Showing papers in "Pakistan Journal of Medical Sciences in 2020"

Advantages, limitations and recommendations for online learning during covid-19 pandemic era

Abstract: Objective: During COVID-19 pandemic, the institutions in Pakistan have started online learning. This study explores the perception of teachers and students regarding its advantages, limitations and recommendations.Methods: This qualitative case study was conducted from March to April 2020. Using maximum variation sampling, 12 faculty members and 12 students from University College of Medicine and University College of Dentistry, Lahore were invited to participate. Four focus group interviews, two each with the faculty and students of medicine and dentistry were carried out. Data were transcribed verbatim and thematically analyzed using Atlas Ti.Results: The advantages included remote learning, comfort, accessibility, while the limitations involved inefficiency and difficulty in maintaining academic integrity. The recommendations were to train faculty on using online modalities and developing lesson plan with reduced cognitive load and increased interactivities.Conclusion: The current study supports the use of online learning in medical and dental institutes, considering its various advantages. Online learning modalities encourage student-centered learning and they are easily manageable during this lockdown situation. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2785 How to cite this:Mukhtar K, Javed K, Arooj M, Sethi A. Advantages, Limitations and Recommendations for online learning during COVID-19 pandemic era. 2020;36(COVID19-S4):COVID19-S27-S31. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2785 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Perceptions of students regarding e-learning during covid-19 at a private medical college

Abstract: Objective: The purpose of this study was to determine the perceptions of students towards e-learning during the lock down. Methods: A descriptive cross-sectional study was conducted at Liaquat College of Medicine and Dentistry. MBBS and BDS students of all levels participated in the study with a sample size calculated as 377. A self-administered questionnaire was developed. After validation from the Medical Education Experts, pilot test was run on 30 participants before the administration of the questionnaire. The questionnaire was emailed to the participants for data collection. Reliability of the questionnaire was determined. Independent T-test was applied for determining the perceptions of students towards e-learning. Frequencies and percentages were also computed for demographics. Results: Total 382 responses were received.137 males and 245 females participated in the study. 0.851 was calculated as Cronbach’s alpha of the questionnaire. Overall, 77% students have negative perceptions towards e-learning. 76% of the students use mobile device for their e-learning. Conclusion: Students did not prefer e-teaching over face-to-face teaching during the lock down situation. Administration and faculty members should take necessary measures for improving e-teaching for better learning during lock down. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2766 How to cite this:Abbasi S, Ayoob T, Malik A, Memon SI. Perceptions of students regarding E-learning during Covid-19 at a private medical college. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S57-S61. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2766 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mental health considerations for children & adolescents in covid-19 pandemic

Abstract: Children are not indifferent to the significant psychological impact of the COVID-19 Pandemic. They experience fears, uncertainties, substantial changes to their routines, physical and social isolation alongside high level of parental stress. Understanding their emotions and responses is essential to properly address their needs during this pandemic. In this article, we highlight children’s vulnerability, provide an overview of common symptoms of distress in different age groups, and summarize the interventions and resources available to promote child mental health and wellbeing during these challenging times. We advocate that prioritizing mental health including child & adolescent mental health is an essential component of any universal, community led response to COVID-19 Pandemic.

Impact of coronavirus disease (COVID-19) pandemic on health professionals

Abstract: Objective: Recognizing the huge potential ramifications of COVID-19 pandemic, this study explores its impact on health professionals personally and professionally along with the associated challenges. Methods: A descriptive cross-sectional qualitative survey was conducted from March-April 2020. Participants included health professionals from various disciplines in both public and private-sector institutions of Pakistan. The sample size was not predetermined, and an iterative approach of simultaneous data collection and analysis was taken until data and time saturation were reached. Thematic analysis of the qualitative data was carried out by two analysts. Results: Two hundred and Ninety health professionals responded. They reported an impact on their mental, physical and social well-being. The clinicians mentioned facing an unprecedented workload in overstretched health facilities, while those in academia become engaged with planning/providing emergency remote teaching for the students affecting work-life balance. Some challenges associated with work-from-home and in the hospitals were identified. Conclusion: During COVID-19, the health professionals are anxious, overworked and financially unstable while planning, creating and caring for others and their families. We need to support them to do their jobs, be safe and stay alive. Future research should explore the fears and coping strategies of health professionals during pandemics. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2779 How to cite this:Sethi BA, Sethi A, Ali S, Aamir HS. Impact of Coronavirus disease (COVID-19) pandemic on health professionals. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S6-S11. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2779 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Covid-19 pandemic: Impact of quarantine on medical students’ mental wellbeing and learning behaviors

