Choice of subject as carrier by medical students in Pakistan

Objective: To find out the preference of medical students in Pakistan

Study Design: Observational / descriptive / cross-sectional study

Place and Duration of Study: This study was conducted at Avicenna Medical College from January 2016 to March 2016

Materials and Methods: All the 2[nd] year students were included in the study. They were asked to fill a self- designed questionnaire in which along the demographic details, they were to mention the field which they want to continue for specialization. Also they were to mention the reason for opting that specialty

Results: A total of 105 students participated in the study. The mean age of participants was calculated as 21.75 +/- 3.68 years. There were 73 [69.5%] females while 32 [30.5%] male participants. The most commonly opted field was clinical sciences and among them surgery was selected by most of the participants. The most common reason for opting particular specialty was interest of the students

Conclusion: We conclude that interest of our medical students into basic medical sciences is less than clinical sciences. We need to identify the factors and take certain measures so that more students could opt basic sciences also as their career

Diagnostic performance of fine needle aspiration cytology [FNAC] in the diagnosis of breast lumps

The aim of the study was to evaluate the diagnostic performance of fine needle aspiration cytology in the diagnosis of breast lumps. All patients who underwent FNA breast lumps at Rehman Medical Institute, Peshawar during 2006 to 2008 were included in this descriptive crosssectional study. The FNA procedure was performed and interpreted by experienced cyto-pathologists. FNAC of 102 breast lumps were analysed. The age range of the patients was 15-80 years [mean 38.11 years]. Inadequate cases were 2.94%, malignant 30.39%, atypical/suspicious of malignancy 6.86%, and benign 59.80%. Malignant lesions predominated in the 5[th] and 6[th] and benign in the 3[rd] and 4[th] decades of life. FNAC of breast is simple, cost-effective and less traumatic method for diagnosis of breast lumps. Combined with physical examination and imaging studies, it is a highly sensitive diagnostic tool and can reduce the need for open biopsy

Adenomyosis among samples from hysterectomy due to abnormal uterine bleeding

Adenomyosis is one of the most common, yet under diagnosed, underlying cause of abnormal uterine bleeding. We aimed to evaluate the presence of adenomyosis among the patients who presented with abnormal uterine bleeding. This was a retrospective study carried out on hysterectomy specimens of subjects who presented to the gynaecologist with the complaint of abnormal uterine bleeding not responding to conservative treatment. Excluded are the hysterectomies performed for malignant pelvic neoplasms and hysterectomy following labour for postpartum haemorrhage. A total of 861 women underwent hysterectomy out of which 779 were abdominal and 82 vaginal from Jan 2008 to Dec 2012. Adenomyosis was found in 296 of the 861 specimens studied. The most frequent combination of diagnosis was leiomyoma and adenomyosis. Pathologic conditions associated with adenomyosis were: leiomyomas 150 [50.6%], endometrial polyp 16 [5.4%], genital prolapse 12 [4.05%], chronic endometritis 10 [3.3%], endometrial hyperplasia 5 [1.6%], endocervical polyps 2 [0.6%]. Adenomyosis is a common pathologic finding significantly related to reproductive and menstrual characteristics of the patients

Comparison of LMA Classic and i-gel in anesthetized, spontaneously breathing patients during elective surgical procedures

The primary objective of this study was to compare two supraglottic airway devices regarding mean insertion time. Secondary objective was to assess the devices regarding first attempt success and ease of insertion. Tertiary objectives were to compare the post removal cough, laryngospasm and blood on device. Interventional quasi experimental study conducted in Department of Anesthesiology, ICU and Pain Management Sheikh Zayed Hospital, Rahim Yar Khan from April 2012 to October 2012. 100 adult patients aged 15 to 70 years, ASA-I and II, Mallampati I and II, who were scheduled for various elective surgical procedures under general anesthesia were taken. Study was conducted in anesthetized spontaneously breathing patients. The patients were divided into i-gel and LMA groups by draw method. SPSS 16 was applied for analysis. No statistically significant difference was reported between the groups, regarding mean insertion time, first attempt success, ease of insertion, cough and laryngospasm. Blood on LMA after removal had significantly greater incidence than on i-gel [10% on LMA group while none in i-gel group]. Both i-gel and LMA Classic can be used safely and effectively in selected patients under general anesthesia with spontaneous breathing

Effect of gestational diabetes on blood sugar, liver and renal function tests

Type 2 diabetes adversely affects the liver and kidney function tests. This study was conducted to determine that either the liver and kidney functions are disturbed in the patients having gestational diabetes mellitus [GDM]. One hundred and three women with GDM, and 97 healthy pregnant women [HPW] in their third trimester were registered in the Obs/Gyn Unit of Khyber Teaching Hospital, Peshawar in the time period Apr-Sep 2012. Blood sugar level, glycosylated haemoglobin status HbA1c, haemoglobin concentration, platelet count, liver function tests including alanine amino transferase [ALT], alkaline phosphatase [ALP] and bilirubin, renal function tests including urea and creatinine were determined. Blood glucose level and HbA1c of GDM was significantly higher [p<0.001] than HPW. Fasting and random blood glucose and HbA1c of GDM and HPW were 110.90 +/- 9.10 vs 84.68 +/- 7.01 mg/dl, 148.53 +/- 7.21 vs 124.42 +/- 9.46 mg/dl and 6.49 +/- 1.20 vs 4.99 +/- 0.55 respectively. Haemoglobin percentage, platelet count, ALT, ALP, serum bilirubin and urea were not significantly different among the two groups. However, mean serum creatinine [0.82 +/- 0.32 mg/dl] in GDM was significantly higher [p<0.05] than in HPW [0.74 +/- 0.15 mg/dl]. In gestational diabetes the LFTs may not be disturbed, however serum creatinine value is increased.

