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 (Category X), 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.
Proximal facial artery loop mobilization to increase pedicle length and flap reach in submental flap reconstruction: a prospective case series
Objective: To evaluate whether mobilization of the proximal facial artery loops increases pedicle length and flap reach during submental flap reconstruction of orofacial defects. Methods: This prospective case series was conducted at Rehman Medical Institute, Peshawar, Pakistan, from 2024 to 2025. Seven patients undergoing submental flap reconstruction for orofacial defects located >7 cm from the flap harvest site were included. Two pedicle-lengthening techniques were evaluated: mobilization of the mandibular loop by ligating the distal facial artery and mobilization of the pharyngeal loop through submandibular gland mobilization. Pedicle length gained by each maneuver and postoperative outcomes were recorded. Patients were followed for at least one year. Results: The mean age was 47.5 years (range: 20–74 years); four patients were male and three were female. Defect sizes ranged from 4×4 cm to 8×8 cm. Pharyngeal loop mobilization was performed in all seven patients, increasing flap reach by a mean of 1.5 cm (range: 1.2–1.8 cm). Mandibular loop mobilization was required in three patients and provided an additional mean pedicle length gain of 1.0 cm (range: 0.9–1.1 cm). Partial donor-site necrosis occurred in five patients, one required rhomboid flap reconstruction, and one developed transient House-Brackmann grade II marginal mandibular nerve weakness. No locoregional recurrence was observed during follow-up. Conclusion: Mobilization of the proximal facial artery loops effectively increases pedicle length and flap reach, extending the reconstructive versatility of the submental flap for selected orofacial defects while maintaining acceptable morbidity.
Copyright (c) 2026 Zubair Durrani, Momina Ghani, Khawaja Zara Noor https://creativecommons.org/licenses/by/4.0
Beyond the white coat: barriers facing female doctors in Pakistan
Dear Editor Pakistan is one of the countries where gender inequality is a major issue impacting all walks of life, from nutrition to healthcare and education to employment.1 In the context of the medical field, every year almost 80% of the medical graduates in Pakistan are females, out of which 50% are unable to practice medicine after completing their degrees.2 A study shows that 6 out of 10 female post graduates are unemployed. Another survey by the Labour Force states that compared to 64% males, only 18% females are employed. The statistics might be misleading to the disappointment that female doctors do not focus on their careers but one should not forget that the decision to quit career isn't always made out of free will.3 Despite years of hard work and continuous efforts to excel academically, women find themselves shackled by the traditional norms which assign them gender roles restricting their medical practice. Certain cultural norms act as barriers for Pakistani female doctors to practice medicine, including early marriage, cultural expectations, family responsibilities, gender discrimination at workplaces and challenges in work life balance.4 Traditionally, women are expected to perform their assigned gender roles, and that means to put their careers on hold. This gender disparity not only wastes the career potential of female doctors but also deprives the healthcare system of many health professionals.3 In a developing country like Pakistan, where medical sector is already suffering, this loss adds up to the problems exponentially. The government spends about 2.5 million rupees on each medical student. According to a report, state had lost around 200 billion rupees because 35,000 female doctors quit their medical practice. A multifaceted approach is required to tackle this issue. Firstly, families need to be educated about the importance of pursuing careers for women and how it can help financially in this inflation. Flexible working hours and telemedicine opportunities can be provided to facilitate work life balance for doctors. At national level, policies should be introduced requiring doctors who have studied in government medical colleges to work in public healthcare institutions until they've paid off the subsidy received for their education. In conclusion, fostering a supportive environment for female doctors to focus on their careers will be a great step towards women empowerment as well as improved healthcare services and accessibility.
Copyright (c) 2026 Fyqa Mujtaba https://creativecommons.org/licenses/by/4.0
Vaping and oral health: an emerging threat to young smiles
The use of electronic cigarettes, or vapes, as a substitute to conventional smoking has surged noticeably among young individuals in recent years. Because they believe it is more secure or less dangerous, many people utilize it.1,2 Studies have, however, demonstrated how vaping is contributing to hidden oral health problems and damaging young smiles. According to a cross-sectional study conducted on high school students in California, vaping use is a risk factor for xerostomia. Through a 12-months follow-up, The study assessed how e-cigarettes, cannabis, and tobacco affected young adults. The findings pointed out that 54% of the sample who consumed these resources reported regular xerostomia (consumption >5 days/month) and sporadic complaints of dry mouth (consumption <5 days/month).3 The findings of a systematic review that reviewed eight human case controls studies on the link between vaping and periodontitis indicate that e-cigarette users had more deposits of plaque, deeper pockets, less marginal bone, and less bleeding on inspection (a common sign of gum disease-which may delay early detection and treatment) than non-smokers.4 Similarly, another study reported poorer oral hygiene indices, higher plaque accumulation, and increased gingival bleeding among vapers, further supporting the adverse impact of e-cigarette use on periodontal health.1 Propylene glycol, found in e-liquids, along with sweeteners and flavorings,5 can reduce saliva production, cause halitosis and xerostomia, lower mouth pH, and promote harmful bacteria like Streptococcus mutans to grow, leading to tooth damage.4 Nicotine in vape smoke constricts oral blood vessels, reducing oxygen flow.6 It also creates harmful reactive oxygen species. Depending on the brand, producers say a cartridge can deliver anywhere from 10 to 250 puffs, or five to thirty cigarettes.7 Vapors (temperature reaching 40-65°C) can thicken the oral mucosa, leading to lesions. Vaping disrupts saliva production due to toxic ingredients.8 According to a recent research in Saudi Arabia, more than half of students recognized that e-cigarettes could lead to nicotine dependence, but 62% of them thought they were fashionable substitutes for regular cigarettes.9 These views imply that peer-driven ideas of image and lifestyle, in addition to marketing, influence the allure of e-cigarettes. In conclusion, many young people are attracted to vaping because of its perceived social appeal, often without recognizing its potential oral health consequences. Dental curricula rarely address vaping-related oral pathology in depth, leaving future dental professionals inadequately prepared to identify and manage these conditions. Furthermore, vaping history is frequently omitted from routine dental records, potentially delaying diagnosis and intervention. Greater awareness enhanced dental education, and systematic screening for vaping behaviors are needed to protect the oral health of young populations.
