Year 2020, Volume 36 - Issue 2

Open access Editorial | June 30, 2020
Reply to Bukhvostov AA, Ermakov KV, Kuznetsov DA, A Nuclear Magnetic Insight towards the Cytostatic Potential of Meidicinal Plant Extracts, Biomedical 2020; 36(1): 5-6

Al-Whibi M, Nadin Moubayed, Zahrani H, Mashhour A

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First, we appreciate the interest of Dr. Bukhvostov et al. 2020 in our article detailing the protocol of cytotoxic activity and chemical analysis of Ducrosiaanethifolia extracts against HLA60 and the suggested comments. Our primary goal, however, 
was to reveal the cytotoxic activity of D. anethifolia leave and its major chemical constituents.

Open access Commentary | June 30, 2020
Giving Birth at Times of COVID-19

Sheza Hassan, Ibrahim Sajid, Sajid Abaidullah, Zahida Parveen

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Ever since Coronavirus disease 2019 (COVID-19) has been declared a pandemic by World Health Organization (WHO) it has gradually become top cause of morbidity. Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) possesses the tendency to cause severe symptoms in patients with a weakened immune system. In the setting where a mother develops mild COVID-19 infection yet remains stable, responds to medical treatment and there is no fetal compromise; the pregnancy may be continued to term with close surveillance. What is important in the current scenario is that the patients of COVID-19 along with any other comorbidities or medical conditions are at more risk of having fatal disease then the ones with COVID-19 alone. The pregnancy is one physiological condition in which a patient can face drastic pathological complications with COVID-19 if not given the due care.

Open access Case Report | June 30, 2020
Primary Granulomatous Inflamatin of Liver A Case Report

Shazia Aslam, Sadia Hameed, Sidra Aslam

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Granulomas that consist of focal accumulations of macrophages are commonly found in the liver due to stimulation of the immune system by a number of pathophysiologic agents. Manifestations are variable depending on whether the underlying cause is a systemic disease or a primary hepatic granulomatous reaction. Here we report a case of a 30-year old female who presented with complaint of fever and vomiting. Liver biopsy from focal lesion was suggestive of granulomatous inflammation.

Open access Review Article | June 30, 2020
SPARC in Breast Carcinomas: A Critical Review

Waqas Arshad Mughal, Sobia Khalid, Nadia Naseem, AH Nagi

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Breast cancer is the second most common cancer in the world according to World Health Organization statistics. Among Asian countries, Pakistan has the highest incidence of breast cancer. The normal breast development is interplay between various hormones and transcription factors. Estrogen receptor, progesterone receptor and human epidermal growth factor are being utilized for the targeted therapy of breast cancers. However, there is further need of research to improve the treatment strategies in this regard. Secreted Protein Acidic and Rich in Cysteine (SPARC) is a new biomarker and therapeutic target in breast cancer as well as other tumor types. It’s a matricellular protein whose main function is to mediate interactions between cells and their extracellular surrounding during morphogenesis, tissue remodeling and angiogenesis. Therefore, SPARC enables tumor cells to interact with stromal cells and the extracellular matrix. Regarding breast carcinoma, SPARC has been identified as an important negative regulator of tumor characteristics associated with poor prognosis.

Open access Original Article | June 30, 2020
A Comparison of Human Gut Microbiota and Analysis of Antimicrobial Resistance of E. coli Isolates in Saudi Adults Undergoing Bariatric Surgery

Kawther Aabed, Nadine Moubayed, Abrar Motlak, Al-Anoud Al-Rasheed, Ameerah Al-Otaibi, Aisha Al-Asmri, Hanadi Abu-Dusha

