The "KMUJ: KHYBER MEDICAL UNIVERSITY JOURNAL " is the official journal of KHYBER MEDICAL UNIVERSITY (KMU), Peshawar Pakistan, and is published from Khyber Medical University Institute of Medical Sciences (KIMS), Kohat, Khyber Pakhtunkhwa, Pakistan. KMUJ is an OPEN ACCESS JOURNAL and included in <a href="https://doaj.org/toc/2305-2651?source=%7B%22query%22%3A%7B%22filtered%22%3A%7B%22filter%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22terms%22%3A%7B%22index.issn.exact%22%3A%5B%222305-2643%22%2C%222305-2651%22%5D%7D%7D%5D%7D%7D%2C%22query%22%3A%7B%22match_all%22%3A%7B%7D%7D%7D%7D%2C%22size%22%3A100%2C%22sort%22%3A%5B%7B%22created_date%22%3A%7B%22order%22%3A%22desc%22%7D%7D%5D%2C%22_source%22%3A%7B%7D%7D" target="_blank" rel="noopener">Directory of Open Access Journals ." KMUJ (KMJ) is Indexed & abstracted in: Web of Science, Scopus, WHO IMEMR Current Contents, CAB Abstract & Global Health UK, SafetyLit, Pakistan Scientific and Technological Information Centre (PASTIC), Pakmedinet Recognized by: Higher Education Commission (HEC) Pakistan, Pakistan Medical & Dental Council, & College of Physicians and Surgeons (CPSP) Pakistan (for submission of paper(s) in lieu of dissertations for trainees). Included in "<a href="https://doaj.org/toc/2305-2651?source=%7B%22query%22%3A%7B%22filtered%22%3A%7B%22filter%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22terms%22%3A%7B%22index.issn.exact%22%3A%5B%222305-2643%22%2C%222305-2651%22%5D%7D%7D%5D%7D%7D%2C%22query%22%3A%7B%22match_all%22%3A%7B%7D%7D%7D%7D%2C%22size%22%3A100%2C%22sort%22%3A%5B%7B%22created_date%22%3A%7B%22order%22%3A%22desc%22%7D%7D%5D%2C%22_source%22%3A%7B%7D%7D" target="_blank" rel="noopener">Directory of Open Access Journals" (<a href="https://doaj.org/toc/2305-2651?source=%7B%22query%22%3A%7B%22filtered%22%3A%7B%22filter%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22terms%22%3A%7B%22index.issn.exact%22%3A%5B%222305-2643%22%2C%222305-2651%22%5D%7D%7D%2C%7B%22term%22%3A%7B%22_type%22%3A%22article%22%7D%7D%5D%7D%7D%2C%22query%22%3A%7B%22match_all%22%3A%7B%7D%7D%7D%7D%2C%22size%22%3A100%2C%22_source%22%3A%7B%7D%7D" target="_blank" rel="noopener">DOAJ); Asian Digital Library Registered with: International Serials Data System of France Covered by: Google Scholar ISSN (Print): 2305-2643 ISSN (Online): 2305-2651 KMUJ is a member of the Committee on Publication Ethics and follows the COPE guidelines regarding publication ethics and malpractices. KMUJ also follows the ICMJE Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals
Khyber Medical University (KMU) Peshawar PAKISTAN
Work published in KMUJ is licensed under a Creative Commons Attribution 4.0 License Authors are permitted and encouraged to post their by Plus-HD-V1.8" href="#98991027"> work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
The rare quadruplet: seminoma, microlithiasis, epididymal cyst and varicocele: a case report
Background: Seminomas account for nearly one-third of testicular germ cell tumors and are highly curable, with survival rates approaching 98% in early stages. The incidence of classic seminoma is rising in Pakistan. While the typical presentation is a painless testicular mass, diagnosis can be challenging when patients present misleading histories, such as scrotal trauma. Moreover, the coexistence of multiple testicular pathologies in a single patient is uncommon, further complicating the diagnostic process. Case Presentation: We report the case of a 29-year-old male with a prior history of blunt scrotal trauma who presented with persistent swelling and ecchymosis. Ultrasound revealed multifocal hypoechoic intratesticular lesions with internal vascularity, alongside tubular ectasia of the rete testis, epididymal cysts, microlithiasis, and a left-sided varicocele. Tumor markers were largely within normal ranges. Frozen section during surgery suggested a neoplastic lesion, and left radical orchidectomy was performed. Histopathology confirmed multifocal classic seminoma (pT1a), limited to the testis with rete testis invasion, negative margins, and no lymphovascular invasion. Immunohistochemistry was positive for PLAP, CD117, and OCT3/4, supporting the diagnosis. Conclusion: This case represents an uncommon scenario of multiple concurrent testicular pathologies coexisting with multifocal seminoma, initially masked by a history of trauma. It highlights the critical role of ultrasound as the first-line imaging modality, with definitive confirmation through histopathology and immunohistochemistry. Early surgical intervention remains the cornerstone of management, ensuring accurate diagnosis and favorable outcomes.
Copyright (c) 2025 Khurram Bhinder, Maira Aslam, Suraya Bano, Zarnigar Khan, Muhammad Bilal https://creativecommons.org/licenses/by/4.0
Wearable devices for xerostomia management in acute myeloid leukemia: a case report
Background: Xerostomia, or dry mouth, is a frequent and distressing complication among patients undergoing cancer treatment, significantly impairing quality of life. Conventional therapies are often limited by side effects and poor patient compliance. Reports on wearable devices for its monitoring are limited; this case highlights an innovative approach. Case Presentation: We present the case of a 74-year-old male with acute myeloid leukemia under supportive care who reported persistent xerostomia of moderate severity (2–4 on a 0–10 scale). His medical history included avascular necrosis, previous bone marrow transplantation with acute graft rejection, and multiple cardiac surgeries. The patient was on hydroxyurea, calcitriol, oxycodone, and acetazolamide. Clinical examination revealed oral soft tissue changes consistent with vascular ulceration, and salivary flow was objectively assessed through timed unstimulated saliva collection. To enhance symptom monitoring, the patient was instructed to wear a wristband-based device for seven days, recording physiological indicators of salivary function alongside subjective symptom intensity. Baseline and post-intervention serum and saliva parameters were collected, and patient-reported outcomes were evaluated using standardized quality of life questionnaires. The intervention demonstrated improved symptom awareness, better patient–clinician communication, and enhanced engagement in self-management. Conclusion: This case highlights the feasibility and potential utility of wearable devices in monitoring and managing xerostomia in leukemia patients. Despite limitations such as technical adaptation and restricted availability of comparable studies, wearable technology provided meaningful data to guide individualized care. Further research is warranted to validate these findings and explore integration into routine clinical practice.
