Pioneer Journal of Biostatistics and Medical Research
Pioneer Journal of Biostatistics and Medical Research (Pioneer J Biostat Med Res) is one of the first dedicated journals in the field of biostatistics and medical statistics, published quarterly. The journal aims to empower health researchers by promoting the application of purpose-driven and innovative statistical techniques that yield meaningful insights and guide evidence-based solutions to real-world health challenges. Pioneer J Biostat Med Res welcomes contributions from a wide range of professionals, including clinicians, public health experts, epidemiologists, pharmacists, biostatisticians, statisticians, and other researchers across the life and health sciences domains. Our commitment lies in promoting interdisciplinary dialogue that enhances statistical thinking in healthcare research. Fees and Funding Pioneer J Biostat Med Res is a no-fee, open-access journal. We do not charge any article processing or publication fees. The journal operates independently, without reliance on external funding or sponsorship. This ensures equitable access for authors worldwide and reflects our commitment to academic integrity and open science.
Medical Research and Statistical Consultancy Training Centre (MRSCTC)
Frequency of lower back pain among the private security guards
Background: Low back pain can result in severe and long-term impairment. The nature of the job, which often involves long hours of standing, walking, or lifting, causes strain on the lower back among security guards. Approximating the occurrence of lower back pain is challenging, as its incidence continues to rise, particularly in early adulthood. Objective: To evaluate the incidence of lower backache among private security guards in Lahore, Pakistan. Methods: A Cross-sectional survey was conducted from March 2017 to August 2017 after approval of synopsis. Data was collected from 124 security guards in Lahore by using Oswestry questionnaire for disability and visual analogue scale (VAS) for pain. Results: The frequency of lower back pain among security guards was 77 (62.1 %). 52.4% (65 individuals) reported not experiencing pain at the moment, while 47.6% (59 individuals) reported feeling pain at the time of survey. 33.9% (42 individuals) reported having no pain at the moment, while 22.6% (28 individuals) described their pain as very mild. 29.0% (36 individuals) experienced moderate pain, and 14.5% (18 individuals) reported their pain as fairly severe. Conclusion: Low back pain significantly affects the majority of security guards who took part in this study. The findings suggest that back pain is a major cause of disability, impacting the ability to sit, stand, and lift comfortably. This condition not only affects daily work performance but also has broader implications for the well-being and productivity of security personnel. Given the high prevalence of back pain in this profession, it is crucial to implement preventive measures and provide support to reduce its occurrence and improve overall health outcomes for security guards.
Copyright (c) 2026 Behram Ahmed, Amna Afzal, Chaudhary Aftab Ahmed, Zohaib Khan, Muhammad Farooq Iqbal (Author) https://creativecommons.org/licenses/by/4.0
Role of Granulocyte-Colony Stimulating Factor (G-CSF) in Febrile Neutropenia among Pediatric Cancer Patients in Resource-Limited Settings
Background: Chemotherapy-induced Febrile neutropenia (FN) is a potentially catastrophic complication in childhood cancer, requiring urgent management and hospitalization, with a heightened risk of mortality. Granulocyte-colony stimulating factors (G-CSFs) are used both prophylactically to decrease FN episodes and therapeutically during febrile neutropenia. However, evidence supporting their role in resource-limited settings remains scarce. Objectives: To evaluate the effect of granulocyte colony-stimulating factor on hospital stay duration, treatment cost, and mortality among children suffering from febrile neutropenia. Methodology: This prospective cohort study enrolled 250 children with chemotherapy-induced FN at the Children’s Hospital Lahore (CHL) from September 2018 to December 2018. Patients received G-CSF (filgrastim, 10 mcg/kg/day for five days or until ANC >1000 for two consecutive days), primarily in the solid malignancy group. Clinical characteristics, neutrophil counts, hospital stay, treatment costs, and outcomes were recorded. Data were analyzed using SPSS 23. Results: G-CSF significantly decreased hospital stay (p = 0.048) and was administered more frequently in instances of severe neutropenia (ANC < 100x10³/µL in 82% of cases, p = 0.000). Mortality in the G-CSF group was 3%, though not statistically significant (p = 0.147). In clinical settings, G-CSF improved hematological recovery in solid malignancies and was cost-effective (p = 0.027). Conclusion: G-CSF demonstrated superior clinical efficacy compared to intravenous antibiotics alone by reducing hospitalization and neutropenia severity, without imposing a substantial cost burden. These findings support G-CSF as a desirable FN management strategy, even in low-resource pediatric oncology centers.
Chemotherapy-induced febrile neutropenia
Copyright (c) 2026 Alia Ahmad, Fauzia Shafi Khan, Mahvish Hussain, Shakila Mushtaq, Irsa Iqbal, Sana Gull (Author) https://creativecommons.org/licenses/by/4.0
Predictors of In-Hospital Mortality among Liver Disease Patients: A Logistic Regression Approach
Background: Liver disease constitutes a major cause of morbidity and mortality in Nigeria. In-hospital outcomes are influenced by demographic, clinical, and therapeutic factors. Accurate identification of mortality predictors is essential for risk assessment and optimized resource utilization. Objective: This study aimed to identify independent predictors of in-hospital mortality among patients admitted with liver disease at a Nigerian tertiary hospital, viz University of Ilorin Teaching Hospital (UITH) using logistic regression modeling. Methods: A retrospective hospital-based study analyzed 295 complete records of liver disease admissions at the University of Ilorin Teaching Hospital, Ilorin, from the study period until 2024. Data included age, sex, body mass index (BMI), length of stay, and outcome (discharged or deceased). Normality was assessed via the Anderson-Darling test; group differences were evaluated using the Wilcoxon rank-sum test and chi-square test. Binary logistic regression was employed to estimate crude odds ratios (ORs) for mortality predictors. Results: Numerical variables (age, BMI, length of stay) were non-normally distributed. Wilcoxon tests revealed significant differences in length of stay between survivors and non-survivors (p < 0.05). A chi-square test indicated borderline association between sex and outcome. Logistic regression identified length of stay as the only significant predictor (OR = 0.944, 95% CI: [0.920, 0.968], p < 0.001), with each additional day reducing mortality odds by approximately 5.6%. Age, sex, and BMI were non-significant. Conclusion: Prolonged hospital stay emerged as a strong protective factor against in-hospital mortality in liver disease patients, highlighting the critical role of timely admission and sustained management. These findings underscore the need for early intervention and improved ‘in-patient’ care to improve survival. Keywords: Liver disease, In-hospital mortality, Logistic regression, Length of stay.
