INNOVAPATHTM: Journal of Translational Medicine & Biotechnology is a premier scientific journal of the INNOVACORE Center for Research & Biotechnology and CorePath Laboratories. Our mission is to bridge the gap between scientific discovery and clinical application by publishing cutting-edge research in translational medicine, pathology, biotechnology, precision medicine, clinical research and innovations in healthcare. We aim to accelerate the development of innovative diagnostics, therapeutics, and biomedical technologies by fostering collaboration between researchers, clinicians, and industry leaders.
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TGFBR2-Guided Biomaterial Scaffolds for Aortic Root Reconstruction in Loeys-Dietz Syndrome: Toward Precision Aortopathy Repair
Loeys-Dietz syndrome (LDS) is a rare heritable aortopathy characterized by aggressive aneurysm formation and early dissection, frequently involving the aortic root. Mutations in TGFBR1 and TGFBR2 disrupt canonical TGF-β signaling, resulting in medial degeneration, elastin fragmentation, and aberrant matrix remodeling. Despite advances in surgical and endovascular repair, conventional grafts remain biologically inert and fail to address the underlying molecular dysregulation, predisposing patients to progressive downstream dilation and reoperation. Recent biomaterials research has introduced the concept of bioactive scaffolds—engineered vascular grafts capable of modulating local cell behavior and extracellular matrix (ECM) homeostasis. Emerging data suggest that targeted modulation of TGF-β signaling pathways can restore structural integrity in aneurysm-prone tissue. Incorporating TGFBR2-specific signaling cues within scaffold microarchitecture—via peptide-functionalized polymers or microRNA-loaded nanofibers—offers a precision approach to promote adaptive remodeling and reduce maladaptive fibrosis (1–3). Early in vitro studies using smooth muscle cell (SMC) cultures from TGFBR2-mutant models demonstrate partial normalization of elastogenesis and reduced MMP-2 expression when exposed to receptor-modulating environments (4). Beyond material design, computational modeling and machine learning can optimize scaffold composition, predicting mechanical resilience and cytokine release kinetics under pulsatile flow (5,6). Such integration aligns with the emerging paradigm of intelligent biomaterials—structures that dynamically respond to biomechanical and biochemical feedback, particularly vital in genetically mediated aortic disease. Proposed Translational Framework Preclinical modeling: Evaluate TGFBR2-guided scaffold prototypes in Loeys–Dietz syndrome (LDS) murine or porcine models to assess their ability to stabilize aneurysms, integrate histologically with host tissue, and restore normal TGF-β/SMAD signaling. Key outcomes will include improved medial architecture, reduced matrix degradation, and normalized smooth muscle cell phenotype. Computational optimization: Utilize finite element analysis (FEA) and AI-based predictive modeling to refine scaffold architecture—specifically fiber orientation, pore size, and mechanical compliance—to closely match native aortic root dynamics and minimize local stress concentrations. Simulations will guide iterative design improvements before in vivo testing. Regulatory readiness: Develop GMP-compliant fabrication protocols with standardized sterilization, material traceability, and quality control measures. Conduct biocompatibility and cytotoxicity testing according to ISO 10993 standards to ensure safety, regulatory alignment, and scalability for eventual clinical-grade production. Clinical Translation: Initiate first-in-human compassionate-use implants under rigorous ethical and regulatory oversight in high-risk LDS patients who are unsuitable for standard graft repair. Early outcomes will focus on safety, feasibility, and short-term aortic stability to inform subsequent clinical trial design. SMART Objectives Specific: Design TGFBR2-responsive scaffolds that actively modulate dysregulated TGF-β/SMAD signaling in human aortic smooth muscle cells (SMCs) to promote tissue homeostasis. Measurable: Demonstrate a ≥30% reduction in pathological MMP activity compared to standard ePTFE grafts, along with improved elastic modulus and reduced inflammatory response in preclinical models. Achievable: Employ polymer–nanoparticle hybrid scaffolds with tunable ligand density and controlled mechanical properties, using established materials and fabrication platforms to ensure feasibility. Relevant: Target the high reoperation rates in LDS patients caused by graft maladaptation and progression of aortic pathology beyond the repair site, addressing an unmet clinical need. Time-bound: Complete prototype optimization, preclinical validation, and regulatory documentation within 24 months, progressing from computational design to in vivo testing. By converging molecular genetics with adaptive biomaterial engineering, TGFBR2-guided scaffolds represent a promising avenue for patient-specific aortic repair. Such precision solutions could redefine management of genetically mediated aneurysms, transforming outcomes in a disorder where conventional materials fall short.
