BioFrontiers Journal (ISSN Online: 3106-7964 | ISSN Print: 3106-7956) is an open-access, quarterly, double-blind peer-reviewed journal dedicated to the advancement of research in the biological sciences. The journal publishes high-quality, original contributions across a broad range of disciplines, including molecular biology, biotechnology, microbiology, genetics, biochemistry, environmental sciences, and interdisciplinary areas of the life sciences. BioFrontiers Journal is published by the Factum Research Institute (SMC-Private) Limited, a legally registered entity with the Securities and Exchange Commission of Pakistan (SECP) under registration number 0310960. Committed to the highest standards of academic integrity, rigorous peer-review processes, and global open accessibility, the journal provides a credible platform for researchers and scholars to disseminate scientific knowledge and foster innovation in the biosciences.
Factum Research Institute (SMC-Private) Limited
EVALUATION OF SCABIES KNOWLEDGE AMONG RURAL WOMEN IN LAHORE
Background: Scabies is endemic in many mountainous regions of Pakistan, and overcrowded, unhygienic conditions—such as in post-earthquake IDP camps—can trigger large-scale outbreaks. Objective: To assess knowledge of scabies among women in a rural community in Lahore. Methodology: A descriptive cross-sectional study was conducted among 75 women from the Gajjumata community in Lahore, selected via convenience sampling. Results: Among participants, 93.3% identified scratching as a cause of scabies, 73.3% recognized the skin as the main affected organ, and 86.7% were aware that nighttime itching and heat sensation are key symptoms. Conclusion: Women in the Gajjumata community demonstrated generally good knowledge of scabies, particularly regarding its symptoms and affected areas.
Scabies, Awareness, Rural Women, Gajjumata, Lahore
SHARED GENETIC PATHWAYS IN HEPATITIS B, HEPATITIS C, AND CIRRHOSIS: A NETWORK-BASED GENE EXPRESSION ANALYSIS
Hepatitis B and C (HBV, HCV) are major global contributors to liver disease and often lead to cirrhosis. This study explored shared genetic features linking HBV/HCV infections to cirrhosis using a network-based analysis of gene expression data. Transcriptomic profiles from GEO datasets (GSE121248, GSE55092, GSE89377, GSE139602) were integrated, identifying 47 commonly upregulated genes associated with disease progression. Functional enrichment and pathway analysis were conducted using R, while a protein-protein interaction (PPI) network was constructed via the STRING plugin in Cytoscape. Ten hub genes (CDC20, CCNB2, MELK, AURKA, PRC1, TOP2A, CDCA5, PTTG1, TYMS, UBE2C) were identified as key modulators. Additional interaction networks—TF–miRNA and drug–gene—were developed using NetworkAnalyst. This systems biology approach highlights the molecular complexity underlying hepatitis-related cirrhosis and identifies candidate genes for potential therapeutic targeting, pending further validation.
HBV/HCV, Cirrhosis, PPI Network, Hub Genes, Drug Interaction Network
USE OF TENS FOR POSTOPERATIVE PAIN CONTROL IN CABG PATIENTS: A RANDOMIZED CONTROLLED STUDY
Background: Managing postoperative pain after Coronary Artery Bypass Graft (CABG) surgery remains challenging, with limited evidence on effective interventions. This trial evaluated the impact of Transcutaneous Electrical Nerve Stimulation (TENS) on post-CABG pain. Methodology: A single-blind, two-arm randomized controlled trial was conducted with 68 CABG patients aged 40–70 years. Patients with serious cardiac or pulmonary conditions were excluded. Participants were randomly assigned to Group A (TENS + standard care, n=34) or Group B (standard care only, n=34). TENS was applied twice daily for 30 minutes over 5 days. Pain was measured using the Visual Analogue Scale (VAS) before and after intervention. Data were analyzed with SPSS 25, and chi-square tests determined significance (p ≤ 0.05). Results: Group A showed a significant reduction in pain compared to Group B (p < 0.001). Notably, 61.8% of Group A reported no pain post-treatment, while 44.1% of Group B experienced moderate pain. Conclusion: TENS combined with standard care significantly reduces postoperative pain after CABG and offers a cost-effective, efficient pain management option.
