Journal of Evidence-Based Medical Research
The Journal of Evidence-Based Medical Research (JEBMR) is a peer-reviewed, open-access journal dedicated to publishing high-quality research that applies the principles of evidence-based medicine. It aims to bridge the gap between research and clinical practice by disseminating studies, reviews, and meta-analyses that support informed healthcare decision-making. The journal welcomes submissions from all fields of medicine, public health, and healthcare policy, with a strong focus on methodological rigor, clinical relevance, and global applicability.
The Role of Immunometabolic Dysregulation in Obesity-Associated Cardiovascular Risk: A Narrative Review
Background: Obesity is a major global health problem and an established risk factor for cardiovascular disease (CVD). Beyond traditional risk factors, chronic low-grade inflammation and immune-cell metabolic dysfunction may provide a mechanistic link between obesity and vascular disease. Objective: To synthesise current evidence on adipose tissue inflammation, monocyte and macrophage immunometabolic reprogramming, mitochondrial dysfunction, and the pathways connecting obesity with cardiovascular risk, while identifying emerging therapeutic targets. Methods: A narrative review was conducted using PubMed, Scopus, Web of Science, and Google Scholar for studies published from 2000 to July 2026. Original human, animal, and in vitro studies addressing adipose tissue macrophages, immunometabolic reprogramming, inflammatory signalling, metabolic dysfunction, or cardiovascular outcomes were included and synthesised thematically. Results: Obesity was consistently associated with adipose tissue macrophage recruitment and expansion, particularly through CCR2/CCL2 signalling, together with pro-inflammatory metabolic reprogramming characterised by increased glycolysis, altered fatty-acid oxidation, mitochondrial dysfunction, reactive oxygen species production, and activation of HIF-1α and NF-κB. The resulting release of TNF-α, IL-6, and IL-1β contributes to insulin resistance, endothelial dysfunction, hepatic steatosis, and atherosclerosis. Shared inflammatory and metabolic pathways were identified in obese adipose tissue and atherosclerotic lesions. However, a subgroup of individuals with obesity showed little adipose inflammation and relatively preserved vascular function, indicating that adipose tissue quality may be more informative than adiposity alone. Potential therapeutic targets include CCR2, AMPK, ANT2, SIRT3, mitochondrial reactive oxygen species, and dietary macronutrient composition. Conclusion: Immunometabolic dysregulation appears to be a central mechanism linking obesity with cardiovascular disease. Strategies that restore immune-cell metabolism, preserve mitochondrial function, and reduce adipose tissue inflammation may complement conventional weight-management approaches, although further longitudinal and clinical studies are required.
Copyright (c) 2026 Journal of Evidence-Based Medical Research
Attempted Self-Circumcision Using a Non-Medically Approved Device Purchased Online: A Case Report
Background: Circumcision is a common urological procedure with established medical, cultural, and religious indications when performed by trained practitioners in an appropriate clinical setting. Self-circumcision using internet-purchased devices is uncommon but clinically important because it may cause uncontrolled bleeding, tissue loss, urethral injury, infection, psychological distress, and delayed presentation. This case is reported to highlight the emergency management and public health implications of online access to non-medically approved circumcision devices. Case Presentation: A 48-year-old male presented to the emergency department 24 hours after attempting circumcision at home using a preputial stapler and cutting device purchased from an online marketplace. He reported ongoing bleeding, pain, and partially detached preputial and penile shaft skin. Clinical assessment showed a circumferential penile shaft wound with retained staples, exposed shaft tissue, and a cut approximately 7-8 mm proximal to the usual circumcision line. Blood and urine investigations were reported as normal; actual values should be inserted from the clinical record before submission. The patient was counselled and consented for emergency surgical repair. In theatre, staples were removed, haemostasis was secured, and primary wound repair/reconstruction was performed. A mental health assessment was completed during admission. Conclusion: Self-circumcision using devices purchased online may result in significant penile injury requiring urgent urological assessment. Emergency clinicians should document haemodynamic status, wound extent, glans and urethral integrity, infection risk, operative management, mental health assessment, and follow-up outcomes.
