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Outcomes of the butler neural mobilization technique and manual therapy for chronic low back pain in patients with lumbar radiculopathy: a cross-sectional comparative study
No full textSurgeries were considered the only effective treatment method for patients suffering from chronic low back pain with lumbar radiculopathy for a while. However, in the contemporary world, it is not regarded as the primary treatment method until other conventional pharmacological and physical therapy interventions have not proven effective. Therefore, this study compares the outcomes in terms of pain relief and perceived level of mobility in patients with chronic low back pain with lumbar radiculopathy, regardless of whether the butler neural mobilization technique or manual therapy is used. This comparative cross-sectional study was conducted in Lahore, recruiting 100 patients by rendering a purposive sampling technique undergoing any treatment method mentioned above. Observations were recorded pre- and postintervention with a follow-up of 7 days to assess the response to both techniques using a questionnaire. Face-to-face interviews were conducted to assess pain levels using the Numeric Pain Rating Scale (NPRS) and Modified Oswestry Disability Questionnaire (MODQ). Descriptive statistics, chi-square test, Mann‒Whitney U test, independent t test, and the Wilcoxon signed-rank test were used to analyze the data. The medical characteristics of patients who had opted for manual therapy and butler neural mobilization were not different (p > 0.05), except for the quality of pain (p < 0.05). However, pre- and postintervention NPRS scores, pain intensity during the last 24 hours using NPRS scores, and MODQ scores were significantly different among the groups, indicating postintervention pain reduction for both groups comprising patients who had opted for manual therapy (p = 0.001) and butler neural mobilization technique (p = 0.001). Moreover, patients who had opted for either technique had improved their disability levels compared with the preintervention disability levels (p = 0.001). The study concluded that both techniques significantly reduce pain and disability levels, including butler neural mobilization and manual therapy, among patients suffering from chronic low back pain with lumbar radiculopathy
Road traffic accidents in Pakistan: unveiling the emergency service challenge
No full textWe address the critical issue of road traffic accidents (RTAs) that significantly impact global mortality and morbidity. Annually, RTAs cause nearly 1.35 million deaths worldwide, making them one of the top ten leading causes of death, exceeding rates of tuberculosis and diarrheal diseases. In Pakistan, the situation is particularly dire due to its vast population and extensive road network. The increasing number of vehicles combined with rapid urbanization intensifies RTA occurrences. Inadequate enforcement of traffic laws leads to high-risk driving behaviors. Most victims are young adults, with motorcyclists, cyclists, and pedestrians being the most vulnerable groups. This highlights a pressing need for comprehensive reforms to enhance road safety practices, improve emergency response systems, and implement effective public health education to mitigate the devastating impact of RTAs
Assessment of the nutritional status of tuberculosis patients visiting public sector hospitals in Bhakkar district, Punjab, Pakistan
No full textNearly 1.7 billion people are exposed to tuberculosis (TB) globally, and low- and middle-income countries (LMICs) are the major contributors to the burden of TB. Malnutrition affects the severity of illness, the effectiveness of treatment regimens, and the recovery process. Moreover, TB is often referred to as a disease of a poor population. Therefore, this descriptive cross-sectional study was conducted at DHQ Hospital in Bhakkar District and tehsil headquarters (THQ) hospitals in Mankera and Kaloor Kot to assess the nutritional status of TB patients. Data were collected from 329 adult TB patients via a purposive sampling technique with a semistructured questionnaire. Patients’ nutritional status was assessed via BMI and malnutrition indicators adopted from the Mini Nutritional Assessment (MNA®). The associations between sociodemographic factors and BMI with malnutrition were analyzed via chi-square tests, with the significance level set at p < 0.05. Among the 329 respondents, 55.6% were at high risk of malnutrition, and 36.5% were malnourished. A BMI of less than 19 was observed in 5.5% of patients, with a statistically significant association between BMI and malnutrition (p = 0.001). However, no significant associations were found between sex or marital status and malnutrition, with p values of 0.194 and 0.339, respectively. The study concluded that malnutrition is prevalent among TB patients, with 36.7% malnourished and 50.46% at risk of malnourishment. The findings revealed no significant associations between malnutrition and sex or marital status, but a significant relationship was observed between malnutrition and BMI, indicating the importance of addressing malnutrition as a critical component of TB management
Pharmacokinetics and dosage regimen of roxithromycin in adult healthy female subjects
