Pakistan BioMedical Journal https://pakistanbmj.com/journal/index.php/pbmj <p>Title of Journal: <strong>Pakistan Biomedical Journal (ISSN Online: 2709-2798, Print: 2709-278X)</strong></p> <p>Frequency: <strong>Monthly</strong></p> <p>Affiliated with: <strong>Lahore Medical Research Center</strong></p> <p><strong>Website: (</strong><a href="http://www.lmrc.com.pk">www.lmrc.com.pk</a>)</p> <p>Published By: <strong>CrossLinks International Publishers LLC</strong></p> <p><strong>Website: (</strong><a href="http://www.clip.com.pk">www.clip.com.pk</a>)</p> <p><strong>Address: </strong>117 S Lexington St Ste 100, Harrisonville, MO 64701, USA</p> <p><strong>Description:</strong></p> <p><strong>Pakistan BioMedical Journal (PBMJ)</strong> is an Official Journal of "<strong>Lahore Medical Research Center LLP" (LMRC)</strong> and is being funded and supported by Lahore Medical Research Center LLP (LMRC). Pakistan Biomedical Journal (PBMJ) is an open access, double blind peer-reviewed international journal. </p> <p><strong>Aim &amp; Scope</strong></p> <p>The Pakistan BioMedical Journal (PBMJ) covers a diverse range of disciplines crucial to healthcare and academia. This includes Public Health, Clinical Sciences, Dentistry, Nursing, Medical/Health Professions Education, and Biological Sciences related to human health. By embracing such a wide spectrum of topics, PBMJ aims to serve as a comprehensive platform for the dissemination of research and knowledge, fostering interdisciplinary collaboration and advancements in understanding human health and well-being.</p> <p><span style="text-decoration: underline;"><strong>Accreditation:</strong></span></p> <p><strong>Approved by Higher Education Commission of Pakistan for the year 2024-25</strong></p> <p><strong>Fee &amp; Subscription Charges</strong></p> <p>Article Processing Fee: 5000 (W.e.f 1st Jan-25) <strong>(Non-Refundable)</strong></p> <p>Article Publication Fee (National) Rs 30000 / Article</p> <p>Article Publication Fee (International ) 200 USD / Article</p> <p>Printed Version ((Selected Articles on Authors Request): Rs 2500/per copy (For InLand Delivery)</p> <p><span style="text-decoration: underline;"><strong>Annual Subscription for Printed Versions</strong></span></p> <p>For Institutes: Rs 20,000/ Annually</p> <p>Single Copy (Selected Articles): Rs 2500/-</p> <p><strong>Bank Details</strong></p> <p>Account Title: Lahore Medical Research Center LLP</p> <p>Bank Name: Meezan Bank</p> <p>IBAN: PK36MEZN0002840105377903</p> <p>Account # 02840105377903</p> <p><span style="text-decoration: underline;"><strong>Waiver Policy</strong></span></p> <p>If an author has no funds to pay such charges, he may request for full or partial waiver of publication fees. The decision may however vary from case to case.</p> <p>We do not want charges to prevent the publication of worthy material.</p> <p><strong><u>Submissions</u></strong></p> <p><span style="font-size: 0.875rem;">Submission are welcome and may be submitted here. </span><a style="background-color: #ffffff; font-size: 0.875rem;" href="mailto:submissions@pakistanbmj.com">submissions@pakistanbmj.com</a></p> CrossLinks International Publishers en-US Pakistan BioMedical Journal 2709-278X <p>This is an open-access journal and all the published articles / items are distributed under the terms of the <a href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</a>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments <a href="mailto:editor@pakistanbmj.com">editor@pakistanbmj.com</a></p> <p> </p> <p> </p> <p> </p> Habit Reversal Training and Relaxation Training for the Treatment of Adult-Onset Trichotillomania due to Premature Greying https://pakistanbmj.com/journal/index.php/pbmj/article/view/1229 <p>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.</p> Sara Aleem Haqqi Sheeba Farhan Syed Zahid Ali Shah Saba Kalhoro Syed Kawish Ali Neeta Maheshwary Muhammad Iqbal Asif Waseem Asif Copyright (c) 2025 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 10.54393/pbmj.v8i6.1229 Association Analysis of CYP2A6 Gene Variant (rs1801272A>T) with Nicotine Metabolism and Smoking Tendency among Pakistani Youth https://pakistanbmj.com/journal/index.php/pbmj/article/view/1236 <p>Cytochrome P450 2A6 (<em>CYP2A6</em>) is a key enzyme in nicotine metabolism, with its genetic variants playing a role in smoking behavior. Particularly, g.40848628A&gt;T is significantly associated with nicotine metabolism and smoking tendency in different populations. <strong>Objectives:</strong> To examine the genetic diversity of this locus and association analysis within smokers and non-smokers cohorts among Pakistani youth. <strong>Methods: </strong>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. <strong>Results:</strong> 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. <strong>Conclusions:</strong> 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.