Reforming medical education in pakistan through strengthening departments of medical education

Objective: To review the current status of departments of medical education in all public and private medical colleges located in the city of Lahore, Pakistan

Methods: This was a quantitative, cross sectional descriptive study; conducted from March to October 2015 in Pakistan Medical and Dental Council [PM and DC] recognized medical colleges located in Lahore, Pakistan. Respondents were the heads of departments of medical education or any other well-informed faculty member. A questionnaire was prepared to obtain information about the current status of the departments of medical education [DMEs]. The investigator personally visited all medical colleges for data collection. Both verbal and written consents were obtained and the questionnaire was administered to the resource persons. The data was organized and entered in SPSS for descriptive analysis

Results: Out of the 18 medical colleges in Lahore, six [33.3%] belonged to public sector and 12 [66.7%] were from private sector. All medical colleges reported to have a functional DME. However, eight had established DMEs during the past five years. Only one [5.6%] head of DME was working on full-time basis. Eleven [61.1%] heads of DMEs did not have any formal qualification in medical education. Eight [44.4%] colleges claimed to have adequate human resources for DME. Thirteen [72.2%] colleges mentioned that adequate financial resources were available for running DMEs. It is encouraging to see that DMEs in private sector medical colleges are playing increasingly significant role in managing educational activities. Similarly, the senior management of private sector seems to be relatively more eager to promote educational activities

Conclusion: There is an increasing recognition towards establishing DMEs in the medical colleges, but their infrastructure, proper functioning and availability of human and financial resources are serious impediments requiring immediate attention

Association of Polymorphisms [rs 1799782, rs25489 and rs25487] in XRCC1 and [rs 13181] XPD genes with Acute Coronary Artery Syndrome in Subjects from Multan, Pakistan

Acute coronary artery syndrome [ACS] is the major cause of mortality in Pakistan with genetic and environmental influence on the incidence of the disease. This case-control study was designed to find out if a correlation is existing between ACS and single nucleotide polymorphisms [SNPs] in DNA repair genes XPD [at codon 751, rs 13181 [Lys to Gln]] and XRCC1 [at codon 399, rs25487 [Arg to Gln]; 280, rs25489 [Arg to His] and 194, rs 1799782 [Arg to Trp]] either individually or in various combination with each other [haplotype analysis]. The objective of this study was to find out the association of various studied risk factors and serum lipid profile of the subjects with the disease, if any. PCR-RFLP method was used to determine genotype at specific codon in 221 subjects [115 ACS patients and 106 healthy controls] from Southern Punjab population. Genotypic and allelic frequency distribution among the cases and controls revealed that all the studied SNPs were not individually associated with the ACS. Haplotype analysis revealed that subjects having wild type combination of all three XRCC1 SNPs had greater susceptibility to ACS than any other studied genotypic combinations. Analysis of risk factors revealed that hypertension [P<0.001], age [P=0.05], education [P<0.001], gender [P<0.001], family history [P=0.005], smoking habit [P=0.002] and diabetes [P<0.001] were significantly associated with the incidence of ACS. Serum lipid profile analysis indicated that cholesterol level was significantly higher [P=0.048] in patients [161.5mg/dL] than controls [142.1mg/dL] while triglyceride remained unaffected [P=0.87] when compared between the two treatments

Pattern of dyslipidemia and other risk factors for coronary artery disease and macrovascular complications in diabetic patients

Objective: to determine the pattern of dyslipidemia and other risk factors and their association with macrovascular complications in our diabetic patients presenting to OPD [outpatients department] on routine follow up

Methods: this study was done in medical outpatients department, Akhter Saeed teaching hospital, from December 2014 to August 2015. one hundred diabetic patients, male and female, coming for routine follow up were screened for macrovascular complications, and risk factors like obesity, hypertension, deranged glucose levels and lipid abnormalities were measured and analyzed

Results: of the one hundred patients recruited for this study, fifty three were females and forty seven were males. Male patients were more likely to be obese and overweight [5 [10%] and 11 [23%] respectively] than the females [2 [3%] and 10 [19%] respectively]. Males were also more likely to be hypertensive [24 [51 %]] than females [23 [43%]]. The average BP [blood pressure] for males was [141+/-44 SD]/ [91+/-14 SD] mmHg, and [129+/-41 SD]/ [85+/-15 SD] mmHg for females. All the patients had fasting hyperglycemia; however females were having more deranged values [FBS [141+/-79 SD] mg/ di for males and [151+/-91 SD] mg/ di for females]. Male patients were found to have dyslipidemia predominantly in the form of high total and LDL cholesterol or low HDL cholesterol, while more of the females had hypertriglyceridemia. In this study, high LDL cholesterol or total cholesterol and low HDL cholesterol were found to be associated with hypertension and macrovascular complications. Of the 72 among all the 100 patients with evidence of macrovascular complications, high total cholesterol was seen in 58 [80%] patients while it was seen in 17 [61 %] of the remaining patients. High BMI [Body Mass Index] was also independent risk factor for hypertension and coronary artery disease in age matched patients. Increased triglyceride levels did not show any clear correlation with macrovascular complications