CABG, Cardiac Surgery, Postoperative Pain, TENS
MANAGEMENT OF MAJOR DEPRESSION IN PATIENTS WITH BORDERLINE PERSONALITY TRAITS: THERAPEUTIC PERSPECTIVES
The co-occurrence of Major Depressive Disorder (MDD) and borderline personality traits presents clinical challenges marked by emotional instability and interpersonal difficulties. This case-based study examines a multimodal therapeutic approach combining cognitive-behavioral techniques with positive psychology interventions—such as strengths identification, gratitude, hope-building, and self-compassion. Psychoeducation and family involvement further supported communication and social functioning. The integrated approach led to improvements in mood stability, interpersonal skills, and self-efficacy. Findings highlight the value of strength-based, holistic models in treating individuals with MDD and borderline traits.
Depression, Borderline Traits, CBT, Positive Psychology, Emotion Regulation, Therapy Strategies
NON-ENDOSCOPIC EVALUATION OF ESOPHAGEAL VARICES IN PATIENTS WITH LIVER CIRRHOSIS
Objective: To determine the frequency and non-endoscopic predictors of esophageal varices in liver cirrhosis patients at a tertiary care hospital. Study Design: Cross-sectional. Setting & Duration: Department of Gastroenterology, Liaquat University of Medical and Health Sciences, Jamshoro. Methodology: This observational study included 109 liver cirrhosis patients. Each underwent clinical assessment, laboratory tests, portal vein Doppler, and upper GI endoscopy to confirm esophageal varices. Data were analyzed using SPSS v26. Quantitative variables were expressed as mean ± SD; qualitative variables as frequencies and percentages. Results: Mean age was 45 ± 14.32 years; 65.1% were male. Child-Pugh classification showed 36% Class A, 30.4% Class B, and 33.6% Class C. Ascites (80%) was the most common cirrhosis presentation. Esophageal varices were found in 52.2% of patients, with Grade III being most common. Significant non-endoscopic predictors included age, gender, Child-Pugh class, splenomegaly, portal vein diameter, serum albumin, bilirubin, platelet count, and Hepatitis B/C status. Conclusion: Non-invasive clinical, biochemical, and radiological markers can help predict esophageal varices, potentially reducing the need for routine endoscopy.
esophageal varices, non-invasive, predictors, platelet/spleen
CONTRACEPTIVE USE AND UNMET FAMILY PLANNING NEEDS IN DERA GHAZI KHAN
This study, conducted at AIMS Muzaffarabad (April–September 2024), compared 12 mg and 15 mg doses of bupivacaine for spinal anesthesia in elective cesarean sections. Maternal hypotension occurred in 16% of patients with 12 mg and 24% with 15 mg. Other complications like bradycardia, respiratory depression, nausea/vomiting, and patient discomfort were also assessed. The study concludes that 12 mg bupivacaine results in less hypotension, potentially reducing the need for interventions such as vasopressors or fluid overload.
EFFECT OF ANTENATAL CORTICOSTEROIDS ON NICU ADMISSIONS IN PRETERM NEONATES: A PROSPECTIVE STUDY
Preterm birth remains the leading cause of neonatal morbidity and mortality globally. While antenatal corticosteroids (ANC) are well-established for promoting fetal lung maturity and reducing respiratory complications between 24 and 34 weeks of gestation, their role in late preterm births (34–36+6 weeks) is still being evaluated. This prospective observational study, conducted over six months at Akhtar Saeed Medical College, included 120 high-risk pregnant women between 34+0 and 36+6 weeks of gestation who received intramuscular betamethasone (12 mg for two consecutive days). The sample size was calculated using the WHO sample size calculator, and maternal demographics, delivery details, and neonatal outcomes—including NICU admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), and hypoglycemia—were recorded and analyzed using SPSS v26. The findings revealed a statistically significant reduction in NICU admissions (1.25 vs. 1.32 in historical controls) and improved respiratory outcomes in the ANC group, including reduced incidence of RDS and TTN and less need for invasive respiratory support. These results support the use of ANC in late preterm pregnancies and align with emerging clinical guidelines advocating for its inclusion in management protocols for pregnancies at risk of late preterm delivery.
PREVALENCE OF DIABETES AND GLYCEMIC CONTROL IN CHILDREN WITH CELIAC DISEASE
Background: Celiac disease (CD) and type 1 diabetes (T1D) are autoimmune disorders, with children having CD at higher risk for T1D. Objective: To determine the incidence of T1D in children with CD and evaluate their glycemic control using postprandial glucose (PPG) and HbA1c levels. Methods: This cross-sectional study included 115 pediatric CD patients at CNH, Lahore (July 2023–Jan 2024). Clinical and lab data were collected, and patients were assessed by gastroenterologists and endocrinologists for medical history, diet adherence, and symptoms. Results: Among 115 children, 7% (n=8) were diagnosed with T1D based on PPG. Additionally, 10% (n=12) had HbA1c >6.5%, indicating poor glycemic control; 8 had T1D, 4 had elevated HbA1c without T1D diagnosis. Strict gluten-free diet adherence correlated with better glycemic control (mean HbA1c 5.8%) versus moderate (6.4%) or poor adherence (7.0%). Conclusion: Children with CD have increased T1D risk; regular diabetes screening via PPG and HbA1c is vital. Adherence to a gluten-free diet significantly improves glycemic control and may reduce diabetes risk.
