The Purpose and Value of Research

Human cognition and intellect have always strived for improvement of the human condition. Improvements are primarily based upon development of new knowledge and its application. This remains the prime purpose of all research and its value.There is often a spatiotemporal disconnect between the occurrence of research and realization of its value. Translation of new knowledge into socio economically valuable application takes time. An apt example is as follow:Alfred Haar, a Hungarian mathematician-scientist, introduced the idea of HAAR orthogonal system through his doctoral thesis at University of Gottingen, Germany in 1909. Ingrid Daubechics, a Belgian mathematicianphysicist, working at Courount Institute of Mathematical Sciences at New York University, USA, in 1980s developed compactly supported continuous wavelets finding useful application of wavelet theory in digital signal processing especially image compression. Stephen Hallet, originally from France, also helped develop wavelet theory applications in signal and image processing. It took at least seven decades before valuable applications were developed based on Haar's theoretical concepts. New knowledge thus created through research, in one part of the world, may lead to production of valuable applications in a different part of theworld, at a different time.The puritan idea of research as enumerated above, has been corrupted with time. A lot of Ivory tower's research today is taking place to fulfil criteria of job placement and promotions. The concept of impact factor supports this purpose by providing a mechanism, howsoever flawed, of providing a quantitative mechanism to judge research capabilities of individuals and institutions. This lends greater impetus to self-serving researchthan to society serving. This impact factor approach appears to have helped increase the quantity of research, but certainly not its quality in terms of socio economic value.Much greater interaction between the elements of quadruple helix (of academia, industry, society and government) is required to improve our understanding to develop means for enhancing the ratio of socioeconomically valuable research to self serving one.By directing our endeavors to yield better fruits for the society as a whole, serves a far higher purpose and generates much greater value.

Empathy among Medical Students Studying Different Curricula: A Comparative Study

Objective: To determine and compare empathy among medical students, studying two different curricula.Study Design: Cross Sectional.Place and Duration of Study: The study was carried out at the Department of Community Medicine of WahMedical College, Wah Cantt from January 2018 to June 2018.Materials and Methods: The study was carried out on second and fourth year MBBS students. The sample sizewas 90, calculated by Open Epi calculator and the students were selected by using stratified random samplingtechnique. A data collection tool comprised of two parts; demographic information about the individual wascollected in the first part and second part was based on Toronto Empathy Questionnaire. The questionnaire had16 questions and scored between 0-64. The questions were responded on a Likert scale of never, rarely,sometimes, often and always. The data was analyzed by using software program of SPSS version 20. Descriptivestatistics and Mann-Whitney U test was applied to compare the mean scores of empathy of students studyingdifferent curricula.Results: Mean score of empathy among students was 42.89+ 8.535. Mean empathy score of 2 year studentsth nd was 45.58 +7.203 and 4 year students came out to be 40.20 +8.981. Empathy was statistically significant in 2 year students and in female students; female students' empathy score was 46.38 while male students score was 39.40.Conclusion: It is concluded that 2 year students who studied integrated curriculum showed higher empathyth scores than 4 year students studying traditional curriculum. Moreover, female students showed significantlyhigher empathy scores as compared to the male students.

Effect of Play Based Learning on the Development of Logical Reasoning in Early Childhood Education

Objective: To determine the effect of play-based learning on developing logical reasoning in early childhoodeducation in Islamabad.Study Design: Quantitative quasi-experimental study and the pre-and post-experimental paradigm was used.Place and Duration of Study: The population of the current study included the students from Headstart Schoollocated in Islamabad from March 2020 to September 2020.Materials and Methods: The population was selected through cluster sampling technique. Sample size of 80students with 40 each of control and experimental group were considered le. Both the groups were taught acourse 'classification of vertebrates' in Science either through play-based (experimental group) or conventionalmethod (controlled group) in a 45 minutes session, 5 days for four weeks. A pictorial self-developed testconsisted of 6 questions based on understanding by design (UbD was used. Descriptive (percentage andfrequency) and inferential statistics were used for the analysis of data.Results: The control condition (Pre & Post) for the logical development and experimental condition (Pre & Post)was positively correlated. No effect of gender by the play-based learning in developing logical reasoning amongstudents was found in both the control and experimental group at early childhood education.Conclusion: The relationship between experimental and control conditions for the logical development byusing play-based learning was significant. The play-based activities based on the curriculum should be designed to ensure meaningful learning and long-term knowledge retention in children as it ensures a child's interest and fun factor.

