Return of the infectious ghost: tuberculosis

To find out the incidence of Abdominal Tuberculosis, its presentation, morbidity and mortality. Prospective, descriptive study from Jan. 2001 to Dec. 2004. Setting: Surgical Unit III, Bahawal Victoria Hospital, Bahawalpur. All patients who presented with abdominal tuberculosis and were confirmed on histopathology. Patients with tuberculosis at other sites were excluded. The data of the patients was collected and analyzed. A total of 123 patients were inducted in the study. Amongst them 65 [52.85%] were male and 58 [47.15%] female, with most [92] patients between 20-40 years of age. Eighty four patients presented with acute abdominal symptoms; 23 had intestinal obstruction, 49 peritonitis, while 12 patients had mesenteric lymph node abscess or primary tuberculous peritonitis with military tuberculosis. The remaining 39 patients presented with chronic symptoms i.e. subacute intestinal obstruction/abdominal masses. At laparotomy 31 cases had ascites and 49 cases gut perfora-tions [mostly in the ileum], whereas 55 cases had strictures and adhesions formation. Lymphadenopathy was seen in 24 and abscesses in 13 cases. Five patients had masses in the ileocaecal region and two at other places, whereas two patients had hepatomegaly. In the majority [63] of patients an ileostomy was made either alone or with resection and anastomosis, strictureplasty or closure of perforation. In 17 cases only biopsy and in 13 right hemicolectomy was carried out. In the post-operative period high morbidity was noted in the form of wound infection in 54 [43.9%] cases, while intra-abdominal abscesses were found in seven and severe sepsis in eight patients. Faecal fistula due to anastomotic leakage was noted in five cases in which redo surgery was done in the form of ileostomy. Jaundice was seen in six patients, two amongst them had tuberculous liver masses. As far as mortality was concerned, four [3.25%] patients died in this study. Tuberculosis has come back very strongly and with more involvement of extra-pulmonary sites

Frequency of dyslipidemia in normotensive diabetics

As diabetes mellitus has been declared CHD equivalent we conducted the study with the idea of the presence of clustering of risk factors. These risk factors may appear mild when considered individually, but when added together, they can raise the risk for heart disease significantly. We specially looked the level of various fractions of lipid -in -type 1-and type 2 diabetes mellitus. This cross sectional comparative study was conducted on 100 diabetic patients [50 patients of type-1 and 50 patients of type-2 diabetes mellitus] selected by convenience, who presented in OPD, Department of Medicine, Bahawal Victoria Hospital, Bahawalpur and Qazi Diabetic Clinic located in the premises of Medical Colony Bahawalpur. Study included diabetic patients of all groups and from both sexes. Patients with at least one year history of diabetes mellitus. Among the 100 patients suffering from diabetes mellitus, 68 [68%] were males and 32 [32%] were females. Having 18 to 60 years, in type 1 average age 39.18 +/- 9.86, in type 2 average age was 53.64 +/- 9.95 years. Level of serum total cholesterol was 211.91 +/- 40.19 mg% in type 1, 229.54 +/- 55.60 mg% in type 2. Level of serum triglycerides was 217 +/- 62.34 mg% in type 1 and it was 352.54 +/- 181.47 mg% in type 2. Level of serum LDL-C was 131.82 +/- 32.17 mg% in type 1 and 134.08 +/- 38.48 mg% in type 2. Level of serum HDL-C was 38.88 +/- 3.88 mg% in type 1 and 38,82 +/- 3.62 mg% in type-2. Dyslipidemias were more common in female diabetic patients. Duration of diabetes showed linear correlation with dyslipidemias. We found elevated levels of serum triglycerides and total cholesterol, decreased HDL-C and disturbed values of LDL-C in both types of diabetes mellitus. So all the diabetics should be educated about dyslipidemias and their serum lipid levels should be checked regularly. Primary prevention can minimize the complications resulting due to diabetic dyslipidemias

Is it a diabetic hand?

This is a prospective study conducted in the department of surgery from 1-04-1999 to 31-012002 at BVH Bahawalpur. All the diabetic patients of both types [IDDM or NIDDM] of any age or sex, suffering from infection of hand or Foot were included in the study. A total of 36 diabetic patients had hand infection [Group A] as compared to 207 patients with Diabetic Foot [Group B]. Average age of the patients in Group A was 39.6 years which was quite younger as compare to 57.5 years in Group B. Pain was the dominant presenting complaint [100%] in Group A patients. All these patients were manual workers [Tailors, Carpenters, Farmers, Blacksmiths, Embroidery workers or Housewives] and had minor trauma to their digits during work; which they had neglected for few days or received first aid treatment from a family member or quack. In Hand Group, no patient was in Grade 0, I, or III. During the course of treatment, all the patients [100%] of Hand Group required amputation of one or more digits of the dominant hand including amputation of the thumb in 22 patients. No patient required amputation of the whole hand or forearm. The involvement of thumb or index finger alone or along with other digits in almost all the patients of Hand Group, reflects their common use, in manual work and their more susceptibility to repeated minor trauma. The loss of thumbs in 22 patients reflected high morbidity in terms of loss of hand function though thumb reconstruction is a valid option. Morbidity in terms of hospital stay was quite less in Hand Group but it was 100% in terms of loss of crafted digits. Mortality in Hand Group patients was nil in contrast to 9[4.3%] in the Foot Group. Infection of the hand in Diabetics can be named as DIABETIC HAND without any ambiguity. This can lead to opening up of new era of research for better management of this entity in terms of DIABETIC HAND CLINICS. Surgical management of infection in diabetics should be early, aggressive and specialized to avoid poor outcome in the form of loss of vital craft hand