Insights-Journal of Health and Rehabilitation

Background: Hospitals play a vital role in disaster management, requiring robust preparedness to mitigate internal crises. Effective disaster readiness involves equipping healthcare professionals with adequate knowledge, fostering positive attitudes, and ensuring readiness to practice. Despite global advancements in disaster preparedness, private hospitals often face challenges in implementing comprehensive strategies. This study focuses on evaluating the preparedness of healthcare professionals in private hospitals in Islamabad, Pakistan, providing insights into their disaster management capabilities and identifying areas for improvement. Objective: To assess the knowledge, attitudes, and readiness of healthcare professionals toward internal disaster preparedness in private hospitals and to identify gaps for formulating improved disaster management strategies. Methods: A cross-sectional survey was conducted among healthcare professionals, including doctors, nurses, and paramedical staff, from two private hospitals in Islamabad. Data were collected using a validated self-administered questionnaire comprising 22 items on knowledge, 16 items on attitudes, and 8 items on readiness to practice. A total of 303 participants were selected using a convenient sampling technique. The data were analyzed using SPSS software, employing descriptive statistics and independent sample t-tests to assess differences between groups. Results: Among the 303 respondents, 51.5% were from Shifa International Hospital and 48.5% from Ali Medical Complex. The occupational distribution included 57.1% nurses, 36% doctors, and 6.9% paramedical staff. Educational qualifications varied, with 36.6% holding master’s degrees and 32.7% bachelor’s degrees. Reliability analysis showed acceptable scores, with Cronbach’s alpha ranging from 0.684 for knowledge to 0.891 for attitudes. T-test results indicated no significant differences between the hospitals in knowledge (p = 0.367) and attitudes (p = 0.206). However, readiness to prepare scores differed significantly (p < 0.001), favoring Ali Medical Complex. Conclusion: The study highlights the need for enhanced training, resource allocation, and feedback mechanisms to address gaps in disaster preparedness. While knowledge and attitudes were comparable, significant differences in readiness emphasize the need for targeted interventions. Improved collaboration, infrastructure, and workforce development are essential to strengthen disaster response capabilities in private hospitals.

Background: Copper has long been recognized for its antimicrobial and anti-inflammatory properties. With the advancement of nanotechnology, copper nanoparticles (Cu NPs) have garnered significant attention for their broad-spectrum antibacterial and antiviral properties. Cu NPs demonstrate potential in various medical applications, including infection control, biofilm prevention, and viral inactivation. Objective: This review aims to evaluate the medical applications of copper nanoparticles, focusing on their antimicrobial and antiviral properties, their mechanisms of action, and their potential therapeutic benefits in treating bacterial and viral infections. The paper also discusses the safety concerns and potential toxic effects associated with Cu NPs. Methods: A comprehensive review of recent literature was conducted, focusing on the antimicrobial and antiviral activities of copper nanoparticles against a variety of pathogens. The antiviral effects of Cu NPs, particularly against viruses such as Hepatitis B, C, HIV, and COVID-19, are explored. The review also highlights the applications of copper nanoparticles in healthcare settings, particularly in medical devices and hospital environments. Results: Copper nanoparticles have shown exceptional efficacy in eliminating pathogenic microorganisms, including antibiotic-resistant bacteria and various viruses. The mechanisms behind their antimicrobial action include contact-killing properties, the release of reactive oxygen species (ROS), and viral genome inactivation. Cu NPs also exhibit significant promise in reducing bacterial biofilm formation, enhancing the effectiveness of medical devices, and inactivation of respiratory viruses like SARS-CoV-2. Conclusion: Copper nanoparticles are emerging as a promising tool for combating microbial infections. Their potential to inactivate a wide range of pathogens, including viruses and bacteria, makes them highly valuable in medical and healthcare settings. However, further research is necessary to address potential health risks and optimize the use of Cu NPs in clinical applications.

Background: Artificial intelligence (AI) has revolutionized personalized medicine and predictive diagnostics by enabling data-driven, individualized healthcare strategies. AI-powered models leverage vast datasets, including genomic, proteomic, and clinical information, to improve disease detection, optimize treatment selection, and enhance patient outcomes. With the increasing burden of chronic diseases and the growing demand for precision medicine, AI presents significant opportunities to transform traditional healthcare paradigms. However, challenges related to clinical implementation, algorithmic bias, and regulatory considerations necessitate a critical evaluation of its applications. Objective: This narrative review aims to explore the role of AI in personalized medicine and predictive diagnostics, analyzing its clinical applications, benefits, limitations, and future directions. The review synthesizes current evidence on AI-driven advancements in disease diagnosis, risk stratification, and treatment optimization while addressing key challenges hindering its widespread adoption. Main Discussion Points: AI has demonstrated superior diagnostic accuracy in various medical domains, including oncology, cardiology, and neurology, through deep learning and machine learning algorithms. Predictive models enhance risk assessment, enabling early intervention and personalized therapeutic approaches. Despite these advancements, methodological limitations, variability in outcome measurement, and concerns regarding data standardization and interpretability pose significant barriers. Ethical considerations, regulatory frameworks, and the need for unbiased, transparent AI models remain critical challenges in integrating AI into routine clinical practice. Conclusion: AI holds immense potential in advancing personalized medicine and predictive diagnostics, yet its real-world application requires rigorous validation, standardized protocols, and ethical oversight. Future research should focus on developing explainable AI models, conducting large-scale randomized controlled trials, and ensuring equitable healthcare access to maximize AI’s impact on patient care.

