King Edward Medical University Research Articles

Relationship of Nottingham Prognostic Index with prognostic parameters of breast carcinoma

Background: Breast cancer (BC) is the commonest malignancy in the female and it is gaining its significance due to worldwide rising incidence. It is also important due to 2.5% higher incidence in Pakistan as compared to neighbouring countries. Nottingham prognostic index (NPI) is an important prognostic factor of BC. It provides information about survival and morbidity. There are significant variations in different studies. Aim: To carry out current study relating NPI with various histopathological parameters of BC. Methods: This was a descriptive cross-sectional study. The study was done at the Department of Pathology, King Edward Medical University Lahore with the collaboration of four surgical units of Mayo Hospital Lahore from 2010 to 2019. Total 137 cases of breast carcinoma were included. Information about age, grade, primary tumor size, axillary lymph node status and stage was entered in the pre designed proforma. NPI was calculated as 0.2xtumor size(cm)+lymph node grade. NPI was scored as excellent, good, moderate and poor and its correlation was calculated against primary tumor size, lymph node grade, tumor grade and stage. Results: We studied 137 cases of breast carcinoma with mean age 49.32±11.64 years. Mean NPI was 5.4±1.4 with range of 2.4 to 9.4. NPI scores in poor 65(47.4%) and moderate 61(44.5%) groups were significantly high as compared to good 10(7.3%) and excellent scores 1(0.7%). Most of the cases of poor NPI were in p T3 and p T4 whereas this was p T2 with moderate score. Poor score of NPI was significant in grade 3 which is in contrast to moderate score where grade 2 dominated the picture. Correlation of NPI with LNG was in favor of LNG 1 with good and moderate scores while LNG3 dominated in the poor group. In stage III, 49 cases (35.8%) were seen with poor score of NPI. Conclusion: NPI is an important prognostic parameter and it can be studied with different histopathological parameters to see correlation between them. In the current study majority of the cases of NPI scored at poor and moderate levels. Correlation coefficient was linear, strong and positive especially with LNG. Mean NPI has ascending correlation with these parameters. Thus NPI can be used as a prognostic indicator when comparing with histopathological parameters of BC. Keywords: Breast cancer, NPI, tumor grade, tumor stage, LNG

‘Sheldon' in the Medical Field: Emotional Intelligence and Its Associated Factors in Medical Students of Pakistan

AimsThe dearth of emotional intelligence leads to medical students’ inability to handle the pressures of medical education, sub-sequently causing burnout and mental illnesses. Poor emotional intelligence in young doctors also begets increased mistrust from the public, lowering the quality of healthcare delivery. Emotional intelligence of Pakistani students, similar to global context, is impacted by a myriad of psycho-socio-economic factors. It is pertinent to find out the detrimental and/or protective factors, and design interventions to enhance emotional intelligence as a soft skill. With this aim in mind, we explored the relationship of emotional intelligence with adverse childhood experiences and prevalent mental illnesses (depression and anxiety) amongst the medical students of one of the most populous cities of Pakistan; Lahore.MethodsA cross-sectional study was conducted including currently enrolled MBBS (Bachelor of Medicine and Surgery) students from first year to final year in 2 medical schools of Lahore. An online google form was constructed by combining Modified Adverse Childhood Experiences Score Scale (ACES), Brief Emotional Intelligence Scale (BEIS-10) and Hospital Depression and Anxiety Scale (HADS). Data were exported to SPSS version 25.0 for descriptive and analytical analysis. Pearson's chi-square analysis and logistic regression analysis were used to study the association between the outcome and dependent variables; Odd's ratio (OR) with 95% Confidence Intervals (CI) were calculated.ResultsParticipants (N = 324) belonging to two different medical colleges in Lahore, namely King Edward Medical College (public) and Shalamar Medical and Dental College (private), took part in the study.Pearson's chi-square showed significant association of emotional intelligence with early private schooling (p = 0.029), nuclear family system (0.044) and the presence of symptoms of depression (0.005). The adjusted logistic regression model showed that people who studied in a private sector school (OR: 2.12, CI: 1.01–4.45) and people who lived in a nuclear family (OR: 2.02, CI: 1.00–4.08) had significantly twice the likelihood of having high emotional intelligence. Also noteworthy is that respondents who were depressed according to HADS showed significantly lower emotional intelligence (OR: 0.37, CI: 0.16–0.86)ConclusionEmotional intelligence is now being recognized as an important life skill for healthcare providers. Emotional intelligence of medical undergraduates is influenced by a number of factors such as early schooling, family's living situation, current mental health and adverse childhood experiences. More prospective researches should be conducted to evaluate these relationships. Carefully crafted interventions for improving emotional intelligence for medical students must be implied at an early level to achieve better outcomes from medical education.

