Comparison of Lipid Profile in Type-II Diabetes Patients on Insulin Vs Oral Hypoglycemic Agents

Objective: To compare parameters of lipid profile in type-II diabetic patients managed with Insulin andOral hypoglycemic agents (OHAs) at Pak Emirates Military Hospital (PEMH, RWP)Methodology: A comparative cross-sectional study was conducted over a period of nine months afterethical approval from July 2021 to April 2022.Written informed consent from the potential participantswas taken using a non-probability convenient sampling technique on patients suffering from type-IIDiabetes Mellitus (DM) and managed with either OHAs or insulin for more than one year were studiedat Medicine department (PEMH, RWP). Serum lipid profile was carried out on all the study participantswith good control of diabetes at the time of enrollment in the study. Comparison of various lipid profileparameters were done in both the study groups.Results: Out of 550 patients included in the final analysis 300 (54.5%) were male and 250 (45.5%) werefemale. Mean age of the patients suffering from DM included in the study was 46.54±4.62 years. Therewere 205 (37.3%) patients with hypercholesterolemia while 181 (32.9%) patients hadhypertriglyceridemia. The incidence of hypercholesterolemia and hypertriglyceridemia wasstatistically significantly high in patients managed with OHAs as compared to those who weremanaged with insulin (p-value<0.001).Conclusion: Serum triglycerides and serum total cholesterol were found more significantly withinrange in patients who were managed with insulin as compared to those who were managed by OHAs.Deranged HDL and LDL levels were not significantly different in both groups.Key Words: Diabetes Mellitus, Insulin, lipid profile, Oral hypoglycemic agents

Evaluation of Patient Satisfaction of Endoscopic Procedures at PEMH Rawalpindi

Objective: To evaluate patients' satisfaction of endoscopic procedures at Pakistan Emirates MilitaryHospital (PEMH), Rawalpindi, Pakistan.Methodology: This cross-sectional survey was conducted in the Gastroenterology Department ofPEMH, Rawalpindi, Pakistan between November 2022 and November 2023. A modified GroupHealth Association of America-9 (GHAA-9) questionnaire was utilized. The assessment ofsatisfaction was based on several factors including assistance of medical staff, technical skills of thephysician, an adequate explanation of the procedure, provision of privacy while checked in andwaiting, waiting time during the day of the procedure, satisfactory explanation of results, and overallexperience for the procedure. The subjects were also asked to grade the pain or discomfort. The chi-square test was employed and p-value < 0.05 was considered statistically significant.Results: The average age of patients was 47.5±13.78 years. Out of all the procedures, there were 275(48.2%) upper GI endoscopy, 134 (23.5%) colonoscopy, 64 (11.2%) ERCP and 49 (8.6%) EUS. Further,83.9% of the patients were satisfied with the overall experience of endoscopic procedure. Thesatisfaction rate for experiencing pain or discomfort during and after the procedure was lower thanother questions. However, when each question of the survey response was stratified based on genderand age, they were not statistically significant, depicting these two factors were not associated withthe satisfaction level except waiting time on the day of procedure (p= 0.006), experienced pain ordiscomfort after the procedure (p= 0.002) for gender and pain/ discomfort during the procedure (p=0.021) for age groups.Conclusion: Although most patients expressed satisfaction with the endoscopy performed at PEMHbut pain or discomfort during and after the procedure was identified, affecting satisfaction scores.Keywords: Patient satisfaction, Endoscopic procedures, Patient discomfort, Waiting time, Survey

Frequency of Musculoskeletal Discomforts and its Association with Various Breastfeeding Positions among Nursing Mothers

