KHYBER MEDICAL UNIVERSITY JOURNAL

Metaverse: a promise avenue for enhancing dental care

Enis Veseli — 2024-03-31

The healthcare industry has consistently recognized the significance of routine in-person engagement with patients in evaluating their holistic well-being. However, the onset of the COVID-19 pandemic disrupted this traditional methodology, prompting healthcare providers to seek feasible alternatives. Consequently, the industry is increasingly embracing remote care technologies like telehealth and the implementation of artificial intelligence. These technologies utilize digital tools for information and communication, enabling the remote delivery of healthcare services.¹As a result, there has been a surge in healthcare advancements and the adoption of innovative business models, utilizing computer-mediated virtual environments as an alternative healthcare system. Currently, digital transformation extends beyond virtual communication, encompassing the digitalization of the healthcare industry's social network with Metaverse technology.²

The Metaverse, facilitated by virtual reality and augmented reality, provides a comprehensive and immersive virtual realm. In this virtual world, people can interact online by using avatars. This technology has numerous applications in clinical dentistry. It is used for distraction therapy during dental surgeries and virtual simulations for implant surgery planning. The technology provides accurate descriptions of dental anatomy and supports augmented reality-assisted navigation for osteogenesis and mandibular restorations, along with virtual orthognathic planning.³Furthermore, while conducting a root canal procedure with the aid of three-dimensional images, it is possible to directly observe the canal's morphology or precisely position an implant in the appropriate location within the alveolar bone.⁴Additionally, neurosurgeons have achieved successful augmented reality surgeries on live patients in medical facilities.The procedure involves a unique head-mounted device equipped with a transparent display, allowing surgeons to view images of the patient's internal anatomy, such as bones and other tissues, generated from CT scans. This revolutionary technology essentially provides surgeons a type of X-ray vision, enabling them to navigate and perform surgeries with enhanced precision and accuracy. These pioneering advancements in surgical techniques represent significant developments in the field of neurosurgery.⁵

Metaverse technology is expected to permit and maintain oral and dental health by offering personalized recommendations, tracking health behaviors, monitoring symptoms, and providing self-care guidance.⁶ Young individuals can actively participate in a virtual environment that facilitates the acquisition of oral hygiene techniques and reduces dental anxiety. Moreover, this technology can inform patients about dental trauma and guide them on the appropriate measures to take in the event of such incidents.⁷ This writeup underscores the extensive research conducted on this topic, and highlighting the transformative potential of this technology in dentistry.

The Metaverse has the potential to revolutionize the dental care sector by utilizing virtual communication to connect specialists with end users. This could enable the seamless delivery of a variety of medical services, including disease prevention, diagnosis, and treatment, ushering in a new era of comprehensive care.

Comparison of Pilates exercises versus muscle energy technique with Kinesio taping in non-specific low back pain: a randomized controlled trial

Anam Akram — 2024-03-31

OBJECTIVE: To compare the effects of Pilates exercise versus muscle energy technique (MET) along with Kinesio Taping (KT) in non-specific low back pain (LBP).

METHODS: This randomized controlled clinical trial was conducted from March 22 to September 14, 2022, at Chaudhry Muhammad Akram Research and Teaching Hospital, Johar Medicare Complex in Johar Town, Lahore, and Mayo Hospital and Jinnah Hospital in Lahore, Pakistan. Study involved 42 non-specific LBP patients randomly assigned to group A (MET with KT) and group B (Pilates exercise with KT) over eight weeks after interventions. Pain, disability index, and range of motion (ROM) were assessed at baseline, 2 weeks, and 8 weeks. Sessions were held twice a week, lasting 30-40 minutes each.

RESULTS: Among 42 participants, 14 (33.3%) were male, and 28 (66.7%) were female, aged 18-40 years. Group B showed greater pain reduction than Group A (p<0.05). In Group A, lumbar extension (p=0.10), lumbar rotation (0.18), right side flexion (0.02), and left side flexion (0.16) did not significantly improve. However, Group B demonstrated improvements in flexion (0.04), extension (0.00), rotation (0.06), right side flexion (0.04), and left side flexion (0.08). The pain and disability improvement between groups exhibited a significant difference (p<0.05). ROM improvement also differed between groups (p<0.05), with Group B showing dominant improvement.

