The use of electronic cigarettes, or vapes, as a substitute to conventional smoking has surged noticeably among young individuals in recent years. Because they believe it is more secure or less dangerous, many people utilize it.1,2 Studies have, however, demonstrated how vaping is contributing to hidden oral health problems and damaging young smiles.According to a cross-sectional study conducted on high school students in California, vaping use is a risk factor for xerostomia. Through a 12-months follow-up, The study assessed how e-cigarettes, cannabis, and tobacco affected young adults. The findings pointed out that 54% of the sample who consumed these resources reported regular xerostomia (consumption >5 days/month) and sporadic complaints of dry mouth (consumption <5 days/month).3The findings of a systematic review that reviewed eight human case controls studies on the link between vaping and periodontitis indicate that e-cigarette users had more deposits of plaque, deeper pockets, less marginal bone, and less bleeding on inspection (a common sign of gum disease-which may delay early detection and treatment) than non-smokers.4 Similarly, another study reported poorer oral hygiene indices, higher plaque accumulation, and increased gingival bleeding among vapers, further supporting the adverse impact of e-cigarette use on periodontal health.1Propylene glycol, found in e-liquids, along with sweeteners and flavorings,5 can reduce saliva production, cause halitosis and xerostomia, lower mouth pH, and promote harmful bacteria like Streptococcus mutans to grow, leading to tooth damage.4Nicotine in vape smoke constricts oral blood vessels, reducing oxygen flow.6 It also creates harmful reactive oxygen species. Depending on the brand, producers say a cartridge can deliver anywhere from 10 to 250 puffs, or five to thirty cigarettes.7 Vapors (temperature reaching 40-65°C) can thicken the oral mucosa, leading to lesions. Vaping disrupts saliva production due to toxic ingredients.8According to a recent research in Saudi Arabia, more than half of students recognized that e-cigarettes could lead to nicotine dependence, but 62% of them thought they were fashionable substitutes for regular cigarettes.9 These views imply that peer-driven ideas of image and lifestyle, in addition to marketing, influence the allure of e-cigarettes.In conclusion, many young people are attracted to vaping because of its perceived social appeal, often without recognizing its potential oral health consequences. Dental curricula rarely address vaping-related oral pathology in depth, leaving future dental professionals inadequately prepared to identify and manage these conditions. Furthermore, vaping history is frequently omitted from routine dental records, potentially delaying diagnosis and intervention. Greater awareness enhanced dental education, and systematic screening for vaping behaviors are needed to protect the oral health of young populations.
Dear Editor Pakistan is one of the countries where gender inequality is a major issue impacting all walks of life, from nutrition to healthcare and education to employment.1 In the context of the medical field, every year almost 80% of the medical graduates in Pakistan are females, out of which 50% are unable to practice medicine after completing their degrees.2 A study shows that 6 out of 10 female post graduates are unemployed. Another survey by the Labour Force states that compared to 64% males, only 18% females are employed. The statistics might be misleading to the disappointment that female doctors do not focus on their careers but one should not forget that the decision to quit career isn't always made out of free will.3 Despite years of hard work and continuous efforts to excel academically, women find themselves shackled by the traditional norms which assign them gender roles restricting their medical practice. Certain cultural norms act as barriers for Pakistani female doctors to practice medicine, including early marriage, cultural expectations, family responsibilities, gender discrimination at workplaces and challenges in work life balance.4 Traditionally, women are expected to perform their assigned gender roles, and that means to put their careers on hold. This gender disparity not only wastes the career potential of female doctors but also deprives the healthcare system of many health professionals.3 In a developing country like Pakistan, where medical sector is already suffering, this loss adds up to the problems exponentially. The government spends about 2.5 million rupees on each medical student. According to a report, state had lost around 200 billion rupees because 35,000 female doctors quit their medical practice. A multifaceted approach is required to tackle this issue. Firstly, families need to be educated about the importance of pursuing careers for women and how it can help financially in this inflation. Flexible working hours and telemedicine opportunities can be provided to facilitate work life balance for doctors. At national level, policies should be introduced requiring doctors who have studied in government medical colleges to work in public healthcare institutions until they've paid off the subsidy received for their education. In conclusion, fostering a supportive environment for female doctors to focus on their careers will be a great step towards women empowerment as well as improved healthcare services and accessibility.
