Duodenal perforation among patients of acid peptic disease

Introduction: Duodenal ulcer [DU] perforation is one of the severe complications of duodenal ulcer. Although, antiulcer drugs reduce the risk of duodenal ulcer perforations but perforation may occur in 2-10% patients taking antiulcer drugs. In elderly patients of duodenal ulcer perforation, the mortality remains 30-50% in-spite of optimal management

Objective: To find out the frequency and characteristics of patients with duodenal ulcer perforation on regular anti ulcer drugs, on irregular therapy and in those not taking medications for acid peptic disease

Study Design: Cross sectional study[Hospital based]

Study Setting: Department of Surgery, Bahawal Victoria Hospital, Bahawalpur

Duration of Study: From 11-02-2009 to 10-01-2010

Subjects and Methods: Fifty five patients of Duodenal Ulcer perforation diagnosed on clinical ground and Laparoscopy/Laparotomy with known history of peptic ulcer, whether taking antiulcer drugs [complete or incomplete course] or not, were included in this study. All the data was recorded on pre-designed Proforma and results were analyzed using SPSS 13.0 version

Results: 55 patients were operated for perforated duodenal ulcer during the study period in the surgical department of Bahawal Victoria Hospital, Bahawalpur. This consisted of 50 males [91%] and 05 females [09%]. The male/female ratio was 10:1; the patients were aged 20-60 years. The peak incidence was in the 5th decade. Duration of acute symptoms before presentation was a few hours to 5 days. None of the perforations was associated with recent ingestion of non steroidal anti-inflammatory drugs [NSAIDS]. There was a history of chronic peptic ulcer disease in 39[71%] patients. Abdominal tenderness and classical signs of peritonitis were demonstrable in 49[89.1%] and 46[83.6%] patients respectively. Plain abdominal and chest x-rays were carried out for all these patients, with free gas under the diaphragm demonstrated in 70% percent of cases. A total of 49 patients [89%] had anterior pyloroduodenal perforations with serous peritoneal fluid in 29 [53%], cloudy/opalescent peritoneal fluid in 13 [24%] and frank peritoneal pus with fibrinoid adhesions in 13 [24%] patients. Six of the perforations were found to be sealed. Five of the perforations were of size 10mm in size. Only six patients out of fifty five [11%] during or after a course of the antiulcer drugs developed Duodenal Ulcer Perforation

Conclusion: Duodenal ulcer perforation may occur in patients who were taking antiulcer drugs. Duodenal ulcer perforation is more common in patients with acid peptic disease who were not taking antiulcer drugs

[ relationship between organizational participation and organizational adaptability among the staffs of Imam Khomeini Hospital in Tehran, Iran]

Changes in political, economic, social, scientific and technological circumstances have a major impact on organizational performance. In such circumstances, the success of organizations depends on their ability to cope and adapt to changing environmental factors. This study investigated the relationship between organizational participation [team orientation, capability development and empowerment] and the organizational adaptability [change, customer orientation and organizational learning] in Imam Khomeini Hospital staff. This cross-sectional study was performed on 114 staffs of Imam Khomeini hospital, Tehran University of Medical Sciences who were selected by random sampling. Data were collected by Denison questionnaire [2006 version], which was confirmed validity and reliability. Data were analyzed with spss17 and statistical methods like the mean, standard deviation and correlation coefficients. The results showed that the rate of the organizational involvement and adaptability of the staffs was 53.44% and 52.37% respectively. The Pearson correlation analysis showed a positive correlation coefficient [p<0.01, r=0.743] between two variables of organizational involvement and adaptability. With increasing organizational involvement of the staffs increases their organizational adaptability

