Intrinsic motivation between face-to-face and blended learning in surgical clinical education.

Objective: The variability and opportunistic nature of surgical clinical education is the main problem for effective teaching and training of medical students. Incorporating online mediums including discussion forums, interactive videos/scenarios, static pages, and quizzes is known as blended learning (BL). This study aimed to compare the intrinsic motivation of surgical students enrolled in blended learning to those enrolled in face-to-face teaching (f2f teaching). Methods: A quasi-experimental, cross-over study was conducted in Surgical Unit-I and Surgical Unit-II of Dow University Hospital, Karachi, from March to August 2014. A total of 31 students participated and were exposed to two different teachings. For the first four weeks, Group A was posted in Surgical-I (f2f teaching) and Group B in Surgical-II (BL). Both groups were taught the same contents with the same schedule. The F2F group had clinical exposure to real patients, and small group discussions (SGDs) while The BL group students were exposed to an additional online learning component. Intrinsic Motivation Inventory (IMI) was administered at the end of four weeks and groups were swapped. Exchanged groups were again taught the same contents with the same schedule for another four weeks and IMI was administered. Results: Fifty-eight students completed IMI; 28 in f2f and 30 in BL group. There was a significant difference in all four subscales of IMI between the two groups. In three subscales, students in BL were more motivated as compared to f2f (p<0.01). Students in f2f experienced more perceived tension than in BL (p<0.048). Conclusion: This study concluded that blended surgical learning programs keep medical students more intrinsically motivated to learn. By utilizing online learning, superior educational opportunities for students can be cultivated. It can result in enhanced faculty effectiveness and efficiency as well.

Trace metals and nutrient analysis of marine fish species from the Gwadar coast.

Trace metals are naturally occurring metals found in very small concentrations in the environment. In the context of fish flesh, metals such as copper, calcium, potassium, sodium, zinc, iron, and manganese are absorbed by fish and play vital roles in various physiological functions. However, if these metals exceed the recommended limits set by WHO/FAO, they are termed 'toxic metals' due to their harmful impacts on both the fish and its consumers. Therefore, the present study aims to analyze the levels of protein, lipids, and certain metals-Aluminum (Al), Sodium (Na), Zinc (Zn), Titanium (Ti), Iron (Fe), Copper (Cu), Potassium (K), and Calcium (Ca) in three commercially important marine fishes i.e. Rastrelliger kanagurta, Sardinella abella, and Otolithes ruber. The study also aims to assess their potential impact on human health. The macro-Kjeldhal method and Soxhlet apparatus were used to estimate protein and lipid contents, while atomic absorption spectroscopy (AAS) was used to estimate trace metals found in fishes. The study found that these fish species are valuable sources of protein, lipids, and certain essential minerals. The protein content (CP) in these three species ranged from 63.35 to 86.57%, while lipid content was from 21.05 to 23.86%. The overall results of the trace metal concentrations analyzed in the present study revealed that Aluminum (Al), Sodium (Na), Zinc (Zn), Titanium (Ti), Copper (Cu), Potassium (K), and Calcium (Ca) were found in low concentration or traces and also within suitable ranges as set by WHO/FAO. However, Iron (Fe) was absent in all three species. Moreover, both copper and potassium were found in all three species, while Zinc was present in Rastrelliger kanagurta and Sardinella abella, calcium in Sardinella abella, and sodium in Otolithes ruber only. Titanium was recorded for the first time in S. abella. However, the total health risk assessment associated with these fish food consumption was measured by THQ and TTHQ and found to be less than 1, which shows no potential risk related to trace metals found in these fishes on human health upon their consumption. In conclusion, these commercially important marine fish species were found valuable sources of protein, lipids, and essential trace minerals that are necessary for human health. Thus, the current study provides useful information for the local population to make informed decisions about their daily diets and highlights the importance of sustainable fishing practices to maintain these valuable marine resources by periodical monitoring of their ecosystem.

Impacts of Some Trace Metals in Cyprinus carpio (Linnaeus, 1758) and Tor soro (Valenciennes, 1842) on Human Health.

