Causes of stress and coping strategies adopted by undergraduate health professions students in a university in the United Arab Emirates

This study aimed to compare causes of stress and coping strategies adopted by a sample of undergraduate health-profession students at the Gulf Medical University, United Arab Emirates. An anonymous voluntary questionnaire-based survey was conducted, from January to July 2011, among first- and second-year medicine, dentistry, pharmacy and physiotherapy students [N = 212] to identify causes of stress. Coping strategies were studied using the Brief COPE Inventory. Worries regarding the future [54.2%] and parental expectations [40.1%] were the major stressors. Poor diet [36.8%] and a lack of exercise [36.3%] were also reported to cause stress. Students used multiple strategies, mainly religion/praying [74.5%], planning [70.5%] and taking action [70.5%] to cope with stress. There were no significant differences observed in the stressors or coping strategies between genders or programmes. First-year students [62.5%] relied on emotional support significantly more [P<0.05] than second-year students [48.5%]. The main causes of stress were worries regarding future and parental expectations. The majority of the students used positive coping strategies, with religion/praying found to be the most frequently used strategy

Comparison of eutectic mixture of local anesthetics cream with dorsal penile nerve block using lignocaine for circumcision in infants

Circumcision is a commonly performed surgical procedure but choice of anesthesia remained an issue of research and debate. This study was conducted to find out the effectiveness of the eutectic mixture of local anesthetic [EMLA] cream with dorsal penile nerve block [DPNB] using lignocaine, for reduction of pain during circumcision. This was comparative study carried out in Surgical Unit B of National Institute of Child Health Karachi, from May 2008 to October 2008. Patients under six month of age were randomized in to two groups [EMLA and DPNB] of fifty patients each. The effectiveness of pain control was assessed by measuring the baseline heart rate [HR], respiratory rate [RR] and Neonatal infant Pain Scale [NIPS scale] before the start of procedure and measuring of these parameters for each step of circumcision. Independent sample t -test was used to compare means and repeated ANOVA was used to compare means of HR, RR, oxygen [O2] saturations and NIPS. The mean age in both the groups was 2.3 months. There was no statistically significant difference in baseline parameters in both the groups except the respiratory rate, which was significantly raised in DPNB group [33 breaths/min in EMLA and 38 in DPNB P < 0.04]. During circumcision there was significant increase in heart rate in DPNB group, especially in step three and step four [p < 0.04]. Oxygen saturation dropped in both the groups [baseline saturation 98% up to 91% in step 4]. While assessing NIPS scores in both the groups, statistically significant difference was found between NIPS at step two and step four in two groups [p < 0.04]. The overall pain control was equal in both the groups, although NIPS score was higherin DPNB in step two and four of circumcision. There was difference in application and cost. EMLA was easy to apply but has increased cost; while DPNB required expertise

Psychological health of first-year health professional students in a medical university in the United Arab Emirates

The aim of this study was to assess the psychological health of first-year health professional students and to study sources of student stress. All first-year students [N = 125] of the Gulf Medical University [GMU] in Ajman, United Arab Emirates [UAE], were invited to participate in a voluntary, anonymous, self-administered, questionnaire-based survey in January 2011. Psychological health was assessed using the 12-item General Health Questionnaire. A 24-item questionnaire, with items related to academic, psychosocial and health domains was used to identify sources of stress. Pearson's chi-squared test and the Mann-Whitney U-test were used for testing the association between psychological morbidity and sources of stress. A total of 112 students [89.6%] completed the survey and the overall prevalence of psychological morbidity was found to be 33.6%. The main academic-related sources of stress were 'frequency of exams', 'academic workload', and 'time management'. Major psychosocial stressors were 'worries regarding future', 'high parental expectations', 'anxiety', and 'dealing with members of the opposite sex'. Health-related issues were 'irregular eating habits', 'lack of exercise', and 'sleep-related problems'. Psychological morbidity was not significantly associated with any of the demographic factors studied. However, total stress scores and academics-related domain scores were significantly associated with psychological morbidity. Psychological morbidity was seen in one in three first-year students attending GMU. While worries regarding the future and parental expectations were sources of stress for many students, psychological morbidity was found to be significantly associated with only the total stress and the academic-related domain scores

