Journal of Rawalpindi Medical College
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Comparison Of Efficacy In Performing Epley’s Maneuver Alone Versus Betahistine Along With Epley’s In Diagnosed Patients Of Benign Paroxysmal Positional Vertigo
No full textObjective: To compare the effectiveness of Epley’s manoeuvre alone and Betahistine with Epley’s in patients with Benign paroxysmal positional vertigo.
Methods: After the ethical approval from the institutional review board, this comparative study was conducted at the Department of Otorhinolaryngology Head and Neck Surgery, District Headquarters Hospital, Rawalpindi, Rawalpindi Medical University, Rawalpindi, from February 2024 to August 2024. Through the non-probability consecutive sampling, 60 patients aged between 18-65 years, of either gender, with Vertigo who got a positive Dix-Hallpike test were included in the present study. After the informed consent form, patients were randomly divided into two study groups: Group A-Betahistine + Epley’s (n=30) and Group B- Epley’s (n=30).
Results: After 10 days of follow-up, only one patient in Group A remained positive for the Dix-Hallpike test, in contrast to 11 patients in Group B, demonstrating a statistically significant improvement in Group A (P<0.0001). On the first day, the mean Vertigo Symptom Scale (VSS) score was 12.6±3.6 in Group A and 14.6±3.03 in Group B, with Group A exhibiting significantly lower symptom severity (P<0.0001). Furthermore, the mean reduction in VSS score was greater in Group A (8.2±3.3) compared to Group B (7.3±2.6), also showing a statistically significant difference (P=0.042).
Conclusion: The use of Betahistine in conjunction with Epley’s maneuver outperforms the application of Epley’s maneuver alone in the treatment of BPPV
Keywords: Vertigo, Epley’s, Dix Hall Pike, VSS, betahistin
Assessing The Impact Of Curriculum Transformation In Undergraduate Medical Education: Faculty Feedback From Rawalpindi Medical University
Full text linkObjective: The objective of this study was to gather and analyze faculty feedback regarding the newly implemented undergraduate MBBS curriculum at Rawalpindi Medical University. The aim was to evaluate faculty satisfaction across areas such as curriculum structure, teaching methods, assessment strategies, policy changes, and institutional support systems.
Methods: A cross-sectional survey was conducted in December 2024, involving 31 faculty members from various departments. A structured questionnaire covering six key domains—circular organization, teaching and learning, assessments, policies, technological support, and general feedback—was administered. Responses were collected using a 5-point Likert scale ranging from “Strongly Agree” to “Strongly Disagree.” Data were analyzed using frequency and percentage distributions to identify trends in satisfaction and areas needing improvement.
Results: Faculty feedback revealed strong support for the revised teaching strategies, with over 70% approving of both the timely scheduling and integrated teaching formats. Research-related activities were highly appreciated, receiving positive ratings from 81% of respondents. In contrast, assessment methods—particularly their frequency and duration—drew mixed responses, with 38.7% expressing dissatisfaction. A major concern emerged around workload, as only 22.6% found their duties manageable, while over half disagreed, pointing to significant faculty stress. Digital tools such as the Learning Management System (LMS) and biometric systems also received mixed reviews, with a large portion of faculty remaining neutral. Overall satisfaction with the curriculum changes stood at 48.3%, though nearly one-third were undecided and 19.4% expressed dissatisfaction, indicating areas that still require attention.
Conclusion: The feedback revealed generally positive perceptions of integrated teaching formats, research activities, and digitalization initiatives. However, concerns were raised about faculty workload, assessment frequency, and the effectiveness of support systems like LMS and biometric tools. While over half of the participants expressed agreement with most reforms, overall satisfaction with the curriculum changes was moderate. These findings highlight the need for continuous dialogue between faculty and curriculum planners to address operational challenges and enhance the efficacy of educational reforms.
Keywords: Curriculum evaluation, Faculty feedback , Medical education refor
Awareness, Willingness, and Concerns Regarding the HPV Vaccine in Rawalpindi District and Islamabad Capital Territory
Full text linkObjective: To evaluate awareness, willingness, and concerns regarding the HPV vaccine among parents and guardians in Rawalpindi and Islamabad.
