Musculoskeletal discomforts with various breast feeding positions and its associated factors 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

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

Integration of Artificial Intelligence Technology in Medical Education

Artificial Intelligence (AI) originating in the mid-twentieth century, replicates human thought processes using computer systems, integrating elements from various disciplines. Since 1955, AI applications have expanded rapidly, addressing educational challenges in the past decade, notably in medical education. A Web of Science search indicates a growing interest, reflected in increasing publications and citations over the last two decades. The surge highlights a recent uptick in AI utilization for research and development in medical education, including virtual inquiry systems, medical distance learning, and teaching video creation in medical schools.1Top of Form Medical education is a continuous learning process, spanning from undergraduate to postgraduate and specialty training, applicable to various healthcare professionals.2,3 Recognizing the need to build on existing knowledge amid rapidly advancing technology, AI in medical education becomes crucial. AI holds potential in enhancing the non-analytical, humanistic aspects of medicine, aiding healthcare professionals in processing vast amounts of information and improving diagnostic capabilities.

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

A Comparison of Ureterorenoscopy and Extra-Corporeal Shock Wave Lithotripsy for the Treatment Of Upper Ureteric Stone Measuring Less than 1cm.

Objective: To compare the efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS) in the management of upper ureteric stone measuring <1cm.Methodology: Randomized clinical trial (RCT) was conducted by targeting the patient admitted in urology ward, Jinnah Hospital Lahorethrough a period of one year. A sample size of 132 patients fulfilling inclusion criteria were selected by employing Non-probability consecutive sampling technique was employed to select 132 (sample size) patients fulfilling inclusion criteria. Patients were randomly allocated into two groups (66 in each group A&B) using lottery method. In group-A, stones were treated using ESWL, while in group-B, URS was performed, and stones were broken with pneumatic energy. Data were analyzed using SPSS version 27, and a Chi-square test was conducted to compare the proportions of qualitative variables, while an independent sample t-test was applied to assess mean differences between two groups of quantitative variables. Asignificance level of ≤0.05 was adopted for determining statistical significance.Results: The sociodemographic profile of the two groups was comparable. It was seen that stone free rate nextto first session was higher in URS (81.8%) as compared to ESWL (63.6%) which later increased to 87.7% after completion of three session. The complaint of pain in ESWL was more as compared to URS (22.7% vs 12.1% p= 0.05)while the differences betweenthe rate of complications like fever, UTI, mucosal abrasion, hematuria or perforation were not statistically significant in both group. (p> 0.05)Conclusion: ESWL outperforms URS for the treatment of upper ureteric stones measuring <1cm in terms of efficacy and safety.Although not statistically significant, ourfindings suggest that URS achieves stone-free rates earlier than ESWL. However, according to our findings, ESWL is recommended as the treatment of choice for the majority of patients due to better compliance.Keywords: Extra-corporeal Shock Wave Lithotripsy, Nephrolithiasis, Ureterorenoscop

Characteristics of Critically ill Obstetric Patients Admitted to the ICU at a Tertiary Care Centre

Objective: To ascertain the characteristics, admission indications, interventions, and outcomes of obstetric patients admitted to ICU.Methodology: A retrospective, descriptive study was conducted at Lady Reading Hospital's ICU in Peshawar, Pakistan (January 1 to December 31, 2022). During this time, a total of 1560 patients were received in the ICU, out of which 132 full filled our inclusion and exclusion criteria. Characteristics of patients, reasons for admission, interventions, demographic information, obstetric history, length of stay, and outcomes were collected through a retrospective review of medical records. Statistical analysis was performed using SPSS software version 21.0.Results: Among the 1,560 admissions in ICU, 132 were obstetric cases (8.5% of all ICU admissions). Majority of these patients had a mean age of 27.05 ± 6.23 years, with mean ICU stay duration of 6.55 ± 7.05 days. Among these, hypertensive disorders of pregnancy were identified in 47 patients (35.6%). Obstetric hemorrhagic disorders accounted for admission in 40 patients (30.3%). Out of the 132 patients, 26 (19.6%) did not survive. Highest mortality rates were of those admitted with fulminant hepatic failure (2 patients, 66.7%). Among patients admitted for direct obstetric reasons, post-natal septicemia caused the highest mortality (3 patients, 37.5%). Ventilatory support was required by 113 patients (85.6%) and vasopressor support was administered to 87 patients (65.9%) of the patients. Conclusions: To decrease maternal mortality and improve healthcare for pregnant individuals, it is crucial to focus on hypertensive disorders of pregnancy and obstetric hemorrhage. Addressing these issues, along with providing effective post-natal sepsis treatment, can contribute to a reduction in mortality rates.Keywords: Obstetric hemorrhage, Pre-Eclampsia, Post-natal septicemia, Mortalit

Skeletal Traction Followed by Plaster of Paris vs Open Reduction and Internal Fixation – Comparison of the Functional and Radiological Outcome of the Two Treatment Modalities in Schatzker Type V and VI Tibial Fractures

