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Objective: To compare the frequency of preterm labour in pregnant patients with and without urinary tract infection in a tertiary care hospital in Punjab. Study Design: Cross-sectional comparative study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Lahore Pakistan, from Jul 2019 to Jan 2020. Methodology: Three hundred and eighty-five pregnant women were inducted into the study. The midstream urine sample was collected from patients between 24-28 weeks of gestation with complaints of burning micturition and was sent for microscopic examination. Urinary tract infection was diagnosed on the urinalysis report. Patients were followed till delivery.Patients were labelled as preterm who delivered neonates

Objective: To ascertain the various aspects directing the undergraduates at Quetta Institute of medical sciences towards anesthesiology as future profession/specialization. Study Design: Cross sectional study. Place and Duration of Study: Quetta Institute of Medical Sciences, Quetta Pakistan, from Mar to Apr 2019. Methodology: Study was conducted among final year medical students with the help of a printed questionnaire consisting of 15 Multiple Choice Questions. The questionnaire provided the required database to explore various factors that influence undergraduates to select their future specialization based on demography and specialty preferences. Results: A total of 65 undergraduates completed the response sheet. While 45 (68.8%) participants were females and 20 (31.2%) were males, 62 (95.4%) were single (unmarried or divorced) and had no children 63 (96.9%). Medicine proved to be the most favourate specialty with 20 (31.4%) student opting for it whereas anesthesiology was chosen by 4 (6.1%) students. Conclusion: Anesthesiology still remains a less popular choice among the medical students of Pakistan particularly Quetta Institute of Medical Sciences due to multifaceted factors. Inferior prestige of the specialty was the most significant factor in deciding against anaesthesiology.

Objective: To determine the positive predictive value of beta Human Chorionic Gonadotrophin in early second trimester for predicting pregnancy induced hypertension. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology Combined Military Hospital, Lahore, from Jun 2017 to Nov 2017. Methodology: A total of 214 female pregnant patients met the criteria for inclusion in this study. Patients with beta human chorionic gonadotrophin (βHcg) levels ≥2 MoM were followed at 22, 26, 30 and 34 weeks of gestation. Blood pressure was monitored. Pregnancy induced hypertension (PIH) was labelled after 20 weeks (as per dating scan) of gestation in patients who did not have proteinuria (≥300 mg 24 hour urine sample) and had a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg (blood pressure readings taken at two separate points in time four hours apart). Results: Patients ranged between 18-35 years of age, with the mean age being 27.3 ± 4.3 years. Mean gestational age was observed to be 15.6 ± 1.8 weeks. Mean BMI was 23.8 ± 3.2 kg/m2. Out of 214 patients, 30 patients (14%) had beta human chorionic gonadotrophin level >2 MoM. Out of these 30 patients, 25 patients (83.3%) developed PIH. There were 100 primigravida (46.7%) and 114 multigravidas (53.3%). Beta human chorionic gonadotrophin in predicting pregnancy induced hypertension showed sensi-tivity of 96.1%, a specificity of 97.3%, with a PPV83.3%, a NPV 99.4% and diagnostic accuracy of 97.2%.

Objective: To determine the pattern of internet and medical application usage among medical students, their perceptions towards these resources, and the subsequent challenges that emerge. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Lahore Medical College, from May to Nov 2018. Methodology: After taking consent, data was collected from 260 students through self-administrated questionnaire by convenience sampling. The data was analysed using SPSS version 20.0. Results: All participants had access to the internet, and 98% had access to a smartphone. Daily internet usage was observed in 92.9% participants, with 29% of them using it for more than 5 hours per day and an equal number of students utilizing it for 3-4 hours per day. Textbooks were the favoured resource for looking up medical information (85.5%). Medical applications were used by 43.1% of the study subjects. Out of all the apps and websites assessed in the study Google was the most used 215 (84.3%) followed by Wikipedia 187 (73.3%), Web MD 153 (60%), Meds cape 121 (47.5%), Pub Med 61 (23.9%), and Google scholar 42 (16.5%). Most participants (42.2%) were either uncomfortable or very uncomfortable with using medical applications in front of patients. Most students believed discouragement from teachers led to decrease application usage. Conclusion: Internet and smartphone usage was found widespread among medical students. While students view medical applications favourably, there was hesitance in using them in classroom and clinical settings.

