Review Journal of Neurological & Medical Sciences Review
The Review Journal of Neurological & Medical Sciences Review (RJNMSR) [ISSN: 3007-3073, P-ISSN, 3007-3065], published by Insightful Education Research Institute, is an international open-access, double-blind peer-review journal. The journal is dedicated to advancing the frontiers of Neurology, Medical and Allied Health Sciences by providing a timely and reliable platform for the publication of significant research and developments. Its mission is to facilitate the exchange of critical scientific knowledge, offering a space for the discussion of emerging trends, news, and pressing issues in the scientific world. Its mission is to facilitate the global exchange of essential scientific knowledge and promote discussions on emerging trends, groundbreaking discoveries, and critical issues in both human and animal health. The Research of Medical Science Review is dedicated to fostering a broad and multidisciplinary dialogue including but not limited to the following areas: Internal Medicine and Subspecialties [Cardiology, Endocrinology, Gastroenterology, Geriatrics, Health, Hematology, Nephrology, Neurology, Oncology, Pulmonology, Rheumatology, Infectious Disease] Surgical and Subspecialties [General Surgery, Orthopedics, OB/GYN, Urology, Otolaryngology, (ENT), Ophthalmology] Diagnostic and Imaging Fields [ Radiology & Pathology] Rehabilitation Sciences [ Physiotherapy and Occupational Therapy] Pediatric Allied Health Professions [ Psychiatry, Nursing, Nutrition and Dietetics, paramedics, Pathology, Public Health, Sports Sciences, Physical Education, Health Management] Genetics and Immunology [Genetics and Genomics & Immunology] Pharmacy Pharmaceutical Sciences Dentistry Biochemistry Environmental Sciences Biological Sciences [Zoology, Botany, Microbiology, Biotechnology, Medical Sciences, Cell Biology, and Molecular Biology] Animal Health and Veterinary Sciences [Veterinary Medicine, Animal Physiology, and Pathology, Animal Nutrition, Zoonotic Diseases, Livestock Management, Wildlife Health and Conservation] Anesthesiology Agriculture Forensic Science
INSIGHTFUL EDUCATION RESEARCH INSTITUTE"
COMPARATIVE ANALYSIS OF ANNUAL AND SEMESTER BASED ACADEMIC OUTCOMES AND PERCEIVED STRESS AMONG NURSING STUDENTS AT SHAHIDA ISLAM NURSING COLLEGE LODHRAN
Background: Academic assessment systems influence nursing students’ learning, performance, and well-being. At the University of Health Sciences (SINC), Pakistan, both annual and semester examination systems are implemented. The semester system emphasizes continuous assessment and frequent feedback, whereas the annual system relies on end-of-year summative evaluations. Limited evidence exists on their comparative impact on academic outcomes, stress, and coping strategies among nursing students. Objective: To compare academic performance and perceived stress among nursing students enrolled in annual and semester systems at SINC-affiliated institutions. Methods: A comparative analytical study was conducted at Shahida Islam Nursing College, Lodhran, with 60 BSc Nursing students (30 annual-system, 30 semester-system). Stratified random sampling was used. Data were collected via a structured questionnaire comprising demographics, the Perceived Stress Scale (PSS-10), and Brief COPE inventory. Academic performance was measured through GPA and examination results. Data were analyzed using SPSS 26.0, with t-tests and chi-square tests applied (p < 0.05). Results: Semester-system students showed higher academic performance than annual-system students (Mean GPA 73.99 ± 2.71 vs 69.87 ± 2.52). An independent samples t-test indicated that this difference was statistically significant(t = −6.10, df = 58, p < 0.001). Perceived stress was also significantly higher among semester students (p = 0.039). Most participants reported moderate stress, and the majority were female nursing students aged 21–25 years. Conclusion: The type of academic system affects students’ psychological well-being rather than overall performance. Continuous assessment in the semester system may enhance GPA but increases stress. Hybrid models, stress management interventions, and faculty support are recommended to balance academic rigor and student well-being.
Nursing students, academic performance, GPA, stress, coping strategies, annual system, semester system, SINC, Pakistan.
ANTIBIOTIC USE PRACTICES AND ENVIRONMENTAL RISK FACTORS ASSOCIATED WITH ANTIMICROBIAL RESISTANCE IN POULTRY FARMING SYSTEMS OF MUZAFFARGARH, PAKISTAN
Antimicrobial resistance (AMR) has emerged as a major global public health challenge driven by the inappropriate use of antibiotics in both human and animal production systems, particularly in low- and middle-income countries. The present study aimed to evaluate the practices of using antibiotics in commercial poultry farms and environmental pathways involved in the spread of AMR in the District Muzaffargarh, Punjab, Pakistan. A structured and pre-validated questionnaire was used to conduct a cross sectional survey of 70 commercial poultry farms. Data were analysed descriptively, with Pearson's chi-square test, and by multivariable logistic regression, in IBM SPSS Statistics version 25.0. 97.1% of farms used antibiotic and therapeutic use was the main purpose of administration (49.0%), followed by use to prevent disease (31.4%), and use to promote growth (20.0%). Over half of respondents (57.1%) obtained antibiotics without veterinary prescription and 45.7% did not comply with recommended periods of withdrawal. The most commonly used antimicrobials were enrofloxacin (45.7%), doxycycline (38.6%) and amoxicillin (32.9%), while the use of colistin was also significant (21.4%). The findings of the environmental assessment were that 71.4% of farms did not have appropriate wastewater drainage systems, 65.7% disposed of untreated poultry waste in open areas and 59.1% reported dissemination of poultry waste from the farms to surrounding agricultural land and water bodies by flood. Multivariable logistic regression identified lack of formal education (AOR = 3.24; 95% CI: 1.28–8.17; P = 0.013), absence of professional poultry management training (AOR = 2.87; 95% CI: 1.16–7.09; P = 0.023), and farm location in flood-prone areas (AOR = 2.54; 95% CI: 1.03–6.28; P = 0.043) as independent predictors of non-prescription antibiotic use. The results have indicated a high prevalence of inappropriate use of antimicrobials and poor environmental management practices, which might speed up the spread of AMR. To reduce AMR risks in a One Health context, strengthening antimicrobial stewardship, farmer education, veterinary oversight, and environmentally sustainable waste management are crucial.
Antimicrobial resistance; Poultry farming; Environmental contamination; Antibiotic use; Biosecurity
EFFECTIVENESS OF DUAL-TASK VIRTUAL REALITY TRAINING ON BALANCE, GAIT PERFORMANCE, AND COGNITIVE FUNCTION IN INDIVIDUALS WITH STROKE: A RANDOMIZED CONTROLLED TRIAL
Background: Stroke frequently results in persistent impairments in balance, gait, and cognitive function, limiting functional independence and quality of life. Although virtual reality (VR) has emerged as a promising rehabilitation approach, evidence regarding the effectiveness of dual-task VR training integrating simultaneous motor and cognitive activities remains limited. Objective: To evaluate the effectiveness of dual-task virtual reality training combined with conventional physiotherapy on balance, gait performance, and cognitive function in individuals with stroke. Methods: A single-center randomized controlled trial was conducted involving 46 individuals with stroke who met the eligibility criteria. Participants were randomly allocated to either the experimental group (dual-task VR training plus conventional physiotherapy; n = 23) or the control group (conventional physiotherapy alone; n = 23). Both groups received supervised rehabilitation for 8 weeks. Balance was assessed using the Berg Balance Scale (BBS), functional mobility using the Timed Up and Go (TUG) test, gait performance using the 10-Meter Walk Test (10MWT), and cognitive function using the Montreal Cognitive Assessment (MoCA). Data was analyzed using paired and independent t-tests, while between-group differences were evaluated using analysis of covariance (ANCOVA). Statistical significance was set at p < 0.05. Results: Both groups demonstrated significant improvements following the intervention; however, participants receiving dual-task VR training achieved significantly greater improvements in BBS, TUG, 10MWT, and MoCA scores compared with the conventional physiotherapy group (all p < 0.001). ANCOVA confirmed significant between-group treatment effects across all primary outcome measures after adjusting for baseline values. Conclusion: Dual-task virtual reality training combined with conventional physiotherapy was more effective than conventional physiotherapy alone in improving balance, gait performance, functional mobility, and cognitive function in individuals with stroke. Incorporating cognitive and motor tasks within an interactive virtual environment may represent an effective strategy for enhancing post-stroke rehabilitation. Larger multicenter randomized controlled trials with longer follow-up are recommended to confirm these findings.