Prognostic Value of Microalbuminuria as an Early Marker of Renal Damage in Newly Diagnosed Hypertensive Patients Without Diabetes
Background: Hypertension is a major global public health concern and a leading contributor to cardiovascular and renal morbidity and mortality. Persistent elevation of blood pressure causes progressive renal vascular and glomerular damage, often remaining clinically silent during the early stages. Microalbuminuria has emerged as a potential early biomarker of renal endothelial dysfunction and subclinical kidney injury in hypertensive patients, even before overt renal impairment becomes apparent. Objective: To evaluate the prognostic value of microalbuminuria as an early marker of renal damage in newly diagnosed hypertensive patients without diabetes mellitus. Methods: This study will be conducted as a cross-sectional observational study among newly diagnosed non-diabetic hypertensive patients attending the medical outpatient department of a tertiary care hospital. Demographic and clinical data including age, gender, body mass index, and blood pressure measurements will be recorded. Urinary microalbumin levels, urinary albumin-to-creatinine ratio (ACR), serum creatinine, and estimated glomerular filtration rate (eGFR) will be assessed. Statistical analysis will evaluate the association between microalbuminuria and indicators of renal dysfunction as well as hypertension severity. Results: The study is expected to demonstrate a significant prevalence of microalbuminuria among newly diagnosed hypertensive patients without diabetes. Higher urinary albumin excretion is anticipated to correlate positively with elevated systolic and diastolic blood pressure and negatively with eGFR values. Microalbuminuria is expected to serve as an independent indicator of early renal injury in this population. Conclusion: Microalbuminuria may serve as a sensitive, non-invasive, and cost-effective early marker of renal damage in newly diagnosed hypertensive patients without diabetes. Routine screening for microalbuminuria could facilitate early detection of target organ damage and enable timely therapeutic interventions to prevent progression to chronic kidney disease.
Copyright (c) 2025 Journal of Evidence-Based Medical Research
Role of Tumor-Infiltrating Lymphocytes in Predicting Pathologic Complete Response in HER2-Positive Breast Cancer: An IMRAD-Based Analysis
Background: Tumor-infiltrating lymphocytes (TILs) have emerged as a promising biomarker reflecting the host immune response in breast cancer, particularly in HER2-positive subtypes. Their role in predicting pathologic complete response (pCR) following neoadjuvant therapy remains an area of growing clinical interest. Objective: To evaluate the predictive value of TILs for pCR in patients with HER2-positive breast cancer undergoing neoadjuvant therapy. Methods: A comprehensive review and synthesis of existing clinical studies assessing stromal TIL levels and their association with pCR in HER2-positive breast cancer patients treated with chemotherapy and HER2-targeted therapy were conducted. Relevant studies were identified through systematic database searches, and findings were analyzed to determine correlations between TIL density and treatment outcomes. Results: Multiple studies demonstrated a strong positive association between higher TIL levels and increased rates of pCR. Patients with elevated stromal TILs showed improved responsiveness to trastuzumab-based regimens. Quantitative increases in TILs were consistently associated with higher pCR rates, suggesting a dose-response relationship. Additionally, TILs were linked with improved long-term outcomes, including disease-free survival. Conclusion: TILs represent a robust predictive biomarker for pCR in HER2-positive breast cancer. Their integration into clinical decision-making could enhance patient stratification and guide personalized therapeutic strategies.
Systematic Review of Artificial Intelligence–Based ECG Algorithms for Early Detection of Left Ventricular Dysfunction
Background: Left ventricular dysfunction (LVD), particularly left ventricular systolic dysfunction (LVSD), is a major precursor to heart failure and is often underdiagnosed due to reliance on imaging modalities such as echocardiography. Artificial intelligence (AI) applied to electrocardiography (ECG) has emerged as a promising non-invasive, cost-effective screening tool for early detection. Objective: To systematically review the diagnostic performance, clinical utility, and limitations of AI-based ECG algorithms for early detection of LVD. Methods: A systematic literature review was conducted across major databases including PubMed, Scopus, and Web of Science. Studies evaluating AI-enabled ECG models for detecting LVD were included. Data extracted included study design, population, model type, and performance metrics such as area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. Results: AI-ECG algorithms demonstrated strong diagnostic performance across multiple studies, with reported sensitivities up to 95.6% and high negative predictive values . Deep learning models were capable of detecting subclinical LVSD up to two years before clinical diagnosis . Both single-lead and 12-lead ECG-based models showed promising results, although most studies relied on retrospective datasets. Challenges identified included limited external validation, variability in datasets, and lack of interpretability. Conclusion: AI-enabled ECG represents a transformative approach for early LVD detection, with potential to improve screening and risk stratification. However, further prospective validation and integration into clinical workflows are required.
