Comparative Study Of Combined Co-Enzyme Q10 And Clomiphene Citrate Vs Clomiphene Citrate Alone For Ovulation Induction In Patients With Polycystic Ovarian Syndrome.

A total of 136 patients with PCOS were followed through the Department of the Obstetrics and Gynaecology, Unit-IV, Lady Aitchison Hospital, Lahore. Patients were randomly divided by lottery method into two groups i.e., Group-A (CoQ10 plus Clomiphene citrate) and Group-B (Clomiphene citrate alone). The selected patients in the study group (group-A) were given Clomiphene citrate 100mg/day from cycle days 2-6 for 45 days (2 cycles) and CoQ10 in a dose of 50mg soft gel capsules thrice per day starting at cycle day-2, until HCG administration. Patients in controlled group (group 21 B) received Clomiphene citrate 100mg/day twice a day cycle for 45 days. Data were analysed in SPSS v25.0. In group-A (CoQ10 plus Clomiphene citrate), successful ovulation induction was noted in 16 (23.5%) patients, showing that with the addition of CoQ10, the chances of ovulation induction increased.

Faculty Willingness For Continuing Online Teaching-Post COVID-19 Pandemic In Pakistan.

Objectives: To determine faculty willingness for continuing online education after coronavirus disease-2019 in Pakistan, and to correlate it with perceived gain in experience in online teaching during the pandemic. METHODS: The cross-sectional study was conducted at Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan, from January to July 2021, and comprised medical faculty with teaching experience of at least 2 years. Data was collected using an online questionnaire though Google Forms. Multiple regression analysis was done to determine faculty willingness with perceived experience levels in online education. Data was analysed using SPSS 25. RESULTS: Of the 100 subjects approached, 68(68%) responded; 51(75%) females and 17(25%) males. Of the total, 30(44.1%) participants were aged 33-40 years, 25(37%) were from Basic Sciences, 27(39.7%) from Clinical Sciences, 16(23.5%) from Allied Health Sciences, and 39(57.4%) had teaching experience <5 years.. Overall, 39 (57.4%) participants were willing to continue online education post-pandemic, 20(29.4%) agreed partially and 9 (13.2%) did not agree. A positive linear relationship was found between willingness to continue online education and increase in perceived experience level in teaching online (p=0.021). CONCLUSIONS: There was a significant difference between perceived experience level in online teaching before and after the coronavirus disease-2019 pandemic. Those with increase in perceived experience level were willing to continue online education.

A narrative study on work place based conflicts in Obstetrics and Gynaecology Department.

OBJECTIVE: To explore the patterns in research and underlying factors of conflicts in obstetrics and gynaecology and its effect on restricting the quality of education and training of residents. METHODS: The narrative study was conducted at the Obstetrics and Gynaecology Department, Lady Aitchison Hospital, King Edward Medical University, Lahore, Pakistan, from October 2018 to January 2019, and comprised narrative essays by residents associated with the department. Data was subjected to thematic analysis. RESULTS: Of the 27 residents, 26(96.3%) were females and 1(3.7%) was male. Overall, 19(70.3%) were aged 25-30 years and 8(29.6%) were aged 30-35 years. Three levels of conflict were identified: organisational, interpersonal and individual. Causes of organisational conflict included inadequate facilities, poor security and unclear duty appointments. Interpersonal factors included lack of communication, lack of patient autonomy, non-cooperative co-workers, illiteracy of attendants and unprofessional behaviour. Individual factors were overburdening duty hours and duty negligence. CONCLUSIONS: There was found to be a need to design education programmes, like workshops, that may enable post-graduate residents in obstetrics and gynaecology to handle conflicts at workplace.

Comparison of effectiveness of WhatsApp and Facebook as learning tool for the students of a medical college.

