Informed consent; awareness and practice among general medical practitioners

Introduction: Informed consent is the back bone of patients' autonomy. The advancement in medical technology has further increased its importance. In the developing countries including Pakistan, general physicians play a vital role in providing health care to the patients but unfortunately majority of them are unaware about the ethical aspects of their medical practice

Methodology:

Objectives: 1. To determine the level of awareness about informed consent among general practitioners. 2. To assess the association between various socio-demographic factors to the awareness about informed consent

Study Design: Community based cross sectional study

Settings: General medical practitioners of district Hyderabad were the study population

Period Of Study: Two months

Material and Methods: One hundred and forty subjects were selected for the study through purposive non-probability sampling. A pretested self-administered questionnaire was the tool for the data collection. The data was analyzed by using SPSS version 16.The variables of interest were gender of general practitioners, their age, level of qualifications, residence and occasions when informed consent was taken. The association between various socio-demographic variables was determined by applying Chi-square test at

Results: One hundred and forty general medical practitioners of varying ages from 32-60 years participated in the study. The mean age of the general physician was 39 +/- 1.8 years. The awareness about informed consent was found among 128[91.4%] subjects but unfortunately only 45.7%of them actually practiced it. The results regarding awareness as well as practice of informed consent among males and females were however not significant [p=0.520]. The young general practitioners i.e age 31-40 years were less practicing informed consent as compared to older general practitioners i.e. age 51-60 years and onwards [p= 0.04].The physicians practicing in urban areas were more cognizant about informed consent [p=0.05].Informed consent from patients was obtained before giving local anesthesia [80%], blood transfusion [24.3%]and before examination of female patients [46.4%]

Conclusions: Informed consent taking is not a routine process adopted by general medical practitioners so there is a strong need for general practitioners to change their attitude and acknowledge the patient's autonomy by taking informed consent, which is the basis of modern medical ethics

Frequency of Surgical Intervention Due to Cord Around the Neck

Objective: To see the frequency of cord around the neck. Study Design: Retrospective Observational Study. Place and Duration of Study: This study was carried out at Shaikh Zaid Women Hospital, CMCH, SMBBMU, Larkana from January 20 12 to December 20 13. Materials And Methods: Total patient 8250 taken from Jan 2012 to Dec 2013. All cases were studied in detail with reference to course of labour, mode of delivery, interference required and maternal and fetal outcome. A detailed history was taken and general and systemic examination was done. The muller Munro Kerr maneuver was used to assess the adequacy of the pelvis and diagonal conjugate was accurately measured. Results: Total patient taken 8250, from Jan 2012 to Dec 2013 among them vaginally delivered 4238[51.3%], 92 have applied forcep 27[0.63%] babies delivered cord around the neck with 30 patient have applied vacuum out of which 16 [0.37%] cord around the neck. Spontaneously vaginal deliveries without surgical intervention 41 16 [3 1.9%], out of which 13 12 [1 5.9%] have cord around the neck. 2360 [28.6%] patient delivered through emergency LSCS. 722[17%] babies with cord around the neck and 1560 [18.9%] patient delivered through elective LSCS among them 759 [17.9%] babies delivered with cord around the neck. Conclusions: Most of these cases delivered vaginally with minimal maternal and fetal morbidity. Frequency of surgical intervention in these cases can be reduced by proper antenatal care especially in 31d trimester, by plotting partogram and using oxytocin judiciously during intrapartum period

Eclampsia and its Association with Seasonal Variations and other External Factors

Objectives: his study was carried out to evaluated the epidemiological aspects of patients presenting with eclampsia in the Shaikh Zaid Women Hospital, Larkana. Study Design: Descriptive retrospective observational study Place and Duration of Study: This study was carried out in the Department of Obstetric and Gynaecology SZWH, CMC and SMBBMU, Larkana from Jan 2012 to Dec 2013. Materials and Methods: All the patient admitted in eclmpasia were included in the study. All the patients were managing according to basic protocol for eclampsia. The data were compiled for frequency distribution of eclmapsia according to gage, parity, socioeconomic status of the patients and seasonal variation. Pregnant patient with other convulsive disorder and more than 7 days post-partum were excluded. Results: In the duration of study of 24 months 50.8% cases of Eclampsia occur in Summer, 25% in Autumn, 12.9% in Winter and 11.2% in Spring Season. During this period of 24 months > 10977 patients were admitted in SZWH, Larkana out of them 108[0.98%]were cases of eclampsia. Conclusion: Pre eclampsia and eclampsia are major obstructed complication with unclear etiologies. Understanding the exist association with different weather patterns may help us in understanding what factors may be involved in triggering these event.

Giant iliac vein aneurysm secondary to long standing traumatic popliteal arteriovenous fistula

A 48-year-old man presented with a traumatic arteriovenous fistula [AVF] in the left popliteal space, due to a bullet injury 20 years back. A computed tomographic [CT] angiography revealed an AVF in the left popliteal space with an associated large iliac vein aneurysm [9.2 x 9.0 cms]. Primary repair of the AVF was done. A Doppler scan showed marked reduction in the size of the aneurysm, 4 months after surgery. Cases associated with a venous aneurysm distant from the site of AVF are rare and there are only 7 cases reported in the international literature

