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Aim: To look at anti-cancer effects of a variety of novel drugs on a variety of cancerous cell lines in the quest for a more inexpensive and effective anti-cancer treatment. Methodology: The research was carried out in conjunction with PCMD at JPMC's BMSI Department of Pharmacology. The experiment lasted about eight months (from April to November 2016). Noninvasive estrogen-dependent tumours, invasive estrogen-independent breast cancer, colorectal cancer, and cervical cancer were all depicted using MCF-7, HT-29, MDA-MB-231and HeLa cell lines, in that order. The MTT assay was used to improve the drugs' anticancer or antiproliferative efficacy in vitro. Using the MTT test, we determined the vitality of all treated tumour cell lines as well as the IC50 values of each chemical against all malignant cell lines. Results: This study demonstrated thatMetformin significantly decreased the survivability of MCF7, HT-29, MDA-MB-231, and Hela cell lines when compared to Apricoxib and Mebendazole. As a result, comparing the IC50 values of the studied agents for each of the evaluated treated cells backed up this claim. Hence, for Hela(p=0.386), MCF-7 (p=0.083), and MDA-MB-231 (p=0.083) cell lines but pochoc analysis revealed no significant differences in IC50 values of Metformin and Methotrexate. Conclusion: When compared to Apricoxib and Mebendazole, Metformin has a significant effect on the survivability of the cell lines studied. Metformin, as a result, would have been a wonderful chemotherapeutic addition Keywords: Cell lines, In vitro, MCF-7, Hela, MDA-MB-231

Child protection is defined as protecting children against violence, abuse, neglect, and exploitation. It is about taking preventative and protective measures to keep all children safe by building a protective environment around them, in general and for those children who are at risk and require immediate care and protection, in particular.

Background and Objective: Identification of clinical characteristics and risk factors for mortality in COVID-19 is important for early detection and precise case management. The study aimed to describe the sociodemographic, clinical, and laboratory characteristics of in-hospital COVID-19 deaths in Almadinah Almonawarah city, Saudi Arabia, and to identify risk factors for early mortality among them. Methods: This is an analytical cross-sectional study. The main outcomes were demographic and clinical characteristics of COVID 19 patients who died from March till December 2020, during the hospital stay. We collected 193 records of COVID-19 patients, from two major hospitals in Al Madinah region, Saudi Arabia. Descriptive and inferential analysis were performed to identify and relate the factors of early death. Results: Out of the total deaths, 110 died during the first 14 days of admission (Early death group) and 83 died after 14 days of admission (Late death group). Early death group had a significantly higher percentages of old age patients (p=0.027) and males (72.7%). Comorbidities were found in 166 (86%) of cases. Multimorbidity were significantly higher in early deaths than in late deaths 74.5% (p=

Aim and objective To investigate the effect of the addition of incipient carious lesions into the WHO caries index on the prevalence of caries in preschoolers of East Lucknow city. Study design A cross-sectional observational study was conducted on 530 participants in the age-group of 3–6 years. Materials and methods The participants were randomly selected from nursery schools of the East Lucknow region. The dental caries status was assessed according to WHO and Ekstrand's criteria. In addition, the prevalence of cavitated and incipient carious lesions was also evaluated. The data were then subjected to statistical analysis. Statistics Chi-square test and Wilcoxon signed-rank test were performed to carry out statistical analysis. p value < 0.005 was taken as statistically significant. Results Out of 530 participants examined, caries prevalence by WHO and Ekstrand's criteria was (36.8%) and (57.4%), respectively. The mean dmft values according to WHO criteria and Ekstrand's criteria were 1.16 and 1.60, respectively. The prevalence of cavitated carious lesions was higher (66.27%) when compared with that of incipient carious lesions (33.73%). Conclusion A significant number of incipient carious lesions observed in the present study is an indication to include these lesions in caries diagnostic criteria. This would help in determining the exact prevalence of caries and aid in implementing proper preventive protocols for remineralization of incipient carious lesions. How to cite this article Asad F, Singh N, Rathore M, et al. Effect of Addition of Incipient Carious Lesions in Caries Diagnostic Criteria on Prevalence of Caries in North Indian Preschool Children of East Lucknow Region. Int J Clin Pediatr Dent 2021;14(5):644–647.

