Pharmaceutical product recalls are essential for safeguarding public health by removing defective, unsafe, or substandard medicines from circulation. Pharmacists play a key role in identifying, communicating, and managing recalled products; however, evidence regarding their preparedness in Pakistan remains limited. A cross-sectional KAP survey was conducted among pharmacists working in clinical, industrial, hospital, community, retail, and academic settings across Pakistan. A structured and internally validated questionnaire assessed participants’ knowledge, attitudes, and practices related to pharmaceutical product recalls. Reliability was evaluated using Cronbach’s alpha. Descriptive statistics, Mann–Whitney U, Kruskal–Wallis, and correlation analyses were performed. A total of 106 pharmacists participated, including 49.1% males and 50.9% females. Most respondents demonstrated good awareness regarding recall definitions, recall classifications, and the importance of timely communication during recalls. More than 95% supported immediate recalls for safety concerns, while 97.2% emphasized timely communication with healthcare professionals and the public. Despite positive knowledge and attitudes, practical exposure was limited, with only one participant reporting direct experience handling a recall. Approximately 38.7% reported never receiving recall-related information from authorities or manufacturers. Significant differences were observed in knowledge scores across gender (p = 0.004) and practice scores across professional domains (p = 0.034). Positive correlations were identified between knowledge, attitude, and practice scores. Pakistani pharmacists demonstrated good knowledge and positive attitudes toward pharmaceutical product recalls; however, practical engagement and communication systems remain inadequate. Strengthening recall reporting systems, communication channels, and practical training may improve recall preparedness and patient safety outcomes.
Breast cancer control in low- and middle-income countries (LMICs) is frequently framed as a choice between screening and early detection. This framing is misleading: screening is not an alternative to early detection but one component of it. Drawing on the World Health Organization’s Global Breast Cancer Initiative, this editorial distinguishes early diagnosis of symptomatic women from population screening of asymptomatic women, and argues that in resource-limited systems early diagnosis should be built first. The dominant clinical problem in LMICs is late presentation rather than missed subclinical disease; lower incidence, high infrastructure demands, and a contested benefit-to-harm balance further weaken the case for early mammographic screening. Detection, moreover, is of value only where a functioning diagnostic and treatment pathway exists. A pragmatic, sequenced strategy is proposed—strengthening early diagnosis and referral first, adding clinical-breast-examination-based screening thereafter, and reserving organised mammographic screening for systems able to sustain it—underpinned by investment in a national cancer registry.
Green synthesis of gold nanoparticles (AuNPs) using plant extracts has emerged as a sustainable and biocompatible approach in nanomedicine. In this study, AuNPs were synthesized using Ifloga spicata (Forssk.) whole-plant extract and evaluated for their biological effects on human blood lymphocytes exposed to hydrogen peroxide–induced oxidative stress. Nanoparticle formation was confirmed using UV–visible spectroscopy, Fourier-transform infrared spectroscopy (FT-IR), and X-ray diffraction (XRD). Exposure to oxidative stress significantly increased intracellular reactive oxygen species (ROS) and thiobarbituric acid reactive substances (TBARS), while suppressing antioxidant enzyme activities, including catalase (CAT), superoxide dismutase (SOD), and peroxidase (POD). Treatment with I. spicata–mediated AuNPs significantly attenuated ROS and TBARS levels and restored antioxidant enzyme activities in a concentration-dependent manner, with maximal protective effects observed at 5 and 50 µg/mL. Importantly, AuNPs did not induce adverse oxidative effects under normal physiological conditions, indicating a favorable cytocompatibility profile. These findings suggest that I. spicata–derived AuNPs exhibit antioxidant and cytoprotective properties and may represent promising candidates for mitigating oxidative stress–related cellular damage. Further in vivo studies are warranted to elucidate their mechanistic pathways and therapeutic potential.
