Evaluation of the Level of Satisfaction Among Family Physicians of their Undergraduate Dermatology Teaching

To evaluate teaching and learning among undergraduate dermatology trainees and also to suggest measures for improvement. Cross sectional survey. The study was conducted at department of dermatology, Pakistan Railway Hospital Rawalpindi, from July 2011 to Dec 2011. An especially designed Proforma was distributed to family physicians in different cities of Punjab and KPK.Total of 121 doctors were recruited for study and 105 Performa were analyzed, which were filled by graduates from Pakistani medical schools.The Information was collected regarding different aspects of their undergraduate dermatology training e.g. lectures, duration of dermatology rotation and assessment techniques used in examination. In the second part of the proforma, family physician's satisfaction level has been assessed regarding adequacy of training, availability of resources and clinical exposure. The responses were recorded on Likert scale 1- 5.Their proforma was analyzed using SPSS version 16. 91% of family physicians disagreed that their Undergraduate dermatology training was adequate regarding duration and content. 85% disagreed that the faculty and infrastructure for dermatology training were adequate in their teaching institution.About 90% of family physicians agreed that more time allocation, early clinical exposure, problem based learning and more question items for dermatology assessments will improve the training of undergraduates. Majority of the family physicians are dissatisfied with their undergraduate dermatology training. They suggest that more time and resources should be allocated for dermatology undergraduate training

Association of cutaneous malignancy with epidermodysplasia verruciformis: a clinicopathological study

To find out presence of nonmelanoma skin cancer [NMSC] in a series of 13 patients with diagnosis of epidermodysplasia verruciformis [EDV]. This prospective descriptive study detailed the clinical presentation of patients with EDV associated with nonmelanoma cutaneous malignancy between 2007 and 2010 presenting to Dermatology OPD Pakistan Institute of Medical Sciences, Islamabad. Patients were diagnosed on clinical basis. Patients with all ages and both sexes were included. Skin biopsies were taken from lesions with suspicion of malignancy, stained with hematoxylin and eosin and studied in collaboration with histopathologist. Different histopathological findings were recorded and results analyzed. 13 cases were studied for presence of NMSC. NMSC were found in 3 [23%] out of 13 patients. Actinic keratosis was found in 2 patients and one patient had seborrheic keratosis with suspicious lesions. The clinically suspicious lesions should always be biopsied, as cutaneous malignancy is a well-known, frequent and serious complication of EDV and there is high potential in these patients to develop premalignant conditions

Nosocomial tracheobronchitis in mechanically ventilated patients: frequency, aetiology and outcomes

The aim of this study was to determine the frequency, etiology, microbiological sensitivity and outcomes of nosocomial tracheobronchitis [NTB] in mechanically ventilated patients admitted in surgical intensive care unit. A prospective observational study was conducted in the Surgical Intensive Care Unit [ICU], Department of Anaesthesiology, Civil Hospital Karachi from April 2009 to April 2010. All the patients on mechanical ventilator for more than 48 hours in the ICU were evaluated according to the criteria for the diagnosis of nosocomial tracheobronchitis [NTB]. Outcomes of the patients were measured in terms of development of nosocomial pneumonia after NTB, length of ICU stay, duration of mechanical ventilation and mortality in the ICU. Two hundred and eighteen patients were evaluated for this study. Nosocomial tracheobronchitis was diagnosed in 72 patients. The frequency of NTB was 33%. Sixteen types of organisms were identified, 61.23% cases were poly-microbial, while in the remaining 39.7% cases single organism was isolated. The most common organism was gram negative Acinetobacter spp [51%], followed by Klebsiella spp [29%] and Pseudomonas aeruginosa [16.6%]. Escherichia coli and other gram negative rods were 13.8 % and 11.4%, respectively. There were 4.16 % cases of MRSA isolated in patients who had positive cultures for gram negative organ-isms [poly-microbial]. Ceftriaxone was given in 44% cases as empirical therapy and continued in 33% cases after microbial sensitivity and replaced in 11% cases after culture sensitivity to Cefiperazone + salbactum and in 14% cases cefiperazone was given in combination therapy. Imipenem was used in 28.5% of patients. Quinolones were used in 19% contaminated cases of gut surgeries. Nosocomial tracheobronchitis was significantly associated with increased length of ICU stay and longer duration of mechanical ventilation in our patients when compared to those patients who did not develop NTB [p<0.001]. Moreover, out of 72 patients, 11 developed subsequent nosocomial pneumonia. There was no statistically significant difference noted in mortality rates among patients with NTB and without NTB [43% vs. 41%]. The mortality was related to concomitant comorbitidies, primary cause and surgical outcomes. Nosocomial tracheobronchitis is a common infection in mechanically ventilated patients that significantly affects the development of pneumonia and length of ICU stay for the patients. This study was an insight to the state of NTB in an ICU setup. The higher frequency of NTB demands such studies to set protocols in every intensive care unit

Two forgotten induction agents; etomidate versus thiopental sodium with rocuronium for rapid sequence induction

