ABSTRACT
The objectives of this study were to examine the level of awareness of the parents regarding Thalassemia Major; the cost of treatment of Thalassemia Major Patients and the sufferings it brings to the families; the social problems faced by patients' families; to identify the barriers patients' families face in the treatment of Thalassemia child. Descriptive study. Four Thalassemic Centers [i] Thalassemia / Hemophilia Centre, The Children's Hospital and the Institute of Child Health Multan [ii] Fatimid Foundation Multan [iii] Amna Blood Foundation [iv] Minhajul Quran Multan. January-2013 to June-2013. A sample of 500 respondents was drawn from the total population and structured interview schedule was administrated. Data were analyzed and interpreted by using SPSS [Statistical Package for Social Sciences] 19.0 version software. The structured interview was discussed with two experts of the Sociology Department and two Senior Doctors [>8 years' experiences] working in the Thalassemia centers and Government Health Institutions. It was revised to incorporate recommended improvements. Descriptive and inferential statistics were applied to analyze the data that includes: frequency, percent, mean, standard deviations. Data indicated that 100[20.0%] respondents were patients' father while 329[65.8%] were mothers and 71[14.2%] were close relatives. Of the 500 respondents, 306[61.2%] were married to their first cousins, 91[18.2%] of the respondents were married to their second cousins, 34[6.8%] of the respondents married in distance relatives and 69[13.8%] of the respondents married out of family. The study summarized that the health care providers should be encouraged to talk about Thalassemia as a public health problem in Pakistan and should enhance the public awareness to eliminate the Thalassemia in Pakistan
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To evaluate the neurological outcome of anterior decompression and fixation with Webb-Morley procedure in dorsolumbar spinal injuries. A case series study. The Neurosurgery Department, Jinnah Postgraduate Medical Centre, Karachi, from May 2008 to July 2010. Patients with post-traumatic unstable dorsolumbar spine having compression of the spinal cord with bony fragments of the fractured vertebra were included in the study. Patients below the age of 15 years and patients with bed sores and unfit for anaesthesia were excluded. Plain X-rays and magnetic resonance imaging [MRI] were done. All patients were treated for dorsolumbar fractures by anterior decompression and fixation with Webb-Morley procedure. All patients were assessed clinically by the Frankel's grading before and after surgery. Among 60 patients, 41 were males and 19 were females. Mean age was 37.2 +/- 4 years. Major cause of trauma was road traffic accident. The commonest level of the fracture was at the dorsolumbar junction i.e. 71.66% [n = 43]. About 19 [31.66%] patients improved to the Frankel's grade-E, while 41.66% [n = 25] improved to grade-D after surgery. There was no postoperative mortality. According to the current study, anterior decompression and fixation with Webb-Morley procedure is an effective and safe approach. Those patients who had complete motor deficit showed no improvement in power but those who had partial motor deficit, had excellent improvement
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To make an audit of laparotomies carried out at Combined Military Hospital Pano Aqil over a three year period. Cross sectional, retrospective study. Study was carried out at surgical department of combined military hospital Panno Aqil over a period of three years from Jan 2009 to Dec 2011. Patients with significant intra-abdominal pathology presenting as acute abdomen and who underwent laparotomy were included in study. Patients were either electively admitted via outpatient department or through Accident and Emergency [A and E] department. Patient charts and records were used to collect data. All 174 patients underwent laparotomy. In [27.6%] cases, intestinal perforation was the underlying cause; gynaecological pathology was found in [21.2%] patients. In 19.5% cases blunt and penetrating abdominal trauma was the cause of acute abdomen. Acute intestinal obstruction was found in [21.3%], tumors were found in [7.9%] and miscellaneous causes were identified in [2.3%] cases. Laparotomies carried out at Combined Military Hospital Pano Aqil fulfilled the evidence based medicine criteria
Subject(s)
Humans , Male , Female , Medical Audit , Hospitals, Military , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Primary polycythemia [polycythemia vera] is a hematopoeitic stem cell disorder giving rise to proliferation of a clone of hematopoietic precursors leading to an excess production of erythrocytes with thrombocytosis and leukocytosis
The optimum management of polycythemia vera remains elusive. Patients requiring surgery are at increased risk of both perioperative thrombosis and hemorrhage
On one hand, thrombosis can lead to multi organ ischemia and infarction while on the other, bleeding diathesis can lead to profuse perioperative hemorrhage; both posing considerable risk to the patient's health and stress to the anesthesiologist concerned directly with perioperative management of the patient
Hence, management guidelines for polycythemia vera needs to be clearly understood and tailored to each patient individually and appropriate management protocols need to be de Ned accordingly
ABSTRACT
Supraclavicular approach to subclavian vein catheterization is still being employed less often than traditional infraclavicular approach. The purpose of this study was to compare the two techniques regarding number of attempts, success rate of catheterization and complications associated with the procedure. Surgical Intensive Care Unit [SICU] of Rehman Medical Institute, Peshawar [Pakistan]. 1[st] June 2010 to 30[th] December 2010. We included 144 adult patients of either sex undergoing central venous catheterization for various indications, selected by nonrandom sampling, in the study. They were divided into the supraclavicular and infraclavicular groups [72 in each group]. Right subclavian vein of the patient was chosen in all patients for catheterization. Variables for comparison included number of attempts, success or failure of catheterization and complications associated with the procedure in each group. Statistical analysis was done by applying Chi-square test and Student's Independent Samples T-test. The overall success rate was 95.83% for right supraclavicular and 87.50% for right infraclavicular approach [p>0.05]. The number of successful attempts for supraclavicular and infraclavicular approaches were 1.13 +/- 0.42 and 1.35 +/- 0.69 respectively [P=0.029]. The complication rate was higher in the supraclavicular group, but the difference was not statistically significant. The supraclavicular approach to subclavian vein cannulation was found to be a more successful method for adult central venous catheterization with complications comparable to the more commonly used infraclavicular approach