COMPARING EARLY AND DELAYED ILEOSTOMY REVERSAL IN INTESTINAL PERFORATION PATIENTS
Background: Ileostomy reversal after intestinal perforation restores gastrointestinal function, but optimal timing (early vs. delayed) remains debated. Objective: To compare outcomes of early versus delayed ileostomy reversal in intestinal perforation patients. Methods: A descriptive case series of 90 patients at Lahore General Hospital was divided into early (reversal ≤3 months) and delayed (>3 months) groups. Data were collected preoperatively, during surgery, at discharge, and during 30-day follow-up. Results: The early group (n=45) showed faster recovery with earlier return to normal activity (21.3 vs. 26.7 days, p=0.01) and work (35.2 vs. 42.1 days, p=0.04). Satisfactory recovery was higher (55.6% vs. 40%, p=0.05), along with better postoperative quality of life scores (80.4 vs. 75.3, p=0.03). No significant differences were found in complication rates, hospital stay, or pain. Conclusion: Early ileostomy reversal promotes faster recovery, higher satisfaction, and improved quality of life without increasing complications.
PARENTAL EMOTIONAL ABUSE, RESILIENCE, AND ACADEMIC PROCRASTINATION IN PAKISTANI MEDICAL STUDENTS
Limited research exists on parental emotional abuse, resilience, expressive suppression, and academic procrastination, especially in Pakistan. This cross-sectional study used purposive sampling to collect data from 18–35-year-old medical students across public and private institutions. Findings showed parental emotional abuse and expressive suppression positively correlated with academic procrastination, while resilience was negatively correlated. Mediation analysis found no significant role for expressive suppression, but resilience significantly moderated the link between emotional abuse and procrastination. The study suggests targeted interventions to improve medical students' well-being.
STAGE-DEPENDENT HEPATITIS C RISK AND OUTCOMES IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE
Hepatitis C virus (HCV) is a significant comorbidity in chronic kidney disease (CKD), yet its prevalence in pre-dialysis populations is underexplored. This cross-sectional study assessed 220 pre-dialysis CKD patients at a tertiary care hospital in Karachi. HCV screening was performed via ELISA, and demographic, clinical, and laboratory data were analyzed using SPSS v16. HCV prevalence was 13.2% (n=29), predominantly in Stage 4 CKD (86.2%, p<0.001), with no cases detected in Stages 2–3. Traditional metabolic risk factors, including hypertension and diabetes, were not significantly associated with HCV positivity. Lower education levels showed a marginal association (p=0.03), while blood transfusions and surgical history were non-significant. These results indicate that HCV disproportionately affects advanced pre-dialysis CKD patients, independent of conventional metabolic risks. The findings support routine HCV screening in Stage 4 CKD and timely antiviral therapy to mitigate renal decline, alongside targeted prevention strategies considering socioeconomic determinants.
RISK FACTORS DURING CARDIOPULMONARY BYPASS INFLUENCING POSTOPERATIVE MECHANICAL VENTILATION DURATION IN ADULT CARDIAC SURGERY
Background: Prolonged mechanical ventilation (PMV) after adult cardiac surgery increases morbidity, mortality, and ICU resource use. While predictors are well-studied in pediatric populations, adult data remain limited. This study aimed to identify risk factors for PMV in adults undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: A prospective study of 85 adult patients undergoing CPB assessed 20 preoperative, intraoperative, and postoperative variables. PMV was defined as mechanical ventilation exceeding 24 hours. Univariate and multivariate logistic regression analyses were performed to determine independent predictors. Results: Ten patients (11.8%) experienced PMV (median 31 hours vs. 5 hours in non-PMV). Independent risk factors included advanced age (p=0.015), prolonged CPB time (p=0.042), higher cardioplegia volume (p=0.004), postoperative pneumonia (p=0.023), and extended ICU stay (p=0.005). Conclusion: Advanced age, extended CPB duration, increased cardioplegia volume, postoperative pneumonia, and longer ICU stay significantly elevate the risk of PMV in adult cardiac surgery. Early identification of these factors can guide perioperative management, minimize ventilator dependence, and improve postoperative outcomes.
