bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Oral Hygiene and Dental Decay among School Children of Rural Area of Pakistan
Authors: Fatema Anees , Waris Aalia , Ali Shah Syed Farjad , Fatima Irij , Zada Noor , Firdous Maryam , Ullah Saif
Published: August 2024

Background: Oral health is a fundamental component of overall health and well-being, with dental caries recognized as a prevalent issue affecting a large number of populations globally. The study aimed to assess Oral Hygiene and Dental Decay among School Children.
Methods: This community based cross-sectional study was conducted among children of government schools in rural area of Punjab tehsil and, District Attock using non-probability consecutive sampling technique. The duration of the study was 6 months. A Self designed questionnaire were developed based on the literature were used. Data were analyzed with Datatab.
Result: A total of 134 school children including 89 females (66.42%) and 45 males (33.58%). The mean age of the all children was 10.75+1.04 years; with age of female respondents to be 10.65 ± 1.06 years, and male to be 10.93 ± 0.99 years. Majority of the children belonged to the middle class families (n=115, 85.82%), whereas, 19 were from low income families (14.18%). results showed 45.52% (n=61) of school children to have varying level of dental decay. Out of these 61 individuals, 34.33% had initial, 8.21% had moderate, and 2.99% had some advanced stage of dental decay. A significantly strong association was found between the oral hygiene and dental decay (p<0.001), concluding that those children having good oral hygiene showed good dental health. There was no significant association between dental decay and gender (p=0.763), showing that the oral health is irrespective of the gender.
Conclusion: Poor oral hygiene is significantly associated with some form Dental caries and is independent of gender.
Frequency of Hepatocellular Carcinoma in Cirrhotic Patients with Hepatitis C in Hyderabad Pakistan
Authors: Attari Salman Ali , Chandar Kumar  , Bushra Kadir  , Ayaz Ahmed Chandio  , Muhammad Faizan Ali
Published: August 2024

Background: Hepatocellular carcinoma (HCC) is a primary liver malignancy predominantly found in patients with cirrhosis due to chronic hepatitis C virus (HCV) infection. Chronic HCV infection is a significant risk factor for the development of cirrhosis, which markedly increases the risk of HCC. This study aims to evaluate the frequency of hepatocellular carcinoma in cirrhotic patients with hepatitis C.
Objective: To evaluate the prevalence of hepatocellular carcinoma among cirrhotic patients with hepatitis C virus infection in Hyderabad, Pakistan.
Methods: This descriptive study was conducted at the Department of Gastroenterology, Asian Institute of Medical Sciences (AIMS), Hyderabad, from January 2024 to June 2024. The study included 152 patients diagnosed with liver cirrhosis due to HCV infection. Non-probability consecutive sampling was employed. Patients with cirrhosis due to other causes, such as hepatitis B virus, alcoholic liver disease, hemochromatosis, Wilson disease, and end-stage liver disease, were excluded. Upon admission, each patient underwent a thorough history and physical examination, followed by laboratory investigations including alpha-fetoprotein (AFP) levels and ultrasonography. An AFP level greater than 200 ng/mL in the presence of a liver mass was considered highly indicative of HCC, obviating the need for a biopsy. All laboratory tests were conducted at a single laboratory to ensure uniformity. Data analysis was performed using SPSS version 26.0. Frequencies and percentages were calculated for categorical variables, while means and standard deviations were computed for continuous variables. Statistical tests of significance were applied at a 5% significance level.
Results: Out of 152 patients, 103 (67.8%) were male and 49 (32.2%) were female, with a mean age of 41.57 ± 10.67 years. The prevalence of hepatocellular carcinoma was found to be 7.2% (11 patients). Significant differences were observed in several liver function parameters between HCC and non-HCC patients: total bilirubin (4.22 ± 0.76 mg/dL vs. 1.44 ± 1.14 mg/dL, p = 0.001), AST (37.82 ± 14.25 U/L vs. 12.39 ± 6.54 U/L, p = 0.001), GGT (171.8 ± 81.27 U/L vs. 54.43 ± 59.41 U/L, p = 0.001), AFP (323.6 ± 59.60 ng/mL vs. 15.50 ± 21.04 ng/mL, p = 0.001), and INR (2.75 ± 1.23 vs. 1.24 ± 0.42, p = 0.001).
Conclusion: A notable prevalence of hepatocellular carcinoma was observed in cirrhotic patients with hepatitis C. This finding underscores the importance of regular screening and surveillance for HCC in this high-risk population to enable early detection and timely intervention.
Exploring Non-Conventional Psychosocial Factors in Patients with Coronary Artery Disease: A Cross-Sectional Study at Mardan Medical Complex
Authors: Yahya Muhammad , Shaukat Ali  , Sania Naz  , Mahnoor Imdad  , Shahab Ali Shah  , Zafar Hamza , Shahzaib
Published: August 2024

