Medical education is a highly regarded career choice among the majority of students in Pakistan. A significant number of students enroll in medical colleges in Pakistan with the aim of serving humanity, obtaining social and financial advantages, and fulfilling their parents' desire to see them become doctors. In that respect the consideration of student satisfaction is important in relation to effectiveness within their performance as well. Objective: To analyze the satisfaction level for the students within the public and private sector medical colleges in Pakistan. Methods: he semi-structured interviews were selected for the current research. The interviews provided the expressive possibility towards collecting efficient data in from of opinions and experiences from 5 medical students enrolled in the public sector medical colleges and 5 medical students from private sector medical colleges in Pakistan. Results: The research highlighted that on the main consideration there were different types of issues which are influencing the satisfaction of students within different considerations and backgrounds from the medical sector. The teacher perception, way of teaching and the aligned developments in relation to better consideration here were related to the specified orientation for the structure of transformative development in relation to the satisfaction of students. Conclusions: On a concluding note, it can be said that the students in private and public medical colleges in Pakistan has satisfaction issues. However, the teacher support and facility have the possibility to enhance satisfaction

BACKGROUND:Accreditation bodies of medical education globally value competency in research that facilitates evidence-based practice of medicine. Physician-scientists need awareness of qualitative research methods for in-depth exploration of sociocultural, gender, behavioural, emotional, and religious factors affecting health that cannot be gauged by quantitative research methods. The introduction of qualitative research at the undergraduate level can enhance understanding of local populations' unique health needs and strengthen evidence-based practice.METHODS:This was a mixed-method study conducted from July to October 2021. Four journals with dedicated student's corner/student journals were hand-searched for qualitative research articles published by students, over the past five years. Quantitative data was collected at four medical colleges of Khyber-Pakhtunkhwa for several qualitative research projects being conducted by students. Quantitative data was collected from the faculty of these colleges about the facilities of research departments. After analysing quantitative data, five semi-structured interviews via email were conducted about factors limiting qualitative research at medical colleges. Written responses were analysed for themes.RESULTS:There was not a single qualitative research article published by students in local journals in five years. Out of 39 research projects by undergraduates at four medical colleges only one was qualitative. Two themes developed from qualitative data were underdeveloped research departments and a lack of attitude toward qualitative research.CONCLUSIONS:There is a felt need and gap to include qualitative research objectives at the undergraduate level, but before that emphasis needs to be placed on providing infrastructure, resources, and trained faculty to facilitate implementation. It will facilitate future doctors to find answers to problems impalpable by quantitative methods.

Pressure ulcers acquired in a hospital are a common problem in patients with neurological disorders. Although a number of risk factors have been identified, no relationships between risk profile characteristics and pressure ulcer outcomes in hospitalized patients in Karachi have been described. This research aimed to identify the elements that contributed to the emergence of open-wound pressure ulcers in patients with neurological disorders who were being treated in hospitals. A cross-sectional analytical study design was used to enroll 93 study participants from Pakistan's Murshid Hospital and Healthcare Centre (MHHCC). The data was collected using a structured questionnaire. The Chi-Square test and an independent t-test were used to analyze the data using SPSS 21 to determine the results. The study discovered that the Glasgow Comma Scale (p = 0.001), length of hospital stay (p = 0.001), and back care (p = 0.03) were statistically associated with the open wound pressure ulcer. In conclusion, hospitalized patients with neurological disorders showed a significant difference between open wound and close PU in terms of mean GCS, length of hospital stay, and back care.pressure ulcer (PU)

Student satisfaction is a complex result influenced by the standard of instruction, available resources, the campus community, support services, and the overall atmosphere of the institution. Since teacher engagement has a significant impact on students' learning experiences, educational institutions should give priority to strategies that increase teacher engagement. Objective: This study investigates the ever-changing elements that impact student satisfaction at our higher education institution by conducting in-depth interviews with a varied range of students. Methods: The sample size kept in the study was 30 (15 from public and 15 from private sector). The researchers utilised thematic analysis to extract significant findings from the participants' replies to inquiries regarding teaching excellence, available resources, community involvement, support services, and institutional regulations. Results: The results involve the presence of a robust sense of belonging and comprehensive support services, coupled with the various problems encountered by students, offered multifaceted insights into the whole educational journey. It has been examined that teachers have an important and major role in satisfaction of students in both private and public sector. The findings provide useful insights for institutional decision-makers seeking to improve student satisfaction and the overall learning environment. Conclusions: Students’ satisfaction was affected by many complex factors. Customized feedback, a variety of teaching styles, and easier access to specialized resources were suggested, but engaging teaching methods, helpful faculty, and well-equipped resources were praised.

