ABSTRACT
Objective: To compare efficacy of topical use of Phenytoin and Vaseline Gauze dressing with Vaseline Gauze dressing alone in healing of diabetic foot ulcers
Methodology: This randomized controlled trial was carried out in Surgical unit I of Benazir Bhutto Hospital from January to June 2013. Study included 60 diabetic patients with Wagner grade 1 and 2 ulcers on foot for more than 04 weeks with adequate control of diabetes. Patients with history of hepatic and renal diseases; on steroid use; or with impalpable foot arteries; were excluded. Thirty each were randomized to phenytoin and vaseline gauze dressing and vaseline gauze alone groups, respectively. At baseline and after 08 weeks, area of wound was measured using graph paper tracings and healing percentage was calculated
Results: Mean age of the sample was 53.83+/-6.66 years. Thirty six [60%] were males. Twenty five [41.67%] patients had Wagner grade 1 and 35 [58.33%] had grade 2 foot ulcers. Age, gender distribution and severity of foot ulcers according to Wagner grades were similar between two groups. In phenytoin and Vaseline group, the mean baseline ulcer area decreased from 1310+/-489.2mm[2] to 492.53+/-460.9 mm[2] at 8-weeks. In vaseline alone group, the mean baseline ulcer area decreased from 1107.53+/-486.58 mm[2] to 662.63+/-497.8 mm[2]. In phenytoin and vaseline group, the treatment was effective in 21 [70%] patients, whereas in vaseline alone group, the treatment was effective in 13 [43.3%] patients; p= 0.037
Conclusion: Phenytoin and vaseline dressings were significantly more effective as compared to vaseline alone dressings
ABSTRACT
Objective: To describe local experience of laparoscopic total extraperitoneal hernia repair in Rawalpindi Medical College [RMC] allied teaching hospitals
Methodology: A descriptive case series was conducted between 2007 and 2012 at Rawalpindi Medical College and Allied Teaching Hospitals including Benazir Bhutto Hospital, Holy Family Hospital and District Headquarter Hospital, Rawalpindi. Eighty seven patients of inguinal hernia were included through non-probability consecutive sampling. They underwent total extraperitoneal hernia repair. Sixty eight patients had unilateral hernia and 19 patients had bilateral hernias
Results: The mean age of the study population was 42.9+/-15.3 years [range: 13-75 years]. The mean operation duration was 62+/-13 minutes [range: 35-90 min]. For bilateral hernias the duration was longer; mean 103.66+/-23.4 minutes with a range of 75-180 minutes. Up to 4.6% had conversion to open surgery and 9.1% had complications. Overall, there were 3.4% hernia recurrences in one year follow up. The mean inpatient hospital stay was 1.85+/-0.65 days
Conclusion: TEP carries an acceptable complication rate, combining the advantages of minimal access surgery and mesh reinforcement of the groin. This approach is associated with short hospital stay and a low recurrence rate
ABSTRACT
To compare the frequency of surgical site infection in patients undergoing delayed primary closure [DPC] with those undergoing primary closure [PC] of surgical wounds after abdominal surgery for perforated appendix, perforated duodenal ulcer and ileal perforation. This quasi-experimental study was carried out at Surgical Unit I at Benazir Bhutto Hospital from January 2011 to December 2011. Patients undergoing contaminated abdominal surgery including perforated appendix, duodenal perforation and ileal perforations were recruited through the emergency department. The study included 86 patients, 43 in the primary closure [PC] and 43 in delayed primary closure[DPC] groups. They were followed for evidence of surgical site infection [SSI] for 30 days. Out of 86 patients 43 [50%] had ileal perforation, 26 [30.2%] had duodenal perforation and 17[19.8%] had appendicular perforation. The mean age was 28.9 +/- 8.7 years. 32 [37.2%] were males and 54[62.8%] were females. Both groups were similar with respect to age, gender distribution and indication for surgery. SSI was diagnosed in 19.8% patients. 30.2% in the PC group and 9.3% in the DPC group developed SSI. Hence significantly greater proportion of PC group patients developed SSI as compared to DPC patients; p=0.015. The severity if infection [superficial, deep or organ space] was not significantly different between the PC and DPC groups; p= 0.378. Significantly greater wound dehiscence was encountered in PC group; p=0.011. There frequency of SSI was significantly lower after delayed primary closure of contaminated wounds as compared to primary closure
ABSTRACT
To evaluate the knowledge and practices of foot care in patients with diabetes mellitus and to stress upon the importance of such knowledge and practices in decreasing morbidity associated with diabetic foot disease. One hundred patients of either sex from three tertiary care hospitals with a 5 year history of Diabetes Mellitus were selected in this study and were asked to fill out a questionnaire about their knowledge and practices about daily foot inspection, foot cleaning, appropriate nail care, and use of footwear in the form of shoe material, open or closed forepart and nature of heel. Out of 100 patients [36 males and 64 females], 34% patients inspected their feet daily and 78% of the respondents knew about care of callosities, minor injuries and cuts, 52% of patients didn't know about correct technique of cutting nails. Eight [22.2%] male and 28 [43.8%] female patients were using open shoes while 24 [66.7%] male and 38 [59.4%] female patients had shoes with narrow forepart. Ten [27.8%] males were using shoes made of hard material as compared to 20 [31.3%] of female patients. Twenty two [34.4%] of our female diabetic patients were using shoes with high heel. Only 68% of the patients were on regular follow up. This simple quality initiative concludes the notion that patients with diabetes who are at risk for the development of diabetic foot ulcers should receive ongoing foot-specific patient education