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"
ASSOCIATION BETWEEN CHRONIC HYPERGLYCEMIA AND LIVER FUNCTION TEST ABNORMALITIES IN DIABETIC PATIENTS
Diabetes mellitus is characterized by hyperglycemia and insulin production and activity abnormalities. Some of the liver parameters discussed in this review are Alanine aminotransferase ALT, Alkaline phosphatase (ALP), Aspartate aminotransferase serum (AST), Gamma-glutamyl transpeptidase GGT, Total bilirubin (TBIL). The factors play a significant role in the occurrence of different types of diabetes such as gestational diabetes (GDM), type 1 diabetes (T1DM), and type 2 diabetes (T2DM). The article highlights that high levels of ALT and AST are associated with inflammation or damage of the liver, particularly in the absence of alcoholic fatty liver disease (NAFLD), and low albumin concentrations could indicate inflammation. Raised ALP can have an effect on changes in bone metabolism, biliary malfunction, or liver inflammation. High bilirubin levels are independently related to both a high risk of T2DM and albuminuria in T1DM. The increase of GGT levels is believed to be the evidence of oxidative stress and liver damage in the situation of T2DM.
type 1, type 2, gestational diabetes, liver parameters, etiology, and diabetes mellitus
PREVALENCE OF NOMOPHOBIA AND ITS RELATIONSHIP WITH DIGITAL DEVICE USE AND TECH-INDUCED POST-EXERTIONAL MALAISE (TI-PEM) AMONG YOUNG ADULTS; A CROSS-SECTIONAL STUDY
Background: The rapid expansion of digital technology had transformed communication, learning, and entertainment among young adults. However, prolonged digital device use had increasingly been associated with psychological dependence and physical fatigue. Nomophobia and technology-induced post-exertional malaise represented emerging concerns, yet limited evidence was available regarding their prevalence and interrelationship among young adults. Objectives: The objective of this study was to determine the prevalence of nomophobia and to examine its relationship with digital device use and technology-induced post-exertional malaise among young adults aged 18–35 years. Method: A cross-sectional study was conducted among 352 young adults aged 18–35 years from academic settings. Data were collected using the Nomophobia Questionnaire, the Chalder Fatigue Scale, and a structured digital device-use questionnaire. Descriptive statistics, frequency distributions, and correlation analyses were performed using Statistical Package for the Social Sciences version 22. Result: Moderate nomophobia was reported by 52.8% of participants, while 28.7% exhibited mild and 18.5% severe levels. Moderate levels of technology-induced post-exertional malaise were observed in 50.9% of respondents. Android smartphones were the primary devices used by 69.9% of participants, and 66.2% reported more than four years of continuous digital device use. Daily screen exposure exceeding six hours was reported by 30.7% of participants. Conclusion: The findings demonstrated a substantial prevalence of nomophobia and technology-related fatigue among young adults. Prolonged screen exposure and long-term digital engagement were associated with increased psychological dependence and post-exertional malaise. Clinical Implications: These findings emphasised the importance of promoting healthy digital device use among young adults. Incorporating digital wellness awareness into educational and healthcare settings may help reduce technology-related fatigue and psychological dependence, while future research may explore targeted preventive strategies.
Nomophobia, digital device use, Ti-PEM, screen time, young adults, smartphone dependence.
PERCEIVED ROLE OF AI CHATBOTS IN SUPPORTING SELF-DIRECTED LEARNING AMONG UNDERGRADUATE NURSING STUDENTS: A CROSS-SECTIONAL STUDY IN MARDAN
Background: The incorporation of artificial intelligence into higher education has put in place new opportunities in enhancing self-directed learning (SDL), specially in nursing education where ongoing learning and clinical thinking is necessary. Objectives: To examine the role of AI chatbots in enhancing self-directed learning among undergraduate nursing students in Mardan. Methodology: This quantitative cross-sectional study was conducted in 197 undergraduate nursing students including Final year students and Nursing internee, selected through convenient sampling technique. Data were collected using structured, self-administered questionnaire examining perceived educational benefits, interaction and personalization concerns, learning limitations, implementation challenges, and reliability problems related to AI chatbot use. Internal Consistency of the questionnaire showed a very good Cronbach’s alpha value of 0.850. Descriptive statistics of the participants provided summary of their background information and opinions. Independent sample t test was applied to compare self-directed learning parts between final year students and nursing interns. Result: The result shows that most of the respondent’s thoughts AI chatbots were helpful for understanding complex nursing concepts, getting ready for exam, and finding medical information. There was a statistically significant difference between final year students and nursing interns in term of how much they think they benefit from their education (p=0.022), and their worries about putting what they learned into practice (p=0.030). Still, there was no statistically significant difference in the overall self-directed learning score between the two groups (p=0.954). Conclusion: Although there are worries about ethics, less interaction with teachers, and whether the information is reliable, many people see AI chatbots as helpful tools for learning on your own. The study finds that AI chatbots can help nursing students learn on their own when used together with regular teaching methods.
Copyright (c) 2026 Review Journal of Neurological & Medical Sciences Review
AUTISM SPECTRUM DISORDER AS A PREDICTOR OF WORKING MEMORY AND PLANNING IMPAIRMENT IN CHILDREN
The present study aimed to assess the Autism Spectrum Disorder as Predictor of Impaired Working memory and Inhibition in autistic children. It was hypothesized that Autism Spectrum Disorder impaired working memory and planninga. Additionallly, To investigate the frequency of ASD in term of gender. The sample (n=120) with the age 4-13 years were drawn through purposive sampling technique from Centre of Excellence for children Autism, Directorate of Social Welfare, the Autism Unit, University of Peshawar and the Autism Jewel. Childhood Executive Functioning Inventory (CHEXI) and the Childhood Autism Rating Scale (CARS) were utilized to assess impact of asd on working memory, planning respectively. Descriptive Statistic, Stepwise Regression analysis was used. The results revealed that Autism Spectrum Disorder significantly affect Working Memory and Planning. Hence Autism Spectrum Disorder was significant predictor of impaired working memory and planning. the results of present study help mental health workers such aspsychologist and ABA therapist to design strength based intervention which help child to manage their executive functioning in academic and non-academic setting.
