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"
COMPARISON OF SLEEP QUALITY AFTER SPINAL AND GENERAL ANESTHESIA IN NON-OBSTETRIC ASA CLASS I PATIENTS
Use the pdf link to find full length abstract
Spinal Anesthesia, General Anesthesia, Sleep quality, PSQI Score.
CARDIOPROTECTIVE EFFECTS OF GREEN TEA AND OMEGA-3 AGAINST ALUMINUM CHLORIDE–INDUCED CARDIOTOXICITY IN RABBITS
Background: Aluminium chloride (AlCl₃) is a widely used inorganic compound known to induce systemic toxicity, especially affecting the cardiovascular system. Chronic exposure to AlCl₃ promotes oxidative stress, myocardial degeneration, and biochemical disturbances that impair cardiac function. Natural antioxidants such as green tea polyphenols and omega-3 fatty acids have shown potential protective roles due to their anti-inflammatory and free radical scavenging properties. This study evaluates the cardioprotective effects of green tea and omega-3 against AlCl₃-induced cardiotoxicity in rabbits. Methods: Thirty-two adult rabbits were divided equally into four groups (n=8). Group I served as the control. Group II received AlCl₃ (300 mg/kg/day) orally for 30 days. Group III received AlCl₃ with green tea extract (50 mg/kg/day). Group IV received AlCl₃ with omega-3 (20 mg/kg/day). Body weight, heart weight, cardiac enzymes (CK-MB, SGOT/AST), and histopathology of cardiac tissue were evaluated. Data were analyzed using one-way ANOVA. Results: AlCl₃ administration caused significant reductions in body weight and increases in absolute and relative heart weight, indicating hypertrophy. CK-MB and AST levels increased sharply, confirming myocardial injury. Co-treatment with green tea lowered these parameters moderately, while omega-3 supplementation showed superior protective effects, restoring cardiac biomarkers close to control values. Histopathological analysis revealed severe myofibrillar degeneration, necrosis, edema, and fibrosis in the AlCl₃ group, while green tea reduced these changes and omega-3 preserved near-normal myocardial architecture. Conclusion: Both green tea and omega-3 exert protective effects against AlCl₃-induced cardiotoxicity, with omega-3 showing greater efficacy. These findings support the potential use of natural antioxidants as therapeutic agents against chemical-induced cardiac injury.
Aluminium chloride, Cardiotoxicity, Green tea, Omega-3 fatty acids, Antioxidants, Rabbits, Cardiac biomarkers, Histopathology
AMELIORATIVE POTENTIAL OF GREEN TEA AND OMEGA-3 AGAINST ALUMINIUM CHLORIDE-INDUCED HEPATOTOXICITY IN RABBITS
Background: Aluminium chloride has been reported to cause toxic effects on the liver by triggering oxidative stress, damaging hepatocytes, and impairing normal hepatic functions. Some natural antioxidants, like green tea and omega-3 fatty acids, can stop such toxic effect, because of their superior anti-inflammatory and free radical scavenging capabilities. The purpose of the current study was to determine whether green tea and omega-3 fatty acids could reduce the hepatotoxicity caused by AlCl₃ in rabbits. Methods: 32 mature rabbits were homogeneously divided into four groups (n = 8). Group I (control group) was given regular diet and distilled water. Group II received AlCl₃ (300 mg/kg) orally, one time in a day for 30 days. Group III was orally given AlCl₃ (300 mg/kg) with green tea extract (50 mg/kg/day), while Group IV was orally given AlCl₃ (300 mg/kg) with omega-3 fatty acids (20 mg/kg/day). Body weight measurement at regular intervals, liver function tests (ALT, ALP, and total bilirubin level), and histopathology were studied. Results: Aluminium chloride led to decrease in weight, while green tea and omega-3 supplementation preserved body weight closer to control values. Aluminium chloride greatly increased RLW when compared with control values, while green tea and omega-3 co-supplementation greatly reduced RLW to near normal values. AlCl₃ greatly elevated ALT, ALP, and total bilirubin values, while both treatments greatly reduced these parameters to near normal values with respect to their efficacy with omega-3 reporting maximum activity. By Histopathological analysis, hepatocellular necrosis, inflammation, and fibrosis were observed in AlCl₃ group. Conclusion: Green tea or omega-3 supplementation greatly rehabilitated biochemical parameters with improved histological architecture. These hepatoprotections can be attributed to green tea and omega-3's antioxidant and anti-inflammatory activities, thereby they potently act as natutal antioxidants (NATs) for chemically induced liver damages.
Aluminium chloride, Antioxidants, Green tea extract, Hepatoprotection, Hepatotoxicity, Histopathology, Liver function tests, Omega-3 fatty acids, Oxidative stress, Rabbits
INTEGRATION OF GENOMICS AND PRECISION MEDICINE IN NURSING EDUCATION
The fast development of genomics and precision medicine has transformed the contemporary healthcare system, requiring a new nursing staff with new scientific skills. With clinical decision making, becoming more and more dependent on the use of genomic data, the incorporation of genomics into nursing education has become a necessary step to provide personalized and evidence-based care. This review explores the contemporary situation, developments, and obstacles involved in the integration of the concept of genomic and precision-medicine into nursing curricula across the educational systems of the world. It mentions the growing role of nurse in risk assessment, patient education, pharmacogenomics, disease prevention and interpretation of the genetic test results-capabilities that are now regarded as essential to quality patient care. Although this is becoming more and more recognized, there are still huge gaps in the curriculum design, faculty readiness, and access to genomic learning resources. Most facilities continue to use the traditional models of teaching which fail to embrace the scientific and technological developments that are transformed to influence healthcare. The review explains the successful means of integration such as competency-based models, case-based learning, interprofessional learning, virtual simulation, accessing genomic databases and digital tools. Ethical, legal and social issues i.e. privacy, informed consent, equity in access to genomic services are also talked about and it is in the role of the nurse to navigate these tricky situations. This review highlights the shortage of understanding on the importance of thorough genomic training to equip future nurses with precision-medicine settings by integrating new trends and best practices. The reinforcement of curriculum designs, improvement of faculty education, and the establishment of clinical collaborations can enable nurses to assume the central role in the provision of personalized healthcare. It is not only important to incorporate genomics into nursing education but it is the future of health in the world. Keywords: Genomics integration, Precision medicine, Nursing education, Competency-based curriculum, Clinical decision-making, Digital health technologies, Genetic risk assessment, Genomic data interpretation, Personalized healthcare..