Copyright (c) 2026 Danish Khan Swati https://creativecommons.org/licenses/by/4.0
Allied health degrees in Pakistan: opportunity or uncertain promise?
In recent years, universities across Pakistan have started offering an increasing number of Allied Health Sciences programs.1 While these programs appear promising, an important question remains: what is the future of the growing number of graduates produced each year? A large proportion of students enrolling in these programs are those who could not secure admission in public sector medical colleges of Pakistan. At the same time, they are unable to afford the high fees of private-sector medical colleges. As a result, allied health sciences programs appear to be the only viable option for many families. Universities promote these degrees as attractive career paths, but the realities of the job market are often not discussed openly with students before admission decisions are made. Unfortunately, the employment opportunities for many allied health graduates in Pakistan remain limited. Government hospitals offer only a small number of positions, and the private sector is not expanding quickly enough to absorb the increasing number of graduates. Consequently, many young professionals struggle to find stable employment even after spending several years and significant financial resources on their education. Some people suggest that graduates can seek employment opportunities abroad. However, this option is not practical for everyone. The visa process, licensing exams, and relocation costs can be both expensive and challenging.2 Not every graduate has the financial capacity to pursue this route. Similarly, obtaining scholarships for higher education in leading international universities is highly competitive and cannot be considered a realistic solution for for most graduates. This situation raises an important policy question. Should universities continue to expand allied health sciences programs without considering the capacity of the job market? It may be time for regulatory bodies, universities, healthcare institutions, and policymakers to work together to assess workforce needs and guide students more responsibly. We hope this letter encourages constructive discussion and practical solutions from academics, healthcare administrators, and policymakers on how to secure a better future for allied health sciences graduates in Pakistan.
Copyright (c) 2026 Rehana Khadim, Rabia Mahmood https://creativecommons.org/licenses/by/4.0
Health-related quality of life and associated factors among health workers in tertiary care hospitals of Peshawar, Pakistan: an analytical cross-sectional study
Objective: To assess health-related quality of life (QoL) and its associated factors among health workers (HWs) in tertiary care hospitals of Peshawar, Pakistan. Methods: This analytical cross-sectional study was conducted from February to May 2024 in Medicine & Allied and Surgical & Allied departments of three public and six private tertiary care hospitals in Peshawar. Using non-probability convenience sampling, 365 HWs, including specialists, trainee medical officers, house officers, and nurses, were recruited. Health-related QoL was assessed using World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. Data were analysed using descriptive and inferential statistics, with p<0.05 considered statistically significant. Results: Among 365 health workers, majority (n=211, 57.8%) were male, with overall mean age of 29.22±6.49 years. The WHOQOL-BREF demonstrated good internal consistency (Cronbach's α=0.883). Mean scores for the physical, psychological, social relationships, and environmental domains were 50.96±14.99, 58.31±16.40, 61.97±23.28, and 54.27±17.83, respectively. Male gender, married status, and employment in Medicine and Allied departments were significantly associated with higher social relationship scores. Nurses had higher physical health scores than other professional groups (p=0.010). Morning shifts, working <8 hours/day, and private-sector employment were associated with better QoL in selected domains. Age was weakly associated with social relationships (r=0.110, p=0.036), while commute duration had no significant impact on any domain. Conclusion: Health-related QoL among HWs varied across WHOQOL-BREF domains and was significantly associated with demographic and occupational factors, particularly gender, professional designation, department, work shift, shift duration, and hospital sector. Workplace interventions targeting modifiable occupational factors may improve well-being and QoL of HWs.
Copyright (c) 2026 Mohammad Omar, Muhammad Ahmad, Aqib Muhammad, Seema Iqbal, Abdul Basit, Saqib Iqbal, Baseer Ahmed, Shahzada Abdul Rafay, Lubaba Waheed, Maheera Zulfiqar, Salman Khan, Syed Tauseeq Haider, Kashif Ur Rehman Khalil https://creativecommons.org/licenses/by/4.0
Functional readiness as the linchpin of integrated tuberculosis and comorbidity care in Pakistan: a health-system and ethical imperative
In Pakistan, for the effective management of tuberculosis and its comorbidities, functional readiness at the point of service delivery, including the preparedness of health facilities in terms of infrastructure, human resources, screening and diagnostics, coordination mechanisms, and culturally sensitive service delivery, is of utmost importance. Despite having a nascent TB services infrastructure, Pakistan’s health system faces persistent challenges, such as inadequate diagnostic capacity at basic health units, logistical obstacles in patient referrals, workforce shortages, and sociocultural barriers that impede timely and effective TB comorbidity management. These challenges are exacerbated across all care levels, from primary to tertiary hospitals, and thus restrict the extent and effectiveness of integrated interventions. In this viewpoint, we discuss these barriers in detail and propose that comprehensive health system strengthening to enhance functional readiness and ultimately improve clinical outcomes for patients with TB with comorbid conditions.
