Journal of Gandhara Medical and Dental Science
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Formative and Summative Assessment in the Light of Students Perceptions
Get PDFOBJECTIVESTo collect information about the Perceptions of dental students regarding Formative and Summative Assessment in Sardar Begum Dental College.METHODS This cross sectional study was conducted at Sardar Begum Dental College, Peshawar. Pre validated Assessment Experience Questionnaire was used to collect information. All the students of 2nd, 3rd, 4th year BDS and House officers who have joined and continued their bachelors education at Sardar Begum Dental College and Hospital from the first year were invited to participate in this study through Convenience sampling technique after taking verbal and written consent.RESULTSOverall response rate was 29.3% in 2nd Year, 35.1% in 3rd year, 75.7% in 4th Year and 92.7% among house officers.60-70% students opined that formative assessment experiences stimulated deep learning and were useful in the preparation for summative assessment. Majority of the students were satisfied with the atmosphere, structure and conduct of summative assessment. More than 70% admitted that they learn more when preparing for summative assessment near the examination. Almost 60% prefer to have more number of SEQs by claiming that these let them apply deep learning. Despite of accepting the contents of OSCE/OSPE as of good quality, majority students from all the professional years were dissatisfied from the time allocation as well as slides and images placed in each stationCONCLUSIONStudents like formative assessment mainly because of feedback as it helps them in learning as well as preparing for summative assessment. All parts of summative assessment were more satisfactory for the students
Outcome of Hemorrhoidectomy with the Ligasure in Comparison with the Traditional open Method
Get PDFOBJECTIVETo compare the operative time and outcomes of Ligasure hemorrhoidectomy with that of the traditional open hemorrhoidectomy.METHODOLOGYA total of 49 patients were included in this study. Out of which 24 were in the Ligasure group and 25 in the open group. The main objective or the primary variable was to assess the operative time for the excision of a single hemorrhoidal lesion, the need for morphine, for post operative pain relief and any other complications such as preoperative bleeding and the time to return to work. The data like age, sex, type of Haemorrhoidectomy, type of complicating etc. were recorded in already prepared proforma. The data was analysed through computer program SPSS10.RESULTSThe demographic data were comparable between the two groups. The time spent in excision of a solitary hemorrhoidal lesion was significantly shorter in the Ligasure group compared to the open group (8.25 min Vs 16.75 min ) and this difference was found to be statistically significant (p<0.001). Operative bleeding was also significantly lower than the open method of Haemorrhoidectony. Other parameters like post operative pain, opioid requirement, urinary retention and chronic complications like anal stenosis and gas incontinence were not significant. There was no difference in the period of convalescence and return to work between the two groups.CONCLUSIONHemorrhoidectomy with the Ligasure entails a shorter surgical time and could be associated with a lesser pain besides being safer
THE GROWING MENACE OF ANTIBIOTICS MISUSE IN PAKISTAN
Get PDF'Use and abuse of antibiotics has longbeen recognised as a challenge confronting many developed and developing nations. While the more vigilantnations have been able toaddresstheissuethroughstrict drug controlregulations,countrieslikePakistan continuetostruggle with themenace ofimproper useofmedicines speciallytheantiinfective agents.Impact of thishazardous trendonthehealthand economyofoursocietytends togo un-noticedandthepublic, health officials aswellas media officials seem tobeeitherleastinterested orcompletely unaware of the implications involved.Antibioticsareessentialdrugswhich appear tochange, forbetter orworse,thenatureofseveraldisorders,including bowelconditions,metabolicdisordersorliver disease1.Theyare known toreduce morbidityfrom a varietyofbacterial infectionsandarepotentiallifesaversin certain floridseptic conditions suchas bacteremia and meningitis.Their inappropriate use, however has ledtodecreased efficacyandbacterialresistance, therebyundermining theirusefulpotential. Thelater effect i.e. resistance ofcertain bacterium to respondto drugs theyare usuallysusceptible to, results froma genemutationthateither protects it from the actionof the drug orneutralizesit2.Globally therehasbeen a surge ofresistant pathogensincluding methicillin resistantstaphylococcus aureus, penicillin resistantstreptococcus pneumonia andvancomycin resistantenterococci.Anymicro-organism thatsurvives anantibiotic treatmentcan multiplyand pass on its resistantproperties. Afactor responsible for this unfortunatescenarioincludes;Over-prescribing