Sarcopenia: Recent Advances for Detection, Progression and Metabolic Alterations along with Therapeutic Targets.

Sarcopenia, a disorder marked by muscle loss and dysfunction, is a global health concern, particularly in aging populations. Sarcopenia is intricately related to various health conditions, including obesity, dysphagia, and frailty which underscore the complexity. Despite recent advances in metabolomics and other omics data for early detection and treatment, the precise characterization and diagnosis of sarcopenia remains challenging. In the present review we provide an overview of the complex metabolic mechanisms that underlie sarcopenia, with particular emphasis on protein, lipid, carbohydrate, and bone metabolism. The review highlights the importance of leucine and other amino acids in promoting muscle protein synthesis and clarifies the critical role played by amino acid metabolism in preserving muscular health. In addition, the review provides insights regarding lipid metabolism on sarcopenia, with an emphasis on the effects of inflammation and insulin resistance. The review also emphasizes the complex relationship between bone and muscle health by highlighting the interaction between sarcopenia and bone metabolism. Furthermore, the review outlines various therapeutic approaches and potential biomarkers for diagnosing sarcopenia. These include pharmacological strategies such as hormone replacement therapy and anabolic steroids as well as lifestyle modifications such as exercise, nutrition, and dietary changes.

Bioethics curriculum for undergraduate medical students: an evaluation study utilizing mixed methods approach.

BACKGROUND: The undergraduate bioethics curriculum introduced in a private medical college in Pakistan in 1988 and revised in 2009 has evolved over time to incorporate globally relevant innovations, including integration of bioethics spirally within an existing problem-based learning curricular framework. The present evaluation study shares the results of this integrated bioethics curriculum delivered for 10 years across the five-year undergraduate medical curriculum. The study assessed the effectiveness of the curriculum in terms of student achievement, appropriateness of course contents and efficiency of instructional methods. METHODS: The study utilized a mixed method sequential explanatory design. The quantitative method was used in the first phase to gather data by utilizing a structured online questionnaire. This was followed by the second phase of qualitative methods to explain the findings of the first phase and enrich the data gathered. This phase was based on focus group discussions and document review. RESULTS: Student and faculty responses showed the curriculum contents to be relevant, informative, and appropriate as per learning objectives and student achievement. Multi-modal instructional methods used were stated to be effective and engaging; small group teaching and shorter sessions suggested to be preferable for fostering discussion and maintaining student engagement and attention. Large class formats were stated to be less effective. Students affirmed the contribution of bioethics education to their personal and professional development and ethical positioning. The majority of students agreed that the curriculum contributed to their knowledge acquisition (60.3-71.2%), skill development (59.41-60.30%) and demonstration of ethical/professional behavior (62.54-67.65%). The ranges indicate agreement with related sets of questions. Participants suggested that the curriculum could be further strengthened by better integration in clinical years, role modelling and providing opportunities for application in clinical health care settings. Moreover, topics like ethical issues related to the use of social media, public health ethics and ethics and law were suggested as additions to the existing curriculum. These findings have regional and global relevance for the development and assessment of effective bioethics curricula. CONCLUSION: An effective bioethics curriculum for undergraduate medical education should run longitudinally across the 5 year curriculum and be integrated in the modules and clerkships. Basic acquisition of knowledge and skills takes place in Years 1 & 2 with reinforcement and application in Years 3-5. Learning embedded in an integrated curriculum can help students recognize, critically analyze and address ethical dilemmas. Involvement and commitment of the clinical faculty is essential for reinforcing the ethical principles and concepts learnt in the earlier years.

Enhancing caregivers self-management for their children who require medical technology: A feasibility study for the COPE-STAR intervention.

