Pakistan BioMedical Journal

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

Muhammad Irshad Ul Haq, Syed Muhammad Yousaf Farooq, Muhammad Moazzam — Wed, 31 Dec 2025 00:00:00 +0000

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, Areeba Akram, Neha Tanveer — Wed, 31 Dec 2025 00:00:00 +0000

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, Ambreen Khan, Muhammad Junaid — Wed, 31 Dec 2025 00:00:00 +0000

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

Wed, 31 Dec 2025 00:00:00 +0000

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.

Attention Deficit Hyperactivity Disorder Genetics and Future Perspectives

Amara Shaukat — Wed, 31 Dec 2025 00:00:00 +0000

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.