Background The integration of large language models (LLMs) like ChatGPT in diagnostic medicine, with a focus on digital pathology, has garnered significant attention. However, understanding the challenges and barriers associated with the use of LLMs in this context is crucial for their successful implementation. Methods A scoping review was conducted to explore the challenges and barriers of using LLMs, in diagnostic medicine with a focus on digital pathology. A comprehensive search was conducted using electronic databases, including PubMed and Google Scholar, for relevant articles published within the past four years. The selected articles were critically analyzed to identify and summarize the challenges and barriers reported in the literature. Results The scoping review identified several challenges and barriers associated with the use of LLMs in diagnostic medicine. These included limitations in contextual understanding and interpretability, biases in training data, ethical considerations, impact on healthcare professionals, and regulatory concerns. Contextual understanding and interpretability challenges arise due to the lack of true understanding of medical concepts and lack of these models being explicitly trained on medical records selected by trained professionals, and the black-box nature of LLMs. Biases in training data pose a risk of perpetuating disparities and inaccuracies in diagnoses. Ethical considerations include patient privacy, data security, and responsible AI use. The integration of LLMs may impact healthcare professionals’ autonomy and decision-making abilities. Regulatory concerns surround the need for guidelines and frameworks to ensure safe and ethical implementation. Conclusion The scoping review highlights the challenges and barriers of using LLMs in diagnostic medicine with a focus on digital pathology. Understanding these challenges is essential for addressing the limitations and developing strategies to overcome barriers. It is critical for health professionals to be involved in the selection of data and fine tuning of the models. Further research, validation, and collaboration between AI developers, healthcare professionals, and regulatory bodies are necessary to ensure the responsible and effective integration of LLMs in diagnostic medicine.

Objective: To assess effect of tranexamic acid on blood loss during and after cesarean section.Methodology: We performed a randomized controlled trial at Bahawal Victoria Hospital, Bahawalpur from March to December 2013. A total of 120 parturient women with singleton gestation planned to have cesarean section (CS) at ? 37 weeks were randomized to receive 1 g tranexamic acid slowly intravenously over 10 minutes or placebo injection 20 minutes before CS. Blood loss was measured during and for up to two hours after the operation. Any side effects, complications, medications required, and duration of hospital stay were recorded.Results: Sixty women received transexamic acid and 60 received placebo. Mean blood loss was 260 +/- 11 ml vs 485 +/- 16 ml in the tranexamic acid group versus the control group (p = 0.003). Only mild, transient adverse effects like nausea and visual disturbances were observed in study group.Conclusions: Administration of tranexamic acid was associated with reduced blood loss during and after CS. This could be of benefit for anemic women or those who either refuse blood transfusion or can't arrange donors.

Objective: To study the role of mast cells and angiogenesis in different histological types of ameloblastoma.Methodology: In this prospective study, 28 biopsies of different histological types of ameloblastoma were evaluated. Microvessels were stained with CD-34 and mast cells were counted using Toluidine blue stain.Results: Mean age of patients was 29.71 +/- 2.544 (95% Cl: 24.4934.93). The most common histological type was plexiform followed by follicular type. Mandible was more commonly involved (89.3%) than maxilla (10.7%). Mean mast cell count in all 28 cases was 6.39 +/- 0.915 and was significantly higher than normal oral mucosa (p=0.000). Mean microvessel count was 12.75 +/- 1.234 but it was not significantly higher than mean MVD of normal oral mucosa (p=0.242). The mast cell count differed significantly among different histological types of ameloblastomaConclusion: The mast cell density was significantly increased in ameloblastoma but the increase in mast cells did not correlate with angiogenesis in and around the tumour tissue.

Objective: We studied expression of S100A6 and its pattern to see its role in differentiation of various keratinocytic tumors.Methodology: Immunohistochemistry was performed using streptavidin-biotin peroxidase technique with the polyclonal antibody for S100A6. The expression was based on percentage of tumor cells showing cytoplasmic positivity and the cytoplasmic staining intensity. Only cytoplasmic expression was considered as positive.Results: All the types of keratinocytic tumors showed positivity for S100A6 except basal cell carcinoma (BCCs). Among SCCs, higher expression of S100A6 was seen in well-differentiated squamous cell carcinoma (SCCs) as compared to poorly-differentiated ones. Only basosquamous BCCs i.e. BCCs with focal areas of squamous differentiation showed S100A6 positivity. In benign keratinocytic lesions including acanthomas and verrucas, mature squamous cells were found positive with no significant difference in pattern of staining. The precancerous lesion i.e. actinic keratosis and Bowen's disease showed non-specific S100A6 staining.Conclusions: S100A6 is consistently expressed in mature squamoid cells of keratinocytic tumors with a sensitivity of 98%, if we exclude BCCs.

