Pandemic-Risk Pathogens
Shahid Kamal
Parasites, fungi, bacteria and viruses cause significant impact on the community health. Of these the simplest are the viruses that can be highly transmissible, and even can be generated from synthetic DNA. Viruses can trigger outbreaks. The 1918 influenza pandemic killed 17 million people [1]. Small pox and measles have also been major killers. Prior to effective eradication program, small pox caused more than 2 million fatalities a year [2]. Before the initiation of widespread vaccination, measles was also a big killer. Advances in virology has led to the development of vaccines and therapeutic agents that have enabled a drastic reduction in disease burdens caused by influenza, COVID-19, poliomyelitis, hepatitis C, HIV/AIDS etc. Recently development of COVID-19 vaccines within a period of one year is a remarkable example. The rapid development and deployment of these vaccines prevented 14-20 million deaths worldwide [3].
doi.org/10.21089/njhs.102.0064
The Role of the Psycho-Oncology Multidisciplinary Tumor Board in Enhancing the Caregivers’ Well-Being for Cancer Patients
Urooj Hasan, Habiba Zaheer, Fabiha Shakeel and Muhammad Muaz Abbasi
Providing care to family members with prolonged illness challenges caregivers’ well-being. Cancer is not just a disease, it reshapes the life of the patient and the family of the patient. The caregivers carry a heavy and unseen burden in a low-middle-income country like Pakistan, where the cancer system is already overburdened. In a research study conducted in Karachi, Pakistan, it was observed that 64% of caregivers experienced a burden in the Mild to Moderate range [1].
Along with this, in another study, it was seen that fatigue was reported as the most challenging aspect by the caregivers providing support to patients receiving active radiotherapy and having an advanced cancer diagnosis [2], and about 40-70% of caregivers experienced symptoms of depression [3]. Despite the evidence highlighting the need to support caregivers’ well-being, there remains a lack of resources. Therefore, integrating a psycho-oncology multi-disciplinary tumor board (MDT) in cancer care can play a pivotal role in the well-being of cancer patients and in reducing the burden on the caregivers [4].
Received: August 22, 2024
Revised: June 12, 2025
Accepted: June 14, 2025
doi.org/10.21089/njhs.102.0066
Strengthening Family Planning to Sustain Pakistan’s Future
Sameera Ali Rizvi, Iftikhar Soomro, Syeda Tabeena Ali and Yasmeen Sabeeh Qazi
Pakistan is a country of more than 241.49 million people; the large and diverse population poses complex challenges in executing effective family planning (FP) services [1]. The improvement of FP faces continued barriers that particularly affect populations in rural areas and low socioeconomic status since they experience limited health access laterally with social and cultural barriers. The PDHS 2017-18 indicates the importance of as only 34% of women in Pakistan use a modern method of contraception, and 17% have an unmet need [2]. These gaps can only be addressed through a collective and innovative effort to redesign various sectors of the healthcare system in the country.
Received: February 13, 2025
Revised: June 16, 2025
Accepted: June 20, 2025
doi.org/10.21089/njhs.102.0069
Intestinal Parasitic Infections in Pregnant Women: A Public Health Concern
Dipa Dhakal and Janak Raj Subedi
Abstract: Background: Intestinal parasitic infections affect pregnant women all over the world. The infection has been linked to the development of life-threatening conditions in both pregnant women and their developing fetus.
Objective: This study was conducted to determine the prevalence, intensity of infection and associated risk factor among pregnant women of five different wards of Hetauda sub-metropolitan city, Makawanpur, Bagmati province, Nepal.
Materials and Methods: A cross- sectional study was carried out among (100) conveniently sampled pregnant women receiving antenatal care services at Rural Urban health care center of Two, four, five, ten and 11 numbers wards of Hetauda in between July to December of 2023 after obtaining approval from the Ethical committee of the Institute of Science and Technology, Tribhuvan University, Nepal (IRB approval no. 23-0067). Structured questionnaires were administered to study participants to assess socio-demographic and other possible factors. Stool samples were collected from each pregnant woman and examined for the presence of intestinal parasites by microscopy using direct wet mount, flotation as well as formal-ether sedimentation techniques.
