Journal of Muhammad Medical College ( J Muhammad Med Coll)
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Exploring the Learning Styles of Postgraduates in a Public-Sector University at Karachi
Full text linkIntroduction: Learning styles is a term used to refer to the methods of gathering, processing, interpreting, organizing and thinking about information. Knowledge of the learning styles can be helpful in making teaching and learning process more efficient. Little is mentioned in medical education literature in Pakistan about the learning styles knowledge in deciphering the teaching and learning process.
Objective: To identify the distribution of the learning styles among the postgraduate students and to find ways to improve the way the courses, the practical hours and training are performed.
Methodology: The current study analyses the learning styles of post graduate students of Dow University of Health Sciences Karachi to guide facilitator as well as students in organizing their teaching sessions more efficiently and maximize the utility of educational resources with subsequent improvement in educational process. During Jan 2016 to Dec 2016, this cross-sectional study using Kolb’s learning inventory as the instrument to find out the learning styles was conducted among post-graduates’ students of a public-sector university by using English language versions of Learning Style Inventory (LSI)of 216 post-graduates ‘students.
Results: According to observation and data analysis by Kolb’s learning Styles Inventory most of the postgraduates had their learning style reflector (Diverger). However, some were Theorist (Assimilators) and then very few were Activist (Accommodator) and Pragmatist (Converser) respectively.
Conclusions: Differences in the learning styles and learning approaches have important implications in development of effective medical curricula in post graduate medical education.
Key words: Learning style, Postgraduate students, medical educatio
Complications of early Cholecystectomy in acute Biliary Pancreatitis
Full text linkIntroduction: Pancreatitis, inflammation of pancreas, is an acute emergency having mortality rate 2 to 7%. Acute pancreatitis can be caused by various factors, like drugs, alcohol, toxins, gallstones, trauma, infection etc. and amongst these, gallstones are the most common cause and is seen in around 75% of the cases. Regarding gall stones, the size of it and number are important parameters. Management usually depends upon the clinical scenario, underlying conditions of pancreas, presence of co morbid conditions and cholecystectomy. This can be done immediately or with an interval while the acute episode of pancreatitis is settled; each having their own benefits and complication rates.
Objective: To determine the complications of early cholecystectomy in acute biliary pancreatitis.
Methodology: A descriptive cases series study was carried out at Mayo Hospital Lahore during June through December 2017. The cases of either gender aged 18 years and above of acute biliary pancreatitis diagnosed clinically with epigastric pain, tenderness and vomiting with raised pancreatic enzymes with history of gall stones were selected purposively. The cases underwent open laparoscopic cholecystectomy in the same admission within 5 days of admission. These subjects were then followed to lo ok for duration of surgery, duration of hospital stay and recurrence of pancreatitis. Final outcome was seen at 3 months to look for recurrence.
Results: We took 50 cases of acute biliary pancreatitis. There were 20 (40%) males and 30 (60%) females. The mean age at presentation was 43.56± 4.68 years. The mean duration of surgery was observed as 54.56 ±12.33 minutes. Total complications were seen in 9 (18%) of the cases; few had combination of these. The most common complication seen was prolonged duration of hospital stay (18%), followed by prolonged duration of surgery (10%) and recurrent pancreatitis (8%).
Conclusion: Early cholecystectomy has higher compilations rate and the most common is long duration of hospital stay.
Key words: Pancreatitis, Early cholecystectom
In Celiac disease: Type 3a, 3b and grade BI is more frequent on Marsh Modified (Oberhuber) / Corraza classification.
Full text linkIntroduction: Histopathological alterations in celiac disease (CD)are villous atrophy, intraepithelial lymphocyte infiltration and crypt hyperplasia. It is caused by gluten in genetically predisposed persons. Duodenum and proximal part of jejunum are most commonly involved. Various classifications are used to define histopathological features of CD, but it is easier to define on Marsh modified (Oberhuber) Corraza classification.
Objective: The object of study is to differentiate histopathogical feature of celiac disease on Marsh modified (Oberhuber) and Corraza classifications
Methodology: This retrospective study of 66 cases of CD carried out at Muhammad Medical college Mirpurkhas Sindh Pakistan between January 2016 to December 2017. Fresh slides prepared and dually observed. All observations denoted and systemized on Marsh modified (Oberhuber) Corraza classification. There are many mimics of CD, they should be excluded for the proper approach to diagnosis.
