Year 2021, Volume 37 - Issue 3

Integration implies meaningful connections that can be applied to disciplines, domains or linking education to real life practice. The essence of any integrated curriculum is a program that can improve patient care by graduating work ready professionals. Based on this approach an Integrated Discipline-Aligned (IDiAl) curriculum model is being proposed for undergraduate medical education in an effort to provide sound knowledge base with an explicit focus on clinical and professional skills so that doctors of tomorrow can meaningfully contribute to profession and society.

Traumatic brain injury (TBI) is a focal injury with limited reliable treatment options. Despite the large volume of basic research into TBI (particularly on the complex pathophysiology and on the application of various techniques), the treatment of TBI currently remains a challenge due to the low efficacy of available therapeutic options. Recent studies have shown that stem cells possess the ability to aid in recovery from the damaging effects of the craniocerebral injury. Herein, we attempted to present a generalized critique for the role of mesenchymal stem cell therapy in TBI, its underlying mechanisms, and the scope for improvements in TBI treatment identified through preclinical studies, clinical studies, and other research in the light of previously reported literature. Finally, we summarized some novel strategies to overcome the clinical challenges in TBI recovery. Collectively, the major objective of this review is to highlight the to-date available findings regarding role of stem cell therapy in TBI and pave the way for the development of safe and efficient regenerative treatment modalities for TBI by comprehensive understanding the specific mechanism.

Enlargement of breast tissue in neonates is a condition seen as a physiological response to the decline in maternal hormonal levels postnatal. It is commonly seen in the initial weeks, but can progress in size within two months of life. We herein report a case diagnosed as neonatal mastauxe in a two months old female, which was followed up without any medical or surgical intervention. Neonatal mastauxe means enlargement of breast tissue in newborn, which is sometimes essential to be differentiated from breast abscess and mastitis in babies.

Background and Objective: The aim of this study was to report the short-term outcomes of early idiopathic brachial plexus neuritis after low-dose corticosteroid combined with antiviral agent.

Methods: Five patients with early brachial plexus neuritis presenting from April to June 2019 were included in this study. According to individual patient conditions, electromyography (EMG), nerve B-ultrasound and/or brachial plexus magnetic resonance imaging (MRI) were performed. After the diagnosis was confirmed, modified conservative treatments were initiated, including low-dose corticosteroid therapy and antiviral therapy for 2 weeks each while neurotrophic therapy for 4 weeks.

Results: Of the five patients, only two patients had symptoms of pain at onset, and three patients had sensory disturbances. Two patients reported a common cold before onset. The lesion involved the upper trunk of the brachial plexus in two patients. MRI showed slightly intense signals, of which one patient also had supraclavicular lymph node augmentation. The other three patients suffered ipsilateral radial nerve (RN) palsy. At 1 month of modified treatment, four patients recovered well with almost complete shoulder and hand movements; however, their muscle strength was still weaker comparing with the contralateral side. One patient restored full range of motion after surgery in 2 months.

Conclusion: Early treatment is the key to good prognosis in patients with brachial plexus neuritis. Antiviral therapy combined with lowdose corticosteroid therapy may be superior to traditional treatment alone. In terms of early diagnosis, the clinical value of imaging examinations such as ultrasound and MRI is more specific as compared to that of EMG.

Background and Objective: Thyroid imaging reporting and data system (TI-RADS) is developed to determine the risk of malignancy in patients with thyroid nodules. The aim of this study was to determine the diagnostic accuracy of TI-RADS classification for diagnosing malignant thyroid nodules taking Fine needle aspiration cytology (FNAC) as a gold standard in the local population.

Methods: In this cross-sectional validation study, 201 patients presenting with thyroid nodules at the Department of Radiology, Bakhtawar Amin Hospital Multan, Pakistan from July 2020 to December 2020 were included. In all patients, thyroid nodules were evaluated on grey scale (B-mode) modality. TI-RADS score was calculated for each patient. Patients with TI-RADS score 4 and 5 were labelled as having malignant nodules. After that FNAC samples were taken and sent for histopathologic evaluation of thyroid nodules. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TI-RADS taking FNAC as a gold standard were determined.

