Empathy scores amongst undergraduate medical students and its correlation to their academic performance.

Introduction: Empathy is one of the soft skills required for building rapport and having meaningful patient-doctor interaction. Its effect on academic performance at the undergraduate level amongst Pakistani medical students is not known. This study was done to assess the relationship between empathy and gender, and the academic performance of undergraduate medical students of Azad Kashmir. Methods: This cross-sectional study was done in Poonch Medical College, Azad Kashmir, Pakistan, from May 2018 to May 2019. The sample size for this study consisted of 200 students, determined by Krejcie and Morgan sample size determination chart. Students who agreed to participate in the study were enrolled according to convenience sampling using google forms. The Interpersonal Reactivity Index (IRI) questionnaire was utilized as the data collection tool. Data were analyzed using SPSS version 25. The ethical review board approved the study. Comparisons between males and females at the IRI questions level, IRI domains level, and total IRI were made using the Mann-Whitney U test. The Spearman Rank Correlation test was used to assess the correlation between academic performance, IRI domains, and total IRI scores. A one-way ANOVA test was done to assess the relationship between academic performance and their study years. Results: A total of one hundred and fifty-one students (males 83, females 68, response rate 75.5%) participated in the study from the third to the final year of medical college. The mean empathy scores of males and females were 90.76 ± 8.39 and 91.72 ± 9.76 (p-value = 0.552). On the empathic concern scale, female students had significantly higher empathy scores (25.44 ± 3.49) than males (23.78 ± 3.88) (p-value=0.008). No significant correlation was found between the empathy scores and academic performance, using Spearman's correlation test (p>0.05). Conclusion: Females showed significantly higher empathy scores than males for two Interpersonal Reactivity Index items and empathic concern scale. Overall, male and female students had similar total empathy scores. The relationship between empathy and academic performance was non-significant.

Assessment of the relationship between the educational environment and academic performance of undergraduate medical students of Azad Kashmir.

OBJECTIVE: To assess the relationship between the educational environment and academic performance of undergraduate medical students of Azad Jammu and Kashmir. METHODS: The cross-sectional study was conducted from September 2018 to September 2019 at Poonch Medical College, Rawalakot, Azad Jammu and Kashmir, and comprised undergraduate medical students of either gender from first to fifth year of studies. Data was collected using the Dundee Ready Education Environment Measure questionnaire which was distributed electronically to the students. The percentage of scores achieved in the last professional examination was taken as the academic performance, and it was corelated with the questionnaire's subscale scores. Data was analysed using SPSS 23. RESULTS: Of the 500 students approached, 324(64.8%) returned the questionnaire fully completed; 92(28.4%) males and 232(71.6%) females. The largest group was from the third year of studies 108(33.3%). The mean questionnaire score was 96.31±18.47 and it was not significantly correlated with academic performance (p>0.05). The subdomain mean scores were also not significantly correlated with academic performance (p>0.05). Academic performance was significantly higher among females compared to males (p=0.002). CONCLUSIONS: There was found a huge scope for improvement of the educational environment.

Assessment of the relationship between self-esteem and academic score of undergraduate medical students of Azad Kashmir, Pakistan.

A cross-sectional observational study was performed at the Poonch Medical College, Azad Kashmir, Pakistan, from June 2018 to June 2019 to assess the relationship between self-esteem and the academic score of undergraduate medical students. Rosenberg Self-Esteem (RSE) scale was used as data collection tool. The study questionnaire was electronically distributed to all 500 students enrolled in the Bachelor of Medicine and Surgery (M.B.B.S) programme out of which 253 submitted the questionnaire (response rate: 50.6%). The mean academic score of all students was 66.61± 5.42 and the mean RSE score was 28.66± 3.98). A statistically significant correlation was not found between age, academic score, and RSE score. Female students had slightly higher academic performance scores and RSE scores compared to the male students, but this difference was not statistically significant. Future studies are required to assess the contributing factors responsible for better academic performance.

Histological Stains in the Past, Present, and Future.

