Allied Medical Research Journal

Misunderstood OSCE Variants in Physical Therapy Education: A Call for Standardization

2025-11-14T10:42:29+00:00

Misinterpretations of the OSCE in physical therapy education—such as static paper-based stations and queue-based written circuits—undermine its purpose as a performance-based assessment. These variants reduce validity and fairness. Standardized design, proper examiner training, and elimination of non-interactive formats are essential to preserve the integrity of OSCE and ensure competent clinical practice.

DOI: https://doi.org/10.59564/amrj/03.04/002

Evaluation of the Antimicrobial Activity of Chlorella vulgaris Against MDR Bacteria Isolated from Diabetic Wound Pus Samples

2025-07-23T05:41:43+00:00

Background: The aim of this study was to isolate and characterize pathogenic microbes from the pus of diabetic patients and to evaluate the antibiotic susceptibility of multidrug-resistant (MDR) isolates along with their resistance patterns against the microalgae Chlorella vulgaris extract (CVE).

Methods: This hospital-based biphasic research study (cross-sectional and experimental) included 100 pus samples from diabetic patients. Out of these, 10 isolates were identified as multidrug-resistant (MDR) and were subsequently subjected to further characterization. Two methods were employed to evaluate the antimicrobial activity of the microalgae Chlorella vulgaris. Since the Kirby-Bauer disc diffusion method did not provide sufficient results, a turbidity assay was performed in an ELISA 96-well microtiter plate to evaluate the inhibitory effect of microalgae CVE on bacterial growth. To assess the biofilm-forming ability of pus isolates and to evaluate the inhibitory potential of CVE against their biofilms standard microtiter plate assays were performed.

Results: The CVE exhibited species-dependent antibiofilm activity against pus isolates from diabetic patients. The strongest % inhibition at MIC with algal extract was observed in Acinetobacter species (48.28%) and Streptococcus pyogenes (42.12%), while the weakest response was noted in Klebsiella pneumoniae (27.48%). Overall CVE demonstrated significant inhibitory potential (p < 0.05) with comparatively stronger effects against certain Gram-negative and selected Gram-positive bacteria.

Conclusion: Microalgae CVE exhibited antimicrobial and anti-biofilm activity against MDR isolates from diabetic patients with the strongest effects on Acinetobacter species and Streptococcus pyogenes indicating its potential as a natural therapeutic requiring further mechanistic and in vivo validation.

DOI: https://doi.org/10.59564/amrj/03.04/003

Impact of Inspiratory Muscle Training with Biofeedback vs Traditional Breathing Exercises on Dyspnea and Exercise Tolerance in COPD: A Randomized Controlled Trial

2025-11-14T10:55:34+00:00

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability globally, with symptoms that include dyspnea and exercise intolerance. Although breathing exercises are typically considered standard of care in rehabilitation, inspiratory muscle training (IMT) with visual biofeedback might be more beneficial. In this study we visualized the effects of IMT with visual biofeedback compared to breathing exercises on dyspnea and exercise tolerance in patients with COPD.

Methods: A parallel-group, assessor-blinded randomized controlled trial was conducted across three sites between March and November 2024. Sixty-six adults, ages 40-60, with moderate to severe COPD (GOLD stages II-III) were randomized to an IMT group using an incentive spirometer with visual biofeedback (n=33) or a breathing exercise group (n=33). All participants engaged in 6 weeks of intervention. The primary outcomes were dyspnea (mMRC scale, Borg CR10) and exercise tolerance (6-minute walk distance, 6MWD). Secondary outcomes included pulmonary function (FEV1% predicted) and health-related quality of life (CAT score). Data were analyzed using independent t-tests and repeated measures ANOVA.

Results: Significant within-group improvements were observed in both groups; however, the IMT-biofeedback group exhibited a greater magnitude of between-group differences measured by mMRC (-0.4 points, p=0.002), Borg CR10 (-0.8 points, p=0.001), 6MWD (+34.7 meters, p<0.001), FEV1 % predicted (+3.7%, p=0.001), and CAT score (-2.5 points, p=0.001). Effect sizes ranged from 0.84 to 1.09, and all outcomes demonstrated statistically significant time × group interactions (p≤0.001). No adverse events were registered during the study in either group.

