Chitosan nanoparticles loaded with Foeniculum vulgare extract regulate retrieval of sensory and motor functions in mice

In this study, chitosan nanoparticles (CSNPs) encapsulating Foeniculum vulgare (FV) seed extract (SE) were prepared for the controlled delivery of bioactive phytoconstituents. The prepared CSNPs encapsulating FVSE as sustain-releasing nanoconjugate (CSNPs-FVSE) was used as a potent source of functional metabolites including kaempferol and quercetin for accelerated reclamation of sensory and motor functions following peripheral nerve injury (PNI). The nanoconjugate exhibited in vitro a biphasic diffusion-controlled sustained release of quercetin and kaempferol ensuring prolonged therapeutic effects. The CSNPs-FVSE was administered through gavaging to albino mice daily at a dose rate of 25 mg/kg body weight from the day of induced PNI till the end of the experiment. The conjugate-treatment induced a significant acceleration in the regain of motor functioning, evaluated from the sciatic function index (SFI) and muscle grip strength studies. Further, the hotplate test confirmed a significantly faster recuperation of sensory functions in conjugate-treated group compared to control. An array of underlying biochemical pathways regulates the regeneration under well-optimized glucose and oxidant levels. Therefore, oxidant status (TOS), blood glycemic level and total antioxidant capacity (TAC) were evaluated in the conjugate-treated group and compared with the controls. The treated subjects exhibited controlled oxidative stress and regulated blood sugars compared to the non-treated control. Thus, the nanoconjugate enriched with polyphenolics significantly accelerated the regeneration and recovery of functions after nerve lesions. The biocompatible nanocarriers encapsulating the nontoxic natural bioactive constitutents have great medicinal and economic value.

Online Teaching of Final-Year Medical Students during COVID-19 Pandemic: Merits and Challenges

OBJECTIVE

To explore the fresh medical graduates' perspectives regarding online teaching of clinical subjects in the final year MBBS program during the COVID-19 pandemic.

STUDY DESIGN

Qualitative research with exploratory study design. Place and Duration of the Study: Punjab Medical College (PMC), Faisalabad Medical University (FMU), Faisalabad, from January to June 2022.

METHODOLOGY

Semi-structured, open-ended, in-depth interviews were used to collect data from fresh medical graduates of PMC, FMU, who had experienced online teaching from March 2020 to May 2021, during their final year of undergraduate medical degree. Fourteen graduates, selected on the basis of non-probability purposive sampling, were interviewed. The interviews were audio recorded and transcribed verbatim. An iterative process was employed in data collection and analysis. Thematic analysis was used to interpret data. Manual coding was done inductively and the codes were synthesised into categories and themes with consensus.

RESULTS

Four themes emerged including advantages, disadvantages, challenges, and suggestions for improvement. Comfort, efficient learning, self-directed learning, and flexibility were the categories of advantages. The disadvantages theme had three categories including deficient clinical skills, demotivation, and unprofessional behaviour. Infrastructure limitations, distractions, and digital illiteracy came up as the main challenges. The students suggested the use of a hybrid model and simulated patients for improvement of the online teaching experience.

CONCLUSION

Fresh medical graduates consider online teaching a convenient and efficient method of learning theoretical concepts in clinical subjects, during their final year. However, the lack of contact with patients results in deficient clinical skills in their opinion.

KEY WORDS

Coronavirus infection, Medical students, Undergraduate medical education, Teaching, Distance learning.

Prehabilitation for frail patients undergoing total hip or knee replacement: protocol for the Joint PREP feasibility randomised controlled trial

BACKGROUND

Approximately, 8% of community-based adults aged ≥ 50 years in England are frail. Frailty has been found to be associated with poorer outcomes after joint replacement. Targeting frailty preoperatively via exercise and protein supplementation has the potential to improve outcomes for people undergoing joint replacement. Prior to proceeding with a randomised controlled trial (RCT), a feasibility study is necessary to address key uncertainties and explore how to optimise trial design and delivery.

