Pakistan BioMedical Journal https://www.pakistanbmj.com/journal/index.php/pbmj <p>Title of Journal: <strong>Pakistan Biomedical Journal (ISSN Online: 2709-2798, Print: 2709-278X)</strong></p> <p>Frequency: <strong>Monthly</strong></p> <p>Affiliated with: <strong>Lahore Medical Research Center</strong></p> <p><strong>Website: (</strong><a href="http://www.lmrc.com.pk">www.lmrc.com.pk</a>)</p> <p>Published By: <strong>CrossLinks International Publishers (CLIP), Lahore, Pakistan</strong></p> <p><strong>Website: (</strong><a href="http://www.clip.com.pk">www.clip.com.pk</a>)</p> <p><strong>Address:</strong> Allama Iqbal Town, Lahore, Pakistan</p> <p><strong>Description:</strong></p> <p><strong>Pakistan BioMedical Journal (PBMJ)</strong> is an Official Journal of "<strong>Lahore Medical Research Center LLP" (LMRC)</strong> and is being funded and supported by Lahore Medical Research Center LLP (LMRC). Pakistan Biomedical Journal (PBMJ) is an open access, double blind peer-reviewed international journal. </p> <p><strong>Aim &amp; Scope</strong></p> <p>The Pakistan BioMedical Journal (PBMJ) covers a diverse range of disciplines crucial to healthcare and academia. This includes Public Health, Clinical Sciences, Dentistry, Nursing, Medical/Health Professions Education, and Biological Sciences related to human health. By embracing such a wide spectrum of topics, PBMJ aims to serve as a comprehensive platform for the dissemination of research and knowledge, fostering interdisciplinary collaboration and advancements in understanding human health and well-being.</p> <p><span style="text-decoration: underline;"><strong>Accreditation:</strong></span></p> <p><strong>Approved by Higher Education Commission of Pakistan for the year 2023-24</strong></p> <p><strong>Fee &amp; Subscription Charges</strong></p> <p>Article Processing Fee: <strong>NONE</strong></p> <p>Article Publication Fee (National) Rs 35000 / Article</p> <p>Article Publication Fee (International ) 200 USD / Article</p> <p>Printed Version ((Selected Articles on Authors Request): Rs 2500/per copy</p> <p><span style="text-decoration: underline;"><strong>Annual Subscription for Printed Versions</strong></span></p> <p>For Institutes: Rs 20,000/ Annually</p> <p>Single Copy (Selected Articles): Rs 2500/-</p> <p><span style="text-decoration: underline;"><strong>Waiver Policy</strong></span></p> <p>If an author has no funds to pay such charges, he may request for full or partial waiver of publication fees. The decision may however vary from case to case.</p> <p>We do not want charges to prevent the publication of worthy material.</p> <p><strong><u>Submissions</u></strong></p> <p><span style="font-size: 0.875rem;">Submission are welcome and may be submitted here. </span><a style="background-color: #ffffff; font-size: 0.875rem;" href="mailto:submissions@pakistanbmj.com">submissions@pakistanbmj.com</a></p> en-US <p>This is an open-access journal and all the published articles / items are distributed under the terms of the <a href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</a>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments <a href="mailto:editor@pakistanbmj.com">editor@pakistanbmj.com</a></p> <p> </p> <p> </p> <p> </p> submissions@pakistanbmj.com (Prof. Dr. Riffat Mehboob) oric@lmrc.com.pk (Khurram Mehboob) Tue, 30 Apr 2024 18:50:07 +0000 OJS 3.3.0.7 http://blogs.law.harvard.edu/tech/rss 60 Investigating the Smartphone Addiction among Undergraduate Nursing Students https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1069 <p><span class="TextRun Highlight SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="none"><span class="NormalTextRun SCXW158620678 BCX0">In today's digital era, smartphones have become a</span><span class="NormalTextRun SCXW158620678 BCX0">n essential part of our society.</span><span class="NormalTextRun SCXW158620678 BCX0"> However, excessive use of smartphones can have a wide range of consequences and it affects students' physical and mental </span><span class="NormalTextRun SCXW158620678 BCX0">health.</span> </span><span class="TextRun SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW158620678 BCX0">Nursing students should </span><span class="NormalTextRun SCXW158620678 BCX0">know</span><span class="NormalTextRun SCXW158620678 BCX0"> the </span><span class="NormalTextRun SCXW158620678 BCX0">appropriate use</span><span class="NormalTextRun SCXW158620678 BCX0"> of smartphones to prevent health complications</span><span class="NormalTextRun SCXW158620678 BCX0">.</span></span><span class="TextRun SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW158620678 BCX0"> Objective</span><span class="NormalTextRun SCXW158620678 BCX0">: </span></span><span class="TextRun SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW158620678 BCX0">T</span><span class="NormalTextRun SCXW158620678 BCX0">o investigate the prevalence of smartphone addiction among nursing students.