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"
ASSESSING OUTCOMES OF CENTRAL VENOUS CATHETER INSERTION WITH AND WITHOUT ULTRASOUND GUIDANCE, FOLLOWED BY A QUALITY IMPROVEMENT INITIATIVE INTRODUCING MANDATORY ULTRASOUND USE IN A TERTIARY CARE HOSPITAL IN PAKISTAN
Background Central venous catheter (CVC) insertion is a commonly performed and high-risk procedure in acute medical practice, particularly in patients requiring urgent hemodialysis. Although ultrasound guidance is recommended internationally to improve safety and procedural success, its routine use remains limited in many resource-constrained settings. At Ayub Teaching Hospital, Abbottabad, CVCs were traditionally inserted using landmark techniques due to lack of bedside ultrasound availability in the medical wards, leading to potentially avoidable complications. Objective To assess baseline outcomes of CVC insertion performed with and without ultrasound guidance and to evaluate the impact of a quality improvement initiative introducing mandatory ultrasound guidance in the general medicine ward. Methods A clinical audit followed by a quality improvement intervention was conducted in the general medicine ward of Ayub Teaching Hospital. Baseline data were collected from 10 April to 10 July 2025, including 96 CVC insertions. The intervention consisted of ensuring bedside ultrasound availability, staff training, and implementation of a mandatory ultrasound policy. Post-intervention data were collected from 25 July to 25 September 2025 and included 82 CVC insertions. Process measures, procedural outcomes, and complication rates were compared between the two phases. Results Ultrasound-guided CVC insertion increased from 18.7% (18/96) at baseline to 92.7% (76/82) post-intervention. First-attempt success rates improved from 40.6% (39/96) to 72.0% (59/82). The overall complication rate decreased significantly from 19.8% (19/96) during the baseline period to 6.1% (5/82) following the intervention. Reductions were observed in arterial puncture, hematoma formation, and multiple needle attempts. The need for senior clinician assistance also declined post-intervention, indicating improved procedural confidence among trainees. Sustained improvement in complication rates was observed over time. Conclusion Implementation of mandatory ultrasound guidance for CVC insertion resulted in significant and sustained improvements in procedural safety and success in a high-volume tertiary care medical ward. This quality improvement initiative demonstrates that evidence-based procedural practices can be successfully adopted in resource-limited settings through structured system-level interventions, leading to meaningful improvements in patient care.
ANALYSIS OF PERIOPERATIVE MEDICATION ERRORS AND THE ROLE OF HEALTH INFORMATION SYSTEMS IN ENHANCING ANESTHESIA SAFETY AND QUALITY CARE
Background: Perioperative medication errors are a major concern in anesthesia practice due to the use of high-risk medications, time-critical decision making, and the complex working environment of operating rooms. Errors during prescribing, preparation, labeling, documentation, or administration can lead to serious patient harm, including hemodynamic instability, prolonged recovery, and increased morbidity and mortality. Health Information Systems (HIS) have been introduced to enhance medication safety and improve quality of care; however, evidence regarding their effectiveness in perioperative and anesthesia settings remains limited at the local level. Objective: This study aimed to analyze the frequency, types, and contributing factors of perioperative medication errors and to evaluate the role of Health Information Systems in enhancing anesthesia safety and quality of care at Mayo Hospital, Lahore. Methodology: A descriptive cross-sectional study design was used. Data were collected from 100 healthcare professionals working in anesthesia and perioperative departments, including anesthesiologists, nurse anesthetists, operating room nurses, and anesthesia technicians. A structured questionnaire was employed to gather information regarding experiences of medication errors, contributing human and system factors, utilization of Health Information Systems, and perceptions about their effectiveness in improving medication safety. Results: The findings showed that perioperative medication errors were common, with wrong dose and wrong drug errors being the most frequently reported. Heavy workload, time pressure, and communication gaps were identified as major contributing factors. Participants who used Health Information Systems reported fewer medication errors compared to those who relied on manual systems. HIS improved medication accuracy, documentation quality, communication, and traceability, and supported safer clinical decision-making through standardized digital processes. Conclusion: The study concludes that Health Information Systems play a significant role in reducing perioperative medication errors and improving anesthesia safety and quality of care. Effective implementation of HIS, combined with continuous staff training, standardized medication protocols, and a strong patient safety culture, can substantially minimize preventable medication-related harm.
ASSESSMENT OF NURSES’ COMPETENCE IN PROVIDING SPIRITUAL CARE IN A TERTIARY HEALTHCARE SETTING IN DISTRICT MARDAN: A CROSS-SECTIONAL STUDY
Background: In holistic nursing practice, spiritual care is a crucial component, especially when it comes to acute, chronic, and end-of-life care. Nurses worldwide report differing degrees of proficiency in delivering spiritual care, despite its acknowledged significance. Objective: To assess the level of nurses’ competence in providing spiritual care in a tertiary healthcare setting in District Mardan. Methods: A descriptive cross-sectional study was conducted among 175 registered nurses working in medical, surgical, critical care, and emergency units. Data were collected using a socio-demographic questionnaire and the 27-item Spiritual Care Competence Scale (SCCS). Data were analyzed using descriptive statistics and Chi-square test. Result: A moderate to high level of competence was indicated by the total mean spiritual care competence score of 3.89 ± 0.547. Excellent internal consistency was shown by the SCCS (Cronbach's alpha = 0.920). Spiritual care competency was significantly correlated with age (p = 0.018), professional experience (p = 0.029), and prior spiritual care training (p = 0.042), but not with gender, religion, educational level, or unit/ward (p > 0.05). The majority of participants were Muslim (98.9%), female (64.0%), between the ages of 20 and 25 (33.7%), and had a BSN or Post-RN BSN (92.6%). 79.4% of nurses reported having previously received spiritual care training. Conclusion: Nurses demonstrated a satisfactory level of spiritual care competence, which was significantly influenced by age, clinical experience, and prior training. These findings highlight the importance of experiential learning and structured spiritual care education to strengthen holistic, patient-centered nursing practice.