Pathogenesis of COVID-19: ACE2, Cytokine Storm and Extrapulmonary Manifestations

The coronavirus disease 19 (COVID-19) is a global pandemic of the twenty-first century and currently fourthwave is creating fear and panic worldwide. It is caused by severe acute respiratory syndrome coronavirus 2(SARS-COV-2), a highly contagious viral infection of humans. The COVID-19 can be spread mainly throughrespiratory droplet particles and in contact with a COVID-19 infected person. Clinical manifestation of COVID-19patients includes cough, fever, diarrhea, loss of taste and smell. In critical cases of COVID-19, the developmentof pneumonia and dyspnea leads to acute respiratory distress syndrome that may cause the death of thepatient. It is well established that Angiotensin-Converting Enzyme 2 (ACE2) receptors on alveolar cells act as anentry gate for the SARS-COV-2. However, ACE2 is also highly expressed in multiple extrapulmonary vital organssuch as the gastrointestinal system, cardiovascular system, kidney, etc. Therefore, the direct viral entry in theseorgans can be a likely pathway of injury. In addition, decoupling of immune responses leads to the cytokinesstorm, which might contribute to the injury of extrapulmonary organs. In this review, we report the multipleorgan pathogenesis and clinical manifestations of COVID-19 patients, which could aid clinicians and researchersin prioritizing therapeutics remedies and developing research for all vital body systems involved.

Disease Severity, Clinical Characteristics and Outcome of Patients Hospitalized with Novel Coronavirus Disease at a Tertiary Care Hospital, Rawalpindi

Objective: To describe the clinical characteristics, signs & symptoms, disease severity, and outcome of patientsadmitted with novel coronavirus infection.Study Design: Comparative cross-sectional study.Place and Duration of Study: The study was conducted in the Department of Medicine of Pak-Emirates Militaryst th Hospital, (PEMH), Rawalpindi from May 1 , 2020 to June 30 , 2020.Materials and Methods: Patients hospitalized with novel corona virus infection during the study period wereprospectively enrolled in this study. Patients at least 15 years and above, either gender, hospitalized withconfirmed diagnosis of covid-19 (SARS-CoV-2) were eligible to be enrolled. The study outcomes includeddisease presentation, severity at time of reporting, admission to critical care or intensive care unit andmortality. Patients were identified as mild, moderate, severe and critical in accordance with World HealthOrganization guidelines, based on symptom severity, laboratory and imaging findings.Results: There were 400 hospitalized patients with confirmed SARS-CoV-2, out of which 51 (12.8%) werefemales, while 349 (87.3%) were males with overall mean age of 48.45±16.2 years. There were 300 (75.0%)patients with mild disease severity, while 65 (16.3%), 20 (5.0%) and 15 (3.8%) with moderate, severe and criticaldisease condition, respectively. The number of patients died were 22, with fatality rate of 5.5%. Age andpresence of comorbidities (cardiac disease, diabetes, hypertension, pulmonary disease, kidney disease) weresignificantly associated with disease severity and death due to novel coronavirus infection.Conclusion: Patients with older age, diabetes, hypertension, pulmonary disease, kidney disease were at higherrisk of developing severe disease condition and death due to novel coronavirus infection.

Clinical Characteristics, Seasonal Variation, Outcome and Disturbance of Taste and Smell in Cases of COVID-19

Objective: To assess the various clinical characteristics, seasonal variation, outcome and disturbance of taste(aguesia) and smell (anosmia) in cases of COVID-19.Study Design: Cross sectional study.Place and Duration of Study: The study was carried out in the Department of COVID-19 at Combined MilitaryHospital (CMH), Mardan from March 2020 to February 2021.Materials and Methods: Suspected case of corona virus disease-2019 (COVID-19) admitted and managed atCMH Mardan from March 2020 to February 2021 were included in the study and their nasopharyngeal swabswere sent for COVID-19 polymerase chain reaction (PCR) test. Only those clinically suspected cases withpositive PCR for COVID-19 were considered as cases of COVID-19. Demographic and clinical data includinggender, age, result of COVID-19 PCR test, symptoms, severity of disease, body system affected with COVID andoutcome, were recorded and entered in SPSS 21. Chi square was used to analyze qualitative variables and T testwas used for quantitative variables. P value less than 0.05 was considered significant.Results: The reported clinically suspected cases of COVID-19 were 1552. Positive PCR test for COVID-19 were221 (14.2%) with mean age 37.53 +11.05. The highest number of COVID-19 cases were seen from May 2020 toJuly 2020. The positivity ratio of COVID-19 was highest during May 2020 (29.9%). Majority of COVID-19 caseswere asymptomatic (45.7%) and only ten cases died of COVID-19, i.e. mortality was 4.5%.Out of 221 COVID-19patients, 38.5% cases had olfactory and taste dysfunction.Conclusion: COVID-19 surged during the months of May to July 2020 followed by a downhill course. Majority ofCOVID-19 cases were asymptomatic. Respiratory system of body was most common system involved followedby gastrointestinal and combination of respiratory and gastrointestinal system. Olfactory and taste dysfunction(anosmia and aguesia) was seen commonly in COVID-19 patients.

