Pattern of bony injuries among civilian gunshot victims at tertiary care hospital in Karachi, Pakistan / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Firearm injuries impose a continuous economic burden on society and hospital resources. The aim of this study was to assess the pattern of bony injuries among victims of gunshots.</p><p><b>METHODS</b>A retrospective study was conducted in the Department of Orthopedics, Dow University of Health Sciences and Civil Hospital Karachi from January 2011 to December 2012. Patients with isolated bony injuries were included while patients with other systemic injuries were excluded.</p><p><b>RESULTS</b>There were 90 cases and the majority of them were male (84.4%). Mean age was (32.52 ± 10.27) years. Most of the patients (72.2%) belong to the younger age group. A low velocity weapon was used in 61 (67.8%) cases and a high velocity weapon was used in 29 (32.2%) cases. Armed robbery (64.4%) was the cause of conflict in more than half of the cases. Lower limb was involved in 72.2%. Fifty eight (64.4%) patients remained hospitalized for 15-20 days and others for more than 20 days. Internal fixation with intramedullary nailing was done in 35 patients while K-wire was used in 5 patients. Fifty patients were managed with external fixation, either uniplanar or multiplanar ilizarov. Deep wound infection and nonunion were observed more often in high velocity injuries.</p><p><b>CONCLUSION</b>Armed robbery was the leading cause of gunshot bony injuries in our hospital. Young males were victimized in a majority of cases. High velocity injuries were associated with more complications.</p>

Vacuum assisted closure- utilization as home based therapy in the managementof complex diabetic extremity wounds

Vacuum assisted closure is a reported technique to manage complex wounds. We have utilized this technique by using simple locally available material in the management of our patients on outpatient basis. The objective of this study is to present our experience. This study was conducted from June 2011 to June 2013 at Dow University Hospital and Aga Khan University Hospital, Karachi. There were 38 patients managed with vacuum assisted closure. Mean age was 56 +/- 7.8 years. Twenty three patients presented with necrotizing fasciitis and 15 patients with gangrene. Lower limbs were involved in majority of the patients. Debridement or amputations were done. Vacuum dressing was changed twice weekly in outpatient department. Wounds were closed secondarily if possible or covered with split thickness skin graft in another admission. All the wounds were successfully granulated at the end of vacuum therapy. Mean hospital stay was 7.5 days. Vacuum dressing was applied for a mean of 20 days. There was reduction in the size of the wound. Thirteen patients underwent secondary closure of the wound under local anesthesia, 18 patients required coverage with split thickness skin graft and 7 patients healed with secondary intention. Vacuum assisted closure appeared to be an effective method to manage complex diabetic wounds requiring sterile wound environment

Low attendance in lectures at medical colleges of Karachi - a cross sectional survey

To evaluate the attendance of medical students in the lectures and to identify different factors responsible for low attendance. This cross sectional study was conducted at three medical colleges in Karachi, Pakistan during July to September 2012. Medical students of3rd year and above representing different medical colleges were asked to fill out a questionnaire to assess the different reasons why medical students tend to absent themselves from lectures, their views regarding content and quality of lectures. Students having attendance of 50% or more were included in the study. A total of 509 student responded to the survey. Two hundred and eighty two students [having >50% attendance in the last semester] were included in the study. Mean age was 21.14 +/- 1.9 years. There were 110 [39%] males and 172 [61%] females. The two most common reasons for not attending the lectures were; timing of the lectures not adjusted according to the students schedule [n=180; 63.8%] and the students preferred self/group study over lectures [n=198; 70.2%]. On the other hand majority of the students [n=173; 61.3%] were also of the opinion that it is difficult and complex to learn without lectures. There are various reasons for absenteeism from lectures including timing of the lectures and preference for self study. These need to be rectified in order to strengthen the learning process in medical undergraduates

Primary diaphyseal tuberculous osteomyelitis of tibia

Diaphyseal tubercular osteomyelitis of long bone is extremely rare and few cases have been reported in literature. We are presenting a case of 17 years old girl presented with pain and swelling over lower half of leg for 7 months. There was often low grade fever but no history of weight loss or pulmonary symptoms. X-ray chest was normal. X-rays and MRI of involved leg were suggestive of osteomyelitis. Curettage and biopsy was done, report was suggestive of tuberculous osteomyelitis. As tuberculosis is still common in developing countries, for an osteolytic lesion in bone, tuberculous osteomyelitis should be considered in differential diagnosis

Back pain - are health care undergraduates at risk?

