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Background: Dysfunctional uterine bleeding is the idiopathic complication in premenopausal females or females that have chance to get pregnancy. It can have significant impact on quality-of-life of female and also lead to several complications including subfertility. Objective: To determine the frequency of dysfunctional uterine bleeding in patients presenting with problem of sub-fertility. Study design: Cross sectional study. Setting: Department of Obstetrics & Gynaecology, Lahore General Hospital, Lahore. Duration: 3 months (July to October 2020). Method: Sample size of 150 patients were enrolled in the study through Non Probability, Consecutive Sampling. Patients of age 20-40 years, presented with diagnosis of subfertility were included. Then females were evaluated for presence of dysfunctional uterine bleeding. Data was recorded on proforma and analyzed by using SPSS version 22. Results: The mean age of females was 32.56 ± 8.93 years. The mean BMI of females was 29.61 ± 12.43 kg/m2. The mean duration of marriage was 8.94 ± 3.47 years. There were 97 (65%) females with primary subfertility while 53 (35%) females had secondary subfertility. Out of 150 females, dysfunctional uterine bleeding was noted in 69 (46%) females while 81 (54%) females did not had dysfunctional uterine bleeding. In females with primary subfertility, dysfunctional uterine bleeding was observed in 38 (39.2%) females. In females with secondary subfertility, dysfunctional uterine bleeding was observed in 31 (58.5%) females. The difference was significant (p

This article, while attempting to rethink the media historiography of South Asia, traces the early origins of press systems in princely India. Focusing on Jammu and Kashmir state, it offers an assessment of socio-political and historical factors which contributed to the trajectory of growth of the press in the state while tracing its relationship with the princely politics, indigenous politico-religious movements, and the British colonial state vis-a-vis an emerging colonial public. The larger aim of the article is to shift focus to media cultures of princely India and bring them onto the centre stage of postcolonial historiography. We argue that such a study of the press systems—which existed in princely states but have hitherto remained a neglected subject—will not only complement the current understanding of postcolonial media studies but substantially offer an alternative reading of the dominant discourse within postcolonial studies. The article maps the webs of patronages, loyalities, struggles and resistance that marked the coming of the periodical press in the state and how they differently shaped its practices, aspirations and outcomes.

Objective: To assess the perceptions of 2nd year medical students regarding certain approaches introduced in the course of Nutrition and Metabolism module. Method: The descriptive study was conducted at the Shifa College of Medicine, Islamabad, Pakistan,in December 2020, and comprised all 2nd year medical students who completed the Nutrition and Metabolism module in which new components had been added, including introduction to community nutrition, school visits, Islamic perspective of nutrition, journal club and e-posters.Data was collected usinga questionnaire based on the modified Dundee Ready Education Environment Measure, and had 5 categories with a total of 25 questions that were scored on a 5-point Likert scale. Data was analysed using SPSS 22. Results: Of the 100students, 65(65%)were females and 35(35%)were males. The overall mean age was 20.5 ± 0.5 years. The total mean score was 74.68±2.53. mean score for student’s perception of learning was 38.17±0.17, student’s perception of teachers 9.27±0.18, student’s academic self-perceptions 12.1±0.11, student’s perceptions of atmosphere 9.03±0.03 and student’s social self-perceptions 6.11± 0.01. Conclusion: The perceptions medical students about innovations were positive, showing an encouraging attitude in terms of learning approach and outcome. Key Words: Educational environment, Problem-based learning, DREEM, Innovations, Shifa college.

Background: Placenta Previa is one of the major obstetric complication. It is a serious condition that may lead to severe morbidity and mortality. The risk of cesarean and blood loss, particularly, in emergency cesarean section. Objective: To compare the mean blood loss and need for blood or blood products with emergency versus elective cesarean section in females with placenta previa. Study design: Cohort study. Settings: Department of Obstetrics & Gynaecology. Duration: 3 months (April to June 2020). Method: Sample size of 70 patients were enrolled in the study through Non Probability, Consecutive Sampling. Patients of age 20-40 years, presented >24 weeks of pregnancy, with diagnosis of placenta previa were included. Then females were booked and were followed-up in OPD till delivery. Emergency cesarean section was done if active labor and bleeding started while elective cesarean was done on given date for delivery. Intraoperative blood loss and need for blood or blood components transfusion was noted. Data was recorded on proforma and analyzed by using SPSS version 22. Results: The mean age of females in emergency group was 30.80 ± 4.36 years and mean age of females in elective group was 31.06 ± 3.76 years. The mean gestational age of females at delivery in emergency group was 35.74 ± 2.89 weeks and in elective group was37.54 ± 0.70 weeks. The average blood loss during emergency caesarean section was 1471.43 ± 891.65 ml while during elective cesarean section, average blood loss was 1042.86 ± 402.41 ml (p

