Learning styles of medical students and their demographic characteristics

Background: Learning styles are different ways of collecting information. Every individual has a different learning style which can be measured by using different inventories

Objective: To determine the learning styles of the third year medical students in Sheikh Zayed Medical College Rahim Yar Khan and to find association of learning styles with the demographic characteristics

Material and Methods: This cross sectional study was conducted at Sheikh Zayed Medical College Rahim Yar Khan during May 2013 and target population was 3[rd] year medical students including all the medical students of third year MBBS to analyse learning styles. The instrument used was the "Kolb Learning Style Inventory" which divides the individuals in to four different types of learning styles. The results were tabulated and were analysed by using SPSS version 17

Results: Analysis of learning styles inventory showed that among third year medical students, the dominant learning style was convergent learning style as 42 out of 122 [34.4%] students' opted for it. The second, third and fourth preferred learning styles were accommodative 33 [27%], assimilative 25[20.5%] and divergent 24[19.7%] respectively

Conclusion: The dominant learning style was convergent among 3[rd] year medical students and there was significant association of learning styles with demographic characteristics

Perceptions of medical students about educational environment at services institute of medical sciences, Lahore

Objective: the objective of this study was to assess the perceptions of undergraduate medical students of Services Institute of Medical Sciences [SIMS], using DRE EM questionnaire

Material and Methods: all students from the final year MBBS class of the medical college [n=150] were included in the study. The non-parametric chi-square test and Mann Whitney U Test were used to determine the significance of differences [proportion of frequencies] for individual items

Results: the total no of final year students of medical college were 150 with 135 respondents with 43% males and 57% females. DREEM score SIMS medical college in metropolitan city was 118.6 indicating a positive perception

Conclusion: DREEM is a valid instrument for the measurement of students' perceptions worldwide. The students of SIMS have positive perception about educational environment of the institute

Maternal perception of fever in children by tactile technique. how valid it is?

To determine the validity of tactile technique as a tool for fever assessment in children by mothers. Study Design: A cohort study. The study was conducted at the department of Paediatrics, Combined Military Hospital, Bahawalpur, Pakistan, from September 2007 to September 2009. Convenient sampling technique was employed. Three hundred and ninety three children between the ages of 6 months and 5 years, brought to hospital by mothers with history of prolonged fever [7 days or more] perceived by tactile technique. Children were not supposed to be necessarily febrile at the time of enrollment. A six hourly temperature recording was done. Moreover, whenever mothers felt that their child is febrile by using tactile method of their choice, axillary thermometry was done irrespective of the number of recordings. Standard mercury thermometry by axillary technique [without adding a degree to measured value] was chosen. Reading of more than 99.50 Fahrenheit [37.50 centigrade] was labeled as fever. Cases that remained fever free for five days were labeled afebrile and discharged. Mothers were advised to watch for fever for one week at home and to report back immediately if they felt that their child has fever, confirmed by a single tactile measurement. Those who reported back were readmitted and subjected to the same method of monitoring and recording as was applied on first admission. Data was analyzed using SPSS version 17. Descriptive statistics were applied to calculate the frequencies, means and standard deviations. Among the 392 children 58.4% were males and 41.4% were females. The mean age was 24.4 +/- 14.39 months. Majority had a history of fever of 5 to 24 days [70.2%]. In only 184 [46.93%] patients fever was confirmed. In 208 [53.08%] patients no fever was recorded and were discharged. Twenty one patients reported back with fever. However, fever was confirmed in only 11 patients. In summary, a total of 195 [49.74%] patients actually had fever while a large population of 197 [50.25%] did not had fever. Fever was over estimated by the mothers when detected by tactile technique. Axillary thermometry as a tool for fever assessment at home and clinics should be encouraged. This will significantly reduce the need for undue investigations and unnecessary medications

Management of ureteric calculus renal failure: a cost effective and decision making analysis with and without percutaneous nephrostomy

Background: Calculus acute renal failure is a urological emergency. Prompt treatment in the form of either temporary urinary diversion, or definite treatment can save the patients from developing chronic renal failure

Objectives: To compare the management of patients with obstructive uropathy with and without percutaneous nephrostomy

