Shaheed Mohtarma Benazir Bhutto Medical University

Background: Post-traumatic stress symptoms may impair psychological well-being, academic functioning, sleep, concentration, and clinical performance among healthcare students, yet local evidence from resource-limited medical education settings in Pakistan remains limited. Objective: To assess the distribution and severity of post-traumatic stress symptoms among healthcare students in Larkana using the DSM-5-aligned PTSD Checklist for DSM-5 and to examine their association with gender, academic department, and age group. Methods: This cross-sectional descriptive-analytical study was conducted from March to May 2025 at a public sector medical university in Larkana, Sindh, Pakistan. A total of 324 students from MBBS, BDS, DPT, Nursing, and Pharmacy programs completed the 20-item PCL-5, rated on a five-point Likert scale. Associations between demographic variables and item-level symptom severity were analyzed using chi-square tests with Monte Carlo exact significance; effect sizes were estimated using Cramér’s V, and post-hoc column proportion tests were applied where appropriate. Results: Complete PCL-5 data were available for all participants. Females showed consistently higher symptom severity across PCL-5 items, with large gender-associated effects (Cramér’s V=0.708–0.720). Departmental differences were moderate, with MBBS students showing greater symptom burden across several domains (Cramér’s V=0.454–0.469). Students aged 18–21 years accounted for the highest proportion of severe intrusion, concentration difficulty, and sleep disturbance, although ordinal age trends were non-significant. Conclusion: Post-traumatic stress symptoms were common and unevenly distributed among healthcare students, with greater symptom concentration among female students, MBBS students, and those aged 18–21 years. Institution-based confidential screening, early counseling, and targeted support for cognitive-emotional and hyperarousal symptoms are warranted.

Background: Depression is a long term, multifaceted mental illness that manifests as a range of symptoms, such as mood swings, anhedonia, and fatigue. An Imbalance in neurotransmitters, especially those involving serotonin is one of the major biological factors contributing to depression. Objective: To investigate the repurposing potential of selected clinically used drugs as antidepressant acting via monoamine oxidase A (MAO-A) inhibition. Methods: Existing clinically used drugs were evaluated for their structural features supportive for MAO inhibition as documented. Swiss ADME was used for pharmacokinetic profiling of short listed drugs, which included including Gastrointestinal (GI) absorption, Blood Brain Barrier (BBB) permeability, lipophilicity, Topological Polar Surface Area (TPSA) and Cytochrome (CYP) P450 inhibition. Furthermore, the drugs were virtually assessed for their ability to interact with the catalytic residue of MAO-A enzyme by using AutoDock Vina version 1.5.6. Results: The cefazolin, etodolac, indomethacin, ondansetron and procarbazine demonstrated structural attributes favorable as MAOI. With an exception of cefazolin, all other short listed showed pharmacokinetic profile appropriate for centrally acting drugs. Among these four drugs, the ondansetron engaged the active residues (TYR407, TYR444, ILE335, PHE352, and LEU337) along with strong binding affinity for MAO-A enzyme. Conclusion: Owing to favorable structural and pharmacokinetic attributes, the ondansetron present itself as a promising candidate molecule to be repurposed as MAO-inhibition based antidepressant.

Background: Seasonal smog is a recurrent environmental hazard in urban Pakistan and may aggravate asthma through short-term exposure to particulate matter and irritant gases. Objective: To determine the frequency of asthma exacerbations during the smog season, examine the relationship between AQI and hospital admissions, and evaluate medication adherence and preventive behaviours among urban Pakistani adults with asthma. Methods: This prospective cohort study followed 250 adults with physician-diagnosed asthma from October through January. Participants underwent baseline assessment and weekly follow-up for exacerbations, emergency visits, hospital admissions, medication adherence, preventive behaviours, and AQI exposure. Categorical associations were assessed using the chi-square test, while weekly mean AQI and admission counts were examined using Pearson correlation. Results: At least one exacerbation occurred in 137 participants, corresponding to 54.8% (95% CI: 48.6–60.9), and 202 exacerbation episodes were recorded. December had the highest mean AQI (318), exacerbation count (71), emergency visits (39), and admissions (27). Of 66 admissions, 51 (77.3%) occurred on unhealthy, very unhealthy, or hazardous AQI days. Weekly mean AQI correlated positively with admissions (r=0.72; p=0.003). Exacerbations occurred in 63.4% of participants with poor adherence and 44.8% with good adherence (RR=1.42; 95% CI: 1.11–1.80; p=0.003). Only 19.2% regularly checked AQI, 36.4% used masks, and 30.4% avoided outdoor activity during severe smog. Conclusion: Asthma morbidity increased during periods of poorer air quality, while inadequate controller adherence was associated with a higher exacerbation risk. These findings support AQI-informed asthma planning and improved adherence during the smog season

