ADVANCES IN BASIC MEDICAL SCIENCES

Ayesha Saba Association between sectorial retinal nerve fiber layer thickness with anatomical variables of Lamina Cribrosa- A comparative study

Ayesha Saba Naz Naz — 2023-12-31

Objective: To compare sectorial retinal nerve fiber layer thickness (RNFLT) with anterior Lamina Cribrosa depth (ALCD) and Lamina Cribrosa thickness (LCT) in primary open-angle glaucoma (POAG) cases and healthy age-matched controls

Methods: This case-control study was conducted at Al-Ain Eye Institute, Karachi from November 2018 till February 2019. Senior ophthalmologist recruited 57 POAG cases and 46 age-matched healthy controls. Calculation of intraocular pressure (IOP) and open angle carried out using Goldmann tonometry and Slit-lamp biomicroscopy with stereoscopic ophthalmoscopy respectively. Extremely precise spectral domain ocular coherence tomography with enhanced depth imaging (EDI-OCT) utilized to determine ALCD, LCT and RNFLT.

Results: RNFLT in various sectorial regions displayed statistically significant results (p-value of 0.001) when compared with controls. Superior retinal sector revealed the highest ranges of thickness (75.50 ± 9.64 µm), while thin retina was observed in global measurements (48.40 ± 0.84 µm). Enhanced ALCD was seen (545.50 ± 3.53 µm) among 15 POAG cases. Least thickness of LCT documented in the four POAG cases in inferior retinal sector (204.57 ± 79.04 µm).

Conclusion: Assessments of RNFLT, ALCD and LCT provides valuable knowledge that can be utilized for the management and predicting the course and prognosis of POAG.

Bedside teaching with case based discussions and flipped classroom in undergraduate medical students

kainat@313 javed@2313 — 2023-12-31

Background: Bedside teaching has remained a foundation of medical education because it fosters learning, teaches appropriate behavior, and can be applied efficiently to promote learning. Case-based learning (CBL) is a new teaching method introduced in the undergraduate medical curriculum that entails preparing students for clinical practice by utilizing real-life clinical scenarios. The study's objective is to look into the impact of combining case-based learning and bedside teaching on motivation, critical analysis, and cognitive development in final-year MBBS students.

Methods: The study participants were final-year medical students placed in a surgery unit for clinical rotations. The research was conducted on 52 students who were placed between August and October 2022. Earlier, an MCQ-based pretest was performed at the start of the rotation. For one hour, students were taught the contents using a case-based learning method, which was shared through flipped classroom before the session, and then they were shown relevant clinical examinations on the bedside. The skills related to the case were performed in front of the teacher by the students, which was then followed by the post-test and questionnaire.

Results: This strategy was deemed motivating by 91% of students. It enhances critical thinking, according to 82% of students. 70% of students improved their pre-test and post-test scores by more than 40%.

Conclusions: Integration of case-based learning with bedside clinic was correlated with increased motivation of final-year MBBS students and the enhancement of critical thinking skills in students.

Keywords: Integration, case-based teaching, bedside teaching, surgery

Burnout among Gynaecological and Obstetrical Resident Doctors in Tertiary Health Care Settings of Pakistan

Muhammad Eyan Khan — 2023-12-31

Objective

To assess the prevalence and degree of burnout among resident doctors of gynaecological and obstetrical units in tertiary care hospitals of district.

Methodology

A cross sectional study was implied by using Maslach Burnout Inventory questionnaire as a validated study tool to analyse the 3 dimensions of burnout. Data was collected from resident doctors of various category tertiary care hospitals including public, private and autonomous hospitals in district Peshawar. Non-probability convenience type of sampling technique was used and the residents were selected irrespective of gender or age. Three levels of burnout dimensions were calculated and comparison was made among residents of different category hospitals.

Results

Of the 212 distributed self-administered questionnaires, 147 were returned (69% response rate). Highest prevalence of high burnout levels were recorded among the study participants in Emotional Exhaustion component with 62 percent followed by 39 percent in Depersonalization and 26 percent in reduced personal accomplishment. Autonomous public hospitals recorded the highest levels of emotional exhaustion and depersonalization whereas reduced personal accomplishments levels were the highest among residents in public hospitals.

Conclusion

Results revealed high burnout with high levels of emotional exhaustion in all hospitals. Similarly high levels of reduced personal accomplishment had the lowest prevalence.
Proper patient referral system and greater number of doctor (in order to improve the doctor patient ratio) are needed in order for adequate patient load distribution. Screening programs for early detection, interventions and proper stress management programs to better cope with the hectic routine.

