Objective: To evaluate the knowledge and practice of gynecologists with regard to oral and dental health during pregnancy. Design of the Study: It was a cross-sectional study. Study Settings: This study was carried out at Outpatient Department of Dentistry Combined Military Hospital, Lahore from January 2019 to July 2019. Methods & Materials: The questionnaire was distributed among 450 gynaecologists. The evaluation tool was questionnaire. It was consisted on 23 items in which 18 questions were about the knowledge and five questions about the practice. The response of the respondents was received as yes or no. All the collected data entered in software and statistical analysis of data was done using the SPSS version 22.0. For quantitative variables mean and standard deviation were calculated. Qualitative variables were presented in the form of frequency and percentage. Results: In our study response rate was found to be 84.4%. During pregnancy related to the oral healthcare average of gynaecologist’s knowledge was 12.31±2.73 which showed that they have appropriate knowledge level. During pregnancy related to the oral healthcare measures average of gynaecologist’s knowledge was 3.31 ± 1.256 which exhibited that they have appropriate knowledge level of practices measures. A significant relationship between year of graduation and gynaecologist’s knowledge was observed (P = 0.31), whereas insignificant relationship between graduation year and practice was observed (P = 0.763). During pregnancy related to the need of oral and dental care before & during pregnancy gynaecologist’s knowledge was 3.67 ± 1.035. Conclusion: Gynecologist’s knowledge about oral and dental hygiene measure during the pregnancy was appropriate. Women who are planning their pregnancy must get knowledge from dentist, obstetricians and gynecologists to reduce the rate of complications. Effect of pregnancy on oral and dental hygiene is on the one hand and inhibition from its side effects is on the other hand. Keywords: Gynecologist, Oral Health, Pregnant women

Context:Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation in children and it occurs in approximately 1:2,000-1:4,000 newborns.Aims and Objectives:The aim of this study is to determine the frequency of CH in neonates.Settings and Design:This cross-sectional study was conducted in neonatal units of the Department of Pediatrics Unit-I, King Edward Medical University/Mayo Hospital, Lahore and Lady Willington Hospital Lahore in 6 months (January-June 2011).Materials and Methods:Sample was collected by non-probability purposive sampling. After consent, 550 newborn were registered for the study. Demographic data and relevant history was recorded. After aseptic measures, 2-3 ml venous blood analyzed for thyroid-stimulating hormone (TSH) level by immunoradiometric assay. Treatment was started according to the individual merit as per protocol.Statistical Analysis Used:Data was analyzed by SPSS 17 and Chi-square test was applied to find out the association of CH with different variables.Results:The study population consisted of 550 newborns. Among 550 newborns, 4 (0.8%) newborns had elevated TSH level. CH had statistically significant association with mother's hypothyroidism (P value 0.000) and mother's drug intake during the pregnancy period (P value 0.013).Conclusion:CH is 0.8% in neonates. It has statistically significant association with mother's hypothyroidism and mother's drug intake during pregnancy.

Autologous blood donation (ABD) has been widely recommended. Data from one of the oldest hospital-based programmes in Canada describe both activities and drawbacks. Data were compared over the nearly two decades of activity that peaked in 1996. A 5-year review of recent activity showed that of the 2410 patients referred for consideration, 1823 (75.64%) were accepted into the programme. Surgical services requested 5825 units of autologous blood. Of these, 3147 units were donated by 1536 patients, 803 units were transfused in the operating room and 558 units were given postoperatively. In total, only 1361 units (43.25%) were transfused. The mean age of the patients was 58 years (median 61 years and mode 69 years). The haemoglobin concentrations before donation were significantly higher, averaging 145.2 g L(-1) before donation and 114.9 g L(-1) immediately before surgery, whereas at the time of discharge, the haemoglobin concentration averaged 126.2 g L(-1) (P = 0.0001) in transfused patients. Data from this well-established ABD programme indicate less than 50% overall utilization. The activity in the programme increased until 1996 following which it dropped progressively. The low haemoglobin concentration after surgery is of concern and should foster a transfusion algorithm for these patients.

