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Objective: To assess the perceived stress, its sources, and severity and evaluated the relationship between causes of perceived stress and their coping mechanisms. Study Design: Cross-Sectional Survey. Place and Duration of Study: Army Medical College Rawalpindi and Fuji Foundation University Medical College, Islamabad Pakistan from Jun 2018 to Jun 2019. Methodology: Four hundred undergraduate medical students of the first and second-year MBBS were included in this study. Voluntary consenting students filled the questionnaires regarding perceived stress, its sources, and severity, along with the coping mechanisms. Results: Among 400 participants, the male and female students were 55.3% and 44.8%, respectively. Three hundred and forty (85%) students were stressed. Perceived stress was not statistically associated with academic stress (p-value=0.77). The coping mechanisms that were found significant were the 'use of tranquillizer' and 'positive reframing' with p-value of 0.018 and 0.025. Conclusion: A higher level of perceived stress was found in the medical students. Mostly the stressors were associated with the academic domain and not related to health and psychosocial domains. The coping mechanism used by the medical students were tranquillizers and positive reframing. [ABSTRACT FROM AUTHOR]

This comparative cross-sectional study provides insight into the perceptions of Pakistani Muslim parents and teachers with respect to sex education. A validated questionnaire was distributed to 418 participants, using uncontrolled quota sampling and a total of 273 subjects responded. Data analysis was conducted using SPSS v.25. In this study, 76.1% of the parents and 64.4% of the teachers responded affirmatively when asked whether they thought that age-appropriate sexuality education should be provided in school. However, most believed that sex education was in conflict with Islamic ideology. 'Bullying prevention' and 'sexual abuse prevention' were strongly supported sexuality-related topics while pregnancy prevention was the least supported. The major perceived challenge to the implementation of sexuality education was that some parents did not want the subject taught in schools. Around 46% of the parents responding said that they had never even spoken to their child about sexual issues. Therefore, prior the introduction of any such curriculum-based programme, it is imperative to educate the general population and train teachers to ensure the provision of high-quality sex education. The development of scientifically accurate, age-appropriate and context-relevant sex education and the identification of modalities for its effective implementation remains a major challenge in Pakistan. [ABSTRACT FROM AUTHOR]

Objective: To explore whether the performance of a 2nd year MBBS student in subject of physiology by continuous assessment method as determined by internal assessment correlates to the final summative evaluation in 2nd professional examination. Study Design: Cross sectional analytical study. Place and Duration of Study: Army Medical College, Rawalpindi, from Jan to May 2017. Material and Methods: Data pertaining to the result of 2nd Professional MBBS examination and internal assessment in the subject of Physiology of the whole 2nd year MBBS class was used making a total sample size of 173. Sample size was calculated using the software G Power version 3.1.9.2. Data were analyzed using SPSS version 23. Mean and standard deviation were calculated for numerical variables. Correlation between marks of 2nd Professional examination and internal assessment was calculated using Pearson Correlation. Association between internal assessment and the result of 2nd Professional examination was computed using Chi Square test and Odds ratio. Alpha value was kept at 0.05. Results: There were 101 (52.4%) male and 72 (41.6%) female students out of total 173 with a mean age of 20.01 ± 0.69 years. Total marks of 2nd professional examination and internal assessment were normally distributed with mean values of 126.43 ± 17.56 and 36.79 ± 5.9 respectively. Results of the present study reflect significant correlation of 2nd year MBBS professional result with the internal assessment. Conclusion: A definitive correlation is found between the internal assessment performance and the summative final profession result in 2nd year MBBS students. [ABSTRACT FROM AUTHOR]

