Punjab Medical Center

Background: Hearing loss is a frequently underdiagnosed condition among children attending Madrasahs, with significant consequences for academic progress and psychosocial development. Conductive hearing loss predominates in such settings, often resulting from preventable factors such as trauma and ear infections, yet systematic data on prevalence and etiology remain scarce in low-resource contexts. Objective: To determine the types, degrees, and causes of hearing loss in male Madrasah students aged 5–16 years in Dera Ghazi Khan, Pakistan, and to identify clinically significant associations between etiological factors and severity of impairment. Methods: In this cross-sectional observational study, 100 male students were selected via purposive sampling from a Madrasah. Each participant underwent otoscopic examination and pure tone audiometry following standard protocols. Hearing loss was categorized by type and severity; etiological data were collected through clinical assessment and structured parent interviews. Statistical analyses included descriptive and inferential statistics, with odds ratios and confidence intervals used to assess associations between trauma and severity of loss. Results: Conductive hearing loss was present in 63% of students, with moderate loss identified in 35%. Trauma accounted for 34.3% of hearing loss cases and was strongly associated with moderate severity (OR: 2.98, 95% CI: 1.32–6.71, p=0.008). Otitis externa (25.4%) and otitis media (11.9%) were also prominent causes. No significant association was found between hearing loss prevalence and duration of Madrasah study. Conclusion: Conductive hearing loss is highly prevalent among Madrasah students, with trauma and preventable infections as leading contributors. Implementation of routine auditory screening, injury prevention, and health education in Madrasahs is warranted to mitigate the burden of hearing impairment.

Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, self-harming behaviors, and difficulties in interpersonal relationships. While Dialectical Behavior Therapy (DBT) is widely recognized as the most effective treatment for BPD, some individuals continue to struggle with severe mood disturbances and impulsive behaviors, necessitating additional therapeutic interventions. This study aimed to compare the outcomes of DBT alone versus DBT combined with second-generation antipsychotic medication (olanzapine) in the treatment of BPD. Methodology: A randomized controlled trial was conducted at Gulab Devi Hospital, Lahore, where 102 participants diagnosed with BPD, as per DSM-5 criteria, were recruited and assigned to one of two treatment groups. Group A received DBT alone, while Group B received DBT along with olanzapine (5-20 mg/day). Treatment effectiveness was assessed using standardized clinical scales, including the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HARS), and Barratt Impulsiveness Scale (BIS-11). Additionally, self-harm attempts and emergency unit visits were recorded over a 12-week period. Result: The results indicated that both groups showed significant symptom reduction; however, the DBT + Olanzapine group demonstrated greater improvements across all measured outcomes. Participants in the combination therapy group exhibited significantly lower post-treatment scores for depression, anxiety, and impulsivity compared to the DBT-alone group (p < 0.05). Moreover, there was a notable reduction in self-harm attempts and emergency visits in the DBT + Olanzapine group, suggesting enhanced emotional stabilization and crisis prevention. Conclusion: These findings support the potential benefits of combining DBT with pharmacological intervention in the management of BPD, particularly for individuals with severe emotional dysregulation and high-risk behaviors. However, given the side effect profile of olanzapine, individualized treatment plans should be considered. Further research with long-term follow-up is needed to assess the sustainability of treatment effects and medication adherence.

Women have responsibilities of home management and raising children, and in recent times, they have been engaged themselves professionally. Objectives: To compare insights into working and non-working women's mental and physical health. Methods: The study was conducted to perform a retrospective and comparative analysis of the sociodemographic status and health of working along with non-working women, as well as their kids. The study included both working and non-working mothers aged 25 to 45 who had their independent incomes. Their children were between 2 and 18 years old. The health factors being studied were bone density, body mass index, haemoglobin, calcium levels, and socioeconomic status (based on Kuppuswamy's scale). Data were analyzed by SPSS version 25.0. Results: The bone scan results of working and nonworking women differ significantly (p-value=0.033), indicating that working women had a little higher prevalence of osteopenia and hypocalcemia than nonworking women. However, the haemoglobin, body mass index, and socioeconomic status levels of both groups and their kids do not differ significantly. Conclusions: It was concluded that the comparison was made from the health outcomes of non-working and working women. Although some divergence and convergence were present, there is not much of a difference between health and sociodemographic characteristics.