This study was conducted to describe and compare the demographic and clinical profiles of patients with cervical cancer, colorectal carcinoma, and acute leukaemia at a tertiary oncology centre in Karachi, Pakistan, and to benchmark these findings against local, regional, and global reference data, with a view to informing screening policy and cancer awareness strategies in a resource-limited setting. This study was secondary synthesis of aggregated data from published cross-sectional observational studies. The study was conducted at the Department of Medical Oncology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. A combined cohort of 329 adult patients with histologically confirmed malignancies: 92 with cervical cancer, 107 with colorectal carcinoma, and 130 with acute leukaemia were included. The mean age at diagnosis was 53.4 years (SD 10.9) for cervical cancer, with approximately 11% of patients under 40 years — consistent with local and global norms. By contrast, colorectal carcinoma presented at a median age of 40 years (IQR 16), with an estimated 65% of patients under 40, and acute leukaemia at a mean age of 27.9 years (SD 14.5), with approximately 80% under 40. These younger age profiles align broadly with South Asian data but diverge substantially from global medians of 68–72 years for colorectal carcinoma and 68–71 years for acute leukaemia. A descriptive comparison of the proportion of under-40 patients across the three cancer types showed a marked gradient (cervical ~11%, colorectal ~65%, leukaemia ~80%). Male predominance was observed in both colorectal carcinoma (66%) and acute leukaemia (65%). Advanced-stage disease was common in both solid tumours, affecting 60% of cervical and 67% of colorectal cases. Sedentary behaviour (92%) and smoking (58%) were frequently documented among colorectal carcinoma patients. This synthesis demonstrates a pronounced age divergence in colorectal carcinoma and acute leukaemia relative to global benchmarks, consistent with broader trends across Pakistan and South Asia. The findings support a review of locally appropriate screening thresholds and underscore the need for age-inclusive cancer awareness programmes. Multi-centre collaborative studies are required to generate the evidence base necessary for context-specific national guidelines
The objective of this cross-sectional study was to establish the association between idiopathic toe walking and gross motor skill acquisition among children aged 4 to 10 years. Data were collected between July 2025 and January 2026 from the Physical Therapy and Rehabilitation Department at the University of Lahore Teaching Hospital (ULTH) and the Physical Therapy Department at Sehat Medical Complex (SMC), Hanjarwal, Lahore, Pakistan, after obtaining informed written consent. Children with idiopathic toe walking (ITW) were recruited through non-probability convenience sampling (n = 29). ITW characteristics were assessed using the Toe Walking Tool (TWT), while gross motor performance was measured using the locomotor subtest of the Test of Gross Motor Development, Third Edition (TGMD-3). Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 26, applying descriptive statistics and the Spearman rank correlation. A statistically significant moderate negative correlation was found between toe-walking frequency and gross motor development scores (r = -0.529, p = 0.003). Children with higher severity of toe walking demonstrated lower gross motor performance, and significant differences in motor scores were observed across severity groups. Idiopathic toe walking is significantly associated with reduced gross motor skill development; increased frequency and severity of toe walking are linked with poorer motor performance, highlighting the importance of early identification and physiotherapy intervention.
This study was a cross-sectional study conducted to assess the attitudes and practices regarding tuberculosis (TB) infection control among nurses working at Khyber Teaching Hospital, Peshawar. The study included 187 registered nurses at Khyber Teaching Hospital, Peshawar. Participants were selected through convenience sampling. Data were collected using a structured, self-administered questionnaire assessing attitudes and practices related to TB infection control. Data were analyzed using SPSS version 22, and results were presented as frequencies and percentages. Majority of participants demonstrated positive attitudes toward TB infection control. Most nurses reported routinely screening patients for cough (79.1%) and ensuring separation of suspected TB cases (77%). A high proportion (89.3%) reported consistent use of personal protective equipment when managing TB patients. Additionally, 88.7% emphasized the importance of proper ventilation in infection control. Regarding practices, 88.8% reported using protective measures, and 85.5% expressed confidence in managing TB patients. However, gaps were identified in specific practices such as sputum collection in well-ventilated areas. Nurses exhibited generally positive attitudes and satisfactory practices regarding TB infection control. However, inconsistencies in certain practices highlight the need for continuous training and reinforcement of infection control guidelines to minimize the risk of TB transmission in healthcare settings.
