Making fair, fairer - Implementing the FAIR-ER principles of education in an integrated curriculum

When an integrated organ system based curriculum was adopted by the University for its Medical School, curricular changes had to be implemented in the Clinical Clerkship phase called Phase 3. To design an effective educational strategy using certain principles of education such as Feedback, Active learning, Individual learning and Relevance [FAIR] together with Evaluation and Reflection. [FAIRER] The first batch of the Integrated Curriculum students of the MBBS program formed the study population. Certain principles of education such as Feedback, Active learning, Individualisation of learning and relevance that have been advocated for use to enhance learning, together with continuous evaluation and Reflection were applied in educational strategies for the implementation of the Integrated Curriculum Implementing the Integrated Curriculum for the Clinical phase of the MBBS program offered a tremendous opportunity to apply the F-A-I-R principles of education together with E-R that is Evaluation and Reflection. The scores obtained during the summative assessment and the positive student response validated the enhancement of learning objectively and subjectively

Blunt abdominal trauma with pseudomyxoma peritonei

Trauma is a common cause of morbidity and mortality. Timely surgical intervention in a hemodynamically unstable patient can save life. This case reports an adult of 27 year age who sustained blunt abdominal injury. During evaluation and simultaneous management fast deteriorating circulatory status prompted exploratory laparotomy. A tributary of middle colic vein was the reason for blood loss which was ligated. Further inspection of the bowel revealed complete transection of the jejunum which was repaired. An interesting finding was an incidentaloma; a hard, fixed mass arising from the appendix region which was subsequently diagnosed as pseudomyxoma peritonei and right hemicolectomy was done at another elective surgery. The case highlights thorough inspection of abdominal cavity in all cases as unusual / rare pathologies may be discovered incidentally.

Profile of patients with granulomatous mastitis presenting to a university teaching hospital in UAE: a case series

Objective: To highlight the profile of five patients diagnosed as having granulomatous mastitis by histopathological examination

Materials and Methods: This presentation is a case series of patients, diagnosed as idiopathic granulomatous mastitis by histopathological examination of excised specimens

The total number of cases included in the report was five females over a 4-year period from 2005 to 2009

Results: The mean age of the patients was 29.6 years and the duration of symptoms varied from three weeks to four months. All the patients presented with a palpable mass in the breast, and two patients had associated pain and one had a bloody nipple discharge

The average size of the excised masses was 3.8 cm x 3.1 cm. Four out of the five patients diagnosed to have breast abscess or segmental mastitis had taken a course of antibiotics. One patient had a persistent wound sinus which subsided with ATT and the rest of the patients had no post-operative complications

Conclusion: Idiopathic Granulomatous Mastitis [IGM] is a relatively rare disease which mimics the common breast disorders in the reproductive age group including malignancy

Profile of patients with granulomatous mastitis presenting to a university teaching hospital in UAE: a case series

To highlight the profile of five patients diagnosed as having granulomatous mastitis by histopathological examination. This presentation is a case series of patients, diagnosed as idiopathic granulomatous mastitis by histopathological examination of excised specimens. The total number of cases included in the report was five females over a 4-year period from 2005 to 2009. The mean age of the patients was 29.6 years and the duration of symptoms varied from three weeks to four months. All the patients presented with a palpable mass in the breast, and two patients had associated pain and one had a bloody nipple discharge. The average size of the excised masses was 3.8 cm x 3.1 cm. Four out of the five patients diagnosed to have breast abscess or segmental mastitis had taken a course of antibiotics. One patient had a persistent wound sinus which subsided with ATT and the rest of the patients had no post-operative complications. Idiopathic Granulomatous Mastitis [IGM] is a relatively rare disease which mimics the common breast disorders in the reproductive age group including malignancy

