Background: Catheter-associated urinary tract infections (CAUTIs) are among the leading healthcare-associated infections in intensive care units (ICUs), contributing to prolonged hospitalization, antimicrobial resistance, and increased mortality. Locally relevant data from Pakistani ICUs on uropathogen profiles and resistance patterns are limited. Objective: To determine the frequency, microbiological profile, and antimicrobial susceptibility of uropathogens causing CAUTI in catheterized ICU patients at a tertiary care hospital in Lahore, Pakistan. Methods: A cross-sectional study was conducted from December 2024 to April 2025 in the Medical ICU of Mayo Hospital, Lahore. Urine samples from 70 eligible patients were cultured on CLED, Blood, and MacConkey agars, followed by Gram staining and biochemical identification. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method according to CLSI 2024 guidelines. Phenotypic extended-spectrum beta-lactamase (ESBL) and carbapenemase detection were performed. Data were analysed using SPSS version 26.0. Results: Eighteen of 70 patients (25.7%) had culture-confirmed CAUTI. Predominant isolates were Candida albicans (33.3%), Klebsiella pneumoniae (27.8%), Escherichia coli (16.7%), Acinetobacter spp. (16.7%), and Staphylococcus aureus (5.5%). ESBL was confirmed in 60% K. pneumoniae and 66.7% E. coli isolates. All three Acinetobacter isolates were carbapenem-resistant. Prolonged catheterization was significantly associated with CAUTI (p =0.003), while female sex and diabetes mellitus also showed notable associations. Conclusion: The CAUTI affected approximately one in four catheterized ICU patients and was predominantly caused by multidrug-resistant organisms, including ESBL-producing Klebsiella pneumoniae and Escherichia coli and carbapenem-resistant Acinetobacter species, together with a notable proportion of Candida albicans.
Zika virus (ZIKV) of the Flavivirus genus was initially reported in 1947 in Uganda's Zika Forest. It has since become a major global health issue. The virus is mainly spread by Aedes spp. mosquitoes, but it also passes through maternal–fetal (vertical) transmission, sexual transmission, and blood transfusions. Symptomatic ZIKV disease has clinical overlaps with dengue and chikungunya, such as low-grade fever, arthralgia, retro-orbital headache, conjunctivitis, rash, and headache. In the majority of cases, ZIKV produces mild, self-limited illness; however, in certain patients it can produce severe complications like Guillain-Barré syndrome (GBS).1 In pregnant women, ZIKV is linked with congenital Zika syndrome (CZS), which results in severe birth defects like intracranial calcifications, ventriculomegaly, hydrocephalus, and neurodevelopmental impairment. Research indicates that as many as 90% of infected children have long-term cognitive and learning difficulties.2 In 2023, the ZBC-Consortium indicated that babies born to mothers who were infected during pregnancy had a higher likelihood of being small for their gestational age, with about 1.5% having microcephaly at birth, but others had it later in infancy. Such observations highlight the importance of long-term developmental follow-up of infected children.3 Although ZIKV has mainly caused outbreaks in tropical and subtropical regions, its circulation in South Asia remains poorly understood. Climate change has expanded Aedes mosquito vectors into previously low-risk regions, including parts of Asia, Africa, Europe, and the Americas.4 Until recently, Pakistan had no confirmed clinical cases of ZIKV.5 However, detection of ZIKV in Karachi by Aga Khan University marked the first evidence of its circulation in the country, highlighting the urgent need for surveillance and epidemiological research because of its association with congenital abnormalities and neurological complications.6 Pakistan has experienced recurrent dengue outbreaks for over a decade, while chikungunya has also been reported in Karachi. The co-circulation of DENV, CHIKV, and ZIKV complicates clinical diagnosis because they share the same Aedes aegypti vector, similar symptoms, and overlapping geographic distribution.7 Improved clinician awareness and laboratory capacity are therefore essential to distinguish these infections and prevent underreporting. As no licensed ZIKV vaccine is available, prevention relies on integrated vector control, including elimination of mosquito breeding sites, insecticide use, and public education, particularly for pregnant women and high-risk populations.8 Personal protection through insect repellents, protective clothing, window screens, and safe sexual practices should also be encouraged. Enhanced surveillance and antenatal counseling remain critical because of the risk of congenital Zika syndrome. Management of ZIKV infection is supportive, including rest, hydration, and analgesics. Aspirin and other NSAIDs should be avoided until dengue has been excluded because of the risk of hemorrhage.8 Experimental therapies such as quercetin hydrate have shown antiviral activity against ZIKV in laboratory studies but require further evaluation.9 The World Health Organization recommends laboratory confirmation of suspected ZIKV cases to differentiate them from other flaviviral infections, particularly dengue.10 Strengthening diagnostic capacity and surveillance is therefore essential in Pakistan. In conclusion, the detection of ZIKV in Karachi represents an important public health concern. With dengue and chikungunya already endemic, coordinated efforts focusing on vector control, surveillance, laboratory diagnosis, public awareness, and maternal health are needed to prevent future outbreaks and reduce adverse pregnancy outcomes.
