E-learning among medical students: comparison between medical colleges of two metropolitan cities in punjab

Background: Information and communication technology is a new approach to the teaching and learning process, now widely accepted as a necessary tool for attainment of developmental goals. From traditional blackboard and lectures, education has moved to e-learning. E-learning is a flexible term that refers to the improvement in knowledge and performance through use of computer and internet technologies

Objective: To compare the e-learning in medical students of medical colleges of two metropolitan cities of Punjab

Methodology: This cross sectional survey was conducted for the final year MBBS students of King Edward Medical University, Lahore [KEMU] and Khawaja Muhammad Safdar Medical College, Sialkot [KMSMC] from 1st January to 30th June 2017. A 5 domained validated questionnaire was used. Students were included by non-probability convenient sampling. A questionnaire was emailed to 210 study participants. A total of 145 students [69% response rate] from both the colleges responded to the questionnaire. Data was entered in SPSS 20 for statistical analysis. Independent sample t-test was applied where data was normal while Mann Whitney U test was applied where data was not normally distributed

Results: In this study, a total of 145 students participated. The mean scores for perceived usefulness for e-learning, ease of e-learning, e-learning stressor and e-distance use of e-learning was statistically same in KEMU and KMSMC students. However, the score for intention to adopt for e-learning had statistically higher mean in students of KEMU. [p-value = 0.004]

Conclusion: Medical students from both the institutions of metropolitan cities recognize the uses of e-learning in medical education and are perceptive to adopt it

Impact of inter pregnancy interval of less than 18 months on neonatal birth weight

Objective: To find association between low birth weight and short inter-pregnancy interval [< 18 months]

Methodology: 150 females planned for full term delivery were taken in this study from department of Obstetrics and Gynaecology, Shaikh Zayed Hospital Lahore were taken. After taking an informed consent for subjects or attendants, their age, address, contact details, parity and gestational age in weeks were taken. All pregnant females having gestational age > 37 weeks were enrolled and shall be followed till their normal vaginal delivery. Females delivering baby with < 18 months birth interval [as per operational definition] were considered as cases and females delivering baby with >/= 18 months interval were considered as controls. Babies' weight were recorded immediately after their birth and were categorized as low birth weight if weight is < 2.5 kg normal if birth weight is >/= 2.5 kg. All data were collected by researcher herself of attached proforma. All collected data were entered and analyzed using statistical package for social science [SPSS] 22

Results: In this study mean age of females having short inter-pregnancy interval [IPI < 18 months] was 27.20 +/- 2.93 years and mean age of those who do not had short inter-pregnancy interval [IPI >/= 18 months] was 27.77 +/- 3.13 years, there was no statistical difference in mean age among both groups, p-value = 0.248. The average birth weight was significantly higher [2.68 +/- 0.35] in females having IPI >/= 18 months when compared with females having IPI < 18 months i.e. 2.51 +/- 0.428, p-value 0.001. In females with < 18 months of IPI there were 27[36%] low birth weight babies while 48[64%] females delivered normal weight babies. For those who had >/= 18 months of IPI there were 14[18.7%] low birth weights and 61[81.3%] babies had normal weight. On applying relative risk we found there were 2.45 times higher chance of low birth weight baby for those who had < 18 months of IPI, with significant difference , p-value = 0.017

Conclusion: We conclude that pregnancy interval of <18 months is a risk factor for low birth weight. Although efforts are being made to educate population on keeping the pregnancy procedures and intervals safe, further implications are needed to be taken in terms of family planning and awareness campaigning

Frequency of group B streptococci in pregnant women in a tertiary care hospital

Objective: To determine the frequency and risk factors of Group B Streptococci [GBS] in pregnant patients in third trimester in a tertiary care hospital in Lahore

Study Design: Cross-sectional, prospective study

Place and Duration of Study: Lady Willingdon Hospital, Lahore, from October 2014 to March 2015

Methodology: Sterile lower vaginal swabs were taken from 200 women aged 20 years and over, in third trimester, with no history of vaginal bleeding, ruptured membrane, recent intake of antibiotics or chronic illness. These swabs were cultured for detection of GBS. The risk factors of GBS and its frequency were noted in the pregnant population. Quantitative and qualitative data was analyzed by SPSS version 20. Chi-square test was applied to see association between diagnosis of GBS and other categorical variables. P-value