CONCLUSION: Pilates exercise, combined with Kinesio Taping, demonstrated superior reduction in pain and improved range of motion compared to muscle energy technique with Kinesio Taping in non-specific low back pain.

Seroprevalence of SARS-COV-2 antibodies among school-age children in the Swabi district of Pakistan

Muhammad Arif — 2024-03-31

OBJECTIVES: To determine the seroprevalence of SARS-CoV-2 antibodies (IgM, IgG) in school-age children and identify the predominant symptoms in seropositive children in the Swabi district of Khyber Pakhtunkhwa, Pakistan.

METHODS: This descriptive cross-sectional study was conducted from November 2020 to May 2021. Blood samples from 246 randomly selected children (aged 5-16 years) in Swabi district of Pakistan were analyzed using ELISA. The study focused on the general pediatric population, excluding those over 16 years, with chronic illnesses, or whose parents declined participation. Data was collected through a structured questionnaire.

RESULTS: Among 246 participants, 5 (2.03%) individuals tested positive for IgM and 58 (23.6%) for IgG antibodies, totaling 63 (25.6%) participants with both IgM & IgG antibodies. Mean age of seropositive and seronegative children was 11.2±3.0 and 10.3±2.98 years respectively (p=0.030). Out of 63 seropositive children, 51 (80.96%) were symptomatic, and 12 (19.04%) were asymptomatic. Common symptoms among seropositive individuals included fever (98.0%, n=50/51), cough (88.02%, n=45/51), sore throat (78.4%, n=40/51), coryza (66.7%, n=34/51), myalgia (60.8%, n=31/51), and loss of smell and taste (49.0%, n=25/51). The mean antibody titer was 20.9±10.41 IU/ml and 13.35±5.6 IU/ml for symptomatic and asymptomatic individuals respectively (p=0.013).

CONCLUSION: In our study, approximately one fourth of the participants tested positive for SARS-CoV-2 antibodies, predominantly IgG. Females exhibited higher seropositivity than males, with a significant association between seropositivity and exposure to confirmed COVID-19 cases. Symptomatic cases comprised 80.95% of seropositive individuals, with predominant symptoms of fever, cough, and sore throat. Symptomatic individuals had a higher mean antibody titer.

Awareness and attitude towards fertility and parenthood: a comparative study among medical students in Saudi Arabia

Fehmida Tehsin — 2024-03-31

OBJECTIVE: To compare the awareness, attitudes towards fertility, and intentions for parenthood between preclinical and clinical medical students.

METHODS: An online cross-sectional study was conducted among preclinical and clinical medical students of King Faisal University, Al Ahsa Saudi Arabia. The study was conducted during the first semester of the academic year of a medical bachelor's degree program, utilizing a convenience sampling technique. A total of 225 students, comprising 148 from the 3rd year and 77 from the 4th year blocks, voluntarily completed self-reported questionnaires. Data analysis was performed using IBM SPSS version-26.

RESULTS: The mean age of participants was 21.56±1.55 years, with a slightly higher representation of females (54.2%) compared to males (45.8%). Among the participants, 45.8% were married, and only 11.1% had children, while the majority expressed a desire to have children (73.8%) within the age range of 25-29 years. A significant proportion (44.9%) indicated a preference for 2-3 children. In terms of childcare, most participants agreed to its necessity. Interestingly, females across both academic years showed similar responses regarding the possibility of combining work/study, with almost equal numbers agreeing or remaining undecided. Clinical students exhibited greater fertility knowledge compared to preclinical students, with no significant differences observed based on gender. Furthermore, participants with a family history of infertility were more inclined to consider both IVF and adoption (p-value = 0.0001).

CONCLUSION: Clinical-year medical students showed improved understanding of female fertility decline and infertility causes, coupled with positive attitudes towards parenthood at a suitable reproductive age, preferring smaller families.