METHODS

The Joint PRehabilitation with Exercise and Protein (Joint PREP) study is a feasibility study for a multicentre, two-arm, parallel group, pragmatic, RCT to evaluate the clinical and cost-effectiveness of prehabilitation for frail patients undergoing total hip or knee replacement. Sixty people who are ≥ 65 years of age, frail according to the self-reported Groningen Frailty Indicator, and scheduled to undergo total hip or knee replacement at 2-3 hospitals in England and Wales will be recruited and randomly allocated on a 1:1 ratio to the intervention or usual care group. The usual care group will receive the standard care at their hospital. The intervention group will be given a daily protein supplement and will be asked to follow a home-based, tailored daily exercise programme for 12 weeks before their operation, in addition to usual care. Participants will be supported through six follow-up calls from a physiotherapist during the 12-week intervention period. Study questionnaires will be administered at baseline and 12 weeks after randomisation. Embedded qualitative research with patients will explore their experiences of participating, reasons for nonparticipation, and/or reasons for withdrawal or treatment discontinuation. Primary feasibility outcomes will be eligibility and recruitment rates, adherence to the intervention, and acceptability of the trial and the intervention.

DISCUSSION

This study will generate important data regarding the feasibility of a RCT to evaluate a prehabilitation intervention for frail patients undergoing total hip and knee replacement. A future phase-3 RCT will determine if preoperative exercise and protein supplementation improve the recovery of frail patients after primary joint replacement.

TRIAL REGISTRATION

ISRCTN11121506, registered 29 September 2022.

Causal attributions of failure among post graduate medical residents in exit fellowship examination in Pakistan: A qualitative study

Background and Objective

Causal attributions are reasons given to certain events in life including failure and success. The objective of this qualitative study was to explore the attributions perceived as the cause of failure by post graduate residents, failing the final clinical exit examination of Fellowship of College of Physicians and Surgeons Pakistan (FCPS).

Methods

This exploratory study was conducted from July 2021 to July 2022, at Jinnah Hospital, Lahore. Study population was selected by purposeful maximal variation sampling. A total of ten post graduate residents from four specialties, failing in FCPS part two clinical examination were included. After written informed consent, semi structured face to face, in depth interviews were conducted. Data saturation was achieved after eight interviews after which two more interviews were carried out. All interviews were recorded and transcribed verbatim. Thematic analysis of the data was done by synthesizing codes into categories and themes.

Results

A total of 17 attributions noted were grouped into five categories namely 'Inadequate exam preparation', 'Personal factors,' 'Exam related factors,' 'Training related factors and 'Luck'. Two main themes of External and Internal factors emerged from these. Common attributions were; lack of effort (8/10), inadequate knowledge (8/10), family commitments (7/10), luck (8/10) and examiner's attitude (5/10).

Conclusions

Most of the residents attributed internal, unstable and controllable factors like inadequate knowledge and lack of effort. In addition, external uncontrollable factors of bad luck and harsh attitude of examiners were considered as contributory factors towards failure.

Nanosuspension of Foeniculum Vulgare Promotes Accelerated Sensory and Motor Function Recovery after Sciatic Nerve Injury

The seed extract of Foeniculum vulgare (FV) was used for the preparation of a nanosuspension (NS) with an enhanced bioavailability of phytoconstituents. Subsequently, it was employed as a potent source of polyphenols, such as quercetin and kaempferol, to accelerate the regeneration and recovery of motor and sensory function in injured nerves. The NS was administered through daily gauging as NS1 (0.5 mg/mL) and NS2 (15 mg/mL), at a dose rate of 2 g/kg body weight until the end of the study. The NS-mediated retrieval of motor functions was studied by evaluating muscle grip strength and the sciatic functional index. The recovery of sensory functions was assessed by the hotplate test. Several well-integrated biochemical pathways mediate the recovery of function and the regeneration of nerves under controlled blood glucose and oxidative stress. Consequently, the NS-treated groups were screened for blood glucose, total antioxidant capacity (TAC), and total oxidant status (TOS) compared to the control. The NS administration showed a significant potential to enhance the recuperation of motor and sensory functions. Moreover, the oxidative stress was kept under check as a result of NS treatments to facilitate neuronal generation. Thus, the nanoformulation of FV with polyphenolic contents accelerated the reclamation of motor and sensory function after nerve lesion.

