BackgroundThe present study aimed to evaluate psychological impact of COVID-19 outbreak on postgraduate trainees in Pakistan by quantifying the symptoms of depression, anxiety and acute stress disorder and by analysing potential risk factors associated with these symptoms.MethodsFollowing Institutional Review Board approval, a cross-sectional study was conducted among 10,178 postgraduate trainees following COVID-19 outbreak through e-log system of College of Physicians and Surgeons of Pakistan. The nine-item Patient Health Questionnaire, seven-item Generalised Anxiety Disorder scale and Stanford Acute Stress Reaction Questionnaire were used to collect data. Statistical analyses were conducted using SPSS.26. Descriptive statistics, Mann-Whitney U test, the χ2 test and logistic regression analysis were performed. The significance level was set at α=0.05.ResultsThe prevalence of depressive symptoms, generalised anxiety disorder and acute stress disorder were 26.4%, 22.6% and 4.4%, respectively. Female postgraduate trainees, senior trainees and front-line workers reported experiencing more anxiety, depression and acute stress symptoms (p value<0.001). Logistic regression showed that being a front-line and senior staff member and female was associated with higher risk of experiencing symptoms of depression, anxiety and acute stress.ConclusionsOur study findings raise concerns about the psychological well-being of postgraduate trainees during the acute COVID-19 outbreak in Pakistan. It is necessary to employ strategies to minimise the psychological distress and provide adequate psychosocial support for postgraduate trainees during crisis situation such as COVID-19 pandemic.

Objective: Our study was designed to explore the frequency of hypoglycemia events in type 2 diabetic patients. We further aimed to correlate the hypoglycemia events with treatment regimes and diabetes duration. Place and Duration: Mayo Hospital Endocrine Outpatient Department. From 1-04-2022 to 30-06-2022. Study type: Clinical based study Methodology: We used the already tested questionnaire from the American Diabetes Association and The Endocrine Society to collect the relevant information. The questionnaire was translated into the local language to facilitate the interview. Copies of the questionnaire were distributed to 1000 patients at the study site. The questionnaire was based on socio-demographic and clinical information including gender, age, duration of diabetes, treatment, frequency of hypoglycemia events, and symptoms. Chi-square was used to analyze the association of risk factors. While odd ratios were also computed at a 95% confidence interval. P-value <0.05 was considered for statistical significance. Results: Total of 360 cases T2DM had hypoglycemic events with a prevalence of 36%. The mean age of patients was reported as 51 years. A total of 200 cases were found in the mentioned age group with a 55.56% prevalence. Elderly age patients were also the secondary target of hypoglycemia with a prevalence ratio of 27.78%. Out of these 360 patients, 320 (86.11%) had mild to moderate hypoglycemia with symptoms of eye tarnishing, tremors, numbness of the tongue, and drowsiness while 15% of cases lost their consciousness and were categorized as severe events of hypoglycemia. Conclusion: The study concluded on a note that insulin-treated patients should be aware of the hypoglycemia events because in these cases the risk is comparatively high than in others. Keywords: Diabetes mellitus, Insulin, Hypoglycemia

doi: https://doi.org/10.12669/pjms.38.5.6464 How to cite this:Ali SMH, Masood HMU, Malik A. Need for a single standardized licensing & residency-entrance level exam policy in the medical education system of Pakistan. Pak J Med Sci. 2022;38(5):1083-1085. doi: https://doi.org/10.12669/pjms.38.5.6464 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: Gallstones are very common worldwide with a prevalence of 6% in men and 29% in women of all ages. Laparoscopic cholecystectomy is the gold standard treatment for gallbladder diseases associated with frequent complication of haemorrhage. Applying direct pressure or electrocauterization can be used for securing hemostasis and pain control. Objective: To compare hemostatic control by direct pressure versus electrocauterization while dissecting the gall bladder from liver bed during laparoscopic cholecystectomy in terms of intra-operative bleeding, Post-operative bleeding and pain. Methods: This randomized controlled trial was conducted at Surgical Unit of Mayo Hospital Lahore. Total 200 patients were enrolled, in 100 patients haemorrhage from liver bed was controlled by applying direct pressure with the help of gauze for 5 minutes (Group A) and remaining 100 patients (Group B) it was controlled by electrocauterization. Intra-operative bleeding. post-operative bleeding, and post-operative pain scores were recorded and all patients were discharged after 24 hours of close monitoring. Results: The mean age of cases in A Group and B group was 40.38 ± 12.30 and 42.15 ± 10.40 years res-pectively. Intraoperative bleeding was secured in 85 (85%) patients in Group-A and in 96(96%) patients in Group-B. Group-B treatment was more effective than Group-A treatment for bleeding (p-value= 0.008). Mean pain score of patients at 12th hour was 4.76 in group A and 5.55 in Group B. It was 3.09 in group A and 3.60 in group B at 24th hour postoperatively with p-value of 0.0001. Conclusion: Electrocauterization is a better technique for hemostasis of liver bed in comparison with direct pressure during laparoscopic cholecystectomy.