Characteristics and motivational factors of candidates applying to the Master in Health Professions Education (MHPE) program.

Objective: To determine characteristics and motivational factors of applicants applying for MHPE program at a Public-sector University, Karachi. Methods: This cross-sectional descriptive study, conducted from September till October 2022, included all 60 applicants of MHPE program at Jinnah Sindh Medical University. The survey questionnaire was administered (google form) and comprised questions seeking demographic information, few questions with options to select and 34 statements to be responded on 5-point scale. One open-ended question asking motivational factor/s. Data was analyzed using SPSS and independent sample t-test was used to determine the differences between groups of applicants based on demographic factors. Results: 48 participants responded, mean age was 35.8 ± 7.3 years, with predominantly males (81.3%), graduates of medical and dental programs (n = 29), and employed in medical education departments (n = 36). Most of the applicants wanted to join the program to improve their teaching skills, especially psychomotor skills teaching (96%) and educational research [90%]. Majority (64.6%) learned about the program through peers, whereas 29.9% independently chose to pursue the program. Their primary motivation stemmed from their inability to secure admission elsewhere and the belief that minimal effort was needed to acquire the degree (mean score 4.58 ± 0.87 and 4.42 ± 0.94), respectively. For medical and dental graduates, comparable responses emerged, displaying a statistically significant correlation (p < 0.05). However, there was mutual disagreement regarding the program's structure and faculty as motivating factors. Conclusion: Primary motivations to earn an MHPE degree were to improve teaching skills. Motivations to apply to this particular program was the failure to be accepted elsewhere and the perception that minimal efforts were needed to complete this program. The program goals and purpose need to be better propagated along with changes in the admission processes in order to encourage those individuals to apply who are motivated to pursue medical education as a career.

Relationship Between Genetic Variant Of OXTR (Rs53576) And MTNR1B (Rs1387153) And Symptoms Of Psychological Stress In Females With Gestational Diabetes Mellitus.

Objective: To assess the association of oxytocin receptor (rs53576) and melatonin hormone receptor 1B (rs1387153) gene single nucleotide polymorphisms with psychological symptoms in women with gestational diabetes mellitus. METHODS: The case-control study was conducted from May 1 to June 1, 2022, at the Department of Physiology, University of Karachi, in collaboration with the Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, and the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. Fifty gestational diabetic pregnant women and ninety healthy pregnant women were recruited. Sanger sequencing was performed to assess the genotypic frequency and polymorphic variation of all subjects. Perceived stress scale and diabetes-related distress scale were used to assess the stress levels. Data was analysed using SPSS 23. RESULTS: Of the 140 subjects, 90 (64.3%) were controls with mean age 24.96±4.35 years, and 50 (35.7%) were cases with mean age 28.78±5.25 (p<0.05). Mean body weight and mean gestational age were not significantly different between the groups (p>0.05). Melatonin hormone receptor 1B rs1387153 frequency was significantly different between the groups (p<0.05). Among the cases, a significant mean difference for regimen distress scores between AA and GG was observed for oxytocin receptor rs53576 (p=0.04). A significant mean difference in sum of PSS, diabetes-related stress, total diabetes- related stress and emotional distress was noted between CC and TT genotypes for melatonin hormone receptor 1B rs1387153 (p=0.001). Conclusion: MTNR1B rs1387153 genotypes were associated with perceived stress, diabetes-related stress, diabetic distress, and emotional burden, while OXTR rs53576 genotypes were associated with regimen distress in GDM women.

Nanotechnology and narasin: a powerful combination against acne.

