Pakistan BioMedical Journal

Habit Reversal Training and Relaxation Training for the Treatment of Adult-Onset Trichotillomania due to Premature Greying

Sara Aleem Haqqi — 2025-06-30

This case study demonstrates the use of Habit Reversal Training (HRT) combined with Relaxation Training (RT) in addressing trichotillomania. The subject, a 28-year-old woman, reported experiencing stress and frequent lateness to work. Her hair-pulling behavior, triggered by the early appearance of grey hair, led her to spend 30 to 60 minutes each morning pulling her hair, which contributed to her tardiness. Over the course of 14 weekly therapy sessions, interventions included self-monitoring, psychoeducation, identification and modification of visual triggers, stimulus-response strategies, and restructuring daily routines. The treatment resulted in reduced stress and effective control of hair-pulling behaviors. The case suggests that incorporating a hair care regimen into therapy may further enhance positive outcomes. It also highlights the importance of considering both psychological and societal influences in the development and treatment of trichotillomania.

Association Analysis of CYP2A6 Gene Variant (rs1801272A>T) with Nicotine Metabolism and Smoking Tendency among Pakistani Youth

Iqra Yasmin — 2025-06-30

Cytochrome P450 2A6 (CYP2A6) is a key enzyme in nicotine metabolism, with its genetic variants playing a role in smoking behavior. Particularly, g.40848628A>T is significantly associated with nicotine metabolism and smoking tendency in different populations. Objectives: To examine the genetic diversity of this locus and association analysis within smokers and non-smokers cohorts among Pakistani youth. Methods: The allele-specific ARMS PCR genotyping technique was applied to examine a total of 100 samples as a case-control study of n=50 from each cohort. Results: From the sampled individuals, 92% were found to be homozygous wild-type (AA), 7% were heterozygous (AT), and 1% were homozygous mutant (TT). PLINK software was used for the Chi-square test yielded, χ² (1, n=100) =2.91, p=0.088, suggesting a non-significant trend towards association, where alternative allele frequencies were calculated as 0.07 and 0.02 in cases and control cohorts, respectively. Similarly, Hardy-Weinberg Equilibrium (HWE) p=0.1714 indicates genotype frequencies did not significantly deviate from HW expectations and no error or selection in the overall samples. The carriers of the alternative allele have 3.688 times higher odds of being affected by the condition compared to non-carriers with the reference allele. Conclusions: It was concluded that future studies with a larger sample size may help to clarify the population structure of the subject locus. Genome-wide association studies using next-generation sequencing may also aid in predicting nicotine metabolism and resistance to smoking cessation in the Pakistani population.

Impact of COVID-19 Pandemic on the Expanded Programme on Immunization (EPI) Vaccination Uptake in Lahore, Pakistan - A Cross-Sectional Study

Ali Gohar — 2025-06-30

The 2019 (COVID-19) Coronavirus pandemic has presented a variety of challenges which have not only affected the society's health but also the economies, the sociocultural trends and political situations. Routine health-related programs have been harmed. Objectives: To provide an insight into the prevalence of delay of Expanded Program of Immunization (EPI) and its causative factors during the pandemic in the province of Punjab, Pakistan. Methods: After approval from the Ethical Review Board, this prospective, cross-sectional study was carried out at Ameer ud Din Medical College (AMC) from July 1, 2023, to September 1, 2023. An interview-based survey was conducted across the suburbs of college. Results: About 66% participants were female parents, out of which 51.3% indicated that their children's vaccinations had been delayed for more than a week. Participants who had delayed their children's vaccination visits owing to a fear that the children would not be able to follow the proper precautions for protection against COVID-19 were 10%, while 16% of respondents stated that the fear of COVID-19 exposure while traveling to and from the health facility was the reason for the delay in vaccination. Fear of COVID-19 exposure at the health facility caused 33% of cases to delay the vaccination uptake. Conclusions: It was concluded that COVID-19 harmed EPI-associated vaccination uptake. Solutions to the reasons for delay were ignored by the involved parents and healthcare setups.

