Development and Psychometric Evaluation of Bilingual English-Urdu Pakistani Critical Thinking Disposition Scale.

Objective: To develop and test the psychometric properties of the Pakistani Critical Thinking Dispositions Scale. Methods: In the item generation phase, constructs of the scale were identified through an in-depth literature review and items were written to measure the constructs. Following this, input of the experts was obtained for content validity index. In the item reduction phase, psychometric properties were measured. Initially, the scale was administered to 580 study participants during May 2018-2020 after approval from the institutional review board. Data was analyzed through SPSS v21, AMOS v21 and Omega extension. Results: First phase identified 54-items for seven constructs including contextual perspective, perseverance, reflection, intellectual integrity, creativity, open-mindedness, and inquisitiveness. Second phase determined KMO test value of 0.974 and Bartlett's test (P-Value < 0.001). The second-order confirmatory factor analysis showed a good fit model explaining 73.37% total variance. Parsimony and baseline comparison indices were favorable. Alpha and Omega value of 42-items was 0.869. Conclusion: Pakistani Critical Thinking Dispositions scale owning seven constructs and 42-items is valid, reliable, and feasible to use in undergraduate nursing education. However, its utilization in other healthcare disciplines can be tested.

Comparison Of Free Androgen Index In Polycystic Ovary Syndrome And Non-Polycystic Ovary Syndrome Infertile Patients.

BACKGROUND: One of the leading causes of infertility in child bearing age females is polycystic ovary syndrome. It is characterized by altered hormonal profile causing androgen excess and insulin resistance which eventually leads to decreased ovulation rate. METHODS: This was a crosssectional study that included 40 polycystic ovary syndrome (PCOS) patients and 40 infertility patients that did not have polycystic ovary syndrome determined by sonography and clinical features through quota sampling technique. Serum Total Testosterone and Sex Hormone Binding Globulin Levels were assayed. Using these two parameters, Free Androgen Index was calculated. Body Mass Index and central obesity was also determined. RESULTS: Total Testosterone, Free Androgen Index and Body Mass Index were raised in PCOS group as indicated by p-value <0.05. Hirsutism was present in PCOS group (p-value <0.05). Sex Hormone Binding Globulin Levels were decreased in PCOS patients (p-value <0.05) but were within the lower half of normal range. CONCLUSIONS: Levels of Sex Hormone Binding Globulin were decreased in PCOS cases and Free Androgen Index can help in better determining hyperandrogenaemia than total testosterone alone.

Frequency and genotype distribution of high risk human papillomavirus in esophageal squamous cell carcinoma.

INTRODUCTION: Esophageal squamous cell carcinoma (ESCC) is a dismal disease exhibiting striking geographical differences in its incidence. It is multifactorial in origin. Among infectious agents, human papillomavirus (HPV) was introduced as a possible causative agent in the development of ESCC in 1982. Subsequent studies using various methods have confirmed the presence of HPV in ESCC. We aimed to determine the frequency of HPV in ESCC in northwest Pakistan which is part of high risk belt for this disease. METHODOLOGY: This study was conducted on two hundred and forty-three (243) diagnosed cases of ESSC at two tertiary care hospitals of Peshawar, Pakistan, from 2011 to 2016. DNA was extracted from all specimens. Polymerase chain reaction (PCR) was used to check the quality of DNA using ß-globin primers and frequency and genotypes of HPV using HPV general primers and type-specific primers respectively. HPV and its genotypes were confirmed through the sequencing of a few selected cases. RESULTS: Two hundred and three (203) tissue specimens had adequate DNA and were further analyzed. HPV positivity with general primers alone was 15.7% (32/203). Using HPV general primers and type-specific primers (HPV 16 or HPV 18), the overall positivity of HPV was 31% (63/203). For type-specific primers, frequency of HPV types 16 and 18 was 20.19% (41) and 7.8% (16) respectively where 6 cases were positive for both HPV 16 and 18. CONCLUSIONS: The overall high prevalence of HPV indicates it as a possible risk factor for ESSC.

