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Background Multiple sclerosis (MS) is a chronic autoimmune disease caused by multiple factors. It can lead to many physical and mental symptoms. Fatigue is one of the most commonly mentioned complaints among MS patients that can affect their quality of life. Physical activity has many benefits for the physical and mental health of patients with MS. Aim To assess the role of exercise on fatigue among patients with multiple sclerosis and identify the relationship between depression, sleep quality, sociodemographic variables, and fatigue. Methods This is an analytical cross-sectional study based on a sample size of 235 patients recruited from the MS clinic at King Fahad Hospital (KFH) in Madinah. The outcome of the study was fatigue among MS patients. Data were collected through telephone calls from February to May 2022 using a structured questionnaire and scales, such as the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Modified Fatigue Impact Scale (MFIS), Patient Health Questionnaire (PHQ2), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed through SPSS version 20 (IBM Corp., Armonk, NY, USA). The correlation coefficient (r), Chi-square tests, and simple and multiple logistic regression were used as found appropriate. Results Out of the total samples, 37.4% were male and 62.6% were female. The median age of patients was 36 years. The prevalence of fatigue was 37% among patients, with a reported median fatigue score of 26. It was found that 63% of the patients were physically inactive; 32.2% were overweight, 14.2% were obese; 63.8% of patients had poor sleep quality. The fatigue score was negatively correlated with the GLTEQ score, but the results were not significant (r=-0.066; P-value (level of significance)=0.335). Nonetheless, a moderately significant correlation was observed between the MFIS and PSQI and MFIS and PHQ2 (r=0.505, P=<0.001 and r=0.520, P=<0.001, respectively). The Chi-square test showed a significant association between fatigue and progressive types of MS, the primary progressive MS (PPMS), secondary progressive MS (SPMS), and relapsing-remitting MS (RRMS) (odds ratio (OR)=4.4; 95% confidence interval (CI): 2.1-8.9), P=<0.001). Depressed patients were 9.7 times more likely to develop fatigue compared to non-depressed patients (P=<0.001). Those with poor sleep quality were 4.6 times more likely to develop fatigue compared to those with good sleep quality (P=<0.001). Fifty-six percent of fatigue among MS patients were predicted by low income, progressive types, unemployment, obesity, depression, and poor sleep quality. Conclusion Fatigue is a major complaint among MS patients. Most of the patients were found to be physically inactive, depressed, and have poor sleep quality. This study found an association between physical inactivity and fatigue, but the results were not significant. There was a significant association between sociodemographic factors like low income and unemployment, poor sleep quality, obesity, progressive types of MS, depression, and fatigue. Encouraging exercise practice and implementing a regular exercise program are needed, along with weight management plans. Further studies and psychological support meetings are required, with the importance of a holistic approach to patient care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alsharif et al.)

Background and Objective: Identification of clinical characteristics and risk factors for mortality in COVID-19 is important for early detection and precise case management. The study aimed to describe the sociodemographic, clinical, and laboratory characteristics of in-hospital COVID-19 deaths in Almadinah Almonawarah city, Saudi Arabia, and to identify risk factors for early mortality among them., Methods: This is an analytical cross-sectional study. The main outcomes were demographic and clinical characteristics of COVID 19 patients who died from March till December 2020, during the hospital stay. We collected 193 records of COVID-19 patients, from two major hospitals in Al Madinah region, Saudi Arabia. Descriptive and inferential analysis were performed to identify and relate the factors of early death., Results: Out of the total deaths, 110 died during the first 14 days of admission (Early death group) and 83 died after 14 days of admission (Late death group). Early death group had a significantly higher percentages of old age patients (p=0.027) and males (72.7%). Comorbidities were found in 166 (86%) of cases. Multimorbidity were significantly higher in early deaths than in late deaths 74.5% (p=<0.001). Women had significantly higher mean values of CHA2SD2 comorbidity scores (3.28 versus 1.89 for men; p <0.001). Moreover, predictors of high comorbidity scores were older age (p=0.005), higher respiratory rate (p=0.035), and raised alanine transaminase (p=0.047)., Conclusion: Old age, comorbid illness, and severe respiratory involvement were prevalent among COVID-19 deaths. Comorbidity scores were significantly higher in women. Comorbidity was found to be significantly more associated with early deaths., Competing Interests: Conflict of Interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

