Diagnostic accuracy of mid upper arm circumference [MUAC] for screening low birth weight babies

Objective: To determine the diagnostic accuracy of Mid Upper Arm Circumference [MUAC] for screening low birth weight babies

Study Design: Cross-sectional study

Place and Duration of study: This study was conducted at the Pediatric Unit II and Gynecology Unit II at Civil Hospital Karachi, Pakistan, from January to June 2012

Materials and Methods: A hospital base study was carried out on full term, singleton 112 live born babies. Birth weight was taken through digital weighing scale as gold standard against anthropometric measurement of MUAC in centimeters

Correlation between MUAC and low birth weight was calculated with 95 % confidence interval

Sensitivity, specificity, positive and negative predictive values were calculated

Results: Out of 112 newborn babies studied, 44 [39 %] were male and 68 [61%] were female. The mean birth weight was 2.316 +/- 0.563 kgs and 51 [45.5%] newborns were low birth weight [LBW]

The mean MUAC was 8.90 +/- 1.08. In low birth weight mean MUAC was 8.41 +/- 0.87; 95% CI [8.21; 8.61] and in normal birth weight mean MUAC was 9.90 +/- 0.70; 95% CI [9.66; 10.13].Pearson correlation between low birth weight and MUAC was found statistically significant [r= 0.858;P-value <0.001]. A cut-off point of <9.3 cm of MUAC showed 81.1% sensitivity and 78.3% specificity

Conclusion: Mid upper arm circumference was statistically significant anthropometric surrogate of birth weight at cut-off point < 9.3 cm in the study population. Further studies are needed to validate the finding of this study in community setting. MUAC is a simple, practicable, quick and reliable indicator for predicting LBW newborns in the community and can be easily measured by paramedical workers in developing nations

Retrieval of gallbladder through epigastric port as compared to umbilical port after laparoscopic cholecystectomy

This comparative prospective study was conducted at the Ghulam Muhammad Mahar Medical College Hospital and Red Crescent General Hospital, Sukkur, Pakistan, for a period of two years from July 2012 to June 2014. The study included 1800 patients who underwent laparoscopic cholecystectomy for symptomatic cholethiasis. These patients were divided in to two groups. Group I included 900 patients, who underwent conventional laparoscopic cholecystectomy with the four port technique. In these patients, the gall-bladder was retrieved through umbilical port by a sterile surgical hand glove [size 6[1/2] or 7 inches] endobag. The fascial defect of 10 mm umbilical port was closed by vicryl "0" with J-shaped needle, while three 5 mm ports closed by applying steri strips. Group-II also included 900 patients. In these patients laparoscopic cholecystectomy was done by using three ports, 10 mm epigastric working port, 5 mm umbilical port for 5 mm telescope and lateral 5 mm port for assistant. The gall-bladder was retrieved through epigastric port without endobag. The results of both these techniques were collected and analyzed on SPSS version 14. The mean age of patients was 45 years. The male to female ratio was 1:3. In group-I, after laparoscopic cholecystectomy, gall-bladder was retrieved safely through 10 mm umbilical port in surgical glove endobag. In acutely inflamed cases, the gall-bladder was opened at the umbilical port site inside the endobag and decompressed before retrieval. In this group, wound infection of umbilical port occurred in 5.11% patients, port-site hernia in 3.66%, port-site bleeding in 1.33% while difficulty in retrieval of gall-bladder in acutely inflamed cases in 1.88% patients. In group-II, wound infection in epigastric port was found in 1.55% patients, port-site hernia in 0.11%, port-site bleeding in 4%, difficulty in retrieval of gall-bladder in 5.33% while leakage /perforation of gall-bladder in 4.11% patients. The serious complications like wound infection and port-site hernia are more frequently found in group-I patients as compared to group-II

Role of laparoscopy in blunt abdominal trauma

To evaluate the role of laparoscopy in the diagnosis and management of blunt abdominal trauma. This descriptive, prospective study was conducted in the departments of surgery, Ghulam Mohammad Mahar Medical College, Sukkur and Chandka Medical College, Larkana, Pakistan from June 2010 to May 2012. It included 32 patients with blunt abdominal trauma admitted in emergency at GMMMC, Sukkur and at CMC Larkana. Initially, all were resuscitated with iv fluids, analgesics, iv antibiotics and blood transfusion, if required and then investigated by ultrasound abdomen, plain x-ray abdomen and chest and other routine investigations. Laparoscopy was performed in hemodynamically stable patients not showing free gas under the diaphragm in plain x-ray abdomen and ultrasound showing hemoperitoneum. The patients with penetrating abdominal wounds, non-traumatic abdominal emergencies and iatrogenic injuries were excluded. Out of 32 parents, 29 were male and only 3 were female. The age ranged from 12 to 60 years. The organs injured were spleen in 5 [15.6%] patients, liver in 17 [53.12%], omental bleeding in 2 [6.25%], small bowel mesenteric bleeding in 6 [18.75%] and associated Jejunal [injuries in 2 [6.25%] patients. Only 3 [9.37%] patients with Grade-iii liver injury developed post- operative collection, 1 [3.12%] patient developed biliary fistula and 1 [3.12%] developed right sided pleural effusion. No post-operative bleeding or mortality was recorded. Laparoscopy could be useful in selected patients with blunt abdominal trauma as a diagnostic and therapeutic tool, thus avoiding unnecessary laparotomies

experience of trans-abdominal repair of vesico-vaginal and uretero-vaginal fistulae

