Pioneer Journal of Biostatistics and Medical Research
Pioneer Journal of Biostatistics and Medical Research (Pioneer J Biostat Med Res) is an international, peer-reviewed, open-access journal published quarterly. The journal publishes high-quality research in biostatistics, medical statistics, epidemiology, public health, clinical research, and related health sciences. PJBMR welcomes original research, systematic reviews, meta-analyses, methodological studies, clinical investigations, and other scholarly contributions from clinicians, biostatisticians, statisticians, epidemiologists, pharmacists, and health researchers worldwide. The journal is committed to scientific rigor, research integrity, innovation, and evidence-based healthcare. Fees and Funding PJBMR is a fully open-access, no-fee journal. There are no submission fees, article processing charges (APCs), or publication fees. The journal operates independently and is committed to equitable publishing, editorial independence, and open science.
Medical Research and Statistical Consultancy Training Centre (MRSCTC)
How Pregnancy Affects Blood Flow in the Kidneys: A Doppler Ultrasound Study
Background: During pregnancy, the kidneys undergo significant physiologic and hemodynamic adaptations, such as increased renal blood flow and GFR. Renal Doppler ultrasonography is a non-invasive and reliable tool for monitoring these changes through measurements of some parameters like Resistive Index (RI) and Pulsatility Index (PI). But there are not enough regional data on trimester-specific changes of these indices especially in low and middle income countries, like Pakistan. Objective: This study was designed to investigate and compare parameters of Doppler ultrasound of renal arteries (RI and PI) in pregnant women in all trimesters, non-pregnant women, find local reference values and examine the changes in these parameters during pregnancy. Method: A cross sectional analytical study was done among 200 women (148 pregnant and 52 non-pregnant) at THQ Hospital Sabzazar, Lahore. Convenience sampling was used for the recruitment of participants. The Doppler measurement of the renal blood flow was performed using a Canon Xario 100 G ultrasound machine equipped with convex probe 3.5 MHz. Independent sample t-tests were used to compare pregnant and non-pregnant groups and one-way ANOVA was used to show differences between pregnancy trimesters. P value of < 0.05 was taken as significant. Results: The values of RI and PI were significantly lower in pregnant women than in non-pregnant women for both kidneys (p < .05). Right RI was higher in non-pregnant women (M = 0.63, SD = 0.05) compared to pregnant women (M = 0.59, SD = 0.05), t (198) = 3.10, p = .002, Cohen’s d = 0.60. Similar significant increases were observed for Right PI (p = .026), Left RI (p = .006), and Left PI (p < .001). In the trimesters, there were fluctuations but these were not statistically significant, so it did not show a consistent and progressive increase in vascular resistance with increasing gestation in this sample. Conclusion: The findings confirm that renal artery Doppler indices RI and PI significantly declined during pregnancy, with notable differences across trimesters. The changes are indicative of physiological adaptations and emphasize the need to have local reference values for correct interpretation.
Copyright (c) 2026 Iqra Nawaz, Aruj Latif, Syed Muhammad Yousaf Farooq, Muhammad Farrukh Asif, Anum Khalid (Author) https://creativecommons.org/licenses/by/4.0
Association of Polycystic Ovary Syndrome with Stress and Life Satisfaction Among Young Female University Students
Background: PCOS is a widespread endocrine disease in women of reproductive age, which is accompanied by severe metabolic and reproductive dysfunctions. In addition to its physical expression, it is also becoming known to have a psychological toll, such as stress and decreased satisfaction in life. Objective: The research paper aimed to examine the relation between polycystic ovary syndrome (PCOS) and perceived stress and life satisfaction in female university students. Methods: The cross-sectional design was used, and 400 students aged 18-25 years were used to gather the data through convenience sampling. Symptoms of PCOS were evaluated with the help of the Polycystic Ovary Syndrome Questionnaire (PCOSQ), whereas stress and life satisfaction were measured with the help of Perceived Stress Scale (PSS-10) and Satisfaction with Life Scale (SWLS), respectively. Results: The descriptive statistics, Pearson correlation, and linear regression analyses were performed. Findings showed that perceived stress (β = .34, p <.001) and life satisfaction (β = -.15, p <.05) had a significant relationship with PCOS symptoms. PCOS had a variance of 12% in the stress and 2% in life satisfaction. Conclusion: The results indicate the mental cost of PCOS in young women and emphasize the importance of a combined health intervention.
