Karachi

Researchers are evaluating the effectiveness of Mulligan Mobilization Technique compared to proprioceptive exercises for treating adults aged 40 and above with mild to moderate knee osteoarthritis, classified as Grades 2 and 3 on the Kellgren and Lawrence scale. The study aims to assess these treatments over a 10-week period, focusing on pain levels, movement, functional activities, balance, and quality of life improvements. Participants are selected based on clinical diagnosis and mobility ability without assistive devices. The study involves three groups one receiving proprioceptive exercises designed to improve balance and joint position sense, another receiving Mulligan Mobilization Technique, a manual therapy to improve joint mobility, and a control group undergoing traditional physical therapy. Each participant receives 30 treatment sessions over 10 weeks, with three sessions per week lasting 40 to 60 minutes each. Treatments are delivered by trained physical therapists, and assessments occur at the start and end of the treatment period. Participants will complete questionnaires and undergo evaluations measuring pain intensity, range of motion, functional status, and balance using tools like the Numeric Pain Rating Scale, Universal Goniometer, Knee Injury and Osteoarthritis Outcome Score, and Berg Balance Scale. Quality of life is also assessed using the SF-36 questionnaire. The study follows a double-blind, randomized design to ensure unbiased results. Confidentiality is maintained, and participants may withdraw at any time without penalty.

Researchers are observing patients at preventive cardiology clinics to better understand how cardiovascular risk assessment tools can be used most effectively. The study aims to explore how these tools influence the risk of cardiovascular disease CVD and related outcomes, focusing on both primary and secondary prevention. This ongoing research collects data to help clinicians develop personalized, effective treatment plans by combining individual risk factors. The study involves adult patients attending the National Institute of Cardiovascular Diseases NICVD in Karachi, Pakistan. It gathers detailed information such as demographic data, physical exams, clinical history, risk modifications, laboratory tests, and risk scores like the ASCVD and WHO Cardiovascular Risk scores. These assessments are recorded at the first visit and during follow-ups to track changes over time. Participants provide verbal consent and are followed over a long period, with data collection continuing regularly. Researchers analyze this information to measure cardiovascular risk over ten years, changes in risk levels, and cardiovascular-related deaths. The study uses structured questionnaires and statistical methods to evaluate the findings, aiming to contribute valuable insights into cardiovascular disease prevention and management.

Researchers are investigating the effects of vitamin D supplementation and topical fluoride treatments on people aged 12 to 45 who have vitamin D deficiency and early dental cavities called Initial Carious Lesions ICL. This trial aims to compare how these treatments influence the progression of ICL by measuring changes in the International Caries Detection and Assessment System ICDAS scores, concentrations of proteins in saliva, and the presence of cavity-causing bacteria over six months. The study is conducted as a randomized controlled trial at multiple outpatient centers. Participants are randomly assigned to one of three groups Group A receives vitamin D supplements and oral hygiene instructions Group B receives vitamin D supplements, topical fluoride application, and oral hygiene instructions and Group C, the control group with sufficient vitamin D levels, receives topical fluoride and oral hygiene instructions. Vitamin D supplements include weekly 50,000 IU doses for two months followed by daily maintenance doses of 5,000 IU for one month. Fluoride treatments involve professional application of 5% sodium fluoride gel for five minutes on affected teeth. During the six-month study, participants will have their dental health monitored through assessments of their ICDAS scores, saliva samples analyzed for protein levels using ELISA, and bacterial counts measured by PCR techniques. Researchers will also check serum vitamin D levels. Oral hygiene and diet counseling are provided. The study evaluates the progression of initial cavities, changes in saliva biomarkers, and oral bacteria to understand how these interventions impact dental caries management.

