Undergraduate medical education in the Gulf Cooperation Council: a multi-countries study (Part 2).

BACKGROUND: The Gulf Cooperation Council (GCC) countries have witnessed over the last 40 years a rapid and major social, cultural, and economic transformation. The development of medical education in the region is relatively new, dating from the late 1960s. An important goal among the medical colleges in the region is to graduate national physicians who can populate the healthcare service of each country. AIM: The aim of this study is to provide understanding of undergraduate medical education in each of the six GCC countries and the challenges that each face. METHODS: This is a descriptive cross-sectional study. Fourteen senior medical faculty were requested to submit information about undergraduate medical education in their own countries, focusing on its historical background, student selection, curriculum, faculty, and challenges. RESULTS: The information provided was about 27 medical colleges: 16 from the Kingdom of Saudi Arabia (KSA), five from the United Arab Emirates, two from the Kingdom of Bahrain, two from Sultanate of Oman, one from Kuwait and one from the State of Qatar. It was found that older colleges are reviewing their curriculum while new colleges are developing their programs following current trends in medical education particularly problem-based learning and integrated curricula. The programs as described 'on paper' look good but what needs to be evaluated is the curriculum 'in action'. Faculty development in medical education is taking place in most of the region's medical colleges. CONCLUSION: The challenges reported were mainly related to shortages of faculty, availability of clinical training facilities, and the need to more integration with the National Health Care services. Attention to quality, standards, and accreditation is considered essential by all colleges.

Undergraduate medical education in the Gulf Cooperation Council: a multi-countries study (Part 1).

BACKGROUND: The Gulf Cooperation Council (GCC) countries have witnessed over the last 40 years a rapid and major social, cultural, and economic transformation. The development of medical education in the region is relatively new, dating from the late 1960s. An important goal among the medical colleges in the region is to graduate national physicians who can populate the healthcare service of each country. AIM: The aim of this study is to provide understanding of undergraduate medical education in each of the six GCC countries and the challenges that each face. METHODS: This is a descriptive cross-sectional study. Fourteen senior medical faculty were requested to submit information about undergraduate medical education in their own countries, focusing on its historical background, student selection, curriculum, faculty, and challenges. RESULTS: The information provided was about 27 medical colleges: 16 from the Kingdom of Saudi Arabia (KSA), five from the United Arab Emirates (UAE), two from the Kingdom of Bahrain, two from Sultanate of Oman, one from Kuwait, and one from the State of Qatar. It was found that older colleges are reviewing their curriculum while new colleges are developing their programs following current trends in medical education, particularly problem-based learning and integrated curricula. The programs as described 'on paper' look good but what needs to be evaluated is the curriculum 'in action'. Faculty development in medical education is taking place in most of the region's medical colleges. CONCLUSION: The challenges reported were mainly related to shortages of faculty, availability of clinical training facilities and the need to more integration with the National Health Care services. Attention to quality, standards, and accreditation is considered essential by all colleges.

An incidental case of breast cysticercosis associated with fibroadenoma.

It is unusual for cysticercosis to occur in the substance of the breast. Only a few cases have been described in the literature. We report a case of cysticercosis perched on fibroadenoma of breast found on surgical excision in a 35 year old Nepali woman. The patient had no discernible evidence of cysticercosis in the other organs.

Clinico-haematological and management profile of aplastic anaemia--a first series of 18 cases from Nepal.

AIM OF STUDY: To study the prevalence, clinico-haematological and management profile of aplastic anaemia (AA) among severely anaemic patients treated at BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. METHOD: A retrospective analysis of 18 cases of biopsy proven AA patients was done between September 1995 and August 1997. RESULTS: Over a period of 2 years, 140 patients with severe anaemia were admitted to our institution. Eighteen patients were diagnosed with AA. The ages of the AA patients ranged from 7 to 56 (median 15) years, with a male: female ratio of 1.23:1. Pallor, bleeding diathesis, weakness and fever were the most common presenting complaints. Blood counts showed pancytopenia in 16 cases. Bone biopsies of all the cases were hypoplastic. Sixteen cases were non-severe AA and the remaining 2 were severe. Of the 18 cases, 16 were idiopathic; 1 case each was associated with chloramphenicol toxicity and hepatitis B infection respectively. Most of the patients were treated with corticosteroids or androgens or a combination of both. Only six patients came for regular follow-up. CONCLUSION: The high (12.85%) prevalence of AA among patients admitted with severe anaemia in this hospital (which acts as a catchment area for the Eastern region) may not reflect the actual prevalence of the disease in the local community. However, a prospective study may delineate the causative factors peculiar to this region. The clinico-haematological profile is typical of the disease. However, the management profile is incomplete without a proper follow-up. This limitation may be overcome by providing free or subsidized treatment.