Patients and methods: A prospective interventional study conducted at SIMS/ SZMC, 2007-10. Twenty patients of ureteric calculus presenting with acute renal failure were included in our study. Patients were divided into two groups. Age, sex, duration of anuria and biochemical profile like serum creatinine and serum potassium levels were noted in both groups. In group A, a preliminary percutaneous nephrostomy tube was placed as a temporary diversion. On normalization of clinical and biochemical profile, definite treatment in the form of ureterorenoscopy/ lithoclast was performed. In group B, all the patients underwent definite treatment in the form of ureterorenoscopy/ lithoclast without preliminary temporary urinary diversion. The duration of normalization of renal function test, efficacy of URS lithoclast, hospital stay and cost effectiveness in both the groups were noted

Results: A total of 20 patients with 75% male and 25% female were included. Duration of anuria in group A was one day in 1 patients and 2-3 days in 6 patients. The duration of anuria in group B was 102 days in 8 patients. Mean normalization of serum creatinine level in group A was 5.9 days while it was 5.2 days in group B. The mean hospital stay was 10 days in group A while it was 4.7 days in group B. The mean cost of treatment in group A was Rs. 12300 and Rs. 4800 in group B

Conclusion: In patients with deranged renal functions but otherwise clinically normal can be offered definite treatment without temporary diversion in the form of PCN. This not only decreases the morbidity associated with PCN but also comforts the patients in term of shorter hospital stay and cost effectiveness

Tuberculous intestinal perforation: a nightmare for the surgeons

Introduction: The incidence of abdominal tuberculosis has been steadily increasing over the past 20 years. The situation is worse in underdeveloped countries like Pakistan where poverty, overcrowding, unhygienic environment and recent outbreaks of multidrug resistant tuberculosis [MDR-TB] have posed more challenges for the management of abdominal tuberculosis. Tuberculous intestinal perforation is an even bigger challenge for the surgeons

Objectives: To reduce the morbidity and mortality related to tuberculous intestinal perforation vide application of Modified New Scoring system based upon simple pre-operative and intraoperative criterias

Patients and Methods: This descriptive study was conducted at surgical ward II, SZMC/Hospital, Rahimyar Khan, from 1[st] March 2009 to 31[st] August 2010 and 13 patients of tuberculous intestinal perforation were included in this study. Based on Modified New Scoring system, patients were divided into three groups. Group I were managed with primary closure, Group II with ileostomy, Group IIIA with peritoneal tube drainage and Group III B with tube enterostomy

Results: Overall, 12 [92%] patients developed wound infections, 2 [15.3%] presented with fecal fistula after surgery and were re-explored, and 3 [23%] patients developed burst abdomen due to fecal fistula or severe sepsis. The overall mortality was 2[15.3%] in this study which is less than other national/international studies

Conclusion: Modified new scoring system is practical to categorize the patients on the scale of severity of disease and to offer precise guideline to the surgeons for damage control with minimum injury and with good initial promising results

Causes of ureteric injures and outcome of different surgical procedures for the repair of ureter

Background: iatrogenic ureteric injuries have long been recognized as a potential complication of any abdominal or pelvic surgery. The present descriptive study was conducted at the Department of Urology Services Hospital, Lahore and Sheikh Zayed Medical College Rahim Yar Khan

Objectives: the specific objective of the study was to determine causes of ureteric injures and outcome of various treatment options

Patients and Methods: a total of 40 patients included in the study were presented either in the emergency ward or referred from other wards. Detailed History and thorough general and physical examination was done. Routine investigations were done in all cases while ultrasonography, intravenous urography, retrograde urography, ante grade urography and Computed Tomography [CT] scan were done in selected cases. Various procedures for ureteral repair were performed according to the site and extent of injury. Ureteral repair was done over a DJ stent

Results: in our study out of 40 patients 33 [82.5%] were female and 7 [17 .5%] males. Mean age of patients was 36 years. Maximum number of patients had lower ureteric injuries i.e 29 [72.5%] while 8 [17.5%] had upper ureteric injuries and 3 [7.5%] presented with mid ureteric injuries. 38 [95%] patients presented with iatrogenic injuries and 2 [ 5%] patients with firearm injury. Abdominal hysterectomy was the main cause in lower ureteric injuries. In case of upper and mid ureteric injures pyeloplasties and ureterouretrostomy was performed while in case of lower ureteric injuries 27 patients underwent extra vesical and intra vesical ureteroneocystostomy. Boari flap with psoas hitch was performed in two patients. Patients were followed at fourth week, three months and six months interval. Success rate in upper and mid ureteric injuries were 100% while in case of lower ureteric injuries it was [93 .1 % ]

