Innovation in medical education: implementation of problem based learning under the umbrella of a traditional curriculum - perceptions of students and faculty

To take the feedback of the students regarding the process of PBL, and of the faculty about student's performance. Descriptive study. The department of Medical education, Rawalpindi Medical College from 2007 till June 2008. The study was carried out in the first year class of 270 students at Rawalpindi Medical College. The Basic Sciences teaching was augmented by problem-based learning and integrated approach. Students of first academic year were allocated randomly to 20 batches each comprising 12-13 students. One facilitator was randomly allocated to each batch. Basic science faculty was made to participate actively in problem based learning along with clinical experts. The completed program was evaluated based on structured questionnaires. The response of students towards PBL as teaching strategy, was encouraging. Quantitative analysis showed that the mean score of the student's performance was 14.74 [SD +/- 3.255] out of 20. Most of the students [78.6%] agreed that the problem based learning facilitated their learning process whereas 6.5% disagreed and 14.9% did not comment. The study showed that it is possible to adopt problem based learning in the undergraduate medical course under a conventional curriculum

Extra-luminal air fluid level on abdominal X-ray of a patient with isolated jejunal blow out case report

Patients with trivial blunt abdominal trauma may present with isolated jejunal blow out [IJBO]. A high index of suspicion is required as delayed presentation or delayed diagnosis may increase morbidity. Presentation with frank perforation peritonitis can be diagnosed by abdominal X-rays. We report the case of a patient who presented with features of peritonitis 10 days after being injured by a knee kick trauma. An erect abdominal X-ray showed extraluminal air-fluid levels, suggesting a hollow viscous injury which on exploration was found to be IJBO

Transperitoneal drainage versus non drainage in advanced secondary peritonitis due to enteric fever

Background: Whether or not to utilize peritoneal drainage in patients with diffuse peritonitis has been a subject of controversy for years

Objective: This study was designed to compare the incidence of various postoperative complications after ileostomy in secondary advanced peritonitis due to enteric perforation with or without drains

Patients and Methods: This prospective interventional study was conducted in Surgical UnitI, Sheikh Zayed hospital, Rahim Yar Khan, from 1[st] January 2010 to 30 September 2010. All patients having history of secondary peritonitis for more than 48 hours were included in the study. Ileostomy was performed in patients showing features of systemic toxicity. Patients were randomized into two groups; Group A, in whom transperitoneal drainage was employed and Group B, without drainage. Patients with primary repair were excluded from the study

Results: A total of 50 patients with secondary peritonitis due to typhoid perforation [with evidence of systemic toxicity] requiring ileostomy, with or without gut resection, were included in this study. Mean age of patients was 24.75 +/- 10 years. 56% was males with M:F ratio of 1.27:1 Twenty six patients were without drainage and twenty four patients had drainage [group A and B]. Mean post operative hospital stay for group A and B were 9.5 +/- 0.5 and 6.5 +/- 0.51 respectively. 5 patients in group A, developed wound infection as compared to 3 patients in group B. In group A one patient got burst abdomen, two patients got intra abdominal collection, one chest infection compared to none in group B

Conclusion: The study has shown no benefit of drainage of peritoneal cavity in secondary advanced peritonitis, infact there was a slightly higher rate of complications like burst abdomen, intra abdominal collection and pulmonary infections among patients in whom drain was placed

Result of surgical decompression and internal fixation with titanium cage in patients with carries spine

The objective of the study is to assess, the postoperative outcome of the intervertebral titanium cage, in patients operated for Caries spine with unstable spine with/without neurological deficits. This is a retrospective study, carried out in department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan, during 2 years, from January 2006 to December 2007. All patients underwent a neurological and radiological assessment. Those patients who had collapse of vertebral body/s, with/without gibbus formation having some neurological deficit were included. Patients fit for surgery, were operated upon, with placement of intervertebral adjustable titanium cage. These patients were followed up for eighteen months. The study comprised of 11 patients, with their age ranging from 20 to 53 years having 7 males and 4 females. The patients were admitted through OPD or the emergency department in neurosurgical ward of Sheikh Zayed hospital, Rahim Yar Khan. The majority of the patients had D10-11 lesion [36.3%] followed by L2 in 18.1%. The neurological status of the patients received showed paraplegia in 27.27% while paraparesis in 72.72% of patients. The neurological outcome of 11 patients, after eighteen months of follow up, showed marked improvement in 72.72% patients of incomplete spinal cord compression [paraparesis]. While some improvement in 27.27% patients of complete spinal cord damage [paraplegia]. All patients with kyphotic lesions had near normalization of the anatomical curve of the spine. All patients were kept on antituberculous chemotherapy for one year. Our experience with usage of the titanium cage for internal fixation in Caries spine showed very promising results, especially in patients of paraperesis with/without gibbus formation. This technique may become a main stay of surgical management in Caries spine for thoracolumber region in our setup

study of complications seen in 300 cases of ventriculo peritoneal shunts managed at Sheikh Zayed Hospital, Rahim Yar Khan

The objective of the study is to assess, the postoperative complications of 300 hydrocephalic patients, operated with ventriculo peritoneal shunting system. This is a retrospective study, carried out in the department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan. 300 patients including both adults [20.3%] and children [79.6%] with various causes of hydrocephalus were operated upon. All patients underwent a neurological and radiological assessment, and all those patients who had clinical and radiological evidence of hydrocephalus and were fit for surgery, were operated. All patients underwent a ventriculo peritoneal shunt placement. The follow up of the patients was for six months and all the complications were noted and dealt with. The common cause of hydrocephalus seen in children was Aequeductal stenosis, followed by post meningitis hydrocephalus, whereas in adults, trauma and tumours were responsible for the disease. Most common complication seen in our study was shunt blockade [33%] followed by wound infection and meningitis [23%].The study was to identify complication rate of ventriculoperitoneal shunt in our setup. Inspite of low socioeconomic setup and poor hygiene our results are still comparable to some foreign studies