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An unprecedented global health crisis has developed due to the emergence of the mysterious coronavirus-2 of the severe acute respiratory syndrome, which has resulted in millions of deaths around the globe, as no therapy could control the ‘cytokine storm’. Consequently, many vaccines have been developed and several others are being developed for this infection. Although most of the approved vaccines have been highly effective, many developing, and economically poor countries are still deprived of vaccination against SARS-CoV-2 due to the unequal distribution of vaccines worldwide. Furthermore, the uncertainty about the effectiveness of the available vaccines against the emerging mutants and variants also remains a matter of concern. Due to the multistep pathogenesis and unique features, combination therapy using safe immunomodulatory and antiviral drugs should be considered as the most effective and acceptable therapeutic regimen for this infection. Based on a thorough assessment of the literature, it was determined that it would be interesting to study the therapeutic potential of ivermectin and doxycycline, given their roles in several biological pathways involved in SARS CoV-2 pathogenesis. Following that, a comprehensive literature search was undertaken using Scopus, Web of Science, and Pubmed, depending on the inclusion and exclusion criteria. The present study provides a mechanism and comprehensive report, highlighting the role of combined therapy with ivermectin and doxycycline in alleviating the ‘cytokine storm’ of COVID-19 infection.

Pyrazole are potent medicinal scaffolds and exhibit a full spectrum of biological activities. This review throws light on the detailed synthetic approaches which have been applied for the synthesis of pyrazole. This has been followed by an in depth analysis of the pyrazole with respect to their medical significance. This follow-up may help the medicinal chemists to generate new leads possessing pyrazole nucleus with high efficacy.

Globalization has resulted in more women participating in the workforce, but it has also led to an alarming increase in human rights violations. A persistent issue in the modern workplace is harassment. Workplace harassment takes many forms, including verbal abuse, physical assault, discrimination, and sexual misconduct. It creates hostile and offensive experiences for individuals and groups, despite being illegal in many places. This not only hampers productivity and job satisfaction but also harms employees’ mental and physical health. Organizations have a moral and legal duty to address workplace harassment. Organizations should promote awareness of the legal and ethical consequences of sexual harassment through dialogue, leadership support, and accessible resources. Key strategies to combat workplace harassment include clear policies, training, inclusive culture, strong legal frameworks, victim support, monitoring, and collaboration. Implementing these strategies creates safe and thriving workplaces. This article focuses on workplace harassment, particularly sexual harassment against women. It highlights the prevalence of harassment, its various forms, and the challenges women face in addressing it. The article emphasizes the need for societal and governmental recognition to effectively combat workplace harassment. It also explores global and regional prevalence of workplace harassment, its consequences, and strategies for prevention.

Abstract Background The evaluation of undergraduate medical curricula plays a crucial role in ensuring effectiveness and helps in continuous improvement of the learning process. This study aims to compare the effectiveness of online and hybrid teaching models of the first-year MBBS curriculum in the COVID-19 era (2019–20) and the para-COVID-19 pandemic (2020–21). Study methodology Mixed methods study with CIPP model was used. Data was collected by administering a survey and focus group discussions (FGDs) with first-year students from the 2019–2020 and 2020–2021 cohorts, faculty and administrators, which were recorded for analysis. Recorded lectures, guidebooks, planners, and question papers were also scrutinized for quality and adequacy. Furthermore, admission merit, module assessments, and professional examination results were compared and correlated. The learning environment was evaluated through the questionnaire (validated and used by Pakistan Medical and Dental council for inspections of medical schools) and the facilities provided in both years were juxtaposed. The study utilized NVIVO for qualitative and SPSS version 23 for quantitative data analysis. Results Contextual analysis underscored the critical need for online teaching during the COVID-19 pandemic, with provided resources being deemed sufficient. Notably, the student-faculty ratio stood at 4:1, and essential resources were readily available. The fully online batch outperformed the hybrid teaching class in 2020–21. Process analysis revealed successful session delivery in hybrid and online through webinars and Zoom, accompanied by timely provision of study guides and punctual assessments. Moreover, examination papers demonstrated acceptable reliability (Cronbach’s alpha: 0.61) in core subjects. Product analysis indicated that the 2020–21 cohort performed better in modular and professional examinations across all subjects (P