Funding Brains, Not Bytes: Keeping Seed Grants Focused on Investigators
Care for the Caregivers: The Patient and Client First Paradox
The Forgotten Electrolyte in Dengue: Hypophosphatemia Matters
AI-Augmented Sleep Apnea Screening in Neurology Clinics: Bridging Sleep and Cognitive Health
Dear Editor, Sleep apnea is a prevalent yet underdiagnosed disorder with profound neurological implications, including cognitive decline, impaired memory, and increased stroke risk. Despite strong evidence linking sleep-disordered breathing to neurocognitive dysfunction, routine screening remains uncommon in neurology clinics due to reliance on polysomnography and limited interdisciplinary coordination. Artificial intelligence (AI)-based tools offer a translational pathway to bridge this gap by providing accurate, non-invasive, and cost-effective screening integrated into clinical workflows. Recent advances in machine learning and computer vision have enabled automated detection of obstructive sleep apnea (OSA) using facial images, wearable devices, and simple physiological inputs. Deep learning models analyzing craniofacial photographs demonstrated high diagnostic performance (AUC up to 0.916 for apnea–hypopnea index ≥5), suggesting clinical utility even without polysomnography (1). Meta-analyses of wearable AI systems report pooled sensitivity and specificity above 85%, outperforming traditional screening questionnaires (2,3). Furthermore, image-based algorithms incorporating facial and clinical features such as body mass index and neck circumference significantly improve accuracy and enable accessible community-level screening (4,5). Integrating AI-driven OSA screening into neurology clinics could transform patient management by facilitating early detection among individuals with stroke, Parkinson’s disease, or mild cognitive impairment—populations where untreated sleep apnea worsens outcomes. These tools also align with global health priorities by offering scalable diagnostic solutions adaptable to low-resource settings. To fully realize this potential, a collaborative translational framework is essential, linking data science innovation with clinical validation and ethical oversight. We call for urgent global action through three measures: Validate AI-based OSA screening in neurological populations across diverse ethnic and socioeconomic groups. Establish cross-disciplinary collaborations between neurologists, sleep physicians, and data scientists. Implement ethical guidelines ensuring transparency, data privacy, and equitable access to AI-assisted diagnostics. By bridging sleep and cognitive health through intelligent screening, translational neurology can move closer to precision-based, accessible, and data-driven patient care.
Building Leadership Capacity in Health Sciences: Rationale, Design, and Early Outcomes of the Emerging Leadership Academy at Dow University of Health Sciences
Abstract Background: Many universities, particularly medical schools, report persistent gaps in formal leadership training, despite a consensus that leadership development enhances individual performance, team function, and institutional outcomes. Objective: To describe the rationale, design, implementation, and early outcomes of the Emerging Leadership Academy (ELA) at Dow University of Health Sciences (DUHS), created to address this unmet training need across faculty, trainees, and administrative leaders. Methods: ELA was implemented as a hybrid, cohort-based program emphasizing servant leadership, core human skills, and applied problem-solving. Program architecture, eligibility criteria, and selection criteria, as well as competency maps, were defined prospectively. The curriculum integrates case-based seminars, simulations, peer-learning circles, and individualized coaching aligned with DUHS priorities. Evaluation utilizes multiple modalities, including application and selection metrics, participation and completion rates, pre– and post–self–assessments mapped to leadership competencies (e.g., self-awareness, communication, teamwork, conflict management, decision-making, and change leadership), and qualitative feedback from mentors and supervisors. A longitudinal tracker follows alumni milestones, including role expansion, project impact, and contribution to institutional initiatives. Results: Launched in September 2023, ELA has run multiple cohorts with sustained demand and capacity-limited enrollment. Participants report high perceived relevance and applicability to clinical, academic, and operational settings. Preliminary analyses indicate gains in leadership self-efficacy, teamwork behaviors, emotional intelligence, and communication clarity, with capstone projects demonstrating practical improvements in service quality, research operations, and learner experience. Early signals indicate a growing pipeline of graduates assuming formal and informal leadership roles. Conclusion: A structured leadership academy embedded within a health-sciences university is feasible, scalable, and responsive to the documented training gap. By combining competency-based design, hybrid delivery, mentorship, and project-based learning, ELA offers a reproducible model for cultivating leaders who can advance patient care, education, and research. Continued cohorts and longitudinal follow-up will clarify downstream effects on individual and organizational performance and culture.
