Fast ultrasound; a basic tool to evaluate the blunt abdominal trauma patient and help to decision making for emergency surgery

Fast ultrasound is a basic tool to evaluate the blunt abdominal trauma patient and help to decision making for emergency surgery. Observational study. The King Fahad Hospital Madina Munawara, over a period between 2010 and 2011. This study consisted of 765 patients came in Emergency department The King Fahad Hospital Madina Munawara Level II, or Regional Resource Trauma Center Saudi Arabia. Detailed History was taken from all the patients with special regard to bland abdominal trauma. All patients were brought to a trauma resuscitation area where a trauma team conducted a primary survey, after an airway and adequate oxygenation/ventilation were established. The FAST examinations were performed using 4 windows: subxiphoid, right upper quadrant, left upper quadrant, and suprapubic. The critical areas for intra-abdominal bleeding were the hepatorenal space [Morrison's pouch], the spleno-renal space, and the pelvic pouch of Douglas. The FAST examinations were interpreted on the spot and results Recorded. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 73 out of 765 patients who underwent FAST ultrasound in the Emergency Room. 40 [54.79%] cases were road traffic accident [RTA] injuries followed by injury due to fall were in 33[45.20%] cases. Findings are fast ultrasound observed 49 out of 73 patients [67.12%] were considered positive FAST who had fluid [blood] in the peritoneal cavity and these patients shift to Operative Room for surgery. While 24[32.87%] patients with no evidence of intraperitoneal fluid were considered negative for FAST and these patient underwent CT scans for evidence of solid organ injury[Chart No.2]. 5 out of 24 cases of solid visceral trauma found on CT scan abdomen, but had not been detected by FAST then shift to operative room after resuscitation. We conclude that FAST ultrasound is very helpful to assessment of blunt abdominal trauma and to detect intraabdominal fluid. Fast ultrasound can help in the quick decision for surgical intervention within minutes of a patient's arrival at emergency department

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

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

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.

Chest trauma management: good outcomes possible in a general surgical unit

To determine the predominant pattern of injuries following chest trauma and assess the adequacy of the management strategies employed in a general surgical unit of a trauma care hospital. This Case Series study with prospective data collection was conducted in Surgical Unit-Il ft Unit-VI of Civil Hospital Karachi, from September 2007 to February 2009. One hundred and three consecutive patients with thoracic trauma presenting in emergency department were evaluated. Patients above 12 years of age, who presented with chest trauma either alone or associated with multiple trauma were included. A total of 103 patients were studied for various chest injuries during eighteen months period. As a whole 58% of patients had blunt chest injury as compared to 42% who had penetrating injuries. Thirty patients [29%] had chest wall injuries [rib fracture, mild lung contusion] without haemothorax or pneumothorax, who were managed conservatively. Chest intubation was required in 64 patients [62%] having hemothorax I pneumothorax. Thoracotomy was required in nine patients [9%], in which only two were emergency thoracotomy and seven were elective. Over all mortality rate was 8%.Penetrating injury of chest is rising with time due to gunshot injuries although blunt trauma is still more common. Majority of chest trauma patients can be managed in a general surgical unit satisfactorily and few patients need major operative management

Primary closure of common bile duct after open choledochotomy

To assess the outcome of primary closure of common bile duct after open choledochotomy. Descriptive case series. Department of surgery, unit II, III and VI, Dow University of Health Sciences and Civil Hospital Karachi from June 2005 to May 2009. Clinical records of all the patients who underwent bile duct exploration followed by primary closure were reviewed. Main outcome measures were operating time, duration of hospital stay and postoperative complication; including bile leakage, subphrenic abscess, biliary peritonitis and postoperative jaundice. The SPSS version 11 was applied to the data for analysis. A total of 38 patients were found from clinical records having male to female ratio of 1:6.6. Mean [ +/- SD] operating time was 95 [ +/- 7] minutes. The overall complication rate was 10.52%. Bile leak was encountered in three [7.89%] patients whereas small subphrenic collection was noticed in one [2.63%] patient who was treated conservatively. None of the patients experienced postoperative jaundice and biliary peritonitis. Mean [ +/- SD] duration of hospital stay was 7.63 [ +/- 1.63] days. Primary repair of common bile duct after open choledochotomy is safe and associated with low complication rate