Effects of interval training on haemodynamic variables after coronary artery bypass graft: A meta-analysis.

Objective: To assess the combined impact of interval training programme on haemodynamic variables, specifically blood pressure and heart rate, in patients having undergone coronary artery bypass graft surgery. METHODS: The meta-analysis was conducted from October to December 2022, and comprised search on PubMed, MEDLINE, Web of Science, PeDro, EMBASE, Science Direct, Cochrane Central Register of Controlled Clinical Trials, Google Scholar and Scopus electronic databases by two researchers independently for literature published between 2009 and 2020 related to the effects of interval training on coronary artery bypass graft patients. Meta-analysis was then performed to analyse the effects of an interval training on systolic blood pressure, diastolic blood pressure, and heart rate. The meta-analysis was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. RESULTS: Of the 122 studies initially located, 7 were related to the effects of different forms of interval trainings and their impact on systolic and diastolic blood pressure of the patients, and 5 studies analysing the effects of interval trainings on heart rate. Interval training showed mild improvement in decreasing SBP compared to control groups. Standardized mean difference suggested an effect size of -0.226 in random effect model (I2=52.01; p=0.064). Similarly, a small effect size of 0.136 (I2=39.19%, p=0.14) was observed for diastolic blood pressure. Also, there was a small effect size of 0.155 (I2= 28.08, p=0.23) observed for heart rate. Conclusion: Interval training programmes, including high-intensity interval training, low-volume interval training, and aerobic interval training, had a small effect on systolic blood pressure, whereas continuous training protocols had a similarly small effect size on diastolic blood pressure and heart rate.

Health Sciences Faculty Attitude and Readiness Towards Simulation-Based Inter-Professional Education.

OBJECTIVE: To explore attitude and readiness of health sciences faculty towards simulation-based inter-professional education (IPE). STUDY DESIGN: Qualitative case-study; critical realist paradigm as used. Place and Duration of the Study: Bahria University Health Sciences Campus from December 2022 to March 2023. METHODOLOGY: Maximum variation purposive sampling technique was used for selecting the participants. A total of thirty-one participants were selected. Five faculty members from Nursing, five from Doctor of Physical Therapy (DPT), five Medical Laboratory Technologists (MLT), eight participants from medical, and eight from the dental faculty. Data were collected using individual semi-structured interviews and two focus group discussion. Duration of an individual interview was 30 minutes and that of the focus group discussion was 60 minutes. All interviews were recorded and transcribed. Community of inquiry and community of practice theoretical framework were used for guiding the research design and interviews. Pattern matching technique was used for the data analysis. Atlas ti-9 was used for organising the data. RESULTS: Ten themes were identified after the analysis. teamwork, understanding roles and responsibilities, time constraint communication skills, curriculum integration, patient outcome, interprofessional boundaries, ethics in practice, faculty training, and visionary leadership. CONCLUSION: The faculty members valued interprofessional education but were reluctant to implement it due to the limited resources. There is a need of faculty development for implementation of simulation-based interprofessional education. There is insufficient research on simulation and interprofessional education in Pakistan because of which faculty members are unacquainted of its benefits. KEY WORDS: Interprofessional education, Simulation-based learning, Medical education.

Improving Kyphotic Postures and Neck Pain in Young Adults: A Meta-Analysis of Exercise-Based Interventions.

The study aimed to review the findings concerning the effects of exercises on Cobb angle and pain in patients suffering from cervical pain caused by thoracic kyphosis. Two investigators separately conducted a systematic review of the electronic literature from 2018 till 2022. PubMed, MEDLINE, Web of Science, Science Direct, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and Scopus were among the electronic databases that were accessed. This meta-analysis included 5 studies, published between 2019 and 2022. A sample size of 261 patients; included in 5 studies were estimated on Cobb angle and pain. The between-groups pooled random SMD for Cobb angle and pain showed a larger effect size of -2.146 and -1.126, respectively. The findings suggested that physical therapy exercise may result in larger changes among the Cobb angle and neck pain of kyphotic patients. Key Words: Exercise, Physical therapy, Cobb angle, Pain, Thoracic kyphotic angle, Conservative management.

Evaluation of the Efficacy of Manual Toothbrush Versus Power Toothbrush in Reduction of Gingivitis: A Comparative Clinical Study.