Acute necrotising pancreatitis (ANP) is a severe and rare form of acute pancreatitis (AP) in children. It can present with complications like pancreatic pseudocysts and vascular thrombosis which significantly increase chances of morbidity in patients and require a comprehensive diagnostic and therapeutic approach. We report the case of a 3-year-old male presenting with abdominal pain, vomiting and fever. Radiological imaging revealed findings consistent with acute on chronic necrotizing pancreatitis complicated by multiple intra- and peripancreatic pseudocysts with partial portal vein thrombosis. The patient was conservatively managed with intravenous fluids, antibiotics, anticoagulation and nutritional support. This case highlights the significance of considering severe pancreatic pathology in pediatric patients who present with non-specific abdominal complaints and emphasises the critical role of imaging and multidisciplinary care in improving clinical outcomes.
Objective: Myocardial Infraction leading to significant myocardial damage if not promptly addressed. The Aim of this study is to determine the frequency and predictors and assessing the associated factors with LV Dysfunction in patients with AMI undergoing PPCI. Methodology: A Descriptive cross-sectional study conducted at department of Cardiology department of SICVD hospital Larkana for the period of six month on 340 patients. All the patients from the age range between 30-70 years old with confirmed diagnosed cases of AMI based on angiography and undergone PPCI were included in the study. Primary PCI procedures were performed by the cardiologists; pre- and post-procedure clinical and pharmacological management were kept uniform. Descriptive analysis was applied and association between LVD and various demographic and clinical characteristics assessed by conducting the Chi-square/ sample t-test/ Mann-Whitney U test appropriately. The statistical significance was considered =p-value<0.05. Results: There was a male majority in the sample, with 264 (77.6%) of these being male and 76 (22.4%) being female. Only 6 patients (1.8%) were under 30 years old, according to the age distribution. The mean age score for patients with intact LVEF (>50%) was 3.76, while the averages for gender and hypertension were 1.23 and 1.36, respectively. The mean age of those with slightly decreased LVEF (40–50%) was 3.85, whereas the averages for gender and hypertension were 1.23 and 1.32, respectively. Conclusion A significant percentage of patients experience severe LV systolic dysfunction, which is linked to unfavourable clinical outcomes. significant LV systolic dysfunction after PPCI is independently predicted by larger myocardial infarction, renal impairment, and significant coronary artery disease.
A significant number of patients with end-stage renal disease (ESRD) experience a paradoxical rise in systolic blood pressure (SBP) during or immediately following hemodialysis (HD), a condition known as intradialytic hypertension (IDHTN). While the physiological removal of excess fluid typically lowers blood pressure, IDHTN has been linked to increased morbidity, hospitalization, and mortality. A cross-sectional study was conducted on 134 adults undergoing thrice-weekly maintenance HD at a tertiary care center in Karachi, Pakistan, to investigate the prevalence and associated factors of this condition in a resource-constrained setting where data are scarce. Intradialytic hypertension was defined as a change in SBP of at least 10 mmHg from pre- to post-dialysis, averaged over three consecutive sessions. The study found a prevalence of 35.8% (48 out of 134 patients). The condition was significantly associated with several factors, including pre-existing hypertension (p=0.005) and diabetes mellitus (p=0.012), ultrafiltration volumes below 2 L (p=0.020), and, most notably, the use of antihypertensive medications (p<0.001) and dialyzable agents (p<0.001). Additional associations were observed with age 30 years or younger (p=0.018) and smoking (p<0.001). The findings indicate that IDHTN is a common finding in this cohort and is strongly linked to clinical and treatment-related factors. The results suggest that interventions focused on optimizing ultrafiltration targets and tailoring antihypertensive regimens, particularly by selecting non-dialyzable agents, may be crucial for reducing the incidence of this condition and improving patient outcomes.
