Testing an educational intervention to enhance resilience and self-efficacy among schoolteachers in Karachi Pakistan.

OBJECTIVE: A pilot study using a pre-post interventional design, was carried out to evaluate the effectiveness of a resilience-based training workshop on the self-efficacy and resilience of schoolteachers in a peri-urban area of Karachi, Pakistan. Four in person workshops were held at the school's location during January to June 2022. RESULTS: A total of 14 teachers participated in the workshop. The effectiveness of interventions was evaluated by assessing self-efficacy and resilience in pre- and post-teaching modules. The Wilcoxon Signed Rank Test determined a significant difference between the pre- to post-module scores of Self Efficacy (p = 0.016) and resilience (p = 0.006). The pre-median scores with IQR of Self-Efficacy were 28 (10), and Resilience scores 76 (12); and post-scores for Self-Efficacy and Resilience scores increased to 35 (5.5) and 88 (14) respectively. This indicated significant improvement in general self-efficacy and resilience skills after four weeks of training. This pilot study showed that building knowledge regarding mental health struggles in students and oneself, learning ways to cope with stress and manage student behavior, and forming a peer support system are crucial in building self-efficacy and resilience in teachers.

The Effect of Vitamin D Supplementation on Incidence of Type 2 Diabetes: A Systematic Review.

With the clinical increase in Type 2 Diabetes worldwide, several interventions to decrease its incidence have been investigated. One such intervention is Vitamin D supplementation, as it affects Insulin secretion from the pancreas and Insulin receptors in the cells of the body. This systematic review addresses whether or not Vitamin D supplementation has a role in reducing the risk of developing Type 2 Diabetes. Systematic searches were conducted on PubMed, and Cochrane Library mainly but also checked Google Scholar. Randomized controlled trials, systematic trials and cohort studies were retrieved that included keywords pertaining to Vitamin D supplementation and the incidence of Type 2 Diabetes. Exclusion criteria included studies that looked at different forms of Diabetes, studies including patients aged less than 18 or more than 85 years of age and studies that were not English language. For all the trials identified, the incidence of Type 2 Diabetes among the cohort receiving vitamin D supplementation was compared to the cohort receiving placebo medication. Additionally, the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was analyzed to observe if there was a difference between Insulin resistance among these two cohorts between the start of the trials and the end. Thirteen randomized controlled trials were identified. Seven of these identified incidences of Type 2 Diabetes as a research outcome, out of which six showed no statistically significant impact of vitamin D on the incidence of Type 2 Diabetes. Out of the 13 trials, 10 analyzed the impact of vitamin D supplementation on patients' HOMA-IR. In six of these trials, patients receiving vitamin D supplementation had a decrease in their HOMA-IR, while it increased in 4 trials. In seven of the ten trials that analyzed for HOMA-IR, the HOMA-IR was less in the vitamin D cohort than the placebo cohort. There is insufficient evidence to suggest that vitamin D supplementation significantly reduces the incidence of Type 2 Diabetes despite its effects on insulin resistance. Further research in this area would be helpful in order to influence clinical guidelines on vitamin D supplementation among patients at risk of Type 2 Diabetes.

A Case Report of a Young Patient Presenting With Syncope Secondary to Arrhythmogenic Ventricular Cardiomyopathy.

Arrhythmogenic ventricular cardiomyopathy is an inherited condition mainly affecting adults. A 35-year-old Asian male patient presented with syncope while walking home. He experienced a number of episodes of light-headedness and dizziness over the past few weeks. A clinical examination found visible injuries to his face and hands. An electrocardiogram showed right axis deviation and right bundle branch block. Echocardiography showed normal biventricular function and the left ventricular ejection fraction was > 55%. A computerized tomography scan of the head and face showed a small fracture to the superior maxillary wall and a computerized tomography pulmonary angiogram demonstrated an inflammatory nodule with right upper and middle lobes changes as well as right hilar lymphadenopathy, suggestive of possible tuberculosis. Blood tests were unremarkable, and troponin was negative. Cardiovascular magnetic resonance imaging showed preserved biventricular function, mild bi-atrial dilatation, and extensive, crescentic-shaped, subepicardial late gadolinium enhancement from basal to apical inferior, basal to apical lateral, and mid to apical anterior segments of the left ventricle suggestive of arrhythmogenic ventricular cardiomyopathy. The patient was commenced on bisoprolol and had an implantable cardioverter defibrillator fitted. He was discharged home with outpatient cardiology follow-up.

Experiences from implementing an Lessons from teaching psychiatry trainees at a tertiary care hospital in Karachi, Pakistan.

Early childhood trauma can have adverse effects on brain development. This results in higher rates of mental health and medical problems in adults. Unfortunately, psychiatry trainees are not adequately trained in dealing with trauma survivors. Hence, we implemented an online trauma curriculum and assessed its efficacy. Socratic methods of teaching, flipped classroom approach, brainstorming, role play, and case-based discussions were utilized. Participants were able to exhibit good knowledge and clinical skills as assessed through summative assessment and communication skills assessment. This curriculum showed online training can help with clinical skill development along with improving knowledge when dealing with trauma survivors.

