Send-up exam performance; a predictor of scores in annual exam for preclinical medical students

One of the criteria for admission in Annual Professional Exam for medical students in Pakistan is to have 75% attendance during the session and the other is to pass Send up exam with 50% marks. To assess the usefulness of send-up exams in predicting the annual marks by comparing their results with annual University examination results for preclinical medical students. A cross sectional analytical study. A total of 173 preclinical students of 1st and 2nd year MBBS passing the First Professional Exam in first attempt were included in the study. Send up result of each student during the year was entered as percentage and compared with percentage total marks of same students in their 1[st] professional exam conducted by the University. Data maintained by Physiology Department was entered and analysed by SPSS 21. Descriptive statistics in the form of numbers and percentages were used and further analyzed using Pearson Correlation and Paired T Test of Significance. The p value of < 0.05 was considered significant. A total of 173 students [81 from 1st Year and 92 from 2nd Year] who had passed the annual exam in first attempt were included in the study. Out of these, 132[76.3%] were females and 41[23.7%] males. All students were within the age group of 18-24 years, mean age being 21.06 years. Mean send-up score in the subject of Physiology was 57.37 [Range=33-78]. Percentage total marks in all subjects [Anatomy, Physiology, Biochemistry] in annual exam had a mean of 69.46 [Range=55-84]. Send-up result in percentage was directly assessed against the percentage marks obtained in annual exam for each student. The send-up marks were significantly related to the marks in the final exam [p=0.01]. The strength of association was same as that for average test marks with annual marks. Girls performed better than boys during the send up [Mean 58.35 Vs 54.21] as well as in the annual exam [Mean 70.12 Vs 67.33]. There was also a difference amongst different classes with 2nd year performing better than first year in both send-up [Mean 58.60 vs 55.98] and annual exams [Median 70.83 vs 67.91]. Send-up results may be good predictors of the academic performance in professional examination in preclinical years in a medical college. Female students perform better than their counterparts during both send-up and annual exams

Glycated hemoglobin [HbA1c]; screening for undiagnosed diabetes in healthy individuals in Sargodha

HbA1c gives an integrated index of glycemia over the entire 120 days life span of red blood cells. Therefore, measuring HbA1c would be appropriate in diagnosing a disease characterized by chronic hyperglycemia and a gradual progression to complications. our primary objective was to evaluate the use of HbA1c as screening test for undiagnosed diabetes [WHO criteria of Fasting plasma glucose [FPG] of >/= 7mmol/l [126mg/dl]] in healthy asymptomatic individuals in Pakistani population. A cross sectional population survey was carried on asymptomatic, healthy individuals without past history of diabetes. Venous blood was obtained to measure fasting plasma glucose [fasting > 8 hours] and Hb A1c. Khan lab Sargodha from July 2013 to March 2014. It was performed by using NycoCard HbA1c in vitro diagnostic medical device for quantitative determination of glycated hemoglobin in whole blood. In our sample size of 775, the lowest HbA1c was found to be 5% and Highest 13.2%. Arithmetic means was 6.7565%, while the median value was 6.2% and standard deviation 1.3323. When using FPG only, the detection rate of diabetes was 32.65% [female, 14.71%; male, 17.94%]. When HbA1c was included as a diagnostic test, the detection rate increased to 40% [female, 18.84%; male, 21.16 %]. An additional 7.6% of participants were diagnosed with diabetes when using HbA1c criteria. ROC [A receiver operating characteristic] curve was used for analysis. At HbA1c cutoff of >/=6.5% it demonstrated sensitivity of 98.02% [95% CI] and specificity of 88.12% [95% CI] for detection of undiagnosed diabetes mellitus in healthy asymptomatic individuals in Pakistani population. Area under the ROC curve was 0.981354 with significance level P [Area=0.5] 0.0001. Our study reveals that HbA1c is a highly specific and convenient alternative to fasting plasma glucose for screening of diabetes mellitus in Pakistani population. A large scale survey should be carried out to set our own national standardizations

Vitamin D status; the epidemiology in Sargodha

Our primary objective was to estimate the vitamin D status among both the rural and urban dwellers of Sargodha. A cross sectional population survey. Individuals were selected from six different medical centers in the Sargodha city, Vitamin D measurement was done in Khan Lab Sargodha from January 2013 to June 2013. After an awareness campaign, healthy individuals and medical patients from six different clinics in Sargodha city were selected after excluding the diseases that interfered with the metabolism of calcium and vitamin D. The initial assessment involved an interview based questionnaire, at the clinic by the treating doctor. It recorded the information regarding age, sex, weight, residence, and co-morbid conditions like, DM, hypertension, ischemic heart disease and kidney disease and medications especially oral vitamin D supplementation. The physical assessments included height, weight record and blood pressure measurements. It was performed in Khan Lab Sargodha. Quantitative determination of 25-OH vitamin D was done from the serum by using competitive immunoluminometric assay on Maglumi 1000 fully automated chemistry analyzer. Out of total 100 specimens 46 were found to be having low levels of vitamin D levels. Insufficient levels [21-29 ng/ml] were present in 10 individuals. It was less than 10 ng/ml in 11, less than 5 ng/ml in 4, while 21 individuals were having levels between 10-20 ng/ml. Five individuals had levels more than 100 ng/ml. None of the individuals had level in toxic range. Out of 56 females 27[48.22%] had low vitamin D levels, while out of 44 males 19 [43.2%] were found to be having levels less than 30ng/ml. The median age of individuals having levels less than 30ng/ml was 37 years [14-57 years]. The relationship of high BMI and vitamin deficiency was statistically non-significant [p-value = .282]. Although the sample size is small, however our study reveals that a large proportion [46%] of studied individuals representing the asymptomatic general population is having low level of vitamin D. in order to address this public issue concrete measures need to be taken in order to prevent adverse consequences of low vitamin D levels

