Task Oriented Assessment of Clinical Skills (TOACS): A Modified Form of OSCE.

College of Physicians and Surgeons, Pakistan (CPSP) is a premier postgraduate medical institution of the country. It introduced Objective Structured Clinical Examination (OSCE) in the 1990s, and later came up with its modified form known as Task Oriented Assessment of Clinical Skills (TOACS). This modified assessment has been incorporated in clinical examinations of its majority fellowship programmes. Despite the use of TOACS for so many years at CPSP, it is surprising to note that this form of assessment does not appear in the literature. The objective of this viewpoint is to describe the rationale for the development of TOACS and to compare its structure and functions with OSCE. Key Words: Medical education, Assessment, Objective Structured Clinical Examination, Interactive, Task Oriented Assessment of Clinical Skills.

Balancing the Scale: Reconsidering the Overemphasis on Electronic Scaling in Dentistry.

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Optimum Working Hours for College of Physicians and Surgeons Pakistan Fellowship Residents of General Medicine and General Surgery Disciplines.

OBJECTIVE: To determine the optimum working hours per week for CPSP trainees of Fellowship Programmes in the disciplines of General Surgery and General Medicine. STUDY DESIGN: Mixed-methods, explanatory study. Place and Duration of the Study: Department of General Medicine and Department of General Surgery, Abbasi Shaheed Hospital, Karachi, from February to August 2023. METHODOLOGY: The total number of subjects included were 33 residents, 7 supervisors (4 from General Medicine and 3 from Geneneral Surgery), and 3 hospital managers (from private sector), constituting a representative sample. Postgraduate trainees (PGTs) of third-and fourth-year FCPS training programme who showed willingness to participate were included as were all supervisors and hospital managers involved in the training programme. FCPS residents, who were not willing, on leave, and on rotation to other departments were excluded, as were PGTs enrolled in university and other programmes. For quantitative analysis, survey forms were distributed to the selected participants. For qualitative analysis, one-to-one interviews were conducted in-person and through video-link. Data collection procedure included distribution by hand and via email. SPSS was used for the data analysis. RESULTS: All residents recorded that duty stress, fatigue, and burnout resulted in poor quality of family and social life. All the stakeholders were convinced that acquisition of skills, learning outcomes, and patient safety with optimum care is compromised. The duration of emergency calls varied from 30 to 36 hours. There were 19 out of 33 residents (57.5%) who recommended 24 hours of rest after each emergency call. All the supervisors recommended six to eight daily duty hours and 66 to 90 weekly working hours. Four out of seven supervisors (57.1%) suggested emergency duty of 30 hours with post-call rest of 24 hours at every 3rd  day. CONCLUSION: There is a need for a comprehensive approach that caters to the patient care as well as learning outcomes and residents' well-being when devising the duty schedules. KEY WORDS: Training hours, Fellowship programme, Fatigue, Learning outcomes.

Neurologic sequelae of phosphide poisoning: A case report.

Background: Aluminum phosphide (ALP) is extremely toxic with a high mortality rate, mainly due to its cardiovascular complications. Some neurologic effects have also been reported with this pesticide. Case presentation: We present a 23-year-old male who presented with confusion after ingestion of a toxic dose of ALP. Computerized tomography scan demonstrated diffuse bilateral hypoattenuation of the cerebellar hemispheres, midbrain, thalamus, and globus pallidus resulting in tonsillar and transtentorial herniation and eventually brain death four days after admission. Conclusions: This is the first documented case of neurologic sequela following phosphide poisoning that emphasizes the importance of brain imaging studies for patients with loss of consciousness.

Etodolac Enhances the Radiosensitivity of Irradiated HT-29 Human Colorectal Cancer Cells.

BACKGROUND: Radioresistance is found to be the main therapeutic restriction in colorectal radiation therapy. The aim of this study was to investigate the synergistic effect of Etodolac (ET) and ionizing radiation on human colorectal cancer cells. METHODS: Pretreated HT-29 cells with ET were exposed to ionizing radiation. The radiosensitizing effect of ET was evaluated using MTT, flow cytometry, and clonogenic assay. The amount of nitrite oxide (NO) in irradiated cells was also measured with the Griess reagent. RESULTS: The present study found that pretreatment of HT-29 cells with ET decreases their survival and colony formation. Higher concentrations of ET cause total apoptosis and an increase in NO levels in irradiated cells. CONCLUSION: Applying ET in a concentration-dependent manner had an incremental effect on the amount of apoptosis and cell death induced by radiation.