Methods: A cross-sectional survey was conducted among 1,007 respondents. Data on demographics, HPV awareness, willingness to vaccinate daughters, and concerns were analyzed using descriptive statistics. Comparative analysis was performed by stratifying responses based on education level and HCW status.
Results: Awareness of the HPV vaccine was reported by 66.2% of respondents, while 42.3% were willing to vaccinate their daughters. Safety perceptions were mixed: 40.6% considered the vaccine safe, 37.2% were unsure, and 22.1% believed it was unsafe. The most common concerns were side effects (43.1%), infertility (28.8%), vaccine effectiveness (21.5%), and quality (21.4%). HCWs demonstrated significantly higher awareness (88.3% vs. 48.3% for Non-HCWs) and willingness (63.9% vs. 24.7%). A direct, positive correlation was observed between higher education and both awareness (from 38.1% in the Low education group to 89.2% in the Postgraduate group) and willingness (from 20.5% to 59.7%). Despite these concerns, 42.1% supported inclusion of the HPV vaccine in Pakistan’s Expanded Programme on Immunization (EPI).
Conclusion: A substantial gap exists between HPV vaccine awareness and definitive acceptance in the twin cities of Rawalpindi and Islamabad. Misconceptions regarding side effects and infertility represent significant barriers. While HCW status and higher education strongly predict acceptance, targeted public health campaigns are urgently needed to dispel misinformation, specifically addressing the safety and effectiveness of the vaccine, to ensure the success of the newly launched national HPV immunization program.
Keywords: Cervical cancer, HPV, health concern, Immunization, Public Awarenes
Efficacy Comparison of Nitazoxanide Combined with Lactulose versus Lactulose Monotherapy in Managing Overt Hepatic Encephalopathy
Full text linkObjective: To evaluate the efficacy of combining Nitazoxanide with lactulose compared to lactulose alone in the treatment of overt hepatic encephalopathy.
Methods: This Comparative Cross-sectional Study was conducted at the department of Gastroenterology and Hepatology, Pakistan Institute of Medical Sciences, Islamabad from July 2019 to December 2019. In this study, 150 cirrhotic patients with overt hepatic encephalopathy were randomized into two groups: one receiving Nitazoxanide plus Lactulose (Group A) and the other receiving Lactulose alone (Group B). Patient demographics, aetiology of cirrhosis, MELD score, and efficacy of treatment were assessed. Statistical analysis was conducted to compare outcomes between the two groups.
Results: A total of 150 patients, with a mean age of 44.08 ± 11.31 years were enrolled. Hepatitis C was the predominant aetiology in 81 patients (54%). The mean MELD score was 23.24 in Group A and 22.36 in Group B. Upon admission, 20 patients (13.3%) presented with grade 2 hepatic encephalopathy (HE), while 70 patients (46.6%) had grade 4 HE. The duration of hospital stay showed statistical significance in both groups (p < 0.001). Furthermore, a significant difference in drug efficacy was observed between the two groups (p < 0.005).
Conclusion: In conclusion, our study suggests that combining Nitazoxanide with Lactulose yields superior efficacy compared to Lactulose alone in managing overt hepatic encephalopathy among cirrhotic patients.
Keywords: Comparison, Efficacy, Hepatic encephalopathy, Lactulose, Management, Nitazoxanide, Treatment
Intraoperative Localization Of The Marginal Mandibular Nerve In The Pakistani Population: A Cross-Sectional Study
Full text linkObjective: This study aims to evaluate the proximity of the marginal mandibular nerve to the lower border of the mandible in the Pakistani population, in comparison with previous studies to reduce the risk of inadvertent nerve damage during surgical interventions.
Methods: A total of 60 patients in the age range between the second & sixth decade requiring incision in the submandibular region were selected. Intraoperative identification of the nerve followed by measurement of its lowest point from the inferior border of the mandible was done. A total of 45 distinct nerves were recognized. Measurements on both the left and right sides were taken and compared with each other. The association of nerve position with the age of the patients was distinguished.