Spiritual care, nursing competence, holistic care, SCCS, tertiary hospital, Pakistan
ASSOCIATION OF MATERNAL AND NEONATAL RISK FACTORS WITH EARLY ONSET NEONATAL SEPSIS
BACKGROUND Early-onset neonatal sepsis (EONS) remains a significant cause of neonatal morbidity and mortality, particularly in low- and middle-income countries. It is primarily acquired through vertical transmission and is influenced by a combination of maternal, intrapartum, and neonatal factors. Identifying locally relevant risk factors is essential for improving early recognition, guiding preventive strategies, and optimizing neonatal care. OBJECTIVE To determine the association between selected maternal and neonatal risk factors and the occurrence of early-onset neonatal sepsis among neonates admitted to the neonatal unit of Combined Military Hospital (CMH) Abbottabad. METHODS A hospital-based unmatched case–control study was conducted over five months, from 15 August 2024 to 15 January 2025, at CMH Abbottabad. Neonates aged ≤72 hours admitted to the NICU were enrolled. A total of 240 neonates were included in the final analysis after exclusions, comprising 120 cases diagnosed with EONS and 120 controls admitted for non-infectious conditions. Data on maternal, intrapartum, and neonatal variables were collected using a structured proforma. EONS was defined based on clinical features and supportive laboratory findings, with or without a positive blood culture. Statistical analysis was performed using appropriate univariate tests, followed by multivariate logistic regression to identify independent predictors of EONS. Adjusted odds ratios (AORs) with 95% confidence intervals were reported. RESULTS Among the 120 EONS cases, 38 (31.7%) were culture-positive. Maternal factors significantly associated with EONS included unbooked antenatal status (40.8% vs 20.0%, p=0.001), maternal anemia (43.3% vs 24.2%, p=0.002), urinary tract infection (32.5% vs 15.0%, p=0.002), genital tract infection (15.8% vs 6.7%, p=0.03), prolonged rupture of membranes ≥18 hours (34.2% vs 10.0%, p<0.001), intrapartum fever ≥38°C (21.7% vs 5.8%, p<0.001), and suspected chorioamnionitis (15.0% vs 3.3%, p=0.002). Neonatal factors significantly associated with EONS included preterm birth (25.8% vs 13.3%, p=0.01), low birth weight (54.2% vs 30.0%, p<0.001), Apgar score <7 at 1 minute (24.2% vs 10.8%, p=0.008), and need for resuscitation at birth (19.2% vs 7.5%, p=0.009). On multivariate analysis, independent predictors of EONS were prolonged rupture of membranes (AOR 3.82), maternal intrapartum fever (AOR 4.11), preterm birth (AOR 2.34), low birth weight (AOR 2.97), maternal urinary tract infection (AOR 1.96), and unbooked antenatal status (AOR 2.12). Group B Streptococcus (28.9%) and Escherichia coli (26.3%) were the most commonly isolated organisms. CONCLUSION Early-onset neonatal sepsis in this setting is strongly associated with preventable maternal risk factors and neonatal vulnerabilities. Prolonged rupture of membranes, maternal intrapartum fever, untreated maternal urinary tract infection, inadequate antenatal care, prematurity, and low birth weight were the most significant predictors. Strengthening antenatal screening, improving intrapartum monitoring, and ensuring early neonatal surveillance for at-risk infants may substantially reduce the burden of EONS in similar resource-limited settings.
SELECTIVE LASER TRABECULOPLASTY OUTCOMES IN A REAL-WORLD UK NATIONAL HEALTH SERVICE COHORT
Background: Selective laser trabeculoplasty (SLT) is an established intervention to reduce intraocular pressure (IOP) in ocular hypertension and open-angle glaucoma. In addition to randomized trial evidence, routine-service outcome reporting helps departments understand real-world performance and variability of response. Methods: We conducted a retrospective observational analysis of consecutive eyes undergoing SLT in a UK National Health Service (NHS) glaucoma service. Eyes were included if baseline (pre-treatment) IOP and the first available post-treatment follow-up IOP were documented. The primary outcome was change in IOP from baseline to first follow-up. Absolute IOP reduction was calculated as baseline IOP minus follow-up IOP, and percentage IOP reduction as absolute reduction divided by baseline IOP multiplied by 100. The analysis evaluated overall outcomes and was not designed for glaucoma subtype comparisons. Results: A total of 117 eyes met inclusion criteria. Mean baseline IOP was 21.0 ± 5.2 mmHg, reducing to 15.5 ± 6.4 mmHg at first follow-up. Mean absolute IOP reduction was 5.5 mmHg, corresponding to a mean percentage reduction of 24.9%. The baseline-versus-follow-up scatter plot demonstrated that most eyes lay below the line of equality, indicating IOP reduction after SLT in the majority of treated eyes. Conclusions: In a real-world NHS cohort, SLT achieved a clinically meaningful reduction in IOP at first follow-up. The magnitude of IOP lowering is consistent with published evidence, supporting SLT as an effective option within routine glaucoma care pathways.
INVESTIGATING THE IMPACT OF AGE AND PARITY ON BREAST CANCER RISK: A STUDY AT KTH PESHAWAR
Background: Breast cancer is the most prevalent cancer in women all over the world, and one of the major causes of cancer deaths. Although age and parity are the most known risk factors that have been well studied in the Western population, its use in low and middle-income countries such as Pakistan is unclear. It is worth mentioning that regional clinical observation indicates that breast cancer is very prevalent in grand multiparous women and this observation contradicts the perceived protective effect of multiparity. Purpose: The study was aimed at evaluating the parity and age relations with breast cancer risk and stage at diagnosis among women in northwestern Pakistan. Methods: The study was a prospective descriptive study that was performed in Khyber Teaching Hospital, Peshawar, on a population of 163 women with primary breast cancer. Demographic, reproductive, and tumor data determined such as age, parity, age at which a child was born, and Ki-67 proliferation index were obtained through a semi-structured proforma. Categorical variables were analyzed relating to AJCC stage descriptively and by post-stratification chi-square test with the use of significance levels of p ≤ 0.05. Findings: Mean age at diagnosis was 48.29 years (SD=10.24), with the most frequent at the end of the forties and the beginning of the fifties. The mean parity was 2.6 (SD = 1.7), the mean number of pregnancies was 3.9 (SD = 2.1), which means that reproductive exposure was more moderate than in the previous studies. The age of first birth was 18.8 years (SD = 8.63), indicating that there was a high degree of variability in age of first birth which was very early. The levels of Ki-67 indicated intermediate-to-high proliferation (mean = 37.96, SD = 22.17). The Chi-square test demonstrated that there were significant relationships among AJCC stage and both age group ( 2 = 18.456, 9 -1, p = 0.0302) and age at first birth group ( 2 = 17.717, 9 -1, p = 0.0386), but not between parity group (p = 0.1872). Conclusion: This cohort of breast cancer is more common among midlife women who are moderately parity and very young at the time of first birth (~18.8 years). Although total parity is not a significant predictor of the disease stage, older age and earlier age at first childbirth are still found to be significantly correlated with higher AJCC stages.
: Age; parity; age at 1st birth, TNM stage; ER/PR/HER2; Ki-67; prospective study, Pakistan
SMART PHONE USE BEFORE SLEEP AND INSOMNIA SYMPTOMS AMONG MEDICAL STUDENTS: A CROSS SECTIONAL STUDY AT AYUB MEDICAL COLLEGE ABBOTTABAD
Background Insomnia and poor sleep quality are increasingly reported among medical students, with growing concern regarding the impact of smartphone use before sleep. Excessive nighttime smartphone exposure may disrupt sleep through delayed sleep onset, cognitive arousal, and circadian rhythm disturbance. However, local evidence examining this association among medical students in Pakistan remains limited. Objective To assess the association between smartphone use before sleep and insomnia symptoms among undergraduate medical students at Ayub Medical College, Abbottabad. Methods A cross-sectional study was conducted among MBBS students from all academic years at Ayub Medical College. Data were collected using a structured, self-administered questionnaire that assessed patterns of smartphone use before sleep, including duration, frequency, timing, and purpose of use. Insomnia symptoms were evaluated using the validated Insomnia Severity Index (ISI). Insomnia severity was categorized as no insomnia, subthreshold, moderate, or severe. Data were analyzed using descriptive and inferential statistics, with associations examined between smartphone use variables and insomnia severity. Results A total of 265 medical students participated in the study. According to ISI scores, 31.7% of students had no insomnia, 41.9% had subthreshold insomnia, 21.1% had moderate insomnia, and 5.3% had severe insomnia. Prolonged smartphone use before sleep was significantly associated with higher insomnia severity. Moderate to severe insomnia was observed in 15.2% of students using smartphones for less than 60 minutes, 31.7% of those using smartphones for 60–90 minutes, and 34.6% of those using smartphones for more than 90 minutes before sleep. Non-academic smartphone use accounted for 61.5% of bedtime use. Students sleeping less than six hours per night had higher mean ISI scores and a greater prevalence of moderate to severe insomnia compared to those with longer sleep duration. Conclusion Insomnia symptoms were highly prevalent among medical students, with prolonged smartphone use before sleep showing a strong association with increased insomnia severity. Smartphone use before bedtime represents a modifiable risk factor for sleep disturbance. Targeted interventions promoting healthy smartphone habits and sleep hygiene may help reduce insomnia and improve well-being among medical students.
