Pakistan BioMedical Journal

Diagnostic Approaches and Causes of Male Infertility: A Comprehensive Clinical Review

Muhammad Irshad Ul Haq — 2025-12-31

Male infertility accounts for approximately 30–50% of infertility cases worldwide and poses a significant reproductive health challenge. This review synthesizes current knowledge on the etiology of male infertility, emphasizing the pivotal role of diagnostic imaging, particularly ultrasonography, in identifying structural and functional abnormalities. Common causes include varicocele, testicular failure, genetic abnormalities such as chromosomal defects and Y-chromosome microdeletions, obstructive pathologies, and idiopathic factors. Ultrasound techniques, especially scrotal and transrectal ultrasonography, have become essential tools in detecting conditions often missed during routine examinations, thereby facilitating accurate diagnosis and targeted management. Despite advancements, standardization of imaging protocols and access remain limited in resource-constrained settings. An integrated diagnostic approach, combining semen analysis, hormonal profiling, genetic testing, and imaging, enhances diagnostic precision, reduces unexplained cases, and guides personalized treatment. Early identification of causative factors is crucial for optimizing reproductive outcomes.

Evaluation of Brain Stroke by Using Computed Tomography

Almeera Anwar — 2025-12-31

A stroke is a serious emergency in the medical sector, occurring when the flow of blood to the brain is blocked or cut short. This may occur due to the bursting of a blood vessel within the brain, an ischemic stroke, or the blocking of a blood vessel in the brain (Hemorrhagic stroke). Objectives: To assess the demographic profiles, clinical presentations, and neuroimaging images of brain stroke patients with the help of computed tomography and name the most common type of stroke and risk factors in a Pakistani sample. Methods: This cross-sectional study was done in a setting of Gondal Medical Complex Hospital, Gujranwala, Pakistan, with a sample size of 60 patients who had brain CT scans after a brain stroke. 16 slices CT machine was applied in the study. Results: It was as per this research that there was a greater impact of brain strokes on men compared to women. The age between 71 and 90 years is the most affected age group, and the frontal lobe is the most affected site, with hypertension being the major contributor. Conclusions: As per the results of this study, a CT scan is an excellent diagnostic measure in the location and cause of a brain stroke. Hypertension is the primary risk factor for brain stroke.

Assessment of Knowledge and Education Regarding Artificial Intelligence Among Medical Teaching Faculty at Bolan Medical College, Quetta

Maqbool Ahmed — 2025-12-31

In the context of the continued rapid progress of the incorporation of AI technology into the healthcare system of the state of Pakistan, there are considerable shortcomings regarding the knowledge and readiness of the faculty who teach medicine at various institutions of the country’s education system, including provinces with historically underrepresented portions of the community, like Balochistan. Objectives: To evaluate the knowledge, educational experience, perceptions, and preparedness of the medical teaching staff of Bolan Medical College regarding AI technology. Methods: A cross-sectional observational study with a sample of 200 teaching faculty. A 24-point questionnaire was based on the literature received and the study used Google Forms, ensuring objectivity with anonymization. Descriptive and inferential analyses were used with SPSS version 27.0. Results: The sample, 119 (59.5%), were aware of applications of AI in medicine; only 53 (26.5%) reported being formally educated on AI. Awareness of AI in clinical sciences was 112 (56%). Knowledge of at least one AI-related programming language was 126 (63%), while familiarity with AI-related journals was 60 (30%). Only 42 (21%) reported AI-related education in their curriculum. The average knowledge stood at 2.33 ± 1.07 on a 6-point scale, reflecting moderate awareness, with only moderate application of AI knowledge, and 53 (26.5%) reporting ease of application. Conclusions: Teaching staff appear interested and aware of AI; however, major shortcomings point to the requirement of immediate faculty development programs to equip educators with knowledge and wisdom so that AI can safely be implemented in medicine.

