bluuebunny/crossref_metadata_2025 huggingface dataset:
PHYSICAL ACTIVITY AND SLEEP PATTERNS AS DETERMINANTS OF ACADEMIC PERFORMANCE IN SECONDARY SCHOOL TEENAGERS: A DESCRIPTIVE CROSS-SECTIONAL STUDY
Authors: Naz Iffat , Fouzia Naz  , Nafisa Bardaie  , Mahreen Aslam  , Mohammad Shahid Chaudhary  , Mohammad Abid  , Muhammad Farrukh Habib
Published: December 2024

Background: Physical health factors, notably physical activity and sleep quality, play a crucial role in adolescents' academic performance. Regular physical activity has been associated with enhanced cognitive functions, including improved concentration and memory, as well as better mood regulation. Adequate sleep, typically 8–10 hours per night for teenagers, is essential for processes such as memory consolidation and maintaining attention. Insufficient sleep and physical inactivity have been linked to diminished academic outcomes and increased absenteeism.
Objective: This study aimed to assess the levels of physical activity and sleep patterns among secondary school teenagers and to evaluate their academic performance.
Methods: A descriptive cross-sectional study was conducted among 384 students from private secondary schools in Bahawalnagar. Participants were selected using a census sampling technique. Data collection instruments included the International Physical Activity Questionnaire (IPAQ) to measure physical activity levels, the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality, and the Academic Performance Scale (APS) to evaluate academic outcomes. Descriptive statistics, including means, standard deviations, frequencies, and percentages, were calculated using SPSS version 27.
Results: Among the participants, 32.8% exhibited low to moderate levels of physical activity. Regarding sleep quality, 37.2% reported good sleep, while 60% experienced disturbed sleep patterns. Despite these physical health challenges, 65.6% of the students achieved excellent academic performance. The analysis indicated that both physical activity levels and sleep quality had a substantial impact on academic outcomes.
Conclusion: The findings suggest that a significant portion of secondary school teenagers have suboptimal physical activity levels and sleep patterns. Nonetheless, a majority attained excellent academic performance, indicating that additional factors may contribute to academic success. Interventions aimed at improving physical activity and sleep quality could potentially enhance academic outcomes.
ASSESSING CONFLICT MANAGEMENT STYLES AMONG HEAD NURSES WORKING IN A TERTIARY CARE HOSPITAL, LAHORE, PAKISTAN
Authors: Ashraf Rizwana , Parveen Najma , Saif Pakiza , Zafar Misbah , Arshad Hina
Published: December 2024

Background: Conflict in the workplace can range from minor disagreements to high-intensity disruptions and legal actions. It is often stratified by intensity and categorized by duration as acute, sub-acute, chronic, or interminable. Effective conflict management is critical in healthcare settings to ensure staff well-being and patient safety. Understanding the conflict management styles employed by head nurses is essential for creating a harmonious work environment and improving healthcare delivery outcomes.
Objective: The objective of this study was to assess the conflict management styles used by head nurses working in a tertiary care hospital in Lahore, Pakistan.
Methods: This quantitative descriptive cross-sectional study was conducted over four months at the Children’s Hospital Lahore after obtaining approval from the Institutional Review Board (IRB). The study utilized a convenient sampling technique to recruit 52 head nurses with more than five years of managerial experience. Data were collected using a validated Rahim Organizational Conflict Inventory-II and a sociodemographic questionnaire. The conflict management styles were assessed through a five-point Likert scale. Data were analyzed using SPSS version 25.0, with descriptive statistics and linear regression applied to interpret findings.
Results: The study included 52 head nurses, all female, with 71.2% aged over 40 years, 21.2% aged 30–35 years, and 7.7% aged 36–39 years. Most participants (86.5%) had more than 11 years of managerial experience, and all were government employees. Educational qualifications included 67.3% with BSN, 26.9% with GNM, and 5.8% with MSN degrees. Collaborating was the most frequently utilized conflict management style (94.7%), followed by compromising (93.2%), accommodating (91.9%), avoiding (91.35%), and competing (82.32%).
Conclusion: Head nurses employed all five conflict management styles, with collaboration being the most frequently used. These findings emphasize the need for targeted interventions, such as training and education, to further enhance conflict resolution skills in healthcare management.
Keywords: Accommodation, Collaboration, Conflict Management, Cross-Sectional Studies, Hospitals, Nurse Managers, Pakistan.
COMPARATIVE EFFECTIVENESS OF SENSORY-MOTOR INTEGRATION AND ROODS APPROACH ON SENSORY AND MOTOR ABNORMALITIES IN PATIENT WITH DIABETIC POLYNEUROPATHY
Authors: Rasool Anbreena , Ehsan Kinza , Naz Hafsa , Ullah Butt Saad , Aneela Umar  , Affi Ayesha , Ali Zain
Published: December 2024

