Knowledge and perception of medical students towards the use of artificial intelligence in healthcare.

OBJECTIVE: To assess the knowledge and perception of medical students regarding the utility and applications of artificial intelligence in medicine. METHODS: The cross-sectional study was conducted at the Shifa College of Medicine, Islamabad, Pakistan, from February to August 2021, and comprised medical students regardless of gender or year of studies. Data was collected using a pretested questionnaire. Differences in perceptions were explored relative to gender and the year of studies. Data was analysed using SPSS 23. RESULTS: Of the 390 participants, 168(43.1%) were males and 222(56.9%) were females. The overall mean age was 20±1.65 years. There were 121(31%) students from the first year of studies, 122(31.3%) second year, 30(7.7%) from third year, 73(18.7%) from fourth year, and 44(11.3%) from the fifth year. Most participants 221(56.7%) had a good familiarity with artificial intelligence, and 226(57.9%) agreed that the biggest advantage of using artificial intelligence in healthcare was its ability to speed up the processes. In terms of gender of year of studies, there were no significant differences on both counts (p>0.05). CONCLUSIONS: Medical students, regardless of age and year of studies, were found to have a good understanding of the usage and application of artificial intelligence in medicine.

An indirect evaluation of medical residents' research writing skills by research synopsis review.

OBJECTIVE: To scrutinise the research proposals of medical residents fo inadequacies in writing dissertation synopsis. METHODS: The analytical cross-sectional study was conducted at the regional centre of the College of Physicians and Surgeon Pakistan, Islamabad, Pakistan, and comprised synopsis from January t June 2020 of postgraduate residents attached wit different hospitals in Rawalpindi and Islamabad. For evaluation purposes, an institutional checklist was used that had domains: general, epidemiological, statistical, and bibliographical review. These were assessed by a single epidemiologist Data was analysed using SPSS 21. RESULTS: Of the 400 research proposals, 224(56%) were submitted by male and 176(44%) by female residents. Also, 208(52% proposals were submitted by residents at public-sector hospitals, a 114(28.5%) by those at private-sector hospitals, while 78(19.5%) were from military hospitals. Significant association of errors was found with training institutions, speciality an duration of training (p<0.05). No gender difference was seen (p>0.05). CONCLUSIONS: Majority of the research proposals lacke correcunderstanding of all the concepts related to research. Difference in research writing skills across specialties and trainin institutions may be related to the lack of availability o research assistance and good mentorship.

Maternal depression and its correlates: A longitudinal study.

OBJECTIVE: To estimate the burden of antenatal and postpartum depression, and to explore possible predictors of perinatal depression. METHODS: The longitudinal study was conducted at the Department of Obstetrics and Gynaecology, Shifa International Hospital and its Community Healthcare centre in Islamabad, Pakistan, from October 2018 to May 2019, and comprised women in their third trimester of pregnancy. Socioeconomic and obstetrical history was recorded on a proforma, and the Edinburgh Postnatal Depression Scale was used for screening of depression. Data was analysed using SPSS version 23. RESULTS: Of the 200 women, 71(35.5%) were primigravida and 129(64.5%) were multigravida. The overall mean age was 27.1±5.08 years. Further, 64(32%) women belonged to the low-income group, 99(49.5%) middle-income and 37(18.5%) to upper-income group. Women in postnatal period had higher depression scores than women in antenatal period (p<0.05). Antenatal depression increased the risk of postpartum depression (p<0.05). In women having unplanned pregnancies, or being multigravida, or belonging to middle and lower socioeconomic classes, the chances of perinatal depression were higher (p<0.05). CONCLUSIONS: Antenatal depression was strongly associated with postpartum depression, indicating that the former was a significant predictor of the latter. Social class and parity were also found to be directly linked with perinatal depression.

Effect of Pesticides on Biological Control Potential of Neoscona theisi (Araneae: Araneidae).

The present study was designed to record the effect of λ-cyhalothrin, Bifenthrin, and Glyphosate on the mortality, avoidance behavior, foraging activity, and activity of Acetylcholine esterase (AChE) and Carboxylesterase (CarE) in Neoscona theisi (Walckenaer, 1841). Highest mortality (70%) in N. theisi was recorded against λ-cyhalothrin. However, Glyphosate was found to be least toxic. Spider spent less time on insecticides/herbicide-treated surfaces. Insecticides/herbicide-treated N. theisi consumed less prey than untreated control spiders. Similarly, when N. theisi were offered insecticide/herbicide-treated prey, they consumed significantly less. Increased AChE and CarE activities were recorded in insecticides/herbicide-treated spiders as compared to control group. Total protein contents were less in insecticides/herbicide-treated spiders than control group. The results revealed that λ-cyhalothrin is more harmful to spiders as compared to Bifenthrin and Glyphosate. It is suggested that the effect of all pesticides used in agro-ecosystem on beneficial insects should be evaluated before using them in the fields.

Thoracic impalement injury: A survivor with large metallic object in-situ.

Impalement injuries, is a severe form of trauma, which are not common in civilian life. These injuries rarely occurs in major accidents. Abdomen, chest, limbs and perineum are often involved due to their large surface area. Thoracic impalement injury is usually a fatal injury, due to location of major vessels and heart in the thoracic cavity. These injuries are horrifying to site, but the patients who are lucky enough to make it to hospital, usually survive. Chances of survival are larger in right sided impalement injuries while central injuries are always died at the scene. Our patient, 25 years old male, was brought to the emergency room (ER) with large impaled metallic bar (about 2.5 feet long) in situ, in right sided chest. The patient was immediately shifted to operation room (OR) and was operated, his recovery was uneventful without any sequelae. Such patients should be treated and resuscitated according to advanced trauma life support (ATLS) protocols and operated without any delay for further investigations. Such operations are carried out by the most experienced surgeon team available. The impaled objects should not be processed if not necessary to avoid major hemorrhage and damage to vital structures, until the patient is in operation room. Large size and unusual position of impaled objects, makes the job difficult for surgeons/anesthetists. Although horrifying at scene, patients with thoracic impalement injuries are mostly young and healthy, and those who survive the pre-hospital phase are potentially manageable with proper resuscitation. Usually these patients make recovery without any further complications.

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.

Frequency of carrier screening and preventive orientation among first degree relatives of Thalassaemia patients.

OBJECTIVE: To get preliminary data regarding the prevention of thalassaemia major in future generations. METHODS: This Knowledge Attitude Practices study was conducted at Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from January to June 2016, using non-probability purposive sampling. Parents of children undergoing transfusion were interviewed. Questionnaires were used to collect demographics and data about awareness, attitude and frequency of screening among the first degree relatives of a thalassaemia major patient. SPSS 20 was used for data analysis. RESULTS: Of the 270 respondents 240(88.9%) had utilised screening services for their asymptomatic children and had a positive attitude towards prevention, but 30(11.1%) families did not screen asymptomatic children for thalassaemia minor. Besides, 49(18.1%) families had more than one thalassaemia major child in their nuclear family, while, 3(1.1%) were unwilling to let their children undergo tests. Nine (3.3%) respondents said they will not ask a prospective daughter/son-in-law to get tested for thalassaemia minor, while 194(71.9%) respondents had had cousin marriages. CONCLUSIONS: There were significant gaps in awareness among affected families.

Dietary habits and practices of type-2 diabetic patients in a tertiary care centre of Islamabad, Pakistan.

OBJECTIVE: To determine the relation between food intake and diabetes control. METHODS: This cross-sectional study was carried out at Department of Medicine and Endocrinology, Shifa International Hospital, Islamabad, Pakistan, from July 2016 to February 2017, during which type-2 diabetes patients were interviewed using a structured questionnaire. Demographics, intake of high glycaemic index foods consumed in each food group, and general dietary practices were assessed by means of number of meals per day and adherence to the dietary plan. Glycated haemoglobin A1c values were recorded as well. SPSS 21 was used for data analysis. RESULTS: Of the 180 patients, 100(55.6%) were taking three meals a day. Besides, 108(60%) had an income >Rs50,000. Moreover, 127(70.6%) patients were not aware of the type of diabetes, while 117(65%) patients had high glycated haemoglobin levels. Furthermore, 148(82.2%) made a change in diet following diabetes diagnosis, while 168(93.3%) had recommended food available in their house, and 65(36.1%) followed a strictly-recommended dietary schedule. A statistically significant association was found between the consumption of different desserts/sweets and glycated haemoglobin levels (p=0.008) followed by fruit intake like mangoes (p=0.004) and grapes (p=0.02). CONCLUSIONS: There is a need to educate diabetics regarding diet management in terms of glycaemic index of foods.

Frequency of different lifestyle modification measures among patients with GERD based on monthly income.

A cross-sectional study was carried out at Shifa International Hospital Islamabad over a period of 6 months, to determine the frequency and compare the different lifestyle modifications among patients with Gastroesophageal Reflux Disease (GERD) of different monthly income groups. Two hundred patients of GERD were enrolled in the study and divided into two groups based on monthly income less than and more than Rs. 30,000 respectively. Data was analyzed using SPSS 21. Descriptive statistics were calculated. Chi-square test was applied keeping p-value <0.05. Mean age was 40±13 years, 82 (41%) males and 118 (59%) females. Walking was undertaken by 32% after meals and 87.5% consumed tea. Significant difference was seen between income groups and higher intake of fried and spicy foods respectively. Thus, effort needs to be made in creating awareness and counseling patients to practice lifestyle modifications to reduce GERD symptoms and stop sole reliance on medications.

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.

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.

