Frequency of peptic ulcer perforation during fasting and without fasting

Objective: To find out the frequency of peptic ulcer perforation during fasting in the month of Ramadan with non-fasting during other months

Study design: Descriptive case series

Place and duration of study: Department of Surgery Ward-3 Jinnah Postgraduate Medical Center Karachi, from January 2005 to November 2014

Methodology: The data of 220 patients who were operated due to peptic ulcer perforation, was analylsed. Patients were divided into 2 groups. Group I [n= 139] included patients who were operated in the months other than Ramadan, while group II [n= 81] included patients who were operated during the month of Ramadan. The patients of peptic ulcer due to malignancy were excluded

Results: Of the total there were 209 male and 11 female patients. Age range was 12 year to 65 year. Most of the patients [n=178 - 85%] were between 20 year to 50 year of age. Frequency of perforation was highest in Ramadan then in Shawal month and was less in other months of the year. On average patients with peptic ulcer in Ramadan were 8.1 and in non-fasting months 1.2

Conclusion: The frequency of perforation in peptic ulcer disease was higher in Ramadan month during fasting state as compared to other months of the year

CT guided percutaneous drainage of pancreatic abscess

Objective: to determine the outcome of CT guided percutaneous drainage of pancreatic abscess

Study design: descriptive case series

Place and Duration of study: department of General Surgery Unit I, Jinnah Postgraduate Medical Centre Karachi, from October 2011 to October 2015

Methodology: all patients with acute pancreatitis who developed pancreatic abscess which was diagnosed on clinical grounds and with CT scan abdomen underwent CT guided percutaneous drainage. Following aspiration fluid sent for culture and sensitivity and drain was placed in the abscess cavity. CT scan was repeated and if no residual collection found with clinical improvement of symptoms, patients were discharged. Patients who did not improve up to 40 days or clinically deteriorated and developed complications like sepsis or pancreatic fistula formation, underwent surgical intervention. Data was collected on specially designed performa

Results: five Hundred and fifty eight patients of acute pancreatitis were admitted during the study period and among them 25 [4.48%] patients developed pancreatic abscess. Four [16%] patients were male and 21 [84%] female. Mean age was 45 +/- 10 year. Twenty [80%] patients were cured with percutaneous drainage in 20 - 40 days and five [20%] developed complications for which open surgical intervention was done. One [4%] developed pancreatic fistula and one [4%] patient died. Three patients improved with surgical intervention

Conclusion: CT guided percutaneous drainage is minimally invasive and effective surgical treatment for pancreatic abscess

Morbidity and mortality in acute pancreatitis

Objective: to determine the morbidity, mortality and causes of acute pancreatitis in patients presenting to a tertiary care hospital

Study design: descriptive case series

Place and Duration of study: department of Surgery Ward 3 Jinnah Postgraduate Medical Centre Karachi, from October 2013 to October 2015

Methodology: patients diagnosed as having acute pancreatitis were included in the study. Laboratory and radiological investigation were carried out. Local, systemic complications, mortality and causes of acute pancreatitis were noted. Patients were followed up to 3 months to record the late complication of acute pancreatitis

Results: a total of 220 patients of acute pancreatitis were included. Average age of patients was 43 year. There were 150 [68.18%] female and 70 [31.82%] male patients. Of the total 176 [80%] patients had acute mild pancreatitis, 24 [10.90%] acute moderate pancreatitis and 20 [9.10%] acute severe pancreatitis. Overall mortality was 3.64% [n=8]. Mortality in acute moderate pancreatitis was 8.33% and in acute severe pancreatitis 30%. Local and systemic complications occurred in 18.33% patients. This included ARDS [20%], pleural effusion [20%], hypocalcaemia [20%], shock [18.8%], neurological [13.63%] and renal failure [13.63%]. In 85% cases cause of acute pancreatitis was cholelithiasis

Conclusions: overall mortality in acute pancreatitis was 3.64. It was more in cases of acute severe pancreatitis. The major cause of acute pancreatitis was cholelithiasis

Routine episiotomy versus selective episiotomy in primigravidae

Objectives: To compare the maternal and fetal outcome in routine versus selective episiotomy in primigravidae

Study Design: A randomized controlled trial conducted at Jinnah Hospital, Lahore, Pakistan. The two interventions compared were selective [limited to specified maternal or fetal indications] and routine episiotomy [following the hospital policy]. 200 primigravidae were included in the study, 100 women in each group. The main outcome measure was severe perineal trauma [3rd degree and 4th degree tear]

Results: Episiotomy was made in 32% of deliveries in the selected and 100% in the routine group. Severe perineal trauma was not seen in either group. Anterior vaginal/ Paraurethral trauma was more common in the selected group. However, posterior surgical repair, perineal pain, wound dehiscence and other healing complications were all less frequent in selected group

Mid-trimester termination of pregnancy-comparison of sublingual with vaginal misoprostol

This paper compares the efficacy, side effects and patient's satisfaction of sublingual with vaginal misoprostol for mid-trimester termination of pregnancy. The study was performed in the department of Obstetrics and Gynaecology, Jinnah Hospital, Lahore. One hundred patients presenting for termination of pregnancy between 13-24 wks of gestation were selected. They were divided into two groups, group I was managed with sublingual and group II with vaginal misoprostol. The dose of misoprostol was 200 pg repeated at intervals of 6 hours up to a maximum of four doses. The primary outcome measure was induction expulsion interval and secondary outcomes were maternal complications, and women's acceptance of the termination procedure. Successful termination was achieved in 96% patients in group I and 94% in group II. The patients in the two groups were comparable regarding their parity, gestational age and indications for termination. As regards the dosage, 76% in each group required a dose of 400 - 600 ug [P value 0.000]. Induction expulsion interval was < 12 hrs in 92% patients in group 1 and 88% in group II, a difference not statistically significant [P value > 0.005]. Pyrexia > 38°C was found in 8% and 6% in each group respectively while 8% in group I and 4% in group II had nausea and vomiting. So, sublingual misoprostol is as effective as vaginal misoprostol but with more nausea and vomiting, which can be managed easily. As a conclusion misoprostol can play a very important role in the practice of obstetrics and gynecology in resource poor countries where cost of other prostaglandins is prohibitively high and temperature maintenance is a problem. In proper dosage the risk of complications is low and most of the patients achieve completion of expulsion in less than 12 hrs by both routes