Foundation University Medical Journal

Diagnostic utility of the Glasgow-Blatchford score in predicting rebleeding in upper gastrointestinal bleeding: a tertiary care study

Sidra Rehman — 2024-12-31

Objective: This study was conducted to ascertain the Glasgow-Blatchford bleeding score's diagnostic accuracy in upper GI bleeding patients as risk stratification tool for rebleeding.

Study design: Cross-sectional observational study.

Place and duration of study: The study was conducted at Medical unit DHQ Hospital, Rawalpindi from 7th August 2022 to 7th February 2023 after ethical approval.

Patients and Methods: A total of 165 patients of both genders, aged 20 to 50 years presenting with upper GI bleeding were included and written informed consent was taken. Patients having pre-existing bleeding disorder, anticoagulants or antiplatelets use, history of corrosive intake, traumatic GI bleed cases were excluded. The Glasgow Blatchford score (GBS) was calculated and cut off value >3 was taken as a risk factor for rebleed. Data were analyzed using SPSS-22, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPPV) for GBS > 3 were calculated. Diagnostic accuracy of Blatchford score was calculated as risk stratification tool for rebleeding.

Results: Amongst 165 patients, mean age was 39.4 ± 5.8 years. There were 73(44.2%) females and 92(55.8%) males. There was upper GI rebleed in 32(24.2%) cases. Study found 80% sensitivity and 92% specificity of Glasgow Blatchford (GBS) score to predict the rebleed. The positive predictive value (PPV) was 76.2% and negative predictive value (NPPV) was 93.5%. GBS was 89.09% accurate in diagnosing the rebleed. Age group data stratification was substantial (p-value <0.001). There was a substantial gender-based data stratification (p-value <0.01). Significant data stratification was found for the duration of symptoms (p<0.001).

Conclusion: Glasgow Blatchford score is a sensitive and specific score for predicting risk of rebleeding in patients of upper GI bleed demonstrating high sensitivity, specificity and diagnostic accuracy. GBS score should be used to identify the emergency room patients at risk of rebleeding.

Dietary transition and its determinants among residents of Skardu city

Siddiqa Batool — 2024-12-31

Objective: To assess the dietary transition among residents of Skardu city, its association with sociodemographic variables and the determinants of dietary transition.

Study Design: A cross-sectional study

Place and duration of study: Study was carried out on residents of Skardu city during a period of six months from March 2022-August 2022.

Patients and Methods: A total of 362 respondents, were randomly selected for the purpose of the study. Data on dietary transition was collected using Food Frequency questionnaire (FFQ) scale. Independent sample t-test and One Way ANOVA test were applied to check the association of dietary transition with sociodemographic factors.

Results: Majority were male (n=182, 50.3%) and were 18-25 years of age (n=168, 46.4%). There was significant association of dietary transition with some variables of sociodemographic characteristics (p value=<0.05). There was a significant association between modern food with sociodemographic characteristics of gender, age, marital status, other residency, education, job nature, family income, perceived health status and weight status (p value=<0.05). Association between traditional food with sociodemographic characteristics of age, gender, marital status, family structure, education, perceived health status and weight status (p value=<0.05). The mean score for modern food was 40.54±10.64 and traditional food was 37.24±8.43. The difference between two groups was significantly associated that p value is 0.0001.

Conclusion: The study concluded that majority of the respondents were undergoing food transition from modern to traditional and there was significant association with sociodemographic characteristics. Majority of the respondents started modern food before 10 years ago and come to know regarding modern food through community.

Effects of psychosocial rehabilitation in patients with breast cancer in pre-operative period

Bisma Nauman — 2024-12-31

Objective: To compare physical, clinical and psychosocial outcomes in patients having undergone a clinical program of prehabilitation planned for breast cancer surgery versus those having undergone conventional surgical treatment only.

Study Design: Quasi-experimental study.

Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi from January to June 2024

Patients and Methods: The patients were randomized into Group P (n=30) to receive pre-habilitation for four weeks prior to surgery and Group S (n=30) to receive conventional surgical resection without the pre-habilitation program. Prehabilitation parameters were assessed for pain, disability, anxiety, depression, physical and mental well-being using standard questionnaires. Primary variables studied were median scores for SF-12, HADS and SPADI scoring systems assessed between both groups before and 4 weeks after surgery.

Results: Median values for anxiety component of HADS scoring showed values of 3.00 (1.00) in Group P versus 8.00 (1.00) for Group S (p<0.001). Median values for depression component of the HADS scoring were 3.00 (1.00) versus 9.00 (1.00) between both groups (p<0.001). Median pain scores on the SPADI were 20.00 (6.00) versus 20.50 (8.00) between Group P and Group S (p=0.982). Median vales for the disability component showed values of 22.00 (4.00) in Group P versus 22.00 (3.00) for Group S (p=0.514).

Conclusion: We conclude that anxiety and depression levels were considerably improved with no clinical change in other parameters in the pre-habilitation program.

Back pain among medical students and its associated risk factors

Anwar Bibi — 2024-12-31

Objective: The aim of the study was to identify the frequency and risk factors associated with low back pain among medical and dental students.

Study Design: Cross-sectional study.

Place and Duration of Study: The study was conducted at Hitec Medical Institute, Taxila from May to October 2024.

