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 need for expanded cochlear implantation services in rural Pakistan
Cochlear implantation is an established and effective intervention for auditory rehabilitation in children with profound hearing loss. Its widespread adoption has been transformative, with over 100,000 users worldwide, offering renewed hope to affected children and their families by reducing the psychosocial burden of deafness. Bilateral cochlear implantation is increasingly practiced to further optimize auditory outcomes. According to World Health Organization, approximately 80% of children with profound hearing loss live in developing countries and are potential candidates for cochlear implantation.1,2 Pediatric cochlear implantation was initiated in the United States in 1990, with subsequent recommendations extending implantation to children younger than 12 months with profound hearing loss. However, post-implantation observations revealed that successful surgery alone does not ensure optimal communication outcomes, highlighting the need for structured speech and language rehabilitation.3,4 Cochlear implantation has since been widely adopted in adults with severe-to-profound hearing loss and represents the first successful cranial nerve stimulator, marking a major advancement in otolaryngology. A prospective study from India (2019) demonstrated significantly better auditory outcomes in children implanted before 5 years of age compared with those implanted later, although implantation after 5 years still provided meaningful auditory benefit.5 Pakistan is a developing country with an estimated prevalence of bilateral hearing loss of approximately 1.6 per 1,000 individuals, with nearly 70% of cases attributed to consanguineous marriages, particularly in rural populations.6 A community-based survey from rural Pakistan reported a hearing loss prevalence of 7.9%.7 Genetically, about 80% of cases involve autosomal recessive non-syndromic hearing loss, typically congenital, while approximately 20% are autosomal dominant and often progressive. X-linked and maternally inherited mitochondrial DNA–related hearing loss are relatively rare. The higher burden of hereditary hearing loss in consanguineous populations reflects the increased likelihood of inheriting two pathogenic alleles from a common ancestor. Mutations in the GJB2 gene are the most identified cause of non-syndromic hearing loss in Pakistan, leading to impaired potassium ion recycling in the inner ear and subsequent sensorineural hearing loss.8 The cochlear implant program in Pakistan began in 2000, but initially only a small proportion of patients could afford the procedure. In rural areas, limited counselling and the prolonged rehabilitation process caused significant stress for families. Currently, several hospitals, in collaboration with international companies, provide cochlear implant surgery with habilitation services, including Dow University of Health Sciences, Karachi; Capital Development Hospital, Islamabad; Combined Military Hospital, Rawalpindi; Bahria International Hospital, Lahore; and Central Park Hospital, Lahore. Although some programs now offer free cochlear implant surgery with one year of funded audiological and speech therapy services, these efforts remain inadequate given the rapidly growing population. There is a critical shortage of cochlear implant surgeons, devices, and rehabilitation teams, particularly in rural areas. Inadequate rehabilitation and counselling have also led to device abandonment and loss to follow-up. Strengthened government and NGO support is required to expand funding, rehabilitation services, and community-based programs, especially in underserved regions.
Copyright (c) 2025 Syed Qasim Hashmi, Muhammad Arsalan Bashir, Saqib Sattar https://creativecommons.org/licenses/by/4.0
Editorial resilience in Pakistan’s biomedical journals: challenges and conflicts
Dear Editor Being an editor today extends far beyond correcting grammar, formatting references, or deciding which manuscript to publish. It requires resilience in the face of persistent external and internal pressures. In academic publishing, particularly within biomedical journals in Pakistan, editors encounter distinctive challenges. They must address the expectations imposed by regulatory bodies such as the Higher Education Commission (HEC) and the Pakistan Medical and Dental Council (PM&DC). At the same time, they are required to manage divergent views among senior editorial members and mentor junior team members who may lack commitment or avoid responsibility through internal dynamics. The true test of editorial resilience lies in balancing these pressures while safeguarding journal integrity and maintaining professional dignity. Editors are frequently subjected to regulatory pressures from bodies like HEC and PM&DC. While these institutions play a crucial role in enhancing research quality and promoting ethical publication standards, frequent policy revisions and stringent compliance requirements can generate considerable stress for editorial teams. Editors may receive sudden directives related to journal indexing, publication frequency, or peer-review structures that are difficult to implement within constrained resources. In such circumstances, adaptability and transparent communication are essential. Rather than perceiving regulatory requirements as burdens, editors may approach them as opportunities for gradual process improvement. 