Dow University Of Health Sciences Research Articles

Positive predictive value of Birads IV Lesions on mammogram in detection of breast carcinoma.

To determine the positive predictive value of Breast Imaging Reporting and Data System category IV lesions, and to evaluate interobserver agreement among radiologists in interpreting the subcategories. The cross-sectional study was conducted at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi, from September 2018 to February 2019, and comprised adult females aged 30-60 years diagnosed with Breast Imaging Reporting and Data System IV. Already diagnosed breast carcinoma patients were excluded. The positive predictive value of Breast Imaging Reporting and Data System category IV was calculated using histopathology findings as the gold standard. Data was analysed using SPSS 22. There were 191 patients with a mean age of 49.01±11.79 years. Positive family history of breast cancer was found in 33(17.3%) subjects. Category IV-A was noted in 53(28.0%) subjects, IV-B in 45(23.6%) and IV-C in 93(48.7%). The overall positive predictive value of category IV was 151(79.1%), IV-A 27(50.9%), IV-B 35(77.7%) and IV-C 89(95.6%). Malignant disease was significantly associated with architectural distortion and suspicious microcalcifications (p<0.001). A good agreement was observed in the categorisation of Breast Imaging Reporting and Data System category IV between observers 1 and 2 (kappa 0.85, 95% confidence interval: 0.70-0.99), between observers 1 and 3 (kappa 0.77, 95% confidence interval: 0.61-0.94), and between observers 2 and 3 (kappa 0.63, 95% confidence interval: 0.43-0.83). Breast Imaging Reporting and Data System BI-RADS IV was found to have a high positive predictive value in the diagnosis of breast cancer. Besides the interobserver agreement in terms of identifying BI-RADS IV subcategories was good.

Anatomical variations of human sphenoid sinus in terms of volume and septation pattern in a subset of Pakistani population using computed tomographic images.

To compare the sphenoid volume between the genders and to analyse variations in septal insertions on bony wall of optic nerve and internal carotid artery. The prospective study was conducted from October 2020 to February 2021 at the Radiology Department of Dow University of Health Sciences, Karachi, and comprised paranasal sinus patients of either gender aged 20-60 without any bony deformity of sphenoid sinus who were analysed for sphenoid volume, number of septa and variable septal insertions using computed tomography of paranasal sinus. On the basis of septal insertions, the scans were categorised into Group 1 with no risky septal insertion, Group 2 with septal insertion on bony wall of optic nerve, Group 3 with septal insertion of internal carotid artery, and Group 4 with septal insertion on both optic nerve and internal carotid artery. Differences in sphenoid volume were analysed between males and females and among the four groups. Data was analysed using Graph Pad Prism 9. Of the 300 patients, 171(57%) were males and 129(43%) were females. The overall mean age was 39.28±10.9 years. Multiple septa were found in 208(69.3%) of the sinuses. There were 129(43.7%) patients in Group 1, 34(11.3%) in Group 2, 119(39%) in Group 3 and 18(6%) in Group 4. Significant difference was found between volume and gender as well as among the four groups (p<0.001). The sphenoid volume between the genders and the variations in septal insertions on bony wall of optic nerve and internal carotid artery were significantly different.

IDF21-0084 Role of serum copeptin levels in Type II Diabetes Mellitus patients with progressive stages of diabetic nephropathy

