Assessment of learning environment in anesthesia by using ATEEM tool

Objectives: To assess the learning environment for anesthesia trainees and compare the results between two leading public and private hospitals of Islamabad region

Study Design: A prospective descriptive study involving postgraduate anesthesia trainees

Duration: January 2016 to February 2016

Setting: Anesthesia Department of a leading public and private hospital, Islamabad [Pakistan]

Methodology: Anesthesia Theater Education Environment Measure [ATEEM] questionnaire was administered to trainees of public and private teaching hospital after taking informed consent. ATEEM total score was calculated using descriptive statistics while comparisons were made using Student's t-test

Results: Thirty trainees responded each from one public and one private hospital. The mean total ATEEM score was 117.16/160. Mean score of trainees from private hospital was higher in all the domains of ATEEM. A total of 18 variables out of total 40 resulted in statistically significant results [p value < 0.05]

Conclusion: The learning environment of anesthesia trainees is positively perceived by all the participants. However, the ATEEM scores in four of the five domains showed that the trainees' perception of their educational environment varies profoundly between a public and the private hospital under study. There were no differences on the basis of gender and the scores are similar to international studies

Synthesis, characterization, antioxidant and brine shrimp cytotoxic activity of novel 3-benzothioyl-l-[3-hydroxy-3-phenyl -3-propyl]-l-methylthiourea

In the present research work novel ephedrine based thiourea derivative, 3-benzothioyl-l-[3-hydroxy-3-phenyl -3-propyl]-l-methylthiourea 4is synthesized and then characterized elemental analyzed via various techniques i.e., Proton NMR, carbon13 NMR and fatherly confirmed via X-ray crystallography. Compound 4 was then screened for their possible antioxidant and cytotoxic potentials. Benzoyl chloride was treated with an equimolar potassium thiocyanate in acetone to achieve benzoyl isothiocyantes. It was then treated with an equimolar [1R, 2*S]-[-]-Ephedrine to obtain the 3-benzothioyl-l-[3-hydroxy-3-phenyl-3-propyl]-l-methyl thiourea4. It was then screened for antioxidant and cytotoxic potentials. The compound 4 showed excellent antioxidant activity almost comparable to ascorbic acid [standard] and have significant cytotoxic activity with LC[50] value 05+/-0.58 ppm

Synthesis, acute toxicity, analgesic activity and cytotoxicity of Some bisthiourea derivatives

Bisthiourea derivatives were synthesized by the reaction of benzoylisothiocyanate and diamines to give 1,2-Bis [N'-benzoylthioureidobenzene [1], l,3-di[benzoylthioureido] benzene [2] and l,4-di [benzoylthioureido] benzene [3] in acetone. Acute toxicity study revealed that LD[50] of compound [1] and [3] is 120 mg/kg body weight. Visceral pain induced by injecting i.p acetic acid in mice were strongly inhibited by all the compounds. 94.65, 95.25 and 85.54% analgesic activity were observed in compounds [1], [2] and [3] at 15 mg/kg and [2] and [3] shows 97.63 and 96.42% at 30 mg/kg body weight respectively while [1] gives 100% analgesic activity. 100% cytotoxicity was observed in compounds [2] and [3] and 96% in compound [1] at 750 ppm. The results suggest that these compounds may have potential values for treatment of cancer and painful disorders

Various Risk Factors in Stroke Patients at Military Hospital Rawalpindi

To determine the frequency of various risk factors of stroke. A descriptive study. Military Hospital Rawalpindi, from January 2011 to January 2012. Three hundred diagnosed patients with stroke were probed into for different risk factors, based on history, clinical examination and laboratory methods. Nineteen percent were female and eighty one percent were male patients. The mean age of the patients was 59 years. Minimum age was 38 years and maximum age was 90 years in the patients under study. Physical inactivity was the most common risk factor [78%] followed by hypertension [72%], obesity [67%], type 2 diabetes mellitus [42%], smoking [42%] etc. Physical inactivity is the most common risk factor followed by hypertension which contribute to the pathology of stroke