autism spectrum disorder, working memory, planning, children with autism
RISK OF FIBROADENOMA IN PATIENTS PRESENTING WITH BREAST LUMP
Background Breast lump remains one of the common clinical presentations in surgical practice, and worry about malignant potential is always a concern. Fibroadenoma is the most common lesion encountered aroused breast diseases especially in young women. Much, though its relative frequency and age distribution varies across populations so local data are needed to shape helpful clinical information. Objective To assess the risk (incidence) of fibroadenoma among patients who visit with breast lump. Study Design Retrospective cross-sectional study. Place and Duration of Study Study conducted at the Department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi from January 2024 to December 2024. Methods The records of patient treated with breast lump were evaluated. Age, sex, clinical presentation before surgery, imaging findings and histopathological diagnosis were obtained. Triple assessment including clinically, imaging [ultrasound and/or mammography (MAMO)] and cytological/histopathological evaluation [fine needle aspiration cytology (FNAC) or core biopsy] was done in all patients. SPSS version 26 was used for data analysis. Frequencies and percentages were calculated, while associations were evaluated based on the chi-square test with p ≤ 0.05 is considered statically significant. Results In total, 180 patients were enrolled with a mean age of 26.8 ± 8.4 years. The majority were females (97.2%). Fibroadenoma was the most prevalent breast lesion, accounting for 102 (56.7%) of patients diagnosed with such a condition. The frequency highest in the age group of 21–30 years. Younger age was significantly associated with fibroadenoma (p = 0.001). Conclusion Fibroadenoma is the most prevalent cause of a breast lump, especially in young women. Triple assessment allows accurate diagnosis to guide management and discard malignancy.
Breast lump Fibroadenoma Benign breast disease FNAC Retrospective Study Triple assessment
INFLUENCE OF LOWER EXTREMITY MALALIGNMENTS ON MOVEMENT KINEMATICS AND DISABILITY IN ACUTE VS. CHRONIC LOW BACK PAIN PATIENTS
Background: Low back pain (LBP) is one of the leading causes of disability worldwide. Lumbar biomechanics may be impacted by lower extremity malalignments like pes planus, genu varum, genu valgum, and limb length discrepancy, leading to discomfort and disability. However, there is limited information on the comparison of movement kinematics and impairments between acute and chronic LBP. Objectives: This study examined lower-extremity alignment, movement kinematics, lumbar range of motion (ROM), pain severity, and functional impairment in individuals with both acute and chronic low back pain. Methods: This cross-sectional study included 50 participants, divided into two equal groups: 25 with acute low back pain and 25 with chronic low back pain, all aged 18–25 years and recruited through convenience sampling. Outcome measures included the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RMDQ), lumbar range of motion (ROM) assessed with a goniometer, and a composite functional movement score. Group differences were analyzed using independent samples t-tests. Outcomes: Individuals with long-term low back pain (LBP) reported far more pain. (VAS: 6.92 ± 3.04 versus 5.24 ± 1.61; p = 0.018), increased disability (ODI: 23.84 ± 7.80 compared to 17.96 ± 5.79; p = 0.004; RMDQ: 12.24 ± 3.06 versus 9.92 ± 3.40; p = 0.015), greater restriction in range of motion (10.32 ± 2.82 versus 8.56 ± 2.72; p = 0.030), and poorer functional performance (16.28 ± 4.18 compared to 12.92 ± 3.29; p = 0.003) than those with acute LBP. In conclusion, chronic LBP is associated with increased pain, disability, and movement impairments. Malalignments in the lower extremity might contribute to these effects.
MINIMAL EEG ELECTRODE SELECTION FOR EMOTION RECOGNITION: A 2-CHANNEL CROSS-SUBJECT STUDY ON THE DREAMER DATASET
EEG-based emotion recognition holds considerable promise for affective computing, neuromarketing, and brain-computer interface (BCI) applications, yet its practical deployment remains constrained by the requirement for dense electrode configurations. This study investigates whether a minimal subset of electrodes from the consumer-grade Emotiv Epoc headset (14 channels) can preserve or exceed emotion classification accuracy, enabling low-cost wearable emotion recognition. The DREAMER multimodal affective dataset (23 subjects, 14-channel EEG, 18 video stimuli) was used, and log band power features were extracted across five frequency bands: theta, alpha, beta-low, beta-high, and gamma. Three complementary electrode importance ranking methods — mRMR, SHAP, and permutation importance — were applied within a Leave-One-Subject-Out (LOSO) cross-validation loop to produce a leakage-free consensus electrode ranking. A systematic ablation study evaluated SVM (RBF kernel) and LDA (SVD solver) classifiers for top-ranked subsets ranging from 2 to 14 channels. The top-ranked 2-channel subset (F4 and P7) achieved 62.39% valence and 75.43% arousal accuracy with SVM, exceeding the full 14-channel baseline (53.36% and 74.62% respectively) by +9.03 percentage points for valence. This improvement was statistically significant (Wilcoxon signed-rank test: W = 266.0, p < 0.001; paired t-test: t = 4.477, p < 0.001), with 20 of 23 subjects individually showing improved performance. Notably, LDA maintained consistently higher valence accuracy (58.99%–61.94%) than SVM across all subset sizes, with the gap widening at larger subsets, corroborating a bias-variance overfitting interpretation. An 86% reduction in electrode count was achieved with no loss in classification performance. The arousal-valence accuracy gap of 21.26% observed at baseline narrowed to 13.04% under the minimal electrode configuration, consistent with neurophysiological theory.
EEG; Emotion Recognition; DREAMER; Brain-Computer Interface; Affective Computing;
SPATIOTEMPORAL DISTRIBUTION AND PUBLIC HEALTH IMPLICATIONS OF THE SYNANTHROPIC FLY MUSCA DOMESTICA IN PAKISTAN BASED ON GBIF OCCURRENCE RECORDS (2010–2025)
Musca domestica (housefly) is a medically important synanthropic insect with a well-documented role in the mechanical transmission of human pathogens. This study investigates the spatiotemporal distribution and seasonal dynamics of M. domestica in Pakistan using occurrence records obtained from the Global Biodiversity Information Facility (GBIF) for the period 2010–2025. After data filtering, 18,739 georeferenced records were analyzed. Temporal trends revealed a substantial increase in occurrence records after 2018, with a peak in 2024, indicating intensified reporting and/or expansion of synanthropic populations. Spatial analysis demonstrated widespread distribution across Pakistan, with pronounced clustering in densely populated and agriculturally active regions. Density-based hotspot analysis identified high-risk zones associated with urban centers, livestock operations, and waste accumulation sites. Seasonal patterns showed peak occurrence during late summer and early autumn, followed by a marked decline in winter, reflecting environmental constraints on population dynamics. These findings highlight the strong association of M. domestica with human-modified environments and underscore its potential role in pathogen transmission in high-density regions. This study demonstrates the utility of open-access biodiversity data in identifying vector hotspots and provides a baseline framework for integrating ecological surveillance into public health risk assessment and vector control strategies.
