Journal of University Medical & Dental College

Editor — 2023-02-20

Effective mentorship in health care, need of the time

Sundus Tariq — 2023-02-23

Personalized Management of Breast Cancer, In the Era of Precision Medicine

Saira Saleem — 2023-02-15

Stress levels among pre-clinical Medical students and their coping strategies

Muhammad Hasnat Akhtar — 2023-01-21

BACKGROUND & OBJECTIVE: Stress is no doubt prevalent among medical students. Insight into how different personality types cope with this challenge might give the opportunity to healthcare authorities to devise a more standardized guideline for conducting a psychological aptitude test at the time of intake into medical school. Our objective is to look at the stress and anxiety among medical students and how different personality types cope with stress.

METHODOLOGY: A Cross-sectional descriptive study was carried out at CMH Kharian Medical College from November 2020 to May 2021. Agha Khan University, Anxiety and Depression Scale was employed to assess stress and anxiety levels among medical students. Myers–Briggs Type Indicator (MBTI) was used to identify personality traits, and the “Brief COPE Inventory Scale” was employed to investigate stress coping styles(approach or avoidant) among students. SPSS was used to analyze the results.

RESULTS: Out of 158 participants, 108(68.4%) were females, and 50(31.6%) were males. More than half of the preclinical medical students, 93(58.86%) were having stress [females 73(67.59%), males 20(40%)]. Personality types showed that 100(63.3%) students belonged to the introvert group, while 58(36.7%) students belonged to the extrovert group. Most participants, 144(91%) students, adopted approach coping styles rather than avoidant ones (14 (8.86%). Stress was significantly associated with personality types (p=0.021), coping style (p=0.007), and gender (female) (p=0.001). However, we did not find any association between personality types & coping styles (p=0.936).

CONCLUSION: High level of stress and anxiety (58.86%) was found among students and was more prevalent among females and extroverted medical students. Both personality types (extroverts and introverts) used approach coping styles rather than avoidant trends.

Three-Pronged Approach to Curb Cancer Metastasis

Jariya Kalsoom — 2023-02-14

BACKGROUND & OBJECTIVE: Extracellular signal-regulated kinases 1 and 2 [ERK1/2] have been reported to promote cancer spread through receptor tyrosine kinase (RTK)/Ras/Raf/MEK/ERK1/2 pathway hyperactivation. The extracellular signal-regulated kinase ERK5 has also been linked to cancer. However, inhibition of ERK1/2 has been reported to cause compensatory hyperactivation of the ERK5 pathway. Therefore, there is a need for simultaneous inhibition of this trio by a common inhibitor. This study aimed to find a novel common inhibitor for ERK1, ERK2 and ERK5, with a special focus on phytochemicals.

METHODOLOGY: All the available co-crystallized inhibitors of MEK1, ERK1/2 and ERK5 were used as references for 2D search across zillions of compounds. One hundred molecules with the best matching pharmacophores were extracted per virtual chemical space. A total of 20,000 new structurally diverse chemical entities with scaffold hopping ability were sifted out from these chemical spaces. Virtual screening of ERK1/2 and ERK5 was performed against these compounds. The successfully docked molecules with estimated affinities less than 500 nm were filtered. These filtered protein-molecule complexes of ERK1/2 and ERK5 were exported as Excel sheets, which were then compared to find any overlapping inhibitors. Four novel common/overlapping potential inhibitors were identified. Their pose views were generated, and binding interactions were analyzed. These novel compounds were compared for their absorption, distribution, metabolism, excretion and toxicity (ADME-Tox) properties.

RESULTS: The molecules m240690bcc215667167368734, rxn109fEMOL37110279EMOL314046334 and LIND027BT1904LN00213276AK0086 showed good binding affinities to the conventional ATP binding pockets of the kinases ERK1/2 and ERK5.

CONCLUSION: These novel compounds may be proposed as potential common inhibitors of ERK1, 2 and 5. Further in silico analysis and in vitro testing of proteins are required to confirm their inhibitory potential.

Students’ perception of WhatsApp usage as an additional learning aid at a Dental College in Pakistan

Afifa Ehsan — 2023-02-14

BACKGROUND & OBJECTIVE: Technological advancements have transformed society into a global entity; medical education is no exception. Innumerable social media platforms such as Facebook, WhatsApp, Instagram, and Edmodo encourage collaborative learning, improved communication, and knowledge-sharing. The current study aims to assess students' perception of WhatsApp as an additional educational and learning aid for communication purposes, sharing of learning materials, and as a discussion forum.

