The Role of E-learning in Medical Education during the COVID-19 Pandemic: A Cross-Sectional Study of Student Perception

Background: In march 2020, with the declaration of COVID-19 as a global pandemic, the schools, colleges, and universities of the highly contagious areas of the world were instantaneously closed to mitigate the deleterious effects of COVID-19. Moreover, as a result of social distancing, the most effective preventative strategy since the emergence of COVID-19, medical education has been profoundly disturbed. In light of the prevailing pandemic, an abrupt shifting of the educational system was made from face-to-face learning to online methodologies to provide uninterrupted education to the students of the affected countries. By and large, traditional education was replaced by various forms of e-learning. The aim of this study was to evaluate the perception of e-learning in undergraduate medical students at Medical Colleges during covid pandemic. Material & Methods: This was a cross-sectional questionnaire-based study and was conducted from December, 2020 to February, 2021 in the CARe Medical College, Dhaka, Bangladesh. In the present study we included 270 undergraduate medical students as our participants and students who were not willing to participate were excluded from our study. Results: In our study we found the mean age of the respondents was 23.05 ± 1.28 years and majority of our students were female (68%) compared to male (32%). Most of the students (67%) had moderate grade of IT skills. We found major advantage of e-learning was the ability to record classes 67% and the disadvantage was poor internet speed (68.9%). Among all students, 51.1% & 6.7% students were able to increase knowledge, 62.6% & 3% were able to increase clinical skill and 37.8% & 7.4% were able to increase social skill via conventional & e-learning methods respectively. Majority (88.1%) students preferred face-to face learning method and 11.9% preferred e-learning method. Conclusion: In our study, we evaluated the student’s perception of e-learning and its associated advantages and disadvantages in terms of learning outcomes. While comparing e-learning and face-to-face learning among undergraduate medical students,we found face-to-face learning was considered the most effective way of learning to increase knowledge, practical skills and social skills. Therefore, most of our students preferred the face-to-face learning method compared to e-learning.

Antibacterial activity of crude methanolic extract and various fractions of Vitex agnus castus and myrsine africana against clinical isolates of methicillin resistant staphylococcus aureus

Staphylococcus aureus is a nosocomial pathogen that resides in the soft tissues causing many diseases. The current study was conducted to determine the prevalence of Methicillin Resistant S. aureus [MRSA] in ear discharge and pus of patients and antibacterial activity of crude methanolic extract [Cr. MeOH Ext.] and various fractions of M. Africana and V. agnus castus against clinical isolates of MRSA. A total of 40 samples were collected from ear, nose and throat [ENT] outpatient department and wards of Khyber Teaching Hospital [KTH], Peshawar. Out of 40 samples, 36 [90%] samples showed growth on Mannitol Salt Agar [MSA] media out of which 9[25%] were MRSA and the remaining 27[75%] were methicillin susceptible S. aureus [MSSA]. A good antibacterial activity was observed for the Cr. MeOH Ext. [76.1%] and ethyl acetate [EtOAc] fraction of V. agnus castus against S[11] [71.4%]. The n-hexane fraction also showed good antibacterial effect [70%] against S[26]. The chloroform [CHCl[3]], butanol [BuOH] and aqueous fractions of M. africana showed good antibacterial activity against S[11] [71.4%], S[32] [70%] and S[26] [75%], respectively. The above results revealed that the selected plants can be further utilized for isolation of the active ingredients as the crude extracts were found good for inhibition of MRSA

Survey of patient awareness and beliefs regarding emergency contraception

To investigate patient's knowledge and beliefs regarding emergency contraception and its use. Cross-sectional descriptive study. A six months cross-sectional descriptive study, from 1[st] July 2009 till 31[st] December 2009 carried out at Shifa international Hospital [SIH] and Shifa community health centre [SFCHC] Islamabad. All married women of reproductive age coming to SIH or SFCHC clinics after informed consent were interviewed regarding their knowledge of emergency contraception. A total of 770 women were interviewed, but the data was completed for 759 women. 131 women [17.3%] had knowledge about emergency contraception but only 79 [10.4%] had actually used this method for contraception. There is a very low awareness level regarding emergency contraception among women of developing countries even in the urban population

