Take a break: should breaks be enforced during digital breast tomosynthesis reading sessions?

OBJECTIVES: Digital breast tomosynthesis (DBT) can improve diagnostic accuracy compared to 2D mammography, but DBT reporting is time-consuming and potentially more fatiguing. Changes in diagnostic accuracy and subjective and objective fatigue were evaluated over a DBT reporting session, and the impact of taking a reporting break was assessed. MATERIALS AND METHODS: Forty-five National Health Service (NHS) mammography readers from 6 hospitals read a cancer-enriched set of 40 DBT cases whilst eye tracked in this prospective cohort study, from December 2020 to April 2022. Eye-blink metrics were assessed as objective fatigue measures. Twenty-one readers had a reporting break, 24 did not. Subjective fatigue questionnaires were completed before and after the session. Diagnostic accuracy and subjective and objective fatigue measures were compared between the cohorts using parametric and non-parametric significance testing. RESULTS: Readers had on average 10 years post-training breast screening experience and took just under 2 h (105.8 min) to report all cases. Readers without a break reported greater levels of subjective fatigue (44% vs. 33%, p = 0.04), which related to greater objective fatigue: an increased average blink duration (296 ms vs. 286 ms, p < 0.001) and a reduced eye-opening velocity (76 mm/s vs. 82 mm/s, p < 0.001). Objective fatigue increased as the trial progressed for the no break cohort only (ps < 0.001). No difference was identified in diagnostic accuracy between the groups (accuracy: 87% vs. 87%, p = 0.92). CONCLUSIONS: Implementing a break during a 2-h DBT reporting session resulted in lower levels of subjective and objective fatigue. Breaks did not impact diagnostic accuracy, which may be related to the extensive experience of the readers. CLINICAL RELEVANCE STATEMENT: DBT is being incorporated into many mammography screening programmes. Recognising that reporting breaks are required when reading large volumes of DBT studies ensures this can be factored in when setting up reading sessions. TRIAL REGISTRATION: Clinical trials registration number: NCT03733106 KEY POINTS: • Use of digital breast tomosynthesis (DBT) in breast screening programmes can cause significant reader fatigue. • The effectiveness of incorporating reading breaks into DBT reporting sessions, to reduce mammography reader fatigue, was investigated using eye tracking. • Integrating breaks into DBT reporting sessions reduced reader fatigue; however, diagnostic accuracy was unaffected.

Effect of COVID-19 vaccination on menstrual cycle irregularities among females: A cross-sectional study in Pakistan.

This study was aimed to assess the type and severity of COVID vaccine-induced menstrual disorders and also to investigate the risk factors for menstrual changes following COVID-19 vaccination in Pakistani females. A cross-sectional survey-based study was conducted in females between 12 -70 years of age from February to July 2022. The survey was conducted via in-person interviews as well as via social media. The data was analyzed using standard descriptive statistical parameters, the sociodemographic and clinical features were evaluated and reported as frequencies (percentages). The study comprised a total of 1023 female subjects. Approximately 36.9% of women reported menstrual abnormalities following immunization, with 30.5% experiencing them following their second dose. However, in majority of these women (21%) the symptoms were resolved after 3 months of irregularity. Vaccine type significantly influenced the incidence of menstrual disorders (p <0.001) which were linked to Pfizer-Biontech, Sinopahrm, Sinovac, Moderna at rates of 14.9%, 9.5%, 4.7% and 2.7%, respectively. Both AstraZeneca and Moderna were implicated in postmenopausal bleeding (1.6% and 0.8%, respectively). The study showed that females receiving COVID-19 vaccines experienced menstrual irregularities such as short duration of periods, decreased volume of bleeding, and frequent menstrual cycles. However, the symptoms were temporary and self-limiting.

Harlequin syndrome.

