ZU Journal System (Ziauddin University)
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Neuroprotective Changes Induced In Substantia Nigra Of Rats By The Combination Of Passiflora, Melatonin & Vitamin B6
No full textBackground: Parkinson\u27s is an age-related neurodegenerative disorder characterized by loss of dopaminergic neurons. The standard drug Levodopa has been used in the treatment of Parkinson’s for decades, but long-term use leads to motor complications like dyskinesia and on-off phenomena. This study aimed to observe the neuroprotective effect of supplements (melatonin, vitamin B6, and Passiflora) in a rat model.
Method: This was an experimental animal study conducted on healthy male albino Wistar rats weighing between 150-200 g. The study was conducted at Baqai Medical University and Dow University of Health Sciences after getting approval from IREB of BMU (BMU-IREB/03-2023) for a period of 6 months. The Model was formed by MPTP (1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine). 40 rats were selected by using the power analysis technique & were divided into groups: A: Control, 0.9% saline, B: MPTP, C: MPTP + Levodopa, D: MPTP + Levodopa + Supplement (melatonin 10mg/kg, Passiflora 25mg/kg & vitamin B6 100mg/kg). Weight of animals & behaviour tests (Pole and Plus Maze) were recorded for 5 weeks. Brains were isolated to observe histological changes & Alpha synuclein expression. Data was analysed by using SPSS version 27. One-way analysis of variance (ANOVA) was applied followed by an independent sample t-test.
Results: Behavioural analysis revealed a statistically significant difference between MPTP and treatment groups (p<0.001). Bradykinesia was reduced after the intake of the supplement in the pole test. The time spent in the open arm of the plus maze was significantly improved by approximately 80.28% (p<0.001) with supplement + L-Dopa. MPTP caused 50% reduction in the neuronal count, observed on H&E staining, while the supplement ameliorated this decrease. Degenerative changes like pyknosis, shrinkage, glial infiltration, and vacuolation were improved in the levodopa + supplement group(p<0.001). IHC revealed, supplement reduced the accumulation of alpha synuclein aggregates, which were around 25-30-fold in the MPTP group.
Conclusion: The supplement has a neuroprotective role as observed by betterment in behavioural performance, improvement in neuronal degeneration, and reduction in the expression of alpha synuclein
Quantitative Ultrasonographic Evaluation of Tonsil Volume and Its Anthropometric Determinants in adults
No full textBackground
To investigate the impact of demographic, anthropometric, and clinical factors such as age, gender, BMI, Epworth Sleepiness Scale (ESS), and neck circumference on tonsil hypertrophy using ultrasonographic assessment.
Method:
The present cross-sectional study was conducted at a tertiary care hospital in Karachi from January to July 2021. Fifty-four adults aged 18-60 with enlarged tonsils participated. Exclusion criteria included ages outside this range, trauma, surgical tonsil excision, pregnancy, and lactation. Participants provided informed consent and principal investigator completed a proforma taking demographic data, physical examination, Brodsky tonsil grading, ESS scoring, BMI calculation, and neck circumference measurement. Ultrasonographic assessment of tonsil volume was performed using a Toshiba Aplio 500 machine with a 13.6 MHz probe. Statistical analysis was conducted using IBM© SPSS© version 23, with significance set at p ≤ 0.05.
Results
The mean age of participants was calculated to be 25.72 ± 7.9 years, with 29 males and 25 females. Significant associations were found between tonsil volume and gender, neck circumference, BMI, and ESS scores. Females and individuals with larger neck circumferences or higher BMI had significantly larger tonsil volumes. Higher ESS scores correlated with increased tonsil volume, suggesting a link between daytime sleepiness and tonsil hypertrophy.
Conclusion
Ultrasonographic assessment showed significant links between tonsil volume and gender, neck circumference, BMI, and ESS scores, suggesting ultrasound and neck circumference measurements as effective tools for diagnosing enlarged tonsils. Further research with larger, diverse populations is needed
Association of Restless Legs Syndrome with Hypertension and its Complications: A Cross-Sectional Study: RLS, Hypertension, and Related Complications
No full textBackground: Hypertension-associated complications and comorbidities continue to be widespread, although hypertension management has improved. Given the wide variability in the global frequency of Restless Legs Syndrome (RLS) in hypertensive patients and lack of data specific to Pakistan, where ethnic, healthcare and awareness differences limit the applicability of international findings, this study aims to determine the frequency of RLS in hypertensive individuals within the Pakistani population.