Background: Diabetic sensory-motor polyneuropathy causes a gradual loss of vibratory, thermal, tactile, and proprioceptive sensations, alongside motor symptoms such as reduced ankle reflexes, mild foot drop, and lower limb weakness, leading to functional limitations like frequent tripping and impaired pincer grasp. Effective therapeutic strategies are essential for managing these symptoms to enhance patients' quality of life. This study investigates the comparative effectiveness of sensory-motor integration and the Rood approach in managing diabetic polyneuropathy symptoms.
Objective: To compare the effects of sensory-motor integration and the Rood approach in improving sensory and motor functions in patients with diabetic polyneuropathy.
Methods: This single-blinded, randomized clinical trial included 64 patients with diabetic polyneuropathy recruited from Allied Hospital Faisalabad and Madina Teaching Hospital. Patients were randomly assigned to either a sensory-motor integration group or a Rood approach group. Both groups received 6 weeks of therapy, with three sessions per week. Sensory function was assessed using the Michigan Neuropathy Screening Instrument (MNSI), muscle strength via the Medical Research Council (MRC) scale, and functional mobility with the Walking Impairment Questionnaire (WIQ). Pre- and post-treatment data were analyzed using SPSS 20.0.
Results: The Rood approach group demonstrated a significant improvement in MNSI History scores, decreasing from a mean of 9.26 ± 2.33 pre-treatment to 5.68 ± 1.49 post-treatment. The sensory-motor integration group showed a mean decrease from 10.21 ± 1.65 to 8.42 ± 1.43. For MRC scale scores, the Rood group improved from 46.95 ± 3.98 to 51.52 ± 3.67, while the sensory-motor integration group rose from 44.79 ± 4.05 to 46.63 ± 4.99. WIQ scores in the Rood group increased from 52.16 ± 9.19 pre-treatment to 62.47 ± 8.42 post-treatment, outperforming the sensory-motor integration group, which rose from 51.63 ± 6.63 to 54.26 ± 6.70.
Conclusion: Both sensory-motor integration and the Rood approach significantly improved sensory and motor function in diabetic polyneuropathy patients. However, the Rood approach was more effective across all measured parameters, suggesting it as a preferable option for enhancing functionality and quality of life in this patient population.
COMPARATIVE EFFECTS OF ELONGATION LONGITUDINAUX AVEC DECOAPTION OSTEO ARTICULAIRE AND SUSTAINED NATURAL APOPHYSEAL GLIDE ON PAIN, RANGE OF MOTION AND DISABILITY IN PATIENTS WITH UNILATERAL CERVICAL RADICULOPATHY: A RANDOMIZED CLINICAL TRIAL
Authors: Maqsood Naveera , Zulfqar Rubina , Zahir Sana , Shahid Aqsa , Afzaal Fatima , Nawaz Sobia
Published: December 2024

Background: Cervical radiculopathy (CR) is a common neurological condition in the fourth and fifth decades of life, characterized by nerve root impingement resulting from mechanical compression of the cervical spine, disc herniation, osteophyte formation, trauma, or bony spurs. CR leads to pain, reduced range of motion (ROM), and disability, impacting daily function. This study aimed to evaluate the comparative effects of Elongation Longitudinaux Avec Decoaption Osteo Articulaire (ELDOA) and Sustained Natural Apophyseal Glide (SNAGS) techniques in managing unilateral cervical radiculopathy.
Objective: To compare the effects of ELDOA and SNAGS on pain reduction, improvement in cervical ROM, and reduction of disability in patients with unilateral cervical radiculopathy.
Methods: A randomized clinical trial was conducted at the Physical Therapy OPD of Allied Hospital Faisalabad from February to May 2024. Twenty-eight participants, selected via convenience sampling and randomized using the lottery method, were allocated into two equal groups. Group A received ELDOA, and Group B received SNAGS, alongside baseline therapy including hot packs, TENS, and cervical isometric exercises, administered three times per week for four weeks. The outcome measures included the Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), and cervical ROM assessed with a goniometer. Data were recorded at baseline and after four weeks and analyzed using SPSS version 23 with independent sample t-tests and Mann-Whitney U-tests applied for between-group comparisons.
Results: ELDOA showed significantly greater improvement in pain reduction (NPRS: 6.6±1.2 to 2.2±0.6) and disability (NDI: 47.0±8.9 to 21.7±6.7) compared to SNAGS (NPRS: 6.8±0.8 to 3.1±0.8; NDI: 51.8±12.0 to 28.6±9.5) with p-values <0.05. No significant differences were found in cervical flexion, extension, and side-bending ROM (p>0.05). However, SNAGS was more effective in improving cervical rotation ROM (51.0±3.3 to 61.3±2.3) compared to ELDOA (49.7±3.1 to 58.6±2.5) with a p-value <0.05.
Conclusion: Both ELDOA and SNAGS effectively reduced pain, improved ROM, and addressed disability in cervical radiculopathy. ELDOA was superior in reducing pain and disability, while SNAGS was more effective for enhancing cervical rotation ROM. These findings highlight the complementary benefits of both techniques in managing cervical radiculopathy.
FREQUENCY OF MATERNAL SEPSIS AMONG GRAVID FEMALES WHO HAD VAGINAL DELIVERY TREATED WITH PROPHYLACTIC AZITHROMYCIN
Authors: Khan Khadija Naseer , Noor Ul Huda  , Alveena Khan  , Aqsa Tassadduq  , Maria Ahmed  , Nimra Sajid
Published: December 2024