Objectives: The objective is to study the demographics and clinical characteristics of Saudi multiple sclerosis (MS) patients in Madinah, Saudi Arabia, and assess their extent of disability using the Expanded Disability Status Scale (EDSS)., Methods: This hospital-based study intended to address the population of all MS-diagnosed patients registered between 2018 and 2021 in the Neurology Department of King Fahad Hospital in the Madinah region. Data were gathered from medical records and by interviewing participants in the Neurology Clinic. The chi-square test and linear and logistic regression were applied to draw inferences., Results: A total of 195 MS-diagnosed patients were included in the analysis. Of these, 72.3% were female. The mean age of the total sample was 34.9±9.2 years, and 7.7% reported a positive family history. Of all patients, 17.9% (n=35) had comorbidities. The mean age at diagnosis was 29.3±8.2 years. The majority (85.6%) were diagnosed with relapsing-remitting multiple sclerosis (RRMS); 77.9% had an EDSS score between 0.0 and 1.5, showing little or no disability. A statistical significance existed between EDSS and the current age of the patients (p=0.004), age at onset (p=0.007), type of MS (p=0.000), presence of muscle weakness (p=0.044), bladder or bowel difficulties at onset (p=0.043), and the duration of MS (p=0.000). Of the patients, 23.6% were not using disease-modifying therapy (DMT). The most commonly used drug was interferon beta 1-b., Conclusion: A lower EDSS was associated with younger age, diagnosis at a younger age, RRMS, duration less than five years, and lower body mass index (BMI). To increase the generalizability of findings, a national MS registry system and further prospective analytical epidemiological research studies are recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alsaedi et al.)

Objective: To compare the sensitivity and specificity of saline infusion sonohysterography with hysterosalpingography as a diagnostic tool in the assessment of infertile women.., Methods: The comparative cross-sectional study was carried out at a private infertility clinic in Karachi, and comprised women who registered for assessment of infertility from June 2011 to May 2013. Uterine and tubal pathology was assessed as a possible cause of infertility by using saline infusion sonohysterography as an index test and hystero-salpingography as the standard reference. The diagnostic accuracy of the two tests was compared. Sub-fertile patients were followed up for 2 weeks after the tests for any possible adverse effects of the procedures. Data was analysed using SPSS 19., Results: Of the 256 subjects, 184 (72%) presented with primary and 72 (28%) with secondary infertility. Overall mean age of the sample was 28}8 years. The mean BMI was 29.8}4.1 in primary infertile compared to 28.2}.5 in women with secondary sub-fertility. The sensitivity of saline infusion sonohysterography for detecting patency of the tubes was 100% and the specificity was 91% whereas positive predictive value was 69.8% and negative predictive value was 100% (Kappa: 0.61). For large uterine polyps, sensitivity and specificity was 100% and for small polyps sono-hystero-salpingography showed 14% false positive results (Kappa: 0.21)., Conclusions: Saline infusion sono-hysterography was found to be a more reliable method of diagnosing tubal or uterine pathologies compared to hystero-salpingography for cases of infertility.

Objectives: Public health research demands a collaborative approach in working with communities to combat expected challenges in the field. Therefore, to improve primary care services, a training programme on research methodology, focusing on the principles of inter-professional education (IPE), was introduced at Karachi Medical and Dental College. The objectives of this study were to assess the level of learning by participants in the domain of communication and to explore participants' opinions and evaluations of the training programme., Methods: A total of 96 participants, including faculty members, medical students, social works students and health technicians in the research methodology course, were selected during March to September 2010. The study employed mixed method research in which communication competencies and participants' perceptions, as captured by course evaluations, were analysed, and findings were triangulated., Results: The results showed that 87% of faculty enjoyed contributing to 'inter-professional relationships' and that 'teamwork' skills in community-focused areas improved among 90% of students. As many as 78% of students and 70% of faculty members identified 'active listening' and 'communicating information to families', respectively, as being learned to a lesser extent. These findings were defended by their deliberations on course evaluation., Conclusion: Learning through inter-professional relationships was found to be most effective among faculty, whereas learning through teamwork was found to be most effective among students. Moreover, it was found that information was better communicated to families by students than by faculty staff.

