MedERA - Journal of CMH LMC and IOD <p>MedERA-Journal of CMH Lahore Medical College and Institute of Dentistry(JCMHLMC) is an open-access peer-reviewed biomedical journal that publishes current research related to all the aspects of medical sciences. The acronym MedERA stands for Medical and Experimental Research Articles. CMH Lahore Medical College and Institute of Dentistry is the parent body of this Journal.</p> CMH Lahore Medical College and Institute of Dentistry en-US MedERA - Journal of CMH LMC and IOD 2521-0106 Myths & Barriers to Insulin Therapy in the patients of Diabetes Melitus <p><strong>Objective:</strong> Diabetic Patients in Pakistan are either hesitant to use Insulin or have poor compliance. There are numerous misconceptions and barriers to using insulin for the control of blood sugar leading to late adaptation often leading to complications of Diabetes mellitus. The aim of this study was to determine the barriers to Insulin Therapy and the myths associated with poor compliance of insulin therapy in patients with Diabetes Mellitus.</p> <p><strong>Study design:</strong> Across sectional conducted at Sakina Institute of Diabetes &amp; Endocrine Research (SIDER), Shalamar Hospital, Lahore.</p> <p><strong>Methodology:</strong> The study was conducted using questionnaires, designed separately for patients using Insulin, and for those not using Insulin, to determine the barriers to initiation and poor compliance to Insulin therapy.</p> <p><strong>Results:</strong> Out of the 124 patients that participated in our study, 58.9% of these were those who never used Insulin, while 41.1% were on Insulin therapy. Among the patients not using Insulin, about 71.4% expressed their fear of taking Insulin because of the pain from injections; 83.4% felt that self-administration of Insulin is a discouraging factor because of the procedure; 61.9% felt that cost of Insulin therapy is a huge barrier to its use and 78.6% were reluctant in using Insulin, because they feared it would make their life less flexible. Among the patients using Insulin, about 62.7% were satisfied with their lifestyle; 84.3% said they adapted well to the route of administration and 64.7% felt an improvement in their health status after starting taking Insulin. Nearly, 80.4% of the patients currently using Insulin, were reluctant to initiate Insulin therapy; and about 66.7% said that proper information and counselling from their physicians helped them make the decision of starting Insulin and, 19.6% admitted to being motivated by their Family/Friends.</p> <p><strong>Conclusion:</strong> Numerous myths and barriers exist, resulting in reluctance among patients of Diabetes Mellitus to comply with insulin therapy. However with appropriate counselling from physicians and stimulus from the patient's family and friends helped them to start Insulin therapy with proper compliance.</p> Masooma Hashmi Copyright (c) 2021 Masooma Hashmi 2021-06-14 2021-06-14 2 10.5281/zenodo.5081926 Post Placental intrauterine contraceptive device (PPIUCD): Women's experience at Combined Military Hospital Lahore <p><strong>Background&amp; Objectives:</strong> The objective of this study was to evaluate post placental intrauterine contraceptive device (PPIUCD) in terms of awareness, acceptance, and expulsion in women.</p> <p><strong>Place &amp; duration of study:</strong> It was a prospective longitudinal study, conducted at Department of Obstetrics and Gynecology, Combined Military Hospital Lahore over a period of six months.</p> <p><strong>Methods:</strong> All patients visiting antenatal clinic or labor room in early labor were counselled for insertion of Cu T-380A after vaginal delivery or at lower caesarean section. A total number of 232 women were included in the study after informed consent. Women with ruptured membranes for more than 18 hours,antepartum , postpartum hemorrhage, and evidence of chorioamnionitis were excluded from study.All the collected data was entered and analyzed through SPSS version 20.