Conclusion: ureteric injury causes a considerable morbidity for the patients. Detail understanding of anatomical relations of ureter and meticulous surgery will prevent iatrogenic injuries. The most common lower ureteric injuries can be best managed with Modified Liche [taguchi] technique

Case series of unusual intravesical foreign bodies and review of literature

Foreign bodies in urinary bladder are not uncommon. However, very little published series are available. Although, not being a fatal disease can lead to serious complications like acute or chronic cystitis, stone formation or fistula formation. We present 3 cases of different foreign bodies with different etiology which were removed successfully

Sutureless tension free Lichtenstein repair: a safe option for indirect inguinal hernia

Background: lichtenstein technique is a widely used surgical procedure for inguinal hernia repair

Objective: this study aims to evaluate the efficacy of suture less mesh placement in open, tension-free inguinal repair

Methods: this was a prospective and interventional study in which 90 adult male patients with indirect inguinal hernia underwent suture less mesh repair from April 2007 to April 2008

Results: out of the total 90 repairs, 83 [92.2%] were for primary hernias and 7 [7.8%] were for recurrent hernias. Postoperative complications included; scrotal hematoma 2.2%, seromas 5.5%, neuralgia 3.3% and wound infections 3.3%. There were no recurrences observed

Conclusion: suture less tension free Lichtenstein repair has proved to be quite satisfactory and provides high patient comfort in primary or recurrent indirect inguinal hernias encountered in surgical practice

Pneumonia; frequency of under nutrition in children under 5 years of age

To find out an association between undernutrition and severity of pneumonia in children under five years of age. The study was carried out at paediatric department of Military Hospital Rawalpindi. From August 2003 to January 2004. Cross sectional analytical study. Children of either gender from 2 to 59 months of age with the clinical diagnosis of pneumonia made according to WHO guidelines were classified into various grades of nutritional status with referrence to the NCHS standards for weight for age. Five hundred children, including 280 [56%] boys and [220] 44% girls with the mean age 20.36 [ +/- 14.26] months were evaluated. One hundred and ninety five [39%] had pneumonia, 158 [31.6%] had severe pneumonia, whereas 147 [29.4%] had very severe pneumonia. Two hundred and eighty six [57.2%] children were normally nourished whereas 214 [42.8%] were undernourished; 133/214 [62.1%] had moderate and 81/214 [37.9%] had severe undernutrition. Fever [81%], cough [77%], nasal flaring [76%], tachypnoea and chest indrawing [61%] were the commonest presentations. The mean hospital stay was 6.9 [ +/- 2.65] days. Thirteen [2.6%] patients including 5 [38.5%] boys and 8 [61.5%] girls, who all were undernourished, expired. The relative risk of death in undernourished children was 1.065 times [95%CI= 1.029 to 1.102] that of normally nourished children [p<0.0001]. Younger age, severity of pneumonia and undernutrition are significant risk factors for morbidity, prolonged hospitalization and mortality in young children with pneumonia

MultipleBbrain Abscesses in a child with congenital cyanotic heart disease

We report multiple and diffuse supratentorial and infratentorial brain abscesses in a ten months old girl with D- transposition of great arteries. The child was managed medically with intravenous antibiotics for 4 weeks. Her fever settled, however, weakness of right half of the body persisted despite remarkable improvement. Multiple abscesses [about 40 in number], in a child less than 2 years age, associated neutrophilia with toxic granulations and successful therapy with antibiotics alone makes this an unusual case

Diagnostic value of C-reactive protein and haematological parameters in neonatal sepsis

