Clinical trials

Hypertension is a leading global risk factor for cardiovascular disease and is frequently associated with left atrial and ventricular remodeling, leading to subclinical diastolic dysfunction\[cite: 2\]. Left Atrial Volume Index (LAVI) serves as a sensitive indicator of left ventricular diastolic dysfunction and a key predictor of adverse cardiovascular outcomes, including atrial fibrillation, stroke, and heart failure with preserved ejection fraction (HFpEF)\[cite: 2\]. Reversing or preventing left atrial enlargement is critical to improving long-term prognosis in hypertensive patients\[cite: 2\]. While sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor, ARNI) has demonstrated significant clinical benefits in heart failure, limited data exist regarding its comparative efficacy against valsartan alone in reversing left atrial remodeling in hypertensive patients with preserved ejection fraction (LVEF \>50%)\[cite: 2\]. This randomized controlled trial aims to evaluate and compare the efficacy of sacubitril/valsartan versus valsartan monotherapy in reducing LAVI and improving blood pressure control over a 6-month treatment period in hypertensive patients with preserved ejection fraction and enlarged left atrium (LAVI \>34 mL/m²)\[cite: 2\].

This study compares caudal and transforaminal epidural steroid injections for treating unilateral S1 nerve root pain. It evaluates pain relief, functional improvement, treatment satisfaction, quality of life, and complications over 12 months.

Acute appendicitis is one of the most common surgical emergencies globally. While surgical removal of the appendix (appendectomy) is the definitive treatment, the optimal surgical approach-laparoscopic versus open-remains widely debated, particularly in obese patients. Obese individuals present unique surgical challenges due to increased abdominal wall thickness, which often necessitates larger skin incisions during open procedures, potentially increasing postoperative pain, wound healing times, and wound complications. This study aims to compare the postoperative outcomes of laparoscopic appendectomy versus standard open appendectomy in obese patients (BMI ≥ 30 kg/m²) presenting with acute appendicitis. Participants will be randomly assigned to undergo either open appendectomy or laparoscopic appendectomy. The primary outcomes evaluated will be the incidence of surgical site infections (including superficial wound infections and intra-abdominal abscesses) up to 30 days post-procedure and the total length of hospital stay (in days).

Preterm birth-defined as delivery before 37 weeks of gestation-is a leading cause of neonatal morbidity and mortality worldwide, particularly in resource-limited settings. Women with a history of spontaneous preterm birth face a significantly higher risk of experiencing premature labor in subsequent pregnancies. Impaired uteroplacental blood flow, inflammation, and abnormal clot formation are key contributing factors to spontaneous preterm delivery. Low-dose aspirin is an affordable, widely available medication that exerts anti-inflammatory and antithrombotic effects by inhibiting platelet aggregation and prostaglandin synthesis. This study aims to evaluate whether low-dose aspirin (75 mg daily), initiated between 8 and 16 weeks of gestation, can effectively reduce the incidence of recurrent spontaneous preterm labor in pregnant women with a prior history of premature delivery compared to a placebo. Participants will be monitored throughout their pregnancy up to 36 weeks or delivery to evaluate gestational age at birth and labor outcomes.

women globally, often requiring endometrial tissue sampling for accurate evaluation and diagnosis. Traditional office-based sampling techniques like Pipelle are widely used, but the disposable instruments can be relatively expensive in resource-limited settings. Manual Vacuum Aspiration (MVA) using a flexible cannula is an inexpensive, reusable alternative, but clinical data comparing its performance directly to Pipelle remains limited. The objective of this randomized clinical trial is to compare Pipelle endometrial biopsy and Manual Vacuum Aspiration (MVA) cannula in terms of sample adequacy, patient satisfaction, and post-procedure complications in women presenting with abnormal uterine bleeding. Participants will be randomly assigned to undergo endometrial sampling using either a 4 mm MVA cannula or a Pipelle device without anesthesia or cervical dilation. Samples will be analyzed for histopathological diagnosis, and outcomes such as procedure pain, adequacy of tissue, and complications will be recorded.

To compare the frequency of first pass success by short axis versus long axis for cannulation of internal jugular vein.