Certain contemporary histology stains and methods are not the same as those used in the past. This progression has delved into the requirement for more precise, less complex, and efficient staining procedures. The objective of this study is to assess historical and contemporary stains and procedures, as well as the challenges surrounding their improvement. Carmine, hematoxylin, silver nitrate, Giemsa, trichome stain, Gram stain, and mauveine were among the first histological stains discovered in nature. Aside from their utility in the study of tissues at the time, they also laid the groundwork for the development of commercial dyes that are still in use today. Hematoxylin and eosin, Ziehl-Nielsen (ZN) stain, periodic acid-Schiff stain, and Grocott-Gomori methenamine silver stain are some of the most recently developed histological stains. The future of histological stains and processes appears to be influenced by technological advancements and the demand for cost-effective diagnostic approaches in the healthcare system. Thus, currently used histological stains appear to be economical, quick, and reliable tools for interpreting, archiving, and delivering essential diagnoses that could not be achieved by any other means.

Accuracy of lung ultrasound and chest X-rays in diagnosing acute pulmonary oedema in patients presenting with acute dyspnoea in emergency department.

To determine the diagnostic accuracy of lung ultrasound and chest X-ray in diagnosing Acute Pulmonary Oedema in patients presenting with acute dyspnoea in emergency department, a study was conducted at the emergency department of Shifa International Hospital, Islamabad, from July 31, 2018 to January 31, 2019. A total of 225 patients presenting with dyspnoea and satisfying the inclusion criteria were assessed through clinical examination, lung ultrasound (LUS) and chest X-ray. The results of chest X-ray and lung ultrasound were compared with clinical diagnosis. The study revealed sensitivity of chest X-ray and LUS (60.16% versus 91.05%), specificity (66.67% versus 91.18%), positive predictive value (68.52% versus 92.56%) and the negative predictive values (58.12% versus 89.42%) respectively. The present study revealed that the LUS has better accuracy than chest X-ray for diagnosis of acute pulmonary oedema.

Knowledge and attitudes of Pakistani intensive care unit nurses regarding oral care delivery to mechanically ventilated patients.

OBJECTIVE: To assess the knowledge and attitudes of intensive care unit nurses regarding oral care delivery to mechanically ventilated patients. METHODS: The cross-sectional study was conducted from January to July 2018 across four hospitals in the twin cities of Rawalpindi and Islamabad, Pakistan. Data was obtained from randomly selected nurses with the help of a 14-item self-reporting questionnaire. Data was analysed using SPSS 23. RESULTS: Out of 81 nurses, 76(93.8%) were female, and 47(58%) had experience up to 10 years. When the participants were asked if disease can be transmitted from other patients, 23(28.4%) said it was likely, 22(27.2%) said it was most likely and 16(19.8%) said they did not know. When asked if the disease can be transmitted from the aspiration of contaminated secretions from the oropharynx, 32(39.5%) nurses said it was likely, 31(38.3%) said it was not likely and 9(11.1%) did not know. Knowledge level was significantly associated with level of education (p<0.05). In terms of attitude, 54(66.7%) nurses disagreed that there were more important tasks to do for unstable patients than oral care, indicating a good attitude. CONCLUSIONS: Knowledge and attitude among the subjects were found to be good regarding oral care delivery to mechanically ventilated patients.

Trends of utilization of Complete Blood Count parameters for patient management among doctors in Azad Kashmir.

OBJECTIVE: To determine the trends of utilization of CBC parameters in patient management among doctors in different hospitals in Kashmir, Pakistan. METHODD: A self-administered questionnaire-based survey was carried out amongst doctors working in four hospitals of Kashmir i.e. Combined Military Hospital, Muzaffarabad, Combined Military Hospital, Rawalakot, Abbas Institute of Medical Sciences, Muzaffarabad, and District Hospital, Kotli during August to December 2017. RESULTS: Out of 500 physicians, 217 physicians answered the questionnaire, representing a response rate of 43.4%. Only three of the 11 parameters in the CBC report i.e. hemoglobin, white blood cell count and platelets were selected as frequently or always useful by more than 80% of physicians. Rest of the eight parameters of the CBC were found useful by less than 80% of the physicians. Most agreed that the current format of a CBC report gives adequate information. CONCLUSION: The present study concludes that majority of the physicians utilize only three of the basic parameters on the complete blood count. An educational intervention can be planned for the physicians to increase their knowledge about the utility of other parameters.

Knowledge, Attitude, and Practice of Blood Donation Among Undergraduate Medical Students in Azad Kashmir.

