Annals of Punjab Medical College

Medicine and Politics

Muhammad Ali Sarfraz — Mon, 01 Jul 2024 07:33:22 +0000

We were told in Medical College that a doctor, a teacher and a politician have no caste. Later, we found another common ground with politics from Rudolph Virchow (1948): “Medicine is a social science, and politics is nothing else but medicine on a large scale.”

Most doctors are prisoners of their medical education and are shackled by professional ethics. They are content with the knowledge they have and the power that comes with it. They have the license not only to poke and prod people in private places (without offering a ring) but also charge them heavily for this privilege.

A doctor is obviously influenced by personal experiences and background. He may unconsciously bring biases, religious beliefs, and even political discourse into his interactions with patients. This is like walking a tight rope at conscious level where he is bound by medical ethics on one side and healing a sick mind and sick body on the other.

A Parsi doctor, Jal Patel, treated our Father of the Nation for lung cancer. He took this secret to his grave; otherwise, its public knowledge could have been a disaster for the creation of Pakistan. His last physician, Ilahi Bakhsh, wrote a book, which gives us valuable insight into Mr. Jinnah’s last days. Similarly, Allama Iqbal sought medical advice from doctors (Jamiat Singh, Abdul Qayyum, Ameer Chand) and Hakeems (Nabina, Qurshi) in his later days and benefitted from their diverse input. All these medics have recounted anecdotes, which give a dynamic snapshot of Iqbal’s life and politics.

Mr. Ghulam Muhammad was the Governor General of Pakistan from 1951-1955. He had hypertension and then suffered mini-strokes from 1950, which resulted in a worsening paralysis. Dr Sarwar, Dr Hafeez Akhtar and his beautiful private secretary-cum-nurse Ruth Borel kept him quasi-functional during his tenure. Since then, we have had a history of doctors providing life and/or career saving medical support to prominent politicians including Farooq Leghari, Pervez Musharraf, Nawaz Sharif, Shehbaz Sharif and Imran Khan.

Psychiatry somehow features heavily in the medical histories of Pakistani politicians. Its possible reasons may include genetic overloading, their premorbid personalities, and lack of ability to cope with stress. The list would be exhaustive if we include informal knowledge; but there is documented evidence to suggest that our leading politicians received psychiatric consultations. They include Ghulam Muhammad, Z. A. Bhutto, Benazir Bhutto, Asif Zardari, Altaf Hussain and Bilawal Bhutto Zardari.

Leaving personal opinions aside, most physicians focus on their patients. Staying neutral is hard though in the intense current political debate raging in the country about governance, corruption and accountability now. Politics also affects doctors in terms of health budgets, service/pay structure and health service delivery. The state of our economy and political events often push these concerns into overdrive. It no longer makes sense to distinguish between events in Islamabad and the woes of patient sitting in front. It is, however, ridiculous to block the roads repeatedly to improve medical service structure/conditions.

Avoiding politics seems unethical, and may be unprofessional for doctors. They may find political advocacy uncomfortable, but it is a part of their job description. As physicians, they advocate for patients and fight the red tape on daily basis. They need to embrace this ethos on a macro level by lobbying their MNAs/MPAs, joining activist groups and running for office. They, as technocrats, should argue that laws affecting human lives should not be made along party lines, but by an evidence-based policy. As healthcare providers, advocating for patients is an ethical imperative and a professional requirement, whether it comes in the form of pill or policy.

Doctors may take their theatre-gloves off when required and aspire for public service more often. They have great examples of Che Guevara (Bolivia/Cuba), Mahathir Mohamad (Malaysia) and Ram Yadav (Nepal) to follow in politics. Those who took the plunge, graduated from medical politics mostly. The latter is actually more difficult because it is easier to herd cats than unite doctors, especially when the issues are resources and money. Fatima Jinnah and Dr Khan sahib made a great name in the Independence Movement but never received the honours they deserved. Dr Ishrat-Ul-Ibad was perhaps the most successful doctor-politician followed by Arbab Rahim, Zulfiqar Mirza, Firdous Ashiq Awan and Saira Tarar. Safdar Abbasi and Aasim Hussain got “retired hurt” after playing their innings. Farooq Sattar is back trying to revive MQM while Yasmin Rashid is incarcerated for crimes she did not commit. Saeed Elahi is also waiting in the wings for his next chance.