Efficacy of Nanoparticle-based Localised Immunomodulation to Reduce Graft-versus-host Disease in Murine Model of Bone Marrow Transplantation: A Systematic Review
Background and Aim Bone marrow transplantation (BMT), 73.8% of all transplants, is a cornerstone therapy for various haematological disorders. It follows a life-threatening complication; acute graft vs host disease (aGVHD) with 30-60% of incidence. Despite being standard, conventional immunosuppressive therapies are frequently associated with toxicity, infections, and 70% of non-responding patient. A novel, highly targeted nanoparticle-based strategy, while being explored in solid organ transplantation, remains under-investigated in BMT. This systematic review aims to evaluate the efficacy of NP-based strategies to mitigate aGVHD following BMT. Methods A systematic search was conducted using PubMed, Cochrane Library, and Science Direct from April 23, 2001, to August 13, 2024 for propensity-matched studies evaluating efficacy of NP-based therapies in murine models to mitigate GVHD severity. Data were extracted independently by two reviewers. Study quality was assessed using SYRCLE tool. Descriptive analysis was performed as meta-analysis was not possible due to heterogeneity in intervention types. Results Of the 66 studies retrieved, 15 pre-clinical animal studies were selected sample size 2-30/group). Overall, risk of bias was moderate. 12/15 studies reported lower clinical GVHD scores (p< 0.001), 14/15 prevented weight loss (p<0.05), 14/15 prolonged survival with (HR 0.2055, p=0.0112). Histopathological assessments showed decreased tissue damage in the liver (10/11), the intestine (12/12), and the skin (7/7) with p<0.05. 14/15 reported lower levels of inflammatory cytokines (p<0.001). Conclusion NPs therapy has a promising efficacy in mitigating GVHD after BMT. Nevertheless, the heterogeneity of interventions makes generalizability still difficult. It underscores the need for future in-depth translational studies.
Expanding Treatment Options: Ceftobiprole Against Multidrug-Resistant Infections
Optimizing Heart Failure Care in Pakistan : Lessons From UAE Cardiac Center Models.
Heart failure (HF) is a major health concern in Pakistan with high rehospitalization rates and low adherence to guideline-directed medical therapy (GDMT). On the other hand, UAE has implemented effective HF care strategies, including the Get With The Guidelines®️ Heart Failure program, pharmacist-led interventions, and multidisciplinary training, which have improved adherence, reduced hospitalizations and improved quality of life. These differences and the UAE's scalable methods are shown by several studies from Pakistani and UAE sources (2000–2024). By standardizing procedures, including pharmacists, treating comorbidities like iron deficiency, and establishing national registries, Pakistan may be able to lower the burden of heart failure, enhance patient outcomes, and save lives.
Guideline-directed medical therapy (GDMT
Get With The Guidelines® – Heart Failure
Male HPV Vaccination in Pakistan: An Overlooked Preventive Strategy
Background: Human papillomavirus (HPV) vaccination has been introduced in Pakistan to protect girls against cervical cancer. However, the exclusive focus on females overlooks the significant burden of HPV-related diseases in men, including oropharyngeal, anal, and penile cancers, as well as anogenital warts. Discussion: Evidence demonstrates that male HPV vaccination reduces HPV infections, precancerous lesions, and genital warts, while also enhancing herd protection. In contexts where female vaccine uptake is suboptimal, such as Pakistan, gender-neutral vaccination strategies are particularly effective. Operationally, Pakistan’s immunization infrastructure, experience from polio campaigns, and the WHO’s endorsement of single-dose schedules provide feasible pathways for inclusion of boys. Conclusion: Restricting HPV vaccination to girls reinforces misconceptions of HPV as a “women’s disease,” neglects men’s right to protection, and slows progress toward elimination. Expanding HPV vaccination to include boys would accelerate population-level benefits, promote equity, and align Pakistan’s strategy with global best practices.
Virtual Reality Perimetry versus Conventional Perimetry: Balancing Patient Comfort and Reliability
Medical Camps as Catalysts for Health Equity: Reflections from Khyber Pakhtunkhwa, Pakistan
Mobile medical camps in rural Khyber Pakhtunkhwa address critical gaps in primary care and advance health equity by bringing free consultations, basic laboratory screenings, immunizations and health education directly to underserved villages. Drawing on firsthand volunteering experiences and regional data, this work highlights how camps organized by local NGOs and medical trainees overcome the prohibitive costs and geographic barriers that leave families traveling hours for simple care. A 2024 study in KP reported that primary health needs “were not met” largely because of cost and outreach deficits, while a Karachi survey of student volunteers found that 77 % improved their understanding of community health, 85 % gained confidence in outpatient care and 94 % developed communication and empathy skills, with nearly half influenced toward primary care careers. In flood‑affected Sindh, outreach teams served more than 16 000 attendees—offering check‑ups, essential immunizations and even psychological first aid—partnering with religious leaders and youth mobilizers to amplify prevention messages. When aligned with district health departments, camps not only treat acute illness but also seed longer‑term improvements by training community health workers, strengthening referral paths and informing policymakers about chronic disease burdens such as unmanaged hypertension and diabetes. Furthermore, medical students return with a deepened commitment to rural practice and policy advocacy, reinforcing the health system from within. While short‑term missions alone cannot resolve poverty or infrastructure gaps, ethically designed camps that emphasize capacity‑building, continuity of care and community partnership can spark sustainable change—rekindling trust in health services and catalyzing policy shifts toward equitable access for all.
