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Background: An effective communication between the doctor and patient is the foremost factor in establishing good interpersonal relationships. This comprises of both verbal and non-verbal communicators. Particularly in the geriatric population, communication can be hindered due to physiological and psychological deterioration. This study was designed to assess the communication skills of dentistry postgraduate residents (PGRs), with their geriatric patients and provide a baseline for the shortcomings and improvements. Methods: Four postgraduate residents of both genders were selected to take clinical interviews of geriatric patients. Audio-video recordings were made by an expert and reviewed by all researchers. The interviews were transcribed individually and thematic analysis was done. Open and axial coding was done for data organization under themes and subthemes. Results: Data transcription led to initial generation of 61 codes. These codes were categorized under nine codes through axial coding and grouping of similar codes. Persistent overlapping of content was found in data transcription, which may indicate data saturation. Conclusion: Workshop-trained postgraduate students of dentistry demonstrated relatively instrumental communication skills at their clinical encounter with geriatric patients. However, the professional demeanor demands further finesse in soft skills, which can be achieved through its regular practice.

Objective: To compare the frequency of perineal trauma in women undergoing the spontaneous vs the Valsalva-type pushing in the second stage of labour. Study Design: Randomized controlled trial Duration of Study with Dates: The study was carried out from 15-12-2020 to 19-03-2021. Setting: Department of Obstetrics and Gynaecology, Combined Military Hospital, Lahore.National University of Medical Sciences NUMS. Material and Methods: A total of 154 labouring females were enrolled in the study. These females were randomly assigned to one of two groups, A (the Valsava-type pushing method group) and B (the spontaneous pushing group). After the delivery of the placenta, the patients were all examined for any perineal trauma as per the operational definition. Results: Patients ranged between 18-40 years of age with a mean age of 26.3±4.0 years in Group A and 27.0±3.3 years in Group B. All the patients were between 38-40 weeks of gestation at the time of enrollment with mean gestational age being 39±0.7 weeks for group A and 38.9±0.7 for group B. There were 61 primigravida (39.6%, 34 in Group A and 27 in Group B) and 93 multigravida (60.4%, 43 in Group A and 50 in Group B). All women delivered vaginally in the cephalic presentation. The mean length of the second stage of labor was 25.7±29.0 min for the Valsalva pushing group and 31.6±37.5 min for the spontaneous pushing group. The mean fetal weight was 3.1±0.3 kg for both groups. 43 (55.8%) patients in the Valsalva pushing group and 46 (59.7%) in the spontaneous pushing group underwent an episiotomy during delivery. 9 (11.7%) patients in each group sustained perineal trauma (x2 = 0.0, p = 1.0). No one in the sample suffered greater than a second degree laceration. Out of the nine patients that did incur perineal trauma in the Valsalva type pushing group, 4 (44.4%) were first degree perineal tears and 5 (55.6%) were second degree perineal tears while among those in the spontaneous pushing group, 2 (22.3%) fell in the first degree tear category and 7 (77.7%) in the second degree tear category (x2 = 1.0, p = 0.317). Conclusion: Our findings suggest that there is no association between the rate of perineal trauma among patients who underwent the directed Valsalva- type method of pushing and those that employed the spontaneous pushing method during the second stage of labour. Keywords: Perineal trauma, Perineal tears, Second stage of labour, Pushing methods in labour, Valsalva- type pushing, Directed pushing, Spontaneous pushing

Objective: To determine the frequency of pre-eclampsia among high-risk pregnant women treated with low dose aspirin (LDA) presenting in a tertiary care hospital. Study design: Descriptive study Duration of study: Six months from 20-02-2018 to 19-08-2018. Setting: Study was conducted in OPD of Obstetrics and Gynaecology Department, Combined Military Hospital, Lahore National University of Medical Sciences NUMS Material and methods: A total of 175 patients were included in the study. Pregnant females diagnosed as high risk were treated with low dose aspirin (75 mg) daily started at 12 to 16 weeks of gestation till the end of pregnancy. 24 hours urine protein test was done for patients with B.P. >140/90mmHg after 20 weeks of gestation and if at least 300mg protein was present in 24 hours urine then patient was labeled as pre-eclamptic. Results: Patients ranged between 20-35 years of age with mean age of 25.9±3.6 years. Mean gestational age was 14.4±1.1 weeks and mean BMI was 27.3±4.3 kg/m2. Pre-eclampsia developed in 27 patients (15.4%). Obesity found in 53 patients (30.3%). There were 27 (15.4%) primigravida and 148 (84.6%) multigravida patients. Conclusion: In conclusion, low dose aspirin is effective in prevention of preeclampsia in high-risk patients. Indications for aspirin in primary prevention are a matter of debate, but recent publications suggest a strategy based on first-trimester screening of preeclampsia (with clinical parameters, biomarkers and uterine artery Doppler measurements) and aspirin administration to high-risk patients. Keywords: Aspirin, High risk pregnancy, Pre-eclampsia