1 Open communication with regulatory authorities, timely clarification of expectations, and meticulous documentation of compliance efforts can significantly reduce avoidable stress. Internal pressures within the editorial office can be equally demanding. Senior editorial members often hold strong opinions and, at times, conflicting visions for the journal’s direction. Editors must therefore assume the role of mediator, respectfully acknowledge the diverse perspectives while ensuring that the journal’s core objectives are not overshadowed by personal disagreements. Resistance may arise, particularly when introducing stricter peer-review systems or adopting modern editorial workflows. In such situations, patience, respectful dialogue, and evidence-based persuasion are vital. Recognizing the experience of senior colleagues while highlighting evolving professional standards, supported by examples from well-established journals, can help build consensus.2 Challenges intensify when dealing with junior editorial members who avoid responsibilities or engage in subtle workplace politics. This aspect of editorial leadership is particularly draining, as it blends professional obligations with interpersonal dynamics. Delayed submissions, misplaced accountability, and attempts to gain favor through alignment or negativity can undermine team cohesion. Editors must respond with calmness, consistency, and impartiality. Clear written task assignments, defined timelines, and transparent expectations promote accountability. Regular meetings serve not only to monitor progress but also to acknowledge genuine effort, which strengthens morale and discourages unhealthy competition. Persistent avoidance of responsibility, however, must be addressed privately and constructively, focusing on behavior rather than personal traits.3 Maintaining professionalism amid these challenges requires emotional intelligence and self-discipline. Editorial stress is real, and when inadequately managed, it can lead to burnout, frustration, and strained professional relationships.4 Editors should therefore cultivate healthy coping strategies, including delegation, periodic breaks, and clear boundaries between professional and personal life. Equally important is nurturing a supportive editorial culture. Simple practices such as acknowledging contributions, offering assistance during peak workload periods, and facilitating open discussions can foster trust and collective responsibility. Self-reflection is another cornerstone of editorial resilience. Editors must continuously evaluate the environment they create whether it encourages collaboration or fear, transparency or ambiguity. The humility to acknowledge mistakes and the courage to rectify them set a powerful example for the entire team.4 Such leadership ultimately cultivates a sustainable and ethical editorial culture in which roles and responsibilities are clearly understood and respected. In conclusion, editorial resilience is not about ignoring challenges or minimizing difficulties. Rather, it involves confronting pressures with balance, integrity, and composure. Whether managing regulatory demands, mediating internal conflicts, or guiding less motivated team members, an editor’s strength lies in patience, empathy, and clarity of purpose. A resilient editor not only withstands stress but transforms it into an opportunity for continuous improvement.
Copyright (c) 2025 Rehana Khadim, Rabia Mahmood https://creativecommons.org/licenses/by/4.0
Sound-assisted soft tissue mobilization: an innovative approach for musculoskeletal disorders
Musculoskeletal disorders remain a major contributor to injury, functional limitation, and long-term disability worldwide. This viewpoint explores emerging approaches to soft tissue mobilization, with a particular focus on sound-assisted soft tissue mobilization (SASTM) as a novel physiotherapy intervention. A broad review of the literature was undertaken, encompassing all available forms of evidence on soft tissue mobilization techniques without restrictions on study design or database source. Instrument-assisted soft tissue mobilization (IASTM), SASTM, manual cross-fiber massage, and related techniques are widely integrated into contemporary rehabilitation programs. Both IASTM and SASTM operate on similar biomechanical principles, applying controlled mechanical forces to soft tissues to disrupt adhesions, enhance local circulation, and facilitate tissue healing. While IASTM employs steel-based instruments to detect and treat soft tissue restrictions through tactile feedback, SASTM utilizes ceramic polymer tools that identify tissue irregularities through sound-based feedback. Although each modality has defined indications and contraindications, SASTM may offer greater specificity in targeting adhesions. Nevertheless, its application should remain adjunctive, used alongside established therapeutic interventions and only by appropriately trained practitioners in accordance with prevailing professional regulations and state bylaws.
Copyright (c) 2025 Tahir Mahmood, Ashfaq Ahmad, Alberto Sumiya https://creativecommons.org/licenses/by/4.0
The evolution of the male role in nursing: a narrative review study
Background: Although nursing is often viewed as a female-dominated profession, men have played important caregiving roles throughout history. Their contributions have been overlooked due to cultural norms, professional shifts, and gender stereotypes. Objectives: To examine the global historical evolution of the role of men in nursing and highlight their contributions, challenges, and changing professional identity across different historical eras. Methods: This narrative review was conducted using literature retrieved from PubMed, Scopus, Web of Science, ScienceDirect, and SciELO, supplemented by manual searches in Google Scholar and ResearchGate. Studies published in English or Spanish that addressed men’s participation in nursing across various historical periods and regions were included. Article selection and data extraction were independently performed by two reviewers, with disagreements resolved by a third reviewer. Methodological quality was assessed using Joanna Briggs Institute tools. Review: Twenty-seven studies were included and thematically analyzed according to five historical eras: Prehistory, Ancient Age, Middle Ages, Modern Age, and Contemporary Age. Evidence shows that men were actively involved in caregiving in early societies, religious institutions, military orders, and hospitals. Over time, sociocultural shifts, professionalization of nursing, and gender stereotyping led to the marginalization of men, particularly during the modern era. In recent decades, increasing recognition of gender equity has renewed attention to men’s contributions, leadership roles, and educational experiences in nursing worldwide. Conclusion: Men have contributed to nursing throughout history despite gender barriers; recognizing this legacy is vital to promote inclusivity, challenge stereotypes, and support gender-balanced education, policy development, and equitable professional practice globally today.