Copyright (c) 2026 Chikezie Onyeka Okonkwo, Ms Timilehin Adeniji (Author) https://creativecommons.org/licenses/by/4.0
A Conceptual Framework for Prehypertension and Epidemiological Insights: A Narrative Review
The term "prehypertension" was introduced in 2003 by the Joint National Committee (JNC-7) on Detection, Prevention, Estimation, and High Blood Pressure Treatment. It states two BP readings in the range of 120-139 mmHg systolic and 80-89 mmHg diastolic. This middle stage shows important cautionary signals, meaningfully increasing the risk of progressing to hypertension. This article investigates the multifaceted nature of prehypertension, definitions, challenges in diagnostics, prevalence globally, and the consistent risk factors, despite the introduction of a tool to identify the risk of individuals and make early preventive measures. The classification and treatment of prehypertension are still under debate. Inconsistent guidelines in all the regions are creating uncertainty among medical professionals. HTN affects about 36% of adults; in men, specific ethnic populations showed higher vulnerability. The occurrence of other CVD risk factors like obesity, DM, and dyslipidemia impacts health. Prehypertension diagnosis is not a straightforward method. It required repeated blood pressure measurements to mark hypertension. Research indicates that simply labeling someone as prehypertensive does little to motivate behavioral changes. The importance of developing more considerable communication plans to boost meaningful lifestyle adjustments. Conclusion: Prehypertension signifies a public health challenge; there is a persistent need for combined guidelines and further research to improve its management and control the rising global burden of hypertension and linked cardiovascular diseases.
Prehypertension; Diagnosis; Epidemiology
Copyright (c) 2026 Muhammad Ajmal Dina (Author) https://creativecommons.org/licenses/by/4.0
Exploring Cytomegalovirus Infection in Renal Transplant Recipients: A Comprehensive Literature Review
Background: Complication in kidneys the cytomegalovirus (CMV) infection still important in transplantation, due to un favoring effects on grafts survival and general patient result, the role in energizing acute or chronic allograft injury, good recognize but the CMV linked nephritis is regularly undiagnosed, emphasizing about of timely heading and its management. Objective: The review aims to combine between current knowledge on CMV nephritis in the kidney transplant recipients emphasizing its fundamental mechanisms, diagnostic methods with therapeutic plans. Methods: This literature review was conducted counting 15 peer-reviewed articles published in 2010 to 2022, databases searched are PubMed, Google Scholar, Cochrane Library, and Mendeley, with the keywords of “CMV kidney transplant” & “cytomegalovirus nephritis.” The data covered with patients’ clinical presentation, risk factors, histopathology, demographics and outcomes. Results: The comprised studies were on transplant recipients aged rage between 38 to 62 years, representation of numerous ethnic groups and sexes showed with hypertension (HTN) and diabetes mellitus (DM) are common comorbidities, cases with multifaceted CMV-seronegative recipients with grafts due to seropositive donors. In the clinical look characteristically looked between 5 to12 weeks post-transplant having fever, fatigue, weakened graft function and raised serum creatinine (S/Crt), in histological investigation showed tubulointerstitial nephritis with characteristic CMV insertions in tubular epithelial cells. Therapeutic management mainly be subject to Valganciclovir, with immunosuppressive therapy like mycophenolate mofetil or tacrolimus. In the clinical results mixed, complete recovery 6 studies, partial recovery 5 studies, stable function 4 studies and graft lost 2 studies. Conclusion: CMV nephritis had a stealth complication can threats graft survivals and the management have a high index of doubt at-risk patients and histological confirmation. Accurate diagnosis is a essential to get the damaging effects of misdirected anti-rejection therapy like FK to reservation long-term graft function.
Copyright (c) 2025 Muhammad Ajmal Dina Dina, Asifa Karamat, Muhammad Bilal, Muhammad Shakeel Basit, Muhammad Akram Butta, Zar Nigar , Shazia Siddique (Author) https://creativecommons.org/licenses/by/4.0
Comparison of conventional care and kangaroo mother care on very low birth weight babies
Background: In 1978, the concept of kangaroo mother care (KMC) emerged as a compassionate alternative for the care of low birth weight (LBW) infants. In this study, we present the initial findings from a randomized, controlled trial assessing the early outcomes of KMC compared to conventional care methods. Objective: To compare Conventional Care Vs Kangaroo Mother Care on very Low-Birth Weight Babies. Methods: This study employed a randomized controlled trial conducted in the Paediatrics department unit 1 newborn nursery and intensive care unit Services Hospital Lahore. With a duration of 9 months, 104 neonates, 52 in each group, participated based on previous research indicating mean weights at two weeks for kangaroo mother care and conventional care groups. Nonprobability purposive sampling was used. Inclusion criteria encompassed neonates with very low birth weight (<1500 gm), excluding those needing critical care interventions or having congenital anomalies without maternal consent. Data collection involved temperature monitoring and weight measurements, analyzed using SPSS version 26 with significance set at 0.05. Results: Notably, participants in the Conventional Care (CC) group exhibited a significantly longer mean hospital stay (16.1 days) compared to the Kangaroo Mother Care (KMC) group (10.8 days). Moreover, the comparison of weight gain in grams from Day 1 to Day 5 between the Conventional Care (CC) and Kangaroo Mother Care (KMC) groups indicates statistically significant differences across all days. Participants in the KMC group showed higher mean weight gain throughout the observation period, with Day 1 demonstrating a mean weight gain of 1489.6 grams compared to 1461.2 grams in the CC group (p = 0.04). Conclusion: Kangaroo Mother Care (KMC) demonstrates effectiveness in promoting daily weight gain compared to the CC group. Additionally, KMC proves beneficial in shielding neonates from hypothermia. However, insufficient evidence exists to establish a discernible disparity in the incidence of apnea and hospital stay duration between the two groups.