Copyright (c) 2026 Tooba Riaz Chaudary, Bisma Ejaz, Yasmeen Niazi, Muhammad Moazzam (Author) https://creativecommons.org/licenses/by/4.0
Development and Characterization of Barley-Based Cookies for Adolescent Nutrition
Background: In Pakistan, many adolescents still do not get enough nutrients from their daily diet. A low-cost snack made with locally available ingredients can therefore be a useful extra food item, especially when it provides better energy and nutrient value. Objective: This study aimed to prepare cookies with increasing levels of barley flour replacement (0, 10, 20, 30 and 40%) and assess their proximate composition, energy value, antioxidant activity, mineral profile, FTIR characteristics, physical quality, color and sensory acceptability. Methodology: The study was conducted at University of Engineering and Technology (UET), Lahore, Pakistan from 2022-2024. FTIR analysis was performed at the Department of Chemistry, University of the Punjab, Lahore. Cookies were prepared by replacing wheat flour with barley flour at five levels: 0, 10, 20, 30 and 40%, and the samples were labelled as T0, T1, T2, T3 and T4. All formulations were analyzed for proximate composition, calculated energy value, physical quality, color, antioxidant activity, mineral content, FTIR bands and sensory acceptability. The data were statistically analyzed using one-way ANOVA followed by Fisher’s LSD test at p < 0.05. Results: Barley flour addition noticeably influenced the quality of the cookies. Moisture remained within a low range, whereas protein, fiber, ash and fat showed an overall increase with the incorporation of high barley flour. Nitrogen free extract (NFE) decreased, and the calculated energy value ranged from 451.09 to 462.88 kcal/100 g. Antioxidant values improved with the addition of barley; the highest TPC, TFC and DPPH activity were recorded in T4 treatment. Calcium and sodium were highest in T3, whereas potassium was highest in T0. Higher barley levels made the cookies darker and firmer, but all sensory scores remained above 7.0. FTIR spectra showed bands related to proteins, lipids and other fiber components. Conclusion: Barley flour improved the nutritional and antioxidant profile of the cookies without reducing sensory scores below the acceptable range. The product may be considered as an energy-dense supplementary snack option, but shelf-life, microbiological stability and target-consumer testing are needed before any health-related claim is made.
Copyright (c) 2026 Komal Azam (Author); Maha Hanif (Translator) https://creativecommons.org/licenses/by/4.0
Parental Burnout Among Married Parents in Urban Pakistan: Prevalence, Sociodemographic Correlates, and Emotional Regulation Patterns — A Cross-Sectional Study
Background: Parental burnout is a public health issue that is a growing concern because it is a state of parental role extinction, emotional distance from the children and a general feeling of incompetence. Although its adverse effects are well documented such as child neglect and breakdown in family bonding, there is almost no available empirical evidence on this issue in a collectivist society like Pakistan having a diverse socio-cultural risk profile of more than 230 million population. Objective: The aim of this cross-sectional study was to estimate the prevalence of parental burn out among married parents in urban Lahore, to explore the relationship between parental burnout and sociodemographic correlates (gender, education, professional activity, financial status) and to determine the link between parental burnout and emotion regulation. Methods: The study used a convenience sampling technique to recruit a total of 500 married parents (51.2% mothers and 48.8% fathers) with at least one child aged 2-12 years from community centers, school networks, and parenting groups in Lahore between June and October 2025. Parental Burnout Assessment (PBA; α = .985) and Emotion Regulation Questionnaire (ERQ; α = .944) were completed by trained interviewers. For analysis, Pearson correlations, point-biserial correlations and chi-square tests were employed. A clinically significant prevalence of 27.2% was seen with 15.2% in a mild, 6.2% in a moderate, and 5.8% in a severe burnout level. There was a strong negative correlation between emotion regulation and parental burnout (r = −.727, p < .001). Burnout also was marginally slightly associated with gender (r = .128, p = .004) with mothers reporting marginally higher scores. The financial condition was weakly but significantly related to burnout (r = .109, p = .015), whereas professional activity and educational level were not related to burnout. Conclusion: Over a quarter of urban Pakistani parents exhibited clinically significant parental burnout, and emotion regulation proved to be the most significant protective factor. The results highlight the pressing need for culturally sensitive mental health interventions and policy interventions for parents in Pakistan.
