Pakistan Journal of Physiology <p>Pakistan Journal of Physiology (Pak J Physiol, PJP), an HEC Category '<strong>X</strong>' recognised scientific journal, owned and published by Pakistan Physiological Society, is an <strong>Open Access Journal</strong> and is <strong>FREE</strong> for academic and research use only. It is a <strong>Peer Reviewed Journal</strong> and publishes original research work in all areas of Human &amp; Animal Physiology. Pakistan Journal of Physiology enjoys the expertise of a galaxy of editorial&nbsp;board members and reviewers expert in their field of specialization.</p> <p>All articles published, including editorials, letters, and book reviews&nbsp;represent the opinions of the authors and do not reflect the official policy of Pakistan Journal of Physiology, Pakistan Physiological Society, or the Institution with which the author is affiliated unless this is clearly specified.</p> Pakistan Physiological Society en-US Pakistan Journal of Physiology 1819-270X <p><sup>© </sup>Copyrights reserved. Pakistan Journal of Physiology, Pak J Physiol, PJP is free for research and academic purposes only. No part of this publication may be reproduced in any shape, published, or stored in a retrieval media without permission of the Editors.</p> INTEGRATED MEDICAL CURRICULUM: A REVIEW OF UNIVERSITY OF HEALTH SCIENCES CURRICULUM <p><strong><em>To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.</em></strong><strong>&nbsp;Sir William Osler (1849-1919)</strong></p> <p>Integration can be defined as integration of content within a single lecture or integration of a medical school's curriculum. MBBS curriculum of University of Health Sciences seems to be on the basis of Z-shaped curriculum model. Pakistani medical schools are unique in the sense that all teachers of basic medical sciences are physicians having MBBS degree and Faculty have additional post-graduate qualification in the relevant basic subject. Horizontal integration takes place when students prepare for annual examination, when all subjects are learned at the same time. During their lectures, these physician-teachers cross reference for horizontal integration and relate basic concepts with clinical situations for vertical integration. In the UHS curriculum, clinical modules and clinical skills are taught to further facilitate vertical integration. We propose a simple scheme to rationalize integration in the annual assessment. In the first year class only 10% questions may be integrated, clinical scenario based; subsequently 20% increase each year will give the ratios of 30%, 50%, 70% and 90%. To improve medical education in the country, the only way forward is to efficiently train teachers, recruit good teachers, authorize, trust and respect teachers.</p> Tehseen Iqbal ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 1 2 IMPACT OF SMOKING ON ANTI-PLATELET EFFECTS OF ASPIRIN <p><strong>Background: </strong>Cigarette smoking stimulates platelet activation and aggregation and can also influence adversely the antiplatelet effects of aspirin, which is the mainstay of treatment in the primary and secondary prevention of ischemic heart disease. This study was carried out to analyze the effect of smoking on aspirin efficacy in coronary heart disease patients. <strong>Methods: </strong>In this cross sectional analytical study, 384 ischemic heart disease patients were enrolled. Light transmission Aggregometry (LTA) with arachidonic acid was utilized to assess the platelet function. Data was analyzed using SPSS-23. Chi-square test Odds Ratio were utilized to find out association of smoking with aspirin response status. <strong>Results: </strong>The study contained 272 (70.8%) male and 112 (29.2%) females with the mean age of 48.22±11.87 years. There were 199 smokers (51.82%) and 185 non-smokers (48.18%). Frequency of aspirin resistant among smokers was 41 (20.60%) whereas the frequency in non-smokers was 12 (6.50) and the difference was significant (<em>p</em>&lt;0.001). The adjusted Odds Ratio was 4.44 with 95% confidence interval of 2.07–8.90. Frequency comparison of aspirin responders between males and females was non-significant both in, smokers and non-smokers (<em>p</em>=0.14 and 0.92 respectively). <strong>Conclusion: </strong>Cigarette smoking adversely affects the antiplatelet efficacy of aspirin irrespective of gender.