Background: Family planning is a cornerstone of reproductive health, contributing significantly to improved maternal and child health outcomes. In Pakistan, where high population growth, limited healthcare infrastructure, and socio-cultural barriers persist, the role of family planning is pivotal in reducing maternal and infant mortality, enhancing birth spacing, and improving overall health indicators. Despite its importance, challenges such as gender inequality, socio-religious norms, and inadequate healthcare services limit its adoption and effectiveness. Objective: To evaluate the impact of family planning on maternal and child health outcomes in Pakistan, including contraceptive use, maternal and infant mortality, birth spacing, and childhood illnesses. Methods: A narrative review was conducted using electronic databases, including PubMed, Embase, Web of Science, and Scopus, alongside manual reference searches. Studies conducted in Pakistan, published in English, and focusing on family planning's impact on maternal and child health outcomes were included. Data extraction encompassed study characteristics, family planning interventions, maternal and child health outcomes, and key findings. Quality assessment tools such as the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool were employed to evaluate methodological rigor. Data synthesis was performed narratively, and meta-analysis was conducted where feasible to summarize quantitative findings. Results: Family planning interventions demonstrated significant benefits, including reductions in maternal and infant mortality, healthier birth spacing, and lower rates of childhood illnesses. Contraceptive use improved maternal health outcomes by preventing high-risk pregnancies and reducing complications. However, socio-cultural barriers, limited healthcare access, and unmet contraceptive needs were identified as persistent challenges. Conclusion: Family planning has a transformative impact on maternal and child health outcomes in Pakistan. Addressing socio-cultural and healthcare system barriers through integrated strategies and evidence-based policies can enhance its adoption, contributing to improved health and well-being for families nationwide.

Background: Motherhood in collectivistic cultures presents unique challenges, as societal expectations and family structures significantly shape maternal experiences. In Pakistan, new mothers residing in joint family systems often encounter emotional, psychological, and cultural pressures while navigating their early years of motherhood. The balance between caregiving responsibilities, household duties, and personal well-being becomes particularly complex when autonomy is limited by traditional family hierarchies. Understanding these challenges is essential for developing culturally sensitive interventions that support maternal well-being and promote healthier family dynamics. Objective: This study aimed to explore the lived experiences of first-time mothers within Pakistani collectivistic culture, particularly the emotional, relational, and cultural challenges they encounter within the first three years of marriage and motherhood. Methods: A qualitative research design utilizing Interpretative Phenomenological Analysis was employed to provide an in-depth exploration of maternal experiences. A purposive sample of six first-time mothers residing in joint family systems and married for less than three years was selected. Data collection involved semi-structured interviews and demographic questionnaires to capture detailed narratives. Verbatim transcription was performed, followed by thematic analysis to identify emergent patterns. Superordinate themes, including self-identity, resilience, adaptation, and interpersonal relationships, were categorized into master themes such as coping strategies, cultural identity, and social expectations. Results: The findings revealed that new mothers face significant emotional distress due to limited autonomy, cultural expectations, and societal pressures. Challenges included balancing household responsibilities, child-rearing practices dictated by extended family members, and financial constraints. While social support was a primary coping strategy, many mothers found it insufficient, leading to psychological strain. Despite these adversities, resilience was evident among participants who employed self-reflection, boundary-setting, and adaptive coping mechanisms. Conclusion: The study highlights the need for culturally informed support systems that promote maternal mental health and encourage shared caregiving responsibilities within collectivistic family structures. Policies and community-based interventions should be developed to enhance maternal well-being, strengthen spousal support, and foster greater autonomy for new mothers.

