Background There is a lack of data about antibiotic prescription trends and patterns of inappropriate antibiotic stewardship in COVID-19 patient management.   Objective To determine frequency and pattern of antibiotic prescription in COVID-19 patients presenting in DHQ teaching hospital, Sahiwal.    Methods This observational cross-sectional prospective study was conducted from 1st June 2020 to 31st March 2021 in patients admitted in COVID isolation facility of DHQ Teaching hospital, Sahiwal with confirmed COVID-19 infection. Patients of all ages and of both genders were included. Data was collected by a pre-designed proforma. Data included patient’s age, gender, co-morbid conditions, type and duration of antibiotic use, and details of prescribing physicians. Descriptive statistics were applied to determine frequency and percentages of variables.   Results Out of 800 participants, 543(67.8%) were males, and the remaining 257 (32.1%) were females. The majority 328(41%) of patients belonged to the age group 40-60 years. 639(79.8%) patients had co-morbidities. Diabetes mellitus was the most common co-morbid condition 248 (31%). Antibiotics were prescribed to all patients 800 (100%) before admission to the COVID Isolation facility. The majority of patients 348 (43.5%) had used antibiotics for 3-7 days before admission. Macrolides class was the most commonly prescribed antibiotic 417 (52.1%). General practitioners had more tendency to prescribe antibiotics 509(64%) as compared to medical specialists 212(26.5%) and pulmonologists79 (9.8%).   Conclusion Antibiotic stewardship needs to be improved in COVID-19 patients and prescription should be evidence-based aided by laboratory tests. The development of local guidelines for judicious antibiotic prescription in COVID-19 will help in preventing antibiotic resistance.   Key Words Antibiotics, antibiotic resistance, COVID-19, drug prescription, SARS-cov-2

Background: Pathological changes that mainly affect prostate gland are prostatitis, benign prostatic hyperplasia (BPH) and cancerous lesions. Digital rectal examination (DRE), Transrectal Ultrasonography (TUS), and prostate specific antigen (PSA) followed by histopathological examination, are routinely used tests for diagnosis of prostate lesions. The aim of the present study is to determine the role of serum PSA levels in differentially diagnosing the different types of prostate lesions.Material and Methods: This retrospective (observational) study was conducted in Ibn-e-Sina Hospital Multan. Data of 2189 patients who were operated from 2007 to 2017 due to prostatic lesions were included in this analysis. Patients with BPH, prostatitis, prostate carcinoma and Prostatic Intraepithelial Neoplasia (PIN) were grouped according to serum PSA levels (ranging from 0 to >100 ng/ml) into five groups. Frequencies and percentages were calculated for different histopathological findings. Association of PSA levels with different histological patterns was determined with chi-square test with P-value < 0.05 taken as significant difference.Results: Mean age of patients was 62.45+10.64 years. On histopathology, BPH was diagnosed in 1676 (76.56%) patients, prostatitis in 133 (6.07%), carcinoma in 378 (17.26%) and PIN in 02 (0.09%) patients, respectively. Serum PSA levels of 4.01-10 ng/ml were found in 1050 (62.64%) BPH patients and in 59 (44.36%) prostatitis patients. Serum PSA levels of 10.01-20 ng/ml were found in only 40 (2.4%) BPH patients, 47 (35.33%) prostatitis patients, 22 (5.82%) carcinoma patients and in 1 (50.0%) PIN patient. Serum PSA levels of 20.01-100 ng/ml were found in 32 (1.9%) BPH patients, 11 (8.27%) prostatitis patients, 302 (79.89%) carcinoma patients, and in 1 (50.0%) PIN patient. Serum PSA levels of >100 ng/ml were absent in patients with BPH and PIN, and present in 1 (0.75%) prostatitis and 54 (14.28%) carcinoma patients.Conclusion: Benign prostatic hyperplasia was the commonest lesion in our patients (76.56%) with serum PSA levels >10 ng/ml reported in all patients with prostate carcinoma and prostatic intraepithelial neoplasia (PIN) patients.