Autism-Current Status and Challenges in Pakistan

Autism is a group of neuro-developmental disabilities. It has an early-onset and can be diagnosed up to 3 yearsof age. It is characterized by disturbances in child's socialization, communication and cognitive abilities, and anunusual repetitive and restricted behavior. The majority of subjects have comorbid conditions. Males are more1 affected than females.1 The prevalence of autism is increasing in the world that could be due to improvement in1 diagnostic procedures and awareness in public and its worldwide prevalence is around 1%.1In Pakistan, there is a lack of widespread awareness and understanding about autism. We do not have exactprevalence data on this disease in Pakistan. However, according to the Autism Society of Pakistan, there are2 probably 350,000 children with this disease in the country.2 But the actual prevalence is believed to be muchhigher. Many cases remain undiagnosed because of unawareness, lack of medical facilities and stigma that is3 attached to mental conditions in Pakistan. In Pakistan, the distribution of disabilities includes mentalretardation (MR), hearing impairment, visual impairment and physical disability. Autism is not considered as adisability in Pakistani society. Moreover, the term mental disability or cognition problem is considered as asocial stigma or disgrace. Therefore, many people do not disclose the condition to avoid stigma. Anotherimportant reason of undiagnosed cases is lack of medical facilities and untrained doctors that categories autism under intellectual disability that is another condition. Many people especially from rural areas opt traditional therapies or go to preachers for healing.

Prevalence of Refractive Errors among Medical Students and Identification of Associated Factors

Objective: To determine the prevalence of refractive errors among medical students and identify associatedfactors.Study Design: Analytical, cross-sectional study.Place and Duration of Study: The study was conducted in the Department of Community Medicine at AkhtarSaeed Medical and Dental College, Lahore from September 2020 to December 2020.Materials and Methods: The study included 300 medical students using convenience sampling technique. Aself- structured pre- tested questionnaire was used. All medical students including MBBS, BDS, Pharm –D andallied health sciences were included in the study. Those students who did not give consent were excluded fromthe study. Data analysis was done with SPSS version 23. Chi square test of significance was applied to findassociation between the variables and p-value < 0.05 was considered statistically significant.Results: Refractive error was observed in 203 students (67.7%). The commonest refractive error was myopia(37%) followed by hypermetropia (23.7%) and astigmatism (7%). The prevalence of refractive errors wassignificantly associated with positive family history (p value=<.001), family income per month (p value=0.01)and mobile use per day (p value=0.001). Higher percentage of refractive error (70.6%) was reported byparticipants who were comfortable with light in which they study (p value=0.03).Conclusion: The prevalence of refractive error was 67.7% among medical students, and myopia was the mostprevalent refractive error. Refractive errors were significantly associated with positive family history, familyincome and mobile use per day.

Clinical Presentation, Risk Factors and Outcomes of Demographic Analysis of Blepharitis in Adults Presenting at Multiple Healthcare Centres

Objective: To identify symptoms, risk factors and outcomes of demographic analysis in adult patients withblepharitis.Study Design: Cross-sectional study.Place and Duration: The study was conducted in the Department of Ophthalmology at THQ Hospital, Kabirwala from 8 January 2020 to 8 June 2020.Materials and Methods: 100 patients were included in the study. Aged above 21 with symptoms of Blepharitis.Fluorescein strips and Slit lamp 90 D techniques were used to evaluate the patients for the presence of visualindications of blepharitis.Results: Sixty-five females and thirty-five males were included in the study. The age group of 21-30 years hadthe highest number of patients. Dry eyes, poor hygiene, low-socioeconomic factor and seborrhoea dermatitiswere significant risk factors. Most common symptoms included irritation, foreign body sensation, swelling overeyelids, hyperaemia, Epiphora and photosensitivity.Conclusion: Proper guidelines for protection and good hygiene should be provided to people. Dry eyes, poorhygiene, low-socioeconomic factor, seborrhoea dermatitis, irritation, foreign body sensation, swelling overeyelids, hyperaemia, Epiphora and photosensitivity are the most common symptoms and risk factors to find thereason behind Blepharitis, in this study. Females, due to their hormonal changes, are more prone to having thisdisease.

Intensive Care Management of Multiorgan Dysfunction and Hypoxic Brain Injury Secondary to Refractory Status Epilepticus

Refractory Status Epilepticus (RSE) is a medical emergency that may lead to permanent brain damage or death.Mortality rate is 16-39%. It is the life threatening condition in which continuous fits occur, despite treatmentwith benzodiazepines and one antiepileptic drug.A 25-year-old female, brought in emergency department with high-grade fever and frequent fits. GlasgowComa Scale (GCS) was 3/15 with unstable hemodynamics. Resuscitation started immediately and managed asstatus epilepticus. Patient was in multi organ failure on arrival. On the basis of history and examination, hypoxicbrain injury was diagnosed initially. Later on, refractory status epilepticus (RSE) with multi organ dysfunctionsyndrome (MODS) was diagnosed, after necessary investigations and treatment. Patient was managed as ateam with multidisciplinary approach and after continuous effort of 2 weeks, patient was successfullydischarged to home.