Spectrum of Aplastic Anaemia; presentation, etiology and overall survival: ASpectrum of Aplastic Anaemia: Presentation, Etiology and Overall Survival-A Tertiary Care Hospital Experience Tertiary Care Hospital Experience

Aplastic anemia (AA) is a hematological disorder with immune pathophysiology. There is a decrease in bone marrow precursors and cellularity which lead to a peripheral decline in at least two cell lines. The incidence of AA is higher in the Asian population as compared to that in the west. Objective: To highlight the disease spectrum of aplastic anemia patients from the clinical presentation and etiological factors to the disease outcome and overall survival. Methods: It was a descriptive cross-sectional study, conducted at Hematology Department King Edward Medical University. All the patients of both genders, diagnosed with aplastic anemia on peripheral smear and bone marrow trephine biopsy findings were included. The patients were followed up, the results were recorded and data were analyzed using SPSS V22. Results: The study included total 91 patients of aplastic anemia out of which 46(50.5%) were males, 45(49.5%) were females The patients were divided into three groups according to the severity of which moderate aplastic anemia was present in 19 (20.9%) patients, severe aplastic anemia was seen in 42 (46.2%) patients and very severe aplastic anemia was seen in 30 (33%) patients. The etiological factors seen included idiopathic 61.5%, hakim medication 14.3%, infections 12% drugs 9.8% and radiation exposure 2.1%. It was observed that the patients with severe aplastic anemia presented with high ECOG score. Conclusion: Aplastic anemia has life detrimental outcome with high mortality rate if left untreated can be provided to the patients since it is one of the high incidences hematological disorders in Asian population.

Causes of Postponement of Pediatric Surgical Cases on Elective Operation Theatre List

Aim: To establish factors resulting in postponement of patients on elective operation theatre list. Material and Methods: The design of this study was Prospective observational study. This study was conducted at department of pediatric surgery King Edward medical university / Mayo hospital Lahore from October 2019 to October 2021. Elective operation theatre list is made one day before elective operation theatre list. Patient information regarding diagnosis and possible cause of postponement was noted on prescribed proforma. Results: The total number of scheduled cases was 3900 (Average of 15 cases per list). Out of these 3545(90.9%) patients got operated while the remaining 355(9.1%) patients were postponed due to different reasons. Thus, the overall rate of postponement was 1.36 patients per list. Out of these 355(n=1) postponed cases, 160(45.1%) cases were cancelled due to operation theatre related reasons like shortage of surgical instruments, medicine and linen. 120(33.8%) patients were postponed due to reasons directly related to patients and parents. 65(18.3%) cases postponed due to shortage of man power. 10 (2.8%) patients, were postponed due to unscheduled holiday and power breakdown of operation theatre. Conclusion: Postponement of patients from elective surgery list is avoidable. Timely optimization and team work can reduce these issues. Keywords: postponement, elective operation theatre list, pediatric surgery.

