ZU Journal System (Ziauddin University)
Not a member yet
1489 research outputs found
Sort by
Clinicopathological Assessments of Brain-Derived Neurotrophic Factor BDNF Physiology in Diabetic Retinopathy: A Systematic Review
No full textBackground: Diabetic retinopathy (DR) was seen to be one of the most grievous complications of diabetes mellitus that caused gradual loss of vision. Brain-derived neurotrophic factor BDNF has also been drawn into focus as a molecule relevant to retinal health and neuroprotection as more information unfolds. This research aimed to evaluate the clinicopathological significance of BDNF in patients with diabetic retinopathy (DR), with particular reference to its diagnostic and therapeutic implications. It also aimed to compare the diagnostic potential of BDNF with other existing biomarkers and therapeutic applications with an emphasis on treatment outcomes.
Methods: The PRISMA guidelines were followed while conducting the systematic review and the databases for data extraction were PubMed, Scopus, and Web of Science. English language articles that were published in scientific peer-reviewed journals between January 2013 and April 2024 were included. Furthermore, this review included observational clinical studies and clinical research studies with diabetic patients from which the authors examined BDNF levels in retinopathy patients. Any study that contained non-diabetic retinal disease, reviews, reports, and studies with incomplete information were excluded. For proper comparison, BDNF expression patterns were systematically evaluated and compared between the DR stages. For the removal of biases and assessment of risks, the Cochrane risk of bias tool and Newcastle-Ottawa Scale were used by two independent reviewers.
Results: An initial search yielded 106 articles and 15 were selected after fulfilling the inclusion criteria. The current study found that the plasma BDNF levels were lower in the patients with DR stages 4 and 3 compared with stages 2 and healthy diabetic individuals. This reduction was strongly associated with worsening of retinal vascular permeability and inflammation as well as neuronal degeneration. There was converging data to show that higher BDNF levels were being linked to slower DR progression, and thus the neurotrophic factor could be protective.
Discussion: BDNF emerged as a potential biomarker for monitoring the progression of DR. Its lower levels were associated with increased retinal damage and inflammation. Modulation of BDNF expression was beneficial for treatment, it also highlighted its role in neuroprotection and disease progression. However, variations in study designs and measurement techniques limited consistency in results
Evaluation of Hepatic Encephalopathy Triggers and Outcomes in Chronic Liver Disease: A Regional Perspective
No full textBackground: Chronic liver disease (CLD) accounts for a neuropsychiatric complication called hepatic encephalopathy (HE). This study aimed to explore the key precipitating factors in HE and determine how they correlated with disease severity; findings were compared to global trends.
Methods: This cross-sectional study was carried out (December 2019 to July 2020) at the Asian Institute of Medical Sciences (AIMS), Hyderabad, Pakistan. A total of 205 patients with secondary HE to CLD were included. Using the consecutive techniques, demographic characteristics, precipitating factors, used liver dysfunction scores (Child-Turcotte-Pugh and Model for End-Stage Liver Disease) were analysed using SPSS version 20. significant associations (p < 0.05) were identified statistically using Chi-square and ANOVA test.
Results: Electrolyte imbalances (48%) (n=98), principally hyponatremia (18%) (n=37), were the most frequent precipitating factors, while the most common precipitating factors were infections (35.1%) (n=72) with spontaneous bacterial peritonitis being the most frequent (16.6%) (n=34). In 14.6% (n=30) of cases, gastrointestinal bleeding was observed. Infected and severe electrolyte disturbance (p<0.05) were significantly associated with higher grades of HE (Grade III/IV). Patients with Child C classification and MELD >20 had a more severe history of HE episodes. Infections were more common in older patients (≥60 years), whereas younger patients (<40 years) were more susceptible to dehydration and development of gastrointestinal bleeding.
Conclusion: Electrolyte imbalances and infections were the main precipitants. Electrolyte monitoring, infection control, and demographics-specific strategies are paramount to improving patient outcomes
A Systematic Review on Insights to Community Medicine and Clinical Research: Competency Training in Medical and Dental Education
No full textBackground: Competency based training in medical and dental education has become important to train healthcare professionals to tackle clinical, cultural, and social aspects of healthcare. The innovations and developments in these training programs enabled a better understanding of healthcare and treatment planning. The purpose of this systematic review was to assess the implications of competency training in medical and dental curricula; more specifically, the incorporation of competency-based trainings with community medicine and research trials.
