Cost comparison between laparoscopic and open appendectomies in children

Laparoscopic appendectomy [LA] for children has become very popular and is routinely performed in most health care centres around the world. The cost of surgical procedures is always a concern for patients and health care providers. This study compares, the total cost of open appendectomy [OA] with LA in children who required an appendectomy for acute appendicitis. Suitable and safe cost-effective techniques were also explored to reduce the cost of these procedures. The medical records of all the children [ranging between 0 and 12 years] at Sultan Qaboos University Hospital in Oman, who required OA or LA from June 2009 to July 2011, were reviewed. LA were performed in 75 patients while OA were done in 34. Patients from the OA and LA groups were age- and gender-matched. The average operative time was 76 minutes for LA and 49 minutes for OA [P <0.001] while the average hospital stay was 3.14 days for LA and 2.15 days for OA [P = 0.08]. The average cost of the two procedures was Omani riyals [OMR] 534 for LA and OMR 343 for OA [P = 0.00]. The complication rate following procedures was lower in the case of LA, however this was not statistically significant [LA = 8% versus OA = 11.7%, P = 0.32]. LA are costlier procedures than OA, however they are as safe as OA, and do not increase morbidity or the duration of hospital stay

Etiology of pleural effusion among adults in the State of Qatar: a 1-year hospital-based study

There have been no systematic studies of diseases causing pleural effusion in Qatar. This prospective, hospital-based study involved all adult patients [> 15 years] with pleural effusions who were admitted to referral hospitals over a 1-year period. A total of 200 cases of pleural effusion were identified [152 males and 48 females]; mean age 45.1 [SD 18.5] years. A majority of patients [73.5%] were non-Qataris, mostly from the Asian subcontinent. The most frequent cause of pleural effusions was tuberculosis [32.5%], followed by pneumonia [19%], cancer [15.5%] and cardiac failure [13%]. The most frequent cause of malignant effusion was bronchogenic carcinoma [38.7%], whereas Gram-positive organisms were the most frequent isolates from empyema fluid [62.5%]. Histological examination and culture of pleural biopsy were the most useful diagnostic workup for tuberculosis effusions, whereas repeated cytological examination of pleural fluid and pleural biopsy were most useful for malignant effusions

Analytical study of compound Unani drug Habb-e-Mudir

The drugs used in Unani Medicine consist of materials from plant, animal and mineral origin that are either used single or in combination with other drugs as poly-pharmaceuticals. Habb-e-Mudir is a poly-ingredient formulation comprising Sibr [Aloe species], Zafran [Crocus sativus] and Hira Kasees [Ferrous Sulphate], in the ratio of 2:1:1 [NFUM I] indicated for the treatment of amenorrhoea. Present study is aimed to standardize the formulation for quality control purpose. Standard sample of the formulation was prepared in laboratory following the NFUM methodology [National Formulary of Unani Medicine]. Separate studies were undertaken for each ingredient in respect of pharmacognostical characters, physico-chemical constituents and HPTLC profile. Standard formulation was subjected to chemical analysis viz. extractive values, ash values, etc. including chromatographic profile in line with standard pharmacopoeial protocols. The results may ensure the quality of Habb-e-Mudir through determining the genuineness and quality of ingredients as well as the manufacturing process

Smokeless tobacco use in Pakistan and its association with oropharyngeal cancer

Smokeless tobacco [ST], wtclefy used in Pakistan, poses a high risk for oral cancer. Our hospital-based data illustrate that oropharyngeal cancer [9.9%] is the second leading malignancy after breast cancer [16.1%], and is significantly higher than in other Member States of the World Health Organization's Eastern Mediterranean Region. Urdu-speaking communities had a proportionately higher rate of oropharyngeal cancer [20.4%], followed by Balochis [19.9%], Sindhis [16.8%], Punjabis [11.7%] and Pashtuns [9.6%]. Association of oropharyngeal cancer with ST use was four times higher relative to no history of tobacco use after adjusting for age, ethnicity and gender. Our findings also show a predominance of this cancer among males relative to females and one-third of the reported cases occurred among individuals under 40 years. These findings have significant social impact, indicating the need for urgent intervention against the use of ST

Audit of the management of patients admitted to Hamad general hospital with community-acquired pneumonia