Musculoskeletal disorders remain a major contributor to injury, functional limitation, and long-term disabilityworldwide. This viewpoint explores emerging approaches to soft tissue mobilization, with a particular focus on sound-assisted soft tissue mobilization (SASTM) as a novel physiotherapy intervention. A broad review of the literature was undertaken, encompassing all available forms of evidence on soft tissue mobilization techniques without restrictions on study design or database source. Instrument-assisted soft tissue mobilization (IASTM), SASTM, manual cross-fiber massage, and related techniques are widely integrated into contemporary rehabilitation programs. Both IASTM and SASTM operate on similar biomechanical principles, applying controlled mechanical forces to soft tissues to disrupt adhesions, enhance local circulation, and facilitate tissue healing. While IASTM employs steel-based instruments to detect and treat soft tissue restrictions through tactile feedback, SASTM utilizes ceramic polymer tools that identify tissue irregularities through sound-based feedback. Although each modality has defined indications and contraindications, SASTM may offer greater specificity in targeting adhesions. Nevertheless, its application should remain adjunctive, used alongside established therapeutic interventions and only by appropriately trained practitioners in accordance with prevailing professional regulations and state bylaws.
Objectives: To investigate the neuroprotective effects of resveratrol against combined neurotoxicity induced by aluminum (Al), lead (Pb), and arsenic (As) were randomized into three groups (n=10 each): control, metal mixture (Al+As+Pb; 25 mg/kg/day, oral), and metal mixture plus resveratrol (20 mg/kg/day in feed) for 60 days. Cognitive performance was assessed using the Ymaze and Morris water maze (MWM). Gene expression of synaptophysin, postsynaptic-density-protein-95 instead if and CaMKIV in cortex and hippocampus was evaluated by qPCR using the 2<^>-Delta Delta CT method. In-silico target prediction and network pharmacology were performed using Swiss Target Prediction, CTD, and GeneCards; intersecting targets were analyzed via STRING and Cytoscape, followed by GO/KEGG enrichment (DAVID/ShinyGO). Molecular docking (AutoDock Vina) assessed binding of resveratrol with IL6, TNF, IL1-(3, synaptophysin, CaMKIV, and PSD-95. Results: Network pharmacology identified 269 intersecting targets; hub genes included IL6, TNF, and IL1-(3. Enrichment analysis highlighted pathways related to inflammation, apoptosis regulation, PI3K-Akt, MAPK, and neurodegeneration. Docking showed strong affinity with CaMKIV (-8.1 kcal/mol) and moderate affinity with IL6 (-6.8), IL1-(3 (-6.9), and PSD-95 (-6.5). In-vivo, the metal mixture impaired memory in Y-maze and MWM, while resveratrol significantly improved performance. Metal exposure downregulated synaptophysin, PSD-95, and CaMKIV expression in cortex and hippocampus; resveratrol partially to markedly restored expression. cognitive performance and synaptic gene expression, potentially through multitarget modulation of inflammatory and neurodegenerative pathways.
Objective: To estimate age-specific incidence patterns and trends in breast cancer molecular subtypes in a local hospital-based population. Methods: This retrospective cross-sectional study was conducted at Akbar Niazi Teaching Hospital, Islamabad, from August 2022 to August 2024. One hundred women aged >= 20 years with biopsy-proven breast cancer were included through convenience sampling. Male patients, lobular carcinoma, phyllodes tumors, sarcoma/lymphoma, and cases with missing age data were excluded. Demographic, clinical, pathological, and treatment data were extracted from hospital records. Tumors were classified into luminal A, luminal B, human epidermal growth factor receptor-2 (HER2)-enriched, and triple-negative subtypes using immunohistochemistry and Fluorescence in situ hybridization where required. Statistical analysis was performed using SPSS v25. Chi-square test assessed associations between age groups and tumor subtypes, while linear regression estimated age-related incidence trends. Results: Mean age was 50.5 +/- 12.0 years (range: 20-75). Breast cancer occurred in 47% of women aged <= 50 years and 53% in those >50 years. Luminal A was the most frequent subtype (55%), followed by triple-negative (25%), luminal B (15%), and HER2-enriched tumors (5%). Hormone receptor status showed no significant association with age (p>0.05). A significant association was observed between age groups and molecular subtypes (p=0.043), driven primarily by the luminal A subtype after Bonferroni correction. Age was not an independent predictor of breast cancer on regression analysis. Conclusion: Nearly half of breast cancer cases occurred in women aged <= 50 years. Luminal A was the predominant subtype and showed significant age-related variation, emphasizing the need for age-stratified screening and subtype-focused management strategies.
