Awareness of medical ethics in undergraduate medical students- a literature review

Medical ethics is a core issue for all specialties and is encompassed in professionalism. It is a presumption that not dealt appropriately in the undergraduate teaching curriculum. There is a paucity of awareness lectures and seminar workshops in teaching setups for medical ethics for undergraduates in developing countries. The current policy of PMDC does not provide a centralized curriculum for teaching of medical ethics in medical colleges, which results in lack of logical ethical reasoning among students. There is a need to develop a medical ethics curriculum taught by medical ethics department in every medical college in collaboration with the clinicians with real life case scenarios. Students should be evaluated through examinations at the end of every year with fixed hours dedicated to the teaching of the curriculum. Only, through these measures patient satisfaction will improve and medicine can achieve its lost glory and nobility in our part of the world

Total antioxidant capacity of commonly used fruits, vegetables, herbs and spices of Pakistan

The current study was aimed at investigating the total antioxidant activity [TAG] of various fruits, vegetables, herbs and spices habitat in Pakistan. The ferric reducing ability of plasma [FRAP] assay was used to measure the TAG of various extracts [aqueous, ethanolic and aqueous-ethanolic]. Following is the potency order for fruits [guava >strawberry >Pomegranate >apple >kinnow >melon >lemon >banana], vegetables [spinach >Cabbage [Purple] >Jalapeno >Radish >Brinjal >Bell Pepper >Lettuce >Carrot >Cabbage [White] >Onion >Potato >Tomato >Cucumber] and herbs/spices [clove >Rosemary >Thyme >Oregano >Cinnamon >Cumin >Kalonji >Paprika >Neem [Flower] >Fennel >Black Cardamom >Turmeric >Coriander >Ginger >Garlic]. In conclusion, the guava, spinach and clove provide the best natural dietary option for treatment / prevention of oxidative stress and thus could alleviate several associated ailments

Pattern of torso-trauma in road traffic accidents in KSA

To study the pattern and severity of abdominal injuries due to road traffic accidents [RTA] in KSA. Retrospective descriptive. This study was conducted in the Department of Surgery, King Fahad Hospital Al-baha, Kingdom of Saudi Arabia during one year from 2012 to 2013. Materials and Methods: This is retrospective study of all patients admitted with torso-trauma in Department of Surgery KFH Al-Baha from the period of Aug. 2012 to Aug. 2013. In the 01 year period, 2520 patients were admitted following an RTA. Out of these, 537 were admitted due to torso trauma.120 patients were admitted in SICU, 280 in intermediate dependency unit while remaining 137 admitted in surgical ward. 27 patient died due to torso trauma with multiple injuries. 3 patients died of pure liver trauma while 2 patients died of splenic injury. Lot of burden over the hospital because of RTA related injuries. There was very severe and fatal injuries faced because of accidents happened in youth and male preponderance

comparative study of percutaneous suprapubic cystolitholapaxy versus open cystolithotomy in children

To compare the outcome of percutaneous suprapubic cystolitholapaxy with open cystolithotomy in children. Comparative study. Department of Urology and Surgery, Peoples Medical College Hospital Nawabshah, from 2004 to 2007. Hundred patients [87 boys and 13 girls], from 1 to 10 years of age were enrolled in the study. The size of stones ranged from 8mm to 25mm. Patients were divided in two equal groups A and B. Group A submitted for percutaneous suprapubic cystolitholapaxy and group B for open cystolithotomy. The procedure was done under spinal and caudal anesthesia with intravenous sedation. To compare the outcome of percutaneous suprapubic cystolitholapaxy with open cystolithotomy Postoperative complications noted in group A patients included transient hematuria in 2 cases [p 0.495]. Operative time in group A was 10 to 15 minutes while in group B it was 25 to 40 minutes [p 0.0005]. Urinary leakage [n=2 - p 0.495] and wound infection [n=3 - p 0.242] were observed in group B. Duration of catheter placement was 2-3 days in group A, while 5 to 7 days in group B [p 0.0005]. Hospital stay of group A was 2-3 days while 5-7 days in group B [p 0.0005]. All patients became stone free. Percutaneous suprapubic cystolitholapaxy is an efficient, safe, minimally invasive and cost effective method

Early wound complications following modified radical mastectomy with axillary clearance

To identify the pattern of early wound complications after modified radical mastectomy with axillary clearance and to determine the risk factors predisposing to these complications. Descriptive case series. Surgical Unit II, Peoples University of Medical and Health Sciences Nawabshah, from January 2008 to December 2010. One hundred and fifty patients were included in this study who underwent Patey's modified radical mastectomy with axillary clearance These patients were followed up for one month postoperatively in OPD. Age of the patients was between 30-80 years. Seroma formation was the most common complication seen in 50 [33.3%] patients, wound infection in 15 [10%] and flap necrosis in 4 [2.6%] cases. More than 1000 ml discharge in drain was noted in 30 patients. Wound infection found more in patients with prolonged operation time [>150 minutes] and in those with seroma formation. Seroma formation was the most common complication as well predictive factor for wound infection and flap necrosis

