Explore the vast range of titles available.

Background Jigsaw method is a structured cooperative-learning technique that lays the groundwork towards achieving collective competence, which forms the core of effective clinical practice. It promotes deep learning and effectively enhances team-work among students, hence creating a more inclusive environment. Objective Present study was designed to introduce jigsaw model of cooperative learning to early-year undergraduate medical students, measure its effectiveness on their academic performance, and evaluate the perspectives of both students and faculty members regarding the same. Methods It was a mixed method research, involving eighty second-year undergraduate medical students. The jigsaw cooperative learning approach was introduced in two themes within neurosciences module. Students were divided into two equal groups, with one group experiencing typical small-group discussions (SGDs) in first theme and other group exposed to jigsaw approach. The groups were then reversed for second theme. Following the activity, an assessment comprising multiple-choice-questions was conducted to evaluate the impact of jigsaw technique on students’ academic performance, with scores from both groups compared. Student perspectives were gathered through self-designed and validated questionnaire, while faculty perceptions were obtained through focus group discussions. Quantitative data were analyzed using SPSS v22, while thematic analysis was performed for qualitative data. Results The students of jigsaw group displayed significantly higher median assessment score percentage compared to control group ( p  = 0.003). Moreover, a significantly greater number of students achieved scores ≥ 60% in jigsaw group compared to control group ( p  = 0.006). The questionnaire responses indicated a favorable perception of this technique among students, in terms of acceptance, positive interdependence, improvement of interpersonal skills, and comparison with typical SGDs. This technique was also well-perceived within the educational context by faculty members. Conclusion The jigsaw method is associated with higher levels of academic performance among students when compared to typical small-group discussion. The students and faculty perceived this technique to be an effective cooperative learning strategy in terms of enhanced student engagement, active participation, and a sense of inclusivity.

In most mammals, a withdrawal of the pro-gestational hormone progesterone (P4) is necessary for labor onset. In murine cervix, P4 withdrawal is mediated by enzymes steroid 5-alpha-reductase type 1 (SRD5A1) and 20-alpha-hydroxysteroid-dehydrogenase (20α-HSD). Previously, we have shown that inflammatory stimuli induce 20α-HSD levels in uterine muscle (myometrium). Here, we hypothesized that (1) infectious inflammation alters the levels of both P4-metabolizing enzymes in mouse cervix, which consequently ceases P4-mediated inhibition of cervical remodeling, thereby inducing preterm labor (PTL); (2) a progestin, selective progesterone receptor modulator promegestone (aka R5020), non-metabolizable by 20α-HSD, can block lipopolysaccharide (LPS)-induced PTL in mice by maintaining P4 signaling and preventing cervical remodeling. Using RT-PCR and IHC/IF methods, we evaluated the effect of inflammation on the expression of both enzymes in mouse cervix and determined if R5020 can prevent cervical remodeling and PTL in mice. We found significant induction of SRD5A1 and 20α-HSD proteins (p < 0.01), as well as transcript levels of pro-inflammatory cytokines Il1b, Il6, chemokines Cxcl1, Ccl2, cervical ripening enzyme Has2, hyaluronic acid binding protein/HABP (p < 0.05), and a simultaneous decrease in major extracellular fibrillar proteins, collagen type 1 and type 3 (col1a1, col3a1), in mouse cervix during PTL. The prophylactic administration of R5020 in pregnant mice significantly inhibited cervical remodeling and prevented PTL irrespective of the route of LPS-induction, systemic or local. We concluded that R5020 is a promising novel drug application for preterm birth prevention.