Assessment of Tumor Angiogenesis by Expression of CD 105 in Ameloblastoma, Odontogenic Keratocyst and Central Giant Cell Lesion.

BACKGROUND: Angiogenesis is critical for tumor growth and reflects the aggressive behavior of invasive odontogenic lesions [like Ameloblastoma (AM), Odontogenic Keratocyst (OKC) and Central giant cell lesion (CGCL)]. Mean vascular density (MVD) shows the angiogenic potential and CD105 is an ideal endothelial biomarker due to its specificity to new blood vessels for MVD detection. The aim of the study was to compare the MVD (angiogenic potential) among AM, OKC and CGCL in comparison to Pyogenic Granuloma (PG) using CD105 biomarker. METHODS: Sixty-four primary cases of odontogenic invasive tumors (AM, OKC and CGCL) and PG, diagnosed clinically and histologically were included in the study, with 16 samples in each group. Tissue samples of peripheral AM, Peripheral GCL of jaws, malignant AM, and specimen with insufficient tissue were excluded. Tissue sections were embedded, processed and stained using Hematoxylin and Eosin (H and E). Immunohistochemistry was performed using antibodies against CD105, with positive brown cytoplasmic staining in the endothelial cells of neo-vasculature. Distinct countable, positively stained endothelial cell or clusters were evaluated under light microscope for identification of MVD. ANOVA and t-test were applied for statistical analysis of data. RESULTS: Highest MVD was displayed in CGCL (32.99±0.77) and the minimum was observed in OKC (7.21± 0.75) respectively. CGCL showed significantly higher MVD to AM, OKC and PG lesions (p <0.05). AM (8.07± 0.36) and Odontogenic Keratocyst (7.21± 0.75) showed comparable MVD, which was lower than PG (14.7± 0.96) and CGCL vascular density (p < 0.01) respectively. CONCLUSION: CGCL was most aggressive, with highest MVD among the investigated odontogenic lesions (OKC, AM and PG). The proliferative aggressive behavior of Odontogenic Keratocyst is comparable to AM due to comparable mean vascular density.
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Natural Language Input: Maternal Education, Socioeconomic Deprivation, and Language Outcomes in Typically Developing Children.

Purpose The current study was designed to investigate the differences in language input related to family factors (maternal level of education [MLE] and socioeconomic level of deprivation [SLD]) and their association with language outcomes in preschoolers. Method This study used New Zealand SLD and MLE classification systems to examine differences in language input related to these factors among 20 typically developing preschool children aged 2-5 years. The quantity of children's language input (adult words [AWs], conversational turns [CTs]) was calculated using the Language ENvironment Analysis audiotaping technology for two typical weekend days. Four 5-min Language ENvironment Analysis recording segments were transcribed and coded, and parental language strategies were classified as optimal language strategy, moderate language strategy, or sub-optimal language strategy (S-OLS) for child language outcomes. The receptive and expressive language of each child was assessed using the Preschool Language Scales-Fifth Edition. Results Mann-Whitney U tests showed significant differences between the quantity of language input (AWs/hr, CTs/hr) for high and low MLE and high and low SLD groups. Consistent with the literature, the use of S-OLSs was significantly lower for families with high MLE (Mdn = .25, IQR = .14) and low SLD (Mdn = .22, IQR = .13) than for families with low MLE (Mdn = .41, IQR = .24) and high SLD (Mdn = .41, IQR = .26). Spearman correlation coefficients indicated significant associations between language input (AWs/hr, CTs/hr, S-OLSs) and language outcomes. Conclusions Reduced language input and the frequent use of S-OLSs associated with low maternal education and high deprivation and low language outcomes for these children highlight the importance for all parents/families to learn optimal language strategies to support the development of strong language skills in their children in young age.

Luteinizing Hormone To Follicle Stimulating Hormone Ratio In Patients With Polycystic Ovary Syndrome.

