Preparedness of Undergraduate Medical Students for Online Learning.

OBJECTIVE: To determine the preparedness of the first-year undergraduate medical students toward online learning. STUDY DESIGN: Descriptive study. Place and Duration of the Study: The study was conducted at the Department of Medical Education, Fazaia Ruth Pfau Medical College, Air University, Karachi, Pakistan, from September to December 2021. METHODOLOGY: The study participants were first-year undergraduate medical students. A pre-validated instrument developed by Lesley University in July 2014 named 'The Prospective Online Student Readiness Questionnaire' was used. Permission was taken via email. The questionnaire has two parts. Section A consists of the demographic characteristics. Section B evaluates the student's readiness for online learning. RESULTS: Data from 81 respondents were collected through an online questionnaire. The results showed that internet self-efficacy, self directed learning, learner control, and learner style have a positive and significant relationship with students' preparedness for e-learning. CONCLUSION: Students are aware of the use of technology. They could be more comfortable working independently at the beginning of the course. Online environment and communication for learning purposes with peers also appear to be weak areas. Students prefer visual aids for learning, and very few enjoy raising their hands in class to answer questions. They are confident in social communications but need more confidence in using online tools for effective online communication and posting questions on online forums during discussions. KEY WORDS: Medical students, Online learning, preparedness, Self-efficacy, Self-directed learning.

Helicobacter Pylori infection among dyspepsia patients in suburbs of Riyadh, Saudi Arabia.

OBJECTIVE: The objective of the study was to determine the current prevalence of Helicobacter pylori infection among Dyspepsia patients and correlate this with Endoscopic findings. METHODS: A retrospective, descriptive facility-based study was conducted from June to December 2017 to estimate the prevalence of Helicobacter pylori among dyspepsia patients from Majmaah, Sudair, Zulfi and Shaqra areas of Riyadh region, Saudi Arabia. Four years data from January 2012 to December 2016 were reviewd by a checklist and analyzed by SPSS. RESULTS: Out of 1398 dyspepsia patients, 485 (34.7%) were positive and 913 (65.3%) were negative for H-Pylori infection. Majority of patients 1143 (81.7%) had gastritis, out of which, 457 (39.9%) of gastritis patients were H-pylori positive. The frequency of H-pylori infection was significantly higher among patients with gastritis (p < 0.001). There was no statistically significant difference in the frequency of H-pylori infection among patients with erosion, ulcer, polyp and cancer (p > 0.05). CONCLUSIONS: The prevalence of H.Pylori was low as compared to other governorates in the kingdom and regional countries. Gastritis was dominating finding on upper gastrointestinal (GI) endoscopy.

Comparison of Magnetic Resonance Arthrography and Wrist Arthroscopy in the Evaluation of Chronic Wrist Pain in Indian Population.

BACKGROUND: The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain. MATERIALS AND METHODS: Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures - triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL). RESULTS: For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%. CONCLUSIONS: The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong.

Lutetium-177 tin colloid radiosynovectomy in patients with inflammatory knee joint conditions intractable to prevailing therapy.

OBJECTIVE: To evaluate the treatment response of lutetium-177 tin colloid radiosynovectomy (Lu-RSV) in patients with inflammatory knee joint conditions refractory to conventional treatment. PATIENTS AND METHODS: Overall, 29 knee joints in 29 patients with chronic synovitis caused by various inflammatory knee joint diseases refractory to conventional therapy were included in this prospective study. All patients were assessed clinically for pain, tenderness, joint swelling, mobility, analgesic intake, and blood pool activity on bone scan. Different scores were assigned to all these parameters. RSV of knee joint was done using intra-articular injection of Lu tin colloid. Response was assessed at 3 months using various clinical parameter scores and blood pool bone scan as mentioned before and categorized as responders and nonresponders on the basis of change in percentage of cumulative scores. RESULTS: Of the 29 joints, 21 were responders and eight were nonresponders at 3 months after RSV. There was a statistically significant reduction in clinical parameters cumulative scores at follow-up when compared with baseline (P<0.0001). Blood pool scintigraphy also showed decrease in blood pool activity compared with the baseline. There was statistically significant association between the responder group and absence of radiological abnormality. CONCLUSION: Lu tin colloid synovectomy is a useful treatment modality in patients with chronic inflammatory knee joint conditions refractory to conventional treatment. Patients with shorter duration of disease and normal or minor radiographic findings are better candidates for RSV.