Background: Diabetes is a hyperglycemic disease caused by a lack of action of insulin, but serum lipids are also strongly affected by insulin. Serum lipid abnormalities (dyslipidemia) are frequently observed in diabetic populations regardless of insulin deficiency or insulin resistance. Hypertriglyceridemia is the greatest common serum lipid abnormality in diabetic populations. To study the effect of mango seeds on dyslipidemia in diabetes-induced rats. There was a noticeable difference in the body weight (BW) of male and female diabetic rats. Materials and methods: To investigate effect on BW and the antihyperlipidemic actions of ethanolic extract of mango seed (EEMS) on alloxan-mediated diabetic Sprague-Dawley rats. Antihyperlipidemic in addition antidiabetic properties of an EEMS was planned at 100 and 200 mg/kg BW. The antidiabetic effect of EEMS been matched with tolbutamide 500 mg/kg BW. The lipid levels and BW of male and female rats were examined at consistent periods throughout the research. Results: The outcomes displayed that the dyslipidemia was considerably decreased in the different treatment groups, while matched with control, the animals cured with tolbutamide and EEMS control. Conclusion: EEMS exhibited a noteworthy antihyperlipidemic actions in addition with marked difference on BW of both male and female in alloxan-induced diabetic rats.

The aim of this study is to detect the magnitude of bad nutritional habits and assess the strength of association between T2DM and late-night dinner and skipping breakfast in Medina, Saudi Arabia. Methods: A case control study was conducted at Diabetic centre and PHC centres. The cases were Early-onset T2DM (30–45 years of age). A self-administered questionnaire consisted of three parts including socio-demographic information, eating behaviors and questions focusing on DM. Data were analyzed by using SPSS version 28 statistical package software. Results: A total 47 cases with diabetes mellitus type 2 and 188 controls were included. Cases were more prone to be obese with median BMI 30.5. Overall, 74.5% of cases were reported to be physically inactive. 72.4% of cases were skipping breakfast weekly as compared to 65% of controls [p-value 0.015]. Smoking, frequency of exercise, BMI and frequency of eating of fast food were found to be significant risk factors for developing T2DM with OR 4.0, 3.6, 5.5 and 2.0 respectively. Conclusions: Our data confirmed that skipping breakfast and late-night dinner were prevalent, and many risk factors associated with diabetes mellitus have been identified. Therefore, we recommend introducing health education programs to address misconceptions towards prevention and better control of diabetes mellitus. Keywords: Diabetes mellitus type 2, skipping breakfast, late-night dinner.

Introduction: Psoriasis is immuno-inflammatory condition devouring huge negative impact on patient’s life as compare to other diseases. Topical regimen is the standard treatment for mild to moderate psoriasis disease. The data of effectiveness of Betamethasone Valerate 0.1% on large number of psoriatic patients were being deficient in. Objectives: This study evaluates the Topical Betamethasone Valerate 0.1%impact on patient’s life in relation to efficacy and safety. Design: Interventional experimental study. Setting: Study was carried out Basic medical sciences institute (BMSI) alliance with Dermatology Department JPMC, Karachi. Period: June 2013 to June 2016. Methods: 75 chronic plaque type psoriatic patients prescribed Betamethasone Valerate (0.1%) topically along with placebo for 6 months once daily (one week interval after every three week application). The therapeutic effectiveness and safety of studied drug were assessed by means of PASI, DLQI and hsCRP. The results analyzed by using repeated ANOVA. Results: Results revealed that as compare to baseline all parameters were significantly reduced with mean percentage change were 75.001±0.0563, 72.215±3.17and 33.692±7.980 for PASI, DLQI and hsCRP respectively at the end of study. Safety profile of therapy showed non-significant outcomes. Conclusion: Betamethasone valerate 0.1% is better treatment option in mild to moderate psoriatic patients to improve quality of life and decrease disease severity.

