Quality and antioxidant potential of goat's milk paneer prepared from different citrus juices and its whey.

The experiments reported in this research paper aimed to evaluate the physico-chemical and sensory characteristics, microbial quality and antioxidant potential of goat's milk paneer during storage (0-12 d, 4 ± 1°C). The juices from five different citrus fruits were used as coagulant (treatments) to make goat's milk paneer. The pH of all paneer samples decreased during storage whereas titratable acidity increased. Ash (%) fat (%) and protein (%) of paneer increased slightly during storage, whereas sensory perception decreased. The juices from all the citrus fruit varieties showed high contents of total phenolics and total flavonoids which ultimately influenced ferric reducing antioxidant power, total antioxidant capacity and radical scavenging activities. As the contents of different juices were also retained in the paneer matrix, so paneer coagulated with citrus juices also showed encouraging results in terms of total phenolic and flavonoid contents, ferric reducing antioxidant power and radical scavenging activities. Amongst all the paneers, the most promising was that coagulated by kinnow juice. In addition, the whey obtained from paneer coagulated by citrus juices also showed appreciable quantities of total phenolic and flavonoid contents, thereby beneficially influencing ferric reducing antioxidant power andradical scavenging activities. It is concluded that citrus juices improve the sensorial quality and antioxidant potential of goat's milk paneer and its whey.

Occurrence of Toxoplasma gondii antibodies and associated risk factors in women in selected districts of Punjab province, Pakistan.

Toxoplasmosis is a parasitic zoonotic disease caused by Toxoplasma (T.) gondii. Limited data are available on the occurrence of T. gondii in women especially pregnant women in Pakistan. The present study aimed to determine the occurrence and risk factors associated with T. gondii in pregnant and non-pregnant women in Punjab Province, Pakistan. A cross-sectional study was conducted and 593 samples were collected from pregnant (n = 293) and non-pregnant (n = 300) women of District Headquarter Hospitals of Chiniot, Faisalabad, Jhang and Okara, Pakistan. Data related to demographic parameters and risk factors were collected using a pretested questionnaire on blood sampling day. Serum samples were screened for antibodies (IgG) against T. gondii using ELISA. A univariant and binomial logistic regression was applied to estimate the association between seropositive and explanatory variables considering the 95% confidence interval. P value ⩽0.05 was considered statistically significant for all analysis. Out of 593, 44 (7.42%) women were seropositive for T. gondii IgG antibodies. Occupation, age, sampling location, socioeconomic status, contact with cat, pregnancy status and trimester of pregnancy were significantly associated with seropositivity for T. gondii antibodies. Location and trimester of pregnancy were identified as potential risk factors for T. gondii seropositivity based on binomial logistic regression. Toxoplasma gondii is prevalent in pregnant and non-pregnant women. Therefore, now a necessitated awareness is required to instruct the individuals about these infectious diseases (toxoplasmosis) and their control strategies to maintain the health of human population. Moreover, health awareness among public can help the minimization of T. gondii infection during pregnancy and subsequent risk of congenital toxoplasmosis.

Antioxidant potential of a soft cheese (paneer) supplemented with the extracts of date (Phoenix dactylifera L.) cultivars and its whey

Objective: The present study was conducted to evaluate the antioxidant potential of paneer, a soft cheese supplemented with various water soluble date extracts during storage. Further, the whey obtained from all the paneer samples was also investigated for its antioxidant potential. Methods: The date cultivars were evaluated for their physico-chemical characteristics and date extracts were assessed for their antioxidant potential. Physico-chemical evaluation, microbiological quality and further antioxidant potential of the prepared paneer were carried out during storage period (0-8 days, 5°C). Results: All the date extracts were found to have considerable antioxidant activity due to presence of total phenolics and flavonoids. Owing to the presence of phenolics and flavoinds in date extracts, supplemented paneer showed higher trolox equivalent antioxidant capacity, reducing power and DPPH radical scavenging activity than control paneer. Paneer supplemented with Rabi extracts had the highest total phenolics (190.7 µg gallic acid equivalent/g paneer), DPPH radical scavenging activity (928.1 µmol equivalent of Trolx/g paneer) and trolox equivalent antioxidant capacity (9.2 µmol equivalent of Trolx/g paneer). The whey obtained from control paneer showed lower values of total phenolics, total flavonoids, DPPH, trolox equivalent antioxidant capacity and reducing power as compared to the values of whey obtained from paneer supplemented with date extracts. Conclusion: Paneer supplemented with date extracts and its whey may offer potent antioxidant activity.

