Perception of ethical issues, encountered in under graduate medical and dental education

Bioethics has recently gained importance in the developing world. It's teaching in Medical Schools needs careful attention. The aim of this study was to assess the conceptual knowledge for adequacy of the current system of bioethics education and to identify the learning needs of Pakistani medical and dental students. The present study included 114, third year medical students, who had been provided introductory course on bioethics in 1[st] and 2[nd] years. A questionnaire containing 20 clinical situations was answered and assessed against standards. Thirty six percent of participants had forgotten the term bioethics. Patient's opinion and life saving research was recognized as most important where as performing surgery and informing patients about doctor's mistakes was considered as not worthy of obtaining consent. A wide range of gap in knowledge and attitude was identified in bioethics

Dental phobia in patients seeking dental treatment

Phobia against dental procedures is recognized as an important factor in inhibiting patients from seeking dental treatment. To study the types and levels of dental phobia in patients seeking dental treatment. Fatima Memorial Dental College Hospital, Lahore from August, 2008 to January, 2009. All adult patients coming for dental scaling, extraction, filling and root canal treatment who consented to participate in the study were included, while those with impaction, extensive periodontal treatment and edentulous were excluded. All patients were interviewed regarding their fears about dental procedures using structured questionnaire. The information was classified into 3 scales as strongly negative [phobic] moderately negative and neutral. A total of 76 patients were selected for the study. Dental phobia presenting as lack of confidence to ask questions from the dentist was observed in 30% patients while 96% had some previous bad experience at a dental clinic. Varying levels of phobia were noted for all other types of services as well as for the dentist's attitude towards the patients. Dentists should recognize the existence of dental phobia in patients coming for treatment and need to develop skills in minimizing phobia. To reduce fear and phobia dentists need to communicate more with the patients before undertaking any treatment

Risk factors for hypoxic ischemic encephalopathy in children

To determine underlying risk factors in neonates with hypoxic ischemic encephalopathy. Case-control study. Neonatology Unit at the Children's Hospital and the Institute of Childhealth, Lahore, from March to July 2005. All neonates [153] with the diagnosis of Hypoxic Ischemic Encephalopathy [HIE] were included in the study. Controls [187] were selected from admissions on the same day. Possible risk factors such as maternal age, parity, antenatal monitoring, place of delivery, prolonged second stage of labour, type of delivery, type of attendant at delivery and the gestational age were noted and compared. Sixty one [39.9%] mothers of asphyxiated babies reported no antenatal visits compared to 24.1% in the control group [OR 2.1, 95% Cl 1.3-3.2; p=0.002]. Only 6.5% of cases were born in government hospitals [teaching and district] in comparison to 20.9% of controls [OR 3.8, 95% Cl 1.9-7.6; p=0.001]. In 28.1% of cases, mothers had history of prolonged 2nd stage of labour in comparison to 5.9% of controls [OR 6.3, 95% Cl 3.3-11.9; p<0.001]. Fifty five cases [35.9%] were delivered by unskilled birth attendants compared to 28 [14.9%] controls [OR 3.2, 95% Cl 1.9-5.3; p<0.001]. No significant difference was found in maternal age, maternal parity, gestational age and the mode of delivery between the two groups. Delivery by unskilled birth attendant, prolonged second stage of labour, birth in a non-government hospital setup and absence of antenatal care were significant risk factors for hypoxic ischemic encephalopathy in neonates. Improvement in antenatal and intrapartum care may be helpful in decreasing the frequency of this problem

Phased introduction of hepatitis-B vaccination in Pakistan

The study was undertaken to assess the level of sero-protection of children up to five years of age who had received at least one dose of HB vaccination in their infancy. It is a cohort study to follow up vaccinated children from four weeks after completion of vaccination to one, three and five years of age of the children. The study was conducted in three districts of North West Frontier Province [N.W.F.P] from August 1991 to 1996. WHO/EMRO supplied single dose of vaccine for HBV in 1991. Five hundred randomly selected children fulfilling the inclusion criteria of having received at least one dose and 100 each of those children having received two or one dose of the vaccine: serology was conducted by using commercial ELISA. [Abbott]. Anti HBs was detected in 70% of infants who had received all the three doses, four weeks after completion of vaccination. After one year the sero-protection was raised to 90%, it fell to 80% after 3 years and 70% after 5 years. The group with two doses of the vaccine had anti HBs positive rates of 70%, 50% and 16% after one, three and five years respectively. The group having one dose had anti HBs positive rates of 50%, 30% and 6% and one, three and five years respectively. Sero conversion was best in children who had received full course and was significantly lower in those having received partial vaccination

Role of thyroid peroxidase antibodies in the outcome of pregnancy

To assess the prevalence of Thyroid peroxidase [TPO] auto antibodies among pregnant women and its relation with their pregnancy outcome. Cross-sectional analytical study. The study was carried out at Zayed Medical Complex, Lahore, in the department of Obs/Gynae and NHRC from July 2000 to July 2002. The study included 1500 Euthyroid pregnant women, ages 18 - 40, registered for antenatal care at Obs/Gynae department. Previous fertility history was recorded and thyroid peroxidase antibody level was assessed by ELISA method. A cut off value of TPO antibody of upto 100U/ml was considered negative and more than 100 U/ml was considered positive.The cases were followed for the outcome of their pregnancy and compared with TPO antibody levels. A comprehensive proforma was used to collect the data. The prevalence of positive TPO autoantibodies was found to be 11.2%. The raised TPO autoantibodies were found to have higher risk of abortion [O.R 49.2] and prematurity [O.R.8.1]. The complications were found to be significantly raised among positive TPO autoantibodies cases, when analysed by parity and age of mother at time of registration. Thyroid autoimmune diseases among euthyroid pregnant women may contribute to low-birth-weight of neonates and high abortion rate in all pregnancies. Raised levels of TPO autoantibody is a good marker to assess early hypothyroidism state and should form a screening modality in Pakistan

Microalbuminuria as an indicator of kidney function among diabetics

To find out the role of microalbuminuria as an indicator of kidney function among diabetics. Comparative study. Diabetes control clinic of Shaikh Zayed Hospital, Lahore, a tertiary care hospital, was the venue. The study was conducted during March 2002 to August 2003. Timed overnight urine samples were collected from all subjects and albumin was estimated using Radioimmunoassay [RIA] method. Albumin excretion rate [AER] was assessed in three groups including normals, Type 1 and Type 2 diabetics. AER over 30 mg/min was considered as significant. A significantly higher proportion of AER was observed in both types of diabetes. A higher proportion of increased AER was observed in females of Type 2 diabetics. The study has indicated that irrespective of the duration and type of diabetes the damage to the kidney can be avoided if good glycemic control is achieved