Background: In our study, we compare the power toothbrush with the manual toothbrush and the results showed were contradictory. Where few studies have reported that power toothbrushes are superior, other studies showed that both are equally efficacious in removing dental plaque. Aims: The present study was conducted to evaluate and compare the efficacy of manual toothbrush with an electric toothbrush in reducing dental plaque and gingivitis. Materials and Methods: The study included a total of 56 subjects which were randomly divided into two groups of 28 subjects each. At week 1, disclosing agent (two-tone solution) was used to detect plaque, and Loe and Silness Gingival Index were used to assess gingival scores. Oral hygiene instructions and brushing were also reinforced. A similar protocol was repeated at one, two, and six weeks. The collected data were subjected to statistical evaluation. Results: At two weeks, the plaque score for manual and power toothbrushes were 60.253 ± 20.672 and 44.031 ± 16.484, respectively, and this difference was statistically significant with P = 0.0020. At six weeks, plaque scores for manual and power toothbrushes were 43.784 ± 22.647 and 20.489 ± 10.336, respectively, and were statistically significant (P < 0.0001). Conclusion: The present study concludes that powered toothbrush has added advantages of improved oral hygiene compared to manual toothbrush concerning plaque reduction. This can be attributed to predefined power and force which can effectively remove plaque, calculus, and improved gingival health.

Is Colchicine a New Game-Changer in Patients With Acute Coronary Syndrome?

Colchicine, an anti-inflammatory drug, was declared as a potently cheap and effective drug in treating atherosclerosis. This report is a detailed understanding and an in-depth interpretation of the colchicine cardiovascular outcomes trial (COLCOT) that has taken place in recent years. It is a secondary quantitative study that has reviewed studies discussing the role of colchicine in myocardial infarction, inflammation, ST-elevation myocardial infarction, and in general, acute coronary syndrome (ACS). Different trials statistically proved colchicine's role in ACS by lowering the levels of high c-reactive protein, decreasing low attenuation plaque volume, and stabilizing plaque. Hence, in other words, it has been revealed that this drug has potential in the management of ACS. Colchicine reported promising results in reducing the risk of recurrent myocardial infarction, stroke, and sudden cardiac arrest, playing a massive role in lowering inflammation and the mortality caused by cardiovascular diseases.

A Case of Giant Proliferative Periocular Pyogenic Granuloma.

Pyogenic granuloma (PG) is a common vascular anomaly affecting the skin with occasional involvement of mucosa. Ophthalmic surgeons typically encounter these lesions as solitary, bright red, rapidly growing papules following surgery or trauma to the conjunctiva, e.g. chalazion, strabismus, or enucleation surgery. We present a rare and novel case of a disfiguring proliferative & eruptive giant pyogenic granuloma involving both mucosal and non-mucosal tissue of the ocular adnexa in the absence of any previous surgery, trauma, or medical history in a previously fit and well 43-year-old male. We demonstrate the histological features of the lesion following successful management with surgical excision & primary closure. The authors advocate surgery as the gold standard for managing such proliferative lesions ensuring low recurrence rates and histological confirmation for a lesion whose differential diagnoses include malignant eyelid lesions such as keratoacanthoma and squamous cell carcinoma.

Strategies for improving faculty retention: A mixed-methods study in a private medical university in Karachi, Pakistan.

OBJECTIVE: To determine the strategies that improve faculty retention at a medical university. METHODS: The mixed-method study was conducted at Bahria University Medical and Dental College, Karachi, from August to September 2020, and comprised faculty members of either gender associated either with the university or with Pakistan Navy Station Shifa Hospital. Qualitative component comprised of semi-structured interviews. Quantitative data was collected using the 35-item Faculty Retention Strategies Questionnaire (FRSQ). Data was analysed using SPSS 23. Exploratory factor analysis (EFA) was done to extract the common factors influencing faculty retention. RESULTS: Of the 182 faculty members approached, 101(56%) responded. Of them, 66(65.3%) subjects were females, 35(34.7%) were males, 46(45.5%) were aged <36 years, and 65(65.3%) were working at the university for <5 years. The factors affecting faculty retention were direct communication of departmental head with faculty, timely promotions, feedback on teaching performance to junior faculty, clear employment policies, protected research time, teaching expertise-based promotions, implementing innovative faculty ideas, scholarships for postgraduate faculty, faculty administrative positions, equal junior faculty workloads, transport provision, competitive pay-scale and faculty development workshops. Item mean was 4.143±0.380, Cronbach's alpha was 0.894 and inter-item correlation was 0.223. EFA revealed a 4-factor solution: 'institutional work support', 'faculty development', 'faculty communication' and 'faculty leadership initiative'. CONCLUSION: Implementing these strategies could possibly lead to long-term faculty retention.

Development and validation of an instrument for assessment of professional behaviour during laboratory sessions.

