Synthesis, characterization and assessment of antioxidant and antibacterial potential of dihydroquinoline-3-carboxylic acid and their metal derivatives.

Metal complexes of drug are used to inhibit growth of pathogenic microorganisms and reduces drug resistance. Moxifloxacin is a dihydroquinoline-3-carboxylic acid 4th generation fluoroquinolone antibiotic that has tendency to bind with metal ions. In current study four moxifloxacin-metal complexes i.e. Moxifloxacin-sliver (Moxi-Ag), Moxifloxacin-rhodium (Moxi-Rh), Moxifloxacin-titanium (Moxi-Ti) and Moxifloxacin-rubidium (Moxi-Rb) have been synthesized and evaluated for antibacterial activities against resistant microorganisms along with antioxidant effects. The structure elucidation was carried out using FTIR, 1H- NMR and UV-Vis spectroscopy. Agar well diffusion method and DPPH (1, 1- dipheny1-2-picrylhydrazyl) methods were used to study the antibacterial and antioxidant activity respectively. Both 1H NMR and FTIR spectra clearly showed that Moxi-metal complexes are formed due to change in their carboxyl stretching band in IR, H-2 and H-5 peak position in 1H NMR. All the Moxi-metal complexes showed distinguished antibacterial effects against both Gram-negative and Gram-positive bacteria as compared to drug which was found resistant against many microorganisms. Moxi-Rb and Moxi-Ag metal complexes showed higher antioxidant activity (IC50 values range from 8.26 - 9.19 µg/ml) than Moxi-Ti and Moxi-Rh metal complexes (IC50 range from 11.23 - 14.65 µg/ml).

Association Of Adiponectin With Total Leukocyte Count In Patients Of Coronary Artery Disease.

Background: Hypoadiponectinemia and raised total leukocyte count have been associated with coronary artery disease. The aim of this study was to investigate association of serum adiponectin levels with total leukocyte count in patients of coronary artery disease belonging to Khyber Pakhtunkhwa. Method: This cross-sectional/analytical study consisted of two groups. Group A contained 100 patients of coronary artery disease while group B contained 100 healthy controls. Consent of the study subjects was obtained, their history was recorded and fasting blood samples were analyzed for serum adiponectin level, total leukocyte count (TLC), serum lipid profile which included serum total cholesterol (T-C), triglyceride level (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Adiponectin level was determined with ELIZA method, TLC was estimated on automated haematology analyzer and lipid profile was determined using enzymatic colorimetric method. SPSS version 21 was used to analyze the data. Results: Subjects with coronary artery disease when compared to healthy subjects showed significantly high level of total leukocyte count (9.26±1.488 vs. 6.37±4.052) and low level of serum adiponectin (4.3±0.80 vs. 9.6±3.69). Moreover, serum lipid profile showed low HDL-C (30.04±9.1 vs. 43.64±7.3) and rose triglyceride (220.1±67.7 vs. 181.86±41.4), total cholesterol (229.3±37.01 vs. 189.4±32.7), and LDL-C (153.78±38.53 vs. 109.16±33.91) levels. Significant negative association of adiponectin with TLC (r -0.826 with p<0.01) was observed in the study subjects. Conclusion: We observed elevated level of total leukocyte count and reduced level of adiponectin in subjects with coronary artery disease. Moreover, hypoadiponectinemia correlated negatively with TLC levels.

Association Of C-Reactive Protein With Hyperlipidemia In Patients With Polycystic Ovarian Syndrome In Khyber Pakhtunkhwa.

BACKGROUND: It has been unknown whether there exist any relations of C-Reactive Protein (CRP) level with hyperlipidaemia in polycystic ovarian syndromes patients. To determine Association of CRP with Hyperlipidaemia in patients with polycystic ovarian syndrome. METHODS: This was a cross sectional descriptive study conducted among 50 each polycystic ovarian syndrome and normal women. After taking a written consent from participants predesigned questionnaire was filled including information regarding demography and medical history. A 3 to 5 ml blood was taken from patients and controls and transferred to laboratory for determination of CRP level and lipid profile. The test results were collected, compiled, entered and analyzed using SPSS Version 20 for determination of any kind of association of CRP with Hyperlipidaemia in patients with polycystic ovarian syndrome. RESULTS: The mean age of study participants was 29.72±4.00 for cases and 29.04±3.99 for control. The cases and control were with the same age range, however there was a significant difference p=0.00 in BMI of the cases and control. There was no significant association observed between CRP and lipid profile parameters among polycystic ovarian syndrome patients. CONCLUSIONS: There exist no association between increasing CRP level and hyperlipidaemia in polycystic ovarian syndrome patients however CRP and lipid profile parameters showed high values among these patients.

