Confusion is the first step towards understanding: Fixing the problems of E-learning in COVID-19 pandemic

Background: The COVID-19 pandemic forced institutions worldwide to adopt online learning, which opened a new era of challenges. Our research was designed to explore the effect of the pandemic on teaching and learning and identify the solutions to the problems based on participants’ perspectives. Methods: A qualitative study of the phenomenological design was conducted at a medical institute in Pakistan. The participants were selected using the purposive sampling technique. Semi-structured interviews were done which were later audio-recorded, transcribed, and subjected to manual thematic analysis. Credibility was ensured by using multiple data collection sources. Results: The 20 participants selected as interviewees were faculty with more than 5 years teaching experience in the medical institute and had gone through online teaching and learning during COVID-19 pandemic.  The thematic analyses of the data generated six themes which were: 1. “I see what you mean”; Re-exploration of educational psychology, 2. Reorganization of curriculum, 3. Mentoring and coaching, 4. Technology: as ubiquities as oxygen, 5. Constructive feedback: a stimulus in pearl formation and 6. Turn the tables: fixing the problem. Conclusion: Online education has emerged as an important mechanism in delivering medical education to undergraduate medical students. Instead of shying away, efforts are needed to restructure the curricula, incorporating various online innovative teaching, and learning tools that are at par with the changing global demands of medical education. Keywords: E-learning, COVID-19, Challenges                                                                                                          

IgG4-Related Orbital Disease: An Analysis of Patient Profiles, Clinical Presentation, And Histopathological Features

Objective: To study various presentations of patients with a histopathologically confirmed diagnosis of IgG4 disease. Methods: This study is a retrospective review of medical records from the IgG4-RD registry at the Al-Shifa Trust Eye Hospital. Nine patients with orbital manifestations were identified. All had histopathologically confirmed diagnoses of IgG4-RD. Data obtained from the medical records included patient demographic information (name, age, gender), brief patient history, clinical presentation, histopathology reports, and diagnoses. Results: Most patients presented with proptosis and swelling in various parts of the orbital area. Some patients also presented with pain and diplopia. The most common orbital structures involved were the lacrimal gland and the extraocular muscles, with some patients also having soft tissue involvement. 4(44%) patients had bilateral orbital involvement, while the remaining 5(55%) had unilateral disease. Conclusion: Ophthalmic involvement is a feature of IgG4-RD and has significant implications regarding the diagnosis, prognosis, and treatment of patients with IgG4 disease

Clinical profile and outcomes of paediatric patients with diabetic ketoacidosis at a tertiary care hospital in Pakistan

OBJECTIVES: This study aims to present an experience in the management and clinical features of 88 children presenting with diabetic ketoacidosis (DKA) from Pakistan. METHODS: A retrospective medical chart review of all patients, \u3c or = 15 years of age, who presented to the Aga Khan University Hospital, Karachi, Pakistan in the last ten years with a diagnosis of diabetic ketoacidosis was carried out. Severity of DKA was defined as mild (venous pH \u3c 7.30 or bicarbonate=15mEq/l), moderate (venous pH \u3c 7.2 or bicarbonate = 10 mEq/l) and severe (venous pH \u3c 7 or bicarbonate \u3c 5 mEq/l). These classes correspond to 1st, 2nd and 3rd degrees of diabetic ketoacidosis severity respectively. Cases in which diabetic ketoacidosis had occurred at onset of diabetic diagnosis were not included in the study. RESULTS: Mean age was 7.5 +/- 3.6 years; 58 (66%) patients were male. Twenty six patients had mild diabetic ketoacidosis, 44 had moderate while 18 had severe diabetic ketoacidosis at the time of presentation. Severity of diabetic ketoacidosis was significantly associated with the presence of infection, history of omission of insulin, poor compliance, presence of shock at time of presentation, length of stay in the hospital, final outcome (p \u3c 0.01 for each of these associations) and Glasgow Coma Scale score (p = 0.02). Mortality in this series was 3.4%. CONCLUSION: Poor compliance was associated with the severity of diabetic ketoacidosis. Paediatric endocrinologists\u27 should ensure that patients and their parents understand the importance of the need for regular insulin injections and regular monitoring of blood glucose

Blindness in children at the Ida Rieu school for the blind and deaf

Objective: To identify the causes of blindness at the Ida Rieu school for the blind and deaf, Karachi, Pakistan.Methods: A cross sectional study was conducted at the Ida Rieu School for the blind and deaf. The data collected from medical record of students was entered into the WHO/PBL eye examination form for children with blindness and low vision.Results: Records of 144 pupils aged between 4-30 years were reviewed, including 67% males and 33% females. One third (31%) children had visual impairment (\u3c 6/18-6/60) and 69% were blind (\u3c 3/60-NPL). The commonest anatomical site was retina (41%) and whole globe (20%). The etiology was unknown in 49% cases. In 33% of cases, the data suggested hereditary cause as the etiology, 40% of cases were preventable and 13% treatable.CONCLUSION: Avoidable causes of blindness were seenin 53% of children, 58% of which were preventable and 19 were treatable

Frequency of Different Types of Focal Hepatic Lesions on Triphasic Computed Tomography Scan in Adult Patients

Out of various pathologies that affect the liver, focal liver lesion form an important group. Triphasic computed tomography is the imaging modality most often used to evaluate focal liver lesions. The purpose of this study was to evaluate the role of computed tomography in the diagnosis of liver lesions and to determine frequency of these lesions.Keywords: Liver, focal lesion, liver parenchyma, enhancement, iso-dense, hypo-dense and hyper-denseDOI: 10.7176/JHMN/77-04Publication date:July 31st 202

Redefining horizons: Delving into personality trends and diverse challenges in STEM education across Malaysia

Personality is a characteristic feature of a person that is manifested in outward behavior and is influenced by the factors that make up a person's personality in life. The boom in the development of science and technology combined with the rapid progress of Industrial Revolution 4.0 (IR4.0) makes STEM education so important as a career element in the future. However, the trend of STEM students' participation in education in schools is very worrying. The purpose of this study is to evaluate the personality characteristics and trends of students' inclination towards STEM education in schools. The conceptual parts consist of an extensive search and analysis of academic articles and government publications related to personality issues and trends of STEM interest in education. A conceptual framework is proposed to identify the relationship between personality and STEM education trends based on the findings and support from previous studies. The significance of this study provides a new dimension of personality factors as a variable for the trend of interest in STEM education among students in school. This study also helps researchers and government agencies explore and evaluate the extent to which personality factors can add value in strengthening STEM education in schools

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Blockchain adoption readiness assessment framework for health professionals of Malaysian public hospitals

Healthcare professionals are the primary user of health information technology, therefore, before introducing blackchin as an underlying mechanism to Electronic Health Record (EHR), it is vital to understand their readiness to adopt it. The most influential factors of health professionals blockchain technology adoption are largely unknown from the existing literature. A limited number of studies provides a conceptual framework that can be further extended, empirically tested to develop understating in this regard particularly in developing country context like Malaysia. To fill such gaps current study, conducts a literature review to provide an compressive framework compiling the influential factors. The finding hypothesizes that the Unified Theory of Acceptance and Use of Technology (UTAUT), the Norm Activation Model (NAM), and the initial trust factors directly influences the adoption intention while, trust also plays a mediating role between those relationships. A future study will be conducted to empirically test and validate the conceptual framework that has been proposed. The framework can be extended and tasted in other developing country context