Association Between Lipoprotein(a) Levels and Recurrent Ischemic Stroke in Young Adults (<50 Years): A Prospective Cohort Analysis
Background: Lipoprotein(a) [Lp(a)] is a genetically determined lipid particle with pro-atherogenic and pro-thrombotic properties. Emerging evidence suggests its role in ischemic stroke, particularly among younger populations, but its association with recurrent stroke remains inadequately explored. Objective: To evaluate the association between elevated Lp(a) levels and the risk of recurrent ischemic stroke in young adults (<50 years). Methods: A prospective cohort study was conducted including young adults diagnosed with first-ever ischemic stroke. Baseline Lp(a) levels were measured and categorized using clinically relevant thresholds. Patients were followed for recurrent cerebrovascular events over 12–24 months. Multivariate Cox regression analysis was used to assess the independent association between elevated Lp(a) and recurrence risk. Results: Elevated Lp(a) levels were significantly associated with an increased risk of recurrent ischemic stroke. Patients with Lp(a) ≥100 nmol/L demonstrated higher recurrence rates compared to those with lower levels. The association remained significant after adjustment for traditional vascular risk factors. Subgroup analysis indicated a stronger association in patients with large artery atherosclerosis. Conclusions: High Lp(a) levels are an independent predictor of recurrent ischemic stroke in young adults. Routine screening of Lp(a) in young stroke patients may improve risk stratification and guide secondary prevention strategies.
Cervicothoracic Non-dysraphism Intradural Lipoma: A Case Report and Surgical Outcome
Background: Cervicothoracic non-dysraphic intradural lipomas are rare benign spinal tumors that can cause progressive neurological deficits due to spinal cord and nerve root compression. These tumors are challenging to manage due to their dense adhesion to critical neural structures, which often renders complete excision unfeasible. This case demonstrates that subtotal resection can effectively balance symptomatic relief and preservation of neurological function. Case presentation: A 24-year-old male presented with a 2-month history of progressive neck pain, hand numbness, and limb weakness. Magnetic resonance imaging (MRI) revealed a cervicothoracic intradural lipoma causing significant spinal cord compression without intramedullary signal changes, suggesting reversible compression. Posterior decompression and subtotal resection were performed using a surgical microscope. The tumor, pale yellow and soft, was adherent to the spinal cord and nerve roots, necessitating the deliberate decision to leave a small residual portion to minimize neurological risks. Postoperatively, the patient demonstrated marked neurological improvement, including reduced pain, resolution of numbness, and full recovery of muscle strength. A follow-up at 20 days confirmed clinical improvement, with MRI showing substantial reduction in spinal cord compression. Conclusions: Subtotal resection is a safe and effective surgical approach for managing symptomatic cervicothoracic intradural lipomas, particularly when complete excision poses significant risks. This approach allows for significant symptom relief while preserving neurological function. The absence of intramedullary signal changes on preoperative MRI served as a favorable prognostic factor, indicating reversible spinal cord compression. Long-term follow-up is crucial to monitor residual tumor growth and ensure sustained clinical stability. This case highlights the importance of individualized surgical planning and cautious intraoperative decision-making to achieve optimal outcomes.
Prevalence of EGFR Mutations in Stage III–IV Non-Small Cell Lung Cancer: A Single-Center Study from Vietnam
Lung cancer is one of the most common types of cancer in Vietnam, with non-small cell lung cancer (NSCLC) being the most prevalent histological type, accounting for up to 80%. Targeted therapies using TKIs have been confirmed to be effective in patients with EGFR mutations. However, the level of effectiveness, response, or resistance to different generations of TKIs depends on the specific type of EGFR mutation. Therefore, testing for EGFR mutations plays an important role in prognosis and treatment decisions. Objectives: 1. To determine the rate of EGFR gene mutations in stage III–IV NSCLC patients. 2.To evaluate the relationship between selected clinical characteristics and EGFR mutation status in the study population. Subjects and methods: A descriptive study was conducted on 56 stage III–IV NSCLC patients who underwent EGFR mutation testing and received treatment at Gia Lai General Hospital from January 2023 to November 2025. Results: The EGFR mutation rate in the study was 37.5%. Exon 19 (Del19) and exon 21 (L858R) were the most frequently detected mutations. Females had a higher likelihood of harboring EGFR mutations compared to males. Non-smokers exhibited a higher risk of EGFR mutations compared to smokers. Conclusion: The EGFR mutation rate in this study is similar to that reported by most domestic studies. The relationship between EGFR mutation status and clinical characteristics observed at Gia Lai General Hospital is consistent with findings from other studies in Vietnam and worldwide.
