ABSTRACT
To assess the risk of surgical site infection in clean surgeries associated with age, sex and duration of surgery in Abbasi Shaheed Hospital. This study is a Case control study and was conducted in surgical Unit-1, Abbasi Shaheed Hospital, Karachi from January 2006 to December 2008. Its sample size is Non-probability, convenience and 150 patients were taken for this study in which 100 patients with healthy surgical site were taken as control while 50 patients with infected surgical site were taken as the cases. All male and female patients of age between 18 to 55 years were included in this study. For ail diabetic and non-diabetic patients who were admitted in ward for elective clean surgery, same method of skin preparation was under taken with povidone iodine and spirit. Control were patients without surgical site infection while cases were patients with surgical site infection. All patients received three doses of prophylactic antibiotic first generation cephalosporin 500 mg i/v Shourly preoperatively. SPSS version 10 was used to analyze the data. The ages of the patients were between 18-55 years with increased risk of surgical site infection with increasing age. Out of 50 patients with surgical site infection, 28 [56%] were diabetic and 22 [44%] were non-diabetic. It was seen that 24 patients [16%] had surgery of duration 46-60 minutes and 12 of them [50%] had surgical site infection as compared to 36% in surgery of less than 30 min. Odd ratio of infection for diabetes, duration of surgery, age and gender were 10.3, 6.5, 3.1 and 1.3 respectively. Significant association was found between type, duration of surgery and ASA score. Adjusted analysis revealed a significant relation between age, ASA class, diabetes mellitus, uncontrolled postoperative blood glucose level, duration of surgery and surgical site infection. Mastectomy was significantly associated with surgical site infections along with longer duration and ASA class III
ABSTRACT
Meniere's disease is recognised by frequent periods of remissions. The available wisdom about the disease and treatment reflects the openion of experienced clinicians, rather than scientific facts. To determine the efficacy of vasodilator and diuretic therapies in the prophylaxis of Meniere's disease. A randomized controlled trial. The study was carried in the ENT Department, Combined Military Hospital, March 2007 to Dec 2009. Subjects and Methods: All new patients [N=120] of clinically diagnosed Meniere's disease were included by consecutive non-probability sampling. Demographic characteristics of the patients were noted and the patients were divided into three groups irrespective of age and sex. Group A was placed on amiloride 5 mg and hydrochlorthiazide 50 mg combination, one tablet daily, the Group B on tablet betahistine hydrochloride 48 milligram in three divided doses and Group C patients on tab multivitamin once daily respectively. The patients were reviewed after 06 weeks. Improvement in vertigo was seen in 77% in group A, in 68% patients in group B and in 45% in group C [p=0.021]. Hearing thresholds improved in 54% in group A, 63% in group B and in 36% in group C [p=0.067]. There was subjective improvement in tinnitus in 54% in group A, 80% in group B and in 37% in group C. Diuretic and vasodilator had a definitive and significant effect in Meniere's disease, in controlling vertigo and tinnitus, when compared with placebo [p<0.05]. Diuretics and vasodilators do have a significant role in the prophylaxis of Meniere's disease
ABSTRACT
Percutaneous endoscopic gastrostomy [PEG] refers to insertion of a tube into the stomach percutaneously, aided by endoscope and was first described in 1980 by Gauderer. This was devised for feeding the patients who have swallowing problems due to any reason especially neurodisability. There is an enhanced need for greater selectivity in patient referral. Retrospective, single-institution case series. The study was performed in Waterford Regional Hospital, Waterford, Ireland. Jan 2003 to Dec 2007. A total of 203 consecutive patients referred for nutritional support underwent PEG tube insertion during this period. Written informed consent was taken from all the participants or their attendants and the procedure was performed with prophylactic antibiotic and under intravenous sedation. Standard PEG set was used for the procedure. Feeding was started 12 hours after tube placement and care instructions were given. The parameters of study included indications, annual frequency, and overall outcome. A total of 203 patients having a male to female ratio 1:0.7 underwent PEG tube insertion. The age ranged from 26 to 96 years [mean 79+5.17. The mean duration of PEG feeding was 93 [3-785] days. The annual frequency of insertion increased from 19 [9.3%] patients in 2003 to 64 patients [31.5%] in 2007. The length of stay ranged from 1 to 350 days [median 93]. In this cohort, 32 [15.7%] patients died during the same admission. A total of 79 [38.9%] were discharged for home, 92 [45.3%] were discharged back to nursing home care. This study underscores the need for enhanced awareness and protocol-driven selectivity in patient referral for PEG tube insertion
ABSTRACT
To describe the different complications of colostomy that developed after its construction either in emergency or elective surgery in Abbasi Shaheed Hospital Karachi. Descriptive study from January 2006 to Dec. 2007 during which fifty patients who were above 12 years of age were admitted in Surgical Unit-I, of Abbasi Shaheed Hospital, Karachi, through emergency and out patient department. Information of patients including history, clinical examination, investigations, and indication of surgery, operative procedure and operative findings were collected. Gut preparation was done in elective cases only. Detail about stoma, its type, complications and treatment were observed carefully. Emergency colostomies were performed in emergency theatre while elective cases were done in main theatre. Patients were followed up from the construction of colostomy to the fourth post operative week to analyze the complications associated with stoma formation. Reversal of colostomy was done after 8th to 12th post operative period. Among them 40 patients 80% were males and 20% were females. Students, labors and old age were mostly affected class. Most of them were victims of terrorism. Intestinal trauma due to gun shots and stab were the leading cause while the intestinal pathology like tuberculosis, carcinoma, volvulus, intestinal obstruction were found to be the less common causes of stoma formation. 40 patients [80%] were operated in emergency theatre while 10 patients [20%] under went elective faecal diversion. Majority of Colostomies were temporary loop colostomies, formed only for diversion and decompression of distal segment. Out of fifty patients, none of the patients had any major post operative complications like necrosis, prolapsed, parastomal hernia and fistula formations. Only twelve patients [24%] developed complications. Abdominal wall infection in two patients [4%] and skin excoriation in 3 patients [6%] around the stoma were found the commonest local complications. Retraction in 2 patients [4%], stenosis in two patients [4%] with stoma obstruction in 1 [2%] and detachment in 1 [2%] were found. All these cases required refashioning of Colostomy. Stoma bleeding and pain was also observed and treated in 2 patients [4%]. The psychological trauma of having colostomy with a bag on the belly was a considerable problem which patient had during the period, which was reduced and post operative counseling and training was given. Stoma surgery has a wide range of clinical implication. It is relatively a save procedure either to reduce leakage of distal colonic repair or to provide sufficient time for the healing of intraperitonial trauma. The complications occurred in only 24% patients among which skin excoriation and skin infection occured in a few patients. Having an artificial anus was a mental torture for patients