Development of Sustainable Hydrophilic Azadirachta indica Loaded PVA Nanomembranes for Cosmetic Facemask Applications

Nanofiber-based facial masks have attracted the attention of modern cosmetic applications due to their controlled drug release, biocompatibility, and better efficiency. In this work, Azadirachta indica extract (AI) incorporated electrospun polyvinyl alcohol (PVA) nanofiber membrane was prepared to obtain a sustainable and hydrophilic facial mask. The electrospun AI incorporated PVA nanofiber membranes were characterized by scanning electron microscope, Ultraviolet-visible spectroscopy (UV-Vis) drug release, water absorption analysis, 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging, and antibacterial activity (qualitative and quantitative) at different PVA and AI concentrations. The optimized nanofiber of 376 ± 75 nm diameter was obtained at 8 wt/wt% PVA concentration and 100% AI extract. The AI nanoparticles of size range 50~250 nm in the extract were examined through a zeta sizer. The water absorption rate of ~660% and 17.24° water contact angle shows good hydrophilic nature and water absorbency of the nanofiber membrane. The UV-Vis also analyzed fast drug release of >70% in 5 min. The prepared membrane also exhibits 99.9% antibacterial activity against Staphylococcus aureus and has 79% antioxidant activity. Moreover, the membrane also had good mechanical properties (tensile strength 1.67 N, elongation 48%) and breathability (air permeability 15.24 mm/s). AI-incorporated nanofiber membrane can effectively be used for facial mask application.

Should homes and workplaces purchase portable air filters to reduce the transmission of SARS-CoV-2 and other respiratory infections? A systematic review

Respiratory infections, including SARS-CoV-2, are spread via inhalation or ingestion of airborne pathogens. Airborne transmission is difficult to control, particularly indoors. Manufacturers of high efficiency particulate air (HEPA) filters claim they remove almost all small particles including airborne bacteria and viruses. This study investigates whether modern portable, commercially available air filters reduce the incidence of respiratory infections and/or remove bacteria and viruses from indoor air. We systematically searched Medline, Embase and Cochrane for studies published between January 2000 and September 2020. Studies were eligible for inclusion if they included a portable, commercially available air filter in any indoor setting including care homes, schools or healthcare settings, investigating either associations with incidence of respiratory infections or removal and/or capture of aerosolised bacteria and viruses from the air within the filters. Dual data screening and extraction with narrative synthesis. No studies were found investigating the effects of air filters on the incidence of respiratory infections. Two studies investigated bacterial capture within filters and bacterial load in indoor air. One reported higher numbers of viable bacteria in the HEPA filter than in floor dust samples. The other reported HEPA filtration combined with ultraviolet light reduced bacterial load in the air by 41% (sampling time not reported). Neither paper investigated effects on viruses. There is an important absence of evidence regarding the effectiveness of a potentially cost-efficient intervention for indoor transmission of respiratory infections, including SARS-CoV-2. Two studies provide ‘proof of principle’ that air filters can capture airborne bacteria in an indoor setting. Randomised controlled trials are urgently needed to investigate effects of portable HEPA filters on incidence of respiratory infections.

Developing an Assessment-of-Clinical-Exodontia-Skills (ACES) Rating Scale for Undergraduate Dental Students

OBJECTIVE

To develop assessment-of-clinical-exodontia-skills (ACES) rating scale for formative and summative assessment of undergraduate dental students performing exodontia.

PLACE AND DURATION OF STUDY

Faisalabad Medical University, Faisalabad, from May 2017 to February 2018.

METHODOLOGY

A preliminary scale was developed using literature search and informal discussion with experts. In the first round of Delphi, this scale was emailed to oral surgery faculty across Pakistan. Their opinions were sought and the form was modified accordingly. In the second round, the modified form was emailed again to the respondents of first round and thus the form was finalized by obtaining their comments on the modified form.