The thoracolumbar fascia (TLF) is thickened and stiffer in individuals with chronic non-specific low back pain (CNSLBP) and may contribute to pain persistence. Myofascial release (MFR) has been shown to reduce TLF stiffness acutely; however, its longer-term effects on fascial morphology and pain self-efficacy remain unclear. This randomized controlled trial will investigate the effects of a standardized 6-week MFR program targeting the thoracolumbar fascia compared with sham MFR in adults with CNSLBP. A total of 65 participants aged 18-60 years with CNSLBP will be randomized in a 1:1 ratio to either standardized MFR or sham MFR. The intervention will consist of 18 treatment sessions delivered over 6 weeks. Primary outcomes include thoracolumbar fascia thickness measured by B-mode ultrasound, thoracolumbar fascia stiffness measured by shear-wave elastography, and pain self-efficacy measured using the Pain Self-Efficacy Questionnaire (PSEQ). Secondary outcomes include pain intensity, functional disability, lumbar flexion range of motion, and patient global impression of change. Outcomes will be assessed at baseline and after completion of the 6-week intervention period.

Strength and endurance are essential components for physical fitness of any individual. High intensity interval training provides time efficient benefits for strength and endurance training. Physical Therapy professionals and students need physical fitness for effective clinical performance of patients. There is limited research regarding physical performance of physical therapists itself

The goal of this randomized controlled clinical trial is to determine whether oral cryotherapy using ice chips can prevent and reduce the incidence and severity of chemotherapy-induced oral mucositis in adult cancer patients receiving 5-fluorouracil and methotrexate chemotherapy regimens. The main questions it aims to answer are: Does the application of oral ice chips reduce the severity of oral mucositis compared to routine mouth care alone? Is there a significant difference in oral mucositis grades between patients receiving oral cryotherapy and those receiving standard mouthwash care? Researchers will compare the experimental group receiving oral ice chips during chemotherapy plus routine mouthwash care with the control group receiving routine mouthwash care only to evaluate the effectiveness of oral cryotherapy in reducing oral mucositis severity. Participants will: Be randomly assigned to either the experimental group (n = 51) or control group (n = 51) Receive chemotherapy with 5-fluorouracil or methotrexate Use routine mouthwash (normal saline/sodium bicarbonate/chlorhexidine) at home Receive oral ice chips during chemotherapy infusion (experimental group only) Be assessed for oral mucositis severity using the WHO Oral Mucositis Grading Scale before and after the intervention

This study evaluates and compares the clinical and radiographic outcomes of Rosmarinus officinalis and Mineral Trioxide Aggregate (MTA) when used as pulpotomy medicaments in vital mature permanent teeth with irreversible pulpitis. The aim is to determine the effectiveness of both materials in terms of pain reduction and periapical healing. While MTA is considered a gold standard, it has limitations such as high cost, long setting time, and potential discoloration. Therefore, this study investigates Rosmarinus officinalis as a natural, cost-effective alternative with comparable therapeutic potential. This study also provide an alternative to RCT in teeth with irreversible pulpitis

Parkinson's Disease commonly results in impaired hand dexterity, reducing a patient's ability to perform activities of daily living. While digital exergaming has been used to encourage physical activity and improve motor function, it often lacks real-world tactile engagement. Integrating physical objects into exergaming known as a phygital approach which may enhance sensorimotor learning and functional carryover. However, its impact on upper limb functional outcomes in PD remains underexplored. Objectives: To assess the effectiveness of exergaming with physical objects on functional outcomes of upper limb rehabilitation in individuals with Parkinson's Disease. Methodology: This randomized controlled pilot study will include 30 individuals with early-stage Parkinson's Disease, recruited through convenience sampling and randomly assigned to either a phygital exergaming group or a control group. Both groups will receive sessions over three monthd (3 sessions/week, 30 minutes each). The phygital group will perform task-based exergaming using both physical objects and digital prompts, while the control group will use digital prompts alone. Functional outcomes will be assessed using the Box and Block Test (BBT), at baseline (day 1) and post intervention 12 weeks. Statistical Analysis: Data will be analyzed using SPSS version 25. Descriptive statistics like gender, stages of diseases etc. will be summarized and described as bar charts and percentages. Within-group differences will be assessed using paired t-tests or Wilcoxon signed-rank tests based on data normality. Between-group comparisons will be conducted using independent t-tests or Mann-Whitney U tests. A p-value of less than 0.05 will be considered statistically significant.