</p> Mudassar Noor Usman Nawaz Saleem Ahmad Khan Akbar Waheed Chaudhry Altaf ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 3 6 COMBINED EFFECT OF PIOGLITAZONE AND LEVO-CARNITINE ON SERUM LIPIDS AND ADIPONECTIN IN STREPTOZOTOCIN INDUCED TYPE 2 DIABETIC MICE <p><strong>Background: </strong>A strong relationship exists between obesity and weight gain with type 2 diabetes mellitus (T2DM) because of the ability of obesity to cause insulin resistance. The objective of this study was to determine the effect of combined supplementation of pioglitazone and <em>levo</em> carnitine on serum lipids and adiponectin in streptozotocin induced T2DM mice. <strong>Methods:</strong> This randomized controlled trial was carried out on 40 healthy BALB/c mice, divided into four groups. Mice were fed high fat diet for two weeks followed by intraperitoneal injection of streptozotocin. Group I served as diabetic control; group II was administered pioglitazone; group III <em>levo </em>carnitine and group IV was supplemented pioglitazone and <em>levo</em> carnitine. After six days of supplementation, the blood samples were analysed to assess insulin resistance, serum adiponectin levels and lipid profile. <strong>Results:</strong> The serum adiponectin levels revealed significant increase in combined supplemented group as compared with both diabetic control and <em>levo</em> carnitine groups. An improved serum lipid profile was observed in combined supplemented group as compared to the diabetic control group. There was significant positive correlation between serum adiponectin levels with high density lipoprotein (HDL-C) levels and significant negative correlation between serum adiponectin with serum total cholesterol and low density lipoprotein (LDL-C) levels in diabetic control group. <strong>Conclusions:</strong> The combined supplementation of pioglitazone and <em>levo </em>carnitine increases serum adiponectin levels and ameliorates dyslipidemia better than individual administration of each supplement in type 2 diabetic mice.</p> Shahida Parveen Muhammad Mazhar Hussain mahvash khan ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 7 10 DIAGNOSTIC ACCURACY OF THYROID ULTRASOUND IN DETECTION OF MALIGNANCY IN THYROID NODULES <p><strong>Background:</strong> Occurrence of thyroid nodules is a common clinical problem in Pakistan being endemic area for hypothyroidism. This study was carried out to evaluate the diagnostic accuracy of thyroid ultrasound in detection of malignancy in thyroid nodules keeping Fine Needle Aspiration Cytology (FNAC) as a gold standard.<strong> Methods:</strong> A descriptive cross-sectional validation study was conducted at Departments of Radiology and Pathology, Shaikh Khalifa Bin Zayed Al-Nahyan Hospital/ CMH, Muzaffarabad from Dec 2014 to Jun 2015. Patients referred for evaluation of thyroid nodules were included in the study. Ultrasound guided FNAC was performed under direct imaging guidance. The imaging findings and FNAC were compared to access the diagnostic accuracy of ultrasound in predicting malignancy in thyroid nodules. <strong>Results:</strong> A total of 175 patients were studied with age range between 20–70 years. Mean age of the patients was 44.05±14.8 years. Of these, 35.4% were males and 64.6% were females. On FNAC, 27.4% cases were positive and 72.6% cases were negative while on thyroid ultrasound 26.3% cases were positive and 73.7% cases were negative. True positive were 24.0%, false positive 2.3%, false negative 3.4%, and true negative were 70.3%. Thyroid ultrasound showed sensitivity 87.5%, specificity 96.8%, diagnostic accuracy 94.2%, positive predictive value 91.3% and negative predictive value 95.3%. <strong>Conclusion:</strong> High resolution ultrasound is a very useful tool in accessing and selecting thyroid nodules for biopsy with a high diagnostic accuracy.</p> Sadia Nawaz M Babar Khan Bushra Parveen M Asif M Rashid M Azeem M Nawaz ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 11 13 FREQUENCY OF PREMALIGNANT LESIONS IN WOMEN SCREENED BY PAP SMEAR <p><strong>Background: </strong>Cervical cancer related morbidity and mortality among women are major health problems in developing countries. Premalignant lesion of the cervix, i.e., intraepithelial neoplasia precedes cervical cancer and can be detected by Pap smear test. This study aimed to determine the prevalence of premalignant lesion of cervix in District Quetta. <strong>Methods: </strong>This study was based on 100 cases from the Outpatient Department of Obstetrics and Gynaecology at Combined Military