ABSTRACT: BACKGROUND: One of the most frustrating challenges faced by the medico legal doctors / forensic pathologists is the inability to determine the cause of death in cases of sudden / unexpected deaths of medicolegal nature even after detailed autopsy as well as Histopathalogical / Toxicological analysis. OBJECTIVE: The study was aimed to find out the percentage of negative autopsy against the total cases of medicolegal autopsies conducted during the study period. MATERIAL AND METHODS: The study was carried out in the Department of Forensic Medicine & Toxicology, Punjab Medical College Faisalabad and was based upon five years autopsy data from 1st January 2006 to 31st December 2010. All the medicolegal autopsies conducted by the demonstrators of Forensic Medicine Department were included in the study whereas; the cases of alleged custodial deaths / police encounters and autopsies conducted by the District Standing Medical Board (DSMB) were excluded. The cases where gross examination at initial autopsy, histopathalogical examination & toxicological analysis failed to detect the cause of death were labeled as negative autopsies. STUDY DESIGN: Retrospective Study. SETTING & DURATION: The study was conducted in Forensic Medicine Department of Punjab Medical College Faisalabad; for a period of five years from 1st January, 2006 to 31st December, 2010. RESULTS: Out of the total 1681 autopsies, 1298 (77.22%) were males and 383 (22.78%) were females. After conducting detailed autopsy, histopathologic examination as well as toxicological analysis; 155 (9.22%) cases were found to be negative. The highest percentage of negative autopsy (12.30%) was found in year 2009 while average percentage of negative autopsy was 9.22%. Among the total 155 cases, the percentage of negative autopsy in males 119 (76.77%) was higher than females 36 (23.23%). The age of deceased ranged from 8 – 73 years. Majority i.e. 51 (32.90%) were in the age range of 20-29 years, followed by 38 (24.51%) in the age range of 30-39 years. Twenty nine (18.71%) cases were in the age range of 40-59 years and 21 (13.54%) cases belonged to the age group of 0-19 years. Among these negative autopsies, 92 (59.35%) belonged to the urban community and 63 (40.65%) were inhabitants of rural areas of Faisalabad. Majority of negative autopsies were of young adults from urban areas.

Background: Tutor has an essential role in conducting tutorial sessions and encouraging effective learning in students. The tutor develops learning objectives, monitors and clarifies the queries of students. Whereas students learn to understand and teach each other by participating and this helps the students better understand the subject and gain deeper knowledge of the various topics of each module in medical curriculum. The advantage of these sessions is to improve students understanding of topic, allowing time for discussion, and making them, self-learners. Problem-based learning (PBL) is a tool in medical education to teach and learn basic and clinical concepts in medicine and become self-learner. Aim of the study was, to evaluate the significance of tutorials as effective learning tool and was compared to problem – based learning for medical and dental undergraduate students, for topic understanding, time required to understand the topic, filling in gaps in knowledge and improvement in examination scores. Methods: Tutorial sessions and PBL were conducted as small group learning in Department of Pharmacology, Jinnah Medical and Dental College, Karachi, Pakistan. In each class of undergraduate MBBS and BDS, students were distributed into 10-12 students groups. Students, from MBBS III year students and BDS II year, participated in this study and filled in questionnaires at the end of tutorial sessions. Comparison of tutorial and PBL sessions were evaluated by a second questionnaire by MBBS undergraduate students. Conclusion: The study participants were undergraduate students of MBBS and BDS. They found the tutorial sessions were effective tool. Although in comparison to tutorial, the students found problem-based learning more significant in understanding concepts of medical curriculum.