Circumcision, Acetaminophen, and Autism: Untangling Association from Causation
Alternate Pathways to Integrate International Medical Graduates (IMGs) into the U.S. Healthcare Ecosystem: A Policy Analysis of Texas HB 2038 (“the DOCTOR Act”).
Background: The United States and Texas, in particular, face persistent and worsening physician shortages, disproportionately affecting rural and underserved communities. Texas HB 2038 (“the DOCTOR Act”) establishes alternative licensure pathways intended to streamline the entry of qualified International Medical Graduates (IMGs) into supervised clinical roles, with a focus on service in safety-net and shortage settings. Objective: To distill the policy architecture of HB 2038 into an implementation-ready framework describing eligibility, site requirements, supervision, geographic constraints, and procedural steps for two licensure routes: the Foreign-Licensed “Provisional” license and the “Physician Graduate” limited license. Methods: Descriptive policy analysis of an implementation presentation and its cited resources (professional association briefs, state board guidance, and the bill text). Information was extracted, categorized (by eligibility, sites, supervision, geography, and testing), and synthesized into operational checklists and proposed evaluation metrics. Results: Both pathways require an ECFMG-eligible primary medical qualification (from a WDOMS-listed school with a sponsor note), primary-source verification, and English proficiency as demonstrated by OET-Medicine. The “Provisional” license requires an active foreign license, completed postgraduate training abroad, a Texas employment offer, and completion of the Texas Medical Jurisprudence Exam; practice initially occurs at ACGME-accredited/affiliated sites and, upon renewal, is restricted to rural/MUA/HPSA settings. The “Physician Graduate” limited license requires Texas residency, valid U.S. work authorization/citizenship/permanent residence, a supervising practice agreement, and non-enrollment in a residency program. Practice is limited to clinics in counties with fewer than 100,000 residents and FQHC/FQHC-LAL sites. Conclusions: HB 2038 offers structured, supervised, and shortage-area–oriented on-ramps for IMGs. Effective execution will hinge on supervisory capacity, safety-net site readiness, jurisprudence, and access to language testing, as well as outcomes monitoring (including access, quality, and retention). (Texas Legislature, n.d.). (Texas Medical Board, n.d.)
AI Triage for Stroke Imaging: Promise vs risk of Deskilling Radiology Trainees
Dear Editor, Artificial intelligence (AI) has entered acute stroke care at remarkable speed. Commercial platforms now detect large-vessel occlusion (LVO) on CT angiography and immediately notify stroke teams. Randomized and real-world data confirm that these tools shorten notification and thrombectomy initiation times, translating into improved functional outcomes for patients (1,2). In spoke-and-hub networks, AI-assisted notification particularly strengthens equity of care by expediting transfers during nights and weekends (2). Alongside these benefits, one underrecognized concern is the potential deskilling of radiology trainees. Overreliance on automated alerts risks diminishing the very competencies that training should cultivate: visual pattern recognition, logical reasoning, and confident communication with clinicians. Survey-based studies suggest that while trainees appreciate AI’s efficiency, many worry about erosion of independent judgment (3). A second challenge is algorithmic variability. Reported sensitivity and specificity for LVO detection range widely—from 85–95% for anterior circulation to lower performance in posterior circulation or artifact-heavy studies (4,5). Such blind spots create a paradox: AI accelerates decisions in straightforward cases but risks missed diagnoses in the difficult ones—the very cases where human expertise is indispensable. The solution is not to resist AI but to integrate it deliberately into radiology education. With thoughtful design, AI can both streamline workflow and strengthen training. We propose three practical steps: 1. AI-enhanced teaching modules: Residency curricula should include structured sessions on AI fundamentals, limitations, and critical appraisal. For instance, case-based teaching where 20% of cases are AI-flagged and 80% require independent interpretation can balance efficiency with skill-building. 2. Dual-read policy during rollout: For the first 12–18 months post-implementation, trainees should interpret CT angiography independently before reviewing AI output. Discrepancies should be logged to track both trainee learning curves and AI reliability. 3. Continuous audit and feedback: Institutions should perform monthly audits comparing AI performance with ground-truth adjudication. Cases of false negatives or false positives can be integrated into morbidity-and-mortality or case conferences to reinforce learning. Such an approach acknowledges both the transformative benefits of AI in stroke triage and its risks to training. By embedding AI into structured teaching and feedback loops, future radiologists can remain technologically adept while preserving diagnostic rigor. Conflict of Interest: None Ethical Consideration: None Funding: None Declaration of AI Use: This letter was drafted and revised with the assistance of an AI language model (ChatGPT, GPT-5, OpenAI) for grammar refinement, structural reorganization, and clarity enhancement. All intellectual content, interpretation, and final approval of the text are solely the r esponsibility of the authors.
