This study aimed to evaluate and compare the cognitive and spatial learning outcomes of two instructional modalities, traditional 2D atlas-based learning and 3D atlas-based visualization, in the teaching of human embryology. Conducted as a cross-over experimental study at Khyber Medical University, the research involved thirty-four postgraduate students equally divided into Group A and Group B. In Phase 1, Group A received 2D instruction while Group B received 3D instruction. Each participant completed a pretest, a two-hour instructional session on heart development, a post-test immediately after, and a delayed post-test two weeks later. Cognitive understanding was assessed using a structured questionnaire, while spatial ability was evaluated using the Visualization of Rotation (ROT) test. After Phase 1, the instructional methods were flipped between the groups, and the assessments were repeated. Before flipping, a significant difference was observed in pretest cognitive scores between the groups (F = 5.405, p = 0.026), with the Group B (3D in Phase 1) scoring higher; however, this difference did not persist in post-test or delayed post-test results. Spatial scores also showed a clear advantage for the Group B before the flip, with significantly higher post-test (F = 27.781, p < 0.05) and delayed post-test scores (F = 55.07, p < 0.05). After flipping, the group receiving 3D instruction achieved higher spatial scores at both the post-test and delayed post-test stages confirming the consistent advantage of 3D visualization across both phases. Within-group analysis revealed modest improvements after instruction for both groups, followed by a normal decline at delayed testing. Overall, the findings suggest that 3D atlas-based learning enhances spatial reasoning and visualization skills, while traditional 2D learning remains effective for factual content mastery. The cross-over design minimized the influence of baseline differences and allowed direct comparison of both modalities within the same participants. These results support an integrated pedagogical approach where 3D visualization tools are introduced early to build spatial frameworks, followed by 2D resources to reinforce conceptual understanding and retention.

Objective: To compare the histo-morphological features and CHEK2 expression in breast cancer versus benign breast disease. Methods: This cross-sectional study was conducted at the Department of Anatomy, Basic Medical Sciences Institute, in cooperation with Department of Surgical Units Jinnah Postgraduate Medical Centre, Karachi, from 31-March-2021 to 30-March-2022. A total of 80 female participants were allocated in two groups. Group A = 40 with fibroadenoma and group B = 40 having breast cancer. After gross anatomical examination breast tissue was processed for Hematoxylin and eosin staining for histomorphology and immunohistochemical analysis for CHEK2 expression. Data was analysed using SPSS 23. Results: Mean age of group A was 30.05±6.4 years and group B was 43.139±8.3 years. Common presenting complaint of group A was pain 15 (37.5%) whereas group B presented with painless lump 35 (87.5%). In both groups tumors had affected the upper outer quadrant of left side of the breast. On microscopy 38(95%) of group B participants had invasive ductal carcinoma. Out of those, 26(65%) had grade II and 22 (55%) had stage II cancer. Necrosis, ductal carcinoma insitu (DCIS) component, calcifications and lymphocytic infiltration were significantly noticeable in group B. Immunohistochemical expression of CHEK2 was significantly higher in group B as compared to group A participants (p= 0.001). Conclusion: There was a significantly higher expression of CHEK2 in breast cancer (group B) patients. This may be considered as an important diagnostic marker in breast cancer pathogenesis. Key words: Breast cancer, Fibroadenoma, Chek point kinase 2, Immunohistochemistry, Histomorphology.

Depression is a pervasive mood disorder that continues to challenge researchers and clinicians worldwide. Caffeine and its derivatives have been studied for their neuroprotective and antidepressant effect. Current study aimed to explore the potential antidepressant effect of a caffeine derivative, Sy-2476 [4-(1, 3, 7-trimethyl-2, 6dioxo-2, 3, 6, 7-tetrahydro-1H-purin-8-yl) benzo nitrile], in corticosterone-induced rat model of depression. Depression-like behaviour in rats was induced by administering 20 mg/kg hydrocortisone s.c for 21 days. Behavioural studies evaluated the potential antidepressant effect of caffeine derivative Sy-2476, its effect on cortisol levels, modulation of A1/A2A receptors mRNA expression and antioxidant assays. Treatment of rats with Sy-2476 exhibited robust antidepressant-like effects in corticosterone-exposed rats by increasing sucrose preference (p = 0.0002) while reducing immobility time (p = 0.0118) in the forced swim test. Sy-2476 also reduced lipid peroxidation and increased the level of antioxidant enzymes, including glutathione, catalase, and superoxide dismutase. Moreover, Sy-2476 significantly lowered cortisol levels (p = 0.0019) and up-regulated mRNA expression of A1 (p = 0.0001) and A2A receptors (p = 0.0016) compared to the corticosterone-only treated group. In conclusion, Sy-2476 showed an antidepressant effect primarily by suppressing serum cortisol levels, modulating the expression of adenosine receptors, and exhibiting antioxidant properties.

