Students' perception of educational environment at Aga Khan University Medical College, Karachi, Pakistan

Objective: To assess educational environment in Aga Khan University Medical College [AKUMC] by Dundee Ready Educational Environmental Measure [DREEM] scale

Methods: A cross-sectional survey of students at the AKUMC with simple random sampling was carried out from June 2014 till March 2015. Responses in five subscales were used to calculate DREEM scores

Results: The average DREEM score was 125.77 +/- 16.8 with a reliability of 91.3%. With regards to subscales, on the 12-item students' perceptions of learning [PoL] subscale, the maximum score was 48; 11 items of students' perceptions of teachers [PoT] had a maximum score of 44; students' academic self-perceptions [ASP] identified by 8 items showed maximum score of 32; students' perceptions of atmosphere [PoA] with 12 items obtained maximum score 48 and students' social self-perceptions [SSP] subscale of 7 items had a maximum score of 28

Conclusion: Students perceived a positive learning environment at AKUMC Karachi

Incidence of Pinhole Type Durotomy and Subsequent Cerebrospinal Fluid Leakage Following Simple Laminectomy

STUDY DESIGN: Cross sectional study. PURPOSE: The purpose of this study was to determine the incidence and the associated risk factors of pinhole type of durotomy and cerebrospinal fluid (CSF) leakage following a simple laminectomy for spinal stenosis. OVERVIEW OF LITERATURE: The incidence of spinal stenosis is expected to rise with increasing life expectancy. Moreover, lumbar spinal stenosis is the most common indication for spinal injury in the geriatric population. It is therefore important to identify and prevent the risks associated with laminectomy, the most widely used surgical procedure for spinal stenosis. The serious complication of incidental dural tear or durotomy and subsequent CSF leakage has not been studied in the region of Southeast Asia. METHODS: In this cross sectional study, we included 138 adult patients (age>18 years), who underwent a simple laminectomy for lumbar stenosis between 2011 and 2012. CSF leakage was the main outcome variable. Patients' wounds were examined for CSF leakage up to 1 week postoperatively. RESULTS: The incidence of pinhole type durotomy and subsequent CSF leakage in our region was 8.7%. Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively. Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage. CONCLUSIONS: Glycemic control and cessation of smoking prior to a simple laminectomy procedure reduced the incidence of a dural tear. Larger clinical studies on this lethal complication are required.

Mortality trend among hemodialysis patients during the islamic month of ramadan: a 24 years retrospective study

The effect of month of Ramadan on the mortality in hemodialysis patients, and to compare it with that in all other Islamic months. A descriptive study. Hemodialysis Unit, The Kidney Center, Karachi, from January 1989 to December 2012. All those patients who were diagnosed to have end stage kidney disease and on maintenance hemodialysis for more than 3 months, regardless of underlying cause of kidney failure were included. Patients with acute kidney injury were excluded. Status of the patients was recorded at the end of the study period. The fasting status of the patients was not mentioned. The deaths of the patients were further evaluated and frequencies of death in all twelve Islamic months were calculated. A total of 1,841 patients were registered, out of whom 897 [48.7%] died, and 269 [14.6%] survived till the end of the study. One thousand and fifty six [57.3%] were males, 651 [35.4%] were diabetic. Total number of 143 [7.76%] events occurred in Ramadan, out of which 94 patients died which make nearly 11% of the total deaths distributed in 12 Islamic months. Frequency of death was higher in Ramadan when compared with other months. Ramadan reflected a higher frequency of death. Therefore, there is a need to evaluate the risk factors in a prospective study so that the dialysis patients can be better managed during this period

Financial wellness awareness: a step closer to achieve millennium development goals for Pakistan

To explore financial wellness [FW] awareness amongst public and private sector medical college students of Karachi. A cross sectional questionnaire based survey was conducted on medical students from 3 public and 5 private sector medical colleges of Karachi from February 2011 to December 2011. All ethnic groups having age range of 18-23 years were included. A questionnaire tailored from wellness wheel evaluated the responses of FW on a four point Likert's scale ranging from 0-3[never, sometimes, mostly, and always]. Factor analysis explored common FW factors among both public and private sector medical college [MC] students. Private MC Students were better in terms of making short and long terms financial goals compared to students in public sector. The students of public MC were more focused to make and restricting to given budgets [p=0.05]. The FW element of keeping savings in bank account was responded more by private MC candidates [P < 0.0001] but was spent thrift as well [P < 0.0001]. Factor analysis revealed two factors; 'Financial Security Wellness' which was better in Private MC Students [p=0.001] and 'Care towards Expenses Wellness" in which results were not significant. Both groups of medical college students lacked FW awareness element in terms of caring towards financial expenses. The awareness of importance of financial security was practiced better by private MC students in terms of making short and long term financial goals and keeping savings in bank accounts. They were however deficient in the knowledge of making and restricting themselves to budgets