Results: In this study, the mean age of all the females was 26.36 +/- 4.32 years and mean duration of pregnancy was 35.54 +/- 2.65 weeks. Frequency of GBS in pregnant women was found as 14%. We observed significant association of GBS with parity and previous history of miscarriage [p-value = 0.033 and 0.010 respectively]. Moreover, significant association between vaginal discharge and GBS was also found [p = 0.027]

Conclusion: GBS is present in a small but significant number of pregnant women in our setting and it has association with multiparity, vaginal discharge during pregnancy, and previous history of miscarriage

Oral squamous papilloma and squamous cell carcinoma; diagnostic utility of P53 in differentiating

Objectives: The objective of this study was to determine the diagnostic utility of p53 in differentiating oral squamous papilloma and squamous cell carcinoma

Study Design: A cross-sectional study

Setting: Pathology Department of Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore

Period: Six months [6-10-10 to 6-04-11]

Patients and Methods: A total of 100 oral biopsies fulfilling the inclusion criteria were collected. The expression of P53 was observed in biopsies of squamous papilloma and squamous cell carcinoma. Data was entered and analyzed on SPSS version 20 and was analyzed in same package. Sensitivity, specificity, positive predictive and negative predictive values were calculated along their confidence intervals at 95% level

Results: One hundred oral lesions were studied, of which 90 cases were of squamous cell carcinoma and 10 cases were of squamous papilloma. Majority of the patients were male [60%]. Mean age was 46 years. P53 IHC stain had sensitivity of 92% and specificity of 80% and diagnostic utility of 91% in lesions of squamous cell carcinoma

Conclusion: P53 is positively expressed in oral squamous cell carcinoma and is negative in squamous papilloma. Hence evaluation of p53 expression can be a useful adjunct in the diagnosis of squamous cell carcinoma, especially in cases where it is difficult to distinguish between these two entities on morphological grounds

Iron deficiency anemia; prevalence in children of Lahore

Objective: The objective of this study was to determine prevalence of iron deficiency anemia in children of Lahore

Study Design: Cross sectional survey

Setting: Hospitals in different areas of Lahore

Period: 3 months

Methodology: A total sample of three hundred and sixty children was taken from different areas of Lahore. Simple random sampling technique was used. Data collection was done by using a cross sectional survey. An informed consent was taken from the parents of children selected for including in the study and using their data for research purpose. The complete demographic information like name, age, sex, address was obtained. Venous blood samples were obtained for analysis of their hemoglobin [Hb] level. All the data collected was entered and analyzed by using SPSS version 20

Results: A total of 360 children were selected for the study. The mean age of respondents was 9.87 +/- 2.67. Among all subjects there were 158[43.89%] male and 202 [56.1%] were female patients. The mean Hb in all subjects was 9.82 +/- 3.46. The overall prevalence of iron deficiency anemia was 224[62.2%]. Among anemic patients there 101 [45%] male and 123 [55%] female patients in this study, we found no significant association between anemia and gender, p-value >0.05

Conclusion: Prevalence of iron deficiency anemia is considerably higher in children of Lahore under study. We should take some defensive measure to cope with it as mathematical deficiency affect children's health, mental and physical activities

