Shifa College of Medicine

ABSTRACT Situs inversus totalis (SIT) reverses normal anatomical landmarks used during cholecystectomy, requiring careful preoperative imaging, a mirror‐image surgical strategy, and strict achievement of the critical view of safety before ductal or vascular division. Despite visceral transposition, open cholecystectomy via a left subcostal (mirror‐image Kocher) incision can be performed safely.

Posterior reversible encephalopathy syndrome (PRES) remains a serious neurological complication associated with eclampsia/pre-eclampsia. Early identification remains challenging due to heterogeneous presentations and limited consensus on associated clinical and laboratory factors. Therefore, we aimed to assess clinical and laboratory factors associated with PRES by pooling data from primary studies. A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Embase, and Web of science were searched from inception to March 25, 2025. Primary outcomes included PRES incidence, while secondary outcomes included biomarkers, maternal and fetal outcomes, and imaging characteristics. Risk of bias was assessed using Newcastle Ottawa’s scale and National Institutes of Health (NIH) tool. A random-effects model was employed for meta-analysis. A total of 28 studies were included. The pooled incidence of PRES was 38.68

INTRODUCTION:The goal of the current study was to identify factors forming the professional identity of medical teachers teaching basic health sciences by developing and validating a questionnaire. METHODOLOGY:A self-administered questionnaire was developed with items on community of practice, passion for teaching, students' feedback, work-life balance, religious values, administrative support, work environment, job satisfaction, societal apathy, and opportunities for professional growth. The questionnaire was created after conducting interviews with faculty of basic health sciences, pilot tested, modified and verified by expert panel. Overlapping items and those which did not represent themes were removed and a final 20-item questionnaire was created. Finally, exploratory factor analysis was performed. The sample size was 301, and the participants recruited, regardless of gender, were medical teachers teaching basic health sciences, and had teaching experience of more than one year. RESULTS:A total of 20 high-loading components made up the five variables of Exploratory Factor Analysis, which explained 50% of the variance. The 20-item questionnaire was found to have satisfactory psychometric qualities. Five major constructs grouped as "CLaSiC-R" were unveiled and termed as identity blueprint of basic sciences medical teachers. They are Community of practice, Legacy, job Satisfaction, Commitment to excellence and Resilience. Cronbach's alpha of the 20 items was 0.648. CONCLUSION:The CLaSiC-R determines the five major constructs that form the professional identity of basic sciences medical teachers. The scale serves as a valuable indicator of key areas of professional development namely, socialization, religious values, emotional intelligence, motivation, job roles, committment to excellence, and work environment. Reforms in service structure and structured faculty development programs might facilitate their professional journey.

ABSTRACT Familial partial androgen insensitivity syndrome is a rare cause of 46, XY disorder of sex development. It includes marked phenotypic variability, even among siblings. Persistent undervirilization despite normal androgen levels should prompt early multidisciplinary evaluation and counseling, especially where genetic testing is limited.

Background Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) accounts for 5–10% of all cases of acute myocardial infarctions. It has recently been observed in increasing numbers in younger patients without established coronary risk factors. While thought to be less severe, MINOCA may be associated with malignant arrhythmias and conduction disturbances. A post-anterior ST-elevation myocardial infarction (STEMI) complete heart block (CHB) is uncommon in this demographic and may be related to severe septal ischemia. Case Presentation We describe a case of a 19-year-old male who never had comorbid conditions before admission for classic ischemic chest pain with anterior STEMI. He underwent streptokinase thrombolytic therapy, for which coronary arteriography disclosed normal coronaries with suggestions of transient thrombotic occlusions with spontaneous recanalization. He returned with recurrent pain in the chest with prompt development of symptomatic CHB with hypotension for which he required dopamine infusion with transvenous pacing. His conduction disturbances progressed from CHB to bifascicular block, then to trifascicular block, with CHB eventually. Repeat coronary arteriography disclosed normal coronaries once more. The echocardiogram disclosed an ejection fraction of 45% with moderate wall motion abnormalities. Because of conduction instabilities, he underwent permanent pacing with significant improvement thereafter, to be sent home in stable conditions. Conclusion This case brings into focus a very rare presentation of MINOCA in a young patient that was complicated by progressing conduction system disease that needed permanent pacing. The importance of early recognition of MINOCA-related STEMI due to conduction system disease with careful monitoring, irrespective of a normal coronary cath angiogram, can once again be appreciated.