Biological and Clinical Sciences Research Journal

Comparison of Anthropometric Measurements in Premature Neonates Receiving High-Dose vs Low-Dose Parenteral Amino Acid (PAA) Nutrition: A Randomized Controlled Trial

Ayesha Akhtar — 2025-11-30

: Extra-uterine growth retardation in preterm neonates is associated with poor short and long-term outcomes. Adequate early parenteral nutrition, particularly amino acid supplementation, is essential to support optimal growth and development. Objective: To compare mean changes in anthropometric measurements among preterm neonates receiving high-dose versus low-dose parenteral amino acid nutrition. Methods: This randomized controlled trial was conducted at the Department of Pediatrics, Holy Family Hospital, Rawalpindi, from May to November 2023. A total of 270 preterm neonates born at less than 37 weeks of gestation were enrolled and randomly allocated into two equal groups of 135 each. Group A received high-dose parenteral amino acids starting at 2 g/kg/day from the second day of life with increments of 0.5 g/kg every 24 hours up to a maximum of 3.5 g/kg/day. In comparison, Group B received low-dose parenteral amino acids, starting at 1 g/kg/day with similar daily increments up to a maximum of 2 g/kg/day. Amino acid infusion was initiated 24 hours after birth. Anthropometric parameters, including weight, length, and head circumference, were recorded at baseline, day 7, day 14, and day 21 of life. Data were collected using a structured proforma and analyzed using SPSS. Results: At 21 days of life, preterm neonates receiving high-dose parenteral amino acids demonstrated significantly better anthropometric outcomes compared to the low-dose group. Mean weight was 1301.15 ± 28.48 g in the high dose group versus 1245.53 ± 17.02 g in the low dose group (p = 0.0001). Mean length was 37.80 ± 0.28 cm compared to 37.39 ± 0.13 cm (p = 0.0001), and mean head circumference was 28.99 ± 0.40 cm versus 27.58 ± 0.16 cm, respectively (p = 0.0001). Conclusion: High-dose parenteral amino acid nutrition is associated with significantly improved weight gain, linear growth, and head circumference in preterm neonates compared to low-dose regimens, supporting its role in optimizing early postnatal development.

Role of Clinical Pharmacist in Improving Medication Adherence and Monitoring Medicinal Plant–Drug Interactions in Heart Failure Patients

Muhammad Shafiq Khan — 2025-11-30

Heart failure (HF) remains a leading cause of morbidity and mortality worldwide. Medication non-adherence and the concurrent use of medicinal plants increase the risk of adverse events and reduce therapeutic efficacy. Clinical pharmacists may play a critical role in optimizing adherence and monitoring herb–drug interactions. Objective: To evaluate the role of clinical pharmacists in improving medication adherence and tracking medicinal plant–drug interactions in HF patients. Methods: A prospective, controlled, interventional study was conducted from January 2023 to June 2024, including 230 adult patients with HF. Participants were randomized into intervention (pharmacist-led counseling and monitoring) and control (usual care) groups. Medication adherence was assessed using MMAS-8, and herb–drug interactions were monitored using standard databases over six months. Results: The intervention group showed significant improvement in adherence (MMAS-8: 6.32±1.12 to 7.85±0.70) compared to controls (6.28±1.15 to 6.50±1.05; p<0.001). Adverse events from interactions were lower (3.48% vs. 10.43%; p=0.03), and interaction resolution was higher in the intervention group (34.78% vs. 13.04%; p<0.001). Conclusion: Clinical pharmacist interventions significantly enhance medication adherence and reduce herb–drug–related risks in HF patients.