Results: The study revealed that of the 100 samples examined, 19 samples (19%) were found to be positive for gastrointestinal parasites. Parasites covering five genera. Ascaris lumbricoides (8%) was most predominant followed by Entamoeba histolytica (4%), Strongyloides stercoralis (3%), Trichuris trichiura (2%) and Hymenolepis nana (2%). Parasites are more observed amongst poorer population, independent of their age. Chi-square test conclude that there is association between parasites and financial situation (P= 0.0084).
Conclusion: Screening of the women for intestinal parasites and provision of health education during their ANC (Antenatal care) visit to prevent the adverse effects on maternal and fetal health from these infections.
Received: August 22, 2024
Revised: April 27, 2025
Accepted: April 28, 2025
doi.org/10.21089/njhs.102.0072
Correlation of Oropharyngeal Airway Volume and Transverse Dental Arch Form: A Cone Beam Computed Tomography (CBCT) Study
Muteen Fatima, Kausar Ilyas, Yusra Shaukat, Mehwish Shaheed and Amjad Mahmood
Abstract: Background: Variations in transverse dental arch form can significantly impact airway and breathing. With the advent of cone beam computed tomography, accurate evaluation of airway can be performed, overcoming two-dimensional limitations of lateral Cephalogram.
Objective: The aim of the study is to compare oropharyngeal airway volume and index of inter-canine width relative to the intermolar width (ICW/IMW), and internal angles; interincisor, canine, and molar angle of the maxillary and mandibular arches using CBCT. The study also aims to compare gender and oropharyngeal airway volume and all transverse dental arch form variables.
Materials and Methods: This cross-sectional study was conducted in the duration of January 2024 to June 2024 at Margalla Institute of Health Sciences, Rawalpindi. The Ethics Review Committee of Margalla Institute of Health Sciences Rawalpindi, granted approval, (Ethical Approval Number: DM/199/23). The SPSS software version 23 was employed for data analysis. Independent T test was applied for gender comparison of OPV and all transverse dental arch form variables while correlation between OPV and transverse dental arch form variables was determined using Pearson’s coefficient (r).
Results: A positive significant correlation was found between OPV and maxillary inter-incisor angle(r=0.363), maxillary canine angle (r=0.393) and mandibular inter-incisor angle. (r=0.476). Significant negative correlation was observed between OPV and maxillary molar angle (r=-0.348), mandibular canine angle (r=-0.559), ICW/IMW ratio of mandible (r=-0.224). There was insignificant negative correlation of OPV with maxillary ICW/IMW ratio (r=-0.151) and mandibular molar angle (r=-0.004).
Conclusion: Oropharyngeal volume was significantly positively correlated with transverse dental arch morphology. These results indicate a complex interdependence between transverse dental arch form and airway volume and call for airway assessment in conjunction with the dental arch form.
Received: August 10, 2024
Revised: April 30, 2025
Accepted: May 19, 2025
doi.org/10.21089/njhs.102.0081
Prevalence and Antimicrobial Resistance of Deep Neck Space Infections (DNSIs) in Patients at Combined Military Hospital (CMH), Muzaffarabad, Azad Jammu & Kashmir
Muzaffar Mahmood Khan, Saima Saeed, Maryum Riaz, Tehniat Ghias, Tayyeba Sarfraz and Syed Saad Hussain
Abstract: Background: Deep neck infections are one of the major threats for cellulitis and abscess in the head and neck region which may have various origins. Therefore, it is required to have microbes identified and anti-microbial sensitivity to be established which may lead to better therapeutic decisions and patient outcomes.
Objective: This study aimed to determine the clinical presentation, the bacterial agents involved, and the antimicrobial sensitivity patterns of microorganisms associated with DNSI in our hospital patients.
Materials and Methods: A cross-sectional study was conducted at the ENT department of Combined Military Hospital, Muzaffarabad, from April to October 2022 (Ethical Approval No. DME-469). The 115 patients, aged between 18 and 60 years, who were of DNSI, were included in the study. Data collection involved detailed patient history, a physical examination, a microbiological study of pus, and a CT scan. In terms of the data analysis, SPSS was utilized.