Although fish are rich sources of various trace metals in their bodies, when these metals exceed health safety limits, it becomes a global concern. Fish exposed to trace metal pollution in their aquatic ecosystems can lead to bioaccumulation and transfer to consumers. Monitoring trace metal contamination of fish food is crucial because they can reach humans through the aquatic food chain, resulting in health problems. Therefore, a first attempt was made for the analysis of trace metals in two cyprinid fish species, namely Cyprinus carpio (Common carp) and Tor soro (Mahseer), which were abundantly found in Khanozai Dam and assessing their potential health impacts when consumed by humans. A total of 200 fish specimens were collected from this area. These specimens were divided equally between the two carp species, with 100 individuals from each species. The fish specimens were collected over 12 months, from June 2020 to May 2021 to determine the concentration of some trace metals, i.e. Manganese (Mn), Calcium (Ca), Iron (Fe), Potassium (K), and Zinc (Zn), Sodium (Na), Phosphorus (P), Magnesium (Mg), and Chlorine (Cl) using a Flame Atomic Absorption Spectrophotometer with a multi-element hollow cathode lamp. The obtained results from the trace metal analysis of Cyprinus carpio and Tor soro in this study revealed that both calcium and phosphorus were present in higher concentrations. However, iron, manganese, and zinc were not detected in both species. Additionally, magnesium was also not detected in C. carpio. For Cyprinus carpio, the arrangement was Ca > P > K > Na > Cl, while for Tor soro, it was Ca > P > Na > K > Cl > Mg in decreasing order. The health risks associated with fish consumption were assessed using factors like estimated daily intake (EDI), Target Hazard Quotient (THQ), and Total Target Hazard Quotient (TTHQ). The THQ values for all analyzed trace metals in both carp species exceeded the maximum value of 1.0, except for Cl in Tor soro. This suggests the potential for various health-related diseases in regular consumers due to their elevated levels. In both species, the TTHQ factor also surpassed the standard value of 1.0, indicating an acute health risk for humans. Although EDI values did not surpass the recommended daily allowance (RDA), continuous consumption of these contaminated fish from this area could lead to severe health complications. Therefore, these results strongly indicated that the elevated levels of trace metals found in the highly abundant cyprinid species of Khanozai Dam could pose serious health-related issues for the local inhabitants.

The 21st century disaster: The COVID-19 epidemiology, risk factors and control.

The 21st century will be indelible in the world as ruin of the outbreak of COVID-19 was arose in Wuhan, China has now spread all over the world, up to August 2020. This study was based on the factors affecting the epidemiology of this virus in human societies of global concern. We studied the articles published in journals on various aspects of nCoVID19. The Wikipedia and WHO situation reports have also been searched out for related information. Outcomes were followed up until 2020. The COVID-19 is a virus with pandemic potential which may continue to cause regular infection in human. The pandemic outbreak of COVID-19 threatened public health across the globe in form of system as reflected in the shape of emergency. Approximately 21 million humans are infected and 759,400 have lost their lives till 2020 in all over the world. We have described epidemiological features, reservoirs, transmission, incubation period, rate of fatality, management including recent clinical chemotherapeutic approach and preventive measurements and masses which are at risk of COVID19. This virus causes viral pneumonia when it attacks on respiratory system and multiple failure which can leads to life threatening complications. It is believed to be zoonotic importance although it is not clear from which animal and how it is transmitted. Zoonotic transmission of COVID-19 has not yet known by science. The current study will help to establish a baseline for early effective control of this rapidly spreading severe viral illness. The available data on COVID-19 indicates that older males with comorbidities would have been more infected, which can result in severe respiratory complications. Implementation of preventive measurements, investigation of proper chemotherapeutics and detection of cross species transmission agents must be ensured.

Bioaccumulation of heavy metals in the different tissues of Mackerel scad, Decapterus macarellus (Cuvier, 1833) collected from Karachi and Gwadar Coasts of Pakistan.

