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Background and objective: Leptin facilitates onset of puberty by impact on hypothalamic Kisspeptin, gonadotropin releasing hormone, follicle stimulating and luteinizing hormone. The link of peripheral Leptin-Kisspeptin in regulating the ovarian and endometrial tissue in relation to adiposity is unknown. Therefore, we wanted to identify Kisspeptin-Leptin association with body mass index [BMI] and success of assisted reproductive treatments [ART] in infertile females
Methods: A cross sectional study was carried from August 2015 till May 2017 after receiving ethical approval at Australian Concept Infertility Medical Centre, and Aga Khan University. The study group comprised of females with an age range of 25-37 year who had duration of unexplained infertility for more than two years. They were grouped as; underweight [<18 kg/m2], normal weight [18-22.9 kg/m2], overweight 23-24.99 kg/m2 and obese [>25 kg/m2]. Kisspeptin and Leptin levels were measured by enzyme linked immune sorbent assay before down regulation of ovaries and initiation of treatment protocol of ART.Failure of procedure was detected by beta human chorionic gonadotropin <25mIU/ml [non-pregnant] whereas females with levels >25mIU/ml and cardiac activity on trans-vaginal scan were declared pregnant
Results: Highest Kisspeptin and Leptin levels were seen in normal weight group [374.80 +/- 185.08ng/L; 12.78 +/- 6.8 pg/ml] respectively, yet the highest number of clinical pregnancy was observed in overweight group [42%].A strong correlation of Kisspeptin with Leptin [r=0.794, p=0.001] was observed in the overweight females
Conclusion: Leptin-Kisspeptin-fertility link is expressed by maximum number of clinical pregnancies in the female group that showed strongest relationship between serum Leptin and Kisspeptin levels, irrespective of their BMI
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Chronic kidney disease [CKD] patients are at an increased risk of cardiovascular complications and plasma leptin level is elevated in cardio renal syndrome. We wanted to explore leptin levels in patients with different stages of CKD and find its association with risk of cardiovascular disease. This cross-sectional study was conducted in Nephrology Department of Jinnah Post Graduate Medical Centre [JPMC] from January 2014 to September 2014. Group I comprised of controls [GFR=116+/-8.3, n = 44] acquired from general population, CKD patients were grouped as II, III and IV respectively with GFR; 85.77+/-9.9 [n = 42], 53.84+/-9.9 [n=42] and 20.22+/-8.4 [n = 42].CKD patients with any inflammatory disease, Diabetes Mellitus and on steroid therapy were excluded. Serum leptin, lipid profile and C reactive proteins [CRP] were measured. Leptin and CRP levels increased significantly with progression of CKD. High density lipoproteins [HDL] to low density lipoproteins [LDL] ratio was significantly high in control as compared to CKD groups [p<0.001]. A positive correlation of leptin was observed with CRP and HDL/LDL ratio [r= 0.994,p<0.001 and r=-0.403 p<0.001] respectively. Hyperleptinemia observed with progression of CKD contributed to pathogenesis of cardiovascular disease by decreasing HDL/LDL ratio
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Objective: The objective of the study was to identify "implications" of guidelines provided to participants at the end of a survey for improvement in stethoscope hygiene
Methodology: A cross sectional survey was conducted from January to March 2016 in which a questionnaire was designed to know the awareness of stethoscope hygiene among health care practitioners. The questionnaire was distributed to 150 consented participants, out of which 138 complete [92%] responses [49, [32%] attending physicians, 50[33%] residents and 39[26%] medical students]; comprising of 84 [61%] females and 54 [39%] males was acquired. The responses included following consulting clinics [n=30, 22%], wards [n=41, 30%], intensive care units [n=41, 30%] and acute care units [n=26, 18%]. At the end of the survey practicing guidelines were discussed and hard copy given to respondents. They were then asked to tell about to the impact of these guide lines on their measures to maintain stethoscope hygiene
Results: It was observed that health care practioners consented to start stethoscope cleaning at the start of every clinic, 33.3% showed their intentions for educating others by verbal instructions, and 66.7% were said they will recommend alcohol swab for cleaning of stethoscope
Conclusion: The survey on stethoscope hygiene with practicing guidelines reflects the awareness generated in the respondents. It is further expected that they will disseminate the information and educate others to consider importance of stethoscope sanitation and practice its hygiene
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Objective: A health risk behavior like physical inactivity, unhealthy diet, tobacco use, drug abuse, unprotected sexual practices or harmful use of alcohol is linked with serious ailments like liver cirrhosis, hypertension, abnormal lipid profile and number of cardiovascular diseases. Our study is aimed to explore perception of students about health risk behaviors; eating routines, life style and stress handling practices and compare amongst medical students of first and second year