Copyright (c) 2025 Hafiz Ahma Kamal, Kanwal Bibi (Author) https://creativecommons.org/licenses/by/4.0
Cost-effectiveness of treating Febrile neutropenia in Children with Cancer in Resource-limited settings
Background: Febrile neutropenia in children on intensive chemotherapy is very frequent requiring urgent evaluation and management, imposing a significant strain on the already available limited resources in low-middle-income countries (LMIC) Objectives: To evaluate the need of cost-effectiveness in managing in-hospital FN and explore the mechanisms to implement in public sector LMIC to pave the way for cost-minimization Methodology: Prospective extraction of patient level costs from hospital records to evaluate the costing of injectable antimicrobial and inotropes provided by the hospital management free of cost as part of the comprehensive childhood cancer care Results: A total of 250 FN episodes were analyzed, all of them managed in the inpatient unit, complete cost data were extracted for these FN episodes. The analysis revealed that despite subsidized purchase of antimicrobials and supportive care materials FN has a huge burden on the public sector hospital resources whereas length of hospital stays, blood products, laboratory tests and staff consultations were excluded. Majority of these patients were of acute leukemia, having the last session of chemotherapy in a week time in 87% and majority on intensive chemotherapy and suffered from respiratory tract infections and mucositis. More than half had severe derangements of Laboratory parameters and gram-negative septicemia among positive cultures. The mean estimated cost per FN episode was around 15,000 PKR. Conclusion: Febrile neutropenia exerts a huge burden on childhood cancer care services emphasizing the need to explore the cost-effectiveness in FN management by different mechanisms including parents’ health literacy to promote early seeking behavior, emergency management, shared care therapy and social support and standardized de-escalation of therapy to minimize the costs.
Copyright (c) 2025 Alia Ahmad, Mahvish Hussain, Asma Mushtaq, Amber Goraya, Naima Mehdi, Safwan Ahmed, Fauzia Shafi Khan (Author) https://creativecommons.org/licenses/by/4.0
Temporal trends and sex disparities in live and stillbirths: A five-year study at ring road general hospital, Ibadan, Nigeria
Background: Stillbirth remains a critical indicator of maternal and perinatal health, with global disparities influenced by time, season, and fetal sex. Understanding localized patterns is essential to evaluate the impact of health interventions. This five-year retrospective study examined temporal trends and sex-related disparities in live births and stillbirths at Ring Road General Hospital, Ibadan, Nigeria (2020–2024), in the context of targeted maternal care improvements. Objective: To assess temporal and seasonal trends in birth outcomes and evaluate sex-based disparities in stillbirth risk over a five-year period. Method: A retrospective analysis of 4,294 birth records (live and stillbirths) was conducted from January 2020 to December 2024. Time-series analysis was used to identify seasonal and annual trends. Kruskal-Wallis and chi-square goodness-of-fit tests assessed differences in outcomes across time and sex. Logistic regression was employed to examine the association between fetal sex and stillbirth risk. Results: Live births showed significant seasonal variation, with peaks in the first and second quarters of each year. Stillbirth rates declined substantially from 21.38 to 2.99 per 1,000 births over the study period (p < 0.05), suggesting improved outcomes. The sex ratio remained stable for both live births (1.07 male-to-female) and stillbirths (1.00), with no significant deviation from expected norms. Male fetuses had 22.6% higher odds of stillbirth compared to females, though this difference was not statistically significant (OR = 1.226, p = 0.159). Conclusion: This study revealed a marked reduction in stillbirth rates over five years, likely reflecting the success of maternal health interventions and enhanced data surveillance. The consistent sex ratios and lack of significant sex-based disparity in stillbirth risk diverge from global patterns, indicating equitable maternal and neonatal care practices within the study setting.
Copyright (c) 2025 Alfred Ayo Ayenigba, Olutunde Michael Ajao, Oluwafunmilayo E. ADETONA (Author) https://creativecommons.org/licenses/by/4.0
Temporal and demographic patterns of malaria prevalence in Adiyan, Ogun State, Nigeria (2019–2022): A retrospective study using antimalarial drug sales as an indicator of disease burden
Background: Malaria remains a major epidemic in Nigeria, continuing to impact lives negatively through-out the country and especially in semi-urban settlements such as Adiyan Ogun state. In spite of efforts to educate and promote awareness of malaria to the people and to help them control it, there continues to be a slow increase in cases during certain seasonal periods and an uneven distribution based on age (teenagers vs. adults). A thorough examination of local pharmacy sales will offer more accurate insight into the actual burden of malarial disease because medical professionals may be unable to properly capture all cases in traditional surveillance methods. Objectives: Provide insight into the seasonal and age-related distribution of malaria cases in Adiyan for the time frame of 2019-2022 by providing management of the medications that are being issued for treatment of malaria. Methods: The study examined the effect of weather and seasonality on malaria incidence. Data sources included historical sales data from Kotz Pharmacy in Ogun State, categorized into three groups based on age: Adults, teenagers, and Children. Seasonal trend analysis was performed to identify any seasonal patterns in malaria cases within each age group. ANOVA and Tukey's post-hoc tests were performed to determine if there were differences between the age groups regarding the number of malaria cases. Pearson correlations were performed to determine how closely the number of malaria cases tracked across all three(age) groups. Result: Adult (Ages 18-64) Anti-Malarial Purchases were over 78% of total 'over-the-counter' sales of Anti-Malarials during the rainy season (between June and August) of each year, and peaked (142) in July 2021. The burden of disease was significantly greater among adults, than either Children, or Teenagers (ANOVA statistic F(2, 107) = 109.28, p< .001). The result reveals that there was strong relationship between the teen and child (r = +0.72, p < 0.001), but the pattern did not hold between adults and children (r = +0.25, p = 0.090). Conclusion: The findings make it clear: malaria in Adiyan follows a seasonal rhythm and hits adults hardest. Using pharmacy sales data alongside environmental information paints a more detailed picture and can help tailor malaria prevention efforts by age group. Keywords: Malaria, ANOVA, Proxy indicator, Seasonality, Age groups, Antimalarial drug
Copyright (c) 2026 Alfred Ayo Ayenigba, Dr. D. A. Afariogun (Author) https://creativecommons.org/licenses/by/4.0
Risk factors of hyperuricemia in type II diabetes mellitus patients
Background: Pakistan has an increased incidence of type II diabetes mellitus, a serious national health problem. Hyperuricemia, which is marked by increased Serum Uric Acid (SUA) levels, often goes along with diabetes mellitus type II and raises the threat of Kidney disease, BMI, dietary intake, and other comorbid diseases all contribute significantly to hyperuricemia. The research on hyperuricemia among Pakistani diabetic type II patients is very little. Objectives: To identify the associated risk factors of hyperuricemia in type II diabetes mellitus. Method: An Analytical Cross-Sectional Study was conducted at Government Kot Khwaja Saeed Teaching Hospital Lahore, involving 362 participants recruited through convenient sampling over 9 months. Patients aged 30–60 with type II diabetes mellitus for at least one year were included, while those with type I or gestational diabetes, known patient of hyperuricemia, relevant medication use, or unwillingness to participate were excluded. Results: Key results show that 69.6% of patients had no hyperuricaemia levels, while 30.4% had hyperuricemia. The mean uric acid level ranged from 2.90 to 9.30 mg/dL, with an average of 5.60 ± 0.75 mg/dL. Female gender is the strongest indicator of hyperuricemia, while BMI, diabetes duration, glycemic control, and comorbidities showed no correlations. Hyperuricemia was highly prevalent among housewives, indicating potential lifestyle factors. These findings stress the need for focused treatments, especially for women, to reduce hyperuricemia risks in TDM II female patients. Conclusion: This study reveals that female gender, height, housewives, low saturated fat foods and eating of the lean meats (poultry, fish, eggs etc.,) are the strongest predictor of hyperuricemia, with higher prevalence and odds. Factors like duration of diabetes mellitus in years, glycemic control, BMI and comorbidities showed no significant associations. Housewives exhibited a higher prevalence, suggesting lifestyle-related influences. These findings emphasize the need for targeted measures among females to reduce hyperuricemia risks and complications.