Causes of root canal failure noted in AFID

The aim of the study was to determine the most common causes of root canal failure in patients who reported to the operative department of AFID [Armed forces institute of dentistry] for retreatment. This was a cross sectional study carried out at the operative department of ARID Rawalpindi from January 2011 to December 2012. Among 200 patients included in the study, 112 [56%] were male and 88[44%] were female with mean age of 31.24 years [SD +/- 10.1]. In the present study the most common cause of root canal failure was found to be underfilled [42%] followed by poor lateral condensation [22%] and unfilled / untreated [20%], overfilled [6%], fractured instruments [4%] and inadequate coronal restorations [3%]. The patients presented with different symptoms The most common symptom being the tenderness [74%] followed by pain [20%], swelling [15%], loss of restoration [13%], sinus formation [6%], mobility [4%], fractured crown [4%] and split tooth [1%]

Status of glycemic control in patients of type 2 diabetes mellitus

To determine the status of glycemic control in patients of type 2 diabetes mellitus. Cross sectional descriptive study. Medical out-patient/ in -patient departments at Military Hospital Rawalpindi from January 2011 to December 2012. Six hundred and fifty patients of type 2 DM fulfilling the required criteria were included in the study. Glycemic control of these patients was determined by estimation of blood glucose [fasting and random] and glycosylated haemoglobin [HbA1c]. The patients were grouped in three categories good, fair and poor diabetic control having their HbA1c values of being 6-7%, 7.1-8% and more than 8.1% respectively. Statistical package for social sciences [SPSS] version 15 was used for analysis. Out of 650 patients 377 [58%] had poor glycemic control with mean HbA1c of 9.5% +/- 0.95, 78 [12%] patients had fair control of glycemic control with mean HbA1c of 7.8 +/- 0.25, and 195 [30%] patients had good glycemic control with mean HbA1c of 6.4 +/- 0.17. Majority of patients had poor control of their glycemic status which is an important indicator and predictor of both micro and macrovascular complications

Frequency determination of aetiological factors in teeth treated endodontically

To study the effect of morphine on in vitro production of testicular T from un-stimulated or LH stimulated Leydig cells. Experimental study. Biological and Biomedical Sciences Department, Aga Khan University Karachi. De-capsulated testes from two rats were subjected to enzymatic dispersion for each experiment. Cells were pre-incubated in the incubation medium to remove endogenous Testosterone Thereafter, 80K cells were used for each treatment in 2001 of suspension. Incubation medium contained either no treatment [control] or different concentrations of morphine [5x10-5 -10-9 M]. Leydig cells were also incubated with different doses of LH [16-500 ?IU] and morphine. Naloxone, an opioid receptor antagonist [10-6 M], was used to determine if morphine induced effects on the Leydig cells could be reversed. Incubations were carried out for three hours in a shaking water bath at 340C. Reaction was stopped by placing the tubes in a water bath at 600C, and thereafter the tubes were transferred to a tray containing ice before freezing. Testosterone was measured directly in the incubation medium by radioimmunoassay. Morphine reduced Testosterone production from Leydig cells at all concentrations tested [p<0.01]. There was a dose dependent response to LH stimulation by the Leydig cells and testosterone levels were significantly different from control [p<0.01] and incubation with morphine in the presence of LH significantly reduced T levels [p<0.01]. Inhibition of opioid receptors with naloxone significantly attenuated morphine induced inhibition of T [p<0.01]. These in vitro results show that the morphine inhibits T secretion directly at the testis level

