https://www.annalskemu.org/journal/index.php/annals/issue/feed 2023-12-08T09:22:19+05:00 Publication Office (Annals Editorial Board) publications@kemu.edu.pk Open Journal Systems <p style="text-align: justify;">Annals of KEMU is a biomedical research journal that is devoted to publishing the recent advances in all areas of biomedical research for physicians, surgeons, post-graduate trainees, and undergraduate students with special emphasis on clarity of presentation and accuracy of the presented data.</p> <p style="text-align: justify;">Articles published in the Annals of KEMU cover a wide range of fields from basic medical sciences, clinical specialties, and super-specialty areas. Articles describing original clinical or laboratory investigations, case reports, and public health-related studies and surveys are always considered for publication.</p> <p style="text-align: justify;">As a multi-disciplinary journal published by the most renowned and oldest medical institute in Pakistan, Annals of KEMU publishes the most relevant original research articles that form the foundations of tomorrow's medicine in Pakistan and around the globe.</p> <p style="text-align: justify;"><strong>Links:</strong></p> <p style="text-align: justify;">1) <a href="https://www.youtube.com/watch?v=rXNiQyOWs0E" target="_blank" rel="noopener">Tutorial on how to Upload your Submission</a></p> <p style="text-align: justify;">2) <a href="https://hjrs.hec.gov.pk/index.php?r=site%2Fresult&amp;id=911140#journal_result" target="_blank" rel="noopener">HEC Ranking</a></p> https://www.annalskemu.org/journal/index.php/annals/article/view/5546 2023-10-30T11:26:36+05:00 Saira Afzal annals@kemu.edu.pk Ramsha Mushtaq Khan annals@kemu.edu.pk

In Pakistan, women comprise over 70% of the health workforce yet confront multifaceted challenges limiting their advancement and well-being.1 Pakistan ranks the second lowest in the world for women’s labor force participation, and deep-rooted gender biases permeate the workplace.2 Concrete action is imperative to transform the status quo and empower women across health system levels.

2023-10-30T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5548 2023-10-31T08:47:45+05:00 Mariam Khalid annals@kemu.edu.pk Kainat Kanwal annals@kemu.edu.pk

You are a Female Kemcolian graduate. Deep in your heart, you know you are amazing, have made this far and in the words of Professor Mumtaz Hassan, one of the “best of the best” to “make it to KE” When you graduated, you saw endless possibilities in front of you that life could offer and rightfully so! For you sky is the only limit and as a Kemcolian woman, you can definitely break all the barriers, no matter what stage of life you are in. However, at some point, life hits you. Maybe it is a parent passing away, a difficult relationship or a child’s disability. Or perhaps it is just “uncertainty” where being a female is the only “demerit” you think you have . So how to “not lose your worth” in those times when you feel that everyone around you, all your classmates and even the ones junior to you, are way ahead and you are the only one left behind?

2023-10-31T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5575 2023-12-08T08:21:18+05:00 Zarabia Pervaiz Butt annals@kemu.edu.pk Rabia Arshed Usmani annals@kemu.edu.pk Misbah Jehangir Kashmiri annals@kemu.edu.pk Seema Hasnain annals@kemu.edu.pk Kashif Ur Rehman Khalil annals@kemu.edu.pk Farah Rehman annals@kemu.edu.pk

Background: Despite the early institution of a family planning program, following its inception, Pakistan is still struggling to stabilize its fast-growing population. The objectives of the study were, to determine the contraceptive practices & related factors among married women in an urban slum and also to assess the reasons for non-utilization of contraceptives among these women. Methods: The Cross-sectional study was conducted in an urban slum, Shah di Khui, in district Lahore following approval. A total of 300 eligible married females were selected through a systematic random sampling technique. After obtaining informed consent, information was solicited using a structured pretested questionnaire in privacy. Confidentiality of participants was maintained. SPSS version 24 was used for data analysis. The chi-square test was used to determine a statistically significant relationship between independent and dependent variables. Results: It was found that 33.7% of married women were using contraceptives as compared to 66.3% of non-users. Among users, 76.2% were using Modern methods and 23.8% were using traditional methods. The duration of marriage (p =0.000), education standing of the respondent (p = 0.012) and her spouse (p = 0.003), and total number of alive children (p = 0.018) were significantly related to contraceptive usage. The main reasons for non-utilization were a desire for more children (30.2%), fear of side effects (25.1%), objection by spouse/in-laws (21.1%), and Lack of knowledge (15.6%). Conclusion: It was concluded that only 33.7% of slum dweller married women were using contraceptives. Contraceptive usage was found to be related significantly with the duration of marriage, Education status of husband and wife, and total number of living children. There is a need to make targeted efforts to address barriers and enhance uptake in this often-neglected segment of society.

