Relationship between prostate-specific antigen, alkaline phosphatase levels, and time-to-tumor shrinkage: understanding the progression of prostate cancer in a longitudinal study.

BACKGROUND: This study delves into the complex interplay among prostate-specific antigen, alkaline phosphatase, and the temporal dynamics of tumor shrinkage in prostate cancer. By investigating the longitudinal trajectories and time-to-prostate cancer tumor shrinkage, we aim to untangle the intricate patterns of these biomarkers. This understanding is pivotal for gaining profound insights into the multifaceted aspects of prostate cancer progression. The joint model approach serves as a comprehensive framework, facilitating the elucidation of intricate interactions among these pivotal elements within the context of prostate cancer . METHODS: A new joint model under a shared parameters strategy is proposed for mixed bivariate longitudinal biomarkers and event time data, for obtaining accurate estimates in the presence of missing covariate data. The primary innovation of our model resides in its effective management of covariates with missing observations. Built upon established frameworks, our joint model extends its capabilities by integrating mixed longitudinal responses and accounting for missingness in covariates, thus confronting this particular challenge. We posit that these enhancements bolster the model's utility and dependability in real-world contexts characterized by prevalent missing data. The main objective of this research is to provide a model-based approach to get full information from prostate cancer data collected with patients' baseline characteristics ( Age , body mass index ( BMI ), GleasonScore , Grade , and Drug ) and two longitudinal endogenous covariates ( Platelets and Bilirubin ). RESULTS: The results reveal a clear association between prostate-specific antigen and alkaline phosphatase biomarkers in the context of time-to-prostate cancer tumor shrinkage. This underscores the interconnected dynamics of these key indicators in gauging disease progression. CONCLUSIONS: The analysis of the prostate cancer dataset, incorporating a joint evaluation of mixed longitudinal prostate-specific antigen and alkaline phosphatase biomarkers alongside tumor status, has provided valuable insights into disease progression. The results demonstrate the effectiveness of the proposed joint model, as evidenced by accurate estimates. The shared variables associated with both longitudinal biomarkers and event times consistently deviate from zero, highlighting the robustness and reliability of the model in capturing the complex dynamics of prostate cancer progression. This approach holds promise for enhancing our understanding and predictive capabilities in the clinical assessment of prostate cancer.

Effects of informal learner handover in clinical dental education.

BACKGROUND: It is currently under discussion whether Learner Handovers (LH) are beneficial, disadvantageous, or useful in Health Professions Education. Research has not been conducted to determine the extent of existing informal learner handover (ILH) through faculty discussions. In addition to providing stakeholders with added context, examining the nature of ILH may also provide insight into the bias associated with Learner Handover. METHODS: Transcripts from a series of semi-structured Focus Group Discussions (FGDs) and interviews (from January to March 2022) were iteratively reviewed to identify relevant patterns and correlations. The study involved the voluntary participation of 16 active clinical dental faculty members with a variety of designations. We did not discard any opinions. RESULTS: It was found that ILH had a mild impact on students' training. ILH effects can be categorized into four key areas: (1) faculty behavior with students, (2) faculty expectations from students, 3) teaching approach, and 4) faculty feedback practices. Furthermore, five additional factors were identified as having a greater influence on ILH practices. CONCLUSIONS: In clinical dental training, ILH has a minor effect on faculty-student interactions. Faculty perceptions and ILH are strongly influenced by other factors contributing to the student's 'academic reputation. As a result, student-faculty interactions are never free of prior influences, so stakeholders need to take them into consideration when creating a formal LH.

Emotional regulation strategies (ER) used by trainees to overcome negative emotions.

