Biological and Clinical Sciences Research Journal

Level of Depression among Diabetic Patients with Lower Limb Amputation in Lahore, Punjab, Pakistan

2025-07-22T11:55:09+00:00

Lower limb amputation is a major complication of diabetes mellitus (DM) with profound physical, psychological, and social consequences. Depression is among the most common psychological reactions to amputation, yet it is often underrecognized in diabetic patients, particularly in low-resource settings like Pakistan. Objective: To assess the prevalence and severity of depression and its association with demographic and clinical factors among diabetic patients with lower limb amputation in Lahore, Pakistan. Methods: A cross-sectional descriptive study was conducted in three tertiary care hospitals of Lahore, enrolling 202 adult diabetic patients (above or below knee amputation) with a post-amputation duration of 4 months to 2 years. Patients with prior psychiatric illness or receiving rehabilitation services were excluded. Data were collected using a structured questionnaire capturing demographic and clinical details and a validated depression scale for amputees. Depression scores were categorized as mild (25–50%), moderate (50–75%), and severe (75–100%). Data were analyzed using SPSS v20, with chi-square tests to assess associations (p < 0.05 considered significant). Results: The mean age was 48.3 ± 6.9 years, with 66.3% males and 81.7% having below knee amputations. The mean depression score was 70.50 ± 12.82. Overall, 27.7% had mild depression, 65.3% moderate, and 6.9% severe depression. Depression severity was significantly associated with age (p = 0.023), gender (p < 0.001), education (p < 0.001), occupation (p < 0.001), duration of disability (p < 0.001), and level of amputation (p = 0.039). Notably, 73% reported always feeling “heartbroken in loneliness,” and 30% reported they “always forgot to smile.” Conclusion: Depression is highly prevalent among diabetic patients with lower limb amputation, with the majority experiencing moderate symptoms. Targeted mental health interventions, integrated into post-amputation care, are urgently needed to improve quality of life and rehabilitation outcomes in this population.

Managing Change Through Leadership Discourse: An Experience in the Surgical Ward

2025-07-02T16:57:36+00:00

Leadership is a phenomenon that develops in social interaction. This phenomenon is expressed at individual level when a leader with his clearly stated vision, leadership qualities, and style of working, leads the followers to work for the common goals, which are usually ethically motivated and aimed to benefit human life and experience. Leadership governs at the organizational level when different institutions and instruments of the organization work in coherence with meaningful concerted interaction, sharing their roles and responsibilities to produce the best possible results aligned with the ‘vision statement’ of the organization. Leadership is not just limited to those who are in a formal position of authority, but it is the use of power and influence to create a positive change that can benefit humans and society by alleviating their difficulties, worries, and anxiety. Objectives: To create a change through leadership discourse in order to reduce the difficulties of patients and their attendants regarding laboratory investigations. Methods: A change project was accomplished in the surgical ward of Bahawal Victoria Hospital, Bahawalpur, Pakistan, during September-November 2017, to introduce a facilitated method of handling patients’ laboratory samples. Transformational leadership style and SSM methodology were adopted as the change management model. The outcome of the project was studied through mixed methods. Quantitative method was used through specific questions from trainee doctors, house officers, and nurses. And the qualitative method was applied through focus group discussions with the same groups. Results: All the participants unanimously agreed on the ‘need’ for change. And their majority opined that the method was appropriate and deemed the change successful. However 25 % to 33% participants in stakeholders’ groups expressed their concerns over the methodology and long-term success of change. Qualitative exploration revealed the reasons underpinning their concerns.

Comparative Embolectomy Outcomes by Age in Patients with Acute Lower Limb Ischemia