2023-12-08T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5576 2023-12-08T08:39:52+05:00 Syed Sohaib Bukhari annals@kemu.edu.pk Sher Afgan Ali Khan Burki annals@kemu.edu.pk Rana Sajawal Joiya annals@kemu.edu.pk Farhat Ijaz annals@kemu.edu.pk Fariha Rahman annals@kemu.edu.pk Muhammad Abdullah Awan annals@kemu.edu.pk Mohammad Talal Tariq annals@kemu.edu.pk

Background: Stress is an unwelcome yet necessary aspect of all our lives which dictate our quality of life. This emotion is particularly unwelcome in the period of exams which is why this research was conducted, and for females specifically. Premenstrual Syndrome is a collection of symptoms occurring one week to ten days prior to a menstrual cycle involving but not limited to, fatigue, abdominal cramps, and restlessness. These symptoms can lead to disruption in their lives and a negative effect on the academic performance of female medical students. Objective: To determine the effect of examination stress on Premenstrual Syndrome in Pakistani medical students and to see if there is any correlation present. Methods: This was a cross-sectional study which was conducted between March and September of 2022 in CMH Lahore where 177 females were enrolled, prior to their exams with an exclusion criterion of females on antiepileptic medication, antipsychotics or birth control. Non-probability convenient sampling was used. Two pre-tested questionnaires were used to measure stress and Premenstrual Syndrome simultaneously, the Student Stress Inventory (SSI) and Premenstrual Syndrome Scale (PMSS), consensually and anonymously. Chi-squared test was utilized with a P-value less than 0.05 was taken as significant. Results: Out of 177 female students, for SSI, 53 had mild stress, 115 had moderate stress while 5 had high stress. As for PMSS, 2 students had no symptoms, 34 had mild symptoms, 63 had moderate symptoms, 57 had severe symptoms and 17 had very severe symptoms. We found a statistically significant link between pre-modular stress and its detrimental effects on premenstrual syndrome. Both the PMSS and the SSI had a p value of 0.004, which established a noteworthy association. Conclusion: A strong link was found between pre-examinational stress and menstrual irregularities in this research.

2023-12-08T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5577 2023-12-08T09:02:58+05:00 Mehreen Bukhari annals@kemu.edu.pk Aftab Iqbal annals@kemu.edu.pk Syed Razi Haider Zaidi annals@kemu.edu.pk

Background: Women prisoners’ health is one of the major challenges among public health issues since the increasing incarceration rate has a direct impact on prisoners’ health status. Female prisoners often face many health issues in which most important are reproductive health problems. The prison services regarding reproductive health needs of female inmates vary in every jail. Unfortunately, in many prisons, health care services for women are still not adequate. Objectives: The objectives of the study are to determine the frequency of reproductive health problems of female inmates and to assess the health care services offered to female inmates of Women Jail Multan. Method: It was cross-sectional descriptive study in which 118 female inmates of reproductive age group were included. Data was collected through questionnaire which was entered in to computer using SPSS 20.0. Frequencies and percentages were calculated and data was presented in tables. Means, Standard Deviations and Correlation were calculated. ANOVA was applied to test significance and Chi-square test was applied. Level of significance was kept at p ≤ 0.05. Results: Among 118 female inmates, 33.9% were 31-40 years old, 87.3% were married and 78.0% were illiterate. The length of incarceration of 42.4% female inmates was upto 12 months. 35.0% had 1-2 children and 16.5% were living in jail with their children. Majority (92.4%) had gynecological problem and 82.2% had medical problems while 11.0% had experienced sexual violence by jail staff. Only 2 females were pregnant. 100.0% female inmates had availability of lady doctor or LHV for antenatal check-up.100.0% female inmates were provided proper diet and food supplements and the quality of food was satisfactory. Conclusion: Study revealed that health care services for reproductive problems including obstetric and gynecological issues was satisfactory however prevalence of gynecological issues was high. Sexual violence of female inmates faced by jail staff during imprisonment was noticed for which strict legislative measures should be taken.