Patients and Methods: A validated questionnaire was used to collect data from 207 students. Data was analyzed to assess the prevalence of low back pain and its contributing factors. The chi-square test was applied to determine the association between exercise and back pain. The mean age and BMI of participants were 21.36 ±0.501 and 19.2 ±0.613 respectively.

Results: A higher prevalence of pain was observed among female students (63.3%). Third-year students reported more back pain compared to first- and second-year students. Key contributing factors included prolonged sitting (25%), uncomfortable seating, exam-related stress (18.4%), and improper posture (17.4%). A significant association was found between regular exercise and reduced back pain (P = 0.005).

Conclusion: Back and neck pain are common among medical and dental students with significant contributing factors such as prolonged sitting and poor posture. Implementing strategies like posture correction, ergonomic interventions, and promoting regular physical activity may help alleviate pain and improve musculoskeletal health in this population.

The evaluation of patient satisfaction and perceived quality of care in OPD settings in Mirpur AJK: a cross-sectional study

Fatima Khurshid — 2024-12-31

Objective: Patient satisfaction is a reliable indicator of healthcare quality and an outcome measure for physicians. This study sought to assess patient satisfaction at Ahsan's Medical Complex, Mirpur Azad Jammu and Kashmir, Pakistan.

Study Design: Cross-sectional study.

Place and Duration of Study: Ahsan's Medical Complex, Mirpur Azad Jammu and Kashmir, Pakistan from August to October 2024

Patients and Methods: One hundred and seventy patients participating in face-to-face interviews using convenience sampling method. The Patient Satisfaction Questionnaire Short Form (PSQ-18) was used to rate patient satisfaction across seven dimensions. The responses were summarized using descriptive statistics and the data was analyzed using SPSS.

Results: One hundred and seventy participants had a variety of demographic features, with the largest age groups being 27-36 years (28%) and 37-46 years (23%), majority were female (71%) and married (91%). The PSQ-18 results showed high overall patient satisfaction, with a 90% rating in the high satisfaction category. Patients expressed high levels of satisfaction with interpersonal manner, communication, time spent with clinicians and accessibility. However, 10% patients reported moderate or low satisfaction levels, citing worries regarding technical quality and economical elements of care.

Conclusions: In general, patients were satisfied with the medical care they received, particularly with the interpersonal and communication skills of the staff.

Biosafety in the age of Biotechnology: Challenges and opportunities with genetically modified organisms

Ayesha Saeed — 2024-12-31

Genetically modified organisms (GMOs) have emerged as a product of biotechnological advancements, raising concerns about biosafety and regulatory frameworks. This review explores the intersection of GMO technology and biosafety, covering its evolution, applications as well as regulatory measures. Scientists have used recombinant DNA technology, a mechanism for genetic manipulation to alter organisms. This has significant implications for organismal phenotypes and protein production. GMOs hold significant promise for agriculture, medicine, and industry offering potential benefits for food security and national development. However, concerns remain regarding their environmental impact and human health risks. These concerns include transgene transfer, biodiversity loss, and potential health implications, alongside regulatory frameworks, and risk management strategies. Several international agreements, like the Convention on Biological Diversity and the Cartagena Protocol on Biosafety, aim to regulate GMOs and safeguard biodiversity. Pakistan has implemented Biosafety Rules of 2005 and has established the regulatory bodies like the National Biosafety Committee (NBC). Bacillus thuringiensis (Bt) cotton, a genetically modified crop, is grown in Pakistan. Several studies on food safety and environmental safety have been carried out about BT Cotton's biosafety concerns. This review provides a comprehensive overview of the evolution, applications, risks, and regulatory landscape of GMOs, offering insights into their role in sustainable development and biosafety governance.

Addressing research ethical dilemmas on cognitively impaired mentally ill patients (CIMI): insights from a prisma-guided review

Aqsa Saleem — 2024-12-31

Participants reserve the right to privacy and confidentiality like other patients to maintain their dignity. This research aims to identify the problems encountered by the researchers and the solutions they proposed while researching cognitively impaired mentally ill patients, to encourage the involvement of this neglected population in terms of research and hence management. The objective of this review was to identify the ethical solutions while researching cognitively impaired mentally ill patients. 21 studies, fulfilling the inclusion criteria from 2003-2024 were selected. This review follows the Cochrane Book of Systematic Review and PRISMA guidelines 2020. Informed consent remained the most inevitable challenge for researchers. There should be the revision of policies for researching such vulnerable populations to find ways to minimize the ailment while keeping in mind the privacy and safety concerns of research participants. Ethical recommendations for research involving cognitively impaired, mentally ill patients include adaptive consent processes using simplified language, involvement of legal guardians, and continuous consent reassessments. Privacy protections and strict data handling protocols are essential, along with minimizing risks and maximizing benefits. Researchers should receive specialized training, and studies should be regularly reviewed by ethics committees to ensure adherence to high ethical standards.

'One Health' and Health Professions Education: The uphill path

Azhar Rashid — 2024-12-31

The whole cosmos is interconnected maintaining an intricate balance of creative – destruction. Similarly, here on the 'Pale Blue Dot', as Sagan called our planet Earth, every living and non-living thing is woven together. They all function according to the laws of nature including, cells and organs within our bodies.^1,2 The laws of nature demand respect. Disrespect has a price, at times very high.

The human trait to think, leads to curiosity. Its ability to seek, find, create and innovate is unstoppable. At times the brilliance of mind transgresses the laws of nature, inviting its wrath.