Riffat Mehboob

Cancer poses a substantial health burden in Pakistan, with breast, lip and oral cavity, lung, colorectal, and esophageal cancers leading in incidence and mortality. Breast cancer accounts for 30,682 new cases and 15,552 deaths, followed by lip and oral cavity cancer (15,915; 10,181), lung cancer (9,464; 8,307), colorectal cancer (9,447; 5,235), and esophageal cancer (9,289; 8,704). The persistently high mortality across these cancers reflects critical disparities, ranging from delayed diagnosis and demographic factors to inadequate treatment access and poor survival outcomes. This review analyzed the epidemiology of the five most prevalent cancers in Pakistan and identified disparities in diagnosis, demographics, risk factors, and healthcare access. A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar for English-language publications from 1990 to 2024, supplemented by GLOBOCAN data. The review highlighted how these inequities contribute to high incidence, delayed detection, and poor survival outcomes. Breast cancer disproportionately affects rural and low-income women, with delays in diagnosis and treatment due to stigma, limited awareness, and financial barriers. Oral cancer is more common in men due to tobacco use, while younger patients and rural populations face aggressive disease and late detection. Lung cancer mainly affects older men, with smoking, air pollution, and limited healthcare access contributing to advanced-stage diagnoses. Colorectal cancer shows delayed detection in older adults and aggressive forms in younger patients, compounded by poor screening and awareness. Esophageal cancer exhibits regional disparities, with rural areas experiencing more squamous cell carcinoma and late diagnosis, while urban populations show a rise in adenocarcinoma. Based on these disparities, targeted strategies were proposed for each cancer type, alongside broader measures to enhance early detection, improve healthcare access, and increase public awareness. Addressing these inequities is essential to reduce mortality and improve cancer outcomes across Pakistan.

Pakistan is once again facing a familiar crisis now a days. Since the beginning of the monsoon season in Pakistan on 26 June, 47 people have been reported killed and 123 injured in different provinces due to floods or flash floods. Flash floods have continued along major rivers in Punjab. This comes at a time when the country is still recovering from the 2025 floods that claimed the lives and livelihoods of more than 1037 people and displaced people to the tune of approximately 2.9 million during the period of peak flood [1, 2]. It is no longer an exception, but rather a trend, and in 2022, 2023, 2025 and 2026 significant health emergency conditions were reported due to the flooding events [3]. In each cycle the same direction is taken. Sanitation facilities are washed away and drinking water sources are contaminated by flood water, families are displaced to relief areas, and stagnant water breeds disease vectors [1, 4]. In 2025, floods occurred in Punjab and resulted in more than 3500 reported Dengue cases, which was very high as compared to 2024 and thus a Province-wide Dengue Alert was issued [1]. In the relief camps of flood affected people in all over Punjab, the exposed population continued to be subjected to contaminated water and mosquitoes, which could lead to diarrhea, typhoid, malaria and dengue [2]. The downside of this trend is that it's very costly in terms of unnecessary morbidity. The same fragmented data reporting system could have undercounted similar outbreaks in the subsequent floods in 2022, as researchers have warned [2] and similar cholera and dengue data was recorded in 2022 for the flood alone in Sindh [5]. In addition to floods, Pakistan is experiencing a public health emergency over and over again, but without any reference to the basic needs of the people. There is further confirmation for this diagnosis given by recent analysis of the 2022 and 2025 floods. Drawing on the disaster management cycle, Akhter et al. found that the existing meteorological, hydrological and disease surveillance data systems were not linked, and that there were gaps in the data information systems, which led to failing forecasting and the lack of timely dissemination of early warning information, leaving high-risk districts unprepared for each flooding season [6]. The findings of these analyses point to the fact that the severity of flooding events does not seem to be the reason for the increasing number of public health crises in the country, but rather the failure to develop institutional capacity following previous public health crises. It will require an entirely new strategy to end this vicious cycle. Pakistan's health system has been treating the floods as a stand-alone event and has been reacting to outbreaks with spraying of larvicides after the event for the last two years. The missing component is climate-integrated public health infrastructure, including the pre-positioning of vector control and water-testing infrastructure and training of the workforce to view the initial response to flooding and the outbreak response as two sides of the same coin.

