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Objective: To compare the effectiveness of flipped classroom and video-assisted learning techniques with didactic lectures in promoting clinical reasoning skills in Forensic Medicine., Study Design: Quasi-experimental study. Place and Duration of the Study: Department of Forensic Medicine, Dow International Medical College and Dow University of Health Sciences, Karachi, Pakistan, from May to October 2023., Methodology: The study included 114 third-year medical students divided into three predefined tutorial groups. Over four weeks, within the Forensic Medicine respiratory module, each group was taught one topic per week using a distinct teaching strategy: Traditional lectures (TL) for the first group, flipped classroom (FC) method for the second group, and video-assisted teaching (VAT) for the third group. Students' learning achievements and clinical reasoning skills were assessed through a pre-test, post-test, and revision post-test., Results: Pre-test scores showed no significant differences among the groups (p = 0.655). However, post-test scores differed significantly (F2:111 = 11.93, p <0.001). Tukiye's test indicated that the mean score for the FC group was significantly different from the TL group (p = 0.003) and the VAT group (p <0.001), but there was no significant difference between the TL and VAT groups (p = 0.422). The revision post-test indicated a significant decrease in mean scores across all groups, regardless of the instructional approach (p <0.001)., Conclusion: The FC approach for teaching clinical reasoning in Forensic Medicine shows promising results, effectively improving student performance and learning experience., Key Words: Flipped classroom, Video-assisted teaching, Clinical reasoning, Forensic Medicine teaching.

Irrigation of food crops with untreated wastewater leads to the accumulation of heavy metals in their edible parts. Exposure to toxic elements through consumption of contaminated vegetables even at very low concentration is becoming a serious problem for human health in many countries. This issue of heavy metals contamination needs great attention especially in Pakistan where irrigation by wastewater has become a common practice in urban and periurban areas. The present study was conducted to assess the contamination of different heavy metals including nickel (Ni), cadmium (Cd), lead (Pb) and chromium (Cr) in vegetables irrigated with wastewater in different districts of Punjab (Pakistan) like, Faisalabad, Lahore, Gujranwala, Sargodha, Sahiwal, Multan, Rawalpindi and Bahawalpur during years 2016-2019. The maximum contamination factor (Ni, 1.39; Cd, 5.86; Pb, 3.99; Cr, 2.24), pollution load index (2.92) and degree of contamination (13.48) were observed in wastewater irrigated agricultural soils of district Gujranwala as compared to other districts. Mean metal concentration in vegetables grown with untreated wastewater and transfer factor varied with plant type, frequency of irrigation and soils types/series of different districts of Punjab. The highest metal contamination was observed in Gujranwala where 44% vegetable samples were contaminated with Ni, 87% with Cd, 97% with Pb and 88% with Cr. Radar analysis and hierarchical cluster analysis showed that mustard leaves, spinach and lettuce were more contaminated vegetables compared to other vegetables. This study contributes to the evidence-based conclusion that cultivation of vegetable with untreated wastewater should be prohibited and required treatment of wastewater is needed., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: To determine the association of chronological age through ossification of the medial clavicular epiphysis using computed tomography (CT) scan., Study Design: An Observational study. Place and Duration of the Study: Dow Institute of Radiology, Dow University Hospital, Karachi, Pakistan, from February 2021 till October 2021., Methodology: Subjects aged 10-35 years of either gender reported without any clavicular trauma or fracture, no known chronic illness or malignancy, or no congenital bony abnormalities, or any prior surgical intervention to the sterno-clavicular region were included. The fusion of maturity of medial clavicular epiphyses was evaluated on either side by using the five-stage classification system reported by Schmeling., Results: Of 200 patients, a significant increase in the age of the patients was observed with respect to the increase in the stages (p <0.001). When stratified on the basis of gender, a significant increase in age was also observed with respect to the increase in stages (p <0.001). Stage 4 was observed in majority of the patients, i.e., 81 (40.5%), followed by stages 2 and 3 in 35 (17.5%) each, stage 5 in 32 (16%), while stage 1 was observed in 17 (8.5%) patients. An insignificant difference of age was observed with respect to the gender of the patients (p= 0.472, 95% CI -2.91 - 1.35)., Conclusion: The fusion of the medial clavicular epiphysis showed a considerable degree of variability. Fused clavicles at stage 4 could be observed at age 22 years or less in males while at 21 years or less in females., Key Words: Age estimation, Schmeling method, Medial clavicular epiphysis, Computed tomography.

