Comparative evaluation of the efficacy and safety of ormeloxifene and norethisterone in abnormal uterine bleeding

Background: Abnormal uterine bleeding is a typical condition for women of reproductive age. It can be painful and uncomfortable, create social disgrace, and have a considerable impact on health-related quality of life. Several studies have shown that ormeloxifene and norethisterone are useful in the treatment of abnormal uterine bleeding, however there is a scarcity of data comparing the efficacy and safety of these medicines. Methods: A prospective comparative study was conducted over 100 women, age group of 30-50 years, attending the gynecology outpatient department with subjective complaints of heavy menstrual bleeding at a tertiary care hospital, in Hyderabad. Group A (n=50) received 60 mg of ormeloxifene and Group B (n=50) received 5mg of norethisterone, respectively. Ethical approval was taken from the institutional ethical committee. Results: 38% aged 41-45, 86% had irregular cycles, 76% reported subjective improvement in group A, and 38% in group B. Group A showed a mean difference of 80.22 in decreasing PBAC score, 0.70 in hemoglobin rise, and 3.5 in decreasing ET, while group B showed 53.70 in PBAC decrease, 0.28 in hemoglobin rise, and 1.76 in endometrial thickness reduction. Both groups have no notable side effects and no significant p value. Conclusions: Reducing PBAC score, subjective improvement, hemoglobin, and endometrial thickness with ormeloxifene and norethisterone works. Ormeloxifene has a far greater effect than norethisterone and has fewer adverse effects

Prevalence and severity of urinary incontinence among females after normal vaginal delivery

Background: Urinary Incontinence is the most common disorder associated with women after vaginal delivery due to the weakening of pelvic floor muscles. More than 50% of females experience urinary incontinence. It is defined as the involuntary leakage of urine. The condition is common not only in older women but also in young nulliparous women. Objective: The key objective of the study was to determine the prevalence and severity of Urinary Incontinence after normal vaginal delivery. Method: The study was Cross-sectional and there were 160 participants in the study. The study was conducted at the Physical Therapy department and Gynaecology Ward of Fauji Foundation and Geo hospital Lahore. The data was collected from women who had delivered between the ages of 20-40 years. The data collection was done by using Incontinence Severity Index that was used as primary outcome measure. Results: A total of 160 responses were received, based on inclusion and exclusion criteria. Among respondents, females in the age group of 20-25 had a rate of urinary incontinence with 31.3 percent. Results showed that females in the age group of 25-30 had high BMI and had a high rate of urinary incontinence with the range of 61.3 percent. As result, there was a positive correlation of urinary incontinence between age and score that ranged from 0.185. There was a positive correlation of urinary incontinence between the score and BMI that ranged between 0.174. Conclusion: This analysis revealed that there was a high prevalence rate of urinary incontinence among females after delivery that had a correlation with age

Antidiabetic effect of Nigella sativa compared with metformin on blood glucose levels in streptozotocin induced diabetic albino wistar rats

Background: Antidiabetic drugs are many but all of them have adverse effects ranging from simple side effects to serious side effects like hypoglycemic coma. We need alternative drugs which will not only lower blood sugar level but have fewer side effects. One such daily use ingredient in our food is Nigella sativa (kalonji) which has many properties.Methods: This was an objective study in an experimental animal. We divided albino wistar rats into six groups each group with six rats. Diabetes was induced using drug streptozotocin. Three doses of Nigella sativa 0.5 ml, 1 ml, 1.5 ml orally per rat were used. Metformin (100 mg/kg body weight) was used as standard drug. Blood sugar was estimated using glucometer on day 0 (starting day of treatment), day 5, day 10, day 20, day 40. The effect of Nigella sativa was compared with metformin group using the Anova test. Statistical analysis was done using SPSS software version 20.Results: Nigella sativa (NS) produced significant hypoglycemic effect. NS in the dose of 0.5 ml, 1 ml and 1.5 ml produced significant reduction in blood glucose in comparison to day 0. Metformin also (100 mg/kg body weight) produced significant reduction in blood glucose on day 20 and day 40. Comparison of hypoglycemic effect of Nigella sativa is not significantly different on day 10 (1 ml) and day 20 (1.5 ml) in comparison to Metformin (100 mg/kg body weight). Histopathological examination showed that there was partial regeneration of beta islet cells of pancreas by 1.5 ml of Nigella sativa which were damaged due to streptozotocin treatment.Conclusions: Alternative method of treatment for diabetes is very much needed and the study shows the use of the spice (Nigella sativa) daily can lower the blood sugar levels and can serve as an alternative treatment of diabetes mellitus

Empowering health professions educators: enhancing curriculum delivery through customized e-tutorial training on fundamental digital tools