Background: Type II Diabetes mellitus (DM) is one of the leading metabolic diseases. It has multiple serious complications. Diabetic nephropathy is one of them. Progressive deterioration in renal functions due to DM makes the patient’s life completely handicapped. Thus, patients start depending on dialysis and ultimately develop its complications. Arginine Vasopressin (AVP) maintains glucose hemostasis and therefore, plays an important role in the pathophysiology of DM and its related complications such as diabetic nephropathy. Copeptin is an inactive analogue of AVP and considered as a reliable surrogate biomarker of AVP. Therefore, it is hypothesized that changes in the levels of copeptin can be correlated with diabetic and renal markers and thus may have potential role in predicting progressive stages of DM and diabetic nephropathy. Aim: The aim of the study is to find out the relation of copeptin with different diabetic and renal function biomarkers and to find out a potential role of copeptin as a predictive biomarker in DM and its associated progressive diabetic nephropathy. Method: It was a comparative cross-sectional study. A total number of 120 individuals were recruited into four groups i.e. controls, pre- diabetes, DM without nephropathy and DM with nephropathy as per the criteria of American Diabetes Association (ADA) 2018 and National Kidney Foundation/ Kidney Disease Outcome Quality Initiative (NKF/ KDOQI) 2018 guidelines. All cases were controlled hypertensive. Serum copeptin levels were measured by sandwich ELISA. While, Blood Urea Nitrogen (BUN), creatinine, Glycosylated Hemoglobin (HbA1c), urine micro albumin (UAE) and urinary creatinine were got done using spectrophotometry on Abbott Architect c8000 and electrolytes (Na+, K+ and Cl−) by iso electric method from Dow Diagnostic Research and Reference Laboratory (DDRRL), Dow University of Health Sciences. Statistical analysis was done using Analysis of Variance (ANOVA) and Pearson’s correlation tests on SPSS. Confounders were controlled using univariate linear regression. Results: The average copeptin levels of the study population were 215.096 pg/ml. Copeptin levels were significantly elevated in subjects with positive family history of DM (p = 0.025), levels were also raised in pre diabetes patients (252.85pg/ml) as compared to other groups. Copeptin levels were positively correlated with HbA1c r=0.171 (p=0.101), urea r=0.244 (p=0.007), creatinine r=0.215 (p=0.018), UAE r=0.310 (p=0.001), UACR r=0.375 (p=< 0.001). No significant correlation of copeptin was found with major electrolytes of the body. However, copeptin is found to be significantly associated with progressive stages of albuminuria and declining Glomerular Filtration Rate (GFR). Discussion: The raised levels of copeptin in subjects with positive family history of DM recommends its role in the early prediction of DM. Moreover, significant association of copeptin with progressive stages of albuminuria and declining GFR suggest the contribution of copeptin in the worsening of renal functions in DM and its associated nephropathy.

Maxillary sinus involvement of maxillary third molars: An OPG study conducted at Dow International Dental College, Karachi.

Objective: This study aims to evaluate the angulation, position, and impaction of the maxillary third molar and its proximity and relationship to the maxillary sinus assessed through dental OPGs. Study Design: Cross-sectional Analytical study. Setting: Department of Oral Surgery, Dow International Dental College, Dow University of Health Sciences. Period: November 2019 to February 2020. Material &amp; Methods: Through convenience sampling, 1684 Orthopantograms were collected. Out of which 864 OPGs were selected and included in this study. From these OPGs, 1228 maxillary third molars were evaluated for their proximity to the floor of the maxillary sinus. Results: Most common relation of the maxillary sinus with third molar roots was in class II which is 0-2mm bone presenting between the root and the sinus unanimously between both genders. Most of the roots of maxillary third molars present within the maxillary sinus were found within the second and third decade of life in both genders. Conclusion: Dental OPGs present a cost-effective viable alternative to CBCT in the treatment planning of impacted maxillary upper incisors in combination with other radiographs. The findings of this study further strengthen the proposal of using dental OPGs in the diagnostic repertoire of impacted wisdom teeth in low resource settings.

Gene-gene and gene-environment interaction: An important predictor of oral cancer among smokeless tobacco users in Karachi.

To determine the risk for oral cancer caused by simultaneous occurrence of more than one of the tested cytochrome P450 CYP1A1 MspI, glutathione S-transferase M1 null gnd Glutathione S-transferases T1 null gene polymorphisms. The cross-sectional case-control study was conducted from December 2011 to October 2016 at the Ziauddin University, Karachi, in collaboration with Dow University of Health Sciences, Karachi, and comprised oral squamous cell carcinoma cases in group A and healthy tobacco habit-matched controls in group B. All investigations were done using standardised laboratory protocols. The outcomes were determined in terms of association of various combinations of cytochrome P450 1A1MspI, glutathione S-transferasesM1 null and glutathione S-transferases T1 null polymorphisms with oral cancer. Data was analysed using SPSS 20. Of the 238 subjects, 140(58.8%) were in group A and 98(41.2%) were in group B. Mean ages in group A and B were 47.1±12.22 and 41.6±14.58 years, respectively. Male/Female ratio in group A was 1.88:1 while 83.4% were using tobacco. When cytochrome P450 1A1MspI homozygous (m2/m2) and glutathione S-transferases M1 null variants occured simultaneously in an individual, an odds ratio of 12.8 (95% confidence interval: 1.20-135.5; p=0.03) among overall tobacco chewers was observed. For glutathione S-transferases M1 not null and glutathione S-transferases T1 null variant combination among overall tobacco users, the conferred odds ratio was 4.58 (95% confidence interval: 0.99-21.2; p=0.05). The other studied gene combinations did not reveal significant associations (p>0.05). A higher risk of oral squamous cell carcinoma was found to be associated with combined-gene polymorphisms of phase I and phase II enzymes than that attributed to a single-gene polymorphism.