Efficacy of oral versus vaginal progestogens for early pregnancy maintenance in women with recurrent miscarriages: a randomized controlled trial

Laiyla Shinwari — 2024-03-31

OBJECTIVE: To compare the effectiveness of oral and vaginal progestogens in the maintenance of early pregnancy in women with recurrent miscarriages.

METHODS: This randomized controlled trial was conducted at Lady Reading Hospital, Peshawar, Pakistan, from April to September 2021. Pregnant women aged 16–40 years with a history of at least three recurrent miscarriages presenting at or before 7 weeks of gestation were enrolled. A total of 108 patients were randomly assigned to two groups: Group A received oral progestogens (10 mg twice daily), and Group B received vaginal progestogens (200 mg twice daily). Treatment lasted for 12 weeks, with successful outcomes defined as no vaginal bleeding and pregnancy continuing beyond 12 weeks. Data analysis was conducted using SPSS-20 software.

RESULTS: The mean age of patients was 29 ± 3.88 years in Group A and 27 ± 3.12 years in Group B. Oral progestogens (Group A) were effective in 48 (88.9%) patients, whereas vaginal progestogens (Group B) were effective in 36 (66.7%) patients (p=0.03). Oral progestogens showed significantly greater efficacy compared to vaginal progestogens in individuals aged 20-30 years (p=0.04) and those with fewer than four previous miscarriages (p=0.03). However, there was no significant difference in efficacy between the two groups for participants aged 31-40 years or those with 4 or more previous miscarriages.

CONCLUSION: Oral progestogens are more effective than vaginal progestogens in preventing recurrent miscarriages, especially in participants aged 20–30 years and with fewer than 4 previous miscarriages. More research needed to validate and explore underlying mechanisms.

Identification of target genes and pathways regulated by miRNA-132, miRNA-182, and miRNA-124 in depression: a bioinformatics analysis

Shamaila Wadud — 2024-03-31

OBJECTIVE: To investigate the associations of miRNA-132, miRNA-182, and miRNA-124 with long-term depression and elucidate their target genes and translational implications utilizing miRabel, a bioinformatics tool.

METHODS: This study is a part of a randomized controlled trial conducted in Psychiatry OPD of a teaching hospital, Peshawar, Pakistan from February-2021 till December-2021. It’s a computational study using miRabel which is a miRNA target prediction instrument. This software improves bioinformatic analysis by anticipation of microRNAs targets by grading and grouping.

RESULTS: By utilizing the miRabel software, our research reveals that miRNA-132, miRNA-182, and miRNA-124 target a total of 123 genes involved in long-term depression. Out of these genes, twelve (PRKCB, PLA2G4A, PRKCG, GNAZ, GNAO1, GUCY1B3, GNAI2, PLCB3, PPP2R1A, PLCB2, GNA11, and GUCY1A2) display significant potential impact, with scores close to 1.0 (0.9). These particular genes exhibit a stronger influence compared to other target genes of miRNA-132, miRNA-182, and miRNA-124 concerning long-term depression. Our investigation also revealed that these genes target several pathways, including Beta-catenin independent WNT signaling, Corticotropin-releasing hormone relating pathway, ErbB communicating path, G protein signaling, Glutamic acid attachment, triggering of AMPA receptors, GnRH communication , Ras signaling, Serotonin and anxiety-related events, communication by WNT, Signaling by GPCR, MAPK pathway, NO/cGMP/PKG neural-preservation, Phosphodiesterases neuronal tasks, Neuroinflammation and glutamatergic signing, along with several other pathways.

CONCLUSION: miRNAs such as miRNA-132, miRNA-182, and miRNA-124, identified via comprehensive bioinformatic analysis, show potential as depression biomarkers and treatment targets. Insight into their roles and target genes within depression pathways could inspire innovative treatment strategies.

Efficacy of simulated equestrian therapy in improving gait parameters among children with Down syndrome: a randomized controlled trial

Maha Siddiqui — 2024-03-31

OBJECTIVE: To compare the effectiveness of Simulated Equestrian Therapy (SET) and Standard Physical Therapy (SPT) in improving gait parameters among children with Down syndrome (DS).