Copyright (c) 2026 Saima Aleem, Bilal Ahmad, Saima Afaq https://creativecommons.org/licenses/by/4.0
Knowledge and perceptions of artificial intelligence in medical writing among medical and health sciences students: a comparative study of Saudi and Non-Saudi students
Objective: To determine the knowledge, perceptions, and perceived benefits of artificial intelligence (AI) in medical writing among Saudi and non-Saudi undergraduate medical and health sciences students. Methods: This comparative cross-sectional study was conducted from May to July 2024 among undergraduate medical and health sciences students enrolled at universities in Saudi Arabia and other countries. Using convenience sampling, 116 participants (52 non-Saudi and 64 Saudi students) were recruited. Data were collected using a structured, face-validated questionnaire assessing demographics, knowledge, perceptions, and perceived benefits of AI in medical writing. Data were analyzed using SPSS version-25.0. Results: The mean age was higher among non-Saudi students than Saudi students (29.03±7.1 vs. 23.29±6.9 years). Overall, 109 (94.0%) participants demonstrated knowledge of AI, 108 (93.1%) reported positive perceptions, and 94 (81.0%) recognized its benefits in medical writing. No significant differences were observed between non-Saudi and Saudi students regarding knowledge (96.2% vs. 92.2%; p=0.372), positive perceptions (94.2% vs. 92.2%; p=0.720), or awareness of AI benefits (82.7% vs. 79.7%; p=0.681). The most frequently reported concerns included data privacy, accuracy and reliability of AI-generated content, and fear of being identified for using AI tools. Approximately half of the participants believed AI could potentially replace human medical writers. Conclusion: Medical and health sciences students demonstrated high knowledge and positive perceptions regarding AI in medical writing irrespective of nationality. However, concerns regarding privacy, reliability, and ethical implications highlight the need for formal training on the responsible use of AI in medical education.
Copyright (c) 2026 Imrana Tanvir, Manal Ahmed Halwani, Marwah Ahmed Halwani, Amber Hassan, Humaira Waseem, Samah Said Elbasateeny , Fehmida Bibi, Syed Kashif Zaidi, Muhammad Imran Naseer https://creativecommons.org/licenses/by/4.0
Postoperative dentinal sensitivity following four restorative strategies in vital posterior teeth: a randomized controlled trial
Objective: To compare postoperative dentinal sensitivity following restoration of vital posterior teeth using four restorative strategies: total-etch resin composite, self-etch resin composite, high-strength glass ionomer cement (GIC), and bioactive resin restoration over a three-month follow-up period. Methods: This single-center, parallel-group randomized controlled trial included 160 participants aged 18–40 years with Class I or Class II cavities in permanent molars. Participants were randomly allocated to four restorative groups (n=40 each). Postoperative dentinal sensitivity was assessed using a modified 100-mm Visual Analogue Scale at 24 hours, 48 hours, 7 days, and 3 months. Between-group comparisons were performed using non-parametric tests, with stratified subgroup analyses according to gender and cavity class. Results: Postoperative dentinal sensitivity decreased substantially over time in all restorative groups. At 24 hours, the self-etch resin composite demonstrated significantly lower sensitivity than the other restorative materials (p<0.001), whereas the high-strength GIC group exhibited the highest postoperative sensitivity (p<0.001). No significant difference was observed between the total-etch resin composite and bioactive resin groups (p=1.000). At three months, postoperative sensitivity was comparable among the total-etch, self-etch, and bioactive resin groups, while the high-strength GIC group continued to demonstrate significantly greater sensitivity than the other restorative strategies (p<0.001). Male participants and Class I restorations showed significantly higher postoperative sensitivity within GIC group. Conclusion: Self-etch resin composite was associated with the lowest immediate postoperative dentinal sensitivity, whereas high-strength GIC demonstrated significantly greater postoperative sensitivity that persisted at three months. Total-etch resin composite and bioactive resin restoration showed comparable short- and long-term clinical performance.
Copyright (c) 2026 Priya Rani, Mahwish Memon, Kelash Kumar, Sarang Suresh, Saima, Rajesh Kumar https://creativecommons.org/licenses/by/4.0
Platelet-to-lymphocyte ratio as a potential inflammatory marker for assessing the severity of vertebral destruction in patients with tuberculous spondylitis
Objective: To determine the association between platelet-to-lymphocyte ratio (PLR) and the severity of vertebral destruction in patients with tuberculous spondylitis. Methods: This retrospective study was conducted at Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Medical records of patients diagnosed with tuberculous spondylitis between January 2017, and December 2022 were reviewed. Patients aged ≥15 years with confirmed spinal tuberculosis and complete clinical, laboratory, and radiological data were included. PLR was calculated by dividing the absolute platelet count by the absolute lymphocyte count. Vertebral destruction was assessed by measuring the kyphotic angle using the Cobb method on lateral radiographs or sagittal computed tomography images. Pearson correlation and simple linear regression analyses were performed to evaluate the relationship between PLR and kyphotic angle. Results: Out of 232 patients, 128 (55.2%) were male and 104 (44.8%) were female. The mean PLR was 209.3±139.2, while the mean kyphotic angle was 19.2±7.6°. No significant differences in haematological parameters or kyphotic angle were observed across age or gender groups (all p>0.05). PLR showed a weak but significant inverse correlation with kyphotic angle (r=-0.156, 95% CI: -0.28 to -0.03; p=0.020). Linear regression demonstrated that each one-unit increase in PLR was associated with a 0.087° decrease in kyphotic angle (β=-0.087, p=0.020), although the explanatory power was low (R²=0.024). Conclusion: PLR demonstrated a statistically significant but weak inverse association with vertebral destruction severity in tuberculous spondylitis. Although PLR may serve as a readily available inflammatory marker, its ability to predict disease severity appears limited and requires validation in prospective multicentre studies.