Quality assurance programme in haematology at a teaching hospital in the eastern region of Nepal.

Quality assurance in haematology laboratory is intended to ensure the reliability of the laboratory tests. A quality assurance programme has two main aspects, namely, internal quality control and external quality assessment. A two year experience of quality assurance in haematology laboratory at B.P. Koirala Institute of Health Sciences, Nepal, is presented here. As a part of internal quality control, test results in the laboratory were scrutinized before release on a daily basis. Inconsistent result were checked for the given values with control material. In addition, the laboratory is a participant of the 'External Haematology Quality Assurance Programme' conducted by WHO regional reference centre at AIIMS, New Delhi, India. Variations related to errors in manual and autopipetting, calibration and inter-observer differences have been noted from time to time and rectified. The programme has helped us to deliver quality service in haematology laboratory at BPKIHS.

Giant cell tumours of the hand.

A study of seven cases of giant cell tumours of the hand is reported. All tumours were treated by an en bloc excision of the tumour or by whole ray resection. En bloc resection of the tumour and reconstruction with a fibular graft where necessary should be considered as the treatment of choice in giant cell tumour of the hand.

Isolation & cryo-preservation of human foetal articular chondrocytes.

An attempt to determine the ideal temperature and duration of storage of human foetal chondrocytes yielded highly cellular preparations with no alteration in morphology or loss of viability. Initial digestion with activated papain was followed by incubation in 0.5 per cent collagenase. Trypan blue exclusion test revealed a viability count of 95-99 per cent and radioactive thymidine uptake a corresponding labelling index. On TEM no subcellular damage was evident. The isolated viable chondrocytes were further banked at varying temperatures of +4 degrees, -4 degrees, -30 degrees, -79 degrees and -196 degrees C, in Eagles MEM with 10 per cent dimethyl sulfoxide. Post storage morphology and viability of these cells, thawed after durations of 20 h, 1 wk, 1, 2, 3, 4 and 6 months, were compared with prestorage readings in an attempt to define the ideal temperature for banking. Storage in liquid nitrogen at -196 degrees C demonstrated excellent preservation even at the end of six months with minimal subcellular change. Electron microscopy and labelling index were found to be superior to Trypan blue exclusion test in assessing the stored chondrocytes for retention of their functions.

Measurement of ultrasonic velocity and attenuation in bone tumors, in vitro.

Ultrasonic velocity and attenuation are determined in different types of bone tumors by using a double-probe-through-transmission ultrasonic technique. The average values of propagation velocity in different types of tumors are found as 2106, 2304, 2677.5, and 3586 m/s with 1.49%, 1.04%, and 0.74% standard deviation in Giant Cell, Lymphoma, Chondro Sarcoma, and Osteogenic Sarcoma, respectively. Absorption coefficient of ultrasound is found to be minimum as 19.7 dB/cm with 0.002% standard deviation in Lymphoma, and high in Osteochondroma and not measurable with the present setup. A direct technique for the diagnosis and differentiation of various types of tumors can be developed by standardization of the data.

En bloc excision and reconstruction with a fibular autograft of giant-cell tumour of the metacarpal--a case report.

A giant-cell tumour involving the diaphysis of the third metacarpal is reported. The unusual site, age, radiographic atypicality and therapeutic options are reviewed.

A small-cell osteosarcoma with multiple skeletal metastases.

A 10-year-old child presented with small-cell osteosarcoma of the proximal end of the tibia. Pulmonary metastases appeared after a gap of 9 months of ablative surgery, as did late multiple extra-pulmonary skeletal metastases, including the hand and foot bones after 6 months of pulmonary metastases. These late extrapulmonary metastases appear to be secondary to pulmonary metastases.

Allogenic transplantation of ultra-deep frozen osteochondral grafts. An experimental study in dogs.

Twenty dogs were subjected to allotransplantation of the lower end of the femur, frozen at -196 degrees C for 24 hours in liquid nitrogen, and stored at -30 degrees C. Two dogs were sacrificed at monthly intervals, providing the grafted bone for histological study. Eight dogs were excluded from the study following infection or death, resulting in a follow up of only 6 months. Monthly roentgenographic assessment showed bridging of the host-graft unit by the second month, with posterior subluxation of the graft with subsequent malunion. Histologically, exuberant callus was seen around the interface with progressive incorporation of the graft. However, the articular cartilage degenerated after 2 months. Attempts to repair the articular surface with new fibrocartilage were poor in the malunited grafts. The technical problems in surgery including control of infection, sound mechanical fixation and repair of tendons and ligaments must be solved to ensure a successful allograft.