Background: Coronary artery disease (CAD), marked by the constriction or obstruction of the coronary arteries responsible for heart supply, remains the foremost cause of death globally. This condition is universally acknowledged as the primary contributor to mortality rates. Traditional risk factors for CAD are extensively documented, such as hypertension. Recent research emphasizes the importance of non-conventional psychosocial factors, including depression, anxiety, marital status, job strain, effort-reward imbalance, work stress, and social support.
Objective: The objective of this study is to examine non-conventional psychosocial factors in order to gain a deeper insight into their influence on coronary artery disease.
Methods: This descriptive cross-sectional study utilized convenience sampling to collect data via questionnaires from volunteer patients who visited the cardiology department at Mardan Medical Complex. The sample size comprised 323 CAD patients, determined with a 95% confidence level using Open-Epi, based on an anticipated frequency of 30% and a critical limit of 5%. Data were analyzed using SPSS 22. Numerical variables were assessed with mean and standard deviation, while categorical variables were analyzed using frequency and percentage computations.
Results: The study encompassed 323 patients diagnosed with CAD, with a response rate of 100%. Among these individuals, 171 (52.9%) were male, while 152 (47.1%) were female. Work-related stress was observed in 33 patients (10.2%). Marital stress affected 13 patients (4%), while financial stress was present in 97 patients (30%). The mean age of patients was 60.5 ± 10.3 years. Financial stress showed a significant association with CAD, while marital stress did not.
Conclusion: In this study, male CAD patients experienced a higher prevalence of work-related stress compared to females. A substantial portion of the patient population was between the ages of 50 and 70 years, a demographic particularly prone to CAD and its complications. Among the non-conventional psychosocial factors investigated—work stress, marital stress, and financial stress—financial stress exhibited a significant association with CAD development, while marital stress showed no significant contribution to the disease.
Sputum Bacteriology in Chronic Obstructive Pulmonary Disease Exacerbation Patients
Authors: Rafia  , Muhammad Amir  , Irfan Najam Sheen  , Karamat Ali  , Attia Khaliq
Published: August 2024

Background: Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous respiratory condition characterized by persistent airflow limitation and associated with inflammatory responses in the lungs. COPD exacerbations can significantly impact patient health and often necessitate medical intervention. Understanding the bacterial etiology of these exacerbations can aid in optimizing treatment strategies.
Objective: The objective of this study was to determine the frequency of bacterial pathogens in the sputum of patients experiencing COPD exacerbations at a tertiary care hospital.
Methods: This cross-sectional study was conducted in the Department of Pulmonology at Pakistan Emirates Military Hospital, Rawalpindi, from December 12, 2023, to June 12, 2024. A total of 160 patients aged 18 to 60 years, admitted with acute exacerbation of COPD, were included using non-probability purposive sampling. Exclusion criteria were patients with lung malignancy, acute asthma exacerbations, bronchiectasis, or interstitial lung disease. Sputum samples were collected, and standard microbiological procedures were followed. Microscopy with Gram staining was performed, and specimens with more than 10 epithelial cells per low power field were cultured. Quantitative culture was conducted using blood agar and chocolate blood agar plates incubated in 5% CO2 at 35°C for 18–24 hours. Isolates with higher than 10^5 colony-forming units were reported as positive growth. Statistical analysis was performed using SPSS Version 25.
Results: The mean age of the patients was 37.89 ± 11.2 years, with 94 (58.8%) males and 66 (41.3%) females. The average duration of COPD was 4.87 ± 1.19 years. Among the participants, 89 (55.6%) were from urban areas, and 71 (44.4%) from rural areas. Educational status showed 33 (20.6%) illiterate, 111 (69.4%) with intermediate education, and 16 (10.0%) graduates. Comorbid conditions included diabetes mellitus in 37 (23.1%) patients, hypertension in 29 (18.1%), ischemic heart disease in 15 (9.4%), and smoking in 62 (38.8%). Sputum cultures revealed pathogens in 43 (26.9%) patients. Klebsiella pneumoniae was the most frequently identified bacterium (19 cases, 11.9%), followed by Staphylococcus aureus (10 cases, 6.3%), Pseudomonas aeruginosa (5 cases, 3.1%), Actinobacter (1 case, 0.6%), and Streptococcus pneumoniae (10 cases, 6.3%).
Conclusion: The study concluded that COPD exacerbation patients exhibited a variety of single pathogenic bacterial isolates, with Klebsiella pneumoniae and Streptococcus pneumoniae being the most common. Sputum culture is a valuable tool in identifying bacterial pathogens in COPD exacerbations, guiding appropriate antibiotic therapy.
Determine the Frequency of Pneumothorax in Patients Undergoing Large Volume Thoracentesis
Authors: Rafia  , Muhammad Amir  , Irfan Najam Sheen  , Karamat Ali  , Attia Khaliq
Published: August 2024