Parental Perceptions of Sensory Avoidance and Sleep Disturbances among Autistic Children in Lahore: A Cross-sectional Study

Eman Nasim — 2025-06-30

As literature shows, children with autism often experience sensory processing difficulties and sleep disturbances. Objectives: To determine parent-reported sensory avoidance behaviours and sleep habits in school-aged children with autism spectrum disorder in Lahore. Methods: This observational cross-sectional study was conducted on 249 autistic children. Outcome measures of this study were the prevalence of sensory avoidance behaviours and sleep habits. The standardized tools were the Short Sensory Profile (SSP) and the Children's Sleep Habits Questionnaire (CSHQ) to assess the sensory avoidance behaviours and sleep problems. Data were analyzed by using SPSS version 27.0. Results: 38% were aged 3-7 years, and 61% were aged 8–12 years. Parent reports showed that 17% of children exhibited probable differences and 53% exhibited significant differences in tactile sensory avoidance behaviours. Movement sensitivity issues were definite in 54% and probable in 30% of children. Regarding auditory sensory avoidance, 55% showed significant changes, and 1% showed probable changes. For visual and auditory sensory behaviours, only 44% showed typical performance. Overall, 74% of children demonstrated definite sensory avoidance behaviours across multiple domains, while 8% showed some level of sensory avoidance. Additionally, 20% did not display low energy behaviours. Regarding sleep habits, 16% had typical sleep patterns, 3% faced sleep issues at a minimum level, 22% faced sleep issues at an intermediate level, and the remaining 57% faced sleep issues at a severe level. A p-value was >0.05. Significant association between sensory avoidance behaviour and sleep habits. Conclusion: Sensory avoidance behaviour had a significant association with sleep habits.

Prevalence of Urinary Incontinence among Middle Aged Women and Its Association with Quality of Life

Muskan Jafar — 2025-06-30

Existing literature had shown a significant rise in the prevalence of urinary incontinence among female. This increasing trend in urinary incontinence had been associated with a noticeable decline in quality of life. Objective: To evaluate the prevalence of urinary incontinence in middle aged women to find the association between urinary incontinence and quality of life of middle aged women. Methods: This observational cross-sectional analytical study was conducted in a six-month study duration in Lahore. Female patients aged 35 to 65 years were selected. Outcome measures of this study were measuring urinary incontinence and quality of life. Data were collected from Sir Ganga Ram Hospital. Data were gathered by using ICIQ-SF and SF12. Data were analyzed by using SPSS version 27.0`1. Results: This observational study enrolled middle-aged women aged 35 to 65 years. The majority (53%) were housewives, while 46% were employed. Regarding socioeconomic status, 53% reported financial stability, whereas 79% indicated economic instability a discrepancy suggesting possible reporting error. Marital status distribution showed that 59% were married, 12% unmarried, and 27% widowed. In terms of Quality of Life (QoL), 19% of participants reported poor physical health, 62% fair, and 17% good physical health. Conclusions: Most middle-aged women in this study experienced urinary incontinence, with greater severity linked to poorer physical and mental health, especially among housewives.

Attitude of Healthcare Workers Towards the Termination of Pregnancy in Peshawar, Pakistan

Emaan Arif — 2025-06-30

Unsafe abortion remains a major public health issue in Pakistan, including Peshawar, due to restrictive laws, stigma, and limited access to safe services. Objectives: To assess the healthcare workers’ perspective towards the termination of pregnancy and their legal and religious perceptions regarding it. Methods: A cross-sectional study was conducted among gynecologists, Lady Health Workers (LHWs), and nurses in the Gynecology and Obstetrics Department of public and private hospitals in Peshawar from January 2025 to March 2025. Structured questionnaires were distributed among 200 healthcare workers, and their responses were analyzed using SPSS version 20.0. The frequencies and percentages were calculated for qualitative variables, and the chi-square test was applied to check statistically significant association between different categorical variables, with a p-value<0.05 considered significant. Results: Among healthcare workers in Pakistan, nearly all (96.5%) agreed to terminate pregnancies when the mother's life was at risk, while approval was also high for severe fetal anomalies (87.5%). However, most disapproved of TOP for socio-economic reasons like unaffordability, unplanned pregnancy, or extramarital pregnancy. Though 66% were aware of Pakistan's TOP laws, many found them ambiguous, and 85.5% desired stricter regulations. Religion was the primary reason for not performing abortions. Significant differences in views were observed between specialities and sectors, with private providers holding more liberal attitudes on several TOP-related issues. Conclusions: Most healthcare workers showed a negative attitude toward abortion, largely influenced by religious beliefs, and many advocated for clearer and stricter abortion laws.