</p> <p><strong>Results:</strong> Total number of deliveries were 1814 and acceptance rate is 12.8%.Only 4.5% of patients were aware about PPIUCD insertion. Maximum patients were between 25-29 years of age(36.6%).Patients with two children have highest acceptance rate of 32.8%. At six week postpartum,the expulsion rate is 1.9% while 3.3% of patients have missing strings which were coiled up in the uterus. The discontinunation rate is 6.5% (15),the reason being irregular vaginal bleeding in 3.5% cases, infection in 1.3% cases and other causes in 1.7%. The patients willing to continue PPIUCD were 93.5%.</p> <p><strong>Conclusion:</strong> Insertion of IUCD in immediate postpartum period is an acceptable ,effective, safe and convenient contraceptive intervention in both caesarean section and vaginal deliveries.</p> Dr Saima Qamar Copyright (c) 2021 Dr Saima Qamar 2021-06-14 2021-06-14 2 10.5281/zenodo.5082000 Comparison of Oral Progesterone with Oral Progesterone plus Inj. HCG for the Management of Threatened Miscarriage <p><strong>Background&amp; Objectives:</strong> To compare the efficacy of progesterone alone versus progesterone plus human chorionic gonadotropin for management of threatened miscarriage.</p> <p><strong>Study design:</strong> Randomized controlled trial</p> <p><strong>Place &amp; duration of study:</strong> The study was carried out in department of Obstetrics &amp; Gynecology, CMH Lahore for six months from 12" July 2018 to 12th Jan 2019.</p> <p><strong>Methods:</strong> One hundred females with threatened miscarriage fulfilling inclusion criteria were divided in two groups. In group A, 50 females were given progesterone in oral tablet form plus human chorionic gonadotropin (hCG) as intra-muscular injection, while in group B, 50 females were given (oral only) progesterone till 14 weeks. Females were followed up in OPD on weekly basis till 14 weeks of gestation and efficacy of treatment was compared. Efficacy was defined as successful treatment leading to continuity of pregnancy to second trimester (14 weeks of pregnancy) with no vaginal bleeding and no abdominal discomfort/pain.</p> <p><strong>Results:</strong> The mean age of females in group A and B was 24.10 +3.21 and 26.63 +6.05 years, respectively. The mean gestational age, BMI and parity of females in group A and B were 10.01+2.84 vs 10.98+1.52 weeks, 25.10 + 4.43 Kg/m2 vs 27.95 + 3.61 Kg/m2 and 3.01+0.84 vs 1.98+1.24, respectively. Efficacy was 86% with progesterone plus hCG and 42% with progesterone alone for management of threatened miscarriage and it differs significantly among two groups (P&lt;0.05).</p> <p><strong>Conclusion:</strong> Progesterone plus hCG is more effective than progesterone alone for management of threatened miscarriage.</p> Dr Shazia Tufail Copyright (c) 2021 Dr Shazia Tufail 2021-06-14 2021-06-14 2 10.5281/zenodo.5081994 Evaluation of Hospital Management System at combined Military Hospital Lahore <p><strong>Objective:</strong> To evaluate HMS in terms of user satisfaction, time management, data retrieval, record keeping, confidentiality in terms of medical records and comparison of user preference according to job description.</p> <p><strong>Study Design:</strong> Cross sectional study.</p> <p><strong>Place of Study:</strong> Combined Military Hospital Lahore, from 1" Dec to 31" March 2018.</p> <p><strong>Methodology:</strong> All doctors and hospital personnel using HMS for more than 6 months in CMH Lahore were included by means of nonprobability convenient sampling. The total sample size was of 200 participants. Questionnaire was filled regarding user satisfaction, time management, data retrieval, record keeping, confidentiality in terms of medical records and comparison of user preference according to job description and results were analyzed using SPSS 20.</p> <p><strong>Results:</strong> Out of a total of 200 participants, 58 (29%) were satisfied while 142 (71%) were dissatisfied with HMS mostly due to system hang-ups (34.5%) which were observed while using this software. Out of the total respondents, 133 (66.5%) participants believed it increased time spent per patient mostly due to too much information being present on patient encounter form (28%), and 66 (33%) participants were wary of its confidentiality. 142 (71%) participants believed that manual records needed to be kept alongside HMS. However, 141 (70.5%) thought it is an efficient tool for data retrieval, and 156 (78%) believed it to be reliable software.