Background: Maternal sepsis is a significant contributor to maternal morbidity and mortality globally, accounting for nearly 10% of maternal deaths. The use of prophylactic antibiotics during childbirth has shown promise in reducing infection-related complications. Azithromycin, a broad-spectrum macrolide, has demonstrated efficacy in reducing maternal infections in previous studies. This study evaluates the frequency of maternal sepsis among gravid females who underwent vaginal delivery and were treated with a prophylactic dose of azithromycin.
Objective: To determine the frequency of maternal sepsis among gravid females who had vaginal delivery and were treated with a single prophylactic dose of oral azithromycin.
Methods: This descriptive case series was conducted over six months in the Department of Obstetrics and Gynecology at Jinnah Hospital, Lahore. A total of 140 gravid females, aged 18–40 years, were enrolled using non-probability consecutive sampling. Patients received a single oral dose of 2g azithromycin within six hours of vaginal delivery. They were observed for 24 hours post-delivery, discharged if asymptomatic, and monitored via phone for six days. Maternal sepsis was defined based on clinical symptoms, vital signs, and blood culture results. Data were analyzed using SPSS version 25.
Results: Among 140 participants, 27 women (19.2%) developed maternal sepsis. Of these, 22 (15.7%) had a low-grade fever (99°F), while 5 (3.6%) experienced high-grade fever (≥101°F). The highest recorded temperature was 103°F. The remaining 113 patients (80.7%) remained asymptomatic, reporting no fever or other signs of infection. All patients tolerated azithromycin without adverse effects.
Conclusion: Prophylactic administration of oral azithromycin within six hours of vaginal delivery significantly reduces the risk of maternal sepsis. This intervention is well-tolerated and holds promise for improving maternal outcomes, particularly in settings with limited resources.
EFFECTS OF SLUMP NEURAL MOBILIZATION FOR THE TREATMENT OF CHRONIC RADICULAR LOW BACK PAIN
Authors: Rasool Anbreena , Ashraf Javeria , Mehmood Mariam , Zulfqar Rubina , Saqib Mehneel , Zia Mahnoor
Published: December 2024

Background: Low back pain is a prevalent global health issue affecting individuals across all age groups, impacting their physical, mental, and social well-being. It is a significant concern in both developed and underdeveloped countries and a leading cause of disability worldwide. Chronic radicular low back pain, characterized by radiating discomfort due to neural irritation, demands effective therapeutic interventions to alleviate symptoms and improve quality of life.
Objective: This study aimed to evaluate the effects of slump neural mobilization in conjunction with baseline treatments for managing chronic radicular low back pain.
Methods: A randomized clinical trial was conducted in outpatient departments of multiple hospitals, enrolling 20 participants who met the inclusion and exclusion criteria. Participants were randomly allocated into two groups, with 10 in each group. Group A received slump neural mobilization combined with proprioceptive neuromuscular facilitation rhythmic stabilization and hot pack therapy. Group B received rhythmic stabilization techniques and hot pack therapy alone. Interventions were provided three times per week for five weeks. Pain intensity was assessed at baseline, the second week, and the fifth week using the Numeric Pain Rating Scale. Statistical analyses included the Mann-Whitney test for between-group comparisons and the Friedman test for within-group comparisons.
Results: Between-group analysis revealed significant reductions in pain levels, with p-values of 0.018 at baseline and 0.02 at the fifth week, while results at the second week were not significant (p = 0.173). Within-group analysis using the Friedman test demonstrated statistically significant reductions in pain for both groups, with p = 0.000. In the treatment group, mean pain scores decreased from 5.70 at baseline to 3.90 at the second week and 1.40 at the fifth week, while the control group showed reductions from 4.20 at baseline to 3.30 at the second week and 2.90 at the fifth week.
Conclusion: The study concluded that slump neural mobilization, when combined with baseline treatments, significantly reduced pain levels in patients with chronic radicular low back pain. These findings support its incorporation as an effective non-invasive intervention in physical therapy.
INVESTIGATING THE ROLE OF ORAL MICROBIOME DYSBIOSIS IN THE DEVELOPMENT AND PROGRESSION OF ATHEROSCLEROSIS AND CARDIOVASCULAR DISEASES: A META-ANALYSIS
Authors: Bint e Rashid Amna , Rashid Abdul , Dev Chetan , Arif Aurwa , Ibrahim Marwa , Muaz Shafique Ur Rehman  , Hassan Iram , Faisal Muhammad , Subhan Muhammad , Ramsha Bukhari Syeda
Published: December 2024

Background: The oral microbiome, comprising bacteria, fungi, and viruses, plays a critical role in oral and systemic health. Disruption of this microbiota balance, termed oral microbiome dysbiosis, is associated with systemic conditions such as cardiovascular diseases (CVDs) and atherosclerosis. Dysbiosis triggers systemic inflammation characterized by elevated pro-inflammatory cytokines and acute-phase proteins, which may exacerbate CVD progression. Despite substantial evidence linking oral dysbiosis to systemic health, the exact extent and mechanisms of this relationship remain underexplored.
Objective: This meta-analysis aimed to investigate the association between oral microbiome dysbiosis and cardiovascular diseases, with a particular focus on its role in systemic inflammation and the progression of atherosclerosis.
Methods: A systematic search of PubMed, Scopus, and Google Scholar was conducted according to PRISMA guidelines. The analysis included randomized controlled trials, observational studies, and reviews evaluating oral microbiome dysbiosis and its impact on systemic inflammation and cardiovascular outcomes. Data were synthesized using a random-effects model to calculate pooled odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. Subgroup analyses were performed for high-risk populations, including diabetic individuals and patients with periodontitis.
Results: Nine studies involving 1,930 participants were included. Pooled analysis revealed significant associations between oral microbiome dysbiosis and systemic inflammation (OR: 1.8; 95% CI: 1.5–2.1; p < 0.01; I² = 30%) and myocardial infarction (RR: 1.4; 95% CI: 1.2–1.6; p = 0.02; I² = 20%). Periodontitis strongly correlated with systemic inflammation (OR: 2.1; 95% CI: 1.8–2.4; p = 0.005; I² = 40%). Subgroup analyses highlighted increased cardiovascular risks in diabetic patients (RR: 1.6; 95% CI: 1.3–1.9) and alcohol drinkers (OR: 1.4; 95% CI: 1.2–1.6).
Conclusion: Oral microbiome dysbiosis significantly contributes to systemic inflammation and cardiovascular diseases. Addressing this dysbiosis through interdisciplinary strategies, including oral health interventions and lifestyle modifications, may mitigate cardiovascular risks. Further longitudinal and interventional studies are needed to establish causal pathways and assess the efficacy of periodontal treatments in reducing systemic inflammation.
LONG-TERM CARDIOVASCULAR OUTCOMES AND SAFETY PROFILE OF PCSK9 INHIBITORS IN HIGH-RISK POPULATIONS FOR SECONDARY PREVENTION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE: A COMPREHENSIVE META-ANALYSIS OF MORTALITY, MAJOR ADVERSE CARDIAC EVENTS, AND METABOLIC IMPACT
Authors: Chetan Dev  , Rana Muhammad Naveed  , Nur Qistina Binti Mohammed Haniff  , Lavinya Vasudevan  , Haider Hasnain  , Jerin Xavier Polackal  , Majid Ali Shah  , Ayaan Rafiq Shaikh  , Saja Saad  , Zaid Hassan
Published: December 2024