Background: Cancer remains one of the most significant global health concerns, contributing to high morbidity and mortality rates. Conventional treatments such as chemotherapy, radiation therapy, and targeted therapies are widely used but often come with significant limitations, including severe side effects, resistance development, and compromised quality of life. The search for safer and more effective complementary therapies has led to growing interest in natural compounds with anticancer potential. Medicinal mushrooms have long been valued in traditional medicine for their nutritional and therapeutic properties, offering a promising alternative for cancer prevention and treatment. Body: Mushrooms are a rich source of bioactive compounds, including polysaccharides, terpenoids, phenolic compounds, sterols, and lectins, which exhibit diverse pharmacological properties such as antioxidant, immunomodulatory, and tumor-suppressive effects. Notable species, including Shiitake (Lentinula edodes), Reishi (Ganoderma lucidum), Maitake (Grifola frondosa), and Turkey Tail (Trametes versicolor), have been extensively studied for their ability to enhance immune function, induce apoptosis, and inhibit angiogenesis and metastasis. Preclinical and clinical studies have demonstrated that mushroom-derived compounds can influence key cancer-related pathways, including immune regulation, oxidative stress reduction, and cell cycle arrest, suggesting their potential as adjunct therapies alongside conventional treatments. Conclusion: The existing body of research provides compelling evidence supporting the anticancer potential of medicinal mushrooms. However, challenges such as standardization of bioactive compounds, dose optimization, and regulatory validation remain. Further large-scale clinical trials and mechanistic studies are essential to fully harness their therapeutic benefits and facilitate their integration into conventional cancer treatment strategies. Medicinal mushrooms hold promise as natural, well-tolerated agents that could complement existing therapies and improve patient outcomes in oncology.

Background: Nanotechnology has revolutionized modern science by enabling the synthesis of nanoparticles with unique physicochemical properties. Among these advancements, green synthesis using plant-based resources has gained significant attention for being eco-friendly and cost-effective. Nigella sativa (black seed), known for its rich bioactive compounds like alkaloids, flavonoids, and phenolics, has traditionally been used for treating various ailments. Body: This review focuses on the green synthesis of silver nanoparticles (AgNPs) using Nigella sativa as a nanotechnology-driven resource. The process leverages plant extracts to produce AgNPs, showcasing reduced toxicity and environmental impact compared to conventional physical and chemical methods. Key topics include the historical evolution of nanotechnology, top-down and bottom-up synthesis approaches, and the superior antimicrobial and biomedical applications of AgNPs due to their high surface area to volume ratio. The potential of N. sativa in producing nanomaterials highlights its importance in sustainable nanotechnology for diagnostics, antimicrobial therapies, and other applications. Conclusion: The incorporation of nanotechnology and green synthesis has positioned Nigella sativa as a promising resource for environmentally safe and biocompatible nanoparticle synthesis. Its role in modern science underscores its potential in addressing global challenges in medicine and environmental management.

Background: The integration of Artificial Intelligence (AI) into physical therapy is transforming traditional practices, presenting a range of ethical, professional, and technical challenges. These include concerns about patient data security, algorithmic bias, job displacement, the need for continuous education, and system reliability. While AI has the potential to enhance diagnostic accuracy and treatment personalization, its adoption necessitates significant adaptations in clinical workflows and professional roles, emphasizing the need for a strategic approach to address these challenges and optimize its application. Objective: The objective of this systematic review was to analyze the ethical, professional, and technical challenges associated with implementing AI in physical therapy and to propose strategic recommendations for mitigating risks while maximizing the potential benefits. Methods: A systematic review was conducted following PRISMA guidelines, with a comprehensive search across PubMed, Scopus, Web of Science, and IEEE Xplore databases up to July 2024. The search terms included "Artificial Intelligence," "physical therapy," "challenges," "ethics," "professional development," and "technical reliability." Studies were included if they addressed ethical, professional, or technical barriers to AI integration in physical therapy. Titles and abstracts were screened independently by two reviewers, with disagreements resolved by a third reviewer. Data were extracted on study characteristics, AI applications, identified challenges, and suggested solutions. Quality appraisal was conducted using the CASP tool. Results: A total of 12 studies met the inclusion criteria. Ethical concerns, including patient data security and algorithmic bias, were reported in 60% of studies. Professional challenges, such as job displacement and the need for continuous education, were highlighted in 50%. Technical issues, including system reliability and integration into clinical workflows, were evident in 75%. The findings also showed that 40% of studies emphasized the importance of adapting clinical training programs to include AI-focused education. Conclusion: AI holds transformative potential for physical therapy by improving diagnostic precision and personalized care. However, its integration is hindered by significant ethical, professional, and technical challenges. Addressing these requires the establishment of robust ethical frameworks, continuous education and training for professionals, and rigorous technical validation processes to ensure AI's safe and effective application in clinical practice.