Conclusion: this study shows increased incidence of lipid abnormalities and other risk factors in diabetics especially in patients with evidence of macrovascular disease

Association of Endothelial Nitric Oxide Synthase [eNOS] gene polymorphism [Glu 298 Asp] with coronary artery disease in subjects from Multan, Pakistan

Acute Coronary Syndrome [ACS] is the most common disease and cause of mortality in both genders across the world and certain risk factors i.e. age, gender, smoking, diabetes, hypertension, drugs usage, weight etc are known to be associated with the disease. The aim of this study was to find if there is any correlation exists between ACS and hereditary genetic defect in endothelial nitric oxide synthase [ecNOS] gene as eNOS generates Nitric oxide in blood vessels and regulates the vascular tone hence directly affecting the cardiovascular function. Single nucleotide polymorphism [SNP] [Glu 298 Asp] in ecNOS was determined in 280 subjects, from Southern Punjab [in Pakistan] population, including [160 ACS patients and 120 healthy controls] by PCR-RFLP method and genotype was correlated with various risk factors as well as with serum cholesterol and triglyceride levels. Our results indicated that the genotype Glu 298 Asp was not associated with ACS but when various studied parameters were compared among patients suffering from various forms of ACS and their healthy controls, it was observed that age [45-55 years] [P = 0.05], gender [male] [P < 0.001], education [P<0.001], family history [P=0.03], hypertension [P<0.001], diabetes [P<0.01] and smoking habit [P = 0.03] were the significantly different parameters among them and may be associated with the incidence of cardiovascular disease. Cholesterol [161.5 +/- 79 mg/dL] level was found to be higher in patients [P = 0.04] than controls while triglyceride remained unaffected [P = 0.87] in both groups

Indications and outcome of small and large bowel stomas in emergency intestinal surgery

To evaluate the indications and outcome of small and large bowel stomas made during emergency intestinal surgery. Cross sectional study. Dow University of Health Sciences Civil Hospital Karachi, from January 2006 to December 2012. All emergency exploratory laparotomies performed for intestinal surgery, managed by stoma were included in this study. Decision for making stoma was based upon etiology, condition of the gut and judgment of the operating surgeon. Total numbers of patients were 200 [male 114, female 86] with mean age of 32.7 year. Trauma was the most common etiology. Firearm injury was the commonest mode [n=67, 33.5%] followed by stab wounds and blunt trauma [n= 12, 6.0%]. Patients also presented with perforation leading to peritonitis [n=65, 32.5%] and intestinal obstruction [n=52, 26%]. Tuberculosis was diagnosed in 5 [26.5%] patients, typhoid perforations in 35 [17.5%] and malignancy in 30 [15%] cases. The mortality in this series was 10%. Wound infection occurred in 42 [21%], burst abdomen in 10[5%] and enterocutaneous fistula and stoma retraction noticed in 6 [3%] patients. Stoma formation was a helpful adjunct surgical procedure performed in emergency intestinal surgery for various conditions with satisfactory outcome

Detection of Babesia bovis in blood samples and its effect on the hematological and serum biochemical profile in large ruminants from Southern Punjab

<p><b>OBJECTIVE</b>To determine the presence of Babesia bovis (B. bovis) in large ruminants in southern Punjab and its effect on hematological and serum biochemical profile of host animals.</p><p><b>METHODS</b>Blood samples were collected from 144 large ruminants, including 105 cattle and 39 buffaloes, from six districts in southern Punjab including Multan, Layyah, Muzaffar Garh, Bhakar, Bahawalnagar and Vehari. Data on the characteristics of animals and herds were collected through questionnaires. Different blood (hemoglobin, glucose) and serum (ALT, AST, LDH, cholesterol) parameters of calves and cattle were measured and compared between parasite positive and negative samples to demonstrate the effect of B. bovis on the blood and serological profile of infected animals.</p><p><b>RESULTS</b>27 out of 144 animals, from 5 out of 6 sampling districts, produced the 541-bp fragment specific for B. bovis. Age of animals (P=0.02), presence of ticks on animals (P=0.04) and presence of ticks on dogs associated with herds (P=0.5) were among the major risk factors involved in the spread of bovine babesiosis in the study area. ALT concentrations were the only serum biochemical values that significantly varied between parasite positive and negative cattle.</p><p><b>CONCLUSIONS</b>: This study has reported for the first time the presence of B. bovis in large ruminant and the results can lead to the prevention of babesiosis in the region to increase the livestock output.</p>

importance of socio-economic status and sex on the prevalence of human pediculosis in government schools children in Lahore, Pakistan

The present project was designed to study the effect of age, sex and socio-economic status on the prevalence of Pediculosis [Pediculus capitis]. A survey was conducted among 1-5 class children of five public sector schools located in Lahore, where most of the students belonged to middle and low income classes. After obtaining ethical clearance from the parents, school principals and students, 500 children of age >/= 7 years were examined both macroscopically and microscopically on first come first basis up to 100 children from each school. Of 500 children [n=122 boys; n=378 girls], overall 387 [77.40%] while in girls 323 [85.45%] and in boys 64 [52.46%] were positive for Pediculosis. A higher prevalence was recorded in children of