Translating and Validating PRISMA-7 Questionnaire in Urdu: A Screening Tool to Identify Frail Individuals.

Frailty is a condition in which the affected individual is more prone to both external and internal stressors and has a higher risk of succumbing to chronic diseases. The aim of this research was to translate and validate the PRISMA-7 questionnaire in the Urdu language. This is a validation study conducted in a hospital in Khyber Pakhtunkhwa, Pakistan. PRISMA-7 Questionnaire was translated into Urdu language using forward and backward translations and was then piloted on a sample of 151 subjects, aged 60 and above, and validated by applying reliability and validity statistics. Amongst the sampling population, frailty was found to be 63.26%. All the items in the questionnaire were significantly different from each other, however, the correlation between each was found to be low. Cronbach's alpha was found to be 0.322. Urdu translated version of PRISMA-7 is not a valid and reliable tool for screening frailty in the elderly population of Khyber Pakhtunkhwa, Pakistan. Key Words: Frailty, Validation, Translation, Frail elderly, Urdu.

Identification of appropriate tools to gauge brain functions in a clinical setup of a developing country: A pilot study.

Objective: To identify the most appropriate tools to measure functions of the brain that can be utilized in the clinical setups of developing countries. Methods: This qualitative research with a three-step approach was carried out from January 2022 to May 2022 at the Institute of Basic Medical Sciences, Khyber Medical University, Pakistan. Firstly, literature was searched to identify main brain faculties, then interviews were conducted with regional field experts to identify appropriate scales for the selected functions. Lastly a rubric was filled using interview transcripts and literature. Results: The identified functions were vision, hearing, cognition, motor and emotions. Based on the rubric the best tests were visual fields (17/24), pure tone audiometry (16/24), Mini-Mental State Exam (20/24), Trait Emotional Intelligence Questionnaire (18/24), Romberg's test (19/24) and Manual Muscle Testing (18/24). Conclusion: The clinicians in developing countries can utilize the visual fields, pure tone audiometry, Mini-Mental State Exam, Trait Emotional Intelligence Questionnaire, Romberg's test and Manual Muscle Testing for most efficient, feasible, accurate and cost-effective measurement of brain functions.

Comparison of Pulmonary Functions After Induction of Stress Between Post-COVID and Healthy Adults.

Since the emergence of COVID in 2019, it has spread worldwide. COVID has affected all the systems of the human body. The present research aimed to assess the effects of COVID-19 on the pulmonary system after stress induction. Healthy and affected individuals between the age of 18 and 40 years were made to perform the 6-minute walk test and their pulmonary functions were compared before and after the stressor. Individuals who were three months post-COVID-19 infection were included as cases. Healthy individuals with no history of COVID were included as controls. The pulmonary functions were performed and noted both at baseline and after the 6-minute walk test. The forced expiratory flow 25 (FEF 25) and peak expiratory flow (PEF) showed statistical significance between both groups (p=0.033 and p=0.007, respectively). FEF 25, 50, and 75, maximum voluntary ventilation (MVV) index, and PEF were positively correlated with all respiratory parameters. Forced expiratory volume % (FEV%) was negatively correlated with vital capacity (VC) and forced vital capacity (FVC). This research helped us establish that the effect on the lungs due to COVID is not due to airway restriction or obstruction but reduced lung volume.

A Syringe in an Emergency Saves Time: An Audit on the Utility of Syringe Provision in Eye Emergency.

Background Patient satisfaction is the top priority of health care facilities in addition to the quality of health care delivery services. The convenience of health care receivers, be it temporal or monetary, fall in this domain. Hospitals should be equipped with dealing with all kinds of emergencies no matter how trivial or catastrophic. Aim To improve the provision of emergency care equipment (1 c.c. syringes) in the examination room of our ophthalmology department by 50% in two months' time. Materials and methods This quality improvement project (QIP) was conducted in the ophthalmology department of a teaching hospital in Khyber Pakhtunkhwa. This QIP was conducted over a period of two months in the form of three cycles. All cooperative patients with embedded and superficial corneal foreign bodies who presented to the eye emergency were included in the project. The provision of 1 c.c. syringes in the emergency eye care trolley of the eye examination room was ensured at all times after the first cycle survey. A record was maintained of the percentage of patients receiving syringes from the department as well as the percentage of patients purchasing them from the pharmacy. The progress was measured every 20 days, following the approval of this QI project. Results A total of 49 patients were included in this QIP. This QIP shows that the provision of syringes was improved to 92.8% and 88.2% in cycles 2 and 3 from the previous statistics of 16.6% in the first cycle. Conclusions It is concluded that this QIP achieved its target. The provision of emergency equipment, such as a 1 cc syringe costing less than 1/20th of a dollar, is a simple act that saves resources and improves patient satisfaction.