Abstract: Background and Objectives: The novel coronavirus COVID-19 pandemic causes great public health and socioeconomic harms. Worldwide many countries implemented quarantine policies to minimize the spread of this highly contagious disease. The present study aim was to investigate the impact of quarantine on the medical students’ mental wellbeing and learning behaviors. Methods: In this descriptive study, we used a questionnaire with a Five-Point Likert Scale to collect the information. The questionnaire was distributed among 625 medical students through their emails with a response rate of 530 (84.8%), majority 294 (55.47%) being female. The survey questionnaire consisted of total 20 items; 12 items were related to psychological wellbeing and stress-allied queries and 08 items were about learning behaviors. Results: The findings encompass two important characteristics related to quarantine, psychological wellbeing, and learning behaviors. A combined cohort of 234 medical students, either female or male, (which was 44.1% of the total responders) showed a sense of being emotionally detached from family, friends and fellow students, 125/ 530 (23.5%) medical students felt disheartened. Both female and male medical students showed a marked decrease in their overall work performance. Moreover, 56.2% of the total students (61.5% of the females and 49.5% of the males) felt a decrease in the time they spent studying. Conclusions: Both female and male medical students have identified that quarantine has caused them to feel emotionally detached from family, fellows, and friends and decrease their overall work performance and study period. The findings also show that one-fourth of the medical students who participated in this study felt disheartened during the quarantine period. The long-term quarantine due to COVID-19 pandemic may causes further worsening in the psychological and learning behaviors of these medical students. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2809 How to cite this:Meo SA, Abukhalaf AA, Alomar AA, Sattar K, Klonoff DC. COVID-19 Pandemic: Impact of Quarantine on Medical Students’ Mental Wellbeing and Learning Behaviors. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S43-S48. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2809 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How nutrition can help to fight against covid-19 pandemic

Abstract: Currently Covid-19 pandemic is a leading challenge across the globe. It is mandatory to attain and maintain good nutritional status to fight against virus. Nutritional status of individual is affected by several factors such as age, sex, health status, life style and medications. Nutritional status of individuals has been used as resilience towards destabilization during this COVID-19 pandemic. Optimal nutrition and dietary nutrient intake impact the immune system, therefore the only sustainable way to survive in current context is to strengthen the immune system. There is no evidence found that supplement can cure the immune system except Vit C, which is one of the best way to improve immune system. A proper diet can ensure that the body is in proper state to defeat the virus. However along with the dietary management guidelines the food safety management and good food practices is compulsory. This article explores the importance of nutrition to boost immunity and gives some professional and authentic dietary guidelines about nutrition and food safety to withstand COVID-19.

Psychological burden of quarantine in children and adolescents: A rapid systematic review and proposed solutions

Abstract: As COVID-19 grips the world, many people are quarantined or isolated resulting in adverse consequences for the mental health of youth This rapid review takes into account the impact of quarantine on mental health of children and adolescents, and proposes measures to improve psychological outcomes of isolation Three electronic databases including PubMed, Scopus, and ISI Web of Science were searched Two independent reviewers performed title and abstract screening followed by full-text screening This review article included 10 studies The seven studies before onset of COVID 19 about psychological impact of quarantine in children have reported isolation, social exclusion stigma and fear among the children The most common diagnoses were acute stress disorder, adjustment disorder, grief, and post-traumatic stress disorder Three studies during the COVID-19 pandemic reported restlessness, irritability, anxiety, clinginess and inattention with increased screen time in children during quarantine These adverse consequences can be tackled through carefully formulated multilevel interventions

Risk assessment of healthcare workers at the frontline against COVID-19

Abstract: The novel coronavirus disease 2019 (COVID-19) is a global pandemic. Healthcare workers (HCWs) are on the frontline of treating patients infected with COVID-19. However, data related to its infection rate among HCWs are limited. The aim was to present evidence associated with the number of HCWs being infected with COVID-19 from most viral affected countries (Italy, China, United States, Spain, and France). Furthermore, we looked into the reasons for HCWs COVID 19 infections and strategies to overcome this problem. Early available evidence suggested that HCWs are being increasingly infected with the novel infection ranging from 15% to 18% and in some cases up to 20% of the infected population. Major factors for infection among HCWs include lack of understanding of the disease, inadequate use and availability of Personal Protective Equipment (PPE), uncertain diagnostic criteria, unavailability of diagnostic tests and psychological stress. Therefore the protection of HCWs by authorities should be prioritized through education and training, the readiness of staff, incentives, availability of PPEs, and psychological support.

Impact of the COVID-19 pandemic on adult mental health

Abstract: The outbreak of the Novel Coronavirus (COVID-19) in December 2019 has progressed to the status of a global pandemic, with countries across the seven continents adversely affected and the number of human cases exceeding two million. With no available vaccine, the treatment is primarily symptomatic for those affected and preventative for those at risk. Most countries have taken action to curtail the spread of COVID-19 through measures such as lockdowns, social distancing and voluntary self-isolation. Whilst necessary, such measures and the disease itself, may have an adverse impact on mental health. In view of research from previous pandemic crises, it is known that such situations are likely to increase stress levels and have negative psychiatric effects. The impact is likely to be felt by the general public, sufferers of COVID-19, their families and friends, persons with pre-existing mental health conditions and healthcare workers.

