Pakistan Journal of Medical & Health Sciences

Association between Ambient Air Pollution Exposure and Ocular Surface Disorders Among Adults in Urban Lahore. A Cross-Sectional Clinical Study

IRUM ABBAS — 2025-11-30

Background: Urban air pollution has turned out to be a leading issue of public health in Lahore with frequent air smog cases, contributing to a high level of ocular morbidity. Pollutants of the air particularly affect the eyes because the eyes constantly encounter the environment.

Objectives: It is aimed to determine the correlation between the exposure to air pollution in the ambient setting and ocular surface diseases among adults living in Lahore.

Methods: It was a cross-sectional clinical study in 100 adults who were recruited at ophthalmology outpatient clinics. The structured questionnaires and clinical examinations, which were used to get the data included tear break-up time (TBUT), Schirmer test, eyelid margin test, conjunctival hyperemia, allergic conjunctivitis, and meibomian gland dysfunction. The level of exposure was determined with the help of outdoor time per day, living in close relation to traffic and industrial facilities, and environmental AQI.

Results: Eye redness (72%), dryness (68%), burning sensation (61%), tearing (54%) and foreign-body sensation (49%) were found to be the most common. Clinically diagnosed dry eye (TBUT <10 seconds) was found in 58% of the subjects, low tear production in 40% and meibomian gland dysfunction in 32%. The percentage of allergic conjunctivitis was detected as 27. The exposure to greater pollution levels was associated with greater ocular symptoms and lower tear stability.

Conclusion: There are several ocular surface disorders that have a close correlation with ambient air pollution among the adult population in Lahore. There is an urgent need to implement preventive methods such as the development of public awareness, protection-based eyewear, and prompt ophthalmic examination during smog-prone instances to decrease the morbidity of the eye in a highly polluted environment.

Association between Chronic Allergic Rhinitis and Sleep Quality Disturbances among Young Adults. A Cross-Sectional Clinical Study

SAIRA ZAMN — 2025-11-30

Background: Chronic allergic rhinitis (CAR) is a common IgE-mediated upper airway inflammatory disease, which is often accompanied by nasal congestion, rhinorrhea, and sneezing. There is a growing body of evidence indicating that CAR has a major disturbance effect on sleep quality, especially in young adults who are already exposed to various academic and psychosocial stressors.

Aims: To evaluate the relationship between chronic allergic rhinitis and sleep quality disturbances in young adults with the aid of a uniform sleep assessment instrument.

Methods: Cross-sectional clinical study will be done in an ENT outpatient clinic between January and December 2024. One hundred and fifty (150) individuals of ages 18-35 years old were randomized to participate in the study with 75 participants being patients of CAR and other 75 controls. The level of sleep quality was measured through use of the Pittsburgh Sleep Quality Index (PSQI). Demographic data, severity of the symptoms, and triggers were noted. A chi-square, t-tests, and a logistic regression of p = 0.05 were used to conduct statistical comparisons.

Results: CAR group scored considerably greater global PSQI scores in comparison with controls (9.2 ± 3.4 vs. 4.1 ± 2.2; p < 0.001). A lower sleep quality (PSQI > 5) was found in 69.3% of CAR and 25.3% among the controls (p < 0.001). Constant and moderate-to-severe CAR was closely linked to sleep disturbance. The logistic regression revealed that CAR is an independent finding that predicts poor sleep quality (adjusted OR 3.84; 95% CI: 2.146.91).

Conclusion: CAR has a considerable negative effect on sleep quality in young adults, and persistent and moderate-severe symptoms are the factors that lead to an adverse effect on sleep. Sleep quality assessment should be performed regularly among CAR patients to ensure complete management and the general condition of well-being.

Association between Chronic Psychological Stress, Cortisol Dysregulation, and Risk of Breast Cancer Development in Women. A Case Control Clinical Study

MUHAMMAD HAMZA — 2025-11-30

Background: Chronic psychological stress has been seen as a more and more probable factor in the development of cancer via its impact on the hypothalamic-pituitary-adrenal (HPA) axis and dysregulation of cortisol. Nevertheless, there is limited evidence among clinical populations (especially in low- and middle-income nations).