Acute Appendicitis Presenting as Right Ovarian Torsion in a Teenage Girl - A Case Study
Background: Acute appendicitis is the most common abdominal surgical emergency in the pediatric population. In adolescent females, its diagnosis can be challenging as gynecological pathologies, particularly ovarian torsion, can present with similar symptoms. While both conditions are recognized, the phenomenon of appendicitis perfectly mimicking the clinical and radiological features of ovarian torsion is unusual and can lead to significant diagnostic and management delays. Case Presentation: A 16-year-old female presented to the emergency department with a 24-hour history of acute, severe right lower quadrant pain, nausea, and vomiting. Physical examination revealed localized tenderness and guarding. A pelvic ultrasound, ordered to rule out gynecological pathology, showed a peripherally located, hypoechoic right adnexal mass with absent Doppler flow, highly suggestive of ovarian torsion. No clear, non-compressible appendix was identified. Based on these findings, the patient was taken for an emergent diagnostic laparoscopy with a presumptive diagnosis of right ovarian torsion. Intraoperatively, the right ovary and fallopian tube were found to be viable and normally positioned. Instead, a severely inflamed, retrocecal appendix was identified, which was adherent to the right pelvic sidewall, causing secondary inflammatory changes in the right adnexa. A laparoscopic appendectomy was performed. The patient recovered uneventfully. Conclusions: This case highlights a critical diagnostic pitfall where acute appendicitis, especially in a retrocecal position, can clinically and radiologically mimic ovarian torsion. It underscores the limitations of ultrasonography and the importance of maintaining a broad differential diagnosis in adolescent females with acute abdominal pain. A low threshold for diagnostic laparoscopy is essential in such ambiguous cases to ensure correct identification and treatment of the underlying pathology, preventing unnecessary oophorectomy and managing the true surgical cause promptly.
Early Prediction of Type 2 Diabetes Using Deep Learning on Continuous Glucose Monitoring (Cgm) Data - A Systematic Review
Background: Type 2 diabetes mellitus (T2DM) is a major global health burden characterized by chronic hyperglycemia resulting from insulin resistance and β-cell dysfunction. Despite well-established diagnostic criteria, early detection of individuals at risk remains challenging. Continuous glucose monitoring (CGM) provides real-time, high-frequency glucose data, offering a dynamic view of glucose fluctuations that may precede overt diabetes. Recent advances in deep learning (DL) have created opportunities to analyze these complex time-series data to identify early glycemic irregularities predictive of future diabetes onset. Objective: This systematic review aims to synthesize and critically evaluate existing evidence on the use of deep learning algorithms applied to CGM data for early prediction of type 2 diabetes. It explores the types of models developed, their predictive performance, validation strategies, and methodological quality. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, an electronic search will be conducted in PubMed, Embase, Scopus, IEEE Xplore, and Web of Science from inception to October 2025. Eligible studies will include original research using deep learning methods (e.g., recurrent neural networks, convolutional neural networks, transformers) to predict T2DM onset or progression using CGM data. Two reviewers will independently perform screening, data extraction, and risk of bias assessment using the PROBAST tool. Extracted data will include study characteristics, model architectures, input representations, and performance metrics such as area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and calibration. Narrative synthesis will be provided, and meta-analysis will be performed if sufficient homogeneity exists. Results: The review will summarize key findings regarding the performance of deep learning models in predicting early T2DM, highlight methodological limitations, and identify trends in model interpretability and validation. Conclusion: This systematic review will provide comprehensive insights into the current landscape of deep learning-based CGM analysis for early diabetes prediction. It will identify existing gaps, propose methodological improvements, and outline future directions for translating these models into clinical practice.
