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Introduction: The medical curriculum, the medium of instruction and evaluation in India, is primarily English. While it has the advantage of preparing Indian medical graduates to represent and interact globally, it also translates into learning difficulties for a substantial population of Indian medical students. Hindi is the common language of communication among majority of the population in Uttar Pradesh.Madhya Pradesh Government in India has already started the option of pursuing the allopathic graduate medical course in Hindi. There is paucity of data regarding opinion of medical professionals about implementation of Medical Education in Hindi in Uttar Pradesh and nearby states. Objective: To assess the attitude and opinion of medical students and medical professionals towards using Hindi in Medical Education. Method: A cross-st stsectional web-based online survey was conducted between 1 December 2022 and 31 January 2023. Undergraduate medical students, interns, residents and faculty from medical colleges, hospitals of Uttar Pradesh and neighbouring states (Uttarakhand and Bihar) were contacted to participate in this survey using pretested structured questionnaire. Results: A total of 1606 participants responded and answered the questionnaire and 1575 responses were found complete and used in analysis.Most participants (52.8%) believed that Medical Education in Hindi would attract more students from Hindi backgrounds to join the medical field. Similarly, 58.9% of participants were of the opinion that Medical Education in Hindi would improve communication with patients. However, about half of the participants (49.5%) perceived teaching in Hindi as a hurdle in acquiring higher education. Conclusion: More than half of the participants thought that medical education in Hindi will attract more students from Hindi backgrounds to join the medical field. Similarly, Medical Education in Hindi was perceived to improve communication skills with patients, at least where Hindi is a vernacular language by majority of the participants.
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Intraoperative cholangiogram with cholecystectomy is a routinely performed procedure in living donor liver transplantation [LDLT].The objective of this study was to determine the frequency of gall bladder pathology in healthy living donors and whether routine histopathology can be omitted. This was a retrospective review of 366 donors who underwent donor hepatectomy between 2012 and 2016. Primary outcome of interest was frequency of abnormal histopathology findings in removed gall bladder specimen; and if their distribution was different with respect to gender, age and BMI. Male to female ratio was 2.1:1. Median age was 26 [18-50] years. Median BMI was 23.9 [15.7-35] Kg/m2. The most common finding was chronic cholecystitis in 189 [51.6%]. Gall bladder pathology was more frequently seen in donors with BMI >25 Kg/m2
, i.e. 69.3 % versus 30.7% [p<0.001]. Due to high frequency of abnormal findings, gall bladder should be sent routinely for histopathology in healthy liver donors after cholecystectomy
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Syphilis is a bacterial infection caused by spirochete bacterium treponemapallidum. It is transmitted from one person to another through direct contact during sexual intercourse. During pregnancy the infection can also pass from mother to her child. Men who have sex with men are showing fastest rise in syphilis cases. Highest risk populations are young adults aged between 15 to 25 years. Neurosyphilis can occur anytime during the course of syphilis, it was rampant in the preantibiotic era whereas in the modern world it is considered a disease of the past and is rarely seen. However it is resurfacing the medical literature with sporadic cases being reported from all over the world. Here we are reporting a young male who presented with spasticity and ataxia; on investigation he had white matter lesions on MRI in the brain and spinal cord. His CSF showed pleocytosis and his blood and CSF serology was positive for syphilis. The patient later on confirmed sexual contacts in the past hence diagnosis was confirmed and he responded very well to treatment with nearly complete recovery. It is of prime importance to consider this disease in neurological differential diagnosis so as to identify this disease as early as possible and to reduce the mortality risk associated with delayed diagnosis
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Background: Ninety-five millions of Pakistan's 161 million people, roughly 60% of Pakistan's population live in malaria endemic regions. Despite a well-established malaria control programme, 500,000 malaria infections and 50,000 malaria-attributable deaths occur each year in Pakistan. In Pakistan 15% population lives in high transmission area, 84% in low transmission and 1% in malaria free area, with 64% vivax and 36% Falciparum infections
Objective: The objective of this study was to assess the therapeutic efficacy and safety of Dihydroartemisinin- piperaquine [DP] for the treatment of uncomplicated Plasmodium vivax malaria in subjects