Assessment of Primary Sources of Stress Among Staff Nurses in Sir Gangaram Hospital, Lahore

Tahira Maqsood — 2025-11-30

Nursing is globally recognised as a highly demanding profession characterised by emotional labour, hierarchical pressures, understaffing, and heavy workloads. In Pakistan, these challenges are intensified by limited healthcare resources, political influence over workplace decisions, and inadequate administrative support, all of which contribute substantially to occupational stress among nurses. Objective: To assess the primary sources of occupational stress among staff nurses working at Sir Ganga Ram Hospital, Lahore, and determine the perceived prevalence and burden of stress in their clinical practice. Methods: A descriptive cross-sectional study was conducted at Sir Ganga Ram Hospital, Lahore, over six months from February to July 2025. A convenience sample of 384 registered nurses with at least 1 year of experience was surveyed using a validated, structured questionnaire comprising demographic information, a 17-item Likert-based stress scale, and seven dichotomous organisational stress items. Instrument reliability was established through pilot testing, and Cronbach's alpha exceeded 0.70. Data were analysed in SPSS using descriptive statistics. Results: The majority of participants were female (95.6%) and married (63.5%). Emotional strain was prevalent: 53.6% sometimes felt upset by unexpected events, and 31.7% often or very often felt nervous or stressed. Nearly 36.2% lacked confidence in handling problems, and 43% felt things were not going well at least sometimes. Workload stress was notable: 31.8% reported a lack of time to complete tasks, and more than half reported persistent staffing shortages. Interpersonal factors, including criticism from physicians, weak team communication, and emotional exhaustion, were frequent. Organisational stressors were prominent, with 60.2% citing political influence and 61.2% attributing stress to management practices. Overall, 81.8% perceived nursing as a stressful profession, and 51% personally reported feeling stressed during duty. Conclusion: Nurses at Sir Ganga Ram Hospital experience substantial occupational stress arising from workload burdens, interpersonal conflicts, emotional exhaustion, and organisational limitations. System-level interventions addressing staffing, leadership support, communication, and workload management are required to mitigate stress and enhance nurse wellbeing.

Self-Care Behavior Regarding Hypertension in Elderly Patients in Lahore

Nabila Nafees — 2025-12-15

Hypertension is a major contributor to global morbidity and mortality, particularly among the elderly in low- and middle-income countries. While self-care behaviors are essential in blood pressure control, limited evidence exists regarding self-care practices among elderly hypertensive patients in Pakistan. Objective: To assess self-care behavior and its associated determinants among elderly hypertensive patients attending tertiary hospitals in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted among 200 elderly hypertensive patients recruited from outpatient departments of three tertiary hospitals in Lahore from January to December 2024 using non-probability purposive sampling. A culturally adapted self-care behavior questionnaire assessing six domains was administered. Anthropometric and clinical data were recorded following standardized protocols. Descriptive and inferential statistics were applied, including Chi-square tests and independent t-tests, with significance set at p ≤ 0.05. Results: Participants had a mean age of 65.3 years, and 58.5% were male. Most respondents lived with family (89.5%), and 78.5% perceived their health as fair or poor. Overall, only 22.5% of participants demonstrated adequate self-care behavior. Physical activity (78.5%) and smoking avoidance (77%) showed acceptable adherence, whereas medication adherence (22%), weight management (26%), salt restriction (38%), and stress control (32%) remained suboptimal. Self-care behavior was significantly associated with living status, marital status, education, income, and self-rated health (p<0.05), but not with gender or treatment duration. Patients with inadequate self-care had significantly higher systolic blood pressure, diastolic blood pressure, and BMI than those with adequate self-care (p<0.001). Conclusion: Elderly hypertensive patients in Lahore exhibit poor overall self-care behavior, particularly in dietary control, stress management, and treatment adherence. Social and economic determinants strongly influenced self-care performance, and inadequate self-care was associated with worse clinical indicators. Tailored educational initiatives, family support mobilization, and community-based self-management programs are urgently needed to improve hypertension outcomes in this high-risk population.