ABSTRACT Background: The purpose of this study is to assess radiological features (CT and Ultrasound) of retinoblastoma in clinically susceptible patients. Methods: This study has been conducted at Jinnah Medical College and Hospital from January 2016 to January 2017. 39 children with clinical diagnosis of retinoblastoma referred from Layton Rahmatulla Benevolent Trust (LRBT) Eye hospital and by other eye clinics to Jinnah Medical College and Hospital Karachi. Ultrasound and CT scan of orbit of all children under the age 5 years was performed to see local tumor extent and associated intracranial primitive neuroectodermal tumor (trilateral retinoblastoma). Results: Out of 39 children with clinically suspected to have retinoblastoma, of these 32 were male and 7 were female children. Mean age of patients was 2.5 years. Out of 39, only 25 children had unilateral and 14 had bilateral intraocular tumor on ultrasound and CT scan. It appeared as a heterogenous mass with areas of calcification and retro- orbital extension, was better seen on CT images. Ultrasound of orbits showed calcification in only 29 children out of 39. Only 3 children found to have trilateral retinoblastoma. Ultrasound was found to bediagnostic but CT showed better results for imagining and diagnosis of retinoblastoma (unilateral, bilateral). Conclusion: This study shows that CT scan, is more accurate for the assessment of tumor size, localization and retro-orbital and intracranial extension of the retinoblastoma rather than other modalities. Thus CT scan, found to be affective in diagnosis, planning treatment and determining the prognosis of this disease. Key words: Retinoblastoma, Leukocoria, CT scan, Doppler Ultrasound.

Background: Prescription writing is highly intricate. It is a reflection of the prescriber’s knowledge of clinical pharmacology and well-defined judgment. Weak prescribing skills are mostly exhibited by junior doctors. Contributory factors include improper training, integrated system, and weak skills of the prescriber. Research provides substantial evidence that these flaws can be minimized through structured educational interventions. Objective: To evaluate medical and dental students on rational prescription writing, identification of elements and abbreviations of a prescription. Methods: A cross sectional study was performed on second year medical and dental students of Ziauddin University. In three 3 sessions, the students were taught rationale prescription writing, abbreviations, and elements used in prescription writing consecutively. The elements were based on doctor’s and patient’s information, followed by the drug component written explicitly. Each session was followed by exercises on case scenarios, to assess their comprehension of the topic. The p value < 0.05 was considered significant. Results: In the study 83% of the students completed components of rational prescription writing for a given case scenario, with 75% and 77% students identifying abbreviations and various elements in five tailor-made prescriptions respectively. Conclusion: Rational prescription writing is a curriculum-based inherent skill acquired by medical and dental students during their training. When rational prescription writing is taught together with elements of a prescription and abbreviations, it equips students with sound knowledge of clinical pharmacology and refines their judgment in formulating prescriptions. Key Words: Rational Prescription Writing, Elements, Medical Abbreviations.

Background: Obesity is responsible for beta dysfunction and insulin resistance. This is main cause of type 2 diabetes and excess in glycosylated hemoglobin. The concentration of glycosylation is directly proportional to the amount of blood glucose. It is investigated that oxidative stress can play a major role in the destruction of tissue that directly link with diabetic complication. This condition also associated with elevated level of lipid peroxidation. Murraya leaves may cause hypoglycemic and hypolipidemic effects and thus reduce lipid peroxidation in experimental animals. Methodology: The animals (rabbits) were randomly divided into three groups of equal size; a control group that did not receive any sort of modification in diet throughout the study while the group 2 and 3 were orally administered 10gm of fructose and 6gm of butter in addition to normal animal chow. While a dietary modification by addition curry leaves , was made in group 3 and it received 10g curry leaves per day for the next 45 days. The blood levels of glucose, glutathione and lipid profile were measured. Results: After consumption of Murraya leaves concentration of blood glucose and LDL-C, TC, TG was significantly decreased and increased HDL-C. Glutathione evaluation was used as a parameter for the oxidative stress showed a mark decline. Conclusion: Murraya leaves acted as anti-diabetic because it is also responsible to decrease the absorption of the glucose from gastrointestinal tract and anti-hyperlipidemic effects. KEY WORDS: Murraya Koeniigi, diabetes mellitus, hypoglycemic, anti-hyperlipidemic