To assess the effect on intubating conditions and haemodynamic response on intubation of two different induction agents etomidate and thiopental sodium with rocuronium during rapid sequence induction. This prospective quasi experimentalstudy was conducted in Department Of Anaesthesia, SICU and Pain Management, Dow Medical College, Civil Hospital Karachi and Abbasi Shaheed Hospital Karachi Medical and Dental College over a period of one year. Total 120 American Society of Anaesthesiologists [ASA] physical class I and II, adult patients of either gender, aged between 18 to 60 years, undergoing elective surgery were allocated randomly into two equal groups to receive either intravenous thiopental sodium [Group NTR] or etomidate[Group NER] for rapid sequence induction. Group NER was given nalbuphine 0.1 mg/kg, induction agent etomidate 3 mg/kg with muscle relaxant rocuronium 1.0 mg/kg while in group NTR induction agent thiopental sodium was given in the dose of 4 mg/kg with nalbuphine and rocuronium in the same doses. After sixty seconds, laryngoscopy was done. Intubating condition was assessed using the criteria of Cooper and colleagues: ease of intubation, condition of vocal cords and response to intubation. Cardiovascular response on intubation in terms of systolic and diastolic blood pressure and heart rate was evaluated at 0,1, 3 and 5 minutes. Demographic data were comparable between the groups. Intubating conditions which were assessed in terms of ease of laryngoscopy, condition of vocal cords at intubation and intubation response coughing, bucking and diaphragmatic movement were significantly better in the group NER [p<0.05]. Similarly, arterial blood pressure remained close to base line in NER group but there was significant fall in both systolic and diastolic blood pressure in group NTR. However, there was no significant difference in change in the heart rate in the groups. Etomidate-rocuronium is better than thiopental-rocuronium in terms of intubating conditions and haemodynamic stability during rapid sequence induction in non-septic surgical patients in emergency department

Spectrum of Pediatric Dermatosis and Seasonal Variation

To determine the pattern of skin disorders seen among children attending a Medical College Hospital. A descriptive Study. The study was conducted at Dermatology Dept. Pakistan Railway Hospital from Dec 2011 to July 2012. All children 13 years and below attending the Dermatology OPD with skin diseases were included between the period of December 2011 to July 2012. A detailed history was taken; thorough clinical examination was done and was supported by investigations wherever necessary. The diseases were tabulated based on the various groups and results were analysed. A total of 2357 cases [boys 1037; girls 1320] with different dermatosis were included in the study. Most of the disorders were seen between 1 to 5 years of age. The most common dermatoses were bacterial infections [26.21%] and infestations [13.70%] followed by viral and fungal infections [11.96%, 1.41%]. Seasonal variation among childhood dermatosis were also noted during summer and winter. Total of 996 patients were included in the study. Most common dermatosis seen among children during summer were bacterial infections [41.16%] followed by miliaria [12.55], viral and fungal infections [11%] napkin dermatitis [10.84] and infestations [9.63]. During winter most common dermatosis seen were infestations [26.26%], seborrheic dermatitis [24.45%] bacterial and fungal infections and pityriasis alba [9.31%]. Among other dermatosis seen were papular urticaria, vitiligo, alopecia areata, papulosquamous disorders, acne and genetic disorders [0.76%]. In the present setting bacterial infections and infestations are the most common pediatric dermatoses followed by viral and fungal infections and eczematous eruptions

Injudicious use of topical steroids, a misconcept in treatment of patients with acne vulgaris

To determine the frequency of use of topical steroids by acne patients and to observe various cutaneous side effects in these patients. Descriptive study. This study was conducted in Dermatology out patient department, Pakistan Railway Hospital, Rawalpindi from February 15 to April 15, 2012. Total 110 patients were enrolled in the study. All the patients were having clinical diagnosis of acne vulgaris. Patients of both genders with age range of 13- 35 years were included in the study. Frequency of patients using topical steroids to treat acne was calculated and cutaneous side effects of topical steroids were noted. Out of 110 patients of acne, 76 were females [69%] and 34 were males [31%]. Age range of patients was from 13 to 35 years. Topical steroids were used by 68 patients [62%] with acne vulgaris. Mean duration of application of topical steroids ranged from 2weeks to Smonths. Most commonly used steroid was betamethasone valerate [62%], followed by clobetasol propionate [29%] and flucinolone acetonide [8%]. Out of 68 patients using topical steroids cutaneous side effects were seen in 50 patients in the form of aggravation of existing lesions in 18 patients [36%], perioral dermatitis 12 patients [24%], telangiectasias 8 patients [16%], increased facial hair growth 7 patients [14%], tinea incognito in 3 patients [6%] and acne rosacea in 2 patients [4%].This study shows that a large number of patients are using topical steroids to treat acne lesions. Use of topical steroids is a misconcept in treating the lesions of acne vulgaris and their use is associated with various cutaneous side effects including aggravation of acne lesions, skin atrophy, telangiectasias, perioral dermatitis, hirsutism, acne roacea and tinea in cognito