OBJECTIVE: To develop an instrument to assess professional behaviour among medical students, and to determine its validity, reliability, feasibility and acceptability. METHODS: This cross-sectional study was conducted at Bahria University Medical and Dental College, Karachi, from July to September 2017, and comprised of medical students in years 1 and 2 of their academic programme. The instrument was developed for the Physiology laboratory sessions using nominal group technique and was tested for validity, reliability, feasibility and acceptability by two assessors through validity and reliability statistics. Data was analysed using SPSS 23. RESULTS: Of the 250 students enrolled, 232(92.8%) had their assessment completed. Applicability of the scale was indicated by exploratory factor analysis. Two factors were isolated which explained 57.65% of the variation. The first factor, comprising of 7 sub-factors, was labelled as 'practical performance', and the second factor, consisting of 5 sub-factors, as 'personal interactions'. A final 12-item instrument was retained. Cronbach's alpha was determined to be high at 0.863. Intra class correlation was 0.863 for both years 1 and 2 combined. CONCLUSIONS: It was possible to develop an instrument for professional behaviour assessment in Physiology laboratory skills session which could indicate valid, reliable, feasible and acceptable results.

Report: Interactions and conflicts of interests between prescribers and medical sales representatives (MSRs) regarding prescribing and drug promotion practices in Karachi, Pakistan.

Pharmaceutical drug promotion practices are found to have potentially controversial ethical standards. They may compromise on patient's wellbeing especially when it inordinately affects the clinical care and patient's interests by influencing the prescribing behavior of physicians. There is no proper system to keep a watch on the drug marketing and promotion strategies by the pharmaceuticals in Pakistan. A cross sectional study using a specially designed questionnaire and convenience sampling was conducted in Karachi for 6 months targeting prescribers and medical sales representative (MSRs). A total of 600 MSRs and prescribers consented to participate. 66% of MSRs highlighted that prescribers follow ethical prescribing but only (58%) seek evidence base behind promoted drug. This was contradictory to prescribers' response to same, which was 87%. Only (10%) of prescribers acknowledged demanding expensive gifts such as laptops, ACs, furniture and renovation of the clinic which was about 40% according to MSRs. This study offered intricate insights into the MSR and physicians interactions. It highlighted various aspects of these relationships from both MSRs' and prescribers' point of view. Although majority of the physicians negated the notion of expecting expensive favors from the sales representatives, responses by MSRs suggest that anticipation of gifts and incentives exists on part of the physicians. This has the potential to indulge in unethical promotion and irrational prescribing on part of MSRs and prescribers respectively that may further contribute to untoward patient outcomes such as increased treatment costs and adverse drug reactions.

Dietary Supplement Use Among Students of Pharmacy Colleges in the City of Karachi, Pakistan: Prevalence, Opinions, and Attitudes.

This study was conducted among pharmacy students in Karachi, Pakistan, to document prevalence, opinions and their attitudes toward dietary supplement (DS) use. A cross-sectional study was conducted for a period of four months. The study used a specially formulated dietary supplement questionnaire (DSQ). The prevalence of DS use was reported at 48.2%: 51% in males and 47.3% in females. Physician recommendation was cited by majority of students as reason for DS use (n = 153, 25%). Most of the students used multivitamins (n = 315, 51.5%). The average monthly cost attributed to DS use was reported at PKR 1,396.3 (USD 13.55). For every year increase in age, DS use in students decreased (OR = 0.917). Male students were more likely to recommend DS use (OR = 1.425). The most noteworthy finding was the cautious approach of students as the majority reported DS use only upon recommendation of a physician.

Estimation of the Direct Cost of Poliomyelitis Rehabilitation Treatment to Pakistani Patients: A 53-Year Retrospective Study.

BACKGROUND: Pakistan is one of the last few countries in which poliomyelitis is endemic. Evidence indicates that out-of-pocket expenditures are a barrier to polio rehabilitation treatment, yet there are no reported figures related to the financial burden of this disease on patients in a recently polio-endemic country. OBJECTIVE: This study investigated direct costs attributed to rehabilitation treatment of poliomyelitis among Pakistani patients and reported its duration along with the socioeconomic status of poliomyelitis survivors. CONCLUSION: The cost of poliomyelitis rehabilitation in Pakistan is high; it has an economic effect on the lives of patients and their families. Despite good education, polio survivors in Pakistan appear to have low socioeconomic status, lower chances of employment and marriage, as well as fewer children. Further research is recommended to explore the burden of disease on society, i.e., indirect costs and suffering.

