Insights-Journal of Medical and Dental Research
Insights - Journal of Medical and Dental Research Advancing Medical and Dental Sciences Insights - Journal of Medical and Dental Research is a distinguished academic publication committed to advancing knowledge in the fields of medicine and dentistry. The journal provides a platform for cutting-edge research, clinical innovations, and interdisciplinary studies that enhance healthcare outcomes and patient management. Comprehensive Scope The journal covers a broad spectrum of topics, including internal medicine, surgery, pharmacology, pathology, and emerging medical technologies. In dentistry, it features research on oral health, prosthodontics, orthodontics, periodontology, endodontics, and maxillofacial surgery, fostering advancements in dental care and treatment. Bridging Research with Practice By integrating evidence-based studies with clinical applications, the journal supports healthcare professionals in improving diagnostic accuracy, therapeutic interventions, and preventive strategies. It serves as a vital resource for researchers, practitioners, and educators dedicated to medical and dental excellence. Explore More on Our Platform For the latest publications, submission guidelines, and research updates, visit our official website at https://hrinsights.link/. The platform provides seamless access to high-quality scholarly content, contributing to the continuous evolution of medical and dental sciences.
Risk Factors for Temporomandibular Joint Disorders in Young Adults in Khyber Pakhtunkhwa
Background: Temporomandibular joint disorders (TMD) are among the most prevalent causes of non-odontogenic orofacial pain, yet their multifactorial etiology remains insufficiently characterized in young adults from developing regions. Psychosocial stress, sleep disturbance, and oral parafunctions have been identified as potential contributors, but population-specific evidence from Pakistan is limited. Objective: To identify and quantify behavioral, psychosocial, and anatomical risk factors associated with TMD among young adults in Khyber Pakhtunkhwa through a case–control analysis. Methods: A hospital-based case–control study was conducted in private hospitals across Peshawar, Mardan, and Abbottabad between May and October 2025. A total of 236 participants (118 clinically diagnosed TMD cases, 118 matched controls aged 18–35 years) were assessed. Diagnosis was based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Data on sociodemographic, behavioral, and psychosocial factors were collected using validated instrumentsthe Oral Behaviors Checklist (OBC), Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire-4 (PHQ-4). Logistic regression analyses identified independent predictors of TMD, with significance set at p < 0.05. Results: Sleep bruxism (37.3% vs 15.3%; p < 0.001), awake parafunction (39.8% vs 17.8%; p < 0.001), poor sleep quality (51.7% vs 22.0%; p < 0.001), and elevated anxiety/depression (29.7% vs 12.7%; p = 0.003) were significantly more common among cases. In multivariate analysis, sleep bruxism (aOR = 2.94; 95% CI: 1.53–5.68), poor sleep quality (aOR = 3.21; 95% CI: 1.72–5.99), and awake parafunction (aOR = 2.78; 95% CI: 1.49–5.18) remained independent predictors of TMD. Conclusion: Behavioral and psychosocial factorsparticularly sleep bruxism, parafunctional activity, and poor sleep qualityare major risk determinants for TMD in young adults. Addressing these modifiable variables through early screening and behavioral interventions may help reduce TMD prevalence in this population. Keywords: Anxiety; Case-Control Studies; Orofacial Pain; Parafunctional Habits; Sleep Bruxism; Temporomandibular Joint Disorders; Young Adults
Anxiety; Case-Control Studies; Orofacial Pain; Parafunctional Habits; Sleep Bruxism; Temporomandibular Joint Disorders; Young Adults
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Prevalence of Rotator Cuff Injuries Among Provincial-Level Athletes in Balochistan and KP
Background: Rotator cuff (RC) injuries are a leading cause of shoulder dysfunction among athletes, particularly those engaged in overhead sports. Despite growing global awareness of sports-related shoulder pathology, data from developing regions such as Balochistan and Khyber Pakhtunkhwa (KP) remain scarce. Understanding the prevalence and characteristics of RC injuries in these populations is essential for guiding preventive and rehabilitative strategies in sports medicine. Objective: To determine the prevalence and characteristics of rotator cuff injuries among provincial-level athletes in Balochistan and KP, and to identify associations with sport type, training duration, and load exposure. Methods: A cross-sectional study was conducted in private hospitals and sports rehabilitation centers in Quetta and Peshawar. A total of 412 provincial-level athletes aged 18–40 years were evaluated through standardized clinical examination and diagnostic shoulder ultrasound. Inclusion criteria required active participation in organized sport within the previous 12 months. Data were analyzed using SPSS v26, applying chi-squared and t-tests, with p < 0.05 considered significant. Ethical approval was obtained from the institutional review board, and informed consent was secured from all participants. Results: Ultrasound revealed RC pathology in 158 athletes (38.3%). Tendinopathy was observed in 22.8%, partial-thickness tears in 10.2%, and full-thickness tears in 5.3%. Overhead athletes showed a significantly higher prevalence (48.9%) than non-overhead athletes (30.5%) (p < 0.001). RC injury was positively associated with older age, longer training duration, and greater weekly training hours. Notably, 61.4% of affected athletes were asymptomatic at the time of assessment. Conclusion: Rotator cuff pathology is common among provincial-level athletes in Balochistan and KP, with a high proportion of subclinical cases. Early screening, preventive physiotherapy, and training load management should be prioritized to reduce long-term morbidity and enhance athletic performance. Keywords: Athletes; Cross-Sectional Studies; Epidemiology; Khyber Pakhtunkhwa; Prevalence; Rotator Cuff Injuries; Shoulder Pain; Sports Medicine
Athletes; Cross-Sectional Studies; Epidemiology; Khyber Pakhtunkhwa; Prevalence; Rotator Cuff Injuries; Shoulder Pain; Sports Medicine
Impact of Physiotherapy-Led Exercise Programs on Quality of Life in Post-COVID-19 Patients in Punjab and Khyber Pakhtunkhwa.
