Pakistan Medical Research Articles

THE JOURNEY CONTINUES

With the change of editor in chief the centre of publication of Pakistan Heartjournal in 2011 shifted to Peshawar after being published for 44 years in Karachi.The journal has been published regularly for eight years with its office in LadyReading Hospital, Peshawar by a dedicated team of editors supported byreviewers. I am especially be holden to executive editor Prof Adnan Gul and managing editors Dr Tahir Shah-volumes 44-48, (12 issues)2011-2014, Dr Abdur Rauf-volumes 48 and 49 (5 issues) 2014 -15 and Dr Umair Ali- volumes 49 -52 (16 issues) July 2015 tillDecember 2019 for their wonderful and whole hearted contribution. In a whole we published 33 issues. Since 2012 PakistanHeart Journal is being published regularly quarterly. It is indexed and abstracted in WHO IMEMR, Current Contents, IndexCopernicus Poland, and registered with International Serials Data System of France. It is recognized by Higher EducationCommission of Pakistan and approved by Pakistan Medical and Dental Council. The journal is covered by Pak medinet, googlescholar and new jour. What is the way forward on this journey? Regular, timely and more frequent publication of the journal, high quality articlesthrough rigorous peer review, introduction of newer sections and launch of new journals of specialties like interventional, electrophysiology, pediatric and preventive etc. Eventual aim remains indexation of the journal. Let me conclude the way I did eightyears ago, “Proactive efforts are required to inculcate the culture of research at all levels and we need to formulate a researchagenda for Pakistan. PHJ wishes to foster exchange of information among clinicians, researchers and health careprofessionals. The eventual goal is to translate the research and scientific advances to improve patient care. Journal reflects1 what is submitted and the quality can only improve if we all work harder and contribute more.”

Prevalence and the Risk Factors for Asymptomatic Carotid Artery Stenosis Among Type II Diabetes Mellitus Patients

Prevalence and the Risk Factors for Asymptomatic Carotid Artery Stenosis Among Type II Diabetes Mellitus Patients

General Needs Assessment of the Undergraduate Medical Students to Integrate Courses on Medical Ethics, Time Management and Communication Skills into the Bachelor of Medicine, Bachelor of Surgery Curriculum of Pakistani Medical Colleges.

In Pakistan, medical ethics, time management, and communication skills are not taught to medical students and are not a part of the curriculum of Bachelor of Medicine, Bachelor of Surgery (MBBS) developed jointly by Higher Education Commission and the Pakistan Medical & Dental Council. The objective of this general needs assessment was to assess the significance of these courses for undergraduate medical students. The literature review of the two online databases (PubMed and ERIC (Education Resources Information Centre)) was conducted in January 2018. The current literature emphasizes the significance of these undergraduate medical courses for medical students in Pakistan.

Importance of Quality in Medical and Dental Institutes

There is a dire need to incorporate quality improvement measures in medical education of our country as now worldwide the paradigm is shifted from the students’ outcome to the continuous quality improvement (CQI) measures. The ultimate goal of CQI is to provide optimal patient care. This is the responsibility of the accreditation council (PMDC) to ensure the true application of quality improvement indicators in medical institutes. The quality document introduced by the PMDC is the true reflection of the world accreditation bodies WFME, WHO. By ensuring the true application of this quality document, Pakistan Medical and Dental Council will be able to compete with the International standards of medical education through competent future physicians.

Targeted need's assessment: Medical ethics in MBBS curriculum of Pakistan.

Objective:To assess the learner need’s assessment of medical ethics in undergraduate medical curriculum of Pakistan.Methods:To establish an actual need, three methods were employed during October 2018. The first included a review of the curriculum for medical ethics as designed by the Pakistan Medical and Dental College (PMDC). A supplementary document “Code of Ethics”, published by Pakistan Medical and Dental College (PMDC), was also reviewed. In the second method, a self-administered questionnaire was distributed to all 500 undergraduate medical students at Poonch Medical College. Data analysis was performed through SPSS v 23.0 (IBM Corporation, Armonk, NY, US) at 95% CI. The results were expressed in the form of frequencies. The third method employed was an extensive review of literature to identify gaps and to propose learning strategies.Results:In the section on guiding principles in the curriculum, Ethics is considered as an optional subject. Bioethics is designated to be taught in the 3rd year of the MBBS, as part of Forensic Medicine. The agreement to study Medical Ethics Principles as part of the curriculum among final-year medical students saw numbers almost double to 84.61%. The highest majority was seen among final year medical students where 84.6% of the students agreed to study principles of medical ethics as part of their curriculum.Conclusions:Data and the PMDC curriculum support the incorporation of medical ethics in undergraduate education. Thus, an effective educational program based on the assessment of needs could be developed for medical ethics.

