Mortality prediction in patients admitted in surgical intensive care unit by using APACHE IV

Objective: To predict the mortality by the mean Acute Physiology and Chronic Health Evaluation [APACHE] IV score of all the patients admitted in a Surgical Intensive Care Unit [ICU] and comparing the score of the survivors and non-survivors

Study Design: Descriptive study

Place and Duration of Study: Surgical Intensive Care Unit, Mayo Hospital, Lahore, from June 2013 to November 2014

Methodology: All adult patients admitted in the Surgical ICU were included in this study. The demographics and other data of the patients were recorded. The APACHE IV scores of all patients were calculated at the time of admission. The scores of the survivors and the non-survivors were compared for prediction of survival and mortality

Results: The age of these patients ranged from 13 to 70 [mean 38.39] years with 86 [55.48%] males and 69 [44.52%] females. The mean APACHE IV score of these patients was 34.96 +/- 14.93 ranging from 11 to 63 years. Eighty-three [53.55%] patients survived and 72 [46.45%] died. With respect to gender, 41 [47.67%] males out of 86 and 31 [44.92%] females out of 69 did not survive. The mortality increased with an increase in APACHE IV score and all the patients with score more than 39 did not survive

Conclusion: The predicted mortality can be assessed by APACHE IV score, so it is good for application among the surgical ICU patients

CPSP/HSE postgraduate overseas rotational programme: residents' perspective

Objective: to get direct upward feedback from the residents of first batch of CPSP/HSE Postgraduate Scholarship Programme

Study Design: mixed methods qualitative research study

Place and Duration of Study: CPSP, Regional Office, Lahore, in June 2015

Methodology: it is a mixed-method study that was conducted in June, 2015. Data was collected through an email survey with 33 medical residents doing their rotation in Ireland; and focus group discussions were carried out with 8 residents, who had successfully completed their rotation. Data were collected through pre-designed questionnaires comprising of open- and close-ended questions. The data were entered into SPSS version 21 and analyzed

Results: the mean age of residents was 29.9 +/- 1.1 years, 7 [21.2%] were females and 24 [72.7%] respondents were males. Residents agreed that HSE programme has improved their evidence-based decision making [mean score of 3.3 +/- 1.2] and enhanced professionalism [mean score of 3.6 +/- 1.1]. They disagreed that training has polished their procedural skills [mean score 2.4 +/- 1.2]. The identified strengths of the programme are: adopting a systematic approach towards patients, evidence-based decision making, better exposure and opportunities, financial stability and development of communication skills. The weaknesses are: less exposure to procedural skills, difficulty in synopsis and dissertation writing and difficulty in adjustment with rotational schedules

Conclusion: residents of CPSP/HSE Programme believed that CPSP/HSE has improved their professionalism, communication skills and increased their future opportunities for career growth. Better communication between CPSP focal person and residents will help sort out many minor but important issues

E-Log system in monitoring of residency program: trainees' perspective

To record residents' perspective about the utility of newly introduced E-Log system at the College of Physicians and Surgeons Pakistan [CPSP]. Sequential mixed method design using survey questionnaire and in-depth interviews. CPSP, Regional Center, Lahore, from March to June 2014. Data was collected from registered trainees through a web-based survey questionnaire on a scale of 1 to 7 about the utility of E-log system. In-depth interviews were conducted with 7 students using non-probability purposive sampling. The interviews were tape recorded and subsequently transcribed. Quantitative data was analyzed using SPSS version 20 and qualitative data was analyzed using content analysis by identifying themes and patterns. A total of 4399 responses were received. Motivation was 4.61 +/- 1.98; 4.33 +/- 2.00 remained acknowledgment of control of one's training by the new system. Ease of use got a mean score of 4.56 +/- 2.15. The overall acceptance of the students regarding E-Log system was high. Scheduling IT workshop at the start of training will add to the student satisfaction regarding utility of E-Log system

Knowledge, attitude and practice - regarding EPI among parents attending paediatric outdoor, Nishtar hospital Multan