Clinical presentation of neonatal malaria

To study the prevalence, clinical presentation and laboratory findings in neonates suffering from malaria. Paediatrics Unit-I Bahawal Victoria Hospital, Bahawalpur from April 2006 to March 2008. Neonates with negative blood culture but positive slides for malarial parasites were included. The prevalence rate of neonatal malaria was 3.06%. 54% cases were due to plasmodium falciparum and 40% were due to plasmodium vivax while in 6% cases species could not be identified. The male to female ratio was 1.5:1. 46% cases presented within 7 days of birth. 80% cases were born by spontaneous vaginal delivery, 16% by spontaneous vaginal delivery with episiotomy while 4% by Cesarean section. Fever was present in 100%, hypothermia on examination in 4%, splenomegaly in 24%, hepatomegaly in 28%, jaundice in 30%, irritability in 52%, reluctant to feed in 8%, vomiting in 48%, cough in 8%, diarrhea in 50%, abdominal distension in 8%, seizures in 8%, apnoea in 4%, lethargy in 24%, respiratory distress in 28%, bloody stool in 4%, leucopenia in 6%, anemia in 40%, thrombocytopenia in 6% and hypoglycemia in 10% cases. There was no statistically significant difference in the clinical features or laboratory findings of malaria due to both the species. Neonatal malaria is, although, uncommon but resembles to that of neonatal sepsis and clinical presentation of malaria due to falciparum or vivax is same

Prevalence of HBV, HCV and HIV in blood donors at Liaquetpur

To know the prevalence of hepatitis B, hepatitis C and HIV. Observational cross sectional study. Blood Transfusion Center Tehsil Headquarter Hospital Liaquetpur. The data of blood donors from 2001 to 2003. Total blood donors studied were 1426. The prevalence for hepatitis B was 5.96% [CL 4.84%-7.32%] It was 0.07% [CL <0.01% - 0.44%] for HCV and zero for HIV. The prevalence of HBV in males was 6.03% [CL 4.87%-7.45%] while 5.05% [CL 1.91%-11.63%] in females [p=0.6917]. The prevalence in 17-20 years age group was 6.4% [CL 3.92%-10.23%], 5.81% [CL 4.6%-7.33%] in 21-40 years age group and in 41-60 years age group it was 4.35% [CL 1.33%-28.19%] [p=0.9029]. Hepatitis B is common, hepatitis C is an uncommon health problem while HIV is not present in this area

Understanding of puberty and related health problems among female adolescents in Karachi, Pakistan

To understand the level of knowledge, a community based study conducted with the objectives as follows: To estimate the proportion of common facilities available and accessible and frequency of utilizing of it. To estimate the proportion of female adolescent utilizing the availability of facilities. To assess the level of understanding related to puberty and related health problems among female adolescents. This cross-sectional study was conducted to determine the understanding and level of knowledge related to puberty and related health problems among female adolescents of Karachi, Pakistan. Data was collected from 150 female adolescents between 10-19 years of age. The pre-coded questionnaire was used to collect the data which was double entered and analyzed in SPSS

First report of ophthalmomyaisis externa in Pakistan

Two individuals presented to the Aga Khan University Opthalmology service with foreign-body sensation, pain and redness in one of their eyes. Slit-lamp biomicroscopy revealed tiny larvae crawling around the conjunctival sac. They were mechanically removed under topical anaesthesia and preserved for light microscopy and photography. Comprehensive liaison was established with the Australian Centre for International Agriculture Research for identification of these larvae. Their morphology characterized them as members of fruit-fly, Oestridae family. At least one of them was positively identified as first instar larva of Oestrus ovis. This report describes the first instance of such infections in Southern Pakistan, as concluded after a Medline search

Hemoglobin and packed cell volume - reference values for healthy Pakistani adults

For meaningful interpretation of laboratory results, it is essential to establish normal reference values. In Pakistan only a handful of studies have been conducted to achieve this purpose. This need was also felt at the Aga Khan University Hospital and we embarked on a project to establish these normal ranges for Pakistani population. As the first part of the project, the hemoglobin and packed cell volume [PCV] estimation were done on 300 males and 200 females from different socio-economic and ethnic strata. As regards these two parameters, there has been general misconcepetion that the general healthy Pakistan population's hemoglobin and PCV is lower than the developed countries. Our study negated this point of view and we found out that the normal ranges of hemoglobin and PCV for the general healthy Pakistan population is at par with other developed countries. Our results show that the mean hemoglobin for Pakistani males is 15.01 +/- 1.338 gm% and for females is 12.53 +/- 1.416 gm%. The mean PCV for males is 45.3 +/- 3.43 and for females is 38.7 +/- 3.34