Real-World Clinical Efficacy and Tolerability of Direct-Acting Antivirals in Hepatitis C Monoinfection Compared to Hepatitis C/Human Immunodeficiency Virus Coinfection in a Community Care Setting

BACKGROUND/AIMS: Limited data exist comparing the safety and efficacy of direct-acting antivirals (DAAs) in hepatitis C virus (HCV) monoinfected and HCV/human immunodeficiency virus (HIV) coinfected patients in the real-world clinic practice setting. METHODS: All HCV monoinfected and HCV/HIV coinfected patients treated with DAAs between January 2014 and October 2017 in community clinic settings were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy, factors affecting sustained virologic response at 12 weeks (SVR12) after treatment, and adverse reactions were compared between the groups. RESULTS: A total of 327 patients were included in the study, of which 253 were HCV monoinfected, and 74 were HCV/HIV coinfected. There was a statistically significant difference observed in SVR12 when comparing HCV monoinfection and HCV/HIV coinfection (94% and 84%, respectively, p=0.005). However, there were no significant factors identified as a predictor of a reduced response. The most common adverse effect was fatigue (27%). No significant drug interaction was observed between DAA and antiretroviral therapy. None of the patients discontinued the treatment due to adverse events. CONCLUSIONS: In a real-world setting, DAA regimens have lower SVR12 in HCV/HIV coinfection than in HCV monoinfection. Further studies involving a higher number of HCV/HIV coinfected patients are needed to identify real predictors of a reduced response.

case study of multidimensionality of organizational culture

The right kind of institutional culture enhances its effectiveness that ultimately leads towards achieving its missions, objectives and goals. This case-study was conducted in the University of Health Sciences, Lahore to identify the Institutional Culture in the University. Academic Culture Inventory [ACI] and Values Survey Module [VSM] 08 were used as survey questionnaires. Fifty ACI questioners were distributed among grade 16 - 20 officials, 10 in each grade. Hundred VSM 08 Questionnaires were distributed among the garde 1-15 employees. Ten questionnaires from each category and fifty six VSM 08 questionnaires were retuned and institutional culture was identified. Responses and behaviors of the people on different social and job situations were determined on the findings of VSM 08 through Chi-Square Test. Microsoft Excel and Statistical Package for Social Sciences [SPSS] were used to generate the results. A p-value of = 0.05 was considered as statistically significant. Developmental Culture' and 'Virtual Culture' were identified as the strongest institutional cultures by the higher and lower grade officials respectively. 'Tangible Culture' was identified as the weakest institutional culture in both cases. In the VSM 08 questionnaires, the response rate was 56%. Various demographic variations within the culture were identified based on the VSM 08 questionnaire survey. Communication gap between the Higher-grade officials and lower-grade employees should be bridged by holding various meetings, conferences and seminars where the lower-grade staff gets the opportunity to interact with their officers and share their own ideas about the policies and strategies of their institutes

Medical colleges admission test in Punjab, Pakistan

Nearly 18,000 candidates securing 60% and above marks in Higher Secondary School Certificate [HSSC] examination contest for admission in Medical Colleges, in Punjab, Pakistan by sitting in the Medical College Admission Test [MCAT] each summer. This cross-sectional study was conducted to identify patterns related to demographic, economic and educational backgrounds, over a two-year-period, in this population, and how HSSC and MCAT marks predict future performance of the selected candidates. Marks obtained by candidates in HSSC, MCAT, and 1st Professional MBBS [Part-I] Examinations over two years 2008-2009, were analysed using parametric tests in SPSS. Total 18,090 candidates in 2008 and 18,486 in 2009 sat in the MCAT. National HSSC candidates scored higher marks in HSSC and MCAT but lower marks than their foreign qualified HSSC counterparts [e.g., Advanced-Levels from Cambridge University, UK] in Part-I overall and in all its subcomponents individually [p<0.05]. Female students scored higher marks than males in HSSC [p>0.05], MCAT [p>0.05] and Part-I theory, practical, viva voce, continuous assessment and Objective-Structured Performance Evaluation [OSPE] components [p<0.05]. In both years, students from the Dera Ghazi Khan District scored the highest marks in the HSSC Examinations [p<0.05] but least marks in MCAT in 2008 [p<0.05] and in Part-I in 2008 and 2009 [p<0.05]. Students from 'tougher' Boards like Rawalpindi in 2008 and the Federal Board in 2009 who scored least marks in HSSC scored highest marks in MCAT, and in Part-I Examinations [p<0.05]. Linear regression on Part-I by taking HSSC and MCAT marks as independent variables showed that the MCAT marks exerted the greatest positive influence consistently at 0.104 [2008] and 0.106 [2009]. In 2009 HSSC marks were shown to exert a negative influence [-0.08] on Part-I. There is need to standardise HSSC education and examination across all Intermediate Boards. MCAT is a better predictor of Medical Students' future performance

effect on student performance of scrambling questions and their stems in medical colleges admission tests