Students perception towards feedback in clinical sciences in an outcome-based integrated curriculum.

BACKGROUND & OBJECTIVE: Feedback has been identified as one of the key strategies for learning in the outcome-based curriculum. Students are more interested in their grades paying little attention to the feedback, may not understand the importance of feedback and its effect on their performance because of their perception, and beliefs. Non-constructive feedback will not result in the improvement of the students' performance. This study aims to explore; student's perception of useful feedback; the purpose of feedback and believes about written feedback. METHODS: This analytical cross-sectional study was conducted from November 2017 to January 2018 at Majmaah University. Students studying in clinical phase were recruited. Data were collected from 121 students by self-structured questionnaire using complete enumeration sampling method. RESULTS: Majority of the students (45.5%) disagreed that the feedback should always contain marks; (49.6%) commented that the tutor did not provide enough constructive feedback. While we ask the purpose of feedback (62.8%), agree with two-way nature of feedback, and it is helpful to find there expected performance. Almost two third (67.8%) of the students believe that limited feedback is the reason for frustration and they did not receive comments for improvement. CONCLUSIONS: Students are aware of the purpose of feedback. Senior students give more value to feedback and in the opinion that feedback provides useful suggestions for future improvement and limited feedback is the reason for frustration. The results highlight the need for more structured feedback mechanism, and there is a need for faculty engagement in training to fill the existing gapes to create an effective educational alliance.

Prevalence of generalized anxiety disorder and major depression in health-care givers of disabled patients in Majmaah and Shaqra cities, Kingdom of Saudi Arabia.

INTRODUCTION: Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes such as increased blood pressure, etc. The impact of anxiety and depression on health-caregivers of disabled patients are very important because these psychological disorders effects both the health-caregivers and the patients which lead to unexpected bad events. OBJECTIVES: The current study was aimed to find out the prevalence of generalized anxiety disorder and major depression in health-care givers of disabled patients and to observe associations between demographic characteristics and psychological disorders in Majmaah and Shaqra Cities, Kingdom of Saudi Arabia. METHODS: A cross-sectional community-based study was conducted in rehabilitation centers at Majmaah and Shaqra Cities. The data comprising 100 health-care givers was collected from February to April 2015 through complete enumeration sampling method. A pre-validated "general health quality questionnaire" was used to collect the data. RESULTS: Majority of the participants were male (n = 75, 75%). More than 50% of the participants were holding bachelors' degree. Almost three-fifths of the participants had monthly income between 5000 and 15,000 SAR. The prevalence of somatic disorder was only (2%), anxiety disorder (3%), and depression (1%). However, in psychosocial and stress, the prevalence was (8%), respectively. No significant association was observed between demographic characteristics (nationality, gender, marital status, educational level, occupation, and income) and psychological disorders (somatic, anxiety, psychosocial, depression, and stress) P > 0.05, respectively. CONCLUSION: The prevalence of psychological disorders was very low. Nationality, gender, marital status, educational level, occupation, and income were not significantly associated with psychological disorders.

Effect of diet on type 2 diabetes mellitus: A review.

Globally, type 2 diabetes mellitus (T2DM) is considered as one of the most common diseases. The etiology of T2DM is complex and is associated with irreversible risk factors such as age, genetic, race, and ethnicity and reversible factors such as diet, physical activity and smoking. The objectives of this review are to examine various studies to explore relationship of T2DM with different dietary habits/patterns and practices and its complications. Dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM among developing countries. In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. Awareness about diabetes complications and consequent improvement in dietary knowledge, attitude, and practices lead to better control of the disease. The stakeholders (health-care providers, health facilities, agencies involved in diabetes care, etc.) should encourage patients to understand the importance of diet which may help in disease management, appropriate self-care and better quality of life.

Sudden peroneal nerve palsy in an osteoarthritic knee: a case report.