Thermal behavior of cylindrical buckling restrained braces at elevated temperatures.

The primary focus of this investigation was to analyze sequentially coupled nonlinear thermal stress, using a three-dimensional model. It was meant to shed light on the behavior of Buckling Restraint Brace (BRB) elements with circular cross section, at elevated temperature. Such bracing systems were comprised of a cylindrical steel core encased in a strong concrete-filled steel hollow casing. A debonding agent was rubbed on the core's surface to avoid shear stress transition to the restraining system. The numerical model was verified by the analytical solutions developed by the other researchers. Performance of BRB system under seismic loading at ambient temperature has been well documented. However, its performance in case of fire has yet to be explored. This study showed that the failure of brace may be attributed to material strength reduction and high compressive forces, both due to temperature rise. Furthermore, limiting temperatures in the linear behavior of steel casing and concrete in BRB element for both numerical and analytical simulations were about 196°C and 225°C, respectively. Finally it is concluded that the performance of BRB at elevated temperatures was the same as that seen at room temperature; that is, the steel core yields prior to the restraining system.

Seismic performance of RC beam-column connections with continuous rectangular spiral transverse reinforcements for low ductility classes.

The seismic performance of RC columns could be significantly improved by continuous spiral reinforcement as a result of its adequate ductility and energy dissipation capacity. Due to post-earthquake brittle failure observations in beam-column connections, the seismic behaviour of such connections could greatly be improved by simultaneous application of this method in both beams and columns. In this study, a new proposed detail for beam to column connection introduced as "twisted opposing rectangular spiral" was experimentally and numerically investigated and its seismic performance was compared against normal rectangular spiral and conventional shear reinforcement systems. In this study, three full scale beam to column connections were first designed in conformance with Eurocode (EC2-04) for low ductility class connections and then tested by quasistatic cyclic loading recommended by ACI Building Code (ACI 318-02). Next, the experimental results were validated by numerical methods. Finally, the results revealed that the new proposed connection could improve the ultimate lateral resistance, ductility, and energy dissipation capacity.

Review on cold-formed steel connections.

The concept of cold-formed light steel framing construction has been widespread after understanding its structural characteristics with massive research works over the years. Connection serves as one of the important elements for light steel framing in order to achieve its structural stability. Compared to hot-rolled steel sections, cold-formed steel connections perform dissimilarity due to the thin-walled behaviour. This paper aims to review current researches on cold-formed steel connections, particularly for screw connections, storage rack connections, welded connections, and bolted connections. The performance of these connections in the design of cold-formed steel structures is discussed.

Effect of different preservatives on the physicochemical characteristics and shelf stability of Rasmalai: A comparative study.

Rasmalai is a very popular, delicious, and nutritious indigenous sweet dish in Indo-Pakistani civilization. It has a very short shelf life, i.e., up to 3 days. The study was designed to assess the effect of preservatives (potassium sorbate and calcium propionate) on the shelf stability of Rasmalai. Moreover, proximate composition and sensory evaluation of prepared Rasmalai were also carried out in the present study. In general, potassium sorbate and calcium propionate significantly increased the shelf life of Rasmalai. But treatment (R5) containing a combination of both potassium sorbate and calcium propionate (500 ppm each) improved its shelf life by up to 12 days by keeping good sensorial characteristics. The maximum total plate counts as well as yeast and molds were observed in control Rasmalai (without any preservatives) whereas minimum counts were found in R5 treatment containing a combination of both potassium sorbate and calcium propionate (500 ppm each). In conclusion, all the preservatives used in the present study were effective in enhancing the shelf life of Rasmalai but R5 treatment containing a combination of both potassium sorbate and calcium propionate (500 ppm each) was the most effective in enhancing shelf life without deleterious effect on sensorial characteristics.

Relationship between Characteristics of the Wound and Healing Duration among Patients Treated during Home-Visits.