Copyright (c) 2025 Muhammad Kashif Shahzad Virk, Muhammad Yaqoob (Author) https://creativecommons.org/licenses/by/4.0
Risk Assessment of chronic venous insufficiency and varicose veins Among Teachers: Prevalence, Patterns, and Perspectives in Sahiwal Division, Pakistan
Background: The prevalence of varicose veins in the legs is commonly observed across the global population. However, the specific prevalence of varicose veins and the associated risk factors within the Sahiwal division are not clearly known. Objectives: This study aimed at clarifying the risk factors for varicose veins among teachers in Sahiwal division. This study's objective was to evaluate the risk of varicose veins among teachers Sahiwal division, Pakistan. Methodology: Distributions of frequency and percentage were used to summarize the data. The t-test and chi-square test were used to assess statistical significance. This cross-sectional survey was carried out during February to April 2025 among teachers of both genders working in Sahiwal division's Primary, elementary, and high schools. Results: Mean age of both gender were 42.2 ± 2.06 years, 306 (51%) of the 600 participating instructors were male, while the remaining teachers were female. Pain in the legs increase especially during work (20.5%). The majority of participants (31.0%) had been employed for more than 15 years, and (41.0%) had been standing for fewer than five hours each day. Spider leg-shaped veins were the most noticeable symptom (24.2%). Swelling in the leg or ankle, was the common indicator (40.5%). 179 instructors in all had a family history of varicose veins; 84 of them (14.0%) had already received a varicose vein diagnosis. Conclusion: Obesity, family history, more than five hours standing is associated risk factor of chronic venous insufficiency and varicose veins among teachers that are above 45 years old. In summary, female educators who have a family history of varicose veins are at a higher risk of chronic venous insufficiency and varicose veins disease. Teachers in the Sahiwal division have a significant prevalence of varicose veins. This study indicates that teachers are far more likely to develop the disorder because of the way they work, which accelerates the condition's advancement.
Copyright (c) 2025 Ansar Ali Faraz, Waqas Makhdoom (Author) https://creativecommons.org/licenses/by/4.0
The Spectrum of Socio-Economic Barriers of Families of Children with Cancer during Cross-Border Care: A Paediatric Tertiary Care Hospital Experience
Background: Childhood cancer care needs timely access to diagnostic, treatment, and follow-up services for better survival of these children. Unfortunately, there is a lack of established comprehensive childhood cancer centers in Afghanistan, so these children with cancer and blood disorders consult healthcare providers working cross-border to seek specialized care. The research to explore the distress linked with childhood cancer and associated socioeconomic hurdles is lacking in low-middle-income LMIC countries. Objective: To evaluate the challenges faced by these families while their children with cancer are being managed cross-border in Pakistan. Methodology: This is a cross-sectional study done at Children’s Hospital Lahore, Pakistan, from 1st January 2023 to 31st March 2023. The study involved families with twenty-four children. We interviewed the Afghan families of these children to understand the challenges they faced during this ordeal. Results: The study included children with a mean age of 7.4 years; only 21% were females. They spoke Pushto and Dari languages. Twenty-five percent did not understand Urdu, finding communication exceedingly difficult in 50% of families. Only 4 families had the facility of a translator. Sixty-seven percent were diagnosed with acute lymphoblastic leukemia, and the rest with solid malignancies. The monthly family income was meager. In 85% of cases, the remaining family was sponsored by loans or charity, and 75% were escorted by one or both parents. Ninety-five percent took loans and had a significant effect on siblings education and emotional well-being. Eighty-five percent declared the economic difficulties more disturbing than communication and logistic challenges. Conclusion: During cross-border care, immense challenges were faced by them, requiring efficient socioeconomic support and parental support groups.
Copyright (c) 2025 Alia Ahmad, Laeeq Ur Rehman, Asma Mushtaq, Amber Goraya, Aysha Akram, Mahvish Hussain (Author) https://creativecommons.org/licenses/by/4.0
Case report on preferential use of surgical management for treating cesarean scar pregnancy
Cesarean scar pregnancy( CSP/ Cesarean scar ectopic pregna) although rare ( 1 in 1800- 2500 pregnancies) is continually on the rise due to rising cesarean section rate. It contributes to maternal morbidity and mortality due to placenta accrreta and uterine rupture.This issue is addressed by early diagnosis and definitive management to enhance quality of life.CSP case of woman with previous two cesarean sections and no alive issue is presented where various management options have been tried leading to ultimate recovery with surgical management.