Researchers are evaluating the effect of adenosine pre-medication on the occurrence of slow flow or no-reflow after primary percutaneous coronary intervention PCI in adults with ST-segment elevation myocardial infarction STEMI. This study is a randomized controlled trial involving 1,148 patients, designed to assess whether giving adenosine before PCI can improve heart muscle blood flow and reduce complications associated with inadequate myocardial perfusion. Participants will be randomly assigned to one of two groups one group will receive intracoronary adenosine before PCI along with standard pharmacological treatment, while the control group will receive only standard care during PCI. The adenosine dose is 2 mg for the left coronary artery and 1 mg for the right coronary artery, diluted in 20 mL normal saline, administered immediately before the procedure. The study will take place over 12 months at multiple centers. During the study, researchers will collect baseline and procedural data, monitoring the incidence of slow flow or no-reflow using TIMI flow grades during the PCI procedure. They will also assess myocardial perfusion through the Myocardial Blush Grade. Safety will be monitored for potential side effects such as transient bradycardia or heart block. Statistical analysis will evaluate the outcomes, and participants will be followed until the study concludes at the end of 2026.

Researchers are comparing the effects of xylometazoline nasal drops and adrenaline nasal packing on nasal bleeding during nasotracheal intubation in participants undergoing elective oromaxillofacial surgeries. The trial aims to determine which of these two treatments better reduces nasal bleeding during the procedure. This study includes participants aged 18 to 60 years with specific health criteria to ensure safety and accuracy. Participants are randomly assigned to one of two groups. One group receives 0.1% xylometazoline nasal drops, administered as 3 to 5 drops in the selected nostril 15 minutes before surgery. The other group receives adrenaline nasal packing, where a gauze soaked in adrenaline is placed inside the nostril 15 minutes before surgery and removed after 7 to 10 minutes. Both groups undergo nasotracheal intubation under general anesthesia with careful monitoring. Throughout the study, participants will have vital signs monitored, including blood pressure, heart rate, ECG, and oxygen saturation. An experienced anesthesiologist will perform the procedures and record the incidence and severity of nasal bleeding during intubation and extubation. Data will be analyzed to compare bleeding outcomes between groups while considering factors like age, gender, and medical history. Participation lasts through the surgical procedure and immediate recovery monitoring.

Researchers aim to create a diverse and detailed dataset of eye images from 1000 participants aged 50 and older, including both healthy individuals and those diagnosed with any stage of Age-Related Macular Degeneration AMD. This dataset will support the development of an Artificial Intelligence AI tool to help screen for early AMD, a condition that can lead to vision loss. The study addresses the challenge of identifying early AMD in primary care settings to help prevent late-stage vision loss. Participants will undergo a single retinal imaging session of both eyes, which includes single field stereo color fundus photography before and after pupil dilation and macular spectral domain-optical coherence tomography. Additional study procedures include collecting patient history such as demographics, smoking, and family history of AMD, a physical exam measuring height and weight, vision testing using Snellen best-corrected visual acuity, and AMD classification using the Beckman scale. The study is observational and cross-sectional, conducted at multiple international sites to ensure a wide representation. During the study, participants will provide detailed imaging and clinical data in one visit. Researchers will collect and annotate images for a reference standard classification of AMD and track participant counts by AMD classification and geographic location over up to 18 months. The study involves no treatment but focuses on data collection to facilitate AI development. Participation involves no therapeutic procedures, and safety monitoring is not required since this is an observational study. Total involvement is limited to the imaging session and consent process.

This research aims to evaluate whether showing an animated video of the procedure can reduce pain and anxiety in children undergoing pin removal after supracondylar fracture fixation. The study focuses on pediatric patients aged 4 to 12 years who have had K-wire fixation for these fractures. Pain and anxiety related to pin removal can be distressing, and this study investigates a distraction method to ease these symptoms. Participants will be randomly assigned to one of two groups. One group will watch an animated video of the pin removal procedure during the treatment, while the other group will undergo pin removal without the video. The procedure involves removal of the K-wire used to fix the fracture. The study uses a randomized, quadruple-masked design to compare outcomes between these two approaches. Childrens pain and anxiety will be measured using several scales, including the Wong Baker Pain Scale, Childrens Hospital of Eastern Ontario Pain Scale, Childrens Anxiety Meter-State, and Short State Trait Anxiety Inventory Scale. These assessments will be done before, during, and 60 minutes after the procedure. The study will monitor changes in pain and anxiety levels to determine the impact of the animated video. The trial runs from October 2025 to January 2026 and is sponsored by Liaquat National Hospital & Medical College.

