Medical Students' Perceptions at Dow University of Health Sciences using Dundee Ready Education Environment Measure Inventory.

Objectives: To assess medical students' perceptions regarding learning, teachers, academics, atmosphere at campus and social self-perceptions at Dow University of Health Sciences using Dundee Ready Education Environment Measure (DREEM) Inventory. Method: This cross-sectional observational study was conducted from March 1st, 2022 to September 30th, 2022. All medical students at Dow University of Health Sciences were offered to participate. All students were given the choice to respond to DREEM questionnaire via online Form or printed copy anonymously. The DREEM Inventory measures five domains of students' perceptions of a given institution. Comparison of responses between different years and institution was carried out by χ2 test. Means scores were compared by Student's t-test and ANOVA, p-value of ≤.05 was taken as significant. Results: Total of 1054 out of 1750 (60.23%) students submitted fully completed forms and were included, out of these 632 (60.0%) belonged to Dow Medical College & 422 (40.0%) belonged to Dow International Medical College. The mean ±SD of total score of DREEM by DMC students was 100.07 ±31.46 and that of DIMC was 100.52 ±32.73. According to DREEM Global scoring both colleges scores fell into category of "many problems". Analysis according to domains showed that maximum score was given to 2nd domain of their "perception regarding teachers" and minimum score was allocated to 5th domain regarding "social self-perceptions". Conclusion: Overall Students perceived environment at DUHS as "many problems" category. This needs to be investigated for betterment of Educational Environment (EE) at campus.

Awareness, screening, practices and attitudes of cervical cancer among doctors and nursing staff working at a tertiary care centre.

Objectives: To assess knowledge, attitude and practice of medical and paramedical staff about cervical cancer as well as its screening and prevention. METHODS: The descriptive cross-sectional study was conducted at the Jinnah Post-graduate Medical Centre, Karachi, from March 1 to August 30, 2019, and comprised women medical and paramedical staff randomly selected from different specialties. Data was collected using a structured questionnaire. Data was analysed using SPSS 20. RESULTS: Of the 347 participants 144(41.5%) were nurses and 203(58.5%) were doctors. The overall mean age was 26.22±6.38 years. Of the total, 108(30%) respondents were married and 239(68%) were single. Overall, 239(68.8%) were well aware of Pap smear being the screening test; 85(24.5%) were aware of the true guidelines to repeat the test; 152(43.8%) had an idea of the exact use of visual Inspection with acetic acid; 61(17.6%) had got a Pap smear done; and 156(45%) thought they were at risk of developing carcinoma cervix. The common risk factors identified were multiple sexual partners 254(73.2%), age at first sexual intercourse 160(46%), smoking 131(37.8%), foul-smelling discharge 221(63.7%), and post-coital bleeding 231(66.6%). CONCLUSIONS: Cervical cancer prevalence is rising due to inadequate knowledge and awareness among healthcare personals. Improvement can be brought by regular use of Pap smear.

Efficacy and safety of N-acetylcysteine for the treatment of non-acetaminophen-induced acute liver failure: an updated systematic review and meta-analysis.

AIM OF THE STUDY: N-acetylcysteine (NAC) is the treatment of choice for acetaminophen-induced liver injury. However, recent years have witnessed growing interest in its role in the treatment of acute liver failure (ALF) due to other aetiologies. This study aims to determine both its safety and efficacy by pooling data from multiple studies. MATERIAL AND METHODS: A search was conducted for all controlled randomized/non-randomized studies that measured the efficacy and safety of NAC in adult patients with non-acetaminophen-induced acute liver failure (NAI-ALF). Transplant-free survival (TFS) was considered the primary endpoint, while secondary endpoints such as length of hospital stay, and incidence of adverse events during treatment, were included in our analysis. Data were pooled via a random-effects model, I 2 was used as a measure of heterogeneity, and publication bias was assessed via a funnel plot. RESULTS: A total of 3 studies [2 randomized controlled trials (RCTs) and 1 non-randomized cohort] were pooled in this meta-analysis. TFS was significantly higher in patients given NAC, when compared to the placebo/control (PBO) group (RR = 1.54, CI = 1.19-1.98, p = 0.01, I 2 = 0.0%). No secondary endpoint was observed to have improved significantly in patients prescribed NAC: length of hospital stay (SMD = -0.405, CI = -1.44-0.63, p = 0.445, I 2 = 91.1%), renal failure (RR = 1.01, CI = 0.65-1.57, p = 0.967, I 2 = 21.3%), infections (RR = 1.18, CI = 0.91-1.52, p = 0.208, I 2 = 2.3%), pulmonary failure (RR = 1.19, CI = 0.57-2.49, p = 0.649, I 2 = 84.6%). Minimal side effects were reported in around 10-14% of the patients prescribed NAC. CONCLUSIONS: NAC was shown to significantly improve TFS in adult patients with NAI-ALF, while no significant benefit was observed concerning the secondary endpoints of length of hospital stay and incidence of adverse effects.

