The emergence of COVID-19 caused a significant global threat, affecting populations worldwide. Its impact extended beyond just physical health, as it inflicted severe damage and challenges to individuals' well-being, leading to a deterioration in mental health. The lived experiences of patients hold a paramount position to explore and understand their perception of care which can ultimately strengthen the health system’s delivery domain. This study explores the lived experiences of patients in the isolation ward, their recovery, and the quality of care being provided in the hospital and its effects on their mental health.Study DesignA phenomenological qualitative study using in-depth interviews.MethodsWe conducted 11 in-depth interviews of COVID-19 patients admitted to the isolation ward of the public hospitals of Peshawar, Pakistan. Participants who stayed for a minimum of 10 days in an isolation ward were included in this study. Interviews were transcribed and analyzed using NVivo 12 software and generated five themes through inductive analysis.ResultsFive themes emerged from the participants’ lived experiences: Heading towards the hospital, Health Care Quality, Impact on Mental Health, Recovering from COVID-19 and Back on one’s feet. These included all the positive and negative lived experiences. Socio-environmental factors along with their experiences of the disease itself and with the healthcare providers guided their reaction which was important conciliators in their experiences during the pandemic.ConclusionBased on the findings, the environment of isolation had a major influence on the mental well-being of the individuals involved. Considering the important role of the ward environment in shaping patient experiences and outcomes prompts a reevaluation of healthcare practices and policies. By addressing these factors healthcare systems can strive for greater effectiveness, resilience, and compassion in managing the pandemic's impact on patient care.

IntroductionAlmost a quarter of patients with tuberculosis (TB) in Pakistan may also have diabetes, with an additional quarter in a pre-diabetic state. Diabetes is a risk factor for TB. When it co-occurs with TB, it leads to poorer outcomes for both conditions, considerably increasing the burden on individuals, families and the healthcare system. We aim to improve health, quality of life and economic outcomes for people with TB and diabetes by optimising diabetes prevention, screening and management within TB care. The objectives of this study are to: (1) design an integrated optimised tuberculosis-diabetes care package (Opt-TBD) and its implementation strategies; (2) pilot and refine these implementation strategies and (3) implement and evaluate the Opt-TBD care package in 15 TB care facilities in Pakistan.Methods and analysisWe will work with the TB programme across two provinces of Pakistan: Khyber Pakhtunkhwa and Punjab. TB care facilities will be selected from urban and rural settings of these provinces and will include three levels: primary, secondary and tertiary care settings. This multiphase mixed-method study has three sequential phases. Once ready, the care package and its implementation strategies will be piloted to inform further refinement. The package will be implemented in 15 urban and rural TB care facilities and evaluated for its Reach, Effectiveness, Adoption, Implementation and Maintenance, and potential for scale-up. Quantitative data will assess provider adoption and the package’s accessibility and effectiveness for patients with TB and with diabetes and pre-diabetes. Qualitative data will explore barriers and facilitators for successful implementation and scale-up. Data will be analysed using statistical methods—including descriptive and inferential statistics—for quantitative data and framework analysis for qualitative data, with triangulation to integrate findings.Ethics and disseminationEthics approval was granted by the National Bioethics Committee of Pakistan (NBCR-1010). Findings will be shared through academic publications, conferences and public outreach.

OBJECTIVE:Patients reporting to emergency departments frequently use different ambulance services; therefore, the measurement of patient satisfaction is relevant to encouraging those services to meet patient expectations. The aim of this study was to determine the patients' satisfaction and utilization of different ambulance services at a tertiary health care hospital in Peshawar relating to prehospital services.METHODS:This cross-sectional study was conducted at Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, from July 2019 to January 2020 using a consecutive sampling technique with a total sample size of 378. The patients reporting to the emergency department using any ambulance service were included in this study. Different types of ambulance services were used as an outcome variable. Proportions were compared for the categoric variables using the chi-square test, whereas the 1-way analysis of variance test was used to determine the mean response time and age. Results were considered significant at a P value ≤ .050. All analyses were completed using SPSS version 20 (IBM Corp, Armonk, NY).RESULTS:Of the total 378 study participants, approximately 166 (43.9%) used Rescue 1122 services, 99 (26.2%) used private ambulance services, and 44 (11.6%) used public ambulance services. Road traffic accidents were the most common complaint by 98 (25.9%, P < .003) participants. The mean response time for Rescue 1122 was 13.2 ± 18 minutes followed by the Chippa Foundation (private) at 17.8 ± 20 minutes (P < .005). Males (n = 254) were the predominant users of all services. Participants from the urban region (n = 112) used Rescue 1122, whereas the public ambulance service was used only by 31 patients (P < .005). Among all the ambulance services, 19 (61.3%) participants were not satisfied with the Chippa service regarding vehicle cleanliness, whereas participants were highly satisfied with Rescue 1122.CONCLUSION:Overall, the patients were more satisfied with the services provided by the Rescue 1122 ambulances compared with all other ambulance services.

