Postoperative outcome of early oral feeding following elective colonic anastomosis

To assess the safety of early oral feeding after colonic anastomosis. Descriptive case series. Department of Surgrey Lady Reading Hospital Peshawar, from September 2009 to April 2011. Preoperative evaluation included history, physical examination and base line investigations. A limited bowel preparation was done in all the patients. Postoperatively 10-60 ml of sips were allowed 3 hourly after recovery from anesthesia. Free oral fluid intake was allowed on postoperative day-1, semisolids on day-2 and 3 as tolerated and full oral diet allowed on day-4. In case of two episodes of vomiting and absence of bowel sounds, patients were kept nil by mouth and nasogastric tube was placed. Out of total 101 patients, 77 [76.24%] were males and 24 [13.76%] females [M:F 3.2:1]. The age range was from 25 year to 77 year with mean age of 49.5 +/- 2.3 year. The time of passge of first flatus was 2 to 6 days [mean 2.4 days], and the time of first passage of stool was 4-9 days [mean 4.6 days]. Twenty two [21.78%] patients did not tolerate feeding. They developed vomiting and abdominal distension. Postoperative complications included wound infection [7.92%], electrolyte imbalance [4.95%], respiratory tract infection and aspiration pneumonia [5.94%], anastomotic leaks [0.99%] and wound dehiscence [1.98%]. The hospital stay was 3-8 days [mean 5.4 days]. Early oral feeding after colonic surgery was safe and well tolerated by majority of the patients

Modified posterior sagittal ano-rectoplasty: a new approach for the management of ano-rectal malformations in children

To introduce a technical modification in Posterior Sagittal Ano-rectoplasty [PSARP], commonly known as Pena's procedure, and to analyse the outcome of such modified procedure in terms of fecal continence and other relevant complications in children with ano-rectal malformations. It was a prospective and descriptive study, conducted at the department of pediatric surgery, Lady Reading Hospital Peshawar from January 2004 to December 2006. Forty patients were studied. All children of either sex with ano-rectal malformation who presented first to our department were included in our study excluding others treated some where else. Relevant investigations were performed in all patients. Diverting colonic or small bowel stoma was created in all patients at presentation to our department. The technique was performed at or after six months of age, depending upon the clinical condition of the patient. After discharge, all patients were examined and monitored in the out-patient department over a period of two years. Out of 40 patients 25[62.5%] were male and 15 [37.5%] were female age range from 6-12 months. On 35 [87.5%]. Isolated PSARP while on 5 [12.5%] patients modified PSARP with abdominal approach were performed. Anal stenosis was found in 3[7.50%] patients, rectal mucosal prolapse in 4[10%], faecal soiling and faecal incontinence in 17[43.58%] and 7[17.05%] patients were respectively. Faecal continence was good, fair and poor in 15[38.46%], 17[43.58%] and 7[17.94%] patients respectively. Our results of the present series suggest that this procedure is a valuable alternative to PSARP for the treatment of anorectal malformations

Diagnostic yield of fine needle aspiration cytology in diagnosis of thyroid nodule and its comparison with national and international studies

OBJECTIVE: To determine the diagnostic value of fine needle aspiration cytology in the diagnosis of solid solitary thyroid nodule

STUDY DESIGN: This was cross-sectional comparative study

PLACE AND DURATION OF STUDY: This study was conducted at the Department of Ear, Nose, Throat, Head and Neck surgery, Post Graduate Medical Institute, Lady reading Hospital, Peshawar. The duration of the study was one year from June 17, 2010 to June 16, 2011

METHODOLOGY: The sample size was 82 patients with solid solitary thyroid nodule, fulfilling the inclusion criteria. After taking detailed history and thorough examination, relevant investigations were performed. Informed consent was taken from all the patients and Fine needle aspirations were carried out in all cases and compared with open biopsies taking as gold standard

RESULTS: Our study included 82 cases consisting of 57 female and 25 male, with female: male ratio of 2.28

1.The age of the patients was ranged from 16-65 years with mean age of 42.56 + S.D 11.60 years. The FNAC diagnostic accuracy was 82.92% along with a sensitivity of 88.09% and specificity 77.50%. The positive predictive value was 80.43% that supports our hypothesis

CONCLUSION: FNAC is a primary diagnostic tool for solitary thyroid nodule because it is simple, safe, quick, reliable, minimally invasive, and cost effective

Cost of depressive disorders in indoor patients

To estimate the direct and indirect cost of depressive disorders in indoor patients. This hospital based descriptive study was carried out on thirty patients admitted consecutively in department of psychiatry Jinnah Postgraduate Medical Center Karachi from January to July 2000. International Classification of Disease-10 diagnostic criteria for depressive disorders were used to identify the patients. Cost prof or ma was devised to calculate direct and indirect cqst. The cost of hospital stay per day was calculated by using opportunity costs model. There were 9 [30%] male and 21 [70%] female patients. Majority of the patients were in their twenties [n=ll, 36.67%] and thirties [n=9, 30%]. There were 24 [80.02%] married and 6 [19.98%] unmarried patients. A total of 20 [66.66%] were jobless and 10 [33.33%] were having a job. Most of the patients were suffering from moderate depressive disorder and recurrent depressive disorder [n=ll, 36.67% and n=10, 33.33%]. The overall cost of all the patients was Rs. 472,542 with Rs. 73,026 [15%] in direct and Rs. 399,516 [85%] in indirect costs with a ratio of 1:5.5. The diagnosis of moderate depressive disorder was the commonest in the sample. The indirect cost of depressive disorder in indoor patients was 5.5 times more than the direct cost

Cognitive disturbance comparison among drug-naive depressed cases and healthy controls