Validity of surgical bypass in un-resectable pancreatic cancer

To evaluate the efficacy of surgical bypass as a palliative procedure in patients with pancreatic cancer. This prospective descriptive analytical study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro, Sind, Pakistan from January 2005 to December 2010. All patients with obstructed jaundice and gastric outlet obstruction, later on diagnosed as pancreatic cancer are included in the study. LFT'S, Blood CP, Ultrasound abdomen, CT scan abdomen, and x-ray chest were performed in all patients. Surgical treatment was planned after assessing the resectability of the tumor. The variables studied included presentation, procedure performed, post operative complications and follow up after discharge from the hospital. The Chi square test is applied and data were statistically analyzed on SPSS v17. Forty three patients with a mean age of 62.09 +/- 6.782, with advance carcinoma of head of pancreas were operated and bypass surgical palliation was done. The morbidity, mortality and efficacy of various surgical bypass operations are evaluated. Bilio-gastric bypass still offers a reasonably safe and effective method of billiary decompression and duodenal obstruction caused by inoperable pancreatic cancer

outcome of well's operation in the surgical management of rectal prolapse

To see the outcome of Well's operation in the surgical management of rectal prolapse. Quasi Experimental study. This study was carried out in Department of surgery, Liaquat University of Medical and Health Sciences, Jamshoro from 11-5-2006 to 10-05-2009. This study consisted of 30 cases of rectal prolapse admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro. Detailed History was taken from all the patients with special regard to the rectal prolapse. Inclusion criteria were that all the adults patients [Male and female] of rectal prolapse on the basis of history and fit for anesthesia and surgery were included in the study. Exclusion criteria included unfit patients for general anesthesia, another local pathology like haemorrhoids or rectal tumor. Data was analyzed through SPSS software. Out of 30 cases, 14[46.7%] were males and 16[53.3%] were females. There was wide variation of age with mean age + SD was 40.67 + 12.4 years. Most of the patients had constipation 23[76.7%] cases, 20[66.6%] cases were presented with Mucus discharge, 11[36.6%] cases had urinary incontinence, 09[30.0%] cases had Diarrhoea and 07[23.3%] cases had bleeding. Co-morbidity factors were diabetes mellitus in 07[23.3%] cases, hypertension was present in 09[30.0%] and IHD was found only in 02[6.7%]. Ten [33.3%] cases were anemic, 05[16.66%] cases with HBsAg, 07[23.3%] had Hepatitis C and only 1[3.3%] case had duel viral infection. Complications were seen in all the cases, 28[93.3%] cases were found in majority who had pain after the procedure, 08[26.7%] cases developed the wound infection associated with retention of urine, 05[16.7%] had urinary incontinence associated with reactionary haemorrhage, 07[13.3%] had anal stenosis associated with incisional hernia, 01[3.3%] were found with ureteric damage, 03[10.0%] cases had sexual dysfunction and only 1[3.3%] case had Rectal stricture. Recurrence of rectal prolapse occurred in only 1[3.3%] patient. In conclusion, this study suggests that Wells operation may be a good choice for treatment of complete rectal prolapse, in view of its low complication and recurrence rates

Cetirizine and loratadine - comparing their antagonist effects on isolated trachea of rabbit

To study and compare the antagonist effects of Cetirizine and Loratadine on histamine induced contractions of isolated trachea of rabbit. Comparative controlled invitro experimental study. This study was conducted at The Department of Pharmacology and Therapeutics, Basic Medical Sciences Institute [BMSI] Jinnah Postgraduate Medical Center [JPMC] Karachi, for the period of six months. Isolated tracheal smooth muscles of twenty four rabbits were used. Fresh Kreb's nutritional solution was prepared for each subject. Tracheal smooth muscles were exposed to standard dilution of Histamine, and then they were challenged with serial dilutions [10 [-18]to 10 [-3]gm. /ml] of Cetirizine and Loratadine separately. Responses as rate and amplitudes of contractions were recorded by 7B Grass Polygraph machine. Cetirizine inhibit the rate of histamine induced contractions of tracheal muscles from 0.85 to 12.33% and amplitude from 0.0 to 82.69%, as concentration of drugs increased. While Loratadine inhibit the rate of histamine induced tracheal contractions from 0.85 to 10.59% and amplitude from 6.5 to 76.82% as concentration of drugs increased. Cetirizine found more potent than Loratadine as inhibitor of histamine induced contraction in isolated tracheal smooth muscles of rabbit. Basic Sciences

Feasibility of early surgical intervention in postoperative entero-cutaneous fistulae

