Incidence of wound infection following inguinal hernia tension free mesh repair [hernioplasty] without antibiotics

Objective: To see thewound infection incidencepost hernioplasty without the use of antibiotics

Study Design: Observational / Cross-sectional study

Place and Duration of Study: This study was conducted Surgical Unit III, V and VI, Civil Hospital Karachi from January 2006 to December 2013

Materials and Methods: There were a total of 250 patients. There were no use of antibiotics after hernioplasty. Patients under eighteen years, recurrent hernias, immunosuppressive diseases [like diabetes mellitus], or already on antibiotic were excluded from the study

Results: Incidence of wound infection was 3.6%, which were then treated conservatively. No mortality observed

Conclusion: The incidence of post operative wound infection following inguinal hernioplasty without antibiotic use was 3.6%

Hepatitis B and C virus infection in surgical practice

Objective: To determine frequency of hepatitis B and C virus infection in surgical patients and its relation to already reported risk factors

Study design: Case series

Place and Duration of Study: Department of Surgery Civil Hospital Karachi, from May 2012 to September 2012

Methodology: All patients who were scheduled for surgical procedures were screened for HBsAg and anti-HCV using immunochromatography [ICT]. The variables already known for the possible transmission were also inquired. The data was entered into a Performa and entered into SPSS version 17. Descriptive statistics were used for computation of the results

Results: Out of the total 662 patients, 325 [49.1%] were males and 337 [50.9%] females. Mean age of patients was 37.52 year. Hepatitis B surface antigen [HBsAg] was positive in 19 [2.9%] patients of whom 12 [63.15%] were males. Hepatitis C [anti-HCV] was found in 45 [6.8%] patients of whom 24 [53.33%] were females. Among HBsAg positive patients, 17 [89.47%] had history of intravenous injections; similar history was found in 44 [97.77%] anti-HCV positive patients

Conclusions: Frequency of hepatitis B was slightly more than hepatitis C in surgical patients. Routine serological screening prior to surgery should be made mandatory so that health care workers especially surgeons can take precautions before surgery

Frequency and sensitivity of micro-organism in post-operative wound infections: a quest for microbes

To determine the frequency of common organisms involved in post- operative wound infection. To determine the sensitivity of micro-organism for different antibiotics. Prospective cross-sectional descriptive study. This study was carried out at Surgical Units of Civil Hospital Karachi from April to September, 2010. 72 swab samples were collected from patients who had undergone operations. Samples were obtained from the hospital and processed in Civil Hospital Karachi lab [Microbiology Department]. Out of 72 bacterial isolates found in post-operative wound infection, 30 [41.66%] were E.Coli, followed by Klebsiella species 14 [19.44%], pseudomonas aeruginosa 13 [1.38%], staphylococcus aureus 6 [9.72%], providential species 1 [1.38%], proteus mirabilis 1 [1.38%], Actinobacter 1 [1.38%] and no growth 6 [9.72%]. The result showed that the occurrence of infection was higher in the age group between 20 -40 than any other group. There is no significant difference between male and female sexes in the occurrence of infection. Infection was more in the operation done under emergency circumstance than the elective ones.There was no significant association between infection, and co-morbidities and past history of wound infection. The sensitivity pattern of 4 main bacteria, Frequently found in the study i.e. E.coli, klebsiella, pseudomonas aeruginosa and s.aureus isolates, suggested that the organisms were more sensitive to imipenem, Amikacin sulphate, Ceftazidime, Cefperazone/Sulbactum and Pipercillin/Tazobactum than other groups of drugs. The most common causative organism was E.coli, infection rate was higher among the patients operated in emergency and imipenem, Amikacin sulphate were found to be more sensitive

Knowledge, attitude and perception regarding dengue fever among university students of interior Sindh