To assess the success rate of trans-abdominal repair of vesico-Vaginal fistula. This prospective descriptive study was conducted in the Departments of Surgery, Gynaecology and Urology, Ghulam Mohammad Mahar Medical College Hospital, Sukkur, Pakistan from August 2009 to July 2012. A total 27 patients of vesicovaginal fistula [VVF] and Uretero-Vaginal fistulae were included in the study. All patients had supra-trigonal multiple or single VVF were repaired by the abdominal approach. The outcome of the procedure and post-operative complications were recorded. Thirteen patients had single Supra-trigonal, three had multiple VVF. Three had vesico-Uterine and four had uretero-vaginal fistulae. All were operated by abdominal approach successfully. Pelvic surgery [abdominal hystrectomy /LSCS] was the major cause of VVF, accounting for 66.66 %[18 Patients], while in remaining 33.33% [9 patients] the obstructed and prolonged labor were the cause. All fistulae healed successfully with minor leaking in 2 [7.4%] patients which settled spontaneously. One patient developed post-operative adhesions [small bowel obstruction] and was explored and adhesiolysis was done. Three [11.11%] patients developed post-operative wound infection and healed by dressing. Trans abdominal is an excellent approach for supra-trigonal, vesico-uterine and uretero-vaginal types of fistulae

Frequency of HBs Ag and anti-HCV in trauma patients

This study was carried out to determine the frequency of Hepatitis B and C Viral infection in patients undergoing emergency surgical operations after trauma, and to evaluate the associated risk factors. Descriptive Study. This study was conducted at General Surgical, Orthopaedic and Paediatric Surgery Department of Ghulam Muhammad Mahar Medical College Hospital Sukkur from May-2011 to April-2012. All the patients who were admitted in the Surgical and orthopaedic department for emergency surgical operations followed by trauma were included in the study. The patients were screened for HBsAg and Anti-HCV using immunochromatography [ICT] method. Those who were weak positive by ICT were further confirmed by Enzyme Linked Immunosorbent Assay [ELISA]. 592 patients were admitted in Surgical and orthopaedic department during a period of last one year for emergency operations after trauma and were screened for HBsAg and Anti-HCV. Out of these 592 patients 472 [79.7%] were males and 120 [20.27%] were females. Mean age of these patients was 40 years. After screening, 33 [5.57%] patients were found HBsAg positive and 117 [19.76%] were Anti-HCV positive, while 09 [1.5%] were positive for both. Hepatitis-B was found in 21 [2.3%] males and 12 [1.3%] females, while Hepatitis-C was predominantly found in 68 [7.44%] males and 49 [5.36%] female patients. Parenteral injections by Quacks, previous surgery, blood transfusion and shaving by barbers were found to be the risk factors. High frequency of HBs Ag and Anti-HCV was found in trauma patients undergoing emergency surgery. Our message is that "Prevention is better than cure". So it is essential to prevent the spread of Hepatitis B and C by screening every patient before surgery and counseling of patients

How early is early laparoscopic cholecystectomy in acute cholecystitis?

The efficacy and timing of early laparoscopic cholecystectomy for acute cholecystitis has been a subject of debate for years. Prospective comparative study, done at Ghulam Muhammad Mahar Medical College and Hira Medical Center, Sukkur, from July 2007 to June 2010. All patients undergoing Laparoscopic cholecystectomy for acute cholecystitis were included in the study. They were admitted through emergency with acute cholecystitis. Patients were divided into two groups according to the timing of surgery from the onset of symptoms. Group I included 205 patients who presented with acute cholecystitis within 48-72 hours of onset of symptoms and their surgery was done within 48-72 hours of presentation. Group II included 95 patients who presented after 72 hours of onset of symptoms and their surgery was done after 72 hours to one week of presentation. Clinical data was recorded and routine investigations along with ultrasound abdomen were carried out. The procedure performed, and its complications and success rate noted and compared between the two groups. The study included 300 patients with acute cholecystitis who underwent early laparoscopic cholecystectomy within 48 to 72 hours of onset of symptoms in Group I and after 72 hours to 1 week in Group II. Among 300 patients there were 90[30%] males and 210[70%] females. The age of patients ranged from 20 to 70 years with a mean of 45 years. There were no open conversion in group I while 4.2% had to be opened in group II, the median operative time was 65 minutes in group I and 90 minutes in group II, postoperative hospitalization was 1 day in group I and 3.5 days in group II and total hospital stay was 2 days in group I and 4.5 days in group II. Intra-operative and postoperative complications were less in group I as compared to group II. Early laparoscopic cholecystectomy within 48-72 hours of onset of symptoms results in lower conversion rate, shorter operative time and reduced hospitalization. All patients with acute cholecystitis should be operated within 48-72 hours of the symptoms