Intracytoplasmic sperm injection and advanced maternal age: Success or treatment failure

Infertility rate documented in Pakistan is 21.9% with only 25% success rate even after procedures like intracytoplasmic sperm injection (ICSI). This rate is further on the decline with enhancement of female age. We aimed to observe the effect of female age on oocyte parameters and reproductive outcome after ICSI. It was done by retrospective analysis of a quasi- experimental design carried out after approval from Ethical review board of Islamabad clinic serving infertile couples from July 2010 to August 2011. The response to ovarian stimulation in (282) females was assessed on the basis of groups, A, B, C and D with age ranges up to 25years; 25.1 to 30years; 30.1 to 35years and \u3e35years, respectively. The outcome was assessed as non-pregnant, preclinical abortion and clinical pregnancy groups on the basis of beta hCG and cardiac activity by trans-vaginal scan. We observed that maximum number of pregnancies 32 (38%) occurred in C group, and least 10 (10%) in group A. There was a statistical reduction in the number of mature and fertilized oocytes as the age advanced from group C to D (p\u3c0.05).This shows that reduction in maturity and fertilization of oocytes with advancement of age recommends early referral of couples to assisted reproductive clinics

EVALUATION OF PHARMACOECONOMICS AWARENESS AND ITS APPLICATION AMONG POSTGRADUATES OF A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL OBSERVATIONAL STUDY

Objectives: Pharmacoeconomics (PE) is a branch of health economics which focuses particularly on the cost and benefit of drug therapy. Postgraduatestudents form the first line of the health care delivery system, especially in government run hospitals; therefore, it is essential that they need to beaware of the concept of PE. The main objective of the study was to assess the extent of knowledge and awareness of PE and its methods of applicationamong medical professionals who are doing postgraduation in various departments.Methods: This study was conducted at Sheri Maharaja Hari Singh (SMHS) Hospital, a tertiary care hospital associated with Government MedicalCollege, Srinagar. Self-administered questionnaire was distributed among 100 students, out of which 78 completely filled questionnaires were finallyused for statistical analysis. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 19, Chicago, IL, USA).Results: It was observed that most of the participants were willing to participate in the study, and a good proportion of them (45%) were awareabout the concept of PE. However, the majority of the respondents had little knowledge about the principles of PE and only 16% of them respondedpositively. When it comes to the application of PE, it was found that only 9% are applying these principles in their day to day clinical practice.Conclusion: There is need to sensitize the health care providers to the concept of PE at undergraduate level so that they will be able to utilize theirknowledge of PE, in their clinical practice in the future.Keywords: Pharmacoeconomics, Postgraduate students, Level of knowledge, Methods of application

Changes in specific activity of ascorbate peroxidase during seed development of pea (Pisum sativum L.) treated with salicylic acid

A field split-split plot experiment in randomized complete block design was conducted during years 2003-04 and 2004-05 to evaluate the effects of salicylic acid (SA) at concentrations of 0, 10-4 and 10-5 M on four pea varieties (Meteor, Climax, Greenfeast and Rondo). Four phenological growth stages were selected of seed and fruit development (BBCH 73, BBCH 77, BBCH 83 and BBCH 88) for enzyme assay. Aqueous SA was applied by three different modes: Seed treatment, seed treatment plus foliar spray and foliar spray. Maximum ascorbate peroxidase (APX) activity was exhibited by the variety Rondo as compared to other three varieties during both years of study. At BBCH 77, all the varieties showed maximum specific activities of APX which gradually decreased in BBCH 83 and BBCH 88 phenological growth stages. The specific activities of APX were recorded as maximum in the pea seeds treated with SA concentration 10-4 M as compared to 10-5 M and 0 M during both years of study. In comparison of modes of application of SA, it was observed that maximum specific activity of APX was in plants which were given seed treatment plus foliar spray (STFS) as compared to only seed treatment (ST) or foliar spray (FS).Keywords: Salicylic acid, BBCH, pea, ascorbate peroxidase, foliar application, Pisum sativumAfrican Journal of Biotechnology Vol. 9(33), pp. 5333-5337, 16 August, 201