Objectives: To assess the relationship between chronic psychological stress and cortisol dysregulation and the risk of breast cancer in women.

Methods: The present study is a hospital-based case-control study, comprising of 47 women with a newly diagnosed, histologically confirmed breast cancer and 47 age-matched healthy women, as controls. A structured proforma was used to record the sociodemographic variables, reproductive history and exposure to chronic stress. The Perceived Stress Scale (PSS-10) was used to measure psychological stress. Cortisol levels in the morning went through tests of chemiluminescent immunoassay and evening cortisol in a subset was taken to determine the diurnal rhythm. Dysregulation of cortisol was characterized by abnormal morning cortisol and/or flattened morning to evening cortisol ratio. The statistical tests were chi-square, independent t-test and multivariate logistic regression.

Results: PSS scores were much higher among breast cancer patients than they were among controls (24.8 vs. 17.2, p < 0.001). The cases were much more likely to have high psychological stress and long-term stressors in life. The mean morning cortisol levels were greater in cases (19.6 3g/dl) compared to controls (14.2 3g/dl) and cortisol dysregulation was more common in cases (61.7 vs. 27.6, p < 0.001). Multivariable regression demonstrated stress (AOR: 3.84) and dysregulated cortisol (AOR: 4.46) to be high predictors of breast cancer.

Conclusion: Cryptic psychological stress and dysregulation of cortisol are both of significant relevance in risking breast cancer. The stress and endocrine imbalance screening can be used to detect women who are at high risks and aid the preventive measures.

Association between Dyslipidemia Patterns and Early Cardiovascular Complications among Adults. A Cross-Sectional Clinical Study

ATTAULLAH KHAN NIAZI — 2025-11-30

Background: Dyslipidemia is a significant risk factor that is not only majorly modifiable but also a cardiovascular disease (CVD) risk factor in South Asian populations due to the tendency to develop atherogenic lipid patterns at a younger age. Cardiovascular complications such as diastolic dysfunction, carotid intima-media thickness (CIMT) increase, subclinical ischemia and early ventricular remodeling usually proceed undetected. To enhance preventive cardiology, it is important to understand the association between the various patterns of dyslipidemia and early cardiac abnormalities.

Objectives: to establish the correlation between dyslipidemia trends and early heart diseases in adults.

Methods: A cross-sectional study was carried out on 100 adults aged 30-70 years, in terms of clinical data. After an overnight fast, detailed lipid profiles (TC, LDL-C, HDL-C, TG) were determined. The patterns of dyslipidemia were divided into isolated elevated LDL-C, isolated hypertriglyceridemia, low HDL-C and mixed dyslipidemia. Each participant had ECG and echocardiography to determine the early cardiovascular involvement, such as the diastolic dysfunction, enlargement of the CIMT, LV hypertrophy, decreased EF, and silent ischemic alterations. The SPSS 26 version was used to analyses the data, and Chi-square and logistic regression were used to evaluate the associations.

Results: Dyslipidemia was found in 72 percent of the participants and early cardiovascular problems were detected in 38 percent. Mixed dyslipidemia presented the most significant correlation (64.7%), then isolated high LDL-C (40.9%), and low HDL-C (33.3%). Early cardiac abnormalities were observed in only 10.7% of people having normal lipid profiles.

Conclusion: Mixed dyslipidemia and high LDL-C are channels with high predictivity of early cardiovascular complications. Lipid profiling must be regularly incorporated into cardiovascular risk measurement to help identify the problem early and provide preventive care on time.

Effect of Dietary Fiber Intake on Intestinal Motility in Healthy Adults. A Clinical Study

NEHA AHUJA — 2025-11-30

Background: Normal intestinal motility plays a critical role in normal digestion and clearance. Dietary fiber plays a role in the regulation of the bowel activity though majority of the adult population in the adult population is consuming inadequate amounts. This study investigated the impact of the consumption of dietary fibers on the bowel movement of healthy adults.

Methods: The cross-sectional study was conducted on 100 healthy adults aged adults of 18 to 60 years. Dietary fiber was assessed using a validated food frequency questionnaire and categorized into low (<15 g/day), adequate (15 25 g/day), and high (> 25 g/day). Intestinal motility was measured by use of frequency of bowel motion and Bristol Stool Form Scale. Data were analyzed using chi-square and ANOVA.