Role of Virtual Reality-Assisted Distraction in Reducing Labor Pain and Improving Delivery Outcomes
Background: Labor pain is one of the most intense forms of acute pain experienced by women, and inadequate management can negatively affect both maternal and neonatal outcomes. While epidural analgesia remains the gold-standard pharmacological intervention, it is associated with side effects, high costs, and limited availability in low- and middle-income settings. These limitations have increased interest in non-pharmacological alternatives such as Virtual Reality-Assisted Distraction (VRAD). Objective: To critically examine the role of VR-assisted distraction as an innovative, safe, and patient-centered adjunct for labor pain management, and to explore its implications for clinical practice, adoption barriers, and future research. Methods: This review synthesizes evidence from clinical trials, observational studies, and experimental research evaluating the impact of VR-mediated distraction on labor pain, maternal psychological outcomes, obstetric indicators, and neonatal health. Additional literature on implementation factors, patient education, and health system integration was also analyzed. Results: Across multiple studies, VR-assisted distraction demonstrated significant reductions in perceived labor pain, anxiety, and stress through its immersive multisensory engagement of sensory, emotional, and cognitive pathways. VR use during labor has been associated with higher maternal satisfaction, shorter active labor duration, fewer obstetric interventions, and improved neonatal outcomes, including higher APGAR scores and enhanced maternal–infant bonding. Beyond analgesia, VR has shown potential as a tool for patient education, emotional support, and empowerment during childbirth. However, its implementation is influenced by factors such as device cost, equipment availability, staff training, and cultural acceptance. Conclusion: VR-assisted distraction represents a promising non-pharmacological complement to traditional labor analgesia, offering holistic benefits for maternal comfort, emotional wellbeing, and obstetric outcomes. To integrate VR effectively into obstetric care, health systems must address logistical and cultural barriers, develop clear clinical guidelines, and invest in research exploring cost-effectiveness, patient preferences, and long-term impacts. The adoption of immersive technologies such as VR may strengthen maternal health services globally and enhance patient-centered childbirth experiences.
Severe Dengue Presenting as Acute Myocardial Infarction in a Young Patient: A Case Study
Background: Dengue virus infection is a worldwide arboviral hazard that is typically characterized by fever, aches, and, possibly, excessive plasma loss and blood loss. Though subclinical cardio-involvement is a frequent occurrence, it is a noteworthy and daunting clinical challenge to manifest in a syndrome so indistinguishable with acute myocardial infarction (MI). The case highlights the important overlap between cardiology and infectious disease. Case Presentation: A 32-year-old previously well male patient, having lived all his life in an area with endemic dengue, presented with acute crushing chest pain, electrocardiogram (ECG) showing ST-segment elevation in anteroseptal leads, and a highly elevated high-sensitivity cardiac troponin I level (15.2 ng/mL), which meet the diagnostic criteria of ST-elevation MI (STEMI). He has given a recent history of febrile disease. Physical evaluation demonstrated relative bradycardia and lab results were important in terms of thrombocytopenia and leukopenia. An increase in positive dengue NS1 antigen was a sign of acute infection. Emergency coronary angiography showed normal coronary arteries, which exclude the possibility of atherosclerotic disease. The eventual diagnosis was severe dengue myocarditis and faking STEMI. The management was changed to supportive care and the symptoms were completely resolved and the cardiac function started recovering significantly. Conclusions: The case demonstrates that dengue virus may lead to the development of a severe acute syndrome of myocardial injury that is clinically similar to STEMI. There is a great possibility of overdiagnosis and unnecessary anticoagulation or invasive coronary surgery, and this could prove detrimental in the backdrop of thrombocytopenia and a systemic viral disease. In young, endemic, patients who have STEMI-like manifestations and a febrile prodrome, greater clinical suspicion of dengue myocarditis is urgent. Coronary angiography is the gold standard of a definitive diagnosis and appropriate and possibly life saving management.
