Etiological spectrum of Ileal perforation on surgical grounds

Objective: The aim of this study is to determine the incidence of ileal perforation on its etiological basis

Study design: The data is collected prospectively and the patients are selected by consecutive sampling technique

Sample size: 119 patients

Place and duration: The study is conducted at Surgical Emergency of Allied Hospital, Faisalabad from 1st June, 2017 to 1st Dec, 2017, over the period of 6 months

Results: Out of 119 patients, 86 are male and 33 are female with male to female ratio of 2.61. According to the results of the study, the order of etiologies of ileal perforation is as follows: Nonspecific 66 [55.5 percent], Traumatic 34 [28.6 percent], Typhoid 14 [11.8 percent], Intestinal Tuberculosis 3 [2.5 percent], and Iatrogenic 2 [1.7 percent]

Conclusion: Typhoid and Tuberculous perforation are the third and fourth most common cause of ileal perforation, respectively. Ileal perforations are more common in males

Misunderstanding of parents about using of anti-biotic in upper respiratory tract infection in Riyadh, Saudi Arabia

Background: Misuse of antibiotics has become a global public health issue for several reasons, one of which is the rapid development of antibiotic resistance that leads to high morbidity and mortality

Objectives: Objective of this study was to study the misconceptions of parents of primary school children in Riyadh about the use of antibiotics for upper respiratory tract [URT] symptoms; and also study perceptions, attitudes, and behavior toward antibiotic use and identifies the factors affecting this

Methods: Analytic cross sectional study of parents in one large city: Riyadh, Saudi Arabia. Study population were parents of children studying in these schools, and were selected multistage sampling and proportional to population size [PPS]

Results: The questionnaire was distributed to 1306 parents. The response rate was 78.9%, 56.6% respondents were mothers with a mean age of 40 +/- 7. Sixty seven percent of the parents admitted to self-prescription once or more, and the most common reason for self-prescribing, was because they thought the child was not ill enough to be taken to hospital [41.8%]. This was followed by 37.7% who used "leftovers". Regarding the attitude toward antibiotic prescription, 62.5% agreed that children should not be given an antibiotic when they have fever and nasal congestion. In addition, 63.5% agreed that they should give their child antibiotic for ear or throat pain. Around two thirds agreed that upper respiratory tract infection [URTI] was caused by a virus. Those who obtained their information from primary health care centers and general practitioners had the lowest median of total knowledge score, and the highest knowledge was for those who obtained information from websites and the social media. Multiple linear regressions revealed that parents whose incomes were high, had high education, had children in private schools were more likely to have good knowledge and highly favorable attitudes and practices toward antibiotic use

Conclusion: Thirteen percent had an excellent knowledge, and 52.7% had an intermediate level of knowledge. Of those with excellent knowledge, 58.6% still expected to get antibiotic prescription from a physician for URTI

Comparison of surgical techniques used in adult varicocele

Background: A varicocele is an abnormal dilatation of veins in the pampiniform plexus of the spermatic cord. Several methods have been used for its treatment including open surgical ligation of the spermatic vein as well as laparoscopic and microsurgical varicocelectomy

Objective: To compare laparoscopic varicocelectomy with open varicocelectomy techniques in patients of varicocele in terms of operative time, duration of hospital stay, recurrence rate and effect on semen parameters

Methodology: Study Design: Randomized clinical trial Setting: Punjab Medical College and affiliated hospitals. Duration: 27 September 2014 to 26 September 2016. A total of 129 patients of varicocele were included in the study. All patients were diagnosed clinically as having varicocele. 43 patients underwent laparoscopic varicocelectomy [group A], 43 open varicocelectomy using retroperitoneal approach [group B] and 43 underwent open inguinal approach[group C]. Outcome in terms of operative time, duration of hospital stay, recurrence rate and impact on semen parameters, was compared in three groups. The data was entered and analyzed by using SPSS version 20

Results The operative time and hospital stay in the laparoscopic group were significantly shorter than in retroperitoneal and inguinal groups [P < 0.01]. Recurrence rate was 18.6% in the open inguinal group, 16.27% in the retroperitoneal group, and 4.65% in the laparoscopic group. This lower rate of recurrence was statistically significant in the laparoscopic group [P < 0.05]. Among the three groups, comparisons between preoperative and postoperative semen parameters revealed improvements in sperm concentration and motility [P < 0.01]

Conclusion: Outcome of laparoscopic varicocelectomy is better than open varicocelectomy techniques in patients of varicocele

Comparison of morbidity in rubber band ligation and milligan morgan hemorrhoidectomy

Background: Hemorrhoidectomy treatment has multiple options, depending on grade of disease

Objective: This study was conducted to compare the postoperative morbidity of rubber band ligation [RBL] and milligan morgan haemorrhoidectomy in terms of frequency of pain and bleeding in patients with third degree hemorrhoids

Material and Methods: This study was conducted in Department of Surgery, District Headquarter Hospital Faisalabad, affiliated with Punjab Medical College from 25[th] January, 2012 to 24[th] January, 2014. This study included 140 [70 in each group] patients of grade 3 hemorrhoids. Patients were randomly allocated into either the rubber band ligation [RBL] group or milligan morgan haemorrhoidectomy groups by using computer generated random number tables. Both groups were observed for the impact of these treatment modalities on post operative pain and bleeding