Background: Post-COVID-19 syndrome, characterized by persistent fatigue, dyspnea, and reduced exercise tolerance, continues to affect global populations long after acute infection. In Pakistan, the lack of structured rehabilitation programs has limited recovery for many survivors. Physiotherapy-led exercise programs, incorporating aerobic and resistance training, have shown promise in restoring function and improving quality of life among post-COVID-19 patients. Objective: To evaluate the impact of physiotherapy-led exercise interventions on the quality of life, physical performance, fatigue, and respiratory function of post-COVID-19 patients in Punjab and Khyber Pakhtunkhwa. Methods: A randomized controlled trial was conducted across private physiotherapy clinics in Lahore, Multan, and Faisalabad. One hundred post-COVID-19 patients were randomly assigned to either an intervention group receiving an 8-week structured physiotherapy program or a control group receiving standard care. Primary outcomes included the Short Form-36 Health Survey (SF-36) for quality of life, while secondary measures included the Six-Minute Walk Test (6MWT), Fatigue Severity Scale (FSS), and spirometric parameters (FVC, FEV₁). Data were analyzed using paired and independent t-tests, with significance set at p < 0.05. Results: Ninety-four participants completed the study. The intervention group demonstrated a significant increase in SF-36 total scores (from 51.4 ± 9.6 to 78.6 ± 7.8; p < 0.001) and 6MWT distance (from 376.8 ± 42.6 m to 465.2 ± 48.1 m; p < 0.001). Fatigue levels decreased significantly (FSS 5.6 ± 0.9 to 3.2 ± 0.8; p < 0.001), and spirometry revealed notable improvements in FVC and FEV₁ compared with controls. Conclusion: Physiotherapy-led exercise programs effectively improve quality of life, exercise capacity, and respiratory outcomes among post-COVID-19 patients. Integrating structured rehabilitation into Pakistan’s healthcare system could promote functional recovery and reduce long-term disability. Keywords: COVID-19 rehabilitation, Exercise therapy, Fatigue, Physiotherapy, Pulmonary function, Quality of life, Randomized controlled trial, Respiratory physiotherapy
COVID-19 rehabilitation, Exercise therapy, Fatigue, Physiotherapy, Pulmonary function, Quality of life, Randomized controlled trial, Respiratory physiotherapy
Evaluation of Antibiotic Misuse and Resistance Patterns in Outpatient Clinics Across Pakistan
Background: Antimicrobial resistance (AMR) has become a critical public health challenge in Pakistan, driven largely by irrational antibiotic prescribing in outpatient settings. Inadequate regulation, empirical treatment, and misuse of broad-spectrum antibiotics have accelerated resistance trends, compromising effective infection management. Objective: To evaluate antibiotic misuse and resistance patterns in outpatient clinics across Lahore, Multan, and Islamabad, and to assess adherence to the World Health Organization’s Access, Watch, and Reserve (AWaRe) classification for rational antibiotic prescribing. Methods: A multicenter, cross-sectional analytical study was conducted across private hospitals in three major Pakistani cities from January to September 2024. Stratified random sampling was used to collect 1,300 outpatient antibiotic prescriptions. Data were analyzed using IBM SPSS version 26. Descriptive statistics, chi-square, and logistic regression tests were performed, with p < 0.05 considered significant. Resistance data were obtained from hospital antibiograms. Ethical approval was obtained from the Institutional Review Board (Ref No: UOL/PHR/2024/126). Results: Of 1,300 prescriptions analyzed, 58.9% were “Watch” antibiotics, 36.2% “Access,” and 4.9% “Reserve.” Ceftriaxone (24.7%) and azithromycin (13.2%) were the most prescribed agents. Only 41.4% of prescriptions adhered to standard treatment guidelines, while polypharmacy occurred in 27.8% of encounters. E. coli showed 72.8% resistance to amoxicillin/clavulanate and 64.5% to ciprofloxacin. Junior prescribers were twice as likely to prescribe “Watch” antibiotics (OR 2.17, 95% CI 1.29–3.65). Conclusion: The study reveals a high prevalence of irrational antibiotic use and significant resistance among outpatient pathogens. Strengthened stewardship programs, prescriber education, and stricter prescription policies are imperative to mitigate AMR in Pakistan. Keywords: Antimicrobial stewardship; Antibiotic resistance; Cross-sectional studies; Drug utilization; Outpatients; Pakistan; Prescription audit.