METHODOLOGY: This cross-sectional study was carried out from July 2021 to December 2021 at Faryal Dental College, Sheikhupura, Pakistan. A standardized questionnaire was prepared and circulated amongst students of 1^st Year BDS to Final Year BDS. Responses were analyzed using SPSS Version 20.

RESULTS: The study comprised 150 participants; the majority, i.e., 62% (n=93), were females, and 38% (n=57) were males. Learning through WhatsApp was found to be useful by 90% of students. An association (p≤0.02) was found among both genders regarding the usefulness of WhatsApp as an additional learning aid.

CONCLUSION: These days, social media is a dominant mechanism used for communal exchanges and is also utilized as an additional aid for teaching and learning purposes. Incorporating social media with conventional class teaching in medical education has evident advantages.

Frequency of Thrombocytopenia in Malaria and its prognostic significance

Saleh Ahmad — 2023-02-15

BACKGROUND & OBJECTIVE: Thrombocytopenia is a common hematological manifestation of malaria, but locally there is limited data on the association of thrombocytopenia degree and malarial species in Pakistan. Therefore, the present study aims to assess the frequency of thrombocytopenia and its severity among patients with malaria.

METHODOLOGY: In this prospective cross-sectional study, a total of 120 patients with smear-positive for malaria on microscopy were included. The patient's complete blood count (CBC) was assessed daily to monitor the platelet counts, and thrombocytopenia was divided into four categories, i.e., mild, moderate, severe, and very severe thrombocytopenia.

RESULTS: Out of the total 120 malaria-positive cases, 78(65%) were positive for P. vivax, 32(26.7%) were affected by P. falciparum, and 10(8.3%) patients had mixed infection. Thrombocytopenia developed among 73% of the total patients with malaria; of these, 35.23% developed mild thrombocytopenia, while 31.82%, 23.86%, and 9.09% developed moderate, severe, and very severe thrombocytopenia, respectively. Among those 30(34.0%) infected with P. falciparum, 8(26.7%) developed mild thrombocytopenia, while 8(26.7%) and 14(46.7%) developed moderate to very severe thrombocytopenia. Similarly, most patients with P. vivax 23(39.7%) had mild to moderate 20(34.5%) thrombocytopenia, 15(25.9%) had severe, and only 5.19% had very severe thrombocytopenia p-value=0.141 shows non-significant association. Furthermore, P. vivax group developed complications, while two of the four patients of the P. falciparum group developed cerebral malaria, one developed renal failure, and the last one had pancytopenia.

CONCLUSION: In conclusion, thrombocytopenia is frequent among patients with malaria. Moreover, the severity of thrombocytopenia and complications are more evident among those infected with P. falciparum than those with P. vivax.

Assessing rabies knowledge and practice from a one health lens in healthcare professionals in Sargodha district, Pakistan: A zero by 2030 approach

Hina Shan — 2023-02-14

Comparison of metoclopramide–dexamethasone combination and metoclopramide alone for prophylaxis of postoperative nausea vomiting in laparoscopic cholecystectomy

Humaira Ahmad — 2023-02-16

BACKGROUND & OBJECTIVE: Post operative nausea and vomiting (PONV) is an important concern in laparoscopic surgeries. Aim of this study is to identify the role of metoclopramide dexamethasone combination for prophylactic management of post laparoscopic cholecystectomy nausea and vomiting in comparison to metoclopramide alone.

METHODOLOGY: The study group comprised of 150 patients. These were the patients with symptomatic gallstones for whom elective laparoscopic cholecystectomy was planned. Study was conducted from 15-04-2018 to 15-07-2019. Non-probability consecutive sampling technique was used.Two groups were generated by simple random method. Group M was given injection metoclopramide only, whereas patients in Group D+M were injected with both dexamethasone and metoclopramide, intravenously, before induction of anesthesia. Parameters observed for 24 hours during postoperative period included; nausea, episodes of vomiting, requirement for rescue antiemetic drugs and total duration of hospital stay after the surgical procedure.

RESULTS: In Group D+M (dexamethasone+metoclopramide), out of total 75 patients, 8% developed nausea while 5.33% had both nausea along with emesis. While in group M (metoclopramide), 16% out of the total 75 patients had nausea only but 18.7% patients had complaints of nausea and emesis. Three patients out of 75, that is (4%) from group (D+M) had extended duration of in hospital admission (> 24 hours), while in group M, this percentage was 13.33% that is 10 patients.

