Karachi

Researchers are evaluating the effectiveness of Mulligan Mobilization Technique compared to proprioceptive exercises in treating patients with mild to moderate knee osteoarthritis (OA), specifically those classified as Grades 2 and 3 on the Kellgren and Lawrence grading system. The study aims to assess these treatments combined over a 10-week period, focusing on pain levels, movement, functional activities, balance, and quality of life improvements in patients aged 40 and above with primary knee OA. Participants will be randomly assigned to one of three groups: Proprioceptive Exercises, Mulligan Mobilization Technique, or Traditional Physical Therapy. Each participant will receive 30 treatment sessions across 10 weeks, with three sessions weekly, each lasting about 40 to 60 minutes. Mulligan Mobilization involves specific manual therapy techniques to improve knee joint mobility, while proprioceptive exercises focus on balance and joint position sense. Traditional physical therapy includes stretching exercises targeting key leg muscles. Throughout the study, assessments will be conducted at the start and end of treatment using tools like the Numeric Pain Rating Scale, Universal Goniometer, Knee Injury and Osteoarthritis Outcome Score, and Berg Balance Scale to measure pain, range of motion, function, and balance. Researchers will monitor participants' progress to gather data on treatment effectiveness, with the study taking place at a physical therapy outpatient department in Karachi, Pakistan.

Researchers are evaluating the effectiveness of Casein Phosphopeptide Amorphous Calcium Phosphate paste (CPP-ACP) alone or combined with a Lasotronix diode laser to treat dentin hypersensitivity (DH). DH is characterized by sharp, short pain from exposed dentin in response to chemical, thermal, or tactile stimuli and commonly affects older adults. This study explores new treatment approaches using laser therapy, which may block pain by altering dentin structure or fluid, with CPP-ACP as a potential desensitizing agent. Participants are divided into four groups: one receiving CPP-ACP paste applied to exposed dentin areas, another treated with the Lasotronix diode laser following its protocol, a combination group receiving both treatments, and a control group with no active treatment. The laser uses a 635nm wavelength for photo-activated therapy and safe bio-stimulation. The study aims to determine which treatment or combination is more effective at reducing dentin hypersensitivity. During the study, researchers will assess treatment effects on dentin hypersensitivity over a period of up to three months. Participants will be monitored for pain relief and response to stimuli. The study includes follow-ups to evaluate safety and effectiveness, with all treatments and assessments conducted according to protocol. The total participation duration covers the treatment and observation period needed to measure outcomes.

Researchers are investigating the use of screening tools in cardiovascular risk assessments to better understand their impact on cardiovascular disease (CVD) mortality and morbidity. This observational study is conducted at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, focusing on patients attending preventive cardiology clinics. The study aims to improve how clinicians combine patients' unique cardiovascular risk factors to create effective treatment plans. Participants undergo cardiovascular risk assessments using tools such as the ASCVD Score and the WHO Cardiovascular Risk score. Data is collected through structured questionnaires that record demographic information, physical examinations, clinical history, risk modifications, lab assessments, and ASCVD risk scores at the initial visit and during follow-ups. The study uses non-probability consecutive sampling and obtains verbal informed consent from patients. Throughout the study, researchers collect and analyze data on participants' cardiovascular risk factors and outcomes over time, including a ten-year cardiovascular risk assessment. Data analysis includes statistical evaluations of baseline characteristics and categorical variables. The study is ongoing and aims to support shared decision-making between clinicians and patients to develop comprehensive plans for primary and secondary prevention of cardiovascular disease.