Objective: To explore the factors influencing belief formation regarding COVID-19 vaccine acceptance among women diagnosed with breast cancer in Pakistan. Methods: This exploratory qualitative study, guided by an interpretivist paradigm, was conducted at a tertiary care hospital in Rawalpindi, Pakistan. Semi-structured, in-depth interviews were conducted between December-2021 and March-2022 among adult breast cancer patients receiving active treatment, using typical case sampling. Interviews were audio-recorded with informed consent and continued until data saturation. Transcripts were analysed concurrently using reflexive thematic analysis based on Braun and Clarke's six-phase framework, with trustworthiness ensured through reflexivity, audit trails, team discussions, and inclusion of verbatim quotations. Results: Eleven female participants (mean age 49.4 +/- 11.3 years) were interviewed. One overarching theme, Belief Formation Regarding COVID-19 Vaccination, emerged, supported by five inter-related themes: psychosocial concerns during the pandemic, cancer-and COVID-19-related beliefs, vaccination experiences, interactions with healthcare providers, and coping and support mechanisms. Vaccine acceptance was shaped by emotional distress following cancer diagnosis, fear of immunosuppression, religious and familial influences, trust in healthcare workers, prior vaccine experiences, and exposure to misinformation and conspiracy beliefs. Supportive healthcare interactions and adaptive coping strategies facilitated acceptance, while financial stress, social isolation, and distrust in authorities contributed to hesitancy. Conclusion: Beliefs regarding COVID-19 vaccination among breast cancer patients are complex and deeply embedded within psychosocial, cultural, and healthcare contexts. Resilience grounded in faith, family support, trust in healthcare providers, and active coping facilitated acceptance, whereas conspiracy beliefs, distrust of rapid vaccine development, fear of treatment-related immunosuppression, and social isolation contributed to hesitancy.
Objectives: To examine the impact of emotional exhaustion on psychological well-being and to investigate the mediating role of psychological capital among rescue service providers. Methods: This correlational study was conducted from May to August 2023 among rescue workers in South Punjab, Pakistan. Using purposive convenience sampling, 206 active-duty rescue personnel aged 20-40 years were included. Emotional exhaustion was assessed using the Maslach Burnout Inventory-Emotional Exhaustion subscale, psychological capital with the Psychological Capital Questionnaire (PCQ-12), and psychological well-being with the WHO-5 Well-Being Index. Data were analyzed using SPSS version 27. Pearson correlation analysis was performed, followed by mediation analysis using Hayes' PROCESS macro (Model 4) with 5,000 bootstrap samples. Results: Out of 206 participants, 195 (95%) were males and 11 (5%) were females. Mean age of participants was 27.26 +/- 4.77 years. Emotional exhaustion showed a significant negative association with psychological well-being (r = -0.60, p <0.001) and psychological capital (r = -0.38, p <0.001). Psychological capital was positively correlated with psychological well-being (r = 0.43, p <0.001). Mediation analysis revealed that emotional exhaustion had a significant direct negative effect on psychological well-being (beta = -0.51, p < 0.001). Additionally, emotional exhaustion exerted a significant indirect effect on psychological well-being through psychological capital (beta = -0.09, SE = 0.04, p < 0.001), indicating partial mediation Conclusion: Emotional exhaustion adversely affects psychological well-being among rescue workers, while psychological capital serves as a protective mediator. Interventions aimed at strengthening psychological capital may help mitigate burnout-related psychological distress in emergency service personnel.