Conclusion: For patients with moderate-to-severe COPD, inspiratory muscle training with visual biofeedback in addition to breathing exercises is significantly more effective in improving dyspnea, exercise tolerance, pulmonary function, and quality of life compared to traditional breathing exercises alone, which supports its added value in the pulmonary rehabilitation curriculum.

DOI: https://doi.org/10.59564/amrj/03.04/004

School Nutrition Standards and Childhood Obesity Prevention: Assessing Policy Compliance and Long-term Health Effects in Low-Income Communities in Pakistan

2025-11-14T11:10:32+00:00

Background: Childhood obesity is an escalating crisis in Pakistan, exacerbated in low-income communities by obesogenic food environments. The national School Health and Nutrition (SHN) Strategy aims to create healthier school food spaces, but its real world effectiveness remains unassessed. This study investigated the relationship between compliance with the SHN Strategy and long-term changes in children's weight status in low-income schools in Karachi.

Methods: A three-year (2020-2022) longitudinal cohort study was conducted across 12 schools. Policy compliance was assessed using a validated tool, categorizing schools as High, Moderate, or Low Compliance. Anthropometric measurements (BMI z-scores) of 528 children were tracked annually. Mixed-methods included quantitative surveys and qualitative interviews with stakeholders.

Results: Only 16.7% of schools maintained High Compliance. A significant interaction was found between time and compliance group on BMI z-scores (p<0.01). Children in High Compliance schools showed a slight decrease in mean BMI z-score (-0.07), while those in Moderate and Low Compliance schools showed increases (+0.11 and +0.19, respectively). The prevalence of overweight/obesity remained stable in High Compliance schools (18.2% to 17.0%) but increased significantly in Moderate (21.4% to 26.4%) and Low Compliance schools (20.5% to 29.1%). Key barriers to compliance were financial pressures, student preferences, and lack of enforcement.

Conclusion: Faithful implementation of school nutrition standards is effective in mitigating unhealthy weight gain in children. Moving from voluntary guidelines to mandatory, monitored regulations with economic incentives is crucial for public health impact.

DOI: https://doi.org/10.59564/amrj/03.04/005

Effect of Blood Flow Restriction Training vs. Conventional Strength Training on Quadriceps Strength in Early Knee Osteoarthritis: A Randomized Controlled Trial

2025-11-14T12:26:22+00:00

Background: Knee osteoarthritis is a common musculoskeletal condition marked by quadriceps weakness and functional deterioration. Blood flow restriction training (BFRT) has emerged as a beneficial alternative to traditional high-load strength training, although comparable data in early knee osteoarthritis is sparse. The purpose of this study was to assess the effects of blood flow restriction training and traditional strength training on quadriceps strength, pain, and functional outcomes in patients with early knee osteoarthritis.

Methods: A randomized controlled experiment with two arms and parallel groups was done at Ikram Hospital in Gujarat, Pakistan. Sixty people with Kellgren-Lawrence grade I-II knee osteoarthritis were randomly assigned to receive either BFRT (20-30% of 1 RM with 60-80% arterial occlusion) or conventional strength training (CST; 70-80% of 1-RM) for 12 weeks (3 sessions per week). Quadriceps muscle strength, knee injury and osteoarthritis outcome score (KOOS), counter movement jump performance, and Timed Up and Go test were measured at baseline, 6 weeks, and 12 weeks, respectively.

Results: The study had 51 individuals (26 BFRT and 25 CST). The BFRT group outperformed the CST group in quadriceps strength (6.84 vs 4.78 Nm/kg, p=0.001), KOOS scores (17.38 vs 13.35 points, p=0.002), and countermovement jump height (4.87 vs 3.39 cm, p=0.001). There were no adverse events reported in either group.

Conclusion: In patients with early knee osteoarthritis, blood flow restriction training with low-load resistance exercises improved muscle strength, pain, and functional performance more than conventional high-load strength training, while remaining safe and tolerable.