Peroneal nerve injuries have been reported in association with various causes around the knee such as traumatic varus injury, traumatic dislocation, upper tibial osteotomy, knee arthroscopy and total knee arthroplasty. Two instances of varus arthritic knee associated with a peroneal nerve palsy have been reported so far. One presented with gradual onset peroneal nerve palsy that recovered with time and the other with sudden onset peroneal nerve palsy that did not recover. We describe the case of a 63-year-old man who presented with a symptomatic varus arthritic knee and sudden onset peroneal nerve palsy with synovial cysts over the lateral aspect of the knee. We performed a total knee arthroplasty with decompression of the synovial cyst in the same patient. Three months following the surgery the patient was walking pain free with a completely recovered nerve palsy.

Public knowledge and attitudes toward epilepsy in Majmaah.

OBJECTIVES: Epilepsy is very common in the Kingdom of Saudi Arabia, occurring in 6.54 out of every 1000 individuals. The current study was conducted to determine the level of public awareness of and attitudes toward epilepsy in the city of Majmaah, Saudi Arabia. SUBJECTS AND METHODS: This descriptive study was conducted in Majmaah, Saudi Arabia. The study population included respondents derived from preselected public places in the city. Stratified random sampling was used, and the sample size was made up of 706 individuals. A structured questionnaire was used for data collection from respondents after receiving their verbal consent. The data were analyzed using SPSS version 2.0. Ethical approval was obtained from the Ethics Committee of Majmaah University. RESULTS: The results showed that 575 (81.4%) of the respondents had heard or read about epilepsy. Almost 50% of the respondents knew someone who had epilepsy, and 393 (55.7%) had witnessed what they believed to be a seizure. Results showed that 555 (78.6%) respondents believed that epilepsy was neither a contagious disease nor a type of insanity. It was found that 335 (47.5%) stated that epilepsy was a brain disease, and almost one-quarter of the respondents said that the manifestation of an epileptic episode is a convulsion. Regarding attitude, 49% and 47.3% of respondents stated that they would not allow their children to interact with individuals with epilepsy and would object to marrying an individual with epilepsy, respectively. CONCLUSION: Although knowledge about epilepsy is improving, it is still not adequate. The study showed that the attitude toward epilepsy is poor.

Risky health behaviors among students in Majmaah University, Kingdom of Saudi Arabia.

INTRODUCTION: Risky behaviors are those that potentially expose people to harm, or significant risk of harm, which prevent them from reaching their potential in life and which can cause significant morbidity or mortality. OBJECTIVES: The objectives of the study were to determine the overall prevalence of risky behaviors among university students; to determine the prevalence of smoking, drifting, fast driving and physical inactivity among university students; and to determine the associations between such behavior and demographic characteristics. MATERIALS AND METHODS: An observational cross-sectional study conducted in three colleges. The data were randomly collected from 340 students aged 18-30 years from February to March 2015 using a self-administered questionnaire in Arabic. The data were entered using SPSS v 22.0. Mean and standard deviation were calculated for quantitative variables, and frequency and percentages were computed for categorical variables. Chi-square or Fisher's Exact test, as appropriate, were used to test for statistical significance. RESULTS: The overall prevalence of risky behaviors (smoking, drifting, fast driving, and physical inactivity) among students was 47.35%. Overall, 28% of the students were smokers, 25.2% were involved in drifting, 60.9% reported driving fast, and 66.4% were physically inactive. The age between 18-20 years was significantly associated with higher rates of drifting, fast driving, and physical inactivity. CONCLUSION: The prevalence of risky behaviors among university students was high. Physical inactivity and fast driving were the most common identified risky behaviors. Increasing awareness of these risks in the youth may significantly decrease related morbidities, complications, and even mortalities.

Giant cell tumour of tendon sheath with simultaneous two tendon involvement of the foot treated with excision of the tumour and reconstruction of the flexor retinaculum using tibialis posterior tendon in a paediatric patient: A rare case report.

Giant cell tumour of tendon sheath is a benign soft tissue tumour arising from the tendon sheath. The involvement of foot and ankle by such tumours is relatively rare. Children are not commonly afflicted by this condition. All such tumours are reported to arise either from a single tendon sheath or one joint. We report a case of giant cell tumour of tendon sheath in a 12-year-old child, arising simultaneously from the tendon sheaths of tibialis posterior and flexor digitorum longus tendons, as well as extending into the ankle joint. It was treated by complete excision of the mass along with the tendon sheaths with reconstruction of the flexor retinaculum. The location of the tumour, age of the patient, diffuse nature of the tumour and novel technique of reconstruction of the flexor retinaculum make this case extremely rare and the first to be reported in literature.