Comparison of pore size analysis of existing and experimental surgical gowns

Majority of the public and private sector hospitals are using reusable gowns and scrubs whereas only a few hospitals are using disposable ones. Protection during surgery is very important both for the patient as well as for the surgeon. The reasons are not only hygienic but also creating a barrier so that the bacteria and the viruses do not transfer from patient to doctor and vice versa. The surgical gowns have been in use for many decades. With the advancements in the field of manufacturing [weaving and finishing], the quality of gowns has been improving over the period of time. In Pakistan, there is no awareness yet regarding the construction of surgical apparels viz. surgical gowns and scrubs so no standards are being followed as such during the manufacturing [weaving and finishing] of surgical apparels. For effective barrier function of surgical gowns and scrubs, it is necessary for them to comply with certain standards in terms of physical characteristics viz. mass per unit area, number of threads per unit length, tensile strength etc. The idea behind this study was to evaluate the physical characteristics of surgical gowns and scrubs currently being used in different public sector hospitals of Lahore. [1] To evaluate the pore size of existing and experimental surgical gowns being used in different hospitals of Lahore. [2] To compare the pore size analysis of existing surgical gowns with experimental surgical gowns. Experimental study design was used. January 2014- April 2014. Samples of fabric used for making surgical gowns and scrubs were collected from different hospitals of Lahore and evaluated for pore size with the help of optic microscope. For experimental gowns the fabric was developed according to the international standards. Pore size of surgical gowns was measured with the help of scanning electron microscope. The results showed large pores in existing surgical gown. No length or width wise pores in the experimental surgical gowns fabric except there are tiny holes of 0.5 after 20 launderings. The existing reusable surgical gowns did not offer any resistance against bacterial penetration because of large pores. The fabric used for the existing surgical gowns was not up to the mark and did show large pores under microscope. The experimental surgical gown showed no pores in the fabric structure when subjected to scanning electron microscope. The functional ability of resistance against bacterial penetration of the surgical gowns is important because the risk of SSI. If the patient develops SSI weather it is grades 1, 2 or 3, the cost is significant. The cost effectiveness of the existing reusable surgical gowns becomes insignificant as none of the existing surgical gowns offer any resistance against bacterial penetration and the risk of SSI with subsequent treatment cost. Necessary guidelines can be formulated and proposed to the concerned departments of various hospitals, in the light of which they can design some specifications and select appropriate materials for surgical apparels in future

Assessment of dengue fever severity through liver function tests

To assess the utility of liver function tests [LFTs] for early recognition and prediction of severity of Dengue fever in hospitalized patients. An analytical study. Services Institute of Medical Science and Fatima Memorial Hospital, Lahore, from September - December 2010. Admitted cases of Dengue fever were divided into 3 groups; mild, moderate and severe increases in aminotransferases. Elevation in LFTs was co-related with good or bad outcome i.e. [survival or complication free stay] or [death or complications]. Results were analyzed in SPSS version 18. Out of the 353 patients with mean age of 37.12 +/- 15.45 years, 245 [69.4%] were males and 108 [30.6%] were females. Seventy five patients [21.2%] had mild elevation of aminotransferases [2 fold increases], 265 patients [75.1%] had moderate increases [3 to 4 fold] and 13 [3.7%] had severe [> 4 fold increase]. ALT was statistically higher in patients with septicemia, hepatic and renal failure [p-value [2] 0.05]. AST was higher in almost all complications. Prolonged hospital stay was associated with raised LFTs and greater complications and mortality. AST was found to be twice as much raised as ALT. AST and ALT were statistically higher in patients with worse outcome thus can lead to early recognition of high risk cases

Pregnancy outcomes: a comparative study of hypertensive and normotensive Pakistani population

Pregnancy is a normal physiological event but some pregnancy specific or other medical conditions can cause maternal as well as fetal morbidities and even mortalities. Among them, raised blood pressure during pregnancy adversely affects both maternal and fetal outcomes. In this study, risk factors associated with hypertensive disorders of pregnancy are explored and pregnancy outcomes of hypertensive women with normotensive pregnant women are compared. Case control study. Obstetrics and gynecology department of Jinnah hospital Lahore. 1st October 2011 to 24 February 2012. The case control study of 250 cases [pregnant females with hypertensive disorders] and controls [pregnant females without hypertensive disorder], presented at obstetrics and gynecology department of Jinnah hospital during 1st October 2011 to 24 February 2012 was conducted. SPSS software [16] and MS excel were used for statistical analysis. Mean age for cases and controls was 26.96 +/- 5.29 years and 25.25 +/- 4.60 years, respectively. Age and history of pregnancy was found to be significantly associated with hypertensive disorders of pregnancy. Comparison of neonatal outcome between case group and control group showed that hypertensive pregnant women were at higher risk of having adverse pregnancy outcome. Women with hypertension during pregnancy are at increased risk of having adverse pregnancy outcome as compared to normotensive women and age, history of pregnancy induced hypertension are contributing risk factors for developing hypertension during pregnancy

