Pakistan Postgraduate Medical Journal

TIME TO INTRODUCE A MENTORING PROGRAM IN POSTGRADUATE MEDICAL TRAINING IN PAKISTAN

Nudrat Sohail — 2025-07-01

Mentoring is an ancient, reliable method to ensure the transfer of knowledge and skills, where one or more trainees/learners are attached to a mentor, who guides them through all the different learning experiences. Mentoring for a long time is recognized to improve learning and transfer of skills, in all types of education, be it arts, social sciences, business, medical education, or any other technical specialty. Beyond doubt, mentoring is beneficial to both mentors and mentees. In medical education, mentorship at the undergraduate level is an integral part of teaching planners, providing not only guidance and supervision to students to pass their assessments but also helping them choose future careers. Researchers, academicians and program directors have talked about factors that influence and impact postgraduate mentoring programs.¹ However, the inception and utilization of a mentorship program in postgraduate training seems limited. Most of the training programs entrust the training of residents to the supervisors, where the role of the supervisor remains to keep the trainee on track to complete the required competencies involving knowledge, skills, and attitudes, through the entire training and finally facilitate them to get through the summative assessments and become a successful practitioner.

It may be argued that the supervisor acts as a mentor for the trainee, but in the true sense of mentorship, neither the supervisor nor the trainee fulfills the requirements of the process of mentoring. Mentors have to be committed to the professional and personal development of mentees without any favour or bias. Supervisor may be viewed primarily as a guide and adviser, but a mentor stands tall wearing the cap of a dependable, experienced senior who finds strategies to provide the mentee with the best possible support and solutions to help the mentee overcome challenges and advance in their careers.²

It seems the right time to introduce a structured and formal mentorship program within the residency training programs being run in Pakistan. The infrastructure of the mentorship program can be designed by the college or university running the program. These residency program mentorship practices can be compared to International Accreditation Council.³The administrative and financial support incentives for mentors can be predetermined. The supervisors can act as mentors after attending mandatory training workshops for their capacity building. Most of the mentors may do it free as an altruistic favor. Few studies are available from Pakistan, where departments have run informal surveys or a pilot study of short duration, whether to run a mentoring program or not.

Literature search on mentorship and leadership shows that postgraduate medical training can help in achieving clinical excellence, enhancement of academic productivity, career advancement, coping with stress, improving communication skills, effective team building, improving research culture and professional leadership.⁴ The "Mentor Match" has been identified as an effective tool in developing a formalized mentorship program with positive results after one year of implementation.⁵ Formal mentorship programs included in residency programs are reported to range from 50 % to 82 % in the United States and Canada.⁶ The primary goals of these mentoring programs were to improve resident wellness, reduce burnout, enhance academic performance, increase resilience, and provide psychosocial support. These mentoring programs in residency were included only 15 years ago (approximately) in America and Canada, with mentors selected from staff physicians setting prior goals for mentorship, and evaluation of these programs was carried out through feedback and surveys at regular intervals. The results were utilized in improving the implementation and outcomes of the program.

The postgraduate residency programs can make use of existing mentoring models according to the needs of the program and mentees. The traditional “one one-on-one” mentoring makes use of a single mentor guiding one mentee. In the group mentoring model, one mentor works with multiple mentees. In the peer mentoring method, colleagues or peers mentor junior and less experienced peers. Each model carries benefits and challenges. Each model can be tailored to a specific requirement. It seems that group mentoring is most appropriate for residency programs, as one mentor can support multiple mentees.⁷ Moreover, the mentees can share and relate to each other's experiences and, in doing so, learn from one another as they face similar challenges. The mentor can help find solutions and endorse the positive approaches. All these models of mentorship are based on the philosophy of keeping the mentees physically, psychologically, and emotionally in health.⁸

