Why has the caesarean rate increased dramatically in Bangladesh?

OBJECTIVE: The objective is to assess the reasoning by families in deciding between a home vs. facility delivery and vaginal vs. caesarean. STUDY DESIGN: The authors selected a convenience sample of 16 villages in Sathkira district in southwest Bangladesh. Evidence was drawn from detailed in-home post-delivery interviews with all mothers in these villages who delivered in 2015 or 2016. METHODS: Local family health workers and paramedics used a structured questionnaire that enabled gathering of relevant quantitative and qualitative evidence. Mothers' reasons for selection of delivery location and type were categorized, and regression analysis was conducted to assess significance of variables that proxy supply and demand factors. RESULTS: Among 492 completed interviews, 48% were home deliveries, 52% facility deliveries; two-thirds of facility deliveries in private clinics. Overall, sample caesarean rate is 39%, public hospital rate 53%, private clinic rate 86%. Over half of reasons for home delivery refer to pregnancy without complication or access to trusted birth attendant. Over half of reasons for facility delivery refer to medical complications allegedly precluding home delivery, or requiring home-to-facility transfer during labour for reasons not clear to the mother. The decision depends on both 'demand' factors originating with the family (proxied by family income, birth order and education levels) and 'supply' factors originating with obstetric care providers (proxied by number of antenatal visits and variation of caesarean rate by village). In a regression controlling for both demand and supply variables, the above proxy variables are all significant. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Bangladesh has inadequate nursing support for vaginal delivery in either home or facility. Hence, physicians frequently recommend that women deliver in a facility (usually a physician's clinic). Physicians are reluctant to hire adequate nurses to attend vaginal deliveries. Hence, families with some discretionary income are increasingly opting for a caesarean over vaginal delivery. Facility deliveries reduce incidence of obstructed labour fistula, but probably contribute to rising incidence of iatrogenic fistula. Reducing caesarean rates requires a large increase in numbers of nurses and midwives, and acceptance by physicians of a broad scope of practice for nurses/midwives in vaginal deliveries.

Survey of Emergency and Essential Surgical, Obstetric and Anaesthetic Services Available in Bangladeshi Government Health Facilities.

OBJECTIVE: Evaluate the capacity of government-run hospitals in Bangladesh to provide emergency and essential surgical, obstetric and anaesthetic services. METHODS: Cross-sectional survey of 240 Bangladeshi Government healthcare facilities using the World Health Organisation Situational Analysis Tool to Assess Emergency and Essential Surgical Care (SAT). This tool evaluates the ability of a healthcare facility to provide basic surgical, obstetric and anaesthetic care based on 108 queries that detail the infrastructure and population demographics, human resources, surgical interventions and reason for referral, and available surgical equipment and supplies. For this survey, the Bangladeshi Ministry of Health sent the SAT to sub-district, district/general and teaching hospitals throughout the country in April 2013. RESULTS: Responses were received from 240 healthcare facilities (49.5% response rate): 218 sub-district and 22 district/general hospitals. At the sub-district level, caesarean section was offered by 55% of facilities, laparotomy by 7% and open fracture repair by 8%. At the district/general hospital level, 95% offered caesarean section, 86% offered laparotomy and 77% offered open fracture treatment. Availability of anaesthesia services, general equipment and supplies reflected this trend, where district/general hospitals were better equipped than sub-district hospitals, though equipment and infrastructure shortages persist. CONCLUSION: There has been overall impressive progress by the Bangladeshi Government in providing essential surgical services. Areas for improvement remain across all key areas, including infrastructure, human resources, surgical interventions offered and available equipment. Investment in surgical services offers a cost-effective opportunity to continue to improve the health of the Bangladeshi population and move the country towards universal healthcare coverage.

Electrocoagulation treatment of raw landfill leachate using iron-based electrodes: Effects of process parameters and optimization.