he frequency and complexity of public health emergencies have increased dramatically over the past two decades. The Coronavirus Disease 2019 (COVID-19) pandemic, recurring outbreaks of emerging infectious diseases, climate-related disasters, humanitarian crises, and antimicrobial resistance have demonstrated that resilient health systems depend not only on infrastructure and technology but, more importantly, on a competent and rapidly deployable health workforce. In response to escalating health emergencies, the World Health Organization (WHO) has urged Asia-Pacific countries to strengthen emergency workforce capacity through sustained investment, multisectoral collaboration, and preparedness planning.1 This is particularly important for low- and middle-income countries where emergencies can quickly overwhelm health systems. Health crises increasingly occur alongside floods, heatwaves, earthquakes, displacement, and environmental challenges. WHO reports that many hazards are interconnected, creating cascading effects that intensify health risks and disrupt services. These complex emergencies require a workforce skilled not only in clinical care but also in emergency management, surveillance, logistics, risk communication, and coordination, making reliance on routine healthcare personnel alone insufficient. The COVID-19 pandemic exposed major weaknesses in global emergency workforce preparedness. Many countries struggled; even nations with advanced healthcare systems experienced burnout, workforce attrition, and disrupted essential services.2 These lessons underscore that emergency preparedness should not begin during a crisis; it must be embedded within routine health system strengthening.3 The concept of a health emergency workforce extends beyond physicians and nurses. It encompasses epidemiologists, laboratory scientists, emergency medical technicians, public health professionals, logisticians, environmental health specialists, mental health experts, risk communication officers, veterinarians, and community health workers. Each plays a critical role during emergencies, and effective response depends on their ability to function as an integrated multidisciplinary team. Investments in training, competency-based education, simulation exercises, and continuous professional development are therefore essential components of national preparedness strategies. Strengthening the emergency workforce has become an urgent public health priority for countries like Pakistan. The country faces multiple recurring hazards, ranging from climate disasters like floods, earthquakes, and heatwaves, to persistent health threats such as dengue, tuberculosis, polio, antimicrobial resistance, and emerging zoonotic diseases. Climate change further increases vulnerability by expanding the range of vector-borne diseases and intensifying extreme weather events.4 These challenges frequently occur simultaneously, placing immense pressure on healthcare services. Building a resilient emergency workforce capable of rapid mobilization and coordinated response should therefore become a national strategic objective rather than an emergency response afterthought. Pakistan has demonstrated considerable emergency response capacity through the efforts of institutions such as the National Disaster Management Authority, Provincial Disaster Management Authorities, Rescue 1122, the armed forces, and numerous national and international humanitarian organizations. Their contributions during major disasters, including floods, earthquakes, and disease outbreaks, have been instrumental in saving lives and restoring essential services. However, the increasing frequency, scale, and complexity of emergencies have stretched these response systems across multiple regions simultaneously. Preparedness also requires institutional reforms. International collaboration and regional partnerships further enhance surge capacity by facilitating technical assistance, shared expertise, and coordinated responses during transboundary crises.5 Digital surveillance platforms, telemedicine, electronic health records, artificial intelligence-assisted decision support, and mobile communication systems can substantially improve situational awareness and response coordination. However, technological innovation cannot substitute for a well-trained workforce. Investments in digital infrastructure must therefore be accompanied by capacity building.6 An equally important but frequently neglected dimension is workforce well-being. Health emergencies place extraordinary physical and psychological demands on healthcare workers. Protecting the emergency workforce requires ensuring occupational safety, adequate personal protective equipment, mental health support, fair compensation, and supportive working environments. A resilient health system cannot exist without a resilient workforce.7 The WHO's recent regional initiative aligns closely with the broader Health Emergency Preparedness, Response and Resilience (HEPR) Framework, which advocates integrated preparedness rather than disease-specific responses.8 This approach recognizes that investments made in emergency workforce development strengthen routine health services while simultaneously improving readiness for future crises. Ministries of health, finance, education, disaster management, and local governments must collaborate to establish sustainable financing mechanisms, expand workforce training programs, and develop policies that retain skilled professionals within national health systems.9 The WHO's call to strengthen emergency workforce capacities should serve as a catalyst for immediate action rather than another policy recommendation awaiting implementation. Future pandemics, climate-related disasters, and emerging infectious threats are inevitable. Whether countries can mitigate their impact will depend largely on the preparedness, competence, and resilience of the people standing on the front lines. Investing in emergency workforce capacity today is not merely preparation for future crises-it is an investment in health security, national resilience, and the protection of future generations.