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Background and Objective: Human gut harbors a diverse community of more than 100 trillion microbial cells that play an important role in human metabolism, physiology, immune function, and nutrition. Similarly, disruptions to the composition of this population can be linked with gastrointestinal conditions,such as obesity and inflammatory bowel disease. The aim of the present study was to compare the microbial community characteristics among obese, normal-weight and post-gastric bariatric surgerypatients.
Methods: Fifteen healthy adults, who were classified into (1) normal-weight (n=5) (2) obese (n=5) according to their Body mass index (BMI) and (3) post-bariatric surgery (n=5) groups. Gut microbiota from fecal samples were profiled by the streak plate method and theconstituent populationswere identified by biochemical analysis (Vitek2). Finally, specific bacterial strains were identified via molecular techniques, such as Polymerase chain reaction (PCR). Moreover, the antimicrobial sensitivity of E. coli strains isolated from healthy adults was evaluated to determine the pathogenic strains.
Results: The findings revealed that gut microbiota diversity increased following bariatric surgery, whereby84.6% of increased bacteria belonged to Proteobacteria, especially Escherichia coli (member of Gammaproteobacteria). The main bacterial groups in individuals that underwent bariatric surgery were Gemella morbillorum, Citrobacter freundii, Serratia odorifera, Proteus mirabilis, Enterococcus gallinarum, Klebsiella pneumonia, Enterobacter cloacae complex, Pseudomonas aeruginosa and Escherichia coli. The main bacterial groups in the normal-weight group were Citrobacter freundii, Serratia marcescens, Proteus
mirabilis and Escherichia coli. Finally, in obese individuals, Enterobacter cloacae complex, Klebsiella pneumonia, Enterococcus gallinarum and Escherichia coli were the main bacterial groups.Conclusion: These results indicate that inducing changes in the gut microbiota may be a relevant therapeutic approach for obesity and other metabolic defects.

Open access Original Article | June 30, 2020
Knowledge and Perception about Ketogenic Diet among Medical Students

Muhammad Umair Butt, Mohammad Danyal Bawa, Hina Ahmed

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Background and Objectives: Ketogenic diet has gained lotre cognition nowadays through its various health implications; it is extensively used for weight reduction besides its therapeutic use in other diseases.The diet constitutes high-fat, low-carbohydrates that utilize fats for metabolism. The objective of the study was to determine the Knowledge and Perception about ketogenic diet, its therapeutic uses, side effects and benefits among medical students of Fatima Memorial College.
Methods: This was a cross sectional study conducted at Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore. The duration of study was 6 months from July 2019 to December 2019. A total of 250 students of MBBS were interviewed after taking informed consent through a structured questionnaire and data was analyzed statistically.
Results: A total of 250 participants were interviewed. Among all 183 (73.2%) of the participants heard about ketogenic diet, and 52 (20.8%) knew the difference between could differentiate ketogenic diet and fasting. Most of the participants 102 (40.8%) were aware about its high fat and low carbohydrate content. Out of 250 participants, 191 (76.4%) and 147 (58.8%) agreed weight loss and cardiovascular disease the main therapeutic aim for taking this diet however, 144 (57.6%) had a perception that elderly cannot take this diet. Most of the participants 146 (58.4%) and 139 (55.6%) considered hair fall and acidosis as main adverse effects of the diet to the human body respectively.
Conclusion: The study shows that medical students had compelling knowledge about ketogenic diet’s therapeutic uses, side effects and benefits on the body. Weight loss was observed as the most important factor for choosing it. Pre-diet counseling came out to be valuable as a guide towards people thinking for adopting this diet.

Open access Original Article | June 30, 2020
Role of Internal Sphincterotomy as an Adjunct to Open Haemorrhoidectomy for Management of Third- and Fourth Degree Haemorrhoids

Waseem Sadiq Awan, Arslan Ahmed, Raza Farrukh, Yar Muhammad, Salman Athar, Hafiz Muhammad Sajid Jehangir, Ghulam Mustafa Arain

