MedERA (E-Journal)
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Comparison of Lipid Profile in Type-II Diabetes Patients on Insulin Vs Oral Hypoglycemic Agents
Full text linkObjective: To compare parameters of lipid profile in type-II diabetic patients managed with Insulin andOral hypoglycemic agents (OHAs) at Pak Emirates Military Hospital (PEMH, RWP)Methodology: A comparative cross-sectional study was conducted over a period of nine months afterethical approval from July 2021 to April 2022.Written informed consent from the potential participantswas taken using a non-probability convenient sampling technique on patients suffering from type-IIDiabetes Mellitus (DM) and managed with either OHAs or insulin for more than one year were studiedat Medicine department (PEMH, RWP). Serum lipid profile was carried out on all the study participantswith good control of diabetes at the time of enrollment in the study. Comparison of various lipid profileparameters were done in both the study groups.Results: Out of 550 patients included in the final analysis 300 (54.5%) were male and 250 (45.5%) werefemale. Mean age of the patients suffering from DM included in the study was 46.54±4.62 years. Therewere 205 (37.3%) patients with hypercholesterolemia while 181 (32.9%) patients hadhypertriglyceridemia. The incidence of hypercholesterolemia and hypertriglyceridemia wasstatistically significantly high in patients managed with OHAs as compared to those who weremanaged with insulin (p-value<0.001).Conclusion: Serum triglycerides and serum total cholesterol were found more significantly withinrange in patients who were managed with insulin as compared to those who were managed by OHAs.Deranged HDL and LDL levels were not significantly different in both groups.Key Words: Diabetes Mellitus, Insulin, lipid profile, Oral hypoglycemic agents
Evaluation of Patient Satisfaction of Endoscopic Procedures at PEMH Rawalpindi
Full text linkObjective: To evaluate patients' satisfaction of endoscopic procedures at Pakistan Emirates MilitaryHospital (PEMH), Rawalpindi, Pakistan.Methodology: This cross-sectional survey was conducted in the Gastroenterology Department ofPEMH, Rawalpindi, Pakistan between November 2022 and November 2023. A modified GroupHealth Association of America-9 (GHAA-9) questionnaire was utilized. The assessment ofsatisfaction was based on several factors including assistance of medical staff, technical skills of thephysician, an adequate explanation of the procedure, provision of privacy while checked in andwaiting, waiting time during the day of the procedure, satisfactory explanation of results, and overallexperience for the procedure. The subjects were also asked to grade the pain or discomfort. The chi-square test was employed and p-value < 0.05 was considered statistically significant.Results: The average age of patients was 47.5±13.78 years. Out of all the procedures, there were 275(48.2%) upper GI endoscopy, 134 (23.5%) colonoscopy, 64 (11.2%) ERCP and 49 (8.6%) EUS. Further,83.9% of the patients were satisfied with the overall experience of endoscopic procedure. Thesatisfaction rate for experiencing pain or discomfort during and after the procedure was lower thanother questions. However, when each question of the survey response was stratified based on genderand age, they were not statistically significant, depicting these two factors were not associated withthe satisfaction level except waiting time on the day of procedure (p= 0.006), experienced pain ordiscomfort after the procedure (p= 0.002) for gender and pain/ discomfort during the procedure (p=0.021) for age groups.Conclusion: Although most patients expressed satisfaction with the endoscopy performed at PEMHbut pain or discomfort during and after the procedure was identified, affecting satisfaction scores.Keywords: Patient satisfaction, Endoscopic procedures, Patient discomfort, Waiting time, Survey
Diagnostic Accuracy of Alpha Fetoprotein in Diagnosis of Hepatocellular Carcinoma
Full text linkObjective:To look forthe association ofraisedalpha fetoprotein (AFP) withdiagnosis of hepatocellularcarcinoma (HCC) and factors associated with raised levels in patients managed for space occupyinglesion of the liver.Methodology: Aprospective cross-sectional study was conducted over a period of nine months afterethical approval from July 2021 to April 2022.Using non probability convenient sampling technique470 patients managed for space occupying lesion of the liver (SOL) at medicine and GI departmentPak Emirates Military Hospital Rawalpindi (PEMH, RWP) and Oncology Department CombinedMilitary Hospital Rawalpindi (CMH, RWP) were included in the study. Routine investigationsincluding AFPand liver biopsy were performed on these patients. Association of presence of HCC onbiopsy and other sociodemographic factors was assessed with raised AFP levels among the studyparticipants.Results: The gender distribution of patients showed that 318 (67.6%) were male while 152 (32.4%)were female. From patients who were evaluated for SOL of liver 341 (72.6%) patients were havingHCC while 129 (27.4%) were negative for the findings of malignancy.353 (75.2%) patients had raisedAFP levels while 117 (24.8%) had levels within range. Presence of HCC on biopsy and viral origin ofdisease were statistically associated with raised AFPlevels (p value<0.001).Conclusion: AFP was raised in most of the individuals managed for space occupying lesion of liver.Patients having HCC and viral origin of liver disease had significantly higher levels of AFP ascompared to benign and non-viral origin lesions.Key words: Alpha fetoprotein, hepatocellular carcinoma, lesion, liver disease, liver biops
Incidence of Skip Metastasis in Squamous Cell Carcinoma of Tongue.