Copyright (c) 2025 Jhan Carlos Manuel Fernández-Delgado, Higinio Fernández-Sanchez, Loujain Saud Sharif, Carlos Canova-Barrios , Ruba Matouq Alharazi https://creativecommons.org/licenses/by/4.0
MicroRNAs as biomarkers in prostate cancer: a scoping review with implications for the Pakistani healthcare setting
Objective: to critically evaluate the diagnostic, prognostic, and therapeutic significance of microRNAs (miRNAs) in prostate cancer (PCa), with particular emphasis on their potential relevance to the Pakistani healthcare context. Methods: This scoping review was conducted in accordance with PRISMA-ScR guidelines. Electronic searches were performed in PubMed, MEDLINE, EMBASE, and the Cochrane Library for studies published between January 2010 to June 2025. Regional literature was identified through the Journal of Pakistan Medical Association, Journal of the College of Physicians and Surgeons Pakistan, Pakistan Journal of Medical Sciences, Pakistan Journal of Pathology, and Pakistan Armed Forces Medical Journal. Keywords included microRNA, prostate cancer, diagnostic biomarker and therapeutic target. Original human studies evaluating miRNA expression in prostate cancer tissues or biological fluids with diagnostic, prognostic, or therapeutic implications were included. Reviews, conference abstracts, non-human studies, and studies lacking specific miRNA outcome data were excluded. Results: Out of 64 identified records, 16 studies met the inclusion criteria. miR-375 and miR-141 emerged as the most consistently dysregulated miRNAs with strong diagnostic potential, frequently incorporated into multi-miRNA panels outperforming prostate-specific antigen alone. Additional miRNAs, including miR-182, miR-200b, miR-21, miR-106b, and miR-1255b-5p, were predominantly upregulated and associated with disease presence, progression, and aggressive pathological features. miR-93 demonstrated post-treatment downregulation, indicating its potential role as a biomarker of therapeutic response. Conclusion: Current evidence supports the promising role of miRNAs as non-invasive biomarkers for prostate cancer diagnosis, prognosis, and treatment monitoring. However, locally generated data remain scarce, highlighting the need for well-designed Pakistani studies to enable clinical translation.
Copyright (c) 2025 Shameen Fatima Shoaib, Maham Javed, Maham Akhlaq, Fazal Ur Rehman Khan Niazi, Nadia Naseem https://creativecommons.org/licenses/by/4.0
Cholera outbreak preparedness in public sector hospitals from Lahore, Pakistan: a cross-sectional assessment
Objective: To assess the level of preparedness for cholera outbreaks in public sector hospitals of Lahore and to evaluate the knowledge of designated cholera focal persons at these facilities. Methods: This cross-sectional study was conducted in July 2023 in 12 public sector hospitals of Lahore, Pakistan, designated as cholera treatment centers. Hospital preparedness was assessed using a structured proforma based on the WHO Global Strategic Preparedness, Readiness and Response Plan for Cholera, limited to hospital-level domains. Five domains were evaluated: Infection Prevention and Control (IPC) & Water, Sanitation and Hygiene (WaSH); healthcare professionals’ appointment and training; clinical management; testing facilities; and data management and reporting. Each indicator was scored as fulfilled or not fulfilled, and pooled domain scores were calculated. A knowledge survey was conducted among 15 nominated cholera focal persons (5 doctors, 10 senior nurses). Descriptive analysis was performed using Epi Info™ version 7.2.6. Results: The highest preparedness scores were observed in clinical management (95.8%) and data management and reporting (91.6%). IPC and WaSH (85.4%) and healthcare professionals’ appointment and training (81.3%) demonstrated moderate preparedness. Testing facility domain showed the poorest performance (45.8%), as only one-third of hospitals had on-site laboratory capacity for cholera testing. Knowledge related to clinical management was satisfactory among focal persons; however, deficiencies were noted in epidemiological understanding, outbreak definition and asymptomatic carriage. Conclusion: While public sector hospitals in Lahore show reasonable preparedness in clinical management and surveillance for cholera outbreaks, gaps in laboratory diagnostic capacity and targeted training of focal persons require urgent attention.
Copyright (c) 2025 Huda Sarwar, Muhammad Sajid Mustafa, Amna Khalid, Saima Ayub, Maaz Suhail Rana, Muhammad Ali Awab Sarwar https://creativecommons.org/licenses/by/4.0
Emotional exhaustion, psychological capital, and psychological well-being among rescue workers: a mediation analysis
Objectives: To examine the impact of emotional exhaustion on psychological well-being and to investigate the mediating role of psychological capital among rescue service providers. Methods: This correlational study was conducted from May to August 2023 among rescue workers in South Punjab, Pakistan. Using purposive convenience sampling, 206 active-duty rescue personnel aged 20–40 years were included. Emotional exhaustion was assessed using the Maslach Burnout Inventory–Emotional Exhaustion subscale, psychological capital with the Psychological Capital Questionnaire (PCQ-12), and psychological well-being with the WHO-5 Well-Being Index. Data were analyzed using SPSS version 27. Pearson correlation analysis was performed, followed by mediation analysis using Hayes’ PROCESS macro (Model 4) with 5,000 bootstrap samples. Results: Out of 206 participants, 195 (95%) were males and 11 (5%) were females. Mean age of participants was 27.26±4.77 years. Emotional exhaustion showed a significant negative association with psychological well-being (r = −0.60, p <0.001) and psychological capital (r = −0.38, p <0.001). Psychological capital was positively correlated with psychological well-being (r = 0.43, p <0.001). Mediation analysis revealed that emotional exhaustion had a significant direct negative effect on psychological well-being (β = −0.51, p < 0.001). Additionally, emotional exhaustion exerted a significant indirect effect on psychological well-being through psychological capital (β = −0.09, SE = 0.04, p < 0.001), indicating partial mediation Conclusion: Emotional exhaustion adversely affects psychological well-being among rescue workers, while psychological capital serves as a protective mediator. Interventions aimed at strengthening psychological capital may help mitigate burnout-related psychological distress in emergency service personnel.