Use of ring fixator in the management of degloving injuries of lower limb.

High-velocity trauma causes degloving injuries of extremities. Management depends upon the viability of the degloved flap. The degloved area must be covered either with flaps or with split skin grafts. Various methods have been described to provide skin coverage. However, graft uptake depends upon the surgical expertise, graft quality, graft bed circulation and of course immobilization of the grafted area, especially across joints. We describe here a simple technique, which eventually helps graft bed preparation, eases application of graft tissue, facilitates graft care and allows passive mobilization of joints as well.

The extremes in orthopaedics! Whom to blame?

Traditional medicines especially the herbal paste is routinely prescribed by the herb sellers. The unsupervised combinations and preparations are easily available in our part of world. The demand and supply of such irrational combination is only based on the principle that anything natural is safe. Drugs and preparations made by the people who lack the scientific knowledge of traditional herbal medicines adversely affect the consumer. We put forward few complications that resulted after herbal paste application in those who already had visited the specialist but opted the easily available unsupervised herbal preparations.

Birth-related femoral fracture in newborns: risk factors and management.

PURPOSE: Femoral shaft fracture following birth in newborns is a very rare injury. However, the risk factors for, mechanism of and management of these injuries remain a matter of debate. We describe our observations in a tertiary centre. METHODS: Ten cases of femoral shaft fracture encountered during a study period from January 2005 to December 2009 were evaluated. The demographic details, risk factors during birth, systemic illness, mode of delivery, type of fracture and management used were documented, and an analysis was performed. RESULTS: Mean gestational age was 37.2 weeks. Mean time to diagnose was 4 days. Two patients had subtrochanteric fracture, and eight patients had mid-shaft fracture. Most patients had breech presentation and had been born by Caesarean section. All patients showed complete union at the end of 4 weeks. No residual angulation or limb length discrepancy was noted after mean follow-up of 5 years. CONCLUSIONS: Thorough clinical examination and proper orthopaedic consult in the event of doubtful presentation help in early diagnosis and management. These fractures have good prognosis at long-term follow-up.

Malarial hepatopathy in falciparum malaria.

OBJECTIVE: To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: This study was conducted at Medical Unit-I (Ward 5), Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. METHODOLOGY: A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease (e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice) was excluded on the basis of history, relevant clinical examination and investigations. RESULTS: Age of the patients ranged from 13-48 years (mean 26.04+/-8.33). All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two (51.6%) had serum bilirubin 3-6 mg%, 20 (32.2%) had 6-10 mg% and 10 (16.1%) had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients (45%) had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 (35.4%), splenomegaly in 48 (77.4%) and both hepatomegaly and splenomegaly in 16 (25.8%). Gallbladder wall thickness was increased in 5 (8.06%) patients. There was no evidence of biliary dilatation. CONCLUSION: A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given.

Nutritional iron deficiency in women of child bearing age--what to do?

BACKGROUND: Iron deficiency is the most common aetiology of anaemia worldwide and has several risk factors. Although iron deficiency anaemia (IDA) can occur at any age, women from reproductive age group are particularly vulnerable to develop IDA due to increased nutritional demand during pregnancy. Objective was to determine the frequency and nutritional risk factor of iron deficiency anaemia in women of child bearing age. This descriptive, cross sectional study was conducted from October 2005 to March 2006 at the Department of Medicine, Ward-5, and out-patients department of Jinnah Postgraduate Medical Centre, Karachi. METHOD: Two hundred non-pregnant females of child bearing age were included in the study; 100 with no previous pregnancy and remaining 100 with at least one prior history of pregnancy. All the relevant information, i.e., demographic and socioeconomic was collected through a questionnaire. RESULTS: Two hundred patients with signs and symptoms of anaemia were recruited. Out of them 89 patients were found to be having iron deficiency anaemia in various age groups. Results also showed that dietary habit of patients was one of the causative factors leading to iron deficiency anaemia. CONCLUSION: To overcome iron deficiency anaemia a thorough and comprehensive strategy is required, i.e., educating the subjects to consume food rich in iron, community based program, monitoring severely anaemic cases and their treatment.