Journal of Islamabad Medical & Dental College
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Learning at the Workplace: The Call of the Day
No full textIn the present era of modern medical education, the clinicians are realizing the importance and role of workplace learning as compared to the formal classroom teaching. However, multiple practical challenges hamper the process and prevent the optimization of this type of learning. The author has tried to identify the issues and provide suggestions as how all members of the learning team can be prepared to optimize this learning situation. This team includes the student, the tutor, the patient, and an inductive learning environment. The student and tutor should equip themselves with necessary skills and knowledge by reviewing the subject before approaching the patient. The patient should be taken into confidence as their consent, is important. Lastly, the educational environment in the ward should be modified to facilitate learning.Key Words: Learning environment, Medical education, Workplace learningAddres
Comparison of Efficacy of Laryngeal Mask Airway and Intersurgical-Gel Supraglottic Airway Device During General Anesthesia in a Tertiary Care Hospital
Get PDFBackground: Upper airways collapse during anesthesia is a common issue faced by anesthetists. Air way maintenance is an essential component of general anesthesia. Laryngeal mask airway and Intersurgical-gel (i-gel) air way devices are new advances in general anesthesia. Present study aims to compare the ease of insertion and hemodynamic response of i-gel supraglottic and laryngeal mask airway (LMA).
Material and Methods: A Randomized Clinical trial was conducted at the Department of Anesthesia, Shaikh Zayed Hospital, Lahore. Study duration was 6 months (June 2014- December 2014). A total of 60 patients were selected through non-probability consecutive sampling. Ethical approval was taken from ethical review board of Sheikh Zayed Hospital and informed written consents were taken from all the participants. Patients were randomly divided into two groups using lottery method. Group A was given laryngeal mask airway device while group B patients were provided with i-gel supraglottic device during anesthesia. Patients were compared for ease of insertion and hemodynamic parameters. Data was analyzed using SPSS version 24. Chi-square and t-test were applied and p-value ≤0.05 was considered statistically significant.
Results: A total of 60 patients were included in study. Mean age of patients was 35.2±11.7 years in LMA group and 36.7±13 years in i-gel group. Group B had lower number of insertion attempts (p=0.01) and high insertion satisfaction (p=0.4) as compared to group A. However, process failure and bleeding rate was found to be slightly higher in group B (16% and 13% respectively) as compared to group A (p>0.05).
Conclusion: i-gel supraglottic device is a successful alternative option in terms of ease of insertion and less hemodynamic response as compared to laryngeal mask airway during general anesthesia.
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Patients Satisfaction Levels in Out Patient Department of a Teaching Hospital
Get PDFObjective: To evaluate patient satisfaction and its relation with different demographic factors of respondents in the outpatient department of a teaching hospital.
Methodology: A cross sectional study was performed between February 2011 and June 2011. A total sample size of 150 participants was collected by consecutive sampling technique. Participants were interviewed privately face to face in the hospital in Outpatient department of PESSI hospital Rawalpindi. Interviews were conducted by trained interviewers using pre tested questionnaires. Data was entered and analyzed by using SPSS v 15. Descriptive statistics was used to analyze the data. Percent mean score technique was used to show the satisfaction score of the participants.
Results: In this sample of 150 participants 89 (59.30%) were males. Mean age of the sample was 38.15±10.919 years. Majority of the participants [105 (70%)] were married. Most of the participants [72 (48%)] were under matric and 66 (44%) were illiterate. Maximum patients [72 (48%)] belonged to low income class (< 7000 Rs.). The overall patient’s satisfaction in terms of mean percent satisfaction score was 61.39±9.8793 ranging from 33.5 to 84. The highest mean percent satisfaction score (64.15±11.61) was observed in age interval of 25-35 years and the higher satisfaction was noted in females (62.10±8.95). The highest satisfaction with respect to marital status was seen in widowed category and minimum in single patients. The highest mean percent satisfaction score (67.75±5.08) was in patients who had intermediate level education but the patients who were in under matric category of education had lowest mean percent satisfaction level of 58.63±9.56. Similarly the highest satisfaction was observed in low income class (63.33±10.09).
Conclusions: In general, patients were satisfied with their hospital care; overall satisfaction level was 61%. Patients’ level of satisfaction showed a relation with age, gender, education and income level. 
Uterine Leiomyomata –Unusual Number Managed with Conservation of Uterus
No full textUterine leiomyomata are the commonest neoplasms of female reproductive tract. On an average there are six to seven fibroids in the affected uterus. These neoplasms may lead to symptoms like menorrhagia, dysmenorrhea, pressure effects, urinary frequency, pelvic pain, infertility and pelvic mass. Here we present a case report of 34 years old nulliparous women having an unusual number (48) of fibroids. As she was nulliparous and wanted to conceive, her uterus was conserved and all the fibroids were surgically removed
Spontaneous Bacterial Peritonitis and its Common Pathogens in HCV Cirrhotic Patients
Get PDFObjective: To determine the spontaneous bacterial peritonitis and its common pathogens in HCV Cirrhotic patients. Patients and Methods: This cross-sectional descriptive study was conducted at department of Medicine, Liaquat University Hospital Hyderabad/Jamshoro. This study was carried out for period of six months, i.e. from 1st March, 2009 to 31st August, 2009. Patients with liver cirrhosis caused by hepatitis C virus, ranging from 15 to 70 years of age and either gender were included in this study. Ascitic fluid was sent to Diagnostic and Research Laboratory of LUMHS within half hour of collection and ascitic fluid culture was done on blood agar media. TLC count >500-cells/µl or polymorph nuclear leucocyte >250-cells/µl were labelled as SBP positive. Growth positive on different disc was labelled with respect to the positive pathogen. All the data was entered on predesigned proforma. Results: Total 177 cases were studied and the mean age was 50.06±11.5 years with range of 20 to 70 years. Males were found in majority (78.5%) of cases, with male/female ratio of 2.3:1. Most of the patients 120(67.8%) were found having cirrhosis for 1-5 years’ duration. Most of the cases 77(43.5%) presented with Child Pugh-Class B. Spontaneous bacterial peritonitis was present in 100(56.49%) patients. Among these 100 cases, 85.0% were found with positive culture, which showed Escherichia coli (most common) in 54.11% patients, followed by Klebsiella in 16.47% patients, Pneumococci in 9.41% and Enterococci in 7.0% patients. Conclusion: It is concluded that spontaneous bacterial peritonitis was 56.49%, which is a major complication of HCV cirrhosis and E. coli is the major culprit micro-organism. Ascitic fluid culture is a sensitive method to detect the microorganism causing spontaneous bacterial peritonitis. 
