Pakistan Health Research Council

One among Pakistan's most ambitious transit projects is the Peshawar Bus Rapid Transit project, otherwise known as “Zu Peshawar” locally. Thus, through the provision of a long-awaited, health-based, and environmentally positive mass transit solution, it is expected to solve congestion-driven challenges to economic development posed for long by the city as well as particular population concerns for its burgeoning urban population. This transport route, developed as part of Khyber Pakhtunkhwa's reform program for its urban development, forms part of a broader socioeconomic sector program aimed at increasing accessibility and reducing commuting times and distances and linking remote residents to crucial urban centers of commercial and educational activity. Boasting 21st-century transport solutions such as intelligent transport systems, transit-exclusive roadways, and hybrid fuel technologies, such a project is expected to provide transport solutions for many millions of people.The paper reviews project management methodologies employed in planning, implementation, and operation during the rollout of BRT projects. Governance, procurement, institution building, capacity development, stakeholder management, financial management, and risk management practices are involved in this appraisal. Analysis of documentations, inspection outcomes, performance achievement, and financial analyses conducted in 2014 and 2015 have been incorporated in this paper. Analysis indicates there have been major success stories, including the introduction of environment-friendly vehicles, integration at large scales, and creation of an inter-modal transport authority, in addition to important managerial challenges encountered in the BRT.The major issues cited included corruption cases, contract irregularities, cost escalation and the lack of strong monitoring that made the process non-transparent and unaccountable. Financial sustainability a big challenge Still high (Even rising) revenue cost ratio, fat PSR and yet to be resolved vendor issues continue to trouble the long-term viability of Railways operationally as well as financially. Capacity weaknesses in relevant government agencies, inadequate inter-agency cooperation and politicization of project priorities further curbed the opportunity for effective governance. Issues technology related such as infrastructure upkeep, rolling stock replacement cycles and congestion spill in the feeder services continue to thwart deployment of quality of service methods and customer satisfaction.However the experiences of BRT system are also successful as a result of good things of projects. These include; the promotion of environmentally friendly modes of transportation, improved accessibility of services for women and other disadvantaged groups, automated ticketing and scheduling as well as pedestrian- centric infrastructure to support non-motorized modes. The paper closes with emphasizing the need to strategically plan transport policies on a large scale in these developing environments. These will include the accretion of good governance from independent regulatory scrutiny, strengthening institutional capacity, enacting transparent contract management systems and performance monitoring based on data as well as enhanced long-term financial sustainability to achieve less dependence upon subsidies. The BRT project in Peshawar can be a lesson and the construction of delivery infrastructure should synchronize with sustainable management structures that are resilient enough to not have any failure in service.

BACKGROUND: Maternal and newborn mortality and morbidity are major concerns in rural areas of KPK. One of the major causes of this is the lack of quality services. OBJECTIVE: The study aims to evaluate MNCH services in health care facilities within the newly merged districts of KPK and to compare those services across different Health Care Centers with the Minimum Initial Service Delivery Package METHODOLOGY: A cross-sectional study was conducted from June 2023 to December 2023. Primary health facilities were randomly selected, while secondary health facilities were chosen on a census basis. 10 facilities from each district will be selected, including Basic Health Units (BHUs), Rural Health Centers (RHCs), Tehsil Headquarters Hospitals (THQs), and District Headquarters Hospitals (DHQs). Data were collected using a pre-validated questionnaire developed by the World Health Organization, known as the SARA tool, which includes various variables for assessing service availability and readiness. RESULTS: The majority of hospitals, 85.7%, are situated in urban areas, while only 14.3% are located in rural regions. Alarmingly, 66% of these facilities provide poor health services, with just 33% categorized as average and a mere 1% deemed good. There is a distinct difference in mean health service scores based on facility type; however, there is no significant difference (P = 0.567) in health care services between rural and urban facilities. CONCLUSION:The present study showed that the health facilities in the merged districts are below the standards. Government should take measure to improve these facilities. KEYWORDS: Maternal, Neonatal, Services, Newly Merged Districts, Khyber Pakhtunkhwa.