OBJECTIVE: To identify the use of different emotion regulation strategies by medical trainees, and to determine the frequency and the predominant pattern of emotional response in emotion-triggering situations. METHODS: The descriptive cross-sectional study was conducted at 2 public and 1 private medical college in Lahore, Pakistan, from March to September 2019, and comprised postgraduate medical trainees of either gender from all clinical disciplines from years 1-4. Data was collected using a questionnaire based on the Gross theory of emotional regulation and the Situational model of emotion. Emotion regulation strategies included situation selection, situation modification, cognitive change, attention deployment, and response modulation. Data was analysed using SPSS 25.. RESULTS: Of the 377 trainees approached, 308(81.69%) participated; 206(67%) females and 102(33%) males. The overall mean age was 27.8 ± 2.91 years. The majority of the trainees were from the Obstetrics and Gynaecology department 133(43.2%) and were in the first year of their training 116(37.7%). The most frequent emotiontriggering situation identified was prolonged working hours 292(95%), and the major emotional response was quietness in 5 out of ten situations (50%). The trainees used greater emotion regulation strategies in sad situations 3.49±1.79 (p<0.01). Trainees managed sad emotions by keeping themselves involved in other activities 152 (49%); in anger, they blamed others 124(40.3%); in fear, they opted for suppression of emotions 71(22.7%); in disgust, they preferred avoidance 90(29.2%); and in shock, acceptance was a common strategy 21(12.7%). CONCLUSIONS: Postgraduate medical trainees struggled to manage emotions and used maladaptive strategies.

Enriching operating room based student learning experience: exploration of factors and development of curricular guidelines.

BACKGROUND: Operating Room (OR) is a high-pressure setting where multiple complex surgical, educational, and administrative facets interplay. Contrary to resident training, the dynamics of undergraduate medical students' learning process is highly demanding, opportunistic, unstandardized, and suboptimal owing to many reasons. Upon reviewing the existing published literature regarding the medical students' experience in the OR setting, it was clear that this field is still to date, unstructured, and ambiguous, with many grey areas that need to be worked on. To achieve an optimized and enhanced theatre experience, it is of immense importance to recognize the recurrent themes affecting medical students within this setting and deduce ways to overcome these challenges. This study explores and prioritizes factors influencing OR-based student learning quality and develops guidelines for structured clinical encounters within the OR setting. METHODS: The study involved an extensive literature review and thematic analysis to generate themes and subthemes, which were subjected to a modified Delphi technique where students and teachers participated to identify, debate, and produce a consensus on the relative value of these factors. Finally, expert-validated guidelines were developed for OR curricular designs. RESULTS: Operating theater-based student learning is multifactorial. Structured learning through optimized course planning, content selection, assessment, and administration are decisive in determining the quality of OR learning experience. The teacher's interest, attitude, and students' desire and preparedness to learn play a central role in OR-based student learning, suggesting an enhanced need for adequate faculty training. Similarly, emotional, socio-environmental, and organizational factors can influence students' learning in a significant way. A new model for undergraduate student learning in OR has been proposed based on these factors and the stakeholders' interplay. In this model, the teacher's role is responsible despite OR learning being student- led. Guidelines for the OR curricular designs have been developed. CONCLUSION: Structured learning process within the OR setting can lead to optimized lesson planning, content selection, assessment, and administration for a more meaningful and enriched OR learning experience.

Exploiting the power of Gamification in Journal club.

OBJECTIVE: To compare the effect of individual versus team competition gamification on trainees' engagement in journal club. METHODS: The quasi-experimental study was conducted at two tertiary care hospitals in Lahore, Pakistan, from December, 2019 to May, 2020, and comprised all plastic surgery residents in training years 3-5 who had attended non-gamified journal club sessions. They were divided into two groups. Initially, two journal club sessions were run in a gamified manner. Group 1had an individual competition whereas group 2 had a team competition. In the second phase, the group orientation was reversed. Engagement scores were measured using the student engagement survey tool at baseline, at the completion of the first part, and at end of the intervention. Data was analysed using SPSS 22. RESULTS: Of the 44 participants, 23(52.3%) were in group 1 and 21(47.7%) in group 2. Overall, there were 27(61%) females and 17(39%) males. The mean age of the sample was 31±2 years. Gamification resulted in significant increase in the level of residents' engagement in journal club activities compared to the baseline scores(p<0.05). There was no significant inter-group difference in the post-intervention engagement scores (p>0.05). CONCLUSIONS: Gamification designs used in the journal club activity increased student engagement level compared to the pre-intervention score, but gamification design was not a significant factor in this regard.

