To evaluate povidone-iodine effect on post appendectomy surgical site infection

Objective: Evaluating the effects of Povidone- Iodine against the surgical site infection in post- appendectomy wound infection

Study design: Randomized clinical trial

Place and duration: Department of Surgery, Isra University Hospital Hyderabad from January 2016 to December 2017

Subjects and Methods: Patients of acute appendicitis with classical clinical presentation were selected according to inclusion and exclusion criteria. 60 patients were those in which wound was irrigated with 1% povidone-iodine solution versus 60 patients in whom wound not irrigated with it before skin closure. Data was analyzed on SPSS 22.0 using Student t-test and Chi- square test respectively. Data was analyzed at 95% confidence interval [P=0.05]. P-value of =0.05 was taken statistically

Results: Mean +/- SD age of control and cases was noted as 22.5 +/- 7.5 and 23.5 +/- 6.5 years respectively [P=0.86]. Male and female population in control and cases were noted as 45 [75%] and 15 [25%] and 47 [78.33%] and 13 [21.66%] respectively [P >0.05]. Grade 4 pus discharging wound infection was noted in 3.33% in control compared to 1.66% in cases [P= 0.87]. Normal wound healing [grad 0] was noted in 37 [61.6%] and 43 [71.6%] of control and cases respectively. In control grade 1-4 lesions were noted in 38.4% compared to 28.4% in cases [P < 0.05]

Conclusion: Simple irrigation of appendectomy wound with 1% povidone- iodine significantly prevents against the surgical site infection and pus formation

Antibiotic prophylaxis in preventing surgical site infection in patients undergoing lichtenstein's hernioplasty

Objective: To determine the antibiotic prophylaxis in preventing surgical site infection in patients undergoing Lichtenstein's hernioplasty

Study design: Observational study

Place and Duration: Department of surgery, ISRA University Hospital, Hyderabad. from December 2015 to March 2017

Materials and Methods: 120 cases of inguinal hernia planned for Lichtenstein's hernioplasty were selected according to exclusion criteria and divided into control and antibiotic group. Pre- operative patient history, physical examination and inguinal hernia examination was performed. Prophylactic antibiotic ceftriaxone [1000 mg] was given over night of surgical procedure. Statistical software SPSS 21.0 was used for data analysis at 95% CI [P <0.05]

Results: Mean+/- SD age was noted as 39.51 +/- 7.56 years [15 – 61 years]. Of 120, who underwent Lichtenstein's hernioplasty the direct and indirect hernias were noted in 35 [29.16%] and 33 [27.5%] and 25 [20.83%] and 27 [22.5%] of control and antibiotic groups respectively. Of 120 subjects, the SSI was noted in 17 [14.1%] in control and 5 [4.16%] in antibiotic group. Cumulative SSI in 120 cases was 22 [18.33%]

Conclusion: The present study reports low incidence of surgical site infection with antibiotic prophylaxis in Lichtenstein's mesh repair in open inguinal hernioplasty

Frequency of post-operative hypocalcaemia following thyroid surgery at a tertiary care hospital of Sindh

Objective: The present study was conducted to determine the frequency of post-operative hypocalcaemia following thyroid surgery at a tertiary care hospital of Sindh Study design: Observational study Place and Duration: Department of surgery, Isra University Hospital from December 2014 to July 2017

Materials and Methods: 100 cases of thyroid swellings were selected according to inclusion and exclusion criteria. Pre- operative patient history, physical examination, thyroid gland examination and laboratory investigations were performed. A serum calcium levels < 0.05] was considered significant

Results: Of 100 patients, 67% were female and 33% were male [P=0.0001]. Female dominancy was noted with female to male ratio of 2.03:1. Age [mean+/- SD] was noted as 37.5 +/- 9.5 years [19 - 48 years]. Frequency of symptomatic hypocalcaemia was noted in 23% subjects post operatively. Mean+/- SD serum calcium and phosphate in post operative hypocalcemia subjects was noted as 7.31 +/- 0.38 mg/dl and 2.95 +/- 0.63 mg/dl respectively. Majority of symptomatic hypocalcemia were noted within 72 hours post operatively

Conclusion: The present study reports 23% frequency of post thyroidectomy hypocalcemia noted within 72 hours post operatively. Goiters of long duration, recurrent goiters, hyperthyroidism and goiters with retro sternal extensions were found risk factors for the post thyroidectomy hypocalcemia

Thyroid function test, C- reactive protein and blood lipids in subclinical hypothyroidism patients reporting at surgical wards

Objective: To investigate the thyroid function, C-reactive protein [CRP] and blood lipid profile in the subclinical hypothyroidism [SH] patients in surgical wards and outpatient department. Study design: Cross sectional study Place and Duration: Department of surgery, Isra University Hospital from August 2014 to May 2017

Materials and Methods: 100 subclinical hypothyroid cases and 100 controls were included according to inclusion and exclusion criteria. Serum TSH level > 6.2 [microIU /ml] with normal free T4 and T3 was considered as subclinical hypothyroidism. Venous blood was taken from ante cubital vein, centrifuged and processed. Sera were used for the assay of thyroid hormones, TSH, blood lipids and C-reactive protein. Data variables were analyzed by Statistix 8.0 [95% confidence interval] [P-value =0.05]

Results: Age in controls and cases was noted as 51.3+/-12.5 and 50.8+/-11.95 years respectively. SH cases show serum T3, T4 and TSH as 0.89+/-0.18 microg/dl, 4.96+/-0.85 microg/dl and 11.95+/-2.85 microU/ml respectively. Serum total cholesterol, triglycerides and LDLc were raised with concomitant low HDLc in SH cases. C- reactive protein in SH cases was 6.91+/-3.38 ng/ml compared to controls 2.56+/-1.51 ng/ml [P=0.0001]. Serum TSH showed negative correlation with HDLc, serum T3 and T4

Conclusion: The present study reports dyslipidemia with elevated inflammatory marker of C-reactive protein in subclinical hypothyroid patients

Blood transfusion is associated with increase resource utilization and bacterial infection

To observe the association of blood transfusion and clinical outcome in cardiac surgery patients. Forty patients underwent cardiac surgery during a period of two months in a single institution. Coronary artery bypass surgery [CABG] was performed in 21 [52.5%] patients, Mitral valve replacement [MVR] in 15 [37.5%] patients, aortic valve replacement [AVR] in 2 [5%] patients and Atrial septal defect [ASD] was closed in 2 [5%] patients. The mean age of the patients were 41.7 +/- 18 years, 80% were male. Twenty five [62.5%] patients required blood transfusion. Transfusion group showed chest wound infection [7.5%], pulmonary oedema [12.5%] and shortness of breath [10%]. Total leukocyte count and platelets count were significantly lower in transfusion group. We conclude that blood transfusion is associated with increased rate of infection and pulmonary oedema, with high cost and resource utilization. Blood transfusion should be used with appropriate caution