Smartphone use; Insomnia; Sleep disturbance; Medical students; Insomnia Severity Index; Sleep hygiene; Bedtime smartphone use; Cross-sectional study.
ASSOCIATION BETWEEN FEAR OF FALL AND FUNCTIONAL STATUS IN ELDERLY POPULATION
This cross-sectional study was conducted over six months in various settings across Lahore, including community centers, outpatient clinics, and residential care facilities, to assess the association between fear of falling and functional ability among older adults. A total of 117 elderly individuals aged 60 years and above were selected using non-probability convenient sampling, as determined through Cochran’s formula. Participants were eligible if they could ambulate independently or with assistive devices and reported fear of falling, measured using the Falls Efficacy Scale-International (FES-I). Individuals with severe cognitive impairment, acute medical illness, neurological or musculoskeletal disorders, psychiatric illness, or major sensory deficits were excluded. Data were analyzed using SPSS version 25. Descriptive statistics were used for demographic variables, and Chi-Square analysis was applied to assess the relationship between fear of falling and functional ability. The results showed a statistically significant relationship between FES-I and FAQ5 scores (r = –0.370, p < 0.01), indicating that as fear of falling increased, functional ability decreased. The mean FES-I score was 38.26 (SD = 9.80), reflecting moderate to high fear levels, while the mean FAQ5 score was 12.04 (SD = 3.80), indicating moderate limitations in physical function. These findings underscore the importance of addressing fall-related fears to preserve functional independence in the elderly
ANTIBIOTIC SUSCEPTIBILITY PROFILE OF KLEBSIELLA PNEUMONIAE ISOLATED FROM URINARY TRACT INFECTIONS IN LAHORE
Background: Urinary tract infections (UTIs) are prevalent bacterial infections often complicated by multidrug-resistant pathogens. Klebsiella pneumoniae, a key uropathogen, exhibits rising resistance to common antibiotics, highlighting the need for local susceptibility monitoring to guide empirical therapy and curb antimicrobial resistance. Objective: To assess the antibiotic susceptibility phenotype of K. pneumoniae isolates from UTI cases in Lahore. Methodology: 92 urine samples from suspected UTI patients were analysed. K. pneumoniae was isolated using conventional microbiological methods, with susceptibility tested via Kirby-Bauer disk diffusion per CLSI guidelines. MDR and ESBL production were evaluated, and statistical analyses examined associations with age and gender. Results: K. pneumoniae was isolated from 27 samples (29.3%), predominantly in females (66.7% vs. 33.3% males). Carbapenems (imipenem, meropenem) and amikacin were most sensitive; cephalosporins (ceftriaxone, ceftazidime) and fluoroquinolones (ciprofloxacin) were most resistant. 55.6% isolates were MDR, 44.4% ESBL-producing. ESBL production correlated with MDR (p=0.016); no significant associations with age or gender, though older groups showed slightly higher resistance to some antibiotics. Conclusion: Moderate K. pneumoniae prevalence in Lahore UTIs, with alarming MDR and ESBL rates. Carbapenems and amikacin remain effective treatments. Regular monitoring of resistance patterns is crucial for empirical therapy and antibiotic stewardship programs.
Klebsiella pneumoniae, Urinary Tract Infection, Antibiotic Susceptibility, Multidrug Resistance (MDR), Extended-Spectrum Beta-Lactamase (ESBL), Lahore
ASSESSING THE ADHERENCE TO INFECTION CONTROL PROTOCOLS IN INTENSIVE CARE UNITS AT TERTIARY HOSPITALS IN LAHORE
Background Hospital-acquired infections (HAIs) continue to be a central concern to patient care, especially in Intensive Care Unit (ICU) where patients are highly vulnerable due to poorly functioning health conditions and immunocompromised conditions. Despite the established evidence-based protocols in infection control, there is usually inconsistency in compliance of the practices by healthcare workers. In Pakistan, there is a lack of information regarding the degree of compliance with the infection control procedures in ICU facilities, particularly in the tertiary care hospitals. The objective of this study was to determine the compliance of ICU nurses working in ranked tertiary hospitals in Lahore to infection control measures. Materials and Methods The study design was a descriptive cross-sectional study. The research was done in the Intensive Care Units of Sir Ganga Ram Hospital, Jinnah Hospital and General Hospital Lahore. The selected sample consisted of 300 ICU nurses who were identified through a convenience sampling method. A standardized Standard Precaution Adherence and Practice Questionnaire was used to collect the data. The data was summarized using descriptive statistics (frequency and percentages) and chi-square tests were used to establish relationships among demographic variables, hospitals, and infection control practices. The analysis of the data was done using SPSS version 26.0. Results The results revealed that there was a relatively high rate of compliance with infection control behaviour among ICU nurses where the overall rate of compliance with the 20 items of the standard precautions was about 84%. The highest level of compliance was seen in hand hygiene practices, usage of gloves when taking blood, sharps, and dealing with blood or body fluids. Nevertheless, the compliance on wearing gloves during changing of dresses and some low-risk or routine situations were observed to be less. Chi-square showed that there is no statistically significant relationship between the practices of infection control and gender or the hospital setting (p > 0.05). Conclusion The research results in the conclusion that the compliance of the ICU nurses with the infection control measures in the tertiary hospitals of Lahore is high; nevertheless, some gaps are still observed in the particular practices like the use of gloves during the change of dressing. There was no major difference in the basis of gender or hospital. It is suggested that the identified gaps should be filled through the focused training, constant monitoring, and support by the institution to support the infection control practices in the ICUs further.
Infection Control Protocols (ICP), Intensive Care Units (ICU), Hospital-Acquired Infections (HAIs), Compliance, Hand Hygiene, Personal Protective Equipment (PPE), Standard Precautions (SP).