BACKGROUND: Polycystic ovary syndrome is the most commonly occurring endocrinopathy in females of reproductive age group. It is characterized by a wide range of signs and symptoms resulting from hormonal derangements leading to reduced fertility. METHODS: This was a crosssectional (comparative) study. We took 40 cases of polycystic ovary syndrome and 40 controls of infertility without polycystic ovary syndrome depending on the presence of clinical features and ultrasound scans. Blood samples were collected and assayed for luteinizing hormone and follicle stimulating hormone. Data was analyzed with SPSS-19. RESULTS: Luteinizing hormone to follicle stimulating hormone ratio was raised in 3 out of 35 patients (8%) in cases and in 2 out of 39 patients (5%) in controls. There was no statistically significant difference in the luteinizing hormone levels and the follicle stimulating hormone levels and the luteinizing hormone to follicle stimulating hormone ratio of the two groups as indicated by a p-value> 0.05. CONCLUSIONS: Luteinizing hormone to follicle stimulating hormone ratio was not found to be raised in majority of the polycystic ovary syndrome patients included in this study.

Dataset on the calculations of daily adult word and conversational turn counts, and use of styles of oral interaction in 2-5-year olds with hearing loss in New Zealand.

This article describes the data regarding the calculations of language input from the natural language environments of children with hearing loss, taken from four full typical days in a week using a LENA (Language ENvironment Analysis) digital recorder. Calculations were based on 14 children with hearing loss from 24 to 60 months as they interacted with their family. Participants were recruited from the Hearing House, the Speech Clinic at the University of Auckland, and Early Childcare Centers (ECC) in Auckland, New Zealand. All families were interacting with their children orally without using sign language. Data were collected from natural language environments from May 2018 to May 2019. Language environments were examined in terms of daily quantity of language input and styles of oral interaction children were exposed to when interacting with their parent/primary caregiver. To determine quantity of language input, two kinds of observations were taken from the LENA automatic calculation of the number of adult words and number of conversational turns. Segments of the recordings were manually transcribed and coded onto 17 styles of oral interaction, which were further classified into three categories (optimal, moderate, and sub-optimal).

Investigation of anti-inflammatory and analgesic activities of camel milk in animal models.

Opioids and non-opioids have long been used as analgesic, anti-inflammatory and antipyretic. Long-term use of these drugs may lead to severe toxicities. Therefore natural remedies are now being explored to avoid risk of adverse effects associated with the use of these conventional medicines. Bioactive components from milk of different species have been identified as nutraceuticals, but no experimental or clinical study is conducted so far to explore the analgesic and anti-inflammatory potential of camel milk. In this study we evaluated camel milk for its possible analgesic and antiinflammatory activity. The anti-inflammatory effects of camel milk was studied in rats using paw edema method (induced by acetic acid) while tail-flick method was used to evaluate its analgesic effect in mice. Significantly increased tail-flick latency was shown after camel milk (33ml/kg) treatment when compared with acetylsalicylic acid at all time intervals. Anti-inflammatory activity of camel milk was significant (p<0.001) at 4th hour of treatment as shown by maximum percentage inhibition in edema volume (46.84%) in comparison to control. Results of our present study suggested possible use of camel milk as adjuvant therapy in treating various chronic pain and inflammatory ailments. Camel milk could further be investigated in future for recognition of biochemical constituents responsible for its antiinflammatory and pain relieving activities.

Analysis of Amount and Style of Oral Interaction Related to Language Outcomes in Children With Hearing Loss: A Systematic Review (2006-2016).

