vs. 98.5% for manual methods) and throughput (150–300 samples/hour vs. 50–60 samples/hour), with 60–75% lower error rates due to reduced human intervention. However, high initial costs, technical complexity, and infrastructure dependencies limit their adoption in resource-constrained settings. Manual techniques, such as slide and tube agglutination, remain cost-effective and adaptable for low-volume or emergency testing but are prone to subjectivity, longer turnaround times, and higher misclassification rates (8%). Emerging advancements, including point-of-care devices and CRISPR-based typing, promise to bridge current gaps. The review concludes that while automation optimizes precision and scalability in high-volume laboratories, manual methods retain niche relevance in complex serological cases and low-resource environments. Hybrid models integrating automated workflows for routine testing and manual protocols for discrepancies are recommended to balance efficiency and accessibility. Future efforts should prioritize subsidizing automation in underserved regions, advancing AI equity, and strengthening technician training to enhance global transfusion safety.

Role of Gut Microbiota in The Development of Psychiatric Disorders (A Review)

Bilal Ayub — 2025-04-21

Introduction: The human gut microbiota plays a pivotal role in maintaining not only physical but also mental health. Emerging evidence highlights its influence on brain development and function through the gut-brain axis. Disruption of this communication system has been linked to various psychiatric disorders.
Objective: This review aims to explore the relationship between gut microbiota and the development of psychiatric disorders such as depression, anxiety, autism spectrum disorder (ASD), and schizophrenia. It also evaluates the therapeutic potential of microbiota-targeted interventions.
Methodology: A comprehensive review of current literature was conducted using scientific databases including PubMed, ScienceDirect, and Google Scholar. Studies involving both animal models and human subjects from the last 10 years were analyzed to understand the role of gut microbiota in psychiatric conditions.
Results: Different psychiatric disorders are associated with specific gut microbial profiles. Depression correlates with reduced Bifidobacterium and Lactobacillus; anxiety with altered microbiota in germ-free mice; ASD with increased Actinobacteria and Erysipelotrichi; and schizophrenia with Collinsella and Corynebacterium. Modulating gut microbiota through probiotics, prebiotics, or fecal microbiota transplantation has shown promising outcomes in reducing psychiatric symptoms. However, more human-based studies, particularly on anxiety, are needed.
Conclusion: The gut-brain axis plays a vital role in psychiatric health. Understanding gut microbiota’s influence on mental disorders opens avenues for novel therapeutic interventions. Future research should focus on personalized microbiota-based treatments to manage psychiatric conditions effectively.

Acute Kidney Injury in A Young Adult Following Whey Protein Supplement and Gym Workout (Case Report)

Nasir Manzoor — 2025-04-21

The use of supplements whey protein and excerise for muscle building is prevalent in society. while these suppliments carry signficants risks including severe medical complication like acute kidney injury, gastrointestinal problems. We present a 37-year-old male with mild to moderate swelling on face and feet, bilateral sided flank pain, nausea and vomiting. These suppliments and extreme gym workout enhanced the acute renal injury and gastrointestinal problems. This case highlight the importance of recognizing and managing complications related to exercise and whey protein suppliments. Enhance the social awareness and research on these complications avoid these suppliments and excercises to prevent from the longterm potential problems.

Coexisting Acute Respiratory Distress Syndrome, Guillain-Barré Syndrome, and Falciparum Malaria in A 16-Year-Old Female: A Diagnostic and Therapeutic Challenge

Suneel Khan — 2025-04-21

This study highlights the complexities of overlapping life-threatening conditions—acute respiratory distress syndrome (ARDS), Guillain-Barré syndrome (GBS), and falciparum malaria—that must be diagnosed and managed in resource-poor settings. A 16-year old young girl presented with 7day history of fever, diarrhea, lower limb weakness, and rectal bleeding. Initial screening confirmed Plasmodium falciparum malaria. She subsequently developed ARDS and GBS, evidenced by albuminocytologic dissociation of cerebrospinal fluid. In spite of mechanical ventilation, intravenous artesunate, and corticosteroids, the patient deteriorated and died on day 8. The case points to the necessity of early diagnosis of GBS in malaria-endemic regions and advocates for multidisciplinary approaches in resource-constrained environments.

Evaluating the Efficacy of Kegel Exercises in Reducing Postoperative Urinary Incontinence Among Elderly Patients Following Pelvic Surgery

Dr. Sabiha — 2025-04-23

Background: UI continues to affect elderly patients considerably after pelvic operation, leading to 40-60% prevalence rates. The evidence supporting the effectiveness of Kegel exercises (pelvic floor muscle training) for elderly surgical patients is not substantial because research in this area remains scarce.
Aim: This study evaluated the effectiveness of structured Kegel exercises in reducing UI severity and improving self-management confidence among elderly patients undergoing pelvic surgery.
Methods: The research employed a quasi-experimental design to study 50 elderly patients (minimum age 60) at a tertiary medical institution. Patient participants conducted Kegel exercises with standard protocols consisting of three daily sessions of ten to fifteen concentrated repetitions for four weeks. Valid questionnaires measured UI severity and confidence levels through a 5-point Likert scale before and after the intervention. A statistical analysis of paired t-tests and chi-square tests was conducted through SPSS version 26.
Results: The outcomes of this study showcased an essential decrease in urinary incontinence severity since participants started from 3.6 (±0.8) but ended at 2.1 (±0.9) (p<0.001, d=1.38). Participants who performed Kegel exercises twice daily achieved an 87.5% improvement while participants with minimal exercise reported only 38.9% improvement in urinary incontinence severity (p=0.001). Participant confidence in performing Kegel exercises showed a significant improvement based on the "Very Confident" ratings, increasing from 4% to 36%. A significant reduction in incontinence occurred most prominently in the patients who started with moderate to severe incontinence, since they comprised 60% of the cohort.
Conclusion: The success of Kegel exercises for UI management highly depends on patient adherence frequency when used by elderly surgical patients. The intervention helps patients feel more confident and incorporates postoperative care as a standard practice

Association of Lipid Profile Abnormalities with NAFLD Severity in Patients with Metabolic Syndrome

Muhammad Usama — 2025-04-23

Background: Nonalcoholic fatty liver disease (NAFLD) is becoming a significant global health issue, and it is frequently associated with metabolic conditions, including hypertension, diabetes, and obesity. Unlike other liver diseases, NAFLD is not caused by alcohol consumption. One of the main characteristics of this disorder is dyslipidemia, or abnormal lipid levels, which is fundamental in metabolic disorders and may lead to NAFLD development. Often coexisting with NAFLD, metabolic syndrome consists of a group of risk factors including insulin resistance, abdominal obesity, high blood pressure, and dyslipidemia. The complicated interaction of these elements drives the evolution of NAFLD. Timely diagnosis, assessment of illness severity, and development of focused treatment plans depend on early recognition of dyslipidemia and knowledge of its relationship to the elements of metabolic syndrome.
Objective: This study aims to investigate these relationships to gain a better understanding of the metabolic processes underlying NAFLD, consequently driving improved therapy options.
Methodology: 135 people in total participated in this cross-sectional study to evaluate the frequency of many metabolic diseases including NAFLD, diabetes, dyslipidemia, and hypertension. Clinical evaluations and laboratory tests helped to compile information on these diseases. Descriptive statistics is used to determine the frequency rates of every situation. Chi-square test was performed to evaluate the relationships between NAFLD and other metabolic diseases; Pearson's correlation was utilized to investigate the relationship between NAFLD and dyslipidemia. Setting statistical significance at p < 0.05, all studies were run using the SPSS program to guarantee correct and reliable comparisons.
Results: The study found hat dyslipidemia was the most prevalent condition, affecting 57.00% (77 participants) of the sample, followed by NAFLD, which affected 63.00% (85 participants) of the participants. Hypertension was present in 46.70% (63 participants), and diabetes was diagnosed in 41.50% (56 participants) of the cohort. A positive but weak correlation (0.171, p = 0.047) was found between dyslipidemia and NAFLD, suggesting that the presence of dyslipidemia is associated with an increased likelihood of NAFLD. Descriptive statistics revealed a mean NAFLD score of 0.63 (SD = 0.485) and a mean dyslipidemia score of 0.57 (SD = 0.497), indicating a moderate to balanced prevalence of both conditions. Furthermore, 43.5% of participants with NAFLD also had diabetes, compared to 38.0% in the non-NAFLD group. Hypertension was observed in 51.8% of NAFLD patients, compared to 38.0% in those without NAFLD.
Conclusions: This study highlights the high prevalence of metabolic disorders, including dyslipidemia, NAFLD, hypertension, and diabetes, within the sample population. A weak but statistically significant correlation between dyslipidemia and NAFLD suggests that the presence of one condition may increase the likelihood of the other. Furthermore, the study emphasizes the significance of monitoring complications, particularly hypertension and diabetes, in patients with NAFLD. The results imply that more thorough statistical investigations including chi-square tests are required to investigate the relevance of these correlations in greater depth and enhance our knowledge of the interrelationships among several diseases.

Exploring Nurse Managers' Perception and Attitudes Towards Artificial Intelligence Integration in Healthcare Settings.

Amna Jabeen* — 2025-04-23

The integration of Artificial intelligence in healthcare setting has the potential to transform the delivery of patient care. However, the success of AI adoption depends on the perception and attitudes of nurse managers, who play a crucial role in implementing and managing healthcare technologies. Such developments will only serve to strengthen the place of AI in the provision of health care services, as well as in the management of patients The healthcare industry is experiencing a significant shift towards digital transformation, with AI being a key driver of this change. This study employed a cross-sectional design, using convenience sampling and questionnaire was designed on Likert scale. Data collected was systematically organized and analyzed using SPSS and Excel. As a result, this research supportss the alternate hypothesis and reject the null hypothesis. AI is recognized as having the potential to revolutionaries’ healthcare, by enhancing the quality of care delivered to patients, streamlining many backend tasks, as well as supporting medical decisions. Establish elaborate training programs tailored towards teaching nurse managers all that they need to know about the AI systems to use and how to use them to their advantage. Skills training should involve demonstration and ethics, agendas and cases on success stories of Artificial Intelligence tools.

Anitimicrobial Susceptibility Pattern of Acinetobacter Baumanni at Tertiary Care Hospital in Lahore Pakistan

Muhammad Shahid Shakoor — 2025-04-25

Objective: The aim of study was to check the Anitimicrobial Susceptibility Pattern of Acinetobacter baumannii at tertiary care hospital in lahore Pakistan.
Methodology: Data from clinical specimens of patients with Acinetobacter baumannii infection were retrospectively studied. Standard microbiological techniques were used to screen for antibiotic susceptibility, and the results were then examined to identify patterns of resistance.
Results: Out of 50 clinical isolates of Acinetobacter baumannii, the highest infection rate (52%) was observed in patients above 51 years of age, with a slight female predominance (54%). Alarming levels of resistance were recorded against commonly used antibiotics: 92% to ciprofloxacin, 80% to meropenem, 70% to imipenem, and 72% to gentamicin. Only 24%, 8%, 6%, and 16% of isolates, respectively, remained sensitive to these antibiotics. No significant association was found between gender and resistance patterns for any of the tested drugs (p > 0.05). These findings indicate a high prevalence of multidrug-resistant A. baumannii strains in the hospital setting, underscoring the urgent need for improved antimicrobial stewardship.
Conclusion: The study spotlighted Acinetobacter baumannii’s antibiotic susceptibility pattern at a tertiary care facility in Lahore, Pakistan. In order to address the growing problem of antibiotic resistance, these findings are crucial for directing antimicrobial stewardship initiatives and empirical treatment decisions.

Sonographic Assessment of Various Causes of Pelvic Pain in The First Trimester of Pregnancy Across Different Age Groups

Mahnoor Riaz — 2025-04-25

Background: Acute pelvic pain during early pregnancy presents diagnostic challenges due to varying underlying causes. Ultrasonography is the primary imaging modality used in these scenarios due to its safety and diagnostic accuracy
Objective: To evaluate the effectiveness of ultrasonography in identifying various causes of pelvic pain during the first trimester of pregnancy across different age groups.
Methods: A descriptive study was conducted at the University of Lahore Teaching Hospital. A total of 82 symptomatic pregnant women in their first trimester were included through convenience sampling. Transabdominal and transvaginal ultrasounds were performed. Data analysis was conducted using SPSS v24
Results: Among 82 participants, 35.4% experienced bleeding. The most common findings were fibroids (22%), corpus luteal cysts (17.1%), and ectopic pregnancies (9.8%). A strong association was noted between fibroids and bleeding (p < 0.001). The majority of patients (63.4%) had normal findings, and younger women (18–27 years) represented the most affected age group.
Conclusion: Ultrasonography is essential in diagnosing pelvic pain causes during early pregnancy. Fibroids, corpus luteal cysts, and ectopic pregnancies are the predominant pathologies, with a higher prevalence among younger patients.