Assessment is an indispensable part of an educational program. Multiple Choice Questions [MCQs] is an objective tool of assessment provided cheating is controlled. A method employed to reduce the chance of cheating is to scramble the sequence of the MCQs and responses in multiple papers having the same content. It is assumed that the performance of students is mainly dependent on the difficulty of the items and not the order in which they are placed within the instrument. The marks obtained by 1,02,211 candidates sitting in Medical Colleges Admission Test [MCAT] from 2008 to 2011 and given similar-content but scrambled-sequence question paper codes were analyzed using parametric tests. A significant difference amongst the mean marks of candidates in the different codes of MCAT 2008 [F = 22.15, p < 0.001] and MCAT 2011 [F = 3.85, p = 0.009] was identified. No significant difference was found in the mean marks of the candidates' each year for different codes in each centre.

Perceived variations in dental graduate competency outcomes based on demographic variables

The 30 final competencies required to be possessed by a dental graduate to be identified as a 'safe' health professional practicing dentistry in the community have already been validated and grouped into five overarching integrative themes i] Clinical competence, confidence and a multidisciplinary approach; ii] Role of dental house officer in the health services; iii] Treatment Planning; iv] Attitude, ethical stance and legal responsibilities and v] Communication Skills, information handling and teaching. These themes encompass all three domains of cognition, affect and skills. The purpose of this study was to identify variations in the acceptability of the 30 competencies amongst the three stakeholders, the students, the public and the faculty based on gender and demographic socioeconomic variables. 1876 students in the three public and seven private dental colleges were administered a questionnaire eliciting responses in the 30-item dental graduate competency document. 103 Faculty of the affiliated dental colleges and 173 general public were included in the survey. The response rate was 95% in students, 85% in public and 92% in faculty. Variations in the perceived value in each item and overall were identified within each group based on gender, socioeconomic status, educational background, urban/rural setting and public/private work place settings. These differences are real and will be encountered by the junior dental practitioner in his/her practice and should therefore be factored in to the educational outcomes

English language proficiency; an important socio-economic factor and its impact on student's performance

Each year, more than 30,000 students sit in the Government sponsored Entrance Test conducted by University of Health Sciences, Lahore for admission in Public and Private Medical and Dental Institutes of Punjab, Pakistan. In this study, we have embarked to seek the relationship of the performance of students in the English component of the test and their sciences components scores and how this English-Science relationship varies amongst the developed and underdeveloped districts of Punjab, Pakistan. Three years from 2008 to 2010. The sciences components scores of the candidates in MCAT, their scores in English portion in the test and their demographic variables were entered into Statistical Package for Social Sciences [SPSS] v.16. Parametric tests were applied. Nearly 14% of the question paper tests proficiency of the candidates in the English Grammar. The students from the socioeconomically challenged districts scored less marks in English component as well as in the sciences component of Entrance Test when compared with the scores of the students of more developed districts [p<0.05]. The difference in the mean marks of English and Sciences components of the test when adjusted for weightage was higher in the socioeconomically developed districts [p<0.05]. A steady improvement from 2008 to 2010 in the scores obtained by candidates in English component of the Entrance Test was observed [p<0.05]. For admission in Medical and Dental Colleges in Punjab, candidates scoring more than 60% marks in their Higher Secondary School Certificate Board Examination, have to sit in a uniform Entrance Test in which from the year 2008-2009, candidates from socioeconomically low districts have performed poorly in both English component and sciences components of test in comparison to the candidates from more developed districts. The comparatively lower score is more significant in sciences components of test. The lower scores of the less developed districts, candidates can not therefore be attributed to their low proficiency in the English language but rather to a lower general educational performance

Measuring the medical education environment in undergraduate medical colleges across Punjab, Pakistan

The University of Health Sciences [UHS] is responsible for regulating medical education in all affiliated Private and Public medical colleges in Punjab Province. Measuring the education environment in these institutions will be the initial step in understanding the factors affecting it. In this cross sectional study, the Population was limited to all the students of the Final Year Baccalaureate of Medicine; Baccalaureate of Surgery in Medical Colleges affiliated with UHS in 2008. DREEM questionnaire was collected anonymously from the students. The given data was analysed using parametric tests in Statistical Package for Social Sciences v.16. Significance was taken at p < 0.05. The response rate was 84.14%. The overall average age was 23.5 years with comparable male, female age [23.9 and 23.2 respectively]. The Mean Score of DREEM in the private sector - [M = 137, SD = 21.25] is statistically significantly higher [t = 9.93, df = 410.38, 2 - tailed p