Multiple pathological changes affect lower extremity of patients directly leading to amputation and death-Dr. Shazli Naseer


 Shalamar Medical College Conference Proceedings-V

Multiple pathological changes affect lower
extremity of patients directly leading to
amputation and death-Dr. Shazli Naseer

Academic and intellectual corruption is rampant in our
medical institutions which are not fulfilling their
responsibility to the society- Prof.Lubna Baig

Uro-Gynae diseases are under reported, under
diagnosed and under treated-Stephen Jeffery

LAHORE: Dr. Shazli Naseer from USA was one of the invited guest speakers in State of the Art Session-II during the recently held Second International Medical Conference of Shalamar Medical & Dental College Lahore held from February2-4, 2018. The topic of her presentation was advances in treatment of diabetic foot ulcer- Save a Limb to Save Life. Speaking about the prevalence of diabetic foot ulcers, she pointed out that almost 65% of diabetic patients in China suffer from foot ulcers. She emphasized the importance of educating the patient, educating the Family Physicians and one should never ignore feet of diabetic patients.

Prof. Lubna Baig Pro VC Jinnah Sindh Medical University presenting Mementoes to Dr. Masood Jawaid,
Dr. Ahsan Sethi and Mr. Shaukat Ali
Jawaid at the Second International Medical Conference of
Shalamar Medical & Dental College held from February 2-4, 2018.

Multiple pathological changes affect lower extremity of these patients which directly lead to amputation and death. Almost about 85% of lower extremity amputations are produced by diabetic foot ulcers. About 50% of diabetic patients develop ulcers and five years mortality is about 55%. Almost 75% of mortality in these patients, she said, is due to lower extremity amputation. Loss of limb results in poor quality of life. There are serious risks of uncontrolled diabetes. Speaking about the type of diabetic foot ulcers she said 51% are neuropathic, others are neuro ischaemic and ischaemic ulcers. For assessment of diabetic foot ulcers, one must concentrate on history and physical examination. Also ask the patient about duration of ulcer. Wound in uncontrolled diabetes will never heal. Some may develop chronic ulcers. Peripheral vascular disease can be diagnosed based on symptoms and history. Screen all these patients for infections. Diabetic foot has foul smell. If Ankle Brachial Index shows bone is affected, it is usually osteomylitis. She also talked about Wagner classification of diabetic foot. Grade-V needs amputation. She advised the treating physicians to take the photograph of diabetic foot every week to monitor the patient.

Prof. M. A. Wajid presenting certificates to speakers at the Second International Medical Conference
of Shalamar Medical & Dental College held recently.

Talking about treatment of diabetic foot ulcers, she mentioned adequate vascular supply, infection control, pressure off loading and sharp surgical debridement. She then referred to different dressing products and said that wound dressings have come a long way. One can also use combination of dressings, silver dressings gives good results. Use of honey is also very effective. She then referred to different off loading devices, wound care centers, use of Manuka honey, negative pressure wound therapy and HBOT therapy. It is important that one makes correct diagnosis, do not use total cast, do not ignore nutrition counseling and know the patient beneath the wound. Consider aggressive wound care and early Introduciton of intravenous antibiotics, she added.

Prof. Zahid Bashir Principal SMDC presenting Mementoes to Prof. M.A.Wajid and
Dr. Zakiuddin Ahmad at
the Int. Medical Conference of SMDC held recently.

Social accountability
of medical institutions

Prof. Lubna Baig Pro Vice Chancellor of Jinnah Sindh Medical University from Karachi was the next speaker in this session who talked about social accountability of medical institutions. She pointed out that we have now one hundred fifty six medical and dental colleges and they are expected to produce competent trained physicians. They must ensure patient safety and these medical institutions are also desired to produce the future leaders of healthcare. These are the responsibilities of the healthcare institutions. Main functions of the medical institutions are to provide service, education and research. The concept of social accountability in health sector was coined in 1990s but we are still struggling for it. Social accountability means that these institutions have some responsibility to the society. Studies show that we have just 30.8% contraceptive use, IHD, infectious diseases and tuberculosis are still very common. We have highest neonatal deaths. Even Sri Lanka has much better health indicators as compared to Pakistan despite the fact that they have also reported growth in population. She then asked, are we fulfilling our responsibilities?

Prof. Kh. Azeem presenting Mementoes to Prof. Ayaz Ali Khan, Prof. Abrar Ashraf and
other speakers at
the Int. Medical Conference of SMDC held recently.

 HEC and PM&DC, Prof.Lubna Baig said have defined the core competencies of the doctors. We need to look at patient in holistic manner. We do not have good role models. Academic and intellectual corruption is rampant in our medical institutions. We must look at ourselves. We have seen some quality improvement in medical education. We need to address Evaluaiton, assessment and accountability issues. Students need to be involved in curriculum development. Media has an important role to play. We need to enter into partnership with community. She suggested that each institution should adopt a community and train students there.

Prof. A. Majeed Chaudhry Principal Lahore Medical & Dental College presenting a memento to
Prof. Kh. Azeem during the Second International Medical Conference of
Shalamar Medical & Dental College held recently.

It will lead to better quality of care, community development. Students should be trained in the community at practice sites. It will lead to improvement in our health indicators. Then community will start trusting you and this will also reduce the burden on teaching hospitals. She asked are we ready to accept this challenge? Are the faculty members ready to accept this challenge? Are the students ready going to the community for training? Our graduates need to be evaluated in their site of practice, she concluded.

Establishing Uro-Gynaecology departments

Dr. Stephen Jeffery talked about establishing Uro-Gynaecology Departments in tertiary care institutions. He pointed out that about thirty thousand deliveries take place annually in South Africa in special maternity units. Their hospital has IVF facilities in the Gynae department and a busy ultrasound department. We have many full time and part time urologists. There is lot of fistulas in Pakistan. One needs skills to pick up these fistulas. He also talked about recurrence and treatment, stigma of incontinence, low self esteem. It results in lowering the quality of life. He then talked about surgery for Prolapse. Uro-Gynae diseases, he opined, are under reported, under diagnosed and under treated. These patients need supportive hospital management through a team work which should consist of urologist, colorectal surgeon, physician, nurses. These patients have higher complications and increased recurrence rate. He emphasized the importance of building a team.

Group photograph shows some of the delegeates attending the Second Int. Medical Conference
organized by Shalamar Medical & Dental College
from February 2-4, 2018.

Some of the problems, challenges which one faces while establishing these Uro-Gynae departments include Lack of training, Lack of resources, anaesthesia facilities, and lack of proper investigations. Our hospital he stated offers observer ship grants as well as Fellowship grants. Develop good relationship with various institutions. Get the basics right. He also referred to cystoscopy, perineal ultrasound, treatment of overactive bladder. He concluded his presentation by emphasizing the importance of building a team, collaboration, building surgical volume, counseling the patients besides good post operative follow up. He then quoted late Nelson Mandela who had said that “It always seems impossible until it is done.”