Objectives: To evaluate electrolytes levels in patients suffering from iron deficiency anemia and to compare it with patients without anemia. Study Design: Descriptive Cross Sectional study. Setting: Department of Pathology, Sahiwal Medical College Sahiwal. Period: November, 2019 to May, 2020. Material & Methods: After taking informed consent, five milliliter of blood was drawn from each patient. Blood sample was analyzed for electrolytes, complete blood counts and serum ferritin levels. Results were compared in normal and iron deficiency anemic groups. Results: A total of 287 clinically anemic suspects including 181 (63.0%) female and 106 (37.0%) male with mean age of patients as 36.11±12.23 were included in this study. A total of 205 (71.4%) of the suspects had anemia whereas frequency of anemia remained higher among females (78.5%) as compared to males (59.5%) in this study. On the basis of serum ferritin levels a total of 178 (62.0%) patients had iron deficiency. Mean values of Sodium (130.41±0.59) and Bicarbonate (24.10±0.31) remained low while mean Potassium (4.33±0.07) and Chloride (103.93±0.47) levels of Iron Deficiency Anemia (IDA) group remained high as compared to non-anemic group. Conclusion: Levels of sodium and bicarbonate are found to be on the lower side while potassium and chloride remained on higher side in patients with Iron deficiency Anemia in this study. Thus these findings indicate close monitoring of electrolytes to evade impediments during management of patients.

Objective: The e-learning technique for teaching has been gradually active in undergraduate medical education in current years. This article serves as an early exploration into medical student perceptions of the benefits and limitations of the E-learning. Study Design: Prospective study. Setting: Sahiwal Medical College Sahiwal. Period: 1st February 2020 to 31ST March 2020. Material & Methods: To determine the perception of undergraduate students towards E-learning vs. Traditional Learning the students of the 4th year and Final year MBBS were provided with a questionnaire. Students of Sahiwal medical college have already been taught via both methods i.e., traditional face to face teaching and via video lectures and WhatsApp e-learning. Results: Students’ perception of E-learning as compared to Traditional learning: Fifty-two % students disagreed with that Traditional learning is more difficult and challenging than E-learning. Out of 182 responses again 54 % of the students disagreed with the fact that Learning materials or recorded lectures are as effective as face-to-face teaching/classroom situations. Conclusion: To date in our study, the students’ reaction to e-learning solicitations in undergraduate medical education is not much optimistic. Moreover, students generally did not express strong satisfaction for active learning modalities over traditional lecture-based learning.

Background and Objective: Interstitial lung disease (ILD) causes depression due to its painful course in patients. The aim of this study was to determine the prevalence of depression and find the association of depression with selected clinical variables in patients with ILD. Methods: This questionnaire based cross-sectional study was done at the department of pulmonology, District head quarter hospital Sahiwal from 1st Oct 2019 to 31st March 2020. The questionnaire was distributed among the diagnosed cases of ILD who presented in outpatient department of DHQ Sahiwal after taking informed consent. The depression scoring was done in them according to Beck depression inventory II. Frequency distribution statistics and inferential statistics were done by using Statistical Package for Social Sciences (SPSS) version 20. P-value < 0.05 was taken as statistically significant. Results: Depression was graded into four types according to Beck depression inventory II scoring system. Depression levels of minimal, mild, severe and extremely severe were found to have frequencies of 42.90, 14.30, 31.40 and 11.4% respectively. Depression was more prevalent in females (77.14%). Sixty two percent of severely depressed had rural background. Three fourth (75%) of severely depressed patients were from lower class group. Half of the severely depressed patients were suffering from hypertension. One fourth had ischemic heart disease. Illiteracy dominated in severely depressed where 3/4th of the participants had not received any education. Our study found statistically significant result of Beck score with socioeconomic groups (P = 0.037). High statistically significant result was also found when Beck scoring was associated with co-morbidities (P = 0.001). Conclusions: The increased frequency of depression in the patients of ILD was associated with many demographic factors. The development of improved methods for the assessment of ILD and its co-morbidities could have profound effects on the quality of life and expected survival of ILD patients.