Subjects and Methods: In this cross-sectional study, 233 female students between 1 8-25 years of age, from first two years of medical college were administered a self-structured questionnaire Response of each item was rated on five-point Likert scale. Maximum points in the scale were five and the minimum was one for each item. Mean score was obtained by adding points of all responses. Degree of health awareness was categorized into low, medium and high on the basis of mean cumulative scores. Independent sample t test was used to compare means between study groups based on academic level [Year I and II medical students]
Results: The overall results of the study revealed positive health behaviors among medical students. Year I MBBS had superior acquaintance on healthy eating routines [p-value = 0.001], lifestyle patterns [p-value = 0.002], and stress handling practices [p-value < 0.001] as compared to senior class. Tendency to have anxiety attacks was more in 1st year students [p-value=0.002] while capability to withstand stress was better in senior class [p-value=0.004]
Conclusion: Majority of medical students practiced positive health behaviors. These attitudes in terms of selection of life style choices; healthy food and physical activity with avoidance of health risk behaviors and supportive practices was better in Year I students
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Background: obesity may establish a crucial barrier for effective fertility treatment in polycystic ovary syndrome [PCOS] females
Objective: to compare results of intra-cytoplasmic sperm injection [ICSI] in females with and without polycystic ovarian syndrome and further appraise the effect of obesity in PCOS females
Materials and Methods: a cross-sectional study from June 2015 to July 2016 included non-PCOS and PCOS [recognized by Rotterdam criteria] females who underwent ICSI. The PCOS were further stratified into non-obese and Obese according to the South Asian criteria for body mass index. Results were categorized on the basis of beta-human chorionic gonadotropin [beta-hCG] and transvaginal scan into non-pregnant [beta-hCG <25 mIU/ml], preclinical abortion [beta-hCG >25 mIU/ml with no fetal cardiac activity] and clinical pregnancy [beta-hCG >25 mIU/ml with fetal cardiac activity on transvaginal scan]. In addition, reproductive outcomes; implantation rate, clinical pregnancy rate and miscarriage rate among obese and non-obese PCOS and non-PCOS patients were compared
Results: our results revealed 38.5% clinical pregnancy rate in non-PCOs females, 23.8% in non-obese PCOS females whereas 26.4% in obese PCOS. Preclinical abortions were found to be highest [31.5%] in non-obese PCOS females and were the lowest [26.2%] in non-PCOS females. In non-PCOS group and non-obese PCOS females 35.4% and 44.6%, respectively, failed to become pregnant
Conclusion: the success after ICSI in terms of number of clinical pregnancies was more in non-PCOS patients as compared to PCOS. Increase in body mass index reflected a negative impact on the reproductive outcome in PCOS patients
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Background: Factors causing increased cholesterol levels in the body may include inactivity, obesity, genetic factors and an unhealthy diet. The high colesterol levels or hyperlipidemias may contribute to high concentrations of its precursor triglycerides and low density lipoproteins in plasma of the individuals. High triglyceride levels signal insulin resistance. This study was designed to determine an association of hyperlipidemia and diabetes mellitus with depression
Method: This case-control study involved 30 patients diagnosed with type 2 Diabetes Mellitus [DM] and hyperlipidemia [HL], and 30 non-diabetic healthy individuals having normal glucose tolerance test and no other co-morbidity. All subjects were of 30-50 years age. Blood samples from all participants were collected for determination of the HbA1C and lipid profiles. PQ9 score questionnaire for depression was asked from all subjects
Results: Patients suffering with hyperlipidemias and diabetes mellitus had higher incidence of depression compared to healthy subjects [p<0.05]
Conclusion: Depression was more prevalent in hyperlipidemic and diabetic patients
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Objective: To assess mid-luteal estradiol [E2] levels in poor and good responders and determine its effect on the outcome after intracytoplasmic sperm injection [ICSI]
Methods: The current study was carried out in females who underwent ICSI from June 2011 to September 2013 in "Islamabad Clinic Serving Infertile Couples". They were categorized into good and poor responders on the basis of female age 5, respectively. Their mid-luteal E2 measured on the day of embryo transfer was stratified into groups [A-E] on the basis of 20th, 40[th], 60[th] and 80[th] percentile values. The outcome was categorized into non-pregnant with beta human chorionic Gonadotrophin [hCG] 5-25 m IU/ml, and clinical pregnancy with beta hCG>25 m IU/ml
