Journal of Shalamar Medical & Dental College

ChatGPT-4 versus human generated multiple choice questions - A study from a medical college in Pakistan

2024-12-31T11:39:41+00:00

Background: There has been a growing interest in using artificial intelligence (AI) generated multiple choice questions (MCQs) to supplement traditional assessments. While AI claims to generate higher-order questions, few studies focus on undergraduate medical education assessment in Pakistan.

Objective: To compare the quality of human-developed versus ChatGPT-4-generated MCQs for the final-year MBBS written MCQs examination

Methods: This observational study compared ChatGPT-4-generated and human-developed MCQs in four specialties: Pediatrics, Obstetrics and Gynecology (Ob/Gyn), Surgery, and Medicine. Based on the table of specifications, 204 MCQs were ChatGPT-4-generated and 196 MCQs were retrieved from the question bank of the medical college. ChatGPT-4-generated and human-generated MCQs were anonymized and MCQs quality was scored using a checklist based on the National Board of Medical Examiner criteria. Data was analyzed using SPSS version 23 and Mann-Whitney U and Chi square tests were applied.

Results: Out of 400 MCQs, 396 MCQs were included in the final review as four MCQs were not according to the table of specification. Total scores were not significantly different between human-generated and ChatGPT-4 generated MCQs (p=0.12). However, human-developed MCQs performed significantly better than ChatGPT-4-generated MCQ in Ob/Gyn (p=0.03). Human-developed MCQs scored better than ChatGPT-generated MCQs in the item checklist “stem includes necessary details for answering the question’’ in Ob/Gyn and Pediatrics (p < 0.05) as well as in "Is the item appropriate for cover the options rule"? in Surgery.

Conclusion: With a well-structured and specific prompting, ChatGPT-4 has the potential to assist in medical examination MCQ development. However, ChatGPT-4 has limitations where in depth contextual item generation is required.

Carotid sinus massage: A reconsideration in supraventricular tachycardia

2024-12-31T11:40:01+00:00

Background: Supraventricular tachycardia (SVT) is attributable to the orthodromic re-entry phenomenon when tachycardia is secondary to normal anterograde electrical conduction.

Objective: To determine the clinical efficacy of carotid sinus massage in terminating the episode of supraventricular tachycardia and the incidence of adverse events associated with carotid sinus massage.

Methods: A Quasi experimental pretest post-test study was conducted in the emergency department of CMH Multan after Institutional ethical approval (13/Trg, ERC no. 22/2024) from 20^th March to 15^th June 2024. This study involved 200 patients, above 25 years of age, presenting to the emergency department with palpitations. Standard 12 lead electrocardiogram was done to diagnose SVT. After informed consent was obtained, patients were placed supine with the neck slightly extended and turned to the opposite side. Carotid sinus massage (CSM) was done, and patients were retained in the emergency detention room. The efficacy of CSM was assessed by termination of SVT within 30 seconds of CSM and incidence of its adverse events was noted during or 1 hour after the CSM procedure.

Results: The mean age of study participants was 35.55±8.6 years and the majority were females (59.5%). The CSM was successful in terminating SVT in 18.5% of the patients. The frequency of adverse events of CSM was dizziness (3.5%), vomiting (2.5%), syncope (1.5%), exacerbation of arrhythmia (3.5%), and temporary neurologic complications (1%). The success rate of CSM was higher in non-diabetic patients (p=0.020) and those reporting within 2 hours of the onset of the first episode of SVT(p=0.000).

Conclusion: Carotid sinus massage is an effective and safe intervention for early-on spot management of supraventricular tachycardia.

Association between microvascular complications and chronic kidney disease stages in type 2 diabetic patients

2024-12-31T11:39:32+00:00

Background: Rapid urbanization and lifestyle changes have led to a surge in type 2 diabetes mellitus (T2DM) rates and its microvascular complications.

Objective: : To assess the association between microvascular complications and the stages of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus and to compare HbA1c levels across the different stages of CKD.

Methods: It was a cross sectional descriptive study conducted from 27^th October 2022 to 26^th April 2023 at outpatient Department of Nephrology, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan. Data was collected after approval from the Ethical Research Committee (LUMHS/REC/-243). Informed consent was obtained from 136 patients, males and females, 45 to 65 years of age, type 2 diabetics (for more than 10 years) with diagnosed CKD. The modification of diet in renal disease (MDRD) formula was used to estimate eGFR for chronic kidney disease staging. Diabetic retinopathy was diagnosed using fundoscopic examination and diabetic neuropathy was confirmed by symptoms and positive signs on examination. Data analysis was performed using SPSS version 22. A p-value of ≤ 0.05 was deemed statistically significant.