This randomized controlled trial aims to compare the efficacy and safety of levofloxacin-based sequential therapy versus bismuth-based quadruple therapy for eradication of Helicobacter pylori infection in adult patients. Helicobacter pylori infection remains highly prevalent in developing countries and is associated with gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Increasing antibiotic resistance has reduced the effectiveness of conventional treatment regimens, creating a need for alternative first-line therapies with improved eradication rates and acceptable tolerability. Eligible adult patients diagnosed with H. pylori infection by stool antigen testing will be recruited from the Gastroenterology Department of Services Hospital Lahore. Participants will be randomly assigned in a 1:1 ratio to receive either levofloxacin-based sequential therapy or bismuth-based quadruple therapy for 14 days. The primary outcome of the study is successful eradication of H. pylori infection, confirmed by stool antigen testing performed 6 weeks after completion of therapy. Secondary outcomes include treatment-related adverse effects, treatment compliance, and overall treatment cost. The study aims to identify an effective and affordable treatment strategy for H. pylori eradication in a population with high antibiotic resistance and socioeconomic limitations.

This study aims to evaluate the effect of foot reflexology on chemotherapy-induced nausea and vomiting in breast cancer patients. Nausea and vomiting are common side effects of chemotherapy and can negatively affect patients' comfort and quality of life. Foot reflexology is a non-invasive complementary therapy that involves applying pressure to specific points on the feet. The study will compare patients who receive foot reflexology along with standard care to those who receive standard care alone, to determine whether foot reflexology helps reduce the severity of nausea and vomiting during chemotherapy.

The goal of this clinical trial is to determine whether hand and foot exercises can reduce the severity of Taxane-based chemotherapy-induced peripheral neuropathy (CIPN) in adult cancer patients aged 20-60 years who have Grade 1I neuropathy as defined by the NCI-CTCAE criteria. The main questions it aims to answer are: * Do hand and foot exercises reduce the severity of sensory and motor neuropathic symptoms in patients receiving Taxane based chemotherapy? * Is the severity of peripheral neuropathy lower in the exercise group compared to patients receiving standard care alone? Researchers will compare patients receiving standard care (control group) with those receiving standard care plus a structured hand and foot exercise program (experimental group) to see if the exercises lead to greater improvement in neuropathy severity scores. Participants will: * Receive baseline assessment using the EORTC QLQ-CIPN20 questionnaire. * In the experimental group, learn and perform a 15-minute hand and foot exercise routine on chemotherapy day and continue it at home using a provided brochure. * Participate in telephonic follow-ups to support compliance and monitor symptoms. * Undergo a follow-up assessment at alternate week to measure changes in neuropathy severity.

The goal of this clinical trial is to evaluate whether respiratory nursing interventions can improve respiratory outcomes in patients hospitalized with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The main questions it aims to answer are: Do respiratory nursing interventions improve dyspnea levels measured by the Modified Medical Research Council (mMRC) Dyspnea Scale? Do these interventions improve oxygen saturation and pulmonary function (FVC, FEV1, and FEV1/FVC ratio)? Researchers will compare patients receiving respiratory nursing interventions plus routine hospital care with patients receiving routine hospital care alone to determine whether the interventions improve respiratory outcomes. Participants will: Undergo baseline assessment using the mMRC Dyspnea Scale, pulse oximetry, and pulmonary function tests. Receive either respiratory nursing interventions (deep breathing exercises, chest percussion, postural drainage, and lukewarm water intake) along with routine care or routine hospital care alone. Be reassessed after the intervention period using the same respiratory outcome measures.

The aim of this clinical trial is to study the effects of Pilates intervention versus conventional therapy on postural correction, core strength and flexibility in young individuals with complaint of non-specific low backache. The main question is whether the Pilates has better improvement as compared to the conventional therapy on postural correction, core strength and flexibility moreover to compare the effectiveness of two intervention. Participants of age 18-25 years and with complaint of non-specific low backache will be recruited. 50 participants will be enrolled. Participants will perform Pilates and conventional therapy for 3 times per week for six weeks. Participants will be randomly allocated to two groups and assessor blinding will be done to take baseline assessment. Assessor blinding is done to minimize biasness. Pre and Post assessments will be taken by the assessor. SPSS will be used for the analysis of the data.