Abstract Background Many physicians use point-of-care ultrasound (PoCUS) in their clinical practice to improve their diagnostic capabilities, accuracy, and timeliness. Over the last two decades, the use of PoCUS in the emergency room has dramatically increased. This study aimed to determine emergency physicians’ retention of knowledge and skills after a brief training workshop on a focused ultrasound-guided approach to a patient presenting with undifferentiated shock, shortness of breath, and cardiac arrest in the emergency department of a tertiary care hospital. The secondary aim was to deliver the PoCUS-guided algorithmic approach to manage a patient presenting with undifferentiated shock, respiratory distress, and cardiac arrest in the emergency department. Methods A quasi-experimental study was conducted with a single-day Point of Care Ultrasonographic Life Support in Emergency (PULSE) training workshop in October 2021 at the Aga Khan University Hospital, Karachi, Pakistan. A total of 32 participants attended the course, including twenty-one junior residents (PGY 1 and 2) and medical officers with experience of fewer than two years working in different emergency departments of urban tertiary care hospitals across Karachi, Pakistan. Pre- and post-assessment tools comprised a written examination, evaluating participants' knowledge and skills in ultrasound image acquisition and interpretation. Cronbach's alpha was used to calculate the validity of the tool. Results obtained before and after the training session were compared by the McNemar’s test. A p value of ≤ 0.05 was considered significant. Results There was a significant improvement in response to each question pre to post-test after completion of the course (Table 1). The significant change can be seen in questions 7, 8, 13, and 15, with a percentage change of 33.3, 80.9, 42.9, and 47.7. There was a significant improvement in the understanding and knowledge of participants after the training. The scores in the post-test were high compared to the pre-test in each category, i.e., respiratory distress (p

Background The Society for Cardiovascular Angiography and Interventions proposed a staging system (A–E) to predict prognosis in cardiogenic shock. Herein, we report clinical outcomes of the RECOVER III study for the first time, according to Society for Cardiovascular Angiography and Interventions shock classification. Methods and Results The RECOVER III study is an observational, prospective, multicenter, single‐arm, postapproval study of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support. Patients enrolled in the RECOVER III study were assigned a baseline Society for Cardiovascular Angiography and Interventions shock stage. Staging was then repeated within 24 hours after initiation of Impella. Kaplan‐Meier survival curve analyses were conducted to assess survival across Society for Cardiovascular Angiography and Interventions shock stages at both time points. At baseline assessment, 16.5%, 11.4%, and 72.2% were classified as stage C, D, and E, respectively. At ≤24‐hour assessment, 26.4%, 33.2%, and 40.0% were classified as stage C, D, and E, respectively. Thirty‐day survival among patients with stage C, D, and E shock at baseline was 59.7%, 56.5%, and 42.9%, respectively (P=0.003). Survival among patients with stage C, D, and E shock at ≤24 hours was 65.7%, 52.1%, and 29.5%, respectively (P

Background: Noncompliance to treatment is a widespread problem globally, particularly among people with chronic conditions like diabetes mellitus. Objective: We aimed to assess the frequency of treatment noncompliance and its associated factors among patients with type 2 diabetes. Methods: The study was conducted at the family medicine outpatient clinics at the Aga Khan Hospital during one month from 1st to 30th December, 2019. Using a cross-sectional design, we recruited 151 patients with type 2 diabetes who willingly agreed to participate in the research. We employed a pre-approved, self-administered, and structured questionnaire to gather data on demographics, clinical features, and treatment compliance among patients. Results: There were 77 female and 74 male participants. The average age of the participants was 54.7±11.5 years. Among the 151 individuals in the study, 112 were noncompliant with their prescribed treatment. There was a significant association between treatment non-compliance and lower monthly income (p=0.039), participant’s age (p=0.020), and duration of the disease exceeding 5 years (p

Monkeypox has emerged as the most significant human pathogen in recent times and is a rapidly growing threat to public health globally. Monkeypox virus is an orthopoxvirus, that belongs to the Poxviridae family. The smallpox virus also belongs to this family. Monkeypox virus, endemic to Central and West Africa can infect various animal species but can also transmit to humans. Monkeypox viruses circulate among wild animals and usually spread to people when they eat or have other close contacts with infected animals. Getting bitten or scratched by the infected animal, direct contact with its bodily fluids, blood, blisters or scabs; indirect contact with lesion material, e.g. contaminated bedding, linens and even eating the undercooked animal infected with monkeypox, could result in transmission. Among humans, Monkeypox is contracted through close physical contact, and contact with contaminated materials. Monkeypox presents with fever, headaches, myalgia, and enlarged lymph nodes. This is followed by a rash that starts from mouth to face and spreads to the trunk and arms. The illness is usually mild and patients fully recover within four weeks. Nucleic acid testing (NAT) is the primary diagnostic tool for detection. Polymerase chain reaction (PCR) is the preferred method for NAT. Treatment is mainly supportive and is directed to alleviate symptoms, prevent long-term sequelae and mitigate disease spread. Patients require isolation and symptomatic care. The smallpox vaccine, antiviral agents and vaccinia immunoglobulin (VIG) have been used in earlier outbreaks but sufficient evidence to recommend their use is still lacking.