Nurse-Led Strategies for Postoperative Pain Management in Patients with Opioid Use Disorder: Focusing on Buprenorphine Continuation Protocols

Nishat Perveen — 2025-04-30

Background: Patient recovery from Opioid Use Disorder encounters multiple hurdles when treating postoperative pain because opioid tolerance exists alongside public prejudice and the danger of returning to drug abuse. Healthcare professionals need strategies for implementing buprenorphine continuation protocols, but research about nurse-led implementation in limited-resource areas remains scarce.
Aim: This study aimed to investigate nurse-led buprenorphine continuation protocols for postoperative pain management in OUD patients, focusing on challenges, strategies, and outcomes in a surgical ward setting.
Methods: The research design was qualitative descriptive, relying on semi-structured interviews with 10 registered nurses at Saidu Teaching Hospital in Swat, Pakistan. The research interviewed nurses because of their experience with postoperative care and buprenorphine administration. Braun and Clarke’s thematic analysis was the basis for analyzing the gathered data.
Results: The study identified four main themes which included (1) buprenorphine maintenance as essential for withdrawal prevention and pain management (2) personalized patient-centered pain care plans (3) healthcare staff faced barriers of stigma and opioid tolerance and institutional barriers and (4) nursing professionals should act as advocates by promoting education to ensure patient adherence and reduce bias-related issues. Personalized treatment strategies built better relationships with patients and better results despite problems with institutional prejudices and untrained staff members.
Conclusion: Nurses’ implementation of buprenorphine protocols proves essential for providing appropriate postoperative pain care to patients with OUD. Delivering superior postoperative pain care for patients with OUD requires institutional backing, reduced stigma, and standardized training programs. Future initiatives require interdisciplinary cooperation with specialized educational programs to meet the specific needs of individuals who require such care.

Challenges and Issues Faced by Agalactorrhic Mothers in Matta Swat Hospital, Pakistan

Zubaida Bibi — 2025-05-02

Background: According to the World Health Organization (WHO), breastfeeding is the ideal food for new-borns up to six months of age. It provides all the nutritional needs of infants and protects them from many childhood illnesses. Therefore, the current study results provided baseline data of those mothers who may not breastfeed due to a lack of milk production or insufficient intake of proper nutrients, which may worsen this condition.
Aim: The study aimed to explore challenges and issues faced by Agalactorrhric mothers in Matta Swat Hospital, Pakistan.
Methods: Using purposive sampling and in-depth interviews, a descriptive phenomenological design explored the lived experiences of 13 agalactorrheic mothers at a Category C Hospital in Matta, Swat. Mothers with known medical conditions or who were unwilling to participate were excluded. Data were collected using a semi-structured, audio-recorded interview guide. Braun and Clarke’s six-phase thematic analysis was used to analyze the data.
Result: The data identified 128 open codes. Additional and unnecessary codes were omitted, resulting in the identification of 18 categories from the open codes. From these categorical data, significant themes emerged, which were listed as follows: insufficient nourishment, physical and health discomfort, financial strain, emotional and psychological consequences, and alternative feeding complexities.
Conclusion: This was a comprehensive study that highlighted challenges and issues faced by Agalactorrhric mothers. It revealed that financial constraints and inadequate access to nutritious food can significantly impact milk production, leading to adverse effects on both milk production and the baby's health. Additionally, the findings highlighted significant hardships mothers face due to societal and familial pressures. Financial burden is a key factor contributing to insufficient milk production among Agalactorrhric mothers.

Recurrent Diarrhea as a Rare Presentation of Budd-Chiari Syndrome: A Case-Based Insight into Hepatic Venous Outflow Obstruction (Case report)

Asadullah Soomro — 2025-05-02

Budd-Chiari syndrome (BCS) is a hepatic disease of rare occurrence characterized by hepatic venous outflow obstruction, traditionally presenting with hepatomegaly, ascites, and liver dysfunction. Gastrointestinal manifestations like diarrhea are underdiagnosed and rare. Here we report a case of a 21-year-old male patient with the presenting complaints of abdominal pain, ascites, jaundice, and chronic diarrhea. Imaging showed hepatic venous outflow obstruction and laboratory findings showed a hypercoagulable state with positive lupus anticoagulant and factor V Leiden mutation. The patient was treated by having a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure, with resolution of the diarrhea. Recurrence of the symptoms after shunt blockage and resolution after TIPS had been reevaluated only further established the association between hepatic congestion and symptoms. This situation does point to a possible pathophysiologic connection between hepatic congestion and abnormal gut motility and it does emphasize the necessity of heightened surveillance and investigation for gastrointestinal symptoms in BCS.

Formulation, Evaluation of Vitamin E Emulgel for Topical Application with Herbal Enhancers

Rahman Gul — 2025-05-03

Vitamin E, an antioxidant with low water solubility and bioavailability, which can protect the skin from atopic dermatitis and other negative effects of sun radiation by scavenging free radicals. The current work aimed to establish and evaluate a microemulsion-based gel considering transdermal drug delivery of vitamin E, herbal enhancers. clove oil, thymus oil and carbopol 940 used as a gelling agent. Emulsion was developed and it was incorporated in gel base. Formulations were assessed for pH, viscosity, spread ability, conductivity, Homogeneity, drug content, FTIR, XRD, DSC, in-vitro drug release and stability studies were conducted. The formulations characteristics showed improved and stable results. F5 showed higher released rate as compared to others formulations, FTIR and XRD confirmed compatibility and stable physical states, while DSC revealed a suitable formulation. In-vitro studies indicated a sustained drug release profile suitable and fit on first release order for transdermal delivery. It can be concluded that the Vitamin E emulgel demonstrated likely as an effective topical drug delivery system. Its stability, enhanced release, and possible physicochemical characteristics showed a promising option for treating inflammatory skin conditions. It was then thoroughly assessed utilizing methods including FTIR, XRD, SEM, and other common tests for efficacy and quality control. In addition to discussing the emulgel's potential for topical drug delivery, this report also covers its synthesis, characterisation, and in-vitro release investigations

Formulation, Characterization of Piroxicam Ointment for Topical Drug Delivery with various Enhancers

Muhammad Jaffar — 2025-05-03

The primary objective of the current study was to develop and then assess Piroxicam ointment with penetration enhancers, including castor oil, thymus oil, and clove oil. As per B. P., 4.750 g of hard paraffin was melted at sixty degrees Celsius, and then 4.75 g of Cetostearyl alcohol, 4.75 g wool fat was added to create the 0.5% formulations of Piroxicam salt ointment was mix in it. Following the addition of 82.25 g of soft paraffin, , and 3 ml of each of the following oils, such as thymol, clove, and castor, were added, first separately and then all at once, while stirring constantly. At last, the room temperature was reached by letting the ointment cool. These formulations were subjected to a comprehensive evaluation of their consistency, homogeneity, spreadability, viscosity, pH, drug content, UV absorbance, FTIR,DSC, and XRD study conducted. In addition to utilizing dialysis cellulose membrane, an in vitro study was carried out using Franz cells. Very well physicochemical properties were demonstrated by every synthesized composition. According to FTIR, SEM and XRD studies, the active ingredient (piroxicam salt) and additives used as drug permeation enhancers (oils) did not exhibit any physicochemical incompatibilities. The maximal release of the F4 thymol enhancer formulation was 69.183%. The current study found that the topical ointment of Piroxicam salt can be more permeable when it contains thymus oil >DNSO>clove oil >and castor oil

Enhancing Preoperative Patient Understanding and Nurse-Led Communication Using 3D-Printed Surgical Models: A Multimodal Study in the Surgical Departments of Saidu Teaching Hospital, Swat.

Salma Khatir — 2025-05-04

Background: Patient education before surgery proves vital because it helps patients grasp their condition better and lowers their anxiety and delivers better satisfaction results. Patients find insufficient understanding when they rely on traditional methods which include verbal explanations together with simple 2D images. Staff nurses work with 3D-printed surgical models to teach preoperative patients better in low-resource healthcare facilities.
Aim: This research evaluates how 3d-printed anatomical models assist nurses in delivering preoperative education to evaluate patient comprehension, minimize anxiety, and boost patient satisfaction in surgical departments.
Methods: Sixty elective surgical patients underwent research at Saidu Teaching Hospital, Swat, Pakistan, with thirty patients in the intervention group and thirty patients in the control group. Preoperative patient counseling included patient-specific 3D-printed model demonstrations for the intervention group but the control patients received standard education methods. The research relied on comprehension questionnaires together with APAIS (anxiety scale) measurements and a satisfaction rating assessment tool for data collection. Semi-structured interviews were conducted with both 10 patients and 10 nurses, producing qualitative data.
Results: The participants who received patient-specific 3D-printed models experienced better understanding results (mean +8.3, p < 0.001) as well as reduced anxiety scores (mean -7.7, p < 0.001) compared to standard education model patients. Patients in the intervention group demonstrated superior levels of satisfaction, since 73% of them expressed very high satisfaction. The analysis yielded four main themes, which included patients getting better comprehension alongside better emotional reassurance and improved communication methods. The nurses articulated their training needs as another significant theme.
Conclusion: Through the use of 3d-printed surgical models, nurses achieve better patient understanding while simultaneously reducing patient anxiety and improving their educational satisfaction. Resource-limited healthcare facilities can implement 3D-printed surgical models that create positive impacts through their deploy ability.

Prevalence and Influencing Factors of Self-Esteem in Undergraduate Nursing Students from Public and Private Institutions in Karachi: A Cross-Sectional Analysis

Sadia Sattar — 2025-05-04

Introduction: Self-esteem is a critical determinant of nursing students' academic achievement and mental health. It affects their confidence, communication, and coping with clinical challenges. Nevertheless, self-esteem can differ based on individual and socio-demographic factors, which affect students' learning experiences and professional growth. Objectives: To compare the levels of self-esteem among undergraduate nursing students in public and private institutions in Karachi another is to determine socio-demographic determinants of self-esteem among these students. Methodology: Comparative cross-sectional study was carried out at two different nursing colleges in Karachi, Pakistan. The population for the study consisted of Generic BSN students from all years of study. A sample of 192 students was chosen using non-probability convenient sampling. Data was collected through a validated structured questionnaire, consisting of a socio-demographic section and the Rosenberg Self-Esteem Scale (RSES). Data analysis was conducted using SPSS version 21.0, where p-values ≤ 0.05 were regarded as statistically significant. Results: The study revealed that 20.3% of students exhibited low self-esteem, 72.4% normal self-esteem, and 7.3% high self-esteem. Gender, year of study, and socioeconomic status were strongly correlated with levels of self-esteem. Low self-esteem was reported by female students and students from lower socio-economic groups. Conclusion: Most of the nursing students had normal self-esteem, with some socio-demographic characteristics determining their level of self-esteem. Targeted interventions to enhance self-esteem in vulnerable groups can be recommended based on these findings, which can lead to improved academic and professional performance.

Structural Characterization, Antioxidant, Antidiabetic and Antimicrobial Activities of Cynodon Dactylon, Arundo Donax, Alstonia Scholaris Linnand Plumeria Rubra Linn.

Ibtisam Elahi* — 2025-05-05

Numerous plants were being used in conventional treatment and for cure of many diseases along with maintaining health from ancient times. Cynodon dactylon, Arundo donax, Alstonia scholaris linn and Plumeria rubra linn have great medicinal importance due to their antioxidant, antidiabetic, antimicrobial, antirheumatic or antihyperlipidemic activities. In this study, extract of aerial parts of C. dactylon , Arundo donax, Alstonia scholaris and Plumeria rubra were prepared in three different solvent via ethyl acetate, methanol and aqueous. Extracts were further processed in order to assess antioxidant, antidiabetic and antimicrobial activity of C.dactylon, A.donax, Alstonia scholaris and Plumeria rubra. Antioxidant activity was assessed by TPC, TFC and DPPH scavenging assay while antidiabetic activity was assessed by Alpha amylase inhibition and glycation analysis. Minimum inhibitory concentration was performed for the determination of antimicrobial activity. Structural characterization were done by Fourier transform infrared spectroscopy (FTIR) and High-performance liquid chromatography (HPLC).Highest yield was obtained by the aqueous extract of P. ruba (10.47%) while lowest yield was obtained by ethyl-acetate extract of C.dactylon and A.donax (0.652%).Highest TPC was observed in Arundo donax aqueous extract (681.27±0.40mg GAE\100g dry weight) while lowest was observed by aqueous extract of Cynodon dactylon (270.83±0.40mg GAE\100g DW). Highest TFC was observed in A. scholaris ethyl acetate extract (807.36.69±0.66mg CE\100g dry weight) while lowest was observed by ethyl-acetate extract of Arundo donax (26.96±0.37mg CE\100g DW). Similarly highest DPPH radical scavenging activity was observed in ethyl acetate extract of P.ruba (77.84±0.33%) while lowest in aqueous extract of A.scholaris (16.96±0.22%). Arundo donax showed highest zone of inhibition against Escherichia coli (15.1±0.94mm) while P.ruba showed lowest zone of inhibition against Staphylococcus aureus (6.0±0.40mm). Highest antiglycation activity was observed in methanolic extract of A.donax (70.20±0.76%) while lowest was observed in ethyl- acetate of C.dactylon (28.40 ±0.15%). Best alpha-amylase activity was observed in methanolic extract of A.scholaris (61.14±0.21%).FTIR analysis of selected plants showed the presence of compounds like alcohol, phenol, carboxylic acid, primary and secondary amides and amines, alkanes, sulphonyl , sulphones, nitro groups, alkyl-halides ,aldehydes, methyl and methylene groups, fluorides, chloride ,alkenes, aromatic compounds ,ether ,ester and anhydrides were observed. HPLC analysis showed the presence of gallic acid, quercetin, caffeic acid, vanillic acid, m-coumaric acid, p-coumaric acid, sinapic acid syringic acid, ferulic acid, benzoic acid and chlorogenic acid. Data was analyzed statistically by using one-way ANOVA and hence it was concluded that a significant difference (p<0.001) was present among extracts made by using different solvents in term of all biological activities.

