Workplace based assessment (WPBA) refers to a group of assessment modalities which evaluates trainees’ performance during the clinical settings. Hallmark of WPBA is the element of observation of the trainee’s performance in real workplace environment along with relevant feedback, thus fostering reflective practice. WPBA consists of observation of clinical performance (mini-clinical evaluation exercise, direct observation of procedural skills), discussion of clinical cases (case based discussion), and feedback from peers, coworkers, and patients (multisource feedback). This literature review was conducted on the databases of MEDLINE, EMBASE, CINAHL, and The Cochrane Library. Data were retrieved by connecting Medical Subject Headings (MeSH) keywords: ‘workplace based assessment’ AND ‘mini-clinical evaluation exercise’ AND ‘direct observation of procedural skills’ AND ‘case based discussion’ AND ‘multi-source feedback’. Additional studies were searched in the reference lists of all included articles. As WPBA is gaining popularity, there is a growing need for continuing faculty development and greater evidence regarding the validity and reliability of these instruments, which will allow the academia to embed this strategy in the existing curricula. As of today, there are conflicting reports about the educational impact of WPBA in terms of its validity and reliability. This review draws upon the spectrum of WPBA tools, their designs and applications, and an account of the existing educational impact of this emerging assessment strategy in medical education. Finally, the study reports some educational impact of WPBAs on learning and emphasises the need for more empirical research in endorsing its application worldwide.

Due to globalizing trend of homogenisation of culture, changes in the health care delivery system and market economics infringing on the practice of medicine, there has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As the subject has gained worldwide prominence, we want to review this topic from Islamic perspective due to its significance in medical ethics and clinical practice.

Objectives: Anxiety and depression among doctors may negatively affect quality of patient care, patient safety, and professionalism. Despite the potentially serious personal and professional consequences of depression, there are very limited researches done on depression among Pakistani doctors. Therefore this study was aimed to determine the prevalence of anxiety and depression among doctors in a private teaching hospital in Pakistan. Method: This was a cross-sectional survey conducted in a tertiary care teaching hospital in Pakistan. The Self-Reporting Questionnaire for Anxiety and Depression (SRQ 20) Scale was administered to a sample of 300 medical doctors. Chi-square test and multiple regressions were used for data analysis. Results: Anxiety and Depression among doctors was measured to be 27.3 % (95% CI: 22.3, 32.4) in our study. Conclusion: More than one quarter of our doctors are suffering from anxiety and depression but this subject is fairly neglected in Pakistan and more studies should be conducted to collect more validated information on this matter.

The quality of education is one of the controversial topics and vital issues that requires more emphases from researchers due to the current challenges in education at the university level. Involvement and participation from the studentis essential to implement quality assurance and to reach for academic accreditation. The aim of this study is to assess knowledge, attitudes, and practices (KAP) of students towards TQM in education and its influencing factorsatHigh Institute of Health Sciences (HIHS) in Sana'a, Yemen. A cross-sectional study using a self-administered questionnaire was conducted in 2016. A total of 208 students from second and third study levels in HIHS had participated from 268 students were observed (study population). Descriptive statistics, chi-square, and one-way ANOVA were used to determine the association between students’ KAP towards TQM in education with its influencing factors. Mean age of the students were 22.44(SD±2.027) year old. Majority of HIHS students were male 135 (64.9%) and 108 (51.9%) were from the third studying level. The highest students' KAP scores were 53.4%, 65.4%, and 41.3% for good knowledge, good attitudes, and moderate practices respectively. Education Department was found to be significantly associated with students' knowledge and practices with p<0.05. In addition, the means of knowledge, attitudes, and practices were higher among pharmacy, radiology, and physiotherapy students respectively than laboratory students. Students' practices were found to be significantly associated with management, academic, and material factors with p<0.001. HIHS students were observed to have good knowledge, good attitudes, and moderate practices towards TQM.​

