Efficacy and accuracy of focused assessment sonography for trauma [FAST] in management of isolated gastrointestinal injury due to blunt abdominal trauma

Objective: To determine the diagnostic accuracy of Focused Assessment Sonography for Trauma [FAST] in patients having isolated gastrointestinal injury due to blunt abdominal trauma

Study design, settings and duration: Prospective, interventional study was done in department of General Surgery and Diagnostic Radiology, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from July 2012 to June 2014

Materials and Methods: All patients who came with blunt abdominal trauma underwent emergency ultrasound with FAST technique to detect free fluid/ collection in abdominal cavity as an indicator of intra-abdominal organ injury. After ultrasound examination, most patients underwent surgical laparotomy to identify the gut and solid organ injury and were managed accordingly. The surgical findings were compared with ultrasound findings to see the correlation

Results: A total of 317 patients with blunt abdominal trauma underwent emergency US with FAST technique. Out of these, 296 [93.37%] underwent exploratory laparotomy. During surgery, 52 [17.56%] patients had evidence of bowel injury with 38 [12.83%] having solid organ injury plus bowel injury and 14 [4.72%] having only bowel injury. Amongst them, FAST ultrasound showed free fluid/ collection in 28 [53.8%] patients [true positive] while it was negative in 24 [46.15%] patients [false negative]. Among these, 24 patients with negative FAST, 15 [62.5%] had both solid organ injury plus bowel injury and 09 [37.5%] had only bowel injury [False negative]

Conclusion: FAST ultrasound missed 46% bowel injury with or without other solid organ injury and is therefore not reliable in diagnostic tool for assessing isolated bowel injury due to blunt abdominal trauma

Role of the dentist in tobacco cessation: a cross-sectional survey

Tobacco use is considered to be one of the five greatest risk factors for mortality worldwide. Visit to a dentist provides an opportunity during which the patient may be willing to accept tobacco cessation advice. The aim of this study was to determine whether patients visiting dental hospitals are provided with tobacco cessation counseling by the dentists. A cross-sectional survey was conducted and the participants were interviewed according to a self-developed closed questionnaire. The study population comprised of tobacco users reporting to the dental hospitals of Peshawar. 152 tobacco users were interviewed. Data analyses were performed using SPSS version 16. Most of the study participants [64.5%] were never advised by their dentist to quit tobacco use. Only 19.1% of the subjects considered it a duty of the dentist to play a role in tobacco cessation. Twenty four percent of the participants believed that tobacco cessation counseling from a dentist may be more successful than general physicians. Only 23% believed that advice or assistance by dentist may be helpful in tobacco cessation. Among the subjects who were advised to quit tobacco, 93% made an attempt to quit but only 20% were able to successfully quit. It was concluded that dentists can play an influential role in tobacco cessation provided they are properly educated and trained in tobacco cessation counseling and interventions

Relationship of anemia during pregnancy with education and trimester of pregnancy

To find out relationship of anemia during pregnancy with education and trimester of pregnancy. Community based cross-sectional descriptive study. This study was conducted in urban slum areas of Taluka Qasimabad, District Hyderabad during six months of studying period from 1[st] March 2011 to 31[st] August 2011. The total population residing in the study areas was twelve thousand two hundred and seven [12207]. During the study period of six months, two hundred and fifty [250] pregnant women were enrolled for the study. Pregnant women during 2[nd] and 3[rd] trimester of pregnancy were included in the study. The data was collected by conducting interviews, filling of the pre-tested, structured questionnaire and by assessing anemia by determining the hemoglobin level in the enrolled pregnant women. The questionnaire was a close-ended one, filled by the principle researcher herself. It comprised of demographic information about woman, her family, trimester of pregnancy about her education. Every woman's hemoglobin was determined by using Sahli's Hemoglobinometer. Anemia in pregnancy according to WHO classified into mild anemia hemoglobin level in the range of 10.0-10.9 g/dl, moderate anemia hemoglobin level in the range of 7-9.9 g/dl and severe anemia hemoglobin level is <7 g/dl The association of various factors [determinants] with anemia was analyzed by applying chi-squared test; the p-value of <0.05 was taken as the level of significance. Two hundred and thirty three pregnant women were anemic while only seventeen women [6.8%] were found non-anemic. Majority of the women i.e. 70% presented with moderate anemia [hemoglobin level 7.0-9.9Gm /dl] while severe anemia [hemoglobin level <7 Gm/dl] was recorded in 5.2% pregnant women. Among total studied women, one hundred and forty seven were illiterate and were having different levels of severity of anemia; moderate anemia was recorded in majority of them ie in 127 pregnant women. The educational level had strong association with occurrence of anemia as well as on its severity [p=0.00].Regarding trimester of pregnancy and the occurrence of anemia, out of 158 pregnant women presenting in their third trimester of pregnancies, 143 were moderately to severely anemic. Trimester of pregnancy and occurrence of anemia were found statistically significant. It was also associated with severity of anemia [p=0.00]. Relationship of anemia during pregnancy with low level of education and trimester of pregnancy is very high residing in urban slum areas of Taluka Qasimabad, District Hyderabad is high. Current findings highlight the anemia in pregnancy, education and early booking during pregnancy as a priority area of concern

