Career Choices of Medical doctors at Graduate level - A Multicenter Study.

OBJECTIVE: To find out the specialty choices being taken by Final year Medical students and graduate Doctors. METHOD: This is a cross sectional survey study which was conducted over two months from 1st November to 31st December 2016. Final year students and house job doctors were asked for the filling of Performa, after filling the consent form. A self-developed, anonymous questionnaire was used to conduct the study using close ended type of questions. This was a multi-center study conducted at Dow International Medical College and Jinnah Medical and Dental College. An IRB approval was taken for the study. A total of 317 individuals completed the Performa. Demaographic data included information regarding the year of passing, number of family members already in the medical profession, then specific questions were asked regarding their future career choice and the reason for choosing that particular speciality. After collection of data from both the centers a single operator entered the Data on SPSS 16 version. Frequencies and chi-square test were performed and p-valves were tabulated. RESULTS: A total of 317 individuals completed the Performa. Two hundred and nine participants (65.9%) were females and one hundred and eight (34.1%) were male participants. The age ranged from 22-29 years mean of 25.15 and SD of 1.348. One hundred and twenty one (38%) had a family member as a doctor in the family. Medicine and allied was the most sought after specialty 184(58%), followed by surgery and allied in 108(34%). Non-Clinical Specialty such as radiology, basic sciences was taken up by 27(7.9%). CONCLUSION: The working hours followed by passion for the chosen field were the important reasons for selecting any specialty. The next most important reason was higher income and other family responsibilities of an individual. The ladies are opting more for fields with a controllable life style.

Asymmetric effect of FDI and public expenditure on population health: new evidence from Pakistan based on non-linear ARDL.

The core purpose of the study is to examine the asymmetric effect of foreign direct investment (FDI) and population health (measured by life expectancy index). The study takes time series data for 1980-2020. The non-linear autoregressive distributed lag (NARDL) bound testing to cointegration approach is applied to scrutinize an asymmetric association among foreign direct investment, government expenditures, trade openness, public debt, and population health. The study also used an asymmetric causality test to investigate the causal association between the measured variables. The findings affirm that cointegration exists between the variables in the occurrence of asymmetries. The asymmetric causality outcomes confirm that only positive changes in FDI have bidirectional causality to life expectancy while negative shocks have unidirectional that runs from FDI to life expectancy. The government expenditure and foreign direct investment also provided evidence of social sector health welfare in Pakistan. The output shows that increasing government expenditure can cause an increase in life expectancy while decreasing government expenditure can cause a decrease in life expectancy. The study found that investment in health care medical services is paramount to better results as far as government assistance (welfare) gains. The outcomes of the study have given numerous policy suggestions to boost life expectancy in the general public of Pakistan.

Aged garlic extract reduces left ventricular myocardial mass in patients with diabetes: A prospective randomized controlled double-blind study.

Increased left ventricular myocardial mass (LVM) is a well known prognostic marker of poor cardiac outcomes. Decreases in LVM have been shown to decrease the cardiovascular risk. Aged garlic extract (AGE) has been shown to have an overall favorable effect on cardiac health; however, to the best of our knowledge, no study to date has specifically examined its effects on left ventricular mass. This study investigated whether AGE can affect LVM measured by cardiac computed tomography angiography (CCTA) in patients with diabetes mellitus (DM). This is a double-blind, placebo controlled randomized trial. In total, 65 participants with DM with a mean age of 58 years were prospectively assigned to consume 2,400 mg AGE/day or the placebo orally. Both groups underwent CCTA at baseline and follow-up at 1 year apart. LVM was measured using automated software. The baseline characteristics did not differ between the AGE and placebo groups. There was a trend towards a significant reduction in LVM at follow-up as compared to baseline in the AGE group (119.30±34.77 vs. 121.0±34.70, P=0.059). No change was observed in LVM in the placebo group at 1-year follow-up as compared to baseline (124.6±37.33 vs. 124.6±35.13, P=0.9). On the whole, this study indicated that AGE may decrease or stabilize LVM. Further studies however, with a larger sample size and longer follow-up times are required to evaluate the effects of AGE on hypertension and LVM.