Frequency and Pattern of GIT Anomalies in Neonates: A Retrospective Study at NICU Mayo Hospital Lahore

Aim: To acknowledge magnitude and spectrum of congenital anomalies of gastrointestinal tract in neonates and to establish possible factors resulting in these congenital anomalies. Material And Methods: The design of this study was Retrospective observational study. This study was conducted at NICU department of pediatric surgery King Edward medical university / Mayo hospital Lahore from June 2021 to May 2022. Neonates admitted in NICU department of pediatric surgery with gastrointestinal congenital anomaly were included in this study. Neonates having congenital anomaly other than GIT were excluded. Patient information regarding diagnosis and possible cause of congenital anomaly was noted on prescribed proforma. Results: During the study period total 256 neonates were admitted in neonatal ICU department of pediatric surgery Mayo hospital Lahore. Out of these 156(60.9%) neonates were having congenital anomalies of gastrointestinal tract while reaming 100(39.1%) neonates were having congenital anomalies of other structures. Most common congenital anomaly of GIT was anorectal malformations 35(22.4%) followed by Intestinal atresia’s in 30(19.2%). Conclusion: Congenital anomalies play an important role in neonatal mortality rate of any developing country like Pakistan. Chromosomal disorders, environmental and infectious factors are major contributing factors. Gastrointestinal tract anomalies are the most common anomalies of neonates with predominance of anorectal malformations. Antenatal care and timely interventions can reduce frequency of these anomalies. Keywords: Congenital anomalies, gastrointestinal tract, pattern.

Comparison of Breast Cancer Aggressiveness in Young and Older Patients

Objective: To compare aggressiveness of breast cancer in young and old patients. Study Design: Cross-sectional Place and Duration of Study: Department of Histopathology, King Edward Medical University, Lahore from 1st January 2016 to 31st December 2018. Methodology: One hundred and fifty women were divided into young (<40 years) and adult (>40 years) group depending upon their age. Women with breast cancer within 20-80 years were enrolled. Modified Radical-Mastectomy specimens as well as lumpectomy having axillary-clearance were sent to pathological laboratory. Biopsies were fixed in formalin in addition to hematoxylin, eosin staining. Data was documented and aggressiveness of breast cancer within both groups was evaluated on the basis of factors as tumor size, tumor type, lymph nodes, metastasis, tumor staging and tumor grading. Results: A significant variance in young and adult cases tumor grade, lymph node involvement and tumor size. The young patients had 12.90% cases of metastasis than old only having 4.5% (p<0.05). Similarly high tumor stage and aggressive tumors were also seen in young patients when compared with old. Conclusion: Young patients with breast cancer are more prone towards aggressive carcinoma than older patients. Keywords: Breast cancer. Metastasis, Tumor grade

Impact of COVID-19 pandemic on postgraduate training in Paediatrics.

To assess the impact of the coronavirus disease-2019 pandemic on paediatric postgraduate training as perceived by the trainees. The cross-sectional exploratory study was conducted at the Department of Paediatrics, King Edward Medical University, Lahore, Pakistan, from May to June 2020, and comprised paediatric postgraduate trainees associated with various hospitals across the country who were approached online with a pre-designed 24-item questionnaire during the peak months of the pandemic. Data was analysed using SPSS 25. Of the 226 postgraduates, 134(59.2%) were females. The overall mean age was 28.85±3.06 years. Of the total, 200(88.5%) and 195(86.2%) reported that pandemic had adversely impacted their training and research. The number of trainees managing >30 patients and doing >5 procedures per week before the pandemic decreased from 126(55.8%) and 150(66.4%) to 38(16.8%) and 41(18.1%), respectively, during the pandemic (p=0.01). Regarding e-learning, 168(74.3%) trainees thought it might partly compensate for training, 135(59.7%) showed readiness for it, and 179(79.2%) believed this could not replace actual patient interaction. The coronavirus disease-2019 pandemic was found to have adversely impacted paediatric postgraduate training.

Effectiveness of Mild to Moderate Hypothermic Cardiopulmonary Bypass on Early Clinical Outcomes.