Background: Diabetes mellitus is very common disease; the oral hypoglycemic drugs are utilized for diabetes. In Asia therapeutic plants are extensively used for cure of widespread variation of illnesses. Objectives: To study the Therapeutic effect of mango seed extract on diabetes Mellitus. Study Design: A prospective study and longitude. Setting: This study was conducted at Jinnah Post graduate Center, Karachi. Period: From June 2016 to June 2017. Material and Methods: Mango seeds were taken out with ethanol and used for study. The antidiabetic action of mango seeds extracts were well-thought-out at 100 and 200 mg/kg b.wt. The antidiabetic effect of mango seeds extracts were matched with tolbutamide 500 mg/kg b.wt. Result: The ethanolic extract of mango seeds (200 mg/kg) revealed major (p< 0.01) hypoglycemic outcome in fasted diabetic rats, when matched with normal control group. The mango seed extracts were significantly increased insulin level and decreased HbA1c levels at the dose level (100, 200 mg/kg) in alloxone encouraged diabetic rats. Conclusion: The ethanolic extract of mango seeds ensuring important antidabatic outcome compared to aloxone tempted diabetes in albino rats and its stimulating insulin production in pancreas of albino rats.

الملخص: أهداف البحث: تهدف هذه الدراسةإل قياس مدىالاكتئاب والقلق والإجهادبين العاملين في مجال الرعاية الصحيةبسبب مرض الفيروس التاجي ٢٠١٩(كوفيد-١٩) في المدينة المنورةبالمملكة العربية السعودية. طرق البحث: أجريتدراسة مقطعيةعلى١٢٢ من العاملين في مجال الرعاية الصحية في المدينة المنورة خلال شهري أبريل ومايو ٢٠٢٠،باستخدام استبانةإلكترونيةلقياس القلق والاكتئاب في المستشفيات، ومقياس الإجهادالمتصور.كما تم تقييم تصور المشاركين تجاه وصم مهنتهم في الجائحة الحالية من خلال مقياس ليكرت. وقد تم تحليل القلق والاكتئاب والإجهاد من الناحيتين الكمية والنوعية باستخدام متوسط وحساب الارتباط والنسب المئوية في الإحصاءات المعنية بذلك. النتائج: وجدت هذه الدراسة أن ٣٢.٩٪ من العاملين في مجال الرعاية الصحية تعاملوا مع حالات كوفيد-١٩بشكل متكرر أثناء الجائحة. وكان ما يصل إلى ٣٥.٦٪ قلقين بشكل غير عادي. ولوحظ أن متوسط درجة القلق ٨.٤٣ ± ٤.٦،مع درجات أعلى بكثير للنساء والعاملين الذين لم يتلقوا التدريب الكافي. وعلاوة على ذلك، تم تسجيل متوسط درجة اكتئاب٧.٦ ± ٤.٧للعاملين في مجال الرعاية الصحية الذين لم يتلقوا تدريبا كافيا، بينما كان ما يقارب ٢٧.٩٪ من المشاركين مكتئبين.وكانمتوسط درجة الإجهاد ٦.٨٦ ±٢.٥،بينما عانى٢٤.٥٪ من إجهاد خفيف، وعانى ٧٢.٨٪ من إجهادمعتدل. وجدت هذه الدراسة أن عدم كفاية التدريب على مكافحة العدوى كان مرتبطا بنسبة أعلى من القلق والاكتئاب لدى العاملين في الرعاية الصحية. الاستنتاجات: وجدت الدراسة أنهناك نسبة عالية من القلق والاكتئابوالإجهاد المعتدل بين جميع العاملين في مجال الرعاية الصحية بغض النظر عنطبيعةاختلافوظائفهم. وكانت عوامل الخطر المصاحبة لكل من القلق والاكتئاب بسبب عدم كفاية التدريب على مكافحة العدوى والمشاكل الطبية المصاحبة للإجهاد الموجودة من قبل. Abstract: Objective: This study aims to assess the magnitude of depression, anxiety, and stress among health care workers by the coronavirus disease (COVID-19) in Almadinah Almunawwarah, KSA. Methods: This cross-sectional study examined 122 health care workers between April and May 2020 through the electronic use of the Hospital Anxiety and Depression (HAD) questionnaire, and Perceived Stress Scale (PSS). The perceptions of the participants towards stigmatisation of their profession during the COVID-19 pandemic were also assessed through a Likert's scale. The magnitude of anxiety, depression, and stress were analysed using a mean ± SD, correlation and percentages in respective statistics. A p value of

