Frequency of external hernias in Ayub teaching hospital Abbottabad

Hernia is a protrusion of a viscous or a part of a viscous through an abnormal opening in wall of its containing cavity. Different external hernias present differently and ultimate treatment is surgical, which is most commonly performed elective operation in the world. The objectives were to know the age and gender wise frequency of external hernias in Ayub Teaching Hospital, Abbottabad. This retrospective study was conducted at the surgical units of Ayub Teaching Hospital during June 2004 to June 2005. Records of all cases of hernias operated in Ayub Teaching Hospital during June 2004 to June 2005 were retrieved from the operation registers of the entire three surgical units available at the operation theatres. The data was collected on a proforma and was analysed by SPSS-16. Of the 1063 cases, 982 [92.38%] were male and 81 [7.62%] were female. Right Inguinal Hernia [RIH] was the most frequent as expected, i.e., 44.12%, followed by Left Inguinal Hernias [LIH] 18.72%. Least common hernias were femoral hernias with a frequency of 0.85%. It is concluded that 85% hernias occur in the groin, with 12% incisional and only 3% hernias occur elsewhere. To reduce the rate of complications, health education is the most important intervention. For future health planning maintenance of disease register can not be over emphasized

Maternal and fetal outcome of prelabor rupture of membranes at term [PROM] - a trial of 24 hours of expectant management

To find out the maternal and fetal outcome of 24 hours of expectant management. Prospective descriptive study. Labor room of obstetrics and gynae unit 1, services hospital Lahore. Participants were 100 women presenting with prelabor rupture of membranes at term, 50 nullipara and 50 multipara with cephalic presentation and no contraindication to vaginal delivery. All the participants of the study group were subjected to conservative management for 24 hours under antibiotic cover of inj cefataxime followed by induction if labor did not start spontaneously in 24 hours or if signs of chorioamnionitis developed at any stage. Data was collected on a Performa, which was then entered on database IV and analyzed in percentages on spss statistical package. The magnitude of PROM in gynae unit 1 services hospital in the year 2002 was 7.008%. 84% patients went into spontaneous labor, 2% patients developed signs of chorioamnionitis, and 14% patient did not enter into spontaneous labor after 24 hours of PROM. 94% patients with PROM delivered vaginally total of 6 c/s were carried out, 2% c/s due to fetal distress, 2% for failed induction and 2% for fetal distress after induction. Postnatal complications included chorioamnionitis 2%, PPH 7%, puerperal pyrexia 4%, wound infection 3%. and DVT in 1% patients. Neonatal complications included admission to ICU in 8% babies and neonatal infection in l%. There was no fetal mortality. Conservative approach did not negatively affect fetal or maternal outcomes

Knowledge, Attitudes and practices of patients attending west bay health center towards upper respiratory tract infections

Upper respiratory tract infections [URI] are very common in general practice. Although viruses cause the majority of URI, many patients expect antibiotic treatment. At one Primary Health Care Center in Qatar, during October-November 2004, eleven hundred and eleven adult patients completed a short questionnaire on demographics, knowledge, attitudes, practices towards URI, and patient satisfaction. Four hundred and forty eight [40.3 percent] recognized viruses as the most common cause of URI; seven hundred and eighty-eight [70.9 percent] chose consulting a physician as the first line of action when contracting URI; 721 [64.9 percent] stated that management should be based on physician's diagnosis while 28 percent expected antibiotics. A majority of participants acknowledged the importance of counseling in their satisfaction but 49.6 percent reported dissatisfaction if antibiotics were not prescribed and 31.6 percent reported seeking antibiotics when not prescribed. Participants expecting antibiotics differed significantly regarding knowledge of causes of URI [p = 0.004]. There was no significant difference regarding factors affecting satisfaction based on antibiotic expectation. Results highlight the need for public education and counseling on etiology, course, and management of URI by physicians