Objective: To determine abnormal computed tomography (CT) findings in adult patients presenting with the chief complaint of headache without preceding trauma and focal neurological signs. Methods: A cross-sectional study was conducted at PAC Hospital Kamra from November 4, 2024, to May 4, 2025, enrolling 161 patients aged 18-80 years with headache after obtaining informed consent using non-probability consecutive sampling. Non-contrast CT scans were performed using a 160-slice scanner with contrast-enhanced imaging if indicated. Abnormalities, including space-occupying lesions, paranasal sinus disease, hydrocephalus, intracranial hemorrhage, cerebral infarcts, age-inappropriate cerebral atrophy, dural venous sinus thrombosis, and miscellaneous findings, were recorded. Data was analyzed usingSPSS Version 26. Results: The mean age was 40.5 +/- 15.54 years, with 98 females (60.87%) and 63 males (39.13%). The median duration of headache was 12 weeks, and the interquartile range (IQR) of 2-48 weeks (range, 1-96 weeks). Abnormal CT findings were observed in 43 patients (26.7%), including space-occupying lesions in 2 (1.24%), paranasal sinus disease in 30 (18.63%), hydrocephalus in 2 (1.24%), cerebral infarcts in 4 (2.48%), and miscellaneous findings in 5 (3.11%). No age-inappropriate cerebral atrophy, intracranial haemorrhage, or dural venous sinus thrombosis were detected in any of the patients. Conclusion: Abnormal CT findings were uncommon in adults with non-traumatic headache and no neurological deficits. Paranasal sinus disease was the most frequent abnormality. Selective imaging based on clinical risk factors can reduce unnecessary CT usage.
Objective: To assess the level of preparedness for cholera outbreaks in public sector hospitals of Lahore and to evaluate the knowledge of designated cholera focal persons at these facilities. Methods: This cross-sectional study was conducted in July 2023 in 12 public sector hospitals of Lahore, Pakistan, designated as cholera treatment centers. Hospital preparedness was assessed using a structured proforma based on the WHO Global Strategic Preparedness, Readiness and Response Plan for Cholera, limited to hospital-level domains. Five domains were evaluated: Infection healthcare professionals' appointment and training; clinical management; testing facilities; and data management and reporting. Each indicator was scored as fulfilled or not fulfilled, and pooled domain scores were calculated. A knowledge survey was conducted among 15 nominated cholera focal persons (5 doctors, 10 senior nurses). Descriptive analysis was performed using Epi InfoTM version 7.2.6. Results: The highest preparedness scores were observed in clinical management (95.8%) and data management and reporting (91.6%). IPC and WaSH (85.4%) and healthcare professionals' appointment and training (81.3%) demonstrated moderate preparedness. Testing facility domain showed the poorest performance (45.8%), as only one-third of hospitals had on-site laboratory capacity for cholera testing. Knowledge related to clinical management was satisfactory among focal persons; however, deficiencies were noted in epidemiological understanding, outbreak definition and asymptomatic carriage. Conclusion: While public sector hospitals in Lahore show reasonable preparedness in clinical management and surveillance for cholera outbreaks, gaps in laboratory diagnostic capacity and targeted training of focal persons require urgent attention.
Objective: To evaluate the root trunk length (RTL) and root length of extracted maxillary permanent first molars (MPFM) and to analyze their variation in relation to age, gender and associated clinical characteristics. Methods: This cross-sectional study was conducted at Peshawar Dental College and Hospital from March 2021 to February 2022. Atotal of 135 MPFM with intact roots, cementoenamel junctions, and furcation areas were included, while teeth with anomalies, fractures, resorption, cervical lesions, prior endodontic treatment, or severe dilacerations were excluded. RTL and root length were measured using a digital Vernier caliper (precision 0.01 mm). RTL was recorded from the cervical line to the furcation, and root length from the cervical line to the root apex of the mesiobuccal, distobuccal, and palatal roots. Data were analyzed usingSPSS version 21. Results: Among 135 teeth, 88 (65.2%) were from females and 47 (34.8%) from males. The buccal root trunk (BRT) exhibited the greatest mean length (6.52 +/- 2.53 mm), followed by distal and mesial root trunks. The palatal root was the longest (14.31 +/- 2.77 mm). Higher mean RTL and RL values were observed in the 41-50 year age group and in males; however, differences across age groups and genderwere not statistically significant (p>0.05). Conclusion: MPFM show considerable variation in root trunk and root lengths, with BRT and palatal root demonstrating the greatest mean lengths. Although higher mean values were observed in males and older age groups, these differences were not statistically significant. These morphometric findings may aid periodontal and endodontic treatment planning.