Acne vulgaris is widely regarded as the most prevalent skin disorder characterized by painful, inflammatory skin lesions that are primarily attributed to the pathogenic actions of Cutibacterium acnes (C. acnes). To improve the clinical management of this disease, there is a pressing clinical demand to develop innovative antibacterial therapies that utilize novel mechanisms. The current research aimed to discover the antibacterial efficacy of narasin (NAR), a polyether ionophore, against drug-resistant acne bacteria. In addition, the study aimed to formulate self-nanomicellizing solid dispersions (SNMSD), utilizing Soluplus® (SOL), as a drug delivery system to incorporate NAR and selectively target the lipophilic C. acnes abundant environments within the skin. Furthermore, the study aimed to investigate the ex vivo deposition and permeation of NAR into the various layers of the skin using full-thickness porcine ear skin as a model skin. By encapsulating NAR within spherical polymeric micelles (dn < 80 nm) aqueous solubility was significantly increased by approximately 100-fold (from <40 µg mL-1 to 4600 µg mL-1). Following optimization, the micelle solution was integrated into a gel formulation (containing 0.2% w/v NAR) and evaluated for stability over 4 weeks at room temperature (drug content >98%). Results from drug deposition and permeation experiments demonstrated that the deposition of NAR from the NAR-micelle solution and its gel formulation into the lipophilic stratum corneum (19 835.60 ± 6237.89 ng cm-2 and 40 601.14 ± 3736.09 ng cm-2) and epidermis (19 347 ± 1912.98 ng cm-2 and 18 763.54 ± 580.77 ng cm-2) was superior to that of NAR in solution, which failed to penetrate any skin layers. In conclusion, the outcomes of this study provide evidence that NAR exhibits promising activity against antimicrobial resistant strains of C. acnes (MIC range ≤0.008-0.062) and that micelle nanocarriers can improve the aqueous solubility of poorly water-soluble drugs. Furthermore, our results highlight the ability of nanomicelles to enable selective and targeted drug delivery to the lipophilic skin layers.

Development and Optimization of Imiquimod-Loaded Nanostructured Lipid Carriers Using a Hybrid Design of Experiments Approach.

Background: Imiquimod (IMQ) is an immunomodulating drug that is approved for the treatment of superficial basal cell carcinoma, actinic keratosis, external genital warts and perianal warts. However, IMQ cream (Aldara®) has several drawbacks including poor skin permeation, local toxicity, and compromised patient compliance as a topical pharmacological option. Methods: Our research aimed to develop and optimize nanostructured lipid carriers (NLCs) containing IMQ for the first time using a hybrid design of experiments approach. The optimized formulation was then incorporated into a matrix-type topical patch as an alternative dosage form for topical application and evaluated for IMQ deposition across different skin layers in comparison to the performance of the commercial product. Additionally, our work also attempted to highlight the possibility of implementing environment-friendly practices in our IMQ-NLCs formulation development by reviewing our analytical methods and experimental designs and reducing energy and solvent consumption where possible. Results: In this study, stearyl alcohol, oleic acid, Tween® 80 (polysorbate 80), and Gelucire® 50/13 (Stearoyl polyoxyl-32 glycerides) were selected for formulation development. The formulation was optimized using a 2k factorial design and a central composite design. The optimized formulation achieved the average particle size, polydispersity index, and zeta potential of 75.6 nm, 0.235, and - 30.9 mV, respectively. Subsequently, a matrix-type patch containing IMQ-NLCs was developed and achieved a statistically significant improvement in IMQ deposition in the deeper skin layers. The IMQ deposition from the patch into the dermis layer and receptor chamber was 3.3 ± 0.9 µg/cm2 and 12.3 ± 2.2 µg/cm2, while the commercial cream only deposited 1.0 ± 0.8 µg/cm2 and 1.5 ± 0.5 µg/cm2 of IMQ, respectively. Conclusion: In summary, IMQ-NLC-loaded patches represent great potential as a topical treatment option for skin cancer with improved patient compliance.

pH and its applications in targeted drug delivery.

Physiologic pH is vital for the normal functioning of tissues and varies in different parts of the body. The varying pH of the body has been exploited to design pH-sensitive smart oral, transdermal and vaginal drug delivery systems (DDS). The DDS demonstrated promising results in hard-to-treat diseases such as cancer and Helicobacter pylori infection. In some cases, a change in pH of tissues or body fluids has also been employed as a useful diagnostic biomarker. This paper aims to comprehensively review the development and applications of pH-sensitive DDS as well as recent advances in the field.

Polycystic Ovary Syndrome, Subfertility and Vitamin D Deficiency.

Polycystic ovarian syndrome (PCOS) is the most common endocrine female disorder, affecting 4-18% women of reproductive age. The prevalence of PCOS in South Asian women, especially in Pakistani women, is much higher (52%) as compared to white population (20 - 25% in UK). In Pakistan, vitamin D status displays 31.2% vitamin D insufficiency, 53.5% vitamin D deficiency, and 15.3% normal vitamin D values. Vitamin D deficiency, though very common in the general population, is even more prevalent in PCOS patients, seen in approximately 67-85%, which further correlates to their related comorbidities. A lot of researches have to be directed to examine the association among the PCOS and vitamin D, which may display monitoring role in several symptoms related to PCOS, such as ovulatory dysfunction, endocrine disruption, and insulin resistance. Vitamin D supplementation can, therefore, be employed to improve the metabolic and endocrine disorders; especially improving hormonal profile, oxidative stress, and ovulation outcome in PCOS patients. Key Words: Vitamin D, Infertility, Ovulatory Dysfunction, Insulin Resistance.

