Teaching strategies and academic performances of undergraduates in quaid-I-azam medical college, bahawalpur.

OBJECTIVE: to assess the outcomes and competencies of medical undergraduates regarding their learning abilities after introducing Clinical Presentation Curriculum (CPC) instead of Traditional Curriculum in Quaid-i-Azam Medical College, Bahawalpur. DESIGN: a cross-sectional comparative study. PLACE AND DURATION OF STUDY: 3rd and 4th year MBBS class during session 2004-2005 at Quaid-i-Azam Medical College (QMC), Bahawalpur. SUBJECTS AND METHODS: Five hundred students of 3rd year and 4th year MBBS who were taught for 176 and 172 hours respectively, appeared in 20 tests during session 2004-2005, were included in the study. Students were taught pathology according to Traditional Curricular model for 88 and 86 hours, respectively during college hours. Ten class tests each of 3rd and 4th year MBBS were taken and scores recorded. In the next step, the same group of students were taught in accordance with CPC model for 88 and 86 hours respectively in college hours. Ten class tests each were taken and scores recorded. A standardized questionnaire was given to all 500 students after finishing with each curricular model and then the results were compared on SPSS 8.0 regarding their study trends, thinking abilities, intellectual skills and liking of CPC. Chi-square test was used to get significance values and percentages were used for the evaluation of differences. RESULTS: This study detected the positive effects of CPC model not only on study trends and thought process but also had the beneficial effects on learning potential of students in QMC where traditional curriculum was being followed for teaching students. When compared with traditional curricula, CPC model significantly ( p =< 0.01) improved the learning methods to improve knowledge and intellectual skills e.g; group discussions, internet use, reading latest and relevant journals and visits to wards and concerned teachers. Academic performances of these students significantly (p =< 0.01) improved regarding their class test attendance, class room attendance and marks obtained in tests when compared with traditional curricula. Similarly, there was significant (p =< 0.01) increase in divergent thinkers. CONCLUSION: CPC, introduced in 3rd and 4th year MBBS of QMC, Bahawalpur, with traditional curriculum, significantly improved the academic performance, learning behaviour and intellectual skills of students.

Estrogen replacement therapy for depression in perimenopausal women.

OBJECTIVE: To determine the effect of a four-week course of oral estrogen therapy on depression in aging women. DESIGN: Quasi experimental. PLACE AND DURATION OF STUDY: The OPD, Bahawal Victoria Hospital, Bahawalpur, from September 2000 to January 2004. PATIENTS AND METHODS: Forty-two depressed women (aged 42-57) who were either perimenopausal (n = 20) or postmenopausal (n = 22) received open label treatment with oral estrogen tablets (1.25 mg/day) for 4 weeks. The Montgomery-Asberg Depression Rating Scale and the Beck Depression Inventory were used to assess depressive symptoms, the Greene Climacteric Scale was used to assess menopause-related symptoms, and the Clinical Global Impression(CGI) was used to assess global clinical improvement in these women at baseline and after treatment. Remission of depression was defined as a score < 10 on the Montgomery-Asberg Depression Rating Scale and a score < or = 2 on the CGI at week 4. RESULTS: The women who completed the study had a median Montgomery-Asberg Depression Rating Scale score of 20 (range = 15-32) at study entry and 11.50 (range = 10-31.0) at week 4 (z = -3.43, p < 0.01). This improvement was consistent with that reported by the women themselves on the Beck Depression Inventory (rs = 0.86, n = 20, p < 0.01). The improvement measured by CGI scores was also significant (p < 0.01). Remission of depression was noted in 5 of the 40 women (after 1 year) who completed the study. Anti-depressant response was not associated with severity or subtypes of depression at study entry or with concomitant improvement in menopause-related symptoms. CONCLUSION: Perimenopausal and postmenopausal women benefit from short-term use of estrogen therapy. Antidepressant effect of estrogen therapy is independent of improvement in menopause-related symptoms.

Effect of pregnancy on diabetic nephropathy and retinopathy.

OBJECTIVE: To determine whether pregnancy worsens renal function in women with diabetic nephropathy and the effect of pregnancy on diabetic retinopathy. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: The study was conducted in OPD, Bahawal Victoria Hospital, Bahawalpur from September 1997 to June 2003. SUBJECTS AND METHODS: Thirty-five patients (aged 20-36 years ) identified with diabetic nephropathy and moderate to severe renal dysfunction(creatinine [Cr] > 1.4 mg/dl) at pregnancy onset by retrospective chart review. Alterations in glomerular filtration rate (GFR) were estimated. An equal number of non-pregnant premenopausal type I diabetic women with similar degrees of renal dysfunction served as controls for non-pregnant rate of decline of renal function and potential contributing factors. Student's t-test and repeated measures analysis of variance were analyzed. RESULTS: Mean serum Cr rose from 1.8 mg/dl prepregnancy to 2.5 mg/dl in the third trimester. Renal function was stable in 27%, showed transient worsening in pregnancy in 27%, and demonstrated a permanent decline in 45%. Proteinuria increased in pregnancy in 79%. Exacerbation of hypertension or pre-eclampsia occurred in 73% and 71% of these showed acceleration of disease during the pregnancy. All the patients had diabetic retinopathy, though proliferative retinopathy was diagnosed and treated in only 54.5.% prepregnancy. The retinopathy progressed, requiring laser therapy, in 45.4%. Macular edema was noted in 6 of the patients. Other diabetic complications included peripheral and autonomic neuropathy in 8 patients. CONCLUSION: Pregnancy induced progression is seen in the decline of renal functions. Patients with diabetic nephropathy were found to have a > 40% chance of accelerated progression of their disease as a result of pregnancy. Forty-five percent of the patients had permanent decline in GFR in association with pregnancy.