Objective: To find the diagnostic accuracy of first trimester hyperuricemia for the prediction of development of subsequent gestational diabetes mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Conducted at department of Obstetrics & Gynaecology, Combined Military Hospital Lahore, from Apr 2017 to Oct 2017. Methodology: All pregnant patients who met the inclusion criteria were enrolled in this study after informed consent. Blood samples in first trimester were collected for analysis of serum uric acid. Then after 24-28 weeks of gestation, Oral glucose tolerance test was done and presence of gestational diabetes mellitus was recorded. All the data were collected on a proforma. Results: The mean age of females was 26.70 ± 5.21 years. The mean height and weight was 1.62 ± 0.07 meters and 61.07 ± 8.54 kg respectively. Body mass index of patients was 23.32 ± 3.72 kg/m2. The mean gestational age of females was 9.96 ± 0.37 weeks at time of enrolment in the study. The mean uric acid level at time of presentation was 4.43 ± 3.61 mg/dl. In this study, the sensitivity and specificity of hyperuricemia for prediction of gestational diabetes mellitus were 91.1% and 95.7%. The positive predictive value and negative predictive value of hyperuricemia were 86.8% and 97.2% respectively. The overall diagnostic accuracy was 94.5%. Conclusion: Hyperuricemia in the first trimester is a reliable marker for prediction of gestational diabetes mellitus in later pregnancy.

Objective: To compare the efficacy of cervical cerclage with vaginal progesterone in patients with cervical insufficiency. Study Design: Quasi experimental study. Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital Lahore, from Jan 2018 to Jun 2018. Methodology: The study involved 188 pregnant women with cervical insufficiency reporting in outpatient Department. After taking informed consent, the outcome variables age, number of mid-trimester pregnancy losses, body mass index and gestational age were recorded on specially designed proforma. Efficacy as if pregnancy was carried to 37 weeks of gestation was recorded. 93 patients were inducted in cerclage arm and 95 patients were treated with vaginal progesterone 400 mg once daily. Results: The mean age of the patients with cervical cerclage and vaginal progesterone was 31.622 ± 1.90 years and 31.42 ± 1.86 years respectively, while mean gestational age of cervical cerclage group was 21.840 ± 1.46 weeks and vaginal progesterone was 21.46 ± 1.52 weeks. The mean number of mid-trimester pregnancy losses with cervical cerclage was 2.39 ± 0.63 and vaginal progesterone was 2.44 ± 0.84. The mean body mass index of cervical cerclage group was 27.84 ± 1.86 kg/m2 and vaginal progesterone group was 28.01 ± 1.7 kg/m2. Efficacy in cervical cerclage group was seen in 79 (84.9%) patients and in 82 (86.3%) patients in vaginal progesterone group. Conclusion: Prophylactic cervical cerclage and vaginal progesterone were equally effective in preventing preterm birth in patients with high risk of cervical insufficiency.

Objective: To correlate student‟s perception of learning environment with scores obtained by participants in their final year MBBS exam. Study Design: Cross-sectional analytical study. Place and Duration of Study: Study was carried out at Bahria University Medical and Dental College (BUMDC), Karachi. Students of batch 2013 final year MBBS participated in the study. Methodology: Students of final year MBBS batch 2013 were inducted in the study after obtaining informed consent. The participants filled the Dundee Ready Education Environment Measure (DREEM) inventory at the end of final year, before their exam break. Subsequently, scores obtained in final year MBBS exams were correlated with the DREEM scores. Results: A strong positive correlation of 0.76 was found between DREEM scores and scores obtained by participants in their final year MBBS exam. Conclusion: Students' perceptions of their educational environment were positive which lead to better academic performance, as depicted by scores obtained in their final year MBBS examination.

Objective: To ascertain the various aspects directing the undergraduates at Quetta Institute of medical sciences towards anesthesiology as future profession/specialization. Study Design: Cross sectional study. Place and Duration of Study: Quetta Institute of Medical Sciences, Quetta Pakistan, from Mar to Apr 2019. Methodology: Study was conducted among final year medical students with the help of a printed questionnaire consisting of 15 Multiple Choice Questions. The questionnaire provided the required database to explore various factors that influence undergraduates to select their future specialization based on demography and specialty preferences. Results: A total of 65 undergraduates completed the response sheet. While 45 (68.8%) participants were females and 20 (31.2%) were males, 62 (95.4%) were single (unmarried or divorced) and had no children 63 (96.9%). Medicine proved to be the most favourate specialty with 20 (31.4%) student opting for it whereas anesthesiology was chosen by 4 (6.1%) students. Conclusion: Anesthesiology still remains a less popular choice among the medical students of Pakistan particularly Quetta Institute of Medical Sciences due to multifaceted factors. Inferior prestige of the specialty was the most significant factor in deciding against anaesthesiology. [ABSTRACT FROM AUTHOR]

