Objective: To find out the correlation between internet addiction and depression, anxiety and stress among undergraduate medical students in Azad Kashmir. Methods: A cross-sectional study including 210 undergraduate medical students (first to the fifth year) was done in Poonch Medical College, Azad Kashmir. The data collection tools were DASS21 questionnaire and Young’s internet addiction questionnaire. Spearman rank correlation test was done to see the correlation between internet addiction and depression, anxiety, and stress. Data were analyzed by SPSS v23 at a 95% confidence interval. Results: A very high prevalence (52.4%) of moderate to extremely severe internet addiction was observed among the respondents. The mild positive correlation between internet addiction and depression was identified (p <0.001) and similar type of correlation was observed between internet addiction and stress (p 0.003). However, anxiety and internet addiction were not significantly correlated. The prevalence of anxiety and depression among the males were higher than the females, whilst the stress level was almost the same across gender. Conclusion: Internet addiction has been found to be associated with various psychiatric diseases. In this study, we also observed such correlation. We have also observed a very high level of internet addiction among medical students. The prevalence of internet addiction may further increase in the coming years as the internet will become more cheap, available and include more high quality psychologically addictive contents. How to cite this:Javaeed A, Zafar MB, Iqbal M, Ghauri SK. Correlation between Internet addiction, depression, anxiety and stress among undergraduate medical students in Azad Kashmir. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.169 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.

Objectives: With the rise in the number of published papers in the biomedical field, plagiarism has become a major ethical concern as it has a direct effect on the quality of these papers. The objective of this research was to determine the perceptions of medical students towards plagiarism, the reasons students engage in plagiarism, the types of plagiarism, the consequences of plagiarism, and solutions to the problem of plagiarism. Methods: This is a cross-sectional study conducted in two medical colleges in Rawalpindi, Pakistan from June to September, 2018, using self-administered structured questionnaires. Results: Of the 1100 participants, up to 86.91% (n=956) were not aware of the existence of plagiarism, but the majority, i.e. 71.18% (n=783) have plagiarised the work of others before. Copying from colleagues or senior students is the most common type of plagiarism that medical students engage in owing to the ease with which fellow students’ work can be shared and copied. However, a lack of institutional awareness of the extent to which plagiarism exists, poor vigilance in detecting it, and the absence of clear policies to deal with plagiarism are mostly to blame. Conclusion: Plagiarism is common among medical students in developing countries, and it is necessary to create awareness about the consequences of engaging in this unethical practice both in the academic field and in the larger medical research society, in order to reduce its prevalence. How to cite this:Javaeed A, Khan AS, Khan SH, Ghauri SK. Perceptions of plagiarism among undergraduate medical students in Rawalpindi, Pakistan. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.33 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 management of acid-base disorders always calls for precise diagnosis and treatment of the underlying disease. Sometimes additional means are necessary to combat systemic acidity itself. In this systematic review, we discuss the concept and some specific aspects of bicarbonate therapy for critically ill patients with metabolic acidosis (i.e., patients with blood pH < 7.35). We conducted a systematic literature review of three online databases (PubMed, Google Scholar, and Cochrane) in November 2018 to validate usage of bicarbonate therapy for critically ill patients with metabolic acidosis. Twelve trials and case series were included in the final analysis, from which we assessed population, intervention, comparison, and outcome data. The current literature suggests limited benefit from bicarbonate therapy for patients with severe metabolic acidosis (pH < 7.1 and bicarbonate < 6 mEq/L). However, bicarbonate therapy does yield improvement in survival for patients with accompanying acute kidney injury.

Objective: To assess the relationship between internet addiction (IA) and academic performance among the medical students of Azad Kashmir, Pakistan. Methods: A cross-sectional study was done involving 316 medical students of Poonch Medical College, Azad Kashmir, Pakistan from May 2018 to November 2018. Dr. Young’s Internet Addiction Test questionnaire was used as the tool of data collection. The questionnaire contained twenty 5-points Likert scale questions to assess internet addiction. IA score was calculated and the association between IA and academic performance was observed by Spearman Rank Correlation test. Relationship between baseline characteristics of the medical students and IA was also seen. Results: Eighty-nine (28.2%) medical students fell under the category of ‘severe addiction’ and most importantly only 3 (0.9%) were not internet addicted according to Dr. Young’s questionnaire. Internet addicted medical students scored significantly poor in their exams (p. <.001). One hundred thirty one (41.4%) students with a median IA score of 45 scored in the range of 61-70% marks as compared to 3 (0.9%) students with a median IA score of 5, secured greater than 80% marks. Conclusion: This study and many other previous studies have revealed that internet addiction affects academic performance. The number of internet users is ever increasing therefore, the number of internet misusers will also increase. If no step is taken to control internet addiction, it may cause a serious impact in the future. doi: https://doi.org/10.12669/pjms.36.2.1061 How to cite this:Javaeed A, Jeelani R, Gulab S, Ghauri SK. Relationship between internet addiction and academic performance of undergraduate medical students of Azad Kashmir. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1061 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.

