Journal of medical & health sciences review.

Background: Wearable IoT devices with artificial intelligence are set to change occupational health by allowing near real-time worker tracking and safety assessment. These technologies can enhance workplace safety, decrease the rate of accidents, and assess the health of workers who are involved in the construction, manufacturing, or logistics sectors. However, the levels of adherence to these devices as well as the perceived utility of the devices differ between one user and another. Objectives: The aim and objectives of the work include a quantitative analysis of the effectiveness, satisfaction, and impact of wearable IoT devices with AI for real-time health monitoring and risk assessment. Instead, it focuses on examining precursors to device usage and how ergonomic technologies are perceived by workers in the area of safety enhancement. Methods: An online self-administered was done on 250 participants in industries that adopt wearable IoT devices. The key variables of frequency, satisfaction, perceived usefulness of health monitoring, and safety analytics generated from AI were captured using a Likert scale questionnaire. Data analysis was done by use of descriptive statistics, inferential statistics, Shapiro-Wilk normality test, Cronbach’s Alpha reliability coefficient test, and linear regression analysis. Results: Descriptive analysis showed that the age ranged from 17–56 years and age was skewed, W(821) = 0.960, P value = 0.000, Shapiro and Wilk's test showed that age was non-normal shaped which indicates different levels of adoption among age groups. The test-retest reliability of Cronbach’s Alpha was 0.014, for the Likert scale items of the survey, indicating a low internal consistency because of the multi-faceted nature of the worker experience. Those who reported how often they used devices differed in their responses with over half claiming that they used devices occasionally, whereas the perceived efficacy of health monitoring was relatively lower, with almost a quarter of the respondents stating that they found health monitoring to be only somewhat effective or not at all effective. Conclusion: The study shows how occupational health and safety can be enhanced through wearable IoT devices with AI but also clarifies some limitations in the usability of the device, the training of the end-users, and how the survey should be designed. Albeit, adoption has risen over time, daily usage is still low, and they do not have one view of it as being effective. Professoring and resolving these challenges may also help improve the design and bring forth better integration including safety measures in different workplaces and advance the effectiveness of these devices.

Background: Adhesive capsulitis (frozen shoulder) is a common condition characterized by pain and restricted shoulder range of motion (ROM), significantly affecting functional independence. While several treatments exist, evidence remains limited regarding the efficacy of shoulder glides with rotation as a therapeutic intervention. Objective: To evaluate the effectiveness of shoulder glides with rotation in reducing pain and improving shoulder ROM and function in individuals with primary adhesive capsulitis. Methods: A single-masked, parallel-group randomized controlled trial was conducted over 8 weeks at two rehabilitation centers in Peshawar, Pakistan. Sixty participants aged 40–65 years with idiopathic adhesive capsulitis were randomized into two groups: an intervention group (shoulder glides with rotation and home exercise) and a control group (conventional physiotherapy). Both groups received treatment three times per week for 6 weeks. The primary outcome was the Shoulder Pain and Disability Index (SPADI); secondary outcomes included a range of motion (ROM) in flexion, abduction, and external rotation, a Visual Analog Scale (VAS) for pain, and the Functional External Rotation Reach Test (FERRT). Assessments were conducted at baseline, week 3, week 6, and week 8. Data were analyzed using repeated-measures ANOVA and intention-to-treat analysis. Results: Fifty-seven participants completed the study (SGR = 29, Control = 28). The intervention group showed significantly greater improvements in SPADI scores (Week 6: 31.4 ± 6.8 vs. 45.7 ± 7.2; p < 0.001), ROM (flexion gain: +41.5°, abduction: +41.4°, external rotation: +30.2°; all p < 0.001), and VAS for pain at rest (–4.3) and during activity (–4.5) compared to controls. Functional reach (FERRT) improved significantly in the intervention group (+13.2 cm vs. +6.1 cm; p < 0.001). Effect sizes for all key outcomes were large (Cohen’s d > 1.0). Conclusion: Shoulder glides with rotation significantly improved pain, ROM, and functional performance in patients with adhesive capsulitis compared to conventional physiotherapy. These findings support the integration of rotational joint mobilization into evidence-based rehabilitation protocols for frozen shoulders.