2025-08-16T07:24:35+00:00

Acute limb ischemia (ALI) is a vascular emergency associated with high morbidity and mortality. Emergent surgical embolectomy remains the standard of care; however, outcomes may vary with age, comorbidities, and timing of presentation. Limited data exist from South Asian populations evaluating outcomes in elderly versus younger patients. Objective: To compare outcomes of surgical embolectomy between patients aged ≥80 years and those <80 years presenting with acute limb ischemia. Methods: This retrospective study was conducted in the Department of Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from June 2024 to June 2025. A total of 100 consecutive patients undergoing emergent femoral thromboembolectomy for ALI were included. Patients were stratified into two age-based groups: Group A (≥80 years, n=50) and Group B (<80 years, n=50). All procedures were performed using a standard open femoral approach under 2% prilocaine local anaesthesia. Demographic data, postoperative complications (hematoma, wound infection, acute renal insufficiency/failure), amputation, and mortality were compared between groups. Statistical analysis was performed using the chi-square test, with p<0.05 considered significant. Results: Baseline demographics were comparable across groups. Postoperative complications did not differ significantly between elderly and younger patients. In Group A, 3 (6%) developed hematoma, 3 (6%) wound infection, 11 (22%) required amputation, 9 (18%) had acute renal insufficiency, 7 (14%) acute renal failure, and 9 (18%) died. In Group B, no hematomas occurred; 5 (10%) developed wound infection, 4 (8%) underwent amputation, 4 (8%) had acute renal insufficiency, 2 (4%) developed acute renal failure, and 2 (4%) died. Late presentation was observed in 7 (14%) of Group A and 5 (10%) of Group B. Mortality rates were not significantly different between groups (p=0.31). However, amputation rates were significantly higher in younger patients with late presentation (p=0.001), with compartment syndrome and Buerger's disease being major contributors. Conclusion: Age alone does not significantly influence outcomes of embolectomy in patients with ALI. Delayed presentation, particularly in younger patients with underlying vascular pathology, is associated with increased risk of limb loss. Early diagnosis and timely intervention remain critical to improving outcomes.

Validating Modified-ANT and Stroop Tests for Diagnosing Minimal Hepatic Encephalopathy (MHE) Patients in the Pakistani Population

2025-08-01T18:02:39+00:00

Minimal Hepatic Encephalopathy (MHE) is a subclinical cognitive impairment affecting a substantial proportion of patients with chronic liver disease (CLD). Early diagnosis remains challenging in resource-limited settings like Pakistan, where standard neuropsychological testing is not widely accessible. This study aimed to validate the Modified Animal Naming Test (ANT) and the Stroop Test as simplified tools for MHE screening in the Pakistani population. Methods: A case-control study was conducted at Holy Family Hospital, Rawalpindi, enrolling 196 participants—98 patients with CLD and 98 age- and gender-matched healthy controls. Participants underwent cognitive assessment using three psychometric tools: Psychometric Hepatic Encephalopathy Score (PHES), Modified ANT, and a smartphone-based Stroop Test. A PHES score ≥ -5 was considered diagnostic for MHE. ANT scores <14 and Stroop completion times >190 seconds were also indicative of MHE. Associations among test results and demographic variables were analyzed using SPSS version 26, with p < 0.05 considered statistically significant. Results: The Modified ANT was completed by all participants and revealed MHE in 51% of patients. PHES confirmed MHE in 31.6% of patients. A statistically significant association was found between Modified ANT and PHES scores (p < 0.001). Stroop Test completion was low, with only 8.2% of patients able to perform it, highlighting barriers related to low education and IT literacy. PHES was also significantly associated with age (p < 0.001) but not with gender or education level. Conclusion: The Modified ANT is a reliable and culturally appropriate tool for MHE screening in Pakistani patients with CLD, showing strong correlation with PHES. The Stroop Test, though theoretically valuable, demonstrated limited applicability due to educational and technological constraints. Incorporating low-literacy-friendly psychometric tests like the Modified ANT into routine hepatology practice can facilitate early diagnosis of MHE and help mitigate progression to overt hepatic encephalopathy.

Comparison of Low-Dose Isotretinoin and Conventional Dosing Regime for the Management of Acne Vulgaris

2025-07-29T15:53:05+00:00

Acne vulgaris is a prevalent dermatological condition that significantly affects quality of life. Although isotretinoin is the gold-standard treatment for moderate to severe acne, its conventional dosing is often associated with considerable side effects, prompting investigation into low-dose regimens for comparable efficacy with improved tolerability. Objective: To compare the efficacy and safety of low-dose isotretinoin versus a conventional dosing regimen in patients with moderate to severe acne vulgaris. Methodology: An observational comparative study was conducted with 120 patients aged 14 years or older, equally divided into two treatment groups. Group A received conventional-dose isotretinoin (80 mg/day) while Group B received low-dose isotretinoin (20 mg/day). Acne severity was assessed at baseline using GAGS scores, with moderate acne classified as 19–30 and severe acne as 31–38. Efficacy was evaluated by calculating the percentage reduction in GAGS scores after 12 weeks, categorized as slight (<30%), moderate (30–50%), good (50–80%), or excellent (>80%). An excellent GAGS score was considered adequate. Safety was monitored through clinical assessments of common side effects (e.g., dry skin and dry eyes. Results: The low-dose group exhibited higher efficacy with 70% of patients achieving excellent improvement (>80% GAGS score reduction) compared to 45% in the conventional-dose group. Adverse effects were notably lower in the low-dose group: dry skin (8.3% vs. 16.7%) and dry eyes (10% vs. 20%). Conclusion: Low-dose isotretinoin is an effective and safer alternative to conventional dosing for moderate to severe acne.

Antimicrobial Efficacy of Biogenic Manganese Oxide Nanoparticles Against Klebsiella pneumonia: A Novel Approach to Combat Antibiotic Resistance

2025-07-27T13:14:53+00:00

The rise of multidrug-resistant (MDR) bacteria has emerged as a critical global health concern, significantly impeding effective infection management. Conventional antibiotics are increasingly failing against pathogens such as Klebsiella pneumoniae, which is notorious for its resistance and prevalence in nosocomial infections. This has necessitated the exploration of alternative antimicrobial strategies. Objective: To evaluate the antibacterial, antibiofilm, and cytotoxic effects of biogenically synthesized manganese oxide nanoparticles (MnO NPs) against multidrug-resistant Klebsiella pneumoniae. Methods: This experimental study involved the biosynthesis of manganese oxide nanoparticles followed by their evaluation against Klebsiella pneumoniae. Antibacterial activity was assessed using the agar well diffusion assay. Minimum inhibitory concentration (MIC) was determined via the broth dilution method. Antibiofilm activity was quantified using the crystal violet microtiter plate assay. The effect of sub-inhibitory concentrations of MnO NPs on extracellular polymeric substances (EPS) was also studied. Cytotoxicity was evaluated using the neutral red uptake assay and morphological analysis of HepG2 human liver cell lines. Results: Manganese oxide nanoparticles demonstrated notable antibacterial activity with clear zones of inhibition in agar diffusion assays. MIC testing revealed significant growth inhibition of K. pneumoniae at defined nanoparticle concentrations. MnO NPs also significantly reduced biofilm formation and disrupted EPS production at sub-MIC levels. Cytotoxicity assays indicated that MnO NPs exhibited minimal toxic effects on HepG2 cells at effective antimicrobial concentrations, suggesting good biocompatibility. Conclusion: Biogenically synthesized manganese oxide nanoparticles possess potent antibacterial and antibiofilm activity against Klebsiella pneumoniae, with minimal cytotoxicity to human liver cells. These findings suggest that MnO NPs may offer a promising alternative therapeutic approach to combat multidrug-resistant bacterial infections.

Peculiarity of Diabetes in Presentation Characteristics and Outcomes in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in Tertiary Care Cardiac Centre

2025-07-17T14:07:48+00:00

Diabetes mellitus (DM) is a major risk factor for cardiovascular diseases. Atypical and late presentations in people with diabetes pose a danger of delayed diagnosis, treatment, interventions, and, as a result, worse outcomes. In patients with AMI undergoing Primary PCI(PPCI), people with diabetes are prone to high thrombus burden and procedural complications. A registry revealed to have a high thrombus burden, high mortality, and delays in interventions. Studies have shown that patients with type 2 diabetes mellitus (T2DM) combined with AMI are in a high-risk group for no-reflow Phenomena because these patients usually have complex coronary artery diseases. Objective: This study aims to systematically assess the presentation characteristics and outcomes of diabetic patients who presented with AMI Undergoing Primary PCI. Method: A retrospective cohort study was conducted on 422 patients admitted with AMI who underwent PPCI. Patients' data were taken from electronic health records (HMIS)-demographics, presentation, and PPCI data. The Primary outcomes evaluated were in-hospital mortality and PPCI-related complications. Results: Out of 422 patients, 33.6% were diabetic and 66.3% were non-diabetic. Diabetic patients had a higher mean age, longer symptoms to hospital visit duration (9.11 hours vs 8.84 hours), more multivessel disease (28% vs 16.7%), and a higher heavy thrombus burden. Despite presenting later, door-to-balloon times were similar. People with diabetes had lower TIMI-III flow rates (23.4% vs 30.36% in nondiabetics), lower complete revascularization rates, and higher MACE incidence. Conclusion: Diabetic patients with AMI show distinct clinical characteristics and significantly worse outcomes compared to nondiabetics, highlighting the need for heightened clinical suspicion, rapid diagnostics, aggressive early management, and future interventions to improve timely access to care and optimize long-term management for this high-risk population.