Background: Breast cancer is most frequently diagnosed cancer globally but there is not any ideal economical and safer agent that not only decreases the progression but also resolve complexities associated with breast cancer such as inflammatory conditions. There was strong link between inflammation and cancer specially breast cancer. Thus by inhibiting the COX enzyme may inhibit the progression of cancer beside of its role in inflammatory conditions of breast. Study Design: Interventional In Vitro trial. Setting: Department of Pharmacology in alliance with PCMD. Period: The duration of study from April 2016 to February 2017. Methodology: For this purpose we used five cancerous lines MCF-7, MDA-MB-231, MCF-10, HT-29 and Hela cell lines. For demonstrating the cytotoxic effects of Apricoxib we used MTT assay (for all cell Lines) and Trypan blue dye exclusion assay (Primarily for MCF-7 cell lines). For calculation of minimum dose required for exert cytotoxic effects of Apricoxib and its selectivitytowards cancerous cells of breast tissue we calculated its IC50 value and Selectivity Index (SI) by MTT assay. Results: Apricoxib significantly reduce the viability of MCF-7, MDA-MB-231, Hela, HT-29 as assessed by MTT assay in dose dependent manner (χ2 (2) = 26.483, p

To compare the sensitivity and specificity of saline infusion sonohysterography with hysterosalpingography as a diagnostic tool in the assessment of infertile women..The comparative cross-sectional study was carried out at a private infertility clinic in Karachi, and comprised women who registered for assessment of infertility from June 2011 to May 2013. Uterine and tubal pathology was assessed as a possible cause of infertility by using saline infusion sonohysterography as an index test and hystero-salpingography as the standard reference. The diagnostic accuracy of the two tests was compared. Sub-fertile patients were followed up for 2 weeks after the tests for any possible adverse effects of the procedures. Data was analysed using SPSS 19.Of the 256 subjects, 184 (72%) presented with primary and 72 (28%) with secondary infertility. Overall mean age of the sample was 28}8 years. The mean BMI was 29.8}4.1 in primary infertile compared to 28.2}.5 in women with secondary sub-fertility. The sensitivity of saline infusion sonohysterography for detecting patency of the tubes was 100% and the specificity was 91% whereas positive predictive value was 69.8% and negative predictive value was 100% (Kappa: 0.61). For large uterine polyps, sensitivity and specificity was 100% and for small polyps sono-hystero-salpingography showed 14% false positive results (Kappa: 0.21).Saline infusion sono-hysterography was found to be a more reliable method of diagnosing tubal or uterine pathologies compared to hystero-salpingography for cases of infertility.

Objectives To evaluate the effect of Atorvastatin as an adjuvant with betamethasone valerate on disease severity and cardiovascular risks in chronic plaque type psoriatic patients. Methods It is an interventional study conducted in Pharmacology Department of BMSI, JPMC with the collaboration of Dermatology Department of JPMC, Karachi. The duration of study was from June 2013 to June 2016. Seventy five psoriatic patients were prescribed Tablet Atorvastatin 40-20 mg/day (40mg for first three months twice daily followed by 20mg once daily for the next three month) plus topical Betamethasone Valerate 0.1% once daily for 6 months (three week apply than one week interval). The efficacy and safety profile of drugs was measured by PASI, DLQI, hsCRP, LFTS and Lipid profile. Results The percentage change of PASI is 86.749±0.547, DLQI is 82.697±.2.61 and hsCRP is 40.371±8.505, which showed highly significant improvement in patient at the end of last follow up. LFTs and CPK for safety profile of therapy showed non-significant results. Conclusion Atorvastatin used as an adjuvant therapy with currently existing standard therapy (topical betamethasone) in patients having mild to moderate plaque type psoriasis reduces disease severity and cardiovascular risks.

