Life and Science

The Decline of Research Integrity in Pakistan: Causes, Consequences, and the Way Forward

Wasim Alamgir, Aisha Mohyuddin — Wed, 08 Oct 2025 00:00:00 +0500

The Research Integrity Risk Index, a metric designed by Professor Lokman Meho at the American University of Beirut, identifies institutions where research integrity may be compromised, on the basis of three parameters a) articles removed from Scopus or Web of Science, after publication, for failing to meet standards of scientific rigor; 2) the number of articles retracted per 1,000 publications due to various ethical violations and 3) the number of self-citations from an institution.¹ The universities with more than fifteen hundred publications in two years are graded on a five-tier scale ranging from ‘red flag’ to ‘low risk”. Alarmingly, of the 24 universities analysed from Pakistan, only one falls in the low-risk and one within the normal variations category. The remaining universities lie in the red flag (N=6); high risk (N=12), and watch list (N=4) categories. The proportion of retractions from Pakistan is reported at 0.18% with the proportion of retractions related to the subset of Medicine is 0.16%.²
This data should serve as a wake-up call, prompting serious reflection on our current academic research practices by the Universities, the Higher Education Commission and other relevant regulatory bodies. While the pressure to publish, “publish or perish”, exists for researchers across the globe, data shows a disproportionate level of red flags in South Asia, including Pakistan, specifically for multidisciplinary universities. So why are we deviating so significantly from the ethical research norms? In Pakistani universities, the reasons are most likely multiple and varied. The emphasis on university rankings is exerting pressure on the faculty to publish. Some universities pay or reward faculty for publications to enhance institutional metrics (rankings, citations, output), thus linking research output to financial reward. This has resulted in an emphasis of quantity over quality, in turn leading to methodologically weak or poorly designed studies and even data fabrication. This is accompanied by an increase in ghost authorship, with principal investigators facing institutional or social pressure to include friends and colleagues as co-authors without meaningful contribution. In some cases, faculty with weak research credentials seeking promotion are turning to networks that offer co-authorships for a fee, often for fraudulent studies.

In addition to the above, many researchers, especially early-career ones and students, simply lack formal education on ethical standards in research. Students are also under pressure to produce positive results, leading to data fabrication and manipulation. Unintentional breaches occur where there is no understanding of what may be classified as misconduct (e.g., self-plagiarism, image manipulation). Furthermore, poor role-modelling from teachers and research supervisors is resulting in the perpetuation and normalization of misconduct among successive generations of researchers. In many universities and institutes, Institutional Review Board and Ethics Committee (IRB&ECs), exist in name only, and the scrutiny required to ensure robust, safe and ethical research is missing. A lack of accountability at universities, discouragement of whistleblowing or discussion on misconduct is also a contributing factor in the erosion of scientific integrity in our universities.

Scientific misconduct, in whichever shape or form, has far-reaching consequences that extend beyond the individual researcher. It erodes trust in science and fuels skepticism toward legitimate research, leading to reluctance to support science-based policies or interventions. This was vividly demonstrated during the COVID-19 pandemic, when misinformation and a lack of trust in scientific institutions contributed to widespread vaccine hesitancy. At the level of academic institutions, there is a loss of credibility that affects international student admissions, academic and research collaborations and partnerships, and global rankings. Moreover, honest researchers get demoralised or disillusioned, and are seeking jobs abroad, thereby contributing to the brain drain in the country.

Preventing scientific misconduct in the country, needs a proactive overhaul, that emphasizes education, transparency and accountability, of the prevailing research culture. Universities must play a central role in shaping the ethical conduct of researchers. A culture must be fostered where universities value rigor over rankings and that reward quality and societal impact over mere publication numbers. Scrutiny of researchers who somehow manage to publish over the normal expected numbers of papers must be carried out. Mandatory research ethics training should be incorporated into undergraduate, postgraduate, and faculty development programs. Research supervisors particularly need to be trained to act as ethical role models, demonstrating integrity in every stage of research. Institutional policies that accept and validate negative or null results should be developed to discourage selective reporting or data fabrication. The IRB&ECs should be independent and autonomous bodies that function transparently and are immune to external pressures. Robust oversight mechanisms should be established and Institutional policies should clearly define misconduct, outline reporting procedures, and emphasize accountability.

Preventing scientific misconduct can only be achieved through the creation of a transparent and ethical academic culture that embeds integrity into every aspect of academic life. Universities, as the custodians of knowledge and innovation, bear the responsibility of ensuring that research integrity is the norm, not the exception.

Editor-in-Chief

How to cite this: Alamgir W, Mohyuddin A. The Decline of Research Integrity in Pakistan: Causes, Consequences, and the Way Forward. Life and Science. 2025; 6(4): 428-429 .doi: http://doi.org/10.37185/LnS.1.1.1065

Effectiveness of Dual Versus Triple Inhaled Therapy in Chronic Obstructive Pulmonary Disease Patients: Results from a Quasi-Experimental Study, Multan

Sidra Batool, Javed Ahmed Khan, Faryal Asmat, Hamna Wajid, Zoha Hashmi — Wed, 08 Oct 2025 00:00:00 +0500

Objective: To compare the efficacy of dual inhaled therapy and triple inhaled therapy in chronic obstructive
pulmonary disease patients.
Study Design: Quasi-experimental study.
Place and Duration of Study: This study was conducted at the Department of Medicine, Combined Military
Hospital (CMH), Multan, Pakistan from 1^st January 2023 to 31^st December 2023.
Methods: A total of 60 patients with chronic obstructive pulmonary disease were included in this study and
allocated to 2 equal groups based on clinical criteria. In Group-D, patients were given dual inhaled inhaler
therapy (Corticosteroid+ Long acting β-2 agonists) while patients in Group-T were given triple inhaled inhaler
therapy (Corticosteroid+ Long acting β-2 agonists+ long-acting muscarinic antagonist) twice daily. The primary
outcome was set as the percentage of patients achieving a reduced number of moderate-severe exacerbations,
while the secondary outcomes included improved post-dose forced expiratory volume, number of patients
achieving improved chronic obstructive pulmonary disease assessment test score, and baseline dyspnea index
focal score after 6 months of treatment.
Results: The results of primary outcomes showed significantly better efficacy in Group-T compared to Group-D,
as a considerably higher number of patients had reduced frequency of moderate-severe chronic obstructive
pulmonary disease exacerbations after 6 months (86.66% vs 53.33%, P=0.035).
There was also significant improvement in secondary outcomes, including post-dose forced expiratory volume
in 1 second, patients who had improved assessment test scores, as well as baseline dyspnea index focal score in
Group-T compared to Group-D.
Conclusion: Triple inhaled therapy is more effective than dual inhaled therapy for reducing moderate-to-severe
chronic obstructive pulmonary disease exacerbations.

