National Journal of Health Sciences (Current Issue)

Water Sorption and Antimicrobial Performance of Alkali-Treated Moringa oleifera Reinforced Heat-Cured Denture Base Resin: An In-vitro Experimental Study

Rabiya Saif¹, Hammad Hassan², Mehvish Sajjad³, Naila Umer⁴, Hira Asghar², Usman Ashraf⁵

¹Department of Oral Pathology, de’ Montmorency College of Dentistry, Lahore, Pakistan.
²Department of Science of Dental Materials, Azra Naheed Dental College, Superior University, Lahore, Pakistan.
³Department of Science of Dental Materials, University College of Dentistry, University of Lahore, Lahore, Pakistan.
⁴Department of Oral, Pathology, Azra Naheed Dental College, Superior University, Lahore, Pakistan.
⁵Department of Science of Dental Materials, Institute of Dentistry, CMH Lahore Medical College, National University of
Medical Sciences (NUMS), Lahore, Pakistan.

Abstract: Background: Heat-cured polymethyl methacrylate (PMMA) is susceptible to water sorption and microbial colonization leading to dimensional instability and denture stomatitis. Natural lignocellulose based fillers like Moringa oleifera , may improve the functional and antibacterial properties of PMMA.

Objective: To evaluate water sorption and antimicrobial activity of heat-cured Polymethyl Methacrylate resin reinforced with alkali-treated Moringa oleifera powder.

Materials and Methods: This in-vitro experimental study was performed at Azra Naheed Dental College and University of Lahore, from 30th March 2025 to 31st December 2025 after obtaining approval from of Ethical Review Board (Ref: ANDC/RAC/2025/66) dated: 29th March 2025. Heat-cured PMMA specimens were prepared as control (0% moringa) and moringa-reinforced groups (5%, 10%, 15% w/w). Powder was washed, oven-dried, milled, sieved, and alkali-treated (5% NaOH), then neutralized and re-dried. Water sorption (%) was measured by mass change after immersion in distilled water for one month. Antimicrobial activity was evaluated using an agar disc diffusion method by measuring zones of inhibition. One-way ANOVA and Tukey HSD were used, followed by Pearson correlation. p-values ≤0.05 were taken as significant.

Result: Water sorption decreased with higher moringa content (control 1.82±0.12 to 15% 1.62±0.08; p=0.008). The Antimicrobial zones increased with the increase in concentration (control 0.00±0.00 to 15% 12.17±0.75; p<0.001). In moringa groups, the correlations were very small and non-significant.

Conclusion: Alkali-treated moringa reinforcement reduced PMMA water sorption and produced measurable antimicrobial inhibition in a concentration-dependent manner.

Keywords: Candida, Denture stomatitis, Moringa oleifera , PMMA denture base, Water sorption.

doi.org/10.21089/njhs.111.0014

Received: January 01, 2026
Revised: February 23, 2026
Accepted: February 24, 2026

Comparative Evaluation of Serum C-Reactive Protein and Albumin Levels in Healthy Controls and Patients with Oral Potentially Malignant Disorders, and Oral Malignancy

Arooj Mahmood¹, Moghees Ahmad Baig¹, Ashfaq ur Rahim², Anum Abid¹, Khurshid Ali Ansari¹,Easha Tahir Butt³

¹Department of Oral and Maxillofacial Surgery, University of Lahore, Lahore, Pakistan.
²Department of Oral and Maxillofacial Surgery, Rahbar College of Dentistry, Lahore, Pakistan.
³Department of Physiology, Azra Naheed Dental College, Superior University Lahore, Lahore, Pakistan.

Abstract: Background: Oral cancers, like oral squamous cell carcinoma (OSCC), are often preceded by oral potentially malignant disorders (OPMDs) and biomarkers like C-reactive protein (CRP) and serum albumin can be indicators for early detection of these disorders.

Objective: To evaluate and compare the levels of CRP and serum albumin in healthy individuals, patients with oral premalignant lesions, and OSCC, and identify their potential as biomarkers.

Materials and Methods: This comparative cross-sectional study was conducted at the University College of Dentistry from 1st January to 31st August 2025 after the IRB approval [(Ref: UCD/ERCA/24/1583), dated 13-12-2024]. A total of 180 participants, aged 18-80 years, were divided into 3 groups i.e., healthy individuals, patients with premalignant lesions, and OSCC, using consecutive sampling. Individuals with inflammatory and chronic disorders, pregnancy, recent surgery or transfusion were excluded. Fasting venous blood samples were assessed. SPSSv24 was used for data analysis and comparisons, using one-way-ANOVA, pairwise comparisons, t-test, and Pearson’s correlation.