IntroductionIn the dynamic landscape of education, the fusion of technology and learning, commonly termed “technology-enhanced learning” (TEL), has emerged as a transformative phenomenon. This study focuses on the imperative integration of TEL in medical education, recognizing the diverse digital literacy levels of adult learners. The exploration introduces the innovative E-Portal training program, designed to empower health professions educators with essential skills for proficiently employing digital tools in instruction.MethodologyA dedicated team of medical educationists conducted a thorough investigation into E-curriculum design and delivery, employing the Moodle Learning Management System as the foundation for the E-Portal training program. The training, spanning crucial stages such as course design, content delivery, self-paced teaching, and quality assessment, facilitated participant progression at individual paces, unlocking subsequent steps upon meeting stipulated prerequisites. A pre-training questionnaire gauged participants’ comprehension of distance learning, e-learning, synchronous and asynchronous teaching, and self-directed study. Subsequent focus group discussion post-training generated rich insights into participants’ experiences, reflections, and identified challenges.ResultsThe results illuminate participants’ limited adeptness with e-learning terminology, successful assimilation of components and functionalities, and heightened confidence in online teaching practices. However, discerned challenges during implementation, such as technical hurdles and engagement issues, highlight the multifaceted nature of TEL integration. While the E-Portal training positively impacted preparedness, participant feedback advocates for improvements in assessment tools, technical training provisions, and exploration of alternative Learning Management Systems.Discussion and conclusionStudy emphasizes the ongoing need for diverse training methodologies across Learning Management Systems, acknowledging the evolving nature of education and technology. This study underscores the transformative role of a tailored E-Portal training program in seamlessly integrating digital tools into medical education. The comprehensive insights provided contribute to a nuanced understanding of the advantages, obstacles, and potential avenues for enhancement in curriculum delivery through technology-enhanced learning, thereby propelling the field forward

Study the effectiveness and safety of vitamin D as an additional treatment for type 2 diabetic patients using oral anti-diabetics at a tertiary care hospital

Background: The prevalence of type 2 DM is alarmingly rising on a global scale. Improved treatments for type 2 DM are still needed, in order to slow the disease’s development. A role in the pathophysiology of type 2 DM has been suggested by the correlation between vitamin D insufficiency and several non-skeletal illnesses, including DM. The goal of the study was to determine if vitamin D supplementation may help type 2 DM patients whose glycemic status was uncontrolled even after using oral antidiabetics. Methods: 60 individuals with type 2 DM and vitamin D insufficiency participated in this 12-week open-label, before-and-after study. For 12 weeks, in addition to oral anti-diabetic medications, these patients also received 60,000 IU of vitamin D3 orally every week. HbA1c, FBS, and 25(OH)D levels parameters were included. Results: The majority of the patients were from 41-50 years of age group (48.3%) with a male predominance (60%). Most of them were having >1 year of type 2 DM duration (78.3%) with a high family history of type 2 DM (70%). After 12 weeks, there was a substantial (p<0.001*) drop in FBG levels and a significant (p<0.001*) decrease in HbA1c. 25(OH)D levels showed a high rise (p<0.001*). None of the patients had any side effects. Conclusions: Vitamin D treatment improves glycemic status, which slows the development of type 2 DM and its associated effects. As such, vitamin D supplementation is a safe and promising adjuvant treatment for individuals with type 2 diabetes who are low in vitamin D

Low-cost peer-taught virtual research workshops for medical students in Pakistan: A creative, scalable, and sustainable solution for student research

Background: Pakistan has not been a major contributor to medical research, mainly because of the lack of learning opportunities to medical students. With the increase in online learning systems during COVID-19, research related skills can be taught to medical students via low-cost peer taught virtual research workshops.Aim of the study: To assess the effectiveness of a comprehensive low-cost peer-taught virtual research workshops amongst medical students in Pakistan.Methods: This quasi-experimental study assessed the effectiveness of five virtual research workshops (RWs) in improving core research skills. RWs for medical students from across Pakistan were conducted over Zoom by medical students (peer-teachers) at the Aga Khan University, Pakistan, with minimal associated costs. The content of the workshops included types of research, ethical approval and research protocols, data collection and analysis, manuscript writing, and improving networking skills for research. Improvement was assessed via pre-and post-quizzes for each RW, self-efficacy scores across 16 domains, and feedback forms. Minimum criteria for completion of the RW series was attending at least 4/5 RWs and filling the post-RW series feedback form. A 6-month post-RW series follow-up survey was also emailed to the participants.Results: Four hundred medical students from 36 (/117; 30.8%) different medical colleges in Pakistan were enrolled in the RWs. However, only 307/400 (76.75%) medical students met the minimum requirement for completion of the RW series. 56.4% of the participants belonged to the pre-clinical years while the rest were currently to clinical years. The cohort demonstrated significant improvement in pre-and post-quiz scores for all 5 RWs (p \u3c 0.001) with the greatest improvement in Data Collection and Analysis (+ 34.65%), and in self-efficacy scores across all domains (p \u3c 0.001). 166/307 (54.1%) participants responded to the 6 months post-RWs follow-up survey. Compared to pre-RWs, Research involvement increased from 40.4 to 62.8% (p \u3c 0.001) while proportion of participants with peer-reviewed publications increased from 8.4 to 15.8% (p = 0.043).Conclusion: Virtual RWs allow for a wide outreach while effectively improving research-related knowledge and skills, with minimal associated costs. In lower-middle-income countries, virtual RWs are a creative and cost-effective use of web-based technologies to facilitate medical students to contribute to the local and global healthcare research community