Know thyself: Development and validation of self-awareness of teaching skills (SATS) measuring instrument for medical teachers.

BACKGROUND: Self-awareness is measured previously in the higher education however not specifically in relation to 'effectiveness of teaching' thus leaving a gap in the literature. AIM: To develop and validate an instrument for medical teachers to measure the self-awareness of their teaching. METHODS: This was an instrument development multiphase mixed-method study design, based on Brookfield's four lenses theory. The instrument was validated after administering content validity, cognitive pretesting, confirmatory factor analysis and reliability analysis. Contrasting groups' method of standard setting was used to determine the cut-off scores for the levels of self-awareness of medical teachers. RESULTS: A 26-item preliminary draft instrument was reduced to a 19-item final instrument having four themes, that is; self-reflection, communication with students, student feedback, and peer review. Content Validity Scale was 0.92. Confirmatory factor analysis yielded a model with a good-to-excellent fit and an internal consistency of 0.85. The cut-off values were calculated to be 79%, 70%, 59%, and 53% for excellent, good, average and poor self-awareness of teaching skills respectively. CONCLUSION: The Self-awareness of the teaching skills instrument has excellent validity and good reliability in measuring the self-awareness of teaching skills of medical teachers.

A Comparative Evaluation of Efficacy of Various Obturating Techniques for the Presence of Voids.

Aim: Evaluation of the efficacy of different obturating techniques and assessment of the presence of voids in different regions of the canal. Materials and Methods: Sixty permanent single-rooted teeth with complete, mature root apices without any anatomic variation having straight patent root canals were included in the present study. Access cavity preparation followed by biomechanical preparation was done. Samples were divided into three groups-Group A: Single cone obturation, Group B: GuttaFlow 2, and Group C: GuttaCore, and obturation was carried out. The samples after obturation were stored at 370°C and 100% humidity in an incubator for 7 days to give adequate time for obturating materials to set. Cone beam computed tomography was performed with i-cat Cb 500 machine. The voids were checked on the root canal wall. The statistical analysis was done and the data after the statistical analysis was presented. Result: GuttaCore obturators presented a lesser volume of voids followed by GuttaFlow 2 than the single cone techniques. Conclusion: All the obturation techniques presented an inadequacy of obturation when the pre- and post-obturated volume of the root canal space was calculated. However, no statistically significant obturated volume differences were found between single cone and GuttaFlow 2 or between GuttaFlow 2 and GuttaCore system.

Evaluation of Different Techniques of Working Length Determination in Comparison with CBCT.

AIM: To estimate the working length of teeth using conventional tactile technique, radiovisiography technique, Apex locator, and confirmation of working length by cone beam computed tomography technique. MATERIALS AND METHODS: Forty patients with the age group between 20 and 50 years with irreversible pulpitis were included in this study. After taking a preoperative radiograph, the procedure was started. The cavity wall buildup was done using composite in the cases needed and then rubber dam application was done. The working length of mesiobuccal and mesiolingual canal was taken using cone beam computed tomography and this was considered as the standard value. Then using tactile method, length of the canal was measured using radiovisiographic software followed by apexlocator. RESULT: The Apex locator has showed best result as compared to tactile and radiovisiography. CONCLUSION: Apex locator values were closest to cone beam computed tomography working length measurement values and electronic apexlocator can be used efficiently as an alternative method for working length determination. The quality of various techniques according to ranks of working length determination was found to be Cone beam computed tomography (CBCT) > Apexloc > Radiovisiography (RVG) > Tactile. Thus, Apex locator can be used as an alternative to cone beam computed tomography for working length determination.

Facemask Therapy in Unilateral Cleft Lip and Palate Patients.