Backgroud: Hypocalcemia can be defined as a state when serum calcium level is less than 7 mg/dl in preterm neonates and less than 8 mg/dl in term neonates and less than 8.5 mg/dl in older children. Nutritional rickets is commonly associated with rickets in children. Objective: To determine the common etiological factors of hypocalcemia and nutritional rickets in children. Study design: Cross sectional analytical study. Place and duration of study: This study was conducted in the department of Pediatrics, King Edward Medical University/Mayo hospital Lahore from March 1998 to January 2001. Patients and methods: 120 patients (2 months to 60 months) who presented with tetany, clinical and skeletal manifestations of rickets and seizures were included in the study. Biochemical profile (serum calcium, phosphate and alkaline phosphatase) and radiographs of wrist joint were done. Each child was accessed for age, sex, feeding pattern, exposure to sunlight, number of children in family, maternal age, educational sta tus of mothers, presenting features of the disease, total calcium, phosphate and alkaline phosphatase level in the serum and X-ray wrist. Results:: The study group comprised of 120 children (72 boys & 48 girls) ranging from 2 months to 3.5 years. 65% of the children had weight below 5th centile on National Center for Health Statistics charts. 32% of children got sunlight exposure for less than 30 minutes/week and 16% got it for 30-120 minutes/week. Out of total 120, 110 were below 2years among these 110, 9% were exclusive breast fed, 35% got diluted fresh milk, 1% got formula milk and 13% got both breast and bottle feeding. In 45% children weaning was not started. 47.5% couples had 2 or more children. 72% mothers were below 30 years of age, at the time of interview. 31% of the mothers were uneducated. 85% children had seizures at the time of presentation. Out of these 24.51% had upper respiratory tract infection and 51.96% had lower respiratory tract infection 79% had clinical signs of florid rickets. 67.5% of patients were had serum calcium between 6 & 7mg/dl, 69% were had serum phosphate level < 4 mg/dl and 76% had alkaline phosphatase level >1000IU/L. Conclusion: Hypocalcemia represents a major health problem in Pakistani children. Infants under 2 years of age are liable to have vitamin D deficiency rickets particularly if they are exclusively breastfed or received fresh milk with reduced exposure to sunlight. The higher the level of education of mothers, the less likely is the chance that their children become rachitic. Hypocalcemia can present with a wide variety of symptoms, the most important of which are seizures and recurrent chest infections. Rickets must be looked for as an underlying cause of these complaints.

Introduction: This study aims to provide more insight on the ideas of whether the supportive leadership is able to influence employees' decision making and how leaders enhance their work group effectiveness as well as encourage work group member retention that will strengthen bottom-line performance. A sample of 161 respondents was chosen through convenience sampling technique. The data were collected from employees working in the tertiary care hospital. Methodology: The data collection tools will be used for this project are Supervisory Support Scale (SSS) and demographic variables developed by Mc Gilton in 2010.Demographic variable: Demographic variable involves Age, Gender, Experience, Qualification, and Department. Supervisory Support Scale (SSS): The 15-items likert scale will be used to collect data from nurses who are working in critical care unit. The nurses will require indicating their opinions by circle from 1=Never, 2=Seldom, 3=occasionally, 4=Often, 5=Always (McGilton, 2010). Dependent tool: A clinical decisionmaking questionnaire with a scale of 27 items was used to collect data. Clinical decision making scale: A clinical decision-making scale of 27 items will used to assess the frequency of decision-making. Each item had a four-point likert scale (1 = Never: 2= rarely; 3 = Sometimes; 4= Always) (Austin, 2010). Results: Pearson Correlation analysis and Multiple Linear Regression analysis were used to test the hypotheses. The results revealed employees' working performance was positively influenced by directive, supportive, participative and achievement-oriented leadership styles. Results: positive linear correlation between Supervisory Support Scale and Nurses decisions at clinical area and the p=.155. Conclusion: Majority of the nurses in critical care units are females and most lie in the age bracket of23 to 40 years. More than half of the nurses in critical care units have professional qualifications of diploma in general nursing and above and majority is appointed at registered nurse levels. There is moderate decision-making among nurses and that acquiring CVP readings, collecting bronchial cultures and conducting history taking & performing physical examination scored the highest as the decisions most commonly made and performed.