The goal of this clinical trial is to learn how two different velocity loss thresholds (15% and 30%) during bodyweight squats affect strength and endurance in non-athletic young women aged 18-25 years. The main questions it aims to answer are: Does a lower velocity loss threshold (15%) during bodyweight squats improve lower-limb strength? Does a higher velocity loss threshold (30%) during bodyweight squats improve muscular endurance? Researchers will compare the two groups (15% vs. 30% velocity loss) to see if one approach works better for strength and endurance. Participants will: Perform bodyweight squats three times per week for six weeks. Be randomly assigned to either the 15% or 30% velocity loss group. Complete strength and endurance tests before and after the program

This randomized controlled trial aims to determine the effectiveness of myofascial release therapy in university students with text neck syndrome as prolonged smartphone and digital gadgets use has been associated with neck pain, forward head posture, and increased perceived stress among young adults with screen time more than 3 hours. Participants will be randomly allocated into control group and intervention group and will be treated for 4 weeks. Clinical outcomes including neck pain, neck pain intensity, craniovertebral angle for posture assessment, and perceived stress levels will be measured at baseline and post-intervention. The study seeks to determine whether Myofascial Release Therapy acts as a non-invasive technique in improving musculoskeletal and psychosocial parameters related to text neck.

Sedation is essential for mechanically ventilated pediatric patients to ensure comfort, ventilator synchrony, and prevention of self-extubation. However, excessive sedation may prolong mechanical ventilation and ICU stay, while inadequate sedation may cause agitation and physiological distress. Continuous Sedation Infusion (CSI) and Daily Sedation Interruption (DSI) are two commonly used strategies. Limited data exist comparing their impact on comfort levels in pediatric patients. This randomized controlled trial aims to compare comfort scores between continuous Midazolam infusion and daily sedation interruption in mechanically ventilated children aged 5-10 years diagnosed with pneumonia. Comfort will be assessed using the COMFORT-B Scale and Richmond Agitation-Sedation Scale (RASS) every 6 hours for 72 hours. The study intends to determine which strategy better maintains optimal sedation and comfort in pediatric intensive care settings.

Gestational Diabetes Mellitus (GDM) is a growing maternal health concern associated with adverse neonatal outcomes such as macrosomia and shoulder dystocia, often aggravated by poor dietary habits and physical inactivity during pregnancy. This randomized controlled study aims to evaluate the effectiveness of structured nursing interventions focusing on diet and physical activity in improving maternal glycemic control and reducing neonatal complications. A total of 66 pregnant women diagnosed with GDM will be selected through purposive sampling and randomly allocated into intervention and control groups using the lottery method. The intervention group will receive individualized dietary counselling, pregnancy-appropriate physical activity guidance, and regular nursing follow-up, while the control group will continue with routine antenatal care. Maternal outcomes, including fasting blood glucose and HbA1c levels, will be measured at baseline and follow-up visits. Neonatal outcomes such as macrosomia, mode of delivery, and shoulder dystocia will be documented at birth. Data will be collected using structured tools and analysed using SPSS, with independent t-tests and chi-square tests applied. The study anticipates that structured nursing interventions will significantly improve glycaemic control and reduce adverse neonatal outcomes, supporting the integration of evidence-based nursing care into routine GDM management.

This study is investigating the effectiveness of two different types of wound dressings in treating diabetic foot ulcers (DFUs), a common complication of diabetes that can be difficult to heal. The study will compare the use of vinegar dressings to normal saline (saltwater) dressings to see which one helps heal the wound faster and more effectively. People with diabetic foot ulcers often struggle with infections and slow healing. The goal of this study is to determine if vinegar, a simple and affordable treatment, works better than saline in improving wound healing and reducing infections. The study will measure how quickly the wound heals, how much dead tissue is removed, and whether the bacteria in the wound disappear. This study will involve patients with infected diabetic foot ulcers. Participants will be randomly assigned to receive either vinegar or saline dressing. The results will help determine the best and most cost-effective treatment for diabetic foot ulcers, potentially making it easier for patients to access better care.