Background: Family physicians constitute the fundamental core of the health system in many parts of the world. However, medical students’ diminishing interest in Family Medicine remains a challenge worldwide. Objective: To assess medical students’ awareness of the Family Medicine specialty and their interest towards selecting Family Medicine as a career. Methods: This cross-sectional study was conducted among medical students of a private medical university in Karachi from January 2021 to June 2021. A total of 333 students from all 5 years of Medicine were given a structured self-administered questionnaire assessing their awareness of Family Medicine, and their interest in it as a future career choice. Results: Response rate was 100%. 91% of students had heard of Family Medicine, 80.8% knew it as a recognized specialty. 91.6% knew family physicians treat individuals of all ages and gender. 88.9% knew family physicians provide comprehensive coordinated care. 82.9% agreed Family Medicine should be taught in the undergraduate curriculum. 95.5% think family physicians can change the healthcare system of Pakistan, and 54.1% have interest in Family Medicine as a future career choice. Among the top three specialty choices, General Surgery ranked first, Emergency Medicine ranked second and Family Medicine ranked third. Conclusion: To attract students to choose a career in Family Medicine, it needs to be an essential part of undergraduate medical education. Career counselling, mentorship and role modelling can help foster interest among students in this field.

Objective: To assess the knowledge of physicians working in the emergency department in choosing appropriate diagnostic imaging in different clinical scenarios. Method: The cross-sectional study was conducted at the Emergency Department of the Aga Khan University Hospital, Karachi, from January 3 to July 2, 2018, and comprised registered medical officers, residents, and consultants of either gender involved in emergency care decision-making. Data was collected using a structured questionnaire that had 10 clinical scenarios based on the American College of Radiology Appropriateness Criteria guidelines. Data was analysed using SPSS 17. Results: Of the 82 participants, 50(61%) were males and 32(39%) were females. The overall mean age was 34.06±6.42 years. Of the total, 50(61%) subjects had appropriate knowledge regarding imaging. The overall mean number of correct responses was 6.90±1.20. Those belonging to the Emergency Medicine specialty had significantly higher odds of having appropriate knowledge compared to participants belonging to other specialties when adjusted for age, gender, position of practice and years of Emergency Medicine training (Odds ratio: 4.73; 95% confidence interval: 1.07-20.91). Conclusion: Physicians belonging to the Emergency Medicine specialty were more likely to have adequate knowledge regarding imaging appropriateness compared to other specialties. Key Words: Appropriateness criteria, Emergency medicine, American College of Radiology, Resident education, Guidelines.

The centrality of teamwork in ensuring the effective functioning of institutions across all sectors is undeniable. However, embedding teamwork into higher education has been hampered due to a range of deeply entrenched practices associated broadly with the foregrounding of knowledge, beliefs about the place of skill training and routines of assessment. As a result, despite an urgent need to address teamwork, little progress has been made with respect to progressing teamwork education. We have designed and evaluated a novel teamwork module delivered to fourth‐year undergraduate medical students involving placements, a cocreated piece of work, reflection and summative peer assessment. This paper aimed to investigate whether the module increased students’ insight into teamwork, including their own skill development, and whether their perceptions of teamwork changed. Throughout the evaluation, students played a key role, with four final‐year medical students working alongside others in the multidisciplinary project team. Five distinct themes emerged from our in‐depth, semi‐structured interviews: (a) importance and meaning; (b) insight into skill development; (c) transferability; (d) peer assessment; and (e) resistance to teamwork education. Themes had positive and negative components, and student perceptions changed in multiple ways after experiencing a longitudinal educational opportunity to develop their teamwork skills. Before practice, students focused on superficial explanations and on where they might improve. In contrast, after practice, students conveyed deeper insights, contextualisation, focus on how they might improve, and shared structured reflection.

