ABSTRACT
Objective: to document changing trends in deliberate self-poisoning in patients admitted in intensive care unit of Accident and Emergency [A and E] Department of Liquate University Hospital Hyderabad
Design: descriptive Retrospective
Setting: intensive care unit of A and E Department at Liquate University Hospital Hyderabad from January to December 2008
Methods: medical records of 236 patients of poisoning admitted in intensive care unit of A and E Department at Liquate University Hospital Hyderabad from January to December 2008 were reviewed; relevant data like history and clinical finding were collected and analyzed
Results: during study period, 236 patients of poisoning were admitted in intensive care unit of AandE Department at Liquate University Hospital Hyderabad. The mean age was31.24+/-10.72, females were 130[55.08%] and males were 106[44.91%], poisoning observed was common [44.49%] in age group 20-30 years. The changing trend was more towards suicidal 160[67.79%] than accidental 76[32.20%]. The drugs used for poisoning were organophosphate [73.30%], benzodiazepines [14.40%], powders [rat killer/ anti lice] [7.62%] and oil [phenyl, kerosene] [4.66%]. The fatal outcome was [9.32%] and the survival rate was [60.67%]. The route / exposure of cases by ingestion was 160[67.79%], by inhalation 50[21.18%] and topical 26[11.01%]
Conclusion: this study shows marked decline in the use of benzodiazepines and other agents as compared to organophosphate poisoning which shows increase in their usage resulting in changing trends of poisonous agents. The reasons of this change were due to easy availability of the toxic agents over the counter. Preventive measures are to be taken to stop the easy availability of these toxins by appropriate legislation. Awareness and education to the people is recommended to avoid such mishaps
ABSTRACT
Objective: To document the management and subsequent outcome of patients with organophosphorus [OP] poisoning in intensive care unit of a university hospital. Design: Descriptive, retrospective study. Setting: Intensive Care Unit of Liaquat University Hospital Hyderabad, Sindh - Pakistan, from May 2004 to October 2006
Methods: Medical records of patients of OP poisoning admitted to intensive care unit of our hospital from May 2004 to October 2006 were reviewed. Diagnosis was confirmed from the history and clinical findings. Management, complications and subsequent outcome were noted
Results: Total 111 patients of OP poisoning were admitted in the ICU during the study period. Majority of patients i.e. 67[60.4%] were males and 44 [39.6%] were females. Mean age was 25.26+/-8.52 years with 85.6% within the age limit of 12-30 years. Majority of patients [89.2%] had suicidal attempt. In 94.6% patients, ingestion was the route of exposure. Mean ICU stay was 2.3+/-3.2 days while 20[18%] patients needed mechanical ventilatory support. Overall mortality rate was 9%
ABSTRACT
Objective: To evaluate the role of a defunctioning ileostomy in the prevention of morbidity and mortality in patients with small bowel perforation. Design: A prospective randomized study. Place and Duration of Study: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro / Hyderabad between October 2005 and September 2006
Subjects and Methods: Total 108 patients who underwent laparotomy for ileal perforation were included
Results: There were 67 males and 41 females. The age of patients ranged from 15 to 72 years with 80% of the patients being in age group of 17-70 years. Typhoid was the commonest cause for ileal perforation which was seen in 69 [63.8%] patients, followed by intestinal tuberculosis which was present in 23 [21.3%] patients. Out of a total of 108 patients, a proximal defunctioning ileostomy was constructed to protect the primary repair or the intestinal anastomosis in 57 patients [group I]. In the remaining 51 patients, primary repair or intestinal anastomosis was done without a defunctioning ileostomy [group II]. Two [3.5%] patients in group I and 7 [13.7%] patients in group II died postoperatively. Six of the 51 patients in group II who underwent primary closure of perforation or resection and end-to-end anastomosis without a defunctioning ileostomy developed postoperative faecal fistula. None of the patients with defunctioning ileostomy developed this complication
Conclusion: We conclude that construction of a temporary ileostomy to provide defunctioning for repair of ileostomy perforations reduce the incidence of fatal complications like faecal fistula. Ileostomy, however, is associated with a number of ileostomy-specific complications. We recommend that defunctioning ileostomy should be preferred over all other surgical options in cases of ileal perforations
ABSTRACT
Objective: To assess the duration and safety of single dose caudal epidural with bupivacaine for postoperative analgesia in children
Design: A descriptive study
Setting: Chandka Medical College Hospital, Larkana from February 2002 to September 2004
Patients and Methods: One hundred and seventy six boys, ASA-I, between the ages of 2 to 8 years, scheduled for inguinal or penile surgery, were randomly assigned in a prospective fashion to receive single shot caudal epidural with bupivacaine 0.25%, 0.75ml.kg-1, and studied for postoperative pain relief. Pain was evaluated by using faces pain scale. Analgesia was administered when pain scale was 3-4. Postoperative complications were also noted
Results: Mean duration of analgesia was 10.43 +/- 3.4 hours. Time for micturation was 161.79 +/- 83.2 minutes while time to stand was 161.21 +/- 69.65 minutes. Haemodynamic and respiratory parameters remained stable during the observation period. Frequency of postoperative nausea and vomiting was 7% while urinary retention occurred in 1.4% patients
Conclusion: Caudal epidural analgesia with bupivacaine 0.25% in a dose of 0.75ml.kg-1 provides safe and effective postoperative pain relief in children undergoing inguinal and penile surgery, with very few complications