Year 2024, Volume 40 - Issue 1

According to World Health Organization, Pakistan and Afghanistan are the last bastions of Poliomyelitis. Rest of the world has become Polio Free. They achieved this freedom after becoming part of Polio Eradication Initiative which was created in 1988 just after the World Health Assembly resolved to eradicate Polio Myelitis from the globe. The woes of Pakistan do not end here. According to “Health Financing Progress Matrix Assessment Pakistan 2023. Summary of findings and recommendations” by World Health Organization, the service coverage index of Pakistan despite showing a consistent surge over the years was still significantly lower with a score of 45 against an average of 58 amongst the low middle income group countries in year 2021. This calls for a need to revisit our strategic policy making in all spheres of life but especially in health and health education. Dr Vaqar Ahmed in Pakistan’s Agenda of Economic Reforms, identified that this country faces a serious and lingering lack of institutional arrangement within our framework for research-based policy formulation, and post implementation feedback.

The current medical education curricula are designed to address the competencies that result in the graduation of a holistic healthcare professionals. The global competency frameworks have highlighted the outcomes of future doctors that not only incorporate necessary medical knowledge and procedural skills but also equip the graduates with human skills of professionalism, ethics, leadership, lifelong learners, critical thinkers and problem solvers. This has led to the incorporation of these domains in the training curricula of undergraduate medical education in Pakistani universities as well. The focus of this paper is to highlight the structure of a Professionalism, Ethics, Research and Leadership skills (PERLs) module that can be implemented in health professions education to be able to graduate a humanistic doctor who can provide holistic care to the community.

Sleep disorders and mental health conditions often coexist, with a complex and bidirectional relationship between the two. This research aims to examine the impact of sleep disturbances on mental health outcomes and explore the efficacy of sleep-focused interventions in managing psychiatric conditions. A comprehensive review of the literature will be conducted to analyze existing research studies, clinical trials, and meta-analyses. The results will shed light on the relationship between sleep disturbances and mental health by outlining the mechanisms underlying it. In addition, this study will assess how well pharmaceutical therapies and other sleep-focused interventions, such as cognitive-behavioral therapy for insomnia, work to improve the mental health of people with psychiatric disorders.

Background and objective: Formocresol is a gold standard medicament in both vital and non-vital Pulpotomies due to its potent antibacterial potential but, it has a controversial nature due to its side effects. Therefore, the demand for natural alternatives of Formocresol as a pulp dressing material, with few or no side effects, became imperative. The purpose of the study was to introduce Turmeric gel as non-vital Pulpotomy medicament in primary teeth by evaluating its antibacterial effect against Streptococcus mutans and Lactobacillus acidophilus.

Method: It was a multi-arm parallel Randomized Controlled Trial in which sixty patients aged between 4 to 8 years, each containing at-least one non-vital primary molar, were selected and randomly divided into Group A (Formocresol) and Group B (Turmeric gel). Non-vital Pulpotomy was performed by removing the coronal necrotic pulp. Sterile paper points were dipped in the root canals and taken to the laboratory. Cotton pellets soaked in the respective medicaments were placed over the root canal orifices and filled temporarily. Patients were recalled after one week. Samples were again taken, and tooth restored. Comparison between bacterial count at baseline and after one week of treatment was made and expressed as Colony-Forming Units/ml (CFU/ml).

Results: There was a significant reduction in median Streptococcus mutans and Lactobacillus acidophilus bacterial count in each group after one week of treatment (p < 0.001). Formocresol showed higher average reduction than Turmeric gel. However, statistically, the difference was insignificant indicating that both the medicaments possessed comparable antibacterial effect.

Conclusion: Turmeric gel was found as effective alternative to Formocresol.

Randomized Controlled Trial registration number in ClinicalTrials.gov: NCT05801354

Background and Objective: Oral health is integral to overall well-being and the desired knowledge, positive behavior and optimal practices regarding oral health among medical and dental students are crucial in their roles as healthcare professionals. This study aimed to evaluate the behavior, knowledge, and practice of undergraduate medical and dental students regarding oral health.
Methods: This descriptive cross-sectional study was conducted among medical and dental undergraduate students of Peshawar Dental College, Khyber Pakhtunkhwa, Pakistan. Data collection involved distributing a three-part questionnaire to 385 participants on-site, ensuring convenience and consistency. Participants were required to provide voluntary consent, and statistical analysis using the latest software-generated descriptive statistics to summarize responses, including frequencies and percentages.
Results: A total of 49.6% of students believed in brushing after meals, 41.3% associated excess food consumption with dental caries, and 62.6% recognized bleeding gums as a sign of inflammation. In addition, 55.6% thought regular brushing prevents all dental problems. Notably, 91.9% acknowledged sugar’s role in tooth decay, while 88.1% linked dental plaque with caries. Most participants (87.8%) believed fluorides strengthen teeth, and 89.6% recognized a link between overall body health and oral health. The majority (51.9%) brushed their teeth twice daily, with popular additional methods being mouthwash (31.4%) and Miswak (30.4%). In addition, 50.9% adhered to the recommended 2-minute brushing duration. Dietary habits varied, with 44.7% consuming sweets 2-4 times daily, and soft drink consumption being reported once a week (51.2%). A total of 8.1% of students admitted to smoking.
Conclusion: The study reveals both strengths and areas for improvement in oral health behaviors among medical and dental undergraduates. While many students adhere to recommended brushing practices, there is a need to enhance their knowledge and education on oral hygiene, brushing duration, and dietary habits. Tailored interventions are essential to promote healthier behaviors ensuring their preparedness to deliver comprehensive oral healthcare in the future.

