Intraoperative Localization Of The Marginal Mandibular Nerve In The Pakistani Population: A Cross-Sectional Study

Objective: This study aims to evaluate the proximity of the marginal mandibular nerve to the lower border of the mandible in the Pakistani population, in comparison with previous studies to reduce the risk of inadvertent nerve damage during surgical interventions. Methods: A total of 60 patients in the age range between the second & sixth decade requiring incision in the submandibular region were selected. Intraoperative identification of the nerve followed by measurement of its lowest point from the inferior border of the mandible was done. A total of 45 distinct nerves were recognized. Measurements on both the left and right sides were taken and compared with each other. The association of nerve position with the age of the patients was distinguished. Results: A total of 45 nerves were identified. The average position of the Marginal Mandibular Nerve was determined to be 11.75 mm below the inferior border of the mandible. There was no significant difference between the left and right sides and about age. Conclusion: The inferior border of the mandible is where the Marginal Mandibular Nerve is situated, consistent with prior research. There is no significant variation between the left and right sides. The position of the nerve is not affected by age as there is no association detected between the position of the nerve and age. The placement of an incision by previous recommendations of one finger breadth below the inferior border of the mandible can be used in the Pakistani population to avoid iatrogenic damage to the marginal mandibular nerve, leading to lesser complications and distress to the patient. Keywords:  Marginal mandibular branch, facial nerve, mandible, Injury

Navigating The Landscape Of Innovation & Entrepreneurship In Pakistan: A Review

This article's abstract explores the concepts of innovation and entrepreneurship and how they work together to promote economic progress. Despite its challenges, Pakistan may prosper in these fields thanks to its large and growing market, skilled labour force, and supportive political environment. However, for innovation and entrepreneurship to live up to their potential, several problems need to be resolved, including bureaucracy and corruption, poor intellectual property protection, inadequate research and development, and limited access to capital. In the medical device industry, innovation and entrepreneurship may drive progress as new technologies and opportunities for expansion and improvement can be developed. Getting finance, negotiating legal and regulatory environments, managing new trends and technologies, The potential for coordinated effort and organisation, and laying the basis for a flourishing enterprising biological system in Pakistan are points shrouded in this article. The article makes various significant proposals for Pakistani entrepreneurs who must work on their odds of coming out on top, including making a strong marketable strategy, finding finance sources, interfacing with others and cooperating, using innovation, and being versatile. Pakistan can lead the way nearby for advancement and business, setting the way for monetary development and improvement, with continuous endeavours and participation. Keywords: Innovation, Entrepreneurship, Economic growth, venture, Value, Workforce,  Research and development, Medical device, Networking, Technology, Adaptability, Success

Zinc Supplementation Mitigates High Salt Diet-Induced Bone Damage: A Histological Evaluation of Osteocyte Apoptosis: Protective Effects of Zinc Against Salt-Induced Osteocyte Apoptosis: A Histological Study

Objective: This study aims to evaluate the protective role of zinc supplementation against bone damage induced by a high-salt diet, with a specific focus on osteocyte apoptosis in rats. Methods: This was an investigational study conducted at the Army Medical College, Rawalpindi, Pakistan, over eight weeks. Thirty female Sprague-Dawley rats were randomly divided into three groups: control (Group C), high-salt diet (Group A), and high-salt diet with zinc supplementation (Group B). Group C received a standard diet, Group A received a diet with 8% sodium chloride, and Group B received the high-salt diet plus zinc supplementation at 50 mg/kg body weight daily via oral gavage. After eight weeks, femurs were harvested, processed, and stained with hematoxylin and eosin. Osteocyte apoptosis was assessed by counting empty lacunae and apoptotic bodies under light microscopy. Results: The high-salt diet group (Group A) exhibited a significantly higher density of apoptotic osteocytes compared to the control group (mean ± SD: 2.3166 ± 0.820 vs. 1.3666 ± 0.431 per unit area; p=0.0005). Zinc supplementation in Group B resulted in a significant reduction in osteocyte apoptosis compared to both the high-salt diet group (mean ± SD: 1.7000 ± 0.492 per unit area; p=0.0087) and the control group (p=0.0009). These findings indicate that zinc supplementation effectively reduces osteocyte apoptosis caused by high salt intake. Conclusion: Zinc supplementation significantly mitigates the harmful effects of a high-salt diet on bone health by reducing osteocyte apoptosis. This suggests its potential as a therapeutic intervention to counteract salt-induced bone damage and prevent related diseases such as osteoporosis. Keywords: Zinc, salt, osteocytes,  apoptosis, osteoporosis

The Comparison Of The Success Rates Of The Prostaglandin E2 (PGE2) Versus Foley Catheter In Females With Postdate Pregnancy

