Inguinal hernioplasty; laparoscopic tep with and without dissection balloon

To compare laparoscopic TEP Inguinal hernioplasty with and without dissection balloon. Observational study. Minimal Invasive Surgical Centre Jamshoro and General Surgical Department at Dow University Hospital, Ojha Campus Karachi. May 2011 and Dec 2012. Twenty [20] male patients with uncomplicated unilateral or bilateral inguinal hernia were prospectively randomized in two groups; group A Commercially available dissection balloon and group B. Telescopic dissection for creating TEP working space. We had 20 male patients for this study. The average age was 43.6 and ranging between 17 to 64 years. Only 2 patients 10% had bilateral groin hernia, 4 patients 40% had direct inguinal hernia in group A and 5 patients 50% had direct hernia in group B. Peritoneum was breached in 5 [50%] patients with telescopic dissection. One patient [10%] with bilateral groin hernia in group B had large tear in peritoneum converted to TAPP while other group normal. The incidence of scrotal edema/seroma was greater in group B then group A. 40% patient in group B developed seroma while 0nly 1 [10%] patient with bilateral groin hernia in group A developed seroma. Pain was scored on VAS at 1 and 4 hours after surgery was higher in group B. The mean operation time was 55 min [45-100] in the group with the balloon and 73 min [50-120] in the group without the balloon [p = 0.004]. TEP laparoscopic inguinal hernia repair is probably the best option amongst the two techniques used in laparoscopic inguinal hernia repair and dissection with balloon is though costly but more helpful in dissection and safer

Fall-related injuries in a low-income setting: results from a pilot injury surveillance system in Rawalpindi, Pakistan

This study assessed the characteristics and emergency care outcomes of fall-related injuries in Pakistan. This study included all fall-related injury cases presenting to emergency departments [EDs] of the three teaching hospitals in Rawalpindi city from July 2007 to June 2008. Out of 62,530 injury cases, 43.4% [N = 27,109] were due to falls. Children [0-15 years] accounted for about two out of five of all fall-related injuries. Compared with women aged 16-45 years, more men of the same age group presented with fall-related injuries [50% vs. 42%]; however, compared with men aged 45 years or more, about twice as many women of the same age group presented with fall-related injuries [16% vs. 9%, P < 0.001]. For each reported death due to falls [n = 57], 43 more were admitted [n = 2443, 9%], and another 423 were discharged from the EDs [n = 24,142, 91%]. Factors associated with death or inpatient admission were: aged 0-15 years [adjusted odds ratio [aOR] = 1.35], aged 45 years or more [aOR = 1.94], male gender [aOR = 1.15], falls occurring at home [aOR = 3.38], in markets [aOR = 1.43], on work sites [aOR = 4.80], and during playing activities [aOR = 1.68]. This ED-based surveillance study indicated that fall prevention interventions in Pakistan should target children, older adult women, homes, and work sites

Medical students' perceptions of peer assessment in a problem-based learning curriculum

Peer assessment [PA] is believed to support learning and help students develop both professionally and personally. The aim of this study was to examine medical students' perceptions of intragroup PA in a problem-based learning [PBL] setting. This study was carried out between September and November 2014 and involved six random groups of fourth-year undergraduate medical students [n = 60] enrolled at the Arabian Gulf University in Manama, Bahrain. While working on set tasks within a curriculum unit, each student evaluated a randomly selected peer using an English language adapted assessment tool to measure responsibility and respect, information processing, critical analysis, interaction and collaborative skills. At the end of the unit, students' perceptions of PA were identified using a specifically-designed voluntary and anonymous self-administered questionnaire in English. A total of 55 students participated in the study [response rate: 92%]. The majority of students reported that their learning [60%], attendance [67%], respect towards group members [70%] and participation in group discussions [71%] improved as a result of PA. Regarding problem analysis skills, most participants believed that PA improved their ability to analyse problems [65%], identify learning needs [64%], fulffil tasks related to the analysis of learning needs [72%] and share knowledge within their group [74%]. Lastly, a large proportion of students reported that this form of assessment helped them develop their communication [71%] and self-assessment skills [73%], as well as collaborative abilities [75%]. PA was well accepted by the students in this cohort and led to self-reported improvements in learning, skills, attitudes, engagement and other indicators of personal and professional development. PA was also perceived to have a positive impact on intragroup attitudes