The main problem of landfill leachate is its diverse composition comprising many persistent organic pollutants which must be removed before being discharge into the environment. This study investigated the treatment of raw landfill leachate using electrocoagulation process. An electrocoagulation system was designed with iron as both the anode and cathode. The effects of inter-electrode distance, initial pH and electrolyte concentration on colour and COD removals were investigated. All these factors were found to have significant effects on the colour removal. On the other hand, electrolyte concentration was the most significant parameter affecting the COD removal. Numerical optimization was also conducted to obtain the optimum process performance. Under optimum conditions (initial pH: 7.73, inter-electrode distance: 1.16 cm, and electrolyte concentration (NaCl): 2.00 g/L), the process could remove up to 82.7% colour and 45.1% COD. The process can be applied as a pre-treatment for raw leachates before applying other appropriate treatment technologies.

Serum Vitamin D and Facial Aging: Is There a Link?

BACKGROUND: The vitamin D endocrine system, besides multiple other functions, regulates aging in many tissues, including the skin. It protects the skin against the hazardous effects of many skin age-inducing agents, including ultraviolet radiation. Thus, in the present study we aimed to investigate the relationship between facial skin aging and 25-hydroxyvitamin D [25(OH)D] serum levels in healthy Egyptian adults. METHODS: Sixty-one healthy adult subjects were included. Photodamage scores (erythema/telangiectasias, lentigines, hyperpigmentation and coarse wrinkling) were assessed and graded. Serum vitamin D was measured using enzyme immunoassay and subjects were classified as sufficient, insufficient or deficient according to the vitamin level. RESULTS: The mean 25(OH)D serum level was 43.90 nmol/l. A high prevalence of vitamin D deficiency was detected in the studied subjects regardless of their age or gender. Also, vitamin D levels were not correlated with photodamage scores and were not affected by the Fitzpatrick skin phototype, duration of sun exposure per day or the use of sunscreens (p > 0.05 for all). CONCLUSIONS: Aging is a complex process that is influenced by many genetic and environmental factors. Facial aging is not correlated with serum vitamin D level, and clinical trials using oral or topical vitamin D to combat aging are better predictors of its effects rather than in vivo studies.

An Extragastrointestinal Stromal Tumor Arising From the Omentum in a Young Hispanic Male.

Gastrointestinal stromal tumors (GISTs) are neoplasms arising from the bowel wall, most often in the jejunoileum of the small intestine, but rarely from extragastrointestinal locations. GISTs most often occur in patients older than 40 years of age and can present with a multitude of gastrointestinal symptoms. We present a rare case of an extragastrointestinal stromal tumor (EGIST) causing abdominal pain and melena in a 34-year-old Hispanic male. The patient presented with diffuse abdominal pain, melena, and severe anemia. Computed tomography of the abdomen revealed a large mass abutting the small bowel. The patient was taken to surgery where the mass, which appeared to be deriving from the omentum and invading the adjacent small bowel, was completely excised and found to be a spindle cell GIST. Excision margins were determined to be negative, and the patient was started on a tyrosine kinase inhibitor for maintenance therapy. The patient continues to follow up on an outpatient basis for surveillance. This case represents the rare disease entity EGIST presenting outside the typical demographics of the disease in a young patient with no identified previous genetic syndromes. Gross examination of the mass in this case was also atypical given the appearance that the mass was rooted in the omentum and invading the small bowel which would suggest the primary tumor site was extragastrointestinal. This case demonstrates the need to build a differential diagnosis that includes GIST and the ability to successfully treat this disease if it is identified early in the clinical course.

Microbial contamination in herbal medicines available in Bangladesh.

Plants have long been used as herbal medicines in many countries. However, microbial contamination of these medicines may affect human health. Present study was performed to assess the pathogenic proliferation in the locally available commercial herbal oral medicines. The pathogenic load was compared with the microbiological standard given by the British Pharmacopoeia. Out of 85 oral liquid samples, 2 were found to be highly contaminated with a total aerobic bacterial load of 1.24 x 10(5) cfu/ml, 10 samples were contaminated with fungi (1.2 x 10(4)-6.3 x 10(4) cfu/ml). Tests for specific pathogens were carried out. One sample showed contamination by coliforms but none of the samples were contaminated by Salmonella spp. and Shigella spp. Among 40 semisolid samples, one showed to be contaminated with bacteria (1.93 x 10(5) cfu/g) and 5 samples consisted of fungal load ranging between 1.5 x 10(4)-2.2 x 10(4) cfu/g. The presence of bacteria and fungi in these samples thus suggest the fact that aseptic handling is necessary during processing of oral herbal medicines.