Comparison of within 7 Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with those with Score of <5.

OBJECTIVE: To compare 7-Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with Those with Score of <5. METHODS: All patients of age more than 18 years, of either gender admitted in HDU of Medical Unit-II, CHK between September 2019 to February 2020 were included. MEWS was calculated for each patient at time of admission. Patients with MEWS score of ≥5 were allocated to Group-A and those with score of <5 were allocated to Group-B. Patients were followed for seven days and outcome status of alive, expired or discharged was noted. RESULTS: Total of 336 patients were selected out of which 168 patients was inducted in Group-A and 168 patients in Group-B. MEWS Score in patients who expired was significantly higher (Mdn=11) than in those who survived (Mdn=4), p <.001. 7-day mortality in Group-A was 62 (39.9%) while in Group-B was 40 (23.8%). ROC was plotted of MEWS Score for mortality, it showed significant area under curve of 68.4% (p <.001, 95% CI = .62 to .75). MEWS Score of 3.5 showed sensitivity of 89.2% and specificity of 65%. CONCLUSION: Our results show that MEWS has a positive trend to predict mortality. MEWS score of 3.5 is suggested cut off based on ROC in our study.

A rare case of gangrenous foot in juvenile systemic lupus erythematosus.

This report describes a rare case of Juvenile Systemic Lupus Erythematosus (JSLE). A young 13-year-old girl presented to the Civil Hospital Karachi on February 15, 2019 with gangrene as the only manifestation of this autoimmune disease. JSLE has several clinical manifestations such as butterfly rash, fever, joint pain, cardiac problems like pericardial infusion and neuropsychiatric disorders. However, in this case gangrene was the only presenting symptom; only laboratory investigations - anti-SSA and anti-ribosomal P protein - were suggestive of JSLE, while anti dsDNA, considered to be the most sensitive and reliable diagnostic tool for Systemic Lupus Erythematosus (SLE), was negative. Raynaud's phenomenon and gangrene have been described as rare symptoms, with gangrene occurring in only a small percentage of SLE patients. Moreover, the patient had received a blood transfusion a few months ago in Hyderabad which was suspected to be the cause of the transmission of infection which lead to polyclonal activation of lymphocytes.

Frequency of hyponatremia caused by sodium picosulfate solution when used as a bowel cleansing agent for colonoscopy.

OBJECTIVE: To determine the frequency of hyponatremia in patients taking Sodium Picosulfate Solution (SPS) solution for bowel preparation prior to colonoscopy and to compare serum sodium levels before and after SPS. METHODS: This interventional study was conducted at Dr. Ruth K. M. Pfau, Civil Hospital Karachi between June 2019 to November 2019. Patients undergoing colonoscopy were included in the study. All patients were given SPS. Two samples of blood for electrolytes were taken, one 30 minutes before taking SPS solution and another 30 minutes before colonoscopy. Paired sample t-test was used to determine the difference between serum sodium level before taking the colonoscopy solution and serum sodium level before colonoscopy. RESULTS: Fifty- four patients fulfilling inclusion criteria were included. Out of the 54 patients 28 (51.9%) were males and 26 (48.1%) were females. Mean sodium levels before taking colonoscopy solution was 139.7 ±3.5 mEq/L and mean sodium level before colonoscopy was 138.9 ±3.8 mEq/L. The difference between serum sodium level before taking SPS colonoscopy solution and before colonoscopy was found to be statistically insignificant (t (53) = 1.308; p = 0.196). CONCLUSION: No serious adverse effects were reported in any of our patients. There was no significant difference in the serum sodium level of patients undergoing colonoscopy before taking SPS bowel preparation solution and serum sodium level before colonoscopy.

Effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility: A single blinded, placebo control, randomized trial.