Sex-Linked Differences in Pulmonary Functions of COVID-19 Patients After a Six-Minute Walk Test.

Coronavirus disease 2019 (COVID-19) predominantly impacts the respiratory system. Historically, numerous lung diseases have shown sex-related differences throughout their progression. This study aimed to identify sex-linked disparities in pulmonary function tests (PFTs) among individuals who have recovered from COVID-19 when subjected to a six-minute walk test (6MWT). In this observational cross-sectional study, we analyzed 61 participants, consisting of 39 (64%) males and 22 (36%) females, all of whom previously contracted COVID-19 three months or more prior. We measured vitals such as blood pressure, pulse, oxygen saturation, and PFT values before and after the 6MWT. The post-6MWT evaluation revealed notable mean differences between males and females in parameters systolic blood pressure (SBP) (p = 0.003), diastolic blood pressure (DBP) (p = 0.026), forced expiratory volume in the first second (FEV1) (p = 0.038), forced vital capacity (FVC) (p = 0.041), and maximum voluntary ventilation (MVV) index (p = 0.011). PFT outcomes indicated sex-based variations among post-COVID-19 subjects. Specifically, post-stress values for FEV1, FVC, MVV index, SBP, and DBP were more elevated in males than in females. However, females presented with higher oxygen saturation levels post-COVID-19 compared to males. Using multiple linear regression modeling, sex was not found to be a strong predictor of PFT results. However, individual regression analyses for FEV1, FVC, and MVV index consistently showcased higher values in males. In conclusion, significant PFT differences exist between males and females after recovery from COVID-19 when exposed to stress induction via the 6MWT.

The menace of self citation: An audit of two years from journals of Khyber Pakhtunkhwa.

Objective: To assess the author and journal self-citation amongst journals of Khyber Pakhtunkhwa. Methods: This is a cross-sectional study conducted from January 2021 to July 2021. In total, manuscript published in 10 journals of Khyber Pakhtunkhwa, either recognized by the Higher Education Commission or Pakistan Medical Commission, in the years 2018 and 2019 were included in the present research. All types of manuscripts were analyzed using a pre-designed data extraction table. Results were extracted, analyzed and appropriate statistics were applied. Results: About 1235 manuscripts published in 68 issues over a period of two years' time were analyzed. The majority of manuscripts were 1039 (84.1%) original articles followed by case reports 90 (7.3%). Author self-citation came out to be 11.26% and journal self-citation was 6.5%. The same institute's author affiliation came out to be 40.6%. Conclusion: The trend of author self-citation was found to be high while that of journal self-citation was low when compared with already prevalent literature.

Link between COVID-19 vaccines and myocardial infarction.

BACKGROUND: Vaccines for coronavirus disease 2019 (COVID-19) include ChAdOx1-SARS-COV-2 (AstraZeneca), Ad26.COV2.S (Janssen), mRNA-1273 (Moderna), BNT162b2 (Pfizer), BBIBP-CorV (Sinopharm), CoronaVac (Sinovac), and Bharat Biotech BBV152 (Covaxin). AIM: To find the association between COVID-19 vaccines and myocardial infarction (MI). METHODS: This is a systematic review that involved searching databases such as MEDLINE, EMBASE, and PakMediNet after making a search strategy using MeSH and Emtree terms. Eligibility criteria were set, and studies having no mention of MI as a complication of COVID-19 vaccination, protocols, genetic studies, and animal studies were excluded. Data was extracted using a predesigned extraction table, and 29 studies were selected after screening and applying the eligibility criteria. RESULTS: The majority of studies mentioned AstraZeneca (18 studies) followed by Pfizer (14 studies) and Moderna (9 studies) in subjects reporting MI after vaccination. Out of all the studies, 69% reported MI cases after the first COVID-19 vaccination dose and 14% after the second, 44% reported ST-segment elevation MI, and 26% reported non-ST-segment elevation MI. The mortality rate was 29% after MI. CONCLUSION: In conclusion, many studies linked MI to COVID-19 vaccinations, but no definitive association could be found.

Let's Play Games: A Comparison of Case-Based Learning Approach With Gamification Technique.

