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

Acute management of hypertensive emergencies in pregnancy: Oral Nifedipine versus Intravenous Labetalol

Objective: To compare the outcome of oral Nifedipine and intravenous Labetalol in severe pregnancy induced hypertension in terms of time taken to achieve the target blood pressure

Study Design: Randomized controlled trial

Place and Duration of Study: Conducted at department of Obstetrics and Gynaecology, Combined Military Hospital Lahore, from Jan 2014 to Jun 2014

Materials and Methods: After taking ethical approval, pregnant women at >/=28 weeks of gestation with sustained blood pressures of >/= 160/110 mmHg were included in the study. Patients were randomly assigned into two groups to receive either oral Nifedipine or intravenous Labetalol. The data was collected and analyzed on SPSS version 20

Results: In oral Nifedipine group 64 percent patients were between 18-30 years while 36 percent were between 31-35 years of age. In intravenous Labetalol group, 58 percent patients were between 18-30 years while 42 percent were between 31-35 years of age. Fifty two percent patients in oral Nifedipine group and 54 percent cases in intravenous labetalol were between 29-34 weeks of gestation while 48 percent patients in oral Nifedipine and 46 percent in intravenous labetalol group were between 35-40 weeks of gestation. Time taken to achieve the target blood pressure is 31.14 +/- 3.14 minutes in Oral Nifedipine and 51.08+4.11 minutes in Intravenous Labetalol group. A p-value was 0.011671 which was significant

Conclusion: Nifedipine is more effective in severe pregnancy induced hypertension to achieve the target blood pressure as compared to labetalol. It is more suitable in our setup as it is economical and easy to administer

Comparison of heparin and low dose aspirin with low dose aspirin alone in improving theperinatal outcome in pregnancies with recurrent pregnancy losses

To compare the perinatal outcome of low dose Aspirin [LDA] alone and low dose Aspirin with Heparin in pregnancies with recurrent pregnancy loss [RPL] with or without positive antiphospholipid antibodies [aPL]. Randomized controlled trial. Departments of Obstetrics and Gynaecology Combined Military Hospital [CMH] Quetta, Lahore and Rawalpindi. 30 April 2009 to 30 April 2011. 60 women with recurrent pregnancy losses [RPL] fulfilling clinical criteria of antiphospholipid syndrome [APS] with or without aPL antibodies positive reporting to the antenatal clinic at the three hospitals were included. Convenience sampling was done and subjects were randomly allocated into groups A and B using random numbers table. GroupA received low dose Aspirin[LDA] 75 mg once daily starting from first trimester and GroupB received unfractioned Heparin [UH] 5000IU SC BD or low molecular weight Heparin [LMWH] 40mg subcutaneous along with LDA. In group A 26[86.7%] and in group B 25[83.3%] live births were attained. Significant side-effects were observed in groupB including bruising and injection site pain. Cost of drug for treatment over 28 weeks in groupA was Rs 300 and in groupB was Rs 6300. LDA alone have comparable perinatal outcomes with Heparin in cases of RPL, with an added benefit of no pain and bruising, low cost and more convenience of administration.

Frequency of different presentations and surgical management of ectopic pregnancy at combined Military Hospital Lahore

To determine frequency of different presentations of ectopic pregnancy presenting at Combined Military Hospital Lahore and types of surgical management offered. Descriptive study Department of Gynaecology and Obstetric Combined Military Hospital, Lahore from1-06-2006 to 31-12-07. Fifty women with ectopic pregnancy whether booked or unbooked were treated at CMH, Lahore, during study period were included. Diagnosis was made from history, clinical examination and confirmed by ultrasonography, serum beta-hCG or laparoscopy. The mean age of patients was 23.6 +/- 5.0. The commnest presentation was with pain lower abdomen 92.0%. Eighty two percent of patient presented with amenorrhea. Vaginal bleeding/spotting was present in 76.0% while 18.0% presented with shock and fainting attacks were the presenting feature in 14.0% of cases. Regarding surgical management salpingectomy was performed in 84.0% of cases. Linear salpingostomy in 6.0% of patients. Segmental resection with reanastomosis in 4.0% of cases, salpingoophrectomy in 4.0% and partial oophrectomy in 2.0% of cases. Ectopic pregnancy is still a major obstetric and gynaecological emergency. As majority of patients present at late stage with either ruptured ectopic pregnancy or irrepairable damage to tube and ovary so management by laparotomy is more practicable in developing countries like ours