Pakistan Journal of Medical Research

Frequency of Tetanus Toxoid Vaccine and Associated Factors among Pregnant Women in District Shaheed Benazirabad

Fri, 17 Jul 2026 00:00:00 +0500

Background: Maternal and Neonatal Tetanus (MNT) is an acute and possibly fatal illness affects women during pregnancy or within six weeks of postpartum.

Objective: To assess the frequency of Tetanus Toxoid (TT) vaccination among pregnant women and to identify the factors associated with TT vaccination during pregnancy.

Methods: This cross-sectional study was conducted in Department of Gynecology and Obstetrics in collaboration with Department of Community Medicine, Peoples Medical College Hospital (PMCH), Nawabshah from March to August 2023. A total of 192 pregnant women aged 15 to 49 years were included. Data were collected on a pre-designed Proforma. The data entry and analysis were performed by SPSS software version 25. A chi-square test was used to identify associated factors contributing to the vaccination of TT, data was compared using appropriate stats and a p-value of <0.05 was considered significant.

Results Around 41% of pregnant women received the recommended doses of TT. Only 32% of all illiterate participants were fully vaccinated while this factor surged to 80% in participants who received university education. Considering the major cause of not having vaccination, about 80% participants had lack of awareness regarding vaccination.

Conclusion: The present study demonstrated inadequate coverage of TT vaccination among women. Several factors were significantly associated with TT vaccination, including place of residence, women’s educational status, knowledge regarding TT doses during pregnancy and across the lifetime, employment status of women, husband’s income, travel time to the health facility, husband’s consent, and availability of a TT vaccination card.

Menstrual Hygiene Management of Lower Socio Economic Status Females

Afshan Sultana Zia, Zahida Parveen Brohi, Ambreen Mughal, Anila Mahmood — Fri, 17 Jul 2026 00:00:00 +0500

Background: Hygiene is essential for safeguarding personal health against infectious agents. Around one-fourth of all females of reproductive age (between the ages of 12 to 50), are thought to lack the resources necessary to control their menstrual cycles. Girls in Low- and Middle-Income Countries (LMICs) experience critical challenges maintaining proper menstrual hygiene.

Objective: To assess menstrual hygiene management among low household income females in rural areas around Hyderabad Sindh.

Methods: This cross-sectional study was conducted in rural areas of Hyderabad region from July to December 2022. Participants included premenopausal females aged 15 years and older. After taking informed consent and ascent data were collected on pre-designed questionnaire. Data were stored and analyzed using IBM-SPSS version 23.0; Pearson Chi-Square test was used to evaluate the association of menstrual hygiene with the age group of low socioeconomic class, with p-values less than 0.05 considered statistically significant.

Results Of the 129 low-socioeconomic-status women included in this study, 59.7% were between 15 and 25 years of age. Among the women surveyed, 78.3% used cloth pieces as an absorbent material, and 59.5% changed their absorbent only once per day. Regarding sanitation and hygiene, 27.9% disposed of materials in a dustbin, 98.4% used water alone for washing, and 63.6% bathed only once during their menstrual cycle. Additionally, 88.4% washed and sun-dried their undergarments. While 68.2% experienced complications during menstruation, only 15.5% possessed basic awareness of menstrual hygiene and a mere 0.8% had received formal hygiene information.

Conclusion: Menstrual hygiene management found to be poor among ..........

Reliability, Validity and Factor Structure of Fenigstein Paranoia Scale Urdu Version

Farhan Kamrani — Fri, 17 Jul 2026 00:00:00 +0500

Background: Paranoia, the mistrust of others’ motives, is a common sign of many psychological disorders. The Fenigstein Paranoia Scale Urdu (FPSU) is widely used for identifying paranoia in both clinical and non-clinical populations Its Urdu version is widely used and cited in the context of paranoia research in Pakistan. Although it is widely used, no studies have evaluated the factor structure of the scale, which could further validate it.

Objective: The objective of this study is to evaluate the reliability, validity, and factor structure of the Urdu version of the FPSU for clinical and research purposes in Pakistan.

Methods: This psychometric study was conducted at the University of Karachi, Karahi Pakistan, in June 2024. Validity was established by inter item correlation and factor analysis and the reliability was assessed by Cronbach's alpha, Spearman Brown coefficient and split half. The correlation between two halves was adequate (r =0.69). Validity was calculated through inter item correlation and factor analysis. Principal component analysis revealed five factors, which correspond to the aspects of paranoia identified in the original scale development study. Factor B accounted for 24.68% of the variance and was therefore the dominant factor of paranoia measured by the FPSU. The scale was found to be theoretically consistent and valid.