OBJECTIVE: To compare the effectiveness of Facebook and WhatsApp as learning tools for undergraduate medical students in ophthalmology. METHODS: The quantitative, quasi-experimental study was conducted at Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan from October 2017 to March 2018, and comprised 4th year medical students. A pre-test of ophthalmology topics was taken and participants were divided into Facebook and WhatsApp groups by gender-based stratified randomisation. Four topics were taught through Facebook and WhatsApp to the relevant groups and post-test was taken using multiple choice questions. Data was analysed using SPSS 20. RESULTS: Of the 100 students, 35(35%) were males and 65(65%) were females. The overall mean age was 21.76±0.85 years (range: 20-24 years of. The two groups had 50(50%) subjects each. A significant difference was found between pre- and post-test results of both the groups (p<0.001). There was no significant difference between the groups (p>0.05) neither the baseline nor post-intervention. There was significant difference along gender lines (p>0.05). CONCLUSION: Facebook and WhatsApp as learning tools had no significant difference in terms of impact on the learning process.

Burn out among the paediatric surgeons of Pakistan.

This study was to assess the prevalence of Burnout syndrome among physicians, medical students and other healthcare professionals as they are considered more prone to it. It has been reported to be as high as >85% among surgeons, due to the sensitive and exhaustive nature of their job. The objective was to determine the prevalence of burnout among Paediatric surgeons (PS) of Pakistan. For this cross-sectional study, all PS working in Pakistan were included. In order to assess burnout, Maslach Burnout Inventory (MBI) was used. Burnout was found among 15% of the PS. In this group, it was also found that 17.5% of PS had high Emotional Exhaustion (EE), 12.5% had high Depersonalisation (DEP) and 30% had low Personal and Professional Achievement (PPA). Also 35% of PS were experiencing burnout in at least one domain. The significant protective factors we found in this group was having a non-doctor spouse for low EE (P=0.014), FCPS fellowship degree for low DEP (P=0.011), more than 2 post-graduation degrees for high PPA (P=0.008) and private practice for high PPA (P=0.020). We concluded that a large number of PS are facing burnout, and at the same time, a large proportion of them are at risk of moderate levels burnout from EE, DEP and PPA.

Conservative management of placenta increta in a primigravida: A case report.

Morbidly adherent placenta in the absence of risk factors is a rare entity in primigravida, and its conservative management becomes important in such patients to preserve future fertility. We report a case where a primigravida was discovered accidentally having placenta increta while her caesarean section was being performed due to foetal distress (grade 2 meconium). There was unexpected delay in delivery of the placenta. It was managed conservatively by performing a bilateral uterine artery ligation and methotrexate post operatively. On weekly follow-ups serum beta Human Chorionic Gonadotropin(bHCG) levels were done as well as and two weekly ultrasounds. Conservative management of morbidly adherent placenta can be considered in primigravidas where there is a great need to preser ve fer tility and avoid hysterectomy.

Educational environment for residents in Obstetrics and Gynaecology working in teaching hospitals of Lahore, Pakistan: A cross-sectional study.

The objective of this study was to determine the educational environment of residents in the specialty of Obstetrics and Gynaecology (OBG) working in the hospitals of Lahore, Pakistan. This cross-sectional study was conducted at OBG Department, King Edward Medical University. All the Post-graduate Residents (PGR's) of OBG working in Lahore, Pakistan were included in this study. Educational environment was assessed using Postgraduate Hospital Educational Environment Measure (PHEEM).A total of 368 PGR's from 11 institutions were included in this study. The mean PHEEM score was 63.68 ± 29.60. Most of the participants labeled the environment as 'plenty of problems' as per global scale of PHEEM. PHEEM score was significantly higher for those working in Government hospitals. Gender, year of residency and marital status showed no difference in PHEEM score. We conclude that educational environment in our OBG departments is not adequate and up to the mark.

Role of placental blood drainage as a part of active management of third stage of labour after spontaneous vaginal delivery.