Copyright (c) 2025 Review Journal of Neurological & Medical Sciences Review
RECENT ADVANCES IN IMMUNOTHERAPY AND TARGETED THERAPIES FOR HEPATOCELLULAR CARCINOMA (HCC): MOLECULAR MECHANISMS, CLINICAL PROGRESS, AND FUTURE DIRECTIONS
Hepatocellular carcinoma (HCC) is an extremely dangerous cancer globally with high molecular heterogeneity, late diagnosis, and treatment inefficacy. Knowingly, the last 10 years have brought about the immunotherapy and targeted therapies that have transformed the way advanced HCC is treated to be replaced with the traditional monotherapy therapy, based on sorafenib. IMbrave150, CheckMate 040, and HIMALAYA deliver valuable results to the domain of immune checkpoint inhibitors (ICIs) and their combinations with anti-angiogenic agents, becoming a new standard of care, with a significant positive impact on overall survival and the quality of life. Simultaneously, the identification of molecular drivers and the explanation of the signaling effectors oncogenic as the Wnt/ 2 -catenin, PI3K/Akt/mTOR, and MAPK have informed resistance mechanisms and facilitated the advances of precision therapies. Irrespective of these developments, therapeutic resistance, immune evasion and toxicities associated with treatment are significant problems. The current studies focus on the combination of theliquid biopsy, circulating tumor DNA (ctDNA), and multi-omics platforms to determine predictive biomarkers and maximize patient stratification. Also, clinical efficacy and practical applicability are convergent at the point of real-world evidence and adaptive designs of clinical trials, so that precision immuno-oncology is a reality. Future perspectives are on coupled ICIs with epigenetic modulators, metabolic inhibitors, and adoptive cell therapies that can lead to long-term responses and worldwide efforts, which can bolster access and equity in the treatment of HCC. This is an overarching review of the current literature that outlines the molecular pathways, treatment advances, and translation issues that are changing the management of HCC in the context of targeted and immune-based treatment.
Hepatocellular carcinoma (HCC); immunotherapy; targeted therapy; immune checkpoint inhibitors; tyrosine kinase inhibitors; tumor microenvironment; biomarkers; ctDNA; multi-omics integration; clinical trials; real-world evidence; personalized medicine; mTOR signaling; VEGF/VEGFR pathway; combination therapy.
ROLE OF CONTRAST ENHANCED MRI IN DIAGNOSIS OF BRAIN TUMORS WITH PATIENTS HAVING BLURRED VISION AND HEADACHE IN LAHORE
Background: MRI using contrast boosts how well doctors spot brain tumors, since it shows irregularities more clearly. For patients with symptoms such as blurred vision and headache, advanced imaging is often warranted to investigate the presence of an underlying mass or lesion. This article endeavors to review the diagnostic value of enhanced MRI for diagnosing brain tumors in symptomatic patients. Objective: The aim of this study will determine the diagnostic value of contrast-enhanced MRI for detecting brain tumors in patients who present to the hospital with blurred vision and headaches. Methodology: This cross-sectional analytical study was conducted at Sheikh Zayed Hospital, Lahore, over four months and included 45 adult patients based on the prevalence 3%, selected through convenient sampling. Participants presented with headache and/or blurred vision and underwent contrast-enhanced MRI using standard sequences. Clinical imaging data were retrospectively reviewed and analyzed using SPSS version 25, with descriptive statistics and Chi-square tests applied to assess associations while maintaining ethical standards and patient confidentiality. Result: Of the 45 people, ages and genders were fairly even though more were men (52.2%) and tended to be older. Right-side weakness showed up in 19.6%, blurry vision in 60%, headaches in 60.9%; yet 60.9% didn’t have limb weakness at all. Most had physical brain issues mostly tumors (54.3%) or damaged areas (32.6%) spreading into nearby tissue half the time, though actual infiltration was uncommon (2.2%), along with strong pressure signs in 73.9%. Conclusion: The study showed about equal numbers of men and women, mostly older people. Right-side weakness, fuzzy eyesight or head pain popped up a lot but major brain issues didn't show up much. A good chunk had physical changes in the brain, like growths or damaged areas, which frequently pressed on nearby tissue. Still, deep spreading damage or blocked fluid buildup hardly ever happened. Overall, the findings suggest that despite certain clinical and structural issues being highly prevalent, most participants exhibited conditions that were manageable or not particularly serious in nature.
CE-MRI, Brain Tumours, Headache, Blurred Vision
GENDER AND AGE-SPECIFIC DISTRIBUTION OF ANTI-CCP ANTIBODIES IN RHEUMATOID ARTHRITIS: A SINGLE-CENTER STUDY
Rheumatoid arthritis is a chronic autoimmune inflammatory disorder characterized by progressive joint destruction and significant disability. Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific for RA and play a key role in early diagnosis and prognostication. This study aimed to characterize the demographic profile of anti-CCP–positive individuals in a Pakistani population presenting with joint symptoms. Serum samples from 140 participants were analyzed using a commercially available ELISA kit. A distinct age- and gender-related distribution was observed, with male patients clustered exclusively within the 31–60-year age range, while females showed a broader age distribution. These findings highlight the relevance of demographic factors in the clinical profiling of rheumatoid arthritis and support the utility of anti-CCP testing for early diagnosis and risk stratification, particularly in middle-aged males with early inflammatory symptoms and females at younger ages.
Rheumatoid arthritis, Anti-CCP, demographic profile, ELISA.
TARGETED PREVENTION OF PEDIATRIC SHUNT INFECTION: DEVELOPMENT OF A USABLE RISK SCORE FOR LMIC SETTINGS
Background: Hydrocephalus is a major pediatric neurosurgical condition, particularly in low- and middle-income countries (LMICs), where shunt infection remains a major cause of morbidity and resource strain. Despite advances in shunt technology, infection rates remain 5–15%. This study aimed to identify modifiable risk factors for early postoperative infection and develop a pragmatic, point-based risk score for use in LMICs Methods: We retrospectively analyzed 1,185 pediatric cerebrospinal fluid (CSF) shunt procedures performed at Lady Reading Hospital, Peshawar (2019–2024). Early infection (≤90 days) was defined using CDC criteria. A matched case–control model (127 infections, 381 controls) and time-to-event analysis identified independent predictors. Logistic regression and bootstrap validation (500 resamples) assessed model performance. Regression coefficients were translated into an integer-based risk score. Results: Early shunt infection occurred in 10.7% of cases, with a median onset of 21 days. Multivariable analysis identified five independent predictors: absence of an antibiotic-impregnated catheter (aOR 2.52, 95% CI 1.48–4.29), operative time >90 min (aOR 2.10, 95% CI 1.22–3.62), prior external ventricular drain (aOR 1.89, 95% CI 1.18–3.02), low weight-for-age (aOR 1.85, 95% CI 1.12–3.06), and cloudy/purulent CSF at surgery (aOR 3.45, 95% CI 1.62–7.33). The internally validated model showed excellent discrimination (AUC = 0.83, Brier = 0.072). The derived score stratified infection risk as low (4.5%), intermediate (18.8%), and high (41.6%). Conclusions: This study confirms established predictors and identifies new, practical markers nutritional status and intraoperative CSF clarity for early pediatric shunt infection. The derived, easy-to-use score enables targeted preventive strategies such as selective use of antibiotic-impregnated catheters or deferred surgery in high-risk children, optimizing outcomes and costs in resource-limited LMIC settings.
