Journal of Health, Wellness and Community Research
Journal of Health, Wellness and Community Research (JHWCR) ISSN: 3007-0570 | DOI Prefix: 10.61919 JHWCR is dedicated to advancing global health and community well-being by publishing high-quality, peer-reviewed, open-access research. We actively encourage submissions from early-career researchers and support interdisciplinary work across the health sciences, rehabilitation, allied health, public and behavioral health, epidemiology, biostatistics, chronic and infectious diseases, environmental and global health, healthcare innovations, and basic or allied sciences with human health implications. All manuscripts undergo double-blind peer review and strict ethical screening in line with the guidelines of the Committee on Publication Ethics (COPE) and ICMJE. Frequency: Biweekly Indexing: HEC Pakistan (Y Category), Google Scholar, EuroPub, PakMediNet, Afro-Asian Research Index, CrossRef Open Access: Creative Commons Attribution 4.0 (CC BY 4.0) Publication Fee: PKR 18,000 or equivalent in USD.
Link Medical Interface, Lahore, Pakistan
Health Insurance and Rehabilitation, Bridging the Accessibility Divide
Copyright (c) 2025 Naseem Khan, Syed Asadullah Arslan (Author) https://creativecommons.org/licenses/by/4.0
Challenges in Trauma Rehabilitation in Pakistan: An Editorial View
Copyright (c) 2025 Fozia Nawaz, Syed Asadullah Arsalan Gillani (Author) https://creativecommons.org/licenses/by/4.0
Impact of Probiotics on Mucin Production in the Ocular Surface
Background: Dry eye disease is a common ocular surface disorder characterized by tear film instability and ocular discomfort, frequently managed using artificial tears with variable effectiveness. Emerging evidence suggests that probiotics may modulate immune and microbial pathways relevant to ocular surface homeostasis and tear film stability. Objective: To compare probiotic therapy with artificial tears in adults presenting with dry eye symptoms, using symptom improvement and tear break-up time (TBUT) as indicators of clinical response. Methods: A comparative two-arm interventional study was conducted in a tertiary care hospital in Lahore, enrolling 384 adults with dry eye symptoms allocated equally to a probiotic group (n=192) and an artificial tear group (n=192). Symptom improvement in dryness, itching, burning sensation, and treatment satisfaction was recorded, and post-intervention TBUT was assessed in seconds. Between-group comparisons were evaluated using appropriate inferential tests, with statistical significance defined at p<0.05. Results: The probiotic group reported high improvement rates in dryness (91.1%), itching (89.1%), burning (93.2%), and overall satisfaction (93.2%), while no improvement was recorded in the artificial tear group (all p<0.001). Post-intervention TBUT was higher in the probiotic group (9 seconds) than in the artificial tear group (6 seconds), reflecting an absolute difference of 3 seconds (p<0.001). Conclusion: Probiotic therapy was associated with substantially greater symptom improvement and improved tear film stability compared with artificial tears among adults with dry eye symptoms. Further randomized trials with validated symptom instruments and objective biomarkers are needed to confirm efficacy and clarify mechanisms.
Probiotics; Dry eye disease; Ocular surface; Tear film stability; Tear break-up time; Lactobacillus; Bifidobacterium
Copyright (c) 2025 Iqra Siddiqui, Tehreem Mukhtar, Attia shahzadi, Sadia Tabassum, Hina Areej, Bushra Shafiq baig, Laraib aslam (Author) https://creativecommons.org/licenses/by/4.0
Assessment of Knowledge among Final Year Nursing Students Regarding Diabetes Mellitus in Nursing Institutions of Peshawar
Background: Diabetes mellitus is a major global chronic disease associated with substantial morbidity and mortality, and nurses play a key role in diabetes prevention, education, and complication management; however, inadequate diabetes knowledge among nursing students may compromise clinical preparedness. Objective: To assess the level of knowledge regarding diabetes mellitus among final-year nursing students across KMU constituent and affiliated nursing institutes in Peshawar and to explore associations with educational engagement factors. Methods: A descriptive cross-sectional study was conducted among final-year nursing students using a validated diabetes knowledge questionnaire. A total of 329 participants from 13 institutes completed the survey (response rate 87.2%). Knowledge was categorized as good (14–16), average (12–13), and poor (<12). Descriptive statistics were reported, correlation analysis examined associations between interest and teacher satisfaction, and regression evaluated the relationship between workshop attendance and knowledge score. Results: The mean age was 22.9 ± 1.519 years and 59.3% were male. Good knowledge was observed in 28.9% (n=95), average in 28.9% (n=95), and poor in 42.2% (n=139). Most students were interested in diabetes (76.9%) and satisfied with teachers (64.7%), with a positive correlation between satisfaction and interest (r=0.199, p<0.001). Workshop attendance was low (15.5%) and was not significantly associated with higher knowledge scores (B=−0.393, p=0.056). Conclusion: A substantial proportion of final-year nursing students demonstrated poor diabetes knowledge, highlighting the need for strengthened curriculum delivery and competency-based training.
Diabetes mellitus; knowledge assessment; nursing students; Peshawar; KMU.