Copyright (c) 2025 Abdullah Saeed, Mohammed Y Aseeri https://creativecommons.org/licenses/by/4.0
Invisible burden: addressing rare and genetic disorders in Pakistan’s healthcare landscape
Rare and genetic disorders remain largely invisible in Pakistan’s healthcare landscape, yet they place a devastating burden on patients, families, and health systems. Their neglect in national health agendas contrasts sharply with global commitments under the UN 2030 Agenda, Universal Health Coverage (UHC), and the 2021 UN Resolution, which recognize equity for persons living with rare diseases as a priority.¹ However, the absence of a universally accepted definition, thresholds and criteria vary widely across countries, continues to hinder coherent policy and regulation.² Establishing a consistent definition is essential to guide strategies, prioritize research and drug development, and reduce inconsistencies shaped by demographic and socio-cultural contexts.³ Rare diseases, though individually uncommon, collectively affect an estimated 3.5–5.9% of the global population, about 263-446 million people at any time. With nearly 72% of these conditions being genetic and about 69.9% often manifested in childhood, their burden is profound yet largely invisible within health systems.4 While global figures highlight the magnitude of rare and genetic disorders, the challenge is even greater in developing countries, where fragile health systems, scarce resources, and competing priorities limit progress.5,6 In such contexts, the lack of clear definitions, inadequate diagnostic infrastructure, and weak policy attention widen inequities. Pakistan exemplifies these challenges, highlighting the urgent need to translate global commitments into locally responsive strategies. The Undiagnosed Diseases Network International (UDNI), now spanning 41 countries including Pakistan, aims to strengthen diagnosis of undiagnosed rare diseases and develop standardized care pathways. Despite this inclusion, Pakistan faces profound barriers in rare disease diagnosis and care. Public and professional awareness remains low, access to and financing for genetic testing is limited, and multidisciplinary services are poorly funded and fragmented. The country also suffers from a shortage of trained specialists, weak institutional coordination, and minimal culturally appropriate care models.7 Broader systemic issues compound these gaps, including the absence of regulatory frameworks, limited expertise in medical genetics, scarce funding for genomic research, and a lack of genomic literacy across both providers and patients. Social determinants, such as high consanguinity, rural–urban disparities, gender inequities, and cultural or religious constraints, further impede the prioritization of clinical genetic services. Together, these barriers illustrate why Pakistan, despite global initiatives, struggles to build a sustainable framework for rare disease diagnosis and care.8 The multifaceted challenges surrounding rare disease care in Pakistan highlight the urgent need for a comprehensive, system-wide response, grounded in global health commitments yet responsive to national realities. A significant milestone has been the establishment of the country’s first Rare Registry for inherited metabolic disorders by the Biochemical Genetics Laboratory at Aga Khan University, marking an important step in quantifying and recognizing the burden of rare diseases.9 To build on this progress, a coordinated registry and surveillance system across all provinces is essential to capture the true prevalence and spectrum of rare and inherited conditions. Simultaneously, strengthening diagnostic infrastructure through the expansion of genetic laboratories and ensuring equitable access to early detection services must be prioritized. Addressing the critical shortage of trained professionals requires targeted capacity-building initiatives for clinicians, pediatricians, and genetic counselors. Public–private partnerships can also play a transformative role by reducing financial barriers, making advanced diagnostics and long-term care more accessible in low- and middle-income settings.10 Professional societies such as the Pakistan Society of Medical Genetics and Genomics (PSMG)11 and the recently established Pakistan Society for Novel and Rare Diseases (SNARE)12 are well positioned to advance the field of medical genetics and rare disease care. By fostering interdisciplinary collaboration, raising awareness among both professionals and the public, and supporting education and telehealth initiatives, these organizations provide vital platforms for advocacy and innovation. Their efforts are equally crucial for promoting the culturally sensitive integration of medical genetics into Pakistan’s healthcare framework. Pakistan stands at a pivotal juncture in addressing rare and genetic disorders. The path forward requires a coordinated national strategy that integrates registries, diagnostic infrastructure, workforce development, and sustainable financing into a cohesive framework. Aligning these efforts with global commitments under the UN 2030 Agenda and UHC will not only reduce inequities for patients and families but also strengthen the resilience of the entire health system. By leveraging professional societies, fostering public–private partnerships, and promoting culturally sensitive care, Pakistan can bring the “invisible burden” of rare diseases into the national spotlight. This approach can bridge science, policy, and compassion to create a more equitable and hopeful future for those affected.
Copyright (c) 2025 Akhtar Sherin https://creativecommons.org/licenses/by/4.0
Perceptions, practices, and fasting patterns of pregnant women during Ramadan: a multi-center study in Rawalpindi and Islamabad
Objective: To assess perceptions, practices, fasting patterns, and sleeping habits of pregnant women during Ramadan in Rawalpindi and Islamabad cities of Pakistan. Methods: A cross-sectional study was conducted during Ramadan 1444H (2023) at three private and two public hospitals. Ethical approval was obtained from Shifa International Hospital and Rawalpindi Medical University. Pregnant women with singleton, spontaneous conceptions attending antenatal clinics were included, while those with multiple pregnancies, assisted conception, or significant medical complications were excluded. Data were collected through a structured, self-administered questionnaire. Socioeconomic groups were stratified by hospital type. Data were analyzed using SPSS-21, employing chi-square, t-tests, Wilcoxon signed-rank test, and logistic regression. Results: Of 1004 participants, 73.0% reported fasting during Ramadan, with 58.1% fasting for 21–30 days. Fasting was more prevalent among lower-income women (82.2%) compared to higher-income women (66.0%, p<0.0001) and among Pathan (86.9%) compared to Punjabi (75.4%) women (p=0.004). First-trimester women fasted more (86.3%) than third-trimester women (69.8%, p<0.0001). Religious sentiment was the most common reason for fasting (79.6%). Mean weight and BMI were significantly lower in fasting women. Daytime sleep increased (1.8±1.9 to 2.4±2.1 hours), whereas nighttime sleep decreased (7.0±1.8 to 5.7±2.1 hours) during Ramadan (p<0.0001). Logistic regression identified trimester, ethnicity, religious sentiment, and perception that women should “never fast” as significant predictors, correctly classifying 80.6% of cases. Conclusion: Most pregnant women in Rawalpindi/Islamabad fast during Ramadan, primarily due to religious conviction, with patterns influenced by socioeconomic status, ethnicity, and trimester. These findings highlight the need for culturally sensitive counseling by healthcare providers.
