Disaster management in combined military hospital Quetta

Objective: To review the mass casualty management at Combined Military Hospital Quetta [CMH QTA], from 2012 to 2015 and to recommend measures for enhancement of capabilities in order to handle major mass casualty events

Study Design: Descriptive, cross sectional

Place and Duration of Study: Combined military hospital Quetta, from Jan 2012 to Dec 2015

Material and Methods: This study is a review of the patients brought to CMH QTA, in different types of mass casualty events from 2012 to 2015. The type of trauma, the procedure carried out and the patient outcome in each case was recorded. The data were analyzed and based upon the mortality and morbidity of casualties, the evaluation of facilities available and required was carried out as per Joint Commission on Accreditation of Healthcare Organizations [JCAHO] standards

Results: Over a period of four years, out of 3507, the highest number of casualties [42%] were received in year 2013. Civilians represented the commonest victims [79%] followed by army personnel [13%] and frontier corps [8%]. The gunshot wounds and Improved Explosive Device [IED] blasts were on the top [53.5%] as a cause of mass casualty followed by road traffic accidents [37.5%]. The highest number of patients [89%] underwent minor procedures like debridement, stitching and aseptic dressing. Twenty five percent of patients required a team work of various surgical specialists

Conclusion: The existing resources are sufficient for managing minor and moderate mass casualty scenarios but proper planning and enhancement of resources [equipment, infrastructure and personnel] is essential to cope with any probable major mass casualty event. We recommend training of paramedical staff for receiving, triage, resuscitation and definitive management of casualties

Frequency and antibiogram of isolates from surgical units of a tertiary care hospital in Quetta

Objective: To determine the frequency and antibiogram of the isolates from infected patients in surgical units of a tertiary care hospital

Study Design: Cross-sectional, descriptive study

Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Quetta, from March to October 2015

Methodology: Clinical samples from the surgical units received in Department of Microbiology for culture and sensitivity were analyzed by Gram stain, culture and biochemical tests for identification of the isolates; and the antibiotic susceptibility was determined by modified Kirby Bauer disc diffusion method. Data was analyzed by Statistical Package for Social Sciences [SPSS] version 19

Results: The commonest isolate was Acinetobacter baumannii [22%] followed by Escherichia coli [20%], Pseudomonas spp. [15%] and Methicillin-resistant Staphylococcus aureus [MRSA] [11%]. Acinetobacter baumannii showed highest susceptibility to doxycycline [41%], Enterobacteriaceae to meropenem [96%], Pseudomonas spp. to polymyxin-B [100%] and Gram positive bacteria to linezolid [100%]. Seventy-two percent of the isolates were found to be multi-drug resistant

Conclusion: There was a high infection rate in surgical patients with Acinetobacter baumannii, Eschericia coli, Pseudomonas spp. and MRSA being the commonest isolates. Acinetobacter baumannii showed highest susceptibility to doxycycline, Enetrobacteriaceae to meropenem, Pseudomonas spp. to polymyxin-B and Gram positive bacteria to linezolid

Diabetes mellitus prediction; Serum lipids, ALT and fasting blood glucose: using serum lipids and ALT

The rapid change in lifestyles and dietary has led to a pandemic of diabetes mellitus. The diagnosis of diabetes mellitus sometimes requires 2 hr OGTT sampling. Recent evidence has shown that there are lipid related abnormalities associated with diabetes mellitus, so a consideration comes in fortheir utilization as a marker to support diabetes mellitus. [1] To correlate serum total cholesterol, triglycerides and ALT with fasting blood glucose [2]. To predict diagnosis of diabetes mellitus using above serum markers. Cross-sectional analysis, descriptive study. This study was carried out between Mar-2010 to Jan-2011 at the department of pathology, PNS RAHAT in collaboration with PNS SHIFA. A total of 251 subjects were screened for presence of glucose dysregulation. Based upon the results of fasting blood glucose, subjects were grouped as having normal glucose tolerance [NGT], impaired fasting glucose [IFG], and newly diagnosed diabetes mellitus [NDDM]. A comparison of lipids including triglycerides, total cholesterol and alanine aminotransferase [ALT] were made in the above groups to measure the differences between the above mentioned three groups. ALT, triglyceride and total cholesterol were correlated with results of fasting blood glucose through pearson's correlation. Later the performance of different cut-offs of triglycerides, total cholesterol and two mathematical models [[Factor-l=FBG [mmol/L] + triglycerides [mmol/L]] and [Factor-ll=FBG [mmol/L] + triglycerides [mmol/L] + total cholesterol [mmol/L]]] were evaluated for detecting diabetes mellitus against the gold standard 2 hr OGTT in 71 subjects. The results of triglycerides, total cholesterol and serum ALT between the three groups were as: [[Triglycerides: NGT =1.91, IFG =2, 10, NDDM= 2.75, p=0.003] [total cholesterol: NGT=5.03, IFG=5.19, NDDM=5.74, p=0.056] [ALT:NGT=28.47, IFG=27.95, NDDM=25.78, p=0.846]]. Most correlation was found between serum triglycerides and fasting blood glucose [r2=0.235, p<0.001]; while serum total cholesterol and ALT showed lesser correlations [[total cholesterol:r2= 0.172, P=0.007], [ALT:r2= 0.010, p= 0.877]]. While triglycerides demonstrated superiority in terms of sensitivity to total cholesterol for detection of diabetes mellitus, the factors incorporating lipids and glucose had the highest overall diagnostic efficiency. Triglycerides and total cholesterol levels rise from normoglycemic individuals to subjects having impaired fasting glucose and newly diagnosed diabetics. The inclusion of triglycerides and total cholesterol for diagnosis of diabetes mellitus improves the chances of for detection of diabetes mellitus