Ferroptosis Inhibitors as Potential New Therapeutic Targets for Cardiovascular Disease.

Ferroptosis is a novel form of programmed cell death that occurs due to an increase in iron levels. Ferroptosis is implicated in a number of cardiovascular diseases, including myocardial infarction (MI), reperfusion damage, and heart failure (HF). As cardiomyocyte depletion is the leading cause of patient morbidity and mortality, it is critical to thoroughly comprehend the regulatory mechanisms of ferroptosis activation. In fact, inhibiting cardiac ferroptosis can be a useful therapeutic method for cardiovascular disorders. The iron, lipid, amino acid, and glutathione metabolisms strictly govern the beginning and execution of ferroptosis. Therefore, ferroptosis can be inhibited by iron chelators, free radical-trapping antioxidants, GPX4 (Glutathione Peroxidase 4) activators, and lipid peroxidation (LPO) inhibitors. However, the search for new molecular targets for ferroptosis is becoming increasingly important in cardiovascular disease research. In this review, we address the importance of ferroptosis in various cardiovascular illnesses, provide an update on current information regarding the molecular mechanisms that drive ferroptosis, and discuss the role of ferroptosis inhibitors in cardiovascular disease.

Recent Achievements about Targeted Alpha Therapy-Based Targeting Vectors and Chelating Agents.

One of the most rapidly growing options in the management of cancer therapy is Targeted Alpha Therapy (TAT) through which lethal α-emitting radionuclides conjugated to tumor-targeting vectors selectively deliver high amount of radiation to cancer cells.225Ac, 212Bi, 211At, 213Bi, and 223Ra have been investigated by plenty of clinical trials and preclinical researches for the treatment of smaller tumor burdens, micro-metastatic disease, and post-surgery residual disease. In order to send maximum radiation to tumor cells while minimizing toxicity in normal cells, a high affinity of targeting vectors to cancer tissue is essential. Besides that, the stable and specific complex between chelating agent and α-emitters was found as a crucial parameter. The present review was planned to highlight recent achievements about TAT-based targeting vectors and chelating agents and provide further insight for future researches.

Curcumin-incorporated crosslinked sodium alginate-g-poly (N-isopropyl acrylamide) thermo-responsive hydrogel as an in-situ forming injectable dressing for wound healing: In vitro characterization and in vivo evaluation.

Sodium alginate products have been extensively used for wound-dressing. In present study, a series of thermo-sensitive cross-linked poly(N-isopropylacrylamide) grafted sodium alginate (Alg-g-pNIPAM) copolymers were synthesized for delivery of curcumin to wound. FTIR, 1H NMR, elemental analysis and DSC showed successful polymerization and precise structure of copolymers. Thermogelation at 27-42 °C depending on the copolymer concentration, chain-length of pNIPAM and pH was observed. The optimum copolymer with proper rheological and syringeability properties showed excellent thermogelling at a wide range of pH and concentration, and could prolong the release of curcumin up to 72 h. In-vivo wound contraction and histopathological evaluations revealed that in addition to the higher efficacy in wound contraction, the curcumin formulation (Cur-F) significantly reduced the inflammation, enhanced the collagenesis and resulted in increased number of fibroblasts. Well-known anti-oxidant and anti-inflammatory properties of curcumin and in situ-forming nature of Alg-g-pNIPAM can make the system an excellent candidate for further investigations.

Paclitaxel-loaded polypeptide-polyacrylamide nanomicelles overcome drug-resistance by enhancing lysosomal membrane permeability and inducing apoptosis.