Full text linkObjective: This study aimed to determine the incidence of skip metastasis in patients with tongue squamous cell carcinoma, focusing on those who presented to tertiary care settings in Lahore. Methodology: This was a cross-sectional study with a prospective time frame. The sample size was determined using the formula for estimating proportions, which was 59. Sixty patients with TSCC were selected based on rigorous inclusion criteria, and informed consent was taken before participants were included in the study. Paper-based forms were used to collect data following the examination of the patient by the researcher after obtaining informed consent. After the collection of results, an analysis was done to determine the correlation between the prevalence of SM and factors such as age, gender, level of lymph node involvement, smoking status, betel chewing, and alcohol usage.
Results: Of the 60 participants, 71% showed evidence of metastasis involving lymph node levels I-IV. Isolated skip metastasis (SM), involving only levels IV and V, was only seen in 5% of the total group. The prevalence of skip metastasis could be correlated with gender, indicating a male predilection. Advanced age did not impact the prevalence of skip metastasis, as the mean age of participants was 54, while that for showing skip metastasis was 51.3 years.
Conclusion: The study provides clinicians with a deeper understanding of the prevalence of skip metastasis. However, further research is necessary to improve the diagnosis and management of TSCC. This study provides avenues for further research into skip metastasis, its existence in the Pakistani population, and its thorough management.
Key Words: Metastasis, Skip Metastasis, Squamous Cell Carcinoma, Tongue Carcinom
Knowledge, Attitudes, and Practices of Medical Students Regarding use of Vitamin Supplements
Full text linkObjective: To explore the knowledge, attitudes, and practices of medical students regarding use ofvitamin supplements, and compare them with the use of prescribed vitamin supplements.Methodology: A cross sectional (KAP study) was conducted in public and private medical colleges ofFaisalabad, recruiting all the student enrolled in different specialities of medical sciences. Threehundred and eighty-seven participants were recruited in this study over a period of two months(Nov-Dec 2023) with help of convenient sampling technique. Subjects who filled incomplete form orwere not willing to participate in the study were excluded. A quantitative, close ended questionnaire wasfloated on WhatsApp groups. Data was analysed using SPSS. P value≤0.05 was taken as significant.Results: Study recruited 387 subjects of both genders, male 164 (42.4%) and female 223(57.6%) ofmean age 21.99±1.74 from different medical-related fields including MBBS 259 (66.9%), BDS97(25.1%), Allied health Sciences 31 (8.0%) and freshly graduated students with the help of validatedquestionnaire. It was filled by different medical colleges in Faisalabad. Forms were floated on Socialmedia and WhatsApp. It is shown that a significant number of the female population is usingvitamins as compared to males (P value=0.000). Moreover, a majority of the female population isusing it with a doctor's prescription as compared to males (P value=0.000)Conclusion: Majority of the population are using the vitamin supplements after being prescribed bythe doctor though no biochemical analysis was done to assess the levels of essential vitamins.Keywords: Vitamin supplements, Nutrition, Medical student
Knowledge, Attitudes and Practices about determinants of Diabetes among Non-Diabetic Pakistanis
Full text linkObjective: To identify the determinants of diabetes-related knowledge, attitudes, and practices among the non-diabetic Population in Pakistan.