How to cite this: Batool S, Khan JA, Asmat F, Wajid H, Hashmi Z. Effectiveness of Dual Versus Triple Inhaled Therapy in Chronic Obstructive Pulmonary Disease Patients: Results from a Quasi-Experimental Study, Multan. Life and Science. 2025; 6(4): 430-436. doi: http://doi.org/10.37185/LnS.1.1.763

A Descriptive Cross-Sectional Study on Patient Satisfaction with Healthcare Services Provided in the Outpatient Department of a Tertiary Care Hospital, Lahore

Hina Ali, Seema Daud — Wed, 08 Oct 2025 00:00:00 +0500

Objective: To assess patient satisfaction with key aspects of outpatient healthcare services, including patientphysician interaction, communication, service availability, treatment explanation, waiting time, cost of care, and to identify factors influencing patients' satisfaction levels at a tertiary care hospital.
Study Design: Descriptive cross-sectional study.
Place and Duration of Study: The study was conducted at the Medical Outpatient Department (OPD) of Ghurki
Trust Teaching Hospital, Lahore, Pakistan from August 2024 to January 2025.
Methods: A total of 125 patients were selected through non-probability convenience sampling. Data were
collected using the modified Short Assessment of Patient Satisfaction (SAPS) questionnaire, comprising
demographic information and seven satisfaction domains measured on a 5-point Likert scale. Statistical
analysis was performed using SPSS version 22, and independent-samples t-tests were used to assess
associations between demographic factors and patient satisfaction levels, with significance set at P ≤ 0.05.
Results: Among 125 participants, 80 (64%) were female. The mean age of participants was 42.03±15.93 years.
Overall, patients expressed a high level of satisfaction with outpatient services, with a mean total satisfaction
score of 28.93 ± 2.67 out of 35. The highest satisfaction was reported in physician communication and
thoroughness of examination, with 96 (77%) patients stating they were highly satisfied. The employed
participants displayed a higher level of satisfaction with treatment (P=0.048) and healthcare provided
(P=0.018) as compared to the unemployed respondents.
Conclusion: Patients were generally satisfied with the outpatient services provided, in terms of physicianpatient
interaction and respectful treatment. Continued focus on maintaining quality standards and addressing
operational challenges can further enhance service delivery.

How to cite this: Ali H, Daud S. A Descriptive Cross-Sectional Study on Patient Satisfaction with Healthcare Services Provided in the Outpatient Department of a Tertiary Care Hospital, Lahore. Life and Science. 2025; 6(4): 437-447. doi:
http://doi.org/10.37185/LnS.1.1.976

Intra-articular Hyaluronic Acid with Versus without Corticosteroids for Knee Osteoarthritis Among Patients Presenting at Dr. Ziauddin Hospital, Karachi, Pakistan: A Retrospective Cohort Study

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To compare the effectiveness of intra-articular hyaluronic acid injections with and without added
corticosteroid in patients with knee osteoarthritis.
Study Design: Retrospective cohort study.
Place and Duration of Study: This study was conducted at the Department of Orthopedic Surgery, Dr. Ziauddin
Hospital (North Nazimabad Campus) in Karachi, Pakistan from 1^st February 2025 to 30^th April 2025.
Methods: A total of 150 adults (aged 30–70) with symptomatic knee osteoarthritis who received a single intraarticular knee injection were identified: 75 patients received a 6 mL injection of cross-linked sodium
hyaluronate alone, and 75 patients received 6 mL of the same hyaluronic acid combined with 8g triamcinolone
hexacetonide. Pain was assessed by the Visual Analog Scale (VAS) at baseline and at 3, 12, and 24 weeks postinjection. Knee symptoms and function were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 12 weeks. SPSS version 23 was used for data analysis.
Results: At 3 weeks, mean VAS pain was 4.35 in the hyaluronic acid and corticosteroid group vs 5.97 in the
hyaluronic acid group (P=0.001). This advantage persisted at 12 weeks (P=0.001) and 24 weeks (P=0.001). Both
groups showed significant improvement from baseline in WOMAC scores at 12 weeks. WOMAC pain decreased
by 0.57 points in hyaluronic acid and corticosteroid vs 0.44 in hyaluronic acid only (P=0.001 for within-group
improvements), and WOMAC function scores improved by 7.07 vs 5.46 points, respectively (both P=0.001
within-group).
Conclusion: Hyaluronic acid and corticosteroid co-injection can be a valuable option for more rapid symptom
relief, while hyaluronic acid alone remains beneficial for longer-term management.

How to cite this: Shahid S, Munshi N, Siddiqui AM, Azmatullah U, Azizi A, Aziz A. Intra-articular Hyaluronic Acid with Versus without Corticosteroids for Knee Osteoarthritis Among Patients Presenting at Dr. Ziauddin Hospital, Karachi, Pakistan: A Retrospective Cohort Study. Life and Science. 2025; 6(4): 448-454. doi: http://doi.org/10.37185/LnS.1.1.982

Sleep Quality and Psychological Distress Among Undergraduate Students at a Private Medical and Dental College of Islamabad: A Cross-Sectional Study

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To find the relationship between sleep quality and psychological distress among undergraduate
medical college students; to investigate the influence of demographic variables such as age, gender, year of
study, residence, BMI, screen time, exercise, smoking status, and hostel/day scholar status on sleep quality and
psychological distress; and to identify which component of psychological distress (anxiety, depression, or
stress) shows the strongest correlation with poor sleep quality.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Community Medicine, HBS
Medical and Dental College, Islamabad, Pakistan from August 2024 to July 2025.
Methods: A total of 320 undergraduate medical students were enrolled. A stratified random sampling
technique was applied. Validated scales were used to assess sleep quality and psychological distress. Data were
collected using a structured proforma and analyzed using SPSS version 25.0.
Results: Among 320 undergraduate medical students, 55.0% were females, and the mean age was 21.37 ±
1.546 years. The correlation between sleep quality and demographic variables was significant for BMI, exercise,
and screen time. Sleep quality also showed a significant association with psychological distress components,
including depression, anxiety, and stress. Multiple linear regression indicated that, among demographic
factors, age, exercise, and screen time, and among psychological variables, depression, anxiety, and stress were
significant predictors of sleep quality.
Conclusion: The study concluded that poor sleep quality was prevalent among undergraduate medical
students and was significantly correlated with psychological distress. Depression, anxiety, and stress were
found to be important contributing factors influencing sleep quality.

