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Background: Stressful situations are often linked with poor health and lifestyle behaviors (e.g., unhealthy diet, limited physical activity, poor sleep quality etc.). Subsequent to the nationwide lockdown in Pakistan due to COVID-19 pandemic, medical students experienced substantial lifestyle changes along with academic stresses. The goal of this study was to measure the impact that the COVID-19 lockdown had on lifestyle like sleep, physical activity and nutrition, substance abuse, dealing with finances, spirituality and family life, with respect to a sample of Pakistani medical students. Methods: This cross- sectional online study involving 1100 medical students (68.7% females) from five medical colleges in Pakistan, used self-administered questionnaire to evaluate the impact of pandemic related restrictions on lifestyle of medical students in Pakistan from August- September 2020. Parameters such as physical activity, sleep, nutrition, smoking and substance abuse, family life, finances, internet use and spirituality were studied. Results: Fifty-nine percent of medical students reported a significant effect of lockdown on their physical activity. Only 5.8% people clearly followed or adhered to a routine during the pandemic. About 54.6% students have found that physical activity and exercise significantly reduced their anxiety. More than half of respondents reported increase in screen time, weight gain and poor sleep with 3.1% of students stating an increased use of sleeping pills to fall asleep Another 18.3% students had an increased worry regarding COVID19 based on the information they received on internet. No significant increase in substance uses and alcohol use or family conflicts among students post pandemic was noted. Conclusion: Our findings underscore that COVID-19 pandemic has led to undesired changes in health and lifestyle habits of medical students, which may, to some extent, be responsible for higher negative impact. Hence it is important for medical colleges to start awareness campaigns to tackle challenges for medical students physical and emotional well-being. doi: https://doi.org/10.12669/pjms.38.7.6031 How to cite this:Tahir SM, Imran N, Haider II, Mustafa AB, Aqeeb-ur-Rehman, Azeem MW, et al. A study to evaluate the impact of COVID-19 on Lifestyle of Medical students. Pak J Med Sci. 2022;38(7):1730-1737. doi: https://doi.org/10.12669/pjms.38.7.6031 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Since the start of January 2019, COVID-19 has caused unparalleled disruption to all aspects of life globally, including the delivery of medical education. Each university and institution have a different approach on how medicine, as a course, is taught and delivered, however, generally there is a consensus that in the earlier years, more emphasis should be given to the acquisition of theoretical and scientific knowledge, including anatomy and physiology. In the later years, medical students are then expected to apply their theoretical knowledge in a practical setting by attending various placements and interacting with patients and other healthcare professionals. The duality of this approach results in doctors who are both competent in their knowledge of the basic sciences whilst being good clinicians with sound practical and inter-personal skills. Covid-19 causes an unprecedented interruption to all students, however with courses such as Medicine, whereby a practical element is crucial, the adaptation to deliver the course effectively is more of a challenge. Clinical rotations were cancelled during the start of the pandemic due to concerns about the students and their families contracting the virus and also for the protection of the vulnerable patients in hospitals. In this manuscript we have explored the adaptations made in order to deliver medical education and evaluate the effectiveness of these methods. We will also be discussing the implications and limitations of these methods. doi: https://doi.org/10.12669/pjms.38.1.5269 How to cite this:Karim Z, Javed A, Azeem MW. The effects of Covid-19 on Medical Education. Pak J Med Sci. 2022;38(1):320-322. doi: https://doi.org/10.12669/pjms.38.1.5269 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background & Objective: The Coronavirus disease 2019 (COVID-19) pandemic has caused widespread psychological distress. The aims of the study were a) to assess mental health symptoms experienced by expatriate hospital staff and b) to determine the impact of staff wellbeing interventions specific to pandemic related stress. Methods: The study was conducted from June 2020 until August 2020. A 16-question survey was disseminated online via Survey Monkey to assess the mental health needs of hospital staff during the pandemic. Based on results, a virtual, tiered mental health support model was developed, and staff feedback was collected. Results: Almost 46.2% of respondents (N: 1001) reported at least one mental health symptom in the initial survey. The most common symptoms were anxiety, low mood and feelings of isolation. Being single and in poor health status were predictors of developing mental health symptoms (P

