Pakistan Journal of Physiology http://pjp.pps.org.pk/index.php/PJP <p>Pakistan Journal of Physiology (Pak J Physiol, PJP), an HEC Category '<strong>X</strong>' recognised scientific journal, owned and published by Pakistan Physiological Society, is an <strong>Open Access Journal</strong> and is <strong>FREE</strong> for academic and research use only. It is a <strong>Peer Reviewed Journal</strong> and publishes original research work in all areas of Human &amp; Animal Physiology. Pakistan Journal of Physiology enjoys the expertise of a galaxy of editorial&nbsp;board members and reviewers expert in their field of specialization.</p> <p>All articles published, including editorials, letters, and book reviews&nbsp;represent the opinions of the authors and do not reflect the official policy of Pakistan Journal of Physiology, Pakistan Physiological Society, or the Institution with which the author is affiliated unless this is clearly specified.</p> Pakistan Physiological Society en-US Pakistan Journal of Physiology 1819-270X <p><sup>© </sup>Copyrights reserved. It is free for research and academic purposes only. No part of this publication may be reproduced in any shape, published, or stored in a retrieval media without permission of the Editors.</p> SUPERVISOR AS A CHANGE AGENT http://pjp.pps.org.pk/index.php/PJP/article/view/182 <p>Interestingly the only constant we always come across is change. The 'change supervisor’s capabilities' have a major role in victory of the program, and on the extent of probable unwanted side-effects.&nbsp;It is necessary to win the support and commitment of the trainees. This acceptance depends extensively on high competency&nbsp;as well as soft skills, including communication skills, the capability to appreciate and to take into thought the views and suspicions of others. The role of a supervisor is to provide directions and motivation, and as a final step be able to implement plans.&nbsp;By increasing the urgency people start telling each other ‘let’s go, we need to change things’. They start building the guiding team. Now this group is powerful enough to guide a big change. The guiding team develops the right vision and strategy for the change effort. People begin to buy in the change which is reflected in their behaviors. Through empowered action, more learners feel able to act and do act on the vision. Momentum builds up as trainees try to fulfill the vision, while fewer and fewer resist change. Supervisors make wave after wave of changes until the vision is fulfilled. The new and winning behavior continues despite the pull of tradition perspectives. The ‘gravitational pull’ of conservative approaches is huge and proportionate but persistent force is required to break the barriers. The proportionate force cannot be generated without developing ‘muscles’ which is essential for the supervisors to act as change agents. This translates into a change that is firm and constant.</p> <p>Pak J Physiol 2018;14(2):1-2</p> Khadija Qamar ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 1 2 IMPACT OF PARICALCITROL ON INFLAMMATORY AND ANAEMIA MARKERS IN DIALYSIS PATIENTS http://pjp.pps.org.pk/index.php/PJP/article/view/190 <p><strong>Background:</strong> The role of Vitamin D in calcium and phosphate homeostasis is renowned. The effects of vitamin D on bone metabolism have been established for long. We planned to see the effects of vitamin D analogue paricalcitrol as on mineral bone disorder in chronic kidney disease. (CKD MBD) parameters and markers of anaemia and inflammation. <strong>Method:</strong> This prospective and observational study was done at King Fahd Hospital, Medina, Saudi Arabia for 3 months from Jan to Apr 2017. Two hundred and ten (210) patients fulfilled the eligibility criteria. Paricalcitrol was given at a dose of 0.04 μg/Kg 3 times a week and parathyroid (PTH) was monitored for 3 months and subsequently the dose was titrated to the PTH levels. We looked at the relationship between paricalcitrol and anaemia markers, inflammatory markers, and erythropoietic stimulating agent dose. <strong>Results:</strong> Two hundred and ten (210) patients were studied, mean age was 50 years, 55% were males; 120 were excluded who had vitamin D level in the normal range, who received vitamin D in the recent past, with phosphate levels &gt;2 and calcium levels &gt;2.55 mmol/L, on calcimimmetics, parathyroidectomy cases, and patients with active infection or malignancy. Parathyroid hormone (PTH) fell significantly -166.4 (95% CI -290, -42.5, <em>p&lt;</em>0.05), Transferrin saturation improved significantly (4.4% 95% CI 1.6, 7.2 <em>p</em>=0.003). CRP fell significantly (<em>p</em>&lt;0.01). However, Hb or ESA requirement did not reach statistical significance. <strong>Conclusion:</strong> Paricalcitrol treatment is associated with improvement in secondary hyperparathyroidism in haemodialysis population. There is a signal towards improvement in markers of inflammation and anaemia but a larger Randomised Control Trial (RCT) is needed to be done.