How to cite this: Zubair AA, Zubair FA, Gillani SMAHS. Sleep Quality and Psychological Distress Among Undergraduate Students at a Private Medical and Dental College of Islamabad: A Cross-Sectional Study. Life and Science. 2025; 6(4): 455-463. doi: http://doi.org/10.37185/LnS.1.1.1023

Association of High Agatston Coronary Artery Calcium Score with Critical Coronary Artery Disease: A Cross-Sectional Study from Rawalpindi, Pakistan

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To determine the association and pattern of critical coronary artery disease in patients with high
calcium scores.
Study Design: Analytical cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, Pakistan from May 2025 to August 2025.
Methods: A total of 250 patients between the ages of 25 and 70 years, belonging to both genders, with the
diagnosis of coronary artery disease (CAD), having a coronary artery calcium score (CACS) of >400, were
included. Patients with a previous history of coronary artery bypass grafting, unstable angina, valvular heart
disease, previous myocardial infarction, and chronic kidney disease were excluded. All patients underwent
coronary angiography, and the frequency of patients with critical stenosis and the pattern of CAD was
ascertained. Data analysis was done using SPSS version 26, taking a P-value of less than 0.05 as significant.
Results: The mean age of patients was 57.4±9.2 years. Out of 250 patients, 161 (64.4%) had CACS of 400-1000,
while 89 patients (35.6%) had CACS above 1000. A total of 184 patients (73.6%) had significant CAD. CACS of
more than 1000 was significantly associated with a higher risk of critical CAD (P=0.004). Age >50 years (P=0.035)
and male gender (P=0.019) were found to be significantly associated with a higher CACS as well as the presence
of critical CAD.
Conclusion: A high and very high CACS was significantly associated with the presence of critical coronary artery
disease and multivessel involvement in this study. A higher score may help identify patients at risk and help in
risk stratification; however, further longitudinal studies are required to establish predictive and causal
relationships.

How to cite this: Farhan S, Khan MN, Sadiq MW, Hashmi MO, Shah SA. Association of High Agatston Coronary Artery Calcium Score with Critical Coronary Artery Disease: A Cross-Sectional Study from Rawalpindi, Pakistan. Life and Science. 2025; 6(4): 464-470. doi: http://doi.org/10.37185/LnS.1.1.1008

A Laboratory-Based Experimental Study on the Protective Effects Against Isoniazid- Induced Hepatotoxicity in Mice

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To evaluate the role of Alpha Lipoic Acid (ALA) as a potential antidote to isoniazid-induced hepatitis.
Study Design: Laboratory-based experimental animal study.
Place and Duration of Study: The study was conducted at the Department of Pharmacology, Army Medical
College, Rawalpindi and The National Institute of Health, Islamabad, Pakistan from January 2020 to June 2021.
The study was designed and reported in compliance with the ARRIVE (Animal Research: Reporting of in Vivo
Experiments) guidelines.
Methods: A total of 90 adult male healthy mice were obtained from NIH and were kept at the animal house of
NIH, Islamabad under standard conditions with a daily photoperiod of 12 hours light and 12 hours dark at temp
22 30C. The mice were acclimatized to the laboratory conditions for 1 week, prior to experimentation, and were
provided with a standard diet and water ad libitum. Male mice having a weight of 30-50 grams were included in
the study. Mice having deranged liver function tests at the start of the experimentation were excluded. Mice
were equally divided into three groups. In group A, hepatotoxicity was induced by administration of 100 mg/kg
of oral isoniazid, which was indicated by elevated liver enzymes and changes in histo-pathological parameters.
Alpha-lipoic acid (ALA) was administered orally at 50mg/kg 1 hour prior to isoniazid for 28 days. Animals were
sacrificed on the 29^th day, and samples of blood and liver were taken for biochemical and histopathological
analysis.
Results: Results of this study indicated that ALA offered protection against isoniazid-induced hepatotoxicity by
reducing levels of bilirubin and liver enzymes in the serum. Hepato-protection was further evident from the
preservation of liver architecture, which was indicated by reduced necrosis, steatosis, and portal inflammation.
Conclusion: Alpha-lipoic acid (ALA) proved to be effective in protecting against isoniazid-induced
hepatotoxicity.

How to cite this: Khan IU, Waheed A, Khan WU, Aslam J, Mehmood MS, Khan BU. A Laboratory-Based Experimental Study on the Protective Effects Against Isoniazid-Induced Hepatotoxicity in Mice. Life and Science. 2025; 6(4): 471-476. doi: http://doi.org/10.37185/LnS.1.1.784

Functional Endoscopic Sinus Surgery Outcomes Assessed by the Sinonasal Outcome Test-22: A Prospective Cohort Study from a Single Institution in Rawalpindi

Wed, 08 Oct 2025 00:00:00 +0500

Objective: Using the Sinonasal Outcome Test-22 (SNOT-22), this study aimed to evaluate the effectiveness of
Functional Endoscopic Sinus Surgery (FESS) in improving symptoms and quality of life among patients with
chronic sinusitis.
Study Design: Prospective cohort study.
Place and Duration of Study: The study was conducted at the Department of ENT, Combined Military Hospital
(CMH), Rawalpindi, Pakistan from 1^st September 2023 to 1^st September 2024.
Methods: A single-arm prospective cohort study assessing surgical outcomes was performed on 50 patients
diagnosed with chronic rhinosinusitis to evaluate the impact of FESS on quality of life. Participants completed
the SNOT-22 questionnaire before surgery and at 1-, 3-, 6-, and 12-month postoperative intervals. Patients
were categorized as having chronic rhinosinusitis with lesions, without lesions, or fungal sinusitis. Pre- and
postoperative SNOT-22 scores were compared using an independent t-test; P-values <0.001 were considered
significant.
Results: The mean age of participants was 34.5 ± 5.45 years (range 25–50 years). Of the total, 30% had chronic
rhinosinusitis without lesions, 50% lesions, and 20% had fungal sinusitis. Recurrence occurred in 12% of cases,
and 8% required revision surgery. Asthma was present in 24% of patients. Postoperative SNOT-22 scores
showed a highly significant reduction (P < 0.001), indicating marked symptom improvement. Patients with
lesions demonstrated greater improvement in sinonasal outcomes and quality of life following surgery.
Conclusion: Functional Endoscopic Sinus Surgery significantly improves symptoms and overall well-being in
patients with chronic rhinosinusitis. The substantial decrease in SNOT-22 scores after surgery confirms its
effectiveness, especially among patients with lesions, by enhancing disease control and quality of life.

