Introduction The overall environment of the medical school is often considered very stressful. It projects negative effects not only on the academic performances of medical students but also deteriorate their physical health and psychosocial wellbeing. The aim of this study was to determine the frequency of depression, stress, and anxiety among final year medical students. Methods This observational study was conducted in public and private medical colleges in February 2019. The instrument utilized in this study was Depression, Anxiety, and Stress Scale (DASS-21). Factors predisposing to depression, stress, and anxiety were also recorded. Data were entered and analyzed using SPSS v. 21. Results The mean scores of depression, anxiety, and stress were 18.00 ± 11.5, 19.15 ± 11.2, and 20.92 ± 11.2, respectively. The mean score of anxiety and stress was higher in private college students, while that of depression was higher in public college students. Overall, 57.6% of the students suffered from moderate to extremely severe depression, 74% of the students suffered from moderate to extremely severe anxiety, and 57.7% students had moderate to extremely severe stress. The common reasons to high stress and anxiety included the pressure of passing exams, the pressure of living up to family’s expectations, fear of stepping into the real world of medicine, and dissatisfaction with the administration. Conclusion The incidence of psychological illnesses including anxiety, stress, and depression is high among the medical students of Pakistan. Reasons predisposing the students to these illnesses must be efficiently tackled.

Introduction Diabetes mellitus (DM) is a chronic, progressive metabolic illness which is commonly complicated by coexistence of depression and anxiety. This study aimed to assess the prevalence of anxiety and depression among diabetic patients and the factors predicting this coexistence. Methods It was a cross-sectional, observational study which included patients of type 2 DM admitted in the hospital due to diabetes-related condition - diabetic foot infections/ulcers, hyperosmotic hyperglycaemic state (HHS), and hypoglycaemic coma/seizure. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Data was entered and analysed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Results Mean anxiety score of the participants was 10.88 ± 4.075 and mean depression score was 11.82 ± 4.049. There were 72 (50.7%) patients who had anxiety and 70 (49.2%) patients who had depression. Higher scores of anxiety and depression were statistically significant in female gender, older participants, individuals with longer duration of diabetes, those taking non-insulin treatment, and individuals with painful neuropathy, nephropathy, and foot ulcers. Conclusion The incidence of depression and anxiety among hospitalized patients of diabetes mellitus is high. The coexistence of these two chronic debilitating illnesses is worsening the overall quality of life. It is very important to diagnose and manage anxiety and depression in patients with type 2 DM to ensure higher quality of life and life expectancy.

Background Occupational burnout is an unwanted outcome of chronic workplace stressors which may be emotional or interpersonal. Chronic exposure to human suffering and long working hours have contributed to greater job stress and early burnout among healthcare providers. This study utilized the abbreviated Maslach Burnout Inventory (aMBI) to gauge the extent of overall burnout and on three subscales – perspective taking, compassionate care, and walking in patients' shoes – among interns, postgraduate trainees, and physicians of internal medicine. Materials and methods In this cross-sectional study, 71 internal medicine doctors – 40 interns, 22 postgraduate trainees, and nine physicians – completed aMBI with informed consent. It is a nine-item scale with three subscales – emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Each subscale has three items that are marked on a seven-point Likert scale. Higher scores of EE and DP indicate higher burnout, and a higher score of PA indicates lower burnout. Overall burnout was taken as the sum of EE and DP. Data were entered and analyzed using SPSS v. 22. Results There were 23 (32.4%) male and 48 (67.5%) female doctors with a mean age of 24.25 ± 13.17 years. The mean score of overall burnout was 22.51 ± 6.07 (range: 0–36) and PA was 15.35 ± 1.82 (range: 0–18). Overall moderate to high burnout was seen in 33.8% of doctors. On an individual subscale, 47.8% had high EE, 24% had high DP, and 25.4% reported high burnout on PA. Overall burnout had a statistically significant correlation with the marital status of the doctors, their working hours per week, their average on-call days per week, and their level of expertise. Conclusion There is a high degree of burnout among internal medicine physicians. Working hours and the number of on-call days per week were significant predicting factors. Interns reported the highest frequency of burnout.