Surgical management of suspected enteric ileal perforations in children

To find the outcome of protocol adopted for suspected enteric ileal perforations in children. Descriptive case series. Department of Paediatric Surgery National Institute of Child Health [NICH] Karachi, from December 2010 to November 2011. A total of 23 patients were managed during the study period. The protocol varied depending upon condition of the child at presentation. Tube laparostomy was done as initial procedure in patients who were judged unfit for surgery within 24 hours of admission based upon need of resuscitation. Once optimized, children underwent surgery. Procedure was tailored according to the operative findings and included either primary repair of the perforation or stoma formation [exteriorization of perforation - Ileostomy]. There were 16 male and 7 female patients. Age ranged from 3-13 year [mean 7.82, + 2.94 year]. Duration of symptoms ranged from 7-45 days [mean 15.56, + 9.39 days]. Free intraperitoneal gas under diaphragm on x-ray abdomen was found in 19 patients. Initial tube laparostomy was done in 12 cases. Laparotomy was performed in our hospital in 21 patients while one child had surgery done elsewhere and referred with stoma already made. A single perforation found at antimesenteric border of distal ileum in 20 cases. Primary closure of perforation was done in 5 patients. Ileostomy was made in 16, of whom 11 had reversal in 2 to 5 months time. The patient who had surgery done outside, developed burst abdomen and was re-explored. More perforations were found in proximal ileum and stoma was refashioned. This patient died later. Two patients in whom stoma was made expired in early postoperative period. In one patient only tube laparostomy was performed. He died before any definitive procedure. Overall mortality was 17.3% [n 4]. Patients with enteric perforation had varied presentation. The surgical procedure has to be tailored according to the condition of the child. Mortality remained significant in this condition

Surgical biliary tree pathologies in paediatric patients

To find out various pathologies affecting biliary tree in paediatric age group and mode of investigations performed to arrive at diagnosis. Descriptive case series. Department of Paediatric Surgery Unit B, National Institute of Child Health Karachi, from January 2007 to December 2007. All paediatric patients below the age of 12 years who presented with symptoms related to biliary tree were included. A detailed history was taken including presence of jaundice, color of stool, mass an pain in right upper abdomen etc. all wee subjected to ultrasound as a screening test. Laboratory investigations included blood complete picture, liver function tests including bleeding profile, TORCH titre where appropriate, HIDA scan and CT scan as indicated. Laparoscopy was done in cases with persistent jaundice for operative cholangiogram and liver biopsy. Surgical procedure was tailored according to the pathology found. A total of 18 patients were managed. The number of male and female patients was nine each. The ages of the patients ranged from one month to nine years. Most common pathology was biliary atresia [n7]. Eleven patients presented wit persistent jaundice with age range from one month to 18 months. In all them HIDA scan showed failure of visualization of excretion of contrast into duodenum. All underwent laparoscopy and in seven of these biliary atresia found. There were four patients in whom extrahepatic biliary tree was found patent on cholangiogram. They were in older age range [from three months to 18 months]. All had grossly cirrhotic liver. Three patients had choledochal cyst [two males and one female]. The age ranged from 1 1/2 month to 9 year. A female of 2 1/4 year presented with history of fever and failure to thrive. Ultrasound showed presence of gall stones. Cholecystectomy was done in this child. Three patients had common bile duct [CBD] pathology. All had history of fever, recurrent jaundice with dilated CBD on ultrasound. All had CBD stone/ sludge. In two choledochotomy and removal of stone/ sludge was done while other had cholecystectomy in addition because of inflamed gall bladder. No T tube was places. One patient with idiopathic variety of gall stone had cholecystectomy. Ultrasound in expert hands is a good screening test in patients suspected of having surgical biliary tree pathology. HIDA scan can be safely omitted from list of investigations and laparoscopy is recommended in all cases of prolonged neonatal jaundice where surgical pathology is suspected

Anterior sagittal approach for anorectal malformations in female children: early results

To determine the technical applicability and early postoperative outcome of anterior sagittal approach for anorectal malformations in female children. Study Design: Case series. Place and Duration of Study: Surgical Unit B of National Institute of Child Health [NICH], Karachi, from April to November 2007. Female patients with congenital anorectal malformation who underwent anorectoplasty through anterior sagittal approach were included in the study. Surgery was done either as primary or staged procedure [with initial colostomy or cut back]. Operative details were recorded. Follow-up was done in OPD. Thirty patients with mean age of 11.5 months underwent anorectoplasty through anterior sagittal approach. Eighteen patients had ASARP as a primary procedure. Staged procedure with initial colostomy was done in 9 patients. Initial cut back was done in 2 cases and one redo surgery done. Vaginal tear occurred in one, while partial tear of most distal part of fistula occurred in 4 children. At follow-up, 2 patients with primary ASARP developed wound infection with superficial disruption. Bleeding with wound disruption occurred in one case. Anal mucosal prolapse, anastomotic stricture and recurrent fistula occurred in one patient each. Cosmetic appearance of perineum was good in 10, satisfactory in 5 and poor in 3. Among patients staged with colostomy, bleeding with wound disruption, anal stenosis and retraction occurred in one case each. Cosmetic results were good in 7, satisfactory and poor in one case each. Two patients with initial cut back did not have any complication and one operated for disrupted wound developed disruption again. Anorectoplasty can satisfactorily be done through anterior sagittal approach in females with anorectal malformations. Primary ASARP has almost the same results as staged procedure, which should be done in selected patients

