Rehman Medical College

Virulence factors can vary between Shigella (S.) flexneri serotypes. The current study characterized virulence genes among 199 S. flexneri from different serotypes in Peshawar, Khyber Pakhtunkhwa Province, Pakistan, by sequence analysis. Moreover, using the homology model, the 3D protein structure of the serine autotransporter toxin (sat) from S. flexneri was examined for the first time to determine structural changes in the mutant sat protein. Interestingly, the present study reported that ial(spa29/spaR) gene has not shown any relationship to the previously known sequence of S. flexneri, but it has a striking resemblance to previously reported cases that were identified in Shigella dysenteriae and Escherichia coli. Furthermore, 15 strains of S. flexneri, all of which are members of serotype 7a, were found to carry the single-point mutation (G246A) in sat, which resulted in an exchange of amino acid (Gly82Arg). Preliminary data reveal a potential link between the sat gene mutation and severe clinical illness patients; however additional study is needed to verify this relation. Overall, the results of the mutant sat proteins homology model validation showed a slight, but not significant, alteration in protein structure.

HPV vaccine is effective in preventing cervical cancer in adolescents and young adults. Despite its proven effectiveness, vaccination rates remain suboptimal due to several barriers, such as insufficient knowledge and vaccine hesitancy. Gamification has emerged as an effective strategy for getting people involved and altering their health-related behaviors. To date, there are no literature-based systematic reviews on the effectiveness of gamification in leveling up HPV immunization and knowledge among adolescents or young adults. This systematic review seeks to evaluate the impact of gamification interventions on HPV vaccine knowledge, intentions, and attitudes in adolescents and young adults. This systematic review was conducted using PRISMA guidelines and PI(E)COS model. The study protocol was registered in PROSPERO: CRD42024557308. Peer-reviewed scientific articles regarding gamification interventions in the context of promoting HPV were included. The database search encompassed PubMed, Scopus, Cochrane Central, PsycINFO, as well as manual searches from Google Scholar. This systematic review identified 216 records, of which nine studies met the full inclusion criteria. These studies focused on adolescents and young adults between the ages of 11 and 26 across different geographical locations. The reviewed studies indicate that gamification interventions, particularly those delivered through digital platforms, can effectively enhance knowledge, positively influence attitudes, and improve intentions to receive the HPV vaccine among adolescents. Customization features and interactive elements in the gamified intervention played a crucial role in engaging participants and driving vaccine-related behaviors. However, the findings were not universally consistent, with some studies reporting no significant impact. The evidence from this review supports the potential of gamification interventions to positively influence adolescent health, particularly in the context of HPV vaccination. Nonetheless, the review is limited by the small number of quantitative studies. Consequently, larger-scale studies are necessary to validate the effectiveness of these interventions robustly. CRD42024557308.

BACKGROUND:Microcalcifications are among the earliest radiographic findings suggestive of breast malignancy and are often detected in women undergoing diagnostic mammography. Their association with breast cancer, independent of other risk factors, is clinically important but not fully understood. OBJECTIVE:To investigate the associations between mammographic microcalcifications and breast cancer risk in women undergoing diagnostic mammography. DESIGN:Case‒control study. SETTING:Breast Care Unit (BCU), Rehman Medical Institute (RMI), Peshawar, Pakistan. PARTICIPANTS:Three hundred women aged 30 years and above who underwent diagnostic mammography; 150 patients with histologically confirmed breast cancer and 150 (age, menopausal status and ACR density) matched controls with normal breasts. MAIN OUTCOME MEASURES:The presence of microcalcifications on mammography. Covariates: ACR breast density, menopausal status, and age group. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated via multivariable logistic regression. RESULTS:Microcalcifications were significantly more common in patients (50.7%) than in controls (20.7%) and were independently associated with breast cancer (adjusted OR 5.51, 95% CI: 3.02-10.05; p<0.001). Compared with premenopausal women, perimenopausal women had the highest odds of having breast cancer (adjusted OR 14.30, 95% CI: 3.80-53.78, p<0.001), followed by postmenopausal women (adjusted OR 4.50, 95% CI: 1.74-11.63, p=0.002). The ACR breast density categories B and C were significantly associated with microcalcifications but not independently with breast cancer. CONCLUSION:Mammographic microcalcifications are strong independent predictors of breast cancer, particularly among peri- and postmenopausal women, highlighting their clinical value in risk stratification and diagnostic evaluation.

Respected Editor, An inflammation of the heart muscle is called myocarditis. COVID-19 mRNA vaccine related myocarditis has drawn a considerable amount of attention in public. Fear of complications post-vaccination is a key obstacle in vaccine uptake. Therefore, it is crucial to put these concerns to contextualiseof extensive clinical data. A meta-analysis by Voleti et al reported that relative risk of getting myocarditis in patients with covid-19 related infection was seven times more than the group with mRNA covid vaccines1. The U.S. food and drug administration in their 2025 updated reported that myocarditis was reported to be approximately eight cases per million doses in individuals aged 6 months to 64 years and the number rose to 27 per million doses in males aged 12 to 24 years2. A study conducted from March 2020 to January 2021 reported that the risk of getting myocarditis in covid-19 patients was 16 times higher than those without infection3. A study by Shay et al (2021) reported that myocarditis associated with vaccine typically presented as mild, was rarely associated with deaths, and was responsive to non-steroidal anti-inflammatory drugs (NSAIDs) 4. Patone et al (2022) reported contrasting presentation of myocarditis associated with covid-19 infection, this type of infection more frequently led to ventricular dysfunction, arrhythmias and fatalities5. Semenzato et al (2024) conducted a countrywide cohort study in France which reported less severe cardiovascular events after 18 months of follow up in post-vaccinationmyocarditis compared to myocarditis of other origins6. The disparity in incidence and outcomes severity strongly suggest that the benefits of COVID-19 mRNA vaccine outweigh the risks. Considering these findings, we recommend that the public should be informed regarding the risks of COVID-19 infection related myocarditis, which poses a greater threat as compared to COVID-19 mRNA vaccine associated myocarditis. We recommend that high risk groups should be identified, and alternate formulations or dosing intervals should be used for the high-risk group. More extensive randomised trials and continuous monitoring of vaccinated people should continue to refine our understanding of vaccine and infection related complications.