Radiomics: A Powerful Tool

Shahid Kamal

The Artificial Intelligence based technique of radiomics is an evolving modality that employs data characterization algorithms to extract a variety of useful features from medical images [1].Tumoral patterns are revealed that cannot be appreciated by the naked eye [2]. This can aid in assessing prognosis and gauging the response of tumor cells to therapy [3].
Various imaging modalities like CT, PET MR provide essential raw data. Extraction tools then use the raw data volumes to analyze pixel/voxel characteristics. Using these images, “volumes of interest” can be generated since such segmentation entails handling and processing of large image data; automatic and semiautomatic segmentation algorithms are employed enabling automation [4]. However, thorough testing and quality assurance are vital to ensure that the algorithm used is not only accurate, consistent, and reproducible but also time-efficient [5].


Nanotechnology: A New Era of Incredible Developments in the Field of Dentistry

Angabeen Anjum

The science and engineering that is conducted at the nanoscale is termed nanotechnology. In this, the materials that are used have components smaller than 100 nm in at least one dimension. Such materials are called nanomaterials and may include clus¬ters, fibers, grains, nanoholes, or a combination of these forms. The surface area of such particles is increased and as a result, the material’s chemical, physical as well as optical properties get improved [1]. Nanotechnology is emerging as an interdisci¬plinary field and has brought about a remarkable paradigm shift in medicine and dentistry [2].

Received: June 01, 2023
Revised: November 11, 2023
Accepted: November 15, 2023


The Prognostic Value of Tumor Budding in Breast Biopsies and its Relationship with Survival: A Cross Sectional Study

Songul Peltek Ozer

Abstract: Background: In 1954 Imai described Tumor Budding (TB), as a tumor sprouting at the invasive tumor front of colorectal carcinomas. TB is associated with poor prognosis. TB has prognostic importance in invasive ductal carcinoma of the breast.

Objective: The present study aims to examine TB in breast needle core biopsy specimens with invasive ductal type carcinoma, and its relationship with other clinicopathological parameters and overall survival.

Materials and Methods: From February 2015 to December 2022, patients who had undergone breast carcinoma surgery at the Bolu Abant Izzet Baysal Training and Research Hospital and had preoperative needle core biopsies at the same center were retrospectively analyzed. Needle core biopsy slides were re-evaluated for TB. Tumor size, and nodal status, were retrieved from pathology reports. Overall survival was considered. Analysis of the data was done with statistical software (SPSS 18.0 for Windows, IBM Inc., Chicago, IL, USA).

Results: 122 patients were enrolled in the study. The mean age of the study and control groups were 55±12 years and 54±11 years, respectively. TB was identified in 68 (55%) patients; the rest 54 (45%) patients didn’t have any TB. The median value of the metastatic axillary lymph node in the TB absent group was 0 (0-51); in the TB group was 1 (0-21), and this was statistically significant (p=0.03). Lymphovascular invasion was detected in 33 patients (48.5%) in the TB present group and in 14 patients (25.9%) in the TB absent group. That was statistically significant (p=0.01). In the overall survival analysis, mean survival times were lower in the TB group compared to the TB absent group, but it was not statistically significant (p=0.33).

Conclusion: In conclusion, tumor budding is a robust prognostic indicator; therefore, assessing tumor budding especially in core needle biopsy specimens will be very helpful for individual treatment options.

Received: May 16, 2023
Revised: July 26, 2023
Accepted: August 02, 2023


Cloward Procedure Outcome using Hashmi Cage for Anterior Cervical Discectomy and Fusion Experience in Pakistan

Aurangzeb Kalhoro, Kashif Ahmed, Pervaiz Ali and Abdul Sattar M. Hashim

Abstract: Background: We aim to focus on ACDF patients treated with Hashimi cage filled with autologous bone. We will assess the safety of this approach based on the specific surgical level and its outcome.

Objective: Study aims to evaluate the results of the Hashmi cage used in the Cloward Procedure while using odom’s based criteria for the outcome.

Materials and Methods: This was a descriptive study researched at the Neuro Spinal Cancer Care Institute in Karachi, time duration from 16 June 2016 to 31 June 2022. The study included patients with a single-level prolapsed intervertebral cervical disc. During the surgery. Bony Fusion was assessed using movement ≤ 1 mm in flexion and extension cervical X-rays, was required.