Methodology: A cross-sectional survey was performed from July to December 2023 using snowball sampling 400 non-diabetic Pakistani nationals were enrolled; the data regarding diabetes knowledge, attitudes, and practice was acquired on a structured online questionnaire distributed through a social media platform. The sociodemographic variables and diabetic characteristics were the exposure of interest, and Diabetes Knowledge Attitude and Practice (KAP) was considered the outcome of interest. The data was analyzed using SPSS version 27, with chi-square testing and regression analysis used to study the relationship between sociodemographic variables and KAP outcomes.
Results: The study revealed a high level of general awareness about diabetes (86.75% knew what it was), but specific knowledge about its management and complications was low (<50% were sufficiently informed). Attitudes towards diabetes were proactive regarding diet and family support, yet less than half of the respondents recognized the importance of physical activity and regular glucose monitoring. Practices varied, with 88% avoiding fatty foods but only 18.75% maintaining a healthy weight and 31.5% engaging in regular blood sugar monitoring. Socioeconomic factors and education levels significantly (P<0.05) influenced KAP, with higher education significantly associated with better knowledge and practices.
Conclusion: Overall, the non-diabetic Pakistanis have a good general awareness of diabetes. However, there are significant gaps in comprehensive knowledge and practice.
keywords: Diabetes Mellitus; Knowledge Attitudes Practices; Non-diabetic Pakistan
Characteristics of Critically ill Obstetric Patients Admitted to the ICU at a Tertiary Care Centre
Full text linkObjective: To ascertain the characteristics, admission indications, interventions, and outcomes of obstetric patients admitted to ICU.Methodology: A retrospective, descriptive study was conducted at Lady Reading Hospital's ICU in Peshawar, Pakistan (January 1 to December 31, 2022). During this time, a total of 1560 patients were received in the ICU, out of which 132 full filled our inclusion and exclusion criteria. Characteristics of patients, reasons for admission, interventions, demographic information, obstetric history, length of stay, and outcomes were collected through a retrospective review of medical records. Statistical analysis was performed using SPSS software version 21.0.Results: Among the 1,560 admissions in ICU, 132 were obstetric cases (8.5% of all ICU admissions). Majority of these patients had a mean age of 27.05 ± 6.23 years, with mean ICU stay duration of 6.55 ± 7.05 days. Among these, hypertensive disorders of pregnancy were identified in 47 patients (35.6%). Obstetric hemorrhagic disorders accounted for admission in 40 patients (30.3%). Out of the 132 patients, 26 (19.6%) did not survive. Highest mortality rates were of those admitted with fulminant hepatic failure (2 patients, 66.7%). Among patients admitted for direct obstetric reasons, post-natal septicemia caused the highest mortality (3 patients, 37.5%). Ventilatory support was required by 113 patients (85.6%) and vasopressor support was administered to 87 patients (65.9%) of the patients. Conclusions: To decrease maternal mortality and improve healthcare for pregnant individuals, it is crucial to focus on hypertensive disorders of pregnancy and obstetric hemorrhage. Addressing these issues, along with providing effective post-natal sepsis treatment, can contribute to a reduction in mortality rates.Keywords: Obstetric hemorrhage, Pre-Eclampsia, Post-natal septicemia, Mortalit
Beyond Anxiety: Unveiling the Power of Self-Efficacy in Shaping Academic Performance among Medical Students
Full text linkObjective: The study aimed to explore the relationship between anxiety and academic performance and discuss a key boundary condition i.e., self-efficacy as a strategy to manage anxiety in the academic setting.
