Perception of peer teaching on learning anatomy: A qualitative study.

The aim of this study was to identify the effectiveness of peer-assisted learning while giving presentation on assigned anatomy topics in class by medical students for enhancement of their learning and communication skills. Sixty top performing students were selected for the study. They were given assigned topics related to anatomy to be presented in the class after taking their consent. The duration of the study was 32 weeks. At the completion of the projects by the students, each of them was interviewed for three to five minutes; the questions were very precise and few in number and were then analysed. Focus group discussions were conducted from the rest of the class who were the audience and enjoyed the activity. The study showed that by conducting such an activity among medical students their knowledge about the subject, communication and teaching skills and confidence are enhanced. It is a fun activity for them and can be added in the routine timetable for its beneficial outcomes.

Gene expression of Interleukin-18 in rheumatoid arthritis patients on disease modifying anti-rheumatic drug therapy.

BACKGROUND & OBJECTIVES: The hallmark of rheumatoid arthritis is the inflammation that is mediated by the macrophages and monocytes that cause release of pro-inflammatory cytokines like interleukin-18. It is highly expressed in serum of patients suffering from rheumatoid arthritis and has a positive association with disease activity. The aim of this study was to analyze the gene expression of interleukin-18 in rheumatoid arthritis patients on disease modifying anti-rheumatic drug therapy. METHODS: The cross sectional comparative study is conducted at Department of Biochemistry and Molecular Biology and Center for Research in Experimental and Applied Medicine (CREAM-1Lab), Army Medical College, Rawalpindi, in collaboration with Rheumatology Department, Military Hospital, Rawalpindi. Study was conducted on two groups consisting of Group-I of rheumatoid arthritis patients on diseases modifying anti-rheumatic drugs and control Group-II comprising of normal healthy individuals. Non-probability purposive sampling was done from patients and controls. The duration of study was one year i-e from November 2015 to November 2016. Relative quantification of gene expression of interleukin-18 was done by Real time PCR using ∆∆CT method. RESULTS: Expression analysis for interleukin-18 showed down regulation of gene in rheumatoid arthritis patients as compared to controls. CONCLUSION: Interleukin-18 gene shows down regulation in rheumatoid arthritis patients on disease modifying anti-rheumatic drugs therapy.

Expression of Estrogen Receptors (ER), Progesterone Receptors (PR) and HER-2/neu receptors in Endometrial Carcinoma and their associations with histological types, grades and stages of the tumor.

OBJECTIVE: To study and detect immunohistochemical expression of Estrogen Receptors, Progestrone Receptors and HER-2/neu Receptors in Endometrial Carcinoma (EC) and to find their associations with histological types, grades and stages of the tumor. METHODS: A cross sectional study of one year duration from January 2016 to January 2017 was conducted at Histopathology department of Army Medical College, Rawalpindi. A non-probability purposive sampling technique was used to include 56 cases of EC. The specimens were tested for ER, PR and HER-2/neu expression using immunohistochemical analysis. Data was analyzed in SPSS and the significance of association of expression of the receptors with histological types, grades and stages of the tumor was assessed. RESULTS: Significant association of Her-2/neu overexpression with histological types and grades of EC was seen, whereas the association of ER and PR expression with histological types, grades and stage of EC was statistically insignificant. CONCLUSION: It is suggested that EC showing over expression of HER2/neu with immunohistochemistry may be treated with anti HER-2/neu treatment with better chances of survival and decreased post-treatment morbidity.

Standardization of the Arabic version of the Voice Handicap Index: an investigation of validity and reliability.

Validity and reliability of the Arabic version of the VHI (VHI-Arab) were investigated. Possible effects of participant-inherent factors (i.e. age, sex) on participant (77 females, 35 males) responses were also investigated. Results showed high internal consistency (Cronbach's alpha r > 0.857 for all scores). Test-retest reliability was found to be strong (r > 0.87 for all scores). Validity results indicated significant moderate correlations between total VHI score and responses to severity (r = 0.521, P = 0.015) and satisfaction (r = 20.556, P = 0.009) questions. VHI-Arab was found to be unaffected by age (P > 0.10 for all scores) or sex (P > 0.05). This study produced a valid and reliable instrument for measuring participation restriction in Arabic-speaking individuals with voice disorders.

