Artificial Intelligence - Perception of Clinical Laboratories' Technical Staff a Nationwide Multicentre Survey in Pakistan.

Introduction: As Artificial Intelligence (AI) technology continues to assimilate into various industries, there is a huge scope in the healthcare industry specifically in clinical laboratories. The perspective of the laboratory professionals can give valuable insight on the ideal path to take for AI implementation. Methods: The study utilized a cross-sectional survey design and was conducted at the section of Chemical Pathology, Department of Pathology and Laboratory Medicine, the Aga Khan University (AKU), Karachi, Pakistan in collaboration with Consultant Pathologists of 9 clinical laboratories associated with teaching hospitals across Pakistan from October-November 2023. The survey was for a duration of 2 weeks and was circulated to all working laboratory technical staff after informed consent. Results: A total of 351 responses were received, of which 342 (male=146, female=196) responses were recorded after exclusion. Respondents ranged from technologists, faculty, residents, and coordinators, and were from different sections (chemical pathology, microbiology, haematology, histopathology, POCT). Out of the total 312 (91.2%) of respondents stated that they were at least somewhat familiar with AI technology. Experts in AI were only 2.0% (n=7) of all respondents, but 90% (n=6) of these were < 30 years old. 76.3% (n=261) of the respondents felt the need to implement more AI technology in the laboratories, with time saving (26.1%) and improving performances of tests (17.7%) cited to be the greatest benefits of AI. Security concerns (n=144) and a fear of decreasing personal touch (n=143) were the main concerns of the respondents while the younger employees had an increased fear of losing their jobs. 76.3% were in favour of an increase in AI usage in the laboratories. Conclusion: This study highlights a favourable perspective among laboratory professionals, acknowledging the potential of AI to enhance both the efficiency and quality of laboratory practices. However, it underscores the importance of addressing their concerns in the thoughtful implementation of this emerging technology.

EFFECT OF NEBIVOLOL ON TONE OF TRACHEAL MUSCLE OF GUINEA PIG.

BACKGROUND: The use of ß-blockers is limited by adverse effects such as bronchospasm in asthmatics. Third generation ß-blockers such as nebivolol may show better tolerability in asthmatic subjects because they lack ß-blocker induced bronchoconstriction. Methods: Effects of nebivolol on the tracheal muscle strips prepared from ovalbumin-sensitised guinea pigs of both sexes were studied. Two sets of experiments were designed after dividing the animals randomly into two groups. Using oxygenated Krebs-Henseleit solution as the nutrient medium, the trachealis muscle activity was measured with isometric force displacement transducer and recorded on 4-channel Oscillograph. RESULT: Nebivolol 10(-6) M did not produce significant effect on contractions evoked by histamine in concentrations ranging from 10(-7) M to 10(-3) M. The mean of amplitude of contraction for different concentrations of histamine were calculated and compared with the group treated with histamine only. Mean of amplitude of contraction, percent responses and percent deviations when compared with the control group were insignificant (p>0.05). CONCLUSION: Nebivolol did not affect the tone of airway smooth muscle in ovalbumin-sensitised guinea pigs. Nebivolol may be considered safe in patients with airway disease however, further clinical evaluation and exploratory work is required.

Expression of osteopontin in patients with thyroid dysfunction.

Thyroid dysfunctions are common endocrine problems. They are often misdiagnosed, misunderstood, and frequently overlooked. These disorders affect almost every aspect of health. Most of them remain undetected because the clinical assessment alone lacks both sensitivity and specificity. As it is not sufficient enough we require the biochemical tests to confirm the diagnosis. As a consequence there is still great interest in new biomarkers that complement existing diagnostic tools. Osteopontin, a glycoprotein that can be detected in plasma, was found to be upregulated in several patients with hyperthyroidism and downregulated in hypothyroid patients so it may represent a new biomarker. 100 patients with thyroid dysfunctions (50 hyperthyroid, 50 hypothyroid) and 100 normal subjects were included in the study. Osteopontin and other clinical parameters for diagnosis of thyroid disorders were measured. Osteopontin is positively correlated with T3 and T4 (r = 0.62 and r = 0.75 respectively) while it is negatively correlated with thyroid stimulating hormone (r = -0.52) showing a significant correlation (p-value <0.001). Our findings suggest that osteopontin might be useful as a novel prognostic biomarker in patients with impaired thyroid function.