In humans, wound healing is a vital but complex process governed by chronological yet overlapping stages, such as hemostasis, inflammation, proliferation, and remodeling. Because of the complexities of wound healing, it is prone to pausing at multiple levels. Wound healing can potentially be influenced by factors that affect cellular functions and physiologic responses. This research aimed to investigate the relationship between wound healing duration and demographic properties and characteristics of wounds among patients treated during home visits in Erbil, Iraq. To this end, a longitudinal correlational quantitative design was employed in the current study. A random sample of about 101 chronic wounds was found in 77 patients of both genders selected from all ages during home visits for around four years in Erbil. The professional nurse applied nursing management according to the nursing plan during home visits until the wound recovered. The total duration of wound healing was calculated and documented for each wound. Seventy-seven patients participated in the current study, with their mean±SD age being 58.02±16.29 years, ranging from 19 to 89. The median age was 60. More than half of the sample (54.5%) were ≥60 years, and 62.3% were males. Less than one-third of patients (31.2%) were of normal weight, 93.5% were married, 37.7% were housewives, and 35.1% were illiterate. Regarding the duration of wound healing, in more than one quarter (26.7%), it was delayed (took more than three months for healing). The longest mean healing time (20.06 weeks) was for pressure ulcers (P<0.001), which was significantly higher than all the mean healing times of other types of wounds. The study showed a significant (P=0.011) association between the mean healing time and the anatomic location of wounds, revealing that the highest mean healing time was for wounds located in the trochanteric area (21.10 weeks) or the sacrum (18.25 weeks). A significant association (P=0.002) was also detected between the mean healing time and the edge of the wound, with the highest mean healing time (18.64 weeks) found in wounds with undermined edges. Furthermore, the mean healing time was significantly higher among those with infected wounds (14.59 weeks) than the mean (6.50 weeks) among those with no infection (P<0.001). In conclusion, wound healing progression is an important but complicated process that healthcare providers use for patients during home visits. It is divided into phases, including hemostasis, inflammation, proliferation, and remodeling. The current study revealed that the healing time was affected by the anatomical site of the wound and took longer in pressure ulcers, undermined edge wounds, and infected wounds.

Isolation of alkaloidal and glycosidal fractions from leaves of Trigonella foenum-graecum L. cv. Desi indigenous to Pakistan for antiprostaglandin evaluation as substitute of nonsteroidal anti-inflammatory drugs.

ETHNOPHARMACOLOGICAL RELEVANCE: Trigonella foenum graecum (fenugreek) has been in use for a long time as a traditional medicine and natural food additive. The reported gastro-protective property makes it unique among other herbs. Seeds and leaves have been shown to exert significant antiatherogenic, antidiabetic, antianorexic, antioxidant, anticarcinogenic, antihyperlipidemic, galactogogue and anti-inflammatory effects in several animal and human models. But its use as a substitute for ulcerative nonsteroidal anti-inflammatory drugs needs to be confirmed. AIM OF THE STUDY: Nonsteroidal anti-inflammatory drugs (NSAIDs) are in common use in treating inflammation associated with a variety of ailments, fever and pain such as menstrual cramps, back pain, arthritic pain and headaches. Their toxicity profile includes the risk of severe gastro-intestinal adverse events like increased bleeding tendency, ulceration, perforation, etc. Conventional NSAIDs have also been reported to reduce the glomerular filtration rate (GFR) by affecting afferent arterioles in nephrons. Exacerbated potassium levels were noted in patients using NSAIDs concomitantly with antihypertensive drugs belonging to the angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) classes. In this context, the need of the hour is to discover and isolate new compounds from the reported medicinal plants for evaluation of antiprostaglandin potential and safety profile in terms of the hepato-renal system. These compounds may be used as substitutes for NSAIDs in the future management of inflammation and pain with therapeutic equivalency and organ safety. In this scenario, the present study aimed to assess the antiprostaglandin potential of alkaloidal and glycosidal fractions from the leaves of Trigonella foenum-graecum L. cv. Desi variety, indigenous to Pakistan, in albino mice along with safety profile. The herb has been used as folk medicine since ancient times for treating inflammation and pain. MATERIAL AND METHODS: Alkaloidal and glycosidal fractions were separated from a methanol extract of leaves of the fenugreek Desi variety. After separation of fractions, their subsiding effects on carrageenan-induced inflammation, air pouch exudate prostaglandin-E2 levels, Brewer's yeast induced pyrexia and acetic acid induced abdominal constrictions were assessed in adult male albino mice. The safety profile of fractions was assessed by measuring their effects on mice sera hepato-renal biomarkers. RESULT: Alkaloidal fraction of T. foenum Desi variety was found to be significantly effective in reducing inflammation, air pouch exudate PGE2 levels, fever (≤37 °C) and pain by inhibiting writhes (up to 96.58%) Gradual inhibition of paw edema was observed 1-6 h post-dose, with maximum reduction percentages of 62.82% and 62.57% for 100 mg and 200 mg, respectively. Both fractions did not disturb the normal physiology of the hepato-renal system by showing normal biomarker values. CONCLUSION: In summary, the results demonstrate the potent antiprostaglandin potential of the alkaloidal fraction of gastroprotective fenugreek "Desi" leaves with hepato-renal system safety and hence justify its use as a substitute for ulcerative nonsteroidal anti-inflammatory drugs.