Comparison of Antioxidant Effect of Crocus Sativus and Vitamin E on Amakicin Induced Nephrotoxicity in Albino Rats

ABSTRACT&#x0D; Objectives: The present study evaluated the protective effect of Crocus Sativus against Amikacin-induced Nephrotoxicity.&#x0D; Methods: The prospective descriptive study was conducted at the department of orthopedic surgery, Dr. Ruth KM Pfau Adult laboratory albino rats of the Wistar strain were used in this experimental study. In this study, 75 albino rats were subdivided into 3 groups, including experimental groups B and C. The control group (A) received normal saline intraperitoneally, group (B) received Amikacin 30mg/kg body weight intraperitoneally and Group (C) received Crocus sativus 50 mg/kg body weight orally and vitamin E orally in a dose of 50mg/kg of body weight. Kidneys of rats obtained after dissection were processed, sectioned, and stained in PAS Hematoxylin and Gomoris Methenamine Silver stains. The present study was conducted at Dow University of Health Sciences in the Institute of Biomedical Sciences and Animal House of Dow University and Dow Diagnostic Research and Reference Laboratory. The duration of the study was Three months. Inclusion criteria were Albino rats of both sexes, kidneys of either side (right &amp; left), rats with an approximate weight of 140 to 180 grams were included in the study. Exclusion criteria were overweight rats and pregnant rats.&#x0D; Results: A significant increase in kidney weight was observed in group B. A considerable addition was observed in proximal tubular in groups B and C. A considerable increase was also observed in the number of intact proximal tubule nuclei and the nuclear diameter of groups B &amp; C.&#x0D; Conclusion: The study provides evidence that Crocus Sativus has protective effects in Amikacin-induced nephrotoxicity, comparable to widely used Antioxidant Vitamin E. The study recommends the addition of Crocus Sativus in dietary supplements after further evaluation in human subjects.

To associate the fetal distress, IUD and IUGR observed in normal, diabetic and hypertensive pregnancies

To associate the fetal distress, IUD and IUGR observed in normal, diabetic and hypertensive pregnancies. Study Design: Cross sectional study with non probability purposive sampling was done. Place and Duration of Study: Institute Basic Medical Sciences, Dow university of Health Sciences, Karachi, from 2011-2013. Method: Cross sectional study with non probability purposive sampling was done.The patients were identified and selected through OPDs of two different hospitals in public and private sector. A total of 150 patients were selected, on the basis of history and clinical examination they were divided into three groups, Control (A), Diabetic (B), and Hypertensive (C), each having 50 individuals. Ultrasound and cardiac tocography (CTG) for all patients was carried out. The newborn was examined most of the time by a doctor from pediatric ward and, apgar scoring recorded at 1st min, 5th min and 10th min of birth. The data was entered and analyzed on SPSS version 16.0. Mean ± standard deviations was computed for the quantitative variables like Apgar score, by using ANOVA. P-value was determined at 95%confidence interval and &lt;0.05 taken as significant. Qualitative variables such as fetal distress, IUGR and IUD were presented by frequencies and percentages Results:Fetal distress was highest 46% in hypertensive group(p-0.005). IUGR was seen highest 6% in hypertensives(p-0.005). IUD was observed 10% in diabetic group (p-0.005). Results found by ultrasound scans were 92 % normal in control group, 68 % in hypertensive and 54 % in diabetic group.Mean Apgar score of baby in 1 minute was same in all the three groups. Conclusion:It is confirmed by this study that there are more no of cases with poor outcome of pregnancy in diabetic and hypertensive as compared to control group.