2023-12-08T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5578 2023-12-08T09:07:06+05:00 Sana Fatima annals@kemu.edu.pk Shazia Rasul annals@kemu.edu.pk Shabnam Tahir annals@kemu.edu.pk Maryam Raana annals@kemu.edu.pk Durdana Mehreen annals@kemu.edu.pk Maimuna Unbreen annals@kemu.edu.pk

Background: Normal vaginal delivery is frequently associated with perineal trauma that can be iatrogenic (episiotomy) or spontaneous. Episiotomy is the most common surgical procedure in obstetrics being performed in approximately 20% of deliveries Objective: To compare the efficacy of lignocaine Jelly versus lignocaine injection during perineum repair after episiotomy in normal vaginal delivery. Methods: Study was done at Department of Obstetrics & Gynecology, Shalamar Hospital, Lahore during September 2020 - Feb 2021. For this randomized control trial, a total of 160 women fulfilling selection criteria were recruited for study from labour room. Informed consent was obtained from each case. Women were then segregated in group A& B and treatment was randomly allotted using lottery method, while in group A 2% lignocaine Jelly was applied on their perineum during active phase of labour at 8-9 cm cervical dilatation, before estimated time of one hour pre delivery. Women in group B were administered 10 ml of 1% lignocaine injection locally at the proposed site of episiotomy just before crowning. Then females were observed for pain and discomfort or adverse reactions during delivery, perineal repair and in immediate post partum period. After 2 hours of delivery, females were asked for perineal pain using visual analogue scale (VAS) then females were followed up in post-delivery wards for 12 hours. After 12 hours, they were discharged and asked for satisfaction of procedure. Results: The average ages of the cases among Group-A i.e. Lignocaine Jelly group and Lignocaine injection group (group-B) was 26.20 ± 3.32 years and 26.46 ±3.47 years respectively. The mean gestational age in Lignocaine Jelly group was 38.65 ± 0.90 weeks and in Lignocaine injection group was 38.67 ± 0.87 weeks. The mean BMI in Lignocaine Jelly and injection group was 26.70 ± 1.39 and 26.46 ± 2.20 respectively. Average pain score observed in Lignocaine Jelly was 3.58±1.06, whereas in Lignocaine injection group was 4.39 ± 1.26. There was statistically significant difference in average pain scores as the mean pain score in the Lignocaine Jelly group was lower compared with Lignocaine injection group ( p-value ≤ 0.001). In Lignocaine Jelly group 77(96.2%) females were satisfied while in Lignocaine injection group 68(85%) cases were satisfied, higher satisfaction rate was seen in lignocaine Jelly group, p-value (0.015) Conclusion: Women to whom lignocaine Jelly was applied before episiotomy had less mean VAS Pain Score and higher satisfaction rate during perineal repair than women who were given lignocaine injection for perineal repair. So lignocaine Jelly can be used as a good alternative of local infiltration of lignocaine injection, in term of less pain, less adverse effects and more patient satisfaction during perineal repair of birth process.

2023-12-08T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5579 2023-12-08T09:11:00+05:00 Samina Malik annals@kemu.edu.pk Javeria Usman annals@kemu.edu.pk Samia Ali annals@kemu.edu.pk Tahseen Fatima annals@kemu.edu.pk