and under prescribing antibiotics by the caringphysician.Exaggerationofsymptomsbypatients togeta prescriptionofantibiotics not actually needed3Reluctance onpartof the patients to followcomplete course ofantibioticsas theyfeel better4wrongchoice of antibioticsUsingantibioticsforconditions where theyarenot indicated such asviral infections (common cold andflu like symptoms)IntheUnitedStates,according toa2013report bytheCentresforDisease Controland Prevention,atleast 2 millionpeople annually"acquireseriousinfections with bacteria thatare resistant to one ormore oftheantibiotics designedto treatthose infections."Itis estimatedthatatleast 23,000people die annuallyfromantibiotic-resistantinfections.Comparative morbidityand mortalityis muchhigherin underdevelopedand developingnations of the world.Thespectrum of resistance differsacross developed and developing countries specificto theirown circumstances5. Pneumococcalresistance towards penicillin and macrolides are the highest in Latin Americancountries, as is resistance ofSalmonella and Escherichia coli towards ampicillin and sulfamethoxazole-trimethoprim6In Pakistanas in manydeveloping countries especiallyAfrican, Asian and LatinAmerican, antibacterial drugs are grossly mis-used for reasons citedbelow;There seems tobe a culture ofselfdiagnosisandtreatmentbasedon previous experiencesDoctorsarekeen onempericaluseof antibioticswithout bothering todetermine actualsensitivity of the organismsinvolvedPrivate practitionercharginghandsome fees feel somewhatobliged to prescribehigh endantibioticsfor patient satisfaction.Trendtouseantibioticsleft overfromprevious prescriptions in favour oftheindividualor other household members. Desiring aquickrelief fromsymptoms without waitingfor final diagnosis based onappropriate investigations suchas cultures.There isa basiclackofawareness 7about theilleffects of antibiotic misuseamongstthepublic andagrowingtrendof injudicious antibiotic prescriptionbyhealthprofessional,lay person and unskilledpractitioners.Theincreasingnumber of drug-resistant infections results in:Crippling illness ordisabilityIncreasedmortality from previouslytreatable infectionsProlongedrecoveryRepeated hospitalization with increased lengthof stayMore medicalconsultationsLess effective and more-invasive treatmentsHigher costof treatmentAnumberofimportant bodies suchas the World Health Organisationand the British HouseofLords have identified the reasons for the emergenceof resistance to antimicrobialagentsandthe preventive measureswhich need to beurgentlyimplementedto curbthe spread of resistantorganisms.8It’s abouttimethatwe in Pakistan shouldstart thinkingintermsof Antibioticstewardship -i.e.appropriate use of Antibiotics.Itinvolves a multifaceted approach topreventing emergenceof antimicrobialresistancebyselecting an appropriatedrugandoptimizingitsdoseandduration to cure an infection while minimizingtoxicity9.This willhelp ensure maintaining efficacyand life spanofantibiotics. Available data suggestthatgood antibiotic stewardship reduces ratesofClostridium difficile-associated diarrhea, resistantgram-negative bacilli, and vancomycin-resistant enterococci.For anAntibioticStewardship Programme(ASP)tobeeffective, it should focus onimproving qualityofcare,reducingdrugresistance, andensuring costeffectiveness. Forimplementation of such a programme itis importantto understand and allaythe concerns of general population andhighlight thebenefitsofthe proposed changes.10There is also a need forcreating public awareness and imposingdiagnostic and therapeutic guidelines at the levelofhospitals and other healthinstitutions onlines set out below;Doctor prescription should bemandatoryfor dispensing antibiotics.Dosage regimens should be strictly adhered to forthe durationprescribed.Do away with left over antibiotics Discouragethe practice ofself diagnosis and treatmentDisregard anyprevious prescriptionsand donot takeantibiotics prescribed for anyotherpersonThe age old concept of'prevention is better than cure'should be followed bypracticing basic hygiene principles like handwashing, covering food and vegetables and keeping kitchen surface and utensils clean,atall times.Some vaccines protect againstbacterial infections, suchas diphtheriaandwhoopingcough(pertusis).Toconclude, we arealreadywitnessingadipin utilityof antibiotics inthis post antibiotic era and ifthis abuseis allowed to progress unchecked we mayfindourselves atthe mercy of dangerous infections and epidemics that we willstruggle to control
Bariatric Surgery: Cosmesis or Therapy
