Safety of fasting in diabetic and non-diabetic patients with stable chronic kidney disease during Ramadan.

Objective: To assess the safety of fasting in diabetic and non-diabetic patients with stable CKD during Ramadan. Methods: This prospective observational study was conducted at three secondary and tertiary care hospitals of Karachi during the month of Ramadan from 25th March to 7th May 2022. Patients who met the eligibility criteria were assessed pre-Ramadan, and their baseline blood pressure, serum urea, creatinine, electrolytes, uric acid, and estimated glomerular filtration rate (eGFR) were documented and tracked over the course of Ramadan and up to one week post-Ramadan. Deterioration in renal functions (defined as a rise of ≥30% in serum creatinine from the baseline or the decline of ≥25% in eGFR from the baseline) was observed during the month of Ramadan. Results: A total of 68 patients (34 males and 32 females) with the mean age 58.7±12.16 years were included in the study. Out of 66 patients, 38 were diabetic and 28 were non diabetic. Majority 23(34.8%) were stage-3a and 23(34.8%) were stage-4 followed by stage-3b in 14(21.2%), stage-2 in 3(4.5%) and stage-5 in 3(4.5%) patients respectively. Statistically significant improvement in pre and post Ramadan values of systolic and diastolic blood pressure, serum creatinine and uric acid levels were found in both diabetic and non-diabetic group (P value <0.0001). Conclusion: Our study shows no worsening of renal functions in both diabetic and non-diabetic patients with stable CKD who intended to fast.

Self-Directed Learning And Approach To Seeking Medical Evidence: Perceptions Of Students From A Private Medical University Of Karachi.

Objectives: To assess self-directed learning among medical students and their approach towards seeking medical evidence. METHODS: The cross-sectional study was conducted from November 30, 2021, to June 30, 2022, at the Baqai Medical University, Karachi, and comprised first to fifth year medical students of either gender. Data was collected using a structured online questionnaire which also included questions from the self-directed learning instrument. Data was analysed using SPSS 21. RESULTS: Of the 250 students who approached, 159(63.6%) responded were received; 102(64.2%) females and 57(35.8%) males. The overall mean age was 21.78±1.72 years, with 88(54.1%) subjects aged >21 years. Majority 127(79.9%) participantsscored above average on the self-directed learning instrumentscale, while 131 (84.2%)showed satisfactory approach towards evidence-based medicine. Students with better attitude towardsself- directed learning were more likely to have satisfactory approach towards evidence-based medicine, but this relationship was not significant (p=0.136). CONCLUSIONS: Medical students were found to be keen to adopt self-directed learning and practice evidence-based medicine though they have not been formally exposed to it.

COVID-19 related risk perception and altruistic response amongst undergraduates on reopening of educational institutes.

OBJECTIVE: To determine the coronavirus disease-2019-related risk perception and altruistic response among undergraduate medical students post-lockdown. Methods: The analytical cross-sectional study was conducted from October 1, 2020, to March 31, 2021, at the Baqai Medical University, Karachi, and comprised undergraduates aged 16 and above, studying in medical, dental, physiotherapy, pharmacy and Information technology departments. Data was collected using a structured and standardised online questionnaire. Positive responses led to a perceived risk score ranging 0-9, with a higher score indicating a greater perception of risk. The score was corelated with demographic variables. Data was analysed using SPSS 21. RESULTS: Of the 743 subjects, 472(63.5%) were females. The overall mean age of the sample was 21.34±1.8 years. The mean risk perception score was 3.8±2.5, and it was significantly associated with disease exposure (p<0.001). Altruism had a strong association with the perceived risk score (p<0.001), indicating lower risk perception. Conclusion: The risk perception among the students was low, pointing towards a need of psychological assistance programme for the students.

Clinically significant endoscopic findings in a dyspeptic rural population cohort of Sindh, Pakistan: Are we over-investigating?

Objectives: To discuss the clinically significant endoscopic findings of the upper GI tract and their association with different age groups in a dyspeptic rural population of Gadap town, Sindh. Methods: This was a retrospective secondary data analysis of 806 patients conducted in the medical ward of Fatima Hospital, Baqai Medical University from December 2016 to May 2019. It was approved by the University Ethics Committee. Patients' demographics and other data related to the procedure were recovered from patients' records. SPSS version 20 was used for statistical analysis. Results: There were marginally more women suffering from dyspepsia as opposed to men (51.5% vs 48.5% respectively). Majority of the patients were less than 45 years of age, with most procedures being performed as outpatients. Nearly 40% of the patients did not have clinically relevant endoscopic findings. Most common significant finding on endoscopic examination was gastritis followed by hiatal hernia. Conclusion: Normal upper gastrointestinal endoscopy, regardless of age, is a common finding in patients suffering from dyspepsia in our setting. Therefore, in a resource constraint environment like ours, expensive endoscopic procedures should be reserved for those patients who are not responding to medical therapy or those who have alarm symptoms.