Pattern of peer review proforma of medical journals of Pakistan.

Objective:To analyze the contents and format of peer review proforma of Medical journals of Pakistan.Methods:This descriptive study was conducted in the Department of Orthopaedics and Traumatology Lady reading Hospital Peshawar Pakistan from 3rd August 2018 to 9th February 2019.An email was sent to the chief editors of all the medical journals listed on the official website (www.pmdc.org.pk) of Pakistan Medical and Dental Council (PM&DC).They were requested to send peer review proformas of their journals. The received proformas were analyzed for major contents and format or style. The proforma had a structured format when each portion of the manuscript i.e, title, abstract, key words, methodology, results, discussion, conclusion and references were individually sectioned for evaluation. Whereas in the unstructured proformas the reviewer was asked to assess the manuscript as a whole.Results:We received 41 proformas via emails. Majority (82.9%) of the proformas were structured while 17% were unstructured. A scoring or rating system for the manuscript was present in 31.7% of the proformas while 43.9% of the proformas were without any scoring system. Guidelines for the peer reviewers were given in 58.5% of the proformas. The peer review policy (closed or open) was mentioned in only 7.3%.About 9.7% of the proformas asked the reviewers to disclose conflict of interests.Conclusion:A spectrum of contents and format of peer review proformas of medical journals were observed. We found structured peer review proforma with a scoring scale comprehensive and more appropriate for peer review.

Radiographic Interpretation Skills of Clinical Dental Undergraduates Studying in Karachi, Pakistan

Radiographs facilitate dentists to envision diseases of the teeth and neighboring tissues that cannot be visualize through a clinical oral examination. A competent authority, in Pakistan for approving and monitoring dental curricula – Pakistan Medical and Dental Council has set 5 hours for didactic and clinical teaching of oral radiology to undergraduate dental students. This study has been planned to confirm whether the undergraduate students acquire the obligatory knowledge and interpretation competency or not within the stipulated time for oral radiology teaching. Material and Methods: A pretested power point presentation was shown to the clinical undergraduates present on the day of the evaluation. Among the twelve slides presented, seven slides contained radiographs showing basic pathological lesions like caries, bone loss, periodontal pocket, apical radiolucency and amalgam restoration opacity & five slides showed radiographs with anatomical structures; enamel, lamina dura, PDL, mental foramen and inferior alveolar nerve. The responders were asked to answer with anonymity on provided response sheets. Results: A total of N=97 students took part in the study; n=43 were from third year of Bachelors of Dentistry tenure and n=54 were from the final year. Apical radiolucencies, PDL spaces, and mental foramina were the toughest to identify for most of the participants involved whereas it was considerably too easy for both groups to radiographically report caries, missing teeth, and amalgam restorations. Conclusion: Despite very easy interpretation skill assessment, none of the student could score 100% marks revealing some weakness in radiology teaching which could be attributed to lesser number of teaching hours allocated for oral radiology.

Protocol for the mixed-methods process and context evaluation of the TB & Tobacco randomised controlled trial in Bangladesh and Pakistan: a hybrid effectiveness–implementation study

IntroductionTuberculosis (TB) remains a significant public health problem in South Asia. Tobacco use increases the risks of TB infection and TB progression. The TB& Tobacco placebo-controlled randomised trial aims to...

Retraction notice.

At the request of the Journal Editor and the Publisher, the following article has been retracted. Sajid M.S. Bioethics and Medical Education. Scottish Medical Journal 2008; 53(2): 62-63. DOI: 10.1258/rsmsmj.53.2.62 The above paper has substantial unreferenced overlap to the following paper: Jafarey A.M. Bioethics and Medical Education. Journal of Pakistan Medical Association 2003; 53 (6): 210-214.

Reforming Medical Education in Pakistan through strengthening Departments of Medical Education.