Background: In today's society, body image issues are becoming more prevalent among young women particularly female university students. While most studies have focused on the specific consequences of social media addiction and low physical activity levels, however, less is known about how these factors interact to cause body image concerns. Therefore, the purpose of this cross-sectional study was to investigate the relationship of social media addiction with physical activity levels, BMI and self-perceived body image among female university students. Objective: The objective of this study was to investigate the relationship between social media addiction, physical activity levels, BMI, and body image concerns among female university students in Lahore, Pakistan. Methods: The data was collected from five different universities. The participants of this study were 200 females with ages between 18 and 25 years (M = 20.93 and SD = 1.710). The questionnaire included survey regarding personal information, IPAQ short version, BSMAS and BSQ 16-B questionnaires. Results: The findings indicated that social media addiction was directly associated with low physical activity levels thus increasing sedentary behaviour among female university students. Additionally, it was also observed that those female students who were more prone to addictive nature of social media, had increased BMI values and body image concerns. Results: The results revealed that social media addiction was significantly associated with lower physical activity levels, increased BMI, and heightened body image concerns among female university students. Higher addiction scores correlated with increased sedentary behaviour and dissatisfaction with body image. Conclusion: The findings of this study suggested the promotion of increased physical activity levels to reduce the social media addiction and body image concerns among female university students to improve their mental health and well-being.

Background: Environmental pollution from industrial, agricultural, and municipal sources presents a significant threat to ecological and human health. As traditional wastewater treatment methods face limitations in cost, efficiency, and pollutant removal, biotechnological approaches have emerged as sustainable alternatives. Microbial and enzymatic bioremediation techniques offer the potential for targeted, eco-friendly degradation of a broad range of contaminants, including heavy metals, hydrocarbons, and synthetic chemicals. Objective: This narrative review aims to explore recent advances in biotechnological and microbial approaches for bioremediation and wastewater treatment, with a focus on enzymatic catalysis, microbial consortia, and integrated treatment systems. Main Discussion Points: Key mechanisms such as biosorption, enzymatic degradation, and microbial metabolism are discussed in detail. Special emphasis is placed on the roles of laccases, hydrolases, and oxidoreductases in the breakdown of persistent pollutants. The review also highlights innovations in enzyme engineering, CRISPR-based microbial enhancement, and nanotechnology to improve efficiency and environmental adaptability. Integrated treatment systems, including constructed wetlands and algae-based bioreactors, are reviewed as models for circular economy and resource recovery. Conclusion: Biotechnological strategies hold transformative potential for pollution control and environmental restoration. However, challenges such as environmental variability, scalability, and regulatory limitations remain. Continued interdisciplinary research and the integration of emerging technologies are essential to optimize these systems for real-world applications.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in people with type 2 diabetes mellitus and may progress to clinically important liver disease. The Fatty Liver Index (FLI) is a simple non-invasive score derived from routinely available anthropometric and biochemical variables and may help identify hepatic steatosis when imaging is not immediately available. Objective: To determine the frequency of steatotic liver disease in patients with type 2 diabetes mellitus using the FLI, evaluate its diagnostic performance against abdominal ultrasonography, and identify demographic, anthropometric, and biochemical factors associated with ultrasound-confirmed steatosis. Methods: This hospital-based cross-sectional observational study included 124 consecutive patients with type 2 diabetes mellitus attending the diabetic clinics and Medical Outpatient Department of Jinnah Postgraduate Medical Centre, Karachi, from mid-March 2026 to mid-June 2026. Demographic, clinical, anthropometric, and biochemical data were collected using a structured proforma. The FLI was calculated from body mass index, waist circumference, triglycerides, and gamma-glutamyl transferase. Abdominal ultrasonography was used as the reference standard for hepatic steatosis. Diagnostic performance was evaluated using sensitivity, specificity, predictive values, diagnostic accuracy, Cohen’s kappa, and receiver operating characteristic analysis. Multivariable binary logistic regression was used to identify independent predictors of ultrasound-confirmed steatosis. Results: The mean age was 50.00 ± 10.31 years, and 71.0% of participants were female. Ultrasound-confirmed hepatic steatosis was present in 88 participants (71.0%), whereas 77 (62.1%) had FLI ≥60. At this threshold, sensitivity was 73.9%, specificity 66.7%, positive predictive value 84.4%, negative predictive value 51.1%, and overall diagnostic accuracy 71.8%. Agreement with ultrasonography was fair (Cohen’s kappa = 0.372, p < 0.001), and the area under the receiver operating characteristic curve was 0.776. Participants with steatosis had significantly higher body mass index, waist circumference, alanine aminotransferase, and gamma-glutamyl transferase levels. In multivariable analysis, body mass index was the only independent predictor of steatosis (adjusted OR 1.270, 95% CI 1.121–1.438; p < 0.001). Conclusion: Hepatic steatosis was common in this hospital-based sample of patients with type 2 diabetes mellitus. The FLI showed acceptable discrimination and a high positive predictive value, but its modest sensitivity and low negative predictive value indicate that an FLI <60 should not be used alone to exclude steatosis. Body mass index was independently associated with ultrasound-confirmed steatosis. Keywords: body mass index; diabetes mellitus, type 2; Fatty Liver Index; metabolic dysfunction-associated steatotic liver disease; ultrasonography

