Clinical trials

Restrictive lung diseases (RLD) represent a significant cause of morbidity, often necessitating intensive interventions such as mechanical ventilation due to diminished lung compliance (LC) and reduced total lung capacity (TLC). Mechanical ventilation, while vital, is associated with ventilator-induced diaphragmatic dysfunction (VIDD), leading to rapid muscle atrophy and impeding patient recovery. This proposed study aims to evaluate the clinical impact of IMT and PEP on improving respiratory muscle strength, lung compliance and mobilizing secretions (effective cough reflex) in patients with RLD who require mechanical ventilation.

The goal of this randomized controlled trial is to compare the amount of pain experienced during removal of dental caries using Smart burs, Carisolv, and conventional diamond burs in adults aged 18-45 years with active caries in asymptomatic mandibular molars. The main questions it aims to answer are: Does the method used for caries removal affect the amount of pain experienced? Is there a difference in pain perception between Smart burs, Carisolv, and conventional diamond burs? Researchers will compare the three treatment groups to see whether pain perception during caries excavation differs between the methods. Participants will: Be randomly assigned to one of three groups: Smart burs, Carisolv, or conventional diamond burs. Undergo caries removal using the assigned method. Rate their pain during the procedure using a 0-10 Visual Analogue Scale (VAS).

The goal of this clinical trial is to learn whether a shorter course of antibiotics (7 days) works as well as the usual longer course (14 days) for adults admitted to hospital with a flare-up of chronic obstructive pulmonary disease (COPD), a long-term lung disease. The trial takes place at CDA Hospital Islamabad, Pakistan. The main questions it aims to answer are: * Do patients who take antibiotics for 7 days recover as well by Day 30 as patients who take them for 14 days? * Does the shorter course lead to fewer side effects and less antibiotic use, without more treatment failures, relapses or hospital readmissions? Researchers will compare a 7-day antibiotic course with the usual 14-day course to see if the shorter course is just as effective. Participants will: * Be assigned by chance (like flipping a coin) to take antibiotics for either 7 days or 14 days. Their doctor chooses which antibiotic to use. * Receive all other usual hospital care for their COPD flare-up. * Have check-ups about 3-5 days, 7 days, 14 days and 30 days after joining the trial, in hospital or by telephone, to record their symptoms, any side effects and any return to hospital. About 560 adults will take part.

Diabetic foot ulcers (DFUs) are one of the serious complications of diabetes, typically resulting from neuropathy or peripheral arterial disease, and can often lead to amputation. It affects approximately 6.3% of people with diabetes globally. In Pakistan, the overall prevalence of DFUs is 16.83%, with a slightly higher rate in females. Diabetic foot ulcers are the main reason for lower extremity amputation (LEA) with non-traumatic origin, hospitalization, healthcare costs, and mortality.

This study is a two-arm randomized parallel group trial designed to compare the effects of alternate nostril breathing vs diaphragmatic breathing on oxygen saturation and Heart-rate variability in hemodynamically stable post-PCI patients. Participants will be randomly allocated in a 1:1 ratio to alternate nostril breathing or diaphragmatic breathing and will receive the allocated intervention for 2 consecutive days with three supervised sessions per day in addition to routine post-PCI care. Oxygen saturation will be assessed using a pulse oximeter and heart-rate variability will be assessed using a Polar H10 sensor at baseline and after the intervention. The study will determine whether there is a difference between two breathing interventions in the prescribed outcome measures.

This randomized controlled trial aims to compare the mean postoperative pain after using double antibiotic paste (DAP) versus calcium hydroxide (CH) as an intracanal medicament in teeth with symptomatic apical periodontitis. Symptomatic apical periodontitis is a painful dental condition caused by inflammation and destruction of the tissues around the root apex of a tooth. It is diagnosed clinically by a painful response to biting, percussion, or palpation, and radiographically by widening of the periodontal ligament space. Patients aged 16 to 50 years with a single tooth diagnosed with symptomatic apical periodontitis will be randomly divided into two groups. Group A will receive calcium hydroxide as an intracanal medicament, and Group B will receive double antibiotic paste (a mixture of metronidazole and ciprofloxacin). Postoperative pain will be measured using a 10-point Visual Analog Scale (VAS) at 1 hour and 24 hours after treatment. Patients will be contacted by telephone to record their pain scores. The hypothesis is that there is a difference between the mean postoperative pain after using double antibiotic paste versus calcium hydroxide in teeth with symptomatic apical periodontitis.