BackgroundReplacing bioprosthetic valves is common but can cause coagulation issues. This study assesses the safety and efficacy of Direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in bioprosthetic valve procedures.MethodsPubMed, Cochrane Central, and ScienceDirect were searched till May 2025. The risk ratios (RRs) were pooled with 95% confidence intervals (CIs) under the random effects model using Review Manager software. The quality assessment was conducted using the Cochrane risk of bias (RoB 2.0) tool.ResultsEight randomized controlled trials involving 3863 patients were included in the meta-analysis. DOACs were associated with a significant reduction in the risk of stroke or systemic embolism compared with VKAs (RR = 0.48; 95%CI: [0.26, 0.88]; p = .02). The rate of major bleeding was similar between the DOACs and VKAs (RR = 0.92; 95%CI: [0.49, 1.72]; p = .79). There was no significant difference in the incidence of any stroke between the two groups (RR = 0.65; 95%CI: [0.32, 1.31]; p = .23). The occurrence of clinically relevant non-major bleeding (RR = 1.17; 95%CI: [0.97, 1.40]; p = .10), all-cause mortality (RR = 0.94; 95%CI: [0.75, 1.17]; p = .57), and intracranial hemorrhage (ICH) (RR = 0.71; 95%CI: [0.40, 1.26]; p = .25) were comparable between the groups.ConclusionDOACs seem safe after bioprosthetic valve implantation, lowering the risk of stroke or systemic embolism. However, rates of major bleeding, clinically relevant non-major bleeding, any stroke, ICH, and all-cause mortality were comparable between DOACs and VKAs.

Background/Objectives: Coronary artery disease (CAD) remains the leading cause of mortality worldwide, with South Asia bearing a disproportionately high and rising burden, particularly at younger ages. The present study aimed to investigate genetic variants associated with premature coronary artery disease (PCAD) using whole-genome sequencing (WGS). Methods: WGS was conducted on 12 people (five PCAD cases, seven matched controls) to assess feasibility and methodology for future large-scale research. High-quality genomic DNA was sequenced at a minimum read depth of 10× with a quality threshold of Q30. Variant calling with stringent quality control identified single-nucleotide polymorphisms (SNPs), followed by annotation against gnomAD for allele frequencies and ClinVar for pathogenicity. Protein-coding variants were filtered, and candidate genes were prioritized for comparative analysis between cases and controls. Results: An average of over 8.8 million SNPs per individual was identified, with comparable overall variant distributions between cases and controls. Initial analyses revealed 120 SNPs exclusively present in PCAD cases. All protein-coding variants were rare (allele frequency < 0.0001), and none were previously classified as pathogenic in ClinVar. After filtration, 87 candidate genes were prioritized. Enriched or unique variants in PCAD cases are mapped to genes involved in lipid metabolism, endothelial dysfunction, inflammatory signaling, immune regulation, thrombosis, vascular remodeling, and metabolic processes. Additional variants were identified in genes related to smooth muscle proliferation, oxidative stress, and other biological pathways. Conclusions: This WGS pilot study provides an initial overview of the genomic landscape of PCAD in a South Asian cohort, highlighting rare variants across multiple biological pathways implicated in atherosclerosis that need validation in a large-scale study.

Background Helicobacter pylori infection, linked to peptic ulcer disease and gastric cancer, faces declining eradication rates due to antibiotic resistance. High-dose esomeprazole-amoxicillin dual therapy (HDDT) is a promising rescue regimen, but its efficacy and safety compared to standard therapies remain unclear. Methods This systematic review and meta-analysis, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, included four randomized controlled trials ( n  = 1,230) that compared HDDT with standard regimens. PubMed, Embase, and Cochrane CENTRAL were searched through April 2025. Outcomes included eradication rates, compliance, and adverse events. A meta-analysis was conducted using the inverse variance method, with heterogeneity assessed via I² statistics. Results HDDT showed no significant difference in eradication rates (RR = 0.98, 95% CI: 0.89–1.08, P  = 0.6438) or compliance (RR = 1.04, 95% CI: 0.97 to 1.12, P  = 0.2522) compared to standard therapies. However, HDDT significantly reduced overall adverse events (RR = 0.28, 95% CI: 0.18–0.44, P  < 0.0001), including nausea, headache, fatigue, dysgeusia, bloating, and abdominal pain. No significant differences were observed for serious adverse events, diarrhea, dizziness, decreased appetite, constipation, or skin rash. Heterogeneity varied across the outcomes. Conclusion HDDT is as effective as standard regimens for H. pylori rescue treatment, with a superior safety profile, supporting its use in patients with prior treatment failures.