The practice of medicine has been transformed by antimicrobials. However, overuse and misuse of anti-microbials is one of the major global health problems. Longer and expensive hospital stays are expected for those patients who are suffering from multi-drug resistant organisms.1       Antibiotic stewardship is an emerging concept and may be defined as coordinated interventions to imp-rove and measure the appropriate use of antimicrobials with selection of the optimal antimicrobial drug regimen, duration, dose, and route of administration.” Antibiotic stewardship program (ASP) is aimed to tar-get the antibiotic related optimal clinical outcomes, minimal toxicity and adverse events, cost reduction for infections, and curtail the selection for antimicrobial resistant strains.Centre for disease control and prevention (CDC) has described core elements of hospital ASP, the essentials of these are leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.2 This program has larger impact on infection rates, resistance patterns, costs and clinical outcomes in many studies.3, 4       Pakistan, being the developing country, is facing the problem of antimicrobial resistance at large due to irrational use of antimicrobials. Review of data on drug use in Pakistan shows the excessive and irrational drug use in Pakistan with higher use of antimicrobials and injections and choice of more expensive drugs with inadequate dispensing, compared to the lower middle income countries. The injudicious use of anti-microbials attribute towards antimicrobial resistance and emergence of new mutant strain.5-8       In Pakistan, there is need to conduct drug utilization to identify appropriate usage of drugs in terms of medical, social and economic aspects. To overcome the problem, strategies to decrease unnecessary anti-biotic prescription like “Antibiotic Stewardship Programs” must be implemented.9 In Pakistan, Medical microbiology and Infectious diseases society of Pakis-tan (MMIDSP) has taken initiative to develop indigenous ASP and training program. The ASP should be the part of undergraduate curriculum to sensitize our future doctors. The regulatory authorities should also be active in monitoring the judicious use of antimicrobials. The masses should have easy access to the quality health care services, so as to minimize the irrational antimicrobial use.

Objective:To assess the clinical teaching skills of Pediatrics’ residents as rated by final year MBBS students by using augmented Stanford Faculty Development Program questionnaire (SFDPQ) in a teaching hospital, Lahore.Methods:This cross- sectional survey was conducted in the Department of Pediatrics, King Edward Medical University, Lahore in six months in 2016.Total of 265 students of final year MBBS, attending the teaching sessions organized by residents during their four weeks rotation in Pediatrics were included by non-probability purposive sampling. The augmented SFDPQ was emailed to the study participants after the completion of the clinical rotation, following several encounters with the resident. The data was entered in SPSS 22 for statistical analysis. Scores for each domain (learning climate, control of session, communication of goals, promoting understanding and retention, evaluation, promoting self-directed learning, teacher’s knowledge and teacher’s attitude) were also presented as mean and standard deviation. One-sample Kolmogorov-Smirnov test was applied to observe the normality of data. Where normality of data was observed, independent sample t-test was applied and where normality of data was not observed, Mann-Whitney U test was applied to compare the score between genders. Score of four was considered as cut off score for satisfactory results.Results:Out of 265 students, 250 responded with response rate of 94.3%. Out of 250 medical students, 105 (42.0%) were male and 145(58.0%) were female. The internal consistency (Cronbach’s alpha) of this score was excellent (0.973). The mean score for all SFDPQ domains was also sub-optimal (2.90±0.611). The mean total score was sub-optimal for learning climate (3.39±0.69), control of session (3.25±0.77), communication of goals (3.26±0.86), promoting understanding and retention (3.26±0.77), evaluation (2.25±0.67), promoting self-directed learning (3.17±0.90), teacher’s knowledge (3.14±0.93) and teacher’s attitude (3.31±0.89), while it was good only for feedback (4.03±0.11). The mean total score for all SFDPQ domains in males and females was 3.05±0.54 and 2.79±0.64 respectively. Although sub-optimal in both the genders, the score was significantly higher in males with p-value 0.001.Conclusion:We found suboptimal clinical teaching skills of Pediatrics’ residents as rated by final year MBBS medical students.

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