Role of nitric oxide in the effect of nebivolol on isolated tracheal muscle of guinea pig.

BACKGROUND: The use of beta blockers is limited by their ability to produce bronchospasm in asthmatics. Third generation beta-blockers like Nebivolol may show better tolerability because they may augment the release of nitric oxide (NO) from endothelial cells. However the involvement of NO in the respiratory effect of Nebivolol remains controversial. The present study, carried out on isolated tracheal muscle strips of guinea pigs, was designed to explore this controversy. METHOD: Varying concentration of histamine ranging from 10(-7) M to 10(-3) M were used to plot a concentration response curve on the isolated tracheal muscle strips of guinea pig and was used as a control. The same concentration response curve was plotted in presence of a fixed concentration of Nebivolol 10(-6) M and then again in presence of a fixed concentration of L-Nitro Arginine Methyl Ester (L-NAME) 10(-4) M and Nebivolol 10(-6) M together in a series of experiments using six sets of isolated tracheal muscle strips in each case. RESULTS: Nebivolol did not produce any significant shift in the concentration response curve while in the presence of L-NAME, Nebivolol shifted the histamine concentration response curve upwards and to the left. CONCLUSION: Nebivolol does not augment the histamine induced contraction of respiratory smooth muscle of guinea pig but in the presence of Nitric Oxide inhibitor L-NAME a significant augmentation of the same curve occurs, indicating a role of NO in the sparing of respiratory smooth muscle by Nebivolol.

In vitro response of tracheal smooth muscle from hyperresponsive guinea pigs to celiprolol.

BACKGROUND: The use of beta-blockers is limited by adverse effects such as bronchospasm in asthmatics. Third generation beta-blockers such as celiprolol may show better respiratory tolerability because they lack beta-blocker induced broncho-constriction. METHOD: Effect of celiprolol on the histamine induced contraction of tracheal muscle strips prepared from ovalbumin-sensitised guinea pigs was studied. Using oxygenated Krebs-Henseleit solution as the nutrient medium, the trachealis muscle activity was measured with isometric force displacement transducer and recorded on 4-channel Oscillograph. RESULT: Celiprolol 10(-4) M shifted the concentration-response curve of histamine downwards and to the right. Mean of amplitude of contraction, percent responses and deviations when compared with the control group were significantly different (p < 0.05). CONCLUSION: Celiprolol antagonised histamine-induced contractions of tracheal muscle of guinea pigs. So it may be considered safe in patients with asthma. However, further clinical evaluation and exploratory work is required.

Teaching strategies and academic performances of undergraduates in quaid-I-azam medical college, bahawalpur.

OBJECTIVE: to assess the outcomes and competencies of medical undergraduates regarding their learning abilities after introducing Clinical Presentation Curriculum (CPC) instead of Traditional Curriculum in Quaid-i-Azam Medical College, Bahawalpur. DESIGN: a cross-sectional comparative study. PLACE AND DURATION OF STUDY: 3rd and 4th year MBBS class during session 2004-2005 at Quaid-i-Azam Medical College (QMC), Bahawalpur. SUBJECTS AND METHODS: Five hundred students of 3rd year and 4th year MBBS who were taught for 176 and 172 hours respectively, appeared in 20 tests during session 2004-2005, were included in the study. Students were taught pathology according to Traditional Curricular model for 88 and 86 hours, respectively during college hours. Ten class tests each of 3rd and 4th year MBBS were taken and scores recorded. In the next step, the same group of students were taught in accordance with CPC model for 88 and 86 hours respectively in college hours. Ten class tests each were taken and scores recorded. A standardized questionnaire was given to all 500 students after finishing with each curricular model and then the results were compared on SPSS 8.0 regarding their study trends, thinking abilities, intellectual skills and liking of CPC. Chi-square test was used to get significance values and percentages were used for the evaluation of differences. RESULTS: This study detected the positive effects of CPC model not only on study trends and thought process but also had the beneficial effects on learning potential of students in QMC where traditional curriculum was being followed for teaching students. When compared with traditional curricula, CPC model significantly ( p =< 0.01) improved the learning methods to improve knowledge and intellectual skills e.g; group discussions, internet use, reading latest and relevant journals and visits to wards and concerned teachers. Academic performances of these students significantly (p =< 0.01) improved regarding their class test attendance, class room attendance and marks obtained in tests when compared with traditional curricula. Similarly, there was significant (p =< 0.01) increase in divergent thinkers. CONCLUSION: CPC, introduced in 3rd and 4th year MBBS of QMC, Bahawalpur, with traditional curriculum, significantly improved the academic performance, learning behaviour and intellectual skills of students.