Background: Hajj pilgrimage, which takes place in Makkah, Kingdom of Saudi Arabia, is the largest mass gathering of Muslims. The diverse crowd with varying demographic profiles, immunity levels and disease exposure, creates an environment that facilitates the transmission of infectious diseases. Objective: To observe the frequency, patterns and gender distribution of medical illnesses among Pakistani Hajj Pilgrims attending the medical facilities of the Pakistan Hajj Medical Mission during Hajj 2024. Methods: This retrospective study was conducted at Pakistan Hajj Medical Mission (PHMM) hospitals /dispensaries in Makkah (Mission hospitals) and Medina from May to July 2024. All Pakistani Hajj pilgrims attending PHMM hospitals outpatients were included in study. Data collected using a specially designed proforma was analyzed. Results A total of 168,884 patients received medical consultations at outpatient departments of these hospitals during the Hajj pilgrimage, with a male to female ratio of 60:40. A total of 81 deaths occurred during the 10-week Hajj pilgrimage period. Respiratory tract infections and musculoskeletal disorders were the most common illnesses (18%), with predominance among males. Primary causes of death were cardiorespiratory arrest secondary to complications of chronic diseases, road traffic accidents, and heat stroke. Old age, overexertion, and irregular use of medications further contributed to mortality. Conclusion: During Hajj 2024, the PHMM observed a predominance of male patients with respiratory tract infections and musculoskeletal disorders being the most common ailments. Mortality also remained almost double among males as compared to females.
Background: Pulmonary hypertension (PH) is a progressive disorder and the condition is often undiagnosed until advanced stages, moreover limited local data available regarding etiology of disease. Objective: To assess the prevalence and clinical features of PH and to evaluate its demographic characteristics, clinical features and associated comorbidities among patients presenting in Mardan Medical Complex. Methods: This retrospective study was conducted at Department of Medicine, Mardan Medical Complex, Mardan from January 2022 to January 2023. A total of 185 patients were evaluated in this study, with 2 groups as transthoracic echocardiography (TTE) suggested PH and non-PH. Diagnosis of PH was based on echocardiographic findings only as limited access to Right Heart Catheterization (RHC) which is gold standard for PH diagnosis. Relevant ICD 10 coding, ICD 127.0 for primary PH and ICD 127.2 for secondary PH was used to categorrised COPD, ILD, LHD. Results A total of 40 patients were identified as having pulmonary hypertension (PH), the prevalence was 21.6% and 145 were non PH. The largest percentage of people studied had reached 45-59 years old (51.4%). Most PH patients were women (55.0% versus 45.0% men). The most commonly reported clinical manifestation among PH patients was dyspnea reported by 78.9% of patients, followed by fatigue 64.3% and chest pain 41.6%. COPD was significantly associated with PH compared to the non PH group (p-value <0.05). Conclusion: Approximately one-fifth of study’s population had PH, with COPD and advancing age as key risk factors. Similarly TTE-based screening provides valuable insights.
Background: Paranoia, the mistrust of others’ motives, is a common sign of many psychological disorders. The Fenigstein Paranoia Scale Urdu (FPSU) is widely used for identifying paranoia in both clinical and non-clinical populations Its Urdu version is widely used and cited in the context of paranoia research in Pakistan. Although it is widely used, no studies have evaluated the factor structure of the scale, which could further validate it. Objective: The objective of this study is to evaluate the reliability, validity, and factor structure of the Urdu version of the FPSU for clinical and research purposes in Pakistan. Methods: This psychometric study was conducted at the University of Karachi, Karahi Pakistan, in June 2024. Validity was established by inter item correlation and factor analysis and the reliability was assessed by Cronbach's alpha, Spearman Brown coefficient and split half. The correlation between two halves was adequate (r =0.69). Validity was calculated through inter item correlation and factor analysis. Principal component analysis revealed five factors, which correspond to the aspects of paranoia identified in the original scale development study. Factor B accounted for 24.68% of the variance and was therefore the dominant factor of paranoia measured by the FPSU. The scale was found to be theoretically consistent and valid. Results The research was conducted on a purposive sample of 600 participants (317 males, 283 females). The sample’s mean age was 24.73 years (SD =8.30). The Cronbach's alpha value was .83, indicating a good degree of internal consistency.................
