The Conundrum of Medical Writing

Writing is an art. Medical writing is an amalgamation of art with science. Not all medical writers have the inherent capability to pen down their work. For some it is a source of contentment, happiness, and authorization whereas it’s a hard nut to crack for others, requiring additional efforts to accomplish this uphill task. Future medical writers confront many challenges before they embark upon this worthwhile endeavour.Some may not realize its importance; others simply enter into the world of bewilderment as to how to start. Yet others are well versed with the subject but just cannot pen it down and the majority cannotsqueeze their time in because of their hectic daily routines. In order to counter these challenges, one has to overcome the conundrum of medical writing. Why to Write?Medical writing is an essential feature of evidencebased medicine and is mandatory for progress in the medical profession. Apart from religious, international, national, institutional, and professional gains, the honor, regard, and respect a medical writer earns in the scientific world is priceless. High research scores, h-indices, portfolios, citations, and references quoted by other researchers and writers elevate you to unfathomable heights. Your work creates an opportunity for others to get benefit from the work done and the medical knowledge grows in a stepladder fashion. Ultimately the main aim i.e. Benefit humanity also fulfilling the divine requirement for a Muslim medical writer.This qualm of writers' hesitancy can have devastating effects on the professional career of a writer. Age limit constraints, fear of losing an opportunity to appear in examinations on time, poor prospects for gaining senior posts and promotions, etc. can be detrimental to the psychosocial well-being too. This initiates the unfortunate vicious circle causing further delay or even abandonment of work. This state of affairs could be demoralizing for a doctor who is otherwise humane, hardworking, conscientious, and has been courteous to patients. Even his research could be an extraordinary work but he is unable to put it down in black and white. The medical writers have to trounce over this perplexing situation by getting acquainted with the essence of writing. The significance of Medical writing cannot be undermined as it forms the basis of development, evolution, and progress in the medical field. It is the only preservable way of transferring knowledge to others. The importance of gaining knowledge and preserving it is very well depicted and stressed in Islam. The first Divine word “IQRA” and the second revelation related to “THE PEN” is ample evidence. Numerous Hadiths stress gaining knowledge and preserving it. I quote one Hadith “TAQYID Al ILM”, {define, preserve and record knowledge by ‘writing it down}’

University Faculty Development Program at Rawalpindi Medical University

Faculty development program refers to all activities taken up by the faculty in an institution targeting their development, both personal and professional, and finally implying the growth of the institution.1 The last two decades have witnessed dramatic changes in various fields of life. In the field of medicine, a paradigm shift has been observed from individualized and conventional approach to evidence based strategies. In Pakistan, the mushroom growth of medical colleges has occurred. The standard of education has deteriorated and recently some new universities have appeared on horizon. In order to thrive, they have to meet these challenges amicably. For a university, the continuous endeavour to excel is mandatory in order to accomplish its goals. They are no longer an institution that imparts degrees, rather they have to focus on improving and improvising medical education, conducting purposeful research and imparting best possible services to the patients and the society. In Pakistan, there is not only a shortage of school teachers but the medical teachers also. Doctors, who join the medical university as teachers, may not be well versed in teaching skills, although they may be good clinicians. As the students of today belong to generation Y, the changes they have observed in last two decades are substantially more in absolute quantity and magnitude than their precedents. Consequently, the generation Y (the millennial) have a higher processing capacity, are more complex and more sophistication than the older generation X (born in 1960-1980). The world has become smaller and sharper, with better resolution and better internet speed. Thus, there is a communication gap between the students and the teachers. Therefore, there is a dire need to change teaching strategies. The curriculum needs to be updated and better aligned to today’s needs. The assessment tools must be revised and more technology-oriented delivery needs to be incorporated rather than the conventional lectures strategy. Thus, improvement in teaching strategies will enhance the quality and capability of graduating doctors. The second challenge faced by the professionals is the patient care, which has to be evidence based. This requires solid evidence through research. The university has to provide an environment where research culture prevails. From Pakistan, the number and quality of medical research articles is far behind that of even the neighbouring countries.2 A dedicated department with adequate staff is mandatory to fulfil this gap. A constant support to the researchers at faculty level is required not only to refresh their knowledge but also to familiarize them with statistical and medical writing capabilities. High quality research brings credentials to the university and improves individual’s portfolio apart from delivering best service to patients. Moreover, the role of university also encompasses the grooming of the professional as a mentor, a leader, a supervisor and an administrator. It is a multifaceted prism that needs to be enlightened.            The faculty is an asset of the university. Highly professional faculty will self-perpetuate quality research as well as academic excellence. Ultimately, the university ranking improves as the national and international standards are met. High ranking universities act like a magnets and attract highly motivated professionals who enter into a structured system and contribute positively. The universities although are fully aware of the need but often there is a difficulty in implementation.  How to start the program and how to devise a curriculum are big challenges for the faculty of a newly formed universities due to lack of faculty development programs. Rawalpindi medical university (RMU), although being only few months old, has devised a fully structured faculty development program (UFDP) with five main domains to be addressed, i.e. medical education, research, administrative skills, supervisory & leadership skills and patient care.3 Both formal and informal methods are being employed. The strategy focuses more on workshops of one to two days, being conducted regularly throughout the year, symposia, guest lectures, seminars and theme based grand rounds. UFDP upholds the motto of the University i.e. “Wisdom, Truth and Service”. Highly trained and professional faculty of the University has not only won credentials at national and international level but also contributes in escalating the ranking of the University globally. Moreover, the first and the foremost aim of a professional doctor is explicitly achieved, as ‘the patient deserves the best’. The learning objectives, need assessment, audit, quality assurance, feedback, tangible scoring, monitoring, supervision and funding of the workshops were finalized under the able advice of Vice Chancellor, RMU.4 The UFDP of RMU is expected to serve as a role model for other universities so that they can move closer to their cherished goals