Parental burnout, emotion regulation, urban Pakistan, prevalence, sociodemographic correlates, cross-sectional study
Copyright (c) 2026 Muhammad Yahya Qureshi, Amjad Tufail, Umber Nawaz, Rubab Shoukat, Aqeel Tariq (Author) https://creativecommons.org/licenses/by/4.0
Psychosocial Effect of Malocclusion on Young Adults
Background: Malocclusion can have a negative impact on the psychological health, social interactions and self-esteem of a person, especially when it happens during young adulthood. Knowledge of the psychosocial effects of malocclusion and the correlation of malocclusion severity and its effects is important in planning orthodontic treatment that is geared toward the patient's needs and enhancing their quality of life. Objectives:To assess the effect of malocclusion from a psychosocial aspect and to see if this is correlated with the severity of malocclusion, and to see if there is a difference between males and females in this correlation. Methods: This study was conducted at the Department of Orthodontics, Punjab Dental Hospital, a high-volume teaching hospital with an OPD of around 150 orthodontic patients daily, ensuring adequate recruitment. A convenience sampling technique in a cross-sectional design was used to sample young adults (ages 18 to 28) who fulfilled the inclusion and exclusion criteria. The validated Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was used to gather data as well as malocclusion assessment was carried out using the Index of Orthodontic Treatment Need (IOTN). Ethical approval was obtained, and informed consent, confidentiality, and participants’ rights were strictly maintained. Results: Among 279 young adults, malocclusion was associated with varying psychosocial effects. The mean total PIDAQ score was 36.26 ± 15.25, with higher scores reflecting greater psychosocial burden. While participants reported moderate concerns in self-confidence, social, psychological, and aesthetic domains, Spearman correlation showed no significant relationship between severity of malocclusion (IOTN grade) and psychosocial effect (all p > 0.05). Conclusion: Malocclusion exerted a psychosocial effect on young adults, particularly affecting dental self-confidence and psychological well-being. However, the severity of malocclusion showed no significant correlation with psychosocial outcomes, except for higher psychological impact reported among males.
Malocclusion; Psychosocial Impact; Dental Aesthetics; Orthodontics; Young Adults; Gender Differences
Copyright (c) 2026 Dr. Joshua Javaid, Dr. Dephney Helen Khokhar, Dr. Javed Iqbal, Dr. Maloney Karen Javed (Author) https://creativecommons.org/licenses/by/4.0
Regulating Artificial Intelligence in Clinical Medicine: Governance Framework Principles for Safe and Accountable Implementation
Artificial intelligence (AI) is transforming the field of clinical medicine at a fast rate. AI is being used in the field of clinical medicine in areas such as diagnostic imaging, prediction, documentation, and large language model-based clinical reasoning tools such as ChatGPT. Algorithm-based triage tools are also being used in clinical settings such as hospitals. Radiology departments are also using AI-based detection tools. However, the rate at which AI is transforming the field of clinical medicine is much higher than the rate at which the regulatory bodies are keeping pace with the developments in the field. Even though the Food and Drug Administration (FDA) has developed a pathway to regulate AI-based Software as a Medical Device (SaMD) and machine learning-based technologies, the current system that is in place to ensure the safety and efficacy of these technologies was developed to ensure the safety and efficacy of static technologies and not those that have the capability to learn. The rate at which AI is being incorporated in the field of clinical medicine is much higher than the rate at which these technologies are being regulated. The issue of clinical AI governance is not about the regulation of AI; it is about patient safety. This article outlines the need for a structured framework of five principles of safety, accountability, fairness, explainability, and adaptive oversight.
Copyright (c) 2026 Nauman Ismat Butt (Author) https://creativecommons.org/licenses/by/4.0
Integrating Artificial Intelligence, Statistics, and Health: Toward a Translational and Trustworthy Evidence Ecosystem
Regarding public health, the statistics and artificial intelligence (AI) combination has many advantages. Improvement in monitoring of disease, outbreak prediction, and resource allocation are managed through the analysis of data. In terms of international health crises, such as pandemics, AI-based models along with epidemiological statistics are utilized to make policy decisions, enhance the management strategies, and follow the effectiveness in the population. Even so, these AI uses must be guided by statistical ideals, which preclude confusing inferences as well as unintended results.