ADVANCES IN ARTIFICIAL INTELLIGENCE FOR LUNG CANCER: TOOLS, APPLICATIONS, AND LIMITATIONS
Artificial Intelligence (AI) has become a transformative tool in medicine, offering innovative approaches for diagnosis, prognosis, and treatment planning. Lung cancer remains a leading cause of mortality globally, necessitating advanced strategies for early detection and effective management. This review highlights current AI applications in lung cancer, including tools for detection, diagnosis, prediction, and therapeutic planning. It also addresses key challenges in clinical implementation, such as data quality, model interpretability, and integration into healthcare systems. Strategies to overcome these limitations are discussed, alongside future directions for AI development in oncology. By improving diagnostic accuracy, optimizing treatment decisions, and enhancing accessibility, AI holds significant potential to advance lung cancer management and improve patient outcomes worldwide.
ASSOCIATION BETWEEN HELICOBACTER PYLORI INFECTION AND VITAMIN B12 DEFICIENCY IN DYSPEPTIC PATIENTS: INSIGHTS FROM A LOW-INCOME SETTING
This cross-sectional study examined the relationship between Helicobacter pylori infection and vitamin B12 deficiency among 273 dyspeptic patients undergoing endoscopy at a tertiary care center. Gastric biopsy confirmed H. pylori infection, while serum vitamin B12 levels were assessed biochemically. Overall, 61.2% of patients were H. pylori-positive, among whom 70.6% exhibited vitamin B12 deficiency, compared to 29.5% in uninfected individuals (p < 0.05). Socioeconomic status showed a significant association, with deficiency rates of 30% in lower-income groups versus 3.6% in higher-income groups (p = 0.045). These findings indicate that H. pylori infection markedly increases the risk of vitamin B12 malabsorption, particularly in resource-limited populations. Routine screening for B12 deficiency in H. pylori-positive dyspeptic patients, along with integrated nutritional and antimicrobial interventions, is recommended to mitigate deficiency-related complications.
EFFECTIVENESS OF DRY HEAT APPLICATION IN REDUCING POST-EPISIOTOMY PAIN DURING EARLY POSTPARTUM RECOVERY
Post-episiotomy pain can hinder a mother’s physical recovery, emotional well-being, breastfeeding, and mother–infant bonding. Effective pain management during the early postpartum period is therefore essential. Non-pharmacological strategies, such as dry heat and moist heat applications, have been shown to alleviate discomfort; however, limited evidence compares their effectiveness. This study was conducted in the postnatal ward of a secondary healthcare hospital in Tharparkar, Sindh, Pakistan. A total of 1,094 postpartum women with episiotomies were randomly assigned to two groups: dry heat (n=547) and moist heat (n=547). Pain levels were assessed using the Visual Analog Scale (VAS) before and after each intervention, administered twice daily for two consecutive days. Data were analyzed using SPSS, with statistical significance set at p<0.05. By day two, mean VAS scores decreased from 6.1 to 2.5 in the dry heat group, compared to 6.2 to 3.8 in the moist heat group (p<0.001). Furthermore, 65% of women in the dry heat group achieved effective pain relief (VAS ≤3), compared to 45% in the moist heat group. These findings suggest that dry heat therapy is more effective than moist heat in relieving post-episiotomy pain during the early postpartum period. Given its significant reduction in pain and higher effectiveness rates, dry heat application should be considered a first-line non-pharmacological intervention for postpartum pain management.
EVALUATING THE PROFICIENCY OF NURSES IN MANAGING THALASSEMIA: A CASE OF TERTIARY CARE CENTRE
Background: Thalassemia is a common autosomal recessive blood disorder caused by defective synthesis of hemoglobin chains, leading to chronic anemia. It remains one of the most prevalent genetic conditions worldwide, necessitating skilled nursing care to improve patient outcomes. Aim: This study aimed to evaluate the knowledge and practices of nurses regarding the care of thalassemia major patients at a tertiary care hospital. Methodology: A descriptive cross-sectional study was conducted using purposive sampling. Data were collected from nurses directly involved in the management of thalassemia patients. Results: Among participants, 39.3% demonstrated good knowledge, 35.7% had moderate knowledge, and 25.0% exhibited poor knowledge. Regarding practices, 60.2% of nurses reported good practices, while 39.8% demonstrated poor practices. Conclusion: The study revealed that most nurses possessed adequate knowledge and appropriate practices concerning the care of thalassemia major patients. Nonetheless, identified gaps underscore the importance of ongoing training and professional development programs to enhance nursing competence and ensure optimal patient care.