Outcome of cervical disectomy and fusion with stabilization in single level cervical disc.

BACKGROUND: Cervical radiculopathy is a common and distressing problem. Only those patients who failed conservative treatment should undergo surgery. The anterior cervical disectomy is the procedure which offers maximal exposure of the disc space. It easily removes the portion of disc which compresses the nerve root. Possibility of developing late kyphosis from disc space collapse supported the fusion procedure after single level disectomy. The goal of instrumentation is to provide immediate stability, increase fusion rate, prevent graft failure, improve rehabilitation process and possibly no need for external orthosis. Objective of study was To see the results and complications of cervical disectomy thru anterior approach and fusion and stabilisation with titanium made plate. METHODS: This was a prospective study, comprised of 32 patients admitted during period from 2005-2008. Patients presented with radiculopathy or radiculo-myelopathy were evaluated. MRI was carried out in all the cases. Each patient was carefully evaluated to confirm clinico-radiological correlation and patients with significant disc and failure of conservative treatment were included in the study. RESULTS: Males were 28 (87.5%) and female were 4 (12.5%). Twenty patients (62.5%) were in fourth decade. C5-6 was involved in 18 (56.25%) patients. No significant postoperative complications noted. Persistent neck and back pain noted in patients in disectomy group without plating. CONCLUSION: Anterior cervical disectomy, fusion and stabilisation with plating is a safe and easy procedure in single level cervical disc disease without significant complications.

The performance of the time-frequency analysis software (TF32) in the acoustic analysis of the synthesized pathological voice.

The purpose of this study was to examine the algorithm-measuring capabilities used in the Time-Frequency Analysis Software Program for 32-bit Windows (TF32) for measuring fundamental frequency (F0), its dependent measures, and signal-to-noise ratio (SNR). The stability, accuracy, and linearity of its algorithm to systematic changes in aspiration noise and/or spectral slope (to mimic the perceptual characteristics of breathiness, roughness, and hoarseness) were evaluated using its analysis output to five female and five male synthesized voices. TF32 was used to calculate F0, Jitter%, Shimmer%, and SNR for each of the synthesized signals. The findings indicate that although TF32 produced stable results for male synthesized samples, they were not accurate when measuring F0, Jitter%, and Shimmer% with the addition of noise and variations in open quotient independently and in combination. In contrast, TF32 was neither stable nor accurate in making the same measurements for female synthesized samples. However, TF32 was stable and accurate in measuring SNR for male and most of female voices. These results point to an inappropriate F0 extraction algorithm in TF32 and stress the need for further research to remediate the algorithm or to identify a superior one.

Tutorial on maximum inspiratory and expiratory mouth pressures in individuals with idiopathic Parkinson disease (IPD) and the preliminary results of an expiratory muscle strength training program.

Respiratory symptoms are recognized as sequelae of motor dysfunction in idiopathic Parkinson's disease (IPD) and these symptoms have the potential to cause problems with swallow, cough, voice and speech. Specifically, maneuvers that require rapid activation and coordination of upper airway and chest wall musculature become progressively impaired as motor dysfunction progresses during the natural course of the disease. This study reports on the maximum inspiratory and expiratory pressures produced by 28 participants (average age 64) diagnosed with moderate to severe IPD (average stage 2.5 with a range of 2.0-3.0). All measures were collected during the "medication on" state. Outcomes of a specific respiratory muscle strength training technique for improving maximum expiratory pressure are reported for three of the patients in this study. Techniques that focus on strengthening the respiratory muscles in patients with IPD (other than with low load breathing exercises), have not been previously reported. The results of this pilot study demonstrate that respiratory muscle weakness may be an important factor in the respiratory complications in IPD and that respiratory muscle strength training has the potential to improve expiratory muscle strength for this population. This improvement has the potential to positively impact high forced respiratory activities, such as forced breathing maneuvers, swallow, cough and speech functions that require greater magnitude and duration of expiration.

Orthographic directionality and thematic role illustration in English and Arabic.