Road traffic injuries in Rawalpindi city, Pakistan

Data on road traffic accident [RTA] injuries and their outcome are scarce in Pakistan. This study assessed patterns of RTA injuries reported in Rawalpindi city using standard surveillance methods. All RTA injury patients presenting to emergency departments of 3 tertiary care facilities from July 2007 to June 2008 were included. RTA injuries [n=19 828] accounted for 31.7% of all injuries. Among children aged 0-14 years females suffered twice as many RTA injuries as males [21.3% versus 11.4%], whereas this trend reversed for the age group 15-24 years [41.9% versus 21.7%]. One-fifth of injuries were either fractures or concussion. Severity and outcome of injuries were worse for the age group 45 years and older. For every road traffic death in Rawalpindi city, 29 more people were hospitalized and 177 more received emergency department care. These results suggest the need for better RTA injury surveillance to identify preventive and control measures for the increasingly high road disease burden in this city

Health disparities between Muslim and non-Muslim countries

We examined differences in health indicators and associated factors across countries according to the proportion of the population who are Muslim. Of 190 UN countries, 48 were classified as Muslim-majority countries [MMC] and 142 as non-MMC. Data on 41 potential determinants of health were obtained from 10 different data sources, and 4 primary outcome measures [male and female life expectancy, maternal mortality ratio and infant mortality rate] were analysed. Annual per capita expenditure on health in MMC was one-fifth that of non-MMC. Maternal mortality and infant mortality rates were twice as high in MMC as non-MMC. Adult literacy rate was significantly higher for non-MMC. Four significant predictors explained 52%-72% of the differences in health outcomes between the 2 groups: gross national income, literacy rate, access to clean water and level of corruption

Road safety in the Eastern Mediterranean Region -findings from the Global Road Safety Status Report

A secondary data analysis using the Global Status Report on Road Safety [GSRRS] was carried out to assess the epidemiology of road traffic injuries [RTIs] and preventive strategies in the Eastern Mediterranean Region [EMR]. EMR countries ranked equal first in the world for the highest number of fatalities due to RTIs [32.2 per 100 000 population]. The region had about 4% of the world's vehicles with 0.097 registered vehicles per person. The number of injured cases in EMR was 210.1 per 100 000 population. Only 15% of EMR countries had a funded, independent, multisectoral body for road safety. Only 25% had mandatory seat-belt laws for both front-seat and rear-seat passengers, 60% had mandatory helmet laws for both drivers and passengers of motorized two-wheelers and 10% had child restraint laws. Road safety in EMR countries needs more attention and consideration

Intrauterine contraceptive use in women attending a tertiary level health care center in the UAE

To evaluate the awareness of Intrauterine Contraceptive Devices [IUD] among women, estimate the frequency of IUD use and identify the common symptomologies associated with the use of IUDs. A cross section survey was conducted in the OPD of OBG Department in Gulf Medical College Hospital and Research Centre, UAE, on 111 women aged 18-50 years who used any form of contraception. Data were collected using a 21 item pre-tested, self-administered questionnaire. Data was analyzed on PASW 19. Of the 111 participants, 58.6% were in the 18-29 years age group, with 36.9% Arabs and 63.1% Non-Arabs; 80.2% of them were married. Approximately 72% were aware of intra uterine devices. Oral contraceptive pills [54%] were used more often than IUDs [39.6%]. When asked specifically about IUDs, non-Arabs [62%] used IUDs more than Arabs, 45% used it because it was easier, 25% felt it was safer. For those who were aware of IUDs physicians [57%] were the main source of information. Among the users of IUD, around 52% used Copper T, 37% used Progestasert, and 10% used other IUDs [mainly Mirena]. The majority of IUD users complained of high fever and irregular bleeding [32.9% of cases each], followed by lower abdominal pain and pain with coitus [26%], and 20% vaginal discharge. Failure of IUDs was reported in 7 women [15.9%], three had normal delivery and two each had miscarriage and ectopic pregnancy. We could not establish a relation between types of IUDs and changes in menstrual pattern. Even with the wide availability of mass media and the internet 28% of the women were not aware of IUDs. Despite being a safe method most did not use this method of contraception. Efforts must be made to educate women about the different choices they have for contraception with their indications and contraindications