Methodology: This cross-sectional study was carried out from April to July 2025 at Departments of Medicine, Cardiology and Nephrology at Chaudhary Muhammad Akram Teaching and Research Hospital Lahore Pakistan. Using non-probability convenience sampling, 406 hypertensive patients aged ≥18 years were included. Patients were excluded if they had hypertensive emergencies, seizures, ongoing stroke or myocardial infarction, iron deficiency anemia, malignancies, a history of leg surgery or amputation, alcohol use disorder, acute kidney injury, were on hemodialysis or were pregnant. RLS was diagnosed according to the National Institutes of Health (NIH) criteria. Hypertension was defined as having blood pressure readings greater than 140/90 mm Hg on two separate occasions 2 weeks apart, ambulatory measurements exceeding 140/90 mm Hg at least 15 days apart, a prior diagnosis or antihypertensive medication use. Demographic information was collected and each participant underwent clinical evaluation to assess blood pressure control, antihypertensive treatment, comorbid conditions and the presence of RLS.
Results: Among the 406 patients, RLS was present in 64 (15.8%) patients. Post-stratification chi-square analysis showed that CKD (p<0.001) and IHD (p=0.010) had statistically significant associations. In multivariate logistic regression analysis, CKD emerged as a significant independent predictor of RLS (p<0.001, OR=12.649, 95% CI: 3.150–49.362). No other variables including gender, age, employment, marital status, hypertension duration or control, treatment regime, hypertensive retinopathy, diabetes, hypothyroidism or family history of hypertension had statistical significance.
Conclusion: Not an uncommon finding, RLS was more common with presence of co-morbid conditions in hypertensive patients. Routine screening for RLS, especially in hypertensive patients with CKD, may help improve patient outcomes.
Keywords: Restless Legs Syndrome, Hypertension, Chronic Kidney Disease, Hypertensive Retinopathy, Pakistan.
To cite this article: Waris B, Butt NI, Khizar I, Waris U, Baber A, Javed U. Association of Restless Legs Syndrome with Hypertension and its Complications: A Cross-Sectional Study. Pakistan Journal of Rehabilitation. 2026; 15(1):26-30
Missed Routine Vaccination Leading to Measles Outbreak: A Single Center Study from King Abdullah Teaching Hospital, Mansehra, Pakistan
No full textBackground: In Pakistan, measles is experiencing a particularly dangerous resurgence, with cases rising steadily since 2021. This study was performed to assess the frequency of missed routine measles vaccination among children with measles during the recent outbreak reported at King Abdullah Teaching Hospital, Mansehra, Pakistan.
Methods: This analytical, cross-sectional study was conducted at King Abdullah Teaching Hospital, Mansehra, Pakistan, from January to June 2024, using non-probability consecutive sampling. Inclusion criteria were children aged 6 months to 10 years, with clinical features of measles, and accompanied by cough, coryza, or conjunctivitis. Vaccination status was classified as updated for children who received all age-appropriate measles vaccine doses, unvaccinated for those with no dose, and incomplete for those who received only the first dose or did not complete the full schedule. Analyses were performed in SPSS v26, with significance set at p<0.05, using appropriate comparative statistical tests.
Results: A total of 261 children were included, with a median age of 13.0 (8.0–24.0) months, while 150 (57.5%) were male. Measles-containing vaccine (MCV) status was updated in 70 (26.8%), unvaccinated in 135 (51.7%), and incomplete in 56 (21.5%) children. Urban residence was highest among updated cases (60.0%), while 77.0% unvaccinated children lived in rural areas (p<0.001). Hospital-acquired measles was observed only among unvaccinated children (8.1%). Facility unavailability (30.9%), and parental negligence (30.4%) were leading reasons for missed vaccination.
Conclusion: A high frequency of missed routine measles vaccination was observed among hospitalized children in Mansehra and demonstrated significant differences in clinical and demographic features by vaccination status
Predictors and Features of Interstitial Lung Disease in Patients with Rheumatoid Arthritis
No full textBackground: Rheumatoid arthritis is a rare autoimmune disorder. The study aimed to assess the predictors and features of interstitial lung disease in patients with rheumatoid arthritis.
Methods: A retrospective study was conducted in the Pulmonology Department of Ibn-e- Siena Hospital, Multan, from August 2024 to August 2025. 200 patients diagnosed with rheumatoid arthritis who underwent pulmonary high-resolution computed tomography scan were included in the study by non-probability consecutive sampling. Based on the results of lung CT, patients were categorized according to the presence or absence of ILD. Data analysis was done by SPSS version 23. ANOVA, t-test and rank sum test were performed to assess quantitative variables, which were compared by x2 test. Statistical significance was set at a probability value of less than 0.05.
Results: A total of 86 patients (43%) with RA had interstitial lung disease. The most frequent manifestation in patients with ILD was non-specific interstitial pneumonia pattern in 50 patients (58.2%). The biochemical parameters, including globulin (p=0.005), gamma glutamyl transpeptidase (p=0.031), erythrocyte sedimentation rate (p=0.004), lactate dehydrogenase (p<0.001), CRP (p=0.022) and rheumatoid factor positive (p=0.026) were significantly elevated in ILD positive patients. Multivariate analysis showed age (OR: 1.601, 95% CI: 1.21-2.11), smoking (OR: 2.122, 95% CI: 1.35-3.76), rheumatoid factor (OR:1.689, 95% CI: 1.03-2.78), RA onset duration (OR: 0.373) and lactate dehydrogenase levels (OR: 7.374, 95% CI: 3.24-16.75) as independent risk factors of RA-ILD.