Case-based learning (CBL) has been in practice throughout the world for several decades now. Our institute adopted it some four years back when we shifted toward a modular system of teaching. It is the main technique being used for conducting small group discussions. We decided to introduce a new technique called the gamification technique for conducting small group discussions. There was a need to determine the effectiveness of this new method, as well as to assess factors for its preference so that it could be modified to increase its efficacy. The aim of this research was to quantitatively and qualitatively assess the effectiveness of said gamification teaching technique by comparison with the traditional CBL technique. This was a mixed-method, randomized controlled trial. It was conducted at Khyber Medical College on first-year medical students from June to October 2021. Group-based teaching involving both CBL and the gamification approach was used in this study in a crossover manner. Addressing the ethical concerns, and after informed consent pre-testing and post-testing were done to quantify the performance, an open-ended survey was disseminated after the sessions to check the perceptions of the students. The study recorded (quantitatively) that the post-testing mean score of the gamification teaching technique was 3.41 ± 0.982. For CBL, the mean was 3.55 ± 1.055. This showed a recording of an insignificant difference with a p-value of 0.608. In qualitative analysis, about 12 (80%) students preferred the gamification technique. Their perception was that it instilled competitiveness and increased the involvement of students in class. Gamification also raised their motivation level. This research further revealed that the CBL approach had the advantage of quick learning via the facilitator presentation. Due to the handouts, it was easy to follow. One of the negative points of CBL was that the participants found it a boring and monotonous way of learning. The chief drawback of gamification was that the students were unsure about the accuracy of the information they initially prepared, as it was not being directed by the facilitator. The study concluded an insignificant quantitative difference between the two techniques. On the qualitative end, however, the students preferred gamification.

The Link Between Autism Spectrum Disorder And Gastrointestinal Microbiota.

BACKGROUND: In recent times multiple attempts have been made to search for the link between Autism Spectrum Disorder (ASD) and gut microbiota. This link is not a myth as the microbiota composition and in turn its bi-products affect not only the Gut-Brain axis but also the hypothalamic-pituitary-adrenal (HPA) axis and the immune response. Aim of the study was to find the relation between the Gut Microbiota and the pathophysiology and in turn manifestations of ASD. METHODS: Eight original articles were identified by a systematic search of the MEDLINE database. Those articles were included in the review with clear mention of ASD and microbiota in titles and abstracts. RESULTS: In the majority of studies, Bacteroidetes/ Firmicutes ratio was deranged only one reported it to be normal. Bacteria such as Actinomyces and Proteobacteria were increased and Bacteroides, Bifidobacterium, Lactobacillus, and Prevotella were decreased. The commonest method of sequencing observed was 16S rRNA. CONCLUSION: The microbiota composition of the gut does affect the manifestations of autism spectrum disorder. The derangement of the gut commensals may lead to mood disorders, depression, and other symptoms in autistic kids.

Assessment of gender differences in autonomic nervous control of the cardiovascular system.

OBJECTIVE: To determine the differences in the control of the cardiovascular system by the autonomic nervous system between young males and females.. METHODS: The cross-sectional study was conducted at the Khyber Medical College, Peshawar, Pakistan, from June 2017 to April 2018, and comprised physically healthy medical students of both genders studying in first and second year of their academic studies. The subjects were made to perform the hand grip test and the Valsalva manoeuvre. Their electrocardiogram was recorded during and after the Valsalva manoeuvre. Blood pressure and heart rate were monitored before, during and after both the manoeuvres. Parasympathetic activity was assessed by calculating the Valsalva ratio. Sympathetic activity was measured by observing the increase in diastolic blood pressure during hand grip manoeuvre, and decrease in systolic blood pressure during the Valsalva manoeuvre. Data was analysed using SPSS 20. RESULTS: Of the 140 subjects, 70(50%) each were males and females. There was no significant difference between the parasympathetic system and sympathetic system working of the two genders (p>0.05). There was significant difference between the two groups in sympathetic system when checked on the basis of the hand grip test (p<0.05). CONCLUSIONS: Sympathetic system was found to be acting more efficiently in young males compared to their female counterparts.

Luteinizing Hormone To Follicle Stimulating Hormone Ratio In Patients With Polycystic Ovary Syndrome.

BACKGROUND: Polycystic ovary syndrome is the most commonly occurring endocrinopathy in females of reproductive age group. It is characterized by a wide range of signs and symptoms resulting from hormonal derangements leading to reduced fertility. METHODS: This was a crosssectional (comparative) study. We took 40 cases of polycystic ovary syndrome and 40 controls of infertility without polycystic ovary syndrome depending on the presence of clinical features and ultrasound scans. Blood samples were collected and assayed for luteinizing hormone and follicle stimulating hormone. Data was analyzed with SPSS-19. RESULTS: Luteinizing hormone to follicle stimulating hormone ratio was raised in 3 out of 35 patients (8%) in cases and in 2 out of 39 patients (5%) in controls. There was no statistically significant difference in the luteinizing hormone levels and the follicle stimulating hormone levels and the luteinizing hormone to follicle stimulating hormone ratio of the two groups as indicated by a p-value> 0.05. CONCLUSIONS: Luteinizing hormone to follicle stimulating hormone ratio was not found to be raised in majority of the polycystic ovary syndrome patients included in this study.