Copyright (c) 2025 Nazeer Khan, Lubna Ejaz Kahloon, Zaira Hussain, Maria Rahim, Mara Qasim, Hamna Fatima https://creativecommons.org/licenses/by/4.0
Workplace bullying as a predictor of emotional intelligence and self-efficacy among nurses
Objectives: To examine the relationship between workplace bullying, emotional intelligence, and self-efficacy among nurses, and to explore differences across age groups and educational levels. Methods: This cross-sectional study was conducted from February to May 2024 in six government, semi-government, and private hospitals of Sialkot, Pakistan. A purposive sample of 196 nurses (aged 21–60 years) who reported workplace bullying was recruited. Data were collected using a demographic sheet and validated Urdu versions of the Negative Act Questionnaire-Revised (NAQ-R), Wong and Law Emotional Intelligence Scale (WLEIS-U), and General Self-Efficacy Scale (GSE-U). Analyses were performed using SPSS v.21. Results: Workplace bullying showed a significant weak negative correlation with emotional intelligence (r = –0.262, p < 0.01) but no significant association with self-efficacy. Emotional intelligence demonstrated a moderate positive correlation with self-efficacy (r = 0.471, p < 0.01) and significantly predicted it, explaining 22.2% of the variance (R² = .222, F (1,194) = 55.260, p < .01). Age-based comparisons revealed that bullying decreased, while emotional intelligence and self-efficacy increased with age, particularly among nurses aged 31–60 years. Education-based analysis showed that intermediate-qualified nurses reported the highest levels of emotional intelligence (93.5%) and self-efficacy (71%) with fewer bullying experiences, whereas degree-holders reported comparatively higher bullying and lower emotional intelligence. Conclusion: Workplace bullying negatively influences nurses’ emotional intelligence, whereas emotional intelligence positively predicts self-efficacy. Enhancing emotional intelligence through training and fostering a supportive organizational culture may buffer the adverse effects of bullying and improve resilience, particularly among younger and more highly qualified nurses.
Copyright (c) 2025 Umara Rauf, Muneeza Kanwal, Manahil Fatima, Seerat Amin, Saba Arooj https://creativecommons.org/licenses/by/4.0
Imposter syndrome and its association with burnout and psychological morbidity among undergraduate medical students in Sindh, Pakistan
Objectives: To investigate the relationship between psychological morbidity, burnout, and imposter syndrome (IPS) among undergraduate medical students in Sindh, Pakistan. Methods: This cross-sectional study was conducted from February to July 2023 by the Department of Community Medicine, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, and Isra University, Hyderabad in Sindh, Pakistan. Third- and fourth-year MBBS students without prior psychiatric illness or medication use were included through non-probability convenience sampling. Data were collected via Google Forms using four tools: a socio-demographic questionnaire, Young’s Imposter Scale (IPS), Depression Anxiety Stress Scale (DASS-21), and Maslach Burnout Inventory. Statistical analysis was performed using SPSS v23. Chi-square test and multivariate logistic regression were applied, with p<0.05 considered significant. Results: Out of 500 distributed forms, 289 valid responses were analyzed (response rate 61.2%). The mean age of participants was 20.8±3.4 years; 54% were female. IPS was prevalent in 58.5% of students, with higher rates in females and fourth-year students (p<0.05). IPS was significantly associated with age, residence, depression, and stress. Burnout was common, with 63.7% reporting high emotional exhaustion and 57.4% high depersonalization. Multivariate regression identified female gender (AOR=2.10, p=0.002), fourth-year status (AOR=1.75, p=0.018), rural residence (AOR=1.70, p=0.042), depression (AOR=2.60, p=0.001), stress (AOR=2.30, p=0.002), emotional exhaustion (AOR=2.95, p=0.001), and depersonalization (AOR=1.92, p=0.021) as significant predictors of IPS. Conclusion: IPS is highly prevalent among undergraduate medical students and is strongly associated with burnout, depression, and stress. Early recognition and targeted interventions are essential to safeguard the psychological well-being and academic performance of future physicians.
Copyright (c) 2025 Tariq Feroz Memon, Manzoor Ali Jamali, Ambreen Qureshi, Ghulam Hussain Baloch, Saba Alam, Farah Deeba Shaikh https://creativecommons.org/licenses/by/4.0
Dual challenges of oral cancer and COVID-19: a qualitative exploration of barriers, experiences, and coping strategies among patients in Pakistan
Objectives: To explore the physical, psychological, and social experiences of oral cancer patients six months after diagnosis and completion of treatment during the COVID-19 pandemic in Khyber Pakhtunkhwa, Pakistan. Methods: This qualitative follow-up study was conducted in January 2021 during the second wave of COVID-19. Seventeen patients with oral squamous cell carcinoma, originally recruited at diagnosis in July 2020 from the Department of Maxillofacial Surgery, Khyber College of Dentistry, Peshawar, Pakistan, were re-interviewed using face-to-face semi-structured interviews. Maximum-variation purposive sampling ensured diversity in age, gender, and cancer stage. Interviews were conducted in Pashto, audio-recorded with consent, transcribed ad verbatim into English, and analyzed thematically using Braun and Clarke’s framework with ATLAS.ti 8.0 software. Methodological rigor was maintained through peer debriefing, member checking, and confirmability audits. Results: Five themes emerged: (1) psychological vulnerability due to treatment delays, facial disfigurement, and COVID-19-related restrictions; (2) physical impairments including speech difficulties, dry mouth, and restricted jaw movement; (3) reliance on faith as a source of emotional strength; (4) social support systems, particularly family support and the Sehat Sahulat Program, which facilitated access to care; and (5) financial decline aggravated by treatment costs, unemployment, and long-term indebtedness. Conclusion: Six months after diagnosis, oral cancer patients in Khyber Pakhtunkhwa experienced persistent physical symptoms, emotional distress, and financial strain, compounded by the COVID-19 pandemic. Reliance on faith and social support were central coping strategies. These findings highlight the need for integrated, patient-centered cancer care addressing psychosocial and financial dimensions, particularly during public health crises in resource-limited settings.