Background: Unsafe drinking water remains an important environmental and public health concern, particularly in communities located near industrial areas where microbiological and chemical contamination may coexist. Objective: To assess the microbiological, physicochemical, and selected chemical quality of drinking water from industrial-area supply points in Multan, Pakistan, and examine its association with recent gastrointestinal morbidity among adjacent communities. Methods: A community-based analytical cross-sectional study was conducted from January to June 2026 among 300 adult residents. Sixty drinking-water samples were assessed for total coliforms, Escherichia coli, physicochemical parameters, nitrate, lead, and arsenic. Gastrointestinal symptoms during the preceding 14 days were collected using a structured interviewer-administered questionnaire. Descriptive statistics, chi-square testing, and logistic regression were used for analysis. Results: Total coliforms were detected in 35/60 samples (58.3%) and E. coli in 25/60 (41.7%). High turbidity and TDS occurred in 30.0% and 36.7% of samples, respectively; nitrate, lead, and arsenic exceeded reported limits in 15.0%, 13.3%, and 8.3%. Gastrointestinal morbidity was reported by 96/300 participants (32.0%), with diarrhea reported by 21.3%. Reported morbidity among participants classified as exposed to E. coli-contaminated water was 47.1% (p<0.001). Conclusion: Microbiological contamination was common in sampled industrial-area water supplies and was associated with greater reported gastrointestinal morbidity. The cross-sectional findings support strengthened water-safety surveillance but do not establish causality

Background: Complex internal medicine admissions are prone to diagnostic discordance and variable treatment outcomes, particularly in high-volume tertiary settings, motivating the adoption of structured, technology-assisted clinical protocols to standardize diagnostic and therapeutic pathways. Objective: To evaluate whether emerging protocol-based care is associated with improved diagnostic concordance and better inpatient and short-term post-discharge outcomes compared with conventional care among adults with complex internal medicine disorders. Methods: A retrospective observational cohort study was conducted across tertiary care teaching hospitals in Lahore, Pakistan, over a 12-month period. Adult inpatients (n=300) managed under internal medicine services were classified by documented care pathway into emerging protocol-based care (n=152) or conventional care (n=148). Primary diagnostic performance was assessed as diagnostic concordance between the initial working diagnosis within 24 hours and the final adjudicated discharge diagnosis. Outcomes included clinical improvement at discharge (CGI-I ≤3), length of stay, in-hospital complications, and 30-day readmission. Multivariable logistic regression adjusted for age, sex, comorbidity burden, disease category, and baseline severity. Results: Diagnostic concordance was higher with emerging protocols (90.8% vs 81.1%; risk difference 9.7%, 95% CI 2.8–16.6; p=0.006). Clinical improvement was more frequent (84.2% vs 69.6%; OR 2.34, 95% CI 1.36–4.03; p=0.002), length of stay was shorter (5.8±1.9 vs 8.4±2.3 days; mean difference −2.6, 95% CI −3.1 to −2.1; p<0.001), and 30-day readmissions were lower (7.9% vs 14.9%; OR 0.49, 95% CI 0.23–0.99; p=0.046). Protocol-based care independently predicted favorable outcomes (adjusted OR 2.47, 95% CI 1.44–4.22; p=0.001). Conclusion: Emerging protocol-based care was associated with improved diagnostic concordance and clinically meaningful gains in efficiency and short-term outcomes in complex internal medicine admissions.