Background The emergence of the COVID-19 pandemic has affected the lives of many people, including medical students. The present study explored internet addiction and changes in sleep patterns among medical students during the pandemic and assessed the relationship between them. Methods A cross-sectional study was carried out in seven countries, the Dominican Republic, Egypt, Guyana, India, Mexico, Pakistan, and Sudan, using a convenience sampling technique, an online survey comprising demographic details, information regarding COVID-19, the Pittsburgh Sleep Quality Index (PSQI), and the Internet Addiction Test (IAT). Results In total, 2749 participants completed the questionnaire. Of the total, 67.6% scored above 30 in the IAT, suggesting the presence of an Internet addiction, and 73.5% scored equal and above 5 in the PSQI, suggesting poor sleep quality. Internet addiction was found to be significant predictors of poor sleep quality, causing 13.2% of the variance in poor sleep quality. Participants who reported COVID-19 related symptoms had disturbed sleep and higher internet addiction levels when compared with those who did not. Participants who reported a diagnosis of COVID-19 reported poor sleep quality. Those living with a COVID-19 diagnosed patient reported higher internet addiction and worse sleep quality compared with those who did not have any COVID-19 patients in their surroundings. Conclusion The results of this study suggest that internet addiction and poor sleep quality are two issues that require addressing amongst medical students. Medical training institutions should do their best to minimize their negative impact, particularly during the current COVID-19 pandemic.

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Background: Sweat excretion from eccrine sweat glands, is primarily considered for theromoregulation. It loses body heat by means of it is more active during exercise or hot environmental conditions. In Ayurveda, sweat (Sveda) is defined as the waste product of fat tissue (Meda Dhatu). Besides it is also linked to Pitta Dosha, responsible for all metabolic process in the body. Aim and Objective: Thus it is proposed that sweating regulates temperature but also reduces the metabolism. This may lead to loss of appetite, lesser energy and also compromised digestive potential (Jatharagani). Materials and Methods: This review initially focuses on the basic mechanisms of eccrine sweat secretion and its role in temperature regulation from Ayurveda as well as modern point of view followed by critical discussion of Ayurvedic concepts in the light of modern knowledge. Observations: In Ayurveda, collection, transportation and excretion of Sveda is under the regulation of Pita Dosh, Agni, Samana Vayu and Vyana Vayu through Svedavaha Srotas and Ambuvaha Srotas by Gati & Gyan. Scope and Limitations: This ayurvedic concept has revealed a clear and detail mechanism of temperature and appetite regulation by stomach, Rashdhatu and Lasika. They are taking an important role before the action of blood and sweating. The clinical trial should be done in future to make this concept completely valid.

This paper examines the scenario of research orientation in Ayurveda educational institutions of India. We demonstrate through the data obtained by searching the SCOPUS that the actual research output by these institutions is not very significant in terms of number of publications. While a lack of research expertise and infrastructure is one contributing factor to this status, a lack of questioning attitude is more crucial one. Mushrooming of new colleges, laxity in regulations, corruption, lack of atmosphere for ethical and quality research make the problem more complex. We show, with the help of SCOPUS Data, that the recent trend of establishing stand-alone institutions of Ayurveda may not help in invigorating research activities since the research contributions from such institutions have always been very poor. Instead, we suggest that existing stand-alone institutions of Ayurveda be merged with other established Central/State universities or other Medical colleges. The data demonstrates that the research output has been always significant when an institution has many experts working in different streams of science within, than when the institutions have only Ayurveda experts. We also take up the question of designing the clinical trials that are suitable for Ayurveda and propose an algorithm that may be considered for research in educational institutions, at least at doctoral level. We further enlist a set of recommendations that could potentially change the scenario. Evidence-informed policy making, inducting clinicians into the education system, making the curricula more attractive by including recent advances, introducing efficient faculty training programs, and rigorous implementation of the existing regulations - are some of the key recommendations we have made.

Objective: To determine the effectiveness of Fragility Fracture Integrated Rehabilitation Management (FIRM) on mobility, activity of daily living and cognitive functioning in elderly with hip fracture. Methods: A randomized control trial was conducted at Seoul National University Bundang Hospital, South Korea from August 2017 to January 2018. Patients of both genders with the age 65-95 years, diagnosed cases of hip fracture specifically fractures neck of femur, intertrochanteric, subtrochantric, patients who got bipolar hemiarthroplasty, total hip replacement arthroplasty, reduction and internal fixation were included in this study. A total of n=39 sample was collected through non probability convenience sampling technique and randomly divided into Fragility Integrated Rehabilitation Management (FIRM) group (n=20) and Conventional Physical therapy (CPT) group (n=19). The data was collected through KOVAL for walking ability, modified barthal index (MBI) for behaviors related to activities of daily living (ADLS) and mini mental status examination (MMSE) for cognitive functions at baseline on 2nd postoperative day and after 10th FIRM session on 15th postoperative day. Results: The mean age of study participants was 82.07±6.00 years. The post intervention comparison did not show any significant difference (p>0.05) in walking ability, overall ADLs and cognitive functioning. But FIRM group showed significant improvement in stair climbing {0(5) ver. 2(7.5), p=0.049} and ambulation or walker use {8(5) ver. 2(4), p=0.037}, as compared to CPT group. Conclusion: Both groups improved in indoor mobility with walker and crutches as well as activities of daily living. But FIRM showed more improving ambulation with walker and stair climbing. While cognitive functioning was observed only in FIRM group. ClinicalTrials.gov Identifier: NCT03430193. https://clinicaltrials.gov/ct2/show/NCT03430193. doi: https://doi.org/10.12669/pjms.36.5.2412 How to cite this:Aftab A, Awan WA, Habibullah S, Lim JY. Effects of fragility fracture integrated rehabilitation management on mobility, activity of daily living and cognitive functioning in elderly with hip fracture. Pak J Med Sci. 2020;36(5):---------.   doi: https://doi.org/10.12669/pjms.36.5.2412 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.