</p> <p><strong>Conclusion:</strong> Most personnel- young and old-were largely dissatisfied with HMS, even though it is believed to be reliable and an efficient tool for data retrieval. Many would still keep manual records and were wary of its confidentiality.</p> Shehreena Z. Butt Copyright (c) 2021 Shehreena Z. Butt 2021-06-14 2021-06-14 2 Role of Vitamin D in Preventing Relapse and maintaining Remission in Patients with Ulcerative Colitis - A Case Control Study <p><strong>Background &amp; Objectives:</strong> Ulcerative colitis (UC) affects the mucosa of the rectum and the colon, and is characterized by flares and remission. It is observed that defect of proliferation of T-lymphocytes is the causative factor of ulcerative colitis. Vitamin D appears to play an important role in decreasing the incidence of active UC. The study was undertaken to determine the effect of Vit.D in patients with ulcerative colitis (UC).</p> <p><strong>Place &amp; Duration of Study:</strong> This study was conducted from January 2014 to January 2016 in Mayo Hospital, Lahore, Pakistan.</p> <p><strong>Methodology:</strong> Data was collected from patients suffering from UC who visited the surgical out-patient department and/or were admitted to the surgical floor. A total of 84 patients within the age range of 18-70 years and divided into two equal groups of 42 were included in the study. The control group was given standardized treatment of ulcerative colitis according to severity of disease as measured by Truelove and Witt's criteria. The intervention group was given an additional dose of Vitamin D along with primary disease treatment.</p> <p><strong>Results:</strong> It was seen that patients in the intervention group showed significant remission and a decrease in the frequency of relapses.</p> <p><strong>Conclusion:</strong> Our study supports the hypothesis that vitamin D supplementation helps to achieve significant remission and reduce relapse in patients suffering with active ulcerative colitis.</p> Dr Muhammad Asim Rana Copyright (c) 2021 Dr Muhammad Asim Rana 2021-06-14 2021-06-14 2 10.5281/zenodo.5082030 Significance of Feedback Analysis in Undergraduate Gross Anatomy Teaching <p><strong>Background&amp; Objectives:</strong> Gross anatomy teaching is fundamental in the future learning of clinical subjects in undergraduate medical courses. Students are the most important stakeholders in this process of teaching and learning, so their constant feedback evaluation is essential to construct a comprehensive, clinically oriented, composite gross anatomy curriculum. The present study was carried out to assess and evaluate students' feedback regarding gross anatomy teaching/assessment in CMH Medical College Lahore.</p> <p><strong>Study design:</strong> Cross sectional, descriptive studies</p> <p><strong>Place &amp; duration of study:</strong> Conducted in the Anatomy department of CMH Lahore Medical College.</p> <p><strong>Methods:</strong> Present study was based on the observation and analysis of a feedback data. A total of 150 medical students of the first year MBBS class took part in this study. A feedback opinion form was distributed amongst them during the active session. The form comprised of 16 questions, based on the subject matter, instructional methodology, standard of teaching, teaching instruments, modes of assessment used, and students' suggestions for improvement in the current state of gross anatomy teaching.</p> <p><strong>Results:</strong> Although majority (77%) of the students showed interest in the subject and were satisfied with the subject matter, methodology and tools of teaching but a quite reasonable (23%) number of students suggested that audiovisual aids and innovative tools should have been used more. Moreover, they wanted more CBL sessions and clinical visits.</p> <p><strong>Conclusion:</strong> The traditional teaching tools are becoming less affective as well as the new student of modern age becomes more challenging to handle, modification in the courses and redesigning the teaching tools is the need of the hour for an efficacious, balanced gross anatomy course. As there is always a room for improvement, a constant system of feedback analysis can make teaching-learning more conducive to our learning outcomes as well as more fun for students.