EVALUATING THE EFFECTIVENESS OF COGNITIVE REHABILITATION ON COGNITIVE PERFORMANCE
This study examined the effectiveness of cognitive rehabilitation exercises in improving general cognitive functioning among stroke patients. A quasi-experimental design was employed with a sample of 40 stroke patients recruited from government and private hospitals in Lahore. Participants were randomly assigned to an experimental group (n=20) and a control group (n=20). Cognitive functioning was assessed using the Mini-Mental Status Examination (MMSE) at both pre- and post-intervention stages. The experimental group received targeted cognitive rehabilitation exercises aimed at enhancing cognitive abilities, while the control group received no such intervention. Paired sample t-test analysis revealed significant improvements in cognitive functioning within the experimental group, whereas no notable change was observed in the control group. These findings highlight the potential of culturally relevant, evidence-based cognitive rehabilitation approaches in supporting stroke recovery, with implications for clinical practice, caregivers, and rehabilitation programs.
TANTALUM CHEMISTRY IN MEDICINE: ATOMIC-SCALE APPROACHES TO CORROSION RESISTANCE AND BIOCOMPATIBILITY
Tantalum is recently been considered as a highly promising candidate for biomaterials in medical implants, useful for its high corrosion resistance, favorable biocompatibility, and antimicrobial properties. The atomic scale mechanisms for corrosion resistance in tantalum and for biocompatibility have been studied through a combination of electrochemical, in vitro, and clinical evaluations in the field. Tantalum is a metal that has been electrochemically investigated as far superior to titanium or stainless steel in resistance to corrosion by forming a passive surface film of stable tantalum oxide (Ta₂O₅). In vitro assays with MG63 osteoblast-like cells and endothelial cells showed that the tantalum surface significantly increased cell adhesion, proliferation, and osteogenic differentiation. Tantalum reduced biofilm formation by the pathogenic agent Staphylococcus aureus, indicating its potential to lessen an infected implant. Clinical evaluations in hospitals further validated the administrative performance of tantalum, which confirmed successful osseointegration and had very minimal inflammatory response in patients with tantalum orthopedic and dental implants. This research has also highlighted problems such as the escalating cost of tantalum and the requirement of further optimization of porous configuration for improvement in mechanical properties. Nevertheless, because of the very excellent biological and chemical properties of tantalum, it will be a promising biomaterial for the next generation of medical implants. The future research should focus on improving its clinical applications and application potential into drug delivery and regenerative medicine.
GENERAL ANESTHESIA VERSUS COMBINED SPINAL-EPIDURAL ANESTHESIA IN GYNECOLOGIC LAPAROSCOPIC SURGERIES: A COMPARATIVE STUDY
Background: The choice of anesthesia in laparoscopic gynecological surgeries plays a critical role in patient outcomes, including intraoperative stability, postoperative recovery, pain control, and overall satisfaction. General anesthesia (GA) and combined spinal-epidural anesthesia (CSEA) are two commonly employed techniques, each with distinct advantages and limitations. However, limited evidence exists regarding their comparative efficacy and safety in gynecological laparoscopic procedures. Objective: To compare the effectiveness of GA and CSEA in laparoscopic gynecological surgeries with respect to hemodynamic stability, postoperative pain, recovery time, and perioperative complications. Methods: This randomized controlled trial included 120 patients undergoing gynecological laparoscopic surgery. Participants were randomly assigned to two equal groups: GA (n=60) and CSEA (n=60). Parameters assessed included intraoperative hemodynamic stability (heart rate, blood pressure), postoperative pain (measured by visual analog scale), recovery time (time to ambulation and discharge), and complications (nausea, vomiting, respiratory depression). Results: Patients in the CSEA group demonstrated superior hemodynamic stability, lower postoperative pain scores, and faster recovery times compared to those in the GA group. Complications such as nausea, vomiting, and respiratory depression were less frequent in the CSEA group. Conclusion: CSEA appears to be a safe and effective alternative to GA in laparoscopic gynecological surgeries, particularly for patients with comorbidities or at higher risk of hemodynamic instability. Further studies with larger sample sizes are warranted to confirm these findings and explore long-term outcomes.