Frequency, Indications And Complications Of Pulmonary Artery Catheter Insertion In Adult Open-Heart Surgery Patients Of A Tertiary Care Hospital

Background: Patients presenting for cardiac surgery have unstable cardiovascular disease and haemodynamics with multiple coexisting diseases. Optimal monitoring in the perioperative period is very important for best perioperative outcome. The introduction of the flow-directed pulmonary artery catheter (PAC) into clinical practice is one of the most important and popular advances in the field of cardiac anaesthesia. The objective of the study was to determine the frequency, indications and complications of pulmonary artery catheter insertion in adult open-heart surgery patients.Methods: A Prospective observational study was conducted at cardiac operating rooms and Cardiac Intensive care unit (CICU) of Aga Khan University Hospital for a period of six months from Nov 2015 to April 2016.Two hundred and seven patients were included in this study. PAC was inserted through right/left internal jugular vein or subclavian vein. Complications noted were arrhythmias (atrial and ventricular), right bundle branch block, coiling and knotting, pulmonary artery rupture, and infection up to 72 hours of PAC insertion. Frequency and percentage were computed for gender, comorbids (Hypertension, Diabetes, Chronic kidney disease, Chronic Obstructive Pulmonary Disease) and PAC frequency of insertion, indications and complications were noted.Results: The frequency of PAC insertion was 47.83%. Major indications for PAC insertion were poor left ventricular function, acute coronary syndrome, cardiogenic shock, significant left main disease and valvular heart disease patients. Minor complications were found in 23.22% cases, which included arrhythmia in 19.2% cases and coiling in 4.02%.CONCLUSIONS: TPulmonary artery catheter insertion is a safe technique with useful clinical application in the management of high-risk cardiac surgical patients. The PAC insertion rationale must be standardized to confirm the judicious use

Outbreak of coronavirus disease 2019 (COVID 19) in Pakistan: Psychological impact and coping strategies of health care professionals

Objective: This study was conducted to explore factors that can impact psychological health and coping strategies to help health care professionals (HCPs) to perform their duties.Methods: A cross sectional survey was conducted using structured questionnaire electronically shared with the participants after ethical approval. Descriptive statistics were calculated for socio demographic variables. Chi squared χ2 test was used to compare the responses between different groups of HCPs.Results: Survey was completed by 250 participants. They performed their duties diligently during outbreak but were concerned about their safety, had fear of infecting themselves and their family members. Lack of evidence-based guidelines for patient management, news about pandemic situation through media and to deal with uncooperative patients not willing for quarantine added to their stress. receiving honour and respect from general public in recognition of services, monetary benefit, adequate training to treat COVID-19, provision of personal protective equipment from government were reported as coping strategies for psychological impact.Conclusions: COVID-19 outbreak had psychological impact on HCPs, yet they continued to perform their duties carefully as moral obligation. Continued moral with financial support and acknowledgement of their services by government, organization and general public was reported to have psychological benefit

Rational prescribing practice assessment among resident doctors in a tertiary care teaching hospital: a questionnaire based observational study

Background: One of the important factors in health policy is recognised to be rational use of medicines (RUM). Physicians can influence the health and well-being of patients by prescribing appropriate drug in right doses and they should be taught to prescribe rationally at the earliest of their professional carrier.Methods: This cross-sectional, questionnaire-based study was carried out in SMHS hospital which is a tertiary-care teaching hospital associated with Government Medical College, Srinagar, Jammu and Kashmir, India.Results: Out of 106 resident doctors enrolled in the study, 96.2% respondents were aware about the term essential medicines of India, and 47.6% had National List of Essential Medicines of India available at their work place. When the participants were questioned about the term RUM only 17% of them responded positively, but majority of the resident doctors (88.67%) were aware about the ingredients of the drugs they use to prescribe. Though only 3.7% of our participating doctors always use essential medicines during their prescription writing but majority of them (96.22%) would always use to inform the patient regarding disease, drug therapy and monitoring of drug therapy.Conclusions: Considering the fact that respondents are future prescribers they should be aware of all aspects about RUM and improper knowledge in certain areas of RUM is a matter of concern that needs to be addressed