Objective: To determine the pattern of internet and medical application usage among medical students, their perceptions towards these resources, and the subsequent challenges that emerge. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Lahore Medical College, from May to Nov 2018. Methodology: After taking consent, data was collected from 260 students through self-administrated questionnaire by convenience sampling. The data was analysed using SPSS version 20.0. Results: All participants had access to the internet, and 98% had access to a smartphone. Daily internet usage was observed in 92.9% participants, with 29% of them using it for more than 5 hours per day and an equal number of students utilizing it for 3-4 hours per day. Textbooks were the favoured resource for looking up medical information (85.5%). Medical applications were used by 43.1% of the study subjects. Out of all the apps and websites assessed in the study Google was the most used 215 (84.3%) followed by Wikipedia 187 (73.3%), Web MD 153 (60%), Meds cape 121 (47.5%), Pub Med 61 (23.9%), and Google scholar 42 (16.5%). Most participants (42.2%) were either uncomfortable or very uncomfortable with using medical applications in front of patients. Most students believed discouragement from teachers led to decrease application usage. Conclusion: Internet and smartphone usage was found widespread among medical students. While students view medical applications favourably, there was hesitance in using them in classroom and clinical settings. [ABSTRACT FROM AUTHOR]

Objective: To find the diagnostic accuracy of first trimester hyperuricemia for the prediction of development of subsequent gestational diabetes mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Conducted at department of Obstetrics & Gynaecology, Combined Military Hospital Lahore, from Apr 2017 to Oct 2017. Methodology: All pregnant patients who met the inclusion criteria were enrolled in this study after informed consent. Blood samples in first trimester were collected for analysis of serum uric acid. Then after 24-28 weeks of gestation, Oral glucose tolerance test was done and presence of gestational diabetes mellitus was recorded. All the data were collected on a proforma. Results: The mean age of females was 26.70 ± 5.21 years. The mean height and weight was 1.62 ± 0.07 meters and 61.07 ± 8.54 kg respectively. Body mass index of patients was 23.32 ± 3.72 kg/m². The mean gestational age of females was 9.96 ± 0.37 weeks at time of enrolment in the study. The mean uric acid level at time of presentation was 4.43 ± 3.61 mg/dl. In this study, the sensitivity and specificity of hyperuricemia for prediction of gestational diabetes mellitus were 91.1% and 95.7%. The positive predictive value and negative predictive value of hyperuricemia were 86.8% and 97.2% respectively. The overall diagnostic accuracy was 94.5%. Conclusion: Hyperuricemia in the first trimester is a reliable marker for prediction of gestational diabetes mellitus in later pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of cervical cerclage with vaginal progesterone in patients with cervical insufficiency. Study Design: Quasi experimental study. Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital Lahore, from Jan 2018 to Jun 2018. Methodology: The study involved 188 pregnant women with cervical insufficiency reporting in outpatient Department. After taking informed consent, the outcome variables age, number of mid-trimester pregnancy losses, body mass index and gestational age were recorded on specially designed proforma. Efficacy as if pregnancy was carried to 37 weeks of gestation was recorded. 93 patients were inducted in cerclage arm and 95 patients were treated with vaginal progesterone 400 mg once daily. Results: The mean age of the patients with cervical cerclage and vaginal progesterone was 31.622 ± 1.90 years and 31.42 ± 1.86 years respectively, while mean gestational age of cervical cerclage group was 21.840 ± 1.46 weeks and vaginal progesterone was 21.46 ± 1.52 weeks. The mean number of mid-trimester pregnancy losses with cervical cerclage was 2.39 ± 0.63 and vaginal progesterone was 2.44 ± 0.84. The mean body mass index of cervical cerclage group was 27.84 ± 1.86 kg/m2 and vaginal progesterone group was 28.01 ± 1.7 kg/m2. Efficacy in cervical cerclage group was seen in 79 (84.9%) patients and in 82 (86.3%) patients in vaginal progesterone group. Conclusion: Prophylactic cervical cerclage and vaginal progesterone were equally effective in preventing preterm birth in patients with high risk of cervical insufficiency. [ABSTRACT FROM AUTHOR]