Background: Intraoperative hypothermia is an integral part of cardiopulmonary bypass (CPB), and a precise degree of hypothermia may improve the early clinical outcomes of cardiac surgery. Presently, there is no agreement on an accurate, advantageous temperature range for routine use in CPB. To address this issue, we conducted a retrospective observational study to compare the effects of different hypothermic temperature ranges on primary (inotropic support, blood loss, and platelet count) and secondary (ventilation support and in-hospital stay) outcomes in patients undergoing elective cardiac surgery. Methods: Data were retrieved from the medical database of the Cardiovascular Surgery Department, King Edward Medical University, Lahore-Pakistan (a tertiary care hospital), dating from February 2015 to December 2017. Patients were divided into mild (34 °C to 36 °C), intermediate (31 °C to 33 °C), or moderate (28 °C to 30 °C) hypothermic groups. Results: Out of 275 patients, 245 (89.09%) fit the inclusion criteria. The cohort with mild hypothermic CPB temperatures presented better clinical outcomes in terms of requiring less inotropic support, less blood loss, fewer blood transfusions, improved platelet counts, shorter in-hospital stays, and required less ventilation support, when compared with other hypothermic groups. Conclusions: Mild hypothermic CPB (34 °C to 36 °C) may produce better clinical outcomes for cardiac surgery and improve the quality of health of cardiac patients.

Behavioural Determinants for Hand Hygiene Practices among Primary School Children during COVID-19 Pandemic

Background: Children acquire SARS CoV-2 infection from their family members but they experience mild symptoms. Hand washing promotion programs are being executed in many countries to enhance child healthcare development. Objective: This study was designed to identify behavioural determinants to increase hand washing practices among primary school children during COVID-19 pandemic. Methods: This was a cross-sectional study conducted by the Department of Pediatrics, King Edward Medical University/ Mayo Hospital, Lahore from June to November 2020. Total of 195 mothers of primary school children were enrolled by non-probability consecutive sampling. A 23-item, 5 points likert scale questionnaire assessed 5 domains related to handhygiene. Data was entered in SPSS 24. Domains were presented as frequency tables. Independent sample t-test was applied to 8 mean score of sub-category of each domain, and to cumulative mean score of each domain. A cut off mean score of ≥3 was taken as satisfactory. Results: We found satisfactory mean scores amongst mothers for knowledge regarding the importance of hand-washing (3.59±0.62), and commitment regarding maintenance of hand-hygiene (3.44±0.773). Better mean score for liking hand washing with alcohol rub/sanitizer than with soap and water (3.14±1.063 versus 1.10±1.229) was seen. Children reported not feeling dirty if they did not practice hand-hygiene (2.99±1.195). Elders in the households promoted hand-washing, but lacked practicing it themselves (3.48±0.881 versus 2.85±1.242). There was below satisfactory mean score for hand-hygiene amongst children after sneezing, coughing, blowing their nose, or playing (2.50±1.253, 2.23±1.265, 2.27±1.301, 2.83±1.280 respectively). Norm and self-efficacy factors had adequate overall scores (3.17±0.84, 3.17±0.65). The total score for this study was 2.8759±0.419. Conclusion: We found satisfactory mean scores for risk, attitudes, norms, ability, and self-regulation factors of handhygiene among primary school children.

Impact of COVID-19 on chronic respiratory disease outcome survey in Pakistan

Introduction: Pakistan has high prevalence of chronic respiratory diseases, especially bronchial asthma and chronic obstructive pulmonary disease (COPD). Objectives: The main objective of the study is to find the impact of COVID-19 on chronic respiratory disease in Pakistan. Material and methods: This cross sectional study was conducted in King Edward Medical University, Mayo Hospital Lahore during January 2021 to July 2021. Before and after the COVID-19 period were defined by a predetermined set of criteria in the form of a questionnaire. Results: The data was collected from 314 respondents. According to the respondents, the survey also queried about the presence of respiratory comorbidities in patients who had tested positive for COVID 19. COPD was mentioned as a comorbidity by more than a third of those who responded, and several others, including bronchial asthma, ILD, and tuberculosis (TB), were also mentioned by many respondents. Conclusion: It is concluded that because of the lockout's efficacy and the widespread use of masks outside the facility, the air was probably rather clean. As a result, both the number of people visiting an asthma outpatient clinic and the number of people being admitted to the hospital with acute severe asthma dropped. Keywords: COVID-19, Respiration, Patients, COPD