Introduction: Among other aquatic animals, fish can also accumulate a large number of toxic metals in their various body organs, which may enter in the human body and cause serious health issues. Therefore, the basic aim of this study was to observe the level of some heavy metals (i.e., Pb, Fe, Cu, Cd, Cr) found in the different tissues of Decapterus macarellus collected from the Karachi and Gwadar coasts of Pakistan. Methods: About 200 fish samples of five different size groups of Decapterus macarellus were collected from Gwadar and Karachi fish harbors during April to September 2020. Total 10 samples of each size group i.e., S1, S2, S3, S4 & S5 were collected from each coast. Heavy metals were analyzed in fish samples by using the atomic absorption spectrophotometer (AAS). Results: The overall results revealed that some metals like Cu, Pb, Cd & Cr contents were high in the stomach, while less in the muscles. Whereas, the concentration of Fe was found to be high in the liver, while low in skin of fish. The average values of bioaccumulation of these heavy metals (BAF) were found in decreasing order of Cu > Cd > Fe > Cr > Pb. In this study, except Cd and Cr, all metals were found within the permissible limits. Both sediment and water from the selected site areas were also analyzed to observe their pollution levels in the order of; sediment > water > fish tissues. Conclusion: Thus, it was concluded that the Karachi environment was much more polluted than the Gwadar environment because it is in an industrial unit and a busy sea site for trade. Moreover, consuming muscles from this species is safe for human health except for iron toxicity, but the use of the liver is not beneficial for all selected metals. Thus, the present work will also be helpful to monitor these toxic metals in a food chain and maintain a healthy life, and reduce all kinds of health risks associated with them.

Effect of dietary supplementation of Neem, Azadirachta indica leaf extracts on enhancing the growth performance, chemical composition and survival of rainbow trout, Oncorhynchus mykiss.

Rainbow trout Oncorhynchus mykiss has a great nutritional value and delicious taste. A 90-days experimental trial was conducted to investigate the effect of dietary leaf extract of neem tree Azadirachta indica as a feeding supplement on the growth performance and proximate composition of O. mykiss. Four experimental diets were designed as T1 (with 5% A. indica leaf extract), T2 (with 7% of A. indica leaf extract), T3 (with 10% A. indica leaf extract), and T4 (control group feed with a regular diet with 0% A. indica leaf extract). The average initial weight of fry 0.4 ± 0.14 g was stocked at 25 fish/tank with two replicates per treatment (4 × 2 = 8). After 90 days of the experimental trial, One-way ANOVA showed significant differences in final body weight, weight gain, specific growth rate, feed conversion ratio, and survival rate among the treatment groups (p < 0.05). The highest final body weight (48.10 g) and weight gain (47.70 g) was observed in T2 with 7% A. indica leaf extract, which was significantly different from the other treatments (p < 0.05). The lowest FCR was recorded in T2 (1.90), which was significantly different compared to other treatment groups (p < 0.05). Inclusion of A. indica leaf extract in formulated feed for rainbow trout had significant effects in the hepatosomatic index, viscerosomatic index and Fulton's condition factor (p < 0.05), but there was no significant difference in the survival rate of rainbow trout fry treated with different experimental diets (p > 0.05). The phenomenal regression indicates that 7.5% A. indica inclusion is optimum for best growth performance for rainbow trout under a controlled environment. Thus, the present study suggests that the dietary leaf extract has performed an excellent nutritional supplement by enhancing growth performance and health conditions of rainbow trout in the hatchery conditions.

Growth performance, haematological assessment and chemical composition of Nile tilapia, Oreochromis niloticus (Linnaeus, 1758) fed different levels of Aloe vera extract as feed additives in a closed aquaculture system.

A 105-day experimental trial was conducted to assess different levels of dietary Aleo vera extract supplementation on water quality parameters, proximate composition, growth performance and haematological parameters of fry Oreochromis niloticus. Four different percentages of dietary leaf extract powder of Aleo vera (ALE) with a basal feed, designated as, i.e., T0 (Control group; without ALE), T1 (1% ALE), T2 (2% ALE), and T3 (3% ALE). Fish fry was reared in concrete tanks (7.0 m, 1.6 m, 1.0: L, W, H; water volume 11.2 m3/tank), with an average initial weight 4.04 ± 0.03 g/ fry, and each treatment was triplicated. Fry was randomly distributed at a stocking rate of 450 individuals/ tanks. The water quality parameters revealed that temperature, pH, salinity, dissolved oxygen (DO) and nitrates were found in a promising range as given by FAO/WHO limits. However, the record values obtained for Electric Conductivity (EC), Total dissolved solids (TDS), and alkalinities were not found in all tanks' suitable range according to FAO/WHO limits. The results revealed a significant impact of different percentages of dietary ALE supplementation on fry's body composition and haematological parameters. Moreover, the final body weight, final body length, average daily weight gain (g), net weight gain (g) and specific growth rate (%) were significantly higher (p < 0.05) in T1 and T2 compared with T0 and T3 treatments. The poorest feed conversion ratio was recorded in the T2 group compared with other treatments. Thus, the current study provides information about the nutritional quality of Nile tilapia culturing in Pakistan.