Early stage ingrown toe nail and role of conservative treatment- an experience at Sukkur

To find out the frequency, causes and role of conservative treatment in early stage ingrown toe nail. Descriptive, observational, case series study. This study was conducted at the Department of Surgery, Ghulam Muhammad Mahar Medical College [GMC] ,Teaching Hospital, Sukkur from March 2011 to February 2012. Detailed history and physical examination especially local examination of the affected toe was made in OPD, to stage the disease. Only patients with early stage [Stage-I] ingrown toe nail were included in this study. Patients in advanced stages [stages-II and III], with history of diabetes, trauma, vascular diseases and all recurrent cases, which were operated upon in past excluded from this study. The patients were treated conservatively by advising for good foot hygiene and cutting the nails properly. Selected patients required wicking technique. This procedure was taught to patients so that they could do it once or twice daily at their homes. Patients were kept on antibiotics where required and simple pain killers. The patients were advised to visit the OPD regularly at defined time. 86 patients participated in this study, 54 [62.7%] were males and 32 [37.2%] were females with male: female ratio of 1.68: 1. Age ranged from 17-66 years, majority of patients were in between 21 to 40 years of age [44.1%] with mean age of 36 years. In majority of patients the right big toe was affected [n=56, 65.1%], in 22 [25.5%] left big toe and in 08 patients [09.3%] there was bilateral involvement of both big toes. Lateral nail fold was affected more [n=38, 44.1%] than medial fold [n=12, 13.9%]. In 36 [41.8%] patients both nail folds were affected. Various causative factors were identified with most important was improper nail trimming [n= 17, 19.7%] followed by tight fitting shoes [n=14, 16.2%] and idiopathic [n=02, 2.3%]. Majority of the patients [n=52, 60.4%] were only required antibiotic, pain killer and advice on foot care while 34 [39.5%] patients were advised for wicking. In our study, the success rate of conservative treatment remained 92.85% [n=65] at one year follow up. Ingrown toe nail is quite common condition. In early stage, it can be safely treated by conservative methods, if applied properly, which avoid disfigurement and train the patients to care for their own toes

Etiological factors and treatment outcome of genital and perineal necrotizing fascitis [Fournier's gangrene]

To analyze clinical and laboratory parameters in patients with Fournier's gangrene [FG] and to assess factors that determine mortality. A retrospective review of 82 patients with FG from January 2007 to December 2011 was made. They were divided into two groups: those who survived [survivors] and those who did not [non survivors]. We analyzed clinical and laboratory data. The mortality rate remained 36.6% [30/82 patients]. Increased heart and respiratory rates, elevated serum creatinine, pre-existing kidney disease, and higher extent of affected body surface were associated with higher mortality. Severe sepsis on admission and hypotension < 90 mm Hg] were also predictive for higher mortality. The median FG severity index [FGSI] score was higher in non survivors [22 vs 12, p < 0.0001]. Besides standard clinical and laboratory parameters included in the FGSI calculation, higher extent of affected body surface area and presence of hypotension on admission were positively associated with mortality. Early clinical identification and prompt aggressive treatment are essential for reducing mortality and morbidity in patients

Abdominal tuberculosis: varied presentations

To study various clinical presentations and out come of management of abdominal tuberculosis. Prospective cross-sectional study. This study was conducted at the Surgical Unit-1 Ghulam Mohammad Maher Medical College Hospital Sukkur and Al-Khair Hospital Sukkur from January 2007 to December 2010. The 65 patients admitted throughout patient department and emergency with abdominal catastrophes. Ages ranged between 14 to 70 years. Out of 65 patients 37 were males and 28 were females. All the patients were evaluated with history, examination and investigations. 34 patients were operated and the resected tissue sent for histopathology to conform the diagnosis of tuberculosis. Out of 65 cases of abdominal tuberculosis, 37 were male and 28 female. The mean age was 30.9 years with SD 14.19 [range 14 to 70 years]. The mean duration of symptoms at presentation was 6 months [range 1 month to 24 months]. 35 [52.3%] out of 65 patients were admitted with different complications in which 10 [29.4%] presented with peritonitis due to gut perforation, 9 [26.5%] with sub-acute intestinal obstruction, 8 [23.5%] with abdominal mass, 5 [14.7%] with acute appendicitis and 2[5.9%] with umbilical fistula. Surgery was performed in all these patients, Stricturoplasty done in 13 [38.3%], Ileostomy in 8 [23.5%], resection anastomosis in 5[14.7%], Right Hemicolectomy in 5 [14.7%] and adhesionolysis and biopsy in 3 [8.8%] patients. Diagnosis in these patients was confirmed with biopsy. Morbidity and mortality in this group was 40.2% and 17.6% respectively. Early diagnosis of the abdominal tuberculosis is possible only by the specific investigations like PCR. As these are not available in the remote areas of Sindh so the general surgeons in the peripheral tertiary care hospitals have to face such patients with complications. Early diagnosis of ATB can be made by high index of clinical suspicion to symptoms of abdominal pain, weight loss, low grade fever and vague ill health of more than one month duration and refractory to conventional treatment associated with raised ESR, positive Montoux test. To above symptomatology if empirical ATT is started early many of the complications of ATB can be avoided