This study will compare two physiotherapy treatments for adults with long-lasting neck pain and tender muscle spots, called trigger points, in the upper trapezius muscle between the neck and shoulder. The aim is to find out which treatment was more effective in reducing pain, improving neck movement, and reducing difficulty with daily activities. The study will includ 76 adults aged 20-40 years at Mayo Hospital, Lahore, Pakistan. Participants will be assigned by chance to one of two treatment groups. One group will receive a cooling spray followed by gentle stretching of the affected muscle. The other group will receive sustained pressure applied by a therapist to the tender muscle spots. Both groups also will receive routine physiotherapy, including heat, exercises, and advice about neck care and posture. Participants will receive six treatment sessions over two weeks. Pain, neck movement, and difficulty with daily activities will be assessed before treatment, immediately after the first session, and after the sixth session.

This study is a two-arm randomized parallel group trial designed to compare the effects of Incentive spirometry vs diaphragmatic breathing on oxygen saturation and Heart-rate variability in hemodynamically stable post-PCI patients. Participants will be randomly allocated to either the incentive spirometry group or the diaphragmatic breathing group and will receive the allocated intervention for 2 consecutive days with three supervised sessions per day in addition to routine post-PCI care. Oxygen saturation will be assessed using a pulse oximeter and heart-rate variability will be assessed using a Polar H10 sensor at baseline and after the intervention. The study will determine whether there is a difference between two interventions in the prescribed outcome measures.

The goal of this study is to learn if a nutritional smartphone application can improve the dietary habits in adults. The main objectives are: To explore if the use of a nutritional mobile application can improve a) mindful eating b) dietary diversity c) self-regulation of eating behavior d) calories consumed from healthy food groups vs unhealthy food groups among adults living in a low and middle income country.

Depression is a common mental health problem affecting almost 300 million people worldwide. Antidepressants are recommended as one of the first line treatments for people with moderate-to-severe symptoms of depression. In our recent trial, PETRUSHKA, on the acute treatment of depression, we demonstrated that the PETRUSHKA Tool, an evidence-based shared decision support system to personalise antidepressant treatment, in comparison with usual care reduced by almost 40% the number of participants stopping their antidepressant early, also improving their depression and anxiety symptoms. To identify the best treatment for each individual, the PETRUSHKA Tool used clinical and demographic predictors. Pilot data show that genetic information can aid stratification of people experiencing depression and better target their treatment. Genetic data can be collected using low-cost DNA-sequencing technology in diverse clinical settings and low-resource environments. Hence, we hypothesised that individual-level pharmacogenomic information can further personalise antidepressant treatment. In this project called PRADA ("Prescribing the Right Agent for Depression in Adults"), we will develop and test in a global trial across Ethiopia, Pakistan and the UK, an evidence-based multimodal web-tool to help participants and clinicians choose the best pharmacological treatment for depression jointly, based on participant preferences and their individual clinical, demographic, cultural, and also genetic profile (PRADA Tool). We will compare the new tool with the PETRUSHKA Tool in a blind fashion, measuring adherence to antidepressant treatment, clinical response and quality of life over a 12-month follow-up.

Surgical site infection (SSI) is one of the most common postoperative complications following elective laparotomy and contributes significantly to patient morbidity, prolonged hospital stay, and increased healthcare costs. Various techniques are available for skin closure, including skin staples and polypropylene sutures; however, evidence regarding their comparative effectiveness remains inconsistent, particularly in low- and middle-income countries. This randomized controlled trial aims to compare skin staples with polypropylene sutures for skin closure following elective laparotomy. Eligible adult patients undergoing elective laparotomy at the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, will be randomly allocated in a 1:1 ratio to receive either skin staples or polypropylene sutures. The primary outcomes are skin closure time and incidence of surgical site infection within 30 days of surgery. Secondary outcomes include wound dehiscence, postoperative pain, cosmetic scar appearance, patient satisfaction, and duration of hospital stay. The findings will provide evidence regarding the optimal skin closure technique for elective laparotomy in the Pakistani population.

The PICCTURE trial is a cluster randomized controlled study which will be conducted in District Badin, Pakistan, to evaluate the effectiveness of community-based interventions in improving resilience to climate-related hazards. The study compares community-led adaptation and resilience strategies and community interventions integrated with primary healthcare engagement against a control group. The objective is to determine whether these approaches improve household-level resilience, adaptive capacity, and health-related outcomes in a coastal, climate-vulnerable population.

The PICCTURE trial is a cluster randomized controlled study that will be conducted in District Astore, Pakistan, to evaluate the effectiveness of community-based interventions in improving resilience to climate-related hazards. The study compares community-led adaptation and resilience strategies and community interventions integrated with primary healthcare engagement against a control group. The objective is to determine whether these approaches improve household-level resilience, adaptive capacity, and health-related outcomes in a mountainous, climate-vulnerable population.

