Intra-operative predictors of difficult cholecystectomy and conversion to open cholecystectomy - a new scoring system

Objective: To evaluate the intra-operative scoring system to predict difficult cholecystectomy and conversion to open surgery

Methods: This descriptive study was conducted from March 2016 to August, 2016 in the Department of Surgery, Shalimar Hospital. The study recruited 120 patients of either gender, age greater than 18 years and indicated for laparoscopic cholecystectomy [LC]. Intra-operatively all patients were evaluated using the new scoring system. The scoring system included five aspects; appearance and adhesion of Gall Bladder [GB], distension or contracture degree of GB, ease in access, local or septic complications, and time required for cystic artery and duct identification. The scoring system ranges from 0 to 10, classified as score of <2 being considered easy, 2 to 4 moderate, 5-7 very difficult, and 8 to 10, extreme. Patient demographic data [i.e. age, gender], co-morbidities, intra-operative scores using the scoring system and conversion to open were recorded. The data was analysed using statistical analysis software SPSS [IBM]

Results: Among one hundred and twenty participants, sixty seven percent were females and the mean age [years] was 43.05 +/- 14.16. Co-morbidities were present in twenty percent patients with eleven diagnosed with diabetes, six with hypertension and five with both hypertension and diabetes. The conversion rate to open surgery was 6.7%. The overall mean intra-operative scores were 3.52 +/- 2.23; however significant difference was seen in mean operative score of converted to open and those not converted to open [8.00 +/- 0.92 Vs. 3.20 V 1.92; p-value = 0.001]. Among eight cases converted to open, three [37.5%] were in very difficult category while five [62.5%] were in extreme category. Moreover, age greater than 40 years and being diabetic were also the risk factors for conversion to open surgery

Conclusion: The new intra-operative scoring system is a valuable assessment tool to predict difficult laparoscopic cholecystectomy and conversion parameters to open surgery and its utility could improve patient's clinical outcome indicated for laparoscopic cholecystectomy

Pattern of physical activity among persons with Type-2 diabetes with special consideration to daily routine

Objective: Physical activity is essential in maintaining a healthy lifestyle. Physical activity can improve general health, quality of life and diabetes management. The aim and objective of the study was to assess the physical activity trends in daily routine of people with type 2 diabetes

Methods: Two hundred persons with diabetes from four different clinical settings were included to access the trends of physical activity using a customized questionnaire EPIC-2. Pattern of physical activity was assessed across a set of domains including sleep time, hours of TV watch, preferred mode of transport for specific distance and household activities. Data was analyzed using SPSS 21

Results: Out of 200 persons with diabetes, 104[52%] were male and 96 [48%] were female. Out of the total sample of patients, 85 [81.7%] Male and 80 [83.3%] female patients preferred walk to cover a distance of less than one mile. There was a significant difference in selection of mode of transport for all other specified distance, esp. in female patients with both age groups. There was insignificant difference for physical activity pattern related to household activities in young and elderly male subjects. The mean sleeping time for younger male subjects on weekend was 464.31 +/- 88.88 minutes/day and for elder it was 418.65 +/- 102.66 minutes/day while for young female subjects was 476.25 +/- 113.74 minutes/day and in female elderly subjects it was 420.62 +/- 120.62 minutes/day respectively

Conclusion: In type 2 diabetics we observed a low level of physical activity which may be detrimental for the control of diabetes mellitus

Fulminant hepatic failure [FHF] due to acute hepatitis-C

Acute hepatitis C [HCV] infection has been identified as an important cause of fulminant hepatic failure [FHF], characterized by rapid deterioration of liver function from massive hepatic necrosis leading to encephalopathy and multi-organ failure. We admitted a female patient at Shalamar Hospital with jaundice, fever, encephalopathy and coagulopathy of short duration with no history of any comorbidity. Her hepatitis viral screen revealed positive anti HCV. Her viral loads were also high. A diagnosis of FHF due to acute HCV infection was made. Patient was treated conservatively and improved gradually. In summary, acute HCV can cause FHF and should be ruled out in patients with FHF of unknown cause in an endemic country for HCV like Pakistan