To study the prevalence of low back pain in medical and nursing undergraduate students in our institutes and its association with physical activity, smoking, depression, use of computer and other variables. It was a comparative cross sectional study carried out at two institutes of Dow University of Health Sciences, Karachi, Pakistan during October to December 2011. Two hundred and fifteen undergraduate students representing different semesters were asked to fill out the structured questionnaire. Back pain was assessed in terms of lifetime one year and point prevalence. Bivariate analysis was done to study the relationship between back pain and different variables; including gender, study program, smoking, computer use, depression and level of physical activity. Both the groups were compared for duration/ intensity of pain, seeking medical advice and duration of computer use. There were 183 undergraduate students who completed the questionnaire for back pain. Mean age was 22.84 [SD +/- 5.85] years. Gender distribution was nearly equal [females = 51.4%]. Life time prevalence was 57.9% [72% in medical students; 41% in nursing students]. Medical students were 0.47 times more at risk of having back pain [95% CI 0.15-1.48; P=0.198]. Smoking [OD=0.39, 95% CI 0.04-3.6; P=0.001] and use of laptop [OD=4.9; 95% CI 1.2-19.2; P=0.031] were found to be associated with increased prevalence of back pain. Nursing students sought medical opinion more as compared to medical students but it was not significant. However duration of computer use was more in medical students which was significant [P=0.03]. High lifetime prevalence of back pain was observed in undergraduate students. Medical students appeared to be more at risk. Preventive measures are required to improve the quality of life in future health care professionals

Effect of early release of tourniquet in total knee arthroplasty

To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Comparative study. Department of Surgery, The Aga Khan University Hospital, Karachi, from January 2004 to June 2007. One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood loss [determined by Gross method] and other study variables were noted as per objective and computed. There were 22 males and 108 females with comparable BMI. All had undergone posterior stabilized cemented total knee replacement. Calculated blood loss was 1.208 Land 1.108 Lin group-Aand B respectively [p = 0.27]. Significant increase in duration of surgery was noted in group-A patients. Four patients in group-B showed complication related to wound with 3 being minor and 1 requiring additional operation room visit. Mean length of hospital stay was 9 days. Transfusion frequency was higher in group-B despite comparable postoperative haemoglobin values. Intraoperative tourniquet release does not reduce overall blood loss with no effect in conserving blood after total knee replacement, however, this group had relatively shorter hospital stay

Academic misconduct among students in medical colleges of Karachi, Pakistan

To determine the trends of academic misconduct in undergraduate students of different private and government section medical institutes. This cross sectional study was conducted at three medical colleges of Karachi, Pakistan. The students were evaluated by giving a self reported questionnaire containing various questions assessing their educational dishonesty and cheating behaviors. A total of 274 students from different years completed the questionnaire. Mean age was 21.48 +/- 1.89 years. Most of the students were in 4[th] year [n=86; 31.3%]. There were 182 [66.5%] females and 92 [33.5%] males. Majority of the students [n=155; 55.1%] accepted that they have cheated at least once. There was no significant difference regarding acceptance of cheating among different years of study [p=0.23] however females were found to accept cheating more as compared to males [p=0.036]. First year students were found more to ask teachers for answers during OSCE [p=0.01]. A large number of students accepted that they mark proxy for their friends [85.7%] and also ask their friends to mark proxy for them [85.03%]. Nearly half [44.02%] of the students rotating in wards also admitted to write fake histories. A large number of medical students admitted cheating and involvement in other academic misconduct. We need to improve our educational system, formally add professional session and strict disciplinary action should be taken against those who are found guilty

Patients' receptiveness for medical students during consultation in out patient department of a teaching hospital

Objective: Patients' attitude towards medical students' presence during treatment depends on the cultural values of the society. This study was conducted to find out the patients' receptiveness in our society to be involved in teaching process for medical students during consultation in out patient department of a teaching hospital in Karachi Pakistan

Methodology: This cross sectional study was conducted in the surgical Out Patient Department [OPD] at Dow University Hospital from May 2012 to June 2012. Four hundred and eleven patients consented for participation through non probability purposive sampling, in which 279 patients were from morning clinics in the presence of students for clinical teaching, while 132 patients participated through evening clinics of surgery, when students were not present for comparison in specific dimensions of care for patients' satisfaction

Results: Majority of patients 293 [71%] agreed with the teaching of students during consultation and they feel they are contributing in future doctor's teaching, only 24% patients disagreed. Fifty two percent of patients who disagreed reported interference in privacy, 34% reported interference in consultation and 43% felt it resulted in prolong waiting time due to teaching

Conclusion: Majority of the patients agree to be part of teaching for medical students and this study can be used to assess the educational interventions designed to improve the patient based teaching

Hepatitis and AIDS fear and misconceptions; Are our students ready for contact with these patients?

Blood born infection is also one of the medical profession hazard which is added due to virus transmission by needles and medical instruments and Hepatitis and HIV viruses are leading viruses in this hazard. Medical students who are actively participating in clinical practices and due to contact with patients, face exposure of patient's needles, instruments, and blood and this exposure starts in clinical posting of third year when their clinical knowledge and professional skills are in early phases. To assess and evaluate the existing level of knowledge about these blood born infections [Hepatitis B, C and AIDS] to ensure their participation in clinical activities during their clinical posting. An observational cross sectional study with prospective data. Dow lnternational Medical College. From 2010 to 2011. This is an observational cross sectional study with prospective data, done through a questionnaire survey on third year MBBS students. 47% of the students have fear about to be infected by patient's examination during clinical posting and majority of students have misconceptions about transmission of these infections. Students have more knowledge about HIV compare to hepatitis but there is no relation in knowledge score and student's fear as shown by p value of 0.3 and 0.73 for HBV and HIV but for HCV [p= 0.035] during this study. Up to half of the students have fear to be infected by these infections during patient's examination and this perceived risk of infection is due to lack of knowledge and these misconceptions and attitude to these patients are the sources to make them reluctant in active participation of clinical activities directly related to patient.