Background: Thoracentesis is a medical procedure used to remove excess fluid or air from the pleural space, the space between the lungs and the chest wall. Pleural effusion occurs when excess fluid collects in the pleural cavity, leading to symptoms such as difficulty breathing and chest discomfort. Large volume thoracentesis, which involves the removal of more than one liter of pleural fluid, can provide significant symptom relief. However, this procedure is associated with risks, including pneumothorax. Previous studies have reported varying incidence rates of pneumothorax following thoracentesis, highlighting the need for further investigation in different clinical settings.
Objective: To determine the frequency of pneumothorax in patients undergoing large volume thoracentesis.
Methods: This cross-sectional study was conducted at the Department of Pulmonology, Pakistan Emirates Military Hospital, Rawalpindi, from December 12, 2023, to June 12, 2024. A total of 120 patients, both male and female, aged 20-75 years, who required large volume thoracentesis due to pleural effusion were included. Patients with a history of pneumothorax, pre-existing pleural diseases, chronic lung diseases, coagulation disorders, or those who were pregnant were excluded. Non-probability consecutive sampling was used for recruitment. Informed consent was obtained from all participants. Each patient underwent a comprehensive clinical examination, followed by thoracentesis using a 16-gauge intravenous cannula. The volume of aspirated fluid was recorded. Post-procedure, an erect chest radiograph was performed to confirm pneumothorax. Data were analyzed using SPSS Version 26.
Results: The mean age of the patients was 49.68 ± 12.0 years, with ages ranging from 23 to 74 years. Among the patients, 71 (59.2%) were male and 49 (40.8%) were female. The majority of patients, 79 (65.8%), were in the 41-60 years age group. Pneumothorax was detected in 21 (17.5%) patients. Stratification of pneumothorax occurrence based on gender showed that 13 (18.3%) males and 8 (16.3%) females developed pneumothorax. Age group stratification revealed that 5 (31.3%) patients in the 20-40 years age group, 11 (13.9%) in the 41-60 years age group, and 5 (20.0%) in the >60 years age group developed pneumothorax. The P-values for gender and age group stratification were not statistically significant.
Conclusion: The study concluded that pneumothorax is a significant complication associated with large volume thoracentesis, occurring in 17.5% of patients. The findings underscore the need for careful procedural planning and consideration of techniques such as ultrasound guidance to reduce the risk of pneumothorax.
Frequency of Hyperkalemia in Patients Presenting with Heart Failure with Reduced Ejection Fraction at Tertiary Care Hospital Karachi
Authors: Aadil Memon  , Umera Ali  , Asmat  , Sonam  , Rakesh Kumar  , Sattar Jamali
Published: August 2024

Background: Hyperkalemia, characterized by elevated serum potassium levels greater than 5.0 mmol/L, poses significant risks for patients due to its potential to induce cardiac arrhythmias and conduction abnormalities. This condition is particularly prevalent among patients with chronic conditions such as kidney disease, heart failure (HF), and diabetes, especially those treated with renin-angiotensin-aldosterone system inhibitors (RAASi). While these medications are beneficial for heart failure management, they can exacerbate renal dysfunction and hyperkalemia, both associated with poor clinical outcomes.
Objective: The study aimed to determine the frequency of hyperkalemia among patients presenting with chronic heart failure with reduced ejection fraction (HFrEF) at a tertiary care facility in Karachi.
Methods: A cross-sectional study was conducted at the Department of Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, from August 22, 2020, to February 21, 2021. The study enrolled 139 patients aged between 20 and 70 years diagnosed with HFrEF based on echocardiography findings. Informed consent was obtained from all participants. Comprehensive clinical evaluations and laboratory measurements of serum potassium were performed to identify hyperkalemia. Data collection included demographic information, clinical history, comorbid conditions, and serum potassium levels. The data were analyzed using SPSS Version 25, with descriptive statistics summarizing demographic characteristics and chi-square tests assessing the relationships between hyperkalemia and patient characteristics.
Results: The mean age of the study cohort was 58.4 ± 15.9 years, with a male predominance of 55.4%. Dyslipidemia was observed in 30.2% of the participants. Hyperkalemia was found in 39.6% of the patients. The analysis showed no significant correlation between hyperkalemia and gender (p=0.991), hypertension (p=0.948), dyslipidemia (p=0.098), monthly income (p=0.770), or smoking status (p=0.853).
Conclusion: Hyperkalemia is significantly prevalent in patients with chronic heart failure and reduced ejection fraction. Routine screening and management of serum potassium levels are crucial in this patient population to mitigate the risks associated with hyperkalemia and optimize heart failure management.
Intrarater Reliability of Catherine Bergego Scale and Albert’s Test in Chronic Stroke Patients With Unilateral Spatial Neglect
Authors: Bajwa Maryam , Tariq Rimsha , Rehan Amna , Pervaiz Arooba , Fatima Aroob , Khalid Mahnoor , Burhan Muhammad , Mazher Fatima
Published: August 2024

Background: Unilateral spatial neglect (USN) frequently occurs following a right hemisphere stroke, leading to impaired awareness of one side of the body. This condition affects daily activities despite intact motor and sensory functions. The Catherine Bergego Scale (CBS) and Albert's Test are tools used to assess USN severity, but their reliability needs further investigation.
Objective: This study aimed to evaluate the intra-rater reliability of the Catherine Bergego Scale and Albert's Test in chronic stroke patients with unilateral spatial neglect.
Methods: A cross-sectional study was conducted from November 2023 to March 2024 across three hospitals in Lahore, Pakistan. Using non-probability convenient sampling, 218 chronic stroke patients aged 50 to 80 years were recruited. Participants exhibited signs of USN but had no severe cognitive impairments or concurrent neurological conditions. The CBS and Albert's Test were administered by trained raters in controlled settings. The reliability of these assessments was evaluated using Cronbach's alpha coefficients, and statistical analysis was performed with SPSS version 25.
Results: The CBS showed a Cronbach's alpha of 0.737, indicating acceptable reliability. Albert's Test demonstrated a Cronbach's alpha of 0.931, reflecting excellent reliability. These findings support the consistency and dependability of both assessment tools in evaluating USN severity.
Conclusion: The study confirmed that the CBS and Albert's Test are reliable tools for assessing USN in chronic stroke patients, facilitating accurate diagnosis and tailored rehabilitation interventions.
Prevalence of Urinary Incontinence in Different Age Groups of Women
Authors: Ishma Ali  , Wajeeha Fatima  , Ushna Aslam  , Khalida Parveen  , Saman Tariq  , Ayesha Nazir  , Fahad Ali  , Faisal Nawaz  , Rafique Hira
Published: August 2024