Copyright (c) 2025 Inam Ullah, Irfan Ullah, Muhammad Sohail, Fasil Khalil, Afaq Khalid, Shafaat Khan, Atif Ullah, Muhammad Suliman, Gauhar Rahman (Author) https://creativecommons.org/licenses/by/4.0
Effects of Gum Chewing on Post-Operative Ileus, Specifically Focusing on the Time Taken by the Patients to Pass Flatus After Their Ileostomy Reversal
Background: Postoperative ileus after ileostomy reversal commonly delays recovery of gastrointestinal motility and prolongs hospitalization. Sham feeding through gum chewing may stimulate vagal activity and gastrointestinal hormone release, potentially accelerating bowel function recovery. Objective: To evaluate the effect of postoperative gum chewing on time to first passage of flatus after ileostomy reversal. Methods: This randomized controlled trial was conducted at the General Surgery Department, Unit-I, Lahore General Hospital, Lahore, from June 23, 2022, to December 23, 2022. Seventy patients aged 13–65 years undergoing ileostomy reversal for typhoid or tuberculous peritonitis were randomized into two groups (n=35 each). Group A received standard postoperative care without gum chewing, while Group B chewed gum for 30 minutes every 6 hours starting 6 hours after surgery. The primary outcome was time from surgery completion to first passage of flatus; secondary outcomes included length of hospital stay and duration of surgery. Results: Mean time to first flatus was significantly shorter in Group B than Group A (20.53±9.53 vs 33.27±19.47 hours; p<0.001), with an absolute mean reduction of 12.74 hours (95% CI −20.03 to −5.45). Hospital stay was also reduced (4.40±1.03 vs 5.68±1.07 days; p<0.001), while surgery duration did not differ significantly (p=0.566). Conclusion: Postoperative gum chewing significantly reduced time to first flatus and shortened hospital stay after ileostomy reversal, supporting its use as a safe and inexpensive adjunct to enhance postoperative recovery
Abdominal surgery, chewing gum, gastrointestinal motility, ileus, ileostomy reversal, peritonitis
Copyright (c) 2025 Fateen Ahmad, Rabbia Saeed, Aun Jamal, Syed Shams Ul Hassan, Tania Mahar, Sidra Aleem (Author) https://creativecommons.org/licenses/by/4.0
Cranial Ultrasound Findings in Premature Neonates Admitted in Tertiary Care Hospital
Background: Preterm neonates are vulnerable to hemorrhagic and ischemic brain injury, which contributes substantially to mortality and long-term neurodevelopmental impairment. Cranial ultrasound is the most accessible bedside neuroimaging tool for early detection of intraventricular hemorrhage and cystic white matter injury in neonatal intensive care settings. Objective: To determine cranial ultrasound findings among premature neonates admitted to a tertiary care neonatal unit and evaluate associations with gestational age, birth weight, maternal risk factors, neonatal comorbidities, and mortality. Methods: This cross-sectional observational study was conducted in the Department of Pediatrics, Bolan Medical College, Quetta, from 2 December 2023 to 3 June 2024. Premature neonates admitted to the NICU were enrolled after informed consent. Cranial ultrasound was performed by an experienced radiologist, and findings were categorized as normal or abnormal. Associations with gestational age, birth weight, maternal factors, neonatal comorbidities, and outcomes were analyzed using chi-square/Fisher’s exact tests, with statistical significance set at p≤0.05. Results: Among 152 premature neonates, 97 (63.8%) had abnormal cranial ultrasound findings. Intraventricular hemorrhage was the most frequent abnormality (40.42%), followed by periventricular hyper-echogenicity (21.27%). Abnormal ultrasound was significantly associated with lower gestational age and low birth weight, and with respiratory distress syndrome (p=0.014) and birth asphyxia (p=0.008). Mortality was 36.1% and occurred exclusively in the abnormal ultrasound group, with intraventricular hemorrhage reported as the leading imaging-associated correlate of death. Conclusion: Abnormal cranial ultrasound findings were common and clinically meaningful, with intraventricular hemorrhage predominating and carrying the highest mortality risk, supporting risk-stratified neurosonographic screening in premature neonates.
Preterm neonates, Cranial ultrasound, Intraventricular hemorrhage, Periventricular leukomalacia, Respiratory distress syndrome, Birth asphyxia
Copyright (c) 2024 Sona Noor, Mubeen Ur Rehman, Mohammad Waqas Sadiq, Arslan, Lubna Ali (Author) https://creativecommons.org/licenses/by/4.0
Impact of CO2 Pneumoperitoneum on LFTS in Laparoscopic Cholecystectomy Surgery: A Prospective Surgery
Background: Transient abnormalities in liver function tests (LFTs) following uncomplicated laparoscopic cholecystectomy (LC) have been attributed to CO₂ pneumoperitoneum–related hepatosplanchnic perfusion changes, yet the magnitude and time course of these alterations remain clinically relevant in routine standard-pressure practice. Objective: To quantify perioperative changes in ALT, AST, bilirubin, and ALP after uncomplicated LC performed under 14 mmHg CO₂ pneumoperitoneum and to assess whether longer CO₂ insufflation duration is associated with greater postoperative enzyme elevation. Methods: In this prospective observational study conducted at Sandeman Provincial Hospital, Quetta (January–July 2025), 100 adults (20–70 years) with uncomplicated gallstone disease and normal baseline LFTs underwent standardized LC with CO₂ pneumoperitoneum maintained at 14 mmHg. ALT, AST, bilirubin, and ALP were measured preoperatively and on postoperative day 2 and day 10. Paired t-tests compared postoperative values with baseline. Results: On postoperative day 2, ALT increased from 28.19±5.29 to 51.11±13.06 U/L (p<0.001), AST from 31.23±5.51 to 53.79±12.92 U/L (p<0.001), and bilirubin from 0.8229±0.1378 to 1.3840±0.2727 mg/dL (p<0.001), while ALP showed no clinically meaningful rise. Enzyme elevations were more pronounced with longer CO₂ insufflation duration and returned near baseline by day 10. Conclusion: Uncomplicated LC under standard-pressure CO₂ pneumoperitoneum is associated with reversible elevations in ALT, AST, and bilirubin that normalize by postoperative day 10, with greater changes observed after prolonged insufflation exposure.
Laparoscopic cholecystectomy; liver function tests; CO₂ pneumoperitoneum; ALT; AST; bilirubin.
Copyright (c) 2025 Danish Ramzan, Shoaib Ahmed Qureshi, Muhammad Idrees Khan (Author) https://creativecommons.org/licenses/by/4.0
Comparative Study Between Stoma and Primary Anastomosis in Emergency Gut Surgery
Background: Emergency bowel surgery is frequently required for intestinal perforation, obstruction, and trauma, and postoperative wound morbidity remains a major driver of prolonged hospitalization and adverse outcomes. Objective: To compare postoperative wound infection and wound dehiscence rates between stoma creation and primary anastomosis in emergency gut surgery. Methods: This comparative non-randomized clinical study was conducted at the Department of Surgery, Bolan Medical College/Sandeman Provincial Hospital, Quetta, from 04 January 2025 to 04 July 2025. Eighty-six patients undergoing emergency gut surgery were enrolled consecutively and grouped according to operative procedure: stoma creation (Group A, n=43) or primary anastomosis (Group B, n=43). Patients were followed during admission and at one week and one month postoperatively to determine wound infection and wound dehiscence. Between-group comparisons were performed using chi-square tests, and effect sizes were expressed as risk ratios with 95% confidence intervals. Results: Mean age was 37.3±9.9 years, with no significant difference between groups (p=0.231). Wound dehiscence occurred in 25.6% of Group A versus 34.9% of Group B (p=0.348; RR 0.73, 95% CI 0.38–1.41). Wound infection occurred in 4.7% of Group A versus 30.2% of Group B (p=0.002; RR 0.15, 95% CI 0.04–0.64). Conclusion: Stoma creation was associated with significantly lower postoperative wound infection compared with primary anastomosis, while wound dehiscence rates were comparable.