Antimicrobial stewardship; Antibiotic resistance; Cross-sectional studies; Drug utilization; Outpatients; Pakistan; Prescription audit.
Effectiveness of Silver Diamine Fluoride vs. Fluoride Varnish for Arresting Dental Caries in School-Aged Children in Gilgit-Baltistan
Background: Dental caries remains a prevalent chronic disease among children, particularly in underserved regions such as Gilgit-Baltistan, where access to restorative dental care is limited. Minimally invasive, cost-effective interventions are vital for effective caries management. Silver Diamine Fluoride (SDF) has recently gained global attention for its dual antibacterial and remineralizing properties, offering a simple, affordable, and efficient method to arrest carious lesions. Objective: To evaluate and compare the effectiveness of 38 % Silver Diamine Fluoride and 5 % Fluoride Varnish in arresting active dentinal caries among school-aged children in Gilgit-Baltistan. Methods: A randomized controlled trial was conducted among 180 children aged 6–12 years attending private hospitals in Gilgit-Baltistan. Participants were randomly assigned to receive either 38 % SDF or 5 % Fluoride Varnish. Lesion activity was assessed at baseline, 6 months, and 12 months using standardized clinical criteria. The primary outcome was the proportion of arrested carious lesions. Data were analyzed using chi-square tests and logistic regression, with significance set at p < 0.05. Results: At 12 months, 82.1 % of lesions in the SDF group were arrested compared to 50.0 % in the Fluoride Varnish group (p < 0.001). The mean number of arrested lesions per child was higher in the SDF group (1.87 ± 0.82) than in the FV group (1.02 ± 0.76). No serious adverse effects were reported, apart from expected black discoloration of arrested lesions. Conclusion: SDF demonstrated superior caries-arrest effectiveness compared to Fluoride Varnish, confirming its value as a safe, efficient, and feasible caries management option for school-aged children in resource-limited settings. Keywords: Caries Arrest, Children, Dental Caries, Fluoride Varnish, Gilgit-Baltistan, Randomized Controlled Trial, Silver Diamine Fluoride
Caries Arrest, Children, Dental Caries, Fluoride Varnish, Gilgit-Baltistan, Randomized Controlled Trial, Silver Diamine Fluoride
Diagnostic Accuracy of Low-Dose CT Versus Chest X-Ray for Early Detection of Pulmonary Tuberculosis in High-Burden Districts of Balochistan.
Background: Pulmonary tuberculosis (TB) remains a global health challenge, particularly in high-burden, low-resource settings such as Balochistan. Early and accurate diagnosis is essential to control disease transmission and improve outcomes. Conventional chest X-ray (CXR), though widely used, has limited sensitivity for early-stage disease. Low-dose computed tomography (LDCT) offers improved image resolution with minimal radiation exposure, presenting a potential diagnostic advantage. Objective: To compare the diagnostic accuracy of LDCT and CXR for early detection of pulmonary tuberculosis in high-burden districts of Balochistan, Pakistan. Methods: A multicentric cross-sectional study was conducted in private hospitals across Quetta, Gwadar, and Sui over six months. A total of 270 suspected TB patients were enrolled, of whom 262 completed both imaging modalities and Gene-Xpert confirmation. Radiological findings were independently interpreted by blinded radiologists. Diagnostic performance parameters, including sensitivity, specificity, predictive values, and accuracy, were analyzed using SPSS version 26. Receiver Operating Characteristic (ROC) curves were generated to compare diagnostic capacities. Results: Out of 262 participants, 128 were confirmed TB cases. LDCT demonstrated a sensitivity of 92.9% and specificity of 89.2%, compared to 75.7% and 80.5% for CXR, respectively. The overall diagnostic accuracy was 91.9% for LDCT and 77.8% for CXR (p<0.001). LDCT identified subtle lesions, including small cavities and tree-in-bud patterns, missed by CXR. The mean radiation dose for LDCT was 1.27 mSv, remaining within international safety limits. Conclusion: LDCT provides superior diagnostic accuracy over CXR for early pulmonary TB detection while maintaining low radiation exposure. Its integration into diagnostic pathways in high-burden settings could significantly enhance early case detection and improve TB control outcomes. Keywords: Balochistan, Chest X-Ray, Diagnostic Accuracy, Low-Dose Computed Tomography, Pulmonary Tuberculosis, Radiography, Sensitivity and Specificity
Balochistan, Chest X-Ray, Diagnostic Accuracy, Low-Dose Computed Tomography, Pulmonary Tuberculosis, Radiography, Sensitivity and Specificity
Determinants of Maternal Undernutrition in Rural Communities of Tharparkar and Southern Punjab.