Copyright (c) 2025 Maria Ishaq Khattak, Saad Ishaq Khattak, Sayeda Saira Bokari, Muslim Khan, Hira Shakoor, Gail Douglas, Zohaib Khan, Norkhafizah Saddki https://creativecommons.org/licenses/by/4.0
Association of glycemic and lipid markers with fall risk, kinesiophobia and cardiopulmonary endurance in post-stroke diabetic patients
Objectives: To determine the relationship between glycemic control (HbA1c, blood sugar random [BSR]) and serum triglycerides with risk of falls, kinesiophobia, and cardiopulmonary endurance in post-stroke diabetic patients. Methods: This correlational study was conducted from June 2022 to July 2023 at The Diabetic Centre, Pakistan Institute of Medical Sciences, Islamabad. A total of 226 post-stroke diabetic patients of both genders were recruited through non-probability purposive sampling. Assessments included glycemic and lipid profiles, the Tampa Scale for kinesiophobia, the six-minute walk test, and the timed up-and-go test. The age range of 45 to 85 years was considered, including individuals who had recovered from stroke, excluding those with hematological disorders, co-morbidities, or neurological complications. For statistical analysis, Pearson correlational performed using SPSS-21. Results: Out of the 226 subjects, 54% were female and 46% were male, with a mean age of 61±10 years and a mean body mass index of 24.8±5.26 kg/m2. Serum triglyceride levels showed a negligible and non-significant correlation with the risk of falls and kinesiophobia (r=0.088, r=0.096; p>0.05, respectively), but a negligible negative relationship with cardiopulmonary endurance (r= -0.09; p < 0.05). Blood sugar random demonstrated a negative moderate relation with cardiopulmonary endurance (r= -0.3; p<0.05). HbA1c exhibited a moderate negative correlation with cardiopulmonary endurance (r= -0.50; p <0.05). Conclusion: Among post-stroke diabetic patients, poor glycemic control, particularly elevated HbA1c, was significantly associated with higher fall risk, increased kinesiophobia, and reduced cardiopulmonary endurance. Routine monitoring and optimization of HbA1c may be critical in mitigating functional decline in this population.
Copyright (c) 2025 Saira Jahan, Eisha Iftikhar, Rida Fatima, Rahyma Fatima, Esha Hamayun https://creativecommons.org/licenses/by/4.0
Occupational health hazards, health conditions and safety measures among sanitation workers in Khyber Pakhtunkhwa, Pakistan
Objectives: To assess the prevalence of occupational injuries and diseases among sanitation workers in Pakistan, and to evaluate their attitudes toward occupational health hazards and practices regarding the use of personal protective equipment (PPE). Methods: This cross-sectional study was conducted from July to December 2021 among 502 permanently employed sanitation workers from five districts of Khyber Pakhtunkhwa (KP), Pakistan. Data were collected using a self-constructed, piloted questionnaire covering sociodemographics, occupational health problems, attitudes, and PPE use. Analysis was performed using SPSS version 22, with Chi-square tests applied for associations. Results: The mean age of participants was 35.7±7.9 years; most were male (97%), married (88.6%), and had education below secondary school. Reported communicable diseases included dengue (50%), typhoid (14.4%), and hepatitis C (5.4%). Hospital admissions were primarily due to eye problems (17.5%), accidental injuries/falls (14.0%), and skin diseases (11.3%), with burns, allergies, and sharps injuries also noted. Only 23.1% of sanitation workers reported consistent use of PPE, and 14.7% had witnessed a co-worker’s death during duty. The majority (77%) bore healthcare expenses out-of-pocket. Significant associations were observed between work experience and frequency of occupational diseases/injuries (p=0.005). Conclusion: Sanitation workers in KP are exposed to multiple occupational health hazards, compounded by low literacy, poor awareness, and inadequate use of PPE. Lack of structured health coverage and financial protection further exacerbate their vulnerability. Implementation of occupational safety policies, provision of PPE, and comprehensive health and safety training are urgently needed to safeguard this marginalized workforce.
Copyright (c) 2025 Umme Kulsoom Khattak, Fouzia Sadiq, Syed Nasir Shah, Hammad Ur Rehman, Quratul Ain https://creativecommons.org/licenses/by/4.0
Impact of ADRB2 gene polymorphisms and environmental factors Exposure on asthma control in adolescents from Pakistan
Objective: To explore the association of ADRB2 Gly16Arg (rs1042713) and Gln27Glu (rs1042714) polymorphisms with asthma control in Pakistani adolescents and explore potential interactions with environmental exposures like tobacco smoke and air pollution. Methods: This cross-sectional study was conducted from January-June 2022 at University of Sindh and Liaquat University Hospital, Jamshoro and its affiliated respiratory clinics. Adolescents aged 12–18 years with physician-diagnosed asthma (GINA-2023 criteria) were consecutively recruited. Asthma control was assessed using Urdu Asthma Control Test (ACT; score ≤19 = uncontrolled). Spirometry followed ATS/ERS 2019 guidelines. Buccal swabs were used for genotyping ADRB2 variants by PCR–RFLP. Environmental exposures (tobacco smoke, biomass fuel, residential proximity to roads/industry) were recorded. Associations were analyzed using χ² tests, t-tests, and multivariate logistic regression adjusting for confounders. Gene–environment interactions were examined with interaction terms. Results: Of 100 adolescents (mean age 14.6±1.9 years; 50% female), 54% had uncontrolled asthma. Arg16 allele frequency was 39% and Glu27 allele 22%. Uncontrolled asthma was significantly associated with Arg16 (χ²=5.12, p=0.024), but not Gln27Glu (p=0.31). Compared with controlled asthma, uncontrolled cases had lower ACT scores (16.5 vs. 20.7, p<0.001) and reduced FEV₁ (77.5% vs. 87.4%, p=0.008). Tobacco smoke exposure independently predicted poor control (AOR 2.51; 95% CI 1.08–5.84; p=0.032). Arg16 carriers exposed to smoke had the highest risk (AOR 3.12; 95% CI 1.01–9.61; p=0.048). Conclusion: ADRB2 Arg16 variant was linked with poor asthma control, especially with household tobacco smoke, indicating gene–environment interaction. No significant effect was observed for Gln27Glu. Larger longitudinal studies are warranted.
