Annals of Jinnah Sindh Medical University

Artificial intelligence in Medical Education: Advantages and Challenges

Masood Jawaid — Sun, 31 Dec 2023 00:00:00 +0500

Artificial intelligence is rapidly transforming medical education. With the increasing need for clinicians to use such tools, medical education must prepare future healthcare professionals for the evolving landscape of artificial intelligence.¹

To determine the functional outcome of Philos plate fixation in patients with proximal Humerus fracture.

Sun, 31 Dec 2023 00:00:00 +0500

The Functional Outcome of Philos Plate Fixation in Patients with Proximal Humerus Fracture

Objective: To determine the functional outcome of Philos plate fixation in patients with proximal Humerus fracture.

Methodology: A prospective observational study was conducted at the Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi as well as Neurospinal and Medical Institute (NMI), Karachi between June 2016, and January 2021. Post-operative patients with proximal humerus fracture treated with Philos plate fixation were enrolled. Detailed history and physical examination were recorded. Patients were followed up to 12 weeks to determine functional outcome. Constant-Murley Score was used to assess the functional outcome as either satisfactory or unsatisfactory.

Results: A total of 304 patients were recruited in the study with a mean age of 51.42+7.939 years (range; 30-60). 216 (71.05%) patients who were managed with Philos plate for the management of fracture of the proximal humerus had satisfactory outcomes while only about 88 (28.95%) patients had unsatisfactory outcomes. 54 (17.76%) patients with an unsatisfactory outcome were older than 45 years. Body Mass Index was not significantly associated with patient outcome. However, delay in presentation of more than three days was significantly associated with unsatisfactory outcome in patients as 82 out of 90 patients with delay > 3 days had unsatisfactory outcome at the end of the study (p=0.0002)

Conclusion: We reported that philos plate fixation provided adequate stability and overall, a good functional outcome. Further large-scale studies should be conducted to ascertain our findings and assess the long-term complications.

Key words: Philos plate fixation, Proximal humerus fracture, Constant-Murley Score

Cytopathological Spectrum of Pleural Fluid Effusion at a Tertiary Care Hospital of Karachi

Syed Mehmood Hasan, Asma Shabbir, Nazish Jaffar, Syed Muhammad Hasan — Sun, 31 Dec 2023 00:00:00 +0500

Objective: The aim of this study was to evaluate the spectrum of pleural fluid effusion for the period of one year received at tertiary care centre of Karachi.

Methodology: This descriptive study was conducted after ethical approval at Burhani hospital laboratory, Karachi. Data of cytopathologically diagnosed peural fluid effusion was collected from the records available between June 2018 – June 2019. Relevant data pertaining registration number, age, gender of the patients and diagnosis were recorded. Data was entered and analysed using SPSS version 21

Results: Of the total 59 cases received, 44 (74.4%) were males & 12 (25.5%) were females. Age range was between 35 – 70 years with mean value = 55±12.8. From 59 cases, 15 (25.4%) were mixed inflammatory infiltrate, 12 (20.3%) showed chronic inflammatory cells, 08 (13.5%) had predominantly neutrophils, 06 (10%) with atypical cells, 04 (6.7%) presented with adenocarcinoma and 14 (23.7%) were labelled as inadequate/haemorrhagic samples.

Conclusion: Majority of the pleural effusion samples were adequate. Inflammatory lesions were more common in comparison to malignancy. Adenocarcinoma was the most common neoplastic entity. Pleural fluid cytology is an effective initial diagnostic modality in Pakistani health care setup.

Keywords: Pleural effusion, inflammatory cells, adenocarcinoma, atypical cells.

Screening Mammography: A Preliminary Study On its Significance

Sun, 31 Dec 2023 00:00:00 +0500

Introduction: Breast cancer screening is a crucial preventative measure for finding early indicators of cancer even in the absence of symptoms. A common type of cancer that is a major factor in women's mortality is breast cancer. For the purpose of preserving lives, early and precise diagnosis is crucial. For women with moderate risk, annual screening is advised beginning at age 40, according to the American College of Radiology (ACR). However, due to financial constraints, certain nations have difficulty implementing efficient screening techniques like mammography. To enhance early diagnosis and lower mortality rates, especially in high-risk populations like Pakistani women, it is critical to increase awareness of the value of cancer screening and investigate practical alternatives.
Objective:. To evaluate the effectiveness of mammography screening, clinical breast examination, and self-examination in lowering breast cancer mortality in older, average-risk women as well as the risks connected with screening.

Materials and Methods: Aliya Begum Cancer Diagnostic Centre in Mirpur, AJK, Pakistan, hosted a one-day screening mammography camp. This cross-sectional methodological study included twenty female participants who were at least 40 years old. We evaluated the concept, face, and content validity of a questionnaire on breast cancer screening beliefs. Following a clinical evaluation, bilateral mammography was done. Breast Imaging Reporting and Data Systems (ACR-BIRADS) fifth edition guidelines were followed while reporting mammogram results.

Results: Twenty women with an average age of 48.6 years underwent mammography, with ages ranging from 40 to 65. The behaviours associated with breast cancer screening—breast awareness, clinical breast examination, and mammography—were found to be strongly correlated with attitudes towards routine physical examinations and the perception of mammographic screening obstacles.

Conclusion: Regardless of cost constraints, a national program for the diagnosis of breast cancer must include mammography, a tried-and-true screening technology. Mammography camps can be a very effective way to spread knowledge about these services and encourage people to use them.

