Diagnostic Accuracy of Different Bedside Clinical Methods in Evaluation of Peripheral Neuropathy in Patients of Diabetes: Experience at a Tertiary Care Center

Background and Objectives: At present, the gold standard for diagnosis of diabetic peripheral neuropathy is biothesiometry. Sincethe data are sparse comparing the biothesiometry with commonly used bedside tests, we conducted this study to evaluate theclinical accuracy of simple bedside clinical screening tools for evaluation of peripheral neuropathy in patients of diabetes mellitus.Materials and Methods: Atotal of 120 patients with diabetes mellitus referred from the endocrinology department, from August2014 to July 2017 were included in this study. A detailed clinical assessment including diabetic neuropathy symptom (DNS)score, diabetic neuropathy examination (DNE) score, ankle reflex, vibration sensation with a 128 Hz tuning fork, and 10 gSemmes-Weinstein monofilament, and biothesiometry was done in all the subjects.Results: The prevalence of peripheral neuropathy was 36% with biothesiometry. Only 33.33% of patients followed foot carepractices in the study population. Monofilament was the most sensitive and accurate of all the diagnostic tests for the evaluationof peripheral neuropathy in diabetes patients. On statistical analysis correlations observed between the biothesiometry andthe DNE score (r = 0.572, P < 0.00018) and DNS score (r = 0.436, P < 0.0004) and absent tuning fork sensation (r = 0.510;P < 0.0007), monofilament sensation (r = 0.713; P < 0.0002) and ankle reflex (r = 0.456, P = 0.0002) were significant.Interpretation and Conclusions: we concluded that simple bedside tests are useful for diagnosing peripheral neuropathy indiabetes patients including those in whom foot care practices are not followed.

Outcome karydakis procedure for pilonidal sinus

To analyze the Outcome of karydakis procedure for pilonidal sinus. Prospective interventional Lahore General Hospital, Lahore from January 2001 to December 2004. Patients with chronic pilonidal sinus and Karydakis procedure was adopted. Total No of 60 patients underwent excision and asymetrical primary closure. Six patients required intravenous analgesia minor wound infection was present in twelve patients [20%]. Forty eight [80%] patients were able to resume normal household activities with in two weeks while full outdoor activities were possible in two to three weeks in nearly 100% of cases conversion to open methods was zero with recurrence rate 5% [3 Cases] patients acceptability was 90% [54 Cases]

Minilaprotomy cholecystectomy with mini clip applicator a useful alternative to laparoscopic cholcystectomy

To analyze outcome of after LC [Laparoscopic Cholecystectomy] and MC [Minilaparotomy Cholecystectomy] for symptomatic Gall Stones. Randomised prospective study. Lahore General hospital Lahore from January 2003 to December 2004. Study comprised of two groups [A and B] of 320 people with 160 patient in each group. Group A was offered LC and Group BMC outcome data looked at operative time, rate of conversion to conventional cholecystectomy, operative complication, post of stay, wound infection and patient satisfaction. A total number of 320 patients underwent cholecystectomy with 160 in each LC and MC group. There were 280 [77%] females and 40[33%] males. Median operating time was 60 and 40 minutes for LC and MC, while conversion to conventional cholecystectomy was 12.5% in LC group and 6% in MC group. There was 3% minor bile duct injury in LC and 0% in LC group. There was 6% of wound infection in LC group and 9.3% in MC group while median hospital stay was 1 day for LC and 2 days for MC group while patient satisfaction was 90% for LC and 80% for MC group. MC [Minilaparotomy Cholecystectomy] is a safe and feasible technique in which minimal invasiveness of LC [laparoscopic cholecystectomy] is preserved, so advocating MC for those patients who do not need to return to work early and who are also concerned with cosmetic result

Evaluation of the management of penetrating abdominal injuries - Lahore general hospital experience

Objectives To study the changing pattern of penetrating abdominal injury, to check the effectiveness of management, to audit the associated morbidity and mortality and to suggest ways and means to improve serious outcome. Study Design: Prospective interventional. Place and Duration of study: Department of surgery Lahore General Hospital, Lahore from March 1998 to March 2004. Subject/Method: Exploratory laparotomy of all patients with history of penetrating abdominal injury with at least breach of peritoneum. In a 114 20 patient exploratory laparotomy was performed their average pulse rate was 110 / min, systolic blood pressure 90 / mm Hg with Hb range of 5.5 gm / dl to 11.5 g / dl. There were 68% victim of firearm injury and 32%o were suffered from stab on exploration virtually no organ found to escape injury while 42 [10%] cases turned out to be negative with uneventful postoperative recovery. 94[24.2%] patients developed post operative complications while 42[10%] patients expired. Time should not be wasted in investigating unstable patients rather these should be resuscitated in Operation Theater and early exploratory laparotomy should be performed more sophisticated diagnostic facilities like ultrasound, CT, MRI, Endoscopy, selective angiography should be made available in emergency and there should be regular audit of all penetrating abdominal injuries