Year 2022, Volume 38 - Issue 2

A sustainable healthcare framework implies maintaining both the current and future quality of healthcare through balancing social, environmental and financial constraints. Health care faculties in Medical Universities hold a professional obligation to yield ‘sustainability-oriented’ healthcare leaders, having a sense of eco-accountability, environmental justice, and intergenerational resource equity. For this multipronged diverse approach, the most cardinal contribution, for a sustainability continuum, by the current generation of professionals is to develop a ‘sustainability mindset’ for the healthcare leaders of tomorrow. The ripple effect of the ‘sustainability mindset’, thus created will be the key factor, to traverse through generations to come, for individual health, healthcare systems and most importantly for the planetary health.

Surviving the lethal Coronavirus pandemic just recently, the world is now facing another challenge to prevent getting infected with the Monkeypox virus. Antiviral vaccines and treatments are being explored for the possible protection and treatment. The health workers and paramedics are the front line fighters who are facing high risk of acquisition. Safe human practices, like adopted in COVID-19 pandemic, are at the core of preparedness and response to curb the spread of this distressing disease. 

The orexinergic system involves orexin (OX) neurons, OX peptides, and OX receptors. OX neurons are located throughout the central nervous tissue (including many nuclei) and the peripheral nervous tissue and organs. These neurons are critically involved in the sleepwake transition, cardiorespiratory, and autonomic regulations. OX antagonists include selective OX type 1 receptor (OX1R) antagonists, selective OX type 2 receptor (OX2R) antagonists, and dual OX1/2R antagonists. Similarly, OX agonists include dual OX1/2R agonists and selective OX1R or OX2R agonists. Recent understandings of the therapeutic mechanism of OX have led to possible therapeutic options in diseases such as insomnia, narcolepsy, psychiatric disorders, and neurodegenerative diseases. This review focuses on the therapeutic roles of OXs as agonists or antagonists in animal models and human patients, which can lead to possible avenues related to their application in health and disease.

Background and Objective: Ketogenic diet (KD) has gained a high popularity recently. It is extensively used for weight reduction besides its therapeutic use in some diseases. The aim of this study was to determine the awareness, knowledge, and perception about KD, its therapeutic uses, and side effects among university students in Saudi Arabia.
Methods: This survey-based study was conducted at Jazan University, Jazan, Saudi Arabia, during the month of December, 2021. A validated and pretested questionnaire was electronically distributed via a Google Drive link to collect data from the students enrolled in the study. Data were computed using correlation statistics.
Results: A total of 701 students completed the questionnaire. Among all students, 64% were females and 64.6% were studying in non-health related specialties. Majority of the students (84.8%) had heard about KD at the time of survey administration and 70.6% knew someone who were using KD. More than half (69.5%) of the students reported weight loss as the purpose of KD use. Most of the participants did not know about the therapeutic use of KD for diabetes and epilepsy (58.9% and 81%, respectively). Majority of the students did not know about most of the adverse effects of KD; however, 87.2%, 79.7%, and 80.9% of the participants had a perception that everyone cannot follow KD, it is not safe to follow KD lifelong, and the diet has to be recommended and supervised by a physician, respectively.
Conclusion: The study shows that the students had low knowledge about KD’s therapeutic uses and side effects. Weight loss was considered as the main purpose for using KD. Most of the students rightfully perceived the importance of consulting a physician before adopting this diet plan.

Background and Objective: The essential goal of any medical school is to train medical graduates to work as independent clinicians. Inadequately prepared doctors put the well-being of patients at a great risk. The objective of the study was to evaluate the preparedness for independent clinical practice of house officers who graduated from medical schools with the traditional discipline-based curriculum, from both public and private sectors, and with high and low merit.
Methods: A quantitative correlational study was conducted by using an already validated questionnaire. A total of 241 house officers who graduated from public and private sector medical schools from Lahore, Pakistan, with high and relatively low merit, were selected. The data from the filled responses were analyzed by using Statistical Package for the Social Sciences version 25.0
Results: Of the 241 respondents, 152 (55.3%) were females and 89 (32.4%) were males. The mean age of the respondents was 24.19 ± 0.91 years. The difference in mean score between the public and private sectors was significant in the subscales of clinical skills, procedural skills, and patient management. Analysis of free-text responses showed a deficiency in procedural skills, communication skills, time management, and management of acutely ill patients in the emergency department in both classes of medical schools. Many graduates suggested early clinical exposure with hands-on training and the addition of modules of ethics and medical laws in the curriculum.
Conclusion: The medical graduates lack pertinent training in professionalism, ethics, medical laws, and communication skills which may hamper their appropriate preparedness before dealing directly with the high turnover of patients during house jobs.