Role of Ommaya Reservoir in Pediatric Hydrocephalus: Experience in Bangladesh Medical College Hospital from 2019-2021.

The goal of this study was to analyze the efficacy of the Ommaya reservoir within all the different types of hydrocephalus in pediatric patients. At the same time, it's safe for repeated aspirations or long-term retention of the reservoir in the body. This retrospective, cross-sectional study was performed from January 2019 to December 2021, 33 consecutive cases of reservoir implantation were taken into the study irrespective of the etiology of hydrocephalus in the Neurosurgery Department of Bangladesh Medical College Hospital, Dhaka, Bangladesh. These were mostly placed along with endoscopic third ventriculostomy and some were placed as an intermediary procedure to combat shunt complications in emaciated infants. Cerebrospinal fluid (CSF) aspiration was done in case of failed endoscopic third ventriculostomy and the frequency of aspiration depended upon the production of cerebrospinal fluid. Acetazolamide was routinely administered in each patient to reduce the frequency of aspiration. Most of the patients required ventriculo-peritoneal (VP) shunt while they had sufficient body weight and few required no surgery. The average age at presentation was 76.88 days. All the neonates and infants had less weight in terms of their age. 42.4% of babies needed aspiration 2 times per week. Among all cases, 9.1% developed reservoir complications. Complications were not related to the number and volume of aspiration or duration of the reservoir in the body. Two (2) patients died after one year of reservoir implantation due to unknown etiology. Out of the 31 survivors, 3 patients did not need any further aspiration and 19 patients needed a ventriculo-peritoneal shunt, but the reservoir was kept in situ for a future emergency. The rest of them is waiting for a definitive shunt procedure. Other findings include low socioeconomic group was more prone to low birth weight and they carried the burden of congenital hydrocephalus and meningomyelocele. Most affected babies had their prenatal period in arsenic-affected areas in Bangladesh. Overall folic acid supplementation was started after the formation of the neural tube irrespective of socioeconomic status. Ommaya reservoir placement along with endoscopic third ventriculostomy plays a vital role in delaying shunt in endoscopic third ventriculostomy failure. It is a 'time buying' procedure until the baby has sufficient weight for successful shunt surgery. It has been found very effective intermediary intervention for managing shunt infection and it also helps revive a channel in shunt obstruction.

Freeze-thaw stability of duck surimi-like materials with different cryoprotectants added.

In this study, the effect of the addition of different cryoprotectants on the freeze-thaw stability of duck surimi-like material (DSLM) was tested. A 6% (wt/wt) low-sweetness cryoprotectant (i.e., polydextrose, trehalose, lactitol, or palatinit) was added to a 3-kg portion of DSLM, and the mixture was subjected to freeze-thaw cycles during 4 mo of frozen storage. The DSLM with no cryoprotectant added (control) and with a 6% sucrose-sorbitol blend (high-sweetness cryoprotectant) added also were tested. The polydextrose-added sample had the highest water-holding capacity among the sample types tested (P < 0.05), and it retained its higher value during frozen storage. The protein solubility of the cryoprotectant-added samples decreased significantly (P < 0.05) from 58.99 to 59.60% at initial frozen storage (0 mo) to 48.60 to 54.61% at the end of the experiment (4 mo). The gel breaking force of all samples significantly decreased (P < 0.05) at 1 mo; this breaking force then stabilized after further frozen storage for the cryoprotectant-added samples, whereas it continued to decrease in the control samples. Gel deformation fluctuated during frozen storage and was significantly lower (P < 0.05) at the end of experiment than at the beginning. The presence of cryoprotectants reduced the whiteness of DSLM. Samples containing polydextrose, trehalose, lactitol, and palatinit were able to retain the protein solubility, gel breaking force, and deformation of DSLM better than control samples after 4 mo of frozen storage and exposure to freeze-thaw cycles. The effects of these low-sweetness cryoprotectants are comparable to those of sucrose-sorbitol, thus, these sugars could be used as alternatives in protecting surimi-like materials during frozen storage.