</span></span><span class="TextRun SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW158620678 BCX0"> Methods: </span></span><span class="TextRun SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW158620678 BCX0">A</span> <span class="NormalTextRun SCXW158620678 BCX0">d</span><span class="NormalTextRun SCXW158620678 BCX0">escriptive </span><span class="NormalTextRun SCXW158620678 BCX0">c</span><span class="NormalTextRun SCXW158620678 BCX0">ross-sectional study </span><span class="NormalTextRun SCXW158620678 BCX0">design </span><span class="NormalTextRun SCXW158620678 BCX0">was </span><span class="NormalTextRun SCXW158620678 BCX0">utilized</span><span class="NormalTextRun SCXW158620678 BCX0"> in </span><span class="NormalTextRun SCXW158620678 BCX0">a total of </span><span class="NormalTextRun SCXW158620678 BCX0">98 nursing students of </span><span class="NormalTextRun SCXW158620678 BCX0">Saifee Burhani</span><span class="NormalTextRun SCXW158620678 BCX0"> S</span><span class="NormalTextRun SCXW158620678 BCX0">chool of</span><span class="NormalTextRun SCXW158620678 BCX0"> N</span><span class="NormalTextRun SCXW158620678 BCX0">ursing</span> <span class="NormalTextRun SCXW158620678 BCX0">in</span><span class="NormalTextRun SCXW158620678 BCX0"> Karachi, Pakistan. </span><span class="NormalTextRun SCXW158620678 BCX0">A convenience sampling technique</span> <span class="NormalTextRun SCXW158620678 BCX0">was </span><span class="NormalTextRun SCXW158620678 BCX0">used</span><span class="NormalTextRun SCXW158620678 BCX0"> to collect data</span> <span class="NormalTextRun SCXW158620678 BCX0">and </span><span class="NormalTextRun SCXW158620678 BCX0">a </span><span class="NormalTextRun SCXW158620678 BCX0">Smartphone Addiction Scale </span><span class="NormalTextRun SCXW158620678 BCX0">s</span><span class="NormalTextRun SCXW158620678 BCX0">hort version</span><span class="NormalTextRun SCXW158620678 BCX0"> (SAS-SV) questionnaire was </span><span class="NormalTextRun SCXW158620678 BCX0">utilized</span> <span class="NormalTextRun SCXW158620678 BCX0">to collect </span><span class="NormalTextRun SCXW158620678 BCX0">data</span><span class="NormalTextRun SCXW158620678 BCX0"> related to smartphone usage patterns and addiction levels among nursing </span><span class="NormalTextRun SCXW158620678 BCX0">students</span></span><span class="TextRun SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW158620678 BCX0">.</span><span class="NormalTextRun SCXW158620678 BCX0"> Results</span><span class="NormalTextRun SCXW158620678 BCX0">:</span> </span><span class="TextRun SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW158620678 BCX0">The study findings revealed t</span><span class="NormalTextRun SCXW158620678 BCX0">hat 68 nursing students (69.39%) were addicted to smartphones</span><span class="NormalTextRun SCXW158620678 BCX0">. </span><span class="NormalTextRun SCXW158620678 BCX0">Descriptive statistics, </span><span class="NormalTextRun SCXW158620678 BCX0">A</span><span class="NormalTextRun SCXW158620678 BCX0">NOVA</span><span class="NormalTextRun SCXW158620678 BCX0">,</span><span class="NormalTextRun SCXW158620678 BCX0"> and </span><span class="NormalTextRun SCXW158620678 BCX0">independent t-independent </span><span class="NormalTextRun SCXW158620678 BCX0">-test</span><span class="NormalTextRun SCXW158620678 BCX0"> w</span><span class="NormalTextRun SCXW158620678 BCX0">ere</span><span class="NormalTextRun SCXW158620678 BCX0"> applied by Statistical Package for Social Sciences (SPSS) software version 25</span><span class="NormalTextRun SCXW158620678 BCX0">.0</span><span class="NormalTextRun SCXW158620678 BCX0"> for data analysis</span><span class="NormalTextRun SCXW158620678 BCX0">.</span> </span><span class="TextRun SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW158620678 BCX0">Conclusion</span><span class="NormalTextRun SCXW158620678 BCX0">s</span></span><span class="TextRun SCXW158620678 BCX0" lang="EN-US" xml:lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW158620678 BCX0">:</span> <span class="NormalTextRun SCXW158620678 BCX0">The p</span><span class="NormalTextRun SCXW158620678 BCX0">resent study revealed that </span><span class="NormalTextRun SCXW158620678 BCX0">Smartphone addiction was found</span> <span class="NormalTextRun SCXW158620678 BCX0">higher</span><span class="NormalTextRun SCXW158620678 BCX0"> among nursing students.