Probiotics and Their Use in Inflammatory Bowel Disease.

Context • Crohn's disease and ulcerative colitis result in similar gastrointestinal (GI) symptoms, including pain, diarrhea, stools with mucus or blood, and ulceration or tissue damage within the alimentary canal. Gut microbiota play a crucial role in triggering, maintaining, and exacerbating inflammatory bowel disease (IBD). Probiotics might help to rebalance the gut flora in a positive way, shifting from pro- to anti-inflammatory. Objectives • The study intended to investigate the safety and use of probiotics and the biological effects of probiotic bacteria on IBD. Design • The research team performed a literature review. The team conducted a database search in April 2015 using Google Scholar and PubMed to find studies relevant to probiotics and their use in IBD. Only papers that were published in English were considered, and all available years in each database were searched. The initial search identified 38 published articles, for which the research team obtained full texts and independently read them in full to identify those papers suitable for inclusion in the review. Setting • The study took place in the main library of the University of Lahore (Islamabad, Pakistan). Results • Many strains of probiotics exist, but the most common strains available today are (1) the Bifidobacterium species, (2) Enterococcus faecium, (4) the Lactobacillus strains, (4) Saccharomyces boulardii, (5) the Bacillus species, and (6) Pediococcus, all used to produce beneficial health effects. These species showed their beneficial effects on the host using different mechanisms involving (1) production of proteins, quorum sensing signaling inhibitors, butyrate, immunoglobulin A, and short-chain fatty acids; (2) decreased production of tumor necrosis factor alpha and interleukin 8; (3) increased expression of mucin 2; and (4) increased upregulation of defensin. Conclusions • Studies on probiotics in animal models of IBD are promising, and clinical results in IBD patients are encouraging; however, the data are limited, and few studies are placebo controlled. Additional placebo-controlled, double-blind studies in IBD are required before recommendations can be offered for routine use of probiotics in IBD. Additional organisms may eventually be developed through genetic engineering. The current evidence also indicates that probiotic effects are strain specific; they do not act through the same mechanisms nor are all probiotics indicated for the same health conditions. More research is needed to determine what strains and at what dose probiotics become more useful as part of a clinical intervention.

CYP21A2 gene mutation analysis in Moroccan patients with classic form of 21-hydroxylase deficiency: high regional prevalence of p.Q318X mutation and identification of a novel p.L353R mutation.

BACKGROUND: Congenital adrenal hyperplasia (CAH) is an autosomal recessive disease most often due to steroid 21-hydroxylase deficiency (21OHD). The incidence of the CYP21A2 gene mutations in 21OHD has been extensively studied in recent years. The p.Q318X mutation presents an ethnic-specific distribution with a higher prevalence (40%) in Tunisia. METHODS: A total of 20 Moroccan patients were studied, using PCR amplification and sequencing, to determine the mutation spectrum and to evaluate whether the incidence of the p.Q318X mutation is similar in Morocco and in Tunisia. RESULTS: Results revealed that 15 patients were with the salt wasting (SW) form and five with the simple virilizing (SV) form of the disease. All patients were homozygous or compound heterozygous for severe mutations of the CYP21A2 gene. The IVS2-13A/C>G was the most common mutation (47% of chromosomes) and the p.I172N (11%) was associated with the SV form. The p.Q318X was the second most frequent mutation (19.4%) with a regional distribution: the mutation was especially detected (75%) in patients from the midland of Morocco (Fez). We found a novel p.L353R mutation associated with the p.V281L mutation on the same chromosome in one patient at homozygous state. CONCLUSIONS: Genotyping for the four common mutations (IVS2-13A/C>G, p.Q318X, large lesions of the CYP21A2 gene and p.I172N) should allow identifying the diseased alleles and providing genetic counseling in 94% of CAH Moroccan cases. The regional distribution of mutations should help in screening studies.