&nbsp;</p> <p><strong>Pak J Physiol 2018;</strong>14(2):3–6</p> Adil Manzoor Khalid Alwadi Ahmed Bhat ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 3 6 ASSOCIATION OF CORD HEPCIDIN AND IRON PARAMETERS WITH MATERNAL HEPCIDIN, IRON STATUS MARKERS AND NEONATAL MORPHOMETRICS http://pjp.pps.org.pk/index.php/PJP/article/view/219 <p><strong>Background: </strong>Hepcidin is the only iron regulating hormone in human body. The foetus begins to synthesize Hepcidin from the 1<sup>st</sup> trimester of gestation to control unidirectional iron transfer from mother to foetus. The objective of the present study was to determine the correlation of cord Hepcidin with iron status markers of mothers, neonates and neonatal morphometrics. <strong>Method:</strong> Twenty-five healthy pregnant women and their neonates were included in the study. Haemoglobin, Iron status markers and Hepcidin were analyzed in maternal and cord blood. Neonatal anthropometric variables were measured. Pearson/Spearman correlation was used for association of different variables of mother-neonate pairs. <strong>Results:</strong> Maternal Hepcidin showed positive correlation with maternal Iron, Ferritin and Transferrin Saturation (TS) (<em>r</em>=0.455 and <em>p</em>=0.022, <em>r</em>=0.511 and <em>p</em>=0.009, <em>r</em>=0.440 and <em>p</em>=0.025 respectively). Cord Hepcidin was positively correlated with cord iron, Ferritin and Transferrin saturation (<em>r</em>=0.593 and <em>p</em>=0.002, <em>r</em>=0.792 and <em>p</em>=0.000, <em>r</em>=0.546 and <em>p</em>=0.005 respectively). Neonatal morphometric variables were neither correlated to cord Hepcidin nor with any other Cord blood variable. Maternal Ferritin showed positive correlation with cord Haemoglobin (<em>r</em>=0.456, <em>p</em>=0.022) and cord Ferritin (<em>r</em>=0.460, <em>p</em>=0.021). <strong>Conclusion:</strong> There was no correlation between cord Hepcidin and neonatal morphometrics. Maternal and neonatal Hepcidin are independent of each other in iron status regulation.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):7–10</p> Tabinda Najeeb Nargis Anjum ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 7 10 COMPARISON OF CONTACT LENS HYGIENE COMPLIANCE AND SELF-MANAGEMENT BEHAVIOURS BETWEEN MEDICAL AND NON-MEDICAL STUDENTS http://pjp.pps.org.pk/index.php/PJP/article/view/232 <p><strong>Background:</strong> Contact lenses are commonly worn by young population for many purposes such as vision correction, cosmetic causes and as a fashion trend. It can cause serious eye infections and corneal ulcers, sometimes resulting into loss of vision. The aim of study was to compare the contact lens hygiene compliance and self-management behaviour between medical and non-medical students of Saudi Arabia. <strong>Methods: </strong>Five hundred (500) young contact lens wearers with an age range of 18–28 years were selected conveniently from student population of Princess Nourah Bint Abdulrahman University, Riyadh. After taking informed consent from the participants, their level of contact lens hygiene compliance and self-management was assessed by using a peer-reviewed questionnaire. <strong>Results:</strong> The mean age of the participants was 21±2 years. Out of 500 students, 38% were medical and 62% were non-medical students. Fifty-six percent (56%) students were wearing contact lens for cosmetic reasons while 44% students were using it for the correction of their myopic refractive error. The self-management behaviour was statistically significant among non-medical students (<em>p</em>=0.026). There was no significant difference between the two groups regarding the compliance of the contact lens hygiene but the knowledge and awareness about the risks and complications was statistically high in the medical students (<em>p</em>=0.028). <strong>Conclusion:</strong> Self-management with contact lens use was very common among non-medical students of Saudi Arabia. They were good in lens hygiene compliance, but their knowledge about risks and complications of contact lens use and accessories care was significantly low.