Plastic Surgery Improves Baseline Anxiety in Males Having Lesions on Face

Background: Congenital and acquired lesions both cause marked elevation in anxiety due to decreased self-esteem and confidence. Plastic surgery can address and markedly improve the anxiety level by addressing such lesions. Medical and surgical concerns related to body may elevate baseline anxiety. Although females are more concerned and fretful about such lesions, we observed that males are also prone to similar levels of anxiety. Objective: The objective of the study is to find out effect of plastic surgery on anxiety level of males having facial lesions. Methods: This prospective study was conducted in Plastic Surgery Department of King Edward Medical University, Lahore, Pakistan from Feb 2018 to Jan 2019 and 100 male patients with either congenital or acquired lesions of face were enrolled and operated. Anxiety level was rated by applying Hamilton anxiety scale immediate preoperatively and satisfaction along with quality of scar was noted after 2 months. Results: 53% of enrolled patients were having educational status above secondary school, 63% patients were from urban, 56% patients were below 27 years of age, 44% were above 27 years of age and 33% were married. Trauma was the cause of lesion in 61% while 13% were with Rhomberg disease and 26% with congenital lesions disorder. Majority of patients had lesion involving forehead. On Hamilton anxiety scale, pre-operative anxiety score was high (21.76±5.846) as compared to
 postoperative score (10.04±4.537). Scar scoring with Vancouver Scar Scale was 4.36±1.798 post operatively. Majority of patients showed significant improvement in anxiety scores post operatively. Conclusion: Irrespective of age, socioeconomic status and education level, lesions involving face elevated baseline anxiety
 in males. Plastic surgery addresses these concerns permanently resulting in marked improvement in anxiety level.

Study of Histopathological Pattern of Endometrial Curettings and Healthcare Burden due to Inadequate Samples

Aim: To determine the frequency of different histopathological findings of endometrial curettings presenting to a tertiary care hospital with a special focus on the frequency of inadequate samples which impose a major healthcare burden. Methods: The data of 975 female patients whose EC samples were received in the Pathology Lab of King Edward Medical University (KEMU), Lahore from August 2019- August 2021 was included in this retrospective, descriptive study. A statistical analysis of endometrial findings according to age and their association with histopathological findings was determined. Results: A total of 975 cases were analyzed (average age, 42.95 years). 34.9% had hormone induced change (n=340), 235 had secretory endometrium (24.1%). Next in the list were Chronic Endometritis, proliferative phase and endometrial polyps accounting for 68(7%), 57(5.8%) and 16(1.6%) of the biopsies respectively. 1.6% patients had Endometrioid Carcinoma 16 and 9(0.9%) had Squamous cell carcinoma. 201(20.6%) of the total were inadequate biopsy specimens. There were 28 cases of hyperplasia, half of which were associated with atypia and half were without atypia, i.e., 14(1.4%). Atrophic endometrium and granulomatous inflammation accounted for 3(0.3%) and 2(0.2%) cases respectively. Conclusion: A diverse spectrum of endometrial patterns was observed that included physiological as well as pathological patterns. The pathologies ranged from benign conditions to malignancies. There was a huge frequency of inadequate biopsies that were indicative of wastage of the limited resources of healthcare system. Keywords: Dilatation and curettage, Endometrial carcinoma, Uterine diseases

Study orientation among high and low achievers in undergraduate students of Medical and Allied health sciences