METHODS: This single-blinded, randomized controlled trial was conducted at Dar-ul-Sukun Institute and Dr. Zaiuddin Hospital, Karachi, Pakistan, from April to August 2023. Sixty individuals, meeting the selection criteria were randomly assigned to either the treatment group (n=30) receiving SET or the control group (n=30) undergoing SPT. Nevertheless, two participants from each group either discontinued the treatment or failed to comply with the therapy and 56 participants (n=28 in each group) were included for analysis. Safety measures included recording blood pressure and heart rate before and after each session. Temporal gait parameters were assessed using the 10-Meter Walk Test at baseline, 6 weeks, and 12 weeks. Data was analyzed using Medcalc software.

RESULTS: Temporal gait parameters were analyzed for 56 (33 males and 23 females) children with DS in both groups. Mean age of patients in SET & SPT groups was 7.89±1.7 and 8.07±0.76 years respectively. Baseline showed similar scores in both groups. At 6 weeks, SET demonstrated significant improvement in cadence (1.78 SPM to 1.35) and gait velocity (2.11 MPS to 2.79), paralleled by SPT (cadence: 2.01 to 1.32 SPM, gait velocity: 2.12 to 2.83 MPS). Between-group analysis revealed no significant differences.

CONCLUSION: Both SET & SPT effectively improve gait parameters in children with Down syndrome. The comparable outcomes highlight SET as a viable alternative, providing clinicians and caregivers additional options for personalized therapeutic approaches.

Role of 6-amino flavone in attenuating cisplatin induced neurotoxicity via inhibition of p-JNK signaling pathway in post-natal day-7 mice

Latafat Kahkashan Ahmad — 2024-03-31

OBJECTIVE: To investigate the protective role of 6-amino flavone (6-AF) in cisplatin-induced neuro-inflammation in the developing brains of post-natal day-7 (PND-7) mice.

METHODS: This experimental study, conducted at the Neuro Molecular Medicines Research Center in Peshawar, Pakistan, included 20 PND-7 mice from January to March 2023. PND-7 mice were randomly distributed into four groups, a control group, a cisplatin group, a cisplatin + 6-AF group, and a 6-AF group. Cisplatin was administered intraperitoneally at a dose of 20 mg/kg to the cisplatin group. 6-AF was injected at a dose of 30 mg/kg after cisplatin administration to cisplatin+6-AF group and 6-AF group mice. After 4 hours of the drug treatment, all the PND-7 mice were sacrificed for Western blot analysis. ImageJ software was used for the densitometry of the blots. One-way ANOVA and post-hoc Tukey tests through Prism Graph-5 were applied for statistical analysis.

RESULTS: Significant differences in p-JNK levels along with TNF-α, NF-κB, and IL-1β proteins were observed in the brain homogenates of PND-7 mice in various groups. A post-hoc Tukey test revealed a significant increase (p<0.001) in the p-JNK, COX-2, NF-κB, and IL-1β levels in the cisplatin group as compared to control group mice. However, a significant decrease (p<0.001) was observed in p-JNK, COX-2, NF-κB, and IL-1β expression levels in the cisplatin + 6-AF group as compared to the cisplatin group.

CONCLUSION: Administration of 6-AF effectively reduced cisplatin-induced neurotoxicity in PND-7 mice, demonstrating a neuroprotective effect by suppressing p-JNK and its downstream TNF-α, NF-κB, and IL-1β proteins.

Prevalence and factors associated with anxiety and depression among undergraduate nursing students amid covid-19: a mixed-method study

Nadia Noreen — 2024-03-31

OBJECTIVES: To investigate the prevalence of anxiety and depression among undergraduate nursing students during the COVID-19 pandemic and identify associated factors.

METHODS: This study employed a concurrent mixed methodology, comprising a quantitative analytical cross-sectional web-based survey and a qualitative descriptive exploratory study using focus group discussions. The study was conducted at two university-based schools of nursing, one public and one private, in Karachi, Pakistan, from May to September 2021, during the third wave of the COVID-19 pandemic. Two questionnaires were employed: the Aga Khan University Anxiety and Depression Scale and COVID-19 related stressors.