Background: Cardiovascular disease (CVD) is the principal cause of mortality globally, especially among individuals at high risk. Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors, innovative lipid-lowering medications, have shown promise in substantially lowering low-density lipoprotein cholesterol (LDL-C) and reducing cardiovascular risks.
Objective: This study aims to evaluate the long-term cardiovascular outcomes and safety profile of PCSK9 inhibitors in high-risk populations with established atherosclerotic cardiovascular disease (ASCVD), focusing on their effects on mortality, major adverse cardiac events (MACE), and metabolic markers.
Methods: Adhering to PRISMA guidelines, a detailed literature review was conducted across PubMed, Scopus, and Google Scholar. The search included randomized controlled trials (RCTs) and observational studies assessing the impact of PCSK9 inhibitors in high-risk ASCVD patients. Outcomes such as mortality, MACE, and metabolic changes were examined. Data were analyzed using random-effects models to accommodate heterogeneity.
Results: The analysis included ten studies comprising patients with high-risk ASCVD, revealing that PCSK9 inhibitors led to a 15% reduction in the incidence of cardiovascular events (pooled effect size: 0.85, 95% CI: 0.78-0.91, p < 0.001). Additionally, there was a significant decrease in LDL-C levels (effect size: 0.87, 95% CI: 0.82-0.93, p < 0.001) and post-acute coronary syndrome (ACS) mortality (effect size: 0.90, 95% CI: 0.84-0.96, p = 0.02). Subgroup analyses further highlighted the pronounced benefits for older adults and individuals with diabetes.
Conclusion: PCSK9 inhibitors significantly reduce cardiovascular events, MACE, and mortality in high-risk ASCVD patients, emphasizing their critical role in secondary prevention strategies for CVD, particularly in those with elevated LDL-C and increased cardiovascular risk.
IMPACT OF ARTIFICIAL INTELLIGENCE ON CLINICAL DECISION SUPPORT SYSTEMS IN HOSPITAL SETTINGS
Authors: Asma Taj  , Tabinda Razzaq  , Muhammad Sohaib Azeem  , Sudhair Abbas Bangash  , Talha Mazhar  , Nazeer Ahmed
Published: December 2024

BackgroundArtificial Intelligence (AI) in clinical decision support systems (CDSS) has become an essential tool in improving patient outcomes, enhancing diagnostic accuracy, and assisting in treatment planning. However, healthcare professionals’ perceptions and accessibility to AI-powered CDSS vary across different roles, impacting their effectiveness. Understanding how clinicians, physicians, and nurses interact with AI can provide valuable insights for improving AI integration in hospitals.
ObjectiveTo evaluate the perception, accessibility, and practical use of AI-powered CDSS among clinicians, physicians, and nurses in a hospital setting, focusing on how these factors influence the overall adoption and effectiveness of AI.
MethodsA cross-sectional survey was conducted in a hospital setting in Sheikhupura, Pakistan, over three months (Feb 2024 to Apr 2024). A total of 54 participants were divided into three groups: clinicians (n=18), physicians (n=18), and nurses (n=18). Data was collected using a structured questionnaire assessing perception (positive/negative), accessibility (easy/complex), and beneficiaries of AI (yes/no). Descriptive statistics, chi-square tests, and ANOVA were used for data analysis, performed using SPSS version 25.
ResultsClinicians showed the highest positive perception of AI at 83.3% (15/18), compared to 77.8% (14/18) for physicians and 55.6% (10/18) for nurses. AI accessibility was reported as easy by 66.7% (12/18) of clinicians, 55.6% (10/18) of physicians, and 44.4% (8/18) of nurses. Beneficiaries of AI were 72.2% (13/18) of clinicians, 66.7% (12/18) of physicians, and 50% (9/18) of nurses. Statistically significant differences were observed among the groups (p < 0.05).
ConclusionThe study demonstrated that while clinicians and physicians generally have a positive perception and easier access to AI, nurses experience more challenges in both areas. Targeted interventions, including training and support, are essential to improving AI accessibility and perception across all healthcare professional groups for optimal clinical decision-making.
PREVALENCE OF MUSCULOSKELETAL PAIN AMONG BRT BUS DRIVERS IN PESHAWAR: A CROSS-SECTIONAL SURVEY
Authors: Ahmad Syed Imtiaz , Naeem Ullah Shinwari  , Syed Issam Ullah Jan  , Muhammad Abrar  , Kainat Jaffary  , Anosha Tariq
Published: December 2024