PURPOSE: To test feasibility of the Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources intervention for caregivers of children who require medical technologies of tracheostomies and feeding tubes. DESIGN AND METHODS: Quasi-experimental one group design with measures at baseline and at 4 weeks. Intervention feasibility was tested from August 2019-June 2021, including recruitment, retention, and adherence, and caregiver satisfaction. Caregiver and child characteristics and outcomes were assessed. RESULTS: Caregivers were enrolled (n = 22) and completed (n = 16) the study. Caregivers were primarily female (n = 21), were predominately Caucasian (n = 14, 64%) followed by African-American (n = 8, 36%), and Non-Hispanic/Latino (n = 18, 82%). Feasibility indicators of recruitment (92%), retention (73%), and adherence (100%) were satisfactory. Outcome measures of management of child's chronic condition, caregiver beliefs about managing their child's symptoms and medical technology, anxiety, and depressive symptoms remained stable. Caregivers agreed that the intervention was useful, easy to use, and acceptable, and had positive feedback. CONCLUSIONS: This is a feasible and acceptable intervention. With further development and efficacy testing, the intervention has potential for use and expansion to a larger population of caregivers of children who require medical technology. PRACTICE IMPLICATIONS: Children who require medical technology have multiple complex chronic conditions and complex care needs at home. This intensive and focused care is provided by informal caregivers who need education and resources for their child's care. This intervention addressed caregiver management of common symptoms and medical technologies of children in the home setting.

Identification of contributing factors, microorganisms and antimicrobial resistance involved in the complication of diabetic foot ulcer treatment.

Diabetic foot ulcer (DFU) is a neurological and peripherical complication of diabetes with unknown etiology that is often associated with polymicrobial infections. The present study was conducted to investigate the contributing factors in 285 DFU patients, which included 200 patients with diabetic foot infections (DFI). Identification and characterization of infecting bacterial isolates were done followed by assessment of their pattern of susceptibility to commonly used antibiotics. Among the studied subjects, type 2 diabetes mellitus (T2DM), ulcer type, depth, grade, loss of sensation, infection type, affected foot, recurrence, smoking status, Body Mass Index (BMI), and obesity levels revealed significant disease risk association. Ulcer grades 1 and 2 were more common in males while grade 3 in females. Recurrent infections were significantly higher in females (P = 0.03). Diabetic duration, hyperglycemia, ulcer type, infection type and BMI were positively correlated with delayed wound healing. In DFI samples, 40.2% consisted of gram-negative bacteria, with Pseudomonas aeruginosa (37.5%) being the most common, while in the 60% gram-positive isolates Staphylococcus aureus (40.5%) was the predominant species. Staphylococcus epidermidis was found more frequently in females (P = 0.05). The isolated bacterial strains presented higher resistance against the tested antibiotics; however, ceftriaxone was effective against most of the pathogens. In the current study T2DM along with diabetes duration, obesity, ulcer severity with polymicrobial infection was found to play a strong role in DFI development, where gender predisposition was also observed in ulcer grade and infection. DFI was correlated with loss of sensation, infection type, affected foot, smoking status, BMI and obesity levels.

Nutritional Assessment in Cancer Patients.

Malnutrition in cancer patients is highly prevalent. The metabolic and physiologic changes associated with the disease and the side effects of treatment regimens all combine together to produce a detrimental effect on the patient's nutritional status. A poor nutritional status significantly reduces the efficacy of treatment methods and the patient's overall chances of survival. Therefore, an individualized nutrition care plan is essential to counter malnutrition in cancer. Nutritional assessment is the first step of this process which sets the foundation for developing an effective intervention plan. Currently, there is no single standard method for nutritional assessment in cancer. Hence, to get a true picture of the patient's nutritional state, a comprehensive analysis of all aspects of the patient's nutritional status is the only reliable strategy. The assessment includes anthropometric measurements and evaluation of body protein status, body fat, inflammation markers, and immune markers. A thorough clinical examination which factors in the medical history and physical signs, along with the dietary intake patterns of the patient, is also important components of nutritional assessment of cancer patients. To facilitate with the process, various nutritional screening tools like patient-generated subjective global assessment (PGSGA), nutrition risk screening (NRS), and malnutrition screening tool (MST) have been developed. While these tools have their own benefits, they only give a glimpse of the nutritional problems and do not bypass the need for a complete assessment employing various methods. This chapter covers all four of the elements of nutritional assessment for cancer patients in detail.

Cardiac Transcription Regulators Differentiate Human Umbilical Cord Mesenchymal Stem Cells into Cardiac Cells.