The objective of the study was to determine the factors underlying maternal and fetal outcomes of Placenta Accreta Spectrum (PAS). This observational, prospective study was conducted during a period of four years. A total of 9080 patients were admitted in Obstetrics & Gynaecology department throughout this duration. Out of which 147 were diagnosed with the history of antepartum haemorrhage with pregnancy. Full term, near term patients or patients with massive antepartum haemorrhage underwent emergency or elective caesarean section while patients diagnosed in the second or early third trimester on ultrasound or with mild antepartum haemorrhage treated conservatively. In our study, we found that the frequency of Placenta Accreta Spectrum was 1.6%. The average age of the participants was 28.08 years, with age ranging between 17 to 42 years. Most participants lived in urban areas (46%), and a significant number were grand multiparous (70%). We observed that a history of previous caesarean section (62%) and previous placenta previa (68%) increased the risk of PAS. During surgery, the most common complication was bleeding (11.5%), followed by bladder injury (8.8%). The occurrence of PAS cases has significantly risen in the recent years. The PAS is linked with serious health risks for both the baby and the mother. It's crucial to implement strategies aimed at reducing the rate of caesarean sections to mitigate the associated complications, such as placenta previa and PAS, which pose significant risks to maternal and fetal health.
The study aimed to compare the effectiveness of chiropractic manipulation and Mulligan’s mobilization in reducing pain, improving range of motion, and enhancing functional outcomes in individuals with subacromial pain syndrome. This was a randomized controlled trial (RCT) at DHQ Jhelum, CMH Jhelum, and Jhelum Sports Complex, Pakistan. A total of 62 participants with subacromial pain syndrome were randomly assigned to a chiropractic manipulation group (n = 31) or a Mulligan’s mobilization with movement (MWM) group (n = 31). Both groups received their respective interventions over a set treatment period. Pain intensity (VAS), functional disability (SPADI), and shoulder range of motion (flexion, extension, abduction, internal and external rotation) were measured pre- and post-intervention. The mean age was 46.71 ± 8.30 years in the chiropractic group and 47.03 ± 7.74 years in the MWM group. Baseline VAS scores were 7.58 ± 1.12 and 7.32 ± 1.14, decreasing post-intervention to 2.45 ± 1.34 and 4.32 ± 1.33, respectively. SPADI scores improved from 63.93 ± 6.24 to 32.97 ± 6.67 in the chiropractic group and from 62.74 ± 5.62 to 42.58 ± 5.46 in the MWM group. Flexion, extension, abduction, internal rotation, and external rotation ROM all increased in both groups, with chiropractic improving from 117.42°, 38.70°, 94.21°, 37.65°, and 52.11° to 155.32°, 47.64°, 126.68°, 50.75°, and 69.13°, and MWM from 118.10°, 38.36°, 95.82°, 37.23°, and 52.74° to 145.56°, 44.91°, 118.34°, 46.12°, and 65.70°, respectively. Both chiropractic manipulation and Mulligan’s mobilization with movement effectively reduced pain, improved range of motion, and enhanced function in individuals with subacromial pain syndrome. Chiropractic manipulation consistently produced superior outcomes across all parameters, likely due to combined biomechanical and neuro-physiological effects.