Copyright (c) 2025 Arsalan Ahmed Uqaili, Komal Siddiqui, Tazeen Shah, Saima Naz Shaikh https://creativecommons.org/licenses/by/4.0
Cone beam computed tomography evaluation of anatomic variations of the maxillary sinus and zygomatic bone to minimize the risk of sinus lift procedures
Objectives: To detect anatomic variations in the maxillary sinus and zygomatic bone with respect to age and gender using cone beam computed tomography (CBCT), to minimize procedural risks during sinus lift surgery and optimize implant planning. Methods: This cross-sectional prevalence study analyzed 98 CBCT scans (49 patients, aged 18–60 years) referred to Kunhitharuvai Memorial Charitable Trust (KMCT) Dental College, Kerala, South India, from December 2017 to August 2019. Multi-planar images were assessed for septa (presence, morphology, location), maxillary sinus pneumatization (MSP), and zygomatic bone pneumatization (ZBP). Associations with age and gender were evaluated. Results: Septa were identified in 35/98 (35.7%) cases, with the highest prevalence in the 51–60-year group [21/35 (60.0%)], most frequently located in the middle region [13/35 (37.1%)]. Complete septa [8/35 (22.9%)] increased with age. MSP was observed in 63/98 cases (64.3%), most frequent in the 51–60-year group [31/63 (49.2%)]. ZBP occurred in 10/98 cases (10.2%), most commonly in the 41–50-year group [5/10 (50.0%)], with all cases showing a multilocular pattern. No significant gender differences were detected for septa, MSP, or ZBP (p>0.05). Conclusion: Maxillary sinus septa and pneumatization patterns are age-dependent, with septa prevalence and completeness increasing with age. ZBP was less frequent but demonstrated a distinct multilocular pattern. Recognition of these variations is crucial for safe sinus lift procedures and effective implant treatment planning.
Copyright (c) 2025 Niyas Umer, Abdul Majeed Kummangal, Manoj Vengal, Auswaf Ahsan, Prejith Sampath, Ramsheena Payambrot https://creativecommons.org/licenses/by/4.0
Expression of APOA4 gene in urothelial bladder carcinoma: a potential diagnostic immunohistochemical biomarker
Objective: To investigate the immunohistochemical expression of Apolipoprotein A-IV (APOA4) as a potential diagnostic and prognostic biomarker in urothelial bladder carcinoma (UBC). Methods: This cross-sectional study was conducted from January 2020 to December 2022, at the Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan. Formalin-fixed paraffin-embedded tumor tissues were stained with hematoxylin and eosin for histopathological classification and with APOA4 antibody for immunohistochemistry (IHC). Stained sections were evaluated microscopically using a blinded method, and APOA4 expression was quantified with a semi-quantitative Histoscore (0–300). Statistical analysis was performed using the Mann-Whitney U test, with diagnostic validity assessed by ROC curve analysis. Results: A total of 121 participants were included (67 UBC patients, 54 controls). Among UBC cases, 31 (46%) were non-invasive low-grade papillary, 24 (36%) were non-invasive high-grade papillary, and 11 (16%) were invasive urothelial carcinoma. The mean proportion of APOA4-positive cells was 44% in cases versus 9% in controls, with mean Histoscores of 76 and 10, respectively (p<0.0001). ROC analysis showed an AUC of 0.79, with sensitivity and specificity varying according to cutoff thresholds. Conclusion: APOA4 expression was significantly higher in UBC tissues compared to controls, with increasing expression correlating with tumor grade and stage. These findings suggest that APOA4 has potential diagnostic and prognostic value in UBC, warranting further validation in larger, prospective studies.
Copyright (c) 2025 Naveed Sharif , Walayat Shah, Asif Ali, Taj Ali Khan https://creativecommons.org/licenses/by/4.0
Development and validation of a food frequency questionnaire for assessing dietary vitamin D intake in young adults of Pakistan
Objective: To develop and validate a culturally adapted food frequency questionnaire (FFQ) for assessing vitamin D (VD) intake among young Pakistani adults, using multiple 24-hour dietary recalls (24HDRs) as the reference method. Methods: This cross-sectional study was conducted at Dow University of Health Sciences (DUHS) between August and October 2022. A VD-focused FFQ was developed using international food composition databases and adapted to Pakistani dietary practices, excluding culturally inappropriate or unavailable items. The final tool contained 53 items grouped into major food categories. Participants aged 18–30 years (n=99) were recruited through convenience sampling. Three interviewer-administered 24HDRs and two FFQs (FFQ1, FFQ2) were collected. Validity was assessed by comparing FFQ1 and FFQ2 with the mean 24HDRs using paired t-tests, Spearman’s correlation, and Bland-Altman analysis, while reproducibility was evaluated by comparing FFQ1 and FFQ2. Results: Mean VD intake was higher when estimated from FFQs (FFQ1: 5.96 µg; FFQ2: 6.39 µg) compared to 24HDRs (4.33 µg), reflecting overestimation common to FFQs. Adequate VD intake (>2.5 µg/day) was reported in >55% of participants across all methods. Spearman’s correlation showed strong validity for FFQ1 vs. 24HDRs (r=0.693, p<0.001) and moderate validity for FFQ2 vs. 24HDRs (r=0.538, p<0.001). Reproducibility between FFQ1 and FFQ2 was strong (r=0.700, p<0.001). Bland-Altman indices were within acceptable ranges (3–5%), confirming agreement. Conclusion: The culturally adapted VD-FFQ demonstrated moderate-to-strong validity and strong reproducibility, making it a reliable tool for estimating VD intake in young Pakistani adults. Its use may facilitate future research on dietary determinants of VD deficiency in this high-risk population.