Researchers are investigating the effects of vitamin D supplementation and topical fluoride treatments on dental health, specifically for people with vitamin D deficiency and early-stage tooth decay known as Initial Carious Lesions (ICL). This phase 4 clinical trial aims to observe changes in tooth decay progression using the International Caries Detection and Assessment System (ICDAS) scores, levels of salivary proteins, and the presence of cariogenic bacteria over six months. Participants aged 12 to 50 years with vitamin D deficiency and at least two teeth affected by ICL are randomly assigned to one of three groups. Group A receives vitamin D supplements plus oral hygiene instructions, Group B receives vitamin D supplements, topical fluoride gel, and oral hygiene instructions, and Group C, the control group with sufficient vitamin D levels, gets topical fluoride gel and oral hygiene instructions. Vitamin D supplements are given as 50,000 IU weekly for two months, followed by 5,000 IU daily for one month, and fluoride gel is applied professionally for 5 minutes on affected teeth. During the six-month study, participants provide saliva samples to measure proteins and bacteria linked to tooth decay. Researchers will track changes in ICDAS scores, count cariogenic bacteria species, and assess salivary protein concentrations. Oral hygiene and dietary advice are also given to support dental health. The study monitors participants throughout the treatment period to evaluate the medical management of dental caries using these interventions.

Researchers are conducting a Phase 3, global, randomized, open-label, multicenter trial to evaluate the safety and effectiveness of brelovitug (BJT-778) in treating chronic hepatitis delta virus (HDV) infection. The study aims to compare brelovitug treatment to delayed treatment in participants with chronic HDV infection. Approximately 80 participants will be enrolled and randomized into three groups to assess treatment outcomes. The study includes three arms: one group will receive brelovitug 300 mg by subcutaneous injection once weekly for 96 weeks; the second group will receive brelovitug 900 mg by subcutaneous injection once every 4 weeks for 96 weeks; the third group will initially delay treatment, attending clinic visits for 12 weeks, then start brelovitug 300 mg subcutaneously once weekly for 96 weeks. The study evaluates different dosing schedules and the effect of delayed treatment. Participants will be monitored for safety and efficacy, with the main outcome being the percentage of participants achieving a combined endpoint of virologic response and normalization of ALT levels at Week 24 compared to Week 12 in the delayed-treatment arm. The trial includes regular clinical visits, laboratory tests, and assessments over the treatment period to track response and safety. Total participation duration aligns with the 96 weeks of treatment after initial randomization or delay period.

This research aims to evaluate the clinical presentation, management, hospital course, and prognosis of acute right ventricular infarction (RVI) occurring with or without inferior or infero-posterior wall myocardial infarction. The study focuses on patients presenting with these heart conditions and assesses their outcomes, especially the composite adverse clinical outcomes within 30 days after reperfusion treatment in the hospital and post-discharge. Patients who meet the eligibility criteria and provide informed consent will be enrolled. Data will be collected using a structured form covering demographics, clinical presentation, medical history, co-existing conditions, angiographic, and procedural details. All patients will be observed during their hospital stay, and a follow-up will be conducted by phone 30 days after discharge to record major adverse cardiac events. Statistical analyses will be used to identify clinical predictors of RVI. Participants will be monitored closely throughout their hospital admission, with data verification on a portion of patient files to ensure accuracy. The study will measure outcomes related to adverse clinical events up to 30 days from admission. Overall participation includes hospital observation and a 30-day post-discharge follow-up to evaluate patient prognosis and the occurrence of major adverse cardiac events.

Researchers are evaluating whether giving adenosine before primary percutaneous coronary intervention (PCI) can reduce the occurrence of slow blood flow or no-reflow in patients having a heart attack called ST-segment elevation myocardial infarction (STEMI). This condition happens when blood flow in the heart muscle is poor despite open arteries, leading to worse outcomes. Adenosine may help improve blood flow due to its effects on blood vessels and blood cells, but its preventive use before PCI is not yet clear. The study randomly assigns 1,148 adults with STEMI to one of two groups: one receiving intracoronary adenosine pre-medication plus standard care, and the other receiving only standard pharmacological management during PCI. Adenosine is given at doses of 2 mg for the left coronary artery and 1 mg for the right coronary artery, diluted in saline and administered immediately before PCI. The study takes place over 12 months at multiple centers in Karachi and satellite locations. Participants will be monitored during their PCI procedure for the main outcome of slow flow or no-reflow using TIMI flow grades. Additional assessments include the Myocardial Blush Grade to evaluate heart muscle perfusion. Data on patient condition, treatments, and outcomes will be collected and analyzed statistically. Safety monitoring will address any side effects like temporary slow heart rate or heart block. The study includes adults aged 18 to 80 years and excludes those with cardiogenic shock, heart block, allergy to adenosine, or who do not consent to participate.

