Study on awareness, knowledge, and practices towards antibiotic use among the educated and uneducated people of Khyber Pakhtunkhwa Province, Pakistan

INTRODUCTION: Antimicrobial resistance developed through the inadequate use of antibiotics; is an overriding task for global public health. OBJECTIVE: To explore awareness, knowledge, and practices, and compare the elements associated with antibiotic misuse in different University students and uneducated people of Khyber Pakhtunkhwa Province, Pakistan. METHODS: Cross-sectional study was conducted from July to December 2020 using a validated questionnaire. Data were collected from eleven different university students and uneducated people of Khyber Pakhtunkhwa, Pakistan. RESULTS: 3,600 questionnaires were completed, consisting of 56.9% Male and 43.0% Female. 1,999 (55.5%) of the antibiotic users reported through the survey used non-prescription antibiotics within a one-month study period. Out of the participants, 230 (6.3%) were uneducated or their education level was below matric rest were university students. 1999 (55.5%) reported buying Antibiotics with Medical Prescription. Most self-medicated participants (56.9%) stop taking antibiotics when they feel better. More than 90% of the respondents answered that doctors and pharmacist staff do not guide them well that how to use antibiotics. 2,171 (60.03%) respondents mistakenly believed that antibiotics improve restoration from coughs and colds. Only 720 (20%) respondents knew that antibiotics also disturb normal flora and 547 participants (15.9%) agree that unnecessary use of antibiotics causes bacterial resistance. CONCLUSION: Finding from this study may have important implications for public health policy in Khyber Pakhtunkhwa, Pakistan given the growing global resistance to antibiotics and the reported health issues related to their improper use.

Our Management of Vestibular Schwannomas and Review of Literatures

There is no a clear consensus provided in the literature and there remain controversial on the treatment especially for small to medium size Vestibular schwannomas (VSs). Thus the treatment technique and approach preference vary from centre to centre. This problem too exists in our centre. The purpose of this paper is to develop a consensus in our hospital among our colleagues on the treatment of our VSs patients. We have been treating VSs patient by translabyrinthine approach from time to time for the last 5 years and found it to be a very efficient approach. This approach gives the most direct route to the tumor with excellent exposure of the internal acoustic meatus, cerebropontine angle (CPA) area without the need to retract the brain with facial nerve totally in control early in the surgery. The only problem was, when there is large posterior fossa component of the tumor present. This approach is safe with direct exposure to CPA area and have minimum intraoperative or postoperative complications.

Dermatoses in Human Immunodeficiency Virus Infected Patients with A Focus on Infections: A 12-month Cross-sectional Study in Hospital Sungai Buloh

Background@#Cutaneous disorders are common clinical manifestations of the Human Immunodeficiency Virus (HIV). In the era of antiretroviral therapy (ART), the spectrum of cutaneous disorders in HIV-infected patients has changed. We assessed the types of dermatoses, including cutaneous infections in HIVpositive patients and the association between the peripheral CD4 cell count and the severity of skin infection.@*Methods@#All HIV-positive patients referred to the Dermatology Department of Hospital Sungai Buloh from January 2021 – December 2021 were enrolled in a prospective cross-sectional study. Patients were subjected to a complete medical and physical examination and appropriate investigation to confirm the diagnosis. @*Results@#A total of 112 (92.6%) male and 9 (7.4%) female patients with a mean age of 38.76 ± SD years participated. The majority of patients were Malay (56.2%), with MSM (54.5%) being the commonest mode of transmission. 65.2% of patients had CD4≥350 cells/ mm3 and 86.7% of patients were on ART. Infections (56.1%) were the most common group of mucocutaneous manifestations, with 45.6% of these due to viral infections. There was no statistically significant correlation between the CD4 count and the severity of skin involvement in bacterial (p=0.302), viral (p=0.145) and fungal (p=0.533) infections.@*Conclusion@#Viral infection were the commonest cutaneous manifestations in HIV- positive patients. The frequency and severity of the cutaneous infections were much more common in patients with more advanced immunosuppression.