RESULTS

A preliminary 27-point round-1 questionnaire was sent to 42 experts. Out of these, 30 responded (overall response rate 71.4%) and the form was modified according to their response. Frequency, percentage, and mean of Likertbased responses was calculated along with thematic analysis of individual responses. In round 2, the modified form was sent to the 30 respondents of round 1. Out of these, 21 replied (response rate 70%) and form was further modified accordingly. In round 2, primary focus was on marking/scoring strategy.

CONCLUSION

ACES form was developed, which can be important tool in assessing exodontia skills of undergraduate dental students. This needs practical application and testing for validity.

Association between occlusal force distribution in implant overdenture prostheses and residual ridge resorption

This study aimed to investigate residual ridge resorption (RRR) of anterior and posterior maxillary and mandibular edentulous ridges, in patients treated with mandibular implant overdentures (IOD) and compare with conventional complete denture (CD) wearers, and to determine at each location, the association of RRR with the occlusal forces distribution and other patients' variables. The anterior and posterior RRR of IOD (six males, 17 females) and CD (12 males, 11 females) groups were determined using baseline and follow-up dental panaromic radiographs (DPT) (mean intervals 4 ± 1·8 years). The bone ratios were calculated using proportional area: anatomic to fixed reference areas and mean difference of ratios between the intervals determined RRR. The ridge locations included anterior and posterior maxillary and posterior mandibular arches. The T-Scan III digital occlusal system was used to record anterior and posterior percentage occlusal force (%OF) distributions. There were significant differences in anterior and posterior %OF between treatment groups. Two-way anova showed RRR was significant for arch locations (P = 0·005), treatment group (IOD versus CD) (P = 0·001), however, no significant interaction (P = 0·799). Multivariate regression analyses showed significant association between RRR and %OF at anterior maxilla (P = 0·000) and posterior mandible (P = 0·023) and for treatment groups at posterior maxilla (P = 0·033) and mandibular areas (P = 0·021). Resorption was observed in IOD compared to CD groups, with 8·5% chance of less resorption in former and 7·8% in the latter location. Depending on arch location, ridge resorption at various locations was associated with occlusal force distribution and/or treatment groups (implant prostheses or conventional complete dentures).

Freeze-drying: an alternative method for the analysis of volatile organic compounds in the headspace of urine samples using solid phase micro-extraction coupled to gas chromatography - mass spectrometry

BACKGROUND

Volatile organic compounds (VOCs) can be intermediates of metabolic pathways and their levels in biological samples may provide a better understanding about diseases in addition to potential methods for diagnosis. Headspace analysis of VOCs in urine samples using solid phase micro extraction (SPME) coupled to gas chromatography - mass spectrometry (GC-MS) is one of the most used techniques. However, it generally produces a limited profile of VOCs if applied to fresh urine. Sample preparation methods, such as addition of salt, base or acid, have been developed to improve the headspace-SPME-GC-MS analysis of VOCs in urine samples. These methods result in a richer profile of VOCs, however, they may also add potential contaminants to the urine samples, result in increased variability introduced by manually processing the samples and promote degradation of metabolites due to extreme pH levels. Here, we evaluated if freeze-drying can be considered an alternative sample preparation method for headspace-SPME-GC-MS analysis of urine samples.

RESULTS

We collected urine from three volunteers and compared the performances of freeze-drying, addition of acid (HCl), addition of base (NaOH), addition of salt (NaCl), fresh urine and frozen urine when identifying and quantifying metabolites in 4 ml samples. Freeze-drying and addition of acid produced a significantly higher number of VOCs identified than any other method, with freeze-drying covering a slightly higher number of chemical classes, showing an improved repeatability and reducing siloxane impurities.

CONCLUSION

In this work we compared the performance of sample preparation methods for the SPME-GC-MS analysis of urine samples. To the best of our knowledge, this is the first study evaluating the potential of freeze-dry as an alternative sample preparation method. Our results indicate that freeze-drying has potential to be used as an alternative method for the SPME-GC-MS analysis of urine samples. Additional studies using internal standard, synthetic urine and calibration curves will allow a more precise quantification of metabolites and additional comparisons between methods.Graphical abstractEnhancing VOC profiling from urine samples.