Result: The mean age was 43±12.4years, with 104 males (57.8%) and 76 females (42.2%). Mean CRP was 16.97±17.33mg/L, highest in premalignant lesions (36.67±15.04), followed by OSCC (13.04±4.46) and controls (1.20±1.12) (p<0.001). Albumin levels declined progressively (Normal 4.40±0.61; OSCC 2.90±0.45; Premalignant 2.18±0.55g/dL, p<0.001). No significant differences were observed by gender (CRP, p=0.532; Albumin, p=0.221) or age (CRP, p=0.243; Albumin, p=0.144). CRP and albumin showed inverse correlations in premalignant lesions (p<0.001).

Conclusion: Serum CRP and albumin levels are significantly altered in oral premalignant and malignant lesions. These inexpensive biomarkers may serve as adjuncts for early detection, and prognosis of patients with OPMDs and OSCC.

Keywords: C-reactive protein, Serum albumin, Oral squamous cell carcinoma, Biomarkers, Inflammation, Lesions.

doi.org/10.21089/njhs.111.0020

Received: September 24, 2025
Revised: January 08, 2026
Accepted: January 12, 2026

Anatomical Assessment of Mandibular Buccal-Shelf Area (MBS) on Cone Beam Computed Tomography (CBCT) in the Islamabad/ Rawalpindi Population for Miniscrew Insertion

Muteen Fatima, Amjad Mahmood, Kausar Ilyas, Mehwish Shaheed, Amna Saeed

Department of Orthodontics, Margalla Institute of Health Sciences, Rawalpindi, Pakistan.

Abstract: Background: Extra-alveolar miniscrews exhibit increased advantage over interradicular miniscrews since it does not interfere with constant tooth movement. Total buccal bone thickness in area of mandibular buccal shelf (MBS) area is variable at different sites, depths and also in different ethnicities.

Objective: To assess cortical bone depth (vertical) at horizontal distance of 2, 4 and 6mm and total buccal bone thickness (horizontal) at vertical reference position of 4, 8 and 12mm in mandibular buccal shelf area at distobuccal root of mandibular first molar (DB6), mesiobuccal root of mandibular second molar (MB7) and distobuccal root of second molar (DB7) to determine best site for miniscrew placement.

Materials and Methods: This cross-sectional study was conducted in Department of Orthodontics at Margalla Institute of Health Sciences, Rawalpindi from 1st January 2025 to 31st December 2025 on patients having cone beam computed tomography (CBCT) scans. Prior ethical approval was obtained from the Ethics Review Committee, Margalla Institute of Health Sciences (DM/220/24). SPSS Software (by IBM) version 27.0.1 was used for statistical evaluation. Median with interquartile ranges were tabulated for cortical bone depth (vertical) and total buccal bone thickness (horizontal) .Post-hoc pairwise comparisons following Friedman’s test were performed using the Wilcoxon signed-rank test with Bonferroni-adjusted p-values. A p-value of less than 0.05 was considered statistically significant.

Result: Maximum cortical bone depth (vertical) of 14.7 mm (3.0–19.5) was found buccal to the DB6 site at 4mm, followed by MB7 which showed cortical bone depth (vertical) of 12.1mm (0.0–22.7) at 6mm. Maximum total buccal bone thickness (horizontal) of 8mm was found in DB7 at 12mm depth, followed by 7.5mm thickness seen in relation to DB7 at 8mm depth.

Conclusion: Successful placement of TAD in mandibular buccal shelf (MBS) area in Pakistani population can be done buccal to distobuccal root of mandibular second molar at 12mm apical to cementoenamel junction, since this area has maximum total buccal bone thickness (horizontal) and cortical bone depth (vertical) greater than 1mm.

Keywords: Cone beam computed tomography, Cortical bone depth, Mandibular buccal shelf, Miniscrew, Temporary anchorage devices, Total buccal bone thickness.

doi.org/10.21089/njhs.111.0026

Received: February 02, 2026
Revised: March 05, 2026
Accepted: March 08, 2026

Bacteriological Diversity and Antibiogram Analysis of Blood Culture Isolates in a Pediatric Setting at Tertiary Care Hospital Karachi

Shaikh Ali Masood¹, Shabbir Ahmed Mallick¹, Romana Nisar Ahmed¹, Tooba¹, Haider Abbas²,Ayesha Samad3

¹Department of Pediatric Medicine, Liaquat National Hospital & Medical College, Karachi, Pakistan.
²Department of Pediatric Cardiac, National Institute of Cardiovascular Diseases(NICVD), Karachi, Pakistan.
³Department of Pediatric Medicine, National Institute of Child Health (NICH), Karachi, Pakistan.

