Biological and Clinical Sciences Research Journal

The Determinant of Unintended Pregnancies Among Women of Pakistan

2025-11-16T14:08:39+00:00

Unintended pregnancies remain a major public health concern worldwide, particularly in low and middle-income countries. In Pakistan, socioeconomic constraints, limited access to reproductive health services, unmet contraceptive needs, and restricted spousal communication continue to influence reproductive outcomes. This study aimed to identify the key sociodemographic and reproductive determinants associated with unintended pregnancies among married women attending a tertiary care hospital in Lahore. Methods: A descriptive cross-sectional study was conducted among 171 married women of reproductive age visiting the gynecology outpatient department. Participants were selected through convenience sampling. Data were collected using a structured, validated questionnaire that assessed sociodemographic variables, contraceptive use, communication patterns, reproductive history, and access to communication tools. Statistical analysis was performed using SPSS version 26. Descriptive statistics summarized participant characteristics, while chi-square tests determined associations between independent variables and unintended pregnancy. A p-value below 0.05 was considered statistically significant. Results: The majority of participants were aged 31–35 years (42.1%), resided in urban areas (67.3%), and had secondary education (51.5%). More than half (55.6 percent) had never used contraception, and 38.6 percent had never discussed family planning with their spouses. Unintended pregnancies were significantly associated with non-use of contraception (71.6 percent vs 42.1 percent, p<0.001), lack of spousal communication (69.7 percent vs 39.1 percent, p<0.001), short birth intervals below 12 months (p=0.003), younger age (p=0.042), low educational attainment (p=0.038), limited access to communication tools (p=0.050), and history of miscarriage (p=0.021). Residence, gravidity, parity, and family size did not show significant associations. Conclusion: This study highlights the multifactorial nature of unintended pregnancies in Pakistan, emphasizing the role of contraceptive uptake, effective partner communication, education, and birth spacing. Addressing these determinants through culturally sensitive counseling, enhanced family planning services, and community-based awareness programs could reduce unintended pregnancies and improve reproductive health outcomes among married women.

Nursing Interventions and Their Effectiveness in Reducing Anxiety Among Preoperative Patients

2025-11-09T14:52:56+00:00

Preoperative anxiety is a typical psychological response among patients awaiting surgery, leading to adverse effects such as increased pain perception, delayed recovery, and higher complication risks. Effective nursing interventions can play a vital role in mitigating anxiety, enhancing patients' psychological preparedness, and improving surgical outcomes. Objective: To evaluate the effectiveness of nursing interventions comprising preoperative education, therapeutic communication, relaxation techniques, and environmental modification in reducing anxiety levels among preoperative patients. Methods: A quasi-experimental study was conducted at Ch—Pervaiz Elahi Institute of Cardiology Hospital, Multan, Pakistan, from January to June 2025. Ninety preoperative patients aged 18–65 years undergoing elective surgery were selected through non-probability purposive sampling. The State-Trait Anxiety Inventory (STAI) was administered before and 24 hours after nursing interventions. Data were analyzed using SPSS version 26.0, applying paired sample t-tests with a significance threshold of p < 0.05. Results: The mean pre-intervention anxiety score was 58.6 ± 6.4, which significantly decreased to 42.3 ± 5.7 after intervention (p < 0.001). Both genders exhibited substantial reductions, with females showing a slightly greater decline (mean difference: 17.2) compared to males (mean difference: 15.3). The highest decrease was observed in patients aged 18–30 years (mean difference: 18.1), followed by those aged 31–45 years (16.2) and 46–60 years (15.5), all statistically significant (p < 0.001). These findings indicate that nursing interventions were effective across all demographic subgroups. Conclusion: Structured nursing interventions significantly reduced preoperative anxiety among surgical patients. Educational counseling, relaxation techniques, and therapeutic communication proved practical and feasible within the Pakistani hospital setting. Integrating evidence-based nursing approaches into preoperative care can improve patient satisfaction, reduce psychological distress, and enhance postoperative recovery.

