Pakistan Journal of Medical & Health Sciences

Breast Cancer Awareness and Knowledge Among Undergraduate Students of the University of Home Economics, Lahore, Pakistan: A Cross-Sectional Study

Sadaf Iftikhar — 2026-09-30

Background: Breast cancer is an important public health issue and one of the most frequently diagnosed cancers in the world in women. It is crucial to know its risk factors, warning signs and early detection signs to promote early healthcare-seeking behaviour. Despite the availability of the health information, women, even University students have some gaps and misconceptions regarding breast cancer in Pakistan.

Objective: To determine level of awareness and knowledge about breast cancer amongst female undergraduate students of the University of Home Economics, Lahore, Pakistan and investigate the sources, attitudes, related practices, perceived barriers and link between the academic years and the knowledge.

Methods: The study was designed as quantitative descriptive cross-sectional study in context of female undergraduate students of University of Home Economics, Lahore. A sample size of 300 students was proposed and convenience sampling method was applied for the recruitment of the participants. The purpose of the questionnaire, which was structured, self-administered and assessed, was to gather data on the sociodemographic characteristics, general awareness, sources of information, knowledge on breast cancer risk factors, warning signs, attitudes, practices and perceived barriers. Data analysis was done by SPSS 26.0. The frequencies of the participants' answers were summarised using descriptive statistics and the chi-square test was suggested to test associations between academic year and knowledge categories. A value of p < 0.05 was considered statistically significant.

Results: Results showed many participants had a general awareness of breast cancer; however, differences existed in the level of knowledge of breast cancer risk factors, warning signs, and associated health practices. There were some important potential sources of breast cancer information identified, such as social media and online platforms. Potential barriers were also identified and included a lack of information, embarrassment, fear and access to information.

Conclusion: Breast cancer awareness, among the undergraduate students, must go beyond recognising breast cancer to correct knowledge of known risk factors, warning signs, and recommended health care-seeking behaviours. Practical education programmes at the University, experts' awareness raising, and credible digital health information can be effective in addressing gaps in knowledge and encouraging health-informed choices and decisions among young women.

From Skin to Slide: The Role of Artificial Intelligence in Clinicopathological Correlation in Dermatology for Cutaneous Metastasis

Maria Farooqi — 2026-09-30

Background: Digital pathology has started to be invaded by the artificial intelligence (AI) and deep-learning technologies, and evidence on how they perform in comparison with regarding their diagnostic, metastatic-risk, and prognostic capabilities in various clinical environments is limited.

Objective: To explore the AI and deep-learning model performance in melanoma and cutaneous squamous cell carcinoma (cSCC), especially sentinel lymph-node metastasis (SLNM), melanoma-nevus classification, metastatic-risk prediction, survival stratification, and AI-assisted performance of a pathologist.

Methods: A multicentre comparative study was performed based on histopathological and whole-slide imaging (WSI) data, Anmol Hospital, and Mayo hospital, Lahore, Pakistan. AI methods were convolutional neural networks, multiple-instance learning and CLAM, ResNet based models, hybrid machine-learning models and gradient-boosting. Sensitivity, specificity, accuracy, AUROC and AUPRC were used as measures of diagnostic performance. The metastatic-risk assessment was done by logistic regression and prognostic assessment was done by C-index and survival-based assessment. Paired diagnostic analysis was used to compare the performance of AI-assisted and unaided pathologists.

Findings: AI models performed well on significant diagnostic and prognostic tasks. In predicting SLNM, MISSLE hybrid model showed an AUROC of 0.950 (95% CI: 0.933-1.000) and AUPRC of 0.958, which is better than the clinical nomogram (AUROC 0.869). The C-index of the combined clinicopathological-CNN model in cSCC was 0.92 (95% CI: 0.87 0.95). Trans-MIL demonstrated an AUROC of 0.995, sensitivity of 97.7 and specificity and accuracy of 96.2 with an ability to classify melanoma versus nevus. The AI-RFM demonstrated an AUROC of 0.917 and was strongly associated with adverse outcomes (OR 28.80, 95% CI: 4.50–184.0; p < 0.001). AI assistance improved AUC from 0.68 to 0.81 among resident pathologists (p = 0.0057), from 0.84 to 0.93 among junior pathologists (p = 0.029), and from approximately 0.89–0.90 to 0.93 among senior pathologists (p = 0.033–0.042).