Emergency laparotomy; stoma; primary anastomosis; wound infection; wound dehiscence; intestinal perforation
Copyright (c) 2025 Danish Ramzan, Shoaib Ahmed Qureshi (Author) https://creativecommons.org/licenses/by/4.0
Beyond the Caseload: Valuing the Comprehensive Role of School-Based SLPs
Copyright (c) 2025 Rabia Azmat, Syed Asadullah Arslan (Author) https://creativecommons.org/licenses/by/4.0
Comparison Between the Effectiveness of Core Strengthening Exercises and William Flexion Exercises for Treatment of Non-Specific Low Back Pain in Elderly Individuals
Background: Non-specific low back pain (NSLBP) is highly prevalent among elderly individuals and substantially impairs mobility and independence. Exercise-based rehabilitation is a cornerstone of conservative management, yet comparative evidence between commonly used exercise strategies remains limited in older adults. Objective: To compare the effectiveness of core strengthening exercises (CSE) versus William flexion exercises (WFE) in reducing pain, improving disability, and enhancing trunk muscle strength among elderly individuals with NSLBP. Methods: A randomized controlled trial was conducted among 60 participants aged 60–80 years with NSLBP, allocated to CSE (n=30) or WFE (n=30). Both groups received supervised sessions three times weekly for eight weeks. Outcomes included pain intensity (VAS), functional disability (ODI), and trunk flexor/extensor strength measured using dynamometry at baseline, Week 4, and Week 8. Results: Both groups improved significantly over time. At Week 8, CSE demonstrated superior outcomes compared with WFE for pain (mean difference −0.70, 95% CI −1.19 to −0.21; p=0.006), disability (mean difference −6.70, 95% CI −9.31 to −4.09; p<0.001), flexor strength (mean difference 4.80 Nm, 95% CI 1.16 to 8.44; p=0.011), and extensor strength (mean difference 7.70 Nm, 95% CI 3.85 to 11.55; p<0.001). Conclusion: Both exercise programs improved outcomes in elderly NSLBP, but core strengthening produced greater disability reduction and trunk strength gains by Week 8.
Non-specific low back pain, elderly, core strengthening, William flexion, disability, trunk strength.
Copyright (c) 2025 Sarwat Mehmood, Komal Fatima, Anum Saeed, Ayesha Khalid, Qurrat Ul Ain, Asna Waseem, Rimsha Irshad Ali, Ayesha Saddiqa (Author) https://creativecommons.org/licenses/by/4.0
Comparative Effectiveness of Cervical Spine Mobilization vs. Neuromuscular Re-Education for Cervicogenic Dizziness on Pain, Balance, Function, and Cervical Mobility
Background: Cervicogenic dizziness is characterized by dizziness and postural instability associated with cervical spine dysfunction and is often accompanied by neck pain and restricted cervical motion, yet comparative evidence for manual versus active sensorimotor rehabilitation remains limited. Objective: To compare the effectiveness of cervical spine mobilization versus neuromuscular re-education on pain, balance, dizziness-related disability, and cervical mobility in adults with cervicogenic dizziness. Methods: A prospective, single-blind randomized controlled trial enrolled 70 participants clinically diagnosed with cervicogenic dizziness and allocated them to cervical spine mobilization (n=35) or neuromuscular re-education (n=35). Interventions were delivered three times weekly for eight weeks. Outcomes included Visual Analogue Scale (VAS), Balance Error Scoring System (BESS), Dizziness Handicap Inventory (DHI), and active cervical range of motion (rotation and flexion), assessed at baseline, Week 4, and Week 8. Between-group mean differences, 95% confidence intervals, and Cohen’s d were reported. Results: Both groups improved significantly over time. At Week 8, cervical spine mobilization produced greater pain reduction (mean difference −1.20; 95% CI −1.63 to −0.77; p=0.001; d=−1.30) and greater improvements in rotation (12.0°; 95% CI 7.5–16.5; p=0.002; d=1.26) and flexion (8.0°; 95% CI 4.0–12.0; p=0.01; d=0.94). Neuromuscular re-education yielded superior balance improvement (BESS mean difference 3.40; 95% CI 2.27–4.53; p=0.01; d=1.44). DHI improvements were comparable (p=0.36). Conclusion: Both interventions are effective; mobilization favors pain and mobility, whereas neuromuscular re-education favors balance, supporting deficit-guided treatment selection
Chronic Kidney Disease; Diabetes Mellitus; Emergency Department; Prevalence; Systematic Review
Copyright (c) 2025 Hamdah Rana, Siddra Yasir, Talha Qazi, Farah Iqbal, Anam Maqbool, Burhan Anis, Hamza Afzal, Neha Nasir (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Imbalance and Instability in the Geriatric Population: A Cross-Sectional Study
Background: Imbalance and postural instability contribute substantially to falls, disability, and loss of independence in older adults, yet region-specific functional prevalence data remain limited in developing settings. Objective: To determine the prevalence of balance-related functional dependence among older adults in Lahore, Pakistan, and to examine associations with age and gender. Methods: A cross-sectional observational study was conducted from July to November 2020 among 383 adults aged ≥60 years recruited from community settings and old-age homes in Lahore using convenience sampling. Balance was assessed using the Berg Balance Scale administered by trained assessors, and functional mobility status was categorized as wheelchair-bound, walking with assistance, or independent. Descriptive statistics were calculated with 95% confidence intervals (CIs), and chi-square tests with Cramer’s V were used to evaluate associations. Results: Of 383 participants, 28.2% were wheelchair-bound (95% CI: 23.9–32.9), 48.8% required walking assistance (95% CI: 43.9–53.8), and 23.0% were independent (95% CI: 19.0–27.4). Gender was not associated with functional status (χ²(2)=0.03, p=0.98; Cramer’s V=0.009). Age group was strongly associated with dependence (χ²(6)=54.9, p<0.001; Cramer’s V=0.27), with wheelchair dependence increasing to 56.6% in ages 75–84 and 100% in ages 85–94. Conclusion: Balance-related dependence is highly prevalent among older adults in Lahore and increases sharply after age 75, supporting systematic balance screening and early, targeted interventions to preserve independence and reduce fall risk.
Aged; Postural Balance; Functional Mobility; Activities of Daily Living; Prevalence; Geriatrics; Cross-Sectional Studies.