Reframing the Debate on Abortion Drugs in an Era of Misinformation
The Paradox of Ubiquity: Reassessing the Reported Association Between Prenatal Acetaminophen (Tylenol) Exposure and Autism
Background: Observational studies have reported small positive associations between prenatal acetaminophen (Tylenol) use and autism spectrum disorder (ASD). Because acetaminophen is widely used in pregnancy and the indications for its use (e.g., infection, migraine) are themselves associated with neurodevelopmental risk, even tiny imbalances between users and non-users can generate noncausal signals, the paradox of ubiquity. Objective: To review current human studies on prenatal acetaminophen and ASD, explain how, given the high prevalence of exposure confounding by indication, family factors, and exposure misclassification can distort results, and identify designs that best address these issues, especially sibling analyses. Methods: We conducted a rapid, structured meta-analysis of human studies through September 5, 2025. Priority was given to: (1) large population-based cohorts with family-based (sibling) comparisons; (2) biomarker-based exposure assessments (umbilical cord blood, meconium); (3) high-quality evidence syntheses (e.g., Navigation Guide); and (4) professional guidance from the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC). The primary outcome was autism spectrum disorder (ASD); secondary outcomes were attention-deficit/hyperactivity disorder (ADHD) and intellectual disability (ID). Results: In the nationwide Swedish cohort (n = 2,480,797; 1995–2019), conventional models found marginal risk elevations (e.g., ASD hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.02–1.08), but sibling-control analyses were null (ASD HR 0.98, ADHD HR 0.98, ID HR 1.01), and dose–response patterns vanished; absolute risk differences at age 10 were ≤ 0.21%. Biomarker work in selected cohorts reports higher odds of ASD/ADHD across exposure tertiles, but generalizability and residual confounding remain concerns. Multiple studies link maternal fever, especially in the second trimester and with repeated episodes, to higher ASD risk, consistent with confounding by indication. Conclusions: With ubiquitous exposures and indication-related use, naïve associations are prone to inflation. The strongest, bias-resistant designs (sibling comparisons) do not support a causal link between acetaminophen and ASD. Clinically, the use of acetaminophen remains appropriate when indicated, at the lowest effective dose and shortest duration. Fever, an independent risk factor, should be treated promptly.
Attention-deficit/hyperactivity disorder
Efficacy of Taletrectinib to treat ROS1-positive non-small cell lung carcinoma.
ROS1 rearrangements represent a rare but clinically significant oncogenic driver in non-small cell lung carcinoma (NSCLC), occurring in approximately 1–2% of cases. While crizotinib and entrectinib are established targeted therapies, limitations such as central nervous system (CNS) progression and acquired resistance underscore the need for next-generation inhibitors. Taletrectinib, a highly selective ROS1 tyrosine kinase inhibitor, has shown promising activity in both TKI-naïve and pretreated patients, including those with CNS metastases and resistance mutations like G2032R. Early-phase clinical trials report encouraging objective response rates with a manageable safety profile, distinguishing taletrectinib as a potential best-in-class therapy. Its favorable pharmacokinetics and brain penetration may address key gaps left by earlier ROS1 inhibitors, particularly for patients with intracranial disease progression. Given the unmet clinical need, taletrectinib represents an important advancement in precision oncology for ROS1-positive NSCLC. Ongoing phase II and III studies will be crucial in validating its efficacy and positioning within treatment algorithms. Integration of taletrectinib into clinical practice has the potential to improve survival outcomes and quality of life in this molecularly defined subset of NSCLC patients.
Taletrectinib; ROS1 inhibitor; Non-small cell lung carcinoma
Addressing the Recent Spike in Bird Fancier’s Lung in Karachi: Time for Policy Making and Public Awareness
Bird fancier lung (BFL) is a variant of hypersensitivity pneumonitis (HP), an immune-mediated interstitial lung disease (ILD) caused by the recurrent inhalation of avian proteins present in bird excrement, feathers, and serum presenting with cough and dyspnea mainly. There has been recent surge in BFL cases in Karachi with 20–25 new cases reported weekly that a decade ago was 1-2 cases weekly, primarily due to unhygienic pigeon feeding practices in the city. In order to prevent further increase in the BFL cases and the progression of already existing cases to chronic stages, there is a need of timely policy making by healthcare administration ensuring public awareness about the disease and community engagement in preventive health-strategies.