Objective: To assess sleep quality and sleep patterns among students of Army Medical College, Rawalpindi. Study Design: Cross sectional study. Place and Duration of Study: Army Medical College, Rawalpindi, from Mar to May 2017. Material and Methods: Pittsburgh sleep quality index (PSQI) questionnaire was administered to a total of 567 students. PSQI component and global scores of male and female students were statistically correlated. Excel 2013 was used for statistical analysis of the collected data. Results: Out of the 567 administered questionnaires, complete responses amounted to 362 (Response Rate: 63.8%); among them, 217 (60%) were females and 145 (40%) were males. Class-wise distribution of the students was as follows: 170 (47%) students from 1st year, 140 (38.7%) from 2nd year, 32 (8.8%) from 4th year and 20 (5.5%) from final year. Mean age of the participants was 19.57 ± 1.48 years (range: 17-25 years). Overall, 124 (34%) students were bracketed as 'Good Sleepers' whereas 238 (66%) fell into the category of 'Poor Sleepers' with a mean PSQI score of 6.67 ± 2.275. This percentage frequency distribution and mean PSQI score did not differ significantly (p=0.33) between genders. Female students reported significantly lower sedative usage (p<0.001) but greater daytime dysfunction (p<0.001) than their male peers. Furthermore, mean nocturnal sleep period was significantly shorter (p=0.046) for 1st year students as compared to 2nd year students. Conclusion: Prevalence of poor sleep quality is high among students of Army Medical College and mean nocturnal sleep period appears to be the most deranged sleep component. [ABSTRACT FROM AUTHOR]

Objective: To analyze the evolving perception of graduate students of Masters in 'health professional education with diverse educational backgrounds regarding online learning and teaching. Study Design: Mixed-method' study of Convergent Parallel Design. Place and Duration of Study: Riphah University, Rawalpindi Pakistan, Dec 2021 to Feb 2022. Methodology: Twenty-five graduate students of Masters in 'health professional education' with diverse educational backgrounds answered semi-structured questionnaires at the end of 2 online teaching sessions. Results: The mean scores of 3 domains of 'student's perception of learning, 'contents and teaching strategies and 'educational environment' in 1st vs second online sessions were as follows, respectively: (4.37 0.42 vs 4.09, 0.45; p-value 0.04), (4.40 0.47 vs 4.29, 0.58; p-value 0.44) and (4.43 0.43 vs 4.23 0.69; p-value 0.36). The students agreed that the contents covered, teaching strategies and education environment were satisfactory, and the perception was not statistically different between the two sessions in these domains. In contrast, students' self-perception of learning was more satisfactory in the first online session. Conclusion: The graduate students of Masters in 'health professional education' with diverse educational backgrounds were satisfied regarding the contents covered, teaching strategies and education environment in two online teaching sessions. In contrast, their perception of their learning depreciated in the second online teaching session. [ABSTRACT FROM AUTHOR]

Objective: To determine the demographic features and causes of donor deferral in blood donors. Study Design: Descriptive study. Place and Duration of Study: Conducted at the Armed Forces Institute of Transfusion (AFIT) for a period of 1 year from Jun 2012 to May 2013. Material and Methods: Donors with ages ranging from 18-60 years who reported to the blood bank were incorporated in this study. A comprehensive history was taken from all the potential donors through a structured proforma. A detailed general physical examination was done by the appointed doctor at the blood bank. Furthermore, laboratory testing of the blood samples of potential donors was done. On this basis, donors were accepted or deferred. Results: The commonest cause of the donor deferral was hepatitis C (HCV) (28.6%), the second leading cause was anaemia (24%) and the third leading cause was hepatitis B (HBV) (16.8%). Syphilis was also a major cause of donor deferral causing the rejection of 10.4% donors. Conclusion: The donor deferral rate is 7.3% and the leading course of donor deferral are chronic infections like hepatitis C and B and diseases like anaemia. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: To determine serum levels of Apelin in healthy individuals, type-2 diabetic patients and diabetic peripheral neuropathy patients (DPN) and to find the correlation with serum Apelin levels and serum fasting blood glucose, glycosylated hemoglobin. Study Design: Cross-sectional analytical study. Place and Duration of Study: Physiology Department and Centre for Research in Experimental and Analytical Medicine (CREAM) lab of the Army Medical College/National University of Medical Sciences (NUMS) Rawalpindi Pakistan, from Jan to Dec 2021. Methodology: A total of 90 individuals comprising three Groups having 30 subjects in each were recruited. Group-I included thirty healthy subjects, and Group-II consisted of thirty newly diagnosed patients having T2DM, Group-III consisted of thirty T2DM patients with DPN. We used Michigan Neuropathy Screening Instrument (MNSI) to assess neuropathy. Serum Apelin and tumour necrosis factoralpha (TNFalpha) levels were recorded from the blood samples of all subjects by enzymelinked immunosorbent assay (ELISA) using human serum Apelin and TNFalpha ELISA kit catalogue no. E2014Hu (bioassay technology) and E0082Hu (Bioassay technology), respectively. Results: The mean values of serum Apelin were higher in Group-III compared to Group-II and Group-I, and a statistically significant difference was found (p value=0.001). The serum Apelin levels showed a strong negative correlation with Group-III serum FBG, HbA1c and TNFalpha with r value -0.728, -0.79, and -0.95, respectively. Conclusion: Serum Apelin has a beneficial role in DPN in T2DM, with reduced TNFalpha levels as one of the possible mechanisms. [ABSTRACT FROM AUTHOR]