INSECTICIDE RESISTANCE IN THE GROUND SPIDER, Pardosa sumatrana (THORELL, 1890; ARANEAE: LYCOSIDAE).

Elevated levels of insecticides detoxifying enzymes, such as esterases, glutathione S-transferases (GSTs), and cytochrome P-450 monooxygenases, act in the resistance mechanisms in insects. In the present study, levels of these enzymes in the insecticide-resistant ground spider Pardosa sumatrana (Thorell, 1890) were compared with a susceptible population (control) of the same species. Standard protocols were used for biochemical estimation of enzymes. The results showed significantly higher levels of nonspecific esterases and monooxygenases in resistant spiders compared to controls. The activity of GSTs was lower in the resistant spiders. Elevated levels of nonspecific esterases and monooxygenases suggest their role in metabolic resistance in P. sumatrana. The reduced levels of total protein contents revealed its possible consumption to meet energy demands.

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.

Two years experience with tunneled dialysis catheters in patients requiring haemodialysis.

OBJECTIVE: To look for survival rate and major reasons behind the failure of tunnelled dialysis catheters in patients on haemodialysis. METHODS: The retrospective study was conducted at the Department of Interventional Radiology, Shifa International Hospital, Islamabad, and comprised records of 100 consecutive subjects from a list of patients in whom tunnelled cuffed catheters were placed from February 2009 to January 2011 and were followed up for two years. Data was collected on a proforma from the hospital database and medical records of patients. SPSS 19 was used for statistical analysis. RESULTS: Of the total 122 catheters placed in 100 patients, 49 (40.16%) were lost to follow-up. Of the remaining 73 (59.83%) catheters, 38 (52%) had achieved their desired function, while 35 (48%) failed to achieve the target duration. Among the reasons of catheter failure, infection was the commonest at 13 (37.14%) with infection rate of 0.24 per 1000 catheter days. According to Kaplan Meier analysis, catheter survival rates at 60, 90 and 180 days were 89%, 77% and 64% respectively. Mean effective duration of catheter was 129 +/- 117 days. CONCLUSION: Tunnelled dialysis catheters can be safely used as vascular access till the maturation of fistula and may be an alternative to Arterio-Venous Fistula or graft for long-term vascular access if indicated.

Health-Seeking Behaviour and Its Determinants Following the COVID-19 Pandemic.

OBJECTIVE: The purpose of this study was to determine the change in behaviour of individuals towards any health issues they faced after the coronavirus disease 2019 (COVID-19) pandemic and to compare the health-seeking behaviour of people who were infected by the virus and those who were not infected. METHODS: A cross-sectional study was conducted among 400 participants visiting Shifa International Hospital, Islamabad, Pakistan, and Pakistan Institute of Medical Sciences Hospital, Islamabad, Pakistan. Data was collected through a pilot-tested questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). RESULTS: In 286 participants (71.6%), health-seeking behaviours were significantly altered by the COVID-19 pandemic. Overall, this research showed that COVID-19 was linked to poor health-seeking behaviour. CONCLUSION: Most of the participants' health-seeking behaviours were significantly altered by the COVID-19 pandemic. A significant change in how people behaved towards any health problem was reported. As a result, public awareness campaigns should focus on delivering more information about COVID-19 to promote their health-seeking behaviour.

GSK3 regulation Wnt/ß-catenin signaling affects adipogenesis in bovine skeletal muscle fibro/adipogenic progenitors.

Clarifying the cellular origin and regulatory mechanisms of intramuscular fat (IMF) deposition is crucial for improving beef quality. Here, we used single-nucleus RNA sequencing to analyze the structure and heterogeneity of skeletal muscle cell populations in different developmental stages of Yanbian cattle and identified eight cell types in two developmental stages of calves and adults. Among them, fibro/adipogenic progenitors (FAPs) expressing CD29 (ITGA7)pos and CD56 (NCAM1)neg surface markers were committed to IMF deposition in beef cattle and expressed major Wnt ligands and receptors. LY2090314/XAV-939 was used to activate/inhibit Wnt/ß-catenin signal. The results showed that the blockade of Glycogen Synthase Kinase 3 (GSK3) by LY2090314 promoted the stabilization of ß-catenin and reduced the expression of genes related adipogenic differentiation (e.g., PPARγ and C/EBPα) in bovine FAPs, confirming the anti-adipogenic effect of GSK3. XAV-939 inhibition of the Wnt/ß-catenin pathway promoted the lipid accumulation capacity of FAPs. Furthermore, we found that blocking GSK3 enhanced the paracrine effects of FAPs-MuSCs and increased myotube formation in muscle satellite cells (MuSCs). Overall, our results outline a single-cell atlas of skeletal muscle development in Yanbian cattle, revealed the role of Wnt/GSK3/ß-catenin signaling in FAPs adipogenesis, and provide a theoretical basis for further regulation of bovine IMF deposition.