Conclusion: Histopathogical finding are helpful in CD if they are carefully classified. Typing and grading system of Marsh modified Corraza classification is easier to define and is supportive to observe the features in diagnosis and prognosis of disease.
Key words: Celiac disease, Intraepithelial lymphocytes, villous atrophy. Histopathology, serolog
Caesarean Scar Endometriosis: What protocols should surgeons follow?
Full text linkEndometriosis is defined as presence of functional endometrial glands and stroma outside uterine cavity. Caesarean Scar Endometriosis (CSE) is a rare condition and is difficult to diagnose. We are reporting a case of CSE involving skin and subcutaneous tissues. The incidence pathogenesis, diagnosis, treatment and preventive measures are discussed.
Key Words: Endometriosis, Scar, Caesarean Section. 
Ribavirin Induced Anemia among Patients with Hepatitis-C at Tertiary Care Hospital.
Full text linkIntroduction: Hepatitis C is among one of the major global health issues; which may cause chronic liver disease, end stage liver disease, and hepatocellular carcinoma; subsequently requiring liver transplant. For HCV, standard treatment is a combination therapy of ribavirin and interferon for six months. Ribavirin fostered hemolysis is a major treatment-associated adverse effect.Objective: To assess ribavirin induced anemia among Hepatitis C patients visiting Civil Hospital, Karachi (CHK).Methodology: This hospital-based cross-sectional study was conducted from October 2017 to January 2018. 106 Hepatitis C patients; through non-probability convenient sampling technique; visiting CHK, a public sector tertiary care hospital were enrolled. Results: Among106 patients, 53 (50.0%) were males and 53 (50.0%) were females. Mean ±SD age was 37.05 ±10.793. Mean ±SD duration of ribavirin use was 3.03 ±1.523 months. Around 16.0% had ribavirin dose reduction. All of them experienced weakness, fatigue and light-headedness, 59.4% developed microcytic hypochromic anemia, 23.6% had severe anemia. Mean ±SD hemoglobin (g/dL) level before the onset of treatment was 12.78 ±1.555. Mean hemoglobin level during treatment was 10.72g/dL. Mean reduction in hemoglobin levels was 2.07g/dL. The reduction in hemoglobin levels and the duration of therapy were correlated (p-value <0.05). The severity of anemia was related to age of the patients (p-value <0.05) but not with gender and morphology of red blood cell.Conclusion: Ribavirin induces anemia, its severity is related to the duration of ribavirin therapy and initial hemoglobin levels. It is sometime severe enough to warrant dose reduction and consequently suboptimal dose of ribavirin affect efficacy.
Key Words: Hepatitis C, Ribavirin, Microcytic Hypochromic Anemia
Management of Idiopathic frozen shoulder.
Full text linkIntroduction: Frozen shoulder is a common condition which is characterized by progressive pain &stiffness of shoulder can last up to 2-3 years. It is challenging condition because the effectiveness of treatment is limited. It can cause difficulties with activities of daily living like washing, cleaning, wearing and combing.
Objective: Treatment of idiopathic frozen shoulder with intraarticular corticosteroid injection and exercise.
Methodology: Sixty patients with frozen shoulder were treated in outpatient department of orthopedic surgery in Muhammad Medical College Mirpurkhas from Jan 2014 to Dec 2016. All the patients were given intra articular methylprednisolone mixed with 2% xylocaine. Three injections were given at monthly interval followed by exercise. Follow up was done up to Six months.
Results: 60 patients were treated with three intra articular injections of corticosteroids at monthly interval followed by exercise. 80% have excellent results i.e. relief from pain and achieved full range of motion.10%have mild pain and 10% have restricted internal rotation of shoulder.
Conclusion: Patients with frozen shoulder have excellent results when treated with intra articular corticosteroid injection followed by exercise.
Key words: Frozen shoulder, Adhesive capsulate, intra articular corticosteroid
Implementation of hospital management information system (HMIS) in Muhammad Medical College Hospital (MMCH): Challenges & Opportunities for Management.