Correlation Between Materials-induced Irritation and Oral Mucosal Lesions

2025-08-17T11:16:45+00:00

Material-induced irritation of the oral mucosa can result in a spectrum of lesions, ranging from benign reactive changes to potentially malignant disorders and oral squamous cell carcinoma (OSCC). Establishing correlations between specific irritants and lesion types is critical for prevention, early diagnosis, and effective management. Objective: To evaluate the relationship between material-induced irritation and the development of oral mucosal lesions, with emphasis on risk factors, clinical presentation, and histopathological patterns. Methods: This cross-sectional study was conducted in the Department of Dental Materials, Ayub Medical College, Abbottabad, from April to September 2024. A total of 160 patients aged ≥18 years with clinically and histopathologically confirmed oral mucosal lesions related to irritant exposure (mechanical, chemical, or metallic) were included. Detailed histories, clinical examinations, and photographic documentation were undertaken, followed by incisional or excisional biopsies for diagnosis. Lesions were classified as reactive, potentially malignant disorders (PMDs), or OSCC. Data were analyzed using chi-square and Pearson correlation tests, with p<0.05 considered significant. Results: Of the participants (mean age 43.5 ± 12.2 years; 57.5% male), 71.3% had lesions linked to chronic mechanical irritants, while 28.7% were associated with chemical irritants. Buccal mucosa (42.5%) and lateral tongue (28.1%) were the most common sites. Histopathology revealed reactive lesions in 47.5%, PMDs in 32.5%, and OSCC in 20.0% of cases. Mechanical irritants (ill-fitting dentures, orthodontic appliances) were predominantly associated with reactive lesions, whereas chemical irritants (smokeless tobacco, nicotine) correlated more with PMDs and OSCC. Metallic restorations were significantly linked with lichenoid lesions. A strong positive correlation was found between duration of irritant exposure and lesion severity (r=0.62, p=0.002). Conclusion: Chronic material-induced irritation is a significant risk factor for oral mucosal pathology, with prolonged exposure markedly increasing the likelihood of malignant transformation. Early detection and removal of irritants, patient education, and preventive measures are vital to reduce lesion progression and improve oral health outcomes.

Assessment of the Knowledge and Practice of Generic Nursing Students About Cardiopulmonary Resuscitation

2025-07-30T10:38:03+00:00

Cardiopulmonary resuscitation (CPR) is a fundamental skill required of nursing professionals to improve patient outcomes during cardiac emergencies. Despite global efforts to integrate CPR into nursing education, evidence suggests persistent knowledge and practice gaps among students, particularly in resource-constrained settings like Pakistan. Objective: To assess the knowledge and practice levels regarding CPR among undergraduate nursing students at Superior University, Lahore. Methods: A descriptive cross-sectional study was conducted among 177 Bachelor of Science in Nursing (BSN) students across all four academic years. A structured, pre-validated questionnaire comprising 13 knowledge and nine practice items was administered. Data were collected using simple random sampling and analyzed using SPSS version 23. Descriptive statistics, including frequencies and percentages, were used to summarize the findings. Results: Out of 177 students, 55.4% were female and 50.8% were aged between 21 and 23 years. The majority were second-year students (37.3%). While 80.2% correctly identified the meaning of "BLS", only 47.5% knew how to respond to an unconscious, non-breathing individual. Knowledge about compression locations and AED use was low (30.5% and 31.6%, respectively). In terms of practice, 54.8% identified the adult CPR algorithm correctly, 64.4% knew the correct pulse check site, and only 45.8% identified proper AED pad placement. Awareness of ERC 2015 guidelines stood at 56.5%. Conclusion: The study identified critical gaps in both theoretical knowledge and practical competence of CPR among nursing students. Findings underscore the urgent need for curriculum enhancements, including simulation-based learning, regular refresher training, and inclusion of updated CPR protocols to strengthen emergency response readiness in Pakistani nursing education.

Navigating Parental Knowledge, Experiences, and Challenges Regarding Post-Discharge Care of Preterm Infants