How to cite this: Alvie M, Akhtar S, Haleem U, Azhar H, Abbasi T, Batool F. Functional Endoscopic Sinus Surgery Outcomes Assessed by the Sinonasal Outcome Test-22: A Prospective Cohort Study from a Single Institution in Rawalpindi. Life and Science. 2025; 6(4): 477-482. doi: http://doi.org/10.37185/LnS.1.1.813

Assessment of Response to Concomitant Chemoradiation with Capecitabine in Locally Advanced Rectal Carcinoma: A Descriptive Observational Study from Nishtar Hospital, Multan

Ferwa Nasir, Aalia Bashir, Muhammad Junaid Hassan, Tariq Jamil — Wed, 08 Oct 2025 00:00:00 +0500

Objective: To assess the response of preoperative concomitant chemo-radiation with capecitabine in patients
with locally advanced rectal carcinoma.
Study Design: A descriptive observational study.
Place and Duration of Study: This study was conducted at the Department of Oncology, Nishtar Hospital,
Multan, Pakistan from 5^th November 2024 to 5^th May 2025.
Methods: A total of 100 patients aged 18-70 years old, diagnosed with stage 3 or 4 non-metastatic rectal
adenocarcinoma, were included. Protracted radiotherapy at 50.4 Gray was delivered over 5.5 weeks, with 1.8
Gray per session, five days a week. An 825 mg/m2 dose of Capecitabine was administered orally twice a day
through the radiotherapy course, including weekends, along with the start of radiotherapy. Surgery was
performed 4-6 weeks after the concurrent treatment and the technique was chosen according to the surgeon's
discretion. Adjuvant chemotherapy of four cycles of IV 5-FU (400 mg/m2) and leucovorin (20 mg/ m2) was
started four to six weeks postoperatively.
Results: Frequent grade I and II toxicity included anemia (70%), abdominal pain (50%), proctitis (42%), and
nausea (46%). Capecitabine treatment was stopped in 25 patients due to grade III and IV diarrhea (37%),
abdominal pain (14%), and proctitis (33%), but it did not have a significant impact on compliance. The
radiotherapy compliance was 90% and 93% capecitabine dose was administered as the total dose. A pathologic
complete response was reached in 8 patients (8%). Tumor downstaging was achieved in 55% of patients, and
nodal down staging was observed in 50% of patients.
Conclusion: Concurrent chemoradiotherapy with capecitabine is a safe and well-tolerated treatment in
patients with locally advanced rectal cancer. It has comparable efficacy to 5-FU chemotherapy and can be used
as an alternative to achieve similar outcomes.

How to cite this: Nasir F, Bashir A, Hassan MJ, Jamil T. Assessment of Response to Concomitant Chemoradiation with Capecitabine in Locally Advanced Rectal Carcinoma: A Descriptive Observational Study from Nishtar Hospital, Multan. Life and Science. 2025; 6(4): 483-489. doi: http://doi.org/10.37185/LnS.1.1.933

Doppler Ultrasound Detection and Grading of Portal Vein Thrombosis in Patients with Liver Cirrhosis: Results from a Cross-Sectional Study, Abbottabad

Maaz Khan, Muhammad Ali Zul Husnain, Sara Khan, Muhammad Ishtiaq Ahmad — Wed, 08 Oct 2025 00:00:00 +0500

Objective: To ascertain the portal vein thrombosis frequency via ultrasound in liver cirrhosis patients at the
Combined Military Hospital, Abbottabad.
Study Design: Cross-sectional study.
Place and Duration of Study: This study was conducted at the Department of Radiology, Combined Military
Hospital (CMH), Abbottabad, Pakistan from 29^th December 2023 to 29^th June 2024.
Methods: The study utilized a sequential sampling strategy to recruit participants, excluding those with
hepatocellular carcinoma, coagulopathies, malignancy, infections, or pregnancy. Doppler ultrasound assessed
portal vein thrombosis, with pertinent clinical and laboratory data being recorded. Data analysis was
performed using SPSS v25, considering P ≤ 0.05 as significant.
Results: This study involving 137 patients revealed a mean age of 43.52 ± 15.08 years. The average duration of
liver cirrhosis was 3.9 ± 1.29 months. Patients had a mean serum albumin level of 2.31 ± 0.24 g/dL and a mean
prothrombin time/international normalized ratio (INR) of 1.40 ± 0.11 seconds. Chronic viral hepatitis was
identified as the leading cause of liver disease, accounting for 33.6% of cases. Other causes included nonalcoholic fatty liver disease (NAFLD) 20.4%, autoimmune hepatitis 19.7%, and drug-induced liver injury 15.3%. Portal vein thrombosis was found in 17 patients (12.4%), with Grade I being the most common type, accounting for 4.4%, followed by Grade II and Grade III, be 3.6% & 2.9%, respectively.
Conclusion: This study demonstrates a notable prevalence of portal vein thrombosis (PVT) (12.4%) in cirrhotic
patients, underscoring the critical role of Doppler ultrasound as a non-invasive, accessible tool for early
detection and grading of PVT.

How to cite this: Khan M, Hasnain MAZ, Khan S, Ahmad MI. Doppler Ultrasound Detection and Grading of Portal Vein Thrombosis in Patients with Liver Cirrhosis: Results from a Cross-Sectional Study, Abbottabad. Life and Science. 2025; 6(4): 490-496. doi: http://doi.org/10.37185/LnS.1.1.973

Comparative Effects of Tutor-Led and Peer-Assisted Mock Objective Structured Practical Examinations on Academic Performance and Perceptions of Undergraduate Physiology Students: A Mixed-Methods Quasi-Experimental Study

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To compare the effects of tutor-led and peer-assisted mock OSPE sessions on academic performance
and student perceptions among undergraduate physiology students.
Study Design: A mixed-method quasi-experimental study.
Place and Duration of Study: The study was carried out in two study blocks (I & II) of the undergraduate MBBS
physiology course at CMH Multan Institute of Medical Sciences, Multan, Pakistan from January 2024 to June
2024.
Methods: The experimental group (N=137) participated in weekly mock Objectively Structured Practical
Examinations in Block II, while the control group (N=137) followed the conventional laboratory practical
routine. Students in the experimental group were further divided into tutor-led (N=67) and peer-assisted
(N=70) mock OSPE sub-groups. Summative OSPE scores of Blocks I and II were compared within and between
groups via Student's t-test. Perceptions of performing students and peer assessors regarding feedback quality
were assessed through questionnaires with Likert-scale items and open-ended questions, with the qualitative
data analyzed thematically.
Results: The introduction of mock OSPE significantly improved the academic performance of the experimental
group in Block II compared to Block I (P<0.001). Also, the experimental group performed significantly better
than the control group in Block II (P<0.001). There was no significant difference in OSPE scores between the
tutor-led and peer-assisted subgroups within the experimental group (P=0.54). Students in the experimental
group reported improved exam preparedness, skill development, and self-reliance with both feedback types,
although tutor-led feedback was associated with higher satisfaction (P=0.02). Peer assessors highlighted the
collaborative learning benefit, though concerns about feedback quality were expressed.
Conclusion: Mock OSPE with formative feedback enhanced academic performance. Peer feedback additionally
promoted collaborative learning and personal growth. Concerns about peer feedback quality highlighted the
need for quality assurance in peer-assisted assessments.