Elemental composition of three-spot swimming crab Portunus sanguinolentus (Herbst, 1783) shell from the coasts of Sindh and Balochistan, Pakistan.

The present study aimed to investigate the elemental composition of the hard shell of the three-spot swimming crab, Portunus sanguinolentus, collected from the coasts of Pakistan. Thirty crab shells were collected and divided into three groups considering their size. The element detection was performed by energy-dispersive X-ray spectroscopy with scanning electron microscope (SIM/EDAX). The mean concentration of carbon, oxygen, calcium, copper, magnesium, and phosphorus observed in the shell of P. sanguinolentus was 13.63 ± 6.21%, 46.25 ± 12.62%, 34.39 ± 18.33%, 3.19 ± 1.25%, 1.15 ± 0.99%, and 1.39 ± 0.51%, respectively. The concentration pattern of these observed elements in P. sanguinolentus shells was found in the following order: O > Ca > C > Cu > P > Mg. To compare among the three groups of shells, the highest concentration of calcium (54.60%) was obtained in large-sized shell groups, which was significantly different from the other groups (p < 0.05). A high concentration of copper was found to be accumulated in the large-sized (3.55%) and medium-sized (4.21%) shell groups, which was significantly higher than in small-sized shell groups (p < 0.05). In the case of the large-sized shell group, the mean concentrations of magnesium and phosphorus were significantly lower than the medium-sized shell group (p < 0.05). The results indicate that crab shells could act as a good bio-sorbent for several minerals in its ecosystem. P. sanguinolentus shell is very rich in calcium, magnesium, and phosphorus. Extraction of calcium, magnesium, and phosphorus from P. sanguinolentus shells could be profitable for biofertilizer and pharmaceutical industries.

Effect of feeding frequency as a rearing system on biological performance, survival, body chemical composition and economic efficiency of Asian seabass Lates calcarifer (Bloch, 1790) reared under controlled environmental conditions.

A 70-day rearing trial was done to determine the optimal frequency of feeding on growth performance (GP), feed conversion rate (FCR), cannibalism, survival rate (SR), body chemical composition and economic efficiency of the Asian sea bass. This study tested four different treatments of feeding frequencies (FF), once (T1), twice (T2), three times (T3), and four times (T4) per day. An average initial weight of Asian sea bass fry was 0.2 g (SD = ±0.12) were stocked 10 individuals per m3 (9.14 m × 1.82 m × 1.22 m, L × W × H; water depth 0.61 m) with two replicates per treatment (4 × 2 = 8). Fry were fed a mixture of larval commercial feed and shrimp with a pellet diet containing (46% CP). Initially, the feeding rate of 8% biomass per day was further adjusted according to fish biomass on a weekly basis. Results showed that, the FF significantly affected (p < 0.05) on growth indictors and survival rate (SR). Specifically fry fed three times a day (T3) had the best FBW, FL, SGR, ADWG and FCR followed by T4 and T2 while fry fed one time a day was the lowest in these parameters. Also, VSI, HSI and CF (k) significantly differed among the treatments. The fish whole body content of protein, moisture and ash did not significantly (p < 0.05) be affected by feeding frequency, but lipid content differed and both T3, T4 were the highest. It could be concluded that, increasing FF up to three times a day had a positive effect on weight gain, survival rate and feed utilization of Lates calcarifer. The second degree polynomial regression indicates that fed three times a day is optimum for best growth performance and survival for Asian sea bass.

Occurrence of cestodes and comparative efficacy of Typha angustata and sulphadimidine against cestodes in Columba livia domestica (Domestic Pigeon).

The occurrence of intestinal parasites of Columba livia domestica has been on the increase, leading to high economic and production losses with more fatal cases. This study was designed to investigate the prevalence of cestodes in pigeons and determine the efficacy of Typha angustata extract and sulphadimidine against these cestodes in the domestic pigeon. A total of 30 pigeons were examined. 18 (60%) pigeons were found infected with only one type of cestode species (Raillietina spp.). The difference in prevalence between males and females was statistically significant (χ2 = 8.167, p = 0.004). The mean EPG count in group A (treated with T. angustata extract) before treatment and after treatment was 176 ± 4.33 and 155 ± 4.24, respectively. In group B (treated with sulphadimidine), the mean EPG calculated before treatment and after treatment was 184 ± 6.74 and 35 ± 3.53, respectively. The efficacy at day 28 of T. angustata and Sulphadimidine was 11.93% and 80.97%, respectively. It was concluded on the basis of the EPG and efficacy data that T. angustata extract had low efficacy against raillietiniasis, while as sulphadimidine, which is also used before to treat different intestinal parasites, had a good efficacy against raillietiniasis. Further studies are required to know the prevalence of other gastrointestinal parasites in pigeons and efficacy of different medicinal plants against such parasites.