Objective:To review the current status of departments of medical education in all public and private medical colleges located in the city of Lahore, Pakistan.Methods:This was a quantitative, cross sectional descriptive study; conducted from March to October 2015 in Pakistan Medical & Dental Council (PM&DC) recognized medical colleges located in Lahore, Pakistan. Respondents were the heads of departments of medical education or any other well-informed faculty member. A questionnaire was prepared to obtain information about the current status of the departments of medical education (DMEs). The investigator personally visited all medical colleges for data collection. Both verbal and written consents were obtained and the questionnaire was administered to the resource persons. The data was organized and entered in SPSS for descriptive analysis.Results:Out of the 18 medical colleges in Lahore, six (33.3%) belonged to public sector and 12 (66.7%) were from private sector. All medical colleges reported to have a functional DME. However, eight had established DMEs during the past five years. Only one (5.6%) head of DME was working on full-time basis. Eleven (61.1%) heads of DMEs did not have any formal qualification in medical education. Eight (44.4%) colleges claimed to have adequate human resources for DME. Thirteen (72.2%) colleges mentioned that adequate financial resources were available for running DMEs. It is encouraging to see that DMEs in private sector medical colleges are playing increasingly significant role in managing educational activities. Similarly, the senior management of private sector seems to be relatively more eager to promote educational activities.Conclusion:There is an increasing recognition towards establishing DMEs in the medical colleges, but their infrastructure, proper functioning and availability of human and financial resources are serious impediments requiring immediate attention.

Treatment of a Fellow Doctor in a Public Sector Hospital: Ethnographic Study of Collegial Professionalism

Ethics and collegiality in medical profession requires a doctor to treat fellow professional as brother and sister. Ethnography was employed to study the status of collegiality in public sector hospital, where an ailing doc-tor sought clinical care from a physician. The former, on account of the latter’s cold reception and behaviour, reacted with his blood pressure shooting-up. The communication gap led the ailing doctor, who com-plied by coming to the laboratory, was perturbed, making him firstly unfit and later decided not to undergo the prescribed test. While Pakistan Medical and Dental Council have the responsibility to oversee, the under-graduate medical education and training should also lay greater emphasis on ethics in medical practice and healthy collegiality in the medical profession.

Aspiration in injections: should we continue or abandon the practice?

Aspiration during any kind of injection is meant to ensure that the needle tip is at the desired location during this blind procedure. While aspiration appears to be a simple procedure, it has generated a lot of controversy concerning the perceived benefits and indications. Advocates and opponents of aspiration both make logically sound claims. However, due to scarcity of available data, there is no evidence that this procedure is truly beneficial or unwarranted. Keeping in view the huge number of injections given worldwide, it is important that we draw attention to key questions regarding aspiration that, up till now, remain unanswered. In this review, we have attempted to gather and present literature on aspiration both from published and non-published sources in order to provide not only an exhaustive review of the subject, but also a starting point for further studies on more specific areas requiring clarification. A literature review was conducted using the US National Institute of Health’s PubMed service (including Medline), Google Scholar and Scopus. Guidelines provided by the World Health Organization, Safe Injection Global Network, International Council of Nursing, Center for Disease Control, US Federal Drug Agency, UK National Health Services, British Medical Association, Europe Nursing and Midwifery Council, Public Health Agency Canada, Pakistan Medical Association and International Organization of Standardization recommendations 7886 parts 1-4 for sterile hypodermics were reviewed for relevant information. In addition, curricula of several medical/nursing schools from India, Nigeria and Pakistan, the US pharmacopeia Data from the WHO Program for International Drug Monitoring network in regard to adverse events as a result of not aspirating prior to injection delivery were reviewed. Curricula of selected major medical/nursing schools in India, Nigeria and Pakistan, national therapeutic formularies, product inserts of most commonly used drugs and other possible sources of information regarding aspiration and injections were consulted as well.

Aspiration in injections: should we continue or abandon the practice?

Aspiration during any kind of injection is meant to ensure that the needle tip is at the desired location during this blind procedure. While aspiration appears to be a simple procedure, it has generated a lot of controversy concerning the perceived benefits and indications. Advocates and opponents of aspiration both make logically sound claims. However, due to scarcity of available data, there is no evidence that this procedure is truly beneficial or unwarranted. Keeping in view the huge number of injections given worldwide, it is important that we draw attention to key questions regarding aspiration that, up till now, remain unanswered. In this review, we have attempted to gather and present literature on aspiration both from published and non-published sources in order to provide not only an exhaustive review of the subject, but also a starting point for further studies on more specific areas requiring clarification. A literature review was conducted using the US National Institute of Health’s PubMed service (including Medline), Google Scholar and Scopus. Guidelines provided by the World Health Organization, Safe Injection Global Network, International Council of Nursing, Center for Disease Control, US Federal Drug Agency, UK National Health Services, British Medical Association, Europe Nursing and Midwifery Council, Public Health Agency Canada, Pakistan Medical Association and International Organization of Standardization recommendations 7886 parts 1-4 for sterile hypodermics were reviewed for relevant information. In addition, curricula of several medical/-nursing schools from India, Nigeria and Pakistan, the US pharmacopeia Data from the WHO Program for International Drug Monitoring network in regard to adverse events as a result of not aspirating prior to injection delivery were reviewed. Curricula of selected major medical/nursing schools in India, Nigeria and Pakistan, national therapeutic formularies, product inserts of most commonly used drugs and other possible sources of information regarding aspiration and injections were consulted as well.