Objective To evaluate the knowledge and attitude of undergraduate medical students of Poonch Medical College about blood donation. Methods This cross-sectional study was done using a 27-item, validated, interviewer-administered questionnaire involving undergraduate medical students from March to October 2018. Informed consent and ethical clearance were secured. Results A total of 318 undergraduate medical students (response rate of 63.6%) was included in this study. Most respondents knew the difference between whole blood and blood components (294; 92.5%) and they also believed that spreading knowledge of blood donation among the health workers is a necessity (306; 96.2%). There was a statistically significant correlation between knowledge and attitude (p .021). Overall knowledge was higher among the female students (p = .019). Conclusion The study revealed an overall good level of knowledge and attitude among medical students. However, there are still areas of improvement such as blood donation and vaccination-related knowledge. The study also identified important facilitators and barriers to blood donation.

Prostate-specific antigen velocity in diagnosis and prognosis of prostate cancer - a systematic review.

Prostate-specific antigen velocity (PSAV) is widely used to detect PC and predict its progression. In this study, we qualitatively synthesized the currently available evidence from published studies regarding the PSAV role in PC. Electronic databases were searched to find relevant articles published until January 2019. Inclusion and exclusion criteria were applied to identify related papers. Eventually, data extraction followed by evidence synthesis was conducted. Full-text screening resulted in 42 included studies. Multiple definitions and intervals were used for PSAV calculation across studies. Results from the included studies were conflicting regarding the role of PSAV in detecting PC and predicting progression in active surveillance cases. However, there is evidence that PSAV may have a predictive role in post-treated men. There is no clear-cut evidence from the published literature to support the use of PSAV in clinical practice.

Knowledge, attitudes, and practices related to diabetes mellitus among diabetic patients with complications in Rawalakot, Azad Kashmir.

OBJECTIVE: To determine the knowledge, attitudes and practices of type 2 diabetes mellitus patients. METHODS: The cross-sectonal study was conducted at Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawalakot, Azad Kashmir, from March 26 to September 25, 2017, and comprised patients of type 2 diabetes mellitus who were enrolled using convenience sampling. Each participant completed a self-administered 35-item questionnaire. Data was analysed using SPSS 23 to determine the correlations among variables. RESULTS: Of the 116 patients, 74(63.8%) were females, and the largest group 58(50%) was aged 51-70 years. Of the total, 111(95.6%) had heard about type 2 diabetes mellitus, 112(96.6%) had sought treatment after diagnosis, and 115(99.1%) had blood sugar tested within the preceding year. There was a positive correlation between knowledge and attitude (p=0.005), knowledge and practice (p<0.001), and attitude and practice (p<0.001). Knowledge, attitude and practice improved with increase in education (p>0.05). CONCLUSIONS: The subjects had fair knowledge and good attitude toward type 2 diabetes mellitus, and they appeared willing to improve diabetic control. However, diabetes-related practice was found to be poor.

Assessment of learning styles of undergraduate medical students and its effect on examination outcomes - a cross-sectional study done in Azad Kashmir, Pakistan.

OBJECTIVE: To assess the learning style preferences of undergraduate medical students and the effect of the preferred learning style on examination outcomes. METHODS: The cross-sectional study was conducted from April to September 2018, at Poonch Medical College, Rawlakot, and Azad Jammu and Kashmir Medical College, Muzaffarabad, Pakistan, and comprised students from 2nd to 5th year. Data was collected using 16 item visual, aural, read/write and kinaesthetic questionnaire version 7.0. Data was analysed using SPSS 23. RESULTS: Of the 406 students, 203(50%) belonged to each of the two colleges. None of the students preferred unimodal or bimodal learning styles, while 191(94.1%) at Poonch Medical College and 189(93.1%) at Azad Jammu and Kashmir Medical College preferred quad-modal and the remaining preferred trimodal style. Among the combination of learning styles, aural in different combination was preferred by 201(99.01%) of Poonch Medical College students and 202(99.51%) at the other institution. There was no statistically significant relationship between the preferred learning style and examination outcomes (p>0.05). CONCLUSIONS: Most of the participants preferred multiple sensory modalities for learning.

Relationship between internet addiction and academic performance of undergraduate medical students of Azad Kashmir.