</span></span><span class="EOP SCXW158620678 BCX0" data-ccp-props="{&quot;134233279&quot;:true,&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p> Sunita Aijaz Ali, Pamela Marshall , Shahzad Bashir Copyright (c) 2024 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1069 Tue, 30 Apr 2024 00:00:00 +0000 Factors Influencing the Academic Performance of Undergraduate Nursing Students at Public Sector Institution, Karachi https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1071 <p>Academic performance is a measurement of student accomplishment, which is tremendously achieved by providing a robust learning environment. Factors that hinder the incredible academic performance of nursing students include an uncomfortable learning environment, a shortage of committed faculty, and students' financial backgrounds. <strong>Objective:</strong> To determine the factors influencing the academic performance of undergraduate nursing students at a public sector institution in Karachi. <strong>Methods:</strong> A descriptive cross-sectional study was completed at the Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi. All students who were enrolled in the BSN 4 Years Degree Program were the targeted population. The calculated sample was 300 nursing students. Data were collected by adopted and validated questionnaire "Combined Survey Questionnaire". Factors influencing the academic performance of nursing students were computed in mean and standard deviation. <strong>Results:</strong> Out of total, most participants (67.7%) were unmarried, and nearly one-third (61.7%) were female. Almost (49.3%) of the study participants were between 18 and 24 years old. The highest grand mean value was obtained for teacher-related factors, whereas the lowest mean was found for home-related factors. A significant difference has been established in age (p-value=0.003), marital status (p-value=0.011), discipline (p-value=0.001), and family income (p-value=0.006) have on the academic performance of the student nurse. <strong>Conclusions:</strong> It is established that nursing students face considerable issues depending upon teacher-related factors followed by home-related factors that are linked to deterring the student’s academic performance.</p> Vinod Kumar, . Badil, . Raja, Husan Bano Channar, Ameer Ullah Khan, Tahir Khan, Saran Chandio, Ashok Kumar, Hamid ul Haq Copyright (c) 2024 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1071 Tue, 30 Apr 2024 00:00:00 +0000 Social Media Usage and it's Relationship with Depression among Nursing Students of a Private University https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1073 <p>Social media is a group of electronic and digital appliances which has its basis on internet and allow sharing, transforming and exchanging ideas, information, educational material and content. In the 21<sup>st</sup> century, internet usage has been increased significantly. Our life has been entirely changed by the internet and social media. Social media cause different health related issues and academic decline among students. <strong>Objective: </strong>To observe the relationship between social media use and depression among nursing students. <strong>Methods: </strong>Cross-sectional analytical study was performed on 120 nursing students. Ethical permission was obtained from Ethical Review Committee, Sohail University, Karachi. Descriptive statistics was performed on demographic variables. Pearson Correlation test was performed to check the relationship between social media use and depression. <strong>Results: </strong>Beyond 120 participants, males were in majority (57.5%). Mostly (58.3%) participants were in their 1<sup>st</sup> and 2<sup>nd</sup> year, 20.8% were married and 69.2% were living with their friends. Largely (77.5%) belong to Generic BSN program and 55.0% partakers were using social media from 0-4 hours per day. Mostly (44.2%) participant have moderate to extreme level of depression. We found positive correlation of social media use with depression. <strong>Conclusions: </strong>The findings of this study suggest significant correlation between depression and social media use. Spending more time on using social media can lead to depression. Therefore, policy makers should pay attention in planning to minimize the harmful effects of social media usage among students.</p> Khalid Hussain, Tanseer Ahmed, . Riafat Copyright (c) 2024 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1073 Tue, 30 Apr 2024 00:00:00 +0000 Exploring Blood Donation: Perspectives among Undergraduate Students in Peshawar, Pakistan https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1068 <p>To improve voluntary donation and public health in the face of Pakistan's shifting regulations and challenges, it is crucial to comprehend the blood donation patterns of undergraduate students in Peshawar.<strong> Objective:</strong> To compare and assess undergraduate students in medical, allied health sciences, and non-medical fields in Peshawar, Pakistan, on their knowledge, attitudes, barriers to, and motivations for, blood donation.