Pakistan’s poultry industry,being one of the world’s major chicken producers, is facing economic losses due to a major pathogen Mycoplasma gallisepticum which is the leading cause of Chronic Respiratory Disease (CRD). This study aims to determine the seroprevalence of MG in commercial layer farms (Multan, Muzaffargarh, and DG Khan) in South Punjab, Pakistan. Approximately 400 serum samples were collected for experiment which revealed 47.9% seroprevalence. Multan exhibited a higher prevalence (50.47%) compared to Muzaffargarh (47.25%) and DG Khan (43.15%). The recorded age-wise seroprevalence of MG infection was higher (50.85%) in younger birds (45–65 weeks old) and lower (45.73%) in birds older than 65 weeks. For seroprevalence, enzyme-linked immunosorbent assay was employed using (IDEXX Mycoplasma gallisepticum antibody test kit). The findings indicated a significant seroprevalence of MG in South Punjab, predominantly in younger birds, which can be attributed to insufficient immunity and vertical transmission. Clinical observations were conjunctivitis, frothy nasal and ocular discharge, reduced egg production, while postmortem findings revealed air sacculitis, pericarditis, and ovarian abnormalities. In conclusion, the strategy for controlling MG seroprevalence should focus on ensuring strict biosecurity measures against contamination and transmission and implementing a controlled and comprehensive national surveillance program against MG infection in Pakistan.

Background: Diabetes mellitus is a major independent risk factor for cardiovascular disease and is associated with increased morbidity and mortality following acute ST-elevation myocardial infarction (STEMI). Despite the proven efficacy of thrombolytic therapy, diabetic patients often exhibit impaired reperfusion outcomes and greater complication rates due to underlying microvascular dysfunction and delayed myocardial recovery. Evaluating post-thrombolytic outcomes in diabetic versus non-diabetic patients provides valuable insight into disease-specific prognostic differences. Objective: To compare the efficacy of thrombolysis with streptokinase in diabetic and non-diabetic patients presenting with STEMI using electrocardiographic (ECG) parameters and to assess the incidence of short-term in-hospital complications within 24 hours post-thrombolysis. Methods: This prospective cohort study was conducted in the Department of Cardiology, Federal Government Polyclinic Hospital, Islamabad, from January to May 2025. A total of 115 patients diagnosed with STEMI were included, comprising 48 (41.7%) diabetics and 67 (58.3%) non-diabetics. All patients received streptokinase within 12 hours of symptom onset. ST-segment resolution was evaluated 90 minutes post-thrombolysis, categorized as >70%, 30–70%, or <30%. Clinical outcomes, including resolution of chest pain, arrhythmia, heart failure, cardiogenic shock, and need for rescue PCI, were observed for 24 hours. Statistical analysis was performed using SPSS version 23, with a p-value <0.05 considered significant. Results: Complete chest pain resolution occurred in 37.5% of diabetics and 56.2% of non-diabetics (p=0.023). ST-segment resolution >70% was observed in 31.3% of diabetics versus 46.3% of non-diabetics (p=0.093). Heart failure developed in 60.4% of diabetics and 31.3% of non-diabetics (p=0.006), while cardiogenic shock occurred in 22.9% and 4.4%, respectively. Arrhythmias were noted in 10.4% of diabetics and 5.9% of non-diabetics. One non-diabetic patient died within 24 hours post-thrombolysis. Conclusion: Diabetic patients demonstrated poorer immediate outcomes after thrombolysis, with reduced ST-segment and symptom resolution and a higher incidence of early complications. Diabetes adversely affects reperfusion efficacy and short-term prognosis, emphasizing the need for early recognition and individualized management in this high-risk group