Results The research was conducted on a purposive sample of 600 participants (317 males, 283 females). The sample’s mean age was 24.73 years (SD =8.30). The Cronbach's alpha value was .83, indicating a good degree of internal consistency.................

Estimation of Cardiac Troponin I and T in Patients with Clinically Stable Chronic Kidney Disease

Fri, 17 Jul 2026 00:00:00 +0500

Background: Patients with chronic kidney disease (CKD) have an increased prevalence of cardiovascular disease with declining renal function. However, the concentration of cardiac troponins is increased among CKD patients in the absence of clinical evidence of acute myocardial infarction. In this study cardiac troponin I and cardiac troponin T concentrations were studied in patients with CKD.

Objective: To determine cardiac troponin I and T levels in patients with clinically stable chronic kidney disease presenting to a tertiary care hospital in Rahim Yar Khan.

Methods: This cross-sectional study was conducted in the Department of Chemical Pathology, Sheikh Zayed Hospital, Rahim Yar Khan from January to September 2024. A total of 222 individuals with CKD without any known cardiac diseases were included. Serum cTnI and cTnT were measured on chemiluminescence immunoassay analyzer. Mann-Whitney U test and Kruskal-Wallis H test followed by post-hoc analysis were used for the analysis of significance. Spearman rank was used to evaluate correlation of eGFR with cTnT and cTnI.

Results A total of 222 patients, 142 males (64%) and 80 females (36%), with CKD were included. There was a statistically significant difference between stages of CKD and cTnT levels, p value <0.001 but not between stages of CKD and cTnI levels, p value =0.114. The eGFR showed a negative correlation to cTnT (r = -0.456) but had a negligible negative correlation (r =-0.140) with cTnI.

Conclusion: The level of cTnT increases across CKD stages however the concentration of cTnI appears to be stable.

Prevalence and Clinical Features of Pulmonary Hypertension: A Retrospective Study at Tertiary Care Hospital in Mardan

Fri, 17 Jul 2026 00:00:00 +0500

Background: Pulmonary hypertension (PH) is a progressive disorder and the condition is often undiagnosed until advanced stages, moreover limited local data available regarding etiology of disease.

Objective: To assess the prevalence and clinical features of PH and to evaluate its demographic characteristics, clinical features and associated comorbidities among patients presenting in Mardan Medical Complex.

Methods: This retrospective study was conducted at Department of Medicine, Mardan Medical Complex, Mardan from January 2022 to January 2023. A total of 185 patients were evaluated in this study, with 2 groups as transthoracic echocardiography (TTE) suggested PH and non-PH. Diagnosis of PH was based on echocardiographic findings only as limited access to Right Heart Catheterization (RHC) which is gold standard for PH diagnosis. Relevant ICD 10 coding, ICD 127.0 for primary PH and ICD 127.2 for secondary PH was used to categorrised COPD, ILD, LHD.

Results A total of 40 patients were identified as having pulmonary hypertension (PH), the prevalence was 21.6% and 145 were non PH. The largest percentage of people studied had reached 45-59 years old (51.4%). Most PH patients were women (55.0% versus 45.0% men). The most commonly reported clinical manifestation among PH patients was dyspnea reported by 78.9% of patients, followed by fatigue 64.3% and chest pain 41.6%. COPD was significantly associated with PH compared to the non PH group (p-value <0.05).

Conclusion: Approximately one-fifth of study’s population had PH, with COPD and advancing age as key risk factors. Similarly TTE-based screening provides valuable insights.

Distribution of Medical Illnesses among Pakistani Hajj Pilgrims: Experience of the Pakistan Hajj Medical Mission during Hajj 2024

Jamil Ahmed Lakhiar, Tahira Assad, Quratulain Mehdi, Hafiza Tuseef Sayyar — Fri, 17 Jul 2026 00:00:00 +0500

Background: Hajj pilgrimage, which takes place in Makkah, Kingdom of Saudi Arabia, is the largest mass gathering of Muslims. The diverse crowd with varying demographic profiles, immunity levels and disease exposure, creates an environment that facilitates the transmission of infectious diseases.