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Background and Objective: Post-operative pain and complications are common after open haemorrhoidectomy. Addition of internal sphincterotomy has shown to improve the post-operative outcomes. This study is conducted to compare the outcomes of open haemorrhoidectomy with and without internal sphincterotomy.
Methods: A prospective randomized controlled trial was conducted in the Department of Surgery at Sargodha Medical College/District Headquarter Hospital, Sargodha from February 2016 to December 2017. One hundred and twenty-two patients presenting with third and fourth degree haemorrhoids were divided in two equal groups. In group “A”, haemorrhoidectomy with internal sphincterotomy and in group “B”, haemorrhoidectomy alone was performed. Outcome variables such as pain scores based on Verbal Rating Scales (VRS), hospital stay, complications and wound healing were compared in both groups.
Results: The mean pain scores were less in the internal sphincterotomy group A i.e., 3.3 ± 0.3 while it was 3.6 ± 0.4 in group B at 1st post-op day. The mean duration of hospital stay was less in group A (2.3 ± 0.7 days) and it was 3.4 ± 0.9 days in group B. On the 7th post-operative day, 13 (21.3%) patients in group A and 4 (6.6%) patients in group B had flatus incontinence. Urinary retention was present in 4 (6.6%) cases in group A and 13 (21.3%) in group B. Post-operative bleeding was present in 44 (72.1%) cases of group A and 41 (67.2%) of group B. Constipation was higher in the group B (44.3% vs. 37.7%). Wound healing was better in group A (63.3%). Anal stenosis occurred in 3 (4.9%) patients who were treated with 
haemorrhoidectomy alone.
Conclusion: Addition of internal sphincterotomy improves the outcome of open haemorrhoidectomy in patients of third- and fourth-degree haemorrhoids. It is therefore recommended to carryout internal sphincterotomy when operating on such patients

Open access Original Article | June 30, 2020
Ficus vogelii Stembarks; A Promising Herbal Remedy for Lead Induced Reproductive Toxicity

Uchewa Obinna, Augustine Egwu, Chinedu Uzomba, Emmanuel Uchewa, Ogbonna Egwu

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Background and Objectives: Toxicity is fast becoming a major cause of infertility in this century unknowingly and researchers can no longer be mute over this situation. In this work, we aimed at exploring the potency of the bark of Ficus vogelii as an herbal product in protecting against female toxicity.
Methods: The twenty 25 female Wistar rats used weighed between 140 – 180g and were randomly assigned into five groups of five rats per group with group A servicing as control which received normal saline. Groups B and C received 3.5 mg/kg of Lead acetate 14 days and later received low and high dose of extract respectively. Group D served as lead acetate group while group E received extract only.
Results: There were changes in body, uterine and ovarian weight (P > 0.01). Superoxide Dismutase (SOD) enzyme levels were reduced significantly in B and C (P > 0.01) group animals while there was an increase in its levels in group D. Several alterations were seen in the ovary and uterus which includes reduced folliculogenesis with a marked increase in the number of atretic follicles, oedema and necrotic zones. These effects were seen to be restored near normal in the groups that were administered with extract.
Conclusions: This work showed that the bark of Ficus vogelii could be a good herbal remedy for infertility.

Open access Original Article | June 30, 2020
Comparative Evaluation of Microleakage of Amalgam, High Viscosity and Resin-Modified Glass Ionomers as Restorative Materials in Primary Molars

Md Asdaq Hussain, Shazia Naz, Shahida Rae, Sohail Abbas Khan

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Background and Objective: One of the major requisites of an ideal restorative material is excellent marginal seal. Microleakage has been identified as a significant clinical problem with filling materials. The objective of the study was to evaluate and compare the degree of microleakage of amalgam, high viscosity glass ionomer and resin-modified glass ionomer in primary molars.
Methods: A total of 99 human non-carious primary molars that were liable to exfoliate within the next six months were selected. Standardized Class I cavities were prepared on occlusal surfaces of molars and randomly filled with either Amalgam (Aristaloy 21), High Viscosity Glass Ionomer (Ketac Molar) or ResinModified Glass Ionomer (GC Fuji II LC). The teeth were divided into nine groups (n=11 each) on the basis of filling material used and time of restored tooth extraction viz. one week, six weeks and twelve weeks. After immersion in a 2% methylene blue dye solution for 24 hours, the teeth were sectioned buccolingually in an occluso-apical direction through the middle of the restoration. The specimens were then examined under 
stereomicroscope at 30X magnification. Statistical analyses were performed with ANOVA and Tukey’s test 
at 5% level of significance.
Results: Amalgam restorations had significantly less microleakage as compared to the high-viscosity glass ionomer and resin-modified glass ionomer restorations. High-viscosity glass ionomer restorations were superior in resisting microleakage than resin-modified glass ionomers. The restorative materials used can be arranged in their sealing ability from least to severe microleakage as: Amalgam <High-viscosity glass ionomer <Resin-modified glass ionomer.
Conclusion: Amalgam restorations showed less microleakage as compared to high-viscosity and resinmodified glass ionomer restorations. Amalgam may preferably be used as a restorative material of choice 
for primary molars.