Awareness, knowledge and attitude towards breast cancer, breast screening and early detection techniques among women in Pakistan.

OBJECTIVE: To document the knowledge and attitudes of women towards breast cancer, breast screening and early detection techniques. METHODS: This cross-sectional survey was conducted from December 2015 to May 2016 in Karachi and Islamabad, Pakistan, and comprised women aged above 18 years. The survey used breast cancer inventory as a research instrument after piloting and validation. SPSS 20 was used for data analysis. RESULTS: Of the 1,304 respondents, 948(72.7%) were single, 1,082(83%) belonged to the 18-30 age group, 800(61.3%) had Urdu-speaking ethnicity and 794(60.9%) were educated. The prevalence of breast cancer in family was 226(17.33%). Besides, 446(34.2%) had low knowledge regarding the subject, 646(49.5%) appeared welcoming to the idea of breast screening, 1,008(77.3%) indicated their discomfort in discussing the topic, whereas 1,080(82.8%)preferred a female physician. CONCLUSIONS: There was a dearth of knowledge regarding breast cancer among the participants..

Development of Evidence-Based Disease Education Literature for Pakistani Rheumatoid Arthritis Patients.

Rheumatoid arthritis affects 0.5% to 1% of the population globally and is one of the most common causes of disability. Patient education plays a key role in improving treatment outcomes. The purpose of this study was to discuss the process involved in designing an evidence-based disease education literature for rheumatoid arthritis patients of Pakistan in Urdu language with culturally relevant illustrations. A study was conducted to develop disease education literature using Delphi consensus, content validity, and patient feedback. A panel of experts comprised of university professors and health care experts, including health practitioners and pharmacists as well as a social scientist, was set up to assess the need. Eight patients were randomly selected and were asked to give their feedback. Their feedback was incorporated in the development process. The entire process was carried out in eight steps. A disease education literature for patients of rheumatoid arthritis was developed and edited in the form of a booklet. The booklet contained evidence-based information that must be provided to patients in both Urdu and English languages with culturally relevant illustrations. The availability of such literature is significant, as it enables the patients to seek knowledge at home at their convenience. This home-based knowledge support is as helpful as any other means of medical care. The developed literature is planned to be used in further studies which will evaluate its impact in improving knowledge of RA patients.

Brand versus generic dispensing trend for ciprofloxacin 500 mg, levofloxacin 500 mg, and moxifloxacin 400 mg (oral dosage forms) among pharmacies of Karachi, Pakistan.

INTRODUCTION: Pakistan spends 0.7% of its gross domestic product on health. The public sector health-care system provides services to 22% of population thus paving the way for a dominant private sector. Patients in Pakistan mostly pay their medical expenses directly, and 64% of the health expenditures are borne by the household. Expenditure on medicine constitutes 43% of the total household expenditure. METHODS: A quantitative cross-sectional study was conducted in Karachi, Pakistan, for a month. It was aimed at gathering response from different pharmacies to understand the brand versus generic dispensing trend of ciprofloxacin 500 mg, levofloxacin 500 mg, and moxifloxacin 400 mg oral dosage forms. The study employed convenience sampling and used a survey checklist. The data gathered was entered in SPSS version 22. RESULTS: The mean price per tablet for ciprofloxacin brand and generic was reported at Pakistani Rupees (PKR) 48.44 and PKR 26.85, respectively. The trend for dispensing ciprofloxacin highlighted a split in the market between brand (51%) and generic (49%). For levofloxacin brand and generic, the price per tablet was reported at PKR 36.50 and PKR 36.15 respectively, and despite same price, the market was dominated by generic levofloxacin (92%). Due to a price difference between brand and generic moxifloxacin, i.e., PKR 129.44 and PKR 71.91, respectively, the market was mostly occupied by the generic form (75%). CONCLUSION: Pricing mechanism must be revisited, and the authorities should take stern actions against any illegitimate price hike. The surging burden of drug expenditure on poorer sections of the society must be addressed by the government on an urgent basis.

Analysis of the glutathione S-transferase genes polymorphisms in the risk and prognosis of renal cell carcinomas. Case-control and meta-analysis.

