Medical school dermatology curriculum - are our graduates adequately prepared and aligned to community needs?

Background: There is paucity of research based information regarding the dermatology learning needs and their fulfilment in primary care physicians

Objective: To determine skin diseases burden in the community AND adequacy of preparedness of Primary Care Physicians to deal with skin diseases

Methodology: This was a cross sectional study conducted from 1[st] January 2015 to 31[st] December 2016 at Dermatology Outpatient Department of Sheikh Zayed Medical College/Hospital [SZMC/H], Rahim Yar Khan, for burden of skin diseases and feedback from Primary Care Physicians of both SZMC/H and Primary Health Care setups [BHUs and RHCs] of District Rahim Yar Khan regarding adequacy of their preparedness to deal with skin disease patients. Records from a tertiary care teaching hospital was sought from OPD to assess skin disease burden and Primary Care Physicians from tertiary care hospital and BHU and RHC of district were surveyed regarding content AND teaching adequacy of undergraduates through their dermatology curriculum. Data was entered and analyzed by using SPSS version 20

Results: A total of 356 doctors participated in this study. Of these 233 [65.4%] were males. It was found that 10% of patients attending OPD in Sheikh Zayed Hospital [A tertiary care teaching hospital] suffered from skin disease. Frequencies of "Common skin diseases" in the community were; eczema 12.9%, scabies 10.8%, fungal infection 9%, bacterial infection 8% and acne 7%. Of all participants, 274 [77%] reported that <10% of their patients suffered from skin disease and only 30 [8.4%] of them were fully confident while treating skin disease patients and only 36 [10.1%] reported that most of their patients were cured. It was noted that 145 [40.7%] participants could name only 1-3 of the common skin diseases in the community, 182 [51.1%] named 4-6 while only 12[3.4%] could name 7 or more and 17[4.8%] had no knowledge of even a single common skin disease in the community. Only 92[25.8%] participants rated that their undergraduate training was adequate while 264[74.2%] rated it to be inadequate

Conclusion: This study concluded that primary care physician were not adequately prepared for managing common skin diseases during their undergraduate training. Appropriate exposure and adequate teaching in dermatology throughout undergraduate medical curriculum is essential because skin presentations manifest throughout all aspects of medicine, and most often dermatological problems are dealt with exclusively by non-dermatologists

Correlation between innercanthal distance and the mesiodistal width of the maxillary central incisors

Objective: To establish whether a correlation exists between the innercanthal width and maxillary central incisors

Study Design: A Descriptive cross sectional study

Place and Duration: Department of Prosthodontics, Dr Ishrat ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences Karachi and from 15th October 2012 to 25th March 2014

Methodology: One hundred and seventy five dentate individuals with intact maxillary anterior teeth were investigated. The innercanthal space was calculated among the inner canthal angles utilizing computer software. The mean dimension of the two central incisors was determined extra orally at their widest dimension. Teeth measurement and inner canthal distance association in respect to gender was evaluated by paired t test. Pearson correlation coefficients test was premeditated to establish any association amongst innercanthal space and central incisors width, significance was set at a = 0.05

Results: The mean value for male and female subjects was 33.24 +/- 3.4 mm and 34.90 +/- 3.8 mm correspondingly. The mean width of maxillary central incisors for male and female subjects was recorded 15.84 +/- 1.4 mm and 15.92 +/- 1.3 mm. The value [P = 0.000] for both estimations were significant. The Pearson correlation coefficient were positive [r = 0.202] and highly significant [P = 0 .008] between innercanthal dimension and the maxillary central incisors. The results indicated that innercanthal ratio ratio of 1:0.462 may be used to calculate the combined width of maxillary central incisor teeth

Conclusion: Mean of maxillary central incisor width and inner canthal distance were higher in females significantly. The results proposed that innercanthal distance is a good prognostic factor for determining the maxillary central incisors mesiodistal width

Small breast abscess presented as invasive ductal carcinoma in a young female

Invasive ductal carcinoma of breast and tuberculosis are very rare conditions to coexist. There are no pathognomonic symptoms or signs to distinguish both diseases. A female patient was referred from the emergency for incision and drainage of an abscess in the left upper outer quadrant; with severe localized pain accompanied by pain in the rest of the breast. It was found per-operatively that, besides the abscess in which thick pus was present, cancerous cells were found prevalent in three quadrants of the left breast