ABSTRACT
Objective: to analyze pattern of skin diseases in remote areas of Punjab diagnosed by telemedicine network
Methods: rural centers at the district and tehsil levels [Rajanpur, Dera Ghazi Khan, Khushab, Sahiwal, Gujrat and Jhang regions of Punjab] were connected to tertiary care centers with specialized telemedicine equipment. The images were transmitted live. Prescriptions were written and duly forwarded. Patients were called to the tertiary care center for further investigations and examination if needed
Results: a total of 11,892 patients were treated. Acne was the commonest disorder [42%], followed by dermatophytosis [28%], scabies [22%] and eczemas [18%]. Infestations and infections are common in patients from poor socio-economic strata
Conclusion: telemedicine is beneficial for providing services to remote areas and can be used as a preventive measure by educating people
ABSTRACT
Patients with trivial blunt abdominal trauma may present with isolated jejunal blow out [IJBO]. A high index of suspicion is required as delayed presentation or delayed diagnosis may increase morbidity. Presentation with frank perforation peritonitis can be diagnosed by abdominal X-rays. We report the case of a patient who presented with features of peritonitis 10 days after being injured by a knee kick trauma. An erect abdominal X-ray showed extraluminal air-fluid levels, suggesting a hollow viscous injury which on exploration was found to be IJBO
ABSTRACT
Background: Perforation of peptic ulcer is a life-threatening emergency and associated with marked post surgical morbidity
Objective: To enlist the predictors of the postoperative morbidity in surgically treated patients of perforated peptic ulcer
Methods: A cross sectional study was conducted at Surgical Departments of Allied and DHQ Hospital Faisalabad. Clinically and radiologically suggestive but surgically proven, 60 cases of the perforated peptic ulcer were included in the study. Possible predictors were recorded on admission as well as during surgery. Postoperatively, patients were taken care of and followed up for the development of complication till the time of discharge. Depending upon the presence/ absence of the post operative complications, patients were divided into two groups. Data was entered and analyzed by using SPSS version 11
Results: In our study, age ranged from 24-80 years. 26.7 percent of the cases had clinical features of shock at presentation. Smoking was noted in 47 percent of the cases. In 97% of the cases, the size of perforation was less than 1 cm while more than half of the cases had amount of peritoneal spillage more than 1 Litre. The most common complication was wound infection. Most of the patients were discharged home between the 7[th] and 10[th] postoperative days. Age more than 40 and male sex [p-value < 0.147] were not found to be associated with increased risk of development of the post operative complication. Complication rate was found to be quite high for the patients presenting after 72 hours of the development of the pain [p=0.006, OR=9.3]. Other factors which showed significant difference between the two groups for the development of complication included shock at presentation [p-value= 0.032], history of smoking [p-value= 0.002] and the presence of associated medical illness [p-value= 0.01]
Conclusions: Late presentation, history of smoking, presence of shock at the time of presentation and presence of the associated medical illness significantly influence the rate of development of post operative complications
ABSTRACT
Appendectomy is a common emergency procedure. Negative appendectomy rate is up to 33%. As it is associated with the risks of anesthesia like any operation, it should be avoided where possible. Modified Alvarado score is one of the probable ways to reduce this rate. Our objective of the study was to evaluate its value in reducing the percentage of the negative appendectomy. A non randomized controlled trial was conducted at Emergency Department of DHQ Hospital Faisalabad over the period of 6 months. 60 patients were divided into two groups. In group A, 1st consecutive 30 patients were included who had indication for appendectomy based on the choice of the surgeon while in group, B 30 patients having indication for appendectomy based on modified Alvarado score 7 or more were included. Surgically removed appendix was evaluated by histopathology for the presence or absence of inflammation. Both groups were compared for the percentage of the negative appendectomy. In group A, overall negative appendectomy rate was 20% while gender based negative appendectomy rate was 28.5% in Females and 12% in males. In group B overall negative appendectomy rate was 14% while gender based negative appendectomy rate was l7.6% in females and 7.6% in males. Over all reduction through modified Alvarado score was insignificant [chi-square 0.480, df 1, p value 0.488]. Similarly, statistically significant reduction could not be found both in female [chi-square 0.524, df 1, p value 0.469] and male [chi-square 0.179, df 1, p value 0.672] groups. Modified Alvarado score is not helpful in significant reduction of the over all percentage of the negative appendectomy. Similarly, statistically significant reduction could not be found both in female and male groups. Further methods of evaluation should be used especially in females