The Church banned Machiavelli’s works because he argued that being a good Christian was incompatible with being a good leader. He writes that we cannot be good at all things so we need to let go of some. We have to sacrifice kindness for effectiveness, and lie in order to keep a relationship. We may have to ignore feelings of the workforce to keep a business alive. This is the price of dealing with the world as it is, and not as we think it should be. I have similar fears about doctors entering politics en masse because “the trouble with the rat race is that even if you win, you’re still a rat.”

Melatonin Mystery Key to A Sleepless Stress: A Cross-Sectional Study among Emergency Doctors of LUMHS, Sindh, Pakistan

Sun, 30 Jun 2024 00:00:00 +0000

Objective: To find the relationship of serum melatonin with circadian rhythm disruption (insomnia) and stress-related disorder (PTSD) and to find the relationship between serum levels of melatonin with PTSD and insomnia. Study Design: Cross-sectional study. Settings: Physiology Department of LUMHS, in collaboration with clinical wards and D R (Diagnostic Research) Lab at LUMHS. Duration: August 2021 to March 2022. Methods: The participants were adult male and female doctors performing emergency duties at Liaquat University of Medical & Health Science Jamshoro and Hyderabad, using an array of methods and techniques, questionnaire, and serum samples. Data were collected for serum melatonin, PTSD score, and ISI (Insomnia severity index) score for 116 participants. Data were analysed by using SPSC 26.0 software. Results: A total of 116 participants, out of which 48 (41.3%) were male and 68 (58.6%) were female, The mean age was 36.65 years, and the mean BMI was 29.39. We found that strong negative correlation between serum Melatonin and PTSD (r value= -.907**) with (P=0.001), a negative correlation of serum melatonin with insomnia (-.585**) and we also found a relationship with all these variables which shows a strong dependency. We also found out the prevalence of PTSD (13.71%) and Insomnia (42.25%) with (P=0.0001) and their dependency on departmental variations and the effect of work schedule. Conclusion: This study concludes serum melatonin is linked directly to variables, and then it can be used as primary prevention and potential adjuvant therapy for stress & insomnia.

Preserving Hepatic Glycogen Stores: Investigating the Therapeutic Influence of Vitamin E in Alcoholic Liver Injury-Induced Intracellular Carbohydrate Depletion

Sun, 30 Jun 2024 00:00:00 +0000

Objective: The study aimed to explore and evaluate the effectiveness of Vitamin E in preventing or minimizing glycogen depletion in hepatocytes associated with alcoholic liver damage. Study Design: Experimental study. Settings: The study was conducted in the department of anatomy and animal facility of Peshawar Medical College, Peshawar Pakistan. Duration: February 2022 to April 2023. Methods: The study included eighteen male domestic rabbits (Oryctolagus cuniculus), classified according to the duration of the experiment. Rabbits in "Category E8" were exposed to an 8-week time frame, while those in "Category E4" experienced a 4-week experimental duration. Each classification was further segmented into three sections: "Control Group A" which was administered normal saline as a placebo; "Experimental Group B" received a 30% ethanol solution in distal water (30ml per kg/day) through a nasogastric tube; and "Experimental Group C" treated with a 30% ethanol solution in distal water (30ml per kg/day) administered along with "Vitamin E" (50mg dissolved in 2ml distal water per kg/day). Liver tissue specimens from all subjects underwent staining with PAS stain to quantify glycogen (carbohydrates) in hepatocytes. Results: A statistically significant variance in glycogen depletion within hepatocytes was noted between animals treated with vitamin E and those not treated with vitamin E in both E4 and E8 categories. Nonetheless, vitamin E treated rabbits exhibited higher glycogen levels compared to their non-vitamin E treated counterparts. Conclusion: In the realm of alcohol-induced liver damage, vitamin E provides the expected protective benefits by safeguarding glycogen (carbohydrate) stores within hepatocytes.