Road Traffic Accidents and Trauma Care in Pakistan: Lessons from the UAE
Road traffic accidents cause a very high number of deaths in Pakistan each year. Trauma care in the country is weak because there is no national trauma registry, pre-hospital services are limited, and hospital coordination is poor. In the United Arab Emirates, a trauma registry and organized emergency system have helped improve survival and reduce deaths. This short review looked at reports from the UAE trauma registries and published surveys from Pakistan. The UAE has shown major improvements, while Pakistan still struggles with delays and lack of basic facilities. To improve outcomes, Pakistan needs to build a trauma registry, train and expand emergency medical services, and introduce standard hospital protocols. Learning from the UAE model can help reduce preventable trauma deaths in Pakistan.
Antimicrobial Resistance: The Diagnostic Bottleneck We Cannot Ignore
Antimicrobial resistance (AMR) is a growing global health emergency: in 2021, 4.71 million deaths were linked to infections resistant to drugs, of which 1.14 million were directly due to AMR—and we risk seeing this increase to nearly 1.91 million AMR-associated deaths per annum by 2050 (1). One of the major, under-discussed causes of this menace is the diagnostic gap: in low- and middle-income nations, the delay in culture and sensitivity reports has clinicians making decisions on the basis of broad-spectrum empiric therapy, which itself promotes resistance. Pathologists and microbiologists are key players in filling the gap.Milestone technologies—ultra-rapid antibiotic susceptibility platforms (viz., SERS-AST)—generate same-day MIC values, providing timely, target antimicrobial therapy (2). Furthermore, the WHO’s Antimicrobial Resistance Diagnostic Initiative (2023) places diagnostics at center stage highlighting lab capacity building, equitable access to quality testing, and inclusion of diagnostic testing in stewardship and surveillance (3). Our Three-Step Strategy of Action: Improving diagnosis: Install rapid AST systems to allow same-day MIC reporting. Stewardship via data: Regularly generate and disseminate institutional antibiograms; align with WHO’s AWaRe prescribing framework (4). Laboratory empowerment: Formalize inclusion of pathologists in antimicrobial stewardship committees in a way that laboratory diagnostics inform clinical decision-making in real-time. Pathology is not a spectator during the AMR war, but rather must be the proactive center. Reform focused on diagnosis, established today, is required in order to avoid a post-antibiotic world.
Rising Colorectal Cancer in Young Adults: A Call for Earlier Screening and Awareness in Pakistan
SGLT2 Inhibitors role in Heart Failure: More Than Just Glycemic Control
Evidence-Based Servant Leadership: Development, Mechanisms, and Constraints
Background: Whether servant leadership is innate or can be deliberately developed is a central question for organizations seeking both high performance and a healthy culture. Contemporary scholarship conceptualizes servant leadership as a behavioral philosophy that encompasses empowerment, humility, stewardship, interpersonal acceptance, and clarity rather than a fixed personality type. Methods: This narrative review synthesized peer-reviewed research, integrative reviews, and meta-analyses on servant leadership, focusing on (a) teachable micro-behaviors, (b) organizational conditions that sustain behavior change, and (c) boundaries where selection and accountability are preferable to training. Key databases and leadership journals were searched for studies on servant leadership, leader humility, psychological safety, and leadership development effectiveness. Results: Servant leadership behaviors such as deep listening, empowering with guardrails, coaching, transparent decision-making, and humility-in-action are trainable through high-frequency practice and reinforced by validated instruments. These practices reliably enhance psychological safety and team outcomes. However, durable impact requires alignment with organizational systems, including hiring profiles, onboarding, 360-degree feedback, promotion criteria, and meeting norms. Certain dispositions, including integrity, genuine humility, and respect for others, emerge as non-teachables; they must be addressed through selection and accountability rather than curriculum. Tolerating incivility, even from high performers, undermines retention and innovation. Conclusion: Servant leadership is teachable when approached as both behavioral training and system change. Organizations should adopt a dual strategy: train observable servant behaviors while wiring systems that reward them, and hire/promote for the non-negotiables that training cannot manufacture. This integrated approach shifts servant leadership from an aspirational philosophy to a scalable, durable operating system.