Stem cell-based therapy presents an attractive alternative to conventional therapies for degenerative diseases. Numerous studies have investigated the capability of human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) to contribute to the regeneration of cardiomyocytes, and the results have encouraged further basic and clinical studies on the MSC-based treatment of cardiomyopathies. This study aimed to determine the potential of cardiomyogenic transcription factors in differentiating hUC-MSCs into cardiac-like cells in vitro. MSCs were isolated from umbilical cord tissue and were transduced with the transcription factor genes, GATA-4 and Nkx 2.5, via infection with lentiviruses, to promote differentiation into the cardiomyogenic lineage. Gene and protein expression were analysed with qPCR and immunocytochemical staining. After transduction, differentiated cardiac-like cells showed significant expression of cardiac genes and proteins, namely GATA-4, Nkx-2.5, cardiac troponin I (cTnI) and myosin heavy chain (MHC). The cardiomyogenic-induced group significantly overexpressed cardiac-specific genes (GATA-4, Nkx-2.5, cTnI, MHC, α-actinin and Wnt2). Expression of the calcium channel gene was also significantly increased, while the sodium channel gene was downregulated in the transduced hUC-MSCs, as compared to non-transduced cells. The results suggest that GATA-4 and Nkx-2.5 interact synergistically in the activation of downstream cardiac transcription factors, demonstrating the functional convergence of hUC-MSC differentiation into cardiac-like cells. These findings could potentially be utilised in the efficient production of cardiac-like cells from stem cells; these cardiac-like cells could then be used in various applications, such as for in vivo implantation in infarcted myocardium, and for drug screening in toxicity testing.

Toxicity assessment of heavy metal (Pb) and its bioremediation by potential bacterial isolates.

Lead (Pb) is a non-essential metal with high toxicity, is persistent, is not biodegradable, and has no known biological function. It is responsible for severe health and environmental issues that need appropriate remediation. Therefore, microbes have thrived in a lead-contaminated environment without exhibiting any negative impacts. The present study aimed to examine the toxic effects of lead on animals and the isolation, identification, and characterization of lead-resistant bacterial strains and their biodegradation potential. After oral administration of lead for 4 weeks, mice showed an elevated level of leukocytes and a decrease in TEC, Hb, PCV, MCV, MCH, and MCHC levels. However, a decline in body weight and inflammation and oxidative stress was observed in liver tissues. To remediate toxic heavy metal, lead-resistant bacterial strains were isolated, among which Enterobacter exhibited maximum degradation potential at high lead concentrations. It was identified by molecular basis and after 16S rRNA sequencing, and 99% resemblance was observed with Enterobacter cloacae. FT-IR analysis of the bacteria illustrated the presence of functional groups, including hydroxyl, carboxyl group, sulfide, and amino groups, on the bacterial cell surface involved in the adsorption of lead. Moreover, electron microscopy (SEM) revealed the morphological and physiochemical changes in the bacterial cell after biosorption, indicating the interaction of Cu ions with functional groups. To summarize, the findings show the highly toxic effects of lead on animals and humans and its effective biodegradation by the bacterial strains in the lead-contaminated environment. This biological strategy can be an ideal alternative to remediate heavy metals from contaminated sites to clean up the environment.

Identification and selection of suitable landfill sites using GIS-based multi-criteria decision analysis in the Peshawar District, Pakistan.

Managing municipal solid waste (MSW) is indispensable for public health and quality living standards in urban and rural environments. Suitable landfill site selection (LSS) requires the consideration of many diverse criteria. This study uses various environmental, social and economic criteria in a sophisticated multi-criteria decision analysis (MCDA) within the geographical information system (GIS) and aims to provide a scientific basis for the identification of suitable landfill sites which can efficiently be used for MSW in one of the most urbanized cities (Peshawar district) in Pakistan. The methodology involves pairwise comparisons of the selected and ranked criteria using the analytical hierarchy process (AHP). A weighted linear combination (WLC) was applied to generate the most suitable landfill site for MSW disposal within the study area. The results show that approximately 11.4% (14,485.15 ha) and 16.6% (21,211.95 ha) of the total study area are either very highly suitable or highly suitable, 20.8% (26,525.56 ha) area is unsuitable and the remaining areas are either low (27.3%; 34,834.84 ha) or moderately suitable (23.8%; 30,356.84 ha) for the construction of landfill sites. It is recommended that using the proposed landfill sites would have the least consequences of public health risks and environmental degradation.