Stroke; Virtual reality; Dual-task training; Balance; Gait; Cognitive function; Randomized controlled trial; Neurorehabilitation.
ASSESSMENT OF RISK FACTORS OF ISCHEMIC MITRAL REGURGITATION POST MYOCARDIAL INFARCTION
The study was conducted to assess the incidence of papillary muscle involvement, severity of left ventricular infarction and risk factors of ischemic mitral regurgitation after myocardial infarction. This retrospective study was conducted in the Department of Cardiology from December 2023 to December 2024. A total of 100 patients with severe heart attack as a result of chronic artery disease undergoing cardiac magnetic resonance and ECG were included in the study by consecutive sampling. The degree of ischemic mitral regurgitation was measured by standard PISA method given by European cardiovascular association. The cardiac functionality and structure along with extent of infarcted tissue was examined by cine CMR and LGE CMR, respectively by cardiac magnetic resonance. Among the 100 patients included, 55 patients (55%) had a grade I ischemic mitral regurgitation and 45 patients (45%) had grade II-III ischemic mitral regurgitation. Papillary muscle infarction was found in 20 patients (20%) with posteromedial and anterolateral infarct in 5 patients each and 10 patients had both. Seven patients (35%) had mild regurgitation and 13 patients (65%) had moderate-to-severe regurgitation. Multivariate analysis showed age (OR: 1.08 (95% CI: 1.03-1.23), p=0.001), degree of infarction (OR: 1.16 (95% CI: 1.09-1.20), p=0.000) and global longitudinal strain (OR: 1.28 (95% CI: 1.18-1.47), p=0.000) were independent risk factors of grade II-III regurgitation. It is concluded that there is high incidence of papillary muscle infarction in patients with grade II-III ischemia mitral regurgitation. Age, degree of infarction and global longitudinal strain independent risk factors of grade II-III regurgitation.
Ischemic Mitral Regurgitation, Myocardial Infarction, Assessment of Risk Factors
ASSESSMENT OF SURGICAL CASE TURNOVER TIME AND FACTORS AFFECTING OPERATION THEATRE EFFICIENCY
Background: The operating room (OR) is one of the most resource-consuming and revenue units in any hospital, which makes up about 70% of all hospital revenues. Turnover time (TOT) - the time interval between the completion of one case and the onset of another one- turnover time is a critical non-operative period, the optimization of which is the key to maximizing OR throughput, cost reduction, and preservation of surgical schedules. Regardless of its importance, TOT has a multifaceted interaction of staffing, organizational, patient-related, and time-specific factors which are not fully described in various surgical environments. Objective: To both assess the scale of the TOT delays objectively and examine the most common factors that contribute to these delays, as well as to review how OR team composition, time of the day, and institutional factors affect OR efficiency. Methodology: Evidence synthesis involved a series of observational and retrospective studies that were carried out in academic and teaching hospital environments. There were studies based on prospective observational data observation of TOT in general surgery and orthopaedic theatres, multi-specialty studies of elective cases, and specialty-based studies in hand surgery. Some of the variables that were tested were the identity of the surgeon and continuity, anesthesiologist, nursing team, time of the day, patient ASA status, complexity of the case and institutional/hospital factor. Results: In all studies, most of the turnovers (77-79) included were performed within benchmark ranges and the average ranges of TOT were 15.5 to 96 minutes provided the setting and time of the day. Four major categories of causes that led to delays were surgeon related (22.5%), anesthesia related (9%), patient related (18%), and hospital/institutional related (50.5%), and the latter was the most prevailing. There were also specific identifiable contributors, such as the unavailability of staff, delays in the transportation of patients, the introduction of the emergency cases in the elective lists, equipment problems, and the breakdown of communication. Multivariate analyses continuously showed consecutive surgeon, consecutive anesthesiologist, and same surgical specialty to be independent predictors of lower TOT. Most importantly, time of day proved to be a powerful independent variable- cases that had previously undergone a previous procedure and were terminated after 14:00 had much longer TOT (mean 95.5 vs. 78 min, p<0.001), which coincided with the change of nursing and support staff shifts at 15:00. A dedicated OR staff model was related to a meaningfully lower TOT in hand surgery than a non-dedicated model. Conclusions: Multifactorial determinants that influence the efficiency of TOT and OR include continuity of staffing, institutional infrastructure, time of the day factors, and scheduling of cases. The most influential and adjustable ones are the use of stable surgical, anesthesia teams in the successive cases, the scheduling of staff shift changes in sequence in order to have a time overlap, specialty-specific OR teams, and parallel processing of patient preparation. The most critical interventions to the delay in hospitals are at the hospital level such as the better communication system, standardized turnover practices, and sufficient staffing of support. To maximize the efficiency of the OR, minimize its costs and enhance the overall quality and safety of the delivery of surgical care, it is needed to have a multidisciplinary systems-based approach to its optimization.
OR efficiency; turnover; OR staffing; surgical scheduling; perioperative management; case
IDENTIFICATION OF BEGOMOVIRUS INFECTING CHILLIES GROWN IN TUNNELS
About 50 chilli plants were grown in tunnels at NARC in March 2016. Begomovirus was detected in one sample of chillies out of total 10 samples collected on the basis of morphological and PCR based studies. These morphological characters were leaf curls, yellowing and retarded growth of plants. Begomoviruses (Geminiviridae family) cause diseases in different field crops e.g weeds, ornamental plants and vegetables etc. Molecular detection of this virus was done by using degenerate primers. The degenerative primers that are designed for the amplification of specific DNA fragments. Polymerase chain reaction based assays were performed with the help of these degenerative primers. The samples were processed, sequenced and analyzed. Begomovirus was identified in chili crop from the collected samples of NARC Islamabad. So Begomovirus was found as a causal agent of leaf curl disease in the Chilli plants of NARC Islamabad. Identification of the causal agent (Begomovirus) of leaf curl disease in chillies will further help in future research to produce resistant germplasm against the Begomovirus
Begomovirus, Chilli (Capsicum annuum), Leaf Curl Disease, Geminiviridae, Polymerase Chain Reaction (PCR), Degenerate Primers, Molecular Characterization, NARC Islamabad.
CONSERVATIVE MANAGEMENT OF TUBERCULOSIS-RELATED CHYLOTHORAX AND CHYLOUS ASCITES IN A 14-YEAR-OLD GIRL — A CASE REPORT
Chylothorax and chylous ascites are rare complications of tuberculosis (TB), resulting from lymphatic obstruction or rupture of the thoracic duct. We report a case of a 14-year-old girl presenting with dyspnoea, ascites, and pleural effusion, who was successfully managed conservatively. Early recognition and treatment with anti-tuberculous therapy (ATT) and prednisolone, along with a regular oral diet, led to complete resolution without the need for octreotide therapy, dietary restriction, or repeated aspirations.
