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Open access Editorial | September 25, 2022
Tackling disease burden through primary care

Hina Javaid, Abdul Jalil Khan

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Lack of appropriate knowledge and awareness among the providers and community about the risk factors and essential life style changes is the leading cause of increasing morbidity and hospital admissions due to non-communicable diseases in our country. The foundations of a patient-centred healthcare system in Pakistan needs to be laid down as a priority. Strengthening of capacity building of the primary healthcare teams across all provinces and building an early primary care physician contact must be ensured at all levels.  

Open access Letter to the Editor | September 25, 2022
Breaking bad: barriers in the timely diagnosis of brain tumors

Muhammad Saad Babar, Haseeb Mehmood Qadri

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It is a very common practice to label the episodes of headache, sleepless nights, nausea, vomiting and weight loss as “routine complaints”. Though highly prevalent, such signs and symptoms can be an indicator of a life-threatening brain tumor. The general population of the underdeveloped and the developing countries is habitual of taking over-the-counter drugs to manage these presentations while avoiding  specialists' consultations till later stages of the brain tumours. Here, we try to discuss and identify few major barriers in the timely diagnosis of brain tumors and how to overcome them at the grass-roots level in Pakistan.

Open access Case Report | September 25, 2022
Fungal sinusitis in an immunocompetent patient: a case report

Saima Gulzar, Shameen Shoaib, Maham Akhlaq, Sumera Nighat, Sameer Anjum, Nadia Naseem

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The frequency of fungal rhinosinusitis is increasing over the last two decades worldwide. It is classified into two main types: the invasive disease with a poor prognosis which is predominantly seen in patients with some form of immunosuppression and chronic fungal rhinosinusitis usually affecting the immunocompetent individuals. We present a case of fungal sinusitis in an immunocompetent 40-year-old male. The patient had a history of recent onset of progressive nasal blockage, discharge, and cough. Computed tomography scan of paranasal sinuses showed bilateral maxillary, left ethmoidal and sphenoidal sinusitis, and left inferior nasal turbinate hypertrophy. The sample received was necrotic slough from the nose that was processed for histopathology, and special stains, including Grocott’s Methenamine Silver and Periodic Acid Schiff were applied based on which the diagnosis of non-invasive fungal infection was made. Due to early diagnosis, the patient responded well to sinus clearance and conservative management in the clinical setting.

Open access Review Article | September 25, 2022
Challenges in conducting online assessments in undergraduate medical and dental education: a scoping review

Gul Mehar Javaid Bukhari, Javeria Saleem, Syed Abdullah Javaid Bukhari, Muhammad Ishaq, Muhammad Salman Butt

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Online assessment in medical education is relatively new and there is a paucity of literature available on this topic. The objective of this scoping review was to conduct a systematic search of the published literature on the challenges of conducting online assessments in undergraduate medical and dental curricula. The literature was searched in the recommended electronic databases. The search terms used were “online assessments, e-assessments, computer-assisted assessments, online assessment challenges and opportunities, online assessments in medical education, reliability and validity of online assessments, and online assessments during COVID-19 pandemic” in PubMed Central, Google Scholar, Wiley Online Library, SpringerLink, and Ovid. After screening, 21 full-text articles were included in this scoping review. The data were charted independently and synthesized to present the findings.
Most of the studies included in this review were published in the year 2020 and 2021(till September). Half of the studies (50%) reported that cheating and plagiarism are the most common challenges in online assessments, while a similar number of studies highlighted the issues faced by the teachers in making and conducting online assessments. Similarly, 22% of the studies emphasized the concerns raised by the students, while another 22% reported the technical and financial issues faced by the institutions in conducting online assessments. It was revealed that during COVID-19 the biggest challenge for the educational system was to switch to online assessments, as the educational system was not ready for it. Few studies (16%) reported that the issues of reliability and validity of online assessments are still to uncover.
This scoping review may help to lay the foundation for more empirical future studies on the challenges of conducting online assessments in the undergraduate medical and dental curricula in Pakistan.

