The spectrum of Self-directed learning perceptions among faculty members and students of Bolan University of Medical and Health Sciences.

Objectives: To analyze the perception of students and faculty regarding self-directed learning (SDL). Methods: This mixed method study design (pragmatic) with both positivist and interpretive approaches was conducted on faculty members and students of Bolan Medical College Quetta from 1st April 2021 to 31st Aug 2021 on 246 medical and dental students and 12 faculty members. The research question was about the role of SDL in undergraduate medical students and faculty members. The inclusion criteria were any registered student and permanent faculty member, while exclusion criteria were any selected student and faculty member who not consented to participate in study. Data on self-directed learning instruments from medical students on 5 points Likert scale was collected by regular interval method and faculty members on an open narrative questionnaire by purposive sampling. The data were analyzed by the SPSS version 26, framework method of content analysis, and constant comparison technique. Results: The mean age of students was 21.45 + 2.01 years. There were 114 males and 132 females (ratio 1: 1.15). The maximum mean score (4.35) is 91.1% followed by (4.32) 84.0% of students' percept that SDL constantly improves & excels in learning and successes and failures inspire SDL. The minimum mean score (3.32) 49.2% revealed that students felt difficulty in arranging and controlling their learning time. The faculty perception that SDL leads to professional identity (confidence & self-identity), improved technical skill (better expression & enhanced cognition), professionalism (focused learning, effective reflection, time management & self-satisfaction), collaboration, communicator, and leadership qualities. Conclusion: The students strongly believed that SDL will improve and excel but they need time management. Faculty members concluded that leadership, communication, collaboration, and professionalism are related to SDL.

Giant ovarian cyst--an unusual finding.

A 16 year old unmarried girl presented with complaints of abdominal distension, vomiting, constipation, difficulty in breathing and restlessness. On examination abdomen was grossly distended with fluid thrill. Ultrasonographic examination revealed that there was a huge cystic collection with internal debris, multiple septations involving the whole abdomen and pelvis originating from right ovary. The left ovary was normal. Her laparatomy was done. A giant ovarian cyst measuring 45 x 32 x 28 cm, which weighed 18 Kg (almost 1/3 of whole body weight), was removed as such like a yoyo balloon. Post-operative recovery was smooth. Histopathological examination revealed that it was mucinous cystadenoma.

Comparisons of Onlay versus Sublay Mesh Fixation Technique in Ventral Abdominal Wall Incisional Hernia Repair.

OBJECTIVE: To compare the results of onlay with sublay mesh repair technique for ventral incisional hernia. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Surgical Unit IV, Sandeman (Provincial) Hospital, Quetta and Mohtarma Shaheed Benazir Bhutto Hospital, Quetta, from July 2016 to December 2017. METHODOLOGY: Sixty-five patients, diagnosed by clinical examination as ventral incisional hernia, were included in the study. Patients were divided randomly into two groups. Group 1 had onlay mesh repair while group 2 were subjected to Sublay mesh fixation technique. Results of the procedures done in terms of operative time, wound infection, seroma formation, hospital stay, and follow-up. The data was analysed by the SPSS. RESULTS: The age ranges from 18-65 years, mean 39.13 +11.76 years. There were 42 males (64.61%) and 23 females (35.4%). The distribution of ventral incisional hernia was 42 (64.61%) in midline, followed by subcostal incision in 10 (15.38%) patients. In group 1, a total of 33 (50.76%) patients underwent onlay mesh repair, while 32 (49.23%) patients had underwent sublay mesh repair in group 2 (p=0.007). The wound infection and dehiscence was less in group 2. The seroma formation was prevalent in group1 (p-value 0.005). The hospital stay in group 2 was less (p=0.003).The follow up for 6 months revealed no recurrence in 20 patients of group 1 and 12 patients of group 2. CONCLUSION: Group 2 has a definitive edge over group 1 in the management of incisional hernia. The morbidity of the patient in group 2 was lower than group 1.

Accessory thyroid nodule in sub-mandibular region.

A case of an accessory thyroid nodule with a diagnosis of focal lymphocytic thyroiditis, in 23 years old lady, on histopathological examination, is presented. Patient had a single swelling in the left submandibular region without any abnormality. Postoperative thyroid scan showed thyroid gland in its normal anatomical location with suppressed activity and thyroid profile revealed subclinical hypothyroidism.

Comparison of unfractionated heparin vs low molecular weight heparin in the treatment of acute deep vein thrombosis.