This study was aimed to determine the relationship between study orientation and academic achievements of MBBS and allied health sciences undergraduate students. This cross-sectional survey was conducted in King Edward Medical University, Lahore. The authors selected 450 students using non-probability, convenience sampling. Student of either gender enrolled in MBBS and Allied Health Sciences were included in this study. Study habits were calculated using modified Study Orientation Scale developed on lines of M. Mukhopandy and D.N Sansawal’s Study Habit inventory scale. Quantitative variables were presented as mean ±S.D. Qualitative variables were presented as frequency and percentages. Student were divided into high (CGPA ≥ 3) and low achievers (CGPA < 3). Association of different demographic variables and CGPA with SHI scores was calculated using independent sample t test. P value < .05 was considered significant. Of the 450 respondents, 48 (10.67%) were male and 402 (89.3 %) were female students. Mean age of the participants was 20.98 ± 1.97 years. Majority 331 (73.6%) were Allied Health Sciences (AHS) students. Most of the participants 363 (80.67%) were from urban background while 231 (51.33%) participants were living in hostels. Of the total, 246 (55.4%) participants were labelled as high achievers while 198 (44.6%) were labelled as low achievers. Students with higher CGPA scores were found to have better SHI scores i.e.,113.78 (15.31) as compared to low achievers i.e., 109.56 (16.34) (P value 0.005). Study orientation of students had a significant effect on the performance of students, with high achievers having significantly better SHI scores than their low achiever colleagues so it is recommended that due attention should be given to study habits. Key words: SHI, achievers, study orientation, medical and allied health sciences, undergraduates.

PREDICTORS FOR INSULIN RESISTANCE IN METABOLIC DYSFUNCTION ASSOCIATED FATTY LIVER DISEASE

Background and Aims:Metabolic dysfunction-associated fatty liver disease is a new concept to replace NAFLD as it truly reflects metabolic dysregulation associated with fatty liver. The aim of the study is to find the predictors of insulin resistance in term of mid upper arm circumference and triceps fold thickness in MAFLD subjects.
 Methods and Results: This cross sectional study was conducted at King Edward Medical University in collaboration with Mayo hospital radiology out door patient department from 2016 to 2017 after taking Ethical approval from University (134/RC/KEMU). Total of 148 non diabetic subjects of aged 40-60 years with Nonalcoholic fatty liver disease diagnosed on ultrasonography were enrolled from Mayo hospital. Fasting blood glucose was measured to exclude the diabetic subjects. Mid upper arm circumference and triceps folds were measured following protocol. Subjects were divided into two groups i.e insulin resistant and non-insulin resistant group (NIR) using cutoff values of HOMAIR. HOMA-IR value ? 2.29 were taken as IR group while subject with HOMA-IR value < 2.29 were taken as NIR group.
 Results:Study comprised of 148 NAFLD subjects of both genders. Out of total 148 subjects, 107 (72.3%) subjects were IR and 41 (27.7%) subjects were NIR. Spearman's Correlation did not showed statistically significant association of IR with mid arm circumference. ( P-value 0.70) and triceps fold IR (P- value 0.83).
 Conclusion: Insulin resistance is not associated with triceps skin fold and mid arm circumference in obese individual. Triceps fold and mid upper arm circumference cannot be uses as clinical interpreter of IR in obese individuals.

Awareness of Augmentative and Alternative Communication among Final Semester Students of SLP

The ability to communicate with words is one of a person's distinguishing characteristics. People who have lost their ability to talk are unable to communicate effectively for whatever reason. The acquisition (AAC) approach was implemented as a viable alternative for assisting these individuals. Objective: To find out awareness of augmentative and alternative communication among final semester students of SLP. Methods: The cross-sectional study was conducted in seven major institutes of Lahore (University Of Lahore, Riphah International University, King Edward Medical University, School Of Allied Health Sciences, Fatima Memorial Hospital, Punjab University, NUR International University). Final semester students of BS or MS program in SLP were included in the study. The research employed the convenient sampling methodology and standardized questionnaire was used having 26 questions, with responses obtained through an online form and survey. SPSS17 was used to analyze data collected from 50 respondents. Results: Overall awareness was calculated of respondents regarding Augmentative and Alternative communication. Results indicated that 32(65.71%) of final semester students of speech language pathology have adequate knowledge about AAC technology, 10(18.40%) did not significant knowledge about AAC technology while 8(15.89%) totally unfamiliar about AAC technology. Conclusion: After analysis it was concluded that majority of students had awareness of AAC. Most of Lacking was seen in students who did not have good academic exposure and did not practice with patient of AAC.