Incidence of chylothorax post-esophageal stenting has not been reported. We present a 40-year-old female with metastatic breast cancer who presented with dyspnea. She was recently hospitalized for dysphagia secondary to a mediastinal mass requiring an esophageal stent. CT chest now reported large bilateral pleural effusions. A benign chylothorax was drained from the right side. After persistent high-output drainage, a review of her CT chest revealed thoracic duct impingement by the esophageal stent. The stent was retracted proximally, and pleural fluid output subsequently decreased. Repeat fluid analysis revealed a transudative effusion. This is the first reported case of esophageal stenting causing reversible chylothorax.

Background: Surgical approaches used in the treatment of patients with severe lumbar spondylolisthesis( Grade II and Grade III)are usually associated with a great deal of controversies. The objective of the study was to assessthe surgicaloutcomes of severe Lumbar spondylolisthesis treated with either pedicle screw fixation,reduction and fusion or instrumented Fusion in-situ. Methods: We retrospectively studied 32 patients (20 females and 12males),whohadsevere lumbar spondylolisthesis. All patients were divided in two groups (group Areduction and fusionand group B fusion in-situ).The mean follow-up period was 6 months. Radiological and clinical outcomes were measured by slip percentage, slip angle correction rate, Oswestry Disability index(ODI), visual analogue scale (VAS). Data was analyzed by SPSS version 22.0 Results: The analysis of the preoperative visits and final follow-up of all patients indicated that vertebral reduction and fusioncould slightly enhance the surgicaloutcome in comparison to instrumentedfusion in situ. Preoperative and Postoperative data was collected in all patients and found VAS from7.76to 2.08 in group-A and VAS from 8.5 preoperative to 2.4 postoperative in group-B and ODI from69.42% to 20.06 % in group-Aand 70.9% to 22% in group-B and mean slipcorrection rate was59.8 % . There wasno single caseof loss of reduction. Conclusion: The reduction, fusion and spinal decompression enhances surgical outcome and it can be concluded thatsuch procedure is slightly superior over fusionin situ.Excellent and good levels of satisfaction were observed in all group-A patients,although surgical time was slightly more than fusion in-situ group.

Introduction: Convolutional neural networks (CNNs) have maintained their dominance in deep learning methods for human action recognition (HAR) and other computer vision tasks. However, the need for a large amount of training data always restricts the performance of CNNs. Method: This paper is inspired by the two-stream network, where a CNN is deployed to train the network by using the spatial and temporal aspects of an activity, thus exploiting the strengths of both networks to achieve better accuracy. Contributions: Our contribution is twofold: first, we deploy an enhanced spatial stream, and it is demonstrated that models pre-trained on a larger dataset, when used in the spatial stream, yield good performance instead of training the entire model from scratch. Second, a dataset augmentation technique is presented to minimize overfitting of CNNs, where we increase the dataset size by performing various transformations on the images such as rotation and flipping, etc. Results: UCF101 is a standard benchmark dataset for action videos, and our architecture has been trained and validated on it. Compared with the other two-stream networks, our results outperformed them in terms of accuracy.