Surgical site infection in elective sugery

To determine the causes and rate of surgical rate site infection [SSI]. Descriptive study. Surgical Unit II, Peoples Medical College and Hospital Nawabshah, from August 2009 to July 2010. Patients of different wound categories were included in this study and followed up for 30 days postoperatively. The wound infection which occurred within 30 days of operation was considered as surgical site infection. The diagnosis of infection was made on clinical rather than on bacteriological basis. Total number of patients was 300. Out of 212 patients from 12-50 years of age 14 [6.6%] developed SSI, whereas among 88 patients above 50 years, 14 [15.9%] developed wound infection. Most patients had body mass index between 20-28 kg/m[2]. Obesity was more common in females and BMI more than 35 kg/m[2] appeared to be a risk factor for SSI. Most common organisms were Staphylococcus aureus [50%], E. coli [14.3%], Klebsiella [14.3%] and other organisms found in 5-7% cases. Wound infection occurred in 28 [9.3%] patients. The achievable preventive measures should be taken to save the economic burden on patient, hospital and community as a whole

Compare the outcome of open versus laparoscopic varicocelectomy

To compare the outcome of the laparoscopic surgery with open varicocelectomy. It is also assess the operative time, postoperative pain, postoperative recovery of patients and postoperative complications of both procedures such as, bleeding, haematoma, wound infection, hyderocele, laparoscopic related complications and recurrence. Observational Study. This study was carried out in Surgical Unit-IV, Liaquat University Hospital Jamshoro, from January 2009 to December 2010. This study consisted of 80 patients of varicocele grade III were admitted and divided in two groups. Group A for open varicocelectomy and group B for laparoscopic varicocelectomy in which each group consist of 40 patients. The ages of patients ranged between 11 years to 50 years. The mean age of LV group was 25.72 +/- 6.026 years and for OV group was 27.58 +/- 6.694 years. In OV group 92.5% of patients were having left varicocele, 5% right varicocele and 2.5 bilateral disease where as in LV group 90% of cases were having left, 7.5% right and 2.5% bilateral varicocele. The mean time in OV group was 29.70 +/- 8.498 minutes and 25.08 +/- 5.558 minutes in LV group [p 0.005]. the mild pain was observed in 7 [17.5%] patients of OV group and 16 [40%] patients of LV group. Whereas, severe pain was described by 10[25%] patients in OV group and 4 [10%] patients in LV group [p0.032]. The wound infection was found in 6 [15%] patients of OV group and 2 [5%] patients of LV group. The hydrocele was seen in 5[12.5%] cases of OV as compared 2 [5%] cases of LV group. Residual varicocele and recurrence of varicocele was observed in two cases [2.5%] of OV group and 3 cases of LV group with value p<0.359. It was longer about 2-3 days in 34[855] of OV patients as compared to LV cases where majority 36[90%] were discharged within 1 to 2 days. The results shows that LV is superior than OV in terms of better cosmesis, less operative time, less complications, short hospital stay and early return to work

Postoperative outcome of minicholecystectomy and conventional cholecystectomy

To investigate the effects of different incision lengths following elective Cholecystectomy Prospective cross sectional, comparative study. This study was conducted at Surgical Unit II Peoples Medical University of Health Sciences Nawabshah from January 2009 to December 2010. In this study, 100 patients were taken as a sample size. In this study, sampling technique was Purposive, non probability. Main Outcome Measures were postoperative pain, Length of hospital stay, Cost of treatment, Time until return to work, Complications. Most surgeons still prefer the open approach when dealing with common bile duct stone. The technique of open Cholecystectomy might compete with laparoscopic Cholecystectomy in avoiding prolonged operating time and major expenses. Mini-Cholecystectomy requires less operating time, less postoperative pain, and early return to work than standard conventional open Cholecystectorny. There were 37 female and 13 male in MC group, and 42 female and 8 male in CC group. Median age was 55 [range 20-80 years] median BMI was 23 [range 17-30]. 15 patients in MC and 18 patients in CC group were with acutely inflamed gall bladder and remaining were with chronic gall stone disease. In MC group of 50 patients the mean hospital stay was 2.5 days with shortest 1 day and longest 5 days. 35 [70%] patients were discharged within 2 days 10[20%] on 3[rd] and 5 patients remained for 5 days. Minicholecystectomy offers less pain, earlier recovery and better cosmetic results than conventional open Cholecystectomy

