Efficacy Of Phenylephrine Infusion Verses Colloid Preloading In Resolving Hypotension Due To Spinal Anaesthesia During Caesarean Section.

BACKGROUND: Spinal anaesthesia causes hypotension that is countered through various methods. Phenylephrine is a vasoconstrictor and haemocoel increases the intravascular vascular volume; both have an effect in preventing this hypotension; but their comparison has not been done in local setting. METHODS: Randomized control trial was conducted in month of June, 2017 at Ayub Teaching Hospital, Abbottabad. Block randomization with sealed envelopes was employed. Sample size was set at 90. Two equal groups were formed; Group A received 500 ml of haemocoel before spinal anaesthesia administration and Group B received 300µg of phenylephrine in 100ml infusion over 3 minutes.. RESULTS: An average drop of 8.2 mmHg, 9.7 mmHg and 3.1 mmHg in MAP was observed in Group A participants at 5 minutes, 10 minutes and 15 minutes respectively after spinal anaesthesia. In Group B, an average drop of 1.2mmHg was observed in first 5 minutes. MAP did not change significantly from this value throughout the monitoring period. There was a drop of 1.2 mmHg at 5 minutes in group B. After this, no further drop in blood pressure was observed. CONCLUSIONS: Phenylephrine infusion is better than haemocoel preload in preventing hypotension due to spinal anaesthesia.

Efficacy of two regimens of dexamethasone for Management of preterm labour: pilot study.

BACKGROUND: Dexamethasone is widely used for prevention of respiratory distress syndrome (RDS), necrotising enterocolitis (NEC) and intra-ventricular haemorrhage (IVH) in preterm babies; decreasing the neonatal mortality rate. There is no consensus on the dose of corticosteroid administered to the mother expected to have a preterm baby. This study is conducted to compare the effectiveness of two popular regimens of dexamethasone administration in decreasing incidence of RDS, necrotizing enterocolitis, IVH and neonatal mortality rate. METHODS: Randomized control trial was conducted at Ayub Teaching Hospital, Abbottabad from 1st to 31st August, 2014. Sample size was set at 50. Block randomization was employed in the trial to allocate the patients into corresponding groups 'A' and 'B'. Group A was administered 6mg dexamethasone in 4 doses 12 hours apart and group B was administered 2 doses 12 hours apart. RESULTS: Forty-eight patients participated in the study with 24 patients in each group. Mean age and period gestation of participants were 28.4 years±4.3 SD and 34 weeks±1.9 SD respectively. Four patients in group A gave birth to neonate with RDS compared to two cases in group B. Group B had higher incidence of necrotizing enterocolitis and neonatal mortalities. However, none of these differences observed were statistically significant. No case of IVH was reported in either of the groups.. CONCLUSIONS: Both the popular regimens of dexamethasone administration are equally effective in decreasing the incidence of neonatal diseases.

Hepatitis B And Hepatitis C Virus In Women With First Pregnancy.

BACKGROUND: Hepatitis B and Hepatitis C are amongst the leading causes of morbidity and mortality in pregnant women throughout the globe. This study is aimed at determining the frequency of these infections among primigravid females and the common factors that make them prone to these infections. METHODS: This cross-sectional study was conducted at Ayub Teaching Hospital, Abbottabad from December 2015 to May 2016. A total of 174 jaundiced primigravida patients were included in the study through non-probability consecutive sampling. Blood samples were sent for HBsAg and anti-HCV ELISA. Samples were analysed by the pathologist with more than 5 years clinical experience. All data will be analysed using SPSS-16. RESULTS: The mean age of the subjects was 24±5.7 years. Six (3.4%) patients were HBsAg positive and 13 (7.5%) were anti-HCV positive. About 9% of patients had undergone surgery in their life and 1.7% reported having received blood transfusion during their life. Thirty-two of them had history of intravenous or intramuscular injections. History of piercing of body part mostly ear-piercing for ornaments was present in 170 (97.7%) respondents. However, the frequency of blood transfusion, surgery and body piercing was not statistically significantly between HBsAg positive, HBsAg negative, and anti-HCV positive and negative patients (p>0.05). CONCLUSIONS: The incidence of these viral infections in our community is on the rise. It emphasizes the need of routine antenatal screening in pregnant ladies for these viruses and to educate the public about preventive measures against these infections.

GILBERT'S SYNDROME - A CONCEALED ADVERSITY FOR PHYSICIANS AND SURGEONS.