Objective: To determine the association of serum Vitamin-D levels and placental laminin expression in pre-eclamptic and normotensive women. Methods: This cross-sectional study was conducted from July 2018 to February 2021, in the Department of Anatomy, Basic Medical Sciences Institute (BMSI) in collaboration with the Department of Gynecology and Obstetrics after the approval from Institutional Review Board (IRB), Jinnah Postgraduate Medical Centre JPMC, Karachi. The placentae were collected from 120 women, segregated into two cohorts as normotensive (NT) (n=60) and pre-eclamptic (PE) (n=60) and serum Vitamin-D levels measured. All placentae were examined for histological changes by Hematoxylin & Eosin stain and the expression of Laminin (LN) was calculated by the optical density using ImageJ. Results: The serum Vitamin-D levels (ng/ml) in normotensive were significantly higher as compared to pre-ecclamptics (p-value = 0.001). The Syncytial knots, cytotrophoblast proliferation and basement membrane thickness were also significantly different among normotensive and pre-eclamptics (p-value= 0.001) When compared with normal placenta the optical density (expression) of LNs was significantly lower (p-value 0.001) in preeclampsia placentae. The association between serum Vitamin-D and laminin expression was highly positively significant. NT (r=0.811, p-value 0.001) and PE group (r=0.79, p-value 0.001) Conclusion: Our results show a strongly positive association between serum Vitamin-D levels, LN expression and severity of histopathological changes between normotensive and pre-eclamptic women.

Aim: To explore the neuroprotective effect of pirfenidone in rat’s aneurysm clip compression spinal cord injury. Methodology: A total of 30 healthy Sprague Dawley rats were randomly divided into spinal cord injury groups A, B and C. Group A received a placebo (n = 10), group B received 200 mg/kg/day of pirfenidone (n = 10) and group C received 500 mg/kg/day of pirfenidone. Based on the experimental duration of 14 and 28 days, each group was subdivided into groups 1 & 2 (n = 5 in each subgroup). An aneurysm clip with 70 g closing force was applied to the T7 level of the spinal cord for 1 minute to induce compression spinal cord injury. Immunohistochemistry by MAP2 anti-body for estimating viable neurons was performed. Results: There were no normal viable neuronal cell bodies in the spinal cord injured areas in any groups. Nevertheless, neuronal cell body residues were detected in the injury sites and a statistically significant difference was witnessed within groups and between groups. The higher dose of 500 mg/kg/day of pirfenidone for 14 days slows down the process of neuronal degeneration in injury lesions compared to 200 mg/kg/day for a prolonged duration of 28 days. Conclusion: Pirfenidone has no protective effect on neurons after spinal cord injury but due to its anti-oxidant and anti-inflammatory properties, it alters and delays the neurodegenerative process. This leads us to the future experimentation of pirfenidone in neurodegenerative diseases.

One of the most common structural birth defects is the cleft lip and palate, having an incidence rate of 1:700 live births worldwide. It can be isolated cleft lip, isolated cleft palate or a combination of both cleft lip and palate. The orofacial cleft can be caused by a variety of genetic and environmental factors or through an interaction between these factors. The gene Fork-head Box protein E1 (FOXE1) has been documented to be involved with cleft lip and palate. The present study aims to screen mutations in FOXE1 and to correlate phenotype and genotype of affected individuals. After obtaining ethical approval, peripheral blood samples were collected from 100 affected individuals, irrespective of age and gender. The genomic DNA was extracted, followed by quality control through spectrophotometer and gel electrophoresis. Polymerase chain reaction (PCR) was carried out to perform the targeted Sanger sequencing of FOXE1 gene. A point mutation (c.274C>T, rs3021526) in FOXE1 gene was detected in 15 samples. Based on phenotype, males and isolated cleft palate type was commonly involved,with bilateral occurrence, and moderate cases were frequently seen among the enrolled patients. In this study, a missense substitution was observed in gene FOXE1. This study provides a foundation for genetic counseling for families at risk and offer valuable insights for prevention and management plans.