OBJECTIVE: To determine effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility. METHODOLOGY: A randomized, single blinded placebo control trial was done in patients undergoing oesophago-gastro-duodenoscopy for any indication at DOTs Endoscopy Suite, CHK during the period of April to June 2019. Informed consent was taken. Patients were randomly allocated in two groups. Group-A received placebo while Group-B received Simethicone. Evaluation of mucosal visibility was assessed at 4 sites (oesophagus, fundus, antrum & duodenum) by previously validated scoring. Mean of visibility scores were compared in two groups. RESULTS: Two hundred and forty-eight patients were inducted and randomly allocate to two groups of 124 each. Mean of total sum of scores in Group-A was 8.14 ±2.44 and that of Group-B was 5.80 ±1.75 (p<0.001). Adequate visibility in Group-A was seen in 41.1% and that in Group-B was 78.2% (p<0.001). CONCLUSION: Use of Simethicone significantly improves mucosal visibility during OGD.

Impact of bowel preparation on caecal intubation time during colonoscopy.

OBJECTIVE: To determine the caecal intubation time depending on bowel preparation as per Boston Bowel Preparation Scale. METHODS: This cross-sectional study was conducted at Dr. Ruth K. M. Pfau, Civil Hospital Karachi between August 2018 to February 2019. A total of 201 patients were included in the study. Time was recorded from insertion of colonoscope to the time required to reach the cecum. Bowel preparation was graded during withdrawal of colonoscope by using Boston Bowel Preparation Scale. Pearson Correlation test was used to study correlation of BBPS scores with CIT, gender, BMI, adenoma and polyp detection. RESULTS: In this study 201 patients undergoing colonoscopy were included. Mean ±SD of age of patients was 36.9 ±15.8 years. Out of the 201 patients 112 (56%) were males and 89 (44%) were females. The results of our study showed that increased Boston Bowel Preparation Scale Scores were associated with decreased caecal intubation time. The mean CIT was 10.7 ±5.4 minutes and Pearson correlation was significant at 0.002. Significant correlations of BBPS were also found with BMI and adenoma detection. CONCLUSION: The diagnostic effectiveness of colonoscopy depends upon the quality of the preparation. Good bowel preparation improves the speed of colonoscopy and its completeness.

Why doctors are not satisfied with their job-current status in tertiary care hospitals.

OBJECTIVE: To determine level and factors of job satisfaction among doctors working in tertiary care hospitals in Pakistan. METHODS: This is a multi-center cross-sectional survey conducted among Post graduate trainees, medical officers, consultants and faculty doctors. Job satisfaction was measured using 35 specific questions about sources of work-related stress and sources of work-related satisfaction. Satisfaction was defined if mean score of a factor was≥3.0, where factors were rated using a 5-point Linkert scale ranging from 1 (completely dissatisfied) to 5 (completely satisfied). RESULTS: In this study 373 doctors participated, out of which 215(57.6%) were males. Over all mean satisfaction score was of 2.69 ±0.37. Departmental mean satisfaction scores were Internal medicine 2.71 ±0.35, Medical subspecialties 2.63 ±0.38, Surgical and allied 2.73 ±0.45. Designation means were Consultant 2.87 ±0.38, Faculty 2.78 ±0.44, Medical officer/ Registrar 2.50 ±0.32, Post graduate trainee 2.71 ±0.45. Public and private sector means satisfaction scores were 2.53 ±0.80 and 2.92 ±0.84 respectively. CONCLUSION: Job dissatisfaction was seen among doctors from all the tiers and departments. Public sector doctors were more dissatisfied than private sector doctors. Increasing age, duration of current posting and working experience, positively correlated with satisfaction level.

Frequency of hepatitis D virus infection in hepatitis B surface antigen-positive liver diseases.

OBJECTIVE: To determine the frequency of HDV among hepatitis B surface antigen (HBsAg)-positive liver disorders. STUDY DESIGN: An observational cross-sectional study. PLACE AND DURATION OF STUDY: Medical Unit I, Chandka Medical College Hospital, Larkana, from July 2003 to June 2008. METHODOLOGY: Adult patients with HBs liver related disorders were evaluated for the presence of delta antibodies using commercially available ELISA kits. Descriptive statistics were used for describing data. Proportions of anti D antibodies between gender and age were compared using chi-square test with significance at p < 0.05. RESULTS: Of the 774 cases, 438 were males (60.4%) and 336 were females (39.6%). The mean age was 36.5 ± 14.39 for males and 34.03 ± 13.16 years for females ranging from 15 to 60 years. Anti-HDV was positive in 183 patients (23.6%).The frequency of HDV was not significantly different between the gender groups (p=0.718). HDV infection was markedly higher in chronic than acute liver disorders. CONCLUSION: The HBV/HDV co-infection is frequent in the studied area. Therefore, practitioners and health care managers should be made aware of the risk of dual infection with HBV and HDV.