Researchers are comparing the effectiveness of two treatments, xylometazoline nasal drops and adrenaline nasal packing, in reducing nasal bleeding during nasotracheal intubation for participants undergoing elective oromaxillofacial surgeries. This trial includes adults aged 18 to 60 years with certain health criteria and is conducted in phase 2 and phase 3 settings. The study aims to determine which treatment better prevents nasal bleeding at the time of intubation and extubation. Participants are randomly assigned to one of two groups. The xylometazoline group receives 3 to 5 drops of 0.1% xylometazoline nasal drops in a selected nostril 15 minutes before surgery transfer. The adrenaline group has intranasal packing with adrenaline-soaked gauze placed 15 minutes before surgery and removed after 7 to 10 minutes. Both treatments involve monitoring of vital signs before anesthesia. Standard anesthesia procedures are followed, including preoxygenation, induction with propofol and atracurium, and maintenance with isoflurane and oxygen. During the study, anesthesiologists record nasal bleeding at intubation and extubation times. Participants undergo airway, cardiovascular, and respiratory assessments before anesthesia. Vital signs such as blood pressure, heart rate, ECG, and oxygen saturation are monitored throughout. Data analysis includes controlling for factors such as age, gender, diabetes, and hypertension. The main outcome measured is the incidence and severity of nasal bleeding during the procedure, with safety and effectiveness observed throughout the study duration.

Researchers are collecting detailed eye images and health data from 1000 participants aged 50 and older at up to 25 international locations to build a diverse dataset for Age-Related Macular Degeneration (AMD). AMD is a leading cause of blindness, progressing from early to late stages that cause vision loss. This dataset aims to help develop an Artificial Intelligence (AI) screening tool to detect early AMD in primary care settings, addressing the challenge of early diagnosis and facilitating timely referrals. Participants will have one retinal imaging session of both eyes using single field stereo color fundus photography before and after pupil dilation, and macular spectral domain-optical coherence tomography. The study collects participant history including demographics, smoking and family history, physical exam data, best-corrected visual acuity, and AMD classification. Sites will ensure geographic diversity and balance participants by AMD stage, sex, and age. During the study, participants provide eye images and health information in a single visit. Researchers will assess image quality, classify AMD stage, record visual acuity, and gather demographic and health data. The main outcomes include AMD classification and geographic location distribution of participants over 18 months. This observational study helps create a reference dataset to support AI model development for AMD screening.

This research aims to evaluate whether showing an animated video of a medical procedure can reduce pain and anxiety in children undergoing pin removal after supracondylar fracture fixation. The focus is on pediatric patients aged 4 to 12 years who have had fractures fixed with K-wire pins. The study compares pain and anxiety levels during this pin removal process to see if distraction through animation makes a difference. Participants will be randomly assigned to one of two groups: one group will watch an animated video of the pin removal procedure while it is performed, and the other group will undergo the procedure without any video shown. Both groups receive the standard pin removal treatment, but only one has the added distraction of the animation. Children will be assessed using several pain and anxiety scales before, during, and 60 minutes after the procedure. These include the Wong Baker Pain scale, Children’s Hospital of Eastern Ontario Pain Scale, Children’s Anxiety Meter-State, and the Short State Trait Anxiety Inventory Scale. The study tracks changes in these measurements to understand the impact of the animated video on patient comfort and anxiety levels.