Brain drain: doctors' career intentions and associated factors, a questionnaire survey in Pakistan

Objective: To describe Pakistani doctors' career intentions, future practice locations and their satisfaction with work conditions in home country and also, the factors behind leaving and staying in the country

Methodology: This cross sectional study was conducted on 132 junior doctors of POP Hospital and Wah Medical College, Wah Cantt during November-December, 2015. The self-administered questionnaire was designed after extensive literature review and was distributed. Data was analyzed using SPSS version 19 and p value <0.05 was considered statistically significant

Results: Majority of the participants intended to seek postgraduate training in different specialties of medical field [81.8%]. International careers were anticipated by 27.2% of the participants, and UK, Middle East and US was found to be their preferred choices. 72.7% were not satisfied with working conditions in home country. 40.9% reported less likelihood of returning back to Pakistan if opportunity is given to go abroad. Major factors that stood out as reasons for the intention to emigrate included; doctors being paid a high salary, higher educational opportunities, good working conditions abroad and structured career path

Conclusion: Low expected monthly salary, stressful working environment and lack of professional growth were the most important reasons of physician dissatisfaction and migration from developing countries to developed ones

Ethics in examining victims of sexual assault

Objective: To evaluate the application of medical ethics which is mandatory for examining the victims of sexual assault

Study design: Retrospective case review

Place and Duration of study: Emergency Department of Federal Government Services Hospital and Pakistan Institute of Medical Sciences Islamabad, from January 2012 to December 2012

Methodology: It was a retrospective study in which there were 25 patients from one hospital and 51 from the other who reported with history of sexual assault. All patients presented to the emergency and accident department where they were attended by the medicolegal doctor on duty. The detailed analysis of the victim's examination notes, consent form, findings and the opinion by the examining doctor were assessed

Results: Out of the total 76 cases, 17 [22.4%] were married and 59 [77.6%] unmarried. There were 51 [67%] females and 25 [33%] males. The average age of these victims was 17.2 year. The average time of reporting was as early as 2 hours and as late as after 240 days. In only 6 [7%] cases the assailants were known to the victim. Ten victims had general body injuries. Amongst genital injuries, 64% had vaginal and 28% had anal injuries. On the final analysis of the victim's record no written consent was available of the victims whose examination was done. Only two records showed the written consent of the victims who refused examination. None of the documents showed any proof of counseling the victim of the consequences of this examination. Similarly lot of emphasis was given on the integrity of the hymen rather than the associated trauma signs

Conclusion: Sexual assault is more common in both genders in younger group who are also unmarried. Most of these victims' record was insufficient due to lack of professionalism and expertise in the field of forensic medicine

Osteoporosis in healthy postmenopausal women

Objectives: To determine the frequency of osteopenia and osteoporosis using dual energy x-ray absorptiometry in healthy postmenopausal women within five years of onset of menopause and also to compare the menopausal symptoms between two different age groups

Methodology: This cross sectional study was conducted at the outpatient department of Obstetrics and Gynecology, Fauji Foundation Hospital Rawalpindi from January 1[st] 2010 to May 31[st] 2010. DXA scan of the lumbar spine [L2- L4] and right hip [femoral neck] was requested. Osteoporosis was defined by a T-score of -1. Menopausal rating scale was used and all findings were recorded in predesigned proformas

Results: Out of a total of 33 subjects, who underwent dual energy x-ray absorptiometry, osteopenia and osteoporosis were found in 22 [66.7%] while only 11 [33.3%] have normal results. We took Null hypothesis H0: pi=0.5 against the alternative H1: pi>0.5. The test statistics is 22.4 and p value is zero. So H0 is rejected at all significance levels showing that ratio of abnormal DXA scan findings i.e. osteopenia and osteoporosis among healthy postmenopausal women is significantly much higher than normal findings. Also poor concentration, sexual dysfunctions, urinary symptoms, dyspareunia and joint pains were significantly more common in group II: age >50 than group I: age 50 or below [p-value <0.05]

Conclusion: Osteopenia and osteoporosis are significantly more common in healthy postmenopausal women in early years of menopause. Menopausal symptoms have a significant correlation with advancing age

Frequency of ovarian malignancy in patients reporting with ovarian cysts

Objectives: To Investigate the frequency and type of ovarian cancer amongst patient who underwent surgery for ovarian cyst diagnosed on ultrasound

Study Design: A Prospective, Observational study

Place And Duration: 1st June 2002 to 31st May 2003. Fauji Foundation Hospital, Rawalpindi