Coronavirus disease 2019 (Covid-19) pandemic and economic impact

Abstract: In less than two decades, the world has experienced three outbreaks of deadly Coronaviruses, including the recent pandemic of Coronavirus Disease 2019 (COVID-19) in China. COVID-19 posed an emergency of international concerns, and cases have been reported in more than 200 countries/regions that resulted in health, lives, and economic losses. China’s economic growth is projected to fall to 5.6% this year, the International Monetary Fund (IMF) projected that policy investment and tax policies to implement $3.3 trillion and contributes further $4.5 trillion. IMF forecasts grow from 3.7% of global gross domestic product (GDP) in 2019 to 9.9% in 2020. GDP ratio projected from 3.0% in 2019 to grow 10.7% in 2020, the US ratio expected to increase from 5.8% to 15.7%. France, Germany, Italy, Japan, and the United Kingdom (UK) each reported public sector funding programs totalling > 10% of their yearly GDP. There is a dire need for regional and international co-operation to extend hands to prevent further spreading of COVID-19.

Technology enhanced assessment (TEA) in COVID 19 pandemic

Abstract: Online teaching and learning is not a new phenomenon. For the last many years, it has been mainly used as a part of face to face teaching. Assessment is an essential part of teaching and learning, as it establishes the achievement of course learning outcomes by the students. Computer-based assessment is in place for a long time now, however, online assessments have been less practiced. This is because of the issues of validity, reliability and dishonesty. During the COVID 19 pandemic, the educational environment has taken a paradigm shift in many medical schools, both nationally and internationally. This situation demands a method of assessment that is safe, valid, reliable, acceptable, feasible and fair. This paper describes the different formats of online assessment and their application in formative and summative assessments during and after the COVID 19 pandemic.

Expectations, fears and perceptions of doctors during covid-19 pandemic

Abstract: Objectives: The aim of this study was to explore the expectations and fears faced by doctors during Covid-19 Pandemic. Methods: This is a mixed method exploratory survey. A questionnaire exploring expectations of doctors from administration and seniors as well as their fears while working during pandemic, was developed on Google survey Forms. It included eight closed ended questions and four open ended questions. Data was collected through online Google survey Forms during month of March and April 2020. Doctors were approached through email and WhatsApp group. Results: The mean age of participants was 33.58±4.21 years. Female 150(67.5%) and Male 72(32.4%) participated. 29(13.1%) Associate Professor, 34(15.3%) Assistant Professor, 56(25.2%) Senior Residents and 103(46.3%) residents, medical officers and house officers responded to the survey. 134(60.3%) doctors were working in hospitals which were not dealing with Covid-19. Fear included, infecting family members 177(79.7%), rapid spread of disease 140(63%), complications of disease 134(60.3%), becoming a carrier in 64(28.8%) and 62(27.9%) feared missing the diagnosis. More than 80% expected from seniors and administration, of providing PPE, facilitation, continue chain of supply of essential items, ensuring doctor safety, avoiding exposure of all doctors and keeping reserve workforce, limiting routine checkups, avoid panic and 20% had no expectations. Conclusion: It was concluded that doctors had their fears and perceptions regarding pandemic which need to be addressed while policy making. They fear wellbeing of their families and contacting Covid-19, if not provided proper PPE. Our study provides insight of expectations, fears and perceptions of our frontline which invariably gives insight of the views of healthcare workers. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2643 How to cite this:Urooj U, Ansari A, Siraj A, Khan S, Tariq H. Expectations, Fears and Perceptions of doctors during Covid-19 Pandemic. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S37-S42. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2643 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Knowledge, awareness and practice of health care professionals amid sars-cov-2, corona virus disease outbreak

Abstract: Objective: To assess the knowledge, awareness and practice level of health care workers towards Corona Virus disease - 2019 (COVID-19). Methods: A cross sectional study was conducted by administering a well-structured questionnaire comprising of three sections including knowledge, attitude and practice amongst health care professionals in various hospitals and clinics, over a duration of two months ‘Feb-March’ 2020. The data from 810 participants were collected manually as well as through online survey registered on www.surveys.google.com, using a validated questionnaire. The questionnaire comprised of three sections assessing knowledge, awareness and practice of participants. The descriptive analysis was carried out for demographics and dependent variables with statistical program for social sciences. Spearman test was used to detect any relationship between the health care professional response with respect to their gender and level of education. A p-value of < 0.05 was considered statistically significant. Results: More than half (57.2%) of the health care professionals were working in a hospital setting. Fifty two percent of health care professionals had awareness and 72% were practicing adequate measures to combat COVID-19. The majority (81.9%) believed that the sign and symptoms are similar to a common flu and the main strata of population that could be affected by COVID-19 are elderly (79%). Seventy three percent of participants did not attend any lecture, workshop or seminar on COVID-19 for awareness purpose. Sixty seven percent of health care professionals were practicing universal precaution for infection control and 57.4% were using sodium hypochlorite as a surface disinfectant in dental surgeries. There was no significant relationship (p > 0.05) between the health care professionals’ responses with gender and their education level. Conclusion: The study suggests that the vast majority of the health care professionals have adequate knowledge and awareness related to COVID-19. However some aspects of practice of health care professionals were found to be deficient including, following CDC guidelines during patient care, acquiring verified knowledge related to COVID-19, disinfection protocol and the use of N-95 mask. Mandatory Continued professional development programs including lectures and workshops on COVID-19 for all health care professionals are the need of the hour, to manage the pandemic and limiting the morbidity and mortality related to it. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2704 How to cite this:Ahmed N, Shakoor M, Vohra F, Abduljabbar T, Mariam Q, Rehman MA. Knowledge, Awareness and Practice of Health care Professionals amid SARS-CoV-2, Corona Virus Disease Outbreak. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S49-S56. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2704 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Awareness and attitude of undergraduate medical students towards 2019-novel corona virus