A 56-year-old man presented to the clinic with episodic headaches for several years which had been worsening over a few months prior to the presentation. He described headache as sharp, stabbing pain around the left eye associated with nausea, vomiting, photophobia, and phonophobia lasting for hours associated with flushing on the left side of the face. The picture of his face during these episodes showed flushing of the left side of the face, ptosis of the right eyelid, and miosis (panel A). Flushing in his face would resolve with the abortion of the headache. At the time of presentation to the clinic, his neurological exam was only significant for mild left eye ptosis and miosis (panels B and C). Extensive workup including MRI brain, cervical spine, thoracic spine, lumbar spine, CTA head and neck, and CT maxillofacial was unremarkable. He had tried several medications in the past including valproic acid, nortriptyline, and verapamil without significant benefit. He was started on erenumab for migraine prophylaxis and was given sumatriptan for abortive therapy following which his headaches improved. The patient was diagnosed with idiopathic left Horner's syndrome and his migraines with autonomic dysfunction would present with unilateral flushing opposite to the site of Horner's presenting as Harlequin syndrome [1, 2].

Development and validation of an instrument to measure the Micro-Learning Environment of Students (MLEM).

BACKGROUND: There are multiple instruments to measure different learning environments but no valid and reliable instrument is present for measuring the micro-learning environment. This study aimed to develop and validate an instrument to measure the micro-learning environment of students. Measuring the micro-learning environment can give insight into the real-life experiences of students and enlighten us about the disparity between taught, delivered, and learned curricula. METHODS: Multi-institutional Mixed methods study design with consecutive qualitative and, quantitative components was used based on information processing theory. Literature review, results of semi-structured interviews, and focus group discussion were combined to develop a questionnaire. Content and response process validity were established followed by pilot testing, reliability calculation, and exploratory and confirmatory factor analysis. RESULTS: A forty-nine-item preliminary draft instrument was reduced to a total of twenty-four items final instrument having five themes regarding teaching practices, learners support, competence in teaching, progressive faculty, and teaching environment. The values of SCVI/Ave and S-CVI/UA were calculated to be 0.92 and 0.62 respectively. Reliability was calculated to be 0.94. Fit indices values were within the normal range. CONCLUSION: The instrument for measuring the micro-learning environment has excellent content, construct, response process validity, and reliability.

Validation Of An Assessment Tool For Professionalism In Medical Students: A Mixed Method Study.

Objectives: To develop and validate a tool for the assessment of professionalism in medical students during clerkship. METHODS: The mixed-method study was conducted from February to September 2018 at the Islamic International Medical College, Riphah University, Islamabad, Pakistan. A preliminary focus group discussion was followed by two rounds of Delphi technique to validate micro-scenarios for the relevance of each item of the instrument alongside its content validity. For content and construct validation of the tool, content validity, cognitive validity, cognitive pretesting, confirmatory factor analysis and reliability assessment was done. Piloting was done on medical students doing clerkship. Data was analysed using SPSS 21 and AMOS 21. RESULTS: A 35-item preliminary tool from micro-scenarios generated after focus group discussion was developed for the first Delphi round. For the second round, a 29-item tool was resent to the experts for validation. After the second round, the content validity scale was 0.94. Removal of 1 item produced a 28-item tool. Pre-cognitive testing of the 28 items resulted in rephrasing of 4, modification of 2, and deletion of 1 and a tool with 27 items. Piloting was carried out and after CFA resulted in a reduced 21 item tool. Cronbach's alpha value was 0.96. A good to excellent model fit was produced after performing confirmatory factor analysis. CONCLUSIONS: A tool comprising of 21 items scored on a 5-point Likert scale that had acceptable construct validity and good content validity was developed. It can be used to evaluate the level of professionalism of local medical students doing clerkship.

Phytochemical characterization and anti-arthritic potential of Croton bonplandianus leaves extract: In-vivo and in-silico approach.

