Pakistan Medical Research Articles

EFFICACY OF INDUCTION CHEMOTHERAPY WITH PACLITAXEL AND CARBOPLATIN IN LOCALLY ADVANCED SQUAMOUS CELL CARCINOMA OF THE HYPOPHARYNX: A DESCRIPTIVE CASE SERIES

Introduction: Head and neck cancer including hypopharyngeal carcinoma is one of commonest malignancies in Pakistan. According to the Pakistan Medical Research Council (PMRC) reports, it was found to be the commonest malignancy in males and was second highest to breast cancer in females. The patients for the management of hypopharyngeal cancer present with locally advanced disease. Induction chemotherapy with paclitaxel and carboplatin is being used for few years but the results have not been documented yet. The aim of this study is to design a protocol in future with improved outcome and acceptable morbidity. Objective:To determine the efficacy of induction chemotherapy with paclitaxel & carboplatin in locally advanced squamous cell carcinoma of hypopharynx in terms of frequency of complete and partial response. Settings:This study was conducted at Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad. Study Design: Descriptive case series. Duration of study: 6 months from 01/08/2017 to 31/01/2018 Material and methods:In this study a total of 59 patients were observed by using World Health Organization sample size calculator where confidence level: 95%, anticipated population proportion: 67%, relative precision: 12%. Moreover, nonprobability consecutive sampling technique was used for sample collection. Results:Mean age was 60 ± 11.87 years. 40(68%) patients were males while 19(32%) were females. 22(38%) patients had carcinoma of stage III, 32(54%) patients had carcinoma of stage IVA while 5(8%) patients had carcinoma of stage IVB. Moreover, induction chemotherapy was effective in 42(72%) patients and was not effective in 17(28%) patients. Conclusion:Our study concludes that induction chemotherapy with paclitaxel & carboplatin was 72% effective in locally advanced squamous cell carcinoma of hypopharynx in terms of frequency of complete and partial response.

Personal reflections on basics of research workshop conducted by Journal of Pakistan Medical Association (JPMA).

Recognizing the importance of research in a medicalstudent's life, we were thrilled to volunteer as organizersfor JPMA's research workshop for undergraduate medicalstudents. This five-week long program, held on consecutiveSaturdays, commencing from 18th May 2024, aimed toequip participants with the fundamentals of research. Tomaintain the quality of the workshop, the participant poolwas kept limited to fourteen only. The workshop was heldat the premises of PMA. Every session consisted of twoclasses, each an hour long with a brief lunch break inbetween. Besides broadening our understanding onresearch basics, we hoped to gain valuable leadership andcommunication skills through this organizing experience. Continued...

Navigating undergraduate medical education: a comparative evaluation of a fully online versus a hybrid model

BackgroundThe evaluation of undergraduate medical curricula plays a crucial role in ensuring effectiveness and helps in continuous improvement of the learning process. This study aims to compare the effectiveness of online and hybrid teaching models of the first-year MBBS curriculum in the COVID-19 era (2019–20) and the para-COVID-19 pandemic (2020–21).Study methodologyMixed methods study with CIPP model was used. Data was collected by administering a survey and focus group discussions (FGDs) with first-year students from the 2019–2020 and 2020–2021 cohorts, faculty and administrators, which were recorded for analysis. Recorded lectures, guidebooks, planners, and question papers were also scrutinized for quality and adequacy. Furthermore, admission merit, module assessments, and professional examination results were compared and correlated. The learning environment was evaluated through the questionnaire (validated and used by Pakistan Medical and Dental council for inspections of medical schools) and the facilities provided in both years were juxtaposed. The study utilized NVIVO for qualitative and SPSS version 23 for quantitative data analysis.ResultsContextual analysis underscored the critical need for online teaching during the COVID-19 pandemic, with provided resources being deemed sufficient. Notably, the student-faculty ratio stood at 4:1, and essential resources were readily available. The fully online batch outperformed the hybrid teaching class in 2020–21. Process analysis revealed successful session delivery in hybrid and online through webinars and Zoom, accompanied by timely provision of study guides and punctual assessments. Moreover, examination papers demonstrated acceptable reliability (Cronbach’s alpha: 0.61) in core subjects. Product analysis indicated that the 2020–21 cohort performed better in modular and professional examinations across all subjects (P < 0.01) despite their lower admission merit compared to the 2019–20 batch.ConclusionsThe study revealed challenges faced during total online teaching, highlighting knowledge and skills gaps in students. While students favored hybrid teaching for interaction, faculty preferred online strategies and suggested blended learning. The administration recognized faculty’s swift transition but stressed the need for blended learning workshops and strengthening the medical education department. Recommendations include implementing blended learning strategies, conducting faculty workshops, equipping the medical education department for online teaching, and gathering student feedback after each module to enhance the curriculum.

The current status and challenges of bioethics education in undergraduate medical education in Karachi, Pakistan

BackgroundThe importance of including bioethics in the medical curricula has been recognized globally. Certain countries including Pakistan continue to lag behind although some developments have occurred recently.ObjectivesThe research aimed to provide a snapshot of bioethics education in undergraduate medical colleges in Karachi, Pakistan. The secondary objectives included identifying factors promoting or inhibiting integration of bioethics into the curriculum.MethodsA two-pronged strategy was used to collect data including a website review of medical colleges, in existence for more than ten years, recognized by the Pakistan Medical and Dental Council (PMDC), the regulating body for undergraduate medical education in Pakistan. The other arm employed in-depth interviews with medical educationists in colleges fulfilling inclusion criteria. Data from the website was analyzed and presented as frequencies. Qualitative data was analyzed using content analysis method which involved coding of transcripts, multiple readings and arriving at subthemes and themes iteratively.ResultsThirteen medical colleges were included for the website review, of which four were from public sector. Three medical colleges used the word “ethics” in their vision and mission statement and four had provided a detailed curriculum for ethics on their website.Thematic framework included four broad themes: 1) Need for Bioethics Education, 2) Current Status of Bioethics Education 3) Challenges in integration of bioethics in medical curriculum and 4) Recommendations for integration of bioethics in the Curriculum. Participants were in agreement that bioethics was important in development of future physicians. Participants identified various challenges, foremost being shortage of trained faculty, lack of institutional buy-in and overcrowded curriculum.ConclusionThe study identified sporadic inclusion of bioethics in undergraduate medical curricula, left to the discretion of individual institutions. Since Karachi is a cosmopolitan city, the findings may reasonably reflect the situation in other parts of the country. While bioethics is recognized as an important field, it will continue to remain an orphan subject in the curricula unless the regulatory and accreditation bodies make it compulsory for institutions to include ethics in their curricula.

Weaving Stories into Education: An Urgent Need to Integrate Narrative Medicine into Pakistan's Medical Curriculum.

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Vitamin D and Lipid Profiles in Infertile PCOS and Non-PCOS Females.

This research is aimed to explore the relationship between vitamin D and lipid profile in females with PCOS and non-PCOS infertile female subjects. Comparative descriptive study. Place and Duration of the Study: Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan and Jinnah Postgraduate Medical Centre, Karachi, Pakistan in collaboration with the Australian Concept Infertility Medical Centre, from February 2021 to March 2023. A total of 180 infertile women with 120 PCOS and 60 non-PCOS were enrolled. The lipid profile and BMI of the patients were acquired from desk records, and vitamin D was estimated by enzyme-linked immunosorbent assay (ELISA). Participants were classified according to their vitamin D levels as sufficient (30-100 ng/ml), insufficient (20-29 ng/ml), or deficient (below 20 ng/ml). Median, interquartile range, frequency, and percentages were described. Statistical significance was calculated by Mann-Whitney U and Chi-square tests with p-values of 0.05. Females with PCOS had significantly low vitamin D (p <0.001). Total cholesterol, low-density lipoprotein, very low-density lipoprotein, and triglyceride levels were significantly increased, and high-density lipoprotein cholesterol (HDL) was less in comparison to the non-PCOS group (p <0.001). A significant increase in total cholesterol, triglycerides, low-density lipoproteins, and very low-density lipoproteins was found in the vitamin D deficient subgroup compared with insufficient or sufficient groups (p = 0.05). The study provides a link between females with PCOS and abnormalities in lipid profile. Decreased vitamin D levels in females with PCOS were linked with an abnormal lipid profile characterised by rise in cholesterol, triglycerides, and low-density lipoproteins which may lead to metabolic abnormalities. Vitamin D, Polycystic ovary syndrome, Metabolic syndrome, Body mass index, Lipid profile.

Beyond bereavement: Identifying risk and protective factors for prolonged grief disorder

Prolonged Grief Disorder (PGD) manifests as a long-lasting and incapacitating response to bereavement. The goal of this qualitative study is to understand the intricate interplay of risk and protective factors that underlie PGD by exploring into the perspectives of expert clinicians in Pakistan. Our investigation encompassed in-depth interviews with eight clinical experts comprising clinical psychologists (N = 4, possessing Higher Education Commission-recognized degrees) and psychiatrists (N = 4, certified by Pakistan Medical Commission). Collectively, these professionals possessed a wealth of knowledge exceeding five years in the specialized management of PGD. Thematic analysis of the transcribed interviews, conducted using NVIVO, revealed a comprehensive taxonomy of risk factors contributing to PGD. These encompassed maladaptive thought patterns, psychological distress, attachment styles, and environmental factors. We identified a host of protective factors that may mitigate the development of PGD. These encompassed cultural, social, and familial support systems, individual coping mechanisms, and various treatment modalities.

Overcoming barriers to meaningful research in Pakistan: charting a path forward

Research is the most unwanted, and orphaned part of every discipline in Pakistan. Pakistan Medical &amp; Dental Commission, Higher Education Commission (HEC) or numerous medical universities in the country have been responsible for promoting research, but their responsibilities are finished after counting the number of published papers by any candidate for promotion. HEC has developed a software - called HJRS, but you visit this site and find a jumbled-up data which is four years old. Out of 58 listed Pakistani medical journals only 4 are in ‘W’ category. Many of the journals have been derecognized, but listed. Research related software like plagiarism check, reference actuality check, reference accuracy check, language etc. are hard to find by the average researcher. ‘Anaesthesia, Pain &amp; Intensive Care’ was started in 1997, with the objective to foster the culture of research in the members of the neglected specialty of anesthesia, and the journal engaged renowned research fellows to write on the research related topics and published. This invited editorial sheds some light on the barriers to research and the suggested measures to promote research in Pakistan. Keywords: HEC, Pakistan, Research, Research paper, Software Citation: Hussain SA. Overcoming barriers to meaningful research in Pakistan: charting a path forward. Anaesth. pain intensive care 2024;28(4):611−615; DOI: 10.35975/apic.v28i4.2497 Received: 22 June 2024; Accepted: July 05, 2024

COMPARISON OF RADIATION SAFETY PRACTICE AMONG DENTISTS IN THE UNITED KINGDOM AND PAKISTAN

Objectives: This study aims to investigate the radiation safety awareness, attitudes and practice amongst dentists practicing in the U.K and compare them to dentists practicing in Pakistan. Materials and Methods: This was an observational and descriptive study utilizing self-reported questionnaires consisting of 15 MCQs distributed electronically to dentists registered with G.D.C. in the U.K. and the Pakistan Medical and Dental Council, P.M.D.C. in Pakistan, and who are currently practising as a dentist in the appropriate country. Results: There were 102 respondents from Pakistan and 119 from U.K. Within the U.K 84% reported that they received training regarding radiation protection within the past two years. In Pakistan only 6.9% reported receiving such training. In Pakistan 42.2% felt that the X-Ray equipment was periodically serviced whilst 95% in the U.K.indicated their equipment was periodically serviced. In Pakistan 52% responded that there was a radiation safety plan in place whilst 95.8% of U.K. respondents reported the same. In Pakistan 18% of the operators held the image receptor themselves during intra-oral X-Ray whilst none of the U.K respondents reported doing the same. Conclusion: Within Pakistan there is a need for increased training regarding radiation safety for dentists. There is also room for improvement in training U.K. based dentists on radiation protection. There is a risk that Pakistani dentists are exposing themselves to un-necessary levels of radiation which may have long term consequences to their health. Maintenance of X-Ray equipment in Pakistan as well as presence of radiation protection plans are alarmingly low.

Needs analysis for an undergraduate dental curriculum in KPK, Pakistan: Gap identification and general needs assessment.

Dental institutes continue to face challenges in making the transition from a discipline-based to an integrated curriculum. The need analysis is often the first step in the development and implementation of any curriculum. This study intends to carry out a needs analysis for a contemporary dental curriculum in private and public sector dental colleges of Peshawar, KPK, Pakistan. The mixed method study was carried out at public and private dental institutes in Peshawar from April to July 2022. To guarantee triangulation, data were gathered from three sources. The first source was an analysis of the Pakistan Medical and Dental Council's dental curriculum accreditation standards. The second source was gathering the experts' perspectives, and the final source was a systematic literature search to explore the necessity for an integrated undergraduate dental curriculum from the experiences and expertise of contemporary curricula. Thematic analysis identified the need for the dental curriculum to be a five-year BDS program, involvement of students, and inclusion of digital dentistry and environmental sustainability in the dental curriculum. PMDC accreditation standards focus on alignment in mission, vision, curricular outcomes, an integrated curriculum, and a quality assurance system for assessment. Experts identified the need for a patient-centered curriculum focusing on integrated patient care. They also identified that the current educational environment should be improved to sustain a contemporary dental curriculum in Pakistan. For the literature review, nine articles were included in the final review. The current dental curriculum is not accommodating to the needs of the students in Peshawar. The current dental education environment lacks the infrastructure, logistics, and teacher training to sustain the standards set by PMDC.

CME providers’ experiences and practices in Pakistan: a case study

BackgroundPakistan has made numerous attempts to establish and implement a national mandatory CME program which currently do not exist. The purpose of this study is to explore the views of major CME providers in order to identify possible strengths and weaknesses in the current program, and offer evidence-based recommendations to help further enhance the national CME program in Pakistan.MethodsAn exploratory study design using a case study approach through in depth interviews was conducted to examine CME providers’ experiences and perceptions. The study was conducted in Pakistan between August and November 2019 with CME providers from Sindh, Punjab, the North-West Frontier Province, and the Federal Capital Territory. Thirty-six providers recognised by the Pakistan Medical and Dental Council who were involved in providing CME activities at the national level and whose contact information was publicly available on their websites, were selected for the study. Of the 36 providers invited, 22 participated in this study.ResultsThe results generated several organising themes grouped into three major themes: (1) CME current practices, (2) CME past experiences, and (3) Future developments.ConclusionParticipants recommended needs-based educational activities for physicians, a well-structured central regulatory CME body collaborating with existing providers, involving experienced providers for rural CME, accrediting diverse local providers, limiting commercial entities’ role, and implementing CME with proper preparation and a phased approach.

Journey and Experience of an Editor

I had been a member of the editorial board of the Journal of Saidu Medical College (JSMC) for the last 7 to 8 years. Looking back through this period, i grade it a pleasant experience. When I joined the team of JSMC, the journal was passing through its childhood to adulthood period. The hard work of registering it with Provincial Information Department and having the International Standard Serial Number (ISSN) number, already done as well as provisional recognition with Pakistan Medical &amp; Dental Council (PMDC) was also accomplished. Yet a lot was still ahead and required as is usual with the scientific journals. I would like to appreciate the hard work of the pioneers and the struggle and commitment of the present team members, whose commitment has nurtured this young sibling to a fruitful tree. This journal is now indexed and registered with different national agencies like, Higher Education Commission, Pakistan category 'Y', College of Physician &amp; Surgeon of Pakistan, Pakistan Scientific &amp; Technological Information Centre, PakMediNet.com, and also has gained recognition at international level like; Member of Crossref to assign Digital Object Identifier (DOI) to each article, Following Creative Commons license for international acceptability, giving internationally recognized reviewer credits via Reviewer Credits.com, member of Eastern Mediterranean Association of Medical Editors (EMAME) and Index Medicus Eastern Mediterranean Region (IMEMR).

First Death Anniversary of Prof. Dr. Muhammad Aslam khan (1932-2023)

Prof. Dr. Muhammad Aslamkhan died peacefully on February 20, 2023, in Lahore, Pakistan. Prof. Aslamkhan was the founding head of the Human Genetics and Molecular Biology Department of the University of Health Sciences Lahore (UHS). He was also a Director of Sports and cocurricular activities at the UHS. His services to UHS were brought by the Higher Education Commission’s project entitled “strengthening of basic medical sciences at UHS, ” commonly known as SBMS as a project director. This project not only brought a lot of funding for the establishment of research facilities at the UHS but also employment opportunities for young people. Prof. Aslamkhan received his Doctorate of Science (D.Sc.) in Genetics and Anthropology from Johannes Gutenberg University in Mainz, Germany, in 1963, after his master's degree from Punjab University (1953). He was among the founding fellows of the Biological Society of Pakistan (1956) and the Zoological Society of Pakistan (1968). In 1968, he was awarded the Fellowship of the Royal Society of Tropical Medicine and Hygiene, London. Later, the Pakistan Academy of Medical Sciences awarded him a fellowship in 1985. His professional services include academic and research affiliations with the provincial bodies of Punjab, Khyber Pakhtunkhwa, and East Pakistan (now Bangladesh). He served as Deputy Chief for the Division of Medical Entomology of the International Center for Medical Research and Training (ICMRT) at the Pakistan Medical Research Center, Lahore. Later, he became the Chief of Malaria Vector Research at ICMRT. This was the time when he studied the bionomics of mosquito species in Pakistan, which serves as a reference (1). While affiliated with the University of Maryland School of Medicine, he extended his research towards vector-borne diseases of public health importance (2-10). After retirement from the University of Maryland, he worked as an independent consultant for several national and international bodies. Later, he joined the Higher Education Commission’s project SBMS as Project Director. During this affiliation, he also launched the first department of Human Genetics in the country at UHS Lahore. This department is still operational and produces many PhDs in human genetics, working at various reputable organizations in and outside the country. The department’s objective was to study the basics of genetic diseases in the country, and it has been doing very well until today. Prof. Aslamkhan’s research on genetic diseases has mainly focused on the role of consanguinity in gene pooling in the Pakistani population (11-13). Over the past several years, he has also voluntarily offered genetic counselling to patients with hemoglobinopathies at Sundas Foundation Lahore. He also studied the public health dynamics of blood donors at the Sundas Foundation in addition to genetic counselling (14, 15). He was also recognized as an Eminent Professor of Genetics by Higher Education Commission. In 2017, he founded The International Journal of Frontier Sciences and became its first editor-in-chief until he died last year. I am publishing this obituary at his first death anniversary on February 20, 2024, praying for his eternal peace. I wish him to rest in peace in his life in hereafter. Ameen!

Bumping along: Healthcare students' perspectives on interprofessional education

Background: Global regulatory bodies and the PM&amp;DC (Pakistan Medical and Dental Council) share a competency framework that emphasizes the importance of graduates being effective communicators and collaborators in the healthcare system to achieve positive patient outcomes. However, due to unclear roles, conflicting power dynamics, and varying educational qualifications among healthcare professionals, effective interprofessional teamwork is often not realized, leading to suboptimal outcomes. Objective: To evaluate the attitudes and readiness of healthcare students towards inter-professional education. Methods: This comparative cross-sectional study was conducted from March to August 2020 by utilizing a prevalidated inventory called the Readiness of Interprofessional learning scale (RIPLS) to assess the readiness of students in healthcare programs. Data was collected using Google Forms, and the Kruskal-Wallis Test was employed to compare perceptions among the four groups. Results: 157 students completed the questionnaire, resulting in a response rate of 58%. All four groups demonstrated high readiness for mutual learning (mean rank=78.78) although physiotherapy students had higher scores (mean rank=79.36) compared to the other groups, while nursing students had the lowest scores (mean rank=77.92). Conclusion: The positive attitude of students towards interprofessional education and collaboration highlights the need for integration with other healthcare disciplines at both the curricular and co-curricular levels. Clinical case studies, problem-based learning, and simulations can be effective methods for fostering students' understanding of each profession's role.

Impact of unstable environment on the brain drain of highly skilled professionals, healthcare workers, researchers, and research productivity in Pakistan.

The geo-strategic position of Pakistan on the world map is incredibly important and idyllic as the country is considered the gateway to central Asia. Pakistan has faced political instability for the last three decades, causing a brain drain and adversely affecting socioeconomic growth. This study aims to investigate the impact of an unstable environment on the brain drain of highly skilled professionals, healthcare workers, researchers, and research productivity in Pakistan from January 2000 to December 2022. The data were recorded from the World Bank, the Higher Education Commission (HEC) Pakistan, the Pakistan Medical and Dental Council (PMDC), the Bureau of Emigration and Overseas Employment (BEOS), Pakistan, Academic Ranking of World Universities (ARWU), and Web of Science Clarivate Analytics. Initially, 32 documents were selected in this study, and finally, eight fact sheets, official government websites, and international organizations were included. The result revealed that due to political instability, in 2022 about 832,339 highly qualified and accomplished experts headed abroad, among them 17976 (2.15%) were highly qualified and 20865 (2.50%) were highly competent professionals. These include accountants 7197 (0.86%), engineers 6,093 (0.73%), agricultural experts 3,110 (0.37%), doctors 2,464 (0.29%), computer experts 2,147 (0.25%), nurses and paramedics 1768 (0.21%), technicians 23347 (2.80%), electricians 20322 (2.44%), and schools and university faculty 1004 (0.12%). Pakistan has a total of 380 Higher Education Commission-indexed academic journals, among them 11 (2.89%) academic journals were indexed in the Web of Science and 23 journals were placed in the Web of Science emerging indexing. Among these journals, only one journal surpassed the impact factor of more than 2.0. The quartile ranking of Pakistani journals is 01 journal in Q2; 02 in Q3; and the remaining 08 journals in Q4. From August 1947 to December 2022, Pakistan produced a total of 259249 research articles, and from January 2000 to December 2022, the number of articles published was 248457 (95.83%). Since the last 22 years, the trend of research publications was continuously increased; however, the rising trend decreased in 2022 with a declined rate of 1263 (3.42%). The unstable sociopolitical environment in Pakistan caused a brain drain of highly qualified and skilled professionals and impaired the global standing of universities, academic journals, and research productivity in Pakistan. Pakistan must resolve the instability and establish sustainable policies to minimize the brain drain of highly qualified and skilled experts and convalesce their academic institutes and their research productivity for the development of the nation.

The State of Artificial Intelligence and its Prospects in Pakistan's Medical Sector

The State of Artificial Intelligence and its Prospects in Pakistan's Medical Sector

PAKISTAN PSYCHIATRIC SOCIETY: A REFLECTION OF EARLY YEARS

It is nostalgic to recall formative years of the society for the reason that we psychiatric met in different cities of West and the then East Pakistan (now BanglaDesh) to ponder and agree to set up this society. We should be grateful to the Pakistan Medical Association, our national and parent bowly because it was during its annual and biennial conferences that few of us psychiatrists first met to share our frustrations regarding the sate of mental health and psychiatric profession in At a time when our morale was at its lowest ebb and in an attempt to overcome our inhibitions, we, during one of the bigger ventures of Pakistan Medical Association, the joint meeting of Pakistan Medical Association and British Medical Association, met to discuss the possibility of organizing ourself. It was at the lawns of the Boat Club, on a sunny aftercon of a cold December, in 1966, that we used the hospitality of Dr. Afzal Habib. Besides the host, those present included the late Dr. G. A. Asghar, Dr. Zaki Hasan, Dr. H.A.G. Kazi. Dr. Iftikhar, Dr. Raihana Beg and the writer Dr. Farrukh Hashmi from U.K. also attended.

Bridge to Trust: EPAs and the Cultural Odyssey in Pakistan's Medical Training

Bridge to Trust: EPAs and the Cultural Odyssey in Pakistan's Medical Training

Stem Cells In Urology: A Promising Development For The Treatment Of Urological Disorders.

Madam, It was fascinating to read the latest research published in the Journal of Pakistan Medical Association (JPMA) on the utilisation of stem cells in urology. The study had some amazing findings, and I believe it has the power to revolutionise the treatment of urological disorders.1 Recent advances in stem cell research have opened new possibilities for treating various urological conditions. For example, findings have shown that stem cells can be used to promote tissue regeneration and repair in patients with urinary incontinence or erectile dysfunction.2 Additionally, stem cells can regenerate damaged renal tissue, offering the latest treatment options for patients with kidney disease.4 Apromising area of research includes use of mesenchymal stem cells (MSCs) to treat urological conditions. MSCs are multipotent cells that can specify into various cell types, including muscles, bones, and cartilage. They have been shown to up level the symptoms and improve quality of life in patients with urinary incontinence,They may also be very effective in treating a variety of urological conditions.2 One more area of research entails the use of induced pluripotent stem cells (iPSCs) in urology. iPSCs are reprogrammed from adult cells, like skin cells, into an embryonic-like state. They are differentiated into various cell types, making them a potentially important tool for regenerative medicine. Research has shown that iPSCs can be used to produce functional urothelial cells, which line the urinary tract and play a major role in bladder function.5 Overall, stem cell research in urology is a developing area that shows promise. It offers new treatment varieties for patients with urological conditions and has the potential to improve their quality of life. I strongly believe that this research will be of great interest to clinicians and researchers in this urology field, and I look forward to seeing further more developments in this exciting area of medicine. It is also important to note that further research is strongly needed to fully explore the potential of stem cells in urology. This includes examining the long-term safety standards and efficacy of stem cell therapy, as well as identifying the optimal stem cell sources and delivery methods for variety of urological conditions. I strongly believe that ongoing research will continue to shed light on these important questions.

Antibiotics resistance as a major public health concern: A pharmaco-epidemiological study to evaluate prevalence and antibiotics susceptibility-resistance pattern of bacterial isolates from multiple teaching hospitals

BackgroundMulti Drugs Resistance (MDR) is among the most worrisome healthcare issues resulting from inappropriate and indiscriminate utilization of antimicrobial agents which has compromised the efficacy and reliability of antimicrobial agents (AMAs). This has not only put a huge burden on the health care system but also is a major cause of morbidity and mortality. This project was designed to evaluate the prevalence of various microbial strains among patients admitted to various teaching hospitals and to assess their susceptibility and resistance towards clinically approved antibiotics. MethodsThe study was conducted during August 2021-February 2022 to determine the prevalence of common resistant strains of bacteria and to analyze their susceptibility pattern to the commonly prescribed antibiotics using standard procedures. One hundred and thirty biological samples including urine, blood, cerebrospinal fluid (CSF), wound swabs, pus and sputum were collected from the site of infection from the patients admitted at different wards of North West General Hospital (NWGH), Peshawar, Pakistan, Khyber Teaching Hospital (KTH), Peshawar Pakistan, and Hayat Abad Medical Complex (HMC) Peshawar Pakistan. Samples were collected and cultured following standard hospital procedures. The cultured samples were subjected to identification procedures including Gram staining, morphological characterization of bacterial colonies and biochemical assessments. The identified bacteria were tested for their susceptibility using Kirby-Bauer disc diffusion method. The diameter of Inhibitory Zones (DIZ) was analyzed following Clinical and Laboratory Standards Institute (CLSI) criteria. Minimum Inhibitory Concentrations (MICs) were evaluated using agar dilution method. Antimicrobials sensitivity were presented as antibiogram following CLSI M39 standard. ResultsA total of one hundred and thirty biological samples were collected, out of which one hundred and nine samples were positive for bacterial growth and were further processed for detailed analysis. The frequency and type of bacteria isolated from various cultures indicated that Gram negative bacteria (n = 92/109) were more dominant than Gram-positive (n = 17/109) pathogens. The most prevalent bacteria isolated was Escherichia coli (29.35 %), followed by Staphylococcus aureus (15.59 %), and Klebsiella spp, (12.84 %). In addition, other pathogens including, Enterobacter spp, Citrobacter spp, and Acinetobacter spp. showed a prevalence of 9.175 %, 8.25 %, and 5.50 % respectively. As indicated in the antbiogram, several organisms exhibited considerble decline in the sensitivies towards various antibiotics. A high percentage of resistance was observed against some antibiotics including trimethoprim, co-trimoxazole, amoxicillin/clavulanate, ciprofloxacin, piperacillin/tazobactam, cefotaxime and ceftazidime. ConclusionThe prevalence of resistant strains of pathogens is increasing day by day, while the antibiotics commonly prescribed against them are losing their efficacy, which is pushing the world to the era of pre-antibiotics. Unfortunately, the discovery of novel antibiotics is limited and researchers speculate that the is pushing towards pre-antibiotics era. Subsequently, efforts must be directed towards ensuring rational antibiotics use to prevent emergence of MDR pathogens. Our findings indicated that Gram negative bacteria including Escherichia coli was most prevalent. Other bacterial strains including S. aureus, Klebsiella spp, Enterobacter spp, Citrobacter spp, and Acinetobacter spp. were found among the causative agents. Unfortunately, considerable decline in the sensitivities of various bacterial isolated were observed towards the tested antibiotics. Previous studies reported the high prevalence of E. coli and S. aureus in clinical samples of Pakistani hospitals including hospitals in Peshawar and thus our findings are in agreement with the previous reports. Pharmacists being experts can play their role by promoting the optimal use of antimicrobial agents and educating healthcare professionals, patients and the public.