Results: The excessive consumption of fiber had a tremendous improvement in the intestinal motility with 85 percent of the participants reporting favorable bowel frequency and 80 percent with favorable stool consistency. Conversely, the low-fiber consumers reported more infrequent rates of the bowel movement (52.9%), hard stool rates (58.8%). The statistical result indicated that there existed significant association between the intake of fiber and the bowel frequency (p = 0.001) and the stool consistency (p = 0.002).

Conclusion: There is a close relationship between improved intestinal motility of healthy adults and increased dietary fiber intake. The massive consumption of fiber may become an encouraging intervention so that to maintain the bowel functions normal and secure the avoidance of the gastrointestinal issues.

Malaria Resurgence in Lahore – An Urgent Public Health Alarm

NAVEED SHUJA — 2025-11-30

Malaria, once considered a predominantly rural disease in Pakistan, has increasingly become a growing concern for urban centers, including Lahore. While Punjab historically reported lower malaria incidence than other provinces, recent climatic changes, rapid urbanization, and migration patterns have created favorable conditions for Plasmodium vivax and, to a lesser extent, Plasmodium falciparum transmission within the city¹. The resurgence of malaria in Lahore signals a worrying shift in disease epidemiology and highlights significant gaps in surveillance, prevention, and vector-control measures.

The urban environment of Lahore has undergone rapid expansion, with large settlements developing around stagnant water bodies, poorly maintained drainage systems, and construction sites ideal breeding grounds for Anopheles mosquitoes². Increased rainfall variability, prolonged warm seasons, and high humidity have further strengthened mosquito survival and transmission cycles. Informal settlements, peri-urban villages, and low-income neighborhoods remain disproportionately affected due to inadequate sanitation, poor housing structures, and limited access to preventive tools such as insecticide-treated nets (ITNs)³.

Another emerging challenge is the influx of individuals traveling from high-burden regions such as Baluchistan, Khyber Pakhtunkhwa, and Afghanistan ⁴. These population movements often introduce new malaria strains and increase the risk of local transmission in Lahore, particularly when screening and surveillance measures are insufficient. Seasonal agricultural labor and internal migration amplify this risk, especially in areas where healthcare access is limited⁵.

Clinically, Lahore’s hospitals have reported a noticeable rise in P. vivax cases during monsoon and post-monsoon periods. Although P. vivax generally causes less severe disease than P. falciparum, its relapsing nature places a recurrent burden on healthcare facilities⁶. Missed radical cure with primaquine due to concerns about G6PD deficiency further complicates treatment outcomes. Delayed diagnosis, misuse of antimalarials, and limited awareness among households contribute to prolonged illness and the potential for complications⁷.

Public health efforts, while present, remain insufficiently coordinated. Vector-control activities, such as fogging and larviciding, often begin only after cases sharply rise. These reactive strategies provide short-term relief but fail to address the underlying environmental conditions that support mosquito proliferation⁸. Lahore requires sustained and integrated vector-management programs that prioritize environmental cleanup, proper drainage, solid waste management, and year-round surveillance.

Community awareness is another critical pillar. Many residents remain unaware of symptoms, available preventive tools, or the importance of early diagnosis. Schools, local councils, community health workers, and digital media must be mobilized to deliver consistent health education campaigns⁹. Emphasis on household-level interventions such as removing stagnant water, using bed nets, and installing window screens can significantly reduce transmission.

Strengthening laboratory capacity and rapid diagnostic testing across public and private facilities is essential. Timely case reporting can support early identification of outbreaks and guide targeted vector-control responses. Lahore’s healthcare system must also address the irrational use of antimalarials, ensuring adherence to national treatment guidelines to prevent drug resistance¹⁰.

Malaria in Lahore is no longer a peripheral concern it is a rising urban health challenge that demands focused, sustainable, and collaborative interventions. With climate change intensifying transmission patterns, the city must adopt long-term strategies that prioritize environmental management, community engagement, timely diagnosis, and evidence-based treatment. Only through integrated and proactive action can Lahore reduce the burden of malaria and protect vulnerable populations from future outbreaks.