Visceral Adiposity Index: A Simple Tool For Assessing Risk Of Type 2 Diabetes Mellitus.

BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) has increased recently in Pakistan. Visceral adiposity index (VAI) appears to be a better predictor for metabolic syndrome associated with insulin resistance. VAI has been shown to be linearly and positively associated with diabetes mellitus (DM) in many populations. It is, however, uncertain whether VAI could be associated with T2DM in the Pakistani adult population.. METHODS: This is a cross-sectional study of 300 outpatients with a newly diagnosed T2DM. Subjects were recruited from Lady Reading Hospital, Pakistan, during the period from April, 2020 to January, 2021. For all study subjects, anthropometric measurements were performed. Blood samples were collected for the assessment of high-density lipoproteins (HDL-C), triglycerides (TGs), glycated hemoglobin (HbA1c), and random blood glucose. RESULTS: Participants with high VAI showed poor glycemic control. The number of patients with poor glycemic control increased across the VAI quartiles. VAI showed significant correlations with TGs (r=0.715, p=<0.001), total cholesterol (TC) (r=0.256, p=<0.001), low density lipoprotein (LDL-C) (r=0.154, p=0.007), uric acid (r=0.205, p=0.019), duration of diabetes (r=0.171, p=0.033), TSH (r=0.163, p=0.007), and random blood glucose (r=0.195, p=0.019). CONCLUSIONS: Our data suggest that VAI is significantly and positively correlated with the risk factors of DM such as random blood glucose, uric acid and TSH. The findings of the study do not imply a significant direct association between VAI and DM among the Pakistani adult population. Prospective-large scale studies can help inform an effectiveness of VAI for the prediction of the risk of T2DM among Pakistani population.

Using the 'Twelve tips for applying change models' for undergraduate medical curriculum reform in Pakistan: Incorporating a new Trauma Evaluation and Management TEAM® course.

Background: Trauma evaluation and management skills are not taught enough in medical school undergraduate curriculums worldwide. It has been recommended by trauma educators to incorporate trauma training in medical schools' curriculum as first-line management of trauma cases is usually required by junior doctors in ERs. The introduction of formal trauma training in the form of the Trauma Evaluation and Management TEAM® course is a change introduced into the curriculum. Even when introducing such a simple change, certain factors need to be considered including the stakeholders' apprehensions and involvement, the complexity of the internal and external environment, cultural context and political influences, and finally the psychological impact of change. Methods: Based primarily on the " Twelve tips for applying change models to curriculum design, development and delivery" by McKimm and Jones (2018), these 12 tips provide educators, involved in curriculum or program development, a practical example of the systematic and organized outlines to improve medical curricula. Results & Conclusions: While addressing these factors, this framework can guide educators for the successful development and implementation of a suggested change in the existing curriculum.

Perceptions Of Medical Students About Research At Undergraduate Level.

BACKGROUND: Undergraduate (UG) research is new but important concept in modern science. It is considered as an effective educational tool for enhancing the undergraduate medical experience. The objectives of the study were to know the perceptions of UG medical students towards research, main motivating factors and barriers faced by the students. METHODS: It was Crosssectional study with both quantitative and qualitative portions conducted in Ayub Medical College (AMC) from November 2018 to April 2019. The quantitative portion of the study was based on a simple questionnaire with 9 closed ended questions completed by 215 participants selected using stratified random sampling technique. Data was analysed using SPSS 20.0. The Qualitative portion of the study was based on 8 Focused Group Discussions (FGDs), two from each year, with 6-10 participants. The interviews were recorded and reported by obtaining informed consent from each participant. The audio recording of the FGDs was transcribed verbatim and content analysis was done by conventional content analysis. RESULTS: Out of 215, 128 (59.5%) had a previous research experience mostly as a compulsory requirement of undergraduate curriculum; 134 (62.3%) were aware that research is a part of their curriculum. Lack of resources and lack of interest of students was main barrier, i.e., 152 (70.7%). For 133 (61.8%) participants, the main motivating factor was learning research methodology. CONCLUSIONS: Students were aware about research and their awareness about research increased with increasing year in medical school. Hardly any student had a research experience beforehand they took part in mandatory research in 4th year.