Physicochemical characteristics, antioxidant potential, and shelf stability of developed roselle-fig fruit bar.

Fruit bars are prepared by combining different ingredients which are wholesome and nutrient rich. The current study was designed to develop roselle-fig (different proportions) fruit bars and further investigate their physicochemical characteristics and antioxidant potential. Moreover, the prepared fruit bars were scrutinized for microbial and sensory characteristics to assess the appropriateness of ingredients during storage (up to 90 days). It was observed that there was gradual increase in moisture content with the passage of time, while ash, fat, fiber, and protein contents did not change significantly during storage. The pH and total soluble solid contents of these fruit bars during storage were 3.54-4.07 and 1.71-1.86 Brix, respectively. According to the mean values for sensory evaluation, T 2 was preferred over other treatments. The bars received an acceptable sensory evaluation, demonstrating that they were suitable for 90 days of storage. Phytochemical quantities significantly increased in subsequent treatments, but decreased during storage in all the treatments. Similar trend was observed regarding total antioxidant and DPPH radical scavenging activities. The mineral contents increased significantly among the treatments. The microbial analysis of fruit bars exposed that the fruit were microbiologically safe. Hence, on the basis of the results obtained in this study, it may be concluded that the developed roselle-fig fruit bar would be acceptable and nutritious regarding physicochemical characteristics, microbiological quality, and antioxidant potential.

Influence of baking and frying conditions on acrylamide formation in various prepared bakery, snack, and fried products.

The core objective of the present study was to evaluate the influence of baking/frying times and temperatures on the formation of acrylamide in bakery, snack, and fried products such as biscuits, muffins, pizza, cakes, samosa, paratha rolls, nuggets, and potato cutlets during baking/frying at different times and temperature conditions. First of all, the raw material, especially flour, was tested for its proximate composition and rheological characteristics. The quantification of acrylamide produced during the processing of different products was carried out through the HPLC method. A sensory evaluation of these food samples was also carried out to find out the acceptability differences. The raw material was found to have good rheological properties and proximate composition. The results revealed that different times and temperature regimes influenced the formation of acrylamide in those products. Among the bakery products, the highest concentrations of acrylamide were observed in biscuits (126.52 µg/kg) followed by muffins (84.24 µg/kg), cake (71.21 µg/kg), and pizza (62.42 µg/kg). The higher contents of acrylamide were found in paratha roll (165.92 µg/kg) compared to samosa (100.43 µg/kg), whereas among snacks, potato cutlets (135.71 µg/kg) showed higher concentrations than nuggets (43.04 µg/kg). It was observed that baking or frying all the investigated products at higher temperatures produced slightly more acrylamide concentrations. The prepared products in the present study were also accepted sensorially by the panel of judges. So, it was concluded that baking or frying at higher temperatures resulted in higher concentrations of acrylamide compounds in different products in the present study.

Waste Mineral Wool and Its Opportunities-A Review.

Massive waste rock wool was generated globally and it caused substantial environmental issues such as landfill and leaching. However, reviews on the recyclability of waste rock wool are scarce. Therefore, this study presents an in-depth review of the characterization and potential usability of waste rock wool. Waste rock wool can be characterized based on its physical properties, chemical composition, and types of contaminants. The review showed that waste rock wool from the manufacturing process is more workable to be recycled for further application than the post-consumer due to its high purity. It also revealed that the pre-treatment method-comminution is vital for achieving mixture homogeneity and enhancing the properties of recycled products. The potential application of waste rock wool is reviewed with key results emphasized to demonstrate the practicality and commercial viability of each option. With a high content of chemically inert compounds such as silicon dioxide (SiO2), calcium oxide (CaO), and aluminum oxide (Al2O3) that improve fire resistance properties, waste rock wool is mainly repurposed as fillers in composite material for construction and building materials. Furthermore, waste rock wool is potentially utilized as an oil, water pollutant, and gas absorbent. To sum up, waste rock wool could be feasibly recycled as a composite material enhancer and utilized as an absorbent for a greener environment.