This study tested the hypotheses that people had a bias for drawing agents on the left of a picture when given a verb stimulus targeting an active or passive event (e.g., "kicked" or "is kicked") and that orthographic directionality would influence the way events were illustrated. Monolingual English speakers, who read and write left-to-right, and Arabic speakers, who read and write right-to-left, drew agents and patients in response to verb stimuli. We found no significant orthographic directionality effects and no preference for positioning agents on the left of pictures in either group or sentence type. Instead, participants drew agents on the right regardless of language or sentence type, and this was exaggerated in English speakers illustrating passive verbs. These findings support the existence of a preference for placing agents in the right hemispace that may result from asymmetrical hemispheric (i.e., left>right) activation induced by language processing. Our results are consistent with findings that people prefer pictures in which focus is on the right, a preference strongest in pictures with no implicit directionality of movement. This suggests that the methodology of the current study encouraged a static rather than dynamic interpretation of the verb in most participants.

Usefulness of needle biopsy in the diagnosis of paediatric liver disorders.

OBJECTIVE: To see the usefulness of liver biopsy in the diagnosis and to document the spectrum of paediatric liver diseases. METHODS: A retrospective, cross sectional survey at Histopathology Department of Army Medical College Rawalpindi from January 2000 to December 2003. The liver biopsies were taken with Menghini needle. The fixed tissues were processed under standard conditions. RESULTS: During four years period, a total of 100 cases with age range of 1.5 months to 16 years were studied. The most common histological findings in order of frequency were secondary haemochromatosis (30%), biliary atresia (20%), storage disorders (16%), cirrhosis of liver (10%) and neonatal hepatitis (10%). The less common entities were chronic hepatitis (6%), nonspecific reactive hepatitis (3%) and granulomatous hepatitis (1%). One case each of hepatoblastoma, haemophagocytic lymphohistiocytosis and congenital fibrosis was also noted. These findings have been compared with local and international histological studies. CONCLUSION: Liver biopsy is a useful diagnostic technique in the diagnosis of paediatric liver diseases. Biliary atresia, strorage disorders and neonatal hepatitis are the most common entities in our set up.

Respiratory muscle strength training: treatment and response duration in a patient with early idiopathic Parkinson's disease.

The outcome of a 20 week expiratory muscle strength training program (EMST) is documented in a patient with early idiopathic Parkinson's disease. A pressure threshold device was utilized and training occurred in the home setting. The training was intensive with a physiologically challenging load specific to the expiratory muscles, adjusted weekly based on the participant's performance. Results indicated that strength, as indexed by the generation of maximum expiratory pressure (MEP), increased by 50% in the first 4 weeks of training, consistent with the average strength increase obtained in previous research. Strength increases continued beyond the traditional 4 weeks of training with a final improvement in MEP of 158% from baseline over the 20 weeks. When the EMST was discontinued for a period of 4 weeks, the participant's MEP decreased by 16% from the 20 week endpoint measurement. The strength training pattern of the expiratory muscles observed in this study was similar to the pattern previously reported for limb muscles.

Morphological features correlation with serum tumour markers in prostatic carcinoma.

OBJECTIVE: To find out Gleason grades, scores and to see the correlation of these morphological features with tumour markers in prostatic carcinoma. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: The study was conducted at the Departments of Histopathology and Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, over a period of one year. MATERIALS AND METHODS: Fifty cases of prostatic carcinoma were studied. Gleason grades and score of tumour were determined by doing haematoxylin and eosin (HE) staining. Pre-operative serum prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA) assays were carried out in these cases. RESULTS: The patients seen were between 50-102 years of age with an average of 70.9 years. There were 49 cases of adenocarcinoma and 01 case of mixed adeno and transitional cell carcinoma of prostate. Twenty-eight (56%) patients had Gleason score of 5-7. Twenty-nine (58%) patients were having serum PSA levels between 10.0 ng/ml and 50.0 ng/ml. Thirteen (26%) cases showed PSA assays >50 ng/ml. The sensitivity of PSA test was 84 % in these cases. Thirty-five (70%) patients were having PAP values >3.7 U/l (sensitivity 70 %). CONCLUSION: The Gleason grading system is a specific morphological predictor. The serum PSA showed better sensitivity and specificity with Gleason grades and scores as compared to serum PAP. The serum PAP levels showed better correlation with morphological features as compared to serum PSA.