Copyright (c) 2025 Zainab Bohra, Sumaira Nasim, Sidra Zaheer, Habiba Shah, Muhammad Zafar Iqbal Hydrie https://creativecommons.org/licenses/by/4.0
Severity and risk factors associated with comorbid depression, anxiety, and stress in adults with obsessive-compulsive disorder in Peshawar, Pakistan
Objective: To examine the severity and risk factors associated with co-morbid depression, anxiety, and stress in adults with obsessive-compulsive disorder (OCD) in Peshawar, Pakistan. Methods: This cross-sectional study was conducted from August 2022 to January 2023 at Psychiatry Department, Lady Reading Hospital, Peshawar. Through purposive sampling, 104 patients (aged 18–45 years; mean±SD = 29.15±8.18) with DSM-5 diagnosed OCD were enrolled. Severity of OCD was assessed with Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and co-morbid depression, anxiety, and stress were measured with Depression, Anxiety and Stress Scale (DASS-21). Data were analyzed using descriptive statistics, Pearson correlation, regression analysis, and odds ratios (OR) for associated risk factors at p<0.05. Results: Among participants, 79% had co-morbid depression, 76% anxiety, and 51% stress. On Y-BOCS, 54.8% had extremely severe and 35.6% severe OCD symptoms. Depression was mostly moderate (54.8%), while anxiety was moderate (34.6%) to severe (26%), and stress was mild (33.7%) to moderate (17.3%). Y-BOCS scores showed significant positive correlation with DASS-21 depression (r=.345, p<0.01) and stress (r=.285, p<0.01). Regression analysis revealed depression (β=.247, p<0.05), anxiety (β=-.368, p<0.001), and stress (β=.397, p<0.001) as predictors of OCD severity. Significant risk factors for co-morbidities included age ≤30 years, marital status, past psychiatric history, and illness duration >1 year. Conclusion: High rates of co-morbid depression, anxiety, and stress were observed among OCD patients, with significant associations to illness duration, marital status, and psychiatric history. These findings highlight the importance of early screening and integrated management strategies to improve treatment outcomes and quality of life in OCD patients.
Copyright (c) 2025 Sumaira Mehreen, Farhana Jehangir, Erum Irshad, Alaptagin Khan https://creativecommons.org/licenses/by/4.0
Optical coherence tomography metrics in normal, perimetric and pre-perimetric glaucoma: a diagnostic assessment
Objectives: To compare the diagnostic performance of Bruch’s membrane opening–minimum rim width (BMO-MRW), retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL) thickness in distinguishing normal eyes, pre-perimetric glaucoma (PPG), and perimetric glaucoma (PG). Methods: This multicenter cross-sectional study was conducted at Akbar Niazi Teaching Hospital, Islamabad, and Farooq Teaching Hospital, Rawalpindi, from July 2023 to June 2024. A total of 320 patients (76 normal, 127 PPG, 117 PG; one right eye each) aged 18–70 years underwent comprehensive ophthalmic evaluation, including intraocular pressure measurement, slit-lamp biomicroscopy, dilated fundus examination, visual field testing, and optical coherence tomography (OCT). Exclusion criteria were media opacities, retinal disease, prior retinal laser, and non-glaucomatous optic neuropathies. OCT scans (Huvitz, v1.3.3) measured RNFL, BMO-MRW, and macular GCL thickness. Data were analyzed using ANOVA with post hoc testing and receiver operating characteristic curve analysis. Results: Significant intergroup differences were found for all OCT parameters (p<0.05). RNFL and BMO-MRW were thickest in normal eyes, thinner in PPG, and thinnest in PG. BMO-MRW consistently demonstrated highest diagnostic accuracy, outperforming RNFL and GCL. The superotemporal BMO-MRW yielded largest AUC values (0.875 for PG vs normal; 0.797 for PPG vs normal). At 95% specificity, BMO-MRW achieved sensitivity up to 70% (77% at 90% specificity). RNFL showed fair diagnostic performance, while GCL exhibited limited value, particularly in distinguishing PPG from normal eyes. Conclusion: BMO-MRW is the most reliable OCT metric for differentiating glaucomatous eyes from normal controls and demonstrates superior accuracy over RNFL and GCL in early glaucoma detection.
Copyright (c) 2025 Khadija Mohammad, Amena Masrur, Furqan Ahmad Khan, Mishal Batool, Fatima Amjad, Ali Tayyab https://creativecommons.org/licenses/by/4.0
Identifying entrepreneurship competencies for undergraduate medical students: a qualitative case study from Khyber Pakhtunkhwa, Pakistan
Objective: To identify key entrepreneurship competencies for undergraduate medical students studying in different Public and Private Medical Colleges of in Khyber Pakhtunkhwa, Pakistan, and explore perceptions regarding their inclusion in the medical curriculum. Methods: This qualitative case study was conducted from May to October 2023 in one public and one private medical university and their affiliated colleges at Khyber Pakhtunkhwa. Sixteen purposively selected participants, including vice chancellors, deans, hospital administrators, medical educationists, entrepreneurs, and ORIC representatives, were interviewed. Data were analyzed thematically following Braun and Clarke’s six-step framework. Results: Participants unanimously agreed that entrepreneurship education should be integrated into undergraduate medical training. Reported drivers included family influence, altruism, and financial stability, while awareness of entrepreneurship was mostly acquired informally through reading, media, or peer interactions. The core competencies identified were financial management, critical thinking, innovation, leadership, risk management, advertising skills, and creativity. Barriers such as limited financial resources, lack of time, and insufficient institutional support were also noted, along with practical tips emphasizing resilience, work–life balance, and lifelong learning. Conclusion: Our study identified the need for structured entrepreneurship training among undergraduate medical students to develop seven core competencies: financial management, critical thinking, innovation, leadership, risk management, advertising skills, and creativity. Incorporating these into the curriculum may prepare future doctors as innovators, enhance healthcare delivery, and improve patient outcomes. Further research is warranted to validate these competencies and assess their impact in the Pakistani context.
Copyright (c) 2025 Mohsin Shafi, Brekhna Jamil, Iqbal Haider, Zarmina Hussain https://creativecommons.org/licenses/by/4.0
Effects of intra-articular platelet-rich plasma on cartilage regeneration and osteoarthritis progression in a chemically induced rat model
Objective: To evaluate the regenerative effects of intra-articular platelet-rich plasma (PRP) on cartilage regeneration and disease progression in a chemically induced osteoarthritic knee joint rat model. Methods: This laboratory-based experimental study was conducted at the Department of Anatomy, Army Medical College, Rawalpindi (December 2019–October 2020). Ninety male Sprague-Dawley rats (2–3 months, 250 ± 50g) were randomly divided into three groups (n=30 each). Group A (control) received intra-articular saline (30µl). Groups B and C were induced with osteoarthritis via intra-articular injection of 1mg monosodium iodoacetate (MIA). Two weeks later, group C received 0.5 ml PRP, prepared by a double-spin centrifugation method and activated with calcium chloride. After 8 weeks, all animals were sacrificed. Articular cartilage specimens were processed, stained (H&E and toluidine blue), and analyzed for chondrocyte count, matrix loss, and cartilage surface integrity using Image J software. Statistical analysis was performed using ANOVA, Tukey’s test, and Chi-square, with p<0.05 considered significant. Results: Group A showed normal articular cartilage (96.9 ± 1.75 chondrocytes). Group B demonstrated significant reduction in chondrocyte count (46.1 ± 1.9, p=0.000), matrix loss, and severe surface damage (p=0.001). In contrast, PRP-treated group C showed significant improvement in chondrocyte count (86.9 ± 1.4, p=0.000), notable matrix preservation, and improved cartilage structure compared to group B (p=0.001). Conclusion: Intra-articular PRP preserved chondrocytes, reduced matrix loss, minimized cartilage damage, and promoted regeneration of articular cartilage, suggesting its therapeutic potential in slowing osteoarthritis progression. Further studies incorporating biochemical and radiological assessments are recommended for validation.