This study aimed to determine the average retinal thickness with and without diabetes using Spectral Domain Optical Coherence Tomography (SD-OCT). Known diabetic and non-diabetic respondents from Diabetic Eye Clinic & General OPD having no clinical signs of diabetic retinopathy on fundus examination were selected in this study. All the participants gave informed written informed consent. A total of 80 patients (n=156 eyes) were recruited in this study. Average central thickness was 249 µm and 246 µm in diabetic and non-diabetic patients respectively. On quadrant wise evaluation, retinal thickness in diabetic and non-diabetic (Healthy Eye) were: Nasal =310 µm and 324 µm), Temporal =291 µm and 304 µm, Superior =297 µm and 316µm, and Inferior= 292 µm and 314 µm). Retinal thicknesses were greater at nasal and lesser at temporal areas. In conclusion retinal thickness measured in diabetic patients was found to be less in non-diabetic patients. Age and gender were other related demographic factors that influenced macular thickness measurements.
Surgical Site Infections (SSIs) remain one of the most common and costly complications of surgery. Despite decades of advances in surgical safety, infection prevention, and antimicrobial therapy, they continue to undermine outcomes, particularly in low- and middle-income countries. The growing shadow of antimicrobial resistance (AMR) has only made this challenge more difficult, turning once-manageable infections into life-threatening conditions. This editorial reflects on the burden of SSIs, the ways AMR is reshaping their management, and the urgent steps needed, including but not limited to stronger prevention, smarter antibiotic use, and global collaboration, to protect the future of safe surgery.
Current study aimed to examine the association of thyroid hormone with lipid profile in hospitalized patients. 5 ml venous blood sample was collected for evaluation of thyroid and lipid profiles. The study was conducted during January to June 2023 in Rawalpindi Institute of Cardiology (RIC), Rawalpindi, Pakistan. A total of 200 patients were recruited, among these 68 (34%) were females and 132 (66%) were males. On the basis of family history 64 (32%) patients had a family history of heart diseases, while 136 (68%) did not report any such history. The higher proportion of patients had hypothyroidism as compared to hyperthyroidism. Thyroid disorders along with lipid profile have greatly affected the cardiovascular system, consequently the rate of cardiac diseases has increased. The change in thyroid hormone levels can also affect lipid profile which will be directly affecting cardiovascular system even in low risk patients such as those without family history of cardiovascular diseases and without personal history of hypertension and diabetes mellitus. Thus it is essential to evaluate such relationship.
Obesity represents a significant global health concern, impacting nations across all economic strata. Medical students face heightened risks of adopting detrimental habits due to the pressures of academic life, which can result in weight gain and associated health problems. The purpose of this study was to evaluate the prevalence of obesity among medical students at Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan and investigate its association with lifestyle factors including eating habits, physical activity levels, and sleep patterns. This was cross-sectional study including 148 medical students. Data was collected through a structured questionnaire assessing participants' dietary habits, physical activity, and sleep patterns. The mean Body Mass Index (BMI) was 23.53 kg/m²; 20.3% were overweight and 6.8% obese, more common in males. Fast-food intake was higher in these groups. No strong link existed between BMI and sleep, though obese students reported to have irregular sleep patterns. Physical activity was low, with 78.35% of overweight/obese students exercising 1–2 times weekly or not at all. This study identified a significant association between BMI and lifestyle factors among medical students, with males showing a higher tendency toward overweight and obesity. Elevated BMI was linked to frequent fast-food consumption, low levels of physical activity, and irregular sleep patterns. These findings underscore the need for targeted interventions that promote healthy eating habits, regular physical activity, and improved sleep hygiene.
Globally, over-the-counter (OTC) drugs are commonly used as nonprescription medications. Among these, analgesic agents are most frequently consumed, though their indiscriminate use can lead to serious health complications. The use of OTC medicines without prescription and proper awareness has now become a public health concern world-wide. The objective of this study was to assess the awareness, prevalence and handling of OTC medicines among the students of a local university. A cross-sectional survey based study was conducted using a structured open-ended questionnaire, distributed randomly among university students in Karachi, Pakistan. A total of 300 students participated in the study. The questionnaire aimed to evaluate participants' knowledge and usage patterns of common analgesics such as paracetamol, ibuprofen, and aspirin. Out of 300 participants 69% were females and 31% were males, aged between 18 to 30 years. Among them, 56% reported that paracetamol, ibuprofen, and aspirin were used for pain relief, while 44% were unaware of its indication. Pain was the most commonly reported reason for OTC drug use (29%). Awareness of adverse effects was also assessed, with gastrointestinal (GI) complications being the most reported side effect at 43%. The OTC are commonly reported to be taken for pain.
