Impact of salicylic acid and calcium chloride on quality attributes of peach stored at refrigeration temperature.

Salicylic acid (SA) in different concentration were used to assess its individual effect as well as combined impact with 3% calcium chloride (CaCl2) on Swat No. 8 variety of peach stored at refrigerated temperature (6 ± 2 °C) for 21 days. Interestingly, the results revealed that applying 2 mmol L-1 SA with 3% CaCl2 maintained maximum nutritional value and least decay percent (44.1%) as compared to other treatments during storage. Moreover, this combination also exhibited significant weight loss and chilling injury at 6 ± 2 °C whereas increased levels of total phenolic, flavonoids, tannin, alkaloid, ascorbic acid, and antioxidant activity were observed as compared to other treatments. The combination treatment (2 mmol L-1 SA with 3% CaCl2) maintained other sensory attributes of peach fruit during refrigerated storage, therefore, its commercial use was recommended to store peach fruit for up to three weeks without any significant nutritional and physical loss.

The sensitivity of TIRADS scoring on ultrasonography in the management of thyroid nodules.

Objective: To determine the sensitivity of ACR-TIRADS scoring by comparing its results with those obtained on biopsy of respective specimens. Method: This prospective study including N=205 patients with thyroid nodules was conducted in ENT Department of MTI Hayatabad Medical complex, Peshawar during the period from May 1, 2019 to April 30, 2022. Preoperative ultrasonography with assigning of TIRADS scores was performed in all patients. Appropriate thyroidectomies were performed in these patients and specimen biopsied. Pre-op TIRADS scores were compared with biopsy results. To determine the sensitivity of TIRADS, TR1 and TR2 were considered 'benign' and TR3, TR4, TR5 were considered 'malignant' for comparison with biopsy results. Results: The mean age of patients was 37.68 years with standard deviation of ±11.52. The M: F ratio was 1:3.5. Nineteen patients (9.27%) had solitary thyroid nodules & 186 (90.73%) had multinodular goiters. TIRADS scoring was benign for 171 (83.41%) and malignant for 34 (16.58%) nodules. The biopsy results revealed 180 (87.80%) nodules to benign and the rest as malignant. The sensitivity, specificity and diagnostic accuracy were calculated at 80%, 92.77% and 91.21% respectively. Chi square test and p-value determination showed that there was a strong positive concordance between TIRADS scores & biopsy results which is highly significant (p=.001). Conclusion: The Ultrasonographic ACR-TIRADS scoring and risk stratification system is highly sensitive for detecting malignancy in thyroid nodules. It is, therefore, a reliable technique in the initial assessment of thyroid nodules and decisions can safely be based on its results. In cases of doubt, clinical judgment should be exercised before making final decision.

Implementation of structured team-based review enhances knowledge consolidation and academic performance of undergraduate medical students studying neuroscience.

Team-based learning (TBL) provides a systematic approach to teaching and learning and promotes critical thinking and enhances medical educational activities and professional development. TBL-based didactic methodology has proven beneficial in enhancing learning and consolidating key educational concepts throughout educational curricula. Such areas of application include neuroscience, which is traditionally considered to be one of the most difficult disciplines to be taught in undergraduate medical courses to the point where the scientific literature reports "neurophobia" among undergraduate medical students. Herein, we report the design and application of a modified version of TBL, which we termed team-based review (TBR) throughout two cohorts of undergraduate medical students undertaking neuroscience. We show that our TBR methodology enhanced student understanding of neuroscience, increasing average marks and grades achieved in final exams, while also increasing the proportion of students obtaining higher grades. Application of TBR also improved marks obtained by students throughout continuous assessment (midterms, TBL, and problem-based learning grades). In surveys taken following final exams, students strongly felt that TBR enhanced their learning experience and aided knowledge acquisition, consolidation, and exam preparation. Collectively, we show that TBR-based methodology was effective in enhancing the student learning experience and performance in neuroscience and could potentially be successfully used to enhance performance and learning in other subjects in the undergraduate medical curriculum.

