Operational difficulties in obese patients

Background and aim of the work: to give optimal care for obese surgical patients, surgeons and healthcare personnel should be aware about the surgical problems which may be met in obese patient and how to overcome a variety of challenges

In this study the awareness of the surgeons about the obesity as surgical problem would be evaluated from the surgical staff point of view

Patient and methods: a cross-sectional study was done by interviewing the surgeons to fill the questionnaire focusing on their awareness about the prevalence of operational difficulties in obese patients

Results: the study included 82 surgeons most of therti practice general surgery

The majority of surgeons found that the main cause of obesity amongst their patients is dietary factors [91.5%]. The same percent of surgeons [higher percentage in residents] agreed that obesity might modify the surgical decision. According to the survey, they patients of age between 30-45years represented the majority and most of them were females. Over 89% of surgeons found that the complications are more in obese patients than in average weight patients

All specialties [especially general surgeons] agreed that obesity increases the operative time. Infection was the major problem mentioned by surgeons followed by anesthetic problems and the size of the instrument used. Over 64.6% of surgeons agreed that some operations need to reduce patient weight to be performed. Most of surgeons [42.7%]agreed that surgical error is higher in obese patients; however, 37.8% agreed that surgical errors in obese and average weight patients are equal. The majority of surgeons [68.3%] agreed that experience of the surgeon will differ in theatre. 81.7% of surgeons agreed that obese patient needs more evaluation prior to surgery than average weight patient. 72% agreed that obese patients have prolonged hospital stay

Conclusion: The study revealed a good to excellent awareness of KSA surgeons about surgical problems which may be met in obese patient and how to overcome a variety of challenges reflecting the values of continuous medical education programs applied in their hospitals

Acute brucellosis as unusual cause of immune thrombocytopenia: A case report and review of the literature

A 25 year-old male patient was admitted to the causality with complaints of fever, joints pain, epistaxis and gingival bleeding, for the last week, the complete blood count revealed pancytopenia. Serological test for brucella was reported positive as 1/320, but the patient failed to respond to brucella treatment for 4 d. On day 5th the diagnosis of immune thrombocytopenia was confirmed after bone marrow aspiration. Steroid was initiated on 6th day after admission and on the 3rd day of steroid therapy thrombocytes count was raised to 55×10

Maternal deaths from obstetrical hemorrhage in Khartoum-Sudan, 2007-2008

This is a prospective, descriptive, hospital-based study, to determine maternal mortality ratio with regard to obstetric hemorrhage in Khartoum from first of January 2007 to 30th of June 2008. Maternal deaths were immediately reviewed in all maternity units in Khartoum state hospitals. Causes of death were diagnosed on clinical grounds; autopsy was done only for three medico-legal cases. There were 130 maternal deaths reported out of 105210 live births; maternal mortality ratio is 124/100000 live births, 107 cases [82.3%] were due to direct obstetric causes, while 23 cases [17.7%] were from indirect causes. Obstetric hemorrhage was the main direct cause of death 29.2%, 76.3% due to post partum hemorrhage, it affects low risk groups, only 21% were grand-multiparae and 68.8% had no significant abnormal obstetric history, 42.1% did not present with hemorrhage, and 39.5% had no blood transfusion Most of patients [68.4%] died within first 24 hours from admission. This study showed that home delivery, late consultation, suboptimal intra-partum or intraoperative care, late intervention, unavailability of blood or blood substances and poor referral system are the main factors behind maternal deaths

Voice dysfunction following thyroidectomy

Voice dysfunction after thyroidectomy is not rare, and is generally reported in terms of recurrent laryngeal nerve [RLN] or superior laryngeal nerve [SLN] injuries. However, voice dysfunction can occur without laryngeal nerves injuries. Prompt recognition of causes of dysphonia is essential so that relevant therapeutic decision allows early management. The aim is to analyze voice change after thyroidectomy for patients with normal pre-operative voice. The study included 30 patients who had developed voice change within 6 months after thyroidectomy. They were subjected to voice evaluation, indirect laryngoscopy, videostroboscopy and electromyography [EMG]. It was found that dysphonia after thyroid surgery was caused by neurogenic causes [RLN and SLN injuries] in 23 patients [76.7%], non-neurogenic causes in 5 patients [16.7%] and combined causes in 2 patients [6.6%]. EMG studies revealed complete denervation in 6 patients [20] and incomplete denervation [paresis] in 19 patients [63.3%]. Post-thyroidectomy dysphonias are not rare. Injuries of the RLN constitute the main cause. Non-neurogenic injury is another contributing factor. Diagnosis is essential for early management through videostroboscopy and EMG which is specific to differentiate between neurogenic and traumatic injuries and to detect complete or incomplete denervation

Subclinical pulmonary involvement in children with juvenile rheumatoid arthritis and systemic lupus erythematosus: Clinical, functional, high-resolution computed tomographic and laboratory findings

Early detection of collagen-associated pulmonary disease could have an important effect on prognosis and therapeutic strategies to prevent irreversible pulmonary damage. The aim of this study was to determine the prevalence and characteristics of pulmonary involvement in children with juvenile rheumatoid arthritis [JRA] and systemic lupus erythematosus [SLE] of less than 2-year duration and without prior clinical evidence of lung disease. Twenty-eight patients with JRA [18M and 1OF, mean age 10.3 +/- 2.8 years] and twenty with SLE [6M and 14F, mean age 12.9 +/- 3.1 years] and twenty age- and gender-matched controls were studied. Patients were evaluated using the following measures: clinical, pulmonary function testing [PFT], chest radiography [CXR], high resolution computed tomogram [HRCT], induced sputum cells, phospholipids [PLs] and surfactant protein-A [SP-A] concentrations were also measured in 19 JRA and 12 SLE patients. Results: Measurements of PFT and sputum cellular and biochemical variable were significantly different in study patients as compared to controls. Abnormalities in PFTs, CXR, HRCT and sputum cells and SP-A/PL in JRA were 21.4%, 0.0%, 32.2%, 52.6% and 31.6%, respectively; and in SLE were 30%, 10%, 45%, 54.8% and 33.3%, respectively. Restrictive pattern was the commonest PFT abnormality. PFT results correlated significantly only with age in JRA and with hematological data in SLE. HRCT findings correlated significantly in JRA patients with seropositve disease, high activity grade, and diminished diffusion lung capacity [DLCO], and in SLE with PFTs: FVC, FEVI,FEF25-75% and DLco. Neutrophic alveolitis was closely associated with HRCT changes, low DLco and low sputum SP-A values. Pulmonary changes in children with recent onset JRA and SLE are frequent. The significance of these changes is being determined in a longitudinal study

Effects of tonsillar infiltration on intra-and post-tonsillectomy pain in children

The aim of this study was to test the hypothesis that blockade of nociceptive input with lidocaine 1%, bupivacaine 0.5% and ropivacaine 0.5% during tonsillectomy could decrease both the dose of inhalational anesthetic intraoperatively and the pain beyond the immediate postoperative period. Sixty patients between the ages of 6 and 12 years scheduled for tonsillectomy with or without adenoidectomy were randomly divided into four groups. Anesthesia was induced in all groups with 7 mg/kg thiopentone and 1.5 mg/kg succinyl choline. The results showed that after the preincisional infiltration with ropivacaine 0.5%, bupivacaine 0.5% and lidocaine 1%, the operation could be achieved under light general anesthesia using only halothane 0.5% concentration in oxygen with reduced recovery times