Coronary artery disease (CAD) is the leading cause of death worldwide. After percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) is recommended to reduce thrombotic events. This meta-analysis assesses the effectiveness of clopidogrel compared to aspirin monotherapy following DAPT post-PCI. From inception to April 2025, an exhaustive literature search was conducted across electronic databases, including PubMed, Cochrane Library, ScienceDirect, EMBASE, and Web of Science. Risk ratios (RRs) along with 95% confidence intervals (CIs) were pooled using the random-effects model in Review Manager. Leave-one-out sensitivity analysis and funnel plots were used to evaluate heterogeneity and publication bias, respectively. Six studies, including 3 RCTs and 3 observational studies, spanning over 19 494 patients, were included in our analysis. Clopidogrel significantly reduced major adverse cardiovascular events (MACE) (RR = 0.78; 95% CI: [0.69, 0.89];  = .0002;  = 0%) and myocardial infarction (MI) (RR = 0.73; 95% CI: [0.56, 0.94];  = .02;  = 21%) compared to aspirin. Likewise, the clopidogrel group demonstrated a substantial advantage in reducing the incidence of any stroke (RR = 0.66; 95% CI: [0.49, 0.89];  = .006;  = 14%), including ischemic stroke (RR = 0.69; 95% CI: [0.49, 0.97];  = .04;  = 0%). All other endpoints, including hemorrhagic stroke, all-cause mortality, cardiac death, major bleeding, stent thrombosis, repeat, and target vessel revascularization, were comparable between the 2 arms. Clopidogrel significantly reduced the incidence of MACE, MI, and stroke after DAPT following PCI compared to aspirin, indicating greater effectiveness. However, the main conclusion of this meta-analysis depends primarily on the estimates from RCTs. Additional randomized studies are necessary to confirm these results and support clinical decision-making.

Background: Due to neurohormonal disturbances that occur following brain death, thyroid hormone therapy has been proposed as a means to enhance cardiac function in brain-dead organ donors. However, it remains unclear whether thyroid hormone administration improves clinical outcomes in potential heart donors. Methods: A comprehensive review of clinical trials was conducted to evaluate the impact of thyroid hormone therapy on heart viability and transplantation outcomes. A total of nine randomized controlled trials (RCTs) involving 1189 potential heart donors were included. Results: Thyroid hormone supplementation effectively restored circulating thyroid hormone levels in brain-dead donors. However, findings regarding improvements in cardiac function and transplantation outcomes were inconsistent across studies. While some RCTs reported marginal improvements in hemodynamic parameters and heart transplant viability, these results were not consistently replicated. Furthermore, most studies did not demonstrate a significant enhancement in recipient survival or graft function associated with thyroid hormone therapy. Conclusion: Although thyroid hormone therapy restores thyroid hormone levels in brain-dead donors, current evidence does not consistently support its effectiveness in improving donor heart viability or recipient outcomes. Further research is necessary to clarify the role of thyroid hormone therapy in donor management and its impact on long-term transplant success.