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):11–4</p> Dr. Sumera Nisar Areeb Rehman Shehanah Salem Alqhtani Hiba Abdualrahman Alrowibah Fatimah F. Mohammed Hala Maed Alqahtani Anfal Mohammed Aldulhum ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 11 14 SERUM ANGIOPOIETIN-1 AS A BIOMARKER OF MISSED ABORTION http://pjp.pps.org.pk/index.php/PJP/article/view/230 <p><strong>Background:</strong> Waiting in cue for vaginal ultrasound is a stressful situation faced by patients with missed abortion. In Pakistan, it is not a usual practice to go for screening of Angiopoietin-1 for confirmation of missed abortion. This study was conducted to assess the serum Angiopoietin-1 levels in patients with missed abortion. <strong>Methods:</strong> A total of 60 women aged 20–40 years were investigated after written informed consent on the basis of convenience sampling. Out of 60, 30 women having normal viable intrauterine pregnancy with the gestational age of 6–8 weeks were enrolled as control group, and the study group included other 30 women who presented to the hospital with missed abortion at same gestational age. <strong>Results:</strong> The serum Angiopoietin-1 levels were decreased significantly in women with missed abortion compared to women having normal viable intrauterine pregnancy (780.50±134.30 <em>vs</em> 1102.50±112.40, <em>p</em>=0.001). <strong>Conclusion:</strong> The level of serum Angiopoietin-1 in missed abortion decreases and it can be used as an early and effective biomarker for diagnosis of missed abortion.</p> <p><strong>Pak J Physiol 2018:</strong>14(2):15–7</p> Maryam Rao Shumaela Kanwal Qanita Mahmud Hamid J Qureshi Sibgha Zulfiqar ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 15 17 CORRELATION OF TUMOUR NECROSIS FACTOR-α WITH OBESITY INDUCED INSULIN RESISTANCE IN TYPE 2 DIABETES MELLITUS http://pjp.pps.org.pk/index.php/PJP/article/view/228 <p><strong>Background:</strong> Obesity is a major cause of many metabolic disorders characterized by chronic inflammation that is linked with T2DM and insulin resistance. Tumour Necrosis Factor Alpha (TNF-α) is remarkably higher in obese people. The aim of this study was to determine the levels of TNF-α and its correlation with insulin resistance and body mass index in type 2 diabetic patients. <strong>Methods:</strong> This study was conducted at Diabetic Clinic of Mayo Hospital, Lahore. TNF-α levels were determined and correlated with insulin resistance and body mass index in 90 obese type 2 diabetics. TNF-α and serum insulin were determined using ELISA. Insulin resistance was calculated by HOMA-IR. Pearson correlation test was used to correlate TNF-α with Insulin Resistance and body mass index, and <em>p</em>≤0.05 was considered statistically significant. <strong>Results:</strong> There was a strong positive correlation of fasting insulin and HOMA-IR with TNF-α (<em>r</em>=0.986, <em>p</em>&lt;0.001). There was also strong positive correlation of TNF-α with BMI.<strong> Conclusion:</strong> Increased inflammation in obese diabetics explains the role of TNF-α in insulin resistance caused by obesity. Weight reduction in obese individuals will help in reducing TNF-α levels and to improve insulin sensitivity in T2DM.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):18–20</p> Farhat Ijaz Rana Khurram Aftab Syed M. Zubair Rana Rakhshan Aftab ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 18 20 HAPPINESS IN PATIENTS WITH DIABETES MELLITUS AND SYSTEMIC ARTERIAL HYPERTENSION http://pjp.pps.org.pk/index.php/PJP/article/view/226 <p><strong>Background:</strong> Happiness is a state of mind which reflects an array of hormonal interplay within the body. These mechanisms have tremendous overall impact on patient’s health in terms of enhanced immunity. Current study was planned to evaluate happiness in patients with diabetes mellitus and systemic arterial hypertension. The study also aimed to explore the effect of age and gender in such patients. <strong>Methods:</strong> This cross-sectional comparative study was conducted at Department of Psychology, Islamic International University Islamabad from February to May 2016. Thirty-six patients of diabetes mellitus and 44 of arterial hypertension were included through convenience sampling from Heart International hospital and Benazir Bhutto Hospital Rawalpindi. Happiness was measured using a validated and reliable tool ‘the subjective happiness scale’. Mean happiness levels were compared between the groups using independent <em>t</em>-test and One-Way ANOVA. Alpha was kept at 0.05. <strong>Results:</strong> There were 36 (45%) patients with diabetes mellitus and 44 (55%) with hypertension with age range of 30-60 years and male to female ratio of 1:1. Mean happiness levels between diabetics and hypertensives were 19.13±2.64 and 14.11±3.98 respectively and the difference was significant (<em>p</em>=0.02). There was no effect of age and gender on happiness level in these patients. <strong>Conclusion: </strong>Patients with arterial hypertension have lower level of happiness compared to those suffering from diabetes mellitus irrespective of age and gender.