Results: Out of 136 patients, 75 (55.15%) were males and 61 (44.85%) were females. Mean age, eGFR, HbA1c, and duration of diabetes were 53.27 ±6.39 years, 54.55±27.26 mL/min/1.73 m², 9.02±1.67% and 14.06±4.05 years. The analysis showed that 8.1%, 40.4%, 22.05%, 22.05%, and 7.4% of patients were in CKD stages 1, 2, 3, 4, and 5, respectively. There was a significant association between diabetic microvascular complications, retinopathy and neuropathy, and the stages of CKD (p<0.05).

Conclusion: There is an association between microvascular complications i.e. neuropathy and retinopathy and the stages of CKD in type 2 diabetic patients. Additionally, HbA1c levels varied across CKD stages, highlighting the relationship between glycemic control and kidney function.

Neck and shoulder pain in students: Unveiling associated factors of video display terminal devices use

2024-12-31T11:39:51+00:00

Background: Neck and shoulder pain is becoming a major public health concern due to increased use of digital display terminal devices. It negatively affects individual’s health and results in a burden on health care system.

Objective: To determine the frequency of neck and shoulder pain and identify the factors associated with it among students who use video display terminal (VDT) devices.

Methods: This cross-sectional study was conducted from June 2022 to October 2022 in various colleges and universities of the Punjab, Pakistan using a web-based survey. Convenience sampling technique was used to include 415 undergraduate students. A self-structured questionnaire was used to collect data of sociodemographic details and ergonomic practices. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 23. A p-value of ≤ 0.05 was considered as statistically significant.

Results: The mean ±SD age of respondents was 21.3±2.8 years. Neck and shoulder pain was reported by 40.2% of the students who used VDT devices. Gender, course of study, and frequency of taking breaks while using VDT device were significantly associated with neck and shoulder pain (p values ≤0.05).

Conclusion: About 40% of the students reported having neck and shoulder pain. Neck and shoulder pain was more frequent in females, allied health sciences students and those taking frequent breaks.

Self-medication practices in mothers with children under 5 years of age visiting tertiary care hospital

2024-12-31T11:40:24+00:00

Background: Self-medication refers to the practice of individuals using medications to treat their own conditions. Improper utilization of medications without a prescription results in undesirable side effects, detrimental drug interactions, and the emergence of antibiotic resistance, which is becoming a growing problem in developing nations due to the rising burden of infectious diseases.

Objective: To find out the frequency of self-medication practices and the factors associated with it among mothers with children under 5 years of age.

Methods: This descriptive cross-sectional study was conducted at the outpatient department of pediatrics, Holy Family Hospital, Rawalpindi, Pakistan from March 2023 to June 2023. A total of 267 mothers with children younger than five were included in our study. Informed consent was obtained from mothers and maternal socio-demographic characteristics, self-medication knowledge, practice, motivation, and attitude were all documented. The data was analyzed using SPSS version 26. The association between self-medication and other factors was analyzed using Chi Square and Fisher’s Exact tests. A p-value < 0.05 was considered statistically significant.

Results: Self-medication was practiced by 94.4% of the mothers.. There was an association between maternal education level and self-medication practices (p=0.000). No association was found between employment status and self-medication practices (p=0.336). Fever was the most common illness for which mothers self-medicated their children (p=0.002).

Conclusion: Self-medication is common among mothers of children under 5 years of age and is associated with maternal education level, with the highest frequency among the uneducated mothers. Maternal awareness and knowledge regarding the hazards of self-medication is of profound significance.

Enhancement of myocardial recovery with terminal ‘hot shot’ cardioplegia

2024-12-31T11:40:12+00:00

Background: Terminal ‘hotshot’ (THS) cardioplegia is a technique that might contribute into myocardial protection in patients undergoing cardiac surgery.

Objective: To determine the effect of THS cardioplegia administration in patients undergoing coronary artery bypass grafting (CABG).