Perceptions of Nurses, Physicians, and Respiratory Therapists regarding Interprofessional Collaboration in the Intensive Care Unit of a tertiary care Hospital in Karachi. A Qualitative Explorative Study

Iftakhar Ahmed — 2025-05-07

Interprofessional Collaboration (IPC) is pivotal in healthcare, particularly in neonatal intensive care units (ICU). Effective Interprofessional Collaboration between nurses, physicians, and respiratory therapists in patient care can reduce hospital stays, improve the quality of care, and enhance patient health outcomes. It has been determined that Interprofessional Collaboration (IPC) is among the most significant policy strategies for overcoming healthcare staff and patient safety challenges and improving the healthcare organization. This study explores the perceptions of NICU nurses, physicians, and respiratory therapists about IPC in a tertiary care hospital in Karachi, Pakistan. It also investigates the facilitators and barriers to IPC, which impact the quality of patient care. An exploratory qualitative study was conducted through semi-structured interviews of 12 nurses, physicians, and respiratory therapists in a tertiary care hospital neonatal ICU. The study employed a purposive sampling technique, where participants were selected based on their direct engagement in patient care. Interviews were conducted in both Urdu and English, each in-depth interview takes 30-40 minutes. Data analysis proceeded with systematic text condensation, with thematic analysis to determine key patterns and themes. There were three dominant themes identified in the analysis: 1) Attitudes of health professionals toward IPC, emphasizing the significance of patient outcomes and enhanced collaboration opportunities 2) Facilitating factors of effective IPC, stressing the role of effective communication, respect, and trust and professional experience and knowledge; 3) Hindering factors to effective IPC, and the difficulty such as shortage of organizational support, power disparity, workload extension, and factors based on systems. Participants acknowledged the substantial advantages of IPC to improve patient outcomes and stressed the significance of cooperative, respectful, and well-informed practices by healthcare professionals. It also suggests the need to highlight its incorporation in education and research practices. This study adds important insight into the dynamics of IPC in a developing country's healthcare system. It underlines the key position that IPC takes in enhancing patient outcomes and the need for systemic changes to ensure an Interprofessional healthcare culture.

The Role of Pediatric Nurses in Enhancing Caregiver Health Literacy for Effective Home Management of Children with Congenital Heart Disease.

Sidra Khaliq — 2025-05-07

Background: Children with congenital heart disease experience difficulties in house-based management because their caregivers lack the necessary knowledge and understanding of health information. Teaching CHD management to caregivers remains essential for achieving better health results for children while granting caregivers the ability to deliver successful home care. Research documents demonstrate that niche educational approaches produce substantial positive changes in caregiver understanding and competence.
Aim: This study aimed to determine the impact of educational intervention programs on health literacy knowledge acquisition about CHD management for caregivers with children diagnosed with CHD.
Methods: The research implemented a quasi-experimental design using sixty caregivers divided into two groups, totaling thirty participants in each section. The educational intervention program was delivered to the intervention participants, yet the control participants received no educational materials. Healthcare providers completed the NVS tool as the measure for health literacy assessment, and a designed questionnaire determined their level of knowledge about CHD management. Both pre-test and post-test scores underwent group and individual group analyses to evaluate intervention success.
Results: Participants in the intervention experienced notable advancements in their health literacy (p < 0.001), together with increased knowledge about CHD management (p < 0.001). Minimal alteration emerged between pre- and post-tests in both measures for the control group. Data collection showed that intervention group caregivers gained substantial self-assurance in caring for their child at home (p < 0.001), surpassing the levels of the control group.
Conclusion: The systematic educational program effectively improved health literacy, knowledge, and confidence levels among caregivers for managing CHD. The research shows that educational programs that provide specific guidance led caregivers to gain more control over child healthcare needs, thus producing better care.

DEVELOPMENT AND EVALAUTION OF LORATADINE GEL FOR TRANSDERMAL DRUG DELIVERY

Zakia — 2025-05-07

Abstract

Objective:

This research was conducted to develop and evaluate sustained release topical gels containing Loratadine, olive oil used as penetration enhancer with various concentrations to see its effect on drug release concentration.

Method

Several gel formulations were prepared using hydrophilic polymers including Carbopol 940, to investigate their impact on drug release characteristics and physicochemical properties. The formulations were assessed for pH, spreadability, viscosity, drug content, and in vitro release profile. The study used sophisticated advanced techniques including Diffraction (XRD) Scanning Electron Microscopy (SEM) and Transform Infrared Spectroscopy (FTIR) to examine the physicochemical properties of the gel. Franz diffusion cells were employed for release studies, and the release kinetics were interpreted using multiple mathematical models.

Results

Physicochemical evaluation were pretty smooth and homogeneous with pH values ranging from 5.2 to 6.3, drug content uniformity fell within acceptable limits ranging roughly from 97.10% to 98.19% across formulations. Optimized gel released nearly 76.93%.Increase in olive oil concentration increase in permeability. Release kinetics conformed remarkably well to First order. FTIR spectroscopy confirmed chemical stability of Loratadine in gel. XRD analysis revealed Loratadine crystalline peaks diminished in final gel. SEM images revealed a remarkably smooth surface devoid of visible crystalline drug particles indicating homogeneous distribution and efficient entrapment of drug

Conclusion

Indicated that Carbopol gels provided optimal sustained release and acceptable physicochemical characteristics, supporting their potential use for transdermal delivery of Loratadine.

Balancing Innovation and Affordability in the Future of Cost-Effective Smart Surgical Instruments

Basit Kamran — 2025-05-07

The safety, accuracy, and results of surgical procedures have been greatly enhanced by the incorporation of cutting-edge technology into surgical instruments, such as robotics, artificial intelligence, and wireless systems. However, because of their high cost, particularly in low- and middle-income areas, these innovations frequently remain out of reach for many. This study looks into ways to lower the price of sophisticated surgical instruments without sacrificing their functionality. Utilizing a multidisciplinary approach, it investigates manufacturing techniques, modular design, material selection, and policy frameworks with the goal of improving affordability. Economic accessibility is not given enough attention in the development of new devices, according to a review of the literature. The potential for innovation that satisfies both clinical and financial objectives is illustrated by case studies and collaborative models. The study also emphasizes the moral necessity of fair access as well as the contribution of data analytics and digital technologies to cost-effectiveness. The results imply that greater global health equity and more sustainable healthcare practices can result from bridging the gap between innovation and affordability.

Placenta Previa a Lethal Disease: A Correlation With Uterine Scaring

Khadija Hafeez — 2025-05-07

Placenta previa is the main cause of fetomaternal morbidity and mortality globally. Multiparity, advanced maternal age, infertility treatments and recurrent abortions has been linked to the prognosis of placenta previa. Scarred uterus due to history of Cesarean sections is main risk factor as frequently, primary cesarean sections result in recurrent cesareans, which can cause placenta previa. Our study aims to evaluate sonographic association of placenta previa in scarred and unscarred uterus. It was a descriptive cross-sectional study including 84 patients of placenta previa. Data of their previous pregnancies and previous Cesarean sections are also collected. The data is collected from the radiology department of Bhatti International Teaching Hospital Kasur within 3 months. Convenient sampling technique is used in data collection. Among the total 84 cases of females with placenta previa, most of the females had age below 30 years. Previous Cesarean section was mainly associated with the prevalence and grades of placenta previa, while number of previous pregnancies has a non-significant relation to the grades of placenta previa in scarred group of females. Therefore, our study showed that scarring has significant affect on the ultrasonographic grades of placenta previa rather than an unscarred uterus. Our findings indicate that placenta previa grading is significantly greater in the scarred group, indicating a more serious condition than the unscarred group. The result emphasizes the significance of uterine scarring in the development of placenta previa by demonstrating the strong correlation between the severity of the condition and previous Cesarean sections.

Relationship Between Health Literacy and Self-Management of Neurogenic Bladder in Spinal Cord Injury Patients

Muhammad Imran — 2025-05-12

Background: Neurogenic bladder is a common complication arising as a consequence of spinal cord injury (SCI), which affects people in problematic self-care practices. Health literacy is critical for patients to understand and control their condition properly. Research exploring this link is yet to be conducted in Pakistan.
Aim: This study aimed to examine the relationship between health literacy and self-management of neurogenic bladder among adult spinal cord injury patients at Saidu Teaching Hospital, Swat.
Methods: The correlational research design was employed, and 100 adult SCI patients with neurogenic bladder were purposively selected as participants. Data was collected using a structured questionnaire with three sections: < knowledge level, as demonstrated, the adapted Health Literacy Questionnaire (HLQ), and the validated Self-Management Scale for Neurogenic Bladder. Participants were directly interviewed, and the gathered data were analyzed in SPSS version 25. The correlation between health literacy and self-management was formulated using Pearson's correlation test.
Results: The mean age across participants was 42.5 years (SD ± 11.6), and 63% were male. The participant's overall health literacy was 6.8 ± 1.6, with a mean self-management score of 7.1 ± 1.4. There was a positive and significant relationship between each facet of health literacy and self-management; overall health literacy demonstrated the highest correlation (r = 0.61, p < 0.001).
Conclusion: The study results confirm that improved health literacy promotes better self-management of neurogenic bladder in persons with SCI. More emphasis on health literacy through specialized educational interventions may increase long-term outcomes for patients.

Formulation, Evaluation of Naproxen and Dexpanthenol Emulgel for Transdermal Drug Delivery

Esha Ghaffar — 2025-05-12

Objective: The aim of this study was to formulate emulgel of naproxen and dexpanthenol, a NSAID and complex of B vitamin, utilizing Carbapol 940 as a gelling agent. Mineral oil and clove oil were used as penetration enhancers.
Methodology: In the first step emulsion was developed and it was added in gel base. Formulations were assessed for pH, viscosity, spread ability, conductivity, Homogeneity, drug content, FTIR, XRD, SEM, in-vitro drug release and stability studies were conducted.
Results: The formulations characteristics showed improved and stable results. F6 showed higher released rate as compared to others formulations, FTIR and XRD confirmed compatibility and stable physical states, while SEM revealed a uniform surface. In-vitro studies indicated a sustained drug release profile suitable for transdermal delivery.
Conclusion: It can be concluded that the naproxen-dexpanthenol emulgel demonstrated likely as an effective transdermal drug delivery system. Its stability, enhanced release, and possible physicochemical characteristics showed a promising option for treating inflammatory skin conditions.

Effect of Nurse-Led Educational Interventions on Medication Adherence Among Cancer Patients Receiving Oral Chemotherapy

Nageena Bibi — 2025-05-13

Background: Pill taking is paramount in the treatment of cancer diseases using oral chemotherapy. Non-adherence is still a common problem, although a lack of patient education and counselling often causes it. Nurse-delivered educational interventions must be taken further to improve compliance, especially in developing countries.
Aim: The study aimed to evaluate the effectiveness of a nurse-led educational intervention in improving medication adherence.
Methods: An exploratory quasi-experimental study was conducted at the Sinor Hospital oncology clinic, Swat, Khyber Pakhtunkhwa, with 60 samples of only the adult oncology patients. Two groups were formed, out of which 30 were in the nurse-led educational interventional arm and 30 were in the standard care arm. This comprised individual counselling, written directions, bi-weekly check-ups, and three-month group lectures. The Morisky Medication Adherence Scale, a nine-item knowledge assessment questionnaire, and the EORTC QLQ-C30 were used in data collection. Data analysis was done using SPSS version 27. Chi Square and Paired T-Test were used for inferential statistics.
Results: The assessment results after the intervention revealed that the control group had enhanced scores in adherence to medications (p < 0.001) and knowledge regarding chemotherapy schedules and side effects. Concerning the quality of life, the intervention group participants had higher results than the control group (p = 0.012). From the analysis, we found that baseline knowledge level and intervention involvement significantly dictated the amount of adherence.
Conclusion: Health education conducted by an RN improves adherence, knowledge, and health-related quality of life in patients with cancer undergoing oral chemotherapy. The usefulness of such practices is evident; thus, incorporating them into usual oncology treatment is advisable.

Antimicrobial Resistance Pattern of Salmonella Typhi Isolated from Pediatric Population in Lahore

Muhammad Husnain — 2025-05-11

Salmonella typhi is a Gram-negative pathogen that causes typhoid fever in people. Antibiotics have played crucial role in the mitigation of typhoid and its fatality risk. However, rising multidrug-resistance (MDR) and extensively drug-resistance (XDR) in Pakistan has reduced the effectiveness of treatment. This study aimed to determine the antimicrobial resistance pattern of Salmonella typhi isolated from pediatric population in Lahore. A descriptive cross-sectional study was conducted on 100 clinically suspected typhoid patients from March 2024 to January 2025. Blood samples were collected and cultured on blood and MacConkey agar to identify S. Typhi. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Demographic data were also collected and analyzed using SPSS version 24. Out of 100 patients, 53 (53%) were male and 47 (47%) were female. The most affected age group was 5-10 years. Antibiotic sensitivity testing revealed alarming resistance patterns: 37% resistance to Chloramphenicol and Azithromycin, 35% to Ciprofloxacin, 28% to Ceftriaxone, and 34% to Ampicillin and Trimethoprim-Sulfamethoxazole. All S. typhi isolates were found to be multidrug-resistant, with resistance to at least three first-line antibiotics. This study concluded that an alarming increase in antibiotic drug resistance among the children with enteric fever, highlighting the need for fast antibiotic stewardship and contamination control techniques, as well as advanced studies on S. typhi to prevent extreme outcomes.