RESULTS: Among the study participants (n=300) 74%, were female. The 76.3% individuals’ age between 20 to 29 years and 97.3% were single. The study reported 51% prevalence of anxiety and depression in COVID-19 were associated with females (OR=2.56, 95%CI:1.34-4.88), hostel residents (OR=1.9, 95%CI:1.02-3.52), final year students (OR=1.36, 95% CI:1.002-1.870), e-learning (OR=1.74, 95%CI: 1.28-2.37), and those who had COVID-19 academic apprehensions and transition as future nurses (OR=1.13, 95%CI: 1.0-1.29). The qualitative analysis highlighted the theme, the realities of students' academic life amid COVID-19. This theme was emerged from three categories, lack of preparedness, range of emotions and humble submissions.

CONCLUSION: This study revealed a high prevalence (51%) of anxiety and depression among nursing students during the COVID-19 pandemic, particularly among females, hostel residents, and final-year students. Qualitative analysis highlighted challenges in academic adaptation amid COVID-19, revealing themes of lack of preparedness, a range of emotions, and humble submissions, stressing the need for targeted interventions and support systems.

Diagnostic accuracy of computed tomography scan against surgical findings in small bowel obstruction cases

Faryal Gohar — 2024-03-31

OBJECTIVE: To determine the diagnostic accuracy of computed tomography (CT) scan in small bowel obstruction, (SBO), utilizing operative findings as the gold standard.

METHODS: This descriptive cross-sectional study was conducted at Dr. Ruth K.M. Pfau Civil Hospital Karachi, Pakistan from September 2019 to August 2020. A comprehensive assessment, including plain and contrast-enhanced CT scans of the abdomen, was performed on 267 patients with clinically suspected acute SBO. Operative findings were compared with CT results to determine diagnostic accuracy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were evaluated, considering operative findings as the gold standard.

RESULTS: Out of 267 patients, 162 (60.7%) were males, and 105 (39.3%) were females, with a mean age of 33.03±10.58 years. The mean duration of symptoms was 12.11±4.13 days. Overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the CT scan were 92.2%, 87.8%, 87.4%, 92.4%, and 89.9%, respectively. Common CT findings included dilated small bowel loops (128 cases, 100%), the point of transition (105 cases, 82%), and bowel wall thickening (71 cases, 55.5%). Post-operative analysis revealed 118 out of 128 confirmed cases and 17 additional cases initially missed by CT. Tuberculosis emerged as the leading histopathological cause (25.9%), followed by obstructed/strangulated hernias (22.2%) and adhesions (17.7%).

CONCLUSION: This study emphasizes the superior diagnostic precision of CT scans in determining the level and cause of SBO, reflecting a high sensitivity (92.2%) and specificity (87.8%). Common CT findings, including dilated bowel loops, contribute to precise identification, guiding effective clinical management.

Coping strategies, meaning in life and health-related quality of life among young adults with haemophilia

Zoya Zeeshan Rao — 2024-03-31

OBJECTIVE: To investigate the association between coping strategies, meaning in life, and health-related quality of life (HRQoL) among young adults with haemophilia.

METHODS: This cross-sectional study was conducted from February 2023 to August 2023 at the Haemophilia Welfare Centre in Lahore, Pakistan. A purposive sampling technique was used to select the sample size of 80 young adults with haemophilia with an age range of 18 to 40 years. Three scales, along with demographic performa were used for data collection. The data was collected by using the World Health Organization Quality of Life Brief Version Scale 16, Coping Scale 14, and Meaning in Life Questionnaire 15, along with demographic performa.