No full textFew surgical procedures have caught public imagination and expectations the way, weight loss intervention has done during the recent past. This is compounded by the fact that relevant procedures are now available through minimal access surgical approach offering a quick recovery and return to routine life. Moreover surgeons look upon these bariatric surgeries as a new and challenging modality that they are keen to add to their repertoire offering better reputation and financial incentives in addition to established benefits to their patients. The concept was infact introduced in the early 1950's with intestinal bypass acting through inducing malabsorption. However it was not until 1965 that Dr Edward E. Mason and Dr. Chikashi Ito at the University of Iowa developed the original gastric bypass which has since shown more promise with fewer complications and it is by virtue of this that the former has come to be known as the 'father of obesity surgery'. The boom in different procedures to be adopted has however led to a number of queries not only in the minds of those seeking intervention but the ones offering benefits related to ideal body weight and redressal of co-morbidities, that is the doctors as well. Technical debates are raging and recommendations changing as the concept continue to gain acceptability andmomentum. Contrary to the general perception that these procedures are meant primarily for cosmetic reasons, the actual benefits are now believed to be health related. Studies have shown that bariatric surgery contributes to diabetic control, psychological benefits, reduced risk of cardiac events and reduction in mortality of 23% from 40%1 . A lot of research has been afoot for more than half a century looking into possible surgical cures for metabolic diseases such as high lipid , cholesterol and blood sugar. In 1995 Dr Walter Pories et al published a paper2 concluding that gastric bypass is an established and effective therapy for morbid obesity and its associated morbidities, producing a durable and complete control of diabetes mellitus. In 2007, encouraged by the significant impact of bariatric procedures on actual cure of metabolic upsets as described, the American Society for Bariatric Surgery (ASBS) which was established in 1983 changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS). Given the recent public interest in the visible benefits of weight loss surgery and much wider availability of doctors and centres offering various procedures it is essential to have some consensus on standardization of indications for the said intervention. The American College of Physicians recommend that those with a BMI of at least 40 Kg/m2 who have failed an adequate exercise and diet programme and with co morbidities such as hypertension, impaired glucose tolerance , diabetes mellitus , hyperlipidemia and obstructive sleep apnoea should be offered the procedure after consultation with the prime surgeon3 . The American Society for Metabolic and Bariatric Surgery (ASBMS) in its recent guidelines however has suggested a BMI of 30 Kg/m2 with co morbidities as an indication for bariatric surgical intervention. Procedures recommended for affecting weight loss act by way of altering the anatomy of gastrointestinal tract (stomach and digestive system) and inducing physiologic changes in the body that affects energy balance and fat metabolism. They can be classified broadly into three types4 ;Predominantly malabsorptive :These procedures are mainly reliant on creating a physiological upset of normal absorptive mechanisms. They include biliopancreatic bypass, jejunoileal bypass and endoluminalsleeve. None of these are however in vogue given the metabolic and nutritional upset theycreate. Predominantly restrictive :Procedures such as adjustable gastric banding, vertical banded gastroplasty , intragastric balloon, gastric plication and sleeve gastrectomy result in a limited gastric volume thereby producing early satiety and reduced oral intake . Moreover since the continuity of the alimentary canal is not disturbed metabolic complications are not much of an issue5. Mixed:Gastric bypass, sleeve gastrectomy with duodenal switch and implantable gastric stimulation are procedures that apply both techniques simultaneously. Bariatric Surgery is usually supported by a dietary plan in the immediate post operative period, consisting of a clear liquid diet, followed by a blended or pureed sugar free diet for at least two weeks. The restrictive element of these procedures limits the capacity of the stomach inducing nausea and vomiting in case of excessive intake. Vitamin and mineral supplements are needed to compensate for decreased absorption of these essential items. High protein diets are usually recommended in light of the decreased consumption of food. The actual success of weight loss surgery depends on factors other than surgery alone such as long term nutrition and dietary habits, exercise and life style changes. Although there are demonstrable health benefits linked to bariatric interventions, the patient seems more concerned with the visible degree of weight loss. A meta-analysis6 from University of California Los Angeles looked at weight loss as a result of different procedures at thirty-six months and concluded that Biliopancreatic diversion offered maximum benefit at 117 pounds followed by Roux en Y gastric bypass and then vertical banded gastroplasty. Studies7 have also shown that bariatric