Purpose This systematic review summarizes the evidence for differences in the amount of language input between children with and without hearing loss (HL). Of interest to this review is evaluating the associations between language input and language outcomes (receptive and expressive) in children with HL in order to enhance insight regarding what oral language input is associated with good communication outcomes. Method A systematic review was conducted using keywords in 3 electronic databases: Scopus, PubMed, and Google Scholar. Keywords were related to language input, language outcomes, and HL. Titles and abstracts were screened independently, and full-text manuscripts meeting inclusion criteria were extracted. An appraisal checklist was used to evaluate the methodological quality of studies as poor, good, or excellent. Results After removing duplicates, 1,545 study results were extracted, with 27 eligible for full-text review. After the appraisal, 8 studies were included in this systematic review. Differences in the amount of language input between children with and without HL were noted. Conversational exchanges, open-ended questions, expansions, recast, and parallel talk were positively associated with stronger receptive and expressive language scores. The quality of evidence was not assessed as excellent for any of the included studies. Conclusions This systematic review reveals low-level evidence from 8 studies that specific language inputs (amount and style) are optimal for oral language outcomes in children with HL. Limitations were identified as sample selection bias, lack of information on control of confounders and assessment protocols, and limited duration of observation/recordings. Future research should address these limitations.

Ischaemic stroke and peripheral artery disease.

OBJECTIVE: To determine the frequency of atherosclerosis by ankle brachial index in patients with an ischaemic stroke and to assess the association of carotid artery stenosis and ankle brachial index in ischaemic stroke. METHODS: This cross-sectional study was conducted at Abbasi Shaheed Hospital, Karachi, from July 2011 to May 2014, and comprised patients with ischaemic stroke. The patients were classified according to the Asian stroke criteria for classification of brain infarction. Primary outcome measures included carotid artery stenosis and ankle brachial index. The other independent variables were age, gender, body mass index and waist circumference. SPSS 20 was used for data analysis. RESULTS: A total of 327 patients were enrolled. The overall mean age was 57.6±12.8 years. Besides, 168(51.3%) participants were males. Peripheral artery disease was found in 60(18.3%) patients. Mild carotid artery stenosis was found in 182(55.6%) patients, moderate in 140(42.8%), severe in 3(0.9%) and complete occlusion in 2(0.6%) patients. In patients having mild carotid artery stenosis, 32(17.5%) had peripheral artery disease, whereas in patients with moderate carotid artery stenosis, 25(17.8%) had peripheral artery disease. CONCLUSIONS: Abnormally low ankle brachial index suggesting subclinical peripheral artery disease was 18%.

Evaluation of anxiolytic-like activity of Vitis vinifera juice in mice.

OBJECTIVE: Scientific studies have shown that Vitis vinifera (V. vinifera) contains flavonoids and stillbenoids. Flavonoids are well known to possess anxiolytic activities. In view of the idea that flavonoids present in V. vinifera could be useful in anxiety, we evaluated anxiolytic-like activity of V. vinifera juice (VVJ). MATERIALS AND METHODS: Light/dark box and the open field test were used to assess the anxiolytic potential of V. vinifera juice (VVJ). The juice was given orally by gavage at the dose of 4 and 8 mL/kg body weight. Diazepam (1 mg/kg i.p.) was used as the standard drug. RESULTS: It was observed that the juice produced significant and dose dependent increase in the time spent in light cubicle (p<0.001), transfer latency from the light to dark cubicle (p<0.001) and the number of transitions between the two cubicles (p<0.001) as compared with the control group. V. vinifera also demonstrated significant and dose dependent increase in ambulation (P<0.001) and rearing (p<0.001) in open field test as compared to the control group. CONCLUSION: In conclusion, the present study establishes the anxiolytic-like activity of VVJ in animal models of anxiety.

Primary cervical hydatid cyst: a rare occurrence.

Hydatid disease, a parasitic infection is caused by Echinococcus granulosus. It has serious impact on health and economy especially in countries where it is endemic. It occurs frequently in liver and lung. The disease is chronic and cyst can localize in different organs. A hydatid cyst occurrence in the head and neck is extremely rare. To know the distribution of disease can help in its control and prevention. We report a case of primary cervical hydatid cyst in 20 year old female. A high index of suspicion is required to diagnose hydatid cyst in rare locations like this. Hydatid cyst should be considered in differential diagnosis of benign swellings of head and neck region, so that it can be managed during surgery to prevent acute anaphylaxis. VIRTUAL SLIDES: The virtual slides' for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4915595218376646.

The prevalence and clinical profile of angiographic coronary ectasia.