OBJECTIVE: To assess the relationship between internet addiction (IA) and academic performance among the medical students of Azad Kashmir, Pakistan. METHODS: A cross-sectional study was done involving 316 medical students of Poonch Medical College, Azad Kashmir, Pakistan from May 2018 to November 2018. Dr. Young's Internet Addiction Test questionnaire was used as the tool of data collection. The questionnaire contained twenty 5-points Likert scale questions to assess internet addiction. IA score was calculated and the association between IA and academic performance was observed by Spearman Rank Correlation test. Relationship between baseline characteristics of the medical students and IA was also seen. RESULTS: Eighty-nine (28.2%) medical students fell under the category of 'severe addiction' and most importantly only 3 (0.9%) were not internet addicted according to Dr. Young's questionnaire. Internet addicted medical students scored significantly poor in their exams (p. <.001). One hundred thirty one (41.4%) students with a median IA score of 45 scored in the range of 61-70% marks as compared to 3 (0.9%) students with a median IA score of 5, secured greater than 80% marks. CONCLUSION: This study and many other previous studies have revealed that internet addiction affects academic performance. The number of internet users is ever increasing therefore, the number of internet misusers will also increase. If no step is taken to control internet addiction, it may cause a serious impact in the future.

Impact of Social Media Integration in Teaching Methods on Exam Outcomes.

OBJECTIVE: The objective of this study was to assess the impact of social media integration in teaching methods on exam outcomes. METHODS: This study was conducted at Poonch Medical College, Azad Kashmir, Pakistan from November 2018 to January 2019. All 125 students of 4th year MBBS were included in the study. The mean age of all respondents was 22.96 ± 3.25 years. One unit of special pathology was taught using traditional teaching methods and a second unit was taught using traditional teaching methods supplemented by social media. One exam was taken before the integration of social media and a second exam after its integration. Written informed consent was secured from all the participants before starting the project. RESULTS: The mean difference in examination score after social media integration was 8.97 ± 5.23 which was statistically significant (95% CI -7.954-9.988, p <0.001). However, classroom attendance was significantly higher before social media integration (95% CI 0.668-0.197, p <0.001). Social media integration provided better examination outcomes for the students and gave voice or space to those who never previously asked questions or participated in the class. CONCLUSION: Social media broke down the barriers and students communicated with confidence. Educationists may work together to create a guideline on how social media can be efficiently incorporated in the education system.

Clinically-targetable vulnerabilities in cancer metabolism: A systematic review and meta-analysis.

OBJECTIVE: To investigate the efficacy and safety of targeting cancer metabolic vulnerabilities with specific anticancer agents. METHODS: The systematic review and meta-analysis entailed search on PubMed, Embase and Google Scholar databases for cohort-based studies or clinical trials which reported hazard ratio for overall survival and/or median overall survival of patients treated with metabolicallyactive anticancer drugs. Data was analysed using the Number Cruncher Statistical System version 11. RESULTS: There were 16 studies published between 1989 and 2018 that reported improvement in the overall survival (p=0.05) despite the reported significant heterogeneity across the studies (I2=70%). Exploiting amino acid metabolic vulnerabilities was associated with a favourable prognostic outcome (p=0.05), while targeting glycolysis and nucleic acid synthesis had no significant clinical importance (p>0.05). CONCLUSIONS: There is an urgent need to develop future therapies relying on the synergistic actions of nucleotide biosynthesis, glycolysis and amino acid metabolism.

Knowledge and attitude of health workers regarding catheter-associated urinary tract infection in tertiary care hospitals, Pakistan.

OBJECTIVE: To assess the knowledge and attitude of house officers, residents, specialists and nurses regarding urinary catheterisation and catheter-associated urinary tract infection in tertiary care hospitals. METHODS: The cross-sectional study was conducted from February to July 2018 at 9 hospitals in Rawalpindi and Islamabad, Pakistan, and comprised doctors and nurses. Data were collected using an interviewer-administered questionnaire. Knowledge and attitude regarding urinary catheterisation were compared between doctors and nurses. Data was analysed using SPSS 23. RESULTS: Of the768 individuals approached, 485(63%) agreed to participate. Of them, 358(74%) were doctors and 127(26%) were nurses. Among the doctors, 261(73%) were house officers, 58(16%) residents and 39(11%) specialists. When asked if avoiding catheter kinking was an effective way to prevent CAUTI, 194(54.19%) doctors got it correct as opposed to 102(80.31%) nurses. When the doctors and nurses were asked if the catheter should be removed whenever it is convenient for healthcare personnel, 354(98.88) doctors and 112(88.18) nurses gave the correct answer (p=0.041). CONCLUSIONS: There was reasonable knowledge and attitude among nurses and doctors towards urinary catheterisation and preventive measures related to catheter-associated urinary tract infection.