Backache in pregnancy; role of physiotherapy in its relief

Backache is a common problem during pregnancy that is faced by almost one quarter of all pregnant women worldwide. To find an association between backache and pregnancy with respect to obesity and to evaluate the effect of physiotherapy for relief of pain. This longitudinal observational and randomized control study was conducted on pregnant females for a period of six months. 150 females fulfilling the inclusion criteria were enrolled into two groups i.e. obese patients [BMI >29.9] and non obese patients [BMI<29.9]. All information was recorded on a Performa that was later entered and analyzed using SPSS-11.5. The mean age of all patients was 33.67 +/- 6.73 years with overall average gestational age of 27.47 +/- 5.19 weeks. Flexed posture was observed in 90[60%] patients and 60[40%] had very bad sitting habit. There were 80 [53.3%] obese and 70 [46.7%] non-obese patients. Lordosis was observed in 50 cases, straight spine was observed in 90 cases while 60 patients had no straight spine. Most females reported that pain started during the 1[st] trimester [110] but only 40 females reported that they developed pain in the 2[nd] trimester.100 females reported that pain was continuous while 50 had intermittent. There were 50 [33%] patients who had severe backache while 100 [66.7%] had worse possible pain which was regressed to no pain in 140[93.3%] patients at final follow up visit and only 10 [6.7%] had moderate pain after physiotherapy. The difference between pre and post physiotherapy was statistically significant. Both obese and non-obese patients were reported to be benefited but better results were found in non-obese patients. We conclude that physiotherapy is effective in reducing the backache in pregnant females and has no side effects on fetus and mother. Also, more effective results can be achieved through physiotherapy in non-obese patients compared to obese patients. Thus, Physiotherapy can be recommended as the first line treatment for pregnant females

study of vesicovaginal fistula repaired by vaginal route at fistula centre Lady Willingdon hospital, Lahore

Vesicovaginal fistula is an abnormal communication between bladder and vagina that allows the passage of urine through vagina leading to continuous dribbling of urine. According to WHO in developing countries, 5 million of women each year suffer severe maternal morbidity in which obstetric fistula is on the top of the list. To determine the outcome of vaginally repaired vesicovaginal fistula [VVF]. Descriptive case series study. This study was conducted at Fistula centre Lady Willington Hospital/King Edward Medical University for a period of one year from Jan 2010 to Dec 2010. This Descriptive case series was carried out for a period of one year in which 60 cases of VVF were included who were repaired by vaginal route and were followed by symptoms assessment like incontinence of urine and signs like soakage of pads were noted. The patients of 20 - 60 years of age who developed vesicovaginal fistula after obstructed labour or after surgeries like caesarean section, total abdominal hysterectomy, vaginal hysterectomy and operative deliveries whose vesicovaginal fistulae were repaired by vaginal route were included in the study, whereas those patients who developed VVF after malignancy and radiotherapy, or repaired by abdominal route and uretric fistulae were excluded from the study. Data was entered and analyzed on SPSS version 18.0. Majority of the patients included in the study 29 [48%] were between 31-40 years and minimum patients were between 20-30 years old with overall mean age of 44.59 +/- 3.12 years and 6 [10%] patients were diabetic. Among 50 cases of first attempt, the success rate at primary repair was achieved in 48 [96%] patients and only 2 [4%] cases were unsuccessful. The success at secondary repair was achieved in 4 patients [66.66%] and failure in 2 patients [33.33%], four patients were operated third time and surgery was successful in only one case. The success of procedure was significant in 1[st] attempt, p-value = 0.0000. Follow-up visit after 3 weeks soakage of urine [after removal of Foleys catheter] was seen in 6 [10%] patients, follow-up after 3 weeks by dye test proved 7 [11.66%] of cases. Incontinence of urine was found in 6 [10%] of patients. Transvaginal route of VVF repair has better outcome and primary repair is more successful, p-value = 0.0000