Objective: Postdate pregnancies, defined as pregnancies that extend beyond the 40th-week gestation, are associated with an increased risk of adverse maternal and fetal outcomes. Consequently, there is a clinical need to manage these pregnancies effectively to prevent complications. Two common methods for inducing postdate pregnancies are the use of Foley catheters and prostaglandins. To determine the success rates of the Foley catheter and prostaglandin E2 (PGE2) in females with postdate pregnancy. Methods: 162 female participants were randomly divided into two groups through the lottery method. Group A utilised a Foley catheter, where after speculum examination, a 16F standard Foley catheter was aseptically inserted above the internal cervical os and inflated with 30ml of sterile water.  In Group B, PGE 2 gel was administered, with nulliparous women receiving an initial dose of 2 mg per vaginum (PV) and parous women receiving 1mg PV. The gel was inserted into the posterior vaginal fornix.  Success was defined as female giving within 24 hours. The data was analyzed using SPSS version 25. Results: The mean age of patients was 30.35 ± 6.89 years. Success was observed in 87(53.7%) patients, while 75(46.2%) patients did not achieve success. The study findings revealed that success was attained by 30(34.4%) individuals in group A and 57(65.5%) in group B. A statistically significant difference was observed between groups regarding the success of patients. i.e., p-value (<0.05) Conclusion: A study concludes that Prostaglandin E2 (PGE2) showed significantly higher success rates for achieving vaginal delivery within 24.0 hours when compared to Foley catheters in female individuals with postdate pregnancies. Key words: Pregnancy, Prostaglandins E2; Cervical Ripening; Pregnancy Outcome; Labour

Dermoscopic And Clinical Features Of Alopecia Areata In Pakistani Patients: A Cross-Sectional Study

Objective: To evaluate the dermoscopic and clinical findings in Pakistani patients with Alopecia Areata Methods: The study was conducted at THQ Hospital Layyah with a sample size 800 within an age limit of 10-40. The patient's clinical history and demographic information were collected using a structured interviewing questionnaire with informed consent. Patients were examined using a Dermlite dermoscope. Results: Of 800 patients, 52.9% were females and 47.1% were malesThe scalp was the most common site of alopecia among the studied patients, accounting for 89.9% (n=719). Dermoscopy of AA patients revealed the following: yellow dots in 79.9% (n=559), black dots in 33.1% (n=265), exclamation mark hairs in 42.5% (n=340), short villus hairs in 32.6% (n=261), broken hairs in 42.3% (n=338), pigtail hairs in 27.9% (n=223), and Pohl-Pinkus constriction in 25.9% (n=207). The Pearson chi-square test showed a significant correlation between age and the presence of black dots, yellow dots, broken hairs, exclamation mark hairs, pigtail hairs, short villus hairs, and Pohl-Pinkus constriction (p < 0.001). Conclusion: Alopecia Areata affects both men and women equally. The majority of affected individuals are young, between the ages of 10 and 30. The scalp is the typical site of Alopecia Areata. Key Words: Alopecia

Thrombocytopenia Rates In Newborns Diagnosed With Gram-Negative Sepsis. Insights From NICU Experimental Based Study

Objective: To evaluate the prevalence of thrombocytopenia observed in neonates admitted to the hospital with sepsis. Methods: A total of 103 patients, including both males and females with ages below 28 days, who were admitted to the NICU (neonatal intensive care unit) with gram-negative sepsis were enrolled in this study. Blood samples were collected from each patient for sepsis and platelet analysis on the 1st and 3rd day of patients’ admission and sent to the Ghurki Hospital laboratory for analysis. Thrombocytopenia was defined as platelet counts <150,000/mm3. Thrombocytopenia was classified as mild, moderate, and severe. The type of organism and mortality rate related to thrombocytopenia were also recorded. Results: Of 103 neonates, 64 (62.13%) were males while 39 (37.86%) were females. 88 (85.43%) had thrombocytopenia (p <0.001) whereas 15 (14.56%) had normal platelet count. E. coli was found to be the most common organism responsible for gram-negative sepsis. On day one, 61 (59.22%) patients had normal platelet count whereas 12 (11.65%), 14 (13.59%), & 16 (15.53%) neonates had mild, moderate & severe thrombocytopenia respectively. In contrast, on the third day, 18 (17.47%) neonates had normal platelet count, 6 (5.82%) had mild, 33 (32.03%) had moderate, and 46 (44.66%) had severe thrombocytopenia. 12/103 (11.65%) patients died, out of which 11 (10.68%) had thrombocytopenia. Conclusion: Thrombocytopenia is a significant marker of gram-negative sepsis in neonates. Keywords: Neonate, Neonatal Intensive Care Unit, Thrombocytopenia, Sepsis

