Survival in general surgery: The female surgeons' perspective.

Objective: Specialty choices in health profession has long been influenced by gender. The field of General Surgery remains the least preferred specialty by females, especially in Pakistan. The objective of this study was to identify the factors leading to success and retention of females in General Surgery in Pakistan. Methods: Qualitative case study was conducted from February to May 2020 at Khyber Medical University, Peshawar. Ten semi-structured interviews were conducted with purposive sample of female surgeons at various academic position in different tertiary care hospitals of Pakistan. Data were thematically analyzed. Results: Participants were driven by their passion for surgery, which led them to choose this specialty in the beginning. Their survival in male dominant workplace was made possible by their own personality traits and conducive environment provided by the supervisors and peers. However, a structured mentorship program for females was found lacking. Conclusion: The necessary ingredients for success are passion and personality traits in any field but attention to nurturing and supportive environment for females in the General Surgery is paramount in determining success. Due consideration to the factors identified in the current study will enhance the retention and success of females in General Surgery.

Need Assessment Of Teaching Qualitative Research In Undergraduate Medical Education: A Mixed Method Study.

BACKGROUND: Accreditation bodies of medical education globally value competency in research that facilitates evidence-based practice of medicine. Physician-scientists need awareness of qualitative research methods for in-depth exploration of sociocultural, gender, behavioural, emotional, and religious factors affecting health that cannot be gauged by quantitative research methods. The introduction of qualitative research at the undergraduate level can enhance understanding of local populations' unique health needs and strengthen evidence-based practice. METHODS: This was a mixed-method study conducted from July to October 2021. Four journals with dedicated student's corner/student journals were hand-searched for qualitative research articles published by students, over the past five years. Quantitative data was collected at four medical colleges of Khyber-Pakhtunkhwa for several qualitative research projects being conducted by students. Quantitative data was collected from the faculty of these colleges about the facilities of research departments. After analysing quantitative data, five semi-structured interviews via email were conducted about factors limiting qualitative research at medical colleges. Written responses were analysed for themes. RESULTS: There was not a single qualitative research article published by students in local journals in five years. Out of 39 research projects by undergraduates at four medical colleges only one was qualitative. Two themes developed from qualitative data were underdeveloped research departments and a lack of attitude toward qualitative research. CONCLUSIONS: There is a felt need and gap to include qualitative research objectives at the undergraduate level, but before that emphasis needs to be placed on providing infrastructure, resources, and trained faculty to facilitate implementation. It will facilitate future doctors to find answers to problems impalpable by quantitative methods.

Azoles resistance of candida species causing vulvo-vaginitis in reproductive age women at a tertiary care setting.

Objectives: To study prevalence and resistance pattern to azoles of candida species causing vulvovaginitis in reproductive age women. Methods: Samples were collected from Hayatabad Medical Complex from November 2018 to May 2019. This cross-sectional study was conducted at the department of Microbiology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University Peshawar, Pakistan. A total of 369 high vaginal swabs were collected. Candida was isolated by vaginal swabs inoculation on Sabouraud's dextrose agar (SDA). Colonies on SDA were inoculated on Candida CHROM agar to identify candida species. Wet film microscopy and Gram staining were performed. Biochemical identification was done with 20C AUX. Antifungal susceptibility testing was done by disc diffusion and broth micro-dilution methods to find the resistance pattern of azole drugs. Fluconazole, Clotrimazole, Miconazole, Voriconazole and Itraconazole were the azoles drugs used. Results: Among 43%(n=158) positive candida cases, 44%(n=85) were non pregnant women while 41%(n=73) were pregnant. The Candida species distribution of 158 isolates was as follow; Candida albicans (C. albicans) 46.2%(n=73), Candida krusei (C. krusei) 29.1%(n=46), Candida parapsilosis (C. parapsilosis) 19%(n=30) and Candida glabrata (C. glabrata) 5.7%(n=9). Overall Candida isolates were highly resistant 72%(n=113) to Fluconazole while least resistant 21.5 % (n=34) to Itraconazole. Conclusion: C. albicans is the most prevalent specie involved in Vulvovaginal candidiasis. Candida species were found to be least resistant to Itraconazole followed by Voriconazole, Miconazole, Clotrimazole and Fluconazole.

Educational Environment In The Transition Phase Of Curriculum At Ayub Medical College Abbottabad, Pakistan.

BACKGROUND: Evaluation of the educational environment is key to the delivery of high-quality medical education. Especially, when an institute is in the transition phase of curriculum. In curriculum transformation phase of Ayub Medical College Abbottabad, no such evaluation has been done. This study aimed to find the direction of Educational environment in the transition phase curriculum of Ayub Medical College Abbottabad and compare different domains of educational environment with gender, residency, pre-medical education's medium of instruction, and doctors among sibling or parents. METHODS: This descriptive cross-sectional survey was conducted among students of integrated and traditional curriculum of Ayub Medical College, Abbottabad from 1st December 2019 to 29th February 2020. By Non-probability convenience sampling technique, pre-validated Dundee Ready Educational Environment Measure questionnaire was used. Descriptive and inferential statistics were calculated in SPSS v22. RESULTS: A total 149 (100%) participants, 66 (44.3%) males and 83 (55.7%) females with mean age of 20.5±1.07 years responded. Among total, 76 (51%) were from integrated curriculum and 73 (49%) were of traditional curriculum. Significant difference was found among different aspect of education environments and both classes. CONCLUSIONS: The current transitional phase of curriculum at Ayub Medical College Abbottabad is more positive than negative. Some areas like student social-self-perception still need improvement. Moreover, gender and place of birth affect student's perception about their learning environment.