Tuberculosis, Chylothorax, Chylous Ascites, Conservative Management, Octreotide, Pediatric TB.
FREQUENCY AND FACTORS ASSOCIATED WITH SUSPECTED FUNCTIONAL NEUROLOGICAL DISORDER AMONG PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL IN PESHAWAR
Background: Functional Neurological Disorder (FND) produces genuine but neurologically unexplained symptoms that are diagnostically difficult to separate from deliberate symptom fabrication in the high-pressure setting of the emergency department (ED). No published data describe the frequency of suspected FND-consistent presentations in a Pakistani ED prior to this study. Objective: To determine the frequency of suspected FND-consistent presentations, and their associated sociodemographic and clinical factors, among patients attending the ED of a tertiary care hospital in Peshawar. Methods: In this four-month cross-sectional study, 140 patients above five years of age were enrolled by convenience sampling at the ED of Lady Reading Hospital (LRH), Peshawar. A structured questionnaire recorded sociodemographic and clinical presentation data alongside seven pre-specified behavioural indicators; patients with three or more positive indicators, together with the attending physician's overall clinical impression, were classified as having a suspected FND-consistent presentation. Data were analysed descriptively using SPSS v22.0. Results: A suspected FND-consistent presentation was identified in 89.3% of patients (n=125/140; 95% CI 84.2–94.4%). The sample was predominantly female (80.0%), under 40 years old (73.6%), unemployed (69.3%), and without formal education (52.1%). Shelter-seeking was the commonest primary reason for ED attendance (45.0%). The most prevalent behavioural indicators were inconsistency between symptoms and physical findings (95.0%), inconsistent history on repeated questioning (90.0%), and symptom worsening when discharge was discussed (85.7%). Most patients were discharged (67.1%). Conclusion: Suspected FND-consistent presentations were highly prevalent in this ED population and were closely linked to unmet social need. Structured, checklist-based assessment and locally adapted clinical pathways may improve the consistency and compassion of care for this population. Keywords: Functional Neurological Disorder; Conversion Disorder; Emergency Service, Hospital; Prevalence; Secondary Gain; Somatoform Disorders; Pakistan; Cross-Sectional Studies.
Copyright (c) 2026 Review Journal of Neurological & Medical Sciences Review
EFFECTIVENESS OF A FAMILY-CENTERED APPROACH ON CAREGIVER STRAIN AND COPING STRATEGIES AMONG STROKE CAREGIVERS: A QUASI-EXPERIMENTAL STUDY
Background/Objective: Stroke leaves a substantial minority of survivors dependent on family caregivers, who in turn experience considerable strain. This study investigated the strain and coping strategies of stroke caregivers and evaluated the effectiveness of a family-centered approach in improving these outcomes. Methods: A quasi-experimental study was conducted using non-probability purposive sampling. Thirty-one caregiver–patient dyads were recruited at the Department of Occupational Therapy, Lady Reading Hospital, Peshawar. Caregivers received a four-week family-centered intervention (30-minute sessions, 3 days/week). Coping was assessed with the Brief-COPE inventory and caregiver strain with the Modified Caregiver Strain Index (MCSI), administered before and after the intervention. Data were analyzed in SPSS v.22 using descriptive statistics and paired-samples t-tests. Results: Mean caregiver age was 32.06 ± 11.97 years; mean patient age was 46.39 ± 17.17 years. Following the intervention, mean Brief-COPE scores improved from 66.39 ± 10.84 to 90.39 ± 7.73 (p = 0.003), and mean MCSI scores improved from 16.39 ± 2.82 to 7.16 ± 1.79 (p = 0.001), both statistically significant at the 95% confidence level. Conclusion: Caregivers of stroke patients used a range of coping techniques, and a structured family-centered approach was associated with a significant reduction in caregiver strain and improvement in coping scores. Structured psychosocial support for stroke caregivers is recommended as a low-cost, time-efficient intervention.
Copyright (c) 2025 Review Journal of Neurological & Medical Sciences Review
ANASTOMOTIC LEAK AFTER COLORECTAL SURGERY: A NARRATIVE REVIEW OF CLASSIFICATION, RISK FACTORS, DIAGNOSIS, AND STRATEGIES FOR PREVENTION AND MANAGEMENT
Anastomotic leak (AL) remains the most feared complication following colorectal surgery, contributing to significant morbidity, mortality (2–16%), and poorer long-term oncological outcomes. Despite advancements in surgical technology and perioperative care, its incidence has remained stable, ranging from 3% to 19% depending on anastomosis location. In this review, we synthesize current evidence on multifaceted risk factors of AL and propose integrated, multimodal strategies for its prevention and management. Key findings suggest that effective prevention must span the entire perioperative continuum, beginning with preoperative optimization of nutritional status, smoking cessation, and adoption of combined mechanical bowel preparation with oral antibiotic prophylaxis. Intraoperatively, meticulous technical execution focused on tension-free union and adequate perfusion—increasingly assessed through indocyanine green (ICG) fluorescence angiography—is essential to ensuring biological integrity. Postoperatively, early diagnosis is facilitated by standardized surveillance protocols utilizing biochemical markers—specifically dynamic C-reactive protein (CRP) trajectories—alongside contrast-enhanced computed tomography (CT) imaging. Management of AL has become increasingly tailored to individual’s clinical stability and leak severity according to the International Study Group of Rectal Cancer (ISREC) grading, utilizing wide spectrum of interventions from conservative percutaneous drainage and emerging endoscopic vacuum therapy to definitive surgical re-intervention for source control. In conclusion, while technological innovations continue to evolve, the persistent challenge of AL necessitates coordinated, evidence-based approach to perioperative care, highlighting urgent need for further high-quality, multicenter research to validate emerging predictive models and salvage techniques.
Anastomotic leakage, colorectal surgery, colorectal cancer, C-reactive protein, computed tomography, indocyanine green fluorescence angiography, diverting stoma, endoscopic vacuum therapy, multimodal prevention.
ASSESSMENT OF HEPATITIS B VACCINATION STATUS AND FACTORS CONTRIBUTING TO NON-ADHERENCE AMONG SURGICAL STAFF AT SOCIAL SECURITY HOSPITAL, LAHORE
Background: Blood, body fluids and sharp instruments are sources of exposure for healthcare workers, particularly surgical workers, and pose a high risk for infection with hepatitis B virus (HBV). The most effective measure to prevent is vaccination; however, even in many developing countries such as Pakistan the vaccination coverage of HCWs is not optimum. Objective: To determine the hepatitis B vaccination status of surgical staff of public hospital, Lahore and to determine the factors hindering the adherence of Hepatitis B vaccination policy in these hospitals. Methods: This will be a cross sectional study to be conducted in selected public hospital at Lahore including hospital social security. Using purposive sampling, surgical personnel having at least six months work experience in surgical departments will be recruited by the researcher. Structured questionnaires to record vaccination status and factors associated with incomplete and non-vaccination will be used to collect the data. Descriptive and inferential statistics will be used to give quantitative assessment of the data to estimate the extent of vaccination coverage and contributing factors. Expected Results: The study should reveal the percentage of fully vaccinated surgical staff as well as the main barriers to vaccination (such as lack of awareness, vaccine availability, institutional policies, time and financial constraints). Conclusion: The findings will provide evidence regarding Hepatitis B Vaccination Coverage among SHWs in Lahore and can be helpful in designing specific interventions and institutional policies that will help to increase the uptake of Hepatitis B vaccination and ensure occupational safety.