Background: Multiple choice questions and Modified Essay Questions are two widely used methods of assessment in medical education. There is a lack of substantial evidence whether both forms of questions can assess higher ordered thinking or not. Objective: The objective of this paper is to assess the ability of a well-constructed Multiple-Choice Question (MCQ) to assess higher ordered thinking skills as compared to a Modified Essay Questions (MEQ) in medical education. Methods: The medical education literature was searched for articles related to comparison between multiple choice questions and modified essay questions, looking for credible evidence for using multiple choice questions for assessment of higher ordered thinking. Results and Conclusion: A well-structured MCQ has the capacity to assess higher ordered thinking and because of many other advantages that this format offers. Multiple choice questions should be considered as a preferable choice in undergraduate medical education as literature shows that different levels of Bloom's taxonomy can be assessed by this assessment format and its use for assessing only lower ordered thinking i.e. recall of knowledge, is not very convincing.

The objective of this study was to assess the impact of social media integration in teaching methods on exam outcomes. Methods: This study was conducted at Poonch Medical College, Azad Kashmir, Pakistan from November 2018 to January 2019. All 125 students of 4th year MBBS were included in the study. The mean age of all respondents was 22.96 ± 3.25 years. One unit of special pathology was taught using traditional teaching methods and a second unit was taught using traditional teaching methods supplemented by social media. One exam was taken before the integration of social media and a second exam after its integration. Written informed consent was secured from all the participants before starting the project. Results: The mean difference in examination score after social media integration was 8.97 ± 5.23 which was statistically significant (95% CI −7.954-9.988, p <0.001). However, classroom attendance was significantly higher before social media integration (95% CI 0.668-0.197, p <0.001). Social media integration provided better examination outcomes for the students and gave voice or space to those who never previously asked questions or participated in the class. Conclusion: Social media broke down the barriers and students communicated with confidence. Educationists may work together to create a guideline on how social media can be efficiently incorporated in the education system.

The role of several metabolic changes, such as hypoxia and acidosis, in the tumour environment has caught the attention of researchers in cancer progression and invasion. Lactate transport is one of the acidosis-enhancing processes that are mediated via monocarboxylate transporters (MCTs). We conducted a systematic review and meta-analysis to investigate the expression of two cancer-relevant MCTs (MCT1 and MCT4) and their potential prognostic significance in patients with metastasis of different types of cancer. Studies were included if they reported the number of metastatic tissue samples expressing either low or high levels of MCT1 and/or MCT4 or those revealing the hazard ratios (HRs) of the overall survival (OS) or disease-free survival (DFS) as prognostic indicators. During the period between 2010 and 2018, a total of 20 articles including 3831 patients (56.3% males) were identified. There was a significant association between MCT4 expression (high versus low) and lymph node metastasis [odds ratio (OR)=1.87, 95% confidence interval (CI)=1.10-3.17, P=0.02] and distant metastasis (OR=2.18, 95%CI=1.65-2.86, P<0.001) and the correlation remained significant for colorectal and hepatic cancer in subgroup analysis. For survival analysis, patients with shorter OS periods exhibited a higher MCT4 expression [hazard ratio (HR)=1.78, 95%CI=1.49-2.13, P<0.001], while DFS was shorter in patients with high MCT1 (HR=1.48, 95%CI=1.04-2.10, P=0.03) and MCT4 expression (HR=1.70, 95%CI=1.19-2.42, P=0.003) when compared to their counterparts with low expression levels. Future research studies should consider the pharmacologic inhibition of MCT4 to effectively inhibit cancer progression to metastasis.

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