Mini Clinical Evaluation Exercise (Mini-CEX): An overview

Over the last two decades, medical education has changed its role significantly to move from the traditional curriculum to the outcome based education. This is done after deciding the competencies to be achieved by the students more clearly1. The Institute for International Medical Education (IIME) has clearly focused the minimum essential core competencies that a medical graduate must possess including the clinical skills, communication skills, professional values, attitudes and behaviors1.&nbsp

Transfusion transmitted malaria in three major blood banks of Peshawar, Pakistan

Malaria is one of the most important transfusion associated infections in many parts of the world, particularly the developing countries where it is endemic. This study estimates the risk of acquiring malaria from a single unit of blood in North of Pakistan. A prospective study was conducted to investigate transfusion transmitted malaria in three major blood banks of Peshawar, Pakistan. A total of 1558 (1534 males and 24 females) healthy volunteer blood donors were screened for the presence of malarial parasites in thick and thin smears using microscopy. Nine donors (0.577%) were found positive for malarial parasite, with trophozoites and gametocytic stages of Plasmodium falciparum (1) and Plasmodium vivax (8). Majority of the donors (82.09%) belonged to age group 15 - 30 years. Donors who suffered from malaria in recent years were 28 in number and 3 of them were found positive for malaria in the present study. The results of the present study indicated that transfusion transmitted malaria is a risk in malaria endemic regions like Pakistan. Further research on this aspect using more sophisticated and advanced diagnostic techniques like enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) are required for proper assessment of actual situation and control of transfusion transmitted malaria in Pakistan.Keywords: Transfusion, malaria, blood-borne infections, screening, microscopy, blood banksAfrican Journal of Biotechnology Vol. 9(33), pp. 5445-5449, 16 August, 201

Vitamin B6 and homocysteine levels in carbamazepine treated epilepsy of Khyber Pakhtunkhwa

Objectives: The study focused on the plasma levels of vitamin B6 and homocysteine in different genotypes of MTHFR (C677T, A1298C) and GABRG2 (C588T, C315T) genes in carbamazepine resistant epilepsy in the population of Khyber Pakhtunkhwa.Methodology: Patients who were possible candidates for carbamazepine therapy were followed for six months for their seizure control. Plasma levels of vitamin B6 and homocysteine were determined using immunoassay based techniques at baseline and after six months. MTHFR (C677T, A1298C) and GABRG2 (C588T, C315T) genes were genotyped using restriction fragment length polymorphisms. Seizure control during therapy was recorded on a standardized proforma.Results: Low vitamin B6 levels and hyperhomocysteinemia were found in 61.7% of resistant patients (n=34). Resistant patients had the following frequencies of variant genotypes (677CT=38.1% and 677TT=24.4%; 1298AC=42.2% and 1298CC=26.1%; 588CT= 47.6% and 315TT= 33.3%) of MTHFR (C677T and A1298C) and GABRG2 (C588T and C315T) genes. A significant decline in vitamin B6 (P<0.0001) and hyperhomocysteinemia were found in variant genotypes of MTHFR (C677T, A1298C) and GABRG2 (C588T, C315T) genes.Conclusion: Following six months of carbamazepine of therapy in heterozygous variant genotypes of MTHFR (677CT and 1298AC) and GABRG2 (588CT and 315CT) genes, we observed a significant fall in vitamin B6 levels and hyperhomocysteinemia.Keywords: Carbamazepine, epileptics, homocysteine, seizure control, RFLP, vitamin B

Linking Managerial Coaching with Employees' Innovative Work Behaviors through Affective Supervisory Commitment: Evidence from Pakistan

Organizations in the era of globalization are promoting managerial coaching (MC) as human resource development practice to improve employees' outcomes in the workplace. The existing literature on manager coaching lacks the empirical studies showing the linking MC with attitudes and behaviors of employees. To fill the gap mentioned above, this study explores the direct linkage between the MC and innovative work behaviors (IWBs) of employees as well as an indirect relationship through the intervening role of affective supervisory commitment (ASC). The 250 surveys were sent to employees working in the software industry of Pakistan, and 207 questionnaires were received back from the respondents, and the response rate was approximately 83%. The findings showed that managerial coaching had a positive influence on innovative work behaviors among employees. Results also showed that ASC mediated the link between MC and IWBs. Affective supervisory commitment as a mediator has not been tested yet between the linkage of MC with IWBs. The implications of the study and limitations are also discussed. Keywords: Affective supervisory commitment, innovative work behaviors, managerial coaching JEL Classifications: M12, M53 DOI: https://doi.org/10.32479/irmm.971

ARE BEHAVIORAL BIASES INFLUENCED BY DEMOGRAPHIC CHARACTERISTICS & PERSONALITY TRAITS? EVIDENCE FROM PAKISTAN

The study investigates the influence of demographics (residential area, age, gender, marital status, education background) and personality traits (extraversion, openness, conscientiousness, neuroticism, and agreeableness) on the financial behavioral biases (overconfidence, herding/mass behavior and disposition effect) and risk taking behavior in Pakistan. The study will be beneficial for the financial advisors and individual investors. As it will help financial advisor to know potential behavioral biases in each type of investors while making investment decision and therefore they can advise investors properly to mitigate such biases. Personality dimensions are categorized under Big Five Personality model. Questionnaire survey method is used to collect the data from a Sample size of 225 respondents that includes bankers, finance students as well as investors. Structure equation modeling (SEM) analysis is used to analyze the impact of personality traits and demographics on the investment biases through Amos 20. The results show that big five personality traits have a significant relationship with overconfidence, herding/mass behavior and risk taking except disposition effect

