Peer Assisted Learning; The Perspective of Peer Tutors

Objective: To determine the perspective of PAL tutors regarding the effectiveness of PAL in promoting knowledge and skills among the undergraduate students using small group discussions in an integrated module. Methodology:  A prospective qualitative method study was conducted at Rawal Dental College, Islamabad, from April to June, 2021, for 12 weeks. Students from the second year of BDS (n = 50) were divided into five small groups. Five students’ volunteers were chosen from those who completed the previous units with more than 80% summative assessment score and with good communication skills. The group discussion centered on the application of core knowledge and skills in pathology. Responses from the tutors for the qualitative data were obtained using in depth one-on-one semi-structured interviews with audio recorded. The verbatim in the form of audio and notes were transcribed, and the qualitative analysis was performed by two independent investigators, generating codes, themes, and subthemes. Results: The results showed the comprehensive understanding of the insights of tutors and the motivational elements for achieving academic goals and improving teamwork and teaching skills. Many factors encouraged their participation as tutors, including the acquisition of knowledge and leadership skills. The students felt that their compassionate attitude encouraged active participation by the fellow students, increasing their confidence and learning. The students perceived that they had attained essential attributes that would benefit them in professional life in the future. Conclusion: The students enjoyed the Peer-assisted learning experience and recognized its importance for their academic and professional development. While learning in a relaxed environment, the students achieved their basic learning goals, developed leadership skills, improved communication skills, and gained confidence. Keywords: Peer Group, Integrated curriculum, Near-Peer tutoring.

Pharmacological evaluation of Vernonia elaeagnifolia (Asteraceae) leaves in hyperlipidemic albino rabbits

Purpose: To evaluate the antihyperlipidemic efficacy and phytochemical constituents of Vernonia elaeagnifolia aqueous leaf extract.Method: Qualitative phytochemical analysis of V. elaeagnifolia leaves was performed. Thirty healthy albino rabbits were divided into six groups (n = 6). Cholesterol powder (0.5 g/kg) in 10 mL coconut oil (vehicle) was given orally to induce hyperlipidemia. The aqueous leaf extract of Vernonia elaeagnifolia was administered at 250 mg/kg and 500 mg/kg per oral. Lipid profile, hepatic enzymes and oxidative stress markers were evaluated.Results: Phytochemical screening indicated the presence of tannins, proteins, flavonoids, phenols, alkaloids and saponins. Oral administration of cholesterol powder significantly (p < 0.05) raised the level of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and triglyceride (TG) along with significant (p < 0.05) decrease in serum concentration of high-density lipoprotein cholesterol (HDLc). Concentration of serum TC, LDL-c, TG and liver enzymes was significantly reduced in V. elaeagnifolia-treated groups. The levels of oxidative stress markers were restored to normal when the animals were treated with V. elaeagnifolia leaf extract; increased levels of antioxidant enzymes were observed.Conclusion: The aqueous leaf extract of V. elaeagnifolia possesses antihyperlipidemic and antioxidant potentials that are dose-dependent. However, further studies are required to develop the plant for therapeutic applications.Keywords: Hyperlipidemia, Oxidative stress markers, Cholesterol, Vernonia elaeagnifoli

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Households Socio-Economic Determinants of Childhood Diarrhoea Morbidity in Selected South Asian Countries

This study attempts to find out the association between the householdsocioeconomic factors with childhood diarrhoea in Pakistan, Bangladeshand Nepal. To estimate the determinants of diarrhoea, the study uses thedata derived from the Demographic and Health Surveys (DHS) in threeAsian countries: Pakistan, Bangladesh and Nepal from 2011 to 2013. Tofind out the diarrhoea morbidity among child under five, the child age,child gender, mother’s education and working status, child immunization,source of drinking water, type of toilet facility, washing hands behavior,floor material, and economic status of household has been used asindependent variables. Binary logistic model is used to estimate theprobability of diarrhoea morbidity among children of selected countries inthis study. The results of binary logistic regression indicate that to reducediarrhoea morbidity, washing hands especially after using toilet and attime of preparing food and eating food can play a major part. Mother’seducation and work status have significant impact on diarrhoea morbidity.The study concludes that family size has a strong impact on childhooddiarrhoea morbidity. In small families, mothers have more time for childcare than large families. So the chances of diarrhoea incidence are less insmall families