Surgical management and outcome analysis of extradural hematoma at combined military hospital Rawalpindi

The aim of this study is to see the frequency of extradural hematomas [EDH] at neurosurgical centre CMH Rawalpindi. Descriptive study. Department of Neurosurgery CMH Rawalpindi over a period of 2 years [Jan 2001 to Jan 2003]. All patients with head injury reporting to trauma center CMH Rawalpindi from 2001 to 2003 were reviewed. Using non-probability convenient sampling, patients with closed head trauma were included in the study. A total of 1215 patients were reviewed during the study period. Maximum patients were under 12 years of age. Extradural haematoma was found in 23 [2%] patients. Out of 23 patients, 18 [78%] were males and 5 [22%] were females, the male to female ratio was 3.5:1. Alteration of consciousness was the most common presentation [61%]. Location of EDH was temporoparietal in majority of patients. Bilateral EDH was found in 1 patient only. At 6 months follow up, good recovery was observed in 15 [65%] patients. Level of consciousness at the time of surgery is the single most important decisive factor in the outcome hence early diagnosis and surgical intervention is essential

Management of multilevel lumbar disc herniation

To identify and document more then one level symptomatic lumbar disc herniation and to find its frequency presentation and outcome. Descriptive study Combined Military Hospital Rawalpindi from 2001 to 2002. A total number of 260 male patients were selected from out patient department over a period of 1 year. After clinical evaluation, confirmation was done by nonenhanced Electro-resonance imaging [MRI] of the lumbar spine. All the patients with multilevel disc herniation on MRI underwent never conductions [NCS] electromyography [EMG] studies. All the patients were males. Maximum number of patients was between 32 - 40 years of age; mean age was 35 with a standard deviation of 2. 48 belonged to military setup and 82 were civilians. Out of all, 14 had multilevel lumbar disc herniations, the frequency being 5.8 in our study. All the patients with multilevel disc herniations underwent surgery. Only 4 patients had multilevel discectomy where 10 had discectomy at single level. Mortality was nil and there were no postoperative neurological deficits. All the patients were back to work at 6 weeks. Data was analyzed using the descriptive SPSS package. The identification of symptomatic multilevel disc herniation is extremely important in order to manage the patients with multilevel disc herniation as single level discectomy in such patients will not ameliorate the symptoms and may require another difficult surgery

Peripheral vascular trauma an experience of two years

The incidence of vascular trauma has increased considerably during last 40 years. The study was carried out to describe the causes of injury, presentations, surgical approaches, outcome and complication of vascular trauma of the upper and lower limbs. This was a descriptive study. Surgical Department CMH Kharian, in which this study lasted from Oct 1997 to Oct 1999. In the study, 30 patients were operated for peripheral vascular injuries. Diagnosis was made by physical examination and hand Doppler alone. Primary vascular repair was carried out where possible; if not interposition vein graft was placed. Early liberal fasciotomy was considered as and when required. Patients with isolated venous trauma and patients with obviously unsalvageable lower extremity injury requiring primary amputation were excluded from the study. The limb salvage rate was 93.3%. A total no of 30 patients were included in this study. Out of these 24 [80%] were males and 6 [20%] were females, all were young adults with age ranging from 14 to 52 years, a mean age of 22 years and a standard deviation of. Gun shot wound [GSW] constituted the major cause of trauma and was present in 18 [60%] Patients, road traffic accident [RTA] in 6 [20%] patients and stab wound in 6 [20%] patients which are comparable to international studies. Primary end-to-end anastomosis was done in 20 [66.07%] patients and graft interposition was done in 10 [33.3%] patients. Vein graft was used in 20 [66.07%] patients lateral repair was done in 7 [23.3%] patients while in 3 [10%] patients ligation was performed. Early complications included bleeding in 2 [6.7%], thrombosis in 4 [13.3%] and wound infection in 3 [10%] patients respectively. Late complications are amputation in 2 [6.7%] patients and muscle ischaemia in 2 [6.7%] patients. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present. Early fasciotomy is warranted if there is any suspicion of occurrence of compartment syndrome