Postgraduate medical education in Pakistan

This paper discusses the current status of various postgraduate medical qualifications [from Pakistan and abroad]. Till 1947, doctors holding academic posts in British India possessed both clinical and academic postgraduate qualifications [e.g., MRCP with MD/Ph.D] or a local postgraduate qualification combining high quality research and clinical training e.g., MD [Punjab University]. After creation of Pakistan, an account of a scarcity of trained doctors, an adhoc arrangement was adopted. For several decades, doctors [trained in Pakistan and abroad] were appointed to academic posts on the basis of clinical postgraduate qualification only [e.g., MRCP, FRCS]. A large number of doctors have now passed postgraduate medical examinations. Hence, the contingency which prompted the adhoc arrangement no longer exists. There is, therefore, a need to revise the selection criteria for academic posts. The author recommends that doctors holding postgraduate qualifications be offered two types of appointments depending upon the type of postgraduate qualification[s] they hold. A- Those holding a clinical qualification only, such as: [i] MRCP, FRCS [U.K.], [ii] American Board from USA, [iii] FCPS [Pakistan], [iv] Master of Medicine from Punjab University [a new qualification, proposed to be offered by Punjab University, similar in standard to MRCP, FRCS/FCPS/American Board]. The holders of these qualifications will be entitled to clinical appointments only. B-Those holding a clinical qualification mentioned above plus one of the following: [i] M.Ss/Ph.D from a British University based on original full time research of a duration not less than two years. [ii] Doctor of Medicine qualification from Punjab University [a doctorate based on full time research for at least two years duration]. [iii] An equivalent qualification from another University but with the same provisions as that recommended for Punjab University. [iv] A full time research fellowship of a duration of at least two years on an original topic, at a recognized institution. Such individual would qualify for academic appointments. C-The paper recommends that those individuals holding only a research qualification such as M.Sc from a British University, without a clinical postgraduate qualification, may not be considered for academic clinical posts or for the post of consultants in Medicine

Syringomyelia: syringosubarachnoid shunt

Syringomyelia, a disease first recognised and treated almost a century ago, has been diagnosed and treated more readily since the advent of modern neuroradiological investigations like delayed Myelo C.T. and MRI. In our Department, during the last 9 months, four patients have been investigated and treated with syringosubarachnoid shunt. No patient had associated hind brain abnormality; one had a past history of tuberculous disease of the spine, while in three cases, no cause could be identified. Operative results are being presented and pathophysiology of syringomyelia discussed

Portal hypertension

Portal Hypertension is a common cause of mortality and morbidity in our hospitals. Most of the literature which has originated from Western countries indicate the aetiology of Portal Hypertension as cirrhosis in the majority of patients. Studies from India show that almost one third of patients with portal hypertension have non-cirrhotic portal fibrosis. They are relatively of younger age group, have got massive splenomegaly with features of hypersplenism and near normal liver function tests. Variceal bleeding is a very common presentation. It is possible that similar disease pattern may exist in our population. However, very little work has been done on this subject and it is necessary to find out the incidence of Non-Cirrhotic Portal Hypertension [N.C.P.H.]. Hence a study of the disease in Pakistan is mandatory

Health effects of ethylenediamine

The study was done in a chemical factory manufacturing polyamides and using Ethylene diamine [EDA]. Diethyltriamine [DETA], Triethylenetetramine [TETA] as well as xylene, toluene caustic soda, sulfuric acid in secondary process. The whole procedure was enclosed, except workers were exposed to EDA while manually pumping and discharging the chemical. The results have shown that the workers in the exposed group were having chronic respiratory symptoms of cough 7/12, phlegm 8/12, wheezing 4/12, attacks of sneezing 7/12, and skin itching or rash 7/12. The lung functions i.e. FVC, FEV1, FEV1/FVC ratio were lower and diurnal variation in paek expiratory flow rates were higher in the exposed group. It is concluded that exposure to these substances poses greater risk for health of workers and special measure should be adopted for prevention