surgery improved diabetic status in more than 85% of the affected and afforded remission in 78%. One of the key questions related to bariatric surgery is the amount of risk associated with this intervention. Complications related to the procedure as reported from time to time include gastric dumping syndrome, anastomotic leaks, incisional hernias, infections, pneumonia, osteopnia, secondary hyperparathyroidism, rhabdomyolysis, gallstones and hyperoxaluria. Studies have shown a mortality of less than 0.3% in individual undergoing surgery and a lower risk of death in the later group as compared to those plagued by obesity and its co-morbidities who do not have the procedure. Taking all the facts into consideration bariatric surgery certainly promises to attract headlines with introduction of modified interventional procedures from time to time as research into the best possible modality with maximum benefits and least risk continues. Patient variation and surgeon's expertise has its bearing on the ultimate choice in this respect as improvement in health,longevity and quality of life tops the list of core determinants acting as a guiding principle in making the ultimate decision regarding the intervention indicated
Effectiveness of Disc Excision in the Treatment of Herniated Lumbar Intervertebral Disc
Get PDFOBJECTIVETo determine the efficacy of disc excision in the treatment of herniated lumbar intervertebral disc.METHODOLOGYThis study was conducted at Neurosurgery Department of Naseer Teaching Hospital, Peshawar from February 2015 to January 2016.The study design was descriptive case series in which consecutive non probability sampling technique was used. Clinical outcome of patients undergoing discectomy was determined using Stauffer-Coventry criteria and patients rated as excellent, good, fair and poorRESULTA total of 88 patients were recruited with 64% males and 36% females. Mean age was 39 years+4.68 SD.70% patients had L4-L5 and 30% had L5-S1 level disc herniation. Laminectomy was performed in 58%,fenestration in 34% and hemilaminectomy in 8% patients. Postoperatively at four weeks, satisfactory pain relief reported by 85% and unsatisfactory pain relief reported by 15% patients.CONCLUSIONConventional laminactomy, fenestration or hemilaminectomy is a feasible, safe and effective treatment in patients with lumbar disc herniation. Relief of pain is faster for patients assigned to early surgery
Predictors of Success Of Vaginal Birth After Previous Cesarean Section: An Analysis of 100 Cases
Get PDFBACKGROUNDWomen eligible for vaginal birth after cesarean section (VBAC) have lower morbidity rates than women who undergo subsequent elective cesarean sections.Objective:To identify the obstetric parameters those influence the success of vaginal delivery in women with previous cesarean section.METHODOLOGYThis descriptive cross sectional study was conducted at Gynaecology and Obstetrics Department of Khyber Teaching Hospital, Peshawar from 1st May 2015 to 31st April 2016.Inclusion criteria was all women of any age or parity presenting at >36weeks gestational age, with singleton pregnancy, vertex presentation, estimated fetal weight of 2.5 -3.5kg and documented previous lower uterine segment cesarean section for a non recurrent cause. Five predictors of success of vaginal birth after previous cesarean including maternal age, gestational age, and history of vaginal delivery, onset of labor and bishop score were evaluated in each patient.RESULTSOut of 100 women, 64 had VBAC and 36 had cesarean section. Fifty five were booked and 45 were non booked. Total women with history of VBAC were 24, out of these 16(66%) had VBAC and 8(33%) had repeat cesarean section. Ninety three had spontaneous onset of labor whereas 7 were induced,88 patients had Bishop score >5,out of these 61(69%) ended in VBAC and 27(30.6%) had cesarean section. The most common age group where VBAC occurred in majority was 25- 35 years. Thirty nine (61%) women had period of gestation between 38weeks to 39weeks+6days. Mean maternal age was 29.42 + 3.54 yearsCONCLUSIONHistory of vaginal delivery, spontaneous sonset of labor and Bishop score >5 are the factors which are associated with more chances of vaginal delivery after cesarean section
To Determine the Frequency of Pyrexia in Women with Prelaborrupture of Membranes
Get PDFOBJECTIVETo determine the frequency of pyrexia in patients with prelabor rupture of membranesMETHODOLOGYThis descriptive (cross sectional) study was conducted in Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar from 12th January 2016 to 13th July 2016.Sample size was 369,keeping 4% proportion of pyrexia among women with PROM,95% confidence interval and 2%margin of error under WHO sample size calculation. All women with any age or parity who presented with prelabor rupture of membranes were included in the study.RESULTSIn this study, 369 women with PROM were observed.41(11.1%) patients were less than 20 years,139(37.7%) were in 21-30years age range,179(48.5%) were in age group 31-40years and only 10(2.7%) were more than 41 years age. Average age was 29.53+6.3SD.The pyrexia among women with PROM was observed in 39(10.57%)women, being more common in 31-40 years age group where it was noticed in 20(11.2%),followed by 21-30years age where 14(10.1%)patients were pyrexial.CONCLUSIONPyrexia is an enormous public health problem, accounting for the majority of cases of PROM in this part of the country