Non-Communicable Diseases (NCDs) in Mothers and Negative Outcomes of Pregnancy: A Narrative Review

Maria Haris — 2025-05-14

Non-communicable diseases (NCDs) lead to 74% fatalities worldwide including disproportionate impact on the low and middle-income nations including Pakistan. With a population of 255 million, Pakistan ranks as the fifth most populous country globally, where 64% of the people reside in rural areas. In Pakistan, the swift increase in premature deaths poses a significant threat. Even though there have been worldwide advancements in maternal and newborn health (MNH), the rates of maternal, fetal, and newborn mortality in Pakistan continue to be unchanged. Despite having a detailed National Action Plan, there have been no significant policy-level advancements to address this issue.
NCDs elevate the risk of negative pregnancy results such as preterm deliveries, caesarean deliveries, and low weight at birth, which result in detrimental effects on the mother, the child, as well as the future generations health across generations, stemming from negative pregnancy results that greatly heighten the likelihood of adult offspring developing NCDs. In developing countries such as Pakistan, diseases that result in negative pregnancy outcomes and endanger the health of future generations represent not only a health threat but also an economic one. The long-term consequences of these effects can diminish the nation’s overall productivity.
A comprehensive literature search was conducted on PubMed and Google Scholar. Reports from the W.H.O, various national and international organizations were also examined. Common non-communicable diseases (NCDs) were identified, and the prevalence of major diseases which include diabetes, obesity, cardiac diseases, hypertension, diseases of the respiratory tract among mothers was examined, along with their effects on newborns. Further investigation is needed regarding the evaluation of long-term effects of maternal NCDs on the children born to these mothers to identify potential mechanisms and pharmacological treatments for managing or preventing maternal NCDs. In order to identify specific risk factors linked to these NCDs and prioritize intervention areas, it is essential to conduct a thorough nationwide study.

Fitness to Practice: A Concept Analysis

Suleman Jacob — 2025-05-14

Background: Fitness to practice (FTP) is a concept fundamental to nursing, such that practitioners are held to professional, ethical, and clinical standards for delivering safe patient care. Fitness to practice has no clear operational definition among the regulatory agencies, curriculum in academe, and health care settings.
Objective: This research is proposed to examine and define the concept of fitness to practice in the practice of nursing through Walker and Avant's concept analysis framework.
Methods: This paper uses Walker and Avant's eight-step approach to analyze the uses, defining characteristics, antecedents, consequences, and empirical referents of the FTP concept. Literature was obtained from CINAHL, PubMed, and Scopus databases (2010–2025) with emphasis on regulation, clinical competence, impairment, and ethics.
Results: The most important characteristics of fitness to practice are clinical competence, psychological and physical health, ethical conduct, and compliance with professional standards. Antecedents are educational preparation, licensure, and regulatory mechanisms. Consequences of compromised FTP are patient injury, professional misconduct, and licensure revocation. A model case is illustrated with borderline and contrary cases to illustrate concept clarity.
Conclusion: Clearing fitness to practice improves regulatory uniformity and guides policy, education, and intervention activities related to the delivery of safe, competent nursing practice.

Antibiotic Susceptibility Pattern of Bacterial Isolates in Wound Infections

Saba Hussain — 2025-05-15

Background: Wound infections caused by bacteria like Pseudomonas aeruginosa and Klebsiella pneumoniae are a major health risk, especially for immunocompromised individuals. Antibiotic overuse has increased resistance, complicating treatment. Ongoing monitoring and species-specific antibiotic use are vital for effective treatment.
Objective(s): To determine the prevalence of micro-organisms responsible for wound infections, identifying the most common pathogens involved, assess the antibiotic susceptibility patterns of these microorganisms to guide effective treatment and prevent the spread of resistant strains.
Methodology: In this study, bacterial isolates from wound infections were collected in a clinical setting, and species were identified using common microbiological protocols. Using the disk diffusion method, antibiotic susceptibility and resistance was evaluated by measuring the zone of inhibition. Bacterial species and resistance patterns were compared using statistical techniques such as Chi-Square testing. The therapeutic effect of antibiotics for various isolates was evaluated using descriptive statistics.
Results:The study found S.aureus (59%), and E.faecalis (42%) were common in wound infections, after P.aeruginosa(30%), S.pyogens(29%), E.coli(20%) and K.pneumoniae(19%). Meropenem and Imipenem was the most effective antibiotic, while Penicillin and Amikacin showed high resistance. Vancomycin and Ceftriaxone had moderate efficacy with variable susceptibility. The results highlight the importance of species-specific antibiotic selection for treating wound infections.
Conclusion(s): The study on the antibiotic susceptibility pattern of bacterial isolates in wound infections reveals important findings regarding the prevalence of pathogens and their resistance to commonly used antibiotics. S. aureus, E. faecalis, and P. aeruginosa are the main causes of wound infections, and their resistance to widely used antibiotics is growing. Penicillin and Amikacin shown great resistance, although Meropenem and Imipenem were the most effective. To improve treatment outcomes and fight resistance, species-specific antibiotic tactics must be tailored.

Investigating the Association of Platelet Indices and Renal Dysfunction in Thrombotic Thrombocytopenic Purpura

Farheen Sajjad — 2025-05-15

Background: Thrombotic Thrombocytopenic Purpura (TTP) is a rare, life-threatening disorder caused by ADAMTS13 deficiency, leading to uncontrolled platelet aggregation and microvascular thrombosis. It results in thrombocytopenia, hemolytic anemia, and organ damage, particularly affecting the kidneys and CNS. This study examines the relationship between platelet indices and renal dysfunction to improve disease understanding and management.
Objective: To explore the correlation between the platelet parameters (such as Mean Platelet Volume) and renal function markers.
Methodology: This combination of retrospective data from medical records and prospective follow-ups was used, focusing on laboratory results of platelet indices and renal function. Data collected from Shaikh Zaid Hospital. Descriptive statistical analysis was performed to determine the mean, standard deviation, and range for each parameter. Additionally, histograms and bar charts were used to illustrate the distribution patterns of age, platelet indices and renal function markers.
Results: The study shows that there are notable variations in hemoglobin levels, platelet indices, and kidney parameters between the normal and abnormal groups. Anemia, elevated platelet production, and compromised renal function were seen in abnormal individuals. Its crucial involvement in TTP pathogenesis was validated by lower ADAMTS13 enzyme levels in the aberrant group.
Conclusion(s): This study highlights the association between platelet indices and renal dysfunction in TTP, emphasizing their role in disease severity. Low platelet counts, elevated MPV, and renal impairment indicate complications, while ADAMTS13 variability suggests distinct patient subgroups, influencing diagnosis and treatment.

Antimicrobial Susceptibility Pattern of E. Coli, P. Aeruginosa, K. Pneumoniae and E.faecalis isolates in UTI infection ”

Ayesha Riaz — 2025-05-15

Background: Antimicrobial Susceptibility Pattern: The ability of microorganisms to resist the effects of antimicrobial agents, such as antibiotics. Urinary Tract Infection: An infection that occurs in the urinary system, including the kidneys, bladder, and urethra. Escherichia coli: A gram-negative bacterium that commonly causes UTIs, particularly in women. Pseudomonas aeruginosa: An opportunistic pathogen that causes UTIs, especially in patients with compromised immune systems or urinary tract devices. Klebsiella pneumoniae: A gram-negative bacterium known for causing UTIs and producing ESBLs, which confer antibiotic resistance. Enterococcus faecalis: A gram-positive bacterium that can cause UTIs, particularly in people with urinary tract abnormalities or compromised immune systems.
Objective(s): The research aimed to explore both the antibiotic resistance patterns among isolated microorganisms in addition to determining which antibiotics provide the best treatment for UTI sufferers. It also investigated both the antibiotic resistance information of isolated microorganisms and the connection between antibiotic prescriptions and UTI patient resistance patterns.
Methodology: In this study, bacterial isolates from UTI infections were collected in a clinical setting, and species were identified using common microbiological protocols. Using the disk diffusion method, antibiotic susceptibility and resistance was evaluated by measuring the zone of inhibition. Bacterial species and resistance patterns were compared using statistical techniques such as Chi-Square testing. The therapeutic effect of antibiotics for various isolates was evaluated using descriptive statistics.
Results: This study analyzed 200 UTI samples, showing a higher prevalence in females (67.5%) compared to males (32.5%). E. coli was the most common pathogen, with significant antibiotic resistance observed, particularly to FF and Cefipime. Resistance patterns varied across bacterial species, with Pseudomonas showing high resistance to AMC, and Enterococcus having no resistance to SXT and Cipro. Chi-square tests confirmed significant associations between bacterial species and antibiotic resistance, highlighting the need for improved antimicrobial management.
Conclusion(s): E. coli was the most prevalent UTI pathogen, especially among females, showing high resistance to key antibiotics like Ciprofloxacin and SXT. The findings stress the importance of improved antimicrobial stewardship and exploring alternative therapies.

Effectiveness of General Anesthesia Versus Spinal Anesthesia in Inguinal Hernia Repair

Muhammad Anwar khan — 2025-05-15

Inguinal hernia repair is a common surgical procedure performed under either general anesthesia (GA) or spinal anesthesia (SA). The choice of anesthesia can significantly impact post-surgical recovery, including pain management, functional recovery, and complications. Understanding the comparative effectiveness of these anesthesia types is essential for optimizing patient outcomes. The objective of this study was to evaluate and compare the outcomes of GA versus SA in patients undergoing inguinal hernia repairs. A total of 113 patients undergoing inguinal hernia repairs at Ali Fatima Hospital, Lahore, were included in this descriptive observational study. Participants were administered either GA or SA. Post-surgery outcomes, including pain intensity (assessed using the Numeric Pain Rating Scale), functional recovery, complications (such as nausea, vomiting, and respiratory issues), and overall patient satisfaction were recorded. Data analysis was conducted using SPSS, with a chi-square test used to assess the association between anesthesia type and post-surgery pain. The study found significant difference in pain levels between GA and SA groups (p = 0.005). However, functional recovery was limited in both groups, with 78.8% unable to sit up unassisted and 74.3% unable to walk a few steps post-surgery. Respiratory complications were more common in GA patients (54%), while spinal headaches were noted in 57.5% of SA patients. Patient satisfaction was relatively high, with 62.8% feeling comfortable and pain-free during recovery. Both GA and SA are effective for inguinal hernia repair, with significant differences in pain outcomes. SA was associated with better pain control and quicker recovery, while GA was linked to more respiratory complications and nausea. Tailored anesthesia protocols are recommended for optimal patient care.

Epidural Vs. Spinal Anesthesia in Lower Limb Orthopedic Surgries

Awais Islam — 2025-05-15

Neuraxial anesthesia, including spinal (SA) and combined spinal-epidural anesthesia (CSEA), is widely used in lower extremity orthopedic surgeries for its regional pain control, reduced opioid dependence, and faster recovery. Despite its advantages, conflicting evidence exists regarding the comparative efficacy, perioperative complications, and patient satisfaction between SA and CSEA. While SA offers rapid onset and hemodynamic stability, CSEA provides prolonged analgesia, yet consensus on optimal technique remains elusive. This study addresses this gap by evaluating their clinical outcomes and complications to guide evidence-based decisions. The objective: To systematically compare SA and CSEA in achieving analgesic adequacy, assess perioperative complications (hemodynamic instability, neurological effects), and analyze patient outcomes (satisfaction, recovery duration, postoperative analgesia needs). A prospective, randomized, double-blind controlled trial was conducted at the Department of Orthopedics and Anesthesiology, General Hospital, Lahore, over four months. Sixty patients (18–70 years, ASA I-II) undergoing elective lower limb surgeries were allocated to SA (n=30) or CSEA (n=30) groups. Sensory/motor block onset, hemodynamic stability, pain scores (Visual Analog Scale), and complications were monitored. Statistical analysis employed Student’s t-test and chi-square (α=0.05). Ethical approval and informed consent were obtained. Main findings SA demonstrated faster sensory block onset (3.0±0.9 vs. 14.9±2.1 minutes, p<0.001) and higher intraoperative hemodynamic stability (hypotension: 13.3% vs. 30%, p=0.04). CSEA provided prolonged postoperative analgesia (240±45 vs. 156±32 minutes, p<0.001) but required more vasopressor support. Patient satisfaction was comparable (SA: 86.7%, CSEA: 83.3%, p=0.65), though 72% reported suboptimal postoperative pain relief. Side effects like headache (14%) and transient paresthesia (8%) were frequent but minor. SA is optimal for rapid surgical readiness, while CSEA excels in prolonged pain management. Suboptimal postoperative analgesia underscores the need for multimodal approaches. Hemodynamic monitoring remains critical for CSEA. Tailored anesthetic selection, guided by patient risk and surgical demands, is recommended.

