Adipo-myokine Irisin, a Promising Antioxidant against Nicotine Induced Oxidative Stress in BALB/c mice.

Objectives: To determine the role of r-irisin in attenuating nicotine-induced oxidative stress by estimating serum oxidative stress markers and antioxidant enzymes in BALB/c mice. Method: This 18 month experimental study was carried out at Foundation University Islamabad and National Institute of Health starting in 2020. Thirty healthy BALB/c mice were divided into three groups. Group-I (control group) received normal saline 1ml/kg body weight intra-peritoneally daily for 28 days. Experimental group, Group-II received nicotine 2mg/kg body weight intra-peritoneally, for 28 days to induce oxidative stress. Experimental Group-III was given r-irisin 0.5 µg/g body weight/day via tail vein injection, for the last 14 days in addition to intraperitoneal nicotine for 28 days. On 29th day, intra-cardiac blood samples were taken for estimation of serum antioxidant enzymes [Superoxide dismutase (SOD), Reduced Glutathione (GSH) and Catalases (CAT)], and Thiobarbituric Acid-Reactive Substances (TBARS) levels as lipid peroxidation marker using ELISA. SPSS version 24 was used for statistical analysis. Significant difference in parameters across groups was calculated using one way ANOVA. P-value of < 0.05 was considered significant. Results: Group-II showed statistically significant increase in serum lipid peroxidation marker (TBARS) levels (p<0.001) and reduction in serum anti-oxidative enzymes (SOD, CAT, GSH) levels (p< 0.001) as compared to Group-I. In Group-III, with co administration of r-irisin, significant improvement in antioxidant enzymes levels and reduction in TBARS levels was observed (p< 0.001) as compared to Group-II. Conclusion: Irisin ameliorates nicotine induced oxidative stress by improving serum anti-oxidant enzyme levels and reducing serum lipid peroxidation marker.

Feasibility of video assessment of operative skills in FCPS vascular surgery.

Objective: To explore the feasibility of assessment of operative skills of FCPS vascular surgery trainees based on video recordings of the surgical procedures with a view to introduce it in the curriculum. Methods: This qualitative study was carried out from 9th April 2021 - 15th July 2021 at Shifa Tameer e Millat University, Islamabad, Pakistan. It is a qualitative study based on constructivist grounded theory. Semi structured interviews of 16 participants, including five vascular surgical trainees, six vascular surgical consultants/supervisors/examiners, and five medical educationists were conducted, recorded and transcribed. Open and axial coding method was employed to identify recurring themes. Results: Six themes could be identified. (1) There was consensus among participants on deficiency in current assessment of surgical skills. (2) Most participants believed that this is a useful method, although four out of 16 participants believed that current methods were sufficient. (3) There was a unanimous opinion that its purpose should be initially formative assessment and later for summative assessment. (4) It was suggested that it is practical with logistic support; it can be made part of trainee's record to be reviewed later; maybe by independent observers. (5) Participants believed that the logistic issue in term of equipment and trained manpower will be a challenge in implementing this mode of assessment. Other barriers included medicolegal and ethical issue and acceptability by the stake holders. (6) Participants also suggested remedies for the barriers. Conclusion: Video review of surgical procedures can improve assessment of operative skills of trainees provided it is used as formative tool initially with a need to overcome logistics, medicolegal and cultural barriers.

Role of r-irisin in Nicotine-induced Oxidative Stress and Endothelial Dysfunction in BALB/c mice.

OBJECTIVE: To determine the protective role of irisin in attenuating nicotine-induced oxidative stress in vascular tissue in mice. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Foundation University, Islamabad, Pakistan, from January 2019 to June 2020. METHODOLOGY: Thirty healthy BALB/c mice were divided into 3 groups. Group 1 was control, group II received nicotine 2 mg/Kg body weight intraperitoneally for 28 days, and group III, in addition, received r-irisin 0.5 µg/g body weight /day via tail vein, for the last 14 days. The tissue anti-oxidant enzymes (SOD, CAT, and GR) and lipid peroxidation marker (TBARS) were estimated. Aortic endothelium was analysed for atherosclerotic changes. The significant difference across groups was calculated using ANOVA. RESULTS: Group II showed statistically significant increase in lipid peroxidation marker (TBARS) levels (1059.04±32.31 ng/ml, p<0.001) and reduction in anti-oxidative enzymes (SOD, CAT and GR) levels (5479.24±25.38 pg/ml, 11.51±0.24 ng/ml and 1924.88±31.23 ng/ml, p<0.001) in aortic tissue homogenate as compared to group I. In Group III, with co- administration of r-irisin, significant improvement in antioxidant enzymes i.e. SOD, CAT, and GR levels (7958.70±110.54 pg/ml, 20.86±0.57 ng/ml, and 2897.18±52.93 ng/ml) and reduction in TBARS levels (239.14±19.90 ng/ml) was observed as compared to Group II (p<0.001). Endothelial damage manifested to type IV on histological examination. Co-administration of r-irisin in group III showed significant improvement in histological grading (only Type I and II lesions were seen). CONCLUSION: Exogenous administration of irisin improves anti-oxidant enzyme levels, ameliorates nicotine-induced oxidative stress, and endothelial dysfunction in the BALB/c mice. KEY WORDS: Irisin/FNDC-5, Oxidative stress, Anti-oxidant enzymes, Endothelial dysfunction, Atherosclerosis.