Dengue is among the most common mosquito-borne viral diseases that affect humans. It has now become a major public health dilemma, annually affecting approximately 50-100 million people worldwide. This study aimed to assess the knowledge, attitude and perception of dengue fever among university students of interior Sindh. A cross-sectional study was conducted during the period of April-June 2012. Four hundred and fifty students were surveyed. A structured pre-tested questionnaire was used to collect data. The data were analyzed using SPSS version 17. Overall, 94.6% of participants [43.3% male and 56.7% female, p-value 0.03] reported that they had heard about dengue, and 58.6% of participants reported "Aedes mosquito" as a vector of dengue virus, with gender difference [37.5% male vs 62.5% females with p-value <0.001]. The Aedes mosquito is "A small dark mosquito having white stripes on its leg" was reported by 54.8% students. The Aedes mosquito breeds in "Stagnant clean water" was reported by 47.6% [male 40.2% vs female 59.8%, p-value 0.003] and usually bites at "Dusk" by 44.7% and at "Dawn" by 51%. Regarding symptoms of dengue fever, "Prolonged high fever" was reported by 52.6%, "Muscular pain" by 39.6% [p-value 0.009], "Bleeding" by 41.3% [p-value 0.001] and "Headache, nausea and vomiting" by 44.7% [p-value 0.001]. Approximately half of the participants in our study were unable to correctly identify the Aedes mosquito as a transmission source [41.4%], its appearance [45.2%], its breeding place [52.4%] and its bite time [52.2%]. The enhancement of knowledge through different educational programs is needed to increase awareness of dengue fever

Frequency and sensitivity of micro-organism in post-operative wound infections: a quest for microbes

To determine the frequency of common organisms involved in post- operative wound infection. To determine the sensitivity of micro-organism for different antibiotics. Prospective cross-sectional descriptive study. This study was conducted in 3 Surgical Units of Civil Hospital Karachi from April to September 2010. 72 swab samples were collected from patients who had undergone operations in 3 Surgical Units of Civil Hospital Karachi during a period of 6 month from April to September, 2010. Samples were obtained from the hospital and processed in Civil hospital Karachi lab [Microbiology Department]. Out of 72 bacterial isolates found in post-operative wound infection, 30 [41.66%] were E.Coli, followed by Klebsiella species 14 [19.44%], pseudomonas aeruginosa 13 [1.38%], staphylococcus aureus 6 [9.72%], providential species 1 [1.38%], proteus mirabilis 1 [1.38%], Actinobacter 1 [1.38%] and no growth 6 [9.72%]. The result showed that the occurrence of infection was higher in the age group between 20 -40 than any other group. There is no significant difference between male and female sexes in the occurrence of infection. Infection was more in the operation done under emergency circumstance than the elective ones. There was no significant association between infection, and co-morbidities and past history of wound infection. The sensitivity pattern of 4 main bacteria, Frequently found in the study i.e. E.coli, klebsiella, pseudomonas aeruginosa and s.aureus isolates, suggested that the organisms was more sensitive to imipenem, Amikacin sulphate, Ceftazidime, Cefperazone/Sulbactum and Pipercillin/Tazobactum than other groups of drugs. The most causative organism was E.coli, infection higher among the patients operated in emergency and imipenem, Amikacin sulphate were found to be more sensitive

Postraumatic stress disorder in Karachites due to random events of violence

Karachi is one of the biggest City in Asia and since past 20 years terrorism in Karachi is increasing frequently, due to these terrorist activities people living here have developed several phobias and anxiety disorders. To contrast the occurrence of traumatic events and its relationship with symptoms of post-traumatic stress disorder in Karachites. Survey of residents of Karachi was conducted between January 12, 2011 and March 4, 2012. Symptoms of PTSD were assessed using questionnaire related to psycho social factors that prone to PTSD .Out of total 164 both male and females, 62% of respondents reported appetite changes due to these terrifying activities, 58% of respondents reported hostile personalities, depression and mood fluctuations, while remaining 30% reported insomnia. 76.82% reported depression According to their economical condition 71% Middle class was highly affected as compare to upper class and lower class. There was also a significant difference observed among the populations who are engaged both in education and also doing jobs for survivals. 88% of them were found frustrated and protesting against the situation of the city. The results of the current study suggest that the trauma incident by the resident population is significant. Stresses tend to be numerous and chronic. The trauma experienced correlated strongly with psycho social, somatic, PTSD symptoms and depression

Early laparoscopic cholecystectomy for acute calculous cholecystitis: what is the optimal timing?