Background: Menopause is a natural biological transition, yet in many underserved communities, it is misunderstood as a disease, supernatural affliction, or cause of social isolation. Women face psychological distress, marital struggles, and limited healthcare access, worsening their quality of life. Objectives: This study aims to examine menopause-related stigma, psychological challenges, and healthcare accessibility gaps in low-resource settings. It presents qualitative findings from structured interviews with ten perimenopausal women to identify barriers to medical support, emotional struggles, and cultural misconceptions. Methods: A qualitative research approach was employed, including structured in-depth interviews with ten perimenopausal women from underserved communities. Thematic analysis was conducted to extract key trends regarding healthcare attitudes, social stigma, and psychological effects of menopause. Results: Interviewed women reported, Social stigma and marital distress due to misconceptions about infertility and loss of attractiveness. Severe mood swings, aggression, and depressive symptoms, often misinterpreted as mental instability. Fear of rejection or second marriages, preventing open communication with spouses about menopause symptoms Shame in discussing urinary incontinence and sexual dysfunction, leading to emotional isolation. Conclusion: Findings emphasize the urgent need for structured menopause education, accessible healthcare interventions, and culturally informed counseling services. This research advocates for policy-driven healthcare initiatives, community outreach programs, and inclusive medical training to combat stigma and improve women’s well-being.

Air pollution and climate change are two of the most pressing environmental challenges of the 21st century, posing a combined threat to both natural ecosystems and human health. While often studied separately, these issues are deeply interconnected, sharing common sources and amplifying each other’s effects. This paper explores the dual impact of air pollution and climate change, emphasizing their synergistic nature and the resulting consequences on ecological stability and public health. Anthropogenic activities such as fossil fuel combustion, industrial emissions, and deforestation contribute significantly to the release of air pollutants (e.g., particulate matter, nitrogen oxides, sulfur dioxide) and greenhouse gases (e.g., carbon dioxide, methane). These pollutants not only disrupt atmospheric composition but also lead to acid rain, ocean acidification, soil degradation, and biodiversity loss. Simultaneously, climate change exacerbates air quality problems through increased frequency of wildfires, heatwaves, and stagnant air masses. The human health implications include a rise in respiratory and cardiovascular diseases, premature deaths, and heightened vulnerability among children, the elderly, and low-income communities. This paper also discusses the socioeconomic dimensions of the crisis and highlights current mitigation and adaptation strategies, including clean energy technologies, policy frameworks, and community-based actions. By examining the interplay between air pollution and climate change, this research underscores the need for integrated, interdisciplinary approaches to achieve sustainable environmental and health outcomes. Coordinated global efforts are essential to curb emissions, enhance resilience, and safeguard both ecological integrity and human well-being.

Background: Personalized medicine has revolutionized cancer treatment by tailoring therapies to individual genetic and molecular profiles, enabling more targeted and effective interventions. Advances in genomic technologies, such as Next-Generation Sequencing (NGS), and biomarker analyses have allowed for precise identification of actionable mutations and personalized treatment strategies. However, understanding the clinical and economic implications of these approaches remains a priority to optimize their application in cancer care. Objective: This study aims to evaluate the clinical and economic impact of personalized medicine on cancer treatment outcomes, focusing on progression-free survival (PFS), overall survival (OS), quality of life, and cost-effectiveness. By comparing patients receiving personalized treatments with those undergoing standard care, the study seeks to assess the benefits and challenges associated with precision oncology. Methods: A retrospective cohort study was conducted at tertiary cancer centers, including patients diagnosed with breast, lung, and pancreatic cancer who underwent personalized medicine interventions. Genomic and molecular profiling was performed using NGS and biomarker analyses (e.g., PD-L1, EGFR, BRCA mutations). Outcomes such as PFS and OS were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards models. Cost-effectiveness was evaluated through incremental cost-effectiveness ratio (ICER) calculations. Data sources included electronic health records (EHRs), cancer registries, and genomic databases such as The Cancer Genome Atlas (TCGA). Results: Patients receiving personalized medicine interventions demonstrated significantly improved PFS and OS compared to those on standard therapies (PFS: median 12.4 vs. 8.3 months; OS: median 24.6 vs. 18.7 months, p < 0.05). Biomarker-driven therapies exhibited the highest efficacy, particularly among patients with actionable mutations such as EGFR and BRCA. Cost-effectiveness analysis revealed that personalized medicine, while initially more expensive, resulted in better quality-adjusted life years (QALYs), making it economically viable in the long term. Conclusion: The findings underscore the transformative potential of personalized medicine in enhancing cancer treatment outcomes, with notable improvements in survival and quality of life. However, high costs and accessibility challenges must be addressed to ensure broader adoption. Future research should focus on scaling these interventions and exploring their utility across diverse populations and cancer types.