ASSESSMENT OF HEPATITIS B VACCINATION STATUS AND FACTORS
CONTRIBUTING TO NON-ADHERENCE AMONG SURGICAL STAFF AT
EVALUATION OF EARLY COMPLICATION OF MODIFIED RADICAL MASTECTOMY WITH SPECIAL REFERENCE TO THE SEROMA FORMATION AND FLAP NECROSIS
Background: One of the most prevalent diseases among women globally, breast cancer continues to be a serious public health issue. One popular surgical method used to treat breast cancer is the Modified Radical Mastectomy (MRM). Despite its effectiveness, patients may experience a number of early postoperative problems, including ipsilateral neuralgia, cellulitis or abscess, shoulder decreased mobility, flap necrosis, and seroma formation, which can worsen patient morbidity and prolong recovery. Therefore, improving surgical outcomes requires early detection of these problems Methodology: 71 patients who had Modified Radical Mastectomy for astrologically confirmed breast cancer were included in a prospective descriptive observational study. The study comprised patients who met the inclusion criteria and were at least eighteen years old. A standardized data collection form was used to gather information on demographics, body mass index (BMI), comorbidity, Neoadjuvant chemotherapy, surgical features, and early postoperative problems. After the data was examined using SPSS, descriptive statistics like frequencies, percentages, means, and standard deviations were calculated. Results: The participants' average age was 49.77 ± 10.08 years, and their average BMI was 30.16 ± 5.37 kg/m². The majority of patients were overweight or obese, and prevalent commodities included diabetes mellitus (56.3%) and hypertension (71.8%). 85.9% of procedures involved electrosurgical unit, while 64.8% of patients underwent Neoadjuvant chemotherapy. Seroma development was the most frequent early postoperative consequence (64.8%), followed by ipsilateral neuralgia (29.6%), shoulder decreased mobility (45.1%), flap necrosis (43.7%), and cellulitis or abscess (39.4%). Conclusion: Patients receiving Modified Radical Mastectomy continue to experience early postoperative problems, the most prevalent of which is seroma development. Higher BMI, diabetes mellitus, hypertension, and surgical features are examples of patient-related factors that may influence these results. To reduce problems and enhance patient recovery, thorough preoperative evaluation, careful surgical technique, standardized postoperative care, and frequent follow-up are crucial.
Breast Cancer, Modified Radical Mastectomy, Seroma Formation, Flap Necrosis, Postoperative Complications, Shoulder Impaired Mobility, Cellulitis, Ipsilateral Neuralgia, Body Mass Index, Breast Surge
PREVALENCE AND ANTIMICROBIAL RESISTANCE PATTERNS OF BACTERIAL ISOLATES FROM SURGICAL WOUND INFECTIONS IN A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL STUDY
Background: Surgical site infections (SSIs) remain among the most frequent healthcare-associated infections worldwide and are increasingly complicated by antimicrobial resistance (AMR), particularly in resource-limited tertiary care settings. This study aimed to determine the prevalence of culture-positive surgical wound infections and characterize the antimicrobial resistance profiles of the causative bacterial isolates. Methods: A hospital-based, prospective cross-sectional study was conducted over a 12-month period (January–December 2025) at the Department of Surgery and Microbiology, , a 500 -bed tertiary care teaching hospital Peshawar. Wound swabs/pus aspirates were collected aseptically from patients with clinically suspected SSI following the Centers for Disease Control and Prevention (CDC) surveillance definitions. Bacterial identification was performed using standard microbiological and biochemical methods (and/or an automated VITEK-2 system), and antimicrobial susceptibility testing (AST) was performed by the Kirby–Bauer disc diffusion method interpreted per current Clinical and Laboratory Standards Institute (CLSI) breakpoints. Multidrug resistance (MDR), extensive drug resistance (XDR), and pandrug resistance (PDR) were classified according to the Magiorakos et al. international consensus definitions. Data were analyzed using SPSS (version 26.0); categorical variables were expressed as frequencies/percentages, and associations were tested using the chi-square test, with p < 0.05 considered statistically significant. Results: Of 850 surgical patients screened, 210 (24.7%) developed clinical signs of SSI, of which 158 (75.2%; 95% CI: 68.9–80.7%) were culture-positive, yielding 172 bacterial isolates (7.9% polymicrobial). Gram-negative bacteria predominated (108/172, 62.8%), led by Escherichia coli (19.8%), Klebsiella pneumoniae (16.3%), and Pseudomonas aeruginosa (14.0%); Staphylococcus aureus was the leading Gram-positive isolate (22.1%), of which 57.9% were methicillin-resistant (MRSA). High resistance was observed among Gram-negative isolates to ampicillin (88.9%), amoxicillin-clavulanate (74.1%), and ceftriaxone (65.7%), with comparatively preserved susceptibility to meropenem (91.7%) and colistin (97.2%). Gram-positive isolates showed high resistance to penicillin (90.6%) but retained near-universal susceptibility to vancomycin (98.4%) and linezolid (100%). Overall, 46.5% (80/172) of isolates met criteria for multidrug resistance, and 8.1% (14/172) were extensively drug-resistant. Conclusion: Gram-negative organisms, particularly Enterobacterales and non-fermenters, are the predominant cause of surgical wound infections at this tertiary center, with a substantial burden of multidrug resistance. Carbapenems, colistin, vancomycin, and linezolid remain the most reliable empirical options, but their reserved use should be safeguarded through structured antimicrobial stewardship, periodic antibiogram updates, and strengthened infection-prevention practices.
surgical site infection; antimicrobial resistance; multidrug resistance; antibiogram; tertiary care hospital; nosocomial infection
SLOWING MYOPIA PROGRESSION IN CHILDREN: EXPLORING INTERVENTIONS AND MANAGEMENT WITH MISIGHT CONTACT LENSES
Due to the rise in myopia prevalence over the past few decades and the sight-threatening conditions linked to severe myopia, including cataracts, glaucoma, and particularly myopic maculopathy, myopia has become a significant global public health concern. The evidence currently available for contact lenses (CLs) intended to treat myopia and halt its progression is reviewed narratively in this article. In order to put the subject in context, we go over the various labels and classifications that have been applied to myopia, the burden that comes with being myopic today, and the available treatments to stop and slow the condition's progression. There is evidence that exposure to sunlight lowers the risk of developing myopia. The best way to control the progression of myopia is through pharmacological treatment with atropine, which is followed by optical interventions like CL fitting (orthokeratology or CLs specific for myopia control) that aim to lessen retinal peripheral hyperopic defocus. We shall pay particular attention to MISight CLs. The US Food and Drug Administration (FDA) has approved MiSight, a daily replacement soft contact lens, based on clinical evidence to slow down the advancement of myopia in children. In order to address this escalating public health concern, health care providers need to stay up to date on developing trends and actively engage in collaborative decision-making with patients and their families.