Background: Musculoskeletal pain (MSP) is a common health issue affecting muscles, bones, and joints, often caused by prolonged sitting, obesity, aging, physical inactivity, smoking, and systemic inflammatory or cardiovascular conditions. Professional drivers are particularly at risk due to prolonged static postures, repetitive movements, and ergonomic challenges. Musculoskeletal disorders (MSDs) are a significant cause of reduced quality of life and work-related disability, necessitating research into their prevalence and risk factors among occupational groups such as bus drivers.
Objective: The objective of this study was to determine the prevalence of musculoskeletal pain among BRT bus drivers in Peshawar and to explore its association with occupational ergonomics.
Methods: A cross-sectional study was conducted over six months among 235 BRT bus drivers in Peshawar, selected through a convenience sampling technique. The Nordic Musculoskeletal Questionnaire (NMQ) was used to assess pain, and data were collected through structured interviews. Drivers aged 25–60 years with a minimum of one year of job experience were included, while those with pre-existing musculoskeletal issues or systemic conditions were excluded. Data analysis was performed using SPSS version 27, and results were presented using bar charts and pie charts. Descriptive and inferential statistical analyses were conducted, with significance set at p < 0.05.
Results: Among 235 participants, 181 drivers (77.0%) reported experiencing musculoskeletal pain over the past year, while 54 (23.0%) reported no pain. Neck pain was reported by 71 participants (30.2%), shoulder pain by 19.1%, upper back pain by 19.6%, and lower back pain by 22.6%. Pain in the hips/thighs affected 11.5%, knees 22.6%, ankles/feet 8.1%, elbows 2.1%, and wrists 3.0%. The findings suggest that ergonomic interventions may have contributed to the mild nature of the pain experienced by most drivers.
Conclusion: The study concluded that while BRT bus drivers in Peshawar commonly experienced musculoskeletal pain, its severity was generally mild, likely due to existing ergonomic practices. However, further improvements in ergonomics and supportive workplace policies are recommended to achieve complete mitigation of musculoskeletal discomfort and enhance drivers' occupational health.
SYSTEMATIC REVIEW OF COMMUNITY-BASED INTERVENTIONS TO REDUCE ANTIBIOTIC RESISTANCE
Authors: Ammar Hazrat , Room Shah , Behram Shah , Shah Hakim , Shaikh Abdul Sami , Akbar Naveed
Published: December 2024

Background: Antibiotic resistance represents a critical public health challenge globally, driven by inappropriate antibiotic use and inadequate public awareness. Community-based interventions have emerged as a key strategy to mitigate resistance by addressing misuse at its root. These interventions engage diverse stakeholders, including patients, healthcare providers, and pharmacists, and target behavioral, educational, and diagnostic gaps in antibiotic stewardship. Understanding the effectiveness and scope of such interventions is essential for guiding future policy and research.
Objective: This systematic review aims to evaluate the effectiveness of community-based interventions in reducing antibiotic resistance and to identify factors influencing their success across diverse populations and settings.
Methods: A comprehensive search was conducted across PubMed, Scopus, Google Scholar, Cochrane Library, and Embase, using MeSH terms and keywords such as “antibiotic resistance,” “community-based interventions,” and “antimicrobial stewardship.” Inclusion criteria encompassed peer-reviewed studies published between 2018 and 2023, focusing on human populations and measurable outcomes related to antibiotic use. Data extraction followed a standardized protocol, and effect sizes were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and sensitivity analyses were performed to ensure robustness.
Results: Ten studies met inclusion criteria, reporting an average odds ratio (OR) of 0.85 (95% CI: 0.75–0.95, p = 0.03) for reducing resistance. Pharmacist-led interventions achieved the highest impact (OR = 0.78; 95% CI: 0.68–0.88). Educational strategies showed an average compliance improvement of 20%, while diagnostic-driven interventions reduced resistance by up to 24%. The I² statistic of 35% indicated low heterogeneity, enhancing reliability.
Conclusion: Community-based interventions are effective in mitigating antibiotic resistance, with multifaceted approaches demonstrating the greatest success. Future efforts should address regional disparities and scalability challenges to maximize global impact.
EFFICACY OF NOVEL ANTIMICROBIAL AGENTS AGAINST MULTI-DRUG RESISTANT BACTERIA
Authors: Naveed Hussain  , Rashid Iqbal Rana  , Muhammad Naveed Aziz  , Zunaira Fatima
Published: December 2024

Background: The rise of multi-drug resistant (MDR) bacteria poses a significant threat to public health worldwide, undermining the efficacy of conventional antibiotics and escalating the severity of infections. Addressing this challenge requires the development of innovative antimicrobial agents that can effectively combat these resistant strains.
Objective: To evaluate the efficacy of novel antimicrobial agents against isolated MDR bacteria from clinical samples, assessing their potential as viable therapeutic options.
Methods: This experimental study was conducted at Nishtar Medical University Multan, with ethical approval from the hospital’s ethical board. Bacterial strains were isolated from various clinical samples and identified as MDR pathogens. The antimicrobial efficacy of three novel agents was assessed using minimum inhibitory concentration (MIC) tests and bactericidal assays, quantifying the agents' ability to inhibit and eradicate bacterial growth.
Results: The novel agents demonstrated varying efficacy against the bacteria. Agent A showed a significant reduction in Klebsiella pneumoniae with 99.0% bactericidal activity. Agent B reduced Pseudomonas aeruginosa by 82.4%, while Agent C was particularly effective against Acinetobacter baumannii, with an MIC of 0.66 µg/ml. These results indicate the agents' potent antimicrobial properties across different MDR bacterial strains.
Conclusion: The study highlights the promising potential of novel antimicrobial agents in treating infections caused by MDR bacteria. The significant bactericidal effects observed suggest these agents could be crucial in developing new therapeutic strategies against resistant pathogens.
Impact of Integrated Nursing and Rehabilitation on Recovery Outcomes after Pediatric Appendectomy
Authors: Zubeira Syed Ani  , Farrukh Murtaza  , Muhammad Bin Zia  , Ali Hamza Arshad
Published: December 2024