To enhance the quality of patient care, Hamad Medical Corporation [HMC] has previously adopted guidelines for the management of community-acquired pneumonia [CAP] based upon the PSI model. We audited retrospectively the management of CAP inpatients admitted to Hamad General Hospital from 1 January until 31 June, 2008 with the objective of establishing whether these HMC guidelines were being implemented appropriately. Sixty-nine patients with CAP were admitted during the study period. Guidelines for the assessment of disease severity at presentation were not followed in all patients. Appropriate antibiotic therapy was instituted in 52 [75.4%] cases. Ten patients died [14.5%]. The rate of use of a severity assessment score to stratify patients with CAP based on recognized guidelines was zero and the death rate of 1 4.5% might reflect that noncompliance

Injection safety at primary health care level in south-western Saudi Arabia

In a study of injection safety in Abha health district, Saudi Arabia, data were collected from 47 physicians and 85 nurses at 24 primary health care centres, using an observation checklist and an interview questionnaire. All centres used individually packed disposable syringes and puncture-proof containers to collect used needles. Needlestick injury in the previous year was reported by 14.9% of physicians and 16.5% of nurses [0.21 and 0.38 injuries/person/year respectively]. Logistic regression analysis identified recapping the needle after use [physicians and nurses] and bending the needle before disposal [physicians] as significant risk factors for injury

Cystic hygroma as a rare cause of obstructive sleep apnea

A 16-year-old female presented with a seven-month history of episodic cessation of breath during sleep, associated with loud snoring and bluish discoloration of lips. She was a known case of cystic hygroma since birth with many surgical interventions and multiple relapses, the last having been laser therapy of a laryngeal cyst seven months previously. She had obvious throat scarring and a small cyst in soft palate. On the right side of the neck there was a non-tender soft tissue mass 6 x 4 cm in diameter and decreased breath sounds on auscultation of the right upper zone of the chest. MRI of the neck and chest showed a mass involving the right side of neck to the upper part of the chest and severe narrowing of the upper airway at the base of the tongue. A sleep study confirmed obstructive sleep apnea. She was referred to the UK for further surgery and treatment and died suddenly while there. The rare association of cystic hygroma and sleep apnea is reviewed

Chest radiographic findings in neurotuberculosis without pulmonary signs and symptoms

To determine the chest radiographic findings in patients of adult neurotuberculosis, with no pulmonary signs and symptoms. Descriptive study. Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from January 2004 to January 2006. A total of 100 patients fulfilling pre-defined criteria of neurotuberculosis were included. Chest radiographic [CXR] evidence of pulmonary TB was looked for in those patients and its frequency, pattern and association with the clinical grades at presentation was determined by using Chi-square test. Out of the 100 patients of neurotuberculosis, with no clinical evidence of pulmonary TB, radiographic evidence of pulmonary TB was seen in only 30% patients. The predominant patterns on CXR were apical infiltration [26.6%], miliary mottling [20%] and hilar enlargement [16.6%]. Positive CXR was found in 16.7% patients in clinical grade I and 40% and 43.3% in patients in grade II and III respectively. There was a strong association of grade II and grade III with positive chest radiographic findings [p= 0.03]. Patients of neurotuberculosis may have chest radiographic evidence of pulmonary TB even in the absence of pulmonary signs and symptoms at presentation. There is a strong association of clinical grade II and grade III with positive chest radiographic findings

Altitude and bronchial asthma in south-western Saudi Arabia

Through a house-to-house survey, 1325 people aged 11+ years registered at 2 primary health care centres [1 at high altitude and 1 at sea level] in Asir region, Saudi Arabia, were interviewed and examined for weight, height and peak expiratory flow rate. The prevalence of bronchial asthma at sea level [19.5%] was significantly higher than at high altitude [6.9%]. Illiteracy, low income, use of coal and wood for heating, having a mud or tent house, lack of electricity inside dwellings and presence of sheep were also significant risk factors for bronchial asthma. In multivariate logistic regression, only altitude was found to be significantly associated with bronchial asthma [adjusted odds ratio = 3.94]

Complications of cerebrovascular accident in two tertiary care hospitals of Peshawar, Pakistan

Stroke is considered as a lethal condition associated with significant mortality and morbidity. After stroke, complications are common and cause devastating effects on rehabilitation. The present study was designed to study the frequency of complications in acute stroke patients in Peshavar, Pakistan. This prospective observational study was conducted from March 2006 to February 2007 in the General Surgery and Neurosurgery Postgraduate Medical Institute, Lady Reading Hospital and Department of General Medicine of Hayatabad Medical Complex in Peshawar, Pakistan in a tertiary health care facility. The study was conducted on 100 consecutive patients of acute stroke, presenting within 7 days of the onset of stroke. All patients fulfilling WHO definition of acute stroke were admitted. The patients with subarachnoid hemorrhage were excluded from study. After initial assessment for the degree of neurological defect and functional disabilities, the patients were investigated for stroke types and cause. Daily assessment of all patients for occurrence of complications was done till discharge from hospital or death of the patient. Fift-eight [58%] patients were male and 42 [42%] were female with a mean age of 59.98 [11.95] years. The patients with intra-cerebral bleeding were 32 while those with cerebral infarction were 64 and cases with lacunar infarction, were 4. The median hospital stay was 6 days. The main complications were aspiration pneumonia in 28 [28%], constipation in 28 [28%], chest infection in 27 [27%], dehydration in 21 [21%] and urinary tract infection [UTI] in 12 [12%]. 16 patients [16%] had no complications and seven patients died. Aspiration pneumonia was the cause of death in four patients [57%] during their hospital stay. Post-stroke complications are very common and these can alter the outcome of stroke patients. Multidisciplinary stroke management is needed to decrease the complications of acute stroke

Colopleural fistula: Case report and review of the literature

We report a 28-year-old woman, pregnant, at 24 weeks, with 3-day history of right-sided chest pain and shortness of breath. Few hours after admission, she delivered a dead baby. She had a history of right partial hepatic lobotomy and cholecystectomy at UK on May 2004 because of multiple pyogenic liver abscesses. Chest examination revealed signs of hydrothorax on the right side. Chest X-ray showed pleural effusion on the right side. Pleural fluid was exudative with high neutrophils. Gram stain and culture showed multiple organisms. CT scan chest and abdomen with contrast, combined with barium enema, revealed right colothorax communication. Colothorax fistula was closed surgically. On the following days, the patient's symptoms resolved, and she was consequently discharged

Surgical interventions in multidrug-resistant tuberculosis: retrospective analysis of 27 patients treated at a tertiary level care center

To assess the results of surgery for Muttidrug- Resistant Tuberculosis [MDR-TB]. Retrospective analysis was done in 27 cases of multidrug- resistant tuberculosis in whom some surgical interventions were carried out at department of Thoracic surgery, Lady Reading Hospital Peshawar between the years 2002 to 2007. There were 18 male and 9 female patients in the age group of 14-54 years. All were sputum positive at the time of surgery. Majority of patients were treated with pulmonary resections [pneumonectomy [n=07], bitobectomy [n=08] and lobectomy [n=10]], while primary thoracoplasty with apicotysis was done in two patients. Post operatively 2[nd] line anti tubercular chemotherapy was prescribed for 24 months. There was one early and one Late death. Postoperative complications were seen in three cases. One patient developed bronchopleural fistula with empyema. At a mean follow-up of one year bacteriological cure was achieved in 24 patients. Judiciously performed adjuvant surgery can yield excellent long term bacteriological cure with acceptable mortality in multidrug- resistant tuberculosis. Morbidity and drug compliance remain as problem areas

Tuberculous tenosynovitis: a rare presentation of miliary TB

We present, as a rare manifestation of miliary TB, a case of tuberculous tenosynovitis, preceding by two weeks onset of tuberculous meningitis. A gradual progressive onset of a painless swelling of the right forearm was followed by high-grade fever, headache and neck pain. A suspected diagnosis of tuberculous meningitis based upon analysis of cerebrospinal fluid [CSF] was confirmed later by positive CSF polymerase chain reaction [PCR] for mycobacterium tuberculosis. Although the patient had a positive Mantoux test of 20 mm, there was no evidence of pulmonary TB and a negative CSF smear for acid fast bacilli but a positive smear from a fine needle aspirate of the swelling of the right forearm. The antituberculous therapy led to a successful outcome

Primary health care emergency services in Abha district of southwestern Saudi Arabia

To study emergency services delivery in all 30 primary health care centres in Abha district of Asir region, Saudi Arabia, data were collected about equipment and facilities, physicians' practices and attitudes, and patients' utilization of and satisfaction with emergency services. Two centres had no devoted place for emergency services. Lack of some essential equipment and drugs was evident. The greatest continuing medical education need for doctors was the management of cardiovascular emergencies [72.3%]. Many doctors [40.4%] did not consider the majority of cases as true emergencies. Many patients [43.7%] used the centres for emergency services, the most common being trauma, burns and orthopaedics [47.8%]. Most patients were satisfied overall with emergency services [82.2%]