Background: Maternal and Neonatal Tetanus (MNT) is an acute and possibly fatal illness affects women during pregnancy or within six weeks of postpartum. Objective: To assess the frequency of Tetanus Toxoid (TT) vaccination among pregnant women and to identify the factors associated with TT vaccination during pregnancy. Methods: This cross-sectional study was conducted in Department of Gynecology and Obstetrics in collaboration with Department of Community Medicine, Peoples Medical College Hospital (PMCH), Nawabshah from March to August 2023. A total of 192 pregnant women aged 15 to 49 years were included. Data were collected on a pre-designed Proforma. The data entry and analysis were performed by SPSS software version 25. A chi-square test was used to identify associated factors contributing to the vaccination of TT, data was compared using appropriate stats and a p-value of <0.05 was considered significant. Results Around 41% of pregnant women received the recommended doses of TT. Only 32% of all illiterate participants were fully vaccinated while this factor surged to 80% in participants who received university education. Considering the major cause of not having vaccination, about 80% participants had lack of awareness regarding vaccination. Conclusion: The present study demonstrated inadequate coverage of TT vaccination among women. Several factors were significantly associated with TT vaccination, including place of residence, women’s educational status, knowledge regarding TT doses during pregnancy and across the lifetime, employment status of women, husband’s income, travel time to the health facility, husband’s consent, and availability of a TT vaccination card.
Background: Malignant pleural effusion (MPE) is a common oncological complication that requires accurate diagnosis to guide appropriate management. Cytological smears are widely used; however, they have variable sensitivity. The cell block technique has emerged as a potentially superior diagnostic tool due to its better preservation of cellular architecture and compatibility with ancillary testing. Objective: This study aims to compare the diagnostic utility of the cell block technique with the conventional cytological smear in detecting MPE, using histopathology as the gold standard. Methods: This cross-sectional study was conducted at the Institute of Tuberculosis and Chest Medicine, Mayo Hospital, Lahore. One hundred and thirty-eight patients, aged 18 to 75 years, with probable malignant pleural effusion were enrolled. Pleural fluid specimens were subjected to both conventional cytology and cell block analysis. All patients subsequently received a pleural biopsy for histological validation. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated using SPSS version 27.0. Results Cytology demonstrated a sensitivity of 65.82%, specificity of 86.44%, PPV of 86.67%, NPV of 65.38%, and overall diagnostic accuracy of 74.64%. The cell block technique demonstrated a significantly higher sensitivity (89.87%), specificity (94.92%), PPV (95.95%), NPV (87.50%), and overall diagnostic accuracy (92.03%) (p =0.002). Conclusion: The cell block technique is more effective than conventional cytological smears in diagnosing malignant pleural effusion, offering higher sensitivity, specificity, and diagnostic accuracy.
Background: Patients with chronic kidney disease (CKD) have an increased prevalence of cardiovascular disease with declining renal function. However, the concentration of cardiac troponins is increased among CKD patients in the absence of clinical evidence of acute myocardial infarction. In this study cardiac troponin I and cardiac troponin T concentrations were studied in patients with CKD. Objective: To determine cardiac troponin I and T levels in patients with clinically stable chronic kidney disease presenting to a tertiary care hospital in Rahim Yar Khan. Methods: This cross-sectional study was conducted in the Department of Chemical Pathology, Sheikh Zayed Hospital, Rahim Yar Khan from January to September 2024. A total of 222 individuals with CKD without any known cardiac diseases were included. Serum cTnI and cTnT were measured on chemiluminescence immunoassay analyzer. Mann-Whitney U test and Kruskal-Wallis H test followed by post-hoc analysis were used for the analysis of significance. Spearman rank was used to evaluate correlation of eGFR with cTnT and cTnI. Results A total of 222 patients, 142 males (64%) and 80 females (36%), with CKD were included. There was a statistically significant difference between stages of CKD and cTnT levels, p value <0.001 but not between stages of CKD and cTnI levels, p value =0.114. The eGFR showed a negative correlation to cTnT (r = -0.456) but had a negligible negative correlation (r =-0.140) with cTnI. Conclusion: The level of cTnT increases across CKD stages however the concentration of cTnI appears to be stable.