No full textMacrolides are a group of antibiotics produced by Streptomyces bacteria commonly used to treat bacterial infections, including gum infections, gingivitis, and stomach and intestinal ulcers. Roxithromycin is a macrolide antibiotic that effectively targets bacterial cells and inhibits their growth, promoting symptom relief and recovery. Despite this, there is limited research on roxithromycin pharmacokinetics and dosing regimens, particularly in healthy female volunteers from the local population. Thus, this study aimed to investigate roxithromycin's pharmacokinetic parameters and dose regimen in ten healthy female volunteers aged 18 to 30 years. Participants received an oral dose of 300 milligrams of roxithromycin, and blood samples were collected at various intervals for 48 hours. Pharmacokinetic parameters were assessed using two open compartmental models and high-performance liquid chromatography (HPLC). The results showed that the Cmax of roxithromycin was 10.13 ± 0.43 µg/mL, attained at a time to reach tmax of 2.42 ± 0.34 hours. Moreover, the drug exhibited a volume of distribution of 1.38 ± 0.55 L/kg, an elimination half-life of 34.95 ± 22.51 hours, and a total body clearance of 0.04 ± 0.01 L/hr/kg. In accordance with these results, the calculated dosage regimen for 24-hour intervals was 975 milligrams as a priming dose and 372 milligrams as a maintenance dose. In conclusion, this study found that the elimination half-life (t1/2 β) of roxithromycin was higher than literature values, leading to less clearance and ultimately increased Cmax, tmax, and area under the curve (AUC) values of the orally administered drug, indicating the need for dose adjustment in patients
Ankle sprain risk and contributing factors among women wearing high heels at work
No full textHigh heel use in professional environments is a common occupational norm for women, particularly in the hospitality, retail, and fashion industries. However, extended and repetitive use may increase the risk of ankle injuries. The objective of this exploratory study was to examine the factors associated with a history of ankle sprain among women wearing high heels at work. A total of 203 participants were recruited from selected workplaces in Lahore, Pakistan, via a nonprobability convenience sampling technique. Data were collected through a structured questionnaire assessing sociodemographic information, footwear usage patterns, pain symptoms, occupational standing duration, and ankle sprain history. Chi-square analysis revealed significant associations between ankle sprains and heel height, duration of heel wear, type of heel, workplace footwear requirements, and the presence of pain during high heel use (p < 0.05). Women wearing heels ≥ 10 cm and those wearing stilettos were more likely to report a history of ankle sprain. Logistic regression analysis revealed that standing more than 4 hours per day (OR = 3.803), footwear requirements at work (OR = 3.534), and pain during heel use (OR = 9.893) significantly increased the odds of experiencing an ankle sprain, whereas increasing age (OR = 0.789) and being married (OR = 0.304) were associated with lower risk (p < 0.05). Ankle sprains led to productivity loss in more than 75% of the participants, with the majority missing 1–5 workdays. These findings highlight the occupational health risks of high heel use, with prolonged standing, footwear mandates, and early pain symptoms identified as key predictors of injury. Implementing preventive workplace measures—such as ergonomic footwear policies, scheduled standing breaks, and employee education—may help reduce ankle injury risk among women in professions requiring high heels
Investing in the future: prioritizing adolescent health in Pakistan
No full textAdolescence is the stage of life between ages 10 and 19, marking the journey from childhood to adulthood, and is considered the most critical time of human development. During this time, many significant physical, psychological, sexual, reproductive, and social changes occur, making it a critical phase of life. Despite the fact that approximately 21% of Pakistan's population consists of adolescents, the country currently lacks almost any policies focused on promoting adolescent health. Adolescents in Pakistan face significant challenges due to the lack of access to physical, mental, and sexual health services and limited opportunities for physical activity and recreation. Therefore, it is crucial to prioritize this population group's health and well-being to address these pressing concerns by employing a holistic approach so that young people can be empowered to make informed decisions
Diagnostic delay in breast cancer diagnosis: the role of health practitioners
No full textBreast cancer is a significant health concern for women in Pakistan, with one in nine women facing a high lifetime risk of being diagnosed with the disease. Accessing timely and appropriate healthcare services for breast cancer patients can be challenging in Pakistan, and understanding the role of different health practitioners is essential to understand the functioning of the informal referral system. Therefore, this study aimed to explore the different aspects of patients' consultations with various health practitioners for diagnosing breast cancer symptoms. Data were collected from 168 breast cancer patients who had consulted local health practitioners before being diagnosed with breast cancer. Descriptive statistics, the Kruskal‒Wallis H test, and post hoc tests were used to analyze the data. The study found that most patients consulted general practitioners (59.52%) and pir (56.55%) for their health-related concerns. Consultants referred most patients to diagnostic centers, while pir and hakim referred no patients. Patients visited pir and general practitioners the most, but the average number of visits to pir and hakim was higher than that to other health practitioners (p < 0.05). Moreover, pir (130 days) and hakim (120 days) had longer treatment periods than other health practitioners, with hakim charging the highest consultation fees [i.e., Pakistani rupees (PKR) 18,000] and patients incurring the highest travel expenses to visit pir (p < 0.05). Our study highlights the challenges faced by breast cancer patients in seeking timely and effective healthcare services. The absence of a formal referral system resulted in prolonged diagnosis times, extensive travel, and financial burdens on the patients. The findings suggest the need to improve general public awareness regarding breast cancer symptoms and establish an active cancer referral system to achieve early diagnosis, timely treatment, and improved quality of life for breast cancer patients, especially those with a lower socioeconomic status
Knowledge of rheumatoid factor in the diagnosis of rheumatoid arthritis: a survey of family physicians in Punjab, Pakistan