Ovarian tumors under 20 years of age

To analyze the cases of Ovarian Tumors in less than 20 years of age and to know its outcome in same patients. A Case Series Descriptive Study. This study was conducted at Sheikh Zaid Women Hospital, Gynaecology Unit II, Chandka medical college Larkana over the of period of two years from December 2007 to December 2009. Over the period of 2 years, a total of 30 patients with ovarian tumors of less than 20 years age were studied. Patients with more than 20 years of age were excluded. All the patients received as out patient department except 4 cases, were admitted through emergency. Detailed history taken to know their presentation and all the patients were investigated for complete blood picture, ESR, Random Blood Sugar, Urine detailed report, Urea, Creatinine, Serum Electrolyte, LFTs, Ultrasound and X.Ray Chest. In some patients IVP, CT scan and Serological markers e.g. CA-125 were done. Management done in all patients noted and statistically analyzed. In two years period 30 patients under 20 years of age reported. Mean age of presentation was 15 +/- 2 years. Out of 30 patients 25 [83.33%] had benign ovarian tumors while 5 patients only [16.66%] had malignant tumors. Of the benign ovarian tumors mature teratoma were 10[40%], serous cyst adenoma were 5[20%], mucinous cyst adenoma were 3 [12%], endometriotric cysts were 3 [12%], corpus luteal cysts were 3 [12%], para-ovarian cyst was 1 [4%]. Of the malignant variants immature teratoma was 3 [60%], dysgerminoma was 1 [20%] and endodermal sinus tumor was 1 [20%]. Most of patients had benign ovarian tumors e-g germ cell tumors. Almost in all of the patient's diagnosis was confirmed by laparotomy and histopathology. No complication was encountered ttendance ly and post operatively. Patients, less then 20 years of age, had mainly benign ovarian tumors, and were germ cell tumors. For benign tumors adhesion prevention strategies should be used. Surgical intervention should as much as possible be directed towards preservation of ovarian tissue

Well baby visits - an experience in a squatter settlement of karachi

To determine the profile of healthy children visiting to the well child clinic in relevance to their growth and development. A cross-sectional study. The Study was conducted at the Primary Health Care [PHC] center in a squatter settlement of Karachi from December 2003 to December 2004. A cross-sectional survey of children under 3 years attending the Primary Health Care [PHC] center in a squatter settlement situated near Ziauddin Medical University [ZMU], Clifton. Karachi. It is divided into five blocks with a population of approximately 20,000. It is a low socio-economic area with poor literacy rate. For convenience of follow-up, only those children were enrolled in the well child clinic living within a distance of 5 kms. from the center. The information was recorded on a structured proforma, which included the introduction of the child; natal and pre-natal history; immunization and feeding history; past medical and surgical history; complete general and systemic examination. The growth parameters were recorded on growth chart recommended by the WHO. A total of 62 children were enrolled from birth to 3 years with a mean age and standard deviation of 2.2+1.3 years. Almost half the mothers [34 out of 62] preferred ghutti as a pre-lacteal feed, 6 preferred honey while the rest were unable to remember giving any prelacteal feed. Almost half of the children [n=31] were given colostrum. Breastfeeding was initiated in 18 children while the rest were bottle fed. The weaning age ranged from 4 to 24 months. All the children were fully immunized according to the EPI schedule. Majority of the children were malnourished [82%] and only 18% had normal weight for age according to the growth chart and Gomez's classification. It iwas found in this study that the improved nutrition can lead to improvement in child growth

Morbidity pattern and utilization of a primary health care center in a low socioeconomic area of Karachi

To identify the morbidity pattern according to age, gender and seasonal variation using the ICD coding and the utilization of Primary Health Care [PHC] center services in a demographically defined community. The data collected from 2001-2003 was analyzed using the International Classification of Diseases - 10 [ICD-10] coding for identifying the morbidity patterns presenting at the PHC Center. The age and gender distribution of the patients and the seasonal variation of few diseases were noted. Only the residents of the area visiting the center for preventive or curative services were included. A structured performa was designed to enter the age, gender, disease and ICD codes. The faculty was trained for using the coding system. A total of 13,519 patients visited the PHC during three-year period. On an average, 376 patients were seen during a month with male to female ratio of 1:2. The most common diseases presented belong to the respiratory system, followed by infections or parasitic infestations and diseases of the reproductive system. The women presented for first visit of antenatal check up were 960 out of 4614 women of reproductive age group. Among the adult population, 391 [6%] presented with hypertension, 64 [1%] were Type 2 diabetics and 86 [1.3%] were asthmatics. The paediatric population analysis showed that 918 [13%] had upper respiratory infections and 1339 [19%] had diarrhoea. Problem oriented medical records from health centers, computerized in a uniform standardized way, can give extensive information about the content and burden of health problems in family practice and presumably public health

Improving vaccination status of children under five through health education

To improve awareness and knowledge of mothers regarding vaccine preventable diseases and the immunization status of children under five through health education messages by medical students, at Gulshan-e-Sikanderabad, a squatter settlement adjacent to Ziauddin Medical University, Karachi. The undergraduate medical students' visit families in the squatter settlement. This study compared the effect of intervention by medical students on vaccination status of children under five in the intervention households versus those without intervention. A baseline study was done in 1998 and a follow-up study was done after four years to assess the differences in knowledge and practices of mothers regarding immunization. A total of 110 houses from block I and 207 houses from block V were selected. An increase of 22% [52% vs 30%] in block-I [p=0.003] and 19% [32% vs 13%] increase in block V was seen in the utilization of PHC Center for vaccination [p=0.001]. Mothers' knowledge regarding the age when first vaccine is administered to the child, increased in the follow-up from 60% to 76.5% [p<0.01] in block I and from 50% to 62% in block V. The immunization status increased significantly in block I from 46.5% to 75% after the intervention [p<0.005], no significant difference could be seen in block V [p=0.16]. In the follow-up survey a significant difference was seen in the vaccination status between the two blocks [p=0.001]. The health education messages significantly increased the vaccination status of children under 5 in the intervention area