How to cite this: Ikram F, Sheik A, Arshad S, Ameen I, Imtiaz I, Rabbani MA. Comparative Effects of Tutor-Led and Peer-Assisted Mock Objective Structured Practical Examinations on Academic Performance and Perceptions of Undergraduate Physiology Students: A Mixed-Methods Quasi-Experimental Study. Life and Science. 2025; 6(4): 497-503. doi: http://doi.org/10.37185/LnS.1.1.846

Diagnostic Accuracy of the Clinical Assessment of Chorioamnionitis Compared with Histological Findings: A Cross-Sectional Study at Private Healthcare Setting, Multan

Hafsa Tauseef, Farhana Haider, Faryal Akhtar — Wed, 08 Oct 2025 00:00:00 +0500

Objective: To determine the diagnostic accuracy of clinical diagnosis of chorioamnionitis by comparing it with
histopathological findings in a tertiary care hospital setting.
Study Design: A cross-sectional study.
Place and Duration of Study: This study was conducted at the Department of Obstetrics and Gynaecology in
Ibn-e-Siena Hospital, Multan, Pakistan from 3^rd July 2024 to 3^rd January 2025.
Methods: A total of sixty pregnant women with singleton pregnancies at gestational age >28 weeks, who
fulfilled the clinical diagnostic criteria for chorioamnionitis, were included. Following delivery, placentas were
sent for histopathological examination. The placental tissues were fixed in 10% buffered formalin, processed,
and stained with haematoxylins and eosin. The histological diagnosis of chorioamnionitis was made based on
established microscopic criteria, including the presence of acute inflammatory infiltrates in the chorion,
amnion, or umbilical cord. Data were analyzed using SPSS version 25 to assess diagnostic accuracy and the
predictive value of individual clinical features.
Results: Of 60 clinically diagnosed cases, histological confirmation was observed in 39 (65%), while 21 patients
(35%) did not show histological evidence of infection/inflammation. This reflects a diagnostic accuracy of 65%
for clinical diagnosis compared to the histopathological gold standard. Fetal tachycardia (PPV: 76.2%), foulsmelling vaginal discharge (PPV: 78.6%), and PROM >24 hours (PPV: 78.9%) were strong predictors of
histological chorioamnionitis, significantly increasing the likelihood of actual intra-amniotic infection.
However, clinical features such as maternal tachycardia and uterine tenderness showed moderate predictive
value.
Conclusion: The clinical diagnosis of chorioamnionitis showed a moderate correlation with histological
findings. Incorporating histopathology in diagnostic workups can enhance diagnostic accuracy and help
optimize the management of suspected intra-amniotic infections.

How to cite this: Tauseef H, Haider F, Akhtar F. Diagnostic Accuracy of the Clinical Assessment of Chorioamnionitis Compared with Histological Findings: A Cross-Sectional Study at Private Healthcare Setting, Multan. Life and Science. 2025; 6(4): 504-509. doi: http://doi.org/10.37185/LnS.1.1.968

Antenatal Umbilical Cord Coiling Index and Adverse Perinatal Outcome: A Prospective Observational Study at A Tertiary Care Hospital in Multan

Wed, 08 Oct 2025 00:00:00 +0500

Objective: The study aims to determine the association between antenatal umbilical cord coiling index (aUCI)
measured by Color Doppler ultrasonography in the late second trimester and adverse perinatal outcomes.
Study Design: Prospective observational study.
Place and Duration of Study: This study was conducted at the Department of Radiology, Combined Military
Hospital, Multan, Pakistan from 1^st January 2022 to 30^th September 2022.
Methods: The study sample included 173 pregnant females aged 20-35 years. Females presenting at
gestational age 20-24 weeks with a singleton pregnancy for a routine fetal anomaly scan were consecutively
included after informed consent. The aUCI was calculated by taking the average of the reciprocal value of the
distance (cm) between coil pairs at 03 different points in the middle segment of the umbilical cord. The subjects
were categorized based on aUCI <10th percentile, between 10th and 90th percentile, and >90th percentile,
respectively. All subjects were evaluated at delivery for perinatal outcomes, including mode of delivery,
preterm delivery, low birth weight (LBW), intrauterine growth retardation (IUGR), APGAR score, admissions to
the neonatal intensive care unit (NICU), and perinatal death. All the data was statistically analyzed. P-value
<0.05 was considered significant.
Results: Out of 173 females, 97 were primigravida. Mean aUCI was 0.37 ± 0.073. The frequency of abnormal
coiling index was 18.5%, 17 (9.8%) were categorized as hypercoiled, and 15 (8.7%) as hypocoiled. Hypocoiled
index was significantly associated with preterm (RR= 7.54, P=.006), LBW (RR= 10.96, P=.001) and admission to
NICU (RR= 6.36, P=.012) while hypercoiled index was significantly associated with perinatal death (RR= 6.58,
P=.010), preterm (RR= 6.28, P=.012), admission to NICU (RR= 5.08, P=.024) and LBW (RR= 5.44, P=.020).
Conclusion: Abnormal antenatal umbilical cord coiling index is associated with various adverse perinatal
outcomes. Thus, its measurement can help in identifying high-risk pregnancies.

How to cite this: Latif A, Zahra S, Aziz S, Aziz M, Sadiq N, Iftkhar A. Antenatal Umbilical Cord Coiling Index and Adverse Perinatal Outcome: A Prospective Observational Study at A Tertiary Care Hospital in Multan. Life and Science. 2025; 6(4): 510-515. doi: http://doi.org/10.37185/LnS.1.1.771

Knowledge, Attitude, and Practices Regarding Contraception Among Postnatal Mothers: A Cross-Sectional Study at a Single Institution in Lahore

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To assess the knowledge, attitude, and practice towards contraception among postnatal mothers
presented in a tertiary care hospital.
Study Design: A cross-sectional descriptive study.
Place and Duration of Study: This study was conducted in the Department of Obstetrics and Gynecology,
Hameed Latif Hospital, Lahore, Pakistan from February 2024 to February 2025.
Methods: A total of 325 females, aged 15-40 years, who presented in the postnatal ward within 4 weeks of
delivery were selected by non-probability, consecutive sampling. Knowledge was assessed by 12 multiplechoice
questions. Attitudes were assessed by a 13-item questionnaire, which could be answered on a Likert
scale with 1 (strongly agree), 2 (agree), 3 (undecided), 4 (disagree), and 5 (strongly disagree). The practice was
assessed by asking about the use of contraception, its duration, and type.
Results: The mean knowledge score was 9.4 ± 3.2, and the attitude score was 45.8 ± 18.9. 297 (91.4%) had a
good knowledge level, and 28 (8.6%) had a score of less than 10. The knowledge score was associated with place
of residence and qualification. A total of 203 (96.7%) women living in urban areas had a good knowledge score,
compared with 94 (81.7%) in rural areas. Similarly, 180 (77.2%) illiterate women, 53 (86.8%) women with
primary education, 19 (86.3%) with secondary education, and 9 (100%) with higher education had good
knowledge. A favorable attitude was demonstrated by 198 women (60.9%), and 127 (39.1%) had a score below
50. Good contraceptive methods were practised by 102 women (31.4%), and 223 (68.6%) had poor practices.
Conclusion: There is a good level of knowledge, favourable attitudes, and poor practices regarding
contraception in postnatal women; however, there is a need to raise awareness regarding the practice of these
tools to ensure maternal health.