COMPARATIVE OUTCOMES OF VENTRICULOPERITONEAL SHUNT AND ENDOSCOPIC THIRD VENTRICULOSTOMY IN OBSTRUCTIVE HYDROCEPHALUS ASSOCIATED WITH POSTERIOR FOSSA TUMORS
Background: Obstructive hydrocephalus is common in children with posterior fossa tumors (70–90%) but less frequent in adults (10–21%). Ventriculoperitoneal shunting (VPS) is effective but carries lifelong risks, while endoscopic third ventriculostomy (ETV) offers a hardware-free alternative. This study compared outcomes of ETV and VPS in such patients. Methods: In a randomized controlled trial at Mayo Hospital, Lahore, 168 patients with tumor-related hydrocephalus were assigned to ETV (n=84) or VPS (n=84) prior to tumor surgery. Primary outcome was treatment success, defined as no additional CSF diversion within 12 months. Secondary outcomes included complications, reoperations, hospital stay, and Karnofsky Performance Scale (KPS) scores. Results: Baseline demographics and tumor characteristics were similar between groups. At 12 months, treatment success was achieved in 80% of ETV patients versus 75% with VPS (p=0.42). Hospital stay was shorter in the ETV group (4.2±1.5 days) compared to VPS (6.8±2.0 days; p<0.001). Complication rates were lower with ETV (8% vs. 18%, p=0.11). No shunt-related infections occurred in the ETV group, while VPS patients experienced 4 CSF infections and 6 shunt failures requiring revision. No mortality was observed. KPS scores improved equally in both groups (+18 points; p=0.33). Conclusion: Both ETV and VPS are effective for managing obstructive hydrocephalus in posterior fossa tumors. However, ETV offers advantages of shorter hospitalization and fewer complications, making it a favorable alternative to shunting in suitable candidates.
KNOWLEDGE, PRACTICES, AND CHALLENGES OF NURSES IN EARLY DETECTION AND PREVENTION OF DIABETIC FOOT ULCER COMPLICATIONS: A CROSS-SECTIONAL STUDY
Diabetic foot complications are among the most serious outcomes of diabetes mellitus, often leading to infections, amputations, and life-threatening conditions. Early detection and prevention largely depend on the knowledge, practices, and interventions of nurses. This study aimed to assess the awareness, practices, and challenges faced by nurses in the early identification, prevention, and management of diabetic foot complications. Data were collected using structured questionnaires administered to nurses working in diabetic clinics, general wards, and wound care units. The findings revealed that while Kenyan nurses demonstrated a basic understanding of diabetic foot care, significant barriers—including limited education, time constraints, and inadequate resources—hinder the implementation of effective preventive measures. The study underscores the urgent need for comprehensive training programs, enhanced educational resources, and stronger institutional and policy support to improve nurses’ capacity in diabetic foot management. Strengthening these areas is essential to reducing severe complications, minimizing amputations, and improving patient outcomes in diabetic care.
INFLUENCE OF UTERINE FIBROIDS ON MATERNAL AND FETAL OUTCOMES AT DIR LOWER
Uterine fibroids are the most common benign tumors in women of reproductive age and can significantly complicate pregnancy and delivery outcomes. This study aimed to evaluate the clinical characteristics, anatomical distribution, delivery patterns, and maternal complications associated with fibroids during pregnancy. A retrospective analysis was conducted on 112 pregnant women diagnosed with uterine fibroids. Data were collected on fibroid type, location, number, gestational age at delivery, mode of delivery, cesarean section indications, and maternal complications. Subserous fibroids were the most frequent (65.18%), followed by submucous (25.89%) and intramural types (8.93%). The uterine fundus was the most common site of localization (77.68%). More than half of the patients (50.89%) presented with two to three fibroids. Most women delivered at term (37–40 weeks, 75.89%), with cesarean section being the predominant mode of delivery (62.50%). The leading indication for cesarean was premature rupture of membranes (PROM) with a poor Bishop score (21.43%). The most common maternal complications included threatened preterm labor (22.32%), blood transfusion requirement (19.64%), and threatened miscarriage (17.86%). Findings indicate that uterine fibroids substantially affect pregnancy outcomes, increasing the risk of cesarean delivery and maternal morbidity. Early diagnosis, close monitoring, and individualized antenatal care are critical to optimizing maternal and fetal health in affected women.