Croton bonplandianus, a natural source traditionally used for treating various illnesses, including rheumatoid arthritis, was evaluated in this study. The effects of ethanolic extracts (CBEE) and aqueous fractions (CBAF) of C. bonplandianus leaves on arthritis-induced inflammation were studied using an albino rat model of inflammation induced by Freund's complete adjuvant. Eight test groups (n = 5 per group) and one vehicle control were used to evaluate the antiarthritic effects of different doses of CBEE and CBAF (125 mg.kg-1, 250 mg.kg-1, and 500 mg.kg-1) on days 5, 10, 15, and 20 compared to arthritic and vehicle controls. Arthritis severity was assessed using macroscopic arthritis grading, histological analysis, body weights, and paw thickness. CBEE and CBAF were found to reduce the prevalence of arthritis, increase body weight, and decrease paw inflammation compared to the vehicle control group by the 23rd day. In addition, they showed no effect on biochemical parameters, but a significant difference (p < 0.05) in hematological parameters compared to the arthritic control group. The study identified Hentriacontane compound as a potential contributor to the anti-inflammatory effect of C. bonplandianus, as it showed the lowest dock score for IL-1ß and IL-6. Palmitoylethanol amide was identified as a potential contributor to the anti-inflammatory effect of TNF-α. Gene expression of IL-6, IL-1ß, and TNF-α was down-regulated significantly (p < 0.05) in a dose-dependent manner in all treatment groups compared to the arthritic control group. In conclusion, this study validated the anti-arthritic and anti-inflammatory properties of CBEE and CBAF in a time and dose-dependent manner.

A Review of Twenty Years of Research on the Regulation of Signaling Pathways by Natural Products in Breast Cancer.

Breast cancer (BC) is the second leading cause of death among women, and it has become a global health issue due to the increasing number of cases. Different treatment options, including radiotherapy, surgery, chemotherapy and anti-estrogen therapy, aromatase inhibitors, anti-angiogenesis drugs, and anthracyclines, are available for BC treatment. However, due to its high occurrence and disease progression, effective therapeutic options for metastatic BC are still lacking. Considering this scenario, there is an urgent need for an effective therapeutic strategy to meet the current challenges of BC. Natural products have been screened as anticancer agents as they are cost-effective, possess low toxicity and fewer side effects, and are considered alternative therapeutic options for BC therapy. Natural products showed anticancer activities against BC through the inhibition of angiogenesis, cell migrations, proliferations, and tumor growth; cell cycle arrest by inducing apoptosis and cell death, the downstream regulation of signaling pathways (such as Notch, NF-κB, PI3K/Akt/mTOR, MAPK/ERK, and NFAT-MDM2), and the regulation of EMT processes. Natural products also acted synergistically to overcome the drug resistance issue, thus improving their efficacy as an emerging therapeutic option for BC therapy. This review focused on the emerging roles of novel natural products and derived bioactive compounds as therapeutic agents against BC. The present review also discussed the mechanism of action through signaling pathways and the synergistic approach of natural compounds to improve their efficacy. We discussed the recent in vivo and in vitro studies for exploring the overexpression of oncogenes in the case of BC and the current status of newly discovered natural products in clinical investigations.

Comparison of cortisol levels in patients with vasovagal syncope and postural tachycardia syndrome.

OBJECTIVES: To compare the levels of cortisol in patients of vasovagal syncope (VVS) and postural tachycardia syndrome (POTS). METHODS: A cross-sectional analytical study was conducted at Islamic International Medical College, Rawalpindi and Electrophysiology Department at (AFIC). This study included 80 subjects, comprising of 35 patients in each group of vasovagal syncope and postural tachycardia syndrome and 10 healthy subjects. Patients with complaint of syncope was evaluated for vasovagal syncope and postural tachycardia syndrome using Head Up Tilt Test (HUTT. Blood samples of all the participants were taken and serum cortisol was analyzed using ELISA method. Results were analyzed on SPSS Statistics 21 using ANOVA with a p value of ≤0.05 regarded as significant. RESULTS: Hormonal analysis shows that cortisol levels in the vasovagal, postural tachycardia syndrome and in control group was 153±16.7pg/ml, 160.17±pg/ml, and 69.65± 5.8pg/ml respectively. Cortisol levels were significantly higher in both vasovagal and POTS groups as compared to controls with a p-value of 0.04 and 0.023 respectively. However, there was no significant difference between vasovagal and POTS patients with p value 0.570. CONCLUSION: It is concluded from the study that cortisol responses of VVS and POTS were positive.

Population pharmacokinetics of meropenem among post-operative patients in Pakistan.