Objective: To quantify the strength of dominant and non-dominant wrist flexors with respect to grades of manual muscle testing in young healthy females of different age group. Methods: In this cross-sectional study 300 young healthy females in the age of 18-39 years were enlisted. The sampling technique employed was non-probability convenienceampling. The strength of dominant and non-dominant wrist flexors of young females was quantified through manual muscle testing and hydraulic Hand-Held dynamometer. The strength measured by dynamometer was then evaluated and formulated in accordance with grade 4 and 5 in three different age groups. The SPSS version 25 was used for data analysis and the values were formulated by comparing mean values of the quantitative strengths with respect to grades in respective age group through independent sample t-test. Results: In dominant side 182 (60.70%) participants had normal muscle strength with quantitative mean as 7.24 kg and range of dynamometrical measures was 3.63-15.65kg, the muscle strength of 118 (39.30 %) participants was in grade 4 with quantitative mean to be 6.55 1.42kg minimum-maximum range of strength was 3.17-11.68kg;. In non-dominant side 183 (61.00%) participants were in grade 5 with dynamometric mean as 7.05 kg and range of variation of muscle strength was 3.17-11.45kg. 117 (39.00%) participants were found to have strength of wrist flexors in grade 4, with dynamometric mean as 6.40 kilogram and minimum-maximum range varying between 2.95-11.68kg. Conclusion: The available range of strength measured by dynamometer in dominant and non-dominant wrist flexors of young healthy females showed overlap between grade 4 and 5 revealed by minimum and maximum ranges across both grades. A significant number of normal healthy population had weaker wrist flexors. The dominant side was stronger as compared to non-dominant. Keywords: Muscle Strength Dynamometer, Muscle strength, Wrist flexors.

Background:Patients on antidepressant therapy have no contact with their physicians until their next appointment, which in most cases could be more than two weeks apart. This crucial time is of utmost importance as this could assess the patient's will to follow the prescribed therapy and the general belief about the benefits of using antidepressant treatment. Thus medication adherence is necessary to reduce the risk of suicidal tendencies and mortality in these patients. The study aimed to evaluate medication adherence and adherence to antidepressant therapy in patients with major depressive disorder.Methodology:in this cross-sectional study, a total of 101clinically diagnosed patients with Major Depressive Disorder (MDD) were included in the study from psychiatric and medical OPD from June 2018 to June 2019, from Jinnah Medical College Hospital (JMCH). Belief about medicines questionnaire (BMQ specific and BMQ general), regarding their views about the prescribed medication and the modified questionnaire of the medication adherence scale used, scores were calculated to give a numerical value to measure the adherence to antidepressant medication.Results:According to the study, 101 patients with major depressive disorder had an overall good belief about medication but have low adherence. Belief about medicines questionnaire (based on BMQ) BMQ-the specific q1-10 score was 36.54 (necessity, concern), BMQ-general 27.98 score, q11-18 (overuse and harm). Regarding their views about the prescribed medication. 86% of participants with the major depressive disorder had low adherence (scores 0-5), and those with high adherence were only 14% (scores 6-8). The patients diagnosed with the major depressive disorder who had co-morbid (diabetes, hypertension, hypothyroidism, etc.) had better adherence for their prescribed treatment as compared to those without co-morbid.Conclusion:This study indicates that although patients with major depressive disorder from tertiary care hospitals in Karachi had a positive belief about medication but have low adherence to antidepressant therapy.

Background: In the field of family medicine, patient satisfaction holds the utmost value. Patient satisfaction surveys help family physicians; understand their patients' needs, learn about patients' experiences, identify areas of dissatisfaction, improve their practice and increase job satisfaction. Objective: To determine the association of patients' satisfaction with demographic and socio-economic characteristics of patients visiting the family medicine clinics of the Aga Khan University. Methods: This cross-sectional study was conducted at family medicine clinics at the Integrated Medical Service Centers, Aga Khan University, Karachi, from January 2017 to July 2017. A total of 160 consecutive patients (48 males and 112 females, age range 18 – 65 years) visiting the family medicine clinics were recruited with informed consent. A validated questionnaire consisting of 18 items was administered to all patients who consented to participate in the study. The reasons for dissatisfaction were also assessed. Descriptive statistics were calculated. Stratification was done, and the association of satisfaction with age, gender, marital status, education, and economic status was investigated using the chi-square test. The p-value ≤0.05 was considered significant. Results: Out of a total of 160 study participants, 86.3% indicated their satisfaction, while 13.8% were found to be dissatisfied with the services at the family medicine clinic. The most common reason (50%) for dissatisfaction among the dissatisfied patients was the state of OPD facilities. On chi-square analysis, gender (p=0.028), education level (p=0.010) and socioeconomic status (p=0.002) were found to be significantly different among satisfied and dissatisfied patients. On multivariable analysis, education, marital status and socioeconomic status were found to be independently associated with patient satisfaction. Conclusion: The results showed that higher satisfaction was associated with higher education, higher socioeconomic status and higher among the widowed population.