Liver assessment in patients with osteoarthritis taking non steroidal anti inflammatory drugs mainly [diclofenac acid] within two to six weeks of treatment

Non steroidal anti-inflammatory drugs [NSAIDs] are used to treat musculoskeletal disorders, inflammation and to control pain. Virtually all [NSAIDs] are capable of producing liver injury ranging from mild reversible elevation of liver enzymes to severe hepatic failure. To estimate the hepatic risk associated with the use of some NSAIDs. 80 osteoarthritis patients were on diclofenac acid [voltarin] tablets 75 mg, 60 of them were female and 20 were male, laboratory estimateion of serum alkaline aminotransferase [ALT], serum aspartate aminotransferase [AST], serum alkaline phosphatase activity and total serum bilirubin [TSB] were done. For comparison age and sex matched 96 apparently healthy persons serve as controls. 27 [33.75%] of the diclofenac treated patients had some impairment of liver function tests, 66.6% of the liver injury found in patients aged more than 50 years and 88.8% had occurred in females. Hepatocelluar injury characterizes most USAIDs induced hepatotoxicity. The frequency of drug induced liver injury [DILI] in diclofenac treated patients is about 33.75%. DILI is more common in females and old age

Assessment of a modification of bruckner's test as a screening modality for anisometropia and strabismus

Current amblyopia screening methods are not cost effective. To evaluate the diagnostic capability of a modified Br_ckner test [MBT] for amblyopiogenic risk factors. We applied the MBT using the streak retinoscope to identify anisometropia and strabismus by noting an inter-ocular difference in movement and glow, from children who failed 6/9 Snellen on community vision screening, followed by comprehensive eye examination. Data were analyzed by 2 _ 2 tables for diagnostic test parameters [95% CI]. From 7998 children vision-screened, 392 failed 6/9 VA and were referred. Since 34 failed to reach the centers, and 15 were excluded due to poor/ no glow, data from 343 was analyzed. The prevalence of anisometropia of 0.5D was 17%, of 1D was 11% and of strabismus 5%. For the MBT the accuracy was ? 90% [95%CI 89% to 97%] over the three outcomes. The sensitivity, specificity, NPV and +LR for anisometropia of 0.5D were: 0.57 [0.48, 0.64], 0.97 [0.95, 0.98], 0.92 [0.90, 0.93] and 18 [9.7, 35]; for 1D: 0.74[0.60, 0.82], 0.95 [0.94, 0.97], 0.97 [0.95, 0.98] and 16 [9.3, 28]; and for strabismus: 0.5 [0.32, 0.66], 0.98 [0.97, 0.98], 0.97 [0.96, 0.98] and 20 [9.1, 42]. Our data suggests that the MBT is highly accurate and useful for ruling in anisometropia and strabismus in children who fail 6/9 Snellen. The MBT needs further validation, both by different care givers and on differing populations. It offers an affordable, portable, and clinically useful tool to detect anisometropia and strabismus. We suggest that performing an MBT prior to uniocular retinosocpy should be a routine practice

Firearm injuries presenting to a tertiary care hospital of Karachi, Pakistan

Violence in a public health problem in low and middle income countries. Our study attempted to define the circumstances, risk groups, extent and severity of firearm-related injuries in patients coming to the Aga Khan University Hospital [AKUH] Karachi, Pakistan. This was a retrospective study conducted in the department of Emergency Medicine [EM] at AKUH Karachi, Pakistan. Past medical records of all patients who were injured by firearms and were presented to the AKIH Emergency Department [ED] from June 2002 till May 2007 were reviewed. Data were recorded on the basic demographics of injured, length of hospital stay, body parts injured and the outcome [alive vs. dead]. Total of 286 patients with firearm injuries were identified. Majority of them were males [92%, n=264]. More than half of them patients [63%] were in the age group of 21-40 years. Upon arrival to the hospital 85% [n=243] of patients had Glasgow Coma Scale [GCS] >/= 13. The mean injury severity score [ISS] was found to be 6 [SD +/- 4]. The length of hospital stay of patients ranged from 0 to 54 days with a mean of 7 days. Lower limb were the most affected body parts [30%, n=86] followed by abdomen pelvis [27%, n=77]. Seven percent [n=21] of the patient who were brought to the hospital were labeled as 'deceased on arrival]. Most of the injuries were caused during the act of robbery [40%, = 103] in the city. Robbery was the most common cause of firearm injures. Lower limb, abdomen and pelvis were the most affected body regions. Educational efforts, and individual, community and societal approaches are needed to alleviate firearm-related injuries