<strong> Methods:</strong> An eight-month observational cross-sectional study with 1232 undergraduate students from various academic fields was conducted. Participants were assessed through a comprehensive questionnaire regarding blood donation. Data were analyzed using SPSS version 27.0, employing descriptive statistics and the chi-square test.<strong> Results:</strong> The study enrolled 1232 undergraduate students, with 65.2% male and 34.6% female participants. Among them, 82.3% were aware of their blood group. While 24.74% exhibited poor knowledge about blood donation, 62.98% demonstrated moderate knowledge, and 12.29% had good knowledge. Additionally, 39.9% had never donated blood, but 83.9% expressed willingness to donate in the future. Fear of needles (13.90%), fear of infection (13.20%), and medical unfitness (13.10%) were significant barriers, while motivations included saving lives (22.20%), helping friends and family (19.40%), and moral obligation (14.80%). <strong>Conclusions:</strong> The study concluded that undergraduate students in Peshawar possess a moderate level of understanding regarding blood donation, with medical students showing higher knowledge levels. Despite variations across disciplines, positive attitudes towards donation were common, indicating potential for increased voluntary donation</p> Salman Zahir, Khansa Khan, Muhammad Atif, Wisal Khan, Haseeb Khan, Imad Khan, Somia Mazhar, Jamal Shah Copyright (c) 2024 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1068 Tue, 30 Apr 2024 00:00:00 +0000 Diabetes Distress, Depression and Coping Strategies in Adults with Type 2 Diabetes https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1076 <p>People with diabetes often experience two mental health conditions which are diabetes distress and depression. Both the conditions affect them negatively and increase their risk of diabetes complications and poor disease management. <strong>Objectives:</strong> To find out the prevalence of diabetes distress and depression in our sample and examine the relationship among diabetes distress, depression and coping strategies among adults with Type 2 diabetes. <strong>Methods:</strong> Cross-sectional research design was used in this study. The sample consisted of 125 patients of Type 2 diabetes with age range between 40 to 55 years (M=49.94, SD=4.21). Non probability purposive sampling technique was used to select the sample. Diabetes distress scale, depression scale and coping scale were used to assess the study variables. <strong>Results:</strong> 34% patients had moderate distress worthy of attention. Being woman, younger age, having poor coping skills and depression were significantly associated with diabetes distress. <strong>Conclusions: </strong>High rates of diabetes distress in the study highlights the significance of identifying distress and other mental health issues in individuals having diabetes to provide psychological management and collaborative care to them.</p> Nudra Malik, Momina Arshad, Amina Muazzam Copyright (c) 2024 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1076 Tue, 30 Apr 2024 00:00:00 +0000 Gratitude, Self-Efficacy and Self-Care Behaviors among Patients with Cardiovascular Diseases https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1078 <p>Cardiovascular disease (CVD) is a complex disease with persistent course of treatment having serious consequences for the patients’ wellbeing. Positive psychological factors can play a significant role in improving CVD outcomes. <strong>Objectives:</strong> To better understand the intricate relationships among gratitude, self-efficacy, and self-care behaviors in individuals diagnosed with cardiovascular diseases. <strong>Methods:</strong> A quantitative cross-sectional research design was employed for the study. 160 patients with CVD aged between 40 to 60 years (M=49.79, SD=5.59) were selected for the study through purposive sampling. The Gratitude Questionnaire, Self-Care Behavior Scale-9 and General Self Efficacy Scale were used to measure gratitude, self-care behaviors, and self-efficacy respectively. <strong>Results:</strong> Results revealed a significant relationship between gratitude, self-care behaviors and self-efficacy. The findings also indicated self-efficacy to be a significant predictor of self-care behaviors. <strong>Conclusions:</strong> The study advocates for inclusive healthcare interventions that emphasize the role of gratitude and self-efficacy on self-care behaviors for enhancing wellbeing of CVD patients. It contributes to the understanding of the psychological dynamics within CVD patients emphasizing the role of interventions that promote holistic well-being.