Objective: To observe the frequency, patterns and gender distribution of medical illnesses among Pakistani Hajj Pilgrims attending the medical facilities of the Pakistan Hajj Medical Mission during Hajj 2024.

Methods: This retrospective study was conducted at Pakistan Hajj Medical Mission (PHMM) hospitals /dispensaries in Makkah (Mission hospitals) and Medina from May to July 2024. All Pakistani Hajj pilgrims attending PHMM hospitals outpatients were included in study. Data collected using a specially designed proforma was analyzed.

Results A total of 168,884 patients received medical consultations at outpatient departments of these hospitals during the Hajj pilgrimage, with a male to female ratio of 60:40. A total of 81 deaths occurred during the 10-week Hajj pilgrimage period. Respiratory tract infections and musculoskeletal disorders were the most common illnesses (18%), with predominance among males. Primary causes of death were cardiorespiratory arrest secondary to complications of chronic diseases, road traffic accidents, and heat stroke. Old age, overexertion, and irregular use of medications further contributed to mortality.

Conclusion: During Hajj 2024, the PHMM observed a predominance of male patients with respiratory tract infections and musculoskeletal disorders being the most common ailments. Mortality also remained almost double among males as compared to females.

Uropathogens in Catheterized ICU Patients: Frequency, Pattern and Antimicrobial Susceptibility

Fri, 17 Jul 2026 00:00:00 +0500

Background: Catheter-associated urinary tract infections (CAUTIs) are among the leading healthcare-associated infections in intensive care units (ICUs), contributing to prolonged hospitalization, antimicrobial resistance, and increased mortality. Locally relevant data from Pakistani ICUs on uropathogen profiles and resistance patterns are limited.

Objective: To determine the frequency, microbiological profile, and antimicrobial susceptibility of uropathogens causing CAUTI in catheterized ICU patients at a tertiary care hospital in Lahore, Pakistan.

Methods: A cross-sectional study was conducted from December 2024 to April 2025 in the Medical ICU of Mayo Hospital, Lahore. Urine samples from 70 eligible patients were cultured on CLED, Blood, and MacConkey agars, followed by Gram staining and biochemical identification. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method according to CLSI 2024 guidelines. Phenotypic extended-spectrum beta-lactamase (ESBL) and carbapenemase detection were performed. Data were analysed using SPSS version 26.0.

Results: Eighteen of 70 patients (25.7%) had culture-confirmed CAUTI. Predominant isolates were Candida albicans (33.3%), Klebsiella pneumoniae (27.8%), Escherichia coli (16.7%), Acinetobacter spp. (16.7%), and Staphylococcus aureus (5.5%). ESBL was confirmed in 60% K. pneumoniae and 66.7% E. coli isolates. All three Acinetobacter isolates were carbapenem-resistant. Prolonged catheterization was significantly associated with CAUTI (p =0.003), while female sex and diabetes mellitus also showed notable associations.

Conclusion: The CAUTI affected approximately one in four catheterized ICU patients and was predominantly caused by multidrug-resistant organisms, including ESBL-producing Klebsiella pneumoniae and Escherichia coli and carbapenem-resistant Acinetobacter species, together with a notable proportion of Candida albicans.

Diagnostic Accuracy of Cell Block versus Conventional Cytological Smear in Malignant Pleural Effusion: A Comparative Study

Fri, 17 Jul 2026 00:00:00 +0500

Background: Malignant pleural effusion (MPE) is a common oncological complication that requires accurate diagnosis to guide appropriate management. Cytological smears are widely used; however, they have variable sensitivity. The cell block technique has emerged as a potentially superior diagnostic tool due to its better preservation of cellular architecture and compatibility with ancillary testing.

Objective: This study aims to compare the diagnostic utility of the cell block technique with the conventional cytological smear in detecting MPE, using histopathology as the gold standard.

Methods: This cross-sectional study was conducted at the Institute of Tuberculosis and Chest Medicine, Mayo Hospital, Lahore. One hundred and thirty-eight patients, aged 18 to 75 years, with probable malignant pleural effusion were enrolled. Pleural fluid specimens were subjected to both conventional cytology and cell block analysis. All patients subsequently received a pleural biopsy for histological validation. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated using SPSS version 27.0.