Diagnostic validity of leukocyte esterase dipstick test for diagnosis of spontaneous bacterial peritonitis in cirrhotic patients.

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis (SBP) is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate, so early diagnosis and treatment of SBP is therefore necessary for survival. Leukocyte esterase dipstick test can rapidly diagnose the SBP. Objectives were to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis. METHODS: This cross-sectional, validation study was conducted from January 2009 to June 2009 at Medical Unit-II, Chandka Medical College Hospital Larkana. All the Patients with cirrhosis and ascites of either gender were included in this study. Paracentesis were performed on admission. The ascitic fluid obtained at bedside was immediately tested with reagent strip Multistix 10 SG. Ascitic fluid was then analysed for PMN cell count. The result of reagent strip was compared with ascitic fluid PMN cell count for determination of sensitivity, specificity, PPV and NPV of the test, while taking ascitic fluid PMN count > or = 250/mm3 as standard for diagnosis of SBP. Leukocyte esterase dipstick read positive from +1 to +3 reaction while negative and trace reaction regarded as negative test result. RESULTS: Total ninety four patients were enrolled in this study. Ninety-four Ascitic fluid samples were obtained. SBP was diagnosed in 52 (55.3%) patients, 42 (44.7%) patients were negative for SBP by manual cell count. The sensitivity, specificity, PPV, NPV of leukocyte esterase dipstick test to diagnose SBP were 92%, 95%, 96%, 90% respectively. CONCLUSION: The leukocyte esterase dipstick test can be used as rapid test for diagnosis of SBP due to its high diagnostic validity.

Neonatal outcome in meconium stained amniotic fluid-one year experience.

OBJECTIVES: To determine the effect of clear liquor and meconium stained liquor on mode of delivery, and to evaluate neonatal outcome. METHODS: It was a Cross sectional analytical study, conducted in the department of Obstetrics and Gynaecology, Shaikh Zyed Federal Postgraduate Medical Institute/Hospital, Lahore and Shaikh Zaid Women Hospital Larkana, from April 2006 to March 2007. Two hundred and fifty patients from Larkana and 250 patients from Lahore in clear liquor group were included in the study. Similarly 125 patients from each city, that is 250 patients which had meconium stained liquor were included in group 2. The subjects with meconium stained amniotic fluid and clear amniotic fluid were registered as group 1 and 2. The socio demographic information, fertility history and gestational age of subjects were recorded. The investigations and information regarding mode of delivery and duration of labour were also noted. All babies delivered were attended by paediatricians. RESULTS: In this study 500 cases with clear liquor and 250 cases of meconium stained liquor were selected from two cities, Lahore and Larkana. Out of these 55 (22%) patients had grade I meconium stained liquor, 140 (56%) patients and 55 (22%) patients had grade II and grade III meconium stained liquor respectively. The mode of delivery is significantly affected by meconium staining of liquor. The effect of meconium stained liquor was significant on time of delivery. There were 40 (16%) post date deliveries in meconium stained liquor as compared to 1% in subjects with clear liquor. The effect of meconium staining of liquor was significant on Apgar score, neonatal admission, meconium aspiration syndrome and neonatal deaths. CONCLUSION: Meconium stained amniotic fluid (MSAF), is associated with increased neonatal morbidity and mortality. Caesarean sections were performed twice as frequently in women presenting with MSAF.

Frequency and transmission mode of hepatitis C virus in northern Sindh.

OBJECTIVE: To study the frequency of hepatitis C and mode of transmission in patients of chronic liver disease (CLD). DESIGN: A descriptive, non-interventional study. PLACE AND DURATION OF STUDY: The study was conducted in the department of Medicine, Chandka Medical College Hospital, Larkana over a period of 6-year (January 1997-December 2002). PATIENTS AND METHODS: The study included 1074 patients of chronic liver disease admitted to the department of medicine due to HCV. Their variables were recorded and analyzed. RESULTS: A total of 1074 patients, comprising of 564 of chronic hepatitis (group I) and 510 of cirrhosis liver (group II) respectively were studied. The male to female ratio was 2:1 in both groups. Anti-HCV antibody was present in 51% in group I and 57% in group II. Use of syringes (62%) was an important risk factor. CONCLUSION: HCV is a leading cause of CLD. The leading risk factor identified is the use of contaminated syringes.