To assess the perspectives of the first year and second year MBBS students of College, regarding the effectiveness of flipped classroom learning as compared to the traditional mode of teaching.A descriptive study.Shifa College of Medicine, Islamabad, Pakistan, from August to September 2021.This descriptive study was conducted on all first and second year MBBS students in College after informed consent. A self-developed questionnaire formulated after a thorough literature search, with 16 questions was given. Quantitative data was collected after ethical approval and was analysed using SPSS version 22. Percentages and mean were calculated for descriptive analysis whereas qualitative data was analysed through thematic analysis Results: Out of the 156 responders, 61% students believed that flipped classroom buttressed a better understanding of study objectives, 24% stated that it didn't make much of a difference whereas 15% had a negative response in this respect. The majority (90%) reckoned that learning beforehand fostered better discussions and made the whole learning process much easier. Seventy-five percent believed that it has improved their grades. Although, some students did point out that sometimes meandering through various study sources consumed a lot of their time but overall they held a satisfactory opinion of flipped pedagogy (85%).The students enrolled in the study asserted the usage of flipped classrooms as a likeable and preferable teaching method in medical institutions. Not only it engaged students in active learning and helped them improve their grades but also enabled them to sharpen cognitive and presentation skills, which are the prime objects of undergraduate pedagogy.Flipped classroom, Medical education, Medical students, e-learning.

BACKGROUND Deep learning-based radiological image analysis could facilitate use of chest x-rays as triage tests for pulmonary tuberculosis in resource-limited settings. We sought to determine whether commercially available chest x-ray analysis software meet WHO recommendations for minimal sensitivity and specificity as pulmonary tuberculosis triage tests. METHODS We recruited symptomatic adults at the Indus Hospital, Karachi, Pakistan. We compared two software, qXR version 2.0 (qXRv2) and CAD4TB version 6.0 (CAD4TBv6), with a reference of mycobacterial culture of two sputa. We assessed qXRv2 using its manufacturer prespecified threshold score for chest x-ray classification as tuberculosis present versus not present. For CAD4TBv6, we used a data-derived threshold, because it does not have a prespecified one. We tested for non-inferiority to preset WHO recommendations (0·90 for sensitivity, 0·70 for specificity) using a non-inferiority limit of 0·05. We identified factors associated with accuracy by stratification and logistic regression. FINDINGS We included 2198 (92·7%) of 2370 enrolled participants. 2187 (99·5%) of 2198 were HIV-negative, and 272 (12·4%) had culture-confirmed pulmonary tuberculosis. For both software, accuracy was non-inferior to WHO-recommended minimum values (qXRv2 sensitivity 0·93 [95% CI 0·89-0·95], non-inferiority p=0·0002; CAD4TBv6 sensitivity 0·93 [0·90-0·96], p

Objective: To assess the learning impact of e-curriculums on healthcare professionals (HCPs). The second objective was to report the screening, detection and clinical features of patients with obstructive lung diseases (OLD) through an integrated care program at The Indus Hospital & Health Network (IHHN), Karachi, Pakistan. Methods: A retrospective, observational study was conducted in the Family Medicine outpatient department from January 2019 till July 2021. HCPs were trained on the diagnosis and management of OLD through e-learning. Patients were screened clinically for OLD and had spirometry performed if suspect. Baseline characteristics, patient-reported outcome measures (PROMs), spirometry and treatment modalities were collected. Univariate analysis was done on Excel and paired t-testing was performed on Stata 16. Results: Online training on clinical aspects of OLD was completed by 33 HCPs, amongst whom 77.9% demonstrated improved post-test evaluations of 26.8% (p=0.000). Of 1896 patients screened, 60.8% were diagnosed as OLD. Asthmatics accounted for 66.5% (60.9% females, median age 39 years). In 84.5% of patients who completed PROMs, poor control of symptoms was reported. Inhaler technique was taught in 66.5%. Breathless patients, with a high modified Medical Research Council score (mMRC ≥ 2, n=234), were referred for pulmonary rehabilitation in 92% of cases. Tobacco cessation advice was delivered to 61.1% of all current users (n=229). Conclusion: The OLD program uses capacity building, gold standard diagnostics and updated management strategies in primary care, allowing earlier diagnosis of suspected patients and implementation of evidence-based interventions, aiming to improve their morbidity and mortality. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5781 How to cite this:Saeed S, Siddiqui M, Altaf R. The Obstructive Lung Diseases Program: Integrated obstructive lung disease services within primary care in Pakistan. Pak J Med Sci. 2022;38(2):334-339. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5781 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.

