Gender based outcome of acute cholecystitis

Objective: To find out whether or not male gender is associated with more severe gallbladder inflammation

Study design Retrospective review of records

Place and Duration of study: Sheikh Khalifa Bin Zayed Al Nahyan [SKBZ] Hospital / CMH Muzaffarabad, from January 2012 to June 2015

Methodology: A retrospective data analysis of patients who underwent laparoscopic cholecystectomy for acute cholecystitis was done. Data for 740 patients with cholecystitis was retrieved. Out of these 220 patients who had laparoscopic cholecystectomy within 72 hours of admission, were included in the study. Gallbladder inflammation was confirmed on histopathology report

Results: There were 110 male and 110 female patients in this series. There was a significant number of male patients who had severe gallbladder inflammation in comparison with female patients [p=0.002]. The male gender was confirmed in a multivariate analysis as an independent risk factor for severe cholecystits [p=0.018]

Conclusions: Male gender is a risk for severe gall bladder inflammation. Early surgical intervention is therefore warranted to prevent complications

Risk factors for stroke; a prospective hospital based study

The stroke is third leading cause of death in world and most patients die with an acute event in stroke. Various clinical variables have been investigated as risks factors of stroke. The study was aimed to identify these risks factors for stroke. This prospective study included 205 consecutive patients of stroke admitted in Combined Military Hospital/Sheik Khalifa Bin Zyad Hospital Muzaffarabad Azad Kashmir. The risk factors of stroke were investigated. Examination included clinical, neurological evaluation, laboratory tests, and brain CT. The follow-up at 14 days were done for all patients. Patients included were with acute first ever stroke onset of 48 hours of hospital admission. All patients completed a structured questionnaire and a physical examination and most provided blood for relevant investigations. Two hundred and five cases stroke sub-types were [n=156, 76%, with ischemic stroke [CI]; n=49, 24%, with intra-cerebral hemorrhagic stroke [ICH]. The significant risk factors for all stroke were: Hypertension [p=0.003], diabetes [p=<0.001], Hypercholesterolemia [p=0.686]; atrial fibrillation [p=0.445], cardiac diseases [p=0.938], smoking [p=0.926] for brain infarction and hypertension [p=0.002], diabetes [p=<0.001], Hypercholesterolemia [p=0.018]; atrial fibrillation [p=0.449], cardiac diseases [p=0.749], smoking [p=0.829] for hemorrhagic stroke. Age significance [CI; p=0.247 vs. ICH; p=0.013] and age category significance were [CI; p=<0.001 vs. ICH; p=0.871] for subtype of stroke. High mRS [p<0.001] low GCS score [p<0.001] on admission were associated with worst outcome for both stroke subtype. These risk factors were all significant for CI as well as ICH. This study signifies the association of risks factors with acute stroke. Targeted interventions that reduce these risk factors could substantially reduce the burden of stroke

Role of prophylactic antibiotics in low risk elective laparoscopic cholecystectomy: is there a need?

Elective cholecystectomy for symptomatic gall stone disease carries low risk of postoperative infective complications. Yet the routine use of prophylactic antibiotic is in vogue in many centres. The aim of this study was to find out the efficacy of antibiotic prophylaxis in preventing postoperative infective complications in low risk elective laparoscopic cholecystectomy patients. Randomised controlled trial was carried out in our hospital from 1[st] Nov 2009 to 15[th] Oct 2011. A total of 350 patients were included in the study and were divided into Group A [n=177], and Group B [n=173]. Group A was given single dose of injection Cefuroxime 1.5 gm as prophylactic antibiotic at the time of induction of anaesthesia, and Group B was not given any antibiotic. In both groups, age, sex, duration of surgery, American Society of Anesthesiologists classification, duration of surgery and length of hospital stay were recorded. Patients were followed-up weekly for 4 weeks and rates of superficial surgical site infections as well as intra-abdominal infections were recorded. There were no significant differences in both groups in terms of age, sex, duration of surgery, length of hospital stay. Eight [4.5%] cases of superficial surgical site infection were noted in Group A and 7 [4.0%] in Group B which was insignificant statistically [p>0.05]. In low risk patients antibiotic prophylaxis does not seem to affect the incidence of postoperative infective complications in elective laparoscopic cholecystectomy. The use of prophylactic antibiotics should be reserved for high risk patients undergoing laparoscopic cholecystectomy