Open access Review Article | September 25, 2022
Insulin-like growth factor-I signaling plays a pivotal role in the development of oral premalignant lesions in patients with diabetes mellitus

Sidra Aslam, Sarah Ghafoor

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Diabetes mellitus is a disorder of the metabolic system that is diagnosed by hyperglycemia and glucose intolerance. Diabetic patients are frequently prone to developing oral health complications, such as being at a higher risk for developing oral precancerous conditions like lichen planus, leukoplakia, and erythroplakia. Insulin-like growth factor-I (IGF-I) is a peptide hormone with a structure similar to insulin and belongs to the family of growth factors that play a vital role in the development of embryonic, postembryonic, and normal physiological functions of the human body. IGF-I, through autophosphorylation of its receptor, activates the mitogen-activated protein kinases pathway that leads to the expression of IGF-I hormone. In oral premalignant conditions, like lichen planus, submucous fibrosis, leukoplakia, and erythroplakia, the levels of the IGF-I hormone are increased. Subsequently, IGF-I can be used as a marker for early detection of malignancy in oral premalignant lesions.

Open access Original Article | September 25, 2022
Schizophrenia is linked to dyslipidemia with minimal alterations in the inflammatory biomarkers - an experience from Saudi Arabia

Razan Ahmed Alyoubi, Sawsan Hassan Mahassni

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Background and Objective: Schizophrenia (SZ) is a chronic mental illness that is associated with increased inflammation, adverse effects on the immune system, and abnormal concentrations of biochemical molecules. This study is the first to determine the concentrations of C-reactive protein (CRP) and some  proinflammatory and anti-inflammatory cytokines, the differential complete blood count (CBC), and the lipid profile in Saudi patients with SZ.
Methods: Blood samples were collected from 45 randomly chosen male in-patients with chronic SZ and 29 healthy males, with an age range of 28-47 years. The concentrations of CRP, IL-6, IL-4, TNF-α, and IFN-γ; body mass index (BMI); CBC; and the lipid profile were determined through standard guidelines and compared between the patients and controls.
Results: The results showed that there were no significant differences in the CRP and cytokines’ concentrations for the patients compared with those of the controls. Patients, however, had significantly higher red blood cell (RBC) distribution width. Additionally, patients had significantly lower BMI, basophil and RBC counts, basophil-lymphocyte and eosinophil-lymphocyte ratios, hemoglobin, cholesterol, and low-density lipoprotein concentrations.
Conclusion: In conclusion, patients with SZ in local population showed slight inflammation and the immune system was minimally affected. Additionally, patients had dyslipidemia and were possibly more prone to anemia.

Open access Original Article | September 25, 2022
Effect of anterior chamber depth on the accuracy of different intraocular lens’ formulas

Muhammad Moin, Tayyaba Gul Malik, Rabail Alam

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Background and Objectives: Due to the difference in anterior segments among different races, intraocular lens formulas behave differently. Asian eyes have smaller anterior segment dimensions than Caucasian eyes. This study was carried out to evaluate the effect of different values of anterior chamber depth on the accuracy of Sanders, Retzlaff, Kraff/Theoretical (SRK/T), Hill Radial Basis Function (Hill RBF 2), and Barrett Universal II (Barrett U II) formulas.
Methods: This was a descriptive observational study. Ninety-six eyes of patients, who underwent phacoemulsification with intraocular lens implantation and ended uneventfully, were included. The patients were divided into two groups based on the anterior chamber depth (ACD). Group 1 had ACD > 3 mm and group 2 had ACD < 3 mm. Intraocular lens (IOL) power with SRK/T was calculated with a built-in formula in IOL Master 500. Barrett Universal II and Hill RBF 2 formulas were calculated using online calculators. Descriptive statistics were calculated for both groups. An independent t-test was applied for group comparison.
Results: Comparisons of the mean prediction errors of groups 1 and 2 using three different formulas were not statistically significant (p > 0.05). However, SRK/T had the lowest median prediction error for both groups but the highest percentage of eyes within ±0.5 D of absolute prediction error (APE) for group 1 and the lowest percentage of eyes within ±0.5 D of APE for group 2.
Conclusion: There was no statistically significant effect of different anterior chamber depths on the accuracy of SRK/T, Barrett U II, and Hill RBF 2. The three formulas behaved similarly with different depths of the anterior chamber.