Background: Maternal undernutrition remains a significant public health issue in Pakistan, particularly in rural regions such as Tharparkar and southern Punjab, where poverty, food insecurity, and inadequate healthcare access persist. Understanding the determinants of maternal nutritional status in these regions is vital for developing effective interventions and policies aimed at improving maternal and child health outcomes. Objective: To identify the socioeconomic, environmental, and behavioral determinants of maternal undernutrition among women of reproductive age in rural communities of Tharparkar and southern Punjab. Methods: A cross-sectional study was conducted among 400 women aged 15–49 years from rural Tharparkar (Sindh) and southern Punjab (Dera Ghazi Khan and Rahim Yar Khan). Data were collected using a pretested structured questionnaire assessing sociodemographic, dietary, and environmental factors. Anthropometric measurements, including BMI and MUAC, were recorded to assess nutritional status. Statistical analyses were performed using SPSS version 26, applying chi-square tests and multivariate logistic regression to identify predictors of undernutrition, with a significance level set at p<0.05. Ethical approval was obtained from the Institutional Review Board of the University of the Punjab (Ref. No. IRB/PU/2024/112). Results: The prevalence of maternal undernutrition (BMI <18.5 kg/m²) was 38.5%, higher in Tharparkar (44%) than in southern Punjab (33%). Low household income (AOR 2.61; 95% CI: 1.44–4.72), lack of education (AOR 2.03; 95% CI: 1.10–3.75), poor dietary diversity (AOR 1.87; 95% CI: 1.09–3.21), and absence of improved sanitation (AOR 1.78; 95% CI: 1.02–3.11) were independent predictors of undernutrition. Conclusion: Maternal undernutrition in rural Pakistan is driven by intertwined socioeconomic, dietary, and environmental factors. Targeted, multisectoral interventions addressing poverty, education, food access, and sanitation are essential to improve maternal nutrition and health equity. Keywords: Anemia; Dietary Diversity; Malnutrition; Maternal Health; Rural Population; Socioeconomic Factors; Undernutrition
Anemia; Dietary Diversity; Malnutrition; Maternal Health; Rural Population; Socioeconomic Factors; Undernutrition
Assessment of Medication Errors in Government vs. Private Hospitals of Islamabad and Rawalpindi
Background: Medication errors represent a major and preventable threat to patient safety worldwide, with developing countries facing higher risks due to resource constraints and system inefficiencies. In Pakistan, data comparing error prevalence across different hospital sectors remain limited, particularly in the twin cities of Islamabad and Rawalpindi, where both government and private hospitals operate under distinct management structures. Objective: To assess and compare the prevalence, types, and determinants of medication errors in government and private hospitals of Islamabad and Rawalpindi, and to identify key risk factors contributing to their occurrence. Methods: A cross-sectional observational study was conducted in selected tertiary-care hospitals—two government and two private—over six months. A total of 310 inpatients and 1,278 medication exposures were evaluated using a validated audit tool covering prescribing, dispensing, administration, and documentation phases. Data were analyzed using SPSS v25. Descriptive statistics summarized error types and frequencies, and inferential tests (two-proportion Z-test and multivariable logistic regression) assessed differences and predictors, with significance set at p < 0.05. Results: Overall, 191 medication errors were identified (14.9% of exposures), with a significantly higher rate in government hospitals (17.8%) than private hospitals (12.4%) (p = 0.02). Administration errors predominated (46.6%), followed by prescribing (27.2%), documentation (13.6%), and dispensing errors (12.6%). Polypharmacy (≥ 5 medications; OR = 2.45, 95% CI 1.67–3.61) and longer hospital stay (≥ 7 days; OR = 1.78, 95% CI 1.11–2.87) were significant predictors. Night-shift administration accounted for 65% of administration errors. Conclusion: Medication errors are frequent in both hospital sectors, with a greater burden in government facilities. Strengthening medication safety protocols, staff training, and adoption of electronic systems are critical for minimizing preventable harm. Keywords: Administration errors, Hospital safety, Islamabad, Medication errors, Pakistan, Patient safety, Polypharmacy, Private hospitals, Public hospitals, Risk factors
Administration errors, Hospital safety, Islamabad, Medication errors, Pakistan, Patient safety, Polypharmacy, Private hospitals, Public hospitals, Risk factors
PREVALENCE OF UNDIAGNOSED PREDIABETES IN YOUNG ADULTS IN PAKISTAN AND ITS ASSOCIATION WITH SEDENTARY BEHAVIOR: A SCREENING-BASED ORIGINAL STUDY