Background and Objective: To improve the reliability and validity of assessment methods, it is always required to revisit older modalities and introduce new ways to promote students’ engagement and learning. The objective of this study was to compare standardized, structured clinical case and traditional long-case examination systems for the evaluation of clinical competency of final year medical students.
Methods: A non-randomized control study was conducted at the Department of Obstetrics (Obs) and Gynecology (Gyne), Shalamar Medical and Dental College, Lahore, Pakistan, from January 2021 to 2022. All the final-year MBBS students were assessed by standardized, structured clinical case examination at the end of the clinical rotation of Gyne/Obs. Their scores were compared with the scores of previous year students who were examined by traditional long case at the end of the clinical rotation in the same discipline. The perceptions of students and examiners were also obtained by using the predesigned questionnaire using the Likert scale.
Results: The mean scores obtained by the students assessed by traditional long case structured long case were 64.3 and 69.2, respectively (p = 0.001). An overall positive perception for structured long-case examination by students and examiners were seen in comparison to the traditional long-case method of assessment.
Conclusion: The standardized, structured clinical case evaluation system is better than the traditional long-case examination as it helps in identifying areas of weakness and covers a wide range of clinical skills to be assessed. However, time management for each station remains a challenge for both examiners and students.

Background and Objective: Pandemics like COVID-19 adversely affect children’s behavior and psychological development by disrupting routine life activities. Children of healthcare workers are exposed additionally due to the fear of parental exposure to the virus. The objective of this study was to assess the perception of frontline healthcare workers (HCWs) regarding the psychological impact of the COVID-19 pandemic on their children. We also sought to identify the difference of the psychological impact on children of the male and female healthcare workers.
Methods: A survey questionnaire was developed comprising 10 questions about the perception of HCWs regarding the psychological impact of COVID-19 on their children. It was distributed both online and face to face among 150 healthcare professionals, working in training and non-training posts in 4 public and 5 nongovernment hospitals of Pakistan. The mean and standard deviation were calculated for each survey item using Statistical Package for the Social Sciences 26.0.

Results: The response rate was 71.3% and majority (64.2%) of the healthcare professionals were ≥30 years of age. Ninety-two HCWs (85.98%) either agreed or strongly agreed that the parental separation from their kids for long hours during the pandemic had a negative psychological impact on their children. There was a significant difference in perceived psychological impact of COVID-19 on the children of male and female HCWs, with a mean survey score of 2.29 ± 1.82 and 1.69 ± 0.79, respectively (t = 2.29, p-value = 0.024).
Conclusion: Children of the healthcare workers experience more stress and anxiety because of long duty hours and working in high-risk settings. Continuous psychological support and counseling services may be adopted formally to prevent unforeseen adverse events or any long-term negative impact on their physical and mental health.

Background and Objective: Hepatotoxicity induced by antituberculosis drugs is quite common and often linked with oxidative stress. Ajwa dates are rich in antioxidants and flavonoids; therefore, these may be protective against the oxidative stress to liver. This study was designed to determine the hepatoprotective effects of Ajwa dates on hepatotoxicity induced by antituberculous drugs in an experimental model.
Methods: This experimental study was conducted at the Post Graduate Medical Institute, Lahore, Pakistan. A total of 30 male rabbits were divided into 5 groups, with 6 animals in each group. Group A and B were fed on normal diet. Group C, D, and E were fed on a diet supplemented with whole Ajwa dates, flesh, and seed powder, respectively. Group B, C, D, and E were given isoniazid 50 mg/kg and rifampicin 100 mg/kg orally for 14 days. After the rabbits were sacrificed, hepatotoxic changes were examined histologically in all groups according to standard criteria.
Results: Liver to body weight ratio was higher in disease group (B) as compared to the healthy control group A (p-value = 0.03), Ajwa flesh group D (p-value = 0.02) and Ajwa seed powder group E (p-value = 0.07). Differences between experimental groups were not statistically significant for both liver weight, and liver weight to body weight ratio. On histological examination, degeneration, necrosis, steatosis, triaditis, and fibrosis were seen in the disease group B while no such changes were observed in group C, D, and E.
Conclusion: Ajwa dates (Phoenix dactylifera L.) has a protective role against isoniazid and rifampicin-induced hepatocellular injury and fibrosis.

