Clinical features and outcome in paediatric newly diagnosed immune thrombocytopenic purpura in a tertiary care centre

Objective: The study aimed to demonstrate the pattern of clinical presentations and outcome of acute Immune Thrombocytopenia [ITP] in our Centre

Methods: A descriptive, observational study was conducted by collecting and analysing the data of 103 patients of acute ITP, ageing between 1-14 years, at The Children's Hospital, Lahore from January 2016 to December 2016. We collected the data regarding age, sex, clinical presentations, history of preceding viral infections, vaccination history, laboratory values, different treatment options used, and response to the treatment concerning complete response, partial response and poor responders. Statistical analysis performed by using IBM SPSS statistics version 20

Results: We retrospectively, reviewed total 103 patients cases. The median age, at the time of presentation, was 5 +/- 3.4 years while mean age was 4.5 +/- 2.9 years. The male to female ratio was 1.28:1. Mean platelet count on presentation was 7 x 109/L [range: 0-24]. Twenty three [22.3 percent], patients had the history of preceding illness. Bruises, petechiae, epistaxis and hematemesis remained the common presentations. Six [5.8 percent] patients showed spontaneous recovery while 97 [94 percent] patients received treatment for ITP. Overall, 71 [68.9 percent] showed a response after treatment. Sixty-two patients [59.22 percent] showed loss of response and received treatment again. Among these patients, thirty-four patients [33 percent] developed chronic disease

Conclusion: Majority of patients presenting to our tertiary care centre had severe acute ITP on presentation. After management and follow-up, almost 1/3 of the patients develop chronic disease hence the incidence of developing chronic disease remained high as compared to the other centers

Open versus closed haemorrhoidectomy: evaluation of morbidity and complications

To compare the outcome of open Milligan-Morgan haemorrhoidectomy [MMH] with that of closed Ferguson haemorrhoidectomy [FH] regarding post operative pain, wound healing and complications. Quasi Experimental study design. The study was conducted from 1st of May 2008 to 31st December 2013 at Islamic International Medical college Hospital Islamabad. Forty eight patients suffering from haemorrhoids were divided into two equal groups by consecutive sampling method. In 24 patients [group I] haemorrhoidectomy was done by open method [Milligan-Morgan], and remaining 24 patients [group II] were treated by close method [Ferguson]. Outcome in the two groups such as post operative pain, wound healing, anal stenosis and anal incontinence were compared. Post operative pain was less in group-ll [close] compared to group-l [open]. In group-ll pain score on VAS was 4.8 at 8 hours post operatively which subsided to 2.1 at 48 hours, mean score was 2.9. In group-l post operative pain on VAS was 7.2 at 8 hours which came down to 3.8 at 48 hours, mean score was 5.28. Wound healing in group-ll [close] took 7 to 12 days, while in group-l [open] it occurred in 15 to 25 days. Post operatively analgesia was required for an average 10 days in group-ll, and for 19 days in group-l patients. Anal stenosis and anal incontinence were not noted in either group within 6 months. Close haemorrhoidectomy has shown better outcome compared with open haemorrhoidectomy in terms of post operative pain, analgesic requirement and wound healing. Anal stenosis and anal incontinence are not seen in either group within observation period of 6 months

Medical students perception about the effectiveness of interactive session in small groups

To find out the perception of undergraduate medical students about the effectiveness of interactive sessions in smallgroups. A descriptive cross sectional study. This study was conducted at Islamic International Medical College Rawalpindi from 10[th] April to 12[th] June 2014. A total of 100 students from 3rd and 4th year MBBS were enlisted on first come first basis out of those who volunteered to participate in the study. They were provided with questionnaire [Table I] to give their opinion about the effectiveness of interactive sessions in small groups as learning tool during undergraduate medical studies. Out of the 100 participants 65% considered interactive small group discussions effective, 16.7% were indecisive, while 18.3% disagreed that interactive small group discussions were very effective at undergraduate level in medical education. In students' opinion sessions kept the students attentive [93%], promoted group interaction skills [95%] and promoted critical thinking [63%]. A majority [76%] thought that there was good retention of the subject discussed in an interactive session. In students'opinion it gave them a good chance to evaluate them [71%].It is concluded that interactive group discussions is an effective method of imparting education to medical students at undergraduate level

Methods and complications of septic induced abortion in patients managed at a tertiary care hospital

To study the methods used for the termination of pregnancy and associated complications of induced abortion. This descriptive study was conducted in the department of obstetrics and gynaecology, Fauji Foundation Hospital Rawalpindi. One Hundred patients were included in the study who was admitted with the history of induced abortion. The patients were assessed by detailed history and thorough clinical examination according to the study protocol. Data was collected on a specially designed Performa. Patients were interviewed in privacy and factors contributing to termination of pregnancy like age, parity, socioeconomic status and contraceptive failure were determined. Methods used for the procedure, status of abortionist were asked. Complications were determined by history, clinical examination and ultrasound examination. In view of all above data recommendations of preventing unwanted pregnancies were made. All patients were married and 57% of women belonged to age group of 31-40 years. Fifty-four 54% were grand multipara. In 63% of patients, induced abortion was carried out by Dai's. Most commonly used method was instrumentation [72%]. Financial problems [46.7%] and high parity [40%] were the most common factors contributing to termination of pregnancy. Serious complications like uterine perforation with or without bowel injury were accounted in 13% of women, septicaemia in 61%, peritonitis in 15% and DIC in 2%. During the study period illegally induced abortion accounted for 2% maternal deaths. Prevalence of poverty, illiteracy, grand multiparity and non-compliance of contraception were strong determinants of induced abortion, instrumentation being the most commonly used procedure resulting in high morbidity and mortality