Copyright (c) 2026 Jainal Arifin, Yustin Marinta, Kwan Silvea Kwandou, Dave Kennedy, Syauqi Darussalam Lutfi https://creativecommons.org/licenses/by/4.0
Genomic and transcriptomic profiling reveals prognostic nucleoporin alterations in head and neck squamous cell carcinoma
Objective: To characterize the mutational and expression landscape of nucleoporin (NUP) genes and evaluate their prognostic significance in head and neck squamous cell carcinoma (HNSCC). Methods: This retrospective bioinformatic cross-sectional study utilized publicly available data from The Cancer Genome Atlas (TCGA). Thirty-eight nucleoporin genes were identified using the Human Genome Organisation Gene Nomenclature Committee database and relevant literature. Genomic alterations were analyzed in the TCGA HNSCC PanCancer Atlas cohort (n=523) using cBioPortal. Gene expression profiles were evaluated in the TCGA HNSC cohort (n=564) through the UCSC Xena platform. Overall survival was assessed in 500 HNSCC patients using Kaplan–Meier Plotter. Statistical significance was set at p<0.05. Results: Genetic alterations in nucleoporin genes were identified in 41.1% of HNSCC cases. POM121L12 exhibited the highest alteration frequency (8%), followed by NUP155 (6%). Differential expression analysis revealed significant upregulation of NUP37, NUP62, NUP62CL, NUP85, NUP107, and NUP155, whereas SEC13, RANBP2, and DDX19B were significantly downregulated. Survival analysis demonstrated that elevated expression of NUP37 (HR=1.33, 95% CI: 1.02–1.75; p=0.037) and NUP54 (HR=1.31, 95% CI: 1.00–1.71; p=0.050) was associated with poorer overall survival. Conversely, increased NUP210L expression was associated with improved survival (HR=0.75, 95% CI: 0.57–0.98; p=0.031). Conclusion: Nucleoporin genes exhibit frequent genomic and transcriptomic dysregulation in HNSCC. NUP37, NUP54, and NUP210L emerged as potential prognostic biomarkers, highlighting the nuclear pore complex as a promising target for future mechanistic and therapeutic investigations.
Copyright (c) 2026 Shafaq Zafar, Rashid Mehmood, Walayat Shah, Muhammad Mustafa Khalid, Sami Siraj https://creativecommons.org/licenses/by/4.0
Breteau index as a potential warning tool for dengue outbreaks: a 14-year retrospective analysis in high-risk districts of Punjab-Pakistan
Objective: To evaluate the dengue fever burden across three high-risk districts: Lahore, Sheikhupura, and Rawalpindi, over 14 years (2011–2024), and to assess the predictive validity of the Breteau Index (BI) for forecasting dengue outbreaks. Methods: This retrospective ecological study utilized dengue surveillance data collected from 2011 to 2024 at the Institute of Public Health, Lahore. Laboratory-confirmed dengue cases from Lahore, Sheikhupura, and Rawalpindi were analyzed to determine temporal trends. For BI validation, two Union Councils in Rawalpindi were selected by simple random sampling. The BI was calculated using entomological data from the preceding 10 days at 5-day intervals, with a threshold of >3 considered predictive of dengue transmission. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated using laboratory-confirmed dengue cases as the reference standard. Results: Lahore reported the highest dengue burden, with peak outbreaks in 2011 (16,984 cases) and 2021 (19,942 cases), while Rawalpindi showed a rising trend, reaching 6,606 cases in 2024. Sheikhupura consistently reported fewer cases. A weak negative correlation was observed between dengue cases and vector surveillance activities (r = –0.293). In BI validity assessment, UC Dhoke Munshee showed high sensitivity (100%) and specificity (78.18%), with diagnostic accuracy of 84%, while UC Chak Jalal Din demonstrated high sensitivity (96%) but lower specificity (44.9%) and overall accuracy (62.16%). Conclusion: Lahore remained the principal dengue hotspot, while Rawalpindi showed an increasing disease burden. BI demonstrated high sensitivity and negative predictive value, supporting its usefulness as an early warning tool for dengue surveillance.
Copyright (c) 2026 Saira Afzal, Uzair Mukhtar, Aizaz Mustehsan , Muhammad Farooq https://creativecommons.org/licenses/by/4.0
Peritraumatic dissociation as a predictor of post-traumatic stress disorder symptom severity: mediating roles of psychological inflexibility and emotional dysregulation
Objective: To investigate the association between peritraumatic dissociation and post-traumatic stress disorder (PTSD) symptom severity and to examine the mediating roles of psychological inflexibility and emotional dysregulation. Methods: This cross-sectional study was conducted from February to December 2024 in psychiatric departments of public and private tertiary care hospitals and outpatient mental health facilities in Punjab, Pakistan. A total of 206 trauma-exposed adults aged 20-40 years with PTSD symptoms were recruited through purposive sampling. Data were collected using the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Acceptance and Action Questionnaire-II (AAQ-II), Difficulties in Emotion Regulation Scale-Short Form (DERS-SF), and PTSD Checklist for DSM-5 (PCL-5). Pearson correlation, regression, and mediation analyses using the PROCESS macro with bootstrapping were performed. Results: Peritraumatic dissociation showed a moderate positive correlation with PTSD symptom severity (r=0.547, p<0.001), emotional dysregulation (r=0.408, p<0.001), and psychological inflexibility (r=0.405, p<0.001). Peritraumatic dissociation significantly predicted emotional dysregulation (β=0.407, p<0.001), psychological inflexibility (β=0.404, p<0.001), and PTSD symptoms (β=0.315, p<0.001). Emotional dysregulation (β=0.570, p<0.001) and psychological inflexibility (β=0.605, p<0.001) were independent predictors of PTSD symptom severity. Mediation analyses demonstrated significant partial mediation by emotional dysregulation (indirect effect=0.651, 95% CI: 0.428-0.892) and psychological inflexibility (indirect effect=0.686), while the direct effect of peritraumatic dissociation on PTSD symptoms remained significant. Conclusion: Peritraumatic dissociation is significantly associated with greater PTSD symptom severity through both direct and indirect pathways. Psychological inflexibility and emotional dysregulation partially mediate this relationship, highlighting potential therapeutic targets for improving outcomes in trauma-exposed individuals.