</p> Dr Shaista Jarral Copyright (c) 2021 Dr Shaista Jarral 2021-06-14 2021-06-14 2 Knowledge Assessment of Designing of Removable Partial Dentures <p><strong>Objectives:</strong> To assess the knowledge of designing removable partial dentures amongst graduates of last five years and to assess the association of experience with knowledge of designing removable partial dentures.</p> <p><strong>Study Design &amp; Setting:</strong> A questionnaire based survey conducted in three dental colleges of Lahore.</p> <p><strong>Subjects &amp; Methods:</strong> Graduates of the last 5 years were categorized in two groups according to their ages. They were asked to design a removable partial denture for a given Kennedy's class and knowledge about the design was assessed through questions. The experience of respondents was compared with their knowledge.</p> <p><strong>Results:</strong> In the age group of 21-25 years, approximately 73% subjects scored &gt; 50%, whereas in the age group of 26-31 years, approximately 59% of the subjects scored&gt;50%, 14% of general dental practitioners had fabricated only 5 RPDS. p value was &lt;0.01.</p> <p><strong>Conclusion:</strong> Awareness about the designing of RPDs was unsatisfactory. Experience of designing RPDs had a positive correlation with knowledge.</p> Hina Zafar Raja Copyright (c) 2021 Hina Zafar Raja 2021-06-14 2021-06-14 2 10.5281/zenodo.5081908 Burnout: Comparative Study between House Officers and Final Year Medical Students across Gender and Sector <p><strong> Background&amp; Objectives:</strong> The purpose of this study was to compare the burnout in house officers and medical students of final year in public and private sector of Lahore. Additionally the current study aims to find out the gender differences and sector wise differences on the variable of burnout.</p> <p><strong>Study design:</strong> Cross-sectional study. Place &amp; duration of study: Public and private medical colleges and hospitals of Lahore, Pakistan. The duration of the study was from March 2017 to Dec 2017.</p> <p><strong>Methods:</strong> The sample of 240 participants(120 final year MBBS students &amp; 120 house officers) having age range of 22 to 25 years of age was selected from public and private sector.For assessment purpose demographic form and the abbreviated nine items inventory “abbreviated Maslach Burnout Inventory (MBI)" was used for the measurement of burnout among medical students and house officers.</p> <p><strong>Results:</strong> Findings of current study revealed more "depersonalization" (t (238) = 3.14, p&lt;.05) and more "personal accomplishment"(t (238) = 4.24.p&lt;.05) on the sub-scales of burnoutin house officers as compared to the final year medical students. No significant gender differences were revealed. Further sector wise analysis showed interesting findings that participants from public sector showed more "personal accomplishment" (t (238) = .029, p&lt;.05) than their counterparts from private sector, but revealed no significant differences on other subscales of burnout of "emotional exhaustion” and “depersonalization".</p> <p><strong>Conclusion:</strong> This study highlighted that house officers are suffering more from "depersonalization” which indicates lack of commitment, distancing from patients, and handling of the patients as inanimate objects. This study also revealed that public sector house officers and final year students showed more personal accomplishment which represents high sense of efficacy, commitment and capacity to involve, change and improve than their counter parts in private sector.</p> Prof Dr Maqbool Ahmad Copyright (c) 2021 Prof Dr Maqbool Ahmad 2021-06-14 2021-06-14 2 10.5281/zenodo.5081998 Management of Osteroarticuler Infection by Different Treatment Options <p><strong>Background &amp; Objectives:</strong> Osteo-articular infections (OI) are a common problem and challenging for Orthopedic Surgeons. The consequences can be local manifestations to a systemic infection or limb loss. Accurate diagnosis is necessary for good treatment and control the drastic consequences. Conventional treatment may require antibiotics for prolonged duration according to culture and sensitivity. Our study objective was to determine osteo-articular infection and the effectiveness of treatment modalities.