Musca domestica, housefly, synanthropic insects, temporal trends, spatial distribution, seasonal variation, Pakistan, biodiversity databases
MOLECULAR BASIS OF ANTIBIOTIC RESISTANCE, GENETIC MECHANISM AND THERAPEUTIC STRATEGIES
Antibiotic resistance has become a global health crisis, driven by transferable resistance genes and diverse molecular mechanisms. Bacteria evade antibiotics through three core strategies: preventing drug access, altering or protecting targets, and directly inactivating drugs (e.g., via β-lactamases). Despite the clinical success of β-lactams—over 40 variants widely used—bacterial enzymes now threaten their utility. Even β-lactamase inhibitors are losing effectiveness as resistant mutants emerge. Genetic mechanisms include mutations and horizontal gene transfer. Biochemically, resistance arises through drug inactivation (β-lactamases, acetylases, phosphorylases), target modification (altered penicillin-binding proteins), permeability changes, and active efflux pumps. Clinically significant examples include enterococci (intrinsic and acquired resistance to multiple drug classes) and staphylococci (altered PBPs and β-lactamase expression). The transfer of glycopeptide resistance from enterococci to staphylococci is particularly concerning. Antimicrobial resistance (AMR) emerges from overuse in human medicine, veterinary practice, and agriculture, creating selection pressure. Multidrug resistance (MDR) involves genomic duplication, enzymatic modification, target alteration, membrane modulation, and efflux pumps, leading to treatment failures. New therapeutic directions include antivirulent therapy, antimicrobial peptides, phage therapy, vaccines, and nanoparticles. Combating AMR requires antimicrobial susceptibility testing, rapid diagnostics, timely clinical response, and novel pharmacodynamic approaches. The genetic plasticity of bacterial pathogens—through mutations and gene acquisition—has enabled resistance to nearly all clinical antibiotics. Understanding biochemical and genetic fundamentals is essential to reduce resistance transmission and develop effective therapies against multidrug-resistant organisms. Without urgent action, we face an era where common bacterial infections may become untreatable.
antimicrobial agent; drug; antibacterial drug; bacteria; antibiotic resistance; efflux; multidrug efflux
IMPACT OF POINT OF CARE TESTING ON CLINICAL DECISION-MAKING IN BIOCHEMISTRY – A REVIEW
Background: Point-of-Care Testing (POCT) is a relatively new concept in contemporary clinical biochemistry, offering quick diagnostic data close to the bedside. In contrast to traditional laboratory testing, which is characterized by delays in the transportation of samples, their processing, and reporting, POCT provides real-time biochemical data that can have a direct impact on clinical judgment. The rise in its application in emergency rooms, intensive care units, outpatient departments, and critical care environments has piqued the curiosity on its application in enhancing patient management and healthcare efficiency. Purpose: To assess the effects of point-of-care testing on clinical decision-making in biochemistry, and to determine how effectively point-of-care testing can be used to help reduce turnaround time, enhance diagnostic efficiency and aid in the timely management of a patient. Methodology: This research was done as a cross-sectional analytical research within the biochemistry and clinical care sections, of a tertiary care hospital. Professionals in healthcare who dealt with the diagnosis and management of patients were factored in. A structured proforma was used to collect the data that included turnaround time, accuracy of results, impact on treatment decisions, and overall clinician satisfaction. The results of POCT were compared to the traditional laboratory testing in routine clinical practice. Data were compared with proper statistical techniques to establish the significance of the differences observed. Findings: The research revealed that POCT greatly led to a shortening of the turnaround time, and it also offered quicker access to biochemical findings. This resulted in a more timely clinical decision, a timely start or change in treatment and enhanced patient flow in acute care. The majority of clinicians claimed that POCT enhanced the confidence in immediate patient care, especially in emergency and critical care situations. All in all, POCT had a positive effect on diagnostic efficiency and clinical decision-making. Conclusion: POC testing has a useful purpose in clinical biochemistry as it helps in better clinical diagnosis and makes prompt clinical decisions. Its adoption in the medical environment could enhance patient care and maximize clinical performance.
Point-of-care testing, clinical decision-making, biochemistry, turnaround time, rapid diagnosis, patient management
THE IMPACT OF DARK TRIAD, NATURE CONNECTEDNESS, AND EUDAIMONIC WELLBEING AMONG UNIVERSITY STUDENTS
This paper examines how Dark Triad personality characteristics and Nature Connectedness impact Eudaimonic Wellbeing in university students at Sargodha in Pakistan. University life is a crucial period of identity, relationship building, and seeking purposes. The knowledge of the impact of personality traits and environmental relationships on the psychological prosperity of students will be especially important in developing nations, where cultures, social and economic conditions influence the experiences of young individuals. It used a cross-sectional research design and purposive sampling was used to recruit 300 university students (62.7 percent female, 37.3 percent male; age range 19-35 years) in government and private universities of Sargodha. The respondents were given the Short Dark Triad Scale (SD3), Connectedness to Nature Scale (CNS), and the Questionnaire of Eudaimonic Wellbeing (QEWB). Pearson correlation, multiple regression analysis and independent samples t-tests were used to analyze the data. Findings showed that there was a significant positive correlation between Nature Connectedness and Eudaimonic Wellbeing (r = 0.33, p < 0.01) in favor of the hypothesis that the stronger the relationship to nature, the more the flourishing of the psyche. Conversely, Eudaimonic Wellbeing was also significantly positively correlated with Dark Triad traits (r = 0.23, p < 0.01), indicating that there are more complicated relations between dark personality traits and wellbeing. Regression analysis showed that both Dark Triad (0.12, p < 0.003) and Nature Connectedness (0.39, p < 0.001) had a significant predictive value on Eudaimonic Wellbeing, explaining, 13% of the variance. Males scored significantly higher on Dark Triad characteristics, males ranked much higher than females (t = 3.42, p = 0.001, Cohen d = 0.40) as was previously seen in the difference between the male and female dark personality traits. These results add depth to the psychological thriving in non-Western educational settings, and highlight the value of nature involvement in student wellbeing, in addition to delivering complex associations between personality traits and wellbeing that contradict simplistic conceptualizations of the idea of dark characteristics as all equally bad
Dark Triad, Nature Connectedness, Eudaimonic Wellbeing
PREVALENCE OF MALARIA DISEASE AND ITS VECTORS ANOPHELES CULICIFACIES AND ANOPHELES STEPHENSI (DIPTERA: CULICIDAE) IN MAIN MALARIA AFFECTED AREAS OF SINDH.