e17003 Background: Genital organ neoplasms contribute to cancer deaths, with gender-based differences in incidence and outcomes. Despite treatment advances, mortality remains high, influenced by age, gender, healthcare access, and region. Using CDC WONDER data, this study analyzes mortality trends in adults 25 and older, providing insights for targeted health strategies. Methods: Using data from the CDC WONDER database, we calculated the crude and age-adjusted mortality rates (AAMRs) per 1,000,000 individuals (≥25 years) and used Joinpoint regression to determine annual and average annual percent change (AAPC) in the mortality trends. Results: Between 1999 and 2022, 1,817,018 deaths from genital organ neoplasms were reported in the US, with 1,043,269 in males and 773,749 in females. Overall AAMR declined from 261.9 to 182.7 in males and from 162.8 to 136.8 in females per 1,000,000. When comparing across racial groups, NH Black or African American males had the highest AAMR at 363.4, followed by NH White males (190.3), NH American Indians or Alaska Natives (165.9), Hispanics or Latinos (149.3) and NH Asians or Pacific Islanders (85.4). Similarly, NH Black or African American females had the highest AAMR at 194.9, followed by NH White females (145.4), NH American Indians or Alaska Natives (117), Hispanics or Latinos (116.2) and NH Asians or Pacific Islanders (91.6). Males with genital neoplasms had AAMR as follows: West (207.7), Midwest (203.6), South (196.5) and Northeast (189.7). In comparison, females with genital neoplasms had AAMR: Northeast (155.5), Midwest (151.4), South (142) and West (138.6). Age groups 65-85+ had the highest CMR in both sexes. The highest number of deaths occurred in the decedent's home, with males accounting for 370,868 and females 280,210 deaths. Conclusions: Mortality from genital organ neoplasms has decreased overall, with males showing higher AAMR than females. NH Black or African American individuals have the highest mortality rates across both genders. Regional disparities emphasize the need for region-specific healthcare strategies. Targeted interventions are crucial to improve outcomes and ensure equitable care access. Deaths and AAMRs per 1,000,000 for male vs female genital organ neoplasms among (1999-2022). Variable Males Females Deaths (n) AAMR (95% CI) Deaths (n) AAMR (95% CI) NH American Indians 3,683 165.9 (160.4 to 171.5) 3,300 115.2 (99 to 131.4) NH Asians 14,042 85.4 (84 to 86.9) 18,628 91.6 (90.3 to 93) NH Blacks 146,257 363.4 (361.5 to 365.3) 89,384 194.9 (193.6 to 196.2) NH White 729,358 190.3 (189.9 to 190.8) 538,911 145.4 (145 to 145.8) Hispanics 47,782 149.3 (148 to 150.7) 4,7,90 116.2 (115.1 to 117.3) Northeast 179,914 189.7 (188.8 to 190.6) 144,414 155.5 (154.7 to 156.3) Midwest 219,600 203.6 (202.7 to 204.4) 161,964 151.4 (150.6 to 152.1) South 335,566 196.5 (195.8 to 197.1) 248,760 142 (141.4 to 142.5) West 208,111 207.7 (206.8 to 208.6) 143,942 138.6 (137.9 to 139.3)

The traditional dichotomy between International Human Rights Law (IHRL) and International Humanitarian Law (IHL) is increasingly untenable in the context of modern armed conflicts, where civilian and military domains frequently intersect. This research addresses the core problem of legal fragmentation and uncertainty in applying these regimes simultaneously. The purpose of the study is to examine how and why the convergence of IHRL and IHL is occurring, assess its implications for legal accountability and human protection, and propose a recalibrated framework for their coexistence. Employing a doctrinal legal research design, this study analyzes key international jurisprudence, treaty provisions, and state practices. Case law from the International Court of Justice and European Court of Human Rights demonstrates that both legal frameworks can—and often must—apply concurrently. The findings reveal a growing judicial and scholarly consensus toward harmonized interpretation, particularly through the lex specialis principle. However, significant challenges remain regarding normative conflicts, jurisdictional ambiguity, and institutional fragmentation. The study concludes by advocating for doctrinal integration, unified interpretive standards, and enhanced institutional cooperation as essential to recalibrate legal boundaries and ensure comprehensive protection of human dignity in contemporary conflict scenarios. The evolving nature of armed conflict and the increasing entanglement of military operations with civilian life have necessitated a revaluation of the traditional boundaries between IHRL and IHL. While both legal regimes aim to protect human dignity, they historically functioned in distinct spheres: IHL governs armed conflict, while IHRL applies in times of peace. This article examines the growing convergence between the two frameworks, particularly in asymmetric and non-international conflicts. It analyzes the jurisprudence of international courts, state practices, and theoretical underpinnings to argue for a recalibrated legal approach that ensures both flexibility and accountability. The article concludes by offering proposals for integrated legal interpretation and enhanced institutional cooperation.