ASESSMENT OF THE FREQUENCY OF PITTSBURGH SLEEP QUALITY COMPONENTS AT TERTIARY CARE HOSPITAL HYDEBABD
Background: Sleep is an essential and vital component for optimum and balance the dimensions of health and quality of life and normal brain functions and also the associated body’s system, 7 to 8 hours of sleep is recommended for better condition of health and restoration of body functions. Sleep is a vital component and essential element for the mental, physical, and social dimensions of health, it depends on the amount or quantity and quality or eminence of sleep, both are essential for life. Sleep quantity and sleep quality have a significant effect on health like the cardiovascular system, mental health, cognitive function, memory, immunity, reproductive life, and hormone secretion. Most of the world's population was not getting appropriate sleep like the USA 50 to 70 million adults suffering from various kinds of sleep problems. Methodology: A Comparative Cross-Sectional study was conducted at Medical OPD Liaquat University Hospital Hyderabad/ Jamshoro from May 2024 to October. The Estimated sample size 362n was calculated with the help of Open Epi Info with margin of Error 5%, Confidence Level 95%, non-probability convenient sampling. Participants who visit the Medical OPD for follow-up medical Care with aged 18 years and older who were obese and Non- obese and Consenting Participants and willing to study participants of both genders were included. Non-consenting Participants and Any abnormal neurological condition, intellectually disabled, pregnant women, aged less than 18 years, and those patients were excluded who were not willing to participate in this study were excluded. Results: the majority of the study participants were usually gone to bed at 9:00 pm to 12:00 am 284 (79%), fall asleep every night > 60 minutes 212 (58%), gotten sleep hours per night <5 h 147 (40.6%), could not gotten sleep within 30 minutes three or more times a week 249 (69%), Waking up in the middle of the night or early morning, three or more times a week 267 (73.8%), getup for use the bathroom three or more times a week 260 (72%), Cannot breathe comfortably three or more times a week 258 (71%), Feeling too cold not during the past month 297 (82%), Feeling too hot three or more times a week 315 (87%), participants (83%) were not taking the medicine for help with sleep, prescribed medication was 12% and 5% were OTC medication taken by the study participants for help in sleep. trouble staying awake, three or more times a week (53%), keep up enough enthusiasm, a very big problem (51%), participants rate their sleep quality overall, as very bad (39.8%), very good (34.8%), fairly good (14.9%), and fairly bad (10.8%). Conclusion: This study concluded that most of the participants were suffering from unhealthy sleeping conditions because of their life style and during data collection it was also observed that environmental condition was also depends on their sleep quality.
COMPARISON OF VISUAL OUTCOMES AFTER CATARACT SURGERY IN DIABETIC VS NON-DIABETIC PATIENTS IN SHEIKH ZAYED HOSPITAL, RAHIM YAR KHAN
This comparative observational study evaluated visual outcomes following cataract surgery in diabetic and non diabetic patients at Sheikh Zayed Hospital, Rahim Yar Khan. A total of 100 patients were enrolled, equally divided into diabetic and non diabetic groups, and assessed preoperatively and postoperatively at Day 1, Week 1, and Week 6. Visual acuity, complications, retinal status, and patient satisfaction were analyzed. Both groups demonstrated significant improvement in best corrected visual acuity, with 71% reporting improved or much improved vision. Early postoperative complications such as mild corneal edema were common but resolved by six weeks, while posterior capsular opacification occurred in 35% of cases. Statistical analysis revealed no significant difference in visual improvement between diabetic and non diabetic patients (χ² = 4.848, p = 0.303). Overall, cataract surgery was safe and effective in both groups, with high patient satisfaction, provided adequate preoperative evaluation and glycemic control were ensured.
Cataract surgery, Diabetes mellitus, Visual outcomes, Postoperative complications
COMPARATIVE STUDY ON ONSET AND BLOCK QUALITY FOLLOWING SINGLE VS MULTIPLE INJECTION TECHNIQUES IN AXILLARY BRACHIAL PLEXUS BLOCK
Background: The axillary brachial plexus block is a well-established regional anesthesia technique for forearm and hand surgeries. Despite its reliability, the optimal injection strategy remains controversial. Single- and multiple-injection techniques are commonly used, yet their comparative effectiveness in terms of onset time, block quality, duration of anesthesia, and safety is still debated. This randomized controlled trial aimed to compare these two approaches to determine which provides superior clinical outcomes. Materials and Methods: Seventy-two adult patients (ASA physical status I–III) scheduled for elective forearm or hand surgery were enrolled and randomly allocated into two equal groups: Group S (single-injection technique) and Group M (multiple-injection technique). All blocks were performed using nerve-stimulation guidance with standardized doses of local anesthetic. Hemodynamic parameters were monitored, and the onset times of sensory and motor block were recorded. Block duration, time to first rescue analgesia, block quality, patient satisfaction, and complications were assessed. Data were analyzed using the independent t-test and chi-square test, with a p value < 0.05 considered statistically significant. Results: Demographic characteristics and baseline hemodynamic variables were comparable between groups (p > 0.05). Group M demonstrated a significantly faster onset of sensory block (10.5 ± 2.2 min vs. 12.0 ± 2.4 min; p = 0.004) and motor block (15.8 ± 3.0 min vs. 18.1 ± 3.6 min; p = 0.006). The duration of sensory and motor blockade, as well as the time to first rescue analgesia, was significantly longer in the multiple-injection group (p < 0.01). Excellent block quality and higher patient satisfaction were more frequent in Group M. Complication rates were low and comparable between groups. Conclusion: The multiple-injection axillary brachial plexus block provides faster onset, superior block quality, longer duration of anesthesia, and higher patient satisfaction without increasing complications, making it a clinically preferable technique for upper-limb surgeries.
Axillary brachial plexus block; multiple-injection technique; single-injection; regional anesthesia; block onset; block duration; patient satisfaction
ADVANCES IN NUTRITION PRODUCT FORMULATION AND PROCESSING: INTEGRATING FUNCTIONAL INGREDIENTS, BIOACTIVITY, AND INDUSTRIAL PRODUCTION EFFICIENCY
Background There has been an ever-increasing need for the development of functional foods to provide biological health effects that are still amenable to industrial food processing. Objective The purpose of this research was to assess functional ingredient choice, processing, and encapsulation effects on nutritional profile, bioactive compound stability, and efficiency of production in various food systems. Methodology Protein, and fiber, rich ingredients, including selected by, products, were used to develop baked, extruded, and beverage products. Bioactives, both free and encapsulated, were added and the mixtures were processed under controlled conditions. Determined and compared with control formulations were the nutritional composition, retention of bioactives, techno, functional properties, and in vitro bioaccessibility. Results Fortified products exhibited elevated levels of protein, dietary fiber, and antioxidant activity in comparison to the respective controls. Encapsulation led to improved stability of bioactives during the processing and storage time and also to increased bioaccessibility after the simulated digestion. Processing performance and product quality were found to be within the acceptable range for all systems. Conclusion The evidence illustrates that the optimization of processing techniques can allow the mixing of functional components into a wide range of food products, which leads to the production of nutritional foods that can be made on a large scale with the use of efficient industrial methods.
COMPARATIVE EFFECTS OF INTRANEURAL FACILITATION THERAPY AND NERVE FLOSSING TECHNIQUE ON PAIN, BALANCE, GAIT, AND QUALITY OF LIFE IN PATIENTS WITH DIABETIC PERIPHERAL NEUROPATHY: A RANDOMIZED CLINICAL TRIAL
Background: Diabetic peripheral neuropathy (DPN) impacts >50% of type 2 diabetes patients, leading to microvascular ischemia, neuropathic pain, and functional impairments in balance and gait. Intraneural Facilitation (INF) therapy is a manual technique that reduces endoneurial hypoxia, while the Nerve Flossing (NF) technique enhances neurodynamics through mechanical mobilization. This study compared the effects of INF therapy and NF techniques on pain, balance, gait, and quality of life in patients with diabetic peripheral neuropathy. Methods: This randomized clinical trial employed a non-probability, convenience sampling technique, in which 44 patients with diabetic peripheral neuropathy were randomly allocated to Group A (INF = 22) and Group B (NFT = 22) using a computer-generated method. Interventions were performed in both groups for 50-60 minutes, three times a week, over 8 weeks, and a follow-up was conducted after 2 months. Pain was measured using the Numeric Pain Rating Scale, Balance using the Berg Balance Scale, Gait with the Dynamic Gait Index, and Quality of life was assessed using the QOL-DN Questionnaire. For the between-group comparison, the Mann-Whitney U test was used, and for the within-group comparison, the Friedman test was used. Results: The trial reported that INF significantly improved pain scores (p = 0.01), quality of life (p = 0.018), and balance (p = 0.02) at 16 weeks compared to NFT. Gait also showed significant enhancement (p=0.001), with INF demonstrating superior efficacy. Conclusion: The study reported that both INF and NFT improve pain, balance, gait, and quality of life in patients with diabetic peripheral neuropathy. However, INF demonstrated superior results, particularly in reducing neuropathic pain, enhancing balance and gait, and improving quality of life.