Introduction Clinical empathy is the ability to comprehend the perspectives, feelings, and situation of the patients. Clinical empathy instills a sense of satisfaction in the patient. It also facilitates the healthcare provider (HCPs) in taking more sincere and logical clinical decisions. Although there have been numerous studied conducted to explore the pattern of clinical empathy among medical students, the results are mixed and not consistent. Methods This is a cross-sectional, observational study conducted among medical students of Ghulam Muhammad Mahar Medical College in August 2018. Two hundred and seven out of 500 students of all five years completed the study after informed consent. All students completed the 20-item Jefferson Scale of Empathy-Student Version (JSE-S). Data were entered and analyzed using SPSS version 22 (SPSS Inc, Chicago, IL, USA). The internal consistency of JSE-S was 0.71. Frequencies and percentages were calculated for students’ ages and genders. Mean and standard deviation (SD) were calculated for continuous variables. Group comparisons of the empathy scores were conducted using t-test and one-way analysis of variance (ANOVA). p<0.05 was considered as the significant level. Results There were 93 (44.9%) male and 114 (55.1%) female students. Their mean ± SD age was 20.85 ± 2.27 years (range: 17 to 26 years). The mean ± SD empathy score of all students was 98.11 ± 12.31 (range: 20-140). The mean empathy score was categorized according to gender, year of education, and career preference. Females showed a significantly higher empathy score. The lowest empathy was seen for the final year and the highest for the first year. On all three subscales of (JSE-S) - perspective taking, compassionate care, and walking in patients’ shoes - students with “people-oriented” career preference scored higher. Conclusion JSE-S is a self-administered and self-perceived inventory, which reports declining empathy in medical students with ascending years of education. Qualitative studies that can assess the empathy levels from the patients’ perspective are the need of the hour to decide whether or not empathy is a real phenomenon.

Introduction Academic pressure and its associated stress are responsible for disturbances in the circadian cycle of the students. Adequate sleep has crucial role in enhancing cognitive skills especially memory retention. Poor night time sleep quality and consequent daytime sleepiness affects physical and cognitive health of the students. In this study, sleep quality among medical students is evaluated. Methods It was an observational, cross-sectional study conducted with undergraduate medical students. Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. The data was analyzed using Statistical Package for the Social Sciences (SPSS) 22.0 (IBM Corp., Armonk, NY, USA). Results Of 281 students, 155 (55.16%) were pre-clinical students and 126 (44.83%) were clinical students; 207 (73.66%) were female students and 74 (26.33%) were male. The overall frequency of poor sleepers was 172 (61.2%); 95 (55.2%) of these were clinical sciences and 77 (44.8%) were basic sciences students. Sleep latency, duration, and efficiency were more impaired in clinical students (p-value ≤ 0.05). Use of sleep medications and daytime dysfunction was more common in clinical students (p-value ≤ 0.05). Conclusion Medical students are continuously under high academic stress and pressure. Adequate sleep is essential for them to refresh them every day and help in learning and memory processing. Medical students in advance years of education have worse sleep quality than those in early years. Efforts should be taken to improve their sleep quality in order to protect the psychological and emotional health of future doctors.

Introduction Parkinson’s disease (PD) is a progressive neurological disorder. It presents with motor symptoms and gradually progresses to cognitive impairment. It has debilitating impact not only on the psychological health of the patient but also of the caregivers. The aim of this study is to evaluate the stress level among caregivers of PD and assess its correlation with the disease factors including duration, severity, and presence of on-off phenomenon. Methods One hundred and fifty-six patients of Parkinson’s disease and their caregivers were enrolled. Severity of Parkinson’s disease was assessed using Hoehn and Yahr Scale. Caregiver stress was evaluated using Caregiver Burden Inventory. Data was entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY, USA). Results There were 112 (71.8%) women and 44 (28.2%) men in the caregiver group. Their mean age was 47.75 ± 11.98 years. There were 98 (62.8%) stressed caregivers and 58 (37.2%) non-stressed caregivers. In patients with stage 4 and 5 PD, 67-80% caregivers were stressed as compared to only 28% caregivers of stage 1 PD (p-value = 0.0008). Duration of Parkinson’s disease more than 10 years and presence of on-off phenomenon was also significantly associated with higher stress in the caregivers (p-value < 0.00001; p-value = 0.002, respectively). Among the stressed caregivers, 85 (86.7%) were women and only 13 (13.3%) were men (p-value < 0.0001). Conclusion Psychological health of caregivers of persons with Parkinson’s is bleak. As the disease progresses, they further succumb to debilitating stress and depression. Qualitative and quantitative studies must be conducted in Pakistan to understand the psychosocial status of Parkinson’s disease caregivers and plan strategies to improve their quality of life.