Frequency of Anemia in Early Umbilical Cord Clamping in Term Pregnancy Neonates

2025-11-01T11:36:16+00:00

Placental transfusion during the first few minutes after birth provides the newborn with an additional 80–100 mL of blood, increasing blood and red cell volume, which helps prevent neonatal anemia. Early umbilical cord clamping (ECC), performed within 30 seconds of delivery, interrupts this natural transfusion and may lead to reduced hematocrit and iron stores in neonates. Objective: To determine the frequency of anemia in term pregnancy neonates undergoing early umbilical cord clamping and to evaluate its association with maternal and neonatal factors. Methodology: This cross-sectional descriptive study was conducted at the Department of Obstetrics and Gynaecology, Shaikh Zaid Women Hospital, SMBBMU Larkana, over six months (February–July 2020). A total of 121 term neonates were included using non-probability consecutive sampling. Early cord clamping was performed within 30 seconds of birth, and cord blood hematocrit was measured using an automated analyzer. Neonatal anemia was defined as a hematocrit <45%. Maternal demographic, obstetric, and clinical data were recorded. Data were analyzed using SPSS v26, with chi-square tests used to assess associations; p≤0.05 was considered significant. Results: The mean maternal age was 28.26 ± 5.64 years, and the mean gestational age was 38.21 ± 1.03 weeks. Among 121 neonates, 31 (25.6%) were anemic and 90 (74.4%) were non-anemic. Maternal age, gestational age, parity, booking status, obesity, hypertension, and previous postpartum hemorrhage were not significantly associated with anemia, while maternal diabetes mellitus showed a significant relationship (p=0.039). Conclusion: A considerable proportion of term neonates developed anemia following early cord clamping. Promoting delayed cord clamping may help reduce neonatal anemia and improve early hematologic outcomes.

The Infection Control Paradox: Exploring Knowledge and Practices of ICU Nurses Across Hospitals in Punjab, Pakistan

2025-10-29T11:56:59+00:00

Hospital-acquired infections (HAIs) continue to pose a serious challenge to patient safety, particularly in intensive care units (ICUs) where patients are most susceptible. Nurses are central to infection prevention and control (IPC), yet a persistent gap between knowledge and practice undermines infection control efforts, especially in resource-constrained healthcare settings such as Pakistan. Objective: This study aimed to evaluate ICU nurses' knowledge and self-reported practices regarding IPC measures and to determine the relationship between these two domains in tertiary care hospitals across Punjab, Pakistan. Methods: A descriptive cross-sectional study was conducted among 150 ICU nurses working in selected public and private tertiary hospitals. Data were gathered using a pre-validated structured questionnaire developed in accordance with World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidelines. Knowledge and practice levels were categorized as good (≥75%), moderate (50-74%), or poor (<50%). Data were analyzed using SPSS version 26, applying descriptive statistics, chi-square tests, and Pearson's correlation analysis. Results: The findings indicated moderate levels of knowledge (mean = 11.2 ± 2.1) and practice (mean = 10.6 ± 2.4) among the participants. Only 36% demonstrated good knowledge, while 32.7% exhibited good practices. Notable gaps were found in hand hygiene duration, sterilization techniques, needlestick injury management, and consistent use of N95 masks. Nurses with higher educational qualifications showed significantly better knowledge (p = 0.02), and those with greater years of experience demonstrated better practices (p = 0.01). A strong positive correlation was identified between knowledge and practice scores (r = 0.62, p < 0.001). Conclusion: ICU nurses in Punjab displayed moderate knowledge of IPC but suboptimal implementation in clinical practice. The observed knowledge-practice gap highlights the influence of both personal and institutional factors. Strengthening regular IPC training programs, ensuring continuous supervision, and enhancing resource availability are critical for fostering a robust infection control culture and reducing the burden of HAIs in ICUs.

Change in 4% lidocaine Instillation in the endotracheal tube (ETT) before and after surgery in patients undergoing surgery under general anesthesia.