The use of a gas chromatography-sensor system combined with advanced statistical methods, towards the diagnosis of urological malignancies

Prostate cancer is one of the most common cancers. Serum prostate-specific antigen (PSA) is used to aid the selection of men undergoing biopsies. Its use remains controversial. We propose a GC-sensor algorithm system for classifying urine samples from patients with urological symptoms. This pilot study includes 155 men presenting to urology clinics, 58 were diagnosed with prostate cancer, 24 with bladder cancer and 73 with haematuria and or poor stream, without cancer. Principal component analysis (PCA) was applied to assess the discrimination achieved, while linear discriminant analysis (LDA) and support vector machine (SVM) were used as statistical models for sample classification. Leave-one-out cross-validation (LOOCV), repeated 10-fold cross-validation (10FoldCV), repeated double cross-validation (DoubleCV) and Monte Carlo permutations were applied to assess performance. Significant separation was found between prostate cancer and control samples, bladder cancer and controls and between bladder and prostate cancer samples. For prostate cancer diagnosis, the GC/SVM system classified samples with 95% sensitivity and 96% specificity after LOOCV. For bladder cancer diagnosis, the SVM reported 96% sensitivity and 100% specificity after LOOCV, while the DoubleCV reported 87% sensitivity and 99% specificity, with SVM showing 78% and 98% sensitivity between prostate and bladder cancer samples. Evaluation of the results of the Monte Carlo permutation of class labels obtained chance-like accuracy values around 50% suggesting the observed results for bladder cancer and prostate cancer detection are not due to over fitting. The results of the pilot study presented here indicate that the GC system is able to successfully identify patterns that allow classification of urine samples from patients with urological cancers. An accurate diagnosis based on urine samples would reduce the number of negative prostate biopsies performed, and the frequency of surveillance cystoscopy for bladder cancer patients. Larger cohort studies are planned to investigate the potential of this system. Future work may lead to non-invasive breath analyses for diagnosing urological conditions.

Knowledge, perceptions, and attitudes of dental students towards obesity

Aims

Obesity is a chronic medical condition associated with various oral health problems. The aim of this study was to assess the knowledge, perceptions, and attitudes of dental students towards obesity.

Material and methods

Second-, third-, and fourth-year dental students completed a self-administered questionnaire. An ethics committee approved the study. Participants were asked questions focused on three areas: (i) knowledge, (ii) perceptions, and (iii) attitudes about obesity. Data analyses were carried out using SPSS version 20.

Results

Among the dental students, 78.9% received 0–1 h of formal education about obesity. The mean score of the total time allocated for obesity-related education was 1.31 ± 0.23 h. Eighty-nine percent of the dental students agreed that obesity is a chronic medical condition, 30% agreed that they would modify their equipment and office furniture to accommodate obese patients, and 46.8% were interested in learning more about obesity in dental school.

Conclusion

Obesity-related education should be implemented as a formal component of dental student training. Oral health practitioners should also provide their patients with information about how weight loss is beneficial to both general and oral health.

Urinary Volatile Organic Compounds for the Detection of Prostate Cancer

The aim of this work was to investigate volatile organic compounds (VOCs) emanating from urine samples to determine whether they can be used to classify samples into those from prostate cancer and non-cancer groups. Participants were men referred for a trans-rectal ultrasound-guided prostate biopsy because of an elevated prostate specific antigen (PSA) level or abnormal findings on digital rectal examination. Urine samples were collected from patients with prostate cancer (n = 59) and cancer-free controls (n = 43), on the day of their biopsy, prior to their procedure. VOCs from the headspace of basified urine samples were extracted using solid-phase micro-extraction and analysed by gas chromatography/mass spectrometry. Classifiers were developed using Random Forest (RF) and Linear Discriminant Analysis (LDA) classification techniques. PSA alone had an accuracy of 62–64% in these samples. A model based on 4 VOCs, 2,6-dimethyl-7-octen-2-ol, pentanal, 3-octanone, and 2-octanone, was marginally more accurate 63–65%. When combined, PSA level and these four VOCs had mean accuracies of 74% and 65%, using RF and LDA, respectively. With repeated double cross-validation, the mean accuracies fell to 71% and 65%, using RF and LDA, respectively. Results from VOC profiling of urine headspace are encouraging and suggest that there are other metabolomic avenues worth exploring which could help improve the stratification of men at risk of prostate cancer. This study also adds to our knowledge on the profile of compounds found in basified urine, from controls and cancer patients, which is useful information for future studies comparing the urine from patients with other disease states.

