Importance of vertical integration in teaching and assessment of physiological concepts

Under the existing system of undergraduate curriculum, physiology teaching was done in a traditional non-case based manner. The objective of this research was to develop and implement a respiratory module which would incorporate vertically integrated learning and assessment using multiple teaching methodologies. A respiratory modular team finalized the clinical cases, themes, relevant objectives, learning strategies, time table and assessment tools. The exam results of this Vertically Integrated Respiratory Module were compared with the results of traditionally delivered Introductory Module for the same group of students. Students' feedback questionnaire was also administered at the end of module. 99% of the students responded that integrated approach makes learning and understanding easy. 90% of the students hoped that this mode of teaching would be helpful to them in future clinical years and 92% of the students favored the continuation of this integrated approach in future. Comparison of the results indicated that the passing percentage and the mean score [89% and 68.5] was higher in the Vertically Integrated Respiratory Module as compared to the non case based Introductory Module [70% and 61.5]. Based on the students feedback we may conclude that teaching physiology via vertically integrated approach may be superior than traditional non case based teaching, because it enhances students interest and facilitates meaningful and deep learning

Is Hyperleptinemia a risk factor for hypertension?

Background: Major risk factors of hypertension [HTN] including obesity, insulin resistance, renal pathology, increased sympathetic nerve activity [SNA] and vascular inflammation are associated with hyperleptinemia. Therefore hyperleptinemia may act as a mediator of blood pressure, linking body fat mass with changes in insulin action, sympathetic neuronal outflow and renal pathology

Objective: The objective of our study was to explore the relationship between hyperleptinemia and HTN in Pakistani population

Materials and Methods: It was a case control study of 6 months duration, carried out at Shifa College of Medicine and Shifa International Hospital, Islamabad. One hundred and four male subjects, 52 with HTN and 52 without HTN were included in this study. Leptin levels were measured by enzyme-linked immunosorbent assay [ELISA] technique. The relationship of leptin [LEP], body mass index [BMI], fasting blood sugar [FBS] and cholesterol levels with blood pressure were assessed

Results: Patients with HTN versus patients without HTN had a higher body mass index [28.0 +/- 0.12 to 24.11 +/- 0.27 kg/m[2]], FBS [169.20 +/- 7.34 to 127.50 +/- 2.30 mg/dl], total cholesterol [160 +/- 3.72 to 158 +/- 2.71 mg/dl] and LEP [53.40 +/- 5.32 to 21.65 +/- 3.50 ng/ml] levels. In univariate analysis, obesity, hyperglycemia and hyperleptinemia [with P values of 0.000, 0.001, 0.000, respectively], whereas in multivariate analysis, hyperglycemia and hyperleptinemia [with P values of 0.006 and 0.001, respectively] were risk factors for HTN. Our study also showed that hyperleptinemia is an independent risk factor for HTN

Conclusions: We observed a strong positive relationship between hyperleptinemia and hypertension, thereby indicating that increased leptin levels could be considered as a risk factor for HTN and cardiovascular disease. Further studies are needed to probe the underlying pathophysiological mechanisms responsible for hyperleptinemia in HTN

Deregulation of serum leptin levels in acute coronary syndrome

To test whether leptin is a risk factor for acute myocardial infraction. A case control study. The study was carried out at Shifa International Hospital Islamabad for one year. Serum leptin levels of 86 patients of acute coronary syndrome [ACS] were compared with 86 age and sex matched controls. Leptin levels were measured by enzyme linked immunosorbent assay [ELISA] technique. Our study indicated that patients of ACS have higher body mass index [BMI], systolic and diastolic blood pressure and blood sugar levels as compared to the controls [normal subjects free of any cardiac disease]. Moreover serum leptin levels were also significantly higher in the patients of ACS [47.87 +/- 6.16 ng/ml] as compared to the control group [14.97+ 1.90ng/ml]. Smoking, higher systolic and diastolic blood pressure, blood sugar and leptin levels were significant risk factors for ACS in univariate analysis. Whereas smoking, higher systolic blood pressure, blood sugar and leptin levels also remained significant risk factors for ACS in the multivariate model. Multivariate analysis indicated that increased leptin levels lead to 7.9% increase in the odds ratio of ACS. The current study has indicated that patients of ACS have significantly higher leptin levels as compared to controls, and this leads to 7% increase in the odds ratio of ACS. This study showed that in addition to the traditional risk factors like diabetes mellitus, smoking and hypertension, increased leptin levels is also an important link in the development of cardiovascular disease. Therefore development of therapeutic agents primarily directed against increased leptin levels could contribute in reducing the mortality and morbidity associated with CAD

Effects of isometric and isotonic exercises in osteoarthritis of knee in females of Karachi

Objective: the purpose of this study is to analyze the effects of isometric and isotonic exercises in knee osteoarthritic patients. In this study 22 patients, between 45 yrs. - 75 yrs. of age, suffering from knee osteoarthritis were included out of which 11 patients performed isometric exercises for 10 days and 11 patients performed isotonic exercises for 10 days. They were assessed by visual analog scale, range of motion, Lysholm knee scale Pain score was found to decrease after 1 week of exercises. Both of the isometric and isotonic exercises were effective in knee osteoarthritis. However isometric exercises are more effective than isotonic exercises in knee osteoarthritic pain, when compared with the isotonic exercise regime. Although isotonic exercise resulted in significant changes in pain and functional parameters but it is much lesser compared to isometric exercise regime