“UNDERSTANDING THE LIVED EXPERIENCES, SOCIAL DRIVERS, AND CHALLENGES AFFECTING YOUTH MENTAL HEALTH IN RURAL BALOCHISTAN: A QUALITATIVE STUDY.”
Background: Mental health disorders contribute substantially to the global burden of disease, disproportionately affecting adolescents and young adults in low- and middle-income countries. In Pakistan where 64% of the population is under 30 years of age, youth mental health remains critically under-addressed, particularly in rural and underserved regions such as Balochistan. Stigma, limited-service availability, and systemic constraints further exacerbate unmet mental health needs among medical students, a group uniquely vulnerable due to academic pressures and exposure to distressing environments. Objective: This qualitative study aimed to explore the social drivers, challenges, and perceived mental health needs among undergraduate medical students in Loralai, Balochistan, to inform contextually relevant mental health support strategies for youth in rural Pakistan. Methods: A focus group discussion (FGD) with eight medical students from Loralai Medical College was conducted online using semi-structured guidelines and following COREQ standards. Discussions were held in Urdu and English, recorded, transcribed verbatim, and analyzed independently by two researchers using iterative thematic analysis supported by NVivo 12 Plus. Purposeful sampling was used, and ethical clearance was obtained prior to data collection. Results: Four overarching themes emerged: (1) Severe scarcity of mental health services, highlighting structural barriers and lack of accessible professional support; (2) High psychological stress among medical students, driven by academic burden, isolation, and exposure to traumatic community events; (3) Pervasive stigma surrounding mental illness and help-seeking, reinforced by cultural expectations and fear of judgment; and (4) Urgent need for mental health education and awareness, including training in stress management, communication, and coping strategies within medical curricula. Participants emphasized that the mental health of future physicians directly affects patient safety and clinical performance, and that post COVID-19 consequences further intensified communication gaps and psychological distress. Conclusion: Medical students in rural Balochistan face significant, multifactorial mental health challenges compounded by stigma, inadequate resources, and limited institutional support. Strengthening mental health awareness, integrating student-focused mental health education into medical training, and improving access to culturally sensitive services are essential steps toward improving youth well-being and future healthcare delivery. This study highlights the need for systemic interventions and highlights the value of student-led initiatives like SHAW Pakistan in driving mental health advocacy and support in low-resource setting
PREVALENCE AND EPIDEMIOLOGICAL FEATURES OF CUTANEOUS LEISHMANIASIS IN TEHSIL MAMUND, BAJAUR AGENCY, PAKISTAN
Background: Cutaneous leishmaniasis is a vector-borne parasitic disease caused by protozoa of the genus Leishmania. In Pakistan, it is commonly reported from Baluchistan, Khyber Pakhtunkhwa (KPK), Punjab, Azad Jammu and Kashmir (AJK), and the Federally Administered Tribal Areas (FATA). This study aimed to determine the prevalence and epidemiological characteristics of CL in Tehsil Wara and Tehsil Lowy Mamaund of Bajaur Agency. Methods: In a descriptive cross-sectional study, 207 clinically suspected CL cases from the community and basic health units were examined. Convenience sampling was used. After obtaining informed consent, demographic and clinical data (age, sex, lesion number, type, and site) were recorded. Smears from lesion margins were prepared, fixed with methanol, stained with Giemsa, and examined microscopically for amastigotes. Results: Of 207 suspected cases, 134 (64.73%) were confirmed positive. Prevalence was higher in females (68.30%, n=86/126) than in males (59.26%, n=48/81). The highest infection rate was in the 1-10 years age group (44.93%). The face was the most common lesion site (82.6%, n=171). Most patients had a single lesion (81.2%, n=168), and the wet type of lesion was predominant (93.71%, n=194). Conclusion: Cutaneous leishmaniasis remains a significant public health problem in the study area, disproportionately affecting young children and females. Community awareness and vector control measures are urgently needed.
ASSESING THE INFLUENCE OF HIGH PROTEIN DIET ON KIDNEY DISEASES IN GENERAL POPULATION
Background and aims: Kidneys are one of the most essential organs in the human body. It filters fluids and waste products from our body. Kidney diseases are one of the most common diseases worldwide. The study aims to assess the influence of a high protein diet on kidney diseases in the diagnosed general population. Method: In this cross-sectional study, 30 participants from the age group of 15 -70 years suffering from kidney diseases were taken for this study. Data was collected through a food frequency questionnaire from service hospital dialysis centers and from the diagnosed population of Lahore, to assess the dietary intake of patients. Results: 70% of the participants were in average weight and 17% were overweight according to their BMI ranges. Males participants were 53% and females were 47%. The results of the study showed a negative influence of high protein diet on kidney diseases because high protein diet increases both the blood pressure and creatinine levels still not only high protein diet other dietary factors also plays a role in kidney health deterioration which include increased consumption of milk as milk contains phosphorus and potassium it also affects the kidney functions. And majority of the participants were vegetables and fruits at very merger rate. Conclusion: Diet has an impact on kidney function and diseases progression. A diet low in meat and high in vegetables, fruits and fiber would be helpful for patients with kidney diseases.
