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PubMed | The University of Lahore, Federal University of Santa Maria, Rashid Latif Medical College and Shalamar Medical and Dental College
Type: Journal Article | Journal: Pakistan journal of pharmaceutical sciences | Year: 2014

Prostate cancer is a multifaceted disease that arises because of misrepresentation of linear and integrated signaling cascades that regulate gene network in normal and cancer cells. Programmed cell death is modulated by intracellular regulators within each cell and various lines of evidence suggest that there is under- expression and over-expression of pro-apoptotic and anti-apoptotic gene subsets respectively. Apoptosis is a response to the cellular microenvironment, and the cell microenvironment can be regulated by multiple signaling cascades at a higher organizational level by suppressing survival signals notably at genetic, epigenetic, transcriptional and post-transcriptional level. Unquestionably, drug-discovery approaches over the last decade aiming at neutralizing anti-apoptotic proteins, over-expressing pro-apoptotic proteins and enhancing the cell surface appearance of TRAIL receptors have revolutionized our current information about inducing and maximizing TRAIL mediated signaling in resistant prostate cancer phenotype. In this mini-review we outline outstanding developments in the field of prostate cancer that have played a role in understanding the underlying mechanisms that control TRAIL mediated apoptosis in prostate cancer cells, which may be helpful in the development of cancer therapies based on the apoptotic pathway.


PubMed | University of Karachi, The University of Lahore and Shalamar Medical and Dental College
Type: Journal Article | Journal: Pakistan journal of medical sciences | Year: 2017

To compare the change in interviewers perception of Multiple Mini Interviews (MMI) after MMI training and after actual MMI experience.Six sessions were conducted during two weeks (October 26, 2015- to November 6, 2015) to a total of 87 faculty members. The evaluation dealt with 13 items questionnaire for representation of assessors perception on 5 point rating scale. Assessors rated their perceptions to complete an anonymised questionnaire about rationale behind MMI, the process of MMI, and the use of scoring criteria (rubrics). In addition, assessors were also asked to rate their level of satisfaction on MMI process after training and after interviews. Wilcoxon Signed Ranks Test (two-tailed) was used to compare participants pre- and post-interview ratings.With 81.6% response rate, the positive views of assessors about the MMI selection process and the use of scoring criteria (Rubric) to assess the candidate are not altered after experiencing a MMI selection day (p> 0.001). Assessors (87%) would prefer to be involved in the process of MMI in future.The outstanding consistency of assessors ratings before and after interview concluded that MMI training sessions were helpful in improving knowledge and skills about MMI process and candidates assessment criteria (rubrics).


Munir T.A.,Shifa International Hospital | Afzal M.N.,Shalamar Medical and Dental College
Journal of the Pakistan Medical Association | Year: 2010

Objective: To assess the predictive ability of leukocyte subtypes for mortality in patients with acute coronary syndrome (ACS). Methods: One hundred and thirty three consecutive patients of ACS were assessed in the study and were followed up for one year. Diagnosis was based on clinical characteristics and the laboratory data. The total leukocytes and its subtypes were counted by Sysmex automated cell counter. The predictive ability for death of total count of leukocytes, neutrophils, lymphocytes and monocytes was assessed using Cox regression analysis. Results: Univariate analysis revealed higher prevalence of total leukocytes (HR= 1.001, p=<0.001) and its subtypes, neutrophils (HR 1.001, p=<0.001) and monocytes (HR 1.006, p= <0.001), in patients of ACS. In multivariate modeling, after entering standard coronary risk factors, count of total and differential leukocytesneutrophils, lymphocytes, monocytes and cardiac biomarkers CK-MB, Trop I; the monocyte count (hazard ratio [HR] 1.004, CI 1.002-1.006, p<0.0001) was found to be independent predictor for ACS. A significance correlation between monocyte count and CK-MB, representing extent of myocardial damage, was also seen (r=0.301, p<0.0001). Conclusion: The increase in monocyte count is an independent predictor of death and prognostic marker of the extent of myocardial damage in patients with ACS (JPMA 60:548; 2010).


Shahzad S.,Shalamar Medical and Dental College
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2012

Rapid growth of medical knowledge has created major changes in technology which in turn has created greater demand of the client for better health services, and health sector is constantly under pressure of great internal and external demands. Quality of services, largely depend on to what extent managers are well versed with the concept of evidence based management, team and group approach in achieving organizational objectives. Making an effective health system, addressing the double burden of diseases coupled with resource crunch in developing countries is a big challenge for policy makers and health managers. Comprehensive concepts and application knowledge of leadership is very important for health managers in the present day in order to get best output that satisfies all the stake holders. Present anthropological study was done to assess the perception and knowledge of leadership among the health managers working in tertiary level hospitals. This qualitative study was conducted in two public sector tertiary level hospitals of Lahore chosen randomly out of a total of seven such hospitals in the same city. Convenient sampling technique was used. Observation and in- depth interviews were conducted for data collection. Open ended questionnaire on the lines of MLQ was used. One main domain of leadership was developed and categorisation of the themes was done in the two evolved categories of transformational and transactional leadership. In the domain of leadership 10 of the health managers showed positive themes for transactional leadership, 6 showed positive themes for transformational leadership, and still 1 health manager showed overall negative response for the concept of leadership; he was totally in favour of dictatorship. Health managers with degrees in management/administration had better concept about the key idea of leadership and its variables. Female health managers were more inclined towards transformational leadership behaviour.


Ismail S.,Aga Khan University | Siddiqui S.,Dow Medical College and Civil Hospital | Shafiq F.,Aga Khan University | Ishaq M.,Shalamar Medical and Dental College | Khan S.,Aga Khan University
International Journal of Obstetric Anesthesia | Year: 2014

Background Increasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan. Methods In the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin. Results A total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (P < 0.05). More emergency caesarean sections were performed in the public compared to the private hospitals (85.4% vs. 41.6%). More multiparous patients underwent caesarean section in the public hospital (57.8% vs. 40.4%). Attending physicians took the decision for transfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7 g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals. Conclusion Blood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required. © 2014 The Authors. Published by Elsevier Ltd.


Shahzad S.,Shalamar Medical and Dental College
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2011

Management in health sector is becoming focus of attention world over being an important subject due to resource crunch particularly in developing countries. Beside sociodemographic factors, poor management in health sector is also an important factor responsible for poor health in developing countries. Moreover, there is gross lack of effective leadership in our national setup. It is necessary for health managers to be well versed with the knowledge about emerging theories, concepts and new philosophies of management/administration and leadership. This anthropological study was done to assess the perception and knowledge of Intellectual stimulation, creativity and innovation among the health managers working in the tertiary level hospitals of Lahore. This qualitative study was conducted in two public sector tertiary care hospitals of Lahore. Observation and in-depth interviews were conducted for data collection. Open ended questionnaire, developed on the lines of Multifactor Leadership Questionnaire was used. One main domain of Intellectual stimulation and its variables were developed and emergence of different themes was noted. In the domain of Intellectual stimulation all the participants of the study showed positive themes for the variable of creativity. Seven of the health managers showed positive themes for the variable of innovation, where as three health managers showed negative responses. Health managers with management/administration qualification had better concept about the key ideas of Intellectual stimulation, creativity and innovation; as compared to those who were working at these managerial posts on the basis of their long term experience only. Female health managers were stronger in building their team members on a broader horizon as a wholesome personality and not just taking the daily routine work.


Shahid A.,University of Health Sciences, Lahore | Shahid A.,Shalamar Medical and Dental College | Rana S.,University of Health Sciences, Lahore | Saeed S.,King Edward Medical University | And 3 more authors.
BioMed Research International | Year: 2013

Numerous studies confirmed the association of FTO (fat mass and obesity associated gene) common variant, rs9939609, with obesity in European populations. However, studies in Asian populations revealed conflicting results. We examined the association of rs9939609 variant of FTO gene with obesity and obesity-related anthropometric and metabolic parameters in Pakistani population. Body weight, height, waist circumference, hip circumference, and blood pressure (BP) were measured. BMI and waist-to-hip ratio (WHR) were calculated. Levels of fasting blood glucose (FBG), insulin, leptin, and leptin receptors were measured by enzyme linked immunosorbent assay (ELISA), and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The results showed association of FTO gene, rs9939609, with obesity in females (>18 years of age). FTO minor allele increased the risk of obesity by 2.8 times (95% CI = 1.3-6.0) in females. This allele showed association with body weight, BMI, waist circumference, hip circumference, WHR, BP, plasma FBG levels, HOMA-IR, plasma insulin levels, and plasma leptin levels. In conclusion, FTO gene, rs9939609, is associated with BMI and risk of obesity in adult Pakistani females. Association of rs9939609 variant with higher FBG, plasma insulin, and leptin levels indicates that this polymorphism may disturb the metabolism in adult females and predispose them to obesity and type 2 diabetes. However, the above-mentioned findings were not seen in children or males. © 2013 Adeela Shahid et al.


Shahid A.,University of Health Sciences, Lahore | Shahid A.,Shalamar Medical and Dental College | Saeed S.,King Edward Medical University | Rana S.,University of Health Sciences, Lahore | Mahmood S.,University of Health Sciences, Lahore
West Indian Medical Journal | Year: 2012

Objective: Offsprings of Type 2 diabetics have increased risk of metabolic disturbances. The aim of the study is to assess the potential effect of family history of Type 2 diabetes (FHD) and parental consanguinity on fasting plasma glucose (FPG) levels. Subjects and Methods: Non-diabetic offsprings of one or both parents with Type 2 diabetes and healthy controls of comparable age, without a FHD were the subjects of this study. Family history of Type 2 diabetes was defined by the presence of Type 2 diabetes in one or both parents of the subject. Consanguinity was defined as history of marriage with a first cousin. Fasting plasma glucose levels were determined in cases and controls. Results: Impaired fasting glucose was identified in 42% of subjects with FHD and in 14% without FHD. We found a strong independent association of FHD with impaired fasting glucose in both males and females by logistic regression analysis after adjusting the data for age, gender and body mass index (BMI). Parental consanguinity modifies the effect of FHD on IFG. Conclusion: We concluded that family history of diabetes and parental history of consanguinity determine the risk for impaired fasting glucose in this study population.


PubMed | Dow Medical College and Civil Hospital, Aga Khan University and Shalamar Medical and Dental College
Type: Journal Article | Journal: International journal of obstetric anesthesia | Year: 2014

Increasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan.In the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin.A total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (P<0.05). More emergency caesarean sections were performed in the public compared to the private hospitals (85.4% vs. 41.6%). More multiparous patients underwent caesarean section in the public hospital (57.8% vs. 40.4%). Attending physicians took the decision for transfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals.Blood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required.


PubMed | Shalamar Medical and Dental College Lahore and Shalamar Medical and Dental College
Type: | Journal: BMC endocrine disorders | Year: 2015

Charcot osteoarthropathy or charcot foot is a rare, chronic, non-communicable condition of bones and joints which may results into severe deformity and more prone to develop ulcers possibly leading to amputation. The purpose of this study was to determine the prevalence of Charcot osteoarthropathy and its association with age, BMI, gender, duration of diabetes, HBA1c and peripheral neuropathy.A total of 1931 subjects with type 2 diabetes having mean age 50.7210.66years presenting in a specialist diabetes clinic at shalamar hospital, Lahore, Pakistan were enrolled. The diagnosis of Charcot osteoarthropathy was made by examination of both dorsal and plantar surfaces of foot for swelling, erythema, increase in temperature and any musculoskeletal deformity which was later confirmed by radiographs. Assessment of neuropathy was carried out by checking the sense of pressure, joint position and vibration. BMI (Body Mass Index), fasting blood glucose (FBG) and HbA1C were determined.In all subjects including male 704 (36.45%) and female 1227 (63.55%), 0.4% subjects had charcot deformity, while 0.2%, 0.15% and 0.05% subjects having right, left and bilateral deformity respectively. Bilaterally symmetrical neuropathy was diagnosed in 25.4% in subjects. There was a significant association (p<0.05) of deformity with duration of diabetes, HbA1C and neuropathy, however no significant association (p>0.05) was found with age, BMI, weight, height and gender.There is a need to have a special care of persons with diabetes regarding blood glucose control and development of peripheral neuropathy. Early identification and management of risk factors may prevent the occurrence of charcot deformity. Patients must be educated about the foot care.

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