Open access Original Article | September 25, 2022
Stigma, perceived family support, and post-traumatic stress experienced by seropositive HIV patients in Pakistan

Kiran Zia, Faiza Khalid

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Background and Objective: Stigmatization and discrimination are phenomena familiar to all human immunodeficiency virus (HIV)-positive patients, which create a significant amount of stress; little is known about the role of family support in alleviation of this stressful condition. The current study aims to investigate the relationship between the perceptions of family support, stigmatization, and symptoms of posttraumatic stress in HIV-positive patients in Pakistan.
Methods: A total of 100 seropositive patients, aged between 18 and 50 years, were approached through professional organizations in Lahore, Pakistan, based on purposive and snowball sampling strategies. The magnitude of stigma experienced by the patients was assessed by administering the Berger HIV stigma scale. The multidimensional scale of perceived social support and post-traumatic stress disorder checklist were used to assess post-traumatic stress symptoms (PTSS) and perceived family support (PFS).
Results: The study identified a positive relationship between experiencing stigma and the development of PTSS. Also, a significant inverse relationship between PFS and PTSS was observed, whereas a consequential negative association between experiencing stigma and PFS was evident in patients who disclosed their illness to their families.
Conclusion: The current study documents that HIV seropositive patients in Pakistan experience high levels of stigma, especially in relation to the disease  disclosure to their families and other social contacts. An already immune compromised status and stigmatization leads to significant stress symptoms which ultimately decrease the perception about accessibility of social support in the times of crisis.

Open access Original Article | September 25, 2022
Is the access to healthcare services satisfactory among women prisoners? A survey from Lahore, Pakistan

Firdos Kausar, Mansoor Ghani, Samina Kausar, Najam Ul Sabha

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Background and Objective: All human beings are vulnerable when deprived of their liberty, but the experience of imprisonment has a significant impact on the social, economic, spiritual, intellectual, psychological, and physical health and well-being of different categories of prisoners, particularly children, women, and older people. This study has been conducted to determine the health problems of female prisoners and their level of access to healthcare services.
Methods: TThis was a descriptive cross-sectional study. A sample of 108 female prisoners was included by convenience sampling from Kot
Lakh Pat Jail, Lahore. Healthcare access and women’s health problems were assessed by a self-structured questionnaire. Data were coded
and analyzed by using Statistical Package for the Social Sciences version 20.0. 
Results: Out of 108 females, 78.7% were not satisfied with the health facilities. About 11.1% of the prisoners were suffering from hepatitis C and 1 prisoner was diagnosed with human immunodeficiency virus. Preplacement and periodical health examinations were not conducted as a routine, while stigmatization by healthcare providers was another major issue that female inmates faced during imprisonment.
Conclusion: Female inmates were not satisfied with the overall quality of healthcare provided to them. Poor healthcare access combined with communicable diseases adversely affects their physical and psychological well-being, leading to compromised reformation, rehabilitation, and integration back into society.