Copyright (c) 2025 Mahjabeen Fatima Qureshi, Khadija Qamar, Aqsa Zahid, Muhmmad Marghoob Khan, Sana Malik, Kanza Hamid https://creativecommons.org/licenses/by/4.0
Serum vitamin D status in adults from Peshawar, Pakistan: local burden and public health implications from a hospital-based study
Objective: To evaluate serum vitamin D levels among adults attending the outpatient clinic at Hayatabad Medical Complex, Peshawar, and to assess the prevalence of deficiency and insufficiency. Methods: This cross-sectional study was conducted from January to June 2024 at Hayatabad Medical Complex, Peshawar, Pakistan. Using convenience sampling, 101 adults aged 18–70 years attending routine health checks were enrolled. Individuals with chronic kidney or liver disease, malabsorption syndromes, pregnancy/lactation, or current use of vitamin D supplements were excluded. Demographic data and daily sun exposure were recorded through structured questionnaires. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured using high-performance liquid chromatography. Deficiency was defined as <20 ηg/mL, insufficiency as 20–29 ηg/mL, and sufficiency as ≥30 ηg/mL. Results: Of the 101 participants (49 males, 52 females; mean age 44.9±16.6 years), the mean serum vitamin D level was 30.5±19.4 ηg/mL (range: 4.46–102.12). Vitamin D deficiency was found in 32 (31.7%) participants, insufficiency in 29 (28.7%), and sufficiency in 40 (39.6%). No significant gender-based differences were observed in vitamin D levels or status (p>0.05). A weak positive correlation with sun exposure did not reach statistical significance (p=0.058). Conclusion: Vitamin D deficiency and insufficiency affected 60% of adults in this hospital-based study from Peshawar-Pakistan, indicating a substantial local burden. These findings have important public health implications and call for targeted public health strategies, including dietary fortification, supplementation, and awareness programs, to reduce the prevalence of hypovitaminosis D.
Copyright (c) 2025 Mehwash Iftikhar, Imran Khan, Ayesha Jamal, Mian Mufarih Shah, Mohammad Bilal Khattak, Nazeer Shah, Sheraz Jamal Khan https://creativecommons.org/licenses/by/4.0
Renoprotective effect of Captopril on Tacrolimus-induced renotoxicity in mice
Objective: To evaluate the renoprotective effect of captopril on tacrolimus-induced renal damage in mice. Methods: This experimental study was conducted at Institute of Pathology and Diagnostic Medicine, Khyber Medical University, in collaboration with the Research Laboratory of Khyber Girls Medical College, Peshawar, over a period of six months. Twenty-one adult male albino mice were randomly assigned into three groups (n=7). Group 1 received 0.9% normal saline (control), Group 2 received tacrolimus (5 mg/kg/day orally), and Group 3 received tacrolimus (5 mg/kg/day) with captopril (10 mg/kg/day) orally for 21 days. On day 21, all mice were sacrificed after blood collection. Biochemical (serum urea, creatinine), morphological (absolute and relative kidney weights, length, width, and anteroposterior diameters), and histopathological parameters were assessed. Results: Group 2 (tacrolimus only) demonstrated significant elevations in serum urea (33.85 ± 9.83 mg/dl) and creatinine (0.25 ± 0.05 mmol/l), along with marked histopathological alterations compared to Group 1 and Group 3 (p<0.05). Group 3 (tacrolimus + captopril) showed improvement in biochemical values (urea: 17.94 ± 2.89 mg/dl; creatinine: 0.18 ± 0.03 mmol/l) and attenuation of histopathological changes. Morphological variations included reduced absolute and relative kidney weights and changes in renal dimensions: shorter left kidney length (1.04 ± 0.09 cm vs. 1.14 ± 0.05 cm in controls) and increased right kidney anteroposterior diameter (0.52 ± 0.04 cm vs. 0.44 ± 0.05 cm in controls). Conclusion: Captopril exhibited a renoprotective effect of more than 50% against tacrolimus-induced nephrotoxicity, reflected by improved biochemical, morphological, and histological parameters.