Estrogen replacement therapy for depression in perimenopausal women.

OBJECTIVE: To determine the effect of a four-week course of oral estrogen therapy on depression in aging women. DESIGN: Quasi experimental. PLACE AND DURATION OF STUDY: The OPD, Bahawal Victoria Hospital, Bahawalpur, from September 2000 to January 2004. PATIENTS AND METHODS: Forty-two depressed women (aged 42-57) who were either perimenopausal (n = 20) or postmenopausal (n = 22) received open label treatment with oral estrogen tablets (1.25 mg/day) for 4 weeks. The Montgomery-Asberg Depression Rating Scale and the Beck Depression Inventory were used to assess depressive symptoms, the Greene Climacteric Scale was used to assess menopause-related symptoms, and the Clinical Global Impression(CGI) was used to assess global clinical improvement in these women at baseline and after treatment. Remission of depression was defined as a score < 10 on the Montgomery-Asberg Depression Rating Scale and a score < or = 2 on the CGI at week 4. RESULTS: The women who completed the study had a median Montgomery-Asberg Depression Rating Scale score of 20 (range = 15-32) at study entry and 11.50 (range = 10-31.0) at week 4 (z = -3.43, p < 0.01). This improvement was consistent with that reported by the women themselves on the Beck Depression Inventory (rs = 0.86, n = 20, p < 0.01). The improvement measured by CGI scores was also significant (p < 0.01). Remission of depression was noted in 5 of the 40 women (after 1 year) who completed the study. Anti-depressant response was not associated with severity or subtypes of depression at study entry or with concomitant improvement in menopause-related symptoms. CONCLUSION: Perimenopausal and postmenopausal women benefit from short-term use of estrogen therapy. Antidepressant effect of estrogen therapy is independent of improvement in menopause-related symptoms.

Effect of pregnancy on diabetic nephropathy and retinopathy.

OBJECTIVE: To determine whether pregnancy worsens renal function in women with diabetic nephropathy and the effect of pregnancy on diabetic retinopathy. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: The study was conducted in OPD, Bahawal Victoria Hospital, Bahawalpur from September 1997 to June 2003. SUBJECTS AND METHODS: Thirty-five patients (aged 20-36 years ) identified with diabetic nephropathy and moderate to severe renal dysfunction(creatinine [Cr] > 1.4 mg/dl) at pregnancy onset by retrospective chart review. Alterations in glomerular filtration rate (GFR) were estimated. An equal number of non-pregnant premenopausal type I diabetic women with similar degrees of renal dysfunction served as controls for non-pregnant rate of decline of renal function and potential contributing factors. Student's t-test and repeated measures analysis of variance were analyzed. RESULTS: Mean serum Cr rose from 1.8 mg/dl prepregnancy to 2.5 mg/dl in the third trimester. Renal function was stable in 27%, showed transient worsening in pregnancy in 27%, and demonstrated a permanent decline in 45%. Proteinuria increased in pregnancy in 79%. Exacerbation of hypertension or pre-eclampsia occurred in 73% and 71% of these showed acceleration of disease during the pregnancy. All the patients had diabetic retinopathy, though proliferative retinopathy was diagnosed and treated in only 54.5.% prepregnancy. The retinopathy progressed, requiring laser therapy, in 45.4%. Macular edema was noted in 6 of the patients. Other diabetic complications included peripheral and autonomic neuropathy in 8 patients. CONCLUSION: Pregnancy induced progression is seen in the decline of renal functions. Patients with diabetic nephropathy were found to have a > 40% chance of accelerated progression of their disease as a result of pregnancy. Forty-five percent of the patients had permanent decline in GFR in association with pregnancy.