Frequency of metabolic syndrome in psychiatric patients, is this the time to develop a standardized protocol to reduce the morbidity from an acute care psychiatry unit

To determine the frequency of Metabolic Syndrome among psychiatric patients and to look for the correlation between the two medical conditions. The cross-sectional study was conducted from February to April 2013 at the acute care psychiatry in-patient unit at Kingston General Hospital, Ontario, Canada, and comprised adult patients of both genders diagnosed under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. For Metabolic Syndrome, definitions outlined by the International Diabetes Federation were used. The patients were divided into two groups on the basis of presence or absence of the Syndrome and were compared for clinical and demographic characteristics. SPSS 22 was used for statistical analysis. Of the 50 patients in the study, 24[48%] were found to have Metabolic Syndrome. Besides, 40[80%] patients were taking atypical antipsychotics regardless of the diagnosis; 20[83%] among those with the Syndrome, and 20[77%] among those without it. Patients at high risk of developing metabolic syndrome need to be identified early so that an individualised care plan can be formulated. Identifying the variables to make a management plan is vital

Percutaneous intervention for coronary bifurcations-our experience on 133 patients at army cardiac centre Lahore

To study the safety and efficacy [pre and post procedure outcomes] of stenting the main vessel [MV] with or without stenting the side branch [SB] in the treatment of coronary bifurcation lesions. In this retrospective analysis of 133 patients, operated between Oct 2009 and Sept 2010, true coronary bifurcation lesions using the registry at Army Cardiac Centre were analyzed. All angiograms and case notes were reviewed for sites of lesions, MADINA classification, angle of bifurcation, size of MV and of SB, number and type of stents used, total procedure and radiation time, and patient characteristics. In-hospital MACE events were recorded for all patients. Of the 133 cases, 120 [90.2%] underwent MV stenting alone, while 13[9.8%] underwent SB stenting as well. Drug Eluting Stent [DES] with minicrash technique was deployed in the majority of the latter cases. In hospital clinical follow up showed 2 NSTEMI in the SB stents [p=0.009] whereas no MACE event was recorded for MV stents alone. Stenting of only MV is safer, effective and economical than stenting of both MV and SB. Moreover contrast related risks and risks of radiation are much less with stenting the MV in the treatment of coronary bifurcation as compared to stenting of both MV and SB

Surgical management of liver trauma

To compare the results of operative management of hepatic trauma treated with suture hepatorraphy alone and with suture hepatorraphy in combination with hepatotomy [resectional debridement with individual vessel suture ligation] spongston, and omental packing. Cross-sectional comparative study. The study was conducted at Bahawal Victoria Hospital Quaid-e-Azam Medical College Bahawalpur, from Jaunary 2007 to December 2010. A total of fifty patients were divided into two groups. Group A comprising 25 patients [50%], was treated with suture hepatorraphy alone while the Group B was treated with suture hepatorraphy in combination with hepatotomy, omental packing and spongston. Of the 50 patients of liver trauma mean age was 28.14 years [SD +/- 12.12y] and 94% were males. Sixty percent injuries were blunt in nature and 40% penetrating. Of penetrating trauma 75% were firearm injuries and 25% stab wounds. Right lobe was the site of injury in 56% of patients. Severity of injury was grade I in 14%, grade II in 40%, grade III in 36% and grade IV in 10% .Postoperative complications were sepsis in 24%, bile leak in 16% and recurrent hemorrhage in 24% of group A patients, whereas, in group B patients the sepsis was 8%, bile leak 8% and recurrent hemorrhage 4%. Mean hospital stay in group A was 26.44 days [SD +/- 13.56] while in group B it was 20.20 days [SD +/- 11.06]. In group A patients, the survival rate was 96% while it was 100% in group B. Once decided for Surgical management for blunt and penetrating liver trauma, suture hepatorraphy in combination with hepatotomy, omental packing and use of spongston for hemostasis had marginally better survival rate, reduced hospital stay and significantly fewer postoperative complications as compared to simple suture hepatorraphy

Diabetic hand; management

A case series study held at surgical unit 1. BV Hospital Bahawalpur. Study was conducted from June 2006 to May 2009, to evaluate various aspects of diabetic hand and to establish a protocol to manage it. All diabetic patients presented with hand infection to the unit during this time were included in the study but patients having classical diabetic hand syndrome were excluded. Total 48 patients were admitted during the period under review. Male to female ratio was 2:1 and age was ranged from 31 to 48 years. Data was collected on Performa and shifted to computer program SPSS version 12. All patients were manual workers or house wives and 40 patients gave history of minor trauma to the digits during work. All patients were either undiagnosed [16 patients] or had uncontrolled diabetes. Most of them delayed seeking advice for their trauma and infection of hand properly. During treatment, 30 patients [62.5%] required amputation of one or more digits of the dominant hand including amputation of thumb in 19. Only 4 patients [8.33%] ended up in amputation of hand, whereas, no patient required amputation of forearm. No mortality was seen during study period. It was concluded that diabetic hand involves persons in active life period relatively in younger age group. Undiagnosed or uncontrolled diabetes is major contributory factor. Health education, early diagnosis and prompt treatment in specialized units may be helpful

Acute cholecystitis; early versus interval cholecystectomy for a comparative study

Gallstones are common biliary pathology. The Vast majority of subjects are asymptomatic. About 0.2% of the population suffering from gallstones develop acute cholecystitis every year. In case of acute calculous cholecystitis, cholecystectomy can be performed early i.e during the same admission or interval i.e after 6 weeks of conservative management. To compare the early and interval cholecystectomy in acute calculous cholecystitis for morbidity, postoperative hospital stay, total hospital stay and complications. Study Design: Quasi-experimental study. Department of Surgery Bahawal Victoria Hospital Bahawalpur. Two year study from December 2007 to December 2009. Sixty patients fulfilling the inclusion criteria were selected for this study. The patients were divided into two groups. Group A patients were managed by early cholecystectomy and group B patients by interval cholecystectomy. Postoperatively patients were evaluated for postoperative hospital stay, total hospital stay and postoperative complications. The mean age of the patients in group A was 42.2 + 1 0.7 years and in group B was 42.2+ 1 0.7 years. The Male to female ratio was 1 :4 in both groups. The mean postoperative hospital stay in group A was 4.0+ 1 .Sdays and in group B was 3.8+ 1 .4 days. The mean total hospital stay in group A was 6.5 + 1 .7 days and in group B was 10.2 + 1 .3 days. The P value was less than 0.001, which was significant. In distribution of postoperative complications, in group A there were 1[3.3%] injury to biliary tree, 4[13.3%] wound infection, 1[3.3%] wound haematoma, 3 [10%] seroma and 1[3.3%] wound dehiscence. While in group B there were 1 [3.3%] injury to biliary tree, 3[10%] wound infection,2 [6.7%] wound haematoma, 2[6.7%] and no patient of wound dehiscence. Our study suggests that early cholecystectomy is a better treatment option than interval cholecystectomy because it has less total hospital stay, needs single hospital visit and has no risk of developing complications during wait for surgery

Role of distant flaps in soft tissue defects of the hand

To evaluate the role of different distant [groin, hypogastric] flaps in soft tissue defects of the hand. Design and Observational case series from Jan. 2002 to Jan. 2005.Bahawal Victoria Hospital, Bahawalpur.32 patients, 28 males and four females with large skin defects on hand due to agricultural machine injury 16], road traffic accidents [8], blast injuries [6] and electric burns [2].In 18 cases groin flap while in 14 cases hypogastric flaps were employed to cover the defects. Results: Two flaps were lost completely, partial flap loss occured in one, marginal necrosis in three, while infection was noted in one case.Distal flaps are useful for the coverage of the soft tissue defects of the hand when applied with proper. indications

Emergency haemorrhoidectomy for acute strangulated haemorrhoids

A prospective study was conducted on 20 patients with acute strangulated haemorrhoids, from Jan. 1994 to Dec. 1996, to study the results of emergency haemorrhoidectomy. Diagnosis was made on history and physical examination. All patients underwent the standard technique of dissection, ligation and excision of the primary haemorrhoids. Two patients had reactionary haemorrhage while one developed anal stenosis which responded to repeated dilatations. It is concluded that emergency haemorrhoidectomy is a safe and effective treatment for acute strangulated haemorrhoids