Abstract: Background: In low-middle income countries multi-drug resistant (MDR) bacteria are considered a health priority. The protocols directed by The Clinical and Laboratory Standards Institute (CLSI) recommend to develop antibiogram in hospital settings.

Objective: To analyze the bacteriological diversity and antibiogram patterns of blood culture isolates in a pediatric settings at a tertiary care hospital in Karachi, Pakistan.

Materials and Methods: This descriptive cross-sectional study was executed at Department of Pediatrics, Liaquat National Hospital during 2nd February, 2025 to 30th September, 2025 after taking formal ethical approval of the hospital committee bearing number App#1152-2024-LNH-ERC. Patients admitted to pediatric department and suspected for blood stream infection (BSI) were included. Standard aseptic measures were used to collect the blood sample. According to the CLSI’s breakpoint guidelines, the isolates were classified as susceptible, intermediate, or resistant to the test antibiotics bases on inhibition zone diameter.

Result: A total of 370 patients were enrolled with median age of patients was 35.5 (IQR=12-124) months. BSI was detected in 75 (20%). Out of 75, gram-positive and gram-negative bacteria were found in 17 (22.7%) and 58 (77.3%) patients respectively. Out of total 17 gram positive bacteria, almost half were Streptococcus pneumoniae and other half were Enterococcus species. Among 58 gram-negative bacteria, the commonest detected pathogen was Salmonella Typhi (56.9%). Among gram-positive bacteria, both of pathogens were 100% resistant to meropenem. Resistance of Ciprofloxacin, Ceftriaxone, Cefuroxime was seen in 100% isolates of Klebsiella pneumoniae, E. coli and Hafnia alvei. S.  Typhi was least resistant to Cefuroxime (3%), Chloramphenicol (3%) Gentamicin (6%), Imipenem (6%) while highly resistant to Ceftriaxone (75.8%), Ampicillin (72.7%), Amikacin (69.6%).

Conclusion: A remarkable burden of BSI was found in our settings with higher burden of gram-negative bacteria, Enteric fever being the most frequent. Different resistance patterns were observed for different antibiotics, mostly 100% resistance was seen for most of bacterial isolates. This finding underscores the ongoing monitoring of antimicrobial profile to decide the appropriate empirical therapy of antibiotics.

Keywords: Antibiogram, Antimicrobial profile, Antibiotics, Blood stream infections, Low-middle income countries.

doi.org/10.21089/njhs.111.0033

Received: November 07, 2025
Revised: December 31, 2025
Accepted: January 05, 2026

Assessment of Nerve Regeneration in Post-Operative Median and Ulnar Nerve Injury Patients in Civil Hospital Karachi using Clinical Tools

Sana Shoukat¹, Faisal Akhlaq Ali Khan¹, Waqas Sami¹, Seema¹, Erum Naz², Hiba Moazzam¹

¹Department of Plastic Surgery, Dr. Ruth K.M. Pfau, Civil Hospital (DUHS), Karachi, Pakistan.
²Department of Plastic Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT), Karachi, Pakistan.

Abstract: Background: Traumatic upper limb peripheral nerve injuries are frequent and lead to long-term severe sensorimotor dysfunctions. An early, objective evidence of nerve regeneration is important for assessment of surgical results and rehabilitation especially in resource-poor settings where the sophisticated investigations may not be readily available.

Objective: To evaluate nerve regeneration in post‑operative median and ulnar nerve injury patients using clinical assessment tools at Civil Hospital Karachi, Pakistan.

Materials and Methods: This prospective cohort study was carried out in the Department of Plastic Surgery, Dr. Ruth K.M. Pfau, Civil Hospital, Karachi, Pakistan, from 18th February 2025 to 15th December 2025. The ERC was obtained from Dow University of Health Sciences bearing number IRB-3684/DUHS/Approval/2024/67. Adults (≥18 years) who underwent primary repair of median and/or ulnar nerves in flexor zone V were enrolled by consecutive sampling. Surgery consisted of tension‑free end‑to‑end neurorrhaphy or autologous nerve grafting. Patients were assessed at 1, 3, and 6 months post‑operatively using the Visual Analogue Scale (VAS) for neuropathic pain and sensory recovery, Tinel’s sign, and the Medical Research Council Manual Muscle Testing (MMT) scale; electrophysiological studies were performed selectively. SPSS version 23 was used to analyze the data.