Background & Objective: Child & adolescent mental health needs to be considered as an integral component of overall health, however significant gaps exist in service provision especially inpatient services in Pakistan. The paper presents the characteristics of admitted youths and response to treatment in Pakistan’s first dedicated child & adolescent psychiatry inpatient unit in Lahore over a period of first seven years. The aim of this study was to better understand the various characteristics of children and youth admitted to this inpatient unit and response to treatment over a seven years’ period since the inception of the unit. Methods: Inpatient medical records of children & adolescents admitted to dedicated Child & Adolescent Inpatient Unit at King Edward Medical University, Lahore were reviewed. Data was extracted regarding referral patterns, sociodemographic factors and diagnosis for the first seven years, from 2012 to 2019. Patients’ scores on Strengths and Difficulties Questionnaire and Clinical Global Impressions Scales administered during intake were also reviewed. Results: Six hundred and thirty-four (634) patients, 56% (355) being females were admitted to the unit during seven years with mean age of 12.3±2.3. Mean duration of admission was 15.60±6.3 days. Most predominant ICD-10 Axis-I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262); mood disorders (78); schizophrenia, schizotypal & delusional disorders (77) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44). One hundred and fifty-nine (25%) children had comorbid diagnosis of intellectual disability on Axis-III. Strengths and difficulties questionnaire scores were in abnormal range for significant proportion (>50 %) of patients. CGI mean scores showed marked improvement at discharge. Conclusion: Neurotic, stress related and somatoform disorders are the most common diagnosis in youth needing inpatient treatment in Pakistani setup. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries. doi: https://doi.org/10.12669/pjms.37.2.2611 How to cite this:Imran N, Bodla ZH, Asif A, Shoukat R, Azeem MW. Pakistan’s First Child & Adolescent Psychiatry Inpatient Unit: Characteristics of admitted patients and response to treatment over a 7-year period. Pak J Med Sci. 2021;37(2):305-311. doi: https://doi.org/10.12669/pjms.37.2.2611 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To measure the knowledge of healthcare professionals about increasingly prevalent Autism Spectrum Disorder (ASD) along with perceptions around its management and prognosis and comparison across various specialties. Methods: This Cross sectional survey based comparative analysis took place at Maternity and Children Hospital and King Faisal Hospital Makkah from December 2017 to May 2018. The validated self-administered “Knowledge about childhood autism among health workers” questionnaire was used along with additional questions regarding perceptions about ASD. The mean and mean percent scores were calculated. Chi squared test and ANOVA were applied to find the association between quantitative and qualitative variables respectively. Results: Out of 162 participants, 153 returned the questionnaire and 147 were included in final analysis. Physicians constituted 81.6% (120) of participants. The mean score for participants was 9.80(S.E.M ±0.32) where non-physicians yielded higher mean score (11.2±4.41) as compared to physicians (9.6±3.28) (p=0.113). Psychiatrists had highest score of 16/19 while general physicians had lowest (6/19). Participants with more years of experience had higher mean scores (p-value = 0.01). About 72.10% (106) of participants opted for medication as a treatment option. Nearly 38.1% (56) of participants were skeptical about improvement of ASD with early interventions. Conclusion: There is a lack of knowledge about ASD amongst healthcare professionals in Saudi Arabia. Experienced professionals working with ASD children can be utilized to deliver targeted trainings nationwide.