DOI: https://doi.org/10.59564/amrj/03.04/006

A Comparative Analysis of Neural Mobilization Techniques and Conventional Physical Therapy for Sciatica Pain Management in Lumbar Radiculopathy

2025-11-14T11:21:06+00:00

Background: Lumbar radiculopathy (LR), often manifesting as sciatica, is a prevalent and debilitating condition characterized by neuropathic pain radiating along the sciatic nerve. While conventional physical therapy (CPT) remains a cornerstone of conservative management, the efficacy of targeted neural mobilization techniques (NMT) is a growing area of investigation. This study aimed to compare the effectiveness of NMT versus CPT on pain, disability, and functional outcomes in patients with sciatica due to LR.

Methods: A randomized controlled trial was conducted with 60 participants diagnosed with LR. Participants were allocated to either an NMT group (n=30), receiving slider and tensioner techniques for the sciatic nerve, or a CPT group (n=30), receiving a standardized protocol of lumbar stabilization exercises, stretching, and electrotherapy. The primary outcome was pain intensity measured by the Visual Analogue Scale (VAS). Secondary outcomes included disability, measured by the Oswestry Disability Index (ODI), and lumbar range of motion (ROM). Assessments were performed at baseline, 4 weeks, and 8 weeks post intervention.

Results: Both groups demonstrated significant improvements in all outcome measures over time (p<0.05). However, the NMT group exhibited significantly greater reductions in VAS scores (Mean Difference at 8 weeks: -2.4, 95% CI: -3.1 to -1.7, p<0.001) and ODI scores (Mean Difference at 8 weeks: -12.8%, 95% CI: -16.1 to -9.5, p<0.001) compared to the CPT group at the 4- and 8-week follow-ups. Improvements in straight leg raise (SLR) ROM were also significantly superior in the NMT group.

Conclusion: Neural mobilization techniques were more effective than conventional physical therapy alone in reducing pain and disability and improving functional outcomes in patients with sciatica from lumbar radiculopathy. Integrating NMT into standard rehabilitation protocols should be considered for optimal management.

DOI: https://doi.org/10.59564/amrj/03.04/007

Associations of Gestational Diabetes, Multiparity, and Hyperlipidemia with Preeclampsia

2025-08-22T20:07:25+00:00

Background: Preeclampsia is a multifactorial disorder of hypertension and proteinuria, which has a global prevalence of 2-8% of pregnancies. Its pathogenesis is still unclear, and the major risk factors are obesity, nulliparity, and preliminary hypertension. Present study was aimed to analyze associated risk factors and altered levels of hematology and serum lipids in preeclampsia patients.

Methods: This case-control study was conducted at the Institute of Biochemistry, University of Sindh, Jamshoro. The study was carried out from June 2024 to May 2025. Pregnant women, 75 with preeclampsia (Preeclampsia patients) and 75 without preeclamopsia (controls) were included. Blood samples (5 ml) were collected from participants to analyze hematology and lipid profile along with questionnaire. SPSS version 21 was used for statistical analysis, p value <0.05 for level was the level of significance at 95% confidence interval.

Results: The study presents an overview of the comparative analysis of complete blood count, altered serum lipid levels, and associated risk factors including gestational diabetes, multiparity, microcytic anemia, and hyperlipidemia were found among preeclampsia patients. It also highlights major differences in parameters like hemoglobin, RBCs, platelets, monocytes, lymphocytes and monocytes in preeclampsia patients and healthy controls.

Conclusion: Gestational diabetes, multiparity, microcytic anemia, and hyperlipidemia are positively associated with preeclampsia. High salt intake and red meat consumption are also significantly positively associated with preeclampsia disease. What these results show is that preeclampsia isn't caused by just one thing, it's a mixture of factors and that pushes hard for thorough prenatal screening of metabolic problems and blood abnormalities.

DOI: https://doi.org/10.59564/amrj/03.04/008

Exploring Trends and Burden of Coronary Artery Disease and its Risk Factors: A Case Control Study

2025-10-02T11:08:56+00:00

Background: Cardiovascular Disease (CVD) has emerged as the foremost non-communicable health challenge globally, accounting for the majority of deaths. This rising prevalence is driven by lifestyle transitions, demographic shifts, and under-recognized risk factors. Despite this growing concern, population-based evidence on CVD prevalence and its determinants remains limited. The present study aimed to estimate the prevalence of CVD and investigate the contribution of major risk factors in the development of coronary artery disease.