Epidemiology of Extended Spectrum Beta Lactamase Producing Gram Negative Rods

OBJECTIVE: To estimate the distribution of ESBL producing capacity among different Gram negative isolates along with specimen and department wise prevalence in a tertiary care hospital. METHODOLGY: This cross-sectional study was conducted at the Microbiology section of Pathology Department, Allama Iqbal Medical College, Lahore, Pakistan, from August 2016 to January 2017. Total of 437 clinical samples were collected from different wards of Jinnah Hospital, Lahore. Sample was cultured on Blood agar, MacConkey’s agar, chocolate agar, CLED agar. After the identification every Gram negative isolate was further processed for the antibiotic susceptibility testing following Modified Kirby Bauer disc diffusion method. ESBL detection was performed by the combination drugs disc method using ceftriaxone + clavulanic acid (30/10 µg) in case of Enterobacteriacae, ceftazidime + clavulanic acid (30/10µg) in case of Pseudomonas species. RESULTS: Among total 437 patients male and female were 61% and 39% respectively, overall 21.5% (94/437) were ESBl producers. Distribution of ESBL producers was as followed Acinetobacter spp 22.3% (31/139), Escherichia coli 37.5% (27/72), Klebsiella spp 31.9% (15/47), Pseudomonas aeruginosa 8.4% (13/154) and Proteus spp 32.0% (8/25). Department wise ESBL positivity was as followed Surgical units 25.6% (32/125) Medical unit 31.9% (30/94), Burn centre 10% (8/80), ICU 20% (8/40) Surgical Allied 11.7% (4/34), Medical Allied 6.2% (2/32), Neurology 36.3% (8/22), Gynaecology 28.5% (2/7) and Dermatology 33.3% (1/3). CONCLUSION: High percentage of ESBL positivity seen in Escherichia coli and Proteus spp, among departments neurology and medical unit is holding maximum positivity. High frequency of ESBL producing Gram negative isolates strongly recommend its detection and management accordingly. It can lead to treatment failures in Gram negative rods associated infections

Plants in vitro propagation with its applications in food, pharmaceuticals and cosmetic industries; current scenario and future approaches

Plant tissue culture technique employed for the identification and isolation of bioactive phytocompounds has numerous industrial applications. It provides potential benefits for different industries which include food, pharmaceutical and cosmetics. Various agronomic crops i.e., cereals, fruits, vegetables, ornamental plants and forest trees are currently being used for in vitro propagation. Plant tissue culture coupled with biotechnological approaches leads towards sustainable agricultural development providing solutions to major food security issues. Plants are the rich source of phytochemicals with medicinal properties rendering them useful for the industrial production of pharmaceuticals and nutraceuticals. Furthermore, there are numerous plant compounds with application in the cosmetics industry. In addition to having moisturizing, anti‐ageing, anti‐wrinkle effects; plant-derived compounds also possess pharmacological properties such as antiviral, antimicrobial, antifungal, anticancer, antioxidant, anti-inflammatory, and anti-allergy characteristics. The in vitro propagation of industrially significant flora is gaining attention because of its several advantages over conventional plant propagation methods. One of the major advantages of this technique is the quick availability of food throughout the year, irrespective of the growing season, thus opening new opportunities to the producers and farmers. The sterile or endangered flora can also be conserved by plant micro propagation methods. Hence, plant tissue culture is an extremely efficient and cost-effective technique for biosynthetic studies and bio-production, biotransformation, or bioconversion of plant-derived compounds. However, there are certain limitations of in-vitro plant regeneration system including difficulties with continuous operation, product removal, and aseptic conditions. For sustainable industrial applications of in-vitro regenerated plants on a large scale, these constraints need to be addressed in future studies

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed