Twelve Tips for Enhancing Student Learning Experience in the Operating Room

Student learning within the Operating Room (OR) is complex and challenging, especially for medical students who heavily rely upon structured learning plans. Medical students’ OR-based surgical learning experience is heterogenous, unstandardized, and inadequate for many reasons. There is a growing need to evaluate the learning modalities and models that we currently use for medical graduates’ OR-based learning process, create a balance between structured and opportunistic learning encounters and incorporate previously identified factors that have been known to influence the quality of OR-based learning positively. In continuation with our previous work on OR-based learning, here we argue for a structured OR-based learning plan that embodies appropriate learning models and teaching methodologies and focuses on a comprehensive plan that justifies a local needs analysis and addresses factors influencing the quality of OR-based student learning to produce enhanced learning outcomes.

Epidemiological and Serum Lipid Analysis of Hepatitis B, C and Cirrhosis Patients in Hyderabad, Sindh, Pakistan

Hepatitis B virus (HBV) and hepatitis C virus (HCV) exerts an intense impact on patient’s lipid metabolism. Hence the aim of present study is to determine metabolic derangement that occurs in subjects suffering from hepatitis B, C and cirrhosis. The fasting blood samples were collected from hepatitis B (n=50), C (n=50) and cirrhosis patients (HBV-cirrhosis n=30 and HCV-cirrhosis n=50) along with age and gender matched controls. After separating serum, lipid profile was analyzed by micro-lab 300 and fatty acids (FAs) composition was examined by gas chromatography. Fatty acids were further confirmed by gas GC-MS technique. The epidemiological risk factors for transmission of HBV, HCV and cirrhosis were measured through standard questionnaire specially designed for that purpose. The demographic factors, mainly positive family history, dental treatment, blood transfusion and shaving from barber shop are significant contributing factors in spread of HBV, HCV, and cirrhosis infection. Hypolipidemia in HBV and HCV patients is possibly due to alter liver function. Lipogenesis is elevated in HCV and HBV patients as evident from reduced serum PUFA and elevated SFA as well as MUFA levels. Hence, it proposes the importance of PUFA supplementation and it may provide synergistic antiviral effects when given as a food supplement during the INF based anti - HCV therapy. The lower level of lipid profile (TAG, cholesterol, LDL–C, HDL–C, VLDL–C and total lipids) indicating hypolipidemia in HBV-cirrhosis and HCVcirrhosis patients specify the nonfunctioning of liver. The increased lipogenesis (increased level of SFA) and reduced PUFA levels may be due to altering desaturases activities, impaired PUFA metabolism and non-enzymatic oxidation is associated with progression of HBV-cirrhosis/ HCV-cirrhosis diseases in patients and promote the hepatic lipotoxicity. In conclusion, the hepatitis B and C viruses alter the total cholesterol and FA metabolic pathways. Therefore, the present study provides the information about the changes associated with lipid metabolism and significant upregulation, which might be used as a biomarker for hepatitis B, C and cirrhosis diseases.