Bridging Physician Shortages in the United States: Supervised Practice Routes for International Medical Graduates
Background: To mitigate physician shortages, especially in rural and Health Professional Shortage Areas (HPSAs), a growing number of U.S. states have created supervised licensure pathways that recognize verified foreign training and experience while requiring time-limited, structured supervision before independent practice. These routes aim to expand access without compromising patient safety. Objective: To describe the design of these state pathways, synthesize standard eligibility, supervision, and conversion models, and translate them into practical access steps for internationally trained physicians (international medical graduates, IMGs). Methods: We conducted a rapid policy scan of publicly available sources, including the Federation of State Medical Boards (FSMB) tracking resources, state statutes and medical board rules/webpages, and policy journalism. For each state pathway, we abstracted the entry criteria, supervision structure (including duration, site, and oversight requirements), and conditions for conversion to full licensure, and then performed a descriptive synthesis. Results: Since 2023, at least 17–18 states have enacted “additional pathway” or analogous supervised practice options. Programs converge on: (1) ECFMG recognition and USMLE Step 1–2 at entry (with Step 3 commonly required before unrestricted licensure); (2) verification of 3–5 years of prior clinical practice and/or foreign postgraduate training; (3) employment at approved facilities often an ACGME-affiliated hospital, Federally-Qualified Health Center (FQHC), or HPSA/rural site under a named supervising physician with a filed practice/supervision agreement; and (4) 2–4 years of supervised practice plus clean evaluations and exam completion for conversion. Implementation status, terminology, and reporting obligations vary by state (Figure 1). Conclusion: Supervised pathways are a credible and safety-conscious mechanism for adding physician capacity where the need is greatest. Their impact will depend on several key factors, including clear “how-to-apply” guidance, supervisor capacity and support, timely board rulemaking/portals, alignment with immigration/visa timelines, and standardized outcome reporting (applicant volume, placement, conversion rates, and patient-safety indicators).
Pakistan’s National AI Policy 2025: A Comparative Appraisal, Advantages, Risks, Execution Pathways, and Regional Benchmarks
Pakistan’s National Artificial Intelligence (AI) Policy articulates a coherent scaffold for nationwide AI adoption built on four pillars: ring-fenced financing through a National AI Fund (NAIF); a geographically distributed network of Centers of Excellence in AI (CoE-AI); ambitious human-capital targets (e.g., nationwide awareness by 2026; ~1M trained learners and ~10k trainers by 2027); and a trust framework centered on an AI Regulatory Directorate with sectoral sandboxes. Using qualitative document analysis, we examine these instruments’ funding architecture, institutional design, skills pipeline, and governance, and assess internal coherence, feasibility, and delivery risks against the policy’s own baselines and timelines. On July 30, 2025, Pakistan’s federal cabinet approved the National AI Policy 2025; approval announcements highlighted an AI Council, a master plan/action matrix, AI Innovation and Venture Funds, and a headline target to train one million AI professionals by 2030. To contextualize feasibility and ambition, we benchmark key instruments against regional peers India (IndiaAI Mission), China (Generative AI Measures), Sri Lanka (National AI Strategy and 2024 AI White Paper), Bangladesh (National AI Policy 2024), and Iran (National AI Plan 2025), and incorporate these comparators throughout the manuscript. (Dawn.com, 2025) Our appraisal finds notable strengths: predictable capital that can crowd-in private and multilateral co-funding; a distributed, demand-driven CoE topology that couples R&D with incubation and workforce development; time-bound, measurable targets that create accountability; and an explicit “pro-innovation with guardrails” posture via sandboxes and rights-respecting oversight. Critical risks include: (1) NAIF portfolio governance (absence of stage-gate disbursement criteria, portfolio-mix guidance, and enhanced conflict-of-interest firewalls); (2) trainer capacity versus timelines (10k master trainers as the throughput bottleneck); (3) regulatory overlap between the AI directorate, sectoral regulators, and higher-education bodies; (4) under-specified data/compute reference architectures and access standards; and (5) ambiguous measurement of “awareness” and public-sector upskilling without protected training time. We propose execution-ready remedies: stage-gated NAIF disbursements tied to outcomes (certifications, sandbox graduates, IP/startups); a funded national Train-the-Trainer corps anchored at CoEs; a published sandbox rulebook (eligibility, risk tiers, pre-deployment testing/red-teaming, exit-to-market); a national data reference architecture (metadata schemas, APIs, consent patterns, access tiers); and independent, pre/post awareness and skills surveys with disaggregated reporting. If implemented, these adjustments materially raise implementation fidelity and the likelihood that Pakistan’s AI ambitions translate into durable economic and social value.
Pakistan National AI Policy; NAIF (National AI Fund)
Avmapki-Fakzynja Combination: A Breakthrough in Treating Low-Grade Serous Ovarian Cancer
Low-grade serous ovarian carcinoma (LGSOC) is a rare subtype of epithelial ovarian cancer characterized by unique molecular features and poor response to conventional chemotherapy. Recent advances in molecular profiling have led to the development of targeted therapies, including MEK and FAK inhibitors. On May 8, 2025, the FDA approved AVMAPKI™ FAKZYNJA™ CO-PACK, a combination of avutometinib and defactinib, specifically for adults with KRAS-mutated recurrent LGSOC who have undergone prior systemic therapy. This dual inhibitor regimen targets the MAPK and FAK signaling pathways, showing promising efficacy with an overall response rate of 44% in clinical trials. While offering a novel and more effective treatment option, the therapy requires careful monitoring for potential side effects such as liver toxicity and skin reactions. This approval marks a significant advancement in personalized treatment for LGSOC and highlights the need for improved accessibility to ensure patient benefit.
