Flower-petal inverted flap for internal limiting membrane in myopic eyes with macular hole and rhegmatogenous retinal detachment

We demonstrate a modified internal limiting membrane (ILM) inverted flap technique for closure of macular holes (MHs) concurrent with rhegmatogenous retinal detachment in myopic eyes. Multiple ILM flaps were created in a flower?petal configuration around the MH over the detached retina after shallowing the retina as much as possible. Traction was always in a direction that allowed the optic disc to act as an anchor to limit iatrogenic breaks and to bridge the hole with multiple, more secure flaps should one of the flaps revert or break away. The technique proved safe and efficient in MH closure in our series of eight cases. The modification described provides an effective approach for challenging myopic cases in which ILM flap creation is needed over a detached retina.

Acute appending: diagnostic algorithm using routine ultrasonography and optional computed tomography

Objective: to access the algorithm in diagnosis of acute appendicitis, using routine ultrasonography and optional computed tomography [CT]

Material and Methods: it was prospective study of 128 patients presenting in emergency department with complaint of pain right lower quadrant of abdomen. After clinical evaluation and lab investigations, ultrasonography abdomen was done for all patients. If provisional diagnosis was made on these bases, treatment was started. If ultrasonography findings were negative or inconclusive, CT was done with intravenous contrast. The final diagnosis was made by ultrasonography/CT report, operative findings, histopathology report of the removed specimen and outcome of the treatment

Results: after completion of initial clinical workup and ultrasonography, we were able to make provisional diagnosis in 90 patients. Ultrasonography showed inflamed appendix in 76 patients, alternate diagnosis in 14 patients and in 38 patients report was normal or inconclusive. CT was done in these 38 patients. CT scan showed inflamed appendix in 15 patients and alternative diagnosis in 4 patients. In 19 patients CT report was normal. 91 patients were operated for open appendectomy. In 85 patients, inflamed appendix was proved on histopathology and in 6 patients, appendix was normal. Accuracy of clinical diagnosis alone was 81 %, with Ultrasonography was 85%, with CT was 97% and accuracy of whole diagnostic pathway was 95%

Conclusion: in suspected case of acute appendicitis, diagnosis algorithm using routine ultrasonography and optional CT yields high diagnostic accuracy. Patients with normal ultrasonography and CT findings can be safely observed

Randomized clinical trial comparing local anesthesia with spinal anesthesia for intestinal stoma reversal

Objective: to compare the outcome of local anesthesia versus spinal anesthesia in intestinal stoma reversal

Material and Methods: it was randomized clinical trial with 64 patients, undergoing reversal of ileostomies and colostomies. Procedure was performed either under local anesthesia plus sedation [n=32] or spinal anesthesia [n=32]. The duration of the operation, conversion or supplementation of the anesthetic technique, time spent in the post-anesthesia recovery room, postoperative complications and length of hospital stay were analyzed

Results: duration of operation and time spent in post-operative recovery room was less in patients operated under local anesthesia. Conversion to general anesthesia was only needed in spinal anesthesia group. Post-operative complications were less in local anesthesia group. Mean length of hospital stay was almost equal in both groups

Conclusion: intestinal stoma reversal under local anesthesia and sedation is safe and more effective than same procedure under spinal anesthesia

Awareness regarding bioethical issues among the students and faculty of hazara university Mansehra, Pakistan

To determine the awareness level regarding bioethical issues among graduate and Post graduate students and faculty of Hazara University Mansehra Pakistan. The study was carried out at the campus of Hazara University Mansehra, Pakistan. it was a questionnaire based survey. Most of the participants were graduate students having relatively better knowledge of Science and Technology as 90.4% of them were found to be familiar with the term "Bioethics". it was encouraging to note that students at this level of education had positive opinion about the role of Science and Technology and had accepted its importance in their daily lives. The fact that the students are eager to learn more about bioethical issues was borne out by our data as 96% students were of the opinion that Bioethics should be taught regularly in the classes. There was a general agreement among the respondents that the government's policies on Bioethical issues are not satisfactory and that the issues need to be addressed; albeit within the frame work of religious [Islamic] teachings. The survey indicated that Cloning, Organ donation, GMO's, Contraception, Abortion and Stem Cell Research are regarded as the most important bioethical issues. Curriculum of educational institutions including Universities, Colleges and Schools should include appropriate courses on bioethics. The society in general needs to debate the issues through conferences, seminars, workshops and media for enhancing awareness, allaying fears and formulating opinions based on correct information

Integration of sexual and reproductive health in the medical curriculum in Pakistan