2025-10-29T08:36:19+00:00

Post-operative sore throat and airway-related complications are common after general anesthesia with endotracheal intubation. Lidocaine instillation into the endotracheal tube cuff and lumen has been proposed to reduce these complications, but evidence remains variable. Objective: To evaluate the effect of 4% lidocaine instillation on post-operative airway morbidity in patients undergoing surgery under general anesthesia. Methods: A quasi-experimental trial was conducted on 130 patients undergoing various elective surgeries under general anesthesia with endotracheal intubation. Patients were divided into two groups: the lidocaine instillation group (n = 65) and the non-lidocaine group (n = 65). Demographic and intraoperative data were recorded. Airway complications, including sore throat, hoarseness, cough, dysphagia, and laryngospasm, were assessed pre-operatively and post-operatively. Logistic regression analysis was performed to identify predictors of post-operative sore throat. Results: Post-operative airway complications increased significantly compared to pre-operative status, with sore throat (29.2%), cough (32.3%), hoarseness (20.0%), dysphagia (13.8%), and laryngospasm (6.2%) observed after surgery (all p < 0.05). Compared to the non-lidocaine group, the lidocaine group had significantly lower incidence of sore throat (18.5% vs. 40.0%, p = 0.010), hoarseness (12.3% vs. 27.7%, p = 0.032), cough (15.4% vs. 43.1%, p = 0.001), and dysphagia (6.2% vs. 21.5%, p = 0.018). Regression analysis showed that age ≥40 years, female sex, intubation duration ≥2 hours, cuff pressure >30 cmH₂O, and absence of lidocaine instillation were independent predictors of sore throat. Conclusion: Instillation of 4% lidocaine in the endotracheal tube significantly reduces the incidence of common post-operative airway complications. Careful control of cuff pressure and limiting intubation duration further mitigates risk. These findings support the routine use of lidocaine instillation as a simple and effective strategy to improve post-anesthesia airway outcomes.

Prevalence of Pain In Depressed Patients and Its Impact on Treatment Outcomes

2025-11-19T16:50:06+00:00

Depression and pain frequently co-occur, sharing overlapping neurobiological mechanisms that can amplify symptom severity and hinder treatment efficacy. Chronic pain among individuals with depression substantially affects their functional outcomes and quality of life, yet integrated management approaches remain underutilized. This study aimed to determine the prevalence of pain in patients with depression and evaluate its impact on treatment outcomes. Methods: This prospective, randomized controlled trial was conducted over six months at the psychiatric outpatient department of a tertiary-care teaching hospital. A total of 200 adults diagnosed with Major Depressive Disorder or Persistent Depressive Disorder (DSM-V criteria) were enrolled and randomly assigned to either an intervention group receiving structured collaborative care or a control group receiving standard care. Depression severity was assessed using the Hopkins Symptom Checklist-20 (HSCL-20), and pain interference was evaluated through the Short Form-36 (SF-36) pain subscale at baseline, 3 months, and 6 months. Data were analyzed using repeated-measures ANOVA and multivariate regression to identify predictors of depression outcomes. Results: At baseline, 42% of participants reported moderate to severe pain interfering with daily activities. Both groups showed significant improvements in HSCL-20 and SF-36 scores over six months (p < 0.001). The intervention group exhibited greater improvement in depressive symptoms (p = 0.03), while pain reduction was comparable between groups (p = 0.41). Despite overall progress, 32% of patients continued to report moderate pain at 6 months. Regression analysis revealed that baseline pain severity and reduction in pain over time significantly predicted depression remission (p < 0.001). A significant interaction between pain reduction and treatment group was observed (p = 0.027), suggesting that integrated care enhanced depression recovery independent of pain persistence. Conclusion: Pain is highly prevalent among patients with depression and significantly influences treatment outcomes. Although depressive symptoms improved in both study groups, persistent pain remained in a substantial subset, underscoring the need for integrated, multidisciplinary approaches addressing both mood and pain symptoms concurrently. Collaborative care demonstrated superior efficacy in improving depression, supporting its adoption in clinical practice to optimize holistic recovery.

Nurses' Attitudes and Readiness Toward the Integration of Artificial Intelligence in Clinical Practice in Pakistan

2025-11-10T18:01:24+00:00

Artificial Intelligence (AI) is increasingly transforming healthcare delivery, offering opportunities to enhance efficiency, clinical decision-making, and patient safety. However, successful AI implementation in nursing practice depends on nurses' readiness and attitudes toward its integration. Limited data exist on this topic within the Pakistani context. Objective: To assess nurses' attitudes and readiness toward the integration of Artificial Intelligence in clinical practice using the Technology Readiness Index 2.0 (TRI 2.0). Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital in Pakistan from July to December. A total of 90 registered nurses working in inpatient, outpatient, emergency, and critical care units were recruited using non-probability convenience sampling. Data were collected using an adapted version of the TRI 2.0 scale, comprising four dimensions: optimism, innovativeness, discomfort, and insecurity. Each item was rated on a 5-point Likert scale, and composite readiness scores were computed. Reliability was confirmed with Cronbach's alpha (α = 0.88). Statistical analysis was performed using SPSS version 26. Associations between demographic factors and readiness were evaluated using t-tests and a one-way ANOVA, with p < 0.05 as the significance level. Results: Participants had a mean age of 31.6 ± 5.8 years; 81.1% were female, and 70.0% held a Bachelor of Science in Nursing. The overall AI readiness score was high (mean = 3.91 ± 0.54), with optimism (4.12 ± 0.65) and innovativeness (3.96 ± 0.71) showing strong positivity. Moderate discomfort (2.85 ± 0.78) and insecurity (2.72 ± 0.82) indicated manageable apprehension toward AI technologies. Educational qualifications were significantly associated with AI readiness (p < 0.01), whereas gender and experience were not. Conclusion: Nurses in Pakistan demonstrated positive attitudes and high readiness toward AI integration in clinical practice. Educational advancement emerged as a key factor enhancing acceptance and preparedness for AI technologies. Targeted educational interventions and structured training programs are essential to address residual concerns and promote effective, ethical, and confident AI adoption in nursing practice.

Critical Thinking and Decision-Making Ability of Nurses Working in Critical Care Units Regarding Pain Management

2025-11-06T12:19:12+00:00

Effective pain management in critical care settings requires nurses to employ strong critical thinking and decision-making abilities. These competencies enable timely, evidence-based interventions for patients with complex, dynamic pain conditions. Despite their importance, few studies have examined this relationship in the Pakistani context, where nurses often face high workloads, limited training, and systemic constraints. Objective: To assess the critical-thinking and decision-making abilities of nurses working in critical care units and to determine the relationship between these two variables in the context of pain management. Methods: This descriptive cross-sectional study was conducted in the critical care units of General Hospital Lahore between January and June 2024. A total of 60 registered nurses with at least one year of ICU experience were enrolled through non-probability purposive sampling. Data were collected using a structured questionnaire comprising demographic data, the Critical Thinking Disposition Inventory (CTDI), and a validated Decision-Making Questionnaire for Pain Management. Descriptive statistics summarized demographic variables, while Pearson correlation and ANOVA tests assessed relationships between variables. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 29.4 ± 5.8 years, with a predominance of females (78.3%). The overall mean critical-thinking score was 69.7 ± 8.2, indicating a moderate to high level of critical-thinking ability, with the highest domain score in Interpretation (12.3 ± 2.4). The mean decision-making score was 74.2 ± 9.6, reflecting satisfactory decision-making competence. More than half (51.7%) demonstrated moderate decision-making ability, while 30% demonstrated good decision-making ability. A strong positive correlation (r = 0.68, p < 0.001) was observed between critical thinking and decision-making abilities. Educational qualifications were significantly associated with decision-making performance (p = 0.03), with higher levels of education associated with higher scores. Conclusion: Critical-thinking ability strongly influences decision-making in pain management among critical care nurses. Enhanced educational attainment correlates with improved clinical reasoning and decision-making competence. Strengthening continuous professional education and integrating critical-thinking modules into nursing curricula can significantly improve pain management practices and patient outcomes in critical care settings.