Copyright (c) 2026 Ravi Kant, Saurabh Mazumdar (Author) https://creativecommons.org/licenses/by/4.0
Frequency and risk factors of prehypertension among patients aged 35 years and above in Samanabad Lahore
Background: Prehypertension often turns into Hypertension, putting a person at risk for heart disease and a stroke. Objective: The current investigation was planned to investigate prehypertension's prevalence and risk factors among individuals living in Samnabad, Lahore. Methodology: It is a descriptive-analytical study. The sample size was 192 individuals who were recruited via convenient and purposive sampling from the area of Lahore, Samanabad. Participants' blood pressure was recorded twice, and an average of the blood pressure record and other data in terms of demographic variables and risk factors were gathered by a self-developed questionnaire. The latest version of SPSS was utilized to analyze the data. Descriptive analysis, Chi-square, ANOVA, and Wilcoxon test were used to study the data. Results: the study findings revealed that the adjusted prevalence of prehypertension is 26%, there was higher prevalence of prehypertension in male as compared to females, and the frequency declined with age. A rise in BMI was associated with an increase in the prevalence of both prehypertension and hypertension. High cholesterol, diabetes, smoking, and an elevated heart rate were all found to be risk factors for both Prehypertension and Hypertension. Prehypertension was strongly linked to a high-calorie intake. Male gender, obesity, smoking, salt intake, and diabetes were all linked to prehypertension, p< 0.05. Conclusion: An alarming number of participants are pre-hypertensive, highlighting the need for early prevention programs to improve awareness, early screening, and lifestyle change to limit the rising burden of Hypertension and its associated problems.
Copyright (c) 2026 Sajid Mukhtar, Ammara Waqar (Author) https://creativecommons.org/licenses/by/4.0
A Cross-Sectional Survey on the Professional Scope of Sonographers in Pakistan
Background & Objective: Sonographers play a critical role in diagnostic imaging, however, their scope of practice in Pakistan remains underexplored. This study aimed to determine the scope of practice of sonographers in Pakistan and to evaluate whether their responsibilities correspond to globally recognized standards of sonography. Another purpose of the study was to identify the gaps in the training, professional recognition, and clinical autonomy. Material and Methods: A cross-sectional survey, was distributed among the practicing sonographers within the public and the private healthcare facilities in Pakistan. The prospective participants had at least 2 years of clinical experience. The survey questions asked about the demographics, education, training background, certification status, specialties being practiced, job title, institutional policies, and indicators of scope of practice. Results: A total of 206 responses were analyzed. The majority of participants were female (63.1%) and under the age of 35 (89.3%), indicating a young and predominantly female workforce. Most held either a Master’s (44.7%) or Bachelor’s degree (40.8%), and 66% identified as staff sonographers. The most frequently practiced specialties were abdominal (86.4%), obstetric (62.1%), and gynecologic (61.2%) sonography. Female sonographers were primarily engaged in women’s health imaging, while male sonographers more often reported involvement in vascular (42.1%), musculoskeletal (36.8%), and procedural domains. Notably, 76.7% of respondents lacked formal credentials. Participants also reported performing a wide range of additional tasks, such as patient education, training students, and assisting with administrative duties. Common workplace challenges included inadequate pay, overbooked schedules, and limited time per patient. Conclusion: The findings highlight significant disparities in training, credentialing, and role distribution among sonographers in Pakistan. While sonographers contribute extensively to clinical care, many undertake responsibilities that extend beyond their official job descriptions, often without formal recognition or standardized training. The study underscores the urgent need for national guidelines, certification requirements, and structured professional development pathways to ensure equitable, safe, and standardized sonographic practice in the country.
Copyright (c) 2026 Syed Muhammad Yousaf Farooq, Syed Amir Syed Amir Gilani, Yasmeen Niazi, Muhammad Uzair, Muhammad Irshad-Ul-Haq, Sohaib Khurram (Author) https://creativecommons.org/licenses/by/4.0
The Cox model of predicting adverse maternal outcomes of preeclampsia / eclampsia at the Federal Teaching Hospital, Birnin Kebbi, Nigeria
Introduction: Preeclampsia and eclampsia are the foremost reasons behind feto-maternal morbidity as well as mortality, particularly in developing nations, and are a common cause of pregnancy complications globally. The Cox regression model is utilized for the identification of adverse maternal consequences of preeclampsia/eclampsia, which is imperative in effectively managing preeclampsia/eclampsia patients. Objective: The study aimed to recognize the maternal adverse consequences of preeclampsia and eclampsia among women with pregnancy-induced hypertension in Northwest Nigeria using the Cox proportional hazards model. Methods: This retrospective research was performed among preeclampsia/eclampsia cases attending the Federal University Teaching Hospital, Birnin Kebbi, Kebbi State, Nigeria. Data were extracted from patients’ charts using a proforma. Descriptive analyses were calculated, and the Cox regression model was used for the analysis to determine the adverse maternal outcomes of preeclampsia/eclampsia in the study area. Results: The Cox regression model results identified six maternal outcomes of preeclampsia/eclampsia: stillbirth, placenta abruption, premature birth, maternal demise, low birth weight and unconsciousness as statistically significant and clinically plausible maternal consequences behind preeclampsia or eclampsia. Conclusion: The findings of this research provided the unfavorable maternal consequences of preeclamptic/eclamptic cases in FTH Birnin Kebbi, which affirms that preeclampsia/eclampsia are causes of both fetomaternal morbidity as well as mortality. Employment and continuous training of healthcare professionals, especially in rural areas, should be considered a priority; creating awareness of preeclampsia and eclampsia should be raised, focusing on younger women and women of childbearing age.