Open access Original Article | June 30, 2020
Hypertension and its Underlying Socioeconomic Factors among People in Rural Area, Nain Sukh

Fahd Asif Sahi, Fatima Israr, Aiman Shafique, Mehnaz Munir, Benazir Gill, Naheed Humayun Sheikh

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Background and Objective: Hypertension is a major health concern worldwide and is showing an alarming increase in prevalence. In Pakistan, there is limited community-based research on its prevalence and control. The objective of the study is to determine the prevalence of hypertension and assess the relationship between hypertension and life style of people in the defined population of village of Nain Sukh, Punjab-Pakistan.
Methods: This descriptive cross-sectional study was carried out in the Department of Community Health Sciences, FMH College of Medicine & Dentistry, after an ethical approval. In this study, 190 individuals of both genders, aged 40 and above were examined. The weights and heights of the patients and two readings of blood pressure at 15 minutes interval were recorded in relevant proformas. Information regarding their socioeconomic profile and lifestyle was also obtained through a structured questionnaire.Statistical Package for the Social Sciences (SPSS) version 21 was used to analyze data hence taking P-value ≤ 0.05 as significant.
Result: Among N = 190 individuals, 34.7% were males and 65.3% were females. Prevalence of hypertension was found to be 44.2%. Out of these, 40% were known hypertensive and the disease was controlled in only 34%. The disease is more prevalent in males than females (P = 0.012). A total of 73.8% of housewives had high blood pressure values (P = 0.031). Families having more than 5 family members also showed greater prevalence of hypertension (P = 0.007).
Conclusion: In rural settings, there are more cases of high blood pressure common among males of the community. There is major role of psychosocial factors such as stress of larger family size, sedentary lifestyle of females (housewives) in development of hypertension. These factors should be considered important along with other dietary and lifestyle factors.

Open access Original Article | June 30, 2020
Management of Early Pregnency Loss by Surgical Evacuation or Medical Termination Which is a Better Choice?

Tasneem Hayat, Munawar Afzal, Humaira Bilal, Waqas Latif

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Background and Objective: Comparative efficacy of medical termination has always remained debatable as compared to surgical techniques. The study was designed to assess the safety, acceptability and success of oral Misoprostol as an agent of medical termination as compared to surgical evacuation in cases of early pregnancy loss.
Methods: This was a quasi-experimental study conducted in Department of Obstetrics and Gynaecology at Sughra Shafi Medical Complex, affiliated with Sahara Medical College Narowal from August 2017 to February 2019. Diagnosed cases of missed miscarriage before 13 weeks (n = 150) were allocated either for surgical evacuation (n = 50) or medical termination by oral Misoprostol (n = 100) on patients’ own choice after counselling. Effective dosage schedule of Misoprostol, its adverse effects, number of days taken for complete expulsion and duration of hospital stay were recorded. Main outcome measure was successful termination.
Results: Patients enrolled for surgical evacuation had 100% success rate while those in medical termination had 80% success rate and 20% treatment failure.Significant differences were also observed in symptoms, bleeding and hospital stays between the two groups.
Conclusion: Surgical evacuation is still a gold standard method recommended for suitable cases, while medical termination by Misoprostolis low cost, better accepted and effective but has unpredictable outcomes.

