Assessment of predictor variables and clinical consequences associated with surgical site infection in tertiary care setting, Karachi, Pakistan

Among the well-known Health care-associated infections [HAIs], surgical site infections [SSIs] contribute to considerable high mortality and morbidity rate, substantial prolongation in hospitalization period and extra expenses in terms of treatment cost. This study was aimed to evaluate the predictive variables associated with surgical site infections, and their clinical consequences. This was a prospective, cross sectional study conducted in the surgical department of tertiary care setting in Karachi, Pakistan. Each patient was followed up from the time of admission until time of the discharge postoperatively for 30 days. A total of 554 surgical procedures were performed and 81 SSIs were identified. The predictor variable/risk factors significantly associated with the presence of SSI were age, gender, BMI, ASA score, co-morbid condition, surgical wound class, emergency surgeries, duration of surgery, type of anesthesia, prosthetic implant, pre operative length of stay and pre operative blood transfusion. Outcomes of such studies may be utilized in the design of a multi factorial practice to get better patient's safety and clinical outcomes

Diagnostic accuracy of Ultrasound B scan using 10 MHz linear probe in ocular trauma; Results from a high burden country

Objective: To study the diagnostic accuracy of Ultrasound B scan using 10 MHz linear probe in ocular trauma

Methods: A total of 61 patients with 63 ocular injuries were assessed during July 2013 to January 2014. All patients were referred to the department of Radiology from Emergency Room since adequate clinical assessment of the fundus was impossible because of the presence of opaque ocular media. Based on radiological diagnosis, the patients were provided treatment [surgical or medical]. Clinical diagnosis was confirmed during surgical procedures or clinical follow-up

Results: A total of 63 ocular injuries were examined in 61 patients. The overall sensitivity was 91.5%, Specificity was 98.87%, Positive predictive value was 87.62 and Negative predictive value was 99%

Conclusion: Ultrasound B-scan is a sensitive, non invasive and rapid way of assessing intraocular damage caused by blunt or penetrating eye injuries

Intestinal obstruction caused by postoperative adhesions: 5 years'experience at a teaching hospital

Objective: The objective of this study was to determine the common abdominal surgical procedure causing postoperative adhesive intestinal obstruction, and outcome of its surgical management

Study Design: Retrospective as well as prospective analysis

Place and Duration of Study: This study was conducted in the Department of Surgery, Khawaja Muhammad Safdar Medical College, Sialkot from June 2010 to November 2015

Materials and Methods: Patients operated on for intestinal obstruction with at least one abdominal surgical scar were included in the study. A total of 152 patients were eligible, all ages were eligible irrespective of gender. A minimum of 6 months follow up was set for inclusion in the study. Patients with intestinal obstruction presenting with surgical scars for renal, ureteric and urinary bladder surgery were not included as these surgeries did not involve opening of peritoneum. Patients with Crohn's disease, ulcerative colitis, known malignancies, a past history of abdominopelvic irradiation were excluded. Patients with less than 6 months follow up were excluded from the study

Results: Out of 152 patients, 74 [48.68%] surgeries for appendicular pathologies, 18 [11.84%] lower segment caesarean section and 9 [5.92%] total abdominal hysterectomy were the main pathologies causing obstruction; while patients had recurrence in 11[7.23%] and 8[5.26%] mortality

Conclusion: Operated adhesive postoperative intestinal obstruction proves to be a clinical entity with high incidence and specific risk factors of recurrence: age <40 years, presence of adhesion or matted adhesion, and postoperative surgical complications. Infected cases of appendicitis, enteric perforations, lower segment caesarean section and total abdominal hysterectomy are the main causes and the treatment may lead to stoma formation, recurrence and mortality

Intrapleural streptokinase in management of complicated parapneumonic effusion and empyema

We report our study of the use of intrapleural streptokinase [IPSK] in ten patients with multiloculated complicated parapneumonic effusion and empyema who had failure of conservative first line of treatment with antibiotics and intercostal tube drainage. In order to break the multiple loculi and facilitate tube drainage, we instilled intrapleurally streptokinase 250,000 units diluted in 100 ml of 0.9% saline. All our patients showed improved fluid drainage after IPSK. Five patients experienced clinical and radiological resolution. IPSK therapy was unsuccessful in the remaining five, who then underwent successful surgical intervention

burden of anxiety and depression among patients with chronic rheumatologic disorders at a tertiary care hospital clinic in Karachi, Pakistan