The goal of this clinical trial is to evaluate whether photobiomodulation therapy (low-level laser therapy) can reduce fatigue and improve quality of life in patients with chronic fatigue syndrome (CFS). The study will include adults aged 18-60 years diagnosed with chronic fatigue syndrome. The main questions it aims to answer are: Does photobiomodulation therapy significantly reduce fatigue levels as measured by the Fatigue Severity Scale (FSS) and Multidimensional Fatigue Inventory (MFI-20)? Does photobiomodulation therapy improve pain, functional capacity, sleep quality, and psychological well-being in patients with chronic fatigue syndrome? Researchers will compare the low-level laser therapy group with a placebo (sham laser) group to determine whether photobiomodulation therapy leads to greater improvements in fatigue, pain, and overall quality of life. Participants will: Receive either active low-level laser therapy or placebo treatment three times per week for eight weeks Undergo assessments of fatigue, pain, functional capacity, quality of life, sleep quality, and psychological well-being at baseline and follow-up intervals (3, 6, and 12 months)

The current study is a double-blind, parallel-group randomized controlled trial involving 80 participants with chronic low back pain. The trial will compare a program of Pain Neuroscience Education plus Sensory Discrimination Training and core stability exercises with a program of Pain Neuroscience Education and core stability exercises alone. Interventions will be delivered twice weekly for eight weeks. The primary outcome is pain catastrophizing. Secondary outcomes include kinesiophobia and functional movements. Assessments will be conducted at baseline, 4, and 8 weeks. The trial will be carried out at Nutricao Lahore Clinic and Model Town Hospital, Lahore. The hypothesis is that Pain Neuroscience Education with Sensory Discrimination Training will result in greater reductions in pain catastrophizing and kinesiophobia, as well as improvements in functional movements.

This is a Phase 3, global, randomized, open-label, multicenter, trial evaluating brelovitug (BJT-778) vs bulevirtide for the treatment of chronic hepatitis delta infection (CHD). The main goal of this study is to test the effectiveness of brelovitug compared to bulevirtide as a long-term treatment in patients with chronic HDV infection.

patients reported at department of Operative dentistry diagnosis section , patients coming to operative department of DIDC-DUHS with the chief complain of moderate to severe pain will be assessed .Complete history of each patient will be obtained along with clinical examination including percussion test, presence of swelling, sinus tract and mobility of tooth. Pulp sensitivity will be assessef. Periapical x-ray will be used to evaluate periapical status PAI score. . Following anesthesia, the tooth will be isolated with a rubber dam to maintain a dry operating field. An access cavity will then be prepared. The presence of bleeding within the pulp chamber will be regarded as an indicator of pulp vitality. The (WL) will be established using patency files . An endodontic motor (eight teeth E-connect) will be programmed for root canal instrumentation. Root canals will be irrigated with sodium hypochlorite (NaOCl). Root canals will be dried using paper points, and will take master cone periapical radiograph before final obturation procedure. For the CSBS group (CERASEAL; Meta Biomed Co., Cheongju, Korea), the sealer will be applied and a single cone will be used for obturation. For the CHBS group (Seal apex), the obturation will be completed via cold lateral condensation. The teeth will be restored with composite (LUNA SDI). Single operator will perform the complete procedure. Analgesic ibuprofen 400 mg (Brufen) will be prescribed to the patient in case of severe pain

This randomized, two-arm, parallel-group clinical trial is designed to compare French Contrast Training (FCT) with Oregon Circuit Training (OCT) for improving explosive strength, lower-limb power, and agility in competitive football players aged 16 to 25 years. Twenty-six participants are planned. Both interventions are delivered three times per week for 8 weeks in approximately 45-minute supervised sessions. Outcomes are assessed at baseline and after the 8-week intervention using vertical jump height, squat one-repetition maximum, and the Agility T-test.

To compare the mean onset of sensory block and mean time to first rescue analgesia between ropivacaine with dexmedetomidine and ropivacaine with tramadol in ultrasound-guided pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgeries.

The goal of this clinical trial is to evaluate whether a climate- and gender-responsive integrated package of nutrition, hygiene (WASH), and heat-adaptation counselling can improve maternal and child health and nutrition outcomes among women of reproductive age and young children in rural Sindh, Pakistan. The main questions it aims to answer are: 1. Does training Lady Health Workers, at the community level improve women's knowledge, attitudes, and practices related to maternal nutrition, infant and young child feeding, hygiene, and heat-adaptation behaviours? 2. Does training healthcare providers at facilities improve women's knowledge, attitudes, and practices related to maternal nutrition, infant and young child feeding, hygiene, and heat-adaptation behaviours? Researchers will compare communities receiving the enhanced training package to those receiving standard care to determine its effectiveness. Participants will: 1. Receive counselling from trained Lady Health Workers and healthcare providers on nutrition, hygiene, and heat-adaptation practices. 2. Take part in household surveys assessing knowledge, attitudes, and practices. 3. Followed over time during pregnancy and early childhood (only applies to a cohort of participants).