Predictors of prolonged mechanical ventilation in patients admitted to intensive care units: A systematic review.

OBJECTIVE: Although intensive care medicine has evidenced a significant growth in recent decades, the number of patients requiring prolonged mechanical ventilation (PMV) still represents a considerable burden on health-care expenditure. The prediction of the need for PMV seems to provide a plausible cost-effective intervention. The objective of this study is to systematically review the predictors of the need for PMV of adult patients admitted to intensive care units (ICUs) due to medical and surgical needs. METHODS: We conducted a systematic search on three online databases (PubMed, Embase, and MEDLINE) till February 20, 2019. The search process employed several combinations of specific keywords and Boolean operators. RESULTS: A total of 15 articles were included in the study. Based on pooling the outcomes of odds ratios (ORs) and their respective 95% confidence intervals (CIs) as reported from logistic regression analyses, the pooled PMV incidence in 8220 patients (69.59% males) was 17.67 cases per 100 ICU admissions (95% CI 13.69-21.65). We could not conduct a meta-analysis of ORs and 95% CIs due to the significant heterogeneity observed between the included studies (P < 0.001, I2 = 97%). Pre-operative/preadmission kidney dysfunction and chronic obstructive pulmonary disease were the most significant independent predictors of the need for PMV. Following cardiac surgeries, repeated or emergency surgery, prolonged cardiopulmonary bypass time, and the need for blood transfusion were predictors of the need for PMV. CONCLUSION: Within the study limitations, several predictors were identified, which could be further investigated using a unified PMV definition. Successful prediction of the need for PMV would assist clinicians in identifying and adjusting a "weaning strategy" as well as improving patient care to reduce morbidity. Furthermore, establishing specialized weaning units could be warranted based on PMV incidence and prediction in the local settings.

Dismal situation of cardio pulmonary resuscitation knowledge and skills among junior doctors in twin cities of Pakistan.

OBJECTIVE: To assess the knowledge, attitude, and practice of cardio pulmonary resuscitation (CPR) among junior doctors in 13 tertiary care hospitals of Rawalpindi and Islamabad. METHODS: A total of 317 junior doctors from 13 tertiary care hospitals in Rawalpindi and Islamabad in Pakistan were included in this cross-sectional study. Data were collected using a 37-item interviewer-administered structured questionnaire by the researchers. Informed consent and ethical approval were secured. Doctors' knowledge, attitude, and practice regarding CPR were presented and compared across the demographic variables (age, gender, CPR training etc.). Data analysis was done using SPSS V 23 at an alpha level of 5%. RESULTS: Response rate for this study was 87.08%. Abbreviations of BLS, AED, and EMS were known by 94.3%, 36.0%, and 41.0% doctors respectively. No doctor had complete knowledge of CPR. Less than half of the participants knew the proper compression depths. Overall knowledge regarding CPR steps was poor. Out of 31 CPR knowledge, attitude, and practice related questions 21 correct answers were given by two doctors which was the highest score. The mean KAP score was 14.18 ± 0.15. CONCLUSION: Awareness regarding CPR is essential for all doctors. Many authorities in developed countries are giving CPR training to the general population whereas in Pakistan, many of the doctors never had CPR training. The current study showed the clear majority wants hands-on CPR training. Hospital authorities may find this as an opportunity to improve the knowledge and skills of health workers.

Metastatic potential and prognostic significance of SOX2: A meta-analysis.