Aim: The aim of the study was to develop sciatic nerve compression model in rats using aneurysmclip And to validate compression injury by histological examination and behavior testingStudy design and duration: experimental animal modelMethodology: The study included 16 healthy Sprague Dawley rats weighing 250 to 300 gm. The ratswere divided into two groups. Each group comprised of 4 male and 4 female rats. Sham group animalswere given only skin incision while in control group rats’ sciatic nerve injury was induced in rightlimb under isoflurane anesthesia with an aneurysm clip having a force of 0.6 N. Animals wereobserved on day 0, 1 and 7 for behavior changesResults: On histological and behavior examination the animals showed marked changes in crushinjury group. On microscopy of tissue after H & E staining clearly evident injury was seen withdiscontinuity in architecture of nerve and macrophage infiltration at the site of application ofaneurysm clamp. Animals in Injury group showed marked mechanical and thermal hyperalgesia andcold allodynia as compared to sham group.Conclusion: The evident histological alterations supported by the behavior changes in the injurygroup confirm that the aneurysm clip model is a valid, self-effacing and easily reproducible methodto induce sciatic nerve injury in rats with uniform force application for experimental studies.

Glioma, the most frequent and malignant brain tumor, is one of the most lethal forms of cancer. Among a wide range of aberrantly expressed genes, Angiotensin-2 Receptor Type-1 (AGTR1) is reported to be up-regulated in glioma and associated with aggressive tumor traits and progression. The current study evaluates the anticancer potential of commonly used angiotensin receptor blocker (ARB) telmisartan. A total of eleven, Food and Drug Administration (FDA) approved ARBs were selected, and eight drugs were docked against the AGTR1 receptor. The antihypertensive drug with the highest docking score was selected for in vitro experimentation. Half maximal inhibitory concentration was determined and subsequently applied to patient-derived glioma cell lines. Quantitative gene expression post-drug treatment was determined through real-time polymerase chain reaction (PCR). In vitro growth inhibitory assays revealed that telmisartan at a dose of 45±0.06 μM was able to inhibit 50% of the cell population in malignant glioma U87 cell lines. The PCR results show that AGTR1 expression in the untreated sample was high, as evidenced by 2-ΔΔCt values (342.4, 138.5, 1467.3) for sample IK148-Glioblastma multiform (GBM), IK163-low grade glioma (LGG), and IK231-Medulloblastoma (MDB), respectively. The comparison was made with positive control U-87 cell lines. Following the drug treatment, an increase in the cycle threshold (Ct) mean value for AGTR1 was observed, coinciding with a decrease in mean fold changes of 0.06±0.8, 0.5±2.0, and 0.02±0.02 for GBM, LGG, and MDB samples, respectively. Based on the findings of this study, it can be concluded that telmisartan exhibits successful inhibitory effects against AGTR1 expression in glioma cell lines.

The objective of this study was to evaluate the effectiveness of mixed reality models in anatomy teaching and learning at Kirkpatrick’s level I, using Peer Assisted Learning approach. This study was based on a single group, post-test study design and was carried out at three affiliated medical schools of Khyber Medical University, Peshawar, over four months. A total of 97 first- and secondyear medical students from three medical schools were enrolled. All students received a basic introduction to the use of Hololens (Microsoft), the mixed-reality simulator-based course on the anatomy of the heart and liver via peer-assisted learning (PAL) method. Student satisfaction was evaluated at Kirkpatrick Level I of program evaluation using a validated and structured PAL questionnaire. Most students agreed or strongly agreed to the effectiveness of questions (mean ± SD 4.3±0.2, percentage 86±4.4%). There was no difference between the satisfaction scores of male and female students (p=0.34), whereas a slight difference was seen between 2nd- and 1st-year students’ satisfaction scores (88% versus 85%, p=0.03). There was also a statistically significant difference of perceptions between different medical schools’ students’ scores (p=.000). Students appear to be satisfied with the use of the mixed reality model for learning anatomy. A randomized trial to directly compare the satisfaction levels between traditional methods and mixed-reality model may be conducted and the effects of mixed-reality models on learning should be assessed.