Background: Appendicitis is a common surgical emergency in children, often requiring appendectomy. Traditional postoperative care focuses on nursing protocols for pain management and mobility. Recent evidence suggests that integrated care models combining nursing and rehabilitation services can enhance recovery outcomes. This study aims to investigate the effectiveness of such a model in pediatric appendectomy patients.
Objective: To evaluate the impact of an integrated nursing and rehabilitation care model on recovery outcomes in children undergoing appendectomies.
Methods: This study was conducted over one year with 42 pediatric appendectomy patients randomly assigned to either an integrated care group or a standard care group. The integrated care group received combined nursing and rehabilitation services, while the standard care group received traditional postoperative care. Immediate postoperative recovery was evaluated using pain scores, wound healing assessments, and mobility tests at 24, 48, and 72 hours post-surgery. Long-term functional outcomes, including return to school and physical activity levels, were assessed at 1, 3, and 6 months. Patient and family satisfaction were measured at discharge and follow-up intervals.
Results: The integrated care group demonstrated significantly better outcomes: mean pain scores at 72 hours were 2.9 (SD = 0.3) compared to 3.8 (SD = 0.5) in the standard care group (p < 0.01). Wound healing scores at 72 hours were 1.4 (SD = 0.4) versus 2.3 (SD = 0.4) (p < 0.01). Mobility (TUG) scores improved from 9.0 (SD = 0.4) to 8.1 (SD = 0.4) (p < 0.01). Physical activity scores were 3.4 (SD = 0.6) at 1 month, 4.0 (SD = 0.4) at 3 months, and 4.4 (SD = 0.5) at 6 months, compared to 3.0 (SD = 0.5), 3.2 (SD = 0.6), and 3.6 (SD = 0.4) in the standard care group, respectively (p < 0.01). The integrated care group also had fewer days absent from school (mean 4.9, SD = 1.4 vs. 8.7, SD = 2.0) and higher patient satisfaction scores at all time points (p < 0.01).
Conclusion: The integrated nursing and rehabilitation care model significantly improved recovery outcomes for pediatric appendectomy patients, demonstrating better pain management, wound healing, mobility, and long-term functional recovery. These findings support the adoption of integrated care models to enhance postoperative recovery in pediatric surgical patients.
OUTCOMES OF PRETERM NEONATES WITH RESPIRATORY DISTRESS SYNDROME USING EARLY NON-INVASIVE VENTILATION
Authors: Anum Pervaiz  , Talal Waqar  , Muhammad Tariq Nadeem  , Iqra Irfan  , Muhammad Ali Zia  , Adeel  Mehmood
Published: December 2024

Background: Premature neonates are highly susceptible to respiratory distress syndrome (RDS), requiring advanced interventions like non-invasive ventilation to manage their condition effectively. This study investigates the application of early continuous positive airway pressure (CPAP) to manage RDS in preterm neonates, focusing on associated outcomes and predictive factors for success or failure of the therapy.
Objective: The objective current study is to assess the frequency of outcomes linked with early non-invasive ventilation in preterm neonates with RDS. Secondary objective is to evaluate the impact of various factors on the success or failure of early non-invasive ventilation in these patients.
Methods: A nested case-control study was conducted at the Department of Pediatrics, Combined Military Hospital, Kharian, from October 2022 to September 2023, involving 75 premature neonates with RDS. Exclusion criteria included neonates requiring intubation at birth or those with major congenital anomalies. All subjects were treated with CPAP and surfactant and monitored for 28 days for the necessity of mechanical ventilation and the emergence of complications.
Results: CPAP therapy failed in 13 (17.3%) neonates. Complications included bronchopulmonary dysplasia in 14 (18.7%) patients, patent ductus arteriosus in 15 (20.0%), air-leak syndromes in 5 (6.7%), and necrotizing enterocolitis in 3 (4.0%). The mortality rate was 17.3%. Neonates born at less than 30 weeks of gestation, those with a low birth weight, or severe RDS showed significantly higher odds of CPAP failure.
Conclusion: Early CPAP provides a critical non-invasive ventilation strategy in the management of RDS in preterm neonates, although it is associated with substantial failure rates and complications. Identifying predictive factors for CPAP outcomes can guide clinical interventions and improve neonatal care.
OUTCOMES OF TERM NEONATES WITH MECONIUM-STAINED AMNIOTIC FLUID
Authors: Pervaiz Anum , Talal Waqar  , Muhammad Tariq Nadeem  , Iqra Irfan  , Muhammad Ali Zia  , Adeel  Mehmood
Published: December 2024