Background: Knee osteoarthritis (OA) is a common cause of pain, functional limitation, and reduced quality of life. Women engaged in household work may experience knee symptoms during middle adulthood. This study aimed to determine the proportion of self-reported knee pain among women engaged in household work in Sukkur and examine its association with quality of life. Methods: This cross-sectional study included 384 women aged 35-57 years in Sukkur. Participants were recruited through non-probability convenience sampling from households and the Physical Therapy Outpatient Department of Hidayat Hospital. Quality of life was assessed using a modified SF-36, and pain intensity was assessed using the Visual Analogue Scale (VAS) within a structured questionnaire. Data were collected through face-to-face interviews. No clinical examination or radiographic assessment was documented to confirm knee osteoarthritis. Results: The mean age of the participants was 45.4 ± 6.5 years. Of 384 participants, 151 (39.3%) reported study-defined knee pain. Pain-intensity data were available for 150 participants, of whom 100 (66.7%) reported mild pain, 35 (23.3%) moderate pain, and 15 (10.0%) severe pain. Participants reporting knee pain had significantly lower quality-of-life scores than those without reported knee pain (25.21 ± 6.75 vs 30.11 ± 7.73). The mean difference was -4.90 (95% CI, -6.41 to -3.39), t(382) = -6.37, p < 0.001, with a standardized mean difference of 0.67. Quality-of-life scores did not differ significantly across reported pain-intensity categories (F(2,146) = 2.55, p = 0.082). Conclusions: In this convenience sample, 39.3% of participants reported knee pain, and reported knee pain was associated with lower quality-of-life scores. Because the sample was selected using non-probability convenience sampling and included outpatient participants, this proportion should not be interpreted as a population prevalence estimate for all women in Sukkur. In addition, because no clinical or radiographic diagnostic criteria were documented, the findings refer to self-reported knee pain rather than confirmed knee osteoarthritis.

Background: Sepsis remains a major cause of preventable hospital death, and early recognition of patients at greatest risk is central to timely resuscitation and critical care planning. The Sequential Organ Failure Assessment (SOFA) score measures the extent of acute organ dysfunction, whereas serum lactate reflects metabolic stress and impaired tissue perfusion. Although both are established prognostic indicators, the additional value obtained by combining them at admission has not been fully defined, particularly in resource-constrained hospitals. Objective: To assess the individual and combined predictive value of admission SOFA score and serum lactate for in-hospital mortality in adults with sepsis. Methods: This hospital-based observational analytical study included 210 adults fulfilling Sepsis-3 criteria who were managed in the emergency department, medical ward, or medical intensive care unit of Jinnah Postgraduate Medical Centre. Clinical and laboratory data were extracted from patient records using a structured proforma. The SOFA score and first lactate concentration obtained within 24 hours were analysed using multivariable logistic regression and receiver operating characteristic curves. Optimal thresholds were derived through the Youden index, and AUCs were compared using the DeLong test. Results: In-hospital mortality was 27.6%. Non-survivors had higher median SOFA scores than survivors, 8.5 versus 2.0, and higher lactate concentrations, 4.6 versus 2.4 mmol/L (both p < 0.001). Lactate independently predicted mortality (adjusted OR 1.54, 95% CI 1.13–2.08; p = 0.006), as did SOFA score (adjusted OR 1.28, 95% CI 1.13–1.45; p < 0.001). The AUC was 0.802 for lactate, 0.805 for SOFA, and 0.832 for the combined model. The combined model yielded 74.1% sensitivity, 81.6% specificity, 60.6% positive predictive value, and 89.2% negative predictive value. Its AUC was numerically higher than either marker alone, although the differences were not statistically significant. Conclusion: Admission SOFA score and serum lactate independently predicted in-hospital mortality, while their combined assessment provided the highest discrimination for practical early risk stratification. Keywords: Hospital Mortality; Lactic Acid; Logistic Models; Organ Dysfunction Scores; Prognosis; Sepsis; Shock, Septic.