Modified Bloom's Taxonomy: Perspective of a Doctor of Philosophy Scholar

The educational landscape is constantly evolving; with it, the frameworks we use to assess and foster learning must adapt. One such framework, Bloom's Taxonomy, has been a cornerstone in education since its inception in 1956.1 It first offered a hierarchical picture of cognitive abilities, from basic recollection to intricate assessment. But in a time of multidisciplinary integration and quick technical breakthroughs, reviewing and adapting this taxonomy to fit modern educational requirements is essential. As a doctor of philosophy, I suggest a revised Bloom's Taxonomy that leads to the highest learning objective: integration into practice-based systems. As a PhD and post-doc, I regularly develop original ideas, but I think the hardest part is integrating them into practice-based systems. The healthcare system does not gain from the innovations that are developed since they are not incorporated into the system and eventually go away. Revisiting Bloom's Taxonomy Knowledge, comprehension, application, analysis, synthesis, and evaluation were the six levels that made up Bloom's original taxonomy. These categories were modified to Remember, Understand, Apply, Analyse, Evaluate, and Create in 2001 by Anderson and Krathwohl. The generation of new ideas was emphasised as the highest cognitive capacity in this version, which moved the emphasis from static knowledge to dynamic processes.2 Though the updated taxonomy provides a strong foundation for cognitive growth, it falls short of addressing education's ultimate objective, which is real-world application in systems. The Need for Practice-Based Systems The significance of education in the linked world of today is found in both the development and acquisition of knowledge as well as in its efficient application. Integrative frameworks known as practice-based systems place a strong emphasis on converting theoretical knowledge into practical abilities for use in both professional and real-world settings.3 This method guarantees that learning is not only profound and long-lasting, but also immediately applicable and significant. Modified Bloom's Taxonomy: A New Hierarchy The proposed modified Bloom's Taxonomy includes the following levels, with incorporation in practice-based systems as the highest: Remember: Recalling facts and basic concepts. Understand: Explaining ideas or concepts. Apply: Using information in new situations. Analyze: Drawing connections among ideas. Evaluate: Justifying a decision or course of action. Create: Producing new or original work. Incorporate: Embedding the innovation into practice-based systems. Potential verbs for this level: Embed, integrate, encompass, assimilate, blend, fuse. From Creation to Incorporation Although coming up with new concepts is an important first step, integration is what connects theoretical knowledge with real-world implementation.4 To ensure that the newly developed knowledge informs, enhances, and innovates real-world processes, it must be incorporated into practice-based systems. This greatest level of cognitive ability demonstrates a thorough comprehension of the topic and its ramifications, as well as the capacity to establish and maintain advancements in professional practice.5 Implications for Education and Training The highest level of Bloom's Taxonomy's inclusion of practice-based systems has significant ramifications for training and education. It promotes a change from learning only theory to a more comprehensive strategy that emphasises real-world application and ongoing development.6 To promote a culture of creativity and lifelong learning, educational programs would concentrate not only on the creation of knowledge but also on how that information may be applied to other professional sectors.7 Current Dilemma The most prominent challenge that is being faced in the thesis being written by PhD scholars is that the new innovative discovery never finds its way into the clinical practice or the workplace. It remains in text and the hardbound theses keep getting stacked in the storerooms of educational institutions as the scholars move on without even a pilot incorporation of their findings in the real workplace-based systems. Hence, this highest cognitive level must be made part of the objectives of the PhD scholar’s thesis so that it can make an impact through incorporation into the existing systems. Conclusion: A crucial development for the twenty-first century is the updated Bloom's Taxonomy, which is incorporated as the apex in practice-based systems. It makes sure that students are not just informed and creative but also able to contribute significantly to their professions by bringing educational goals into line with the demands of a world that is changing quickly. As academics and educators, we must welcome this change and equip students to navigate and influence the future with competence, self-assurance, and a dedication to practical excellence. References Seaman M. BLOOM'S TAXONOMY. Curriculum & Teaching Dialogue. 2011 Jan 1;13. Krathwohl DR. A revision of Bloom's taxonomy: An overview. Theory into practice. 2002 Nov 1;41(4):212-8. Gul R, Kanwal S, Khan SS. Preferences of the teachers in employing revised Bloom's taxonomy in their instructions. sjesr. 2020 Jun 25;3(2):258-66. Nkhoma MZ, Lam TK, Sriratanaviriyakul N, Richardson J, Kam B, Lau KH. Unpacking the revised Bloom’s taxonomy: developing case-based learning activities. Education+ Training. 2017 Mar 13;59(3):250-64. Sobral SR. Bloom's taxonomy to improve teaching-learning in introduction to programming. Elmas R, Rusek M, Lindell A, Nieminen P, Kasapoğlu K, Bílek M. The intellectual demands of the intended chemistry curriculum in Czechia, Finland, and Turkey: a comparative analysis based on the revised Bloom's taxonomy. Chemistry Education Research and Practice. 2020;21(3):839-51. Rush RD. Using learning taxonomy to enhance understanding of innovation adoption