BACKGROUND: Prediabetes is a growing metabolic concern in Pakistan, particularly among young adults, where lifestyle transitions and sedentary behavior contribute to early glucose dysregulation. Despite its reversibility, prediabetes often remains undiagnosed, leading to delayed intervention and a heightened risk of developing type 2 diabetes mellitus. OBJECTIVE: To determine the prevalence of undiagnosed prediabetes among young adults in Pakistan and to assess its association with sedentary behavior across urban populations. METHODOLOGY: A cross-sectional, community-based study was conducted between January and August 2023 in three urban centers—Lahore, Karachi, and Peshawar. A total of 186 apparently healthy adults aged 18–35 years were enrolled using stratified random sampling. Data were collected through structured questionnaires, anthropometric measurements, and biochemical screening, including fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) testing. Sedentary behavior and physical activity levels were evaluated using the International Physical Activity Questionnaire–Short Form (IPAQ-SF). Statistical analyses were performed using SPSS version 26, applying chi-square tests, t-tests, and binary logistic regression. RESULTS: The overall prevalence of undiagnosed prediabetes was 14.2%. Participants with sedentary time ≥7 hours per day had significantly higher odds of prediabetes (Adjusted Odds Ratio: 2.71; 95% CI: 1.28–5.74; p=0.009). Overweight and obesity (BMI ≥25 kg/m²) were also strongly associated (AOR: 2.36; 95% CI: 1.05–5.28; p=0.037). The mean HbA1c among prediabetic participants was 6.1 ± 0.2%, compared to 5.3 ± 0.4% in normoglycemic individuals. CONCLUSION: A notable prevalence of undiagnosed prediabetes exists among young adults in Pakistan, with sedentary behavior identified as a significant modifiable risk factor. Targeted public health interventions emphasizing early screening and active lifestyles are essential to curb the rising diabetes burden. KEY TERMS: Adolescents, Body Mass Index, Diabetes Mellitus Type 2, Pakistan, Physical Inactivity, Prediabetic State, Sedentary Behavior
Adolescents, Body Mass Index, Diabetes Mellitus Type 2, Pakistan, Physical Inactivity, Prediabetic State, Sedentary Behavior
Oral Hygiene Practices and Prevalence of Early Childhood Caries in Low-Income Communities of Karachi, Lahore, and Peshawar.
Background: Early childhood caries (ECC) is one of the most common chronic diseases affecting young children, disproportionately impacting those from socioeconomically disadvantaged communities. In Pakistan, limited data exist comparing oral hygiene practices and ECC prevalence across major urban centers, despite evidence of widespread oral health disparities. Objective: To assess the association between oral hygiene practices, feeding behaviors, and the prevalence of ECC among children aged 2–6 years in low-income communities of Karachi, Lahore, and Peshawar. Methods: A cross-sectional study was conducted among 425 children and their caregivers using a multistage random sampling approach. Clinical dental examinations were performed according to World Health Organization (WHO) criteria, and ECC was measured using the decayed, missing, and filled teeth (dmft) index. Oral hygiene status was evaluated using the Simplified Oral Hygiene Index (OHI-S). A validated caregiver questionnaire captured data on demographics, hygiene routines, and dietary practices. Data were analyzed using IBM SPSS version 26.0, employing t-tests, chi-square tests, and multivariate regression. Ethical approval was obtained from the Institutional Review Board of Dow University of Health Sciences (Ref: IRB-2025/DUHS/0349). Results: The overall prevalence of ECC was 51.8%, with the highest rates in Karachi (56.4%). Mean dmft score was 2.46 ± 1.78. Infrequent tooth brushing (<1/day) and absence of fluoride toothpaste use were associated with significantly higher dmft scores (p < 0.001). Frequent sugary snacking and night-time feeding also increased ECC risk (OR = 2.17; 95% CI: 1.48–3.12). Maternal education and household income were inversely related to ECC prevalence. Conclusion: ECC remains highly prevalent among children in Pakistan’s low-income urban populations. Modifiable behaviors—such as oral hygiene frequency, fluoride exposure, and feeding practices—play a critical role. Community-based preventive programs focusing on caregiver education and early oral health promotion are essential to mitigate this burden. Keywords: Caregivers, Child, Dental Caries, Feeding Behavior, Oral Health, Oral Hygiene, Pakistan
Caregivers, Child, Dental Caries, Feeding Behavior, Oral Health, Oral Hygiene, Pakistan
IMPACT OF MATERNAL HEALTH LITERACY ON NEONATAL OUTCOMES IN PUBLIC HOSPITALS OF PAKISTAN: A PROSPECTIVE OBSERVATIONAL STUDY
BACKGROUND: Maternal health literacy significantly influences neonatal outcomes, particularly in low- and middle-income countries where preventable neonatal mortality remains high. In Pakistan, limited maternal understanding of newborn care, breastfeeding, and illness recognition continues to impede neonatal health progress. OBJECTIVE: To assess the impact of maternal health literacy on breastfeeding practices, illness recognition, and early neonatal health indicators among mothers delivering in public hospitals of Pakistan. METHODOLOGY: A prospective observational study was conducted across four tertiary public hospitals in Pakistan from February to October 2023. A total of 420 postpartum mothers were enrolled using systematic random sampling. Maternal health literacy was measured using the Health Literacy Questionnaire (HLQ), while neonatal outcomes were assessed through Apgar scores, birth weights, breastfeeding initiation timing, and maternal illness recognition ability. Data were analyzed using SPSS version 26. Descriptive statistics, ANOVA, Pearson correlation, and logistic