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Open access Commentary | March 31, 2021
Mask Asphyxia in the Innocent Breeds

Dr. Muhammad Imran

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Face masks, no doubt, are the first line of defence during this pandemic. Besides health protection, mask litter has reportedly polluted the land and water and reports of the wildlife entangled and choked in the elastic straps of the face masks are published off and on. Therefore, guidelines must be issued to the authorities and the public for appropriate handling and disposal of the “pandemic related litter” or else the climate change and the environmental disasters may become another future pandemics.

Open access Review Article | March 31, 2021
The New Normal: History and Impact of Pandemics

Muhammad Imran, Muhammad Touqeer Hanif, Waseem Abbas, Amjad Bilal, Sara Siddiqi, Syed Ali Hassan Rizvi

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Fear is one of the psychological emotions that humans adapt to a potentially threatening situation, but when this fear is not calibrated well to the situation, it can become maladaptive. For instance, in the present wave of pandemic, the panic over the year is excessive, there may have deteriorating effects both on the individuals and the society. At individual level for example mental health problems and social anxiety may be seen, and at the level of society panic shopping, xenophobia, decline in the economy may well be noted. Pandemics have been seen in the history in many eras. They have brought about enormous changes in the existing world through ages. This rapid narrative review summarizes various aspects of the many pandemics in the history.

Open access Case Report | March 31, 2021
Odontogenic Cutaneous Fistula with Geminated Right Mandibular Second Molar: A Case Report

Lu Chen, Zao Chen

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Odontogenic cutaneous fistula is pathological sinus tract originating from the oral cavity to skin of the face and neck. Geminated teeth are rare, morphological alteration of teeth.This paper reports a case of buccal skin fistula caused by the geminated tooth on theright side of mandible. The anatomical morphology of the geminated tooth and the periapical and periodontal bone destruction were comprehensively determined by doing careful examination and radiographic investigations including cone beam computed tomography (CBCT).In this case, crownof geminated microdontiapresent on mesiolingual side was extracted and performed the periodontal and root canal treatment of tooth followed by the restoration of the normal occlusal relationship. This case explores the use of appropriate diagnostics and therapeutic measures for the complex cases.

Open access Original Article | March 31, 2021
Genetic Analysis of Inhibin Alpha (INHα) Mutation (769G>A) in Patients with Premature Ovarian Failure in a Local Population

Sabahat Fatima, Zeenat Usman, Saqib Mehmood, Shagufta Khaliq

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Background and Objective:  Premature ovarian failure is a worldwide concern effecting 1% of females of reproductive age. The objective of the present study was to analyze the role of inhibin alpha (INHα) gene mutation (769G>A) in patients with premature ovarian failure (POF) in the local population.

Methods:  This case-control association studywas conducted in Department of Gynecology, Jinnah Hospital and The Children’s Hospital and Institute of Child Health  from July 2015-July 2016. A total of n = 100  were recruited for this study and divided into two gropus females with equal number (n = 50)of patients andnormal controls of reproductive age (14 – 40 years). The screening of theINHα for 769G>A variation in exon 2 was done through DNA sequencing.

Results:  A higher frequency of the major allele G was seen in both the patients (99%) and the controls (87%) while comparing to minor allele A (1% in patients and 13% in controls). None of the patients was found to be homozygous (AA = 0%) for allele A, whereas, four of the controls were homozygous (AA = 8%). The frequency of the minor A allele in controls was found to be statistically significant (P-value = 0.002).

Conclusion:  An association of decreased risk of POFwith A allele of the 769G>A variant rather than increasing the risk of development of ovarian failure.

Open access Original Article | March 31, 2021
Detection of Malignant Cases From Focal Liver Masses by Fine Needle Aspiration Cytology and Cell Block

Saniyah Ali, Nausheen Henna, Uzma Aslam, Tayabba Rashid, Urfa Shafi, Naveed Akhtar

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Background and Objecive:  Fine needle aspiration cytology of the focal liver lesions in conjunction with cell block formation offers a  convenient, less invasive and better diagnostic tool. This study was carried out to determine the diagnostic accuracy of fine-needle aspiration cytology in comparison with cell block from the aspirates taken from focal liver masses.

Methods:  This cross-sectional study was carried out over 13 months inthe Department of Pathology, Allama Iqbal Medical College Lahore, Pakistan in collaboration with the Department of Radiology, Jinnah Hospital Lahore, Pakistan. A total of 60 ultrasound-guided fine-needle aspiration cytological smears along with cell block material were collected from patients with focal liver lesions.Features of malignancy were noted on the fine-needle aspiration of liver lesions followed by cell blocks.

Results:  Cytological diagnosis based on FNAC in 59 cases was benign, out of which 39 (66.0%) were amoebic liver abscess, 14 (23.7%) were pyogenic liver abscess, 2 (3.4%) were tuberculous hepatic abscess supported by the same findings on cell block. One case (1.7%) was diagnosed as malignant on FNAC, later on, confirmed by the cell block. Four (6.7%) cases on FNAC were reported as benign lesions which were later on diagnosed as hepatocellular carcinoma on the cell block. Taking cell block as gold standard, the sensitivity, specificity, positive predictive value negative predictive value and diagnostic accuracy of FNAC was 93%, 100%, 100%, 20% and 93.3% respectively.