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

Conversion from Laproscopic Cholecystectomy to open Cholecystectomy when and why?

In this study 450 patients presented with symptomatic cholelithiasis, under went Laproscopic cholecystectomy from 1-1-2003 to 30-6-2004.Sex ratio showed that 92% were female and 8% male patients. Most of the cases 44% are in the age group 40-49 years. About 74% patients had chronic cholecystitis while 15% had acute cholecystitis. Mucocoele was present in 6%and empyema in 5% of cases. Conversion from laproscopic to open cholecystsectomy was done in 14 patients i.e 3.11%. The reason for conversion among these patients was acute cholecystitsis in 1.33% and anatomy was not clear. Heamorrhage occurred in 0.88%, empyema gall bladder with thickened, odematous gall bladder in 0.66% cases. Hypotention occurred in one patient

Stapled Hemorrhoidectomy: hope or hype!

This study was carried out to assess the feasibility of Stapled haemorrhoidectomy. This included 45 patients of which twenty nine were males and sixteen females. Age ranged from 23 to 84 years. The severity of the disease ranged from 3rd to 4th degree haemorrhoids. Place of study was Sir Ganga Ram, Masood and Wishaw Hospital Scotland. Period of study was two years from October 2002 to October 2004

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

Amebic liver abscess: clinical presentation and diagnostic difficulties

To identify the symptoms and signs of amebic liver abscess [ALA] in our population in order to establish early diagnosis. Subjects and A prospective study was conducted in the Department of Surgery, Unit-I, Sir Ganga Ram Hospital Lahore, Pakistan, during the year 2000 to 2002 [2 1/2 years]. All patients with a confirmed diagnosis of A L A during this period were included in the study. The detailed history and relevant clinical data including investigations and daily progress were recorded on proforma, later analyzed and compared with other studies. Fifty-three patients with ALA, accounting for 0.5% of yearly hospital admission were included in this study. The age ranged from 10 to 60 years [mean 29 years]. The male to female ratio was 2.8 to 1. Upper abdominal pain occurred in 90%, right upper abdominal quadrant pain in 70%, radiation to tip of right shoulder in 10%, fever in 85%, co-incident diarrhea in 7.5% and concurrent pulmonary symptoms in 26%. The most common signs were tender hepatomegaly in 79%, and jaundice in 20.7%. Abscess ruptured in 3.8% due to delayed diagnosis, and ruptured despite treatment in another 3.8%. Diagnosis was missed in 28% of the patients particularly those with atypical presentations. Ultrasonography [US] was useful in diagnosing ALA. A L A has a highly variable presentation. Clinical diagnosis is difficult. Delayed diagnosis may result in rupture of abscesses. High index of clinical suspicion combined with US of abdomen is helpful in reaching an early diagnosis

Sclerosing peritonitis: a report of 4 cases

Represent 4 cases of a rare disease of sclerosing peritonitis treated by us in last 15 years. Tuberculosis was found out to be the cause in two but no specific cause could be ascertained in other two cases. All were treated by laparotomy, Excision and removal of the thick plastic membrane encasing the whole small intestine. All had perfect recovery without any complication and recurrence

Comparison of end-tidal carbon-dioxide with arterial carbon-dioxide during laparoscopic cholecystectomy

In laparoscopic cholecystectomy, insufflation of C02 into the peritoneal cavity brings about changes in cardiovascular and respiratory systems due to compression of inferior vena cava, abdominal aorta, splinting of diaphragm and hypercarbia due to absorption of C02 from peritoneum into circulation. This study was designed to compare the PaC02 and PETC02 and evaluate the predictability of PETC02 as an index of PaC02 Thirty patients of either sex, receiving general anaesthesia were studied. PaC02 and PETC02 were determined before insufflation of C02 into the peritoneal cavity and then at 30 minutes intervals until the end of the procedure Before insufflation of C02, PaC02 ranged from 32-38.7 mm of Hg and PETC02 from 30-35 mm of Hg. Both the parameters at various intervals have shown parallel changes. The difference between PaC02 and PETC02 at all times during surgery had a definite upward trend which is statistically highly significant [P<0.0001]. It has been concluded from results of this study that PETC02 is a reliable predictor of PaC02 during laparoscopic cholecystectomy

Comparative bioavailability of commercially available mefenamic acid tablets

A study of the comparative bioavailability of three commercially available mefenamic acid tablets [500 mg] was carried out on six healthy human male volunteers using Latin square design of experiments. Variations observed in the values of different bioavailability parameters could hr attributed to the factors affecting the in-vivo dissolution of a tablet dosage form