Non-academic attributes of hidden curriculum in medical schools

To identify the non-academic attributes developed during 5 years of training in medical school. Sequential mixed method. The study was conducted on final year medical students of four medical colleges in the city of Lahore, from March to September 2010. Probability random sampling was employed to identify public sector medical colleges for inclusion in the study through Lottery method. In the first phase, survey was done with the help of questionnaires, distributed amongst 280 students, selected on the basis of convenience sampling. It was triangulated with data collected by in-depth structured interviews on 46 students selected using purposive sampling after formal informed consent. For quantitative data percentages of the categorical variables were calculated through SPSS version 10. For qualitative data, themes and patterns were identified using Content Analysis technique. Majority of the medical students [80%] learn the attributes of integrity, self-reliance, tolerance and independence during their schooling. Sixty five percent students thought that the values of humanity, forbearance, righteous attitude in face of adversities and sympathetic behaviour towards peers and patients helped them in being better medical students. Thirty five percent said they faced the negative influences of gender bias and gender discrimination which has led to their impaired professional growth. Eighty percent of the students believe that the teaching methodology employed is teacher centric which does not let them become problem solvers, team players, reflective learners and hampers development of effective communication skills. Medical schooling in our part of the world helps in developing untaught attributes such as integrity, selfreliance, tolerance, independence, sympathetic attitude and good communication skills which are the same as are developed in the medical students of advanced countries, which can be fostered further by formally addressing them in the curriculum

Role of barium enema preceding colostomy closure in trauma patients is limited and challangeable

The prospective study comprising 50 cases was conducted in West Surgical Ward, Mayo Hospital, Lahore from January 2000 to December 2001. Majority of the patients 45[90%] were male and 5[10%] patients were female. Cause of colostomy in 28[56%] patients was firearm, stab injury in 13[26%], blunt trauma in 4[8%], rectal impalement in 3[6%] and iatrogenic injuries in 2[4%] patients. Barium enema preceding colostomy closure was advised in all patients with 98%[49 patients] negative results and 2%[1 patient] false positive results which were found negative o n further evaluation by proctoscopy/sigmoidoscopy. Gut was prepared pre-operatively by both chemical and mechanical methods. Colostomy closure was performed in 43[86%] and resection and end t o end anastomosis in 7[14%] patients. Skin was left open in all cases. Post-operative complications observed in the series were interloop abscesses in 1[2%], anastomosis narrowing in 1[2%] and urinary tract infection in 1[2%] patient. All complications were managed according to their own protocol and priority. No mortality was recorded in the study

Acute appendicitis - incidence of perforated appendicitis

The prospective study was carried out in West Surgical Ward, Mayo Hospital, Lahore during the year 2003 consisting of 200 patients. There was slight preponderance of males 102[51%] to females 98[49%]. Age ranged from 13-75 years with the mean of 28.2 years. Appendicectomy was done in all patients by making gridiron incision in 165[82.5%], muscle cutting in 15[7.5%], Lanz`s incision in 16[8%] and right Para-median in 4[2%] patients. Regarding position of the appendix, retroceacal was the most common, found in 160[80%] and pelvic position in 31[15.5%] patients. Perforated appendix was delivered in 10[5%] patients with male to female ratio 4:1. Postoperative complications observed in the series were wound infection in 11[5.5%], prolonged ileus in 2[1%] and gastritis in 2[1%] patients. All the complications were managed according to their own protocol. No mortality was recorded in the series

Thyroidectomy in carcinoma thyroid - a three years experience

Twenty-five patients were operated for thyroid malignancy in dept. of Surgery, SRGH, Lahore over a period of 3 years. From Nov 2001 to Nov 2004. Carcinoma was diagnosed on FNAC in 10 pts [40%] and Total Thyroidectomy planned as first and definite procedure. In rest of 15 patents [60%] complete thyroidectomy was performed after initial total lobectomy and subsequent Histopathology. Eight pts were found to have follicular carcinoma and 16 had papillary carcinoma revealed on H/P of resected specimen. Thyroid function tests in almost all showed euthyroid status. The only exception was a female pt who`s hormonal assay showed hypothyroidism but she was operated for FNAC suggested follicular adenoma. All the pts had Iodine-131 whole body scan for residual thyroid and metastatic disease. No thyroxin was started before Iodine-131 scan. Twenty pts were given single dose of 50-75 miCu ff radioiodine, followed by thyroxin in suppressive dose. No recurrence of tumor noted during follow-up 2 years. Only one pt diagnosed finally as thyroiditis on histology of resected specimen. On FNAC, she had suspicion of follicular neoplasm mandating thyroidectomy. A female prepondondrance with age ranging from 15-45 yrs was observed

Spaghetti wrist: management and outcome

To determine the outcome of emergency management of the spaghetti wrist. Design: Descriptive study. Place and Duration of Study: Department of General Surgery, Sir Ganga Ram Hospital Lahore, Pakistan, from January 2000 to December 2003. Patients and During this period, all patients of more than 12 years, with sharp clean cut volar forearm lacerations [spaghetti wrist] of <6 hours were included, with a follow-up of one year, clinically and with nerve conduction studies, where appropriate. Sensory and motor recovery was evaluated according to S0-S4 and MRC [medical research council] scale respectively. The power of first dorsal interosseous and adductor pollicis was used to monitor the recovery of ulnar nerve; and abductor pollicis brevis and opponens pollicis for the median nerve. The tendon recovery was evaluated by Strickland Adjusted System Score. This study comprised of 10 patients [M:F, 4:1], of 14 to 38 years [mean 22.9 years]. Injury was accidental in 70%; due to broken glass in 50% and kite string in 40%; involving right hand in 70%. 8.2 [4-12] structures per patient were involved. The injury involved median nerve in 70%, ulnar nerve in 60%, [30% had both nerves involved], flexor carpi ulnaris in 70%. There was predilection of injury for medial structures. In 80%, wrist flexors were involved, and all wrist joints recovered to the full range of movements and power. The ulnar nerve showed less total motor and sensory recovery than median nerve. However, sensory and motor recovery was good. Overall functional results were good and did not correlate with neurophysiological studies. Immediate primary repair is safe and has good outcome, which also depends upon good physiotherapy, close follow-up and patients compliance. Overall clinical and functional assessment is more appropriate than series of individual observations and neurophysiological studies

Complications of total parenteral nutrition in surgery

From May 95 to November,96 twenty two patients [18 males and 4 females] were on total parenteral nutrition [TPN] for more than seven days at West Surgical Unit, Mayo Hospital, Lahore and a note was made of the complications encountered specifically due to total parenteral nutrition. Fecal fistula was the leading indication for total paranteral nutrition [55%] and among them ilea] fistula was the commonest [66%]. Complications due to central venous line were encountered. Those resulting from total paranteral nutrition were hyperglycaemia, hypoglycaemia, hyponatracmia, apathy, fits, coagulopathy etc. One patient died [4%], 23% cases were abandoned half way and success rate was 68%. We noted complications tend to come on in "clusters". Also the lack of adequate monitoring was observed. Total Parenteral Nutrition should be given when gastrointestinal tract is unavailable, unreliable or being rested. Stress is laid upon monitoring Total Parenteral Nutrition delivery. Total Parenteral Nutrition is expensive but total parenteral nutrition is beneficial