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):21–3</p> Nazia Iqbal Muhammad Alamgir Khan Rabia Zonash ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 21 23 CO-EXISTENCE OF CIPROFLOXACIN RESISTANCE IN METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS FROM CLINICAL SAMPLES http://pjp.pps.org.pk/index.php/PJP/article/view/224 <p><strong>Background: </strong>Ciprofloxacin is a broad-spectrum, fluorinated quinolone antibiotic. It has been successfully prescribed against a variety of bacteria. Though its use was limited to a last resort therapy against complicated infections, however widespread usage has led to the emergence of ciprofloxacin resistance. The current study was planned to evaluate the existence of ciprofloxacin resistance in methicillin resistant and sensitive <em>Staphylococcus aureus</em> from clinical samples. <strong>Methods: </strong>The clinical <em>S. aureus</em> isolates from wound, blood, urine and nose, were obtained from various labs of Hyderabad over nine months. The methicillin resistant strains were identified by Kirbey baur disc diffusion test using oxacillin (1 µg) discs. The response of <em>Methicillin Resistant</em> <em>S. aureus</em> and <em>Methicillin Sensitive</em> <em>S. aureus</em> strains against 2<sup>nd</sup> generation flouroquinolone, i.e., ciprofloxacin was demonstrated. <strong>Results: </strong>A total of 150 <em>S. aureus</em> isolates from various clinical specimens were included in this study. About 14.6 % (n=22) showed resistance against ciprofloxacin while 30% (n=48) were identified as MRSA. About 25% of the Methicillin Resistant <em>S. aureus</em> (MRSA) isolates displayed the co-resistance against ciprofloxacin. Among various specimens the maximum co-resistance was seen in case of blood isolates (37.5%) followed by urine isolates (33.3%). Comparatively, ciprofloxacin resistance was found to be lower in Methicillin Sensitive <em>S. aureus</em> (MSSA) strains (9.1%). Odds Ratio [OR] was calculated to be 0.30 [95% CI=0.12–0.77]. Statistically significant differences (<em>p</em>˂0.05) for ciprofloxacin resistance were seen between MRSA and MSSA. <strong>Conclusion: </strong>The results suggest a statistically significant increase of ciprofloxacin resistance in <em>Methicillin Resistant</em> <em>S. aureus</em> as compared to <em>Methicillin Sensitive </em><em>S. aureus</em> in clinical samples.</p> <p><strong>Pak J Pysiol 2018;</strong>14(2)24–7</p> Atif A. Patoli Bushra B. Patoli Zulifqar A. Laghari Taj M. Maachi ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 24 27 CORRELATION OF GLYCEMIC CONTROL WITH SEVERITY AND EXTENT OF PERIODONTAL STATUS http://pjp.pps.org.pk/index.php/PJP/article/view/222 <p><strong>Background:</strong> Diabetes is one of the main causes of periodontitis. People who do not maintain good oral hygiene or good metabolic control of their diabetes are more prone to get periodontitis especially those people who are of old age and people who have had diabetes for many years. The objectives of this study were to evaluate and correlate the extent and severity of glycaemic control with periodontal disease. <strong>Method:</strong> Sixty patients visiting the dental OPD of Isra dental college and Isra University (Diabetic OPD) from February to July 2016 were recruited. Diabetic patients who had no evidence of systemic disease other than diabetes and who had advanced periodontitis (30% or more of the teeth examined having &gt;4 mm probing depth) were included. Glycaemic control was measured using glycated haemoglobin whereas periodontal status was measured using plaque and gingival indices according to the standard protocols. A well-designed proforma was used to record demographic characteristics, oral hygiene maintaining methods, medical history, drug history and current status of periodontium on the basis of indices i.e., gingival index and plaque index. All the readings were taken at day one and after three months. <strong>Results:</strong> Of the 60 subjects; 36 (60%) were male and 24 (40%) were female with a mean age of 48.30±8.718 years. There was a significant and positive correlation between glycated haemoglobin and gingival index at day one and after three months (<em>r</em>=0.62, <em>p</em>=0.001 and <em>r</em>=0.58 and <em>p</em>=0.001 respectively). However, plaque index was correlated with glycated haemoglobin only after three months (<em>r</em>=0.15, <em>p</em>=0.02). <strong>Conclusion:</strong> Glycated haemoglobin and periodontitis are positively correlated implying that diabetic control may improve periodontal status as well.