</p> <p><strong>Place &amp; duration of study:</strong> This study was a case series done at the Department of Orthopedic Surgery KEMU/Mayo Hospital, Lahore from December 2010 to March 2013.</p> <p><strong>Methods:</strong> We included 200 hemodynamically stable patients 18 to 55 years of age of either gender with osteo-articular infection. They were diagnosed on history, clinical examination both local and systemic, previous treatment, previous surgical procedure and baseline included CBC, ESR, CRP, LFT's with albumin, globulin, RFT's, blood sugar random, affected joint radiographs, pus &amp; soft tissue culture sensitivity, CT scan and MRI. We managed all patients both medically and surgically who presented with infection of bone and joint due to trauma, hospital acquired infection or due to hematogenous spread. We followed patients in out-patient department for six months and observed the post-operative treatment outcomes.</p> <p><strong>Results:</strong> Out of the total 200 patients, majority 172 (86%) were male and 28 (14%) were female. Lower limb infection was observed in 128 (64%) patients, while 46 (23%) patients had upper limb infection, and 27 (13.5%) patients had septic arthritis of lower limb. Treatment outcomes were observed and there were excellent outcomes in 31 (15.5%) patients, good in 56 (28%), fair in 69 (34.5%) and poor in 43 (21.5%) patients.</p> <p><strong>Conclusion:</strong> Staphylococcus aureus is the most common causative organism of osteoarticular infection. Males are predominantly affected. Antibiotic regime for 03 weeks according to culture and sensitivity is the most effective treatment in conjunction with surgical wound debridement, curettage, arthrotomy, sequestrectomy and exchange of infected prosthesis show favourable outcomes.</p> Dr Asad Ali Chaudhry Copyright (c) 2021 Dr Asad Ali Chaudhry 2021-06-14 2021-06-14 2 10.5281/zenodo.5081981 Failure of tooth suported fixed dental prothesis and future restorability of abutment teeth among patients visiting CMH Lahore Medical College, Lahore, Pakistan <p><strong>Objective:</strong> Extent of failure of tooth supported fixed prosthesis may affect the future restorability of abutment tooth. The objective of this study was to identify the cause of failure in tooth supported the fixed prosthesis and to assess the future restorability of abutment teeth.</p> <p><strong> Study Design:</strong> Cross sectional study.</p> <p><strong>Place and duration:</strong> Study was conducted in department of prosthodontics, Institute of Dentistry CMH Lahore Medical College in year 20162017.</p> <p><strong> Patients and Methods:</strong> Total 50 patients were examined with 80 abutment teeth. A self-administered Proforma was made to collect data regarding patient's age, gender, type of prosthesis and cause of failure. Intra-oral examination of patients was carried out along with prosthesis evaluation. Radiographic assessment of abutment teeth was done with the aid of peri-apical and bitewing radiographs. Failure was classified and data were analyzed using SPSS 21.</p> <p><strong>Results:</strong> Periodontal breakdown of abutment teeth was reported as a most common cause of failure (38.8%) followed by caries (31.3%). endodontic failure (7.5%), mechanical failure (6.3%), and esthetic failure (5%). Least reported factor was decementation (2%). Data showed that 32.5% failures fall in grade 4 category, 22.1% in grade 6 followed by grade 5 (18.2%), 3(16.9), 2 (7.8%) and 1 (2.6%) being least common.</p> <p><strong>Conclusion:</strong> While planning any fixed prosthesis the future longevity of prosthesis as well as serviceability of abutment tooth should be considered. Oral hygiene status, endodontic status and periodontal condition of abutment teeth must be assessed before giving any prosthesis.</p> Dr Hina Zafar Raja Copyright (c) 2021 Dr Hina Zafar Raja 2021-06-14 2021-06-14 2 10.5281/zenodo.5081883 Survey of Fasting Blood Glucose levels in New Medical College Entrants of CMH LMC and IOD <p><strong>Background &amp; Objectives:</strong> Our objective was to measure the fasting blood sugar level (BSL) in new college entrants of CMH Lahore Medical College and Institute of Dentistry (CMHLMC&amp;IOD), and to compare if fasting BSL is affected by positive family history of Diabetes Mellitus (DM).