Role of Amphotericin B in Nasal Irrigation for Chronic Rhinosinusitis with Nasal Polyps.

OBJECTIVE: To determine the effect of topical antifungal irrigation fluid containing amphotericin B on nasal polyp and their recurrence pattern, and to study the association of serum IgE in predicting the presence of fungus along with the nasal polyps. STUDY DESIGN: An interventional study. PLACE AND DURATION OF STUDY: Dow University Hospital, Dow International Medical College, DUHS, Karachi, from June 2015 to June 2017. METHODOLOGY: All adult patients having nasal polyps, who had not undergone any previous nasal surgery, were included in the study. Patients aged under 18 years, history of granulomatous diseases, immunosuppression, invasive fungal sinusitis, and pregnant ladies were excluded from the study. The ratio was kept as 1:2; one receiving irrigation with amphotericin B and the other only saline nasal irrigation without the medicine. After surgery, the patients were divided into two groups; 58 patients were in the placebo group and 29 in the amphotericin group. Serum IgE levels were documented before and one month postoperative treatment. Serum IgE level of more than 250 ng/ml was taken as a high value. All the patients were followed for six months. Recurrence was defined as the recurrence of nasal symptoms and recurrence of mucosal thickening based on repeat CT scan. Frequency tables and cross tabulations using Chi-square test were performed with p-values of 0.05 taken as significant were performed on different variables. RESULTS: A total of 87 patients were inducted. Overall 22 (25.3%) patients had recurrence of symptoms at six-month followup visit. Twelve (13.7%) of these were in the placebo group and 10 (11.5%) were in the amphotericin B nasal irrigation group. Serum IgE level preoperatively ranged between 52 - 9344 ng/dl; postoperatively it ranged from 13-1050 ng/dl. When pre and postoperative serum IgE level were compared with each other and CT scan scores, using Chi-square test, the difference was significant (p<0.001). CONCLUSION: Amphotericin B improved the CT scan score of the patients. The nasal irrigation of amphotericin B did not show significant change in the recurrence pattern of chronic sinuses with polyps. Serum IgE can be used as marker for the presence and response to treatment for non-invasive fungal sinusitis.

Economics of death and dying: a critical evaluation of environmental damages and healthcare reforms across the globe.

The economics of death and dying highlighted that environmental factors negatively influence healthcare sustainability. Therefore, this study conducted a system-based literature review to identify the negative externality of environmental damages on global healthcare reforms. Based on 42 peer-reviewed papers in the field of healthcare reforms and 12 papers in the field of environmental hazards, we identified 25 factors associated with death and dying and 15 factors associated with health-related damages across the world respectively. We noted that environmental factors are largely responsible to affect healthcare sustainability reforms by associating with the number of healthcare diseases pertaining to air pollutants. The study suggests healthcare practitioners and environmentalists to devise long-term sustainable healthcare policies by limiting highly toxic air pollutants through technology-embodied green healthcare infrastructure to attained efficient global healthcare recovery.

Managing crime through quality education: A model of justice.

The study examines the role of quality education in access to justice, using a panel data of 21 diversified countries for the period of 1990-2015. The findings show that there is a positive relationship between the presence of scientific and technical journals (STJ) articles and crime rates. The R&D expenditures does not substantially reduce crime rate while per capita income, trademark applications, and technical cooperation grants significantly reduce crime rates across countries. The panel fixed effect (FE) model confirmed the inverted U-shaped relationship between per capita income (GDPpc) and crime rate in the presence of STJ, while this result is changed in the case of GMM estimator. The results of panel causality confirmed the unidirectional causality running from crime rate to STJ and R&D expenditures, while there is bidirectional causality between i) GDPpc and technical cooperation grants, and between ii) energy efficiency and refugee population by country. The variance decomposition analysis (VDA) shows that R&D expenditures have a greater share to influence crime rate, while technical cooperation grants will affect STJ for the next 10 years time. This finding bolsters the conversation on the relationship between education and a reduction in crime rates.