Pulmonary tuberculosis; frequency of smear positive in private laboratories of Sargodha outside the TB-DOTS programme

To assess the frequency of smear positive pulmonary tuberculosis patients diagnosed at private laboratories of Sargodha not included in the national DOTS [Direct Observational Therapy Short Course] programme. A retrospective study. Private laboratories of Sargodha from January 2007 to December 2012. Data analysis of 3952 patients who reported to private laboratories of Sargodha for staining of sputum for AFB was carried out. They were all self reporting and were either suspects of pulmonary tuberculosis or had a history of contact with a smear positive case of TB. Staining was done by Ziehl-Neelson method. The smear results were reported as positive or negative. Out of total 3952 specimens 373 [9.21%] were found to be positive for the presence of acid fast bacilli. From these 373 positive cases 164 [44%] were female and 209 [56%] were males. The age group most frequently associated with the smear positive result was aged > 55 years [13.89%] followed by age < 15 years [10%]. A large number of smear positive patients are diagnosed in private sector. These patients are not registered in DOTS programme of World Health Organization. Their number is not included in the calculating the prevalence TB in our country. It is recommended that TB case notification should be made mandatory by law by private sector health care providers

Evaluation of absence of clinical pallor in recruits

Clinical findings such as pallor of the conjunctivae, nail beds, lips, oral mucosa and palmar creases have been used by physicians in the diagnosis of anaemia. This study was carried out to determine the value of absence of clinical pallor in ruling out anaemia in recruits by measuring blood haemoglobin concentration as a true standard. A cross-sectional descriptive study. Pathology department of Combined Military Hospital Sargodha from Jan 2009 to Jun 2009. Young adults selected for recruitment in army after medical examination by general duty medical officers were included in the study. Haemoglobin estimation was done on Sysmex KX-21 semi automated haematology analyzer. Out of total 1760 individuals who were not having conjunctival pallor as per assessment of the doctors, 109 [6.19%] were found anaemic [haemoglobin<13.5g/dL] by haemoglobin estimation. Among the anaemic recruits, 88 [80.73%] were having haemoglobin 13.49 to 10.00 g/dL. The absence of clinical pallor is not likely to rule out mild anaemia in all selected recruits

Seroepidemilogical survey of hepatitis b virus infection amongst Barbars in Faislabad

Barbers who have occupational hazard of accidental exposure to blood are at increased risk for acquiring blood borne infections. There are many blood borne infections but hepatitis due to hepatitis B and C viruses is leading cause of morbidity and mortality worldwide including Pakistan. The objective of this study was to find the frequency of HBsAg in barbers and to assess their knowledge of this occupational risk. This is a cross-sectional epidemiologic survey, that was conducted at Faisalabad between Jan 2007 to March 2007. A total of 139 barbers working in Faisalabad city were included in the study. A closed structured questionnaire was filled to asses the knowledge and attitude of the barbers. HBsAg test was carried out by rapid test method for each barber. Mean age of barbers was 37.3 years and they had worked in the trade for an average of 15.9 years. Only 37 [26.62%] regarded hepatitis B as occupational hazard for barbers. HBsAg was positive in 4.63% of barbers working at hair dresser shops and 6.45% of roadside barbers. Awareness about the occupational hazard of hepatitis B among barbers is poor. All means of prevention must be used to protect the health of these workers and of the general population

Organophosphorus poisoning leading to respiratory failure

Organic insecticide poisoning [suicidal, accidental or occupational exposure] is quite prevalent in the rural areas of Pakistan. Presentation is variable, ranging from GIT symptoms to severe neurological manifestations of paralysis and cardiovascular instability. Such patients need careful thorough assessment, vigilant monitoring and aggressive supportive management. We present a case of such poisoning who went into respiratory failure

Mechanical ventilation in snake bite

A reversible neuromuscular blockade occurring after envenomation by a neurotoxic snake may lead to respiratory and bulbar paralysis. We present our experience in managing such a case in which all modalities of treatment including anti-snake venom [polyvalent antiserum], anticholinesterases and assisted ventilation were used. An 18 years old boy was admitted in Intensive Care Unit of Pakistan Ordinance Factories Hospital Wah Cantt with two hours history of snake bite on the dorsal aspect of left thumb. At the time of admission he was conscious with normal muscle power and breathing. The bleeding profile did not reveal any abnormality. Three hours later he developed blurring of vision, slurred speech and muscle weakness followed by difficulty in breathing and became tachypnoeic and cyanosed. He was immediately intubated and placed on ventilator after initial ventilatory support with Ambu bag. Polyvalent anti-snake venom, neostigmine and atropine were administered. Meticulous nursing care was provided with continuous monitoring of haemodynamic and respiratory variables. The clinical condition started improving on 4[th] day with spontaneous opening of eyes but on 6[th] day he developed pneumonia which was aggressively treated with antibiotics. Respiratory effort appeared on 9th day and gradually increased to adequate level on 14[th] day. He was removed from ventilator on 15[th] day. We suggest that mechanical ventilation is a helpful modality in case of respiratory failure occurring due to snake envenomation and its timely institution results in better prognosis

Angiodysplasia of upper gastrointestinal tract with coagulopathy

A combination of duodenal telangiectasia with factor X deficiency presenting as recurrent malena is rarely reported. Pylorus preserving pancreaticoduodenectomy done under cover of prothrombin complex resulted in complete recovery. Histopathology was consistent with angiomatosis. It is suggested that in managing a case of upper gastrointestinal bleeding, besides establishing the source of bleeding, it is important to detect underlying coagulopathy