This research aims to compare the effects of oral anticoagulation versus no anticoagulation in patients aged 55 and older who have had recent episodes of transient atrial fibrillation triggered by stress and have additional factors that increase their risk of stroke. The study is a multinational, investigator-initiated, prospective, randomized, open-label trial evaluating the impact of non-vitamin K oral anticoagulants NOACs on preventing stroke and other serious cardiovascular events. Participants will be randomly assigned to either receive one of several NOACs, such as edoxaban, apixaban, dabigatran, or rivaroxaban, prescribed by their physician for the duration of the follow-up, or to a control group that will not receive anticoagulants unless medically indicated during the study. The choice of specific NOAC and dose adjustments are determined by the prescribing doctor. The study excludes patients with certain conditions like chronic atrial fibrillation, severe kidney or liver disease, recent cardiac surgery, or bleeding risks. During the study, participants will be monitored for up to 24 months to assess the occurrence of non-hemorrhagic stroke, systemic embolism, vascular mortality, myocardial infarction, peripheral arterial thrombosis, amputation, and venous thromboembolism. Regular follow-up will include evaluation of these outcomes to measure the effectiveness and safety of anticoagulation compared to no anticoagulation. Participants will provide informed consent and remain under medical supervision throughout the trial.

Researchers are evaluating the safety and effectiveness of low-dose Apixaban combined with standard medical therapy compared to standard therapy alone to prevent left ventricular LV thrombus formation after primary PCI in patients with acute anterior myocardial infarction and severe LV dysfunction. This open-label, randomized controlled trial focuses on patients aged 18 to 65 years with an ejection fraction below 35% and specific heart motion abnormalities. Participants will be randomly assigned to receive either Apixaban 2.5 mg twice daily plus dual antiplatelet therapy aspirin and clopidogrel for four weeks along with guideline-directed medical therapy, or guideline-directed medical therapy alone including dual antiplatelet therapy. After four weeks, those in the Apixaban group will continue with dual antiplatelet therapy. In case of stent thrombosis, some medication adjustments may be made. Follow-up includes phone assessments at two weeks and an in-person visit with echocardiography at four weeks. During the study, participants will be monitored for LV thrombus formation using echocardiography at four weeks, and clinical status, medication side effects, and adherence will be assessed. The primary outcome is the incidence of LV thrombus formation at one month. Secondary measures include rates of death, recurrent heart attacks, stent thrombosis, heart failure hospitalizations, bleeding events, and drug discontinuation due to side effects. Safety and outcomes will be independently reviewed by a clinical events committee.

Researchers are investigating the effects of sweet almonds on healing femur and tibia shaft fractures compared to routine vitamin D3 supplements. This study addresses the need for an affordable and safe alternative to bone-strengthening drugs, which often cause side effects and are costly. The trial focuses on patients with vitamin D insufficiency or deficiency, assessing the potential of almonds to improve bone healing and vitamin D levels in the blood. The trial is a single-center, open-label, crossover randomized controlled study involving 136 participants aged 18 to 55 with trauma-related femur and tibia shaft fractures. Participants are divided into two groups based on their vitamin D levels and receive treatments including daily whole almonds 5 gramsday and weekly oral vitamin D3 200,000 units in various sequences with washout periods. Group 1 includes vitamin D insufficient patients receiving almonds and vitamin D3 in a crossover design, while Group 2 includes vitamin D deficient patients receiving vitamin D3 alone, almonds alone, or a combination followed by crossover treatments. Participants undergo follow-up visits at 4 and 13 weeks post-treatment, where fracture healing is monitored through routine X-rays and Radiological Union Score for Tibial fractures RUST. Safety is closely assessed, with adverse events recorded and managed according to international guidelines. The study also tracks treatment adherence with daily diaries and compares costs and changes in blood vitamin D levels. Patients may withdraw at any time without losing their rights, and the study will be completed within 24 months including a close-out period.