Copyright (c) 2025 Yashma, Muhammad Ahmed Saleemi, Muhammad Jabbar, Muhammad Haroon-ur-Rahman, Eayza Riaz (Author) https://creativecommons.org/licenses/by/4.0
Background: Job satisfaction among physiotherapists influences workforce retention, productivity, and service quality, particularly in early career stages when professionals are adapting to workplace demands and professional accountability. Objective: To determine overall job satisfaction and domain-level satisfaction patterns among early-career physiotherapists working as clinicians and lecturers in Lahore using the Minnesota Satisfaction Questionnaire (MSQ). Methods: This observational cross-sectional study recruited early-career physiotherapists from universities, clinics, and hospitals in Lahore using purposive sampling. Demographic and occupational characteristics were recorded, and job satisfaction was assessed using the MSQ. Data were analyzed in SPSS version 25 using descriptive statistics and presented as frequencies, percentages, and mean ± standard deviation. Results: A total of 183 physiotherapists participated (51.9% female). The mean age was 26.57 ± 2.10 years and mean experience was 1.89 ± 0.99 years. Overall MSQ scores ranged from 44 to 100, with a mean of 71.40 ± 10.53. Based on MSQ scoring categories, 70 (38.3%) participants were highly satisfied and 113 (61.7%) were moderately satisfied. Satisfaction was strongest for autonomy-related domains and workplace environment indicators, while comparatively lower satisfaction was observed for pay relative to workload and praise/recognition. Conclusion: Early-career physiotherapists in Lahore reported moderate to high job satisfaction, with improvement opportunities centered on compensation and professional recognition
Job satisfaction, Physiotherapists, Minnesota Satisfaction Questionnaire, Early career, Workplace factors
Copyright (c) 2025 Muhammad Ahmed Saleemi, Amna, Adeena Asif, Maheen Sohail, Yashma (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Balance Impairment and Its Association with Quality of Life Among Older Adults
Background: Balance impairment is common in aging and is strongly associated with falls, disability, and reduced health-related quality of life (HRQoL). Objective: To determine the prevalence of balance impairment and examine its association with HRQoL among older adults in Sialkot, Pakistan. Methods: A cross-sectional study was conducted from December 2024 to August 2025 across hospitals, outpatient clinics, and old homes in Sialkot. Using convenience sampling, 267 adults aged ≥60 years were recruited. Balance was assessed using the Berg Balance Scale (BBS) and categorized as normal (40–56), mild (21–39), moderate (11–20), or severe impairment (0–10). HRQoL was evaluated using the SF-36 questionnaire. Associations between balance categories and HRQoL categories were tested using chi-square with effect size estimation, and correlation between total BBS and HRQoL scores was assessed using Pearson’s correlation. Results: Participants had a mean age of 67.62 ± 7.46 years; 70.8% were female. Normal balance was observed in 37.5%, while 44.2% had mild, 10.1% moderate, and 8.2% severe impairment (mean BBS = 33.79 ± 13.64). Mean HRQoL score was 93.73 ± 10.15. Balance category showed a borderline association with HRQoL category (χ² = 12.475, df = 6, p = 0.052; Cramér’s V = 0.153), while total BBS correlated positively with HRQoL (r = 0.308, p < 0.001). Conclusion: Balance impairment was highly prevalent and was positively associated with HRQoL, supporting the need for routine balance screening and targeted rehabilitation interventions in older adults.
Balance impairment, Berg Balance Scale, older adults, SF-36, health-related quality of life, falls risk.
Copyright (c) 2025 Hina Khalid, Sadaf Azam, Esha Shahid, Sawera Amanat, Hafiza Rabia Javed, Raveena Rajpot (Author) https://creativecommons.org/licenses/by/4.0
Effects of Cawthorne–Cooksey Exercises on Balance and Quality of Life in Children with Hearing Deficits
Background: Balance deficits and impaired sensory organization are common in children with severe-to-profound sensorineural hearing loss (SNHL), frequently reflecting vestibular dysfunction that can limit functional participation and health-related quality of life (HRQOL). Objective: To determine the effects of adding Cawthorne–Cooksey vestibular rehabilitation exercises to Swiss ball training on balance and HRQOL in children with SNHL. Methods: A randomized controlled trial was conducted in a school for deaf children in Lahore. Thirty children aged 7–12 years with SNHL (PTA >90 dB) were randomized into Group A (Swiss ball exercises) or Group B (Cawthorne–Cooksey exercises plus Swiss ball exercises). Training was delivered for 45 minutes, three times weekly for eight weeks. Balance and HRQOL were assessed pre- and post-intervention using the Pediatric Balance Scale (PBS), Four Square Step Test (FSST), and a pediatric HRQOL questionnaire. Non-parametric analyses were applied. Results: Mean age was 9.20 ± 1.74 years in Group A and 9.80 ± 1.90 years in Group B. Shapiro–Wilk testing confirmed non-normality of outcomes (p ≤ 0.001). Wilcoxon signed-rank testing showed significant improvement in FSST (p < 0.001) and HRQOL (p = 0.005), while PBS change was not significant (p = 0.102). Mann–Whitney U testing demonstrated significant post-intervention differences for PBS (p = 0.035) and HRQOL (p = 0.002). Conclusion: Vestibular rehabilitation incorporating Cawthorne–Cooksey exercises may improve dynamic balance performance and HRQOL in children with severe-to-profound SNHL.
Balance; Cawthorne–Cooksey; Hearing Loss; Sensorineural Hearing Loss; Vestibular Rehabilitation; Quality of Life
Copyright (c) 2025 Aamir Latif, Sara Khan, Shah Salman, Malik Muhammad Atif, Jaweria Shakeel, Iqra Zenub (Author) https://creativecommons.org/licenses/by/4.0
Impact of Gastrocnemius Tightness on Increased Risk of Plantar Fasciitis Among Hairdressers
Background: Plantar heel pain and plantar fasciitis are common causes of functional limitation, particularly in occupations requiring prolonged standing. Isolated gastrocnemius tightness may increase plantar fascia strain through restricted ankle dorsiflexion, but occupation-specific evidence in hairdressers is limited. Objective: To determine the association between isolated gastrocnemius tightness, pain intensity, and foot health status among hairdressers exposed to prolonged standing. Methods: A cross-sectional observational study was conducted among 155 male and female hairdressers in Lahore using purposive sampling. Isolated gastrocnemius tightness was assessed using the Silfverskiöld test, pain intensity using the Numeric Pain Rating Scale, and foot health status using the Foot Health Status Questionnaire. Associations were evaluated using Pearson’s chi-square test and linear-by-linear association in SPSS version 23, with significance set at p < 0.05. Results: Significant associations were observed between gastrocnemius tightness and foot health status (Pearson χ² = 120.564, p = 0.002; linear-by-linear χ² = 18.562, p < 0.001), gastrocnemius tightness and pain intensity (Pearson χ² = 9.563, p = 0.008; linear-by-linear χ² = 7.730, p = 0.005), and pain intensity and foot health status (Pearson χ² = 201.532, p = 0.004; linear-by-linear χ² = 7.845, p = 0.005). Conclusion: Isolated gastrocnemius tightness is significantly associated with higher pain intensity and poorer foot health status among hairdressers, supporting early screening and preventive interventions targeting calf muscle flexibility in prolonged-standing workers.