PREDICTIVE VALUE OF HYPERTHERMIA ON NEUROLOGICAL OUTCOMES IN SEVERE TRAUMATIC BRAIN INJURY
Background: Hyperthermia is a frequently observed physiological disturbance after traumatic brain injury (TBI) and has been linked to secondary brain insults that worsen neurological outcomes. Post-traumatic hyperthermia may result from hypothalamic dysfunction due to direct injury, cerebral inflammation, metabolic derangements, or early infectious processes. Despite extensive global research, local data regarding early hyperthermia as a prognostic indicator in severe TBI remains scarce in Pakistan. Objective: To determine the predictive value of early hyperthermia on mortality and neurological outcomes in patients presenting with moderate to severe traumatic brain injury at JPMC, Karachi. Methods: A prospective observational study was conducted at JPMC over six months. One hundred patients aged 13 years and above, presenting within four hours of acute head trauma with documented fever within three days, were enrolled. Patients with polytrauma, congenital CNS anomalies, vascular lesions, tumors, or spinal injuries were excluded. Temperature measurements, Glasgow Coma Scale (GCS), radiological findings, and neurological assessments were recorded. Outcomes were assessed using the Glasgow Outcome Scale (GOS) at three months. Data were analyzed using SPSS v22. Results: Early hyperthermia (≥38°C within the first 72 hours) was recorded in 48% of patients. Mortality at three months was significantly higher in hyperthermic patients (43.7%) compared to normothermic patients (21.1%). Poor neurological outcome (GOS 1–3) occurred in 68.7% of the hyperthermia group versus 39.4% of the normothermia group. Multivariate logistic regression demonstrated that hyperthermia was an independent predictor of poor outcome (OR 2.81, p = 0.008) after adjusting for age, initial GCS, and CT findings. Conclusion: Hyperthermia within the early post-injury period is a strong and independent predictor of poor neurological outcomes and increased mortality in severe TBI patients. Early targeted temperature management and aggressive fever control should be considered integral components of acute neurocritical care protocols to improve outcomes in this population.
A PROSPECTIVE COHORT ANALYSIS OF INCIDENCE AND RISK FACTORS CONTRIBUTING TO FAILED BACK SURGERY SYNDROME (FBSS)
Background: Failed Back Surgery Syndrome (FBSS) represents a complex postoperative condition characterized by persistent or recurrent lumbar pain following spinal surgery. Despite advancements in surgical techniques, FBSS remains a significant cause of disability, psychological burden, and repeated healthcare utilization. Degenerative Lumbar Disease (DLD) is one of the leading indications for spinal surgery, and the identification of pre- and postoperative risk factors remains essential in predicting and preventing surgical failure. Objective: To determine the incidence, associated demographic, clinical, psychosocial, and surgical risk factors contributing to FBSS among patients undergoing surgery for DLD at Jinnah Postgraduate Medical Centre (JPMC). Methods: This prospective cohort study enrolled 220 adult patients undergoing lumbar spine surgery for DLD. Preoperative, intraoperative, and postoperative variables were recorded using structured questionnaires and clinical documentation. Outcomes were evaluated over 6 months using a validated 5-point Likert scale, Oswestry Disability Index (ODI) components, and predefined FBSS criteria. Statistical analysis included chi-square testing, Anderson–Darling normality testing, independent t-tests, Levene’s test, correlation analysis, and multivariate logistic regression. Results: The incidence of FBSS in this cohort was 28.6%. Significant predictors included preoperative anxiety (p < 0.01), smoking status (p = 0.02), obesity (p = 0.03), severity of stenosis (p < 0.01), and surgery type, with open laminectomy demonstrating higher FBSS rates compared to minimally invasive surgery (p = 0.04). Logistic regression identified preoperative psychological distress (OR 2.74), high baseline pain levels (OR 1.89), and postoperative complications (OR 3.11) as independent predictors of FBSS. Conclusion: FBSS remains a multifactorial entity influenced by psychosocial, biomechanical, and procedural factors. The findings highlight the need for improved preoperative psychological screening, meticulous surgical planning, targeted lifestyle interventions, and structured postoperative rehabilitation strategies to reduce FBSS incidence.
LUNG PROTECTIVE VENTILATION STRATEGIES FOR PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME IN PACU AN OBSERVATIONAL STUDY
Background: Acute Respiratory Distress Syndrome remains a critical postoperative complication, and mechanical ventilation though lifesaving worsen lung injury if not carefully managed. Lung-protective ventilation strategies, which use low tidal volumes, optimal PEEP, and controlled plateau pressures, are well-established in the intensive care setting but understudied in the Post-Anesthesia Care Unit. Objectives: To observe and evaluate the use of lung-protective ventilation strategies in postoperative patients with or at risk for ARDS in the PACU of Lady Reading Hospital, Peshawar, and to assess adherence to established LPV guidelines. Methods: In this observational cross-sectional study, 188 adult surgical patients admitted to the PACU over a four-month period were enrolled via non-probability convenience sampling. Ventilator parameters (tidal volume, PEEP, FiO₂, plateau pressure, mode) and demographic data were recorded using a structured checklist. Data were analyzed descriptively and compared against guideline-based targets for LPV. Results: Among 188 patients, the majority were male (59.6%) with a broad age distribution. Volume-controlled ventilation was used in 50% of patients. Ideal low tidal volumes (≤ 6 mL/kg predicted body weight) were applied in 40.4%, while 28.7% received non-protective volumes (> 8 mL/kg). Moderate PEEP (6–8 cmH₂O) was used in 43.6% of patients, and 65.4% maintained plateau pressures under 30 cmH₂O. Complete adherence to LPV (all three criteria: low tidal volume, plateau pressure <30, PEEP ≥5) was seen only in 30.8% of patients. Conclusion: Lung-protective ventilation is partially implemented in the PACU, with many patients achieving some but not all LPV targets. There is a need for standardized ventilation protocols, ongoing training, and monitoring in the perioperative setting to improve adherence and potentially reduce postoperative pulmonary complications
ARDS, lung-protective ventilation, postoperative ventilation, PACU, PEEP, tidal volume
“RESTORING SHOULDER MOBILITY THROUGH THORACIC MANIPULATION IN ADHESIVE CAPSULITIS: A CLINICAL CASE REPORT”
Background: Adhesive capsulitis (AC), or frozen shoulder, is characterized by progressive pain and restriction of shoulder range of motion (ROM). While conventional physiotherapy focuses on the shoulder complex, emerging evidence suggests a role for the regional interdependence model, where thoracic spine dysfunction may contribute to shoulder symptoms. Case Presentation: A 45-year-old male presented with a 3-month history of right shoulder pain and stiffness, diagnosed with idiopathic adhesive capsulitis (Stage II, frozen phase). Initial treatment with a 2-week structured physiotherapy program (including moist heat, pendulum exercises, Spencer techniques, Maitland mobilizations, and progressive strengthening) yielded minimal improvement in pain and ROM. Intervention: Following the lack of progress, high-velocity, low-amplitude (HVLA) thrust manipulation was applied to the thoracic spine twice daily for three consecutive days. Outcomes: Immediate and significant improvements were noted post-intervention. Pain on the Visual Analogue Scale (VAS) decreased from 8/10 to 2/10. Shoulder ROM improved markedly: flexion increased from 70° to 140°, abduction from 55° to 150°, and external rotation from 15° to 50°. The patient regained independence in daily activities. Conclusion: This case demonstrates that thoracic spine HVLA manipulation can rapidly improve pain and restore functional ROM in a patient with AC who was unresponsive to conventional shoulder-focused therapy. It supports the principle of regional interdependence in shoulder rehabilitation. Thoracic assessment and manipulation should be considered as an adjunct intervention in the management of adhesive capsulitis, particularly when progress with standard care plateaus.
