ZU Journal System (Ziauddin University)
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Insights into Critical Connections: Exploring Lipid Dynamics of ICU Patients In Tertiary Healthcare Settings
No full textBackground: The critical illness involves dramatic changes in metabolic and inflammatory processes that have a long-lasting effect on lipid metabolism. The objective was to investigate the lipid dynamics among Intensive Care Unit (ICU) patients and establish relationship between repeated changes in lipid levels and clinical outcomes in patients with critical illness.
Methods: This prospective observational study, (June to November of 2024) was conducted at Department of Chemical Pathology, Combined Military Hospital Malir, Karachi, Pakistan. A total of 112 critically ill patients who were admitted to the ICU were enrolled. On day 1, day 3 and day 5 of ICU admission, Serum Total Cholesterol (TC), High-density lipoprotein Cholesterol (HDL-C), Low-density lipoprotein Cholesterol (LDL-C), C- Reactive protein (CRP) were measured. They were organized into two groups: Group A (increasing lipid trend) and Group B (decreasing lipid trend). Temporal changes and relationships with CRP levels and clinical outcomes were compared in SPSS version 27.
Results: Serum total cholesterol (p < 0.001), HDL-C (p = 0.002), and LDL-C (p < 0.001) showed a significant decrease between day 1 and day 5, but CRP showed a significant increase (p < 0.001). Group B patients (patients with a decreasing cholesterol trend) had a longer stay in the ICU (8.4 ± 3.2 days) and higher mortality rates (38.6) than Group A (5.9 ± 2.7 days, 14.3%). The reduction in LDL-C and HDL-C was greater in non-survivors than in survivors (p < 0.05).
Conclusion: Serial lipid measurements can be considered effective predictors of mortality and disease progression in patients with severe illness
The Effectiveness of VELscope in Monitoring Cellular Alterations in Oral Premalignancies
No full textBackground: Oral cancer represents a significant global health issue, accounting for approximately 3% of all malignancies and causing considerable morbidity and mortality. The cellular alterations can result in the development of premalignant conditions, including leukoplakia, erythroplakia, and oral submucous fibrosis. To obtain autofluorescence data on different histopathologically distinct oral lesions and assessment of direct auto fluorescence examination validity in identifying premalignant and malignant lesions using VELscope.
Methods: A prospective, randomized in-vivo clinical study was conducted at Department of Oral & Maxillofacial Surgery, Dow University of Health Sciences, Karachi, in time duration of four months (i.e. 18-3-2025 to 17-6-2025) on 160 patients (ages 25–65) with clinically visible oral lesions. VELscope examination was performed to identify abnormal fluorescence (loss of green autofluorescence), followed by incisional biopsy and histopathological analysis. Sensitivity, specificity, and correlations with demographic and lesion characteristics were assessed. SPSS v.26 was used for data analysis. A p-value < 0.05 was considered statistically significant.
Results: Abnormal fluorescence was observed in 63.8% (102/160) of cases, strongly correlating with dysplasia/malignancy (p < 0.0001). Leukoplakia was the most common lesion (49.4%), followed by erythroplakia (30.0%) and oral submucous fibrosis (20.6%). No significant associations were found between fluorescence loss and gender (p = 0.610), age (p = 0.565), or lesion type, confirming VELscope’s consistent performance across subgroups.
Conclusion: VELscope effectively enhances early detection of oral premalignancies in high-risk populations, guiding targeted biopsies. While its high sensitivity aids screening, false positives necessitate histopathologic confirmation. Future research should explore longitudinal outcomes and cost-effectiveness in diverse settings to optimize clinical integration
User Satisfaction and Functional Trunk Support Using a Robotic Assistive Device: A Pilot Study: User Satisfaction with Robotic Trunk Support: A Pilot Study
No full textBackground: Neurological, spinal, or age-related variables can cause trunk mobility impairments, which impair posture control and raise the risk of falls, both of which have an adverse effect on quality of life. Few active and passive trunk-assistive devices have been created to help these people, but their portability, range of motion, and customizability are limited. The aim of this study is to create and assess a novel, active trunk assistive technology that overcomes these constraints.
Methodology: An active wheelchair add-on device design was suggested using intelligent Dynamixel actuators. Its four degrees of freedom movement design comprised movable pulleys and a configurable jacket harness. Ten healthy participants (male: age 31.2 ± 6.55 years and female: age 26.5 ± 6.61 years) completed the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) and System Usability Scale (SUS) questionnaires to provide feedback on the device\u27s performance. Additionally, statistical analysis was used in order to further evaluate device usefulness.