OBJECTIVES: To determine the prevalence of oral manifestations among PCR-confirmed COVID-19-positive patients and their potential correlations with age, gender, and systemic manifestations. METHODS: This cross-sectional study was conducted at Khyber Medical University among 117 randomly selected PCR-confirmed COVID-19-positive patients from October 1, 2020, to January 30, 2021. All the patient records were taken from the Public Health Reference Lab, Peshawar, Pakistan. Telephonic interviews were conducted for data collection using a structured questionnaire. SPSS version 24.0 was used for data analysis. Regression analysis was done to determine the association between dependent variables (oral manifestations) and independent data like age, gender, and systemic features. RESULTS: Among 117 participants, 56% experienced oral manifestations associated with COVID-19. Taste alterations were experienced by 49.6% (n = 58), xerostomia 34.2% (n = 40), inflammation of the oral cavity 14.5% (n = 17), oral ulcers 10.3% (n = 12), angular cheilitis 6% (n = 7), white lesions 0.9% (n = 1), and bleeding gums 0.9% (n = 1). The average duration for symptoms to last was 10 days. General clinical manifestation of COVID-19 include fever, cough, sore throat, nasal congestion, body aches, diarrhea, difficulty breathing, etc. Oral manifestations had a significant association with gender (p<0.02), loss of smell (OR 0.034, 95%CI 0.008-0.153, p <0.001) and use of medication (OR 0.051, 95% CI 0.011-0.231, p<0.001). CONCLUSIONS: Oral manifestations were observed in 56% of PCR-confirmed COVID-19-positive patients, with taste alterations being the most common at 49.6%. Significant associations were identified with gender, loss of smell and medication use.

Objective:To assess household poverty, sanitation and hygiene practices, and food security in both urban and rural settlements of district Peshawar. Methods:We conducted this cross-sectional study from March 2019 to October 2019 in the urban and rural households of Peshawar, KPK. Using stratified random sampling, 554 households (HH) having children and young adolescents of age 5-19 years, adult men > 19 - 62 years, and adult women >19 - 62 years were included in this study. Data was collected using comprehensive tool comprised of all validated questionnaires and was analyzed using SPSS Version 24.0. Result:Within the urban clusters, the maximum number of households (n=29) were from Gari Baloch and the minimum number of households (n=7) were from Gulberg. In the rural clusters, the maximum number of households surveyed (n=41) were from Lamara, minimum(n=21) was from Chargula. The average age of household heads was 44.5 ±12.5 with mean age slightly higher in urban areas (45.1 ±11.8) compared to 44.0 ±13.2 in rural areas. The mean poverty score was 56.8 (±11.6) with 72.1% non-poor households, and 94.2% households being food secure. Handwashing practices were highly prevalent among all the HH, however, handwashing practices before eating were comparatively lower in all HH (45.2%), lowest (37.8%) among rural households. Conclusion:The findings of the study revealed both non-poor and food secure households with satisfactory water, hygiene and sanitation practices.

Objectives: To explore the perception of postgraduate public health students regarding e-learning in context to Covid-19 pandemic and its effect on their academic performances Methods: This cross-sectional study was conducted at Sarhad Institute of Health Science, SUIT Peshawar from 3rd October 2020 to 4th February 2021. The Census method was incorporated for sample selection. Participation in the study was subjected to consent by participants. A self-administered questionnaire was used for data collection. Data was analyzed using SPSS Version-26. Results: Out of 95 participants, 72 (75.8%) were males and 23 (24.2%) were females. The mean grade point average (GPA) of previous semester-1 and semester-2, when they were having a conventional education system on campus before the pandemic was 2.741±0.499 and 2.643±.498 respectively. The current mean GPA of semesters 1, 2, and 3 who had online classes during this pandemic was 2.41±0.66, 3.06±0.51, and 2.80±0.47 respectively. Fifty-one (53.7%) students preferred to use mobile for e-learning. Convenience to the use-learning management system (LMS) was 67.4% and 72.6% responded that their academic performance was positively affected by e-learning. Logistic regression revealed that source of learning (p 0.99), uninterrupted internet (p 0.87), convenience with LMS (p 0.17), stress (p 0.505), convenient communication with faculty (p 0.69), and compatibility with professional routine (p 0.21) were not significantly associated with good academic performance, however, students of semester 2 (p 0.001) and those using laptops (p 0.02) were more likely to get a GPA of 3.0 or above Conclusions: Students in this study had a positive perception regarding e-learning however, there is a definite need to amalgamate both online and on-campus learning modalities for post-graduate students especially during the uncertain situations.