Abstract: Objective: To assess the knowledge, awareness and attitudes of medical students towards recently discovered coronavirus disease-19 (COVID-19). Methods: This was a cross sectional study conducted on medical students in CMH Lahore Medical College,(LMC), Institute of Dentistry (IOD). A questionnaire containing demographic information, 14 knowledge and eight attitude items was completed by 384 participants. Results: Overall, >90% people were aware about the etiology, mode of transmission and possible symptoms; however, very few of them knew about the in-depth details. Knowledge score revealed that 80% of participants had sufficient knowledge about coronavirus. MBBS students and nursing Students had significantly better knowledge in comparison with other students. In terms of attitude, >80% of students showed positive attitudes among which the nursing students were dominant. Conclusion: The medical students of CMH LMC showed a satisfactory level of awareness and attitudes towards COVID-19 with an obvious difference with regard to disciplines. More educational efforts with periodic educational interventions are still needed about the current pandemic. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2636 How to cite this:Ikhlaq A, Bint-e-Riaz H, Bashir I, Ijaz F. Awareness and Attitude of Undergraduate Medical Students towards 2019-novel Corona virus. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S32-S36. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2636 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The psychological impact of the COVID-19 pandemic on medical students in Turkey

Abstract: Objective: We aimed to investigate the knowledge of medical students about COVID-19, the effects of the traumatic situation they experienced, the stress they perceived and the factors affecting them. In addition, we aimed to learn the thoughts of the students about the virus due to the uncertainties. Methods: The study was carried out online between April 30, May 5, 2020 with a questionnaire prepared with googleforms. For the study, all students studying at the Faculty of Medicine of Istanbul Yeni Yuzyil University were called through class representatives and WhatsApp class groups. The questionnaire included sociodemographic information, knowledge and sources of information about the disease, to agreement degree the proposition whether covid 19 is produced as a biological weapon. The Perceived Stress Scale (PSS) and Impact of Events Scale-Revised (IES-R) were applied. Results: The total number of participants was 275 students. No student was infected with COVID-19 at the time of the survey. The presence of chronic disease in the participants was found to be a factor that increased anxiety (p = 0.01). Majority of participants (60.40%) stated that they agree with COVID-19 is a biological weapon. The mean scores of women ‘s total PSS and IES-R were higher than men. It was found that the families of the students had a lower monthly income than the minimum monthly wage is increasing the anxiety about getting COVID-19 infection and perceived stress. One-third of the students reported that sleep and appetite were impaired than the before pandemic. The announcements and website of Ministry of Health and the social media was the main source of information of the participants. Conclusions: It was found that medical students were highly worried about being infected with COVID-19. The scores obtained from the pre-clinic students’ anxiety to become infected with COVID-19, PSS and IES-R total scores were found to be significantly higher than their clinical students. doi: https://doi.org/10.12669/pjms.36.6.2985 How to cite this:Torun F, Torun SD. The psychological impact of the COVID-19 pandemic on medical students in Turkey. Pak J Med Sci. 2020;36(6):1355-1359. doi: https://doi.org/10.12669/pjms.36.6.2985 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Tobacco smoking a potential risk factor in transmission of COVID-19 infection

Abstract: Corona Virus disease 2019 (COVID-19) is a global pandemic and is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) group of viruses. To date, April 25, 2020, more than 2.4 million humans are infected and more than a hundred thousand deaths have been reported from more than 200 countries from COVID-19. There is no evidence-based treatment for the infection and prevention of transmission using social distancing, isolation and hygiene measures is widely recommended. Tobacco smoking is rampant in communities around the globe and the addiction to tobacco results in deaths of more than 8 million individuals each year. As COVID-19 transmits through salivary droplets and causes severe lung pneumonia, tobacco smokers are also at high risk of severe COVID-19 infection due to poor lung function, cross-infection and susceptible hygiene habits. Smoking tobacco (cigarette, e-cigarettes or waterpipe) produces exhaled smoke, coughing or sneezing, aerosols containing SARS-CoV-2 in the surroundings and contaminating surfaces. Therefore, smoking tobacco is a possible mode of transmission for the virus for both active and passive smokers. Smoking should be considered a risk factor for the disease transmission until further availability of evidence and measures to limit its direct and indirect effects should be implemented within the community.