Background: Chronic sleep restriction is increasingly recognized as a contributor to impaired glucose regulation, yet its effect on day-to-day glycemic instability remains incompletely defined. Working adults with type 2 diabetes mellitus are especially vulnerable because shift work, extended schedules, occupational stress, and irregular sleep timing may compound insulin resistance. Continuous glucose monitoring offers a more sensitive assessment of these effects than glycated hemoglobin alone by capturing glucose excursions, nocturnal instability, and time spent within target ranges. Objective: To evaluate the association between chronic sleep restriction of fewer than six hours nightly and glycemic variability among working adults with type 2 diabetes mellitus. Methods: This PRISMA-guided review searched PubMed, Scopus, Web of Science, Embase, and Google Scholar for English-language peer-reviewed studies published from 2010 to 2025. Eligible studies examined working adults with type 2 diabetes mellitus, short sleep or occupational sleep disruption, and continuous glucose monitoring-derived or related glycemic outcomes. Screening, standardized extraction, and design-appropriate risk-of-bias assessment were completed. Methodological heterogeneity required narrative synthesis. Results: Of 419 records identified, 13 studies involving 1,200 participants were included. Individual samples ranged from 19 to 210 participants, and the studies represented 10 countries. Twelve studies reported adverse associations between restricted or disrupted sleep and glycemic outcomes. Sleep-restricted participants generally showed higher mean amplitude of glycemic excursions and coefficient of variation, lower time in range, elevated glycated hemoglobin, increased nocturnal and fasting glucose fluctuations, reduced insulin sensitivity, and impaired glucose tolerance. Shift workers and employees exposed to occupational stress showed less stable glucose profiles. Conclusion: Chronic sleep restriction was consistently associated with poorer glycemic stability among working adults with type 2 diabetes mellitus. Sleep duration and work schedules should be assessed in diabetes care, while longitudinal and interventional studies are needed to clarify causality and clinical benefit. Keywords: Blood Glucose; Circadian Rhythm; Continuous Glucose Monitoring; Diabetes Mellitus, Type 2; Occupational Stress; Shift Work Schedule; Sleep Deprivation.

Background: Pseudomonas aeruginosa is an important opportunistic pathogen associated with complicated and healthcare-associated urinary tract infections. Its intrinsic resistance, capacity to acquire additional resistance mechanisms, and persistence in moist clinical environments can limit treatment options and increase the risk of therapeutic failure. Local surveillance is therefore essential because antimicrobial susceptibility patterns vary across institutions and geographical areas. Reliable regional data can support empirical treatment, antimicrobial stewardship, and timely selection of effective antipseudomonal therapy for affected patients. Objective: The study determined the occurrence of P. aeruginosa in urine specimens from patients with suspected urinary tract infection and assessed the antimicrobial susceptibility profile of confirmed isolates. Methods: A multicentre, laboratory-based cross-sectional study processed 565 clean-catch midstream urine specimens collected from four public and private laboratories in Punjab, Pakistan, between January and March 2020. Specimens were cultured on cetrimide agar, and suspected isolates were identified through colony morphology, Gram staining, motility, and biochemical testing. Antimicrobial susceptibility to 14 agents was assessed by the modified Kirby–Bauer disc diffusion method using CLSI 2019 interpretive criteria. Frequencies and percentages were calculated. Results: Fifty-two specimens were positive for confirmed P. aeruginosa, giving an occurrence of 9.2%. Of the confirmed isolates, 30 (57.7%) were obtained from females and 22 (42.3%) from males. Susceptibility was highest to colistin at 100%, followed by tobramycin at 88.5%, meropenem at 78.8%, piperacillin–tazobactam and cefepime at 73.1% each, amikacin at 71.2%, imipenem at 69.2%, and gentamicin at 67.3%. Resistance was highest to amoxicillin–clavulanate at 94.2% and ceftriaxone at 82.7%, followed by levofloxacin at 53.8%, ofloxacin at 50.0%, ciprofloxacin at 46.2%, and ceftazidime at 44.2%. Conclusion: P. aeruginosa showed substantial variation in antimicrobial susceptibility, supporting culture-guided therapy and regular local antibiogram surveillance. Rational prescribing and strengthened antimicrobial stewardship remain necessary to limit further resistance and preserve effective treatment options. Keywords: Anti-Bacterial Agents; Drug Resistance, Bacterial; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Urinary Tract Infections; Urine

Background: Pediatric keratoconus is a progressive corneal ectatic disorder affecting children and adolescents, with earlier onset, faster progression, and greater disease severity than adult-onset keratoconus. Advances in corneal imaging have improved detection of subclinical disease and revealed a higher disease burden than previously recognized. Although corneal collagen cross-linking has changed clinical management, evidence remains scattered across epidemiology, diagnosis, treatment, psychosocial outcomes, and economic impact. Objective: This scoping review aimed to map the available evidence on pediatric keratoconus and identify major research themes, knowledge gaps, and future priorities related to epidemiology, diagnostic approaches, therapeutic strategies, and psychosocial consequences. Methods: This review was conducted according to the PRISMA-ScR framework and guided by the Joanna Briggs Institute methodology for scoping reviews. Eligible studies included children and adolescents aged 18 years or younger diagnosed with keratoconus. English-language publications from January 1998 to December 2025 were searched in PubMed/MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. Studies of any design were considered if they reported epidemiological data, diagnostic methods, treatment outcomes, psychosocial findings, economic burden, or quality-of-life outcomes. Data were charted using a standardized extraction framework and synthesized narratively. Results: The search identified 1,802 records. After removal of duplicates, 777 articles were screened, 97 full-text articles were assessed for eligibility, and 76 studies were included. Reported prevalence varied widely, with estimates reaching 1 in 251 confirmed cases and 1 in 72 when suspected cases were included. School-based studies reported prevalence values of 626 per 100,000 children and 3.6% in selected populations. Corneal cross-linking demonstrated disease stabilization in more than 80% of treated pediatric cases, including evidence from 2,186 eyes across 35 studies. However, progression criteria, imaging parameters, follow-up duration, and outcome measures varied substantially. Psychosocial, educational, caregiver-related, and economic outcomes were limited. Conclusion: Pediatric keratoconus is an important childhood eye condition requiring early detection, standardized monitoring, timely treatment, and broader patient-centered assessment. Future research should strengthen population-based screening, harmonize progression criteria, and evaluate long-term clinical, psychosocial, and economic outcomes. Keywords: Adolescent; Child; Corneal Cross-Linking; Corneal Topography; Epidemiology; Keratoconus; Quality of Life.