Background and Objective: A concerning increase in occurrences of COVID-19-associated mucormycosis (CAM), has been reported worldwide in people who are coping with COVID-19 disease. Despite this apparent correlation, the exact association is yet unknown. To ascertain the degree to which mucormycosis and coronavirus illnesses are associated, this study was conducted to analyze the relationship between COVID-19 and mucormycosis infection.
Methods: This observational study examined 35 individuals who had been diagnosed with mucormycosis at Lahore General Hospital, Lahore, Pakistan. The relationship between mucormycosis and coronavirus disease was determined by analyzing the patient’s demographics, gender, COVID-19 status, and co-morbidities.
Results: The mean age of the enrolled patients was 49.40 ± 13.511 years with the majority (54.3%) being male. A total of 25.7% had confirmed COVID-19-positive disease. Notably, diabetes mellitus (DM) was the predominant co-morbidity in a significant proportion of patients (74.3%), followed by comorbidity of DM with chronic kidney disease (11.4%), chronic liver disease (8.6%), and hypertension (5.7%). The presence of co-morbidities and COVID-19 were significantly correlated (p < 0.05) in mucormycosis patients, whereas age and gender had no significant association (p > 0.05).
Conclusion: In conclusion, mucormycosis could be an additional aspect of the pandemic’s spectrum. The data from our study supports this claim since a significant percentage of the patients with mucormycosis had a positive COVID-19 disease concomitantly.

Background and Objective: Dentures require regular cleaning and without proper guidance on how to clean and care for their dentures, patients may experience discomfort, bad breath, and an increased risk of oral diseases. This study explored the level of awareness, hygiene practices, and the guidance received regarding denture care among individuals wearing dentures in Punjab.
Methods: This survey was conducted with the agreement of the IRB, using systematic sampling, from November 2021 to August 2022 using a questionnaire developed by the authors, validated through expert review, and administered through interviews. The questions were asked in English language and in Urdu with those who did not understand English language. The survey instrument had 18 items targeting demographics, denture hygiene awareness and practices amongst private and public dental hospital patients. 
Results: There was a statistically significant difference between private and public dental hospitals regarding instructions given for denture hygiene awareness. Most respondents received instructions verbally (83.3%), followed by practical demonstration (20%) and written instructions (9.3%). The majority agreed that unclean dentures have an association with oral (56%) and systemic (70.7%) health and may act as a source of infection (57.3%). A total of 56% of the respondents cleaned their dentures once daily while 16.7% reported halitosis. A significant proportion of the patients had the habit of wearing dentures overnight. 
Conclusion: Approximately half of the patients were aware of the optimal denture hygiene and the implications of wearing unclean dentures. The majority received instructions from dentists verbally and were wearing dentures overnight.

Background and Objective:

The environment in medical college itself is recognized as inherently stressful. The competitive atmosphere, constant evaluations, and high expectations can contribute to a feeling of constant pressure and anxiety among students. This study aimed to determine the learning and relaxation techniques adopted by high-achieving medical students.

Methods: It was a cross-sectional study completed in six months duration. A self-designed, customized, and experts validated questionnaire was used to collect data from consecutive medical students who scored above 70% in their professional exams and were enrolled in a five-year MBBS program at Central Park Medical College, Lahore, Pakistan. The data were analyzed using statistical software and the percentages of responses were calculated by keeping the power of study at 80%.

Results: The results showed that the most frequently adopted learning techniques were group study 63(61.8%)], discussing with classmates 54(85.7%)], selective study pattern but reading once 56(54.9%)], studying a week before the test 51(50%)] and revising twice 60(58.8%). the most common relaxation technique was watching, dramas, movies, and seasons

Conclusion: The high achiever undergraduate medical students employed different learning strategies while the most favored medium for studying was YouTube channel. Concurrently, brief breaks during study sessions, listening to music, watching movies, and other forms of visual entertainment were the most reported relaxation techniques.