Vincristine is the drug of choice for Hodgkin’s lymphoma, acute lymphoblastic leukemia, and non-Hodgkin lymphoma. Despite its significant anticancer effects, it causes dose-dependent neuropathy, leading to compulsive dose reduction. The available drugs used for vincristine-induced neuropathic pain (VINP) have a range of safety, efficacy, and tolerability issues prompting a search for new therapies. 5,7-Dimethoxycoumarin (5,7-DMC) also known as citropten, is a natural coumarin found in the essential oils of citrus plants such as lime, lemons, and bergamots, and it possesses both antidepressant and anti-inflammatory effects. This study was designed to investigate the possible analgesic and antiallodynic effects of 5,7-DMC in a murine model of VINP. Vincristine was administered to groups of BALB/c male mice (0.1 mg/kg intraperitoneally) once daily for 14 days to induce VINP. Thermal hyperalgesia and mechanical allodynia were quantified using the tail immersion test and von Frey filament application method. The levels of monoamine neurotransmitters and vitamin C in frontal cortical, striatal and hippocampal tissues, as well as the TNF-α level in plasma, were quantified using high performance liquid chromatography and ELISA respectively. On day 15 of the protocol, acute treatment with 5,7-DMC clearly reversed VINP thermal hyperalgesia, mechanical static allodynia, mechanical dynamic allodynia, and cold allodynia. The activity of 5,7-DMC against hyperalgesia and allodynia was inhibited by pretreatment with ondansetron but not naloxone, implicating a 5-HT3 receptor involvement. VINP vitamin C levels were restored by 5,7-DMC in the frontal cortex, and changes in serotonin, dopamine, adenosine, inosine and hypoxanthine levels caused by vincristine were reversed either fully or partially. Additionally, the vincristine-induced rise in hippocampal serotonin, dopamine, inosine and striatal serotonin was appreciably reversed by 5,7-DMC. 5,7-DMC also reversed the vincristine-induced increase in the plasma level of TNF-α. In negating the changes in the levels of some neurotransmitters in the brain caused by vincristine, 5,7-DMC showed stronger effects than gabapentin. It was concluded that, there is a potential role of 5-HT3 receptors and monoamines in the amelioration of VINP induced by 5,7-DMC, and the use of this compound warrants further investigation.

BACKGROUND & OBJECTIVE: Arsenic is present both naturally and from manmade sources like factory effluents. Contamination by arsenic of the groundwater is a major source of health detriment in south-east Asian countries. The aim of this study was to identify levels of arsenic in drinking water sources and factory effluents and to analyse arsenic levels in hair samples from factory workers and their families, along with morphological changes in hair in industrial workers in Peshawar. METHODOLOGY: Water and hair samples were collected by random sampling from a labor colony of 81 factory and non-factory household members living and working in the same industrial estate and analyzed for arsenic. Hair morphology was carried out in histomorphology laboratory at Khyber Medical University, Peshawar. The results obtained from both groups were compared with normal hair histomorphology. The data was analyzed by using SPSS version 20. RESULTS: The arsenic level in drinking water, colony tube wells and households was not within the permissible level of WHO (10µg/L). The arsenic level in factory effluent was 68µg/l (Pakistan Government's acceptable level is 50µg/L). The difference was statistically significant p≤0.001 between the two groups, the factory workers had a relatively higher level of arsenic, ~34ppb, in their scalp hair. Hair arsenic level also came out to be <1.00µg/g. There was a wide variation in the histomorphology of the hair samples in both groups. CONCLUSION: Elevated levels of arsenic in factory effluent demonstrate improper decontamination. The arsenic levels were within permissible levels, long term effects cannot be ruled out.