Introduction: Vitamin D3 (VD3) deficiency is a strong predictor of gestational diabetes. Therefore, VD3 supplementation during the antenatal period could prevent the development of gestational diabetes via its effects on insulin secretion, insulin sensitivity, body mass index (BMI), and adiponectin production.Objectives: To observe the effect of VD3 supplementation on adiponectin and BMI and to explore the effect of VD3 supplementation on the association among VD3, adiponectin, and BMI in pregnant women with gestational diabetes.Methods: A randomized control trial was performed after receiving consent at Postgraduate Medical Institute, Lahore. Subjects at 20-26 weeks of gestation with gestational diabetes and with a deficiency/insufficiency of VD3 were included. The study excluded those who were smokers, had multiple pregnancies, or had other gestational complications. Subjects were categorized into interventional (VD3 supplementation) and control groups. The institutional ethical committee approved the study. Serum samples were used for enzyme-linked immunosorbent assay estimation of VD3 and adiponectin levels. Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 21.0, Armonk, NY) software was used to analyze data. Student t-tests were applied to compare quantitative variables, and Chi-square tests were utilized to compare qualitative variables. Pearson’s correlation and linear regressions were performed to explore the association. At a 95% confidence interval, a p-value of ≤0.05 was taken as significant.Results: With an increase in serum VD3 levels, a decrease in serum adiponectin level was observed in pregnant women with gestational diabetes (interventional group: r = -0.088, p = 0.74); however, after the intervention of VD3 supplementation in the same subjects, an increase in serum adiponectin level was noted with an increase in VD3 (interventional group: r = 0.273, p = 0.28). A significant direct relationship was found between BMI and adiponectin in the same study population (interventional group: r = 0.7, p = 0.001). Interestingly, after the intervention, BMI tends to be less likely to increase adiponectin levels (interventional group: r = 0.09, p = 0.73). Moreover, an inverse association was exhibited between BMI and VD3 levels in all the study groups before intervention (control group: r = -0.07, p = 0.78; interventional group: r = -0.035, p = 0.89) and after intervention (interventional group: r = -0.12, p = 0.65), except in the control group after the intervention span, where BMI mildly raises the VD3 levels (r = -0.12, p = 0.65).Conclusion: BMI increases with an increase in serum adiponectin levels in gestational diabetic women, but after VD3 supplementation, BMI was less likely to influence adiponectin. Also, with an increase in BMI, a decrease in the VD3 in all study groups was observed except in the control group after VD3 supplementation.

Introduction Greying of hair is an inevitable phenomenon that occurs commonly as a person ages. It usually occurs in the fourth decade regardless of gender but now a days, even people in their early twenties can experience premature greying. The objective of our study was to determine the frequency of premature greying of hair and its impact on the socio-cultural spheres of life and self-esteem of medical students. Methodology It is a descriptive cross-sectional study conducted at Foundation University Medical College (FUMC) from January to February 2017. All medical students of FUMC who gave their consent were included in the study sample. Students who were absent or unwilling to participate were excluded. Data was collected through a self-administered questionnaire, which was then analysed using SPSS version 17 (SPSS Inc., Chicago, IL). Results Out of 673 students, 210 (31.2%) suffered from premature greying of hair. The prevalence was higher among females (155/73.8%) as compared to males (55/26.2%). There was a statistical difference in perception of both the genders, regarding those with premature greying of hair trying to hide it (p-value = 0.000), premature greying of hair as contagious (p-value = .009) and the affected looking older than their actual age (p-value = 0.036). Conclusion The study showed that premature greying affected the socio-cultural spheres of students' lives. Females were more prone to developing premature greying of hair. Genetics also play a significant role in the phenomenon. No positive correlation was found by using Rosenberg Self-esteem scale.

Objective: To determine and compare serum ferritin levels in non-alcoholic fatty liver disease (NAFLD) patients of our ethnicity. Study Design: Cross sectional comparative study. Place and Duration of Study: The study was conducted at Radiology department of Shalamar Hospital, Medical OPD of Combined Military Hospital, Lahore and Medical OPD of Omer Hospital, Lahore, from Jul 2015 to Sep 2015. Methodology: A total number of 43 non-alcoholic fatty liver disease patients diagnosed after ultrasonography were included in the study. An equal number of age, gender and body mass index (BMI) matched healthy controls were selected by non-probability purposive sampling. Fasting serum ferritin levels, body mass index and waist circumference were measured in both the cases and controls. Data were entered and analyzed on SPSS 21. For quantitative data median IQR was calculated. Mann Whitney U-test was used for group comparison. To find an association, Spearman‟s Ranked correlation was applied. A p-value of ≤0.05 was taken as significant. Results: The non-alcoholic fatty liver disease cases had significantly higher serum ferritin (p<0.001) compared to the controls and a significant correlation between ferritin with body mass index and waist circumference in the non-alcoholic fatty liver disease subjects was recorded (p=0.04 and p=0.03 respectively). Conclusion: The non-alcoholic fatty liver disease patients have higher levels of serum ferritin as compared to the healthy controls in our ethnicity but within normal range.