Structural safety, optimization of materials, and sustainable construction practice depend on the prediction of concrete compressive strength. Traditional methods of testing use the laboratory method, which is time‑consuming, expensive, and destructive. Recent progress in deep learning has made it possible to predict the compressive strength in an accurate, rapid, and non‑destructive way by modeling nonlinear complex relationships between the constituents of concrete, curing conditions, and mechanical performance. This review is a systematic review of the deep learning architectures that have been applied to predict the concrete compressive strength with state‑of‑the‑art, such as Convolutional Neural Networks (CNNs), Artiϐicial Neural Networks (ANNs), Deep Neural Networks (DNNs), Long Short‑Term Memory (LSTM) networks, Gated Recurrent Units (GRU), Transformer‑based models, and hybrid architectures (CNN‑LSTM, CNN‑GRU, and ensemble stacking). It has been shown in the literature that higher hybrid and ensemble models allow the high predictive performance to be achieved, with the value of R² often exceeding 0.95, with the best possible models having an R² of 0.99 when using controlled datasets. Both metaheuristic optimization algorithms (e.g., PSO, GA, ACO, TLBO) and Bayesian hyperparameter tuning would greatly increase the model generalization and robustness. Moreover, interpretable artificial intelligence tools, such as SHAP and sensitivity analysis, have enhanced interpretability, and cement content, curing age, and water‑cement ratio are confirmed to be the most significant predictors of strength. Applications have been spread over the spe‑ cialized materials like ultra‑high‑performance concrete (UHPC), geopolymer concrete, recycled aggregate concrete, self‑compacting concrete, and waste‑based sustainable concretes. However, the issues of data standardization, cross‑laboratory generalization, and model transparency persist in spite of impressive advances. The future research is to be directed at physics‑informed neural networks, the multi‑objective optimization that considers the metrics of environmental impact, real‑time edge deployment, and the standardized benchmark datasets. In general, methods using deep learning as its core technology can be discussed as a revolutionary development in intelligent concrete design and sustainable construction engineering

Thalassemia is an autosomal recessive genetic disorder characterized by impaired synthesis of hemoglobin due to mutations affecting the production of alpha (α) or beta (β) globin chains. This imbalance causes ineffective erythropoiesis, microcytic anemia, and hematological abnormalities. Objectives: To assess the prevalence and distribution of β-thalassemia carriers for implementing targeted screening and preventive strategies. Methods: This retrospective observational study analyzed 108 samples from patients who were suspected of a complete blood count parameter; which included Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, and total red blood cell count. After that analysis of the suspected patients’ blood for Hb A2 through Hb Electrophoresis for the screening of the thalassemia trait was carried out. The data were sourced from Shahida Islam Medical College Hospital, reflecting the carrier status of the participants. Results: The findings of the study are distributed between 62 male and 46 female and demonstrated the presence of β-thalassemia trait across various age groups (mean age 25) and found typically higher (52.8%) in the age of 21 to 30 years. Specifically, 68 out of the 108 patients tested positive for the β-thalassemia trait having raised Hb A2 level on the Hb electrophoresis. Conclusions: It was concluded that the β-thalassemia trait is widespread across diverse ethnic groups. It highlights the necessity for standardized blood testing protocols for β-thalassemia screening. Implementing comprehensive screening programs, coupled with enhanced public awareness and educational campaigns, is crucial to mitigate the incidence of thalassemia major. These measures are essential for populations to prevent the transmission of this genetic abnormality.

Dentine Hypersensitivity (DH), or sensitive teeth, was a dental pain caused by exposure of dentinal tubules. Understanding patients' experiences and perceptions was crucial for developing effective diagnostic and treatment plans. Objective: To investigate the patients' experiences, perceptions, and diagnostic techniques for DH. The research also addresses the therapy approaches to limit dentine hypersensitivity for the better quality of life in patients. Methods: A non-probability convenience sampling technique was used to conduct the study for three months, from April 2024 to June 2024, in the University of Lahore's dental hospital and private dental clinics in Lahore. A close-ended questionnaire consisting of 20 items was used for data collection. The relationship between DH, gender, and other variables was examined using a chi-square test; P-value < 0.05 was considered statistically significant. Results: The study with 1105 participants found a slightly higher representation of females (51%) than males (49%), with both genders reporting similar rates of tooth pain during food consumption. DH was most prevalent in the 41-60 age group (33.8%), with 74% experiencing pain with certain foods, 88% not receiving professional treatment, and 99% acknowledging DH's significant impact on their quality of life. Conclusions: This study highlighted the significant prevalence of DH among adults, substantially impacting their quality of life. The findings emphasize the need for increased awareness, better diagnostic strategies, and patient-centred treatments to manage this condition effectively.