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.

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.

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