Conclusion: The incidence of interstitial lung disease in rheumatoid arthritis patients was 43% with advanced age, smoking, duration of RA onset and positive rheumatoid factor as independent predictor of incidence of ILD. Given the significant association with elevated inflammatory markers and high mortality risk, early HRCT screening is essential for timely diagnosis and improved management
Comparison of Prevalence of Pre-Diabetes and Type-2 Diabetes Mellitus Between Athletes and Non-Athletes
No full textBackground: Sports and Exercise activities are exceedingly advantageous for the human body and extremely helpful in decreasing the risks of diseases. The purpose of this research was to know the prevalence of pre-diabetes and Type 2 diabetes mellitus among athletes and non-athletes.
Methods: This analytical cross-sectional research was conducted between April 2021 and November 2021 at the Department of Physiology, Bolan Medical College, Quetta. The 670 male participants were interviewed randomly primarily on demographics and complete medical history with 350 athletes and 320 non-athletes from the general population of the same approved and recruited athletes. HbA1c was used to define prediabetes and type 2 diabetes using the American Diabetes Association criteria for various signs and symptoms. The data analysis was conducted using SPSS version 21. The independent t-test was used to compare both groups and correlation analysis was used to determine the relationship (r) between HbA1c levels and BMI. A p-value <0.05 indicated statistical significance.
Results: In athletes, the prevalence of pre-diabetes was 11 (3.1%) and Type-2 diabetes mellitus (T2DM) was 21 (6%) compared to non-athlete control participants having pre-diabetes was 73 (22.8%) and T2DM was 61 (19.0%) (p=0.001).
Conclusions: Regular exercise decreases the prevalence of pre-diabetes and T2DM among the athletes compared to non-athlete participants. The results of the study indicated that there is a necessity to increase awareness of the importance of physical activity, support, and urge people to engage in physical activity and fight this rapidly increasing ‘diabetes epidemic’
Frequency of In-Hospital Mortality in Patients with Upper Gastrointestinal Bleeding (UGIB) Due to Liver Cirrhosis
No full textBackground: Upper Gastrointestinal haemorrhage is a common medical emergency, and a fatality in liver cirrhosis patients The most common complication of portal hypertension in liver cirrhosis patients is esophageal variceal bleeding. This clinical survey was conducted to determine the mortality rate of cirrhotic patients with UGI bleeding in-hospital. In addition to those clinical presentations of patients, pre- and post-endoscopic findings, re-bleeding, and other outcomes were also studied during hospitalization.
Methods: This cross-sectional study employed a non-probability consecutive sampling technique to collect data over six months. A total of 202 patients were included in the sample, with a 95% confidence level and a 5% margin of error. Data were collected from participants meeting through clinical examination, endoscopy, and laboratory tests. Samples were analyzed for relevant parameters such as hemoglobin levels and bleeding source. All data was documented into pre-designed proformas, then the collected data was used to analyze it using SPSS Statistics 30.0.0.
Results: The main cause of UGIB in cirrhotic patients was rupture of esophageal and gastric varices. However, 70% of bleeding in the variceal bleeding group was due to esophageal, and 9.5% was dedicated to gastric varices. Whereas the UGI bleeding from non-variceal patients was due to peptic ulcer it was around 20.5% of total UGIB cirrhotic patients.
Conclusion: The findings revealed that variceal bleeders have a significant chance of rebleeding, and those patients have higher mortality chances than non-variceal bleeders. The proper clinical presentation of patients, their treatment, and management, including endoscopy and its outcomes, are critical to formulating the important guidelines for liver cirrhosis and UGI haemorrhage patients.
A Systematic Review on Clinicopathological Evaluation of Neutrophil-Percentage-To-Albumin-Ratio (NPAR): An Emerging Biomarker for Hepato-Pathology and Hepato-Oncology
No full textBackground: The Neutrophil Percentage to Albumin Ratio (NPAR) proved to be an advanced combined pathological marker for assessing hepatopathology and hepatocellular carcinoma (HCC). The diagnostic value of NPAR remained unclear because research on its clinical applications and performance in contrast to typical biomarkers remains scarce. The goal of this evaluation was to methodically analyze and assess NPAR’s role as a biomarker in the examination of hepatopathology and hepatocellular carcinoma.