OBJECTIVE: To determine the incidence of Coronary Artery Ectasia (CAE) at our teaching hospital to describe the patients and angiographic characteristics. METHODS: A retrospective analysis was conducted on all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases, a tertiary care center, between the period of August 2006 and August 2008. A one year follow up was performed to look for primary and secondary endpoints. Data were collected from catheterization films, and medical records. RESULTS: Five thousand coronary angiograms were performed during the periof of the study. A total of 140 (2.8%) angiograms showed coronary ectasia of both mixed and pure types. Pure ectasia with no coronary obstructive lesions was seen in 75 (1.5%). The left anterior descending artery (LAD) was the most commonly affected vessel (63%) followed by the right coronary artery (RCA) 25% and 10% patients had circumflex artery involvement. The primary composite endpoint showed 6 (4.2%) patients with non-ST elevation MI, 5 (3.6%) with ST elevation inferior wall myocardial infarction, 70 (50%) with unstable angina and 2 (1.4%) deaths due to pulmonary oedema. Secondary endpoints showed 50% of the patients still complaining of chest pain. CONCLUSION: Prevalence of Coronary ectasia in the population presenting to KIHD during the study period was 1.5%. Majority of patients were males, associated with dyslipidaemia, hypertension and smoking. CAE was associated with obstructive coronary artery disease in about 80% of cases. LAD was the most commonly affected vessel.

Percutaneous coronary intervention for chronic total coronary occlusion in patients at Karachi Institute of Heart Diseases.

OBJECTIVE: To evaluate the successful revascularization in chronic total coronary occlusion lesions and to examine the relationship between lesion characteristics and procedural success and the frequency of in-hospital major adverse cardiac events after percutaneous coronary intervention in these patients. METHODS: All patients subjected to percutaneous coronary intervention from 2006 to 2008 were identified. These patients had unstable angina ranging from 2 weeks to more than 3 months duration, and majority was subjected to stent implantation. RESULTS: A total of 110 consecutive patients were studied. They had been treated for chronic total coronary occlusion lesions during this period. There were 76 males and 34 females. Drug eluting stents (DES) were used in 84 patients whereas 26 received Bare metal stents (BMS). Successful revascularization was achieved in 103 lesions (94%). Only 6% patients showed unsuccessful results due to failure of the wire to cross the lesion. There was no recorded death during the procedure. CONCLUSION: Due to latest guide wire technology, procedural techniques and operator experience, our study showed more than 90% success in percutaneous revascularization of chronic total coronary occlusion lesions, with an excellent survival rate .

Door to needle time of streptokinase and ST segment resolution assessing the efficacy of reperfusion therapy at Karachi Institute of Heart Diseases.

BACKGROUND: Early start of treatment including coronary revascularisation has been recognised as crucial variable in the outcome of acute ST-segment Elevation Myocardial Infarction (STEMI). Objectives of the study were to determine the magnitude of ST-segment resolution after thrombolytic therapy predicts short- and long-term outcomes in patients with an Acute Myocardial Infarction (AMI). METHODS: The duration of quasi experimental study was 3 years, from July 2006 to June 2009, conducted at Karachi Institute of Heart Diseases. Total 1,023 patients of STEMI treated with streptokinase (SK) were enrolled in the study. RESULT: Of the total 1023, 689 (67.3%) patients were males and 334 (32.6%) were females. Six hundred and twenty-nine (61.5%) were successfully resolved after thrombolytic therapy while in 395 (38.5%) patients ST-segment could not resolve into 3 conventional ST-segment resolution categories at 60 minute and 90 minute after thrombolysis. Three hundred and twelve (30%) and 444 (43.4%) with complete resolution, 344 (33.62%) and 325 (31.76%) with partial resolution, 367 (35.8%) and 491 (19.29%) were with no resolution at 60 and 90 minutes respectively. CONCLUSION: Shock, congestive heart failure, and recurrent angina and ischemia occurred more often in patients with partial or no ST resolution as compare to complete resolution.

Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension.