RESULTS: The reliability of all study scales was satisfactory. Study comprised of 40 males and 40 female participants, ranging in age from 18 to 30 years. Most study participants were educated and diagnosed with type A haemophilia. Thirty-five percent of the participants were suffering from moderate levels of haemophilia. Results of the study revealed a significant positive relationship between HRQoL, coping strategies (r =.235*, P<0.01), and meaning in life (r =.468, P<0.01). Regression analysis revealed meaning in life (β =.76, p<.001) as a positive predictor for HRQoL. Coping strategies were found to mediate between meaning in life and HRQoL among young adults with haemophilia.

CONCLUSION: Our study highlights the positive correlation between HRQoL, coping strategies, and meaning in life, with coping strategies partially mediating this relationship. Addressing psychosocial factors is crucial for improving the well-being of individuals with haemophilia.

Living in the shadow of autism: the lived experience of having a sibling with autism

Saba Poolaie — 2024-03-31

OBJECTIVE: This study was conducted to illuminate lived experiences of individuals having a sibling with autism.

METHODS: This qualitative case study was conducted to explore the lived experiences of a 20-year-old girl living with a 17-year-old brother with autism. Data was collected through interactive, semi-structured interviews. Two 60-minute interactive interview sessions were conducted, recorded and transcribed. Rigor in the study was ensured through prolonged engagement and researcher familiarity with the data. Feedback from the participant and nursing faculty members was sought for revisions. Data was analyzed following Van Manen's six-step phenomenological approach. OneNote 2016 software was utilized to record, organize, and extract interview data and codes.

RESULTS: The data analysis resulted in the identification of three main themes: "hiding autism," "I never had a childhood", and "motherly sister". These themes were further divided into seven sub-themes, including "withdrawing from friends", "anguish over non-normative behaviors", "avoiding others' questions", "you have to take care of him", "struggling with academics," "an embrace full of positive energy," and "never leaving him alone".

CONCLUSION: This study highlights the complex experiences of siblings living with a sibling diagnosed with autism, revealing both challenges and moments of resilience and love. The findings emphasize the importance of tailored support and increased awareness for promoting the well-being of siblings in similar situations. However, its single-participant limitation calls for broader, diverse studies to understand these experiences across various cultural, economic, and social contexts.

Probing the underlying causes of thyrotoxicosis and its applied significance: a comprehensive evaluation

Fasih Iqbal — 2024-03-31

OBJECTIVE: To determine the significance of etiological basis of thyrotoxicosis in guiding optimal treatment selection and its correlation with age and the presence of goiter.

METHODS: This cross-sectional study was conducted at MTI-Hayatabad Medical Complex in Peshawar, Pakistan, from December 2022 to May 2023. Utilizing nonprobability-consecutive sampling, we enrolled 119 participants, focusing on individuals presenting with thyrotoxicosis confirmed by thyroid function tests (TFTs). Those already undergoing treatment for hyperthyroidism were also included. Essential diagnostic assessments, such as radioiodine scans, erythrocyte sedimentation rate (ESR), and thyroid receptor stimulating antibody tests, were performed as needed. Patients with chronic renal disease, chronic liver disease, and pregnant and lactating women were excluded.

RESULTS: The mean age of participants was 40.39±13.65 years, with 84.03% having TSH <0.1 mIU/L. Elevated ESR (74.17±33.62 mm/1st hour) was noted in thyroiditis. Females constituted 72.3%. Overt hyperthyroidism (51.3%) and Graves’ disease (50.4%) were prevalent. Inappropriately treated cases were 19.3%. Graves’ disease patients with Thyroid receptor stimulating antibodies showed 88% positivity. Treatment modalities included anti-thyroid drugs (43.7%), radioactive iodine therapy (28.6%), conservative (12.6%), and surgery (10.1%). Thyroid dysfunction was most prevalent in the age range of 31-40 years (32.7%). Goiter was absent in 44.5% of participants. Notably, 17.6% had apathetic hyperthyroidism.

CONCLUSION: This research emphasizes the vital understanding of thyroid dysfunctions in Pakistan, revealing Graves' disease as the primary cause of overt hyperthyroidism. Females, particularly aged 31-40, exhibit higher susceptibility. Emphasizing the importance of accurate diagnosis, this study highlights the prevalence of inappropriate prior treatments in thyrotoxicosis cases.