Introduction: Medical education is based upon innovating teaching strategies to teach more problem-solving attitudes in medical students. Teaching methodologies have evolved over the last few decades with the sole purpose of making teaching and learning interactive for students. This study aimed to evaluate the teaching methodologies and their effectiveness concerning students' perceptions. Methodology: We conducted this cross-sectional study for six months. We included 115 medical students of Rawalpindi and Islamabad through convenient sampling who were willing to participate in the study. We used a self-structured questionnaire for the data collection, and data were analyzed using SPSS Version 24. Result: In this study, 57% of participants were female, and 43% were male. The majority of the study participants (49%) were from second-year MBBS. Around 91% of students were aware of different teaching methodologies. As per student perception, the most preferred teaching methodology was task-based (27.0%). The most ineffective method for students was self-directed learning (34.78%) and conventional lectures (26.1%). Conclusion: Medical students of different medical colleges have various teaching and learning methodologies, and they do have their perceptions regarding other effective and ineffective teaching and learning methods. Key Words: Medical Students, Teaching Methodology, Perception, Learning

OBJECTIVE: To understand and evaluate the perspectives of patient regarding use and misuse of antibiotics. METHODOLOGY: This cross-sectional study was conducted at rural health center SANN from November 2018 to May 2019. Both male and female patients over the age of 15 years were included in this study subjected to their willingness by convenient sampling. Sample size was 628. A self- structured questionnaire was used for data collection. Data was analyzed using SPSS Version-24 RESULTS: Sample size was 628 out of which 43.2% were male (n=271) and 56.8% were female (n=357). Around 65% responded that antibiotics were always safe to use and 79% responded that they take antibiotics from friends and family without even consulting medical practitioner and 72% had purchased antibiotics even without prescriptions. Self-request for unnecessary prescriptions of antibiotics was reported by 83% of the respondents. CONCLUSION: This specific study reflects a gap regarding the appropriate knowledge about usage of antibiotics and owing to this the misuse is likely to happen.

Objective: To assess the oral health status of 10-15-year-old children enrolled in government schools. Materials and Methods: This cross-sectional study was conducted over a period of 11 months from March 2020 till Feb 2021 among children aged 10-15 years going to government schools in Kheshgi Payan District Nowshera KPK. Multi stage sampling technique was incorporated. Children of age 10 -15 years were included and those above or below this age group were excluded from study. Pre-Validated WHO oral health assessment tool was used for this study. Data was analyzed using SPSS Version 24. Results: Data from 200 students 100 each from girls’ and boys’ schools was collected. Majority of students 21% (n=42) were of 12 years of age. The mean age was 12.58 ±1.64. A total of 59% children had sound dentition. Caries was present in (n=44) male and (n=29) female children. There was a significant association between the gender and the dentition of the children (p 0.005). Gingivitis and periodontitis were prevalent in 20% of the study participants. Conclusion: This study concludes significant association between gender and dentition of the children. Over all the oral hygiene of the children was found to be satisfactory.

Objective: To determine the frequency of gingivitis among patients visiting Sardar Begum Dental College (SBDC) and Hospital Peshawar. Materials and Methods: A Descriptive cross-sectional study was conducted in Sardar Begum Dental College and Hospital Peshawar, over a period of six month from March 219 to August 2019. Patients of both genders aged 16 to 60 years having all permeant teeth erupted were included in the study. The sample size for this study was three hundred eighty-four and method employed was consecutive sampling technique. The data were analyzed through SPSS version 24. Results: In this study 384 patients were examined in which the number of males were 176 (45.80%) and females were 208 (54.20%). Two hundred and fifty (65.10%) subjects had gingivitis. 137 (65.86%) Females in comparison to 113 (64.20%) males having gingivitis. The study variables including age, gender, frequency of tooth brushing, regular dental checkups were strongly associated with the gingivitis (p value <0.001). Educational status was also found to be associated with frequency of tooth brushing and dental checkups (p value < 0.01). Conclusion: This study concluded that the gingivitis was highly prevalent among the patients visiting to SBDC& Hospital, Peshawar and various factors were strongly associated to its causation.