Effect of Daily Water Intake on Periodontal Health and Dental Caries: A Cross-Sectional Study

Sun, 30 Jun 2024 00:00:00 +0000

Background: Water is crucial for maintenance of human body health. Objective: The study aimed to determine the effect of water intake on oral health and to compare the water intake behaviors in people of different age groups, genders, and professions. Study Design: Cross-sectional study. Settings: Study was conducted in the outpatient department of Punjab Dental Hospital through systemic random sampling. Duration: November 02, 2022 to January 03, 2023. Methods: A close-ended questionnaire was designed and administered; the later clinical examination was performed, and findings were recorded. Data were analyzed using SPSS version 23. Results: DMFT score was highest among those aged between 45 to 54 years, males, having elementary school education, unemployed, and having sedentary job activity level. Males (33.6%) were consuming more water. Respondents drinking adequate water had coral pink gingiva (25.6%), whereas those who were consuming less water had red gingiva (25.6%), bleeding on probing (37.6%), and supra gingival calculus (33.6%). The main reasons for not drinking adequate water were forgetfulness, followed by adipsia and fear of polyuria. Most respondents (72.8%) preferred drinking water at home rather than at work. Most respondents (72.8%) do not drink water at their workplace as they preferred (32%) to drink home-filtered water. Most respondents (83.2%) used only water for oral cleaning. Conclusion: Those consuming less than 1 liter of water daily had an increased prevalence of supragingival calculus, bleeding gums, and dark red gingiva. The mode of intervention should be mass education regarding water consumption, as per guidelines of WHO and ADA.

Randomized Controlled Trials and Consolidated Standards of Reporting Trials “Consort” 2010- 2019, Pakistan

Sun, 30 Jun 2024 00:00:00 +0000

Background: Contrary to general practice, research transparency and reliability of published material is related to the Reporting Guidelines like endorsement of CONSORT Statement for reporting Randomized Controlled Trials. Objective: To assess the compliance of Randomized Control Trials (RCTs) with the Consolidated Standards of Reporting Trials (CONSORT) conducted and reported from Pakistan. Study Design: Systematic Review. Settings: NA. Duration: Six months after ethical clearance. Methods: Systematic Review with 781 RCTs published from 2010-2019 in 44 online Pakistani journals retrieved from PakMediNet. CONSORT checklist has been used to verify whether the items have been followed or not and if followed then to which extent by calculating Summation score drawn from the CONSORT checklist items by allotting mark for each item. Individual RCT suggests ≥70% adherence which is considered to have Adequate Compliance (AC). Results: The mean score achieved was 16.85/37 (45.54%). A statistically significant association was found between Funding and Adherence. The publications have increased over the years with only 15/781(1.9%) RCTs published in 2010 to 138/781(17.7%) in 2019 but the Adherence to the CONSORT remained almost the same with the mean overall yearly Adherence of 45.54 % of individual articles. Conclusion: The use of CONSORT statement has not significantly improved the reporting of trials due to inadequate adherence to guidelines, hence reinforcing use of statement for the reporting of trials. Nonetheless, statistically significant association of Funding and Adherence has supported Funding to achieve Adequate Compliance to CONSORT.

Fruits and Vegetable Consumption and Risk of Cholecystectomy in Young Women of Low Socioeconomic Status

Sun, 30 Jun 2024 00:00:00 +0000

Background: Lifestyle & dietary habits with reduced intake of fruits, vegetables, and homemade food has increased the incidence of cholelithiasis in younger women of low socioeconomic class. Objective: To ascertain the occurrence of disease & subsequent cholecystectomy in young females of lower socioeconomic class, to highlight the importance of fruits & vegetable consumption in lowering the incidence of disease and to define the role of lipid abnormalities. Study Design: Cross –sectional design. Settings: Allied Hospital, Faisalabad Pakistan. Duration: Six months (Jan–June 2018). Methods: Sample size was 80; 50 patients 30 control. Diagnosis confirmed by USG. Data collection was done by questionnaire. Serum cholesterol & triglycerides were assayed by kit method. Statistical analysis was done using SPSS 17. Results: Outcomes generated mean value of 35.01 ± 5.437 SD for age. Out of 50 patients, 19 females were in the range of 25-35 years and 31 were in 36-45. The disease was found to be high in lower middle class. Decreased consumption of fruits & vegetables showed association with the disease but homemade food had no association. 14% patients had increased cholesterol level, 86% had normal levels. Increased TG level was seen in 56% patients whereas 44% patients had normal level. Conclusion: Gallstone incidence is rising in young females of low middle class. Increasing age, reduced intake of fruits, vegetables and homemade food has a very strong association with disease. Increased cholesterol and triglycerides was found to have no correlation.