Results: A total of 45 nerves were identified. The average position of the Marginal Mandibular Nerve was determined to be 11.75 mm below the inferior border of the mandible. There was no significant difference between the left and right sides and about age.
Conclusion: The inferior border of the mandible is where the Marginal Mandibular Nerve is situated, consistent with prior research. There is no significant variation between the left and right sides. The position of the nerve is not affected by age as there is no association detected between the position of the nerve and age. The placement of an incision by previous recommendations of one finger breadth below the inferior border of the mandible can be used in the Pakistani population to avoid iatrogenic damage to the marginal mandibular nerve, leading to lesser complications and distress to the patient.
Keywords: Marginal mandibular branch, facial nerve, mandible, Injury
Serum Vitamin D Levels in Neonates and Their Mothers at Birth: A Comparative Analysis Highlighting Need for Therapeutic Strategies
Full text linkObjective: Objective: The study was conducted to examine serum vitamin D levels in preterm and full-term neonates and their mothers at birth to explore potential associations.
Methods: A cross-sectional analytical study was carried out in the Pediatrics and Obstetrics departments of Khyber Teaching Hospital, Peshawar from May 2022 to Nov 2022. After taking institutional approvals, 198 healthy pre-term and full-term neonates and their mothers were enrolled in the study. A structured proforma comprising demographic data was filled and samples of blood were obtained from the mothers at birth and the neonates within 72 hours of birth. Serum levels of Vitamin D were determined by ELISA and based on these levels the subjects were classified as sufficient, insufficient, or deficient.
Results: Of 198 infants studied, 77.8% were full-term and 22.2% were preterm. Males comprised 57.1% of the sample. A majority, 74.2% came from poor socioeconomic backgrounds, with 62.6% of mothers being uneducated. Both preterm and full-term infants predominantly exhibited vitamin D deficiency. Among 44 mothers of preterm and 154 mothers of full-term infants, vitamin D levels differed significantly (p=0.003). However, in both groups, there was a higher prevalence of mothers with insufficient vitamin D levels compared to those with adequate levels. Significant associations (p=0.001 and 0.003) suggest maternal vitamin D levels may influence neonatal vitamin D status and risk of preterm labour.
Conclusion: A notable proportion of mothers exhibited deficient levels of vitamin D, and correspondingly, their neonates also displayed deficient levels. A potential correlation between maternal Vitamin D status and the occurrence of preterm labour was also observed.
Keywords: Mother, Neonate, Pediatrics, Vitamin D
Unmasking The Hidden Clues: Shedding Light On The Potential Of Novel Biomarkers In Endometrial Cancer, Comparing RT-Qpcr And Immunohistochemical Analysis In Clinical Specimens
Full text linkObjective: The objective of this study was to compare the diagnostic accuracy of RT-qPCR in endometrial cancer using novel biomarkers in clinical specimens, keeping immunohistochemical analysis as the gold standard.
Methods: This cross-sectional validation study involved 210 endometrial biopsies, suspicious of endometrial carcinoma. RT-qPCR was performed, and relative gene expressions were calculated using the 2^-ΔΔCt method, with the endogenous control. Findings of the RT-qPCR were statistically analyzed keeping immunohistochemical analysis as the gold standard. Sensitivity, specificity, accuracy, negative predictive value (NPV) and positive predictive value (PPV) were calculated for the PCR technique. The clinical sensitivity of the test was determined by the Area under the curve (AUC)/Receiver Operating Curve (ROC).
Results: RT-qPCR diagnosed 61 patients while histochemical analysis diagnosed 60 patients with endometrial carcinoma. RT-qPCR has shown a sensitivity of 96.67%, specificity of 98% and diagnostic accuracy of 97.62%. PPV and NPV of Rt-qPCR were 95.08% and 98.66%.
Conclusions: RT-qPCR promises a highly sensitive and specific method for screening patients with endometrial carcinoma with expression of HE4, L1CAM, miR-200c, ARID1A, and PI3K.
