How common is burnout? Are there protective factors? A study from a tertiary cancer center

Background: Heathcare professionals (HCPs) in the field of oncology face challenging clinical situations, difficult conversations, and death. This can seriously affect their physical and psychological health. Methods: One hundred and eighty doctors and nurses participated in this descriptive study. The primary objective was to determine the proportion of burnout in HCPs in a tertiary care cancer hospital. The secondary objectives included assessment of psychological morbidity, correlation of burnout with demographic factors and years of experience, and resilience and its correlation with burnout. Data were collected using Maslach Burnout Inventory, General Health Questionnaire� (GHQ-28), and a Resilience scale (Dr. Vijaya Lakshmi and Dr. Shruti Narain). Descriptive statistics correlation and regression analysis were used to analyze the data. Results: One hundred and twenty-six (70%) respondents were young adults. Thirty-two (17.78%) respondents had a high Emotional Exhaustion (EE) score. A high Depersonalization score (DP) was seen in 24 (13.33%) and a low sense of Personal Accomplishment (PA) was perceived by 22 (12.22%). More nurses (55, 52.4%) had high resilience scores compared with doctors (21, 28%). Doctors (21, 28%) experienced more psychological morbidity than nurses (15, 14%). Among the domains of GHQ-28, high scores were observed in Somatic, Anxiety/Insomnia, and Social Dysfunction (mean 4.44 � 3.92, 4.61 � 3.85, and 4.54 � 3.16, respectively) and low scores in the severe depression domain (mean 2.48/�29). Conclusion: Fifteen to eighteen percent of HCPs scored high levels of EE, DP, and low PA. Burnout was more common in doctors who had worked in the cancer center for longer. However, the converse was true for nurses. HCPs with high resilience scores had less burnout. Age and resilience protect from burnout.

Currently available tools and teaching strategies for the interprofessional education of students in health professions

Interprofessional education [IPE] is designed to provide students from different health sectors with opportunities to work together to enhance future collaboration. The implementation of IPE activities is a current trend in various countries. This review exclusively targets IPE issues involving undergraduate health profession students and highlights various approaches in different regions. A total of 28 articles published in peer-reviewed journals between January 2012 and July 2015 were assessed to determine recent trends in IPE implementation. Nine main strategies were identified: simulation-based education programmes; rotations in rural and community settings; interprofessional training wards; patient-centred case studies; theme-centred workshops; student seminars; student-delivered lectures; health promotion activities; and interactive lectures in a common setting. Many of these institutions had not restricted themselves to a single strategy and supplemented these activities with additional teaching or learning methods. Recommendations gathered from these diverse approaches may assist the development of sustainable strategies for implementing IPE in undergraduate medical curricula

Stretching the boundaries of medical education: a case of medical college embracing humanities and social sciences in medical education

Objective: Aga Khan University, a private medical college, had a vision of producing physicians who are not only scientifically competent, but also socially sensitive, the latter by exposure of medical students to a broad-based curriculum. The objective of this study was to identify the genesis of broad-based education and its integration into the undergraduate medical education program as the Humanities and Social Sciences [HASS] course

Methods: A qualitative methodology was used for this study. Sources of data included document review and in-depth key informant interviews. Nvivo software was utilized to extract themes

Results: The study revealed the process of operationalization of the institutional vision to produce competent and culturally sensitive physicians. The delay in the establishment of the Faculty of Arts and Sciences, which was expected to take a lead role in the delivery of a broad-based education, led to the development of an innovative HASS course in the medical curriculum. The study also identified availability of faculty and resistance from students as challenges faced in the implementation and evolution of HASS

Conclusions: The description of the journey and viability of integration of HASS into the medical curriculum offers a model to medical colleges seeking ways to produce socially sensitive physicians

Knowledge, perceptions, and attitudes of dental students towards obesity

Objective: Obesity is a chronic medical condition associated with various oral health problems. The aim of this study was to assess the knowledge, perceptions, and attitudes of dental students towards obesity