OBJECTIVE: To compare the duration of 3rd stage of labour and blood-loss in patients with and without placental cord blood drainage following normal vaginal delivery. METHODS: The quasi-experimental study was conducted at the Services Hospital, Lahore, Pakistan, from October4, 2015, to April 4, 2016, and comprised pregnant women aged 18-40 years with any parity having gestation >36 weeks and haemoglobin >7.0gm. The subjects were divided into two groups. In one group, routine active management of third stage of labour was done and placental end of the umbilical cord was left open to drain blood in a kidney tray till flow ceased. In the other group, the placental end of the cord was left clamped and spontaneous expulsion was carried out by controlled cord traction. Data was analysed using SPSS 22. RESULTS: Of the 200 females, 100(50%) were in each of the two groups. The overall mean age was 29.22}6.84 years. The mean baseline haemoglobin in placental cord drainage group was 11.48}0.89 and that in the control group was 11.40 } 0.91 (p>0.05). The mean duration of third stage of labour in placental cord drainage group was 5.67}1.81 hours and in control group it was 8.44}2.50 hours (p<0.001). The mean blood-loss in placental cord drainage group was 174.69}13.69mlcompared to 196.25}15.06ml in the control group (p<0.001). CONCLUSIONS: In the management of the third stage of labour with the cord drainage method, results showed significant reduction in postpartum blood-loss and the duration of the third stage in normal vaginal birth patients.

Do parents have knowledge of first aid management of burns in their children? A hospital based survey.

OBJECTIVE: To ascertain knowledge of first aid among parents of children suffering from burns. METHODS: The cross-sectional study was conducted at Mayo Hospital, Lahore, Pakistan, from July 2017 to January 2018, and comprised parents of patients in the paediatric burns unit. Questionnaires were filled by the duty doctor after interviewing parents, and data was collected regarding first aid, application of traditional remedies and demographic details. Optimal knowledge was defined as parent's knowledge of application of tap water on burns as first aid. SPSS 20 was used for data analysis . RESULTS: There were parents of 310 patients who had a mean total body surface area of burns of 25.11}13.80%. All (100%) accidents had occurred at home. All (100%) parents had removed their children from heat and electric source immediately after the accident, while 282(91%) stripped their children of their clothes. Only 41(13.2%) parents irrigated the burn area with tap water and 93(30%) applied traditional remedies. Further, 21(6.8%) parents had covered the burnt area with sterile dressing, while 25(8.1%) had covered the child to avoid hypothermia. One (0.3 2%) parent had attended a first aid course, while 13(4.2%) had knowledge of first aid because of previous history of a child having suffered from burns. Optimal knowledge wasstatistically associated with previous knowledge of first aid (p=0.0001), level of education of the parent (p=0.003) and monthly income (p=0.01). CONCLUSIONS: The knowledge of first aid among parents was found to be inadequate and there was an urgent need to introduce campaigns focussing on prevention and first aid to manage burns, especially among illiterate and poor classes.

Evaluation of educational environment for postgraduate residents using Post Graduate Hospital Educational Environment Measure.

The objective of this study was to determine the level of educational environment among residents working in our hospital using Post graduate hospital educational environment measure (PHEEM). This cross-sectional study was conducted at services hospital, Lahore. All the Post-graduate residents (PGR's) working at Services hospital, Lahore were asked to fill a proforma having 2 parts: Bio-data and PHEEM. Out of 110 PGR's, 87 completed questionnaires, of which majority labelled education environment into level 3 (71%). Overall mean PHEEM score calculated was 90.49 ±15.44. Maximum score was found for teaching subscale followed by autonomy and social support subscale. Highest mean score was found for neurology (104) department and lowest for anaesthesia (72 ± 9.19). General surgery, internal medicine, paediatric medicine and gynaecology gave mean score of 90, 92, 93 and 89 respectively. There was non-significant difference in terms of PHEEM score when stratified for gender, year of residency and marital status.

Burnout among gynaecological residents in Lahore, Pakistan: A cross-sectional survey.