Background: Malaria is a vector borne disease and one of the leading serious health issue in south Asia including Pakistan. Globally approximately 282 million cases and 610,000 deaths were reported during the year (2024). The main affected regions of the world are Africa and Asia, probably due to significant challenges poses to elimination efforts against its vectors, Anopheles culicifacies and Anopheles stephensi. Aim: This study aimed to observe the frequency of malaria cases in endemic area of Sindh and seasonal diversity of its vectors which transmitted malaria parasite in different areas of studied localities. Methods: Blood samples were collected through finger pick and then observed by thick and thin microscopy. While mosquito were collected by aspirator and insect neat at the time of dawn and dusk, larvae were collected by dipping method from different breeding habitats. Results: During the study period twelve months (361247) blood samples were screened out of which (17127) were found positive for malaria parasites. Most frequent species Plasmodium vivax (11803) followed by P. falciparum (3969) and mixed infection (1355). Seasonal diversity of malaria vectors (121) adults were collected during dry season (pre-monsoon) and (239) were collected during wet season (post-monsoon). Conclusion: Proper awareness should be important regarding to wearing of proper protective clothing to low socioeconomic people. Civilian bodies and Non-government should encourage local population to actively take part in clearing mosquito breeding places. As number of malaria patients are increasing day by day, it is recommended that malaria control program should also focus on research regarding development of novel synergistic and compound combination effective against drug resistant Plasmodium species and Anopheles mosquito.
Anopheles mosquito, Anti-malaria drugs Resistant, Control measurements, Health issue, Monsoon rain, Plasmodium
A CROSS-SECTION INVESTIGATION OF FALL INCIDENTS IN CRITICAL CARE UNIT IN TERTIARY SETTING OF PESHAWAR PAKISTAN
Background: Falls in intensive care unit is a major public health concern as they lead to catastrophic injuries and consequences. Critically sick individuals are more susceptible due to limited mobility, drugs side effects and physiological instability. Objective: The aim of the study was to examine the frequency of falls occurrence, investigate relevant clinical and environmental variables, and analyzed related outcomes in intensive care units patients admitted to tertiary settings. Materials and methods: A cross sectional quantitative study was conducted from January to June 2025 at three tertiary care hospital approved by IRB of Iqra National University, Peshawar. Purposive sampling technique was used and sample size was 169 ICU patients. Data was gathered using standardized and verified questionnaire and analyzed (descriptive statistic and chi square test) via SPSS version 30. Results: The study found a significant incidence of falls among elderly individuals Age p=0.014, and females accounted for 59%cases, medication usage (p=0.023), vision impairment ( p=0.009), gender (p=0.013) were also significant risk variable for falls. Environmental factors such as poor illumination and worker breaks were also identified as crucial. Clinically, fall resulted in injuries such as bone factors (mean=3.08) and head trauma (mean=2.95). Interestingly mobility assistance utilization was statistically significant (p=0.070), indicating the need for good training and monitoring Conclusion: Falls among ICU patients are complex and represented major to their safety. The study emphasize the of ICU specific fall prevention method prevention that on continuous monitoring, environmental changes, and staff education. Moreover triangulation an d a longitudinal study is suggested for future research work with large sample for in-depth generalizability.
Falls incident, intensive care units, patients safety, Risk factors
ASSESSMENT OF DOCUMENTATION AMONG NURSES USING ELECTRONIC HEALTH RECORD; A DESCRIPTIVE CROSS-SECTION STUDY
Background: Electronic health record (RHRs) are digital systems that store, organize, and communicate patient’s healthcare data across many healthcare settings in order to improve service and coordination. Objective: This study examined HER documentation practice among nurses in a resource constrained tertiary hospital to identify patterns of electronic health records, major barriers to effective to effective documentation, and documents quality determined. Material and Methods: A quantitative cross sectional study was conducted comprised of 148 nurses from medical, surgical, intensive care unit, and emergency and pediatric departments. A standardized questionnaire was used to gather data on documentation practices, perceived barriers, and implications of HER. Variables association were studied using descriptive statistics, chi square test, t test and regression analysis. Results: Nurses recorded vital signs at a high rate (84%), however care plan adjustment (44%) and template usage (37%). Workload (60%), and system usability issues affected performance, especially among novice (p< 0.001) and male nurses (p=0.003). ICU nurses Had 3.5 times higher probability of optimal documentation than medical unit personal (OR=3.12 p<0.001). Nurses with over three years of experience and MSN degree performed much better (p<0.001). A regression research found that experience (β=4.12, p<0.001) and ICU posting (β=3.55, p=0.001 are significant predictors of documentation quality. Conclusion: These findings provide practical insights for healthcare set up seeking to improve nurse’s documentation habits in an electronic health records. To maximize the benefits of EHRs, customized intervention such as unit specific training, usability enhancement and gender sensitive measure are necessary.
Electronic health records, nursing records, documentation, healthcare information system, workflow
FREQUENCY OF MENINGITIS IN LATE-ONSET NEONATAL SEPSIS IN PATIENTS PRESENTING TO SAIDU GROUP OF TEACHING HOSPITAL
Background: Late-onset neonatal sepsis (LONS) remains a major contributor to neonatal morbidity and mortality, particularly in developing countries. Meningitis is a serious complication of LONS and may result in seizures, developmental delay, hearing impairment, hydrocephalus, and death. Early diagnosis is difficult because neonates often present with non-specific symptoms. Determining the frequency of meningitis among neonates with LONS helps clinicians identify the need for early cerebrospinal fluid (CSF) evaluation and timely treatment. Objective: To determine the frequency of meningitis in patients with late-onset neonatal sepsis presenting to Saidu Group of Teaching Hospital. Methods: A cross-sectional study was conducted in the Department of Pediatrics over six months. A total of 159 neonates aged 5–28 days diagnosed with LONS were enrolled through consecutive non-probability sampling. Demographic characteristics, clinical findings, and CSF analysis were recorded. Data were analyzed using SPSS version 25. Results: Among 159 neonates, 92 (57.9%) were male and 67 (42.1%) female. Mean age was 14.2 ± 6.1 days. Meningitis was diagnosed in 36 patients, giving a frequency of 22.6%. Higher frequency was noted among preterm neonates, low birth weight infants, and rural residents. Conclusion: Meningitis is a common complication of late-onset neonatal sepsis. Routine consideration of lumbar puncture in clinically stable neonates with suspected LONS may improve early diagnosis and outcomes.