Abstract: Background: Covid-19 was first identified in Wuhan China in December 2019, and rapidly spread world over. Vaccine was always thought as first line defence against viral infections, and Covid was no exception. Although developed through different technologies, Pakistan got its share of Sinopharm from China and vaccination started in February 2021, with priority for Healthcare workers. There were lot of myths and hesitancy related with the adverse effects and urgency in approving these vaccines. Addressing adverse effects in post vaccinated population hence, became an important matter. Objective: Aim of this study was to observe the adverse effects of this vaccine in Pakistani population, to assess safety and develop confidence in Healthcare Workers. Materials and Methods: A cross-sectional Observation study was carried out in vaccinated Healthcare Professional through Non-probability purposive sampling over a period of one month. A team collected data directly, as well as on the telephone call. A Google form was also generated and sent. Information was collected and analysed on IBM-SPSS 23.0 Result: Majority of the participants were less than 55 years with female dominance. Among co-morbidities, hypertension was most common, followed by diabetes. In local and systemic adverse effects, pain and fatigue were most common, followed by muscle weakness, fever and headache respectively. These effects were also more common after first injection. Conclusion: Results favor that people should be more careful after the first dose as more adverse effects were felt after that. This vaccine has a good safety profile as no major adverse effects were noticed. It was also considered safe for patients with co-morbidities.

Public health is an essential field that plays a crucial role in safeguarding the well-being of communities and populations. However, it is faced with numerous approaches and challenges that require continuous efforts and adaptations. One of the key approaches in public health is prevention, which involves promoting healthy behaviors and implementing interventions to reduce the occurrence of diseases. Through education campaigns, vaccination programs, and early detection initiatives, public health professionals strive to minimize the burden of illnesses and enhance the overall health status of individuals. This proactive approach not only saves lives but also reduces healthcare costs in the long run. Nevertheless, public health faces various challenges in its pursuit of improving community health. One of the prominent challenges is limited resources. Public health agencies often operate on tight budgets, making it difficult to implement comprehensive programs and interventions. Adequate funding is necessary to support research, surveillance systems, and the development of effective strategies. Without sufficient resources, public health efforts may be constrained, compromising their ability to respond to emerging health threats and address existing disparities. Additionally, public health must navigate complex socio-political landscapes and overcome resistance to change. Health policies and interventions may face opposition from vested interests, misinformation, or skepticism, hindering progress in implementing evidence-based practices. Public health professionals need to communicate effectively, engage stakeholders, and build trust within communities to overcome these challenges. Collaboration with policymakers, advocacy groups, and the public is crucial to garner support and create an environment conducive to positive health outcomes. In conclusion, approaches and challenges in public health go hand in hand. While prevention remains a fundamental approach, limited resources and societal barriers present significant hurdles. As we navigate the complexities of modern healthcare, it is imperative to invest in public health infrastructure, foster evidence-based decision-making, and promote partnerships to overcome these challenges. By doing so, we can ensure that public health continues to make strides in improving the well-being of individuals and communities, leading to healthier and happier societies overall.

Cognitive impairment (CI) is frequently a comorbid condition in heart failure (HF) patients, and is associated with increased cardiovascular events and death. Numerous factors contribute to CI in HF patients. Decreased cerebral blood flow, inflammation, and activation of neurohumoral factors are all thought to be factors that exacerbate CI. Hypoperfusion of the brain due to decreased systemic blood flow, cerebral venous congestion, and atherosclerosis are the main mechanism of CI in HF patients. Abnormal circadian BP rhythm is one of the other conditions associated with CI. The conditions in which BP does not decrease sufficiently or increases during the night are called non-dipper or riser BP patterns. Abnormal circadian BP rhythm worsens CI in HF patients through cerebral congestion during sleep and atherosclerosis due to pressure overload. Interventions for CI in HF patients include treatment for HF itself using cardiovascular drugs, and treatment for fluid retention, one of the causes of abnormal circadian rhythms. Proposed pathways of cognitive impairment in heart failure through abnormal circadian blood pressure rhythm.