Pakistan Journal of Medical Sciences: A bibliometric assessment 2001-2010

Objective:The aim of this study was to measure the growth of scientific research, authors’ productivity, affiliation with the institute and geographic locations published in the Pakistan Journal of Medical Sciences during the period of 2001 – 2010.Methods:This numerical analysis was conducted during mid-August 2016 to mid-October, 2016. The data for the study was downloaded from websites of e-journal of Pakistan Journal of Medical Sciences (PJMS) and Pak Medi-Net Com.Results:A total number of 1199 articled were covered by PJMS in 10 volumes and 40 issues with contribution of 3798 (3%) authors during 2001 – 2010. The average number of papers per issue is 30%. A gender wise contribution of males was higher 3050 (80%) than the females 748 (20%). A majority of articles were multi-authored 1052 (87%) as opposed to single author contribution 147 (13%). All 1199 articles were covered under four major disciplines i.e Basic medical sciences, medicine & allied, surgery & allied and radiological sciences and 39 sub-specialties according to medical subject headings (MeSH). It observed that 467 (39%) articles were published in Pakistan and 732 (61%) articles produced by other 32 countries. The Karachi city of Pakistan has produced 199 (16%) articles as highest as its national level and followed by Tehran (Iran) 77 (6%) as followed internationally.Conclusion:This study reveals that the participation of 32 countries in the PJMS publications proves it to be an internationally circulated journal to support research with the constant approach of publishing articles to each volume in basic medical sciences, biomedical, clinical and public health sciences.Abbreviations:DOAJ: Directory of Open Access JournalsIMEMR: Index Medicus Eastern Mediterranean RegionHEC: Higher Education Commission (Pakistan)PJMS: Pakistan Journal of Medical SciencesMeSH: Medical Subject HeadingsPMDC: Pakistan Medical & Dental CouncilSCIE: Science Citation Index Expanded

Professionalism in Medical Journalism and Role of HEC, PM&DC

Professionalism in Medical Journalism and Role of HEC, PM&DC

Introducing a structured prescription form improves the quality of handwritten prescriptions in limited resource setting of developing countries.

Incomplete or illegible prescriptions can lead to serious errors in administration of the prescribed medication, which can become hazardous. Our aim is to determine if a structured prescription form can improve the quality of handwritten prescription in terms of completeness and legibility. We conducted a prospective, non-randomized, time series study of quality of written prescriptions of general practitioners at a tertiary teaching hospital in Peshawar, Pakistan. The study involved an intervention, composed of the introduction of a pre-printed structured prescription form. The data were collected within 4 weeks including a 2-week pre-intervention phase and 2-week post-intervention phase. Completeness, quality of prescriptions and legibility were compared before and after the intervention of the pre-printed structured prescription form. A total of 463 prescriptions were obtained (260 in the pre-intervention phase and 203 in the post-intervention phase). Between pre-intervention phase and post-intervention phase, the Pakistan Medical and Dental Council registration number presence in prescriptions improved from 73.1% to 100% (P < 0.0005). The presence of prescriber's signature improved from 92.7% to 99% (P = 0.001). Drug duration was not missing in 99.5% in post-intervention phase as compared with 90.4% in pre-intervention phase (P < 0.0005). Prescriptions with no legibility problems improved from 76.2% to 94.1% (P < 0.0005). Although not statistically significant, prescriptions in which drug dosage was not missing improved from 85% to 90.6% (P = 0.07). We have a limited single-center study. A larger study in multiple settings is needed to develop adequate evidence for such interventions. Subjective nature of prescription legibility can also be considered as a limitation. Structuring a prescription form alone may improve certain aspects of quality of written prescription in terms of completeness and legibility.

Use of Massive Online Open Courses as a Potential Resource to Provide Continuing Medical Education in Pakistan.

The Pakistan Medical and Dental Council (PM&DC) has made Continuing Medical Education (CME) mandatory for doctors, from 2015 onwards. Aminimum of 15 credit hours of CME per year for general practitioners and 30 credit hours for specialist doctors have been made mandatory for renewal of the PMDC registration. While doctors can attend conferences to earn this CME credit, the opportunities are minimum and limited to major cities across Pakistan. Webbased CME is an attractive alternative to attending conferences. It can make up for 25% of the yearly PMDC requirement. So far, only two web-based CME providers have been launched in Pakistan, which is a shortage. Could Massive Online Open Courses (MOOCs) be used to fill this shortage? The MOOCs are online courses that are easily accessible to all learners irrespective of geographical boundary and resources, and can be used as a tool to provide CME to physicians. The problem as to how credit from PM&DC can be obtained, will need to be explored further.