Physicochemical and sensory characteristics of burger made from duck surimi-like material.

Burgers were prepared using duck surimi-like material (DSLM) with polydextrose added (SL) and DSLM with sucrose-sorbitol added (SS), and the properties of these burgers were compared with those of burgers made of chicken meat (CB) and duck meat (DB). Quality characteristics such as chemical composition, cooking loss, diameter shrinkage, color, and texture were measured. The DB had a lower moisture content (55.58%) and higher fat content (21.44%) and cooking loss (11.01%) compared with other samples, whereas CB, SS, and SL did not differ significantly in moisture (65.21-66.10%) and fat (10.42-11.16%) content or cooking loss (5.32-6.15%). The SS and SL were positioned below CB and above DB in terms of hardness, chewiness, and springiness. Ten trained panelists assessed the burgers using quantitative descriptive analysis. Among the burgers, CB had the greatest brightness of color, hardness, springiness, and chewiness. The SS had greater sweetness than the other burgers. Both SL and SS had significantly less animalic odor, meaty flavor, oiliness, juiciness, and saltiness compared with DB. The physicochemical and sensory characteristics of burgers prepared from DSLM approached those of burgers made of chicken.

pH dependent synthesis and characterization of bismuth molybdate nanostructure for photocatalysis degradation of organic pollutants.

Bismuth molybdate (Bi2MoO6) nanostructures has attracted many researches as an advanced photocalysts for the organic contaminants. In this paper, bismuth molybdate Bi2MoO6 nanoparticles were synthesized using a simple hydrothermal method at varied pH (2, 4, 6, 8, and 10) for 15 h at 180 °C. The results reveal the variation pH precursor solutions have a significant impact on the morphology, phase formations, and photocatalytic activity of samples. The synthesized samples at low pH level were characterized by FESEM analysis revealing Bi2MoO6 nanoplates have formed while gradually convert to Bi2MoO6 spherical nanoparticle at high PH level as shown in energy dispersive X-ray spectroscopy (DES) peaks. The X-ray diffraction patterns reveal characteristic peaks corresponding to mixed phases of Bi2MoO6 and cubic Bi4MoO9 at high pH value. The optical absorption study exhibit Bi2MoO6 nanoplates absorbed visible light with blue shift when compared to the cubic Bi4MoO9 structures. Moreover, the photocatalytic activity results revealed that nanoplates in pH = 4 sample has excellent photocatalytic activity for degradation of rhodamine (RhB), methylene orange (MO), and phenol under visible-light irradiation (λ > 400 nm) as well as exhibit the photodegradation 90% of phenol within 300 min.

Association between Psychological Status and Functional Outcome in Surgically Managed Fractures around Hip in Geriatric Patients - A Prospective Study.

INTRODUCTION: Fractures around the hip in the geriatric population not only lead to functional but also psychological impairment. Psychiatric disturbances can be associated with poor participation in rehabilitation, increased risk of falling again, and higher rates of mortality. The present study was undertaken to assess the association between the psychological status and functional outcome of surgically managed elderly Indian patients who had sustained fractures around the hip. MATERIAL AND METHODS: The present study was a hospital based prospective, single centre study. One hundred and two geriatric patients who had sustained hip fracture and had been managed surgically, having no cognitive dysfunction, living independently, having unhindered walking capability before the fracture, were included in the study. They were called for follow-up at 3rd, 6th, and 12th month after the hip surgery. Psychological assessment was done by the Hospital Anxiety and Depression Scale (HADS) and functional outcome by using the Harris hip score (HHS). RESULTS: Our study did not show association between psychological status and functional outcome except in one sub-group. Significant correlation was observed between the psychological status and functional outcome in most of the patients in the extra-capsular group. We have identified improvement in the depression, anxiety and functional scores during the follow-up. CONCLUSION: We conclude that psychiatric disturbances in a geriatric patient after undergoing a surgery for hip fracture may lead to poor recovery. We recommend that all such geriatric patients should undergo a psychological assessment and proper therapy should be instituted to achieve good functional recovery.