Results Cytology demonstrated a sensitivity of 65.82%, specificity of 86.44%, PPV of 86.67%, NPV of 65.38%, and overall diagnostic accuracy of 74.64%. The cell block technique demonstrated a significantly higher sensitivity (89.87%), specificity (94.92%), PPV (95.95%), NPV (87.50%), and overall diagnostic accuracy (92.03%) (p =0.002).

Conclusion: The cell block technique is more effective than conventional cytological smears in diagnosing malignant pleural effusion, offering higher sensitivity, specificity, and diagnostic accuracy.

Global Health Emergency Workforce: Bridging the Health Security Gap and Implications for Pakistan

Muhammad Kashif Munir — Fri, 17 Jul 2026 00:00:00 +0500

he frequency and complexity of public health emergencies have increased dramatically over the past two decades. The Coronavirus Disease 2019 (COVID-19) pandemic, recurring outbreaks of emerging infectious diseases, climate-related disasters, humanitarian crises, and antimicrobial resistance have demonstrated that resilient health systems depend not only on infrastructure and technology but, more importantly, on a competent and rapidly deployable health workforce. In response to escalating health emergencies, the World Health Organization (WHO) has urged Asia-Pacific countries to strengthen emergency workforce capacity through sustained investment, multisectoral collaboration, and preparedness planning.¹ This is particularly important for low- and middle-income countries where emergencies can quickly overwhelm health systems. Health crises increasingly occur alongside floods, heatwaves, earthquakes, displacement, and environmental challenges. WHO reports that many hazards are interconnected, creating cascading effects that intensify health risks and disrupt services. These complex emergencies require a workforce skilled not only in clinical care but also in emergency management, surveillance, logistics, risk communication, and coordination, making reliance on routine healthcare personnel alone insufficient. The COVID-19 pandemic exposed major weaknesses in global emergency workforce preparedness. Many countries struggled; even nations with advanced healthcare systems experienced burnout, workforce attrition, and disrupted essential services.² These lessons underscore that emergency preparedness should not begin during a crisis; it must be embedded within routine health system strengthening.³

The concept of a health emergency workforce extends beyond physicians and nurses. It encompasses epidemiologists, laboratory scientists, emergency medical technicians, public health professionals, logisticians, environmental health specialists, mental health experts, risk communication officers, veterinarians, and community health workers. Each plays a critical role during emergencies, and effective response depends on their ability to function as an integrated multidisciplinary team. Investments in training, competency-based education, simulation exercises, and continuous professional development are therefore essential components of national preparedness strategies.

Strengthening the emergency workforce has become an urgent public health priority for countries like Pakistan. The country faces multiple recurring hazards, ranging from climate disasters like floods, earthquakes, and heatwaves, to persistent health threats such as dengue, tuberculosis, polio, antimicrobial resistance, and emerging zoonotic diseases. Climate change further increases vulnerability by expanding the range of vector-borne diseases and intensifying extreme weather events.⁴ These challenges frequently occur simultaneously, placing immense pressure on healthcare services. Building a resilient emergency workforce capable of rapid mobilization and coordinated response should therefore become a national strategic objective rather than an emergency response afterthought.

Pakistan has demonstrated considerable emergency response capacity through the efforts of institutions such as the National Disaster Management Authority, Provincial Disaster Management Authorities, Rescue 1122, the armed forces, and numerous national and international humanitarian organizations. Their contributions during major disasters, including floods, earthquakes, and disease outbreaks, have been instrumental in saving lives and restoring essential services. However, the increasing frequency, scale, and complexity of emergencies have stretched these response systems across multiple regions simultaneously.

Preparedness also requires institutional reforms. International collaboration and regional partnerships further enhance surge capacity by facilitating technical assistance, shared expertise, and coordinated responses during transboundary crises.⁵ Digital surveillance platforms, telemedicine, electronic health records, artificial intelligence-assisted decision support, and mobile communication systems can substantially improve situational awareness and response coordination. However, technological innovation cannot substitute for a well-trained workforce. Investments in digital infrastructure must therefore be accompanied by capacity building.⁶

An equally important but frequently neglected dimension is workforce well-being. Health emergencies place extraordinary physical and psychological demands on healthcare workers. Protecting the emergency workforce requires ensuring occupational safety, adequate personal protective equipment, mental health support, fair compensation, and supportive working environments. A resilient health system cannot exist without a resilient workforce.⁷