To analyse various parameters of sepsis screen singly and in combination to formulate a guideline for the diagnosis of neonatal sepsis. Design: A cross-sectional analytical study. Place and Duration of Study: The neonatal intensive care unit at the Paediatric Department, Military Hospital, Rawalpindi, over a period of seven months from 1st June to 31st December 2003. Subjects and One hundred neonates having clinical features of sepsis and 100 normal asymptomatic neonates were evaluated with a set of investigations. C-reactive protein [CRP], erythrocyte sedimentation rate, total leukocyte count, absolute neutrophil count [ANC], immature neutrophils to total neutrophil count ratio [I/T ratio], thrombocytopenia, degenerative changes in the neutrophils and gastric aspirate cytology [GAC] for polymorphs were used for diagnosis of neonatal sepsis. CRP was positive in 24/28 [85.7%] of group-A [proven sepsis] and 58/72 [80.5%] of group-B [probable sepsis] and had a specificity of 95%. ANC was the second most sensitive test having sensitivity of 71.4% for group- A and 63.9% for group-B and 88% specificity. For group-A, sensitivity of GAC for polymorphs and platelet count was 71.4% and 64.3% respectively. The sensitivity, specificity and predictive values [PV] of the individual tests and different tests combination was also calculated for group-A and B. A set of investigations including CRP, TLC, ANC, thrombocytopenia, cytoplasmic vacuolization in the neutrophils and GAC for polymorphs are highly sensitive in detection of culture negative cases of neonatal sepsis. Moreover, a combination of three tests enhances the sensitivity of these tests

Down syndrome clinical and cytogenetic analysis

To describe the clinical features and cytogenetic analysis of patients with Down syndrome [DS]. An observational study. The Departments of Paediatrics and Internal Medicine of Military Hospital, Rawalpindi [MH, RWP] from January 1998 to December 2001. Two hundred and ninety-five children <18 years of age clinically diagnosed as DS were included. The clinical presentation features, associated anomalies and maternal characteristics were noted. Out of 295, 170 boys and 125 girls had chromosomal findings consistent with the diagnosis of DS. The mean presentation age was 16.2 months while 49 [16.6%] children presented in the neonatal period and 124 [42%] in infancy. Mongoloid slant, epicanthal folds, hypertelorism, simian crease, flat nasal bridge, and microcephaly were observed in >60% of cases. Congenital heart disease was documented in 103 [34.9%] cases and ventricular septal defect was the commonest cardiac anomaly. The cytogenetic analysis revealed that 282 [95.6%] had trisomy 21, 11[3.7%] had translocation, and only 2[0.7%] were mosaic. The mean maternal age was 29.8 years. One hundred and sixty [56.7%] cases with trisomy 21 had maternal age> 35 years, whereas 9/11[81.8%] cases of translocation had maternal age < 35 years. The cytogenetic pattern of DS was similar to previously described series. Inadequate antenatal screening and scarce neonatal examination results in late presentation of DS. Majority of cases can be diagnosed on the clinical features of DS

Wilms' tumour: presentation and treatment

To determine the clinical presentation and treatment results of patients of Wilms tumour treated with United Kingdom Children's Cancer Study Group [UKCCSG] protocol. Design: An interventional study. Place and Duration of Study: The study was conducted in the Paediatric Oncology Department of Combined Military Hospital, Rawalpindi [CMH RWP], from January 1999 to December 2000. Subject and All patients of Wilms' tumour managed by using UKCCSG treatment protocol were included in the study. The patients were thoroughly investigated before treatment. Surgery, chemotherapy and radiotherapy were performed as per protocol. Twenty-two patients including 13 boys and 09 girls with the mean age of 28 months, ranging from 4 months to 7 years were studied. The tumour involved right kidney in 13 and left in 9 patients. Two [09%] patients had stage I, 5 [23%] stage II, 11 [50%] stage III and 04 [18%] stage IV disease. Histology was favourable in 18 and unfavourable in 04 patients. Nineteen [86.4%] patients underwent primary surgery, one had delayed surgery while 02 [9%] patients had inoperable tumour and died despite chemotherapy. Three patients died during maintenance chemotherapy and one after completion of treatment. The overall mortality was 06 [27.3%]. Three patients were lost to follow-up. The treatment outcome is comparable to UKCCSG results. Challenges to be addressed in our set up include illiteracy, deficiency of resources, and regularity of treatment and follow-up. system and, therefore, its application is recommended to evaluate ovarian masses in clinical practice

