Nevin Manimala

J Ayub Med Coll Abbottabad. 2021 Jan-Mar;33(1):82-88.

ABSTRACT

BACKGROUND: Feedback is an essential component of the clinical skills development of dental students. The clinical training is a complex integration of knowledge, psychomotor skills, behaviour and clinical communication skills under stress for both instructor and student. This study aimed to investigate the perceptions of undergraduate dental students and their instructors on the quality of clinical feedback.

METHODS: The current cross-sectional observational study was conducted at the Department of Operative Dentistry and Endodontics, Riphah International University, Islamabad from August to December 2019. A self-administered questionnaire was used to collect responses from final year undergraduate dental students and faculty. The questionnaire comprised of 13 items, subdivided into six categories, targeting the various aspects of clinical feedback. SPSS 23 was utilized to analyse the data. Descriptive statistics were tabulated and data was analysed using the Mann-Whitney test (p<0.05) for differences between the two cohorts.

RESULTS: The mean age of the 64 students who responded was 24±0.8 years. Students’ male to female ratio was 1:1.56, while for the 18 instructors the ratio was 1:1. Good agreement between the students and instructors was shown for items related to personal dignity and empathy. Moderate agreement was found for items covering the domains of time, understanding, comfort level, professionalism, and self-assessment. The disagreement was observed for the items associated with conflicting feedback, conflict satisfaction, and effective communication.

CONCLUSIONS: Incongruousness existed between the dental students and instructors, about the quality of clinical feedback provided to the dental students. Communication between the instructors and learners must be promoted to increase the level of understanding of the feedback given by the clinical instructors.

PMID:33774960

J Ayub Med Coll Abbottabad. 2021 Jan-Mar;33(1):54-59.

ABSTRACT

BACKGROUND: Recently the Coronavirus pandemic presented with different manifestations in different parts of the world, both on clinical examinations and on imaging. CT Scanning (CT Scan) chest is used for detailed evaluation of the different characteristic patterns determining the depth of disease. The study is aimed to assess the variations in spectrum of Covid-19 CT findings and relating severity (CT Severity Score) with the Clinical Symptoms in Bahawal Victoria Hospital, Bahawalpur.

METHODS: In this cross-sectional study, patients referred to radiology department from outdoor for COVID screening were included from 1st May to 30th June 2020. Mean age range of patients was calculated, while presenting complaints and co-morbidities were tabulated in frequencies and percentages after analysis. Severity of symptoms and CT findings were correlated with biochemical and haematological tests.

RESULTS: Patients’ age range from 25 to 85 years with 62% males and 38% females. Statistically no significant difference was observed in CTSS on gender basis. As sensitivity of RT PCR is about 70%, negative cases cannot be considered disease free and this is seen in this study as CT findings suggestive of COVID are seen in these patients. Using 40-point CT-SS, 11 patients had a score of >19 with severe diseases, while 14 patients had common disease with a score range of 11-18 and 35 patients had <10 score with mild or no symptoms.

CONCLUSIONS: In this study, a spectrum of patchy ground glass opacities, bilateral peripheral predominantly lower lung consolidations were observed. Quantitative analysis of inflammatory process as occurring in lungs in Coronavirus Disease 2019, using 40-point CTSS scoring on Imaging could provide a timely and objective approach towards identifying patients requiring intensive care and hospitalisation.

PMID:33774955

J Ayub Med Coll Abbottabad. 2021 Jan-Mar;33(1):49-53.

ABSTRACT

BACKGROUND: Combination of DAAs, Sofosbuvir and Ribavirin has been known as an effective treatment for HCV genotype 3. The aim of our study is to assess the efficacy of Sofosbuvir and Ribavirin in relapsed HCV genotype 3 patients.

METHODS: A cross-sectional retrospective analysis of hospital records between January 2015 and December 2016. Data was taken of only those patients who were followed for one year. A total of 193 cases were included in this study who were HCV genotype 3 relapsers and out of these 28 patients failed to be followed. Data was entered and analysed in IBM SPSS software package 23.