Results: The conception rate was 12% [63/513] in poor responders and 72% [237/329] in good responders respectively. The mid-luteal E2 levels were higher in conception as compared to non-conception cycles [p<0.001] in good and poor responders
Conclusion: Maximum pregnancies in poor and good responders [53% and 98% respectively] with mid-luteal E2 levels above 80th percentiles confirm the role of the increase in mid-luteal E2 for augmentation in conception rate of females after ICSI
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Background: Kisspeptin [KP] is a neuropeptide that causes the release of the gonadotropin releasing hormone, which controls hypothalamo pituitary ovarian axis and exerts a number of peripheral effects on reproductive organs. The primary objective of this study was to compare baseline KP levels in females with different types of infertility and identify possible correlations with risk of failure to conceive, preclinical abortion and pregnancy after intracytoplasmic sperm injection [ICSI]
Materials and Methods: A longitudinal cohort study was carried out from August 2014 until May 2015 by recruiting 124 female patients undergoing ICSI, after obtaining ethical approval from the Australian Concept Infertility Medical Center. Cause of infertility due to male, female and unexplained factors was at a frequency of 32 [24%], 33 [31%] and 59 [45%] among the individuals respectively. KP levels were measured by ELISA assay before the initiation of the ICSI treatment protocol. Outcome of ICSI was categorized into three groups of non-pregnant with beta-human chorionic gonadotropin [beta-hCG]<5-25 mIU/ml, preclinical abortion with beta-hCG>25 mIU/ml and no cardiac activity, and clinical pregnancy declared upon confirmation of cardiac activity. Results based on cause of infertility and outcome groups were analyzed by one-way ANOVA
Results: Females with unexplained infertility had significantly lower levels of KP when compared with those with male factor infertility [176.69 +/- 5.03 vs. 397.6 +/- 58.2, P=0.001]. Clinical pregnancy was observed in 28 [23%] females of which 17 [71%] had a female cause of infertility. In the non-pregnant group of 66 [53%] females, common cause of infertility was unexplained 56[85%]. A weak positive correlation of KP levels with fertilized oocytes and endometrial thickness was observed [P=0.04 and 0.01 respectively]
Conclusion: Deficiency of KP in females with unexplained infertility was associated with reduced chances of implantation after ICSI
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Background: Problem-based learning [PBL] and case-based learning [CBL] are teaching methodologies, which regulate self-directed learning skills. In medical schools of Pakistan either or both are being consistently used in the undergraduate and postgraduate curriculum. The objective of our study was to compare CBL with PBL on the basis of perception of those students who have observed this transition of learning methodologies in the undergraduate medical curriculum
Methods: It was a cross sectional comparative study, conducted from February to May 2016 whereby all 3rd year medical students who were exposed to PBL in the third year of education after two years experience of CBL were included. Response of students on the usefulness of PBL was acquired on 5-point Likert scale. Results were compared by chi square test
Result: The complete response was obtained from 212 students. Eighty four percent students preferred PBL over CBL [p<0.01]. PBL significantly assisted students to; identify gaps in knowledge, improve their areas of weakness, manage time, make decisions, solve problems, use critical reasoning skills and communicate with each other [p<0.01] in comparison to CBL. It enhanced the ability to find information from internet and libraries. Students recommended that PBLs were time consuming and proper training of facilitators was required as compared to CBL. They were convinced with system of education of CBL followed by PBL
Conclusion: The PBL was effective in terms of retention of concepts, critical reasoning and problem-solving approaches yet satisfaction with the current system of education elucidated role of CBL in the first two years of undergraduate medical curriculum to prepare students through guided enquiry and presentation of clinical scenarios. Proper training of facilitators will be a key point to improve learning of students through PBLs
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There is a severe dearth of post graduate institutes in our country. Therefore, there is a need to initiate post graduate program for students who have talent and passion for research and teaching. The post graduate program will be aimed to strengthen the multi-disciplinary integrated concepts of Basic sciences as a solid foundation for developing research mentors and educators. This can only be made possible by analyzing the challenge in structural, human, political and symbolic leadership frames and device a solution which is in line with the vision and mission of the organization