Background: Urinary incontinence (UI) is the accidental leakage of urine, a condition most prevalent among women, often exacerbated by activities that increase intra-abdominal pressure such as coughing, sneezing, or lifting heavy objects. UI significantly impacts quality of life, particularly in older women, due to factors like postmenopausal changes, pelvic trauma, and age-related physiological changes.
Objective: The primary objective of this study was to observe the prevalence of urinary incontinence among women in different age groups. The secondary objective was to determine the correlation between UI and various demographic and physical factors.
Methods: This observational study was conducted over six months in hospitals located in Sahiwal, Pakistan. A sample size of 377 women, aged 22-65 years, was selected using a non-probability convenient sampling technique. Inclusion criteria included non-pregnant women experiencing unwanted urinary leakage due to physical exertion. Exclusion criteria included women with diabetes, those who had undergone surgery for incontinence, and those with neurological conditions. The Modified International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was used to evaluate UI. Data were analyzed using SPSS version 25.0, employing Chi-square tests to assess relationships between variables with a significance level set at 0.05.
Results: The study found that 83.3% of the women experienced urinary leakage. The prevalence of UI was highest among women aged 55-65 years (54.32%). Leakage frequency was reported as follows: 29.44% experienced leakage once a week or less, 17.78% two to three times a week, 4.51% once a day, 13.00% several times a day, and 4.24% all the time. Severity of leakage was reported as 16.71% no leakage, 49.34% a small amount, 22.02% a moderate amount, and 11.94% a large amount. There was no significant difference in UI frequency across BMI categories (P > 0.05) or between types of delivery (SVD vs. C-section, P > 0.05).
Conclusion: The study concluded that urinary incontinence is highly prevalent among women, particularly in the older age group of 55-65 years. There is a significant correlation between age and UI, emphasizing the need for targeted interventions and routine screenings to manage and mitigate the impact of UI.
Serum Creatinine Levels Across Different Stages of Chronic Kidney Disease and its Impact on Periodontal Health
Authors: Ashraf Maham , Moghees Asjad , Humayun Daniyal , Abdullah Muhammad , Saeed Fizza , Ahmad Talha , Butt Hira
Published: August 2024

Background: Chronic kidney disease (CKD) is a progressive condition characterized by a decline in renal function, which is often assessed through serum creatinine levels. Periodontal disease is a common comorbidity in CKD patients, potentially worsening systemic inflammation and further impairing kidney function.
Objective: To assess the varying levels of serum creatinine in CKD patients and their impact on periodontal health.
Methods: A descriptive comparative cross-sectional study was conducted at Sharif Medical and Dental College Lahore, including 50 CKD patients. Data on serum creatinine levels, CKD stage, and sociodemographic factors were collected using a structured proforma. Periodontal health was assessed using the Community Periodontal Index of Treatment Needs (CPITN). Ethical approval was obtained (No. SMDC/SMRC/100-19), and informed consent was secured from all participants. Patients aged 18 and above with CKD, irrespective of the stage, were included, while those with other systemic illnesses or on medications for conditions other than CKD were excluded. Statistical analysis was performed using the Kruskal-Wallis test in SPSS version 25, with a significance level set at p≤0.05.
Results: The study included 50 individuals with a mean age of 45.26±16.799 years (52% males, 48% females). Serum creatinine levels varied significantly across CKD stages (p=0.001), with mean ranks of 6.55 for stage 3, 19.32 for stage 4, and 34.38 for stage 5. Significant differences were also observed across periodontal health categories (p=0.042), with mean ranks of 5.75 for healthy periodontium, 18.00 for bleeding gums, 31.63 for calculus, and 25.50 for pocket depth of 4-5mm.
Conclusion: Serum creatinine levels were highest in stage 5 CKD patients and those with severe periodontal disease. These findings underscore the importance of integrating periodontal health management into the overall care of CKD patients to potentially reduce systemic inflammation and improve outcomes.
Impact of Negative Air Ions on Hematological and Hormonal Parameters in Cerebral Palsy
Authors: Rafique Ammara
Published: August 2024

Background: Cerebral Palsy (CP) is a group of permanent disorders arising from non-progressive brain development disruptions during the fetal or infant stages, affecting movement, posture, and various physiological and cognitive functions, including blood parameters, cognition, communication, hearing, metabolism, oral health, sensation, speech, swallowing, and vision.
Objective: This study aimed to investigate the effects of Negative Air Ions (NAIs) on hematological and hormonal parameters in CP patients, evaluating NAIs as a potential therapeutic intervention.
Methods: Conducted over two months in 2021 at a specialized rehabilitation center in Karachi, Pakistan, the study involved 31 structured NAI exposure sessions over six weeks. Participants were randomly divided into control and intervention groups, with the latter exposed to 10,000 NAIs/cm³ for 40 minutes, three times per week. Hematological assessments, including complete blood count (CBC) and differential analysis, were performed using automated and manual methods. Serum cortisol levels were measured for hormonal assessment. Statistical analysis utilized paired t-tests for within-group comparisons using SPSS version 25.
Results: Both groups showed normal parameters at baseline. The control group had significant increases in hemoglobin (p<0.05), MCV (p<0.05), MCH (p<0.05), and PCV (p<0.01) and decreased platelet count (p<0.01). The intervention group exhibited reductions in leukocyte and platelet counts (p<0.05). No significant changes were observed in cortisol levels.
Conclusion: NAI therapy is safe with no adverse hematological or hormonal effects, suggesting its potential as a progressive, non-pharmacological, and cost-effective therapy for CP patients.
Role of Loss of mRNA-7a2 in Congenital Hypogonadotropic Hypogonadism and Male Infertility
Authors: Talib Tehmina , Shaista Jabeen  , Hamra Bano  , Uroosa Aslam  , Iqra Mukhtar  , Fizah Rubab  , Bushra Parveen  , Sajal Batool  , Uzma Khalid  , Najma Badar  , Rabea Ejaz
Published: August 2024