Methods: Its an observational study, conducted at Outpatient Department of Liaquat University Hospital Hyderabad, from December 2012 to December 2013. World Health Organization [WHO] standard protocol for efficacy studies [open-labelled clinical trial] was followed. The subjects with fever or history of fever for 48 hours aged between 6 months to 15 years with microscopically confirmed uncomplicated P. vivax infection were included. Total 109 patients fulfilled the inclusion criteria. Out of 109 patients, 103 had completed the study. Patients were treated with Dihydroartemisinin-piperaquine over three days. Clinical and parasitological parameters were monitored over a 42-days follow-up period to evaluate drug therapeutic efficacy
Results: Adequate clinical and parasitological response of treatment [ACPR] for Dihydroartemisininpiperaquine [DP] was seen in 102/103 [99.02%] patients, no early or late clinical failure was seen while late parasitological failure was seen on 21[st] day in one patient. No adverse events were reported
Conclusion: Dihydroartemisinin-piperaquine is safe and effective treatment option for uncomplicated vivax malaria
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Objective: To determine and assess the common causes of conversion of laparoscopic cholecystectomy to conventional cholecystectomy
Methods: A cross sectional hospital based study was conducted in Surgical Unit-III, Abbasi Shaheed Hospital and Karachi Medical and Dental College. Overall 197 patients were selected through consecutive non probability sampling. Patients included were those with symptomatic cholelithiasis including acute cholecystitis, chronic cholecystitis and asymptomatic gall stones in which ultrasound abdomen demonstrated cholelithiasis with normal common bile duct. Written consent was taken from each admitted patients and assessed clinically androutine investigations [CBC, ESR, RBS, Urea, Creatinine, Liver Function test, Hepatitis Profile, X-ray chest, ECG and ultrasonography of abdomen] were done. Laparoscopic cholecystectomy was done under general anesthesia
Results: Laparoscopic cholecystectomy was successful in 188 patients [95.43%] while in 9 patients [4.59%] laparoscopic cholecystectomy was converted to open cholecystectomy
Conversion was because of haemorrhage in one patient [0.51%], Common bile duct injury inone patient [0.51%], non-visualization of gall bladder in one patient [0.51%], shortage of time for laparoscopic cholectectomy in two patients [.02%], cholecystoduodenalfistula in two patients [1.02%] while two patients [1.02%] were converted to open procedure due to carcinoma gall bladder
Conclusion: The conversion rate was five percent from laparoscopic cholecystectomy to open cholecystectomy hence laparoscopic cholecystectomy is a safe procedure
The knowledge of common reasons of conversion in our tertiary hospital will help to overcome these factors in future, which benefit in reducing cost and improve patients wellbeing
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The aim of this work was to evaluate the effectiveness of Osteoporosis Prevention Exercise Protocol [OPEP] in younger females. One hundred young female volunteers aged 20-30 were selected from IPM and R Dow University of Health Sciences. This was a comparative study in which 64 females participants were randomly assigned into two groups [32 in OPEP exercise group and 32 in walking group]. The exercise session had three components 1] stretching 2] strengthening 3] high impact weight bearing exercises. Both interventional programs consisted of 3 sessions per week for twelve weeks under the supervision of physiotherapist. Pre and post intervention bone mass density [BMD] was measured on the lumbar spine [L1-L4], hip, femur, and distal forearm by using Dual-Energy X-ray Absorptiometry [DEXA] scan. After twelve weeks of intervention BMD was found to be statistically insignificant at hip, femur, lumbar spine and wrist [p > 0.05] comparing the post results in the OPEP and exercise group. Moreover BMD at hip, femur, lumbar spine and wrist was unaltered in both groups comparing the results of pre and post intervention. Though significant changes were observed in BMI in the OPEP exercise group [p value =0.010] mean +/- standard deviation pre and post found to be 20.2578 +/- 3.11123 and 21.0942 +/- 3.64203 but no variations in anthropometrics in walking group were found. The present study highlights the burden of osteopenia in younger females. The Osteoporosis Prevention Exercise Protocol formulated by author was not useful to bring any significant changes in BMD moreover it had no significant effects in comparison to walking group. However additional studies are needed to evaluate the efficacy of Osteoporosis Prevention Exercise Protocol on bone quality with long term effects
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Humans , Female , Exercise , Walking , Bone Density , Absorptiometry, PhotonABSTRACT