CLIMATE RESILIENCE IN ANIMALS: EPIGENETIC MECHANISMS AND CONSERVATION IMPLICATIONS
Climate change poses critical threats to biodiversity, demanding rapid adaptive responses beyond the pace of traditional evolutionary processes. Epigenetics—heritable modifications in gene expression without changes to DNA sequence—has emerged as a key mechanism enabling short-term phenotypic plasticity and resilience. This review synthesizes evidence on epigenetic mechanisms, including DNA methylation, histone modification, and non-coding RNA regulation, that facilitate animal responses to climate stressors such as temperature extremes, habitat loss, and ocean acidification. Case studies highlight heat-tolerant lizards exhibiting methylation-driven heat-shock protein expression and marine fish showing transgenerational inheritance of salinity-resilient traits. These findings underscore the role of epigenetics in bridging immediate environmental stress and long-term adaptation. The conservation relevance of epigenetic plasticity is also explored. Epigenetic diversity may act as an underrecognized reservoir of adaptive potential, particularly in small or isolated populations. However, uncertainties remain regarding the stability of epigenetic changes across generations, their interaction with genetic variation, and the ecological implications of epigenetic drift. Advances such as CRISPR-based epigenome editing and high-resolution sequencing offer new opportunities to clarify these dynamics. Integrating epigenetics into conservation strategies will require interdisciplinary collaboration and careful consideration of ethical challenges. Prioritizing long-term studies and comparative approaches can help unlock the potential of epigenetics to enhance biodiversity resilience in the face of rapid climate change.
ADDRESSING MONKEYPOX WORLDWIDE: PREVENTION, VACCINATION, AND CHALLENGES TO CONTROL
Monkeypox, a zoonotic viral disease caused by the monkeypox virus (MPXV), was historically confined to Central and West Africa but has now emerged as a significant global public health concern. Transmission occurs through direct contact with bodily fluids, lesions, or respiratory droplets, as well as via animal-to-human exposure. Individuals with weakened immune systems are at higher risk of severe disease. The 2022 international outbreak, driven by global travel, human–animal interactions, and waning smallpox immunity, marked the virus’s spread beyond endemic regions and posed particular challenges for healthcare systems and professionals. Preventive measures such as personal hygiene, patient isolation, and the use of protective equipment remain critical. In clinical management, antivirals such as Tecovirimat and smallpox-based vaccines (JYNNEOS and ACAM2000) are valuable tools. Public health strategies—including contact tracing, quarantine, and early diagnosis—are essential for containment. However, prevention and control efforts are hindered by barriers such as limited healthcare infrastructure, misinformation, stigma, and resource constraints. Addressing these challenges requires strengthened surveillance systems, targeted vaccination strategies, and coordinated international collaboration. Enhancing these measures will be vital to mitigating the global impact of monkeypox outbreaks.
PREVALENCE AND CAUSES OF SHOULDER PAIN IN PATIENTS ATTENDING PHYSICAL MEDICINE AND REHABILITATION OUTPATIENT CLINICS
Background: Shoulder pain is one of the most common musculoskeletal complaints encountered in physical medicine and rehabilitation (PM&R) outpatient clinics. It significantly affects patients’ daily functioning and quality of life, making accurate diagnosis and appropriate management essential. Aim: This study aimed to identify the most frequent causes of shoulder pain among patients presenting to PM&R outpatient clinics and to support improved diagnostic and therapeutic strategies. Methods: A quantitative comparative cross-sectional study was conducted on 320 patients. The sample size was determined using the WHO calculator at a 95% confidence interval, 2.3% absolute precision, and an estimated prevalence of shoulder osteoarthritis of 4.6%. Data collection included patient interviews, physical examinations, and imaging modalities (X-ray, MRI, and ultrasound). Statistical analysis comprised descriptive statistics, ANOVA, chi-square tests, and multivariate logistic regression, with results presented through tables, bar charts, pie charts, and scatter plots. Results: The most common etiologies of shoulder pain were rotator cuff tendinitis (30%), adhesive capsulitis (20%), osteoarthritis (15%), bursitis (10%), and cervical radiculopathy (5%). Additional causes included labral tears (7.5%), fractures (5%), and referred pain (10%). Demographic factors such as age, gender, and occupation were found to be significantly associated with specific pathologies. Conclusion: Rotator cuff tendinitis and adhesive capsulitis were identified as the leading causes of shoulder pain in PM&R outpatients. Early recognition of these conditions and other less common etiologies is crucial for timely and targeted management, ultimately improving patient outcomes and reducing the overall burden of shoulder-related disability.