Pattern and Causes of Hearing Loss Among Patients Visiting the GMT Clinic in Rawalpindi

Muhammad Farhan — 2025-12-31

An estimated 430 million individuals in the world, with 34 million children, need to have their disabling hearing loss rehabilitated. Objectives: To identify the nature, extent, and etiology of hearing impairments among patients visiting the Global Management Team (GMT) Clinic in Rawalpindi, Pakistan. Methods: The cross-sectional study was a quantitative observational study that was carried out between February, 2025 and May, 2025, involving 383 patients having hearing loss. A purposive sampling was used, which was non-probability. The data were gathered with the help of a self-administered questionnaire that was validated with a study involving ten respondents and regular audiological tests, such as pure-tone audiometry and tympanometry, conducted by a qualified audiologist. SPSS version 25.0 was used to conduct the data analysis through cross-tabulations and descriptive statistics. Results: Sensorineural hearing loss ranked highest (71.8%), conductive (14.7%), and mixed hearing loss (10.4%). The majority of patients were severely and profoundly impaired in hearing. The top causes were disease-related conditions (41.2) and presbycusis (31.8), and genetic factors, trauma, and noise exposure were less common. Bilateral and acquired hearing loss was predominant. Conclusions: The clinic is mostly affected by presbycusis and disease-related conditions, which are the major causes of severe to profound sensorineural hearing loss. The findings highlight the need to diagnose early, screen hearing regularly, and carry out public awareness to enhance prevention and treatment measures.

Isolation and Identification of Escherichia Coli and Klebsiella Species using Chromogenic Agar from Drinking Water of District Thar, Sindh, Pakistan

Jawaid Mian Larik — 2025-12-31

Most of the studies do not conduct bacteriological analysis of the Thar region drinking water, except for transportation and travel problems. Objectives: To identify the bacteriological profile of water at various regions of the Thar Desert, Sindh, Pakistan, concerning the presence of the indicator Coliform, i.e. E coli and Klebsiella spp., on Rapid Media Chromogenic agar. Methods: A total of 70 (70) drinking water samples were collected in 5 talukas of District Tharparkar, namely, Islamkot, Nangrpar, Kalohi, Dahri, and Diplo between December 2021 and May 2022. Water samples were tested right after the collection, with the help of the membrane filtration method. MacConkey agar and Chromogenic agar and plates were inoculated with filters and incubated aerobically in 35-37 o C, respectively, and kept for 24 hours. Bacterial identification tests were performed on the colonies on MacConkey agar plates and E. coli and Klebsiella spp. produced turquoise-blue colony and Mergenda color colony on chromogenic agar, respectively. Results: The findings of the bacteriological test revealed that the water samples are not potable, and 47 (67) samples contained bacteria. There were 28 (59) coliform and 19 (41) non-coliforms. Escherichia coli (18; 40%) was most common, followed by Klebsiella spp. (12; 27%), Pseudomonas spp. (9; 20%), Salmonella spp. and Proteus spp. were the least common (3 each; 6%). Conclusions: Chromogenic agar is a fast and convenient way of presumptive identification of bacterial contaminants in drinking water. E. coli and Klebsiella spp. were the largest bacterial communities in drinking water specimens of the Thar region.

A Single-Center, Retrospective Study of Chest X-Rays in Potential Expatriates From KPK: A Descriptive Investigation

Urooj Amjad — 2025-12-31

Lung diseases are serious medical conditions that significantly impact the migrant populations. Chest X-rays are one of the most commonly used and cost-effective diagnostic tools for identifying various lung conditions. Objectives: To establish the prevalence of lung anomalies detected on X-ray in prospective expatriates, to evaluate their distribution by age, gender, region, occupation, and to determine the unfit cases within these groups. Methods: In this study, the chest X-ray reports of 42,688 Pakistani candidates from the year 2022 (Jan-Dec) were analyzed, who underwent medical screening (chest X-rays) for overseas employment under the guidelines of the Gulf Cooperation Council (GCC). The candidates aged between 18 and 51 years, with a mean age of 31.54 ± 4.86. Results: Out of 42,688 candidates examined over a year, 1,347 (3.15%) were deemed unfit based on chest X-ray findings. Chest X-ray anomalies were most prevalent among costophrenic angle obliteration (0.63%), pleural effusion (0.42%), and moderate apical scaring (0.31%). The population in the study was predominantly male, with no unfitness among females. Of these anomalies (n=1347), the most infected age group was 31–35 years (39.9%), followed by 36–40 (35.4%) and 41–45 (12.6%) years. Occupationally, the most affected were laborers (88.2%) and drivers (4.97%), whereas geographically, the highest prevalence was in Peshawar (12%), Mardan (11.3%), and Bannu (8.16%). Conclusions: This research allows us to determine the burden and distribution of chest-related anomalies among prospective expatriates, identify demographic, occupational, and geographic groups, and provides baseline epidemiological evidence from an understudied screening population.