Video assisted thoracoscopy in children

To determine the outcome of video-assisted thoracoscopic surgery [VATS] in terms of its efficacy, safety and usefulness in children. Case series. Department of Paediatric Surgery Unit B, National Institute of Child Health, Karachi, from May 2006 to December 2006. This study was carried out on patients who were admitted with various intra thoracic pathologies and had video assisted thoracoscopy. Total of 13 patients underwent VATS. There were 6 patients of empyema thoracis who underwent thoracoscopic decortication and done successfully. There were four patients of hydatid disease among which three were converted into open thoracotomy. Two patients were of mediastinal mass and one of bronchopleural fistula. In these patients only biopsy was done which was conclusive in one patient, who was diagnosed as having ganglioneuroma. In other biopsy was inconclusive. Biopsy report was that of tuberculosis in patient with bronchopleural fistula. Video-assisted thoracoscopy is a safe and effective diagnostic and therapeutic procedure in children and this new approach has an important place in pediatric thoracic surgical practice. Thoracoscopic decortication can be treatment of choice for early empyema thoracis. As the learning curve progresses, more and more procedures can be done by VAT

Prenatal counseling and informed consent: ethical dilemma

With advancement in technology, congenital anomalies are increasingly recognized on antenatal ultrasound with great accuracy. This has opened up an entirely new field where all those who care for expectant parents and prospective baby like obstetricians, neonatologists, pediatric surgeons, psychologists, social workers etc are required to prove their expertise to deal with psychological issues and be able to guide expectant couple and their families as to what to expect and approach the baby born with congenital anomaly. If some life threatening condition is recognized at anomaly scan the decision of termination of pregnancy is even more difficult to make. This report describes an experience gained in dealing with one such couple whose baby on antenatal ultrasound, well beyond the age of termination of pregnancy, found to have omphalocele major. Many counseling sessions were held but the desired result was not achieved. How such problems should be dealt with in future, is discussed

Complication problems of colostomy in infants and children

To determine the frequency of complications/problems occurring with construction of colostomy in infants and children. Descriptive study. Surgical Unit B, National Institute of Child Health, Karachi, from September 2001 to March 2003. All the patients admitted in the unit who required colostomy as part of their management were included in the study. The patients who were operated upon previously or operated elsewhere and referred after having colostomy, were excluded. Problems associated with colostomy construction like skin excoriation and chronic blood loss were also recorded. Chi-square test of proportion was used to determine the p-value. There were 121 patients. Most of the patients were operated due to anorectal malformations [n=71] and Hirschsprung's disease [41]. Complications/problems related to colostomy occurred in 67.7% patients. The most common problem was skin excoriation. Second in rating was chronic blood loss from stoma. Prolapse of stoma was more common in transverse loop colostomies. Divided colostomies had higher number of complications as compared to loop colostomies, similarly, transverse colostomies had high number of complications but in both the cases difference was not statistically significant. Four [3.3%] patients died. Construction of colostomy in paediatric patients carries high frequency of complications/problems and requires careful technique. The role of stoma care clinic and enterostomal therapist can be instrumental in preventing problems associated with colostomy

Renal hydatid cyst: an isolated involvement

Hydatid cyst can occur in any part of the body. Isolated involvement of viscera other than liver and lung is rare In this report we present a case of seven years old male child who had an isolated involvement of left kidney with hydatid cyst. CT scan showed multiple cysts of left kidney with no renal function. His indirect hemagglutination [IHA] test showed a value of 1:8192. He was initially put on albendazole to which he showed partial response. At surgery multiple hydatid cysts were removed from kidney. Post operative radio isotope renal scan revealed the function of 15%