Comparative Assessment of Lead and Copper Toxicity on Growth Dynamics of Spinacia oleracea L.
Soil contamination with heavy metals is a serious environmental problem that negatively affects plant growth, crop productivity, and food safety. This study was conducted to evaluate the growth and stress responses of Spinacia oleracea L. under lead and copper stress conditions. Plants were treated with different concentrations of lead and copper salts at 0, 100, 200, and 300 ppm under controlled conditions. Several growth parameters were measured, including plant height, root and shoot length, number and size of leaves, fresh and dry biomass, and inflorescence development. The results showed that copper exhibited a concentration dependent effect on plant growth. At lower concentrations, copper slightly enhanced growth parameters, likely due to its essential role as a micronutrient involved in enzymatic activities and metabolic processes. However, higher concentrations led to growth inhibition. In contrast, lead exposure caused a significant and consistent reduction in all measured growth parameters, indicating strong phytotoxic effects. Lead toxicity likely interfered with physiological processes such as photosynthesis, nutrient uptake, and water balance, resulting in reduced biomass and overall plant vigor. Statistical analysis confirmed that these effects were significant compared to control treatments. The findings highlight that while copper may support plant growth at optimal levels, lead poses a severe risk even at relatively low concentrations. This study emphasizes the importance of monitoring and managing heavy metal contamination in agricultural soils. Future research should focus on understanding the physiological, biochemical, and molecular mechanisms underlying heavy metal stress tolerance and developing effective strategies to mitigate their adverse effects in crop plants.
Soil contamination, heavy metals, Spinacia oleracea, lead toxicity, copper stress, plant growth.
VALIDATION OF THE TOKUHASHI SCORE AND TOMITA SCORE IN PREDICTING SURVIVAL IN PATIENTS WITH SPINAL METASTASES: A RETROSPECTIVE COHORT STUDY IN AN LMIC POPULATION
Background: Proper preoperative prognostication is critical in making surgical decisions and resource allocation in patients with spinal metastases. The Tokuhashi and Tomita scores have been revised, but their effectiveness in low- and middle-income country (LMIC) settings with delayed presentation and limited adjuvant therapies remains poorly assessed. Methods: This retrospective cohort study included adult patients (aged 18 years and older) who underwent surgery for spinal metastasis at a tertiary neurosurgical unit between January 1, 2020, and December 31, 2025. Standardized parameters were used to calculate preoperative revised Tokuhashi and Tomita scores. The main outcome was overall survival (OS) after surgery. Harrell measured discrimination using the C-index and 6- and 12-month time-dependent area under the receiver operating characteristic curve (AUC) of survival. The DeLong test was used to assess comparative discrimination. Decision curve analysis (DCA) measured net clinical benefit at threshold probabilities. Independent predictors were determined using multivariable Cox regression. Results: Among 265 surgical patients, 228 were eligible (mean age 56.8 ± 13.1 years; 61% male). Median OS was 8.4 months (IQR 3.2–15.6); 12-month survival was 42.5%. The revised Tokuhashi score was better discriminatory (C-index 0.73, 95% CI 0.68 0.78) than the Tomita score (C-index 0.68, 95% CI 0.62 0.73). Tokuhashi was statistically better on DeLong testing (12-month survival) (AUC 0.71 vs 0.67; 0.04 difference, p=0.041). DCA showed a higher net benefit of the Tokuhashi score with a 20-50% threshold probability of 12-month mortality. A subgroup with high risk (Tokuhashi ≤8 and untreatable visceral metastases, n=62) had a median OS of 3.9 months (6-month survival 19.4%). The independent predictors were Tokuhashi score (adjusted HR 0.82 per point increase, 95% CI 0.760.88, p<0.001), rapid-growing primary tumours, visceral metastases, and postoperative complications. Conclusion: In this LMIC cohort, the revised Tokuhashi score shows slightly better discrimination and clinical utility than the Tomita score. Preoperative use is supported by routine use to help select surgical versus palliative care, especially in resource-constrained settings, based on evidence.
spinal metastases; Tokuhashi score; Tomita score; survival prediction; decision curve analysis, LMIC, prognostic validation
EVALUATION OF THE FREQUENCY, CONTRIBUTING FACTORS AND IMPACT ON PATIENT OF REPEAT EXAMINATION IN NON-INVASIVE IMAGING MODALITIES IN PESHAWAR, PAKISTAN
Introduction Although non-invasive imaging is a major component of modern medical diagnosis, repeated examinations can result in increased radiation exposure, unnecessary costs, and treatment delays. Therefore, this study examines the frequency of repeat imaging in Peshawar, Pakistan, which identifies the underlying reasons for such repetitions, and evaluates their consequences on patients, with the aim of improving imaging practices and enhancing patient safety. Methodology Our study proposed a descriptive cross-sectional model which involved 150 radiologists and technologists from PGH, KTH, RMI, and NWGH, using structured questionnaires for data collection and SPSS for statistical analysis. Results Results show most repeat examinations were in the range of 1–5 among all 6 modalities and chest examinations were the most repeated one (38%). While assessing the causes of repeat examination results showed most of the repetition in x-ray (44.4%), CT (46.9%) and MRI (42.3%) were due to patient movement while in fluoroscopy (52.6%) and USG (57.9%) were due to uncooperative patients and in mammography they were due to inadequate compression and patient positioning (44.4%). Furthermore, Patient weight (78%), workload (64%) are also main contributors to repeat examinations. The most common negative impact of these examinations on patients was radiation overexposure (53.3%). Conclusion Overall, our study reveals that patient movement was the primary causes of repeat imaging tests, in X-rays, CT, and MRI, in fluoroscopy and ultrasound, it was uncooperative patients while in mammography it was positioning errors. Chest examinations are most often repeated. Repeat rates are greatly influenced by variables including patient size, workload, and technician education. Overexposure to radiation was shown to be the most frequent adverse effect on individuals.