MiSight contact lens; Myopia control; Soft contact lens for myopia control, Ortho-K lens, Atropine
HEMODYNAMIC CHANGES AFTER LARYNGOSCOPY IN PATIENTS UNDERGOING ELECTIVE SURGERY UNDER GENERAL ANESTHESIA AT DHQ HOSPITAL KURRAM; PROSPECTIVE DESCRIPTIVE OBSERVATIONAL STUDY
Background: Endotracheal intubation and laryngoscopy during general anesthesia cause significant hemodynamic changes due to sympathetic stimulation. Mechanical airway stimulation triggers catecholamine release, resulting in increased blood pressure and heart rate, which are usually transient but clinically important. This study evaluates these changes in elective surgical patients at district-level hospitals to improve perioperative safety. Objectives: To assess changes in HR, SBP, DBP, and MAP following laryngoscopy in patients undergoing elective surgery under General Anesthesia. To determine the duration of hemodynamic changes at baseline, immediately after laryngoscopy, and at 1, 3, 5 and 10 minutes after endotracheal intubation. Methodology: Data were collected in a prospective descriptive observational study at DHQ Hospital, District Kurram (Parachinar) over 4–5 months, including elective surgical patients using a predesigned proforma. Demographic variables (age, gender, ASA status, type of surgery, weight) and hemodynamic parameters (HR, SBP, DBP, SpO₂, MAP) were recorded at baseline and at 1, 3, 5, and 10 minutes post-intubation. Additional data laryngoscope type, intubation attempts, and anesthetic agents were recorded and analyzed using SPSS version 22. Results: A total of 70 patients were enrolled, with a mean age of 32.6 ± 9.9 years; most were male (61.4%) and ASA I (77%). All patients were successfully intubated, 95.7% on the first attempt, with no cardiac disease; mean laryngoscopy duration was 22.6 ± 3.7 seconds. After induction, heart rate decreased from 85.7 ± 13.7 bpm to 74.2 ± 10.9 bpm, and systolic BP from 125.0 ± 8.4 mmHg to 114.6 ± 10.2 mmHg. At 1 mint post-intubation, significant increases were observed: HR 95.5 ± 10.2 bpm, SBP 139.3 ± 12.2 mmHg, DBP 89.4 ± 10.1 mmHg, MAP 105.6 ± 11.3 mmHg. By 3 minutes parameters declined, and by 5–10 minutes approached baseline (HR 81.9 ± 9.5 bpm, SBP 125.6 ± 8.8 mmHg, DBP 79.8 ± 7.0 mmHg, MAP 94.4 ± 7.8 mmHg).Repeated measures ANOVA showed highly significant changes (p < 0.001), with maintained oxygenation and no clinically significant desaturation. Conclusion: Laryngoscopy and endotracheal intubation in ASA I–II patients cause significant but transient hemodynamic responses, peaking at 1 minute and returning to baseline within 5–10 minutes. These changes are usually well tolerated in healthy individuals but require vigilant peri-intubation monitoring. Findings from this district-level study provide baseline data and emphasize careful airway management, especially in patients with cardiovascular risk.
• Hemodynamic Changes, Laryngoscopy, Endotracheal Intubation, Airway Management, Sympathetic Response, Pressor Response, General Anesthesia
KNOWLEDGE, AWARENESS AND ATTITUDES TOWARD POLYCYSTIC OVARY SYNDROME (PCOS) AMONG ALLIED HEALTH SCIENCE STUDENTS
Background: The most common endocrine disorders that affect women with reproductive capacity include polycystic ovarian syndrome (PCOS). Symptoms of the disease include irregular periods, obesity, acne, and insulin resistance. Clinical symptoms include problems with ovulation, hyperandrogenism and ovarian cysts despite miscarriages. PCOS also creates psychological problems such as anxiety, depression, lack of confidence due to body concerns due to increased levels of androgens. Objective: To assess knowledge and attitude gaps that are required for educational interventions for Allied Health Science students. Methodology: A cross-sectional questionnaire-based study carried out among 89 Allied Health Science Students. Data analysis was done using SPSS software and was presented in graphs and tables. This is done to create more awareness and knowledge about the early symptoms and treatment and investigations of the disease. Questions included (Yes / No) multiple choices. Results: Out of the total 89 respondents, 65.2% were females. In terms of their awareness, 89.9% had some information about PCOS, 85.4% were familiar with obesity as one of the factors associated with PCOS, 71.6% were informed about its relation with insulin resistance, and 81.8% knew that it could make the women infertile. There was also a favorable attitude towards PCOS with 89.9% of the respondents agreeing on the importance of early diagnosis in order to have better treatment outcomes, 84.1% believing that lifestyle modifications were an effective approach in managing PCOS, and 89.5% emphasizing on the importance of increasing awareness about PCOS. Conclusion: The study finds that Allied Health Sciences students showed satisfactory knowledge and a positive attitude toward Polycystic Ovary Syndrome (PCOS). Most participants were aware of its risk factors, complications, diagnosis, and lifestyle management. However, there were low understanding of its genetic basis, hormonal mechanisms, pharmacological treatment, and diagnostic imaging. These findings emphasize the need for focused educational efforts and improvements in the curriculum to help students better understand PCOS and support early detection and effective management in their future clinical practice.
PCOS, Obesity, Type 2 Diabetes, Infertility, Irregular periods, Acne
FREQUENCY OF COLOR VISION DEFICIENCY AND IT’S TYPES IN STUDENTS OF REHMAN COLLEGE OF ALLIED HEALTH SCIENCES, RMI, PESHAWAR
Background: (Color vision deficiency, CVD), where the person has difficulty in distinguishing certain colors from one another. Aim of the Study: To identify the prevalence among students of Rehman College of Allied Health Sciences as color discrimination is essential for most clinical and laboratory settings and to provide them of information related to their career. Methods: A Cross-sectional study was conducted anonymously on 85 students of Rehman College of Allied Health Sciences. A structured close-ended questionnaire was distributed for data collection and checking awareness concerning Color vision deficiencies amongst all.
ASSESSMENT OF BICAUDATE INDEX VALUES IN SIALKOT, PAKISTAN ADULT POPULATION USING COMPUTED TOMOGRAPHY: A PROSPECTIVE CROSS-SECTIONAL STUDY
Background: The bicaudate index (BCI) is a dimensionless ratio derived from CT that is a linear radiological measurement calculated by dividing the minimum distance between the heads of the caudate nuclei by the maximum internal skull diameter at the same level. The BCI accounts for the variability in skull size between individuals; normalizing for head size, the BCI gives a reproducible and directly comparable measure of central ventricular expansion and caudate atrophy. It is important for diagnosis in a range of diseases such as cerebral atrophy, hydrocephalus, Huntington's disease, multiple sclerosis, cognitive decline, and is found to be increasing with age and disease load. Although clinically useful, age and sex-stratified normative CT reference values for BCI are not yet available for the adult population of Pakistan. Objective: To derive reference values of CT bicaudate index in normal adult population of Pakistan across different age and sex basis and to find out the effect of age and sex on BCI. Methods:
EXPLORING AWARENESS OF ANTIBIOTIC STEWARDSHIP AMONG UNDERGRADUATE NURSING STUDENTS
Background: Antibiotic resistance is a growing global health threat, and nursing students, as future healthcare providers, play a pivotal role in antibiotic stewardship. Antibiotic stewardship was first introduced in the 1990s in response to the growing challenge of antimicrobial resistance (AMR). Initially hospital-focused, stewardship practices have since expanded into outpatient care, veterinary medicine, and agriculture under the broader One Health approach. Nurses play a vital role by administering antibiotics, monitoring patient responses, educating patients, and collaborating with healthcare teams to prevent unnecessary prescribing. The World Health Organization (WHO) has emphasized the importance of undergraduate training programs in promoting responsible antibiotic use. Despite these initiatives, AMR continues to rise, particularly in low-resource countries such as Pakistan, which is among the world’s highest antibiotic consumers. Globally, AMR accounted for 1.27 million deaths in 2019 and is projected to cause 10 million deaths annually by 2050, underscoring the urgent need for improved stewardship through education. Objective: To assess the general and specific knowledge, awareness, and perceptions regarding antibiotic use, resistance, and stewardship among undergraduate nursing students in larkana. Methods: A descriptive cross-sectional study was conducted among 136 nursing students from all four academic years at affiliated colleges of SMBB Medical University Larkana. Data were collected using a structured questionnaire covering demographics, knowledge, awareness, and perceptions of education. Analysis was descriptive, expressed as frequencies, percentages, and overall knowledge scores (OKS). Results: Most participants (88.2%) were aged 21–25 years, and 59.6% were female. General knowledge was moderate; 76.1% correctly identified amoxicillin as an antibiotic, while 41.5% misclassified aspirin. Misconceptions included use for viral infections (26.2%) and pain or inflammation (40.3%). Awareness of adverse effects was moderate (57.9% secondary infections; 58.6% allergic reactions), while only 41.0% understood adherence principles. The overall knowledge score (OKS) had a mean of 15.5 (SD ±5.9; range 0–28), reflecting wide variability among students. Perceptions of education revealed gaps, with only 26.5% feeling adequately trained to select antibiotics, though 40.4% strongly supported further training in stewardship. Conclusion: Nursing students demonstrated moderate knowledge but substantial misconceptions and gaps in practical application. Strengthening curriculum-integrated training on antibiotics, resistance, and stewardship is essential to better prepare future nurses in combating AMR.