Sialorrhea: Less Commonly Addressed Symptom of Patients Presenting with Neurological Disorders in Neurology and Oral Medicine Specialties

Sun, 30 Jun 2024 00:00:00 +0000

Background: Saliva-related challenges significantly impact individuals diagnosed having motor neuron disease (MND). Despite existing clinical guiding principles outlining evaluation and management protocols, research attention towards the management of saliva problems has been limited. Objective: To evaluate physicians' perspectives on sialorrhea as a major concern for patients presenting with neurological disorders in neurology clinics. Study Design: Retrospective hospital-based cross-sectional study. Settings: Department of Oral Medicine, Lahore Medical and Dental College. Neurology departments of various hospitals in Lahore including Lahore General Hospital, Jinnah Hospital and Sharif Medical & Dental College, Lahore Pakistan. Duration: An analysis was conducted on individuals diagnosed with MND between January 2021 and January 2023. Methods: The association between clinical factors and drool matters was scrutinized through univariate and multivariable logistic regression, with outcomes presented as odds ratios and corresponding 95% confidence intervals. Additionally, a survey involving health care authorities responsible for patients with motor neuron disease (pwMND) care was carried out to provide context to the conclusions. Results: 250 individuals with motor neuron disease (pwMND) received a diagnosis, with data on saliva issues available for 125 (50%) through direct questioning. Those without available data on saliva problems were slightly older (mean age 68.0 vs. 65.2 years; p = 0.032), but no significant differences found in terms of gender, location of onset, and MND subtype. Conclusion: Saliva problems are prevalent in individuals with MND. Despite this association, a noteworthy proportion of pwMND encountering drooling did not undergo suggested treatments.

Medical Undergraduates’ Attitude and Perceptions About Choosing a Career in Basic Sciences

Sun, 30 Jun 2024 00:00:00 +0000

Background: There is lack of awareness among medical students regarding career prospects in basic medical sciences. Also, they are not encouraged to pursue such career. Objective: To identify characteristics that affect a student's decision to pursue a career in basic sciences. Study Design: Cross-sectional study. Settings: Aziz Fatimah medical and dental college, Faisalabad Pakistan. Duration: Four months from August 16, 2022 to December 16, 2022. Methods: A sample size of 230 was taken. About 46 students were taken from every class from 1st-5th year. Medical undergraduate students who gave consent were included. A validated questionnaire titled “To evaluate medical and dental students and graduates’ inclination towards Basic Sciences as a future career option” was used. The data was analysed using IBM SPSS Statistics Version 25. Frequencies and percentages were calculated. Chi-square test of significance was applied. P-value less than 0.05 was considered as statistically significant. Results: About 76 participants (33%) showed their interest in pursuing career in basic sciences while majority of them were either not sure about this or they don’t want to pursue career in basic sciences. Most important reason for choosing basic sciences were liking a particular subject (32, 13.9%) followed by better balance between work and life (20, 8.7%). While, most important reasons for not choosing basic sciences were they want to become clinicians (85, 37%) followed by no interest in teaching job (22, 9.6%). Conclusion: There is lack of motivation and awareness among medical students regarding career prospects in basic sciences.

Long-Term Antibody Response to SARS-CoV-2 in Healthcare Workers of Allied Hospital Faisalabad: A Post-Infection Analysis

Sun, 30 Jun 2024 00:00:00 +0000

Background: Analyzing SARS-CoV-2 antibody persistence is crucial for optimizing public health and deepening our understanding of immunity. Addressing geographic gaps is necessary for comprehensive insights into antibody persistence post-infection. Objective: To evaluate the persistence of SARS-CoV-2 antibodies post-infection among healthcare workers (HCWs) at Allied Hospital, Faisalabad Pakistan. Study Design: Longitudinal study. Settings: BSL-III Laboratory/Department of Pathology, Allied Hospital, Faisalabad Pakistan. Duration: July, 2020 to June, 2021. Methods: Blood samples were obtained from naturally infected individuals two weeks after their PCR-positive diagnosis providing informed consent. The detection and quantification of SARS-CoV-2 IgG antibodies were conducted utilizing the Enzyme-Linked Immunosorbent Assay (ELISA) to ascertain the IgG antibody levels. Results: A total of 94 HCWs were included with a mean age of 30 years. The antibody persistence was observed in 39% of participants with a mean age of 35 years. The study also highlighted a decrease in antibody reactivity across all age brackets over time particularly noticeable in young adults, with all groups demonstrating a decrease to approximately 60% reactivity by the end of the twelfth month. Conclusion: The study revealed a similar distribution among both genders. A notable finding is an overall decrease in antibody reactivity over time in all age groups, particularly in young adults, with a general decline to about 60% by the twelfth month. This study provides vital insights for public health policies and clinical management of SARS-CoV-2 among healthcare professionals.