BACKGROUND: Midfacial hypoplasia is a common feature in patients with combined cleft lip and palate. The current study was done to assess the effect of facemask (FM) therapy in patients with unilateral cleft palate. MATERIALS AND METHODS: A total of 16 patients with unilateral complete cleft lip and palate were treated with maxillary transversal discrepancy with rapid maxillary expansion (RME) followed by FM therapy. After the completion of the RME treatment, the same appliance was used for protraction. Radiographs were taken after removing the RME appliance (T1) and at the end of the FM treatment after removing the appliance (T2). RESULTS: There were 5 males and 11 females. SNA was 73.1° and 79.4°, SNB was 75.2° and 72.4°, ANB was -3.21° and 2.90°, SN-PP was 11.2° and 10.4°, Co-A was 84.3 mm and 87.5 mm, A-HR was 55.2 mm and 57.8 mm, A-VR was 62.4 mm and 64.7 mm, and SN-MP was 38.2 mm and 41.5 mm before and after treatment, respectively. CONCLUSION: FM proved to be beneficial in causing significant improvement in patients having combined cleft lip and palate.

Root Resorption of Endodontically Treated Teeth Following Orthodontic Treatment: A Cross-Sectional Study.

BACKGROUND: Root resorption is an unwanted phenomenon occurring in a substantial population proportion these days. Hence, the current study was conducted to evaluate root resorption in endodontically treated teeth following fixed orthodontic treatment. MATERIALS AND METHODS: A total of 100 patients were enrolled. Only those patients were enrolled that were scheduled to undergo fixed orthodontic therapy. Pretreatment examination was done in all the patients, and their radiographs were obtained. Both orthopantomograms and peri-apical radiographs were taken. All the patients were recalled on follow-up, and radiographic examination was again carried out. Pretreatment radiographs and follow-up radiographs were compared. The incidence of root resorption was documented. The data were entered in an Excel sheet (Microsoft office version 2007) and analyzed using IBM SPSS software version 20. RESULTS: Root resorption was present in 30 patients. Among these 30 patients, 20 were male, whereas 10 were female. In 19 patients, root resorption was present in the maxillary arch, whereas in 11 patients, it was seen in the mandibular arch. The most common tooth involved with root resorption was premolars, followed by anteriors and molars. CONCLUSION: The risk of root resorption is higher in endodontically treated teeth under the influence of orthodontic forces.

Prevalence of extended-spectrum-ß-lactamase-producing Enterobacteriaceae: first systematic meta-analysis report from Pakistan.

Background: South-Asia is known as a hub for multidrug-resistant (MDR) bacteria. Unfortunately, proper surveillance and documentation of MDR pathogens is lacking in Pakistan. The alarming increase in the prevalence of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae is a serious problem. From this perspective, we analysed published data regarding ESBL-producing Enterobacteriaceae in different regions of Pakistan. Methods: A meta-analysis was performed to determine the prevalence of ESBL-producing Enterobacteriaceae in Pakistan. A Web-based search was conducted in electronic databases, including PubMed, Scopus and PakMedi Net (for non-indexed Pakistani journals). Articles published (in either indexed or non-indexed journals) between January 2002 and July 2016 were included in the study. Relevant data were extracted, and statistical analysis was performed using the Metaprop command of STATA version 14.1. Results: A total of 68 studies were identified from the electronic data base search, and 55 of these studies met our inclusion criteria. Pakistan's overall pooled proportion of ESBL-producers was 0.40 (95% CI: 0.34-0.47). The overall heterogeneity was significant (I2 = 99.75%, p < 0.001), and significant ES = 0 (Z = 18.41, p < 0.001) was found. OXA, SHV, TEM and CTX-M were the most commonly found gene variants for ESBLs in these studies. Conclusion: The prevalence of ESBL-producing Enterobacteriaceae is high in Pakistan. Little is known about the annual frequency of ESBLs and their prevalence in different provinces of Pakistan. No data are available regarding ESBL frequency in Baluchistan. This underscores an urgent demand for regular surveillance to address this antimicrobial resistance problem. Surveillance to better understand the annual ESBL burden is crucial to improve national and regional guidelines.