Antibiotics, Antimicrobial Resistance, Nursing Students, Stewardship, Awareness
EVIDENCE-BASED FUNCTIONAL NUTRITION STRATEGIES FOR IMPROVING DIET QUALITY, GUT HEALTH, NUTRIENT ADEQUACY, AND BODY COMPOSITION IN ADULTS THROUGH INTEGRATED CLINICAL DIETARY INTERVENTION
Background: Functional nutrition interventions targeting multiple health domains simultaneously represent a promising approach to addressing the global burden of chronic disease. However, comprehensive evidence synthesis examining integrated effects on diet quality, gut health, nutrient adequacy, and body composition remains limited. Objective: This systematic review synthesizes evidence from randomized controlled trials and intervention studies examining functional nutrition strategies that simultaneously improve multiple health outcomes in adult populations. We analyzed 30 high-quality studies (n=399 to 1,260 participants per study) published between 2016-2026, including randomized controlled trials, parallel-group designs, and crossover studies. Studies evaluated dietary interventions ranging from 4 weeks to 24 months, focusing on Mediterranean diet patterns, high-fiber plant-based approaches, macronutrient modulation, probiotic supplementation, and multi-domain lifestyle interventions. Primary outcomes included gut microbiome composition (16S rRNA sequencing, alpha/beta diversity), body composition (DXA, bioimpedance), nutrient adequacy assessments, and validated diet quality indices. High-fiber plant-based interventions (30+ diverse ingredients) significantly improved gut microbiome diversity (weighted UniFrac, p<0.05), reduced gastrointestinal symptoms (indigestion, constipation, flatulence), and enhanced subjective energy levels in healthy adults over 6 weeks. Mediterranean diet interventions with energy restriction increased gut microbial species richness and diversity while promoting significant weight loss (-5.2 kg, p<0.001) and improvements in body composition over 8 months in obese older adults. Macronutrient modulation targeting tissue-specific insulin resistance improved cardiometabolic biomarkers and altered gut microbiota composition. Probiotic supplementation (Bifidobacterium bifidum, Lactobacillus species) reduced circulating zonulin, TNF-α, and insulin levels while modulating gut permeability markers. Multi-domain interventions combining dietary modification with exercise demonstrated synergistic effects on metabolic health, fitness, quality of life, and modest gut microbiota shifts. Nutrient adequacy improved significantly with structured dietary counseling, particularly for protein, fiber, and micronutrient intake in older adults and clinical populations. Integrated functional nutrition strategies effectively improve multiple health domains simultaneously, with strongest evidence supporting high-fiber plant-based diets, Mediterranean dietary patterns, and personalized macronutrient modulation. Gut microbiome modulation appears to mediate many metabolic and body composition benefits. Future research should focus on precision nutrition approaches, longer intervention durations, and mechanistic pathways linking dietary components to multi-system health outcomes.
functional nutrition, gut microbiome, body composition, nutrient adequacy, dietary intervention, Mediterranean diet, plant-based diet, probiotics, insulin resistance, randomized controlled trial
THE RELATIONSHIP B/W PSYCHOLOGICAL STRESS, SELF-ESTEEM AND SUICIDAL IDEATION AMONG MEDICAL STUDENTS.
Medical students globally face a disproportionately high burden of psychological distress, with established links between academic stress and severe mental health outcomes. This study investigated the interrelationships between psychological stress, self-esteem, and suicidal ideation among 150 medical students, aged 18-25, selected via purposive sampling. Utilizing a cross-sectional design, participants completed standardized measures: the Student Stress Inventory (SSI), Rosenberg Self-Esteem Scale (RSES), and Beck Scale for Suicidal Ideation (BSSI). Data analysis employed Pearson correlations, linear regression, and independent samples t-tests. The results revealed a significant positive correlation between psychological stress and suicidal ideation (r = .341, p < .01), and subsequent regression analysis confirmed stress as a significant predictor, accounting for 11% of the variance in suicidal thoughts (R² = .11, p < .001). Contrary to theoretical expectations, no significant correlations were found between self-esteem and suicidal ideation (r = .005, p > .05) or between self-esteem and psychological stress (r = .114, p > .05). Further regression analyses confirmed that neither stress nor suicidal ideation was a significant predictor of self-esteem within this sample. Regarding demographic differences, female students reported statistically significant higher levels of psychological stress than their male counterparts (t(148) = -2.92, p = .004); however, no significant gender differences were observed for levels of self-esteem (p = .803) or suicidal ideation (p = .270). The findings underscore that psychological stress operates as a direct and significant contributor to suicidal ideation in this population, while the role of self-esteem appears less central than previously theorized. This highlights the critical imperative for medical institutions to prioritize robust, accessible stress-reduction interventions and mental health support systems, rather than focusing primarily on self-esteem building, to effectively mitigate the risk of severe psychological outcomes in future medical professionals
Psychological Stress, self-Esteem, suicidal ideation, medical students, mental health.