Oral aspects and complications in type 2 diabetes mellitus - a study

Type 2 diabetes mellitus comprises an array of dysfunctions resulting in several soft tissue abnormalities in the oral cavity. These include gingivitis periodontitis, salivary dysfunction, taste dysfunction, oral fungal and bacterial infections, geographic tongue, benign migratory glossitis, fissured tongue, traumatic ulcer, lichen planus, angular cheilitis, delayed mucosal healing, dental root caries, tooth loss, mucosal neurosensory disorders, and oral mucosal lesions. This article aims to determine the frequency of different oral manifestations and complications in patients of Type 2 Diabetes Mellitus. This will not only increase the awareness of oral manifestations and complications of diabetes mellitus but also help in expediting the research on the subject. It was a descriptive study and was carried out at the Operative Dentistry Department of Armed Forces Institute of Dentistry from January 2010 to January 2011. 200 patients fulfilling the inclusion criteria [diagnosed cases of type 2 diabetes mellitus of >35 years of age] were included in the study. 70 [35%] were female and 130 [65%] were male patients. The frequency of different oral manifestations and complications seen in these patients in descending order were; gingivitis [45%], periodontitis [36%], dental root caries [22%], taste dysfunction [7%], neurosensory dysesthesias [5%], xerostomia [4%] and oral candidiasis [2%]. It was concluded that diabetic patients are more prone to get oral complications so health education, timely diagnosis and effective treatment should be carried out to prevent these complications

Evaluation of tooth brushing technique and oral hygiene knowledge at Afid, Rawalpindi

The aim of the present study was to evaluate tooth-brushing technique and oral hygiene knowledge in Rawalpindi population. This study was a single centre, descriptive study which was carried out at the Department of Operative Dentistry, AFID, Rawalpindi from January 2010 to January 2011. 500 individuals fulfilling the inclusion criteria were included in the study. They were asked about their tooth brushing technique and oral hygiene knowledge using a questionnaire. The data obtained were analyzed using Statistical Package for Social Sciences [SPSS] version 15. Out of 500 adult participants, 140 [28%] were females and 360 [72%] males. 425 [85%] brushed their teeth regularly, 87% twice a day, 10% once a day and only 3% thrice a day. The study subjects demonstrated the brushing technique in front of the researcher. The result showed that only 4% knew proper technique. Only 7% used the brush for 2 minutes, 67% for one minute and 36% for less than one minute. 45% used fluoride tooth pastes and 24% which did not contain fluoride. 31% did not know about fluoride. The overall awareness about oral hygiene knowledge was not satisfactory

Frequency of different grades of retinopathy in type-2 diabetes mellitus patients at military hospital Rawalpindi

To analyse the various types of retinopathy in individuals with type 2 DM. Descriptive study. Military Hospital Rawalpindi from January 2010 to July 2010. One hundred and fifty patients with type 2 DM were studied into for different types of retinopathy, based on history, clinical examination [ophthalmological] and laboratory investigations. Out of 150 patients who fulfilled the criteria for study, 93[62%] were male and 57[38%] were female patients, frequency of retinopathy was 28.67%. The duration of diabetes ranged from 5 to 30 years. The frequency of retinopathy was higher in males as compared to females. The mean age of the patients was 51.10 +/- 8.33 years with range 36-77 years. Proliferative retinopathy was seen more in those diabetic patients whose duration of disease was more than 10 years. They also showed poor glycaemic control in the form of raised blood glucose and HbA1C levels. About twenty eight percent of our diabetic patients are suffering from diabetic retinopathy. This can be controlled by early detection and effective treatment both in terms of strict glycemic control and laser photocoagulation, thus decreasing the morbidity and mortality due to this chronic disease

Diabetic patients; level of awareness about oral health knowledge, attitude and practices