Cognition improvement strategies, study behaviours and stress among medical students of Dow University of Health Sciences: A cross-sectional study.

To determine the effects of cognition improvement strategies on academic performance, stress and sleep quality of medical students. The cross-sectional study was conducted at the Dow University of Health Sciences, Karachi, from March 2019 to March 2020, and comprised medical students regardless of gender and academic year. Academic performance was assessed through grade point average, while stress and sleep were assessed using the Perceived Stress Scale and Pittsburgh Sleep Quality Index. Data was analysed using SPSS 25. Of the 770 subjects, 748(97%) formed the final sample with mean age 20.32±1.49 years; 619(82.7%) females and 129(17.2%) males. Overall, there were 655(87.6%) consumers of cognitive enhancers and 93(12.4%) non-cunsumers. The mean Pittsburgh Sleep Quality Index score of consumers was 6.05±3.306, while that of non-consumers was 5.80±3.701. The respective mean Perceived Stress Scale scores were 21.18±6.09 and 20.5±6.8. There was no significant association of consumption of cognitive enhancers with academic performance and stress levels (p>0.05), but it was significant with sleep quality (p<0.05). Majority of the students were found to be consuming cognitive enhancers, but no significant association of the stimulants was found with either academic performance or stress.

Bonded amalgam as a fissure sealant in low-income setting: A randomised controlled trial.

To compare one year retention rate of bonded amalgam sealants (BAS) with that of conventional resin-based sealant (RBS). It was a parallel group, equivalence, randomised controlled trial done during March 2018 to December 2019 at the dental clinics of Dow University of Health Sciences, and the Jinnah Sind Medical University, Karachi, Pakistan on children aged 12-16 years, who were randomly assigned to one of the two treatment groups (BAS vs. RBS). Complete retention of the sealant at one year follow-up was labeled as success. Multi-level mixed effect logistic regression model was employed. Study was registered at www.clinicaltrials.gov # NCT NCT03130725. There were 137 teeth (23 subjects) in the BAS and 128 teeth (15 subjects) in the RBS group that were evaluated for sealant retention at 12 months follow-up. Among the BAS group, 100/137 (73%) sealants were completely retained whereas 110/128 (86%) were fully retained in the RBS group. Nearly, 22/137 (16%) BAS and 10/128 (7.8%) RBS were completely dislodged. In multivariable analysis, subject age >15 years and male gender were found to be significantly associated with the dislodgement of sealants. At 12 months follow-up, the retention of bonded amalgam sealant (BAS) was significantly lower than that of the resin-based sealant (RBS). www.clinicaltrials.gov with # NCT NCT03130725.

Clinical characteristics, obstetric and perinatal outcome of COVID-19 Infection in pregnant women.

To determine clinical characteristics, obstetrics and perinatal outcome of coronavirus disease 2019 infection in pregnant women. The cross-sectional study was conducted at the Department of Obstetrics and Gynaecology of the Ruth Pfau Civil Hospital, Karachi, and Dow University of Health Sciences, Karachi, from August 2020 to July 2021, and comprised pregnant women with suspicion of coronavirus disease 2019 infection, who underwent recommended testing, and were found to be positive. Oral swabs for the presence of infection were also taken from the neonate within 24 hours of delivery. Data was analysed using Stata 11. There were 41 women with a mean age of 27±5 years, a mean gestational age of 35±3 weeks, and mean parity 1.2±1.01. Of them, 3(7.3%) women died. Medical complications found along with coronavirus disease 2019 infection were pregnancy-induced hypertension 2(4.8%), eclampsia 4(11%) and diabetes mellitus 2(4.8%). Fever was the most common symptom seen in 12(30%) women, followed by cough 7(20%) and shortness of breath 6(14%). Majority 32(82%) of the women underwent caesarean section. The most common maternal complication was postpartum haemorrhage 6(20%). Also, 36(86%) women required intensive care unit stay for a mean 5±9 days. Fever, followed by cough and breathlessness, were the most common clinical features. Most common maternal and foetal complication was postpartum haemorrhage and low birth weight, respectively.

Frequency and Predictors of Acute Kidney Injury in Patients With Acute Coronary Syndrome in a Tertiary Care Hospital: A Retrospective Study.