Relationship of Emotional Intelligence with academic scores and gender in students of Masters in Health Professions Education (MHPE) at a Public Sector University.

Objective: To determine the correlation between Emotional Intelligence (EI) scores and academic scores and identify other factors that have a relationship with EI. Methods: Cross-sectional analytical study was conducted in the year 2021 on 52 students enrolled in three batches of the MHPE program of a public sector university in Karachi. Data was collected by using Sterrett's Emotional Quotient Self-Assessment Checklist along with a self-constructed form for obtaining demographic profile information. Descriptive analysis was done by calculating percentage, mean and standard deviation. The correlation was done by using Spearman rho and association was tested by Chi-square. Results: Data from forty-one participants showed that the majority need to improve their EI. Females and married participants had higher EI scores. There was a significant positive correlation between EI scores and academic performance but no significant association was found between EI and gender of the participants. Conclusion: The study showed that EI competencies have a strong positive correlation with the academic performance of MHPE students. Hence, it emphasizes the need for including development of EI in the outcomes and curricula of the existing MHPE program.

Hypervalent Phosphorus(V) Porphyrins with meso-Methoxyphenyl Substituents: Significance of the Number and Position of Methoxy Groups in Promoting Intramolecular Charge Transfer.

To study the photophysical and redox properties as a function of meso-aryl units, a series of hypervalent phosphorus(V) porphyrins, PP(OMe)2·PF6, PMP(OMe)2·PF6, PDMP(OMe)2·PF6, P345TMP(OMe)2·PF6, and P246TMP(OMe)2·PF6, with phenyl (P), 4-methoxyphenyl (MP), 3,5-dimethoxyphenyl (DMP), 3,4,5-trimethoxyphenyl (345TMP), and 2,4,6-trimethoxyphenyl (246TMP) units, respectively, have been synthesized. The P(+5) in the cavity makes the porphyrin ring electron-poor, whereas the methoxy groups make the meso-phenyl rings electron-rich. The presence of electron-rich and electron-poor portions within the porphyrin molecule promoted an intramolecular charge transfer (ICT). Also, the study suggests that the ICT depends on the number and position of the methoxy groups. The ICT is more prominent in m-methoxy-substituted phosphorus(V) porphyrins (PDMP(OMe)2.PF6, P345TMP(OMe)2·PF6) and almost no ICT was found in no-methoxy, o-methoxy, and/or p-methoxy phosphorus(V) porphyrins (PP(OMe)2·PF6, PMP(OMe)2·PF6, P246TMP(OMe)2·PF6). Transient absorption studies indicate that the ICT takes place on the picosecond time scale. The most striking results come from P246TMP(OMe)2·PF6, where each phenyl ring carries three methoxy units, like the P345TMP(OMe)2·PF6, but it failed to induce the ICT process. Electrochemical studies and time-dependent density functional theory (TD-DFT) calculations were used to support the experimental results. This study extensively explores why and how slight variations in meso-aryl substitutions lead to intricate changes in the photophysical and redox properties of phosphorus(V) porphyrins.

Treatment success with two doses of methotrexate vs single dose of methotrexate in Ectopic Tubal Pregnancy.

Objectives: To compare the success rates and safety of two-doses of methotrexate versus single dose of methotrexate in ectopic tubal pregnancy. Methods: This was an open-label, randomized controlled trial done at "The Department of Obstetrics & Gynecology, Nishtar University Hospital, Multan" from January 2020 to July 2021. A total of 100 women (50 in each group), aged 20 to 35 years with a tubal ectopic pregnancy were enrolled. All patients were randomly allocated to either single-dose or two-dose methotrexate protocol. Cases were evaluated for treatment success, side effects, beta-human chorionic gonadotrophin (ß-hCG) resolution time and treatment satisfaction. Results: In a total of 100 cases, mean age was 29.6±4.5 years. Mean serum ß -hCG levels at baseline was 1212±78 mIU/ml. Treatment success was noted among 43 (86.0%) cases of single-dose group versus 45 (90.0%) cases (p=0.5382). Duration of ß -hCG resolution time was significantly shorter in two-dose group (23.0±12.1 days versus 28.2±12.8 days, p=0.0394). No significant difference was noted in methotrexate associated side effects in both study groups (p=0.9996). Overall, mean satisfaction score was 4.0±1.3 (out of 5). Conclusion: Although, ß -hCG resolution time was significantly low in two-dose protocol but single-dose methotrexate offered comparable success rates versus two-dose protocol. Side effects were mild and comparable in both methotrexate treatment protocols. Methotrexate was found to be effective in the medical management of ectopic pregnancy.