The frequency of involvement of head & neck sites in referred otalgia - An experience at a tertiary care hospital.

OBJECTIVE: To determine the frequency of involvement of distant head & neck sites which share sensory innervations with the ear in referred otalgia. METHODS: This prospective study was conducted in the Department of ENT at Hayatabad Medical Complex, Peshawar, during the period from July 1, 2017 to December 31, 2017.*Non probability convenience sampling technique was used to include patients in the study. Patients with true 'otogenic pain' as determined on clinical examination or imaging studies were excluded from analysis. Only those who presented with referred ear ache were included in the study to determine the frequency of involvement of distant head & neck sites in 'referred otalgia'. Otalgia was designated as "Unknown Origin" when the ear and distant sites too were found normal. RESULTS: Out of a total of 150 patients, there were 81(54%) males and 69(46%) females. The ages ranged from 5 to 66 years with a mean age of 29.15 years. The commonest age groups involved were 21-35 years and 36-55 years. Referred otalgia of tonsillar origin was found in 47(31.3%) of patients followed by that of dental origin in 35(23.3%). Otalgia due to pharyngitis, rhinosinusitis and cervical origin was 24(16%), 8(5.3%) and 6(4%) respectively. Otalgia due to temporomandibular joint was noted in 12(8%) of females and 3(2%) of males & that of "unknown origin" affected 5(3.33%) of females and 2(1.3%) of males. CONCLUSIONS: The ear should be examined in detail in patients presenting with earache to look for indigenous pathology. In the presence of a 'Normal Ear', it is important to examine the tonsils, teeth, pharynx and the nose & paranasal sinuses as the possible sites of origin of earache.

Team-based learning in an undergraduate pathology curriculum and its effects on student performance.

OBJECTIVES: Team-based learning (TBL) is a student-centered learning modality in which high and low achievers are organized in groups where students learn from each other at their own pace. The purpose of this study was to explore the correlations between TBL scores and final examination scores and student perceptions of a TBL system. METHODS: A cross-sectional survey was conducted on a sample obtained using quota sampling of a population of second-year students enrolled in the College of Medicine, University of Sharjah, Sharjah, United Arab Emirates. A self-administered questionnaire was employed to collect data on the students' perceptions and opinions, TBL scores, and final examination scores. The data were processed and analyzed using SPSS Version 22. RESULTS: A sample of 101 students participated in the study. The Team Readiness Assurance Test scores were consistently higher than the mean Individual Readiness Assurance Test (IRAT) scores. The results found a statistically significant correlation between the IRAT and the final examination scores (r = 0.46, p < 0.001). About 57% of the sample agreed that TBL increased the understanding of course content, 45% reported that TBL was a useful learning activity, and 67% indicated that TBL enhanced interpersonal and communication skills. CONCLUSION: The findings imply that TBL is an effective tool to facilitate inter-professional and team-based learning outcomes. Collaborations among TBL group members help learners to develop communication and interpersonal skills and to gain knowledge.

Can Facebook pages be a mode of blended learning to supplement in-class teaching in Saudi Arabia?

The aim of this study was to examine the potential of a self-designed Facebook page on Neuroscience, to supplement in-class teaching as a mode of blended learning. Posts were split into multiple choice questions (MCQs), general interest articles, neuroscience-related external links and resources, and lecture notes and PowerPoint presentations. The study was divided into three distinct phases: before, during, and after the Neuroscience block. Student responses were evaluated via a self-developed questionnaire. Grades achieved by students undertaking the block in 2015 and 2014 were recorded, as were the grades achieved by the same cohort in concurrent blocks in the same year of study. Results showed that ~80% of students reported that use of the page enhanced their overall subject knowledge and exam preparation. Highest page activity occurred during the Neuroscience block. Peak activity occurred directly before summative assessments, with MCQ posts having the highest impact. The cohort of students with access to the Facebook page achieved better grades in the block compared with the previous cohort, despite similar average performance in other subjects. We demonstrate the utility of Facebook as a powerful tool for undergraduate education, supplementing in-class teaching, and assisting in exam preparation, potentially increasing average student performance.

Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies.

OBJECTIVE: (1) The diagnostic accuracy of tympanometry in detecting fluid in the middle ear space in children with otitis media with effusion by comparing its findings with those of myringotomies. (2) Identify the age group most commonly affected by OME. METHODS: This prospective study was conducted at the Department of ENT& Head and Neck Surgery, Postgraduate Medical Institute Hayatabad Medical complex, Peshawar from July 1, 2012 to April 30, 2015. Patients with suspicion of OME underwent tympanometry and later myringotomies. Using Jerger's classification, Type B tympanogram with normal canal volume was considered as conclusive evidence of fluid in the middle ear space. Its findings were compared with those of the respective myringotomies. From the data collected, the accuracy, sensitivity, specificity, positive predictive value and negative predictive values were calculated. RESULTS: A total 117 ears of 63 patients were operated. The age range was 3 to 12 years. The commonest age group (58.7%) affected by OME was 6-8 years. Type B tympanogram with flat curve and normal canal volume was obtained in 71.4% of the ears. Comparison with myringotomy findings showed TP 85, TN 13, FP 5 and FN 14. The diagnostic value of tympanometry was; Sensitivity 85.85%, Specificity 72.22%, PPV 94.44%, NPV 48.14% and Accuracy of 83.76%. P value calculated using chi square test showed that there was significant difference between tympanometry and myringotomy findings in OME (p < 0.05). CONCLUSIONS: OME is common in age group 6-8 years. Tympanogram Type B with normal canal volume is fairly sensitive in diagnosing this condition. However for occurrence of false positive results, final decision regarding management should be made on clinical findings and other supportive audiological tests.

Control of bleeding by silk ligation and diathermy coagulation during tonsillectomy: A comparison of efficacy of the two techniques in the first 24 hours after surgery.

OBJECTIVE: To assess and compare the relative efficacy of silk ligation and diathermy coagulation techniques in controlling bleeding during tonsillectomy in the first 24 hours. METHODS: This prospective study was conducted at the Department of ENT, Khalifa Gul Nawaz Teaching Hospital, Bannu and this department related consultants' private clinics from January 1, 2012 to December 31, 2014. The study included 180 cases. All patients included were having history of recurrent, acute tonsillitis, with more than 6-7 episodes in one year, five episodes per year for two years, or three episodes per year for three years. All the surgeries were performed by dissection method. Haemostasis during the procedure was secured by either ligation with silk 1 or using diathermy. The results were analyzed using SPSS 16.0 for windows. RESULTS: A total of180 cases were included in the study. The ages of the patients ranged from 5 to 40 years with the mean age of 15.56 years and a std.deviation of +/- 8.24. The male to female ratio was 1.25:1. The number of hemorrhages occurring was greater in the 'diathermy coagulation' group as compared to the 'silk ligation' group. However, the observed difference was statistically insignificant (p >.05). CONCLUSION: Primary haemorrhage occurring during tonsillectomy is a serious threat and control of bleeding during the procedure should therefore be meticulous. Both suture ligation and coagulation diathermy for control of bleeders during the procedure by dissection method are equally effective.

Tackling student neurophobia in neurosciences block with team-based learning.