Coping Strategies of Derogatory Comments and Cynical Humor in Clinical Teaching among Dental Students

Sun, 30 Jun 2024 00:00:00 +0000

Objective: To identify the strategies students adopt to cope with derogatory comments from senior clinicians and/or teachers. Study Design: Qualitative study. Settings: The study was done at Punjab medical college (PMC) dental institute, Faisalabad medical University, Faisalabad Pakistan. Duration: 6 months from 01-03-2023 to 31-08-2023. Methods: The study was a qualitative phenomenological study. Final year bachelors of dental surgery students from one public and one private-sector institute were enrolled in this study. Semi-structured interviews of 10 students were conducted. Data collected was recorded by audio device, backed up, transcribed, arranged and coded. Data was analyzed using interpretative phenomenological analysis (IPA) approach. Lazarus model of stress and coping strategies formed the basis of this study. Results: 44 codes were identified which were grouped in 8 subthemes. These eight subthemes were further grouped into two themes i.e. Successful Coping strategies and unsuccessful Coping strategies. Ten different coping strategies were identified when the interpretative phenomenological analysis was done. Lazarus model of stress and coping was modified to derogatory comments coping model. Conclusion: Medical educators must provide the platform to the students where student issues can be discussed and resolved within the comfort zone of students, so we can make sure that the dentist we are producing has adequate knowledge and skill to treat the patients in society.

Obstetric Outcome in Grand Multipara at Term with Singleton Pregnancy in a Tertiary Care Hospital

Rabia Sadozai, Saira Bibi, Sahira, Sara Jamil Khan, Kausar Robeen, Heema — Sun, 30 Jun 2024 00:00:00 +0000

Background: A woman with more than five children is considered grand multiparous. Grand multiparous women have increased pregnancy and delivery risks as a result of inadequate prenatal care and advanced maternal age. Objective: This study aimed was to find the obstetric outcomes for grand multipara individuals who presented with a term singleton pregnancy. Study Design: Descriptive cross-sectional study. Settings: Obstetrics & Gynecology Department of Hayatabad Medical Complex in Peshawar, Pakistan. Duration: From June 1, 2022, to January 1, 2023. Methods: A total of 50 women patients with >5 number of children between 37–40 weeks of gestational period diagnosed clinically and through ultrasound with singleton pregnancy irrespective of age groups were included. Collected data analyzed using SPSS version 21. Results: Of the fifty patients, eighty percent were in the age range of 30-40 years. Vaginal delivery was the most common method of birth, with a normal-birth-weight infants accounting for 80% of cases and an Apgar score of 92% with >6 at five minutes. Anemia and hypertension accounted for 16% and 14% of the common complications. These patients had obstructed labor (6%), previa (6%), placental abruption (6%), and malpresentation (14%) as obstetrical complications. Conclusion: Grand multiparas are more vulnerable to increased risks due to several factors including a shorter pregnancy interval, inadequate health care, and an increase in age-related risks. Improving the literacy rate, health care facilities, availability of safe and effective contraception, and reproductive health status are necessary for better obstetrical outcomes.