Copyright (c) 2025 Iram Batool, Iram Sohail Quraishi, Huma Batool, Ghulam Ishaq https://creativecommons.org/licenses/by/4.0
Exploring the perceptions and factors affecting social accountability in dental education: a qualitative study from Abbottabad, Pakistan
Objective: To explore perceptions and factors influencing social accountability (SA) among key stakeholders in dental institutions in Abbottabad, Pakistan. Methods: This qualitative exploratory study was conducted at three dental colleges in Abbottabad after obtaining ethical approvals. Faculty members, administrators, and final-year Bachelor of Dental Surgery (BDS) students with relevant experience were recruited through purposive sampling. Four focus group discussions (FGDs), each comprising six participants, were conducted using a semi-structured guide to explore perceptions, barriers, curricular integration, institutional support, and perceived impact of SA. FGDs were audio-recorded, transcribed verbatim, anonymized, and analysed using inductive thematic analysis. Data collection continued until thematic saturation was achieved, and rigor was ensured through reflexive journaling, peer debriefing, and participant validation. Results: Twenty-four participants (62.5% female) took part, representing faculty, students, and administrators. Six major themes with twenty-one subthemes emerged. Emerging themes included understanding & importance of social accountability, institutional & systemic barriers, integration into the dental curriculum, perceived impact of SA, institutional support & resources, and suggestions for improvement. Participants acknowledged the importance of SA but highlighted limited formal training, inadequate funding, lack of institutional structures, and insufficient faculty development as major barriers. Community-based education and early curricular integration were strongly recommended. SA activities were perceived to enhance students’ empathy, leadership, and problem-solving skills. Conclusion: Stakeholders recognize SA as an essential component of dental education; however, its implementation is constrained by systemic and institutional limitations. Structured curricular integration, faculty development, and strengthened institutional support are required to embed SA effectively within dental education in Pakistan.
Copyright (c) 2025 Farida Naz Aamir, Brekhna Jamil, Nowshad Asim, Nadia Munir https://creativecommons.org/licenses/by/4.0
Cytopathological changes of oral mucosa in dialysis-dependent chronic kidney disease: association with KDIGO staging
Objective: To determine cytopathological changes in the oral mucosa of patients with chronic kidney disease (CKD) undergoing dialysis and to assess their association with Kidney Disease: Improving Global Outcomes (KDIGO) staging. Methods: This cross-sectional study was conducted at University of Health Sciences, Lahore, from January to November 2019, after institutional ethical approval. One hundred CKD patients on dialysis were recruited from tertiary care hospitals in Lahore using predefined criteria. Socio-demographic data, oral hygiene status, clinical oral manifestations and relevant laboratory parameters were documented. CKD staging was performed according to KDIGO-2013 guidelines, and renal ultrasound grading was assessed. Oral mucosal smears were evaluated for inflammatory changes and cytological atypia. Associations between clinical, cytological, and KDIGO variables were analyzed through SPSS version-23. Results: Mean age of participants was 50.09±14.98 years, with a male predominance. Xerostomia (86%), metallic taste (48%), and uremic fetor (45%) were the most frequent oral manifestations. Cytologically, reactive- and non-reactive atypia were identified in 29% and 40% cases respectively. Significant associations were found between inflammatory atypia and thickened mucosa, and between non-reactive atypia and angular cheilitis. Prominent nucleoli were significantly associated with metallic taste and higher KDIGO stages. Grades 3b and 4 CKD showed significant associations with duration of dialysis, xerostomia, periodontitis, and prominent nucleoli. Conclusion: Oral cytopathological alterations are common in CKD patients undergoing dialysis and show significant associations with disease severity as per KDIGO staging. Oral cytology may serve as a useful adjunctive tool for early detection and monitoring of mucosal changes in patients with advanced CKD.