Objective: To determine the association between musculoskeletal discomforts and breastfeeding positions among nursing mothers.Methodology: It was an analytical cross-sectional conducted from January 2023 to June 2023 at Imran Idrees Teaching Hospital and Idrees Hospital, Cantt Sialkot. The participants were selected using a convenient sampling technique. All 232 participants were recruited after the informed consent who met the inclusion criteria for the study. A musculoskeletal discomfort form developed from the Nordic Musculoskeletal Questionnaire was used as an outcome measuring tool. The data were analyzed using SPSS version 22. Descriptive statistics and chi-square tests were used to analyze the data. Results: The mean age of participants is 28.91±4.10 years. The majority of the participants had 1 breastfeeding child N=181 (78.0%), postpartum duration 1-3 months N=86 (37.1%), with the frequency of breastfeeding 1-3 sessions/day N= 87(37.5%) respectively. Most nursing mothers had a caesarian section as their mode of delivery N=120 (51.7%) and cross-cradle hold was the most common breastfeeding position N=83 (35.8%) causing musculoskeletal discomfort among N=213 (91.8%) of participants. Chi-square showed a significant association for ache/pain and discomfort in the regions of shoulders, elbows, wrist/hands as (p=0.00); upper back (p=0.01) and neck (p=0.02) at significance level 0.05. For prevention scale regions of the neck (p=0.00), wrist/hand, low back (p=0.01)and trouble scale regions of the upper back (p=0.01), shoulder, wrist/hand (p=0.02) respectively. Conclusion: The Musculoskeletal discomforts were more pronounced in regions of the neck, shoulders, elbows, and wrists, upper/lower back with the breastfeeding positions among nursing mothers.Key Words: Breastfeeding positions, musculoskeletal pain, nursing mothers, postur

Oral Health Status of Pregnant Women and their Referral to Dentist during Antenatal Period

Objective: The aim of this study was to assess oral health status of pregnant women and theirreferral to dentist during antenatal period.Methodology: This descriptive cross-sectional study was conducted in Outpatient Department,(Gynae and Obs.) Jinnah Hospital Lahore, Pakistan after ethical committee approval. The sample sizewas calculated using formula for finite population and found to be 340 pregnant women who wereconveniently sampled and interviewed by using a self-administered questionnaire following verbaland written consent. Oral health status was examined clinically using dental mirror and Michiganprobe. Scoring was done using WHO oral health assessment form for adults, 2013 includingCommunity periodontal index, DMFT, and Dean's fluorosis index. Data was statistically analyzedusing SPSS version 24. Chi-square test was applied to compare categorical variables (p≤ 0.05 assignificant).Results: Total 236 (69.4%) out of 340 pregnant women had oral health problems. Only 11 (3.2%)participants were referred by the gynaecologist to dentist for their oral health issue. Out of 236participants, 67% had dental caries, 80.9% had gingival bleeding, 58.8% had gingival pockets, 41.7%had loss of attachment, 1.8% had dental erosions, 63.8% had dental fluorosis and 1.5% had oralmucosal lesions. The majority of pregnant women who participated in this study had lowsocioeconomic status (mean income PKR 20300±10304.14) reported with more oral health problems.Conclusion: As reported in this study, majority of pregnant women had oral health problems andonly few of them were referred to dentist by gynaecologist.Key Words: Pregnant women, Oral health status, Gynaecologist, Antenatal perio

A Unique Case of Acute Deterioration in Visual Acuity: Vogt-Koyanagi-Harada Disease

Vogt-Koyanagi-Harada (VKH)disease is a chronic autoimmune inflammatorydisorderwithmultisystem involvement particularly involving the eye, skin, ear and brain. Our patient reported in the Ophthalmology OPD, CMH, Lahore, a 41-year-old female patient who presented with decreased visual acuityof 6/9 and 6/18 in her right and left eye respectively with intermittent tinnitus. Aslit lamp examination revealed bilateral paramacular choroiditis, more pronounced in the left eye. Fundoscopy showed the 'sunset glow fundus.' HerOCTshowedslightflattening ofthe foveal contourinthe left eye withgeneralized foveal thinning while the right eye had parafoveal thickening with a foveal lamellar hole. FFAshowed a serous detachment in herleft eye.Adiagnosis of bilateral incomplete Vogt-Koyanagi-Haradasyndrome was made as she tested negative for infectious diseases. She was started on an oral course of steroids initially but after persistent episodic exacerbations ciclosporin 75mg twice daily was started and regular 2 weekly follow-ups were advised. The mainstay of treatment for Vogt–Koyanagi–Harada disease is systemic corticosteroid therapy but the refractory cases get additional immunosuppressants like ciclosporin which was required in our patient as well.Keywords: Autoimmune, Fovea, Visual acuity