Methodology: A quantitative survey design was used employing a cross-sectional time frame. Public sector medical colleges of Lahore affiliated with the University of Health Sciences (UHS) were selected such as Allama Iqbal Medical College, Ameer-ud-Din (PGMI) Medical College, Services Institute of Medical Sciences, and Shaikh Khalifa Bin Zayed Al-Nahyan Medical & Dental College. The duration of the study was from June 2021 to January 2022. A convenience sampling technique was used to collect data from 259 medical students through self-administered questionnaires. The inclusion criteria applied were that the medical institution needs to be recognized by UHS and should be located in Lahore. Medical students included belonged to second to final year MBBS. First-year students were omitted as they had not taken their professional examinations.
Results: Hayes PROCESS Macro analysis in SPSS version 22 showed that social media overload and academic performance were significantly related (B=-0.198, p<0.05). Moreover, a significant moderating role of self-efficacy in the relationship between anxiety and academic performance was found.
Conclusion: Results suggested that when medical students faced anxiety their academic performance was decreased however this did not apply to medical students with high self-efficacy. Medical students with low self-efficacy who see themselves as incompetent, lose motivation easily when they try to attempt tough tasks and focus too much on potential failure.
Key Words: Anxiety, academic performance, self-efficacy
Effects of Stretching and Positional Release on Calf Muscle Pain in Post- Natal Females
Full text linkObjective: To determine the effects of stretching and positional release on calf muscle pain in postnatalfemales.Methodology: The quasi-experimental study was conducted on a sample of 40 subjects from October2022 to February 2023 at Arif Memorial Teaching Hospital Lahore. Non probability samplingtechnique was used. These subjects were allocated non-randomly in Group A and Group B. Stretchingwas performed on subjects of group A and positional release was performed on group B. The groupswere assessed before and after treatment by a numeric pain rating scale and ankle dorsiflexion Range,while SPSS V. 21 was used for pretest post-test comparison using paired sample t test at P value <0.05.Results: The study comprised females with a mean age±sd of participants is 26.00±4.38 years. The preand post values on Numeric pain rating scale were 8.00±1.28, 2.47±1.33 respectively. While thedorsiflexion angle pretest was 6.53±1.280 and post-test was 12.53±2.780. There was significant differencein pre and post values and p value≤0.05, which show that the results were significant. Both stretchingand positional release were effective for postnatal calf pain. But results showed that Stretching wasmore effective than positional release.Conclusion: The study concluded that stretching is more effective in reducing calf muscle pain inpost-natal females compared to positional release.Keywords: Ankle dorsiflexion, Calf muscle tightness, Females, post-natal care, Positional release,Stretching, pain
Oral Health Status of Pregnant Women and their Referral to Dentist during Antenatal Period
Full text linkObjective: The aim of this study was to assess oral health status of pregnant women and theirreferral to dentist during antenatal period.Methodology: This descriptive cross-sectional study was conducted in Outpatient Department,(Gynae and Obs.) Jinnah Hospital Lahore, Pakistan after ethical committee approval. The sample sizewas calculated using formula for finite population and found to be 340 pregnant women who wereconveniently sampled and interviewed by using a self-administered questionnaire following verbaland written consent. Oral health status was examined clinically using dental mirror and Michiganprobe. Scoring was done using WHO oral health assessment form for adults, 2013 includingCommunity periodontal index, DMFT, and Dean's fluorosis index. Data was statistically analyzedusing SPSS version 24. Chi-square test was applied to compare categorical variables (p≤ 0.05 assignificant).Results: Total 236 (69.4%) out of 340 pregnant women had oral health problems. Only 11 (3.2%)participants were referred by the gynaecologist to dentist for their oral health issue. Out of 236participants, 67% had dental caries, 80.9% had gingival bleeding, 58.8% had gingival pockets, 41.7%had loss of attachment, 1.8% had dental erosions, 63.8% had dental fluorosis and 1.5% had oralmucosal lesions. The majority of pregnant women who participated in this study had lowsocioeconomic status (mean income PKR 20300±10304.14) reported with more oral health problems.Conclusion: As reported in this study, majority of pregnant women had oral health problems andonly few of them were referred to dentist by gynaecologist.Key Words: Pregnant women, Oral health status, Gynaecologist, Antenatal perio