A study skills course for First-Year Medical Students: Experience of a Private Medical School in Pakistan.

OBJECTIVES: To share the experience of study skill module development and implementation for first year MBBS students at Liaquat National Hospital and Medical College (LNH&MC). To compare the change in students' self- assessment of their knowledge of study skills before and after the course. METHODS: This quasi-experimental study was conducted from November 2019 to April 2020. A structured study skills course was offered to 100 first year MBBS students of Liaquat National Hospital & Medical College, Karachi. Steps involved in the development included identification of outcomes, instructional objectives, content and instructional strategies. Students were given two questionnaires. In the first questionnaire, students rated their interest in implementing the learning techniques learnt. In the second questionnaire, students rated their level of knowledge of effective study skills before and after the course. Analysis included computing percentages for students' preferred study skill technique. Change in knowledge was assessed by comparing retrospective pre-post self-rating using Wilcoxon Signed Ranks Test (two-tailed). RESULTS: Analysis of survey forms showed that more than 50% of the students were willing to implement active listening techniques, metacognitive note taking and writing reflections in their future study practice.There was also a statistically significant change in students' self-rating of their knowledge about study skills (pre-test median 3, post-test median 4, p0.00). CONCLUSION: This study provides an insight of structured study skills course development and implementation in early medical college studies that could help them in combating academic stress. In addition, students' response about their preferred technique and their feedback comparison concluded their positive attitude towards the course.

The Prevalence of Subclinical Hypothyroidism During Early Pregnancy in Pakistan: A Cross-Sectional Study.

Introduction Subclinical hypothyroidism (SCH) during early pregnancy is associated with an increased risk of miscarriage or premature birth. In Pakistan, the prevalence of SCH among pregnant women is not well documented. This multi-center study aims at identifying the prevalence of SCH among Pakistani pregnant women. Methods A cross-sectional multi-center study was conducted over a period of 12 months. Pregnant females in the first trimester of pregnancy were recruited from the antenatal clinics of seven centers from six Pakistani cities. We assessed the frequency of SCH in pregnant females and associated risk factors. Results A total of 500 pregnant women were enrolled in this study. Only eight women (1.6%) had a newly-diagnosed SCH. While 1.2% of women had hyperthyroidism, 6% had known hypothyroidism, and 1% had overt hypothyroidism. Ten females (33.3%) with known hypothyroidism were receiving an inadequate dose of thyroid replacement therapy. The association between BMI and SCH was not statistically significant (p = 0.69). Moreover, we could not find any significant difference between patients with or without SCH in terms of age (p > 0.90), dyslipidemia (p = 0.157), history of miscarriage (p > 0.90), the regularity of the cycle (p > 0.90), and history of infertility (p > 0.90). Conclusions The frequency of undiagnosed SCH in pregnant females in the study from Pakistan was 1.6%. The rate of uncontrolled hypothyroidism was high, which raises an alarm of the potential risks of untreated thyroid disorder.

Trauma Evaluation and Management TEAM® course for medical students in Pakistan.

OBJECTIVES: To assess the immediate effect of TEAM® on trauma related knowledge of undergraduate medical students and to highlight the stakeholders' acceptability of TEAM® for trauma training of undergraduate medical students. METHODS: Effectiveness of TEAM® course in terms of knowledge gain was assessed using 20-item-MCQs at three different timings to three cohorts of medical students from year 2017 (Group A), 2018 (Group B) and 2019 (Group C). Group A attempted the test after traditional teaching in wards, Group B attempted it after reading books and videos of TEAM®, along with traditional trauma teaching. Finally Group C attempted the test after TEAM® course along with videos and books. Students and faculty also filled evaluation questionnaire for their acceptability assessment. Kruskal-Wallis Test was applied for comparison between scores of the three groups. The evaluation questionnaire of students as well as for faculty was evaluated by determining frequencies and percentages. RESULTS: A statistically significant difference is found after comparing the scores of the three groups (p< 0.00). More than 85% of the students were of a view that this course would help in their future practice and application. Similarly, 80% of the faculty would prefer to be involved in TEAM® teaching in future. CONCLUSION: There is an improvement in trauma cognitive knowledge, after the TEAM® program. Students and faculty strongly supported its introduction in the undergraduate curriculum and hence acceptable to both.