How to cite this: Tanveer H, Altaf S, Hafeez S, Anwar Z, Younas B, Khalil S. Knowledge, Attitude, and Practices Regarding Contraception Among Postnatal Mothers: A Cross-Sectional Study at a Single Institution in Lahore. Life and Science. 2025; 6(4): 516-521. doi: http://doi.org/10.37185/LnS.1.1.978

Efficacy of Empagliflozin in Slowing the Progression of Renal Disease in Patients with Type 2 Diabetes: Single-Blind Interventional Study with Placebo Control at Tertiary Care Setting Quetta

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To assess the role of SGLT2 Inhibitor, Empagliflozin, in slowing renal disease progression in type 2
diabetics.
Study Design: Single-blind interventional study with placebo control.
Place and Duration of Study: The study was carried out at the Department of Nephrology, Combined Military
Hospital (CMH), Quetta, Pakistan from July 2023 to July 2024.
Methods: This was an experimental study with placebo controlinvolving 100 type 2 diabetics (N=100), who
were assigned to receive either Empagliflozin (10 mg OD) or a placebo. Estimated glomerular filtration rate
(eGFR) by (CKD-EPI Formula), HbA1C levels, and Urine Protein Creatinine Ratio (UPCR) were measured at 0, 3,
and 6 months. Improvement in GFR and reduction in proteinuria & HbA1C levels were taken as primary
objectives. Three mixed-design analyses of variance over time (baseline, 3 months, 6 months) conducted for
significance.
Results: Average age was 57.44 ± 10.48 years. The treatment group had 47 patients, and the placebo group had
53 patients. The treatment group showed a lesser reduction in mean eGFR (70.94mL/min to 68.56mL/min)
than the placebo group (69.60mL/min to 62.11mL/min). The treatment group showed a greater decrease in
HbA1c levels (8.36% to 7.36%) than the placebo (8.30% to 8.01%). Proteinuria was reduced in the treatment
group (2.51 g/day to 1.28 g/day) compared to an increase in the placebo group (2.66 g/day to 3.17 g/day). All
findings were statistically significant (P < 0.05).
Conclusion: In type 2 diabetics, addition of empagliflozin to standardized care resulted in a greater reduction in
proteinuria, greater reduction in HbA1c levels, and lesser decline in eGFR, signifying the beneficial effects of the
drug on glycemic control and prevention of renal deterioration.

How to cite this: Khan Z, Altaf A, Jhanzaib S, Ijaz MU, Fazal, N, Ikhlaq A. Efficacy of Empagliflozin in Slowing the Progression of Renal Disease in Patients with Type 2 Diabetes: Single-Blind Interventional Study with Placebo Control at Tertiary Care Setting Quetta. Life and Science. 2025; 6(4): 522-527. doi: http://doi.org/10.37185/LnS.1.1.870

Effect of Nicotine Consumption on Oral Health and Hygiene Practices Among Medical and Non-Medical Undergraduate Students: A Comparative Cross-Sectional Study in Islamabad and Peshawar

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To examine patterns of nicotine consumption, oral hygiene practices, and associated oral health
outcomes among undergraduate students in Pakistan, with a comparative focus on medical and non-medical
disciplines across two major cities in Pakistan.
Study Design: A comparative cross-sectional study.
Place and Duration of Study: The study was conducted from March 2024 to September 2024 among
undergraduate students enrolled in selected medical and non-medical universities across two major cities in
Pakistan —Islamabad and Peshawar.
Methods: A total of 500 undergraduate students were invited to participate; 364 completed the survey
(response rate: 73%). Participants were recruited using a structured convenience sampling approach through
classroom invitations and institutional online platforms. Data were collected via a validated, self-administered
questionnaire. Responses were analyzed using SPSS version 26, and associations were assessed using the chi- square test, with P < 0.05 considered statistically significant.
Results: The mean age was 21 ± 1.64 years. Nicotine use was reported by 58%, mainly via vapes/e-cigarettes
(48%) and cigarettes (35%). Use was higher among males than females (75.2% vs. 24.8%, P = 0.012), with no
difference between medical and non-medical students (49.5% vs. 50.5%, P = 0.285). Oral hygiene habits were
similar, though users reported greater use of adjunctive aids (90.5% vs. 75.3%, P < 0.001). Oral health problems
were significantly higher among users: oral lesions (38.1% vs. 13.6%), decay (40.5% vs. 11.7%), xerostomia
(52.9% vs. 16.2%), bleeding gums (41.4% vs. 29.2%), halitosis (20.0% vs. 9.1%), discoloration (51.0% vs. 29.9%),
and sensitivity (61.4% vs. 32.5%) (all P < 0.05).
Conclusion: Despite comparable hygiene behaviors across groups, nicotine consumption was strongly
associated with multiple oral health problems. These findings underscore the urgent need for targeted health
promotion, oral hygiene education, and campus-based nicotine cessation interventions to address this public
health concern among young adults.

How to cite this: Sultan S, Niaz MO, Awais J, Bashir S, Tahira K, Khosa ZA. Effect of Nicotine Consumption on Oral Health and Hygiene Practices among Medical and Non-Medical Undergraduate Students: A Comparative Cross-Sectional Study in Islamabad and Peshawar. Life and Science. 2025; 6(4): 528-535. doi: http://doi.org/10.37185/LnS.1.1.891

Occupational Determinants of Varicose Veins: Insights from a Cross-Sectional Study at a Tertiary Care Hospital in Islamabad

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To identify the occurrence varicose veins in relation to occupation.
Study Design: Cross-sectional study.
Place and Duration of Study: This study was conducted at the Department of General Surgery, Pakistan
Institute of Medical Sciences (PIMS), Islamabad, Pakistan from January 2023 to December 2023.
Methods: All adult patients of either gender who presented to the outpatient department with varicose veins
were enrolled after taking consent by convenience sampling. Patients with chronic diseases like Diabetes
Mellitus, Hypertension, Liver disease and Kidney disease were excluded from the study. The patient's
demographic details, occupation, anthropometric measurements, smoking status, duration of symptoms, and
other medical data were recorded. Data was collected on the proforma, and analysis was done using SPSS
version 22.
Results: There were eighty patients with an overall mean age of 38.62±4.68 years (15-60 years). Among these,
there were 38 (47.5%) males and 42 (52.5%) females. The majority of varicose vein patients were caused by
standing or sitting for prolonged durations. The mean duration of standing or sitting per day and per week was
5.82±3.64 hours and 55.6±8.45 hours, respectively. It has been observed that varicose veins were significantly
associated with age, family history, and standing/sitting time. The mean duration of symptoms was 20.3±8.47
months or (1.667±0.67 years).
Conclusion: The study emphasized that certain occupational activities involving prolonged standing or sitting
are associated with an increased risk of varicose veins. The findings suggest that occupational factors, such as
prolonged periods of standing or sitting, play an essential role in the onset and progression of varicose veins.