A CASE OF BREECH PRESENTATION IN A PRIMIGRAVIDA WITH BICORNUATE UTERUS AND PLACENTA ACCRETA
A 20-year-old primigravida at 38 weeks of gestation presented in active labor with breech presentation. Clinical assessment suggested a bicornuate uterus with a noncommunicating rudimentary horn. An emergency cesarean section was undertaken, resulting in the delivery of a breech neonate. Intraoperatively, placenta accreta was identified with partial adherence to the uterine wall, complicating placental separation. The majority of placental tissue was manually removed, though a portion remained adherent. Importantly, no active postpartum hemorrhage was observed. Hemostasis was achieved, and the surgical site was secured. Postoperatively, the patient was closely monitored, and ultrasonography was utilized to evaluate retained products of conception. Scheduled follow-up visits were arranged to ensure early detection and management of potential complications.This case highlights the critical importance of early antenatal recognition of müllerian anomalies and placental pathology. A bicornuate uterus with a rudimentary horn significantly increases obstetric risks, including uterine rupture and abnormal placentation. The coexistence of placenta accreta further exacerbates peripartum morbidity, demanding meticulous surgical management and heightened intraoperative vigilance. Timely operative intervention, precise intraoperative evaluation, and rigorous postoperative surveillance are imperative to optimize outcomes. Early and accurate diagnosis remains essential for reducing maternal and neonatal morbidity in such high-risk pregnancies.
ASSESSMENT OF NURSES’ KNOWLEDGE AND ATTITUDES REGARDING ELDERLY PATIENT CARE
Background: Globally, there are approximately 605 million adults aged 60 years and above, and this number is projected to rise to two billion by 2050, with 80% residing in developing countries. Elderly individuals often require long-term psychosocial support, nursing care, and hospitalization due to diverse health challenges. Aim: The study aimed to assess the knowledge and attitudes of nurses toward caring for elderly patients. Methodology: A descriptive cross-sectional study design was employed using a purposive sampling technique. Data were collected from nurses meeting the inclusion criteria. Results: Findings revealed that 68 nurses (47.9%) demonstrated low levels of knowledge, while 90 nurses (63.4%) exhibited a positive attitude toward elderly care. Conclusion: The study concluded that while many nurses demonstrated a positive attitude toward caring for elderly patients, their knowledge remained moderate, highlighting the need for targeted training and continuous professional education to enhance geriatric care.
EVALUATION OF NURSES’ KNOWLEDGE AND PRACTICES IN MANAGING THALASSEMIA MAJOR PATIENTS AT A TERTIARY CARE HOSPITAL
ASSESSMENT OF KNOWLEDGE AND PRACTICES REGARDING POSTURAL AWARENESS IN UNDERGRADUATE PHYSICAL THERAPY STUDENTS AT KHYBER MEDICAL UNIVERSITY, PESHAWAR
Postural awareness plays a vital role in preventing musculoskeletal disorders and maintaining overall health and well-being. Despite its significance, postural distortions such as forward head posture, increased lordosis, round shoulders, and kyphosis are commonly observed among students due to poor ergonomics and lifestyle habits. This study aimed to assess the knowledge and practices regarding postural awareness among undergraduate physical therapy students at Khyber Medical University, Peshawar. A descriptive cross-sectional study was conducted from September 2018 to January 2019, involving 415 students selected through non-probability convenience sampling. Data were collected using a structured questionnaire. Results showed that 290 (69.88%) students demonstrated correct knowledge of postural awareness, whereas 125 (30.12%) had insufficient knowledge. Regarding practices, 243 (58.55%) students reported correct practices, while 172 (41.45%) exhibited poor practices. Gender-based differences revealed that male students had lower rates of correct practices (41.2%) compared to females (58.8%). The findings highlight that although a majority of students possess adequate knowledge, a significant proportion still lack proper practices, placing them at risk of musculoskeletal issues. These results emphasize the need for targeted educational strategies and preventive interventions to improve postural awareness and promote healthy practices among future physical therapy professionals.
EMERGING NANOTECHNOLOGY STRATEGIES FOR TARGETED ANTIPARASITIC DRUG DELIVERY: A REVIEW
Parasitic infections remain a major global health challenge, particularly in tropical and subtropical regions. Conventional antiparasitic therapies are often limited by poor bioavailability, emerging drug resistance, and non-specific toxicity. Nanotechnology offers promising strategies to overcome these limitations by enhancing drug stability, enabling site-specific delivery, and minimizing adverse effects. This review highlights recent advances in nanotechnology-driven delivery platforms—including nanoparticles, liposomes, dendrimers, and polymeric carriers—for the treatment of protozoan and helminthic infections. Furthermore, it explores current challenges, safety considerations, and future directions for integrating nanomedicine into antiparasitic drug development, underscoring its potential to transform therapeutic outcomes in parasitology.