Is Anesthesia an attractive career choice for undergraduates and young doctors of Pakistan?

Objective:To evaluate the factors that act as a barrier for medical students and young doctors inPakistan to choose anesthesia as a career choice. Study design:Cross-sectional study. Study settings:CMH Lahore.Study duration: From January toJune 2021. Materials and Methods:A total of 163 medical students and house officers who were on rotation in operation theatre in various specialties were recruited for this study. A questionnaire was distributed to all the participants. Participants had to select theirspecialty of choice and the reason for not choosing anesthesia. They also had to choose the most important factor for choosing the specialty and the person who influenced them the most to choose the specialty. Results:Only 10 (6.1%) participants chose the anesthesia specialty for their post-graduation, out of these ten, 5 (50%) were male and 5 (50%) were female. The most commonly chosen option {62 (54.87%)} for not selecting anesthesia was “no personal interest”. In response to “What is the most important factor while choosing a specialty?” most of the participants (55%) chose the option “Scope of the specialty”. In response to “Who had the most influence in choosing a specialty?” most of the participants {63 (38.7%)} chose the option “Teachers of the clinical rotations”. Conclusion:It is concluded in our study that only a very small number of students and young doctors willingly opt for anesthesia for their post-graduation which results in a shortage of workforce in this specialty. It is recommended that anesthesia rotation be made compulsory and that the barriers tomentorship in anesthesia be properly addressed. Keywords:Anesthesia, career choice, Influencing factors, specialty, workforce

Is Anesthesia an attractive career choice for undergraduates and young doctors of Pakistan?

Objective:To evaluate the factors that act as a barrier for medical students and young doctors inPakistan to choose anesthesia as a career choice. Study design:Cross-sectional study. Study settings:CMH Lahore.Study duration: From January toJune 2021. Materials and Methods:A total of 163 medical students and house officers who were on rotation in operation theatre in various specialties were recruited for this study. A questionnaire was distributed to all the participants. Participants had to select theirspecialty of choice and the reason for not choosing anesthesia. They also had to choose the most important factor for choosing the specialty and the person who influenced them the most to choose the specialty. Results:Only 10 (6.1%) participants chose the anesthesia specialty for their post-graduation, out of these ten, 5 (50%) were male and 5 (50%) were female. The most commonly chosen option {62 (54.87%)} for not selecting anesthesia was “no personal interest”. In response to “What is the most important factor while choosing a specialty?” most of the participants (55%) chose the option “Scope of the specialty”. In response to “Who had the most influence in choosing a specialty?” most of the participants {63 (38.7%)} chose the option “Teachers of the clinical rotations”. Conclusion:It is concluded in our study that only a very small number of students and young doctors willingly opt for anesthesia for their post-graduation which results in a shortage of workforce in this specialty. It is recommended that anesthesia rotation be made compulsory and that the barriers tomentorship in anesthesia be properly addressed. Keywords:Anesthesia, career choice, Influencing factors, specialty, workforce

Rationale and design of the CONFIRM2 (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) study.

BACKGROUND In the last 15 years, large registries and several randomized clinical trials have demonstrated the diagnostic and prognostic value of coronary computed tomography angiography (CCTA). Advances in CT scanner technology and developments of analytic tools now enable accurate quantification of coronary artery disease (CAD), including total coronary plaque volume (TPV) and low attenuation plaque volume (LAP). The primary aim of CONFIRM2, (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is to perform comprehensive quantification of CCTA findings, including coronary, non-coronary cardiac, non-cardiac vascular, non-cardiac findings, and relate them to clinical variables and cardiovascular clinical outcomes. DESIGN CONFIRM2 is a multicenter, international observational cohort study designed to evaluate multidimensional associations between quantitative phenotype of cardiovascular disease and future adverse clinical outcomes in subjects undergoing clinically indicated CCTA. The targeted population is heterogenous and includes patients undergoing CCTA for atherosclerotic evaluation, valvular heart disease, congenital heart disease or pre-procedural evaluation. Automated software will be utilized for quantification of coronary plaque, stenosis, vascular morphology and cardiac structures for rapid and reproducible tissue characterization. Up to 30,000 patients will be included from up to 50 international multi-continental clinical CCTA sites and followed for 3-4 years. SUMMARY CONFIRM2 is one of the largest CCTA studies to establish the clinical value of a multiparametric approach to quantify the phenotype of cardiovascular disease by CCTA using automated imaging solutions

Seasonal And Regional Effects of Air Quality Index on Hematological Indices of Dogs Under Local Environmental Conditions In Pakistan

Air pollution is found to have significant association with living health all over global world. Environment Protection Department of Punjab, Pakistan provides the monthly air quality index (AQI) data on air pollution with concentrated particulates like PM2.5, PM10, NO2, SO2 and O3. Air particulates concentrations may vary of season, regional geography and climate. We performed blood sampling of 45 dogs from different breeds (Labrador retrievers, German shepherds and Pit bulls) from three different areas categorized on basis of AQI as less polluted (Gulberg), polluted (Town Hall) and highly polluted (Shadman) in winter and spring seasons. Data were analysed using paired sample t-tests for seasonal study and independent sample t-tests for area and breed study by SPSS (P < 0.05 ascertained as significant). Seasonal study resulted that less polluted area had no significant effects on hematological indices in any three breeds of dogs in both seasons. Polluted area was presented with increased significant effects on values of monocytes in Labrador retrievers, Hct and MCHC in German shepherds while decreased significant effects on MCH value in Pit bulls in winter season as compared to spring season. Highly polluted area had significant effects with decreasing WBC counts only in German shepherds in winter season than spring season. This study concludes that polluted and highly polluted areas in winter season with worst AQI affects blood indices more than spring season in dogs

Does isolated mitral annular calcification in the absence of mitral valve disease affect clinical outcomes after transcatheter aortic valve replacement?

AIMS  Mitral annular calcification (MAC) has been associated with adverse outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) but has been investigated in isolation of co-existent mitral regurgitation or mitral stenosis, which may represent important confounders. This study sought to investigate the effect of MAC with and without concomitant mitral valve disease (MVD) on clinical outcomes in patients treated with TAVR. METHODS AND RESULTS  Computed tomography (CT) and echocardiographic data in consecutive TAVR patients enrolled into a prospective registry were categorized according to presence or absence of severe MAC and significant MVD, respectively. A total of 967 patients with adequate CT and echocardiography data were included between 2007 and 2017. Severe MAC was found in 172 patients (17.8%) and associated with MVD in 87 patients (50.6%). Compared to TAVR patients without severe MAC or MVD, all-cause mortality at 1 year was significantly increased among patients with severe MAC in combination with MVD [adjusted hazard ratio (HRadj): 1.97, 95% confidence interval (CI): 1.12-3.44, P = 0.018] and patients with isolated MVD (HRadj: 2.33, 95% CI: 1.56-3.47, P < 0.001), but not in patients with isolated severe MAC in the absence of MVD (HRadj: 0.52, 95% CI: 0.21-1.33, P = 0.173). CONCLUSION  We found no effect of isolated MAC on clinical outcomes following TAVR in patients with preserved mitral valve function. Patients with MVD had an increased risk of death at 1 year irrespective of MAC