Clinical factors and comorbidities affecting health-related quality of life in postrenal transplant patients.

BACKGROUND: Health-related quality of life is different among different transplant cohorts with respect to different variables which predict mortality and graft survival. The aim of this study was to identify the effects of clinical factors on the health-related quality of life in postrenal transplant patients. METHODS: This census study was conducted at the Institute of Kidney Diseases Peshawar, Pakistan. Data were collected on a questionnaire " Kidney Diseases Quality of Life-Short Form-1.3 Urdu version" and were analyzed in the 3 main domains, for example, physical component summary (PCS), mental component summary, and kidney disease component summary using SPSS version 21. Mean scores for patients with diabetes mellitus (DM), hypertension, levels of hemoglobin, and serum creatinine were compared by unpaired t-test. RESULTS: A total of 277 men (87.9%) and 38 (12.1%) women participated in the study. Mean age was 37.26 (±10.14) years (range 18-65 years). Hypertension was reported in 72.2% and DM in 10.8%. Hemoglobin was <12.5g% in 26.0% patients. Patients with DM had significant lower PCS (P = .001) and mental component summary (MCS; P = .001) scores. Patients with hypertension had significant lower MCS score (P = .01). Patients with hemoglobin <12.5g% had significantly lower PCS (P = .001) score than those with hemoglobin >12.5 g%. The PCS score in patients with serum creatinine level >2 mg% was significantly lower (P = .02) than those with serum creatinine <2 mg%. CONCLUSION: Lower graft function and DM were associated with lower PCS and MCS scores. Hypertension was associated with lower MCS score and anemia with lower PCS score.

Synergistic Effect Of Oral Allopurinol And Intralesional Sodium Stibogluconate In The Treatment Of Cutaneous Leishmaniasis.

BACKGROUND: Leishmaniasis is an endemic disease and a major public health problem throughout the world. Its geographic distribution has been extended over the past few years in Pakistan. The available treatment options of Leishmaniasis are limited and mostly parenteral, and hence a nontoxic oral alternative therapy is urgently needed to overcome the problem. The objective of this study was to evaluate the synergistic effect of Allopurinol as an adjunct therapy along with conventional intra-lesional sodium Stibogluconate in the treatment of cutaneous Leishmaniasis. METHODS: This single blinded randomized controlled trial was carried out at the tertiary care hospitals of district Peshawar, Pakistan. A total of one hundred and sixty-four (164) patients of age range from 19-56 years, consisting of both genders were included in this study. All subjects were randomly allocated to Group-1 and Group-2 where each group had 82 patients of comparable age and genders. Group-1 patients were given an intra-lesional injection of sodium Stibogluconate at a dose of 1-5 ml depending on the lesion size, where one ml injection contained 100 mg of the drug. Group-2 patients were given combination therapy of oral Allopurinol (20 mg/kg/day in divided doses) along with the same intra-lesional sodium Stibogluconate dose as group-1 until complete cure of the lesion. RESULTS: Combination therapy of sodium Stibogluconate along with Allopurinol was found superior to sodium Stibogluconate alone in terms of duration of treatment. Group-1, patients who received only sodium Stibogluconate required prolonged treatment duration of 6-9 weeks depending upon the lesion size, while group-2 patients who received combination therapy of sodium Stibogluconate and Allopurinol responded more quickly and their lesions cured in 3-6 weeks depending upon the lesion size. CONCLUSIONS: Oral Allopurinol has a synergistic effect when used with intra-lesional sodium Stibogluconate and effectively reduces the treatment duration required for complete cure of cutaneous Leishmaniasis. Treatment duration was reduced by 3 weeks in the present study when combination therapy was given to the patients of cutaneous Leishmaniasis.

Rheumatological manifestations in patients hospitalized with COVID-19 in a tertiary care setting.

BACKGROUND: Corona virus disease 2019 (COVID-19) is a pandemic affecting over 150 million people worldwide since its emergence in Wuhan, China in December 2019, and is leading to over 600 thousand deaths. Severe acute respiratory syndrome novel coronavirus 2 (SARS-nCoV-2) causes a wide range of symptoms by affecting different organ systems of the body. This study was designed to specifically look for its rheumatological manifestations. METHODS: It was a cross-sectional study conducted in the corona complex MTI Lady Reading Hospital Peshawar. A total of 141 COVID-19 positive hospitalized patients requiring oxygen therapy and having no previous rheumatological diseases were enrolled and studied for any rheumatological manifestations. RESULTS: There were 88 (62.4%) males and 53 (37.6%) females, with age range from 27-88 years, and mean age of 58.5±11.5 SD. Arthralgia and myalgia were found very common, occurring in 128 (90.8%) and 119 (84.4%) of patients. Arthritis was not found in any patient. CONCLUSION: Arthralgia and myalgia were reported frequently in patients with severe COVID-19 requiring oxygen therapy, while arthritis was not present even in a single patient as is reported in other viral infections.