Journal of Rawalpindi Medical College
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Lifestyle Medicine Assessment Among The General Population Of District Sialkot, Pakistan: A Comparative Study
No full textObjective: To assess the lifestyle medicine among the general population of the district of Sialkot, Pakistan.
Methods: A comparative cross-sectional study was conducted in 4 Tehsils of District Sialkot, from April to September 2024. A calculated sample of 400 healthy individuals was selected by a non-probability consecutive sampling technique, and data were collected through a modified version of the lifestyle assessment short form questionnaire
Results: The average age of participants was 33.58 ±13.06 years, with a predominant representation of males (60%). The majority of the respondents were young (93.5%) and graduates or post-graduates (55.4%). The mean lifestyle medicine score was 38±4.41. Only 40%of the participants had a favourable lifestyle medicine score above the mean. Education of the participants showed a significant association with lifestyle medicine score(p=0.027), while age, area of residence and social class revealed a non-significant association.
Conclusion: Most of the study participants had unfavourable lifestyle medicine scores below mean indicating poorer adherence to recommended lifestyle medicine practices. Similarly for individual life style medicine domains, score was below the mean except for smoking and substance abuse domain
Association Of Iron Deficiency Anaemia With Preterm Birth: A Cohort Study At Dhq Hospital Sargodha
Full text linkObjectives:
IDA is a major health concern for pregnant women throughout the world, mainly attributable to differences in socioeconomic and geographical status. This study investigates the association between IDA in pregnant women and the incidence of preterm births.
Materials and methods:
This cross-sectional, consecutive cohort study was performed in the Gynaecology and Obstetrics department at DHQ Hospital, Sargodha, from August 16, 2020, to January 5, 2021 and included 60 pregnant women with an exposure (IDA) and 60 pregnant women with normal hemoglobin values. Demographic variables for age, gestational age at presentation, and maternal weight were similar across the groups.Results:
In the various groups, the results indicated that the IDA group exhibited a significantly higher prevalence of preterm births of 43.3% compared to the control group with only 20%, and a relative risk estimate of 2.2 and a p-value of 0.052, suggesting the results were near or at statistical significance. Methods of stratification indicated that low weight of the mother was statistically associated with increasing risk of prematurity within the IDA group. It seems that early intervention in cases of IDA during pregnancy is crucial to have a reduced rate of neonatal complications.
Conclusion:
Hence, this study adds to the literature the relationship between maternal iron status and preterm birth, with an appeal to improve pre-antenatal care practices that incorporate initial assessment and correct supplementation of iron
Effect Of Transverse Abdominis Plane Block With 0.25% Bupivacaine On Post-Operative Opioid Consumption After Cesarean Section: A Prospective Study
Full text linkObjective: Transverse Abdominis Plane (TAP) block is a technique that can offer post-operative analgesia to patients who have had surgical procedures involving incisions made in the infra-umbilical region. In our study, we investigated whether or not a TAP block administered in conjunction with 0.25% bupivacaine was effective as an analgesic during the full 24-hour postoperative period after cesarean section.
Methods: 100 patients undergoing spinal anaesthesia for caesarean section were randomly chosen to receive TAP block (50 patients in each group). Following surgical intervention, a bilateral TAP plane block was carried out by giving 0.25% bupivacaine to Group A patients and 0.9% normal saline to Group B patients (10 ml on each side). The procedure was guided by ultrasonography. An investigator blinded to the procedure evaluated the post-operative visual analogue scale VAS pain score of each patient and noted the amount of tramadol demanded over the next twenty-four hours.
Results: Patients who received TAP block with 0.25% bupivacaine had a significantly lower post-operative VAS score at first analgesic request time, at 12 hours and 24 hours as compared to those patients who received normal saline (p <0.05). The mean consumption of intravenous opioid (tramadol) given during 24 hours by the surgical ICU staff was significantly decreased in Group A as compared to Group B (p <0.05).
Conclusion: Ultrasound-guided bilateral TAP block with 0.25% bupivacaine lowers postoperative opioid analgesic intake in patients undergoing caesarean section.
Keywords: Bupivacaine, Cesarean section, Prospective stud
Effect Of Dexmedetomidine Added To Intrathecal Hyperbaric Bupivacaine Versus Bupivacaine Alone On Mean Postoperative Analgesia After Spinal Saddle Block
No full textObjective: Spinal saddle anaesthesia is the most prevalent method for perineal surgeries. Dexmedetomidine, a unique medication that acts on α2-adrenergic receptors in the spinal cord, relieves pain. The goal is to assess the efficacy of intrathecal dexmedetomidine in combination with bupivacaine.
Methods: A total of 60 patients undergoing elective uncomplicated peri anal surgeries were included in the study. 30 patients were in the 0.75% hyperbaric Bupivacaine group (Group A) and 30 patients were in the 0.75% hyperbaric Bupivacaine with Dexmedetomidine 5 mcg group (Group B). Intensity of pain was analysed through the Visual analogue pain score VAS which was described to the patients on a scale from 0-10 (No pain to severe pain). Mean analgesia duration was measured from time 0 of SSB until the patient asked for additional pain killers (VAS score >4).