Introduction: Self-care activities are behaviors adopted in order to enhance one's health. Selfcare behaviors and activities are studied in their role to enhance glycemic control, reduce diabetes-related complications, and contribute to enhancing overall quality of life in people with diabetes. The aim of this observational study was to evaluate the impact of diabetes selfcare activities and behaviors on glycemic control in people with diabetes.Methods: This observational, cross-sectional study was conducted at the outpatient department of a secondary care hospital in Karachi, Pakistan from 1st September 2019 till 30th November 2019. Patients with known type II diabetes of age ≥45 years visiting the hospital for routine follow-up visit were included. Diabetes Self-Management Questionnaire (DSMQ) in Urdu version was used to assess their status of self-management. For data entry and statistical analysis SPSS for Windows version 21.0 was used.Results: There were 174 (54.9%) males and 152 (47.9%) were of age 45-60 years. Glycemic control was good (HbA1c <7%) in 125 (39.4%) and poor (HbA1c ≥7%) in 192 (60.6%) patients. Patients with good glycemic control scored significantly better on DSMQ overall (5.53 ± 0.35 vs. 4.32 ± 0.61; p<0.0001), and on three sub-scales -dietary control (4.24 ± 1.04 vs. 3.63 ± 0.98; p<0.0001), physical activity (4.16 ± 0.56 vs. 3.47 ± 1.17; p<0.0001), and healthcare use (4.22 ± 0.78 vs. 3.98 ± 0.65; p=0.003). Conclusions:The self-care activities that impact glycemic control in patients with diabetes include dietary control, physical activity, and healthcare use.

Background: The global incidence of pre-obesity and obesity is rising noticeably. Where medical students should be advocating healthy lifestyles, they are actually indulging in unhealthy eating habits and sedentary lifestyle. This is resulting in an increased incidence of obesity in this population.Methods: It was a descriptive cross-sectional study conducted from September 2018 till January 2019 in four medical colleges of Karachi. Sociodemographic profile, body mass index (BMI), food habits, and exercise routine of the students were recorded. Data was entered and analyzed using SPSS version 22 (IBM Corp., Armonk, NY).Results: The mean BMI of the study population was 21.717 ± 4.33 kg/m2 (range: 16.24–38.19). The mean age was 21.345 ± 1.4709 years with a minimum of 17 years and maximum of 25 years. The combined frequency of pre-obese and obese students was 33.2%. Among these, there were more women (60.6%) than men (39.3%). Among these pre-obese and obese students, 55% had breakfast rarely to sometimes, 47.9% took four or more meals per day, 39.3% consumed fast food thrice weekly or more, and 58.1% consumed soft-drinks/juices alternate to every day. Among the students who indulged into binge eating when stressed, 56.9% were pre-obese to obese. The nutritional status of the study sample was significantly associated with female gender, living status with parents, irregular breakfast, infrequent daily meals, increased consumption of fast food and beverages, decreased consumption of red meat, sedentary lifestyle, and altered eating habits when stressed.Conclusion: The incidence of pre-obesity and obesity is noticeably escalating among young adults. If this trend continues, obesity-related complications will form the major chunk of medical illnesses in the near future. Strategies are needed to nip this dilemma in the bud by indulging in healthy and clean eating habits and performing regular physical activity.