Results: Mean age of patients included were 39.8 ± 12.1 years with male to female ration being 1.6:1. Symptoms that were most frequently reported in the cases with dysphagia (29.6%) and sore throat (29.6%). The preferred site of abscess formation was the parapharynx (38.3%). Streptococci were the predominant isolates (40%) to be recovered from the patients, followed by anaerobes (30.4%) and Staphylococci (29.6%). The isolates were highly susceptible to the combination of amoxicillin/clavulanic acid and chloramphenicol.
Conclusion: This study emphasizes that Streptococcus is the most frequently encountered pathogen for DNSI and therefore, early diagnosis and targeted antibiotic therapy of DNSI are very important. It is recommended to use the empirical treatment of amoxicillin/clavulanic acid or chloramphenicol.
Received: April 12, 2024
Revised: May 27, 2025
Accepted: May 27, 2025
doi.org/10.21089/njhs.102.0088
Frequency of Thrombocytopenia and its Association with Short-Term Outcomes among ICU Patients
Waqas Siddiqui, Fizvia Farooq Hereker, Abdul Nafay Kazi and Muzeer Ahmed
Abstract: Background: Thrombocytopenia can result from various etiologies. The development of thrombocytopenia in critically ill patients is associated with increased bleeding and transfusion risk and, hence, higher mortality.
Objective: To determine the frequency of thrombocytopenia and its association with short-term outcomes in patients admitted to the Medical ICU of the tertiary care center.
Materials and Methods: A prospective observational study was conducted in the Medical Intensive Care Unit (MICU) at The Indus Hospital, Karachi, from March to September 2023. The study obtained the permission from the Ethical Review Board of Indus Hospital (IRB#: IHHN_IRB_2023_01_022). Each patient was followed with a platelet count on the first, third, fifth, and seventh day. Patients’ outcomes in terms of aliveness or death were noted on the first, third, fifth, and seventh days.
Results: The study included 152 patients with a mean age of 42.50 ± 18.11 years. On admission, thrombocytopenia was seen in 42%. The frequency at day 3, day 5, and day 7 was 50%, 56.1%, and 50.4%, respectively. At day 5, a significant association was found between mortality and thrombocytopenia, with 68.5% mortalities among thrombocytopenia patients and 31.5% mortality among patients without thrombocytopenia (p=0.002). The association becomes even more obvious by day 7, where thrombocytopenia was found to be strongly linked to mortality, with a higher mortality rate of 68% among those with thrombocytopenia than a 31% death rate among those without thrombocytopenia (p<0.001). Conclusion: Thrombocytopenia was common in MICU and correlated with short-term mortality. The findings indicate the prognostic role of platelet count. To confirm these findings, more multicenter investigations with a bigger sample size and modified analysis are required.
Received: March 08, 2025
Revised: June 10, 2025
Accepted: June 11, 2025
doi.org/10.21089/njhs.102.0095
Effectiveness of Dexmedetomidine versus Ketamine for Control of Shivering and Hemodynamic Stability in Vaginal Hysterectomy under Spinal Anesthesia
Nida Shahid, Asim Masroor Rashid and Atia Kazim
Abstract: Background: Shivering is an attempt by the body to increase the generation of heat through metabolism in response to core hypothermia. Ketamine and dexmedetomidine have been used to prevent shivering during anesthesia with variable findings.
Objective: To determine effectiveness of dexmedetomidine versus ketamine for control of shivering and comparing hemodynamic stability in vaginal hysterectomy under spinal anesthesia.
Materials and Methods: This double blinded randomized control trial was performed in Hamdard University Hospital during January to October, 2023. Before commencing the study, formal permission was taken from Ethics Committee of Hamdard University Hospital (Ref#HCM&D/20/2022). Patients of age 45-55 years undergoing vaginal hysterectomy with ASA grade of I-II were enlisted. Group D was given a prophylactic dose of dexmedetomidine (1mcg/kg) and Group K was given a prophylactic low dosage of ketamine (0.25 mg/kg). Blood pressure (mmHg), heart rate (bpm), oxygen saturation (%) and mean arterial pressure (mmHg) were recorded after every 15 minutes throughout the procedure.