To study the out come and benefits of an early surgical intervention in postoperative entero-cutaneous fistulae. It's a retrospective descriptive study conducted at department of surgery LUMHS from Jan 2001 to November 2008. Two hundred and thirteen [213] post-operative fistulae are included as study subjects while those due to inflammatory bowel diseases, road traffic accidents or following blunt, stab or gunshot abdominal trauma are excluded. An aggressive treatment to build up nutritional status, correction of anaemia and control of sepsis was followed by surgical intervention as soon as the patient's condition permitted. Variables such as type of fistula, out put per 24 hours, duration since development, complications due to fistula, nutritional status, operative procedure, operative time, post-operative complications, total post-operative stay, follow up schedule, outcome. The results were statistically analysed on SPSS-12. A total 213 patients comprising 184 males [85.6%] and 29 [13.5%] females with a mean age of 36.08 years and a range of 64 [78-14] years presenting with post-operative enter-cutaneous fistula are included in the study. Maximum number of patients [171, 79.5%] developed fistula between 4[th]-6[th] postoperative day and a vast majority of fistula occurred in the ileum [207, 97.18%] either as a result of anastomotic failure [103], leak from primary closure [99] or from un-noticed missed perforations [5]. Of the total number, 24 patients eventually died making a mortality of 11.2%. Early surgical intervention proved life saving [p<0.001]. A strong relation was found pre-operative albumin levels and surgical closure of the fistula [p<0.001] and associated mortality [p<0.001]. High out put fistula is unlikely to close spontaneously on conservative measures. Early surgical intervention can be life saving

Verapamil and loperamide; to compare the inhibitory effects on isolated guinea pig ileum

In smooth muscle cells, an increase in cytosolic free calcium concentration is an essential step for the cells to contract. The increase in calcium concentration occurs by influx from the extra cellular medium through calcium ion channels. Calcium channels have potential role in regulation of motility in gastrointestinal tract so there is growing interest in calcium channel blockers as a potential pharmacological approach to the treatment of various gastrointestinal motor disorders. In this study we evaluate the inhibitory effects of verapamil on spontaneous contractions of isolated guinea pig ileum and compare them with inhibitory effects of loperamide. Isolated intestinal segments of sixteen guinea pigs were used in this study. Serial dilutions [10-18 -10-3 gm/ml] of loperamide and verapamil were administered; effects observed and recorded by 7B Grass Polygraph machine. We observed that at lower concentrations, loperamide showed more inhibitory effects than verapamil while at higher concentrations [10-4 and 10-3 gm/ml] verapamil showed more inhibitory effects than loperamide on the contractions of isolated guinea pig ileum. This study gave us a clue that verapamil found a potent inhibitor of small intestinal contractions as loperamide. However one can presume further that calcium channel blocker verapamil acting on calcium channel receptor on GIT will be developed with more specific effects on smooth muscle of intestinal tract

Identification of recurrent laryngeal nerve during thyroidectomy decreases the risk of nerve injury

To determine the effect of Recurrent Laryngeal Nerve [RLN] exposure on the incidence of nerve injury, and compare the injury rate with that when nerve is not exposed during thyroid surgery. This prospective observational study was carried out in department of general surgery, at Liaquat University of Medical and Health Sciences, Jamshoro, from January 2005 to December 2006. A total of 120 patients were included, with 24 males and 96 females [male: female of 1: 4]. Mean age of our patients was 30.85 years [range 14-68 years]. The different surgical procedures, performed on thyroid gland included total thyroidectomy 23, near total thyroidectomy 58, subtotal thyroidectomy 28, and hemi-thyroidectomy 11. The RLN was exposed in 60 patients, in other group of 60 patients thyroidectomy was carried out without exposing RLN, and incidence of nerve injury was compared between two groups. RLN identification decreased the nerve injury incidence from 5% to 1.6%. When recurrent laryngeal nerve is not identified during thyroid surgery the chance to incur damage to RLN is statistically significant [Chi square at 1df 0.000] We believe that RLN identification during thyroidectomy would be the best approach to avoid nerve injury