Plantar fasciitis; plantar heel pain; gastrocnemius tightness; Silfverskiöld test; foot health; pain; hairdressers
Copyright (c) 2025 Eman Basharat, Muhammad Ahmed Saleemi, Maham Khan, Maryam Mushtaq, Farwa Liaqat, Bakhtawar Sikandar, Yashma (Author) https://creativecommons.org/licenses/by/4.0
Impact of Fall-Related Anxiety on Post-Stroke Balance and Functional Performance: A Review
Background: Fear of falling is a frequent psychological consequence after stroke and may limit balance recovery, mobility, and functional independence. Objective: To synthesize contemporary evidence on the association between fall-related anxiety (fear of falling, reduced falls self-efficacy, or low balance confidence) and post-stroke balance and functional performance in adult stroke survivors. Methods: A systematic review without meta-analysis was conducted using PubMed and Google Scholar to identify studies published between January 2020 and February 2025. Eligible primary studies assessed fear of falling or balance confidence using validated instruments and reported outcomes related to balance, mobility, gait, functional performance, participation, or falls. Findings were synthesized using structured narrative methods due to heterogeneity in designs and outcome measures. Results: Across included studies, fear of falling was consistently associated with impaired balance and reduced functional mobility, and was linked to lower limb weakness, frailty, sensory deficits, prior falls, and assistive device use. Several studies also reported significant associations between fear of falling and recurrent falls, and longitudinal evidence suggested early fear may persist and predict later fear trajectories. Conclusion: Fear of falling is consistently associated with worse balance, mobility, and functional outcomes after stroke and may contribute to ongoing fall vulnerability, particularly among frail and physically impaired survivors. Rehabilitation programs should incorporate routine screening and integrated interventions addressing both physical impairments and fear-related avoidance
Fear of falling; Stroke; Balance confidence; Functional mobility; Rehabilitation
Copyright (c) 2025 Maryam Aslam, Tehreem Mukhtar, Imama Tahir, Iqra Rafiq, Aqsa Tabassum, Muhammad Hammad Saleem, Nimra Rehman (Author) https://creativecommons.org/licenses/by/4.0
Impact of Blue-Cut and Anti-Reflective Coating on Contrast Sensitivity and Color Vision: A Review
Background: Blue light (400–500 nm) has raised concerns regarding retinal photochemical stress, and blue-cut (blue-filtering) spectacle lenses and anti-reflective (AR) coatings are increasingly used to reduce glare and improve visual comfort; however, their functional effects on contrast sensitivity and color vision remain debated. Objective: To synthesize evidence on the impact of blue-cut lenses and AR coatings on contrast sensitivity and color discrimination outcomes in adults under photopic, mesopic, scotopic, and glare conditions. Methods: This narrative review searched PubMed, Scopus, Web of Science, and Google Scholar for English-language studies published between 2011 and 2025 evaluating blue-filtering spectacle lenses, AR-coated lenses, commercially available blue-blocking filters, or blue-filtering intraocular lenses and reporting objective contrast sensitivity and/or color vision outcomes. Results: Most included studies reported no clinically meaningful change in contrast sensitivity with moderate blue-cut filtration across photopic and glare conditions, including studies using AULCSF-based metrics over repeated time points. In contrast, color discrimination outcomes were more sensitive to short-wavelength attenuation, with several studies demonstrating subtle impairment in blue–yellow discrimination or reduced color contrast sensitivity, particularly with stronger blue filtering and under mesopic or low-contrast conditions. Conclusion: Blue-cut spectacle lenses and AR coatings generally preserve contrast sensitivity in most testing conditions, but stronger blue attenuation may modestly reduce blue–yellow color discrimination. These trade-offs should be considered in individuals with high color-critical occupational demands, and standardized spectral reporting and harmonized testing protocols are needed to strengthen clinical guidance.
Anti-Reflective Coating; Blue Cut Lenses; Contrast Sensitivity; Color Vision; Color Discrimination.
Copyright (c) 2025 Sadia Tariq, Tehreem Mukhtar, Palwasha Kanwal, Subhan Tahir, Sadaf Noreen, Soma Nasheen, Samia Khaliq (Author) https://creativecommons.org/licenses/by/4.0
A Randomized Trial of Collagen Peptides Combined with Resistance Training for Pain and Cartilage Turnover in Knee Osteoarthritis
Background: Knee osteoarthritis causes chronic pain and functional limitation, and while resistance training improves symptoms, its influence on cartilage metabolism is uncertain. Collagen peptide supplementation may support connective tissue health, but evidence for combined use with exercise remains limited. Objective: To determine whether collagen peptide supplementation combined with supervised resistance training improves pain and serum biomarkers of cartilage metabolism compared with resistance training alone in adults with mild to moderate knee osteoarthritis. Methods: In this 12-week parallel-group randomized controlled trial conducted in South Punjab, 120 participants were randomized (1:1) to collagen peptides plus resistance training or resistance training alone. Pain intensity was assessed at baseline and 12 weeks using a knee-specific pain rating scale. Serum biomarkers representing cartilage degradation and synthesis were assessed at baseline and follow-up and expressed as percentage change. Between-group differences were evaluated using independent sample tests, with effect sizes and 95% confidence intervals reported. Results: Of 120 randomized participants, 114 completed follow-up. Pain decreased in both groups, with greater improvement in the combined group (12-week pain: 3.2 ± 0.9 vs 4.5 ± 1.0; mean difference −1.30, 95% CI −1.64 to −0.96; p < 0.001). Cartilage degradation biomarkers decreased more in the combined group (−22.4 ± 6.8% vs −10.1 ± 5.9%; p < 0.001), and synthesis biomarkers increased more (+18.6 ± 5.2% vs +7.9 ± 4.8%; p < 0.001). No adverse events were reported. Conclusion: Collagen peptides combined with resistance training produced superior short-term improvements in pain and cartilage turnover biomarkers compared with resistance training alone.
Knee osteoarthritis; collagen peptides; resistance training; pain; cartilage turnover; serum biomarkers.