Results: We had 162 patients; among them males were 102 (62.96%) and female patient were 60 (37.03%). The median range for the age was from 23 to 63 years with mean 48 years ± 3.6 age. Clinically the patients presented with radiculopathy, commonly of the C6 level which was patients (63.73%). Odom’s based criteria were used to evaluate the results of the procedure. Among the patients, 92.84% showed excellent outcomes, 4.9% had good results, 1.8% had fair outcomes, and 1.23% had a poor outcome.

Conclusion: ACDF with the Hashmi cage and plate application is a highly effective treatment option. This approach not only ensures better removal of the problematic discs but also significantly increases the likelihood of successful fusion and better radiological outcomes.

Received: August 17, 2023
Revised: October 07, 2023
Accepted: October 12, 2023


Observed Adverse Effects of Sinopharm COVID-19 Vaccine in Healthcare Workers

Khadija Muneer, Nimra Tufail, Muhammad Imran Hassan Khan, Sadia Inam and Saima Ayub

Abstract: Background: Covid-19 was first identified in Wuhan China in December 2019, and rapidly spread world over. Vaccine was always thought as first line defence against viral infections, and Covid was no exception. Although developed through different technologies, Pakistan got its share of Sinopharm from China and vaccination started in February 2021, with priority for Healthcare workers. There were lot of myths and hesitancy related with the adverse effects and urgency in approving these vaccines. Addressing adverse effects in post vaccinated population hence, became an important matter.

Objective: Aim of this study was to observe the adverse effects of this vaccine in Pakistani population, to assess safety and develop confidence in Healthcare Workers.

Materials and Methods: A cross-sectional Observation study was carried out in vaccinated Healthcare Professional through Non-probability purposive sampling over a period of one month. A team collected data directly, as well as on the telephone call. A Google form was also generated and sent. Information was collected and analysed on IBM-SPSS 23.0

Results: Majority of the participants were less than 55 years with female dominance. Among co-morbidities, hypertension was most common, followed by diabetes. In local and systemic adverse effects, pain and fatigue were most common, followed by muscle weakness, fever and headache respectively. These effects were also more common after first injection.

Conclusion: Results favor that people should be more careful after the first dose as more adverse effects were felt after that. This vaccine has a good safety profile as no major adverse effects were noticed. It was also considered safe for patients with co-morbidities.

Received: November 20, 2023
Revised: January 18, 2024
Accepted: January 22, 2024


Determinants of Partial Stone Clearance after Mini-PCNL in the Pediatric Population

Farmanullah, Javed Altaf Jat, Muhammad Murtaza Azad and Syed Daniyal Raza

Abstract: Background: The prevalence of renal stones in pediatric population is increasing in Pakistan, to minimize the adverse outcomes of renal stone disease accurate diagnosis and proper management is necessary.

Objective:This study aim to evaluate the risk factors of partial stone clearance after mini-PCNL in the pediatric population of Pakistan.

Materials and Methods: This is a retrospective, cross-sectional study conducted at Godhra Hospital, Karachi, during 2021, patients diagnosed with single or multiple renal stones requiring PCNL were enrolled in the study, Guy’s stone score was used as a prediction method for complete clearance. SPSS version 22 was used to analyze the data, chi-square test was used to assess the significance of the data keeping a p-value ≤0.05 as significant. The risk estimation was analyzed with the help of the odds ratio test.

Results: A total of 234 participants with mean age of 6.4 ± 4.8 years were enrolled. Stone clearance was reported 203 (86.7%) and 31 (13.2%) residual fragments. 09 (3.8%) out of the residual stone group needed intervention for complete clearance while the remaining were reported as stone free after 4 weeks with METs. The mean residual stone size was 0.7 ± 0.3, upon assessing the determinants maximum patients had Staghorn (> 4) cms stone size with 7 (2.9%) of patients out of 13 (5.5%). The odds of having partial clearance were reportedly positive with 2.34 in staghorn ≥ 4cms stone size and 1.62 in Grade IV Guy’s stone score.