Role of Politics, Guilds and Pedagogy in defining Policies in Medical Education: The Pakistan Scenario.

Politics in education is not a new concept and has been a sore point of discussion between academia and policy makers. The politics of medical education has led to the formation of informal guilds that have taken control over medical education. Policy decisions concerning medical/dental education affecting the lives of the community, at large are implemented without giving due consideration to the pedagogy of medical education. This paper delves into the definitions of politics, pedagogy and guilds and with evidence identifies that major policy decisions in medical education are strongly influenced by politics. The paper will discuss that politics of medical education is not necessarily a bad thing if it ensures public safety and is based on best evidence medical education. In the same context the guilds formed for medical education reforms should uphold the principles of pedagogy.

Macrosomia predictors and pregnancy outcomes in Gestational Diabetes patients: An observational study from Ha'il, Saudi Arabia.

Objectives: To determine the prevalence, risk factors for macrosomia and pregnancy outcome in women with gestational diabetes (GDM). Methods: In this prospective observational study, we included the data of 161 pregnant females diagnosed with GDM. The study was conducted from December 1st, 2020 to June 30, 2021, at the Maternity and Children Hospital (MCH) of Hail, Saudi Arabia. The data regarding risk factors of macrosomia was obtained from each patient. The patients were followed till the delivery of the baby. The data regarding the prevalence of fetal macrosomia and its associated outcomes was noted. Results: The prevalence of fetal macrosomia was 19.8%. Maternal obesity (OR 4.87), poorly controlled diabetes (OR 3.3), previous history of good-sized baby (OR 2.30), previous history of congenital abnormalities (OR 7.2) were the significant risk factors of fetal macrosomia. The prevalence of maternal and fetal complications was high among pregnancies complicated by fetal macrosomia. The prevalence of fetal macrosomia and other fetal complications was high in poorly controlled GDM patients in comparison to optimal control GDM patients. Conclusion: Fetal macrosomia is a common complication among GDM patients. Maternal obesity and poorly controlled diabetes are the common modifiable maternal factors contributing to macrosomia.

Exploring the linkage between PM2.5 levels and COVID-19 spread and its implications for socio-economic circles.

A pneumonia-like disease of unknown origin caused a catastrophe in Wuhan city, China. This disease spread to 215 countries affecting a wide range of people. World health organization (WHO) called it a pandemic and it was officially named as Severe Acute Respiratory Syndrome Corona virus 2 (SARS CoV-2), also known as Corona virus disease (COVID-19). This pandemic compelled countries to enforce a socio-economic lockdown to prevent its widespread. This paper focuses on how the particulate matter pollution was reduced during the lockdown period (23 March to April 15, 2020) as compared to before lockdown. Both ground-based and satellite observations were used to identify the improvement in air quality of Pakistan with primary focus on four major cities of Lahore, Islamabad, Karachi and Peshawar. Both datasets have shown a substantial reduction in PM2.5 pollution levels (ranging from 13% to 33% in case of satellite observations, while 23%-58% in ground-based observations) across Pakistan. Result shows a higher rate of COVID-19 spread in major cities of Pakistan with poor air quality conditions. Yet more research is needed in order to establish linkage between COVID-19 spread and air pollution. However, it can be partially attributed to both higher rate of population density and frequent exposure of population to enhanced levels of PM2.5 concentrations before lockdown period.

Strengthening the feedback culture in a postgraduate residency program.