The aim of the current project was to investigate the in vitro properties of Paclitaxel (PTX)-loaded pHPMA5kD -pHis5kD -pLeu3kD nanomicelles (NMs) on multidrug resistance cell line. Circular dichroism analysis was done to investigate the effect of pH on the secondary structure of the copolymer. Cytotoxicity assay together with fluorescence imaging and flow cytometry were performed to get an insight about toxicity and cellular uptake mechanism of NMs. Acridine orange assay, rhodamine 123 (Rh123) accumulation assay, and apoptosis analysis were conducted for further investigation. It was found that the secondary structure of the copolymer changed in response to pH, PTX-loaded NMs had higher cytotoxicity on both drug-sensitive (MES-SA and MCF-7) and multidrug resistant cells (MES-SA/DX5) compared to free PTX, and interestinly free copolymer inhibited the growth of MES-SA/DX5 cells while it was nontoxic on drug-sensitive cells. Moreover, the copolymer was able to induce lysosome membrane permeation and increase Rh123 accumulation inside cells indicating inhibition of the P-gp efflux pumps. Finally, apoptosis was strongly induced in MES-SA/DX5 cells upon treatment with PTX-loaded NMs. It can be concluded that the designed hybrid copolymer is a good candidate for in vivo assay and developing a powerful system against multidrug resistance tumors.

Comparison of stress levels among medical and dental students in the clinical years of training and their coping strategies.

OBJECTIVE: To compare the stress levels among medical and dental students and to evaluate their coping strategies. METHODS: The cross-sectional comparative study was conducted at the Liaquat College of Medicine and Dentistry, Karachi, from January to February 2018, and comprised medical students from 3rd, 4th and 5th years, and dental students of 3rd and 4th year. Cohen Perceived Stress Scale was used to collect data which was then analysed using SPSS 21. RESULTS: Of the 400 students approached, 281(70.25%) responded. There were 159(56.5%) medical and 122(43.4%) dental students. Also, 78(27.7%) students were males and 203(72.2%) were females. The stress level was moderate or high in 267(95%) students; 118(96.7%) dental, 149(93.7%) medical. Stress management strategies included meditation/praying 181(64.4%), spending some time to relax 180(64.1%) and sleeping 177(63%). CONCLUSIONS: Dental students had slightly higher stress level than medical students. The most common stress management strategy was meditation/praying.

Perceptions of students regarding E-learning during Covid-19 at a private medical college.

OBJECTIVE: The purpose of this study was to determine the perceptions of students towards e-learning during the lock down. METHODS: A descriptive cross-sectional study was conducted at Liaquat College of Medicine and Dentistry. MBBS and BDS students of all levels participated in the study with a sample size calculated as 377. A self-administered questionnaire was developed. After validation from the Medical Education Experts, pilot test was run on 30 participants before the administration of the questionnaire. The questionnaire was emailed to the participants for data collection. Reliability of the questionnaire was determined. Independent T-test was applied for determining the perceptions of students towards e-learning. Frequencies and percentages were also computed for demographics. RESULTS: Total 382 responses were received.137 males and 245 females participated in the study. 0.851 was calculated as Cronbach's alpha of the questionnaire. Overall, 77% students have negative perceptions towards e-learning. 76% of the students use mobile device for their e-learning. CONCLUSION: Students did not prefer e-teaching over face-to-face teaching during the lock down situation. Administration and faculty members should take necessary measures for improving e-teaching for better learning during lock down.

Dual-frequency ultrasound for ultrasonic-assisted esterification.

The optimization of wheat starch esterification (acetylation) with a high degree of substitution was performed through response surface methodology (RSM) via various concentrations of reagents (acetic anhydride), pHs, and temperatures under various ultrasonication frequencies (25, 40, and 25 + 40 kHz). According to RSM methodology, optimized samples were selected by achieving high degrees of substitution at various frequencies, temperatures, and pHs. Solubility, swelling, X-ray, RVA, DSC, freeze-thaw stability, texture, and SEM analysis of the optimized samples were performed at three frequencies. X-ray pattern exhibited a more significant reduction in the crystallinity percentage of esterified starch at frequency 25 + 40 kHz compared with 25 kHz, 40 kHz, and native starch. According to DSC analysis, To, Tp, Tc, and enthalpy of gelatinization (ΔH gel) were lower in AC at frequency 25 + 40 kHz compared with AC at frequency 25 and 40 kHz and N starches. According to morphology analysis, in acetylated starches at 25 and 40 kHz, the surfaces and small granules underwent more damage, whereas in 25 + 40 kHz, large granules were more affected than small granules. Upon acetylation, freeze-thaw stability and textural properties of the starch significantly increased and decreased, respectively. The peak and final viscosity of acetylated starch increased (25 + 40 kHz Ëƒ 25 kHz Ëƒ 40 kHz Ëƒ N starch).