Effect of Blood Flow Restriction Training on Quadriceps Muscle Performance Following ACL Reconstruction: A Systematic Literature Review
Background: Owing to disadvantage of conventional rehabilitation, there is need for specific intervention to overcome muscle atrophy or deficits following anterior cruciate ligament reconstruction (ACLR). This clinically significant quadriceps muscle deficiency led to knee pain and biochemical disruptions. Objective: The study aimed to determine the effectiveness of blood flow restriction therapy (BFRT) in the enhancement of clinical outcomes such as muscle strength, muscle size, patient-reported outcomes, and functional performance. Methodology: A systematic review was conducted following Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 guidelines. The literature was searched on PubMed, Scopus and Cochrane library. The search was limited to only articles written in English and published between 1st January 2020 and 31st August 2025. Risk of bias (ROB) was assessed using Cochrane Risk of Bias (ROB) 2.0. The narrative synthesis and data driven iterative approach was used to synthesize evidence. P-value < 0.05 was taken to determine statistical significance. Results: The initial database search yielded 105 articles. After removing (20) duplicates, the titles and abstracts of 85 articles were screened for relevance. Sixty (65) articles were excluded due to irrelevant titles and abstracts. One article did not retrieve full text. The remaining full text of 19 articles was assessed, and 7 met eligibility criteria. The 7 RCTs were included to synthesize evidence. Conclusion: BFRT reported mixed effectiveness for patients underwent ACLR. One model for BFRT incorporation in ACLR rehabilitation emphasize its use in the early post-operative period (2-8 weeks) with low-load resistance training (<30% 1RM) and then implementing it mid-term when high load training (>70% 1RM) is not tolerated. There is clear evidence that 80% or higher AOP/LOP is the ideal dose for muscle strength and size. However, evidence also synthesized that BFRT as an adjuvant to high-intensity protocols reduce knee pain initially but no long-term outcomes. Some RCTs also examined that BFRT did not provide superior role to conventional rehabilitation (pre- or peri). Therefore, future RCTs are emphasized to validate the findings.
The Intersection of Sleep Disorders and Postoperative Pain: A Narrative Review of a Bidirectional and Understudied Relationship
Background: The relationship between pain and sleep represents one of the most significant yet insufficiently researched interactions between physiological systems during the perioperative period. Evidence indicates that pre-existing sleep disturbances, such as insomnia or sleep-disordered breathing, are strong predictors of postoperative pain intensity, higher opioid consumption, and increased risk of chronic postoperative pain. Objective: This review aims to examine the bidirectional interaction between sleep and postoperative pain, highlighting its impact on rehabilitation and recovery, while proposing strategies for improved perioperative care. Methods: Relevant literature was reviewed to evaluate the effects of postoperative pain on sleep architecture, including changes in sleep continuity, slow-wave sleep, and rapid eye movement (REM) sleep. Clinical and mechanistic findings on the reciprocal relationship between sleep disturbance and pain were also analyzed. Results: Postoperative pain was found to fragment sleep, reduce restorative sleep stages, and impair overall sleep quality. Poor sleep, in turn, heightened pain sensitivity, interfered with rehabilitation, and delayed recovery. This cyclical relationship is rarely addressed in standard perioperative care despite its clear impact on patient outcomes. Conclusion: A paradigm shift is required in perioperative medicine to incorporate preoperative sleep screening and targeted multidisciplinary interventions for sleep and pain management. Implications: Future studies should focus on mechanistic and clinical investigations to break the cycle between pain and poor sleep. Integrating sleep-focused assessments and interventions into perioperative care pathways could reduce opioid use, improve recovery, and enhance overall patient well-being.
Nanotechnology-Based Insulin Delivery Systems: A Review of Progress and Challenges
Background: Diabetes mellitus is a chronic metabolic disorder characterized by impaired insulin production or action, leading to hyperglycemia. Conventional insulin delivery methods, such as subcutaneous injections, are limited by poor patient compliance and inability to mimic physiological insulin secretion. Objective: This paper reviews the recent advancements in nanotechnology-based insulin delivery systems, examining their mechanisms, advantages, challenges, and potential for clinical application. Methods: A comprehensive literature review was conducted focusing on lipid-based nanoparticles, polymeric nanoparticles, aquasomes, and electro-responsive systems. Studies exploring AI integration in insulin delivery were also analyzed. Results: Nanocarrier-based delivery systems enhance insulin stability, allow controlled release, improve bioavailability, and provide opportunities for personalized diabetes management. Despite progress, challenges such as formulation stability, scalability, regulatory barriers, and patient acceptance remain. Conclusion: Nanotechnology offers promising strategies to revolutionize insulin delivery. Future research should focus on smart, glucose-responsive systems, biocompatible materials, and streamlined regulatory pathways to facilitate clinical translation.