Background: Hygiene is essential for safeguarding personal health against infectious agents. Around one-fourth of all females of reproductive age (between the ages of 12 to 50), are thought to lack the resources necessary to control their menstrual cycles. Girls in Low- and Middle-Income Countries (LMICs) experience critical challenges maintaining proper menstrual hygiene. Objective: To assess menstrual hygiene management among low household income females in rural areas around Hyderabad Sindh. Methods: This cross-sectional study was conducted in rural areas of Hyderabad region from July to December 2022. Participants included premenopausal females aged 15 years and older. After taking informed consent and ascent data were collected on pre-designed questionnaire. Data were stored and analyzed using IBM-SPSS version 23.0; Pearson Chi-Square test was used to evaluate the association of menstrual hygiene with the age group of low socioeconomic class, with p-values less than 0.05 considered statistically significant. Results Of the 129 low-socioeconomic-status women included in this study, 59.7% were between 15 and 25 years of age. Among the women surveyed, 78.3% used cloth pieces as an absorbent material, and 59.5% changed their absorbent only once per day. Regarding sanitation and hygiene, 27.9% disposed of materials in a dustbin, 98.4% used water alone for washing, and 63.6% bathed only once during their menstrual cycle. Additionally, 88.4% washed and sun-dried their undergarments. While 68.2% experienced complications during menstruation, only 15.5% possessed basic awareness of menstrual hygiene and a mere 0.8% had received formal hygiene information. Conclusion: Menstrual hygiene management found to be poor among ..........
Background: There is growing evidence linking recurrent abdominal pain (RAP) in children to mesenteric lymphadenopathy (MLA), which is often a benign and incidental finding. Evaluating MLA in broader clinical context is crucial to prevent unnecessary invasive procedures. Objective: To assess the frequency of MLA in children aged 5-12 years with RAP compared to age-gender matched controls and to assess the association between MLA and symptoms. Methods: Children aged 5-12 years who experienced RAP were included in this prospective case-control study, which was carried out at the outpatient of Paediatric Department of the Federal Government Polyclinic Hospital, Islamabad from June 2022 to December 2023. The controls were age and gender matched children without minor abdominal complaints, children with abdominal pain due to other causes were carefully excluded. MLA was diagnosed when lymph nodes size was ≥ 5 mm on abdominal ultrasound. Using SPSS V.23, odds ratios (OR) were calculated with statistical significance set at p <0.05. Results: There were 300 children in the study (150 cases and 150 controls), all of whom had comparable ages and genders (p >0.05). Compared to controls, MLA was more prevalent in cases (30% vs. 8.7%, p =0.001) and mean lymph nodes size was significantly larger on both short and long axis (p < 0.05). For nodes larger than ≥ 5 mm, the OR was 4.5. MLA was not significantly associated with severity of symptoms (p >0.05). Conclusion: Children with RAP had a much higher prevalence of MLA than matched controls. However, no significant association ............
Background: Visual impairment caused by refractive errors is one of the most common issues faced by school-age children. Despite ongoing developments in access to health care, multiple factors, including awareness and recognition of issue, still contribute to persistence of uncorrected refractive errors especially among madrasah students. Many studies have estimated the prevalence of refractive errors in school-going children but data from madrassahs are lacking so this study aims to find the prevalence of refractive errors in madrassahs of Karachi. Objective: To determine the prevalence of refractive errors among the students of five registered madrassahs in Karachi and Sukkur. Methods: This cross sectional study was conducted in five madrassahs across Karachi and Sukkur, during August 2024 to December 2024. After taking approval from Institutional Review Board, informed consent and assent were obtained for each participant. In children aged 7–15 years, Subjective refraction was performed using standard Snellen's visual acuity chart at 6 meters’ distance. Individuals identified as ametropic during subjective refraction were subsequently referred for objective refraction. Results: Refractive errors are more common in females than males (p <0.05), and in urban population than rural ones (p <0.05). Myopia was found to the most common refractive error (57.7%) followed by astigmatism (22.1%) and then hypermetropia (20.1%). Conclusion: Screening Madrassah children for refractive errors is crucial due to the high prevalence and prolonged near-work associated with their curriculum.