OBJECTIVE: To determine the prevalence of burnout among gynaecological residents and factors associated with it. METHODS: This cross-sectional study was performed at the University Medical and Dental College, Faisalabad, Pakistan, from March to April 2016, and comprised female medical students. Participants were divided into groups on the basis of their ABO blood groups and on body mass index criteria. Blood groups were determined by simple conventional slide method. Blood pressure was estimated by manual auscultatory technique with a mercury sphygmomanometer. Data was analysed usingSPSS20. RESULTS: Of the 102 participants, 57(55.9%) were satisfied after choosing gynaecology as career. It was found that emotional exhaustion and depersonalisation were significantly higher among residents working in government institutions than private institutions (p<0.05). Those having more than 2 years of post-graduate experience had significantly higher depersonalisation than those with lesser experience (p=0.016). Also, working for 50-60 hours/week and feeling dissatisfied with the specialty were associated with significantly higher emotional exhaustion and depersonalisation (p<0.05). CONCLUSIONS: Burnout was highly prevalent among gynaecological residents.

Glycaemic Control Of Type 2 Diabetic Patients During Ramazan Fasting.

BACKGROUND: Among five main pillars of Islam Fasting is one of the key elements, all healthy adult Muslims have to observe fast from dawn till dusk during the holy month of Ramadan. According to a 2009 demographic study, Islam has 1.57 billion believers, making up 23% of the world population of 6.8 billion, and is growing by 3% per year. EPIDIAR (epidemiology of diabetes and Ramadan) study showed that 43% patients with type 1 and 79% patients with type2 diabetes observe fast during the month of Ramadan. Whereas those people who are suffering from diabetes and are fasting may be at risk of adverse outcomes and the risks may rise with longer fasting periods. Ideal management of diabetic patients who wish to fast during Ramadan needs to be done to avoid the complications. The purpose of this study was to observe the effect of fasting on glycaemic control in type 2 diabetic patients during the month of Ramadan. METHODS: This was an observational cross sectional study; it was conducted at outpatient department Jinnah institute of diabetes and endocrinology Jinnah hospital Lahore during the month of Ramadan. Patients were advised to monitor blood sugar levels for two days before and after three meals (lunch, breakfast and dinner) before Ramadan and then during Ramadan blood sugar levels were monitored for four days in first Ashra before and two hours after Sehari, for four days at noon during second Ashra and then for four days pre and two hours after Iftar in last Ashra of Ramadan. Patients were educated Pre-Ramadan about glucose monitoring and drug dosage adjustments were done along with dietary counselling. RESULTS: Blood glucose levels two days before and during Ramadan fell within range of mean glucose level of 150-187 mg/dl showing no extreme fluctuations in blood glucose levels only one patient reported symptomatic and biochemical hypoglycaemia severe enough to break the fast at noon. CONCLUSIONS: We concluded that in Ramadan fasting, type 2 diabetic patients with proper education, dietary counselling and drug dosage adjustments glycaemic control can remain in safe acceptable range preventing any life-threatening complication.

Role of Vitamin D in reducing number of acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD) patients.

BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is characterized by chronic incompletely reversible poor airflow and air trapping and usually this debilitating disorder limits the outside activities of the patients depriving them of sunlight which is a rich source of Vitamin D. The objective of this study was to determine the effect of vitamin D supplementation in reducing number of acute exacerbation in COPD patients. METHODS: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore from January to December 2015 as exacerbations of COPD are season dependent. Diagnosis was confirmed by performing Pulmonary Function Tests (PFTs). Basic demographical information was obtained and baseline PFTs of the patient was done. Only Group A patients was treated with oral vitamin D intake of 2000 IU daily for 6 months. Vitamin D level was measured at 0, 2, 4, and 6 months and exacerbation of COPD, FEV1 and FVC was measured weekly. Both the groups were given standard treatment for exacerbation of COPD. Spirometry was repeated at each visit. Blood samples were collected every 2 months for vitamin D. Supplementation was stopped if vitamin D level exceeded 100ng/ml. RESULTS: The mean age of the patients was 46.28±8.83 years, the male to female ratio was 1.8:1. The mean 25(OH) level at baseline was 24.08±2.58 and at 6th month was 29.60±8.74. The mean FVC at baseline was 77.83±5.49 and at 6th month was 91.34±5.52. The exacerbation at baseline was present in all 120(100%) patients and at 6th month was reduced to 4(3.3%). CONCLUSION: Vitamin D supplementation has significant effect in reducing number of acute exacerbation in COPD patients when it is given for prolonged period.

