Journal of the College of Physicians and Surgeons--Pakistan : JCPSP最新文献

Objective: To assess the effectiveness of whole wheat in reversing hormonal disturbances and sperm abnormalities induced by stress in male rats.

Study design: An experimental study. Place and Duration of the Study: Department of Physiology, Islamic International Medical College, Rawalpindi, in collaboration with the National Institute of Health, Islamabad, Pakistan, from April 2024 to April 2025.

Methodology: Thirty-six male Sprague-Dawley rats were divided into three groups: Normal Control (NC), receiving no stress; Positive Control (PC), subjected to immobilisation and a standard diet for 10 weeks; and Whole Wheat (WW), exposed to stress for 10 weeks with 4 weeks on a standard diet followed by 6 weeks on whole wheat. Serum cortisol, follicle-stimulating hormones (FSH), and testosterone levels, along with sperm count, morphology, motility, and agglutination, were assessed at weeks 0, 4, and 10. Data were analysed using Pearson's correlation, ANOVA with post-hoc Tukey, and the Chi-square test, as appropriate.

Results: Compared to NC, PC rats showed significantly elevated cortisol and reduced FSH and testosterone levels (p <0.001). In contrast, WW rats exhibited decreased cortisol and increased FSH and testosterone compared to PC (p <0.001). Semen analysis revealed that PC had higher sperm agglutination (p = 0.02) and lower sperm count, motility, and morphology (all p <0.001) compared to NC. Conversely, WW showed significant improvement in all semen parameters relative to PC (p <0.05). Cortisol levels correlated positively with sperm agglutination but negatively with FSH, testosterone, sperm count, motility, and morphology.

Conclusion: Whole wheat reduced stress-related hormonal imbalance and improved semen quality, suggesting protection against male reproductive damage.

Key words: Whole wheat, Cortisol, Spermatogenesis, Stress, Sperm agglutination.

Students' comprehension of the assessment process is critical for effective evaluation. The authors at the Aga Khan University Hospital developed a questionnaire to assess Pakistan's dental postgraduate residents' understanding and satisfaction with the summative assessment system conducted by the College of Physicians and Surgeons Pakistan. Following ethical approval, six senior dental faculty and one medical educationist reviewed and validated the 37-item tool across seven domains from September to November 2023. The scale-level content validity index for relevance and clarity was 0.97, with a modified Kappa statistic of ≥0.85. All items received item-level content validity index  ≥0.86 except one regarding "examiner calibration" (0.71) which was retained based on literature support. Internal reliability testing with 15 participants yielded a Cronbach's alpha of 0.7. This reliable and validated tool can be used to evaluate learners' perceptions and satisfaction with assessment procedures and is applicable across postgraduate dental education specialities. Key Words: Competency-based learning, Dental education, Postgraduate education, Tool validation, Assessment system, Dental residents, Content validity, Internal reliability, Summative assessment, Curriculum alignment.

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Objective: To explore the association between the use of pacifiers during infancy and the occurrence of binge eating disorder (BED) and obesity in adolescence.

Study design: A case-control study. Place and Duration of the Study: Department of Paediatric Endocrinology, Izmir Tepecik Training and Research Hospital, Izmir, Turkiye, from January 2022 to January 2023.

Methodology: One hundred thirty-seven obese adolescents, aged 12-18 years, with a body mass index (BMI) above the 95th percentile, and 123 healthy subjects, with a BMI between the 3rd-95th percentiles, who had a similar age and gender distribution, were included. A survey, including questions about feeding during the infantile period and oral habits (chewing gum, nail-biting, smoking, and substance use) in adolescence, was applied to the mothers of all participants. The presence of BED was evaluated according to DSM-5 diagnostic criteria.

Results: No significant difference was found between the obese and control groups regarding age, gender, and the use and duration of the pacifier. In the obese group, total breast milk intake period, night feeding after one year, nail-biting behaviour, and smoking rate were higher than in the control group (p <0.015, p <0.001, p <0.027, and p <0.015, respectively). BED was detected in 53.3% of the cases in the obese group (p <0.001). There was no statistically significant difference between obese patients, with and without BED, in terms of the use and duration of pacifier (p = 0.136).

Conclusion: This study suggested that pacifier use in the infantile period (0-12 months) was not associated with oral habits, binge eating disorder, and obesity in adolescence. However, continuing night feeding (00-07 A.M, breast milk or formula) after one year of age may be related to obesity.

Key words: Childhood obesity, Pacifier, Binge eating disorder, Adolescents.

Objective: To digitise genitourinary glass slides and use them for research, education, and knowledge sharing.

Study design: Observational study. Place and Duration of the Study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan, from May 2025 to June 2025.

Methodology: This study used 31 renal biopsy cores with special stains and 21 prostate tissue cores with haematoxylin and eosin stains. Videos at 10x magnification were recorded using a microscope-mounted camera and uploaded to the DeepLIIF open-source cloud platform to generate whole-slide images (WSIs). Three pathologists independently reviewed the images, and inter-observer agreement was assessed using the Kappa statistic.