Objective: To measure the knowledge of healthcare professionals about increasingly prevalent Autism Spectrum Disorder (ASD) along with perceptions around its management and prognosis and comparison across various specialties. Methods: This Cross sectional survey based comparative analysis took place at Maternity and Children Hospital and King Faisal Hospital Makkah from December 2017 to May 2018. The validated self-administered “Knowledge about childhood autism among health workers” questionnaire was used along with additional questions regarding perceptions about ASD. The mean and mean percent scores were calculated. Chi squared test and ANOVA were applied to find the association between quantitative and qualitative variables respectively. Results: Out of 162 participants, 153 returned the questionnaire and 147 were included in final analysis. Physicians constituted 81.6% (120) of participants. The mean score for participants was 9.80(S.E.M ±0.32) where non-physicians yielded higher mean score (11.2±4.41) as compared to physicians (9.6±3.28) (p=0.113). Psychiatrists had highest score of 16/19 while general physicians had lowest (6/19). Participants with more years of experience had higher mean scores (p-value = 0.01). About 72.10% (106) of participants opted for medication as a treatment option. Nearly 38.1% (56) of participants were skeptical about improvement of ASD with early interventions. Conclusion: There is a lack of knowledge about ASD amongst healthcare professionals in Saudi Arabia. Experienced professionals working with ASD children can be utilized to deliver targeted trainings nationwide. doi: https://doi.org/10.12669/pjms.35.4.605 How to cite this:Hayat AA, Meny AH, Salahuddin N, Alnemary FM, Ahuja KR, Azeem MW. Assessment of knowledge about childhood autism spectrum disorder among healthcare workers in Makkah- Saudi Arabia. Pak J Med Sci. 2019;35(4):951-957. doi: https://doi.org/10.12669/pjms.35.4.605 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: The most important desideratum of a provisional crown is an adequate marginal fit that is essential for maintaining optimal periodontal health, reducing the sensitivity of freshly prepared dentin and protection of the pulp. The purpose of this in vitro study was to compare the vertical marginal accuracy of provisional crown materials using three different material systems (chemically activated PMMA powder-liquid system, light activated UDMA single paste system, and chemically activated Bis-GMA two paste auto mix system) and two different techniques (direct and indirect). Methods: Two customized stainless steel dies, simulating prepared and unprepared tooth were used to fabricate 40 provisional crowns. Additional silicone elastomeric impression and a vacuum-formed polypropylene sheet were used as a matrix. Ten crowns, each of the three material systems used in the study (n = 10 × 3) were fabricated using the direct technique and ten crowns from chemically activated PMMA powder-liquid system (n = 10 × 1) using an indirect technique. Scanning electron microscope (SEM) was used to measure vertical marginal discrepancies at x100 magnification. The results were analyzed using descriptive statistics and comparisons between various groups were made using one way analysis of variance (ANOVA) after checking the normality of data using Shapiro Wilk’s Test. Post Hoc Tukey HSD Test was used to determine the statistical difference between the means of independent group pairs. Results: The mean marginal discrepancies of Bis-GMA composite resin, UDMA composite resin, and PMMA acrylic resin using direct technique were 67.15 µm, 71.01 µm, and 84.56 µm respectively. PMMA acrylic resin showed a mean marginal discrepancy of 103.03 µm using the indirect technique. Conclusion: This study has shown that provisional crowns fabricated with Bis-GMA composite resin material (two paste auto mix system) registered the best marginal accuracy. Provisional crowns fabricated with indirect technique recorded less marginal opening than with direct technique. How to cite this:Naqash TA, Alfarsi M, Hussain MW. Marginal accuracy of provisional crowns using three material systems and two techniques: A scanning electron microscope study. Pak J Med Sci. 2019;35(1):55-60. doi: https://doi.org/10.12669/pjms.35.1.5 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