Level of Patients’ Satisfaction with the Dental Care Provided at Private Dental Hospital, Peshawar
Get PDFOBJECTIVEQuality is a major concern of health care authorities all over the world. Patient satisfaction regarding the dental treatment they receive is essential for the improvement of oral health service and practice. The aim of this study is to evaluate the levels of patient satisfaction regarding quality of dental care provided at Sardar Begum Dental Hospital.METHODSA random sampling technique based over one-month period; June 5th _ July 5th 2016 was used. Comprising of interviewer-administered questionnaires with a five point Likert scale (strongly agree, agree, uncertain, disagree, strongly disagree) to assess the level of patients’ satisfaction with the dental services provided at the Sardar Begum Dental Hospital.RESULTSA total of 360 patients participated that has received and/or was still receiving treatment at Sardar Begum Dental Hospital with a response rate of 73 %.The overall estimate of factors related to satisfaction showed a mean percentage of74.8% for the 4 disciplines of satisfaction displaying a high level of satisfaction.CONCLUSIONMajority of patients receiving treatment at Sardar Begum Dental Hospital were satisfied with dentist-patient interaction, administrative efficiency, technical competency and hospital environment
Refeeding Syndrome in a 5 Years Old Child: A Rare Complication of Malnutrition Management
Get PDFRefeeding syndrome is a rare but preventable complication of malnutrition management. This is the second case of refeeding syndrome being reported from Pakistan. Although many cases have been reported worldwide. It is a clear indication of lack of knowledge of the entity (Refeeding syndrome) in our doctor’s community. Refeeding syndrome presents with a mix picture of clinical manifestations and thus it is necessary to keep a regular check and balance of electrolyte disturbance especially serum phosphate levels before and after initiating nutrition irrespective of the route nutrition are given through. We are reporting a case of refeeding syndrome in a severely malnourished 5-year-old child which unfortunately died despite taking strict lifesaving actions
Different Types of Complications in Patients Suffering from B-Thalassemia (Thalassemia Major)
Get PDFINTRODUCTIONThalassemia is a heterogeneous group of gene disorders caused byan inherited mutation or deletion of genes at chromosome 16 & 11 resulting in decreased synthesis of adult hemoglobin. Its incidence is higher in people/children having a positive family history of Thalassemia Among its various types Beta Thalassemia major is the one which requires regular blood transfusions.OBJECTIVESThe main objective of the study was to determine the frequency of different types of complications in patients suffering from B-Thalassemia.METHODOLOGYThe study was conducted in two private originations in Peshawar i.e. Fatimid Foundation and Hamza Foundation.150 patients) were studied, the study was Cross-Sectional, descriptive type and sampling type was Non-Probability, convenience type sampling. All necessary data were obtained by using semi structured questionnaire, having both closed and open ended questions. Pilot Study was conducted on 15 patients (10%of target questionnaires). After completing the pilot study necessary changes were made in questionnaire and a well-informed, well-designed and organized questionnaire was finalized. An informed consent was taken from respondents and the responses were obtained each from the parents & from children themselves (in case of older children). Data was collected and results were presented in the form of tables and charts. Manual analysis of the data was carried out.RESULTSAccording to the study, among 150 patients, Splenectomy was done in about 86% patients. Consanguinity among the parents of these patients was about 76%, while awareness only 72% of patients. About 64% patients were having psychological problem. Among neurological problems 57% of patients had headache. Among complications, majority of patients had palpitations about 54% joint pains about 32% & history of bones fractures about 21%. Socioeconomic condition of majority of them was poor about 52%. All of them were taking primary treatment i.e. Blood transfusion &Chelating Therapy to prevent iron overload.CONCLUSSIONSThalassemia major is a life threatening disease causing morbidity and mortality among those who are not treated properly. The incidence of the disease is high among those with a family history of Thalassemia