OBJECTIVE: To compare the results of unfractionated heparin (UFH) with low molecular weight heparin in the treatment of acute deep vein thrombosis of lower limb. DESIGN: Randomized control trial. PLACE AND DURATION OF STUDY: Bolan Medical Complex Hospital, Quetta from January 2002 to July 2003. PATIENTS AND METHODS: Thirty patients who presented with acute deep vein thrombosis of lower limb, confirmed by either Doppler ultrasonography or venography, were selected for the study. Patients were divided randomly into two groups for treatment. Group 1 was started with unfractionated heparin while group 2 with low molecular weight heparin. Comparison of two treatments to determine the efficacy was done by certain criteria like pain improvement, reduction in swelling, alteration in bleeding profile, complications of therapy, recurrence, morbidity and mortality. RESULTS: The age of the patients ranged from 16-82 years. There were 15 females (50.00%) and 15 males (50.00%). Pain and swelling were present in all patients (100%), while temperature and superficial vein dilation in 43.3% and 30% respectively. The distribution of DVT in left lower limb was in 13 patients (43.33%), right lower limb involvement in 12 patients (40.00%) and both limbs involvement in 5 patients (16.67%). In group 1 improvement in pain occurred after 4th day in 13 patients, while in group 2 before 4th day in 8 patients (p-value = 0.068). Improvement in swelling was observed after 6th day in 11 patients (group 1), while before 6th day in 8 patients (group 2) (p-value = 0.171). Bleeding time was prolonged in 5 patients in group 1 and statistically found significant (p-value = 0.014), while in group 2 it was normal. Thromboembolism in 3 patients and major bleeding was observed in 2 patients in group 1, while in group 2 it was normal. Recurrence was reported in 2 patients in group 1 and 1 patient in group 2 (p-value 0.0815). The hospital stay was more than 10 days in group 1 (12 patients), and less than 10 days in group 2 (13 patients). It was found statistically significant (p-value = 0.001). Three patients died in group 1, while no mortality was observed in group 2. CONCLUSION: Treatment with low molecular weight heparin (LMWH) has good patient compliance and is easy to administer. LMWH has an advantage over UFH due to its normal bleeding profile and significantly less hospital stay.

Diagnostic yield of color Doppler ultrasonography in deep vein thrombosis.

OBJECTIVE: To see the diagnostic yield of color Doppler ultrasonography in patients who presented with clinical symptoms and signs of acute deep vein thrombosis of lower limb. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The study was carried out in Bolan Medical Complex Hospital, Quetta from January 2002 to December 2002. SUBJECTS AND METHODS: Twenty five patients, who presented with clinical symptoms and signs of acute deep venous thrombosis of lower limb, were selected. In all patients color Doppler ultrasound and venography was performed to compare the results. RESULTS: The age of the patients ranged from 16-82 +/- 20.33 years. The mean was 49.16, median 50.00 and mode 60.00 There were 15 females (60.00%) and 10 males (40.00%). Left lower limb involvement was seen in 12 patients (48.00% +/- 0.51), right lower limb involvement in 10 patients (40.00% +/- 0.50) and both limbs involvement in 3.0 patients (12.00% +/- 0.33). Color Doppler ultrasound was positive in 16 patients (64.00% +/- 0.48) while venography was positive in 21 patients (84.00% +/- 0.37%). Doppler ultrasonography and venography showed that 11 patients (52.38%) had distal DVT, while 10 patients (47.62%) had distal as well as proximal DVT. Ten patients (100.00%) of proximal as well as distal DVT were diagnosed by CDU and later confirmed by venography. Eleven patients (100.00%) of distal DVT only in whom 6 patients (54.54%) were diagnosed by CDU, while 5 patients (45.46%) had inconclusive findings, which were confirmed by venography. Doppler ultrasonography compared venography showed sensitivity 76.1%, specificity 100%, positive predictive value 100%, negative predictive value 44.45% and accuracy 80.00%. CONCLUSION: Color Doppler ultrasonography is a non-invasive, safe, efficient and cost-effective method in diagnosing acute deep venous thrombosis of lower limb but still it has not 100% accuracy. It is better for diagnosing proximal DVT than distal DVT. 7.

Spontaneous feeding tube knotting over a vesical calculus.

A case of spontaneous feeding tube knotting over a vesical calculus, in a 3 years child, is presented which had evaded clinical diagnosis and was discovered at open cystolithotomy. A vesical calculus with a firm simple knot of feeding tube over it and stuck at internal urethral meatus was found. Feeding tube was cut and cystolithotomy performed. Postoperative follow-up was without complication.

A functional ectopic vaginal anus: a rare clinical entity.

A case of functional ectopic vaginal anus is presented in a 20 years old girl. Patient complained of passage of stool through her vagina. She was continent and had no complaint of constipation. Her examination revealed imperforated anus with functional ectopic vaginal anus. Her surgery was performed in two stages. In first stage, anoplasty was performed at midpoint between the vulval and anal opening. The posterior vaginal wall was repaired in two layers and protective loop colostomy was made. In the second stage, after a period of 3 months loop colostomy was closed. Patient's recovery was smooth, she is not constipated and continent with Wexner score of 3. She was advised pelvic floor rehabilitation exercises.She improved within a month with Wexner score of zero.