BACKGROUND: Meropenem, a potent carbapenem is considered the first choice for the empirical treatment of severe infections. Being a hydrophilic drug, more than 83% of the administered dose is eliminated through the renal route, and therefore, the kidney status of the patient may have a significant effect on meropenem clearance (CL). MATERIALS AND METHODS: The data of 205 samples obtained from 59 patients treated with meropenem at the General Hospital Lahore, Pakistan, was used for the development of a population pharmacokinetic (-popPK) model by using nonlinear mixed-effects modeling software. The effect of age, body weight, creatinine clearance (CRCL), and gender was observed on meropenem CL through a stepwise covariate modeling approach. Simulations of 1,000 mg q8h and 1,500 mg q12h over 3-hour infusion were performed based on the renal status of the patients. RESULTS: A two-compartment model was used for popPK analysis, and the values of the pharmacokinetic parameters for CL, V1, V2, and Q were 12.2 L/h, 21.7 L, 7.74 L, and 3.28 L/h, respectively. Meropenem CL was significantly influenced by CRCL, while no significant effect of body weight, age, and sex was observed. Both simulated dosage regimens were equally effective if CRCL of the patient was ≤ 100 mL/min, while 1,000 mg q8h produced better results if CRCL was > 100 mL/min. CONCLUSION: The CL of meropenem depends on the renal status of the patients. The model can be used for dosing simulations based on the CRCL of the patients in order to tailor the dose of meropenem in Pakistani patients.

Population pharmacokinetics of ciprofloxacin in Pakistani patients suffering from enteric fever.

BACKGROUND: Ciprofloxacin, a potent carboxy-fluoroquinolone is proved to be effective against some resistant strains of Gram-negative bacteria. Being a hydrophilic drug, it is primarily excreted through the kidney; almost 66% of the clearance from the body occurs through glomerular filtration. Therefore, renal status of the patient can have a significant effect on ciprofloxacin clearance. MATERIALS AND METHODS: A total of 158 samples were collected from 32 patients treated with ciprofloxacin in the Surgical Unit-I of Lahore General Hospital, Pakistan. The data was used for the development of a population pharmacokinetic model by using non-linear mixed-effect modeling (NONMEM) software. The influence of different covariates (age, sex, body weight, serum creatinine (SeCR), and creatinine clearance (CRCL)) was observed on ciprofloxacin clearance (CL) and volume of distribution (Vd) by stepwise covariate modeling (SCM). RESULTS: A one-compartment model was used for ciprofloxacin population pharma-cokinetik (popPK) analysis, and the values for ciprofloxacin CL and Vd in the final model were estimated at 19.8 L/h and 74.9 L, respectively. Among all the tested covariates, only CRCL was proven to have significant influence on ciprofloxacin CL. CONCLUSION: A strong relationship was found between the ciprofloxacin CL and renal status of the patients. The model can be used for dose tailoring in patients based on their CRCL values before the start of therapy with ciprofloxacin among Pakistani patients.

Association of age and symptoms with frequency of Premature Ventricular Contractions on 24 hours Holter monitoring.

OBJECTIVES: This study was done with the objective to identify the determinants of mild, moderate and frequent burdens of premature ventricular contractions (PVCs) which may guide the health care professionals to stratify the high risk patients on basis of their symptoms. METHODS: It was a cross sectional descriptive study conducted in Islamic International Medical College (IIMC) in collaboration with Armed Forces Institute of Cardiology (AFIC) from 18th April 2016 to 20th March 2018. It comprised 60 diagnosed patients of PVCs, divided into three groups on the basis of their PVCs burden determined by Holter monitoring report. Each group of mild (Group-A), moderate (Group-B) and frequent burden (Group-C) constituted 20 patients having PVC burden<10%, 10-20% and >20% respectively. All patients were evaluated for their symptoms by a cardiologist. Statistical analysis was done to determine the association of patient's symptom and age with mild, moderate and frequent PVCs burden. RESULTS: PVCs were significantly associated with presence of symptoms as compared to asymptomatic patients. While no significant correlation of age or any specific symptom (palpitations, chest pain, dizziness, shortness of breath) was found with mild, moderate and frequent PVCs burden with p-value of 0.466. CONCLUSIONS: Mild, moderate or frequent PVCs burden are not associated with any specific symptom predominantly or old age. So, it is equally important for all the patients presenting with any symptom of palpitations, chest pain, dizziness or shortness of breath to undergo the work up of PVCs, irrespective of their age.

