Intra-articular corticosteroids versus physiotherapy in the management of adhesive capsulitis

Objective: To compare the intra-articular corticosteroid versus physiotherapy in the management of adhesive capsulitis in terms of mean pain score. Study Design: Randomized controlled trial. Place and Duration of Study: Outpatient department, at Armed Forces Institute of Rehabilitation Medicine, from Jul 2013 to Jul 2015

Material and Methods: A total of 90 patients with adhesive capsulitis were enrolled as per inclusion criteria by non probability consecutive sampling. Forty five patients were assigned to group "A" and were given intra-articular injection of triamcinolone 40mg [2ml] and bupivacain 2ml into the shoulder joint. Group "B", having forty five patients received eight session of physiotherapy on alternate day. Outcome measure included mean pain score using visual analogue scale at six week follow-up

Results: Statistically significant improvement in pain score on visual analogue scale was found in patients with group "A", with improvement in score from 7.2 +/- 0.91 at the start of the study to 5.6 +/- 0.18 at six week follow-up [p<0.001]. Whereas no statistically significant results were obtained in patients with group "B" having pain score on visual analogue scale of 7.4 +/- 0.14 at the start of the study to 7.3 +/- 0.14 at six week follow-up [p=0.54]

Conclusion: The use of intra-articular corticosteroid injection in shoulder joint potentially offers a significantly greater clinical improvement in pain relief over the use of supervised physiotherapy in the management of patients suffering from adhesive capsulitis

Frequency of hyperuricemia in thyroid dysfunction

Objective: To determine the frequency of hyperuricemia in patients with thyroid dysfunction. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Department of Chemical Pathology, Army Medical College Rawalpindi, National University of Sciences and Technology [NUST] Islamabad and Military Hospital [MH] Rawalpindi, from Apr 2013 to Jun 2014

Results: Among the fifty five participants, 16 [29.1%] were male while 39 [70.9%] were females. Mean age of the subjects was 45.49 +/- 16.7 years in this study. Hyperuricemia was observed in seventeen [30.9%] individuals with thyroid dysfunction. Mean serum uric acid level was found to be 418.3 +/- 147 micromol/l in participants

Material and Methods: Fifty five individuals with thyroid dysfunction were included in this study. Detailed history was recorded on a questionnaire, blood samples were collected and serum total tri-iodothyronine [T3], free thyroxine [T4], thyroid stimulating hormone [TSH] and uric acid levels were measured

Conclusion: High frequency of hyperuricemia occurs in patients with thyroid dysfunction. Therefore in patients presenting with thyroid dysfunction, evaluation of underlying hyperuricemia should be considered by the clinicians

Effect of delayed post-stroke rehabilitation program on patient's functional outcome

Objective: To examine the effects of delayed admission to rehabilitation on functional outcomes in post stroke patients

Study Design: Observational study

Place and Duration of Study: Department of Physical Medicine and Rehabilitation of Combined Military Hospital Kohat, from Sep 2016 to Sep 2017

Material and Methods: A total of 55 patients with age ranging from 20-80 years who were diagnosed with first ever stroke and reported within 150 days of the onset of stroke to rehabilitation setup were selected through non-probability purposive sampling. The patients were divided into 2 groups as early [group-A ?30 days] and delayed admission group [group-B=30-150 days] based on the length of time from stroke onset to admission to inpatient rehabilitation facility. Reasons for delay admission were identified and noted. Functional independence measure [FIM] score was used to assess functional status of the patient at admission. Patients in both groups underwent identical eight weeks of regular rehabilitation program with therapy sessions 3 hours a day, 5 days a week. Functional independence measure score was noted again at eight week of indoor rehabilitation

Results: Total 52 patients completed the study with 27 [51.9 percent] male and 25 [48.1 percent] female. Lack of awareness of Rehabilitation was the most common patient related factor found in 11 [34.4 percent] while Lack of care giver support was most common external factor reported in 6 [18.7 percent]. The patients with early admission to inpatient rehabilitation facility had a better functional independent measurement scores gain than the patients with delayed admission to inpatient rehabilitation facility [40.4 +/- 11.4 vs. 11.9 +/- 8.4, p=0.01]. However, FIM scores at admission in both groups were not statistically significant

Conclusion: Delayed admission to inpatient rehabilitation facility after stroke event caused poorer functional outcomes in stroke patients

Effectiveness of test-enhanced Learning [TEL] in lectures for undergraduate medical students

Objective: To determine the effectiveness of Test-Enhanced learning as a learning tool in lectures for undergraduate medical students

Method: This quantitative, randomized controlled trial included eighty-four students of 4th year MBBS from Yusra Medical and Dental College, Islamabad. The duration of study was from March 2016 to August 2016. After obtaining the informed consent; participants were equally assigned to interventional and noninterventional study groups through stratified randomization. Single best answer MCQs of special pathology were used as data collection instrument after validation. A pre- and post-test was taken from both groups, before and after the intervention, respectively and their results were compared using SPSS version 21