Comparative Outcomes of Laparoscopic Clipless Cholecystectomy Using Harmonic Scalpel versus Conventional Technique with Liga Clips: A Clinical Study

Muhammad Farrukh Aftab — 2025-11-30

Gallstone disease is an increasingly prevalent global health issue. Laparoscopic cholecystectomy, a minimally invasive surgical approach, ensures smaller incisions and quicker recovery. The Harmonic scalpel offers a safe and efficient tool for dissection and haemostasis, but conflicting evidence regarding its efficacy exists in the literature. Objective: To compare intraoperative and postoperative outcomes of clipless laparoscopic cholecystectomy using the Harmonic scalpel versus conventional clip-based cholecystectomy for managing gallbladder stones. Methods: A randomized controlled trial was conducted at the Department of General Surgery, Nishtar Medical University/Hospital, Multan, over six months, from January 1, 2025, to June 30, 2025. A total of 120 patients were enrolled via non-probability consecutive sampling and randomly divided into two equal groups. Group A underwent clipless cholecystectomy with the Harmonic scalpel, while Group B underwent conventional clip-based cholecystectomy. Outcomes measured included operative time, gallbladder perforation, intraoperative blood loss, postoperative pain (Visual Analogue Scale), bile leakage, and wound infection. Follow-up assessments were conducted at 24 hours, 3 days, and 7 days postoperatively. Data were recorded on a standardized proforma and analyzed using SPSS 26.0. Results: Patients in the Harmonic scalpel group (Group A) had a mean age of 44.12±13.84 years, while the conventional group (Group B) had a mean age of 47.08±13.16 years. The Harmonic scalpel group demonstrated significantly shorter operative times (49.82±6.06 min vs. 55.43±9.39 min, p<0.001), reduced intraoperative blood loss (65.58±8.94 ml vs. 74.00±14.79 ml, p<0.001), and fewer complications, including gallbladder perforation (1.7% vs. 11.7%, p<0.05), postoperative pain (15% vs. 31.7%, p<0.05), bile leakage (8.3% vs. 21.7%, p<0.05), and wound infections (5.0% vs. 16.7%, p<0.05). Conclusion: The Harmonic scalpel demonstrates superior outcomes and fewer complications compared to conventional methods in laparoscopic cholecystectomy. Its adoption may enhance surgical practices and improve patient satisfaction.

Isolation and Harvesting of Lumpy skin disease virus (LSDV) strain from infected cattle breeds, Bos indicus and Bos taurus, in Sindh, Pakistan, from in-vivo Vero cell line culture to stabilize LSDV, an insight through NGS sequencing and quality analysis

Roohi Kanwal — 2025-11-30

Lumpy Skin Disease Virus is an economically important poxviral pathogen of cattle that causes nodular skin lesions, reduced milk yield, and trade limitations. Molecular characterization, including whole-genome sequencing, can reveal markers of disease susceptibility and inform diagnostic and preventive strategies. Objective: To identify, isolate, and characterize Lumpy Skin Disease Virus strains circulating in native and exotic cattle in Sindh Province, Pakistan, and to assess their in vitro behaviour during cell-culture adaptation and stabilization. Methods: A field-based sampling of clinically suspected cattle cases was conducted under veterinary supervision in Sindh Province. Laboratory confirmation of infection was performed using validated molecular and serological assays. LSDV-positive samples were subjected to controlled recovery and propagation in accredited cell-culture facilities, followed by phenotypic evaluation during adaptation and stabilization phases. Whole-genome sequencing and comparative genetic analysis were performed to assess diversity among isolates relative to reference strains. All procedures were completed in accordance with approved biosafety and animal welfare protocols. Results: LSDV infection was successfully confirmed in the selected field samples using standardized molecular and serological methods. Viable viral isolates were recovered and showed consistent replication patterns during cell-culture adaptation and stabilization. Comparative phenotypic evaluation demonstrated distinguishable growth characteristics across isolates. Genomic analysis revealed measurable diversity between local strains and reference isolates, suggesting region-specific viral evolution. These findings provide actionable molecular evidence to strengthen surveillance and diagnostic preparedness in Sindh. Conclusion: The study successfully identified and characterized LSDV strains endemic to Sindh Province and demonstrated notable phenotypic and genomic variability. These insights support improved regional surveillance, diagnostic capacity, biosafety planning, and vaccine policy development. Enhanced molecular understanding will contribute to more effective control measures and reduced economic and welfare losses in affected cattle populations.