Pakistan's healthcare system stands at a critical juncture, facing challenges that demand innovative solutions. Among these, the role of public-private partnerships (PPPs) emerges as a promising avenue to bridge gaps, enhance service delivery, and transform the healthcare landscape. The collaboration between public and private sectors has the potential to bring together diverse expertise, resources, and perspectives, ultimately leading to a more resilient and effective healthcare system. In a country where public healthcare resources often struggle to meet the demands of a growing population, PPPs offer a strategic approach. Private sector entities, with their operational efficiency and investment capabilities, can inject vitality into the system. The provision of healthcare services, infrastructure development, and technology implementation are areas where PPPs can make a substantial impact. This synergy allows the public sector to leverage the strengths of the private sector while ensuring equitable access to quality healthcare services for all citizens. However, successful PPPs in healthcare necessitate careful planning, transparent frameworks, and clear delineation of roles and responsibilities. Balancing financial viability with social responsibility remains a challenge. It is essential to strike a harmonious equilibrium where the interests of both sectors converge for the greater good. Moreover, effective governance and regulatory oversight are crucial to prevent any compromise on healthcare quality or ethics. As Pakistan strives to achieve its healthcare development goals, lessons from successful PPP models globally can offer valuable insights. These models emphasize collaboration built on trust, open communication, and a shared vision. By fostering an environment that encourages innovation and collaboration, Pakistan can harness the full potential of PPPs to create a healthcare system that is robust, inclusive, and responsive to the needs of its citizens. In conclusion, the role of public-private partnerships in strengthening Pakistan's healthcare system is undeniable. By pooling resources, knowledge, and expertise, both sectors can collectively address the challenges that have long impeded the nation's healthcare progress. A well-structured and ethically sound approach to PPPs can pave the way for a future where quality healthcare services are accessible to all, setting Pakistan on a transformative path toward healthier communities and improved well-being.

Schizophrenia (SCZ) is a chronic mental disorder with a lifetime risk of approximately 1%. It is characterized by a profound disruption in cognition, behavior, and sensation with heritability estimated at up to 80%. It is a disorder with a complex etiology that involves multiple and heterogeneous genetic factors. The polygenic model of genetic susceptibility of psychiatric diseases explains that genetic variants of multiple genes determine the overall risk of disease because of their multiplicative effect. Two subunits of voltage-gated calcium channels, cacna1c and cacnb2 genes, play important roles in balancing calcium in brain cells, and their single-nucleotide polymorphisms (SNPs) have been associated differently with schizophrenia risk in different ethnicities. Two SNPs (rs1006737 & 4765913) of the cacna1c gene and a SNP (rs12257556) of the cacnb2 gene have been associated with schizophrenia. In this study, confirmed diagnosed schizophrenia patients and age-matched healthy control subjects were analyzed for the association of SNPs (rs1006737, 4765913 & rs12257556) with schizophrenia risk in Pakistani patients. Both SNPs of the cacna1c gene (rs1006737 and rs4765913) showed significant association with schizophrenia risk in this population. Moreover, two haplotypes (AT and GA) out of four for SNPs (rs1006737, rs4765913) of cacna1c further verified their significant association with the risk of schizophrenia. For cacnb2 , no significant association with the risk of schizophrenia in the SNP (rs12257556) was observed. The results of this study offer compelling evidence of a strong link between cacna1c polymorphisms (individual variant & haplotypes) and schizophrenia risk in the Pakistani population. Keywords: single-nucleotide polymorphisms, rs1006737, rs4765913, rs12257556. https://doi.org/10.55463/issn.1674-2974.50.12.10