Impact of laundering on bacterial penetration in surgical gowns

The objective of this study was to compare the mean bacterial penetration% in surgical gowns at different laundering cycles which were used in three different categories of Hospital. Fifty, locally available reusable surgical gowns were collected from all the major teaching hospitals of Lahore as sample. Samples were analyzed and compared against international standards. Samples were tested at different laundering cycles [after 0, 5, 10, 15, and 20 washings]. The gowns were laundered at Mayo hospital laundry services. The surgical gowns were subjected to multiple laundering cycles. The bacterial penetration test was performed at Microbiology Lab., PCSIR [Pakistan Council of Scientific and lndustrial Research] Laboratories Complex, Lahore. Data was analyzed by using SPSS 16 versions and for comparison Repeated measurement ANOVA was used. A p-value less or equal to 0.05 will be considered as significant. Overall the mean +/- S.D penetration of bacteria in all samples was as under, at 0 Washing [86.47 +/- 2.91%], 5th washing [91.53 +/- 1.72%], 10th washing [95.60 +/- 0.91%], 15th washing [08.53 +/- 0.34%] and at 20th washing [99.47 +/- 0.13%]. While comparing on different laundering intervals or times the penetration of bacteria [%] was statistically increased from 86.47 +/- 2.91% to 99.47 +/- 0.13%, p-value 0.001. When studied for change in porosity after laundering reusable surgical gowns set up of hospitals in Pakistan resulted in increased porosity and hence more penetration of bacteria across the fabric used for manufacture of surgical gowns. The loss of barrier effect of surgical gown is further compounded by lack of standardization of laundering technique, infra-structure use of improper detergent and other cleaning agents. This loss of fabric characteristics results in more bacterial contamination of surgical wound risk of infection to the patient.

Association of alveolar bone loss with obesity: a comparative study

Background: Obesity acts as a risk factor for many diseases like diabetes mellitus, hypertension, and ischemic heart disease. Recently, it has been found that obesity is also associated with periodontal disease especially in adults and urban population

Objective: The objective of the present study was to assess association between obesity and alveolar bone loss caused by periodontal diseases in urban Pakistani population in 30-40 years age group

Subjects and Methods: 100 patients of established periodontal disease were selected based on Community Periodontal Index [CPI]. Patients were divided into obese and non-obese groups of 50 each. The criterion for diagnosis obesity was based on body mass index [BMI]. The selection of all 100 subjects was done according to exclusion and inclusion criteria which possibly excluded all other factors which might enhance alveolar bone loss except obesity. Then panoramic radiographs of all subjects were taken and alveolar bone loss was measured. Then to rule out the effect of age on alveolar bone loss an age-related alveolar bone score was calculated for all subjects of both; obese and non-obese group

Results: In this study there were 43 males and 57 females with the mean age of 35.10+2.24 and mean alveolar bone score 64.51+8.21. Obese patients had higher Alveolar Bone loss sore than non-obese individuals with an odds ratio of 4.33 [2.43 - 6.57]

Conclusion: In middle aged patients of periodontal disease belonging to urban Pakistani population obesity as assessed by body mass index [BMI] is associated with increased alveolar bone loss

Evaluation of performance of basic life support and clinical skills among interns in mayo and allied hospitals of king Edward medical university, Lahore

Training of medical students on basic life support and clinical skills is an important part of under graduate medical education. Teaching hospitals can provide these skills efficiently. To compare the performance of basic life support and clinical skills among trained and non-trained medical graduates, working as interns in Mayo and Allied Hospitals of King Edward Medical University. Study type settings and duration: Cross sectional study conducted in the Department of Medical Education, King Edward Medical University, Lahore from May 2010 to April 2011. A total of 227 medical graduates [academic year of 2010] were trained for basic life support of child and adult, neonatal resuscitation, airway opening maneuvers, endotracheal tube insertion and aseptic techniques. They were divided into two groups; group A consisted of 125 King Edward Medical University graduates who, as students were trained in above mentioned skills and now as interns, were working in emergency and intensive care units of Paediatrics, Neonatology, Medicine, Surgery and Gynecology and Obstetrics of Mayo and Allied Hospitals of King Edward Medical University. Group B consisted of 125 interns who graduated from other medical schools, and had not learnt above mentioned skills as undergraduate students. Interns of both the groups were interviewed using a structured questionnaire for importance of learning the skills at undergraduate level and performance of above mentioned skills as an intern. Study group A was also interviewed about grading the skills that they learnt as undergraduate students. Data was entered in SPSS 17. Chi square test was applied to compare the performance of the skills while, logistic regression analysis was done to calculate odds ratio and 95% confidence interval. In group A, 74[59%] interns performed basic life support for child and adult well. Almost 79[63%] performed neonatal resuscitation, 63[50%] airway opening maneuvers, 37[30%] endotracheal tube insertion and 91[73%] aseptic techniques well. In group B, 98[78%], 120[96%], 104[83%], 117[94%], and 81[65%] interns were unable to perform above mentioned skills respectively. The difference between the groups was statistically significant for all the skills. Training of basic life support and clinical skills' courses at undergraduate level can result in better performance of these skills in their practical life