Zoonotic and non-zoonotic helminths in black rats of rain-fed and irrigated areas of Swat, Khyber Pakhtunkhwa, Pakistan.

Present study was conducted to get information on helminth parasites of zoonotic importance among the black rats of district Swat, Pakistan. Two hundred and sixty nine rats were captured from agricultural ecosystem of the district using live captured traps from 2011 to 2013. Captured rats were anesthetized and surveyed for the presence of ectoparasites, then were carefully dissected for investigation of endoparsites. Helminth parasites of 8 species were identified. Presence of parasite was noticed in 23.7% of sampled rats. The infection rates of sampled rats was given in order of their infectivity as Syphacia obvelata 13(4.83%), Aspiculuris tetraptera 13(4.83%), Heterakis spumosa 12 (4.46%), Hymenolepis spp. 9(3.34%), H.diminuta 8(2.97%), Hymenolepis fusa 4(1.48%), Lutziella microacetabularae 4(1.48%) and Lutziella spp. 1 (0.37%). No significant difference (P < 0.4289) was found in prevalence of parasites among areas, crops, crop stages and sex of the host while adult rats were found more infected than sub-adults. S. obvelata and A. tetraptera were the most common species of helminths while Lutziella sp., 1 (0.37%) was found only in one host. Rattus rattus (the black rat) was regarded as the host of helminth parasites of zoonotic importance, therefore the hidden health hazards of this rodent species needed to be considered to prevent infectivity of humans. Current study was concluded that Rattus rattus harbored a wide variety of helminth parasites which shows a hidden risk to inhabitants of the region. Monitoring rats' population in settle areas and educating the local community about the risk of rat borne parasitic diseases transmission through rats appears to be absolutely essential.

Assessment of growth characteristics, the survival rate and body composition of Asian sea bass Lates calcarifer (Bloch, 1790) under different feeding rates in closed aquaculture system.

One of the essential factors to be addressed in the development of aquaculture is the feeding regime. This study was investigated to assess the effects of feeding rate on growth performance, feed utilization, chemical body composition survival rate, cannibalism and morphological indices of Asian Seabass, Lates calcarifer. Intended for the trial, one hundred forty sea bass individuals with an average weight 5.47 ± 0.11 g were randomly distributed in 4 concrete tanks (914 cm × 183 cm 122 cm) each; length × width × depth) and volume 18,399 L, for total 68 days. The fishes were fed with a pelleted diet containing 46% crude protein for different feeding groups designated as (T1, T2, T3 and T4). The feed was supplied with a rate of (T1) 3%, (T2) 4%, (T3) 6%, and (T4) 9% of fish biomass per day and feeding frequency were maintained three times per day to all the groups. At the end of the trial water physicochemical parameters was in acceptable range for Asian sea bass growth. The average daily weight gain (g), weight gain (g) and specific growth rate (%) was significantly higher (p < 0.05) in T3 and T4 as compared to T1 and T2 group. The poorest feed conversion ratio was recorded in T1 group with 3% biomass per day. The cannibalism rate was significantly (p < 0.05) higher in T1 (3%) compared to T3 and T4 treatment. The morphological indices, condition factors (CF), viscerosomatic index and hepatosomatic index (HSI) was significantly higher in T4 group as compared to other treatments. The protein, moisture and ash contents of the whole biomass of the Asian sea bass were not significantly influenced by feeding rate. The fat levels in the fish bodies increased significantly (p < 0.05) with increasing feeding ratio. The phenomenal regression indicates that 6.5% feeding rate per day is optimum for best growth performance, survival and minimum cannibalism rate for Asian sea bass in captivity. The outcome of the finding will help in promotion for not only the coastal aquaculture in Pakistan abut also elsewhere.

Effect of Paper- and Computer-based Simulated Instructions on Clinical Reasoning Skills of Undergraduate Medical Students: A Randomized Control Trial.