Patients experiences and satisfaction from surgical out patient department of a tertiary care teaching hospital

To find out patients experiences and satisfaction from the Surgical Out Patient Department [OPD] of Civil Hospital, Karachi. This cross-sectional study was done in surgical OPD of Civil Hospital, Karachi from January to March 2008. Patients were asked questions regarding general condition of the OPD, administrative procedure, waiting time, consultation time, doctors attitude and ethical behaviour, their professionalism, overall satisfaction, future reutilization and recommendation to others apart some demographic information. Total 490 patients were interviewed after taking verbal consent. More than three fourth of the patients agreed with good atmosphere [administrative procedure, receptionist attitude, waiting room] of the OPD department, but only 64[13.1%] said that inside the hospital the surgical OPD sign was clearly visible. Mean waiting time was 47.47 +/- 15.29 minutes [Range: 15-150]. Three hundred one[61.4%] patients were examined and treatment advised by Residents only while 189[38.6] patients received treatment by Consultants. Mean consultation time was 6.03 +/- 3.34 minutes [2 - 20] and 246 [50.2%] patients said that consultation time was adequate. From only 287 [58.6%] patients consent was taken before examination but patients privacy was maintained while examining 306 [62.4%] patients. Sixty five [13.2%] patients experienced subsequent visit problem with other units. Four hundred seventy three [96.5] patients said they will utilize the OPD in future and 461 [94.1%] said they will recommend it to other. Overall patient's experiences and satisfaction from Surgical OPD were fair to good. We have highlighted number of areas in which improvement can be made to increase the quality of care and patient satisfaction

Evaluation of albuim-cobalt binding as a specific test for assessment of myocardial infarction

The new biological marker, ischemia modified albumin [IMA] measured by albumin cobalt binding [ACB] test was introducted for the detection of myocardial ischemia. The aim of the present study was to describe the performance characteristics of the ACB test in suspected acute coronary syndrome patients who presented to the emergency myocardial infarction. Forty five patients presented to the emergency department [ED] with chest pain and 31 healthy controls were involved in the study. Serum albumin and ACB test were performed on all subjects, while serum CK-MB was done on patients with chest pain only. The patients were diagnosed to have either myocardial infarction, MI [30] or unstable angina, UA [15]. Thesensitivity and specificity of the ACB test for the detection of ischemia were evaluated by ROC curve analysis. ACB test could be considered as an early test for myocardial ischemia and could detect ischemia much earlier than other eardiac markers the significant negative predictive value of the test may play an important role in the rapid ride out of myocardial ischemia and will reduce the inappropriate admission of low risk patients. However it is a poor discriminator between patients with MI and those with UA

Non - traumatic emergencies - Experience from a tertiary care centre In Karachi

To review the incidence, clinical presentation and outcome of Non traumatic Aortic emergencies in a tertiary care hospital and its evaluation in the Emergency department [ED]. We conducted a retrospective review of cases presented to the ED at Aga Khan University Hospital during 15 year period [1988 - 2002] who had final diagnosis of Aortic Dissection or Ruptured Aortic Aneurysm. Patients without confirmatory investigations were excluded. We aimed at looking for the incidence, clinical presentation, evaluation in the ED and final outcome. Of the 12 cases, 7 had aortic dissection while the remaining 5 had ruptured aortic aneurysm. For Aortic dissection, mean age of presentation was 53 years with male predominance. Most of these patients had chest pain. Most common comorbid condition was hypertension. Pulse deficit was found in 2 cases, murmur in 4 cases, and focal neurologic deficit in 2 cases. Electrocardiogram revealed ischemic changes in 3 cases. Widened mediastinum on chest x-ray was present in all cases. The only initial misdiagnosis was cardiac ischemia. One patient survived to discharge. For patients presenting with ruptured aortic aneurysm, mean age of presentation was 52 yrs with a male predominance. The associated comorbid condition was hypertension. Almost all patients presented classically with abdominal pain, hypotension and palpable mass. No patient survived to discharge. Aortic emergencies although rare, are associated with significant mortality. High index of suspicion and prompt recognition by the emergency physician is of key importance