Results: Total 104 patients were enrolled into the study with equal allocation in both the groups. In dexmedetomidine group, only 2 (3.8%) patients experienced shivering whereas in Ketamine group shivering was seen among 9 (17.3%). Among dexmedetomidine group, both of the patients developed shivering at 98 minutes. In ketamine group, average shivering onset time was 84 ± 29.8 minutes with range of 60-105 minutes. Average duration of shivering in dexmedetomidine group was 20±2.1 minutes whereas average duration of shivering for ketamine group was 26.1 ± 9.6 minutes.
Conclusion: The present study demonstrated that dexmedetomidine is superior to ketamine in shivering prevention and control following spinal anesthesia. This study also found that dexmedetomidine is also effective in maintaining hemodynamic stability throughout the procedure.
Received: February 14, 2025
Revised: May 20, 2025
Accepted: May 21, 2025
doi.org/10.21089/njhs.102.0101
Assessing Job Satisfaction and Perceived Improvement Measures among Early Career Hospital Pharmacists in Karachi: A Cross-Sectional Study
Sarmad Iqbal, Soha Khan, Sana Sarfraz and Fizza Faisal
Abstract: Background: Hospital pharmacists play a critical role in patient care, medication management, and efficiency of the healthcare system. Inadequate workload management, recognition and monetary remuneration may lead to higher turnover, lower job satisfaction which affects patient care.
Objective: The aim of this study was to assess the job satisfaction among early career pharmacist of Karachi Pakistan. Together with the perceived measures needed to be taken in order to improve the job satisfaction.
Materials and Methods: From August 2023 to October 2023, a descriptive cross-sectional study was carried out by distributing a self-administered questionnaire through electronic media channels to pharmacist of different hospital sectors in Karachi. The study was approved from Institutional Bioethics Committee of University of Karachi and assigned the reference number of IBC KU-354/2023. The questionnaire was divided into Professional interaction with healthcare professionals, salary/incentive benefits and professional work environment. A five-point Likert scale, value ranging from 1 (strongly disagree) to 5 (strongly agree), was used to rate the questions. Since all of the questions were positively worded therefore, smaller mean values were considered as lower satisfaction.
Results: A total of 107 pharmacists responded to the questionnaire of which majority were females (82.2%). Overall, two-third of the pharmacist (63%) in Pakistan are dissatisfied. Major area of dissatisfaction was observed due to salary and incentive benefits (79%) received by the pharmacist. An otherwise positive response was observed with pharmacist professional interaction (56%). Pakistani pharmacists were inclined with receiving more trainings for their professional development preceded by more salary benefits.
Conclusion: Statutory bodies should devise a strategy to cope with the dissatisfaction of hospital pharmacists in Pakistan especially related to pharmacist salary and trainings.
Received: March 22, 2025
Revised: June 13, 2025
Accepted: June 14, 2025
doi.org/10.21089/njhs.102.0109
Evaluation of Sensory Deficit in Foot Following Sural Nerve Graft
Shiza Mehak Sohail, Faisal Akhlaq Ali Khan, Waqas Sami, Hiba Moazzam, Sumaira Sattar and Sana Shoukat
Abstract: Background: The sural nerve is the most commonly used donor nerve for autologous nerve grafts in reconstructive surgery. The functional outcomes may be impacted with harvest of SNG as it may lead to sensory deficit at donor site.
Objective: To evaluate sensory deficit and patients’ experiences of functional impairment after sural nerve graft.
Materials and Methods: The present prospective observational study was performed in Plastic & Reconstructive Surgery Department of Dr. KM Ruth Pfau Civil Hospital during 1st August 2024 to 28th February 2025. This study received approval from the Institutional Review Board (IRB) at the Dow University of Health Sciences with reference number IRB-3502/DUHS/Approval/2024/176. Sensory examination was performed via Semmes-Weinstein monofilaments. Patients were also asked to report their experience regarding postoperative discomfort, sensory deficits, pain, cold intolerance, and their effect on daily activities, sleep, work, and leisure.