Background and objectives Skilled clinical reasoning is a critical tool for physicians. Educators agree that this skill should be formally taught and assessed. Objectives related to the mastery of clinical reasoning skills appear in the documentation of most medical schools and licensing bodies. We conducted this study to assess the differences in clinical reasoning skills in medical students following paper- and computer-based simulated instructions. Materials and methods  A total of 52 sixth semester medical students of the Dow University of Health Sciences were included in this study. A tutorial was delivered to all students on clinical reasoning and its importance in clinical practice. Students were divided randomly into two groups: group A received paper-based instructions while group B received computer-based instructions (as Flash-based scenarios developed with Articulate Storyline software [https://articulate.com/p/storyline-3]) focused on clinical reasoning skills in history-taking of acute and chronic upper abdominal pain. After one week, both groups were tested at two objective structured clinical examination (OSCE) stations to assess acute and chronic pain history-taking skills in relation to clinical reasoning. Results There were 27 students in group A and 25 students in group B. The mean OSCE score for group A (paper-based) was 28.6 ± 9.4 and that for group B (computer-based) was 38.5 ± 6.0. Group B's mean score was statistically significantly greater (p < 0.001) than group A's mean score for clinical reasoning skills.  Conclusion A computer simulation program can enhance clinical reasoning skills. This technology could be used to acquaint students with real-life experiences and identify potential areas for more training before facing real patients.

Quality of Surgical Case Notes at Dow University Hospital according to modified ANKLe score.

OBJECTIVE: To find out quality of surgical case notes according to modified Adjusted Note keeping and Legibility (ANKLe) score in Dow University Hospital. METHODS: For this audit, medical records of all the patients admitted in Dow University Hospital surgery department were reviewed from February 2012 to April 2012. The modified ANKLe score (total 24) is formed by the combination of, the content (out of 20) and legibility (out of 4) to give an overall score out of 24. A score of at least 20 (content score 17/20; legibility score 3/4) is considered as acceptable. It means that a surgical record is legible and the majority of the essential content is recorded. RESULTS: A total of 236 records were evaluated. Overall mean ± standard deviation (SD) of ANKLe score was 18.4± 2.1 out of maximum score of 24. Content and legibility has overall mean scores of 14.4 out of 20 and 3.9 out of 4 respectively. Only two variables, patient's name and consultant on call were documented in 100% of records while the least documented variable were social history 2 (0.2%). Legibility scoring system provides that 218notes out of total set of 236 notes (that is 92.4% of overall notes) have achieved a score of 4. The benchmark of 80% was achieved in 26.1% for total ANKLe score, 6.8% for contents and 99.1% for legibility. CONCLUSION: Overall, quality of records is not good but legibility part scores exceptionally high.

Effectiveness of the Primary Trauma Care Course: Is the outcome satisfactory?

OBJECTIVE: To assess the improvement of knowledge and skills of trauma management among participant of Primary Trauma Care (PTC) workshop. METHODS: A two days Primary Trauma Care (PTC) provider workshop was organized at Dow International Medical College, Karachi - Pakistan on March 5(th) and 6th 2011. Participant's knowledge was assessed by 30 Best Choice Questions (BCQs) and their trauma management skills were assessed by management of trauma case scenario both at pre and post workshop. All scenarios performed by participants were video recorded and marked on a 20 points check list and evaluated by two PTC trainers and graded after consensus. Percentage of participants who scored more than 70% marks on knowledge and skills component were also analyzed. Data was analyzed by SPSS version 17. Wilcoxon Sign Rank test was used to find out significant difference between pre and post workshop score. RESULTS: A total of 20 participants attended the full workshop. Median One best question score before the workshop was 19.5 and post workshop was 25 (p<0.0001). Trauma skills scenario score also showed marked improvement with median score of 3.5 pre workshop and 9.5 post workshop (p<0.0001). Total 19 participants had ≥70% post workshop knowledge score. However, only 4 participants had trauma skill score with ≥70 marks. CONCLUSION: Primary Trauma Care workshop could be an effective course for gaining of knowledge and skills of initial management of trauma patients. However, some modifications need to be done for training of skills components to maximize the output of this interactive workshop.

An analysis of interactive hands-on workshops on medical writing.