To assess the outcome of optimal timing of early laparoscopic cholecystectomy in cases of acute calculous cholecystitis. Descriptive case series. Shaukat Omer Memorial [Fauji Foundation] Hospital and Hill-Park General Hospital Karachi, from April 2010 to November 2011. Clinical records of 164 patients who underwent early laparoscopic cholecystectomy in acute calculous cholecystitis were retrieved and categorized into two groups according to the timing of surgery from the onset of symptoms [A, who had laparoscopic cholecystectomy within 72 hours; B, who had laparoscopic cholecystectomy after 72 hours]. Outcome of interests were conversion to open procedure, postoperative complications and length of hospital stay. The SPSS version 11 was utilized for data analyses. Chi-square test was used to assess qualitative and unpaired Student t test was employed for quantitative data. A value of p < 0.05 was considered statistically significant. The mean [+SD] age was 40.42 +12.42 year. There were 21 [12.8%] males and 143 [87.2%] females with male to female ratio being 1:6.8. Comparing the two groups, the conversion rates [2.9% versus 13.6%, p=0.012], postoperative complications [1.9% versus 10.2%, p=0.026], and length of hospital stay [2.34 versus 3.93 days, p<0.001] were significantly reduced in group A. The early laparoscopic cholecystectomy within 72 hours minimizes the conversion rates and postoperative complications, and shortens the length of hospital stay in cases of acute calculous cholecystitis

Primary closure of common bile duct after open choledochotomy

To assess the outcome of primary closure of common bile duct after open choledochotomy. Descriptive case series. Department of surgery, unit II, III and VI, Dow University of Health Sciences and Civil Hospital Karachi from June 2005 to May 2009. Clinical records of all the patients who underwent bile duct exploration followed by primary closure were reviewed. Main outcome measures were operating time, duration of hospital stay and postoperative complication; including bile leakage, subphrenic abscess, biliary peritonitis and postoperative jaundice. The SPSS version 11 was applied to the data for analysis. A total of 38 patients were found from clinical records having male to female ratio of 1:6.6. Mean [ +/- SD] operating time was 95 [ +/- 7] minutes. The overall complication rate was 10.52%. Bile leak was encountered in three [7.89%] patients whereas small subphrenic collection was noticed in one [2.63%] patient who was treated conservatively. None of the patients experienced postoperative jaundice and biliary peritonitis. Mean [ +/- SD] duration of hospital stay was 7.63 [ +/- 1.63] days. Primary repair of common bile duct after open choledochotomy is safe and associated with low complication rate

Mechanical intestinal obstruction: etiology and management in adults at civil hospital, Karachi

To determine the etiological factors, management and outcome of mechanical intestinal obstruction in adults at Civil Hospital, Karachi. The hospital records of all patients operated on for mechanical intestinal obstruction in Civil Hospital, Karachi, over a period of one year [July 2006 to June 2007] were reviewed. Signs and symptoms with duration, etiology, surgical management, morbidity and mortality, apart from demography, were recorded. Patients were followed until their discharge. A total of 119 patients, 74 male and 45 female, with a mean age [ +/- SD] of 37.29 [ +/- 16.08] years were operated on during the study period. Their mean [ +/- SD] duration of symptoms was 4.1 [ +/- 3.9] days. Obstructed external hernias were the most common cause of intestinal obstruction, seen in 36 [30.2%] patients, followed by intestinal tuberculosis in 24 [20.2%] patients. Stoma formation was the most common surgical procedure performed in 40 [33.6%] patients followed by hernia repair, with or without resection, and anastomosis of bowel in 36 [30.2%] patients. Complications were documented in 34.4% of patients. Mortality was 9.2% during the hospital stay. Obstructed external hernias were the commonest cause of intestinal obstruction followed by intestinal tuberculosis. Stoma formation was the commonest surgical procedure performed. During the first year of surgical training, all residents should master the skills of making an appropriate stoma, while during the second year they should be able to manage obstructed hernias properly