How to cite this: Waqar SH, Khaliq M, Akhtar F, Farrukh K, Mahmood Q, Shahzad F. Occupational Determinants of Varicose Veins: Insights from a Cross-Sectional Study at a Tertiary Care Hospital in Islamabad. Life and Science. 2025; 6(4): 536-541. doi: http://doi.org/10.37185/LnS.1.1.1026

Evaluation of Turnaround Time for Serum Electrolytes and Troponin I in a Clinical Chemistry Laboratory: A Retrospective Observational Study

Tahseen Kazmi, Hira Tahir, Zainab Hameed, Muhammad Zubair, Saira Farhat — Wed, 08 Oct 2025 00:00:00 +0500

Objective: The purpose of this research was to assess the turnaround time (TAT) of the clinical chemistry
laboratory for serum electrolytes and Troponin I.
Study Design: Retrospective observational study.
Place and Duration of Study: The study was conducted at the Clinical Chemistry Laboratory of Shalamar
Hospital, Lahore, Pakistan from 4^th January 2020 to 15^th April 2022.
Methods: This retrospective hospital-based study involved 3399 and 573 reports of patients who were
recommended in the clinical chemistry laboratory of the Hospital for serum electrolytes and Troponin I,
respectively. Serum electrolytes and Troponin I were measured on the Diestro analyzer and Abbott i-1000 SR,
respectively. Data analysis was performed on SPSS version 22.
Results: Overall, 3399 patient reports referred for serum electrolyte tests were analyzed, with 1964 tests
reported within TAT and 1435 delayed. Percentages of delay in the three phases of analysis, including before
analysis, during analysis, and after analysis, were 86.7%, 10.00% and 3.30% respectively. A total of 573 reports
of patients referred for Troponin I were analyzed, which shows 227 tests were reported within the standard
Turn Around Time (TAT) and 346 were delayed. Percentages of delay in the pre-analytical phase, analytical
phase, and post-analytical phase were 74%, 20% and 6% respectively.
Conclusion: Standard time for the reporting of serum electrolytes and Troponin I was 120 minutes (2 hours) and 60 minutes (1 hour), respectively. The study concluded that the main reason for the delay was found in the
analysis phase before for both serum electrolytes and Troponin I. So, there is a need to overcome the preanalytical errors to boost the efficiency of the clinical chemistry laboratory.

How to cite this: Kazmi T, Tahir H, Hameed Z, Zubair M, Farhat S. Evaluation of Turnaround Time for Serum Electrolytes and Troponin I in a Clinical Chemistry Laboratory: A Retrospective Observational Study. Life and Science. 2025; 6(4): 542-546. doi: http://doi.org/10.37185/LnS.1.1.743

A Prospective Analysis of the Association Between Antepartum Cerebroplacental Ratio and Risk of Adverse Fetal Outcomes in Full-Term Pregnancies at Tertiary Care Setting, Sahiwal, Pakistan

Yasir Jamal, Mahpara Shaukat, Rafia Irum — Wed, 08 Oct 2025 00:00:00 +0500

Objective: To evaluate the association of cerebroplacental ratio, Doppler ultrasound, and risk of adverse fetal
outcomes in normal-term pregnancies.
Study Design: A prospective cohort study.
Place and Duration of Study: This study was conducted at the Department of Gynecology and Obstetrics and
Radiology, Sahiwal Medical College and Teaching Hospital, Sahiwal, Pakistan from 1^st April 2024 to 30^th March
2025.
Methods: A total of 250 pregnant women with singleton pregnancies and gestation age between 37 and 41
weeks, admitted to the hospital during latent labor, were included in the study. The cerebroplacental ratio was
calculated as the middle cerebral artery pulsatility index divided by the umbilical cord pulsatility index. All
measurements were classified by gestational age percentile into specific groups. Adverse fetal outcomes
included fetal death, meconium-stained amniotic fluid, Apgar score <7 at 5 minutes, stillbirth, NICU admission,
and need for ventilator, sepsis, hypothermia, non-invasive ventilation, hypoglycemia, and necrotizing
enterocolitis.
Results: The incidence of abnormal heart rate was higher in fetuses with cerebroplacental ratio (CPR) <5^th
percentile in comparison with CPR >5^th percentile (54.5% vs 30%). Similar results were recorded in both groups
with CPR <1 (60% vs 30%, P=0.04). A cerebroplacental ratio (CPR) <5^th percentile had a positive predictive value
of 24% and a negative predictive value of 90% for abnormal fetal heart rate. However, the positive predictive
value of cerebroplacental ratio (CPR)<1 and 1.08 for both parameters was 5% and 7%, respectively. The
cerebroplacental ratio (CPR) >95^th percentile had a negative predictive value of 98% and 99%, respectively.
Conclusion: A low cerebroplacental ratio is a predictor of fetal distress requiring operative delivery and
abnormal fetal heart rate, with low positive predictive value and high negative predictive value. A
cerebroplacental ratio (CPR) <5^th percentile, however, was only correlated to abnormal fetal heart rate.

How to cite this: Jamal Y, Shaukat M, Irum R. A Prospective Analysis of the Association Between Antepartum Cerebroplacental Ratio and Risk of Adverse Fetal Outcomes in Full-Term Pregnancies at Tertiary Care Setting, Sahiwal, Pakistan. Life and Science. 2025; 6(4): 547-552. doi: http://doi.org/10.37185/LnS.1.1.943

Urban Inequality and the Dystopian Landscape: A Case Study of Urban Dystopia in Islamabad

Maryam Bibi, Abdul Qadar — Wed, 08 Oct 2025 00:00:00 +0500

Objective: This study investigates how the post-colonial transition of the economy unleashed a wave of
restructuring through modernity and capitalism. Originally planned to ensure holistic well-being, the city's
utopian vision has produced dystopian realities for marginalized communities. We explore how the
development of the 'perfect city' was based on aesthetics rather than health and well-being as its cornerstones.
Therefore, the research seeks to understand how health has evolved and has been taken into practical
consideration among the underprivileged residents of the Katchi Abadi population (slums, squatter
settlements, and permanent temporaries of the city).
Study Design: Qualitative study inclusive of participant observation among slum dwellers, unstructured
interviewing (with residents and officials from state bureaucracy), and archival data (CDA documents).
Place and Duration of Study: This fieldwork was conducted in the Katchi Abadies of Islamabad, Pakistan, from
June 2022 to December 2024.
Methods: In-depth interviews, ethnography, and participant observation examine Katchi Abadi health norms
and their relation to Islamabad's utopian planning. The study is purposive in locating the forgotten or ignored
realities and how they are patronized in settled and planned hierarchies of Islamabad.
Results: The study shows how Islamabad's utopian vision is experienced differently by socio-economically
marginalized residents. The study finds that a more substantial relation with the city is mainly based on
understanding who lives where within the city's socio-spatiality. Therefore, Dystopia emerges for many
residents despite Islamabad's utopian ideals.
Conclusion: We have argued that the utopian vision of Islamabad is turning into a dystopian reality for many of
its urban poor. The Katchi Abadi Walay, often seen as the city's neglected population, includes many who face
homelessness, addiction, and social exclusion. However, it is essential to recognize that not all their hardships
stem from government inaction; a lack of personal initiative, reluctance to work, and dependence on begging
also play a role. Real change demands both systemic reform and individual responsibility.

