Pakistan Journal of Medical Sciences最新文献

Objective: In recent years, artificial intelligence (AI) applications have become widespread in many fields, including medical education. This study aimed to examine the reliability of widely used generative AI programs, such as Microsoft Copilot, Google Gemini and OpenAI ChatGPT, by evaluating the accuracy of first- and second-year medical students' responses to anatomy questions on mid-term board, final and make-up exams.

Methodology: Total 286 anatomy questions from the 2023-2024 academic year by first and second semester medical school students in anatomy, 222 with analysis reports were included in the study. The difficulty levels of the questions were divided into four groups (very difficult, difficult, medium, easy) based on students' correct answer rates. The same questions were then posed to three AI applications. The data were analyzed by SPSS-version 27.

Results: According to the findings, Copilot, ChatGPT and Gemini achieved significantly higher accuracy compared to students, with 97.7% accuracy, 94.4% accuracy and 86.5% accuracy, respectively. However, Gemini and ChatGPT remained similar to students, particularly on very challenging questions. Gemini did not perform as well on questions requiring basic knowledge (first year) as on questions requiring clinical interpretation (second year).

Conclusion: While the study found that AI applications provide higher accuracy compared to students, systems that fail to achieve 100% accuracy are not suitable for unrestricted and unsupervised use in critical basic medical sciences like anatomy. Because AI models lack clinical reasoning and human experience, they should be used only as supplementary educational tools and integrated in a controlled manner to enhance student success.

Objective: Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is evolving technique for advance stage malignancies. Studies have shown that CRS and HIPEC improve survival, however initial published results were not promising in view of high morbidity 20% and mortality 4.8%, hence it has yet to be standard of care for certain malignancies and further trials are awaited. This study presents outcomes of HIPEC in a Single center of a developing country.

Methodology: This retrospective cross-sectional study was conducted in Shifa International Hospital, Islamabad, Pakistan. Data is collected from January 2019 to December 2023. Patients who underwent CRS and HIPEC for curative intent were included in the study. Quantitative analysis is represented by mean and standard deviation, qualitative analysis is represented by frequency and percentage.

Results: Fifty patients were included. Out of these 17 (34%) were Male, and 33(66%) Female. Ovarian carcinoma was most common pathology 36%, Adenocarcinoma Colon and Low grade Appendiceal Mucinous Neoplasm 24%. No 30-day mortality was observed in our study. Recurrence was observed in 16 (32%) patients. Patient with poor tumor biology had a higher rate of recurrence (p= 0.003). Mean Overall Survival among patient who underwent HIPEC was 45±3 months. For patients who had LAMN, mean survival was 50±5 months which was significantly better than rest of pathologies.

Conclusion: Cytoreduction and HIPEC offers a hope for patients with advance malignancy, however patient selection for undergoing HIPEC is of utmost importance.

Background and objective: Pineal region tumors are rare intracranial lesions accounting for less than one percent, with heterogeneous histopathology. This study aimed to provide a comprehensive overview of pineal region lesions, their clinical and radiological presentation, and their management and outcomes.

Methodology: This was a retrospective case series conducted at the Departments of Punjab Institute of Neurosciences. The study included all patients who underwent surgical excision or supportive procedures (cerebrospinal fluid [CSF] diversion and biopsy) for pineal region space-occupying lesions (SOLs) between January 1, 2022, and December 31, 2024. A non-probability consecutive sampling technique was used to enroll all the patients who fitted inclusion criteria, during the defined study period. A total of 32 patients were included in the final analysis.