Solitary skin nodule in a young male: a case of cutaneous leiomyosarcoma

A case of cutaneous leiomyosarcoma in a young male is reported and literature reviewed. A 31-year old Asian male presented to the Dermatology OP with the complaint of a solitary swelling in the posterior aspect of the upper third of left thigh. On examination a skin colored nodule of about 1.6 cm diameter was found. It was dome-shaped, firm to hard, fixed to the skin and tender. An excision biopsy was done and the specimen was sent for HPE study. The result of biopsy was reported as cutaneous leiomyosarcoma. Cutaneous leiomyosarcomas are uncommon malignant soft tissue tumors which arise from the smooth muscles of the skin, the superficial type from arectorpilori muscle and the deep from the vascular wall of the capillaries. They comprise about 2-3% of soft tissue sarcomas. Our patient was an apparently healthy male who wanted to remove a small swelling in the thigh which had recently appeared. There were no remarkable clinical features to make a clinical diagnosis of cutaneous leiomyosarcoma. It was only when the skin biopsy was done that the histopathological examination revealed a cutaneous leiomyosarcoma. Hence a histopathological examination is most useful and necessary for the diagnosis of soft tissue tumors. The prognosis of the condition can be predicted using criteria laid down by Jenson et al. Long term follow up is necessary because of the risk of recurrence and metastasis

Lipid profile of patients with and without diabetic foot ulcers

To compare the lipid profile of patients with and without diabetic foot ulcers visiting surgery department in a university teaching hospital in Ajman, UAE. This hospital-based retrospective record analysis was conducted for patients with diabetes mellitus with or without foot ulcers visiting department of surgery during a period of eight years, from 2002 to 2010. Lipid parameters included were total cholesterol, HDL, LDL, VLDL. Among the diabetic patients recruited for this study, 75% were males and 25% were females. The mean HDL value for diabetic patients with foot ulcers was 37.3 +/- 8.3 whereas that for the non-foot ulcer patients was 31.3 +/- 7.9. The difference observed was statistically significant [p<0.05]. The mean value for the total cholesterol level was in the safe range for both non-foot ulcer and foot ulcer patients as they were both under 200. The mean total cholesterol was higher for diabetic patients with foot ulcer. Similar patterns can be seen for the LDL and VLDL with mean values for non-foot ulcer group being 102.1 and 35.5 and for foot ulcer group being 103.3 and 48.2 respectively, revealing that the mean is higher for diabetic patients with foot ulcer. The mean values for triglycerides were 207.4 and 186.1 for non-foot ulcers and foot ulcer patients respectively, which does not follow the pattern like the other values but this may be due to diet control. The mean values of all lipids except triglycerides were higher for the diabetic patients with foot ulcer group than those without but the only value which was statistically significant was HDL levels. This could be attributed to inability to adhere to an exercise regime due to the presence of foot ulcers. The differences observed in levels of total cholesterol, LDL, VLDL and triglycerides between the two groups were not significant

Effect of urinary ph and specific gravity in urolithiasis

This retrospective descriptive study was conducted to explore the role of urine pH and specific gravity in the formation of urinary stones among ultrasonographically proven urolithiaisis patients who reported to the Department of Surgery and Urology of Gulf Medical College Hospital and Research Centre [GMCHRC], Ajman, United Arab Emirates [UAE]. Patient's age, gender, anatomical sites of the stone and biochemical parameters were obtained from case records. One way Analysis of Variance [ANOVA] was used to find whether the mean specific gravity and pH changed according to anatomical sites of stone and different seasons. The analysis of variance showed that there is no statistically significant difference in urine pH between patients with stones in different anatomical sites. On comparing specific gravity of urine samples between patients with stones in different anatomical sites, a statistically significant difference [p<0.05] was observed. Duncan's multiple range test showed mean significant difference in the ranges of pH and specific gravity among patients with stone in urinary bladder compared to all other sites with a decrease in the pH and increase in the specific gravity [p<0.05]. On testing the correlation between pH and specific gravity using Pearson correlation, a statistically significant [p<0.001] negative correlation of-0.3 was obtained. The study identifies an association between pH and specific gravity in urinary stone formers

Mystique of Bezoars

We present a case report documenting an unusual case of small bowel obstruction due to phytobezoar which required exploratory laparotomy in a middle aged man with history of peptic ulcer surgery done two decades before. Bezoars are large conglomerates of vegetable fiber, hair or concretions of various substances in the gastrointestinal tract and patients with gastric surgery are at increased risk of development. The advent of acid reducing drugs and H. pylori eradication therapy has led to dramatic reduction in the need for surgical treatment of uncomplicated peptic ulcer. Thus, gastrointestinal bezoars are encountered less frequently than in the past but still may be a complication following gastrectomy for malignant disease, a procedure still undertaken frequently in regions where the disease is endemic. Whilst uncommon it is of interest to gastroenterologist and general surgeons as well as general practitioners who see patients with a previous history of gastric surgery