Evaluation of performance of basic life support and clinical skills among interns in mayo and allied hospitals of king Edward medical university, Lahore

Training of medical students on basic life support and clinical skills is an important part of under graduate medical education. Teaching hospitals can provide these skills efficiently. To compare the performance of basic life support and clinical skills among trained and non-trained medical graduates, working as interns in Mayo and Allied Hospitals of King Edward Medical University. Study type settings and duration: Cross sectional study conducted in the Department of Medical Education, King Edward Medical University, Lahore from May 2010 to April 2011. A total of 227 medical graduates [academic year of 2010] were trained for basic life support of child and adult, neonatal resuscitation, airway opening maneuvers, endotracheal tube insertion and aseptic techniques. They were divided into two groups; group A consisted of 125 King Edward Medical University graduates who, as students were trained in above mentioned skills and now as interns, were working in emergency and intensive care units of Paediatrics, Neonatology, Medicine, Surgery and Gynecology and Obstetrics of Mayo and Allied Hospitals of King Edward Medical University. Group B consisted of 125 interns who graduated from other medical schools, and had not learnt above mentioned skills as undergraduate students. Interns of both the groups were interviewed using a structured questionnaire for importance of learning the skills at undergraduate level and performance of above mentioned skills as an intern. Study group A was also interviewed about grading the skills that they learnt as undergraduate students. Data was entered in SPSS 17. Chi square test was applied to compare the performance of the skills while, logistic regression analysis was done to calculate odds ratio and 95% confidence interval. In group A, 74[59%] interns performed basic life support for child and adult well. Almost 79[63%] performed neonatal resuscitation, 63[50%] airway opening maneuvers, 37[30%] endotracheal tube insertion and 91[73%] aseptic techniques well. In group B, 98[78%], 120[96%], 104[83%], 117[94%], and 81[65%] interns were unable to perform above mentioned skills respectively. The difference between the groups was statistically significant for all the skills. Training of basic life support and clinical skills' courses at undergraduate level can result in better performance of these skills in their practical life

Tuberous sclerosis

Tuberous Sclerosis is an autosomal dominant disorder. It occurs with frequency of 1:5800-30000. It present as cutaneous and systemic manifestations. We report here a case of Tuberous sclerosis in a 10 month old infant who presented with infantile spasms and ash leaf lesions. Treatment with steroids showed good response

Risk factor analysis in asphyxiated newborns and their outcome in relation to stage of hypoxic ischemic encephalopathy

Hypoxic ischemic encephalopathy [HIE] is one of the common causes of neonatal mortality and long term sequale. The incidence is reported at 2-9/1000 live births. To find out the frequency of risk factors in asphyxiated newborns and outcome of these newborns in relation to the stage of hypoxic ischemic encephalopathy in hospital setting. Prospective descriptive study. This study was conducted in the Neonatology Unit of the Department of Paediatrics Unit-II, King Edward Medical University/Mayo hospital, Lahore, over a period of six months from April 01, 2006, to September 30, 2006. All the asphyxiated babies admitted during study period were included in study. Babies having congenital anomalies were excluded. The mothers were interviewed by using a pre-tested structured questionnaire. Out of 449 total admissions in study period, 227[51%] babies were asphyxiated. Eighty five [37%] newborns had stage I HIE, 39% had stage II and 24% had stage III HIE. One hundred and sixty four [73%] were full term. Majority of the newborns were male [60%]. One hundred and thirteen [49%] newborns were between 1.5 and 2.5kg. One hundred and thirty four [59%] babies delivered normally while seventy four [33%] were delivered by caesarian section. Hundred and sixty seven [74%] newborns were referred from government hospitals. Most of the deliveries [80%] were conducted by doctors. Majority of the mothers [48%] were below 25 years of age, 34% mothers were primigravida and 33% mothers received general anesthesia during labor. One hundred and sixty five [73%] babies had cephalic presentation. None of the deliveries were attended by a paediatrician in any of the cases. Maternal hypertension was found in 53 [23%] mothers, gestational diabetes in 9 [4%], hypoxia in 6 [3%], anemia in 31 [14%], toxemia in 19 [8%], pelvic abnormality in 30 [13%] and antepartum hemorrhage in 14 [6%]. No mother was found to be smoker. Eight [4%] babies had cord around the neck during delivery. One hundred and ten [48%] newborns were brought to the neonatal unit within one hour of delivery. Majority 21% of HIE I remained admitted in neonatology unit for less than 24 hours while 27[12%] of babies of HIE III died within 24 hour of admission. Among the factors studied, gestational age, weight, mode of delivery, birth attendant, sedation during labor and late arrival in neonatal unit were found to be significant with p value of < 0.05. HIE is caused by the risk factors that may be antepartum, intrapartum or postpartum. Monitoring for the known risk factors of asphyxia, proper training of primary birth attendants and improvement in neonatal resuscitation services can minimize the incidence of HIE