Background: Dengue fever lacks reliable biomarkers to explain its complex pathophysiology. Substance P (SP) and its receptor, the Neurokinin‐1 receptor (NK1R), known regulators of inflammation and vascular permeability in viral infections, may play a role in dengue but remain unexplored. Aim/Objective: To investigate the levels of SP and NK1R in serum samples of diagnosed dengue patients. Methods: Participants were selected from a pool of diagnosed dengue fever patients using a convenience sampling technique ( n = 40), along with a control group of healthy individuals ( n = 12). Serum samples were collected, and SP and NK1R levels were measured using enzyme‐linked immunosorbent assay (ELISA). Complete blood count (CBC) parameters were also evaluated. Results: The mean NK1R levels in the control and case groups were 2.681 ± 3.147 and 0.57 ± 0.131, respectively. NK1R levels were significantly lower in dengue patients compared with controls ( p < 0.0001). SP levels did not differ significantly between male and female dengue patients (Mann–Whitney U = 85, p = 0.899). Conclusion: NK1R may be associated with dengue pathogenesis through its potential involvement in vascular permeability, immune activation, and cytokine responses. These findings suggest a possible connection between NK1R and the pathophysiological mechanisms underlying dengue infection.

Lung cancer is a cancer that starts in the cells in the lungs, which is often caused by smoking or exposure to air pollution. It is defined as the uncontrolled growth of cells. There are two main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) [1]. Early detection and treatment are key, but lung cancer is often diagnosed at advanced stages, which makes it challenging to treat effectively [2]. Lung cancer is a form of cancer with an incidence of 9,464 new cases in Pakistan (5.1% of all cancers). It is the third most common cancer. The mortality due to lung cancer is 8,307 deaths (7.0% of total cancer deaths). It continues to be a persistent disease with a 5-year prevalence of 12,805. The cumulative risk of developing lung cancer before the age of 75 is 0.69%. Lung cancer continues to increase in both males and females, especially in big cities like Karachi and Lahore [3]. The environmental determinants significantly influence the burden and geographical distribution of lung cancer in Pakistan. The combined effect of rapid urbanization, industrial growth, growing motorized transportation, and unsafe working conditions has led to a general increase in exposure to carcinogenic pollutants in both urban and rural areas. Furthermore, the vulnerability of high-risk communities is growing due to differences in environmental regulation and a lack of public knowledge of hazardous exposures. Environmental exposure, such as industrial emissions, vehicle pollution, occupational risks, and indoor air pollution, is a primary factor contributing to this rise. Industrial activities and emissions from vehicle traffic are linked to the release of polycyclic aromatic hydrocarbons (PAHs), which can make people more susceptible to cancer, as noted by Rehman et al. [4]. They are common pollutants in urban air pollution and have a strong association with lung carcinogenesis. Likewise, Luqman et al. report that occupational exposure (elevated ORs 5.1 and 3.1) to pesticides and diesel exhaust is an important risk factor in agricultural workers [5]. Other environmental-lifestyle interactions that were reported were dietary patterns, especially high intake of red meat and chicken. The particulate matter exposure (PM2.5, PM10) in the Salt Range was high, as reported by Nasir et al. and is linked to the mortality of lung cancer, especially in adults over 30 years of age [6]. Abbas et al. also, through machine learning-based risk modelling, found that air pollution, tobacco smoke, benzene, and PAHs were the major environmental risk factors for lung cancer in major cities of Pakistan, such as Lahore, Karachi, and Islamabad [7]. The other key concern is indoor environmental exposure. Kausar et al. describe how biomass fuel use in rural households, including wood and coal burning, results in persistent levels of indoor air pollution and high exposures to particulate pollutants, which play a significant role in the burden of respiratory diseases, such as lung cancer [8]. Lung cancer in Pakistan demonstrates that the disease is strongly influenced by environmental carcinogens like outdoor air pollution, industrial pollution, occupational exposures, and indoor biomass fuel use, which have medical, environmental, and socioeconomic dimensions, and are associated with rapid urbanisation, industrialization, and household energy use. To conclude, a concerted and coordinated environmental health strategy is needed, with a focus on the need to regulate industrial and vehicle sources of emissions, increase occupational safety measures, and progressively move towards cleaner household fuels, as well as enhance air quality monitoring and environmental policy implementation in both urban and rural areas. Along with public health awareness campaigns and early screening programs, delayed diagnosis and poorer survival are also problems that must be addressed. The environmental burden associated with the incidence of lung cancer in Pakistan is ever-increasing and requires a concerted effort from healthcare authorities, environmental agencies, and policymakers.