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Tension pneumothorax during ventilating bronchoscopy for foreign body removal is a rare but life threatening complication, which if not promptly diagnosed and treated can prove fatal. We present a case of tension pneumothorax, due to a laceration in the right main bronchus caused by bronchoscope, in a one year old child, who underwent bronchoscopy for removal of foreign body [bead]. The child was successfully treated and managed by immediate insertion of 14 gauge IV cannula in the pleural cavity followed by chest tube insertion. The laceration was subsequently repaired and foreign body removed by thoracotomy
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To compare the effects of erythromycin and metoclopramide on gastric fluid volume and pH in patients undergoing elective caesarean section. Randomized, controlled trial. The study was conducted in Gynaecology Ward and Operation Theatre, Rehman Medical Institute Peshawar from July 2009 to June 2010. We recruited 144 patients, ASA grades I and II, scheduled to undergo elective caesarean section and divided them in two equal groups of 72 patients each by simple random sampling. Patients in group A were given tablet erythromycin 250 mg and patients in group B were given tablet metoclopramide 10 mg orally with 10ml of water one hour before surgery. Both groups were then compared in terms of gastric fluid volume and gastric pH according to Robert and Shirleys' criteria, using a cut off value of 25 ml and pH 2.5, respectively. Statistical analysis was done by applying Chi-Square test and Students' T- test. Among the patients of group A 87.5% patients had acceptable volume [25ml] and 62.5% patients had acceptable pH of gastric fluid [pH >= 2.5]. In group B patients 69.4% patients had acceptable gastric fluid volume and 19.4% patients had acceptable pH of gastric fluid. Oral erythromycin reduces gastric fluid volume more effectively than metoclopramide, if given one hour before surgery. Erythromycin increases while metoclopramide has no effect on the pH of gastric fluid
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To compare the technical aspects of Wilms' tumour [WT] surgery in patients with and without pre-operative chemotherapy. Quasi-experimental. Military Hospital [MH] and Combined Military Hospital [CMH], Rawalpindi, from January 1999 to December 2004. Patients of WT, presenting between January 1999 and December 2001, were treated, using the NWTSG protocol, with primary surgery [group I]. Between January 2001 and December 2004, WT patients were treated according to SIOP protocol, with pre-operative chemotherapy followed by surgery [group II]. Volume reduction with chemotherapy, duration of surgery, rupture of tumour, extent of excision, adherence and damage to surrounding structures, blood loss, complications, stay in hospital and event-free survival [EFS] were compared in the two groups. Out of 22 patients in group I, 19 [86.4%] underwent primary surgery. Of the 23 patients in group II, 21 [91.3%] received pre-operative chemotherapy followed by surgery. Average volume reduction in this group was 54% with chemotherapy. Difference in duration of surgery and blood loss was significantly low in group II [p=0.003 and p<0.001, respectively]. In group I, rupture [6 vs 2], adherence [14 vs 10] and damage to surrounding structures [5 vs 2] were more. Complete macroscopic excision was possible in 90.5% of WT in group II as compared to 73.7% in group I. Immediate postoperative complications and length of hospital stay were similar in both groups. There was no difference in EFS. Pre-operative chemotherapy makes it technically easier and safer to operate, without jeopardizing the final outcome
Subject(s)
Humans , Male , Female , Kidney Neoplasms/pathology , Antineoplastic Combined Chemotherapy Protocols , Preoperative Care , ChildABSTRACT
Objective: Evaluation of the advantages and disadvantages of laparoscopic varicocelectomy and its comparison with open ligation of varicocele
Design: Prospective comparative study between two techniques of varicocelectomy
Place and Duration Of Study: Surgical unit III of Jinnah Hospital, Allama Iqbal medical college, Lahore over a period of two years from January 1, 2002 through December 31, 2003. Subjects and Methods: Study comprised of two groups [A and B] with 52 consective patients fulfilling the inclusion criteria and comparative variables. Laparoscopic varicocelectomy [LPV] was performed on 26 patients [Group A] and open Palomo varicocelectomy [OPV] was performed on 26 patients [Group B]. Outcome data looked at relapse rate, postoperative hydroceles, wound complication and scrotal edema. Operating time, postoperative hospital stay and pain control were compared. In both groups operation was performed by Palomo technique i.e. ligation of both artery and internal spermatic vein in the retro peritoneum above the internal inguinal ring
Results: In LPV versus OPV group, the recurrence rate of varicocele was 3.8% in-group A versus no recurrence in-group B [p<0.001]. Postoperative hydroceles formation was 7.6% in group A versus 11.4% in group B [p < 0.003].wound complication was 3.8% in group A versus 7.6% in group B [p < 0.001]. Testicular or scrotal edema was 7.6% in group A versus 11.4% in group B.Postoperative hospital stay was 24 hours in group A versus 72 hours in group B [p < 0.001]. Operating time was 20 minutes in group A versus 30 minutes in group B [p <0.001]. Postoperative analgesia required was almost half in group A as compared to group B [p < 0.005]
Conclusion: The study shows that clinical efficacy of laparoscopic varicocelectomy is superior to traditional open varicocelectomy