Copyright (c) 2026 Lubna Kanwal Dar, Shazia Hasan https://creativecommons.org/licenses/by/4.0
Hematological profile alterations in suicidal organophosphorus poisoning: a comparative case control study between addicted and non-addicted individuals
Objective: To evaluate the effects of organophosphorus (OP) poisoning on hematological parameters and compare these changes between non-addicted individuals and patients with chronic alcohol or benzodiazepine addiction. Methods: This comparative cross-sectional study was conducted at Liaquat University Hospital, Hyderabad, Pakistan, from July to December 2024. A total of 260 male patients (20–40 years) with confirmed suicidal OP poisoning were recruited using convenience sampling. Participants were categorized into non-addicts (Group A, n=120), alcohol addicts (Group B1, n=90), and benzodiazepine addicts (Group B2, n=50). Hematological parameters were measured using an automated hematology analyzer. Comparisons among groups were performed using one-way ANOVA and the Chi-square test. Results: Mean age was comparable across the three groups. Among 260 patients with OP, abnormal complete blood count findings were significantly more frequent in addicted than non-addicted patients’ groups (p<0.05). Normal blood profiles were observed in 80 (66.7%) non-addicts, 40 (44.4%) alcohol addicts, and 20 (40.0%) benzodiazepine addicts, whereas hematological abnormalities were detected in 40 (33.3%), 50 (55.6%), and 30 (60.0%) patients, respectively (p=0.0006). Hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, white blood cell count, and neutrophil percentage differed significantly among the study groups (p<0.05). Conclusion: Chronic alcohol and benzodiazepine addiction are associated with greater hematological abnormalities in patients presenting with OP. Addicted individuals demonstrated lower hemoglobin indices and higher leukocyte and neutrophil counts, than non-addicts, suggesting that substance addiction may exacerbate the hematological effects of OP poisoning. Early hematological assessment may facilitate risk stratification and clinical management of these patients.
Copyright (c) 2026 Syed Farhan Uddin Uddin, Jamshed Warsi https://creativecommons.org/licenses/by/4.0
Severity of reduced near point of convergence in patients with Parkinson’s disease: a cross-sectional study
Objective: To assess the severity of reduced near point of convergence (NPC), indicative of convergence insufficiency (CI), in patients with Parkinson's disease (PD). Methods: This cross-sectional study was conducted on 80 patients with PD at Services Hospital, and Lahore General Hospital, Lahore, Pakistan from March to September 2024. Patients aged 40–70 years with a confirmed diagnosis based on the UK Parkinson's Disease Society Brain Bank criteria were included. Demographic and clinical data were collected using a structured investigator administered questionnaire. NPC was measured with a Royal Air Force ruler under standardized conditions. Patients with refractive errors of ≥5.00 DS and those with coexisting neurological or ocular disorders were excluded. Data were analyzed using SPSS version-25.0. Results: The study included 42 males (52.5%) and 38 females (47.5%). Mean age was 55.90±8.33 years in males and 51.39±5.47 years in females. Mean disease duration was 2.33±1.44 years, while the mean NPC value was 19.94±3.97 cm. Based on NPC measurements, 35 patients (43.8%) had mild CI (10–18 cm), 35 (43.8%) had moderate CI (19–26 cm), and 10 (12.5%) had severe CI (27–34 cm). A statistically significant positive correlation was observed between disease duration and NPC values (r = 0.628, p < 0.001), indicating greater convergence impairment with longer disease duration. Conclusion: Reduced NPC, consistent with convergence insufficiency, was universally present among patients with Parkinson's disease, with severity predominantly in the mild-to-moderate range. These findings highlight the importance of routine neuro-ophthalmic screening.