Melanoma is a heterogeneous, complex and aggressive disease that, despite recent advances in molecular-targeted drugs and molecular and genetic analysis, represents approximately 65% of skin cancer deaths, and unfortunately survival dramatically decreases in melanoma stages III/IV. In young people there is an increased incidence of developing melanoma; hence new therapeutic strategies must be urgently investigated. Peptidergic systems play a crucial role in these strategies to fight melanoma. The scope of this review is to show the enormous potential of targeting peptidergic systems alone or in combination therapy with standard therapeutic strategies currently used in clinical practice to treat melanoma. In this sense, key points such as peptidergic systems and anti-melanoma treatments, oncogenic/anti-melanoma peptides, peptide receptors, peptidergic systems, melanoma risk and immune system relationships, clinical relevance, peptidergic systems and delivery strategies in melanoma will be discussed. Peptides exert oncogenic, anti-melanoma and dual oncogenic and anti-melanoma effects in melanoma, showing a high functional complexity in regulating melanoma development. A plethora of anti-melanoma strategies have been developed or repurposed for potential clinical applications, including peptide/peptide receptor antibodies, peptide receptor antagonists or agonists, enzyme inhibitors, CAR-macrophages, microRNAs and vaccines. Strategies for peptide delivery and protection from enzymatic degradation have also been developed. Some of the previous anti-melanoma strategies are based on the expression/overexpression of peptide receptors in melanoma cells which is crucial for diagnosis, melanoma risk and progression and metastasis development and for the application of more specific and safer anti-melanoma strategies. A meticulous and in-depth study of the peptidergic systems may help to understand how peptidergic systems regulate melanoma progression and shed light on possible therapeutic applications that can be applied in clinical practice. This review shows the enormous potential of targeting peptidergic systems alone or in combination therapy with standard therapeutic strategies currently used in clinical practice to treat melanoma. The benefits to be gained from these studies will be enormous because the peptidergic systems are promising antitumor targets in melanoma, based on the numerous anti-melanoma strategies that have been developed until now.

Background and Aims: Primary dysmenorrhea is a prevalent condition that causes significant menstrual pain and discomfort, impacting many women′s daily activities. The Substance P/NK1 receptor (SP/NK1R) pathway has been linked to the pain mechanisms underlying dysmenorrhea, yet its potential as a therapeutic target remains inadequately explored. This study aimed to evaluate the therapeutic potential of NK1R antagonists, specifically dexamethasone and aprepitant, in alleviating the symptoms of primary dysmenorrhea. Methods: A randomized controlled trial was conducted from March 2024 to December 2024 using a convenience sampling technique. Forty female participants were divided into three phases: Phase 1 (pre‐medication), Phase 2 (NSAIDs), and Phase 3 (dexamethasone + aprepitant). Ten control females without dysmenorrhea were also recruited. The study lasted for three menstrual cycles, with assessments of SP/NK1R levels, visual analogue scores (VAS), and pictorial blood loss. Data were analyzed using Two‐way ANOVA with repeated measures. Results: The mean age of participants was 25.1 ± 7.6 years, and BMI was 20.47 ± 3.61 kg/m². SP/NK1R levels were significantly elevated in Phase 1 compared to controls. NK1R levels decreased significantly from 15.4 ng/mL in Phase 1 to 8.42 ng/mL in Phase 3. VAS scores decreased by 4.79 units. A linear mixed‐effects model revealed significant reductions in NK1R levels in Phase 2 versus Phase 1 ( p < 0.001) and Phase 3 versus Phase 1 ( p = 0.006). VAS scores improved significantly in Phase 3 compared to Phase 2 ( p = 0.0001 for SP and p = 0.0028 for NK1R). Heavy period patients had higher SP levels. Both SP and NK1R levels decreased across phases for normal and heavy period patients. Conclusion: This pilot study suggests that NK1R antagonists (dexamethasone and aprepitant) may reduce discomfort in dysmenorrhea. Further research with a larger sample size and control for intra‐individual hormone levels is needed.