Results: There were 13 male [31%] and 29 female [69%] participants in each study group who showed an equivalent baseline performance on pre-test [p=0.95]. Statistically significant difference was found among mean scores of interventional and non-interventional study groups at exit exam [p=0.00]. Interventional group also showed a significant improvement in their post-test scores [mean: 17.17+/-1.59] as compared to pre-test scores [mean: 6.19+/-1.81]

Conclusions: Test-enhanced learning has significant effect on improving the learning of course content delivered to undergraduate medical students through lectures

Urodynamic bladder patterns in spinal cord injury patients

Objective: To determine the frequency of various neurogenic bladder patterns in patients with traumatic spinal cord injury presenting at Armed Forces Institute of Rehabilitation Medicine Rawalpindi based on urodynamic studies

Study Design: Descriptive cross sectional study

Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi, from Jul 2014 to Jun 2016

Material and Methods: One hundred and forty traumatic spinal cord injury patients fulfilling the inclusion criteria were included both from indoor and outdoor departments through non-probability purposive sampling. Urodynamic studies were performed using the urodynamic equipment at urodynamic laboratory. Data were collected and recorded on specialized proforma by the principal investigator

Results: Among 140 study participants detrusor overactivity was found in 100 patients out of which 76 [76%] had thoracic level of injury, 20 [20%] had cervical level and 4 [4%] had lumbar level of injury. Detrusor areflexia was the bladder pattern in 40 patients out of which 26 [65%] had thoracic level of injury, 10 [25%] had cervical level, and 4 [10%] had lumbar level of injury

Conclusion: Detrusor overactivity was the commonest neurogenic bladder pattern among the traumatic spinal cord injury patients

Internet use: Disruptive or enhancing towards learning? Views and perceptions of undergraduate medical students

Objective: To describe the perceptions and behaviors of undergraduate medical students regarding the use of internet

Study design: Cross-sectional descriptive study

Place and Duration of Study: Army Medical College, National University of Medical Sciences [NUMS] Rawalpindi, from January 2014 to June 2014

Methodology: Data had been obtained from volunteer undergraduate medical students who were computer literate and were using the internet facility in their daily routine. Students, who did not have the computer and internet using skills and were not using the internet services, were excluded from this study. A structured questionnaire was used which included following items: duration and frequency of internet use, impact of internet use on academic grades, influence of internet usage on relationships with friends and family, effect of overuse on sleep cycle and having the self-knowledge of being internet addicted

Results: Two hundred and twelve students gave consent to participate in this study. Different perceptions of undergraduate medical students regarding the internet use were observed: 64 [30.2%] students spent about two hours daily in internet surfing and 79 [37.3%] participants in our study utilized internet facility for social networking while 67 [31.6%] used it for educational and learning purposes. A total of 147 [69.3%] participants reported that internet use enhanced their learning and had a positive effect on their academic grades

Conclusion: Our study concludes that internet-using skill is a very powerful tool in today's world with regards to academic learning. With appropriate guidance and support, students can get maximum benefit from this facility and can enhance their learning capabilities. Institutes should play their role by making every student computer literate and also by making on-campus advisory services available to figure out internet abuse related issues of the students

Diabetic foot: a snapshot from a tertiary care hospital, Rawalpindi

Objective: To study the pattern of diabetic foot among diabetic patients visiting the tertiary care hospital

Study Design: Observational descriptive study

Place and Duration of Study: Combined Military Hospital [CMH] Rawalpindi and Military Hospital [MH], Rawalpindi, from June 2014 to August 2014

Material and Methods: Fifty six known diabetic patients, undergoing treatment or follow up for diabetic foot were included in the study. A detailed medical history was obtained and recorded in the proforma. Frequencies and percentages of complications of diabetic foot were calculated. SPSS version 16 was used for data analysis

Results: Out of fifty six diabetic patients, 35 [62.5%] were male and 21 [37.5%] were females; their mean age was 58.21 +/- 7.10 years. Mean duration of Diabetes mellitus was 6.04 +/- 3.35 years. The median known duration of DM2 was 11 [5-43] years. 21.4% of patients had foot infection while 35.7% patients were suffering from foot ulcers. 42.9% patients had both, foot infection along with ulcers

Conclusion: Foot infections and foot ulcers are common feature of diabetic foot. Infected foot ulcer is a common cause of morbidity in diabetic patients, ultimately leading to dreaded complications like gangrene and amputations. All patients with diabetes should have an annual foot examination

Searching the research or re-searching the search: where to start from? a post-graduate medical trainees perspective from rawalpindy lslamabad