Objectives: To identify the changing trends and crucial preventive approaches to road traffic accidents (RTAs) adopted in the Kingdom of Saudi Arabia (KSA) over the last 2.5 decades, and to analyze aspects previously overlooked., Methods: This systematic review was based on evidence of RTAs in KSA. All articles published during the last 25 years on road traffic accident in KSA were analyzed. This study was carried out from December 2013 to May 2014 in the Department of Family and Community Medicine, Taibah University, Al-Madinah Al-Munawwarah, KSA., Results: Road traffic accidents accounted for 83.4% of all trauma admissions in 1984-1989, and no such overall trend was studied thereafter. The most frequently injured body regions as reported in the latest studies were head and neck, followed by upper and lower extremities, which was found to be opposite to that of the studies reported earlier. Hospital data showed an 8% non-significant increase in road accident mortalities in contrast to police records of a 27% significant reduction during the years 2005-2010. Excessive speeding was the most common cause reported in all recent and past studies., Conclusion: Disparity was common in the type of reporting of RTAs, outcome measures, and possible causes over a period of 2.5 decade. All research exclusively looked into the drivers' faults. A sentinel surveillance of road crashes should be kept in place in the secondary and tertiary care hospitals for all regions of KSA.

Objective: To assess the association of osteopenia and osteoporosis with menopause and compare the health seeking behaviour of women related to menopause in different strata of society., Study Design: A cross-sectional study., Place and Duration of Study: Three different socioeconomic strata of Karachi from May till August 2004., Methodology: A sample of 925 women, over 35 years of age, was selected from 16 clusters of 250 households (50 houses in each cluster). All apparently healthy women having age between 35 and 50 years were selected in the cluster houses. Those who were not willing to be the part of the study or giving history of taking treatment for any disease for more than 4 weeks were excluded. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the Medical College. T-scores were calculated to get BMD (Bone Mineral Density) for all the subjects through heel ultrasound., Results: A total of 287 women were found to be experiencing menopause. The mean age of menopause was 47.8+4.7 years. Out of those 287 women, 135 (47%) wanted their menses to continue and 235 (82%) had consulted a physician after menopause. There was a significantly lower score of BMD of postmenopausal women (mean=-1.833+0.65) compared to pre-menopausal women (mean=-1.597+0.60, p=0.016). Out of the 925 women interviewed, 53% had consulted a physician for various symptoms related to menopause. The symptoms experienced by pre-menopausal women included lack of sleep (25%), fear of becoming sterile (13%) and urinary incontinence (18%)., Conclusion: The average age of menopause was found to be similar to other studies of the country. Lower bone mineral density was found in greater proportion among older females. Majority needed intervention inclusive of awareness through health education and medication.

Objective: To identify Byssinosis in cotton spinning mill workers, probable associations of disease with factors such as different work areas, safety gadget usage and overtime and to ascertain proportions of byssinosis to accidental injuries., Methods: This study was conducted in a spinning mill of Karachi in June 2006. Mill workers who had worked for a period of minimum 5 years were selected. A sample size of 83 conveniently selected workers participated in the research study. Data collection was done via questionnaire, and pulmonary function tests., Results: The mean age of the sample was 30 +/- 6.9 years. Of all the workers 72% used safety gadgets (masks) while working and 50% availed overtime. Smokers amounted to 31% of the total subjects. Around 35% workers complained of having respiratory ailments of which 19% (16 workers) closely matched byssinotic symptoms. Pulmonary Function Tests (PFTs) confirmed 13 of 16 workers to be byssinotics, with the remaining being labeled as Probables. The overall proportion of Byssinotics in the mill was 19.28% (95% C.I. 11-27) and that of accidental injuries was 22.9%. The association of byssinosis with respect to work areas was significantly high in Ring area (O.R. = 2.04) followed by carding (O.R. = 1.3). The association of byssinosis was also high in workers who did not use safety gadgets, e.g. dust masks (O.R = 4.89) and in people who worked overtime (O.R. = 1.82). Associations with respect to duration of employment and smoking could not yield significant results., Conclusion: Results indicate a very high probability of association of disease to non-usage of safety gadgets and overtime working. Studies comprising of a greater sample size would show precisely the overall prevalence of the disease.

