Fatima Jinnah Medical University (Urdu: جامعہ طبی فاطمہ جناح), previously known as Balak Ram Medical College, is a public medical university located in Lahore, Punjab, Pakistan. Fatima Jinnah Medical University with its associated teaching hospital Sir Ganga Ram Hospital, is a medical institution to teach and train female doctors and post-graduate students and provide medical and healthcare facilities to the citizens of the country, particularly in and around Lahore, and more particularly to the female population. It is now a tertiary healthcare unit and is recognised by the Higher Education Commission of Pakistan.Sir Ganga Ram Hospital was established in 1921 in the walled city of Lahore by a philanthropist Sir Ganga Ram who also donated a piece of land. The hospital was shifted to its present location in 1943 to cope with the growing demand for medical and health care services.On June 30, 2015 the Health Department of Pakistan changed the status of the Medical College to the Medical University and the current principal was made the vice chancellor of the university.
This tutorial explains when systematic review authors may consider performing a sensitivity analysis in a meta-analysis. Such scenarios include removing studies at high risk of bias, exploring the effect of outliers and examining differences in study characteristics (e.g., participants’ age, study design). In addition, examples are provided, as well as advice on how to interpret and report the results. The tutorial also explains the differences between subgroup and sensitivity analyses, as well as describing the disadvantages of a sensitivity analysis. To support this tutorial, a link to an online module, which includes videos and quizzes, is also provided.
Guillain-Barré syndrome (GBS) is a severe immune-driven polyneuropathy marked by the acute onset of flaccid paralysis, areflexia, and in severe cases, life-threatening autonomic or respiratory failure. Although the clinical presentation and diagnostic criteria are widely established, the precise mechanisms underlying GBS are complex and poorly understood. This review summarizes current literature on the interplay of post-infectious triggers, molecular mimicry, and host susceptibility as influenced by genetic and epigenetic variables. Infectious pathogens such as Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, and, more recently, Zika and SARS-CoV-2 operate as initiators via molecular mimicry, in which pathogen antigens imitate peripheral nerve components, triggering the formation of autoreactive antibody and T-cell responses. Acute inflammatory demyelinating polyneuropathy (AIDP) is characterized by demyelination and inflammatory cytokine responses, whereas acute motor axonal neuropathy (AMAN) is associated with ganglioside-targeting antibodies and axonal loss. Genetic polymorphisms, such as those in HLA, TLR4, MMP9, and CD1A, influence vulnerability to the disease and its progression. Given that many patients experience persistent sensory, motor, and autonomic dysfunction despite treatment, the identification of long-term complications highlights the necessity of customized rehabilitation and long-term follow-up. Traditional therapeutic techniques, such as plasma exchange and intravenous immunoglobulin, remain in use, but current trials on complement inhibitors, antibody-degrading enzymes, and mesenchymal stem cell therapies indicate a move toward mechanism-driven approaches. Despite these advances, significant knowledge gaps remain regarding predictors of poor outcomes and underlying causes of persistent disabilities and complications, highlighting the need for continued translational and clinical research.
End-stage organ failure remains a leading cause of morbidity and mortality worldwide. Organ transplantation is the most effective treatment for irreversible organ dysfunction; however, donation rates remain critically low in many low- and middle-income countries, including Pakistan. Understanding knowledge, attitudes, and intent toward organ donation among future healthcare providers is essential for designing effective educational interventions. Cultural, religious, and societal factors strongly influence organ donation behavior in Pakistan, yet no validated, context-specific instrument exists to systematically assess these determinants among medical students. To develop and psychometrically validate a questionnaire assessing knowledge, attitudes, and intent toward organ donation among undergraduate medical students in Pakistan using exploratory and confirmatory factor analysis. A multicenter cross-sectional study was conducted among undergraduate medical students from five medical universities in Punjab, Pakistan. A questionnaire was developed through literature review, expert panel evaluation, and cognitive testing, followed by psychometric validation. Exploratory factor analysis (EFA) was performed to identify the underlying factor structure, and confirmatory factor analysis (CFA) was used to assess model fit. Internal consistency was evaluated using Cronbach’s alpha. Receiver operating characteristic (ROC) curve analysis was conducted to determine an optimal cut-off score for predicting willingness to donate organs. A total of 425 students participated. Exploratory factor analysis identified a six-factor structure: (1) Eligible donor and needed recipient, (2) Benefits of organ donation, (3) Scientific and religious knowledge about organ donation, (4) Fears about organ donation, (5) Barriers to organ donation registration, and (6) Organ donation mindset in Pakistan. Confirmatory factor analysis demonstrated acceptable model fit (CFI = 0.94, TLI = 0.91, RMSEA = 0.059). The overall questionnaire showed acceptable internal consistency (Cronbach’s alpha = 0.61), with subscale values ranging from 0.621 to 0.837. ROC analysis yielded an area under the curve of 0.716, with an optimal cut-off score of ≥36, demonstrating moderate accuracy in predicting willingness to donate organs. This study developed and validated a culturally sensitive, six-factor questionnaire to assess Pakistani undergraduate medical students’ knowledge, attitudes, and willingness regarding organ donation. The tool demonstrated good reliability and acceptable model fit, supporting its utility in capturing key sociocultural influences on donation perceptions. While findings suggest roles for religion, trust in healthcare, and procedural barriers, the study’s primary aim was tool validation, and these trends require further investigation. The validated instrument offers a valuable resource for future research and targeted educational interventions, though its generalizability is limited to similar populations and does not encompass all psychosocial determinants.
Background: Variability in breast cancer response to neoadjuvant chemotherapy highlights the need for minimally invasive biomarkers capable of reflecting treatment effectiveness during therapy. Circulating exosomal microRNA-21 may provide dynamic molecular information because of its stability and association with tumor progression and treatment response. Objective: To evaluate longitudinal changes in circulating exosomal miR-21 during neoadjuvant chemotherapy and examine their association with tumor response. Methods: This parallel-group randomized controlled trial enrolled 72 women with stage II–III breast cancer at a tertiary-care oncology center in Punjab, Pakistan. Participants were allocated equally to protocolized exosome-guided monitoring or routine clinical monitoring. Blood was collected at baseline and before chemotherapy cycles for exosomal miR-21 quantification using quantitative reverse-transcription polymerase chain reaction. Final outcomes were available for 67 participants. Analyses included t-tests, repeated-measures analysis of variance, risk ratios, and Pearson correlation. Results: Post-treatment miR-21 expression was lower in the intervention group than in the control group (1.42±0.39 versus 2.11±0.53; mean difference=−0.69; 95% CI: −0.92 to −0.46; p<0.001). Tumor shrinkage was greater by 15.50 percentage points (95% CI: 6.80–24.20; p<0.001). RECIST response was 84.8% versus 64.7% (p=0.058), and pathological complete response was 39.4% versus 23.5% (p=0.162). miR-21 reduction correlated with tumor shrinkage (r=0.62; 95% CI: 0.45–0.75; p<0.001). Conclusion: Serial exosomal miR-21 measurement reflected treatment-associated molecular changes and was associated with radiological tumor reduction, but larger standardized trials are required before clinical implementation