Effects of Pediatric Endurance and Limb Strengthening Program versus Lower Limb Strength Training in Diplegic Cerebral Palsy: A Randomized Clinical Trial

Objective: To evaluate the comparative effects of pediatric endurance and limb strengthening (PEDALS) program versus lower limb strength training in diplegic cerebral palsy (CP). Methodology: This Randomized clinical trial on a sample of 24 children with CP enrolled consecutively was completed after ethical approval. Group A (n=12) received the PEDALS program and group B (n=12) received lower limb strength training. PEDALS program was applied for 30 minutes, 3 days/week for 12 weeks and Group B received the intervention 6-8reps, 1-3sets for3 days/ week for 12 weeks. Outcome was measured with GMFM-88, Six-minute walk test and range of motion using goniometer pre and post treatment. Results: Mean age was 9.95±2.21 years. Post treatment mean value for total GMFM score for Group A was 64.916±8.129 and Group B was 65.33±9.92 with p-value > 0.05 respectively. Post treatment mean value for six minutes' walk test for Group A was 199.58±13.55 and for Group B was 195.50±15.71 with p-value >0.05 and post treatment ROM for Group A and Group B with p-value>0.05, there was no significant difference between these techniques. Conclusion: PEDALS program as well as lower limb strength training is equally effective in improving endurance, gross motor function and ROM in children with diplegic CP . Keywords: Cerebral palsy, endurance, pediatric, strength, training

Knowledge, Attitudes, and Practices of Medical Students Regarding use of Vitamin Supplements

Objective: To explore the knowledge, attitudes, and practices of medical students regarding use ofvitamin supplements, and compare them with the use of prescribed vitamin supplements.Methodology: A cross sectional (KAP study) was conducted in public and private medical colleges ofFaisalabad, recruiting all the student enrolled in different specialities of medical sciences. Threehundred and eighty-seven participants were recruited in this study over a period of two months(Nov-Dec 2023) with help of convenient sampling technique. Subjects who filled incomplete form orwere not willing to participate in the study were excluded. A quantitative, close ended questionnaire wasfloated on WhatsApp groups. Data was analysed using SPSS. P value≤0.05 was taken as significant.Results: Study recruited 387 subjects of both genders, male 164 (42.4%) and female 223(57.6%) ofmean age 21.99±1.74 from different medical-related fields including MBBS 259 (66.9%), BDS97(25.1%), Allied health Sciences 31 (8.0%) and freshly graduated students with the help of validatedquestionnaire. It was filled by different medical colleges in Faisalabad. Forms were floated on Socialmedia and WhatsApp. It is shown that a significant number of the female population is usingvitamins as compared to males (P value=0.000). Moreover, a majority of the female population isusing it with a doctor's prescription as compared to males (P value=0.000)Conclusion: Majority of the population are using the vitamin supplements after being prescribed bythe doctor though no biochemical analysis was done to assess the levels of essential vitamins.Keywords: Vitamin supplements, Nutrition, Medical student

Beyond Anxiety: Unveiling the Power of Self-Efficacy in Shaping Academic Performance among Medical Students