Methods: Second-, third-, and fourth-year dental students completed a self-administered questionnaire. An ethics committee approved the study. Participants were asked questions focused on three areas: [i] knowledge, [ii] perceptions, and [iii] attitudes about obesity. Data analyses were carried out using SPSS version 20

Results: Among the dental students, 78.9% received 0-1 h of formal education about obesity. The mean score of the total time allocated for obesity-related education was 1.31 +/- 0.23 h. Eighty-nine percent of the dental students agreed that obesity is a chronic medical condition, 30% agreed that they would modify their equipment and office furniture to accommodate obese patients, and 46.8% were interested in learning more about obesity in dental school

Conclusions:Obesity-related education should be implemented as a formal component of dental student training. Oral health practitioners should also provide their patients with information about how weight loss is beneficial to both general and oral health

Chronic inflammation and cancer: paradigm on tumor progression, metastasis and therapeutic intervention

As early as the 19th century, inflammation has been perceived to have a link with cancer but this perception has waned through the passing of time. In recent years however a renewed interest on inflammation and cancer connection stemming from different lines of work has been evolved that leads to a generally-accepted paradigm. In the tumor microenvironment, smouldering inflammation contributes to the proliferation and survival of malignant cells, angiogenesis, metastasis, subversion of adaptive immunity, reduced response to hormones and chemotherapeutic agents. Thus, this review will try to unravel and explain molecular events, mediators and regulators linking inflammation to cancer

Fall-related injuries in a low-income setting: results from a pilot injury surveillance system in Rawalpindi, Pakistan

This study assessed the characteristics and emergency care outcomes of fall-related injuries in Pakistan. This study included all fall-related injury cases presenting to emergency departments [EDs] of the three teaching hospitals in Rawalpindi city from July 2007 to June 2008. Out of 62,530 injury cases, 43.4% [N = 27,109] were due to falls. Children [0-15 years] accounted for about two out of five of all fall-related injuries. Compared with women aged 16-45 years, more men of the same age group presented with fall-related injuries [50% vs. 42%]; however, compared with men aged 45 years or more, about twice as many women of the same age group presented with fall-related injuries [16% vs. 9%, P < 0.001]. For each reported death due to falls [n = 57], 43 more were admitted [n = 2443, 9%], and another 423 were discharged from the EDs [n = 24,142, 91%]. Factors associated with death or inpatient admission were: aged 0-15 years [adjusted odds ratio [aOR] = 1.35], aged 45 years or more [aOR = 1.94], male gender [aOR = 1.15], falls occurring at home [aOR = 3.38], in markets [aOR = 1.43], on work sites [aOR = 4.80], and during playing activities [aOR = 1.68]. This ED-based surveillance study indicated that fall prevention interventions in Pakistan should target children, older adult women, homes, and work sites

Knowledge and attitudes regarding bleeding gums among school children of Peshawar

The objective of this cross sectional study was to assess Knowledge, Attitude and Practices [KAP] regarding bleeding gums in school going children of Peshawar. Seventy-four percent of students were aware of the term bleeding gums whereas 26% did not have any idea. Sixty three percent of the students were suffering from bleeding gums and 51% consulted a dentist in order to get them cured. While the rest used some home remedy or did nothing, and ignored bleeding gums. Based on these results it was concluded that the school going children of this study were not fully aware about bleeding gums and their effects on oral health