Self-care perspective taking and empathy in a student-faculty book club in the United States / 보건의료교육평가

Purpose@#We aimed to study the impact of a combined faculty-student book club on education and medical practice as a part of the informal curriculum at the University of Florida College of Medicine in the United States. @*Methods@#Sixteen medical students and 7 faculties who participated in the book club were interviewed through phone and recorded. The interview was then transcribed and entered into the qualitative data analysis program QSR NVivo (QSR International, Burlington, MA, USA). The transcripts were reviewed, and thematic codes were developed inductively through collaborative iteration. Based on these preliminary codes, a coding dictionary was developed and applied to all interviews within QSR Nvivo to identify themes. @*Results@#Four main themes were identified from interviews: The first theme, the importance of literature to the development and maintenance of empathy and perspective-taking, and the second theme, the importance of the book club in promoting mentorship, personal relationships and professional development, were important to both student and faculty participants. The third and fourth themes, the need for the book club as a tool for self-care and the book club serving as a reminder about the world outside of school were discussed by student book club members. @*Conclusion@#Our study demonstrated that an informal book club has a significant positive impact on self-care, perspective-taking, empathy, and developing a “world outside of school” for medical school students and faculty in the United States. It also helps to foster meaningful relationships between students and faculty.

Self-care perspective taking and empathy in a student-faculty book club in the United States / 보건의료교육평가

Purpose@#We aimed to study the impact of a combined faculty-student book club on education and medical practice as a part of the informal curriculum at the University of Florida College of Medicine in the United States. @*Methods@#Sixteen medical students and 7 faculties who participated in the book club were interviewed through phone and recorded. The interview was then transcribed and entered into the qualitative data analysis program QSR NVivo (QSR International, Burlington, MA, USA). The transcripts were reviewed, and thematic codes were developed inductively through collaborative iteration. Based on these preliminary codes, a coding dictionary was developed and applied to all interviews within QSR Nvivo to identify themes. @*Results@#Four main themes were identified from interviews: The first theme, the importance of literature to the development and maintenance of empathy and perspective-taking, and the second theme, the importance of the book club in promoting mentorship, personal relationships and professional development, were important to both student and faculty participants. The third and fourth themes, the need for the book club as a tool for self-care and the book club serving as a reminder about the world outside of school were discussed by student book club members. @*Conclusion@#Our study demonstrated that an informal book club has a significant positive impact on self-care, perspective-taking, empathy, and developing a “world outside of school” for medical school students and faculty in the United States. It also helps to foster meaningful relationships between students and faculty.

Peer-assisted feedback: a successful approach for providing feedback on United States Medical Licensing Exam-style clinical skills exam notes in the United States / 보건의료교육평가

Purpose@#Peer-assisted learning (PAL) promotes the development of communication, facilitates improvements in clinical skills, and is a way to provide feedback to learners. We utilized PAL as a conceptual framework to explore the feasibility of peer-assisted feedback (PAF) to improve note-writing skills without requiring faculty time. The aim was to assess whether PAL was a successful method to provide feedback on the United States Medical Licensing Exams (USMLE)-style clinical skills exam notes by using student feedback on a survey in the United States. @*Methods@#The University of Florida College of Medicine administers clinical skills examination (CSEs) that include USMLE-like note-writing. PAL, in which students support the learning of their peers, was utilized as an alternative to faculty feedback. Second-year (MS2) and third-year (MS3) medical students taking CSEs participated in faculty-run note-grading sessions immediately after testing, which included explanations of grading rubrics and the feedback process. Students graded an anonymized peer’s notes. The graded material was then forwarded anonymously to its student author to review. Students were surveyed on their perceived ability to provide feedback and the benefits derived from PAF using a Likert scale (1–6) and open-ended comments during the 2017–2018 academic year. @*Results@#Students felt generally positively about the activity, with mean scores for items related to educational value of 4.49 for MS2s and 5.11 for MS3s (out of 6). MS3s perceived peer feedback as constructive, felt that evaluating each other’s notes was beneficial, and felt that the exercise would improve their future notes. While still positive, MS2 students gave lower scores than the MS3 students. @*Conclusion@#PAF was a successful method of providing feedback on student CSE notes, especially for MS3s. MS2s commented that although they learned during the process, they might be more invested in improving their note-writing as they approach their own USMLE exam.