INTRODUCTION: Traditionally, neurosciences is perceived as a difficult course in undergraduate medical education with literature suggesting use of the term "Neurophobia" (fear of neurology among medical students). Instructional strategies employed for the teaching of neurosciences in undergraduate curricula traditionally include a combination of lectures, demonstrations, practical classes, problem-based learning and clinico-pathological conferences. Recently, team-based learning (TBL), a student-centered instructional strategy, has increasingly been regarded by many undergraduate medical courses as an effective method to assist student learning. METHODS: In this study, 156 students of year-three neuroscience block were divided into seven male and seven female groups, comprising 11-12 students in each group. TBL was introduced during the 6 weeks of this block, and a total of eight TBL sessions were conducted during this duration. We evaluated the effect of TBL on student learning and correlated it with the student's performance in summative assessment. Moreover, the students' perceptions regarding the process of TBL was assessed by online survey. RESULTS: We found that students who attended TBL sessions performed better in the summative examinations as compared to those who did not. Furthermore, students performed better in team activities compared to individual testing, with male students performing better with a more favorable impact on their grades in the summative examination. There was an increase in the number of students achieving higher grades (grade B and above) in this block when compared to the previous block (51.7% vs. 25%). Moreover, the number of students at risk for lower grades (Grade B- and below) decreased in this block when compared to the previous block (30.6% vs. 55%). Students generally elicited a favorable response regarding the TBL process, as well as expressed satisfaction with the content covered and felt that such activities led to improvement in communication and interpersonal skills. CONCLUSION: We conclude that implementing TBL strategy increased students' responsibility for their own learning and helped the students in bridging the gap in their cognitive knowledge to tackle 'neurophobia' in a difficult neurosciences block evidenced by their improved performance in the summative assessment.

Prevalence and clinicopathological characteristics of appendiceal carcinoids in Sharjah (United Arab Emirates).

AIM: To determine the incidence and clinico-pathological profile of appendiceal carcinoids in a cohort of patients undergoing emergency appendicectomies for clinically suspected acute appendicitis in Sharjah, United Arab Emirates (UAE). METHODS: The study included the retrospective data of 964 patients operated for clinically suspected acute appendicitis, and the resected specimens were received at Al-Qasmi Hospital (Sharjah) from January 2010 to December 2010. The data of the patients who were histologically reported to have carcinoid tumors of the appendix were extensively evaluated for the patient's demographics, indication for surgery, surgical procedure, tumor localization in the appendix, diameter of the lesion, concomitant appendicitis, immunohistochemistry studies and clinical follow-up. RESULTS: Out of the 964 patients included in the study, 9 (0.93%) were found to have appendiceal carcinoids. The mean age reported was 28.7 years with a male to female ratio of 2:1. Eight tumors were located near the tip of the appendix with a mean diameter of 3.3 mm, while the remaining one was near the proximal end of the appendix. All the cases were associated with concomitant suppurative appendicitis. In seven reported cases, tumors were confined to the muscular layer while in one case each there was an extension to the serosa and mesoappendix, respectively. All tumors were found to be positive for chromogranin A, synaptophysin and neuron-specific enolase on immunohistochemistry but negative for cytokeratin-7. None of the patients developed recurrence or any reportable complications in the short follow-up period (12-26 mo) that was arranged as a six-monthly re-evaluation by abdominal ultrasonography. CONCLUSION: Our study found a higher incidence of appendiceal carcinoids in patients undergoing emergency appendectomy for acute appendicitis in Sharjah, UAE compared to two previous studies from the Persian Gulf region. Interestingly, tumors were found to be more commonly in young males, which is in contrast to previous studies. Moreover, all the tumors were positive for common neuroendocrine markers.

Histological evaluation of pulp tissue from second primary molars correlated with clinical and radiographic caries findings.

BACKGROUND: Managing dental caries in young children is demanding due to the elusions present on the right diagnostic criteria for treatment. The present study evaluated the histological status of pulp tissues extracted from primary second molar with caries involvement. Histological findings are correlated with clinical and radiographic assessment. MATERIALS AND METHODS: Simple experimental study was conducted on upper or lower second primary molars with occlusal (22 teeth) or proximal (22 teeth) dental caries. Selected children were below 6 years of age. Percentage of caries involvement, residual dentin thickness (RDT), radiographic assessment of interradicular and periapical areas, clinical caries depth and signs and symptoms are the parameters considered for comparing with the histological findings. The specimens were grouped based on the nature of the inflammatory process as acute or chronic. The data were analyzed by Student t-test to compare histological types of inflammation with clinical parameters. P value < 0.05 was considered as significant. RESULTS: Four cases revealed severe acute inflammation in coronal and relatively mild acute inflammation in radicular pulp. In the rest of the specimen coronal and radicular pulp had similar acute or chronic inflammatory changes. Histological evidence of pulpitis correlated with dental caries depth of ≥80%, RDT of ≤1 mm, radiographic rarefactions in the interradicular regions and symptoms of pain. CONCLUSION: Primary second molars with more than two-third caries involvement with symptoms of pain histologically showed inflammation of both coronal and radicular pulp tissues in all cases.