Background: PU is caused by physical elements such as shearing forces, friction, and dampness. Long periods of sitting or lying in the same position without moving can cause ischemia and necrosis of the skin and underlying tissues in patients with neurological problems. Schizophrenia, severe depression, and other serious mental illnesses, as well as any hygienic neglect and the older age group, between 60 and 80 years, also enhance the risk of PU development. Objective: To identify the association of braden scale with the development of open wound PU among patients who were hospitalized with neurological disorders at a private tertiary care hospital in Karachi, Pakistan. Methodology: According to calculated sample size 93 people from Pakistan's Murshid Hospital and Healthcare Centre (MHHCC) were enrolled in the study using a cross-sectional analytical study design. An organized questionnaire was used to collect the demographic data and braden scale was used associate the findings. SPSS 21 was used to analyze the data and the Chi-Square test was applied to find the association. Results: . Patients in group I had an average age of 54.27±17.49 years. It was 52.23±19.77 years in group II, with no statistically significant difference between the groups (p = 0.47).

Objective: Specialty choices in health profession has long been influenced by gender. The field of General Surgery remains the least preferred specialty by females, especially in Pakistan. The objective of this study was to identify the factors leading to success and retention of females in General Surgery in Pakistan. Methods: Qualitative case study was conducted from February to May 2020 at Khyber Medical University, Peshawar. Ten semi-structured interviews were conducted with purposive sample of female surgeons at various academic position in different tertiary care hospitals of Pakistan. Data were thematically analyzed. Results: Participants were driven by their passion for surgery, which led them to choose this specialty in the beginning. Their survival in male dominant workplace was made possible by their own personality traits and conducive environment provided by the supervisors and peers. However, a structured mentorship program for females was found lacking. Conclusion: The necessary ingredients for success are passion and personality traits in any field but attention to nurturing and supportive environment for females in the General Surgery is paramount in determining success. Due consideration to the factors identified in the current study will enhance the retention and success of females in General Surgery.

Background: There are multiple techniques used worldwide to repair inguinal hernia. The open mesh hernioplasty is easy to carry out, tension free repair and having good long term results but has few complications as well. Recently the laparoscopic repair of inguinal hernia is the best option because of its merits like lower recurrence rate, lesser postoperative pain, fast recovery and lower risk of complications. The results are controversial so there is a need to evaluate that which technique is better in our population so the aim of current study was to compare the outcome of open mesh hernioplasty versus laparoscopic total extra-peritoneal mesh repair in the treatment of inguinal hernia. Methods: A randomized controlled trial was conducted in the department of surgery, Ziauddin hospital, Karachi during May to December 2021. Patients included in the study were divided into two groups, Group A included those who underwent open mesh hernioplasty while Group B contained patients treated with laparoscopic total extra peritoneal mesh repair. The complication including scrotal hematoma was assessed clinically and confirmed by ultrasound then putted on follow up for two weeks. Data was collected on self-designed proforma. Statistical Package for Social Science (SPSS) version 20 was used for analysis of data. Results: The mean age of the study participants was 36.2±5.6 years. In both group A and B, majority of patients were having right sided inguinal hernia. In Group A, majority of patients were presented with direct inguinal hernia while majority of Group B patients were presented with indirect inguinal hernia but the p-value was non-significant. Postoperative scrotal hematoma was found in 19.5% of the study participants among them 7.8% participant were having direct inguinal hernia and 11.7% presented with indirect inguinal hernia. The frequency of scrotal hernia in patients of Group A, having open mesh hernioplasty was 15.6% while in Group B lesser frequency of postoperative scrotal hematoma was noted and the results were highly significant. Conclusion: It can be concluded that laparoscopic total extra-peritoneal mesh repair is the best technique for repairing inguinal hernia because of its minimal postoperative complications in comparison to open mesh hernioplasty. It is recommended to consider laparoscopic total extra-peritoneal mesh repair as the first line treatment option in the case of inguinal hernia. Keywords: Inguinal Hernia, Laparoscopic total extra-peritoneal mesh repair, Open mesh hernioplasty

Objective: To determine the frequency of metabolic syndrome and its associated factors in patients with biopsy proven breast cancer at tertiary care university hospitals of Karachi, Pakistan. Methods: This cross sectional study was conducted at the hospitals affiliated with Dow university of health sciences & Baqai medical university from January 2018 to September 2019.A total of 114women between 30 to 50 years of age presented to the out patients clinics and underwent triple assessment including detailed history &examination, radiological assessment and fine needle aspiration cytology for confirmation of breast cancer were included in the study after taking written informed consent. Along with the routine baseline investigations blood sugar for hyperglycemia&blood sample for lipid profile was taken in fasting from Dow Lab. Blood pressure of the patients was also checked along with the weight, height and waist measurements. The SPSS version 19 was applied to the data for description and analysis. Results: Mean age of the patients was 42.57 ±4.90 years. Stages of cancer showed that stage III was found in majority (n=50, 43.9%). Frequency of metabolic syndrome was observed in 44 (38.6%) of the patients. A significant association of metabolic syndrome with educational status (p-value <0.001), Hypertension (p-value <0.001), Central obesity (p-value <0.001), Fasting blood sugar levels (p-value <0.001), Triglyceride levels (p-value <0.001), High density lipoprotein levels (p-value <0.001), and different Stages of breast cancer (p-value 0.003) was observed. Conclusion: This study show that a significant number of patients with breast cancer are suffering from metabolic syndrome which is also correlates with the educational status of the patients.

BACKGROUND:A range of surgical options from banding to open haemorrhoidectomy are available for the treatment of haemorrhoids. Haemorrhoidal artery ligation operation (HALO) with or without Doppler guidance is a newer option with claims of having better efficacy. We aimed to study the efficacy of HALO without Doppler guidance in terms of presence of postoperative complications including pain, bleeding, prolapse and overall patient satisfaction.METHODS:This interventional study was conducted in the Department of Surgery Combined Military Hospital Rawalpindi, from 1st September 2013 to 31st July 2015. Consenting patients with second degree haemorrhoids not responding to banding or sclera-therapy and those with third and fourth degree haemorrhoids were included in the study. They were followed up at 1 week, 6 weeks and then at 6 months. All of them were questioned regarding pain, bleeding, prolapse and overall satisfaction with the procedure.RESULTS:A total of 97 patients (n=97) were included in the study. At 1 week follow up after HALO, mean pain score was 1.76, at 6 weeks it was 0.4 and at 6 months none of the patients had any pain. Postoperative bleeding was seen in 1 patient at 1 week (1.03%). None of the patients had bleeding at 6 weeks (0%), and 2 patients reported mild occasional bleeding at 6 months' post op (2.06%). Four of our patients had persistent prolapse post-operatively (4.12%) which persisted throughout follow up. Ninety-four (96.91%) patients were overall satisfied with the procedure, whereas 3 patients (3.09%) were not satisfied.CONCLUSION:Haemorrhoidal artery ligation operation without Doppler guidance is an effective method to treat haemorrhoids in terms of post-operative pain, bleeding and patient satisfaction.

BACKGROUND:Both Total and Subtotal Thyroidectomy are correct treatment options for symptomatic Euthyroid Multinodular Goitre. The choice depends upon surgeon's preference due to consideration of disadvantages like permanent hypothyroidism in Total Thyroidectomy and high chances of recurrence in Subtotal Thyroidectomy. Many surgeons believe that there is a higher incidence of Recurrent Laryngeal nerve injury in Total Thyroidectomy which affects their choice of surgery. This study aimed to compare the incidence of recurrent laryngeal nerve injury in total versus subtotal thyroidectomy.METHODS:This non randomized controlled trial was carried out at Department of Surgery and ENT of Ayub Teaching Hospital Abbottabad, and Combined Military Hospital Rawalpindi from 1st September 2013 to 30th August 2014. During the period of study, patients presenting in surgical outpatient department with euthyroid multinodular goitre having pressure symptoms requiring thyroidectomy were divided into two groups by convenience sampling with 87 patients in group 1 and 90 patients in group 2. Group-1 was subjected to total thyroidectomy and Group -2 underwent subtotal thyroidectomy. All the patients had preoperative Indirect Laryngoscopy examination and it was repeated postoperatively to check for injury to the recurrent laryngeal nerve.RESULTS:A total of 177 patients were included in the study. Out of these, 87 patients underwent total thyroidectomy (Group-1). Two of these patients developed recurrent laryngeal nerve injury (2.3%). In group-2 subjected to subtotal thyroidectomy, three of the patients developed recurrent laryngeal nerve injury (3.3%). The p-value was 0.678. The overall risk of injury to this nerve in both surgeries combined was 2.8%.CONCLUSIONS:There is no significant difference in the risk of recurrent laryngeal nerve damage in patients undergoing total versus subtotal thyroidectomy.