Chest x-rays findings in covid 19 patients at a university teaching hospital-a descriptive study

Abstract: Objective: To analyze Chest X-ray findings in COVID 19 positive patients, presented at corona filtration center, Benazir Bhutto Hospital Rawalpindi, based on CXR classification of British Society of Thoracic Imaging (BSTI). Methods: In this study, all RT-PCR COVID-19 positive patients screened at corona filtration center, Benazir Bhutto hospital Rawalpindi from 20th March 2020 to 10th April 2020 were included. Mean age of the cohort with age range was calculated. Presenting complaints & Co-morbid were analyzed and tabulated in frequencies and percentages. Portable CXR findings were classified according to BSTI classification and documented in frequencies and percentages. Results: Mean age of the patients was 44 years. Presenting complaints were cough 20 (67%), fever 18 (60%), shortness of breath 11 (37%), sore throat six (20%), loss of sense of taste and smell four(13%). Main co-morbid was hypertension six (20%). Two (7%) patients had normal and seven (23%) had classical COVID CXRs. 21 (70%) patients were in indeterminate group with only one (3%) having unilateral lung disease. Three (10%) patients had diffuse lung involvement and 18(60%) had peripheral lung involvement. Majority of patients 19 (63%), had bilateral middle and lower zonal involvement. Conclusions: In this study, COVID-19 CXRs generally manifested a spectrum of pure ground glass, mixed ground glass opacities to consolidation in bilateral peripheral middle and lower lung zones. BSTI CXR reporting classification of COVID-19 is valid in our patients with addition of middle zonal involvement in classical COVID-19 criteria as opposed to just lower zone involvement. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2778 How to cite this:Durrani M, Inam-ul-Haq, Kalsoom U, Yousaf A. Chest X-rays findings in COVID 19 patients at a University Teaching Hospital - A descriptive study. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S22-S26. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2778 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Frequency of depression, anxiety and stress among university students.

Abstract: Objective: The main objective of the present study was to explore the frequency of Depression, anxiety and stress among university students in Sialkot, Pakistan. Method: Survey research method was used to collect data from three universities of Sialkot by using simple random sampling technique from 500 university students. The study was conducted at GC Women University, Sialkot in total duration of five months from February 2019 to June 2019. A demographic sheet and DASS-21 (Depression, Anxiety Stress Scale) were used to measure the level of depression, anxiety and stress. Data was scored according to the standard scoring procedure for each subscale and for further analysis frequency distribution method was applied through statistical package for social sciences (SPSS. 21). Results: The means of Depression, Anxiety and stress are M=15.08, M=18.24 and M=19.02 respectively. The frequency of depression, anxiety and stress among university students was found 75%, 88.4% and 84.4% respectively. The findings of the study showed the prevalence of Depression within the range of normal (25%), mild (16%), moderate (35.8%), severe (14.6%) and extremely severe (8.6%). The prevalence of anxiety was found to be in the range of normal (11.6%), mild (4.4%), moderate (19.4%), severe (17.8%) and extremely severe (46.8%). Stress was normal (15.6%), mild (33.8%), moderate (35.4%), severe (13.2%) and extremely severe (2.8%). Conclusion: It is concluded that symptoms of anxiety and stress are more prevalent with moderate to extremely severe range than depression in the current sample. These findings suggest urgent need of some preventive measures and interventions to improve the mental health of students. doi: https://doi.org/10.12669/pjms.36.5.1873 How to cite this:Asif S, Mudassar A, Shahzad TZ, Raouf M, Pervaiz T. Frequency of depression, anxiety and stress among university students. Pak J Med Sci. 2020;36(5):971-976. doi: https://doi.org/10.12669/pjms.36.5.1873 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dentin bond strength of bioactive cement in comparison to conventional resin cement when photosensitized with Er,Cr:YSGG Laser