Adhesive Capsulitis; Frozen Shoulder; Thoracic Manipulation; High-Velocity Low-Amplitude Thrust; Regional Interdependence; Physical Therapy.
EVALUATION OF GENEXPERT VERSUS CONVENTIONAL DIAGNOSTIC METHODS FOR DETECTION OF PULMONARY AND EXTRA-PULMONARY TUBERCULOSIS
Introduction: Tuberculosis (TB) remains a major global health challenge, necessitating rapid and accurate diagnostic methods. While conventional techniques like acid-fast bacilli (AFB) smear and culture are widely used, their limitations in sensitivity and turnaround time highlight the need for more efficient tools. The GeneXpert MTB/RIF assay offers a molecular-based solution for the simultaneous detection of Mycobacterium tuberculosis and rifampicin resistance. Objectives: This study aimed to evaluate the diagnostic accuracy of GeneXpert in comparison to AFB smear and fluorescent staining, focusing on their sensitivity, specificity, and overall diagnostic performance. Material and Methods: This prospective cross-sectional study was conducted at Mahaban Medical and Research Hospital, Topi, District Swabi. A total of 227 samples (115 males and 112 females) were analyzed, categorized by age and sample type (pulmonary and extra-pulmonary). All samples underwent diagnostic testing with GeneXpert, AFB smear, and fluorescent staining. Results: Of the 227 samples, 36 (15.85%) were positive for M. tuberculosis, comprising 19 (52.77%) pulmonary and 17 (47.3%) extra-pulmonary specimens. The most affected age group was 1-20 years (36.11%). The GeneXpert assay demonstrated a sensitivity of 97.2%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 99.5%. In comparison, AFB smear showed sensitivity, specificity, PPV, and NPV of 72.2%, 99.5%, 96.3%, and 95.02%, respectively, while fluorescent staining showed corresponding values of 83.33%, 98.96%, 93.75%, and 97.44%, respectively. The incidence of rifampicin resistance was 2.8%, detected in one sputum sample by GeneXpert. Conclusion: GeneXpert demonstrates superior sensitivity and specificity compared with conventional smear microscopy. Its ability to rapidly and accurately detect both M. tuberculosis and rifampicin resistance makes it an invaluable tool for the timely diagnosis and effective management of tuberculosis. Incorporating GeneXpert into routine diagnostic protocols can significantly enhance TB control efforts
GeneXpert, rifampicin, Mycobacterium tuberculosis
RADIOLOGICAL STAGING OF METASTATIC OVARIAN TUMORS AND COMPARATIVE DIAGNOSIS ACCURACY OF CT AND MRI
A retrospective analysis was conducted on 30 patients diagnosed with metastatic ovarian tumors. Few patients underwent through CT while other went through MRI scans as part of their diagnostic workup. For lesions indeterminate on ultrasound, MRI increases the specificity of imaging evaluation, thus decreasing benign resections. CT is useful in diagnosis and treatment planning of advanced cancer. Both CT and MRI are valuable tools in the radiological staging of metastatic ovarian tumors, with MRI showing slightly higher sensitivity and specificity. However, the choice of imaging modality should consider the clinical context, availability, and potential radiation risks.
Impact of Mental Health on Post-Operative Recovery in Cardiac Patients: A Multi-Disciplinary Approach
The increased awareness of the mind-heart relationship has changed the concept of cardiac recovery. The previous evidence demonstrates that the psychological disorders like depression, anxiety, and post-traumatic stress disorder (PTSD) are not the indirect complications but the primary outcome determinants following cardiac surgery. Patients with psychological suffering have a slow recovery, more complications, and they are more likely to readmission. However, the integration of mental health in the cardiac care is still not sufficient because of stigma, lack of training, and systemic challenges. This review demonstrates the need to have a multidisciplinary model that brings together cardiologists, psychologists, nurses, and social workers to deal with both physical and emotional aspects of healing. Early screening of mental health through standardized methods such as PHQ-9 and GAD-7 have been seen to increase adherence and reduce the hospital stay. Besides, new digital interventions, such as mobile-based CBT, tele-counseling, wearable monitoring, further expand the availability of mental health support to institutions outside the hospital and at a lower cost. The evidence suggests that an immediate change is needed to incorporate psychological evaluation and treatment into the cardiac pathways. An all-inclusive cardiac care system should not only fix the failing heart but also the troubled mind - since healing can be achieved only when the two hearts beat in tune. Keywords: Cardiac Surgery, Post-operative Recovery, Mental Health, Depression, Anxiety, Psychological Resilience, Stress Management, Digital Health Intervention, Rehabilitation. https://doi.org/10.5281/zenodo.17825275
EFFECT OF LONG TERM HIGH DOSE ANTI-DEPRESSANT MEDICATION ON TEAR FILM STABILITY, A DESCRIPTIVE CROSS-SECTIONAL STUDY
Purpose: The primary aim of this research was to explore the relationship between long-term antidepressant use and the development of dry eye disease (DED). In addition, the study compared the ocular surface effects of two commonly prescribed antidepressant medications—escitalopram and sertraline—to determine whether one posed a higher risk of inducing dry eye symptoms than the other. Methods: A descriptive cross-sectional study was carried out between NOVEMBER 2023 and NOVEMBER 2025 at MAYO HOSPITAL, LAHORE. Participants using either escitalopram or sertraline were selected through purposive sampling. After obtaining informed consent, each individual underwent a Schirmer test to evaluate tear production, and the Ocular Surface Disease Index (OSDI) questionnaire was administered to assess symptom severity. All collected data were entered and analyzed using SPSS version 20. Chi-square tests were applied to determine the statistical significance of associations between antidepressant use, duration of intake, and dry eye findings. Results: A total of 180 subjects aged 20–40 years, including both males and females, were evaluated. Analysis revealed a strong association between dry eye disease and the duration of antidepressant usage, with longer treatment periods showing significantly higher rates of reduced tear production and increased symptom scores (p < 0.001). When comparing the two medications, no statistically significant difference was found in the likelihood of developing dry eye between users of escitalopram and those of sertraline (p = 0.488). This indicates that both drugs contribute similarly to tear film alteration and ocular surface discomfort. Conclusions: indings from this study emphasize the importance of considering ocular side effects in patients undergoing long-term antidepressant therapy. Prolonged use of either escitalopram or sertraline is associated with a higher risk of dry eye disease, underscoring the need for routine ocular assessment and detailed medication history in affected individuals. Eye care practitioners and other healthcare providers should remain aware of this association to ensure early detection and effective management of dry eye symptoms in antidepressant users. Keywords: Antidepressants, Dry eye disease, Schirmer test, OSDI, escitalopram, sertraline, ocular surface