To assess the Knowledge, Attitude and Practice regarding Expanded Programme of Immunization [EPI] among parents attending Paediatric Department, Nishtar Hospital, Multan. Cross sectional descriptive study. This study was carried out among the parents attending Paediatric medicine and Paediatric Surgery out patients Departments, Nishtar Hospital, Multan for the treatment of their children during the month of September 2011. Two hundred and sixty parents were selected by convenient sampling and surveyed with a self reported questionnaire comprising of questions regarding knowledge attitude and practice about EPI. Data gathered was analyzed and results were obtained to make table. Among 260 parents interviewed, 40 [15.4%] were male and 220 [84.6%] were female. 258 [99.2%] had knowledge about EPI and only 2 [0.8%] had not. According to 242 [93.1%] EPI was beneficial, while 18 [6.9%] thought it to be non beneficial. Children of 197 [75%] parents were fully immunized. 40 [15.38%] were partially immunized and 25 [9.62%] were not immunized at all. 158 [60.8%] parents were educated and 102 [39.2%] were illiterate. Out of 260 parents 214 [82.3%] reported fever/ rash/ itching as a result of vaccination, while 46 [17.7%] were not. Majority of the parents belong to middle class i.e. 137 [52.7%] while 46 [17.7%] rich class and 77 [29.6%] of the lower class. We conclude that there is a significant difference in the knowledge of the parents. Majority of the parents had awareness about EPI. Middle class has greater attitude to get immunized their children as compared to poor and rich class. Our study demonstrates the importance of education in the practice of vaccination of the children

Postgraduate trainee performance with structured assessment techniques in competency-based model of training

To determine the effect of changes in curriculum and structured assessment on the performance of candidates at the end the first phase of residency program by comparing pass percentages of candidates with older residency program. Interventional study. From 2007 to 2009 at the College of physicians and Surgeons Pakistan. Results of midterm assessment [intermediate module, IMM] for the years 2006-2007 [Historical group] in 9 specialties were compared with those of years 2008-2009 [Interventional group] after implementation of curricular changes. The changes were evaluated with structured assessment technique. Results for the IMM exams for years 2006 to 2009 were included in the study. Percentage changes in results of both groups were subjected to statistical analysis. The average pass percentage for theory examination in the Historical group was 52.6% +/- 13.87, and 59.96 +/- 14.88 in Intervention group. The pass percentage in old-residency program for the clinical examination was 61.6% [ranging from 48.0% to 78.4%] which was less when compared with the new residency system that was 73.9% [ranging from 61.55 to 82.45%]. The curricular changes and structured assessment at set competency standard resulted in better performance and higher pass percentages of candidates of midterm assessment

Stray bullet in inferior vena cava

A young boy presented in emergency with history of being hit by a stray bullet injuring the right hypochondrium. Ultrasound of abdomen showed hemoperitoneum and the radiograph showed bullet in the pelvis. Exploratory laparotomy showed injuries to liver and cystic duct with tract leading retroperitoneally into the inferior vena cava. The bullet was found wandering inside the vena caval lumen. Stray bullets are presumed to remain limited to the soft tissues. However, the trajectory, impact velocity and the involved region ultimately determine the outcome and influence management

In Silico Study of Human Gap Junction Beta-2 Protein by Homology Modeling

Asp66his, Asp54Lys, and Asp50Asn are mutations in connexin 26 that are observed in the clinic and give rise to autosomal dominant syndromes. They are the result of point mutations in the human gap junction beta-2 gene. In order to investigate the structural mechanism of Bart-Pumphrey Syndrome, Keratitis-Ichthyosis-Deafness Syndrome, and Vohwinkel Syndrome, homology modeling was carried out. Asp66 has direct contact with Asn62 by two hydrogen bonds in the wild-type protein, and in Asp66His, the biggest change observed is a tremendous energy increase caused by hydrogen bond breakage to Asn62. Shifts in the side chain and new hydrogen bond formation are observed for Lys54 compared to the wild-type protein (Asn54) and result in closer contact to Val84. Asp50Asn causes a significant decrease in bond energy, and residual charge reversal repels the ion and metabolites and, hence, inhibits their transportation. Such perturbations are likely to be a factor contributing to abnormal functioning of ion channels, resulting cell death and disease.

