Implementing Lifestyle Medicine in Undergraduate Medical Education at Riphah International University, Pakistan.

The Need of the LM content in Medical undergraduate curriculum was imperative based on the mortality and morbidity statistics in Pakistan along with lack of LM training and unhealthy lifestyle of physicians themselves. Aims and Objectives for integrating LM content were designed including cognitive, affective and psychomotor domains of learning. while embedding LM content in an integrated modular system, every step was technically monitored and matched with the academic year, teaching methodology and importance of the topic. LM content was integrated in every educational activity from first to final year by adding or modifying LM learning objectives. The alignment of learning domains was in accordance with the teaching and assessment strategies. Teaching methods chosen were according to the designed learning objectives and phase of curriculum. LM content was assessed in formative and summative assessment through, single best and case cluster MCQs, reflections, OSPE. LM curriculum was communicated to teaching faculty and medical students through academic calendar, module guides and timetables. It was shared on Moodle and Teams. Educational environment incorporated both physical and virtual learning and has been supportive of lifestyle practices among medical students. The entire process of embedding LM content in medical education has been multifaceted. Different committees were formed including Steering, Core, implementation, and Evaluation Committees. Students were part of each committee. This write-up describes the evidence-based approach used to embed LM content in Undergraduate Medical Education and offers guidance to other undergraduate medical colleges that may wish to implement lifestyle medicine content.

Fat but Fit: How physical fitness can mitigate the cardiovascular risks of obesity?

Obesity has long been recognized as a major independent risk factor for cardiovascular diseases (CVD). However, intriguing paradoxes such as the "obesity paradox" and the "fat but fit" phenomenon have been associated with it. The "fat but fit" paradigm suggests that overweight or obese individuals might face a lower risk of developing cardiovascular disease if they possess high levels of physical fitness. In other words, higher fitness levels may mitigate the negative impact of obesity on cardiovascular risk, leading to a reduction in overall mortality due to CVD. The evidence surrounding this paradox is conflicting, highlighting the necessity for further research. The complex relationship between physical fitness, obesity, and cardiometabolic health is influenced by individual and environmental factors. Consequently, it becomes imperative to conduct more studies to comprehend this intricate interplay fully. To address this issue, it is important to focus on formulating strategies that promote the maintenance and enhancement of cardiorespiratory fitness in overweight and obese individuals. Moreover, including fitness evaluations in comprehensive risk stratification can significantly improve clinical decision-making.

The Use of AI in Diagnosing Diseases and Providing Management Plans: A Consultation on Cardiovascular Disorders With ChatGPT.

BACKGROUND: Cardiovascular diseases (CVDs) have remained the leading causes of death worldwide and substantially contribute to loss of health and excess health system costs. According to WHO, cardiovascular diseases (CVDs) take an estimated 17.9 million lives each year. One of the reasons for an immensely high fatality in CVDs is lack of efficient diagnosis and prompt treatment. Timely recognition and management are crucial to minimize mortality. In the advancing world, AI (artificial intelligence) and machine learning technologies continue to progress, this advancement has opened new avenues for innovative approaches in the field of medicine. Despite the rapid development in the field of AI, there is a limited understanding of the potential benefits among clinicians and medical practitioners. METHODS: In this study, we aimed to investigate the potential that the AI language model holds to assist health practitioners in the diagnosis and treatment of cardiovascular disorders. We asked Chat Generative Pre-trained Transformer (ChatGPT) 10 hypothetical questions simulating clinical consultation. The responses given by ChatGPT were accessed for its accuracy and accessibility by a team of medical specialists and cardiologists with extensive experience in managing cardiovascular disorders.  Result: Out of the 10 clinical scenarios inserted in ChatGPT, eight were perfectly diagnosed, however, the other two answers given by ChatGPT were not entirely incorrect since those conditions were associated with the actual diagnosis. Furthermore, the management plans and the treatment protocols that were given by ChatGPT were in line with the literature and current medical knowledge. The exact drug names and regimens were not provided but a general guideline that was given by this AI tool is definitely beneficial for junior doctors in getting an idea on how to proceed or refresh their previous knowledge. CONCLUSION: ChatGPT is a valuable resource in the field of medicine. Its comprehensive and properly organized response in an understandable language has made it an effective and efficient tool to be used. However, it is crucial to note that its limitations, such as the need for all associated and typical signs, symptoms, and physical examination findings, and its inability to personalize treatments need to be acknowledged.

Combined Effect of Aerobic and Resistance Interval Training on Ejection Fraction in Myocardial Infarction.

This study was conducted to determine whether combination of aerobic and resistance interval training had superior effects than aerobic interval training alone on ejection fraction, cholesterol, and triglycerides in myocardial infarction patients, at Pakistan Railway General Hospital Rawalpindi from July to December 2016. Patients were randomly allocated in interventional (n=13) and control group (n=13) using toss and trial method. Aerobic interval training at 65%-85% of target heart rate was performed in three intervals in both groups; whereas, resistance training at 30-50% of one repetition maximum was added in experimental group. The outcomes were measured before and after six weeks. Ejection fraction was significantly (p=0.029) improved in interventional group 55 (10) as compared to control group 50 (5). Cholesterol levels also showed significant decrease (p=0.021) in control group. The study concluded that combined training has superior effect in improving ejection fraction; whereas, aerobic interval training alone is more effective than combine training in improving cholesterol.

Coronary Artery Ectasia: Clinical and Angiographic Features.

OBJECTIVE: To investigate the clinical and angiographic characteristics of coronary artery ectasia (CAE) and its relation with the inflammatory marker, HsCRP. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Rawalpindi Institute of Cardiology, Rawalpindi, from April 2015 till November 2016. METHODOLOGY: Eighty-one patients with CAE and 57 age matched patients with stenotic coronary artery disease (CAD), but without CAE, were included in the study. Clinical, angiographic, and laboratory data were documented. Chi-square test was used to compare coronary risk factors between two groups. T test was used to compare means between the groups. Analysis of variance was used to analyse HsCRP levels among various types of ectasia. Correlation analysis was used to study association of ectasia with different risk factors. RESULTS: Males were predominant in both with & without CAE. Hypertension, smoking and obesity were significantly more common among CAE patients than those without (60.5% vs. 52.6%, 56.8% vs. 43.9% and 80.2% vs. 14%, respectively). Diabetes was much less in CAE group (32.1% vs. 42.1%). HsCRP was higher in patients with CAE than those without and was significantly higher in patients with more extensive ectasia. Majority (65.4%) of CAE patients had significant CAD; whereas, only 7.4% had isolated CAE. Most common artery involved was RCA (70.4% of total) and most common pattern was single ectatic vessel. CONCLUSION: Obesity and smoking predispose to CAE, along with male sex and hypertension. While diabetes is negatively associated with CAE. HsCRP levels tend to be higher in ectasia patients, especially those with severe forms. Finally, CAE has a predilection for RCA.