RESULTS: Out of the total 193 cases, 74.1% of cases achieved RVR at 4 weeks of therapy. ETR was achieved by 91.2% cases, while 8.8% of cases were non-responders. There was statistical significance in gender achieving ETR with a p-value of .008. 84.5% of cases achieved SVR-12. Statistical significance was noted between haemoglobin levels at presentation and 4 weeks follow-up with a p-value <0.005, and also between 4 weeks and 12 weeks follow-up with a p-value <0.005. Statistical significance was also found between age and PCR at 4 weeks (p-value of .002), age and PCR at 24 weeks (p-value of .051) and between ALT levels and PCR at 4, 12 and 24 weeks follow up (p-value <0.005). At 1-year follow-up, 79.3% of cases achieved a negative PCR, 28 patients failed to be followed, 6.2% of cases had a positive PCR. 5.5% of cases of the total 163 SVR cases had a relapse at 1 year.

CONCLUSIONS: HCV genotype 3 patients can benefit from Sofosbuvir and Ribavirin. With the SVR of more than 80%, this combination is cost-effective and safe. Treatment duration should be dependent on RVR and viral load at 4 weeks follow-up.

PMID:33774954

J Ayub Med Coll Abbottabad. 2021 Jan-Mar;33(1):44-48.

ABSTRACT

BACKGROUND: Accounting for 30% cases of all lymphoid neoplasms, Diffuse large B cell lymphoma (DLBCL) is the commonest lymphoma worldwide. It occurs over a wide age range and has diverse morphology, immunophenotype and clinical outcome. Objectives of the study were to determine the frequency of Double expressor lymphoma (DEL) in a tertiary care hospital.

METHODS: This descriptive cross-sectional study was carried out in the Department of Histopathology, Rehman Medical Institute Peshawar from June 1st to December 1st, 2018. A total of 88 newly diagnosed cases of diffuse large B-cell lymphoma (DLBCL); diagnosed on incisional or excisional biopsies were included in the study by non-probability consecutive sampling. Statistical analysis was carried out using SPSS-23. Quantitative variables were calculated as mean±SD. Qualitative variables were computed as frequency and percentages. Post stratification chi-square test was applied keeping p value equal or less than 0.05 as significance.

RESULTS: In our 88 cases of DLBCL, 56 (63.6%) were males and 32 (36.4%) were females. Age of patients ranged from 15yrs to 84yrs. Mean age was 50.8±15.2SD. Activated B-cell like (ABC) subtype of DLBCL constitute 51 cases (58%) while 37 cases (42%) were of germinal centre B-cell like (GCB) subtype. Nineteen cases (21.6%) were of DEL. Cervical node was the commonest site of involvement (n=17, 19.3%) followed by stomach (n=10, 11.4%) and tonsil (n=6, 6.8%). Out of 19 cases of DEL, 17 cases (89.5%) were of ABC type. DEL was found to have significant correlation with ABC subtype of DLBCL (p=0.002). DEL had no correlation with gender (p=0.6), age (p=0.27), Mib-1 (p=0.36) and tumour site (p=0.42).

CONCLUSIONS: The frequency of DEL in our study was 21.6% which is comparable to other studies who used similar cut-offs for c-Myc and BCL2 and similar criteria of inclusion as in our study. Significant association was found between DEL and ABC subtype of DLBCL.

PMID:33774953

J Ayub Med Coll Abbottabad. 2021 Jan-Mar;33(1):39-43.

ABSTRACT

BACKGROUND: Aspirin is one of the popular, economical, easily accessible and commonly used drugs all over the world. Injudicious use of this over-the-counter available drug is a common cause of nephrotoxicity. The aim of the present study is to assess the protective effects of Nigella Sativa (NS) on the histology of kidneys against aspirin-induced toxicity. It was an experimental study that included comparative analysis of control and experimental groups, conducted in the department of Anatomy, University of Health Sciences, Lahore, from October 2016 to December 2016.