Factors and Determinants of Unmet Needs: Identifying Association Between Variables and Unmet Needs Among Married Women of Child Bearing Age in Lahore, Pakistan

Background: Unmet needs for family planning is an important method to evaluate family planning programs hence this study was conducted to assess the unmet needs of contraception and its associated factors and reasons. Objectives: 1) to determine the unmet needs, its determinants and reasons among fecund and sexually active married women 2) to identify association between variables and unmet needs among fecund and sexually active married women. Materials & Methods: It was a community based cross sectional study, conducted in the catchment area of Institute of Public Health Lahore. Sample size was 200 women of Child Bearing Age (CBA) who were fecund and sexually active, with no history of hysterectomy, and living with their husbands. Simple random sampling technique was applied to recruit the sample population. Data was collected upon a structured questionnaire. Dependent variable was unmet needs; and independent variables included socio demographic variables and factors related to reproductive health. Data entered and analyzed upon SPSS version 23. Descriptive statistics calculated; Bivariate analysis was applied to identify association of variables with met and unmet needs.  Results: About 19.38% women had unmet needs for family planning; 8.59% for limiting and 10.79% for spacing. Family Planning knowledge, discussion about family planning between spouses and Husband’s sole role as a decision maker were significantly associated with unmet needs. Reasons for unmet needs were fear of side effects 29.5%, experience of side effects 21.6% mainly menstrual cycle disturbance and weight gain, Lack of information 13.6%, disapproval from their husbands 20.5% and by their Mother in Laws 9.1%. Conclusion: Our study indicated unmet needs for contraception comparable to latest report by Pakistan Bureau of Statistics 2015-2016 (35.5%) but still there is a scope to improve health education system, plan a structured counselling for Family Planning, reduce the impact of obstacles and address current issues to meet contraception needs.

Pregnant women risk perception of medications and natural products use during pregnancy in Alahsa, Saudi Arabia

Introduction: The use of medications during pregnancy has increased in the recent years. Some congenital anomalies, birth defects, and miscarriages have been found to be preceded by some medications use during pregnancy. The use of herbal medicines is not yet proved to be safe during pregnancy, since some herbs showed increased risk of certain congenital malformations

Aim: This study assesses the pregnant women perception, beliefs, and attitude toward medication and natural products use and their influencers during pregnancy

Methodology: This is a cross-sectional study targeting women in Alahsa, Saudi Arabia. More than 300 women have responded to a pretested questionnaire collecting their sociodemographic, perception and attitude toward medication and natural product. The data were analyzed using SPSS Statistics under the supervision of a statistician

Results: This study involved 184 participants, 29.2% of pregnant women avoided using prescribed medications, 40.7% non-prescribed, and 33.3% natural products during pregnancy. Paracetamol was on the top of the avoided medications, and herbals were on the top of the avoided natural products. The most common reason for avoidance was fearing of its effect on fetus. More than half of the participants always looked for the product safeness. Pain killers, antibiotics, cinnamon, and pineapple are the most commonly believed products to be harmful during pregnancy. 1st trimester is believed to be the critical period in which medications and herbals should be avoided

Conclusion: Pregnant women should be educated more about unsafe products during pregnancy. Women's beliefs about natural products need further exploration because of lack of evidence

Comparison of active and conservative management of post-term pregnancy: a quasi- experimental study

Objective: To compare the maternal and perinatal outcomes of prolonged pregnancy between active and conservative group

Study Design: Quasi experimental study

Place and Duration of Study: This study was conducted at the Department of Obstetrics / Gynaecology Unit-1, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad from March 2003 to Feb. 2004

Materials and Methods: There were one hundred cases, fifty in each group with a technique of convenient sampling. Women with uncomplicated pregnancies at >/=41 weeks and