Open access Original Article | June 30, 2020
Impact of Hypodontia on Social Well-Being and Quality of Life of Children

Qurrat-ul-Ain Fatima, Unaiza Jawad, Muhammed Mujtaba, Wali Dad

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Background and Objective: The congenital absence of one or more deciduous or permanent teeth is called  hypodontia. It is the most common congenital dental anomaly. Hypodontia could be caused by a number of genetic and environmental factors. The aim of the current study was to find out the impact of hypodontia on the social well-being and quality of life of children.
Methods: A cross sectional comparative study was carried out on 40 patients suffering from hypodontia and 40 healthy controls in the outpatient Department at Nishtar Institute of Dentistry, Multan. Patients and healthy controls were selected by non-probability convenient sampling technique without any gender discrimination. Age of the selected patients and controls was 11 – 14 years. Urdu proformas were used for better understanding of children.
Results: Mean age of the patients suffering from hypodontia was 11.8 (± 0.90) years and mean age of healthy controls was 11.9 (± 0.98). Most common missing tooth was maxillary lateral incisor. Out of n = 40 patients, 85% and 82.5% used to avoid smile and urge with other people respectively. Almost 85% children were teased by other children and also were repetitively asked questions about their anomaly.
Conclusion: Hypodontia has substantial impact on the social well-being and quality of life of the children. Patients were socially disturbed and had a poor quality of life.

Open access Original Article | June 30, 2020
Analysis of Serial C-Reactive Protein Levels in Critically Ill COVID-19 Patients Receiving Tocilizumab

Atika Masood, Omair Farooq, Sadaf Waris, Muhammad Khan, Asim Mumtaz, Maleeha Aslam, Muhammad Usama

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Background and Objective: COVID-19 can cause severe acute respiratory distress syndrome. With deteriorating disease, most of the patients may require intensive care admission. This study was carried out to determine and evaluate the response of Tocilizumab with special reference to C-reactive protein (CRP) in critically ill patients presented to Farooq Hospital, West Wood Lahore.
Methods: This retrospective study included the data of 55 critically ill COVID-19 patients (respiratory rate ≥30, SpO2<93%, oxygen requirement ≥5L/min, PaO2/FiO2 ≤300 mmHg) admitted in Corona unit of Farooq Hospital West Wood Lahore, who were being treated with Tocilizumab alongwith standard treatment protocol between April 27 and June 21, 2020. The data has been retrieved from hospital records after taking appropriate permission and consent. Demographic, clinical features and serum CRP were recorded for each of them, before and after administration of Tocilizumab. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 22.0 and expressed as frequency and percentages.
Results: Out of 55 patients who were administered Tocilizumab, 72.7% survived whereas 27.3% died. There was higher median reduction of CRP levels in patients who survived (77.5 to 34.9 mg/L) as compared to those who died (65.5 to 45.3 mg/L). There was a statistically significant difference between CRP levels at the time of admission, 72 hours after Tocilizumab was administered (P<0.0001).
Conclusion: Tocilizumab administration might be helpful in reducing the complications of cytokine storm in patients with severe COVID-19 pneumonia.

Open access Original Article | June 30, 2020
The Quality of Life amongst Caregivers of Cancer Patients at Tertiary Care Centers in Lahore, Pakistan