The entire process of mentorship rests on the shoulders of the mentors. Most of the time, faculty members voluntarily opt to take on the role of mentors. Those who have good communication and leadership qualities are successful. Foremost requirement for an effective mentor would be to treat the mentees with respect, keep an open mind to listen and respond to their problems. At times, it may be limited to motivating positive behaviours, and at times, it could be teaching them a professional skill. The mentor needs to stay honest and generous at all times in helping the mentees. Similarly, the mentees must also take responsibility for making the mentorship program successful. They must understand the efforts made by the institute and mentors to help them. They must attend the meetings and complete the allocated tasks and assignments. Strategies to employ for group mentoring in residency programs include defining clear goals for professional and ethical development through a structured format. This can be designed by the institute according to the needs assessment. Scheduled meetings with a pre-decided agenda can be carried out. Regular feedback must be sought on the predesigned proforma with open suggestions on improving the process. Typical challenges to mentorship are time constraints on the part of the mentors, which can be overcome by prior planning, online meetings or mobile joint conversations. Mentor malpraxis (malpractice), where the mentor exploits the mentees by making them do work for the mentor's personal gains or stealing the mentees' research idea or data. This can be avoided by mentees being proactive towards this dishonesty and changing the mentor.

The ultimate and most powered value that can be inculcated in the postgraduate trainee through the mentoring sessions would be to make them lifelong learners and reflective practitioners, who are intrinsically motivated to keep themselves updated in knowledge and skills for the benefit of the patient and the community they serve Continuing professional development to foster behaviour change: from principles to practice in health professions education.⁹

Mentoring future mentors includes stages such as mentee initiation, mentee-mentor matching, and initial meetings.¹⁰ Finally, the question that needs to be answered is whether the supervisors can be the mentors in a residency program. The answer is yes. The intrinsic attributes within the supervisor, along with learnt skills through faculty/supervisor training workshops, may help supervisors to be the mentors. Evaluation of mentorship programs must be carried out to show their cost-effectiveness, positive outcomes on both the careers of mentees and mentors and improved health care services provided by the institution

PREVENTION OF BISPHENOL A INDUCED HISTO-PATHOLOGICAL INSULTS TO URINARY CORPUSCLE OF ALBINO RAT KIDNEYS BY MORINGA OLEIFERA

Rabia Ejaz — 2025-07-01

Background: The use of medicinal herbs has been in practice in our society since ages. Similarly with the evolution of plastics, the use of plastic ware has increased in the past few decades. Along with other injurious substances, it contains Bisphenol A, that is a known deleterious agent for human health. Now a days modern medicine has evolutionized and taking refuge in using herbal substances in preparing allopathic medicines too. One such medicinal plant being studied far and wide for its excellent antioxidant properties is Moringa oleifera.

Objectives: To establish the protective effects of Moringa leaves in renal damage induced to renal corpuscle of albino rat kidneys by Bisphenol A.

Method: A total of 30 adult albino rats of either gender were taken and made three groups A, B and C each of which contained 10 rats. The group A, was control. The group B, BPA-exposed, was ingested with 50mg/kg of BPA. The third group, C, was simultaneously administered 400mg/kg MoLE along with 50 mg/kg BPA. Rat kidney specimens were histologically evaluated by hematoxylin and eosin staining. The experimentation took total eight weeks investigated the probable efficacies of leaves of Moringa Oleifera in comparison to histo-pathological alterations in the renal corpuscles of albino rats induced by BPA.

Results: The results depicted that BPA exposure resulted in renal corpuscle damage in the rat kidneys as evident via increased urinary space diameters along with glomerular congestion noticed in the group B. However, rats getting MoLE indicated notable absence of these histopathological alterations. This shielding provided by MoLE against BPA may be credited to its nutritiously active contents like polyphenols and flavonoids, which fight oxidative injuries as well as inflammation.

Conclusion: This study guides us into the large number of medicinal benefits of Moringa plant including its role in prevention of oxidative injuries being caused by toxins like BPA to renal corpuscles in rat kidneys.