Gilbert's syndrome (often abbreviated as GS) is most common hereditary cause of mild unconjugated (indirect) hyperbilirubinemia. Various studies have been published depicting clinical and pharmacological effects of Gilbert's syndrome (GS). However GS as a sign of precaution for physician and surgeons has not been clearly established. A systematic study of the available literature was done. Key words of Gilbert's syndrome, hyperbilirubinemia and clinical and pharmacological aspects of GS were searched using PubMed as search engine. Considering the study done in last 40 years, 375 articles were obtained and their abstracts were studied. The criterion for selecting the articles for through study was based on their close relevance with the topic. Thus 40 articles and 2 case reports were thoroughly studied. It was concluded that Gilbert's syndrome has immense clinical importance because the mild hyperbilirubinemia can be mistaken for a sign of occult, chronic, or progressive liver disease. GS is associated with lack of detoxification of few drugs. It is related with spherocytosis, cholithiasis, haemolytic anaemia, intra-operative toxicity, irinotecan toxicity, schizophrenia and problems in morphine metabolism. It also has profound phenotypic effect as well. The bilirubin level of a GS individual can rise abnormally high in various conditions in a person having Gilbert's syndrome. This can mislead the physicians and surgeons towards false diagnosis. Therefore proper diagnosis of GS should be ascertained in order to avoid the concealed adversities of this syndrome.

Medical education and social environment.

BACKGROUND: A positive learning environment and quality of course content have an imperative role in academic achievement of students. This study aims to assess students' point of view about the quality of education and social environment of a public sector medical college in Pakistan. Relative scarcity of data from students' perspective merited this study. METHODS: A cross-sectional survey was undertaken at Ayub Medical College, Abbottabad, Pakistan, including 300 medical students from all five years of the MBBS course. Systematic random sampling was used with a kth interval of 4 for each class. Self-administered questionnaire was used and contained items related to academics, learning environment, learning resources, teaching methodologies and student-friendly activities. The data were analysed using SPSS-16. RESULTS: There were 265 respondents (88.3%) to the questionnaire with males accounting for 58.9% (n=156). In general students showed satisfaction with quality of content being taught; however there was discontent towards various academic and non- academic facilities provided to the students. Only 44.10% and 31.50% students reported provision of academic related facilities and interactive sessions as up to mark respectively; 83% students reported that undergraduate medical research was in need of improvement; 55.5% and 60.2% reported that facilities in hostel and recreational facilities needed improvement respectively; and 52.8% students stated presence of a healthy, student friendly, encouraging environment was not up to mark. CONCLUSION: Although course content and teaching methodologies are generally satisfactory, a healthy, student friendly, encouraging environment is vet to be created to help students foster their abilities completely.

Expectations of a medical student: the deficit between 'what is' and 'what should be'.

BACKGROUND: Over past few decades, the expectations of medical students about their academics, extracurricular support from college and about their social life at campus have all been changed greatly. The relative scarcity of data about the expectations of Pakistani medical students has merited this study. METHOD: A cross-sectional survey was undertaken at Ayub Medical College, Abbottabad at the in December, 2012 based on random sampling technique. Expectation questionnaire of University of Northumbria for Survey of Student Attitudes, Experiences and Expectations was used. RESULTS: One hundred and sixty-two students responded to the questionnaire with 93 (58.1%) males. Students had a fairly realistic picture of academic demands and college environment. There was major difference in the opinions of male and female students about physical environment of college with female having prior misconception about it. Forty-eight percent student found medical education challenging. About 63.3% students had realistic picture about study habits needed in the college. About 77.9% and 73.8% students had reasonable picture of academic staff and teaching methods at the college respectively. Students had a fair picture of the thorough help from teachers. About 63.5% students seemed well-prepared for the extent to which they would need to be independent learners at medical college. However expectations of 55.6% students about non-academic support were higher than provided. Also only 20.3% students found social adjustments easier than expected. About 39.5% students had fairly accurate expectations regarding the physical environment of the college; however in gender based comparison, about 55% female students felt being mistaken about the environment. CONCLUSION: Academic demands are fairly in accordance with the expectations of students. However there is a need to make course content interesting and more understandable. Also the extracurricular support in form of various facilities should be bolstered. Most importantly, the physical environment needs to be made more amicable especially for female students.

First cancer statistics report from Hazara division.

BACKGROUND: 'Cancer' is on rise globally. Cancer registry is vital for policy making, resource allocation, progress tracking and overall cancer control. In Pakistan, cancer prevention, screening and standardised clinical trials, as well as quality assurance through surveillance are badly hampered due to the lack of a National Cancer Registry. For Pakistan a well-integrated system of Cancer Registry is need of the day. METHODS: This retrospective study was conducted on the hospital records at the Oncology Department of Ayub Teaching Hospital, Abbottabad from year 2007-12. Data were collected tIhrough a standard data capture form with a final figure of 555 patients. The malignancies were diagnosed clinically and histopathologically at different laboratories of Pakistan. RESULTS: Among these cases, 54.08% were male and 45.92% female. Incidence of cancer in patients below 14 years age was 8.47% and 91.53% above 14 years. Majority (31.95%) cases were from Mansehra followed by Abbottabad with 27.08% and Haripur 14.26% cases. Leukaemias were at top with 15.14% cases followed by breast carcinoma (13.69%), Lymphomas (12.07%), ovarian carcinomas (8.65%), and gastric carcinoma and skin cancers with 2.70% each. Among men, the highest incidence was of Hodgkin's lymphoma (14.9%) followed by lymphocytic Ieukaemia (14.3%). Prostate cancer was seen in 8.3% male patients. Another 5.7% patients had lung cancer. In women, the highest incidence was carcinoma breast (19.7%) followed by ovarian carcinoma (13.4%), leukaemia (9.7%), and Hodgkin's lymphoma (4.3%). CONCLUSION: A variety of cancers are prevalent in the indigent population. Record-keeping in wards is sub-optimal. Commonest cancers in the area have slight differences with rest of the country.