Objective: To assess the perceived stress, its sources, and severity and evaluated the relationship between causes of perceived stress and their coping mechanisms. Study Design: Cross-Sectional Survey. Place and Duration of Study: Army Medical College Rawalpindi and Fuji Foundation University Medical College, Islamabad Pakistan from Jun 2018 to Jun 2019 Methodology: Four hundred undergraduate medical students of the first and second-year MBBS were included in this study. Voluntary consenting students filled the questionnaires regarding perceived stress, its sources, and severity, along with the coping mechanisms. Results: Among 400 participants, the male and female students were 55.3% and 44.8%, respectively. Three hundred and forty(85%) students were stressed. Perceived stress was not statistically associated with academic stress (p-value=0.77). The coping mechanisms that were found significant were the 'use of tranquillizer' and 'positive reframing' with p-value of 0.018 and 0.025. Conclusion: A higher level of perceived stress was found in the medical students. Mostly the stressors were associated with the academic domain and not related to health and psychosocial domains. The coping mechanism used by the medical students were tranquillizers and positive reframing. [ABSTRACT FROM AUTHOR]

Objectives: To assess the students' perception of educational environment of Army Medical College, Rawalpindi, Pakistan and to determine gender difference in this perception. Study Design: A survey-based study Place and Duration of Study: Army Medical College, Rawalpindi, Pakistan from Jan 2012-June 2012. Participants and Methods: Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to 805 1st year to 5th year MBBS students of AM College, after written and informed consent. DREEM total and subscores were calculated according to Likert scale. Comparison was made for responses of male and female students as well as among students of each class by student's t test and ANOVA. Results: Valid responses were 647 out of 805 (response rate = 80.17%). The education climate was rated as more positive than negative determined by overall DREEM scores (mean 116.57 ± 24.96). Students perceptions of learning, teachers, academic self-perception, atmosphere and social self-perception were determined by sub scales and responses were found to be more on the positive side though sub scores of academic perception were highest (19.32 ± 5.25) and those of social self-perception were lowest (15.42 ± 3.85). There was no statistical difference in perception of male and female students (p = 0.12). The sub scores were significantly higher in 1st year students but all other classes had almost similar scores (p = 0.06) on ANOVA and post hoc tukey's test. Conclusion: Army Medical College as an institution has a positive education environment where most of the students feel positive about education climate, learning environment, teachers, their own academic achievements, institutional atmosphere and their social well-being. [ABSTRACT FROM AUTHOR]