Background: ST elevation myocardial infarction (STEMI) is a life-threatening condition that is often due to a thrombotic occlusion of an offending coronary artery. Measuring the degree of stenosis is important for defining risk and choosing a revascularization strategy. Objective: To establish the prevalence and extent of stenosis of culprit coronary arteries in patients with acute STEMI who are treated with primary PCI. Methods: The current study is a cross-sectional descriptive study carried out at the Department of Inpatients of Cardiology, NICVD Karachi, from October 2019 to April 2020. A total of 181 patients with STEMI undergoing primary PCI were included. Quantitative coronary analysis parameters of vessel diameter, lesion length, area stenosis, and diameter stenosis were measured through angiography. Results: Severe Stenosis (>70%) was noted among 60.2% of the patients, moderate stenosis among 26.5% of patients, and minimal stenosis among 13.3%. Severe stenosis was significantly correlated with lower TIMI flow grades and higher thrombus burden. Conclusion: Culprit arteries of STEMI have a predominant angiographic finding of severe stenosis requiring early recognition and intervention.

Chronic wound infections are a global health concern, affecting up to 4% of diabetic populations. Biofilm-producing bacteria significantly delay healing and increase multidrug resistance (MDR. This study assessed the prevalence of biofilm-forming bacteria in chronic wounds and their antibiotic resistance patterns. A total of 100 chronic wound samples were collected. Bacterial identification and biofilm quantification were performed using standard microbiological techniques, while antibiotic susceptibility testing followed CLSI guidelines. Data were analyzed using SPSS v26, with p < 0.05 considered significant. Of 100 samples, 85 (85%) showed bacterial growth. Gram-negative isolates predominated (70/85, 82.4%) over Gram-positives (15/85, 17.6%). The most frequent pathogens were Pseudomonas aeruginosa (25, mean 0.29 ± 0.06), Staphylococcus aureus (20, 0.24 ± 0.05), Escherichia coli (15, 0.18 ± 0.04), and Klebsiella pneumoniae (10, 0.12 ± 0.03). Biofilm production was detected in 62 isolates (72.9%): strong (18, 0.29 ± 0.07), moderate (25, 0.40 ± 0.09), and weak (19, 0.31 ± 0.08). Strong biofilm formation was most common in P. aeruginosa (48%, 0.83 ± 0.08) and S. aureus (20%, 0.50 ± 0.08). Antibiotic resistance was high: S. aureus showed 80% penicillin and 60% erythromycin resistance, with 35% MRSA. E. coli (40%) and K. pneumoniae (50%) were ESBL producers. Overall, 45/85 isolates (52.9%, mean 0.53 ± 0.15) were MDR, significantly higher in biofilm producers (67.7%, mean 0.68 ± 0.10) than non-producers (13%, 0.13 ± 0.05; p < 0.01). Polymicrobial infections showed greater biofilm prevalence (83.3%) and MDR (70%) than monomicrobial (45.5%). Chronic wound infections are dominated by biofilm-forming MDR bacteria, particularly P. aeruginosa and S. aureus. Biofilm formation correlates strongly with MDR, wound duration, and polymicrobial infections, emphasizing the need for anti-biofilm therapies in wound management.

Combating with food insecurity, malnutrition and achieving zero waste for the sustainable environment, there has been a surging interest in exploration of alternative techniques for extracting bioactive compounds derived from plants. Green extraction techniques have demonstrated effectiveness and economic affordability in improving the extraction of different plant derived bioactive compounds. In recent years, emphasis on good health and mental well-being has sparked a rising interest in bioactive compounds in food industries. These bioactive compounds have gained much more popularity due to their numerous health benefits. Due to this reason, the demand for these compounds has also increased, whether it extracted from edible or non-edible sources. This paper examined advanced techniques utilized in the extraction process, with a focus on their effectiveness, and specificity such as ultrasound-assisted extraction (UAE), supercritical fluid extraction (SFE), enzyme assisted extraction (EAE), pulsed electric field (PEF), pressurized liquid extraction (PLE) and microwave-assisted extraction (MAE). The concepts, benefits, and challenges of each technique have examined within the context of extracting bioactive substances, including polyphenols, alkaloids, carotenoids, flavonoids and essential oils. These approaches offered various advantages in terms of enhanced extraction efficiency, low solvent consumption and reduced processing time that would be able to meet the growing demand for sustainable decision-making in industries such as food, and pharmaceuticals. Moreover, the incorporation of green chemistry idealized to reduce the amount of solvents used and energy consumption have been emphasized, demonstrating a sustainable approach for extraction of bioactive compounds from plants. Polyphenols extracted from each technique with the specified plant source and their results have been mentioned. Lastly, this article discussed the present challenges and future recommendations in the field, to promote ongoing innovation and awareness of these methods in improving the extraction of new bioactive compounds from plant resources.