Copyright (c) 2025 Tooba Khanum, Humera Usman, Syeda Amnah Gillani, Sher Dil Khan, Alize Shahbaz, Abeera Adnan Butt (Author) https://creativecommons.org/licenses/by/4.0
Comparison of Visual and Corneal Parameters Before and After Corneal Cross-Linking Therapy in Patients with Keratoconus
Background: Keratoconus is a progressive ectatic corneal disorder leading to irregular astigmatism and reduced visual acuity, and corneal collagen cross-linking (CXL) is used to improve biomechanical stability and delay progression. Objective: To compare visual acuity and corneal parameters before and six months after epithelium-on accelerated CXL in patients with keratoconus. Methods: A quasi-experimental before–after study was conducted on 30 keratoconic eyes from patients aged 10–30 years attending Mayo Hospital, Lahore. Uncorrected and corrected distance visual acuity (logMAR), keratometry (K1, K2, mean K), and pachymetry (central and thinnest) were recorded preoperatively and at six months postoperatively using Galilei G4. Normality was assessed using Shapiro–Wilk test, and comparisons were performed using paired-sample t-test or Wilcoxon signed-rank test as appropriate (p≤0.05). Results: Mean age was 21.19±6.31 years. UDVA improved from 1.00±0.76 to 0.64±0.30 logMAR (mean improvement 0.36; p=0.005) and CDVA improved from 0.51±0.48 to 0.28±0.26 logMAR (mean improvement 0.23; p=0.001). K1, K2, and mean K increased significantly (p=0.001 for all). Central and mean pachymetry remained stable (p>0.05), with a borderline non-significant reduction in thinnest pachymetry (p=0.056). Conclusion: Epithelium-on accelerated CXL resulted in significant visual improvement with pachymetric stability at six months, while keratometric indices increased, warranting structured tomographic monitoring over longer follow-up.
Keratoconus; corneal collagen cross-linking; visual acuity; keratometry; pachymetry; Galilei G4
Copyright (c) 2025 Tahira Jabeen, Sidrah Latif, Faiza Akhtar, Ammara Tahir, Irfana Bibi, Rao Umair Alam (Author) https://creativecommons.org/licenses/by/4.0
Correlation of Myofascial Trigger Points in Hamstring and Calf Muscle in Patient With Patellofemoral Pain Syndrome
Background: Patellofemoral pain syndrome (PFPS) is a prevalent cause of anterior knee pain in young adults and may involve myofascial dysfunction beyond the quadriceps mechanism, including posterior-chain muscles. Objective: To determine the association between myofascial trigger points (MTrPs) in hamstring and calf muscles and PFPS severity. Methods: A cross-sectional observational study was conducted among 197 adults with PFPS recruited by convenience sampling from tertiary care physical therapy settings in Lahore. PFPS severity was categorized as mild, moderate, severe, or extreme, and pain intensity was categorized using Numeric Pain Rating Scale (NPRS) levels. Palpation-based assessment was used to document the presence of hamstring and calf MTrPs and classify participants into calf-only, hamstring-only, or combined hamstring-plus-calf MTrP patterns. Associations between MTrP patterns and PFPS severity were evaluated using Pearson’s chi-square test with effect size estimation. Results: The mean age was 24.95 ± 3.04 years and 72.6% were male. Calf MTrPs were present in 52.8% and hamstring MTrPs in 58.4%. PFPS severity was moderate in 45.7% of participants. PFPS severity differed significantly across posterior-chain MTrP patterns (χ² = 163.67, df = 4, p < 0.001; Cramer’s V = 0.645), with a higher proportion of extreme severity in participants exhibiting combined hamstring and calf MTrPs. Conclusion: Posterior-chain MTrPs are common in PFPS and demonstrate a strong association with PFPS severity, supporting comprehensive myofascial assessment in clinical evaluation and rehabilitation planning
Patellofemoral pain syndrome; myofascial trigger points; hamstring; calf; anterior knee pain; pain severity.
Copyright (c) 2025 Sibgha Javaid, Sidra Faisal, Tasneem Shahzadi (Author) https://creativecommons.org/licenses/by/4.0
Effects of Post Isometric Relaxation Versus Post Facilitation Stretch to Increase Mobility Among Rounded Shoulder University Students
Background: Rounded shoulder posture (RSP) is common among university students and is associated with muscle imbalance, reduced shoulder mobility, and functional limitations. Muscle Energy Techniques such as Post-Isometric Relaxation (PIR) and Post-Facilitation Stretching (PFS) are used to improve flexibility and restore mobility, but direct comparative evidence in RSP remains limited. Objective: To compare the effectiveness of PIR versus PFS in improving shoulder mobility, posture-related wall test performance, and pain-related disability among university students with RSP. Methods: A randomized clinical trial was conducted at Gujranwala Institute of Medical and Emerging Sciences. Students aged 18–28 years with confirmed RSP were allocated into PIR (n=65) or PFS (n=65). Both groups received postural correction guidance and scapular retraction exercises; Group 1 received PIR and Group 2 received PFS three sessions/week for four weeks. Outcomes included goniometric shoulder ROM (flexion, extension, abduction, adduction, internal and external rotation), SPADI, and wall test. Results: Both interventions significantly improved mobility and function (p<0.001). PFS demonstrated superior post-intervention outcomes for flexion (p=0.002), extension (p<0.001), adduction (p<0.001), SPADI (p<0.001), and wall test (p<0.001) at p≤0.01. Abduction (p=0.029) and external rotation (p=0.022) favored PFS but did not meet the prespecified alpha. Conclusion: Both PIR and PFS were effective, with PFS producing greater short-term improvements in key mobility and functional outcomes among students with RSP.
rounded shoulder posture; post-isometric relaxation; post-facilitation stretching; SPADI; goniometry; wall test..
