ABSTRACT
Objective: To find out risk factors of heart failure after ST Elevation Myocardial Infarction [STEMI] and to see the most commonly involved vessels in myocardial infarction responsible for heart failure
Methodology: This cross-sectional study was conducted from June 2013 to November 2013. 225 patients of heart failure [HF] following STEMI who came in the emergency department of the hospital were included. The selected patients were followed till the angiography reporting. Statistical analysis was done in SPSS version 16
Results: Mean age of patients was 51.42 +/-11.78 years. 49.0% patients were hypertensive, 37.3% patients were diabetic, 44.0% were smokers and 18.2% had positive family history. In this study, anterior wall MI was predominant and found in 30.7% patients. 46.7% patients had triple vessel disease [TVD]. There was 33.7% involvement of Left main stem [LMS]
Conclusion: Hypertension and smoking are most common risk factors of heart failure. The patients who present with heart failure are most who have involvement of triple vessel coronary artery disease. Left main stem [LMS] is most commonly involved vessel in these patients
ABSTRACT
Objective: To determine the frequency of post-operative pulmonary complications [PPCs] after cardio-pulmonary bypass and association of pre-operative and intraoperative risk factors with incidence of PPCs
Methods: This study was an observational analysis of five hundred and seventeen [517] patients who underwent cardiac surgery using cardiopulmonary bypass. Incidence of PPCs and risk factors of PPCs were noted. Logistic regression was applied to determine the association of pre-operative and intraoperative risk factors with incidence of PPCs
Results: Post-operative pulmonary complications occurred in 32 [6.2%] patients. Most common postoperative pulmonary complication was atelectasis that occurred in 20 [3.86%] patients, respiratory failure in 8 [1.54%] patients, pneumonia in 3 [0.58%] patients and acute respiratory distress syndrome in 1 [0.19%] patients. The main risk factor of PPCs were advance age > 60 years [odds ratio 4.16 [1.99-8.67], p-value <0.001], prolonged CPB time > 120 minutes [odds ratio 3.62 [1.46-8.97] p-value 0.003], pre-op pulmonary hypertension [odds ratio 2.60 [1.18-5.73] p-value 0.016] and intraoperative phrenic nerve injury [odds ratio 7.06 [1.73-28.74], p-value 0.002]. Operative mortality was 9.4% in patients with PPCs and 1.0% in patients without PPCs [p-value 0.01]
Conclusion: The incidence of post-operative pulmonary complications was 6.2% in this study. Advanced age [age > 60 years], prolonged CPB time [CPB time > 120 minutes], pre-op pulmonary hypertension and intraoperative phrenic nerve injury are independent risk factors of PPCs after surgery
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Aged , Aged, 80 and over , Postoperative Complications , Lung Diseases/epidemiology , Risk Factors , Incidence , Logistic Models , Respiratory InsufficiencyABSTRACT
Objective: To confirm that either Fibrinolytic therapy or open decortication which of the two is an effective First line treatment of pleural empyema
Methods: This prospective comparative study was conducted in the department of surgery Sheikh Zayed Medical College and Hospital, Rahim Yaar Khan. Seventy eight [78] patients were included in this study. There were two groups of patients; Group I [n=35] patients treated with fibrinolytic therapy, Group II [n=43] patients treated with open decortication. Data was entered and analyzed in SPSS v16. Student's t-test was used for comparison of quantitative variables. Chi-square and Fisher's Exact test were used for comparison of qualitative variables. P-value
Results: There was no significant difference in base baseline characteristics of patients of Group I and II. Incidence of comorbidities was also same between the groups. Most of the patients in Group I and II were in empyema stage III. Fluid cultures was positive in 33 [94.3%] patients in group I and 39 [90.7%] patients in group II. 30 [85.7%] was successfully treated using fibrinolytic therapy but this therapy failed in five [14.3%] patients, two of these patients expired within the hospital. There was only one [2.3%] treatment failure in open decortication Group that patient expired within the hospital [p-value 0.04]. Overall duration of hospitalization was significantly high in fibrinolytic group, this was 17.6 +/- 1.95 days versus 12.09 +/- 2.18 days in open decortication group [p-value <0.0001]. There was no significant difference regarding operative mortality within the two groups
Conclusion: Open Drainage is associated with better outcomes as compared to fibrinolytic therapy when used as a First line treatment of empyema
ABSTRACT
Objective: To compare the rate of complications of Plastibell and bone cutter circumcision technique and recognition of top worries and satisfaction rate in the mind of parents before and after the procedure of Plastibell device [PD] circumcision in infants less than 6 months of age
Methods: It was a descriptive prospective study conducted at department of surgery Sheikh Zayed Hospital, Rahim Yar Khan. Two hundred parents of infants of less than six months of age were recruited for this study. Infants were divided into two equal groups. Group I included Plastibell circumcision technique and Group II included Bone Cutter Circumcision technique. Data was analyzed using SPSS Version 17. Independent sample t-test and chi-square test was used to compare quantitative and qualitative variables respectively. P-value <0.05 was taken as significant difference
Results: Total number of two hundred infants were included in this study. Most common worries of parents about Plastibell Device circumcision were; fear of fever [42.0%]. Fear of pain and bleeding [66.0%]. Plastibell Device method was associated with less operation time and bleeding as compared to bone cutter method [P-value <0.0001 and <0.0001 respectively]. Incidence of complications other than bleeding and infection was 3.0% in bone cutter method and 1.0% in Plastibell device method. Pain score was significantly less in plastibell device group [p-value <0.0001]. Post-operatively, 98% parents showed complete procedural satisfaction in Plastibell group versus 87% parents in bone cutter one month after surgery [P-value 0.003]. About 4% parents in bone cutter method group showed cosmetic displeasure versus only 1% parents in plastibell device group