BACKGROUND: The Glutathione S-transferases (GSTs) genes deletion polymorphisms have been associated with the progression of several cancers. The association studies between the 2 GSTs (GSTM1 and GSTT1) null polymorphisms with the susceptibility to renal cell carcinoma (RCC) have been inconclusive. Therefore, with the inclusion of our own data, we performed a comprehensive meta-analysis to assess the association between these 2 polymorphisms and the risk of RCC. METHODS: A systematic literature search was carried out for studies published in the PubMed, EMBASE, Cochrane library, and Google Scholar from 1997 to December 2014. Results were stated as pooled odds ratios (ORs) for nonparametric data after heterogeneity analysis with 95% CI using fixed effect or random effect model. RESULTS: We systematically selected 13 relevant studies after thorough searches from the databases. Data showed no association between the GSTM1 and the GSTT1 null genotypes and the risk of RCC (OR = 1.01; CI: 0.92-1.11; P = 0.89 for GSTM1 and OR = 1.14; CI: 0.91-1.42; P = 0.25 for GSTT1). No association was found when the data were stratified according to the geographical/ethnic basis, source of control, and the risk factor evaluation. Subgroup analysis of occupational exposure to pesticides showed an inverse association of the active genotypes of both GSTM1 and GSTT1 polymorphisms with the exposed group of RCC (P<0.00001 and P<0.00001, respectively). The combined null genotype of the GSTM1/GSTT1 significantly increased the susceptibility to RCC by 1.4-fold (P = 0.001). This association remained significant for the Asian populations in subgroup analysis (OR = 1.8; CI: 1.30-2.49; P = 0.0004). CONCLUSION: In conclusion, this meta-analysis suggests that the 2 GSTs deletion polymorphisms independently have no association with the risk of RCC. However, combination of both deletions increases the risk of developing the RCC.

Clinical Spectrum of Disorders of Sexual Differentiation.

OBJECTIVE: To describe the mode of presentation and causes of the disorders of sexual differentiation in patients presenting in the Endocrine Clinic. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: The Endocrine and Diabetes Unit of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from July 2012 to July 2014. METHODOLOGY: Patients with phenotypic, psychosocial gender confusion or absence of gender appropriate secondary sexual maturation were enrolled in the study. Patients having chronic systemic disease, as cause of delayed puberty, were excluded from the study. SPSS 13 was used to evaluate the data. RESULTS: A total of 48 patients registered in the study with mean age of 19.9 ±8 years. Female gender was assigned to 28 (58.3%) of which 8 (28.57%) had genital ambiguity. Male gender was assigned to 20 (41.66%) patients at the time of birth and 7 (35%) of them had ambiguous genitalia. Karyotyping could be done in 36 (75%) patients of which 17 (47.2%) were females and 19 (52.7%) were males. Karyotypic gender of the 19 (48.57%) male patients was 46 XX, 46 XY and 47 XXY; in 4 (21.05%), 5 (26.3%) and 10 (52.6%) patients, respectively with 9 Klinfelter syndrome. Karyotypic gender of 17 (47.42%) female patients were 46 XX, 46 XY and 45 X0; in 5 (29.4%), 3 (17.64%) and 9 (52.9%) patients, respectively. CONCLUSION: Disorder of sexual development constitutes a small but difficult area of endocrinology with disastrous consequences, especially if assigned wrong sex at birth. Mode of presentation of these cases was diverse ranging from delayed puberty, to gender confusion, to pregnancy in a male. Eventually in an adult patient assignment or reassignment of gender identity was primarily the patient's prerogative.

Developing a Research Instrument to Document Awareness, Knowledge, and Attitudes Regarding Breast Cancer and Early Detection Techniques for Pakistani Women: The Breast Cancer Inventory (BCI).

There is a general hesitation in participation among Pakistani women when it comes to giving their responses in surveys related to breast cancer which may be due to the associated stigma and conservatism in society. We felt that no research instrument was able to extract information from the respondents to the extent it was needed for the successful execution of our study. The need to develop a research instrument tailored for Pakistani women was based upon the fact that most Pakistani women come from a conservative background and sometimes view this topic as provocative and believe discussing publicly about it as inappropriate. Existing research instruments exhibited a number of weaknesses during literature review. Therefore, using them may not be able to extract information concretely. A research instrument was, thus, developed exclusively. It was coined as, "breast cancer inventory (BCI)" by a panel of experts for executing a study aimed at documenting awareness, knowledge, and attitudes of Pakistani women regarding breast cancer and early detection techniques. The study is still in the data collection phase. The statistical analysis involved the Kaiser-Meyer-Olkin (KMO) measure and Bartlett's test for sampling adequacy. In addition, reliability analysis and exploratory factor analysis (EFA) were, also employed. This concept paper focuses on the development, piloting and validation of the BCI. It is the first research instrument which has high acceptability among Pakistani women and is able to extract adequate information from the respondents without causing embarrassment or unease.