Potential risk factors related to academic failure in a medical college: A comparative approach.

OBJECTIVE: To compare risk factors related to medical students' failure based on gender, year of study and living away from home. METHODS: The cross-sectional, non-interventional, comparative study was conducted at a private medical college of Islamabad, Pakistan from 2015 to 2017, and comprised students who had even once scored <50% marks in their professional examinations. Data was collected using a questionnaire that was scored on a five-point Likert scale. Data was analyzed using SPSS 23. RESULTS: Of the 115 students, 62(52%) were day scholars compared to 55(48%) hostellers; 64(56%) were females compared to 51(44%) males; and 50(43%) belonged to the second year. Overall, differences in terms of gender, year of study and living away from home were not significant (p>0.05). CONCLUSIONS: Risk factors for poor academic performance were found to be common among all students.

Quality of life of post-graduate medical students working in private and public hospitals in Punjab as measured by WHOQOL-BREF questionnaire.

OBJECTIVE: To determine the impact of the type of specialty and hospital on the quality of life of medical consultants and residents.. METHODS: This cross-sectional study was conducted at leading hospitals in Punjab and Islamabad Capital Territory from June 2016 to January 2017 to assess the quality of life of medical consultants and residents doing clinical practice for more than 6 months in private and public hospitals. The World Health Organisation Quality of Life - BREF instrument was used to assess the quality of life of the subjects. SPSS 21 was used to analyse the data. RESULTS: Of the 1,154 respondents, 677(58.7%) were male while 477(41.3%) were female. The physical health domain had the highest overall mean score of 66.10±11.40 while the psychological health domain had the lowest overall mean score of 64.13±9.88. Physical health domain, psychological health domain, and social relationship domain score were found to be significantly higher in male doctors compared to female doctors (p<0.05). Overall, quality of life was rated as good by 743(64.4%) and very good by 324(28.1%) subjects. CONCLUSIONS: Physical health scroes were better than psychological health scores among the participants.

Practice of breastfeeding and Immunisation in a periurban community in Pakistan.

OBJECTIVE: To assess the practice of breastfeeding and immunisation in a peri-urban community and correlate it with maternal care during pregnancy of the index child. METHODS: This community-based, cross-sectional survey was conducted at Shifa Tameer-e-Millat University and Shifa College of Medicine, Islamabad, Pakistan, from June 2014 to January 2016, using a self-generated questionnaire. Systemic random sampling method was used to collect data. SPSS 21 was used to analyse the data and to find associations between maternal care and practices of breastfeeding. RESULTS: There were 1,275 participants in the study. The mean age of the participants was 31.61±8.026 years and the mean number of family members was 7.28±3.42. Overall, 1,121(87.9%) women had exclusively breastfed all their children while 906(71.1%) women had their children fully vaccinated. The mean duration of exclusive breastfeeding was 5.30±1.31 months while the mean duration of mixed breastfeeding was 16.70±8.62 months. Mothers who were given prenatal care were 2.60 and 2.91 times more likely to do exclusive breastfeeding and immunisation, respectively, compared to women who were not given prenatal care (p<0.05). CONCLUSIONS: There is a dire need to focus more on routine services compared to massive immunisation and breastfeeding campaigns.

Maternal health status in terms of utilisation of antenatal, natal and postnatal services in a Periurban setting of Islamabad: A community based survey.

OBJECTIVE: To determine the maternal health status in terms of antenatal, natal and postnatal care. METHODS: This cross-sectional study was conducted at Shifa College of Medicine, Islamabad, Pakistan, from August 2015 to February 2016, and comprised married women living in Nurpur Shahan, a peri-urban community..A systemic random sampling method was used to raise the study sample. Only members of the household aged18 to 45 years and permanent residents of that area were selected. SPSS 21 was used to analyse the collected data. RESULTS: There were 1,275 participants in the study with an overall mean age of 31.6±8 years. The mean age of marriage was 19±3.6 years while the mean age of first childbirth was 20.8±3.6 years. Besides, 950(74.5%) participants had undergone an antenatal check-up. Moreover, 685(53.7%) underwent delivery in a hospital, 433(34%) had postnatal check-up, and 432(33.9%) were using contraception. Participants who had undergone hospital delivery were 18.7 times more likely to have taken prenatal care and 6.9 times more likely to utilise postnatal care compared to participants who had not utilised antenatal care (p<0.001). CONCLUSIONS: Most of the participants did not give significant importance to postnatal care.