Peripheral catheter embolization to the heart is common but infrequently reported. In view of the hazardous complications of thrombosis, embolism, infection, arrhythmia and even death, percutaneous retrieval of such foreign bodies is usually attempted. Previously reported percutaneous technique of retrieval mainly involved the snaring technique. Herein, we report a novel nonsurgical retrieval technique for successful removal of a 46 cm long embolized intracardiac peripherally inserted central catheter by utilizing a flexible biopsy forceps. To the best of our knowledge, the use of flexible biopsy forceps for retrieval has hitherto been unreported and this case report therefore adds to the repertoire of percutaneous retrieval techniques for safe and easy removal of embolized catheters to the heart
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Humans , Female , Middle Aged , Embolism , Surgical Instruments , Biopsy , HeartABSTRACT
To study the results of primary pterygium excision through bare sclera technique with and without intraoperative Mitomycin C use. This was an experimental study with randomised controlled trial. This study was conducted at Eye A unit, Khyber Teaching Hospital, Peshawar from May, 2007 to April,2009. One hundred patients with primary pterygium were selected from ophthalmology Deptt. OPD at Khyber Teaching Hospital, Peshawar. Detailed history was taken. Complete ocular examination done and those fulfilling inclusion criteria were included in the study. Anesthesia used was topical proparacaine 0.5% and local infiltration of 2% lignocaine. Mitomycine C [MMC] 0.02% [0.2mg/ml] was applied through a cotton swab at the bare part of the sclera for five minutes in 50 of these patients. Patients were followed up till three months. In bare sclera technique without MMC, recurrence rate was 70% [35 patients] while in MMC group, it was 16% [08 patients].There was one punctuate epithelial keratitis in MMC group and two cases of conjuntival granuloma one in each group. Pterygium excision through simple bare sclera technique had significantly high recurrence rate as compared to intraoperative use of MMC
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The objective of this study was to analyze and document the presentation of liver trauma and associated injuries. Present study was conducted from January 2010 to December 2011 at Jinnah Postgraduate Center, Karachi, Pakistan. Oral and written consent was obtained from the participants before the start of the study. Inclusion criteria included all patients, aged more than 13 years with hepatic trauma admitted in the wards. The patients with co existing chronic hepatic diseases were excluded. This study comprised of 61 participants, among those [95%] were males and [5%] were females. The mean age of the participants was 31.4. The mean age for female participants was 28.3 while for male was 31.6. Amongst the patients with hepatic trauma, 67.2% had road traffic accidents [RTA] as the cause of their liver injury followed by firearm injury in 19.7%of the cases, physical assault in 9.8% and stab wound in 3.3% of the patients. Investigations done on the patients were ultrasound and C.T scan. In this study 60.7% patients were diagnosed on abdominal ultrasound and 14.8% were found to have hepatic trauma on the abdominal C.T scan. In all the patients with hepatic injury 50.8% had associated injuries. The most common associated injury was chest complications which was present in 10 [16.4%, C.I: 3.7-39.7] patients followed by gut perforation which was present in 11.4% patients. Other common injuries included forearm fracture which was present in 09.8%patients, spleen injury was found in 8.1% and diaphragm injury in 4.9% patients. In Pakistan Road traffic accident is one of the most frequent causes of Hepatic injury and middle aged men are at the highest risk of hepatic trauma
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Patient satisfaction is a good yardstick to measure care giver's success. Patient satisfaction is one of the pertinent objectives of health care system. Since doctor-patient relationship is most crucial and decisive in patients' perception of care and satisfaction, from this survey, we explore various aspects of care received from doctors that determine the overall satisfaction level of patients. The objective of this study was to find out the level of patients satisfaction with various aspects of care provided by doctors in surgical ward in a tertiary care hospital in Karachi. Data was collected from a convenient sample of 174 patients, at the time of discharge from the health facility, who were admitted to surgical ward of Ziauddin Hospital, KDLB campus. Study design was cross sectional. Data collection was done from August till September 2013. Questionnaire was developed after literature review. Patient satisfaction was recorded using the 5 point Likert scale. Data analysis was done on SPSS version 19. Overall there were 57.5% males and 42.5% females participants. 41% of the participants were between 35-44 years of age. 42.5% were educated up to primary level, while 19.5% were not educated at all. Overall satisfaction level was 100%, with 66.7% noted as very satisfying while 33.3% as satisfying. Doctors' politeness, availability, provision of post operative care and discharge counseling were strong determinants of overall satisfaction. Explanation of medicines and patients' participation in their illness discussion were areas of uncertainty and dissatisfaction. Doctors' polite attitude, consultation and availability are vital to patient satisfaction. Areas that need more attention are, seeking patient views in their illness discussion, explaining them prescription drugs and lab investigations