Association between common bile duct diameter and abdominal aorta calcium score.

BACKGROUND AND OBJECTIVE: There is evidence of association between aging and increase in the normal upper limit of the common bile duct (CBD) diameter. As aging is a documented risk factor for atherosclerosis, and the possible effect that atherosclerosis can have on the CBD diameter via affecting its smooth muscle contractility and blood flow, we decided to determine the association between CBD diameter and atherosclerosis in the abdominal aorta (AA). METHODS: A total of 99 asymptomatic patients (53 males and 46 females; age range of 18-88 years) without history of cholecystectomy who underwent abdominal contrast-enhanced CT scan were included. The CBD diameter was measured. The atherosclerosis of AA was quantified by Agatston score. RESULTS: Mean (± SD) CBD diameter was 6.14 (± 1.95) mm; range = 2.4-12.7 mm. Agatston score was 0 in 59 patients. In the remaining 40 patients, median (interquartile range, IQR) Agatston score was 497.5 (2026.3). Mean (± SD) CBD diameter in patients with Agatston score > 0 was 7.39 (± 2.07) mm compared to 5.29 (± 1.32) mm in patients without calcification plaque (P < 0.001). A moderate correlation was seen between CBD diameter and Agatston score (ρ = 0.43; P = 0.005). CONCLUSION: Although the exact cause of increased CBD diameter with advancing age is not understood, a general atherosclerotic process which occurs with aging may affect smooth muscle of the CBD. Whether an upper limit for normal CBD should be defined or not when evaluating dilated CBD for patients with subclinical or clinical atherosclerosis needs further studies.

Formulation and in vitro evaluation of a fast-disintegrating/sustained dual release bucoadhesive bilayer tablet of captopril for treatment of hypertension crises.

Hypertension crisis is one of the main health problems and its effective treatment is of high importance. For this purpose, fast-disintegrating and sustained release formulations of captopril, as a drug of choice, were prepared using conventional mucoadhesive polymers hydroxypropyl methylcellulose (HPMC), sodium carboxymethyl cellulose (Na-CMC), hydroxypropyl cellulose (HPC), Carbopol 934 (CP934) and sodium alginate (Na-alg). The optimum sustained release formulations were selected based on mean dissolution time (MDT). The swellability and mucoadhesive properties of selected formulations were assessed and compared. A direct relationship between swelling and release rates/adhesiveness of sustained release formulations was observed. The results showed that formulations containing combination of CP934 and cellulose-based polymers had the highest swellability, sustainability and adhesion strength. These formulations prolonged drug release up to 8 h showing good fitness to Korsemeyer-Peppas model. Moreover, the adopted fast-disintegrating tablet could release up to 100% of drug within 3 min in oral pH. Finally, a dual fast-disintegrating/sustained release bucoadhesive bilayer tablet consisting of optimized formulations was prepared releasing 30% of the drug initially within 15 min and the remaining up to 8 h which could be considered as an appropriate formulation for the treatment of hypertension crises.

Effect of C/N ratio and media optimization through response surface methodology on simultaneous productions of intra- and extracellular inulinase and invertase from Aspergillus niger ATCC 20611.

The study is to identify the extraction of intracellular inulinase (exo- and endoinulinase) and invertase as well as optimization medium composition for maximum productions of intra- and extracellular enzymes from Aspergillus niger ATCC 20611. From two different methods for extraction of intracellular enzymes, ultrasonic method was found more effective. Response surface methodology (RSM) with a five-variable and three-level central composite design (CCD) was employed to optimize the medium composition. The effect of five main reaction parameters including sucrose, yeast extract, NaNO3, Zn⁺², and Triton X-100 on the production of enzymes was analyzed. A modified quadratic model was fitted to the data with a coefficient of determination (R²) more than 0.90 for all responses. The intra-extracellular inulinase and invertase productions increased in the range from 16 to 8.4 times in the optimized medium (10% (w/v) sucrose, 2.5% (w/v) yeast extract, 2% (w/v) NaNO3, 1.5 mM (v/v) Zn⁺², and 1% (v/v) Triton X-100) by RSM and from around 1.2 to 1.3 times greater than in the medium optimized by one-factor-at-a-time, respectively. The results of bioprocesses optimization can be useful in the scale-up fermentation and food industry.