In Pakistan, where the blaCTX-M gene, specifically blaCTX-M-15, drives resistance in these pathogens, Klebsiella pneumoniae and Escherichia coli that produce extended-spectrum beta-lactamase (ESBL) are major contributors to the global antimicrobial resistance (AMR) crisis. The molecular epidemiology of blaCTX-M genes in Pakistan is summarized in this review, with particular attention paid to the genes' prevalence, genetic diversity, modes of transmission, and implications for public health. Using a "One Health" viewpoint, it investigates how zoonotic reservoirs, hospital and community settings, and environmental factors contribute to the spread of resistance. To counter this threat, novel strategies like bacteriophage therapy, CRISPR-based gene editing, and AI-driven resistance prediction are suggested. Alongside tactics like antimicrobial stewardship, advanced diagnostics, and policy reforms, public health issues such as limited treatment options, infection control gaps, and socioeconomic drivers are examined. To illustrate the clinical significance of blaCTX-M genes, a new table that summarizes their prevalence in Pakistan across a range of infectious diseases is included. The urgent need for creative, integrated solutions to reduce blaCTX-M-driven AMR in Pakistan is highlighted by this review.

One of the most frequent causes of doctor visits worldwide is gastroenteritis. Acute gastrointestinal disorders are a major medical and financial concern. Such conditions need to be managed more skillfully. There is still much to learn about how to lower the risk of intestinal infections through diet. Antibiotics can effectively inhibit infections, but they cannot be used prophylactically and should not be provided in the absence of sickness. Probiotics, or beneficial bacteria found in the gut, have been shown to have a variety of inhibitory effects on pathogens. Probiotics are currently gaining popularity due to the growing antibiotic resistance of pathogenic bacteria, especially in hospitals, as well as clinical data demonstrating the effectiveness of some probiotic bacteria. One probiotic that is good for human health is Bacillus clausii. One of its primary traits is the capacity to proliferate; the ensuing resistance to heat, acid, and salt guarantees an accessible route via the human digestive system without cellular loss. The advantageous qualities of other probiotics, like Lactobacillus and Bifidobacterium species, are more commonly known throught the literature, despite the fact that B. clausii has been utilized extensively for many years.

Introduction: Bartter syndrome is a rare autosomal recessive renal tubulopathy characterized by renal salt wasting, hypokalemia, and metabolic alkalosis. Although it usually presents during infancy or childhood, adult-onset disease is uncommon. Severe hypokalemia may cause neuromuscular manifestations such as acute paralysis and can mimic neurological disorders. Case Presentation: A 19-year-old man presented with progressive weakness and paralysis involving all four limbs. He had a previous episode of painful lower-limb cramps following gastroenteritis. Examination revealed muscle power of 1/5 in all limbs, diffuse hyporeflexia, and blood pressure of 90/60 mmHg. Laboratory investigations showed severe hypokalemia (1.4 mEq/L), alkalemia (pH 7.5), and bicarbonate of 28.7 mmol/L. Urinary investigations demonstrated renal electrolyte wasting, supporting Bartter syndrome. Duodenal biopsy confirmed severe giardiasis. Following intravenous potassium and fluid replacement, muscle weakness improved within one to two hours. Conclusion: Adult-onset Bartter syndrome can rarely present as severe hypokalemic paralysis. Early recognition and potassium replacement are essential for rapid recovery.