Otomycosis; clinical features, predisposing factors and treatment implications.

UNLABELLED: Objectives : The aim of this study was to determine the frequency of otomycosis, the clinical presentation, predisposing factors and treatment outcomes. METHODS: This observational study was conducted at ENT department of Combined Military Hospital Attock, from October, 2010 to September, 2012. Convenient sample comprising 180 patients of both sexes and all age groups were selected from ENT OPD. The frequency, predisposing factors and most common symptoms of otomycosis were recorded. The response to different antifungal agents was also observed. RESULTS were recorded in percentages. RESULTS: There were 180 patients with documented diagnosis of otomycosis. There were 107 (59%) males and 73 (41%) females. The age of patients ranged from 1½ years to 75 years with a mean age of 38.5 years. Mean follow up time was 2 years. Most common presenting symptom was hearing loss (77.7%) followed by pruritis (68.8%) and otalgia (40%). We prescribed 1% clotrimazole drops or lotion in 58% patients and 2% salicylic acid in 31% cases. Both of these agents are effective. Topical 1% clotrimazole drops yielded highest resolution rate with lowest recurrent rate. Overall 149 (83%) patients were improved with initial treatment and 31 (17%) did not respond to initial treatment. Eight (4.4%) patients had a history of otological procedures. Four (2.2%) patients had canal wall down procedures that resulted in mastoid cavity. To analyse the efficacy of 1% clotrimazole and 2% salicylic acid we applied Z-Test to calculate the difference between 2 proportions of patients before treatment with those patients who remained uncured after treatment. CONCLUSION: Otomycosisis commonly presented with decreased hearing, pruritis, otalgia & otorrhoea. It usually resolves with local toilet of ear and instillation of antifungal agents. Eradication of disease is difficult in presence of a mastoid cavity and metabolic diseases like diabetes mellitus.

Anatomical relationship between recurrent laryngeal nerve and inferior thyroid artery in thyroidectomy patients.

BACKGROUND: Thyroid surgery is performed very frequently now a day. Previously it was used to be associated with high morbidity especially hoarseness. This complication is now almost negligible as most of the surgeons are well acquainted with the anatomical knowledge of the nerves in relation to the gland. The objective of this study was to find out variable anatomical relationships between Recurrent Laryngeal Nerve and Inferior Thyroid Artery in patients undergoing thyroid surgery. METHODS: This cross-sectional retrospective study was conducted in Government Lady Reading Hospital Peshawar and Abasyn Hospital (Private) Peshawar from May 2010 to June 2014. Patients undergoing surgery for benign goiters, T1, T2 well differentiated thyroid cancers without lymph node involvement was included. Data on various types of relationships between RLN and ITA were recorded. RESULTS: In total 271 patients operated and included in the study, 117 were male and 154 were female. Total of 398 RLNs were identified in 416 sides operated. In 55.27% cases the nerve was found to be anterior to inferior thyroid artery while it was posterior to the artery in 34.67% cases. In the remaining 10.05% cases the nerve was observed passing within the branches of inferior thyroid artery. CONCLUSIONS: The anatomical relationship between Recurrent Laryngeal Nerve RLN and Inferior Thyroid Artery ITA is highly variable. For all head and neck surgeons to perform safe surgery on thyroid, it is necessary to have sound anatomical knowledge of these variable relationships between recurrent laryngeal nerve and inferior thyroid artery.

Comparing the efficacy of team based learning strategies in a problem based learning curriculum.

