Venous thromboembolism [VTE]: risk assessment in hospitalized patients

To determine the number of hospitalized patients at risk for developing venous thromboembolism [VTE] / deep vein thrombosis [DVT], identifying the most common risk factor and to document the use of thromboprophylaxis. Observational and cross-sectional study. Chandka Medical College Hospital, Larkana, from October to December 2011. A total of 170 patients underwent this study and these included 51 [30%] from general medical, and 119 [70%] from surgical units. Inclusion and exclusion criteria were defined and data was collected on printed format. VTE risk assessment was done according to Caprini Model and criteria defined by the American College of Chest Physicians- ACCP. Out of 170 patients, 91 were male and 79 female with mean age of 39 +/- 16 years. According to ACCP criteria for VTE risk assessment, 20% [n=34] patients were identified to be at low risk, 20% [n=34] at moderate risk, 47.65% [n=81] at high risk and 12.35% [n=21] at very high risk of developing VTE. The commonest risk factor significantly identified was immobility [54.7%, p < 0.005], followed by advancing age [41.17%, p < 0.005] and obesity [18.23%]. The most common risk factor in all types of surgical patients was anaesthesia for more than 45 minutes 82.35% [n=98/119] and in medical patients advancing age 45% [n=23/51]. Only 6 [3.5%] patients received thromboprophylaxis, all were surgical patients of very high-risk category. Majority of studied hospitalized patients were at high risk of developing VTE. Immobility was the commonest risk factor for developing VTE, followed by advancing age and obesity. Very few hospitalized patients actually received thromboprophylaxis

Does caesalpinia bonducella ameliorate genotoxicity? An in vitro study in human lymphocyte culture and in vivo study in albino mice

Most of the world's populations residing in developing countries depend on alternative medicine and use of plant ingredients. The plant Caesalpinia bonducella belongs to the family of Caesalpiniaceae and it is commonly known as Natakaranja in Hindi. It contains bonducin and two phytosterols namely sitosterol and hepatsane. The twigs and young leaves of C. bonducella are rationally used for curing tumors, inflammation and liver disorders. In our present work alcoholic extracts of this ayurvedic plant were tested for their antimutagenic and anticarcinogenic properties. The aim of the study is to investigate the antimutagenic and antigenotoxic potential of alcoholic extracts of C. bonducella against methyl methane sulfonate [MMS] induced genotoxicity. In this experiment we have used in vitro method i.e., human lymphocyte culture and in vivo method in bone marrow cells of albino mice, while the parameters studied included chromosomal aberrations [CA], sister chromatid exchanges [SCEs] and cell growth kinetics [RI] both in the presence as well as in the absence of exogenous metabolic activation system for in vitro studies whereas total aberrant cells and the frequencies of aberrations were used for in vivo methods. Alcoholic extracts of C. bonducella significantly reduce chromosomal aberration from 42.75%, 44.25%, and 51.75% levels [at 24, 48, and 72 h due to methyl methane sulfonate [MMS]] to 28.50%, 30.25%, and 35.10%, respectively similarly sister chromatid exchanges were reduced from 7.70 +/- 1.50 to 5.20 +/- 1.50 at 48 h of treatment and replication index was enhanced in vitro for each concentration and duration of treatment and their ameliorating potential was dose and duration dependent. Similarly these extracts significantly reduced the number of aberrant cells and frequency of aberrations per cell in in vivo

Four Year Experience of Hypospadias Surgery in a Tertiary Care Center with Snodgrass and Two-stage Bracka Repair

Objectives: The purpose of our study is to evaluate the outcome of hypospadias reconstruction using two different techniques [Snodgrass and two-stage Bracka Repair] in different types of hypospadias patients

Study Design: Case series

Methods: Over a period of 4 years from Nov 2009 to Nov 2013 we operated 38 patients of hypospadias in the department of Plastic and Recostructive surgery and surgical unit II Lahore General Hospital Lahore. The age of patients ranged from 1 to 14 years [mean 7 years]. Among these patients 8 patients had previous multiple surgeries [3-6 procedures]. Initial repair comprised tubularized incised plate repair [Snodgrass] in 12 patients, two-stage Bracka repair in 26 patients

Results: Satisfactory results were obtained in 33 [86%] patients. Final location of urethra at glans tip achieved in 36 [94%] patients. Urethral fistula developed in 2[5%] patients operated with Bracka's repair and in 1[2.5%] patients with Snodgrass urethroplasty. There was no incidence of proximal stenosis, diverticulum or urethral stricture. Meatal stenosis seen in 2[5%] patients

Conclusion: Versatility of Bracka's staged reconstruction enables its use in all types of hypospadias with consistently reproducible results. In selected cases of primary hypospadias when partial circumference uretheroplasty is required the tubularized incised plate [TIP] repair is a simple and effective solution

Are drains really required in thyroid surgery

Background: Traditional use of drain in thyroid surgeries was to avoid any possible hematoma. The aim of the present study was to prospectively determine whether the use of the drain in thyroid surgery really helps the patient or it just adds morbidity to patients' post operative recovery phase

Patients and Methods: 132 patients who underwent total thyroidectomy without drain placement for benign conditions of thyroid were evaluated for outcome in terms of in hospital stay, wound infection, hematoma formation and re-exploration owing to untoward bleed. The study was conducted for 42 months with one month followup period. Results were compared with the control group from hospital records during the same study period

Results: Hematoma developed in 4 [3%] patients, infection in 2 [1.5%], hypocalcemia in 28 [21%] and recurrent laryngeal nerve [RLN] palsy 01[.75%] patients. There was no re-exploration for hematoma nor any in hospital mortality. In hospital stay was 1.8 days on average

Conclusion: Use of drain in thyroid surgery has no added benefit in terms of patient outcome rather it may increase the cost of treatment, patient's morbidity and hospital stay