Imaging Modalities, Repeat Imaging Examinations, Radiation Overexposure
PRECISION NEUROREHABILITATION IN CHRONIC STROKE: BIOMARKER-GUIDED, AI-OPTIMIZED DOSING OF TASK-SPECIFIC TRAINING TO ENHANCE CORTICOSPINAL NEUROPLASTICITY
Background: Chronic stroke recovery plateaus reflect heterogeneous neurobiology and fixed-dose rehabilitation. Precision approaches integrating biomarkers with adaptive dosing may optimize corticospinal neuroplasticity. Objective: To evaluate whether biomarker-guided, AI-optimized task-specific training (TST) enhances corticospinal tract (CST) neuroplasticity and motor function versus fixed-dose TST in chronic stroke. Methods: In a multicenter, assessor-blinded RCT, 88 chronic stroke survivors (≥6 months; FMA-UE 10–50) were randomized to AI-closed-loop dosing (biomarker-initialized) or standardized TST for 12 weeks. Primary outcomes: TMS-evoked MEP amplitude and CST fractional anisotropy. Secondary outcomes included clinical motor scales and kinematics. Linear mixed-effects and mediation analyses were applied. Results: AI-optimized TST yielded superior MEP amplitude (F(1,84) = 14.36, p < .001) and CST FA (p = .001) gains, sustained at 24 weeks. Functional improvement was greater (FMA-UE: +14.4 vs. +6.1, p < .001), with 42% of gains mediated by CST neuroplasticity. AI dosing achieved 92.8% adherence without increased adverse events. Conclusion: Biomarker-initialized, AI-optimized TST safely drives dose-dependent corticospinal remodeling, translating neural adaptation into functional recovery. This closed-loop precision framework warrants clinical adoption.
precision neurorehabilitation; chronic stroke; artificial intelligence; task-specific training; corticospinal tract; neuroplasticity; biomarkers
DIAGNOSTIC ACCURACY OF PLACENTA INVASION IN LOWER UTERINE SEGMENT MEASURED BY ULTRASOUND IN PREDICTION OF PLACENTA ACCRETA SPECTRUM AND ITS CORRELATION WITH GROSS PATHOLOGY POSTOPERATIVE
Background: Placenta Accreta Spectrum (PAS) is a leading cause of severe obstetric hemorrhage and maternal morbidity, with increasing incidence due to rising cesarean section rates. Accurate prenatal diagnosis is essential for optimizing surgical planning and reducing complications. Ultrasound is the primary imaging modality; however, its diagnostic performance in the lower uterine segment (LUS) requires further validation against a pathological reference standard. Objective: To evaluate the diagnostic accuracy of gray-scale and Doppler ultrasound in detecting Placenta Accreta Spectrum through assessment of the lower uterine segment, using histopathological findings as the reference standard in a high-risk cohort. Methods: This cross-sectional analytical study included 40 pregnant women with suspected PAS at a tertiary care hospital in Karachi, Pakistan. All participants underwent standardized gray-scale and Doppler ultrasound evaluation of the LUS prior to cesarean delivery. Sonographic findings were compared with postoperative histopathological diagnosis. Sensitivity and positive predictive value (PPV) were calculated with 95% confidence intervals. Due to the very small number of histopathology-negative cases, specificity and negative predictive value (NPV) could not be reliably estimated. Results: PAS was confirmed in 38 of 40 cases (94.9%). Ultrasound demonstrated a sensitivity of 89.2% (95% CI: 75.3%–95.7%) and a PPV of 94.3% (95% CI: 81.4%–98.4%). Loss of the retroplacental clear zone (87.2%) and placental lacunae (82.1%) were the most frequently identified ultrasound features. Obstetric hysterectomy was performed in 94.9% of cases, with a mean estimated blood loss of 2354 ± 530 ml. No maternal mortality was recorded. Diagnostic performance estimates are influenced by the high prevalence of PAS in this selected high-risk cohort. Conclusion: Ultrasound demonstrates high sensitivity and strong positive predictive value for detecting PAS in high-risk populations when assessing the lower uterine segment. However, diagnostic performance is affected by spectrum bias, limiting generalizability. Larger multicenter studies with more balanced populations are required to validate these findings
Placenta Accreta Spectrum, ultrasound, lower uterine segment, diagnostic accuracy, gross pathology, cesarean section, sensitivity, specificity
GLOBAL OCCURRENCE PATTERNS OF AEDES MOSQUITOES BASED ON BIODIVERSITY DATABASE RECORDS
Mosquitoes of the genus Aedes are widely distributed and play an important ecological and public health role as vectors of several arboviral diseases. Understanding their global distribution is essential for ecological assessment and vector surveillance. In this study, occurrence records of Aedes mosquitoes were obtained from the Global Biodiversity Information Facility and analyzed to evaluate global distribution patterns. After data cleaning and filtering, a total of 69,541 occurrence records from 188 countries were included in the analysis. Country-wise assessment revealed that the highest number of records originated from the United States, followed by Spain, Italy, Mexico, and Australia. Spatial visualization demonstrated a widespread global distribution, with higher concentrations in tropical and subtropical regions. The findings highlight the extensive geographic range and ecological adaptability of Aedes mosquitoes and demonstrate the usefulness of open biodiversity databases for large-scale ecological studies. This study provides a data-driven overview of Aedes distribution and supports the integration of biodiversity informatics into vector monitoring and public health research.
Aedes, mosquito distribution, biodiversity databases, global occurrence, vector ecology, public health entomology
COMPARISON OF LASER AND CONVENTIONAL OPEN LATERAL INTERNAL SPHINCTEROTOMY IN PATIENTS WITH CHRONIC ANAL FISSURE: A RANDOMIZED CONTROLLED TRIAL
Objective: To compare postoperative outcomes between laser, lateral internal sphincterotomy (LIS) and conventional open LIS in patients with chronic anal fissure. Methods: This prospective randomized controlled trial was conducted at SIMS Hospital & Research Center, Swat, over 12 months. Eighty patients diagnosed with chronic anal fissure were randomized into two groups: Laser LIS (n=40) and Open LIS (n=40). Primary outcome was postoperative pain assessed using Visual Analogue Scale (VAS) at 24 hours and Day 7. Secondary outcomes included operative time, healing rate at 4 weeks, postoperative complications, Wexner incontinence score, hospital stay, and time to return to normal activity. Statistical analysis was performed using independent sample t-test and Chi-square test. Results: Mean VAS at 24 hours was significantly lower in the Laser group (4.28 ± 1.00) compared to the Open group (5.97 ± 1.20) (p < 0.001). At Day 7, Laser group continued to demonstrate significantly lower pain scores (2.01 ± 0.80 vs 3.47 ± 1.00; p < 0.001). Operative time was shorter in the Laser group (18.2 ± 3.0 minutes vs 25.76 ± 4.0 minutes; p < 0.001). Healing at 4 weeks was 95% in the Laser group and 85% in the Open group (p = 0.18). Mean Wexner score was significantly lower in the Laser group (0.46 ± 0.70 vs 1.53 ± 1.00; p < 0.001). Hospital stay and return to work were significantly reduced in the Laser group (p < 0.001). Conclusion: Laser lateral internal sphincterotomy demonstrated reduced postoperative pain, shorter operative time, improved short-term continence, and faster recovery compared to conventional open LIS, with comparable healing rates.