Genotoxic and cytotoxic assessment of sitagliptin and simvastatin alone and in combination.

Type 2 Diabetes Mellitus (T2DM) patients are at high risk of Coronary Heart Disease (CHD) and need a global therapeutic intervention. A fixed-dose combination prescription medication containing anti-diabetic drug (Sitagliptin) and lipid lowering (Simvastatin) has recently been approved. Present study was designed to explore the potential synergistic toxic effects of sitagliptin and simvastatin at cellular level. MTT assay revealed the potential synergistic cytotoxic effect whereas Comet assay spotlighted the genotoxicity. MTT assay conducted on Vero cell lines revealed no significant change in proliferative activity upon treatment with simvastatin but cell survival percentage (CSP) decreased upon treatment with sitagliptin (51% at 1000µg/mL). However, combination of both drugs exhibited a better survival percentage except highest dose combination (1000:500µg/mL) which augmented antiproliferative effects rendering CSP 71.6%. The genotoxic assay spotted that Simvastatin produced less damage to DNA with the threshold of 500µg/ml whereas Sitagliptin significantly damage above the 250µg/mL, However, combination of drugs produced lesser damage than Sitagliptin alone. The findings concluded a non-genotoxic combination of sitagliptin and simvastatin which possess a least cytotoxic potential suggesting the safe use of the combination both in T2DM and CHD.

Exploration of constructs of professionalism identified in the ABIM framework as perceived by the faculty fitting the Pakistani context.

OBJECTIVE: Domains of professionalism are well-described in the literature. Examining the elements of Professionalism in the local context have received less attention from education experts. The aim of the study was to explore the construct of professionalism as perceived by the faculty that fitted the Pakistani context identified in the ABIM framework of professionalism. METHODS: This qualitative ethnographic research was conducted involving nine participants from Islamic International Medical College in Riphah University Islamabad. A four hours Focus Group Discussion was undertaken to explore the views of the faculty. The focus group session was audiotaped, transcribed and technique of triangulation was employed. Shortened meaningful unit (SMU) were identified from the transcribed data and analyzed to make codes for themes for the behaviors. Forty-six meaningful units were categorized and codes were identified. The themes were identified under the domains of the ABIM frameworks for the Pakistani context. RESULTS: The participants listed 2-8 elements for each domain of the framework describing the professional conduct which lead to 140 shortened meaningful units. These were organized into 46 higher order codes. CONCLUSIONS: The study concludes that that ABIM framework can be used to build consensus regarding the domains of professionalism. No difference was found cross contextually regarding the domains of ABIM framework of professionalism.

Berberis lycium Royle. extracts attenuate inflammation and modulates hyperglycemia in alloxan induced diabetic rats.

Berberis lycium Royle (Berberidaceae) is traditionally used for the treatment of diabetes mellitus. Present study was conducted to determine the antioxidant, antidiabetic and anti-inflammatory effects of aqueous and methanolic whole plant extracts. Total phenolic contents were determined by Folin-ciocalteu method whereas antioxidant activity was determined by 2,2-diphenyl-1-picryl hydrazyl (DPPH) method. In vitro anti-diabetic activity was determined using alpha amylase assay. Acute hypoglycemic activity was investigated on normoglycemic rats. Sub-acute anti-diabetic effects were investigated in alloxan induced diabetic rats for 14 days. Methanolic extract exhibited 183.5±1 mg/g Gallic acid equivalent (GAE) phenolic contents. The methanolic extract exhibited an IC50 of 242µg/mL and 37.26 mg/mL in antioxidant and alpha amylase inhibitory assays respectively. Administration of methanolic extract in normoglycemic rats exhibited significant anti-hyperglycemic effect at 90 and 120 min. Methanolic extract (500 mg/kg extract) significantly reduced blood glucose at day 14. Methanolic extract (500 mg/kg) significantly reduced the concentration of tumor necrosis factor (TNF-α) and interleukin (IL-6) along with reduction in total cholesterol and triglyceride levels in diabetic rats. Administration of methanol extract also improved the hepatic markers. The study suggested that the methanolic extract possessed antidiabetic effect that might be attributed to its alpha amylase, antioxidant and anti-inflammatory potential.