Synthesis and Evaluation of Green Nanostructured Excipients for Improving the Solubility and Bioavailability of BCS Class II Drugs
The greatest disadvantage of oral delivery of BCS Class II drugs is poor aqueous solubility and this translates into low bioavailability and unpredictable therapeutic effects. This paper set out to review and analyze green nanostructured excipients with plant-based extracts to improve the bioavailability and solubility of a BCS Class II model drug. Interestingly, nanoparticles were synthesized through a green synthesis method that involved the utilization of plant phytochemicals as reducing and stabilization agents, and they were analyzed by UV-vis spectrophotometry, FTIR, XRD, TEM and DLS. The nanostructures that were synthesized were spherical, had particle sizes of about 40 nm, evenly distributed, and colloidal. Nanoparticle drug formulations showed a strong rise in solubility in aqueous, buffer and simulated gastric environments to a high of 6.9 fold increase relative to the solubility of the pure drug. In vitro dissolution analysis revealed the rapid and almost complete release of the drug in 45 minutes, whereas the in vivo pharmacokinetic analysis demonstrated that the relative bioavailability was increased three-fold, with significant increases in C max and AUC values in the in vivo environment. The compatibility tests established that the drug and the green excipients do not have any negative interactions. The results suggest that the green nanostructured excipients are a safe, sustainable and highly effective approach to address solubility and bioavailability challenges in BCS Class II drugs, which offers possible future pharmaceutical preparations. Keywords: BCS Class II drugs, green nanostructured excipients, solubility enhancement, bioavailability, plant-mediated nanoparticles
ANTIBIOTIC RESISTANCE PATTERNS AND EMPIRICAL THERAPY OUTCOMES IN CLINICAL SPECIMENS FROM QUETTA, PAKISTAN: A CROSS-SECTIONAL SURVEILLANCE STUDY
Background: Globally, antimicrobial resistance is a global threat, especially in developing countries like Pakistan, where AMR is rising because many are not able to afford proper treatment. This study analyzes a region surveillance with low data available, prevalence of bacterial pathogens, and antibiotic susceptibility in specimens from Quetta, Pakistan. Methods: A retrospective cross-sectional study was conducted in the tertiary care hospitals of Quetta from January to October 2025 total of 615 specimens were analyzed during our study, following CLSI and manufacturer guidelines for culture and sensitivity testing. R- Studio and SPSS were used for statistical analysis. Results: Among our study's total of 615 specimens, 36.0% have shown different microbial growth. The most common organism isolates were Pseudomonas aeruginosa (20.8%), Acinetobacter spp. (19.4%), Salmonella typhi (18.1%), and S. aureus (18.1%). The rate of antibiotic resistance was seen to increase in Pseudomonas aeruginosa and Acinetobacter spp., especially in 3rd-generation antibiotics, cephalosporins, and fluoroquinolones. E. coli has shown the highest sensitivity, 75.0% to Imipenem, Nitrofurantoin, and Amikacin. The success rate of empirical therapy was seen in 43.3% of cases and the mismatch rate was 56.7%, highlighting the limitations of current prescribing practices. Conclusion: Our study shows an increasing rate of AMR resistance among common pathogens in Quetta, and there is a vital need to develop a localized antibiogram and revisit empirical therapy protocols. This study also suggests working on antimicrobial stewardship and regional surveillance for a better understanding of clinical outcomes and mitigation of resistance.
Antimicrobial resistance, Empirical therapy, Antibiotic susceptibility, Pseudomonas aeruginosa, Acinetobacter spp
ROLE TRANSITION EXPERIENCES OF NEWLY GRADUATED NURSING STUDENTS (NURSING INTERNEE); A QUANTITATIVE CROSS- SECTIONAL STUDY AT MMC MARDAN
Background: The transition from academic training to independent clinical practice, which is frequently characterized by reality shock and increased emotional and professional demands, presents substantial challenges for recently graduated nurses. This shift is acknowledged as a crucial factor in determining competence, retention, and long-term job satisfaction on a global scale. Objectives: The purpose of this study was to evaluate the role transition experiences of nursing interns at Mardan Medical Complex Hospital in Mardan, Pakistan. Methodology:137 recently graduated nursing students were chosen by convenient sampling using a descriptive cross-sectional design. A self-modified questionnaire that was adapted from earlier research was used to collect the data, and a Cronbach's alpha value of 0.75 confirmed internal consistency. Non-parametric tests were used because the normality assessment using the Kolmogorov-Smirnov and Shapiro-Wilk tests revealed p-values <0.001, indicating a non- normal data distribution. Results: According to the findings, the majority of participants were male, between the ages of 24 and 26, single, and had CGPAs between 3.0 and 3.5. The majority of respondents agreed they received sufficient orientation, acquired the necessary clinical skills, effectively prioritized patient care, and felt competent in patient education, all of which contributed to positive overall perceptions of clinical competency and organizational readiness. Despite the fact that 40.1% of participants reported feeling stressed during the transition, they expressed strong confidence in their ability to make moral decisions, communicate effectively across disciplines, and be prepared to the transition program. There were no significant gender differences in competency (U = 1957.0, p = 0.766) or organizational skills (U = 1840.5, p = 0.401) according to Mann-Whitney U-tests, and there was no significant association between CGPA and competency (H = 2.222, p = 0.528) or management skills (H = 3.808, p = 0.283) according to Kruskal-Wallis tests. Conclusion: These results imply that nursing interns generally believe they are clinically competent and organizationally prepared, supported by structured orientation and teamwork, even though they are under stress. According to the study's findings, although role transition is still difficult, new nurses may find it easier and feel more confident if mentorship, clinical support systems, and organized orientation programs are strengthened.