Methods: This case-control study was carried out among 216 adults aged above 30 years. Participants were recruited using consecutive sampling methods. Information on demographics, smoking, physical activity, diet, family history, and medical conditions was obtained through medical records. Patients with developed coronary artery disease (cases) and the participants who have not developed the disease (controls). Prevalence was expressed as percentages with 95% confidence intervals. Chi-square tests assessed group differences, while binary logistic regression identified independent predictors of CVD.

Results: Study participants were evenly distributed into cases and controls. The distribution of CVD was higher in males (69.4%) compared to females (39.6%) and rose sharply with increasing age (24.5% in > 50 years versus 10.6% in <40 years, p < 0.05). In regression analysis, hypertension (OR = 1.356), diabetes mellitus (OR = 1.706), dyslipidemia (OR = 2.733), obesity (OR = 1.00), and smoking (OR = 1.606) were independently associated with CVD, after adjusting for age and sex.

Conclusion: This study reveals that the most important independent risk factor for coronary artery disease in the studied population is dyslipidemia, found in cases in comparison to controls. Furthermore, the prevalence of CAD in older persons points to the necessity of focused screening initiatives in these demographics.

DOI: https://doi.org/10.59564/amrj/03.04/009

Molecular Detection of Mycobacterium tuberculosis in the Indigenous Population of Tharparkar, Sindh, Pakistan. Using GeneXpert Assay: Age and Gender Stratified Analysis

2025-10-14T14:44:19+00:00

Background: Mycobacterium tuberculosis (MTB) the causative agent of Tuberculosis (TB), spreads through air from infected persons via coughing, sneezing etc. It affects various body organs such as kidneys, brain, spine but in majority of cases it affects lungs and causes pulmonary TB. The distribution of the Pulmonary tuberculosis burden across Pakistan is diverse, with incidence rates ranging from 110 cases per 100,000 to 462 cases per 100,000 inhabitants. Given that Tharparkar is a rural and underdeveloped area, the TB burden is underreported. The current paper evaluates the burden of TB cases in the indigenous population of Tharparkar region of Province Sindh with age and gender wise stratified analysis.

Methods: A total of 1,099 sputum samples from clinically and radiologically suspected TB patients were tested for MTB and rifampicin resistance using the GeneXpert/RIF assay. Data was analyzed using IBM SPSS Statistics version 20, applying chi-square tests and odds ratios (95% CI) to assess differences in MTB positivity across age groups and genders.

Results: Of the 1,099 samples, 198 (18%) were MTB positive. Notably, no case of MDR-TB was detected. MTB prevalence was slightly higher in males (n=133, 18.9%, median age: 40) than in females (n=65, 16.4%, median age: 35). The highest positivity (n=11, 25.6%) was observed in the 71–80 age group. Gender-specific trends showed peak prevalence in males aged 71–80 (n=9, 33%) and in females aged 11–20 (n=10, 27%, mean age: 18.08 years). Differences in prevalence between genders exceeded 60% in the 41–50 and 71–80 age groups, though not statistically significant (p-values = 0.083 and 0.130).

Conclusion: Tharparkar data indicates a significantly lower prevalence, approximately 61.5% lesser, than in KPK and FATA, earlier onset in females and absence of MDR-TB, indicating region’s unique environmental or sociocultural factors need further investigation.

DOI: https://doi.org/10.59564/amrj/03.04/010

Patient Perspectives on the Role of Occupational Therapy in Managing Rheumatoid Arthritis: A Cross-Sectional Study

2025-08-13T09:51:25+00:00

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that significantly impacts patients' functional independence and quality of life. While occupational therapy (OT) plays a crucial role in RA management through joint protection techniques and adaptive strategies, patient awareness and utilization of these services remain suboptimal. This study aimed to assess patient perspectives on the role of OT in managing RA, evaluating their awareness, experiences, and barriers to accessing OT services.