Background: Congenital Hypogonadotropic Hypogonadism (CHH) is a condition characterized by deficient secretion of gonadotropin-releasing hormone (GnRH), leading to impaired reproductive function and male infertility. The role of mRNA-7a2 in gene expression regulation and its potential impact on CHH and male infertility is crucial but not well understood.
Objective: To investigate the significance of mRNA-7a2 loss in CHH and its association with male infertility.
Methods: This study included 100 participants, 50 with CHH and 50 healthy controls. Comprehensive clinical evaluations, hormone level assessments, and semen analysis were conducted. Blood samples were collected for serum GnRH, LH, FSH, and testosterone measurements using immunoassay techniques. Semen analysis followed WHO guidelines. Genetic testing involved next-generation sequencing to identify mutations in the mRNA-7a2 gene. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and Western blot analyses were performed on testicular biopsy samples to measure mRNA-7a2 expression and protein levels. Data were analyzed using SPSS version 25.0.
Results: CHH patients showed significantly lower levels of serum GnRH (4.3 ± 1.2 pg/mL), LH (1.8 ± 0.5 IU/L), FSH (2.1 ± 0.7 IU/L), and testosterone (150 ± 35 ng/dL) compared to controls (p < 0.001). Sperm count (12.5 ± 3.8 million/mL), motility (22.4 ± 7.1%), and morphology (15.3 ± 4.6%) were also significantly reduced (p < 0.001). mRNA-7a2 expression was significantly lower in CHH patients (ΔCt 7.5 ± 1.8) than controls (ΔCt 3.2 ± 0.9) (p < 0.001). Protein levels of mRNA-7a2, SOX9, and Dmrt1 were significantly lower in CHH patients (p < 0.001). Genetic analysis identified several mRNA-7a2 mutations in CHH patients but not in controls.
Conclusion: The loss of mRNA-7a2 is significantly associated with CHH and male infertility, affecting hormone levels and spermatogenesis. Targeting mRNA-7a2 may offer new therapeutic strategies for managing CHH and improving male reproductive health.
Association of Depression and Anxiety with Consumption of Caffeine-Containing Beverages in University Students of Lahore, Pakistan
Authors: Aleem Ayesha , Amanullah Iram , Ali Muhammad Abubakar , Masud Ghumman Muhammad Hamza , Tahir Iqra , Tahir Rida , Yaqoob Aqsa , Qureshi Momina Tariq , Butt Mobasher Ahmad
Published: August 2024

Background: The prevalence of depression and anxiety among university students worldwide is a growing concern. Concurrently, caffeine consumption has increased, attributed to perceived benefits. While moderate caffeine intake might offer protective effects, excessive consumption has been linked to anxiety and depression. Although studies have explored this relationship globally, research specific to Pakistan remains limited.
Objective: This study aimed to evaluate the impact of excessive caffeine consumption on the levels of anxiety and depression among university students in Lahore, Pakistan.
Methods: A cross-sectional observational study was conducted over eight weeks from June 20th to August 15th, 2023, among 324 university students in Lahore, Pakistan. Participants were selected through convenient sampling from both medical and non-medical universities. Data were collected using a validated questionnaire, which included sections on socio-demographic information, academic history, mental health history, and caffeine intake. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scales were used to assess depression and anxiety, respectively. Ethical approval was obtained from the Research and Ethics Committee of Gulab Devi Institute of Pharmacy (REC/GDIP/23/DCP/16). Statistical analysis was performed using SPSS Version 25, with Pearson's correlation coefficient employed to evaluate the relationship between caffeine consumption and mental health outcomes.
Results: Of the 324 participants, 238 were female (73.5%) and 86 were male (26.5%). The majority were in their fifth year or higher (52.5%). Tea was the primary source of caffeine (75.9%), followed by coffee (22.8%) and energy drinks (17.9%). Significant positive correlations were found between caffeine consumption and PHQ-9 scores (r = .216, p < .001) as well as GAD-7 scores (r = .258, p < .001).
Conclusion: Excessive consumption of caffeine-containing beverages is significantly associated with higher levels of depression and anxiety among university students in Lahore. These findings highlight the need for awareness and preventive measures to mitigate the mental health risks associated with high caffeine intake in this population.
An Analysis of Anaemia and Serum Calcium Levels in Chronic Kidney Disease as an Indicator of Severity and Progression of Disease in Patients of South Punjab, Pakistan
Authors: Haji Sahrish , Atta Asia , Ahmad Sageer , Tareen Farrukh Zia , Javed Nusrat , Muhammad Noor , Abbas Komal , Mahmood Amna
Published: August 2024

