Introduction Undergraduate medical research is very important not only for scientific learning but also for career progress. However, there are barriers, especially in developing countries, that restrict undergraduate research. This study aims to evaluate the barriers experienced by medical students in conducting research at undergraduate level. Methods It was an observational, cross-sectional survey conducted with 687 clinical students of two public medical universities of Pakistan. A self-structured questionnaire consisting of seven items was administered to assess the barriers in conducting research at undergraduate level. Data was processed and analysed through SPSS v 22.0 (IBM Corp., Armonk, NY, USA). Results Lack of knowledge as a barrier was identified by 90.68% (n = 623) students. The second most common barrier identified by the students was lack of time (88.79%; n = 610), followed by lack of mentoring as the third most common barrier (85.74%; n = 572). Subgroup analysis showed that lack of knowledge, lack of mentoring, limited data base access, lack of time, and lack of finances were more crucial barriers for female gender (p < 0.05). Only lack of interest was a crucial barrier for male gender (p < 0.05). Conclusion A number of barriers need to be addressed in order to enhance students' participation in clinical research such as lack of interest, funding, and poor availability of research mentors and access to scientific databases to improve participation in clinical research. Substantial amendments in the medical undergraduate curriculum are needed.

Introduction High-sensitivity C-reactive protein (hs-CRP) has emerged to be a very useful and reliable clinical marker of primary as well as secondary cardiovascular morbidity and mortality. Elevated hs-CRP contributes to underlying atherogenesis and worsens disease prognosis. Along with their lipid-lowering properties, statins also contribute to the alleviation of micro-inflammation and reduces pro-inflammatory markers. The aim of this study is to compare the effects of rosuvastatin and atorvastatin in lowering hs-CRP levels in statin-naive patients admitted with acute coronary syndrome (ACS). Methods In this prospective, open-label randomized trial, group A was given rosuvastatin 40 mg daily and group B was given atorvastatin 20 mg daily along with standard post-ACS therapy. Lipid profile (mg/dL), hs-CRP (mg/L) and erythrocyte sedimentation rate (ESR) (mm/Hr) were recorded and measured as the baseline (before starting therapy) and then again after four weeks. The data were analyzed using SPSS for Windows version 22.0 (IBM Corp., Armonk, NY). Results With four weeks of treatment, both group A and B showed statistically significant reduction in serum hs-CRP levels (p<0.0001). In group A, there was a mean 51% decrease in hs-CRP levels, and in group B, a 35% reduction was seen. Group A showed markedly low hs-CRP levels than group B after four weeks of therapy (18.46 ± 6.35 vs. 24.67 ± 8.45) (p<0.0001). Group A showed mean 16% decrease in ESR levels as compared to 14% decrease in group B. Group A showed lower ESR levels than group B after four weeks of therapy (19.59 ± 11.83 vs. 20.52 ± 12.13) (p<0.0001). Conclusion Rosuvastatin showed a 50% decrease and atorvastatin showed a 35% reduction in serum hs-CRP levels in statin-naive ACS patients. Rosuvastatin has a more effective role in reducing micro-inflammation in ACS patients.

Purple urine bag syndrome (PUBS) is a very rare phenomenon strongly associated with long-term indwelling catheterization that results in an increased risk of urinary tract infection. The color change in the urine bag results from the altered metabolism of tryptophan into color pigments by certain bacteria which produce sulfates and phosphates enzymes. Although it is benign in nature, PUBS results in greater anxiety among patients and their families. The most important risk factors include long-term catheterization, female gender, chronic constipation, old age and bed-bound patients. Here, we present a case of PUBS in a middleaged woman with a history of the neurogenic bladder that needed long-term catheterization along with chronic constipation.

Purpose:  To determine visual rehabilitation of Phacoemulsification in comparison to small incision cataract surgery after implantation of rigid intraocular lens. Study Design:  Quasi Experimental Study. Place and Duration of Study:  Shaheed Mohtarma Benazir Bhutto Medical College Lyari and Sindh Government Lyari General Hospital, Karachi, from July 2018 to December 2019. Methods:  Patients with 35 – 70 years age and diagnosed with senile cataracts and visual acuity of <6/36were included. Patients having any corneal disease, intra-ocular pressure > 22 mmHg, high ametropia, any other eye disease were excluded. Patients were divided into two groups of 80 patients each. Group I underwent Phaco-emulsification and group II had Small incision cataract surgery. For data analysis, SPSS version 20.0 was used. Frequency and percentages were calculated for qualitative data and quantitative data was presented as mean and standard deviation. Results:  In a total of 160 patients operated of cataract, male to female ratio was 1:1. The range of astigmatism after 6 months in the group I was between 0.5 – 1.00 D while in the group II, it was between 0.75 – 1.75 D. Uncorrected visual acuity and best corrected visual acuity of 6/18 or better was seen in 90 and 97% group 1 while it was 85% and 95% in group II patients respectively at sixth month. Conclusion:  No significant difference was seen in uncorrected and best corrected visual acuity between the two groups. Time of surgery was lesser group 2 and Astigmatism was lesser in group 1. Key Words:  Phaco-emulsification, Small Incision Cataract Surgery, Visual Rehabilitation.

