The relationship between timing of admission to a hospital and severity of injuries following 2005 Pakistan earthquake.

PURPOSE: The objective of this study was to establish the relationship between the timing of admission to a hospital and the severity of injuries following an earthquake. METHODS: It was a retrospective chart review of injured patients admitted to a tertiary care teaching hospital following the 2005 Pakistan earthquake. Age, gender, injury severity score, type of injuries, complications, operations, hospital stay and mortality were studied and compared at different time intervals using SPSS. RESULTS: Most injuries were musculoskeletal [145 (59%)] vs. all other injuries, including minor lacerations [103 (41%)], but the percentage of non-musculoskeletal injuries was higher within 24 h (67% vs. 53% respectively, p = 0.4). Injury severity score (25 ± 10 vs. 16 ± 9, p=0.01), multiple injuries [73% vs. 45%, p=0.05] and crush syndrome [20% vs. 03%, p = 0.02] were significantly higher in patients admitted within 24 h. More patients with head and neck injuries were admitted within 24 h (27% vs. 18%, p = 0.4). Patients admitted within 24 h had higher complication rates (67% vs. 32%, P = 0.01) as well as mean operative procedures (2.8 ± 1.9 vs. 1.9 ± 1.9, p= 0.08). CONCLUSION: Our study showed that patients admitted to a hospital within 24 h following an earthquake had more severe injuries and higher complication rate than those admitted after 24 h.

Association of Body Mass Index and Diet with Symptomatic Gall Stone Disease: A Case-Control Study.

BACKGROUND: Gall stone disease (GSD) is one of the commonest gastrointestinal disorders. Causative factors can be non-modifiable as genetics and modifiable like dietary habits. High-fat diet and high BMI are well known contributing factors world-over. Local and regional data is deficient about these factors. Moreover, Indo-Pakistani dietary patterns are very different from the western population. This study was conducted to see the association of high BMI and diet with GSD in our population. MATERIALS AND METHODS: This case-control study was conducted in Shifa International Hospital, Islamabad, from 2012 to 2017. We included all female patients above 25 years of age with symptomatic gall stones on ultrasonography as cases and all females above 25 years of age with no gall stones on ultrasonography (done for any reason) as controls. The patients with gall stones having some other clear predisposing cause for gallstone formation, e.g., stoma, sudden weight loss, etc. were excluded. BMI, demographic details, dietary habits, and clinical profile of cases and controls were recorded. Data were analyzed by SPSS v 21. p-values were calculated. RESULTS: A total of 396 patients were included in this study, with 103 cases and 293 controls. The mean BMI of GSD cases was 27.576±5.753, while controls had a mean BMI of 25.638±7.008 (p=0.08). About 26.4% of cases had an average fat consumption greater than 100g/day as compared to 11.9% controls (p=0.035). The average red meat intake per week was 222g among cases while 210g among controls (p=0.001). The average intake of fried food per week was 270g among controls and 250g among cases (p=0.012). The average intake of bakery items per week was 240g among cases and 210g among controls (p=0.038). CONCLUSION: Gall stone disease is significantly related to high BMI and high dietary fat and meat intake in our population.

Colovesical fistula: should it be considered a single disease?

PURPOSE: This research was conducted to compare the management and the outcome of patients with colovesical fistulae of different aetiologies. METHODS: Retrospective data were collected from 2002 to 2012 and analyzed with SPSS ver. 17. Age, gender, aetiology, management, hospital stay, postoperative complications, and mortality were studied and compared among colovesical fistulae of different aetiologies. RESULTS: A total of 55 patients, 46 males (84%) and 9 females (16%), with a median age of 65 years (interquartile range [IQR], 48-75 years) were studied. Diverticular disease was the most common benign cause and recto-sigmoid cancer the most common malignancy. Anterior resection and bladder repair were the most frequent operations in benign cases, as was total pelvic exenteration in the malignant group. Multiple intestinal loop involvement and subsequent resection were significantly higher in those with Crohn disease than it was in patients of colovesical fistula due to all other causes collectively (60% vs. 6%, P = 0.006). Patients with malignancy had a higher postoperative complication rate than patients who did not (12 [80%] vs. 7 [32%], P = 0.0005). Pelvic collection (11, 22%) was the most frequent early complication (predominantly in the malignant group) whereas incisional hernia (8, 22%) was the most common late complication, with a predominance in the benign group. The median hospital stay was significantly prolonged in the malignant group (32 days; IQR, 17-70 days vs. 16 days; IQR, 11-25 days; P < 0.001). CONCLUSION: Despite their having similar clinical presentation, colovesical fistulae of various aetiologies differ significantly in management and outcome.

What do medical students expect in a teacher?

BACKGROUND: Medical students prefer some teachers over others within the same medical school or department. The objective of our study was to find out what qualities may allow all teachers to be nearly on a par in terms of student preference. METHODS: A single-centre cross-sectional study was conducted among first- to fifth-year medical students. All students were surveyed with a questionnaire to identify the qualities that they would like to see in their medical teachers. Three rounds of survey were conducted using the Modified Delphi technique in order to obtain the consensus of the students. If more than 85 per cent of the students agreed on a quality, it was considered final. In the final round students were asked to rate the chosen qualities in order of importance. The data were analysed using the statistical software spss 17. RESULTS: A total of 181 students responded to the survey. The qualities identified by medical students were grouped into four major and 11 minor categories. All qualities were ranked according to importance, as determined by the students. Teaching (158; 88%) and interpersonal (157; 87%) skills were ranked as the most important skills required of a medical teacher, followed by personal (150; 83%) and professional (140; 77%) skills. Administrative skills were deemed the least essential (112; 62%) of the skills sought in a medical educator. CONCLUSION: Medical students' preference for one teacher over another is directly correlated with a teacher's ability to teach, his or her interpersonal skills, as well as personal and professional qualities.