Assessment of the Effects of Breastfeed and Bottle Feed on Health in Children

Humaira Ramzan — 2025-11-30

Infant feeding practices play a critical role in determining childhood health and developmental outcomes. Although the World Health Organization recommends exclusive breastfeeding for the first six months of life, bottle feeding and mixed feeding remain common in low- and middle-income countries, including Pakistan, potentially increasing the risk of childhood morbidity and developmental delay. Objective: To assess the association between breastfeeding, partial feeding, and bottle feeding with childhood illnesses and developmental outcomes among children aged 18 to 36 months attending a tertiary care hospital in Lahore, Pakistan. Methods: This cross-sectional analytical study was conducted in the pediatric unit of Sir Ganga Ram Hospital, Lahore, from March 2025 to August 2025. A total of 384 children aged 18–36 months were enrolled using convenience sampling. Data on feeding practices during the first six months of life, sociodemographic characteristics, childhood illnesses, and developmental outcomes were collected through a structured and validated questionnaire. Cognitive, gross motor, and fine motor development were assessed using standardized developmental tools. Data were analyzed using SPSS version 26. Associations between feeding practices and outcome variables were evaluated using the chi-square test, with p < 0.05 considered statistically significant. Results: Of the 384 children, 43.0% were exclusively breastfed, 43.5% received partial feeding, and 13.5% were bottle-fed. Bottle-fed children had significantly higher rates of pneumonia (69.4%), diarrhea (59.5%), vomiting (67.5%), and seizures (67.2%) compared with breastfed children (p < 0.001). Exclusively breastfed children demonstrated superior developmental outcomes, with 87.9% achieving above-average scores in cognitive, gross motor, and fine motor domains and none scoring below average. In contrast, bottle-fed children showed higher proportions of below-average developmental scores across all domains. Parental or caregiver ratings were consistent with objective developmental assessments (p < 0.001). Conclusion: Exclusive breastfeeding is strongly associated with reduced childhood morbidity and significantly better cognitive and motor development. Bottle feeding is linked to increased infectious illnesses and poorer developmental outcomes. These findings emphasize the need to strengthen breastfeeding promotion and support strategies to improve child health outcomes in Pakistan.

Assessment of Staff Nurses' Knowledge, Attitudes, and Practices Regarding Infection Prevention and Control for Reducing Nosocomial Infections

Husna Bibi — 2025-11-30

Nosocomial infections remain a major cause of morbidity, mortality, and prolonged hospital stay worldwide, particularly in low- and middle-income countries. Nurses play a pivotal role in infection prevention and control (IPC) due to their continuous patient contact. Assessing nurses' knowledge, attitudes, and practices (KAP) is essential for identifying gaps and strengthening infection control strategies in hospital settings. Objective: To assess the knowledge, attitudes, and practices of staff nurses regarding infection prevention and control measures aimed at reducing nosocomial infections at a tertiary care hospital in Lahore, Pakistan. Methods: A quantitative descriptive cross-sectional study was conducted among 385 registered staff nurses working in adult clinical departments of Sir Ganga Ram Hospital, Lahore, from February to June 2025. Participants were recruited using convenience sampling. Data were collected using a structured, self-administered questionnaire adapted from the World Health Organization hand hygiene assessment tool that covered socio-demographic characteristics, knowledge, attitudes, and practices related to IPC. Descriptive statistics were used to summarize KAP levels, while inferential analysis examined associations between demographic variables and KAP scores. Data were analyzed using SPSS version 25. Results: Among the 385 participants, 88.3% were female, and the majority were aged between 20 and 30 years. Overall, 91% of nurses demonstrated good knowledge of infection prevention, and 85% exhibited positive attitudes toward IPC. High awareness of the importance of hand hygiene before and after patient contact was observed (97.7%). However, notable knowledge gaps persisted, particularly regarding the correct use of alcohol-based hand rubs (46.8%). Despite favorable knowledge and attitudes, only 50.6% of nurses demonstrated good infection prevention practices, with lower compliance observed before patient contact and after glove removal. No statistically significant association was found between demographic variables and KAP scores (p > 0.05). Conclusion: Although staff nurses demonstrated strong knowledge and positive attitudes toward infection prevention and control, practical adherence to IPC measures was suboptimal. Targeted interventions focused on behavioral reinforcement, ongoing training, and improved institutional support are required to bridge the gap between knowledge and practice and reduce the burden of nosocomial infections.