Pregnancy-associated asymptomatic bacteriuria and drug resistance

In developing countries, bacteriuria is associated with significant maternal and foetal risks. Rapid emergence of antibiotic resistance warrants continuous monitoring of the susceptibility patterns of bacterial isolates. In this study, we report our findings regarding the drug resistance patterns of bacteria isolates from pregnant women with urinary tract infections [UTI]. This study included 1358 pregnant women attending the antenatal clinic at the Department of Obstetrics and Gynecology between July 2013 and August 2014. Urine specimens were processed for isolation and identification of bacterial species following standard microbiological methods. The disc diffusion test was used to determine the antimicrobial resistance patterns of the recovered isolates at the Central Laboratory of Microbiology of Nepalgunj Medical College, Nepal. Three hundred and seventeen isolates were positive for significant bacteriuria. E. coli, K. pneumonia, P. aeruginosa, E. faecalis, S. aureus, P. mirabilis, CoNS, and P. vulgaris accounted for 61.5%, 17%, 7.5%, 5.3%, 2.8%, 2.5%, 1.8%, and 1.2% of bacterial isolates, respectively. Resistance to erythromycin [58.6%], co-trimoxazole [57.4%] and ciprofloxacin [50.1%] was observed. Among the 317 positive isolates, 203 [64%] were from women in the 21-30-year-old age group, and the rate of bacteriuria in this group was statistically significantly more than those for the other age groups [P < 0.05]. Bacteriuria is frequent among pregnant women, which generates a need for routine urine culture screening. In this study, E. coli was the most predominant bacterial species identified followed by K. pneumonia. Furthermore, women in the 21-30-year-old group were at a higher risk of UTI. Erythromycin, co-trimoxazole and ciprofloxacin should not be empirically used as first-line drugs in the treatment of UTIs. Continuous local monitoring of resistance patterns is necessary to determine the appropriate empirical antimicrobial therapy

Dentists[5] perception and practices regarding primary prevention of dental caries

Aims: The primary aim of this study was to determine dentist's knowledge and practices regarding caries prevention. The secondary aim was to compare preventive practices of dentists that have not studied community and preventive dentistry, to dentists that had it included in their curriculum

Methodology: A cross-sectional study of dental practitioners of Peshawar will be carried out, using a structured, self-administered, close ended questionnaire. Responses will be collected and statistical analysis will be performed using SPSS version

Results: The majority of respondents in the study were male [51.6%] and [48.3%] were female dentists. Only 37.5% of the dentists report providing dental sealants, whereas 62.5% did not provided dental sealant treatment to their patients. Only 38% of the dentists informed their patients about the different forms of fluoride available [dietary fluoride drops/tablets and fluoride varnish]. And the dentists who informed about the different forms of fluoride only 28% among them performed pits and fissure sealing. The lowest level of understanding was regarding caries risk assessment [CRA] and availability of oral health awareness material for patients

Conclusion: Dentists' lack of understanding of dental caries prevention impacts not only their clinical decision-making but also what they tell their patients. The results of this study recommend that there is a need to enhance the level of awareness of dentist regarding the practice of preventive dentistry. In order to effectively reduce the burden of oral diseases and especially prevent early childhood caries

Road traffic crashes in Ramadan: an observational study

The aim of this study was to investigate trends in road traffic crashes [RTCs] managed by an emergency service, Rescue 1122, in 2011 in Punjab, Pakistan. RTC data were collected from 35 districts of Punjab and reviewed retrospectively. Data analysis revealed that the service responded to 12 969 RTC emergencies during August 2011 [Ramadan], compared with an average of 11 573 RTCs per month from January to August 2011. The younger age group [11-27 years] was victims in 29% of RTCs; 39% were due to speeding and 43% occurred in peak rush hours [14:00-18:00] before iftar [breakfast].Results of the study showed that Rescue 1122 faced more RTCs during Ramadan compared with the preceding months. Road safety is an important public health issue in Pakistan. Although there have been great improvements in roads in the past few years, much work needs to be done to deal with mounting trends in RTCs. Public awareness, political will and stringent law enforcement are key factors

Unusual sex differences in tuberculosis notifications across Pakistan and the role of environmental factors

In developing countries, only one-third of new tuberculosis cases notified are from women. It is not clear whether tuberculosis incidence is lower in women than men, or whether notification figures reflect under-detection of tuberculosis in women. Pakistan, however, presents an unusual pattern of sex differences in tuberculosis notifications. While 2 of the 4 provinces [Sindh and Punjab] report more notifications from men [female to male ratios 0.81 and 0.89 respectively in 2009], the other 2 provinces [Khyber-Pakhtunkhwa and Balochistan] consistently report higher numbers of smear-positive tuberculosis notifications from women than men [1.37 and 1.40]. No other country is known to have such a large variation in the sex ratios of notifications across regions. Large variations in female to male smear-positive notification ratios in different settings across a single country may indicate that environmental factors, rather than endogenous biological factors, are important in influencing the observed sex differences in tuberculosis notifications.