Background and Objective: The rubber dam is the only method that can ensure complete isolation during dental procedures. During endodontic and restorative procedures, it improves patient protection, treatment efficacy, and infection control. A novel rubber dam system called Optradam has introduced a remarkably comfortable, user-friendly clamp-free technique. Therefore, this study was conducted to compare conventional rubber and OptraDam®Plus (Ivoclar Vivadent) based on patients’ and dentist preferences.
Methods: After receiving ethics board clearance, this trial was carried out at the Department of Operative Dentistry at a tertiary care hospital in Islamabad from June to December 2022. A total of 30 participants were assigned to each group; conventional rubber dam
(Group-1) and OptraDam®Plus (Group-2). Two questionnaires were designed and validated one to be completed by dental practitioners and the other by patients. The gathered information was analyzed using statistical tests of significance.
Results: A total of 60 patients were treated; 31 (52%) males and 29 (28%) females with a mean age of 32.35 years (SD = 4.59). Both the dentists (80% ) and the patients (73.3%) favored the conventional rubber dam system (Group-1). Concerning patient comfort, the conventional rubber dam (96.7%) was considered more comfortable than the OptraDam®Plus (Group-2) (86.7%). More effective moisture management was seen in Group-1 patients (90%). Other factors, such as time, convenience of application, and imaging radiography, had statistically insignificant results among both groups.
Conclusion: The results indicate that both patients as well as operators, preferred the use of conventional rubber dams over OptraDam®Plus during an endodontic and restorative procedure..

Background and Objective: Schatzker type V or VI tibial plateau fractures pose complicated surgical problems, with potential complications including neurovascular injury, compartment syndrome, and soft-tissue and ligament damage. Successful treatment requires regenerating articular cartilage, maintaining biological integrity, realigning the mechanical axis, stabilizing the joint, and preserving mobility. This study compares the functional outcomes of two approaches, the locking plate technique and the hybrid Ilizarov technique, in managing complicated tibial plateau fractures.
Methods: This cross-sectional study was conducted on 78 patients presenting with proximal tibial complex fracture at the Orthopedic Surgery Department of Jinnah Hospital, Lahore. Patients were divided into two groups, Group A received the Hybrid Ilizarov Technique while Group B received the locking plate technique as a treatment modality for their fracture. Data were analyzed using statistical software with a p-value <0.05 as significant.
Results: In Group A (Hybrid Ilizarov Technique), 84.6% of males and 15.4% of females participated, while Group B (locking plate technique) had 82.1% of males and 17.9% of females. Type VI fractures were the most common in both groups. Postoperative Rasmussen’s clinical functional knee score was higher in Group B (24.90 ± 4.266) as compared to Group A (22.23 ± 5.783). Functional outcome was reported as excellent in 46.2% of patients of Group A as compared to 30.8% of patients of Group B suggesting the supremacy of the locking plate technique in treating complex tibial plateau fractures.
Conclusion: The locking plate technique is a more reliable method for treating complex proximal tibial fractures than the hybrid Illizarov technique. 

Background and Objective: Stress-related behaviors such as challenging academic atmosphere and rigorous examinations exert a negative impact on the normal function of temporomandibular joint. This study aimed to determine the prevalence and severity of temporomandibular joint disorders (TMDs) and their association with examination-related stress among medical (Bachelor of Medicine and Bachelor of Surgery) and dental (Bachelor of Dental Surgery) students.

Methods: This cross-sectional survey was conducted at Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan, from June 2022 to November 2022 using the Fonseca’s Questionnaire. A total of 198 medical and dental students were included as study participants. They were required to select just 1 response for each of the 10 items mentioned in the adopted but customized and validated questionnaire. TMD was categorized as mild, moderate, severe, or no TMD based on the sum of these responses. The data were analysed using statistical software and a p-value less than or equal to 0.05 was set as significant.

Results: There were 52 (26.2%) males and 146 (73.7%) females with a mean age of 24.2 +1.22 years. Among 198 students, 104 were dental students while 94 were medical students. The prevalence of TMD was found to be 63.6% among all students. There was no TMD in 36.4% of students while 42.9% of students had mild TMD, and moderate and severe TMD was found in 14.1% and 6.6% of students, respectively. Mild (74%) and severe (6.7%) TMD were more prevalent in dental students than in medical students while moderate TMD was found more in medical students (16%). However, these differences were statistically not significant between dental and medical students (p > 0.005).

Conclusion: TMD was found in both medical and dental students with no significant difference in severity between them. The study indicates the need to take on certain preventive and therapeutic strategies to address this disorder among anxiety-prone medical and dental students.