Comparison of diagnostic BCG test with Mantoux test in children with suspicion of tuberculosis

Mantoux's test has been used conventionally in testing for tuberculosis. Some studies have observed that the Diagnostic BCG Test [Bacille-Calmette-Gueurin] gives better results as compared to the Mantoux's test. This study was designed to compare the Diagnostic BCG Test with Mantoux's test in children, with suspicion of tuberculosis, in our set-up. This study was conducted at Paediatric Department of Services Hospital and Post-Graduate Medical Institute, Lahore, from June, 1997 to May, 1998. A total of 100 patients, less than 15 years of age, who either came to the paediatric outpatient department or were admitted in the hospital, having suspicion of tuberculosis, and who had not been vaccinated for tuberculosis, were included in the study. Both the tests were administered simultaneously, and as a result, the BCG test was positive in 81 patients, while Mantoux's test was positive in 50 patients. The BCG test was positive in all of the patients where Mantoux's test was positive. The BCG test was positive in 84% of severely malnourished children while Mantoux's test was positive in only 4.8% of such patients. In tuberculosis meningitis and respiratory tuberculosis, BCG test was more conclusive [85.7% and 90.9%, respectively] than Mantoux's test [14.3% and 45.5%, respectively]. In this study, the Diagnostic BCG test gave a better yield as compared to the Mantoux's test. The difference was more obvious in tuberculous meningitis, respiratory tuberculosis and children with severe malnutrition

Familial hypercholesterolemia Type II-A

Familial hypercholesterolemia is an autosomal dominant disorder, clinically manifested by xanthomas, and is characterized by elevated levels of total and LDL cholesterol with normal triglycerides. We report the case of a 10 year old girl who had xanthomas and xanthelasmas with no evidence of complications. Drug therapy along with lipid lowering diet was offered

Right Morgagni Hernia

Morgagni hernia is anomaly of the sternal insertions of the diaphragmatic bundle and represents 2% of all surgically treated diaphragmatic hernias. We report here a case of 4 month old male infant who had Morgagni hernia

Co-relation of birth weight with periventricular hemorrhage-a prospective study of two groups of newborns

To determine the difference between prevalence of Periventricular - Intraventricular Hemorrhage [PIVH] in the newborns on the basis of birth weight. Prospective study. Neonatology Unit, Department of Paediatrics, Post Graduate Medical Institute / Services Hospital, Lahore, from 1[st] April to 31[st] July 2000. All new born admitted in Neonatal Unit of Services Hospital within 24 hours of birth were included in the study. Birth weight was documented. Cranial ultrasonography was done twice in all babies, once within 24 hours of birth and second between 4 and 5 days of life. All newborns included in the study were divided into two groups on the basis of birth weight; One group with birth weight less than 1500 gms the second group with weight 1500 gm and more. In babies with PIVH, the extent of hemorrhage was graded. 364 out of 448 [81%] fulfilled criteria for admission to this study. Cranial ultrasound was done twice in all babies, irrespective of diagnosis. 36 babies [9.9%] died within 72 hours of life. Babies with birth weight less than 1500 gm were 110 [30%], whereas, those more than 1500 Gm birth weight it was 68 [62%], 54 [21%] babies were delivered at Services Hospital, 79 [22%] in different maternity centers and 169 [46%] were home delivered. Distribution of grading of PIVH showed that 64 cases had grade-l hemorrhage, 27 had grade-ll, 18 had grade-Ill and 13 had Grade-IV hemorrhage. First scan detected 55 [45%] cases. Cranial ultrasound should be done in all premature and low birth weight newborns within 4-5 days of life to detect PIVH fairly accurate and easily.Co-relation of birth weight with periventricular hemorrhage