Bone marrow negative visceral leishmaniasis in an adolescent male

Visceral Leishmaniasis or Kala Azar is endemic in certain regions of India. In endemic areas, the constellation of fever, progressive weight loss, weakness, pronounced splenomegaly, anemia, leukopenia, and hypergammaglobulinemia is highly suggestive of visceral leishmaniasis. Demonstration of the parasite in liver, splenic or bone marrow aspirates is confirmatory. We present a case in which Leishmania donovani [LD] bodies were demonstrated on splenic aspirate. We were unable to demonstrate LD bodies on bone marrow aspiration

Wandering ascaris coming out through the abdominal wall

A rare case of ascaris coming out through the anterior abdominal wall is reported here. A 40-year-old female had undergone dilatation and curettage by a quack. On the second day she presented with presented with features of peritonitis. She was explored. Resection anastomosis of the ileum was done for multiple perforations of the ileum. Patient developed a fistula in the anterior abdominal wall which was draining bile-colored fluid. On the 12[th] postoperative day a 10-cm-long worm was seen coming out through the fistulous tract which was found to be Ascaris lumbricoids. Ascaris lumbricoids can lead to many complications ranging from worm colic to intestinal obstruction, volvulus, peritonitis, pancreatitis, cholangiohepatitis, liver abscess and many more. Worm has been reported to come out through mouth, nostrils, abdominal drains, T-tubes etc. But ascaris coming out through the anterior abdominal wall is very rare hence reported here

Association between pus cells and semen parameters in infertile Pakistani males

This study evaluated the association between pus cells and semen parameters in infertile Pakistani males. A cross-sectional descriptive study was carried out in the Department of Reproductive Physiology/Health, National Institute of Health, Islamabad, Pakistan, from 2004 to 2009. A total of 1,521 subjects were analysed, along with 97 proven fathers as controls. The mean of pus cells was 7.43 +/- 0.43, 4.35 +/- 0.34, and 4.26 +/- 0.17 per high field in teratozoospermic, oligoasthenozoospermic, and asthenozoospermic groups, respectively, while it was 3.25 +/- 0.26, 3.10 +/- 0.19, and 2.98 +/- 0.04 per high field in azoospermic, oligozoospermic and the proven father groups, respectively. The fewest pus cells were observed among proven fathers, which varied nonsignificantly [P >0.05] with all cases, except with teratozoospermic, oligozoospermic, and oligoasthenozoospermic cases. Pus cells showed an inverse relationship to sperm motility and count, except in azoospemia cases. Similarly, the fewest pus cells were observed among groups where normal forms where significantly more frequent [P <0.05]. More pus cells were observed in cases where motility, and concentration or morphology was compromised. Similarly, low pus cell counts were seen in cases where sperm had the fewest head and neck defects. All kinds of sperm defects varied non-significantly [P >0.05] between proven fathers and normal concentration cases. High pus cell counts were observed in various subclasses of infertile patients. Ignorance of this pyospermic factor will make pyospermic patients to be misdiagnosed as normozoospermic. Therefore, the presence of pyospermia must be considered by physicians as a male infertility factor

Combined use of EUS-guided FNA and immunocytochemical stains disclosed metastatic and unusual diseases in the evaluation of mediastinal lymphadenopathy of unknow etiology