To study the burden of anxiety and depression as a comorbid among patients of chronic rheumatological disorders and to investigate possible determinants of depression and anxiety. It was a cross-sectional study conducted at the rheumatology clinic of The Aga Khan University Hospital [AKUH] Karachi, Pakistan. With convenient sampling, 111 patients who fulfilled inclusion/exclusion criteria were screened for anxiety and depression with help of Aga Khan University Anxiety and Depression Scale [AKUADS]. The data was entered and analyzed by Statistical Package for Social Sciences [Version 10.0]. The population consisted mainly of middle aged [mean age 41] females [80.2%]. The most common diagnosis was rheumatoid arthritis 57% followed by systemic lupus erythmatosis 17% and systemic sclerosis 9%. The permanent joint deformity was present in 33.3% patients and 36.9% patients were suffering from active disease with pain and inflammation. The frequency of anxiety and depression was 65.8%. Educational qualification, permanent joint deformity, active inflammation and time elapsed since diagnosis had significant association with anxiety and depression. Marital Status, gender, economic activity and monthly family income had no effect on the frequency of anxiety and depression. Almost two third of patients with chronic rheumatological disorders, also suffered from a concomitant mood disorder. Systematic evaluation of all patients for mood disorders and psychological distress in rheumatology clinics is highly recommended

Characteristics and outcome of chest pain in young adults

To estimate the frequency of acute coronary syndrome [ACS] at 30 days in patients less than 40 years of age reporting with acute chest pain in Emergency Department [ED]. Prospective cohort study. Emergency Department [ED] of Aga Khan University Hospital, Karachi between July to December 2002. Patients and One hundred young patients with chest pain in whom an electrocardiogram [ECG] was performed. A standardized data collection form was completed. Physical examination included initial vital signs and presence or absence of jugular venous pressure [JVP], rales, or fourth heart sound. Outcome variables were seen in the patients admitted or discharged within 30 days of reporting to the ED. Out of one hundred young patients in the study, 24 had an ACS. Of those, 22 [91.66%] were males and their mean age was 35 years. Most of these patients had cardiac risk factors on physical findings. The final diagnosis of patients consisted of 47 patients with atypical chest pain, 20 with acute myocardial infarction [AMI], 16 with musculoskeletal chest pain, 7 with psychogenic chest pain, 4 with angina, 4 with others and 2 with gastritis. Young patients, presenting to ED with chest pain, had a greater likelihood of suffering from ACS if they were male and between 30 to 40 years of age. People of any age group, presenting to ED with chest pain should not be disregarded in the presence of cardiac risk factors and positive physical findings

Ventricular tachycardia: a hospital perspective

To describe the etiology and outcome in patients with ventricular tachycardia in our patient population. A descriptive study. The study was conducted at the Aga Khan University Hospital from November 2002 to October 2003. Subjects and We enrolled 58 patients who presented to the emergency room with clinical and electrocardiographic evidence of ventricular tachycardia [VT] and/or who developed it during the inpatient stay at the Aga Khan University Hospital. Medical records were retrieved through the computerized data retrieval system. Patients above 18 years of age were included. Those with a pacemaker or who developed VT during electrophysiological testing were excluded. A pre-designed proforma was filled for all patients who fulfilled the inclusion criteria. All patients were worked up for etiological causes of ventricular tachycardia. Outcomes in the form of death or discharge were recorded. There were 58 patients who suffered ventricular tachycardias during the study period. These included 70.7% [42] males and 29.3% [16] females. Mean age of the patients was 57.06 +/- 11.84 years. Emergency room admissions accounted for 55.2% and ventricular tachycardia was seen in 44.8% during the inpatient stay. Unresponsiveness was the presenting symptom in 25.9%, chest pain in 24.1%, palpitations in 13.8% and ghabrahat in 12.1% patients. Myocardial ischemia was seen in 43.5% of the patients while 23.2% had cardiomyopathy, followed by 33.3% miscellaneous. Out of the patients who had myocardial ischemia [43.5%], 76.6% had non-ST elevation myocardial infarction, 20% patients had ST elevation myocardial infarction and 3.3% had unstable angina. Hemodynamic instability was noted in 50%, who subsequently required defibrillation. The mortality among these patients with VT was 13.7%. Myocardial ischemia was most commonly seen in patients with ventricular tachycardia in our group of patients. Ventricular tachycardia is associated with a significant mortality of 13.7%