regression were applied, with p < 0.05 considered significant. Ethical approval was obtained from Jinnah Postgraduate Medical Centre (ERC No. JPMC/ERB/OBGYN/2023/172). RESULTS: Among 420 mothers, 24.5% had inadequate, 29.3% marginal, 27.6% sufficient, and 18.6% excellent health literacy. Early breastfeeding initiation occurred in 88% of mothers with excellent literacy versus 35% among those with inadequate literacy. Higher maternal literacy correlated positively with neonatal Apgar scores (r = 0.48, p < 0.001) and illness recognition ability (r = 0.51, p < 0.001). Logistic regression revealed that mothers with high literacy were 3.4 times more likely to initiate breastfeeding within one hour (AOR = 3.42, 95% CI: 2.15–5.43, p < 0.001). CONCLUSION: Maternal health literacy strongly influences neonatal health and care practices. Integrating literacy-focused education into antenatal and postnatal care programs can substantially improve neonatal survival and wellbeing in Pakistan. KEY TERMS: Apgar Score, Breastfeeding, Health Literacy, Illness Recognition, Maternal Education, Neonatal Health, Pakistan
Apgar Score, Breastfeeding, Health Literacy, Illness Recognition, Maternal Education, Neonatal Health, Pakistan
IMPACT OF AIR POLLUTION ON RESPIRATORY SYMPTOMS AND LUNG FUNCTION IN CHILDREN LIVING IN INDUSTRIAL ZONES OF LAHORE: A CROSS-SECTIONAL ENVIRONMENTAL HEALTH STUDY
BACKGROUND: Air pollution has become a major environmental health threat in Pakistan, particularly in Lahore’s industrialized zones where children are chronically exposed to high pollutant levels. Industrial emissions containing particulate matter (PM₂.₅, PM₁₀), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂) have been linked to respiratory morbidity and impaired lung development in children, yet limited local evidence exists integrating environmental exposure with clinical lung function data. OBJECTIVE: To assess the impact of industrial air pollution on respiratory symptoms and lung function among school-aged children living in industrial zones of Lahore through environmental exposure mapping and spirometric evaluation. METHODOLOGY: A cross-sectional study was conducted from March to November 2023 among 400 children aged 6–14 years (200 from industrial areas and 200 from control areas). Ambient air pollutants were monitored using portable air quality monitors, and geographic mapping was performed to estimate exposure gradients. Respiratory symptoms were assessed via standardized questionnaires, while lung function was measured using calibrated spirometry, recording FVC, FEV₁, FEV₁/FVC ratio, and PEF. Statistical analyses included t-tests, chi-square tests, and multivariate linear regression, with significance set at p<0.05. RESULTS: Mean PM₂.₅ levels were significantly higher in industrial zones (85.6 ± 19.4 µg/m³) compared to control areas (46.7 ± 13.2 µg/m³, p<0.001). Children from industrial areas showed higher prevalence of chronic cough (31%), wheezing (27%), and allergic rhinitis (34%). Spirometry revealed reduced FVC (1.62 ± 0.41 L vs 1.89 ± 0.38 L, p<0.001) and FEV₁ (1.38 ± 0.36 L vs 1.67 ± 0.33 L, p<0.001). PM₂.₅ concentration was inversely correlated with FEV₁ (r = –0.41, p<0.001). CONCLUSION: Industrial air pollution in Lahore is associated with significant respiratory symptoms and measurable declines in lung function among children. Urgent air quality regulation and child-centered health monitoring are needed to prevent long-term respiratory consequences. KEY TERMS: Air Pollution; Child Health; Environmental Exposure; Industrial Emissions; Lahore; Lung Function Tests; Particulate Matter
Air Pollution; Child Health; Environmental Exposure; Industrial Emissions; Lahore; Lung Function Tests; Particulate Matter
EFFECTIVENESS OF MOBILE-APP BASED PHYSIOTHERAPY EXERCISE PROGRAMS IN IMPROVING ADHERENCE AND FUNCTIONAL OUTCOMES IN CHRONIC LOW BACK PAIN PATIENTS IN PAKISTAN
BACKGROUND: Chronic low back pain (CLBP) remains a leading cause of disability worldwide, with poor exercise adherence being a critical barrier to effective rehabilitation. In Pakistan, limited physiotherapy access and inconsistent follow-up further hinder long-term recovery. The integration of mobile health (mHealth) solutions presents an opportunity to enhance self-management and adherence in CLBP rehabilitation. OBJECTIVE: To evaluate the effectiveness of a mobile app–based physiotherapy exercise program in improving adherence and functional outcomes among patients with chronic low back pain in Pakistan. METHODOLOGY: A randomized controlled trial was conducted across three tertiary hospitals in Lahore, Karachi, and Islamabad from March to November 2022. A total of 160 patients with non-specific CLBP were randomly assigned to either a mobile app–based physiotherapy group (n=80) or a conventional physiotherapy group (n=80). The intervention group received a 12-week guided exercise program via the “PhysioBackPak” app, while controls received printed exercise instructions. Outcome measures included the Exercise Adherence Rating Scale (EARS), Oswestry Disability Index (ODI), Numeric Pain Rating Scale (NPRS), Short Form-36 (SF-36), and Pain Self-Efficacy Questionnaire (PSEQ). Data were analyzed using repeated measures ANOVA and independent t-tests, with significance set at p<0.05. RESULTS: The app-based group demonstrated significantly higher adherence (82.4% vs. 64.7%, p<0.001), greater reduction in disability (ODI: 42.8±10.5 to 21.6±8.9), and lower pain scores (NPRS: 6.9±1.1 to 3.2±1.3). Quality of life and self-efficacy improved markedly compared to controls (p<0.01). No adverse effects were reported. CONCLUSION: Mobile app–based physiotherapy significantly enhances adherence, pain relief, and functional recovery in CLBP patients, offering a feasible and scalable approach for digital rehabilitation in Pakistan’s healthcare system. KEY TERMS: Adherence, Chronic Low Back Pain, Digital Health, Mobile Applications, Pain Management, Pakistan, Physiotherapy, Rehabilitation