INVITRO ASSESSMENT AND APPLICATION OF KINETICS MODELS ON DISSOLUTION PROFILE OF SEVERAL BRANDS OF CLOPIDOGREL (75MG) AVAILABLE IN KARACHI, PAKISTAN

Sun, 31 Dec 2023 00:00:00 +0500

Objective: The main objective of this study is to perform the invitro quality assessment of ten different marketed brands of Clopidogrel (75mg) available in the Karachi, Pakistan.

Methodology: Pharmacopoeial and non pharmacopoeial test have been performed on all ten selected brands of Clopidogrel coded as C1, C2, C3…C10. A sample of 10 tablets from each brand were subjects to performed pharmacopoeial test such as weight variation, friability, disintegration, assay and dissolution. Non pharmacopoeial test include hardness, thickness and diameter. All the dissolution data were subjected to model dependent and model independent kinetics approaches.

Result: The average weight variation of all ten coded brands of Clopidogrel were found to be 225.9-356.1 mg, followed the USP specification of ±7.5% deviation. After performing hardness, thickness and diameter of all selected tablets, the values were found to be in specified limited given by USP. The disintegration time of all test formulation was 2-8minutes, which meet the USP standard disintegration limit of film coated tablets. % friability of tested tablets was found to be 0.02-0.3%, which lies in the standard limit of % friability of bearing enough mechanical strength. In this study assay studies of Clopidogrel was found to be in the range of 98.7% to 101.30%, which lying under the limits of USP assay monograph. The dissolution test was subjected to model dependent and model independent kinetics approaches by using Dissolution Data solver (DD solver). 0.1N HCl were used for multiple point dissolution studies, range of 90.9%-99.8% drug released was analyzed on UV spectrophotometer at the wavelength of 270nm which also found to be in USP specifications. The fundamental measures of similarity factor (f1) and dissimilarity factor (f2) values were also found to be in limits. After applying all the kinetics models on coded brands of Clopidogrel, the calculated r² value followed all model kinetics approaches.

Conclusion: In this successful study, application of pharmacopoeial and non pharmacopoeial test on ten different coded brands of Clopidogrel (75mg) available in Karachi, Pakistan. Further work is recommended on large scale sample. All the values were found to be in limits and meets the specifications given by the United State Pharmacopeia. Moreover, invitro multiple point dissolution studies were carried out by the application of Dissolution Data solver (DD solver) and were subjected to all kinetics models.

Post-Operative Sensitivity In Posterior Composite Resin Restorations Using Etch And Rinse Versus Self-Etch Adhesive Systems

Sun, 31 Dec 2023 00:00:00 +0500

Objective

The objective of this study was to compare the frequency of post-operative sensitivity (POS) using two-step etch and rinse versus one step self-etch adhesives.

Methodology:

This study was carried out in the Operative Dentistry Department, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore and it was completed in 18 months from Feburary 2020 to August 2021 after approval of synopsis.

A total of 60 patients presenting with carious lesions in maxillary and mandibular posterior teeth excluding third molars were part of this study. Patients were divided into two groups of 30 patients each. Restoration of group A was performed using Excite (Ivoclar Vivadent, Schaan, Liechtenstein) in etch and rinse technique and restoration of group B was performed using Xeno III (Dentsply, Ballaigues, Suíça) in self-etch adhesive technique.

Result

The results of this study showed that there is no significant difference in the frequency of POS in etch and rinse vs self-etch adhesive groups based on gender, age groups and educational status.

Conclusion

Composite restoration done using self-etch adhesive has similar results in terms of POS in comparison to restorations done using etch and rinse adhesive.

Keywords:

Resin composite, restoration, dental adhesives, post operative sensitivity

DIFFICULTIES IN DIAGNOSIS OF NEUROLOGICAL MANIFESTATIONS OF WILSON DISEASE

Sun, 31 Dec 2023 00:00:00 +0500

A rare autosomal disease caused by altered copper metabolism, Wilson disease, primarily involves liver and basal ganglia of the brain and affects males and females equally. Diagnosis of Wilson disease may be difficult, requiring blood and urine tests, and may include a liver biopsy. Copper chelation with penicillamine or trientine, oral zinc and a low copper diet are recommended therapies. We report the case of a 32-year old gentleman who presented with 6-month history of gradual onset, progressively worsening history of aphasia with loss of comprehension, inappropriate vocalizations, increased aggression and disturbed sleep. The patient had been exhibiting speech abnormalities, wherein his speech patterns and utterances became socially inappropriate and unrelated to the context, making it difficult for him to understand and communicate effectively. A differential diagnosis including auto-immune and infectious encephalitis, neurodegenerative disorders like Creutzfeldt-Jakob disease (CJD) and Wilson’s disease was made. MRI Scan Brain (with FLAIR) showed T2WI hyper-intense signals in bilateral basal ganglia, brain atrophy, hyper-intense signals in periventricular, cortical and sub-cortical regions. CSF analysis showed TLC 74 cells/uL with 90% lymphocytes, RBC 0 cells/uL, Protein 62 mg/dl and Glucose 69 mg/dl with no organisms on Giemsa stain and AFB stain microscopy. GeneXpert-PCR for MTB was also negative. His blood, urinary and spinal fluid cultures did not grow any organism growth. Serum cerulopasmin level was normal at 23 mg/dl. CSF autoimmune profile was negative. However, his 24-hour urinary copper was raised at 1201.8 ug (normal value 20-40 ug). He was diagnosed as having Wilson’s disease and started on pencillamine and zinc sulfate.

The Letter To Editor

Aman Ashar, Mehwash kashif, DR. — Sun, 31 Dec 2023 00:00:00 +0500

The letter to editor has been written to emphasize the necessity of information among the dentists about the Oral microbiology.