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To determine change in practice of mothers having children less than five years of age in five key areas related to child health, growth and development including immunization, feeding during illness, appropriate home treatment for infections and care seeking behavior. This was a community based interventional study of Information, Education and Communication [/EC] intervention in the UC Jamshoro, Taluka Kotri, district Jamshoro of 15 months duration from March 2011 to June 2012. Ninety five mothers having children less than five years of age were selected by systematic random sampling for house hold based survey by questionnaire designed by EPP evaluation and health section of UNICEF during baseline and post-intervention phases. Base line data was collected from the interventional area then health education messages were given through written and pictorial material by LHWs for 9 months. To measure the impact helath education messages, data was again collected by same questionnaire are from the same union council during post-intervention phase. During baseline survey except immunization all other key family practices were poor. After 9 months of intervention of repeated heath education sessions through LHW during their routine visits all practices were improved with statistically significant difference. Regarding the comparison of the results between baseline and post-intervention surveys we found that except immunization which was already better, all those practices which requires mother's knowledge and practice were improved after our intervention with significant P-values. Improving the mother's education level is very important, to empower the first care provider of child in the community. However, in the mean time, health educational messages reteted to the limited number of key family practices should be disseminated
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Objectives: To assess the validity /strength of clinical diagnosis of Malaria on the basis of IMNCI algorithm by slide microscopy [gold standard] and to compare the effectiveness of Rapid Diagnostic Test [RDT ]against slide microscopy
Methods: It is a descriptive cross sectional study of 6 month duration conducted at Pediatric Outpatient Department LUH Hyderabad from June-Dec. 2010. Sample of 400[the minimum required sample was 385 with malaria prevalence 5% [0.05] with margin of error of 3% [0.03, frequency vary from 2-8 % among different studies]] febrile children under 5 years classified as Suspected Clinical Malaria according to algorithm of IMNCI were included; The operational definition for Suspected Clinical Malaria was; fever for more than 2 days with no runny nose, no measel rash and no other cause of fever. Hyderabad was considered as low risk area. Rapid diagnostic test [RDT] and slide microscopy were done, and only confirmed cases were treated according to current guidelines given by National Malaria Program/updated IMNCI
Results: Total 2000 patients under 5 years presented with fever and were evaluated. From 2000 cases 20% [400] were diagnosed as suspected clinical Malaria according to IMNCI algorithm; and only 40 cases [10%] have shown positive results for malaria parasite on slide microscopy and 38 cases on RDT. Regarding the plasmodium species 70% were vivax and 30% were falciparum. As regards the effectiveness, RDT has shown 95% sensitivity for the detection of plasmodium antigens in the febrile clinically suspected cases of malaria
Conclusion: Prompt and accurate diagnosis of malaria is needed for implementation of appropriate treatment to reduce unnecessary anti-malarial prescription. RDT is as effective as slide microscopy for the diagnosis of malaria especially in resource poor countries
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To determine the frequency and causes of accidental upper limb amputations seeking rehabilitation [prosthesis] care in a tertiary care center. Observational Descriptive Study. This study was carried out at outpatients Department of Institute of Physical Medicine and Rehabilitation at Dow University of Health Sciences, Karachi from Jan 2007 to Dec 2010. The Sampling Technique was non Probability Purposive sampling. A study specific Performa was prepared which included patient age, stump complications, level of amputation and associated risk factors. The data was analyzed in SPSS version 15. The Mean+/-SD age of ULA was 28.56 +/- SD 11.97 [years]. Most ULA were reported from Karachi 65 [67.7%]. Labourers were the most commonly affected groups 33 [34.4%].Accidents leading to ULA were reported in 89 [92.70] and machine injury [chaff cutting] was responsible in one third of the ULA. Quarter of the ULA had leading cause electric injury. Only, 16 [16.7%] amputees had road traffic accidents. The study concluded that majority of upper limb amputation were caused by machine accidents affecting mostly labourers. Therefore, machine safety protocols for labourers, farmers and workers should be implemented in their local language and through pictoral messages and inbuilt safety measures machines should be sold by company representatives