Background: Keratoconus is a progressive corneal ectatic disorder characterized by stromal thinning, anterior corneal protrusion, irregular astigmatism, and gradual visual deterioration. Although it has traditionally been considered a non-inflammatory disease, increasing molecular, genetic, and clinical evidence suggests that chronic low-grade inflammation may contribute to its development and progression. Objective: This narrative review aims to summarize current evidence on the role of inflammation in keratoconus, with emphasis on tear-film cytokines, matrix metalloproteinases, oxidative stress, genetic susceptibility, environmental triggers, inflammatory biomarkers, and emerging therapeutic implications. Methods: A narrative literature review was conducted using relevant peer-reviewed articles from major scientific databases. Evidence was synthesized thematically to discuss inflammatory mechanisms, molecular pathways, ocular surface factors, clinical implications, and future directions in keratoconus research and management. Main Findings: Current evidence indicates that patients with keratoconus may show increased levels of inflammatory mediators, including interleukin-1β, interleukin-6, tumor necrosis factor-alpha, high-mobility group box 1, and matrix metalloproteinases. These mediators may contribute to extracellular matrix degradation, keratocyte dysfunction, stromal thinning, and progressive corneal weakening. Oxidative stress, cellular senescence, allergy, atopy, dry eye disease, and habitual eye rubbing may further amplify inflammatory activity at the ocular surface. Recent genetic and molecular studies also suggest that keratoconus susceptibility may involve both biomechanical and atopy–inflammatory pathways. Corneal collagen cross-linking remains the established treatment for progressive disease, while anti-inflammatory, exosome-based, intense pulsed light, and nutritional approaches remain supportive or investigational. Conclusion: Keratoconus should not be viewed as a purely biomechanical disorder. Current evidence supports a broader inflammatory-degenerative model in which inflammation, oxidative stress, genetic susceptibility, ocular surface disease, and environmental factors interact to influence disease progression. Further longitudinal studies, standardized biomarker validation, and controlled clinical trials are needed before inflammatory markers or emerging therapies can be incorporated into routine keratoconus care. Keywords: Keratoconus; inflammation; tear-film biomarkers; cytokines; matrix metalloproteinases; oxidative stress; eye rubbing; corneal collagen cross-linking

Background: Preoperative recognition of difficult airway remains central to safe anesthetic care because failed or delayed airway control may rapidly compromise oxygenation. Conventional bedside tests are simple and widely used, but their accuracy is often limited by subjective interpretation and observer variability. Smartphone-based facial imaging may offer a practical way to capture objective craniofacial measurements related to laryngoscopic view, especially in settings where advanced airway-assessment technology is not routinely available for daily preoperative screening practice locally. Objective: To evaluate smartphone-derived facial anthropometric measurements for predicting difficult laryngoscopy and compare their diagnostic performance with conventional airway assessment methods. Methods: This prospective observational comparative study included 35 adults aged 18–65 years, ASA I–III, undergoing elective surgery under general anesthesia with endotracheal intubation. Conventional assessment included Mallampati class, mouth opening, thyromental distance, sternomental distance, neck circumference, upper lip bite test, and neck extension. Standardized smartphone photographs were analyzed for facial width, mandibular width, chin projection angle, neck-chin angle, neck-to-face ratio, jawline angle, and submandibular contour. Difficult laryngoscopy was defined as Cormack–Lehane Grade III–IV. Analysis included logistic regression, ROC curves, diagnostic indices, leave-one-out cross-validation, bootstrap validation, and calibration assessment. Results: Difficult laryngoscopy occurred in 7 patients (20.0%), while 28 patients (80.0%) had easy laryngoscopy. Chin projection angle showed apparent AUC 0.90 and LOOCV AUC 0.85. Neck-chin angle showed apparent AUC 0.86 and LOOCV AUC 0.81. Thyromental distance had AUC 0.83, sensitivity 85.7%, and specificity 75.0%. The combined model achieved apparent AUC 0.94, LOOCV AUC 0.89, optimism-corrected AUC 0.87, sensitivity 85.7%, specificity 90.0%, accuracy 88.6%, calibration slope 0.72, and Brier score 0.12. Conclusion: Smartphone-derived facial anthropometric measurements appeared useful as adjuncts to conventional airway assessment. Their clinical use requires larger multicenter validation before routine implementation. Keywords: Airway Management; Anesthesiology; Anthropometry; Intubation, Intratracheal; Laryngoscopy; Preoperative Care; Smartphone.