IntroductionAcute kidney injury (AKI) is a complex condition marked by rapid deterioration of renal function (within hours or days), with clinical symptoms ranging from a minor rise in serum creatinine to anuric renal failure needing renal replacement therapy. AKI is one of the complications of acute coronary syndrome (ACS). This study aims to determine the frequency of AKI among patients with ACS and identify its predictors.MethodThis study is a retrospective observational study conducted at the Dow University of Health Sciences, a tertiary care hospital located in Karachi, Pakistan. This study was conducted from January 2020 to June 2021. All patients aged 18-75 years admitted with ACS and admitted for more than 48 hours were included in the study. A pre-set questionnaire was used to collect data from the hospital management information system (HMIS).ResultsThe frequency of AKI among patients with ACS was 24.18%. The factors associated with AKI among patients with ACS on multivariable logistic regression included the age of patients (odds ratio (OR) = 1.04, p-value = 0.018), having diabetes mellitus (OR = 2.33, p-value = 0.031), admission Killip ≥ II (OR = 2.12, p-value = 0.041), previous history of myocardial infarction (MI) (OR = 3.64, p-value = 0.001), baseline glomerular filtration rate (GFR) (OR = 0.94, p-value = 0.001), in-hospital ejection fraction (EF) (OR = 0.93, p-value = 0.001), and serum creatinine at admission (OR = 1.02, p-value = 0.001).ConclusionAge, comorbidities including diabetes mellitus and previous history of MI, admission Killip ≥ II, baseline GFR, in-hospital EF, and serum creatinine level at admission are significant independent predictors of AKI in patients with ACS.

Genetic profiles of different ethnicities living in Karachi as regards to tobacco-metabolising enzyme systems and the risk of oral cancer.

To detect polymorphisms of CYP1A1, GSTM1 and GSTT1 gene loci among various tobacco-consuming ethnicities in an urban centre, and to relate these with susceptibility to oral cancer. The cross-sectional, case-control study was conducted at Ziauddin University, Karachi, and the Dow University of Health Sciences, Karachi, from 2011 to 2016, and comprised patients having oral squamous cell carcinoma in group A, with oral precancerous lesions in group B, and tobacco habit-matched controls in group C. Routine histopathology was followed by molecular analysis through polymerase chain reaction and polymerase chain reaction-restriction fragment length polymorphism techniques. Data was analysed using SPSS 20. Of the 358 subjects, 150(42%) were in group A, 100(28%) in group B, and 108(30%) in group C. There were 190(53.1%) Urdu-speaking subjects, 42(11.7%) Memoni-speaking, 37(10.3%) Sindhi-speaking, 34(9.5%) Balochi-speaking, 25(7%) Pashto-speaking, 15(4.2%) Punjabi-speaking, and 15(4.2) of other ethnicities. Among the Urdu-speaking ethnicity, CYP1A1 MspI heterozygous variant was the most prevalent genotype ingroup A 50(66.7%), group B 37(62.7%) and group C 36(64.3%). The homozygous variant was equally distributed in group A 8(13.5%) and group B 10(13.3%), while it remained quite low in group C 4(7.1%). Homozygous genotype was most common in Pashto-speaking subjects in group A 4(57.1%). In Urdu-speaking subjects, GSTM1-null genotype was mostly found in group B 19(32.2%), while GSTT1-null genotype was most common in group A 12(16%). Other than Urdu-speaking, GSTM1-null variant was most frequent in Sindhi-speaking subjects in group B 8(80%). Intra-ethnic distribution of tobacco-metabolising enzyme genes can be considered an important contributor to oral cancer risk in the population of Karachi.

Emergency Management Readiness of Pakistani Dentists at Public Sector Teaching Hospitals