Prevalence of Temporomandibular Disorders in Dental House Officers of Pakistan & Its Association with Biopsychosocial Factors- A Retrospective Study

Sun, 30 Jun 2024 00:00:00 +0000

Background: Temporomandibular disorders have high prevalence, particularly in dental graduates. They have a biopsychosocial model of pathogenesis, with gender, financial status, working conditions having possible associations. Fonseca Anamnestic Index is a useful tool for assessment of presence of TMD. Objective: To assess prevalence of TMDs in dental house officers of Pakistan and to evaluate the association of TMDs with biopsychosocial factors such as gender, pay status, house job in public or private sector. Study Design: cross sectional study. Settings: Department of Prosthodontics, institute of Dentistry, CMH Lahore Medical & Dental Collage, Lahore, Pakistan. Duration: One year from February 2023 to February 2024. Methods: Data was collected via online validated forms, from 550 dental house officers, working in public and private sector, in Islamabad, Lahore and Karachi. Questions included gender, age, month, and department of house job, pay status and whether house job was in public or private sector. TMD status was evaluated via Fonseca Anamnestic Index. 520 responses were collected and analysed using SPSS 23.0. Results: Prevalence of TMDs was 61.1% out of which 43 % had mild TMD, 20% had moderate TMD and 3.1% had severe TMD. Higher, albeit statistically non-significant, prevalence was found in females, unpaid house officers and those working in public sector. Conclusion: There is high prevalence of TMDs in dental house officers in major cities of Pakistan. Association of TMD with gender, pay status, and public/private sector remains inconclusive but higher prevalence of TMDs in females, unpaid, and public sector dental house officers mandates further investigation behind causative factors, and implementation of policies to ensure paid house jobs and progressive development of healthcare system, particularly in public sector.

Optimizing Multi-Rooted Tooth Extraction: A Comprehensive Study on the Efficacy of Periotome Utilization in Non-Surgical Exodontia

Sun, 30 Jun 2024 00:00:00 +0000

Background: Tooth extraction, is a common yet distressing procedure; using appropriate instruments is crucial. While elevators and luxators are typically used, they can cause significant socket damage due to applied force. Periotomes offer less traumatic alternatives, are designed to facilitate extraction with minimal force, reduced soft tissue damage, and better wound healing. Objective: The intention of this research is to assess the effectiveness of periotomes in non-surgical extraction of multi-rooted teeth. Study Design: Randomized controlled experiment. Settings: Department of Oral and maxillofacial Surgery, Lahore Medical and Dental College, Lahore Pakistan. Duration: The study lasted for one year and six months. Methods: This randomized controlled experiment was carried on 120 patients, age range of 16-60; requiring non-surgical extraction of multi-rooted teeth. Patients were randomly assigned to either an investigational group (extractions performed with a periotome and conventional forceps) or a control group (extractions performed using a straight elevator and conventional forceps). The level of pain was evaluated using a visual analogue scale within first week after surgery. Parameters such as gingival tear, length of procedure, consumption of analgesics and complications were also recorded. Results: Comparison of the two groups explored statistically significant variances (p < 0.05) across all parameters. The investigational group showed reduced extraction time, minimizing damage to surrounding bone and soft tissue a significant reduction in postoperative pain (53.7%), while the control group showed an increase in pain (67%). Conclusion: Findings suggest that incorporating periotomes into tooth extractions may reduce post-extraction pain, shorter extraction time and cause negligible injury to surrounding structures.

Analysis of Rejection rates in a Clinical Biochemistry Laboratory in a Tertiary Care Hospital in Bathinda

Premjeet Kaur, Saranpal Singh, Rajinderjit, Kapil Gupta, Gesu Singla — Sun, 30 Jun 2024 00:00:00 +0000

Background: Total testing process (TTP) in biochemistry laboratory is composed of 3 phases; pre-analytical, analytical and post-analytical. Errors in these phases can lead to erroneous results, hence, compromise the patient management. Objective: 1. To document the nature and determine the frequency of errors in all the three phases of TTP using quality indicators (QI). 2. Applying sigma metrics to data obtained. Study Design: Prospective cross-sectional study. Settings: Clinical Biochemistry Laboratory, at AIMSR, Bathinda, Punjab India. Duration: June 2023 to Nov 2023. Methods: Quality indicators were used to screen errors in requisition forms and samples received in clinical chemistry for analysis. Results: During analysis of 22320 samples, a total of 132 samples were unsuitable for testing and reporting, this resulted in 0.59% of rejection. Out of total 132 rejections, 99 (75%) were in pre-analytical phase, 11 (8.3%) in analytical phase and 22 (16%) in post-analytical phase. The Sigma score of 5 is seen which is acceptable. Conclusion: The preanalytical error is the most common error. Error is unacceptable in the medical field hence training program for the laboratory and non-laboratory personnel involved should be conducted.