Umbreen Navied, Sana Arshad, Uzair Ahmed, Aamir Hameed

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Background and Objective: Cancer is a leading cause of death worldwide and is initiating an overburden in developing countries. A grave illness, such as cancer, not only affects lives of patients, but also the lives of their caregivers. A caregiver nurtures continuous support, responsibility, concern and care hence,undergoes immense psychological distress because of the fear of losing their loved one, thus affecting their own quality of life (QOL). The study aims to assess the QOL of caregivers of cancer patients by using the World Health Organization Quality of Life Instrument (WHOQOL BREF) Questionnaire.
Methods: This cross-sectional study of caregivers of cancer patient’s was carried out at INMOL, MayoHospital, Jinnah Hospital and Children Hospital Lahore within 6 months in 2017. Interviews of 267 caregivers of diagnosed cancer patients were taken using WHOQOL BREF Questionnaire. Information was collected regarding QOL of caregivers and socio-demographic variables. Statistical Package for the Social Sciences (SPSS) software was used for data compilation and analysis hence taking P-value ≤0.05 as significant.
Results: The study results suggest that several conditions obtain an impact on the QOL of caregivers. For all measures the higher the score calculated the better the QOL. The caregivers of cancer patients reported the lowest mean score (6.89 ± 1.56) in general health and QOL. Caregiver’s low educational status, marriedstature, along-with their own current illness and health problems described lowest mean scores in QOL.
Conclusion: The results of this study provided information that caregivers revealed a low QOL. Therefore understanding of several aspects affecting the QOL of caregivers may assist in improving their ability to care for patients and themselves. Initiation of patient care training programs for caregivers would be helpful.

Open access Original Article | June 30, 2020
Mental Health and Chronic Fatigue Syndrome: Is Mental Health the Culprit Behind Your Fatigue?

Tahira Raza, Muhammad Ashraf Chaudhry, Ahsan Masu, Massiha Gulzar Ahmed, Minahil Ahmed, Bushra Amin

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Background and Objective: Mental health has proved to affect the physical and emotional aspects of one’s life. Appreciation of its influence on the physical functionality and efficacy of an individual may provide better treatment plans and coping strategies. This study was designed to find out the frequency of depression, anxiety, and stress among medical students at different levels of education, taking gender differences into account and its relation to chronic fatigue syndrome.
Methods: This cross-sectional descriptive study was carried out from October 2017 – March 2018. Standardized questionnaire was given to 270 MBBS students of Combined Military Hospital (CMH) Medical College, Lahore. The sampling method was non probability convenience sampling. The participants gave free consent. The data was analyzed using SPSS version 23.
Results: Out of the 270 candidates, 246 had fatigue. Females scored higher on both questionnaires and showed greater frequency of fatigue and mental health problems like stress [P = 0.004]. Over all mental health traits showed statistically significant association with chronic fatigue (P = 0.001).
Conclusion: Frequency of chronic fatigue among medical students suffering from anxiety, depression and stress is higher as compared to normal students. Female students suffer more from chronic fatigue syndrome, depression, anxiety and stress as compared to males. Strategies to evaluate and rigorously review medical student’s mental problems, and devising appropriate coping mechanisms is essential for their well-being and optimum health.

Open access Original Article | June 30, 2020
Measurement of Air Concentrations of Particulate Matters, Volatile Organic Compounds and Formaldehyde in Lahore

Shiraz Aslam, Maham Javed, Nadeem Reyaz

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Background and Objective: The volatile organic compounds (VOCs) including formaldehyde (HCHO) are widely concerned due to their harmful impact on human health by productionof photochemical smog and ozone and have great impacton air quality. High air pollution level in urban areas is one of the major concerns therefore, there is need to develop cost-effective devices for measurement of VOCs in the environment. The objective of the study was to quantify the levels of these hazardous chemicals in air in major areas of Lahore.
Methods: This study was a cross-sectional descriptive study. A new multi-item pollution monitoring device (Life Basis DM 106 A) was used to carry out the readings. The areas targeted were busy areas of Lahore including Jail Road, Ferozepur Road, Lytton Road, MAO College, Kacheri, Data Darbar, Bhati Gate, Shahalmi, Davis Road and G.O.R 1.
Results: The highest VOC obtained was in the most crowded area of Lahore-the Data Darbar (10 mg/m3) and HCHO measured was also greatest at the Data Darbar area (0.99 mg/m3). However, G.O.R-1 showed the lowest VOCs and HCHOs measured as 0.004 mg/m3 and 0.002 mg/m3 respectively.Among different sizes of PM, there was a significant correlationbetween PM 1.0 and PM 10.0 (p = 0.000), while PM 2.5 showed a significant negative correlation (p = 0.009) with the relative humidity of the area.
Conclusion: A thorough knowledge of the concentrations of these pollutants and others like the PM2.5 and PM10 are paramount, in order to protect our communities from ill health.