Comparative Outcomes of Flexible Ureterorenoscopy (FURS) versus Mini Percutaneous Nephrolithotomy (Mini PCNL) for Management of Large Proximal Ureteric Stones

Muhammad Tahir Abbas — 2025-12-15

Large proximal ureteric stones present a considerable management challenge, particularly in regions with high urolithiasis prevalence, such as Pakistan. With advancements in endourological techniques, both Flexible Ureterorenoscopy (FURS) and Mini Percutaneous Nephrolithotomy (Mini PCNL) have emerged as standard minimally invasive modalities; however, comparative evidence within the local population remains limited. Objective: To compare the stone-free rate, operative duration, hospital stay, and postoperative complications between Mini PCNL and FURS in the management of large proximal ureteric stones. Methods: A randomized controlled trial was conducted at the Department of Urology, National Institute of Kidney Diseases, Shaikh Zayed Medical Complex, Lahore, from June 2025 to September 2025. A total of 110 patients aged 18–65 years with large proximal ureteric stones (>1.5 cm) were enrolled through consecutive sampling and randomized into two equal groups: Mini PCNL (n = 55) and FURS (n = 55). All procedures were performed under general anesthesia by experienced consultants following standardized surgical protocols. Patients were followed for 4 weeks postoperatively, and stone-free status was assessed using CT KUB. Secondary outcomes included operative time, hospital stay, and complications based on the Clavien Dindo classification. Data were analyzed using SPSS 26.0, applying chi-square and independent t tests with significance set at p < 0.05. Results: The Mini PCNL group achieved a significantly higher stone-free rate (90.9%) compared to the FURS group (76.4%; p = 0.041). Mean operative time was shorter with Mini PCNL (49.6 ± 8.5 minutes) than with FURS (72.4 ± 11.3 minutes; p < 0.001). Conversely, hospital stay was significantly longer in the Mini PCNL group (3.4 ± 0.9 days) versus the FURS group (1.8 ± 0.6 days; p < 0.001). Postoperative complications were comparable between groups, with 16.4% in each group, and no statistically significant difference was observed (p = 1.000). Conclusion: Mini PCNL demonstrates superior stone-free rates and shorter operative times compared to FURS for large proximal ureteric stones, although it requires longer hospitalization. Both procedures exhibit comparable safety profiles. Mini PCNL may therefore be considered the more effective option in appropriately selected patients within the Pakistani population.

Q-RUSH Hysterectomy: A Mini Review of a Novel, Rapid, and Vault-Supportive Modification of Traditional Total Abdominal Hysterectomy

Qudsia Nawaz — 2025-12-15

Background: Total abdominal hysterectomy often requires multiple sequential pedicle clamps and separate vault suspension steps, which can prolong operative time, increase surgeon fatigue, and result in variable apical support. Optimizing both operative efficiency and post-hysterectomy vault support remains a key surgical priority. Objective: To describe the conceptual basis, surgical rationale, and potential advantages of Qudsia's Rapid Unified Suspension Hysterectomy (Q-RUSH) technique as an innovative modification of total abdominal hysterectomy. Methods: This mini-review synthesizes the development and operative concept of Q-RUSH, which streamlines pedicle management and incorporates uterosacral–transcervical ligament suspension into a single, continuous suture technique. Relevant literature on total abdominal hysterectomy, apical suspension, and prevention of post-hysterectomy vault prolapse was narratively reviewed to contextualize Q-RUSH within current practice. Early pilot experience from its use in a tertiary care setting was examined descriptively with respect to operative workflow, hemostatic control, and urinary tract safety; no formal hypothesis testing or comparative statistical analysis was undertaken. Results: Q-RUSH conceptually reduces the number of separate pedicle clamps and consolidates apical support into an integrated suspension step, which appears to shorten operative workflow and lessen intraoperative handling. Early pilot observations indicate meaningful time savings with maintained hemostasis and no evident compromise in urinary tract safety. By providing immediate, anatomically anchored apical support via a continuous uterosacral–transcervical suspension, Q-RUSH may help reduce the risk of post-hysterectomy vault prolapse. However, this requires confirmation in prospective comparative studies with long-term follow-up. Conclusion: Q-RUSH represents a promising modification of total abdominal hysterectomy that unifies pedicle control and apical suspension in a single continuous technique, with the potential to improve operative efficiency and apical support. Robust prospective trials with adequate sample size, standardized outcome measures, and long-term follow-up are needed to validate its safety profile and efficacy in preventing post-hysterectomy vault prolapse.