Leveraging Mobile Health Technologies for Improved Hypertension Control and Patient Adherence
Background: Hypertension is a major global health challenge and a leading risk factor for cardiovascular morbidity and mortality. Despite effective pharmacological and lifestyle interventions, suboptimal adherence to treatment and limited patient engagement remain significant barriers, especially in low- and middle-income countries. Mobile health (mHealth) technologies have emerged as promising tools to address these gaps by supporting adherence, enabling self-monitoring, and fostering behavior change. Objective: This study aimed to explore the role of mHealth technologies in hypertension management, focusing on their impact on treatment adherence, patient engagement, and self-care behaviors. Methods: A convergent parallel mixed-methods design was employed, combining a cross-sectional online survey (n = 150) and semi-structured interviews (n = 30). Participants were adults aged 30–70 years with primary hypertension who had used at least one mHealth application for a minimum of three months. Quantitative measures were guided by the Technology Acceptance Model (TAM) and Health Belief Model (HBM), while qualitative interviews captured lived experiences and contextual factors. Statistical analyses included t-tests, ANOVA, and logistic regression; qualitative data were analyzed using thematic analysis. Results: mHealth usage was widespread, with 91% of participants using apps for blood pressure tracking, medication reminders, or lifestyle monitoring. High-frequency app users demonstrated significantly better adherence scores (p < .01) and more consistent blood pressure self-monitoring (p < .001). Qualitative findings highlighted empowerment through self-monitoring, integration into daily routines, and motivation via feedback and gamification. However, barriers such as technical difficulties, lack of personalization, privacy concerns, and digital inequities—particularly among older adults—limited sustained use. Conclusion: mHealth technologies offer significant potential in improving adherence and self-management in hypertension care. Their effectiveness depends on user-centered design, cultural relevance, personalization, and equitable digital access. Future strategies should integrate behavioral frameworks, enhance digital literacy, and ensure inclusivity to maximize clinical impact.
Prevalence of Musculoskeletal Disorders and Their Risk Factors among Professional Gardeners
Background: Work-related musculoskeletal disorders (WMSDs) are a significant occupational health issue, particularly among professional gardeners due to the physically demanding nature of their tasks. Prolonged awkward postures, repetitive activities, and heavy manual labor contribute to the high prevalence of these disorders. Objective: To systematically review the prevalence, associated risk factors, and preventive strategies for WMSDs among professional gardeners. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Searches were performed in Ovid MEDLINE, CINAHL, EMBASE, and the Cochrane Database of Systematic Reviews for studies published up to May 2022. Inclusion criteria were peer-reviewed studies focusing on professional gardeners and reporting prevalence or risk factors of WMSDs. Data extraction included study design, population characteristics, outcomes, and risk assessments. Quality appraisal was performed using the Newcastle-Ottawa Scale and JBI tools. Results: Fifteen descriptive studies met the inclusion criteria. Across studies, the most affected body regions were the lower back, knees, shoulders, and neck. Common risk factors included repetitive bending and twisting, heavy lifting, prolonged kneeling, and use of non-ergonomic tools. Prevalence rates for WMSDs were consistently high, with lower back pain being the most common complaint. Ergonomic interventions, training programs, and improved tool design showed potential in reducing injury risk. Conclusion: Professional gardeners face a high burden of WMSDs, primarily due to physically strenuous tasks and poor ergonomic practices. Targeted preventive measures, including ergonomic modifications, worker training, and health monitoring, are essential to reduce the incidence of these disorders. Keywords: Musculoskeletal Disorders, Professional Gardeners, Ergonomic Risk Factors, Occupational Health, Work-Related Injuries
Effects of treadmill training with and without weighted ankle cuffs on gait parameters in children with down’s syndrome
Background: The disorder known as Down syndrome is characterized by the presence of an additional chromosome in certain individuals. Within the human body, chromosomes are like little "packages" of genes. It is possible to have Down syndrome (DS), which is often referred to as trisomy 21, if a third copy of chromosome 21 is present, either in its whole or in part. Objective: To compare the effects of treadmill training with and without weighted ankle cuffs on gait parameters in children with Down’s syndrome. Material & Method: Recent clinical trial was randomized. Ethical committee authorized research. After informed permission, patients were enrolled in the research based on inclusion criteria. Simple random sampling yielded 25 samples each category. Everyone was split into two groups. A group underwent treadmill training with weighted ankle cuffs, whereas the other received merely treadmill training. Both groups received conventional therapy—strengthening, and trunk training. The workout had 10 reps/session. Treadmill training for infants (with the help of attendant) lasted for 6 minutes, 4 days a week at 0.18m/sec. After informed consent, gait assessment rating scale and Berg balance scale were used to determine balance and gait characteristics. We gathered data before and after 6 weeks of therapy. Treatment lasted 6 weeks, 1 hour every day, 4 days a week. Comparing improvement before and after 4 weeks was done in SPSS 26.0. Result: The findings indicated no significant difference between groups (p > 0.05). Rejecting the null hypothesis. Treadmill training with ankle cuff improved gait parameters in children with Down's syndrome more than treadmill training alone (Group B). Conclusion: The study found that treadmill training with weighted ankle cuffs offers more clinical benefits than treadmill training without cuffs in improving gait parameters like cadence, cycle duration, and swing time. Additionally, treadmill inclination positively affects hip, knee, and ankle angles, suggesting potential advantages for gait rehabilitation in this group using treadmills.