BACKGROUND: SOX2 is a regulator of pluripotent cellular transcription, yet it has been recently integrated in cancer biology. The present study provides an analytic insight into the correlation of SOX2 overexpression with cancer metastasis and patient survival. AIM: To investigate the association of SOX2 overexpression with metastasis and its implication in the prognosis of cancer patients. METHODS: A meta-analysis was conducted including studies that compared the association of low or high SOX2 expression with lymph node metastasis (LNM) and/or distant metastasis (DM). The following data were additionally extracted: survival, including the overall survival (OS) and disease-free survival (DFS), and prevalence of high and low SOX2 expression. Odds ratios (commonly known as ORs) and their respective 95% confidence intervals (CIs) were used to investigate the association between SOX2 expression and LNM and DM, while hazard ratios (commonly known as HRs) and 95%CIs were applied to evaluate the prognostic markers. RESULTS: In a total of 2643 patients (60.88% males), the pooled prevalence of SOX2 overexpression was 46.22% (95%CI: 39.07%-53.38%) in different types of cancer. SOX2 overexpression significantly correlated with DM (OR = 1.79, 95%CI: 1.20-3.25, P < 0.008) compared to low SOX2 expression. In subgroups analyses, a high SOX2 expression was associated with LNM in cancers of the lung, breast, and colon and associated with DM in hepatic, head and neck, and colon cancers. SOX2 overexpression was also associated with a shorter OS (HR = 1.65, 95%CI: 1.34-2.04, P < 0.001) and DFS (HR = 1.54, 95%CI: 1.14-2.08, P = 0.005). CONCLUSION: A remarkable role of SOX2 overexpression was observed in cancer biology and metastasis. However, many questions in the regulatory pathways need to be addressed to reveal as many functional aspects as possible to tailor new targeted therapeutic strategies.

MCT4 has a potential to be used as a prognostic biomarker - a systematic review and meta-analysis.

The role of several metabolic changes, such as hypoxia and acidosis, in the tumour environment has caught the attention of researchers in cancer progression and invasion. Lactate transport is one of the acidosis-enhancing processes that are mediated via monocarboxylate transporters (MCTs). We conducted a systematic review and meta-analysis to investigate the expression of two cancer-relevant MCTs (MCT1 and MCT4) and their potential prognostic significance in patients with metastasis of different types of cancer. Studies were included if they reported the number of metastatic tissue samples expressing either low or high levels of MCT1 and/or MCT4 or those revealing the hazard ratios (HRs) of the overall survival (OS) or disease-free survival (DFS) as prognostic indicators. During the period between 2010 and 2018, a total of 20 articles including 3831 patients (56.3% males) were identified. There was a significant association between MCT4 expression (high versus low) and lymph node metastasis [odds ratio (OR)=1.87, 95% confidence interval (CI)=1.10-3.17, P=0.02] and distant metastasis (OR=2.18, 95%CI=1.65-2.86, P<0.001) and the correlation remained significant for colorectal and hepatic cancer in subgroup analysis. For survival analysis, patients with shorter OS periods exhibited a higher MCT4 expression [hazard ratio (HR)=1.78, 95%CI=1.49-2.13, P<0.001], while DFS was shorter in patients with high MCT1 (HR=1.48, 95%CI=1.04-2.10, P=0.03) and MCT4 expression (HR=1.70, 95%CI=1.19-2.42, P=0.003) when compared to their counterparts with low expression levels. Future research studies should consider the pharmacologic inhibition of MCT4 to effectively inhibit cancer progression to metastasis.

Diabetes Risk Assessment Among the City Population in Azad Kashmir: A Cross-sectional Study.

Objective To determine the frequency of people at risk of developing diabetes mellitus type 2 (DMT2) and their risk of developing the disease over the next five years, using the Australian type 2 diabetes risk assessment (AUSDRISK) tool. Methods A cross-sectional study was done involving 152 adults; both males and females were randomly selected from city populations in Rawalakot and Muzaffarabad of the Azad Kashmir, irrespective of weight, family history and dietary habits. Patients with the apparent clinical features of DMT2 were excluded from the study. Data were collected over a nine-month period from April 2017 using an interviewer-administered questionnaire based on the AUSDRISK tool. Results Statistical analysis was done using SPSS version 23.0 (IBM, Armonk, NY, USA). Descriptive statistics were used to calculate the frequencies and percentages. Fifty-four (35.5%) participants had a low risk, 88 (57.9%) had an intermediate risk, and 10 (6.6%) had a high risk of developing DMT2 over the next five years. Conclusion Most of the city occupants had an intermediate-to-high risk of developing DMT2 (64.5%) over the next five years.