Comparative Analysis of Primary Closure Versus Ileostomy in the Surgical Management of Typhoid Intestinal Perforation

Shahid Hussan — 2025-11-30

Typhoid fever remains a significant public health concern in low and middle-income countries, particularly in overcrowded and resource-limited settings. In Pakistan, the emergence of multidrug-resistant Salmonella Typhi strains has increased the severity and complications associated with the disease. Intestinal perforation is a common and life-threatening complication requiring urgent surgical intervention. Literature presents conflicting evidence regarding the superiority of primary repair versus ileostomy in the management of typhoid perforation. This study was designed to compare early outcomes of these two surgical approaches. Objective: To evaluate and compare the short-term outcomes of primary repair versus ileostomy formation in patients undergoing surgery for typhoid-related intestinal perforation. Methods: This randomized controlled trial was conducted in the Department of Surgery at Nishtar Medical University/Hospital, Multan, over six months, following ethical approval. A total of 40 patients who met the inclusion and exclusion criteria were enrolled and randomized into two groups. Group A underwent primary repair of the perforation, while Group B received ileostomy formation. Patients were followed postoperatively for 7–10 days, and outcomes, including wound infection, mortality, and duration of hospital stay, were recorded. Results: Wound infection occurred in 11 (55%) patients in the primary repair group and in 4 (20%) patients in the ileostomy group (p = 0.022). Mortality was noted in 3 (15%) patients in the primary repair group compared to 1 (5%) patient in the ileostomy group (p = 0.292). The mean hospital stay was significantly longer in the primary repair group (7.15 ± 2.18 days) compared to the ileostomy group (5.70 ± 1.34 days) (p = 0.017). Conclusion: In the short-term postoperative period, ileostomy formation was associated with significantly lower wound infection rates and shorter hospital stay compared to primary repair in patients with typhoid intestinal perforation. These findings support the use of ileostomy as a preferred initial surgical approach in such cases.

Outcomes of AI-Assisted Interventions to Reduce Nurse Burnout

Amna Nawaz — 2025-12-15

Burnout among nurses is a critical global concern that affects patient safety, job satisfaction, and healthcare quality. Artificial intelligence (AI)–assisted programs have emerged as innovative tools to support mental health and reduce occupational burnout through personalized monitoring and adaptive interventions. Objective: To evaluate the outcomes of artificial intelligence-assisted programs to mitigate burnout in nurses. Methodology: A case-control study was conducted in the Nursing Department of Nishtar Hospital, Multan, from March 2024 to March 2025. A total of 100 nurses working in the hospital for 1 year were included in the study. Nurses were divided into two groups: Group A (case group), comprising 50 nurses attending an AI-assisted burnout intervention program, and Group B (control group), comprising 50 nurses attending a self-selected burnout intervention program. The primary outcome was measurement of burnout on personal, work-related, and patient-related levels. Results: Patient-related burnout changed significantly between groups (F=7.68, p=0.001) and time (F=15.81, p<0.0001) over the duration of intervention. The same pattern was observed for personal burnout between groups (F=10.89, p<0.0001) and over time (F=17.7, p<0.0001). Nurses of both groups had significantly reduced job stress after either intervention (Group A: t=2.99, p=0.005; Group B: t=2.68, p=0.010). The stress response was also reduced considerably between both groups after programs (Group A: t= 1.99, p=0.040; Group B: t=2.82, p=0.008).Conclusion: AI-assisted interventions significantly reduce nurses' burnout, especially at the personal and patient levels.