METHODS: The study included thirty-two female albino rats which were equally distributed into 4 groups. Group A was run as control and given single oral dose of 1% methyl-cellulose (10mg/100gm body weight of rat). Group B and C were treated with a single oral dose of aspirin (1000mg/kg body weight) dissolved in 1% methyl-cellulose (10mg/100gm body weight). Group C animals were left untreated for 7 days. Group D was pre-treated on day 1 with oral dose of Nigella Sativa (NS) extract (250mg/kg body weight) followed one hour later by a single oral dose of aspirin (1000mg/kg body weight), subsequently NS extract was administered till day 7. Rats of group B were euthanized and dissected on 2nd day of experiment while those of groups A, C and D on 8th day. Kidneys were dissected out, weighed and fixed in 10% formalin. 5μm thick sections were yielded after tissue processing and stained with haematoxylin, eosin (H&E staining) and periodic acid Schiff’s reagent (PAS staining). Histological parameters of distal convoluted tubules (DCT) were observed.

RESULTS: All histological parameters were normal in group A. Group B showed marked increase in epithelial necrosis, intraluminal protein casts and broken basement membranes of distal convoluted tubules. Group C showed no self-recovery. Statistically significant improvement was observed in the histology of distal convoluted tubules with treatment of Nigella Sativa extract in aspirin-ingested rats in group D.

CONCLUSIONS: Nigella Sativa extract has shown protective effects on kidneys against aspirin-induced damage as shown by improvement in the histological parameters of distal convoluted tubules.

PMID:33774952

J Ayub Med Coll Abbottabad. 2021 Jan-Mar;33(1):20-25.

ABSTRACT

BACKGROUND: Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)- ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care.

METHODS: This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included.

RESULTS: A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality.

CONCLUSIONS: The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start.

PMID:33774948

Plant Biotechnol J. 2021 Mar 27. doi: 10.1111/pbi.13588. Online ahead of print.

ABSTRACT

Eucalyptus is among the most widely planted taxa of forest trees worldwide. However, its spread as an exotic or genetically engineered form can create ecological and social problems. To mitigate gene flow via pollen and seeds, we mutated the Eucalyptus ortholog of LEAFY (LFY) by transforming a Eucalyptus grandis x urophylla hybrid and two Flowering Locus T (FT) overexpressing (and flowering) lines with CRISPR Cas9 targeting its LFY ortholog, ELFY. We achieved high rates of elfy biallelic knock-outs, often approaching 100% of transgene insertion events. Frameshift mutations and deletions removing conserved amino acids caused strong floral alterations, including indeterminacy in floral development and an absence of male and female gametes. These mutants were otherwise visibly normal and did not differ statistically from transgenic controls in juvenile vegetative growth rate or leaf morphology in greenhouse trials. Genes upstream or near to ELFY in the floral development pathway were overexpressed, whereas floral organ identity genes downstream of ELFY were severely depressed. We conclude that disruption of ELFY function appears to be a useful tool for sexual containment, without causing statistically significant or large adverse effects on juvenile vegetative growth or leaf morphology.

PMID:33774917 | DOI:10.1111/pbi.13588

Vet Comp Oncol. 2021 Mar 27. doi: 10.1111/vco.12696. Online ahead of print.