Platelet Distribution Width: A Severity Marker Of Pre Eclampsia, Experience At Tertiary Care Hospital

Objectives: To determine mean platelet distribution width in patients with pre-eclampsia. Study design: This is a cross-sectional, descriptive study performed in the Department of Obstetrics and Gynecology, Benazir Bhutto Hospital, Rawalpindi, retrospectively from 01 May 2017 to 01 November 2017 by non-probability consecutive sampling technique. Materials & Methods: A total of 150 pregnant females with mild and severe pre-eclampsia with gestational age > 20 weeks, and an age limit of 18-40 years were included in the study. Patients having deranged coagulation or multiorgan involvement were excluded. Blood and urine samples were collected at the time of presentation. All the blood pressure readings were confirmed by two readings 4-6 hours apart. Mean ± SD was used to express data values. The mean PDW value was calculated for pregnant females with mild and severe preeclampsia. Results: In our study Mean PDW in patients with preeclampsia was 15.86± 0.34. The mean PDW for mild preeclampsia was 15.8± 0.35 and for severe preeclampsia 15.98±0.28.. Conclusion: PDW is a useful marker for the prediction of the severity of preeclampsia before the disease progresses to severe preeclampsia and HELLP. Raised values can help the obstetrician to actively manage the patients in time to reduce maternal and fetal mortality

Enhanced production of butyric acid by solid-state fermentation of rice polishings by a mutant strain of Clostridium tyrobutyricum

Purpose: To enhance butyric acid production by solid-state fermentation with a hyper-producing mutant of Clostridium tyrobutyricum generated by random mutagenesis.Methods: Wild type C. tyrobutyricum was mutagenized with UV irradiation, nitrous acid, and ethidium bromide to obtain a hyper-producing strain. Various physiochemical parameters were optimized to increase the butyric acid yield.Results: The UV-induced mutant (C.TUV) produced significantly higher concentrations of butyric acid than the wild type parent, nitrous acid-induced, and ethidium bromide-induced strains. C.TUV increased butyric acid production 1.4-fold more than the parent strain. Fermentation with C.TUV with 2.5 g of rice polishings (w/w), a 2 % inoculum volume (v/v), and a 48-h incubation period at 37°C under anaerobic conditions produced 11.63 mg/100 g of butyric acid. The addition of 0.6 % corn steep liquor as a nitrogen source increased the butyric acid concentration to 26.09 mg/100 g.Conclusion: These optimized fermentation parameters on a small scale can be used on a commercial scale to mass-produce butyric acid.Keywords: Butyric acid, Mutant, Clostridium tyrobutyricum, Mutagen, Solid-state fermentatio