Chronic Lymphocytic Leukemia: Autoimmune Presentations in A tertiary Care Hospital of Lahore

Objective: To determine the frequency of presenting features and complication in chronic lymphocytic leukaemia Methodology: This descriptive study was conducted at the Hematology department, King Edward Medical University and affiliated hospitals, from July to December 2017. For every patient, a through clinical and dermatological examination, abdominal ultrasound , bone marrow examination was done. Afresh 3 ml blood sample for CBC, immune profile, and serum testing was collected by a syringe using aseptic technique. A complete blood count was carried out using Automated Haematology Analyzer (Sysmex KX-21) and chemical examination was done on Beckman Coulter Beckman coulter. Reticulocyte count was done and direct antiglobulin test using coomb’s reagent was done. Every patient was evaluated for the creteia of SLE and was categorized accordingly. Results: Out of the 150 patients enrolled in the study, 122(81.3%) were male and 28(18.7%) patients were female. The mean age was 65.8 ± 1.33 years with the majority of patients falling in the group of 71- 80 years. Out of 150 patients, 40 (26.7%) had coombs positive. Most of the patients who had coombs positive were in stage 4. The patients who presented with complications such as paraneoplastic pemphigus were 1 out of 150 patients. Splenomegaly was found in 87.3 % of all CLL patients with 13.33% presented with massive splenomegaly .Angioedema was found in 2 out of 150 patients. No case of SLE, Sjogren s syndrome Churg strauss Syndrome, Vasculitis or Richters Trasnformation was found. Conclusion: Detection of complications in a significant number of CLL patients is related to disease progression and overall survival. The treatment modalities are different in different causes of anaemia and complications due to CLL. It will help the clinicians in modifying the treatment and decreasing the misery of patients due to co morbidities.

ATTITUDE OF MEDICAL STUDENTS AND PAKISTANI PHYSICIANS TOWARDS EUTHANASIA AND ASSISTED SUICIDE: A DESCRIPTIVE CROSS-SECTIONAL STUDY

Objective: To Determine Attitude Of Medical Students and Pakistani Physicians towards Euthanasia and Assisted Suicide.
 Study Design: Descriptive Cross -sectional Study
 Place and Duration of Study: The Study was carried out at King Edward Medical University, Lahore from 24th August to 24th September, 2020
 Methodology: After taking ethical Approval from Institutional Review Board a questionnaire recording the respondent’s email address was distributed in King Edward Medical University and affiliated Mayo Hospital, Lahore and responses to questionnaire were recorded with informed consent.
 Result: Male to Female ratio of respondents was 2:3 and almost 83.74% of the respondents believed that euthanasia may be against their religious commands and 49.4% of the respondents agreed that euthanasia with necessary safeguards and restrictions should be legalized.
 The characteristics of respondents are given in the Table-1
 Conclusion: Almost half of the health care workers and medical students in Pakistan support judicial practice of Euthanasia.

Frequency of Thyroid Lesions at Pathology Department of King Edward Medical University Lahore