Public health research demands a collaborative approach in working with communities to combat expected challenges in the field. Therefore, to improve primary care services, a training programme on research methodology, focusing on the principles of inter-professional education (IPE), was introduced at Karachi Medical and Dental College. The objectives of this study were to assess the level of learning by participants in the domain of communication and to explore participants' opinions and evaluations of the training programme.A total of 96 participants, including faculty members, medical students, social works students and health technicians in the research methodology course, were selected during March to September 2010. The study employed mixed method research in which communication competencies and participants' perceptions, as captured by course evaluations, were analysed, and findings were triangulated.The results showed that 87% of faculty enjoyed contributing to 'inter-professional relationships' and that 'teamwork' skills in community-focused areas improved among 90% of students. As many as 78% of students and 70% of faculty members identified 'active listening' and 'communicating information to families', respectively, as being learned to a lesser extent. These findings were defended by their deliberations on course evaluation.Learning through inter-professional relationships was found to be most effective among faculty, whereas learning through teamwork was found to be most effective among students. Moreover, it was found that information was better communicated to families by students than by faculty staff.تتطلب بحوث الصحة العامة نهجا تعاونيا أثناء العمل مع المجتمعات لمكافحة التحديات المتوقعة في الميدان. لذلك، أُضيف برنامج تدريبي في منهجية البحث في كلية كراتشي للطب وطب الأسنان، يركز على مبادئ التعليم المتداخل بين التخصصات، من أجل تحسين خدمات الرعاية الأولية. كانت أهداف هذه الدراسة تقييم مستوى التعلم من قبل المشاركين في مجال التواصل واستكشاف آراء المشاركين حول تقييم برنامج التدريب.تم اختيار ما مجموعه ٩٦ مشاركا من بينهم أعضاء هيئة تدريس، وطلبة طب، وطلبة خدمة اجتماعية، وفنيون صحيون خلال الفترة من مارس إلى سبتمبر ٢٠١٠. كان البحث متعدد المناهج حيث تم تحليل كفاءات الاتصال في الدورة وانطباعات المشاركين حول تقييم الدورة وعولجت النتائج من ثلاث زوايا.أظهرت النتائج أن ٨٧٪ من أعضاء هيئة التدريس استمتعوا بالمساهمة في ”العلاقة المتداخلة بين التخصصات“، وأن ”العمل كفريق“ في المناطق التي ترتكز على المجتمعات قد تم تعلمها إلى حد كبير من قِبَل ٩٠٪ من الطلبة. وقد تعرف ما لا يقل عن ٧٨٪ من الطلبة و٧٠٪ من أعضاء هيئة التدريس على ”الاستماع الفعال“ و”إيصال المعلومات إلى الأسر“، على التوالي، على أنهما أداة تعلم فاعلة.وُجد أن التعلم فعَّال باستخدام العلاقة المتداخلة بين التخصصات بالنسبة لأعضاء هيئة التدريس مقارنة بتعلّم العمل الجماعي بصورة أفضل من قبل الطلبة. إضافة إلى ذلك، كان من الواضح أن إيصال المعلومات للأُسر من قِبَل الطلبة كان أفضل مما كان عليه من قِبَل أعضاء هيئة التدريس.

Objectives: To identify the changing trends and crucial preventive approaches to road traffic accidents (RTAs) adopted in the Kingdom of Saudi Arabia (KSA) over the last 2.5 decades, and to analyze aspects previously overlooked. Methods: This systematic review was based on evidence of RTAs in KSA. All articles published during the last 25 years on road traffic accident in KSA were analyzed. This study was carried out from December 2013 to May 2014 in the Department of Family and Community Medicine, Taibah University, Al-Madinah Al-Munawwarah, KSA. Results: Road traffic accidents accounted for 83.4% of all trauma admissions in 1984-1989, and no such overall trend was studied thereafter. The most frequently injured body regions as reported in the latest studies were head and neck, followed by upper and lower extremities, which was found to be opposite to that of the studies reported earlier. Hospital data showed an 8% non-significant increase in road accident mortalities in contrast to police records of a 27% significant reduction during the years 2005-2010. Excessive speeding was the most common cause reported in all recent and past studies. Conclusion: Disparity was common in the type of reporting of RTAs, outcome measures, and possible causes over a period of 2.5 decade. All research exclusively looked into the drivers’ faults. A sentinel surveillance of road crashes should be kept in place in the secondary and tertiary care hospitals for all regions of KSA. Saudi Med J 2015; Vol. 36 (4): 418-424 doi: 10.15537/smj.2015.4.10003