Results: A total of 73 patients were studied with median age of 41 (IQR=26.5-49) years. Some of the patients achieved sensation of 0.5g (30.1%). Majority of patients (42.5%) had mild sensory deficit with who achieved 2.0 g sensation. Around quarter of patients had moderate to profound sensory loss (27.4%). Absence of sensation was not seen in any of the patient. Few patients reported any discomfort in their foot (16.4%), loss of sensation (12.3%), pain in operated leg (11%), cold intolerance (9.6%), sensory deficit effecting daily life (9.6%), sleep (9.6%), work or their attendance (11%) and leisure activities (15.1%).
Conclusion: The findings of present study suggested that according to monofilament examination system nearly a quarter of patients had moderate to severe sensory deficit. However, a smaller proportion of patients reported that their functional activities were impacted substantially after sural nerve graft.
Received: April 24, 2025
Revised: June 11, 2025
Accepted: June 14, 2025
doi.org/10.21089/njhs.102.0117
Perceptions of Young Doctors Regarding Serving in Public Sector Primary Care Level Facilities in Rural Areas of Bahawalpur District
Shanawar Saeed
Abstract: Background: Primary healthcare is essential for achieving social goals, and should be properly supported to promote health.
Objective: This study was performed to assess the understanding and factors of reluctance among young doctors regarding serving in public sector primary care level facilities (BHUs, RHCs & local dispensaries) situated in rural areas of Bahawalpur district, South Punjab, Pakistan.
Materials and Methods: This cross-sectional study was accomplished at BHUs, RHCs, and local dispensaries in Bahawalpur, Pakistan, from 15th September 2024 to 30th March 2025 (IRB approval No. 2651/DME/QAMC/Bahawalpur). A total of 164 doctors of both genders, aged between 25 to 35 years with MBBS, BDS, or higher degrees and working at BHUs, RHCs, or local dispensaries in Bahawalpur district were included. Along with demographic features and other necessary information, perceptions and related factors of doctors working at rural health facilities were assessed.
Results: The study involved 164 doctors (68.9% male, 31.1% female) with a mean age of 30.55±3.28 years. Residential conditions were poor for 101 (61.6%). Facility structures were old but renovated for 83 (50.6%), with 96 (58.5%) reporting poor equipment and electricity. Auxiliary staff had no training in 83 (50.6%). Local cultural challenges affected 53 (32.3%), and 61 (37.2%) faced gender-based issues. Recreational facilities were reported by 23 (14.0%), with 117 (71.3%) feeling government incentives were insufficient. There were delays in post-graduation for 135 (82.3%) and a lack of skill development for 143 (87.2%).
Conclusion: This study highlighted the challenges faced by healthcare professionals in rural settings, such as poor living conditions, inadequate infrastructure, and insufficient professional development opportunities.
Received: May 09, 2025
Revised: June 05, 2025
Accepted: June 10, 2025
doi.org/10.21089/njhs.102.0123
Clinical Profile and Outcome of Patients Undergoing Total Laparoscopic Hysterectomy: A Prospective Study from a Secondary Care Hospital in Karachi
Sana Ashfaq, Mubushra Samina, Maria Jabeen, Summaiya Manzoor, Humaira Tahir and Saira Bhatti
Abstract: Background: The American Association of Gynecologic Laparoscopists recommends that numerous hysterectomies for non-cancerous conditions ought to be performed with laparoscopy. The patient’s obstetric history significantly influences the outcomes. Information on the clinical profiles of patients receiving total laparoscopic hysterectomy (TLH) is rarely documented from Pakistan.
Objective: To present our experience of clinical profile of patients undergoing TLH in our secondary care institution at Koohi Goth hospital in Karachi.
Materials and Methods: The present prospective observational study was performed in Obstetrics & Gynecology Department in Koohi Goth Hospital from 1st August 2018 to 31st December 2023 after obtaining the institutional formal ethical approval (Ref: KGH/HR/134). All of the procedures were performed by single gynecologist having more than 5 years of experiences in performing laparoscopic hysterectomy. Information regarding patients’ demographics, clinical characteristics, procedure information and outcomes were documented.
Results: Total 100 cases were analyzed with mean age of 45 ± 7.8 years. Average BMI was 25.3 ± 8.1 Kg/m2. Almost one-third of patients (32%) had history of previous surgery. The commonest surgical indication was uterine fibroids (54%), and while the least of post-menopausal bleeding. Average surgery duration was 124.26±44.74 minutes. Few patients developed complications (7%) including ureter injury (2%), wound infection (2%), vault infection (2%), and bladder injury (2%). All of complications were seen in either obese females or patients with history of previous surgery.