This study aims to compare the outcomes of two laparoscopic techniques for repairing inguinal hernias: the modified tumescent technique (MT-TAPP) and the conventional laparoscopic transabdominal preperitoneal technique (CL-TAPP). The primary goal is to determine which technique provides better outcomes in terms of operative time, ease of pre-peritoneal space dissection, postoperative pain, and the formation of seromas. The study will involve 60 patients diagnosed with unilateral inguinal hernias, randomly assigned to either group. Participants in Group A will undergo the MT-TAPP procedure, which involves pre-peritoneal infiltration of a local anesthetic solution to improve dissection and reduce pain. Group B will undergo the standard CL-TAPP procedure. Data will be collected on various outcome measures and analyzed to identify which technique leads to quicker recovery, less postoperative pain, and fewer complications. The results of this study will help guide surgical decisions and improve patient outcomes in inguinal hernia repair.

This study compares two commonly used inhalation devices in asthma management. It focuses on evaluating how effectively PMDIs and DPIs deliver the same combination of inhaled corticosteroids and long-acting beta agonists in patients whose asthma remains poorly controlled despite treatment. The study is conducted in a tertiary care hospital setting, emphasizing real-world clinical practice and aiming to determine whether device choice influences asthma control outcomes.

Surgical extraction of impacted third molar is the most common surgical procedure performed in oral and maxillofacial surgery. The immediate post operative complications after 3rd molar surgery are pain, swelling and trismus while delayed post operative complications are mostly seen on the distal surface of second molar due to distal bone loss which include prolonged sensitivity due to increased periodontal pocket depth, gingival recession and root exposure. When PRF clot is given in wound, it causes alterations of the cellular ratios in the wound blood clot, leading to replacement of blood cells with Platelets and growth factors stimulating all phases of healing which will improve the immidiate and delayed post operative complications The purpose of present study is to compare the clinical outcomes in the treatment of senstivity and periodontal pockets at the distal aspect of second molar following surgical extraction of impacted third molar using PRF or Blood clot alone.

Chest tube thoracostomy remains a lifesaving intervention in trauma and thoracic surgery, used for the management of pneumothorax, hemothorax, empyema, and pleural effusions. Despite being one of the most frequently performed procedures worldwide, complication rates remain high, ranging from 20% to 40% \[1\]. Among these, pulmonary parenchymal chest tube (PPcT) insertion represents a rare but potentially devastating event, leading to hemorrhage, air leak, bronchopleural fistula, or infection. In Pakistan, where chest trauma and pneumothorax constitute major thoracic morbidities, PPcT cases are encountered with increasing frequency but remain underreported. Current literature describes only invasive surgical approaches-such as thoracotomy or video-assisted thoracic surgery (VATS)-for PPcT removal \[9,10\], with no established minimally invasive alternatives. In response to this clinical challenge, the Department of Thoracic Surgery at (Hospital Name), Punjab, Pakistan, has developed and implemented a novel, minimally invasive three-stage removal technique, termed the Buzdar Technique, designed to ensure safe extraction of intraparenchymal chest tubes without surgical intervention. The technique follows a standardized protocol involving: Healing phase: Tube left in situ for approximately two weeks to allow localized fibrosis and stabilization of the lung parenchyma. Initial retraction: Gradual 2-cm withdrawal with optional 360° rotation under radiologic and clinical supervision, followed by 24-hour observation and chest imaging. Sequential retractions: Weekly staged retractions of 2 cm until the last fenestration exits the pleural cavity, enabling safe final removal. This prospective cohort study, conducted from July 2025 to June 2026, aims to evaluate the safety, effectiveness, and clinical outcomes of the Buzdar Technique in managing iatrogenic PPcT. Data will include patient demographics, procedural details, complications, radiologic recovery, and overall outcomes. Success will be defined as complete tube removal without pneumothorax, air leak, bleeding, or need for surgical intervention. Preliminary institutional experience over the past decade has shown excellent results, with minimal morbidity, no requirement for thoracotomy or VATS, and full radiologic recovery in the majority of patients. The expected outcomes of this prospective evaluation are to validate these findings, establish the Buzdar Technique as a reproducible, evidence-based approach, and contribute to the global literature on non-surgical management of PPcT. If proven effective, this technique could represent a paradigm shift in the management of intraparenchymal chest tubes-offering a safe, staged, and minimally invasive alternative to surgical removal, particularly beneficial for centers in low- and middle-income countries where advanced surgical options may not always be available.