</p> <p><strong>Study Design:</strong> Observational cross-sectional study.</p> <p><strong>Place &amp; Duration of Study:</strong> This study was carried out in CMHLMC&amp;IOD from January,2018 to August, 2018.</p> <p><strong>Methods:</strong> Non-probability convenient sampling was used to collect data from 67 medical students (MBBS and BDS) after informed consent. The data was enteredand analyzed using SPSS 20.</p> <p><strong>Results:</strong> A total of 67 students were included in the study with mean age of 20.13 + 1.22 years with 44 females and 23 males. The mean fasting BSL was 92.56 10.24 mg/dl. For students with positive family history of DM, mean fasting BSL was 94.10=9.11 and for those with no family history of DM, mean fasting BSL was 90.55 +11.40 mg/dl.</p> <p><strong>Conclusion:</strong> Our study concluded that the mean fasting BSL of students with family history of DM was slightlyhigher as compared to those with no family history of DM but remained statistically insignificant at this sample size.</p> Prof Dr Iram Fayyaz Copyright (c) 2021 Prof Dr Iram Fayyaz 2021-06-14 2021-06-14 2 10.5281/zenodo.5082036 Comparison of Topical ketoconzole alone versus Topical Ketoconazole plus Topical Adapalene in the Treatment of Patients with Pityriasis Versicolor <p><strong>Background&amp; Objectives:</strong> Pityriasis Versicolor (PV) is a chronic cutaneous fungal infection caused by Malassezia species. A recent study showed combination therapy consisting of Ketoconazole plus Adapalene gel to be superior to Ketoconazole monotherapy. The objective of this study was to compare the frequency of patients improved with Ketoconazole alone versus Ketoconazole plus Adapalene in the treatment of Pityriasis Versicolor.</p> <p><strong>Study design:</strong> Randomized controlled trial.</p> <p><strong> Place &amp; duration of study:</strong> Department of Dermatology, CMH Lahore from 20th May 2016 to 19th November 2016.</p> <p><strong>Methods:</strong> This study included 80 patients, both male and female, aged between 18 -70 yrs presenting with Pityriasis Versicolor. These patients were divided into two treatment groups. Randomly Patients in Group-A were given Ketoconazole cream alone while patients in GroupB were given combination therapy with Ketoconazole cream plus Adapalene gel applied separately with different timings. Outcome variable was number of patients improved after 2 weeks of treatment.</p> <p><strong>Results:</strong> The frequency of improvement at 2 weeks was significantly higher with the combination therapy (87.5% vs. 47.5%; p=0.000) as compared to Ketoconazole alone and this difference was significant across all age, gender and duration of disease groups.</p> <p><strong>Conclusion:</strong> The frequency of improvement was significantly higher with the combination therapy consisting of Ketoconazole plus Adapalene as compared to Ketoconazole alone, advocating preferred use of combination therapy in patients presenting with Pityriasis Versicolor in future practice.</p> Dr Sumeet Ashraf Copyright (c) 2021 Dr Sumeet Ashraf 2021-06-14 2021-06-14 2 10.5281/zenodo.5081864 Knowledge and Practice of Specialists and Residents of Gynecology towards the Management of Post- Menopausal Burning Mouth Syndrome <p><strong>Objective:</strong> To assess the knowledge of gynecologists about burning mouth syndrome among post-menopausal women and to assess the treatment modalities used by gynecologists for Burning mouth syndrome among post-menopausal women.</p> <p><strong>Study design:</strong> Cross sectional, Descriptive, Questionnaire based study.</p> <p><strong>Place and Duration of Study:</strong> Data collection for this study conducted in four teaching and practicing hospitals of Lahore (CMH Lahore, Jinnah Hospital, FMH and Ghurki trust teaching hospital) from July 2017 to November 2017.</p> <p><strong>Methods:</strong> A questionnaire was filled by specialists and 3 and 4" year resident gynecologists in four teaching and practicing hospitals of Lahore from July 2017 to November 2017. The inclusion criteria was both genders of any age, teaching and practicing hospitals. The exclusion criteria included: private clinics, medical officers. Data was analyzed using SPSS version 23 (IBM SPSS Statistics, version 23, USA). Chi square test was used to compare frequencies amongst groups. A p value of &lt;0.05 was set as the level for statistical significance.