Copyright (c) 2025 Uzma Jabbar Khan, Rabia Anjum, Naveen Abubakar Bugvi, Nadia Naseem, Abdul Hannan Nagi https://creativecommons.org/licenses/by/4.0
A network pharmacology approach validates resveratrol’s in vivo neuroprotective effects against neurotoxic metals-induced cognitive decline
Objective: To investigate the neuroprotective effects of resveratrol against combined neurotoxicity induced by aluminum (Al), lead (Pb), and arsenic (As) using integrated in-silico and in-vivo approaches. Methods: Thirty adult male Sprague–Dawley rats (10–12 weeks; 180–250 g) were randomized into three groups (n=10 each): control, metal mixture (Al+As+Pb; 25 mg/kg/day, oral), and metal mixture plus resveratrol (20 mg/kg/day in feed) for 60 days. Cognitive performance was assessed using the Y-maze and Morris water maze (MWM). Gene expression of synaptophysin, PSD-95, and CaMKIV in cortex and hippocampus was evaluated by qPCR using the 2^-ΔΔCT method. In-silico target prediction and network pharmacology were performed using Swiss Target Prediction, CTD, and GeneCards; intersecting targets were analyzed via STRING and Cytoscape, followed by GO/KEGG enrichment (DAVID/ShinyGO). Molecular docking (AutoDock Vina) assessed binding of resveratrol with IL6, TNF, IL1-β, synaptophysin, CaMKIV, and PSD-95. Results: Network pharmacology identified 269 intersecting targets; hub genes included IL6, TNF, and IL1-β. Enrichment analysis highlighted pathways related to inflammation, apoptosis regulation, PI3K-Akt, MAPK, and neurodegeneration. Docking showed strong affinity with CaMKIV (−8.1 kcal/mol) and moderate affinity with IL6 (−6.8), IL1-β (−6.9), and PSD-95 (−6.5). In-vivo, the metal mixture impaired memory in Y-maze and MWM, while resveratrol significantly improved performance. Metal exposure downregulated synaptophysin, PSD-95, and CaMKIV expression in cortex and hippocampus; resveratrol partially to markedly restored expression. Conclusion: Resveratrol mitigated Al/As/Pb-induced neurotoxicity, improving cognitive performance and synaptic gene expression, potentially through multi-target modulation of inflammatory and neurodegenerative pathways.
Copyright (c) 2025 Abida Zulfiqar, Saima Bashir, Aymen Tahir, Saadia Zahid, Touqeer Ahmed https://creativecommons.org/licenses/by/4.0
Assessment of heterogeneous response of primary tumor and nodal disease to neoadjuvant therapy in invasive breast cancer
Objective: To assess heterogeneous pathological responses of the primary tumor and axillary lymph nodes following neoadjuvant therapy (NAT) in invasive breast carcinoma and to identify clinicopathological factors associated with variable response patterns, including pathological complete response (pCR). Methods: This cross-sectional study included node-positive, non-metastatic patients with invasive breast cancer who received NAT followed by definitive surgery between October 2024 and June 2025. Tumor and nodal responses were assessed on final histopathology and categorized as pCR, heterogeneous response, or non-complete response. Clinicopathological and biological variables were recorded. Associations were evaluated using univariate analysis, while multinomial logistic regression identified independent predictors of tumor and nodal response. Results: Among 169 patients, heterogeneous response occurred in 53 (31.4%), non-complete response in 95 (56.2%), and pCR in 21 (12.4%). Within the heterogeneous group, 24 (45.3%) patients achieved breast pCR with residual nodal disease, while 29 (54.7%) showed nodal pCR with residual breast tumor. A significant association was observed between breast and nodal responses (p <0.001). Tumor grade III (50.9%, p =0.017), triple-negative receptor status (41.5%, p <0.001), and type of NAT (p =0.032) were significantly associated with heterogeneous response. Residual tumor size (p =0.010), lymphovascular invasion (p =0.023), ductal carcinoma in situ (p =0.007), and extranodal extension (p <0.001) independently predicted tumor and nodal response, but not heterogeneous response specifically. Conclusion: Discordant pathological responses between primary breast tumors and axillary lymph nodes after NAT are frequent and reflect biological heterogeneity. Recognizing these patterns is crucial for individualized surgical planning and optimization of post-neoadjuvant treatment strategies.
Copyright (c) 2025 Zarka Ahmad, Irum Sabir Ali, Faryal Saeed, Anum Wahid, Mah Muneer Khan https://creativecommons.org/licenses/by/4.0
Age-specific patterns and molecular subtypes of breast cancer in a tertiary care hospital in Pakistan
Objective: To estimate age-specific incidence patterns and trends in breast cancer molecular subtypes in a local hospital-based population. Methods: This retrospective cross-sectional study was conducted at Akbar Niazi Teaching Hospital, Islamabad, from August 2022 to August 2024. One hundred women aged ≥20 years with biopsy-proven breast cancer were included through convenience sampling. Male patients, lobular carcinoma, phyllodes tumors, sarcoma/lymphoma, and cases with missing age data were excluded. Demographic, clinical, pathological, and treatment data were extracted from hospital records. Tumors were classified into luminal A, luminal B, human epidermal growth factor receptor-2 (HER2)-enriched, and triple-negative subtypes using immunohistochemistry and Fluorescence in situ hybridization where required. Statistical analysis was performed using SPSS v25. Chi-square test assessed associations between age groups and tumor subtypes, while linear regression estimated age-related incidence trends. Results: Mean age was 50.5±12.0 years (range: 20–75). Breast cancer occurred in 47% of women aged ≤50 years and 53% in those >50 years. Luminal A was the most frequent subtype (55%), followed by triple-negative (25%), luminal B (15%), and HER2-enriched tumors (5%). Hormone receptor status showed no significant association with age (p>0.05). A significant association was observed between age groups and molecular subtypes (p=0.043), driven primarily by the luminal A subtype after Bonferroni correction. Age was not an independent predictor of breast cancer on regression analysis. Conclusion: Nearly half of breast cancer cases occurred in women aged ≤50 years. Luminal A was the predominant subtype and showed significant age-related variation, emphasizing the need for age-stratified screening and subtype-focused management strategies.