Role of sociocultural perceptions in malnutrition of children under the age of 5 years in a semi-urban community of Pakistan.

OBJECTIVE: To assess the impact of sociocultural perception on the nutritional status of children under five years of age. METHODS: This cross-sectional study using a self-constructed questionnaire was conducted at the Shifa Rotary Clinic, Nurpur Shahan, Pakistan, from February to October 2016, and comprised mothers and children. Mothers age 18-45years having a child less than 5 years old were included. SPSS 21 was used for data analysis. . RESULTS: Of the 564 participants, 526(93.3%) were housewives and 38(6.5%) were working mothers. The overall mean age was 27.49±5.197 years. Mother was the decision-maker for child nutrition in 344(61.0%) cases while the father was the decision-maker for child nutrition in 106(18.8%) cases. About 64(11.3%) wasted colostrums, of which 18(28.1%) acted on their own accord 46(71.9%) on others' advice. Mother as the decision-maker for child nutrition was found to be significantly associated with normal child nutritional status (p<0.05).In our study male child was 2.29 times likely to have a normal nutritional status as compared to a female child (p<0.05). CONCLUSIONS: Sociocultural perceptions were found to have a significant impact on nutritional status of children under the age of 5 years.

Safe drinking water and sanitary measures: A cross-sectional study in peri-urban community of Islamabad.

OBJECTIVE: To assess sources of drinking water and its methods of disinfection, sanitary situation and waste disposal methods. METHODS: This cross-sectional study was conducted over a period of 6 months from April 2015 to September 2015 in the village of Nurpur Shahan, a peri-urban slum area of Islamabad, Pakistan. Systemic random sampling method was employed to gather data from an adult household member aged between 18 and 45 years through a structured questionnaire. SPSS 21 was used for data analysis.. RESULTS: A total of 2,078 households were included in the study. The mean age of the participants was 31.5±8.17 years. Moreover, 1,600(77%) residents did not disinfect drinking water. Boiling was the most common 378(18.2) method of disinfection. Majority of the households 1,936(93.2%) had latrine inside their houses. The most common mode of waste disposal was burning 951(45.8%), followed by dumping 601(28.9%) and throwing away in the street 415(20%). CONCLUSIONS: Most participants did not disinfect drinking water.

Quality of life of Pakistani medical students studying in a private institution.

OBJECTIVE: To find the quality of life of medical students using a World Health Organisation questionnaire. METHODS: The cross-sectional study was conducted in February 2015 at Shifa College of Medicine, Islamabad, Pakistan, and comprised students studying in an integrated medical education system. The shortened version of World Health Organisation Quality of Life questionnaire comprising 26 items was used. Consecutive non-probability sampling was used to collect data which was analysed using SPSS 21. RESULTS: Out of 417 medical students, 185(44.4%) were male and 232(55.6%) were female. Of them, 165(39.6%) were in pre-clinical years, while 252(60.4%) were in clinical years. Overall, 347(83.2%) students rated their quality of life as "good" or "very good". Environmental domain had the highest mean score of 70.43±16.38 while Psychological Health domain had the lowest mean score of 66.48±15.64. CONCLUSIONS: Medical education affects students' health, thus their quality of life varies. Identification of this is very important, since long-term stress can induce some permanent personality changes in individuals.

Role of sodium-restricted dietary approaches to control blood pressure in Pakistani hypertensive population.

OBJECTIVE: To assess the change in systolic and diastolic blood pressure in post-interventional phase through dietary approaches to stop hypertension/salt-restricted diet. METHODS: This randomised controlled clinical study was conducted from February 2014 to March 2015 at the Armed Forces Institute of Cardiology, Rawalpindi, and Ali Medical Centre, Islamabad, Pakistan, and involved hypertensive patients and matching controls. The control group followed routine diet while the intervention group was given a diet plan containing 1,500mg of sodium providing 2,000 calories. Both groups were advised not to consume sodium-rich foods. Paired sample t-test was applied to determine the change in blood pressure among the groups at two different occasions. RESULTS: Of the 1,492 participants, 710(47.6%) were controls and 782(52.4%) were in the interventional group. Overall, 417(27.9%) participants got their blood pressure checked less than twice in six months, while 409(27.4%) had it done on a regular basis. Moreover, 941(63.1%)) subjects had a family history of high blood pressure and 149(10.0%) participants did not exercise at all. The overall mean age was 53.42±9.302 years. Mean systolic blood pressure and diastolic blood pressure after five weeks was 126.33±3.35 and 84.40±3.04mmHg in the intervention group, and128.41±3.52 and 84.04±2.953mmHg in the control group. Changes in blood pressure between the two groups were minimal but statistically significant (p<0.05). CONCLUSIONS: A diet which is restricted in salt, rich in fruits, vegetables, and low-fat dairy foods and reduced saturated and total fat can substantially lower blood pressure. Such a diet offers an additional nutritional approach to the prevention and treatment of hypertension.