Attention Deficit Hyperactivity Disorder Genetics and Future Perspectives

Amara Shaukat — 2025-12-31

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition defined by persistent patterns of inattention, hyperactivity, and impulsivity that impair functioning across multiple settings [1]. Symptoms typically emerge in childhood and frequently persist into adulthood, although their expression may change over time. ADHD is clinically heterogeneous, with substantial variability in symptom severity, cognitive profiles, and comorbidity patterns [2]. Global prevalence estimates suggest that approximately five percent of children are affected, with lower rates observed in adults largely reflecting partial symptom remission rather than resolution [3].

The diagnosis of ADHD is based on behavioral criteria and includes three clinical presentations: predominantly inattentive, predominantly hyperactive impulsive, and combined [1]. ADHD commonly co-occurs with anxiety disorders, depression, learning disabilities, and autism spectrum disorder, contributing to diagnostic complexity and increased clinical burden [2]. These overlaps suggest shared biological mechanisms rather than discrete disease boundaries.

Neurobiological studies have consistently implicated fronto striatal and fronto cerebellar circuits involved in executive control, attention regulation, and inhibitory processes [4]. Structural and functional neuroimaging studies report delayed cortical maturation, altered cortical thickness, and differences in large scale brain connectivity, particularly in prefrontal regions [5]. At the neurochemical level, dysregulation of dopamine and norepinephrine signaling plays a central role in ADHD pathophysiology and provides the mechanistic basis for stimulant medications, which remain first line treatment [6].

Genetic factors represent one of the strongest contributors to ADHD risk. Family and twin studies consistently report heritability estimates between seventy and eighty percent, placing ADHD among the most heritable psychiatric disorders [7]. However, ADHD does not follow a single gene or Mendelian inheritance pattern. Instead, it reflects the cumulative effects of many common genetic variants of small effect, consistent with a highly polygenic architecture [8].

Early candidate gene studies focused on dopaminergic pathway genes such as DRD4, DRD5, SLC6A3, and COMT, but these explained only a small fraction of genetic risk. The field advanced substantially with large genome wide association studies. The first genome wide significant ADHD loci were identified by Demontis and colleagues, implicating genes involved in neurodevelopment, synaptic organization, and transcriptional regulation [9]. Subsequent work demonstrated substantial genetic overlap between ADHD and other neuropsychiatric and behavioral traits, including autism spectrum disorder, schizophrenia, educational attainment, and risk-taking behaviors, supporting shared biological pathways across conditions [10,11].

Rare genetic variants, including copy number variations affecting neurodevelopmental genes, also contribute to ADHD risk, particularly in individuals with more severe or persistent symptoms [9]. Environmental exposures such as prenatal smoking, low birth weight, and early life psychosocial adversity interact with genetic susceptibility, influencing symptom expression rather than acting as primary causes.

Future ADHD research is increasingly oriented toward integrative and precision-based approaches. Polygenic risk scores summarizing genome wide genetic liability are being developed, although their predictive value at the individual level remains limited [7]. Combining genomic data with neuroimaging, cognitive phenotyping, and environmental measures may enable biologically informed stratification of ADHD, addressing long standing heterogeneity in diagnosis and treatment response.

Precision medicine represents a key future goal. Pharmacogenomic research seeks to identify genetic predictors of medication response and adverse effects, potentially improving treatment selection and tolerability [12]. Additionally, there is growing recognition of the need for ancestry diverse and lifespan focused research. Most genetic studies to date have focused on populations of European ancestry, limiting generalizability. Expanding global representation and longitudinal study designs will be essential for equitable translation of genetic discoveries into clinical practice.

In summary, ADHD is a complex neurodevelopmental disorder with a strong genetic foundation and substantial biological overlap with other psychiatric traits. Continued integration of genomics, neuroscience, and clinical research is likely to reshape ADHD classification and management, moving toward more precise and individualized care.