ABSTRACT Background: Medical emergencies during dental treatment need to be appropriately equipped to deal with multiple chronic diseases in medically compromised patients. A well-prepared dental team can prevent stress-related medical emergencies. The objective of this study was to evaluate the readiness of dentists in managing medical emergencies, while comparing between postgraduate interns and registered dental graduates, working at a public sector hospital. Methods: The study was conducted in three constituent dental colleges and affiliated hospitals of Dow University of Health Sciences situated in Karachi from January-March 2021. A 28-item validated questionnaire was piloted and designed to assess 250 dentists and interns in managing medical emergencies. For data analysis, responses of a three-point Likert scale related to knowledge was used, while a dichotomous scale was used for diagnosis and management and a p-value less than 0.05 was considered significant. Results: Out of 250 dentists, 208(83%) responded to the questionnaire. Most of the participants 200(96%) of the participants were taking medical histories and 149(87%) were routinely taking vital signs before dental treatment. We found that 62(42%) lacked adequate training for managing medical emergencies. Dental interns had more experience to deal with medical emergencies and were better prepared than general dentists. Conclusion: Most of the participants lacked training in medical emergencies encountered in dental clinics. Concrete measures are needed to address this issue at a national level. Evidence-based recommendations, regular training, drills, and certification are needed to prepare the future dentist to deal with medical emergencies. Keywords: Emergencies; Dental Clinics; Hospitals.

Transversus Abdominis Plane Block Versus Local Anesthetic Wound Infiltration for Postoperative Analgesia in Adult Patients Undergoing Hernia Repair in Daycare Procedure: A Randomized Control Trial.

Introduction: Various modalities are now being used to manage postoperative pain, such as regional nerve blocks techniques, continuous epidural analgesia, patient-controlled analgesia, opioids, and systemic non-steroidal anti-inflammatory drugs. This study compared the mean postoperative pain score between ultrasound-guided transversus abdominis plane (TAP) block and a local anesthetic wound infiltration at the surgical incision site.Methodology: A prospective, comparative, randomized controlled trial (RCT) was carried out from February 2021 to September 2021. The study was conducted in the anesthesia department of Dow University of Health Sciences, Karachi, Pakistan. Patients aged 18-80 years presenting with elective surgery of (both direct and indirect) inguinal hernia repair were enrolled in the study. Participants were randomly assigned into one of the two groups that are local anesthetic wound infiltration (Group A) and TAP block (Group B). The mean pain score was assessed using a visual analog scale and compared between the two groups.Results: The study included 168 patients grouped in two different groups. The mean age in Group A was 43.87 (+17.21), and Group B was 47.01 (±15.37). Mean pain scores in groups A and B were 6.36±1.94 vs 4.51 ± 1.99 (p-value=0.001). The pain rescue medications were given to 57.14% of patients in Group A and 34.52% of patients in Group B, and it was significantly different in the two groups (p-value=0.003). It was found that patients in Group A reported more severe pain (41.67%) than patients in Group B (10.71%).Conclusion: When compared to local anesthetic wound infiltration, ultrasound-guided TAP block had better analgesic activity compared to local anesthetic wound infiltration.

Subgenomic sequence analysis reveals emergence of new circulating recombinant forms of HIV-1 in Pakistan.

Background and Objective:Pakistan has witnessed a dramatic change in the increasing prevalence and emergence of HIV subtypes for more than two decades. Pakistani population is increasingly engaged in high-risk practices, and the prescribed drugs are potentially causing resistance. There are chances that these resistant strains are beginning to circulate from high-risk to the general population.Methods:The study was conducted at the section of Molecular Pathology Lab of Dow Diagnostic and Research Laboratory, Dow University of Health Sciences (DUHS) Karachi. In this study, we analyzed gene sequences of HIV for drug resistance and molecular epidemiology., along with amino acid sequence variability. Furthermore, we undertook phylogenetic analysis for possible geographic linkages of Pakistani HIV strains.Results:Our results demonstrate that A1 is the leading HIV subtype circulating in the country, whereas other emerging subtypes and recombinant forms, including subtype B, CRF02_AG, CRF10_CD CRF35_AD, and CRF11_cpx were also observed. Our sequences cluster with the Middle East, African, and a few European sequences according to geographical distribution. These sequences showed high-level resistance per drug resistance pattern, with 62.5% of patients exhibiting resistance to NNRTI drugs and 60% mutation at E138A and K103N, respectively, against NNRTI drugs. About 75% sequences showed resistance mutation at M184V against NRTI drugs. The antiretroviral drugs are now causing H-LR to the patients with no effect. Our results also revealed that certain regions of RT exhibited high sequence variability, especially at Amino Acids positions p.119, p.130, p.157, p.164.Conclusion:We hereby report major novel mutations and several minor mutations that may have a drastic change in the drug resistance pattern.

