Gandhara University

Introduction: Social distancing and wearing a face mask are highly recommended to mitigate the transmission of coronavirus disease 2019 (COVID-19). However, the success of these strategies relies on individuals’ adherence and public compliance. This study was conducted to assess the level of belief in social distancing and face mask practices in communities in low- and middle-income countries (LMICs) and to identify their possible determinants. Methods: A cross-sectional study was conducted in ten LMICs countries in Asia, Africa, and South America from February to May 2021. A questionnaire was used to assess the belief, practice, and their plausible determinants. Identification of the associated determinants was performed using a logistic regression model. Results: Our data revealed that only 62.6% and 66.9% of the participants had good beliefs in social distancing and good face mask practices, respectively. Residing in the Americas, having a healthcare-related job, knowing people in immediate social environment who are or have been infected and exposure to information of COVID-19 cases on social media or TV were factors significantly associated with good belief in social distancing. Residing country, gender, monthly household income, type of job and exposure to information of COVID-19 cases were significantly associated with face mask wearing practice. Conclusion: The proportion of participants having good beliefs in social distancing and good face mask practices is relatively low (<75%). Hence, sustained health campaigns regarding social distancing benefits and face mask-wearing practices during COVID-19 are critical in LMICs.

Tobacco use is a leading cause of morbidity and mortality globally, with South Asia carrying a significant burden. Dentists are well placed to deliver cessation intervention because of the clear link between tobacco use and oral diseases. However, evidence on the reported outcomes and feasibility of such interventions in South Asian contexts has not been systematically synthesized. This review aimed to map and describe the characteristics, delivery approaches, and reported outcomes of tobacco cessation interventions implemented in dental or related healthcare settings within South Asian populations. We conducted the scoping review following the Joanna Briggs Institute (JBI) framework and reported according to PRISMA-ScR. A comprehensive search of PubMed, Embase, PsycINFO, Medline (via Ovid), Scopus, and CINAHL was conducted from database inception until March 2025. Eligible studies included quantitative, qualitative, and mixed methods designs reporting non-pharmacological cessation interventions delivered by dentists. Data were synthesised narratively with subsequent thematic synthesis examining effectiveness, cultural adaptations, resource limitations, and therapeutic adaptations within South Asian contexts. Five studies from India and Pakistan met the inclusion criteria of this review. Interventions included brief health education (BHE), cognitive-behavioural therapy (CBT), motivational interviewing (MI), and theory-based counselling approaches. Reported cessation-related outcomes varied across studies, with quit or abstinence rates ranging from 4

BACKGROUND Ramadan fasting (RF) is a form of time-restricted feeding, where individuals abstain from eating and drinking from dawn to sunset. RF has been shown to have positive effects on weight loss, as well as vascular and metabolic disorders. We evaluated the effects of RF on the metabolic profiles of a cohort of Muslims in San Antonio. FibroScan (vibration-controlled transient elastography + controlled attenuation parameter) was used to assess liver stiffness and steatosis before and after RF. AIM To evaluate the effects of RF on metabolic and liver profiles, including body mass index (BMI), metabolic syndrome (MS), and hepatic steatosis, in a cohort of Muslims residing in San Antonio. METHODS A total of 41 subjects residing in San Antonio, TX, who fasted for 14-15 hours daily for 30 consecutive days during Ramadan, were included in this study. Subjects with any alcohol intake, chronic hepatitis (B and C), pregnancy, or use of hepatotoxic/steatotic agents were excluded. All subjects completed two visits (within 1-2 weeks before and after Ramadan). Each visit involved measurements of BMI, blood pressure, metabolic markers (fasting lipid panel and glucose), liver tests [gamma-glutamyl transferase, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, bilirubin (total and indirect), albumin], and FibroScan measurements. RESULTS Prior to RF, 29% had MS and 37% had BMI ≥ 30. MS was present in 11% with BMI < 30 and 60% with BMI ≥ 30 (P = 0.01). Hepatic steatosis was more prevalent in the BMI ≥ 30 group (66% vs 30%, P = 0.02) and correlated with BMI (r = 0.54, P = 0.0003). Most participants had mild fibrosis (F0-1 or F2), with advanced fibrosis in 8% (BMI < 30) and 14% (BMI ≥ 30). Liver enzymes were largely normal at baseline. After 30 days of RF, body weight and BMI significantly decreased (P < 0.0001), while MS prevalence remained unchanged. Controlled attenuation parameter scores improved significantly overall (278.6 dB/m to 264.4 dB/m, P < 0.0001) and within both BMI groups, with no major changes in glucose, lipids, or aminotransferases. CONCLUSION In this South Asian Muslim cohort, MS prevalence was high, especially in males with BMI ≥ 30. Higher BMI correlated with steatosis; 30-day RF reduced weight and improved steatosis.

Objectives Depressive symptoms are highly prevalent among medical students globally, yet estimates from Pakistan remain fragmented and inconsistent across studies. Medical students in Pakistan face multiple academic, social and environmental stressors that may increase their risk of depression. We conducted a systematic review and meta-analysis to estimate the prevalence of depressive symptoms among medical students in Pakistan and to explore sources of heterogeneity across studies.Design Systematic review and meta-analysis reported in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines.Data sources MEDLINE (via PubMed), Web of Science, Embase, Scopus, APA PsycInfo and Pakistani journals were searched without date restriction up to September 2025.Eligibility criteria Observational studies conducted among medical students in Pakistan reporting prevalence of depressive symptoms using validated assessment tools (eg, PHQ-9, BDI, DASS-21) were included.Data extraction and synthesis Two independent reviewers screened studies, extracted data and assessed methodological quality using the Joanna Briggs Institute tool. Random-effects meta-analysis was conducted. Subgroup analyses (province and assessment instrument) and meta-regression (publication year) were performed. Heterogeneity and publication bias were assessed using I² statistics, funnel plots and Egger’s and Begg’s tests.Results Seventy-one studies contributed 72 prevalence estimates, including approximately 23 000 medical students. The reported prevalence of depressive symptoms ranged from 9% to 94%, with considerable heterogeneity across studies (I²=99.15%, p<0.001). Subgroup analysis showed slightly higher prevalence estimates in Sindh compared with Punjab and other regions; however, subgroup differences were not statistically significant (Q=1.00, df=2, p=0.61). Prevalence estimates also varied according to the assessment instrument, with generally higher estimates reported using PHQ-9 and DASS-21. Meta-regression demonstrated a significant positive association between publication year and reported prevalence (β=0.016, SE=0.007, 95% CI 0.002 to 0.031, p=0.03). Evidence of publication bias was identified by Egger’s test (p=0.024) and Begg’s test (p<0.001), although adjusted analyses yielded broadly consistent findings.Conclusions The prevalence of depressive symptoms among medical students in Pakistan varies widely across studies, with evidence suggesting an increasing trend over time. However, the findings should be interpreted with caution due to substantial heterogeneity across studies, variability in assessment instruments and cut-off thresholds, and methodological limitations in some included studies. Despite these limitations, the findings highlight the need for scalable mental health interventions, including screening, counselling and educational reforms.PROSPERO registration number CRD420251160506.