Copyright (c) 2025 Noha Arshad, Areeba Saeed Lone, Muhammad Zulkifal, Zunaira Kosar, Sajeel Masih, Laiba Shoaib, Uswa Arshad (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Premenstrual Syndrome and Its Impact on Quality of Life in Married Females With Polycystic Ovary Syndrome (PCOS)
Background: Polycystic ovary syndrome (PCOS) is frequently associated with psychological distress and reduced health-related quality of life (HRQOL), and hormonal dysregulation may increase vulnerability to premenstrual syndrome (PMS). Objective: To determine the prevalence of PMS severity among married women with PCOS and assess its association with HRQOL. Methods: A cross-sectional study was conducted from September 2024 to March 2025 among married women aged 25–35 years with PCOS attending hospitals in Sialkot, Pakistan (Ref # USKT/FAHS/RECLetter-00091). PCOS eligibility was assessed using a clinical diagnostic screening questionnaire (score >2). PMS severity was measured using the Premenstrual Syndrome Scale (PMSS), and HRQOL was assessed using the SF-36. Descriptive statistics were used to estimate prevalence, and simple linear regression examined the association between PMS score and HRQOL summary score using SPSS v26. Results: Among 375 participants (mean age 29.45 ± 2.74 years), PMS severity was predominantly severe (47.5%) or moderate (42.9%), with mild (7.7%) and very severe (1.9%) symptoms less frequent. HRQOL categories were severe impairment (40.5%), moderate impairment (17.1%), mild impairment (10.7%), and healthy (31.7%). PMS score showed a statistically significant association with HRQOL (p=0.042), although the explained variance was small (R²=0.011). Conclusion: PMS is highly prevalent in married women with PCOS and is significantly associated with HRQOL; however, the magnitude of association is small, indicating that additional determinants likely contribute to overall quality-of-life impairment.:
Polycystic ovary syndrome; Premenstrual syndrome; Quality of life; SF-36; Married women; Pakistan
Copyright (c) 2025 Sheezah Arshad, Fatima Bano, Tuba shahid, Ansur Ali, Dr. Nayab Naina (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Neck Pain and Risk of Trapezitis Occuring in Beauticians
Background: Beauticians are exposed to sustained neck flexion, prolonged standing, and repetitive upper-limb tasks that may increase neck pain and trapezius muscle overload risk, yet combined profiling of pain severity and ergonomic risk remains limited in local occupational settings. Objective: To determine the prevalence and severity of neck pain and evaluate ergonomic postural risk related to trapezius overload among beauticians in Sialkot, Pakistan, and to assess the association between ergonomic risk and pain severity. Methods: This observational cross-sectional study included 287 male and female beauticians recruited through purposive sampling from beauty salons in Sialkot. Neck pain severity was assessed using the Numeric Pain Rating Scale (NPRS) and categorized as no pain, mild, moderate, or severe. Ergonomic postural risk was evaluated using the Rapid Upper Limb Assessment (RULA) and categorized into four action levels. Associations were tested using Pearson chi-square with p<0.05 significance. Results: Neck pain was reported by 94.4% of participants, with 43.6% reporting moderate pain and 28.9% severe pain. Only 11.1% demonstrated acceptable posture, whereas 44.9% required posture change soon and 6.6% required immediate action. Higher RULA risk was strongly associated with higher NPRS severity (χ²(9)=166.79, p<0.001; Cramer’s V=0.44). Conclusion: Neck pain is highly prevalent among beauticians and is significantly associated with elevated ergonomic postural risk, supporting urgent ergonomic modification and preventive rehabilitation strategies
Neck pain; Trapezitis; Upper trapezius overload; Ergonomics; RULA; NPRS
Copyright (c) 2025 Faiza Bashir, Momna Munawar, Kiran Iqbal, Muhammad Haseeb, Eman Shahzadi, Raveena Rajput (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of Tuberculosis, a Retrospective Review from Findings of Tertiary Care Hospitals Multan Pakistan
Background: Tuberculosis (TB) remains a major public health challenge in Pakistan, with substantial regional variability in facility burden and diagnostic yield. Facility-based evidence from South Punjab is needed to inform targeted TB control strategies. Objective: To describe the facility-based diagnostic yield among presumptive TB patients tested and the demographic and diagnostic-category distribution of TB cases registered at a tertiary-care TB unit in Multan, Pakistan (2023–2024). Methods: A retrospective facility-based record review was conducted at the TB Unit, Nishtar Hospital Multan, from January 2023 to December 2024. Routine program records were used to quantify outpatient screening, presumptive identification, testing volume, bacteriological confirmation yield, and registered TB case distribution by age, sex, and diagnostic category (PBC, PCD, EPBC, EPCD). Proportions with 95% confidence intervals were computed, and chi-square tests assessed sex-based distribution differences. Results: Among 103,109 OPD attendees, 2,882 presumptive TB patients were identified and 2,644 were tested; 173 were bacteriologically confirmed, yielding 6.54% positivity (95% CI 5.66–7.55). A total of 428 TB cases were registered, with males comprising 54.9% and females 45.1%. The highest case concentration occurred in ages 15–24 years (26.2%), with significant sex-by-age distribution differences (p=0.001). Extrapulmonary clinically diagnosed TB predominated (50.7%), with no sex difference in category distribution (p=0.807). Conclusion: TB case notification burden and diagnostic yield remain substantial in this tertiary-care facility, with young adult concentration and high extrapulmonary clinical diagnosis, supporting strengthened diagnostic pathways and targeted interventions.
Tuberculosis; Retrospective review; Facility-based; Pakistan; Diagnostic yield; Extrapulmonary tuberculosis; GeneXpert
Copyright (c) 2025 Samina Alia, Parveen kosur, Naila khalid, Ahmad Masood, Hamza Qasim (Author) https://creativecommons.org/licenses/by/4.0
Comparative Effects of Sequential Versus Non-Sequential Spencer Techniques on Pain, Range of Motion and Functional Outcomes in Patients with Frozen Shoulder
Background: Adhesive capsulitis is a painful and disabling shoulder disorder marked by progressive stiffness and functional decline, frequently requiring prolonged rehabilitation. The Spencer muscle energy technique is widely used, yet whether structured sequencing of its steps improves outcomes remains uncertain. Objective: To compare Sequential versus Non-Sequential application of the Spencer technique for improving pain, range of motion (ROM), and functional outcomes in patients with adhesive capsulitis. Methods: In this single-blind randomized controlled trial, 40 participants with idiopathic adhesive capsulitis were allocated to Sequential Spencer Technique (SST; n=20) or Non-Sequential Spencer Technique (NSST; n=20). Both groups received identical standardized physiotherapy (TENS, hot pack, ultrasound) and exercises. Outcomes included Numeric Pain Rating Scale (NPRS), Shoulder Pain and Disability Index (SPADI), and shoulder ROM in six planes measured pre- and post-intervention after three weeks. Between-group comparisons were performed using independent tests, with within-group analyses using paired tests. Results: Both groups showed significant improvements in NPRS, SPADI, and ROM (all p<0.001). SST produced greater post-treatment pain reduction than NSST (NPRS 1.45 ± 0.88 vs 2.40 ± 0.94; p=0.002) and superior functional recovery (SPADI 32.85 ± 7.60 vs 40.25 ± 8.05; p=0.007). ROM gains were significantly larger in SST across flexion, extension, abduction, adduction, internal rotation, and external rotation (all p<0.05). Conclusion: Sequencing within the Spencer technique enhances pain relief, ROM restoration, and functional recovery in adhesive capsulitis, supporting structured progression as a preferred clinical approach.