</p> Iqra Yasmin Haider Ali Muhammad Rafeh Muhammad Sikandar Abdul Kashif Muhammad Salahuddin Ammad Shafeeq Rashid Saif Copyright (c) 2025 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 10 15 10.54393/pbmj.v8i6.1236 Impact of COVID-19 Pandemic on the Expanded Programme on Immunization (EPI) Vaccination Uptake in Lahore, Pakistan - A Cross-Sectional Study https://pakistanbmj.com/journal/index.php/pbmj/article/view/1261 <p><span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW77339901 BCX0">The 2019 (COVID-19) Coronavirus pandemic has presented a variety of challenges which have not only affected the </span><span class="NormalTextRun SCXW77339901 BCX0">society's</span> <span class="NormalTextRun SCXW77339901 BCX0">health</span><span class="NormalTextRun SCXW77339901 BCX0"> but also the economies, the sociocultural </span><span class="NormalTextRun SCXW77339901 BCX0">trends</span><span class="NormalTextRun SCXW77339901 BCX0"> and political situations. </span><span class="NormalTextRun SCXW77339901 BCX0">Routine health-related programs have been harmed. </span></span><strong><span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW77339901 BCX0">Objectives:</span></span></strong><span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"> <span class="NormalTextRun SCXW77339901 BCX0">To </span><span class="NormalTextRun SCXW77339901 BCX0">provide</span><span class="NormalTextRun SCXW77339901 BCX0"> an insight into the prevalence of delay of </span><span class="NormalTextRun SCXW77339901 BCX0">Expanded Program</span><span class="NormalTextRun SCXW77339901 BCX0"> of I</span><span class="NormalTextRun SCXW77339901 BCX0">mmunization (EPI) and its causative factors during </span><span class="NormalTextRun SCXW77339901 BCX0">the </span><span class="NormalTextRun SCXW77339901 BCX0">pandemic</span><span class="NormalTextRun SCXW77339901 BCX0"> in </span><span class="NormalTextRun SCXW77339901 BCX0">the province of Punjab, Pakistan</span><span class="NormalTextRun SCXW77339901 BCX0">.</span> </span><strong><span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW77339901 BCX0">Methods</span></span></strong><span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW77339901 BCX0"><strong>:</strong> </span><span class="NormalTextRun SCXW77339901 BCX0">After approval from </span><span class="NormalTextRun SCXW77339901 BCX0">the </span><span class="NormalTextRun SCXW77339901 BCX0">Ethical Review Board, this prospective, cross-sectional study was carried out at Ameer </span><span class="NormalTextRun SpellingErrorV2Themed SCXW77339901 BCX0">ud</span><span class="NormalTextRun SCXW77339901 BCX0"> Din Medical College (AMC) from </span><span class="NormalTextRun SCXW77339901 BCX0">July 1, 2023, to September 1, 2023</span><span class="NormalTextRun SCXW77339901 BCX0">. An interview-based survey was conducted across the suburbs of college.</span> </span><strong><span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW77339901 BCX0">Results</span><span class="NormalTextRun SCXW77339901 BCX0">: </span></span></strong><span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW77339901 BCX0">About 66% participants were f</span><span class="NormalTextRun SCXW77339901 BCX0">emale par</span><span class="NormalTextRun SCXW77339901 BCX0">ents, out of which 51.3% </span><span class="NormalTextRun SCXW77339901 BCX0">indicated</span><span class="NormalTextRun SCXW77339901 BCX0"> 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.</span></span><span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><strong> <span class="NormalTextRun SCXW77339901 BCX0">Conclusions</span></strong><span class="NormalTextRun SCXW77339901 BCX0"><strong>:</strong> </span></span><span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW77339901 BCX0">It was concluded that</span></span> <span class="TextRun SCXW77339901 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW77339901 BCX0">COVID-19 </span><span class="NormalTextRun SCXW77339901 BCX0">harmed</span><span class="NormalTextRun SCXW77339901 BCX0"> EPI-associated vaccination uptake. Solutions to the reasons </span><span class="NormalTextRun SCXW77339901 BCX0">for</span><span class="NormalTextRun SCXW77339901 BCX0"> delay were ignored by </span><span class="NormalTextRun SCXW77339901 BCX0">the </span><span class="NormalTextRun SCXW77339901 BCX0">involved parents and healthcare </span><span class="NormalTextRun SCXW77339901 BCX0">setups</span><span class="NormalTextRun SCXW77339901 BCX0">.