</p> Sadia Khan, Nudra Malik, Raumish Masud Khan Copyright (c) 2024 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1078 Tue, 30 Apr 2024 00:00:00 +0000 Prevalence of Anemia in Community-Acquired Pneumonia Patients https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1088 <p>The frequency of anemia in intensive care units is well documented. Less is known, however, about the prevalence of anaemia in hospitalised patients with community-acquired pneumonia, which is one of the common reasons for hospitalisation, affecting both healthy and co-morbid individuals and is usually not accompanied with acute blood loss. <strong>Objective: </strong>To determine the frequency of anemia in patients presenting with pneumonia. <strong>Methods:</strong> This descriptive cross-sectional study was conducted with pneumonia patients at Department of Medicine Pulmonology in HDU/ICU Jinnah Hospital, Lahore curing thr period of three months. The 345 subjects with mean age 44.4 ± 9.4 (range: 20 – 60) years, male to female ratio 1:1.12, diagnosed with pneumonia underwent assessment of hemoglobin levels at presentation. Relationship between anemia and other co-morbidities has been evaluated that included duration of pneumonia, obesity, diabetes mellitus and hypertension. <strong>Results: </strong>The mean duration of pneumonia symptoms was 8.7 ± 6.9 (range: 2-25) days whereas the mean hemoglobin concentration was found 12.3 ± 6.9 g/dL ranged from 7.1 –14.6 g/dL. The prevalence of anemia was found to be 37.7% and 215 (62.3%) of the 345 patients have shown normal hemoglobin levels. Female gender, higher age, greater duration of pneumonia symptoms and presence of diabetes mellitus significantly correlated with anemia in pneumonia (p-value &lt; 0.05). Whereas, obesity did not have any significant effects on anemia in pneumonia (p-value &gt; 0.05). <strong>Conclusions: </strong>Anemia was present in significant number of patients with pneumonia and was associated with female gender, Diabetes ,Hypertension and prolonged duration of pneumonia.</p> Samina Saeed, Muhammad Usman Yaqub, Aysha Ghayyur, Shazia Siddique, Muhammad Anwar, Ayesha Afzal Copyright (c) 2024 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1088 Tue, 30 Apr 2024 00:00:00 +0000 The Influence of Gut Microbiome Derived Neurotransmitters on Neonatal Immune Response https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1075 <p><span data-contrast="none">The complex interaction between neurotransmitter, gut flora and immune system has expanded dramatically. Infant gut microbiome is a key driver of immune system development [1].</span><span data-contrast="auto">Any disruption in gut microbiota during early life have been associated with childhood disorders such as food allergies, neurodevelopmental disorders and asthma[2].The bacteria in guts are not just inert inhabitants of our digestive systems. Their metabolic activities involve the active creation of neurotransmitters such as GABA, dopamine, and serotonin. Gut is known as second brain because it produces 90% of neurotransmitters including dopamine and serotonin [3]. In adults, neurotransmitters are produced by enterochromaffin cells but in infants there is need to unveil the regulation of neurotransmitters. Some of the studies have shown the relationship between gut flora and immune system.&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <p><span data-contrast="auto">Neonates are more susceptible to diseases because their gut is not mature enough to produce neurotransmitters. Some specific gut microbiome in infants produce serotonin which activates the T-regulatory cells (Tregs). Tregs act as a defence mechanism against autoimmune disorders and food allergic reactions. The number of serotonin producing neonatal gut flora can be influenced by diets, availability of antibiotics and reduce exposure of microbes in their environment. Any change in level of serotonin might affect the development of Tregs. The reason that makes infant more prone to allergic reactions and autoimmune disorders in developed countries.&nbsp;</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:240}">&nbsp;</span></p> <p><span data-contrast="auto">Scientists are trying to dig out about how gut bacteria in human newborn samples, produce serotonin. This research could lead to the development of effective immune system training techniques, which would lower the lifetime risk of inflammatory illnesses like allergies and inflammatory bowel disease. This work highlights the importance of gut microbes in developing immunity in infancy and provides opportunities for further studies targeted at reducing immune-related illnesses. Interventions that support healthier immune responses from infancy through maturity may be made possible by better understanding and utilizing the power of gut flora.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:160,&quot;335559740&quot;:259}">&nbsp;</span></p> Ahmed Alwazzan Copyright (c) 2024 Pakistan BioMedical Journal https://creativecommons.org/licenses/by/4.0 https://www.pakistanbmj.com/journal/index.php/pbmj/article/view/1075 Tue, 30 Apr 2024 00:00:00 +0000