Methods: Using PRISMA criteria, the literature search was done in Google Scholar, ScienceDirect, and PubMed in articles published between 2020 and 2024. This review focused on competency-based education in medical and dental education, especially the intersection of competency-based education and community medicine and clinical research trials. Articles that were published in English and within the last five years were considered. Cross-referencing was done against other databases that ensured high-quality and comprehensive data. Studies that were related to non-healthcare students, without empirical evidence, or that were out of the scope were eliminated. The studies were evaluated by two independent reviewers, and the inter-rater reliability was calculated using Cohen’s kappa coefficient. These reviewers screened the titles and abstracts of studies and then reviewed the full texts of studies for eligibility. Duplicate studies were removed using EndNote X9, and risk of bias was assessed using the Cochrane risk of bias tool.
Results: Out of 94 articles, 15 were selected because they described training designs, outcomes, or difficulties in fulfilling the goals. The total number of participants was 4978 across medical and dental education. Competency training programs illustrated better results on healthcare competencies that included improved communication skills, enhanced cultural competence, and increased patient satisfaction. Hands-on training programs and the use of multimedia tools showed better outcomes as compared to the traditional methods. Challenges that were faced included differences in implementation, constraints in resources, and a lack of standardized assessments. The certainty of evidence showed moderate results for communication skills and patient satisfaction, and low to moderate results for the readiness in clinical trials and cultural competence due to variability in study design.
Discussion: Effective competency training curricula substantially enhanced the functioning of healthcare systems and results for patients. Variations in the implementation of competency training programs and the assessment methods used were the main reasons for heterogeneity. Inaccuracy was seen due to limitations in sample sizes in some studies and a lack of long-term follow-up in others, hence constraining the generalizability of the results. There should be improved structure and specification so that such techniques would be applied in routine across a wide range of establishments to create more systematically planned and effectively delivered training in diverse and complex settings
Quantitative Evaluation of Forensic Odontology Competency: Implications for Community Dentistry: A Curriculum Assessment Survey
No full textBackground: Forensic dentistry plays a crucial role in the identification of individuals and the investigation of crimes. The objectives were to assess the level of forensic odontology competency among dental students and determine how this knowledge can contribute to victim identification and preventive care education.
Methods: An analytical cross-sectional study was conducted for the duration of 5 months May 2023 to October 2023, including n=141 dental students and dentists like Baqai, DUHS, and Hamdard. The convenience sampling technique was used for the selection of study participants. Demographic characteristics, familiarity with applications, level of confidence, perceived significance of this field, and associated barriers were assessed. Data was analyzed using SPSS v.21(P-Value 0.001). Means+ SD were calculated for continuous variables, whereas frequencies and percentages were calculated for categorical variables.
Results: The survey reflects a strong awareness of forensic odontology\u27s importance n= 101 (71.60%) with high confidence in identifying gender and age through dental analysis. However, notable gaps were identified, especially in the recognition of signs of physical or sexual abuse in children and the legal aspects of forensic evidence. The major barriers in maintaining dental records were lack of time (n=64, 45.4%) and lack of equipment (n=63, 44.7%). The age of the participant was significantly associated with competency (p-value <0.001).
Conclusions: There is a high level of interest in the recognition of forensic odontology. Nevertheless, discrepancies in knowledge and confidence levels point to a need for curriculum improvements
Comparative Analysis of Integrated OSPE Versus Conventional OSPE in Assessing First-Year BDS Students’ Competence
No full textBackground: Objective Structured Practical Examinations (OSPEs) are widely utilized in medical and dental education to assess students\u27 practical skills and clinical knowledge. This study aimed to examine the effectiveness of Integrated and Conventional Objective Structured Practical Examinations (OSPE) in evaluating first-year BDS students at Dental College Hitec-IMS, focusing on identifying disparities in performance outcomes and analyzing implementation challenges.
Methods: The retrospective study employed a mixed-methods approach and was conducted at HITEC-IMS Dental College. It investigated assessments completed in June 2022 (Integrated OSPE) and October 2022 (Conventional OSPE). The research included the same cohort of 51 first-year BDS students using a purposive sampling technique. Student performance data were statistically analyzed using mean scores for descriptive analysis and p-values for inferential analysis on SPSS 27. Qualitative data were gathered through focus group discussions involving students and faculty (n=35)The study used a significance level of 0.05, with the comparison yielding a p-value of < 0.001.
Results: Using an independent sample t-test, the findings revealed a statistically significant difference between the two evaluation styles. The Conventional OSPE group achieved a mean score of 68.57 (+/-9.85), outperforming the Integrated OSPE group, which had a mean score of 55.42 (+/-12.34). The performance of the two groups differed significantly (p-value < 0.001), indicating that the conventional OSPE format enhanced overall student performance. Qualitative findings further elucidated key factors influencing these outcomes.