Conclusion:  Accurately sampled FNA smears supplemented by cell-block preparation considerably improve the false positive or negative diagnosis.

Open access Original Article | March 31, 2021
A 6-lncRNA Signature to Improve Prognostic Prediction of Colon Cancer

Wang Yuhang, Chen Lu, Pei Lixia, Chen Yufeng, Hu Yue, Hou Wenzhen, Song Yafang, Sun Mengzhu, Sun Jianhua

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Background and Objective:

Background and Objective:  Colorectal cancer is one of the most common malignant tumors in the world. The prognosis of colorectal cancer is still considered as worse despite the rapid development of treatment methods in the recent years. Therefore, it is important to understand the pathogenesis and development for more accurate prognostic methods. The present study aimed to identify a long non‑coding (lnc) RNAs‑based signature for prognostic determination of colon cancer patients.

Methods:  Datasets from the GEO and TCGA databases were used, differential expression of lncRNA was analyzed, and a 6‑lncRNA signature was identified. KEGG and GO was used to enrich the signal pathway to determine the biological effects of these 6-lncRNA.

Results:  This study has designed a prognosis model containing “LINC01494”, “TRPM2-AS”, “ATP1A1-AS1”, “FRY-AS1”, “LINC01360”, and “RBFADN” based on data set of colorectal cancer patients available in the TCGA and GEO databases. The prognostic model of lncRNAs may predict the prognosis of patients with colorectal cancer.

Conclusion:  The present study identified a 6‑lncRNA signature that could predict the survival rate for colon cancer patients. Further studies may be carried out to strengthen the findings of the present study.

Open access Original Article | March 31, 2021
Factors Affecting Post Placental Intra-Uterine Contraceptive Device Insertion Rate

Meher-un-Nisa, Aattiqa Hayat, Nasira Nuzhat, Madiha Khalid, Ayesha Sabrina Aslam

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Background and Objective:  The immensely increasing rate of population is one of the biggest hindrances in the progress of under developing world including Pakistan. One of the main component of Sustained Millennium Development Goals was to reduce maternal mortality and morbidity by fulfilling the unmet needs of contraception. Keeping these challenges into consideration, program of Post Placental Intrauterine Contraceptive Device (PPIUCD) insertion was initiated at tertiary care hospital settings in Pakistan. Objective of this study is to explore the factors affecting the rate of PPIUCD insertion rate.

Methods:  This cross sectional study was carried out at the Government Teaching Hospital Shahdara Lahore, Pakistan within 15 months (July 2019 to Sep 2020). A total of 4474 pregnant females were included using non probability consecutive sampling. A trained counselorcounselled the patients regarding benefits of PPIUCD and predesigned structured proforma was filled regarding demographic data, obstetric data and other factors related to insertion of PPIUCD. After the subjects were delivered, PPIUCDs were inserted in consenting females. Data was analyzed for statistical inferences.

Results:  Out of the 3292 participants who qualified for insertion, 802 females consented for PPIUCD insertion with an average insertion rate of 24.36%. The main factor affecting rate of PPIUCD insertion was presence of a trained counselor.

Conclusion:  The counseling services by a trained counselor is imperative for success in PPIUCD insertion rate.

Open access Original Article | March 31, 2021
Gastric Adenocarinoma of Fundic Gland Type - Spectrum of Morphological and Immunohistochemical Patterns

Lixin Wang, Gang Chen, Jingui Jiang, Lin Li, Ming Liang Chu

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Background and objective:  Fundic gland adenocarcinoma of stomach is a distinct entity. This study investigated the clinico-pathological features, diagnosis and differential diagnosis of gastric adenocarcinoma of fundic gland type (GA-FG).

Methods:  A total of 16 cases of GA-FG were collected, their clinical characteristics were analyzed, histopathological and immunophenotypic characteristics were observed, and the relevant literature was reviewed.

Results:  There was no typical clinical manifestation of GA-FG. 16 patients were basically hospitalized with abdominal discomfort. Histopathology of GA-FG showed the diffuse multilayering and nuclear stratification with mild cytologic atypia and minimal stromal reaction even in invasive front. Conclusion: Adenocarcinoma of gastric fundus is a novel histologic type of gastric cancer. Its diagnosis is mainly based on the patho-morphological characteristics with supporting immunohistochemistry. The prognosis is good, and it needs long-term follow-up.

Open access Original Article | March 31, 2021
Role of Faculty Development Workshop for Improving MCQS Quality in Basic Medical Sciences

Mirza Aroosa Beg, Afifa Tabassum, Sobia Ali

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Background and Objective:  Multiple-choice questions (MCQs) are a frequently used method of assessment in medical education. MCQs have to be well-constructed and have minimal flaws to achieve higher reliability and validity. Developing high quality MCQs is difficult but formal faculty training has found to have a positive impact on MCQ writing skills and quality. The purpose of the study was to assess the effect of a one-day training session on the quality of MCQs and the change in faculty’s self-rating of their competency in MCQ construction.

