BackgroundFew studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students’ general practice career aspirations in Karachi, Pakistan.MethodsFrom January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item.ResultsA total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The “intent to inherit existing practice” and “other academic or professional experiences prior to medical school” had a positive association with choosing general practice while “having a physician parent’’ had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked “clinical diagnostic reasoning”, “community-oriented practice”, “involvement in preventive medicine”, and “frequent patient communication” as highly important were more likely to choose general practice, whereas, “access to advanced medical fields”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration.ConclusionThe study’s results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine.

BackgroundIn developing countries like Pakistan, treatment is mediated by private and public healthcare setups with a limited budget for health facilities. Moreover, the inappropriate use of treadmill tests imposes a burden on healthcare resources and leads to unwarranted interventions. Our aim is to assess the prevalence and predictors of inappropriate referrals for the exercise tolerance test (ETT) to diagnose coronary artery disease (CAD) while taking public and private healthcare settings into consideration.MethodsA cross-sectional study was conducted to find the prevalence of the inappropriate use of ETT to diagnose obstructive CAD and to determine the factors responsible for it. A total of 264 patients were enrolled from outpatient departments in Karachi. The inclusion criterion was the referral of treadmill testing for the diagnosis of CAT. The analysis was performed by logistic regression models to ascertain independent predictors of inappropriate use.ResultsExercise stress tests were found to be inappropriate in 209 (79%) patients. The study indicated that the majority of patients had a low or very low pre-test probability of CAD. Diabetes, hypertension, and dyslipidemia were less frequent in the inappropriate as compared to the appropriate referrals (10%, 45%, and 16% versus 20%, 69%, and 32%). Both public and private sectors showed a high prevalence of inappropriate testing, but it was much higher in the latter (27% versus 73%, P < 0.001). In all regression models, the private healthcare system was the major independent predictor for inappropriate indications of ETT with an average odds ratio of 4.9 (P < 0.001).ConclusionThe high prevalence of ETT referrals was found for the diagnosis of CAD. This result was consistent with both public and private healthcare systems, but it was considerably higher in private setups. Comorbidities, number of risk factors, and cardiovascular risk were not associated with the inappropriate use of ETT.

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A study was designed to investigate the effects of quinolones antibiotics on the blood profile, blood glucose level, histomorphological features of pancreas and egg production of laying hens. For this purpose, a total of 48 laying hens were selected and allocated into four groups, each group included three replicates containing four birds in each. Three commonly used quinolones including enrofloxacin, ciprofloxacin and norfloxacin were used for four weeks with one week of adaptation period, while, one group served as negative control. Blood was collected directly from wing vein and serum was analyzed for estimation of blood proteins, glucose level, cholesterol and albumin which showed non-significant (P>0.05) response to quinolones treatment. Highest blood glucose level was measured for control (239.21 ± 5.26), followed by groups treated with enrofloxacin (233.54± 4.19), ciprofloxacin (227.76 ±4.71) and lowest in norfloxacin (225.47 ± 4.85). Highest cholesterol level was measured in groups administered with norfloxacin (164.17± 3.55), followed by control (163.36±1.99), ciprofloxacin (161.53±3.14) and enrofloxacin (160.78± 3.18). The highest level of total protein in blood was recorded in control group (18.51±0.18), followed by enrofloxacin (18.43± 0.27), norfloxacin (18.28± 0.10) and lowest in ciprofloxacin treated group (18.12± 0.36). The highest level of albumin in blood was found in control group (2.82±0.19), followed by enrofloxacin (2.70±0.15), ciprofloxacin (2.61±0.06) and norfloxacin (2.54±0.12). The highest count of WBCs (white blood cells) in blood was recorded for group treated with ciprofloxacin (18.6 ± 10.63), followed by norfloxacin (17.6± 3.63) and control group (17.1± 10.63), while, lowest in enrofloxacin treated group (16.9± 2.53). Total RBCs (red blood cells) and average hemoglobin values showed non-significant (P>0.05) changes in blood profile of laying hens in the treated groups. Hens egg production showed significant (P < 0.05) increase in groups treated with different quinolones i.e., 10.95% was in norfloxacin, which was higher than control group followed by group treated with ciprofloxacin (8.63%) and enrofloxacin (6.5%). Histomorphology of pancreas treated with quinolones were noted and findings revealed that quinolones did not affect the histological architecture of the pancreas. It was thus concluded that quinolones have non-significant effect (P>0.05) on the serum biochemistry, blood profile and histomorphology of laying hens.

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