Methodology: A total of 90 patients diagnosed as having ovarian cyst larger than 5X5 cm size were recruited from the outdoor patients department of Obstt/Gynae of Fauji Foundation Hospital. Their details were entered into a predesigned performa. All these patients underwent laparotomy after having detailed ultrasound of abdomen and pelvis. Their histopathology reports were followed up and the final analysis of the data was done

Results: In our study cases malignancy was reported in 18% [n=17] of the cases. Most common benign tumor was serous cyst adenoma 14.4 %[n = 13] while 5.5 % [n=5] had malignant serous cyst adenocarcinoma

Conclusion: All the patients reporting with ovarian cyst larger than 5cm should be carefully evaluated for malignancy

comparative analysis of frequency and patterns of ovarian tumours at a tertiary care hospital between two different study periods [2002-2009]

This study was conducted to investigate the frequency and type of ovarian tumors amongst patients who underwent surgery for ovarian cyst diagnosed on ultrasound and also to compare a change in pattern of type of tumors between 2002 and 2009. Comparative, Observational study. This study was carried out in the department of obstetrics and gynaecology Foundation University Medical College, Fauji Foundation hospital Rawalpindi that is a tertiary care hospital, from 1[st] June 2002 to 31[st] May 2003 [Study period 1, n=90] and from 1[st] November 2008 to 31[st] October 2009 [Study period 2, n=93]. All the patients who had ovarian cysts larger than five centimetres in size diagnosed on ultrasonography and planned for surgery were included in the study. All the relevant details were entered in prof or mas. Histopathology of excision biopsies was analysed. The overall incidence of ovarian tumors was 7.1% and 5.4% with a rate of malignancy 18% and 5.4% in period 1 and 2 respectively which was statistically non significant [p>0.05]. The most common malignant tumour was serous cyst adenocarcinoma during both study periods. The most common benign tumor was simple follicular cyst 25% during study period one and serous cyst adenoma 23% during period 2. The frequency and patterns of ovarian tumors has remained unchanged between 2002 and 2009

Comparison of biochemical and ultrasonographic features in hirsute females with polycystic ovarian syndrome and other causes of hirsutism

Polycystic ovarian syndrome is a heterogeneous disorder and one of the commonest endocrine disorders of women. One of its common presentations is hirsutism. The aim of this study was to evaluate the biochemical and ultrasonographic features of PCOS in patients with hirsutism and to compare these features with other etiologies of hirsutism in our setup. Comparative study. This study was conducted between 1[st] September 2007 to 31[st] December 2008 in the department of Obstetrics and Gynecology, Fauji Foundation Hospital Rawalpindi. All the female patients who presented to gynae and dermatology clinics with hirsutism were included in the study. A detailed history, clinical examination with special reference to Ferriman-Gallwey scoring system, endocrinological workup and abdominopelvic ultrasonography [USG] was done in all patients. We divided the patients into two groups, one labeled as PCOS group [i.e. treatment group] and the other control group including idiopathic hirsutism and other etiologies. Data was analyzed using STATA 11. Multivariant test and logit model was used for statistical analysis. A total of 74 patients were included in the study, 44 had PCOS and 30 were in the control group with other etiologies of hirsutism. Regarding the biochemical tests, only serum FSH, LH and progesterone levels showed statistically significant difference between the two groups [p-value 10 ml] between the two groups was also statistically significant [i.e. p-value

hospital based study of frequency, intensity and impact of premenstrual syndrome symptoms on female patients

To study the frequency, intensity of the premenstrual symptoms and its impact on the women reporting to the hospital with other complaints. Observational Study. This study was conducted at the Outpatient Department of Gyne and Obst. Unit, Fauji Foundation Medical College / Hospital, Rawalpindi from 1[st] June 2008 to 31[st] December 2008. We had total 224 women who were included in this study. These women were included in this study because they were menstruating regularly for the last six months. They were not suffering from any surgical, medical or psychiatric illness and were not pregnant. These women were interviewed by trained personnel and all the symptoms with their intensity were entered into the specially designed proformas. Only those symptoms were given importance which was present in the preceding at least three menstrual cycles. Out of total 224 women only 34% of the women had any awareness regarding the presence of these symptoms in relation to menstruation. Lethargy was the commonest symptom found in 74% of women with mild intensity [51.9%]. Least common symptom was negative thoughts present in 16% of the women. 50% of the women reported that their daily activities were affected by the presence of these symptoms. For the relief of these symptoms the commonest drug used was ponston [39.7%]. The age group mostly affected in our study was from 36 to 50 years. The awareness regarding premenstrual syndrome associated symptoms is very low and especially amongst women belonging to rural background with low educational status. Health providers should be actively involved in providing information and therapies to these women so that they do not suffer in silence

Etiology of hirsutism. Is there a correlation between menstrual regularity, body mass index and severity of hirsutism with the cause?