Objective: The aim of this study was to determine the contents of caffeine and total polyphenol in six brands of market tea cultivated and processed in Bangladesh. Methods: Caffeine and polyphenol contents were determined by solvent extraction (AACC) and the International Organisation for Standardisation Method (ISO) 14502-1 respectively. Results: Caffeine contents of the different tea samples ranged between 0.99 ± 0.17% to 2.08 ± 0.16% (g/100g materials), while that of total polyphenol was from 36.90 ± 1.39% to 17.29 ± 2.30% of gallic acid equivalents (GAE). The order of caffeine concentration in tea samples was found as follows: Organic Black Tea > Taaza Tea > Organic Green Tea > Magnolia Tea > Organic Zinger Tea > Organic Tulsi Tea. The polyphenol concentration in the tea samples was highest in Organic Green Tea followed by Taaza Tea and the rest as follows: Magnolia Tea > Organic Black Tea > Organic Zinger Tea > Organic Tulsi Tea. An indicative difference in amounts of caffeine and polyphenols for different tea brand samples is seen in this study. Conclusion: This systematic screening provides information to producers as well as consumers on the quantities of caffeine and polyphenols in commercial tea available in the markets of Bangladesh.

Gamma-irradiation of blood components is regarded a safe procedure used for prevention of transfusionassociated graft-versus-host disease. However, reports showed that irradiation can cause erythrocyte haemolysis and damage to the RBC membrane. In Universiti Kebangsaan Malaysia Medical Centre (UKMMC), a number of suspected transfusion reactions (TR) featured unusual isolated episodes of red-coloured-urine or haemoglobinuria among paediatric patients without clinical features of acute haemolytic TR. Haemolysis of irradiated red cells was suspected as a cause. This study was conducted to evaluate haemolytic changes of RBC components following irradiation. A prospective, pre- and post- irradiation comparative study was conducted on 36 paired RBC-components in the blood-bank, UKMMC in the year 2013. Samples were tested for plasma-Hb, percent-haemolysis, plasma-potassium (K+) and lactate dehydrogenase (LDH) level. Post-irradiation mean plasma-Hb and percent-haemolysis were significantly higher than pre-irradiation values at 0.09±0.06g/dl VS 0.10±0.06g/dl and 0.19±0.13% VS 0.22±0.13% respectively, while plasma-K+ and LDH values did not show significant difference. However, the mean percent-haemolysis level was still within recommended acceptable levels for clinical use, supporting that irradiated RBC units were safe and of acceptable quality for transfusion. There was no conclusive reason for isolated haemoglobinuria following transfusion of irradiated red-cell products. Further research is suggested to investigate the other possible causes.

Background and Objectives: Despite much medical progress, stroke remains a leading cause of death and disability. The aim of our study was to analyze the frequency of various risk factors and determine predictors of in-hospital mortality among primary intracerebral hemorrhage (PICH) patients, thus providing insight in developing therapeutic strategies to improve the outcome. Methods: A prospective study conducted at a tertiary care hospital. Results: A total of 160 patients (108 male and 52 female) were evaluated. Their ages ranged from 25 to 85 years (mean age was 58.3 ± 11.4 years). Hypertension was the commonest risk factor (74.4%), followed by diabetes mellitus (18.8%) and cigarette smoking (36.3%). The commonest location of ICH was lobar (43.8%) followed by basal ganglia / internal capsule (28.1 %) and multilobar (13.1%). The overall in-hospital mortality was 32.5 %. About one third (32.7%) of the deaths occurred within fi rst 24 hours, this rose to 38.5% within fi rst 2 days and 84.6% within one week. The signifi cant independent predictors of acute in- hospital mortality were Glasgow Coma Scale (GCS) on admission, posterior fossa bleed (OR 11.01; 95% CI 3.21 to 37.81), hematoma volume >60ml (OR 4.72; 95% CI 1.34 to 16.64), mid line shift (OR 3.32; 95% CI 1.05 to 10.50) and intraventricular extension of haemorrhage (OR 5.69; 95% CI 2.24 to 14.47). Conclusion: Low GCS score, posterior fossa bleed, and large hematoma volume were main indicators of mortality following PICH in East coast of Peninsular Malaysia.