Copyright (c) 2026 Sharmeen Shahid, Hamna Habib, Sidra Hameed, Ravish Aman, Ghulam Sughra https://creativecommons.org/licenses/by/4.0
Morphological and histopathological spectrum of ovarian lesions diagnosed at a tertiary care center in Karachi, Pakistan
Objective: To determine the clinicopathological spectrum and histopathological patterns of ovarian lesions and assess their distribution across different age groups among patients presenting to a tertiary care diagnostic center. Methods: This descriptive cross-sectional study was conducted at Department of Histopathology, Dow Diagnostic Research and Reference Laboratory, Dow University of Health Sciences, Karachi, Pakistan, over 14 months following institutional ethical approval. A total of 222 ovarian specimens were examined histopathologically and classified according to World Health Organization classification. Clinical, gross morphological, and histopathological findings were recorded. Associations between lesion type, histological subtype, and age groups were analyzed using Fisher's exact test. Results: Of the 222 patients, 124 (55.9%) aged 21–40 years. Majority (n=200) presented with unilateral lesions. Non-neoplastic lesions predominated (58.6%), followed by benign (35.1%), malignant (3.6%), and borderline neoplasms (2.7%). Follicular cysts (25.7%) and simple ovarian cysts (13.1%) were the most common non-neoplastic lesions, whereas serous cystadenoma (17.1%) and mucinous cystadenoma (6.3%) were the predominant benign neoplasms. Surface epithelial tumors constituted the largest neoplastic category (32.9%), followed by sex cord-stromal tumors (5.0%). Most patients presented with abdominal pain or abdominal mass. No significant association was observed between age group and lesion type (p=0.882), histological subtype (p=0.273), or surface epithelial tumor subtype (p=0.537). Conclusion: Non-neoplastic ovarian lesions were more frequent than neoplastic lesions, with follicular cysts and serous cystadenoma representing the predominant non-neoplastic and neoplastic diagnoses, respectively. Ovarian lesions occurred across all age groups without significant differences in their histopathological distribution. Histopathological examination remains essential for accurate diagnosis and classification.
Copyright (c) 2026 Sabeen Sharif Rathore, Uzma Bukhari, Bushra Sikandar, Farheen Danish , Saba Hassan Shamim, Lubna Avesi https://creativecommons.org/licenses/by/4.0
Exploring medical teachers' perceptions and experiences of workplace incivility in medical colleges of Khyber Pakhtunkhwa: a qualitative study
Objective: To explore medical teachers’ perceptions and experiences regarding workplace incivility in medical colleges of Khyber Pakhtunkhwa, Pakistan. Methods: This qualitative phenomenological study was conducted among faculty members from public and private medical colleges in Khyber Pakhtunkhwa province of Pakistan. Fifteen full-time faculty members were recruited through purposive sampling to ensure representation across gender, academic rank, years of experience, and clinical and basic science disciplines. Semi-structured interviews were conducted between July and October 2025, transcribed verbatim, and analyzed thematically using Braun and Clarke’s six-phase framework. Results: Analysis generated six major themes: (1) nature and manifestations of incivility, (2) sources and power hierarchies, (3) triggers and escalation pathways, (4) multidimensional impact, (5) coping and response strategies, and (6) institutional culture and policy gaps. Participants described incivility as a continuum of overt and covert behaviors, including humiliation, sarcasm, exclusion, and institutional practices perceived as unfair. Reported impacts included psychological distress, reduced work engagement, impaired professionalism, and disruption of teaching and teamwork. Incivility adversely affected psychological wellbeing, motivation, teaching performance, professional relationships, and faculty retention. Most participants adopted passive coping strategies because of fear of retaliation and limited confidence in reporting systems. Institutional silence, weak policy implementation, and gender-related inequities were perceived as perpetuating uncivil behaviors. Conclusion: Workplace incivility was perceived by faculty as a persistent challenge in medical colleges, negatively affecting faculty wellbeing and professional performance. Strengthening institutional accountability, grievance mechanisms, and leadership development may help foster a more respectful and supportive academic environment.
Copyright (c) 2026 Shehla Noor, Brekhna Jamil, Nowshad Asim https://creativecommons.org/licenses/by/4.0
Association of stress, salivary alpha-amylase and periodontal conditions in patients visiting a tertiary care institution
Objective: To assess the association between psychological stress, salivary alpha-amylase (sAA) levels, and periodontal diseases (gingivitis and periodontitis). Methods: This unmatched case-control study was conducted at Baqai Medical University and its affiliated institutes, Karachi, Pakistan, in 2022. A total of 88 participants aged 18–45 years were enrolled, comprising 28 healthy controls, 30 patients with gingivitis, and 30 with periodontitis. Periodontal status was assessed using the Community Periodontal Index of Treatment Needs (CPITN), periodontal pocket depth, and clinical attachment level. Perceived stress was evaluated using the 10-item Perceived Stress Scale (PSS-10), while salivary alpha-amylase levels were quantified by enzyme-linked immunosorbent assay (ELISA). Statistical analyses included Chi-square test, one-way ANOVA, Tukey's HSD test, and Spearman rank correlation. Results: The study groups were comparable in age and gender (p>0.05). Moderate-to-high perceived stress was significantly more common among patients with periodontitis (86.7%) and gingivitis (86.6%) than controls (35.7%) (p<0.01). Mean salivary alpha-amylase levels were significantly higher in the periodontitis (6.8±0.5 µ/ml) and gingivitis (5.2±1.2 µ/ml) groups than in controls (2.4±0.6 µ/ml) (p<0.01). Pairwise comparisons showed significant differences in sAA levels among all three groups (p<0.01). Salivary alpha-amylase demonstrated a moderate positive correlation with perceived stress (r=0.428, p<0.01), whereas no significant associations were observed with age or gender. Conclusion: Patients with gingivitis and periodontitis exhibited significantly higher perceived stress and salivary alpha-amylase levels than healthy controls. Salivary alpha-amylase showed a positive association with psychological stress, supporting its potential role as a non-invasive biomarker of stress in periodontal disease.