</p> <p><strong>Results:</strong> A total of 43 out of the 50 gynecologists including specialists and residents responded to questionnaire. 18.3 % residents and specialists said that they knew about burning mouth syndrome.</p> <p><strong>Conclusion:</strong> The results yielded that only 2.3% of the physicians thought that the condition should be referred to a dentist for the treatment. 11.6% thought that no treatment is required, 9.3% thought only counselling was required and medications were the mode of treatment for 7.0%</p> Dr M Shairaz Sadiq Copyright (c) 2021 Dr M Shairaz Sadiq 2021-06-14 2021-06-14 2 10.5281/zenodo.5082024 Imposter Syndrome Among Medical Students of Private Medical College, Lahore, Pakistan <p><strong>Objective:</strong> The aim of this study is to determine the total prevalence, year of study-wise as well as the gender-wise distribution of Impostor Syndrome (IS) amongst the undergraduate medical students at CMH Lahore Medical College, using the eight-question questionnaire of the Young Impostor Scale (YIS).</p> <p><strong>Study design:</strong> The study was cross sectional and descriptive survey.</p> <p><strong>Place and duration of study:</strong> Conducted in CMH Lahore Medical College from January to April 2018.</p> <p><strong>Methods:</strong> A total of 260 students from five years of MBBS and from both genders were enrolled in the study. Non-probability convenient sampling technique was used. The Youngs Imposter Scale (YIS) was used as the questionnaire.</p> <p><strong>Results:</strong> A total of 79(30.4%) students were positive whilst 181(69.6%) were negative for imposter syndrome. Class-wise distribution shows Imposter syndrome to be most prevalent in students of 2nd year (9.2%) out of the 5 MBBS classes. Also, imposter syndrome is more prevalent in the female (38.8%) population than male (25.35%) and this difference is statistically significant (p=0.02)</p> Afnan Talat Copyright (c) 2021 Afnan Talat 2021-06-14 2021-06-14 2 10.5281/zenodo.5081899 Perception and Practice of Using Energy Drinks by Medical Students of Private Medical College <p><strong>Objective:</strong> To determine pattern, frequency and reasons behind usage of energy drinks among medical students of Pakistan. <strong>Study design:</strong> Descriptive study. <br><strong>Place and duration of the study:</strong> From August 2015 to January 2016 at Combined Military Hospital, Lahore.<br><strong>Methodology:</strong> The study was cross sectional. Research questionnaires were distributed among and filled by 350 medical students. All the data was analyzed by using SPSS 23.The research factors and responses were correlated. <br><strong>Results:</strong> Of the 350 medical students, there were 186(53.1%) males and 164(46.8%) females: 124(35%) considered themselves regular users of energy drinks. The most common brand consumed was "sting" by 52.4%(65) users, followed by red bull used by 35.4%(44) of the users. Of 350 students,124(35.4%) thought that energy drinks helped to stay awake longer, 88(25%) couldn't give any response regarding their perception since they didn't consider themselves active energy drink users and 62(17%) thought energy drinks decreased tiredness. <br><strong>Conclusion:</strong> Majority of the medical students do not consume energy drinks. Among consumers, Sting is the most popular energy drink and the dominant perception and reasoning for energy drink consumption are the need for increased wakefulness and decreased tiredness.</p> Omar Zaman Khan Copyright (c) 2021 Omar Zaman Khan 2021-06-14 2021-06-14 2 10.5281/zenodo.5081897 Orthodontic Camouflage in a Patient with Mild Skeletal Class II Malocclusion <p>Camouflage is the masking of underlying skeletal problem by treating only dental problems. This case report describes a 14 years 2 months old Asian male presented with increased overjet on mild Class-II skeletal base with average vertical facial proportions. Treatment involved orthodontic camouflage by extracting maxillary first premolars with correction of proclined incisors in the upper arch. Treatment took 18 months in completion in which patient profile and esthetics were significantly improved.