Diabetes Mellitus [DM], the commonest endocrine disorder is associated with 2-4 times increased risk of coronary artery disease and other macro and microvascular complications in the body. Oral diseases are also more common in diabetics as compared to normoglycemic individuals. The aim of this study was to gather baseline information on knowledge, attitude, and practices of diabetic patients regarding their oral health with the view of enhancing dental health education for them, which will help in updating their knowledge about the diasese and its associated systemic and various oral complications. This study was a cross sectional descriptive survey of 300 diabetic patients visiting the Operative Department of Armed Foreces Institute Of Dentistry Rawalpindi, Pakistan from January 2010 to January 2011. Out of total 300 patients 195 [65%] were males and 105 [35%] were females. 36 [12%] were suffering from Type 1 Diabetes Mellitus and 264 [88%] were suffering from Type 2 Diabetes Mellitus. 64% of the patients had knowledge about the oral complications of diabetes. 35% of this group knew about this issue from their treating physicians and 65% from dentists. 13% did not know that diabetes predisposed them to oral disease, and 23% denied any existence of a link between diabetes and oral health. The level of awareness end dental health knowledge in diabetic patients are good in our army set up which is comparable to previous studies carried out locally and abroad but it still needs to be improved by health education

Determination of various precipitating factors of hepatic encephalopathy in patients of chronic liver disease at military hospital Rawalpindi

To analyse the various precipitating factors of hepatic encephalopathy. A single centre, retrospective study. Military Hospital Rawalpindi from July 2009 to April 2010 One hundred and fifty admitted patients with hepatic encephalopathy were probed into for different precipitating factors, based on history, clinical examination and laboratory methods. Sixty two percent were female and 38% were male patients. The mean age of the patients was 57 years, with a range of 30-85 years. Evidence of Hepatitis C virus was detected in 141[94%] patients while in 9[6%] patients HBV was detected. Constipation was present in 42.7%, gastrointestinal bleeding in 37.3%, infections in 12%, use of sedatives 2.7%, surgery 2.7%, while hypokalemia and excess protein diet were seen in 1.3% of the total patients. Constipation is the most common precipitating factor followed by upper gastrointestinal bleeding and infections

Frequency of dyslipidemia in type-2 diabetes mellitus patients

To determine the frequency of dyslipdemias in patients of type -2 diabetes mellitus. Descriptive study. Combined Military Hospital Rawalpindi from January to July 2010. A total of 150 patients of DM fulfilling the required criteria were selected and subjected to fasting blood glucose, fasting lipid profile including total cholesterol, HDL- cholesterol, LDL- cholesterol and Triglyceride [TG] levels. The data obtained was analyzed using Statistical Package for Social Sciences [SPSS] version 10. Out of 150 patients 38% were female and 62% were male. The mean age of the patients was 57.63 years [SD +/- 8.09]. Minimum age was 36 years and maximum age was 77 years. Out of 150 patients dyslipidemia was present in 120[80%] patients. Hypertriglyceridemia was present in 120[80%] patients, raised LDL-cholesterol in 94 [62.7%] patients, decreased HDL-cholesterol in 88 [58.7%] patients, and raised levels of total cholesterol in 60 [40%] patients. Diabetic patients have a high frequency of dyslipidemias especially raised Triglycerides, therefore lipid profile is to be checked routinely and its management be given equal importance in addition to glycemic control

Prophylaxis of DVT with enoxaparin in patients undergoing total knee replacement

To evaluate the efficacy and safety of the low molecular weight heparin as prophylaxis against thromboembolism following total knee replacement surgery. Post-operative bilateral lower extremity colour duplex scan was performed on 55 patients subjected to total knew arthroplasty. The scan was performed 7 days after surgery for detection of DVT. All patients were given Enoxaparin 40mg subcutaneous daily for 2 weeks as prophylaxis against DVT. Two patients were diagnosed as DVT by color duplex scanning and both were distal but only one was asymptomatic. Another patient developed pulmonary embolism and died subsequently. The major and minor wound problems were seen in two and six patients respectively; nearly all complications were seen in obese patients. DVT is not a nonexistent entity in our population. Low molecular weight heparins are safe drugs but apparently the bleeding complications are more as compared to Western literature. Larger case control studies are required to determine the true efficacy and safety of LMWH