Results: Comparison of both groups management showed that mean duration of labour in active group was prolonged than that of conservative group [p =0.001]. Interventional deliveries rate was high in active group than conservative group with p value significant statistically. Comparison of intra-partum fetal distress, neonatal morbidity including 1 minute, 5 minute Apgar score and admissions to NICU in both groups was not statistically significant. There was no perinatal mortality in both groups

Conclusion: Active management of prolonged pregnancy increases the maternal morbidity without improving perinatal outcome

Serum progesterone levels and sleep habits in premenopausal and postmenopausal females

Objectives: To evaluate the sleep habits in pre and postmenopausal femalesand to find out the relationship between serums progesterone levels and sleep habits

Study Design: Cross sectional study

Place and Duration: At Islamic International Medical College Rawalpindi from 1[st] March 2010 to 31[st] March 2011

Methodology: A total of 60 females were randomly selected out of which 30 were premenopausal [Group A] and 30 were postmenopausal [Group B] females. The sleep habits were assessed by sleep questionnaire and blood sample was taken for serum progesterone levels and were analyzed by enzyme-linked fluorescent immunoassay [ELFA] technique

Results: The comparison between pre and postmenopausal females was done on the basis of their sleep habits and statistically significant results were found which showed that postmenopausal females had lesser sleep duration than premenopausal females [p=0.011]. Postmenopausal females had more frequency of nocturnal arousals than premenopausal females [p<0.01], postmenopausal females awoke in morning without an alarm while most of the premenopausal females needed an alarm to wake up [p= 0.000] and postmenopausal females woke up earlier in the morning than premenopausal females [p=0.000]. Serum progesterone levels of postmenopausal females were lower than premenopausal females [p= 0.000]

Conclusions: Serum progesterone levels affect the sleep pattern of females across the menstrual cycle and menopause. As the serum progesterone levels decline after menopause; the sleep habits of females get affected and have relatively poor sleep quality, more evening tiredness and more dream remembrance as compared to premenopausal females

"KAP" survey of female undergraduate medical students of an Arab community, regarding coronary heart disease and its association to eating habits and physical inactivity

Objective: To assess the knowledge, attitude and practices of female undergraduate medical students regarding coronary heart diseases

Study Design: A survey research

Place and Duration: Public University, Kingdom of Saudi Arabia, 1[st] November - 31[st] December 2013

Methodology: A questionnaire was designed to reflect the knowledge, attitude and daily practices of the students. A total of 100 students, from 2[nd] and 3[rd] year Medical program of a public university in Saudi Arabia were randomly distributed the questionnaire. Incomplete forms were excluded from the study [n=97]. After filling in the responses, a percentage analysis was done

Results: The results reflected a deficient knowledge of coronary heart diseases among students, especially unawareness of the risk factors. Fifty one and 38% of the students respectively did not know the association of physical inactivity and over-eating, to coronary heart disease. Non-healthy attitudes and practices of frequent junk food consumption [30%], overeating [13%], and inactive lifestyle [77%] was observed in the survey

Conclusion: Proper counseling and training of the medical students for better understanding of the disease and its risk factor prevention is required

Screening and optimization of some inorganic salts for the production of ergot alkaloids from Penicillium species using surface culture fermentation process

The present study deals with the production of ergot alkaloids from Penicillium commune and Penicillium citrinum, using surface culture fermentation process. Impact of various inorganic salts was tested on the production of ergot alkaloids during the optimization studies of fermentation medium such as impact of various concentration levels of succinic acid, ammonium chloride, MgSO[4], FeSO[4], ZnSO[4], pH and the effect of various incubation time periods was also determined on the production of ergot alkaloids from Penicillium commune and Penicillium citrinum. Highest yield of ergot alkaloids was obtained when Penicillium commune and Penicillium citrinum that were grown on optimum levels of ingredients such as 2g succinic acid, 1.5 and 2g NH[4]Cl, 1.5g MgSO[4], 1g FeSO[4], 1 and 1.5g ZnSO[4] after 21 days of incubation time period using pH 5 at 25[degree]C incubation temperature in the fermentation medium. Ergot alkaloids were determined using Spectrophotometry and Thin Layer Chromatography [TLC] techniques