Keywords: Endometrial cancer, Immunohistochemical, biomarkers, radiotherapy
Modified Bloom's Taxonomy: Perspective of a Doctor of Philosophy Scholar
Full text linkThe educational landscape is constantly evolving; with it, the frameworks we use to assess and foster learning must adapt. One such framework, Bloom's Taxonomy, has been a cornerstone in education since its inception in 1956.1 It first offered a hierarchical picture of cognitive abilities, from basic recollection to intricate assessment. But in a time of multidisciplinary integration and quick technical breakthroughs, reviewing and adapting this taxonomy to fit modern educational requirements is essential. As a doctor of philosophy, I suggest a revised Bloom's Taxonomy that leads to the highest learning objective: integration into practice-based systems. As a PhD and post-doc, I regularly develop original ideas, but I think the hardest part is integrating them into practice-based systems. The healthcare system does not gain from the innovations that are developed since they are not incorporated into the system and eventually go away.
Revisiting Bloom's Taxonomy
Knowledge, comprehension, application, analysis, synthesis, and evaluation were the six levels that made up Bloom's original taxonomy. These categories were modified to Remember, Understand, Apply, Analyse, Evaluate, and Create in 2001 by Anderson and Krathwohl. The generation of new ideas was emphasised as the highest cognitive capacity in this version, which moved the emphasis from static knowledge to dynamic processes.2 Though the updated taxonomy provides a strong foundation for cognitive growth, it falls short of addressing education's ultimate objective, which is real-world application in systems.
The Need for Practice-Based Systems
The significance of education in the linked world of today is found in both the development and acquisition of knowledge as well as in its efficient application. Integrative frameworks known as practice-based systems place a strong emphasis on converting theoretical knowledge into practical abilities for use in both professional and real-world settings.3 This method guarantees that learning is not only profound and long-lasting, but also immediately applicable and significant.
Modified Bloom's Taxonomy: A New Hierarchy
The proposed modified Bloom's Taxonomy includes the following levels, with incorporation in practice-based systems as the highest:
Remember: Recalling facts and basic concepts.
Understand: Explaining ideas or concepts.
Apply: Using information in new situations.
Analyze: Drawing connections among ideas.
Evaluate: Justifying a decision or course of action.
Create: Producing new or original work.
Incorporate: Embedding the innovation into practice-based systems. Potential verbs for this level: Embed, integrate, encompass, assimilate, blend, fuse.
From Creation to Incorporation
Although coming up with new concepts is an important first step, integration is what connects theoretical knowledge with real-world implementation.4 To ensure that the newly developed knowledge informs, enhances, and innovates real-world processes, it must be incorporated into practice-based systems. This greatest level of cognitive ability demonstrates a thorough comprehension of the topic and its ramifications, as well as the capacity to establish and maintain advancements in professional practice.5
Implications for Education and Training
The highest level of Bloom's Taxonomy's inclusion of practice-based systems has significant ramifications for training and education. It promotes a change from learning only theory to a more comprehensive strategy that emphasises real-world application and ongoing development.6 To promote a culture of creativity and lifelong learning, educational programs would concentrate not only on the creation of knowledge but also on how that information may be applied to other professional sectors.7
Current Dilemma
The most prominent challenge that is being faced in the thesis being written by PhD scholars is that the new innovative discovery never finds its way into the clinical practice or the workplace. It remains in text and the hardbound theses keep getting stacked in the storerooms of educational institutions as the scholars move on without even a pilot incorporation of their findings in the real workplace-based systems. Hence, this highest cognitive level must be made part of the objectives of the PhD scholar’s thesis so that it can make an impact through incorporation into the existing systems.
Conclusion: A crucial development for the twenty-first century is the updated Bloom's Taxonomy, which is incorporated as the apex in practice-based systems. It makes sure that students are not just informed and creative but also able to contribute significantly to their professions by bringing educational goals into line with the demands of a world that is changing quickly. As academics and educators, we must welcome this change and equip students to navigate and influence the future with competence, self-assurance, and a dedication to practical excellence.
References
Seaman M. BLOOM'S TAXONOMY. Curriculum & Teaching Dialogue. 2011 Jan 1;13.
Krathwohl DR. A revision of Bloom's taxonomy: An overview. Theory into practice. 2002 Nov 1;41(4):212-8.