</span></span><span class="EOP SCXW77339901 BCX0" data-ccp-props="{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559740&quot;:240}"> </span></p> Ali Gohar Hamza Hafeez Farooqi Humza Tariq Asad Ullah Khan Abdul Rehman Shahid Khan Syed Saqlain Haider Shah Usama Afzal Copyright (c) 2025 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 16 19 10.54393/pbmj.v8i6.1261 Parental Perceptions of Sensory Avoidance and Sleep Disturbances among Autistic Children in Lahore: A Cross-sectional Study https://pakistanbmj.com/journal/index.php/pbmj/article/view/1258 <p>As literature shows, children with autism often experience sensory processing difficulties and sleep disturbances. <strong>Objectives:</strong> To determine parent-reported sensory avoidance behaviours and sleep habits in school-aged children with autism spectrum disorder in Lahore. <strong>Methods:</strong> 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. <strong>Results: </strong>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 &gt;0.05. Significant association between sensory avoidance behaviour and sleep habits. <strong>Conclusion: </strong>Sensory avoidance behaviour had a significant association with sleep habits.</p> Eman Nasim Mariam Liaquat Sana Toqueer Muskan Jaffar Taimoor Ahmad Copyright (c) 2025 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 20 25 10.54393/pbmj.v8i6.1258 Prevalence of Urinary Incontinence among Middle Aged Women and Its Association with Quality of Life https://pakistanbmj.com/journal/index.php/pbmj/article/view/1259 <p>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. <strong>Objective: </strong>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. <strong>Methods:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusions: </strong>Most middle-aged women in this study experienced urinary incontinence, with greater severity linked to poorer physical and mental health, especially among housewives.</p> Muskan Jafar Muhammad Waqas Sana Touqeer Eman Nasim Taimoor Ahmad Copyright (c) 2025 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 26 30 10.54393/pbmj.v8i6.1259 Attitude of Healthcare Workers Towards the Termination of Pregnancy in Peshawar, Pakistan https://pakistanbmj.com/journal/index.php/pbmj/article/view/1257 <p>Unsafe abortion remains a major public health issue in Pakistan, including Peshawar, due to restrictive laws, stigma, and limited access to safe services. <strong>Objectives: </strong>To assess the healthcare workers’ perspective towards the termination of pregnancy and their legal and religious perceptions regarding it. <strong>Methods:</strong> 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&lt;0.05 considered significant. <strong>Results: </strong>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. <strong>Conclusions:</strong> Most healthcare workers showed a negative attitude toward abortion, largely influenced by religious beliefs, and many advocated for clearer and stricter abortion laws.</p> Emaan Arif Amjad Ullah Javeria Taj Shafi Ullah Asad Jamal Romana Ayub Aaira Taharat Sada Anwar Rabia Arshad Reesha Aftab Copyright (c) 2025 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 26 31 10.54393/pbmj.v8i6.1257 Review article Pulmonary Tuberculosis Rehabilitation: Evidence-Based Physiotherapy and Technological Advancements for Sustainable Development Goal Achievement, a Narrative Review https://pakistanbmj.com/journal/index.php/pbmj/article/view/1247 <p>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.</p> Danyal Ahmad Syeda Khadija Kazmi Umer Ilyas Gull Mahnoor Hashmi Muhammad Areeb Shahid Saleh Shah Muhammad Naveed Babur Copyright (c) 2025 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 03 09 10.54393/pbmj.v8i6.1247 Ultra Processed Foods, Metabolic Syndrome, and the Pharmaceutical Burden: A Global Paradox https://pakistanbmj.com/journal/index.php/pbmj/article/view/1256 <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> Muhammad Irfan Bashir Copyright (c) 2025 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 01 02 10.54393/pbmj.v8i6.1256