Predictors for number of retrieved oocytes in intracytoplasmic sperm injection. Oocyte numbers and IC SI success

Background: Successful ICSI depends on ovarian response to stimulation and maturation of oocytes retrieved

Objective: To identify predictors of number of retrieved oocytes during intra cytoplasmic sperm injection [ICSI]

Methods: A cross sectional study carried out at Islamabad Clinic Serving Infertile Couples @ Saudi Pak Tower from January 2011 till December 2012. Female subjects [n= 282] aged 20 -40 years had base line estimation of follicle stimulating hormone, estradiol, antral follicle count and ovarian volume on the second day of cycle. Down regulation of ovaries was followed by controlled ovarian stimulation for 12 +/- 2days. On the day of ovulation induction by intramuscular injection of human chorionic gonadotropin, pre-ovulatory follicle count [PFC] was measured by trans vaginal scan and serum estradiol, progesterone and interleukin I- beta were estimated. Data was expressed as mean +/- standard deviation and median with interquartile range. Correlation coefficient was measured to study degree of association of demographic and clinical factors with NRO. Univariate regression of NRO as dependent variable with predictors was confirmed by multivariate regression

Results: Retrieved oocytes had strongest correlation with PFC [r = 0.98]. Multivariable analysis stipulated that in the presence of other variables PFC had similar strongest effect on oocytes. AFC showed significant but negative effect on NRO by multiple regressions. Progesterone, E2, IL-I beta, FSH and injections used for stimulation had insignificant effect in the presence of other variables

Results: PFC measured at the time of ovulation induction is strongest predictor of oocytes which are obtained during oocyte pick up procedure of ICSI

Social wellbeing: a positive energy for wellness in medical students

The objective of the study was to compare the level of social awareness amongst medical students of public and private medical universities of Karachi - Pakistan. It was a cross sectional, questionnaire based study which randomly recruited 800 medical students from three government and five private medical colleges. Their responses on various aspects of social wellness were graded from 0-4 [never, sometimes, mostly and always]. Non-parametric methods were employed for the comparison of social wellness between the students of two types of institutes. Factor analysis was run to extract common factors in our setup. Students from public and private medical universities [public MU/private MU] acquired significantly similar scores on communication wellness. Both group of students reported that they had network of close acquaintances. Students from public institutes not only showed a significant problems solving attitude to help their fellows but also exhibited significant frankness and fairness while dealing with their social bounds. On the other hand the private MU students contributed more social time and money to community projects. Strategies should be made to involve public MU students in community projects. Private MU students need to be taught to care for their social bounds and enhance activities to share their beings with friends and family

Estradiol progesterone ratio on ovulation induction day: a determinant of successful pregnancy outcome after intra cytoplasmic sperm injection

Intracytoplasmic sperm injection [ICSI] is an advanced technique employed in assisted reproductive clinics for treatment of infertile couples. The reproductive endocrinologists try their level best to identify factors that enhance success rate after ICSI. To compare estradiol progesterone ratio on ovulation induction day amongst pregnancy outcome groups following ICSI. A cross sectional study was conducted on 323 couples of Assisted Reproductive Clinic in Islamabad from June 2010 till August 2011. Down regulation of females aged 18-40 years with gonadotrophin releasing hormone agonist was followed by calculated stimulation with gonadotrophin injections [COS]. Oocytes pickup was done 36 hours after ovulation induction by 16G adapter and double lumen oocyte aspiration needle under general anesthesia. Oocytes were fertilized in vitro, graded and only blastocysts were transferred seven days after ovulation induction. Serum estradiol and progesterone were measured by enzyme linked immuno sorbent assay on ovulation induction day, ratio was compared in three groups of females; no conception with betahCG 5-25 mIU/ml, preclinical abortion with betahCG >25 mIU/ml and no cardiac activity on transvaginal scan and clinical pregnancy with betahCG >25mIU/ml and cardiac activity on transvaginal scan. Females having high estradiol/ progesterone ratio were able to achieve clinical pregnancy shown by a positive betahCG and cardiac activity on transvaginal scan. These females also had significantly high number of oocytes, endometrial thickness and implantation rate. A high estradiol/progesterone ratio on the day of ovulation induction predicts the success of intra cytoplasmic sperm injection