Aim: To assess the psychological impact of COVID-19 on mental status of undergraduate medical students, after reopening of educational institutions. Methods: This descriptive, online cross-sectional study was conducted on medical students of Combined Military Hospital Lahore Medical College & Institute of Dentistry, Lahore Pakistan for 6 months from 1st June to 30th November, 2021. Generalized Anxiety Disorder Scale (GAD-7) was used as the study tool. Data was analyzed by using statistical software SPSS - 23. Frequencies and percentages were used for descriptive variables. A univariate analysis was utilized to identify the noticeable associations between traits of sample and the anxiety level in current scenario of COVID-19 pandemic. Finally multivariate logistic regression analyses, odds ratio (OR), and Spearman's correlation coefficient, r, was used to evaluate the association between COVID-19-related stressors and anxiety level. Results: Of the 324 respondents, majority were females residing in urban areas with their parents. Severe anxiety was experienced by 23.8% of students. Female respondents were found to have more anxiety as compared to males (OR = 1.81; 95% CI = 1.173 – 2.815). Moreover, respondents having a relative or an acquaintance infected with COVID-19 reported to have more anxiety (OR = 3.007, 95% CI = 2.377 - 3.804). Conclusion: A significant number of students are experiencing anxiety in the post COVID-19 phase, especially those that had an acquaintance infected with COVID-19. There is a need to look after student's mental health and to implement appropriate psychological strategies and interventions to deal with this level of psychological distress in the students at this phase of pandemic for optimum training of future health professionals. Keywords: Anxiety, COVID-19, healthcare professionals, mental health, medical students, pandemic

Background: Awareness of key issues associated with patient safety is vital for improving patient care in all fields of medical sciences including dentistry. This study was done to assess awareness among dental undergraduates towards patient safety in different dental institutions of Lahore, Pakistan Methods: It was a cross-sectional analytical study conducted at Combined Military Hospital Lahore Medical College & Institute of Dentistry from 1st May to 30th November, 2020. Two hundred third and fourth year BDS students (149 females and 51males; mean age 21.91±1.08) of 4 dental institutions of Lahore, mostly from private institutions (79.5%) completed Awareness of Patient Safety Questionnaire (APSQIII) to assess awareness of patient safety in dental undergraduates. Data was analyzed through SPSS 21. Results: Teaching and learning about patient safety got the highest item scores while “Team functioning” got the highest 6.1 mean domain score. “Professional incompetence as an error cause” got the lowest 3.1 mean score followed by “Disclosure responsibility” (4.3). No significant difference was seen with respect to gender. Fourth year students were found to be more aware about error disclosure and error reporting confidence with statistically significant difference. All reverse coded items were scored in disagreed range by participants. Conclusion: Despite positive attitudes towards patient safety, lack of awareness was seen in key issues. Incorporation of patient safety in undergraduate curriculum may help in improving patient care and health services.

Objective: To compare the outcome in early versus delayed oral intake in patients after cesarean section under regional anesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Lahore, from Dec 2017 to May 2018. Methodology: A total of 352 women undergoing elective cesarean section under regional anesthesia, nil by mouth for at least 8 hours before surgery were divided in 2 groups. In group 1, patients were given sips of clear oral fluid (water)

Objective: To explore the perceptions of Continuing Medical Education participants about the improvement of patient care through Continuing Medical Education activities and to explore the factors hampering or favouring improvement of patient care through Continuing Medical Education activities. Study Design: Qualitative phenomenological study. Place and Duration of Study: University of Health Sciences, Lahore, from Dec 2016 to May 2017. Methodology: In qualitative phenomenological study conducted at University of Health Sciences, Lahore from Dec 2016 to May 2017, semi structured in-depth interviews were conducted individually from 10 General Practitioners which were audiorecorded and transcribed. Code labels were assigned manually and grouped together into broader themes. Interpretation ofthemes was done after thematic analysis. Results: Two participants were female and ten were male with experience ranging between 20-38 years. Three main themes with sub-themes were identified: (1) positive talk (Affirming the link between Continuing Medical Education and improved patient care), (2) negative talk (perceived hindrances in gaining full benefit from Continuing Medical Education activities), (3) concerns regarding current Continuing Medical Education activities. Conclusion: Participants were found inclined towards Continuing Medical Education activities and felt more confident and comfortable in managing their patients. However, they felt that physicians working in rural areas were dealing directly with all sorts of patients and were more in need of targeted and tailored Continuing Medical Education activities.