Increased risk of carcinoma gall bladder in longstanding cases of cholelithiasis

To find out the incidence of carcinoma of gall bladder in longstanding cases of Cholelithiasis with history of more than 5 years. A prospective observational clinico-pathological study. Departments of surgery, Nawabshah Medical College Nawabshah. From March 2000 to Feb: 2005. Total 180 cases were included in the study among all the 520 cholecystectomies performed during this period, which were symptomatic proven cholelithiasis cases for past 5 years or more. Most patients were from rural area with urban rural ratio 30:70. All the specimens of removed gall bladder were examined histologically. Female to male ratio was 4:1 and age incidence was 5 1-72 years. Out of 180 cases included in the study 12 [6.6%] patients were of carcinoma of gall bladder with female to male ratio 3:1 and peak age incidence was 65 years. The longer duration of disease with gall stones increases the risk of carcinoma in gall bladder. The patient diagnosed cholelithiasis should be counseled for early operation and all the specimens of removed gall bladder should be examined histopathologacally

Retroperitoneal tumours in children - Experience at Mayo Hospital, Lahore

To collect the data, mode of presentation and surgical outcome of various types of Retroperitoneal Tumours in Children. Prospective study. Two years [July, 1996 to Jul, 1998]. Paediatric Surgery Department, Mayo Hospital Lahore. During two years period total 30 patients of retroperitoneal tumours were admitted. Only five types of retroperitoneal tumours [Wilm`s tumours, neuroblastoma, teratoma, rhabdomyosarcoma and non-hodgkin lymphoma] were included in this study. Most of patients with retroperitoneal tumours presented under five years of age, particularly within first year of life. Males were predominant. Mass abdomen, anorexia and weight loss were the major mode of presentation. Most common tumour was wilms followed by neurobliastoma. Immediate post operative course was uneventful. We conclude that Retroperitoneal Tumours present commonly first five years of life. Early diagnosis and multimodality treatment improves prognosis

Impact of age and delayed presentation on outcome of intussusception in children

To evaluate the impact of age, weight. delayed presentation on outcome. Retrospective study Period: 7 Years period [January 1997 - December 1999 and January 2001 - December 2004]. Setting: Department of Pediatric Surgery, Mayo Hospital and The Children's Hospital, Lahore. During 7 years period total 130 cases of intussusception were admitted. Most of patients presented under 1 year of age. Majority of patients presented after 72 hours of duration. All were operated and ileocolic was the most common type followed by ileoileal intussusception. Below 1 year 58.25% patients required resection anastomosis and after 5 years 27.7% patients required resection. Before 72 hours 25% patients required resection and after 72 hours 74% patients required resection. We conclude that duration and age have definite impact on outcome of intussusception

Usefullness of topical glyceryl trinitrate in chronic anal fissure

To assess the effectiveness of topical Glyceryl Trinitrate in the treatment of Chronic Anal Fissure. Prospective Observational study from April 2004 to March 2005. Surgical Unit II, Peoples Medical College Hospital, Nawabshah. A total of 46 patients with Chronic Fissure-in-Ano. The data of all the patients who were recruited for the use of 0.2% topical Glyceryl Trinitrate was collected and analyzed for gender, age, symptoms' duration, site, and associated diseases. These patients were followed at regular intervals of four, six, eight and 12 weeks, and six and 12 months to assess the outcome, adverse effects and recurrence. Out of the 46 patients, six did not came back for follow-up, hence they were excluded. Amongst the remaining 40 cases, there were 14 males and 26 females, with ages between 16-64 years. In 26 [65%] patients, the fissure healed completely during eight weeks duration, whereas 10 [25%] patients experienced headache. Recurrence occurred in six [15%] patients; in them lateral internal sphincterotomy was performed. Topical Glyceryl Trinitrate is a good treatment option, as the success rate was 65%, with only 15% recurrence. It is well tolerated and has no chances of faecal and flatus incontinence

Prevalence of hepatitis 'B' and 'C' in surgical patients

To find out the prevalence of Hepatitis-B and C in our surgical patients. Prospective, descriptive study carried out from May to October, 2005. Surgical Unit I, Peoples Medical College Hospital, Nawabshah. Patients of either sex, more than 13 years of age undergoing surgery. All the patients in the study underwent screening for Hepatitis-B and Hepatitis-C The information of the patients was recorded on a prepared proforma, and analyzed. The prevalence of Hepatitis-B was found to be 8.6% [5.8-12.12] and Hepatitis-C 11.6% [8.3-15.6], whereas in 20.33% [16.0-25.1] cases both Hepatitis-B and C were present. The high prevalence of Hepatitis-B and C found by the study suggests a routine, rather mandatory screening of all patients proceeding for surgery

Oesophageal atresia and tracheosophageal fistula

Forty-six neonates with esophageal atresia and tracheoesophageal fistula were admitted in Mayo Hospital Lahore over a three and half years period from Jane 1995 to December 1998. Of these 76.08 percent were male. Delayed referral of 24 hours or more was noted in 78.20 percent. Among the neonates admitted 88 percent had moderate to severe chest infection and 70 percent weighed three or more than three kilograms. Associated congenital anomalies were noted in 41.3 percent, of which high imperforate anus accounted for more than 50 percent. Ligation of fistula and primary oesophageal end to end anastormosis was performed in 28 patients and in 4 neonates oesophagostomy and gastrostomy were performed. Survival rate of category A was 80 percent and overall survival was 40.63 percent