CONCLUSION: A combination of metoclopramide with dexamethasone for prophylaxis against PONV in laparoscopic cholecystectomy patients is preferred to metoclopramide alone.

Comparison of frequency of Hypoparathyroidism in Total Thyroidectomy (TT) versus Near-Total Thyroidectomy (NTT) patients

Sajid Rehman Randhawa — 2023-01-23

BACKGROUND & OBJECTIVE: Hypoparathyroidism in total thyroidectomy and near-total thyroidectomy is debatable. This study will determine the procedure of choice. Our objective is to compare the frequency of hypoparathyroidism in total thyroidectomy versus near-total thyroidectomy patients.

METHODOLOGY: Prospective observational study was conducted at the Department of Surgery, Allied Hospital, Faisalabad. The study duration was six months. A total of 140 patients having multinodular goiter, 30-70 years of age, were selected. Patients were divided into two groups. In group A; patients underwent total thyroidectomy while in group B; patients were offered near-total thyroidectomy. All the parathyroid glands were preserved. In all patients, serum calcium levels and parathyroid hormone (PTH) levels were checked on 1^st & the 2^nd day after surgery.

RESULTS: Mean age in group A was 48.06±8.21 years & in group B was 48.83 ± 7.0 years. The majority of patients, 88 (62.86%) were between 30 to 50 years of age. Out of these 140 patients, 37 (26.43%) were males & 103 (73.57%) were females, with the ratio of 1:2.8. Mean pre-operative serum Parathyroid hormone was 25.67±9.87 pg/mL. The mean postoperative serum Parathyroid hormone was 16.87±2.43 pg/mL. Mean pre-operative serum calcium levels were 11.32 ± 4.52 mg/dl and mean postoperative serum calcium levels were 9.4 ±0.45mg/dl. In this study, the frequency of Hypoparathyroidism in the total thyroidectomy group (28.57%) was significantly higher than near-total thyroidectomy (8.57%) (p=0.002).

CONCLUSION: Hypoparathyroidism is more common after total thyroidectomy as compared to near-total thyroidectomy.

Effectiveness of Ondansetron in comparison to Domperidone for treating vomiting in acute gastroenteritis among children in a tertiary care hospital setting: A quasi-experimental study

Muddassir Zafar — 2023-02-20

BACKGROUND & OBJECTIVE: There is inconsistent evidence on using antiemetic drugs (ondansetron and domperidone) in children with vomiting associated with gastroenteritis having dehydration. The study's objective was to compare the effectiveness of oral domperidone with ondansetron for treating vomiting during acute gastroenteritis in children with either mild or moderate dehydration.

METHODOLOGY: This non-controlled quasi-experimental study was conducted at Allama Iqbal Teaching Hospital, Sialkot, in the department of Pediatrics from 1^stOctober 2019 to 31^st December 2019. Sixty children aged 1-12 years having acute gastroenteritis, with mild or moderate dehydration after the failure of initial oral rehydration therapy, were included. Children in-group A (n=30) received a single dose of an orally disintegrating tablet of ondansetron, and children in-group B (n=30) were treated with domperidone. The absence of vomiting for 6 hours and subsequent successful rehydration in these two groups was the primary outcome. The Chi-square test was applied to compare the frequency of primary outcome between the ondansetron and domperidone groups, considering p-value ≤0.05 was considered statistically significant.

RESULTS: The mean age of patients was 4.4±1.8 years in group A compared to 5.1±2.7 years in group B. Oral Ondansetron was successful in controlling vomiting in 19(63.4%) patients compared to 11(36.6%) in domperidone group (p=0.39).

CONCLUSION: The single dose of oral ondansetron compared to domperidone was significantly effective in controlling the vomiting in-patient with acute gastroenteritis presented with either mild or moderate dehydration, resulting in effective oral rehydration subsequently.