Frequency of infection in cholelithiasis

To determine the frequency of infection in cholelithiasis and find common infecting organisms with their antibiotic sensitivity. A descriptive study. This study was conducted in Surgical Unit - I, Jinnah Postgraduate Medical Centre [JPMC], Karachi, Pakistan, from April 2001 to March 2002. First 100 cases of cholelithiasis, selected and operated by open or laparoscopic cholecystectomy were included in this study. Patients with acute cholecystitis, history of jaundice, stones and / or dilated common bile duct were excluded from the study. Ultrasound was the main tool for pre-operative diagnosis. During cholecystectomy, bile was aspirated and specimens were sent to laboratory for microbiological examination. The results were recorded on a proforma. Out of 100, 36 patients had positive bile culture. The most common organism was E. coli [17 patients] followed by Klebsiella [9], Pseudomonas [6], Staphylococcus aureus [2], Salmonella [1] and Bacteroids fragalis [1] patient. In this study, most of the biliary organisms were highly sensitive to the 2nd generation cephalosporins and quinolones. From the bacteriological assessment, it seems that both endogenous and exogenous contamination were the causes of wound sepsis. It was also found that the infection of bile did not increase the risk of postoperative wound infection when prophylactic perioperative antibiotics were used

Experience of karadykis procedure in the treatment of pilonidal sinus

To evaluate the advantages of karydakis procedure for the treatment of the pilonidal sinus Interventional study. The study was conducted in surgical unit 1[ward 3], Jinnah Post Graduate Medical Center, Karachi from January 2001 to December 2004. In this study we enrolled 1 00 adult patients who presented with pilonidal sinus. All the patients where evaluated by thorough history, physical examination and were investigated before undergoing primary asymmetrical closure of pilonidal sinus by a procedure describe by Karydakis. In this study average age of patients was 28 years. Male/female ratio was 10:1. Most of the patients were hairy 81 percent and over weight 85 percent. Single sinus opening present in the midline of natal cleft in 69 percent patients. Results showed uneventful recovery in 93 percent patients, postoperative wound infection in four patients 4 percent. seroma formation and recurrence in three patient 3 percent. Average hospital stay was 4 days. Experience of karydakis procedure in the treatment of pilonidal sinus is worth adopting and sharing with others, with all its advantages, as with this procedure patient has short hospital stay, early wound healing and less postoperative complications

Primary chest wall Tuberculosis: diagnostic dilemma

Tuberculosis, especially extra-pulmonary tuberculosis, is on the rise with variable presentations at unusual sites causing diagnostic dilemma. This article describes two such cases of primary chest wall tuberculous abscesses that presented clinically as a lipoma and a pyogenic abscess

Bilateral Carcinoma breast

Carcinoma of the Breast is the commonest carcinoma in the females; the incidence being one woman out of every 11 women. The disease can also develop bilaterally, rarely. In this report we are presenting the case of a bilateral carcinoma breast in a female aged 35 years

Causes of intestinal obstruction: a study of 257 patients

To find out the common causes of intestinal obstruction in our practice. Design: Descriptive study. Place and Duration: The study was conducted in Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, Pakistan between February, 2000 to January, 2004. Patient And In this study we included only those patients of intestinal obstruction who underwent exploratory laparotomy. Total of 257 patients of intestinal obstruction were diagnosed on the basis of clinical history, examination, radiological findings and investigations. After resuscitation exploratory laparotomy was performed to confirm the diagnosis and relieve the obstruction. The most common cause of intestinal obstruction was tuberculosis, 38.13% followed by obstructed/strangulated hernia 26.84%, post-operative adhesions 17.12%, large gut malignancy 10.09%, volvulus 6.22% and small gut malignancy 0.77%. The causes of intestinal obstruction are variable in different parts of world. Tuberculosis is one of the leading cause of intestinal obstruction in Pakistan