Background: Schizophrenia is a psychiatric disorder that incapacitates & overpowers the way a person conceives, perceives, conjectures and executes his internal thoughts and reciprocates with the external world. It can also be defined as a persistent deficit in cognition with the negative and positive symptoms, which typically starts in young age. Schizophrenia is characterized by social and functional disabilities not only of the affected patient, but also for the society and the family. Therefore, the current research focused on the impact and burden on quality of life of the primary caregivers of schizophrenic patients. Aims & Objective: To determine the quality of life, predictors of QOL and caregiver burden among primary caretakers of patients having schizophrenia. Methods: The cross-sectional research design was used in the present study and was conducted in Lahore General Hospital from January 2022 to June 2022. Using purposive sampling technique, 150 patients who attended the Psychiatry outpatient department of the hospital were recruited for this study. Results: It shows that out of total 150 people, 98 (65.3%) males and 52 (34.7%) females were present in this study. Mostly parents 101(67.4%) were primary caregivers in the present population along with spouses 13(8.7%) and 26(17.4%) were real brothers/sisters. The frequency and percentage of son/daughter 3(2.2%) and 7 (4.3%) caregivers were with other relationships. Most of the caregivers 121(80.4%) were married, and 13(8.7%) were single. It also shows that the mean age of the male patients was 43.50 (14.73) years and mean age of the female was 48.91 (16.50). Family Burden Schedule interview identifies that financial burden has highest mean and effect on physical health of others has lowest mean. In WHOQOL-BREF physical, psychological and social health subscales has highest mean than environmental one. And that significant inverse relationship of financial burden has been found with social relationships, physical health and environment of caregivers. As financial burden increases environmental conditions, physical health and social relationships of caretakers decreases. Conclusion: Caregiver burden is found to be negatively linked to QOL of the caregivers of individuals having schizophrenia. Moreover, caregiver burden is found to be a significant negative predictor of QOL of individuals taking care of people having schizophrenia. Keywords: Schizophrenia, Quality of Life, Caregivers, Patient Welfare, Burden of Life

Iron is a vital micronutrient that is mandatory for fundamental processes in both humans and bacteria. Iron is an essential trace element which promotes cell proliferation and growth. It also has the potential to initiate redox cycling and free radical synthesis. Hence, it is engaged in initiating tumorigenesis, its microenvironment and metastasis. Acquisition of iron, efflux, storage and regulation pathways are disturbed in carcinogenesis which suggests a reprogramming role of iron metabolism in tumor cell survival. Targeting iron metabolic pathways may give a new insight for prognosis and therapy [1].
 Globally many people suffer from iron overload toxicity diseases e.g. trans fusional iron overload in thalassemia and hereditary haemochromatosis. Accumulated toxic iron deposits can cause tissue damage and identified in neurological disorders as well such as Alzheimer’s and Parkinson’s [2]. Regulation of iron is an essential defense mechanism against microbial infections. Individuals with toxic iron overload are more prone to bacterial infections as it is up taken by bacteria for their growth and survival [3]. These bacteria release iron binding molecules and then resorb them to recover iron deficiency. They also get rid of extra iron from transportation and hemoglobin. Microbes face more metabolic pressure when they have to strive hard to acquire it. Hence, the microbes with iron deficiency have a slower rate of reproduction as compared to others [5]. A small amount of iron is lost by sweating and shedding of cell from skin as well as mucosal lining of the digestive tract. However, most of it is restored and recycled by the reticuloendothelial system, which also breaks down the red blood cells [6].
 Iron homeostasis is perturbed in inflammation and sepsis, causing raised iron transportation, influx into cells and reduction in iron efflux. Iron may be used as a predictive and diagnostic marker to evaluate the severity of diseases related to iron metabolism, sepsis and inflammation. Further studies are required to explore the drugs targeting specifically to iron metabolic pathways and providing an optimal therapeutic opportunity [7].