Abstract: Objective: The purpose of the present study was to assess dentin shear bond strength (SBS) and mode of bond failure of bioactive cement (BA) in comparison to conventional resin cement when photosensitized by Er,Cr:YSGG Laser (ECL). Methods: The present in-vitro study was carried out from March 2019 to May 2019. Sixty permanent non-carious, intact, non-fractured molars were isolated and mounted vertically in acrylic resin. Buccal surface of each molar tooth was ground, polished and surface treated with ECL. Ketac conditioner was applied on the surface washed and air dried surface. Tetric -N-Bond adhesive was applied on forty-five samples and light cured. The specimens were allocated into four groups (n=15) according to the type of cement used i.e., Calibra (C), BA, Variolink II (V) and Maxcem-Elite (ME). For SBS testing was performed using the universal testing machine. Eight samples from each group were assessed for modes of failure. Means and standard deviations were compared using analysis of variance (ANOVA) and Tukey’s post hoc test at a significance level of p < 0.05. Results: The highest mean SBS was observed in group ECL-C (21.55±3.08). The lowest mean SBS was displayed in group ECL-ME (14.25±3.55). Mean SBS values for group ECL-C (21.55±3.08) and group ECL-V (20.74±4.15) were comparable (p <0.05). Similarly, SBS values of group ECL-BA (15.48±3.62) and group ECL-ME (14.25±3.55) were comparable (p <0.05). Conclusion: Dentin surface conditioned with Er,Cr:YSGG and bonded to C and V cements exhibit favourable bond strength values. doi: https://doi.org/10.12669/pjms.36.2.1284 How to cite this:Alkhudhairy F, Al-Johany SS, Naseem M, Bin-Shuwaish M, Vohra F. Dentin bond strength of bioactive cement in comparison to conventional resin cement when photosensitized with Er,Cr:YSGG Laser. Pak J Med Sci. 2020;36(2):85-90. doi: https://doi.org/10.12669/pjms.36.2.1284 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Scarlett letter: A study based on experience of stigma by COVID-19 patients in quarantine

Abstract: Background and Objectives: Stigma around COVID-19 is a major barrier in global efforts to control the COVID 19 pandemic. Limited data is available regarding stigma faced by COVID-19 patients in low- and middle-income countries (LMIC). The aim of the current study was to explore the stigma experienced by hospitalized patients with COVID-19 illness in Lahore, Pakistan. Methods: Following Institutional Review Board approval and informed consent, patients were assessed using modified HIV short form stigma scale and open-ended questions. Questions focused on experiences, feelings, and opinions as to how patients feel and how they were treated prior to and during the hospitalization. Data analysis for quantitative data was performed using SPSS-20, while qualitative responses were interpreted by content analysis method. Results: One hundred and fourteen patients were interviewed (Mean age 38.8 years + 15.3) with 53.5% being males. Widespread experience of stigma was reported by patients particularly for concerns about public attitudes (7.43 + 1.43) & disclosure (6.89 + 1.45). Main themes which emerged from the qualitative responses were social stigma and rejection, humiliating behaviour of others, breach of confidentiality, loss of trust/ respect, and impact of COVID-19 diagnosis on their business. Conclusions: Existence of significant stigma among COVID-19 patients isolated in a tertiary care hospital in a LMIC highlights the need for culturally sensitive strategies to address it. doi: https://doi.org/10.12669/pjms.36.7.3606 How to cite this:Imran N, Afzal H, Aamer I, Hashmi A, Shabbir B, Asif A, et al. Scarlett Letter: A study based on experience of stigma by COVID-19 patients in quarantine. Pak J Med Sci. 2020;36(7):1471-1477. doi: https://doi.org/10.12669/pjms.36.7.3606 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Online Academics in Pakistan: COVID-19 and Beyond

Abstract: COVID-19 is a menace for Pakistan's fragile and overburdened health care system and infrastructure, insidiously permeating the socio-economic fabric. Globally complete to partial shutdown of educational institutions has been enforced, transitioning from face to face to online academics. Academic institutes are floundering to withstand the brunt. Therefore, the current study was conducted to attempt to review and highlight the impact and challenges posed by transition from conventional to online academics and how to approach them, in the wake of COVID-19 pandemic with the perspective of developing countries like Pakistan. For this purpose, search for relevant literature using search engines and websites including Google, Google Scholar and Web of Science as well as Medline database was conducted with keywords "Covid-19, academics, mental health, social impact and e-learning and combination of words". Thirty two English language, full text articles published in the last ten years from 2010 to 2020 were selected for the literature review. With this literature review, we conclude that this lockdown has caused significant distortion in the academic world yet unequal interruption in learning with significant disruptions in internal assessments and qualification examinations with developing countries like Pakistan, compounded by a compromised educational system. However, COVID-19 is spurring the case for conversion to online academics and developing countries like Pakistan are poised to develop reliable, cost effective and secure online academic system whether it is bane or boon.

E-Learning amid the COVID-19 Lockdown: Standpoint of Medical and Dental Undergraduates

Abstract: Background and Objective: The corona-virus (COVID-19) pandemic has had devastating impacts on not only the health and socio-economic conditions but also on the education sector in various countries. Consequently, the world of education entered a new era of E-learning. This descriptive study, thus, aims to evaluate the standpoint of medical and dental undergraduates regarding E-learning amid the Covid-19 lockdown. Methods: A descriptive online questionnaire was used to gather responses via Google forms. The questionnaire consisted of questions categorized as technology access, online skills and relationships, students’ views, and student’s perception of possible advantages of E-learning. Two hundred and eighty three medical and dental students of CMH Lahore Medical College participated in the study. Results: One hundred and seventy nine female and 104 male students responded to the questionnaire. The results of the study showed students encouraging the accommodation of E-learning into current teaching practices. Students agreed online study material not only provides flexibility in the learning process (p=0.003) but also saves time (p = 0.012). Female participants showed a more positive readiness response towards e learning than males (p =0.001). Results also showed students have easier access to online teaching resources. Regarding online lectures, the students believe that online lectures were more organized (p= 0.001) and stimulated student interest (p=0.026). Students believe that frequent participation in the learning process is important for success in online education (p=0.002). Conclusion: Undergraduate medical and dental students from the said private medical college are well equipped and ready to shift towards online education. doi: https://doi.org/10.12669/pjms.37.1.3124 How to cite this:Anwar A, Mansoor H, Faisal D, Khan HS. E-Learning amid the COVID-19 Lockdown: Standpoint of Medical and Dental Undergraduates. Pak J Med Sci. 2021;37(1):217-222. doi: https://doi.org/10.12669/pjms.37.1.3124 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