POST OPERATIVE INFECTIVE COMPLICATIONS OF PCNL
Background: Large and difficult kidney stones are best treated with percutaneous nephrolithotomy (PCNL). Postoperative infectious complications, including fever, urinary tract infection (UTI), pyelonephritis, systemic inflammatory response syndrome (SIRS), and sepsis, remain to be major causes of morbidity with its high stone clearance rate. Early identification of patients at risk will improve surgical results. Readmission was evaluated for the postoperative infective complication of PCNL. Objective: To evaluate the postoperative infective complication of PCNL. Methodology: This was an observational cross sectional study conducted over a period of four months in the Mayo Hospital in Lahore. The adult PCNL patients included were sampled using purposive sampling to achieve a sample size of 78. Those with a positive urine culture and/or fever prior to surgery were not included. A systematic questionnaire was used to gather the data, and SPSS version 26 was used for analysis. The relationship between postoperative fever and risk factors was determined using Chi square and Fisher's exact tests, and descriptive statistics were used to describe the patients' characteristics. Those with a p-value < 0.05 were considered to be statistically significant. Results.: The average age of the 78 patients in this study was 48 years. Men made up the majority (77%), and procedures on the right side were somewhat more common (56%). The most common complaint, occurring in almost 95% of cases, was flank pain. Staghorn stones were present in about one-third of the patients, and multiple calculi were discovered in 28%. Sixty percent of the individuals had hydronephrosis. Tractsizesweresplitequallybetweenthoseunderandover22Fr, and the majority (86%) only had one puncture. In 42% of cases, operations took more than 90 minutes, and 13% of patients had residual stones. Fever was the most common complication, impacting 36% of patients. More serious conditions like pyelonephritis and sepsis were much less common, occurring in only 6% and 5% of cases, respectively, while UTIs came in at 22%. When we looked at what caused these complications, we discovered that the likelihood of getting a fever was greatly increased by surgeries that lasted longer than 90 minutes, leftover stone fragments, a history of previous UTIs, previous episodes of urosepsis, and prior surgical interventions. In a similar manner, patients with a history of urosepsis, prolonged operations, or residual stones were more likely to experience UTIs. Pyelonephritis was closely associated with the presence of staghorn stones, a history of urosepsis, and a previous UTI. A history of urosepsis or UTI was most strongly linked to sepsis, despite its rarity. Gender, surgical side, diabetes, hypertension, stone location, hydronephrosis, and the use of stents or nephrostomy tubes were among the other factors we looked at, but they had no discernible effect on these results. Conclusion: Fever is the most common intra-post-operative complication after PCNL. Long operating time, diabetes mellitus, positive preoperative urine, staghorn calculi and multiple kidney stones are associated with a high risk of postoperative infection. A careful preoperative evaluation, a condition management, adequate antibiotic prophylaxis and surgical precision may help to minimize infectious complications and optimize patient outcomes
COMPARATIVE STUDY BETWEEN SKIN SUTURE VERSUS SKIN STAPLER IN ABDOMINAL SURGERY
Background: An important part of the abdominal operation is closure of the wound. Whether to use skin sutures or skin staplers is still a matter of controversy. In this study, we reviewed the basic data performed at M H Lahore to evaluate these procedures. Objectives: To compare the operative time, wound infection rate (SSI), cosmetic result (SBSE score), pain on removal, and cost between conventional sutures and skin staplers. Methodology: A prospective observational study was conducted on 84 patients undergoing abdominal surgery at Lahore General Hospital. Patients were allocated to the Suture group (n=42) or Stapler group (n=42). Data were analyzed using SPSS, with chi-square and t-tests (p < 0.05 considered significant). Results: The Stapler group had significantly faster skin closure times (p < 0.001). Cosmetic outcomes were markedly superior in the Stapler group, with 78.6% achieving a good SBSE score compared to only 45.2% in the Suture group (p = 0.003). Patients in the Suture group also reported significantly less pain during removal (73.8% had low pain scores) compared to the Stapler group (42.9%; p = 0.008). Surgical site infection rates were high in both groups, with no significant difference (p > 0.05). Conclusions: Skin staplers significantly reduce operative time and provide vastly superior cosmetic results. However, contrary to some literature, this study found that suture removal is significantly less painful than staple removal. Surgeons should weigh these trade-offs — prioritizing staplers for cosmesis and time, and sutures for patient comfort during removal.
Abdominal surgery, Skin stapler, Suturing, Wound closure, Surgical site infection, Cosmesis
COMPARATIVE EFFECTS OF KNEE BRACE VERSUS LATERAL WEDGE FOR PATIENT WITH MEDIAL COMPARTMENT KNEE OSTEOARTHRITIS
Aim: To compare the effect lateral knee wedge verses knee braces in medial compartment knee osteoarthritis Methods:an experimental study were conducted in isra university hydrabad. In this study 30 patient were included in which lateral wedge is applied to 15 patients and knee braces is applied to 15 patients. Purposive sampling technique were use in this study.NPRS and KOOS quiestionare is used in this study for pre and post assessment. Results: there are 30 pateint included in this study in which 12 are male which is estimated as 44.6% and 18 were female which is estimated as 55.4.mean pre value of koos score in lateral wedge is 45.75 and post is 78.08. mean pre value of NPRS in lateral wedge is 7.6 and post value is 4.8. in knee braces pre value is 4.9 and post value is 3.2. Conclusion:lateral wedge is more effective in medial compartment of knee osteoarthritis when comparing with knee braces.
COMPARATIVE EFFECTS OF KNEE BRACE VERSUS LATERAL WEDGE
MENTORSHIP SATISFACTION AMONG NURSING INTERNS: A CROSS-SECTIONAL STUDY AT A PUBLIC SECTOR TERTIARY CARE HOSPITAL IN PESHAWAR, KHYBER PAKHTUNKHWA, PAKISTAN
Background: Mentorship is a fundamental component of nursing education that facilitates the transition of nursing students into competent healthcare professionals. Effective mentorship enhances clinical competence, professional confidence, and job satisfaction; however, evidence regarding mentorship satisfaction among nursing interns in public sector hospitals of Pakistan remains limited. Aim: To assess the level of mentorship satisfaction among nursing interns at a public sector tertiary care hospital in Peshawar, Khyber Pakhtunkhwa, Pakistan. Methodology: A quantitative, descriptive cross-sectional study was conducted among 120 nursing interns selected through simple random sampling. Data were collected using a structured, validated questionnaire with a Content Validity Index (CVI) >0.80 and acceptable internal consistency. Statistical analysis was performed using SPSS version 26. Descriptive statistics summarized participant characteristics and mentorship satisfaction, while inferential statistics were used to examine associations between study variables. A p-value of <0.05 was considered statistically significant. Results: Overall, nursing interns reported a high level of satisfaction with mentorship. Most participants agreed that mentors were approachable (85.9%), treated them with respect and professionalism (86.7%), enhanced their clinical knowledge and practical skills (76.7%), and encouraged ethical, patient-centered nursing practice (85.0%). Furthermore, 81.7% believed that mentorship positively contributed to their professional development, and 75.8% indicated they would recommend the mentorship program to future nursing interns. However, emotional support during challenging clinical situations received comparatively lower satisfaction ratings. Conclusion: Nursing interns demonstrated an overall positive perception of the mentorship program, highlighting its significant role in enhancing clinical learning, professional development, communication, and confidence. Strengthening mentors' capacity to provide emotional support may further improve mentorship quality and facilitate a smoother transition of nursing interns into professional practice.
Mentorship Satisfaction; Nursing Interns; Clinical Mentorship; Clinical Learning Environment; Nursing Education; Tertiary Care Hospital.
PREVALENCE OF ANXIETY AND DEPRESSION IN MALE AND FEMALE CANCER (LYMPHOMA) PATIENTS AND ITS ASSOCIATION WITH SELFESTEEM
Lymphoma is a life-threatening disease that not only affects physical health but also has a profound psychological impact on patients. Anxiety and depression are among the most common psychological problems experienced by cancer patients and may negatively influence self-esteem and quality of life. Gender differences in psychological distress among lymphoma patients remain underexplored. The aim of this study was to determine the prevalence of anxiety and depression among male and female lymphoma patients and to determine the association between anxiety, depression, and self-esteem. A cross-sectional observational study was conducted on 150 male and female lymphoma patients aged 18–60 years receiving active cancer treatment. Participants were selected using a non-probability convenience sampling technique from oncology settings. Anxiety and depression were assessed using the Depression Anxiety Stress Scale (DASS-21), while self-esteem was evaluated through the State Self-Esteem Scale (SSES). Data were analyzed using SPSS version 27. Descriptive statistics and chi-square tests were applied, with p ≤ 0.05 considered statistically significant. The findings revealed that moderate anxiety (26.7%) and moderate depression (28.0%) were highly prevalent among lymphoma patients. Low self-esteem was observed in 43.3% of participants. The chi-square analysis demonstrated a significant association between anxiety and self-esteem (p = 0.001), as well as between depression and self-esteem (p = 0.001). Higher levels of anxiety and depression were associated with lower self-esteem scores. Both anxiety and depression showed statistically significant associations with self-esteem (p=0.001). Anxiety and depression significantly reduce self-esteem among lymphoma patients. The study highlights the importance of psychosocial interventions in oncology care to improve mental well-being in cancer patients.