Frequency of Factors Leading to the Development of Urolithiasis at SIUT, Karachi

2025-10-31T04:46:26+00:00

Urolithiasis is a common urological condition worldwide and a significant cause of morbidity, especially in regions with hot climates and dietary variations such as Pakistan. Understanding the contributing factors is essential for prevention and management. Objective: To determine the frequency of factors leading to the development of urolithiasis at SIUT, Karachi. Methodology: We conducted this study on 385 participants aged 20-70 years presenting with acute renal colic and a confirmed ultrasonographic diagnosis of urolithiasis. Data on predefined demographic and risk factors were collected. Results: The mean age of the 385 participants was 49.49 ± 14.09 years. A majority were male (62.3%), and the most prevalent modifiable risk factor was low water intake (65.7%), which was followed by obesity (51.9%) and aerated beverage consumption (56.4%). Comorbid risk conditions were highly prevalent, including hypertension (37.9%), anemia (48.8%), and diabetes mellitus (28.3%). A strong family history of urolithiasis was reported in 47.5% of the cohort. Other significant factors included an age greater than 50 years (53.8%) and smoking (24.9%). Conclusion: The risk factors leading to the development of urolithiasis were the high frequency of male sex and increasing age, with modifiable risks such as low water intake and comorbid metabolic conditions.

Factors of Non-Adherence to Antihypertensive Medicine in the Elderly Population

2025-10-28T09:13:31+00:00

Hypertension is a leading cause of cardiovascular morbidity and mortality, particularly among the elderly. Despite the availability of effective antihypertensive therapies, medication non-adherence remains a major barrier to optimal blood pressure control. Understanding the multifactorial determinants of non-adherence among elderly hypertensive patients in low- and middle-income countries like Pakistan is essential for designing targeted interventions. Objective: To identify the factors contributing to non-adherence to antihypertensive medication among elderly hypertensive patients attending tertiary care hospitals in Lahore, Pakistan. Methods: A cross-sectional descriptive study was conducted at four public sector hospitals in Lahore from September 2019 to March 2020. A total of 200 hypertensive patients aged ≥60 years were recruited through purposive sampling. Data were collected using two standardized tools—the Drug Attitude Inventory-10 (DAI-10) and the Modified Drug Adherence Work-Up Tool (M-DRAW)—translated into Urdu and validated for internal consistency (Cronbach's α = 0.70 and 0.758, respectively). Descriptive statistics were used to summarize demographic data. In contrast, chi-square, independent t-tests, and ANOVA with post hoc Tukey's test were used to determine associations between demographic and adherence-related variables in SPSS version 20. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 66.74 ± 5.39 years; 52% were male, and 54.5% had no formal education. Most patients (73.5%) had been under treatment for >6 months, and 53.5% were taking three antihypertensive medications. The majority (68.5%) exhibited unintentional non-adherence, while 31.5% demonstrated intentional non-adherence. Financial burden (50%), pill burden (60.5%), and difficulty in maintaining medication schedules were the most frequent barriers. Condition-related factors (mean 3.0 ± 0.7) were the most significant contributors, followed by patient-related and socioeconomic factors (p< 0.001). Significant associations were found between perceived benefit of therapy and education level (p = 0.017), dose adjustment and number of tablets (p = 0.010), and gender with treatment doubts (p = 0.018). Beliefs and health perceptions more strongly influenced intentional non-adherence, whereas unintentional non-adherence was associated with financial and regimen-related constraints. Conclusion: Non-adherence to antihypertensive medication among elderly patients is a multifaceted issue influenced by socioeconomic, educational, psychological, and treatment-related factors. Condition-related beliefs and patient-related perceptions play a dominant role, particularly in intentional non-adherence. Interventions should focus on patient education, simplifying medication regimens, enhancing family and social support, and providing financial assistance to improve long-term adherence and reduce hypertension-related complications in elderly populations.

Effects of Sub-Lethal Concentrations of Oxytetracycline and Erythromycin on Antioxidant Enzymes in Cyprinus Carpio