Comparison of serum sodium before and after use of reduced osmolarity ors solution in children with acute water diarrhea

Background: Oral rehydration salt [ORS] solution has reduced childhood deaths from diarrhea. Recent studies suggest that ORS solutions with reduced osmolarity may be more effective. However, there is concern about hyponatremia with reduced osmolarity ORS. Objectives: To compare the serum sodium level before and after the use of reduced osmolarity ORS solution in children with acute watery diarrhea [AWD]

Patients and Methods: This comparative cross sectional study was conducted in the Department of Paediatrics Unit-I, King Edward Medical University/ Mayo Hospital, Lahore from March to August 2009. Sample was collected by non probability purposive sampling. After consent, a total of 100 children of age 2 to 60 months, consistent with clinical case definition of AWD [passage of 3 or more loose stools/day with duration of less than 14 days] were enrolled. Those children with severe dehydration or having clinical evidence of systemic infection were excluded from the study. Each child was offered reduced osmolarity ORS solution. Serum sodium level was measured before and 6 hour after use of ORS. Data was entered in SPSS 17 and paired sample t-test was applied to compare serum sodium level before and after use of ORS

Results: Mean serum sodium level before and 6 hour after use of reduced osmolarity ORS solution was 133+/-3.4mEq/L and 133+/-2.9mEq/L, respectively. There was statistically insignificant change in serum sodium level after use of reduced osmolarity ORS solution.[p value 0.173] Similar results were found for subgroups of age and gender

Conclusion: Reduced osmolarity ORS solution has no statistically significant risk of hyponatremia in children with AWD

Association between intake of milk or other dairy products along with fish meat and development of vitiligo

Objective: to establish whether there is an association between intake of milk or dairy products along with fish meat and development of vitiligo

Material and Methods: this case control study was conducted in outdoor Dermatology Department Mayo Hospital, Lahore and in some urban areas of Lahore from 7th of August 2003 to 5th of September 2003. Subjects were selected among the adult population. 40 cases and 63 controls were taken

Results: 57.5 % cases and 61.90% controls were factor positive. The chi-square test was applied and p-value was found to be 0.656 which is not statistically significant

Conclusion: no association was found between drinking of milk or other dairy products with fish meat and development of vitiligo

Genitofemoral nerve block and intraoperative analgesia in children during inguinal hernia repair

Ilioinguinal and iliohypogastric nerve blocks has been widely used in children undergoing inguinal herniorraphy. This technique may provide insufficient intraoperative analgesia as the inguinal region may receive innervation from genitofemoral nerve. We proposed that the addition of genitofemoral nerve block might improve the quality of analgesia. The objective was to find the efficacy of genitofemoral nerve block in addition to ilioinguinal and iliohypogastric nerve block for better intraoperative pain management in children under going inguinal hernia repair under general anaesthesia. After informed consent, 100 children of 1-10 yrs of age and ASA I or II status undergoing inguinal hernia repair were selected and divided in group I and II of 50 patients each. After induction of general anaesthesia, Group I patients received ilioinguinal and iliohypogastric block using bupivacaine 0.375% at a dose of 0.75 mg/kg, where as patients in group II were given genitofemoral in addition to ilioinguinal and iliohypogastric nerve blocks using bupivacaine 0.375% at a dose of 0.375 mg/kg at each site. Changes in heart rate, systolic, diastolic and mean arterial pressures were recorded before the start of surgery, at skin incision, at sac traction and at the end of surgery as a measure of efficacy of the block. Haemodynamic data was analysed using repeated measures ANOVA. The two groups showed increase in [Heart Rate] but the increase was lesser in group II at sac traction [p<0.05]. In group I all patients had an increase in systolic, diastolic and mean arterial pressure at sac traction while the patients in group II showed no change during the study period [p<0.05]. We conclude that the addition of a genitofemoral nerve block to ilioinguinal and iliohypogastric nerve blocks may contribute to haemodynamic stability during sac traction indicating better pain relief