Hands in medicine: understanding the impact of competency-based education on the formation of medical students' identities in the United States / 보건의료교육평가

PURPOSE: There have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on 'doing the work of a physician' rather than identity formation and 'being a physician.' This study aims to understand how competency-based education impacts the development of a medical student's identity. METHODS: Three ceramic models representing three core competencies 'medical knowledge,' 'patient care,' and 'professionalism' were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes. RESULTS: Students across all four years of medical school related to the 'professionalism' competency domain (50%). They reflected that 'being an empathetic physician' was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized 'professionalism' as a competency. CONCLUSION: Students perceive 'professionalism' as a competency that impacts their identity formation in the social role of 'being a doctor,' albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.

Clinical evaluation of proximal contact points in fixed prostheses

This cross-sectional study clinically assesses the tightness of proximal contact points of fixed dental prosthesis with natural teeth. Sixty nine [69] patients visiting the Department of Prosthodontics, Armed Forces Institute of Dentists [AFID], Rawalpindi, were included. The crowns, as a single unit or terminal abutment of bridge, prepared and fabricated at the same institute were included. A total of 142 Proximal Contact Points [PCPs] were assessed with the dental floss and categorized as acceptable, loose and tight. Among these, 83 [58.4%] were acceptable, 41 [28.8%] loose and 18 [12.6%] were tight. Out of 142 PCPs, 104 [73.2%] were Porcelain Fused to Metal [PFM] and 38 [26.7%], all metal. Out of 104 PFM crown/FPD PCPs 59 [56.7%] were acceptable, 32 [30.7%] were loose and 13 [12.5%] tight. Out of 38 all metal crown/FPD PCPs 24 [63%] acceptable, 9 [23%] were loose and 5 [13%] were tight. PCPs must be checked for acceptability before cementation. The PCPs of adjacent natural dentition in same patient may serve as guide for assessment

Comparison of frequency of insulin resistance in patients with chronic obstructive pulmonary disease with normal controls

Objective: To compare mean homeostatic model assessment of insulin resistance [HOMA-IR] in patients with and without chronic obstructive pulmonary disease [COPD]

Methods: A Case control analytic study was conducted in medical outpatient department of Medial Unit-II of Dow University of Health Sciences from April 2013 to September 2013. All patients with the diagnosis of COPD were included as cases. Controls were age match healthy individuals with minor illnesses. Age, weight, height and forced expiratory volume in one second to forced vital capacity [FEV1/FVC] ratio were documented. Fasting blood glucose and fasting insulin levels were done. Body mass index [BMI] and IR was calculated using the formulas. HOMA-IR was compared between cases and controls

Results: Forty COPD patients were compared with thirty five age match controls. HOMA-IR was found to be higher in cases as compared to controls [2.85 v/s 2.00] with a p value <0.000

Conclusion: COPD is one of the chronic debilitating diseases in our region with various extra-pulmonary complications. We found IR to be present higher in COPD patients compared with healthy controls. Evaluating the pulmonary function as well as systemic metabolic parameters, may contribute to minimizing mortality and morbidity

Anxiety and Depression in Tuberculosis Can Create Impact on Quality of Life of Patient.

Objective: Despite TB being a major burden in terms of nation’s health, social life and economy and growth, it has to be considered for the psychological effects that it bears on individual life. The resulting drastic consequences showing as poor treatment compliance, increasing Mycobacterium strain resistance to first line anti TB drugs, declining health outcome etc. Our study had determined to take a step in revealing a more competent approach in getting a world free of tuberculosis, by estimating the prevalence of psychiatric co morbidities in patients with TB and to comprehend their effects on patient’s quality of life. Our aim was to assess the prevalence of depression and anxiety in tuberculosis and its influence on individual perception of well being in patients attending outpatient clinic in Karachi, Pakistan. Method: A total of 140 subjects were addressed, 70 of each TB and control. “Hospital Anxiety and Depression scale” (HAD) and “Flanagan Quality of Life scale” was used to assess anxiety and depression and quality of life in these two populations respectively. Result: About 37.1% patients diagnosed with TB were labeled as having anxiety and depression according to HAD scale. However the study has shown that the area of an individual life that experienced dramatic effects included perception towards health, relationship with partner, parents, sibling, friends, work as in job or in home, participation in society, attitude towards learning and increasing awareness, understanding about one’s strength and weaknesses and expressing oneself creatively. Conclusion: Parameters of quality of life that do play a key role in establishing quality including perception relating to health, relationships with spouse, siblings or friend, occupational role and recreation both participatory as well as passive; were found to be dramatically influenced by TB. This entirely enlightens the significance of timely counseling and health education in TB control program for alleviation of mental and social suffering seen in such a high rise.