COMFORT LEVEL OF POST GRADUATE RESIDENTS WORKING IN DIFFERENT CLINICAL DOMAINS IN MANAGING COMMON OPHTHALMIC CONDITIONS.

BACKGROUND: Ophthalmological conditions are frequently encountered in almost all clinical specialties. Assessing the adequacy of ophthalmology teaching in undergraduate medical education is important in order to diagnose and manage different ophthalmological conditions. The objective of this study was to determine the comfort level of post graduate residents working in different clinical domains in managing common ophthalmic conditions. METHODS: A cross sectional survey involving 277 post graduate residents was carried out over a period of six months in both private and public tertiary care hospital. A questionnaire containing two sections and 17 variables in total were distributed among Medical Residents of different specialties except ophthalmology residents. Participants of the study were selected through consecutive non probability sampling. RESULTS: Mean hours of classroom based ophthalmology instruction during undergraduate program was 59.38 hours (55.9) and mean hours of clinical based ophthalmology instruction during undergraduate program was 62.73 hours (60.8) 54% were either "not comfortable" or "somewhat comfortable" in managing common ophthalmic condition. Conclusion: Teaching hours in under graduate program meet or exceed requisite criteria. However graduating doctors generally feel that the time spent does not provide them with the comfort and skill level required to care for patients with ocular presentations.

Rotavirus vaccine--a new hope.

Diarrhoea due to Rotavirus is the leading cause of mortality among children less than 5 years of age in developing countries. Though Rotavirus vaccine has been approved by FDA since 2006 it has not been incorporated in the EPI schedule of Pakistan. Objective of our study was to explore the clinical efficacy, cost effectiveness and safety of Rotavirus vaccine in infants and children against diarrhoea caused by Rotavirus. Online search yielded a total of 103 articles out of which 31 articles were included for perusal. Newly-developed vaccines have been found to have combined efficacy of 61.2-64.6% in African Countries and 82.1-84.7% in Europe and Latin America against Rotavirus-induced diarrhoea. Rotavirus vaccine is a very effective option in terms of efficacy, cost and safety against viral diarrhoea caused by Rotavirus. Consideration should be given to include this vaccine in EPI programme of developing countries.

Role of Artificial Intelligence in Endoscopic Intervention: A Clinical Review.

Gastrointestinal diseases are increasing in global prevalence. As a result, the contribution to both mortality and healthcare costs is increasing. While interventions utilizing scoping techniques or ultrasound are crucial to both the timely diagnosis and management of illness, a few limitations are associated with these techniques. Artificial intelligence, using computerized diagnoses, deep learning systems, or neural networks, is increasingly being employed in multiple aspects of medicine to improve the characteristics and outcomes of these tools. Therefore, this review aims to discuss applications of artificial intelligence in endoscopy, colonoscopy, and endoscopic ultrasound.

Black Esophagus: A Rare Case of Acute Esophageal Necrosis.

Acute esophageal necrosis (AEN) also known as necrotizing esophagitis or black esophagus is an extremely rare cause of upper gastrointestinal (GI) bleeding. This condition is considerably rare, and the exact pathophysiology of the development of AEN is still unclear. There is consensus that it is caused by a combination of esophageal mucosal injury due to gastric acid and ischemic injury due to vascular compromise. The management of AEN includes correcting the multitude of underlying predisposing conditions as well as agile symptomatic management and close monitoring for signs of hemodynamic compromise. We here present an interesting case of a middle-aged male patient who presented with hematemesis and underwent emergent esophagogastroduodenoscopy (EGD), which revealed severe necrotic esophagus. We also discussed the risk factors, pathophysiology, and management of AEN.

Schwann Cell Hamartoma Presenting as a Colonic Polyp: A Rare Case Report With a Literature Review.