Background and Objective: Antimicrobial resistance (AMR) is one of the serious health problems in Pakistan. Excessive use of antibiotics during pandemics has aggravated AMR; hence, rational use in the future is even more important to consider and implement. Clinical audits on antibiotic prescribing in general practice can help improve antimicrobial stewardship. This study was designed as an audit to evaluate if the antibiotics prescribed for Streptococcus pharyngitis at a sub-urban primary care center in Pakistan were in line with the standard and latest guidelines.
Methods: A retrospective audit was carried out at the primary care center located at Nainsukh, Lahore, Pakistan during 1 month period. Both adult and pediatric patients (above 3 years of age) presenting with upper respiratory tract infections were included in the study. A total of 48 consultation cards were identified using International Classification of Diseases 10 coding. The antibiotic prescribing practice of primary care physicians was evaluated against the Modified Centor Criteria (MCC) which was used as a standard. A score of ≤3 required no antibiotic whereas a score of ≥ 3 needed a same-day antibiotic prescription for sore throat.
Results: There were 28 (58.3%) patients presenting with MCC of ≤3 and were not given antibiotics. Antibiotic prescriptions issued on the day of presentation were n = 20; however, only n = 7 (35%) met the standard criteria, i.e., MCC score of ≥3 and among these patients, penicillin remained the first choice with 71% patients receiving amoxicillin, while 28% received co-amoxiclav.
Conclusion: Antibiotic stewardship is lacking among general physicians working at the sub-urban primary health care center in Lahore city. Clinical audits, as a part of clinical governance, may help improving the quality of care provided to the community by the regional primary health care physicians.

Background and Objective: Autism is a neurodevelopmental and heterogeneous disorder that affects people of all ages; also known as autism spectrum disorder (ASD). Nurturing these children puts a tremendous burden on the primary caregivers. It may be due to some compelling reasons, including existential concerns to unknown etiology of autism and lack of understanding of its nature. The aim of the study was to evaluate the stress level in the primary caregivers and its relationship with child’s chronological and diagnosis age.

Methods: This cross-sectional study included 96 primary caregivers (mothers, fathers, siblings, and grandparents) of children diagnosed with ASD reporting at government and non-government institutes of Lahore city. The childhood autism rating scale was used to confirm the diagnosis of autistic children. The parent stress scale was used to evaluate stress levels in primary caregivers.
Results: The mean age of the autistic children was 5.1 ± 2.5 years, while the mean age at the time of diagnosis was 3.2 ± 1.1 years. The mean stress score was recorded as 52.3 ± 7.3, with the range of 36.0-70.0. No correlation (r = 0.015) was observed between stress score of primary caregivers and duration after diagnosis of autism in these children. However, negative associations (r = -0.044) were seen between primary caregiver’s stress and child’s chronological age.
Conclusion: The majority of primary caregivers indicated bearing a significant level of stress, especially in managing the child in earlier years after diagnosis. Appropriate education, counseling, and rehabilitation services may play an important role in reducing the anxiety and stress over time in caregivers as the child’s age increases.

Background and Objectives: Work-related musculoskeletal disorders are increasing due to poor posture adaptation. Increasing the use of technologies in the office settings is one of the main reasons behind muscle and soft tissue strains. The objective of the study was to determine the pattern of posture-related musculoskeletal pain in office workers.
Methods: This observational study was conducted from 15th May, to 25th June, 2021. Data were collected by convenient sampling. The Nordic Musculoskeletal questionnaire on body postural habits was filled by 150 office workers from different universities of Lahore. Statistical Package for the Social Sciences software version 25 was used for statistical analysis.
Results: There were 79 (52.7%) male and 71 (43.7%) female participants, with a mean age of 35.7 ± 5.14 years. Majority (51.3%) of the subjects reported sitting tilted forward, while a few used backrests and footrests for support. Prolonged crossed legs and twisted spine posture were also adopted by many subjects. Neck, lower back, and shoulder were the most affected regions, with increased musculoskeletal pain reported over the last 12 months. Due to recurrent pain in the neck, shoulder, and upper back, difficulty in carrying out routine jobs, housework, and hobbies was reported by 38.7%, 34.7%, and 30% of the subjects, respectively.
Conclusion: Failure to adopt a good ergonomic approach leads to frequent musculoskeletal pain and difficulty in carrying out routine office and household work.

The American Association for Cancer Research has declared the month of April as the global awareness month of Testicular Cancer (TC). Worldwide, TC is the most frequently reported malignancy in males aged 20 – 40 years. Testicular Cancer and Testicular Self Examination awareness should be started at home. This clinical poster is an easy approach to making the general public attending the outpatient department, understand the very basics of TC & TSE.