Rhinophyma Causing Feeding Difficulty- A Rare Case Report with Review of Literature
Get PDFRhinophyma is a rare chronic progressive disease of phymatous type of rosacea and commonly affects males in their fifth to seventh decades. Diagnosis is based on clinical features. It commonly results in cosmetic deformities; however rarely functional issues have been reported like nasal obstruction and feeding difficulty. Medical treatment is usually ineffective in reducing the size of rhinophyma and moderate and severe cases of rhinophyma give reasonably good results to surgical intervention using different modalities. We report a rare case of rhinophyma in a 72-year-male with an unusual presentation of a large rhinophyma with a long hanging tumorous tip presenting with functional issues including partial nasal obstruction and feeding difficulty especially liquids from a cup of glass for which he was adamant to get it operated. Tumor was successfully removed with electrosurgical knife combined with excision and primary repair of nodular growth at the lower end to the satisfaction of the patient. This case highlights that rhinophyma can rarely enlarge in a way that it can result in feeding difficulty posing a challenge in management. The relevant literature is discussed
Validity and Accuracy of FNAC in the Diagnosis of Pleomorphic Adenoma of Salivary Gland: A Clinico-pathological Study
Get PDFObjective: The first objective of the study was to analyze frequency of pleomorphic adenoma with reference to site involvement (i.e., parotid, submandibular, sublingual and minor salivary glands).Second objective was to determine sensitivity and specificity of Fine needle aspiration cytology (FNAC) for diagnosis of pleomorphic adenoma considering histopathology report as gold standardPatients and Methods: This cross sectional study of pleomorphic adenoma of salivary glands was conducted at the Department of otolaryngology, Capital Hospital, Islamabad over a period of 5 years from May 1st, 2007 to April 30th 2012. This study included 50 diagnosed cases of pleomorphic adenoma, of either gender above 30 years of age. Cases who had already received treatment and those in which histopathology reports were not available were excluded from the study. Clinical data included parameters like age and sex distribution, site/ gland involvement, FNAC and histopathology reports were collected. Data was tabulated and analyzed using Microsoft Excel Worksheet. Qualitative data was presented by frequency and percentage and quantitative was calculated as mean + SD. Variables specially studied included frequency of site involvement, and sensitivity and specificity of FNAC.Results: This study included a total of 50 patients, out of which 20 (40%) were males and 30 (60%) were females with a male female ratio of 1:1.5. Age range was 30 to 50 years with mean age of 37.92 + 6.26 years. Sites involved were, parotid in 24 (48%) patients, submandibular in 12 (24%) patients, and minor salivary glands in 14 patients (28%). FNAC done for diagnosis, had a sensitivity and specificity of 87.5% and 40% respectively with an accuracy rate of 78%.Conclusion: FNAC is highly sensitive for the diagnosis of pleomorphic adenoma and should be performed in all such cases without undermining the importance of imaging studies
Primary Malignant Melanoma of Adrenal Gland
Get PDFA 49 years old male presented with abdominal pain for two months. Abdominal examination revealed slight tenderness in the right lumbar region. On radiological examination an abnormal lesion, measuring 5.5cm x 4.5cm, involving the right adrenal gland was found. It was biopsied and histological and immunohistochemical features were consistent with malignant melanoma. After meticulous physical examination, the patient did not have ocular or muco-cutaneous melanoma and he did not have any past significant medical or surgical history. We labelled this case as primary malignant melanoma of adrenal gland. Unfortunately, the patient died two months after the detection of tumor and before the start of treatment. 
Prenatal Diagnosis of Thalassemia: Practices among Parents of Thalassemia Major Patients
No full textObjective: To evaluate the practices and attitudes of parents of thalassemia major patients towards chorionic villous sampling (CVS). Patients & Methods: A cross-sectional study was conducted at thalassemia centre at Pakistan Institute of Medical Sciences in the months of July and August 2011. Information regarding CVS was taken from parents of 100 registered β thalassemia major patients. Parents with no history of pregnancy after index case, parents of α thalassemia patient and those with other haemoglobinopathies were excluded from study. Results were entered and analyzed on SPSS version 17. Results: After the index only 28 families underwent prenatal diagnosis of thalassemia by CVS. There were 72 families in which CVS was not done. Out of these it was not advised in 48 families and there were 24 families in which it was advised but they did not opt for it. Various reasons for this included health, religious and social issues and also the risk of miscarriages. When they were asked for CVS in future pregnancies, majority (67%) said yes but 33% were still not convinced to go for CVS in future. Conclusion: Prenatal diagnosis of ß-thalassemia by CVS is available in Pakistan for over a decade but its use remains limited. The main reasons for the limited use were that either they were not advised, or they did not opt for it for cost, health, social and religious issues. There is a need to impart awareness of the procedure particularly addressing the above mentioned issues