Results: A total of 32 patients were reviewed, 68.8% (22) males and 31.3%(10) females with a mean age of 24.1±12.3 years. The most common presentation was headache in 87.5% (28). Radiologically, the lesion was hypodense in 81.3% (26) on computed tomography (CT). On magnetic resonance imaging (MRI), 34.4% (11) were hypointense on the T1 weighted images and 90.6% (29) were hyperintense on the T2 weighted images, and 53.1%(17) was homogenously enhanced on contrast. Among all, 40.6% (13) had surgical excision,46.9% (15) had only biopsy, and 6.3%(2) underwent cerebrospinal fluid (CSF) diversion surgery. On histopathology, 21.9% (7) were pineocytoma, 21.9% (7) were germinomas,12.5% (4) were pineoblastomas. Post-operative weakness occurred in 6.2% (2) and cerebrospinal fluid (CSF) leak occurred in 3.1%(1) patients.

Conclusion: This study reinforces the clinical and surgical complexity of managing pineal region tumors, which present with symptoms of increased intracranial pressure. Continued integration of minimally invasive techniques, neuronavigation, and multidisciplinary care is essential for optimizing outcomes in this diverse tumor group.

Melanotic Neuroectodermal Tumor of Infancy (MNTI) is a rare tumor of neural crest origin seen in the pediatric population aged less than one year. Despite their very aggressive growth, they are mostly benign in nature, commonly involving the maxilla, but in very rare cases, the skull and brain have also been seen to be affected. We are presenting here two rare cases, including a six months old girl with right orbitotemporal swelling and a three months old boy with right temporal swelling. Both cases were presented consecutively with a gap of one month between April and May 2024 at the Punjab Institute of Neurosciences, Lahore, Pakistan. CT and MRI in both of these cases showed extra-axial lesions. Complete excision of the tumor in both cases was performed with no postoperative complications or recurrence of the tumor at six-month follow-up. The purpose of this case series is to describe these unusual cases of cranial MNTI in infants in order to gain useful insights into the clinical course, diagnostic complexities, and therapeutic techniques for cranial MNTI. This is the first case series on cranial MNTI to be reported from Pakistan.

Primary extraosseous central nervous system Ewing Sarcoma (CNS-EES) in children is a rare disorder, and this study aimed to document the experience of dealing with these rare pathologies of CNS in our center. This ambidirectional descriptive case series included all consecutive cases of CNS-EES in children under the age of 16 years presenting to the The Children's Hospital Lahore, Pakistan, from January 2023 to December 2024. During the 24-month study period, 4 out of 139 incident CNS tumor cases at our center were diagnosed as primary CNS-EES, corresponding to a proportional incidence of 2.9% (95% CI: 1.1-7.2%). The median age of presentation was 8.5 years, with equal gender distribution. Pain was the first presenting symptom, with a median symptom duration of 5.75 weeks. Half of the cases presented with a cerebral hemispheric mass and half with a spinal mass. The median event-free survival was 4.5 weeks with a survival rate of 25%. All cases were diagnosed based on a round blue cell morphology with a positive NKX2.2. Primary CNS-EES is not very infrequent in our population, with possible parietal lobe predilection and association with cancer predisposition syndrome. In resource-limited settings, NKX2.2 might serve as a fair substitute to diagnose CNS-EES.

Background and objective: Alveolar soft part sarcoma is a rare malignancy of unknown histiogenesis. Rarely, primary intracranial alveolar soft part sarcoma has been reported. To review the clinical manifestations, progression and management of this neoplasm was the prime objective of this systematic review.

Methodology: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant review of PubMed Central, Google Scholar, and ScienceDirect identified 18 primary intracranial alveolar soft-part sarcoma cases (eight reports, three series; 2000-2024). Case reports and series providing data on clinical presentation, radiological features, surgical management, histopathological findings, and patient outcomes were included.

Results: Patients were predominantly female 61.1% (11), with a mean age of 23.3 ± 14.2 years. Headache in 50% (9) and papilledema in 33.3% (6) were common presentations. Frontal lobe involvement was most common in 33.3% (6). Magnetic resonance imaging showed iso+hypointense T1 and iso+hyperintense T2 signals in 22.2% (4) each. Meningioma was the leading differential in 27.8% (5). Gross total resection was achieved in 77.8% (14). Transcription Factor E3 immunopositivity occurred in 55.6% (10) of tumors. Average follow-up was 19.9 months.