Rectal diclofenac; an effective modality for pain relief after vaginal birth

Background and Objective: Vaginal delivery (VD) is the safest delivery option for the mother and is associated with quick recovery and minimal maternal morbidity and mortality. However, one of the commonest fears among women about VD is pain. This study aims to assess the effectiveness of diclofenac suppositories (per rectum) compared to the intramuscular diclofenac for the pain relief in females after VD.Methods: This prospective comparative was study conducted at the Emergency Section (labor room) of Obstetrics &amp; Gynecology Department in one of the tertiary care teaching hospitals of Lahore, Pakistan. A total of 182 female patients undergoing VD were selected and further divided into group A and group B. Group A was administered rectal analgesia in the form of rectal suppositories (100 mg) immediately after perineal tear (first and second degree only) repair and repeated after 6 hours. While group B received one injection of intramuscular diclofenac, immediately after perineal tear repair. The pain score was measured on a graphical score using Graphic Rating Scale, immediately at rest, during movement, and during urination. The pain score was reassessed after 6 hours with the same parameters and compared between both groups.Results: The overall pain score was significantly lower immediately (p = 0.004) and 6 hours (p = 0.002) after VD in group A at rest, during movement, and during urination as compared to group B.Conclusion: The use of rectal diclofenac suppositories is a simpler and more effective and acceptable method of reducing the pain experienced by the women following perineal trauma after vaginal childbirth.</p

Construction and validation of ShaMaq developmental screening tool

Introduction: The diagnosis of developmental delay and early intervention ameliorates long-term sequelae. There is a need for an appropriate, regionally adapted and reliable developmental screening tool to be used in low and middle-income countries with scarce resources. Aim: The aim of this research is to construct and validate a screening tool for identifying developmental delay in Pakistani children. Method: ShaMaq developmental screening tool (SDST) was developed consisting of five proformas to be administered at different age groups: 6-8 weeks (Group 1), 6-10 months (Group 2), 18-24 months (Group 3), 3-3.5 years (Group 4), and 4.5-5.5 years (Group 5). On an average, Groups 1-3 took 10-15 min, whereas Groups 4 and 5 took 20-25 min. We sampled children between the ages of 6 weeks to 5.5 years and tested them all within their designated age groups. Internal consistency was assessed by Cronbach\u27s alpha. Interobserver testing was done for reliability and concurrent validity was undertaken by using the senior consultant developmental paediatrician\u27s final diagnosis as the gold standard. Results: Out of 550 healthy children, 8-19% in the five groups were found to have some form of developmental delay using SDST. Approximately 50% of the families were in the low-to-moderate income bracket, and nearly 93% lived in a joint family system. Internal consistency of items in the five groups ranged from 0.784 to 0.940, whereas both interobserver reliability and concurrent validity ranged from 0.737 to 1.0. SDST showed 94.4% sensitivity and 92.9% specificity. Conclusion: SDST is an effective tool for identifying delay in healthy children with good internal consistency, reliability, and validit

Rare earth ions (La3+, Nd3+) substituted cobalt–strontium spinel ferrites for photocatalytic degradation of textile dyes

In the industrial sector, productive and effective treatment of toxic dye-based color pollutants is a key issue. Lanthanum and neodymium substituted cobalt–strontium (Co–Sr) spinel ferrite (Co0.5Sr0.5RExFe2-xO4, x = 0.00 and 0.06) catalysts were synthesized and used to degrade Congo red and rhodamine B dyes from an aqueous solution mixture in this study. For this specific purpose, RE3+ ions substituted Co–Sr spinel ferrite nanoparticles with photocatalytic degradation ability were prepared through sol–gel method. The degradation of CR and RhB in recently synthesized nanoferrites was also examined. SEM and XRD were used to characterize the prepared samples. The optical band gap values of synthesized spinel ferrites were examined with the help of Tauc plots by using UV-visible absorption. It was determined that the energy bandgap ranged from 2.91 to 2.52 eV. For Co0.5Sr0.5Fe2O4, Co0.5Sr0.5La0.06Fe1.94O4, and Co0.5Sr0.5Nd0.06Fe1.94O4 nanoferrites, the rates of CR and RhB dye degradation were 73–90% and 45–85%, respectively, at pH 5–7. The kinetics models successfully described the degradation reaction as pseudo-first-order kinetics. It was, therefore, concluded that the prepared samples can be used as effective photocatalysts in order to eliminate hazardous pollutants present in wastewater. HIGHLIGHTS Rare-earth ion substitution spinel ferrite.; Ferrite for degradation of dyes.; Suitable band gap for photocatalytic purpose.