Bacteriological Profile And Antibiotic Susceptibility Patterns In Diabetic Foot Infections, At Lady Reading Hospital, Peshawar.

BACKGROUND: Diabetic foot ulcer is one of the common complications of diabetes and is also the major cause of hospitalization across the world. To treat it properly, bacteriological profile is important to institute appropriate treatment. This study is done with the objective to determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers in Lady Reading Hospital, Peshawar Pakistan. METHODS: This cross-sectional study was conducted from January to June 2019. Swab samples were collected from 114 patients with diabetic foot infections and inoculated on appropriate media. Antibiotic susceptibility tests were done by Kirby Bauer disk diffusion method. RESULTS: E. coli were predominately isolated in the study, with ESBL in 41.6% of the cases. Strains of Pseudomonas with MDR and XDR were isolated in 21.8% and 6.25% of the patients respectively. Majority of Gram-positive isolates were Staphylococcus aureus, those were MRSA in 76.6% of samples. The commonly involved sites of DFU were the toes and forefoot, and the main causes were blister formation or trauma. Most of the patients were identified to have risk factors such as peripheral neuropathy, peripheral arterial disease, over weight and poorly controlled diabetes. CONCLUSIONS: In our study, Gram negative aerobes were predominantly isolated in the diabetic foot infections. A significant number of MDR isolates were also observed. Lack of awareness about DFU and inappropriate use of broad-spectrum antibiotics may be the main cause of increase in the frequency of MDR isolates.

Using Thypro 39 Scale For Predicting The Quality Of Life In Hypothyroid Patients At Lady Reading Hospital.

BACKGROUND: Thyroid disorders are the second most common of the endocrine diseases. With regards to Hypothyroidism, it has a slow indolent course over the years, before its diagnosis. Most of the patient, on adequate treatment with biochemical euthyroid status, have generalised symptoms that affect their quality of life. Several tools to assess quality of life in thyroid disorders have been validated and recommended for use for those patients in clinical follow ups. ThyPRO 39 is one of a recently developed thyroid-specific quality of life (QoL) questionnaires applicable to patients with benign thyroid disorders (BTD). The purpose of this study was to predict the thyroid-related quality of life (QoL) instrument ThyPRO 39 in patients with Hypothyroidism, who were rendered euthyroid with thyroid replacement therapy prior to the administration of study tool and to assess the internal reliability of this scale in our population. METHODS: A sample of 52 patients undergoing maintenance treatment for Hypothyroidism who visited the outpatient Endocrinology clinics at Lady Reading Hospital was studied. They were interviewed for their baseline demographic details and details on ThyPRO 39 questionnaire were recorded after a written informed consent. The data was entered and analysed using SPSS 25. The Internal reliability of the ThyPRO 39 scale was assessed for multi-item scales using Cronbach's alpha coefficient. RESULTS: The ThyPRO 39 scale demonstrated good response across the whole range of QoL aspects in patients with hypothyroidism. Internal reliability for ThyPRO 39 scale was satisfactory. Cronbach's Alpha in our study was 0.928, which was comparable to the results of other studies. CONCLUSIONS: We suggest implementing this measurement tool as a patient-reported outcome in clinical studies in our indigenous population and further more to utilise it as a screening tool for QoL in clinical management of Hypothyroidism in our routine medical consultations.

Patterns of Diabetes Care Among People with Type 1 Diabetes During Ramadan: An International Prospective Study (DAR-MENA T1DM).

INTRODUCTION: To describe the characteristics and care of participants with type 1 diabetes during Ramadan in the Middle East and North Africa. METHODS: The DAR-MENA (Diabetes and Ramadan-Middle East and North Africa) study was a prospective, observational study of adults with type 1 and type 2 diabetes who were Muslim and did/did not intend to fast during Ramadan 2016. Baseline data were collected 6 weeks prior to Ramadan, with a follow-up visit 1-2 months after Ramadan. This is the analysis of the population with type 1 diabetes. Measurements included proportion who fasted, reasons for fasting and not fasting, changes in diabetes treatment, hypoglycemic events, and proportion with access to diabetes education. RESULTS: Of 136 participants with type 1 diabetes, 76.9% (100/130) fasted for at least 1 day, 72.3% (94/130) fasted for at least 15 days, and 48.5% (63/130) fasted for 30 days. The majority (63.0%, 63/100) reported personal decision as a reason to fast. Fear of diabetic complications (58.6%, 17/29) and previous complications related to fasting (48.3%, 14/29) were the most common reasons for not fasting. Adjustment of diabetic medication regimen occurred for 84.6% (115/136) of participants, and 72.8% (99/136) changed their treatment dose. The incidence and number of adverse events for confirmed and severe hypoglycemia were similar before and during Ramadan. Almost half of participants had access to diabetes education (45.6%, 62/136). CONCLUSION: The DAR-MENA study showed that despite the risks associated with fasting for people with type 1 diabetes, almost half fasted for the full 30 days of Ramadan with no significant change in hypoglycemia events. Since the current International Diabetes Federation and Diabetes and Ramadan guidelines do not endorse fasting for people with type 1 diabetes, it is important that those who insist on fasting work closely with their healthcare practitioner to avoid any complications.