Factors necessary for entrustment decision-making in surgical operating rooms: A modified Delphi study.

Objective: Resident autonomy in an operation theatre has been directly linked with patient safety in healthcare. The objective of this study was to identify the factors necessary for making resident-entrustment decisions from the perspective of a supervisor/consultant viewpoint. The second objective was to develop a checklist for assessing resident readiness for independent work. Materials and methods: This study employed a mixed-method Delphi approach. In the first stage, a comprehensive literature review and a qualitative exploratory study produced a list of factors related to residents. The second phase involved content validation by a panel of experts, followed by a two-round Delphi study with 20 expert panelists. Results: A total of 49 resident-related factors for entrustment were identified, which were reduced to 46 after content validation. During Delphi Round I, 17 factors were fully accepted, 7 were rejected and 22 items were partially accepted. Out of the 39 items sent to Delphi Round II, 23 items were accepted and 16 were rejected. A final 23-item checklist was formed based on the following factors; 6 Cognitive (knowledgeable, risk manager, safe doctor, general manager, field of interest, communicator), 5 Psychomotor (past performer, competent, ability to pick critical findings, ability to act situationally, decision maker) and 12 affective (responsible, leader, honest, empathetic, ethical, receptive, humble, emotionally intelligent, motivated, accountable, team player, disciplined) factors. Conclusion: The study resulted in the formation of a checklist based on the factors necessary for entrustment decision-making in surgical operating rooms. Some of the novel contextual factors were 'general manager', 'field of interest', 'ability to pick critical findings', 'accountable', 'risk manager', and 'past performer'. This framework offers a guideline for supervisors and residents to evaluate progress throughout the residency program. The developed tool demonstrates good content validity and is suitable for entrustment assessment following construct validation.

Frequency of Group B Streptococci in Pregnant Women in a Tertiary Care Hospital.

OBJECTIVE: To determine the frequency and risk factors of Group B Streptococci (GBS) in pregnant patients in third trimester in a tertiary care hospital in Lahore. STUDY DESIGN: Cross-sectional, prospective study. PLACE AND DURATION OF STUDY: Lady Willingdon Hospital, Lahore, from October 2014 to March 2015. METHODOLOGY: Sterile lower vaginal swabs were taken from 200 women aged 20 years and over, in third trimester, with no history of vaginal bleeding, ruptured membrane, recent intake of antibiotics or chronic illness. These swabs were cultured for detection of GBS. The risk factors of GBS and its frequency were noted in the pregnant population. Quantitative and qualitative data was analyzed by SPSS version 20. Chi-square test was applied to see association between diagnosis of GBS and other categorical variables. P-value ≤0.05 was considered as statistically significant. RESULTS: In this study, the mean age of all the females was 26.36 ± 4.32 years and mean duration of pregnancy was 35.54 ± 2.65 weeks. Frequency of GBS in pregnant women was found as 14%. We observed significant association of GBS with parity and previous history of miscarriage (p-value = 0.033 and 0.010 respectively). Moreover, significant association between vaginal discharge and GBS was also found (p = 0.027). CONCLUSION: GBS is present in a small but significant number of pregnant women in our setting and it has association with multiparity, vaginal discharge during pregnancy, and previous history of miscarriage.