Background: Meconium-stained amniotic fluid (MSAF) is a common complication in term pregnancies, occurring in approximately 5-20% of deliveries and often indicating fetal distress. While MSAF can lead to serious neonatal complications, including respiratory distress syndrome (RDS), hypoxic ischemic encephalopathy (HIE), and sepsis, not all cases of MSAF result in adverse outcomes. Identifying factors associated with MSAF is essential to enhance clinical management and improve neonatal outcomes.
Objectives: The primary objective was to determine the frequency of complications associated with MSAF in term neonates. The second objective was to assess the risk of maternal, neonatal, and gestational factors associated with the occurrence of MSAF in term neonates.
Methods: This case-control study was conducted in the Department of Pediatrics, Combined Military Hospital, Kharian, from October 2022 to September 2023. A total of 100 term neonates (50 with MSAF and 50 without) were enrolled. Neonates born between 37 and 42 weeks who experienced a trial of labor were included, while those delivered by elective cesarean section, with major congenital anomalies, or hemorrhagic amniotic fluid were excluded. Data on maternal, neonatal, and gestational characteristics were collected. All neonates were monitored for one month post-birth for any adverse outcomes in both inpatient and outpatient settings.
Results: Complications among neonates with MSAF included HIE in 3 (6.0%), RDS in 6 (12.0%), pneumothorax in 1 (2.0%), persistent pulmonary hypertension in 2 (4.0%), and sepsis in 12 (24.0%). Significant risk factors for MSAF included prolonged active labor over 6 hours (adjusted odds ratio [aOR]: 2.84, 95% confidence interval [CI]: 1.08–7.45, p=0.034), induction of labor (aOR: 4.65, 95% CI: 1.55–13.95, p=0.006), and gestational age at birth greater than 39 weeks (aOR: 4.01, 95% CI: 1.47–10.97, p=0.007).
Conclusion: MSAF is associated with significant neonatal complications, highlighting the need for careful management of risk factors such as prolonged labor, labor induction, and advanced gestational age to reduce the incidence and impact of MSAF.
FACTORS AFFECTING BREAST-FEEDING PRACTICES IN CHILDREN UNDER TWO YEARS OF AGE.
Authors: Mehmood Adeel , Khan Masud Murad , Zaman Saeed , Khan Fawad Ahmed , Irfan Iqra , Pervaiz Anum , Habib Muhammad Farrukh
Published: December 2024

Background: Exclusive breastfeeding for the first six months is crucial for optimal infant health and development. However, various maternal, neonatal, and environmental factors can influence breastfeeding practices, leading to suboptimal outcomes.
Objective: To identify and assess the impact of maternal, pregnancy, birth, and infant factors on exclusive breastfeeding among children under two years of age.
Methods: A case-control study was conducted at the Department of Paediatrics, Combined Military Hospital, Kharian, from July 2022 to March 2023. The study included 150 mothers and their children aged over two years. Exclusion criteria encompassed mothers with a history of breast trauma, surgery, irradiation, contraindications to breastfeeding, and neonates with anatomical facial defects. Data were collected on maternal demographics, pregnancy and birth details, infant characteristics, and breastfeeding practices. Statistical analyses, including calculation of adjusted odds ratios (OR) with 95% confidence intervals (CI), were performed to determine associations between various factors and exclusive breastfeeding.
Results: The study identified several factors associated with increased odds of not providing exclusive breastfeeding. Premature birth was significantly associated with higher odds (OR: 12.5; 95% CI: 3.3–45.1; p<0.001). Maternal obesity also contributed to increased odds (OR: 3.6; 95% CI: 1.0–12.5; p=0.046). Additionally, maternal depression was linked to higher odds (OR: 18.5; 95% CI: 2.6–134.2; p=0.004). A maternal perception of inadequate milk supply was associated with increased odds (OR: 9.1; 95% CI: 2.4–35.2; p=0.001). Lastly, a non-supportive breastfeeding environment was significantly associated with higher odds (OR: 13.5; 95% CI: 4.2–43.0; p<0.001).
Conclusion: Premature birth, maternal obesity, depression, perceived insufficient milk supply, and lack of a supportive environment are significant barriers to exclusive breastfeeding. Addressing these factors through targeted interventions is essential to improve breastfeeding practices and, consequently, infant health outcomes.
SOCIAL MEDIA ADDICTION IS THE RISK FOR LOWER PHYSICAL ACTIVITY, RAISED BODY IMAGE CONCERNS AND INCREASING BMI AMONG FEMALE UNIVERSITY STUDENTS
Authors: Anjum Zunaira , Ali Asif , Ahmed Fariq , Azam Muhammad
Published: December 2024

Background: In today's society, body image issues are becoming more prevalent among young women particularly female university students. While most studies have focused on the specific consequences of social media addiction and low physical activity levels, however, less is known about how these factors interact to cause body image concerns. Therefore, the purpose of this cross-sectional study was to investigate the relationship of social media addiction with physical activity levels, BMI and self-perceived body image among female university students.
Objective: The objective of this study was to investigate the relationship between social media addiction, physical activity levels, BMI, and body image concerns among female university students in Lahore, Pakistan.
Methods: The data was collected from five different universities. The participants of this study were 200 females with ages between 18 and 25 years (M = 20.93 and SD = 1.710). The questionnaire included survey regarding personal information, IPAQ short version, BSMAS and BSQ 16-B questionnaires. Results: The findings indicated that social media addiction was directly associated with low physical activity levels thus increasing sedentary behaviour among female university students. Additionally, it was also observed that those female students who were more prone to addictive nature of social media, had increased BMI values and body image concerns.
Results: The results revealed that social media addiction was significantly associated with lower physical activity levels, increased BMI, and heightened body image concerns among female university students. Higher addiction scores correlated with increased sedentary behaviour and dissatisfaction with body image.
Conclusion: The findings of this study suggested the promotion of increased physical activity levels to reduce the social media addiction and body image concerns among female university students to improve their mental health and well-being.
COMPARISON OF 2% CHLORHEXIDINE AND 5.25% SODIUM HYPOCHLORITE IRRIGATING SOLUTION ON POST OPERATIVE PAIN
Authors: Zia Shahnoor , Syed Atta Ullah Shah  , Sana Kanwal  , Khan Fahad , Ali Naila Amir , Khan Talha Asad , Raisani Sher Afgan , Habib Muhammad Farrukh
Published: December 2024