Objective: To correlate student‟s perception of learning environment with scores obtained by participants in their final year MBBS exam. Study Design: Cross-sectional analytical study. Place and Duration of Study: Study was carried out at Bahria University Medical and Dental College (BUMDC), Karachi. Students of batch 2013 final year MBBS participated in the study. Methodology: Students of final year MBBS batch 2013 were inducted in the study after obtaining informed consent. The participants filled the Dundee Ready Education Environment Measure (DREEM) inventory at the end of final year, before their exam break. Subsequently, scores obtained in final year MBBS exams were correlated with the DREEM scores. Results: A strong positive correlation of 0.76 was found between DREEM scores and scores obtained by participants in their final year MBBS exam. Conclusion: Students' perceptions of their educational environment were positive which lead to better academic performance, as depicted by scores obtained in their final year MBBS examination. [ABSTRACT FROM AUTHOR]

Objective: To determine the knowledge, attitude and practices of family planning methods among Pakistani women attending a tertiary care hospital. Study Design: Cross sectional study. Place and Duration of Study: Outpatient department of Obstetrics and Gynaecology, Combined Military Hospital Lahore, from Jul to Dec 2018. Material and Methods: A total of 200 patients attending the OPD of CMH Lahore were enrolled in the study. After explaining the rationale of the study and taking verbal consent, a predesigned questionnaire was filled by the researcher. Based on their responses data was prepared, analyzed and interpreted. Results: The patients were between the ages of 19 to 48 years while the mean age of the patients was 28.41 ± 4.909. Ninety four percent being housewives. Awareness about contraception was 89% in women but only 66% knew about the benefits of contraception. Barrier method was found to be most popular (66%). Conclusion: Awareness among women regarding contraception is very high but actual contraceptive practice is very low. Mostly it is due to lack of knowledge regarding its benefits, limited sources and inadequate information about various methods. [ABSTRACT FROM AUTHOR]

Objective: Tofollow students' daily learning activities, ensure active participation in learning process and provide immediate feedback to students, facilitators and course directors on daily performance. Place and Duration of Study: This study was conducted at Shifa College of Medicine in an ongoing module of first year medical students for a period of two weeks. Material and Methods: Learner's log was developed and piloted in three study groups (n = 35) of first year medical students and facilitators (n = 9) of multidisciplinary modular team of Shifa College of Medicine (SCM), Pakistan. The learner's log focused on developing the learner as a Scholar, Communicator, Collaborator, Manager, Health Advocate and Professional (Adapted from Can MEDS Physic-ians Competency Framework). Students' and facilitators' questionnaires, comprising of a series of statements and an option for open comments/suggestions, were designed and distributed at the end of study. Results: Analysis showed an appreciating attitude of students and mixed response of facilitators towards learner's log. Sixty percent students and eighty five percent facilitators agreed that this type of learning strategy could be a good tool for self assessment and to keep track of their progress. Fifty seven percent facilitators and fifty three percent students considered it helpful to maintain fair attendance record. A total of 70% students found it helpful in maintaining the log of daily activities whereas 57% facilitators considered it cumbersome and disagreed with its effectiveness as a timely feedback instrument for students. Conclusion: The results support that effective utilization of learner's log could reflect students' performance on daily basis and provide a motivational drive to do better by reviewing their progress and giving them appropriate feedback on their performance. The apprehensions of the facilitators and students about learner's log could be minimized by training of facilitators and sensitization of students to learner's log in pre-clerkship years. [ABSTRACT FROM AUTHOR]

Objectives: To compare emergence time after Total Intra-venous Anesthesia (TIVA) using Propofol and Inhalational Anesthesia using Sevoflurane in minor gynecological and obstetric procedures. Study Design: Randomized controlled study. Place and Duration of Study: Department of Anesthesiology, Intensive Care and Pain Management, Combined Military Hospital, Peshawar. Six months from 15th March 2010 to 14th September 2010. Patients and Methods: A total of 200 gynecological patients of ASA-I and II were included in this study. Patients were divided randomly in 2 groups of 100 each using random numbers table. Group A patients were administered TIVA- Propofol and group B patients were given inhalational anaesthesia using Sevoflurane. A stopwatch was started when the anesthetic drug was discontinued at the end of surgery and was stopped as soon as the patient opened her eyes spontaneously to record the emergence time. All the data was entered in a patient performa. Results: It was observed that group A patients who were administered Propofol had a faster emergence time as compared to group B patients who were administered Sevoflurane. The mean emergence time of TIVA- Propofol group was 6.24 minutes (SD=0.726) while that of inhalational- Sevoflurane group was 8.52 minutes (SD=1.218). The shorter emergence time of Propofol group was highly significant when compared with the Sevoflurane group (p less than 0.001). Conclusion: The study concluded that Propofol provides rapid emergence than Sevoflurane. [ABSTRACT FROM AUTHOR]