To assess and compare cognitive disturbances among newly diagnosed depressed and healthy control cases on the McNair and Kahn auto-evaluation scale. Comparative, cross-sectional study. Out-patients Department of Psychiatry, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from February to May, 2007. All consecutive new cases reporting at the out patient department were screened for depressive illness. They were matched with healthy-controls aged between 18-40 years. Clinical assessment was carried out on the basis of detailed history, physical examination, mental state examination by psychiatrists. For diagnostic purpose, application of ICD-10 followed by administration of Scale for Cognitive Difficulties. Sixty subjects, 30 depressed patients [20 females and 10 males] and 30 healthy-controls [18 females and 12 males] were assessed. The age of cases with depressive disorder ranged 18-38 years. It was found that 63.3% [65% females and 60% males] depressed patients had cognitive difficulties compared to 3.3% of healthy-controls [p<0.001]. Proportions were compared using chi-square test with significance at p< 0.05. Depression is not merely an emotional [mood] disorder but has an impact on cognition domain as well. Attention/concentration was the most common domain of cognition affected, followed by memory disturbance among the drug-na‹ve depressed patients

Substance use in patients of schizophrenia; local perspective

This study is aimed at exploring the demographic pattern of substance use disorder among patients of schizophrenia and to find out the reasons of drug use among them. Cross-sectional study. This study was conducted at Out-patient departments, of Psychiatry at Jinnah Post-Graduate Medical Centre Karachi and Sir Cowasjee Jehangir Institute of Psychiatry Hyderabad from July to December 2009. Approval from ethical research committee was taken, and a structured proforma was developed to record demographic details, reasons of substance use, pattern of use, and diagnosis of the patient after informed real consent from the patient or their attendants. Out of a total 100 patients 62 had substance use disorder. Males had 81% co morbidity. Niswar was the predominant substance of use [54%], followed by cigarette [24%]. Alcohol and cannabis were not much found to be used. Most common cause, stated by schizophrenics for substance use was to alleviate anxiety [40%], followed by use to induce sleep [16%], and peer pressure [8%]. In contrast to the findings in western literature, pattern and reasons of substance use disorder are different in local perspectives. Nicotine has been found to be used in different forms, which can be treated by reducing the perceived reasons of substance abuse by the patients

Psychiatric morbidity in children reporting at a tertiary care hospital

The study is designed to assess the psychiatric morbidity in children reporting at psychiatry OPD, of National Institute of Child Health [NICH], Karachi. Simple descriptive study. This study was conducted during the period of two years from January 2005 to January 2007 at National Institute of Child Health [NICH] Karachi. All consecutive patients who reported in child psychiatry clinic were enrolled in this study if they fulfilled the inclusion criteria having age of 3 years to 15 years of either sex. Cases excluded in the study were psychiatric presentation associated with physical illness and symptoms related to drug side effects. The facility received direct referrals from other professional colleagues, and from parents, school teachers who have been sensitized to child psychiatric issues. Semi-structured interview based on DSM-IV along with an open ended slot of question were used for evaluation. Data regarding demographic characteristics, referral source, reasons for referral and diagnostics based on clinical judgment were collected. Five hundred and seventy new cases were inducted in this study over a period of two years. Males outnumbered females with the ratio of 1.7:1. Majority [42.28%] of children were in the age range from 11-15 years. Standard deviation of age was 6.8 years for male and 3.5 years for female children. Most [69.6%] of the referrals were made from professionals working in pediatric medicine. The most common reason for referral was disruptive behaviour [26.32%], followed by behavioural problem with fits [15.79%] and physical over activity [7.89%]. Other presenting complaints [reasons for referral] included slow learner, self injurious behaviour, aggression, speech delay, unexplained physical symptoms, bed wetting, emotional problems poor attention and tics etc. Mental retardation with behavioural problem was the most frequent [36.14%] provisional diagnosis. About 16.14% of cases related to seizure disorder with behavioural problem while 10.53% were attention deficit hyperactivity disorder [ADHD]. Other diagnoses made were depressive illness, conversion disorder, functional enuresis and autism. After mental retardation, one third of cases comprised of seizure disorder with behavioral problem, attention deficit hyperactivity disorder [ADHD], and depressive illness. It is therefore recommended that professionals at primary health care level should be trained to identify psychiatric illness in children so that early intervention, proper referral and effective management may be possible

Atrial fibrillation following coronary artery bypass graft surgery

To know the frequency of atrial fibrillation [AF] after coronary artery bypass graft surgery and the risk factors which predispose these patients to develop post-operative AF. This prospective, observational, analytic study was carried out at National Institute of Cardlovascular Diseases Karachi, from January 2001 to January 2002. It included 200 patients undergoing elective or emergency coronary artery bypass graft [CABG] surgery without concurrent valvular heart disease, prior history of AF, ventricular arrhythmias or redo CABG surgery. All patients underwent CABG and were followed for three weeks for incidence of AR Patients who developed AF [group A] were compared with patients without AF [group B] for different variables. Univariate analysis was done using Student's t-test for continuous variables and Chi-square test for categoric variables. The mean age was 52.78 +/- 8.32 years. The average bypass time and cross clamp time were 83.20 [SD +/- 18.73] minutes and 29.73 [SD +/- 7.25] minutes respectively. The mean ejection fraction was 49.34%. The median number of grafts was three. The frequency of AF was 12 [6%]. Univariate analysis revealed that advanced age, male sex, right coronary artery lesion, prolonged bypass time and low ejection fraction were statistically significant risk factors [p<0.005]. AF is a common, but potentially preventable, complication following CABG surgery. The Advanced age, low ejection fraction, prolonged cross clamp and bypass time are the important risk factors which may predispose these patients to develop postoperative atrial fibrillation