Translational research is a modern era of medical and clinical research where basic research discoveries are brought in the clinical practice to the patient care. The medical science has been revolutionized by these discoveries and clinical outcome of diseases has improved with longer survival and better quality of life. However, low-middle income countries (LMICs) are not enjoying the magic of translational research in its true sense as they are still dependent on discoveries from high income countries. There is no lacking of talent or ideas in LMICs but there are challenges like inappropriate infrastructure, shortage of trained human resource and also there are issues of funding for translational research projects. The medical research is expensive in fact but LMICs must see it as an investment. While working on local problems and finding their solutions locally, will certainly establish local research based business and the products can reach to the patient at low cost. Thus this may be taken as opportunity.
The study aimed to determine pharmacological and phytochemical potential of different solvent fractions of Ifloga spicata. Antimicrobial potential, free radical scavenging activity 1, 1-diphenyl-2-picrylhydrazyl (DPPH), hydrogen peroxide scavenging assay, and cytotoxic effects of plant samples on human blood lymphocytes under H2O2 induced stress was performed. Ifloga spicata ethyl acetate fraction markedly showed higher antibacterial potential against P. aeruginosa (ATCC 27853) and E.coli (ATCC 25922) bacterias. While higher antifungal potential was shown by the chloroform fraction against all three different strains A. fumigates (ATCC 204305), A. flavus (ATCC 9643) and A. niger (ATCC 16404) as compared to others fractions of the sample. DPPH maximum antioxidant potential was noted for methanolic extract followed by ethyl acetate with order of Methanol>Ethyl acetate>Chloroform>n-Hexane. Similarly, the hydrogen peroxide effect was significantly decreased by ethyl acetate fraction. In blood lymphocytes the raise in ROS and TBARS level due to stress given by H2O2 was also recovered by different extracts of I. spicata. The decrease level of superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) was also restored to its normal by all extract of the Ifloga Spicata.
Anti-N antibodies usually possess cold-reactive properties which make them clinically insignificant and are mostly classified as naturally occurring IgM antibodies. These antibodies sometimes trigger reactions at body temperature (37°C) or in the anti-human globulin phase resulting in serious medical outcomes such as delayed hemolytic transfusion reactions or hemolytic disease of the newborn. This case shows an extraordinary naturally occurring anti-N antibody which was detected in a 20-year-old male liver donor during standard antibody testing because of its unexpected reactivity at 37°C. The absence of any previous blood transfusions or medication use in the patient made this case stand out as particularly intriguing. The antibody identification was successful following the 'pre-warm' technique implementation while antigen phenotyping validated it as an IgG-type anti-N antibody. This medical case demonstrates the critical importance of recognizing unusual antibody responses during blood transfusions and organ transplants because uncommon reactions may lead to serious consequences.
Depressive symptoms after parental loss are a natural phenomenon, tagged with loss of support, financial constraints and disruptive routine. The loss of parent may be further enhanced in cases of painful divorces. At the same time bullying is considered as a major psychological trauma for growing children. This study was conducted to evaluate depression in school children following parental loss resulting in change in family structure and also with the history of peer bullying. This descriptive cross-sectional study was conducted in school going children. A total of 1000 children were evaluated aged between 5 to 15 years. Out of these 42 children had a history of parental loss within last two years while 12 had lost their parents more than two years ago. Depression was reported in 61 students and showed significant association with loss of parent, both by death or divorce. Bullying also showed significant association with depression. In conclusion, children having history of parent loss and bullying showed significant association of depression. Therefore, mental health support for these both group of children should be considered even if they do not show apparent signs of depression.