Modelling COVID-19 growth cases of provinces in java Island by modified spatial weight matrix GSTAR through railroad passenger's mobility.

The movement of positive people Coronavirus Disease that was discovered in 2019 (Covid-19), written 2019-nCoV, from one location to another has a great opportunity to transmit the virus to more people. High-risk locations for transmission of the virus are public transportations, one of which is the train, because many people take turns in or together inside. One of the policies of the government is physical distancing, then followed by large-scale social restrictions. The keys to the policy are distance and movement. The most famous transportation used for the movement of people among provinces on Java is train. Here a Generalized Space Time Autoregressive (GSTAR) model is applied to forecast infected case of 2019-nCoV for 6 provinces in Java. The specialty of this model is the weight matrix as a tool to see spatial dependence. Here, the modified Inverse Distance Weight matrix is proposed as a combination of the population ratio factor with the average distance of an inter-provincial train on the island of Java. The GSTAR model (1; 1) can capture the pattern of daily cases increase in 2019-nCoV, evidenced by representative results, especially in East Java, where the increase in cases is strongly influenced by other provinces on the island of Java. Based on the Mean Squares of Residuals, it is obtained that the modified matrix gives better result in both estimating (in-sample) and forecasting (out-sample) compare with the ordinary matrix.

Nivolumab-Induced Toxic Epidermal Necrolysis: Rare but Fatal Complication of Immune Checkpoint Inhibitor Therapy.

Toxic epidermal necrolysis (TEN) is a rare, but potentially fatal dermatological emergency most commonly caused by medication exposure. It is characterized by skin desquamation affecting over 30% of the body, and it remains a fatal condition with a high mortality rate. Nivolumab, an immune checkpoint inhibitor used in the treatment of various types of malignancies, has been linked to TEN. Nivolumab-induced TEN is a rare phenomenon with a low incidence rate in patients treated with a single-agent immune checkpoint inhibitor, but it has a high mortality rate that exceeds non-nivolumab-induced TEN. Nivolumab-induced TEN can present with many potential complications such as hemodynamic instability from excessive fluid loss, sepsis from bacterial superinfection, and disseminated intravascular coagulation. Due to its high mortality rate, prompt recognition of the condition, immediate withdrawal of the offending drug(s), vigorous skin care, multispecialty collaboration, and close monitoring of complications is needed. We present a case of nivolumab-induced TEN in an elderly male with a history of hepatocellular carcinoma who presented with acute-onset skin desquamation after nivolumab initiation.

Knowledge, Attitudes and Practices Related to HIV Stigma and Discrimination Among Healthcare Workers in Oman.

OBJECTIVES: Stigma and discrimination undermine the quality of life of people with HIV and their access to health services. This study aimed to assess HIV-related knowledge, attitudes and practices among healthcare workers (HCWs) in Oman. METHODS: This cross-sectional study took place between July and November 2016. A questionnaire was distributed to 1,400 government HCWs to determine HIV-related knowledge, attitudes and practices. RESULTS: A total of 1,281 HCWs participated (response rate = 92%). Routine tasks, such as dressing wounds, drawing blood and touching clothes, were a cause of concern for 24-52% of HCWs. Only 69% correctly answered questions regarding the transmission of HIV via eating/drinking and mosquito bites. Compared to other HCWs, doctors had significantly higher knowledge (mean = 0.46, 95% confidence interval [CI]: 0.19 to 0.73; P <0.001), attitude (mean = 0.77, 95% CI: 0.31 to 1.24; P = 0.001) and practice (mean = 2.07, 95% CI: 1.59 to 2.55; P <0.001) scores. Expatriates also scored significantly higher in knowledge (mean = 1.08, 95% CI: 0.93 to 1.23; P <0.001), attitude (mean = 1.23, 95% CI: 0.98 to 1.48; P <0.001) and practice (mean = 1.08, 95% CI: 0.82 to 1.34; P <0.001) compared to Omani nationals. Finally, those with >15 years' work experience scored significantly higher on knowledge (mean = -0.60, 95% CI: -1.12 to -0.08; P = 0.025) and attitude (mean = -0.99, 95% CI: -1.87 to -0.10; P = 0.029) compared to those with less experience. CONCLUSION: The high rate of HIV-related stigma among HCWs in Oman should be rectified in order to achieve the 90-90-90 target set by the Joint United Nations Programme on HIV/AIDS.