Objective: To explore perceptions and factors influencing social accountability (SA) among key stakeholders in dental institutions in Abbottabad, Pakistan. Methods: This qualitative exploratory study was conducted at three dental colleges in Abbottabad after obtaining ethical approvals. Faculty members, administrators, and final-year Bachelor of Dental Surgery (BDS) students with relevant experience were recruited through purposive sampling. Four focus group discussions (FGDs), each comprising six participants, were conducted using a semi-structured guide to explore perceptions, barriers, curricular integration, institutional support, and perceived impact of SA. FGDs were audio-recorded, transcribed verbatim, anonymized, and analysed using inductive thematic analysis. Data collection continued until thematic saturation was achieved, and rigor was ensured through reflexive journaling, peer debriefing, and participant validation. Results: Twenty-four participants (62.5% female) took part, representing faculty, students, and administrators. Six major themes with twenty-one subthemes emerged. Emerging themes included understanding & importance of social accountability, institutional & systemic barriers, integration into the dental curriculum, perceived impact of SA, institutional support & resources, and suggestions for improvement. Participants acknowledged the importance of SA but highlighted limited formal training, inadequate funding, lack of institutional structures, and insufficient faculty development as major barriers. Community-based education and early curricular integration were strongly recommended. SA activities were perceived to enhance students'empathy, leadership, and problem-solving skills. Conclusion: Stakeholders recognize SA as an essential component of dental education; however, its implementation is constrained by systemic and institutional limitations. Structured curricular integration, faculty development, and strengthened institutional support are required to embed SA effectively within dental education in Pakistan.
Objective: To evaluate the effects of different postprandial exercise timings (30, 60, 90, and 120 minutes after meal intake) on serum irisin levels, lipid profile, anthropometric indices, and substrate metabolism in middle-aged adults with prediabetes. Methods: This controlled, repeated-measures experimental study was conducted on twenty-five sedentary adults aged 30-40 years with prediabetes at Khyber Medical University, Peshawar, Pakistan, from July 2022 to December 2023. Participants served as their own controls and completed four treadmill-walking sessions (40 minutes at 50% predicted maximum heart rate), performed one week apart at varying postprandial intervals. Venous blood samples were collected at fasting, pre-exercise, and 60-, 90-, and 120-minutes post-exercise across the study weeks to assess serum irisin and lipid profile. Substrate metabolism (VO2, respiratory quotient), perceived exertion, and anthropometric measures were assessed at baseline and at the end of the study. Results: Exercise performed 30 minutes after meal produced maximum rise in serum irisin (Delta = +115 pg/mL, p <0.001), and significant reductions in total cholesterol, LDL-C, and triglycerides, with an increase in HDL-C (p <0.001). Fat oxidation peaked at the 30-minute exercise condition (p =0.015), whereas carbohydrate oxidation was highest when exercise was initiated 120 minutes post-meal (p = 0.026). Anthropometric indices (BMI, waist circumference, body fat %) showed significant improvement over the study duration. Perceived stress remained largely unchanged, although participants subjectively reported better mood and energy following exercise. Conclusion: Initiating postprandial exercise, particularly within 30-60 minutes after meals, optimally improves lipid metabolism, substrate utilization, and irisin response in prediabetes.