An innovation in Flipped Class Room: A teaching model to facilitate synchronous and asynchronous learning during a pandemic

Abstract: Objective: To conduct an on line Flipped Class Room (FCR) to facilitate synchronous (in class activity) and asynchronous learning [Virtual Learning Environment (VLE)] and acquire feedback of the learning experience from medical students at Aga Khan University. Methods: This interventional study was conducted with year II students undergoing Endocrine Reproduction Module at the Aga Khan University during April 13 to May 22, 2020. Pre reading material and pretest was shared with the students via Virtual Learning Environment (VLE) one week before the class. Microsoft Teams was used to conduct online session by two facilitators, where student discussion on case studies was encouraged. A WhatsApp group was created with the facilitators to respond to any student queries. The session was recorded and later uploaded on VLE. Posttest and a student satisfaction survey was conducted at the end of the session. Results: The average score for the pretest and posttest was 19.67 ± 1.37 and 24.60 ± 1.34 respectively (p value <0.05). The learner curve showed an increase in the knowledge learned by 4.93 points (p value <0.05). Fifty-five percent students felt that placement of session was appropriate and were satisfied with the instructions and expected outcomes, received constructive feedback for improvement and generated positive attitude towards learning. Conclusions: The innovative model of FCR through facilitation of synchronous and asynchronous learning empowered student’s engagement and interactive learning. Students perceived this as a great learning experience which they enjoyed with positive reinforcement from feedback given by the facilitators. They suggested continuation of this model for further learning sessions in other modules of undergraduate medical education at Aga Khan University. doi: https://doi.org/10.12669/pjms.37.1.3096 How to cite this:Rehman R, Fatima SS. An innovation in Flipped Class Room: A teaching model to facilitate synchronous and asynchronous learning during a pandemic. Pak J Med Sci. 2021;37(1):131-136. doi: https://doi.org/10.12669/pjms.37.1.3096 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Epidemiology of covid-19 pandemic: Recovery and mortality ratio around the globe

Abstract: Coronavirus Disease 2019 (CoViD-19) is the third type of coronavirus disease after severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) that appears in human population from the past two decades. It is highly contagious and rapidly spread in the human population and compelled global public health institutions on high alert. Due to genetic similarity of this novel coronavirus 2019 with bat virus its emergence from bat to humans is possible. The virus survive in the droplets of coughing and sneezing and spread around the large areas through infected person resulting in its rapid spread among people. Clinical symptoms of CoViD-19 include fever, dry cough, dyspnea, loose stool, nausea and vomiting. The present review discuss the origin of CoViD-19, its rapid spread, mortality rate and recoveries ratio around the world. Since its origin from Wuhan, the CoViD-19 spread very rapidly all across the countries, on April 17, 2020 this disease has affected 210 countries of the globe. The data obtained showed over 2.4 million confirmed cases of CoViD-19. Higher mortality rate was found in Algeria and Belgium as 15% and 13.95%, respectively. Lower mortality rate was found in Qatar 0.17% and Singapore 0.2%. Recovery versus deceased ratio showed that recovery was 68, 59 and 35 times higher than the death in Singapore, Qatar and Thailand respectively. It is concluded that 2019-novel corona virus is a zoonotic pathogen similar to MERS and SARS. Therefore, a barrier should be maintained between and across the human, household and wild animals to avoid such pandemics.

Sigmoid volvulus: An update for Atamanalp classification.

Abstract: Sigmoid volvulus (SV), the wrapping of the sigmoid colon around itself, is a rare colonic obstruction form SV requires emergency endoscopic or surgical treatment following an urgent resuscitation and the prognosis is relatively poor Although many different classifications have been made for SV in the past, the unique classification system, which assists the decision making in the management in addition to the estimation of the prognosis, was described in 2017 Thereafter, a great number of relevant subjects were discussed in the literature The aim of this study is to update the present classification system in light of above-mentioned discussions and our experience with 1,028 SV patients, which is the largest single-centre SV series over the world doi: https://doiorg/1012669/pjms3652320 How to cite this:Atamanalp SS Sigmoid volvulus: An update for Atamanalp classification Pak J Med Sci 2020;36(5):1137-1139 doi: https://doiorg/1012669/pjms3652320 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommonsorg/licenses/by/30), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