To establish the anti-platelet or aspirin like effects of flavonoid rich food (chocolate).This was a non-randomized quasi experimental study in which, 65 healthy adult volunteers, 27 males and 38 females, participated. The subjects included were healthy, non-smoking adults. Health of subjects was evaluated by a questionnaire for which a written informed consent was taken prior to admission in the study. Research protocol was approved by the college's, "Research and Ethical committee". Division of subjects into two groups, a control group which consumed 100 mgs of oral aspirin and an interventional group consuming 100 mgs oral aspirin and 18.75 gms of dark chocolate (flavonoid rich), was carried out. The Bleeding time estimation for both the groups was done by "Duke Method" of bleeding time estimation.Data was analyzed by SPSS 15.0. First, a bivariate analysis was done by comparing both the pre-test groups i.e. before consumption of aspirin and also before consumption of chocolate and aspirin together through independent t-test Later, regression analysis was also done. Bivariate analysis compared both the control and interventional groups. After comparing pre-test groups a p-value of 0.798 was obtained and after comparing post test groups a p-value of 0.006 was determined. Regression analysis yeilded an R-square of 0.25.Chocolate has a significant role in augmenting the anti-platelet effects of aspirin.

To identify Byssinosis in cotton spinning mill workers, probable associations of disease with factors such as different work areas, safety gadget usage and overtime and to ascertain proportions of byssinosis to accidental injuries.This study was conducted in a spinning mill of Karachi in June 2006. Mill workers who had worked for a period of minimum 5 years were selected. A sample size of 83 conveniently selected workers participated in the research study. Data collection was done via questionnaire, and pulmonary function tests.The mean age of the sample was 30 +/- 6.9 years. Of all the workers 72% used safety gadgets (masks) while working and 50% availed overtime. Smokers amounted to 31% of the total subjects. Around 35% workers complained of having respiratory ailments of which 19% (16 workers) closely matched byssinotic symptoms. Pulmonary Function Tests (PFTs) confirmed 13 of 16 workers to be byssinotics, with the remaining being labeled as Probables. The overall proportion of Byssinotics in the mill was 19.28% (95% C.I. 11-27) and that of accidental injuries was 22.9%. The association of byssinosis with respect to work areas was significantly high in Ring area (O.R. = 2.04) followed by carding (O.R. = 1.3). The association of byssinosis was also high in workers who did not use safety gadgets, e.g. dust masks (O.R = 4.89) and in people who worked overtime (O.R. = 1.82). Associations with respect to duration of employment and smoking could not yield significant results.Results indicate a very high probability of association of disease to non-usage of safety gadgets and overtime working. Studies comprising of a greater sample size would show precisely the overall prevalence of the disease.

To assess the association of osteopenia and osteoporosis with menopause and compare the health seeking behaviour of women related to menopause in different strata of society.A cross-sectional study.Three different socioeconomic strata of Karachi from May till August 2004.A sample of 925 women, over 35 years of age, was selected from 16 clusters of 250 households (50 houses in each cluster). All apparently healthy women having age between 35 and 50 years were selected in the cluster houses. Those who were not willing to be the part of the study or giving history of taking treatment for any disease for more than 4 weeks were excluded. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the Medical College. T-scores were calculated to get BMD (Bone Mineral Density) for all the subjects through heel ultrasound.A total of 287 women were found to be experiencing menopause. The mean age of menopause was 47.8+4.7 years. Out of those 287 women, 135 (47%) wanted their menses to continue and 235 (82%) had consulted a physician after menopause. There was a significantly lower score of BMD of postmenopausal women (mean=-1.833+0.65) compared to pre-menopausal women (mean=-1.597+0.60, p=0.016). Out of the 925 women interviewed, 53% had consulted a physician for various symptoms related to menopause. The symptoms experienced by pre-menopausal women included lack of sleep (25%), fear of becoming sterile (13%) and urinary incontinence (18%).The average age of menopause was found to be similar to other studies of the country. Lower bone mineral density was found in greater proportion among older females. Majority needed intervention inclusive of awareness through health education and medication.