ABSTRACT

Canine gastrointestinal sarcomas, a group of tumors that includes leiomyosarcomas (LMSAs), gastrointestinal stromal tumors (GISTs), and other rarer sarcomas, comprise about 10-30% of all gastrointestinal tumors. This study aims to characterize the histologic characteristics and clinical behavior in order to identify prognostic factors predictive of outcome. A single institution database search for surgically-treated gastrointestinal sarcomas yielded 47 cases with adequate tissue remaining for histologic analysis and 42 cases available for analysis of clinical outcome. Tumors were then prospectively evaluated for mitotic count, necrosis, hemorrhage, and inflammation, as well as categorized via immunohistochemical (IHC) staining for smooth muscle actin, c-KIT, and DOG-1. IHC analysis defined 32 tumors as GISTs, 14 as LMSAs, and one as a sarcoma not otherwise specified. For both GISTs and LMSAs, the overall median survival time (MST) is 1024 days (range 31-1456), which did not differ statistically between tumor types (p=0.92). The overall metastatic rate of GISTs in this study was 32.1% (n=9) which was not significantly different to that of LMSAs at 15.3% (n=2, p=0.45). In multivariate analysis, mitotic count under 9 in GIST patients and complete surgical excision in all tumor types correlated with improved MST. For patients with GISTs, the intensity of c-KIT staining also correlated positively with survival, with an MST of 250 days in cases with weak staining and an MST of 1418 days in cases with moderate or strong c-KIT staining (p=0.005). This article is protected by copyright. All rights reserved.

PMID:33774909 | DOI:10.1111/vco.12696

Andrologia. 2021 Mar 28:e13935. doi: 10.1111/and.13935. Online ahead of print.

ABSTRACT

Intracytoplasmic sperm injection (ICSI) is increasingly used to treat male-factor infertility when sperm parameters are not proper for intrauterine insemination (IUI) or in vitro fertilization (IVF). Among sperm abnormalities, short tail sperm defect is a rare kind of teratozoospermia, which is a severe cause of male infertility. In this study, we evaluated the ICSI outcomes of infertile men with severely short tail sperm defect. 117 infertile men with primary infertility were included in this study. We evaluated the impact of short tail sperm defect on large ICSI series (228 cycles) outcomes. The fertilisation rate (FR) was 49.0%, the clinical pregnancy rate (PR) was 21.7%, and the delivery rate (DR) was 17.5%. The results of statistical analysis show that there is no relationship between short tail sperm defect and clinical pregnancy. According to the present study, there were patients with successful ICSI outcomes despite the severe defect in their spermatozoa flagella. Our results can be considered in two main aspects: (a) it seems that ICSI could be a proper therapy for infertile men with short-tailed sperm defect and (b) the abnormal sperm morphology (especially in sperm flagellum) is not a reliable predictor for the ICSI outcomes. In conclusion, our study suggests that ICSI should be considered as a proper treatment way for infertile men with severe short tail sperm defect and probably other sperm flagella abnormalities.

PMID:33774863 | DOI:10.1111/and.13935

Med Phys. 2021 Mar 28. doi: 10.1002/mp.14867. Online ahead of print.

ABSTRACT

PURPOSE: Ultrasound-targeted microbubble destruction (UTMD) has been widely applied to enhance chemotherapy of tumors, yet few studies have focused on the metastatic potential induced by UTMD. This study aimed to explore the metastasis of VX2 tumors after treatment with UTMD and chemotherapy.

METHODS: Forty-four New Zealand rabbits bearing subcutaneous VX2 tumors were enrolled for the treatment of UTMD with chemotherapy. For UTMD, the tumors were insonated using two pulsing protocols of diagnostic ultrasound (DUS, VINNO and ECARE) with a mechanical index (MI) of 0.29-0.33, tone burst of 8.0 cycles, and frequencies of 3-4 MHz. A total dose of 2 mL SonoVue^® was injected intermittently during 10 min UTMD exposure. The combination therapy was treated using doxorubicin (DOX, 2 mg/kg) and DUS, while the tumors treated using DOX only served as the control. Tumor size was measured using the tumor volume formula. Survival time was observed until animal death or the end of the study (120 days). Specific organs (lung, liver, kidney, and brain) were removed for metastatic evaluation.

RESULTS: There were no statistical differences in overall metastasis classification and individual organ metastases among all groups (P>0.05). The tumor growth rate only showed inhibition on the 5^th day (P<0.01). The survival time did not demonstrate any significant difference between UTMD and chemotherapy only (P>0.05).

CONCLUSIONS: UTMD using long pulse DUS with commercial microbubbles did not pose a risk of metastasis enhancement in DOX chemotherapy.

PMID:33774845 | DOI:10.1002/mp.14867