Hospital Quetta. The selection criterion was sexually active patients presenting with complaints of vaginal discharge, dyspareunia, menorrhagia and lower abdominal pain. Patients less than 20 years of age, known cases of intraepithelial or invasive malignancy, and natives outside District Quetta were excluded. After fixation and staining, each smear was carefully examined according to criteria laid down by The Bethesda System for reporting cervical cytology. <strong>Results: </strong>Mean age of the patients was 47 years. The presenting complaints in descending order of frequency included lower abdominal pain 39%, vaginal discharge 29%, menorrhagia 28% and post coital bleeding in 4%. Out of 100 cases, 17 (17%) cases were positive for premalignant lesions and 79 (79%) were negative, whereas 4 (4%) were inadequate for analysis. <strong>Conclusion: </strong>Pre-malignant lesions of the cervix are common in District Quetta and can be diagnosed early by Pap smears.</p> Ahmad Ahsan Khan Shazia Nayyar ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 14 16 EFFECT OF SUB-CLINICAL HYPOTHYROIDISM ON CHOLESTEROL AND TRIGLYCERIDES <p><strong>Background:</strong> Sub-clinical Hypothyroidism (SCH) is associated with dyslipidemias which may increase the cardiovascular risk.&nbsp;The objective of this study was to compare the serum levels of cholesterol and triglycerides in subclinical hypothyroidism and normal euthyroid subjects. <strong>Methods: </strong>This cross-sectional comparative study had control group of 50 euthyroid subjects selected from Mayo Hospital, Lahore who were advised to get thyroid profile checked. Fifty sub-clinical hypothyroid patients were included on the basis of their thyroid profile reports. Fasting blood samples were taken from both the groups for analysis of serum levels of T4, total cholesterol and Triglycerides. Student’s <em>t</em>-test was used to compare the mean values, and <em>p</em>≤0.05 was considered statistically significant. <strong>Results: </strong>Mean Triglyceride level in SCH was 168.28 mg/dl, and in euthyroid controls it was 133.62 mg/dL (<em>p</em>&lt;0.001). There were no differences of total cholesterol in both groups with value of 190 mg/dL in SCH group and 189.12 in control group (<em>p</em>=0.912). Triglycerides level was raised in SCH and there was no pronounced effect on total cholesterol. <strong>Conclusion: </strong>The effects of SCH are more pronounced on triglycerides and less on total cholesterol.</p> Rana Khurram Aftab Syed Muhammad Zubair Farhat Ijaz Rana Rakhshan Aftab ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 17 20 PREVENTION AND DISSOLUTION EFFECTS OF SANG SARMAHI ON CALCIUM OXALATE CRYSTALS INDUCED BY GLYOXALATE TREATMENT IN RATS <p><strong>Background: </strong>Development of cost-effective therapy for safe removal of kidney stones is very much desired. The purpose of this study was to evaluate litholytic and anti-urolithic effects of <em>Sang sarmahi</em> on calcium oxalate crystals induced by glyoxalate treatment in rats. <strong>Methods: </strong>Thirty male Wistar rats were randomly divided into five equal groups; A, B1, B2, C1 and C2. Group A rats were untreated and served as negative controls. The rats in groups B1 and B2 after induction of calcium oxalate crystals were respectively given placebo and <em>Sang sarmahi</em> treatment and served as positive control and curative groups. The rats in groups C1 and C2 were simultaneously administered&nbsp;&nbsp; glyoxylate+placebo, and glyoxylate+<em>Sang sarmahi</em> treatments and respectively served as positive controls and preventive group. Serum samples of rats in groups A, C1 and C2 were measured for the levels of superoxide dismutase, glutathione peroxidase, catalase, calcium, magnesium, oxalate and creatinine. Similarly, left kidney tissue homogenates of rats in groups A, B1 and B2 were analyzed for the levels of reduced glutathione, malondialdehyde, superoxide dismutase, glutathione peroxidase and catalase. Histological slides of right kidney sections of all 30 rats were prepared for microscopic examination. <strong>Results: </strong>Histological examination of renal tissue sections showed that <em>Sang sarmahi</em> failed to prevent crystallization in kidneys of groups B and C rats. No significant differences were seen in serum and tissue homogenate parameters between positive controls and <em>Sang sarmahi</em> treated rats of both prevention and curative groups. <strong>Conclusion:</strong> <em>Sang sarmahi</em> failed to exhibit any significant litholytic and anti-urolithic activity.</p> Ali akbar shah Fatehuddin Khand Mumtaz Ali Memon Abdullah G. Arijo ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 21 24 ASSOCIATION OF GENDER WITH ABO AND RH BLOOD GROUPS - A CROSS-SECTIONAL STUDY <p><strong>Background:</strong> Both the blood group types ABO and Rh are inherited in Mendelian fashion and are important from transfusion point of view. The objective of this study was to make the gender-based comparison of frequency of ABO and Rh blood groups among the medical and dental students of Sharif Medical and Dental College, Lahore. <strong>Methods:</strong> This cross-sectional study was conducted from Sep 2015 to Sep 2017. Blood groups of 514 students was determined by conventional methods and data was analysed with SPSS for gender differences. <strong>Results:</strong> A total of 514 students were included in the study. Out of 514 students, 186 (36.18%) were males and 328 (63.18%) were females. Out of the males 170 (91.4%), and out of females 301 (91.8%) were Rh positive. The prevalence of Rh negative group in male subjects was 8.6%, and in female subjects it was 8.2%. The frequencies of A, B, O and AB blood groups in Rh positive males were 23.66%, 31.18%, 29.03% and 7.53% respectively, and among females, it was 19.82%, 39.63%, 21.34% and 10.98% respectively. In Rh negative males the frequencies of A, B, O and AB blood groups were 1.08%, 3.76%, 2.15% and 1.61% respectively, and among females these were 1.22%, 2.74%, 3.35% and 0.91% respectively. Frequency comparison of ABO and Rh blood groups across the two genders was not significant (p=0.17 and 0.88 respectively) <strong>Conclusion:</strong> No statistically significant association of gender was found with ABO and Rh blood groups.</p> Sana Qanber Abbasi Rabia Sattar Ghazal Mansoor ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 25 27 INTERNALIZING PSYCHOLOGICAL PROBLEMS AS PREDICTOR OF MENTAL WELLBEING AND LIFE SATISFACTION AMONG PREGNANT WOMEN <p><strong>Background: </strong>Pregnant women are at an increase risk of developing depression, anxiety and stress which can lead to less life satisfaction and decrease mental wellbeing. The present study was intended to examine the impact of internalizing psychological problems, including depression, anxiety, stress, on mental well being and life satisfaction, and to investigate depression impact on stress and anxiety among pregnant women. <strong>Method:</strong> It was a cross-sectional survey conducted at University of Haripur from Nov 2015 to May 2016. Following purposive sampling, one hundred pregnant women with age range of 19 to 38 years without any limitation of gestational age were approached during pregnancy from Obs/Gyn OPD of District Headquarter Hospital, Yahya Welfare Complex, and Allama Iqbal Hospital, Haripur. Depression, Anxiety, Stress Scale, Warwick-Edinburgh Mental Wellbeing Scale and Life Satisfaction scale were used for data collection. Pearson correlation analysis was used to access relationship among study variables. Impact of internalizing psychological problems on mental wellbeing and life satisfaction were computed through linear regression analysis. <strong>Results: </strong>Depression, anxiety and stress were positively related to each other and negatively related to wellbeing and life satisfaction (<em>p</em>&lt;0.001). Linear regression analysis depicted that internalizing psychological problems have significant impact on mental wellbeing and life satisfaction (<em>p</em>&lt;0.001). Further, depression has a significant impact on stress and anxiety of pregnant women (<em>p</em>&lt;0.001). <strong>Conclusion:</strong> Presence of stress, depression and anxiety significantly decreases mental wellbeing and life satisfaction during pregnancy. Increase in depression is highly responsible for rise in stress and anxiety among pregnant women.</p> Sajid Mehmood Alvi Syeda Ayat-e-Zainab Ali Rabia Akbar Shah Tahira Jabeen Nighat Gul Maryam Afridi ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 28 32 PREVALENCE OF IRON DEFICIENCY ANAEMIA IN YOUNG ADOLESCENT GIRLS AT UNIVERSITY OF PESHAWAR <p><strong>Background:</strong> Anaemia is one of the most frequent and important health problems among the adolescent girls throughout the world. Iron deficiency anaemia constitutes major anaemia due to rapid growth, hormonal changes, menarche, and malnutrition due to poor dietary intakes. The current study was designed to investigate the role of dietary intake patterns in prevalence of anaemia among the teenage girls residing in hostels. <strong>Methods:</strong> A convenient random sample of 237 college/undergraduate students residing at girls’ hostels was subjected to anthropometry, biochemical tests for blood iron indices, and dietary intake analysis. <strong>Results:</strong> Normal mean anthropometric measurements were observed among the sampled students. Sixty-one percent (61%) of girls had haemoglobin (Hb) level below normal, 85% had low haematocrit percent and 82% had low serum iron. The highest category of sub normal Hb level was in the range of 9–11.9 g/dl (48%), haematocrit 25–29.9% (52%), and Serum iron 26–35 µg/dl (34%). The daily dietary intake pattern showed good breakfast consumption (82%), snacking on fried and starchy foods and carbonated beverages a common practice, and skipping of major meals a regular feature. Cereals and grains based diets and lack of fresh fruits and vegetables were found to be contributing factors to the gross prevalence of anaemia among this age group. <strong>Conclusion: </strong>Anaemia is the most prevalent dietary deficiency disorder among undergraduate students mainly caused by poor dietary intake patterns.</p> Fazia Ghaffar Falahat Waqar ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 33 36 EFFECT OF ALMONDS AND ATENOLOL ON SERUM LUTEINIZING HORMONE LEVEL IN MALE BALB-C MICE <p><strong>Background:</strong> Along with other advantageous effects nuts are good for fertility and can improve derangements in different fertility parameters. With increasing incidence of hypertension leading to an increase in consumption of antihypertensives it is inevitable to depart their side effects. This study was designed to see the effect of administration of Prunus amygdalus, atenolol and combination of atenolol and Prunus amygdalus on level of serum luteinizing hormone (LH) in male Balb-C mice. <strong>Methods:</strong> This experimental study was conducted from December 2013 to June 2014. One hundred and twenty mice fulfilling inclusion criteria were divided into 4 groups of 30 mice each. Group A served as control group, group B mice were given atenolol, group C mice were given extract of almonds and group D mice were given atenolol and almonds. After the completion of 3 months, blood sampling was done and serum LH was measured. Data was analyzed on SPSS-17, Mean±SD was calculated for luteinizing hormone levels. One-way ANOVA was applied and <em>p</em>≤0.05 was considered significant. <strong>Results:</strong> The mean value of serum LH in group B (Atenolol treated) was found to be significantly elevated. In group C (Almonds) serum LH was decreased but not significantly. Mean serum LH level in group D (Atenolol+Almond) was raised as compared to control group, but not significantly. <strong>Conclusion:</strong> Administration of Prunus amygdalis does not affect serum LH but atenolol causes a rise in serum LH.</p> Irum Rehman Shakir khan ifra ashraf ayesha naveed farheen masood ##submission.copyrightStatement## 2018-08-14 2018-08-14 14 3 37 40 ASSOCIATION OF ANAEMIA WITH DIETARY PRACTICES IN ADOLESCENT GIRLS <p><strong>Background:</strong> Anaemia is one of the ten most serious public health problems world over. Adolescent girls are more at risk to be anaemic due to their rapid growth, hormonal changes, imbalance between food intake and requirement and onset of menarche. This may lead to impaired intellectual growth, development, immunity and reproductive abilities. This study was planned to assess the prevalence of anaemia and its association with dietary habits in adolescent girls of District Rawalpindi. <strong>Methods:</strong> This cross-sectional analytical study was conducted in six villages of two union councils of district Rawalpindi. A sample of 104 randomly selected unmarried adolescent girls (11–19 years) was included in the study. Portable haemoglobin meter (Hemocue) was used to estimate haemoglobin levels. Demographic data was obtained by a self-structured questionnaire. Dietary variables were collected by using food frequency questionnaire and 24 hour’s dietary recall method. Analysis was done using SPSS-21 and Nutrisurvey software. <strong>Results:</strong> The study revealed that 71.2% of adolescent girls were anaemic. The prevalence of mild, moderate and severe anaemia amongst the girls was found to be 53.8%, 15.4% and 1.9% respectively. The results revealed that girls who had anaemia were also found deficient in vitamin A and zinc. <strong>Conclusion:</strong> Anaemia in girls of rural area in district Rawalpindi was found to be substantially high in younger adolescents (9–14 years). Anaemia was significantly associated with vitamin A and zinc deficiency. Nutritional awareness and counselling for adolescent girls in community and educational institution is recommended.</p> Rabia mahmood Rukhsana Khan Shemaila Saleem ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 41 45 RELATIONSHIP OF OBESITY WITH INSULIN RESISTANCE IN POLYCYSTIC OVARIAN SYNDROME <p><strong>Background:</strong> Polycystic ovary syndrome (PCOS) is associated with insulin resistance, hyper-insulinemia and obesity. This study was designed to find out the levels of insulin resistance (IR) and its relationship with obesity in patients of PCOS. <strong>Methods:</strong> Seventy-four (74) females, diagnosed as PCO were selected from the Outpatient Department of Lady Atchison Hospital and divided in two groups. Group 1, PCOS with BMI &lt;25 Kg/m<sup>2</sup> and Group 2 with BMI ≥25 Kg/m<sup>2</sup>. Blood glucose and serum insulin were determined using ELISA. Insulin resistance was calculated using HOMA-IR method. Data was analyzed using SPSS-20. Mean±SD was used to present quantitative data. Normality of data was checked by one sample Kolmogorov Simonov test. Pearson’s correlation test was applied to see relationship between insulin resistance and obesity. The <em>p</em>≤0.05 was considered as significant. <strong>Results: </strong>Serum insulin in Group 2 (26.35±25.78) was statistically higher than Group 1 (16.63±13.58). Insulin resistance in Group 2 and Group 1 was 5.37±4.96 and 4.25±3.53 respectively, with no statistically significant difference (<em>p</em>=0.249). No significant correlation was found between IR and BMI in either cases or controls but overall a weak positive correlation was noted between the two variables. <strong>Conclusion:</strong> Insulin resistance and serum insulin were higher in females with polycystic ovarian syndrome. Insulin resistance and hyperinsulinaemia share the disease and might exacerbate the symptoms of disease. No significant correlation was found between insulin resistance and BMI</p> Imrana Ihsan Qazi Asma Tehreem Qazi Farhat Ijaz Samia Jawed Rana Khurram Aftab Shafia Rasool Qazi ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 46 49 ASSOCIATION OF BODY MASS INDEX WITH CLOPIDOGREL RESISTANCE <p><strong>Background:</strong> Clopidogrel is an essential component of dual antiplatelet treatment for ischemic heart disease. We planned to explore the association of body mass index with clopidogrel resistance in ischemic heart disease patients. <strong>Methods: </strong>Three hundred and ninety patients of ischemic heart disease who were taking clopidogrel 75mg/day, were included in the study. Patients were categorized according to their body mass index (BMI) into underweight (BMI&lt;18.50 Kg/m<sup>2</sup>), normal weight (BMI 18.50–22.99 Kg/m<sup>2</sup>), overweight (BMI 23.00–24.99 Kg/m<sup>2</sup>), and obese (BMI&gt;25 Kg/m<sup>2</sup>). Their blood samples were taken and platelet aggregation studies were performed using Chronolog light transmission aggregometer to confirm clopidogrel resistant status. <strong>Results: </strong>None of the underweight, 19.50% of the normal weight, 24.20% of the overweight and 33.60% of the obese patients were found to be clopidogrel resistant. Clopidogrel resistance was significantly higher in obese patients as compared to normal weight patients, <em>p</em>=0.019. No significant difference in clopidogrel response was found between normal weight and overweight patients, as well as overweight and obese patients. Mean BMI of clopidogrel resistant patients was significantly higher than mean BMI of clopidogrel responders (26.46±3.82 vs 24.15±3.39 Kg/m<sup>2</sup>), <em>p</em>&lt;0.001. Correlation between BMI and platelet aggregation was significant (<em>p</em>&lt;0.001, <em>r</em>=0.20). <strong>Conclusion:</strong> BMI is inversely related to the platelet inhibition by clopidogrel. Higher BMI is related to clopidogrel resistance in ischemic heart disease patients.</p> Usman Nawaz Mudassar Noor Chaudhry Altaf Akbar Waheed Saleem Ahmad Khan ##submission.copyrightStatement## 2018-08-09 2018-08-09 14 3 50 53 OUTCOME OF EXPERIENTIAL LEARNING: A QUASI EXPERIMENTAL STUDY <p><strong>Background:</strong> The practical curriculum of 2<sup>nd</sup> year medical students mainly consists of neurological examination. Objective of this study was to see the effect of experiential learning on performance of medical undergraduates during examination of cortical and peripheral perceptions. <strong>Method:</strong> In this quasi experimental study, 142 students of 2<sup>nd</sup> Year MBBS, University College of Medicine and Dentistry were inducted and Experiential Learning cycle was used as a teaching and learning intervention. This cycle was run in 4 stages: Concrete experience, Observation and reflection, Formation of abstract concepts (analysis) and generalizations (conclusions), and Hypothesis testing leading to new experiences. A conventional practical demonstration was given followed by hands-on training by trained Demonstrators. The students were assessed at observed OSPE stations. Their performance was video-recorded for reflection. The students then reflected on performance videos (reflection on action). They were asked to identify and quote their strengths and weaknesses. They were then subjected to small group discussion/peer-assisted learning. The students evaluated each other with the help of standardized key. In late session exams the students’ final score was recorded. Their performances before and after reflection were compared through paired sample Student’s <em>t</em>-test. <strong>Results:</strong> There were highly significant differences in scores (<em>p</em>=0.006) before and after implementation of the experiential learning cycle.<strong> Conclusion:</strong> Academic performance of students can significantly improve by implementation of experiential learning.</p> Maimoona Nasreen Qasim M. Janjua Tayyaba Azhar Qurrat-ul-ain Leghari Samina Malik ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 54 55 LEARNING OF ECG WITH PUZZLES <p><strong>Background:</strong> The students learn effectively well with active learning strategies as compared to traditional approach. The objective of present study was to evaluate the effect on learning outcome of post lecture puzzles. <strong>Method:</strong> This study was carried out on 1<sup>st</sup> year medical students. Initially a lecture on ECG was given. At the end of lecture, assessment of students was done. On the second day whole class was divided into 6 groups, each group comprising of 12–15 students. Each group was provided with an illustration of ECG waves, cardiac vectors, and ECG leads, and were asked to recognize and label those with chips. At the end of this puzzle, assessment of students was carried out by fill-in-the-blank questions. At the end students’ feedback was taken. <strong>Results:</strong> For ECG, pre puzzle and post puzzle scores of participants were 5.23±2.06 and 6.70±2.27 out of 10 respectively. In feedback 79.5% expressed that it was useful for their better comprehension, 9.6% said that it was necessary and 10.89% students responded that this activity was not necessary but was useful. The passing percentage of Islamic International Medical College improved by 23.1%. <strong>Conclusion:</strong> Post lectures puzzles can lead to better learning outcome. It was well appreciated by the students.</p> Ayyaz Ahmed Mahvash Khan Zeeshan Ahmed Qureshi Arif Siddiqui ##submission.copyrightStatement## 2018-08-20 2018-08-20 14 3 56 59 PERCEIVED STRESS IN UNDERGRADUATE PHYSICAL THERAPY STUDENTS OF PESHAWAR, PAKISTAN <p><strong>Background</strong>: Stress results from different kind of stressors that affect students either positively or<br>negatively depending on their coping ability. Academic stressors are the main cause of stress and<br>depression among undergraduate allied health sciences’ students. The aim of this study was to<br>determine the prevalence of perceived stress and its association with gender among undergraduate<br>physical therapy students of Peshawar. <strong>Methodology</strong>: Level of perceived stress was assessed using<br>cross sectional study design at different Physiotherapy institutes of Peshawar, Pakistan. A total of 300<br>students were recruited from five different institutes. Degree and prevalence of stress was assessed<br>using Perceived stress scale (Cohen PSS 10). <strong>Results</strong>: Seventy-two percent students were found to be<br>moderately stressed, 23.3% were highly stressed whereas 4.7% had low level of stress. Female students<br>showed significantly higher stress levels (23.50±4.80 vs 21.50±5.60, p=0.01). Control on irritation and<br>confidence were considered as positive stressors whereas nervousness, stress and loss of patience were<br>found to be the important negative stressors. <strong>Conclusion</strong>: A significant number of physiotherapy<br>students fall in moderate to high stress categories with female preponderance.</p> Inayat Shah Syed Hamid Habib Yasar Mehmood Yousafzai Asif Ali Sareena Ikram Huma Zia Rashida Said ##submission.copyrightStatement## 2018-09-30 2018-09-30 14 3 60 63 QUALITY OF LIFE AND ITS DETERMINANTS IN TRANSFUSION DEPENDENT THALASSEMIA <p>Background: Patients with transfusion-dependent Beta-Thalassemia carry the burden of chronic illness throughout their lives. Data regarding the impact of disease on the quality of life of these patients is scant. The objective of this study was to assess physical and emotional aspects, family health, school &amp; career functions, and overall quality of life of children with transfusion-dependent thalassemia major and to investigate the determinants of quality of life. Methodology: A total of 365 patients registered in selected thalassemia centres of Peshawar, participated in the study. Data regarding effect of thalassemia on mental health, physical health, family life, career and school was collected using the TranQol questionnaire. Additionally, in a subset of patients (n=40) clinical and molecular genetic information were also collected to assess the role of these variables as determinants of quality of life. Results: Study revealed that thalassemia major affects quality of life negatively. The disease has its manifestations on physical (mean effect 36.05±13.80), emotional (mean effect 42.10±9.42) and family health (mean effect 55.44±8.85) as well as school and career (mean effect 25.85±15.69) of the patients. Moreover, The TranQol scores were positively correlated with higher Hb and hydroxyurea therapy and negatively correlated with serum ferritin levels of patients. Conclusion: Physical, emotional, family and school health are all negatively affected by the transfusion dependent thalassemia. Quality of Life is directly proportional to the Hb levels and use of Hydroxyurea therapy, and inversely proportional to levels of ferritin.<br>Pak J Physiol 2018;14(3):64–7</p> Yasar Mehmood Yousafzai Asfandyar Roghani Naseem Khan Inayat Shah Saba Khan Abid Sohail Taj ##submission.copyrightStatement## 2018-09-30 2018-09-30 14 3 64 67 IN-SILICO ASSESSMENT OF COMMON β-GLOBIN GENE MUTATIONS FOUND IN KHYBER PAKHTUNKHWA, PAKISTAN <p>Background: β-thalassaemia manifests a spectrum of clinical phenotypes, ranging from mild subclinical disease to severe transfusion-dependent anaemia. This remarkable diversity of disease patterns is not completely explained, but various disease modifying factors have been identified and categorized in to primary, secondary and tertiary modifiers. Nearly 300 mutations in β-globin genes (HBB) have been reported so far. In our previous study we identified six mutations; (Cd 5 (-CT), FR 8-9(+G), FR 16(-C), FR 41-42(-TTCT), Cd 30(G&gt;A) and Cd 15(G&gt;A) to be the most frequent ones in Khyber Pakhtunkhwa province of Pakistan. It is aimed to observe if bioinformatics tools could be used to construct the structure of globin chains carrying these six common mutations. Methodology: Using a computational approach, the sequences of mutated HBB were hypothetically constructed, protein structures were formulated and analysed for homology, and post-translational modifications. In mutations where protein structure formation is halted in vivo, stop codons from the DNA sequence of each of the mutational variant were exclude to allow further analysis. Results: These mutants exhibited variable post-translational modification pattern with little effect on overall<br>structure. Mutations at critical sequences in HBB that do not allow further translation of HBB in vivo and did not stop computer modelling from developing protein structure in-silico. Conclusion: Computational analysis for constructing mutant proteins does not take into account some of the critical checkpoints present in the cell. Studies using computational analysis should be followed by rigorous in vivo validation.</p> <p>Pak J Physiol 2018;14(3):68–73</p> Tehmina Jalil Ibrahim Rashid Inayat Shah Ilyas Khan Yasar Mehmood Yousafzai ##submission.copyrightStatement## 2018-09-30 2018-09-30 14 3 68 73