Key words: Burnout syndrome, emotional exhaustion, depersonalization, reduced personal accomplishment, resident doctors

Effect Of Short Term Administration Of Metformin On Endocrine And Clinical Parameters in Overweight/ Obese Polycystic Ovarian Syndrome (PCOS) Women

Uzma Firdous — 2023-12-31

Objective

This study was conducted to determine the effect of short term treatment of metformin on the clinical and endocrine characteristics of overweight/obese PCOS patients.

Methodology

This is the cohort study conducted on 180 Overweight/Obese PCOS subjects where 121 PCOS subjects were grouped as metformin (6 months) exposed and 59 PCOS subjects were grouped as metformin unexposed PCOS patients. A self-structured questionnaire was used along with blood samples for the estimation of insulin, testosterone, chemerin and omentin using Enzyme Linked Immunosorbent Assay (ELISA) while lipid profile was done using photometric methods.

Results

The present study found the higher prevalence of obesity, abdominal fat, weight gain, menstrual irregularities, and infertility in all PCOS patients. There were significant differences in menstrual flow, menstrual irregularities, and infertility (p < 0.05) between studied groups. Non-significant differences were observed in the clinical manifestations of PCOS (hirsutism, acne and alopecia) and other clinical parameters (p>0.05). The studied groups showed higher levels of Insulin, testosterone, chemerin, and cholesterol but the difference was found to be non-significant (p >0.05). High HDL and low LDL levels were found in the metformin exposed PCOS group (p<0.05). Moreover, a significant negative correlation between testosterone and omentin (p = 0.002) was found in the metformin unexposed PCOS group.

Conclusion

The present study showed that short term metformin monotherapy in overweight PCOS women does not have significant effect on BMI, insulin, testosterone and adipokines levels while significant improvement was observed in menstrual irregularities, HDL and LDL levels in the metformin exposed group.

Key words: Insulin, Testosterone, Chemerin, Omentin

Detection of Early Renal Damage using Serum Cystatin-C in Transfusion Dependent Thalassemia Syndrome Patients

Sobia Bashir — 2023-12-31

Background: Transfusion-dependent thalassemia (TDT) patients suffer from several life-threatening complications. These mainly stem from iron overload, a common adverse effect of regular transfusions. Studies discerning renal complications are, however, scarce.

Objective: This study investigatesthe frequency of early renal damage among TDT patients using serum cystatin-C. The relationship between serum cystatin-Cand serum ferritin levels is also elucidated.

Design: Cross-sectional study

Place & duration of study: Khyber Medical University, May 2019 to January 2020

Methodology:Known TDT patients, 3 to 16 years of age, were enrolled in the study.Biochemical tests were conducted on the blood and urine samples of the patients. Data was entered and analyzed for statistical significance.

Results:In pediatric TDT patients, serum cystatin-C was significantly higher, while serum creatinine and estimated glomerular filtration rate (eGFR)were within the normal range when compared to controls. A positive correlation was identified between serum cystatin-Cand serum ferritin. Similarly, Serum cystatin-Cwas found to have a positive correlation with pretransfusion hemoglobin.The interval of transfusion was, however, inversely associated with serum cystatin-C levels.

Conclusion:Asymptomatic renal dysfunction is found in TDT patients. Thismay be attributed to iron overload.

Keywords:Transfusion dependent thalassemia, Thalassemia Major, Renal functions, serum Creatinine, Serum cystatin-C, Glomerular filtration rate

Serum vitamin D levels of Oral squamous cell carcinoma patients of KPK

Sana Ahmad — 2023-12-31

Objective

The objective of this study is to estimate serum levels of vitamin D in oral squamous cell carcinoma cases.

Methodology

It was a multicenter study conducted at the Department of Pathology, Peshawar Medical College (PMC) and Prime Teaching Hospital. The specimens were collected from Department of Oral Pathology; Peshawar Dental College (PDC), Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar; Khyber College of Dentistry (KCD), Peshawar; Bacha Khan Dental College, Mardan. The study consisted of 60 diagnosed cases of OSCC. Blood samples were collected from all 60 participants. Serum vitamin D levels were estimated by Electro-chemiluminescence Immunoassay. The data then was statistically analyzed by Statistical Package for the Social Sciences (SPSS) version 20. The statistical differences between the two groups was calculated by using student t test. Statistical significance was determined at p value ≤ 0.05.