OBJECTIVE: To assess the improvement in participant's knowledge and skills pertaining to medical writing by interactive hands-on workshops. METHODS: During the course of three months (January to March 2009), four interactive 5 hours hands-on workshops were organized on Medical Writing. All participants completed a pre-workshop and post-workshop questionnaire. Fourteen questions were included in both questionnaires related to workshop outline. Eight questions were related to knowledge of the participants about different aspects of medical writing (yes/no). Participants were also asked six questions to rate their skills relating to medical writing on a numerical scale of 1-5 (1: no skills and 5: expert). Participant's feedbacks were also analyzed. The pre-workshop and post-workshop responses were compared to see if there was any significant difference by using McNemar test and paired-t test where appropriate. RESULTS: Response to eight questions regarding knowledge (authorship criteria, types of data, application of significance test, search techniques, plagiarism, Vancouver style of reference and copyright statement) showed that there was a significant difference in all responses (p < 0.005). Same trend was observed in skills rating (literature search, basic data analysis, writing an original article, writing references, paper submission for publication) of participants themselves before and after the workshop (p < 0.0001). Analysis of feedback showed that participants found the workshop informative, practical and helpful in improvement of their skills for paper writing. CONCLUSION: Short interactive hands-on medical writing workshops are helpful and beneficial in improving the knowledge and skills of the participants.

Topical diltiazem hydrochloride and glyceryl trinitrate in the treatment of chronic anal fissure.

OBJECTIVE: To compare the symptomatic relief, healing and side-effects of topical diltiazem (DTZ) and glyceryl trinitrate in the treatment of chronic anal fissure. STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: The Surgical Outpatient Department of Civil Hospital, Karachi, from March 2006 to February 2007. METHODOLOGY: Patients with chronic anal fissure were included in the study and randomized to two groups. One group was administered topical 2% diltiazem hydrochloride and other was given 0.2% glyceryl trinitrate (GTN), perianally twice daily for 8 weeks. Patients with anal fissure due to other diseases like inflammatory bowel disease, malignancy, sexually transmitted diseases, previous treatment with local ointment or surgery; patients who required anal surgery for any concurrent disease like hemorrhoids, pregnant women and patients with significant cardiovascular conditions were excluded. There were four follow-up sessions during the course of treatment. Healing and side-effects were recorded. Analysis was done by SPSS version 10 on intention-to-treat basis. Chi-square was used where appropriate. RESULTS: Eighty patients with symptomatic chronic anal fissure were included in the study and equally divided into two groups. After 8 weeks of treatment healing occurred in 31 of 40 patients treated with diltiazem and 33 of 40 patients treated with GTN (p = 0.576). There were less side-effects with DTZ (n=13) than with GTN (n=29, p < 0.001]. In particular, headache occurred more commonly with GTN (n=27) than with DTZ (n=9, p < 0.0001). CONCLUSION: Diltiazem hydrochloride and glyceryl trinitrate were equally effective in healing chronic anal fissure. Diltiazem caused fewer side-effects particularly headache than glyceryl trinitrate ointment. Diltiazem may be the first-line treatment for chemical sphincterotomy for the chronic anal fissure.

Pre-operative analgesia in the accident and emergency department.

OBJECTIVE: To evaluate the adequacy of pre-operative analgesia and patient's satisfaction at the accident and emergency department, in terms of pain relief. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: The Accident and Emergency Department (A&E) of Civil Hospital, Karachi, during April and May, 2007. METHODOLOGY: Patients presenting with acute abdomen or tauma were included. Visual Analogue Scale (VAS) was used to grade severity of pain. Pain at presentation, analgesic prescribed, post-analgesic residual pain and patient satisfaction were assessed. RESULTS: A total of 166 patients (109 males and 57 females) were enrolled in the study. It included 98 (59%) cases of trauma and 68 (41%) patients with acute abdomen. Mean pain score was 6.95+/-2.03 on VAS. Female patients (p=0.008) and patients with acute abdomen (p<0.001) experienced significantly more pain as compared to male and trauma patients respectively. Analgesics were prescribed to 104 (62.7%) patients. Post-analgesic mean residual pain score was 5.0+/-1.8. Out of them, 47.1% patients waited to be given more analgesia. There was significant less prescription of analgesic to patients with acute abdomen (52.9%) as compared to trauma patients (26.5%) (p=0.001). Overall, more than half of the patients (59.6%) were not satisfied with the pre-operative analgesic treatment in the A&E department. CONCLUSION: Pre-operative analgesia was underprescribed and pain was undertreated in accident and emergency department resulting in more than half patients being not satisfied.