Xeroderma pigmentosum is an uncommon inherited autosomal recessive disorder. Affected patients have a 2000-fold amplified risk of skin cancer. There is an inability to repair the damage to genetic material caused by ultraviolet light. Basal cell carcinoma is the most commonly associated carcinoma followed by squamous cell carcinoma and melanoma. It is a highly mutilating disorder where occurrence of multiple cancers and repeated surgical treatments result in serious psycho-social implications. We present a case of diagnosed xeroderma pigmentosum in a 25 year old male who presented with multiple lesions and non-healing ulcers on face. Four surgical specimens from left lower eyelid, chin, right cheek and upper lip were taken for histopathological diagnosis. Microscopic examination revealed five different tumors from biopsies of these sites - specimen from right cheek revealed two morphologically distinct tumors. The tumors include basosquamous carcinoma, nodular basal cell carcinoma, adenoid basal cell carcinoma, malignant melanoma and cavernous hemangioma.

Aim: To correlate the placental morphometric parameters with newborn weight between the two groups i.e. normal vs. patients of preeclampsiaStudy design: Case-control studyPlace & duration of study: Department of Anatomy, Sheikh Zayed Medical College, Rahim Yar Khan in collaboration with Departments of Anatomy, Pathology and Obstetrics and Gyanecology, Quaid-eAzam Medical College Bahawalpur, from August 2011 to November 2012.Results: One hundred human placentae, 50 were from normal pregnant women as control and 50 from pregnancies complicated by preeclampsia were taken for this study. Samples were grouped as Group A and Group B on the basis of absence and presence of preeclampsia respectively. All samples were studied morphologically. There was significant reduction in weight, diameter, thickness, volume and number of cotyledons of placenta in pre-eclamptic group. Weight and diameter of placenta had significant positive correlation with the weight of newborn in both groups.

Objectives: To find out the risk factors of diabetic retinopathy in type 2 diabetes mellitus. Methodology: It was a cross-sectional study involving 300 patients of type 2 diabetes. Clinical history, relevant examination including fundoscopy and lab investigations were done. Data was analysed with SPSS 17.0. T-test and chi square/Fischer exact were applied to determine significance. Results: Mean age of the patients was 49.04 ± 0.69 years with slight female predominance with male to female ratio of 3:4. Average duration of disease was 7.17 ± 0.38 years. Diabetic retinopathy was diagnosed in (74, 23.9%). Mean HbA1c was 8.15% in patients with retinopathy and 8.884% in those who had no retinopathy (p=0.08). However, duration of DM, age of patients, male gender, high total cholesterol, high LDL and microalbuminuria were significantly associated with the development of retinopathy. Conclusions: Diabetic retinopathy was found in 23.9% of type 2 diabetics. It was associated with duration of disease, age at presentation, male gender, high total cholesterol, high LDL and microalbuminuria. A single high level of HbA1c was not associated with retinopathy.

Objective: To compare the frequency of gestational diabetes mellitus in second and third trimester in obese and non-obese women.Methodology: It was a prospective study conducted at Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital Bahawalpur. Sixty two obese and 62 non-obese women with singleton pregnancy were included in the study at their booking visit at similar to 14-20 weeks of gestation. Women having family history of obesity and chronic ailments and those with age >35 or parity >5 were excluded.Results: Mean age was 28.12 +/- 2.72 years among the group of obese women as compared to 27.89 +/- 2.34 years in non-obese group. Commonest parity among the obese women was 3-4 (n=31, 50%) compared to 46.8 % (n=29) in non-obese group. Development of gestational diabetes mellitus was 22.58% (n=14) in obese group which was significantly higher than 6.45% (n=4) in non-obese group (p=0.001).Conclusion: Gestational diabetes mellitus developed in significantly higher number of obese women as compared to non-obese women.

Objective: Neo-vascularization is vital for an expansion and metastasis of a tumor and is influenced by a number of mediators. Mast cells are believed to release many pro-angiogenic mediators that may help in tumor expansion and invasion. This study describes the role of mast cells and angiogenesis in oral squamous cell carcinoma (OSCC). Study Design: It was a prospective study in which 37 biopsies of well-differentiated OSCC were obtained. Micro-vessels were stained with cluster of differentiation (CD)-34 and mast cells were counted using the Toluidine blue stain. Results: When compared to normal oral mucosal tissue, it was seen that micro-vessel density and mast cell density indeed increases significantly in squamous cell carcinoma; however, they are not correlated to each other. Conclusion: This study reports that angiogenesis does increase in OSCC and mast cells also invade the peri-tumor tissue, but they are not directly correlated.