Frostbite: Severity and predisposing factors amongst Pakistan troops in Siachen

To know the severity and find out the exact causes and predisposing factors of frost bite, so that certain guidelines can be formulated for the troops and the people in command channel in order to minimize significantly the frequency and severity of this disability. Descriptive, questionnaire-based study Study was done in field hospitals of Siachen sector from May 2002 to April 2003. A total of 130 patients who suffered from frostbite in this duration were included, excluding injuries due to other causes. Proforma with questionnaire was completed by the doctor him self. The cumulative incidence was 29/1000 in one year. Maximum injuries were 1st degree [37.7%] and 2nd degree [33.1%]. Feet [56.9%] and hand's [26.9%] involvement was most common. There was a significant relation between lack of proper equipment or lack of knowledge and the injury. Maximum cold injuries [52.3%] were due to ill fitted, defective and soaked boots, socks and gloves. Majority of troops [47.6%] did not have basic knowledge to protect themselves from cold injuries. Maximum cases [about 84%] were seen in peak cold weather i.e. November - February. High altitude serving troops should wear appropriate clothing, properly fitted quality boots, socks and gloves. They should have proper education and training regarding how to deal with cold weather. They should also avoid wet clothing, movement in blizzard, prolonged exposure to severely cold wind, and should be replaced after short intervals from their posts

study on knowledge of diseases causation among adults of an urban slum of Multan

A cross-sectional study with descriptive and analytical components was carried out at Basti Oddan, an urban slum of Multan city. The concept of disease causation regarding tuberculosis, hepatitis B and malaria among 320 adults was assessed utilising a pre-tested questionnaire. Data was entered and analysed using SPSS software, 11[th] version. Running and tabulation of all the variable frequencies were done as part of data management. Tables were used to present the data. Chi -square test was used as the test of significance. Level of significance was set at 0.05. The overall knowledge of disease, causation was poor i.e. less than 50%. Respondents with better educational status had better concept of causation regarding three common communicable diseases. The association between economic status and concept of disease causation was variable i.e. no significant association between economic status and awareness of tuberculosis causation. However a positive association between economic status and awareness regarding hepatitis B and malaria was noted. It is concluded that there is great need to improve the educational status of the people otherwise any health improvement program is unlikely to succeed

Tropical 0.2% glyceryl trinitrate ointment versus lateral sphincterotomy in the treatment of acute anal fissure

To compare the effectiveness of 0.2%GTN with lateral sphincterotomy in the treatment of acute anal fissure and to asses the complications in the two groups. A Quasi experimental study. The study was conducted at Surgical Unit II, Services Hospital Services Institute of Medical Sciences Lahore during Jan 2002 to Dec. 2004. Eighty patients with acute anal fissure confirmed on history and clinical examination were included in the study. Forty patients were randomized in each group using simple random tables. Group A patients were prescribed 0.2% glyceryl trinitrate ointment to apply intra-anally four times a day for eight weeks and group B patients were admitted in ward and underwent lateral internal sphincterotomy by open technique. Comparison of the two treatments to determine the efficacy and to assess the complications was done. Patients were followed up at one week, two weeks, one month, and final follow was done after two months. In group A [0.2%GTN ointment], thirty eight patients completed treatment for eight weeks. Of these 31[81.6%] patients had healed fissures. Two [5%] patients could not complete the treatment because of severe headache and were excluded. In group B, 37 [92.5%] patients had healed fissures after eight weeks following sphincterotomy. At one week after sphincterotomy 20% had some degree of incontinence to flatus that settled in the majority after eight weeks. One patient developed perianal hematoma that also settled conservatively. On the basis of good clinical results and few adverse effects, glyceryl trinitrate ointment can be employed as first line of treatment in the management of patients with acute anal fissure

Prevalence of drug abuse in jails of Punjab

A study was conducted in Central and District Jails, Multan and District Jail, Gujranwala from January 1987 to December 1988 to estimate the prevalence of drug abuse. The prevalence rate of the drug addiction amongst the prisoners was 11.4%, Peak prevalence [50%] was in the age group of 21 to 30 years i.e. Most of the addicts [67.33%] were married, 87% were unskilled, 78% were urbanites. 64% were illiterate and more than 95% belong to low socio-economic group. Heroin was used by 73%. About 95% respondents started taking drugs for pleasure, while the rest [27%] take to ward off worries. The withdrawl symptoms were mostly related to gastro-intestinal tract. Majority of addicts [78%] believed that a complete ban of availability of drug was an effective measures combat addiction