Stress in medical undergraduates; its association with academic performance

Objectives: To explore the difference in level of perceived stress among medical undergraduates of various classes and its association with their academic performance.Methodology: This observational study was conducted by the faculty members at University Medical & Dental College Faisalabad, Pakistan during six months period from October 2012 to March 2013. All the regular medical undergraduate students of five academic years MBBS from 2007 to 2012 were included in the study. The stress level of the students was determined by PSS 14 and the factors leading to stress were evaluated by a predesigned questionnaire. Data was analyzed using SPSS version 19. ANOVA and chi-square tests were used to compare the level of stress among various classes and its causative factors.Results: Mean PSS was highest for final year students. Third year MBBS had significant difference in stress level both with first year (p=0.042) and final year MBBS (p=0.004). High achievers were less stressed as compared to low achievers (p=0.006). Consecutive boring lectures, lack of time for recreation, gap between students and teacher followed by difficulty selecting the reading material turned out to be the major stressors.Conclusion: Students of all the five academic years experience stress and the final year MBBS is the most stressed one. On the other hand low academic achievement group is more stressed as compared to high academic achievers from all the five classes. Student support programs to combat stress may be planned to improve their quality of life and their academic scores as well.Bangladesh Journal of Medical Science Vol.14(2) 2015 p.135-141

A review of the volatiles from the healthy human body

A compendium of all the volatile organic compounds (VOCs) emanating from the human body (the volatolome) is for the first time reported. 1840 VOCs have been assigned from breath (872), saliva (359), blood (154), milk (256), skin secretions (532) urine (279), and faeces (381) in apparently healthy individuals. Compounds were assigned CAS registry numbers and named according to a common convention where possible. The compounds have been grouped into tables according to their chemical class or functionality to permit easy comparison. Some clear differences are observed, for instance, a lack of esters in urine with a high number in faeces. Careful use of the database is needed. The numbers may not be a true reflection of the actual VOCs present from each bodily excretion. The lack of a compound could be due to the techniques used or reflect the intensity of effort e.g. there are few publications on VOCs from blood compared to a large number on VOCs in breath. The large number of volatiles reported from skin is partly due to the methodologies used, e.g. collecting excretions on glass beads and then heating to desorb VOCs. All compounds have been included as reported (unless there was a clear discrepancy between name and chemical structure), but there may be some mistaken assignations arising from the original publications, particularly for isomers. It is the authors' intention that this database will not only be a useful database of VOCs listed in the literature, but will stimulate further study of VOCs from healthy individuals. Establishing a list of volatiles emanating from healthy individuals and increased understanding of VOC metabolic pathways is an important step for differentiating between diseases using VOCs.

A review of the volatiles from the healthy human body

A compendium of all the volatile organic compounds (VOCs) emanating from the human body (the volatolome) is for the first time reported. 1840 VOCs have been assigned from breath (872), saliva (359), blood (154), milk (256), skin secretions (532) urine (279), and faeces (381) in apparently healthy individuals. Compounds were assigned CAS registry numbers and named according to a common convention where possible. The compounds have been grouped into tables according to their chemical class or functionality to permit easy comparison. Some clear differences are observed, for instance, a lack of esters in urine with a high number in faeces. Careful use of the database is needed. The numbers may not be a true reflection of the actual VOCs present from each bodily excretion. The lack of a compound could be due to the techniques used or reflect the intensity of effort e.g. there are few publications on VOCs from blood compared to a large number on VOCs in breath. The large number of volatiles reported from skin is partly due to the methodologies used, e.g. collecting excretions on glass beads and then heating to desorb VOCs. All compounds have been included as reported (unless there was a clear discrepancy between name and chemical structure), but there may be some mistaken assignations arising from the original publications, particularly for isomers. It is the authors' intention that this database will not only be a useful database of VOCs listed in the literature, but will stimulate further study of VOCs from healthy individuals. Establishing a list of volatiles emanating from healthy individuals and increased understanding of VOC metabolic pathways is an important step for differentiating between diseases using VOCs.