Fluvastatin's hepatoprotective impact is being investigated in the current study. It is possible that the oxidative stress pathway is implicated in PCM hepatotoxicity. The acute hepatotoxicity of PCM was investigated in this study. Place of study: Rashid Latif Medical College Lahore Materials and Methods: The rabbits were divided into five groups of ten each. The saline group received (the vehicle). Fluvastatin (20 mg/kg), PCM (600 mg/kg), and PCM + 10 mg Fluvastatin (600 mg PCM + 20 mg Fluvastatin) were administered to the animals. The livers from all the animals were taken out and cleansed. 70% alcohol was used for washing extensively, after which the liver tissue was embedded in paraffin and then 5 mm thick paraffin slices were stained by aid of hematoxylin and eosin. Results: Male rabbits were shown to be harmful to paracetamol (P

Background: Peptic ulcer has become an immense problem in our health care system. One of the major cause being the overuse of NSAIDs in Pakistan. Objective: To evaluate gastro protection by Vitamin E, Vitamin C and combination of Vitamin E and Vitamin C on morphology of aspirin induced gastric mucosal injury in albino rats. Methodology: 45 adult albino rats were taken and organized into 5 groups. Control was formed by Group I. Group II was given aspirin. Group III was given Vitamin C and aspirin. Group IV was given Vitamin E and aspirin. Group V received Vitamin C, Vitamin E and aspirin. All the doses were given for 14 days. Rats were then sacrificed after 24 hours and their stomachs were examined to compare the gross and histological findings regarding the colour of the gastric mucosa, presence of gastric ulcer, site of the ulcer, epithelial integrity and extent of the ulcer. Results: Increased frequency of ulcers extending into the submucosa were found in group given aspirin as compared to the rest of the groups. The group that was given combination of Vitamin E and Vitamin C along with aspirin showed significantly better condition than all the groups by showing normal mucosa and intact epithelium in most of the animals. Conclusion: Combination of Vitamin E and Vitamin C has greater defensive effect on aspirin induced gastric mucosal insult than Vitamin C or Vitamin E alone by showing reduction in frequency and severity of gastric ulcer.

Objective: To explore reflection as a learning tool in undergraduate medical education.Study Design: Cross-sectional survey.Place and Duration of Study: The study was conducted among MBBS and BDS undergraduate students of CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan from 1st January 2022 to 30th June 2022.Materials and Methods: In this online cross-sectional survey, the Reflective practices questionnaire (RPQ) was administered to 290 medical (fourth and final year) and dental (third and final year) undergraduates. Data were analyzed through SPSS 24.Results: Out of 290 participants, the majority were female (179, 61.7%). Most of the participants were from MBBS (188, 64.8%). The overall mean score of the questionnaire was 73.493 ± 17.407 (95% CI: 16.286 ± 18.439) out of a total score of 96. The highest score of critical appraisal was 18.790 ± 4.248 (95% CI: 4.064 ± 4.608). There was no difference of the mean score of different domains based on gender, specialty or year of education.Conclusion: The undergraduate medical and dental students demonstrated good reflective practices. However, there is a need to improve critical thinking and appraisal among students to achieve better outcomes.

Objectives: Primary objective was to explore experiences of female residents of Obstetrics and Gynecology (OB/GYN) regarding lapses in patient safety (PS) while secondary objective was to explore factors hampering or favouring improvement of PS in OB/GYN. Methods: In this qualitative narrative study carried out in OB/GYN department of Combined Military Hospital (CMH) Lahore for six months from 1st April to 30th September 2021, six fourth-year residents were asked to write narratives of their personal experiences of medical error (witnessed or committed) in detail and reflect on those experiences, which were then transcribed. Code labels and themes were assigned manually. Interpretation of these themes was done after thematic content analysis. Results: Six, fourth-year female residents with a mean age of 28.6±1.8 participated in the study. Two main themes with sub-themes were identified: 1) Challenges in patient safety (Personal challenges, Workplace challenges, Barriers to PS), 2) Lessons learnt from experiences (Self-improvement and; Promotion of patient safety culture). Heavy workload with long working hours, lack of communication and teamwork, lack of experience and inadequate supervision were major factors involved in PS lapses experienced by residents. Conclusion: Incidents of Patient Safety (PS) lapses had a strong impact on the emotional and professional life of residents. Formal PS training with improvement of working conditions may help promote PS culture. doi: https://doi.org/10.12669/pjms.38.7.5741 How to cite this:Tufail S, Mustafa N, Kamran R, Khan JS. The blame game- experiences of female residents in obstetrics & gynecology regarding lapses in patient safety. Pak J Med Sci. 2022;38(7):---------. doi: https://doi.org/10.12669/pjms.38.7.5741 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 educational environment can influence students' learning and their attitudes towards various medical specialties, thus affecting their career choices. This study aimed to compare perceptions of medical students about educational environment at the start and end of Obstetrics and Gynaecology (OG) rotation and to assess if these perceptions influenced their career choices.This was a Comparative analytical study carried out in the Obstetrics and Gynaecology Department, Combined Military Hospital Lahore Medical College from 1st February to 30th July 2019. Eighty-eight final year MBBS students (60 females and 28 males; average age 22±1.2 years) completed validated Dundee Ready Education Environment Measure (DREEM) questionnaire at the start and end of three weeks of OG clinical rotation. Two questions were added post rotation to assess impact of their perceptions on career choice. Data was analysed through SPSS version 21 using independent sample t-test.Mean total DREEM score was 126.68±14.17 and 127.49±15.31 out of a maximum of 200 pre and post rotation (p-value 0.001). The sub-scale which improved significantly (p-value 0.010) was Perception of Environment with average scores of 27.88±4.63 and 28.25±4.64 pre and post rotation. Majority of female students (78.7%) felt motivated for choosing OG as a career after this rotation.Final-year medical students perceived the learning environment to be positive. Clinical rotation helped in improving their perception about OG learning environment and helped female students get more inclined to choose this specialty as a career.