Copyright (c) 2025 Munazzah Aziz, Rizwan Aziz, Sohaib Haider, Atiq ur Rehman, Manal Muzammil, Taimoor Ahmed https://creativecommons.org/licenses/by/4.0
Exploring acceptance of COVID-19 vaccination among breast cancer patients: a qualitative study in a tertiary care hospital in Rawalpindi, Pakistan
Objective: To explore the factors influencing belief formation regarding COVID-19 vaccine acceptance among women diagnosed with breast cancer in Pakistan. Methods: This exploratory qualitative study, guided by an interpretivist paradigm, was conducted at a tertiary care hospital in Rawalpindi, Pakistan. Semi-structured, in-depth interviews were conducted between December-2021 and March-2022 among adult breast cancer patients receiving active treatment, using typical case sampling. Interviews were audio-recorded with informed consent and continued until data saturation. Transcripts were analysed concurrently using reflexive thematic analysis based on Braun and Clarke’s six-phase framework, with trustworthiness ensured through reflexivity, audit trails, team discussions, and inclusion of verbatim quotations. Results: Eleven female participants (mean age 49.4±11.3 years) were interviewed. One overarching theme, Belief Formation Regarding COVID-19 Vaccination, emerged, supported by five inter-related themes: psychosocial concerns during the pandemic, cancer- and COVID-19-related beliefs, vaccination experiences, interactions with healthcare providers, and coping and support mechanisms. Vaccine acceptance was shaped by emotional distress following cancer diagnosis, fear of immunosuppression, religious and familial influences, trust in healthcare workers, prior vaccine experiences, and exposure to misinformation and conspiracy beliefs. Supportive healthcare interactions and adaptive coping strategies facilitated acceptance, while financial stress, social isolation, and distrust in authorities contributed to hesitancy. Conclusion: Beliefs regarding COVID-19 vaccination among breast cancer patients are complex and deeply embedded within psychosocial, cultural, and healthcare contexts. Resilience grounded in faith, family support, trust in healthcare providers, and active coping facilitated acceptance, whereas conspiracy beliefs, distrust of rapid vaccine development, fear of treatment-related immunosuppression, and social isolation contributed to hesitancy.
Copyright (c) 2025 Asmara Ahmed Malik, Syed Fawad Mashhadi, Zubaida Rashid, Syeda Rifaat Qamar Naqvi, Mommana Ali Rathore, Imdad Ali Khushk https://creativecommons.org/licenses/by/4.0
Effects of postprandial exercise timing on Irisin and metabolic responses in adults with prediabetes
Objective: To evaluate the effects of different postprandial exercise timings (30, 60, 90, and 120 minutes after meal intake) on serum irisin levels, lipid profile, anthropometric indices, and substrate metabolism in middle-aged adults with prediabetes. Methods: This controlled, repeated-measures experimental study was conducted on twenty-five sedentary adults aged 30–40 years with prediabetes at Khyber Medical University, Peshawar, Pakistan, from July 2022 to December 2023. Participants served as their own controls and completed four treadmill-walking sessions (40 minutes at 50% predicted maximum heart rate), performed one week apart at varying postprandial intervals. Venous blood samples were collected at fasting, pre-exercise, and 60-, 90-, and 120-minutes post-exercise across the study weeks to assess serum irisin and lipid profile. Substrate metabolism (VO₂, respiratory quotient), perceived exertion, and anthropometric measures were assessed at baseline and at the end of the study. Results: Exercise performed 30 minutes after meal produced maximum rise in serum irisin (Δ = +115 pg/mL, p <0.001), and significant reductions in total cholesterol, LDL-C, and triglycerides, with an increase in HDL-C (p <0.001). Fat oxidation peaked at the 30-minute exercise condition (p =0.015), whereas carbohydrate oxidation was highest when exercise was initiated 120 minutes post-meal (p = 0.026). Anthropometric indices (BMI, waist circumference, body fat %) showed significant improvement over the study duration. Perceived stress remained largely unchanged, although participants subjectively reported better mood and energy following exercise. Conclusion: Initiating postprandial exercise, particularly within 30–60 minutes after meals, optimally improves lipid metabolism, substrate utilization, and irisin response in prediabetes.
Copyright (c) 2025 Inayat Shah, Fazeelat Hajra Kareem, Saman Tauqir, Zubia Shah https://creativecommons.org/licenses/by/4.0
Abnormal computed tomography (CT) brain findings in adult patients presenting with the chief complaint of headache
Objective: To determine abnormal computed tomography (CT) findings in adult patients presenting with the chief complaint of headache without preceding trauma and focal neurological signs. Methods: A cross-sectional study was conducted at PAC Hospital Kamra from November 4, 2024, to May 4, 2025, enrolling 161 patients aged 18-80 years with headache after obtaining informed consent using non-probability consecutive sampling. Non-contrast CT scans were performed using a 160-slice scanner with contrast-enhanced imaging if indicated. Abnormalities, including space-occupying lesions, paranasal sinus disease, hydrocephalus, intracranial hemorrhage, cerebral infarcts, age-inappropriate cerebral atrophy, dural venous sinus thrombosis, and miscellaneous findings, were recorded. Data was analyzed using SPSS Version 26. Results: The mean age was 40.5 ± 15.54 years, with 98 females (60.87%) and 63 males (39.13%). The median duration of headache was 12 weeks, and the interquartile range (IQR) of 2–48 weeks (range, 1-96 weeks). Abnormal CT findings were observed in 43 patients (26.7%), including space-occupying lesions in 2 (1.24%), paranasal sinus disease in 30 (18.63%), hydrocephalus in 2 (1.24%), cerebral infarcts in 4 (2.48%), and miscellaneous findings in 5 (3.11%). No age-inappropriate cerebral atrophy, intracranial haemorrhage, or dural venous sinus thrombosis were detected in any of the patients. Conclusion: Abnormal CT findings were uncommon in adults with non-traumatic headache and no neurological deficits. Paranasal sinus disease was the most frequent abnormality. Selective imaging based on clinical risk factors can reduce unnecessary CT usage.