A need for trauma informed care curriculum: Experiences from Pakistan.

Trauma is a major global health problem. Currently a trauma curriculum, from a psychological perspective, has not been uniformly incorporated in medical education. Nonetheless, professionals from various medical disciplines have an integral role in providing trauma care to survivors. The current COVID-19 pandemic only underscores the relevance and urgent need of this training, as studies show an uptick in mental health disorders due to this trauma. This article will present a discussion on the need for trauma curriculum for health care professionals, using information gained through trauma informed care workshops for healthcare personnel at Aga Khan University Hospital Pakistan.

Wellness Services: A Need Assessment Survey for Post Graduate Medical Education Trainees at Aga Khan University Hospital, Pakistan.

OBJECTIVE: The study aimed to assess the need of mental wellbeing services for post graduate medical (PGME) trainees working at the Aga Khan University Hospital in Karachi, Pakistan. METHODS: A cross-sectional study was conducted among all PGME trainees working at Aga Khan University Hospital in Karachi, Pakistan. The study questionnaire was developed by the team of investigators. The data collection was done through online survey from April 2019 to May 2019 and it was analyzed using descriptive and inferential analyses. RESULTS: Out of total 623 PGME trainees, 334 trainees completed the online survey (response rate of 53.61%). A total of 292 participants (87.4%) perceived a need for mental health services. The major stressors identified were increase work hours (77.8%), excessive workload (75.1%), and difficulty balancing between work and personal life (72.8%). The perceived obstacles of utilizing mental services included lack of protected time (69.8%), fear of consequences (36.8%), lack of confidentiality (36.5%), and stigma (32.9%). The study participants indicated various suggestions to reduce their stressors such as separate relaxation space in hospital (91.3%), appreciation gestures like encouraging emails (65%), mentoring programs (43.4%), and regular surveys about resident needs (39.8%). CONCLUSION: It is evident that innovative strategies to address trainees' mental health needs, looking at limitations of developing countries like Pakistan with large population and limited resources, need to be explored.

Cultural considerations in providing trauma care to female, childhood sexual abuse survivors: Experiences from Pakistan.

Abuse is associated with short and long term psychiatric consequences. There is a need to develop more culturally competent treatment, especially in the South Asian context. We present an account of our clinical experience with hospital-based therapeutic strategies that we found to be successful in a largely conservative, developing country.

Clinical significances and diagnostic utilities of both miR-215 and squamous cell carcinoma antigen-IgM versus alpha-fetoprotein in Egyptian patients with hepatitis C virus-induced hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. It has been widely established that the early detection of HCC enables more treatment options with improvements in prognosis and survival. OBJECTIVES: The aim of this study was to assess the diagnostic accuracy of both circulating miR-215 and squamous cell carcinoma antigen-IgM (SCCA-IgM) as serum biomarkers for HCC by examining their diagnostic sensitivity, specificity, accuracy, and predictive values in hepatitis C virus (HCV)-induced HCC patients. SUBJECTS AND METHODS: This study included 60 patients with HCV-related HCC. In addition, 60 patients with HCV-related liver cirrhosis (LC) and 60 apparently healthy subjects were involved, and served as diseased and healthy control groups, respectively. The relative expression levels of miR-215 were detected using quantitative real-time PCR. SCCA-IgM levels in serum were measured by enzyme immunoassay. We used receiver operating characteristic (ROC) curve to calculate the diagnostic accuracy against alpha-fetoprotein (AFP). RESULTS: Relative miR-215 expression levels increased the most in HCC patients compared to that in healthy or diseased controls (P<0.001). Serum concentration of SCCA-IgM was significantly higher in HCC group than that in the two control groups. We performed multivariate analysis using AFP level, focal lesion size, and portal vein thrombosis as independent variables. ROC curves showed that the optimum diagnostic miR-215 cutoff value for identifying HCC patients from cirrhotic ones was 417 (sensitivity, 97%; specificity, 91%) and for SCCA-IgM was 95 AU/mL (sensitivity, 92%; specificity, 98%). Moreover, the superiority of both miR-215 and SCCA-IgM to AFP is obvious in our study and this superiority is more evident in distinguishing HCC with AFP levels <200 ng/mL and HCC patients with small-sized focal lesions from cirrhotic patients. CONCLUSION: Cell-free miR-215 and serum SCCA-IgM could be used for early diagnosis of HCC either each one as a single marker or with AFP complement measurement.

Gaze patterns in navigation: encoding information in large-scale environments.

We investigated the role of gaze in encoding of object landmarks in navigation. Gaze behavior was measured while participants learnt to navigate in a virtual large-scale environment in order to understand the sampling strategies subjects use to select visual information during navigation. The results showed a consistent sampling pattern. Participants preferentially directed gaze at a subset of the available object landmarks with a preference for object landmarks at the end of hallways and T-junctions. In a subsequent test of knowledge of the environment, we removed landmarks depending on how frequently they had been viewed. Removal of infrequently viewed landmarks had little effect on performance, whereas removal of the most viewed landmarks impaired performance substantially. Thus, gaze location during learning reveals the information that is selectively encoded, and landmarks at choice points are selected in preference to less informative landmarks.