Mediastinal lymphadenopathy [ML] is a cause for concern, especially in patients with previous malignancy. We report our experience with the use of endoscopic ultrasound-guided fine needle aspiration [EUS-FNA] with immunocytochemical stains in patients being evaluated for ML. Retrospective analysis of patients with ML of unknown origin who underwent EUS-FNA. On-site evaluation was performed by experienced cytologist, and special immunocytochemical stains were requested as indicated. A total of 116 patients were included, and a total of 136 mediastinal LN were sampled. Prior malignancy was present in 45%. The most common site of examined lymph node [LN] were subcarinal [76%, 103 LN]. The median long and short axis diameters were 28 mm and 13 mm, respectively. FNA was read on-site as malignant, 21 [16%]; benign, 100 [76.9%]; suspicious, six [4%]; atypical, 3 [2%]; and inadequate sample, six [4%]. Sixty-four LN were deferred for additional studies; 22 for immunocytochemical and 26 for Gimesa [GMS] stain and 21 for flow cytometry. Final FNA read was malignant in 28 [21%], benign in 103 [76%], suspicious in three [2%], and atypical in two [1%]. Metastatic malignancies disclosed included Hodgkin's and Non-Hodgkin's lymphoma, melanoma, hepatoma, breast, lung, colon, renal, endometrial, Fallopian tube, and unknown carcinoma. The sensitivity, specificity, and accuracy of the final FNA read to predict malignancy were 100%. EUS-guided FNA with additional ancillary studies is useful in disclosing metastatic ML from a variety of neoplasms. Due to its safety and accuracy profile, it should be considered the test of choice in evaluating abnormal ML in appropriately selected patients

Pattern of therapeutic interventions made by clinical pharmacists in a district hospital

Objective: The present study was aimed to document, classify and examine interventions and examine reasons as to why pharmacists initiate changes in drug therapy and the outcomes of interventions, also examine the acceptability of interventions to analyze if intervention study can be a reliable learning process and to identify the areas of weakness in case of ineffective interventions

Materials and Methods: Interventions were broadly classified into Reactive interventions and Passive interventions. This six months prospective study was conducted at district hospital in Ooty. The scrutinized data were assessed by using Microsoft Excel

Results: A total of 470 interventions were recorded in this study. Out of these 470 interventions, 104 were reactive interventions and 366 were passive interventions. Types of queries [366], types of references and types of enquirers were assessed throughout the study and interventions were classified based on this and recommendations were made on the identified interventions related to dose titration, dosage scheduling and switching of medications from intravenous to per-oral. Out of 92 outcome assessed interventions, the outcomes were beneficial in [91.30%] and had no effect in [8.70%]

Conclusion: Outcomes of the interventions were beneficial in 91.30 % of the cases where outcomes were recorded. Active involvement of clinical pharmacists in the wards helps physicians in taking better therapeutic decisions which highlights areas where clinical pharmacists could prove their skill and knowledge to achieve better patient outcomes. Also clinical pharmacists could provide valuable information to reduce the complications faced by other health care professionals

possible role of selenium concentration in hepatitis B and C patients

The compelling evidence reported that selenium is an essential trace mineral for human beings. Selenium plays a pivotal role in the restoration of immune functions. High rates of hepatitis B and C are present in Pakistan. Epidemiologic surveys demonstrated an inverse association between selenium [Se] level and regional cancer incidence, as well as viral infection. The present study was designed to evaluate the concentration of selenium in the serum of patients suffering from hepatitis B and C. In this cross-sectional descriptive analytical study, serum selenium concentration of 150 patients suffering from hepatitis B and C, along with 26 healthy controls, was determined by atomic absorption spectrophotometer equipped with hydride generation system, model Analytic Jena [Vario III]. The mean and standard deviation of serum selenium concentration observed in male and female patients with hepatitis C were 101.60 +/- 0.55 and 77.43 +/- 0.47 microg/L, respectively, whereas the mean and standard deviation of serum selenium concentration observed in male and female patients with hepatitis B were 107.58 +/- 0.44 and 137.8 +/- 036 microg/L. Analysis of t test showed significant difference between C and B [P<0.001] patients in serum selenium concentration, when compared with the control. The obtained results indicate that serum selenium concentration of hepatitis B and C patients is less than serum selenium concentration of healthy individuals. However, serum selenium decline is relative to severity of disease. Based on findings of this study, it is proposed that selenium should be supplemented in such patients in order to optimize nutritional support and to get better treatment response

