Role of vitamin E in mastalgia in young women

Background: Vitamin E is a fat soluble vitamin and plays key role in many body systems. It has been in clinical practice for mastalgia for decades, however there is still limited literature defining its precise role

Methods: This case series was retrospectively collected from a prospectively established database of a dedicated breast clinic for a period of 16 months. A total of 100 patients came with a complaint of breast pain; 20 patients excluded as 17 were having palpable lump while 3 were post menopausal. Eventually 80 patients were included in this study. They were given Vitamin E 400 mg a day for six months. They were followed up at six weeks then at three months and finally after six months. Patients were given a pain chart to mark severity of pain on daily basis

Results: Follow up initially at six weeks, three and six months suggested significant improvement in the symptoms of cyclical mastalgia [p<0.001]

Conclusion: Vitamin E is relatively safe supplement with a better compliance, therefore can be safely considered as first line management of mastalgia in premenopausal young patients

Haemorrhoidectomy with internal sphincterotomy: a useful method to relieve post operative pain

OBJECTIVE: This study was designed to compare short term outcome of post operative pain in patients operated for haemorrhoidectomy alone and haemorrhoidectomy with internal sphincterotomy

METHODOLOGY: This comparative observational study conducted at Liaquat University Hospital Jamshoro during August 2012 to July 2014. One hundred and sixteen patients of 3rd or 4[th] degree hemorrhoids were enrolled in the study. Patients were divided into two comparable groups. Group A underwent open haemorrhoidectomy along with lateral sphincterotomy whereas group B was operated for open haemorrhoidectomy alone. Postoperative pain was analyzed by using visual analogue score at 24 hours, 48 hours and on 10th post operative day

RESULTS: Total 116 patients were included in the study. Fifty eight patients in each group

The mean age of the patients was 42+/- 10.2. Male were 77 [66.4%] and 39 [33.6%] were female. Male to female ration was 2:1. During follow-up periods, patient in group A experienced less postoperative pain as compared to group B [p value is

CONCLUSION: Lateral internal sphincterotomy combined with haemorrhoidectomy significantly reduces postoperative pain without increasing morbidity

Informed consent; awareness and practice among general medical practitioners

Introduction: Informed consent is the back bone of patients' autonomy. The advancement in medical technology has further increased its importance. In the developing countries including Pakistan, general physicians play a vital role in providing health care to the patients but unfortunately majority of them are unaware about the ethical aspects of their medical practice

Methodology:

Objectives: 1. To determine the level of awareness about informed consent among general practitioners. 2. To assess the association between various socio-demographic factors to the awareness about informed consent

Study Design: Community based cross sectional study

Settings: General medical practitioners of district Hyderabad were the study population

Period Of Study: Two months

Material and Methods: One hundred and forty subjects were selected for the study through purposive non-probability sampling. A pretested self-administered questionnaire was the tool for the data collection. The data was analyzed by using SPSS version 16.The variables of interest were gender of general practitioners, their age, level of qualifications, residence and occasions when informed consent was taken. The association between various socio-demographic variables was determined by applying Chi-square test at

Results: One hundred and forty general medical practitioners of varying ages from 32-60 years participated in the study. The mean age of the general physician was 39 +/- 1.8 years. The awareness about informed consent was found among 128[91.4%] subjects but unfortunately only 45.7%of them actually practiced it. The results regarding awareness as well as practice of informed consent among males and females were however not significant [p=0.520]. The young general practitioners i.e age 31-40 years were less practicing informed consent as compared to older general practitioners i.e. age 51-60 years and onwards [p= 0.04].The physicians practicing in urban areas were more cognizant about informed consent [p=0.05].Informed consent from patients was obtained before giving local anesthesia [80%], blood transfusion [24.3%]and before examination of female patients [46.4%]

Conclusions: Informed consent taking is not a routine process adopted by general medical practitioners so there is a strong need for general practitioners to change their attitude and acknowledge the patient's autonomy by taking informed consent, which is the basis of modern medical ethics

Retained surgical foreign bodies: can these be prevented?