Comparison of Harmonic scalpel and conventional homeostasis in understanding complications followed by total thyroidectomy

Munawer Latif Memon — 2023-02-20

BACKGROUND & OBJECTIVE: Thyroidectomy is a classic surgical procedure used worldwide for thyroid gland excision. A study was conducted to compare the outcomes (mean operative time, drainage volume, postoperative pain and hospital stay) and postoperative complications of Harmonic scalpel and conventional homeostasis in patients who underwent total thyroidectomy

METHODOLOGY: A prospective observational study was conducted at the department of general surgery, POF hospital Wah Cantt. The study duration was six months (June 2020-Novemebr 2020). A sample size of 70 patients was calculated using the WHO calculator. Patients for total thyroidectomy were selected through a non-probability consecutive sampling. Patients whose total thyroidectomy was planned were divided into two groups using a random number table. In Group A, we used a harmonic scalpel, while in Group B, we used the conventional homeostasis method to secure homeostasis operatively. Patients were followed after 4 weeks for complications. Chi-Square test and t-test was applied.

RESULTS: A total of 70 patients were included in the study. The mean operative time was 44.5 min±1.4 in the HS group and 66.0 min±2.0 in the conventional homeostasis group (p≤0.001). Hospital stay was significantly less in the HS group as compared to the conventional homeostasis group (2.3 days ±0.4 vs 3.3 days ±0.4, p≤0.001). Postoperative drainage was significantly high in conventional homeostasis group as compared to HS group (56.4±1.5 mL vs 36.5±1.5 mL, p≤0.001).

CONCLUSION: Harmonic scalpel is an effective, reliable and safe tool for better outcomes in terms of less operative time, lower drainage volume and short duration of hospital stay as compared to conventional methods.

Mutational pattern in Capsid Protein (C) of Dengue Virus isolates from Punjab Province of Pakistan

Saira Musshtaq — 2023-02-20

BACKGROUND & OBJECTIVE: Dengue virus (DENV) genomic study is crucial for understanding how it spreads and presents and become dangerous. Three structural and seven non-structural proteins are encoded by the positive stranded RNA DENV. Capsid protein (C) is one of the structural proteins which helps in the encapsidation of viral RNA. Objective of the study is to identify the DENV serotypes and the most common geographic specific mutations in the C protein, circulating in Punjab province of Pakistan.

METHODOLOGY: It was cross sectional study in which About 120 DENV isolates were selected, by the procedure of temporal sampling done in peak season of dengue fever in 2022, from the major tertiary care hospitals for whole genomes sequence analysis. Among which only 23 whole genomes sequences were performed after virus isolation, quantification and cDNA synthesis.

RESULTS: All the samples were found to be of genotype 1 and 2 in which 44 non-synonymous mutations were detected in the C protein. The most common mutations were; N90S (n=11) and G70S (n=11) followed by V26G (n=5) and R10Q (n=4), in which G70S is novel.

CONCLUSION: Mutations in the current study are of particular interest to design of DENV vaccine projects in future. Genomic epidemiology during each outbreak of DENV in different locations is critical for better public health and for designing new policies for future outbreaks.

Critical Thinking in the Nursing Profession: Analysis with a Socratic Method and Nurse Theorist Philosophy

Badil — 2023-02-14

Critical thinking skills are increasingly imperative skills in the nursing profession. Both the Socratic method and nursing theorist philosophy can lead to enhance critical skills. The Socratic method has been rooted in ancient Greek Philosophy, whereas nursing theorist philosophy in the 21^st century. This paper discusses critical thinking in the nursing profession and compares the critical thinking concept with the Socratic Method and nurse theorist philosophy. The prime aim of this study is to compare which method is effectively utilized in the nursing profession. The literature pertinent to the topic was searched using the database library, including PubMed, BioMed, Google Scholar, PakMediNet, and Cumulative Index to Nursing and Allied Health Literature CINAHL. Literature was searched using keywords including Socratic method, nurse theorist philosophy, critical thinking skills, nursing education, and nursing clinical practice. The full-text article was included in the study. Relevant original articles, systemic reviews, quasi-experimental design, philosophical papers, and cross-sectional studies focusing on nurses' critical thinking skills, the Socratic Method, and nurse theorist philosophy were included. The study analysis portrayed Socratic questioning as primarily embedded in critical thinking concepts which nurses utilized in theoretical knowledge. The Socratic Method is explicitly known as the student-centered method that probes critical thinking in classroom teachings. Critical thinking has become vital in professional accountability and excellent nursing care. Nurse theorists have generally employed critical thinking skills to obtain the maximum patient care outcome. In conclusion, the Socratic method increases critical thinking in academia while nursing’s theorist philosophy in nursing clinical practice.