To evaluate povidone-iodine effect on post appendectomy surgical site infection

Objective: Evaluating the effects of Povidone- Iodine against the surgical site infection in post- appendectomy wound infection

Study design: Randomized clinical trial

Place and duration: Department of Surgery, Isra University Hospital Hyderabad from January 2016 to December 2017

Subjects and Methods: Patients of acute appendicitis with classical clinical presentation were selected according to inclusion and exclusion criteria. 60 patients were those in which wound was irrigated with 1% povidone-iodine solution versus 60 patients in whom wound not irrigated with it before skin closure. Data was analyzed on SPSS 22.0 using Student t-test and Chi- square test respectively. Data was analyzed at 95% confidence interval [P=0.05]. P-value of =0.05 was taken statistically

Results: Mean +/- SD age of control and cases was noted as 22.5 +/- 7.5 and 23.5 +/- 6.5 years respectively [P=0.86]. Male and female population in control and cases were noted as 45 [75%] and 15 [25%] and 47 [78.33%] and 13 [21.66%] respectively [P >0.05]. Grade 4 pus discharging wound infection was noted in 3.33% in control compared to 1.66% in cases [P= 0.87]. Normal wound healing [grad 0] was noted in 37 [61.6%] and 43 [71.6%] of control and cases respectively. In control grade 1-4 lesions were noted in 38.4% compared to 28.4% in cases [P < 0.05]

Conclusion: Simple irrigation of appendectomy wound with 1% povidone- iodine significantly prevents against the surgical site infection and pus formation

Antibiotic prophylaxis in preventing surgical site infection in patients undergoing lichtenstein's hernioplasty

Objective: To determine the antibiotic prophylaxis in preventing surgical site infection in patients undergoing Lichtenstein's hernioplasty

Study design: Observational study

Place and Duration: Department of surgery, ISRA University Hospital, Hyderabad. from December 2015 to March 2017

Materials and Methods: 120 cases of inguinal hernia planned for Lichtenstein's hernioplasty were selected according to exclusion criteria and divided into control and antibiotic group. Pre- operative patient history, physical examination and inguinal hernia examination was performed. Prophylactic antibiotic ceftriaxone [1000 mg] was given over night of surgical procedure. Statistical software SPSS 21.0 was used for data analysis at 95% CI [P <0.05]

Results: Mean+/- SD age was noted as 39.51 +/- 7.56 years [15 – 61 years]. Of 120, who underwent Lichtenstein's hernioplasty the direct and indirect hernias were noted in 35 [29.16%] and 33 [27.5%] and 25 [20.83%] and 27 [22.5%] of control and antibiotic groups respectively. Of 120 subjects, the SSI was noted in 17 [14.1%] in control and 5 [4.16%] in antibiotic group. Cumulative SSI in 120 cases was 22 [18.33%]

Conclusion: The present study reports low incidence of surgical site infection with antibiotic prophylaxis in Lichtenstein's mesh repair in open inguinal hernioplasty

Prevalence of risk factors for noncommunicable diseases in adults: key findings from the Pakistan STEPS survey

Background: Pakistan lacks data on the prevalence of risk factors for common noncommunicable diseases [NCDs]. Objectives: This study aimed to determine the prevalence of risk factors for NCDs among a population-based sample in Punjab and Sindh provinces, Pakistan. Methods: This study was conducted in 2013–2014. The NCD risk factors examined were: current daily smoking, eating fewer than 5 servings of fruits/vegetable a day, low physical activity, overweight and obesity. A total of 7 710 households were selected and 1 adult was enrolled from each household. Data were collected using the WHO STEPS instrument [Step 1 and 2], and analysed according to the STEPS statistical plan. Results: The prevalence of tobacco use was 19.7%. The majority of the respondents [96.5%] consumed fewer than 5 servings of fruits/vegetables a day, 41.5% had a low level of physical activity, 26.3% were overweight and 14.9% were obese. The prevalence of stage I and stage II hypertension, including those on medication, was 37% and 15.9% respectively. The prevalence of NCD risk factors differed significantly by sex and occupation [P = 0.0001] but not by age group [P = 0.118], level of education [P = 0.668] and province [P = 0.056]. Only 0.6% of the sample had none of the 5 NCD risk factors while 40% had 3–5. Conclusion: The high prevalence of NCD risk factors in Punjab and Sindh provinces is of concern. Urgent public health interventions are needed to reduce them, especially in youth and young adults

Frequency of post-operative hypocalcaemia following thyroid surgery at a tertiary care hospital of Sindh

Objective: The present study was conducted to determine the frequency of post-operative hypocalcaemia following thyroid surgery at a tertiary care hospital of Sindh Study design: Observational study Place and Duration: Department of surgery, Isra University Hospital from December 2014 to July 2017

