Higher education in Pakistan : from state cntrol to state supervision

Higher Education forms part of every society. This study focuses on the higher education in Pakistan. It presents development of higher education in Pakistan in which the government has played a major rule for forty years. The higher education system in Pakistan for the majority of the years has remained under the state control; government has played a major role in policy making and implementation. This dependence has given growth to a higher education dependent on the government funds. With an increase in the student numbers, diversification of higher education and with the entrance of private sector has changed the scenario. The increase in number of private higher educational institutions with government finances shrinking, has given rise to a lot of challenges for the future of higher education in Pakistan. These challenges if not addressed effectively and properly can give rise to number of problems that can have an adverse effect on the development of higher education Pakistan

Burnout among diabetes specialist registrars across the United Kingdom in the post-pandemic era

Introduction: Burnout syndrome is a condition resulting from chronic work-related stress exposure and can be identified by the presence of one or more of the three classic dimensions of burnout, i.e., emotional exhaustion, depersonalization, and lack of personal accomplishment, which negatively impact physician health and productivity. Objective: This study aimed to identify burnout among Diabetes and Endocrinology Specialty Training Registrars (DStRs) across the United Kingdom. Design/setting: It was a Cross-sectional observational study after ethical approval ERSC_2022_1166, utilizing the gold standard Maslach Burnout Inventory to measure burnout syndrome, and to determine self-reported stressors and compare them with the results of our previous survey in 2018. Participants: Over 430 DStRs across the United Kingdom were invited electronically through their deanery representatives and specialty training bodies. Results: Using Google Forms™ to gather data, we were able to collect 104 completed surveys. Results revealed that 62.5% (n = 65) of participants have burnout (5% increase from the previous survey in 2018), 38.6% (n = 40) have high emotional exhaustion, and 44.2% (n = 46) feel a lack of personal accomplishment. “General Internal Medicine specific workload” was the most common self-reported stressor reported by 87.5% (n = 91) of participants, whereas bullying/harassment and discrimination at work were reported by 35.6% (n = 37) and 30.77% (n = 32) of participants, respectively. Using multivariable logistic regression model, personal stress (OR, 4.00; 95% CI, 1.48–10.86; p = 0.006) had significant, while Bullying/harassment (OR, 3.75; 95% CI, 0.93–15.12; p = 0.063) had marginal impact on the presence of burnout. Conclusion: Diabetes and Endocrinology Specialty Training Registrars frequently experience burnout syndrome, which has increased over the last 4 years. However, organizational changes can help identify, prevent, and treat physician burnout. Trial registration: NCT05481021 available at https://ichgcp.net/clinical-trials-registry/NCT05481021

Vertical Versus Transverse Incision for the Release of the First Dorsal Compartment of the Wrist for De Quervain’s Tenosynovitis

OBJECTIVES The study aimed to compare the clinical outcome of transverse versus longitudinal incision for surgical release of the first dorsal compartment of the wrist to treat de Quervain’s disease. METHODOLOGY In this quasi-experimental study, all the patients with resistant de Quervain’s tenosynovitis who had the surgical release of the first dorsal compartment between January 2008 and  December 2020 were included. The surgeries were performed under local anaesthesia. The first dorsal compartment of the wrist was approached through either a longitudinal or transverse incision, and the tendons of the abductor pollicis longus and extensor pollicis brevis were released. Patients were followed for a minimum of three months, and the primary outcome measure was the Visual analogue score (VAS) for relief of pain and secondary outcome measures were any immediate or delayed complications. RESULTS98 patients were included in the study with a female-to-male ratio of 7:1. The cohort’s mean age was 44 years (Range 25-75). Most patients were housewives exposed to manual work with the involvement of the dominant hand. There were no major complications besides wound issues and transient paresthesia in few patients. The longitudinal incision was associated with less transient nerve palsies, less duration of surgery and easier identification of structure and anomalies. The only advantage of transverse incision was less scar formation. The clinical outcome was similar in both groups: 94% of patients had complete pain relief (VAS 0). CONCLUSION There was no difference in the outcome of de Quervain tenosynovitis when released with a transverse or longitudinal incision. The longitudinal incision had fewer complications as compared to the transverse incision

MDCT of Small Bowel Obstruction: How Reliable Are Oblique Reformatted Images in Localizing Point of Transition?

The goal of this study is to prospectively assess the additional value of oblique reformatted images for localizing POT, having surgery as a reference standard. Materials and Methods. 102 consecutive patients with suspected small bowel obstruction (SBO) underwent 64-slice multidetector row CT (MDCT) using surgical findings as reference standard. Two independent GI radiologists reviewed the CT scans to localize the exact POT by evaluating axial images (data set A) followed by axial, coronal, and oblique MPR images. CT findings were compared to surgical findings in terms of diagnostic performance. McNemar\u27s test was used to detect any statistical difference in POT evaluation between datasets A and B. Kappa statistics were applied for measuring agreement between two readers. Results. There was a diagnostic improvement of 9.9% in the case of the less experienced radiologist in localizing POT by using oblique reformatted images. The more experienced radiologist showed diagnostic improvement by 12.9%

Molecular detection, phylogenetic analysis and designing of siRNA against Potato Virus X