Copyright (c) 2025 Mehwish Ayyaz, Abida Sajid, Saba Irshad (Author) https://creativecommons.org/licenses/by/4.0
Risk factors of maternal near miss among females: A Systemic Review
Background: Maternal near-miss (MNM) is a critical indicator for evaluating maternal healthcare quality, reflecting cases where women survive life-threatening obstetric complications. This review aimed to identify the leading risk factors associated with MNM based on recent global observational studies. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2020 and 2024. Observational studies assessing maternal near-miss and its risk factors using WHO or similar criteria were included. A total of 30 studies were reviewed from diverse settings, including low-, middle-, and high-income countries. Results: Hypertensive disorders (n=25 studies), obstetric hemorrhage (n=21), lack of antenatal care (n=18), and socio-demographic disadvantages such as rural residence and poor education (n=15) emerged as the most frequent risk factors. Additional contributors included anemia (n=14), previous cesarean section (n=12), and delays in accessing care. Protective factors identified were timely antenatal visits, spontaneous labor, and quality hospital-based multidisciplinary care. Conclusion: MNM remains highly prevalent, especially in LMICs, with preventable factors playing a dominant role. Targeted public health interventions to improve antenatal care coverage, early risk identification, and emergency obstetric services are essential to reduce the burden of MNM and improve maternal outcomes.
Copyright (c) 2025 Kiran Saeed, Nimra Abid, Syeda Tahira Sherazi, Sadaf Fayyaz, Sariya Tul Tahira (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness and side effects of Syanapress (subcutaneous depot medroxyprogesterone) in females of reproductive age groups
Background: Sayana Press® (injectable contraceptive) is associated with a high level of contraceptive efficacy. It is fascinating that the effectiveness of Sayana Press is sustained even if the time of injection is prolonged from the usual three to four months. Objective: To study the effectiveness and side effects of Sayana Press in females of reproductive age to change existing contraceptive practices. Methodology: This descriptive case series was done in a six-month duration (01-04-2023 to 30-09-2023) at the department of obstetrics and gynecology at Lady Aitchison Hospital, which enrolled 96 females after informed consent and followed up for the study duration. We obtained ethical approval and informed consent prior to conducting the study. We used SPSS-v26 for data analysis. Results: We selected 96 females of reproductive age for this study. The mean age of the patients was 31.95±5.06 years. Among 96 patients, 22 (22.9%) were nulliparous, 35 (36.5%) were primiparous, and 39 (40.6%) were multiparous. According to the efficacy of Sayana Press, it was efficacious in 66 (68.7%) patients, and 30 (31.3%) had side effects. Conclusion: The findings of the study revealed that Sayana Press was deemed satisfactory by the women within our specific demographic. The information provided by this study is of importance as it provides significant perception to the government and serves as a pivotal milestone towards the potential implementation of Sayana Press.
Copyright (c) 2025 Arooj Fatima, Mehwish Ayyaz, Aun Ali (Author) https://creativecommons.org/licenses/by/4.0
Comparison of hematological parameters of JAK2 positive and JAK2 negative patients of polycythemia vera: A mini-review
Polycythemia vera (PV) is a malignant disorder with a different frequency based upon age and population. The present review aimed to determine the frequency of Janus Kinase-2 (JAK2) positive and JAK2 negative patients with PV and compare the hematological parameters. Operating polymerase chain reaction (PCR), studies found that mutations in the patients of JAK-2 V617F gene with low serum erythropoietin (EPO) and bone marrow depicted hypercellularity with increased red cell mass. PV is a subtype of myeloproliferative neoplasms (MPN), causing hyperviscosity and thrombotic complications. It’s symptoms include fatigue, headache and pruritus. It’s incidence ranges from 0.02 to 2.8 per 100,000. The JAK-STAT pathway mainly encompasses normal blood cell production and function, but irregularities can lead to disease conditions.
Copyright (c) 2025 Adnan Khan, Afshan Nosheen, Fahad Ur Rehman, Muhammad Maaz Arif (Author) https://creativecommons.org/licenses/by/4.0
Life style medicine: An Emerging Healthier Future
Life style medicine bridges this gap by intervening in daily life habits and behaviors. Life style medicine is an evidence-based approach that works mainly in 6 domains of life style. These domains include nutrition, physical activity, stress management, avoidance of harmful substances, positive socialization and sleep hygiene. Interventions in life style of these domains help in preventing underlying causes of non-communicable diseases.
Copyright (c) 2025 Dr. Rabiah Mahwish (Author) https://creativecommons.org/licenses/by/4.0
The Importance of Hand Hygiene in the Era of Antimicrobial Stewardship
The importance of hand hygiene cannot be overstated in the fight against antimicrobial resistance. By improving hand hygiene practices, we can reduce the spread of infectious diseases, limit the use of unnecessary antibiotics, and slow the emergence of antimicrobial resistance.
Copyright (c) 2025 Muhammad Faheem Afzal (Author) https://creativecommons.org/licenses/by/4.0
Energy bar from a composite of unripe banana, sesame, and semolina flours: Development, sensory evaluation, proximate analysis, and keeping quality evaluation
Background: Globally, the popularity and market for energy bars steadily increases, especially with increasing urbanisation. Fresh bananas suffer much postharvest losses mainly due to their short green life. Semolina, a by-product of wheat is usually destined to waste despite its nutritional profile. Objective: The present study aimed at developing an energy bar from a composite of unripe banana (Musa accuminata), sesame (Sesanum indicum) and semolina flours, assessing the consumer acceptability and determining the nutrient plus keeping quality of the most accepted formulation. Methodology: A total of five energy bars from different composite flour formulations namely; A (20:20:60), B (20:10:70), C (10:10:80), D (30:30:40), and E (10:30:60) for unripe banana flour: sesame flour: semolina flour respectively were developed and tested for consumer acceptability using a nine-point hedonic scale. The most accepted energy bar formulation was further profiled for its proximate composition, selected minerals’ content, and keeping quality using standard AOAC protocols. Results: Formulation D provided the most accepted energy bar regarding the texture, taste, plus overall acceptability, whereas the least accepted sample for most sensory attributes was from formulation A. No significant difference existed in colour for all the formulations. The most accepted energy bar contained 5.72% moisture, 1.02% ash, 5.39% crude protein, 2.94% crude fat, and 4.33% dietary fibre.This energy bar provided a high percentage of carbohydrates and energy value i.e. 72.98% and 1440 KJ/100g (360 calories) respectively. Its mineral analysis revealed 110.51mg/100g of calcium, 38.407 mg/100g of iron, and 399.291 mg/100g of potassium. Indices for the keeping quality of the most accepted energy bar showed a peroxide value of 1.87 and a free fatty acids content of 0.33. Conclusion: This study developed a calories-rich energy bar which can be quickly utilised to fuel plus replenish the body in periods of high energy demand or as an energy-dense snack for people who dont have enough time for meal preparation, manifested in its high carbohydrate content and energy value obtained. Other than increasing the accessibility to cheap high-energy food sources, the present study showed potential of reducing post harvest losses of unripe bananas.