Conclusion: Stone size ≥ 4.0 cm and staghorn calculi present in all calyces are independent risk factors for partial stone clearance after Mini-PCNL.

Received: July 14, 2023
Revised: December 05, 2023
Accepted: December 05, 2023


Oral Hygiene Practices of Rural and Urban School Going Children in Punjab

Hammad Hassan, Zainab Fatima Zaidi, Asma Shakoor, Rabia Asad, Roha Fatima and Bersha Mir

Abstract: Background: The early years of life are essential for establishing a solid foundation for oral and dental health. Children with poor oral and systemic health typically have poor dietary habits and insufficient oral hygiene practices, particularly brushing.

Objective: To assess and compare the oral hygiene practices of rural and urban school-going children in Punjab.

Materials and Methods: This cross-sectional study was conducted from September 2021 to August 2022, after the approval of IRB, among five urban and five rural schools in Punjab using an interview-administered survey tool through purposive sampling of 600 students. The questionnaire was developed by the authors and validated using face validity. The data were stored and analyzed using IBM SPSS version 23.

Results: A total of 650 students were approached; out of them, 600 responded. Almost one-third of them had the habit of brushing twice daily (27%), whereas most were brushing once daily (65.4%). The rural school children used miswak, manjan, and their finger more significantly; however, toothpaste was the major agent for cleaning teeth (89.4%). The urban school children were using toothbrushes more significantly. Rural school children more frequently used Miswak and finger. Urban schoolchildren often brushed at night, whereas no difference was reported between morning and nighttime.

Conclusion: Most urban school children were using toothbrushes and toothpaste. The use of miswak and manjan was more common in rural areas. The most common time for brushing was morning and night. Rural areas need to have access to oral health education and subsidized toothpaste and toothbrushes.

Received: June 02, 2023
Revised: August 22, 2023
Accepted: August 23, 2023


Evaluation of the Progress of Coronavirus Disease-19 Pneumonia using the British Society of Thoracic Imaging Reporting Model: A Validation Study

Javerya Sattar, Azizullah Khan Dhiloo, Saba Sohail, Mukhtiar A. Memon, Nasreen Naz and Rashid Qadeer

Abstract: Background: SARS-COV-2 (also known as severe acute respiratory syndrome corona virus-2), emerged as a pandemic and became an overwhelming global concern, causing substantial morbidity and mortality worldwide. Reverse transcription polymerase chain reaction (RT-PCR) is considered a gold standard in detecting clinically symptomatic patients but can have false negative and false positive results. As chest X-Ray (CXR) is considered as a baseline investigation in many hospitals, BSTI reporting model during COVID-19 pandemic has been a useful tool in diagnosis of COVID-19 pneumonia.

Objective: To validate the British Society Thoracic Imaging (BSTI) coding system in the evaluation of the progress of the disease severity in patients with coronavirus disease-2019 (COVID-19) pneumonia.

Materials and Methods: This is a cross sectional observational study. Total 450 CXRs (which included both the baseline and serial CXRs) of 225 COVID positive patients (RT-PCR positive for COVID-19 on nasal swabs) were included. These were retrospectively reviewed and reported by two Radiologists (having experience of at least 5 years in Radiology Reporting) in Corona Ward in Dr. Ruth K M Pfau Civil Hospital Karachi, Pakistan, for the duration of 10 months from 1st March 2020 till 31st December 2020. BSTI coding system was used to classify and interpret the CXR imaging findings as normal, definitive, indeterminate and non-COVID for baseline (CXR on 1st day of admission) and follow up CXRs (done in between 3rd and 7th day of admission). Data was analyzed using SPSS version 25. Numeric data was assessed for distribution using Shapiro-Wilks test. Median and interquartile range (IQR) were reported for numeric variables. Frequencies and percentages were reported for categorical data. Kappa statistics was applied to assess the agreement between BSTI scoring at baseline and follow-up CXRs. A p-value ≤0.05 was considered as statistically significant.

Results: CXRs (including 225 baseline and 225 follow up CXRs) of 225 RT-PCR COVID-19 positive patients were analyzed. Interval change in BSTI coding system was noted, increase in frequency of probable/definitive COVID-19 findings were diagnosed on serial CXRs. The BSTI scoring at baseline and follow-up showed moderate agreement with kappa statistics as 60.3% (p=0.001).