Mucosal Schwann cell hamartomas (MSCHs) are non-common noncancerous growths derived from Schwann cells in the peripheral nervous system, often found unexpectedly during routine colonoscopy examinations. These growths primarily occur in the colon, although they can also appear in the esophagus and are not linked to familial cancer syndromes. Diagnosis relies on specific histological characteristics and staining patterns. It is essential to distinguish MSCHs accurately since their appearance can closely resemble that of malignant tumors. Characteristically, these hamartomas test positive for S-100 protein but do not exhibit markers typical of other gastrointestinal growths, such as gastrointestinal stromal tumors (negative for KIT), leiomyomas (negative for smooth muscle actin), neurofibromas (negative for CD34), and perineuromas (negative for epithelial membrane antigen or claudin-1). This report discusses the case of a 48-year-old woman who was diagnosed with MSCH during a screening colonoscopy.

Metabolic Dysfunction-Associated Steatohepatitis and Progression to Hepatocellular Carcinoma: A Literature Review.

The prevalence of metabolic-associated fatty liver disease (MAFLD) is increasing globally due to factors such as urbanization, obesity, poor nutrition, sedentary lifestyles, healthcare accessibility, diagnostic advancements, and genetic influences. Research on MAFLD and HCC risk factors, pathogenesis, and biomarkers has been conducted through a narrative review of relevant studies, with a focus on PubMed and Web of Science databases and exclusion criteria based on article availability and language. Steatosis marks the early stage of MASH advancement, commonly associated with factors of metabolic syndrome such as obesity and type 2 diabetes. Various mechanisms, including heightened lipolysis, hepatic lipogenesis, and consumption of high-calorie diets, contribute to the accumulation of lipids in the liver. Insulin resistance is pivotal in the development of steatosis, as it leads to the release of free fatty acids from adipose tissue. Natural compounds hold promise in regulating lipid metabolism and inflammation to combat these conditions. Liver fibrosis serves as a significant predictor of MASH progression and HCC development, underscoring the need to target fibrosis in treatment approaches. Risk factors for MASH-associated HCC encompass advanced liver fibrosis, older age, male gender, metabolic syndrome, genetic predispositions, and dietary habits, emphasizing the requirement for efficient surveillance and diagnostic measures. Considering these factors, it is important for further studies to determine the biochemical impact of these risk factors in order to establish targeted therapies that can prevent the development of HCC or reduce progression of MASH, indirectly decreasing the risk of HCC.

Cryptococcosis and Cryptococcal Meningitis: A Narrative Review and the Up-to-Date Management Approach.

Cryptococcosis is a fungal infectious disease that enormously impacts human health worldwide. Cryptococcal meningitis is the most severe disease caused by the fungus Cryptococcus, and can lead to death, if left untreated. Many patients develop resistance and progress to death even after treatment. It requires a prolonged treatment course in people with AIDS. This narrative review provides an evidence-based summary of the current treatment modalities and future trial options, including newer ones, namely, 18B7, T-2307, VT-1598, AR12, manogepix, and miltefosine. This review also evaluated the management and empiric treatment of cryptococcus meningitis. The disease can easily evade diagnosis with subacute presentation. Despite the severity of the disease, treatment options for cryptococcosis remain limited, and more research is needed.

Is it necessary to stop glucagon-like peptide-1 receptor agonists prior to endoscopic procedure? A retrospective study.

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are effective in diabetes and obesity, reducing hyperglycemia by increasing insulin release and delaying gastric emptying. However, they can cause gastroparesis, raising concerns about aspiration during procedures. Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration. AIM: To evaluate the effect of GLP-1 RAs on gastric residual contents during endoscopic procedures. METHODS: A retrospective chart review at BronxCare Health System, New York, from January 2019 to October 2023, assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures. Two groups were compared based on dietary status before the procedure. Data included demographics, symptoms of gastroparesis, opiate use, hemoglobin A1c, GLP-1 agonist indication, endoscopic details, and aspiration occurrence. IBM SPSS was used for analysis, calculating means, standard deviations, and applying Pearson's chi-square and t-tests for associations, with P < 0.05 as being significant. RESULTS: During the study, 306 patients were included, with 41.2% on a clear liquid/low residue diet and 58.8% on a regular diet before endoscopy. Most patients (63.1%) were male, with a mean age of 60 ± 12 years. The majority (85.6%) were on GLP-1 RAs for diabetes, and 10.1% reported digestive symptoms before endoscopy. Among those on a clear liquid diet, 1.5% had residual food at endoscopy compared to 10% on a regular diet, which was statistically significant (P = 0.03). Out of 31 patients with digestive symptoms, 13% had residual food, all from the regular diet group (P = 0.130). No complications were reported during or after the procedures. CONCLUSION: The study reflects a significant rise in GLP-1 RA use for diabetes and obesity. A 24-hour liquid diet seems safe for endoscopic procedures without aspiration. Patients with upper gastrointestinal symptoms might have a higher residual food risk, though not statistically significant. Further research is needed to assess risks based on diabetes duration, gastroparesis, and GLP-1 RA dosing, aiming to minimize interruptions in therapy during procedures.