COMPARATIVE ANALYSIS OF THYROID PROFILE IN BREAST-FED AND BOTTLE-FED INFANTS

Shazia Akbar Khan — 2025-07-01

Background: Hormonal derangements of infancy are among preventable diseases. Therapeutic administration of synthetic hormone is an expensive option. Breastmilk being optimized with all the required nutrient is a natural option. Breastfed infants are, therefore, supposed to have less variations in hormonal levels.

Objectives: To measure thyroid in infants exclusively on breast feeding and formula milk feeding.

Methods: This study comprised of eighty infants of both gender’s divided into two groups, one exclusively breastfeeding and other on formula fed milk. Blood samples were analyzed for thyroid function tests through chemiluminescent immunoassay technique. Difference if any was statistically calculated by applying One-Way ANOVA/Independent T Test through GraphPad Prism 8.0. A p-value ≤ 0.05 was considered significant.

Results: Serum T3 mean values in all groups ranged from 1.43 ng/mL to 1.65 ng/mL. T3 mean values were numerically higher in formula-fed female group. There is no significant statistic difference present among various groups, with a p value of 0.083. Serum T4 mean values in all groups ranged from 104.95 ng/mL to 119.8 ng/mL. T4 mean values were numerically higher in breast-fed female group. There is no significant statistic difference present among various groups, with a p value of 0.423. Serum TSH mean values in all groups ranged from 2.56 µIU/mL to 2.83 µIU/mL. TSH mean values were numerically higher in breast-fed male group. There is no significant statistic difference present among various groups, with a p value of 0.632.

Conclusion: There is no significant statistical difference present in thyroid hormones in breastfed and formulafed groups.

AN ANATOMICAL STUDY OF THE MORPHOMETRIC ANALYSIS OF ACETABULUM IN PAKISTANI POPULATION AND ITS CLINICAL CORRELATES.

Maria Ilyas — 2025-07-01

Objective: The main objective of this study was to gather morphometric data on the acetabulum. This information supports the mechanics of the hip joint, enabling the planning of appropriate prostheses and various surgical techniques.

Methods: The study was conducted at the Department of Anatomy, AIMC, Lahore, utilizing one hundred hip bones from both sexes. Only healthy adult bones were included, while deformed and eroded specimens were excluded. Osteometric parameters, including the diameter and depth of the acetabulum, as well as the acetabular notch width and shape of the anterior acetabular ridge, were measured using Vernier calipers.

Results: The depth of acetabulum was found to be 2.36 ± 0.48 cm and 1.99 ± 0.65 cm on the right and left side respectively. The diameter of acetabulum was found to be 5.27 ± 0.53 cm on the right side and 5.42 ± 0.80 cm on the left side. The notch width was determined to be 1.63 ± 0.39 cm on the right side and 1.90 ± 0.46 cm on the left side. Most common type of anterior ridge was found to be of irregular type.

Conclusions: The study provides the average diameter and acetabular depth for the local population of Pakistan. The results will be valuable for orthopedic surgeons and prosthetists.

Keywords: Acetabulum, hip joint, dimensions, prosthesis, arthroplasty.

INTERSTITIAL LUNG DISEASES AND MIMICS: EXPERIENCE FROM A TERTIARY CARE HOSPITAL

Muhammad Saqib — 2025-07-01

BAckground: Interstitial Lung Diseases (ILDs) is a diverse group of lung diseases, associated with inflammation and fibrotic changes in the lung interstitium. The etiology of these diseases is multifactorial including idiopathic disorders, associated with connective tissue diseases, due to environmental and occupational exposure and drug related. According to some studies Idiopathic pulmonary fibrosis (IPF) is more prevalent form of ILD but connective tissue disease-associated ILD (CTD-ILD), hypersensitivity pneumonitis (HP) are more common in areas where occupational or environmental exposures are high. This study aims to investigate the distribution of subtypes of ILD among patients presenting to a tertiary care hospital setting.

Methods: This is a retrospective study which was conducted at the Department of Pulmonology, Shaikh Zayed Hospital, FPGMI, Lahore. All 138 patients diagnosed with ILD between January 2021 and December 2024 were included in the study.

Results: The number of patients enrolled in the study was 138, having ages ranging from 25 to 82 years, with the most frequent diagnoses being hypersensitivity pneumonitis (HP) at 27.5%, rheumatoid arthritis-associated interstitial lung disease (RA-ILD) at 15.9%, idiopathic pulmonary fibrosis (IPF) at 11.6%, and sarcoidosis at 10.1%. In patients with HP, avian exposure was the predominant etiological factor, seen in 63.1% of patients. In patients with IPF, all patients were older than 55 years, whereas sarcoidosis was more common in those aged between 25 and 50 years.

Conclusion: Hypersensitivity pneumonitis (HP) and rheumatoid arthritis-associated interstitial lung disease (RA-ILD) are the most prevalent form of ILD in our population.

COMPARISON OF OUTCOME OF BIPOLAR VERSES MONOPOLAR TRANS URETHRAL RESECTION OF PROSTATE IN PATIENTS WITH BENIGN PROSTATIC ENLARGEMENT

Khalil Ahmad — 2025-07-01

Background: The most prevalent condition affecting older men is benign prostate enlargement, or BPE. The most effective treatment for benign prostatic blockage is still transurethral resection of the prostate (TURP) combined with monopolar diathermy. Recently, a less invasive surgical technique for treating BPE was introduced: bipolar plasma kinetic TURP (BP-TURP) with isotonic saline irrigation. The benefits of bipolar TURP include the eradication of TURP syndrome, reduced risk of capsule damage, improved tissue orientation, and a self-cleaned loop.

Objectives: To compare the outcome of bipolar versus monopolar trans-urethral resection of prostate.

Methods: It is randomized controlled trial conducted at OPD of Department of Urology, Lahore General Hospital, Lahore for 12 months. 90 male patients aged >60 years presenting with BPE were admitted from. Patients were randomly divided in two groups by using lottery method. In Group A, patients underwent Monopolar TURP and in Group B, patients underwent Bipolar TURP. Outcome was noted in terms of blood loss and post-operative hospital stay. The collected data was entered and analyzed through SPSS version 25.0.

Results: The mean operative time was almost similar in both groups (55 vs 51 min). Post-operative hospital for M-TURP was 57.7+17.31 hours and for B-TURP was 37.2+15.03 hours. The mean duration of catheterization was found to be higher in M-TURP 3.31 (0.5) and B-TURP duration was 2.55 (0.4). Post-operative hospital stay for M-TURP was 57.7+17.31 hours and for B-TURP was 37.2+15.03 hours (p<0.05).

Conclusion: This study showed that Bipolar TURP has advantage for decreasing the risk of causing TUR syndrome and significant improvement in the bleeding before and after surgical procedure and late complications. The mean hospital stay duration was shorter in bipolar TURP than monopolar TURP group.

COMPARISON OF AIR-BONE GAP POST MYRINGOPLASTY IN CARTILAGE VERSUS TEMPORALIS FASCIA GRAFT: A SINGLE CENTER COMPARATIVE STUDY

Bakht Aziz — 2025-07-01

Background: The myringoplasty using a cartilage graft is always considered to be rigid and stable. The temporalis fasia graft is considered to be thinner and elastic. Multiple ear conditions like a dysfunctional eustachian tube or a retraction pocket, may alter the results. The surgical procedure of Myringoplasty aims to reinstate the ear drum integrity and improving the functionality of the ear drum in terms of hearing improvement (air-bone gap).

Objectives: To compare the audiological and surgical results of cartilage versus temporalis fascia graft in myringoplasty.

Methods: A clinical trial at Jinnah Hospital involved 100 patients who had myringoplasty surgery to repair the tympanic membrane. Patients were chosen from the ENT Outpatient Department from June 2023 to May 2024. The patients were randomly split into two groups. One group (50 patients) used temporalis fascia grafts, while the other group (50 patients) used cartilage grafts.

Results: After surgery, the mean Air-Bone Gap (ABG) for group 1 and 2 is 10.82±2.86 dB and 9.48±2.54 dB, respectively. While after surgery, the mean Air Conduction (AC) for group 1 and 2 is 21.34±3.65 dB and 19.44±3.50 dB, respectively. Overall, there was 89% surgical success rate.

Conclusion: An analysis of the data revealed that there was a remarkably negligible and statistically insignificant difference observed, neither in the surgical success rate that was achieved nor in the extent of hearing gain that was realized between the two distinct groups that were being compared in this particular study.

Keywords: Temporalis Fascia, Cartilage, Myringoplasty.

IN VITRO, ANTI-PROLIFERATIVE, APOPTOTIC AND ANTI-OXIDATIVE ACTIVITIES OF TERPINEN-4-OL

Hera Farooq — 2025-07-01

Objectives: The primary bioactive ingredient in tea tree oil is terpinen-4-ola naturally occurring monoterpene with a wide range of biological activity. Our goal is to investigate the anticancer effects of terpinen-4-ol at different concentrations as well as its mode of action on human brain cell cancer lines.

Methods: The study was designed as an in vitro RCT, from March 2020 to April 2022 and carried out at the University of Lahore's IMBB Department in Lahore, Pakistan. Four groups received study treatment: Terpinen-4-ol (experimental group), cisplatin (positive control), negative control (normal cell line), and vehicle control (DMSO). The cryovials were thawed before the cells were cultivated in T75 flasks. Terpinen-4-ol was administered at varying concentrations, Dead Cells Detection (Trypan Blue Assay) and Live Cells Detection (Crystal Violet Assay) were used to quantify its lethal effects via cytotoxicity and cell viability. VEGF angiogenesis factors and enzyme activity were calculated. The ELISA kit was utilized to assess apoptosis and inflammation. Statistical analysis was done using Graph Pad Prism. One-way analysis of variance (ANOVA) with bonferroni comparison within groups was used to analyze the data. P ≤ 0.05 was considered statistically significant.

Results: Cancer cell proliferation is significantly inhibited by terpinen-4-ol in a dose-dependent manner. The treated cell lines displayed more apoptotic alterations than the control group. The P-value was less than 0.05.

Conclusion: Terpinen-4-ol dramatically slows down the growth of cancer cell lines. Cell death induction is one potential molecular mechanism for its action.

EFFICACY OF DIFFERENT DOSAGE REGIMENS OF CARBIMAZOLE IN TREATMENT OF PRIMARY HYPERTHYROIDISM

Nauman Dawood — 2025-07-01

Objectives: To determine the efficacy of different carbimazole regimens in treatment of primary hyperthyroidism

Methods: This study was conducted at Medical Ward of Mayo Hospital Lahore from September 2023 to March 2024 on 100 patients with primary hyperthyroidism. Patients were assigned to two groups; Group A received carbimazole once a day, whereas Group B were prescribed with divided doses of carbimazole, which were modified based on results of TFTs.

Results: Among 100 patients enrolled (50 in Group A and 50 in Group B), there were no significant differences in baseline levels of TSH and T4, nor in their overall rates of reduction. Additionally, both groups showed comparable rates Of Achieving Euthyroidism During Follow-Up Assessments Conducted At Three-Month Intervals.

Conclusion: When administered in single daily dosing regimen, carbimazole is similarly successful in treatment of hyperthyroidism as daily divided dose regimen. Additionally, it raises the patients' compliance when taken as a single dosage every day.

ASSOCIATION OF LOW ANTENATAL HEMATOCRIT LEVEL WITH LOW BIRTH WEIGHT

Maryam Shahzadi — 2025-07-01

Background: The typical determinants of “low birth weight” are linked with critical biological, environmental & social circumstances that can occur before or during pregnancy. Nutritional elements, including a woman’s weight prior to pregnancy and the amount of weight gained during pregnancy, are crucial in influencing the fetus birth weight.

Objectives: To determine the relationship between low antenatal hematocrit level with “low birth weight”.

Methods: A “retrospective Cohort Study”at Department of Pediatrics, PAF Hospital Mushaf, Sargodha. This study was managed from 10^th June 2024 to 10^th December 2024. A total of 200 newborns (100 exposed/ 100 non-exposed) were covered in the study. 100 sample size for Group A or low antenatal hematocrit group while 100 sample size for Group B or normal antenatal hematocrit level group. Low birth weight was noted from the two groups.

Results: Age range in this research was gestational age >36 weeks with mean age at of 38.300±1.24 weeks, mean mother age 28.950±2.73 years and mean birth weight was 2.775±0.31 kg in exposed group and mean age of 38.800±1.26 weeks, mean mother age 28.000±2.98 years and mean birth weight was 2.936±0.21 kg in non exposed group. Low birth weight was 2.936±0.21 kg in non exposed group. Low birth weight was observed in 23 (23%) patients in exposed group as compare to 5 (5%) patients in non exposed group (P= 0.000, RR=4.6)

Conclusion: Our study showed that low antenatal hematocrit is related with low birth weight

A COMPARATIVE EFFICACY OF STEROID PLUS BUPIVACAINE, 5% DEXTROSE AND HYALURONIDASE FOR MEDIAN NERVE BLOCK IN CARPAL TUNNEL SYNDROME: A RANDOMIZED CONTROL TRAIL

Yusra Hussain — 2025-07-01

Background: Carpal Tunnel Syndrome (CTS) produces three main events including pain and numbness together with functional disability. Multiple physicians have studied individual treatment methods including steroid mixed with bupivacaine and 5% dextrose along with hyaluronidase to treat symptoms, however our study compared the effects of these 3 treatment methods.

Methods: This study involved 90 patients diagnosed with mild to moderate CTS who received three different types of therapy group assignments: Group A therapy included steroid + bupivacaine (30 patients); Group B therapy consisted of 5% dextrose for 30 patients; and 30 patients received Group C therapy of hyaluronidase. The study measured outcomes through Visual Analog Scale (VAS) for pain and Boston Carpal Tunnel Questionnaire (BCTQ) for functional assessment as well as nerve conduction studies (NCS) and median nerve cross-sectional area (CSA) on ultrasound. Analysis was conducted through SPSS version 27.0.

Results: Baseline characteristics were comparable in all groups (p>0.05). At 6 months, Group C (hyaluronidase) showed the greatest pain reduction (VAS: 1.5 ± 0.57), followed by Group B (1.8 ± 0.68) and Group A (3.3 ± 1.30); p<0.001. Functional improvement was highest in Group C (BCTQ-SSS: 1.53 ± 0.31, BCTQ-FSS: 1.20 ± 0.23) compared to Group B (SSS: 1.63 ± 0.49, FSS: 1.33 ± 0.27) and Group A (SSS: 2.86 ± 0.64, FSS: 2.34 ± 0.48); p<0.001. Nerve conduction velocity (NCV) improved most in Group C (43.3 ± 4.58 m/s) compared to Group B (39.8 ± 5.21 m/s) and Group A (33.9 ± 5.78 m/s); p<0.001. Median nerve CSA reduction was greatest in Group C (10.8 ± 1.95 mm²) vs. Group B (11.2 ± 1.89 mm²) and Group A (13.5 ± 2.01 mm²); p<0.001.

Conclusion: Chronic pain intensity along with functional capacity showed improvement in patients who received any of the three treatment modalities. The application of hyaluronidase produced the leading long-term advantages for pain reduction in combination with nerve function and structural repair. Steroid-bupivacaine created the quickest symptom relief and 5% dextrose provided ongoing but moderate symptom relief.