Objective: The study aimed to explore the relationship between anxiety and academic performance and discuss a key boundary condition i.e., self-efficacy as a strategy to manage anxiety in the academic setting. Methodology: A quantitative survey design was used employing a cross-sectional time frame. Public sector medical colleges of Lahore affiliated with the University of Health Sciences (UHS) were selected such as Allama Iqbal Medical College, Ameer-ud-Din (PGMI) Medical College, Services Institute of Medical Sciences, and Shaikh Khalifa Bin Zayed Al-Nahyan Medical & Dental College. The duration of the study was from June 2021 to January 2022. A convenience sampling technique was used to collect data from 259 medical students through self-administered questionnaires. The inclusion criteria applied were that the medical institution needs to be recognized by UHS and should be located in Lahore. Medical students included belonged to second to final year MBBS. First-year students were omitted as they had not taken their professional examinations. Results: Hayes PROCESS Macro analysis in SPSS version 22 showed that social media overload and academic performance were significantly related (B=-0.198, p<0.05). Moreover, a significant moderating role of self-efficacy in the relationship between anxiety and academic performance was found. Conclusion: Results suggested that when medical students faced anxiety their academic performance was decreased however this did not apply to medical students with high self-efficacy. Medical students with low self-efficacy who see themselves as incompetent, lose motivation easily when they try to attempt tough tasks and focus too much on potential failure. Key Words: Anxiety, academic performance, self-efficacy

Knowledge, Attitudes and Practices about determinants of Diabetes among Non-Diabetic Pakistanis

Objective: To identify the determinants of diabetes-related knowledge, attitudes, and practices among the non-diabetic Population in Pakistan. Methodology: A cross-sectional survey was performed from July to December 2023 using snowball sampling 400 non-diabetic Pakistani nationals were enrolled; the data regarding diabetes knowledge, attitudes, and practice was acquired on a structured online questionnaire distributed through a social media platform. The sociodemographic variables and diabetic characteristics were the exposure of interest, and Diabetes Knowledge Attitude and Practice (KAP) was considered the outcome of interest. The data was analyzed using SPSS version 27, with chi-square testing and regression analysis used to study the relationship between sociodemographic variables and KAP outcomes. Results: The study revealed a high level of general awareness about diabetes (86.75% knew what it was), but specific knowledge about its management and complications was low (<50% were sufficiently informed). Attitudes towards diabetes were proactive regarding diet and family support, yet less than half of the respondents recognized the importance of physical activity and regular glucose monitoring. Practices varied, with 88% avoiding fatty foods but only 18.75% maintaining a healthy weight and 31.5% engaging in regular blood sugar monitoring. Socioeconomic factors and education levels significantly (P<0.05) influenced KAP, with higher education significantly associated with better knowledge and practices. Conclusion: Overall, the non-diabetic Pakistanis have a good general awareness of diabetes. However, there are significant gaps in comprehensive knowledge and practice. keywords: Diabetes Mellitus; Knowledge Attitudes Practices; Non-diabetic Pakistan

Role of Hepatic and Renal Biomarkers in Diagnosing Preeclampsia

Objective: The study aims to gain insight into the importance of hepatic and renal biochemical parameters AST, ALT, bilirubin, urea, creatinine, urinary protein to creatinine ratio, and novel marker cystatin C in the domain of preeclamptic patients. Methodology: This prospective cohort study was conducted in Central Park Medical College and Teaching Hospital Lahore from Sep 2023 to Apr 2024 on 300 subjects. Inclusion criteria were pregnant women over 18 years of age, gestational age of 20 weeks, and singleton pregnancy. Women with preexisting hypertension, kidney disease, or other diseases causing liver dysfunction were excluded. Blood and urine samples were collected to measure AST, ALT, bilirubin, urea, creatinine, urinary protein to creatinine ratio, and novel marker cystatin C and data was analysed using an independent t test and Chi-square test by SPSS version 26. Results: ALT, AST, and bilirubin levels were higher (45±12 p<0.001, mean±SD 55±15 U/L, mean±SD: 1.5±0.4 mg/dL) in preeclamptic women. Creatinine, urine protein to creatinine ratio, and cystatin C (mean±SD: 1.0±0.2 mg/dl, mean±SD: 300±100 mg/g, p 1.2±0.3ng/mL) were raised in preeclamptic women as compared to the control group. Conclusions: Serum creatinine, urine protein/creatinine ratio, and cystatin C and creatinine were found in women with preeclampsia compared to women without preeclampsia. Keywords: Preeclampsia, urine protein to creatinine ratio, cystatin C, hepatic and renal biomarker