Importance of clinical assessment in diagnosis of acute appendicitis and its role in decreasing negative appendicectomy rate

Appendicitis is a common diagnosis, but is by no means a simple one to establish. It is impractical to have a definitive preoperative diagnosis, which leads to an appreciable rate of negative appendicectomy as reported in world literature varying from 20-40% with its morbidity around 10%. This retrospective study investigated the value of clinical assessment and medical imaging [ultrasonography] for patients with suspected appendicitis. Negative appendicectomy rate and appendiceal perforation with or without medical imaging were used as end points for this investigation. This study reviewed all patients admitted in Sheikh Khalifa Bin Zaid Hospital with suspected acute appendicitis. The patient cohort was identified from the unit registry and review of medical records. The medical records were analysed, and the outcomes of patients were followed up. Between June 2010 to June 2012, 375 patients' medical records were audited. These included 56.3% males and 43.7% females. The negative appendicitis rate was 7.2% and appendiceal perforation rate was 5.3%. Ultrasound was done in 103 [27.4%] patients in whom diagnosis of appendicitis was doubtful. Medical imaging had a 50% prediction rate for acute appendicitis, 40% false-negative rate, and 10% false-positive rate. Overall, the prediction rate for appendicitis by clinical assessment supplemented by laboratory tests and medical imaging at clinician's discretion was 92.8%.Despite studies advocating routine use of medical imaging for patients with suspected acute appendicitis, this study showed that the clinical evaluation is still paramount to the management of patients with suspected acute appendicitis before considering medical imaging.

Predictors of mortality after acute stroke a prospective hospital based study

Background: The stroke is third leading cause of death in world and 10% of patients with an acute ischemic stroke die within 30 days. Various clinical variables have been implicated as predictors of final outcome of acute stroke. The study was aimed to identify predictors of mortality after an acute stroke. Material and Methods: This prospective study included 149 consecutive patients of acute Hospital Muzaffarabad, Azad Kashmir. The outcome as mortality measures used were Modified Ranking Scale [mRS] and Glasgow Coma Scale [GCS]. Examination included clinical, neurological evaluation, laboratory tests, and brain CT. The follow-ups at 14 days were done for all patients. Results: Hospital mortality was 17.4 % [26/149] within 14 days. Age and gender had no impact on mortality. Hypertension [p=0.008], smoking [p=0.056]], brain infarction [p=<0.001], hemorrhagic stroke [p=<0.001], diabetes [p=0.292], atrial fibrillation [p<0.001], high mRS [p<0.001], low GCS score [p<0.001], on admission were important predictors of mortality. Conclusions: We report 17.4% mortality at 14 days. Mortality associated with acute stroke needs prevention and control of risk factors. Keywords: acute stroke; predictors; mortality, Glasgow Coma Scale, Modified Ranking Scale

Surgery in a temporary setup- sharing an experience of 16 months

Sharing an experience of surgery in a temporary set up. Descriptive study. This study was carried out at Combined Military Hospital Muzaffarabad after the earthquake of October 2005 over a period of 16 months. The workload that this hospital has managed over the period despite running under tents. The hospital was functioning under the temporary set up. Patients were earth quake victims requiring different surgical procedure. A total of 2887 major and 7471 minor surgical procedures pertaining to the specialty of General Surgery, Orthopedics, ENT, EYE and Gynecology were carried out over a period of 16 months. Though the load was comparable to any [C] class and most of the [B] class hospitals, despite being under tents, there was not a single case of post operative infection. The importance of single-use-only surgical disposables in the good management of surgical patients has also been highlighted. The basic sterilization techniques, if followed religiously stand good in preventing postoperative infection, even in compromised working condition