Results: The mean duration of surgery was 29.866±1.87 minutes in group A and 28.866±2.06 minutes in group B. Motor block was of lesser duration in group A (152.90±9.09 minutes) as compared to group B (203.00±18.95 minutes) with p<0.05. Mean analgesia duration was significantly prolonged in group B (630.66±78.50 minutes) versus group A (325.33±36.67 minutes) with a statistically significant p-value. (p<0.05) Postoperatively, a lower frequency of painkiller demands was made by group B patients in 24 hours. (p<0.05)
Conclusion: In SSB, Dexmedetomidine added to Bupivacaine intrathecally increases the duration of analgesia postoperatively
Academic Collaboration Of Rawalpindi Medical University & Al-Azhar University For Gaza Students: A Ray Of Hope In A Catastrophic Scenario
Full text linkObjective: To review the academic collaboration between Rawalpindi Medical University and Al-Azhar University of Gaza for assisting undergraduates of Gaza.
Methods: A cross-sectional descriptive survey was carried out to review academic collaboration of RMU with Al-Azhar University of Gaza that was primarily meant to endow educational facilitation to Palestinian medical students during their country-wide crisis. Of the 36 Palestinian medical students enrolling at RMU for continuation of medical education, 29 underwent an objective assessment of their prior knowledge. Following the assessment of prior knowledge by the shared Table of Specifications (TOS), a composite curriculum designed by the competent faculty of RMU was implemented.
Results: Of the 36 medical students coming from the Gaza Strip to RMU, 29 students underwent subject-wise objective assessment before implementation of the purpose-built curriculum. They attempted C2, C3 level one best Multiple-Choice Questions (MCQs) of Anatomy, Physiology, Biochemistry, Pharmacology and Pathology. Each section consisted of 10 MCQs. The students achieved the highest mean score in Pathology (5.52 ± 2.05). The mean score of the students in Physiology (3 ± 1.4) was the lowest. The comprehensive curriculum with a detailed plan of assessment, learning outcomes, teaching methods and Continuous Internal Assessment (CIA) weightage was also disseminated. A mentoring team was also familiarised with guidance. A thorough monitoring system was also introduced for the smooth execution of the whole process.
Conclusion: The academic collaboration between RMU and Al-Azhar University of Gaza would be useful to Palestinian medical students in completing their medical education.
Keywords: academic collaboration, Gaza Strip, medical students, purpose-built curriculu
Role of Aspartate Aminotransferase to Platelet Ratio Index as a non-invasive predictor of variceal etiology.
Full text link Objective: To determine the diagnostic accuracy of the aspartate aminotransferase to Platelet ratio index as an indicator of upper gastrointestinal bleeding, taking endoscopy as the gold standard.
Methodology: The cross-sectional validation study was conducted in the Department of Medicine Unit I, Benazir Bhutto Hospital, Rawalpindi, from 25th September 2022 to 24th March 2023. A total of 350 patients aged 16-75 years, both genders, diagnosed with cirrhosis were included. Then a blood sample was taken in a 3cc disposable syringe. Reports were assessed, and APRI was calculated. The patient was labelled as positive or negative. Then the patient underwent upper gastrointestinal endoscopy within 24 hours of admission, and the patient was labelled as positive or negative based on endoscopy findings.
Results: Aspartate aminotransferase - Platelet Ratio Index overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy as a predictor of upper gastrointestinal bleeding requiring endoscopy were 93.24%, 91.60%, 94.15%, 90.34%, and 92.57%, respectively.
Conclusion: The Aspartate Aminotransferase Platelet Ratio Index (APRI) has a fairly high diagnostic accuracy for variceal bleeds
Descriptive Epidemiology And Clinical Attributes Of Beta-Thalassemia In Upper Sindh Region Of Pakistan
Full text linkObjective: Thalassemia is a hereditary blood disorder that affects hemoglobin synthesis, leading to anemia and other complications. This study investigated the demographic, clinical, therapeutic, and familial characteristics of beta-thalassemia patients from the upper Sindh region of Pakistan.
Methods: Through an observational cross-sectional study design, thalassemia patients registered at local hospitals and transfusion centers in upper Sindh, Pakistan, were enrolled. For enrollment from rural areas, random door-to-door surveys were carried out. A structured proforma was used to collect information, and descriptive statistics were employed.
Results: Of the 360 patients from independent families recruited (58% males, 42% femaleswere diagnosed with thalassemia major and 12% with thalassemia minor. Majority of the patients with thalassemia major were up to the age of 5 years (p<0.0001) and with low body weight (p<0.0001); and majority received first transfusion within first year of life (p<0.0001). Iron overload was prevalent in 86% of patients; conversely, however, only 4% of patients were receiving iron chelation therapy. The patients had 106 affected siblings and a total of 152 thalassemia-related mortalities were reported across 94 families. Pedigree analysis revealed recurring losses within families highlighting the severe impact of the disease and the limitations of current medical interventions.
Conclusion: This cohort study illustrates the extensive socio-economic, familial, and clinical challenges faced by transfusion-dependent thalassemia patients, particularly those from rural, low-income communities in Pakistan. This research highlights the necessity for preventive public health measures, such as genetic counseling and community education to mitigate the long-term impacts of thalassemia within vulnerable populations.