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Objective: To evaluate integrated learning program of neurosciences for continuation of integrated learning in the forthcoming teaching and learning modules of undergraduate medical curriculum at Bahria University Medical a Dental College [BUMDC]
Methods: A mixed method design was conducted from August 2016 to February 2017 after ethical approval from BUMDC. The quantitative aspect was evaluated retrospectively by desk records of marks obtained in integrated module and nonintegrated module. Focused group discussion were conducted with primary intended users [chair of integration committee, faculty and students of first and second year MBBS] to share their expectations and concerns and get responses on key evaluation questions for implementation and outcome evaluation of integrated learning program
Results: The desk record revealed a positive perception of students and faculty at the time of implementation with improvement in results after integration in subjects of basic sciences. The discussions highlighted reasons which resulted in failure of its continuation and affirmed readiness for re-induction and continuation of integration with clinical sciences
Conclusion: Evaluators considered approval and re-application of integrated curriculum at BUMDC after utilization focused evaluation
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Humanos , Revisão da Utilização de Recursos de Saúde , Ensino , Estudantes de Medicina , NeurociênciasRESUMO
Objective: To identify predictors of fertilization rate in patients of unexplained infertility after intracytoplasmic sperm injection [ICSI]
Methods: Retrospective analysis of females [282] enrolled in quasi experimental design for ICSI at "Islamabad Clinic Serving Infertile Couples" was carried out from July 2013 till June 2014. Females with unexplained infertility were included, whereas well defined male and female causes of infertility were excluded. Fertilization rate [FR] was calculated as percentage transformation of micro injected oocytes into two pronuclei. Categorical variable of FR defined on the basis of 50% FR grouped females; Group I with FR ?50% and Group II with FR >50%. The groups were compared in terms of demographic variables, base line hormones and oocyte parameters. Univariate logistic regression was executed to obtain odds ratio with 95% confidence interval to quantify the association of predictors like age, duration of infertility, oocytes parameters, hormones; Estradiol, progesterone, follicle stimulating hormone [FSH], luteinizing hormone, prolactin and cytokines interleukin-Ibeta [IL-Ibeta] with the FR
Results: In our study out of 282 females, 19 [6.73%] were in group I and 263 [93.26%] comprised of Group II. Females with high FR[group II] had low Progesterone and FSH [p=0.04,p=0.02] respectively. Mature oocytes [OR: 0.35; 95% CI 1 - 2.56] and IL-Ibeta in follicular phase [OR: 1.04; 95% CI: 0.000- 1.20] were significant positive predictors of FR while peak progesterone and FSH had significant negative effect on it
Conclusion: Fertilization of oocytes in females of unexplained infertility depended on maturity of oocytes and optimal amounts of ILI- beta released by developing follicles in the follicular phase of stimulation cycles of ICSI
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Objective: To assess the effectiveness of concept mapping [CM] on the academic performance of medical students' in problem-solving as well as in declarative knowledge questions and their perception regarding CM
Methods: The present analytical and questionnaire-based study was carried out at Bahria University Medical and Dental College [BUMDC] Karachi, Pakistan. In this analytical study, students were assessed with problem-solving questions [A-type MCQs], and declarative knowledge questions [short essay questions], and 50% of the questions were from the topics learned by CM. Students also filled a 10-item, 3-point Likert scale questionnaire about their perception regarding the effectiveness of the CM approach, and two open-ended questions were also asked
Results: There was a significant difference in the marks obtained in those problem-solving questions, which were learned by CM as compared to those topics which were taught by the traditional lectures [p<0.001], while no significant difference was observed in marks in declarative knowledge questions [p=0.704]
Analysis of students' perception regarding CM showed that majority of the students perceive that CM is a helpful technique and it is enjoyed by the students. In open-ended questions, the majority of the students commented positively about the effectiveness of CM
Conclusion: Our results indicate that CM improves academic performance in problem solving but not in declarative knowledge questions. Students' perception about the effectiveness of CM was overwhelmingly positive
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Objective: Anti Mullerian hormone [AMH] is gaining place as ovarian marker, chiefly in infertility assistance
We explored its correlation with oocytes retrieval after long GnRH agonist protocol for stimulation, in younger and older infertile population