A systemic approach to explore the mechanisms of drug resistance and altered signaling cascades in extensively drug-resistant tuberculosis

Background and aim: The persistence of extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis (MTB) continue to pose a significant challenge to the treatment and control of tuberculosis infections worldwide. XDR-MTB strains exhibit resistance against first-line anti-TB drugs, fluoroquinolones, and second-line injectable drugs. The mechanisms of drug resistance of MTB remains poorly understood. Our study aims at identifying the differentially expressed genes (DEGs), associated gene networks, and signaling cascades involved in rendering this pathogen resistant to multiple drugs, namely, isoniazid, rifampicin, and capreomycin. Methods: We used the microarray dataset GSE53843. The GEO2R tool was used to prioritize the most significant DEGs (top 250) of each drug exposure sample between XDR strains and non-resistant strains. The validation of the 250 DEGs was performed using volcano plots. Protein-protein interaction networks of the DEGs were created using STRING and Cytoscape tools, which helped decipher the relationship between these genes. The significant DEGs were functionally annotated using DAVID and ClueGO. The concomitant biological processes (BP) and molecular functions (MF) were represented as dot plots. Results and conclusion: We identified relevant molecular pathways and biological processes, such as cell wall biogenesis, lipid metabolic process, ion transport, phosphopantetheine binding, and triglyceride lipase activity. These processes indicated the involvement of multiple interconnected mechanisms in drug resistance. Our study highlighted the impact of cell wall permeability, with the dysregulation of the mur family of proteins, as essential factors in the inference of resistance. Additionally, upregulation of genes responsible for ion transport such as ctpF, arsC, and nark3, emphasizes the importance of transport channels and efflux pumps in potentially driving out stress-inducing compounds. This study investigated the upregulation of the Lip family of proteins, which play a crucial role in triglyceride lipase activity. Thereby illuminating the potential role of drug-induced dormancy and subsequent resistance in the mycobacterial strains. Multiple mechanisms such as carboxylic acid metabolic process, NAD biosynthetic process, triglyceride lipase activity, phosphopantetheine binding, organic acid biosynthetic process, and growth of symbiont in host cell were observed to partake in resistance of XDR-MTB. This study ultimately provides a platform for important mapping targets for potential therapeutics against XDR-MTB. 2021 Elsevier Inc.Mr. Udhaya Kumar. S, one of the authors, gratefully acknowledges the Indian Council of Medical Research (ICMR), India, for providing him a Senior Research Fellowship [ISRM/11(93)/2019]. The authors would like to take this opportunity to thank the management of VIT for providing the necessary facilities and encouragement to carry out this work. The authors have declared that no conflicts of interest exist.Scopu

A computational overview on phylogenetic characterization, pathogenic mutations, and drug targets for Ebola virus disease

The World Health Organization declared Ebola virus disease(EVD) as the major outbreak in the 20th century. EVD was firstidentified in 1976 in South Sudan and the Democratic Republicof the Congo. EVD was transmitted from infected fruit bats tohumans via contact with infected animal body fluids. The Ebolavirus (EBOV) has a genome size of ~18,959 bp. It encodesseven distinct proteins: nucleoprotein (NP), glycoprotein (GP),viral proteins VP24, VP30, VP35, matrix protein VP40, andpolymerase L is considered a prime target for potential antiviralstrategies. The current US FDA-approved anti-EVD vaccine,ERVERBO, and the other equally effective anti-EBOV combi-nations of three fully human monoclonal antibodies such asREGN-EB3, primarily target the envelope glycoprotein. Thiswork elaborates on the EBOV’s phylogenetic structure and thecrucial mutations associated with viral pathogenicit