Factors predicting the recurrence of spontaneous bacterial peritonitis in patients with cirrhosis

To evaluate the frequency of recurrence of spontaneous bacterial peritonitis [SBP] in patients with end stage liver disease and the factors responsible for it. Descriptive study. The Aga Khan University Hospital, Karachi, from November 2008 till November 2009. Patients with cirrhosis who were admitted at AKUH with diagnosis of SBP during the study period were included. Any episode of SBP after resolution of the first index case of SBP within one year was considered as recurrence. Out of 238 cirrhotic patients, 157 [66%] had single, while 81 [34%] had recurrent episodes of SBP. History of using proton pump inhibitors [PPI] and diuretics was found in 113 [47.5%] and 139 [58.4%] patients respectively. Only 58 [24.4%] patients were on prophylactic antibiotic therapy. Univariate analysis revealed that the female gender [52%], and presence of porto-systemic encephalopathy [PSE, 31%] were statistically significant [p=0.03] among those who had recurrent SBP. On multivariate analysis bilirubin level of > 1.0 mg [OR=7.03; 95%CI=1.55-32], protective factor of hepatitis B [OR 0.31; 95%CI=0.13-0.70] and presence of urinary tract infection [UTl] [OR=2.24; 95%CI=0.99-5.09] were significant in patients with recurrent SBP. Recurrent SBP was noticed in 34% patients. Serum bilirubin level of > 1.0 mg, protective factor of HBV and presence of UTl were significant factors present in patients with recurrent SBP

Career goals of trainee physicians in internal medicine

To survey Internal Medicine trainees' future career choices and factors influencing their decision-making. Cross-sectional study. The Aga Khan University Hospital, Karachi, from November 2006 to January 2007. A standard questionnaire was administered to the residents and Interns working in the Department of Internal Medicine of The Aga Khan University Hospital. The questionnaire covered demographic details, specialty choice, work-time distribution and factors influencing career choice. Descriptive statistics were applied. A total of 49 doctors participated with 57% females; and 43% males, having 33% interns and 67% residents. A minority [22%] opted for internal medicine, while 78% selected sub-specialties with cardiology [20%] being the most sought- after sub-specialty. Majority [69%] wanted to spend more time in clinical activities compared to administration [18%] or research [13%]. Majority [92%] wanted to work in an academic setting. Availability of a structured training program [61%], ability to practice broad area of medicine [41%] and prestige of the specialty [41%] highly influenced their career choices. Forty one [82%] wanted to proceed abroad for further training and 80% wanted to eventually practice in Pakistan. Most of the interviewed under-training physicians wanted to pursue sub-specialty. Clinical work was more attractive compared to research. A structured training program was detrimental in affecting their choices. Majority wanted further training abroad but eventual settlement in Pakistan. The study results can help us create the basis for reforming the current training programs