Adherence, Chronic Low Back Pain, Digital Health, Mobile Applications, Pain Management, Pakistan, Physiotherapy, Rehabilitation
Comparative Burden of Non-Communicable Diseases Across Urban and Rural Divisions of Pakistan
Background: Pakistan is experiencing a rapid epidemiological transition, with non-communicable diseases (NCDs) surpassing infectious diseases as the leading cause of mortality. Urbanization, sedentary lifestyles, and socioeconomic disparities contribute to an increasing NCD burden. However, limited data exist comparing disease patterns between urban and rural regions of the country. Objective: To compare the prevalence and determinants of major NCDs across urban and rural divisions of five representative Pakistani regions—Lahore, Multan, Quetta, Swat, and Gilgit—through a multicenter, population-based assessment. Methods: A cross-sectional, multicenter comparative study was conducted from January to December 2025. A total of 2,850 adults (aged ≥18 years) were enrolled using multistage stratified random sampling. Data were collected through standardized WHO STEPS questionnaires and clinical measurements of blood pressure, glucose levels, and body mass index. Statistical analyses included descriptive statistics, chi-square tests, t-tests, and multivariate logistic regression using SPSS version 27, with significance set at p<0.05. Results: The overall NCD prevalence was 38.6%, with hypertension (21.9%) and diabetes mellitus (14.2%) as the most frequent conditions. Urban participants exhibited significantly higher NCD prevalence (43.1%) than rural participants (31.8%) (p<0.001). Obesity (22.1% vs. 11.3%) and physical inactivity (49.7% vs. 31.4%) were markedly more prevalent in urban populations. Age ≥45 years (AOR 2.9; 95% CI: 2.2–3.8) and obesity (AOR 3.1; 95% CI: 2.4–4.0) were the strongest predictors of NCDs. Conclusion: Urban regions of Pakistan bear a higher NCD burden, reflecting the influence of lifestyle and environmental factors. Region-specific health interventions focusing on prevention, early detection, and equitable resource distribution are essential to address this growing national health challenge. Keywords: Chronic Disease; Cross-Sectional Studies; Epidemiology; Hypertension; Noncommunicable Diseases; Pakistan; Prevalence; Risk Factors
Chronic Disease; Cross-Sectional Studies; Epidemiology; Hypertension; Noncommunicable Diseases; Pakistan; Prevalence; Risk Factors
Workplace Stressors and Coping Strategies Among Nurses Working in Public Tertiary Hospitals of Sindh
Abstract Background: Workplace stress is a critical challenge within the nursing profession, particularly in resource-limited public healthcare systems where nurses face heavy workloads, emotional strain, and organizational constraints. Despite its prevalence, limited research has explored how nurses in Pakistan experience and cope with these stressors. A qualitative approach is essential to understand the depth and complexity of their lived experiences within their socio-cultural and institutional contexts. Objective: This study aimed to explore the workplace stressors and coping strategies among nurses working in public tertiary hospitals of Sindh, Pakistan, through a phenomenological lens. Methods: A qualitative phenomenological design was employed. Twenty registered nurses were recruited using purposive sampling from various departments of public tertiary hospitals. Data were collected through in-depth, semi-structured interviews and analyzed thematically using Braun and Clarke’s six-step framework. Reflexivity, member checking, and peer debriefing were employed to enhance credibility and trustworthiness. Results: Findings revealed multifaceted stressors encompassing heavy workloads, insufficient staffing, lack of managerial support, emotional exhaustion, and moral distress arising from resource limitations. Nurses coped primarily through peer support, personal resilience, spirituality, and self-reflection, though these strategies were often constrained by systemic barriers. Ethical and emotional distress emerged as unexpected yet significant dimensions of workplace stress. Conclusion: The study highlights that occupational stress among nurses in Sindh’s public hospitals is a systemic issue demanding institutional and policy-level interventions. Strengthening supportive supervision, improving staffing ratios, and providing structured psychosocial support can enhance nurse well-being and healthcare quality. Future research should focus on evaluating intervention models for nurse wellness and retention. Keywords: Qualitative Research, Phenomenology, Workplace Stress, Coping Strategies, Nurses, Public Hospitals.
Qualitative Research, Phenomenology, Workplace Stress, Coping Strategies, Nurses, Public Hospitals, Sindh Pakistan.