2025-11-20T12:35:11+00:00

Accumulation of antibiotics in freshwater bodies poses a major ecological threat, as excessive antimicrobial residues induce oxidative stress in aquatic organisms, particularly fish. The antioxidant defence system plays a crucial role in mitigating such stress responses. Objective: To evaluate the effects of oxytetracycline and erythromycin on the activity of antioxidant enzymes in common carp (Cyprinus carpio).Methods: A laboratory-based experiment was conducted using common carp collected from a local fish pond and acclimatized for 10 days under controlled conditions. Fish were exposed for 96 hours to sub-lethal concentrations of oxytetracycline and erythromycin in separate treatment groups, along with a control group. Each group consisted of three replications maintained under identical physicochemical conditions. Antioxidant enzyme activities of superoxide dismutase and peroxidase were quantified in selected organs using a visible spectrophotometer at 560 nm and 470 nm, respectively. Data were analyzed using a two-way ANOVA, followed by Tukey's HSD for mean comparisons. Correlation analysis was performed to determine associations among study variables. Results: A significant reduction in superoxide dismutase and peroxidase activity was observed at 72 and 96 hours of exposure in both antibiotic-treated groups compared with controls (p<0.05). Oxytetracycline exhibited a stronger inhibitory effect on antioxidant responses, consistent with enhanced reactive oxygen species generation. Increasing antibiotic concentration led to a marked decline in enzyme activity across both treatment groups. Conclusion: Acute exposure to oxytetracycline and erythromycin leads to oxidative stress in common carp by suppressing key antioxidant enzymes, indicating that antibiotic pollution in aquatic environments may compromise fish health and physiological homeostasis.

Benign Breast Changes with Adenosis and Duct Ectasia: Diagnostic Challenges and Clinical Implications

2025-10-27T11:01:13+00:00

Rapidly enlarging breast masses during pregnancy pose significant diagnostic challenges. Physiologic breast changes can mask or mimic underlying pathology, and limited biopsy samples may reveal only benign elements such as adenosis, duct ectasia, or tubular adenoma despite an underlying fibroepithelial lesion. Case Presentation: A 34-year-old pregnant woman in her second to third trimester presented with a 1.5-year history of a progressively enlarging left breast mass that rapidly increased in size and became fungating during pregnancy. Earlier histopathology revealed adenosis and duct ectasia, while fine-needle aspiration cytology (FNAC) was reported as C3 ("atypical, probably benign"). Ultrasonography demonstrated an approximately 11 cm multilobulated, hypervascular, exophytic mass classified as BI-RADS 4 B. A wedge biopsy during pregnancy showed a tubular adenoma. Given the lesion's aggressive growth and clinicoradiologic–pathologic discordance, a total left mastectomy was performed. Final histopathology confirmed a benign phyllodes tumour with skin ulceration and a deep margin of 1 mm. Intervention and Outcome: The patient underwent a total mastectomy with complete tumour removal and no perioperative complications. Considering the close deep margin, structured postoperative surveillance was advised. Conclusion: In pregnancy, rapidly growing breast masses with benign or indeterminate histology warrant escalation to complete excision, especially when clinical, radiologic, and histopathologic findings are discordant. This case underscores diagnostic overlap among adenosis, duct ectasia, tubular adenoma, fibroadenoma, and phyllodes tumour and highlights the importance of margin-oriented surgery and long-term follow-up.

From Hive to Hope: Honeybee and Apiculture Derived Products in Pakistan

2025-10-24T16:48:16+00:00

Honeybees are vital for pollination, biodiversity, and the production of apicultural products. Their populations, however, are increasingly threatened by various environmental and biological stressors in Pakistan. Strengthening knowledge on their ecological and economic roles is crucial for sustainable conservation. Objective: To synthesize current evidence on honeybee species, apiculture development, economic potential of bee products, and the major threats to honeybee populations in Pakistan. Methods: This narrative review examined published literature, government reports, and apiculture data relevant to Pakistan. Sources were identified from major scientific databases and national records, with no time restrictions. Information on honeybee species distribution, apiculture production, export trends, and threats was extracted and descriptively analyzed to provide an updated overview for researchers and policymakers. Results: Pakistan hosts four honeybee species, with Apis mellifera being the predominant domesticated species. Despite growth in the apiculture sector, average honey yield remains below 12 kg per beekeeper, nearly half of the global average. Honey, pollen, propolis, beeswax, and royal jelly are produced, although honey remains the major export at approximately five million kilograms annually. Diverse biotic and abiotic pressures are causing significant declines in both wild and managed populations, while national data remain insufficient for informed conservation planning. Conclusion: Honeybees in Pakistan hold considerable ecological and economic value, yet their populations face multiple challenges that are inadequately documented. Strengthening research capacity, improving apicultural practices, and establishing targeted conservation strategies are essential to protecting honeybee diversity and ensuring sustainable resource use.