EPIDEMIOLOGICAL ANALYSIS OF MOST PREVALENT INFECTIOUS DISEASES AMONG HOSPITALIZED PATIENTS IN KHYBER PAKHTUNKHWA, PAKISTAN
Background: Infectious diseases remain a major cause of morbidity and mortality worldwide. Understanding their prevalence and associated risk factors is critical for effective public health interventions. This study aimed to investigate the most prevalent infectious diseases among hospitalized patients in Khyber Pakhtunkhwa (KPK), Pakistan. Methods: A total of 740 patients were enrolled between May 2025 and March 2026 from four clinical laboratories across KPK. Samples were analyzed using immune chromatographic methods. The prevalence and frequency of major infectious agents were determined, and the study was conducted following approval from the institutional ethical committee. The top five infectious diseases were identified based on their frequency among the sampled population. Results: Among the tested patients, 285 (38.51%) were infected with Hepatitis B virus, 155 (20.94%) with Salmonella typhi (Typhoid fever), 120 (16.21%) with Hepatitis C virus, and 109 (12.26%) with Helicobacter pylori. The study population included 443 males (52.73%) and 397 females (47.26%). The majority of cases were observed in patients aged 21–30 years and among married individuals (52.19%). Conclusion: Hepatitis B virus, Salmonella typhi, Hepatitis C virus, and Helicobacter pylori were the most prevalent infectious agents among hospitalized patients in KPK. These findings highlight the need for targeted prevention and management strategies, especially for young adults and married populations in the region.
PHEROMONE-LIKE OLFACTORY CUES MODULATE MALE RODENT COURTSHIP AND AGGRESSION: A SYSTEMATIC REVIEW OF BEHAVIORAL AND NEUROENDOCRINE MECHANISMS
Olfactory cues that resemble pheromones are important to male rodents in directing courtship and aggression, but the interplay among behavioral, neural, and hormonal processes remains incompletely understood. The systematic review had pooled 25 studies reporting on the effects of urinary, glandular, and synthetic pheromones on male social behavior published between 2000 and 2025. Exposure techniques included natural cues, diet chemicals, genetic manipulation, and behavioral measures, and results were mounting, including intromission, ultrasonic vocalizations, and resident-intruder aggression. The neural systems of the vomeronasal organ, medial amygdala, MPOA, and VMH were often involved, as well as the endocrine correlates (testosterone, corticosterone, and luteinizing hormone). The results were consistent and indicated that male courtship and aggression are dose and context-dependent and are regulated by pheromone type, social experience, and hormonal state. There were decreased pheromone-mediated behaviors under the environmental impact of high-dose chemicals (e.g., DEHP, phthalates), underscoring interactions between olfactory and endocrine regulation. This review provides an overall picture of how chemical signals regulate male reproductive and aggressive behaviors, which will guide future studies of neuroendocrine and behavioral plasticity.
FORMULATION DEVELOPMENT, PHYSICOCHEMICAL CHARACTERIZATION AND IN-VIVO WOUND HEALING ACTIVITY OF HIBISCUS ROSA SINENSIS LEAVES EXTRACT LOADED NANO EMULSION
Wounds are tissue damage that can cause functional disorders and risk of infection. Effective wound management is essential to accelerate tissue regeneration and prevent complications. Hibiscus Rosa sinensis leaves extract contains bioactive compounds such as flavonoids, tannins, and saponins that have anti-inflammatory, antibacterial, and wound healing activities. However, the limited bioavailability and skin penetration of these active compounds are challenges in topical therapy. This study aims to develop and evaluate a topical drug delivery system based on Hibiscus Rosa sinensis leaves extract nanoemulsion as an alternative therapy to accelerate wound healing. Extraction was carried out using ethanol solvent, then formulated into a nanoemulsion with oil, distilled water, surfactant and co-surfactant components. Formulation characterization was carried out by measuring particle size, polydispersity index, zeta potential, and physical stability tests. Evaluation of effectiveness was carried out using a wound model in Sprague Dawley rats with the hot plate induction method. Wound healing observations were carried out clinically and histologically for a period of 15 days. The formulation results showed that the nanoemulsion had a particle size of <200 nm, PDI <0.5, and zeta potential of ±25 mV, indicating good physical stability. Wound activity tests showed that topical administration of Hibiscus Rosa sinensis leaves extract nanoemulsion accelerated wound contraction, increased epithelialization, and improved tissue structure compared to the control group. Hibiscus Rosa sinensis leaves extract can be formulated in a nanoemulsion delivery system that shows stable physical characteristics and is effective in accelerating wound healing.
NEUROPATHOGENESIS OF NIPAH VIRUS INFECTION: MOLECULAR NEUROINVASION, SYNAPTIC DYSFUNCTION, AND NEUROINFLAMMATORY CASCADES
Nipah virus (NiV) is an emerging zoonotic pathogen of the genus Henipavirus that endangers human health with a high fatality rate, neurotropism, and a lack of approved therapeutics. The article is a critical review of the neuropathogenesis of NiV, which dwells on synaptic dysfunction, the integration of molecular neuroinvasion mechanisms, and neuroinflammatory cascades. NiV uses several routes of entry into the central nervous system (CNS), among which are endothelial infection with the breakage of the blood-brain barrier, transportation by leukocytes as a Trojan horse, and direct neuroproliferation through the olfactory tract. In the CNS, the virus is characterized by high neuronal tropism and, at the same time, causes endothelial damage and an immune response, which leads to a dual pathology of vasculopathy and parenchymal encephalitis. In addition to structural damage, there is emerging evidence that NiV-associated neurological disease is highly influenced by synaptic-level functional pathology comprising neuromodulator imbalance, calcium hyporegulation, and excitotoxicity, all of which impair the integrity of neural circuits. Such mechanisms offer a reasonable account of acute encephalitic expressions, as well as delayed and relapsing neurological syndromes. Although the biology of viruses has been studied, the current treatment methods are mainly supportive, and the antiviral and immunotherapeutic methods are still being tested. This review shows that there are some critical mechanistic gaps and that synaptic and neuroimmune pathways are currently under-explored but can be used as targets of therapeutic intervention in the future.