Result: Sixty patients (mean age 30.96 ± 13.20 years) were included; males predominated (71.7%). Tinel’s sign was positive in all patients at 1 month, 83.6% at 3 months, and all assessed at 6 months. Median (IQR) VAS improved from 5 (5–6) at 1 month to 8 (7–8) at 3 months and 8 (8–9) at 6 months (p < 0.001). MMT grades improved progressively, though differences between repair and grafting groups were not statistically significant (p = 0.215; p = 0.280).

Conclusion: Serial evaluation with VAS, Tinel’s sign, and MMT provides a reliable clinical measure of nerve regeneration. Significant functional recovery was observed within six months post-repair.

Keywords: Peripheral nerve injury, Median nerve, Ulnar nerve, Nerve regeneration, Tinel’s sign, Manual muscle testing, Visual analogue scale.

doi.org/10.21089/njhs.111.0041

Received: September 24, 2025
Revised: January 08, 2026
Accepted: January 12, 2026

Prognostic Performance of the Admission C-Reactive Protein to Lymphocyte Ratio in Acute Pancreatitis

Sara Reza¹, Lubna Sarfraz¹, Fahad Qaisar², Muhammad Ehsan Sukhera², Saira Saleem¹

¹Department of Pathology, Quaid-e-Azam Medical College, Bahawalpur, Pakistan.
²Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, Pakistan.

Abstract: Background: Early risk stratification in acute pancreatitis (AP) is important, but many prognostic scores are complex or require serial measurements. We evaluated the admission C-reactive protein-to-lymphocyte ratio (CLR) as a predictor of moderately severe/severe AP.

Objective: To assess the diagnostic performance of admission CLR for predicting moderately severe or severe AP (MSAP/SAP) and to derive an optimal admission cut-off for early risk stratification.

Materials and Methods: The Prospective, exploratory diagnostic accuracy study was conducted during January 1st 2024 to 30th June 2025. It was done in collaboration with the Department of Medicine and the Department of Pathology, Quaid-e-Azam Medical College and Bahawal Victoria Hospital, Bahawalpur bearing Ethical approval no. (IRB QAMC 1585, Dated 15 December 2023). Out of 72 AP patients screened, 12 were excluded (including missing admission CRP or absolute lymphocyte count), leaving 60 for complete-case analysis (40 mild AP, 20 MSAP/SAP). Labs were obtained within 24 hours. Discrimination was assessed by ROC analysis and association with MSAP/SAP used Firth-penalized logistic regression limited to pre-specified predictors (CLR per 10 units and age) to reduce overfitting.

Result: Patients who developed MSAP/SAP had higher admission CRP and CLR values, with no significant differences in age or sex between groups. Median CLR increased from 33.6 (IQR 23.7–52.4) in mild AP to 236.5 (IQR 163.2–288.1) in MSAP/SAP (p<0.001). Each 10-unit CLR increase was independently associated with MSAP/SAP (adjusted OR 1.63, 95% CI 1.22–2.37; p=0.001). CLR showed good discrimination (AUC 0.818, 95% CI 0.693–0.942). A Youden-derived cut-off of 67.7 yielded 85.0% sensitivity and 72.5% specificity. Length of stay was longer in MSAP/SAP (10.1±1.9 vs 5.8±2.4 days; p<0.001).

Conclusion: Admission CLR ≥67.7 was associated with MSAP/SAP and may aid risk assessment. Because CRP alone showed higher discrimination, CLR should be viewed as an adjunct, not a substitute for established CRP strategies (including 48-hour CRP). Larger multicenter studies should validate the threshold and assess whether serial CLR adds prognostic value.

Keywords: Acute pancreatitis, C reactive protein, Lymphocyte count, Severity prediction, Biomarker.

doi.org/10.21089/njhs.111.0047

Received: January 17, 2026
Revised: March 06, 2026
Accepted: March 13, 2026

Effect of Serum Ferritin on Serum Zinc Levels in Patients with Thalassemia Major: A Prospective Cross-sectional Study

Uzma Hayat¹, Shabnam Dildar², Saima Siddique³, Nizam-uddin⁴

¹Department of Clinical Haematology, National Institute of Blood Disease & Bone Marrow Transplantation,
Karachi, Pakistan.
²Department of Clinical Pathology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan.
³Department of Haematology & Clinical Laboratory, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan.
⁴Department of Research, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan.