Association between Psychological Status and Functional Outcome in Surgically Managed Fractures around Hip in Geriatric Patients - A Prospective Study

@#Introduction: Fractures around the hip in the geriatric population not only lead to functional but also psychological impairment. Psychiatric disturbances can be associated with poor participation in rehabilitation, increased risk of falling again, and higher rates of mortality. The present study was undertaken to assess the association between the psychological status and functional outcome of surgically managed elderly Indian patients who had sustained fractures around the hip. Materials and methods: The present study was a hospital based prospective, single centre study. One hundred and two geriatric patients who had sustained hip fracture and had been managed surgically, having no cognitive dysfunction, living independently, having unhindered walking capability before the fracture, were included in the study. They were called for follow-up at 3rd, 6th, and 12th month after the hip surgery. Psychological assessment was done by the Hospital Anxiety and Depression Scale (HADS) and functional outcome by using the Harris hip score (HHS). Results: Our study did not show association between psychological status and functional outcome except in one sub-group. Significant correlation was observed between the psychological status and functional outcome in most of the patients in the extra-capsular group. We have identified improvement in the depression, anxiety and functional scores during the follow-up. Conclusion: We conclude that psychiatric disturbances in a geriatric patient after undergoing a surgery for hip fracture may lead to poor recovery. We recommend that all such geriatric patients should undergo a psychological assessment and proper therapy should be instituted to achieve good functional recovery

Genetic Predictors of Azathioprine Toxicity and Clinical Response in Patients with Inflammatory Bowel Disease.

BACKGROUND: Thiopurines (Azathioprine (AZA) and 6-Mercaptopurine (6-MP) are considered a well-established therapy for patients with Inflammatory Bowel Disease (IBD) including ulcerative colitis (UC) and Crohn's Disease (CD). However, nearly 20% of patients discontinue thiopurines due to adverse events. Functional polymorphisms of several enzymes involved in the metabolism of thiopurines have been linked with toxicity. The clinical value of variant carriers such as TPMT, ITPA and GSTs in predicting toxicity and adverse events for IBD patients treated with thiopurines remains to be clarified. OBJECTIVES: To determine if variation in TPMT, ITPA and GST genotypes can predict adverse effects such as neutropenia, pancreatitis, liver enzyme elevation, as well as clinical response for patients with IBD treated with thiopurines. METHODS: Patients known to have IBD and treated with AZA or 6MP were enrolled. Adverse effects were calculated and their correlation with TPMT, ITPA and GST genotypes was evaluated. Further, the correlation between clinical response and TPMT, ITPA and GST genotypes were assessed. RESULTS: A total of 53 patients were enrolled. 16/53 patients (28.6%) responded to AZA therapy. 17 patients experienced adverse events with 10 having to discontinue treatment. Three patients (5.4%) developed severe myelosuppression (WBC< 2.0 or neutrophils <1.0). Loss of function TPMT genotype was associated with adverse events (OR 3.64, 95% CI 0.55 - 24.23, p=0.0313). ITPA and GST polymorphisms were not associated with toxicity. GSTM1 deletion was associated with poor clinical response to therapy (OR 3.75, 95% CI 0.940 - 14.97, p=0.1028), however, neither TPMT*3A nor ITPA polymorphisms were associated with clinical response. CONCLUSION: In addition to TPMT for adverse events, genotyping for GSTM1 appears to predict clinical response in IBD patients treated with thiopurines.

Properties of a-SiGe Thin Films on Glass by Co-Sputtering for Photovoltaic Absorber Application.