Anti myelosuppressant and hematopoietic activities of ethanolic fraction obtained from seeds of Carica papaya L.

Bone marrow suppression is one of the serious consequences of treatment with cytotoxic chemotherapeutic agents such as doxorubicin (DOX). It is very difficult to treat bone marrow suppression caused by anti-cancer drugs. This study was aimed to evaluate hematological effects particularly the antimyelosuppressant effects of ethanolic extract of papaya seeds at 200, 400 and 600 mg/kg daily dose for three weeks in doxorubicin induced hematopoietic suppression in rat model. Hematological parameters were assessed on weekly basis on days 0, 1, 7, 14 and 21. The alcoholic extract was found to cause remission of induced myelosuppression as indicated by a dose dependent increase in WBCs, neutrophils, lymphocytes, platelets, RBCs, Hb, hematocrit & mean corpuscular volume. However, the maximum dose (600mg/kg) of the extract showed maximum activity (p<0.05) in normalizing hematological parameters when compared with group B (induced group) and group A (controlled animals). These effects were compareable with those produced by Filgrastim 5µgm/kg used as standard or reference drug during these experiments. It is concluded from the results that papaya seeds possess myelostimulant activity and can be used to treat myelosuppression caused by chemotherapy. The drug can also be used for curing anemia, thrombocytopenia and immunological disorders characterized by myelosuppression.

Antiviral, embryo toxic and cytotoxic activities of Astragalus membranaceus root extracts.

Antiviral activity of Astragalus membranaceus aqueous and methanol root extracts was determined against Avian influenza H9 virus. Toxicity profile of extracts was evaluated using chicken embryos and BHK-21 cell line. Different concentrations (400, 200, 100, 50, 25. 12.5, 6.25 and 3.12µg/mL) of both aqueous and methanol extracts were mixed with standard virus inoculum (4HAunits) and incubated for 30minutes at 37°C prior to inject the chicken embryos. Chorioallantoic fluid harvested 72 hours post inoculation and evaluated for virus growth using hemagglutination assay. Same concentrations of both extracts without virus were injected in chicken embryos to evaluate embryo toxic activity as well. The cytotoxic activity of aqueous and methanol extracts was determined by MTT colorimetric assay using BHK-21 cells. Three concentrations (400, 200 and 100µg/mL) of aqueous and five concentrations (400, 200, 100, 50 and 25µg/mL) of methanol extract showed antiviral activity. None of the tested concentrations of aqueous and methanol A. membranaceus root extracts caused chicken embryo mortality. Cell survival percentage of aqueous extract was higher than 50 at all of the tested concentrations except 400µg/mL. Two concentrations (400 and 200µg/mL) of methanol extract showed cytotoxicity. It was concluded that aqueous and methanol roots extracts of A. membranaceus have antiviral activity and concentrations which were safe may be used for treatment of Avian influenza H9 virus infections.

Metabolomics and marker-based stability studies of methanol extract of seeds of Syzygium cumini L.

Though, herbal medicines are prone to deterioration upon storage due to their complex nature, but less attention has been paid to investigating stability of such products to assign shelf-life. Therefore, the present study aimed to assess the accelerated stability of methanolic extract of seeds of Syzygium cumini. The extract was kept at three different storage conditions (30oC/60% RH, 40oC/75% RH and 60oC/85% RH) for a period of 6 months. The samples withdrawn at 0 (before starting the study), 1, 2, 3, 4 and 6 months were analyzed to get UV-Visible metabolomics fingerprints and determine caffeic acid contents using RP-HPLC. The comparison of metabolomics fingerprints indicated that the extract was stable for 1 month at all the three storage conditions. However, caffeic acid contents were found to be intact for a longer period of time. Following the zero order degradation, caffeic acid was predicted to be stable for more than 3 years, if kept at 25oC. The results of the present study indicate that metabolomes of methanol extract of seeds of Syzygium cumini change very fast, suggesting the development of stable formulations.

Glutathione sulfotransferase inhibition activity of a self-fermented beverage, Kanji.