Objective: To evaluate the in vitro antifungal activity of Potash Alum (Phitkary) solution on Candida Albicans growth on heat cured acrylic resin. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Oral Pathology, Peshawar Dental College, Peshawar, from Nov 2019 to Jan 2020. Methodology: Acrylic resin discs (n=120) of standard size were prepared following the manufacturer’s instructions. The acrylic discs were contaminated with a suspension of 106cfus/ml of C. albicans in Sabouraud dextrose broth for 24 hours. After contamination, 30 acrylic discs were randomly selected, washed, sonicated, and plated for colony counts. The remaining 90 acrylic discs were randomly divided into 3 groups, 30 acrylic discs in each group. Group A discs were kept in 5.25% Sodium Hypochlrite solution, group B discs were kept in sterile Phosphate Buffered Saline and group C discs were kept in Potash-alum solution (10mg/ml). After 2 hours, all discs were washed, sonicated, and cultured on Sabouraud dextrose agar in serial dilutions for colony counts. Data was analysed using SPSS version-19. Results: Both Potash Alum (10 mg/ml) and Sodium Hypochlorite were effective in completely removing the attached Candida cells from the acrylic resin. In contrast, the negative control was only able to reduce viable counts by 23.6%. Sodium Hypochlorite and Potash Alum both showed statistically significant activity (p<0.01) against C. albicans compared to the negative control. Conclusion: Potash Alum has a significant in vitro antifungal activity against C. albicans on acrylic resin. Its antifungal effect is comparable to the effects of Sodium Hypochlorite.......

OBJECTIVES: To study different umbilical cord cutting techniques prevailing among rural population of district Attock. METHODOLOGY: This descriptive cross-sectional study conducted from April - June 2017 in the rural population of district Attock. The sample size was 300 which were selected by non-probability convenient sampling technique. The data was collected over a period of three months using a pre-tested self-structured questionnaire. Informed consent was taken. Data was analyzed in SPSS version 23. RESULTS: A total number of 300 infantswere included in this study. The mean age (in days) +/- SD of infants was 14.10 +/- 8.96. The mean age (in years) +/- SD of mothers was 27.58 +/- 3.99. Surgical blade usage for cord cutting was 50%, 48.7% used scissors while 1.3% used knife to cut the umbilical cord after birth. 8.7% mothers applied nothing on the cord for cord care, whereas 30.7% of mothers applied domestic products on the infant's umbilical cord which included fried onion, garlic, ghee, oil, kohl and turmeric. Chi-Square test revealed that the use of harmful domestic products was highest among the infants who were born at homes (p<0.05). The application of medical or domestic products on the cord was irrespective of infant's gender and mothers' educational status. CONCLUSION: This study revealed diversity in methods of cutting and caring the cord after birth among the rural population of district Attock. Most of the participants of this study maintained the good cord care practices; however, there were a significant proportion of participants who followed harmful traditional practices for their infant's cord care.

Angiokeratoma corporis diffusum (ACD) is a variety of angiokeratoma, characterized by diffuse cutaneous hyperkeratotic vascular lesions. ACD is usually associated with many lysosomal enzyme deficiencies, though it is not a rule. It is associated with systemic features along with skin lesions. It may also present as isolated cutaneous form. X-linked recessive form usually manifests in males and females act as carriers. We report a case of ACD without systemic features in a young Kashmiri female.

Dermatological diseases, besides involving the skin and its appendages may also involve the oral cavity. The lesions of oral cavity in dermatological disorders deserve special attention, considering that they may be the presenting clinical feature or the only sign of these disorders. Moreover, oral mucosal lesions in skin diseases can be life-threatning and also affect the quality of life in terms of pain, discomfort, social and functional limitations. Various dermatological disorders of diverse etiologies like infections and genodermatosis are associated with oral lesions but pemphigus vulgaris, lichen planus and candidiasis are the most common ones. Oral mucosal lesions may present to a dermatologist as well as a dental surgeon, thus improving the knowledge about them in both the settings will strengthen and enhance interdisciplinary and multisectoral approach and lead to better management of such patients.