Conclusion: Surgical resection remains the primary treatment. Transcription Factor E3 immunoreactivity supports diagnosis. Occult extracranial disease should be excluded. Long-term monitoring is essential due to the indolent course of primary intracranial alveolar soft-part sarcoma.

The classical educational triangle-knowledge, skills, and attitude-has long guided the philosophy of medical education. However, the term attitude inadequately reflects the depth and transformative essence of professionalism. This paper argues that professionalism, rather than being a mere behavioural component, embodies the bridge between knowledge and skills through the internalized concept of professional identity. The development of professional identity represents a vital process in shaping authentic, reflective, and ethically grounded physicians capable of navigating contemporary challenges such as digital transformation and artificial intelligence (AI). By embedding professional identity formation as a core educational goal, medical institutions can cultivate resilient, empathetic, and leadership-oriented professionals ready for the future of healthcare.

Objective: To evaluate the efficacy and safety of acupoint injection of recombinant human erythropoietin (rHuEPO) in the treatment of postoperative hemorrhagic anemia in elderly patients with femoral intertrochanteric fracture (FIF).

Methodology: This retrospective cohort analysis was conducted at Zhejiang Provincial Tongde Hospital. The research data were obtained from 60 elderly patients with hemorrhagic anemia after FIF surgery who were treated from April 2022 to December 2023. Patients who received acupoint injection of rHuEPO (acupoint group) were matched with the cohort of patients who underwent conventional subcutaneous injection of rHuEPO (subcutaneous group) in a 1:1 ratio, 30 patients in each group. The postoperative clinical efficacy, levels of blood routine indicators, coagulation function, transfusion status, and incidence of adverse reactions were compared between the two groups.

Results: The clinical efficacy in the acupoint group was higher than that in the subcutaneous group (P<0.05). One day after surgery, there was no significant difference in blood routine indicators between the two groups (P>0.05). Seven and 14 days after surgery, the levels of red blood cell (RBC), hemoglobin (Hb), and hematocrit (HCT) in both groups increased, and were higher in the acupoint group than in the subcutaneous group (P<0.05). There were significant time-dependent changes in coagulation parameters - prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) - in both groups at 1, 7, and 14 days after surgery (P<0.05), without significant differences between the two groups (P>0.05). The blood transfusion in the acupoint group was lower than that in the subcutaneous group (P<0.05).

Conclusions: Compared with the conventional subcutaneous injection, acupoint injection of rHuEPO seems to be more effective in treating elderly patients with hemorrhagic anemia after FIF surgery.

Objective: This observational analysis aimed to explore the association between gut microbiota and brain axis in pancreatic cysts and assess the impact of this association on clinical outcomes.

Methodology: This retrospective cohort study was conducted at Dicle University Faculty of Medicine, Diyarbakır, Turkey. Forty-seven patients (serous cystadenoma n=16, mucinous neoplasm n=31) treated at a single center between 2015 to 2023 were included in the study. Microbiota analysis (16S rRNA sequencing) of stool samples, biochemical and hormonal parameters from blood samples were evaluated. Depression-anxiety scales and cognitive tests were also performed.

Results: Microbiota diversity in the mucinous neoplasm group (Shannon index: 2.9±0.6) was significantly lower than in the serous cystadenoma group (3.8±0.5) (p=0.012). Firmicutes/Bacteroidetes ratio (2.89±0.5), inflammatory markers (CRP: 4.2±4.8 mg/dL) and depression scores (Beck: 18.6±6.4) were significantly higher in mucinous neoplasm patients (p<0.05). Two-year overall survival rates were 100% in the serous cystadenoma group and 80% in the mucinous neoplasm group (p=0.015).

Conclusion: The microbiota-brain axis has an important role in pancreatic cysts. Microbiota imbalance, increased inflammation and high depression-anxiety levels observed especially in mucinous neoplasms suggest potential targets for future therapeutic interventions in this patient group.