Copyright (c) 2025 Masuma Yaseen, Nakyinsige Khadijah, Babirye Babirye, Abbas Kisambira, Aqsa Abid (Author) https://creativecommons.org/licenses/by/4.0
Mechanistic Pathways Linking Posttraumatic Stress Disorder, Sleep Dysregulation, and Cardiovascular Disease: An Integrative Review
Emerging longitudinal studies establish posttraumatic stress disorder (PTSD) as a significant predictor of cardiovascular disease (CVD). The association is determined by a complex interplay of physiological and behavioral mechanisms. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, autonomic nervous system dysfunction with chronic systemic inflammation are key contributors. Behavioral factors like physical inactivity, smoking, and poor dietary habits further elevate CVD risk. The review highlights that sleep disturbances as a critical, modifiable risk factor linking PTSD and CVD. Sleep dysregulation is a hallmark symptom of PTSD and a well-established risk factor for CVD. Exposure to trauma often leads to persistent sleep problems, including insomnia, nightmares, and sleep fragmentation, these disturbances have direct Cardiotoxic effects like increased sympathetic activation, endothelial dysfunction, and elevated inflammation. Although, even with clear connections, research examining sleep as a mediator in the PTSD-CVD relationship remains limited. Addressing these gaps is essential for understanding the internal mechanisms and developing targeted interventions. Sleep-focused interventions could potentially mitigate CVD risk in trauma exposed individuals with PTSD. Furthermore, integrating sleep assessment into routine PTSD care could improve risk stratification. Behavioral medicine models should prioritize sleep health as a modifiable target for CVD prevention, by addressing sleep disturbances in PTSD populations and advanced precision-based strategies to reduce CVD risk. This approach will not only enhance our understanding of the PTSD-CVD link but will also offer practical solutions for improving long-term health outcomes in trauma survivors.
Copyright (c) 2025 Muhammad Ajmal Dina, Anam Arshed, Arifa Jabeen, Khalid Pervaiz, Mahnoor Khan, Duaa Fatima Rana (Author) https://creativecommons.org/licenses/by/4.0
Global Health and the Role of Artificial Intelligence
Artificial intelligence (AI) is revolutionizing global health by providing novel solutions to enduring concerns. AI has shown significant promise in enhancing diagnosis and treatment accuracy, as well as in advancing healthcare delivery in low- and middle-income countries (LMICs). Technologies such as machine learning and natural language processing are now used across several medical professions, improving results and diminishing inequities. However, challenges like as ethical quandaries, insufficient infrastructure and data related biases should be addressed to provide impartial access. By promoting the collaboration, prioritizing ethical practices and investing in capacity building AI can substantially support in achieving the global health provision and many of the United Nations' Sustainable Development Goals (SDGs). As AI progresses, its integration into the healthcare systems has great potential to create more inclusive, efficient, and impactful global health framework.
Copyright (c) 2024 Asif Hanif (Author) https://creativecommons.org/licenses/by/4.0
Sociodemographic profile of females with in vitro fertilization failure
Background: Infertility affects many of the couples worldwide, bringing along enormous psychological, and physical, challenges for individuals facing it. In vitro fertilization (IVF) stands out as the most popular form of treatment available, yet the success rates of IVF depend on various factors. Objective: To explore sociodemographic profile of females with IVF failure. Methods: We designed a retrospective cohort study with the aim to identify the sociodemographic profile of females associated with pregnancy failure in infertile patients undergoing IVF. A total of 50 women patients who had unsuccessful IVF cycles were enrolled via non-probability consecutive sampling. Results: The mean age was 34.5 years with a standard deviation of 7.6 years. The mean height and weight were 156.9 cm with a standard deviation of 7.6 cm., 62.4 kg with a standard deviation of 9.2 kg, respectively. The mean BMI (kg/m²) and monthly household income (Pkr) were 23.6 kg/m² and 130,000 PKR; having standard deviation of 5.3 kg/m² and 79,600 PKR, respectively. 55% of participants were housewives, and 45% were employed in various jobs. 56.2% of participants resided in urban areas, while 43.8% lived in rural areas. Lastly, 43.8% of participants have education up to primary or matriculation level, 30% have an intermediate or undergraduate education, 13.8% hold a master's or PhD degree, and 12.5% are uneducated. Conclusion: The study concluded that factors like maternal age, BMI, educational level, occupation, household income, and place of residence have significant implications for the success of IVF. These factors must be taken into consideration before planning a successful IVF and avoid unexpected failure. Keywords: Socioeconomic Factors, Age Factors, Educational Status, Marital Status, Employment, Ethnicity
Copyright (c) 2024 Shamroz Aslam (Author) https://creativecommons.org/licenses/by/4.0
Inflammatory Breast Cancer the hidden threat in oncology: A Narrative review
The understanding of inflammatory breast cancer (IBC) has advanced significantly since Dr. Haagensen established the initial diagnostic criteria in 1956 in the United States. Inflammatory breast cancer (IBC) is a rare and high destructive subtype of breast cancer, representing 1% to 6% of all breast cancer identifies, marked with rapid progression and an important tendency for metastasis, the manifesting with inflammatory symptoms in the breast that can lead to misdiagnosis as situations like mastitis. In clinically, diagnosis is based on physical signs like edema, erythema and along with histopathological evidence like dermal lymph vascular tumor emboli, and aggressive nature of IBC is evident in its poor prognosis, with survival rate five-year considerably lower than that of other breast cancer types, due to late-stage diagnosis when patients presents in advanced disease, recent progresses in the considerate of IBC have underscored the implication of its molecular characteristics in shaping treatment approaches, the embattled therapies, for HER2-positive cases, have demonstrated potential in enhancing patient outcomes when used in conjunction with neoadjuvant chemotherapy. But, the absence of standardized treatment procedures when tailored for IBC poses an important challenge, awareness of IBC increases, collaborative efforts across discipline are very important to improve early detection, and refine treatment strategies, ultimately to boost survival rates for those who are affected.