Non-hydrogenated amorphous Silicon-Germanium (a-SiGe) thin films were deposited at two different base pressures by RF magnetron co-sputtering. Moreover, an ex-situ thermal annealing was carried out to investigate the material properties to be suitable as the bottom cell of multi-junction solar cells. Compositional study of the films using EDX showed Ge-rich thin films with 75 atomic% of Ge. XRD reflection study implied that all samples were entirely amorphous in nature. However, a significant improvement of morphology possibly due to low base pressure was observed while thermal annealing caused peening and reduction of surface inhomogeneity in both as-sputtered films. UV-VIS-IR analysis confirmed the FESEM results. The highest transmittance was observed in the as-deposited sample grown at 4 x 10(-5) Torr, which however reduced after thermal annealing. Tauc's model was implied for band gap determination and band gap energy as low as 1.07 eV was found in the annealed sample grown at lower base pressure (4 x 10(-6) Torr). Electrical properties of films were investigated by Hall effect measurement system and results found the reduction of resistivity with the same trend of optical band gap energy.

An introductory course on study skills forming a bridge between traditional and problem based learning (PBL).

OBJECTIVE: To introduce entrants in a medical university coming from traditional system of education to student-centered, problem based learning (PBL) and acquaint them with small group dynamics in order to make them life long learners. SETTING: Ziauddin Medical University, Karachi, Pakistan. SUBJECTS: First Year Students of Medical University. DESIGN: The course was of ten hours, divided in six session. In the first session, there were exercises for interaction in small groups, followed by sessions on principles of learning, learning methodologies, PBL, assessment and lastly importance of feedback. RESULT: Evaluation of the course revealed that 63% of the students agreed that the course achieved its objectives, 25% were not sure while 12% disagreed. Seventy one percent agreed that the course promoted student to student interaction, 24% were not sure while 5% disagreed. CONCLUSION: The course made the process of transition from traditional system of learning to more innovative methods of learning, smoother for the students. The general feeling of the faculty members was that these students were able to perform better than the students who had not taken this course. It is too early to determine the success of this course. A follow-up study however is needed to evaluate the effectiveness of this course by determining the performance of students in small group session of Problem-Based Learning.

Selection procedure as predictor of performance in university examination.

OBJECTIVE: To determine the correlation of SSC, HSC, ZMU achievement test and interview scores with the scores achieved in MBBS 1st, 2nd and 3rd Professional Examinations. METHOD AND PROCEDURE: The SSC, HSC, ZMU admission test and interview scores of 159 MBBS students admitted in 1995, 1996 and 1997 were correlated with the scores of the 1st, 2nd and 3rd professional examinations. Data analysis was done on SPSS Software. RESULTS: No significant relationship was found between the SSC, HSC, ZMU admission test and interview scores and the scores obtained in the professional examinations. SSC scores did not correlate with any variables/matrices, whereas for batches 1 and 2 the HSC school leaving examination scores correlated significantly with ZMU interview score (p < 0.05). No correlation was found between ZMU test and ZMU interviews. Results showed significant relationship (p < 0.01) between all 1st, 2nd and 3rd professionals of all three batches. CONCLUSION: None of the admission criteria (SSC, HSC, ZMU admission test and interview scores) predict the performance of medical students in the professional examinations.

An integrated curriculum for MBBS.

OBJECTIVE: To report the formulation and implementation of an organ system based integrated curriculum for MBBS students at Ziauddin Medical University (ZMU) Karachi. STEPS OF INTEGRATION: The Basic Medical Science Faculty (Anatomy, Physiology and Biochemistry) along with representatives from Medicine, Surgery and Community Health Sciences held joint meetings spread over weeks to design a system based integrated curriculum for the first two years of the MBBS class. Objectives of an integrated course were devised and the duties of term coordinator determined. CONCLUSION: Horizontal integration of Basic Science subjects can be achieved, with the subject specialists coordinating the teaching of a system based as opposed to subject based curriculum. The basic sciences can also be integrated with Community Health Sciences to achieve partial vertical integration.