Knowledge attitude and practices about management of vitamin D deficiency among doctors in Pakistan

Background: Hypovitaminosis D is a common health issue in Pakistan because of its high prevalence. The awareness and practices of doctors treating vitamin D deficiency needs to be highlighted, as it will help in managing this public issue

Objectives: To assess knowledge, attitude and practices for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan

Subjects and Methods: Clinicians from different cities of the Pakistan were participated for a cross-sectional descriptive questionnaire based study about their approach in treating vitamin D deficiency. Results were analyzed using SPSS version 20. Descriptive statistics were calculated

Results: One hundred eighty eight [188] practicing doctors from 21 different cities of Pakistan participated in the study. Majority [85.6%, n=161] prescribed vitamin D levels in patients of hypovitaminosis D. It is empirically treated by 101 [53.7%]. Most clinicians [84%, n=158] prescribe Cholecalciferol, 19 [10.1%] Alfacalcidol and 11 [5.9%] prescribe Calcitriol as a vitamin D supplement, while 155 [82.4%] prescribe a maintenance dose. The prescription form preferred by doctors is tablets by 49 [26.1%], capsule by 29 [15.4%], oral injections by 68 [36.2%] and intra-muscular by 42 [22.3%]. As a follow up tool, 84 [42.6%] clinicians order serum 25 [OH] D and serum calcium levels, 102 [54.3%] assess patients by improvement in clinical symptoms and 3 [1.9%] use both strategies for assessment. Nutritional advice was also given by most doctors

Conclusion: There is no uniform approach for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan. A great variability and gap is seen in prescription options, dosing frequency and duration. This highlights the importance of need for a national guideline regarding prophylaxis, diagnosis and treatment of vitamin D deficiency

Surgical site infections in general surgical wards at a tertiary care hospital

Surgical site infections are important cause of morbidity and mortality in admitted patients world over. To determine the pattern of surgical site infections in General Surgical ward of a tertiary care hospital. Analytical cross-sectional study conducted at Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad for two years from January 2010 to December 2011. All cases were admitted in surgical ward with various surgical problems either as elective or emergency cases who developed wound infection later were included in the study. Cases of wound infection operated elsewhere, diabetic foot, and abscesses were excluded. Data collected included age, gender, primary diagnosis, mode of admission, comorbid factors, type and duration of surgery, expertise of the surgeon, use of antibiotics and hospital stay. After operation, wound was examined for evidence of infection from third post-op day onward. Any discharge was submitted for bacteriological examination. The wounds were followed till healed. A total of 1913 patients underwent surgery, including 983 cases [51.5 %] operated as elective and 932[48.5 %] as emergency. Postoperative wound infections occurred in 165 cases giving an overall incidence of infection in 8.6% cases. Infection rate in elective cases was lower [4.6%] than that in the emergency [12.7%] cases. Sixty one patients [37%] developed minor infection or stitch abscess, 104[63%] has frank suppuration requiring opening and drainage of wound; while 5[3%] cases developed deep seated infection of intra-abdominal spaces. E. coli was the commonest bacteria for wound infection [39%]. Post operative wound infection rate was 8.6%. The infection was significantly higher in cases who underwent emergency surgery and E. coli was the commonest pathogen to cause infection

Two-port laparoscopic cholecystectomy: an early experience

Laparoscopic cholecystectomy is the procedure of choice in all the gall bladder diseases and there is increase in the expertise of the surgeons with newer equipment. Usually the laparoscopic cholecystectomy is performed by using three or four ports. Two ports laparoscopic cholecystectomy is a rarely performed procedure as it demands greater expertise and skills. Benefits of this technique are related to the cost this being cost effective with less scar forming as compared to the conventional approach of laparoscopic cholecystectomy. We present a series of eight cases of laparoscopic cholecystectomy performed by using only two ports. All procedures were completed successfully and no extra port or conversion to open procedure was required. Mean operation time was 50 minutes. No intra and post operative complication occurred in this series. Hospital stay was one day

Two-port laparoscopic cholecystectomy-a new technique

Laparoscopic cholecystectomy is now the procedure of choice in all the gall bladder diseases and there is increase in the skills of surgeons with newer equipment. Normally the laparoscopic cholecystectomy is performed by using four ports or three ports. Two ports laparoscopic cholecystectomy is rarely performed as it demands greater expertise and skills. Also this technique is less expensive and less scar formation than four port laparoscopic cholecystectomy. We present a case of a middle aged female who underwent successfully laparoscopic cholecystectomy by using only two ports

role of one-stage surgery in acute large bowel obstruction

A study was carried out in Surgical-Unit II, Jinnah Postgraduate Medical Centre Karachi from July 1994 to June 1997. A total of 29 patients of large bowel obstruction were selected for this study, who underwent emergency one-stage procedure [resection and primary anastomosis] for colonic obstructive lesions by our surgical team. All but one patient did well with no evidence of anastomotic leak. There were three wound infections and one abdominal wound dehiscence. There was only one death in the immediate post-operative period. The average hospital stay was 19.3 days. The commonest pathology was adenocarcinoma of colon