Background: Chronic kidney disease (CKD) is a major health concern worldwide, particularly in regions like South Punjab, Pakistan. Anemia and hypocalcemia are common in CKD, but their link to disease severity is not well understood in this area. CKD is marked by kidney damage or a glomerular filtration rate (GFR) under 60 ml/min/1.73 m² for over three months, leading to end-stage renal disease (ESRD). The prevalence of CKD ranges from 10.6% in Nepal to 23.3% in Pakistan, underscoring the need for better management.
Objective: This study examined the correlation between anemia, serum calcium levels, and CKD severity among patients in South Punjab, Pakistan.
Methods: Conducted at the Multan Institute of Kidney Diseases, this cross-sectional study involved 2,327 CKD patients (1,437 males, 890 females). Hemoglobin and serum calcium levels were measured and correlated with CKD stages. Statistical analyses were performed using SPSS version 25.
Results: A significant inverse relationship was found between CKD severity and both hemoglobin and serum calcium levels. Advanced CKD stages showed lower levels of hemoglobin and calcium. ANOVA showed significant variance across CKD stages (p < 0.001), with positive correlations between calcium and hemoglobin (Pearson coefficients: 0.443 in males, 0.321 in females).
Conclusion: Hemoglobin and serum calcium levels are valuable biomarkers for CKD progression, aiding early intervention and management in resource-limited settings.
The Impact of Calf Stretching Using Inclined Board Standing on Low Back Pain: An Interventional Study
Authors: Hafeez Muhammad , Muhammad Zia Ul Haq  , Shabana Rahim
Published: August 2024

Background: Low back pain (LBP) is a prevalent condition with significant socio-economic impacts. Among its multifactorial causes, calf muscle tightness is a key mechanical contributor. This study evaluates the impact of a calf stretching intervention on LBP.
Objective: To assess the effectiveness of calf stretching using an inclined board in reducing pain and disability and improving physical health in individuals with chronic LBP and calf tightness.
Methods: A single-group intervention design was utilized with 22 participants aged 18-65 years, clinically diagnosed with chronic LBP and calf tightness. The intervention involved a one-minute standing stretch on a 45-degree inclined wedge, performed three times daily for four weeks. Assessments were conducted at baseline and post-intervention using the Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), and SF-12 questionnaire. Participants’ compliance was monitored through daily logs, and weekly follow-up sessions ensured correct performance of the stretches. Data were analyzed using paired samples t-tests with SPSS version 25.
Results: The paired samples t-test showed significant improvements across all measures. The mean NPRS score decreased by 4.40 points (p < 0.001), indicating reduced pain. The Physical Component Summary (PCS) of the SF-12 improved by 12.96 points (p < 0.001), reflecting enhanced physical health. The ODI score reduced by 4.40 points (p < 0.001), suggesting decreased disability.
Conclusion: The study demonstrates that a structured calf stretching program significantly reduces pain and disability while improving physical health in individuals with LBP and calf tightness. Incorporating calf flexibility assessments and interventions can be crucial in LBP management.
Prevalence of Risk of Fall in Layyah Among Geriatrics
Authors: Rana Asadullah , Syeda Rubab Naqvi
Published: August 2024

Background: The elderly population is increasingly susceptible to falls, which frequently result in morbidity and mortality. Elderly residents in long-term care facilities are particularly prone to falls. Identifying fall risk factors in elderly residents can aid in the management and mitigation of falls within this demographic.
Objective: To assess the prevalence of fall risk among geriatrics in Layyah, Pakistan.
Methods: This cross-sectional study was conducted from March 2023 to September 2023 across various clinics, hospitals, homes, and community settings in Layyah. A total of 120 elderly men and women aged 60 and above were included using convenient sampling. Participants with severe illness, neurological disorders, or those unable to walk were excluded. The Berg Balance Scale (BBS) was employed as the primary assessment tool, with scores below 45 indicating an increased fall risk. Data were collected by trained personnel and analyzed using SPSS version 25. Descriptive statistics were used to present the frequency and percentage distribution of variables, including age, gender, and performance on BBS tasks.
Results: Of the 120 participants, 60% were female and 40% were male, with a mean age of 70.3 years (SD = 5.8). The BBS assessment revealed that 32.5% (n=39) of participants were at high risk of falls, 35% (n=42) were at moderate risk, and 32.5% (n=39) were at minimal risk. Significant gender differences were observed, with 60% of women reporting a fear of falls compared to 40% of men.
Conclusion: The study found a high prevalence of fall risk among the elderly in Layyah, with women exhibiting a higher risk and fear of falling compared to men. These findings highlight the need for targeted interventions to reduce fall risk and improve balance among older adults.
Impact of Coronary Artery Calcification on PCI Outcomes in Pakistani Patients
Authors: Tariq Shah  , Fahad Liaqat  , Syed Muzammil Shah  , Rafi Ullah
Published: August 2024

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality globally, particularly in low- and middle-income countries such as Pakistan. Percutaneous coronary intervention (PCI) is a crucial treatment for CAD, but the presence of coronary artery calcification (CAC) complicates procedures and affects outcomes. CAC is associated with increased procedural complexity, higher rates of restenosis, and adverse cardiovascular events.
Objective: This study aimed to investigate the impact of CAC on PCI outcomes in Pakistani patients, focusing on major adverse cardiovascular events (MACE), restenosis rates, and stent thrombosis.
Methods: This observational cohort study was conducted at Hayatabad Medical Complex, Peshawar, from January 2022 to December 2023. The study included 500 patients aged 35-80 years who underwent PCI. Patients were categorized based on their CAC scores obtained through coronary computed tomography angiography (CCTA): low (<100), moderate (100-400), and high (>400). Data on baseline characteristics, CAC scores, and outcomes were collected from patient records and interviews. The primary outcome was the incidence of MACE within 12 months post-PCI. Secondary outcomes included restenosis and stent thrombosis rates. Statistical analysis was performed using SPSS version 25.0, employing ANOVA for continuous variables and chi-square tests for categorical variables, with significance set at p<0.05.
Results: The mean age of the participants was 58.2 years (SD = 10.4), with 60% men and 40% women. Higher CAC scores were significantly associated with increased MACE incidence: 15% in the low group, 25% in the moderate group, and 45% in the high group. Restenosis rates were 10%, 20%, and 35%, and stent thrombosis rates were 5%, 10%, and 20% for the low, moderate, and high CAC score groups, respectively. Statistical analysis confirmed significant differences across CAC score groups for primary and secondary outcomes (p<0.05).
Conclusion: The study demonstrated that higher CAC scores significantly impact PCI outcomes in Pakistani patients, leading to increased MACE, restenosis, and stent thrombosis rates. These findings highlight the importance of incorporating CAC assessment in clinical practice to improve risk stratification and personalize treatment strategies for better patient outcomes.
Clinical Characteristics and Outcomes of Acute Coronary Syndrome in Pakistani Smokers
Authors: Irum Hussain  , Salman khan  , Fahad Raja khan  , Kamran Aslam
Published: August 2024