diabetic peripheral neuropathy; gait; intraneural facilitation therapy; pain; type 2 diabetes; quality of life
CLINICAL OCCURRENCE OF ORAL POTENTIALLY MALIGNANT DISORDERS IN HEPATITIS C POSITIVE PATIENTS
Background: Hepatitis C is spreading in Pakistan with alarming increase in number. It can cause hepatocellular carcinoma and according to different studies it has some relation with oral potentially malignant disorders and oral cancer. In Pakistan oral potentially malignant disorders also increasing in number. Materials and methods: It was observational cross-sectional study. Duration of the study was six months. 100 patients with hepatitis C positive patients were included in study group. 100 patients had no HCV infection were included in healthy control group. Oral examination was done clinically to check presence and type of oral potentially malignant disorders in both groups. Results: only four patients had oral potentially malignant disorders in non-HCV control group. Twelve patients had oral potentially malignant disorders in HCV positive study group. Six percent of patients had oral lichen planus, three percent of patients had erythroplakia and two percent of patients had leukoplakia and only one percent of patients had oral submucous fibrosis. Conclusion: oral potentially malignant disorders are more in hepatitis C patients. Early diagnosis of these disorders prevents their conversion into squamous cell carcinoma in hepatitis C infection.
Hepatitis C, oral premalignant lesions, oral premalignant disorders, Ora lichen planus, oral leukoplakia, oral erythroplakia
MOLECULAR INSIGHTS INTO SERTOLI CELL FUNCTION: THE IMPACT OF METABOLIC DISORDERS IN CHILDREN AND ADOLESCENTS ON SPERMATOGENIC POTENTIAL
Reduced fertility in males is one of the significant and pertinent health issues throughout the world, including several etiologies of which remain elusive in about half of the man. The male human total sperm count has decreased in past forty years, rising incidence of childhood obesity also couldn’t be fortuitous. Here, the molecular pathways by which childhood and adolescent obesity could disrupt future testosterone production are explained. Several mechanisms related with obesity which occurs in obesity may against the complicated exquisite metabolic cross talks that take place in testicular level during child and adolescent provide base to extrapolate the childhood obesity with low sperm density in adults. The International WHO studies show that since 1975, the prevalence level of heavy and obesity has soared worldwide, three folds. These issues are particularly alarming in children, with over 340 million young individuals aged 5 to 19 classified as overweight or obese as of 2016. When excess body fat accumulates, fat cells release pro-inflammatory cytokines and free fatty acids, triggering low-level, ongoing inflammation. This inflammation interferes with the body’s insulin usage, resulting in insulin resistance. Consequently, being overweight or obese is a key contributor to insulin resistance, prompting pancreatic β-cells to produce more insulin and leading to hyperinsulinemia. The present overview focuses on the influences of obesity in FSH, IGF system, and androgen/estrogen pathways with regard to SC function and the ’extracellular’ ‘niche’. Here they discuss how the molecular disruptions observed in obese as well as insulin resistant individuals could obstruct the principal signaling pathways which are otherwise necessary for SCs and GCs growth and differentiation and hence in adiposity-linked low sperm density risk during adulthood from childhood. Recent studies suggest that overweight or obesity can impact with negative effects the male reproductive system. Many investigations have described a correlation between increased body mass and reduced sperm quality. Epidemiological data also show that for the past 40 years sperm concentrations have reduced, pediatric obesity has increased indicating that there is a correlation between the two events. However, the relationship between childhood and adolescent obesity and possible adulthood male infertility has not been well understood and explored by linking intermediary steps.
Follicle-stimulating hormone (FSH), IGF system, Sertoli cell, gut hormones, hyperglycemia, hyperinsulinemia
ASSESMENT OF COMPLIANCE WITH STANDARDIZED BEDSIDE HANDOVER PRACTICES AMONG NURSES AT A TERTIARY CARE HOSPITAL IN MARDAN
Background: Effective nursing handover is a critical component of patient safety and continuity of care. Communication failures during shift changes are recognized as a major cause of adverse events in hospital settings. The Situation, Background, Assessment, and Recommendation (SBAR) framework has been widely adopted to standardize nursing handovers and improve communication clarity. Objective: To assess nurses’ compliance with standardized bedside handover practices using the SBAR framework and to identify factors influencing compliance among nurses working in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted among 175 registered nurses working in medical, surgical, and critical care wards of a tertiary care hospital. Data were collected using a structured SBAR compliance checklist and a questionnaire assessing influencing factors. Data analysis was performed using SPSS version 27. Descriptive statistics summarized demographic variables and compliance levels, while inferential statistics (independent sample t-test, one-way ANOVA, and Pearson correlation) examined associations between demographic and organizational factors and SBAR compliance. Results: The findings revealed moderate to high compliance with SBAR handover practices among nurses. Female nurse’s demonstrated significantly higher compliance compared to male nurses (p < 0.05). Age was not significantly associated with overall SBAR compliance, although differences were observed in specific SBAR components. Organizational factors such as teamwork, training, and adequate time allocation showed a significant positive correlation with SBAR compliance (r = 0.386, p < 0.001). The study instrument demonstrated good reliability (Cronbach’s alpha = 0.867). Conclusion: Nurses showed satisfactory compliance with SBAR-based bedside handover practices; however, compliance was influenced by gender and organizational factors. Strengthening training programs, promoting teamwork, and improving institutional support may further enhance standardized handover practices and patient safety outcomes.
SBAR: Situation, Background, Assessment, Recommendation PS: Patient Safety, NH: Nurse Handover BScN: Bachelors of Science in Nursing RN: Registered Nurse, RM: Registered Midwife ANOVA: Analysis of Variance Nursing handover; Bedside handover; Nurse compliance; Patient safety Tertiary care hospital Communication
THE FUTURE OF NURSE PRACTITIONERS; A CONFLICT ANALYSIS!
The role of the nurse practitioner was first conceptualized in the late 1960s. Today, there are approximately 70,000 nurse practitioners in practice, they receive third-party insurance reimbursements, and they are in many specialty practices, as well as working in primary care practices promoting health and disease prevention. In the future, economics will shape our health care industry, placing a greater demand for nurse practitioners in this trillion-dollar marketplace. This article explores the evolving role of the nurse practitioner in education, practice, and research to meet the challenges of the health care needs into the 21st century. The face of primary care in the Pakistan is changing and becoming challenging. With a shortage of primary care nurses expected to increase in the coming decades, nurse practitioners; nurses who have completed a master’s or doctoral nursing degree and received advanced clinical training are expected to fill this gap. The Agha Khan University has step forwarded toward the course of Nurse Practitioner and sanctioned 2-3 seats for clinical training. Nurse practitioners are qualified to step in as primary caregivers to varying degrees in Pakistan, where they work directly with the patients, they serve and with other nurses and doctors to ensure the most successful health outcomes possible. The future of nurse practitioners is evolving, and they are taking on new and more expansive responsibilities.