Effect of In Vitro Digestion on the Antioxidant and Angiotensin-Converting Enzyme Inhibitory Potential of Buffalo Milk Processed Cheddar Cheese.

The purpose of this study was to develop an in-vitro digestion protocol to evaluate the antioxidant potential of the peptides found in processed cheddar cheese using digestion enzymes. We first studied antioxidant and angiotensin-converting enzyme (ACE) inhibition and antioxidant activities of processed cheddar cheese with the addition of spices e.g., cumin, clove, and black pepper made from buffalo milk and ripened for 9 months. Then we conducted an in vitro digestion of processed cheddar cheese by gastric and duodenal enzymes. Freeze-dried water (WSE) and ethanol-soluble fractions (ESE) of processed cheddar cheese were also monitored for their ACE inhibition activity and antioxidant activities. In our preliminary experiments, different levels of spices (cumin, clove, and black pepper) were tested into a cheese matrix and only one level 0.2 g/100 g (0.2%) based on cheese weight was considered good after sensory evaluation. Findings of the present study revealed that ACE-inhibitory potential was the highest in processed cheese made from buffalo milk with the addition of 0.2% cumin, clove, and black pepper. A significant increase in ACE-inhibition (%) of processed cheddar cheese, as well as its WSE and ESE, was obtained. Lower IC50 values were found after duodenal phase digestion compared to oral phase digestion.

Influence of ultrasound on the functional characteristics of indigenous varieties of mango (Mangifera indica L.).

The present study was conducted to evaluate the effect of ultrasonic (US) treatment on chemical characteristics and antioxidant potential of pulps obtained from eight mango varieties indigenous to Pakistan. There was a significant (p < 0.05) effect of varieties and US treatment on chemical characteristics i.e. pH, acidity, TSS, vitamin C contents, total sugars (%), reducing sugars (%) and non-reducing sugars (%). Microstructure evaluation of pulp from all mango varieties showed deshaped middle lamella and cell wall of cells after 8 min of US treatment. At 4 min of US treatment as per shaped cell wall and middle lamella, the chemical characteristics and antioxidant potential were higher. The total phenolics (TP), flavonoids (TF) and total antioxidant activity (TAA) of pulp from most varieties increased significantly (p < 0.05) after US treatment for 4 min but decreased successively after each treatment i.e. 8 and 12 min. The maximum value (314.17 µg AAE/mL pulp) of DPPH was shown by pulp from Dosehri and the minimum (158.67 µg AAE/mL pulp) was found in pulp from Langra before US treatment. The DPPH values of pulp from most of the varieties increased significantly (p < 0.05) after US treatment for 4 min but decreased successively after each treatment but pulp from Langra showed increasing trend after 8 min of US treatment which decreased after 12 min of treatment. The total anthocyanin (TA) values of pulp from Chaunsa, Dosehri, Sindhri, Gulab Khas and Langra increased abruptly after US treatment for 4 min but decreased successively after subsequent treatment. The pulp from Desi, Anwar Ratol, Gulab Khas and Langra showed an abrupt decrease in TA after 8 min of US treatment. An increasing trend of values of total carotenoids (TC) was shown by pulp from all mango varieties after 4 min of US treatment but decreasing trend was observed with subsequent increase in time of US treatment.

Seroepidemiology and the Molecular Detection of Animal Brucellosis in Punjab, Pakistan.

Brucellosis is an infectious disease caused by bacteria of the genus Brucella (B.), affecting both animals and humans, causing severe economic loses and severe illness, respectively. The objective of the present study was to determine the seroprevalence and the risk factors associated with caprine, ovine, and bovine brucellosis in selected districts of Punjab, Pakistan. A total of 1083 blood samples were randomly collected from animals (goats = 440, sheep = 203, cows = 206, and buffaloes = 234). Questionnaires were used to collect data on risk factors associated with brucellosis on the sampling day. All samples were initially screened for anti-Brucella antibodies using the rose bengal plate test (RBPT). The seropositive serum samples were confirmed by a quantitative real-time polymerase chain reaction (PCR) assay for the detection of the Brucella genus- and Brucella species-specific DNA (B. abortus and B. melitensis). Univariant and binary logistic regression were used to identify important risk factors of brucellosis. Anti-Brucella antibodies and DNA were detected in 35 (3.23%) serum samples. Thirty-four (97.1%) DNA samples were confirmed as B. melitensis by qRT-PCR. Abortion history and natural mating were found to be potential risk factors. Brucella melitensis was identified as the causative agent of caprine, ovine, and bovine brucellosis in the selected districts of Punjab, Pakistan. Diseased animals may act as a source of infection for other animals. The elimination of positive seroreactors, development of control strategies for brucellosis, and education programs regarding the control of zoonotic disease are highly needed in developing countries like Pakistan.

