Bullying of postgraduate medical trainees in tertiary care hospitals

Objective: To determine prevalence of bullying among postgraduate medical trainees in tertiary care hospitals in Peshawar

Methodology: This cross-sectional study of postgraduate medical trainees from different specialties was conducted in three tertiary care hospitals of Peshawar using convenience sampling. A semi structured questionnaire containing questions regarding type of bullying, who perpetuates bullying and effect of bullying was filled by the participants. The results are expressed in the form of frequency and percentages

Results: Out of 246 Postgraduate medical trainees who responded to semi structured questionnaire, 89% [n=219] reported being bullied in one or more forms, Overload with work was reported by 83% [n=203] as most common type of bulling. The common perpetrator of bullying were registrars, senior registrars were mentioned by 20% [n=49], while 18% [n=44] thought junior registrars are bullying them. The effect of bullying was that 31% [n=71] were depressed because of bullying

Conclusion: Bullying of Postgraduate medical trainees is fairly common in hospitals and registrars are most commonly involved as perpetrators. More awareness should be created about bullying and feedback about working environment should be regularly obtained from postgraduate medical trainees

Correlation of adverse perinatal outcomes and placental infarcts in hypertensive primigravida mothers

To determine the frequency of placental infarcts and its effect on fetal outcome in hypertensive primigravida mothers. This study was conducted at Obstetrics and Gynecology Department, Lady Reading Hospital Peshawar from 1[st] January 2011 to 30[th] September 2011. The sample size was 130 primigravida mothers. This study was cross sectional in which non probability consecutive sampling technique was adopted. The data was collected on predesigned proforma and was analyzed using SPSS version 17. This study included 130 primigravida mothers in age range from 19-35 years with mean age of 27.27+4.04 years. Placental infarcts were seen in 31% [n=40] patients. Sixty percent [n=24] patients had focal placental infarcts while 40% [n=16] had multifocal placental infarcts. Among fetuses whose placenta showed no infarction, 90% fetuses were live born and 10% were still-born while those fetuses whose placenta showed infarction 70% fetuses were alive and 30% fetuses were still-born. The incidence of adverse perinatal outcomes including intrauterine growth restriction and still birth is higher in hypertensive primigravida mothers with placental infarcts than in hypertensive primigravida mothers with no infarcts

Frequency of postpartum haemorrhage in maternal mortality in a tertiary care hospital

To determine the frequency of postpartum haemorrhage as a cause in maternal mortality during a period of seven years in a tertiary care hospital. This descriptive study was conducted in Gynae A unit of Department of Obstetrics and Gynecology, Lady Reading Hospital Peshawar. Data was collected from maternal mortality records retrospectively from 1[st] January 2003 to 31[st] December 2009. All patients who died in the hospital with a diagnosis of postpartum haemorrhage as the primary cause of death were included in the study. A total of 302 maternal deaths were recorded during the study duration. Out of these 302, 74 were due to Post-partum Haemorrhage which constituted 24.5% of maternal deaths. The mean age of the sample was 29.69 +/- 7.10. Uterine atony was the cause of death in 45.9% [n=34], rupture uterus in 32% [n=24], genital tract tears in 14.86% [n=ll] and retained placenta in 6.75% [n=5] of the cases of Postpartum Haemorrhage. Subtotal abdominal hysterectomy was performed in 51.35% [n=38]; repair of tears and removal of placenta in 6. 75% [n=5] each; Subtotal abdominal hysterectomy with internal iliac If gat ion was performed in 5.4% [n=4] cases while only internal iliac ligation and B Lynch suture was applied in 1.35% [n=l] each. The remaining 20 cases expired before they could be prepared for it. Postpartum Haemorrhage was found to be leading cause of maternal mortality making up to one quarter of total deaths in 7 years. Uterine atony and ruptured uterus were the major causes of Postpartum Haemorrahge. Subtotal abdominal hysterectomy was the major procedure performed

audit of change in rate and indications of caesaren section in a tertiary care hospital of Peshawar