Results: A high degree of user satisfaction is shown by the QUEST score of 4.2 ± 0.4 and the SUS mean score of 71.25 ± 7.84, with 7 participants exceeding the threshold of 65. P-value (0.041) < α (0.05) in one sample t-test on SUS scores indicated higher device usability than the acceptable score of 65. The outcomes confirm how well the design works in terms of convenience, comfort, and security.
Conclusion: The suggested design demonstrated the potential to enhance trunk mobility and support everyday activities for those with poor trunk control because of its increased range of motion, adjustable harness, and portability. It effectively addresses the shortcomings of the current trunk support devices.
Keywords: Assistive, Independence, Mobility, Neurological, Robotic, Trunk
To cite this article: Rao AZ, Mushtaq B, Ghauri GAK, Adeen R, Siddiqui MZ, Hasan MA. User Satisfaction and Functional Trunk Support Using a Robotic Assistive Device: A Pilot Study. Pakistan Journal of Rehabilitation. 2026; 15(1):19-25.
Effectiveness of Muscle Energy Technique versus Myofascial Mobilization in Improving Functional Outcome in Sub-Acute Non-Specific Low Back Pain: A Randomized Controlled Trial: MET vs Myofascial Mobilization in Sub-acute LBP
No full textBackground: The low back pain (LBP) is a common musculoskeletal condition. There is limited evidence comparing muscle energy technique (MET) versus myofascial mobilization in managing sub-acute Non-specific low back pain (NSLBP). The study’s aim is to evaluate the effectiveness of MET and myofascial mobilization in reducing pain intensity and functional outcomes in NSLBP.
Methodology: A clinical trial was performed at Sindh Institute of Physical Medicine and Rehabilitation on 60 participants. Outcome measures used were visual analogue scale (VAS) and Roland Morris Disability Questionnaire (RMDQ) to determine pain and disability respectively at baseline and at post-intervention. Subjects were randomized into experimental and control groups which received MET and myofascial mobilization respectively. However, both groups received standard therapy of transcutaneous electrical nerve stimulation (TENS) and general muscle strengthening exercises. SPSS version 23 was used for analysis of data. Wilcoxon signed ranked test employed to comparison of baseline and after treatment outcomes within the group. The Mann-Whitney test was employed for between-group differences. A p-value below 0.05 was considered as significant.
Results: The mean age was 40.9± 8.9 in group A and 44.9±9.3 in group B. 17 (28.3%) were females, and 43 (71.7%) were males. Intra-group analysis revealed statistically significant decrease in pain-like symptoms and level of disability in each group (p < 0.01). However, inter group analysis showed pain and disability were statistically insignificant (p-value > 0.05).
Conclusion: It is concluded that MET and myofascial mobilization are equally beneficial for LBP in alleviating pain intensity and disability.
Keywords: Disability, Exercise, Muscle Energy Technique, Muscle pain, Myofascial Mobilization, Manual Therapy.
Clinical Trial Registration: Prospective registration was done at the clinicaltrial.gov (NCT05428280).
To cite this article: Abdullah F, Akhtar S, Baig AAM. Effectiveness of Muscle Energy Technique versus Myofascial Mobilization in improving Functional Outcome in Sub-Acute Non-Specific Low Back Pain: A Randomized Controlled Trial. Pakistan Journal of Rehabilitation. 2026; 15(1):14-18
Functional And Radiological Outcome Of Colles’ Fracture In Adult Treated By Percutaneous K-Wire Fixation Versus Locking T-Plate
No full textBackground: Colles’ fracture, a common extra-articular distal radius fracture, frequently occurs in adults following low-energy falls or high-energy trauma. The surgical treatment is still controversial, percutaneous K-wire fixation and locking T-plate fixation being the most common ones. This paper compared the radiological outcome and functional outcome of these two forms of fixation.
Methods: This was a prospective comparative study that was carried out in the Orthopedic Department of Bahawal Victoria Hospital, Bahawalpur, from April to September 2025. 60 adult patients (50-80 years aged) who had Colles fractures were recruited and split in half. Group A was subjected to percutaneous K-wire fixation and Group B to locking T-plate fixation. The modified Gartland and Werley score was used to measure functional outcomes at three and six months of the postoperative period. The SPSS version 25 was used to analyze data, and the chi-square tests were employed to evaluate associations with a p-value ≤ 0.05 as the significant one.