Objective: To assess heterogeneous pathological responses of the primary tumor and axillary lymph nodes following neoadjuvant therapy (NAT) in invasive breast carcinoma and to identify clinicopathological factors associated with variable response patterns, including pathological complete response (pCR). Methods: This cross-sectional study included node-positive, non-metastatic patients with invasive breast cancer who received NAT followed by definitive surgery between October 2024 and June 2025. Tumor and nodal responses were assessed on final histopathology and categorized as pCR, heterogeneous response, or non-complete response. Clinicopathological and biological variables were recorded. Associations were evaluated using univariate analysis, while multinomial logistic regression identified independent predictors of tumor and nodal response. Results: Among 169 patients, heterogeneous response occurred in 53 (31.4%), non-complete response in 95 (56.2%), and pCR in 21 (12.4%). Within the heterogeneous group, 24 (45.3%) patients achieved breast pCR with residual nodal disease, while 29 (54.7%) showed nodal pCRwith residual breast tumor. A significant association was observed between breast and nodal responses (p <0.001). Tumor grade III (50.9%, p=0.017), triple-negative receptor status (41.5%, p <0.001), and type of NAT (p=0.032) were significantly associated with heterogeneous response. Residual tumor size (p=0.010), lymphovascular invasion (p=0.023), ductal carcinoma in situ (p=0.007), and extranodal extension (p<0.001) independently predicted tumor and nodal response, but not heterogeneous response specifically. Conclusion: Discordant pathological responses between primary breast tumors and axillary lymph nodes after NAT are frequent and reflect biological heterogeneity. Recognizing these patterns is crucial for individualized surgical planning and optimization of post-neoadjuvant treatment strategies.
Objective: To determine the frequency, patterns, etiology and management outcomes of ptosis in patients presenting to an oculoplastic clinic. Methods: This cross-sectional observational study was conducted from August 2022 to May 2023, at Hayatabad Medical Complex, Peshawar, Pakistan. Patients of all ages presenting with ptosis were included. Detailed history and ocular examination were performed. Ptosis was categorized as congenital or acquired, levator function was assessed and management options were documented. Surgical procedures and postoperative complications were recorded. Results: Thirty-eight patients (56 eyes) were enrolled (mean age 16.4 +/- 17.1 years); 22 (57.9%) were male and 28 (73.7%) were children. Congenital ptosis accounted for 28 patients (73.7%) and unilateral involvement for 22 (57.9%). Levator function was poor in 14 (40%), fair in 20 (57.2%), good in one (2.8%); and un-assessable in 3 (7.9%) infants. Surgery was performed in 33 (86.8%) patients. Etiology was associated with age group (p<0.001) and gender (p=0.0017) and treatment modality (p=0.0001). Frontalis sling with 2/0 prolene was most commonly performed procedure (42.4%), followed by levator resection (33.3%); levator extirpation for Marcus Gunn jaw-winking (12.1%) and levator advancement (9.1%). Complication observed for Frontalis sling 2/0-Proline; Frontalis sling Silicone tube and Levator Extirpation with sling were 14.3% (n=2/14); 100% (n=1/1) and 50% (n=2/4) respectively. No complications were observed for levator resections after 3-4 months of follow-up. Conclusion: Congenital ptosis predominated, especially in children. Surgical correction guided by levator function was effective. Certain sling techniques showed variable early complication rates, highlighting the need for careful procedure selection and close postoperative follow-up.
Background: Focal myositis is a rare, localized inflammatory myopathy of unknown etiology. Owing to its rarity and nonspecific presentation, it is frequently misdiagnosed, which may result in delayed or inappropriate Case Presentation: We report the case of a 37-year-old woman who presented with a three-day history of pain, swelling, and tenderness involving both calf muscles, accompanied by right-sided periorbital edema and diplopia. She had no systemic symptoms or clinical features suggestive of an underlying autoimmune disorder. Laboratory investigations revealed elevated creatine kinase and inflammatory markers. Magnetic resonance imaging (MRI) of the lower limbs demonstrated extensive edema of the right gastrocnemius muscle with associated subcutaneous edema, along with mild edema of the left gastrocnemius and soleus muscles. MRI of the brain and orbits showed inflammatory changes in the right lateral rectus muscle with surrounding periorbital edema. This was her third hospital presentation over the past decade with similar clinical manifestations. An extensive diagnostic workup excluded infectious, autoimmune, metabolic, and malignant causes. A diagnosis of idiopathic recurrent focal myositis with multifocal involvement was established. While her previous two episodes resolved spontaneously without immunosuppressive therapy, the current episode required immunosuppressive treatment due to persistent symptoms and to reduce the risk of recurrence. Conclusion: This case illustrates the recurrent and multifocal presentation of focal myositis and emphasizes the need to consider this rare entity in patients presenting with localized muscle inflammation. Early recognition is crucial to prevent unnecessary investigations and to facilitate timely and appropriate treatment, particularly in recurrent or persistent cases.