Background: Acute coronary syndrome (ACS) is a major global health issue, contributing significantly to morbidity and mortality. Smoking is a well-established risk factor for the development and progression of coronary artery disease (CAD) and ACS, leading to increased platelet aggregation, endothelial dysfunction, and accelerated atherosclerosis. This study focuses on ACS's clinical characteristics and outcomes in Pakistani smokers.
Objective: The primary objective of this study was to evaluate the incidence of major adverse cardiac events (MACE) within 12 months post-ACS in Pakistani smokers. Secondary objectives included assessing improvements in left ventricular ejection fraction (LVEF), reduction in angina episodes, and changes in lipid profiles.
Methods: This prospective observational study was conducted at Hayatabad Medical Complex, Peshawar, from January 2022 to December 2023. A total of 300 adult patients with ACS and a history of smoking were included. The intervention involved standard care for ACS, including pharmacological management with dual antiplatelet therapy, statins, beta-blockers, ACE inhibitors, and lifestyle modifications such as smoking cessation counseling. Data were collected during hospital stays and follow-up visits at 1, 6, and 12 months post-ACS. Primary outcomes measured were the incidence of MACE, including myocardial infarction (MI), stroke, and cardiac death. Secondary outcomes included improvements in LVEF, reduction in angina episodes, and changes in lipid profile parameters. Statistical analyses were conducted using SPSS version 26.0.
Results: The mean age of the participants was 55 ± 10 years, with 70% being male. The overall incidence of MACE was 20%, with MI occurring in 10%, stroke in 5%, and cardiac death in 5% of patients. LVEF improved from 45% ± 7% pre-procedure to 52% ± 6% post-procedure (p < 0.001). The frequency of angina episodes per week decreased from 3.5 ± 1.2 to 1.2 ± 0.7 (p < 0.001). Significant improvements were observed in lipid profiles, with total cholesterol reducing from 200 ± 30 mg/dL to 180 ± 25 mg/dL, LDL cholesterol from 130 ± 20 mg/dL to 110 ± 18 mg/dL, and triglycerides from 150 ± 40 mg/dL to 130 ± 35 mg/dL (all p < 0.01).
Conclusion: This study demonstrates that standard ACS treatment significantly improves clinical outcomes in Pakistani smokers, evidenced by reduced MACE incidence and enhanced secondary outcomes. These findings underscore the importance of continuous monitoring and tailored therapeutic strategies to optimize patient outcomes.
Keywords: Acute coronary syndrome, smoking, major adverse cardiac events, left ventricular ejection fraction, angina, lipid profile, dual antiplatelet therapy, Pakistan
Comparative Effectiveness of Mulligan and Maitland Mobilization Techniques Among Patients with Lumbar Facet Joint Syndrome
Authors: Muhammad Samran Zafar  , Muntaha Babar  , Tamjeed Ghaffar  , Aftab Ansar Lodhi  , Junaid Raza  , Komal Shahbaz
Published: August 2024

Background: Facet joint syndrome is a prevalent cause of low back pain (LBP), contributing significantly to disability and economic impact. The incidence of lumbar facet joint pain ranges from 7.7% to 75% among LBP patients, highlighting the need for effective treatment options.
Objective: This study aimed to compare the effects of Mulligan's Sustained Natural Apophyseal Glide (SNAG) and Maitland's posteroanterior (PA) glide on pain, range of motion, and functional disability in patients with lumbar facet joint syndrome.
Methods: A single-blind randomized controlled trial was conducted in the outpatient physiotherapy department. Thirty male patients aged 24-60 years with lumbar facet joint syndrome were randomly assigned to two groups: Maitland PA glide and Mulligan SNAGs, each comprising 15 participants. Interventions were administered three times per week for one month. Outcomes were assessed using the Modified Oswestry Disability Questionnaire (MODQ), Numeric Pain Rating Scale (NPRS), and goniometer measurements. Data were analyzed using SPSS 25.
Results: The Maitland group showed significant improvements in MODQ (13.07 ± 3.53, p = 0.023) and NPRS (2.87 ± 1.13, p = 0.025) scores compared to the Mulligan group. Lumbar flexion and extension also improved significantly in the Maitland group (p < 0.05).
Conclusion: The Maitland PA Glide technique demonstrated superior efficacy in reducing pain and improving functional outcomes compared to the Mulligan SNAGs technique in patients with lumbar facet joint syndrome.
Prevalence of Hair Loss, Dandruff, and Its Knowledge and Prevention Among the Pakistani Population: A Cross-Sectional Study
Authors: Hamda Tanzeem Khan  , Muhammed Akhlaq  , Neha Tehreem Anwar  , Aiman Shafi Malik  , Warisha Masiullah  , Nimra Faizan
Published: August 2024