To explore the post-graduate medical trainees perceptions and practices towards research and to investigate potential barriers to perform research. Cross sectional descriptive study. Military hospital, Combined Military hospital, Rawalpindi and Pakistan institute of medical sciences Islamabad, from Jan 2013-Dec 2013. A pretested, structured and validated questionnaire was used to collect data from 114 final year post-graduate medical trainees [PGMTs]. SPSS version 17 was used for descriptive data analysis. One hundred and fourteen [n=114] final year post-graduate medical trainees [PGMTs] of fellowship program of College of Physician and Surgeons of Pakistan gave their written consent to participate in this study. Among them 68 [59.6%] were males while 46 [40.3%] were female. One hundred and twelve [98.2%] trainees agreed that research is an important and healthy activity and have a great impact on their future carriers. 63 [55.2%] PGMTs had worked as data collector in various studies conducted at their institutions while only 21[18.4%] PGMTs had published their manuscript. Obstacles that prevented the PGMTs from conducting research included: lack of professional supervisors: 103 [90.3%], poor research training: 98 [86.0%], and lack of resources: 84 [73.6%]. Although the majority of the PG trainees believe that research is important in medical field, only about 55.2% of them have participated in the research activities other than mandatory dissertation during their training. Measures should be taken at postgraduate level to involve and support the PGMTs in health research with formal training programs and good mentorship

Frequency of co-morbidities associated with spinal cord injury

To determine the frequencies of comorbidities [dyslipidemias, diabetes mellitus, and hypertension] in patients with spinal cord injury [SCI] of duration > 1 year. Spinal Cord Injury Department, Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi and Department of Chemical Pathology, Army Medical College, National University of Sciences and Technology [NUST], from October 2013 to March 2014. Thirty six patients with complete spinal cord injury [SCI], level C5 to T12 were included by non-probability, convenience sampling. Control group consisted of age and sex matched healthy individuals. A detailed medical history was obtained. Anthropometric measurements and blood pressure were recorded. Fasting blood samples were obtained and analyzed for plasma glucose and serum lipid profile. Out of thirty six patients, 31 [86.1%] were male and 5 [13.9%] were females; their mean age was 36.6 +/- 11 years. Mean duration of injury was 6.04 +/- 3.35 years. Among cases, dyslipidemias were detected in 25 [69.4%] patients while 7 [19.4%] patients had diabetes mellitus. Whereas in control group, frequency of dyslipidemias and diabetes mellitus were significantly lower than cases i.e 13.8% and 5.5% respectively. Also no significant difference was found between blood pressures of study group when compared with control group. Individuals with chronic SCI had more frequent associated co-morbid conditions like dyslipidemias and diabetes mellitus than normal individuals. Early screening is recommended in patients having SCI >6 months for better patient care and reduction in long term comorbidities in such patients

[Structured viva as an assessment tool: Perceptions of undergraduate medical students]

To document the undergraduate medical students' perceptions regarding the structured viva as an assessment tool. Cross sectional. Army Medical College, National University of Sciences and Technology [NUST], Islamabad from April 2013 to April 2014. Data was collected from fourth year students of a public sector medical college. A structured questionnaire was used to evaluate student's perception regarding relevancy of viva questions to syllabus, level of comfort while being assessed and provision of adequate time to answer, bias or harassment by the mentors, freedom to answer in their own learning styles. One hundred seventy one, fourth year students gave consent to participate in this study. Almost all of the students were satisfid after being assessed in oral structed viva room: the results obtaind were: relevancy of questions to course: 169 [98%]; comfortable environment of viva room: 165 [97%]; appropriate time to answer the questions: 162 [94.7%], structured viva: 132 [94.7%]; welcomed upon arrival for viva: 147 [86%]; encouraged by examiner: 144 [84%]; facilitated to answer in their own learning style: 137 [80%]; covered all the topics: 120 [70% 1; demotivated during viva: 11 [6.4%] and bias during viva: 14 [8.1%] There is substantial need of introducing innovations in the conventional exam strategies being practiced in our medical colleges. Introducing structured viva examination, making the exam environment comfortable and adapting an appreciative inquiry approach while assessing students can greatly help them to overcome exam stress