2025-07-28T18:41:31+00:00

Preterm birth remains a leading cause of neonatal morbidity and mortality globally, with heightened vulnerability persisting after hospital discharge. In resource-limited settings like Pakistan, the caregiving burden shifts predominantly to families, often without adequate preparation or support, leading to adverse outcomes despite advancements in neonatal care. Objective: To explore the knowledge, caregiving experiences, and challenges faced by caregivers of preterm infants after discharge from a tertiary care hospital in Pakistan. Methods: This descriptive, cross-sectional study was conducted in the Neonatology Department of Services Hospital, Lahore, from Nov 2024 to May 2025, following ethical approval (IRB/2025/1530/SIMS). Thirty-six caregivers of preterm infants (born <37 weeks gestation) discharged within the previous six months were recruited through non-probability convenience sampling. Data were collected through structured interviews during follow-up visits using a comprehensive questionnaire covering demographics, infant characteristics, feeding practices, kangaroo mother care practices, hygiene and temperature control, recognition of danger signs, developmental monitoring, emotional well-being, cultural influences, and access to support systems. Descriptive statistics and thematic analysis were used for data interpretation. Results: Most caregivers were mothers (66.7%) with a mean age of 29.94±7.22 years and 44.5% having tertiary level education. Mean infant gestational age was 31.00±2.39 weeks with birth weight 1631.67±429.68g. Primary neonatal diagnoses included respiratory distress syndrome (30.5%), jaundice (22.2%), and sepsis (19.5%). While 83.3% of caregivers knew breastfeeding benefits, only 50% practiced exclusive breastfeeding, with 13.9% incorrectly diluting formula. Hunger cues were confidently recognized by 50% of caregivers. KMC was practiced at home by 44.4% with a mean frequency of 5.1±2.9 hours daily. Despite 83.3% receiving hygiene counseling, only 58.3% consistently practiced good hygiene. Danger sign recognition was limited, with only 27.8% identifying cyanosis, though all caregivers (100%) would seek hospital care when needed. Health concerns were reported in 72.2% of infants, primarily breathing difficulties (27.8%). Developmental concerns were noted by 30.6% of caregivers, while 38.9% reported infants achieving smiling milestones. Follow-up adherence was good (75% attending regular visits), but barriers included scheduling challenges (33.3%), transport issues (11.1%), and financial constraints (5.6%). Traditional practices were used by 47.2% of families. Emotional strain affected 55.5% of caregivers, with stress and fatigue reported by 35.5%. Post-discharge counseling was considered adequate by only 61.1%, while 38.9% received incomplete support. Conclusion: Caregivers of preterm infants face multifaceted challenges after discharge, including significant gaps between knowledge and practice implementation, particularly in exclusive breastfeeding, KMC continuation, and danger sign recognition. Despite relatively high educational levels, practical application of essential neonatal care practices remained suboptimal. Key challenges included feeding difficulties (58.4%), health-related concerns (72.2%), emotional strain (55.5%), and cultural conflicts with medical advice (47.2%). The study reveals urgent needs for structured, culturally-sensitive discharge education extending beyond hospitalization, enhanced psychosocial support addressing maternal mental health, community-based reinforcement mechanisms, and innovative follow-up strategies bridging hospital-to-home care transitions. These findings provide valuable insights for developing targeted interventions to improve neonatal outcomes in similar resource-limited settings.

Audit of Compliance with the WHO Surgical Safety Checklist in the Orthopedic Operating Theatre at Benazir Bhutto Hospital

2025-08-09T17:35:57+00:00

The World Health Organization (WHO) Surgical Safety Checklist (SSC) has been shown to reduce peri-operative harm, but its real-world effectiveness is contingent on consistent, high-quality application. Global evidence indicates considerable variability in adherence, with the sign-out phase frequently showing the poorest compliance. Objective: To evaluate baseline SSC compliance in an orthopedic operating theatre, implement a targeted, low-cost intervention, and reassess compliance in a closed-loop audit. Methods: A closed-loop clinical audit was conducted at the Orthopedic Operating Theatre, Benazir Bhutto Hospital, Rawalpindi, Pakistan. In Cycle 1 (December 2024), 30 consecutive orthopedic surgeries were directly observed using a standardized SSC compliance tool. After the baseline assessment, a multifaceted intervention—comprising a department-wide educational session for surgeons, anesthetists, nurses, and residents; placement of laminated SSC posters at each operating table; and senior-staff verbal reinforcement and coaching—was implemented in February 2025. In Cycle 2 (June 2025), 30 new surgeries were observed by the same team using identical methods. Compliance for each SSC phase (sign-in, time-out, sign-out) was categorized as full (all items completed and verbalized), partial, or non-compliant. Descriptive statistics were applied to compare pre- and post-intervention proportions. Results: At baseline, full compliance was 40% for sign-in, 30% for time-out, and 20% for sign-out; overall, 30% of surgeries were fully compliant, 36% partially compliant, and 34% non-compliant. Following the intervention, full compliance increased to 80% (sign-in), 70% (time-out), and 65% (sign-out); overall, 72% of surgeries were fully compliant, 21% partially compliant, and 7% non-compliant. The most notable improvement occurred in the sign-out phase, which rose from 20% to 65% full compliance. Conclusion: A straightforward, low-cost intervention—combining education, visual reminders, and leadership engagement—more than doubled overall SSC full compliance in a high-volume orthopedic theatre within six months. Embedding such strategies into routine practice, alongside continuous monitoring and reinforcement, is likely essential to sustain improvements.