Maternal Mortality: A 5-year analysis at a District Headquarter Hospital in Pakistan.

BACKGROUND: Maternal mortality ratio is an important figure reflecting the strength of a healthcare system. Traditionally the causes of maternal death are described by the three-delay model. This study was conducted to evaluate the causes and determinants of maternal mortality at a secondary level hospital in a rural area of northern Pakistan over a period of 5 years (2013-17). METHODS: This cross-sectional study was conducted in 2018 on hospital data for the previous 5 years (2013-17) regarding mortality in the Gynaecology department of District Headquarter hospital, Timergara. Cases of maternal death were identified and secondary data was retrieved from the hospital records and patient case sheets. RESULTS: Forty-seven cases of maternal death were identified over a period of 5 years and the average maternal mortality ratio calculated to be 110/100,000 live births. Haemorrhage was the commonest cause (36%) followed by uterine rupture (34%) and hypertensive disorders (21%). Most of the cases seen were in uneducated women belonging to the poor socioeconomic stratum (85%) aged 20 to 35 years (55%). 51% of the women were multigravidae coming from within a distance of 25-50 km from the hospital (53%) Majority of the dying mothers (57%) had no antenatal care and were seen arriving at the hospital in the evening shifts (48%). CONCLUSION: Causes and determinants of maternal death are complex and inter sectorial. Poverty, lack of education, antenatal care, family spacing and prompt access to emergency care contribute to maternal death.

Multiple Mini-Interviews: Current Perspectives on Utility and Limitations.

The growing role of healthcare professionals urged admissions committees to restructure their selection process and assess key personal attributes rather than academic achievements only. Multiple mini interviews (MMIs) were designed in 2002 to assess such domains in prospective healthcare professions. Being a high-stake assessment, the utility and limitations of MMI need to be explored. The purpose of this article is to review the available evidence to establish its utility. The claim of the reliability is verified by the studies assessing the effect of number of stations, duration of stations, format and scoring systems of stations and number of raters assessing the applicants. Similarly, by gathering evidence concerning its content validity, convergent/divergent correlation and predictive ability, validity is ensured. Finally, its acceptability and feasibility along with limitations is discussed. This article concludes by providing recommendations for further work required to deal with the limitations and enhance its utility.

The characteristics and pattern of care for the type 2 diabetes mellitus population in the MENA region during Ramadan: An international prospective study (DAR-MENA T2DM).

AIMS: We aimed to describe the characteristics and care of participants with diabetes during Ramadan in the Middle East and North Africa (MENA). METHODS: In this prospective, observational study, we analysed the number of fasted days, number of participants fasting, glycemic control, rate of hypoglycemic events, and lifestyle patterns for participants with T2DM during Ramadan 2016. RESULTS: The population included 1749 participants with T2DM. The mean (SD) duration of fasting was 27.7 (5.0) days, and 57.3% of participants fasted for the full duration of Ramadan. Following Ramadan, a significant improvement in HbA1c, FPG, and PPG was observed (p < 0.0001). Confirmed hypoglycemia increased significantly from before to during Ramadan (incidence: 4.9% vs. 10.4%, p < 0.001; adverse events: 0.11 vs. 0.22 events/month/participant, p < 0.001) and was dependent on the treatment regimen. Severe hypoglycemia incidence was 0.2% before versus 0.9% during Ramadan (p = 0.031), whereas adverse events remained comparable (0.01 events/month/participant; p = 0.154). Most participants (97.4%) reported lifestyle changes during Ramadan. CONCLUSIONS: This prospective study is the first to describe the characteristics and care of participants with T2DM during Ramadan in MENA, and can be utilized in the development of evidence-based care to ensure the safety of participants who fast.