Copyright (c) 2026 Temitope Folasade Atamamen, Nyi Nyi Naing, Nadiah Wan-Arfah, Benson Macauly Oweghoro, Elizabeth Tunrayo Oluwole (Author) https://creativecommons.org/licenses/by/4.0
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
Sonographic Correlation between objective spleen parenchymal echotexture and Hematological parameters in children with sickle cell disease
Background: Children with sickle cell disease (SCD) are frequently evaluated for spleen involvement using laboratory markers and subjective ultrasound interpretation. Quantitative ultrasound echotexture analysis could offer an objective way to assess spleen parenchymal alterations. Although its relationship with hematological markers of spleen function is not well established. Aim: The study assessed the relationship between selected hematological parameters and quantitative ultrasonography spleen parenchymal echotexture in children with sickle cell disease. Methods: In this cross-sectional study, children with SCD underwent standardized B-mode ultrasound scan of the spleen. Quantitative echotexture measures, including mean pixel intensity (MPI), were extracted from defined regions of interest using a validated MATLAB algorithm. Hematological parameters; white blood cell (WBC) count, red blood cell (RBC) count, and platelet count were obtained on the same day. Pearson correlation coefficients were used for analysis. Results: Mean Pixel Intensity showed a statistically significant moderate positive correlation with WBC count (r = 0.53, p = 0.002). Correlations between MPI and RBC count (r = 0.09, p = 0.58), platelet count (r = 0.18, p = 0.27) were weak and not statistically significant. Conclusion: Quantitative spleen echotexture, assessed via pixel intensity analysis, is meaningfully associated with WBC count in children with SCD. Mean pixel intensity may serve as a promising non-invasive imaging biomarker, complementing hematological assessment and enhancing the objectivity of spleen ultrasound evaluation.
spleen; sickle cell disease; ultrasound; echotexture; pixel intensity; hematological parameters
Copyright (c) 2026 Muhammad Jamma, Dauda Mohammed (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
Statistical assessment of chronic and acute kidney disease trends in a Nigerian Tertiary Hospital (2019–2024)
Introduction: Kidney disease is a global public health burden, and it is especially serious in low-resource settings like Nigeria. Epidemiology of diseases are dictated by temporal, seasonal as well as demographic factors but longitudinal studies from a tertiary hospital in Nigeria are limited. Objective: The objectives of this study are to describe the temporal seasonal patterns in the monthly incidence of kidney disease at the University College Hospital (UCH) Ibadan, January 2019- December 2024 and to ascertain if there is a statistically significant association between the sex of the patient and type of kidney disease chronic kidney disease (CKD) or acute kidney injury (AKI). Methods: Retrospective longitudinal ecological research was conducted using measured aggregate secondary data on 7038 kidney diseases that were reported to the UCH from January 2019 to December 2024. Trends and seasonality were separated using additive time series decomposition. Statistical significance of monotonic temporal trends was assessed using the Mann–Kendall test while the association of patient sex and type of disease was evaluated. Results: The average monthly observation over 72 months indicated cases. According to the Mann–Kendall test, total monthly cases show a statistically significant declining trend The same is true for all subgroups except female CKD . We observed a yearly cycle with peaks in Q1 and troughs in Q2. Among the total 7,038 cases, there were male and female. AKA was seen in cases and CKD in 3,463 (49.2%). The association between sex and type of disease was noted to be significant with a predominance in males for AKA and females for CKD. Conclusion: Over a period of six years at SUCH Ibadan, there has been a significant overall decline in the incidence of kidney diseases. Also, we observed seasonal and sex differences in disease type. These findings warrant planning for targeted surveillance, sex-stratified prevention and resource planning during high-risk seasons.
Kidney disease, Seasonal variation, Temporal trends, Sex differences, Acute kidney injury
Copyright (c) 2026 Alfred Ayo Ayenigba, Moses Sunday AFARIOGUN, Victoria Ayomide ADESOJI (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