Materials and Methods: 100 cases of thyroid swellings were selected according to inclusion and exclusion criteria. Pre- operative patient history, physical examination, thyroid gland examination and laboratory investigations were performed. A serum calcium levels < 0.05] was considered significant

Results: Of 100 patients, 67% were female and 33% were male [P=0.0001]. Female dominancy was noted with female to male ratio of 2.03:1. Age [mean+/- SD] was noted as 37.5 +/- 9.5 years [19 - 48 years]. Frequency of symptomatic hypocalcaemia was noted in 23% subjects post operatively. Mean+/- SD serum calcium and phosphate in post operative hypocalcemia subjects was noted as 7.31 +/- 0.38 mg/dl and 2.95 +/- 0.63 mg/dl respectively. Majority of symptomatic hypocalcemia were noted within 72 hours post operatively

Conclusion: The present study reports 23% frequency of post thyroidectomy hypocalcemia noted within 72 hours post operatively. Goiters of long duration, recurrent goiters, hyperthyroidism and goiters with retro sternal extensions were found risk factors for the post thyroidectomy hypocalcemia

Thyroid function test, C- reactive protein and blood lipids in subclinical hypothyroidism patients reporting at surgical wards

Objective: To investigate the thyroid function, C-reactive protein [CRP] and blood lipid profile in the subclinical hypothyroidism [SH] patients in surgical wards and outpatient department. Study design: Cross sectional study Place and Duration: Department of surgery, Isra University Hospital from August 2014 to May 2017

Materials and Methods: 100 subclinical hypothyroid cases and 100 controls were included according to inclusion and exclusion criteria. Serum TSH level > 6.2 [microIU /ml] with normal free T4 and T3 was considered as subclinical hypothyroidism. Venous blood was taken from ante cubital vein, centrifuged and processed. Sera were used for the assay of thyroid hormones, TSH, blood lipids and C-reactive protein. Data variables were analyzed by Statistix 8.0 [95% confidence interval] [P-value =0.05]

Results: Age in controls and cases was noted as 51.3+/-12.5 and 50.8+/-11.95 years respectively. SH cases show serum T3, T4 and TSH as 0.89+/-0.18 microg/dl, 4.96+/-0.85 microg/dl and 11.95+/-2.85 microU/ml respectively. Serum total cholesterol, triglycerides and LDLc were raised with concomitant low HDLc in SH cases. C- reactive protein in SH cases was 6.91+/-3.38 ng/ml compared to controls 2.56+/-1.51 ng/ml [P=0.0001]. Serum TSH showed negative correlation with HDLc, serum T3 and T4

Conclusion: The present study reports dyslipidemia with elevated inflammatory marker of C-reactive protein in subclinical hypothyroid patients

Asymptomatic dengue infection in adults of major cities of Pakistan

OBJECTIVE@#To determine the asymptomatic dengue infection in adults of Pakistani population.@*METHODS@#This study was conducted in five major cities (Islamabad, Karachi, Lahore, Multan, and Peshawar) of Pakistan. A total of 5 230 adults aged 18 years and above without a history of dengue fever at any point in their life were enrolled from participating laboratories. Those who were confirmed for dengue previously were excluded. Of the total, 62.6% (n = 3 276) were male with an average age of 34.6 years. Participants were briefed about the objectives of the study, and written consent was obtained to perform dengue IgG test using enzyme linked immunosorbent assay. The brief information related to age, gender and area was also taken on proforma.@*RESULTS@#Overall 32.3% (n = 1 691) was having asymptomatic dengue infection which was 67.5% (n = 756) in Karachi followed by 39.1% (n = 391) in Islamabad, 29.9% (n = 316) in Lahore and 21% (n = 228) in Peshawar and none from Multan. More males were affected with asymptomatic dengue infection than females. The asymptomatic dengue infection was significantly higher in different cities; however, there was no significant difference with respect to age groups.@*CONCLUSIONS@#The asymptomatic dengue infection is higher in cities i.e. Karachi, Islamabad and Lahore which are at risk of developing secondary dengue infections. There is a need of awareness among the public about secondary dengue infection.

Asymptomatic dengue infection in adults of major cities of Pakistan

Objective To determine the asymptomatic dengue infection in adults of Pakistani population. Methods This study was conducted in five major cities (Islamabad, Karachi, Lahore, Multan, and Peshawar) of Pakistan. A total of 5 230 adults aged 18 years and above without a history of dengue fever at any point in their life were enrolled from participating laboratories. Those who were confirmed for dengue previously were excluded. Of the total, 62.6% (n = 3 276) were male with an average age of 34.6 years. Participants were briefed about the objectives of the study, and written consent was obtained to perform dengue IgG test using enzyme linked immunosorbent assay. The brief information related to age, gender and area was also taken on proforma. Results Overall 32.3% (n = 1 691) was having asymptomatic dengue infection which was 67.5% (n = 756) in Karachi followed by 39.1% (n = 391) in Islamabad, 29.9% (n = 316) in Lahore and 21% (n = 228) in Peshawar and none from Multan. More males were affected with asymptomatic dengue infection than females. The asymptomatic dengue infection was significantly higher in different cities; however, there was no significant difference with respect to age groups. Conclusions The asymptomatic dengue infection is higher in cities i.e. Karachi, Islamabad and Lahore which are at risk of developing secondary dengue infections. There is a need of awareness among the public about secondary dengue infection.