Background: Stiff Person Syndrome (SPS) is a rare autoimmune neurological disease, which is marked by progressive muscle rigidity and spasms, usually accompanied by anti-glutamic acid decarboxylase (anti-GAD) antibodies. Nevertheless, seronegative cases are a diagnostic dilemma since they do not exhibit characteristic serological markers. Case Presentation: We report a case of a 38-year-old male who presented with a one-year history of progressive stiffness and weakness of both upper limbs, predominantly affecting the hands. Neurological examination revealed increased muscle stiffness with preserved reflexes and normal sensory findings. Laboratory investigations including autoimmune and infectious workup were unremarkable, and anti-GAD antibodies were negative. Magnetic resonance imaging of the brain and cervical spine showed no significant abnormalities. Nerve conduction studies were normal, while electromyography demonstrated continuous motor unit activity, consistent with SPS. Conclusion: The case indicates the significance of considering SPS in patients with typical clinical and electrophysiological manifestations, despite the absence of serological markers. Seronegative SPS needs to be diagnosed at an early stage so that it can be managed properly and thus enhance the outcome of patients.

Malaria exists in epidemic form in 109 countries including Pakistan. The aim of present study was to assess the prevalence of Plasmodium species and its vectors in various altitudes of district Dir Lower, Pakistan. For this purpose, mosquitoes were collected from three different sites on the basis of altitude differences of district Dir Lower. Adult mosquitos were collected from human dwelling areas, animal rooms, rivers, farming field areas, streams, by using nets, various types of traps and sprays from January, 2021 to December, 2021. Data for prevalence of malaria was collected from District health office of Dir Lower and DHQ Timergara. A total of 9217 mosquito specimens were collected from all sites. Four species of malaria vector were prevalent as Anopheles culicifacies 3.53%, Anopheles annularies 1.93%, Anopheles stephensi 5.17% and Anopheles maculatus 1.62% in all collected mosquitos specimens. In the same area human samples were also studied. Out of total 86632 suspected cases, only 2% (1738) cases were positive for malarial infection. A total of 1676 patients were tested positive for P. vivax and 54 patients tested positive for presence of P. falciparum while only 8 patients were tested positive for mix species of Plasmodium. The prevalence ratio of P. falciparum 3.1%, P. vivax was 94.43% and 0.46% mix species in overall positive cases. So, it is concluded that P. vivax mostly causes malaria in district Dir Lower. Anopheles stephensi was abundant among all species of Plasmodium vector. However, the abundance of malarial vectors changes at different altitudes. The anopheles mosquito was abundantly present in the areas of lower altitude sites (Chakdara and Timergara) while at high altitude areas (Laram top) anopheles mosquito is rarely found.

Background: Meleney’s gangrene, also referred to as progressive bacterial synergistic gangrene, is a rare and devastating necrotizing soft-tissue infection characterized by progressive tissue destruction and substantial morbidity. Breast involvement is particularly uncommon, with cases occurring during pregnancy being exceedingly rare. The development of infective endocarditis in association with Meleney’s gangrene has also been rarely reported. Case Presentation: A 27-year-old woman at 37 weeks of gestation presented with a rapidly enlarging, painful swelling beneath the right breast. The lesion was initially lemon-sized but progressed rapidly over several days, extending laterally and involving a substantial portion of the breast and adjacent chest wall. Following hospital admission, she underwent cesarean delivery and was subsequently diagnosed with Meleney’s gangrene. Surgical debridement was performed. Laboratory investigations revealed marked systemic inflammation, including leukocytosis (22.5 × 10⁹/L), neutrophilia (85–94%), elevated C-reactive protein (up to 228 mg/L), elevated lactate dehydrogenase (365 U/L), and hypoalbuminemia (30 g/L). Tissue cultures yielded methicillin-resistant Staphylococcus aureus (MRSA). Approximately 14 days after debridement, the patient developed persistent fever and tachycardia. Blood cultures subsequently grew MRSA. Echocardiography demonstrated a small vegetation attached to the tricuspid valve, accompanied by moderate tricuspid regurgitation and preserved biventricular function, establishing the diagnosis of tricuspid valve infective endocarditis. The patient was treated with prolonged intravenous antimicrobial therapy and remained hospitalized for continued management and monitoring. Conclusion: This case highlights the rare occurrence of tricuspid valve infective endocarditis complicating Meleney’s gangrene in a term pregnant woman. Persistent fever following surgical debridement of severe soft-tissue infections should prompt thorough evaluation for ongoing bacteremia and potential endovascular complications, including infective endocarditis.