Student led outreach workshops to promote basic life support.

OBJECTIVE: To provide basic life support training to the staff, students and faculty of higher educational institutions in urban areas through pre-trained medical students, and to record the qualitative impact of community training on student facilitators. METHODS: The mixed-method quasi-experimental study was conducted at the Foundation University, Islamabad, Pakistan, in collaboration with the Higher Education Commission of Pakistan from 2015 to 2018. Trained volunteer medical students were divided into teams to visit and provide hands-on basic life support training to 15 educational institutions in Rawalpindi and Islamabad with each batch having 45-50 participants. The participants completed pre- and post-training questionnaires, whereas the trainers went through post-training, semi-structured interviews. Quantitative analysis of pre and post-training responses was done using SPSS 21. Qualitative assessment of the impact of learning experience was done through constant comparative analysis of transcripts. RESULTS: There were 120 volunteers and 675 participants subjects. The participants' knowledge about basic life support showed significant improvement (p<0.001) post-training. There were two main recurring themes identified in the interviews; an opportunity to improve self-confidence, and technical skill. CONCLUSIONS: Hands-on training sessions conducted by pre-trained medical students not only resulted in an improvement in Basic Life Support knowledge of the participants, but also had a substantial impact on student trainers' self-confidence and technical skills.

Self-evaluation of ethical review committees functioning at Foundation University Medical College (FUMC) through structured constitution-practice-outcome (CPO) assessment model.

OBJECTIVE: To assess the operational efficiency of the ethical review committee of a medical college. METHODS: This study was conducted at the Foundation University Medical College, Islamabad, Pakistan, from 2012 to 2014. On the basis of literature review, methods for assessment of various features of ethical review committee were studied. A constitution-practice-outcome measurement model for evaluation of ethical review committee assessment process was developed. Data submitted to ethical review committee since its constitution was extracted and quantitatively analysed. RESULTS: The ethical review committee comprised 14 members, including 4(28.6%) permanent and 10(71.4%) rotating clinical, basic sciences and non-medical members. As many as 45 research protocols were submitted, with submission frequency of 8(17.8%), 12(26.7%) and 25(55.5%) per year respectively, and issued ethical approval certificates within a mean duration of 7.2±3.2 days from the time of first submission to final notification. Issues looked into were according to World Health Organisation guidelines. Standard review was done on 29(64.4%) studies and expedited on 16(35.5%). In addition, 24(53.3%) protocols needed resubmission. Only 2(4.4%) protocols were not approved. The number of issues raised for resubmission was 71. Main reasons for resubmission were found to be incomplete documents 26(36.6%), invalid informed consent forms 12(16.9%) and negligence in maintaining confidentiality of study participants 9(12.7%). CONCLUSIONS: Ethical review committee with its limited resources was fulfilling its founding objectives as depicted by constitution-practice-outcome model.

Medical electives: Students perspective.

OBJECTIVE: To identify possible learning targets of undergraduates who opted for local and foreign medical electives and to quantify their level of achievement. METHODS: The cross-sectional study was conducted at Foundation University Medical College, Islamabad, in February 2014, and apprised undergraduates of either gender from second to final year MBBS who had already done medical electives in local or foreign hospitals for 2-4 weeks. Data collection tool was an anonymous questionnaire with four possible intended learning areas; career choice, learning from advanced system, career enhancement and peer pressure. Possible learning objectives were accredited with 'yes' or 'no' option and their level of achievement were quantified on Likert scale of 1 to 5. RESULTS: Among the 45 undergraduates, 12(26.6%) were males and 33(73.3%)were females. A total of 26(57%) believed that electives helped them in making career choice, while 6(14%) disagreed and 7(16%) were not sure. Besides, 20(66%) students were expecting to learn from advanced system, 12(26.66%) felt that their expectations were met, and 11(24%) felt them better than expected. Career enhancement was the main objective of 16(38%) students with an achievement level of 4 and 5 in 11(24%) of students. Only 7(16%) considered peer pressure as one of the motivating factors for electives. CONCLUSIONS: Main professional targets of undergraduates who had done medical electives were found to be learning from advanced system and career selection and an overall significant number felt that their target achievement was up to or beyond their expectations.

Reciprocal benefit to senior and junior peers: An outcome of a pilot research workshop at medical university.