Results

The mean age was 50.27 years with a male to female ratio 2:3. In the oral squamous cell carcinoma patients (n=60), all the participants were deficient in vitamin D with vitamin D levels ≤ 20 ng/ml. Mean serum vitamin D level was 10.78ng/ml, among these 24 were males and 36 were females.

Conclusion

Our study showed deficiency of serum vitamin D in all the cases of OSCC patients

Key words: Vitamin D, Oral squamous cell carcinoma, oral cancers, serum levels

Association between COVID-19 anxiety and temporomandibular disorders among dental students - an institutional survey

Sanna Safi — 2023-12-31

Objective

The objective of this study was to find association between COVID-19 anxiety and temporomandibular disorders among dental students in an institutional survey.

Methodology

This descriptive cross-sectional study was conducted on undergraduate and postgraduate students of Khyber college of Dentistry, Peshawar from August to November 2021. Exclusion criteria was psychological disorders like anxiety, depression; anti-anxiety and anti-depressant medication; house officers and faculty. Data was collected on a questionnaire which consisted of Fonseca anamnestic index (IAF) to diagnose TMD, Hospital anxiety depression scale (HADS) to assess anxiety, depression and COVID-19 anxiety scale (CAS) to evaluate COVID-19 related anxiety. For data analysis, ean ± SD was used for age. Frequency and percentages were done for gender, TMD, anxiety, depression and COVID-19 anxiety. For association between categorical variables, chi-square was applied. Cross-tabulation and prevalence formula were used to find out prevalence of anxiety, depression and COVID-19 anxiety in TMD & non-TMD cases.

Results

A total of 181 students participated in this study. Out of this, 83(45.9%) were males and 98(54.1%) were females with a mean age of 22.7 ± 2.4 years. 99 (54.7%) were TMD cases i.e., greater than non-TMD cases (45.3 %). A higher trend of anxiety (78%) and depression (56%) was seen. Out of 99 (54.7%) TMD cases, 73 (73.7%) were with anxiety. But anxiety was even greater (n=69, 84.1%) in non-TMD cases. Depression was also almost equal in both TMD and non-TMD cases with a prevalence of 1.09. COVID-19 anxiety was seen in very few (1.1%). No association of TMD was seen with anxiety, depression and COVID-19 anxiety (p value ˃ 0.05).

Conclusion

There was no significant association found between COVID-19 anxiety and temporomandibular disorders in dental students of this study, with a very less prevalence of COVID-19 anxiety among them.

Assessing Empathy Levels and Their Associations Among 3rd-Year Medical Students at Khyber Medical College, Pakistan

Mashal Khan — 2023-12-31

Objective

The aim of this study is to assess the empathy levels among 3rd year medical students.

Methodology

A cross-sectional study was conducted from December 2022 to May 2023 using Jefferson Scale of Empathy student-version (JSE-S) at Khyber Medical College, Pakistan to assess 3rd-year students’ empathy. A sample size of 152 was calculated. Data was collected using convenience sampling technique. Descriptive statistics were calculated for JSE-S scores with comparisons across variables using an independent sample t-test and one-way analysis of variance (ANOVA) with post hoc test.

Results

After a response rate of 84.9%, 123 forms (65 males, 58 females) were analyzed. Majority (73.2%) had age < 22 years. Overall, mean empathy score recorded was 103.24 ± 15.83 (range = 53-132). Empathy was significantly higher in group younger than 22 years (p = 0.004) and females (p < 0.001). The difference was non-significant among specialty preference groups (p = 0.08) but separately for females, it was significant (p = 0.02), with the underlying difference between technology-oriented specialties and undecided group (p = 0.02) on post-hoc comparisons.

Conclusion

This article looks into the empathy of 3rd-year medical students. Empathy, as indicated, varied significantly among age and gender groups while specialty preference was found to have little effect. Interestingly, empathy was significantly different for specialty preference only among females. Integration of empathy programs into curriculum is recommended.

Key words: Empathy, Emotions, Medical student, Patient Care, Pakistan.

The Transformative Role of Artificial Intelligence in Biomedical Research

Najma Baseer — 2023-12-31

Artificial Intelligence (AI) has become a powerful ally in the rapidly changing field of biomedical research, thereby transforming the way scientists tackle intricate medical problems. AI's incorporation into biological research has opened up new avenues for discovery, diagnosis, and therapy that were previously unimaginable. This editorial examines the diverse applications of AI in biomedical research and emphasizes how it has revolutionized the field in a number of ways.