Copyright (c) 2026 Dr Fizza Tariq, Qammar Aziz, Saba Abrar, Sobia Nabeel Khan, Tayyaba Kazmi, Adnan Ahmed https://creativecommons.org/licenses/by/4.0
Severity of premenstrual syndrome: a comparative analysis between hosteller and day scholar medical students
Objective: To compare the severity of premenstrual syndrome (PMS) between hosteller and day-scholar female students at Faisalabad Medical University, Pakistan. Methods: This comparative cross-sectional study was conducted at Faisalabad Medical University, from September 2024 to March 2025. A total of 340 female students with PMS (170 hostellers and 170 day-scholars) were enrolled through convenience sampling. PMS was diagnosed according to American College of Obstetricians and Gynecologists criteria. Data were collected using a self-administered questionnaire incorporating the modified Premenstrual Syndrome Scale. PMS severity was categorized as mild, moderate, severe, or extremely severe. Data were analyzed using descriptive statistics, Chi-square test, and logistic regression. Results: Mean age of participants was 22.4±1.0 years. Overall, 203 (59.7%) students reported mild, 101 (29.7%) moderate, and 36 (10.6%) severe PMS, while no participant had extremely severe PMS. Hosteller students experienced significantly greater symptom severity than day-scholars. Severe anxiety (49.4% vs. 24.7%), mood swings (55.9% vs. 30.0%), social withdrawal (56.5% vs. 39.4%), menstrual cramps (62.4% vs. 46.5%), and menstrual backache (63.5% vs. 45.2%) were more common among hostellers (p<0.05). Menstrual backache (55.0%) and menstrual cramps (54.4%) were the most frequently reported severe symptoms overall. Logistic regression identified fatigue (OR=1.80, 95% CI: 1.16–2.79; p=0.008) and breast tenderness (OR=1.57, 95% CI: 1.02–2.40; p=0.039) as significant predictors of increased PMS severity. Conclusion: PMS is highly prevalent among female medical students, with hosteller students experiencing significantly greater symptom severity than day scholars. Targeted support, health education, and stress-management interventions may help reduce the burden of PMS among hostel residents.
Copyright (c) 2026 Saima Kanwal, Laiyla Shinwari, Rana Muhammad Saleem https://creativecommons.org/licenses/by/4.0
Preliminary psychometric validation of the Urdu Trait Emotional Intelligence Questionnaire–Short Form: evidence for a Four-Factor Structure in Pakistani Adults
Objective: To translate and evaluate the psychometric properties of the Urdu version of the Trait Emotional Intelligence Questionnaire–Short Form (TEIQue-SF) among adults in Khyber Pakhtunkhwa, Pakistan. Methods: This cross-sectional psychometric validation study was conducted from March to July 2022, among 100 healthy Urdu-speaking adults recruited from the community. The TEIQue-SF was translated using a forward–backward translation process and administered under standard conditions after informed consent. Item redundancy, sampling adequacy, exploratory factor analysis, internal consistency, and provisional confirmatory factor analysis were assessed. Results: The mean age of participants was 26.4±6.7 years, and 54% were women. Four redundant items were removed, resulting in a 26-item Urdu TEIQue-SF. Sampling adequacy was acceptable, with a Kaiser–Meyer–Olkin index of 0.66 and significant Bartlett’s test of sphericity (χ² = 1240, p <0.001). Parallel analysis suggested five components; however, based on theoretical parsimony, principal component analysis with varimax rotation retained four factors: well-being, self-control, emotionality, and sociability. These factors collectively explained 62% of the total variance. Internal consistency was high, with Cronbach’s alpha of 0.93 and McDonald’s omega total of 0.96. Provisional higher-order confirmatory factor analysis showed suboptimal fit (CFI = 0.86, TLI = 0.84, RMSEA = 0.10, SRMR = 0.09), and the sample size was insufficient for definitive CFA. Conclusion: The 26-item Urdu TEIQue-SF demonstrated high internal consistency and exploratory support for the expected four-factor structure. However, structural validity remains indeterminate due to limited sample size and suboptimal confirmatory fit. Further validation in a larger, demographically diverse sample is recommended.
Copyright (c) 2026 Umema Zafar https://creativecommons.org/licenses/by/4.0
Depression among adult patients with hearing impairment: a cross-sectional study from Kohat, Pakistan
Objective: To determine the frequency of depression among adults with hearing impairment attending the Divisional Headquarters Teaching Hospital (DHTQH) Kohat, Pakistan. Methods: This descriptive cross-sectional study was conducted at DHTQH, Khyber Medical University Institute of Medical Sciences, Kohat, from January to July 2023. A total of 264 patients aged 18–60 years with hearing impairment of at least six-months' duration were enrolled through non-probability consecutive sampling. Patients with previous ear surgery, hearing aid use, psychiatric illness, substance abuse, or chronic neurological or medical disorders were excluded. Hearing impairment was confirmed by pure-tone audiometry. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9). Data were analyzed using R version 4.3.1. Associations between depression and demographic variables were examined using Chi-square or Fisher's exact test. Results: Mean age of the participants was 39.11±16.00 years, and mean PHQ-9 score was 8.21±5.84. Of the 264 participants, 145 (54.92%) were male and 119 (45.08%) were female. Depression (PHQ-9 score ≥5) was identified in 185 (70.08%) participants, including 90 (34.09%) with mild, 67 (25.38%) with moderate, 15 (5.68%) with moderately severe, and 13 (4.92%) with severe depression. Depression was significantly common among males than females (63.95% vs. 36.05%; p=0.001). A significant association was also observed between age group and depression (p<0.001), with the highest proportion occurring among participants aged 21–30 years. Conclusion: Depression was highly prevalent among adults with hearing impairment, particularly among males and younger individuals. Routine depression screening should be integrated into ENT services to enable early diagnosis, timely intervention, and improved patient outcomes.