Abstract: Background: One of the most common cause of hereditary anemia is thalassemia, with carrier rate of 5.2% globally.  Repeated blood transfusions lead to accumulation of iron in multiple organs which causes multiple complications. Among many complications, micronutrient deficiency of zinc does contribute to further hampering of overall general wellbeing of thalassemic patients. Keeping this in mind, a study is conducted to see the association of increased ferritin levels on serum zinc levels.

Objective: The objective of the study is to observe for a likely association between serum ferritin and zinc in patients with Thalassemia Major. Secondary objective is to assess growth and development of Thalassemic children as per growth centile charts.

Materials and Methods: A cross -sectional study was conducted at National Institute of Blood Disease & Bone Marrow Transplantation (NIBD), Karachi with the duration of 3 months from January 04, 2025 to April 14, 2025, after the approval of Ethical Review Committee bearing number NIBD/IRB/267/02-2024, dated: 31-05-2024. Data collected in this study included: age, sex, anthropometric assessment was done by CDC Growth centile charts. Serum ferritin and Zinc level were also estimated. Data was recorded and analyzed by SPSS 25.0 and the statistically significant level, considered as 0.05.

Result: Out of all patients, 40% exhibited zinc insufficiency, 35.7% had serum ferritin levels >3000 ng/ml, 28.6%had levels over 4000, and 21.4% had levels over 5000ng/ml. There was a substantial inverse relationship between high ferritin and low zinc levels. The growth of 62.9% of thalassemic patients were at fifth centile indicating deceleration in growth. Girls being dominant figure (57.1%) showing poor growth
velocity.

Conclusion: Patients with Thalassemia major have showed substantial development retardation. Forty percent of the Thalassemic children had low serum zinc levels. Additionally, low zinc levels were significantly correlated with high ferritin levels.

Keywords: Thalassemia, Zinc deficiency, Serum ferritin levels, Beta globin, Transfusion.

doi.org/10.21089/njhs.111.0054

Received: October 20, 2025
Revised: February 13, 2026
Accepted: February 16, 2026

The NS1 Antigen Positivity and its Association with Day of Illness among Suspected Dengue Patients: A Hospital-Based Study

Shaista Faheem¹, Badeeya Rashid¹, Muhammad Usama¹, Maria Zafar¹, Muhammad Talha Tariq¹,Samina Rashid²

¹Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
²Department of Medicine, Military Hospital, Rawalpindi, Pakistan.

Abstract: Background: The dengue fever has remained a significant health in Pakistan due to its endemic outbreaks. NS1 glycoprotein is an important serological biomarker play an important role in disease progression. Its early identification can optimize the diagnostic testing and result interpretation in suspected dengue patients.

Objective: To associate NS1 antigen positivity with day of illness in suspected dengue patients.

Materials and Methods: This hospital based retrospective cross-sectional study was conducted from 1st June 2025 to 30th November 2025, at Pakistan Institute of Medical Sciences, Islamabad after obtaining ethical approval from the ethical review committee of PIMS under ERC# F-5-2/2024 (ERRC) PIMS, dated: 15-11-2025. A hospital record of total 364 suspected dengue patients was collected and analyzed. The association between NS1 antigen positivity and day of illness were evaluated by using Chi-square. Age was presented as mean ± S.D while frequency was observed for gender distribution.

Result: Among 364 suspected dengue cases, 31.9% tested positive for NS1 antigen, with a higher prevalence in males (67.3%) and a mean age of 36.75 years. NS1 positivity was highest in patients presenting on days 5–7 of illness (33.7%) and reached 100% in those presenting on day 8 or later. Platelet counts showed no significant variation across different days of illness (p = 0.475).

Conclusion: NS1 antigen testing is a valuable early diagnostic tool for dengue, and its accuracy may improve when combined with serological and hematological markers. Future longitudinal studies are needed to better understand NS1 dynamics throughout the illness.

Keywords: Dengue, NS1 antigen, Serological markers, Disease progression, Epidemiology.

doi.org/10.21089/njhs.111.0060

Received: February 14, 2026
Revised: March 13, 2026
Accepted: March 24, 2026