Hepatitis A - frequency in children with non-specific abdominal symptoms

To study the frequency of subclinical hepatitis 'A' in children having non-specific abdominal symptoms. Design: A descriptive study. Place and Duration of Study: This study was conducted at Combined Military Hospital [CMH], Peshawar from June to December 2000. Subjects and Three hundred and sixty children of either gender, < 12 years of age, presenting with vague abdominal symptoms and no jaundice were evaluated for hepatitis. Eighty eight [24.4%] children meeting the inclusion criteria of elevated serum alanine aminotransferase [ALT], twice the upper limits of normal [90 IU/L], and normal serum bilirubin were labelled as subclinical hepatitis. A total of 360 children were evaluated for vague abdominal symptoms and 96 [26.7%] of them had hepatitis on laboratory profile. Eight patients developed early jaundice and were excluded from the study. Out of 88 [24.4%] cases of subclinical hepatitis, 82 [93.2%] had hepatitis-A, 03 [3.4%] had hepatitis-B, while no causative agent was found in 03 [3.4%] children. The common presenting symptoms were abdominal pain/discomfort, loss of appetite, nausea, vomiting, malaise, fatigue and fever. Hepatomegaly and splenomegaly was documented in 56% and 43% cases respectively. A history of exposure to a patient with hepatitis was present in 14/88 [15.9%] cases whereas no child was vaccinated against HAV. Serum ALT level declined to normal limits within 4 weeks for 77/88 [87.5%] cases and within 6 weeks for 84/88 [95.4%]. All cases recovered spontaneously with out any complication. Hepatitis-A was rampant in children presenting with vague abdominal symptoms in our series

Severe, recurrent hiatal hernia in Schwartz syndrome

An 18 months old baby boy was brought by parents with recurrent vomiting since birth, which had increased over the past four months, failure to gain weight, and altered facial features with delayed development. The baby was reported perfectly normal looking till the age of six months. The parents were first cousins, and married for four years. This was their second child and their first baby had died within a week of birth with an encephalocele. The patient had been variably treated for pneumonia, tuberculosis and malnutrition with no improvement. On examination the baby was emaciated and stunted weighing just 6.9 kg with a length of 68 cms, but alert and apprehensive of strangers. There was blepharophimosis with twitching of the upper eyelids, a puckered mouth and abnormal posturing of the limbs. The knees and elbows were flexed, hands fisted and feet were planter flexed. All joints could be passively extended with ease. There were no dysmorphic features. At 18 months of age the baby could not sit independently, though he could cruise along furniture on tip toes, could eat with his own hand, could speak with a vocabulary of 5-6 meaningful words and had appropriate fine motor movements so that he could draw a single match stick out of its box. Though there was generalized hypertonia, the tendon jerks were not exaggerated. Gastroesophageal reflux with tetany was the initial diagnosis. Urine R/E, Serum calcium, parathormone, bicarbonate and serum albumin, serum CPK, aldolase were within normal limits. Barium meal showed a sliding hiatal hernia with marked gastro esophageal reflux and a dilated esophagus. EMG and NCS showed no evidence of myopathy or neuropathy. Ultrasonography of abdomen and CT scan of brain were normnal. Radiograph of the clavicles was normal but the lumbosacral spine showed shortening of the vertebrae. Baseline ECG was also normal. Having excluded the other conditions, a diagnosis of Schwartz syndrome with hiatal hernia was made. After initial supportive management surgical correction with fundoplication was carried out. Carbamazepine helped to revert the tone to near normal. Three months later the patient weighed 9 kg but the tone was still more than normal. Ternaline was added to the treatment and the tone remarkably improved. A repeat barium meal at that time showed normal position of the stomach and a slightly dilated esophagus

Cutis marmorata telangiectatica congenita

A case of cutis marmorata telangiectatica congenita [CMTC] is reported. A young girl had an unusual presentation with sclerosis in the skin lesions, senile features, hypoplasia of the mandible, transverse nail dystrophy, and transverse toe defects resembling Adams-Oliver syndrome. These associated abnormalities are very rare and some have not been documented before with CMTC. The possible relationship of CMTC with Adams-Oliver syndrome is also discussed

Duchenne muscular dystrophy with associated growth hormone deficiency

A patient with Duchenne muscular dystrophy [DMD] and growth hormone [GH] deficiency is described who had no clinical evidence of muscular weakness before initiation of GH replacement therapy. Treatment with human GH resulted in appearance of symptoms of easy fatigability and proximal muscle weakness. Thorough investigations including serum creatinine phosphokinase [CK] levels is recommended in every patient with GH deficiency before starting GH replacement therapy