ABSTRACT
Objective: Assessment of the patient's satisfaction undergoing treatment for haemorrhoids, after stapled haemorrhoidectomy and haemorrhoidal artery ligation methods of surgery at Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan
Study Design: Prospective and analytic study
Place and Duration of study
This study was conducted at the Department of Surgery, Khawaja Muhammad Safdar Medical College, Sialkot from from December 2012 to June 2015
Materials and Methods: All patients presenting in surgical out patients department above 18 years with third degree haemorrhoids were included in the study. Data of 82 patients [stapled haemorrhoidectomy n=55 and haemorrhoidal artery ligation n=27] was collected from December 2012 to November 2015. Patients were distributed in two groups depending upon the surgical procedures carried out
Full detailed history, examination, and investigations were performed
Patients with grade III hemorrhoids underwent the RAR procedure [Recto Anal Repair] i.e
Doppler guided haemorrhoidal artery ligation [DG-HAL] combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures. Results of treatment were assessed by regular follow up. Recording of variables and feedbackof the patients with minimum 3 months follow up, was made and analysed
Results: Out of 82 patients included in our study, Male patients were more in number in our study while 43 years came out to be, of the mean age. Something coming out from the anal canal, painful evacuation of bowels, bleeding per rectum and constipation are the chief presenting complaints
Conclusion: Generally, patients with piles except having severe prolapsed haemorrhoids had postoperative pain, lesser complications and acceptable results in long term can be achieved, in patients undergoing Doppler Guided Haemorrhoid Artery Ligation and Recto Anal Repair. Haemorrhoid artery ligation is a procedure associated with much less pain, in comparison to the stapled haemorrhoidectomy and patients can resume normal routine job, early
Long-term complications still require to be seen and assessed by studies with longer follow up. A lot depends on treating surgeon, his experience, skill and acumen
ABSTRACT
Objective: The study was carried out to determine the prevalence of pityriasisversicolor and its association with ABO blood groups in out patients' department of Dermatology at Islam teaching hospital Sialkot
Study Design: Prospective analytical
Place and Duration of Study: This study was carried out the Department of Dermatology, Islam Teaching Hospital, Sialkot; from December 2012 to December. 2015
Materials and Methods: All patients reporting to our OPD during a period of 3 years were included. The patients with mixed infections were excluded and those did not get their blood grouping and less than 3 months treatment and follow up were excluded from the study. All rashes were examined with wood's lamp. Skin scrapings were taken for KOH examination. Blood samples of all the patients were sent for blood group typing. Data of patients was analyzed using SPSS version 22
Results: Out of 6423 patients attending skin OPD, 197 patients were diagnosed as having Pityriasis versicolor; only 170 patients fulfilled the inclusion criteria. Male to female ratio 71: 29. Most of the patients fell in age group 15-50 years. Commonest rash was in multiple areas while followed by Upper trunk only
The prevalence of pityriasisversicolor was more with blood group B and O
Conclusion: The pattern of distribution of rash is most commonly mixed while upper trunk involvement is next in our patients. The study depicts strong association of Pityriasis Versicolor with blood group B and O
ABSTRACT
Objective: To evaluate and determine the risk factors and outcome of placenta previa in patients undergoing cesarean section at Islam Teaching Hospital. Sialkot
Study Design: Case control, Observational and comparative study
Place and Duration of Study: This study was carried out at theDepartment of Obstetrics and Gynaecology,Islam Teaching Hospital, Islam Medical College, Sialkot from September 2010 to December2014
Materials and Methods: Our study included all the patients who underwent caesarean section for singleton pregnancy after 28 weeks of gestation during the study period, data was collected and analyzed retrospectively for determining risk factors and patients were followed prospectively to see the morbidity and outcome of cesarean section in patients with placenta previa labeled as Group I and patients without placenta previa labeled as Group II. The patients who had normal vaginal delivery were not included in the study. Data was recorded using SPSS version 20 and frequencies were calculated. Statistical analysis and significance was done using OpenEpi calculators. Pvalue was calculated using two by two table and relevant Fischer and mid-P extracttests. P value <0.05 was usedto show significantdifference
Results: During the specified period 46 patients were those whose pregnancy was complicated by placenta previa while 734 patients who underwent cesarean section were not having antenatal or peroperative evidence of placenta previa. The maternal age >35years was present in 27 patients in group 1 and 234 patients in group11 so placenta previa is associated with age greater than 35 years [OR 3.036, 95%CI 1.655-5.572, P value 0.0001700]. The multivariate retrospective analysis showed that independent factors of prior LSCS [OR 2.33, 95% CI 1.272-4.271, P value 0.003940] previous history of D and C [OR 2.341, 95% CI 1.029 -4.936, P value 0.02163 ] and malpresentation[OR 4.142, 95% CI 1.852-8.725, P value 0.0005307] were associated with placenta previa.Placenta previa was associated with adverse maternal outcome. In our study postpartum haemorrhage occurred in 20 patients of group I as compared to group II [43.47% vs 5.3%, P value <0.05 ]. But massive blood transfusion [transfusion of more than 4 units of blood ] was required in 8 patients in group 1 as compared to 22 patients in group II [17.4% vs 3.0%, P value <0.05]. Cesarean Hysterectomy was done in 4 patients in group I and no caesarean hysterectomy was required in group II [8.6% vs 0.00%, P value <0.005]. In 3 patients, indication of hysterectomy was placenta accreta with previous history of cesarean section. In one patient there was fibroid uterus along with placenta previa; so fibroid uterus was a confounding factor in our study so that cesarean hysterectomy percentage is somewhat more in our study. In all 3 cases of placenta accreta, there was history of previous cesarean section so that there is 15% chance of placenta accreta in patients with previous history cesarean section along with placenta previa. The placenta previa was also associated with adverse fetal outcome as perinatal mortality [17.4% vs 2.9%, P value<0.05], low APGAR score at 5 min [19.6% vs 7.1%, P value <0.05] congenital anomalies [10.8% vs 4.1%, Pvalue<0.05 ] was high in group I patients. Placenta previa was not associated with intrauterine growth restriction [4.3%vs 2.6%, P value 0.2379]
Conclusions: Advanced maternal age, previous caesarean section, previous history of D and C and malpresentation are associated with increased risk of placenta previa. Placenta previa is definitely associated with adverse maternal as well as neonatal outcomes. The obstetrician should be vigilant in antenatal as well as peripartum care of such patients in order to manage the associated complications and to decrease maternal and fetal morbidity and mortality