Objective: To determine cytopathological changes in the oral mucosa of patients with chronic kidney disease (CKD) undergoing dialysis and to assess their association with Kidney Disease: Improving Global Outcomes (KDIGO) staging. Methods: This cross-sectional study was conducted at University of Health Sciences, Lahore, from January to November 2019, after institutional ethical approval. One hundred CKD patients on dialysis were recruited from tertiary care hospitals in Lahore using predefined criteria. Socio-demographic data, oral hygiene status, clinical oral manifestations and relevant laboratory parameters were documented. CKD staging was performed according to KDIGO-2013 guidelines, and renal ultrasound gradingwas assessed. Oral mucosal smears were evaluated for inflammatory changes and cytological atypia. Associations between clinical, cytological, and KDIGO variables were analyzed through SPSS version-23. Results: Mean age of participants was 50.09 +/- 14.98 years, with a male predominance. Xerostomia (86%), metallic taste (48%), and uremic fetor (45%) were the most frequent oral manifestations. Cytologically, reactive-and non-reactive atypia were identified in 29% and 40% cases respectively. Significant associations were found between inflammatory atypia and thickened mucosa, and between non-reactive atypia and angular cheilitis. Prominent nucleoli were significantly associated with metallic taste and higher KDIGO stages. Grades 3b and 4 CKD showed significant associations with duration of dialysis, xerostomia, periodontitis, and prominent nucleoli. Conclusion: Oral cytopathological alterations are common in CKD patients undergoing dialysis and show significant associations with disease severity as per KDIGO staging. Oral cytology may serve as a useful adjunctive tool for early detection and monitoringof mucosal changes in patientswith advanced CKD.
Research and publications are integral to evidence-based healthcare, yet within Pakistan's physical therapy education, these elements remain underdeveloped. Although physical therapy programs have grown considerably, faculty often lack advanced research expertise, and students receive limited guidance in project design, critical appraisal, and scientific writing. Consequently, most student theses remain unpublished, representing missed opportunities to strengthen the global evidence base. This viewpoint highlights major gaps in research mentoring and publication culture in Pakistan's physical therapy programs. It emphasizes the need for structured mentorship, early student engagement in research, and institutional reforms to promote academic productivity. Developing a strong research culture is not only an academic necessity but a professional responsibility that directly influences patient care and the advancement of evidence-based practice. International models demonstrate that investment in faculty development, research capacity building, and collaborative publishing can significantly improve outcomes. Adopting similar strategies in Pakistan could empower students, enhance faculty productivity, and ensure that locally generated evidence informs clinical practice. Strengthening research mentorship and cultivating a publication culture are therefore essential steps to bridge the divide between education and practice, aligning physical therapy education in Pakistan with global standards of healthcare innovation.