Prevalence of Rheumatic Fever and Rheumatic Heart Disease in School Children of Bharateswari Homes of Bangladesh.

Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) continue to affect millions of people around the world, including Bangladesh. Children and adolescents are especially susceptible to this disease. Classical risk factors, i.e. poverty, overcrowding, ignorance and insufficient health care services are responsible for the high incidence and prevalence of these diseases. To assess the prevalence of RF and RHD among children, a school survey was conducted in Bharateswari Homes, in the district of Tangail, Bangladesh. Methods: A total of 947 students were examined. Revised Jones’ criteria (1992), and clinical examination were used for the diagnosis of RF and RHD. Results: Four cases of RF/RHD were found giving the prevalence of 4.22/1000. This is lower than the prevalence reported in eighties, but is consistent with those found in nineties. Conclusion: Among the school children, there is a declining trend in the prevalence of RF/RHD.

Role of ERCP; in acute biliary pancreatitis: a local experience

Objective: To determine the efficacy of ERCP in acute severe biliary pancreatitis in relation to rate of complications and hospital stay

Patients and Methods: 30 patents were included in the study, divided into ERCP group and Non ERCP group. The study was conducted at Surgical Unit-I, Holy Family Hospital Rawalpindi from July 2009 to April 2011. ERCP Group comprised of 11 patients and non ERCP Group 19 patients. All patients having severe acute biliary pancreatitis raised alkaline phosphatase and common bile duct diameter >8mm were included in the study

Results: In ERCP Group, there were 3 males and 4 females with mean age 42.77 +/- 14 years. In non ERCP group there were 17 males and 2 females with mean age 46.76 +/- 13 years. ERCP was done within 3 day in 8 patients and within 7 day in 5 patients in ERCP group. The rate of complications in both groups was insignificant [P= .92]. The length of hospital stay also does not differ significantly between two groups [P=.874]

Conclusions: In our set up there was no significant difference in outcome in ERCP and non-ERCP group of severe acute pancreatitis. However, in ERCP group intervention was mostly performed after 72hrs

Students' perspective of and innovative assessment strategy of anatomy

The purpose of this study was to reflect the responses of medical education from the prespective of undergraduate medical students through feed back of an innovative formative assessment strategy. Retrospective, observational study. This study was conducted at the Department of Anatomy, Al Nafees Medical College, Islamabad during May 2012. A feedback questionnaire was filled by the fist year MBBS student in the musculoskeletal module of a PM and DC recognized medical college. A comparison of traditional viva voce and an electronic stage [e stage] examination in Anatomy was made. Majority of the students rated e stage a better option of assessment regarding uniformity, structured evaluation, and self assessment, through and in depth preparation, time economy and non biased approach. However 23% still opted for the traditional viva voce examination as the future preference of assessment. Majority of the students thought that the e stage was a more structured, uniform, time economical, through assessment tool, which had less examination fear and examiner bias. It not only provides a better opportunity to satisfy the examiner but also is a better self assessment tool requiring elaborate exam preparation before taking the exam. The preferred choice of 77% of the students was e stage in comparison to 23% opting for traditional viva voce. Extensive research work and new innovations are required, in the field of medical education in the way of curricula evolvement. In the same time the students' feedback of new adopted strategies should also be given due weight age instead of just imposing the change