doi: https://doi.org/10.12669/pjms.38.4.5799 How to cite this:Huma Z. Anatomy in present times: A satire. Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.5799 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Aim: To evaluate the effects of alcohol on the microscopic morphology of the exocrine pancreas and blood serum amylase and to explored that if vitamin E has a protective role against alcohol-induced damage in the pancreas of rabbits. Study design: Analytical experimental study Place and duration of study: Departments of Anatomy, Pathology and Pharmacology in Peshawar Medical College Pakistan from 1st January 2019 to 30th June 2019. Methodology: Eighteen healthy adult male domestic rabbits weighing 1-1.5 kg were chosen (oryctolaguscuniculus). The control group A received proper food and normal saline as drinking water, experimental group B received proper diet and 30 percent ethanol solution (30ml/kg/day) orally daily with normal saline, and experimental group C received proper diet, 30 percent ethanol solution (30ml/kg/day), vitamin E (50mg/kg/day) orally daily with normal saline. Each rabbit's blood was taken for serum amylase. Morphology of acinar cells included: 1) number of cells, (10 acini/field, 2) size of acini, 3) size of acinar cells, and 4) size of acinar nuclei. Results: Normal value of serum amylase in rabbits was found. The difference in serum amylase levels between the control and experimental groups for both E4 and E8 animals was not statistically significant. There was no significant difference in the number of pancreatic acinar cells, size of pancreatic acini, the pancreatic acinar cell size, and pancreatic acinar cells nuclear size in the control and experimental groups for both E4 and E8 animals. Conclusion: Alcohol consumption had no influence on the histomorphology of the rabbits' pancreatic acini in a short period (4-8 weeks). No significant variation was noted in the pancreatic acinar cells count & size, pancreatic acinar cells nuclear count and size, and pancreatic acini size. Therefore, protective role of vitamin E was not usefully identified. Keywords: Alcohol, Pancreas, Histomorphology, Vitamin E, Serum amylase

Background: Alcohol induces histomorphological changes in the liver and vitamin E has a protective role against these changes. Objective: To observe changes in hepatocytes of rabbits exposed to intragastric administration of alcohol and the protective role of vitamin E against these changes. Study Design: Analytical experimental study Place and Duration of Study: Department of Anatomy, Pathology and Pharmacology of Peshawar Medical College, Peshawar, Pakistan from 1st January 2016 to 30th June 2016. Methodology: Eighteen male rabbits domestic type (Oryctolaguscuniculus) were included. Experimental duration for category E8 animals was 8 weeks while for category E4 animals it was 4 weeks. The groups were, control group A in which animals were given proper food and normal saline as drinking water, experimental group B in which animals were fed on proper diet and 30% ethanol solution (30 ml/kg/day) orally daily with normal saline and experimental group C in which animals were treated with proper diet, 30% ethanol solution (30 ml/kg/day), vitamin E (50 mg/kg/day) orally daily and normal saline as drinking water. Results: The difference in the ALT, hepatocyte count and size and hepatocyte nuclear count and size of control and experimental groups and experimental group B-II and C-II from both category E4 and E8 showed a highly significant P values. Conclusion: Alcohol causes histomorphological changes in the liver even in the short period of 4-8 weeks and these changes can be minimized by the antioxidant action of vitamin E. Keywords: Alcohol, Liver, Histomorphology, Vitamin E, Hepatocyte, ALT

Objective: To find out the depth dependent heat effect of Diamond and Carbide burs on odontoblast layer and processes of premolar teeth. Study Design: Laboratory based experimental study. Place and Duration of Study: Anatomy department, Institute of Basic Medical Sciences, Khyber Medical University, from Mar 2018 to Jan 2018. Methodology: Sixty premolars were obtained from patients undergoing removal of maxillary and mandibular 1st and 2nd premolars from dental hospitals in Peshawar. Cavity preparation by diamond (group B) and carbide bur (group C) at 1mm (B1 & C1), 2 mm (B2 & C2) and 2.5mm (B3 & C3) was carried out and temperature change noted. These were then stained with haematoxylin, eosin and Masson’s trichrome to observe the morphological structure of odontoblast layer and odontoblast processes. Results: The mean temperature change was 3.5°C for both groups (carbide and diamond) though carbide bur showed a significantly higher change in temperature as compared to diamond bur (p<0.001). In the diamond bur group there was a lesser degree of separation of the odontoblast layer as compared to carbide group C2 and C3. The radicular dentin was the most resistant as it has highest mean length of odontoblast processes in all groups at all depths i.e. 601.2 ± 97.9μ. Conclusion: It was concluded that in comparison with diamond bur, the carbide bur caused more microscopic damage to tooth structure as the temperature recorded was higher than the critical value.