Review article Pulmonary Tuberculosis Rehabilitation: Evidence-Based Physiotherapy and Technological Advancements for Sustainable Development Goal Achievement, a Narrative Review

Danyal Ahmad — 2025-06-30

Pulmonary tuberculosis (PTB) remains a leading cause of global morbidity and mortality, with over 10 million new cases annually and 155 million survivors worldwide. Many TB survivors suffer from post-TB lung disease (PTLD), including chronic airflow obstruction, fibrosis, and bronchiectasis, leading to persistent respiratory symptoms and reduced quality of life. This review summarizes the evidence-based physiotherapy interventions and technological advancements in pulmonary rehabilitation (PR) for TB survivors, and highlights their potential contribution to Sustainable Development Goal (SDG) 3 (Good Health and Well-being) by improving lung function, physical capacity, and overall health outcomes. A comprehensive review of recent studies (2015–2025) was conducted, encompassing randomized controlled trials, quasi-experimental studies, and pilot programs investigating PR interventions and technology-assisted rehabilitation for PTLD. Evidence supports the effectiveness of airway clearance techniques (e.g. postural drainage, percussion, breathing exercises), exercise training (aerobic and resistance), and multicomponent PR programs in improving lung function (FEV₁, FVC), exercise tolerance (6-minute walk distance), and quality of life. Technological innovations such as wearables, AI-based monitoring, and virtual reality (VR) platforms enhance remote supervision, adherence, and engagement. AI algorithms show promise in predicting rehabilitation response, personalizing training, and detecting early deterioration, while telerehabilitation platforms facilitate access to PR in low-resource settings. Evidence-based physiotherapy interventions, supported by technological advancements, offer effective rehabilitation strategies for TB survivors with PTLD. Integration of wearable sensors, AI, and VR into PR programs can improve adherence, exercise capacity, and health outcomes, contributing to SDG 3 by promoting inclusive, equitable health services.

Ultra Processed Foods, Metabolic Syndrome, and the Pharmaceutical Burden: A Global Paradox

Muhammad Irfan Bashir — 2025-06-30

The increasing prevalence of metabolic syndrome worldwide presents a paradox: while lifestyles and their associated health risks are becoming well recognised, pharmacological interventions are still on the rise. An increased consumption of ultra-processed foods (UPFs) is a major factor in this public health issues. These highly processed foods contain very less quantity of actual nutrients.

These processed foods are sole dietary sources in many countries. A previous prospective cohort study conducted in 2025 demonstrated that increasing use of UPFs is significantly linked with an elevated risk of hypertension, cardiovascular disease, and all lead to mortality [1]. Findings suggested that these foods are associated with metabolic disorders such as obesity, insulin resistance, and type 2 diabetes.

At the same time, the pharmaceutical industry has rapidly expanded the new drugs for the treatment of metabolic syndrome. Among them statins, antihypertensives, metformin, and GLP-1 receptor agonists are widely used as first line therapy. According to market survey, the global market for such treatments will exceed US$120 billion by 2029 [2]. These approaches are only for the treatment of disease not to prevent it. Mostly physicians recommend to treat diabetes through medicines but some healthcare providers still guide patients for reversal of diabetes by removing processed foods from their life.

The paradox that these two industries expand in relation to each other’s influence offers important ethical and policy implications. One profits from selling unhealthy foods, while the other profits from putting a band-aid on the resulting problems. The absence of a concerted regulatory response has allowed this cycle to continue, especially in jurisdictions where public health policy is under-resourced or poorly enforced.

The economic fallout is no less grave. A recent modelling report showed that if obesity-associated conditions are not mitigated, the global economy could lose GDP by as much as USD 2.76 trillion per annum by 2050 [3]. This anticipated burden exceeds that of many communicable diseases and calls for a new global health focus.

Preventions, we must focus. Such policies include fiscal measures (sugar and UPF taxes), front-of-pack labelling, food reformulation mandates, and subsidies for whole, nutrient-dense foods. Healthcare professionals, particularly pharmacists and general practitioners, could also play a positive role by advising patients on diet and lifestyle before initiating long-term drug treatment.

In summary, the blossoming of metabolic disease despite progress in medical practice demands that we re-examine our food systems and health policies. A successful response will require more than better drugs; rather, it calls for bold policies that encourage healthier dietary patterns and wean people off ultra-processed products. Shifting our emphasis away from treating disease and toward preventing it isn’t just scientifically justified—it’s economically and ethically necessary.