OBJECTIVE: Association between Intellectual disability (ID) and psychiatric disorders in children & adolescents is well established but there is a paucity of published studies from Pakistan on this topic. The main aim of the study was to assess the frequency of ICD-10 psychiatric diagnosis in the hospital outpatient sample of children with ID in Lahore, Pakistan as well as to find out which challenging behaviors, caregivers find difficult to manage in this setup. METHODS: Socio-demographic information was collected, Wechsler Intelligence Scale for Children-Revised & ICD-10 diagnostic criteria was used to assess children (age range 6 - 16 years) with suspected ID along with identification of behaviors found to be difficult to manage by caregivers. RESULTS: 150 children were assessed with mean age of 10.7 years (males 70 %). Majority (72%) had mild ID while 18.7% and 9.3% had moderate and severe ID respectively. Thirty percent of children met the criteria for any psychiatric diagnosis, the most common being Oppositional Defiant Disorder (14%) and Hyperkinetic Disorders (10%). Verbal and physical aggression, school difficulties, socialization problems, inappropriate behaviors (e.g. disinhibition), sleep & feeding difficulties were the significant areas identified by the caregivers as a cause of major concern. CONCLUSIONS: Significantly high prevalence of ICD-10 psychiatric diagnosis in children with ID was found in Lahore, Pakistan. Support services for these children should be responsive not only to the needs of the child, but also to the needs of the family. Language: en

Objective:�Todeterminethefrequencyoflowserumzinclevelinchildrenpresentingwithfebrileseizures� atTheChildren'sHospitalandtheInstituteofChildHealth�(CH/ICH)�Multan. Methods: ThisisanobservationalcrosssectionalstudyconductedattheDepartmentofPediatricMedicine,� TheChildren'sHospitalandtheInstituteofChildHealth,�MultanfromSeptember�2010�toMarch�2011.� Children�(6�monthsto�6�yearsofage)�presentingwithfebrileseizureswhosatisfiedinclusionandexclusion� criteriawereenrolledforthestudy.� Causeoffeverwasdeterminedafterdetailedhistory,� physical� examinationandrelevantinvestigations.�Fourmilliliterscentrifugedbloodsamplewaspreservedinacid� washedtesttube.�SeparatedserumwasusedtomeasureserumzinclevelbyemployingRandoxkitonauto- analyzerinallcases.�Theoutcomevariable�(serumzinclevel)�wasrecordedonapredesignedproforma. Results: Outof�100�enrolledchildren,�therewere�66�(66%)�malewithmaletofemaleratioof�1:0.52.�Mean� ageofthechildrenwas�23.97±14.45�months.�Upperrespiratorytractinfectionwasthemostfrequentcause� offeverapparentin�24�children�(24%)�followedbytonsillitis�17�(17%),�pneumonia�16�(16%),�urinarytract� infection�16�(16%),�otitismedia�15�(15%),�andbronchiolitis�12�(12%).�Frequencyoflowserumzinclevelwas� 26%�inchildrenwithfebrileseizures. Conclusion: Zincdeficiencycouldbeapotentialriskfactorforfebrileseizureinchildren.

Objective: To determine the frequency of low serum zinc level in children presenting with febrile seizures at The Children’s Hospital and the Institute of Child Health (CH/ICH) Multan. Methods: This is an observational cross sectional study conducted at the Department of Pediatric Medicine, The Children’s Hospital and the Institute of Child Health, Multan from September 2010 to March 2011. Children (6 months to 6 years of age) presenting with febrile seizures who satisfied inclusion and exclusion criteria were enrolled for the study. Cause of fever was determined after detailed history, physical examination and relevant investigations. Four milliliters centrifuged blood sample was preserved in acid washed test tube. Separated serum was used to measure serum zinc level by employing Randox kit on auto-analyzer in all cases. The outcome variable (serum zinc level) was recorded on a predesigned proforma. Results: Out of 100 enrolled children, there were 66 (66%) male with male to female ratio of 1:0.52. Mean age of the children was 23.97±14.45 months. Upper respiratory tract infection was the most frequent cause of fever apparent in 24 children (24%) followed by tonsillitis 17 (17%), pneumonia 16 (16%), urinary tract infection 16 (16%), otitis media 15 (15%), and bronchiolitis 12 (12%). Frequency of low serum zinc level was 26% in children with febrile seizures. Conclusion: Zinc deficiency could be a potential risk factor for febrile seizure in children.

Objective To determine the frequency of common causes of short stature in children presenting to the Children's Hospital & the Institute of Child Health, Multan. Methodology This cross sectional study was done in Pediatric Endocrinology department, the Children's Hospital & the Institute of Child Health, Multan, from March to September, 2011. One hundred and sixty nine children with short stature presenting to the outpatient department meeting inclusion criteria were recruited after taking an informed consent. The detailed history, physical examination including anthropometric measurements and relevant investigations were recorded. Causes of short stature (outcome variable) were recorded on a predesigned proforma for final analysis. Results The common causes of short stature identified were; familial short stature (FSS) 36 cases (21.3%), hypothyroidism 29(17.2%), growth hormone deficiency (GHD) 18(10.7%), insulin dependent diabetes mellitus (IDDM) 16(9.5%) and constitutional delayed growth and maturation (CDGM) 11(6.5%) cases. This was followed by primary malnutrition 8(4.7%), celiac disease 6(3.6%),Turner syndrome 5(3%) cases and unknown syndromes 4(2.4%) followed by other rare causes. Conclusion Common causes of short stature identified in this study were endocrine diseases followed by normal variant short stature (NVSS), while nonendocrine causes were the least.