Gastrointestinal stromal tumors (GIST) because of its rarity continues to be a curiosity for radiologists, surgeons and pathologist. These tumors are usually found in gastrointestinal tract (GIT) but account for less than 1% of GIT tumors. A 35-year-old male presented to us with complaints of painful micturation which on radiologic evaluation revealed a large mass in relation to urinary bladder. The tru-cut biopsy reported a low grade soft tissue tumour. The said mass was excised on laparotomy and sent for histopathological examination which reported as high grade GIST or a pleomorphic sarcoma as possibilities. Immuno-histochemistry finally confirmed the diagnosis of a GIST with CD 34 positive and C-Kit negative status. Approximately, 95% of GIST tumors are C-Kit positive and hardly 5% are C-Kit negative. C-Kit negative status makes this case report more worth reporting.
Gastrointestinal Stromal Tumors

The introduction of laparoscopic cholecystectomy has stimulated a renewed interest in the anatomy of Calot’s triangle 1. This triangle is a focal area of anatomical importance in cholecystectomy and a good knowledge of its anatomy is essential for both open and laparoscopic cholecystectomy 2, 3. This triangle was described by Calot in 1891 as bounded by the cystic duct, the right hepatic duct and lower edge of liver 4. In its present interpretation the upper border is formed by the inferior surface of the liver with the other two boundaries being the cystic duct and the common hepatic duct 2,5. Its contents usually include the right hepatic artery (RHA), the cystic artery, the cystic lymph node (of Lund), connective tissue and lymphatics 5,6. The cystic artery is a branch of the RHA and is usually given off in Calot’s triangle 7. Anatomic variations in Calot’s triangle are common. Variations in cystic artery anatomy, based on its origin, position and number are well described 3, 8 because of its importance in avoiding inadvertent bleeding and its consequences. The reported incidence of these variations is from 25 to 50 % in various studies 3,9 with the magnified laparoscopic view having increased the frequency of recognition of these variations. The methods of retraction used in the laparoscopic procedure gives a different view of the area, thus introducing the term ‘laparoscopic anatomy’7. Accurate knowledge of cystic artery anatomy and its variations can reduce the likelihood of uncontrolled intraoperative bleeding, an important cause of iatrogenic extra hepatic biliary injury and conversion to open cholecystectomy 3, 7, 8. The incidence of conversion to open surgery due to vascular injury is reported to be 0-1.9% and its mortality 0.02% 3, hence these variations should stay in surgical conscience to prevent procedure related morbidity. We aim to present the variations in cystic artery seen in laparoscopic cholecystectomy in our patient population.

Objective: To determine antiacanthamoebic activity of natural and marketed honey samples.
Methods: Natural honey samples were collected directly from the bee hive and marketed honey samples were purchased from the local market in Karachi, Pakistan. Both honey samples were tested for their flavonoid content (quercetin equivalent per gram of the extract) and phenolic content (gallic acid equivalent per gram). Furthermore, their anti-oxidant activity was determined by measuring 2,2-diphenyl-1-picrylhydrazyl. Using amoebistatic and amoebicidal assays, the effects of honey samples were tested against growth and viability of Acanthamoeba parasites.
Results: Natural honey exhibited potent amoebistatic and amoebicidal effects, in a concentration-dependent manner. Honey-treated Acanthamoeba castellanii showed loss of acanthopodia, following which amoebae detached, rounded up, reduced in size, decreased in cytoplasmic mass and they were observed floating in the culture medium. Importantly, honey-treated amoebae did not revive when inoculated in fresh growth medium, however, glycerol-treated amoebae exhibited viable trophozoite and active growth. In contrast, marketed honey samples varied in their efficacy against Acantha-moeba castellanii. The proportion of flavonoid, as determined by quercetin measurements and the proportion of phenolic, as determined by gallic acid measurements was higher in natural honey compared with marketed honey. Similarly, the antioxidant activity, as determined by 2,2-diphenyl-1-picrylhydrazyl scavenging activity was higher in natural honey vs. marketed honey.
Conclusions: This study shows that natural honey has antiacanthamoebic properties and possesses higher flavonoid, phenolic and antioxidant properties compared with the marketed honey. These findings are of concern to the public, health officials, and to the manufacturers regarding production of honey for medical applications.