Efficacy of preoperative single dose antibiotic in patients undergoing mesh repair for inguinal hernia

Inguinal hernia is the commonest type of external hernias. Lichtenstein mesh repair is the most favoured technique of inguinal hernia repair nowadays. It is tension free repair of weakened inguinal wall using polypropylene mesh. The present study was conducted to determine the efficacy of single dose antibiotic with placebo on patients undergoing inguinal hernia mesh repair. This randomised controlled trial was carried out in the Department of General Surgery, Ayub Teaching Hospital, Abbottabad from January to December 2011. The study population included male patients presenting with primary unilateral inguinal hernia, above 18 years of age. Mesh repair was performed in all patients. The patients were randomly divided into two groups. Patients in group A were given a single dose of antibiotic before inguinal hernia mesh repair and patients in group B were given placebo before inguinal hernia mesh repair. Efficacy of antibiotic and placebo was accessed in terms of surgical site infections [SSIs]. A total of 166 cases of inguinal hernia mesh repair patients were recorded during the study period. A total of 83 patients were recruited in each group. Surgical site infection was found in 6 [7.2%] in Group B it was 15 [18.1%]. The difference being statistically significant [p=0.036]. Antibiotic prophylaxis is a preferred option for mesh plasty

Spectrum of trigeminal neuralgia

Trigeminal neuralgia [TN] is a very painful condition characterized by paroxysmal shock like pain in the distribution of one or more branches of trigeminal nerve caused by neurovascular conflict at the root entry zone of trigeminal nerve. This study was conducted to analyse the demography and pattern of TN in our setup. This descriptive study was conducted in the Oral Surgery unit, Department of Dentistry, Ayub Medical College, Abbottabad, from April 2009 to October 2011. A total of 117 patients were included in study by convenience [non probability] sampling technique. All the patients presenting with the clinical features of TN were included in study. Out of 117 cases, 49 [41.9%] were males and remaining 68 [58.1%] were females. Age of the patients ranged from 32-72 [53.90 +/- 10.21] years. Right side was involved in 63 patients [53.8%], while the left side was involved in 51 patients [43.6%]. In only three cases [2%] there was bilateral involvement. The maxillary division was involved in 68 cases [58.1%] and mandibular division was involved in 37 cases [31.6%]. The most common site of involvement was infra-orbital, which was involved in 68 cases [58.11%]. The next common site was the mental nerve which showed involvement in 35 cases [29.9%] followed by inferior alveolar nerve which was affected in 14 cases [12%]. Thirty three [28.2%] patients were having mild pain, 54 [46.2%] patients having moderate, 21 [18%] patients with severe and 9 [7.7%] patients were having very severe pain. No patient in our study had a family history of TN. Among our patients 103 [88%] patients underwent dental extraction for the same pain. The incidence of TN is more in old age especially in females. TN is frequently misdiagnosed in with tooth ache, so there is need to educate the medical practitioners and masses in order to avoid un-necessary tooth extractions

Serum homocysteine as a risk factor for coronary heart disease

Homocysteine [Hcy] is an intermediate formed during the catabolism of sulphur containing essential amino acid, methionine and Less than one percent of tHcy is found as the free form. Development of atherosclerotic changes and thrombo-embolism are common features in patients with homocysteinuria. This study was conducted to assess the relationship of Hcy and coronary heart disease [CHD] in our population. The cross-sectional analytical study was carried out at the Department of Biochemistry, Hazara University Mansehra and Ayub Medical College, Abbottabad. A total of 80 subjects were included in this study and were divided into 2 groups. Cases Group consisted of 40 patients who had confirmed Myocardial Infarction [MI] coming for routine follow-up [first re-visit] after the acute attack. Control Group consisted of 40 matching healthy individuals. Demographic data including age, gender, dietary habits, height and weight as documented in preformed proforma. Blood pressure was taken in sitting posture. Serum total Hcy were measured. Data was entered into computer using SPSS 16.0 for analysis. The mean age of the cases was 59.68 +/- 8.06 [30-70] years and that of the controls was 58.93 +/- 6.93 [48-76] years. The average BMI of cases was 27.70 +/- 3.61 Kg/m[2] and of the controls was 25.66 +/- 2.98 Kg/m[2]. This increase of BMI from controls to cases was statistically significant [p<0.050]. The mean systolic BP of the cases was 153.88 +/- 11.90 mmHg in comparison with 142.62 +/- 11.65 mmHg for the controls. This difference was statistically significant [p<0.001]. Mean tHcy level of the cases was 17.15 +/- 4.45 micromol/l while that of controls was 12.20 +/- 2.53 micromol/l. There is a statistically significant difference between cases and controls with respect to Hcy levels [p<0.001]. Plasma tHcy level has a powerful predictor value of CHD and routine screening for elevated Hcy concentrations is advisable especially for individuals who manifest atherothrombotic disease without their traditional risk factors.