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Humans , Male , Female , Upper Extremity , Tertiary Care Centers , Accidents , Accidents, Traffic , Accidents, Occupational , Electric InjuriesABSTRACT
To determine the determinants of lower extremity amputations in diabetics and non-diabetics in a tertiary care institute. Cross-sectional, analytical study. Outpatients Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, from January 2007 to December 2010. All patients with amputations reporting at the study centre for prosthesis fitting were included in the study. Patient's age, level of amputation, stump complications and associated risk factors of amputation were recorded on a structured proforma. Prosthesis and orthotic assessment were carried out. The frequency and determinants were collected to compare diabetic and non-diabetic amputees. The data was analyzed in SPSS windows version 16. A total of 1091 subjects were provided prosthesis, including 847 males [77.6%]. Mean age in diabetic and nondiabetics being 49.6 +/- 15.2 and 26.6 +/- 17.9 years respectively which is significant at [p < 0.001]. Socioeconomic status and educational levels were significantly associated with diabetic status [p < 0.001]. Amputation was more common in non-diabetic 858 [78.6%] compared to diabetics 233 [21.4%]. This study has identified that most common and significant predictors were gender, low social status and educational levels. Other significant predictors of amputation identified were type of lesion, [infections and ischaemia], initial diagnosis acute/chronic arterial insufficiency and diabetic foot
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To compare the frequency and determinants of prosthesis fitting [artificial limbs] in diabetic and non-diabetic amputees at a tertiary care center. Cross Sectional Comparative Study This study was conducted at Institute of Physical Medicine and Rehabilitation [IPM and R] at Dow University of Health Sciences, Karachi during Oct 2007- Sep 2010. Data was collected from amputee records files seeking carefor prosthetic fitting. There were 1469 prosthesis fitted in both diabetic and non-diabetics patients. The data from both groups were compared for frequency of amputation in diabetic and non-diabetics. The data was entered and analysis was performed on SPSS windows version 16. The analysis of data was performed for patients who were provided prosthesis fitting at IPM and R. Diabetic males were 327[73.6%] female were 117 [26.4%].About a third of amputees had primary, secondary and tertiary health care services for control of diabetes. About 60% of all diabetics were not able to seek medical care for control of diabetes. The use of primary, secondary and tertiary health care services to control diabetes were also recorded to correlate with health seeking facilities among diabetics. The prosthesis fitting was given to one third of diabetic patients after lower limb amputation. The major determinants of diabetic amputees were old age, man uneducated, low socioeconomic status. The facilities for primary, secondary and tertiary health care services to control diabetes are available only to one third of diabetic patients. Diabetic control, education of foot care and accessibility to diabetic and prosthesis centre can markedly improve functional integration of diabetic amputees in community
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Humans , Amputation, Surgical/rehabilitation , Amputation, Traumatic/rehabilitation , Artificial Limbs , Peripheral Vascular Diseases , Prostheses and Implants , Cross-Sectional Studies , Diabetes Complications/surgery , Data Collection , Tertiary Care CentersABSTRACT
Amputation is stated to be a foremost but preventable community health problem causing intense financial, social and emotional effects on the patient and family particularly in developing countries where the prosthetic services are limited. The purpose of this study was to identify the causes and levels of amputation in low resource community, Sindh Pakistan. This was a retrospective chart review study that was carried out at first civilian Institute of physical medicine and rehabilitation-Dow University of health sciences from October 2007 to June 2012. After verbal informed consent all patients, who underwent major or minor amputation were enrolled for the study. Data was collected using a pre-tested, coded questionnaire and analysed using SPSS version 16. A total of 1115 patients were enrolled into the study. Their ages were ranged