Hirsutes having regular menstrual history or with body mass index [BMI] within normal range or mild hisutism are often taken as idiopathic hirsutism. To investigate the hirustism in patients presenting in the Fauji Foundation Hospital [FFH], Rawalpindi and to determine if menstrual regularity, BMI and severity of hirsutism correlates with the cause. It was descriptive study over a period of fourteen months in the departments of Dermatology and Gynecology and Obstetrics of FFH, Rawalpindi. Females who presented to either department with hirsutism were enrolled in this study. A detailed history, clinical examination with special reference to Ferriman-Gallwey [FG] scoring system, endocrinological workup and abdominopelvic ultrasonography [USG] was done in all patients. SPSS version 12 was used for statistical analysis. Out of a total of 71 patients, the commonest cause of hirsutism in our study was polycystic ovarian syndrome [PCOS] in 57.7%. Idiopathic hirsutism was present in 22.6% and late onset congenital adrenal hyperplasia in 9.9% patients. Hyperprolactinemia and thyroid disorders were diagnosed in 4.2% respectively. One [1.4%] patient had multiple etiologies. The correlation between menstrual regularity, BMI and severity of hirsutism with the cause of hirsutism was not statistically significant [p >/= 0.05]. PCOS is the commonest cause in our study population. The correlation of menstrual regularity, BMI and severity of hirsutism with its cause is not statistically significant

Rapid clinical diagnostic tests for bacterial vaginosis and its predictive value

To determine the sensitivity and specificity of Amsel's criteria for diagnosis of bacterial vaginosis. This study was carried out at the Outdoor Department of Obstetrics and Gynaecology Fauji Foundation Hospital Rawalpindi from 20[th] Feb to 20[th] August 2008. A total of 556 pregnant patients were seen among which 208 patients had complaints of vaginal discharge. These patients were then scrutinized for the diagnosis of bacterial vaginosis by employing rapid clinical tests i.e. Amsel criteria, which was further confirmed by gram staining in laboratory. Among 208 symptomatic women bacterial vaginosis was diagnosed in 38.55% [n=80]. These women had 3 out of 4 Amsel's criteria fulfilled i.e. presence of milky white vaginal discharge, clue cells, Whiff test or alkaline pH. The specificity of each criterion was calculated which came out to be 96% while for the Amsel's criteria it was 96.8%.The sensitivity was 84% of milky white discharge, 87% of Whiff test, 82% of clue cells and 86% of pH while the overall sensitivity of Amsel criteria was 92%. Amsel's criteria is a sensitive method for the diagnosis of bacterial vaginosis when compared with gram staining. It provides us with a rapid clinical results with sensitivity of Whiff test being 87%

Knowledge, beliefs and misconceptions regarding contraceptive use amongst women reporting with history of induced abortion

To assess the knowledge, beliefs and misconceptions influencing contraceptive use amongst rural women reporting with septic induced abortion in a university hospital in Rawalpindi. A hospital based cross sectional study. The Gynecological unit of Fauji Foundation Hospital Rawalpindi. Study Period: 1[st] May 2002 to 31[st] May 2005. A total of 100 patients with history of septic induced abortion was included in this study In order to collect complete information regarding knowledge, beliefs and misconceptions about contraceptive use a detailed interview of both the partners were taken separately and a special proforma was filled up. Amongst the 100 women included in this study only 15% had their education uptil primary level and most of them were housewives. 58% of the couples agreed to adopting such a dangerous method to limit the size of their family while 21% had financial restraints. Amongst the husbands 63% showed complete ignorance about any contraception. Knowledge of women was slightly better with complete ignorance in only 38%. Fear of side effects [45%] was a major factor for not using contraceptives while the ignorance factor was found in 36%. Severe morbidities included 11% of women undergoing laparotomy while 74% had to undergo a repeat evacuation for retained products of conception [POCs]. There was one maternal mortality in our study due to tetanus. Information regarding contraceptive methods is very scarce and incorrect. leading to increased number of unwanted pregnancies culminating in induced abortions and climaxing in severe maternal morbidities and even mortalities