doi: https://doi.org/10.12669/pjms.38.ICON-2022.5788 How to cite this:Saeed S, Shahroz IM, Khan SU, Agha AA. Voice against tobacco: A call for integrated action for effective change. Pak J Med Sci. 2022;38(2):436-437. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5788

Objective: To evaluate usefulness of e-learning tools in teaching integrated clinical biochemistry. Methodology: The study was carried out on the 1st year medical students of Shifa College of Medicine, Shifa Tameer-e-Millat University. Students were given questionnaire to fill. Statistical procedures were performed with the SPSS software. The qualitative data is presented in the form of frequency and percentages. Results: More than half of the students were already aware of some form of e-learning tool. Most beneficial tool was YouTube followed by Dropbox, WhatsApp. Most of the students wanted recorded video lectures, more online books and more handouts. Majority students wanted a combination of both forms of learning. Conclusion: e-learning means learning which involves technology. It aids in understanding concepts. The best form is blended learning, which is a combination of e-learning and traditional learning. Students found e-learning to be effective and economical. Students of Pakistan are using smart phones, iPads, computers, etc. Their integration will require development of computer systems and training of faculty members. Different institutes may select different modalities depending on their requirement, faculty training and financial resources.

Laparoscopy is considered to be a good diagnostic and surgical way to replace open surgeries in all surgical fields. As it is a least invasive method, with advantages for patients and all associated with medical care. There is a significant increase in the use of laparoscopic surgery in gynecology. This study was done to compare the frequency of operative complications of direct trocar access versus Veress needle insertion technique for initial peritoneal entry in patients undergoing gynecological laparoscopic surgery.This Randomized Controlled Trial was conducted at the Department of ObstetricsGynecology, Lahore General Hospital, Lahore from 26-12-2019 to 25-6-2020. Four hundred consecutive patients were enrolled and divided randomly into two groups by blocked randomization. Direct trocar insertion (DTI) technique was used for initial peritoneal access in group A and Veress needle (VNI) was inserted first for peritoneal access in group B.The mean age of the patients in DTI group was 35.76±8.38 years whereas that in VNI group was 35.85±8.38 years. In DTI group there were 8(4%) patients with extra-peritoneal insufflation and in VNI group there were 19(9.5%) patients with extra-peritoneal insufflation. There were 8(4%) patients in DTI group with Omental injury and VNI group there were 13(6.5%) patients with Omental injury. In DTI group there were 7(3.5%) patients with port-site infection compared to 15(7.5%) in VNI group.According to findings the rate of complications observed with VNI, DTI can be a preferred procedure for gynecological surgeries.

The overwhelming evidence for the benefits of pulmonary rehabilitation (PR) in patients with chronic respiratory diseases has become indisputable. However, it is still underutilised in low-middle income countries such as Pakistan. We aim to identify factors that affect patient attendance of, and adherence to, PR in order to improve our efforts to increase uptake. We conducted a retrospective analysis on referrals to an 18-session PR program at a free-of-cost, charity-based hospital in Karachi, Pakistan. Patients were categorised into attendance (0 or > 0 sessions) and adherence ( ≤ 12 or > 12 sessions) groups. Data collected included sociodemographic factors (age, gender, smoking, marital and employment status, distance from healthcare facility, free transport service usage and health-related factors (exposure to indoor biomass burning, body mass index (BMI), forced expiratory volume (FEV1), and home oxygen use). Statistical analysis was performed using Stata 14. Of 86 referred patients, 38.4% did not attend, 24.4% were not adherent, while 37.2% were adherent. Univariate analysis showed patients exposed to indoor biomass (non-attendance: 21%, non-adherence: 33%, adherence: 47%), those with lower mean FEV1 levels (0.89L, 0.75L, 0.71L), and those who were females (39%, 48%, 63%) were associated with attendance and adherence groups. The average travelling distance from the healthcare facility for non-attendance and non-adherence groups were 11.3 and 10.5 kilometres respectively, while the adherence group travelled 6.9 kilometres. Multiple linear regression showed shorter travelling distances to attend PR (p=0.046) and use of free transport (p=0.006) were independent predictors of attendance and adherence groups. No significant differences were seen in other factors. Many eligible patients did not attend, or adhere to, an available PR program. Distance travelled and/or use of free transport services significantly influenced attendance and adherence. Thus, further implementation steps in our setting may focus on increased transport facilities or developing home-based PR services to maximise attendance.