Copyright (c) 2025 Sidra Irshad, Abdul Hameed Khan, Niaz Ali, Bushra Nasib, Muhammad Nabi, Najma Salahuddin, Rizwan Faisal, Shakir Ullah https://creativecommons.org/licenses/by/4.0
Alarming level of formalin contamination in bovine milk supplies in Khyber Pakhtunkhwa, Pakistan
Dear Editor, I wish to draw urgent attention to the growing and deeply concerning practice of adulterating bovine milk with formalin (formaldehyde) in Khyber Pakhtunkhwa (KPK), Pakistan. As milk is a vital source of nutrition, particularly for children, its contamination with this chemical poses serious risks to food safety and public health, while also underscoring deficiencies in regulatory oversight. According to recent surveillance data from the Khyber Pakhtunkhwa Food Safety and Halal Food Authority (FS&HFA), formalin was detected in 2.91% of tested milk samples, while nearly 93% of samples were found to be substandard, adulterated, or otherwise unsafe for human consumption.1 Although the percentage of formalin-positive samples may appear small, its toxicological implications are severe, as even trace amounts pose significant health risks. Drinking milk that contains formalin affects the human body negatively in that it can cause damage to internal organs, lead to neurological disorders, and make the body prone to cancer. Corrosive injuries are usually most pronounced in the pharyngeal mucosa, epiglottis and esophagus. Systemic effects include metabolic acidosis, CNS depression and coma, respiratory distress, and renal failure.2 The dangers are particularly worrisome for the children, who consume milk daily as part of their nutritional requirements. The intentional addition of such a toxic preservative not only threatens individual health but also undermines consumer confidence in one of the most essential dietary staples. Scientific evidence further supports these alarming findings. A cross-sectional study from Peshawar in 2018 revealed that 5.7% of milk samples contained formalin,3 while more recent data from 2022 confirmed the presence of formalin in milk collected from Mardan district.4 Together, these reports suggest a persistent and possibly expanding pattern of malpractice in dairy handling and distribution across KPK. The detection of formalin in milk is not merely a technical violation of food safety standards, it represents an unlawful, unethical, and dangerous adulteration that compromises public health. Milk is meant to deliver essential proteins, fats, vitamins, and minerals, but its contamination with formalin destroys its nutritional quality while introducing significant toxic risk. To address this urgent issue, we appeal to regulatory agencies, including the Pakistan Food Authority and FS&HFA, to implement a coordinated and robust response. This should involve: Routine and random sampling of milk across urban and rural districts to monitor formalin contamination at all levels of the supply chain. Enforcement of strict legal consequences against suppliers, distributors, and dairy farmers found guilty of adulteration. Comprehensive training and awareness programs for dairy farmers on safe milk production and handling practices. Development of a sustainable monitoring and surveillance program, including laboratory capacity-building, to ensure long-term adherence to food safety standards. Public health protection must remain the foremost priority. Contaminated milk not only threatens physical well-being but also erodes societal trust in food systems. The authorities must adopt a zero-tolerance approach toward milk adulteration to ensure that consumers, particularly vulnerable populations such as children, are protected from the devastating effects of formalin exposure. In conclusion, the evidence indicates that formalin contamination in milk is not an isolated problem but a systemic challenge requiring urgent, science-driven, and regulatory interventions. It is critical for policymakers, enforcement bodies, and health professionals to collaborate in safeguarding the nutritional and health security of the people of Khyber Pakhtunkhwa.
Copyright (c) 2025 Muhammad Anas, Muhammad Usman Sultan https://creativecommons.org/licenses/by/4.0
Hygiene and health challenges of women during floods in northern Pakistan and Khyber Pakhtunkhwa: from menstruation to motherhood
Dear editor, Floods disproportionately affect women's health because of damaged infrastructure, insufficient aid, and cultural norms that exacerbate vulnerabilities from the need for menstrual hygiene to the crucial phases of pregnancy, childbirth, and lactation. Since late June, more than 706 people have died due to floods across Pakistan (328 causalities in Khyber Pakhtunkhwa and 274), suffering devastating loss. According to UNICEF, by mid-august at least 333 people have died, including 21 children, while more than 1600 buildings were damaged leaving women without shelter and access to essential services. 1 Women in flood affected communities in Pakistan face a variety of menstrual hygiene issues, such as restricted access to sanitary products, subpar facilities, and cultural barriers, all of which have an impact on their health and general well-being.2 The necessity for better management of menstrual hygiene is highlighted by the fact that unsanitary behaviors during catastrophes cause health problems such as rashes, sexually transmitted diseases and urinary tract infections in women.2 Floods have a serious detrimental effect on the reproductive health of expectant mothers, leading to hazardous deliveries, malnutrition, interrupted prenatal care, and higher rates of maternal and newborn death.3 They also have a detrimental effect on breastfeeding practices since they reduce milk supply due to inadequate nourishment, stress, and lack of privacy, as well as the availability of alternatives to breast milk.4 Social and cultural barriers limit women's access to reproductive health treatments in flood affected Pakistan; stigma and reluctance keep women from reporting maternal or menstruation needs. These issues underscore the critical need for gender sensitive disaster response by contributing to increased maternal and neonatal mortality, a rise in reproductive tract infections, and long term detrimental maternal health.5 Disaster response needs to be gender sensitive in order to protect the lives, health, and dignity of women affected by floods. This includes integrating reproductive health into relief policies, deploying female healthcare workers, distributing emergency kits with menstrual and maternal supplies, and raising awareness to break cultural taboos.
Copyright (c) 2025 Warda Imran, Hamza Sajid https://creativecommons.org/licenses/by/4.0
Bacteriophages: a new weapon against antibiotic resistance
The emergence of antimicrobial resistance (AMR) poses one of the most significant threats to global public health, with projections indicating 10 million annual deaths by 2050 if left unchecked. As traditional antibiotics lose efficacy against resistant bacterial strains, bacteriophages—nature's bacteria-killing viruses—offer a promising alternative therapeutic approach. This review examines the potential of phage therapy in combating antibiotic-resistant infections, highlighting key advantages including high specificity, minimal disruption to beneficial microbiota, self-replication at infection sites, and co-evolutionary potential with bacterial targets. Recent clinical successes, including the landmark treatment of multidrug-resistant Acinetobacter baumannii infection, demonstrate the therapeutic viability of personalized phage cocktails. However, significant challenges remain, including regulatory frameworks, manufacturing complexities, and limited host range specificity. Future directions encompass engineered phages, combination therapies, prophylactic applications, and phage-derived lysins. While not a panacea, bacteriophage therapy represents a crucial tool in our evolving antimicrobial arsenal, offering hope in the post-antibiotic era through innovative approaches to bacterial infection management.
Copyright (c) 2025 Maajid Mohi Ud Din Malik https://creativecommons.org/licenses/by/4.0
Bridging the gap: the need for research mentorship and publication culture in physical therapy education in Pakistan
Research and publications are integral to evidence-based healthcare, yet within Pakistan’s physical therapy education, these elements remain underdeveloped. Although physical therapy programs have grown considerably, faculty often lack advanced research expertise, and students receive limited guidance in project design, critical appraisal, and scientific writing. Consequently, most student theses remain unpublished, representing missed opportunities to strengthen the global evidence base. This viewpoint highlights major gaps in research mentoring and publication culture in Pakistan’s physical therapy programs. It emphasizes the need for structured mentorship, early student engagement in research, and institutional reforms to promote academic productivity. Developing a strong research culture is not only an academic necessity but a professional responsibility that directly influences patient care and the advancement of evidence-based practice. International models demonstrate that investment in faculty development, research capacity building, and collaborative publishing can significantly improve outcomes. Adopting similar strategies in Pakistan could empower students, enhance faculty productivity, and ensure that locally generated evidence informs clinical practice. Strengthening research mentorship and cultivating a publication culture are therefore essential steps to bridge the divide between education and practice, aligning physical therapy education in Pakistan with global standards of healthcare innovation.
Copyright (c) 2025 Etisam Wahid https://creativecommons.org/licenses/by/4.0