Results: The mean age was 41.2±8.6 years in Group A and 44.7±9.2 years in Group B. At three months, 80% of K-wire patients and 63.3% of T-plate patients showed excellent outcomes. By six months, excellent results increased to 90% in the K-wire group and 83.3% in the T-plate group. No significant association was observed between gender, BMI, or diabetes and the final functional outcome (p>0.05).
Conclusion: Both fixation methods produced satisfactory outcomes; however, K-wire fixation demonstrated slightly better early recovery and cost-effectiveness, making it a practical choice in routine clinical settings
Correlation Between HbA1c Levels and Severity of Diabetic Retinopathy: A Cross-Sectional Evaluation
No full textBackground: Diabetic retinopathy (DR) is a frequent microvascular complication of type 2 diabetes mellitus and the major cause of visual impairment. The most important factors affecting the development of DR are glycemic control and duration of diabetes. The purpose of this study was to determine the correlation between glycemic indices and the extent of DR in patients with type 2 diabetes mellitus.
Methods: This cross-sectional study (November 2022 to April 2023) included 150 patients with type 2 diabetes and was divided into three groups according to the severity of DR, which included No DR (n=60), Non-Proliferative DR (NPDR, n=58), and Proliferative DR (PDR, n=32). The ophthalmic examination was carried out in detail, and HbA1c and glucose levels were assessed with fasting blood samples. Demographic and clinical information were recorded. ANOVA, Pearson correlation, and multivariate logistic regression were used to analyze associations between glycemic indices, diabetes duration, and DR severity.
Results: NPDR and PDR patients reported greater levels of HbA1c, longer duration of diabetes and elevated fasting glucose than patients with no DR. HbA1c had the most significant positive correlation with the severity of DR (r = 0.72, p < 0.001). Multivariate logistic regression found HbA1c (OR=1.92, 95% CI=1.48-2.51) and length of diabetes (OR=1.15, 95% CI=1.07-1.25) as independent predictors of DR.
Conclusion: DR severity is highly linked with poor long-term glycemic control and increased duration of diabetes. HbA1c monitoring and early ophthalmic examination is critical to prevent further development of the disease and minimize the risk of developing vision loss in patients
Modulating the Oral Microbiome Around Orthodontic Mini-Implants Through Lactobacillus reuteri Supplementation
No full textBackground: The orthodontic mini-implants may cause cavities that harbor biofilm causing inflammation of the gums and imbalance in the microbes. This study compared the impact of Lactobacillus reuteri supplementation on the status of the gingival and the composition of the oral microbiome surrounding orthodontic mini-implants.
Methods: This prospective cross-sectional study (January and June 2023) included 60 patients of orthodontic mini-implants with probiotic (n= 30) or placebo (n= 30) protocols. The probiotic cluster was treated to chewable L. reuteri tablets twice daily over a period of 4 weeks; the placebo group was given the same non-active tablets. At baseline and after 4 weeks Gingival Index (GI), Plaque Index (PI), and Bleeding on Probing (BOP) were measured. Chi-square, paired and independent t-tests were used to analyze the data; p < 0.05 was taken to be significant.
Results: At 4 weeks the probiotic group showed significant improvements in GI (1.23 ± 0.24; p = 0.001), PI (1.33 ± 0.28; p = 0.002) and BOP (34.6 ± 7.9; p = 0.001) compared with placebo. qPCR results (log₁₀ copies/mL) showed reductions in P. gingivalis (2.18 ± 0.33; p < 0.001) and S. mutans (3.21 ± 0.48; p = 0.002) and increases in L. reuteri (5.48 ± 0.36; p < 0.001) and A. naeslundii (5.01 ± 0.29; p = 0.01) in the probiotic group (p > 0.05).