Copyright (c) 2025 Sumbal Waheed, Naila Parveen, Javed Anwar https://creativecommons.org/licenses/by/4.0
Examining the root and root trunk's vertical dimensions in extracted permanent maxillary first molar in patients visiting Peshawar Dental Hospital, Peshawar
Objective: To evaluate the root trunk length (RTL) and root length of extracted maxillary permanent first molars (MPFM) and to analyze their variation in relation to age, gender, and associated clinical characteristics. Methods: This cross-sectional study was conducted at Peshawar Dental College and Hospital from March 2021 to February 2022. A total of 135 MPFM with intact roots, cementoenamel junctions, and furcation areas were included, while teeth with anomalies, fractures, resorption, cervical lesions, prior endodontic treatment, or severe dilacerations were excluded. RTL and root length were measured using a digital Vernier caliper (precision 0.01 mm). RTL was recorded from the cervical line to the furcation, and root length from the cervical line to the root apex of the mesiobuccal, distobuccal, and palatal roots. Data were analyzed using SPSS version 21. Results: Among 135 teeth, 88 (65.2%) were from females and 47 (34.8%) from males. The buccal root trunk (BRT) exhibited the greatest mean length (6.52±2.53 mm), followed by distal and mesial root trunks. The palatal root was the longest (14.31±2.77 mm). Higher mean RTL and RL values were observed in the 41–50-year age group and in males; however, differences across age groups and gender were not statistically significant (p >0.05). Conclusion: MPFM show considerable variation in root trunk and root lengths, with BRT and palatal root demonstrating the greatest mean lengths. Although higher mean values were observed in males and older age groups, these differences were not statistically significant. These morphometric findings may aid periodontal and endodontic treatment planning.
Copyright (c) 2025 Bushra Khan, Munawar Aziz Khattak, Sana Arbab, Imran Khattak https://creativecommons.org/licenses/by/4.0
Blepharoptosis, at a tertiary care oculoplastic clinic
Objective: To determine the frequency, patterns, etiology and management outcomes of ptosis in patients presenting to an oculoplastic clinic. Methods: This cross-sectional observational study was conducted from August 2022 to May 2023, at Hayatabad Medical Complex, Peshawar, Pakistan. Patients of all ages presenting with ptosis were included. Detailed history and ocular examination were performed. Ptosis was categorized as congenital or acquired, levator function was assessed and management options were documented. Surgical procedures and postoperative complications were recorded. Results: Thirty-eight patients (56 eyes) were enrolled (mean age 16.4±17.1 years); 22 (57.9%) were male and 28 (73.7%) were children. Congenital ptosis accounted for 28 patients (73.7%) and unilateral involvement for 22 (57.9%). Levator function was poor in 14 (40%), fair in 20 (57.2%), good in one (2.8%); and un-assessable in 3 (7.9%) infants. Surgery was performed in 33 (86.8%) patients. Etiology was associated with age group (p<0.001) and gender (p=0.0017) and treatment modality (p=0.0001). Frontalis sling with 2/0 prolene was most commonly performed procedure (42.4%), followed by levator resection (33.3%); levator extirpation for Marcus Gunn jaw-winking (12.1%) and levator advancement (9.1%). Complication observed for Frontalis sling 2/0-Proline; Frontalis sling Silicone tube and Levator Extirpation with sling were 14.3% (n=2/14); 100% (n=1/1) and 50% (n=2/4) respectively. No complications were observed for levator resections after 3-4 months of follow-up. Conclusion: Congenital ptosis predominated, especially in children. Surgical correction guided by levator function was effective. Certain sling techniques showed variable early complication rates, highlighting the need for careful procedure selection and close postoperative follow-up.