Background: Chronic obstructive pulmonary disease (COPD) is a prevalent able and progressive illness. Uric acid counteracts the effects of oxidants. It is important to assess the influence of serum uric acid levels on the clinical outcomes of hospitalized patients with chronic obstructive pulmonary disease (COPD). Objective: To determine the association of serum uric acid levels with acute exacerbation of COPD in hospitalized patients at a tertiary care hospital in Karachi. Methods: This observational study was carried out in the Chest Medicine Department of Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan, from January to June 2023. It included patients presenting with acute exacerbation, diagnosed per Anthonisen's criteria. Serum uric acid levels were measured from venous blood samples at admission, and hyperuricemia was defined as a level >7 mg/dL. Data on quantitative variables (age, pack-years of smoking, systolic blood pressure (SBP), diastolic blood pressure (DBP), and COPD duration, as well as qualitative variables such as gender, residence status, hyperuricemia, and in-hospital mortality, were recorded. Results: A total of 150 patients were examined during the study, with a mean age of 65.37±11.55 years. There were 107 (71.3%) males and 43 (28.7%) females. The mean duration of COPD was 14.33±14.65 years. The mean hyperuricemia of the patients was 7.89±2.72 mg/dl. The mean serum albumin of the patients was 3.48±0.97 g/dl. In this study, 66 (44.0%) patients were expired. It was seen that 54 (81.8%) expired patients had high uric acid versus 39 (41.9%) patients (p <0.001). Conclusion: Hyperuricemia emerges as a promising biomarker ..............
Background: Autoimmune rheumatic diseases (ARDs) are chronic inflammatory disorders that often require long-term treatment with disease-modifying antirheumatic drugs (DMARDs) to control disease activity and prevent organ damage. However, due to their immunosuppressive effects, DMARDs may increase patients’ susceptibility to various infections. Objective: To assess various types of infections occurring among patients of autoimmune rheumatic diseases receiving disease-modifying antirheumatic drugs in the Department of Rheumatology at Pakistan Institute of Medical Sciences (PIMS), Islamabad Methods: A cross-sectional study was conducted in Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad during April to October 2023. Data of 150 patients having autoimmune rheumatic diseases who were receiving disease modifying antirheumatic drugs was collected after taking informed consent and ethical approval. Frequency of various infections in patients with autoimmune rheumatic diseases on disease-modifying antirheumatic drug therapy was observed. Data was analyzed in Statistical Package for Social Sciences version 23.0. Results: The mean age was 40.7±17.1 years and most of study patients were females 129 (86.0%). All patients experienced infection. Of total, 60 (40.0%) had lower respiratory tract infections, and 45 (30.0%) had skin/soft tissue infections. Other frequent infections were upper respiratory tract infections 24 (16.0%), gastrointestinal tract infections 14 (9.3%) and sepsis found in 7 (4.6%) of study cases. None of the patients had pneumococcal or influenza vaccination. Conclusion: An absolute infection rate was found among ARDs patients under DMARDs therapy. This is alarming situation and underscores the need for risk stratification and preventive measures before initiation of therapies.
Background: Physical injuries can have prominent consequences, affecting not only physical health but also psychological well-being, potentially leading to Post-Traumatic Stress Disorder (PTSD). Moreover, gender plays an important role in the development and manifestation of PTSD symptoms in hospitalized patients. Objective: To observe the development of PTSD in hospitalized patients for physical injuries lasting more than a month in Pakistan Institute of Medical Sciences (PIMS) Islamabad Pakistan. Methods: This cross-sectional study was conducted at Pakistan Institute of Medical Sciences, Islamabad, during September 2022 to March 2023, and included 261 participants. PTSD symptoms were assessed using the Urdu-translated version of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), which aligns with the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Results: The current study revealed that 100% of both male and female hospitalized patients exhibited substantial PTSD symptoms. There were 64.3% male patients categorized as severe while 53.8% females had severe PTSD symptoms and revealed a statistically significant association (p <0.05) of severity of PTSD symptoms and the extent of physical injuries in male patients. The prevalence of severe PTSD symptoms were highest among those with orthopedic trauma (76.0%), while 59.1% female patients of same category showed severe PTSD symptoms. Conclusion: The study concluded that both male and female hospitalized patients with physical injuries show significant PTSD symptoms, with male showing a higher severity.
