Differences in empathy levels of medical students based on gender, year of medical school and career choice

Objective: To measure mean empathy scores of Pakistani medical students and to explore any association of empathy scores with gender, medical school year and future career choice. Study Design: Cross-sectional survey. Place and Duration of Study: Shifa College of Medicine, Shifa Tameer-e-Millat University, during the academic year 2015-2016

Methodology: The student version of Jefferson Scale of Physician Empathy [JSPE] was distributed to the students electronically via the student portal. Response that were completed in full were included in the study. Descriptive statistics was used to analyse student demographic data. The student score on the JSPE was reported as the mean [out of 7] of each item. Independent samples t-test was employed to check the significant differences between genders. Empathy score with advancing year of study was investigated using ANOVA. ANOVA with post-hoc Tukey's test was used to study the relationship between career choice and empathy score

Results: The response rate was 70.94%. The mean score was 4.51 +/-0.69. Females obtained greater, but statistically insignificant [p=0.08] empathy score [4.58] as compared to the male students [4.45]. No statistically significant difference was seen between scores on the survey across the five academic years [F=0.88, p=0.47]. Students who selected medicine and allied as career choice showed a significantly higher empathy score than those who opted for surgery. The internal consistency reliability [Cronbach's alpha] was 0.78

Conclusion: There were low levels of empathy in Pakistani medical students. Students with interest in medicine and allied showed higher empathy scores compared to surgical or technical specialties. No association of empathy scores with gender and medical school year was observed

Treatment for symptomatic bacterial vaginosis: a randomized controlled trial

Objective: To compare the efficacy of multiple doses of vaginal clindamycin with a single oral dose of secnidazole for the treatment of bacterial vaginosis. Study Design: Double-blinded randomized controlled trial. Place and Duration of Study: Shifa Foundation Community Health Center, from March 2012 till February 2015

Methodology: After obtaining written informed consent, a pelvic examination was performed for the confirmation of symptoms of milky white vaginal discharge on speculum examination, positive Amine test and presence of clue cells on microscopy. Pregnant women, known diabetes or any immunocompromised condition, were excluded. Blinding of the patient, doctor, and the pharmacist was done. Study cohort was then divided into two groups, Group A received medicine pack A which contained active clindamycin and placebo oral preparation, whereas group B was given pack B which contained active 2-gm secnidazole with placebo vaginal cream. Primary outcome and therapeutic success were defined by correction of two out of three [normal Nugent score, negative Amine test, and no milky white discharge] on day 15

Results: At 15[th] day of treatment, 96.6% participants in vaginal clindamycin group [Group A], recovered from the bacterial vaginosis; whereas, [group B] 23% patients were cured in oral secnidazole group

Conclusion: Multiple doses of vaginal clindamycin are superior to single dose of oral secnidazole for the treatment of bacterial vaginosis

Complete hydatidiform mole coexisting with three viable fetuses in a quadruplet pregnancy

We hereby report a case of quadruplet pregnancy with delivery of 3 viable infants and a complete mole. This was an induced conception with clomiphene citrate. At 22 weeks, cystic structures were noticed in one of the placentae and a suspicion of co-existant molar pregnancy was made. The case discussed with oncologist and pregnancy was continued with close monitoring of beta-hCG and Ultrasound. Her beta-hCG at 23 weeks was 748 mIU/ml, which continued to rise until the 29th week of gestation to a level of 305881.68 mIU/ml and declined gradually thereafter. Similarly, hydropic change in placenta also continued to increase progressively. She was given steroid cover at 32 weeks and delivery was aimed at 34 weeks of gestation. The patient went into preterm labour at 33 weeks and 3 female infants delivered by lower segment cesarean section [LSCS] followed by removal of 3 placentae along with copious molar tissue at the end. The newborns were kept in the nursery; non-requiring assisted ventilation and discharged in satisfactory condition. The histopathology and immunohistochemistry confirmed the diagnosis of a quadruplet pregnancy comprising of one complete mole with 3 normal placentae

Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy: a randomized controlled trial

To compare the efficacy and safety profile of total dose infusion of low molecular weight iron dextran with divided doses of intravenous iron sucrose for the treatment of iron deficiency anemia during pregnancy. Randomized controlled trial. Shifa International Hospital, Islamabad, over a period of two years from January 2008 to December 2009. Pregnant women at gestational age more than 12 weeks with the confirmed diagnosis of Iron Deficiency Anemia [IDA] were divided into two groups. In the group-A, intravenous iron sucrose was given in divided doses while in the group-B, total daily intake of Low Molecular Weight [LMW] of iron dextran was given. Post-infusion Hemoglobin [Hb] was checked at 4 weeks and at the time of delivery for both groups. Paired sample t-test is applied and comparison [in terms of rise in hemoglobin from pre to post] of both groups was not found to be significant. In the group-A [iron sucrose group], mean pre-infusion Hb levels was 9.09 +/- 0.83 gm/dl. Mean increase in Hemoglobin [Hb] was 10.75 +/- 1.097 gm/dl after 4 weeks of infusion and 11.06 +/- 0.866 gm/dl at delivery [p < 0.001]. In group-B [iron dextran group] pre-infusion haemoglobin was 8.735 +/- 0.956 gm/dl and the mean increase in hemoglobin was 10.613 +/- 1.22 gm/dl at 4-week while mean increase of 10.859 +/- 1.11 gm/dl at the time of delivery [p < 0.001]. Both LMW iron dextran, as well as iron sucrose are equally effective in treatment of IDA during pregnancy, however, LMW iron dextran has the advantage of single visit treatment