Methods:  This was a quasi-experimental study. A targeted workshop was conducted to train 17 faculty members in item writing skills and to improve the quality of existing item bank. Training was provided on the process of developing high quality assessment items and methods to avoid item flaws. Analysis of 48 MCQs from the existing MCQ bank was done for critique and improvement in quality. The MCQs were analyzed for level and type of questions and presence of item writing flaws. Faculty self-rating of their competency before and after the workshop session was also collected. Wilcoxon rank sum test was used to determine any change in the pre and post workshop quality of MCQs. Paired t-test was applied to analyze change in participants’ perception of their competency before and after the workshop session.

Results:  Analysis showed that after the workshop, the number of MCQs testing recall reduced significantly (N 42, 30, P ≤ 0.05). Similarly, questions testing application of knowledge improved significantly (N 6, 17,
P ≤ 0.05). Analysis of faculty’s self-rating of “change in competency” showed a significant improvement (P = 0.00) in their ability to improve the stem, lead-in and options list with appropriate and logically sequenced distractors.

Conclusion:  Targeted faculty development workshops improves the quality of MCQs construction. These trainings should be well structured and conducted on regular basis for better outcome.

Open access Original Article | March 31, 2021
Knowledge, Awareness, and Attitudes of Pakistani Population towards Second Wave of COVID-19 - A Questionnaire Based Survery

Samina Fida, Rabia Nafees, Hala Mansoor, Saba Saif, Mashhood-ul-Hassan, Sahar Sharif, Abbas Cheema

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Background and Objective:  COVID-19 hit 2020 as one of the worst pandemics which happens over 100 years. Although people across the globe did not respond effectively to the pandemic yet Pakistani population responded to this pandemic with a different mindset as it was difficult for them to accept the infectious nature, spread, and associatedrestrictions. This study was designed to determine the awareness and attitudes of the Pakistani population towards the second wave of COVID-19 pandemic regarding reservation to quarantineand trust in healthcare system.

Methods:  The study was carried out from November-December 2020 during the second wave of COVID-19. The data was collected through a self-administered online questionnaire and included subjects from all provinces across Pakistan. Responses about awareness, attitudes, and trust in health care were recorded. The social stigma associated with COVID-19 was also recorded through this questionnaire. Data was entered in SPSS-20 and results were interpreted accordingly.

Results: Of all the participants70-80% of individuals knew about the disease and its spread, 48.8% of participants knew about the severity and prognosis of the disease, only 45-46% of patients were comfortable in getting themselves or their families tested if advised and reporting to healthcare about COVID-19. Out of all participants, 57.9% people admitted that there was a stigma associated with COVID-19 diagnosis, 37.8% believed that lack of testing and reporting was associated with this stigma, 46.6% individuals believed in rumors of false COVID-19 diagnosis and wrong treatment in Pakistani hospitals, 46.9% showed that they did not trust healthcare for patient management,65.9% attributed hiding disease to mistrust in healthcare and 57.5% participants did not want to be quarantined in government centers, if needed.

Conclusion: Knowledge of COVID-19 among people in Pakistan was nearly sufficient, their attitudes were mainly positive, while their practices needed approach that is more satisfactory. There exists a gap in the trust in government policies and local health care system. Pakistani people need more education to beat the stigma associated with COVID-19 to ensure early reporting and prompt treatment for these types of infectious diseases in the future.

Open access Original Article | March 31, 2021
Knowledge and Practices for Dental Treatment during COVID-19 - A Survey Based Study

Samreen Aqeel, Saood Khan Lodhi, Saroosh Ehsan, Adeela Rafique

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Background and Objective:  Coronavirus disease 2019 (COVID-19) is the latest infectious disease to rapidly spread worldwide. The role of dental professionals in preventing the transmission of COVID-19 is critically important while providing routine dental care. The objective of this study was to assess the attitude and perception of dentists to provide treatment to patients and form a general consensus for future dental protocols.

Methods:  Data collection was done using a well-structured web-based questionnaire (Google forms). The survey form was distributed by sending the link via email, WhatsApp and other online forums. Data were collected from n = 299 participants and analyzed by using Statistical Package for the Social Sciences (SPSS) version 25. Frequencies and percentages were determined for qualitative variables whereas mean ± standard deviation was calculated for quantitative variables.

Results:  A total of n = 299 responses were collected. Approximately 90.6% of the respondents were young clinicians with years of experience 1 – 9 years. Most of the respondents i.e. 70.9% were more inclined towards performing only non-aerosol generating procedures. Ninety five percent agreed upon training of dentists and dental chair side assistants regarding donning and doffing of PPEs and 91% preferred to go for high volume suction for aerosol generating procedures. Ninety four percent of the respondents strongly recommended to check for every patient reporting to dental clinic.

Conclusion:  Majority of the dentists are well aware of the current crisis, but trends of ambiguities have been seen regarding adaptation of particular protocol for the dental treatment. Intervention from Government is required to establish proper dental guidelines including provision of PPEs so that treatment could be provided with the best of facilities to the poor patients as well.