Open access Original Article | June 30, 2020
Discriminant Validity and Reliability of Scores of Multiple Choice and Short Essay Questions

Anila Jaleel, Zohra Khanum, Imran Siddiqi, Mohsin Ali, Saba Khalid, Rukshan Khursheed

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Background and Objective: Assessment of learning plays a vital role in curriculum allowing faculty to evaluate the achievement of student and educational process. Quality assurance of the assessments is done to assess the quality of teaching and learning. A study is therefore conducted to find the discriminant validity and reliability of scores of Multiple Choices and Short Answer Questions.
Methods: A correlation study was conducted on 272 second year MBBS students of Fatima Memorial College of Medicine and Dentistry, Lahore from 2016 – 2017. Students were assessed in end of year examination with multiple choice questions (MCQs) and short essay questions and (SEQs) in the subjects of Physiology and Biochemistry. A total of 149 second-year MBBS students took thePhysiologyand143 studentstook the end of year Biochemistry examination with 50% minimum passing level. The mean and standard deviation of the scores were calculated and the scores of MCQs and SEQs were correlated by applying Pearson’s correlation. Reliability was determined by Cronbach’s alpha. Discriminant validity of scores (MCQS and SEQS) was analyzed by Pearson’s correlation.
Results: Students scored significantly higher in MCQsthan SEQsin end of year examination of Biochemistry and Physiology. Positive significant correlation of scores (MCQs and SEQs) was obtained in Biochemistry while correlation was positive but non-significant in Physiology. The reliability assessed by Cronbach’s alpha was moderate in Biochemistry and Physiology assessments. Discriminant validity was determined in both subjects by determining the correlation between the scores of the MCQs and SEQs, constructed  according to the same module.
Conclusion: The internal assessment of students based on end of year examinations in the subjects of Physiology and Biochemistry scored moderate in terms of reliability and discriminant validity was found between scores of MCQs and SEQs in each module.

Open access Original Article | June 30, 2020
Stake Holders Opinions of Multiple Mini Interviews (MMI) for Selection of Medical Students in Pakistan.

Sobia Ali, Muhammad Suleman Sadiq Hashmi, Syed Hasan Shoaib

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Background and Objective: In 2002 Multiple Mini Interview (MMI) was introduced to assess the noncognitive and/or high cognitive traits. Shalamar Medical and Dental College (SMDC), Lahore encouraged the process of MMI resulting in implementing and piloting the process from 2015. Acceptability is considered as the important aspect to support the validity evidence and since MMI was conducting the very first time in Pakistan for undergraduate admission, it was important to address its acceptability. The objective of this study is to assess the stake holder’s acceptability for Multiple Mini Interviews (MMI) for the selection of medical students.
Methods: This was a cross-sectional study and data was collected at SMDC Lahore, in years 2015 and 2016.  The research sample included candidates who applied for the admission in SMDC and examiners, trained faculty of SMDC involved in process MMI for 2015 and 2016. Acceptability of MMI was determined using post-MMI survey through questionnaire with 5-point Likert scale. Data was analysed using Statistical Package for the Social Sciences (SPSS) 20.0. Demographics were determined. Means, standard deviations and frequencies for each statement of the questionnaire were calculated. Mann-Whitney U-test was applied on the similar statements of the questionnaire among the candidates and examiners for both years separately.
Results: In post-MMI survey most of the statements showed more than 80% acceptability for MMI among stake holders for both 2015 and 2016. Comparison of similar statements among candidates and examiners revealed no significant difference except asked about the time duration (5 minutes) was enough to assess the attributes (P=0.003 & P=0.001) for both years 2015 and 2016 respectively.
Conclusion: Study provided the evidence of stake holders’ (candidates and examiners) acceptability of MMI in medical schools’ admission. It reflected that they are contented with the process