Full text linkIntroduction: Since the recent revolution in the IT industry of Pakistan, hospitals are switching to automated information system (IS). Hospitals liked AKU, Indus Hospital, Shaukat Khanum Cancer Hospital are one of the examples of such change. The main purpose of using this technology is its transparency, efficiency and effectiveness in the delivery of services, but at the same time, implementation of such system in hospitals is also a big problem for management.
Methodology: A cross sectional descriptive study was conducted in different departments of Muhammad Medical College Hospital (MMCH), Mirpurkhas. 30 staff members including paramedics, accountants, supervisors and administrators were interviewed by using a closed ended questionnaire. The variables assessed were regarding knowledge, attitude, participation and willingness towards the implementation off HMIS at MMCH.
Results: 30 staff members were approached for interview, majority of them were between 20-30 years of age. Most were unaware about the intention of top management about the implementation of HMIS. 30% of staff had basic IT skills, however 20% were not able to demonstrate IT skill. The gap of communication during between stakeholders were also identified.
Conclusion: This study suggests MMCH should focus on improved planning and coordination between departments, capacity building through trainings and awareness sessions in employees to accept change and involve middle management in the process. The study further recommends hiring professional and qualified personnel in future recruitment process.
Key Words:
HMIS, MMCH, IT, IS, PMIS, MIS, Mirpurkha
AUTOPSY: Knowledge and Perception of undergraduate medical students in current teaching system
Full text linkObjective: To evaluate their acquaintance about autopsy, appropriate way of teaching and to appraise their views for the procedure of autopsy and recognition of Forensic as profession.
Methodology: A cross sectional questionnaire-based study was done in 2015 to 2016, in a public university running modular system. Data were collected by convenient method, from students of 3rd year and ahead. More than 250 forms were distributed and only 193 completed and analyzed by SPSS 17.
Results: Out of 193 students, 165 students claimed to recognize the “autopsy” and 28 not understand the procedure. Only 20 students observed more than 4 autopsies. Out of 193, 179 believed that Forensic education should not be scrapped from the medical syllabi. For teaching methodology 123 preferred a live autopsy and 64 students appreciated watching videos and only 6 favoured books. About 167 students stated autopsy as mandatory in all unsuspected deaths, and 172 agreed for usefulness in medical education but 111 found it disrespectful to the dead body. Around 166 students consider forensic not a prospective profession and 93 suggested its limited scope in Pakistan.
Conclusion: Students were aware of the value and necessity of autopsy as a medicolegal procedure. Adequate time must be fixed for viewing autopsy procedures to insure their complete competency. There is need for continuing efforts to improve the teaching of autopsy within a modular system.
Keywords: Autopsy, Undergraduate Medical Education, Forensic Medicine, Forensic Educatio
Assessment of significant variables to improve admission and teaching learning processes in a medical school.
Full text linkIntroduction: Current selection methods in medical schools emphasize academic competence only, somewhat to the detriment of other essential competencies. Academic grades are frequently considered as the predictors of good academic performance in medical schools and therefore many medical schools still select applicants predominantly on this basis.
Objective: To assess this long-standing trend in order to point out the lacunae associated with it and to explore this effect with a view to improve teaching and learning process.
Methodology: During this retrospective longitudinal study, we studied the students (n=539) admitted to the college of medicine, King Khalid University, Saudi Arabia, between 2006 and 2011. During these years study conditions (i.e. admission procedure, study program and assessment) remained unchanged. The scores of higher school certificate (HSC) were correlated with study duration (number of semesters) and grade point average (GPA). Pearson’s correlation and regression analysis were carried out using effect model.
Results: The results of this study do not demonstrate a correlation between HSC scores and study duration (r = -.018). The relationship bet ween HSC scores and cumulative GPA was moderate positive (r = .476). The HSC scores were found to be poor predictors of the subsequent academic performance (R2 = .273).
Conclusions: The HSC score is a poor predictor of the subsequent academic performance. Our intuition, and perhaps our experience, suggests that study time should be positively associated with grades. However, it is not always the case as study duration-grade association may not be true.
Keywords: School admission criteria, Medical education, Students, Undergraduate
Two testicles in left inguinal region: An unusual presentation of Polyorchidism.
Full text linkWe present a case of 1-year old boy who presented with left undescended testis and hernia. The testis on right side was normally placed. During surgery 2 testicle each with separate epididymis and vasa deferentia.
Keywords: Undescended double testes, Orchidopexy, Herniotomy