Conclusion: The 4-week Lactobacillus reuteri supplement enhanced the health of the gingiva and the composition of the oral microbiota in favor of a more desirable composition near orthodontic mini-implants
The Silent Liver Function Mayhem: Unrevealing The Mystery Of Vanishing Bile Duct Syndrome
No full textVanishing Bile Duct Syndrome (VBDS) is a rare form of cholestatic liver disease that is characterized by the destruction of intrahepatic biliary tree segments. For this narrative review to explore the clinical spectrum, pathophysiology, and outcomes of VBDS, a comprehensive literature search was performed using PubMed, google scholar and other academic databases from year 1995-2025. It was identified that hepatic conditions that can lead to VBDS are primary biliary cholangitis (PBC) and primary sclerosing cholangitis. Our main focus was on non-hepatic aetiologies that have been linked to VBDS such as neoplastic illnesses (especially lymphoma) or drug-induced liver damage (DILI). The diagnosis of VBDS is confirmed by ductopenia, which is a 50% decrease of the interlobular bile ducts on liver biopsy. Significant hepatic inflammation and damage were also observed in chronic active hepatitis. Management centres on withdrawal of the offending agent with added symptomatic relieve with Rifampin, Cholestyramine and ursodeoxycholic acid. High doses of ursodeoxycholic are also beneficial to relieve symptoms of pruritis and improving biochemical markers. In severe cases liver transplant is the only choice
Cerebral Flow Diverter: Pioneering Insights From A Tertiary Care Hospital In A Developing Nation
No full textAbstract:
Objective: To record the early experience about the cerebral flow diverters (CFD) utilization and outcomes at a tertiary care hospital of Pakistan.
Study design: Retrospective cohort study.
Place and duration: Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.
Material and methods: A retrospective review was conducted on patients who underwent CFD placement for cerebral aneurysms at our tertiary care center between 2017 and 2025. Data collected included patient demographics, aneurysm features, procedural details, and both immediate and six-month post-procedure outcomes, such as occlusion rates and any complications. The extent of aneurysm occlusion—categorized as complete or incomplete—was determined based on angiographic imaging obtained immediately following CFD deployment.
Results: In a total of 27 patients, 16 (56.3%) were female and 11 (40.1%) male with mean age of 43.22 ± 17.86 years. The mean aneurysm size was calculated to be 17.87 ± 7.78 mm, whereas 22 (81.48%) were wide necked aneurysms (≥ 25 mm). Immediate post-procedural assessments displayed a 100% success rate in completing the intended procedure successfully across all 27 cases. Immediate angiogram revealed that 15 (55.56%) patients achieved complete contrast stasis/occlusion within the cerebral aneurysms, while 12 (44.4%) displayed partial contrast stasis/occlusion. In the shorter-term follow-up evaluation, 25 (92.59%) cases exhibited complete occlusion of the aneurysms with only 2 (7.41%) patients showing procedure failure, signifying a sustained positive outcome in terms of aneurysm closure. Complications were reported in 4 (4.2%) patients with 2 patients showing aneurysm wall enhancement, 1 patient showing acute thrombosis, and endoleak each.
Conclusion: Despite limited resources, our center achieved good clinical outcomes, aneurysm occlusion rates, and procedural success. The occurrence of complications in a subset of cases underscores the necessity for continued refinement of patient selection criteria and procedural techniques to optimize outcomes and mitigate risks in the evolving landscape of endovascular interventions for cerebral aneurysms
Incidence and Risk Factors of Surgical Site Infection Following Orthopedic Implant Surgeries in a tertiary Healthcare setting at Lahore
No full textBackground: Surgical site infections (SSIs) are a leading cause of postoperative morbidity following orthopedic implant surgeries, resulting in delayed recovery and high healthcare costs. The aim of this study was to establish the incidence and the risk factors of SSIs after orthopedic implant surgery.
Methods: This descriptive cross-sectional study (April 2024 to July) enrolled 180 patients aged 18 years and above who were undergoing orthopedic implant surgeries. A structured proforma was used to collect data on demographic, clinical and perioperative variables. According to the Centers for Disease Control and Prevention (CDC) guidelines, SSIs were detected. The SPSS version 26.0 was used to perform the statistical analysis using the chi-square and t-tests to make the univariate comparisons and multivariate logistic regression to identify the independent predictors of SSI. A p-value of <0.05 was considered statistically significant.
Results: The total incidence of SSIs was 11.7%(n=21). SSIs were significantly related to diabetes mellitus (p = 0.01), smoking (p = 0.03), and prolonged surgical duration (>2 hour, p = 0.02), as well as antibiotic prophylaxis (p = 0.001) deficit. These were affirmed as independent predictors using multivariate analysis: diabetes (Adjusted Odds Ratio (AOR) = 2.84), smoking (AOR = 2.19), duration more than 2 hours (AOR = 2.61), and no antibiotic prophylaxis (AOR = 4.73).
Conclusion: The incidence of SSI was considerably high in orthopedic implant surgeries. The risk of infection can be reduced significantly by optimizing the use of perioperative antibiotics, controlling diabetes, reducing the length of operation, and deterring smoking.