Study Objectives: Escape rooms are physical adventure games developed circa 2006 gaining popularity across the world. The model uses players in a locked room that use elements of the room to solve a series of puzzles to escape the room. Escape rooms are increasingly more popular and have themes that vary from murder mystery to outer space odyssey, but currently not used in emergency medicine education.Objectives: Given the challenge to enhance conference didactics and improve residency education techniques, we proposed a medical escape room for our residents to participate in on a scheduled conference day in lieu of standard conference lectures.Methods: We conducted an escape exercise with 6-8 players per room (of incremental PG year) to participate at our Simulation Center. Given the size of our residency program, group start times were staggered so that each of the 8 groups would have 20 minutes to move onto the next room and start to solve the next case. The escape room is devised to have 4 cases of progressing severity of illness for a particular patient chief complaint. We utilized abdominal pain as this was the topic assigned for our EM model for that cycle. The residents included a residents from academic years 1-4 as well as an APD as the guide. Clues included physical exam findings on the SIM mannequin, lab abnormalities, EKG and radiographic imaging, which when diagnosed correctly would provided a diagnostic code number. When all the clues were solved, this would produce a phone number the group would call and disposition the patient. If the correct disposition was given, they would be given the location of the door key. Points are awarded similar to standard escape rooms where time to diagnosis and use of hints were weighted.Conclusions: It is already known that simulation-based education enhances learning. We believe this was a great team-building exercise for problem-based learning, and offers an opportunity for the resident as an educator. Residents truly enjoyed this approach and since faculty observed the entire exercise, future plans are for milestone evaluations.

Aims: As no data is available in Pakistan so the aim of current study is to find out the link of multiple risk factors with recurrent pregnancy loss (RPL) in Pakistan. Study Design: Case control study. Place and Duration of Study: Study conducted in Obstetrics and Gynecology Clinic of Benazir Bhutto Hospital, Holy Family Hospital Rawalpindi and Polyclinic Hospital Islamabad from November 2018 to April 2019. Methodology: Subjects were investigated on the basis of an in depth Performa. For data analysis Statistical package for social sciences version-20 was used. Beside this, height in cm, weight in kg and blood pressure in mmHg were recorded. All the statistical calculations were performed by using SPSS 20. For association analysis of qualitative variables Spearman bivariate correlation was calculated while for numerical variables ANOVA was applied. Multinomial logistic regression model was used and the odd ratio and relative risk were calculated. Results: Among cases 91.34% were having spontaneous miscarriage and majority (64.86%) were during first trimester. Spearman bivariate correlation reported a strong association of recurrent pregnancy loss with the risk factors including family history, smoking, obesity, history of hypertension and history of diabetes, having highly significant p-values, on the hand, significant association of maternal age with the frequency of recurrent pregnancy loss was found but not with the paternal age and parity. The multinomial logistic regression model showed that smokers were19.012 times more prone to develop recurrent pregnancy loss. Conclusion: The multiple risk factors including maternal age, obesity, smoking, family history, body mass index, hypertension and diabetes have a strong association with the recurrent pregnancy loss. So keeping these risk factors in mind a careful evaluation of each pregnancy is necessary to reduce the risk of recurrent pregnancy loss.

Aims: The aim of current study is to find out the prevalence of depression in doctors in different hospitals of Karachi and its association with lifestyle, the field of specialty and coping mechanisms. Place and Duration of Study: The sample was collected from 10 different hospitals of Karachi, in a period of one Year i.e., March 2019 to February 2020. Methodology: A descriptive cross-sectional study design using non-probability consecutive type of sampling technique was used. Sample size was calculated at 95% confidence interval and was found to be 368. The sample was classified in two broader categories Surgery & Allied and Medicine & Allied. For identification of depression level, Public Health Questionnaire (PHQ-9) was used. A 28-item questionnaire Brief COPE was used to asses coping mechanisms. Results: In total 400 forms were used for data analysis. The mean age of doctors was 35 ± 4 years, 65% were males while 35% were females, there was a statistically significant association of female gender with depression. Chi-Square was applied to determine the association of depression and departments and it was found to be highly significant with a P < .001. Highest level of depression was found in Orthopedics and Psychiatry departments followed by Surgery and Gynecology. While Otolaryngology was the least depressed department. Chi-square was applied and a statistically significant association of low monthly income and depression with a p-value of 0.02. In Surgery and allied there was a statistically significant association of depression with extensive working hours and lack of facilities with a p-value of 0.01 and 0.04. While in Medicine and allied there was a statistically significant association of depression with a harsh attitude of seniors and an uncomfortable working environment with a p-value of 0.02 and 0.03. A linear regression model comparing depression and its associations with coping strategies was applied. Conclusion: Our study shows that depression is present in a vast majority of doctors from multiple specialties. Various risk factors for depression have also been identified so appropriate coping strategies should be formulated to deal with it.

Aims: In developing countries malnutrition is characterized as one of the major risk factors for death in children, due to improper management of cases, lack of resources and escaping the guidelines provided by WHO. However, it is also highlighted that prompt treatment and proper management can reduce the mortality rate and improve the quality of life in children. Current study is designed to investigate the frequency of SAM and its outcomes at time of discharge in tertiary care hospital of Hyderabad. Study Design: A cross sectional study was performed. Place and Duration of Study: Study was performed at nutritional stabilization center of pediatric department of tertiary care hospital Hyderabad from July 2019 to Jan 2020. Methodology: Preformed proforma was designed to record the data of participants that included demographic and primary outcome variable. Hospital protocols using WHO guidelines i.e. 10 steps for in-patient care of severe malnutrition were started & followed with feeding F-75 & F-100. Data was analyzed on SPSS-19, p-value <0.05 was considered as significant. Results: Mean age of the study participant was 13 ± 6.3 months while majority of them were male (72%). About 70% participants were below normal as per weight to height ratio. Out of recruited participants (N=273) admitted in nutritional center prevalence of severe acute malnutrition was found to be 32.6%. After admission and management protocols 91.6% recovered however, mortality was observed in 8.9% participants. Conclusion: We conclude that effective and prompt treatment measures and appropriate management of affected patients according provided guidelines shown decrease in mortality and increased the survival rate in admitted children.