To determine the frequency and modes of presentation of retained surgical foreign bodies. This study was carried out mainly at a private teaching hospital i.e. Isra University Hospital and four other non-teaching private hospitals of Hyderabad city over a period of five years from June 2004 to May 2009. A total of 15 patients with retained surgical foreign body were found during the above mentioned study period. Female patients were more common than male patients. Gynaecological procedures were more frequently associated with surgical retained foreign bodies. Most [60%] of the causative procedures were performed as emergency procedures. Retained sponge was the most frequent foreign body [60%] followed by gauze piece. Discharging sinuses and abdominal masses [33.3% each] were the most frequent presentations followed by intestinal obstruction [20%]. Retained surgical foreign body is a rare but well known iatrogenic complication of surgery mostly seen in procedures done as emergency. Discharging sinuses, abdominal mass and intestinal obstruction are the most common modes of presentation. Proper frequent double sponge count and use of radioopaque markers are the major preventive measures to safeguard against this dangerous complication

Negative appendectomy rate: can it be reduced?

Objective: the objectives of this study were to calculate the current negative appendectomy rate and to determine the predictive value of ultrasonography in patients having suspicion of acute appendicitis

Design: this is a prospective analytical study of patients admitted with suspicion of acute appendicitis and underwent appendectomy

Place and Duration of study: this study was conducted at Isra University Hospital, Hyderabad from January 2003 to December 2006

Patients and Methods: the data of all adult patients [above 14 years of age] admitted from emergency room with suspected acute appendicitis and underwent appendectomy were collected prospectively. These data were analyzed to calculate the negative appendectomy rate as well as the positive and negative predictive values of ultrasonography

Results: in all, 195 patients fulfilled the inclusion criteria during the above mentioned period. The overall negative appendectomy rate was 12.3% . The positive and negative predictive values of ultrasonography for appendicitis were 100% and 85.7% respectively. The sensitivity and specificity of ultrasonography for appendicitis were 97.6% and 100% respectively

Conclusion: the negative appendectomy rate at Isra university Hospital Hyderabad is comparable to the rates reported in the local as well as international literature. The preoperative ultrasonography is an essential tool for reduction of negative appendectomy rate

Spectrum of benign breast diseases

To determine the frequencies of various benign breast diseases [BBD] in female patients in three private hospitals of Hyderabad. This is a prospective cohort study of all female patients visiting the surgical clinic with breast problems. This study was conducted at Isra University Hospital Hyderabad and two other private hospitals of Hyderabad over a period of about three years starting from March 2004 to February 2007. All female patients visiting the surgical clinic with breast problems were included in the study. Patients with obvious clinical features of malignancy or those who on work up were diagnosed as carcinoma were excluded from the study. A total of 275 patients were included in the study. About 44% [120/275] patients belonged to 3[rd] decade of life [age between: 21-30 years] followed by 33% from 4[th] decade [age between: 31 - 40 years]. Fibroadenoma was the most common benign breast disease, seen in 27% [75/275] of patients, followed by fibrocystic disease seen in about 21% [57/275] patients. Benign Breast Diseases [BBD] are common problems in females of reproductive age. Fibroadenoma is the commonest of all benign breast disease in our set up mostly seen in 2[nd] and 3[rd] decade of life. Fibrocystic disease of the breast is the next common BBD whose incidence increases with increasing age

Efficacy of aloe vera gel in the treatment of vulval lichen planus

To compare the efficacy of aloe vera gel and placebo in the topical management of vulval lichen planus. Randomized, double-blind, placebo-controlled trial. Department of Dermatology, Isra University Hospital, Hyderabad, from January 2007 to January 2008. Thirty-four female patients were randomized into two groups to receive aloe vera gel or placebo for local application for 8 weeks. Clinical data and treatment response was graded according to Thongprasom criteria. Z-test was used for comparing response between the groups. Thirty-four consecutive patients participated in the study. We found erosive and ulcerative lesions in 83% and 17%, respectively. The most common site of vulval lichen planus was the labia minora. Fourteen [82%] out of 17 patients treated with aloe vera had a good response i.e. clinically improved by at least 50% after 8 weeks of treatment, while one [5%] of 17 placebo-treated patients had a similar response [p < 0.001]. Furthermore, one patient [5%] treated with aloe vera had a complete clinical remission. No side-effects were found in both groups. Aloe vera gel was a safe and effective treatment for patients with vulval lichen planus