Pakistan is the one of the top ten countries affected by climate change. Floods started this year in Pakistan from June 2025. Since then, approximately two million people have been displaced and 1000 have died.1 Gender is an important determinant in disaster planning and management. Unfortunately Pakistan ranked 148 according to the Global Gender Gap Index Report 2025, hitting rock bottom.2 This is mainly due to socioeconomic and cultural disparities. Women are usually ignored or discriminated against when it comes to relief activities during disasters.3 Risk factors for gender discrimination among women include lack of education, limited access to health facilities, family system and economic dependency.2 In Pakistan the largest sector which provides employment to women (66%) is agriculture4 however their work is usually informal, unpaid and unrecognized. In our patriarchal society women remain at home and fulfill household responsibilities hence they receive no training to cope with natural disasters and are more likely to suffer in such situations. This in turn also makes them more prone to gender based violence, exploitation and child marriages as this issue surges globally during disasters.5 Small home based industries post floods should be established where women can get employed so that they become economically empowered. Women suffer from home based ailments such as anaemia, severe malnutrition, skin and gastrointestinal diseases, dengue, malaria, pneumonia, depression and post-traumatic stress disorder post floods are also common.6 An important issue which women face is of menstrual hygiene. Lack of awareness, inadequate supplies and cultural stigma are the factors which cause menstrual hygiene problems.7 Financial constraints post floods make it difficult for women to buy sanitary products due to which they start using washable cloth pads. As they may not have privacy or proper drying areas they use unclean cloths which cause urinary tract infections and bacterial vaginosis which puts them at risk of premature labour and pelvic inflammatory disease.7 Lack of segregated toilet facilities for women in flood affected areas is also a problem. During the 2022 floods 95% women reported using the same toilet as men because there was only latrine in the flood relief camp.4 In our society menstrual hygiene is a taboo topic and cannot be discussed openly. Majority of the relief workers are men so it is difficult for women to communicate with them. In addition they are also not properly trained. Efforts should be made to create a favorable environment for them to practice menstrual hygiene activities with dignity. Pakistan’s high maternal mortality rate is worsened by inadequate reproductive health services, especially in rural areas, where floods further strain an already fragile health system. During the 2022 floods, around 650,000 pregnant women were deprived of essential antenatal and delivery services.8 The displacement of Lady Health Workers disrupted community-level care, forcing women to travel to distant facilities despite limited transport and financial constraints. Many women delivering in relief camps faced complications due to unhygienic conditions, lack of skilled birth attendants and poor postnatal care, increasing risks for both mothers and newborns, including long-term developmental issues. Implementing the Minimum Initial Service Package (MISP) is crucial in emergencies, as it provides education, hygiene supplies and reproductive health services that reduce maternal and neonatal morbidity and mortality.9 A multisectoral, gender-sensitive approach involving health, social and education sectors is essential. Strengthening structural and systemic capacities will enhance Pakistan’s preparedness for future climate-related disasters.
The most common reason for decreased function and impairment is low back pain (LBP). According to National Institutes of Health epidemiology research, lower back pain affects 60-80% of adults at some point in their lifespan.1 There is a wide range of methods used to treat chronic low back pain (CLBP), and one of them is the "Graston Technique (GT)" or "Instrument-assisted soft tissue mobilization (IASTM)." It is an innovative, proof-based type of instrument-helped delicate tissue activation. GT is a manual therapy that uses specialized instruments with bevelled edges to find and treat soft tissue disorders. GT has slowly started to dominate, using direct compressive stroke techniques to manipulate muscles, myofascial, tendons, and skin. The ground of GT that "James Cryriax '' developed is deep cross-friction massage. Although GT or IASTM originates from Gua sha, a traditional Chinese medicine approach, their rationale, objectives, and application strategies differ. This strategy is the best quality level of myofascial discharge.2 Despite its indications and limitations, the GT has gained popularity due to its efficiency and effectiveness while remaining completely noninvasive. Graston Method involves applying pressure and manipulation to the affected areas with specialized tools for incrementing blood supply and breakage of scar tissue.3 In addition, these changes demonstrate that this method can improve the restoration of nearby morphological microvasculature; hence injured soft tissue blood supply increases. Studies indicate the clinical interest of this method in the treatment-related restoration of pain perception, strength, and joint ranges. The instrument's surface maximizes the force delivered to the tissues while minimizing the energy and force the practitioner uses and therefore, it is possible to stimulate the points adhered in deep areas. The technique assists in changing soft tissue injury to sound working tissue.4 The GT is especially beneficial for patients suffering from CLBP. Physical therapists, chiropractors, and sports medicine professionals frequently employ this method to treat LBP, as it mobilizes scar tissue and myofascial adhesions. Increased vibration sensitivity may aid the clinician's capacity to detect tissue adhesions. Furthermore, the instrument's use provides a mechanical advantage, reducing the imposed strain on the therapist's hand.2 The GT helps with better healing by using the method of vasodilation. It also aids in the better flexibility of the back muscles. When utilized alongside stretching exercises, the approach helps alleviate pain and discomfort, increase muscular flexibility, and increase range of motion (ROM) after a few weeks of treatment.3 GT is a safe and effective way to treat soft tissue areas affected by chronic low back pain. More research studies have confirmed GT's efficacy. The treatment may vary, but all follow Graston's method, proving with evidence-based practice that physiotherapists should use the Graston technique in their practice. Combined with other physical exercises, it creates a practical treatment approach for CLBP.