Unveiling Thrombocytopenia Trends In Pediatric Epilepsy: The Valproate Connection

Objective: To determine the frequency and association of thrombocytopenia in patients on valproate therapy in the Pediatrics department of Pakistan Atomic Energy Hospital, Islamabad. Methods: A descriptive cross-sectional study, conducted in the department of Paediatrics, PAEC General Hospital, Islamabad from 06-June-2022 to 05-December-2022. A total of 125 diagnosed cases of epilepsy and valproic acid therapy were included. After written informed consent from parents/guardians, demographic details were noted, and patients underwent testing for platelet count and thrombocytopenia was labelled as a platelet count of <150000/µL. Results: The mean age of patients included in this study was 8.13±2.80 years. The mean duration of epilepsy was 3.44±1.56 years. Thrombocytopenia was observed in 31 (24.80%) patients on valproic acid therapy and a strong association between higher dosage of valproic acid and thrombocytopenia was observed (p <0.001). Conclusion: An increased risk of thrombocytopenia is observed when valproic acid is used as a monotherapy or a part of polytherapy.  Mostly this thrombocytopenia is not life-threatening but the importance of serial monitoring of platelet count during prolonged valproic acid use cannot be ignored due to the associated risk of bleeding, as children on higher doses of valproate are at greater risk of thrombocytopenia. Keywords: Epilepsy, Valproic Acid, Thrombocytopenia

Unmasking The Hidden Clues: Shedding Light On The Potential Of Novel Biomarkers In Endometrial Cancer, Comparing RT-Qpcr And Immunohistochemical Analysis In Clinical Specimens

Objective: The objective of this study was to compare the diagnostic accuracy of RT-qPCR in endometrial cancer using novel biomarkers in clinical specimens, keeping immunohistochemical analysis as the gold standard. Methods: This cross-sectional validation study involved 210 endometrial biopsies, suspicious of endometrial carcinoma. RT-qPCR was performed, and relative gene expressions were calculated using the 2^-ΔΔCt method, with the endogenous control. Findings of the RT-qPCR were statistically analyzed keeping immunohistochemical analysis as the gold standard.  Sensitivity, specificity, accuracy, negative predictive value (NPV) and positive predictive value (PPV) were calculated for the PCR technique. The clinical sensitivity of the test was determined by the Area under the curve (AUC)/Receiver Operating Curve (ROC). Results: RT-qPCR diagnosed 61 patients while histochemical analysis diagnosed 60 patients with endometrial carcinoma. RT-qPCR has shown a sensitivity of 96.67%, specificity of 98% and diagnostic accuracy of 97.62%.  PPV and NPV of Rt-qPCR were 95.08% and 98.66%. Conclusions: RT-qPCR promises a highly sensitive and specific method for screening patients with endometrial carcinoma with expression of HE4, L1CAM, miR-200c, ARID1A, and PI3K. Keywords: Endometrial cancer, Immunohistochemical, biomarkers, radiotherapy

Efficacy Comparison of Nitazoxanide Combined with Lactulose versus Lactulose Monotherapy in Managing Overt Hepatic Encephalopathy

Objective: To evaluate the efficacy of combining Nitazoxanide with lactulose compared to lactulose alone in the treatment of overt hepatic encephalopathy. Methods: This Comparative Cross-sectional Study was conducted at the department of Gastroenterology and Hepatology, Pakistan Institute of Medical Sciences, Islamabad from July 2019 to December 2019. In this study, 150 cirrhotic patients with overt hepatic encephalopathy were randomized into two groups: one receiving Nitazoxanide plus Lactulose (Group A) and the other receiving Lactulose alone (Group B). Patient demographics, aetiology of cirrhosis, MELD score, and efficacy of treatment were assessed. Statistical analysis was conducted to compare outcomes between the two groups. Results: A total of 150 patients, with a mean age of 44.08 ± 11.31 years were enrolled. Hepatitis C was the predominant aetiology in 81 patients (54%). The mean MELD score was 23.24 in Group A and 22.36 in Group B. Upon admission, 20 patients (13.3%) presented with grade 2 hepatic encephalopathy (HE), while 70 patients (46.6%) had grade 4 HE. The duration of hospital stay showed statistical significance in both groups (p < 0.001). Furthermore, a significant difference in drug efficacy was observed between the two groups (p < 0.005). Conclusion: In conclusion, our study suggests that combining Nitazoxanide with Lactulose yields superior efficacy compared to Lactulose alone in managing overt hepatic encephalopathy among cirrhotic patients. Keywords: Comparison, Efficacy, Hepatic encephalopathy, Lactulose, Management, Nitazoxanide, Treatment