Methods: This retrospective analysis compiled data of 166 females, receiving ICSI treatment from June 2014 to March 2015. Serum FSH, LH, Estadiol, AMH and antral follicle count were assessed. Outcomes were measured as good [5 to 19 oocytes] and bad responders
Results: Higher discriminatory power of AMH [AUROC; 0.771; p < 0.05] was seen in comparison to FSH [0.692; p < 0.05] and AFC [0.690; p < 0.01]. AMH reported strongest association with oocyte retrieved [odds ratio of 15.06]
Subgroup analysis reported 68.6 % risk of bad response with AMH levels of less than 1.37ng/ ml. This association was observed more significant in young infertile patients <35 year of age [=0.245; p=0.012] versus older population >35 year [r=0.169; p>0.05
Conclusion: Our study reaffirms that serum AMH correlates well with oocytes retrieved, particularly in females younger than 35 years. We suggest incorporation of AMH in baseline assessment of infertile females, who are falsely advised to postpone interventions based on their age and normal FSH levels
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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
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Background: The measurement of follicular output rate [FORT] has been proposed as a good indicator for evaluating follicular response to the exogenous recombinant folliclestimulating hormone [rFSH]. This places FORT as a promising qualitative marker for ovarian function. The objective of the study was to determine FORT as a predictor of oocyte competence, embryo quality and clinical pregnancy after intracytoplasmic sperm injection [ICSI]
Materials and Methods: This prospective study was carried out on a group of infer- tile females [n=282] at Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, from June 2010 till August 2013. Downregulated females were stimulated in injection gonadotropins and on ovulation induction day, pre-ovulatory follicle count [PFC] was determined using transvaginal ultrasound scan [TVUS], and FORT was determined as a ratio of PFC to antral follicle count [AFC]×100. Group I consisted of females with a negative pregnancy test, while group II had a positive pregnancy test that was confirmed with the appearance of fetal cardiac activity. Linear regression analyses of categorical variables of clinical pregnancy along with other independent variables, including FORT, were performed using SPSS version 15.0
Results: Pregnancy occurred in 101/282 women who were tested, recording a clinical pregnancy rate of about 35.8%. FORT values were higher in group II as compared to group I females [P=0.0001]. In multiple regression analysis, 97.7, 87.1, 78.2, and 83.4% variations were explained based on the number of retrieved oocytes per patients, number of metaphase II oocytes retrieved, number of fertilized oocytes, and number of cleaved embryos, respectively, indicating FORT as an independent predictor
Conclusion: FORT is a predictor of oocyte competence in terms of a number of retrieved, mature and fertilized oocytes. It also gives information about the number of cleaved embryos and clinical pregnancy rate
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Structured morning meetings [SMM] were introduced in department of Physiology at Bahria University Medical and Dental College from May 2009. The responses from faculty members who attended the SMM for a period of one year affirmed this to be a healthy activity. It helped 9 [90%] and 7[70%] faculty members in preparation and improvement of multiple choice questions and objective structured practical examination for the examination. The presentation skills of 7[70%] presenters were improved by this exercise. The respondents recommended its continuation in future
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Objective: To compare the change in interviewers' perception of Multiple Mini Interviews [MMI] after MMI training and after actual MMI experience
Methods: Six sessions were conducted during two weeks [October 26, 2015- to November 6, 2015] to a total of 87 faculty members. The evaluation dealt with 13 items questionnaire for representation of assessors' perception on 5 point rating scale. Assessors rated their perceptions to complete an anonymised questionnaire about rationale behind MMI, the process of MMI, and the use of scoring criteria [rubrics]. In addition, assessors were also asked to rate their level of satisfaction on MMI process after training and after interviews. Wilcoxon Signed Ranks Test [two-tailed] was used to compare participant's pre- and postinterview ratings
Results: With 81.6% response rate, the positive views of assessors about the MMI selection process and the use of scoring criteria [Rubric] to assess the candidate are not altered after experiencing a MMI selection day [p> 0.001]. Assessors [87%] would prefer to be involved in the process of MMI in future
Conclusion: The outstanding consistency of assessors' ratings before and after interview concluded that MMI training sessions were helpful in improving knowledge and skills about MMI process and candidates' assessment criteria [rubrics]