Comparative Study of Propofol and Ketamine in Trauma Patients with a Focus on Hemodynamic and Respiratory Effect

Hassan Ali — 2025-05-15

The combination of emergency medical procedures, trauma patients present an elevated threat of pulmonary aspiration so Rapid Sequence Induction (RSI) becomes essential for their airway management. The selection between ketamine and propofol as anesthetic agents directly influences both the stability of blood circulation and the respiratory system. The pharmacokinetic differences between these drugs do not prevent their regular usage in RSI protocols. This objective of this to, comparative study of propofol an ketamine in trauma patients with a focus on hemodynamics and respiratory effect. The data analysis was involved collecting and preprocessing patient data, categorizing them into propofol and ketamine groups, and assessing key hemodynamic (HR, SBP, DBP, MAP) and respiratory (RR, SpO₂, EtCO₂) parameters. Descriptive statistics was summarizing the data using mean ± SD or median ± IQR for continuous variables and percentages for categorical variables. The studied patient population aged from 18 to 65 years. Those given ketamine treatment had a mean patient age of 42.02 years while the propofol-treated patients had a mean age of 38.76 years. The age-related data points between groups were equivalent thus maintaining equal evaluation of the agents across various age brackets. The measured systolic blood pressure values extended between 98–157 mmHg in the ketamine group and 92–160 mmHg in the propofol group yet the propofol group demonstrated wider pressure variation. The diastolic blood pressure measurements within the two groups showed no substantial difference because they both remained between 61 to 100 mmHg. The respiratory rates measured in patients receiving ketamine treatment reached 18.26 ± 2.5 breaths/min while patients on propofol had rates of 17.96 ± 2.6 breaths/min. The ketamine group showed a slightly higher reading of oxygen saturation at 96.38% compared to 95.44% in the propofol group. The patients who received ketamine maintained elevated heart rates at 91.04 ± 13.4 bpm rather than patients receiving propofol who showed lower rates at 88.20 ± 14.2 bpm. The effectiveness of ketamine and propofol was similar for trauma patients undergoing RSI because both drugs produced equivalent times to LOC and equivalent pain sensations. Complete assessment of agent effectiveness for RSI should include evaluation of their respiratory and hemodynamic impact on trauma patients to determine the best clinical treatment approach.

Comparison Between Early and Standard Oral Feeding After Emergency Bowel Surgery

Dr Anosha Zafar — 2025-05-17

Background: Postoperative nutritional management plays a crucial role in patient recovery following emergency bowel surgery. Traditionally, oral feeding has been delayed to prevent complications like anastomotic leakage and ileus (standard oral feeding, SOF). However, recent studies suggest that early oral feeding (EOF) may enhance recovery and reduce hospital stay.
Aim: This research intended to associate results of early oral feeding versus standard oral feeding after emergency bowel surgery in terms of tolerance, recovery, complications, and hospital stay duration.
Methods: This randomized controlled study was held at Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, from September 2024 to February 2025.
A total of 160 patients who underwent emergency bowel surgery were included and divided into two groups: EOF (within 24 hours post-surgery) and SOF (after 48 hours or later). Outcomes such as time to first bowel movement, length of hospital stay, incidence of complications and overall patient tolerance were recorded and analyzed using statistical software.
Results: Individuals in EOF group demonstrated very meaningfully shorter time to first bowel movement compared to SOF group (p<0.05). The length of hospital stay was also reduced in EOF group (mean: 5.2±1.3 days) compared to the SOF group (mean: 7.8±1.7 days). There was not any substantial rise in postoperative problems including anastomotic leakage and ileus among two groups. Additionally, patient satisfaction and tolerance to oral intake were higher in the EOF group.
Conclusion: Early oral feeding following emergency bowel surgery was associated with faster recovery, reduced hospital stay without any substantial rise in complications compared to standard oral feeding. These findings support the adoption of EOF as a safe and effective postoperative nutritional strategy.

Evaluation of Adnexal Masses: Diagnosis of Adnexal Masses by Histopathology Versus Diagnosis by Other Imaging Tools

Sana Abbasi — 2025-05-17

Background: Adnexal masses are frequently encountered in gynecological practice, presenting with diverse clinical features ranging from benign cysts to malignant tumors. An accurate preoperative diagnosis is essential for differentiating benign and malignant lesions facilitating an effective treatment strategy. The definitive diagnosis could only be achieved through post-operative histopathology. Ultrasonography (USG), especially transvaginal ultrasound (TVUS), has emerged as a preferred imaging technique due to its easy availability, non-invasive nature, and real-time imaging. The objective of this study was to assess the diagnostic precision of USG in identifying adnexal masses, utilizing histopathology as the definitive standard.
Methodology: An observational study was conducted at the Department of Obstetrics and Gynecology, Rawal General and Dental Hospital, Islamabad, Pakistan from [start date] to [end date]. A total of 132 female patients with USG-confirmed adnexal masses were recruited using consecutive non-probability sampling techniques. The study excluded pregnant women, patients with metastatic malignancies, and those with non-operable adnexal masses. Detailed demographic data, clinical presentations, and ultrasound findings were collected. Each patient underwent surgical resection of the adnexal mass, and the specimens obtained were sent for histopathological examination. Data analysis was performed using SPSS version 26, with results expressed as frequencies, percentages, means, and standard deviations. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of USG were calculated for different types of adnexal masses.
Results: The mean age of the participants was 39.5 ± 10.4 years, with 61.3% being married. The predominant clinical symptom reported was abdominal or pelvic pain, observed in 76.5% of the cases, followed by post-menopausal bleeding at 33.3% and the sensation of a lump at 42.4%. Ultrasound findings indicated that a significant majority of adnexal masses exhibited a cystic morphology (68.1%), were found to be unilateral (92.4%), and were primarily derived from the ovary (87.1%). Histopathological analysis identified endometrioma as the predominant diagnosis, accounting for 21.2% of cases, with dermoid cysts following at 18.9%. Ultrasound imaging exhibited the highest sensitivity for follicular cysts at 90% and dermoid cysts at 88%. Regarding specificity, hydrosalpinx and tubo-ovarian abscesses demonstrated the highest rates, at 97% and 95%, respectively. Overall, ultrasound imaging proved to be a reliable diagnostic tool, achieving a sensitivity of 81.4% and a specificity of 89% for malignancy.
Conclusion: The findings of this study emphasize the role of USG as a reliable diagnostic tool for evaluating adnexal masses, demonstrating significant sensitivity and specificity for both benign and malignant conditions. Despite its operator-dependent nature, USG remains a crucial and cost-effective tool for preoperative assessment, particularly in resource-limited healthcare settings.

Frequency of Suicidal Attempt in Patients Presenting with Major Depressive Disorder (MDD)

Dr. Mujeebullah Khan Doutani — 2025-05-17

Introduction: Major depressive disorders (MDD) are increasing in our society and there is a high risk of suicidal attempt in patients with depression.
Objective: To determine the frequency of suicidal attempt in patients presenting with major depressive disorders.
Patients AND METHODS: This Cross-sectional study was conducted at the department of Psychiatry Bolan Medical Complex hospital Quetta from 13-06-2014 to 15-06-2015. Patients fulfilling the inclusion criteria Taking a thorough history from all the patients and doing mental state examination, the final diagnosis is made according to ICD-10 criteria for depressive disorder. Diagnosis of depression with suicide attempt was made by two consultant psychiatrists. The severity of depressive disorder was assessed by applying HAM-D rating scale for depression version 17. Its scores can be interpreted as minimal or no depression (0-7), Mild (8- 17), Moderate (18-25), Sever (26+). Were enrolled for study. After taking history and performing mental state examination, the final diagnosis is made according to ICD-10 criteria for depressive disorder. Diagnosis of depression with suicide attempt was made by two consultant psychiatrists. The severity of depressive disorder was assessed by applying HAM-D rating scale for depression version 17.
Results: 0ut of 130 patients, 72(55.38%) majority of female and 58(44.62%) male with mean age of 28.52 ± 7.80 years and mean duration of disease 3.31 ± 1.467 years were included with minimum and maximum duration its between 1year to 6 years. Eighty-one (62.31%) patients belong to lower class, 44(33.85%) middle and 5(3.85%) were from upper socio-economic class in this study. Seventy-two patients (55.38%) had suicidal attempt. Analyzed data presented that there is no association between age groups, gender and duration of disease with suicidal attempts, while there was significant association between socio economic class status and suicidal attempts.
Conclusion: The suicidal attempts are highly prevalent in patients with major depressive disorders as they have batter understanding skills. Hence patients with major depressive disorders must be followed up regularly and they must have their psychotherapy to minimize the risks of suicidal attempts.

Wide-band Asymmetric Transmission for Linearly Polarized Wave Using Bi-layered Chiral Metamaterial

Engr Muhammad Asif Ramzan — 2025-04-14

In this paper, a metal-dielectric-metal configuration is employed. The unit cell of the proposed chiral metamaterial design consists of a simple 'EI' shape resonator printed on two opposite sides of dielectric substrate. The metal pattern on the front and back layers is identical, with the exception that the back-layer pattern twisted at a 90o angle to break mirror symmetry in the propagation direction. The optimized dimensions (in mm) of the unit cell are: w=1.5, w1=1.5, d=1, b=6, m=3, h=1.6 and a=8. The dielectric substrate is Roger 5080, which has a dielectric constant εr = 2.33, and tangent loss tan δ = 0.0005. The copper sheet is used as a metallic pattern having a thickness of 35um, and an electrical conductivity of 5.8 x 107 S/m. Commercially available software called CST Microwave Studio is used to carry out the numerical simulations of the suggested design. Unit-cell boundary conditions were applied in the y- and x-directions, while open boundary conditions were used in the z-direction. The numerical simulation is carried out in the frequency range of 11 GHz to 23 GHz. Through numerical simulation, complex transmission coefficients are produced, from which the asymmetric transmission, total transmission and polarization conversion ratio are calculated. The simulation results of complex transmission coefficients for linearly polarized waves in the forward (+z) and backward (-z) direction of propagation shows wide, strong peaks.

Digital Twin in Dental Healthcare: Transforming Diagnostics, Surgery, and Patient Management

Azam Jan — 2025-05-09

Artificial Intelligence (AI) transformed dentistry by improving diagnostic accuracy, treatment planning, robotic-assisted operations, and administrative efficiency. Machine learning algorithms and transformer-based designs perform better in radiography analysis, automated lesion detection, and early dental disease diagnosis. Intelligent robotic systems are also improving implant placement, minimally invasive procedures, and surgical decision-making through real-time feedback in dental surgeries. Despite these advances, data dependencies, algorithmic biases, high implementation costs, and legal impediments hinder the integration of intelligent systems into dentistry. This paper analyses the role of smart technologies the integration of Digital Twin technology in dentistry offers real-time simulation of oral conditions, enabling precise diagnostics and predictive treatment planning. These virtual replicas of patients’ dental structures facilitate personalized care and continuous monitoring. Future advancements in intelligent dentistry will increasingly rely on DT to enhance training, optimize procedures, and improve clinical outcomes.

Exploring Requirement Risk Analysis Through a Qualitative Lens: Application of the Lean Canvas Model

Noreen Khalid — 2025-04-05

Many software development organizations face risk of software failure due to maximizing cost and time. In this situation, several techniques were utilized to identify and control the risk factors, improving the product quality. For this purpose, the selection of best approach to cope this challenge is a great achievement of the developers. Therefore, lean canvas model was introduced in this study on the basis of time saving and low cost features. Furthermore, this technique takes minimum steps to understand the problem by providing better solution. The focus of this qualitative study is to estimate the percentage working of this tool rather than the percentage model value. In this research, we analyze the requirement risk analysis by using lean canvas model. This model will enable the developers to eliminate the risk for gaining the maximum profit in the business to take favorable results in future. In the light of this research, the products shall be available on short notice within short time span.

Credit Card Fraudulent Transactions Detection Using Machine Learning

Ali Ahmed — 2025-04-08

With the rapid growth of the e-commerce industry, the use of credit cards for online purchases has increased significantly. Unfortunately, credit card fraud has also become increasingly prevalent in recent years, creating complications for banks trying to detect fraudulent activity within the credit card system. To overcome this hardship Machine learning plays an eminent role in detecting the credit card fraud in the transactions. Modeling prior credit card transactions with data from ones that turned out to be fraudulent is part of the Card Fraud Detection Problem. In Machine learning the machine is trained at first to predict the output so, to predict the various bank transactions various machine learning algorithms are used. The SMOTE approach was employed to oversample the dataset because it was severely unbalanced. This paper the examines and overview the performance of K-nearest neighbors, Decision Tree, Logistic regression and Random forest, XGBoost for credit card fraud detection. The assignment is implemented in Python and uses five distinct machine learning classification techniques. The performance of the algorithm is evaluated by accuracy score, confusion matrix, f1-score, precision and recall score and auc-roc curve as well.

A Review of Data Analytics Applications in Healthcare: Current Trends and Future Directions

Asad Ullah — 2025-04-14

The review investigates healthcare applications of data analytics that demonstrate potential to create substantial changes toward improved healthcare delivery with better patient outcomes. The healthcare industry implements data analytics as its essential tool to address current rising problems including cost growth beside resource constraints and uneven medical service availability. Healthcare organizations use advanced analytical approaches to obtain practical insights from extensive datasets which enables better evidence-based decisions and better resource utilization decisions. This review examines multiple data analytics applications ranging from Electronic Health Records (EHR) examination to Clinical Decision Support Systems (CDSS) functionality as well as predictive patient diagnosis systems and personal medicine delivery systems and patient engagement solutions. The applications showcase the extensive advantages of data-led solutions because they advance treatment precision and boost medical outcomes while delivering individualized healthcare approaches to patients. The review gives coverage to the practical obstacles healthcare faces when merging data analytics with healthcare yet it arrives at substantial advancements made through data analysis in medicine. Healthcare analytics demonstrates a promising future because artificial intelligence alongside wearable technology and blockchain systems will drive additional healthcare service improvements. This study establishes fundamental knowledge for future analytical studies of healthcare data analytics while it supports evidence-based medical approaches to create global improvements in patient care through policy recommendations.