Results: The mean age of the patients was 47.8 ± 4.5 years; there were 129 (67.2%) women and 72 (35.82%) men. There were 42 patients who tested true positive and 36 patients tested false positive and 12 patients were false negative and 111 patients true negative. The TIRADS sensitivity was 77.8%, specificity was 75.5%, PPV was 53.8%, and NPV 90.2%. the diagnostic accuracy was 76.1%.

Conclusion: Differentiating benign thyroid nodules from malignant using the TI-RADS score has a high diagnostic accuracy. Our study results support the TIRADS as a first-line imaging evaluation for diagnosis of thyroid malignancy.

Background and Objective: Chitinase-3-like protein 1 (CHI3L1) is an upcoming biomarker for the diagnosis of liver fibrosis. The reference intervals (RIs) for CHI3L1 have not been established in the Pakistani population. Thus, this study aimed to determine the RIs in our population and the cut-off value for diagnosis of hepatic fibrosis.

Methods: This is a cross-sectional study. A total of 408 participants (202 healthy and 206 diagnosed liver fibrosis cases) were recruited. Serum CHI3L1 level was measured on CHI3L1 kits (Proprium Biotech Co. Ltd) by manual enzyme-linked immunosorbent assay. The RIs were estimated by percentile and working normal method.

Results: The distribution of CHI3L1 values showed no remarkable variation with gender and age. The 95% RI of CHI3L1 was 12.80-81.80 ng/ ml in healthy Pakistani subjects and the cut-off for the diagnosis was 102.12 ng/ml in hepatic fibrosis cases.

Conclusion: The RIs in healthy adults and the cut-off for the diagnosis of hepatic fibrosis of serum CHI3L1 were determined in a selective adult Pakistani population. This will be a useful reference for further local and international studies.

Background & Objective: The data regarding the effectiveness of various protocols used for controlled ovarian stimulation (COS) in assisted reproductive techniques (ART) in our own population is scant. This study compares recombinant follicular stimulating hormone (rFSH) and human menopausal gonadotrophins (HMG) in terms of follicular numbers and oocytes retrieved in Pakistani women undergoing ART.

Methods: A total of 300 patients were selected out of 1,950 patients who visited the hospital for in vitro fertilization/intra cytoplasmic sperm insemination (IVF/ICSI) from June 2018 to December 2020. These patients were further divided into two categories: first category (1) was given long protocol and the second category (2) was given short antagonist protocol. Each category was further sub-divided into two groups; group A who received HMG, and group B who received rFSH for COS.

Results: There was a significantly higher number of follicles and oocytes retrieved in category 1, with rFSH (20.01 ± 4.91, 15.19 ± 9.18) versus. HMG (16.07 ± 5.67, 11.10 ± 5.07) with a p-value (0.00, 0.004). On the other hand, in category 2, the number of follicles was insignificant (p-value = 0.319) in both groups. Contrary to that the number of oocytes retrieved was significantly higher with a p-value of ≤ 0.05 in both groups.

Conclusion: In COS in ART, long protocol with rFSH has much better results both in terms of follicular numbers and retrieved oocytes. While for the short protocol with the antagonist, rFSH has been demonstrated to be superior to HMG but that is limited to the number of oocytes.

Background and Objective: Trucut biopsy (TCB) is a commonly used technique for histopathological diagnosis of a clinically and radiologically equivocal or suspicious breast mass. This study aimed to determine the sensitivity and specificity of TCB in the diagnosis of equivocal or suspicious breast masses at local tertiary care hospital in Khyber Pukhtunkhwa.

Methods: This descriptive cross-sectional study was conducted at the surgical unit of Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan. The study included 80 patients who presented with equivocal or suspicious breast masses from September, 2015 to December, 2020. The patients underwent TCB and after the histopathology report, they were followed by a definitive surgical procedure. The histopathology diagnosis following TCB was compared with the histopathology report of postsurgical specimen to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TCB taking post-surgery histopathology as a gold standard for diagnosis.

Results: Out of the 80 patients, 68 (85%) were found to have a primary breast malignancy, while 12 (15%) patients were diagnosed with non-malignant lesions. There were only two false negative cases. The specificity and PPV of TCB were found to be 100%, while a sensitivity of 97% and a NPV of 85.7% was calculated.

Conclusion: TCB is a valid, reliable, and simple first line minimally invasive method to determine the diagnosis of breast masses that are clinically and radiologically (breast imaging-reporting and data system 3 to 5) equivocal or suspicious.