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Prevalence and Predictors of Burnout Among Healthcare Workers During and After the COVID-19 Pandemic
Abstract Background: Burnout among healthcare workers has emerged as a critical global issue, particularly during and after the COVID-19 pandemic. The prolonged exposure to high workloads, emotional distress, and limited institutional support has led to alarming rates of psychological strain and professional exhaustion. Although numerous studies have investigated burnout during the pandemic, the long-term trends and predictors following the acute phase remain poorly understood, warranting a comprehensive synthesis of current evidence. Objective: This systematic review aimed to evaluate the prevalence, predictors, and persistence of burnout among healthcare workers during and after the COVID-19 pandemic, providing an updated understanding of its determinants and implications for clinical practice and workforce policy. Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library for studies published between January 2020 and October 2025. Eligible studies included systematic reviews, cohort, and cross-sectional studies assessing burnout among healthcare workers during or post-pandemic. Two reviewers independently screened, extracted data, and assessed study quality using the Newcastle–Ottawa Scale and Joanna Briggs Institute checklist. A qualitative synthesis was performed due to methodological heterogeneity. Results: Forty-seven studies encompassing over 95,000 healthcare workers were included. The pooled prevalence of burnout was 42.3% (95% CI: 38.1–46.5; p < 0.001), with emotional exhaustion being the most reported dimension. Female gender, frontline exposure, and inadequate organizational support were consistent predictors of burnout, while institutional support and resilience training mitigated risk. Conclusion: Burnout among healthcare professionals remains a widespread and enduring consequence of the COVID-19 pandemic. The evidence emphasizes the urgent need for organizational interventions, mental health support programs, and longitudinal studies to evaluate preventive strategies and promote workforce resilience. Keywords: Burnout, Healthcare Workers, COVID-19, Systematic Review, Occupational Stress, Mental Health
Burnout, Healthcare Workers, COVID-19, Systematic Review, Occupational Stress, Mental Health
Empowering Early-Career Researchers: Building the Next Generation of Clinician-Scientists
This editorial highlights the critical need to support early-career researchers (ECRs) in the medical and dental fields by addressing common barriers such as limited access to mentorship, funding, and publication opportunities. It emphasizes the importance of interdisciplinary collaboration, ethical scholarship, and open-access publishing in nurturing a globally inclusive research environment. The role of Insights – Journal of Medical and Dental Research (IJMDR) is underscored as a platform committed to fostering innovation, academic integrity, and professional growth for emerging clinician-scientists. The editorial concludes with a strong call to action to the academic and clinical community to invest in and uplift the next generation of researchers.
ASSOCIATION OF DIETARY PATTERNS WITH CARDIOVASCULAR RISK MARKERS AMONG PAKISTANI ADULTS: A HOSPITAL-BASED ANALYTICAL STUDY
BACKGROUND: Cardiovascular diseases are the leading cause of mortality in Pakistan, largely influenced by modifiable lifestyle factors such as diet. Rapid urbanization has led to a shift from traditional, plant-based diets toward Westernized dietary habits rich in saturated fats and processed foods, contributing to dyslipidemia and cardiovascular risk. OBJECTIVE: To assess the association between traditional, mixed, and Westernized dietary patterns and cardiovascular risk markers, particularly lipid profiles, among Pakistani adults attending tertiary care hospitals. METHODOLOGY: A cross-sectional analytical study was conducted from January to September 2023 in three tertiary hospitals across Lahore, Karachi, and Peshawar. A total of 315 adults aged 25–65 years were enrolled through purposive sampling. Dietary patterns were derived using a validated Food Frequency Questionnaire and principal component analysis. Fasting serum lipid profiles, including total cholesterol, LDL-C, HDL-C, and triglycerides, were measured using enzymatic colorimetric assays. Data were analyzed using SPSS version 26. One-way ANOVA and multiple linear regression were applied, adjusting for age, sex, BMI, smoking, and physical activity, with significance set at p < 0.05. RESULTS: Participants adhering to traditional diets had significantly lower mean LDL-C (108 ± 29 mg/dL) and triglycerides (142 ± 51 mg/dL) and higher HDL-C (54 ± 11 mg/dL) compared to those following Westernized diets, who exhibited higher LDL-C (141 ± 35 mg/dL), triglycerides (189 ± 63 mg/dL), and lower HDL-C (43 ± 9 mg/dL) (p < 0.001). Regression analysis confirmed positive associations between Westernized diets and atherogenic lipid markers after adjustment for confounders. CONCLUSION: Traditional dietary patterns were associated with a more favorable lipid profile, while Westernized diets increased cardiovascular risk. Promoting culturally appropriate, traditional diets may help mitigate the rising burden of dyslipidemia and cardiovascular disease in Pakistan. KEY TERMS: Cardiovascular Diseases, Cross-Sectional Studies, Diet, Dietary Patterns, Dyslipidemias, Lipids, Pakistan
Cardiovascular Diseases, Cross-Sectional Studies, Diet, Dietary Patterns, Dyslipidemias, Lipids, Pakistan