GENETIC LANDSCAPE OF MICROCEPHALY: A COMPREHENSIVE REVIEW
Microcephaly is a neurodevelopmental disorder characterized by a small brain size at birth, which can be caused by various genetic and environmental factors. The clinical presentation of microcephaly can vary widely depending on the underlying cause, severity, and associated comorbidities. In addition to a small head circumference, individuals with microcephaly may exhibit developmental delay, intellectual disability, seizures, motor impairments, and facial dimorphisms. Genetic Basis of Microcephaly: Advancements in genomic technologies, particularly next-generation sequencing, have revolutionized our understanding of the genetic landscape underlying microcephaly. Numerous genes implicated in microcephaly encode proteins involved in essential cellular processes, including centrosome function, spindle assembly, DNA replication and repair, and cell cycle regulation. Mutations in these genes disrupt neuroprogenitor cell division and differentiation, ultimately leading to reduced brain size. Diagnostic Modalities: Diagnosing microcephaly requires a thorough clinical assessment, including measurement of head circumference, neuroimaging studies, and genetic testing. While head circumference measurements serve as a screening tool, neuroimaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) provide valuable insights into brain morphology and structural abnormalities. Genetic testing, including chromosomal microarray analysis and targeted gene sequencing, can identify causative mutations in individuals with suspected genetic forms of microcephaly. Conclusion Microcephaly is a complex neurodevelopmental disorder with diverse etiologies and clinical manifestations. Advances in genetics and neuroimaging have enhanced our understanding of its underlying pathogenesis and facilitated early diagnosis and intervention.
INTEGRATING BIOMEDICAL AND INFORMATION TECHNOLOGY THROUGH PROJECT MANAGEMENT: A QUANTITATIVE SYNTHESIS OF HEALTHCARE INNOVATION
Background: The convergence of biomedical innovation and information technology (IT) has redefined modern healthcare. Artificial intelligence (AI), telemedicine, wearable/Internet of Medical Things (IoMT) devices, and bioinformatics pipelines are enabling precision medicine and remote care at an unprecedented scale. Yet, project failure rates remain high—often exceeding 35–45 %—due to inadequate governance, weak data integration, and regulatory misalignment. Effective project management is increasingly recognised as the key enabler of safe, scalable, and sustainable biomedical–IT innovation. Objectives: This paper investigates how project management methodologies influence biomedical–IT integration outcomes between 2020 and 2025. It quantitatively synthesises peer-reviewed data on technological adoption, performance metrics, and implementation success across four domains—AI in healthcare, telemedicine, wearables/IoMT, and bioinformatics/genomics. It further develops an evidence-based hybrid project-management framework integrating agile, regulatory, and clinical governance practices. Methods: A structured literature synthesis was conducted across PubMed, Scopus, Web of Science, and official regulatory repositories for studies published between January 2020 and June 2025. After screening 120+ records, 68 studies met inclusion criteria, and 47 were fully analysed. Quantitative data were extracted for system accuracy, adoption rates, outcome improvements, and cost- effectiveness. Data were normalised and summarised using descriptive statistics (mean, percentage change, confidence ranges) to reveal sectoral performance and project-success metrics. Qualitative insights on project-governance mechanisms and regulatory compliance were mapped to the PMBOK, Agile, and PRINCE2 frameworks. Results: The analysis revealed significant quantitative gains in biomedical–IT performance, balanced by persistent project-governance challenges. AI in healthcare: Diagnostic AI models achieved a pooled mean accuracy of 89.6 % (95 % CI = 86.9–92.2) in image-based tasks; however, only 27 % reached real-world clinical deployment, mainly due to regulatory and workflow barriers. Telemedicine: Post-COVID adoption reached 87 % of U.S. office-based physicians in 2021, stabilising to 62 % by 2024, with reported patient-satisfaction rates above 78 % and cost savings averaging 18 % per encounter. Wearables/IoMT: Device accuracy averaged 91 % for heart-rate monitoring and 84 % for step count; yet long-term adherence dropped to 57 % after 6 months, correlating with project sustainability challenges. Bioinformatics/genomics: Pipeline throughput increased by 220 % (2020–2024) due to cloud-compute integration, but replication errors were reported in 12 % of studies lacking version-control protocols. Project-management integration significantly improved outcomes: projects employing hybrid governance (agile + regulatory stage-gates) had a 34 % higher probability of meeting performance and compliance goals compared with ad-hoc or purely technical management models. Conclusion: Quantitative synthesis confirms that biomedical–IT integration is technically successful yet organisationally fragile. Projects that combined agile iteration with formal quality assurance, clinical validation, and data-governance oversight achieved measurable improvements in scalability, compliance, and clinician adoption. The findings support a shift toward hybrid project- management models that embed data ethics, regulatory readiness, and stakeholder communication as core deliverables. These results have strong implications for health-system digital transformation, policy design, and cross-disciplinary training in the coming decade.