DRUG RESISTANCE PATTERN AMONG AFB SMEAR POSI-TIVE RETREATMENT COMPLETED CASES

Abstract Background: Worldwide, multidrug resistance (MDR TB) is a serious issue. It has increased over the last decade. Re-treatment completed sputum smear posi-tive cases have much higher incidence of MDR-TB as compared to primary MDR - TB. Objective: To estimate the incidence of drug resis-tance pattern among AFB smear positive re-treatment completed cases. Study Design: Evidence based prospective study. Study Setting: Institute of Chest Medicine, Mayo Khalid M. Ch. 1 Associate Professor, Department of Chest Medicine KEMU / Mayo Hospital, Lahore Hassan S. 2 Registrar, Department of Chest Medicine Mayo Hospital, Lahore Saeed M.S. 3 Chairman, Department of Chest Medicine KEMU / Mayo Hospital, Lahore Younus M. 4 Senior Registrar, Dept of Chest Medicine Mayo Hospital, Lahore Iqbal R. 5 Senior Research Officer Pakistan Medical Research Council Hospital Lahore, Tertiary care hospital affiliated with King Edward Medical University, Lahore, Pakistan. Methodology: A total 50 (Male 22, Female 28) pul-monary TB patients who had completed Re- treatment regimen in the past and are still sputum smear positive for acid fast Bacilli were included in the study. Three consecutive sputum specimens were collected at Aga Khan University collection center at Lahore. The spe-cimen were sent to Agha Khan University Lab Karachi for AFB smear, culture and drug sensitivity both for essential and reserve drugs. Reports for AFB smear were received within a week, while culture and drug sensitivity reports after 6 weeks. Reports data was analyzed for essential and reserve anti tuberculous drug sensitivity for mycobacterium tuberculosis. Results: Data Analysis revealed MDR TB in 31(62%) patients which include 11 males and 23 females. Indi-vidual drug resistance to essential drugs was INH - 62%, Rifampicin - 68%, Ethambutol - 24%, PZA - 25% and Streptomycin - 21%. Poly drug resistance was determined in 38% cases. Individual drug resis-tance to reserve drugs - kanamycin, Amikacin, ofloxa-cin, Ethionamide and PAS was 4%, 4%, 36%, 10% and 2% respectively. Conclusion: There is a very high proportion of MDR TB in sputum smear AFB positive retreatment cases. Suggestion: Comprehensive measures including DO-TS PLUS are needed to control MDR TB in Pakistan. Key words: MDR TB, XDR TB, Re-treatment regi-men, Essential drugs, Reserve drugs, AFB - acid fast bacilli.

Publication Audit - a useful tool to evaluate progress and plan for the future.

Publication Audit is considered an extremely useful tool to evaluate the progress made and it is also helpful in future planning. During the Year 2014, 1577 submissions were made on the website of Pakistan Journal of Medical Sciences and most of them were from China 524, Turkey 441, Pakistan 255 and Iran 107. After peer review three hundred one (301) manuscripts were published which included original articles 248, Case reports 20 and Reviews 10. Overall acceptance rate was 19.8%. Pakistan Journal of Medical Sciences is included in the top ten biomedical journals published from the Eastern Mediterranean Region as per international database Scopus. This list has four journals from Pakistan the other three being Journal of College of Physicians &amp; Surgeons Pakistan, Journal of Pakistan Medical Association and Journal of Ayub Medical College, Abbottabad. doi: http://dx.doi.org/10.12669/pjms.312.7682 How to cite this:Jawaid SA. Publication Audit - a useful tool to evaluate progress and plan for the future. Pak J Med Sci 2015;31(2):490-492. doi: http://dx.doi.org/10.12669/pjms.312.7682

Ontology-Based Clinical Decision Support System for Predicting High-Risk Pregnant Woman

According to Pakistan Medical and Dental Council (PMDC), Pakistan is facing a shortage of approximately 182,000 medical doctors. Due to the shortage of doctors; a large number of lives are in danger especially pregnant woman. A large number of pregnant women die every year due to pregnancy complications, and usually the reason behind their death is that the complications are not timely handled. In this paper, we proposed ontology-based clinical decision support system that diagnoses high-risk pregnant women and refer them to the qualified medical doctors for timely treatment. The Ontology of the proposed system is built automatically and enhanced afterward using doctor’s feedback. The proposed framework has been tested on a large number of test cases; experimental results are satisfactory and support the implementation of the solution.