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):28–30</p> Hassan Shahid Sadia Hassan Ujala Faisal ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 28 30 FREQUENCY OF DEPRESSIVE SYMPTOMS IN PATIENTS WITH DIABETES MELLITUS http://pjp.pps.org.pk/index.php/PJP/article/view/204 <p><strong>Background:</strong> Co-morbid depression in diabetics is associated with hyperglycaemia, diabetic complications and poor compliance<strong>.&nbsp;</strong>Aim of study is to access the frequency of clinically relevant depressive symptoms in adults with type 1 and 2 diabetes and find their association with gender and age of the patient. <strong>Method: </strong>It was a cross-sectional study. The study was conducted in outpatient department of CMH Lahore for a period of six months. We included patients diagnosed with diabetes type 1 or 2 along with depressive symptoms. Any known case of depressive or personality disorder diagnosed before the onset of diabetes and those having&nbsp; a significant known medical history prior to/along with the development of diabetes were excluded from the study. Depression was gauged using Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) criteria. Chi square test was used to access the association between depression among diabetics with age and gender. <strong>Results: </strong>A total of 340 patients, 191 (56.2%) males and 149 (43.8%) females were included, out of which 304 (90.9%) qualified DSM-IV criteria for having depression. Out of 191 males, 160 presented with depressive symptoms whereas all female diabetics had depression. Chi-square value for gender association was 27 (statistically significant, <em>p</em>=0.000) and for age Chi-square value was 1.391, (statistically significant, <em>p</em>=0.014) with a peak at 55 years of age and a count of 40 patients. <strong>Conclusion: </strong>Presence of diabetes increases the frequency of depression along with significant association of age and gender of diabetics with co-morbid depression.</p> <p><strong>Keywords:</strong> Diabetes mellitus, Depression, Hyperglycaemia, Co-morbid, Complications</p> <p><strong>Pak J Physiol 2018;</strong>14(2):31–3</p> Yamina Nasir Qudsia Umaira Khan ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 31 33 COMPARISON OF ARTERIAL STIFFNESS INDEX AND TPE/QT RATIO IN NORMOTENSIVE, PREHYPERTENSIVE AND HYPERTENSIVE SUBJECTS http://pjp.pps.org.pk/index.php/PJP/article/view/217 <p><strong>Background: </strong>When the blood pressure rises, there is decrease in coronary blood flow to the endocardium and mid-myocardial cells, thereby slowing repolarization in these areas. The major underlying pathophysiology in essential hypertension is arterial stiffness. In this study we compared arterial stiffness index (ASI), T wave peak to end interval (Tpe) and Q to T wave (QT) interval on ECG tracings. <strong>Methods: </strong>It was a cross-sectional study. Written informed consent was obtained from all subjects. Using non-probability convenience sampling a total of ninety (90) male subjects aged 35–55 years were selected and divided into 3 equal groups, i.e., normotensive, prehypertensive and hypertensive. Blood pressure was measured with mercury sphygmomanometer according to the standard protocols. The ASI was calculated from digital volume pulse recorded by photoplethysmography via iWorx-214; physiological interface system. The 12-lead surface EGG was recorded with Delta-1 Plus digital ECG machine. The ECG tracings were scanned and saved in the computer. QTc, cQTp and cTpe/QTc ratio was calculated in normotensive, prehypertensive and hypertensive middle-aged men. These intervals were corrected by Bazzet’s formulae. <strong>Results: </strong>The ASI was significantly different (<em>p</em>&lt;0.0001) amongst the groups along with QTc and cQTp. However, cTpe intervals and cTpe/QTc were comparable amongst the groups. <strong>Conclusion: </strong>ASI is major culprit in pathophysiology of hypertension. QTc and cQTp interval are more robust parameter than other ECG markers in detecting trans-mural dispersion of repolarization in prehypertensive and hypertensive subjects.