Complete hydatid form mole in a quadruplet pregnancy with coexisting three viable fetusis: a case report

We hereby report the occurrence of quadruplet pregnancy with delivery of three viable infants and a complete mole. This was an induced conception with clomiphene citrate. At 22 weeks molar change was noticed in one of the placenta. Case was discussed with oncologist and pregnancy was continued with close monitoring of beta-hCG and ultrasound. Patient had no associated medical co-morbidity; she was given steroid cover at 32 weeks and delivery was planned at 34 weeks of pregnancy. Patient went into preterm labor at 33 weeks and three female infants were delivered followed by removal of three placentas along with copious molar tissue at the end. Babies were kept in nursery; none required assisted ventilation and were discharged in satisfactory condition. Histopathology a d immunohistochemistry confirmed quadruplet pregnancy comprising of one complete mole with three normal placentas

Efficacy of levonorgestrel intrauterine system [LNG-IUS] for abnormal uterine bleeding and contraception

To find out clinical response, side effects and patients' acceptability of levonorgestrel-releasing intrauterine system [LNG-IUS]. Observational study. Gynaecology Department of Shifa International Hospital, Islamabad, from June 2005 to May 2008. Adult women were enrolled in the study. In group-A, 57 married women were enrolled presented with abnormal uterine bleeding while in group-B, 16 married women attended for contraception. All women in group-A had thyroid stimulating hormone, pelvic ultrasound and outpatient endometrial biopsy. Detailed counselling was done before insertion. Outcome variables were improvement in bleeding pattern, safety profile, spontaneous expulsion rate and continuation at the end of one year. In group-A [abnormal bleeding] menstrual cycle became normal in 40.4% women in the first 3 months. At the end of one year, 50.9% women experienced normal cycle, 8.8% were oligomenorrhic and 12.3% were amenorrhic. In group-B [contraceptive group] all women started with normal cycles. At the end of 3 months 42% complained of vaginal spotting which reduced to 10% at the end of one year. Menstrual pattern at the end of one year showed normal cycles in 52%, oligomenorrhea in 19% and amenorrhea in 10% women. Vaginal spotting was experienced by 42% women at 3 months as main complaint which reduced to 10% at the end of one year, however, 7% women requested for removal of device at one year. LNG-IUS is an effective and acceptable treatment for abnormal uterine bleeding as well as for contraception. Vaginal spotting was the most frequent side effect experienced by both groups

Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy

To determine the efficacy and safety of Total Dose Infusion [TDI] of low molecular weight iron dextran for the treatment of iron deficiency anemia compared to oral iron replacement during pregnancy through improvement in hemoglobin [Hb] after intervention. Non-randomized control trial. Section of Gynaecology and Obstetrics, Shifa International Hospital and Shifa Community Health Centre, Islamabad during January 2005 to January 2006. A group of 100 pregnant women with gestational age greater than 12 weeks with confirmed diagnosis of iron deficiency anemia attending the antenatal clinics were enrolled in this study. Total dose iron infusion of low molecular iron dextran was given to these patients after calculating iron deficit, in a monitored in-patient setting. Control comprised of a second group of 50 pregnant females matched for age, parity and baseline hemoglobin, tolerant to oral iron supplementation [ferrous sulphate 200 mg three times a day] attending the antenatal clinics during the same period. Post-treatment hemoglobin levels of study group as well as the oral control group were determined between 3 to 4 weeks. In the intervention group, mean pre-infusion hemoglobin level was 8.57 +/- 0.9 gm/dl [range 5-10.5gm/dl] and mean post-infusion Hb was 11.0 +/- 1.1 [range 8.4-14. 3 gm/dl]. In control group, mean pre-oral intake Hb level was 9.5 +/- 0.9 gm/dl [range 7-1 0.5 gm/dl] and mean post-oral intake Hb was 10.2 +/- 1.2 gm/dl [range 6.4-1 2.8 gm/dl]. Mean increase of Hb in intervention group was 2.43 gm/dl [95% Cl 2.4 - 3.8] and for controls it was 0.7 gm/dl [95% Cl 0.6-2.3]. Flushing and palpitations were observed in 4% of interventional group patients and none in the control group. No significant adverse reactions were observed in either group. We conclude that the total parenteral iron replacement with low molecular weight iron dextran is an effective and safe method for the treatment of iron deficiency anemia in a selected group of pregnant women

Neoadjuvant chemotherapy in stage IV ovarian malignancy

A 57 years old woman was diagnosed to have stage IV ovarian malignancy on the basis of ascitic fluid cytology, tumor marker and imaging. Neoadjuvant chemotherapy was administered before surgery. Four months after surgery no evidence of malignancy was found on laparotomy and histopathology. She is under surveillance for any signs of recurrence

Rapid diagnostic tests for bacterial vaginosis and its incidence in obstetrics

This study was conducted in the obstetric and Gynaecology Department of Holy Family Hospital, Rawalpindi from 1st August 98 to 30th October 1998. The purpose of the study was to know the incidence of bacterial vaginosis, which is thought to be the leading cause of cause of vaginal infections in the reproductive life and to evaluate the rapid diagnostic test. Fifty pregnant women attending prenatal clinic between 20-26 weeks of gestation were included in the study. The clinical diagnosis was based on Amsel's criteria that is the presence of homogenous milky discharge aided by microscopic identification of clue cells, a raised pH and Amine test by which addition to secretion gives rise to fishy odor. Overall incidence of bacterial vaginosis in pregnant women with homogenous milky white discharge was found to be 68%. These diagnostic tests were found to be rapid, inexpensive and sensitive requiring minimal apparatus, resulting in easy and quick diagnosis