Effects of light activated bleaching and tetra pack orange juice on micro-morphology and composition of dental enamel

To study the effects of 38% Hydrogen peroxide activated with LED light and tetra pack orange juice on micro morphology and mineral content of enamel surface. A total of 45 human enamel discs were incubated in saliva overnight to allow pellicle formation and then divided into three groups: 15 for control [G1], 15 for bleaching treatment [G2], and 15 for orange juice immersions [G3]. Surface micro-morphology, calcium and phosphorus were measured with Scanning electron microscope along with energy dispersive spectroscopy five day after treatment. Enamel discs of group 2 were treated with H2O2 with LED and group 3 with orange juice for 15 min each cycle repeated four times for five days to simulate daily treatment with the products for 5 days. The discs were stored in saliva between treatment cycles. Normality of the variables was checked by Shapiro-Wilk's test and all variables were found to be approximately symmetric. Repeated measures ANOVA with post-hoc analysis was run to assess the changes in percentages of calcium and phosphorus due to different application. Mild alteration was seen on enamel surface of control group. The photomicrographs of enamel surface after bleaching and irradiated showed moderate generalized surface roughening. Severe alteration of enamel surface was observed in group 3. Group 3 [Orange juice] produced greater calcium and phosphate loss in comparison with all the other groups [p<0.0001]. No significant difference [p>0.999] was observed in calcium and phosphorus loss between group I [control] and group 2 [bleached]. Group 3 [Orange juice immersion] significantly altered morphology and increased loss of calcium and phosphorus erosion of enamel as compared to group I [control] and group 2 [Bleached] so, there was significant difference between control and immersion group. There was in significant difference between control and bleached group

Assessment of job stress; demographic factors in doctors working at the tertiary care hospitals of Karachi

Today medical profession is fully equipped with highly competitive roles and responsibilities which serve as high source of stress in one's daily life. Stress has it negative effects on person's life like unbearable health outcomes are among one of the prominent cause of stress linked occupational diseases. The objective of this study was to determine the job stress among different doctors working in tertiary care hospitals of Karachi and to compare it with different demographical factors. Non- experimental, cross-sectional survey was conducted at different tertiary care hospitals of Karachi. Total one hundred and thirty five doctors filled the standardized job stress questionnaire through convenient sampling method from December 2011 to May 2012. Overall job stress score was 52.56 +/- 16.35. The value of Cronbach's Alpha was 79.65%. Unmarried professionals were significantly more stressed than married professionals [p < 0.0001]. Similarly, participants with only graduate degree with less year of experience were found to have higher stress than postgraduate medical doctors. The change in the marital status, depicted by Gamma coefficient, explained the decrement of job stress observed from single to married. It was concluded from this study that in medical profession stress is never underestimated. Demographic factors like marital status, experience and professional qualification serve as the stress reducing factors among professional

Euthanasia; perspectives of Pakistani medical students and practitioners-a survey

To assess the perception towards euthanasia among Pakistani medical students and practitioners. This descriptive study was conducted at Dow Medical College and Civil Hospital, Karachi, Pakistan. Data was collected by a self administered questionnaire, consisted of case history of a cancer patient and questions regarding end of life issues. Students were less likely to approve euthanasia as a murder than doctors. Large number of participants considered it as an unethical act. The decision of patients' right to die was more discouraged by the students than doctors. Though, both students and doctors were strongly disagreed to perform euthanasia in future. The legalization of euthanasia in Pakistan was favored by 15.4% of practitioners, compared with 10.4% of students. Nearly half of the participants stated that they would not trust doctors if euthanasia become legal in Pakistan. Medical practitioners were found more in favor of euthanasia, its practice and legalization in Pakistan. This study gave insight for elaborating opinions towards euthanasia by Pakistan