Frequency of conservatively managed traumatic acute subdural haematoma changing into chronic subdural haematoma

Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Acute subdural haematoma is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcome of patients conservatively managed may help the neurosurgeon in the decision-making process. We prospectively analysed 27 patients with age ranges 15-90 years, in whom a CT scan diagnosis of acute subdural haematoma was made, and in whom craniotomy for evacuation was not initially performed, to the neurosurgery department of Ayub Teaching Hospital Abbottabad [2008-2011]. Patients with deranged bleeding profile, anticoagulant therapy, chronic liver disease, any other associated intracranial abnormalities, such as cerebral contusions, as shown on CT, were excluded from this study. All patients were followed by serial CT scans, and a neurological assessment was done. There were 18 male and 9 female patients, Cerebral atrophy was present in over half of the sample. In 22 of our patients, the acute subdural haematoma resolved spontaneously, without evidence of damage to the underlying brain, as shown by CT or neurological findings. Four patients subsequently required burr hole drainage for chronic subdural haematoma. In each of these patients, haematoma thickness was greater than 10 mm. The mean delay between injury and operation in this group was 15-21 days. Among these patients 1 patient required craniotomy for haematoma removal due to neurological deterioration. Certain conscious patients with small acute subdural haematomas, without mass effect on CT, may be safely managed conservatively, but due to high risk of these acute subdural haematoma changing into chronic subdural haematoma these patients should be reinvestigated in case of neurological deterioration.

Outcome of transcranial repair of traumatic csf rhinorrhea

Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Posttraumatic CSF rhinorrhea is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcomes of patients with transcranial subfrontal approach for posttraumatic CSF rhinorrhea approach may help the neurosurgeon in the decision-making process. This study was conducted to analyse the outcome of trans-cranial sub-frontal approach for traumatic CSF rhinorrhea, with duroplasty and fibrin glue. This study was carried out in the Department of Neurosurgery, Ayub Medical College, Abbottabad from Jan 2007 to Jun 2011. All patients undergoing trans-cranial sub-frontal repair of traumatic CSF fistulas were included. Where possible primary dural repair was performed under hypotensive general anaesthesia and in the cases where it was not possible, graft was used. This was followed by application of fibrin glue at the repaired site. Graft materials used in this study were taken from fascia lata, pericranium, and temporalis fascia. Out of 27 patients 21 were men and 6 were women. Age of the patients ranged from 17 to 56 [34.5 +/- 4.6] years. Main causes of trauma were road traffic accidents [23, 85%], fall from height [3, 11%], and assaults [1, 4%]. In 23 [85%] cases no CSF leak was observed in immediate postoperative period as well as during the follow-up visits while in 3 [11%] cases additional lumber punctures were required to augment the repair. One patient failed to respond to surgery and lumbar drainage. The CSF rhinorrhea is commonly seen in patients with anterior skull fractures secondary to head injury. Initially conservative trail should be given to the patients, if it fails then on-lay dural technique followed by fibrin glue application through transcranial approach has good outcome with less chances of complications.