Objective: To assess the process of problem-based learning (PBL) as perceived by the medical students and their opinions regarding the process., Methods: A cross-sectional study was conducted at Karachi Medical and Dental College. One hundred and four medical students of fourth year MBBS (52 each of batch 2004 and 2005) were selected for their responses and feedback on problem-based learning in small groups. Data was collected through a closed-ended questionnaire., Results: Seventy nine percent (82 out of 104) of medical students liked the PBL sessions. Overall 85% of students were motivated towards self learning while liking for PBL was 82%. Activation of prior knowledge was observed by 83% students., Conclusion: Students supported problem-based learning (PBL) as an effective method of learning. Majority of students were motivated towards self- learning. They were convinced that PBL helped them in building up communication skills, interpersonal relationship and problem solving capacity.

Objective: The aim of the study was to evaluate the efficacy of cyclosporin-A in patients of rheumatoid arthritis not responding to standard therapy early in the course of the disease., Design: A non-randomized controlled clinical trial., Place and Duration of Study: Outpatients Department of Abbasi Shaheed Hospital and Imam Clinic over a period of 18 months from March 1999 through September 2000., Materials and Methods: The study was carried out on 63 patients of both gender suffering with refractory rheumatoid arthritis for at least 3 months. Patients were divided into two groups A and B. Group-A was the experimental one, treated with cyclosporin-A in combination with methotrexate while Group-B was continued with methotrexate alone. Their pre and post assessments regarding recovery criteria and drug profile had been done in order to establish the efficacy of cyclosporin-A., Results: The study showed a significant difference (p<.000 with a.05) after six months between treatment group and the controls, in the mean values of articular index (2.53 vs. 5.39), right grip (14.28 vs. 33.8 mmHg ), left grip strengths (16.5 vs. 34.31 mmHg) and number of tender joints (26.9% vs. 38.6%). Furthermore, a significant negative correlation between articular index at recruitment and visual analogue scale (VAS) of pain after 6 months of therapy was observed in experimental group., Conclusion: This study indicates that the combination of cyclosporin with methotrexate benefits rheumatoid arthritis patients refractory to methotrexate monotherapy. Cyclosporin was well tolerated by those having shorter duration of disease.

Background: A number of evaluations of the EPI program have been carried out either at a small scale or countrywide in order to identify statistical figures but very few of them reflect population opinions. This study was conducted with an objective to assess the immunization services available through expanded program of immunizations (EPI) and national immunizations days (NIDs) and to determine the reasons for incomplete immunization., Methods: This study is qualitative, based on eight Focus Group Discussions (FGDs) with mothers and fathers as recipients while lady health visitors and vaccinators as service providers., Results: Majority of the mother and fathers were aware of the importance of immunization. Overall the failure of immunization was related to low income, inaccessible government dispensaries and occupancy in house hold work. Almost all mothers and fathers were of the opinion that the private clinics are giving service at a higher cost for quality vaccines than that of government dispensaries. Majority of fathers and mothers are ignorant of the advantages of antenatal immunization. Vaccinators and Lady Health Visitors had adequate knowledge and were partly satisfied with the services they provide. Vaccinators identified the need of local vaccinators and well--run vehicles in order to increase immunization rate., Conclusion: The quality of immunization services is compromised at the recipient level mainly due to lack of motivation and prevailing doubts about immunization importance. The service providers thought that the problem of incomplete vaccination particularly for females and misplacement of cards. Hence solving the problems of the providers at all levels combined with media campaigns to modify rigid behaviour of recipients can significantly improve the immunization coverage in Pakistan.