Bibliometric study on the literature related to dental research and education published in Journal of Pakistan Medical Association.

To analyse characteristics of literature related to dental research and education published in a single medical journal, The Journal of Pakistan Medical Association. The bibliometric study was conducted at the Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University from March till May 2020, and comprised electronic and hand search of scientific literature relevant to dentistry published in the Journal of Pakistan Medical Association from the first issue published in 1953 till March 2020. The selected articles were analysed for year of publication, field of study, type of article, institute and country of first author, number of authors and citation count. Keyword mapping was also carried out. Data was analysed using SPSS 19. Of the 159 articles identified, 117(73.6%) were contributed from Pakistan. The most common specialties were Oral and Maxillofacial Surgery and Epidemiology with 20(12.6%) articles each, followed by Operative Dentistry and Endodontics 19(11.9%). Majority of articles were Original / Research 87(54.7%). The highest number of articles were published in 2019 26(16.35%). The Aga Khan University, contributed the most publications 30(18.9%), followed by Dow University of Health Sciences, 11(6.9%). Majority of the articles were contributed by three authors 48(38.4%). The top cited article was found to have 113 citations, followed by articles with 103 and 91 citations. The contribution of scientific papers related to dentistry and dental education in the Journal of Pakistan Medical Association was significant. With growth of dentistry as a discipline along with a parallel increase in the publication of dental research papers, it is imperative that a dedicated indexed journal for dental research be commenced.

Differentiation of CD117+ Amniotic Fluid Stem Cells towards Nephron Progenitors.

Objective:The study aimed at isolation of CD117+ stem cells from amniotic fluid samples followed by their invitro differentiation towards nephron progenitors that can be potentially used for regenerative medicine studies and to further understand pathways involved in renal pathogenesisMethods:This experimental study was conducted at Dow Research Institute of Biotechnology and Biomedical Sciences (DRIBBS), Dow University of Health Sciences, OJHA Campus Karachi from November 2019 to December 2020. After patient consent, a Pfannenstiel incision was performed by the gynecologist through abdominal and uterine muscles without cutting into Amniotic Membrane. Using a needle of 5CC syringe connected to sterile Redivac bottle, a blunt end insertion was passed through the membrane and the amniotic fluid was aseptically sucked into Redivac bottle, the ice bag was used for transporting amniotic fluid from hospital to the lab and samples were processed within 60 minutes after collection. Amniotic fluid was centrifuged at 4º C for 20 minutes at 1400xg. After centrifugation the cell pellet was treated for analysis of CD117+ cells using flowcytometry, once small percentage of CD117+ cells were identified the cells were prepared for differentiation and that was carried out using specific growth factors including BMP4, BMP7, FGF2, and retinoic acid, providing the niche to the stem cells for differentiation towards nephron progenitors which was confirmed by protein expression of Wilms Tumor-1 (WT1) using immunofluorescence analysis. The sample size for this invitro work was n=3.Results:We successfully isolated small percentage of CD117+ cells in amniotic fluid followed by in vitro expansion and differentiation towards nephron progenitor cells (NPCs) using well defined media and growth factors, initially differentiated cells were spindle shaped and showed fibroblastic appearance later at stage of nephron progenitors it attained the shape of rounded big clusters, differentiated cells stained positive for WT1 and negative for cluster of differentiation (CD117). Therefore, confirming the successful isolation and differentiation of amniotic fluid stem cells towards nephron progenitors.Conclusion:To the best of our knowledge this is the first study from the country on the use of Amniotic fluid stem cells and their differentiation towards nephron progenitors that can be used as substitution source of cell therapy for exploration of renal diseases at cellular and molecular level and potential regenerative medicine applications.