Pharmaceutical compounds and microplastics are ubiquitous aquatic pollutants that frequently co-exist in aquatic environments; however, their combined effects on fish cannot be accurately predicted from studies investigating each pollutant individually. Pharmaceutical compounds can disrupt conserved molecular targets even at low concentrations, whereas microplastics are particulate materials that also act as surfaces capable of sorbing, transporting, and releasing chemical contaminants. This review synthesizes current knowledge on the co-exposure of fish to pharmaceuticals and microplastics, with a particular focus on toxicokinetics, organ toxicity, and associated ecological risks. Findings from direct co-exposure studies indicate that interactions range from synergistic and additive to antagonistic, depending on factors such as particle size, polymer composition, plastic aging, biofilm formation, water chemistry, exposure sequence, pharmaceutical properties, and tissue-specific uptake. The intestine and the gut–liver axis have emerged as particularly vulnerable targets, while the plastisphere may harbor increased abundances of antibiotic resistance genes and exert stronger selective pressure under antibiotic co-exposure. However, most available studies have employed pristine spherical polystyrene microplastics, short exposure durations, and concentrations exceeding environmentally relevant levels. Furthermore, only a limited number of studies have incorporated mixture toxicity models or investigated sub-organismal mechanisms to predict population-level effects. Current evidence suggests that, under environmentally realistic conditions, microplastics should not generally be regarded as vectors of pharmaceutical contaminants but rather as carriers, sinks, sources, and independent stressors. Future risk assessments should prioritize environmentally aged microplastics, realistic pharmaceutical mixtures, time-dependent internal exposure, species-specific sensitivity, and adverse outcome pathways to improve ecological risk predictions.

Background: Pancreatic duct obstruction is an important clinical condition with several causes such as pancreatitis, calculi, pancreatic divisum, malignancy and choledocholithiasis. The clinical presentation varies from abdominal pain, jaundice, nausea, and is not specific, making clinical diagnosis difficult. The introduction of magnetic resonance cholangiopancreatography (MRCP) has made it a preferred technique to ERCP for imaging of the pancreatic ductal system without exposing the patient to ionizing radiation and the risks inherent in ERCP. MRCP can characterize obstruction location, type and degree of dilatation of the obstructed ducts. Objectives: To determine the frequency and etiological spectrum of pancreatic duct obstruction among patients examined with MRCP. Materials and Methods: A retrospective cross-sectional study of MRCP findings in 385 cases of pancreatic ductal obstruction was conducted in Rehman Medical Institute (RMI) and Lady Reading Hospital (LRH). Data concerning patient demographics, presenting symptoms, level and nature of obstruction, as well as etiology were recorded. Statistical analysis involved Chi-square tests to establish associations, and Bayesian estimates of pancreatic duct diameter depending on etiology. Results: Out of 385 patients, 209 (54.3%) were male and 176 (45.7%) were female. Most often, pancreatic duct obstruction occurred in the head of the pancreas (43.6%) followed by the body (37.7%). Epigastric pain was the most common presenting symptom (23.1%), then followed by abdominal pain (19.7%) and previously occurring pain/pancreatitis (19.5%). As for the nature of obstruction, stricture was the most prevalent one (27.3%), followed by pancreatitis (22.9%) and filling defect (20.0%). Calculi (22.3%) and pancreatitis (21.8%) were the leading etiologies, followed by pancreatic mass and periampullary lesions (11.2% each). Pearson Chi-Square test established a significant association between presenting symptoms and etiology of pancreatic duct obstruction (Chi-Square = 102.369, p < 0.001). No significant association was established between the level of obstruction and etiology (p = 0.125) and between gender and etiology (p = 0.146). Bayesian estimate indicated the greatest mean pancreatic duct diameter in choledocholithiasis. Conclusion: MRCP has proved to be an effective tool in elucidating the etiologic spectrum of pancreatic ductal obstruction, with calculi and pancreatitis being the commonest. The significance of the relationship between symptoms and cause underscores the importance of MRCP in diagnosis and management.