Common bile duct injury; management and outcome study at Isra University hospital Hyderabad Sind

To evaluate management and outcome of Iatrogenic Common Bile Duct injury after cholecystectomy. Descriptive study. Isra University Hospital Hyderabad during the period of April 2013 to April 2014. All patients presented with CBD injury after cholecystectomy included while CBD tumor and CBD stone and trauma were excluded from study. Total of sixteen patients with CBD injury were admitted from outside the hospital in surgical ward in Isra University hospital either through OPD or Emergency Room or Endoscopy Suite depending on the mode of presentation and failure of ERCP if performed according to the need and clinical presentation. All patients were resuscitated and investigated thoroughly and the procedure whether ERCP, or reconstructive surgery or conservative treatment performed based on patient's clinical presentation and mode of injury and is recorded in the preset approved Performa from relative hospital's ethical review committee and the data compiled in SPSS version 10. All 16 patients; 4[25%] male and 12[75%] females admitted from outside the hospital in two year period. Presented in variable time interval12 [75%] patients admitted in 1 month, 3[18.8%] in 6 monthsand 1[6.3%] in 12 months. Jaundice was the main presenting symptom. Patients were resuscitated and optimized for invasive procedure i.e. ERCP and reconstructive surgery. Six patients were treated with ERCP successfully and 9 underwent reconstructive surgery and 1with some biliary drainage responded to simple conservative treatment. Operative success rate was 75% with 25% mortality which was related to the presence of peritonitis, development of multiorgan failure and late repair of bile duct injury. Although CBD injury is one of the most devastating complication but its early diagnosis and prompt treatment can prevent patient's life with subsequent few or no complication even after its reconstructive surgery. Training must be emphasized to find the all possible ways of recognizing biliary tract anatomy during surgery and possess skills to overwhelm the primary and leading cause of bile duct injury i.e. the visual misperception

Comparing histopathological and magnetic resonance imaging based mesorectal fascia status in patients with rectal carcinoma

To compare mesorectal fascia status on histopathological findings with MRI based radiological mesorectal fascia status in patients with rectal carcinoma taking histopathology finding as gold standard. Analytical study. Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January 2011 to April 2012. Biopsy proven cases of rectal adenocarcinoma undergoing abdominoperineal resection were included in this study. Microscopic examination of slides was done to determine mesorectal fascia status as involved or otherwise without knowing the results of mesorectal fascia status on MRI. Mesorectal fascia status of MRI was determined by a radiologist who was not aware of the histopathological assessment of mesorectal fascia. Mean and standard deviation was calculated for age. Frequency and percentage were calculated for gender and mesorectal fascia status. 2 x 2 table was generated to calculate sensitivity, specificity, positive predictive value and negative predictive values and diagnostic accuracy of MRI for mesorectal fascia involvement taking histopathology as gold standard. The sensitivity of MRI to detect mesorectal fascia involvement was 23.07% and specificity was 70.5%. Positive predictive value of MRI was 10% and negative predictive value was 54.54%. Diagnostic accuracy of MRI for mesorectal fascia involvement was calculated as 50%.MRI findings regarding mesorectal fascia status as involved or otherwise are not helpful when compared with histopathological findings which is the gold standard.

Association of socioeconomic strata with fecolith in acute appendicitis

To determine the association of socioeconomic strata with fecolith in acute appendicitis. Case control study Department of Surgery Combined Military Hospital and the Military Hospital Rawalpindi, Six months from Jan 2008 to July 2008. 80 patients were included in study. Forty were from high social class and 40 from low social class. History and examination of each patient were noted, including monthly income. Appendicectomy was performed under general anesthesia. Each resected specimen was examined for presence of fecolith and sent for histopathological examination. A total of 80 patients fulfilled the criteria of the study. Out of these 40 patients belonged to high social class and 40 patients belonged to low social class. Both the groups were comparable with respect to age [p = 0.435] and gender [p = 0.104] [Table-1 and 2]. On naked eye examination fecolith was present in 20 [50%] patients of high social class and 9 [22.5%] patients of low social class [p=0.011]. Odds ratio calculated was 1.759