Antibacterial Prevalence of Multidrug Resistant Pseudomonas Aeruginosa from Critically Ill Patients
Background: Pseudomonas aeruginosa, an adaptive pathogen leads to broad-spectrum infection in human. The treatment of infection is difficult as Pseudomonas aeruginosa is innately imperious to numerous antibiotics. Objective: Therefore, the aim of this study is to investigate multiple drug resistance (MDR) pattern of Pseudomonas aeruginosa. Methods: For this purpose, laboratory based positive samples from different sources including blood, urine, peritoneal fluid and tracheal swabs were selected and then processed for the isolation of MDR Pseudomonas aeruginosa. Bacterial spp. was isolated and purified by using standard microbiological practices. Purified cultures were processed for the bacterial identification by using different staining techniques, morphological, physiological and biochemical analysis. Final characterizations was performed, on the basis of 16S rRNA analysis. For this purpose, genomic DNA was extracted and 16S rRNA primers designed. Gene amplification of 16S rRNA was performed with the help of 16S rRNA primers in TaqMan polymerase chain reaction. Attribute of MDR was assessed by performing antibiotic drug sensitivity reaction. Results: Antibiotic reveled the resistance of Pseudomonas aeruginosa against multiple drugs. For instance, 47% Pseudomonas aeruginosa were resistant to carbimipenem, 46% were resistant to meropenem, 37% were resistant to tazobactam, 56% were resistant to ciprofloxacin, 49% were resistant to gentamycin, 44% were resistant to cetazidmine and 53% were resistant to levofloxacin. Results showed lowest resistance towards tazobactam and highest to ciprofloxacin. The attribute of highest resistance against ciprofloxacin was further evaluated by gene amplification of ciprofloxacin resistant Pseudomonas. Aeruginosa. Gene amplification revealed the 90% ciprofloxacin resistant strains contained the ParC gene. Conclusions: In this study, we concluded that selected Pseudomonas aeruginosa showed high resistant pattern against ciprofolxacine and carbapanam, which indicated Pseudomonas aeruginosa as life threatening pathogen for human.
Effects of Reverse Walking with And Without Whole Body Vibration on Postural Balance and Quality of Life in Children with Cerebral Palsy
Background: Cerebral palsy is the most common cause of spasticity and physical disability in children, and spasticity is one of the most common problems in those with neurological disease. It produces non-progressive brain abnormalities, resulting in mobility difficulties and influencing sensation, perception, cognition, behavior, and communication. Spasticity, dyskinesia, and hyperreflexia impair motor control of walking, reaching, and object-gripping precision Objective: To determine the effects of reverse walking with and without Whole-body vibration on postural balance in children with cerebral palsy. Methods: In this randomized clinical trial, 22 subjects aged 6–12 years from both genders and confirmed diagnosis of cerebral palsy having GMFCS levels I & II were included. The study was conducted in Hussain Memorial Hospital, Lahore, over the duration of 6 months. The subjects were divided into two groups; Group A was treated with (Whole Body Vibration + Reverse Walking), and Group B was treated with Reverse Walking alone. They received treatment sessions for 3 days/week for 3 months. Outcomes were measured at baseline and at 12th weeks. Data was analyzed by SPSS version 26. Results: It shows statistically significant results as p= <.001. So, we reject the null hypothesis. Indicates that the mean difference in group A is more than the mean difference in group B, which shows that the whole-body vibration + reverse walking was more effective than reverse walking alone in improving postural balance, reach, and quality of life in cerebral palsy. Conclusions: The current study concluded that reverse walking with and without whole body vibration was effective in improving postural balance, reach, and quality of life in cerebral palsy children. However, whole body vibration and reverse walking provide more clinical benefits than reverse walking alone in improving postural balance, side reach, and quality of life. Whereas both techniques were equally effective in improving forward reach in cerebral palsy children.