MBBS admission criteria as predictor of academic performance in a medical college of Pakistan.

Objective: To determine the relationship between scores obtained by students in assessments considered as admission criteria (cognitive and non-cognitive) with their academic performance in medical college. Method: This correlational study used the data of students who got admission in Shalamar Medical and Dental College (SMDC) in 2015. Spearman correlation and Multiple regression tests were carried out to determine the relationship between admission criteria (Matric, FSC, MDCAT and MMI) and academic performance in medical college (pre-clinical and clinical years). Results: There was significant positive correlation between scores obtained in MDCAT and pre-clinical years. When combined, MDCAT and MMI scores showed a significant positive correlation with scores obtained by students in clinical years. Scores obtained by students in pre-clinical years strongly correlated with their performance in clinical years. While scores obtained by students in FSC showed negative correlation with clinical year scores, significantly. Conclusion: It is concluded that the tools used for admission criteria should include both cognitive and non-cognitive elements. MDCAT is a good predictor of academic performance in pre-clinical years however it can only predict performance in clinical years when combined with MMI since MMI assesses the non-cognitive attributes (communication, empathy, ethics etc.) required in those years. FSC should not be given weightage as admission criteria owing to a lot of variability in the exams and scoring of different academic boards of the country.

Foliar architecture differentially restrains metal sequestration capacity in wheat grains (Triticum aestivum L.) grown in hyper-chloride-contaminated soils.

Anthropogenic activities, such as industrial wastewater and use of water softeners, cause hyper-accumulation of Cl- in water sources and soils. Currently, industries have no sustainable method to remove these Cl- ions from wastewater. This study was conducted to evaluate the integrative responses of wheat cultivated in five industrial effluent-affected areas (S2-S6) by investigating soil characters and bioaccumulation of metals in wheat plants and grains. The S4 site (near the second chloride outlet) exhibited a higher concentration of CO2, SO2, NO2, Cl-, Cd, Mn, Ni, Cr, and Zn. Soil from S6 (sewage wastewater downstream getting mixed with chloride-contaminated water) had a minimum level of nutrients (Na, K, and Ca), maximum metals (Cd, Fe, Pb, Mn), and reduction in plant biomass. In site S2 (sewage wastewater upstream of the chloride factory), a higher level of minerals and metals was noted in the roots. Maximum metals in grains occurred in S6 with higher organic osmolytes. The sequestration capacity of metals in leaves was also increased by alterations in anatomical traits. Results indicated that metals and hyper-Cl- concentration employed a negative influence on the plants because of poor soil quality, extremely damaged microstructures leading to reduced yield, poor grain quality, and excessive translocation from roots to wheat grains. These findings revealed that contaminated plants used as either green forage or hay are noxious to animals and if used as grain for feed or humans can lead to serious health hazards.

Experiences of medical and dental students of Pakistan during COVID-19 pandemic lockdown: a qualitative study.

OBJECTIVE: The COVID-19 pandemic resulted in medical institutes being shut down. Face-to-face activities were shifted to online medium. The unpredictability of the situation impacted medical faculty and students alike, creating panic and anxiety. Since these students are to take hold of the healthcare system of the country soon, it is important to learn their perspective on how COVID impacted them. Therefore, this study aimed to explore the lived experiences of Pakistani medical students in-depth by a qualitative observation of their personal and educational experiences. DESIGN: A phenomenological qualitative study interviewing medical students of Pakistan was conducted. PARTICIPANTS/METHODOLOGY: This study was designed to interview medical and dental students from various cities in Pakistan using a semistructured, open-ended questionnaire. A total of 34 interviews were recorded and transcripts were prepared. All authors (SI, SS, IA and MS) were involved in the thematic analysis of the data, whereby transcripts were read thoroughly, and codes were developed. Similar codes were then combined to generate themes. RESULTS: Three major themes emerged after the analysis of results. The students' 'diverse experiences' of panic and anxiety or excitement were high initially but gradually reduced as time progressed. The 'unprecedented academic experiences' of students included teaching/learning, communication and technical challenges that they faced during online classes. Despite facing a lot of challenges, the students still saw 'light at the end of the tunnel' and looked forward to going back to their college. CONCLUSION: The effects of COVID on the physical, psychological, social and academic life of medical students were enormous. It is highly recommended that institutes and faculty provide support for personal and professional development of students in these unprecedented times in the form of counselling, provision of technical facilities or leniency in fee process. Peer support is also considered crucial in reducing anxiety among students.

Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study.

BACKGROUND: Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery. METHODS: This was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery. RESULTS: The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039). CONCLUSIONS: Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA.

Late adult-onset spinal muscular atrophy with lower extremity predominance (SMALED).

An elderly man in his early 80s presented with a 6-month history of worsening lower limb weakness on a background of a longer-standing waddling gait. Examination revealed bilateral scapular winging, and weakness in his proximal and distal lower limbs. Electromyography showed widespread chronic partial denervation changes, while sensory and motor nerve conduction parameters were preserved. After little progression over the course of 18 months, motor neuron disease was deemed less likely. Genetic testing revealed BICD2-related spinal muscular atrophy with lower extremity dominance (SMALED2), a disease that is usually of earlier onset. He is the oldest patient in the literature to be diagnosed with SMALED2 while maintaining ambulation, suggesting the milder spectrum of BICD2-related disease.

Inducting undergraduate medical students via WhatsApp-based multiple mini interviews during COVID-19 pandemic.

Selection of medical students requires both cognitive and soft skills assessment. Shalamar Medical and Dental College (SMDC) has been using on-campus multiple mini interviews to assess the latter but due to Covid-19 pandemic it became imperative that an alternative be found. The aim of this communication is to share the process SMDC went through to plan, design, and ultimately conduct WhatsApp-based multiple mini interviews (wMMI) in a low risk method as an entry criteria for undergraduate medical students. The process involved designing scenarios appropriate for online interviews, training the faculty members regarding conducting MMI as well as the use of technology, and designing an online webpage for enrolling, scheduling and assessing candidates. We were able to successfully complete wMMI process for 522 candidates within one week in a low risk setting using WhatsApp as communication medium with strong IT and administrative support.