Conclusion: The present study found that minimally invasive TLH is a safe approach which is easily accessible and harmless for patients with minimal complication rate. Patients with previous history of surgery and elevated body mass index should be given additional care and attention to avoid complexity.
Received: April 11, 2025
Revised: June 17, 2025
Accepted: June 18, 2025
doi.org/10.21089/njhs.102.0130
Fetomaternal Outcomes in Intrahepatic Cholestasis of Pregnancy at Tertiary Care Hospital in Lahore
Ambreen Nasir, Nazia Muneer, Arooj Butt, Sidra Hameed, Sidra Asif and Muhammad Nasir Rana
Abstract: Background: Intrahepatic cholestasis in pregnant women (ICP) is a liver disease that usually reported after 24 weeks of pregnancy with both maternal and fetal complications. ICP is common in general and especially in Pakistani-Asian populations. There is still very little information about fetomaternal outcomes related to ICP in the country.
Objective: The aim of this research is to evaluate the fetomaternal outcome of women with ICP in a tertiary health care hospital in Lahore.
Materials and Methods: A hospital-based single arm prospective observational study was conducted in the Department of Obstetrics & Gynecology PRTH/RMDC Lahore from September 1, 2024, to January 30, 2025 approval from institutional review Board (Ref no. 441/2024). 78 pregnant women in 2nd or 3rd trimester diagnosed with ICP were included. Diagnosis was based on clinical and laboratory findings. Information was gathered on the predesigned proforma. MS Excel 2007 and SPSS version 26 were used for data analysis.
Results: This study has 78 participants with a mean age of 26.42 years. The majority were aged 18-24 years (38.5%), and most had a BMI between 25-29 (42.3%). 64.1% were primigravida and 64.1% had completed primary education. 53.84% delivered full term (37-40 weeks), while 33.3% delivered between 34-36 weeks. The most common pregnancy complication was emergency caesarean section (38.46%), followed by preterm delivery (20.51%). There were 7 cases (8.97%) of spontaneous preterm delivery, 5 cases (6.41%) of intrapartum fetal death, and 1 stillbirth (2.5%).
Conclusion: The findings highlight that ICP predominantly affected younger, overweight primigravida with lower educational attainment. Furthermore, the study revealed significant neonatal complications, including low birthweight, respiratory distress, and meconium-staining.
Received: March 10, 2025
Revised: June 23, 2025
Accepted: June 25, 2025
doi.org/10.21089/njhs.102.0135
Beyond Blood Sugar: The Effects of Weight Change on HbA1c and Diabetes
Syed Azar Hussain Zaidi, Syed Amjad Ali, Imtiaz Ahmad, Aurang Zeb, Inayat Ullah and Ambreen Saadat
Abstract: Diabetes, a chronic disease characterised by hyperglycaemia, affects millions worldwide. Despite various treatments, weight management may affect the complications of disease. Weight gain and diabetes have been researched for decades. This review examined the relationship between weight loss and HbA1c level improvements among diabetes, the effects of weight loss on other diabetes outcomes, the factors of individual response to weight management, long-term HbA1c control, and the conditions under which weight reduction may be effective. Hence, diabetes, weight change, HbA1c, and other MeSH terms and keywords were searched in PubMed, Medline, EMBASE, Cochrane Library, Scopus, and CINAHL. We cross-referenced relevant articles’ reference lists and intensively searched grey literature including conference proceedings, preprints, government reports, and institutional research papers. This research reveals that diabetics’ HbA1c control improves with sustained weight loss. Despite individual variation and restrictions, the findings underline the need of weight management in diabetes therapy. The findings emphasis the need of including weight-management strategies into comprehensive diabetes treatment plans, while acknowledging both individual differences and constraints. Subsequent studies should include these characteristics and modify the suggestions appropriately, while also evaluating the long-term outcomes and determining effective strategies for achieving weight reduction in individuals with diabetes.
Received: October 16, 2024
Revised: May 26, 2025
Accepted: June 03, 2025
doi.org/10.21089/njhs.102.0141