BACKGROUND: Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension. METHODS: In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 (31.2%) men and 344 (69%) women > 30 years of age in the study. Among them 177 (35.4%) were diabetic, 224 (45%) were dyslipidemia, 188 (37.6%) were smokers, and 14 (3%) had homocysteinemia. Duration of hypertension (HTN) was > or = 2 years). Mean systolic BP (SBP) was 180 +/- 20 mm Hg and diastolic BP (DBP) was 95 +/- 12 in male and female patients. Left ventricular mass index (LVMI) was 119.2 +/- 30 gm/m2 in male while 103 +/- 22 gm/m2 in female patients. Palpitation was seen in 126 (25%) male and 299 (59.8%) female patients. Atrial fibrillation was noted in 108 (21.6%) male and 125 (25%) female patients, 30 (6%) male and 82 (16.4%) female patients had atrial flutter. Ventricular tachycardia was noted in 37 (7.4%) male and 59 (11.8%) female patients. Holter monitoring showed significant premature ventricular contractions (PVC'S) in 109 (21.8%) male and 128 (25.69%) female patients while Holter showed atrial arrhythmias (APC'S) in 89 (17.8%) males and 119 (23.8%) females. Angiography findings diagnosed coronary artery disease in 119 (23.8%) with CAD male and 225 (45%) without CAD while 47 (9.4%) females presented with CAD and 109 (21.8%) without CAD. CONCLUSION: A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH.

Histopathological features of endometrial carcinoma.

OBJECTIVE: To evaluate and compare the histopathological features of endometrial carcinoma among women of various age groups. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The study was conducted at The Aga Khan University Hospital, Histopathology Department, from January 2001--December 2003. PATIENTS AND METHODS: All cases of endometrial carcinoma who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy were included. RESULTS: Median age was 55 years. Bleeding per vaginum was the commonest feature and endometrioid adenocarcinoma was the commonest histological type. Tumor involved < and > half of the myometrium in nearly half of the patients each. Vascular invasion, endocervical invasion and adnexal involvement were evident in a small number of cases. Amongst the 86 patients majority were well differentiated (grade-1) and stage-1, on FIGO staging. Patients (<40 years) had endometrioid type of endometrial carcinoma, grade-1, and FIGO stage-1. In 85% tumor was invading to < half of myometrium. Significant difference was seen among the 40--49 and >50 years age groups in grade and depth of myometrial invasion. As 76% were grade-1, 80% had myometrial invasion < half in patients <50 years, while 43.6% were grade-I and 41.8% had myometrial invasion >half in patients >50 years. CONCLUSION: Patients with endometrial carcinoma presented in early stage (stage-1) and tumor well differentiated (grade-1). In patients of more than 50 years of age even with stage-1, an increased frequency of deep myometrial invasion and less differentiated tumors, adnexal involvement, endocervical invasion, positive peritoneal cytology, vascular invasion and lymph nodes metastasis found.

Validity of frozen section in the diagnosis of breast lumps: 5 years experience at the Aga Khan University Hospital.

OBJECTIVE: To determine the accuracy of frozen section in the diagnosis of breast lump. METHODS: Frozen section diagnosis given in consecutive breast biopsies performed in 5 years in our laboratory was evaluated against the final pathology report of permanent sections. RESULTS: The Aga Khan University Hospital Lab receives more than 400 cases per year for frozen section. Three hundred and nineteen consecutive frozen sections of breast lumps examined from 1999-2003 were considered for analysis. Age of patients ranged between 22 and 90 years (mean age 49 years). In 316 cases (99%) there was no difference between the frozen section diagnosis and the final diagnosis. Three cases (0.94%) were incorrect; 2 cases (0.62%) were false positive. One case was false negative (0.31%). In 7 cases (2.19%), frozen section diagnosis was deferred to permanent sections. Frozen section diagnostic accuracy was 99%. Sensitivity and specificity was 99.3% and 93% respectively. Positive predictive value and negative predictive values of frozen section were 96.6% and 99.3% respectively. CONCLUSION: High accuracy of the frozen-section diagnosis in the breast lumps was confirmed in our study