Background: Thyroid gland is notorious for carrying commonest endocrine pathologies and also for commonest endocrine malignancy. It is the 5th most common cancer in human beings. This makes to carry out current study to get insight of frequency of thyroid lesions at tertiary care level. Methods: This was a descriptive cross-sectional study. The study was done at the Department of Pathology, King Edward Medical University Lahore with the collaboration of four surgical units of Mayo Hospital Lahore from 2010 to 2019. Total 1601 cases were included. Information about age, sex and diagnosis was entered in the pre designed proforma. SPSS version 22 was used for data analysis. Descriptive analysis was done and the results were presented as frequencies, percentages and ratios. The results were then studied against local and international data. Results: This study revealed non neoplastic and neoplastic lesions as 1323 (82.63%) and 278 (17.37%) respectively. Bulk of the lesions 61.6% were between the age bracket of 20-39 years. Mean±SD for age was 34.22±11.42 years. Female to male ratio(F:M) was in favour of females as 9.81:1. Among the non neoplastic lesions, MNG 1151(87%) was a dominant lesion followed by TH 82(6%). LT 29(2.19%) and HT 26(1.96%) were other important lesions. F:M ratio was 10.80:1. Neoplastic lesions were divided into benign 178(64%) and malignant tumors 100(36%). FA was the leading benign neoplasm 164(59%). Rest of the benign tumors shared a minor fraction except HCA 12(4.31%). Among the malignant category, Papillary carcinoma 69(24.82%) dominated over MC 12(4.31%). FC 7(2.51%) and AC 6(2.15%) were other significant findings. F:M ratio in malignancy was 3.16:1 which was significantly lower than 13.83:1 in benign tumors. Conclusion: MNG is the dominant lesion among the non neoplastic lesions while in the neoplastic category FA was leading as benign neoplasm. Papillary carcinoma turned out to be the commonest malignant tumor. Major share of all the lesions were seen between 20-39 years. Keywords: MNG, Papillary carcinoma, Follicular adenoma, neoplastic lesions

Diagnostic Analysis of Electrolytes (NA+, k+, CL-, MG+2 and PO-34) in Cadaveric Synovial Fluid from Knee Joint to Estimate Postmortem Interval

Accurate determination of Time since death (TSD) has always been a challenge to forensic pathologists. Due to non-precise results using physical methods to estimate time of death, focus has been shifted to biochemical methods using body fluids. Previously, body fluids like cerebrospinal fluid (CSF) and vitreous humour have been used to determine postmortem interval (PMI), but in cases of head and ocular injuries respectively, they can be rendered useless. Synovial fluid is a well-preserved, compartmentalized fluid and hence, can be used to estimate PMI. The aim of this study was to determine death interval based on synovial fluid electrolytes levels (Na+, K+, Cl-, Mg+2, PO-34) and to assess its reliability for future studies. Study design: It was a correlational study. Study settings: The research was conducted at department of Forensic Medicine King Edward Medical University, Mayo Hospital Lahore, from August 2018 to August 2019. Methodology: PMI was regressed on synovial fluid electrolytes and regression formulae were formulated. Significant positive correlation was found between time since death and K+ ion concentration using regression formula. Results: However, there was negative relationship between PMI and Na+ and no significant relationship was found between TSD and Cl-, Mg+2 and PO-34 concentrations. The regression model of K+ gave a 97.9% accuracy and a correlation coefficient of 0.978 which showed the model using K+ values in synovial fluid is the most accurate one. Conclusion: The concentration of potassium ions increases with increasing time of death whereas, that of sodium decreases with increasing PMI. However, magnesium, chloride and phosphate concentrations remain unchanged with time interval. Keywords: sodium, magnesium, chloride, phosphate, electrolytes, synovial fluid

A Comparative Cross-sectional Study Of Conventional Versus Virtual Teaching Methods In The Medical Field

Objective: To compare conventional (physical) versus virtual Teaching in the medical field.Place of Study: Department of Anatomy, King Edward Medical University, LahoreStudy Design: A descriptive Cross Seconal Study.Duration of Study: November 2020 to February 2021Methodology: The study was conducted during the covid-19 pandemic, during which physical classes in medical colleges were suspended all over Pakistan. A sample size of 200 MBBS students was selected. A smartphone app was used to recruit students (i.e., WhatsApp). The participants were requested to take part in an anonymous online survey using Google Forms and provide their informed consent. The preferred teaching method chosen by respondents was reported with percentages, and the benefits and drawbacks of in-person and online teaching were considered. To compare the responses of different groups, the Pearson chi-square test was used.Results: Among 200 students, 84.5% preferred Conventional teaching, 08% went for virtual teaching, and 7.5% were interested in both types of teaching methodologies.Conclusion: Most of the students preferred conventional (physical) teaching to virtual learning.