Effects of exercise training on postmenopausal hypertension: implications on nitric oxide levels

BACKGROUND

Postmenopausal hypertension is one of the leading causes of morbidity and mortality in women. Exercise training has been proved to decrease its risk factors and cardiovascular events. Aerobic exercise training stimulates endothelial nitric oxide release that acts as an antithrombotic and is cardiovascular protective. The effect of aerobic exercise training on postmenopausal hypertension is not fully elucidated.

THE PURPOSE OF THE STUDY

to investigate the effects of moderate exercise training on nitric oxide levels in postmenopausal hypertension.

METHODS

A prospective, randomized, controlled trial was conducted on 30 postmenopausal women involved in this study. The participants had at least one year's history of postmenopausal hypertension. Their ages ranged (40-50) years. Their body mass index ranged (30-36 Kg/m(2)). They were divided into two equal groups (treatment and control). Nitric oxide levels and blood pressure were measured in both groups in the initial examination at the beginning of the study, and at the end of the study. The treatment group received moderate aerobic exercise training. This ranged from 60-70% of maximum heart rate by walking on a treadmill at an average speed of 4km/hour for at least 20 minutes, three sessions a week, for 8 weeks.

RESULTS

Body mass index, systolic and diastolic blood pressures were statistically significantly decreased. Nitric oxide levels were significantly increased in the treatment group. In this group the level of NO increased by 30.4% and systolic blood pressure decreased by 16.2%. Diastolic blood pressure decreased by 9.5% and body mass index decreased by 6%. In the control group the NO level increased by 8%. Systolic blood pressure decreased by 3% and diastolic blood pressure decreased by 3%.

CONCLUSION

Exercise performed at moderate intensity for two months had obvious benefits in improving NO levels and controlling the hypertension in obese postmenopausal women.

A pilot study combining a GC-sensor device with a statistical model for the identification of bladder cancer from urine headspace

There is a need to reduce the number of cystoscopies on patients with haematuria. Presently there are no reliable biomarkers to screen for bladder cancer. In this paper, we evaluate a new simple in–house fabricated, GC-sensor device in the diagnosis of bladder cancer based on volatiles. Sensor outputs from 98 urine samples were used to build and test diagnostic models. Samples were taken from 24 patients with transitional (urothelial) cell carcinoma (age 27-91 years, median 71 years) and 74 controls presenting with urological symptoms, but without a urological malignancy (age 29-86 years, median 64 years); results were analysed using two statistical approaches to assess the robustness of the methodology. A two-group linear discriminant analysis method using a total of 9 time points (which equates to 9 biomarkers) correctly assigned 24/24 (100%) of cancer cases and 70/74 (94.6%) controls. Under leave-one-out cross-validation 23/24 (95.8%) of cancer cases were correctly predicted with 69/74 (93.2%) of controls. For partial least squares discriminant analysis, the correct leave-one-out cross-validation prediction values were 95.8% (cancer cases) and 94.6% (controls). These data are an improvement on those reported by other groups studying headspace gases and also superior to current clinical techniques. This new device shows potential for the diagnosis of bladder cancer, but the data must be reproduced in a larger study.

Faculty perceptions about roles and functions of a department of medical education

OBJECTIVE

To determine faculty's perceptions and expectations from Department of Medical Education (DME).

STUDY DESIGN

Mixed methods study (sequential exploratory design).

PLACE AND DURATION OF STUDY

University Medical and Dental College (UMDC) and Punjab Medical College (PMC), Faisalabad, from March to May 2011.