Conclusion: AI and deep-learning methods showed great diagnostic and prognostic abilities in cutaneous malignancies. Hybrid AI pipelines combining WSI, clinical, and histopathological data presented specific opportunities, and AI-aided interpretation showed enhancements in the performance of pathologists. Before routine clinical application, prospective multicentre external validation is needed.

Effectiveness of Blue Light Blocking Filter on Dry Eye Disease and Asthenopic Symptoms in Screen Users

Tayyaba Shafqat — 2026-09-30

Objective: To evaluate the effectiveness of Blue Light Blocking (BLB) filters on the severity of dry eye disease (DED).

Study Design: Longitudinal study.

Methods: A longitudinal study was conducted using purposive sampling from September 2022 to May 2023 at the University of Faisalabad. A total of 60 patients with varying severity of dry eye disease were included. DED was assessed using the Ocular Surface Disease Index (OSDI), Tear Breakup Time (TBUT), and Schirmer Strip Test-1 (SST-1). Following baseline assessment, BLB filters were prescribed for 4–5 hours daily. Follow-up assessments were conducted at 1 week, 2 weeks, and 1 month. Repeated-measures ANOVA was used for statistical analysis.

Results: Statistical analysis revealed a significant improvement in the severity of DED following the use of BLB filters (P<0.05). The baseline OSDI value was 2 ± 0.8, which decreased to 0.8 ± 0.6 after 1 month. The baseline Schirmer Strip Test-1 value was 14.5 ± 7.9, increasing to 23.6 ± 7.8 after 1 month. Similarly, baseline Tear Film Stability (TBUT) was 3.7 ± 1.2, increasing to 7.8 ± 2.3 after 1 month. The improvements in OSDI, SST-1, and tear film stability were statistically significant (P=0.002).

Conclusion: The use of BLB filters was associated with a significant improvement in dry eye disease. Improvements were observed in OSDI scores, Tear Film Stability (TBUT), and Schirmer Strip Test-1 results.

Interplay Between Psychological Stress, Testosterone Suppression, and Gonadotropin Alterations in Male Infertility

Muhammad Fayyaz — 2026-09-30

Background: The extreme form of male infertility is idiopathic non-obstructive azoospermia (iNOA), the disease, which is identified by the inhibition of spermatogenesis and has no known etiology. Colonial evidence is emerging that psycho-stress can be related to reproductive activity by neuroendocrine process; although there is scarce information on the relationship between psycho-stress and hormonal, infertility risk, especially in developing states like Pakistan.

Objective: To test the connection among psychological stress, hormonal parameters as well as lifestyle factors in patients with non-obstructed azoospermia of idiopathic etiology against fertile controls.

Methods: The study was a case-control study carried in the Iqra Medical complex and Farooq Hospital of Punjab, Pakistan, between the period of January and December 2025. There were 57 participants composed of 35 patients with non-obstructive idiopathic azoospermia and 22 fertile controls. Demographic information, lifestyle and clinical parameters were documented. Hormonal tests were done on follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin and estradiol. The level of psychological stress was measured, the Perceived Stress Scale (PSS), and anxiety and depression measures were used. Statistical processing was done by the use of the SPSS version 25. The independent t-tests and chi-square tests were performed to compare groups, whereas the analysis through logistic regression was performed to determine the factors that predicted infertility. The receiver operating characteristic (ROC) analysis was conducted in order to assess diagnostic capabilities of stress scores.

Results: The patients with iNOA showed much higher perceptions of stress, anxiety, and depression ratings than the controls (p < 0.01). The patients had significantly lower levels of testosterone and higher levels of FSH. The significant predictors of infertility were perceived stress (OR = 1.22, p < 0.001) and elevated FSH (OR = 1.28, p = 0.006) and low testosterone (OR = 0.75, p = 0.002) in the logistic regression analysis, but physical activity had the effect of protection (OR = 0.68, p = 0.005). The analysis of ROC showed that iNOA is well diagnostically predicted by stress (AUC = 0.82). The regression model accounted about 49 percent of variation in the infertility status.

Conclusion: Men develop a lot of psychological stress and hormonal imbalance with idiopathic non-obstructive azoospermia than the fertile controls. A study that further supported the presence of a biopsychosocial model of the aetiology of male reproductive dysfunction was that psychological stress was an independent predictor of infertility. Psychological assessment and lifestyle changes could contribute positively to the management of infertility.