Nipah virus, Synaptic dysfunction, Central nervous system infection, Viral immune evasion, Antiviral therapeutics
BELIEF IN GOOD LUCK PREDICTS PROCRASTINATION THROUGH PERSONALITY TRAITS AMONG UNIVERSITY STUDENTS
Purpose: The purpose of this study was to examine the relationship between belief in good luck and procrastination among university students, with a particular focus on the mediating role of personality traits. Method: A cross-sectional research design was employed. The sample consisted of 200 university students (100 males and 100 females) from universities in Islamabad and Rawalpindi, Pakistan. Data were collected using standardized self-report measures, including the Belief in Good Luck Scale, the General Procrastination Scale, and the Ten-Item Personality Inventory (TIPI). Correlation and mediation analyses were conducted to assess both direct and indirect relationships among belief in luck, personality traits, and procrastination. Findings: The results indicated that both rejection of luck and general belief in luck were indirectly associated with procrastination through several personality traits, including extraversion, agreeableness, openness to experience, and emotional stability. However, conscientiousness did not emerge as a significant mediator in the relationship between belief in luck and procrastination. These findings suggest that personality traits play a crucial role in explaining how belief systems influence procrastination behavior. Conclusion: The study highlights the complex interplay between belief in luck, personality traits, and behavioral regulation among university students. The findings suggest that educational interventions aimed at promoting adaptive personality characteristics and enhancing self-regulatory skills may help reduce procrastination tendencies associated with irrational beliefs in luck.
FREQUENCY OF PULMONARY HYPERTENSION IN COPD PRESENTING TO TERTIARY CARE HOSPITAL
Background; Chronic obstructive pulmonary disease (COPD) is a major global health concern and is frequently complicated by pulmonary hypertension (PH), which significantly worsens morbidity and mortality. Despite its clinical importance, local data on the frequency of PH among COPD patients in Pakistan remains limited. Objective; To determine the frequency of pulmonary hypertension among patients with chronic obstructive pulmonary disease presenting to a tertiary care hospital. Methods: This cross-sectional study was conducted at Ayub Teaching Hospital, Abbottabad, over a period of six months from 1st September 2024 to 28th February 2025. A total of 134 patients aged 18–80 years with spirometry-confirmed COPD were enrolled using non-probability consecutive sampling. Patients with other causes of pulmonary hypertension were excluded. Demographic and clinical data were recorded, and pulmonary hypertension was assessed using transthoracic echocardiography, defined as pulmonary artery systolic pressure (PASP) ≥25 mmHg. Data were analyzed using SPSS version 21, and associations were assessed using chi-square test, with p ≤0.05 considered statistically significant. Results: The mean age of participants was 58.4 ± 10.6 years, with 53.7% in the 41–60 years age group. Males constituted 68.7% of the study population. Regarding smoking status, 44.8% were current smokers, 29.9% former smokers, and 25.4% never smokers. The majority of patients had moderate COPD (46.3%), followed by severe (29.9%), mild (14.9%), and very severe disease (9.0%).Pulmonary hypertension was present in 43.3% (n=58) of patients. Among these, mild PH was observed in 51.7%, moderate in 31.0%, and severe in 17.3%, with a mean PASP of 33.2 ± 8.5 mmHg. Dyspnea (89.6%), chronic cough (80.6%), and sputum production (70.9%) were the most common symptoms.A statistically significant association of PH was found with age (p=0.03) and smoking status (p=0.01), while gender was not significantly associated (p=0.42). PH was also significantly associated with comorbidities, including diabetes mellitus (p=0.002), cardiovascular disease (p=0.01), presence of both conditions (p=0.04), and absence of comorbidities (p=0.001). Echocardiographic findings included right ventricular hypertrophy in 29.9%, right atrial enlargement in 26.1%, and tricuspid regurgitation in 20.9% of patients. Conclusion: Pulmonary hypertension is a common complication among COPD patients, with a frequency of 43.3% in this study. It is more frequently associated with advancing age, smoking, and comorbid conditions. Early screening using echocardiography in COPD patients may facilitate timely diagnosis and improve clinical outcomes, particularly in resource-limited settings.
Chronic obstructive pulmonary disease; Pulmonary hypertension; Echocardiography; Smoking; Comorbidities; Pulmonary artery pressure; COPD complications
DIAGNOSTIC ACCURACY OF NON-CONTRAST MRI FOR DETECTING ENDOMETRIAL CARCINOMA: A CROSS-SECTIONAL STUDY AGAINST HISTOPATHOLOGY IN A PAKISTANI TERTIARY-CARE CENTER
Background: Endometrial carcinoma is the most common gynecologic malignancy, and timely, accurate diagnosis guides definitive management. In resource-variable settings such as Pakistan, a robust, non-contrast MRI protocol could offer practical diagnostic value alongside histopathology. Objective: To determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting endometrial carcinoma, using histopathology as the gold standard. Methods: We conducted a cross-sectional descriptive study at the Department of Radiology, Liaquat University Hospital, Hyderabad, over six months (ethical approval: CPSP/REU/RAD-2018-164-2697). Consecutive women aged 18–65 years with clinical suspicion of endometrial carcinoma underwent pelvic MRI using non-contrast T1-weighted, T2-weighted, and diffusion-weighted (DWI) sequences. Images were reported by a senior radiologist (≥3 years post-training). Histopathology from endometrial biopsy served as the reference standard. Diagnostic indices—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy—and receiver operating characteristic (ROC) area under the curve (AUC) were calculated. Results: A total of 227 women were included (mean age 49.6 ± 8.7 years); 62.6% were postmenopausal. Histopathology confirmed carcinoma in 102 (44.9%). MRI identified 110 positives, yielding 94 true positives, 16 false positives, 8 false negatives, and 109 true negatives. MRI performance was: sensitivity 92.1% (95% CI ~85.3–96.0), specificity 87.2%(95% CI ~80.2–92.0), PPV 85.5% (95% CI ~77.7–90.8), NPV 93.2% (95% CI ~87.1–96.5), and overall accuracy 89.9%. The ROC AUC was 0.90, indicating excellent discrimination. Subgroup analysis showed slightly higher accuracy in postmenopausal vs premenopausal women (91.5% vs 87.1%). Conclusion: Non-contrast multiparametric MRI (T1/T2/DWI) demonstrated high accuracy for detecting endometrial carcinoma against histopathology, with a strong NPV that can confidently exclude disease in many clinically suspected cases. These findings support MRI as a practical, reliable adjunct to guide diagnostic and preoperative pathways in our tertiary-care setting.
Endometrial Neoplasms; Magnetic Resonance Imaging; Diffusion Magnetic Resonance Imaging; Sensitivity and Specificity; Pakistan