</p> Dr Sadia Siddique Copyright (c) 2021 Dr Sadia Siddique 2021-06-14 2021-06-14 2 10.5281/zenodo.5082043 A case report of TRAP Sequence with Preeclampsia and Review of Literature <p>We are reporting a case of the Twin Reversed-Arterial Perfusion (TRAP) sequence, specifically highlighting the autopsy findings of an acardiac twin and the histopathological findings in its placenta. The TRAPsequence or acardiac twining, is an uncommon congenital anomaly involving a grossly abnormal acardiac twin and an otherwise normal pump twin. Thiscomplex congenital anomaly is unique to monochorionicmonozygotic twin gestations. It requires an artery-to-artery(A-A) anastomosis leading to reversal of arterial perfusion with complex pathophysiology. A 19 year-oldgirl delivered twins by C-section at 31 weeks because of preeclampsia and non-reassuring fetal heart tracings. One was a preterm female; the other was an acardiac twin. This is perhaps the first case report of autopsy findings of an acardiac twin pregnancy associated with preeclampsia.</p> Sidra Shafiq Cheema Copyright (c) 2021 Sidra Shafiq Cheema 2021-06-14 2021-06-14 2 10.5281/zenodo.5081935 Alignmen of Teeth by Driftodontics: A Case Report <p>Physiological tooth movement or driftodontics of teeth in extraction space decrease the amount of mechanotherapy during clinical orthodontics. This is especially helpful in young patients with anterior mandibular crowding. We present a case of 13-year-old girl with severe crowding in the lower arch and moderate crowding in the upper arch. Anterior crowding in mandibular arch was relieved by driftodontics after extraction of first premolars and placement of lingual arch to prevent molar mesialization.</p> Dr Maham Batool Copyright (c) 2021 Dr Maham Batool 2021-06-14 2021-06-14 2 10.5281/zenodo.5082045 A Case Report of Dynamic MR Imaging of Cerebral Fat Embolism <p>Cerebral fat embolism (CFE) is highly associated with long bone fractures however incidence is low. Imaging features show spectrum of findings. A 23-year-old male was admitted with right femur fracture in a road traffic accident. Surgically operated patient developed deteriorating confusion and altered sensorium. Subsequent MRI of the brain showed innumerable punctate hyperintense lesions on T2- and T2weighted, FLAIR and restricted diffusion on DW consistent with "starfield" pattern. After 27days hospital stay with supportive therapy patient regained complete neurological function and was discharged home. Diagnosis of CFE remains a challenge because of its various presentations, reversibility and distribution of the brain lesions. MR imaging of the brain by using T2-weighted, (FLAIR), diffusion weighted, and susceptibility-weighted imaging has been applied to CFE and has improved the ability to make an early diagnosis.</p> Brig (R) Dr Tariq Mehmood Mirza Copyright (c) 2021 Brig (R) Dr Tariq Mehmood Mirza 2021-06-14 2021-06-14 2 Person Centered Care <p>The term "patient centered medicine” was coined in 1969 by the psychoanalyst Enid Balint'. This approach understands the patient as a unique human being and considers the patient as a whole instead of having a narrow focus on the condition or symptoms only. It is in contrast to “illness-oriented care” which is aimed at finding a localizable fault, diagnosing it as an illness and then treating it. Over the years, the terminology has symbolically shifted to “person centered care”. The word “person” is used to emphasize a holistic approach in which the person's personal preferences, wellbeing and social and cultural background are also given due importance.</p> Dr Samina Naeem Copyright (c) 2021 Dr Samina Naeem 2021-06-14 2021-06-14 2 10.5281/zenodo.5081960 Nanotechnology in Medicine <p>Nanotechnology is the science that employs the use of materials that have at least one dimension of nanometric (109) scale. Nanomedicine can be defined as the application of nanotechnology for health. It takes the advantage of improved and novel chemical, physical and biological properties of the nanometric materials. The main areas of application of nanomedicine are pharmaceuticals, diagnostics and regenerative medicine.</p> Dr Samina Naeem Copyright (c) 2021 Dr Samina Naeem 2021-06-14 2021-06-14 2 10.5281/zenodo.5081876