Results: Pathologist A showed 100% agreement with the reference diagnosis across all renal stains. Pathologist B demonstrated concordance of 77% for haemoxylin and eosin (H&E) and 74% for periodic Acid-Schiff (PAS), Jones methenamine silver (JMS), and trichrome stains. Pathologist C reported 100% agreement for H&E and PAS, 96% for trichrome, and 74% for JMS. In the prostate biopsies, among 21 cases (6 malignant and 15 benign), the diagnosis regarding malignancy and perineural invasion was compared to the reference diagnosis.

Conclusion: WSIs can be viewed through shareable links, even on smartphones. This helps in getting consensus on improved diagnosis, especially in resource-limited settings.

Key words: Digitisation, Genitourinary pathology, Image interpretation, Telepathology.

Depression has recently been identified as a potential predisposing factor for metabolic dysfunction-associated fatty liver disease (MAFLD) among adults in the US. This cross-sectional, nationwide study examined the association between mental health and MAFLD in Korean adults. Mental state was addressed using a question for suicidal ideation and depressive mood, and MAFLD was assessed according to the criteria established by an international expert panel. A stepwise multivariate logistic regression analysis revealed that MAFLD was significantly more common in men with suicidal ideation and in women with depressive mood compared with their non- suicidal and non-depressed counterparts, respectively. These results warrant mental health screening among patients with MAFLD. Key Words: Depression, Metabolic diseases, Fatty liver disease, Suicidal ideation.

Objective: To identify cellular senescence-associated genes in lung squamous cell carcinoma (LUSC) and explore their relationship with tumour microenvironment, immunotherapy response, and prognosis.

Study design: An observational study. Place and Duration of the Study:  Department of Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China, from September to October 2023.

Methodology: Prognostic genes and clinical information of LUSC were derived from the Cancer Genome Atlas (TCGA). Subsequently, R packages were used to obtain differentially expressed genes (DEGs) associated with cellular senescence prognosis. In addition, univariate and least absolute shrinkage and selection operator (LASSO) Cox regression analyses were used to construct cellular senescence-related gene signatures to determine the degree of risk. Sensitivity to immune checkpoint inhibitors (ICI) was evaluated according to the median risk score, which served as an independent prognostic factor.

Results: By univariate Cox regression analysis of gene expression data and overall survival data in the TCGA-LUSC cohort, 11 DEGs associated with prognostic cellular senescence were identified. The ageing prognostic models include genes of IGFBP1, SERPINE1, SIX1, and TRPM8. Tumour immune dysfunction and exclusion (TIDE) score and tumour mutation burden (TMB) score were better in the low-risk group, with advantages in terms of prognostic and immunotherapy response rate.

Conclusion: The results suggest that senescence-related determinants are involved in the tumour microenvironment through senescence-related secretory phenotypes and can be used as reliable biomarkers for LUSC immunotherapy and prognosis.

Key words: Cellular senescence, Lung squamous cell carcinoma, Tumour microenvironment, Immunotherapy, Prognosis.

Objective: To elucidate the prognostic value of the albumin-to-fibrinogen ratio (AFR) in patients with triple-negative breast cancer (TNBC).

Study design: An observational study. Place and Duration of the Study: Department of Medical Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China, from January 2010 to October 2022.

Methodology: A total of 195 patients diagnosed with TNBC were recruited and followed up till October 2022. The optimal cut-off value of AFR was assessed via receiver operating characteristic curve analysis, after which patients were categorised into low and high AFR groups accordingly. The relevance between TNBC and clinicopathological parameters were evaluated using χ2 and Fisher's exact tests. Survival time was analysed by using the Kaplan-Meier method and log-rank tests. Prognostic factors were identified via Cox regression model analysis. Nomograms were constructed, and calibration curve analysis (CCA) and decision curve analysis (DCA) were applied to evaluate their predictive clinical application.

Results: The optimal cut-off value of AFR was 15. The median survival time of patients with high-AFR values was higher than those with low-AFR values (DFS: 36.54 vs. 33.19 months, p = 0.004; OS: 56.45 vs. 53.29 months, p = 0.003). According to the Cox regression model, AFR was a significant predictor of disease-free survival [DFS; hazard ratio (HR): 0.595, 95% CI: 0.377-0.940, p = 0.026] and overall survival (OS; HR: 0.385, 95% CI: 0.221-0.670, p = 0.001). CCA and DCA indicated that AFR-based nomograms had good predictive clinical utility within the threshold probability range for different survival rates.

Conclusion: AFR is easy and inexpensive to conduct and has the potential to serve as a predictive factor for preoperative evaluation in clinical practice.

Key words: Albumin-to-fibrinogen ratio, Triple-negative breast cancer, Albumin, Fibrinogen, Treatment.

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