Copyright (c) 2025 Naz Jehangir, Sofia Iqbal https://creativecommons.org/licenses/by/4.0
The silent crisis of female physician attrition in Pakistan
According to Pakistan Medical & Dental Council, Pakistan has 383,568 registered medical and dental practitioners, including 340,059 medical practitioners (171,482 females and 168,577 males) and 43,509 dental practitioners (29,941 females & 13,568 males).1 Despite outnumbering male counterparts, nearly 35% of women doctors in Pakistan remain unemployed, as reported by a Gallup Pakistan survey.2 This is a serious concern that warrants deeper exploration of its underlying causes, given its long-term implications for the health system, the economy, and broader social structures. For many well-off families, marrying a doctor is viewed as a status symbol. After marriage, spouses and in-laws often discourage the bride from pursuing clinical practice or employment, leading many female medical graduates to leave the profession soon after completing their degree.3,4 Even when women are permitted to work in public or private healthcare settings, they encounter numerous challenges. Female doctors are often expected to be transferred to their spouse’s city or place of employment, which is further complicated by the availability of vacant positions. They frequently encounter long and exhausting duty hours, night shifts, gender discrimination, inadequate workplace support, and limited childcare facilities.5 Fatima N. et al. found that work-family conflict was widespread; 37% felt family responsibilities hindered their career, and 58% stated that their career negatively affected family life.6 Additional barriers include fertility concerns among women who delay marriage for training, face high rates of harassment, compounded by the near absence of structured support systems like reliable childcare, flexible training pathways, re-entry options, and counseling services, that are essential for sustaining their careers.7-9 Despite constituting the majority of medical graduates, women continue to face limited opportunities for professional growth. Opportunities for specialization or postgraduate training are limited and largely confined to a narrow set of fields such as pediatrics, obstetrics & gynecology, and family medicine. Consequently, there is a persistent shortage of female in primary surgical specialties.9,10 Professional growth within medical and academic institutions is also limited for female doctors. They remain underrepresented in academic positions, as universities and the broader medical profession are still predominantly male-dominated.10,11 This imbalance shapes career pathways and academic structures in ways that hinder women’s advancement. At higher levels, leadership and administrative roles are often perceived as “masculine” because they are largely held by men.11 This further restricts women’s access to senior positions and reinforcing long-standing inequities in promotion and decision-making authority. Local research further highlights that structural barriers, such as policy gaps and subtle workplace inequities, significantly shape women’s career trajectories in medical academia in Pakistan. Many also encounter flawed recruitment practices, restrictive transfer policies, and recurrent workplace harassment. Weak administrative support and limited mentorship opportunities intensify burnout and hinder professional advancement, collectively contributing to the continued attrition of women from academic medicine.4,8,11 This situation is deeply concerning. Each medical graduate represents a substantial public investment. Losing even a single graduate leads to significant financial waste, along with the individual’s lost time, effort, and potential. The declining availability of female doctors, especially in conservative communities, poses an additional risk. It further jeopardizes an already fragile women’s healthcare system and increases the burden on the remaining workforce. A sustainable way forward to reduce female physician attrition requires transformative system-level reforms that establish gender-equitable, supportive, and flexible working environments. Young female graduates need expanded opportunities for postgraduate training. These should include part-time residency tracks and re-entry pathways after career breaks. They also require paid maternity leave and maternity-friendly duty rosters, safe transportation for night duties, and on-site childcare facilities. Universities, medical colleges, and hospitals must implement institutional reforms that promote gender-balanced leadership and ensure transparent promotion systems. They should also enforce strict anti-harassment policies and provide gender-sensitivity training for all faculty members. Additionally, structured mentorship, leadership development programs, and targeted incentives for women serving in hard-to-reach areas are essential to strengthen retention and foster their professional advancement. Pakistan cannot afford to lose its women doctors. Empowering female physicians to thrive, not merely survive, within Pakistan’s medical workforce is essential for their advancement. This is not only an issue of equity but an urgent national priority essential for strengthening the health system and securing the future of healthcare.
Copyright (c) 2025 Akhtar Sherin https://creativecommons.org/licenses/by/4.0
Recurrent focal myositis with extraocular and lower limb muscle involvement: a case report
Background: Focal myositis is a rare, localized inflammatory myopathy of unknown etiology. Owing to its rarity and nonspecific presentation, it is frequently misdiagnosed, which may result in delayed or inappropriate management. Case Presentation: We report the case of a 37-year-old woman who presented with a three-day history of pain, swelling, and tenderness involving both calf muscles, accompanied by right-sided periorbital edema and diplopia. She had no systemic symptoms or clinical features suggestive of an underlying autoimmune disorder. Laboratory investigations revealed elevated creatine kinase and inflammatory markers. Magnetic resonance imaging (MRI) of the lower limbs demonstrated extensive edema of the right gastrocnemius muscle with associated subcutaneous edema, along with mild edema of the left gastrocnemius and soleus muscles. MRI of the brain and orbits showed inflammatory changes in the right lateral rectus muscle with surrounding periorbital edema. This was her third hospital presentation over the past decade with similar clinical manifestations. An extensive diagnostic workup excluded infectious, autoimmune, metabolic, and malignant causes. A diagnosis of idiopathic recurrent focal myositis with multifocal involvement was established. While her previous two episodes resolved spontaneously without immunosuppressive therapy, the current episode required immunosuppressive treatment due to persistent symptoms and to reduce the risk of recurrence. Conclusion: This case illustrates the recurrent and multifocal presentation of focal myositis and emphasizes the need to consider this rare entity in patients presenting with localized muscle inflammation. Early recognition is crucial to prevent unnecessary investigations and to facilitate timely and appropriate treatment, particularly in recurrent or persistent cases.
Copyright (c) 2025 Kamil Khan, Claire Louise Murphy, Eithne Murphy https://creativecommons.org/licenses/by/4.0