Conclusion: The study concluded that Plastibell Device circumcision is a safer technique for circumcision and is associated with highest level of parent's satisfaction
ABSTRACT
Objectives: To see the early post-operative outcomes of off-pump versus on-pump coronary artery bypass graft surgery
Methods: This retrospective analytical study was conducted at Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Our Primary outcome variables were; necessity of inotropic support, nonfatal myocardial infarction, ICU stay, nonfatal stroke, new renal failure requiring dialysis and death within 30 days after operation. There were two groups of patients; Group-1 [On-pump group] and Group-11 [Off-pump Group]. SPSS V17 was used for data analysis. Independent sample t-test and Mann Whitney U test were used to compare quantitative Variables. Chi-square test and Fisher's exact test were used to analyze qualitative variables. P-value < 0.05 was considered significant
Results: Three hundred patients were included in this study. There were no significant difference regarding risk factors except hyper-cholestrolemia which was high in off pump group [p-value 0.05]. Angiographic and Echocardiographic characteristics e.g. preoperative ejection fraction, LV function grade and severity of CAD was same between the groups. Mortality risk scores and Priority status for surgery were also same. Regarding post-operative outcomes; Post-op CKMB Levels, need and duration of inotropic support, mechanical ventilation time and ICU stay was significantly less in Off-Pump group [p-value 0.001, <0.0001, 0.006, 0.025 and 0.001 resp.]. Peri-operative chest drainage was significantly high in On-pump CABG group [p-value 0.027]. Incidence of post-op complications was not statistically different between the groups
Conclusions: At 30 days follow-up, Incidence of myocardial infarction, necessity and duration of inotropic support, ICU stay period and peri-operative bleeding were significantly less in off-pump group. The incidence of neurologic, pulmonary and renal complications was same between the off-pump and on-pump groups
ABSTRACT
Background: Burns are a major source of morbidity and mortality and their incidence is high in the Easter Mediterranean region, including Pakistan. Appropriate measures to prevent burns require adequate knowledge of the epidemiological characteristics and associated risk factors, which may vary among communities
Objectives: To investigate the epidemiological features of patients of burns in Rahimyarkhan, and based on these findings appropriate measures will for prevention of burns
Study design and duration: This was a descriptive study conducted from Feb to Sep, 2010
Patients and Methods: This study was conducted in the Burn Unit of Sheikh Zayed Hospital, Rahim Yar Khan. All the burn patients were included in the study. Data regarding age, sex, causative agents, body parts involved, geographical origin, mode and nature of injury and outcome were obtained from the hospital record. Analysis was done with SPSS version 14.0
Results: Total victims were 109 [56 males, 53 females]. Age ranged from 7 months to 70 years [mean 14.30+/- 4.31 years]. Children <10 years were 53[48.6%], 11-20 years were 19 [17.43%] and 21-70 years were 37 [33.9%]. 65 were from rural areas and 44 from urban. 67 [61.41%] cases were caused by flame, 31[28%] by hot liquids, 8 [7%] by electricity, 3 [2.7%] by chemicals. 107 were accidental and 2 suicidal. 85 healed completely, 16 had complications and 8 expired
Conclusion: By using safe kitchen appliances, majority of all burn accidents can be prevented. Measures should be taken to launch a public health education campaign that will reduce the incidence of these fatal casualties
ABSTRACT
Hirschsprung's Disease is one of the most common congenital anomalies that Pediatric Surgeons manage. In spite of the various modifications of pull through procedures available, the long term functional results are less than ideal. However, Modified Duhamel Procedure is one which has relatively good functional results and that is the reason we have selected this procedure for Hirschsprung's disease in Sheikh Zayed Hospital, Rahim Yar Khan. To evaluate the outcome of patients after Modified Duhamel Procedure for Hirschsprung's Disease. This is case series study. Department of Pediatric Surgery Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Seventeen cases were studied over a period of two year i.e. from November 2006 to December, 2008. Seventeen [1 7] cases from both sexes were operated for Hirschsprung's Disease over a period of one year and Modified Duhamel Procedure was adopted for all these cases. All patients were diagnosed cases of rectosigmoidal aganglionosis and follow up was done over a period of one year according to a comprehensive Proforma. Four parameters like normal stool evacuation, abdominal distension, soiling and stool incontinence were followed and then the results were compared with other national and international studies. Fever 19.4% [n=04], wound infection 19.4% [n=04], vomiting 9.52% [n=02], abdominal distension 4.76% [n=01], and bleeding per rectum 4.76% [n=01], were the immediate post operative complications. Fourteen patients [82.35%], used to pass stool once daily. Abdominal distension was observed occasionally in six patients [28.57%]. Soiling was seen in five patients [29.41%]. Out of Seventeen, stool incontinence was seen in only three patients [1 7.64%]. Modified Duhamel Procedure with the help of linear cutter stapler device is quite safe, easy and less time consuming. Infact Modified Duhamel is a procedure of choice for Hirschsprung's Disease