Closed-Loop Fully Automated Wireless Vagus Nerve Stimulation: Heralding a New Paradigm in Bioelectronic Medicine
Abstract Closed-loop vagus nerve stimulation (VNS) represents a transformative advancement in bioelectronic medicine, offering real-time, adaptive neuromodulation for conditions such as epilepsy, heart failure, inflammatory diseases, and neurorehabilitation. Unlike traditional open-loop systems that rely on fixed parameters and surgical battery-based devices, closed-loop VNS dynamically adjusts stimulation based on physiological feedback, enhancing therapeutic precision and safety. Recent innovations, such as the wireless, fully automated VNS system developed by Mathews et al. (2025), integrate heart rate-driven feedback loops for personalized modulation. Clinical studies further validate its promise: microburst-pattern VNS reduced seizure frequency in 68% of drug-resistant epilepsy patients (Nichol et al., 2024), while closed-loop taVNS improved motor recovery post-stroke (Xie et al., 2024). Functional MRI data show enhanced cortical engagement with optimized VNS protocols (Verner et al., 2024), and real-time motor-triggered stimulation significantly improved outcomes in spinal cord injury rehabilitation (Rennaker et al., 2025). Despite these advances, limitations persist, including variability in patient responses, lack of standardized biomarkers, and insufficient large-scale trials. Future directions must focus on AI-driven algorithms, robust biophysical modeling, and wearable-compatible miniaturization to enable broader clinical translation. With these innovations, closed-loop VNS may redefine the standard of care in precision neuromodulation.
Artificial Intelligence in Rare Disease Diagnosis: A Clinical Milestone with Ethical Considerations
With great promise to transform the rare disease diagnosis scene, artificial intelligence (AI) has emerged. Using huge databases from genomics, imaging, and electronic health records, artificial intelligence systems can identify patterns that even experienced doctors often overlook (1).For those with orphaned diseases, who sometimes have to bear years of uncertainty, this capacity to shorten the diagnostic journey is quite crucial. But while AI has advantages, its abrupt involvement in diagnostic procedures presents major ethical and clinical problems necessitating more investigation. Most artificial intelligence algorithms' interpretability poses a major difficulty. Usually black boxes, deep learning algorithms provide diagnostic results without a clear justification. This hurts openness and may compromise the mutual decision-making process between doctor and patient (2). In medicine, especially when rare diseases are being diagnosed, where patient involvement and customized treatment are vital, trust in medical decision-making grounds decision-making. Bias in the training data for artificial intelligence is another critical problem. Learned from data from high-income nations, the majority of algorithms do not take under resourced populations into consideration (3). This could compromise diagnostic accuracy in ethnically and geographically varied populations and so worsen existing health inequities. For instance, in underrepresented communities (4) using recent artificial intelligence models applied to the diagnosis of genetic disease, performance gaps were observed. Furthermore worrisome is the possibility that doctors will increasingly rely too much on artificial intelligence systems. A 2024 multicenter simulation study showed how clinicians can become too dependent on AI output, even when it goes against clinical intuition (5).Particularly in rare disease environments when subtlety and world understanding are essential, this might cause loss of critical thinking ability and aid in unfavorable patient outcomes. Though AI has the potential to revolutionize the identification of rare diseases, its application in clinical practice must be consistent with the tenets of openness, equity, and ethical responsibility. Independent real-world practice testing, inclusive training datasets, and ongoing clinician education are required to make sure that technical developments result in actual patient benefit.
High-Intensity Focused Ultrasound (HIFU): A Non-Invasive Breakthrough in Therapeutic Intervention
Abstract High-Intensity Focused Ultrasound (HIFU) represents a groundbreaking advancement in non-invasive therapeutic intervention, offering precise tissue ablation with minimal damage to surrounding structures. This paper explores its validated clinical applications across prostate cancer, pancreatic cancer, and refractory hypertension. Recent trials demonstrate that HIFU achieves comparable oncologic outcomes to standard therapies while preserving organ function, improving quality of life, and reducing treatment-related complications. Its expanding utility in neuromodulation further highlights its interdisciplinary impact. With ongoing technological refinement and clinical integration, HIFU is poised to become a transformative modality in the future of precision medicine.