Conclusion: The Conventional OSPE demonstrated greater effectiveness and viability than the Integrated OSPE, which faced logistical and resource constraints. Addressing these challenges may enhance the future viability of the Integrated OSPE success
Steroids in Maxillofacial Space Infections: A Prospective Comparative Study
No full textBackground: Maxillofacial space infections are common and can lead to severe complications if not managed effectively. Standard treatment includes antibiotics and surgical drainage, but inflammation-related morbidity remains a concern. Corticosteroids, due to their anti-inflammatory effects, may help reduce swelling, pain, and hospitalization duration.
Methods: A Prospective comparative study was started at the Armed Forces Institute of Dentistry, CMH Rawalpindi, from April 2023 to November 2024. Current study included 130 patients with maxillofacial space infection involving the maxilla and mandible. consecutive sampling technique was used. Demographic data and the size of the swelling and the mouth opening was measured. Empirical therapy of Augmentin 1.2g was given to all the patients of both groups. Group S was given IV dexamethasone 8 mg, 8-hourly. Incision and drainage were performed on a need basis. After 3 days of the start of treatment, changes in the size of the swelling and the mouth opening were recorded. SPSS version 27 was used for data analysis. Student t test or chi-square tests were involved to compare the data between groups. P value ≤ 0.05 was significant.
Results: Change in size of swelling was 2.93±0.62cm in group-A and 3.26±0.67cm in group-S, (p=0.004). Change in mouth opening was 0.93±0.74cm in group-A and 1.24±0.56cm in group-S (p=0.003). Surgical intervention was needed in 46.2% and 35.4% of group A and S, respectively (p=0.212). Hospital stay was 4.46±1.10 days in group-A and 3.89±1.00 days in group-S (p=0.010).
Conclusion: Corticosteroids with antibiotics in MSIs have a significant impact on the outcomes as evident from a significant increase in mouth opening and reduction in size of swelling after 3 days of treatment
Exploring Enamel Hypoplasia and Metabolic Impacts on Dental Structures in Chronic Kidney Disease: A Systematic Review and Meta-Analysis
No full textBackground: The loss of mineral homeostasis in patients with chronic kidney disease causes significant dental problems, including enamel hypoplasia and increased tooth damage. The current clinical treatments show an insufficient ability to resolve these metabolic dental complications. This review aimed to determine the prevalence, severity, and associated metabolic risk factors of enamel hypoplasia and tooth wear in patients with chronic kidney disease (CKD), and to evaluate the effectiveness of current interventions.
Methods: The present systematic review and meta-analysis were carried out in line with PRISMA 2020 requirements. Thorough research was conducted as far as 2025. The inclusion criteria included human subjects with CKD who were reporting measurable values of enamel hypoplasia, tooth wear, or biomarkers in saliva. Studies were dismissed on the basis of the animal model, the in vitro studies, and unoriginal data. Eight articles were used. Risk of bias was evaluated by the Newcastle-Ottawa tool, and Meta-analyses were being done under the RevMan 5.4.1 utilizing the random-effects models. Dichotomous outcome variables were pooled into odds ratios (ORs) and 95% confidence intervals (CIs) and continuous outcomes standardized mean differences (SMDs). The measure of heterogeneity was represented by the I2 statistic and was visually illustrated by means of forest plots.
Results: In the eight studies identified, the findings were mixed: enamel hypoplasia or mineralization defect, together called CKD-related enamel hypoplasia, had raised DMFT (Decayed, Missing, Filled teeth) index and Developmental Defects of Enamel (DDE) scores in some studies, but not in others. The random-effects pooled analysis proved significant in the difference between the groups, and the compiled odds ratio (OR) was 2.88 (95% CI:1.69 4.91; p < 0.001). Among subgroups of patients with advanced CKD (stage 4 and 5), the effect size was much larger as the OR was 6.05 (95% CI: 2.0118.20; p < 0.001). The result of heterogeneity was about medium (I2 = 65%) in all the studies, but there was no heterogeneity in the subgroup CKD 4 5 (I2 = 0%).
Discussion: CKD produces significant, measurable impacts on dental structures through metabolic pathways. The existing evidence demonstrates this connection but heterogeneous data underlines the necessity for standardizing and conducting multi-site research to enhance appropriate preventive and intervention strategies for these high-risk patients
Bridging Oral Pathology with Diagnostics by Comparative Analysis of Oral Fibrosis as a Precursor to Carcinogenesis: A Systematic Review and Meta-Analysis
No full textBackground: Oral Submucous Fibrosis (OSF) is a chronic, potentially malignant condition that causes progressive fibrosis of the oral mucosa because people consume areca nuts. The purpose of this systematic review and meta-analysis was to compile the most recent data on molecular changes in OSF and assess how they relate to malignant transformation.