Recent Advances in Evaluating Insects as Bioindicators of Heavy Metal Pollution

Natural ecosystems are adversely affected by man-made interventions. Among living organisms, insects are regarded as susceptible to environment disruption as delicate body confirms the presence or absence of polluted environment thus found as suitable indicators of the aquatic and terrestrial ecosystem. Insects are being considered indicators of environmental pollution because different taxa of different localities provide robust information, provide a comparison of various communities, and quantitative data associated with indicators etc. Most of them present the quick reliable influence to heavy metal accumulation as pronounced disruptions were observed at molecular and biochemical level hence considered as best opted indicators of environmental pollution

Bacteriocin-mediated inhibition of some common pathogens by wild and mutant Lactobacillus species and in vitro amplification of bacteriocin encoding genes

Lactobacilli are the most common probiotics used in food and other industries because of their capability of producing bacteriocins. Bacteriocins are compounds that are used to kill pathogenic microorganisms. As most bacteria have become resistant to synthetic antibacterial tools, the importance of using probiotics as antibacterial agents has increased. This work was done to check the bacteriocin effect on some common pathogens and the influence of mutation on the bacteriocin activity of Lactobacilli was also investigated. Four strains were isolated, identified from meat and pickles samples via culturing methods, staining, biochemical tests, and ribotyping. Preliminary tests, including Gram staining and catalase test, were done for the confirmation of Lactobacillus species. All strains were gram-positive and catalase-negative. Antibacterial activity was checked against Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus thuringiensis, Escherichia coli, and Salmonella enteritis via agar well diffusion method. The mutations were done using ethidium bromide and the influence of wild and mutants were also checked. Interestingly, mutants developed more virulence than wild ones. It was also observed that they all were sensitive to pepsin. Protein estimation was done via Bradford method. Ribotyping of GCU-W-PS1 revealed 99 % homology with Lactobacillus plantarum and GCU-W-MS1 to Lactobacillus curvatus (99 % homology). Curvacin A, sakacin P, and plantaricin A genes were also amplified using specific primers. Gene sequence showed the presence of curvacin A gene in GCU-W-MS1. It was concluded that lactic acid bacteria could be used as antibacterial tools against common pathogens

Perception of non-alcoholic fatty liver disease: Real-life experience from Pakistan

Introduction: Non-alcoholic fatty liver disease (NALFD) has become one of the most pervasive causes of hepatic pathology. Because of its marked association with metabolic syndrome, type II diabetes and cardiovascular disease, NAFLD has gained substantial focus recently. Its prevalence and incidence are on the rise in Pakistan. However, due to its indolent and mostly asymptomatic course, NAFLD is often overlooked. This reckless behavior towards a potentially deadly disease is influenced most notably by disinformation or flawed perception, although there are a number of other complex socioeconomic components to this as well. With respect to NAFLD, the gap between disease understanding and steps for management is growing in the Pakistani society. With this study, we hoped and aimed to evaluate just how far and wide these shortcomings were found and how was NAFLD perceived in the local populace via a self-administered survey.Methods: This was a cross-sectional observational cohort study undertaken at the Department of Gastroenterology, Jinnah Postgraduate Medical Centre, and Medical Unit II, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan. All patients ≥18 years with a diagnosis of NAFLD were included in the study. NAFLD was diagnosed on the basis of sonographic evidence. All ultrasounds were done by a senior expert radiologist with at least 10 years of postgraduate experience. Ultrasounds were performed twice in all patients to rule out human error and bias. Perceptions regarding the knowledge of NAFLD were assessed using a self-administered survey questionnaire.Results: The female-to-male ratio in our cohort was 3:1. The mean age and body mass index (BMI) recorded were 39.85 ± 9.79 years and 31.21 ± 3.6 kg/m2, respectively. Sixty participants (26.4%) knew about their disease (NAFLD) while only 36 (15.9%) knew what NAFLD was and only 33 (14.5%) participants knew about the cardiovascular risk associated with it. Nearly two-thirds of the patients considered themselves overweight, while 180 (79.3%) of them were willing to lose weight. However, just about half of the cohort admitted the need for improved eating habits and increased physical activity/exercise in their daily lives. Fifty-seven (25.1%) patients admitted to using alternative or quack medications and only 45 (19.8%) patients considered them harmful.Conclusions: Patients harboring NAFLD have little to no knowledge about the disease and its nature or the fact that they are suffering from it despite being diagnosed clinically. Furthermore, while the general populace is willing to accept being overweight and having unhealthy eating habits, their willingness in initiating real-life practical steps to manage NAFLD is lacking

An incidentally discovered asymptomatic para-aortic paraganglioma with Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal (GI) tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extraGI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers.We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was noted. An abdominal computed tomography scan (CT) revealed multiple polyps in small bowel loops. Gastroscopy revealed multiple dimunitive polyps in stomach and pedunculated polyp in duodenum. Colonoscopy revealed multiple colonic polyps. Pathological examination of the polyps confirmed hamartomas with smooth muscle arborization, compatible with Peutz-Jeghers polyps. CT scan guided left para-aortic lymph node biopsy revealed the characteristic features of extra-adrenal para-aortic paraganglioma. Although cases of various GI and extra GI malignancies in PJS patients has been reported, the present case appears to be the first in literature in which the PJS syndrome was associated with asymptomatic extraadrenal para-aortic paraganglioma. Patients with PJS should be treated by endoscopic or surgical resection and need whole-body screening