Background: Osteoporosis progresses with advancing age. Estimation of bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) is valuable in predicting fracture risk in the elderly. DXA machines however may not always be available in under-resourced developing countries. Aim: To find values of CTI and CFI in normal adult young and old, male and female population of Southern Punjab. Study design: Cross-sectional population study Methods: Measurements were recorded from 107 anteroposterior radiographs of proximal femur of normal adult male and female subjects divided in two groups: Young: 22 male and 26 females with mean age 28±3.4 and Old: 31 male and 28 females with mean age 61+5.2. Results: Statistical comparison between male and female subjects for CTI was not significant in the Y and O groups. Similar comparison for CFI while not significant in the Y-group was highly significant in the O-group. In overall comparison of Y and O groups the difference was very highly significant for CTI and CFI; both showing higher values in the Y-group. Conclusion; CTI and CFI measured from radiographs of proximal femur are reliable parameters and can be recommended for preliminary assessment of bone mineral density in developing countries. Keywords: Proximal femur, morphometry, cortical thickness index (CTI), canal flare index (CFI), bone mineral density

Objective: To determine the effectiveness of Multiple Choice Questions (MCQ) construction as a learning toolfor empowering the students towards self-directed learning.Study Design: Mixed quantitative and qualitative study.Place and Duration of Study: The study was carried out at Department of Obstetrics and Gynaecology, CMHst th Lahore Medical College, from 1 April to 30 September 2019.Materials and Methods: All students of final year MBBS were divided into two groups. After a pre-test (test 1)of MCQs, they attended a workshop on construction of MCQs, followed by construction and vetting of MCQs bystudents. The students took a test (test 2) based on those MCQs and evaluated it, followed by post-test (test 3)08 weeks later to assess deep learning. Semi structured in-depth interviews of 10 randomly selected studentsbased on 10 open ended questions were conducted about their perceptions of learning. Quantitative dataanalysis was performed using SPSS version 17. A thematic analysis was performed for the qualitative data.Results: Comparison of pre and post-tests yielded a p value of 0.013, which is statistically significant.Comparison of the mean results of tests 1 and 2 yielded a p value of 0.001, which is also statistically significant.The qualitative component of the study revealed that use of MCQ construction to enhance self-directedlearning was highly appreciated by the students as a learning tool.Conclusion: MCQ construction when used as a learning tool improved the self-directed learning of thestudents. Experience of construction of MCQs enhanced the cognitive skills of the students while being highlyacceptable.

Haloperidol is first generation antipsychotic used to treat psychosis. Its usage during pregnancy benefits psychotic mother and is indispensable for treating psychiatric emergency situations. Objectives: To evaluate the effects of haloperidol on development of centrilobular vein and portal triad of liver given to albino rats during intrauterine period. Study Design: Experimental study. Setting: PPGMI Animal House, Lahore. Period: July to September 2017. Materials & Methods: Pregnant female rats were randomly divided into three groups A,B and C ,15 rats in each group. Group B & C were given haloperidol in a dose of 0.4mg/kg and 0.8mg/kg body weight by intraperitoneal route whereas group A was considered as control group. Hysterotomy was done on 21st day of gestation and pups were removed. Pups of group A, B and C were designated as A1, B1 and C1. They were grossly examined for any abnormality and liver was removed after dissection. Slides were made and stained to evaluate changes in detailed histological study of centrilobular veins and portal triads. Results: Comparison of centrilobular vein and portal triad of group B1 and C1 with control A1 revealed that there is significant congestion seen in centrilobular veins of group B1 and C1 with P value ≤ 0.001 and signs of inflammation are present in experimental groups where were significant as compared to control group A1 with P value ≤ 0.001. Conclusion: Haloperidol, given during intrauterine life is responsible for initiating cell injury sequelae in the developing liver of fetal albino rats and must be given with caution if necessary.