Background: Shoulder pain is a common musculoskeletal problem among manual wheelchair users because the upper limbs are repeatedly used for propulsion, transfers, pressure relief, and daily mobility. Continuous loading of the shoulder joint may lead to pain, disability, and reduced independence over time. In local rehabilitation settings, limited evidence is available regarding the burden of shoulder pain among long-term manual wheelchair users, making this issue important for clinical screening and preventive care. Objective: To determine the prevalence of shoulder pain among long-term manual wheelchair users and to assess its association with the duration of wheelchair use. Methods: An observational cross-sectional study was conducted among 159 manual wheelchair users recruited from Mayo Hospital, Ghurki Hospital, Sheikh Zayed Hospital, and Services Hospital, Lahore. Participants were selected through a non-probability convenience sampling technique. Male and female participants aged 20–40 years who had used a manual wheelchair as their primary means of mobility for at least one year were included. Shoulder pain and disability were assessed using the Shoulder Pain and Disability Index. Data were analyzed using SPSS version 29.0. Frequencies and percentages were calculated for categorical variables, while mean and standard deviation were used for continuous variables. Chi-square test was applied to determine the association between duration of wheelchair use and shoulder pain severity, with p < 0.05 considered statistically significant. Results: The mean age of participants was 30.0 ± 5.5 years. Among 159 participants, 85 (53.5%) were male and 74 (46.5%) were female. Shoulder pain was reported by 132 (83.0%) participants, while 27 (17.0%) had no shoulder pain. Mild pain was reported by 40 (25.2%) participants, moderate pain by 60 (37.7%), and severe pain by 32 (20.1%). A statistically significant association was found between duration of wheelchair use and shoulder pain severity (χ² = 26.06, p = 0.002). Conclusion: Shoulder pain was highly prevalent among long-term manual wheelchair users and was significantly associated with duration of wheelchair use. Routine screening, early rehabilitation, ergonomic wheelchair training, and preventive shoulder care may help reduce pain and preserve functional independence. Keywords: Cross-Sectional Studies; Disabled Persons; Musculoskeletal Pain; Prevalence; Rehabilitation; Shoulder Pain; Wheelchairs.

Background: Pressure ulcers are preventable yet remain a frequent complication among hospitalized and immobilized patients, particularly in intensive care units and medical wards. Their prevention depends on timely risk assessment, regular skin inspection, repositioning, nutritional support, pressure redistribution, documentation, and patient education. Nurses remain central to these preventive measures because of their continuous bedside role. Assessing their knowledge, attitude, and practices can identify gaps in care and guide targeted quality improvement strategies. Objective: To assess nurses’ knowledge, attitude, and preventive practices regarding decubitus ulcer prevention in ICUs and medical wards of Mayo Hospital Lahore. Methods: A descriptive cross-sectional study was conducted among 154 registered nurses working in ICUs and medical wards of Mayo Hospital Lahore. Participants were selected through a convenience sampling technique according to predefined inclusion and exclusion criteria. Data were collected using an adopted structured self-administered questionnaire that assessed sociodemographic characteristics, knowledge, attitude, and preventive practices regarding pressure ulcer prevention. Completed questionnaires were checked for completeness and entered into SPSS version 25. Descriptive statistics were used to present frequencies, percentages, mean, standard deviation, and overall category levels of knowledge, attitude, and practice. Results: Among 154 nurses, 136 (88.3%) were female and 18 (11.7%) were male. Most participants were aged 18–29 years, 72 (46.8%), followed by 30–44 years, 61 (39.6%). The mean professional experience was 12.51 ± 7.37 years. Overall, 140 (90.9%) nurses had poor knowledge, 14 (9.1%) had average knowledge, and none had good knowledge. Regarding attitude, 10 (6.5%) had poor attitude, 88 (57.1%) had average attitude, and 56 (36.4%) had good attitude. For preventive practices, 14 (9.1%) had poor practice, 82 (53.2%) had average practice, and 58 (37.7%) had good practice. Conclusion: Nurses showed inadequate knowledge but generally acceptable attitudes and moderate preventive practices regarding pressure ulcer prevention. Regular training, standardized protocols, risk assessment tools, and clinical supervision are needed to improve evidence-based nursing care. Keywords: Attitude of Health Personnel; Cross-Sectional Studies; Knowledge; Nurses; Nursing Care; Pressure Ulcer; Preventive Health Services