No full textRheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that requires timely diagnosis and intervention. As frontline healthcare providers, family physicians must have a clear understanding of the diagnostic utility of rheumatoid factor (RF) and its limitations to ensure early recognition and appropriate referral of RA patients. This descriptive cross-sectional study was conducted over three months to assess the knowledge of family physicians in Punjab, Pakistan, regarding the diagnostic role and interpretation of RF in RA. Stratified random sampling was used, and a structured questionnaire was distributed to 300 physicians, with responses collected via Google Forms. The questionnaire evaluated demographic variables and knowledge of RA diagnostic criteria, RF specificity, and related clinical interpretation. The knowledge scores were classified as good (≥ 75%), moderate (50–74%), or poor (< 50%). Data analysis was performed via SPSS version 24, with chi-square tests used to examine associations (p < 0.05). The results revealed that only 27.76% of the participants demonstrated good knowledge. Most respondents had moderate (50.95%) or poor (21.29%) knowledge. Significant associations were observed between knowledge level and factors such as physician age, graduation cohort, experience, type of medical college, involvement in RA patient care, and private practice (p < 0.05). This study revealed significant gaps in family physicians’ knowledge regarding RF’s diagnostic value in RA. Targeted educational interventions and updated clinical training are essential to improve early RA detection, enhance referral practices, and improve patient outcomes at the primary care level
Assessment of acute kidney injury associated with the concomitant use of piperacillin/tazobactam and vancomycin in pediatric cancer patients
No full textThis study aimed to evaluate the renal safety of concomitant piperacillin/tazobactam (Pip-Taz) and vancomycin in pediatric cancer patients by assessing changes in the serum creatinine (SCr) and blood urea nitrogen (BUN) levels. The hospital information system at Shaukat Khanum Memorial Cancer Hospital and Research Centre was used to extract the required information, and laboratory test results were collected for 100 randomly selected patients in whom both Pip-Taz and vancomycin were used. Patients were randomly selected using a computer-generated list to minimize selection bias. The data obtained were statistically analyzed using the Friedman test. Most patients who received Pip-Taz and vancomycin suffered from pre-B lymphocytic leukemia. The Friedman test revealed significant within-group differences in SCr and BUN over time (χ² = 299.945, p < 0.001 for males; χ² = 170.162, p < 0.001 for females), but all posttherapy values remained within normal physiological ranges. Posttherapy, vancomycin-treated patients had slightly lower SCr and BUN levels than did those receiving Pip-Taz, although all values remained within normal ranges. A similar trend was observed in females. These findings suggest that concomitant Pip-Taz and vancomycin did not result in significant nephrotoxicity, as all renal biomarker changes remained within normal ranges. No patients met the acute kidney injury (AKI) criteria during therapy. However, vancomycin-treated patients presented slightly greater reductions in creatinine and BUN levels than did Pip-Taz-treated patients, although this does not indicate improved renal function. Despite these findings, vancomycin’s potential for nephrotoxicity remains an important consideration in pediatric treatment decisions
Prescribing trend of treating malaria patients by public and private healthcare facilities in Lahore
No full textMalaria is an infectious disease caused by parasites of the Plasmodium genus. It is one of the major causes of morbidity and mortality worldwide. The World Health Organization (WHO) has recommended artemisinin combination therapy (ACT) to manage malaria among children and adults. However, chloroquine as monotherapy and ACT are commonly prescribed in treating malaria in Pakistan's healthcare delivery system. Therefore, this study assessed the prescribing trends for treating malaria patients in public and private healthcare facilities. Moreover, the study also determined the number of drugs prescribed per prescription by physicians and consultants. This descriptive study was conducted for six months in Lahore's major public and private healthcare facilities. A purposive sampling technique was employed to review 300 malaria patients' prescriptions accessed from the hospital records. Descriptive statistics and the chi-square test were used to achieve the study's objectives. The study showed that most malaria prescriptions were from both public (64.67%) and private healthcare facilities (42.67%) and comprised a dual-drug regimen involving antimalarials, antibiotics, antipyretics, or their combinations. There was a significant difference (p = 0.002) in the prescription trend between public and private healthcare facilities regarding the number of drugs prescribed for treating malaria. Moreover, prescriptions from private healthcare facilities mainly contained antimalarial drugs (58.59%) and antibiotics (17.60%), while most prescriptions from public healthcare facilities contained antipyretics and other drugs (60.67%) (p = 0.001). Most of the consultants prescribed two (66.67%) or three drugs (33.33%), while the prescribing trends of physicians ranged between one and four, which was also statistically significantly different (p = 0.001). In addition, most prescriptions from public healthcare facilities were rationally prescribed (68%). On the other hand, most prescriptions from private healthcare facilities were rational (54%) and semirational (42%). The rationality of prescriptions by public and private healthcare facilities was also significantly different (p = 0.001). Public healthcare facilities were found to exhibit more rational prescribing trends for managing malaria compared to private healthcare facilities, with a focus on prescribing an optimal number of drugs per prescription and a lower usage of antimalarial and antibiotic medications