Background: Cervical cancer is a serious disease that kills many women around the world, especially in developing countries. It is mostly caused by the Human Papillomavirus (HPV). Doctors and nurses are very important because they can teach people about the HPV vaccine and help stop this cancer. Objective: The main objective of this study was to assess knowledge, attitude and practices of doctors and nurses regarding HPV vaccine, employed in tertiary care hospital, Lahore, Pakistan. This study also assesses the association between attitude and practice of participants. Materials and Methods: A descriptive cross-sectional study using an adapted questionnaire, having 3 portions of questions, knowledge questions, attitude questions, and practice questions. A total of 200 healthcare personnel (61% medical officers and 39% of nurses) took part from Fatima Memorial Hospital, Lahore. The data was collected from December 2025 to May 2026, and analyzed using Statistical Package for Social Sciences (SPSS) 26 Mean and Standard. Results: The results showed that most healthcare workers (73% n=146) have a good knowledge level. For example, 78% knew that HPV causes cervical cancer, 69% knew the vaccine is available in Pakistan, and 77% knew the correct age for the vaccine is 9–14 years. Also, 61% correctly chose the Pap smear as the screening test. However, there were some problems: about half of the participants did not know the correct guidelines for catch-up vaccination. Moreover, 72% of participants acquire a good level of attitude and practices. Additionally, results also show a significant association between attitude and practice regarding HPV vaccination. Conclusion: In conclusion, healthcare workers in Lahore have a good understanding of the HPV vaccine, but they still have some knowledge gap about specific guidelines. Medical leaders and policymakers should create clear training programs and workshops to fix these gaps so that doctors and nurses can confidently recommend the vaccine to patients.

Proteins are functional units of the living world and they share great diversity in structure, function and evolutionary history. Molecular weight is one of the most basic physicochemical properties of proteins with implications in protein stability, interactions and subcellular localization. The relationship between molecular-weight variation and phylogenetic divergence, however, in each of the functionally distinct protein families is still poorly understood. This study compares 20 commonly studied proteins which are representatives of 6 functional classes of proteins including: structural (Actin, Myosin, Collagen, Keratin), enzymatic (Catalase, Amylase, Lipase, Pepsin, Trypsin, Urease, Lysozyme, Ribonuclease), transport (Hemoglobin, Albumin, Transferrin), regulatory (Insulin), immune (Immunoglobulin), clotting (Fibrinogen), storage (Casein), and electron transfer (Cytochrome c) proteins across representative vertebrate species.The protein sequences were obtained from the National Center for Biotechnology Information (NCBI) database, and the molecular weights were computed using standard bioinformatics tools. Multiple sequence alignment to find conserved motifs, variable domains and lineage specific insertions or deletions. Maximum likelihood and neighbor-joining phylogenetic trees were used to determine evolutionary relationships between the selected proteins. The topologies obtained were then compared with the molecular weight data to determine if proteins with similar function have convergent mass profiles or if phylogenetic distance outweighs functional constraints in the determination of molecular weight diversity.Initial studies indicate that structural proteins have relatively invariant molecular masses, with very little inter-species variation, indicating relatively strong constraints on maintaining mass for mechanical integrity. The molecular weight diversity of enzymatic and regulatory proteins is, by contrast, significant due to domain shuffling, alternative splicing and species specific adaptations of catalytic efficiency. Transport proteins fall in the middle with fluctuations in their molecular weight matching the needs for their ligands and circulation in vertebrates. Interestingly, some proteins like Cytochrome c and Ribonuclease are very well conserved in molecular weight, adding to their status as molecular chronometers. In contrast, adaptive immune diversification is revealed by the high weights of proteins such as Immunoglobulin, while hemostasis is specialized in the proteins such as Fibrinogen.The molecular weight of a species does not always reflect its species phylogeny, as molecular constraints often have greater influence than evolutionary distance, especially in enzymes with a strictly defined size requirement in their active site. For proteins of less functional rigidity, however, the molecular weight divergence increases with phylogenetic branching, so that there is a positive correlation between the two quantities, which is consistent with a neutral drift model interrupted by episodic selection. The value of this research lies in the way it demonstrates how useful it is to combine the two approaches of phylogenetics and biophysical parameters to gain insight into the evolutionary paths of proteins. The results help gain a better understanding of the link between sequence evolution and molecular traits of proteins in their phenotypes, and also offer the possibility to predict protein behavior between species. Also, the data produced here provide a useful resource for future studies in biomolecular engineering, protein structure-function relationships, and protein evolution studies. Finally, using a phylogenetic framework, it has been conclusively demonstrated that molecular weight is a useful, but complex, tool for measuring evolutionary constraint, functional specialization, and adaptive divergence for common proteins in vertebrates.

