principals' perspective of the learning environment in undergraduate medical colleges of a developing country

Objective: To explore the perspective of Principals in a developing country regarding the learning environment of their respective undergraduate medical colleges, thus highlighting the difficulties faced by them and obtaining their recommendations for improving the educational environment. Study Design: A concurrent mixed method study in the pragmatic paradigm using survey and interview techniques to collect data. Place and Duration of Study: Study was conducted from June 2015 to December 2015 involving institutional heads of seven undergraduate medical colleges in the twin cities of Rawalpindi and Islamabad in Pakistan

Material and Methods: Principals of seven undergraduate medical colleges in one city were given a brief questionnaire to fill which was followed by interviews. The data from the questionnaire was analyzed using SPSS-21 and the data from the interviews was analyzed using NVivo 11. Themes obtained were studied in detail for analysis and interpretation

Results: The study determined that while the learning environment in different medical colleges is neither uniform nor optimal, most institutional heads have similar opinions about major factors contributing to the learning environment and face more or less similar difficulties. Curriculum emerged as the most important factor contributing to the learning environment. Lack of resources and shortage of academic staff were the main difficulties identified. Improved standards of student and faculty selection and better coordination between the colleges and the affiliated teaching hospitals were two of the important recommendations

Conclusion: Lack of resources, shortage of the academic staff along with the curriculum issues were identified as the major factor contributing towards the learning environment

Mode of presentation and short term response to treatment in cases of congenital adrenal hyperplasia [CAH] detected over a period of one year at Military Hospital Rawalpindi

Congenital adrenal hyperplasia [CAH] is an autosomal recessive condition which not infrequently presents with life threatening emergencies. Awareness of physicians regarding these presentations is a prerequisite for a prompt diagnosis and life saving treatment. In view of the prevalence of the condition as reported from tertiary care centres within the country and other parts of the globe, we carried out a study in the department of paediatric medicine at the Military Hospital Rawalpindi to determine the modes of presentation of congenital adrenal hyperplasia [CAH] and to observe the short term response to treatment. The study extended over a period of one year from Aug 2003 to July 2004. All children presenting with vomiting, dehydration, shock, failure to thrive and ambiguous genitalia were examined and investigated thoroughly. The mainstay of the diagnosis was a raised level of serum 170HP in a child with suggestive clinical features. A total of 30 children were fournd to have CAH during the study period. The major clinical features a presentation were vomiting 8[26.7%], ambiguous genitalia 7[23.3%], vomiting and ambiguous genitalia 10[33.3%], shock 4[13.3%] and failure to thrive 1[3.3%]. All the patients were followed up after initiation of treatment and response was observed. The study highlights the importance of common clinical symptoms life vomiting being the presenting features of CAH and the effectiveness of replacement therapy in ameliorating life threatening emergencies due to this condition

Wilms' tumour: presentation and treatment

To determine the clinical presentation and treatment results of patients of Wilms tumour treated with United Kingdom Children's Cancer Study Group [UKCCSG] protocol. Design: An interventional study. Place and Duration of Study: The study was conducted in the Paediatric Oncology Department of Combined Military Hospital, Rawalpindi [CMH RWP], from January 1999 to December 2000. Subject and All patients of Wilms' tumour managed by using UKCCSG treatment protocol were included in the study. The patients were thoroughly investigated before treatment. Surgery, chemotherapy and radiotherapy were performed as per protocol. Twenty-two patients including 13 boys and 09 girls with the mean age of 28 months, ranging from 4 months to 7 years were studied. The tumour involved right kidney in 13 and left in 9 patients. Two [09%] patients had stage I, 5 [23%] stage II, 11 [50%] stage III and 04 [18%] stage IV disease. Histology was favourable in 18 and unfavourable in 04 patients. Nineteen [86.4%] patients underwent primary surgery, one had delayed surgery while 02 [9%] patients had inoperable tumour and died despite chemotherapy. Three patients died during maintenance chemotherapy and one after completion of treatment. The overall mortality was 06 [27.3%]. Three patients were lost to follow-up. The treatment outcome is comparable to UKCCSG results. Challenges to be addressed in our set up include illiteracy, deficiency of resources, and regularity of treatment and follow-up. system and, therefore, its application is recommended to evaluate ovarian masses in clinical practice

Experience with a hybrid chemotherapy regimen and involved-field radiotherapy in paediatric hodgkin's disease

Although survival rates have improved dramatically for childhood Hodgkin's disease current treatment entails substantial risks for the late effects such as infertility, second malignancies and cardiopulmonary toxicities. A treatment regimen was chosen with decreased risks of long term sequelae while maintaining efficacy in terms of response and survival. Sixteen children with newly diagnosed and previously untreated Hodgkin's disease were registered and monitored over a two year period. After pretreatment evaluation all patients were treated with six cycles of combination chemotherapy-three of chlorambucil, procarbazine, vinblastine and prednisolone [ChIVPP] and three of adriamycin, bleomycin, vincristine and DTIC [ABVD]. Residual disease was treated with 15-20 Gy of involved-field irradiation. Patients were followed up at six-monthly intervals with physical examination, ECG, chest radiographs, echocardiography and levels of thyroid hormones. After the twelfth birthday patients underwent assessment for levels of gonadotrophins and male patients for testosterone every six months.The observation period now ranges from eleven months to twenty-five months. Fourteen patients are in continued complete remission. One patient died of bilateral severe pneumonia six weeks after the completion of therapy. No long term adverse effects of treatment have been observed so far. In our experience this regimen is well-tolerated and effective and is expected to reduce the risks for late toxicities. A longer follow up duration is, however, required for definitive evaluation