Methods: A systematic review in line with PRISMA guidelines used MEDLINE, Scopus, and Web of Science databases to access research articles published from January 2010 to January 2025. The research included original peer-reviewed studies and systematic reviews in the English language that examined the link between NPAR and liver diseases alongside HCC cases. Researchers excluded articles that were not peer-reviewed, along with abstracts and studies lacking complete or sufficient data etc. The researchers evaluated studies based on their research methods, NPAR threshold requirements, and diagnostic capabilities in actual clinical practice. Study bias risk was evaluated through analysis of the Evidence Project Risk of Bias Tool. The authors performed a qualitative data synthesis to provide a comparative understanding of NPAR’s therapeutic relevance.
Results: The initial search yielded 89 articles, which were screened based on inclusion criteria. After reviewing titles and abstracts, 30 articles met the inclusion criteria. Following full-text review, 12 studies were selected for final analysis. Participant samples ranged from 100 to 3000 individuals. Numerous studies in the review examined NPAR\u27s performance as both a diagnostic and prognostic indicator. NPAR proved to be a superior marker to standard biomarkers ALT, AST, and bilirubin for chronic liver disease and HCC diagnosis in most published studies. Clinical implementation of NPAR showed effective results in high-risk patient screening, disease progression tracking, and survival outcome estimation. Research combined NPAR measurements with other biomarkers to demonstrate how it could work with multiple diagnostic markers.
Discussion: The Neutrophil Percentage to Albumin Ratio (NPAR) has proven itself as a vital biomarker for managing liver diseases and hepatocellular carcinoma. The medical field needed sustained, large-scale assessments to establish NPAR\u27s worth as a diagnostic tool, prognostic indicator, and therapeutic target in hepatopathology and hepatocellular carcinoma.
Magnetic Resonance Imaging Findings in Delayed Milestones Associated with Additional Clinical Features in Pediatric Patients
No full textBackground: Rare, but the delay in the process of achieving milestones has a devastating effect,with a vast number of etiologies associated with it. This study aimed to identify the brain MRIfindings in patients showing additional clinical features with developmental delay and thedevelopment of a correlation between clinical findings and MRI findings.Methods: This cross-sectional study included 22 patients with developmental delay at LiaquatUniversity of Medical and Health Sciences, Hyderabad, from August 2022 to August 2024, usingnon-probability consecutive sampling. Clinical histories, examinations, and brain MRIs using a1.5 Tesla scanner were conducted. Data were analyzed in SPSS v26. Descriptive statistics, Chi-square or Fisher’s exact test were applied, and a p-value &lt;0.05 was considered statisticallysignificant for associations between clinical features and MRI findings.Results: The study included 22 patients, evenly distributed between genders (11 males and 11females). The majority, 10 (45.5%), were aged 2–5 years. The most common clinicalmanifestations were epilepsy (14, 63.6%, p = 0.01), gait disturbance (13, 59.1%, p = 0.03), grossdevelopmental delay (9, 40.9%, p = 0.04), visual and auditory disturbances (7, 31.8%, p = 0.02),motor disturbances (7, 31.8%, p = 0.05), neurological deficits (7, 31.8%, p = 0.04), and speechdeformities (6, 27.3%, p = 0.03). Some cases also had associated radiological abnormalities. A p-value &lt; 0.05 was considered statistically significant.Conclusion: Patients of delayed milestones that are exposing additional clinical features arelikely to have some kind of abnormalities on MRI scan despite of their etiological variables
Exploring Cardio-Physician\u27s Clinical Challenges and Outcomes in Managing Multimorbid Cardiac Patients by Cross-Sectional Analysis
No full textBackground: Cardiovascular multimorbidity creates complex patient management challenges that cardio-physicians must prosecute. The study aimed to evaluate cardio-physician viewpoints about clinical challenges and health outcomes from managing cardiac patients with multiple health conditions.
Methods: A cross-sectional observational study involving 40 cardio-physicians was conducted in a tertiary care hospital from February 2023 until May 2023. A validated questionnaire collected data regarding diagnostic dilemmas, therapeutic conflicts, coordination issues, outcome monitoring, and patient adherence in multimorbid environments. The researchers analyzed responses by using descriptive statistics and thematic analysis, and chi-square testing.
Results: A total of 86.8% of participants reported frequent diagnostic confusion because symptoms manifested similarly across various comorbid conditions. Medical patients face three primary difficulties and these include multiple medications (90%) alongside drug treatment restrictions (80%) and fragmented healthcare services (65%). Treatment outcomes suffered for more than half of the patients because their comorbidities led to care delays and changes. The majority of 85% of respondents said essential collaboration with nephrologists and endocrinologists together with geriatricians was required.
Conclusion: Multimorbid cardiac patients present multiple challenges to cardio-physician medical care providers. The treatment approach must address care separation while promoting specialized care interactions to build individual patient profiles because this strategy directly impacts patient health outcomes and quality of life