Background: Hair loss and dandruff are prevalent issues affecting a substantial portion of the Pakistani population. These conditions have significant cultural, social, and psychological impacts, necessitating a comprehensive understanding of their prevalence, causes, and management strategies.
Objective: The objective of this study was to determine the prevalence of hair loss and dandruff among the Pakistani population, identify the contributing factors, and assess the common management practices used by affected individuals.
Methods: A cross-sectional study was conducted from October to December 2023 in Karachi, Pakistan, utilizing a non-probability convenient sampling technique. A total of 353 consenting participants aged 18 years and above were included. Data were collected using a structured questionnaire developed after a comprehensive literature review and under the guidance of a practicing dermatologist. The questionnaire, translated into Urdu, included sections on socio-demographic data, hair type, experiences with hair loss and dandruff, treatment practices, and perceived causes. The survey was distributed via social media platforms such as WhatsApp, Instagram, Facebook, and email. Data were analyzed using SPSS version 25, with descriptive statistics summarizing demographic characteristics and prevalence, and chi-square tests assessing associations between hair conditions and socio-demographic factors.
Results: The study included 353 participants, of whom 58% were female and 40.3% were male. The majority were aged 18-24 years (77.3%). Hair loss was reported by 76.2% of participants, while 20.4% reported dandruff. Common contributing factors included stress (35.1%), lack of proper hair care (28.9%), poor diet (25.2%), and genetics (11.0%). Home remedies were the primary management practice (45.6%), with 30.9% not seeking any treatment.
Conclusion: Hair loss and dandruff are significant issues in Pakistan, with hair loss being more prevalent. Stress, poor diet, and inadequate hair care are major contributing factors. There is a need for increased awareness and effective management strategies, including addressing psychological impacts. Public health initiatives should focus on educating the population about the causes and treatments of these conditions.
Stage Fright to Scholarly Flight: The Impact of Public Speaking Anxiety and Fear of Negative Evaluation on Academic Performance in University Students
Authors: Ul Huda Noor , Bibi Maryam , Muhammad Sajjad  , Mukhtar Sara , Mukhtar Rifat
Published: August 2024

Public speaking anxiety is increasingly prevalent among students, adversely affecting their academic performance, particularly in oral presentations and group discussions. However, the impact of fear of negative evaluation as a mediator in this context has not been thoroughly examined among university students. Therefore, this study aims to investigate the adverse impact of public speaking anxiety on academic performance, with a specific focus on the mediating factor of fear of negative evaluation. Employing a correlational research design and convenient sampling, data were collected from students aged 18 to 25 (M=20.67, SD=2.12). The study employed three measures: the Public Speaking Anxiety Scale, Fear of Negative Evaluation Scale (Revised) and Academic Achievement Scale. Correlational analysis revealed a significant positive correlation between public speaking anxiety and fear of negative evaluation. However, fear of negative evaluation significantly and negatively correlated with academic performance. Mediation analysis depicts that direct and total effect of public speaking anxiety on academic performance is significantly negative despite indirect path is insignificant. There were no significant gender differences observed in public speaking anxiety, fear of negative evaluation, and academic performance. However, women scored higher on public speaking anxiety (M=59.86, SD=7.9) and fear of negative evaluation (M=39.05, SD=10.18) compared to men. Men scored higher in academic performance (M=16.45, SD=7.51) than women. The study discussed recommendations, limitations, and implications for the benefit of students.
Eexploring the Role of Personality Traits and Risk Factors in Cognitive Test Anxiety among Medical Students
Authors: Noshaba Razaq  , Rashid Qayyum  , Muhammad Faheem Anwer  , Zunaira Naveed  , Gul Muhammad Sheikh  , Ayesha Sohail
Published: August 2024

Background: Cognitive test anxiety is a prevalent issue among medical students, adversely affecting their academic and professional performance. The interplay between personality traits, past test experiences, and external pressures contributes to varying levels of anxiety, necessitating targeted interventions.
Objective: This study aimed to explore the relationships between personality traits, past test experiences, external pressures, and cognitive test anxiety among medical students to identify significant predictors of anxiety.
Methods: A cross-sectional quantitative design was employed, involving 352 medical students aged 22 to 26 years. Participants were selected through stratified random sampling to ensure representation across academic years and genders. Cognitive anxiety was measured using the Trait subscale of the State-Trait Anxiety Inventory (STAI), while personality traits were assessed with the Big Five Personality Inventory (BFI). A custom-designed questionnaire evaluated past test experiences and external pressures. Data were collected online and in-person, followed by statistical analyses using descriptive statistics, Pearson correlation coefficients, multiple regression, and moderation analysis with IBM SPSS Statistics, version 25.
Results: Neuroticism (β = 0.45, p < 0.001) and conscientiousness (β = -0.15, p = 0.003) significantly predicted cognitive anxiety. Past test performance history (β = 0.30, p < 0.001) and perceived test difficulty (β = 0.40, p < 0.001) were positively associated with anxiety. Females reported higher anxiety scores (70.1 vs. 65.2, p = 0.02).
Conclusion: Neuroticism and external pressures significantly contribute to cognitive test anxiety among medical students. Managing these factors may effectively reduce anxiety and improve performance.