Background: Feedback is defined as specific information presented to a learner that facilitates professional development through the process of reflection. Timely provision of constructive feedback to learner is important in optimizing the learning curve. The aim of the current study was to see the effectiveness of various interventions on feedback practices of faculty members. Methods: This is a quasi-experimental study (pre- and postdesign). It was conducted from November 2009 to March 2011 at The Aga Khan University, Pakistan. Faculty development workshops, allotment of specified feedback time, and restructuring of residency feedback forms were done as interventions. Data collection was done pre- and postintervention. Resident's and faculty satisfaction regarding the feedback process were evaluated using a prepiloted questionnaire. Paired t-test was applied to assess the effect of interventions on faculty and resident's satisfaction. Results: The mean satisfaction scores of residents were significantly improved (P < 0.05). Pre- and postintervention faculty satisfaction score also demonstrated significant difference in overall satisfaction level, from 47.88 ± 13.92 to 63.40 ± 8.72 (P < 0.05). Discussion: This study showed improved faculty engagement and satisfaction for the provision of feedback to the trainee resident. Strengthening this, culture requires continuous reinforcement, individualized feedback to the faculty members regarding their feedback practices, and continuing faculty development initiatives.

Development and validation of perceived sexual resentment scale for women (PSRS-W).

OBJECTIVE: To develop a valid and reliable scale to asses perceived sexual resentment among married women. METHODS: The cross-sectional validation study was conducted from September 2018 to July 2019 at the International Islamic University, Islamabad, Pakistan, and had three phases. Phase I comprised initial generation/selection of items regarding sexual resentment among married women. Phase II comprised pilot testing of the perceived sexual resentment scale for women items before applying the scale on the actual sample. Phase III determined convergent validity by estimating correlation of the newly developed scale with the Sexual Coercion in Intimate Relationship Scale, and its divergent validity by finding correlation with the Satisfaction with Life Scale. Data was analysed using SPSS 23. RESULTS: The pilot study, done on 20 married women, established the internal consistency of the newly developed scale (α=0.82). Overall, three factors emerged following factor analysis. The scale had 29 items and reliability analysis of the entire scale indicated adequate internal consistency (α=0.93). The convergent validity of the scale and the Sexual Coercion in Intimate Relationship Scale was positive (p<0.001), and the correlation with the Satisfaction with Life Scale was negative (p<0.01), indicating that the newly-developed instrument had a good convergent and divergent validity. CONCLUSIONS: The Perceived Sexual Resentment Scale for Women was found to be a precise and concise 29-item self-reporting tool developed to assess sexual dislikes and displeasures among married women.

Relationship between psychological distress, quality of life and resilience among medical and non-medical students.

OBJECTIVE: To explore inherent associations between psychological distress and resilience, and its effect on quality of life among medical and non-medical students. METHODS: The cross-sectional study was conducted from December 2018 to January 2020 after approval from the Department of Psychology Ethics Committee of the International Islamic University, Islamabad, and comprised medical and non-medical students of either gender enrolled with different institutions of higher learning in Rawalpindi and Islamabad. Data were obtained using Brief Resilience Scale, Kessler Psychological Distress Scale and Quality of Life Scale. Data was analysed using SPSS. RESULTS: Of the 300 subjects, 150(50%) each were medical and non medical students. Within both groups, 75(50%) each were males and females. Psychological resilience was a positive predictor of quality of life ( =0.30) whereas psychological distress served as a negative predictor of quality of life ( =-0.54). Medical students were significantly higher on psychological distress (p=0.001), whereas non-medical students were higher on quality of life (p=0.001) and resilience (p=0.001). Female students were higher on quality of life and male students were higher on psychological distress (p=0.002). CONCLUSIONS: Resilience needs to be promoted among students, particularly medical students, as it may help in reduction and adequate management of academic distress levels.

Stress and coping among surgery residents in a developing country.