Future Nurse, Health Care, Nurse Practitioner, Nurse Practitioner Education, Nurse Practitioner Practice
INTRAMYOMETRIAL INJECTION OF VASOPRESSIN TO MINIMIZE BLEEDING DURING CESAREAN HYSTERECTOMY OF PLACENTA ACRETA SPECTRUM
To evaluate the efficacy and safety of intramyometrial vasopressin injection in reducing intraoperative blood loss and transfusion requirements during cesarean hysterectomy for placenta accreta spectrum (PAS). Methodology: A single-center, prospective, randomized controlled trial was conducted at MCH PIMS from January to March 2025. Sixty antenatal women diagnosed with major PAS by ultrasound were randomly allocated into two groups: Group A (n=30) received intramyometrial vasopressin (20 U in 19 mL saline), and Group B (n=30) received an equivalent volume of normal saline following delivery and cord clamping. Standardized surgical teams and monitoring protocols were employed. Estimated blood loss (EBL) was measured using suction volumes and mop weight differentials. Perioperative outcomes, including hemoglobin change, transfusion requirement, and operative duration, were compared using independent t-tests, chi-square, or Fisher’s exact tests. Results: Mean EBL was significantly lower in the vasopressin group (0.84 ± 0.20 L) compared to controls (1.81 ± 0.48 L; p<0.001). Fewer patients in the vasopressin group experienced blood loss >1 L (60.0% vs 86.7%; p=0.020). The mean number of transfused blood products was lower in the vasopressin group (0.30 ± 0.60 vs 0.97 ± 1.23; p=0.023). Post-operative hemoglobin was higher in the vasopressin group, though not statistically significant (p=0.073). Operative time did not differ significantly (p=0.342). Emergency procedures were associated with greater EBL (p=0.003). Conclusion: Intramyometrial vasopressin significantly reduces intraoperative blood loss and transfusion needs in PAS-related cesarean hysterectomy without prolonging operative time, supporting its use as an effective hemostatic adjunct.
Placenta accreta spectrum, cesarean hysterectomy, vasopressin, blood loss, obstetric hemorrhage, transfusion
THE ROLE OF FOOD ADDICTION AND DEPRESSION IN DETERMINING EXECUTIVE FUNCTIONS AMONG ATHLETICALLY ACTIVE AND NON-ATHLETE VARSITY STUDENTS
To examine the role of food addiction and depression in determining executive functions among athletically active and non-athlete varsity students was the central objective of this study. Data were collected at one point in time using a quantitative research design that was cross-sectional in nature. A total of 335 varsity students participated in the study. Among them, 165 students were athletically active, while 170 students were non-athletes. Participants belonged to the 18–25 years age range group. The mean age of athletically active students was 21.36 years (SD = 2.161). For non-athlete students, the mean age was 20.96 years (SD = 1.707). All participants were enrolled in different BS degree programs in various academic departments of their universities. Data were collected using a questionnaire method. The questionnaire included basic demographic information of the participants. Depression was measured using the PHQ-2 questionnaire. Whereas, food addiction was assessed through the YFA scale. Executive functioning was assessed using the Stroop Test. The collected data were analyzed using SPSS software (2022). Predictive relationships among the variables were examined using hierarchical regression techniques. The results showed that, among athletically active varsity students, depression and food addiction had a positive association with Stroop Test scores. Since higher Stroop scores indicate poorer performance, this finding suggests lower executive functioning among athletes with higher depression and food addiction levels. In contrast, depression did not show any significant relationship with executive functions among non-athlete varsity students. However, food addiction showed a negative association with Stroop Test scores in this group. This indicates that non-athlete students with higher food addiction scores performed better on the Stroop Test. These findings suggest that emotional and behavioral factors may influence executive functioning differently in athletic and non-athletic university students.
executive function, depression, food addiction, varsity students, athletes and non-athletes
MOLECULAR EPIDEMIOLOGY AND WHOLE-GENOME CHARACTERIZATION OF FOOT AND MOUTH DISEASE VIRUS CIRCULATING IN ENDEMIC CLINICAL OUTBREAKS ACROSS PAKISTAN
Foot-and-mouth disease (FMD) remains a major constraint to livestock productivity in Pakistan, causing significant economic losses and hindering trade. This study aimed to characterize circulating FMD virus (FMDV) strains using integrated virological and molecular diagnostics, based on clinical samples collected from cattle and buffalo in endemic regions of Punjab and Sindh. A total of 52 suspected samples were analyzed by RT-PCR, antigen-capture ELISA (Ag-ELISA), and virus isolation in IB-RS-2 cell culture. RT-PCR detected FMDV RNA in 34 samples, with serotype O predominating (34/34), alongside sporadic signals for serotype A and unconfirmed SAT-1. Cell culture confirmed viable virus in 14 isolates, all of which were consistent with serotype O or A, while Ag-ELISA showed lower sensitivity due to field sample limitations. Sequencing of the VP1 region from four representative isolates revealed two distinct genetic clusters: JW53/JW58 (99.21% identity) aligned with the PanAsia-2ANT lineage of serotype O, and JW43/JW48 (99.30% identity) matched the A/ASIA/G-VII topotype of serotype A. Inter-cluster identities (52–55%) confirmed serotypic divergence. Phylogenetic analysis reinforced regional links with strains from India and Afghanistan, highlighting transboundary transmission risks. The findings underscore that FMD in Pakistan is driven by endemic serotypes O and A, with no verified circulation of SAT types. These results advocate for a national control strategy centered on bivalent (O+A) vaccines matched to local lineages, enhanced molecular surveillance, and regional cooperation to mitigate cross-border spread.
Foot-and-mouth disease virus (FMDV); Serotype O; Serotype A; RT-PCR; VP1 sequencing; Phylogenetic analysis; PanAsia-2ANT; A/ASIA/G-VII; Pakistan; Molecular epidemiology
Copyright (c) 2025 Review Journal of Neurological & Medical Sciences Review
CLINICAL PROFILE AND ANTIMICROBIAL RESISTANCE PATTERNS IN PAEDIATRIC ENTERIC FEVER
Background: Enteric fever is one of the biggest causes of morbidities in the children especially where there is poor sanitation. The growing spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Salmonella strains makes its management more complicated and a major health problem to the population. Objective: To identify the clinical picture and antimicrobial resistance patterns of culture-confirmed enteric fever among pediatric patients. Methods: The proposed cross-sectional study was carried out within the Department of Pediatrics for a period of six months from December 2024 to May 2025. The patients who were included were pediatric patients who had blood culture-confirmed Salmonella Typhi or Paratyphi infection and were aged 15 years or less. A structured proforma was used to gather data regarding demographics, clinical features, and laboratory results. The susceptibility test was done by CLSI standards. The SPSS package version 27 was used to analyze data. The continuous variables were represented as mean plus standard deviation or median plus interquartile range, and the categorical variables were in form of frequencies and percentages. Clinical features were correlated with resistance patterns by Chi-square or Fisher exact test with a p-value of below 0.05 being regarded as significant. Results: There were 378 enrolled children whose mean age was 8.1 +3.4 years; 56% were male. Salmonella Typhi was found to cause 88.1 percent of the isolates. All patients had fever; 63 and 51 per cent reported abdominal pain and vomiting, respectively. Hepatomegaly and splenomegaly were observed in 41% and 32% respectively and 19% had both of them. Strains of MDR were identified in 14.8 percent of cases with XDR strains identified in 43.4. There was a high resistance to first-line antibiotics and fluoroquinolones, but azithromycin (91.8%) and meropenem (98.9) were both very effective. Prolonged fever and organomegaly were significantly related to XDR infections (p < 0.05). Conclusion: XDR Salmonella strains continue to become the cause of pediatric enteric fever, which restricts the possibilities of empirical treatment. Constant monitoring, therapy based on resistance, antimicrobial stewardship, immunization, and enhanced sanitation are the key to achieve disease burden reduction and restrict the transmission of resistant infections among children.