Open access Original Article | September 25, 2022
Cabergoline: an effective treatment&nbsp;for conception in prolactinoma

Zahra Safdar, Omair Afzal, Rabia Nafees, Nabeel Choudhary

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Background and objective: Prolactinoma is an uncommon cause of amenorrhea and subfertility in females. When diagnosed, symptoms resolve with medical treatment in 90% of the cases. Conception and uneventful pregnancy, however, remain a big challenge in these patients. The objective of this study was to determine the therapeutic effectiveness of Cabergoline for conception in female patients with prolactinoma. The duration for restoration of menstruation, spontaneous conception, and outcomes of pregnancy were recorded over a period of 1 year in relation to prolactin level estimation.
Methods: This prospective study was carried over a period of 2 years from December, 2019 to December, 2021. A total of 696 female patients of reproductive age, diagnosed with prolactinomas, were included and randomly divided into 2 groups; A (Cabergoline) and B (Bromocriptine), and were given standard doses of both drugs. The duration for restoration of menstruation, spontaneous conception, and outcomes of pregnancy were recorded over a period of 1 year in relation to the serum prolactin level estimations.
Results: Most of the females were 25-30 years of age and most of them (98.2%) presented with amenorrhea. Restoration of menstruation was found to be earlier in group A, i.e., 3.6 months, as compared to group B, i.e., 5.8 months. Spontaneous conception within 6 months was observed in 42.6% of the patients of group A as compared to group B (26.8%). The rate of miscarriage was comparable in both groups. The live birth rate in the Cabergoline and Bromocriptine groups was 84% and 73.4%, respectively (p = 0.02). Mode of delivery was Caesarean section in both groups in all participants. Serum prolactin levels were significantly reduced in the Cabergoline group as compared to the Bromocriptine group (p = 0.035).
Conclusion: Cabergoline is an effective drug for spontaneous conception within 6 months of successful restoration of menstruation in female patients with prolactinomas. Live birth rate is also higher in the Cabergoline group as compared to the Bromocriptine group. 

Open access Original Article | September 25, 2022
Is your blood grouping associated with personality and intelligence?

Kashaf Mustafa, Sana Haseeb Khan, Faiza Javed, Farwa Willayat, Maria Abdullah, Ayesha Bajwa.

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Background and Objective: Personality and blood group type are both heritable factors. Personality is the compound mannerism or constitution that forms an individual’s peculiar state of mind. Intelligence quotient (IQ) is the quantification of one’s aptness to reason and solve problems. There is contemplation on the interconnection of the ABO blood group with personality traits and IQ. This study aimed to uncover the relationship between standard personality traits, IQ levels, and the ABO blood group.
Methods: This cross-sectional descriptive study comprised 200 healthy individuals (faculty and students of a teaching hospital). The blood typing of the participants was carried out by the standard tube method and the Big Five Inventory, a personality questionnaire containing 60 questions and the Naglieri nonverbal ability test, a mental capacity testing form, with 20 nonverbal questions were distributed, which were solved by all participants in a given time. After obtaining the results, scoring for personality traits and the levels of their IQ were determined. Data were analysed to find associations between personality traits, IQ level, and the ABO blood group.
Results: There exists an association between the ABO blood group and one of the personality traits, i.e., agreeableness (p = 0.001), while no significant relationship was found between the ABO blood group and the remaining four personality traits or the IQ level of the participants (p > 0.05).
Conclusion: ABO blood grouping may determine distinct personality-wise characteristics of an individual which may or may not be related to the IQ levels. 

Open access Original Article | September 25, 2022
Assessment of knowledge regarding hand hygiene among healthcare workers at a cantonment-based public sector hospital in Pakistan

Saleh Ahmed, Khola Waheed Khan, Sabeeh Ilyas, Sadia Nadeem

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Background and Objective: Hand hygiene is regarded as one of the most important strategies in limiting infections and hospital-acquired diseases in healthcare settings. Adopting an optimal and scientifically validated technique of maintaining hand hygiene in healthcare centers is considered the safest and cost-effective method to prevent infection transmission to and from the patients. The present study was planned to determine the knowledge of healthcare workers about hand hygiene using the standard questionnaire in a local tertiary care hospital.
Methods: It was a cross-sectional survey conducted at the Pakistan Ordnance Factories Hospital, Wah Cantonment, Pakistan, for 3 months. By adopting purposive sampling, a total of 165 healthcare professionals were recruited for the study. “Hand Hygiene Knowledge Questionnaire for Healthcare Workers,” published by World Health Organization (WHO), was used for data collection. Each subject filled out the questionnaire by himself/herself. Data were entered and analyzed in Statistical Package for the Social Sciences version 22.0.
Results: It was observed that only 11 (6.6%) subjects had good knowledge of hand hygiene according to the standard guidelines, while majority of the respondents (58.2%) had a moderate level of knowledge according to the WHO criteria. There was no statistical difference in the scores among medical doctors and nurses.
Conclusion: The level of knowledge about hand hygiene among healthcare workers is unsatisfactory. It calls for effective reinforcement through repeated training and awareness seminars as a part of routine work to inculcate this habit for better infection control in hospital settings. 