A study was planned to explore and evaluate the role of senior peers in the learning process of their juniors during a Research Methodology workshop, and to assess educational advantages for seniors in leading roles. Twenty medical students participated with 15 juniors (1st to 3rd year) and 5 seniors (final/fourth year) divided into 5 groups with one senior student each at Foundation University Medical College, Islamabad, Pakistan. The seniors supervised and engaged the groups to develop research questions, formulate objectives, review literature, outline study designs, develop study tools/questionnaire and finally shape their projects in synopsis. Overall advantages to both juniors and seniors through this peer-assisted learning model were assessed by feedback proformas with open and closed-ended questions. Senior peers' facilitation was effective in the learning process of junior peers. Senior peers also gained academic benefit by exercising their leadership qualities through teaching and maintaining group dynamics.

Knowledge, attitude and practices of healthcare providers towards deep vein thrombosis prophylaxis in five teaching hospitals of Rawalpindi.

BACKGROUND: Prophylaxis of deep vein thrombosis (DVT) is underutilised in Pakistan. This cross-sectional survey was designed to evaluate knowledge, attitude and practices of healthcare providers towards DVT prophylaxis in teaching hospitals in and around Rawalpindi. METHODS: Knowledge, attitude and practices was assessed by a 12-item questionnaire filled-in by healthcare providers in five teaching hospitals. Eleven out of 12 questions were multiple-choice type and one was open ended. RESULTS: One hundred-sixty-nine, out of 200 questionnaires were returned and were analysed. Total 43.2% of the respondents were house-officers. Although 98.8% agreed that DVT prophylaxis is clinically important, but 39.4% actually prescribed it themselves. Out of these, only 10.3% respondents did it routinely. Low molecular weight heparin (LMWH) was the preferred prophylaxis used (36.7%). Most of the respondents underestimated the prevalence and consequences of DVT in hospitalised patients. CONCLUSION: Knowledge and practices of healthcare providers about DVT prophylaxis in hospitalised patients is less than ideal. Hospitals need to develop their own guidelines for DVT prophylaxis.

PBL wrap up sessions: an approach to enhance generic skills in medical students.

BACKGROUND: Problem based learning (PBL) tutorials are being used in various medical schools world wide. Students' active participation is a must for the success of a teaching program. The objective of this study was to evaluate the effectiveness of PBL Wrap-up sessions in an integrated modular medical curriculum in enhancing the generic skills of medical students. METHODOLOGY: This study was conducted on 100 students of 2nd year MBBS who had been taking PBL sessions since 1 1/2 years. Each session concluded with a wrap-up session where students demonstrated their acquired knowledge in the form of PowerPoint presentations, concept maps, skits, models etc. A questionnaire based survey was conducted to find out overall effectiveness of PBL sessions including wrap-up sessions. The questionnaire comprised of 15 questions. Students were asked to rate all those sessions on a likert scale of 1 to 5. RESULTS: Student's responses showed 'Moderate improvement' in 8 out of 15 skills like communication with peers and teachers, presentation skills, self confidence, application of acquired knowledge, using internet and other resources and understanding group dynamics. Improvement in abilities like problem solving, time management, creativity, motivation in studies and self-directed learning was 'Minimal'. In addition students recommended continuation of PBL in the same way for future classes. CONCLUSION: PBL with wrap-up sessions contributed in bringing moderate enhancement of generic learning skills in students which were not properly addressed in the traditional curriculum and are therefore recommended for future implementation.

Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee.

Neurobiological mechanisms invoking the release of endogenous opioids and depression of stress hormone release are believed to be the basis of acupuncture analgesia. This study compared plasma beta-endorphin and cortisol levels with self assessment scores of intensity of pain, before and after 10 days of electro-acupuncture treatment in patients suffering from chronic pain as a result of osteoarthritis knees. Forty patients of either sex over 40 years with primary osteoarthritis knee were recruited into a single-blinded, sham-controlled study. For electro-acupuncture group the points were selected according to the Traditional Chinese Medicine Meridian Theory. In the sham group needles were inserted at random points away from true acupoints and no current was passed. Both groups were treated for 10 days with one session every day lasting for 20-25min. Pre- and post-treatment Western Ontario and McMaster Universities (WOMAC) index of osteoarthritis knee and Visual Analogue Scale (VAS) for pain were recorded and blood samples were taken for the measurement of plasma cortisol and beta-endorphin levels. Following electro-acupuncture treatment there was a significant improvement in WOMAC index and VAS (p=0.001), a significant rise in plasma beta-endorphin (p=0.001), and a significant fall in plasma cortisol (p=0.016). In conclusion electro-acupuncture resulted in an improvement in pain, stiffness and disability. Of clinical importance is that an improvement in objective measures of pain and stress/pain associated biomarkers was shown above that of a sham treatment; hence demonstrating acupuncture associated physiological changes beyond that of the placebo effects.