Enteric fever; Pediatrics; Antimicrobial resistance; MDR; XDR
HEMATOLOGICAL PARAMETERS OF ACUTE MYELOID LEUKEMIA PATIENTS PRESENTING TO PATHOLOGY DEPARTMENT, HAYATABAD MEDICAL COMPLEX, PESHAWAR
Objective: To evaluate the hematological profiles of Acute myeloid leukemia patients presented at Hayatabad Medical Complex Peshawar. Study Design and Setting: This cross-sectional study was conducted from 1st July 2023 to 30th June 2024, at Pathology Department, Hayatabad Medical Complex. Methodology: The study including 116 AML patients aged ≥18 years. Diagnosis was based on ≥20% blasts in peripheral smear/bone marrow and classified according to FAB subtypes. Hematological parameters including hemoglobin (Hb), leukocyte and platelet counts, anemia, leukopenia, leukocytosis, thrombocytopenia, and blast percentages were recorded. Chi-square test applied for comparisons (p ≤ 0.05 significant). Results: The mean age was 54.8±13.8 years, with male predominance (58.6%). AML-M2 was the most frequent subtype (20.7%). Anemia was present in 81.9% (mean Hb: 8.1±2.8 g/dl), leukocytosis in 52.6%, leukopenia in 17.2%, and thrombocytopenia in 87.9% (mean platelet count: 55.7±16.3×10³/µL). Blast cells>60% were found in 58.6% of patients. No significant gender differences were observed (p>0.05). Younger patients (≤40 years) had higher Hb compared to older patients (8.3±0.5 vs. 7.7±2.0 g/dl, p=0.049). Significant Hb variation was also noted across AML subtypes (p=0.045), but other parameters showed no difference. Conclusion: Anemia and thrombocytopenia were the most prevalent hematological abnormalities in AML patients. Except for hemoglobin variation by age and subtype, no significant differences were observed. These findings highlight the diagnostic value of hematological parameters and provide baseline data for clinicians in this region.
Anemia, thrombocytopenia, leukocytosis, blast cells, hematological parameters
DIAGNOSTIC ROLE OF SUSCEPTIBILITY WEIGHTED IMAGING (SWI) IN DETECTING CEREBRAL MICROBLEEDS IN TRAUMATIC BRAIN INJURY
In cases of traumatic brain injury (TBI), cerebral microbleeds (CMBs) are imperceptible hemorrhagic lesions that are often overlooked. These lesions may be prognostic in nature, and Susceptibility Weighted Imaging (SWI) provides increased sensitivity for identifying them. Objective: to analyze SWI's diagnostic efficacy and determine the presence, distribution, and clinical correlations of CMBs in TBI patients. Methods: MRI brain scans with SWI sequences were performed on eighty-two TBI patients. Individuals with full clinical records, regardless of age or gender, were included; those with metallic implants, tumors, previous brain surgery, or neurological problems were not. The presence, quantity, size, and location of CMBs were assessed separately by two radiologists. Clinical information was documented, including the severity and symptoms of TBI. Microbleeds, clinical factors, and TBI severity were evaluated statistically, and Cohen's κ was used to estimate inter-rater reliability. Results: Males made up 56.1% of the group, and moderate TBI was most prevalent (54.9%). 48.8% of patients had CMBs, primarily in the deep brain (16.7%), cortical (20.8%), and subcortical (33.3%) regions. The most common clinical symptoms were headache (63.4%) and loss of consciousness (58.5%), however there was no significant relationship between the existence of microbleed and the type of symptom or the severity of TBI (χ²(2) = 0.53, p = 0.77). With 94% sensitivity, 91% specificity, 92% positive predictive value, 93% negative predictive value, and 93% overall accuracy, SWI showed excellent diagnostic performance. There was significant inter-rater agreement (Cohen's κ = 0.86). All TBI severity levels, even mild instances, experienced microbleeds. Conclusion: SWI is a highly sensitive and reliable modality for detecting CMBs in TBI patients, including those with mild injuries that may be missed on conventional imaging. Regularly incorporating SWI into TBI imaging methods can enhance patient care, risk assessment, and early detection, thereby influencing long-term prognosis evaluations.
KNOWLEDGE, ATTITUDES, AND PRACTICES OF EXCLUSIVE BREASTFEEDING AMONG MOTHERS IN RURAL SINDH, PAKISTAN
Background: Exclusive breastfeeding for the first six months of life is a proven strategy to improve infant survival, growth, and development. Despite global and national recommendations, exclusive breastfeeding remains suboptimal in many rural communities of Pakistan due to cultural beliefs, misinformation, and limited maternal support. Objective: To assess the knowledge, attitudes, and practices of exclusive breastfeeding among mothers in rural Sindh, Pakistan. Methods: A community-based cross-sectional study was conducted among mothers in Village Paryo Tunio, Kandiaro, Sindh, Pakistan, from August to November 2025, among 96 mothers using convenience sampling. Data were collected using a structured, pre-validated questionnaire covering socio-demographics and EBF-related knowledge, attitudes, and practices. Data were analysed using SPSS v23 with descriptive statistics. Results: Overall knowledge was moderate in 52% of mothers, good in 26%, and poor in 22%. Most mothers (67.7%) had heard of EBF, and 70.8% correctly defined it. While 80.2% recognized the importance of initiating breastfeeding immediately after birth, only 58.3% actually practiced immediate initiation. Colostrum was fed by 63.5%, and 69.8% provided pre-lacteal feeds. Exclusive breastfeeding for six months was reported by 58.3%, with overall practices moderate in 52%, good in 21%, and poor in 27%. Attitudes were generally positive, with 83.3% perceiving breastfeeding as easier than formula feeding. Conclusion: Mothers demonstrated moderate knowledge and generally positive attitudes toward EBF, but practices were inconsistent, reflecting cultural norms, limited formal education, and inadequate counseling. The gap between knowledge and practice highlights the need for community-based education, structured postnatal support, and engagement of family decision-makers to improve EBF adherence and maternal-child health outcomes.