Background: Seminomas account for nearly one-third of testicular germ cell tumors and are highly curable, with survival rates approaching 98% in early stages. The incidence of classic seminoma is rising in Pakistan. While the typical presentation is a painless testicular mass, diagnosis can be challenging when patients present misleading histories, such as scrotal trauma. Moreover, the coexistence of multiple testicular pathologies in a single patient is uncommon, further complicatingthe diagnostic process. Case Presentation: We report the case of a 29-year-old male with a prior history of blunt scrotal trauma who presented with persistent swelling and ecchymosis. Ultrasound revealed multifocal hypoechoic intratesticular lesions with internal vascularity, alongside tubular ectasia of the rete testis, epididymal cysts, microlithiasis, and a left-sided varicocele. Tumor markers were largely within normal ranges. Frozen section during surgery suggested a neoplastic lesion, and left radical orchidectomy was performed. Histopathology confirmed multifocal classic seminoma (pT1a), limited to the testis with rete testis invasion, negative margins, and no lymphovascular invasion. Immunohistochemistry was positive for PLAP, CD117, and OCT3/4, supportingthe diagnosis. Conclusion: This case represents an uncommon scenario of multiple concurrent testicular pathologies coexisting with multifocal seminoma, initially masked by a history of trauma. It highlights the critical role of ultrasound as the first-line imaging modality, with definitive confirmation through histopathology and immunohistochemistry. Early surgical intervention remains the cornerstone of management, ensuring accurate diagnosis and favorable outcomes.
Objective: To evaluate the renoprotective effect of captopril on tacrolimusinduced renal damage in mice. Methods: This experimental study was conducted at Institute of Pathology and Diagnostic Medicine, Khyber Medical University, in collaboration with the six months. Twenty-one adult male albino mice were randomly assigned into received tacrolimus (5 mg/kg/day orally), and Group 3 received tacrolimus (5 mg/kg/day) with captopril (10 mg/kg/day) orally for 21 days. On day 21, all mice were sacrificed after blood collection. Biochemical (serum urea, creatinine), morphological (absolute and relative kidney weights, length, width, and anteroposterior diameters), and histopathological parameters were assessed. Results: Group 2 (tacrolimus only) demonstrated significant elevations in serum urea (33.85 +/- 9.83 mg/dl) and creatinine (0.25 +/- 0.05 mmol/l), along with marked histopathological alterations compared to Group 1 and Group 3 (p<0.05). Group 3 (tacrolimus+captopril) showed improvement in biochemical values (urea: 17.94 +/- 2.89 mg/dl; creatinine: 0.18 +/- 0.03 mmol/l) and attenuation of histopathological changes. Morphological variations included reduced absolute and relative kidney weights and changes in renal dimensions: shorter left kidney length (1.04 +/- 0.09 cm vs. 1.14 +/- 0.05 cm in controls) and increased right kidney anteroposterior diameter (0.52 +/- 0.04 cm vs. 0.44 +/- 0.05 cm in controls). Conclusion: Captopril exhibited a renoprotective effect of more than 50% against tacrolimus-induced nephrotoxicity, reflected by improved biochemical, morphological, and histological parameters.
Objectives: To examine the relationship between workplace bullying, emotional intelligence, and self-efficacy among nurses, and to explore differences across age groups and educational levels. Methods: This cross-sectional study was conducted from February to May 2024 in six government, semi-government, and private hospitals of Sialkot, Pakistan. A purposive sample of 196 nurses (aged 21-60 years) who reported workplace bullying was recruited. Data were collected using a demographic sheet and validated Urdu versions of the Negative Act Questionnaire-Revised (NAQ-R), Wong and Law Emotional Intelligence Scale (WLEIS-U), and General Self-Efficacy Scale (GSE-U).Analyseswere performed usingSPSSv.21. Results: Workplace bullying showed a significant weak negative correlation with emotional intelligence (r =-0.262, p < 0.01) but no significant association with self-efficacy. Emotional intelligence demonstrated a moderate positive correlation with self-efficacy (r = 0.471, p < 0.01) and significantly predicted it, explaining 22.2% of the variance (R2 = .222, F (1,194) = 55.260, p < .01). Agebased comparisons revealed that bullying decreased, while emotional intelligence and self-efficacy increased with age, particularly among nurses aged 31-60 years. Education-based analysis showed that intermediate-qualified nurses reported the highest levels of emotional intelligence (93.5%) and self-efficacy (71%) with fewer bullying experiences, whereas degree-holders reported comparatively higher bullying and lower emotional intelligence. Conclusion: Workplace bullying negatively influences nurses'emotional intelligence, whereas emotional intelligence positively predicts self-efficacy. Enhancing emotional intelligence through training and fostering a supportive organizational culture may buffer the adverse effects of bullying and improve resilience, particularly amongyoungerand more highly qualified nurses.