see the gross qualitative parameters such as general appearance of rats and their testes after long and short term use of sildenafil citrate

To see the gross qualitative parameters such as general appearance of rats and their testes after long and short term use of Sildenafil Citrate. As very little attention has been given to explore the effects of a sildenafil citrate on histological aspects of testes, hence this experimental study was designed to check whether the drug which is being used indiscriminately in our country and abroad is safe or it has any harmful effect on the architecture of rat testis. Experimental Study. This study was conducted in departments of Anatomy and Histopathology Shaikh Zayed Hospital Lahore for a period of six weeks from 02.05.2008 to 17.06.2008. Sample size consisted of 45 animals, divided into Group A [Control], Group B and C [Experimental], Each group was consisting of 15 animals. Physical examination of rats and their testis was done every day by the author himself and recorded. After giving drug, on inspection of rats all the animals were active and healthy and the gross appearance of the testes was normal except in an animal, in which the testes were smaller than the associates of the same group. Eating habits of all the animals were normal, taking food and water freely. After half an hour of giving the drug, they were mounting over each other and looked aggressive. The comparison of all the groups, A vs B, A vs C and B vs C remained statistically non -significant [P>0.05]. No significant difference was observed in qualitative parameters [general appearance] of the rats and their testes after giving sildenafil citrate

Frequency of malignancy in clinically benign open transvesical prostatectomy- a study of 100 cases

Enlargement of prostate can be benign and malignant. Though differentiation between the two can be made on clinical grounds and surgery but still some cases can be missed if not subjected to histopathology. To find out the frequency of malignancy in patients operated for clinically benign open transvesical prostatectomy. Study type settings and duration: It was a prospective observational study conducted in the Department of surgery [Surgical Unit-I], Ghulam Muhammad Mahar Medical College and Hospital, Sukkur from January 2011 to December 2011. Patients presented with the history of prostatic symptoms were evaluated in surgical out-patient's department using digital rectal examination and ultrasound. The findings were recorded in a proforma and those having enlarged prostate weighing above 40gm underwent prostate specific antigen testing. Patients having no malignant findings on history, digital rectal examination and whose prostate specific antigen levels were below 10 ng/dl underwent open transvesical prostatectomy and all specimens were sent for histopathology. Those with suspicion of malignancy either on history or digital rectal examination or high prostate specific antigen were excluded from the study, also the glands below 40 gm in volume were excluded and referred for transurethral resection. All specimens were sent for hisopathology. Out of 100 cases, 41 were between 56 to 65 years of age. The mean age was 58 years. Acute urinary retention requiring catheterization was seen in 36 cases while 18 patients had symptoms suggestive of inguinal hernia but on examination had enlarged prostate. Prostate specific antigen was done in 07 patients with suspicion of malignancy but its value was below 10 ng/dl therefore they were included in the study. On ultrasound the gland volume ranged from 40 to 85 gm and residual post-voidal urinary volume ranged from 100 to 450ml. On histology 06 patients were found to have adenocarcinoma of prostate including 01 patient in whom mucosa of the gland was fixed but as the prostate specific antigen was below 10 ng/dl so the patient was kept in study group. Gleason score ranged from 4 to 9. Direct rectal examination is not a reliable test to detect early malignant changes in prostate and all specimens should be subjected to histopathology. Policy message: Histopathology of all operated and biopsied materials should be done to complete diagnosis