Methods: A randomized control trial (ACTRN12624001225505) was conducted from 20th December 2023 to 10th February 2024 involving 60 patients admitted from the outpatient department for elective CABG at Faisalabad Institute of Cardiology, Faisalabad, Pakistan. It was a single-blinded study and the patients were randomized into two equal groups, group A (control group) and group B (experiment group). During the surgery performed utilizing a Cardiopulmonary Bypass (CPB) machine, both groups received cold blood cardioplegia to arrest the heart, providing a quiescent field at the start of the grafting process in CABG. In group B patients, 100 ml of THS volume was given to each of the grafted territories via saphenous vein grafts and the rest of the volume from the total of 500 mL was given in the aortic root via the antegrade cardioplegia cannula for maximum myocardial distribution. The levels of Troponin I (TnI) and Creatinine Kinase MB (CK MB) were measured in the blood one hour after regaining sinus rhythm and on 5th postoperative day (POD). Durations of postoperative Inotrope use, intubation, aortic cross-clamp, CPB time, time to regain sinus rhythm, and ICU stay were recorded in both the groups. Data was entered and analyzed using SPSS version 25. A p-value ≤ 0.05 was considered statistically significant.

Results: Mean age of the participants was 58.9±7.36 years. The levels of TnI were lower in group B than in group A one hour after regaining sinus rhythm (0.20±0.076 ng/ml and 0.31±0.058 ng/ml respectively, p-value <0.001) as well as on the 5th POD (0.15±0.663 ng/ml and 0.26±0.051 ng/ml respectively, p-values<0.001). CK MB levels were also lower in group B than in group A one hour after regaining sinus rhythm (48.4±25.13 IU/L and 70.5±29.00 IU/L respectively) as well as on the 5th POD (39.2±19.44 IU/L and 71.0±37.08 IU/L respectively, p-values<0.05). Inotropic support was used for a shorter time in group B than in group A (5.9±1.99 hours and 7.0±1.87 hours respectively, p-value=0.031). There were no significant differences in the durations of intubation, ICU stay, cross-clamp time, CPB time, and the time to regain sinus rhythm between the two groups (p-values>0.05).

Conclusion: ‘Hot shot’ cardioplegia decreases the release of TnI from the myocardial cells post-cardiac surgery. The inotropic support time is also shortened when THS cardioplegia is used.

Surgeons’ awareness about ergonomics in the operation theatre

2024-12-31T11:39:21+00:00

Background: Musculoskeletal symptoms are common among surgeons who work in an environment that is not ergonomically ideal.

Objective: To determine the surgeons’ awareness of ergonomics in the operation theatre and factors that may lead to musculoskeletal symptoms.

Methods: A cross-sectional study was conducted from January to March 2024 in the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. The survey was conducted among 110 surgeons working in different surgical specialties. A 30-item questionnaire was designed to ascertain knowledge, attitude, and practices about posture ergonomics among surgeons and was distributed online using Google Forms. The severity of pain was calculated using the Visual Analogue Score (VAS). Factors that contribute to musculoskeletal symptoms were also investigated. Data was collected and analyzed using SPSS version 26

Results: A total of 74 doctors responded to the questionnaire. Out of these, 71.6% were males and 28.4% were females, with a mean age of 38.87±11.4 years. The majority (91.9%) had some discomfort or pain during/after performing the surgery. Backache was the most common (22.8%), followed by pain in the legs (21.4%), neck (17.8%), shoulders (16.6%), hands (14.6%), and wrists (6.8%). Prolonged standing in the same position (52.7%), bad posture (33.8%), and performing a large number of surgeries daily (33.8%) were the major factors for their symptoms. Most surgeons (85.1%) knew about ergonomics in general. Only 32.4% of responders had received ergonomics education, while 67.6% did not.

Conclusion: There is a deficiency of awareness of ergonomics among surgeons. Lack of ergonomics training and inadequate operation theatre resources are the leading causes of surgeons' pain with postural ergonomics.

Simulation in health profession education in Pakistan: Bridging gaps, building futures

2024-12-31T11:40:37+00:00

Simulation-based education (SBE) has revolutionized health profession education (HPE) globally, addressing gaps in clinical training, patient safety, and competency-based learning.¹ In Pakistan, the adoption of SBE reflects a growing acknowledgment of its potential to transform healthcare education in resource-constrained settings.²However, landscape of SBE in Pakistan remains a dynamic interplay of opportunities and challenges.³