Background: Migraine is a frequent neurological condition with a complex pathogenesis and neuro-physicians continue to face difficulties in diagnosing and treating migraines due to their clinical breadth and heterogeneity. Objective: To determine the levels of serum calcitonin gene related peptide (CGRP) outside the attack (interictal) in migraineurs versus healthy controls. Methods: This cross-sectional, analytical study was conducted in Centre of Research in Molecular Medicine, The University of Lahore, Pakistan from November 2023 to June 2024. A total of eighty cases were added in research. Forty were patients of common migraine (as per ICHD-3 criteria) and forty were healthy controls. Serum CGRP levels were estimated by enzyme linked immune-sorbent assay (ELISA) outside the attack in migraineurs and healthy controls. Shapiro-wilk test, Mann Whitney U and Chi square tests were used for statistical analysis. The ROC (receiver operating characteristic) curve and AUC (area under curve) were acquired to assess capacity of discrimination of CGRP levels for common migraine. The p-value <0.05 was considered statistically significant. Results: Migraineurs had a median serum CGRP level of 99.6 (64.4–163.4) ng/L while for the healthy controls it was 14.8 (10.9–24.3) ng/L (p <0.001). ROC curve analysis had found cutoff serum CGRP level of 36.8 ng/L with positive predictive value (PPV) as 86.7%, negative predictive value (NPV) as 97.1%, sensitivity as 97.5%, specificity as 85% and accuracy as 91.3% for the diagnosis of common migraine. Conclusion: Elevated serum CGRP levels outside the migraine attack can be used as a potential biomarker for the diagnosis .................
Background: The esthetics of the face and teeth help in the prognosis of the outcome of orthognathic surgery, implant surgery, operative dentistry, anterior aesthetic surgery, and fixed or removable prosthetic procedure. Objective: To compare the amount of maxillary incisal exposure between patients with normal and short upper lip lengths. Methods: This cross-sectional study was conducted at the Orthodontics Department of Peshawar Dental College and Hospital, Pakistan, and involved clinical measurements of upper lip length and incisal exposure using a digital vernier caliper. A total of 235 adult patients were assessed according to their upper lip length and their classification was done under short upper lip, normal upper lip or enhanced upper lip length. A digital vernier caliper was used to measure the amount of incisal exposure during the resting position as well as during the smiling phase. Results: Out of total 235 participants, 112 (47.7%) were males and 123 (52.3%) females, with a mean age of 32.4±SD years and an age range of 20-45 years. Normal lip length participants had the largest exposure with a mean of 8.19 mm±1.87 SD (p value <0.001) as shown by the outcome whereby different lip length groups presented significant differences in incisal exposures. The angular depth of the incisal edges was less exposed than that analyzed by the observers with increased or decreased labial lip lengths. Conclusion: The study shows that upper lip length significantly affects maxillary anterior tooth visibility at rest and during smiling, with optimal esthetic incisal display observed in individuals ............
Background: The gestational diabetes mellitus (GDM) is one of the most common medical conditions during pregnancy. Insulin is considered to be safe in pregnancy. As compared to Neutral Protamine Hagedorn Insulin (NPH)” insulin detemir shows good safety and efficacy for future use in GDM for better cure. Objectives: To compare the outcome of insulin detemir plus Novolin R versus NPH plus Novolin R in women with GDM. Methods: This experimental study was conducted in outpatient Department of Obstetrics & Gynae., Unit I, Services Hospital, Lahore from February 2021 to February 2022. After taking ethical approval and informed consent, patients were selected by probability double blind sampling technique and randomized in two groups. In group A, patient received insulin detemir plus Novolin R. In group B, patients received insulin NPH plus Novolin R. At baseline and after 3 weeks of treatment, fasting and post-prandial sugar levels were measured and compared for mean change in blood sugar level. Results: In detemir group, the mean fasting blood sugar level was 156.74±16.80 g/dl, which was reduced to 99.34±16.82 g/dl after treatment. In NPH group, the mean fasting blood sugar level was 155.01±18.81 g/dl, and reduced to 104.70±18.97 g/dl after treatment with significant (p <0.05). In detemir group, the mean post-prandial sugar level was 222.44±37.88 g/dl, and reduced to 142.00±15.74 g/dl after treatment. In NPH group, the mean post-prandial sugar level was 210.90±38.39 g/dl, and reduced to 147.97±7.05 g/dl after treatment and the reduction was significant (p-value <0.05). Conclusion: The detemir was found to ....................