Concept mapping improves academic performance in problem solving questions in biochemistry subject.

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.

Exploring the usefulness of interviewers' training before and after Multiple Mini Interviews (MMI) for undergraduate medical students' selection: Was it really helpful?

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 post-interview 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).

Feasibility, relevance and effectiveness of teaching and assessment of ethical status and communication skills as attributes of professionalism.

OBJECTIVE: To examine the feasibility and effectiveness of teaching and assessing professionalism in a developing country. METHODS: The pre-intervention and post-intervention study was conducted from January to August 2012 and comprised 7 workshops of three days each that were held at four teaching hospitals of Khyber Pakhtunkhwa province in Pakistan. Overall, there were 10 Objective Structured Clinical Examination stations and 10 written scenarios. After the pre-test, workshop was held on various aspects of professionalism which was considered 'intervention', and it was followed by a post-test similar to the pre-test at the end of day 3. Stata 12 was used for all statistical analyses. RESULTS: There were 136 postgraduate residents in the study. The correlation between Objective Structured Clinical Examination stations and written exam for pre-test was 0.42 (p<0.001), while for post-test the correlation was 0.17(p=0.046). Correlation between pre-test written and post-test Objective Structured Clinical Examination stations was 0.23 (p=0.001), but the correlation between pre-test Objective Structured Clinical Examination stations and post-test written was not significant (p>0.05).The standardised effect size for the adjusted regression was 0.37 for both comparisons (p<0.001).Mean pre-test scores were 38.13+/-13.13% vs. 76.50+/-14.4%for the post-test score (p<0.001). CONCLUSIONS: Although post-test scores increased significantly both for the Objective Structured Clinical Examination stations and the written scenarios, the former has shown a higher reliability compared to the written test. Furthermore, teaching and assessment of professionalism was found relevant, effective and feasible in resource-constrained countries. Teaching and assessment of professionalism has become globally relevant and is recommended to be included in the curricula of medical institutions.

Students' perception of mentoring at Bahria University Medical and Dental College, Karachi.

OBJECTIVE: To assess the students' perception regarding mentoring at different stages of their studies at a private-sector medical college. METHODS: The cross-sectional study was conducted from April 2012 to July 2014 at Bahria University Medical and Dental College, Karachi, and comprised students from first to fourth year. Data was collected through a self-administered questionnaire, which was developed after literature search and discussion. The total score for the 35 questions was used as the 'perception score' for the students. The perceptions among all students in an academic year were compared using the Kruskall-Wallis test for median score differences. RESULTS: Of the 401 students approached, 341(85%) completed the survey. The median perception scores for personal support (p=0.81) and career advice (p=0.07) were not different across the four years. There was a significant difference in the perception scores for role modelling (p<0.001) and research collaboration (p=0.002). Students in pre-clinical years (1st/2nd years) rated their mentors higher on role modelling aspects of mentoring (p<0.001) compared to those in the clinical years (3rd/4th years). CONCLUSIONS: Agreement for personal support had the highest score out of the four categories which was not different among all the four years. However, students' perception varied among preclinical and clinical groups when it came to the matter of career advising and role modelling.

Evaluation of Multiple Choice and Short Essay Question items in Basic Medical Sciences.

OBJECTIVES: To evaluate Multiple Choice and Short Essay Question items in Basic Medical Sciences by determining item writing flaws (IWFs) of MCQs along with cognitive level of each item in both methods. METHODS: This analytical study evaluated the quality of the assessment tools used for the first batch in a newly established medical college in Karachi, Pakistan. First and sixth module assessment tools in Biochemistry during 2009-2010 were analyzed. Cognitive level of MCQs and SEQs, were noted and MCQ item writing flaws were also evaluated. RESULTS: A total of 36 SEQs and 150 MCQs of four items were analyzed. The cognitive level of 83.33% of SEQs was at recall level while remaining 16.67% were assessing interpretation of data. Seventy six percent of the MCQs were at recall level while remaining 24% were at the interpretation. Regarding IWFs, 69 IWFs were found in 150 MCQs. The commonest among them were implausible distracters (30.43%), unfocused stem (27.54%) and unnecessary information in the stem (24.64%). CONCLUSION: There is a need to review the quality including the content of assessment tools. A structured faculty development program is recommended for developing improved assessment tools that align with learning outcomes and measure competency of medical students.