Using NLP and AI to Enhance Software Documentation and Code Comprehension

Abdulmalik Ibrahim — 2025-04-25

Software documentation plays a critical role in code comprehension, maintenance, and collaboration, yet it is often incomplete, outdated, or inconsistently written. This study explores the application of Artificial Intelligence (AI) and Natural Language Processing (NLP) techniques to automatically generate accurate and context-aware documentation for software code. Leveraging transformer-based models such as CodeT5, GraphCodeBERT, and GPT-3, we developed and evaluated a system capable of producing meaningful summaries of code functions and classes. A comparative analysis between human-written and AI-generated documentation was conducted using both quantitative metrics (BLEU, ROUGE, F1) and qualitative feedback from professional developers. The results indicate that AI-generated documentation significantly improves code readability and developer efficiency, reducing comprehension time and enhancing accuracy in understanding complex code. Additionally, real-time integration of the tool within development environments proved beneficial for continuous documentation support. While AI still faces challenges in handling domain-specific code and interpreting poorly written segments, the overall impact on documentation quality is substantial. This research underscores the potential of NLP-driven tools to automate and standardize documentation practices, offering a scalable solution to one of software engineering’s longstanding challenges. Future work aims to integrate context-awareness, multilingual support, and interactive querying features to further enhance developer experience.

A Pragmatic Investigation of Major Pakistani Political Parties Discourse of Social Media: A Study of Internet Meme

Nasar Khan — 2025-04-02

This study investigates the pragmatic features of internet memes used in representation of different Pakistani major political parties on social media. Language is traversed with opportunities to negotiate meaning. The study delves into pragmatic strategies in meme captions, including implicature, speech acts, presupposition, and politeness strategies. We selected four political internet memes (2020–2022) from social media platforms including Facebook and Twitter. The analysis illustrates the ways in which pragmatic devices employed in memes, including the use of indirect speech acts, satire, irony, and presupposition, influence political discourse. The study concludes that meme captions are functionalized mainly by brevity, implicit meaning, humor and humor-based pragmatics, and by puns and sarcasm, in order to criticize political figures and events. The results indicate memes act as an effective tool of ideological positioning and persuasion to the public. Future studies could have multimodal dimensions, which will also include visual influences (color, font, and imagery), contributing to a broader understanding of political discourse in the context of Pakistani internet memes.

Evaluating the Efficacy of Letrozole and Letrozole-Dexamethasone Combination in Inducing Ovulation in Women with PCOS-Related Subfertility: An Experimental Study

Dr. Mahnoor Karim* — 2025-04-23

Polycystic ovarian syndrome (PCOS) is a major cause of subfertility in women, frequently requiring ovulation induction treatments. This study evaluated the effectiveness of Letrozole alone versus Letrozole plus Dexamethasone in improving ovulation outcomes in women with PCOS-related subfertility. A randomized controlled trial involved 100 participants split into two groups: Group A received Letrozole alone, and Group B received Letrozole with Dexamethasone. Ultrasound was used to assess follicular diameter and endometrial thickness. Results indicated a significantly greater mean follicular diameter (20.70 ± 4.478 vs. 17.54 ± 3.364, p < .000) and endometrial thickness (6.84 ± 0.997 vs. 5.92 ± 0.922, p < .000) in Group B versus Group A. Dexamethasone appears to enhance ovulation induction by promoting follicular growth and improving endometrial receptivity. The study adds to the evidence supporting the Letrozole-Dexamethasone combination for treating PCOS.

Assessment of Sleep Disorders Among Rotating Shift and Day-Shift Nurses in a Tertiary Care Hospital in Swat.

Rizwan Ullah — 2025-04-02

Background
Due to disruptions in circadian rhythms, sleep disorders are prevalent among nurses, particularly those working rotating shifts. These disorders affect their physical, mental, and emotional health, influencing job performance and the quality of patient care. Understanding the sleep patterns of rotating shift and day-working nurses is vital to developing targeted interventions.
Aim: This study aimed to assess and compare the prevalence and severity of sleep disorders among nurses working rotating and day shifts in a tertiary care hospital in Swat.
Methods: A descriptive cross-sectional design was employed with 160 nurses selected through convenience sampling. Data were collected using a structured questionnaire covering demographic details and sleep-related complaints. Statistical analysis, including chi-square tests, was conducted using SPSS version 26.
Results: The findings revealed that 71.9% of nurses reported sleeping six or more hours without night shifts, while 28.1% slept less. Sleep quality was rated as reasonably good by 53.1%, but 12.5% experienced poor sleep. Rotating shift nurses reported significantly higher sleep disturbances, with difficulty falling asleep and waking during the night being prominent. A significant association (p = 0.01) was found between rotating shifts and secondary employment, exacerbating sleep problems.
Conclusion: Rotating shift nurses are more prone to sleep disorders than their day-working counterparts. The findings emphasize the need for healthcare institutions to implement flexible scheduling, sleep hygiene education, and mental health support to mitigate sleep-related issues and improve nurse well-being and patient care outcomes.

The Impact of Strategic Human Resource Management Practices on Competitive Advantage Sustainability: The Mediation of Human Capital Development and Employee Commitment

Muhammad Hamza Ali * — 2025-04-03

It is indeed evident that there is an array of heightened competition among the financial institutions, which calls for strategic emulation of the Human Resource Management (HRM) to establish competitiveness. The purpose of this paper is to determine the mediating effect of human capital development and the commitment level in the relationship between strategic human resource management practices and sustainable competitive advantage in the banking industry. Although much has been written about the concept of strategic human resource management in various businesses, the scholarship on its implementation in the context of financial organizations is still limited. This innovation fills this gap by examining antecedent and mediator influences of strategic HRM on sustainable competitive advantage in banks. In this study, proposition of Strategic HRM practices, human capital development, employee commitment and sustainable competitive advantage are expressed and tested using structural equation modeling (SEM). The research outcomes show that implementation of the opted SHRM practices is significantly related to sustainable competitive advantage since it promotes the human capital and increases the employee commitment levels. Whereby practical pressures and compliance requirements require the banks to have an efficient and comprehensive training, measures for better performance and organizational engagement must also be put in place for the bank to remain competitive.This innovation is important in the financial literature as it supplies details on the strategic function of HRM in finances. The information provided may be of great use to the bank administrators and policymakers to ensure that the HRM is adapted to match the organizational goals to support sustainability and enhance the competitiveness of the business in the long run. Finally, the data point to the need for concurrent professional growth and commitment of the employees as critical success factors in the strategic Human Resource Management in banks.

Impact of Employee Cynicism on Employee Performance: The Moderating Role of Supervisor Support

Muhammad Danish Niaz — 2025-04-05

Employee cynicism is a growing concern in workplace dynamics, particularly in healthcare organizations where teamwork is essential. This study examines the negative impact of employee cynicism on employee performance in public sector hospitals. Additionally, it explores the moderating role of supervisor support in mitigating these adverse effects. A quantitative approach was employed, using a structured questionnaire distributed among 250 nurses working in public sector hospitals in Rawalpindi, Pakistan. Data analysis was conducted using SPSS, applying regression and moderation analysis. Findings indicate that employee cynicism significantly reduces employee performance. However, supervisor support acts as a buffer, weakening this negative relationship. The study provides insights for healthcare administrators, emphasizing the need to foster supportive leadership to counteract workplace cynicism and enhance employee productivity.

Assessing UNODC’s Strategies for Combating Drug Trafficking in Pakistan: A Critical Evaluation

Saima Asghar — 2025-04-06

The research analyzes the drug trafficking control strategies deployed by the United Nations Office on Drugs and Crime throughout Pakistan. Pakistan faces critical threats to national security combined with public health and economic issues stemming from its position in the worldwide drug trafficking hubs. Pakistani authorities together with the UNODC and international organizations work to combat this issue by launching multiple programs. This research analyzes drug trafficking strategies by investigating their operational practices and both the encountered difficulties and achieved results. This research utilizes quantitative investigation approaches to evaluate UNODC’s anti-drug trafficking efforts in Pakistan by interviewing stakeholders and examining UNODC reports with statistical drug seizure and arrest data to conduct a thorough assessment. The research identifies both potential strengths and vulnerabilities which exist in modern interventions and proposes methods to boost future intervention performance. The progress made requires more strategic collaborative work because the region needs better methods to fight its complex drug trafficking challenge. The paper examines drug trafficking in Pakistan while discussing UNODC activities together with anti-drug strategies, the narcotics trade, international cooperation, security challenges, public health aspects, drug control policies, regional security and law enforcement approaches.

Child Rights in Pakistan: A Critical Analysis of International Obligations and Domestic Implementation

Saeeda Mirbaz — 2025-04-09

This study provides a critical analysis of the status of child rights in Pakistan, focusing on the country’s obligations under international conventions—particularly the United Nations Convention on the Rights of the Child (CRC)—and the degree to which these obligations have been implemented within the domestic legal system. This research analyses the statistics indicating the situation of child rights and measures adopted to protect child rights with special reference to international obligations of Pakistan. The research also discusses the jurisprudence developed by Pakistani Courts regarding relevant domestic and international laws and concludes with suitable recommendations for robust legal policy to protect child rights in consonance with international obligations of Pakistan. The study reveals that although numerous legislative reforms have been introduced over the years, a consistent gap persists between legal promises and their enforcement. The research explores how Pakistani courts began to innovate a domestic jurisprudence that internalises international child rights standards. By systematically examining landmark judicial decisions, this study demonstrates that the judiciary has emerged as an instrumental actor in bridging normative international commitments with practical domestic enforcement, often compensating for legislative and administrative shortcomings. This judicial jurisprudence represents an emergent trend in Pakistan that redefines the role of courts in safeguarding vulnerable populations. The paper concludes by offering a set of context-specific legal and policy recommendations aimed at strengthening child rights protections in line with international best practices and advancing the harmonisation of Pakistan’s legal regime with its global commitments.

Effectiveness of Morning versus Evening High-Intensity Interval Training on Selected Performance Parameters of Badminton Players: An Experimental Study

Umar Farooq — 2025-04-21

The current study was conducted to examine the effects of high intensity interval training (HIIT) to be applied at morning and evening on some selected parameters of colleges’ badminton players. A total of 45 male college’s badminton players between the age of 18-24 years was participated in the study. Participants was divided into two groups, Experimental Group (EG) n=30 and Control Group (CG) n=15 based on the aerobic fitness assessment results. The EG was further divided into Morning Group A and Evening Group b. EG was given prescribed training, while CG was remaining as usual. Data was collected two times; T1 pre-test and T2 post-test after eight weeks. T-test and repeated measure ANOVA was applied to measure the statistically significant differences between pre- and post-test results.

Effects of Low Repetition Resistance Training Protocol and High Repetition Resistance Training Protocol On the Muscular Fitness of Preadolescents

Ahmad Amin Bodla — 2025-04-23

The objective of this study was to examine the effects of two different resistance training protocols, low-repetition (6–8) and high-repetition (13–15), on muscular fitness in preadolescents. The results indicated that both protocols were effective in improving the strength and endurance of the subjects, but the low repetition protocol resulted in greater improvements in the maximal strength (1 RM squat and overhead press) and the high repetition protocol led to the improvement of the muscular endurance (knee push up), explosive power (standing long jump and medicine ball throw). There was a gender effect, as males displayed greater increases in strength, and females showed characteristic relative increases in endurance. Overall, both training protocols in the study effectively improved preadolescent muscular fitness, emphasizing the significance of implementing proper training protocols according to the fitness goals. Lastly, this study offers new perspectives on how resistance training could be adjusted to best prevent injuries and improve growth during childhood and adolescence.

Sustainable Strategies to Improve the Quality and Quantity of Sugar Cane Pre and Post –Harvest by Optimizing Management in Pakistan

Abdul Mannan* — 2025-04-25

The purpose of this research was to carried-out the various techniques from sowing to harvesting of sugarcane in order to maintain and enhance the recovery of sugarcane. Sugarcane needs more time to apply a large amount of biomass accumulates, various amendments of cultural practices and high management from cultivation to cutting time. Number of treatments before harvest had more recovery in T1 green manuring and stubble rotation was 9.86 and in T2 CPF 251 variety having more deterioration capacity after ripening maximum recovery was 11.40. While in T3 IPM virtako and trichogramma cards having more recovery 90.90 apply and installed different interval of time. Therefore, in T4 bio fertilizer and gypsum having highest recovery 10.08. After post harvest maximum recovery loss in T5 sour cane 7.93, while after 96 hours from cut to crush loss in 8.8 and reported 24 hours from cut to crush recovery were noted 10.90. Implied waste is enhanced throughout in the field, storage, carriage, treatment mainly in the mills which do not keep suitable sanitation control. Improving sugarcane and making of sugar disseminate by several conditions. Profuse research obtainable on justification of post-harvest deterioration and manageable standards accommodate it. It is concluded that fine variety us 633 has lees deterioration adaptation of new technologies, early maturing, sowing techniques, fertilizer management (stubble rotation, green manuring, bio fertilizer), trash mixing into soil increase the soil health as well as increase the yield and also eco friendly as well as atmospheric save and other infrastructure amenity such as mill management, its capacity and machinery.