COVID-19 outbreak, disruption of dental education, and the role of teledentistry

Abstract: The novel coronavirus disease 2019 (COVID-19) has affected the whole world and has now been declared a Pandemic by the World Health Organization (WHO). Although the mortality rate of this virus is low, it is especially potent against people with underlying systemic conditions. Dentistry is a profession where the doctor, as well as the dental staff, works in close vicinity to the patient’s mouth. Dental education has two core components; didactic and clinical training (including patient care). Dental education has been interrupted in the past due to certain events (Arab Spring and SARS outbreak). Currently, the pandemic of COVID-19 has disrupted dental education globally as most of the dental schools and universities in the world have closed amidst the COVID-19 outbreak. Teledentistry is a subspecialty of telemedicine that helps in the provision of educational activities, advice, and diagnosis about treatment over a distance with the help of technology like video conferencing. The current overview summarizes the potential role of teledentistry in continuing the dental educational process in terms of delivery of didactic components, clinical training, and patient care. It can be concluded that with modern updated devices and tools, teledentistry can be an effective way to prevent disruption of dental education and it can be utilized in continuing the dental educational process in this critical time of the COVID-19 outbreak. doi: https://doi.org/10.12669/pjms.36.7.3125 How to cite this:Farooq I, Ali S, Moheet IA, AlHumaid J. COVID-19 outbreak, disruption of dental education, and the role of teledentistry. Pak J Med Sci. 2020;36(7):1726-1731. doi: https://doi.org/10.12669/pjms.36.7.3125 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

COVID-19 pandemic & skin care guidelines for health care professionals

Abstract: The Novel corona virus is bringing multiple challenges for health care professionals. Skin is the biggest organ and the first line of defense against different infections and external factors. Being the front line warriors, health care professionals are susceptible to various skin conditions due to prolonged use of personal protective equipment. These adverse skin conditions are redness, irritation, itching, contact dermatitis, and aggravation of underlying skin conditions like seborrheic dermatitis and acne vulgaris. In the current global situation, the potential incidence of such adverse dermatological effects does not in any manner cause the HCPs to deviate from the strict specific precautionary hygiene rules. These skin problems are manageable with the few precautionary measures. This article explores the different skin conditions that result from personal hygiene measures and usage of protective gear and will suggest some practical advice about how to manage and protect from these different adverse skin conditions.

Blended Learning: The impact of blackboard formative assessment on the final marks and students' perception of its effectiveness.

Abstract: Objective: To explore the impact of Blackboard (Bb) formative assessment on the final score in the endocrine module and determine the medical students’ perception of the impact and effectiveness of Bb. Methods: This exploratory case study was carried out at the King Abdulaziz University (KAU), Jeddah, Saudi Arabia (SA). Blackboard was used in the course management and formative assessment of third-year medical students and three years of data was collected (2016, 2017, 2019). In the last week of the module before the final exam, a formative assessment test that comprised of 50 Multiple Choice Questions (MCQs) was posted on Bb each year. All the students filled a questionnaire regarding their perception about the impact and effectiveness of Bb. Results: Overall, summative exam scores were significantly higher than the scores in formative assessment (p <0.001). A substantial positive correlation was observed between students’ marks in the online (Bb) MCQ exam and their final exam marks (p <0.001). Regarding the features of Bb, most often used by the students’ were course resources uploaded on the Bb, assignments, online quizzes, and others. Majority of the students were satisfied with the use of Bb in this module. Conclusions: The majority of the students liked this blended learning (BL) method and conceded the impact and effectiveness of Bb. The formative online assessment on Bb improved the students’ performance in the final exam and a positive correlation was noted between students’ marks in online (Bb) exams with their final exam marks. doi: https://doi.org/10.12669/pjms.36.3.1925 How to cite this:Baig M, Gazzaz ZJ, Farouq M. Blended Learning: The impact of blackboard formative assessment on the final marks and students’ perception of its effectiveness. Pak J Med Sci. 2020;36(3):327-332. doi: https://doi.org/10.12669/pjms.36.3.1925 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Artificial intelligence in medical education: Are we ready for it?

Abstract: doi: https://doi.org/10.12669/pjms.36.5.3042 How to cite this:Imran N, Jawaid M. Artificial intelligence in medical education: Are we ready for it? Pak J Med Sci. 2020;36(5):857-859. doi: https://doi.org/10.12669/pjms.36.5.3042 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Covid-19 outbreak – immediate and long-term impacts on the dental profession

Abstract: The health professions and systems have been challenged evoking heightened reactions around the globe as response to Covid-19. While most heavily impacted, the role of the dental professionals in preventing the transmission and responding to its long-term impacts on dentistry is critically important. This report, while outlining the immediate impact that the Covid-19 outbreak currently has on dental healthcare professionals, it also looks at some heavier impacts that this outbreak might have on the profession of dentistry. As such this manuscript offers some suggestions and recommendations based on personal feeling.