Evaluation of In situ Adaptability of Two Types of Fissure Sealants Placed with or Without Enameloplasty

Context: Literature has no consensus over the utility of enameloplasty before fissure sealant placement. Aim: The objective of the study was to explore the effect of enameloplasty using a scanned electron microscope on the adaptability of resin-modified glass ionomer versus flowable resin-based sealants. Settings and Design: An in vitro, experimental study was done from July to November 2017 at the NED University and Dow University of Health Sciences, Karachi, Pakistan. Materials and Methods: An in vitro experimental study was done, for which twenty extracted human molars and premolars were selected. They were divided into two groups on the basis of sealant type (resin-modified glass ionomer versus flowable resin-based sealant). The groups were further subdivided on the basis whether these were subjected to enameloplasty or not. All specimens were thermocycled, sectioned, dried, and gold sputtered before inspection under a scanning electron microscope (×50). Statistical Analysis Used: The adaptability of the sealant material in the tooth fissures was assessed on an ordinal scale. SPSS version 23.0 was used for data analysis. Mann–Whitney U-test and ordinal regression were applied at 0.05 level of significance. Results: There were no statistically significant differences between adaptability scores achieved with resin-modified glass ionomer-based sealant and flowable resin-based sealant (P = 0.96). Moreover, enameloplasty resulted in inferior adaptability of the two sealant materials (P = 0.02). Conclusions: Enameloplasty has shown to exert a negative influence over adaptation of the sealant material into the tooth fissure irrespective of the sealant chemistry.

Analysis of Maternal Morbidity and Mortality Referred to Tertiary Care Hospitals of Pakistan

Background and Aim: Maternal morbidity is a major health problem affecting approximately millions of women annually and had a substantial influence on fetal and infant health that might lead to maternal mortality. Maternal mortality is an indicator of the quality of obstetric care in a community directly reflecting the utilization of health care services available. The present study was conducted in order to analyze the maternal morbidity and mortality cases referred to a tertiary care hospital. Methodology: This cross-sectional study was conducted on 89 maternal deaths out of 9874 obstetrical admissions or births referred to department of Gynae/Obs of tertiary care hospitals i.e Makran Medical College, Turbat/ Teaching Hospital, Kech and Dow University of Health Sciences, Karachi over a period of five years from 2017 to 2021. All the pregnant women with gestation age &gt;24 weeks admitted for any obstetrical emergencies were enrolled in this study. Patient’s demographic characteristics, clinical features during admission, and maternal relevant information were collected on pre-designed proforma. SPSS version 21 was used for data analysis. Results: Out of total 9874 births, maternal deaths were 89; the mortality incidence with prevalence was hemorrhage 7 (7.9%), hypertensive disorders 34 (38.2%), anesthetic issue 2 (2.2%), sepsis 14 (15.7%), and medical complications 31 (34.8%). The occurrence of direct and indirect maternal death was 55 (61.8%) and 34 (38.2%) respectively. The incidence of the mortality rate was 22.9%. Of the total 387 morbidity cases, hypertensive disorders were the prevalent cause with 295 (76.2%) cases followed by obstetric hemorrhage 55 (14.2%), medical complications 25 (6.5%), sepsis 11 (2.8%), and anesthetic complications 1 (0.3%). The incidence of morbidity was 77.4 per year. Conclusion: Medical complications, sepsis, and hemorrhage are the leading causes of maternal mortality, followed by hypertensive disorders. Mortality and morbidity rates were 22.9% and 3.9% respectively. All of these causes can be avoided with proper antenatal care facilitation. Keywords: Hemorrhage, Maternal mortality, Sepsis

To Determine the Frequency of Preterm Births in Abruptio Placentae in a Tertiary Care Hospital, in Urban City of Pakistan

Introduction: Abruption placenta is a serious condition in which a normally sited placenta detaches its attachment from the uterine wall, after 20 weeks of gestation and before the delivery. Abruptio placentae is associated with various complications. In this study, we will focus on frequency of preterm birth in patients with abruptio placentae. Material and Methods: This cross-sectional study was conducted at the department of Obstetrics and Gynecology Unit – I, Civil Hospital Karachi and Dow University of Health Sciences from January 2021 to December 2021. Three hundred and eighty four (384) patients with confirmed diagnosis of abruptio placentae were followed till delivery of their babies. Results: 154 (40.1%) participants had preterm delivery. Preterm delivery was significantly higher in participants with parity more than 3 (p value &lt; 0.0001). There was no difference in frequency of preterm based on age and status Conclusion: Preterm deliveries are very prevalent in pregnant women presenting with abruptio placentae. Booked participants who are at risk of abruptio placentae should be monitored more closely and they should be made aware of the possible complication of preterm delivery associated with abruptio placentae. Keywords: Abruptio placentae, preterm delivery, premature delivery, tertiary care, Pakistan