Gul R, Kanwal S, Khan SS. Preferences of the teachers in employing revised Bloom's taxonomy in their instructions. sjesr. 2020 Jun 25;3(2):258-66.
Nkhoma MZ, Lam TK, Sriratanaviriyakul N, Richardson J, Kam B, Lau KH. Unpacking the revised Bloom’s taxonomy: developing case-based learning activities. Education+ Training. 2017 Mar 13;59(3):250-64.
Sobral SR. Bloom's taxonomy to improve teaching-learning in introduction to programming.
Elmas R, Rusek M, Lindell A, Nieminen P, Kasapoğlu K, Bílek M. The intellectual demands of the intended chemistry curriculum in Czechia, Finland, and Turkey: a comparative analysis based on the revised Bloom's taxonomy. Chemistry Education Research and Practice. 2020;21(3):839-51.
Rush RD. Using learning taxonomy to enhance understanding of innovation adoption
Safety And Efficacy Of Drug-Coated Balloon In Large Coronary Artery Disease
Full text linkIntroduction:
Coronary artery disease is one of the leading causes of death worldwide for which various therapeutic interventions have been proposed. The use of drug-coated balloons (DCBs). DCBs have gained attention as a promising tool for the treatment of large coronary artery disease. This study aims to see the efficacy and clinical outcomes of DCB therapy in large coronary artery disease.
Methods:
This prospective observational study involving 60 patients of CAD, was conducted in the Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi. The patients with large coronary artery disease were included and treated with DCB therapy. The effectiveness of DCB as the primary outcome in terms of target lesion revascularization was observed over time. Similarly secondary (adverse outcomes) were also assessed and represented as frequencies and percentages. Analysis was done by SPSS.V.26.
Results:
In our study, the mean age was 55.217±9.814 and the mean diameter of the target vessel was 3.1 ± 0.249 mm while that of the lesions was 25.25 ± 8.1 mm. On follow-up, target lesion revascularization was noted in only 8 (13.3 %), similarly, the adverse outcomes like MI in 4 (6.7%), target vessel thrombosis in 5 (8.3%), dyspnea in 8 (13.3%), effort angina in 10 (16.7%), and death was reported in just 2 (3.3%) of the patients.
Conclusion:
The use of DCB therapy resulted in a significant reduction in the proportion of patients requiring target lesion revascularization, which was the primary outcome measure. Furthermore, the secondary (adverse) outcomes exhibited a notable decrease in patients who received DCB therapy, thus demonstrating the efficacy of DCB therapy in individuals with large coronary artery disease
Role Of Problem-Based-Learning (PBL) In Producing Seven-Star Doctors: A Cross-Sectional Survey
Full text linkObjective: This study aims to investigate how Sialkot Medical College first-, second, and third-year MBBS students rate the impact of problem-based learning (PBL) on the development of qualities linked to seven-star doctors.
Methods: A six-month study (June–December 2023) at Sialkot Medical College used convenience sampling to survey 173 MBBS students (years 1,2 & 3) on their PBL experiences. A self-designed, expert-reviewed, and pilot-tested questionnaire assessed demographic details and Likert-scale statements linked to Seven-Star Doctor attributes. Data was collected via Google Forms and analysed using SPSS. Statistical analysis, including descriptive statistics and P values, was utilised to interpret the responses.
Results: The results showed that 54.9% of students said PBL motivated them to promote community health, and 71.1% of students believed it significantly improved their ability to think critically. Additionally, 64.7% of participants agreed that PBL improved their capacity to use theoretical knowledge in practical settings. In terms of professionalism, 57.2% of participants agreed PBL aided their professional development, and 55.5% said it promoted a scholarly attitude. Additionally, 68.8% were positive that PBL was crucial for developing leadership skills.
Conclusion: The study acknowledges the positive effects of PBL in developing the traits of a seven-star doctor while also pointing up areas for further investigation and potential enhancements in PBL implementation. Considering the limitations of the study, to further understand PBL's impact on medical education, future research should strive for bigger, more varied sample sizes and more advanced study designs