Copyright (c) 2024 Anam Arshad, Muhammad Ajmal Dina (Author) https://creativecommons.org/licenses/by/4.0
Diagnostic accuracy of 50 g glucose challenge test for screening of the gestational diabetes mellitus using 75 g oral glucose tolerance test as reference standard
Background: Gestational diabetes mellitus (GDM) is a common causative factor of grave maternal and fetal consequences. Prompt and precise diagnosis of GDM can aid in lessening the likelihood of these unfavorable outcomes. Objective: To find the diagnostic accuracy of 50 g GCT (glucose challenge test) for detecting GDM, using 75 g OGTT (oral glucose tolerance test) as the reference standard and to find complications of GDM were also reported. Methodology: A diagnostic cross-sectional study was executed at the outdoor patient department of gynecology unit, Lahore General Hospital, Lahore. It comprised of 285 pregnant females aged ≥ 18 years who were screened for GDM. All participants undertook 50 g GCT, followed by 75 g OGTT. Result was considered true positive if GDM was reported on both tests. A 2x2 table was made to estimate the sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV) and diagnostic accuracy of GCT using OGTT as gold standard. Results: Mean age of patients was 26.28±4.183 years. According to GCT, 39 (13.68%) cases were positive for GDM. On the other hand, 42 (14.74%) tested positive for GDM using 75 g OGTT. We found Sensitivity = 85.71%, Specificity = 98.77% of 50 g GCT and PPV = 92.31 % NPV = 97.56% and overall diagnostic accuracy was found as 96.84%. A total of 86(30.17%) participants reported gestational hypertension whereas Hydramnios was reported in 26 (9.12%) participants. 94(32.98%) patients underwent cesarean section due to cephalopelvic disproportion. Macrosomia, shoulder dystocia and neonatal hypoglycemia was reported in 36(12.63%), 14(4.91%) and 84(29.47%) cases, respectively. Conclusion: 50g GCT provided significantly high sensitivity and specficity for diagnosing GDM. As it is a cost-effective and provides reasonably accurate results, it can be used as an alternate to 75 g OGTT. This could aid in minimizing the maternal and fetal consequences by timely identification of the condition.
Copyright (c) 2024 Surayya Batul (Author) https://creativecommons.org/licenses/by/4.0
Frequency and risk factors associated with musculoskeletal discomfort among prolonged standing workers at the University
Background: Due to the mobility of the legs and the high degree of freedom, standing can be regarded as a diverse position. Workplace musculoskeletal discomforts (MSDs) can have serious consequences for both the affected employees and their companies. From a personal standpoint, MSDs can cause pain, discomfort, and functional restrictions, which can impair a worker's capacity to effectively carry out their job duties. Objective: To assess frequency of musculoskeletal discomfort and to evaluate the risk factors related to musculoskeletal discomfort, e.g. age, sex, body mass index (BMI), marital status, number of children, shoe preferences, profession, working experience, and standing hours. Methodology: An analytical cross-sectional study was conducted by administering a pre-designed questionnaire to two hundred and fifty-four prolonged standing workers (security guards n = 109, sweepers n = 80, messengers n = 37, and chefs n = 28) selected from The University of Lahore. The outcome variable, Musculoskeletal Disorder (MSD), was evaluated using the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), which categorized MSD scores into three levels of discomfort: mild, moderate, and severe. The data collected were analyzed by using Statistical Package for Social Sciences (SPSS) version 22. Results: MSD was most common in the foot 42.2%, lower legs 29.1%, lower back 11.4%, and hip 10.0%, according to the CMDQ tool. More than half (51.9%) of the participants reported no musculoskeletal discomfort, while the remaining participants reported varying levels of discomfort. The prevalence of discomfort was 25.5% mild, 11.9% moderate, and 10.7% severe. Gender, occupation, age, standing hours, daily working hours, weekly working hours, and shoe preference were directly associated with MSDs. Logistic regression analysis revealed that gender, age, profession, and break time were significant predictors of WRMSDs in workers. Conclusion: This study found a high prevalence of musculoskeletal disorders (MSDs) among prolonged standing workers, with lower back and foot pain being the most common complaints. Male workers, older workers, and those with less frequent breaks were more likely to experience MSDs. Implementing regular breaks and ergonomic training may help reduce the risk of MSDs among prolonged standing workers.
Copyright (c) 2024 Zubia Yaqoot, Iqra Hamid Khan, Iqra Yaqoot (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of a picture exchange communication system (PECS) on dental plaque and oral health of children with autism
Background: Children with autism spectrum disorder (ASD) often face challenges in communication and social interaction, impacting their oral health. The Picture Exchange Communication System (PECS) has shown promise in improving communication skills in individuals with ASD. This study aims to investigate the effectiveness of PECS in reducing dental plaque and improving oral health outcomes in children with ASD. Objective: To evaluate the effectiveness of Picture exchange communication system as an intervention strategy on dental plaque and oral health in children with autism spectrum disorder. Methodology: This was a quasi-experimental study. Using PECS as a pictures/cards series showing a structured tooth brushing method, 30 children with ASD and their parents/caregivers were trained on tooth-brushing twice, 2 weeks apart. Data collected after examinations (baseline, 3 months follow up) included gingival and plaque indices (GI, PI) and DMFT score. Results: The mean pre-intervention PI score was 2.32 ± 0.44, which decreased to 1.67 ± 0.42 post-intervention phase. The mean difference in PI was 0.65 ± 0.26. The paired t-test result was 13.794, with a p-value of <0.0001, indicating a highly significant reduction in PI scores post-intervention. The mean pre-intervention GI score was 1.18 ± 0.49, which decreased to 0.85 ± 0.50 post-intervention. The mean difference in GI was 0.33 ± 0.32. The paired t-test result was 5.634, with a p-value of <0.0001, indicating a highly significant reduction in GI scores post-intervention The mean pre-intervention DMFT score was 3.17 ± 3.51, which slightly decreased to 3.13 ± 3.51 post-intervention. The mean difference in DMFT was 0.03 ± 0.18. The z-test (Wilcoxon Signed Ranks Test) result was -1.000, with a p-value of 0.317, indicating no significant change in DMFT scores post-intervention. Conclusion: PECS was useful in improving teeth brushing practices, oral health and gingival and plague indices, indicating improvement in gingival health in children with ASD.