Conclusion: BSTI coding system can be helpful to classify the COVID-19 disease on CXR and filter for the prognosis of disease severity in the serial radiographs. Utilization of BSTI reporting model for reporting CXRs, even before RT-PCR, in future COVID pandemic can be considered as a useful tool.

Received: May 17, 2023
Revised: January 03, 2024
Accepted: January 09, 2024


Undergraduate Nursing Students’ Satisfaction Level with their Clinical Learning Experiences in Multan, Pakistan

Anna Rana, Naghma Rizvi, Hussain Maqbool and Eunice Siaity

Abstract: Background: TClinical experience is an integral part of nursing education. Obtaining quality clinical experiences in a supportive and pedagogically calibrated clinical learning environment is a significant concern for nursing institutions. The quality of clinical learning reveals the quality of the curriculum structure. Therefore, it is important to investigate students’ clinical learning experiences to produce competent future nurses.

Objective: This study aimed to measure the undergraduate nursing students’ satisfaction level with their clinical learning experiences in government and private college of Nursing in Multan, Pakistan.

Materials and Methods: A quantitative approach, with analytical cross-sectional design, was used. A sample of 191 undergraduate nursing students participated in the study. Data was collected using the CLES+T evaluation scale. Online Google survey forms were used to collect data, due to the COVID-19 pandemic outbreak.

Results: The study findings revealed that students were satisfied with their clinical learning experiences. Students’ overall mean satisfaction score was 3.54 + 0.93 and significant (p < 0.05) difference was found in the satisfaction score between the government and private undergraduate nursing students. Attending pre and post-conferences, faculty visit to students’ clinical placement, electronic communication between students and clinical faculty, and environment of clinical placement were the associated factors found with students’ satisfaction. The findings revealed that a meaningful clinical learning environment motivates students to continue nursing as their career choice. Conclusion: This study concluded that, overall, students were satisfied with their clinical learning experiences, however, satisfaction varied according to the type of college and year of study.

Received: August 23, 2023
Revised: October 16, 2023
Accepted: October 26, 2023


Clinical Characteristics of Patients with Oral Submucous Fibrosis: A Single Institute Study

Kanwal Iqbal, Saima Butt and Afifa Razi

Abstract: Background: Oral Submucous Fibrosis (OSMF) is a well-established oral potentially malignant disorder (OPMD) affecting people of Pakistan, India, Bangladesh and Sri Lanka because these nations have a long-standing history of chewing areca nut.

Objective: The primary objective of the current study was to assess the clinical features of OSMF in patients presented to the Department of Oral Medicine, Ziauddin University, Karachi, Pakistan.

Materials and Methods: : This study was done on OSMF patients who came to the Oral Medicine department of Ziauddin University, Karachi, Pakistan from June 2020 to July 2021. Clinicopathological parameters of OSMF like age, gender, habits and its frequency and duration, clinical signs and symptoms and stages were recorded.

Results: There were a total of 60 patients of which 35 were males and 25 were females. The mean age of study subjects was calculated to be 36.46±11.96 years. More than 50% of the participants were using a combination of various tobacco products. Most of the patients in our study were of stage III followed by stages II, I and IV. 70% of patients had buccal fibrous bands bilaterally, 36.66% of patients had tongue restriction and 60% of patients complained of burning sensation in the mouth.

Conclusion: OSMF becomes a disease of the young generation with a slight male predilection. The majority of individuals suffered from a severe and advanced form of the disease. The development of diagnostic aids is necessary to stop the disease in its early stages.

Received: July 19, 2023
Revised: October 18, 2023
Accepted: October 27, 2023


Antifungal Potential of Bioactive Metabolites Produced by Pseudomonas aeruginosa against Candida Species

Hamna Hanif, Sehar Afshan Naz, Nusrat Jabeen, Maryam Shafique and Waleed Ahmed

Abstract: Background: The frequency of fungal infections targeting immune-suppressed patients has been prominently rising day by day. Among these infections, Candidiasis is one of the most common life-threatening systemic fungal infections in recent years. These infections are challenging to treat because of the inconvenience of effective antifungal drugs. Therefore, the insufficiency of current drug regimens coupled with constant mutations by the fungi to develop drug resistance can pose a potential problem for future anti-fungal treatments. This frequent increase in drug-resistant fungi has directed attention toward the use of alternative therapy from natural sources.