Discectomy in single level lumbar disc disease

There is a controversy regarding the treatment of lumbar disc herniation. Most of patients with lumbar disc herniation and radiculopathy improve with rest and medicine. Lumbar disc surgery gives rapid relief to the patients with severe root pain in legs. This study was conducted to see the risks and benefits of surgery in single level symptomatic lumbar disc disease. This prospective study was conducted in Department of Neurosurgery, Liaquat University of Medical and Health Sciences, Jamshoro during 2007-2009. Patients with severe leg pain, positive straight leg raising, and confirmed disc extrusion on imaging were included and conventional open discectomy was performed. Patients were followed up for one year after the surgery. Forty-five patients were operated for lumbar root pain due to a single disc. Most common disc involved was L4-5 and discectomy was performed. Recurrence of disc occurred in 4 patients. Proper selection of patients is necessary for excellent postoperative results in back surgery. Failed back surgery continues to rise with high rate of lumbar spine surgery as many patients are selected inappropriately.

Efficacy of endoscopic third ventriculostomy in noncommunicating hydrocephalus

Hydrocephalus is common problem requiring either extra-cranial [shunts] or intracranial [ventriculostomy] diversion of cerebrospinal fluid. Endoscopic third ventriculostomy obviates all the complications of shunts and has been accepted as the procedure of choice for the treatment of obstructed hydrocephalus in adults and children because of the minimally invasive nature. This study was conducted to determine the efficacy of endoscopic third ventriculostomy in the treatment of noncommunicating hydrocephalus. This cross sectional descriptive study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 2[nd] February 2011 to 1[st] march 2012. A total of 171 patients with non-communicating hydrocephalous, irrespective of gender discrimination and Glasgow coma scale score of 10 and above were included in this study. Patients below one year of age, with lesion in the floor of the third ventricle or near basilar artery, and hydrocephalus with infected CSF or haemorrhage were excluded. Hydrocephalous was diagnosed on CT-scan brain. All the patients were followed up till 72 hours post-operatively for the determination of effectiveness in terms of improvement in Glasgow coma scale by at least 2 points. All the above mentioned information including name, age, gender and address were recorded in a predesigned proforma. The data was analysed using SPSS-17. Frequency and percentage was calculated for categorical variables. Mean +/- SD was calculated for age. A total of 171 patients with noncommunicating hydrocephalous were included in the study. Out of 171 patients, there were 104 [60.8%] males and 67 [39.2%] females. Age ranged from 1-70 years with majority of the patients was below 10 years of age. Majority of the patients had hydrocephalus due to tuberculous meningitis 39.2% of the whole. In 134 [78.4%] patients the procedure was effective. Procedure was more effective in hydrocephalus due to space occupying lesion. Endoscopic third ventriculostomy is a very effective procedure for the treatment of non-communicating hydrocephalus.

Comparative therapeutic response to pegylated interferon plus ribavirin versus interferon alpha-2b in chronic hepatitis C patients

Hepatitis C is an epidemic worldwide since discovery in 1989. Conventional interferon alpha-2b plus Ribavirin therapy was started in 1998 but over all sustained viral response [SVR] rates are much below the desired rates to eradicate the diseases and stopping its epidemic. This study was conducted to access the therapeutic and cost-effectiveness of long acting pegylated interferon alpha-2b plus Ribavirin therapy verses conventional interferon alpha-2b plus Ribavirin. This comparative study was done at PAF Hospital Shorkot Cantt from July 2005 to July 2008. One hundred anti-HCV positive patients were selected randomly for the study according to willingness due to cost affordability of the patients for conventional interferon. Group-A was labelled as pegylated interferon alpha-2b plus Ribavirin group, and Group-B interferon alpha-2b plus Ribavirin group. Both groups were given treatment for 24 weeks. Early virological response [EVR] was accessed at 12 weeks of treatment. Sustained virological response [SVR] in both the groups was done at 24[th] week during the treatment and 6 monthly after treatment for 2 years. Initially non-responders and relapsed patients within 2 years of treatment were re-treated for 24 weeks with the same treatment. In both groups nonresponders and relapsed patients were labelled as resistant patients. Both groups were followed with same protocol for 2 years. Out of 100 patients included in the study, 34% were females and 66% were males. Group-A patients over all showed 94% SVR as compare to 80% in Group-B in 2 year follow-up. Group-A showed 6% resistant patients as compare to Group-B [20%]. Conventional interferons were better tolerated. Higher incidence of side-effects was seen in Group-A. Pegylated interferon plus Ribavirin showed 94% SVR in 2 years. Pegylated interferon plus Ribavirin is the treatment of choice