Objective: To compare the functional and radiological outcomes of Schatzker type V and VI tibialfractures for the two currently employed treatment modalities.Methodology: It was a quasi-experimental study conducted at Orthopedics department. Patientswere admitted through ER and OPD of Mayo hospital Lahore over a period of 1 year. Total 84 patientswere included in the study. Patients were divided into two groups. Patients in Group A weremanaged with skeletal traction for 2 weeks followed by plaster of Paris back splint applied for next 2weeks followed by plaster of Paris casting for stabilization of the fracture for another next 4 weeks.Patients in Group B were managed with ORIF by wires, screws or plates. Functional andRadiographic evaluations were performed to assess pain, range of motion weight bearing andfracture union in each follow-up visitResults: In this study functional outcome of patients was significantly better and higher in patientswho were treated with ORIF techniqueConclusion: ORIF is more effective for treating Schatzker type V and VI tibial fracture in terms offunctional and radiological outcome as that skeletal traction followed by plaster of Paris casting.Keywords: Skeletal Traction; ORIF; Schatzker type V; Schatzker type VI; Tibial Fractur

Screening for Renal Function Impairment in Patients with Chronic Type II Diabetes Mellitus in a Tertiary Care Hospital of Pakistan

Objective: The objective of the present study was to detect early biochemical changes, in type IIdiabetics, indicating renal function impairment leading to Chronic Kidney Disease (CKD).Methodology: This study was conducted in the Department of Biochemistry at Shaikh Zayed FPGMI,Lahore during September 2016 to April 2017. It was a cross-sectional analytical study and was donethrough nonprobability convenient sampling The study comprised of 50 diagnosed patients of typeII diabetes mellitus (for the last 10 years) and 50 healthy subjects. Both male and female participantsin equal number between the age of 35-75 were included in the study. Blood glucose level (random),blood urea, serum creatinine, urinary albumin and urinary creatinine were estimated and albumin tocreatinine ratio (ACR) in mg/g was calculated. eGFR was also calculated using S/creatinine. The labvalues of the study parameters were recorded on the designed proforma after getting proper writtenconsent from the participants. SPSS 20.0 was used for data entry and analysis.Results: Mean values of random plasma glucose level, blood urea, serum creatinine, urine albumin,urine creatinine, ACR and eGFR of patients when compared with those of healthy group showedsignificant p-values (≤0.05).Conclusion: There was a significant difference in renal laboratory parameters between diabeticpatients and healthy controls indicating the presence of CKD. In a developing country like Pakistantype II diabetes mellitus is an incidental finding due to lack of regular health monitoring and it is verydifficult to determine the exact duration of the disease. Patients of type II DM develop CKD (ChronicKidney Disease) due to persistent high plasma glucose levels. Therefore good control of DM andregular monitoring of renal parameters will be helpful in preventing the development of CKD.Key Words: Diabetes Mellitus, Nephropathy, Chronic Kidney Disease, Urinary Albumin toCreatinine ratio

Prevalence of Sleep Paralysis in the Medical Students of a Local Medical College

Abstract Objective: To find out the prevalence of sleep paralysis among the medical students of a local Pakistani medical college. Methodology: This cross-sectional study was conducted on 107 medical students from, Karachi Institute of Medical Sciences (KIMS), Karachi, Pakistan. Non-probability Convenient Sampling Technique was utilized for this study. Students suffering from any psychiatric illness were excluded from this study. The study was performed after taking permission from the Institutional Ethical Review Committee. Written informed consent was taken from all the students. The data were collected using a pretested predesigned Questionnaire which was consisted of 10 questions related to the common10 happening and symptoms of sleep paralysis. Data were recorded in the form of frequency and percentages and analyzed using SPSS 24. Results: 52% (56 out of 107) participants have had an experience of sleep paralysis. Most of the participants (76.6%) described their experience as an Inability to move. Frequency of experience ranged from 0 to 20 times in the last year. Age at first experience ranged between 10-20 years. Conclusion: We found a high prevalence of sleep paralysis (47.2%) among the medical students at a local Pakistani medical college. Majority of the students experienced the phenomenon multiple times in their life. The students associated the symptoms the factors such as academic stress, anxiety, workload, emotional experiences, sleep deprivation, work routine, sleep pattern, sleep deprivation, fatigue, mental disturbance, studies and routine stress. 37.3% of the students also related the phenomenon to their position of sleep (lying on back). The participants described the experience as a source of great distress. Sleep paralysis needs to be studied, investigated and addressed in context of mental health of the students

Prevalence Of Hepatitis B Infection in Personnel and Patients Screened At Combined Military Hospital, Lahore

Objective: This research was conducted to determine the prevalence of hepatitis B infection in personnel and patients screened at CMH, Lahore. Study design: Descriptive study. Place and duration of the study: From August 2015 to January 2016 at Combined Military Hospital, Lahore. Methodology: The serum samples of the patients received at Combined Military Hospital, Lahore were analyzed. The patients of all ages, sex, ranks, blood donors, new recruits and troops going on UN missions were included in the study. The samples were analyzed by ELISA (Linear Chemicals Company, Barcelona Spain). Results: A total of 15,606 serum samples were analyzed on ELISA. Five hundred and thirty one patients were diagnosed positive of HBV. The amount of positive patients fluctuates every month. The prevalence of positive patients in the month of August 2015, 2980/93 (3.1%), September 2015, 2788/107 (3.8%), October 2015, 2814/91 (3.2%), November 2015, 2665/80 (3.0%), December 2015, 2320/ 82 (3.5%) and in January, 2016 2039/78 (3.8%). Total prevalence percentage is 3.4%. Conclusion: Due to proper awareness campaigns, advertisements and infection control programs, the prevalence of HBV at CMH, Lahore is quite low, and could further be reduced