Background: Telehealth and virtual nursing care models have become revolutionary methods of healthcare delivery, offering access to care remotely and improving the interaction between patients, and decreasing the use of the hospital facility when unnecessary. Although they have become increasingly important, doubts still exist regarding their reliability, validity, and acceptability by the various demographic groups. This research was intended to assess psychometric characteristics of a telehealth questionnaire and examine demographic, perceptual, and technological factors that determine the uptake of virtual nursing care. Methods: A cross-sectional survey was used, and 266 participants, such as nurses, physicians, patients, and caregivers, were involved. The structured questionnaire was administered as a data-gathering tool comprised of demographic questions and Likert-scale items, including the perception and quality of care, usability of technology, challenges, and future views. Statistical tests were the Shapiro–Wilk test (normality) and Cronbach's Alpha (reliability), Kaiser-Meyer Olkin and Bartlett test (validity), independent samples t-test, one-way ANOVA, Kruskal-Wallis test, Chi-square test of independence, Pearson correlation analysis, and multiple linear regression. Findings: Normality tests were used to ascertain whether the data were normally distributed (p > 0.05). That instrument showed a good reliability (Cronbach's Alpha = 0.87) and reasonable validity (KMO = 0.72, Bartlett's 2 = 560.45, p = 0.001). There were notable male-female (t = 2.45, p = 0.016) and occupational (ANOVA, p = 0.003; Kruskal-Wallis, p = 0.021) differences. According to the chi-square test, there was a significant relationship between gender and previous telehealth utilization (X 2 = 15.78, p=0.001). The analysis of the correlation showed positive relationships between perception, quality, technology usability, and future acceptance (r = 0.25 -0.85). Regression analysis has verified that factors that significantly predicted future adoption of telehealth were perception ( = 0.32, p = 0.001), quality ( = 0.28, p = 0.001), and technology usability ( = 0.21, p = 0.001). Conclusion: The study shows that the questionnaire was reliable and valid in the determination of telehealth nursing models. Results indicate that demographic variables like gender and occupation have a great impact on telehealth perceptions, whereas perception and technology usability have a strong association with future acceptance. In order to integrate tele-nursing into healthcare systems in a sustainable way, it should be approached by strategies to improve usability, quality of care, and tackle demographic disparities in uptake and use.

Introduction: Nosocomial infections represent a persistent and formidable crisis within global healthcare systems. Among various vectors of transmission, the atmospheric environment of specialized clinical zones specifically surgical suites, intensive care units (ICUs), and neonatal intensive care units (NICUs) presents a heightened vulnerability to microbial colonization. Airborne bio aerosols and particulate matter can easily become vectors for pathogens, propelled by routine clinical traffic, diagnostic machinery, ventilation dynamics, and daily healthcare operations. When left unchecked, these suspended microorganisms facilitate cross-contamination, driving up the incidence of healthcare-associated infections (HAIs). Objective: To evaluate microbial contamination of air in critical areas of hospital and to determine the distribution patterns of airborne microbial contamination in intensive care units and operation theaters. Methodology: A descriptive cross-sectional study was carried out at Railway General Hospital, Rawalpindi, using a convenience sampling technique. The study was conducted in six critical hospital areas: Gynecology Operation Theatre (OT), Eye OT, Orthopedic OT, General Surgical OT, Intensive Care Unit (ICU), and Neonatal Intensive Care Unit (NICU). A total of 42 air samples were collected using the passive settle plate method. Blood agar and CLED agar plates were exposed in each selected area for 20 minutes to allow airborne microorganisms to settle naturally. Following sample collection, the culture plates were incubated at 37°C for 24 hours. Colony-forming units (CFUs) were counted manually, and bacterial isolates were identified through Gram staining, colony morphology, microscopic examination, and biochemical tests, including catalase, coagulase, oxidase, citrate utilization, Triple Sugar Iron (TSI), and indole tests. The collected data were analyzed using SPSS version 25. Result: The study illustrated a significant prevalence of airborne microbial contamination in both operation theatres and intensive care units. The microbial profile of the study reveals the variety of microbial contamination in varying departments. The study highlights a high microbial load in Orthopedics OT (54%), while Eye O T (11.24%) exhibited the lowest contamination. The most prevalent bacteria in Operation Theatres was Bacillus (19%), whereas ICUs showed predominant isolates of Staphylococcus aureus (12%). NICU relatively showed a lower contamination level, with Bacillus (100%) being the dominant isolate detected. The findings indicated noticeable variations in microbial load among different hospital departments. Conclusion: Our study shows that critical units of hospital are important contributors of Hospital Acquired Infections. The prevalence of microbes and pathogens demonstrated the need for advanced infectious control measures, systematic sterilization, improved ventilation systems, environmental sanitation, and strict adherence to aseptic measures. Regular microbial surveillance in critical areas of hospital air is crucial to limit microbial contamination, better environmental health, and to ensure the safety of patients and healthcare workers.