Use of Various Artificial Intelligence Tools for Academic Writing by University Students in Rawalpindi / Islamabad

Dr. Farkhanda Jabeen — 2025-04-30

This study explores university students' perceptions of various Artificial Intelligence (AI) tools such as ChatGPT, Grammarly, and Quillbot—used for academic writing. Utilizing a quantitative research design, data were collected from 100 students across male, female, and co-education universities in Rawalpindi and Islamabad through a structured survey. The analysis focuses on frequency of use, purpose of usage, positive perceptions, and negative concerns associated with AI tools. Findings reveal that AI tools are extensively used for grammar checking, idea generation, paraphrasing, and structuring academic work, significantly enhancing productivity and confidence. However, concerns about over-dependence, creativity loss, ethical implications, and potential plagiarism persist among users. The study recommends promoting balanced AI usage, raising awareness of ethical practices, and integrating workshops on academic writing to mitigate the challenges. Future research directions include longitudinal studies and field-specific analysis of AI tool adoption in academic writing.

ESG Adoption: Pathways Toward a Greener Financial System

Dr. Syed Asim Ali Bukhari* — 2025-04-30

The study conducts a critical review of the development of ESG (Environmental, Social, and Governance) ideology in the context of the global banking industry. It examines the literature to systematically review the integration of environmental and social sustainability in the banking model. Green Banking is studied as a subset of the ESG ideology. Based on the existing literature and Green Banking policies & guidelines, the various dimensions of Green Banking are highlighted. Own Impact Reduction, Green Business Facilitation, and Environmental & Social Risk Management (ESRM) are discussed as part of Green Banking adoption. The study critically analyses the Pakistan banking industry by reviewing the Green Banking adoption journey. The study can provide important insights towards ESG and Green Banking adoption, especially to banks in developing countries.

Compassion in Nursing: A concept Analysis Study Using Walker and Avant’s Framework

Israr Ali Parhiyar — 2025-05-02

Background: Compassion is a core aspect of nursing practice that affects nurse-patient relationships as well as outcomes of care. Although it is central to the practice, the term is often used interchangeably with other conceptually similar terms like empathy or caring.
Aim: This article critiques the concept of compassion in nursing Applying Walker and Avant's framework to make its defining characteristics, antecedents, and consequences clear and to investigate its theoretical and practical implications.
Methods: Systematic concept analysis was carried out based on nursing and interdisciplinary literature using Walker and Avant's eight-step process. Jean Watson's Theory of Human Caring was employed to contextualize the theoretical implications of compassion.
Results: Five defining characteristics were found: empathy, relational understanding, intentionality, presence, and action-oriented care. The identification of suffering was a main antecedent, while improved therapeutic relationships and patient satisfaction were core consequences. Constructed cases demonstrated the real-world application and lack of compassion.
Conclusion: Compassion in nursing goes beyond an affective response; it is a deliberate, relational, and executable commitment to easing suffering. It is essential to holistic and ethical nursing practice and is highly consonant with Watson's theory.

Trauma-Informed Care: A Concept Analysis Using Walker and Avant’s Framework

Zeeshan Ahmed — 2025-05-02

This study analyzes the concept of Trauma-Informed Care (TIC) in nursing practice.
Background: Growing awareness of trauma’s impact, healthcare systems are adopting TIC to enhance patient-centered care. Nursing plays a key role in fostering safety, trust, and empowerment for trauma-affected individuals. Aims: Despite increasing focus on TIC, its attributes, antecedents, and consequences remain unclear in nursing. A concept analysis is needed to define and understand its role in practice. Methods: Walker and Avant’s approach was used to examine TIC’s defining attributes, antecedents, and consequences. Results: Key attributes of TIC include (1) recognizing trauma’s impact, (2) ensuring safety, trust, and collaboration, and (3) promoting patient empowerment. Antecedents include provider education, institutional policies, and trauma awareness, while consequences lead to better patient outcomes, stronger therapeutic relationships, and reduced healthcare disparities. Discussion: This study integrates psychological and nursing theories, emphasizing a holistic approach that includes individual competencies and systemic changes for effective TIC implementation. Conclusion & Implications: Findings support nursing education, policy development, and clinical practice improvements. Nurse leaders and policymakers can use these insights to establish training programs and trauma-sensitive healthcare environments.

Humor as a Coping Mechanism in Mitigating Depression, Anxiety, and Stress

Prof. Dr. Leenah Ãskaree — 2025-05-06

This study investigated the effectiveness of humor as a coping mechanism for mitigating symptoms of depression, anxiety, and stress. A sample of 158 participants completed a demographic questionnaire, the Humor as a Coping Mechanism scale, and the Depression Anxiety Stress Scale (DASS-21). Descriptive statistics indicated moderate to high humor usage (M = 80.04, SD = 12.52) and moderate levels of psychological distress (M = 45.91, SD = 12.21). Pearson correlation analysis revealed a weak, negative, and non-significant association between humor use and distress levels (r = –.036, p = .655), suggesting that greater humor use was not significantly related to lower depression, anxiety, or stress. Regression analysis further demonstrated that humor was not a significant predictor of distress (β = –.036, p = .655), and the model explained only 0.1% of the variance (R² = .001). Despite the non-significant findings, participants reported subjective benefits of humor in enhancing emotional resilience and temporarily alleviating stress. These results imply that humor, while psychologically beneficial in providing emotional relief, may not independently reduce clinical symptoms of distress. Limitations include reliance on self-report measures, potential response biases, and sample homogeneity. Future research is recommended to explore differential effects of various humor styles and to assess humor's role in combination with other coping strategies across diverse populations. Overall, humor presents as an accessible and low-cost tool to support emotional resilience but should be integrated thoughtfully within broader mental health interventions.

Relational Practice: A Concept Analysis

Samreen Nanji * — 2025-05-05

Relational practice is increasingly being recognized as a core framework within contemporary nursing, shifting care away from task-focused routines and towards person-facilitated relationships grounded in compassion, ethics, and mindful engagement. Based in active listening, empathy, respect, and teamwork, relational practice addresses rising healthcare complexity through the development of purposeful therapeutic alliances between nurses, patients, and interprofessional team members (Smith, 2020; Hartrick Doane & Varcoe, 2021). With health care embracing digital platforms, relational competence ensures nurses' human interaction in spite of technological barriers (Smith & Kennedy, 2023). Concept analysis of relational practice undertakes this endeavor to demystify its defining features, antecedents, and consequences and highlight its top priority as it advances nursing theory, ethics, and patient outcomes. Theory assessment is an outcome of the dominance of Peplau's Theory of Interpersonal Relations and Watson's Theory of Human Caring over the current nursing theories, which are especially applicable in a direct sense. These types of theories are intended for relational practice core areas such as trust, empathy, and adaptive nurse-patient relationships. In addition, current relational practice is assisted by Leininger's Culture Care Theory, Orem's Self-Care Deficit Theory, Parse's Human Becoming Theory, and Relational Ethics principles. These models provide for a sophisticated conceptualization of relational practice based on cultural competence, patient empowerment, holistic care, and ethical involvement in nursing practice. Relational practice strengthens trust, reduces inequalities, and increases patient satisfaction and adherence through culturally responsive care, effective communication, and emotional intelligence (Johnson & Watson, 2019; Rouleau et al., 2023). Relational practice enables nurses to provide ethical, holistic care while facilitating interprofessional collaboration and safety in physical and virtual spaces (McCaffrey et al., 2022; Zou & Lau, 2023). Grounded in nursing theory and advocacy, relational practice is a necessary building block of effective, equitable, and ethical care in contemporary global health. Intentional incorporation into practice, education, and leadership is necessary to meet the demands of emerging healthcare environments.

Development and Evaluation of Diclofenac Sodium Cream and Its Released Studies

Umair Ahmed — 2025-05-07

Objective: This study aimed to develop and evaluate diclofenac sodium cream and it’s in vitro rerelease studies with various enhancers.
Methodology: Various formulations of diclofenac cream were developed with good solubility excipients and various enhancers. For in vitro release studies Franz diffusion cell with cellulose membrane and spectrophotmetric method were used for analysis. The study used sophisticated advanced techniques including Diffraction (XRD) Scanning Electron Microscopy (SEM) and Transform Infrared Spectroscopy (FTIR) to examine the physicochemical properties of the cream. The study included physical evaluations of the cream as well as measurements of its pH level and drug content, stability study and skin irritation was performed.
Results: The transdermal delivery of diclofenac sodium showed significant improvement when penetration enhancers were added. Formulation F1 and F2 showed best released (71.993-72.83%).The enhanced permeation in a pattern DMSO>Thymus oil >Clove oil >castor oil> Ethanol, demonstrates that the diclofenac cream formulation successfully by passes the membranes to deliver medication more effectively
Conclusion: Penetration enhancers in diclofenac sodium cream formulation lead to a significant increase in skin absorption. Researchers demonstrated that this method holds potential for creating successful formulations for topical pain treatment options.

Concept Analysis on Cultural Humility

Zamin Hussain — 2025-05-08

Background: Cultural humility is becoming a core concept in nursing, and specifically in the more multicultural healthcare settings of the present day. While cultural competence is more about learning about others, cultural humility is characterized by a more profound, more introspective process rooted in self-awareness, humility, and ongoing commitment to personal and professional development. Aim: The aim of this concept analysis is to investigate and clarify the concept of cultural humility in nursing with an emphasis towards distinguishing it from its related constructs and to establish its application in the promotion of culturally safe and responsive care. Method: The study utilized Walker and Avant's eight-step concept analysis approach. A comprehensive literature review assisted in identifying the most important attributes, antecedents, consequences, empirical referents, and illustrative cases to better understand cultural humility in nursing practice. Result: Cultural humility has been described as an iterative, introspective process characterized by openness to others' experiential realities, rigorous self-reflection, awareness of current power dynamics, and respectful dialogue with all cultural groups. Precursors of note are individual self-reflection, diversity and inclusion training, and extensive cross-cultural contact. Cultural humility outcomes are improved patient-provider communication, enhanced therapeutic relationships, and mitigation of health disparities. Conclusion & Implementation: Cultural humility as a core virtue of the times facilitates fair, inclusive, and patient-centered care. Integration of this practice into nursing education, practice, and leadership can potentially drive social justice in health care and enable the establishment of trust in diverse cultural settings. To operationalize cultural humility in practice, institutions need to integrate it into curricula, clinical policy, and organizational culture. Interventions include integrating reflective practice into curricula, establishing continuing cultural conversation in clinical environments, and developing mentorship models that honor lived experience and multiple viewpoints. With these initiatives, cultural humility can be a sustained and actionable aspect of nursing professionalism and patient advocacy.

Near Miss in Nursing: Concept Analysis

Naeem Ali Keerio — 2025-05-08

Background:Near misses in health care are valuable instances of opportunity to recognize and eliminate anticipated harm prior to its occurrence in the patient. Though extremely common, near misses in nursing practice are underreported, thus cutting their power as safety-improving tools. Objective: This concept analysis investigates the phenomenon of near misses in nursing through theoretical frameworks from Patricia Benner's "From Novice to Expert" and Faye Glenn Abdellah's "21 Nursing Problems." The aim is to define the concept, emphasize its attributes, and affirm its applicability to clinical safety and nursing development. Methods: A literature-based concept analysis was performed, synthesizing findings from scientific journals, international safety guidelines, and nursing theories. The analysis was organized into eight sections: definitions, attributes, antecedents, consequences, and example cases (model, borderline, and contradictory). Results: Five characteristic attributes of near misses were identified: recognition of risk, timely action, lack of harm, reflective practice, and adaptation at the system level. Antecedents of importance are an open safety culture, and consequences are augmented protocols and organizational learning. Theoretical consistency with Benner's and Abdellah's models supports experiential knowledge and systematic assessment of care. Practical instruments like Turnitin, Peergrade, and Moodle Workshop can facilitate documentation and learning from near misses by peers. Conclusion: Near misses play a crucial role in institutionalizing individual clinical experiences into system-wide changes. This discussion reflects the importance of a non-punitive reporting culture, interdisciplinary communication, and technology-enabled safety interventions. Considering near misses as drivers of innovation and learning reinforces their worth in fostering lifelong learning and reflective practice in nurses.