The WHO's recent regional initiative aligns closely with the broader Health Emergency Preparedness, Response and Resilience (HEPR) Framework, which advocates integrated preparedness rather than disease-specific responses.⁸ This approach recognizes that investments made in emergency workforce development strengthen routine health services while simultaneously improving readiness for future crises. Ministries of health, finance, education, disaster management, and local governments must collaborate to establish sustainable financing mechanisms, expand workforce training programs, and develop policies that retain skilled professionals within national health systems.⁹

The WHO's call to strengthen emergency workforce capacities should serve as a catalyst for immediate action rather than another policy recommendation awaiting implementation. Future pandemics, climate-related disasters, and emerging infectious threats are inevitable. Whether countries can mitigate their impact will depend largely on the preparedness, competence, and resilience of the people standing on the front lines. Investing in emergency workforce capacity today is not merely preparation for future crises-it is an investment in health security, national resilience, and the protection of future generations.

Emergence of Zika Virus in Pakistan: Implications on Public Health and Vector Control

Alishba Fatima, Muhammad Hasnain Azeem, Talal Arshad — Fri, 17 Jul 2026 00:00:00 +0500

Zika virus (ZIKV) of the Flavivirus genus was initially reported in 1947 in Uganda's Zika Forest. It has since become a major global health issue. The virus is mainly spread by Aedes spp. mosquitoes, but it also passes through maternal–fetal (vertical) transmission, sexual transmission, and blood transfusions. Symptomatic ZIKV disease has clinical overlaps with dengue and chikungunya, such as low-grade fever, arthralgia, retro-orbital headache, conjunctivitis, rash, and headache. In the majority of cases, ZIKV produces mild, self-limited illness; however, in certain patients it can produce severe complications like Guillain-Barré syndrome (GBS).¹

In pregnant women, ZIKV is linked with congenital Zika syndrome (CZS), which results in severe birth defects like intracranial calcifications, ventriculomegaly, hydrocephalus, and neurodevelopmental impairment. Research indicates that as many as 90% of infected children have long-term cognitive and learning difficulties.² In 2023, the ZBC-Consortium indicated that babies born to mothers who were infected during pregnancy had a higher likelihood of being small for their gestational age, with about 1.5% having microcephaly at birth, but others had it later in infancy. Such observations highlight the importance of long-term developmental follow-up of infected children.³

Although ZIKV has mainly caused outbreaks in tropical and subtropical regions, its circulation in South Asia remains poorly understood. Climate change has expanded Aedes mosquito vectors into previously low-risk regions, including parts of Asia, Africa, Europe, and the Americas.⁴ Until recently, Pakistan had no confirmed clinical cases of ZIKV.⁵ However, detection of ZIKV in Karachi by Aga Khan University marked the first evidence of its circulation in the country, highlighting the urgent need for surveillance and epidemiological research because of its association with congenital abnormalities and neurological complications.⁶

Pakistan has experienced recurrent dengue outbreaks for over a decade, while chikungunya has also been reported in Karachi. The co-circulation of DENV, CHIKV, and ZIKV complicates clinical diagnosis because they share the same Aedes aegypti vector, similar symptoms, and overlapping geographic distribution.⁷ Improved clinician awareness and laboratory capacity are therefore essential to distinguish these infections and prevent underreporting. As no licensed ZIKV vaccine is available, prevention relies on integrated vector control, including elimination of mosquito breeding sites, insecticide use, and public education, particularly for pregnant women and high-risk populations.⁸ Personal protection through insect repellents, protective clothing, window screens, and safe sexual practices should also be encouraged. Enhanced surveillance and antenatal counseling remain critical because of the risk of congenital Zika syndrome.

Management of ZIKV infection is supportive, including rest, hydration, and analgesics. Aspirin and other NSAIDs should be avoided until dengue has been excluded because of the risk of hemorrhage.⁸ Experimental therapies such as quercetin hydrate have shown antiviral activity against ZIKV in laboratory studies but require further evaluation.⁹ The World Health Organization recommends laboratory confirmation of suspected ZIKV cases to differentiate them from other flaviviral infections, particularly dengue.¹⁰ Strengthening diagnostic capacity and surveillance is therefore essential in Pakistan.

In conclusion, the detection of ZIKV in Karachi represents an important public health concern. With dengue and chikungunya already endemic, coordinated efforts focusing on vector control, surveillance, laboratory diagnosis, public awareness, and maternal health are needed to prevent future outbreaks and reduce adverse pregnancy outcomes.