Laparoscopic cholecystectomy: an experience of 550 cases at Sukkur

To see the results and complication rate of Laparoscopic cholecystectomy at Sukkur. Prospective Study. This study was conducted at Ghulam Mohammad Mahar medical College Hospital Sukkur and Sukkur Blood Bank Hospital from December 2004 to December 2009. The study comprises of 550 case. All were admitted from OPD of both hospitals. All patients had routine investigations, Liver function tests and ultrasound abdomen. The patients who underwent laparoscopic cholecystectomy whether successful or converted were included in study. The procedure was carried out by standard four port technique. Clinical examination, investigations, operative time, postoperative complications, reasons for conversion and hospital stay were recorded on proforma and results were drawn. The male patients were 100 and female patients were 450, male to female ratio was 1:4.5. Mean age of patients were 47.63 years ranging from 25 years to 75 years there were 127 [23.09%] obese, 72 [13.90] controlled hypertensive. Anatomical obstacle noted in 40 [7.27%] patients. Adhesions in 52 [9.45%] and acute cholecystitis in 22 [3.75%] patients. Overall conversion rate was 4%. In total of 22 patients which were converted, causes were slipped clip, 2 hemorrhage from falciform ligament 1, severe hemorrhage 3, unclear anatomy 6, common bile duct injury 4, intra abdominal adhesions 4, gangrene gall bladder 1, and advance carcinoma 1. mean hospital stay was 1.8, ranges from 1 day to 10 days. Laparoscopic cholecystectomy has a gold standard procedure. It is safe and effective and becoming cost effective day by day. Incidence of complication is low, morbidity and mortality are low. The pain free postoperative period and early ambulation lead to saving of value able working hours

Effectiveness of ablative partial nail excision with phenolization in advanced stage onychocryptosis [ingrown toe nail]

To determine the effectiveness of ablative partial nail excision with phenolization in advanced stage onychocryptosis [ingrown toe nail]. Study type, settings and duration: An interventional study carried out at Department of Surgery, Ghulam Muhammad Mahar Medical College, Teaching Hospital, Sukkur from January 2009 to December 2009. Patients coming to the surgical department with advanced stage [stage-II and III] or recurrence of ingrown toe nail were included in the study. Patients with stage-I disease, diabetics, with trauma and vascular causes were excluded. All patients were operated as day cases with partial nail excision and chemical ablation with phenol. Results: A total of 56 patients underwent the procedure. There were 44[78.5%] males and 12[21.4%] females. Forty six patients were operated for the first time while 8[14.2%] patients were recurrent cases who were operated previously elsewhere. Post operatively and after chemical ablation, 41[73.2%] patients showed improvement with quite good pain relief and reduced swelling on third day, 15[26.7%] patients improved in two weeks. At 2 months 22[39.2%] patients were lost to follow up. Recurrence was observed only in 7[12.5%] patients after four and a half months. Delayed wound healing for upto three weeks was noticed in 3[5.3%] patients while moderate to severe pain requiring strong analgesics for one month was seen in 6[10.7%] patients. Majority of patients n=36 [64.2%] became symptoms free in 10 days. Partial nail excision with phenolization is a simple and effective procedure with low recurrence rates for patients with advanced ingrown toe nail

Abdominal tuberculosis: varied presentations

To study various clinical presentations and outcome of management of abdominal tuberculosis. This prospective study was conducted in the Surgical Unit-1 Ghulam Mohammad Maher Medical College Hospital Sukkur and Al-Khair Hospital Sukkur, from July 2006 to June 2009. The 65 patients admitted through out patient department and emergency with abdominal catastrophes. Ages ranged between 14 to 70 years. Out of 65 patients 37 were males and 28 were females. All the patients were evaluated with history, examination and investigations. 34 patients were operated and the respected tissue sent for histopathology to conform the diagnosis of tuberculosis. Out of 65 cases of abdominal tuberculosis, 37 were male and 28 female. The mean age was 30.9 years with SD 14.19 years [range 14 to 70 years]. The mean duration of symptoms at presentation was 6 months [range 14 month to 24 months]. 34 [52.3%] out of 65 patients were admitted with different complications in which 10 [29.4%] presented with peritonitis due to gut perforation, 9 [26.5%] with sub-acute intestinal obstruction, 8 [23.5%] with abdominal mass, 5 [14.7%] with acute appendicitis and 2 [5.9%] with umbilical fistula. Surgery was performed in all these patients, Stricturoplasty done in 13 [38.3%], Ileostomy in 8 [23.5%], resection anastomosis in 5 [14.7%], Right Hemicolectomy in 5 [14.7%] and adhesionolysis and biopsy in 3 [8.8%] patients. Diagnosis in these patients was confirmed with biopsy. Morbidity and mortality in this group was 40.2% and 17.6% respectively. Early diagnosis of the abdominal tuberculosis is possible only by the specific investigations like PCR. As these are not available in the remote areas of sindh so the general surgeons in the peripheral tertiary care hospitals have to face such patients with complications. Early diagnosis of ATB can be made by. high index of clinical suspicion to symptoms of abdominal pain, weight loss, low grade fever and vague ill health of more than one month duration and refractory to conventional treatment associated with raised ESR, positive Montoux test. To above symptomatology if empirical ATT is started early many of the complications of ATB can be avoided