Clinical spectrum of post-stroke seizures

To determine the characteristics of post-stroke seizures and compare these in early vs. late post-stroke seizures. Observational study. Department of Neurology, Liaquat National Hospital, Karachi, from March to September 2007. All admitted patients aged over 25 years, with diagnosis of post-stroke seizures were included. Those with known epilepsy, sepsis and eletrolyte imbalance were excluded. Age, co-morbid condition, details of seizures and radiological findings regarding type and location of stroke were collected and entered in a pre-formed proforma. Results were described as frequency and mean. Association of variables was determined through chi-square test with significance at p < 0.05. Out of the 50 patients, there were 28 [56%] males and 22 [44%] females with the mean age of 56.86 +/- 15.26 years. Thirty-one [62%] patients had history of hypertension. Early seizures i.e. within 2 weeks were seen in 29 [58%] patients. Generalized seizures were seen more frequently i.e. in 37 [74%] patients. Thirty-one [62%] subjects experienced more than 2 seizures. Forty [80%] had an ischemic stroke including 36 [72%] arterial infarct and 3 [6%] venous infarcts. Intracerebral hematoma was seen in 10 [20%] of subjects. Comparison between early and late onset seizures revealed significant association between ischemic heart disease [IHD], old stroke, hypertension and late onset seizures [p < 0.05]. Post-stroke seizures were more frequent in males, with history of hypertension, and with cortical ischemic strokes. Early seizures, multiple episodes and generalized seizure type were more common. Venous infarcts were chiefly associated with seizures at presentation. History of old stroke, ischemic heart disease, hypertension and hypercholesterolemia showed a strong relationship with the occurrence of late onset seizures

Measuring the medical education environment in undergraduate medical colleges across Punjab, Pakistan

The University of Health Sciences [UHS] is responsible for regulating medical education in all affiliated Private and Public medical colleges in Punjab Province. Measuring the education environment in these institutions will be the initial step in understanding the factors affecting it. In this cross sectional study, the Population was limited to all the students of the Final Year Baccalaureate of Medicine; Baccalaureate of Surgery in Medical Colleges affiliated with UHS in 2008. DREEM questionnaire was collected anonymously from the students. The given data was analysed using parametric tests in Statistical Package for Social Sciences v.16. Significance was taken at p < 0.05. The response rate was 84.14%. The overall average age was 23.5 years with comparable male, female age [23.9 and 23.2 respectively]. The Mean Score of DREEM in the private sector - [M = 137, SD = 21.25] is statistically significantly higher [t = 9.93, df = 410.38, 2 - tailed p

Encapsulation of theophylline into binary blend of ethylcellulose and eudragit microparticles: development, characterization and kinetic release

The objective of this study was to prepare and evaluate microparticles of Eudragit and Ethyl cellulose binary blend loaded with theophylline for controlled release. Microparticles were prepared by Phase separation method. The method is quite simple, rapid, and economical and does not imply the use of toxic organic solvents. Solid, discrete, reproducible free flowing microparticles were obtained. The yield of the microparticles was up to 92%. More than 85% of the isolated microparticles were of particle size range of 325 to 455 micro m. The obtained angle of repose,% carr's index and tapped density values were well within the limits, indicating that prepared microparticles had smooth surface, free flowing and good packing properties. Scanning Electron Microscopy photographs and calculated sphericity factor confirms that the prepared formulations are spherical in nature. Prepared microparticles were sTab. and compatible, as confirmed by DSC and FT-IR studies. The prepared formulations were quantitatively analyzed for the amount of encapsulated drug. It was observed that there is no significant release of the drug at gastric pH. The drug release was controlled more than 12 h. Intestinal drug release from microparticles was studied and compared with the release behavior of commercially available oral formulation Duralyn CR 400. The release kinetics followed different transport mechanisms