Biomedical informatics; health information technology; project management; artificial intelligence; telemedicine; wearables; bioinformatics; quantitative synthesis; digital health governance
ESBL-PRODUCING ENTEROBACTERIACEAE IN ICU PATIENTS: PREVALENCE AND AMR PATTERNS IN PAKISTAN
Background: Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae are an escalating threat to global healthcare, particularly in Intensive Care Units (ICUs), due to their capacity for multidrug resistance and nosocomial spread. Objective: To determine the prevalence and antimicrobial resistance profile of ESBL-producing Enterobacteriaceae among ICU patients in a tertiary care hospital. Methods: 100 clinical samples from ICU patients were processed using standard bacteriological methods. ESBL production was confirmed by phenotypic techniques including Combined Disk Test (CDT), Double Disk Synergy Test (DDST), and Three-Dimensional Test (TDT). Antimicrobial susceptibility was determined by the Kirby–Bauer method per CLSI 2024 guidelines. Results: Of 100 samples, 58 isolates belonged to Enterobacteriaceae, among which 42 (72.4%) were ESBL producers. E. coli (52.3%) and Klebsiella spp. (38%) were predominant. Resistance was highest to β-lactams and third-generation cephalosporins, while carbapenems remained effective. Conclusion: The high prevalence of ESBL-producing Enterobacteriaceae in ICU settings highlights an urgent need for robust antibiotic stewardship and infection control policies
PREVALENCE OF DE QUERVAIN’S TENOSYNOVITIS AMONG CLINICAL PHYSICAL THERAPISTS IN PESHAWAR, PAKISTAN; A CROSS SECTIONAL STUDY
De Quervain’s tenosynovitis is an idiopathic condition characterized by pain on the radial (thumb) side of the wrist. It is also described as an overuse disease caused by repetitive hand and wrist movements and continued strain. Activities like stapling, writing, brushing hair, shaving, using eating utensils, or even grasping the steering wheel of vehicle may exacerbate pain. Physical therapy is most physically demanding profession because of this physiotherapists are more prone to develop work-related musculoskeletal problems. Objectives To determine the Prevalence of de quervain’s tenosynovitis among clinical physical therapist. Methodology This was descriptive cross sectional study. A total of 189 clinical physical therapists was included in this study and the sample size was taken by Roasoft software, the data was collected through standard based questionnaire. The data was analyzed through SPSS 2.0. The Pearson chi-square test was used for testing the association between the various predictors and the diagnosis of De Quervain’s tenosynovitis. Results A total of 189clinical physical therapists participated in the study. The statistical analysis shows that 27% of the clinical physical therapists were affected by De Quervain’s tenosynovitis. Conclusion This research highlights the significant prevalence of De Quervain's tenosynovitis among clinical physiotherapists. A substantial portion of this professional group reports experiencing symptoms or receiving a diagnosis of the condition. This underscores the importance of implementing preventive measures, making ergonomic workplace adjustments, and providing continuous education about this ailment to safeguard the well-being of clinical physiotherapists
Wrist pain Physical therapist Clinical Physical Therapist, De Quervain's tenosynovitis, Finkelstein test work-related musculoskeletal disorder
"ENVIRONMENTAL AND HEALTH RISKS OF PARABEN PRESERVATIVES IN LOW-QUALITY COSMETICS: PERSISTENCE IN ECOSYSTEMS AND IMPACT ON SKIN SENSITIVITY AND ALLERGIES"
Parabens are widely used as preservatives in high production and low-cost cosmetic products because of their ability to preserve products and their non-biodegradable nature poses a big concern. This paper aims to discuss the bioaccumulative property of parabens in aqueous environment and the skin related consequences of their wide application in cosmetic products. A pilot cross-sectional study to assess consumer understanding and encounters with parabens portrays a low level of awareness regarding the existence and harms of parabens along with high rates of cutaneous manifestations including irritation and allergy. However, the reason why more and more people turn to the exclusion of paraben products is still due to the increasing demand for safer and more environmentally friendly products. From these observations, there is the need to improve legislation on paraben use in cosmetics especially in developed nations and there is the need to increase the amount of public health concern in nations for more effective, less-hazardous preservative substances in cosmetics.
Cosmetic, Environment, Paraben, Skin, Allergy
Quantification and Risk Assessment of Microplastic Contamination in Film-Coated Tablets During the Manufacturing Process
Microplastic (MP) pollution in drug preparations has become a possible human health hazard, with little studies measuring its level in oral dosage preparations. This paper set out to examine the frequency, composition and hazard of microplastics in film-coated tablets during the manufacturing process. Five critical stages (raw material handling, granulation, compression, coating and packaging) were sampled a total of 150 composite samples were taken. Microplastic particles were separated with controlled digestion and filtration, characterized with µ-FTIR spectroscopy, Raman microspectroscopy, and Pyrolysis–GC–MS, and found out that polyethylene (PE) and polypropylene (PP) were the most common polymers and the contamination level was the highest during the coating and packaging stages. The particle size analysis showed that 77% of microplastics were less than 50 µm, which has a possible implication of bioavailability and systemic exposure. The estimate of the daily intake (EDI) showed that the exposure risk was low-moderate in the usual dosing schedules. The investigation reveals the existence of critical points of contamination during the manufacturing process and indicates that the issues of improved quality control measures should be considered such as equipment maintenance, filtration, and polymeric material monitoring. The results offer a background knowledge of microplastic pollution in pharmaceuticals, which can be used to guide regulatory frameworks, Good Manufacturing Practices (GMP), and further studies that aim at mitigating the exposure and the long-term effects of the pollution.
SERUM PIVKA-II PROFILING FOR HEPATOCELLULAR CARCINOMA DETECTION IN BALOCHISTAN: A CROSS-SECTIONAL DIAGNOSTIC STUDY
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with delayed diagnosis contributing to poor outcomes in resource-limited regions. Protein Induced by Vitamin K Absence-II (PIVKA-II), a non-functional prothrombin variant, has emerged as a promising biomarker for HCC detection and risk stratification. This study investigates serum PIVKA-II levels in a regional cohort from Balochistan, Pakistan, to evaluate its diagnostic performance and demographic associations. Methods: A cross-sectional analysis was conducted on 34 patients undergoing liver disease evaluation. Serum PIVKA-II concentrations were measured using Chemiluminescent Microparticle Immunoassay (CMIA) and stratified into three diagnostic categories: Healthy (≤43 mAU/mL), Borderline (44–147 mAU/mL), and HCC (≥148 mAU/mL). Age and gender distributions were analyzed to identify epidemiological trends. Results: Of the 34 participants (25 males, 9 females; age range: 38–75 years), 19 (55.9%) exhibited PIVKA-II levels consistent with HCC, 2 (5.9%) were borderline, and 13 (38.2%) fell within the healthy range. HCC-range elevations were most frequent in males aged 60–69 years. Notably, one male aged 30–39 presented with an extreme elevation (>30,000 mAU/mL), suggesting possible early-onset or aggressive disease. Overall, 74% of HCC-range cases were male, reinforcing known gender disparities in HCC prevalence. Conclusion: PIVKA-II demonstrates strong diagnostic utility for HCC in this underserved population, with clear age and gender correlations. Its integration into routine screening protocols may enhance early detection, particularly in high-risk male cohorts. Further multicenter studies incorporating AFP and molecular profiling are warranted to validate dual-marker strategies and optimize diagnostic algorithms for liver malignancies in low-resource settings.
PIVKA-II , Hepatocellular carcinoma (HCC), Biomarker profiling, Gender stratification, Age-specific prevalence, Balochistan cohort, Non-invasive diagnostics