Complications and outcome with epidurals for labour: Analysis of seven years experience

To audit the incidence of obstetric epidural complications and its outcome at Fatima Memorial Hospital, Lahore. All parturients who received epidurals for painless deliveries in the labour room of Fatima Memorial Hospital from 1999 to 2005 were included in this audit. All parturients received bolus of 500-1000m1 of Ringers lactate or 0.9% Normal saline prior to insertion of epidural catheter. Information regarding parturient's name, age, gravida [primi or multi], effectiveness of epidural or any complication was noted by anaesthetist on register kept in the anaesthesia office. Out of 25916 deliveries during seven years, 2610 [10.07%] parturients received epidural for painless delivery. Those who received epidurals, 437 developed one or more complications. The overall incidence of complications was 19.57%.Consultants gave epidural to 2004 parturients [76.90%] and residents gave to 602 parturients [23.10%]. The most common complication or complaint was shivering, 166 parturient [6.36%]. Next common was hypotension, 162 parturients [6.20%]. Inadequate analgesia and missed segment noted in 99 [3.79%] parturients. Post delivery urinary retention was problem in 25 [0.95%]. Dural puncture occurred in 15 [0.57%] and three [0.11%] received blood patch for control of persistent post dural puncture headache. In three parturients procedure was abandoned. Other complication like Intravascular injection noted in two [0.07%], Catheter blockade in three [0.11%], Reinsertion of catheter required in five [0.19%] and High spinal noted in three [0.11%] parturients. One parturient had total spinal and intubated, Eight [0.30%] parturients complained backaches. Out of 2610, parturients who received epidurals 237 [9.09%] underwent Caesarian sections, 185 [7.09%] deliveries were assisted by Vacuum and 150 [5.57%] by outlet forceps. Every sixth parturient [16.747%] is susceptible to get some form of complications when epidural analgesia is offered for pain relief but these complications can be detected early and managed if monitoring facilities available

Prevalence of cleft lip and palate in cousin marriages

Birth defects are one of the leading causes of paediatric disability and mortality in developing as well as developed countries. The purpose of this study is to report our 3 months experience regarding the prevalence of cleft lip and palate in cousin marriages. A retrospective review of 50 patients who presented with cleft lip or cleft lip/palate during 3 months, from 9th March to 8th June, 2005 was carried out. Among the risk factors cousin marriages is a most frequent risk factor. Cleft lip is more common than cleft lip/palate and cleft lip alone is a different entity than cleft lip and palate combined

Smoking prevalence, knowledge and attitudes among medical students in Karachi, Pakistan

A survey of smoking prevalence and attitudes was made among medical students randomly selected from classes at the Aga Khan University, Karachi, Pakistan. Of 271 respondents, 14.4% were current smokers [22.0% male and 3.8% females] and 3.3% ex-smokers. A majority of students recognized the dangers associated with active as well as passive smoking although only 55% of current smokers planned to quit in the near future. Most smokers [96%] believed that they as well as other health professionals needed training on smoking cessation and 95% of all students believed that doctors should play a role model in smoking cessation by not smoking themselves. Specific training and counselling should be a part of the required curriculum at medical schools

Implications for the practice of a patient expectation and satisfaction survey, at a teaching hospital in Karachi, Pakistan

To study the expectations and satisfaction of patients visiting Family Practice Clinics, at the Aga Khan University Hospital, in Karachi, Pakistan. A cross sectional survey of 316 patients was carried out. A questionnaire, based on the study objectives was developed and administered. The participating patient signed a consent form, after assurance of confidentiality was provided. Data on the demographic profile of the patients was collected. The mean age was 33.81 years, with 105 [33.2%] women, and 211 [66.8%] men. The majority were married, with education above intermediate level and were in private or government service or were housewives. The median for the patient waiting time was 30 minutes, against an expectation of 12.69 minutes. Reading newspaper, watching television, reading magazine, reading Quran and listening to music were quoted as ways to lessen the burden of waiting to see a physician. The average consultation time with the physician was 13.89 minutes, against an expectation of 16.37 minutes. Patient expectation in terms of listening by the doctor with patience, explanation of the diagnosis and treatment, prescription of medicines, ordering of investigations and specialist referral has been documented. Objections to the presence of medical student, nursing student, resident doctor, nurse and an observer, in the consultation room have also been documented. Reasons quoted for the objection include issues of privacy/confidentiality, lack of justification, discomfort, and interference with the consultation process. The expected average cost for doctor's consultation was Pakistani Rs. 124, while 196 [61.8%] of the respondents were satisfied with the consultation based on Rs. 70. We have collected important information to improve the services offered at our Family Practice clinics

Intratracheal catheter insufflation technique for microlaryngeal procedures

Intratracheal catheter insufflation technique was used in 45 patients. It ensures adequate gas exchange and provides optimal conditions for the surgery by fulfilling most of the requirements of the ideal technique. The fall in PaO and rise in gives the clinical impression that the technique may not be suitable in children and for a period of time lasting longer than 45 minutes in obese patients PaCo