Background & Aim: Diabetic nephropathy is a common complication in patients with type 2 diabetes, and insomnia may exacerbate renal dysfunction. This study aimed to evaluate the effects of magnesium and potassium supplementation on diabetic nephropathy markers in diabetic patients with insomnia. Methods: A single‐blinded randomized controlled trial was conducted on 320 diabetic patients. However, only 290 diabetic patients continued the trial after 60 days follow up. Insomnia was defined by using Insomnia Severity Index (ISI). Supplements dosages were prepared in the form of tablets, characterized as T1; placebo, T2; magnesium (Mg), T3; potassium (K), and T4; as magnesium along with potassium. Serum urea level, serum ALT, serum AST, serum creatinine and HbA1c were quantified in blood (serum) employing a quantitative and highly sensitive enzyme‐labelled immunosorbent assay (ELISA), pre‐and post‐trial. Results: The total of 290 participants; 93 male and 197 female, were having mean HbA1c and BMI as 7.77 ± 2.10 and 31.00 ± 23.68 respectively. A significant association was revealed by analysis among pre‐ and post‐trial serum urea level, serum creatinine, serum ALT level and magnesium supplementation, p = 0.000, p = 0.000, p = 0.003. Moreover, there was significant association between pre and post‐trial serum ALT, AST level, RA factor level and magnesium in combination of potassium supplementation, p = 0.000, p = 0.004. 0.000. Conclusions: Study concluded that magnesium, and in combination with potassium supplementation had significant reducing effects on diabetic nephropathy markers and suppression in the RA factor level.

Substance P (SP) and neurokinin‐1 receptor (NK‐1R) as biomarkers of pain and stress: SP and NK‐1R are neuropeptide related biomarkers involved in nociceptive pathways. Dysmenorrhea is frequently associated with psychological distress and biochemical alterations; however, their interrelationship across treatment phases remains insufficiently understood. Objectives: To explore changes in psychological status (depression, anxiety, and stress), nutritional status, and SP/NK‐1R‐related biomarker levels across NSAID and dexamethasone plus aprepitant combination therapy phases in females with dysmenorrhea. Methods: This was a randomized, sequential, within‐subject repeated‐measures crossover exploratory controlled trial with a parallel healthy control group. A total of 40 females were enrolled, including 30 with primary dysmenorrhea and 10 healthy controls. Dysmenorrhea participants were assessed over three menstrual cycles across three phases: baseline (no treatment), NSAID phase (ibuprofen 400 mg three times daily for 3 days), and combination therapy phase (dexamethasone plus aprepitant for 2 days). Psychological status was assessed using DASS‐21, and nutritional status using the mini nutritional assessment (MNA). Serum SP and NK‐1R levels were measured using ELISA in a subset of participants due to sample limitations. Data were analyzed using IBM SPSS Statistics (version 22), with repeated‐measures ANOVA and independent t ‐tests; p < 0.05 was considered statistically significant. Results: Participants with dysmenorrhea were enrolled and assessed for ELISA based SP levels in blood. SP levels showed significant variation across treatment phases ( p = 0.021), with the lowest values observed during the dexamethasone plus aprepitant phase compared to baseline and NSAID phases. NK‐1R levels did not show significant phase‐wise changes. Psychological subgroup analyses indicated greater SP variability in participants with moderate depression, stress, and anxiety, although several subgroups were small. Nutritional status showed partial associations with SP changes, with significant differences in malnourished and normal groups. Overall, biomarker changes were more pronounced than NK‐1R alterations across phases. Conclusion: This study demonstrates phase‐dependent changes in SP levels alongside psychological and nutritional variations in women with dysmenorrhea. However, absence of clinical pain outcomes and small subgroup sizes limit causal interpretation, and findings should be considered preliminary and biomarker‐focused.

Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition characterized by differences in social communication, restricted or repetitive behaviors, and atypical sensory processing. The term “spectrum” reflects the wide variation in strengths, challenges, and levels of support required by individuals with autism, ranging from those who live independently to those needing substantial assistance. As understanding of ASD has expanded globally, it has increasingly been recognized not only as a clinical condition but also as a broader social and public health concern, particularly in countries where awareness, diagnosis, and support systems remain limited [1,2]. Autism Spectrum Disorder (ASD) is among the most urgent and yet least understood social health issues in Pakistan. It influences social communication, behavior, as well as sensory processing, and children and adults display a broad spectrum of skills and disabilities. Worldwide, ASD is found in approximately 1 per 160 children and research in Pakistan shows that prevalence is similar with 1.3% of children in Karachi (2017) and 1.45% of school going children in Lahore (2019) being diagnosed with ASD. In spite of the increased awareness around the world, Pakistan still has a lot of gaps in awareness, diagnosis and care of ASD individuals [1,2]. In Pakistan, the family of children with ASD have enormous challenges in accessing the qualified professionals and evidence-based interventions. Consequently, they are left to deal with complicated behavioral, sensory and co-occurring problems in many cases without much support. This is often postponed through inconsistent screening and lack of professional capacity as a result of early diagnosis, which may greatly improve the outcome. There are also misconceptions and a dependency on untested home remedies or expensive private care and low educational inclusion of children denies them special learning settings. All of these gaps demonstrate that ASD is not merely a medical problem, but a social and even a bigger social and public health problem that requires immediate intervention [1]. The Punjab Autism Act was passed and it has given official support and recognition to the specialized schools, resource centers, research, professional training, and public awareness campaigns. Recent researches emphasize psychosocial needs of families, sensory and behavioral characteristics of children, and the significance of structured and evidence-based interventions. The focus on the early detection of ASD in regular pediatric care and the development of telehealth, as well as on building community-based support networks, such as online parent communities, offering peer support and emotional assistance is growing. These advances are significant progress in the direction of inclusive education and holistic care, and the problems of awareness, early diagnosis, and professional training still exist [3]. Although these positive steps are made, there is still much to be done. To address the problem of stigma, Pakistan needs to invest in ongoing professional training of healthcare workers, implement screening of ASD at the primary pediatric stage, and initiate mass-scale public education programs. There is an urgent need to have robust support systems to families, better access to quality diagnosis and evidence-based therapy. Studies should emphasize on culturally appropriate interventions and experiences of Pakistani families to inform effective policies. Pakistan has the potential to shift the awareness into action by connecting healthcare, education, and social services and promoting community inclusion [3,4]. The developments anticipated in 2025 may represent a critical turning point for autism care and policy in Pakistan. However, sustained, coordinated efforts across healthcare, education, and social sectors will be essential to ensure that individuals with ASD are empowered to thrive and that their families receive the long-term support, inclusion, and dignity they deserve.

Cardiolipin, a critical phospholipid involved in mitochondrial function, has a potential role in the pathogenesis of type 2 diabetes mellitus. This research aims to assess serum cardiolipin levels in type 2 diabetic patients and examine their correlation with their physical activity, age, and gender. The study employed cross-sectional research conducted at Lahore Garrison University and Lahore Medical Research Center. Physical activity and serum cardiolipin levels were measured using the International Physical Activity Questionnaire (IPAQ) and a chemical analyzer, respectively. A sample size of 80 participants was analyzed statistically using t-tests and analysis of variance in GraphPad Prism 8.0.2 (263). IPAQ demonstrated that most patients (56%) were of the moderate activity category. Across age groups, there were significant differences in cardiolipin and blood sugar levels. Similarly, important differences were found in serum cardiolipin (p=0.0001), glycated hemoglobin (p=0.0499), and blood sugar (p=0.0021) levels among low, moderate, and vigorous physical activity groups. No significant difference was noticed among genders. Conclusions: Our research highlighted the potential age-dependent impact of physical activity on cardiolipin levels, emphasizing its relevance to mitochondrial health. A significant difference was also found between physical activity and blood sugar.