Keywords:
Anemia, Thalassemia Major, Thalassemia Minor, beta Thalassemia, Cooley's Anemia, Consanguinity, Transfusio
Effect of Prophylactic Steroid Therapy for Post Thyroidectomy Hypocalcemia
No full textObjective: The purpose of this study was to assess the effect of preoperative dexamethasone used to improve post-thyroidectomy hypocalcemia.
Methods: This study was a Prospective clinical trial (Randomized) conducted in the department of Otorhinolaryngology, Tertiary care hospital, Quetta, for twenty-three months, i.e., from January 2023 till November 2024. 92 patients aged 18–60 with benign thyroid conditions and no preoperative hypocalcemia. Exclusion criteria were Graves’ disease, prior thyroid or neck surgery, and contraindications to corticosteroid use. Patients were arbitrarily allocated to the placebo (Group A) or dexamethasone (Group B) groups. Group B received 8 mg dexamethasone intravenously 60 minutes before anesthesia, while Group A received normal saline.
Results: Postoperative hypocalcemia was more common in Group A (41% at 06 hours, 24% at 24 hours) compared to Group B (22% at 06 hours, 0% at 24 hours), with symptomatic hypocalcemia reported in 24% of Group A and none in Group B. Dexamethasone significantly reduced the incidence and severity of hypocalcemia, demonstrating its potential to improve early postoperative outcomes.
Conclusion: Preoperative dexamethasone effectively reduces postoperative hypocalcemia and improves surgical outcomes in patients undergoing Total Thyroidectomy.
Keywords: Dexamethasone, Goiter, Hypocalcemia, Postoperative Period, Thyroidectomy, Thyroid Disease
Peers To Professors: Exploring The Role Of Students And Faculty In Same-Level Reciprocal Peer Assisted Learning In Family Medicine Clerkship
Full text linkObjective: Peer-assisted learning (PAL) is teaching by the learners to the learners, a teaching strategy globally integrated into curricula. One particular variant is same-year reciprocal PAL, in which peer tutors and tutees are from the same academic year and alternate teaching roles. However, few studies have examined this specific form of PAL, and both student and faculty perspectives on its efficacy remain largely unexplored. To address this gap, we conducted a qualitative study among fourth-year medical students during their Family Medicine clerkship.
Methods: Employing content thematic analysis, we gathered data through in-depth interviews and focus group discussions involving both faculty members and students. Students received training to lead small group discussions, and their perceptions were subsequently collected. Coding of the transcripts was carried out by three researchers independently, with themes agreed upon mutually. COREQ guidelines were followed throughout the planning, implementation, and analysis of this study.
Results: The finalized themes included "Enhancement of Teaching Skills," "Conducive Educational Environment," "Operational Issues," and "Recommendations for the Future".
Conclusion: Our findings suggest that PAL promotes collaboration among students and enhances knowledge, confidence, time management, teamwork and reflecting skills besides many other. It serves as a valuable supplement to traditional teaching methods, although it cannot replace them entirely. Thorough planning prior to implementation is essential for achieving beneficial long-term outcomes for both students and faculty.
Key words: peer groups, medical students, learning, clinical clerkship, teaching methods, undergraduate medical education
Cultivating Leadership Attributes In Undergraduate Medical Education: A Mixed Method Study
Full text linkObjective: This research aimed to train undergraduate medical students through a feasible and achievable program and assess the effectiveness of integrating leadership training into the formal curricula of undergraduate medical education, aiming to enhance the development of leadership attributes and behaviours among medical students.
Methods: This Mix-Method study including 60 students was conducted in a private medical college of Pakistan. The study participants were randomly selected. 30 participants were trained through the Student Leadership Development Program, whereas 30 constituted the control group. A series of training sessions were conducted. The Leadership Trait Questionnaire was administered during the study for Self, Peers and Mentors assessment. Quantitative data was analysed using SPSS version 26. Descriptive statistics were applied, and numerical variables were described using mean, median and interquartile ranges. The aggregate of traits was assessed for both leaders and control groups. Results showing p-value < 0.5 were considered statistically significant. Qualitative data was compiled from students’ responses to open-ended questions by manual thematic analysis.
Result: The results of the study demonstrated that most of the students possessed qualities of effective leaders with similar responses by all three evaluator groups. Traits like articulate, friendly, outgoing, persistent, diligent, trustworthy and sensitive showed significant results (p < 0.5) for peers’ assessment whereas for mentor scores the results were statistically convincing only for items i.e., Friendly and Self-confident. No statistically significance difference was noted between the overall scores of leaders and control groups. However, data analysis of students’ comments to open-ended questions provided information that leadership skills are necessary for successful medical practice and can be learnt with proper guidance given on time. Participants acknowledge that teamwork, communication skills, conflict resolution, and time and stress management as necessary knowledge and skills to develop among undergraduate medical students.
Conclusion: This study concluded that leadership skills should be taught and developed at the undergraduate level.
Keywords: Leadership, Undergraduate Medical Education