Inflammation plays a role in the etiology of type 2 diabetes mellitus (DM). Interleukin-6 is one of the inflammatory markers which play role in the pathogenesis of diabetes mellitus DM. Single nucleotide polymorphism (SNP); -G174C in interleukin −6 (IL-6) gene promoter area has been reported to be associated with type 2 DM (T2DM). The frequency of polymorphism is found to be variable in various ethnic groups and also within an ethnic group. Many studies reported a positive association between T2DM and IL-6 SNP although quite a number of other studies failed to find such association. IL-6 polymorphism has been found to be associated with higher serum IL-6 levels, insulin resistance and BMI, although these findings are also challenged by many studies. There is no single explanation for such highly variable results in different studies. Presence of yet unidentified gene polymorphism in linkage disequilibrium with IL-6 SNP could be responsible. The different results can also be attributed to the study groups differing as age, gender distribution, age of onset of disease, life style, degree of obesity and glucose tolerance. This review highlights the varying results reported in association of IL 6 -G174C SNP with risk of T2DM, serum IL-6 levels, BMI and insulin resistance. [ABSTRACT FROM AUTHOR]

The article focuses on a cross sectional study conducted at the Military Hospital, Rawalpindi and Centre for Research in Experimental and Applied Medicine (CREAM), Army Medical College, Rawalpindi, Pakistan from June 2011 to June 2012 to study inflammatory markers in Type 2 diabetes Pakistani Patients. Levels of erythrocyte sedimentation rate (ESR), total leukocyte count (TLC) intelrleukin-6 (IL6) and tumor necrosis factor (TNF) were determined and correlated to duration of disease, body mass index (BMI) and insulin resistance. Results showed that statistical difference in BMI, fasting sugar and insulin resistance between control and diabetic group was high. TNF was the only marker associated with duration of disease. Other levels of markers were not related to BMI.

Objective. To determine the association of thyroid dysfunction with the severity of the disease and response to treatment in patients of chronic hepatitis C. Design. Cohort study. Patients. One hundred and sixty seven noncirrhotic chronic hepatitis C patients were grouped into treatment group (n = 107) and control group (n = 60). Measurements. Baseline S. ALT and S. AST by IFCC and S. TSH, S. free T4, and S.T3 level were measured by chemiluminescence method. The severity of the disease was measured by Knodell histopathological index (HPI) on liver biopsy. Study group patients underwent 24-weeks IFN and ribavirin therapy and thyroid functions were determined at weeks 0, 12, and 24. Response to therapy was determined by PCR-HCV test. Results. 20 treated patients (18.69%) developed thyroid dysfunction with relative risk (RR) of 11.25 and attributable risk (AR) of 91%. Females were at higher risk. Hypothyroidism was common than hyperthyroidism. There was no significant association between thyroid dysfunction and severity of the disease (P = 0.81) and response to therapy (P = 0.79). Conclusion. Interferon-alpha and ribavirin therapy induces thyroid dysfunction in chronic hepatitis C patients. There is no association between severity of disease and response to therapy with interferon-induced thyroid dysfunction. [ABSTRACT FROM AUTHOR]

Chronic hepatitis C (CHC) is one of the commonest infectious diseases of the liver and may lead to cirrhosis or hepatocellular carcinoma. Combination therapy with pegylated interferon (PEG-IFN) and Ribavirin is the treatment of choice for CHC. Combination therapy is thought to act by means of antiviral mechanisms and immunomodulation. Thyroid dysfunction is the most common autoimmune adverse effect associated with combination therapy; hypothyroidism is more common than hyperthyroidism. Antithyroid antibodies and female sex have a predictive value in the development of interferon induced thyroid disease (IITD). Patients with CHC should be informed of the possibility of side effects on the thyroid gland. Screening for antithyroid antibodies and thyroid function tests should be performed in patients with CHC before the commencement of antiviral treatment, and during and after it. This article reviews different aspects of IITD, including its pathogenesis, clinical manifestations, association with treatment regimens and treatment response and the outcome of thyroid dysfunction. [ABSTRACT FROM AUTHOR]