Picture Exchange Communication System (PECS)
Copyright (c) 2024 Noor ul Ain Munawar, Babar Orangzaib Wattoo (Author) https://creativecommons.org/licenses/by/4.0
The impact of maternal health literacy on pregnancy outcomes: A systematic review
Background: A good level of maternal health literacy is important for pregnancy outcomes. The concept comprises the knowledge, use, and decision-making aspects that a woman possesses to manage health related information that impacts prenatal care, self-management of diseases, and other managerial health solutions. Low HL is predictive of complications during pregnancy and the common indicator of premature birth and low birth weight. Objective: The purpose of this research is to quantify the effects of maternal health literacy on preterm birth, birth weight, and maternal morbidity so as to quantify the correlation coefficients. Methodology: Study design : A systematic review. Duration and place of study : The study was done in 3 months at AJK Medical College. Data collection methods: This systematic review has expanded from 25 studies identified through PubMed, Scopus, and Web of Science that target maternal health literacy and pregnancy outcomes. Quantitative aspects were reported as mean age, standard deviation, and p-values were obtained and cross-compared across the different studies. Selection criteria concerned female subjects aged 18-45 with no comorbidities that would affect their pregnancy outcomes. Results: The study sample comprised the 1,200 patients, with a mean age of 29.4 years (±5.8 years). Statistical analysis revealed that maternal health literacy was to some extent predictive of birth outcomes. Maternal health literacy showed a significant negative correlation both to preterm birth (Z = -2.569, p <0.05) and low birth weight (Z = -3.246, p <0.01 ). A study highlighted higher maternal morbidity where clients with higher health literacy levels recorded lesser gestational diabetes than those with low health literacy levels (p < 0.05). Other utilisation-focused health literacy interventions improved the receiver’s compliance with antenatal clinic attendance and even healthier delivery outcomes. Conclusion: The present research is to describe and explain changes in maternal health literacy and its impact on pregnancy outcomes regarding preterm births, low birth weight, and maternal morbidity. Health literacy should form part of prenatal care, especially for females who have low access to quality care, in order to enhance the overall maternal and neonatal health. Keywords: Health knowledge, pregnancy outcomes, premature delivery, antenatal care.
Copyright (c) 2024 Parsa Ahsan (Author) https://creativecommons.org/licenses/by/4.0
Comparative effects of home-based stabilization and Kegel exercises on low back pain, disability and quality of life in postnatal females
Background: Lower back pain is the most common musculoskeletal postnatal problem and effects the quality of life in postnatal women. Hormonal changes occur in pregnant females and due to which they experience hormonal induced hyper-mobility which results low back pain and decrease joint stability. The optimal biomechanics restoration is amongst goal of physiotherapy of lower back pain in postnatal women. Objective: To find out the comparative effects of home based stabilization and kegel exercises on low back pain, disability and quality of life in postnatal females. Methods: This randomized clinical trial was conducted at the Family Hospital in Lahore. 22 postpartum mothers were divided into two groups ; Home-based stabilization exercises and kegel exercises. For six months, each exercise was done three times daily with 10 repetitions and a holding period of 5 to 10 seconds. The outcome was assessed using the Oswestry Disability Index for pain-related disability and the visual analogue scale for lower back pain and life's quality of life using the Short Form 36. Before and after the treatment's first six weeks, all results were evaluated. The data was examined using SPSS 21. Results: According to the study, the statistically significant p value for the pretreatment session of the two groups' visual analogue scales was 0.762, which was higher than the statistically significant p value for the post treatment session, which was 0.384 for both groups' pain intensity. Pretreatment session for both groups' Oswestry disability indices had a statistically significant p value of 0.805, which was higher than post treatment session's statistically significant p value of 0.719 for both groups' disabilities. The statistically significant value for both groups' SF36 pretreatment sessions was 0.620, which was lower than the value for both groups' SF36 post treatment sessions, which was 0.894. Conclusion: The results of the current study showed that while both regimens were equally successful in reducing low back pain and pain-related impairment, there was no discernible difference in quality of life.
Copyright (c) 2024 Mehak Hassan, Hina Gul, Mehwish Fatima, Amina Batool (Author) https://creativecommons.org/licenses/by/4.0
The Role of medical statistics in Pandemic response and Preparedness
Applying medical statistics, we can solve public health issues more effectively and efficiently, which offers an evidence-based framework for managing infectious diseases or pandemics. Biostatistics will continue to play its important and critical role in protecting global health challenges as long as pandemics are a point of concern.
A cross‐sectional study of emotional exhaustion among parents of autistic children in Pakistan
Background: Emotional exhaustion is globally renowned terminology and described as feeling of being emotionally overstretched, or drained of one's emotional and physical resources. Parenting an autistic child has severe consequences for not only the autistic child but the parents as well. Most of the parents go through stress, phases of skepticism, suspicions, highly grief and despair, self-accusation and guiltiness, while remaining go through the feeling of inability to help and persistent shock. Objective: This study was designed to find out the level of Emotional Exhaustion in the parents of autistic children. Methodology: The study used an exploratory cross-sectional study design. The sample size was N=60 out of which 30 were mother and 30 were fathers. The sample consisted of parents (both Gender), with at least one autistic child, parents’ Age range of was 18 years to 50 years, Divorced and Widowed family was excluded, Family with husband having more than one wife were excluded, Age of the autistic Child/Children range between 4 year- 26 years. Parental Burnout Assessment sub-scale (Emotional Exhaustion) was partially used as a survey questionnaire for data collection. Results: There was substantial variance found in the mean of emotional exhaustion in fathers was 13.73±9.80 and mean score in mothers was 18.46±13.61. 68% parents were less emotionally exhausted, 15% were moderately exhausted and 21% were high at emotional exhaustion. Conclusion: The current study conclusively showed that mothers were more emotionally exhausted than fathers.
Emotional Exhaustion, Burnout, Autism- spectrum disorder, Autism, Parents
Copyright (c) 2024 Muhammad Yahya Qureshi, Asma Zafar, Umber Nawaz (Author) https://creativecommons.org/licenses/by/4.0