Breast Feeding; Maternal Health; Infant Nutrition; Health Knowledge, Attitudes, Practice; Rural Population
Rose (Rosa spp.), often praised and celebrated as the symbol of love and beauty, has potential beyond mere attraction by possessing rich medicinal aspects that go beyond beauty and attractiveness. This review delves into exploring the therapeutic insights of roses in terms of examining the bioactive compounds such as flavonoids, anthocyanins, tannins, and essential oils, which impart pharmacological attributes of diverse nature. It highlights both classical and modern viewpoints, suggesting that it can alleviate ailments such as inflammation, oxidative stress, microbial infections, with mental health disorders. The therapeutic efficacy of rose extracts and essential oils with anti-inflammatory, antioxidant, antimicrobial, and neuroprotective benefits is underscored through in vitro and in vivo studies. Moreover, integrating roses into nutraceuticals and modern pharmacology unveils a promising avenue for the development of remedies that are plant-based with minimal side effects. The review identifies considerable research gaps, such as low clinical trials and inconsistent standardization protocols, which encouraged further exploration to harness roses’ full therapeutic potential. This work synthesizes a logical combination of centuries-old wisdom and modern scientific data, urging people to turn their attention to roses as powerful healing elements. The revelation of their secrets may become a game-changer in the natural medicine field and positively affect the health situations of the world population, and thus, it once again proves the idea that the petals of this eternal flower have much more than just a decorative worth; they are the synonyms of wellness and healing.
THE HIDDEN INFLUENCE OF CORE MUSCLE IMBALANCE ON LOWER-LIMB PERFORMANCE AND INJURY RISK IN ATHLETES
Background of the Study: Lower-limb impairments are common in athletes and are often linked to deficits in neuromuscular control, alignment and movement quality. Core muscle imbalance is thought to influence hip, knee and ankle mechanics by disrupting stability in the kinetic chain. This imbalance can increase the risk of valgus collapse, ankle instability and reduced balance performance. Despite growing evidence, the direct association between core imbalance and lower limb dysfunction across different sports is still not well established. Methodology: A cross-sectional study was conducted with 120 athletes aged 18 to 30 from football, basketball and badminton. Core endurance was assessed using the plank, side bridge and trunk flexor endurance tests. Lower-limb impairments were evaluated using hip abductor strength testing with a dynamometer, knee valgus measurement through single-leg squat video analysis, ankle stability tests and the Y-Balance Test. Data were analyzed using SPSS, and Pearson correlations were used to determine the association between variables. A p-value less than 0.05 was considered statistically significant. Results: The analysis showed strong correlations between core muscle imbalance and several lower-limb impairments. Poor core endurance was associated with increased knee valgus angle (r = .61, p < .001), reduced hip abductor strength (r = .54, p < .001) and lower Y-Balance composite scores (r = .49, p < .01). Athletes with side bridge asymmetry demonstrated higher rates of ankle instability. Football athletes showed the highest imbalance, while badminton athletes had better balance scores. Conclusion: Core muscle imbalance significantly contributes to lower-limb impairments in athletes. Addressing core endurance and symmetry within training and rehabilitation programs may help reduce injury risk and improve movement quality. These findings support the integration of core-focused conditioning into sports performance and injury-prevention strategies.
Core muscle imbalance; lower-limb impairments; knee valgus; hip abductor strength; ankle instability; dynamic balance; athletes; sports rehabilitation
IMPACT OF CUSTOM ORTHOTIC DEVICES ON PLANTER FASCIITIS
Background: The study aimed to compare the effectiveness of prefabricated and custom-made orthotic devices in reducing pain and improving function in individuals with planter fasciitis it sought to evaluate how orthotics influence planter pressure and overall foot mechanics. The research intended to determine whether custom orthotic provide superior long-term benefits compared to prefabricated inserts. Overall, the purpose was to assess the clinical value of orthotic interventions in managing plantar fasciitis symptoms. Methods: Researchers searched multiple medical databases and included randomized controlled trials assessing orthotic treatments for plantar fasciitis. Participants were assigned to interventions such as foot orthoses, exercises, orthotic sandals, or self-management programs. Pain levels and foot function were monitored through regular messages, phone calls, and follow-up questionnaires. The trials compared different orthotic options to determine which approach offered the greatest improvement in pain relief and functional outcomes. Results: Individuals with plantar fasciitis commonly experience sharp heel pain, especially during first Steps in the morning or prolonged Standing. Risk factors such as tight calf muscles, foot posture abnormalities, and unsuitable footwear worsen symptoms. Use of prefabricated or custom orthotic devices reduces plantar pressure and improves daily functional activity. Overall, orthoses provide meaningful symptom relief with no reported adverse effects, making them a safe conservative treatment option. Conclusion: Custom orthotics effectively reduce strain on the plantar fascia by correcting biomechanics and redistributing foot pressure. They provide greater long-term symptom relief and higher patient satisfaction compared to prefabricated inserts, though they work best as part of a combined treatment plan. Overall, custom orthotics are a reliable, evidence-based option that supports pain reduction and improved mobility in plantar fasciitis patients.
Custom orthotics, plantar fasciitis, heel pain, biomechanical correction, plantar pressure redistribution, foot function, pain relief, mobility improvement, long-term symptom management, conservative treatment.
NURSES' PERCEPTIONS, KNOWLEDGE AND EXPERIENCE REGARDING ARTIFICIAL INTELLIGENCE IN A TERTIARY HEALTHCARE SETTING: A QUANTITATIVE CROSS-SECTIONAL STUDY
Background: Artificial intelligence (AI) is increasingly being integrated into healthcare systems to improve efficiency, support clinical decision-making, and address workforce shortages. Nurses are central to patient care delivery and play a key role in the successful adoption of AI technologies. However, limited evidence exists regarding nurses’ knowledge and perceptions of AI in public-sector hospitals in Pakistan. This study aimed to assess nurses’ knowledge, perceptions, and attitudes toward artificial intelligence at Mardan Medical Complex, Mardan. Methods: A cross-sectional descriptive study was conducted among nurses working at Mardan Medical Complex, Mardan. A total of 172 nurses were recruited using a convenience sampling technique. Data were collected using a structured, self-administered questionnaire used in previous study covering demographic characteristics, knowledge of artificial intelligence, and perceptions regarding its use in nursing practice. Data were analyzed using SPSS. Descriptive statistics (frequencies and percentages) were used to summarize the data. Spearman’s rank correlation and Cramer’s V tests were applied to examine associations between demographic variables, AI knowledge, and perceptions, with a significance level set at p < 0.05. Results: The study found that the majority of nurses had limited knowledge of artificial intelligence, with 74.8% (n = 129) reporting low or basic understanding of AI, While only 25.2% (n = 43) reported good or advanced knowledge. Despite limited knowledge, most nurses demonstrated a positive attitude toward AI, with 65.7% (n = 113) perceiving AI as an opportunity in nursing practice, whereas 13.7% (n = 24) viewed it as a threat and 20.6% (n = 35) were unsure. Nurses most commonly identified AI applications in patient monitoring (55.7%), route planning and workflow management (47.7%), and nursing documentation (43.6%). Spearman’s rank correlation showed a significant positive relationship between education level and AI knowledge (ρ = 0.312, p = 0.001), while no significant correlation was found between age and AI knowledge (ρ = 0.087, p = 0.251). Cramer’s V analysis revealed significant associations between gender and AI knowledge (V = 0.239, p = 0.002), education level and AI knowledge (V = 0.329, p < 0.001), and AI knowledge and perception of AI (V = 0.259, p = 0.003). Conclusion: Although nurses at Mardan Medical Complex have limited knowledge of artificial intelligence, the majority perceive AI positively and recognize its potential to support nursing practice. The gap between low AI literacy and high acceptance highlights the need for targeted education, in-service training programs, and institutional policies that actively involve nurses in AI-related initiatives. Strengthening nurses’ AI knowledge may facilitate the ethical, effective, and patient-centered integration of artificial intelligence into nursing services