Objective To evaluate the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with covid-19 admitted to hospital wards. Design Randomised controlled, adaptive, open label clinical trial. Setting 28 hospitals in Brazil, Canada, Ireland, Saudi Arabia, United Arab Emirates, and US. Participants 465 adults admitted to hospital wards with covid-19 and increased D-dimer levels were recruited between 29 May 2020 and 12 April 2021 and were randomly assigned to therapeutic dose heparin (n=228) or prophylactic dose heparin (n=237). Interventions Therapeutic dose or prophylactic dose heparin (low molecular weight or unfractionated heparin), to be continued until hospital discharge, day 28, or death. Main outcome measures The primary outcome was a composite of death, invasive mechanical ventilation, non-invasive mechanical ventilation, or admission to an intensive care unit, assessed up to 28 days. The secondary outcomes included all cause death, the composite of all cause death or any mechanical ventilation, and venous thromboembolism. Safety outcomes included major bleeding. Outcomes were blindly adjudicated. Results The mean age of participants was 60 years; 264 (56.8%) were men and the mean body mass index was 30.3 kg/m 2 . At 28 days, the primary composite outcome had occurred in 37/228 patients (16.2%) assigned to therapeutic heparin and 52/237 (21.9%) assigned to prophylactic heparin (odds ratio 0.69, 95% confidence interval 0.43 to 1.10; P=0.12). Deaths occurred in four patients (1.8%) assigned to therapeutic heparin and 18 patients (7.6%) assigned to prophylactic heparin (0.22, 0.07 to 0.65; P=0.006). The composite of all cause death or any mechanical ventilation occurred in 23 patients (10.1%) assigned to therapeutic heparin and 38 (16.0%) assigned to prophylactic heparin (0.59, 0.34 to 1.02; P=0.06). Venous thromboembolism occurred in two patients (0.9%) assigned to therapeutic heparin and six (2.5%) assigned to prophylactic heparin (0.34, 0.07 to 1.71; P=0.19). Major bleeding occurred in two patients (0.9%) assigned to therapeutic heparin and four (1.7%) assigned to prophylactic heparin (0.52, 0.09 to 2.85; P=0.69). Conclusions In moderately ill patients with covid-19 and increased D-dimer levels admitted to hospital wards, therapeutic heparin was not significantly associated with a reduction in the primary outcome but the odds of death at 28 days was decreased. The risk of major bleeding appeared low in this trial. Trial registration ClinicalTrials.gov NCT04362085 .

A recent survey has demonstrated that traditional healers and herbalists frequently use Nelumbo nucifera plant to treat diabetes. The plant investigated here has been previously reported as natural folk medicine, but until now no scientific investigation of potential anti-diabetic effects have been reported. Plant leaves of Nelumbo nucifera were screened out for quantitative analysis of phytochemicals, in-vitro anti-diabetic activity (Alpha-amylase inhibitory assay) and In-vivo anti-diabetic assay of animals (rabbits). Quantitative analysis indicates that different phytochemicals were present in plant leaves extract/fractions. In-vitro antidiabetic analysis results poses that butanol fraction is significantly more active than other fractions or extract in antihyperglycemic activity with minimum IC50 value of 8.56µg/ml. For In-vivo anti-diabetic assay, animals (rabbits) were examined and animals were divided into 10 groups and except blank group all were treated with standard and plant extracts/fractions doses (25mg and 50mg per Kg body weight) as an aqueous suspension. Their blood sugar level was thoroughly recorded with a glucometer before the administration of sample and standard drug. Alloxan Monohydrate was administrated orally (as an ice-cold water solution) at dose rate 150mg/kg body weight for one week to make animals hyperglycemic. In-vivo analysis indicates that butanol fraction is the most active fraction in antihyperglycemic activity. So Leaves of N. nucifera can be used as antidiabetic remedy. So, it is strongly recommended that N. nucifera leaves should be elucidated further for isolation of active phytochemicals.

doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1729 How to cite this:Saeed S, Shaikh QA. Guest Editorial. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S3. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1729 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.