Background and Objective: COVID-19 disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) having a wide variety of clinical features ranging from asymptomatic carriers to respiratory failure requiring mechanical ventilation. The objective of the study was to analyze the spectrum of different symptoms, laboratory findings and complications in patients who were admitted in either COVID ward or intensive care unit (ICU) of a local hospital.

Methods: A retrospective cohort study of the medical records of 100 COVID-19 disease patients with PCR detected SARS-CoV-2 infection were collected. Participant information was retrospectively obtained from the hospital medical records which included clinical records and laboratory findings. All statistical analyses were done using Statistical Package for the Social Sciences (SPSS) version 21.

Results: The mean age of the patients was 50.8 ±5.86 with male predominance (79%). Most frequent co-morbidities were diabetes mellitus (42%) and hypertension (36%). Most frequent symptoms were fever (95.9%) and fatigue (95.9%) followed by dry cough (86.5%), myalgia (85.1) and shortness of breath (70%). Amongst the patients admitted, leukocyte count was 10.95 x 10³, C-reactive protein (CRP) was 12.8mg/dl, ferritin was 730.8ng/ml and Lactate Dehydrogenase (LDH) was found to be 1254.7 U/l. Hepatic and renal functions were borderline deranged.

Conclusion: COVID-19 disease has a wide spectrum of clinical symptoms. Patients with raised inflammatory markers have severe disease and are more likely in need of an ICU care. By carefully observing these markers may help in better management of COVID-19 disease.

Background and Objective: Augmented Reality (AR) is an effective tool for learning as well as marketing with multilateral interactive communication. It allows brands to give their customers unique experiences with the convenience of tapping into their mobile devices. This study was conducted to assess the perceptions of healthcare professionals (HCPs) to learn through AR and its effectiveness in HCPs’ engagement and learning experience.

Methods: An interventional study was conducted with HCPs across various tertiary care hospitals in Pakistan from May 2020 till December 2020. An AR based activity was carried out with the HCPs where they used pictures of objects around them to create a message. These were geo-tagged to a question related to hypertension and participants answered each question. Mobile application – WallaMe was utilized for this activity. At the end of the activity, HCPs were requested to fill a feedback form based on their experience with the AR app. Data was entered and analyzed by using SPSS version 22.

Results: AR stimulated learning  gives the participants an overall exciting (80%), captivating (81%), and fruitful learning experience (82%). AR for marketing campaign was more effective for Brand Recall with paper based campaign for 82.8% and more effective than digital campaign for 85.6% participants. AR was recommended by 80% participants for learning and brand recall.

Conclusion: AR is a useful tool to enhance user experience for learning as well as improves brand recall and can be used for marketing campaigns.

Background and Objective: Pre-eclampsia (PE) is a hypertensive gestational disease appearing during second trimester of pregnancy. Free radicals are released by the placenta in this condition that may cause oxidative damage. This study was designed to determine the serum ferritin (SF) levels in maternal blood, fetal umbilical cord blood and placenta and the changes associated with oxidative stress as well as cell apoptosis to understand the pathogenesis of PE.

Methods: This cross-sectional analytical study recruited 60 pregnant females with severe PE and assigned into early and late onset PE groups. Another n = 60 cases of normal pregnant females with similar gestational weeks were selected in the control group. Maternal serum and fetal umbilical cord blood ferritin levels were determined by automatic biochemical immunoassay system. Reverse transcription real-time fluorescence, Western blot and colorimetry were used to determine mRNA expression levels of ferritin and ferritin heavy chain, relative expression of ferritin and superoxide dismutase, malondialdehyde (MDA), and glutathione peroxidase (GSH-Px) levels, respectively.

Results: Mean age was 30.89 ± 5.65 and 31.79 ± 5.06 years in early and late onset PE groups respectively. Serum uric acid and creatinine levels of both PE groups were significantly higher than the normal pregnant females. SF levels were also higher in the participants of PE groups. However, the mRNA and ferritin protein levels in placental tissue were significantly lower in PE groups while comparing to controls. The cleaved caspase-3 protein, GSH-Px and MDA levels were significantly higher in both PE groups (p < 0.05).

Conclusion: The alterations in factors related to oxidative stress and cell apoptosis in placental tissue may be helpful to understand the pathogenesis of PE and may provide potential biomarkers for the diagnosis of PE.