Management of idiopathic rectal prolapse in children

To determine the percentage of patients of idiopathic rectal prolapse improving on spontaneously over the period of observation [phase I], and to determine the outcome of patients with rectal prolapse who received injection sclerotherapy [phase II]. Quasi-experimental study. National Institute of Child Health, Karachi from April 2001 to March 2002. The study was conducted in two phases. In phase I of the study, newly diagnosed patients of idiopathic rectal prolapse were followed without any treatment, till the spontaneous resolution of rectal prolapse. The time period at which 50% patients improved clinically was called 'time for spontaneous resolution 50%, [TSR 50%]. In phase II, injection sclerotherapy [IST] was given to those patients whose prolapse was of more than three months duration. This was a separate cohort of patients. One hundred patients were inducted in the study. They all had idiopathic rectal prolapse and their ages ranged from 6 months to 12 years with mean age of 5.30 + 2.30 years. In phase I, out of a total 50 patients, 40 could be followed with non-interventional strategy. In more than 50% of patients, the prolapse disappeared within 3 months. This was called TSR 50%. In phase II study, out of 50 patients who received IST, 29 improved within 2 weeks of single injection while 12 more improved with second injection within two months. Overall rate of resolution of prolapse at two months [41/50] was highly significant in comparison with proportion of improvement in phase I patients with p-value of 0.001. Four patients received third injection. At the end of three months prolapse disappeared in all patients of this phase [p-value <0.0001]. No complication related to injection occurred. Both non-operative and injection sclerotherapy are effective in managing idiopathic rectal prolapse in paediatric population, but in terms of early recovery injection sclerotherapy is recommended as it is associated with less morbidity and is cost-effective

Antibiotic sensitivity pattern in burn wound cultures

To find out the pattern of microbial flora and their sensitivity to antibiotics in burn wounds cultures. Design: Descriptive study. Place and Duration During year 2003, at Burns unit, National Institute of Child Health, Karachi. Subject And Twenty five consecutive patients were included in the study and pattern of most common pathogens was studied with special reference to their antibiotic sensitivity. The bacterial cultures were taken at different intervals during the hospital stay, first on the second day of admission and then subsequently, following every 7-10 days. Antibiotic sensitivity pattern was correlated to the antibiotic the patients were receiving. Our results revealed that the most frequent isolate was pseudomonas [80%] followed by staphylococcus aureus [40%], klebsiella [28%], proteus [16%] and streptococcus [8%]. Time related changes showed that the bacterial isolates were predominantly gram negative rods [70%]. in the first culture taken on the 2nd day of admission and remained high throughout the hospital stay and was up to 90% in the final culture. There is a specific pattern of burn wound microbial colonization, with time related changes in dominant flora. Antibiotic sensitivity profile is helpful to make guidelines for dealing with the burn wound at the outset and for which antibiotic to start with. Following this protocol the morbidity and the resistant flora could be avoided

Congenital pyloric atresia: Isolated and associated with aplasia cutis congenita

Two cases of congenital pyloric atresia [CPA] are, hereby, reported. One was suspected on antenatal ultrasound and turned out to be an isolated anomaly. Other patient had a rare association of aplasia cutis congenita with congenital pyloric atresia. The lesions of aplasia cutis congenita were multiple while congenital pyloric atresia was of type II. The patient with an isolated lesion survived following surgery while the other baby died of sepsis in postoperative period

Congenital midline cervical cleft: a case report

A 4 months old baby girl was brought with the history of mucoid discharge from small midline defect on the ventral aspect of neck since birth. She had no other associated congenital defect. Family history of facial deformity such as cleft lip or palate or of thyroid disease was negative. On examination the lesion consisted of a cephalad skin tag, a mucosal surface and a caudal sinus in the midline of ventral neck between the chin and suprasternal notch. It was approximately 3 cm long and 1 cm wide. Sinogram of the lesion showed a blind tract going behind sternum. The patient was treated surgically and the cleft with its underlying fibrous cord that was attached with sternum excised. The vertical wound was closed with multiple Z plasties. On histological examination the cleft was partly lined by keratinized stratified epithelium with sebaceous gland and partly by non- keratinized stratified squamous epithelium. Underlying the epithelium were small collection of seromucous salivary glands. Surrounding tissue was densely fibrocollagenous and richly supplied with blood vessels. The post- operative course was uneventful. Patient is on follow up

Chemical analysis of urinary calculi in children

A study of 23 cases of urinary calculi, that were chemically analyzed, showed that most common constituent of the stones removed was oxalate followed by urate. Struvite stones were found infrequently. The lower urinary tract stones occurred more frequently than upper tract calculi and all urates calculi were found in patients less than five years of age. These findings differ from those reported from other developing countries