Background: Postoperative pain is a common concern following dental procedures, affecting patient comfort and recovery. Effective pain management is crucial, with irrigating solutions playing a key role in endodontic treatments. Among these, 2% chlorhexidine and 5.25% sodium hypochlorite are widely used due to their antimicrobial and tissue-clearing properties, respectively. While chlorhexidine is known for its lower cytotoxicity, sodium hypochlorite offers stronger antibacterial effects but may increase pain. This study aims to compare the effectiveness of these two solutions in reducing postoperative pain, helping clinicians make informed choices to improve patient outcomes.
Objective: To determine the efficacy of 2%chlorhexidine and 5.25% Sodium Hypochlorite irrigating solution on post operative pain
Methods: This quasi-experimental interventional study was conducted at Sandeman Provincial Hospital Quetta from October 2021 to October 2023. A total of 312 patients experiencing postoperative pain were randomly assigned to two groups, each with 156 participants. Group A received 2% chlorhexidine as the irrigating solution, while Group B was treated with 5.25% sodium hypochlorite. Postoperative pain, the primary outcome measure, was assessed using the Visual Analog Scale (VAS) at baseline, on the 3rd day, the 7th day, and at a 2-week follow-up. Data were collected, entered, and analysed using SPSS version 26.0, with the chi-square test applied to assess group differences, considering p < 0.05 as statistically significant.
Results: Out of 312 patients, with 160 males (51.3%) and 152 females (48.7%). Patients were divided into 2 groups. Group A (2% chlorhexidine) reporting a mean VAS score of 6.3 (±1.2) and Group B (5.25% sodium hypochlorite) showing a mean score of 6.5 (±1.3).  By the 2-week follow-up, both groups reported reductions in pain scores. Group A had a mean VAS score of 1.5 (±1.1), and Group B had a mean score of 2.8 (±1.4). A p-value of < 0.05 was considered statistically significant, which affirmed the effectiveness of 2% chlorhexidine over 5.25% sodium hypochlorite in managing postoperative pain.
Conclusion: 2% chlorhexidine is significantly more effective than 5.25% sodium hypochlorite in reducing postoperative pain following non-surgical root canal treatment
PREVALENCE OF MUSCULOSKELETAL PAIN AMONG HOUSE KEEPING STAFF OF HOSPITAL IN PESHAWAR
Authors: Syed Nigah e Zahra , Khan Muhammad Awais , Hassan Khan  , Aisha Jamil  , Zeeshan Ul Abideen
Published: December 2024

Background: Musculoskeletal disorders (MSDs) encompass a broad spectrum of health issues affecting the body's musculoskeletal system, including muscles, nerves, tendons, joints, and spinal discs. These conditions are exacerbated by certain work-related actions such as bending, climbing stairs, and repetitive motions, and are not typically the result of sudden accidents like slips or falls.
Objective: This study aims to evaluate the prevalence and impact of MSDs among housekeeping staff in hospitals, focusing on identifying significant gender differences in the experience of musculoskeletal pain.
Methods: In this cross-sectional study, 245 hospital housekeeping staff members were interviewed using the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) from September 2023 to May 2024. Participants, comprising 175 males and 70 females with an average age of 36.5 years, were selected through non-probability convenience sampling. Data analysis was performed using SPSS version 24.
Results: The analysis revealed that the most commonly affected areas were the shoulder (38.4%, p=0.006), knee (41.50%, p=0.886), lower leg (33.0%, p=0.798), lower back (38.3%, p=0.418), and foot (16.6%, p=0.919). These findings highlight the impact of non-ergonomic working conditions and intensive work schedules in hospital environments.
Conclusion: The study underscores the need for targeted interventions to reduce risk factors and improve the quality of life and work efficiency among housekeeping staff. Significant gender disparities were noted, with females showing greater susceptibility to MSDs in specific body regions such as the neck, shoulder, lower back, foot, and lower leg.
THE MEDIATING ROLE OF SPIRITUALITY BETWEEN RELATIONSHIP OF RESILIENCE AND COPING
Authors: Akhtar Seemab , Adeela Naureen
Published: December 2024

Background: Adolescence is a critical developmental stage characterized by profound cognitive, emotional, and behavioral changes. This period often leads individuals to seek meaning and purpose in life, with spirituality serving as a pathway for inner peace and coping during adversity. Spirituality has been linked to enhanced resilience and adaptive coping strategies, yet its role as a mediator in the relationship between resilience and coping remains underexplored. This study focuses on understanding the mediating influence of spirituality among adolescents and young adults.
Objective: The objective was to examine the mediating role of spirituality in the relationship between resilience and coping in adolescents and young adults.
Methods: A quantitative, correlational research design was employed to assess the mediation effect of spirituality. The sample included 200 participants (100 males and 100 females) aged 15–30 years, recruited through purposive convenient sampling from universities and colleges in Islamabad and Rawalpindi. Exclusion criteria included participants younger than 15 or older than 30, married individuals, and those with known psychological impairments. Data were collected using the Spiritual Health Assessment Scale (SHAS), Brief Resilience Scale (BRS), and Coping Scale. Participants provided informed consent, and confidentiality was maintained throughout the study. IBM SPSS Statistics was used for data analysis, including correlation, mediation, and t-test analyses.
Results: indings indicated a significant positive relationship between coping, resilience, and spiritual health. Spirituality partially mediated the relationship between coping and resilience (c’ = 0.12, t = 2.233, p = 0.02), with coping predicting spirituality (a = 0.8, t = 6.35, p < 0.01) and spirituality predicting resilience (b = 0.07, t = 2.65, p = 0.009). The total effect (t = 3.66, p = 0.0003) further supported this mediation. Gender differences were non-significant (p > 0.05), and spiritual health was found to be independent of age. Participants with stronger coping abilities exhibited higher resilience.
Conclusion: The study concluded that spirituality significantly mediates the relationship between coping and resilience, serving as a critical support mechanism for adolescents and young adults facing adversity. The findings underscore the value of fostering spiritual health to enhance psychological well-being, irrespective of age or gender.