Results: In group A, 49 patients [70%] and in group B, 47 patients [67.2%] were male. Regarding postoperative pain, 2 patients [2.9%] of group A and 22 patients [31.4%] developed mild postoperative pain [p<0.001], 1 patient [1.4%] of group A and 31 patients [44.3%] of group B faced moderate postoperative pain [p<0.001], 1 patient [1.4%] of group A and 11 patients [15.7%] has severe postoperative pain [p=0.002]. In group A, 2 patients [2.9%] and in group B, 10 patients [14.3%] has mild postoperative bleeding, 1 patient [1.4%] in group A and 8 patients [11.4%] in group B developed severe postoperative bleeding

Conclusion: RBL is a reliable and safe procedure with minimum complications and morbidity after the procedure

Impact of early tracheostomy on outcome in tetanus patients

Background: Tetanus is a disease with high mortality, and different treatment modalities are being tried

Objective: The objective of this study was to compare the impact of early tracheostomy on outcome in tetanus

Patients and Methods: This randomized clinical trial, was carried out in Surgical Unit-5, DHQ Hospital, Faisalabad, Pakistan from 1[st] January, 2012 to 31[st] December, 2013. Sixty patients of tetanus [grade-2] of any age and sex, diagnosed clinically were taken and divided into two groups, 30 patients in each. One group was given only medical treatment and second group was given medical and surgical treatment and both groups were observed for the impact of these treatment modalities on outcome. The data was entered and analyzed in SPSS version 17

Results: Out of 30 patients who underwent medical treatment, 10 [33.3%] were cured and 20 [66.7%] were expired. Among patients who underwent both medical and surgical treatment, 18[60%] were cured and 12 [40%] expired. 21[70%] developed tracheostomy complications and 9 [30%] did not develop any complication. [P-value < 0.05]

Conclusion: Tracheostomy in early stages of tetanus has mortality benefit and it is associated with less morbidity and mortality

Splenic lymphoma in HCV positive patient; a case report

Splenic Lymphoma is a marginal zone lymphoma [MZL's] that is a type of Non-Hodgkin's Lymphoma. It is characterized by a lymphocytic tumor of marginal zone of spleen that may involve splenic hilar lymph nodes and may spill the abnormal BLymphocytes in the blood. A38 years old male, known HCV, presented with pain in left hypochondrium and an abdominal mass in left hypochondriac region. He was diagnosed clinically as a case of splenic hematoma which turned to be splenic lymphoma after investigations and was treated

Splenic lymphoma in HCV positive patient; a case report

Splenic Lymphoma is a marginal zone lymphoma [MZL's] that is a type of Non-Hodgkirf s Lymphoma. It is characterized by a lymphocytic tumor of marginal zone of spleen that may involve splenic hilar lymph nodes and may spill the abnormal B-Lymphocytes in the blood. A 3 8 years old male, known HCV, presented with pain in left hypochondrium and an abdominal mass in left hypochondriac region

He was diagnosed clinically as a case of splenic hematoma which turned to be splenic lymphoma after investigations and was treated

Serum vitamin D deficiency, a new epidemic

Vitamin D deficiency has profound adverse effects on health. Serum calcium, phosphorus and even alkaline phasphatase cannot predict underlying vitamin D deficiency. 1. To determine the frequency of vitamin D deficiency in outpatient private clinic 2. To determine the relation of vitamin D deficiency with the presenting symptom of bone or body aches. To see the relation of its deficiency to the serum calcium, alkaline phosphate and phosphate levels. Descriptive study. One of the local private clinic. 800 patients who presented to the clinic due to any ailment, having presenting complains with bone or body aches or not, were included in this study. The duration of study was 7 months from June to December 2008. The study showed among total 33% [n=264] were male and 67% [n=536] were female. 33 patients [4.1%] were below age of 20 years, 364 patients [45.2%] were having age between 20-40 years, 252 [31 .5%] were between 41 -60 years, 1 43 [1 7.8%] were between 61 -80 years and only 8 patients [1%] were above 80years. Over all vitamin D present in sufficient amount [>30 ng/ml] in only 4 patients [0.5%], reaming patients [n=796, 99.5%] were deficient in vitamin D were further divided into those who were having deficiency [serum level <20 ng/ml] [n=636, 79%] and insufficiency [serum level between 21-29 ng/ml] [n=160, 20%]. All the deficient patients were having normal serum calcium and phosphate levels and only 33 patients were having modestly raised serum alkaline phosphate. Among the sample only 318 [39.7%] were having bone or body aches as a presenting feature while remaining 482 [60.3%] were having no pains. More ever pain has got insignificant relation to any level of serum vitamin D level [p-value=0.201], however younger deficient patients were having lesser chance of bone or body aches as compared to age more then 60 year [p-value<0.001]. Vitamin D deficiency is more prevalent in our community, as compared to published data, targeting young population. Vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health