Background: As potato (Solanum tuberosum L.) is one of the most liked food crops for human diet so increasing its production is an important goal for scientists to achieve. In this molecular study, we characterized the Coat Protein (CP) gene of Potato Virus X (PVX). CP gene is virulence mediator and integral part of viral structural assembly.Methodology: We tissue cultured the PVX positive potato plants for viral RNA extraction. Total RNA was converted to cDNA for priming CP gene in PCR for amplification. To get the complete sequence of gene, we cloned CP gene into pTZ57R/T cloning vector. Upon double digestion of recombinant plasmid with EcoRI and HindIII restriction enzymes, 710 bp fragment was obtained which confirmed cloning. Recombinant plasmid was sequenced with M13 primers.Results: Derived consensus sequence of 710 bp was found to be exact cds of CP gene showing 95% similarity with referenced genome. Phylogenetic analysis suggested Indian isolate of PVX as the nearest one. Multiple siRNA were designed against mentioned and optimized computationally to provide base for further studies.Conclusion: Following facts may be established upon findings of this research; i) CP gene of Pakistani isolate of PVX has high homology with other PVX isolates found around the world, ii) in determining target for efficient siRNA mediated approach to silence PVX genome, this conserved nature can be proved very promising. Thus, to develop PVX-resistant potato crop in Pakistan through siRNA mediated strategy, CP gene could be the best target

Sonographic Correlation of Fetal Foot Length as a Reliable Parameter for Estimation of Gestational Age in 2ND and 3RD Trimester

Objective: To sonographic correlation fetal foot length as a reliable parameter for estimation of gestational age in 2nd and 3rd trimester. Study Design: An analytical cross-sectional prospective study was performed. Settings: The study was performed in Meer Children and family clinic, Tajpora Lahore. Period: An analytical cross-sectional study was conducted from 15 October, 2021 to 15 January, 2021. Material & Methods: The present study is conducted in the in the Meer Children and Family Clinic Tajpura Lahore .In pregnant women attending the OPD during 2nd and 3rd trimester for routine checkups. The present study done in 60 normal pregnant women who were sure about their last menstrual period, have regular menstrual cycle, not experienced any vaginal bleeding. Ultrasonographic fetal foot length measurements was done without previous knowledge of gestational age and then the gestational age confirmed by biparietal diameter, abdominal circumference and head circumference . Results: The present study is conducted in 63 pragnent women between 15 to 35 weeks  of gestational age attending the OPD for 2nd and 3rd trimester routine checkups the  in the Meer Children and Family Clinic Tajpura Lahore . Sonographically we calculated foot length from 15 to 35 weeks of gestation. In our study to Early  age at which fetal foot length could be seen and measured sonographically was found to be 15 weeks of  gestation age. In 27 weeks of gestational age and mean foot length 83.67 with std. deviation 5.718 and std. Error Mean -720 and the mean value of foot length by gestational age is 93.33 with std. deviation and std. error mean 338.740 and 42.677 respectivly.  Along with foot length bipraietal diameter(BPD),Abdominal circumference(AC),head circumference(HC) also measured for comparison. Conclusion: In the normal growing fetus the fetal foot length increases with increasing gestational age. Fetal foot length is a good parameter for gestational age especially in cases of femur achondroplasia, dolichocephaly or brachycephaly and in cases who are not sure about their L.M.P. Fetal foot length is  used as an investigational implement  to measured  of gestational age in the late second and third trimesters of pregnancy. Fetal foot length was especially useful when other parameters did not correctly estimate gestational age, e.g., in cases of short-limb dwarfism hydrocephalus or anencephaly. Keywords: Gestational age, Fetal foot length, Ultrasonographically age estimation DOI: 10.7176/JHMN/93-04 Publication date:September 30th 202

Modulations of cell cycle checkpoints during HCV associated disease

Background Impaired proliferation of hepatocytes has been reported in chronic Hepatitis C virus infection. Considering the fundamental role played by cell cycle proteins in controlling cell proliferation, altered regulation of these proteins could significantly contribute to HCV disease progression and subsequent hepatocellular carcinoma (HCC). This study aimed to identify the alterations in cell cycle genes expression with respect to early and advanced disease of chronic HCV infection. Methods Using freshly frozen liver biopsies, mRNA levels of 84 cell cycle genes in pooled RNA samples from patients with early or advanced fibrosis of chronic HCV infection were studied. To associate mRNA levels with respective protein levels, four genes (p27, p15, KNTC1 and MAD2L1) with significant changes in mRNA levels (\u3e 2-fold, p-value \u3c 0.05) were selected, and their protein expressions were examined in the liver biopsies of 38 chronic hepatitis C patients. Results In the early fibrosis group, increased mRNA levels of cell proliferation genes as well as cell cycle inhibitor genes were observed. In the advanced fibrosis group, DNA damage response genes were up-regulated while those associated with chromosomal stability were down-regulated. Increased expression of CDK inhibitor protein p27 was consistent with its mRNA level detected in early group while the same was found to be negatively associated with liver fibrosis. CDK inhibitor protein p15 was highly expressed in both early and advanced group, but showed no correlation with fibrosis. Among the mitotic checkpoint regulators, expression of KNTC1 was significantly reduced in advanced group while MAD2L1 showed a non-significant decrease. Conclusion Collectively these results are suggestive of a disrupted cell cycle regulation in HCV-infected liver. The information presented here highlights the potential of identified proteins as predictive factors to identify patients with high risk of cell transformation and HCC development

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication