ABSTRACT
Objective: The aim of study is to assess the postoperative levels of pain in accordance with established protocols
Method: The type of study is a hospital wide survey conducted from February 2014 to April 2014, at department of surgery and associated wards, at a tertiary care hospital in Karachi Pakistan. World Health Organization pain scoring system was used as a base to develop a questionnaire to assess the level of pain. The results were correlation with various other variables involved
Results: The study was conducted on 200 patients out of whom 38% [n=76] were males having mean age of 44.16 +/- 20 and 62% [n=124] were females having mean age of 36 +/- 14.5 years. Generally patients experiences mild pain [40%], moderate [39%] severe [16%] and no pain [5%] when recorded after 24 hours postoperatively. While after 48 hours the scores recorded for the same patients were as, mild [56%], moderate to severe [34%] and in the no pain group [10%] of patients were recorded
Conclusion: It is noted that absolute pain free surgeries are not possible at the moment, but with the use of latest advancements in the field of health sciences, post-operative pain can be minimized and should be the one of the prime goals for a good surgical outcome
ABSTRACT
Objective: The purpose of our study is to compare the effectiveness, surgical outcome and complications of locking compression plating as compared with intramedullary nailing for the purposes of fixation of humeral shaft fractures in the adult population
Methodology: The type of study is a prospective randomized controlled trial, which was carried out for a period of three years from Jan 2012 to December 2014, at a tertiary care hospital in Karachi Pakistan. Patients coming to the hospital via the A and E department with radiographic evidence of a humeral shaft fracture were included in the study. 50 patients were selected for the study, who were randomly divided into two groups, group A [n=25] comprised of patients who underwent intramedullary nailing procedure, while group B [n=25] patient underwent compression plating for the fixation of the humeral fracture. The surgical outcome was assessed based on the operative time, intra operative blood loss, the time of hospital stay, the time required for the union of bone, functional outcome and complications. [American shoulder and elbow surgeons score] ASES and the constant score was used to assess the functional outcome of patients
Results: According to our study, the operative time, hospital stay and intra operative blood loss was much lower in group A [the intramedullary nail group] as compared to those in the group B [locking compression plate group]. The rate of bone union, constant and ASES score did not show any significant difference. The union time for group A was lower as compared to group B. Complications such as radial nerve palsy were observed to be associated more with the locking compression plate as compared with the group of patients who underwent intramedullary nailing
Conclusion: According to our study the intramedullary nailing technique for the repair of humeral shaft fractures is a superior technique as compared to the locking compression plate, as it has decreased incidence of blood loss during the procedure, less time required for the procedure, less time of hospital stay and union of bone. It also has a low incidence of complications
ABSTRACT
Objectives: The aim of our study is to determine the outcome and progression of patients presenting with acute severe asthma [status asthmaticus] at a tertiary care hospital in Karachi, Pakistan. Setting: The type of study is a cross sectional study. Period: Two years from January 2013 to December 2015. Place of study: Tertiary care hospital in Karachi Pakistan
Methods: Consisted of 40 patients who were all admitted to the hospital with acute severe asthma. All the patients underwent strict clinical evaluation to assess the various aspects of the illness including the severity and complications. Data was analyzed using SPSS version 23
Results: Of the total n= 40 patients included in our study, 8 [20%] were males and 32 [80%] were females having a mean age of 52.5 +/- 20.4 years, Hypertension was the most common underlying co morbidity observed in 10 [25%] patients. The mean blood pH was found to be 7.33 +/- 0.12 at the time of presentation with a range of 6.96 to 7.57 respectively, respiratory acidosis was found in 17 [42.5%] of the patients. A total of 29 [72.5%] patients required ventilator support out of which 14 [35%] required invasive ventilator support and 15 [37.5%] required a noninvasive ventilator support. Acidaemia was found to have a significant association with the requirement for invasive mechanical ventilation [p value of less than 0.033] also the mean duration of hospital stay was also higher in patients who required ventilator support
Conclusion: According to the results of our study, acidemia is the most severe complication of acute severe asthma, and has a significant association with increased rate of need for artificial ventilation, complication and mortality respectively
ABSTRACT
Objective: The objective of the study is to study the procedure of endotracheal intubation; its methods between Rapid sequence intubation and crash intubation its success rates and the associated short term complications at the accident and emergency department of a government run hospital in Karachi, Pakistan
Study Design: Case series
Setting: Accident and Emergency Department of Civil Hospital Karachi
Period: 2010 to 2012
Methods: The sample size taken is of 260 patients, all of whom must be above the age of 14 years, and undergo the procedure of emergency endotracheal intubation. Rapid sequence intubation is analyzed against crash intubation using descriptive type of statistical analysis. The significance level was p<0.05
Results: From the 260 Endotracheal intubations performed, 45 [17.30%] had to be discarded on account of incomplete data. The remaining study population was 215 patients [123 males, 92 females] Rapid sequence intubation was the commonest type [n=138, 64.18%]. Head and neck injury, pulmonary edema was the common complication. Crash intubation was the second type [n= 77, 35.8%] Primary attempt success was found to be 97% [n=134] in rapid sequence intubation and 80% [n = 62] in crash Endotracheal intubations. A total of 13 complications [6.04%] were observed
Conclusion: In light of the results obtained our study shows a satisfactory success rate on using either mentioned types of intubation procedures that is either RSI or Crash Intubation
ABSTRACT
Background: The aim of my study is to evaluate post-operative pain relief on patients who had hemorrhoidectomy
Materials and Methods: 300 patients who had hemorrhoidectomy were divided equally in to three groups, according to anesthesia type, group 1 [local anesthesia and sedation], while spinal anesthesia was group 2 and general anesthesia was considered to be group 3. Pain relief, post-operative complications, hospital staying time were measured and compared between the three groups. Period: Study was performed between Jan 2012 to Dec 2014
Results: The study showed that patients who had local anesthesia infiltration and sedation a significant decrease of post-operative total pain scores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group II as compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperative analgesia doses in the 3 groups were 120: 140: 180 respectively, total hospital staying time were 130: 210: 260 days, headache in the ratio of 0: 8: 1, urine retention in 0: 6: 1 patients, nausea and vomiting in 0: 1: 5 patients were reduced by 30 % P-value < 0.05. On the other hand, spinal anesthesia which is group 2 showed slight decline of patients numbers who had respiratory symptoms, hypotension and urticarial
Conclusion: Post-operative pain, analgesia, total cost, hospital staying time, nausea and vomiting have been significantly reduced by local anesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higher rate in post-operative urine retention, headache and hypotension compared to local anesthesia with sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced in local anesthesia with sedation compared to spinal and general anesthesia