Neodymium-doped yttrium aluminium garnet (Nd: YAG) laser is a non-invasive and effective means to deal with posterior capsule opacification. Although it is safe, it may have some complications. The purpose of this study was to evaluate the efficacy of Nd: YAG laser capsulotomy in terms of visual outcomes. MethodologyThis retrospective study was carried out at the eye department of Shaheed Mohtarma Benazir Bhutto Medical College, Lyari and Sindh Government Lyari General Hospital, Karachi, by using a convenient sampling technique. The duration of the study was six months from 1 st January 2020 to 30 th June 2020. 50 eyes of patients older than 20 years of age of either gender with posterior capsule opacification after cataract surgery for more than 6 months of duration, capsular fibrosis, and visual distortion due to wrinkling were included in the study. ResultsOur results show that in a total of 50 patients, the mean age was 59.08±5.84 years, of which, 20 (40%) were males. Out of 50 patients, 22 right while 28 left eyes were selected for Nd: YAG laser capsulotomy. None of the patients showed elevated intraocular pressure (IOP) after the 1 st week. Mean IOP was 16.84±3.63 mm of Hg on the 1 st day and mean IOP after 1 st week was 12.48±2.01 mm of Hg. Iritis was observed in 5 (10.0%) patients on the 1 st day and 4 (8.0%) patients on the 1 st week. Raised IOP was observed in 10 (20.0%) cases whereas cystoid macular edema was observed in only 1 (2%) patients on the 1 st day and 1 st week after laser therapy. ConclusionThe study predicted that Nd: Yag laser posterior capsulotomy gives excellent results in terms of visual acuity. Complications that were associated with the Nd: Yag laser capsulotomy was a rise in intraocular pressure, cystoid macular edema, iritis, and IOL pitting.

Introduction: Oral methotrexate (MTX) is the first-line therapy for patients with rheumatoid arthritis (RA). However, not all RA patients respond to MTX. In this study, we will determine the risk factors associated with MTX failure.Methods: This retrospective study was conducted in tertiary care hospital in Pakistan. Data of 612 patients who were diagnosed with RA from June 2019 to January 2021 were retrieved from the medical record room. After inclusion, patients were divided into two groups; respondent and non-respondent. Their characteristics and demographics were compared.Results: Out of the total 612 patients, 112 (18.3%) were labelled as non-respondent to MTX. Nonrespondents had a higher predominance of females (86.6% vs. 60.2%; p-value: 0.001), participants with body mass index (BMI) >25 kg/m 2 (54.4% vs. 22.4%; p-value: <0.00001), smokers (34.8% vs. 18.2%; p-value: 0.0001), participants with diabetes (47.3% vs. 23.4%; p-value: <0.0001) and rheumatoid factor positivity (91.0% vs. 64.8%; p-value: <0.0001). Conclusion:Female gender, higher BMI, smoking, higher disease activity, and diabetes were associated with MTX failure. These easily available parameters can help predict the disease process and outcome of treatment. It is important to screen patients who are at risk of MTX failure, so a contingent treatment plan can be devised, in case patients do not respond to MTX.

Purpose:  To compare the efficacy of the microwave pulse diode laser and argon laser trabeculoplasty in primary open angle glaucoma. Study Design:  Quasi experimental study. Place and Duration of Study:  Shaheed Mohtarma Benazir Bhutto Medical College Lyari and Sindh Government Lyari General Hospital, Karachi, from October, 2017 to March, 2018. Material and Methods:  One hundred and sixty patients, between 42 to 61 years with visual acuity of perception of light to 6/36 were enrolled. Patients diagnosed with POAG were included and patients with intraocular pressure of more than 40 mm Hg, previous glaucoma surgery or laser treatment and narrow angle on gonioscopy were excluded. Ophthalmic examination included visual acuity, slit lamp examination, fundus examination and visual field status using Humphrey perimeter. Patients were divided into two groups. Group A received microwave pulse diode laser (810) and Group B received argon laser trabeculoplasty. Average follow up period was 6 months. Success was assessed objectively by measuring intra ocular pressure and subjectively by visual acuity. Results:  The average time-period for each procedure was 15 ± 5 minutes. In Group A, mean IOP at first week, first month, third month and sixth month was 20.79, 16.34, 16.21and 16.09 mm Hg respectively. While in Group B, IOP at first week, first, third and sixth month was 16.52, 15.76, 13.62, and 12.54 mm Hg at (P < 0.001 in both groups). Conclusion:  Both microwave pulse diode laser and argon laser trabeculoplasty are effective in lowering intra ocular pressures in patients with primary open angle glaucoma.

Objective: Posterior capsule opacification (PCO) after cataract is a common complication of extra capsular cataract extraction with or without intraocular lens implantation. Aim of this study was to evaluate changes in intraocular pressure after Nd-Yag laser posterior capsulotomy for PCO. Methodology: This retrospective study using convenient sampling technique was done at Eye Department of Shaheed Mohtarma Benazir BhuttoMedical College Lyari, Sindh Government General Hospital, Karachi for six months (1st January 2020 to 30th June 2020. After ethical approval and informed permission from patients and guardian, data was collected and analyzed by SPSS version 20 and presented by calculating mean and standard deviation for quantitative data and frequency and percentages for qualitative data. Results: Total 50 patients (20 males and 30 females) were studied where 22 right and 28 left eyes. Mean age was 59.08 years. Mean pre-operative IOP was 13.28 and 13.12 mmHg of right and left eye respectively (Table I). At 2 hours mean IOP was 16.84±3.63 mmHg and after one week 12.48±2.0 mmHg. Base line pre-laser IOP was measured by Goldman Applanation Tonometer (GAT) and slit lamp examination. Pupils were dilated using 1% tropicamide eye drops. IOP was evaluated immediate post-procedure, two hours post–procedure and one week from date of laser. Conclusion: Nd –Yag laser capsulotomy is treatment of choice for PCO and associated with complications like Raised Intraocular Pressure (IOP), Intraocular lens pitting, cystoid macular oedema, retinal detachment. Raised IOP is most common complication and prescribing anti-glaucoma drugs in order to decrease intraocular pressure.