Vitamin D deficiency and undernutrition are major public health concerns globally, particularly among children in low-resource and high-altitude settings. In Pakistan, the recent national nutrition survey has reported alarmingly high prevalence rates of vitamin D deficiency, especially in Ghizer District of Gilgit-Baltistan, where 85% of children under five years of age are vitamin D deficient, placing them at heightened risk for rickets, impaired growth, weakened immune function, cognitive impairments, and long-term socio-economic consequences. This survey did not provide any information on the vitamin D deficiency status of school-going children in Pakistan. However, a study conducted in Karachi reported that 65% of children aged 6-12 years were deficient in vitamin D. Despite abundant natural resources, such as trout fish and locally available cow's milk and eggs, these nutrient-rich foods are underutilized due to limited awareness among local communities about the health benefits for children. This issue is particularly urgent for the Aga Khan University (AKU) and the Aga Khan Education Service Pakistan (AKESP) 's schools in the region, where children's health is integral to academic success and long-term community development. Addressing micronutrient deficiencies aligns closely with AKU's and the Aga Khan Development Network's (AKDN) strategic priorities of improving early childhood development, promoting health equity, strengthening food security, and fostering local capacity through evidence-based interventions. Therefore, this proposal aims to assess whether targeted local food and supplementation, including trout fish, whole cow milk with egg, and vitamin D supplements, can significantly reduce vitamin D deficiency and improve nutritional and cognitive outcomes among school children in AKESP schools.

This randomized controlled trial will compare oral furosemide with placebo for improving blood pressure control in women with severe preeclampsia after delivery. Participants will receive either 20 mg of furosemide or a placebo tablet once daily for 5 days, in addition to standard postpartum treatment for high blood pressure. Blood pressure, symptoms, adverse events, and the need for additional antihypertensive medication will be monitored for 7 days after delivery. The study will assess whether adding furosemide helps achieve better postpartum blood pressure control compared with placebo.

The goal of this clinical trial is to learn if a new trientine tetrahydrochloride (TETA 4HCl) formulation administered once a day compared to d-Penicillamine (DPA) as a first line treatment for people living with Wilson's disease (WD) is effective and safe. The study is enrolling children aged 8 years and older weighing at least 55 lb (25 kg) and adults with a recent diagnosis of WD. People recently diagnosed with WD, may be eligible for the study if they have either not started copper chelating treatment (such as DPA or trientine) or have been taking zinc salts for less than 28 days. Participants will be randomly allocated (like tossing a coin) to receive either DPA or TETA 4HCL for 48 weeks. During this time period participants will have up to 12 visits for health checks and assessments including blood and urine testing. In addition, at some visits participants may be asked to complete questionnaires on treatment satisfaction, and overall well-being.

This randomized controlled trial aims to compare the clinical effectiveness of ischemic release and sustained pressure direct myofascial release for upper trapezius trigger points. The study will compare their effects on pain pressure threshold, cervical range of motion, and scapular upward rotation following a two-week intervention.

Plantar fasciitis is a common musculoskeletal condition characterized by plantar heel pain, particularly during the first steps after waking or following prolonged rest. It can substantially affect walking, standing, daily activities, and overall functional ability. Although conservative physiotherapy management is commonly used, the relative effectiveness of different manual therapy techniques remains unclear. The present study aims to compare the effectiveness of Transverse Friction Massage (TFM) and Instrument-Assisted Soft-Tissue Mobilization (IASTM) in patients with plantar fasciitis. The study will be conducted as a single-blinded randomized controlled trial at Foundation University College of Physical Therapy, Islamabad. A total of 34 participants will be recruited using purposive sampling and subsequently randomized into two groups through a sealed opaque envelope method. Participants will be adults aged 19-44 years with clinically diagnosed plantar fasciitis and symptoms. persisting for more than three months. Group A will receive Transverse Friction Massage, while Group B will receive Instrument-Assisted Soft-Tissue Mobilization. Both groups will additionally receive a standardized physiotherapy protocol consisting of stretching exercises, strengthening exercises, ultrasound therapy, home-based exercises, and activity modification. The interventions will be administered twice weekly for four weeks, resulting in a total of eight treatment sessions. The primary clinical outcomes will include pain intensity, foot-related functional impairment, and ankle range of motion. Pain will be assessed using the Numeric Pain Rating Scale (NPRS), foot function using the Foot Function Index (FFI), and ankle range of motion using a goniometer. Assessments will be performed at baseline, after two weeks, and at the end of four weeks. Data will be analyzed using SPSS. Appropriate parametric or non-parametric statistical tests will be applied according to data distribution, with statistical significance set at p\<0.05 and a 95% confidence interval. The study is expected to provide evidence regarding the comparative effectiveness of TFM and IASTM for reducing pain, improving foot function, and enhancing ankle mobility in patients with plantar fasciitis.