To compare the changes in rate and indications for caesarean section after a gap of ten years i.e., in 1996 and 2006 respectively. This comparative study was conducted in the Department of Obstetric and Gynecology at Lady Reading Hospital Peshawar in December 2006. Record of all the patients who delivered in Gynae B unit in 1996 and 2006 respectively was obtained. Out of all the deliveries, the details of the patients who had Caesarean section were recorded on a semi structured proforma which included the demographic details, gravidity and indication for which caesarean sections were performed. Statistical analysis was done by using SPSS version 10. Chi square test was performed for the comparison and a p value of <0.05 was considered significant for the study. During 1996, the caesarean section rate was 10.26% as compared to 25.10% in 2006 with a p value of <0.01 which was statistically significant for the increase in caesarean section rate. In 1996, the number of caesarean sections performed in multigravida were n=253 [59.81%], followed by grandmultigravida n=93 [21.98%] while n=77 [18.20%] were performed in primigravida. In comparison, during 2006, highest number of caesarean sections were still performed in multigravida n=680 [47.61%] but it was followed by primigravidas n=480 [33.61%] and least n=268 [18.76%] in grandmultigravidas During 1996, the commonest indications in order of frequency were dystocia n=120 [31.20%], previous caesarean section n=71 [16.78%], placenta praevia n=56 [13.23%] and fetal distress n=48 [11.34%] respectively while during 2006, they were dystocia 310 [21.70%], fetal distress n=197 [13.79%], previous caesarean section = 191 [13.37%] and breech presentation n=180 [12.60%] respectively A significant increase [14.84%] in the rate of caesarean section in the last ten years is observed and it has gone particularly high in primigravidas in 2006. The main indications mostly were similar but malpresentations emerged as an important indication in 2006

Single dose versus multi dose cephradine as antibiotic prophylaxis in elective abdominal hysterectomy: a randomized control trial

To compare the efficacy of single dose versus 7 days cephradine prophlaxis for the prevention of post operative infection in patients undergoing elective abdominal hysterectomy. This study was conducted in the department of Obstetrics and Gynaecology, Lady Reading Hospital from January 2006 to March 2007. Twenty patients each were randomly allocated by card method to either group I or group II. Patients in group-I were given one gram of cephradine intravenously 30 minutes before surgery while patients in group-II were given one gram of intravenous cephradine 30 minutes before surgery 2 nd dose of one gram was repeated after 12 hours followed by 500 mg of oral dose for next 6 days. Wound was examined on 2nd, 4th and 7th day then after 2 weeks and after 6 weeks. The efficacy was measured in terms of febile morbidity, surgical and nonsurgical site infection and duration of hospital stay. The statistical analysis was carried out by chi square test. Febrile morbidity was equal in both groups [20%], surgical site infection was 10% in group I and 5% in group II, and duration of hospital stay was equal in both groups. Non surgical site infection occurred in 5% of patients in group-I. There was no statistically significant difference in out come in two groups. Single dose prophylactic antibiotic is as effective as multiple dose antibiotics in elective abdominal hysterectomy

analysis of direct causes of maternal mortality

This study was conducted to analyze the direct causes of maternal mortality during a period of seven years in a tertiary care hospital of NWFP. This retrospective, analytic study was conducted from 1998-2004, and included all the pregnant patients including miscarriage and ectopic pregnancies, presenting during this period to Gynae B Unit, Lady Reading Hospital Peshawar. The records of maternal deaths were reviewed from 19982004 retrospectively and causes of direct deaths were analyzed. Deaths in non-pregnant patients and indirect deaths in pregnant patients were excluded. Total number of live births during the time period was 23720 and total number of maternal. deaths was 311. The maternal mortality ratio [MMR] was calculated as 1311/100,000 live births. Out of 311 maternal deaths, 268 [86.2%] had direct causes and 43 [13.8%] had indirect causes of maternal mortality. Hemorrhage was responsible for 42.16% [113/268] of maternal deaths, followed by hypertensive disorders in 24.63% [66/268], ruptured uterus in 10.45% [28/268], septicemia in 9.7% [26/268], thromboembolism in 7.8% [21/268] and unsafe abortion in 3.4% [9/268] cases. The study shows a very high MMR as compared to national figures. The leading cause of direct maternal death was hemorrhage, followed by pregnancy induced hypertension, ruptured uterus and septicemia. These conditions can be prevented by good antenatal, intranatal and postnatal care

Perinatal and maternal outcome in retained second twin

To evaluate the perinatal and maternal outcome related to retained second twin. This study was carried out in Gynae 'B' Unit, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January 2004 to December 2005. Patients presenting to the labour ward after having delivered the first twin at home and with retention of the second twin in-utero with time interval of more than 30 minutes after the delivery of the first twin were included in the study. A total number of 25 patients presented with retained second twin during the above mentioned time period. Malpresentation in 14 patients [56%] and uterine inertia in 7 patients [28%] were found to be the commonest reasons causing retention of second twin, while malpresentation and uterine inertia together was seen in 4 patients [16%]. The perinatal mortality was 76% [n=19/25]. Maternal morbidity like fever was seen in 12 patients [48%] while post partum hemorrhage occurred in six patients [24 N. Blood transfusion was required in 17 patients [68%]. In post partum period breast engorgement requiring treatment with bromocriptine was seen in 5 patients [20 N]. Retained second twin is associated with a hlgh perinatal mortality rate and also causes increased morbidity in mothers. Thus, patients with twin gestation should be referred earlier to a center equipped to handle such a high-risk pregnancy and its associated problems at birth