BACKGROUND Measuring the microvascular and mast cell density in squamous cell carcinoma of lung and correlating them with the patient survival may be helpful to guide the use of cancer chemotherapeutic agents which target molecular mechanisms of tumour angiogenesis and mast cells. MATERIALS AND METHODS It was an observational study. It included 39 newly diagnosed, adult patients of pulmonary squamous cell carcinoma. Angiogenesis was determined by Chalkley's method after immunohistochemical staining of micro-vessels with CD34. Mast cells per HPF were counted in Tolouidine blue stained sections. RESULTS Mean age of the patients was 58.33 ± 9.14 years. Male to female ratio was 9:1. Most (92.3%) patients were current smokers. Majority of tumours (71.8%) were localised to major bronchi and/or near to hilum and many of them (74.4%) were poorly differentiated. Mean micro-vascular density was 11.80 ± 3.66 per HPF which showed strong negative correlation (r = -0.481, p =0.002) between microvascular density (MVD) and tumour grade. Mean mast cell density was 1.60 ± 2.04 which showed strong negative correlation (r=-.683, p =0.0001) with grade. Angiogenesis and mast cell density were found to be positively correlated (r=0.439, p =0.005). High MVD, but not the MCD was associated with poor survival. CONCLUSION Angiogenesis and mast cell density are positively correlated with each other however; only high MVD is associated with decreased survival. Thus, the anti-angiogenic agents may be useful in squamous cell carcinoma lung, especially the well differentiated tumours.

Objective: To determine frequencies and incidence rates of site-specific head and neck squmaous cell carcinoma from Bahawalpur region.Methodology: It was a descriptive study including 184 biopsy proven cases of squamous cell carcinoma from head and neck region seen by Department of Pathology, Quaid-e-Azam Medical College Bahawalpur, Pakistan during January 2008 and December 2012. Data was acquired from hospital and laboratory records and analyzed using SPSS version 18.Results: Mean age of the patients was 55.76 +/- 7.21 (median: 50) years. Male to female ratio was almost 2:1. History of smoking was positive in 72.28% of patients. The most common affected sites in order of frequency were larynx (n=79, 42.93%), hypopharnx (n=36, 19.56%), oral cavity (n=29, 15.76%), face/skin (n=24, 13.04%), lips (n=10, 5.43%) and tongue (n=6, 3.26%). More than a half of the tumours were classified as well-differentiated squamous cell carcinomas (n=94, 51.09%).Conclusion: Head and neck squamous cell carcinoma has a peak age in 6th decade of life and twice common in men as compared to women. Most frequent site of head and neck squamous cell carcinoma in our region was larynx.

INTRODUCTION:Angiogenesis and mast cells affect the behavior of pulmonary adenocarcinoma. Measuring the angiogenesis and mast cell density (MCD) and their effect on survival of the patients may be helpful to guide the use of cancer chemotherapeutic agents which target tumor angiogenesis and mast cells.MATERIALS AND METHODS:It was a descriptive study, conducted at Gulab Devi Chest Hospital and University of Health Sciences Lahore. It included 23 newly diagnosed, adult patients of invasive pulmonary adenocarcinoma. Clinical history was obtained and biopsy specimen was processed. Angiogenesis was determined by immunohistochemical staining with CD34. Mast cells were counted in toluidine blue stained sections. Patients were followed-up till death.RESULTS:Mean age of the patients was 54.83 ± 2.799 years. Majority (60.9%) were males. Only 39.1% patients were smokers. Morphologically, large proportions of tumors (73.9%) were nonmucinous and moderately or poorly differentiated. Majority (69.6%) of patients presented at advanced stage (Tumor-Node-Metastasis staging (TNM )III and IV). Mean microvascular density (MVD) was 13.04 ± 1.12 and mean MCD was 3.26 ± 0.36 per high power field (HPF). High MVD was associated with poor differentiation and advanced stage and correlated with poor survival (P = 0.0001). High MCD was associated with high grade but not with the advance stage of disease. However, high MCD correlated with poor survival (P = 0.047). Moreover, MCD was positively correlated with angiogenesis (r = 0.727, P = 0.0001). Treatment did not affect the survival significantly (P = 0.069).CONCLUSION:High angiogenesis and MCD predict poor survival and are positively correlated with each other and with the histological grades in pulmonary adenocarcinoma. High angiogenesis is also associated with advance TNM stage of disease.

OBJECTIVES:We investigated the frequency of Metabolic Syndrome and evaluated the level of awareness about this condition in medical community (healthcare workers) of Bahawalpur, Pakistan.METHODS:It was a cross-sectional study. It was carried out over a period of one year (June 2008 to May 2009). The following institutions took part in the study: Bahawal Victoria Hospital, Quaid-e-Azam Medical College, Paramedical and Nursing Schools and Female Jubilee Hospital. A total of one hundred and ninety four (194) Doctors and Paramedics (Nurses and Dispensors) working in the institutions included in study were selected by simple random sampling technique. Demographic, anthropometric, and biochemical data were recorded, lifestyle features were inquired about, and the level of awareness regarding MetS was surveyed. The criteria recommended by the Adult Treatment Panel (ATP) III were used for the diagnosis of MetS. The presence of MetS was evaluated in all (194) subjects.RESULTS:Metabolic syndrome was diagnosed in 29 participants (14.95%), and there was no statistically significant difference between men and women in this respectAt least three criteria of MetS were correctly listed by 36 participants (18.56%), with physicians showing significantly higher awareness levels (p<0.001). The frequency of abdominal obesity was 22.68% and it was significantly higher in males than in females (29.29% vs 14.74%; p<0.001).CONCLUSION:Current study shows that only a minority of medical community are aware of MetS as a clinical entity. Nurses and other paramedics are unaware of the problem.