Methods: A PRISMA-guided thorough search of PubMed, Scopus, Web of Science, and Google Scholar was carried out through March 2025. Original studies assessing molecular or cellular alterations in OSF (with or without comparisons to oral squamous cell carcinoma (OSCC) or normal mucosa) were eligible. RevMan 5.4 was used to conduct the meta-analysis, and GRADE was used to evaluate the degree of evidence certainty, the Newcastle Ottawa tool, and the QUIN Tool for risk of bias.
Results: Eleven studies satisfied the requirements to be included. The main molecular changes were abnormal expression of p53 and Ki67, upregulation of hTERT, shifts in EMT markers, and dysregulation of TGF-β/SMAD signaling. The pooled effect sizes for EMT stemness -0.67 [-1.09, -0.25, I2 = 0%, p=0.0016], for proliferation 4.49 [1.68, 7.29, I2= 96.8%, p=0.0017], for telomerase activation -0.63 [-5.93, 4.68, I2 = 98.3%, p= 0.8172], for signaling pathway mediators -429.76 [-1289.16, 429.94, I2 = 98.2%, p = 0.3272]. The investigators assigned a moderate rating to evidence certainty.
Discussion: The molecular alterations in OSF are persistent and strongly suggest a risk of malignant cell transformation. Healthcare practitioners may be able to improve their early disease detection and risk level classification with the use of molecular biomarkers
Efficacy of Conservative Management versus Sphenopalatine Ganglion Block for Post-Dural Puncture Headache
No full textBackground: Post-dural puncture headache is a common side effect of spinal anesthesia, and conservative management has a role, but the available evidence on comparing the sphenopalatine block and conservative management is scarce locally. This study was conducted to compare the efficacy of conservative management versus sphenopalatine ganglion block for post-dural puncture headache.
Methods: This quasi-experimental study was conducted at the anesthesia department, a tertiary care hospital in Rawalpindi, from October 2024 to March 2025. Sixty women diagnosed with post-dural puncture headache post-cesarean section were selected. Patients were randomly divided in two equal groups. Group C patients were managed conservatively, while Group S received sphenopalatine ganglion block. All patients were followed by one of the researchers, and VAS score, mean arterial pressure, and pulse for 48 hours were noted.
Results: Median and interquartile range for pre-treatment VAS score was comparable in both groups (p-vale=0.059). At 12 hours median and interquartile range for group S and C was 6±2.25 and 5±2.25 respectively (p-value=0.001). The median and interquartile range for group S and C at 24 hours was 1±2 and 3±2 respectively (p-value=0.001). The median and interquartile range for group S and C at 36 hours was 1±2 and 3±2 respectively (p-value=0.026). The median and interquartile range for group S and C at 48 hours was 1±1 and 2±1.25 respectively (p-value=0.049).
Conclusion: This study concluded that pain score was significantly less in patients who received sphenopalatine ganglion block as compared to patients who were managed conservatory for post dural puncture headache
Impact of Glycemic Control, Biochemical Parameters, and Diabetes Duration on Xerostomia in Diabetic Patients
No full textBackground: Xerostomia, or dry mouth, is a common condition among diabetic patients, potentially affecting their quality of life. The study aimed to investigate the prevalence of xerostomia and its association with various demographic, medical, and biochemical variables.
Methods: A cross-sectional study was conducted with 117 diabetic patients at the Department of Oral and Maxillofacial Surgery, Abbasi Shaheed Hospital, Karachi Medical and Dental College, Karachi, for six months from November 2022 to April 2023. Demographic, medical, and biochemical data were collected, including age, gender, diabetes duration, presence of complications, and RBS levels. The prevalence of xerostomia was assessed through a self-reported questionnaire. The severity of salivary dysfunction was categorized according to RBS levels. Data entry and analysis were performed using SPSS version 22. Post-stratification chi-square test was applied, with a p-value of ≤0.05 considered statistically significant
Results: The mean age of participants was 47.16 ± 7.04 years, and the mean duration of diabetes was 10.6 ± 4.86 years. The prevalence of xerostomia in the sample was 55(47.0%). A significant relationship was found between higher RBS levels and more severe salivary dysfunction (p = 0.013). No significant associations were observed between xerostomia and age, gender, dental caries, smoking, alcohol consumption, or medical history. Patients with diabetes for more than 10 years exhibited a higher prevalence of xerostomia, though this association was not statistically significant (p = 0.059).
Conclusion: Poor glycemic control and long-term diabetes duration significantly increased the prevalence of xerostomia among diabetes patients. The results suggest the need for regular monitoring and management of blood glucose so that salivary dysfunction is reduced. Further research is needed to assess other contributing factors and potential prevention