CONTEXT: Kanji, a liquid preparation of roots of Daucus carota L. ssp. sativus (Hoffm.) Arcang. var. vavilovii Mazk. (Apiaceae), may inhibit glutathione sulfotransferase (GST) activity due to ferulic acid content. OBJECTIVES: GST inhibition activity and characterization of Kanji and methanol extract of D. carota roots, and oral absorption pattern of ferulic acid from Kanji in rats. MATERIALS AND METHODS: GST inhibition activity of Kanji and methanol extract of D. carota roots in concentration range 0.001-100.00 mg/mL was determined using Sprague Dawley rat liver cytosolic fraction. Methanol extract upon column chromatography gave ferulic acid, which was used to characterize Kanji and determine its oral absorption pattern in Wistar rats. RESULTS: The GST inhibition activity of Kanji (100.00 µg/mL), methanol extract of D. carota roots (100.00 µg/mL) and tannic acid (10.00 µg/mL, positive control) was found to be 0.162 ± 0.016, 0.106 ± 0.013 and 0.073 ± 0.004 µM/min/mg, respectively. Different Kanji samples and methanol extract contained ferulic acid (0.222-0.316 mg/g) and 0.77 mg/g, respectively. Ferulic acid did not appear in plasma after oral administration of Kanji. DISCUSSION: Kanji having solid contents 80.0 µg/mL, equivalent to 0.0025 µg/mL ferulic acid, does not inhibit the activity of GST. The oral administration of Kanji, in human equivalent dose (528 mg/kg, 16.67 µg ferulic acid), to rats indicated poor absorption of ferulic acid. CONCLUSION: Kanji having solid contents 14-36 mg/mL does not inhibit GST activity, hence may not interfere with drugs that are the substrates of GST, if taken concomitantly.

Stability comparison of two dermal emulsions containing Hippophae Rhamnoides L. oil.

Two formulations of multiple emulsion (ME-1 & ME-2) containing Hipophae rhamnoides L. oil were prepared. Along with emulsifiers (Abil EM 90, Synperonic F127), Magnesium and Zinc were used as stabilizer in ME-1 and ME-2 respectively. Both formulations were prepared using Two-Step Method and after preparation ME-1 and ME-2 were stored at different storage conditions i.e., 4°C, 25°C, 40°C, 40°C+ 75% RH for four weeks for stability evaluation. At 4°C ME-1 and ME-2 showed phase inversion and were excluded from further stability evaluation. While ME-1 and ME-2 both were stable at 25°C for a period of four weeks as no color change, phase separation and liquefaction occurred. ME-1 and ME-2 at 40°C, 40°C+ 75% RH exhibited change in color, liquefaction and phase separation. The decrease in viscosity and globule size whereas increase in electrical conductivity and pH were observed at 40°C, 40°C+ 75% RH for a period of four weeks. Multiple emulsion from Hippophae rhamnoide L. oil are unstable at refrigeration and high temperature conditions. These formulations must be placed at room temperature to increase their shelf life.

Impact of Combined modular assessment on deep learning and personal development of medical students.

OBJECTIVE: To determine the effect of transition of summative assessment from frequent modular to combined block assessment and its role on learning of medical students. METHODS: A descriptive study was carried out at Islamic International Medical College. A questionnaire comprizing of 8 questions with Likert scale (1-5) was designed for 3(rd) year students. The questions were grouped in three categories which included learning acquired, personal development and efficacy of assessment tools used in combined block assessment and frequent modular exam separately. Results of end of year exams were analyzed for difference in performance of students in two exams. The received data was analyzed by using SPPS 21. RESULTS: About 60% students agreed that they need to study regularly in frequent modular exams. Combined block assessment promoted more indepth studies and multiple revisions 51% and 55% students respectively. About 42% students, in comparison with 33%, agreed that CBA helped in their personal development while 42% students agreed to assessment tools used in CBA while only 28% students to those used in frequent modular exam. About 47% students agreed that assessment tools in CBA were useful for deep learning and 47% students agreed that time given in CBA was enough in exam preparation. Comparison of all results (x 2 tests) was statistically significant. The comparison of end of year performance showed improvement in the mean of total marks obtained and decrease in the number of failed students in combined block assessment. CONCLUSION: Transition from frequent to combined block assessment with regular formative assessment has positive effect on learning, personal grooming and performance in summative assessment.