Premenstrual syndrome: messes with my academic performance

This study aims to determine the ediucational impact of premenstrual syndrome [PMS] on various academic activities of undergraduate female medical students. Cross sectional study. Army Medical College, National University of Sciences and Technology [NUST], Islamabad, Pakistan from June 2013 to November 2013. This cross sectional study was conducted at Army Medical College, National University of Sciences and Technology [NUST] Islamabad. Data were collected from 224 undergraduate female medical students of all professional years. PMS was diagnosed according to WHO's ICD-10 criteria. Impact of premenstrual syndrome on academic activities of female medical students was assessed using a 22-itemed, structured questionnaire. Two hundred and twenty four female undergraduate medical students gave their written consent to participate in this study. PMS was present among 207 [92.4%] female students. Major PMS symptoms experienced by the female students were: backache [87.5%], fatigue [80.2%], depressed mood [78.2%], anxiety [76.8%], hypersomnia [71%] and poor emotional control [64.3%]. The frequency of various PMS symptoms interfered with their academic activities [76.3%], with large group discussion sessions [79.2%], with small group discussion sessions [72.9%], written assessment [66.6%] and oral assessment [70.0%].The study findings affirm the fact that premenstrual syndrome profoundly affects the academic activities of young female medical students. In the light of these pertinent findings we recommend that health education and counselling services are essential to be provided at medical college campuses for female undergraduates. This will not only help them alleviate the negative effects of PMS but also develop an understanding about their problems, enhancing their academic output and performance in early medical carrier

What went wrong: why did I fail?

To document the perceptions and views of undergraduate medical students on why did they fail in their annual examinations. Cross-sectional descriptive study. Army Medical College, National University of Sciences and Technology [NUST] Islamabad, Pakistan from March 2013 to March 2014. Data had been obtained from undergraduate students who failed at least once during their MBBS course and volunteered to participate in this study. Students who did not come across any academic failure during their MBBS course were excluded. A structured questionnaire was used which included following items: knowledge overload of failed or other subjects, poor time management for their studies, their own ineffective communication and expression skills [oral/ written], poor teaching skills of teachers/facilitators and boarding problems. One hundred and seventy nine students gave consent to participate in this study. Factors leading to their failure and identified by students were: poor time management with regards to their studies: 81.6%, lack of revision time due to co-curricular activities: 73.7%, poor output in written assignments/assessments: 62.6%, knowledge overload of the failed-in subject: 47.5%, poor motivation to make serious efforts to understand and learn the subject: 57%. The reflections of medical students signify a variety of causes. It would be pertinent to organize strategies to rectify and address the basis of these expressed specific causes, especially those that had the highest impact towards the failure of these students. Such measures will help to rescue majority of these medical students and prevent them from failing in their examinations. Remedial steps when in place, shall also equip them with required skills to work on their weaknesses and turn them into strengths for their academic successes

Low serum HDL-c levels: a hidden threat to patients with spinal cord injury

To determine the serum lipid profile in patients with traumatic spinal cord injury [SCI] of duration >1 year and to compare the serum HDL-c levels of SCI patients undergoing regular physiotherapy for >60 minutes daily with those who did not undergo physiotherapy. Cross-sectional, comparative study. Spinal Cord Injury Department, AFIRM Rawalpindi and Department of Chemical Pathology, Army Medical College, Rawalpindi, from January 2013 to June 2013. Forty six patients suffering from traumatic spinal cord injury [SCI] wore included. After recording the detailed medical history, fasting blood samples were obtained and analyzed for serum lipid profile. Dyslipidemias were assessed using guidelines from the National Cholesterol Education Project Adult Treatment Panel III [ATP III]. Serum high-density lipoprotein cholesterol [HDL-c] < 0.9 mmol/1 [40 mg/dl] was considered as low HDL-c level. Out of total 46 patients, 33 [71.7%] were male and 13 [28.3%] were females with mean age of 34.9 +/- 9.55 years. Low levels of serum HDL-c were found in 21 [45.7%] SCI patients [mean serum HDL-c levels: 0.97 +/- 0.23]. SCI patients were further categorized in two groups depending upon the status of regular physiotherapy. Statistically significant difference was found in mean serum HDL-c levels of 22]47.82%] SCI patients undergoing regular physiotherapy as compared to 24 [52.18%] SCI patients who did not underwent physiotherapy [p < 0.05]. Patients with SCI have decreased levels of serum HDL-c, imparting an increased risk of cardiovascular disease [CVD] in these disabled persons. SCI individuals following regular physiotherapy, have better serum HDL-c levels as compared to bed-ridden SCI patients, suggesting the physical activity as an important factor to elevate the serum HDL-c in such patients. Knowledge of relative risk of CVD in persons with SCI is important for appropriate interventional strategies, including planned physical activities or exercises and therapeutic intervention

Higher stress scores for female medical students measured by the Kessler Psychological Distress Scale (K10) in Pakistan / 보건의료교육평가

The aim of this study was to determine the stress level of medical students and the relationship between stress and academic year. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a five-year curriculum, in Pakistan, from January 2014 to April 2014. Medical students in the first four years were included in the study. The Kessler Psychological Distress Scale (K10), a self-administered questionnaire, was distributed to the students. A total of 445 medical students completed the questionnaire. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43. Stress was experienced by 169 students (41.7%). The scores of female students were higher than scores of males, indicating a higher stress level (P=0.011). The relationship between stress and academic year was insignificant (P=0.392).