Learning approaches and performance of medical students

Objective: To identify the best assessment method for medical students with different learning approaches.Methods: The cross-sectional questionnaire-based study was conducted at Bahria University Medical and Dental College, Karachi, from March 2010 to April 2011, and comprised first year medical students. The questionnaire was tailored from the Approaches and Study Skills Inventory for Students on a five-point scale Deep approach, Surface apathetic approach and Strategic approach were assessed through relevant sub-scales. Response to questions was summed for the subscales and main scales for a learning approach. Mean scores for aggregate marks obtained by multiple choice questions, short answer questions, problem-based learning and objective structured physical examination were derived. Coefficient of variation was estimated to find the most reliable assessment method.Results: Of the 100 students enrolled, 98(98%) completed the study. Of them, 51(52%) were girls and 47(48%) were boys. Overall, 70(71.4%) students displayed Strategic approach, and 13(13.3%) showed Surface apathetic approach. Objective structured physical examination had the least variation (12.27) for all approaches whereas maximum variation (14.92) was observed by problem-based learning scores.Conclusions: Assessment by problem-based learning scores was able to demarcate deep learners whereas consistent scores were obtained by objective structured physical examination which failed to discriminate variance in performance by different learners

FSH/LH ratio in females and intracytoplasmic sperm injection

Objective: To observe the effect of follicle stimulating hormone-luteinizing hormone ratio on oocyte parameters, quality of embryo, implantation and clinical pregnancy rate after intracytoplasmic sperm injection.Methods: The retrospective study was conducted at a fertility clinic in Islamabad, Pakistan, and comprised data of primary infertile females who underwent intracytoplasmic sperm injection from June 2011 to March 2013. All subjects had duration of infertility more than two years, and age range was 20-40 years. Follicle stimulating hormone and luteinizing hormone were estimated by enzyme-linked immunosorbent assay on day 3 of the cycle and the ratio was calculated. Groups were stratified on the basis of median ratio into groups I 1.26. SPSS 20 was used for data analysis.Results: Of the 282 females, 143(51%) were in group I and 139(49%) in group II. Pregnancy was acquired by 79(55%) and 22(16%) females in group I and II respectively. The number of retrieved, metaphase, fertilised oocytes, cleaved embryos and endometrial thickness was significantly larger in group I (p\u3c 0.0001).Conclusions: Follicle stimulating hormone-luteinizing hormone ratio less than 1.26 was associated with good oocyte parameters, top quality embryo and implantation after intracytoplasmic sperm injection

Utilization pattern of drugs among patients attending geriatric outpatient department in a tertiary care hospital in Kashmir

Background: Quality and safety of prescribing in older people remains a global healthcare concern and inappropriate prescribing is a major public health issue because of its direct association with morbidity, mortality and wastage of health resources in this age group. Very limited data is available on the drug utilization pattern in geriatric population and the present study was carried out to see the prescription pattern in geriatric population in this part of the world.Methods: The present study was conducted by the department of pharmacology in outpatient department of geriatrics in a tertiary care centre to look into the prescription pattern among geriatric age group.Results: A total of 237 prescriptions were collected, out of which 108 (45.56%) were males and 129 (54.44%) were females. The majority of the patients were in the age group of 60-69 years (n=141, 59.5%). The most commonly found comorbidity was hypertension (63.29%) and antihypertensive agents (74.68%) were the most frequently prescribed class of drugs. Calcium (37.57%), budesonide (32.91%), thyroxine (27.84%) and pantoprazole (25.31%) were the most common individual drugs prescribed.Conclusions: Like other studies on geriatric population polypharmacy was also observed in the present study and periodic therapeutic audit is essential to ensure rational medicine use