Adhesive capsulitis; frozen shoulder; Spencer technique; muscle energy technique; manual therapy; sequencing; range of motion; SPADI; NPRS
Copyright (c) 2025 Hamza Zahid, Danyal Ahmed, Muteeba Butt, Saher Sheraz, Zuhra Rafiq (Author) https://creativecommons.org/licenses/by/4.0
Is Refractive Error Associated with Body Mass Index?
Background: Refractive errors are a leading cause of visual impairment, and both myopia prevalence and obesity rates are increasing globally. Emerging literature suggests that body mass index (BMI) may be associated with refractive outcomes, but findings remain inconsistent. Objective: To synthesize evidence on the association between BMI and refractive errors, including myopia, astigmatism, and hyperopia/hyperopic reserve. Methods: A narrative review was conducted using PubMed/MEDLINE, Google Scholar, Scopus, and Web of Science to identify peer-reviewed observational studies published within the last ten years examining BMI and refractive outcomes. Keywords included body mass index, obesity, overweight, myopia, astigmatism, hyperopia, and refractive error. Findings were synthesized narratively due to heterogeneity in populations and outcome definitions. Results: The reviewed evidence, predominantly cross-sectional, most consistently linked BMI with myopia, including nonlinear (J-shaped or inverse L-shaped) patterns in large adolescent datasets. Associations appeared stronger for high myopia than for mild-to-moderate myopia in several populations. Astigmatism was also positively associated with higher BMI in adolescents and was supported by maternal BMI associations with offspring corneal curvature. Evidence for hyperopia prevalence was limited; however, higher BMI was associated with suspected insufficient hyperopic reserve in preschool children. Conclusion: Current evidence suggests that BMI is associated with myopia and astigmatism, while evidence for hyperopia remains inconclusive. Longitudinal studies with standardized refraction assessment and precise adiposity measures are required to clarify temporal relationships and biological mechanisms.
Body mass index; obesity; myopia; astigmatism; hyperopia reserve; refractive error.
Copyright (c) 2025 Samina Zahoor, Tehreem Mukhtar, Aksa Davis, Asma Hayat, Bariha Khanam, Fatima Liaquat (Author) https://creativecommons.org/licenses/by/4.0
The Socioeconomic Burden of Trauma in Developing Countries: From Silent Epidemic to Policy Priority
Copyright (c) 2025 Faiza Anwar, Syed Asadullah Arslan (Author) https://creativecommons.org/licenses/by/4.0
Systematic Review on the Clinical Utility of Biomarkers in Early Diagnosis and Prognosis of Human Diseases
Background: Biomarkers may improve early diagnosis and prognostic stratification across human diseases, but translation into clinical practice remains inconsistent. Objective: To systematically evaluate evidence on diagnostic and prognostic utility and clinical readiness of biomarkers across diverse disease domains. Methods: A systematic review of systematic reviews and meta-analyses was conducted using PubMed, Scopus, and Google Scholar. Ten eligible reviews (2008–2024) were included after predefined screening. Data were synthesized narratively due to heterogeneity in diseases, biomarker platforms, matrices, and validation stages. Results: Biomarker clinical utility demonstrated marked heterogeneity driven by validation maturity and biological context. Alzheimer’s disease CSF biomarkers (T-tau, P-tau, Aβ42, NFL) showed the strongest readiness for clinical implementation, supported by large meta-analytic evidence (15,699 patients and 13,018 controls) with robust disease–control separation (e.g., CSF T-tau ratio 2.54; P-tau ratio 1.88; Aβ42 ratio 0.56; all p<0.0001). Promising candidates in other domains remained in early validation or discovery phases, including pancreatic cancer microRNA panels with sensitivity and specificity exceeding 90%, uterine disease metabolomics models with AUC up to 0.99, and acute kidney injury biomarkers such as cystatin C, KIM-1, IL-18, and NGAL. Endometriosis peripheral biomarkers demonstrated persistent validation failure despite extensive candidate identification. Conclusion: Biomarkers are clinically implementable only in select contexts, while most candidates require external validation, assay standardization, and demonstration of incremental value over existing clinical pathways before routine adoption.
Biomarkers; Early diagnosis; Prognosis; Validation; Standardization; Clinical readiness; Precision medicine.
Copyright (c) 2025 Muhammad Sohaib Hassan, Sajed Ali, Zara Batool, Abdul Salam, Hina Ali Ahmed, Nida Naeem (Author) https://creativecommons.org/licenses/by/4.0
Comparison of Single-Incision Laparoscopic Surgery (SILC) Versus Conventional Multi-Port Laparoscopic Cholecystectomy
Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic cholelithiasis, and single-incision laparoscopic cholecystectomy (SILC) has been introduced to reduce access trauma and improve cosmetic outcomes; however, evidence remains inconsistent regarding its comparative benefits and wound morbidity. Objective: To compare operative and postoperative outcomes of single-incision laparoscopic cholecystectomy (SILC) versus conventional multi-port laparoscopic cholecystectomy (CMLC) in patients with uncomplicated symptomatic cholelithiasis. Methods: This randomized controlled trial was conducted at the surgical department of Jinnah Hospital, Lahore, from August 3, 2015, to February 2, 2016. A total of 178 patients (18–80 years) were randomized by lottery method into Group A (SILC, n=89) and Group B (CMLC, n=89). Outcomes included operative time, hospital stay, postoperative pain (VAS) immediately and at 24 hours, and wound infection at postoperative day 7 and day 30. Results: Operative time was longer in SILC (65.73±13.48 vs 50.61±9.38 minutes; p<0.001), while hospital stay was shorter (1.11±0.32 vs 1.91±0.87 days; p<0.001). SILC had lower pain immediately (3.16±0.78 vs 4.72±1.07; p<0.001) and at 24 hours (1.67±0.65 vs 3.42±0.77; p<0.001). Wound infection was higher with SILC at day 7 (16.9% vs 5.6%; p=0.018) and day 30 (10.1% vs 2.2%; p=0.029). Conclusion: SILC reduced early pain and length of stay but increased operative time and wound infection compared with CMLC.
Gallstones; cholecystectomy; laparoscopy; single-incision; multi-port; wound infection; pain
Copyright (c) 2025 Hafiz Muhammad Ejaz, Muhammad Saddique Zishan (Author) https://creativecommons.org/licenses/by/4.0