OBJECTIVE: Stress during residency training in surgical disciplines not only hampers professional development but can also compromise patient care and personal health. The purpose of this study was to measure the stress level among the surgical residents, identify factors within the learning and work environment that cause stress, and identify different strategies that the residents use habitually to cope with these stresses. METHODOLOGY: This mix method study was conducted in the department of Surgery at Aga Khan University, Pakistan. Residents' stress level was measured using Perceived Stress Scale (PSS); focus group discussions (FGDs) with faculty and residents explored stressors during residency training, while Brief COPE Inventory identified the residents' preferred coping strategy. RESULTS: A total of 68 (83%) surgery residents completed the survey of which 19% had high stress scores while only one resident had perception of low stress. Females had significantly higher stress scores (25.7±3.0; p=0.008) as compared to male counterparts. Planning (87.8%) and Self-distraction (65%) were the most commonly used adaptive and maladaptive strategies respectively. The reliability of the PSS and BCI measured by Cronbach's alpha was 0.73 and 0.82 respectively. Work-life imbalance, workload and contradicting programme and hospital policies were identified in FGDs as major stressors during residency. CONCLUSIONS: Although surgical residency programmes are very stressful, coping strategies are not formally taught during surgical training. Academia and hospital should join hands in developing interventions to enable residents cope with the situation.

Small molecule 2'-deoxycytidine differentiates human umbilical cord-derived MSCs into cardiac progenitors in vitro and their in vivo xeno-transplantation improves cardiac function.

Small molecules are widely used to induce stem cell differentiation. 2'-deoxycytidine (2-DC) belongs to the cytidine family. It stimulates the expression of cardiac-specific genes and proteins, and directs mesenchymal stem cells towards cardiomyogenic differentiation. We aim to investigate the role of 2-DC-treated human umbilical cord mesenchymal stem cells (UC-MSCs) into myogenic lineage and explore their application in regeneration of infarcted myocardium. UC-MSCs were treated with 5, 10, 20, and 40 µM 2-DC following optimization by cytotoxicity analysis. Rat model of myocardial infarction (MI) was induced by ligating left anterior descending coronary artery. Normal, and 2-DC treated UC-MSCs were transplanted in the left ventricular wall immediately after ligation. Echocardiographic measurements were performed to assess cardiac function. Tissue architecture of the myocardium was examined by histological analysis to determine fate of the transplanted cells. MSCs were successfully isolated from human umbilical cord tissue. 2-DC treatment did not produce any significant cytotoxic effect in UC-MSCs at all concentrations. qPCR analysis of treated UC-MSCs showed induction of myogenic differentiation, which is more pronounced at 20 µM concentration. Fluorescently labeled 2-DC-treated UC-MSCs showed significant (**P < 0.01) homing in the infarcted myocardium as compared to normal UC-MSCs. Hearts transplanted with 2-DC-treated UC-MSCs significantly (***P < 0.001) improved the cardiac systolic and diastolic functions and pumping ability as compared to normal UC-MSCs and MI groups. Fibrotic area and left ventricular wall thickness were significantly improved (***P < 0.001) in 2-DC-treated group as compared to normal UC-MSCs. Immunohistochemical staining showed co-localization of fluorescently labeled cells and patches of differentiated myocytes which were stained for cardiac proteins in the infarct zone implying that the treated UC-MSCs regenerated cardiomyocytes. We report for the first time that 2-DC induces cardiac differentiation in UC-MSCs. Transplanted cells differentiated into functional cardiomyocytes and significantly improved cardiac performance. These pre-differentiated cardiac progenitors showed better survival, homing, and distribution in the infarcted zone. 2-DC treated cells not only improved cardiac function, but also restored tissue homeostasis, suggesting a better therapeutic option for the regeneration of cardiac tissue in the clinical setup.

Relationship between level of empathy during residency training and perception of professionalism climate.

BACKGROUND: Empathy is one of the vital personality attributes for all physicians. It is essential for establishing general interpersonal relationships among doctors and patients. Unfortunately, there is evidence for the decline of physician's empathy during the clinical training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment. OBJECTIVE: This study examines the relationship between empathy level and perception of climate of professionalism among residents. METHOD: The study participants included 70 residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital in Karachi, Pakistan. Two self-administered internet based surveys - Jefferson Scale of Physician Empathy (JSPE) and "Professionalism Climate Instrument"(PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation. RESULTS: The overall response rate was 81.4% with mean empathy level of 103 ± 13. The internal consistency of each scale measured by Cronbach's coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106 + 8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (rs = 0.56, p = 0.64). CONCLUSION: The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism.