There were low levels of empathy in Pakistani medical students. Students with interest in medicine and allied showed higher empathy scores compared to surgical or technical specialties. No association of empathy scores with gender and medical school year was observed.

Objective: To determine if there was any significant difference in scores of students who acquired knowledge through team-based learning (TBL) versus those who learned through small group discussion (SGD). Study Design: Quasi-experimental cross-over study. Place and Duration of Study: Shifa College of Medicine, Islamabad, from March to December 2015. Methodology: All students of second year MBBS were assigned to either TBL or SGD, based on non-probability sampling, for 8 themes in a five-week module. The groups were flipped after 4 themes. TBL format recommended by the AMEE guide No: 65 was followed. The impact of both learning methods was assessed by comparing end-of-module written examination scores of the two groups through independent sample t-test. SPSS version 23 was used for data analysis. A p-value of <0.05 was considered statistically significant. Results: End-of-module written examination scores showed there was no significant difference in student academic performance when they studied with TBL or SGD in themes 1-4 (TBL 61.90 ±13.01 versus SGD 59.65 ±11.56, p=0.41). However, for themes 5-8 there was a significant difference in scores (TBL 65.36 ±11.62 versus SGD 59.92 ±10.65, p=0.03) A trend towards higher scores was observed in content learned with TBL in all eight themes. Conclusion: TBL is equally effective as an instructional method as SGD. However, it could not be established that it results in significant improvement in learning.

Student performance shows a positive correlation in non-cognitive skills between Multiple Mini Interview and Integrated Practical Examination.

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To determine the efficacy of spinal anesthesia with sub diaphragmatic lidocaine for gynecological laparoscopic surgery at the commencement of the procedure to spinal anesthesia for get pain relief Methods: It was a randomized clinical trial conducted at Ali Medical Hospital in Islamabad. A total of 84 patients were given sub diaphragmatic lidocaine spinal anesthesia, only spinal epidural anesthesia and general anesthesia. During procedure, 2, 4, 6 and 12 hours after surgery, and before discharge, patients' pain perception was measured using Visual Analogue Scale (VAS) Results: Outcomes showed no significant difference in perception of pain at different time intervals in all three groups. (F 4, 77 = 0.38, p = 0.81). At all-time intervals following surgery, patients' pain levels were similar between groups (F 2, 77 = 0.53, p = 0.57). Conclusions: The use of sub diaphragmatic lidocaine at the onset of surgery together with the spinal anesthesia did not result in a prominent statistical difference in patients' postoperative VAS scores when compared to general anesthesia and spinal epidural anesthesia after and prenatal invasive techniques.

Objective: The aim of current study is to determine the effectiveness of caudal bupivacaine and bupivacaine-tramadol combination for postoperative analgesia in children undergoing lower abdominal surgeries. Study Design: Randomized Control trial Place and Duration: Department of Anesthesiology Surgical ICU & Pain Management Ghulam Muhammad Mahar Medical College, Sukkur and Lahore General Hospital, Lahore, during the period from March 2021 to August 2021. Methods: There were 110 children of both genders with ages 2-8 years undergoing lower abdominal surgery were included in this study. A detailed demographics of enrolled patients, including age, sex, and weight were computed after obtaining informed written consent from each individual. Patients were equally divided in two groups. Group I had 55 patients and received combination of tramadol (1 mg/kg) and bupivacaine (0.5 ml/kg of 0.25%) and group II received only bupivacaine 0.5 ml/kg of 0.25% after induction of anesthesia in caudal epidural space. Post-operatively pain score, requirement of rescue analgesia and sedation score was assessed and compared among both groups. SPSS 24.0 was used to analyze complete data. Results: There majority males 35 (63.6%) in group I and 32 (58.2%) in group II. In group I mean age of the patients was 5.9±4.61 years and in group II mean age were 4.8±9.44 years. Mean weight of the patients in group I was 17.6±4.52 kg and in group II mean weight was 19.5±7.34 kg. During the first 24 hours, we noticed a reduced pain score in the bupivacaine–tramadol group. When it comes to postoperative analgesia, the bupivacaine-tramadol group had much longer analgesia durations and a significantly lower need for rescue analgesia with p value <0.003. Postoperative frequency of adverse effects in group II was greater found in 4 (7.3%) cases as compared to group I in 1 (1.8%) patients. Conclusion: In children having abdominal surgery, we found that caudal tramadol with bupivacaine provided more extended and better quality postoperative analgesia than plain bupivacaine. Keywords: Tramadol, Bupivacaine, Abdominal Surgery, Pain Score, Rescue Analgesia

Immunoglobulins are also known as antibodies. Plasma cells are responsible for the production of immunoglobulins. Beta cells are activated against a pathogenic attack and facilitated the formation of different types of immunoglobulins naturally. These immunoglobulins are also artificially synthesized by non-specific laboratorial techniques include fractionation precipitation, electrophoretic methods, gel filtration chromatography, ion exchange chromatography, hydrophobic chromatography and by the specific immuno- adsorbent methods. Third generation immunoglobulins are effectively used for therapeutic purpose against viral infections intravenously. Second generation immunoglobulins synthesis involved removal of anti-complement contaminants and IgG aggregates, through enzymatic degradation and chemical modification. The harmful effects of intravenous immunoglobulins can be reduced by using ultraviolet light, P-propiolactone, and pepsin at pH 4. Intravenous immunoglobulin drugs lead to anti-inflammatory and immunomodulatory effects in various infections. The mechanism of action of intravenous immunoglobulins is dependent on the binding between the Fc portion of injected IgG and target cell receptors. Radiolabeling is performed by two methods as in vivo, in which radiolabeled antibodies are incorporated into the body to bind with the antibodies and in vitro method, radioactive material is bound with already formed antibodies. This chapter highlighted the artificial methods adopted for production of radiolabeled immunoglobulins holding significant therapeutic and diagnostic applications.

Objective: To see if adding a mild dosage of ketamine to tramadol can help avoid shivering when under spinal anaesthesia. Study Design: Randomized study Place and Duration: The study was conducted at the department of Anesthesia, Sindh Government Liyari General Hospital Karachi and Shiekh Khalifa Bin Zayed Hospital, Quetta for the duration of six-months from December 2020 to May 2021. Methods: There were one hundred and seventy patients of both genders undergoing inguinal hernia were included in this study. Informed permission was obtained before to calculating demographic information such as age, sex and BMI. Patients were divided equally into two groups. Group A had 85 patients and received low dose ketamine 0.25 mg/kg (K) into tramadol and group B had 85 patients and received tramadol 0.5 mg/kg (T) alone. Post-treatment effectiveness among both groups was compared in terms of shivering control. We used SPSS 19.0 version to analyze complete data. Results: In group I the mean age of the patients was 33.9±9.76 years and mean age in group II was 31.5±3.23 years. There were 55 (64.7%) males and 30 (35.3%) females in group I while in group II 65 (70.6%) were males and 30 (29.4%) females. HTN and diabetes mellitus were the most common comorbidities found among both groups. 50 (58.2%) patients in group I had ASA class II and in group II 54 (63.2%) had ASA class II. We found that low dose ketamine to tramadol was effective in reduction of shivering in 33 (38.9%) as compared to tramadol alone shivering found in 41 (48.2%) cases. Conclusion: We concluded in this study that low dose ketamine into tramadol under spinal anesthesia is an effective and useful in terms of reduction in shivering as compared to tramadol alone in patients undergoing surgery. Keywords: Spinal Anesthesia, Ketamine, Tramadol, Shivering