Objective: This study aimed to evaluate Pseudomonas aeruginosa for its antifungal potential against Candida species.

Materials and Methods: This study was conducted at the Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan during 2021-2022. For the detection of the antifungal compound, a clinical isolate P. aeruginosa HS 28 (identified conventionally as well as by 16S r RNA analysis) was screened for its bioactivity against Candida species by using agar well diffusion technique. The growth kinetics as well as the effect of different physical and chemical factors were also determined in the study. The compound was also partially purified by ammonium sulfate precipitation.

Results: This antifungal compound showed good inhibitory activity against Candida species such as Candida albicans, C. glabrata, C. tropicalis, C. krusei, etc. This compound retained its stability at a high range of temperatures, and varying pH. Moreover, its bioactivity was also conserved when treated with organic solvents, chloroform vapors, metal salts, and different surfactants/detergents. The growth kinetics analysis illustrated that the maximum production of antifungal compounds occurred in the log phase of growth and extended supreme until the late log phase. Furthermore, the highest saturation of this protein was achieved at the concentration of 60% ammonium sulfate.

Conclusion: The overall results indicated the promising antifungal potential of the compound produced by Pseudomonas aeruginosa HS 28 against Candida species.

Received: June 02, 2023
Revised: October 03, 2023
Accepted: October 06, 2023


Tumefactive Multiple Sclerosis: A Mimicker of Intracranial Space-Occupying Lesions

Muhammad Sohail Ajmal Ghoauri, Nauman Ismat Butt, Fahad Qaisar, Muhammad Bilal Rasheed, Shoaib Luqman and Sabir Ali

Abstract: A chronic disease of CNS, Multiple sclerosis is characterized by inflammation and demyelination with axonal injury affecting upper motor neurons of brain or spinal cord. Tumefactive multiple sclerosis is a rare form of MS which mimics intracranial tumor-like space-occupying lesions on radiography. A 25-year old gentleman presented 2-month history of gradual onset difficulty in walking, slurring of speech and double vision. The patient had an ataxic gait accentuated by tandem walking with tendency to fall towards right and a negative Romberg’s sign. There was dysarthria and signs of cerebellar lesion present on the right side. Muscle tone was normal in upper limbs but increased (spasticity) in lower limbs bilaterally. Power was normal but deep tendon reflexes were exaggerated in all 4 limbs with bilateral up-going plantar reflex. MRI scan of the brain demonstrated tumour-like tumefactive lesions in the right cerebellum, right pons and the left subcortical region with no post-contrast enhancement of these lesions. MRI of whole spine demonstrated subtle hyperintense signals in the cervical spine. He had a past history of transverse myelitis 2 years ago with full clinical recovery with oral steroids. He was diagnosed with Tumefactive Multiple Sclerosis and started on corticosteroid therapy resulting in dramatic improvement.

Received: May 08, 2023
Revised: January 11, 2024
Accepted: January 12, 2024


Surgical Management of Idiopathic Scrotal Elephantiasis: A Rare Case Report

Arif Ali, Ayesha Khan, Farooque Ahmed and Shahzad Ali

Abstract: Etiologically, massive scrotal lymphedema can be either congenital or acquired. Congenital is further divided into different types while the predominant variety in the acquired category includes infectious etiology. We present a case of a 35-year-old male presented with the complaint of scrotal swelling for 3 years. Blood tests for filarial, chlamydia, and tuberculosis were unremarkable. Excision of excessive scrotal skin was done and sent for biopsy. The wound was partially closed, and the remaining was left for healing by secondary intention. The biopsy report showed non-caseating granulomatous inflammation with no significant lymph node involvement.

Received: September 17, 2023
Revised: December 04, 2023
Accepted: December 19, 2023



NJHS Front Page v8.n2
2024 VOL 9 , Issue 1