Copyright (c) 2026 Muhammad Saleem Khan, Muhammad Aimen Ikram, Wasim Sajjad, Sultan Murad, Muhammad Siraj Khan https://creativecommons.org/licenses/by/4.0
When digital health transformation outpaces educational capacity in health professions education: a policy-practice gap
Digital health has become the most dominant policy narrative shaping contemporary healthcare.1 National strategies routinely emphasize artificial intelligence, virtual reality, big data analytics, electronic health records, and learning health systems as essential components of future-ready healthcare delivery. These policies are ambitious, technologically sophisticated, and often framed as inevitable progress. Health professions education (HPE), however, occupies an uneasy position within this transformation. It is frequently expected to respond rapidly to policy agendas, to align rigidly with curricular structures, and to operate within limited faculty capacity and professional norms.2 This results in a widening gap between the ever-evolving mandate of digital health policies and the medical academia's capacity to implement these technology-driven policies in medical education. The disconnect between medical academia's ability to deliver digital health curricula and the institution’s expectations is frequently attributed to faculty reluctance, cautious learners, or slow-moving institutions.3 Educational innovation is typically embedded as tools, platforms, and learner-facing technologies. In contrast, faculty are looked at as passive conduits for implementation rather than as central agents of change. It’s a fact that the medical faculty determines how digital health is interpreted, assessed, and legitimized within educational avenues. If faculty are underprepared, innovation would stall, not because of technology failure, but because educational capacity has not been reciprocally enhanced and consolidated. Digital health policies are novel instruments that set expectations for data use, clinical decision-making, patient engagement, and critical reflections.4 However, these policies rarely align well with the faculty's capacity to deliver, leaving faculty to reconcile new digital workflows within the existing teaching models and assessment frameworks on an individual basis. This reconciliation is neither intuitive nor trivial.5 On the other hand, current faculty development approaches are poorly equipped to align faculty skills with the expected level of digital proficiency. Mostly, institutional initiatives focus on short workshops, technical demonstrations, or targeted training lessons to enhance the faculty’s digital skills. While such efforts may enhance familiarity with the system, they rarely address genuine educational needs. Faculty are not only users of digital health technologies; they are sense-makers who translate policy into practice. Without opportunities to critically examine how digital health reshapes knowledge, authority, and uncertainty, faculty may succumb to incomplete adoption or silent disengagement.6 Digital health policies often emphasize efficiency, data-driven decision-making, and standardized workflows. Medical education assessments, however, continue to encourage individual performance, professional competencies, and observable behaviors in controlled settings.7 Typically, faculty develop assessment designs to evaluate clinical reasoning, judgment, and professionalism, yet there is no guidance on how these constructs manifest in digitally augmented environments.8 This results in an educational disconnect: learners engaging with digital tools in medical education but being assessed using frameworks that predate these tools. Consequently, faculty who are uncertain about expectations may either ignore the digital persona altogether or reduce it to checklist compliance. The aftermath of the misalignment between faculty capacity and expectations extends beyond pedagogy. We observe that digital health transformation increasingly challenges faculty identity. Traditional markers of faculty expertise, such as pattern recognition, predicted academic achievements, and diagnostic authority, are being reprogrammed by algorithms, decision support tools, and data dashboards. For many faculty, this shift represents an implicit threat to their professional authority.9 This phenomenon engenders resistance and stereotyping as rational responses to the evolving landscape of HPE. From a different perspective, digital health tools are not neutral and potentially carry safety and equity concerns.10 During the development of AI-driven software, the tool embeds assumptions, biases, and values that shape clinical decision-making. Faculty who lack critical digital literacy may inadvertently exaggerate inequities, over-trust algorithmic outputs, or fail to recognize ethical risks. Digital health policies may mandate AI adoption, but without faculty able to teach critical appraisal, contextual judgment, and moral reasoning, learners are poorly equipped to navigate these untapped complexities.11 Structural constraints during the delivery of modern medical education also reinforce the policy-practice gap. Faculty development is often under-resourced, poorly incentivized, and peripheral to institutional reward systems.12 To add to the complexity, promotion criteria continue to prioritize research output and clinical productivity, while educational leadership in digital health remains undervalued.13 Faculty are expected to innovate and generate creative ideas in their “spare time,” which does not resonate well with the high-pressure clinical environment. Without protected time and institutional recognition, even motivated faculty struggle to engage meaningfully with digital health education. There is a need to reframe faculty development initiatives to leverage digital health infrastructure as a way forward. This means moving beyond episodic, random training toward longitudinal faculty development that addresses not only how to use digital tools, but also how to teach, assess, and lead in digitally mediated environments. Faculty development should be aligned with institutional digital health strategies, accreditation standards, and workforce planning. Faculty development initiatives should support faculty in preserving human judgment, empathy, and ethical responsibility in HPE.8 If faculty development remains under-resourced and disconnected from policy, digital health innovation in HPE will remain inconsistent. When digital health transformation advances faster than the educational capacity of medical academia, a critical policy-practice gap would emerge. Ambitious digital health policies wrongly assume a sustainable level of faculty readiness and pedagogical expertise that has not been systematically developed, leaving educators struggling to translate the institution’s vision into practice. In conclusion, the future of digital health in HPE will depend not only on technological advances, algorithms, or policy directives, but also on the capacity of institutions to prepare and support their faculty. As digital health continues to transform healthcare delivery, educators must be equipped with the skills to teach, assess, and critically appraise digital technologies in clinical practice. Ultimately, the success of digital health transformation will be determined not by the technologies adopted, but by how effectively institutions invest in the educators responsible for translating innovation into meaningful learning.
Copyright (c) 2026 Salman Yousuf Guraya https://creativecommons.org/licenses/by/4.0