Advances in Basic Medical Sciences Cross Matching Learning Outcomes of Postgraduate Basic Medical Sciences to the Qualification Framework of Pakistan ORIGINAL ARTICLE 1 1 2 Zilli Huma *, Najma Baseer , Usman Mehboob 1 Institute of Basic Medical Sciences (IBMS), Khyber Medical University, Peshawar Institute of Health Professions Education (IHPE), Khyber Medical University, Peshawar 2 This article may be cited as: Huma Z, Baseer N, Mehboob U. Cross Matching Learning Outcomes of Postgraduate Basic Medical Sciences to the Qualification Framework of Pakistan. Adv Basic Med Sci. 2020;4(1): 4-10 INTRODUCTION ABMS Jan-June 2020 VOL. 4 NO. 1 04 | | Learning outcomes, Curriculum matching, Content analysis, Manifest analysis, Latent analysis, Qualification framework To match the learning outcomes defined in PhD course document to guidelines provided Cross referencing the documents showed that on manifest analysis the coverage for A qualitative study by comparative content analysis, carried out at Khyber Medical Objective:

Objectives: Congenital talipes equinovarus (CTEV) is characterized by midfoot cavus, forefoot adducts, hindfoot varus, and equinus. The condition leads to difficulty in walking. CTEV is one of the most common congenital birth defects and an incidence of 1–2/1000 newborns has been reported. The etiology of the CTEV is not completely understood. Multiple etiological factors, both environmental and genetic, have been implicated in the pathogenesis of CTEV. Genetic factors associated with the development of CTEV include mutations in genes related to limb patterning and development of muscle and blood vessels. The present study aims to screen four genes to detect the mutation underlying CTEV in families from Pakistan. Methods: Peripheral blood samples were collected from ten individuals from two Pakistani families with CTEV segregating in an autosomal recessive manner. Genomic DNA was isolated, followed by primer designing and Sanger sequencing of four known genes associated with the isolated form of CTEV (TBX4, PITX1, HOXD12, and HOXD9). Results: Clinical diagnoses of the affected individuals were made by consultant orthopedics. Sequencing analyses revealed that the four candidate genes screened here are not responsible for the CTEV phenotype in both families. Conclusion: Failure to detect sequence variant in four known genes associated with the isolated form of CTEV lead us to the conclusion that TBX4, PITX1, HOXD12, and HOXD9 mutations are not responsible for CTEV in both families. Therefore, genome-wide studies, including whole-genome single nucleotide polymorphism genotyping and whole-exome sequencing, are required to identify the underlying genetic defects in these families.

Objective: To match the learning outcomes defined in PhD course document to guidelines provided by the HEC in terms of both the Pakistan Qualification Framework (PQF) and the National Qualification Framework (NQF). Methodology: A qualitative study by comparative content analysis, carried out at Khyber Medical University in 2016. The learning outcomes in PQF and NQF were defined by purposive sampling based on three major domains of learning; Knowledge, Skills, and application of skills, and matched to the PhD Course guidelines. Results: Cross referencing the documents showed that on manifest analysis the coverage for knowledge and skills ranged from 28 to 36 % but with latent analysis it was bumped up to 160 to 56 %, respectively. Research showed an excellent match in the PQF with 175% but for the NQF it reaches 75% only. Conclusion: Although there is some degree of manifest and a larger degree of latent compatibility as regards the first two domains of Knowledge and Skills, the third component of applicability was entirely deficient. Keeping in focus research as a major component, explicit outcomes on generic skills should be added to address this gap. Key words: Learning outcomes, Curriculum matching, Content analysis, Manifest analysis, Latent analysis, Qualification framework