To assess the knowledge of medical practitioners regarding management of selected reproductive tract infections, diagnosis of sexual dysfunction and identification of sexual abuse and to assess the attitudes and practices of health care providers regarding sexual and reproductive rights in order to recommend areas that need to be incorporated in a sexual and reproductive health curriculum. A cross-sectional survey. From March to August 2003 in the District Turbat of Balochistan, Pakistan. Selected indicators of knowledge, attitudes and practices regarding sexual and reproductive health of primary care physicians were assessed using a pre-tested questionnaire and formal/informal interviews. Variables were identified from the literature and previous in-depth interviews, and then formulated into respective questions. A Lichert scale marked from 1 to 5 was used for categorizing responses into agreed, neutral and disagreed. Descriptive statistics were computed using SPSS version 10 for windows. Qualitative interviews were translated and transcribed and analyzed according to pre-judged and emerging themes Out of 45 physicians interviewed, nearly half scored less than 50% in the knowledge section. Attitudes and practices assessed suggested a tendency to be judgmental, gender/rights discriminatory and with little provision for enabling clients to make their own decisions, so essential for quality sexual health service provision. Keeping in view the importance of the sexual health issues and a lack of ability of health care providers to handle it effectively, deficient areas of sexual health must be integrated into the medical curriculum. Medical educators have the responsibility to train physicians and other health professionals in the core competencies to improve the sexual and reproductive health of their communities

Outcome of patient referral made by the lady health workers in Karachi, Pakistan

The outcome and consequences of referral made by the Lady Health Workers [LHWs] are largely unknown. This cross sectional study was conducted as part of a larger study and aims to assess outcome of patients' referrals made by the LHWs in Karachi, Pakistan. Only 4% of patients referred visited government facilities, the rest having visited private physicians and in-formal practitioners. The median cost of the treatment was 200 Pakistani Rupees [PKR] and 1230 PKR as out -patient and in-patient respectively with almost half the patients [41.3%] borrowed money to finance their treatment. Seventy-eight [31.6%] patients were not satisfied with the management they received from the referral health facilities. Major reasons cited were non-improvement in their condition, expensive, long waiting time and rudeness of the health facility staff. Factors identified in this study should be taken into account to ensure continuity and quality of care and to provide efficient, effective and equitable health services to all.

Recommenndations to strengthen the role of lady health workers in the national program for family planning and primary health care in Pakistan: the helath workers perspective

This study was planned to assess the strengths and weakness of the National Program for Family Planning and Primary from the Lady Health Workers [LHW] perspective. We conducted this study in order to develop recommendations for strengthening LHW's role in Primary Health Care [PHC] in Pakistan in consultation with the health workers. A qualitative study, based on key informant interviews, was carried out in Karachi, Pakistan. A total of 20 workers were interviewed. Analysis was carried out by grouping similar responses in a matrix and then analysis with reference to context. Motivations for joining program included financial benefits, convenient timings and an opportunity to serve humanity. Training was deemed satisfactory but clinical training was resented because of doctors' attitudes. Further training needs identified included basic information about common ailments, reproductive issues and basic clinical skills. Major strengths of the program mentioned included provision of survices at grass root level, reinforcement of health messages and the community acceptability of workers. Weaknesses mentioned included the contractual nature of job, low- salaries, irregularity' of payment, no career development and poor logistical support. Giving LHWs permanent government employee status and a raise in salary may strengthen the workers functions. Eligible LHWs should be given incentives [skills, career development, financial]. The community must be educated about assigned role and responsibilities of LHWs and patient referral system by the LHW needs to be strengthened. The valuable role of LHWs in PHC in Pakistan must be acknowledged and further improvements pursued

Liver biopsy with spinal [lumbar puncture] needel: a cheaper alternative

Percutaneous liver biopsy is widely used for the diagnosis and management of liver diseases. The aim of this study was to investigate the efficacy and safety of spinal [lumbar puncture] needle for percutaneous liver biopsy. 100 percutaneous liver biopsies were carried out on 76 male and 24 female patients [ages 16 to 60 years] using size 18 spinal [lumbar puncture] needles. Adequate tissue for histological diagnosis was obtained in 96% with 4% failures. One pass yielded adequate tissue for histological diagnosis in 70%, 2 passes were required in 25% and 5% needed 3 passes. Mean length of tissue obtained per pass was 4 cm. Fragmentation of biopsy specimen occurred in only 10%. The most common complication was procedure related pain, only one patient [1%] had a serious nonfatal haemorrhagic complication. We found spinal needle to be very economical, safe and efficacious for routine percutaneous liver biopsies