Methods: A cross-sectional study was conducted across service hospitals in Karachi using non-probability convenience sampling. A validated self-designed questionnaire comprising 31 questions was administered to 303 participants diagnosed with RA. The questionnaire assessed demographic information, life satisfaction, specific concerns about RA treatment, and perceptions of OT awareness. Inclusion criteria encompassed participants aged >18 years diagnosed with RA, excluding those with severe mental illness or cognitive impairment.

Results: Among 100 RA patients (predominantly female housewives), 83% experienced significant lifestyle changes due to RA, with 75% reporting difficulties in basic activities of daily living (BADLs). Despite the functional impact, 85% had never received OT services, with 83% citing lack of awareness as the primary barrier. Among those who received OT (15%), 66.7% expressed satisfaction with the intervention. Notably, 89% of participants would recommend OT for RA management, recognizing its benefits in pain reduction (58%) and improving daily activities (41.7%). Joint pain was the most prevalent symptom (39%), with 50% reporting moderate pain intensity and 44% experiencing severe pain.

Conclusion: This study reveals a critical gap in OT awareness among RA patients, despite high satisfaction rates among those who received services. The findings underscore the urgent need for enhanced patient education, structured referral systems, and better integration of OT into multidisciplinary RA care to improve patient outcomes and quality of life.

DOI: https://doi.org/10.59564/amrj/03.04/011

Comparative Analysis of Salivary Electrolyte Concentrations and Flow Rate in Chronic Smokers versus Non-Smokers

2025-11-14T17:05:36+00:00

Background: Tobacco smoking has well-documented adverse effects on oral health, yet the specific mechanisms by which smoking alters salivary electrolyte composition remain incompletely understood. Given saliva's critical role in maintaining oral homeostasis, investigating smoking-induced changes in salivary electrolytes may provide insights into disease susceptibility patterns observed in smoking populations. This study aimed to quantify and compare salivary electrolyte concentrations and flow rates between chronic smokers and non-smokers, while examining relationships between smoking duration and observed salivary changes.

Methods: We conducted a cross-sectional analysis involving 200 participants (100 smokers, 100 non-smokers) between ages 25-55 years. Both stimulated and unstimulated saliva samples underwent electrolyte analysis using ion-selective electrodes and spectrophotometric methods. Statistical evaluation employed independent t-tests, correlation analysis, and multiple regression modeling.

Results: Smokers demonstrated significantly elevated sodium (p<0.001), chloride (p<0.001), and calcium concentrations (p<0.05) relative to non-smokers. Conversely, potassium and phosphate concentrations were significantly decreased in the smoking group (p<0.01). Both stimulated and unstimulated salivary flow rates showed marked reductions in smokers (p<0.001). Strong positive correlations emerged between smoking duration and sodium/chloride concentrations.

Conclusion: Chronic tobacco use produces substantial alterations in salivary electrolyte composition and secretion rates, which may contribute to the heightened oral disease susceptibility observed in smoking populations. These findings suggest potential utility of salivary electrolyte profiles as biomarkers for smoking-related oral health risk assessment.

DOI: https://doi.org/10.59564/amrj/03.04/012

Establishment of an In-Vitro Alzheimer’s Disease Model Through Amyloid-β(25–35) Neurotoxicity in SH-SY5Y Cells

2025-10-14T15:08:44+00:00

Background: Alzheimer’s disease (AD) is a progressively neurodegenerative condition marked by amyloid-β (Aβ) accumulation and neuronal death. Despite substantial research, effective disease-modifying medications remain unavailable, underlining the need for dependable preclinical models to test novel therapeutic techniques. In order to enable future screening of possible anti-Alzheimer's drugs, the current work set out to create an in vitro Alzheimer's disease model with an ideal dose of Aβ (25–35) that causes repeatable neuronal cytotoxicity in SH-SY5Y cells.

Methods: The experiment was conducted at Ziauddin University, Karachi. SH-SY5Y neuroblastoma cells were treated to Aβ (25–35) at doses ranging from 0–80 μM during 24 hours. Cell viability was assessed using the MTT test, and the concentration that reduced survival by 50–60% was determined as the best cytotoxic dose for model development. To confirm cell death and observe membrane integrity and nuclear morphology, cells had been stained with propidium iodide (PI) and DAPI, then studied by fluorescence microscopy.

