ABSTRACT
To evaluate the effectiveness and safety of early Nasogastric Enteral Nutrition in patients with Acute Pancreatitis. Randomized controlled trial. The study was conducted at IIMC Hospital Islamabad, and Railways Hospital Rawalpindi from June 2008 to April 2011. A total of 26 patients were studied over the course of 34 months who were admitted with the diagnosis of acute pancreatitis. Patients were divided randomly in two equal groups by consecutive sampling method. One group was given enteral nutrition [EN] through nasogastric tube beginning within 24 hours of admission [group-I], and the other group was provided nutrition through parenteral route [PN] only [Group-II]. Outcome in the two groups such as length of hospital and ICU stay, infective complications, nutrition related complications, metabolic and catheter related complications were compared. Baseline of the study regarding infective complications and mortality were comparable. Average hospital stay was shorter by 22.3% in enterally fed group. ICU stay was also shorter in group-I patients. Significant difference was seen in relief of abdominal pain amongst the two groups, enterally fed [group-I] patients had earlier relief of pain starting on the 3[rd] day, compared to 5[th] day in group-II. Majority of the patients in group-I [84.5%] had pain relief between 4[th] and 9[th] day, while in group-II, 76.8% had pain relief between 7[th] and 12[th] day. Mean pain relief in enterally fed patients was in 7.5 days and in parenteral nutrition group in 10.2 days. Nutrition related complication of diarrhoea was noted in 2 enterally fed patients. Metabolic complications [hyperglycaemia], and catheter related septic complications were seen only in parenterally fed patients. Acute pseudocyst formation occurred in one patient of enterally fed group as noted on follow up. Early enteral nutrition is safe and effective in the management of acute pancreatitis. Enterally fed patients show advantage of shorter hospital and ICU stay, and earlier relief of symptoms compared to patients managed on parenteral nutrition. Our study considers early enteral nutrition feasible and desirable
ABSTRACT
To determine the frequency of wound infection with skin closure by removable subcuticular sutures in non complicated open appendectomy wound. Descriptive case series. Department of Surgery Railway Hospital Rawalpindi, Seven months and ten days, from 1[st] Nov, 2009 to 10[th] June, 2010. The study was carried out after taking approval from the hospital ethics committee. Seventy three adult patients of either sex admitted in department of surgery with diagnosis of acute appendicitis were included in the study by non probability consecutive sampling. All the patients were explained about the procedure and an informed written consent was obtained. Right grid iron abdominal incision centred over the Me Burney's point was used to open the abdomen. Appendicectomy was done. In all patients subcuticular stitches by using polypropylene 2/0 were applied to close the skin. All the patients were followed on 3[rd], 7th and 30[th] post operative day for examination of wound. Data was entered in the predesigned Proforma [annexed] for analysis. Out of 73 patients 6 [8.2%] suffered from wound infection. Successful open management of the infected wounds was done. Rest of the patients had uneventful recovery. Frequency of wound infection is negligible with removable subcuticular skin suture in non complicated open appendicectomy wound