How to cite this: Bibi M, Qadar A. Urban Inequality and the Dystopian Landscape: A Case Study of Urban Dystopia in Islamabad. Life andScience. 2025; 6(4): 553-560. doi: http://doi.org/10.37185/LnS.1.1.616

Knowledge and Practices of Diabetic Patients Regarding Foot Care: A Cross-Sectional Study

Wed, 08 Oct 2025 00:00:00 +0500

Objective: To determine the knowledge & practices of diabetic patients about foot care.
Study Design: A cross-sectional study.
Place and Duration of Study: This study was conducted at Pakistan Ordnance Factories (POF) Hospital, Wah
Cantt, Pakistan from 1^st June 2024 to 15^th August 2024.
Methods: A total of 178 patients were included by by purposive sampling. Data was collected on closed-ended
questionnaires. Data was analyzed by SPSS 23. Scores for knowledge and practice were assigned out of a total of 10. Knowledge and practice were categorized as good (> 8), average (5-8), and poor (< 5). Chi-square test of
significance was applied to find out the relationship among categorical data at P < 0.05.
Results: Out of 178 males, 97 (54.5%) were while females were 81 (44.5%). 61 (34.3%), 64 (36%), and 53 (29.8%)
had duration of DM less than 5 years, 5-10 years, and more than 10 years, respectively. 80 people (44.9%) were
having normal HbA1c during last 6 months while 98 (55.1%) people were having high HbA1c during last 6
months. Knowledge of 36 (20%) patients was good, 74 (42%) average, and 68 (38%) poor. Practice of 14 (8%)
patients was good, 95 (53%) average, and 69 (39%) poor. The knowledge of foot care was higher among males
(P-value 0.016), patients having higher education (P-value 0.000), and having normal HbA1c levels (P-value
0.041). The practice of foot care was better in subjects having higher educational status (P-value 0.014) and in
patients having normal HbA1c levels during the last 6 months (P-value 0.029).
Conclusion: The knowledge and practice of foot care among diabetics were found to be average. Targeted
health education interventions are needed to promote proper foot care and prevent complications.

How to cite this: Mushtaq R, Waheed K, Ramzan M, Imran SS, Nadeem S, Ahmed S. Knowledge and Practices of Diabetic Patients Regarding Foot Care: A Cross-Sectional Study. Life and Science. 2025; 6(4): 561-568. doi: http://doi.org/10.37185/LnS.1.1.819

Caring for Carers: Biopsychosocial Burden in Caregivers of Persons with Disability- A Cross-sectional Study in Rawalpindi

Wed, 08 Oct 2025 00:00:00 +0500

Objective: The study aimed to determine the caregiver burden experienced by caregivers of persons with
disability (PWD) reporting to a tertiary care rehabilitation medicine facility.
Study Design: A cross-sectional observational study.
Place and Duration of Study: The study was conducted at the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan from April 2022 to March 2023.
Methods: A total of 90 patients were enrolled in the study using a non-probability purposive sampling
technique. The Caregiver Burden Inventory (CBI), a tool developed to assess the burden experienced by
informal caregivers across five domains — time-dependence, developmental, physical, social, and emotional
—was used to measure multidimensional aspects of caregiving and burden of care. Statistical analysis of data
was done using the Statistical Package for the Social Sciences (SPSS).
Results: Total caregiver burden score amongst participants was statistically significant (P value: 0.046). Among
the five domains used by CBI, the physical domain was most affected (P-value: 0.004). The mean total CBI score
was 26.5 (IQR 18.7 - 37). A positive correlation was found between increased age and increased total CBI score
(0.231; P-value of 0.04). There was no correlation between the duration of care provided by caregiver and total
CBI score (0.052; P-value = 0.625).
Conclusion: The presence of a high burden of care seen among female caregivers, older individuals, and in
those providing care to persons with various comorbidities, depicts a need for structured support systems,
including respite care services, financial assistance programs, and caregiver-friendly policies to alleviate this
burden.

How to cite this: Arshad S, Younas U, Khalil MT, Ahmad K, Mumtaz SN, Itfaq M. Caring for Carers: Biopsychosocial Burden in Caregivers of Persons with Disability- A Cross-sectional Study in Rawalpindi. Life and Science. 2025; 6(4): 569-576. doi: http://doi.org/10.37185/LnS.1.1.610

A Cross-sectional Analysis on Anemia, Hemoglobin Level, and Erythrocyte Sedimentation Rate in Pregnant Women in Gilgit–Baltistan, Pakistan

Zareen Akbar, Akbar Khan, Zaineb Akram, Meerab Razzaq, Nazir Ahmed Lone — Wed, 08 Oct 2025 00:00:00 +0500

Objective: The present study was designed to study the prevalence of anemia, hemoglobin level, gestational
age, and erythrocyte sedimentation rate in pregnant women of Gilgit-Baltistan, to determine the factors, and
recommend intervention strategies to reduce this health problem in the female population of reproductive age
in Gilgit-Baltistan and in similar conditions.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: The study was conducted in Gilgit-Baltistan (GB), Pakistan from March 2021 to
March 2022.
Methods: A total of 330 pregnant women from various parts of the region, including Gilgit city, Juglot, Naltar,
Nomal, and Hunza, were enrolled. Hemoglobin level was measured with an automated cell counter (Sysmex K-
21), and the erythrocyte sedimentation rate was determined by the Westergren method. The gestational age
was determined from the last menstrual period, later confirmed by ultrasonography.
Results: A significant proportion of pregnant women who presented with anemia were in their third trimester.
The prevalence of anemia was found to vary across age groups. The highest prevalence (30%) was observed in
the 37-40 years age group. In contrast, a lower prevalence (10.25%) was recorded among women aged 32-36
years. A positive correlation between gestational age and ESR and an inverse relationship between hemoglobin
concentration and ESR were observed.
Conclusion: Anemia was identified as a moderate public health problem among pregnant women in the Gilgit-
Baltistan region, with a prevalence of 30% among those aged 37–40 years. Both hemoglobin concentration and
gestational age were found to be important factors that correlate with an elevated erythrocyte sedimentation
rate.

How to cite this: Akbar Z, Khan A, Akram Z, Razza M, Lone NZ. A Cross-sectional Analysis on Anemia, Hemoglobin Level, and Erythrocyte Sedimentation Rate in Pregnant Women in Gilgit–Baltistan, Pakistan. Life and Science. 2025; 6(4): 577-583. doi: http://doi.org/10.37185/LnS.1.1.854