Results: Aβ (25-35) treatment produced a clear, concentration-dependent reduction in viability. At 40 μM, cell survival decreased to ~54%, meeting the target threshold of 50–60% cytotoxicity. Fluorescence microscopy confirmed thesefindings, with PI staining highlighting membrane-compromised cells and DAPI revealing nuclear condensation and fragmentation. Together, these outcomes validate 40 μM Aβ (25–35) as a reliable concentration for establishing a standardized in vitro model of AD.

Conclusion: This study created an in vitro Alzheimer's disease model utilizing SH-SY5Y cells exposing them to Aβ(25-35), with 40 μM causing ~50-60% cytotoxicity and neurotoxicity. This model may serve as a core basis for future in vitro AD research.

DOI: https://doi.org/10.59564/amrj/03.04/013

MobileNetV2 and EfficientNetB3 Ensemble for Scalable Dermoscopic Skin Lesion Classification.

2025-10-14T14:49:23+00:00

Background: Skin diseases, ranging from mild benign lesions to life-threatening malignant conditions, remain a major global health concern. Early and accurate diagnosis is critical to avoid complications, yet this is often limited by the shortage of dermatologists and the subjective nature of visual inspections, particularly in low-resource settings. To address this challenge, this study proposes an automated deep learning framework for skin disease classification using dermoscopic images.

Methods: The framework employs a hybrid learning approach by integrating transfer learning and ensemble learning techniques. Specifically, MobileNetV2 and EfficientNetB3 models were combined to leverage their unique strengths, thereby enhancing generalization and predictive accuracy. The system was trained on a well-annotated dataset of 22,177 dermoscopic images, representing eight diagnostic categories that include benign, malignant, and pre-cancerous skin conditions.

Results: Experimental results demonstrated strong classification performance, achieving a training accuracy of 96.81%, validation accuracy of 87.66% (loss of 0.455), and test accuracy of 86%. To improve clinical trust and interpretability, Gradient-weighted Class Activation Mapping (Grad-CAM) was utilized to highlight the image regions that contributed most to the model’s decisions. In addition, a user-friendly diagnostic interface was developed, enabling real-time image input, automated analysis, and clear interpretive guidance. This makes the system accessible not only to healthcare providers but also to non-specialists, bridging gaps in dermatological care.

Conclusion: The proposed solution offers a reliable, interpretable, and scalable application of artificial intelligence for skin disease screening, with significant implications for tele-dermatology and seamless integration into clinical workflows.

DOI: https://doi.org/10.59564/amrj/03.04/014

Digital Tools in Rehabilitation: Helping Therapists Work Smarter

2025-11-14T10:34:09+00:00

Digital tools are reshaping rehabilitation by improving access, monitoring, and personalized care. Tele-rehabilitation, motion tracking, and AI-based apps help therapists work more efficiently. In Pakistan, limited resources and digital readiness hinder progress. Investing in affordable, locally relevant technologies and training can expand rehabilitation services and enhance patient outcomes.

DOI: https://doi.org/10.59564/amrj/03.04/001

Time to Embrace the Future? Blended Learning in Medical Universities in Pakistan: A Student's Perspective

2025-07-23T06:13:03+00:00

Background: Medical education follows the traditional route of education delivery, where people are required to be present in person. Recent advances in technology have increased the efficiency of online education as well as the reliability. Not all students learn at the same pace, which is why blended learning can be such a vital tool in educational delivery.

Methods: A narrative methodological approach was used, which was then elucidated with students’ perspectives and current practices in Pakistan. The manuscripts were reviewed and discussed with relevant themes of online medical education in Pakistan.

Results: The literature survey revealed that blended education shows greater efficacy than traditional learning methods. Recent national policies have also worked on the inclusion of technologies in curricula. The existing medical curriculum must be restructured to accommodate a blended format. This involves dividing content between online and face-to-face components.

Conclusion: Blended learning maximizes learning strategies by combining both the strengths of traditional face-to-face learning and the advancement of online learning. Students can avail themselves of education according to their own pace and can revisit concepts as required. It is, however, yet to be implemented in medical universities.

DOI: https://doi.org/10.59564/amrj/03.04/015