The Role of Timely Angiography in Elderly Patients Presenting With Lower Gastrointestinal Bleeding.

Lower gastrointestinal bleeding (LGIB) is associated with significant morbidity and mortality in the elderly population. Timely diagnosis and establishing the etiology of the LGIB can guide appropriate treatment and management. Our patient is a 91-year-old female who presented to the ER with the complaint of several episodes of hematochezia that started four hours before her presentation. The patient underwent an urgent CT angiography showing active bleeding in the proximal ascending colon. She underwent a super-selective arteriogram followed by embolization of the ascending colon arterial culprit bleeding territory using two coils. Her clinical condition improved, and she had no further episodes of hematochezia. Her case highlights the importance of timely diagnosis of the underlying etiology of a patient presenting with LGIB.

Associations of Real-Time Ultrasound and Strain and Shear Wave Elastography with Gastrointestinal Organs: A Systematic Review.

Ultrasound elastography is gaining attention for its diagnostic potential across various medical fields, and its physical properties make it valuable in modern clinical medicine. However, its specific attributes, especially in the context of recent medical advancements, remain relatively unexplored. This study aimed to identify instrument-specific characteristics and applications of real-time ultrasound elastography, shear wave elastography, and strain elastography, particularly within gastroenterology. Following PRISMA guidelines, the study examined elastography articles on databases like PubMed, resulting in 78 included articles. Data on patient demographics, organ involvement, specificity, sensitivity, accuracy, positive predictive value, and negative predictive value were extracted. Statistical analysis involved SPSS version 21, with significance set at p < 0.05. The majority of patients were male (50.50%), with a mean age of 42.73 ± 4.41 years. Shear wave elastography was the most prevalent technique (48.7%), and liver investigations were predominant in gastroenterology (34.6%). Gastrointestinal applications showed higher sensitivity, positive predictive value, and negative predictive values (p < 0.05) but lower specificity (p < 0.05). Real-time ultrasound elastography exhibited increased specificity, accuracy, and predictive values (p < 0.05). Ultrasound elastography appears more accurate and effective in gastroenterological settings. Nonetheless, its performance depends on instrument-specific and operator-dependent factors. While promising, further studies are necessary to ascertain optimal utilization in both gastrointestinal and non-gastrointestinal conditions.

A Reversible Cause of Cutaneous Rash in a Patient With Alcohol Consumption.

The most common cutaneous manifestations of alcoholism include urticarial reaction, flushing, porphyria cutanea tarda, psoriasis, rosacea, seborrheic dermatitis, and pruritus. Here, we present a case of a young male with a history of alcohol abuse who presented with non-blanching, petechial, and perifollicular macular rash secondary to vitamin C deficiency in view of poor oral intake. The rash improved significantly with vitamin C supplementation. Although rare in developed countries, clinicians should keep vitamin C deficiency as a differential diagnosis for skin rash in alcohol consumers.

When Meals Turn Into a Medical Mystery: A Case Report of Sigmoid Colon Impaction by a Chicken Bone.

The presence of foreign objects in the digestive system can lead to various complications within the gastrointestinal (GI) tract. In certain cases, ingesting foreign objects can pose a significant dilemma for surgical teams, primarily because they can lead to blockages or punctures in the upper or lower sections of the GI tract. On occasion, foreign objects located in the lower regions of the digestive tract, such as the colon and rectum, might have entered via the anal pathway, thereby carrying the potential risk of causing perforations in the rectum or sigmoid colon. The other complications encompass the creation of abscesses, blockages in the bowel, fistula, and bleeding. Although these issues associated with foreign objects can arise in a healthy bowel, they can pose challenges in diagnosis when occurring in a bowel that is already affected by inflammation, constrictions, or malignancy. We present a unique case report of a 72-year-old female who presented to the emergency department with left lower quadrant pain associated with nausea and vomiting. Following a detailed clinical evaluation and radiographic imaging, a chicken bone was identified as the culprit, causing an unusual impaction in the sigmoid colon. The patient's medical history revealed no prior GI complications, making this case particularly noteworthy. Timely identification and precise diagnosis of complications arising from foreign bodies are essential to efficiently handle and prevent unfavorable consequences.