between 2-95 years [mean 38.40 +/- 17.38]. Among total population of amputees 83.58% were males. The most common cause for major limb amputation was road Traffic accident 38.38%, followed by Diabetes 15.42%, infection 14.26% and trauma 12.37%. Lower limbs [trans-tibial] amputations were in 47.35% of cases and transfemoral in 27.98% of cases. While for the upper limb trans-radial amputation [7.4%] were found to be more common than trans-humeral [5.56%]. Other amputations were for shoulder, hip and knee disarticulations. Road traffic accidents, complications of diabetic foot ulcers, infections and trauma were the most common causes for major limb amputations found in low resource community, Sindh Pakistan. The majority of these amputations are preventable by endowment of traffic rules, health education, early preventions and appropriate management of the common infections
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Humans , Male , Female , Residence Characteristics , Epidemiology , Retrospective StudiesABSTRACT
To determine obstetrics risk factors for cerebral palsy from birth to 5 years children. A hospital based cross sectional survey. This study was conducted in outpatient department, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences Karachi, Pakistan during October 2007 to October 2010. Children with cerebral palsy between births to 5 years of age were included in the study. The Sampling technique was non probability purposive. Data was analyzed as frequency and association by chi-square in SPSS version 15. Children enrolled in this study were 300 their Mean age +/- SD was age 4.9 +/- SD 3.6 yrs. Mean maternal age +/- SD was 30.8 +/- 6.5 years. Mostly mothers had secondary level of education 110 [36.7]. Father's Mean income +/- SD was 11587 +/- SD. During assessment the pregnancy risk factors were mostly hypertension 55 [18.3%], diabetes mellitus 28 [9.3%] seizures 11 [3.7%] placenta previa 4 [1.3%]. The commonest risk factor was birth asphyxia in one third of children and two third of the deliveries were conducted in institutions as spontaneous vaginal deliveries. Birth asphyxia is the major obstetrics risk factors for cerebral palsy from birth to 5 years children. The obstetrics practices require revisiting and reprogramming to reduce cerebral palsy
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BACKGROUND: Obstructive jaundice is caused due to obstruction to the biliary flow via the biliary system. The most common benign condition causing this obstruction is Choledocholithiasis and the most common malignant cause is Carcinoma head of pancreas. MATERIALS AND METHODS: 40 cases of Choledocholithiasis and 40 cases of Carcinoma head of pancreas were included in this study. Liver function tests and serum iron and its related parameters were estimated in both the groups and were statistically compared. RESULTS: A statistically significant increase in Total bilirubin, Direct bilirubin, Alkaline phosphatase and 5’Nucleotidase was seen among Group 2 cases when compared to Group 1 cases. Serum iron levels showed a statistically significant decrease among Group 2 cases when compared to Group 1 cases. DISCUSSION: Early evaluation of obstructive jaundice to establish the etiology is crucial to avoid secondary pathological changes. Liver function tests provide a simple and non-invasive means of diagnosis. In this study it is observed that the magnitude of alteration of LFT is higher in Carcinoma head of pancreas when compared to Choledocholithiasis thus differentiating the two. Serum iron levels are elevated in hepatocellular injury and as there is hepatocellular injury in obstructive jaundice, serum iron levels were estimated in both the groups of patients. However serum iron levels were within the normal range but the mean value was lower in the group 2 compared to group 1 which demands further study in this field.
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To determine the frequency of raised D-dimer in patients of cerebral venous sinus thrombosis [CVST] at Neurology Department, Military Hospital Rawalpindi. Descriptive study. One year duration conducted in the Department of Neurology at Military Hospital Rawalpindi from 1[st] May 2010 to 1[st] May 2011. Thirty patients were selected randomly from Neurology Department, who were recently diagnosed cases of cerebral venous sinus thrombosis [CVST] on the basis of magnetic resonance imaging [MRI] and magnetic resonance venography [MRV]. D-dimer test samples were drawn and subjected to latex agglutination test. There were 22[73.33%] males and 8[26.67%] females in our study. D dimmer assay analyses revealed 90% [27 patients] as positive and 10% [3 patients] as negative. Raised D-dimer levels are highly suggestive of CVST provided other conditions are clinically excluded and they can be used as an adjunct in the diagnosis of cerebral venous thrombosis
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This case report describes the occurrence of intraventricular haemorrhage in a teenage boy, who was later found to have neurofibromatosis-1, cerebral vascular disease and pectus excavatum