Open access Original Article | September 25, 2022
Emotional and behavioral problems and coping strategies among adolescent orphans

Mahpara Qamar, Mansoor Ghani, Samina Kausar, Zeenaf Aslam, Najam ul Saba, Firdous Kousar, Nasara Shahbir

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Background and objective: Rising incidence of mental health problems is a serious issue all over the world. Adolescents living in orphanages are at a particular risk as they have numerous challenges in their life and coping with them requires adequate life skills. This study aims to assess the emotional and behavioral issues and the coping strategies adopted by adolescent orphans in Pakistan.
Methods: This cross-sectional study comprises 109 adolescent orphans living in different orphanages. The Strengths and Difficulties Questionnaire for evaluating the emotional and behavioral problems (EBPs) was used while KIDCOPE scale was adopted to assess the coping strategies.
Results: About 34.9% of orphans fell in an abnormal range of EBP and 22.9% were in the borderline zone. The most prevalent problem was conduct (25.7%) followed by peer problems (24.8%), emotional instability (18.3%), hyperactivity (17.4%), and prosocial behavior (11%). A significant and positive correlation was observed between peer problems and maladaptive strategies (r = 0.191, p = 0.047) and between prosocial behavior and adaptive strategies (r = 0.294, p = 0.002).
Conclusion: Orphans residing in orphanages suffer from behavioral and emotional problems and are using maladaptive coping strategies. It is highly suggestive to monitor and maintain an optimal psychological health of this vulnerable population in our country. 

Open access Original Article | September 25, 2022
Effect of daily water intake on the level of anxiety among medical students of Khawaja Muhammad Safdar Medical College, Sialkot

Yousra Shahid, Aqsa Ashiq, Shanza Anwar, Zainab Mushtaq, Sadia Zaheer

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Background and Objective: A high incidence of burnout, depression, and anxiety is found among medical undergraduate and postgraduate students worldwide with the increasing prevalence of stress. The objective of this study was to analyze the correlation between water intake and the risk of anxiety among medical undergraduates of a public sector medical college in Pakistan.
Method: This cross-sectional study was conducted on 375 medical undergraduates of Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan. To assess the level of anxiety, the Generalized Anxiety Disorder Assessment Scale 7 (GAD-7) was used. Points 3-0 were assigned to response categories of “nearly every day,” “more than half the days,” “several days,” and “not at all,” respectively. GAD-7 score was calculated by adding together the scores for seven questions. Scores of 15, 10, and 5 were taken as cut-off points for severe, moderate, and mild anxiety, respectively. Calculation of water consumption was carried out based on the number of water glasses intake per day. It was classified into <4, 4-7, and >7 of water/day.
Result: Out of 110 male medical students, 58.2% were suffering from normal to mild anxiety and 41.8% from moderate to severe anxiety. A total of 40.0% and 60.0% of female medical students were suffering from normal-mild and moderate-severe anxiety, respectively. The risk of anxiety was more among female than male students. Logistic regression indicated a correlation between decreased anxiety and female gender and water intake of 4-7 or >7 glasses/day.
Conclusion: The findings of the current study showed lesser anxiety levels in male students and an inverse relationship between water intake and level of anxiety. Therefore, increasing the intake of water can be beneficial in reducing stress and anxiety thus improving the quality of life.