Background: Medical profession is being dominated by female students, but little attention is being paid on making them emotionally and physically competent to match their corresponding gender with whom they have to work in parallel in the near future. Research is crucial in this area to identify their needs and provide solutions. Objectives: To identify female and male gender-related depression, anxiety and stress (DAS) among the undergraduate medical students enrolled in the second versus final year of University College of Medicine and Dentistry (UCMD), The University of Lahore (UOL) and highlight the intricate web of stressors that these medical students encounter. Method: A concurrent mixed method study was conducted on a random sample of 200 medical students of 2nd and 5th year with equal gender distribution. DASS21 scale was used to assess Depression, Anxiety and Stress. Qualitative and quantitative data were collected on Google forms. Quantitative data were analyzed descriptively and the qualitative data by manual thematic analysis Results: The 2nd year female students had significantly higher stress than their male counterparts. No statistically significant difference was appreciated within the 5th year gender wise though the females had relatively higher DASS levels. No significant difference on DASS21 was observed within the same gender between the two academic years. The female and male students reported fear of failure and less preparation time versus syllabus load as their major stressors respectively. Conclusion: The study has identified the stressors that influence the wellbeing of medical students and presented their depression, anxiety and stress comparison with respect to their gender and seniority. It has indicated the need to empower females emotionally at the level of their upbringing to formative medical years. Furthermore, male students must learn to manage time and be responsible doctors.

2023-12-08T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5580 2023-12-08T09:15:09+05:00 Muhammad Awais Khan annals@kemu.edu.pk Noor-i-Kiran Naeem annals@kemu.edu.pk

Introduction: Women play a vital role in the health sector of Punjab, Pakistan occupying 68% percent of total seats for undergraduate students in Pakistani dental colleges. However, this proportion decreases as one moves up in the organizational hierarchy with men dominating leadership positions in Pakistan. This has led to negligible women representation in dental academia. Objectives: This study aimed to explore female dental academia leaders’ perspectives on possible reasons behind the under-representation of women in leadership positions in the dental academia of Punjab, Pakistan. Methods: A qualitative, phenomenological research design using semi-structured interviews and purposive sampling was conducted from March 2018 to February 2019. Eight out of 10 invited female dental academia leaders working in public sector dental colleges of Punjab participated in individual in-depth interviews. Data were organized in Atlas-ti and analyzed through thematic analysis. Results: Thematic analysis led to the development of six themes: 1) Family responsibilities, 2) Work environment, 3) Gender bias, 4) Lack of Counseling, 5) Financial matters, and 6) Transport issues and long distance from the workplace. Sub-themes further elaborate on the findings and provide deep insight into the problem. Conclusion: The problem of female underrepresentation in dental academia leadership is multifaceted. Reserving separate funds for women, arranging career counselling sessions, decreasing working hours during special circumstances, and changing attitudes towards women’s role in households will help overcome the problem. The study opens a path for future research on the development of interventions or strategies to overcome the reasons.

2023-12-08T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5551 2023-10-31T09:26:30+05:00 Aruba Jamal annals@kemu.edu.pk Syed Shafaat Hussain annals@kemu.edu.pk Noman Adil annals@kemu.edu.pk

Madam, Stigma is defined as "an attribute regarded as undesirable and unpleasant and which distinguishes the stigmatised person from other members of the community to which they belong'' that leads to the segregation of such individuals from the society. Despite an advance in knowledge over the past 20 years, people who sought help for a mental health problem still had to deal with the stigmatising attitudes.1 Above 20 million Pakistanis i.e around 10% of population experience some sort of mental illness, which continues to be a substantial reason for concern. The country has just 400 psychiatrists and five psychiatric hospitals in a population of more than 180 million; one of the lowest psychiatrist to person ratio across the world, which highlights the full seriousness of this predicament.2

2023-10-31T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5552 2023-10-31T09:32:38+05:00 Syed Shafaat Hussain annals@kemu.edu.pk Noman Adil annals@kemu.edu.pk Aruba Jamal annals@kemu.edu.pk

Madam, The choice of specialisation by medical students is influenced by a variety of factors, including the specialty's perceived credibility, parental influence, work-life balance, money, cultural background, rotations in the clinic, mentors' experiences, etc. In various medical professions gender disparity persists, in conventionally male-dominated specialties, despite rising numbers of women in medical schools and clinical practice regions globally. Inevitably, there were statistically substantial gender variations in the medical specialties chosen by male and female doctors, with the majority of men choosing surgery and orthopaedics.1

2023-10-31T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5581 2023-12-08T09:17:27+05:00 Fatima Bint Sajid annals@kemu.edu.pk Wajeeha Binte Sajid annals@kemu.edu.pk Aruba Jamal annals@kemu.edu.pk Syed Shafaat Hussain annals@kemu.edu.pk Noman Adil annals@kemu.edu.pk