The paper is an exploration of how petrofiction, as a form of biopolitical fiction, charts out the discontent of the selected Arab writers with the present as well as their visions of the past and the future. Within the context of the United States’ imperialism, expansionism and the resultant Arab Modernism, two postmodern Arabic novels from different nation states and cultures translated into English at different time periods have been chosen for this study with a view to examine themes common to their biopolitical and necropolitical backgrounds. The novels are Cities of Salt (1984), the first volume of a petro-quintet by Saudi-Jordanian novelist Abdel Rahman Munif, and Men in the Sun (1963) by the Palestinian Ghassan Kanafani. These texts are analyzed as petronarratives demonstrating oil as a resource curse, and its fallout of development as a form of distorted modernity. By deconstructing unilinear narratives of progress and possibility, the selected marginalized authors reject easy solutions or fantastic alternatives to the present. Their narratives deterritorialize the codifications of colonial discourse to open up new spaces of possibilities for the dispossessed. They work as writer-activists signifying the attainability of the idea that fiction is powerful enough to effect political change and develop biopolitical memory. The study concludes with the crystallization that although representation of the wounded memory through written text is not possible, the text as a body can initiate biopolitical change.

ObjectivesTo characterise the sketetal muscle metabolic phenotype during early critical illness.MethodsVastus lateralis muscle biopsies and serum samples (days 1 and 7) were obtained from 63 intensive care patients (59% male, 54.7±18.0 years, Acute Physiology and Chronic Health Evaluation II score 23.5±6.5).Measurements and main resultsFrom day 1 to 7, there was a reduction in mitochondrial beta-oxidation enzyme concentrations, mitochondrial biogenesis markers (PGC1α messenger mRNA expression (−27.4CN (95% CI −123.9 to 14.3); n=23; p=0.025) and mitochondrial DNA copy number (−1859CN (IQR −5557–1325); n=35; p=0.032). Intramuscular ATP content was reduced compared tocompared with controls on day 1 (17.7mmol/kg /dry weight (dw) (95% CI 15.3 to 20.0) vs. 21.7 mmol/kg /dw (95% CI 20.4 to 22.9); pConclusionsDecreased mitochondrial biogenesis and dysregulated lipid oxidation contribute to compromised skeletal muscle bioenergetic status. In addition, intramuscular inflammation was associated with impaired anabolic recovery with lipid delivery observed as bioenergetically inert. Future clinical work will focus on these key areas to ameliorate acute skeletal muscle wasting.Trial registration numberNCT01106300.

A key parameter of determining the changing nature of journalism is to address the question of who owns the media and why. Recent revelations of sham transactions, fraudulent trade practices and black money being used to fund the news media in India, suggest a lack of transparency in how news business are run and financed. Five cases involving leading news organizations in India are analysed to illustrate the argument. In conjunction with this, the corporate take-over of news space by non-media entities signals the rise of a press that can no longer serve as a watchdog of democracy. The paper outlines a decline in quality journalism as a consequence of a disconcerting nexus between influential politicians, powerful corporates and profit-maximizing news organizations. Corrupt funding procedures and concealed ownership patterns have orchestrated a crisis of credibility for journalism while posing fresh challenges for media governance and the nature of democracy.

Obesity is an important risk factor for sleep disorders. This study aimed to evaluate the association of leptin, zinc and tryptophan (TRP) in obese subjects with sleep deficits [sleep apnea (SA), insomnia (IN)]. In this cross sectional case control, with the verbal and written consent 206, obese with sleep deficits and 30, non-obese/normal identified from various areas of Karachi, Pakistan. The socio-demographic data including; age, body mass index (BMI), education and residence, of participants was collected. After providing informed consent, fasting blood samples were taken and serum was collected. The serum concentration of leptin, zinc and TRP were analyzed by ELISA (Enzyme-linked immunosorbent assay), FAAS (Flame atomic absorption spectrophotometer) and HPLC (High performance liquid chromatography) respectively. A significant correlation was found between BMI (body mass index) and leptin, BMI and zinc, BMI and TRP. The correlation between leptin consecutively was significantly associated with zinc and TRP in obese patients. Sleep deficits elevated circulatory levels of leptin while lower zinc and TRP levels compared to levels seen in non-obese (Normal) subjects with no sleep deficits. Obese subjects exhibited significantly higher levels of leptin with sleep deficits compared with non-obese subjects with normal sleep pattern, while obese subjects with SA had significantly high levels of leptin than obese subjects with IN and IN+SA. Patients with sleep deficits had significantly lower levels of serum TRP and zinc than non-obese subjects with normal sleep pattern. Obese subjects with SA had significantly lower levels of zinc and elevated levels of TRP than obese subjects with IN. Obese patients with IN+SA had significantly lower levels of leptin and zinc than IN and SA , while TRP levels were significantly lower in subjects with IN than obese subjects with IN+SA and IN. These results suggest that elevated levels of leptin which are possibly by adiposity and lessened levels of zinc and TRP have a great impact on progression of obesity and their association can contribute to tempt sleep disorders.