METHODOLOGY

Faculty members teaching at PMC and UMDC were enrolled for semi-structured interviews with four senior faculty members (non-probability purposive sampling) in the qualitative phase to get in-depth information. After content analysis, themes were generated and a questionnaire with closed ended items was developed to validate the findings of the qualitative phase. In the quantitative phase, a cross-sectional survey was conducted using this questionnaire. It was sent to all 250 working faculty members, out of whom 149 (60%) responded. The results of this survey were analyzed by descriptive analysis using SPSS version 17. The analyses of qualitative and quantitative phases were integrated in the final interpretation phase to draw a conclusion.

RESULTS

In faculty members' opinion, functions of DME were faculty development (83%), interdepartmental collaboration (81%), research (77%), curriculum development (66%), career counselling (62%) and faculty evaluation (60%). Development of DME was considered a positive change by 119 (80%) respondents.

CONCLUSION

Majority of the faculty members working in UMDC and PMC, Faisalabad considered DME a positive change.

Volatile organic compounds as diagnostic biomarkers in gastrointestinal and liver diseases

The assessment of disease activity in various conditions may be performed using a range of different techniques. These include the use of non-invasive tests, such as acute phase inflammatory markers and simple radiological techniques, to more advanced invasive and complex modalities. Over the past two decades the analysis of volatile organic compounds (VOCs) in biological specimens has attracted a considerable amount of clinical interest. The investigation of VOCs, using a variety of analytical techniques, has shown a significant correlation between the pattern and concentration of VOCs and the occurrence of various diseases. This provides a potentially non-invasive means of diagnosis, monitoring of pathological processes and assessment of pharmacological response. It may be rapid, simple and acceptable to patients. In this paper we review the medical literature and research efforts that have been carried out over the past decades, and try to summarize the clinical implications of VOC analysis of various biological emanations including stool, breath and blood samples and their correlation with gastrointestinal and liver diseases.

Effect of potassium chloride supplementation in drinking water on broiler performance under heat stress conditions

The effect of water supplementation of KCl on performance of heat-stressed Hubbard broilers was evaluated in the present experiment. The 3 experimental treatments (i.e., control, 0.3 and 0.6% KCl) were allocated to 3 replicates of 15 birds each. The control group was kept on dugout tap water, whereas the other 2 groups were supplied water supplemented with 0.3 and 0.6% KCl (wt/vol) by supplementing 3 and 6 g of KCl, respectively, per liter of drinking water. Broilers were provided ad libitum access to feed and water for the experimental period of 7 to 42 d of age and kept in open-sided house. The birds were reared under continuous thermostress (minimum 28.2 +/- 1.02 and maximum 37.5 +/- 0.78 degrees C) environment. Supplementing drinking water with 0.6% KCl reduced panting-phase blood pH to 7.31 and significantly increased live BW gain by 14.5 (P = 0.036) and 7.9% (P = 0.029) at 28 and 42 d of age, respectively, relative to control. An improved (P = 0.04) feed:gain and lowered body temperature were noted in groups supplemented with 0.6% KCl as compared with control and 0.3% KCl. Enhanced physiological adaptation with 0.6% KCl was evidenced by a more favorable pH during the panting phase in the present study. These findings demonstrated a possibility of better broiler live performance through KCl supplementation under conditions of severe heat stress (35 to 38 degrees C).

Comparative study of district and community hospitals

Opinions conflict on whether there is a place in the Health Service for general practitioner (community) hospitals in which the patients' treatment is mainly the responsibility of their family doctors. The authors therefore analysed a sample of the patients admitted in the course of a year to a group of two general district hospitals with a comparable sample of the patients admitted to a general practitioner hospital. The aim was to analyse the type of care provided in the general practitioner hospital, to assess whether it was appropriate for the type of cases treated, and to decide whether the patients would have been better off in the district general hospital (and vice versa). The main conclusions are that a district hospital is best for serious illnesses needing skilled decisions and assessments but that most of the work of these hospitals is not of this kind and a community hospital staffed by general practitioners offers many advantages to patients-provided the work being done is constantly under critical assessment. The authors plead for special refresher courses under the N.H.S. for general practitioners working in community hospitals.