Assessment of patients' satisfaction in medical and surgical wards in a tertiary care hospital.

BACKGROUND: Evolution is the natural process that is not limited merely to the biological world but to the social world as well. The standards of living and the expectations change with time. This study was done to generate data that can help doctors and hospital administration to identify and solve problems. METHODS: It was a cross-sectional study conducted at a major tertiary care hospital of KPK through the month of July 2012. An interviewer based patient satisfaction questionnaire was used to estimate patients' satisfaction by asking questions regarding admission procedure, referral, clinical and lab investigation services, attitude of doctors and nurses, nursing services, cleanliness condition of the wards and overall level of satisfaction. RESULTS: Study included 305 patients, 205 from surgical wards (144 males, 61 females) and 100 from Medical wards (52 males, 48 female). Satisfaction level was high among females than males. Most of the patients having low level of education and unemployed patients were satisfied. Cleanliness condition of wards and bathrooms was highly criticised. Attitude of doctors and nurses was much appreciated. About 70% of the patients were satisfied with explanation regarding their disease. More than half (59%) were not aware of post-surgical complications, and 67% were not aware of the use and possible side-effects of medication. About half of the patients couldn't utilise hospital lab. Overall satisfaction level was 68% in medical wards and 77% in surgical wards. CONCLUSIONS: Overall level of satisfaction was fair in both wards. Attitude of doctors and nursing staff was appreciated, but cleanliness conditions were criticised. There is a need for availability of free medicine and improvement of laboratory services and cleanliness.

Isolation of medical students: communication barrier and its effect on career.

BACKGROUND: Communication barriers affect student-student interaction and student-patient interaction. This study is aimed at exploring the social, cultural and academic spheres where medical students feel getting isolated. METHOD: Questionnaire based cross-sectional survey was undertaken at Ayub Medical College, Abbottabad in the month of July, 2013. Cluster sampling technique was employed. RESULTS: Linguistic problems in the college greatly affected medical students. Female medical student are comparatively more affected. These problems were less common in 1st year and most common in 3rd year where clinical classes are started. There are distinct gender based problems in communicating among male and female student with as many as 37.2% reported feeling difficulty in communicating with students of opposite gender. However this difficulty in communication gradually faded on proceeding from 1st year towards final year. About frank interaction with opposite gender, 65.9% students felt that society had negative impact upon it. While communicating with patients of opposite gender, almost a quarter of students (27.3%) reported facing difficulties, 56.9% students reported to have abject apathy towards the colleagues of opposite gender. CONCLUSION: Linguistic issues, gender discrimination, negative impact of society and lack of concern for fellow colleagues is affecting student-student interaction and student-patient interaction. There is need to create student friendly environment.

Compliance of anti-smoking regulations by cigarette industry in Pakistan.

BACKGROUND: The hazards of cigarette smoking and its increasing consumption are well known despite the ongoing tussle between the tobacco industry and global governments. To curb the menace of smoking, anti-smoking laws have been enforced from time to time by various governments. In 2003, Ministry of Health (MoH) Government of Pakistan has imposed certain regulations on cigarette manufacturing industry. The aim of this study was to highlight the compliance of the industry with these regulations. METHODS: A cross-sectional study of major cigarette selling shops was conducted in Abbottabad. It was aimed at determining the availability of total cigarette brands and their compliance with the regulations and also to find out attributes of cigarette customers. RESULTS: A total of 39 varieties of 18 cigarette brands are available in Abbottabad city, out of which 71.8% are imported varieties. A total of 38.4% varieties have displayed health warnings (28.2% pictorial health warning, 10.2% have written health warning. Majority of cigarette customers are between 20-40 years of age, while 5.6% customers include youngsters between 10-20 years of age. Female customers, accounting for 8% of total cigarette customers, buy only those brands which have not displayed the health warning. CONCLUSIONS: Observed compliance with governmental regulation for displaying health warning is 39% which is far less than desired. Sale of cigarette to children is also practiced. Ministry of Health (MoH) should assure the display of these warnings on all the brands so that smokers must be fully aware about the risk involved in smoking