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):34–7</p> Muhammad Sajid Mehmood Muhammad Mazhar Hussain Sadia Mubarak ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 34 37 EFFECT OF AGE, GENDER AND FAMILY TYPE ON CARE GIVING —A CROSS-SECTIONAL STUDY ON CAREGIVERS OF SCHIZOPHRENIC PATIENTS http://pjp.pps.org.pk/index.php/PJP/article/view/215 <p><strong>Background:</strong> Care giving is a fundamental issue in the rehabilitation process of mental illnesses. Most of the patients suffering from schizophrenia are dependent on their families to take care of them and help them out in their daily activities. Present study was planned to find out the effect of age, gender and family type on care giving burden in caregivers of schizophrenic patients. <strong>Methods:</strong> This cross-sectional comparative study was carried out at International Islamic University Islamabad from Jan to Sep 2017. Fifty informal caregivers of schizophrenic patients were included from psychiatry wards of Lady Reading Hospital, and Khyber Teaching Hospital, Peshawar though convenience sampling. Care-givers with any past history of psychiatrist illness were excluded from the study. Care giving burden was measured using ‘Zarit Burden Interview’ questionnaire. Alpha value was kept at 0.05. <strong>Results:</strong> There were 20 (40%) males and 30 (60%) females in the study. The mean age of participants was 31.76±9.13 years with a range of 19–55 years. Twenty-seven (65%) participants were from nuclear family whereas 23 (46%) were from extended family. Mean score of care giving burden was 42.98±13.80 with range of 11–64. Care giving burden was found to be affected by age (<em>p</em>=0.001) but not by gender and family type (<em>p</em>=0.10 and 0.72 respectively). <strong>Conclusion: </strong>Age was the strongest predictor of care giving burden. There was no effect of gender and family type on care giving burden.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):38–40</p> Neelam Ehsan Nigar Johar Muhammad Alamgir Khan ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 38 40 SLEEP AND ACADEMIC PERFORMANCE http://pjp.pps.org.pk/index.php/PJP/article/view/210 <p><strong>Background:</strong> Sleep is an essential physiological process for life. Its quality is strongly related to psychological and physical health and other measures of well-being. Good quality sleep and adequate amount of sleep are important in order to have better cognitive performance and avoid health problems and psychiatric disorders. Sleep disturbances are an important issue among medical students and residents. This study was designed to find out the relationship between the academic performance of students with their sleep habits. <strong>Methods:</strong> A total number of one hundred apparently normal healthy students of First year MBBS Class were divided into three groups on the basis of their sleep habits before and after admission in to the medical college as follows: Group-1: Who had the same quality and duration of sleep in medical college as before admission. Group-2: Who had more sleep duration after admission to medical college. Group3: Who had less sleep duration after admission to medical college. The academic performance of these three groups was compared by taking into consideration the percentage of marks obtained in the annual examination of first year MBBS class. <strong>Results:</strong> Fifty percent of Group-1, and 50% of Group-2 students secured more than 70% marks in the First Year MBBS while 37% of Group-3 students obtained more than 70% marks in First Year MBBS. <strong>Conclusion:</strong> Disturbance in sleep affects academic performance adversely. Decreased sleep duration affects the academic performance more adversely as compared with the increased sleep duration.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):41–2</p> Muhammad Javed Iqbal Muhammad Siddiq Akbar Rana Muhammad Khalid Tehseen Iqbal ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 41 42 IMPACT OF CONTEXTUAL LEARNING ON RETENTION OF KNOWLEDGE http://pjp.pps.org.pk/index.php/PJP/article/view/211 <p><strong>Background:</strong> Case stimulated learning approach provides a link between basic and clinical sciences. Learning in a contextual clinical situation motivates the students and has a positive impact on their assessment. The objective of this study was to assess the effectiveness of interactive and case stimulated teaching of endocrine physiology to medical students at the University of Lahore. <strong>Methods:</strong> In this comparative cross-sectional study, a total of 260 second year medical students of 2014 and 2015 batches were included through convenience sampling. In the first batch, a total of 137 students (43 males and 94 females) were offered interactive endocrinology lectures. Whereas, in the second batch, a total of 123 students (55 males and 68 females), were exposed to case stimulated teaching by the same facilitator. Multiple-choice questions were used to assess the students before and after the teaching sessions. The results of both sessions were analyzed by Student’s <em>t</em>-test.