We introduced two variants of team based learning (TBL) strategies in pathology course to seek their efficacy in a problem based learning (PBL) curriculum. The TBL strategy was adopted in two different sessions. One during regular resource session (RS-TBL) and other during a weekly review session (RVS-TBL) of the PBL curriculum. The study involved 104 second year students during their 8 weeks of cardiovascular-respiratory units and 3 weeks of hematology units. RS-TBL was adopted for cardiovascular-respiratory unit and RVS-TBL for hematology unit. The first 8 weeks of the course were implemented as RS-TBL and the last 3 weeks as RVS-TBL. The results showed that the group performance was markedly improved than individual performance in both RS-TBL and RVS-TBL (p < 0.001). Comparison between the RS-TBL and RVS-TBL revealed that individual student and group performance was better in the RVS-BL (p < 0.001). The result of the student attitudinal survey indicated an 88% agreement that TBL enhanced their understanding of pathology concepts and critical analysis. Most of the participants (85%) found RVS-TBL to be more useful. Post-TBL, end of semester examination results proved beneficial for the students in risk. The study demonstrated that RVS-TBL may be preferably adopted to enhance the philosophy of TBL in a PBL curriculum.

Involvement of mitochondria in acetaminophen-induced apoptosis and hepatic injury: roles of cytochrome c, Bax, Bid, and caspases.

The role of apoptosis in acetaminophen (AAP)-induced hepatic injury was investigated. Six hours after AAP administration to BALB/c mice, a significant loss of hepatic mitochondrial cytochrome c was observed that was similar in extent to the loss observed after in vivo activation of CD95 by antibody treatment. AAP-induced loss of mitochondrial cytochrome c coincided with the appearance in the cytosol of a fragment corresponding to truncated Bid (tBid). At the same time, tBid became detectable in the mitochondrial fraction, and concomitantly, Bax was found translocated to mitochondria. However, AAP failed to activate the execution caspases 3 and 7 as evidenced by a lack of procaspase processing and the absence of an increase in caspase-3-like activity. In contrast, the administration of the pan-inhibitor of caspases, benzyloxycarbonyl-Val-Ala-DL-Asp-fluoromethylketone (but not its analogue benzyloxycarbonyl-Phe-Ala-fluoromethylketone) prevented the development of liver injury by AAP and the appearance of apoptotic parenchymal cells. This correlated with the inhibition of the processing of Bid to tBid. The caspase inhibitor failed to prevent both the redistribution of Bax to the mitochondria and the loss of cytochrome c. In conclusion, apoptosis is an important causal event in the initiation of the hepatic injury inflicted by AAP. However, as suggested by the lack of activation of the main execution caspases, apoptosis is not properly executed and degenerates into necrosis.

Effect of dietary copper supplementation on cell composition and apoptosis in atherosclerotic lesions of cholesterol-fed rabbits.

We have previously shown that dietary copper supplementation modulates the formation of atherosclerotic lesions in the cholesterol-fed rabbit. In the present study, we have investigated the effects of copper supplementation on the cellular composition and characteristics of atherosclerotic lesions in cholesterol-fed NZW rabbits. Rabbits received a 1% cholesterol diet with or without 0.02% copper acetate (containing 12 and 0.3 mg copper per 100 g diet, respectively) for 12 weeks. The tunica intima was significantly smaller in the animals receiving copper supplements (0.016+/-0.005 vs. 0.068+/-0.019 mm(2), P<0.05) and this was accompanied by a significant increase in aortic copper content (4.0+/-0.8 vs. 1.8+/-0.2 microg/g tissue, P<0.05). The percentage area staining for smooth muscle cells (HHF-35 positive) was significantly lower in the intima of animals receiving copper supplements (7.13+/-1.02 vs. 9.72+/-0.82%, P<0.05). However, there were no significant differences in area staining for macrophages (RAM-11 positive) between groups (22.6+/-7.9 vs. 23.3+/-4.9%). There were also significantly fewer apoptotic cells (0.96+/-0.33 vs. 2.54+/-0.56%, P<0.005) in the aortic intima from animals supplemented with copper, but no difference in the number of proliferating cells. However, there was a reduction in intimal collagen staining (Sirius red positivity) in the animals receiving a copper supplement. Taken together, these data show that dietary copper can significantly affect the composition and progression of atherosclerotic lesions.