Uterine Rupture : A Catastrophic Complication

Background: Lack of antenatal care , injudicious use of oxytocin/prostaglandins , delivery by unskilled birth attendants and caesarean sections in previous pregnancies can lead to rupture uterus Methods: In this Prospective observational study, 30 cases of uterine rupture were included. Risk factors, clinical presentations, operative findings and post operative complications were recorded. Results: The incidence of uterine rupture was 0.24% in present study. Most of the patients were nonbooked (86.7%), and came from rural area (76.7%). Common risk factors for uterine rupture were women with previous caesarean sections (86.7%), injudicious use of oxytocin and prostaglandins (33.3%), labour supervised by unskilled birth attendant (86.7%), trial of labour conducted outside the hospital (93.3), grandmultipara(16.7%) and prolonged obstructed labour(23.3%). Shock (36.7%) and sudden loss of uterine contractions (33.3%) were the commonest presentations. Lower uterine segment was involved in 83.3% cases. Repair of the uterus was possible in 80 % cases.Peripartum hysterectomy was done in 20 % cases. Blood transfusion was required in all the cases (100%) and fresh frozen plasma in 50%cases. .There was no maternal death. There were 28 cases of stillbirths, 26 fresh and 2 macerated. Only 2 fetuses were born alive out of which 1 died within 24 hour contributing to perinatal mortality of 933.3per 1000 live births. Conclusion: Injudicious use of Oxytocin/prostaglandin, history of previous caesarean section and labour supervised by unskilled birth attendants can increase the risk of uterine rupture

Optimized production of tannase and gallic acid from fruit seeds by solid state fermentation

Purpose: To investigate the possibility for gallic acid production from different tannin-rich fruit seeds using Aspergillus oryzae via solid-state fermentation. Methods: Fruit seeds of apple, guava, tamarind, black plum and watermelon were analyzed to estimate the synthesis of an enzyme tannase and its product gallic acid. Various physicochemical parameters were optimized to increase the gallic acid yield. Gallic acid was extracted by Soxhlet apparatus and identified by Fourier-transform infrared spectroscopy (FTIR). It was quantitatively determined by high performance liquid chromatography (HPLC). Results: Amongst the various substrates tested, black plum seeds gave the highest activity of 34.40 U/g for tannase and 16.66 mg/g for gallic acid under optimized physicochemical conditions, i.e., 1:3 substrate: moisture ratio, 30 °C, 96 h incubation period and pH 5.5. Addition of carbon source had a negative effect on production while ammonium sulphate (0.2 %) as nitrogen source increased the yield of both products. The gallic acid produced was 98.5 % pure, compared to the standard. Conclusion: Production of tannase and gallic acid via solid-state fermentation conditions has been optimized in vitro. The optimized conditions can be utilized on a commercial scale for economically viable production of gallic acid

Corrosion mechanisms of 304L NAG in boiling 9M HNO3 containing Cr (VI) ions

In this research, the mechanisms of end-grain corrosion of 304L NAG tubes in boiling 9M HNO3-containing Cr (VI) ions are reported to sustainably manage the corrosion of nuclear fuel reprocessing plant components. Specific heat treatments were applied to as-received specimens to produce phosphorus and/or sulphur intergranular segregation. End-grain corrosion on heat-treated specimens and the effect of a Cr (VI) concentration on a 304L NAG tube (as-received) were investigated. It has been reported that an increase in Cr (VI) ions leads to the acceleration of end-grain corrosion due to high electrochemical potential. After systematic heat treatments on the 304L NAG specimens, it is concluded that the primary causes of heat-induced end-grain corrosion are phosphorus or sulphur segregation to the grain boundaries. The key findings of this research are highly significant in terms of understanding the corrosion mechanisms and controlling the end-grain corrosion of NAG steel in boiling HNO3 environments. This research will help to sustainably reduce power plant maintenance costs and will have a significant impact on the delivery of long-term, clean, secure, and tenable energy

A Mosaic of Risk Factors for Female Infertility in Pakistan

Background: To identify different risk factors for female infertility including hormonal imbalance (FSH, LH and Prolactin) Methods: Infertile women were enrolled in this prospective study. A questionnaire was designed to collect information regarding socio-demographic and clinical characteristics of the study participants. Serum FSH, LH and Prolactin levels were estimated between 1-5 days of post menstrual period. Independent sample t- test, Spearman correlation and multivariate logistic regression were performed to find the association of different risk factors with female infertility. Results: Highest percentage (57.7%) of infertile females was in the age bracket of 26 to 35 years. The prevalence of primary infertility was 60.4% . Mean levels of LH and prolactin were significantly higher in women with primary infertility compared to those with secondary infertility. No significant difference was observed in the mean level of FSH . A significant positive correlation was found between infertility and age , marital history and infertility duration. On multivariate logistic regression analysis women with secondary infertility were more likely to be hypertensive(OR=2.126,95%CI:1.020-4.474, p-value0.044), using contraceptive OR = 5.876, 95% CI: 2.491–13.86, p-value .001),have hyperprolactenemia (OR=1.289,95%CI:0.960-1.996,p-value0.001) and have marital history of more than 16 years OR=12.166,95%CI:5.048-29.322, p-value0.001). Conclusion:Highest prevalence of infertility was seen in the age group of 26-35 years. Advanced age, hypertension, hyperprolactemia, use of contraceptive and marital history of more than 16 years are significantly associated with female infertilit