<strong> Results:</strong> Students who were taught through case stimulated methodology performed better during examination as compared to those who were taught through conventional methodology (19.8±0.4 <em>vs</em> 13.5±0.3, <em>p</em>&lt;0.001). <strong>Conclusions:</strong> Students retain knowledge for a longer time when it is relevant and applicable to clinical context. Use of case stories in classrooms promotes better understanding, and the question and answer activity helps in making critical decisions in clinical practice. Case stimulated learning strategy can be adopted not only to enhance academic performance but also to promote contextual learning.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):43–5</p> Maimoona Nasreen Qasim M. Janjua Qurrat-ul-ain Leghari Samina Malik ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nd/4.0 2018-06-30 2018-06-30 14 2 43 45 ROLE OF BCG IN PREVENTING CHILDHOOD TUBERCULOSIS http://pjp.pps.org.pk/index.php/PJP/article/view/840 <p><strong>Background:</strong> Childhood tuberculosis claims many lives and BCG vaccine is the only prevention available against its most serious forms<strong>. Objective</strong> was to find out protective role of BCG vaccine against childhood tuberculosis by calculating odds ratio.<strong> Methods: </strong>It was a case control study. The study was conducted at Paediatrics department of Ayub Teaching Hospital. A total of 308 patients were included in the study. One hundred and fifty-four patients admitted in paediatrics ward and diagnosed with pulmonary, extra pulmonary, disseminated or any other forms of tuberculosis were included as cases in the study. For the control group, 154 children free of tuberculosis were selected as age matched controls from paediatric outpatient department. BCG scar was checked over right upper deltoid in both cases and controls. Data was recorded and analysed using spss. <strong>Results:</strong> From a total of 308 patients 167 (54.22%) were males and 141 (45.78%) were females. BCG scar was found in 170 (55.19%) out of 308 patients and it was absent in 138 (44.81%) children. Only a slight preponderance among males was noted who were affected by tuberculosis (50.9%) as compared to females from which (48.9%) of total were affected. Odds ratio for presence or absence of BCG scar and presence or absence of tuberculosis was less than 1, i.e., 0.692 (95% CI: 0.441 to 1.086). Administration of BCG vaccine was not a potent protective factor in our study. Pearson’s two tailed correlation between BCG scar and presence or absence of tuberculosis showed <em>p</em>&gt;0.05 and was statistically not significant. <strong>Conclusion: </strong>There was no significant protective effect of BCG against childhood tuberculosis.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):46–9</p> Saima Gillani Nasir Hussain Shah Kazmi Muhammad Kamal ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 46 49 STRESS FACTORS AND THEIR COPING STRATEGIES AMONGST THE STUDENTS OF AZAD JAMMU KASHMIR MEDICAL COLLEGE MUZAFFARABAD: A CROSS SECTIONAL STUDY http://pjp.pps.org.pk/index.php/PJP/article/view/842 <p><strong>Background: </strong>Medical studies are known to be highly stressful. Since students get information in Medical Education regarding Health and Development they are also taught the application of necessary skills for them to overcome stress. The aim of this study was to identify various stress factors subjectively, along with the coping strategies in Medical students. <strong>Methods: </strong>The study was conducted at Azad Jammu and Kashmir Medical College, Muzaffarabad. All students of the college were included in the study. Two questionnaires were developed; first to identify the major sources of stress and coping techniques employed by the students and the second for identification of the factors related to the role of Medical College in reduction of stress in students. Data was collected on 5 point Likert Scale and analyzed on Microsoft Excel in percentage. <strong>Results:</strong> Response rate was 65%. Long hours in college were detected as the biggest stressor. Absence of Wi-Fi was the second. The modular system of curriculum was not found to be a major source of stress for the students. Coping skill used most frequently was <em>Namaz</em>/<em>Nawafil</em>, followed by interactions with friends and family. <strong>Conclusion: </strong>The integrated, modular system appeared to be well accepted by the students. Religion and social support provide help in coping with the stress of medical studies.</p> <p><strong>Pak J Physiol 2018;</strong>14(2):50–2&nbsp;</p> Ayasha Mumtaz Bushra Sherwani Muhammad Shakil Sadiq Sarosh Majid Salaria ##submission.copyrightStatement## 2018-06-30 2018-06-30 14 2 50 52