Effect of ultrasound and chemical treatment on total phenol, flavonoids and antioxidant properties on carrot-grape juice blend during storage.

Ultrasonics is one of the developing technologies which is being studied extensively on different food commodities. Our aim was to study the effect of sonication and chemical (Potassium metabisulfite, K2S2O5,) preservation method on grape-carrot juice blend. Sonication/ultrasound treatments (20 kHz frequency, 70% amplitude level (525 W power), and pulse duration 5 s on and 5 s off, 5 min at 15 °C) of all the samples (250 mL) were performed by using an ultrasonic processor with 0.5 in. probe at 2 in. depth of the sample. Additionally, impact of sonication on 90 days of storage period at refrigerated temperature was also measured. It was observed that sonication had a positive effect on nutritional status of juice blend as it enhanced the total phenolic, flavonoid, reducing power and antioxidant properties of juice significantly (p < 0.05) with increase in sonication time. Sonication can be employed successfully for treatment of juice with better nutritional attributes from consumers' point of view.

Fetal scalp stimulation (FSS) versus fetal blood sampling (FBS) for women with abnormal fetal heart rate monitoring in labor: a prospective cohort study.

OBJECTIVE: To evaluate the performance of fetal scalp stimulation (FSS) compared to fetal blood sampling (FBS) as a second line test of fetal wellbeing in labor. STUDY DESIGN: A prospective cohort study was conducted including 298 fetal blood sampling procedures performed due to abnormal fetal cardiotocography (CTG). Two independent observers interpreted the CTG following stimulation. The FSS test was classified as normal when an elicited acceleration and/or provoked fetal heart rate variability was recorded. The FBS was classified as normal (pH ≥7.25), borderline (pH 7.21-7.24), and abnormal (pH ≤7.20). RESULTS: Of the 298 procedures, 249 (84%) had a normal scalp pH result, 199 (67%) had an acceleration in response to FSS and 255 (86%) had an acceleration or normal variability in response to FSS. All 11 of the neonates classified as normal by FSS, but abnormal by FBS were born with normal Apgar scores and cord pH results. The consistency between FSS and FBS was "fair" (kappa 0.28) while the consistency between either test and cord arterial pH was "poor". CONCLUSIONS: This study suggests that FSS has the potential to be a reliable alternative to FBS. The findings require evaluation in a well-designed randomized controlled trial.

Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery.

In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general.

Gynaecological endoscopic surgical education and assessment. A diploma programme in gynaecological endoscopic surgery.

In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills, are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA) recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high-stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy, (b) the Minimally Invasive Gynaecological Surgeon (MIGS) and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence, and it counteracts the problem of the traditional surgical apprentice-tutor model. It is seen as a major step toward standardisation of endoscopic surgical training in general.

The association of nutritional profile and prognosis of degenerative diseases associated with carbohydrate and lipid metabolism at high altitude of district Ziarat, Pakistan.

OBJECTIVE: In the present study the physiological parameters, their comparative analysis with carbohydrate and lipid metabolism were studied. This study suggests life style, environmental and genetic adaptations in the studied population. METHOD: One hundred and ninety eight subjects were selected from different towns of District Ziarat. General characteristics of the population according to their nutritional habits including, age, body mass index(BMI), systolic blood pressure, diastolic blood pressure, glycemia, triglycerides, serum low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL), triglycerides (TG) were measured. RESULTS: Mean cholesterol, LDL, VLDL and triglyceride values were significantly higher in men than women and the values increased with increasing age in both men and women. HDL and glucose values were significantly higher in females than males. In men with various nutritional groups such as A, B and C, the mean cholesterol (P < 0.001), LDL (P < 0.014), VLDL (P < 0.031) and triglyceride (P < 0.025) levels were significantly observed among comparable groups. However, in women with various nutritional groups such as A, B and C, the mean age (P < 0.047) and triglyceride values (P < 0.033) display statistically significant results.