Perceptions and practices regarding the process of obtaining informed consent from surgical patients at a tertiary care hospital.

BACKGROUND: Proper informed consent is essential for patients to have sound knowledge about the indication, risks, and benefits of a proposed surgical procedure. The study aim was to assess the perceptions of postoperative patients about the informed consent process and identify various influential factors in a tertiary care hospital. METHODS: A cross-sectional study was conducted from February to August 2018 at a tertiary care hospital in Lahore, Pakistan. A validated questionnaire was used to conduct interviews of 101 patients planning to undergo elective surgery after fulfilling all ethical considerations. A purposive sampling technique was employed to enroll and the data analysis was performed by using SPSS version 23. RESULTS: Out of total 101 patients, 50 (49.5%) of them were males and the mean age of total sample was 36.98 ± 14.23 years. The majority 92 (91.1%) considered informed consent to be important and that it did not influence their surgical decision 85 (84.2%). Consent was obtained by the consulting surgeon from 41 (40.6%) patients and by the residents/house officer from 60 (59.4%) patients. Fifteen (14.8%) patients signed the consent form themselves, and 86 (85.1%) relatives of patients signed. Ninety-eight (97.0) patients were told about indications of the surgery, and 54 (53.5%) were told about possible complications. Seventy-five (74.3%) patients were informed about alternatives to surgery. Significant reasons for not signing were language (p = 0.03), educational status (p = 0.002), and not being informed by relatives before signing (p = 0.02). CONCLUSION: The patients had adequate knowledge about the process of informed consent and considered it important. Factors identified as barriers to signing the consent form by the patients themselves included language, better educational status, and not being asked by relatives. It is imperative to involve the patients in the process of consent, especially in signing by them or in their presence by their surrogate.

Subinguinal versus peritesticular diameters of varicocele veins in the supine and standing posture.

OBJECTIVE: To determine the region which should be taken as a standard of measurement for varicocele veins. METHODS: The cross-sectional study was conducted at the Fatima Memorial Hospital, Lahore, Pakistan, from October 2018 to October 2019, and comprised patients aged 20-45 years diagnosed with left-sided varicocele and infertility having varicocele vein diameter >2.5mm on scrotal colour Doppler ultrasound. The parameters were determined at subinguinal and peritesticular region in the patients. Data was anaylsed using SPSS 23. RESULTS: There were 35 male patients with a mean age of 32.83±5.91 years. In both supine and standing positions, the mean diameters of varicocele vein at the peritesticular region were significantly greater than the mean values at the subinguinal region (p<0.01). All the 35(100%) patients had semen abnormalities, but the diameter of varicocele veins had no significant correlation with such abnormalities (p>0.05). CONCLUSIONS: Varicocele vein diameter at the peritesticular region was found to be significantly greater than the subinguinal diameter in both lying and standing position.

Presentation of pleural effusion and dilated cardiomyopathy in a case of dystrophic epidermolysis bullosa.

Epidermolysis Bullosa (EB), a genetic disorder of the skin that presents with eruptive lesions accompanied by blistering has multiple types. We present a case of dystrophic and epidermolysis bullosa (DEB), a rare variant of the disease with the underlying pathophysiology involving a mutation of type VII collagen that serves as an anchoring protein for basement membrane to the dermis. The patient presented with palmoplantar hyperkeratosis with blistering extending on multiple sites of the body, bilateral pleural effusion and an ejection fraction of 23% with moderate mitral regurgitation. The patient was treated symptomatically with diuretics and inotropic medication for the dilated heart, along with draining of pleural spaces. No case of DEB with pleural effusion has been reported prior to this one. We believe this is the first case that presented with both pleural effusion and dilated cardiomyopathy.