Endometrial biopsy findings in infertile patients

To evaluate the etiopathological factors in infertile patients, detectable on endometrial biopsy. A total number of 100 endometrial biopsies were studied which were obtained from the patients undergoing investigations for infertility over a period of two years from Jan 2003 - Dec 2004, at Histopathology department Combined Military Hospital Sialkot, to find out the cause of infertility in these cases. All these patients were in fertile age group and were between 25 - 35 years of age. All of these biopsies were taken in premenstrual phase. The most common finding was late secretory endometrium [40%] which was consistent with the phase at which the biopsy was taken. Proliferative endometrium indicating anovulatory cycles was noted in 25% cases. Among the pathological findings, the most common was chronic non specific endometritis [15%] followed by endometrial hyperplasia [8%], chronic granulomatous endometritis of tuberculous etiology [5%] and endometrial polyp [3%]. 4% of the biopsies showed mid secretory endometrium which was also out of phase for the time at which biopsy was taken. Although endometrial biopsy is not the only diagnostic tool in women having infertility, however the confirmation of hormonal changes consistent with ovulation can be very helpful in management of these patients. The presence of out of phase endometrium and other endometrial patterns may direct the physician toward appropriate therapy. In addition, the therapy can be directed according to a specific etiology, if detected

Recovery profile - a comparison of isoflurane and propofol anesthesia for laparoscopic cholecystectomy

To compare the recovery profile in terms of time of extubation, eye opening, orientation and mobility and frequency of Postoperative Nausea and Vomiting [PONV] between propofol and isoflurane based anesthesia in patients undergoing laparoscopic Cholecystectomy with prophylactic antiemetic. Quasi-experimental study. Department of Anesthesia, Civil Hospital and Dow University of Health Sciences, Karachi, from January to April 2007. After informed consent, a total of 60 ASA I-II patients scheduled for laparoscopic Cholecystectomy were divided in two equal groups I and P. Anesthesia in all patients were induced by Nalbuphine 0.15 mg/kg, Midazolam 0.03 mg/kg, Propofol 1.5 mg/kg and Rocuronium 0.6 mg/kg. Anesthesia was maintained with Isoflurane in group I and propofol infusion in group P, while ventilation was maintained with 50% N[2]O/O[2] mixture in both the groups. All patients were given antiemetic prophylaxis. Hemodynamics were recorded throughout anesthesia and recovery period. At the end of surgery, times of extubation, eye opening, orientation [by modified Aldrete score] and mobility [recovery profile] were assessed. PONV was observed and recorded immediately after extubation, during early postoperative period [0-4 hours] and late period [4-24 hours]. Antiemetic requirements were also recorded for the same periods in both the groups. Propofol provided faster recovery [extubation and eye opening times] and orientation in immediate postoperative period with statistically significant differences between the groups [p<0.0001]. Recovery characteristics were comparably lower in group I. More patients achieved full points [8] on modified Aldrete score at different time until 30 minutes in group P. Postoperative nausea and vomiting in early and late periods were significantly reduced in group P. Moreover, requirement of rescue antiemetic doses were significantly lower in group P in 24 hours [p<0.0001]. In this series, recovery was much faster with earlier gain of orientation with propofol anesthesia compared to isoflurane in the early recovery periods. Propofol is likely to be a better choice of anesthesia because of its better anti-emetic property that persists long into postoperative period and reduces the risk of PONV

Acute respiratory failure in an asthmatic pregnant patient

A 34 years old woman was brought with complaints of severe difficulty in breathing, sweating, inability to lie in bed for last 02 hours. She had amenorrhoea for last 09 months and was a known case of Bronchial asthma for the last 15 years, for which she was taking regular treatment. General and physical examination revealed sweating, eye brow lifting, nasal flaring, pursing of mouth, licking of lips, ineffective cough, active expiration, irritability, tracheal tug; Patient was restless all the time and was continuously requesting for help in breathing assistance. She rested in a forward sitting posture at one time but then changed posture sooner. She weighed 50 kg Her Last Menstrual Period [LMP] was 20th Nov 2002 and Expected Date of Delivery [EDD] was 27th Aug 2003. Ultrasound abdomen revealed single alive fetus with cephalic presentation. Weight of fetus was 2649 +/- 397 grams. Fetal heart rate was 90/min. No fetal movements detected in 20 minutes. Patient was shifted to operation theatre in sitting position. Her 02 saturation was 88% with 02 being given by mask at 10 litres per minutes. Her peak expiratory flow rate was 60 L/minute. Patient was given injection metochloperamide 10 mg I/V, lignocaine Hcl 100mg and Oxygenated at 10L/minute for 03 minutes. General anaesthesia was induced in modified supine position. Ventilation was controlled with Intermittent Positive Pressure Ventilation [IPPV]. Intraoperatively Inj Hydrocortisone Sodium succinate 200 mg I/V, and Lignocaine 100 mg I/V were given in addition to already started Inj Aminophylline 250 mg I/V infusion in ITC. As her wheeze and bronchospasm was not relieved. She was given salbutamol [100 ugm] 03 puffs intra operatively during ventilation with anaesthesia circuit although adequate delivery of salbutamol was doubtful Inj Adrenaline 1:1000 ,0.5 ml subcutaneously was given and repeated which relieved bronchospasm and improved wheeze. A full term male baby was delivered through a vertical incision