depression, anxiety, self-esteem, lymphoma, male and female
AI-DRIVEN MICROBIOME-BASED BIOMARKERS FOR EARLY DIAGNOSIS OF CANCER AND AUTOIMMUNE DISEASES: CURRENT ADVANCES AND FUTURE PERSPECTIVES
The human microbiome encompassing the gut, oral, and mucosal microbial communities has emerged as a rich, minimally invasive source of biomarkers for diseases that remain difficult to diagnose at an early, treatable stage, including gastrointestinal and non-gastrointestinal cancers and a broad spectrum of autoimmune conditions. Advances in high-throughput sequencing (16S rRNA amplicon and shotgun metagenomics) have generated large, high-dimensional, compositional datasets that exceed the analytic capacity of conventional statistics. Artificial intelligence (AI) and machine learning (ML) spanning random forests, gradient boosting, support vector machines, deep neural networks, graph neural networks, and, most recently, transformer-based genomic foundation models have become central to extracting reproducible diagnostic signals from this complexity. This review synthesizes recent (2021–2026) evidence on AI-driven microbiome biomarker discovery across colorectal, gastric, pancreatic, hepatocellular, oral/head-and-neck, and breast cancers, and across autoimmune diseases including systemic lupus erythematosus, rheumatoid and juvenile idiopathic arthritis, inflammatory bowel disease, multiple sclerosis, and myasthenia gravis. We summarize commonly used algorithms and representative diagnostic performance, describe the growing role of explainable AI and multi-omics integration in improving biological interpretability, and critically appraise persistent barriers to clinical translation including batch effects, cohort heterogeneity, low-biomass contamination, data leakage, limited external validation, and regulatory uncertainty. We conclude by outlining future directions, including federated learning, foundation models for metagenomics, and prospective multicentre validation, that are needed to move AI-microbiome diagnostics from research cohorts into routine clinical screening.
Artificial Intelligence, Machine Learning, Gut Microbiome, Biomarkers, Cancer Diagnosis, Autoimmune Disease, Metagenomics, Explainable AI, Precision Medicine
PARANORMAL BELIEFS, PERSONALITY TRAITS, AND CAREGIVER STRESS IN CAREGIVERS OF PATIENTS DIAGNOSED WITH CONVERSION DISORDER: A THEMATIC ANALYSIS
Belief system that we adopt from our ancestors and personality traits that are innate and are also shaped by one's environment play a significant role in determining how someone encounters stress and manages it. The qualitative study using reflexive thematic analysis was conducted to capture caregivers’ subjective experiences and generate practice-relevant insights. The sample consisted of twelve (12) adult caregivers of individuals diagnosed with conversion disorder who were purposively sampled to ensure variation in caregiver relationship (e.g., parent, spouse, and sibling), caregiving duration, and care settings. A semi-structured interview was designed and conducted in a private setting, lasting approximately 90 minutes, covering the illness onset and appraisal; caregiving tasks and impacts; interactions with healthcare providers; coping and support; stigma and community responses, perceived needs, associated paranormal beliefs, and personality traits. Interviews were observed with consent and transcribed verbatim. Brief field notes captured contextual observations and reflexive memos. The findings highlight the need for support that addresses both the practical and emotional needs of caregivers, while also recognizing the role of spiritual beliefs in coping.
Paranormal Beliefs, Personality Traits, Caregiver Stress, Conversion Disorder.
“PREVALENCE OF ILIOTIBIAL BAND TIGHTNESS AMONG INCLINE TREADMILL MACHINE USERS AND ELLIPTICAL MACHINE USERS IN GYM POPULATION”
Background: Iliotibial band syndrome (ITBS) has been one of the most commonly observed overuse injuries in Physically active individuals such as gym-goers and runners. Walking/running on incline treadmill was hypothesized to impose higher stress on the lower extremity and iliotibial band. Ellyptical machine trainer was thought to be the low-impact alternate exercise method; however, the ITBS difference between the two types of training has been less studied. Aims & objectives: The purpose of the study was to evaluate and compare the prevalence of ITBS in incline treadmill users with in elliptical trainer users at gymnasium settings. Methodology: A comparative cross sectional study design was implemented using 137 physically active gym-goers, who were regular exercisers using treadmill or elliptical trainer was taken. A convenience sampling was done for the selection of subjects from different gymnasiums of Faisalabad. Data was collected through a well structured questionnaire including demographical information, exercise type and frequency, history of pain, and clinical assessment for ITBS (Noble Compression Test and Ober’s Test). Prevalence was assessed in both groups and compared. Results: The incidence of ITBS was found to be higher in incline treadmill users compared with elliptical trainer users. Conclusion: The outcome of this study may help physiotherapists and fitness trainers understand risk of ITBS with different cardio machines and for safer exercise recommendations for gym members
Iliotibial Band Syndrome, Incline Treadmill, Elliptical Trainer, Gym Users, Overuse Injury, Prevalence
CLINICAL CHARACTERISTICS AND COMPLICATIONS OF HOSPITALIZED PATIENTS WITH HYPOTHYROIDISM AT KHOST PROVINCIAL SPECIALIZED HOSPITAL, AFGHANISTAN: A HOSPITAL-BASED DESCRIPTIVE STUDY
Introduction: Hypothyroidism is one of the most common endocrine disorders caused by insufficient production of thyroid hormones. It affects approximately 1% of the general population, with the prevalence increasing to nearly 5% among individuals older than 60 years. Women account for approximately 85% of affected patients. This study aimed to evaluate the frequency, demographic characteristics, clinical manifestations, complications, management, and outcomes of hypothyroidism among hospitalized patients admitted to the Department of Internal Medicine at Khost Provincial Specialized Hospital, Afghanistan. Materials and Methods: This hospital-based descriptive case series was conducted at the Department of Internal Medicine, Khost Provincial Specialized Hospital, between June and December 2025. All patients diagnosed with hypothyroidism based on clinical presentation and laboratory findings during the study period were included. Data were collected from hospital medical records using a standardized data collection form. Demographic characteristics, clinical manifestations, physical examination findings, complications, treatment, and patient outcomes were recorded and analyzed using Microsoft Excel and SPSS version 26. Results: During the study period, a total of 2,116 patients were admitted to the Department of Internal Medicine, of whom 38 patients (1.79%) were diagnosed with hypothyroidism. Among these patients, 22 (57.9%) were female and 16 (42.1%) were male. Most patients (55.3%) were between 46 and 60 years of age. The most common presenting symptoms were generalized body pain, loss of appetite, cold intolerance, and constipation. The most frequent clinical signs included skin changes, weight gain, and hypertension. Dyslipidemia (76%) and hypertension (55%) were the most common complications observed. Conclusion: Hypothyroidism is a significant endocrine disorder among hospitalized patients in Khost Province, predominantly affecting middle-aged women. Early diagnosis through thyroid function testing and timely initiation of levothyroxine therapy are essential to prevent complications and improve patient outcomes. Strengthening laboratory capacity, increasing public awareness, and implementing routine screening programs for high-risk populations may improve the early detection and management of hypothyroidism in Afghanistan.
Hypothyroidism, Thyroid gland, Levothyroxine, Dyslipidemia, Clinical manifestations, Khost, Afghanistan