Monocular blindness and poor sight among Arabs in Kuwait

This study comprises two groups of patients, the first selected and the second chosen at random. Its aim is to determine the most common causes of blindness among Arabs in Kuwait. In the first group were 2254 eyes in 1680 patients [1292 males, 410 females]. Among them were 138 eyes which were totally blind with no perception of light; 45% being due to glaucoma, 30% to retinal detachment, 13% to ulcer of the cornea, 11.6% to ocular trauma and 8.7% to diabetic retinopathy. Of the overall total, 467 eyes [20.7%] had only perception of light [PL] or "counting fingers" [CF]. Of these 24.2% were due to glaucoma, 21% to retinal detachment, 15.6% to ulcer of the cornea; 9% to ocular trauma, 7.2% to diabetic retinopathy, and 23% to cataract. The second group comprised 2000 eyes from 1000 patients [707 male and 293 female]; 365 [18.3%] of the eyes being affected with 31 [1.5%] blind and without PL, 144 [7.2%] with PL or CF only, and 190 [9.5%] with visual acuity limited to 6/60. In those with blindness, glaucoma was implicated in 58%, retinal detachment in 19.3%, a ruptured globe in 13%, and endophthalmitis in 9.6%. In those with PL or CF only, the defect was due to cataract in 33.3%, keratopathy in 27.7%, trachoma in 11%, glaucoma in 11.8%, retinal detachment in 2.7%, a ruptured globe in 2.7%, diabetic retinopathy in 2.7%, refraction errors in 2%, central retinal vein thrombosis in 2%, rejected graft in 2%, and squint in 1.4%

Risk factors of spontaneous pre-term labor in Pakistani women, a case control study

To evaluate the significance of known risk factors of spontaneous preterm labour in Pakistani Women. A retrospective case-controls study was carried out between 1989-91, on 63 patients with spontaneous preterm labour at>24 and <37 weeks gestation. The controls were 65 women randomly selected with spontaneous labour at>37 weeks. Anthropometric variables, historical factors and events of current pregnancy were studied. The cases and control were matched for age, parity, height, weight and haematocrit level at booking visit. Preterm labour was associated with history of abortions and preterm labour-in the past. Uterine bleeding, pregnancy induced hypertension, urinary tract infection and congenital abnormality in current pregnancy, were identified as associated factors. In a small hospital based study, a number of risk factors in preterm birth have been identified, as compared to a matchable control group

Pterygium occurrence among Arabs in Kuwait

The study was of three groups of patients operated on for pterygium, and its aim was to learn the frequency and time of recurrence among them. The first group consisted of 40 eyes from 34 patients aged from 26 to 75 years [mean 40.3]. In this group the operation consisted of a simple excision of the pterygium and stitching of the conjunctiva without Beta irradiation. The frequency of recurrence was 22.5%, with all recurrences affecting males. The second group consisted of 26 eyes from 22 patients aged from 29 to 72 [mean 43.3]. Excision of the pterygium was followed by Beta-irradiation [2000 to 3000 RD]. Recurrence occurred in 23% of the cases, a figure not significantly different from that for the first group. There were 15 eyes in the third group from 12 patients aged from 27 to 63 [mean 42.7]. The operation consisted of an autoconjunctival graft, and there was no instance of recurrence. All groups were followed up for a period of from 4 to 6 years. Recurrence in the first two groups took place from the fourth to the eleventh month. This study has shown no significant difference in the frequency of recurrence when Beta irradiation was or was not given after excision of the pterygium. Such recurrence as did occur affected only males. The preferred treatment was found to be an autoconjunctival graft, where no recurrence was recorded