Madam, Gender inequality is defined as inequality regarding sex or gender in which one sex or gender is consistently preferred or emphasised above other. Gender disparity is thought to have existed for countless years, with women supposed to be providers at home while men anticipated as leaders with professions outside the home. (1) Implicit biases have an adverse effect on women's careers in medicine and contribute to imposter syndrome, exhaustion, underrepresentation in leadership roles, income inequality, poorer advancement, and less favourable reviews. Gender bias in the promotion process or in the ladder for progression may be a factor for the slower development of women in academic medicine, with fewer women at each succeeding level of career promotion. Men, for example, earn more honours from professional medical associations, whereas women obtain less opportunities to talk at large conferences. According to a 2014 poll of 1066 physicians who received career advancement awards, 66% of women and about 10% of men reported personal gender bias. (1)

2023-12-08T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5582 2023-12-08T09:22:19+05:00 Khadeeja Anjum annals@kemu.edu.pk Syed Imran Ali Shah annals@kemu.edu.pk Aamenah Malik annals@kemu.edu.pk

Women comprise almost 70% of health and social care workers globally and nearly 90% of the nursing and midwifery workforce. Yet, it is estimated that they hold only around 25% of leadership roles in health. Few women are promoted in academia, achieve research grants, and take up senior leadership posts.One of the reported reasons for this discrepancy are flawed and gender inequitable policies which render women at a disadvantage. In Pakistan, male counterparts occupied more than 80% of all leadership posts in health sector except in the academic basic sciences(1). Although women have always wanted to partake in high-ranking positions in healthcare sector based on their merit, multiple obstacles have prevented them from these opportunities as compared to their male counterparts. Obstacles hindering women from advancing the career ladder have been likened to a ‘glass ceiling’. These barriers include absence of gender equitable governmental action, institutional hindrances, andorthodox assumptions of society regarding the female sex and female seniors sabotaging other women. Another factor acting as a handicap to women seeking leadership positions is the “motherhood penalty” which includes career breaks on account of pregnancy and work being affected by physical and emotional load due to domestic responsibilities.

2023-12-08T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5549 2023-10-31T08:59:14+05:00 Khadija Farrukh annals@kemu.edu.pk Shehla Baqai annals@kemu.edu.pk

Women leaders are marginalized in higher healthcare leadership positions. Despite being higher percentage in medical colleges, only few females join healthcare force and even fewer reach top leadership positions. The main reason for this fallout is fixed gender roles in society which mandates female to take care of 1,household. 2 Women continue aspiring leadership positions in all spheres of governance both in public and private healthcare settings; however, they face many challenges in taking leadership positions. Social and cultural barriers hinder women from attaining leadership positions. From the lessons learnt from women leaders, young women entering and excelling in careers and attaining leadership positions should be appropriately educated. Main factors identified by research studies are gender biased society and not maintaining work-life balance. The rigid mindset in male dominated culture denies women the opportunities to attain top management positions in healthcare settings. In response to these opposing factors women either leave healthcare force or opt for part-time opportunities.3,4 The objective of this article is to suggest strategies for advancing women leaders in clinical and educational healthcare settings. Women leader may exclude themselves from being a leader as cost of leadership overweigh, its benefits.

2023-10-31T00:00:00+05:00 Copyright (c) 2023 https://www.annalskemu.org/journal/index.php/annals/article/view/5550 2023-10-31T09:18:42+05:00 Tayyiba Wasim annals@kemu.edu.pk Gul e Raana annals@kemu.edu.pk

The journey through medical residency is a tough test, especially for female health professionals worldwide. As medical field advances and more female students are getting enrolled in medical colleges, an increasing number of women are joining residency programs bringing unique perspectives and invaluable contributions. In Pakistan, female students ratio has increased tremendously in medical colleges. It is reported to be 3:1 and even 4:1 in some medical colleges1. Despite this, the ratio of female workforce remain below 50% due to multiple factors at social, organizational and individual level. There is restriction to work from in laws, child bearing and rearing difficulties, inequalities in promotions which hinder girls to join residency trai- ning.2

2023-10-31T00:00:00+05:00 Copyright (c) 2023