To assess the process of problem-based learning (PBL) as perceived by the medical students and their opinions regarding the process.A cross-sectional study was conducted at Karachi Medical and Dental College. One hundred and four medical students of fourth year MBBS (52 each of batch 2004 and 2005) were selected for their responses and feedback on problem-based learning in small groups. Data was collected through a closed-ended questionnaire.Seventy nine percent (82 out of 104) of medical students liked the PBL sessions. Overall 85% of students were motivated towards self learning while liking for PBL was 82%. Activation of prior knowledge was observed by 83% students.Students supported problem-based learning (PBL) as an effective method of learning. Majority of students were motivated towards self- learning. They were convinced that PBL helped them in building up communication skills, interpersonal relationship and problem solving capacity.

A number of evaluations of the EPI program have been carried out either at a small scale or countrywide in order to identify statistical figures but very few of them reflect population opinions. This study was conducted with an objective to assess the immunization services available through expanded program of immunizations (EPI) and national immunizations days (NIDs) and to determine the reasons for incomplete immunization.This study is qualitative, based on eight Focus Group Discussions (FGDs) with mothers and fathers as recipients while lady health visitors and vaccinators as service providers.Majority of the mother and fathers were aware of the importance of immunization. Overall the failure of immunization was related to low income, inaccessible government dispensaries and occupancy in house hold work. Almost all mothers and fathers were of the opinion that the private clinics are giving service at a higher cost for quality vaccines than that of government dispensaries. Majority of fathers and mothers are ignorant of the advantages of antenatal immunization. Vaccinators and Lady Health Visitors had adequate knowledge and were partly satisfied with the services they provide. Vaccinators identified the need of local vaccinators and well--run vehicles in order to increase immunization rate.The quality of immunization services is compromised at the recipient level mainly due to lack of motivation and prevailing doubts about immunization importance. The service providers thought that the problem of incomplete vaccination particularly for females and misplacement of cards. Hence solving the problems of the providers at all levels combined with media campaigns to modify rigid behaviour of recipients can significantly improve the immunization coverage in Pakistan.

The aim of the study was to evaluate the efficacy of cyclosporin-A in patients of rheumatoid arthritis not responding to standard therapy early in the course of the disease.A non-randomized controlled clinical trial.Outpatients Department of Abbasi Shaheed Hospital and Imam Clinic over a period of 18 months from March 1999 through September 2000.The study was carried out on 63 patients of both gender suffering with refractory rheumatoid arthritis for at least 3 months. Patients were divided into two groups A and B. Group-A was the experimental one, treated with cyclosporin-A in combination with methotrexate while Group-B was continued with methotrexate alone. Their pre and post assessments regarding recovery criteria and drug profile had been done in order to establish the efficacy of cyclosporin-A.The study showed a significant difference (p.000 with a.05) after six months between treatment group and the controls, in the mean values of articular index (2.53 vs. 5.39), right grip (14.28 vs. 33.8 mmHg ), left grip strengths (16.5 vs. 34.31 mmHg) and number of tender joints (26.9% vs. 38.6%). Furthermore, a significant negative correlation between articular index at recruitment and visual analogue scale (VAS) of pain after 6 months of therapy was observed in experimental group.This study indicates that the combination of cyclosporin with methotrexate benefits rheumatoid arthritis patients refractory to methotrexate monotherapy. Cyclosporin was well tolerated by those having shorter duration of disease.

Globally, over the last two decades, medical education and its learning strategies are being made more prone to problem-solving in order to produce better clinicians. The medical curriculum has not changed in Pakistan since its inception and that is reflected in the form of inadequacies in health delivery system. There is a dire need of creating relevance between medical education/training and medical practice in order to introduce an effective health care system.This study is particularly aimed at evaluating the effect of problem-based learning (PBL) in a group of students accustomed to conventional teaching and to assess any change in students attitudes/learning abilities after repeated PBL interventions.An interventional study.Response of 32 students of fourth year MBBS of Karachi Medical and Dental College was recorded against two PBL exercises in September 2002.A significant change in the study trend and analytical ability (p003) was shown in the two PBL sessions. The students who liked PBL were 33% more prone to practice group-study (OR = 1.33 and 95% CI=1.28, 1.39) than those who preferred other modalities of teaching. The final professional grades of these students were significantly higher than those in the previous years (p0.000).A strong association between liking for PBL and group study was found and the analytical performance and thought process of students were significantly improved after the second PBL session.