audit of renal cell carcinoma at Hyderabad

To audit the patients of Renal Cell Carcinoma treated in Surgical Unit-IV, Liaquat University Hospital Jamshoro, Hyderabad. Prospective interventional study conducted from Jan. 2000 to Dec. 2004. Department of Surgery, Liaquat Medical University Hospital, Jamshoro. All patients who presented with Renal Cell Carcinoma during the study period. The history and examination findings of all these patients was recorded. Complete blood picture, urine analysis, liver function tests, ultrasound abdomen, IVU and CT scan was done in all the cases. Staging was done according to the TNM classification and surgery performed in fit patients. A total of 39 cases of Renal Cell Carcinoma were seen during the study period, with a male to female ratio of 3.3:1 and a mean age of 46 years. Most [61.53%] patients presented with a mass in the abdomen; 51.28% were in Stage-II and 25. 64% in stage-III. Thirty four [87.18%] cases were operated, the rest being unfit. Radical nephrectomy was done in 51.28% cases, simple nepherectomy in 10.26%, debulking surgery in 20.51% and biopsy only in 5.13% cases. Three [8.8%] patients died due to postoperative complications. Radical surgery is the curative treatment for Renal Cell Carcinoma. Cases should be diagnosed early in order to decrease the morbidity and mortality of the disease

Use of fresh water alga Spirogyra ellipsospora Transeau as feed supplement to broiler chicks

Attempts were made to formulate a feed ration to poultry birds, broiler [Indian River Variety FS99] in order to achieve a low cost feed with better potentiality. Algal material Spirogyra ellipsospora Transeau was used as feed supplement for broiler chicks. After necessary processing, four concentrations viz. 5%, 10%, 15%, and 20% of algal material were mixed up with commercial feed of chicks [starter and finisher feed]. Feeding 1 experiments were performed from the day old chicks to ten weeks. Biochemical parameters [ash, carbohydrate, fat, protein and water content] of liver of chicks fed on different algal compositions as well as control feed were also studied. It was observed that the birds which were fed on higher concentration [10%-20%] of algal feed showed best results in terms of quality and quantity of meat. Spirogyra ellipsospora [15%-20%] showed best growth. Mortality rate was zero as no chick died during the whole feeding trial. On the other hand chemical analysis of chick's liver showed that there were no significant differences in fat contents of liver in control and algal fed chicks

Serum uric acid level as a marker for predicting progression of gestational hypertension to pre-eclampsia and fetal morbidity

This study was conducted in the Department of Obstetrics and Gynecology Federal Government Services Hospital Islamabad over the year 2001 for Predicting pre-eclampsia in patients with gestational hypertension through maternal hyperuricemia and to see if there is any association between maternal uric acid levels and fetal outcome. All cases presenting with gestational hypertension or pre-eclampsia were studied. Three main groups were recognized gestational hypertension [group I], gestational hypertension progressing to pre-eclampsia [group II] pre-eclampsia [group III], and their clinical and laboratory findings were compared at different times in the study. Among other investigations serial serum uric acid levels were performed and their association with maternal disease progression, fetal growth and fetal outcome were seen. Gestational hypertension was present in 409 [71.01%] of the total 576 cases; with 167 [28.99%] cases of pre eclampsia 86[21.02%] cases out of the 409 cases of GH progressed to PE. Nulliparas accounted for 65.01% cases in-group I, 60.4% cases in group II and 70.04% cases in-group III. Mean serum uric acid levels at delivery were 5.6 +/- 0.3 for groups I, 6.1 +/- 0.76 for group II and 7.02 +/- 1.4 for group III. Mean gestional age at delivery was 38 +/- 2 weeks for patients with uric acid levels of < 6.4mg/dl with a mean fetal birth weight of 3125 grams and 10% babies being small for gestational age. Whereas with serum uric acid of >=6.4 mg/dl mean gestational age at delivery became 35.5 +/- 2 weeks with a mean birth weight of 2774 grams and 28% babies were small for gestational age. Maternal hyperuricemia is a strong predictor of maternal disease progression and fetal outcome. Thus it can be used as a useful and inexpensive marker for predicting preeclampsia and fetal growth retardation in women presenting with gestational hypertension

Complications of induced septic abortions and risk factors

To determine the relationship of different risk factors like age, parity, and socioeconomic status with the incidence of induced septic abortions and to assess the rate of complications in this group. Design: A descriptive study conducted from December, 1999 to December, 2000. Place and Duration: Gynecology Department of Federal Government Services Hospital, Islamabad. A total of 52 cases were included in the study out of which 64% cases were in the age group 25-35 years with grand multiparas making up 57.8% of the patients. There were 84.6% patients married while 15% women were unmarried. Poor socioeconomic status was associated with 78% cases. Fourty-four%. cases were admitted with haemorrhage, 32% with sepsis and 19% with visceral injuries. A lot of preventable maternal mortality and morbidity is associated with induced abortions. Alleviation of illiteracy along with easy and free availability of reliable contraceptives can improve the prevailing situation