Tracing the Roots: Origin and Evolution of the Indigenous Dardic Torwali Culture of Swat

Mohsan Sattar — 2025-05-09

The people of the Torwali community are enriched in culture and traditions from a historical point of view. They have their rituals, customs, and colorful culture just like all the other communities of northern Pakistan. They are the Dardic type of people living with all the other Dardic communities, like Gawri, Kalasha, and Shina. They are not probed and studied historically. So, this article comprises the living traditions and culture of the Torwali people. This work is done with the help of Secondary as well as Primary sources and Data. In the secondary data, some books and research articles are reviewed and studied to get the most relevant Data for this Article. While for primary Data, some interviews are also conducted at the indigenous level. And for interviews, relevant people are approached and questioned. This article is based on the qualitative approach of the research. Interviews are conducted where the Data from the books are felt insufficient for the analysis. The people of this community have two main Dialects, spoken in Bahrain and Chail Valley. The dominant Dialect is the Bahraini Dialect. Their language has its literature and history. A lot of proverbs are spoken and used in their locality. They have their poetry and Grammar. They have their food items and cuisine still in use and famous. A lot of shops and foods are in the market of Bahrain. They have their indigenous style of clothing. There are also some social evils in the Torwali community. Economically they have a multitype of economy consisting, of agriculture, animal keeping, tourism, and some seasonal work. They are probed in this article very deeply and have tried to explore their culture. They should have explored on official and academic levels so that they may be introduced to the people who are unknown to them.

Serological and molecular coverage of brucellosis in high-risk human population of district Swabi, Khyber Pakhtunkhwa, Pakistan

Siraj Ahmad — 2025-05-12

Brucellosis is a contagious and zoonotic disease, affecting human and animals equivocally. It is a seriously neglected disease in underdeveloped countries, causing heavy financial losses in the livestock sector in terms of abortion, and a decrease in milk production. To better cope with socioeconomic impact of brucellosis, this study was conducted in district Swabi with the aim to detect brucellosis in high-risk human population through serological Rose Bengal plate test, Serum plate agglutination test, Enzyme-Linked Immunosorbent Assay, and molecular Polymerase chain rection techniques with respect to different risk factors and clinical history. A total of 250 blood samples (n=250 each from Human) were collected through predesigned questionnaire and were processed for detection of brucellosis through different techniques in Veterinary Research Institute, Peshawar. Detection of brucellosis frequency was performed through SPAT, RBPT, Indirect ELISA (IgM, IgG) and PCR as 12.4, 10.4, 11.6, 12 and 9.6% respectively. A numerical difference was observed through detection of different tools, but the difference was statistically non-significant (p>0.05). The present research contributes to the existing prevalence data concerning brucella infection in humans and emphasizes the benefits and effectiveness of the molecular technique of PCR compared to serological tests.

Workplace Incivility and Its Impact on Innovative Work Behaviors: Self-Efficacy as a Mediator

Mahnoor Shahid — 2025-04-10

Workplace incivility, characterized by low-intensity deviant behaviors such as rudeness and disrespect, has become a universal issue in modern organizations, negatively impacting employee well-being and organizational effectiveness. This study investigates the impact of workplace incivility on innovative work behaviors (IWB), with self-efficacy as a mediating variable. Drawing on Bandura’s Social Cognitive Theory, the research explores how self-efficacy employees' belief in their ability to perform tasks can mitigate the adverse effects of incivility on innovation. Using a cross-sectional design, data were collected from 299 employees in the education and healthcare sectors of Khyber Pakhtunkhwa (KP), Pakistan through structured questionnaires. The findings reveal that workplace incivility significantly reduces both self-efficacy and innovative work behaviors. However, self-efficacy partially mediates this relationship, suggesting that employees with higher self-efficacy are more resilient to the negative effects of incivility and are better able to maintain their innovative behaviors. The study highlights the importance of fostering self-efficacy through training and supportive workplace policies to respond to the harmful effects of incivility. These results are relevant for organizations interested in facilitating innovation by confronting incivility at the workplace and strengthening workers' psychological resilience. The study enriches existing work on workplace dynamics and presents groundwork for further investigation on resilience and innovation under a problematic work environment.

Fintech Innovation and its Impact on Financial Services in Pakistan

Muhammad Zubair Rao — 2025-04-22

This study researches the impact of Financial Technology (FinTech) in the areas of banking transformation in Pakistan. It highlights particular adoption barriers such as regulatory restrictions, cybersecurity issues, trust deficits, and consumer apprehensions. The primary data was collected through the online survey distributed among respondents who are interested in FinTech across the country of Pakistan. A descriptive analysis alongside structural equation model (SEM) analysis was conducted for assessment of consumer adoption patterns and key determinants. Based on the facilitators, results suggest that 72% of the consumers are currently using the FinTech services. These results show increased usage, availability, and affordability. Risk of fraud and data compromise concerns, however, hinder adoption by a wider audience. Mainstream banks are also limited in their adoption of FinTech because of regulation and the technology resistance. There is progress However, Government initiatives like Raast (instant payment system) in Pakistan is boosting aid in financial access but there is still room for improvement. This study contributes to empirical knowledge in the FinTech exploring consumer behavior, challenges of regulation/law and future trends related to adoption in Pakistan. It provides strategic guidance for policy makers, investors, and banks in emerging markets.

The Role of AI and Machine Learning in Enhancing Decision-Making and Operational Efficiency in SMEs in Emerging Markets

Rooha Shahid — 2025-05-02

Purpose: Nevertheless, most SMEs in Nigeria still operate with analogue operations as they have not embraced technological innovations. The purpose of this study will be to examine the impact that AI has brought, specifically machine learning, on the sustainability and operations of SMEs operating in South-East Nigeria. In particular, the study aims to determine the impact that machine learning has on the performance of these enterprises.
Research Methodology: The research methodology used in this study was the descriptive method. The target population was 27,546 SMEs operating in Nigeria, which are registered and certified by CAC. Krejcie and Morgan's (1970) formula was used to determine the sample size and established that a sample size of 379 SMEs was required. Self-administered questionnaires were used as the main instrument for data collection; the questionnaires were subjected to content validity tests and inter-item reliability tests. Thus, the reliability coefficient of the instrument was found to be 0.86, which justified the use of the instrument in the study.
Results: Descriptive statistics tools, such as simple regression analysis, were used to study the relationship between the variables. The result shows that machine learning has a positive influence on the performance of SMEs in south-east Nigeria.
Limitations: One limitation of the study was the use of only inferential statistics, which excluded the use of other advanced statistical analytic approaches. In addition, the study involved the South-East region only; thus, it may not extend the results of the assessment to all SMEs in Nigeria.
Contribution: Since AI's impact is highly related to improving SMES' performance, it is crucial to examine the importance of AI-related technologies and stresses on machine learning, especially for SMES' operation. It stated, in essence, the case for AI in the sector to be made much more extensive.
Practical Implications: The study suggests that policymakers and industry players proactively encourage practices to ensure SMEs can integrate AI into their operations. This could be done by providing extra bonuses, expanding educational possibilities, and collaboratively creating effective legislation to stimulate innovations and support data protection and security.
Novelty: Even though numerous studies have been conducted regarding the effect of AI on SMEs, little research has focused on the relationship between machine learning and the productivity of SMEs in the South-East of Nigeria, hence its significance

The Interaction of Business Strategy, Cash Holding, and Firm Value: Insights from Corporate Finance

Hifsa Akhlaq — 2025-05-07

The present study investigates the association between corporate cash reserves and business strategy in non-financial enterprises in Pakistan from 2011 to 2021. The analysis evaluates how resource allocation and investment behaviour differences affect cash handling by concentrating on two competing strategies—Defenders and Prospectors. Multiple regression analysis reveals that Defender firms, which focus on stability and risk management, own far more cash reserves than Prospector firms, which emphasise expansion and innovation. The results indicate that enterprises employing a Defender strategy prioritise liquidity to mitigate risks and maintain financial stability.
Furthermore, the study provides significant insights for financial managers and investment strategists, emphasising the necessity of matching liquidity policies with business strategy to enhance firm value. Policymakers ought to promote the adoption of cash management methods by enterprises that are congruent with their strategic objectives. The research is confined to Pakistani enterprises; expanding this analysis to include international firms would enhance the findings and offer a more comprehensive knowledge of the relationship between strategy and cash holdings. The findings also demonstrate how business strategy affects cash holdings and firm value, complementing previous research on Pakistani firms.

Effect of Workload on Organizational Commitment Among Academicians in Universities: Mediating effect of Emotional Exhaustion

Dr. Faisal Khan* — 2025-05-07

Increasingly, burnout is seen in bosoth the academic and practical fields. Academicians may also experience burnout differently depending on where they work. Service and health sector burnout has been studied extensively, but education has received less attention. In order to predict burnout, the main predictor is emotional exhaustion. Excessive work pressure, personal demands, or accumulated stress can cause emotional exhaustion. A feeling of mental exhaustion caused by social interactions. This study aims to determine how emotional exhaustion affects academicians' workload and organizational commitment in Malakand division. In order to collect the data from 212 academicians, a cross-sectional method was used, and a variety of statistical tools were used to analyze the data. Workload correlates positively with emotional exhaustion, while organizational commitment correlates negatively. In organizational commitment and workload, emotional exhaustion is a mediating factor. As a result of this study, academicians will have a better understanding of how they interact and to what extent their emotions directly impact their organizational commitment. Results of the study were addressed to students, academicians, administration of universities and policymakers in higher education.

Baseline Hemato-Biochemical Parameters for Health Monitoring of Homing Pigeon

Farrukh Aziz — 2025-04-19

This study was designed to establish the reference values of hematological, liver function (LFT), renal function (RFT), and cholesterol profiles in homing pigeons (Columba livia domestica) to provide baseline data for their health evaluation. Blood samples were collected from male and female homing pigeons during the breeding season in Okara, Pakistan. The hematological parameters revealed that hemoglobin (Hb) levels were 23.53±1.22 g/dL in males and 26.77±2.01 g/dL in females, while total RBCs were 3.63±1.39 ×10⁶/µL in males and 2.73±0.70 ×10⁶/µL in females. PCV was recorded as 58.10±1.59% in males and 61.63±1.35% in females. MCV was significantly higher in females (178±2.29 fL) than males (163.1±1.63 fL). In the biochemical analysis, serum total protein was 7.46±1.22 g/dL in males and 7.1±0.89 g/dL in females, while cholesterol levels were significantly higher in females (230.8±1.43 mg/dL) compared to males (220.7±2.05 mg/dL). Serum Urea levels were 18.33±2.05 mg/dL in males and 28±1.63 mg/dL in females, while serum creatinine was 0.9±0.24 mg/dL in males and 1.33±0.47 mg/dL in females. Highly significant differences (p<0.01) were found in WBCs, MCV, RDW-CV, MPV, eosinocytes, serum alkaline phosphatase, ALT, and serum urea values between male and female pigeons. In conclusion, the present study successfully provides baseline hematological and biochemical reference values for male and female homing pigeons, which can assist in their health monitoring and clinical assessments. It is recommended that future research should include larger sample sizes from different regions to develop a comprehensive health profile of Columba livia domestica for conservation and veterinary purposes.

Metal-Based Nanoparticles in Biomedicine: Recent Innovations, Mechanisms of Action, and Future Perspectives– A Mini Review

Ali Umar — 2025-04-19

Metal-based nanoparticles (M-NPs) have emerged as promising nanomaterials with exceptional potential in diverse biomedical applications due to their unique physicochemical, biological, and functional properties. This mini-review provides a comprehensive overview of recent advancements in the synthesis, functionalization, and biomedical utilization of M-NPs. The review highlights key applications of M-NPs in antimicrobial therapy, drug delivery, cancer treatment, biosensing, and diagnostic imaging. Special emphasis has been placed on recent innovations, including smart/functionalized nanoparticles, surface modification strategies for targeted delivery, nano-hybrids, multi-metallic systems, and metal-organic frameworks (MOFs), which have significantly enhanced the therapeutic performance of M-NPs. The review also discusses how these nanoparticles work, including creating ROS, breaking down membranes, binding to DNA/RNA, changing proteins, and causing cell death, which all contribute to their effectiveness in medicine. However, significant clinical barriers such as toxicity, biosafety issues, and regulatory limitations have so far hampered their progress. Thereafter, the future vantage point for the advancement remains on the introduction of safer methods, personalized nanomedicine, nanoenabled regenerative medicine, and multifunctional intelligent NPs and the interviewing way from the laboratory research to the clinic. In general, metal-based nanoparticles are a powerful and promising platform in nanomedicine that will be part of future healthcare strategies.

Newly reported genera of Beetles (Coleoptera) from Pakistan

Muhammad Sajid — 2025-05-07

The study was carried out to explore the fauna od beetles (Coleoptera) at district Charsadda, Khyber Pakhtunkhwa, Pakistan. Total 170 specimens were collected by using hand net and were identified with the help of available literature. Among the collected specimens, 3 genera via Cyclocephala, Entomoscelis and Limodromus were reported as new to the fauna of Pakistan. Diagnostic characters of the genera along with digital images were also provided.

Risk Factors of Polycystic Ovarian Syndrome Associated with Miscarriages and Diet

Asma — 2025-05-14

Polycystic Ovary Syndrome (PCOS) is a multifactorial disorder influenced by genetic, environmental, and lifestyle factors. It often leads to various reproductive and metabolic complications, including menstrual irregularities, obesity, and infertility, with growing concerns about its association with miscarriages. This study aims to assess the prevalence of PCOS-related miscarriages and explore potential contributing factors among women in a specific population. Data were collected from 400 participants, focusing on demographic, dietary, and clinical characteristics. Results indicate that a significant percentage of women with PCOS experience reproductive challenges, with factors such as obesity, lack of exercise, and family history playing a critical role. These findings highlight the importance of early diagnosis and lifestyle modifications in managing PCOS and reducing the risk of miscarriages. The study provides valuable insights into the regional prevalence and impact of PCOS, which can aid future research and interventions aimed at improving women’s reproductive health.