Handgrip Strength Asymmetry as a Marker of Silent Cerebrovascular Disease in Adults with Hypertension

Farah Shafi — 2026-09-30

Background: Silent cerebrovascular disease (CVD) is common in adult hypertensive patients and can only be detected when cognitive impairment arises. Asymmetry of handgrip strength could be a measure of cerebral injury that reflects disruption of bilateral motor pathways.

Objective: To assess the association between handgrip strength asymmetry and magnetic resonance imaging evidence of silent cerebrovascular disease in hypertensive adults.

Methods: A cross-sectional study was conducted from October 2024 to October 2025 and 120 adults with hypertension at Department of Medicine, General Hospital, Lahore were recruited. Three trials of each handgrip strength were taken with a calibrated dynamometer. Asymmetry was considered as an inter-hand difference of ≥ 10%. Evaluation of the brain magnetic resonance imaging included white matter hyperintensities, lacunes, cerebral microbleeds, and enlarged perivascular spaces. Independent associations were identified using multivariable logistic regression.

Results: The study included 66 men and 54 women, with a mean age of 56.5 ± 7.8 years. Of the 48 participants (40.0%) had handgrip asymmetry and of the 56 (46.7%) had silent cerebrovascular disease. Asymmetry was associated with higher prevalence of disease than was symmetrical strength (60.4% vs 37.5%, p=0.014). The asymmetry group showed a higher prevalence of WMH, lacunes, multiple imaging abnormalities, and microbleeds. Asymmetry was independently associated with silent cerebrovascular disease after adjusting for age, sex, diabetes, duration of hypertension, systolic blood pressure, renal function and average grip strength (adjusted odds ratio 2.61; 95% confidence interval 1.14–5.98; p=0.023).

Conclusions: Silent cerebrovascular disease was independently associated with handgrips strength asymmetry and might be used for risk classification in adults with hypertension.

Health Literacy, Patient Activation, and Self-Care in Heart Failure

Ghulam Farid — 2026-09-30

Heart failure (HF) is a chronic cardiac disease that comes with a requirement for ongoing self-care for clinical stability and preventing disease progression. Good self-care includes taking medicines as prescribed, adopting a healthy diet, keeping an eye on their weight and checking for symptoms and seeking appropriate help when they are needed. Patients may face challenges in practicing these actions due to low health literacy levels, lack of confidence and access of health information. Better education of heart attack and cardiovascular disease is vital in enhancing patient education with regard to its symptoms and prompt care-seeking in Pakistan¹.

Enhance health literacy and self-care adherence: Health literacy is a person's ability to access, understand, evaluate and use health information to make health care decisions. Poor health literacy can lead to poor comprehension when it comes to delivering treatment instructions, medication routines, dietary guidelines, and warning signs of clinical deterioration. Cardiovascular research has shown the significance of health literacy in relation to long-term health consequences after myocardial infarction². Patient education and health Literacy interventions can be used as tools to promote informed decisions and patient engagement in healthcare³. However, consistent adherence to self-care may not be assured by knowledge. The patient will also need to show motivation, skills, confidence, and to implement the information took in their everyday health behaviour.

Patient Activation:

Patient activation is the extent to which people know, have the skills, confidence and motivation to take control of their health and actively engage in health care decisions. ⁴. Likewise, existing research has shown that health literacy and patient activation are important factors in health-seeking behavior, though their roles can be different in various populations and settings⁵.

There is evidence that interventions designed to target health literacy and patient activation will support better outcomes for chronic disease self-management in the outpatient community⁸. Treatment of behavior changes to improve patient activation amongst hypertensive adults have also been examined, and it is possible that the use of such methods can help in improving patient empowerment in self-management⁹. The results of this study highlight the need to combine educational and behaviour change interventions to enable patients to learn how to apply the knowledge of health-related behaviours to long-term self-care.

Digital Literacy and Social Support

Stakeholders must be able to find and make sense of information in digital health guidelines and use them appropriately. Digital resources should, however, be used to complement not supplant communication with health care providers. As patients trust on the medical sources for health information and patients gradually mobile applications, use e-health services and for better health management of the disease, digital health literacy is becoming gradually crucial.

Self-care and health information utilization and navigation through the healthcare system also may be supported by social and family supports. The importance of considering, as part of the health outcomes to be investigated, health-related social support and family support is described in the research on integrated health literacy models⁶. Cardiac rehab also offers opportunities for reinforcement of health literacy through structured education, and patient-centered support¹⁰.