Awareness of novel h1n1 pandemic influenza among non-medical personnel, medical students and medical professionals

To study the awareness of swine flu among general population, medical students and medical professionals Descriptive study. Place and Duration of Study: Study was carried out in the department of Pathology [Microbiology], Army Medical College, the Military Hospital [MH] and Combined Military Hospital, Rawalpindi, from 17th January 2010 to 24th January 2010. Materials and A total of 519 people were included in this study, 228 were medical students, 181 were doctors and 110 were non health care professionals. A questionnaire with closed questions regarding the awareness of the basics of swine flu was required to be filled by all participants. It was found that the general population was totally unaware to the extent that 1/3rd had never heard of this disease. The survey of medical students showed reasonable knowledge in the senior classes [80-85%] knew the main features of the disease], whereas the 2nd year students had the awareness around 40-45%. Among the medical professionals the knowledge was excellent in the seniors, whereas the trainees and house officers had suboptimal knowledge of swine flu. The result of this study show a significant gap between the seniors specialists and the juniors and this gap warrants immediate bridging. The general public also need to be informed by various means more comprehensively

Prescription pattern of benzodiazepines for inpatients at a tertiary care university hospital in Pakistan

To determine the point prevalence of benzodiazepine prescriptions for inpatients at a tertiary care university hospital in Pakistan and to correlate it with prescription patterns of various specialties, indications and demographic variables of the patients. This 24-hours point prevalence study was done at The Aga Khan University Hospital, Karachi. By convenient random sampling, 208 inpatients were interviewed. Patients' files were also studied to record the drugs administered. Data was entered into questionnaires and analyzed by SPSS 10.0. The point prevalence of the benzodiazepines was 21.2%. It was higher among males than females and among surgical than non-surgical patients. Midazolam was the most commonly used benzodiazepine, followed by Alprazolam and Lorazepam. Pre-anesthesia and psychiatric symptoms were the two most common indications. Oral route was used in 84% patients for drug administration and mean Valium equivalent dosage was 4.86mg/day. Mean length of prescription was 3 days. Longer duration of hospitalization was a significant predictor of the requirement of benzodiazepine prescription [p-value=0.020]. Prescription pattern of benzodiazepines at a tertiary care university hospital is similar to that reported in the developed countries through monitoring at various levels by physicians, clinical pharmacist and nursing staff. Data regarding the prescription pattern of benzodiazepines is scarce, and it needs to be expanded to formulate clear guidelines regarding their prescription

Prevalence and pattern of tobacco use in rural area of Peshawar

2975 cases were studied in two villages of Peshawar District. 48.44% were found tobacco users. Out of these 43.79% were males whereas females were only 4.4%. Nasswar was being the most frequently used [64.5%] type of tobacco followed by chillum [17.5%]

Serum protein and albumin, lipid and cholesterol concentration in normal adult population of district Abbottabad

Serum Protein and albumin, lipid and cholesterol levels were studied in 200 randomly selected apparently healthy subjects [118 males and 82 females] of different ages. Age range was between 20-70 years. No significant difference was observed in total protein and albumin levels in both sexes of various age groups. Lipid pattern was positively correlated with the age in males however, in females, this pattern was decreased after 50 years age. Cholesterol showed a progressive rise in both sexes between the ages 20-49 years after which begin to fall. Results also showed Lipid and Cholesterol levels were lower in the females compared to age matched males

Nutrition and acute respiratory infection[ARI]

Seven hundred and sixty children, under 5 years of age were followed up for two years and data collected indicate the following nutritional status. 22% have normal nutrition, 54% have mild malnutrition, 17% have moderate malnutrition and 7% have severe malnutrition. It was observed that significantly greater proportion of severely malnourished children had poor housing facility and did not receive childhood immunization. Thee incidence of ARI with normal and mild malnutrition was [6.46 per child per year. However, this incidence was essentially the same as that for children with moderately severe and severe malnutrition [6.56 per, child per year]. Thus, the results indicate that malnutrition did not correlate with increased overall incidence of ARI. The impact of malnutrition on hospitalised cases indicated that about half of these admitted cases had associated illnesses, mostly Diarrhoea or Measles. Case fatality rate [CFR] in normal children was essentially similar to that of children with mild malnutritions. CFR of children with severe malnutrition [7.54%] has been observed to be significantly higher than either normal or those with mild malnutrition

Still birth rate in district head quarter hospital Abbottabad

This retrospective study was done at District Headquarter Hospital, Abbottabad. The prevalence of still birth was studied among 853 infants born in maternity ward of DHQ Hospital, Abbottabad during two and a half years. The still birth rate observed was 112.5/1000. The rate was higher among multigravida and in females of more than 35 years age. The prominent aetiological factors were multiparity prolonged and obstructed labour and antepartum haemorrhage