There are scarce data about the accumulation pattern and risk assessment of potentially toxic elements (PTEs) in soil and associated potential ecological risks, especially in less-developed countries. This study aims to assess the pollution levels and potential ecological risks of PTEs (As, Cr, Cd, Cu, Ni, Mn, Pb and Zn) in wastewater-irrigated arable soils and different edible-grown plants in selected areas of Vehari, Pakistan. The results revealed that the values of PTEs in soil samples were higher than their respective limit values by 20% for As, 87% for Cd, 15% for Cu, 2% for Cr, 83% for Mn, 98% for Fe, and 7% for Zn. The values of soil risk indices such as the potential ecological risk (PERI >380 for all samples), pollution load index (PLI >4 for 94% of studied samples), and degree of contamination (Dc > 24 for all samples) showed severe soil contamination in the study area. Some vegetables exhibited a high metal accumulation index (e.g., 8.1 for onion), signifying potential associated health hazards. Thus, long-term wastewater irrigation has led to severe soil contamination, which can pose potential ecological risks via PTE accumulation in crops, particularly Cd. Therefore, to ensure food safety, frequent wastewater irrigation practices need to be minimized and managed in the study area., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Respiratory infections, especially those of the lower respiratory tract, remain a foremost cause of mortality and morbidity of children greater than 5 years in developing countries including Pakistan. Ignoring these acute-level infections may lead to complications. Particularly in Pakistan, respiratory infections account for 20% to 30% of all deaths of children. Even though these infections are common, insufficiency of accessible data hinders development of a comprehensive summary of the problem. The purpose of this study was to determine the prevalence rate in various regions of Pakistan and also to recognize the existing viral strains responsible for viral respiratory infections through published data. Respiratory viruses are detected more frequently among rural dwellers in Pakistan. Lower tract infections are found to be more lethal. The associated pathogens comprise respiratory syncytial virus (RSV), human metapneumovirus (HMPV), coronavirus, enterovirus/rhinovirus, influenza virus, parainfluenza virus, adenovirus, and human bocavirus. RSV is more dominant and can be subtyped as RSV-A and RSV-B (BA-9, BA-10, and BA-13). Influenza A (H1N1, H5N1, H3N2, and H1N1pdm09) and Influenza B are common among the Pakistani population. Generally, these strains are detected in a seasonal pattern with a high incidence during spring and winter time. The data presented include pneumonia, bronchiolitis, and influenza. This paper aims to emphasise the need for standard methods to record the incidence and etiology of associated pathogens in order to provide effective treatment against viral infections of the respiratory tract and to reduce death rates., (© 2018 John Wiley & Sons, Ltd.)

Diarrhoea is an important public health problem in Balochistan, the westernmost province of Pakistan. Although the use of oral rehydration solutions (ORS) has been widely promoted, no studies have been reported on the actual uses of ORS in treating infant diarrhoea by the medical doctors in this region. The medical practices of 30 doctors in Balochistan were surveyed. The surveyors posed as the mothers of infants with diarrhoea. The questions asked by the doctors, the physical examinations performed, and the treatments prescribed were noted. The histories and physical examinations were incomplete, as performed by most practitioners. In addition, 80% of the doctors prescribed drugs, usually kaolin preparations to treat diarrhoea. However, 18 of the 30 (60%) practitioners also prescribed ORS for treating diarrhoea and most of them gave some recommendations about ORS use. It is concluded that many medical practitioners have incorporated ORS treatment into their practices. Ongoing educational programmes and refresher courses would likely improve the use of ORS further in this region.