ABSTRACT
Healthcare network is composed of primary, secondary and tertiary care centers. Purpose of each unit in this sophisticated zone is to allow steady and smooth delivery of healthcare to optimum level without wasting essential resources or time. If, primary care centers are not able to fulfill the needs of any health issues then, patients are referred to more advanced setup where their health issues can be timely addressed in a proficient way. Referral system forms an important component of healthcare network and it should be formulated in such a way that it can bring fruitful results with the proper use of time, energy, man force as well as technical resources without compromising patient’s health. In this paper, we discussed the core of healthcare network in the city, working with primary as well as referral health care centers, flaws affecting the referral system and recommendations to improve them.
ABSTRACT
Objective: To compare the laparoscopic inguinal hernia repair with Lichtenstein repair in terms of hospital stay and postoperative pain
Study design: Randomized clinical trial
Place and Duration of study: Department of Surgery Services Hospital Lahore, from September 2013 to May 2014
Methodology: Inguinal hernia patients were admitted electively. They were randomly assigned into groups A and B. The group A patients were treated with laparoscopic total extraperitoneal repair [TEP] and group B patients underwent Lichtenstein's repair. Patients were evaluated for 24 hours discharge rate and postoperative pain
Results: A total of 100 patients were included with 50 patients in each group. Group A patients had short hospital stay [discharged within 24 hours - 68.08%] as compared to group B [31.91% -p <0.001]. From 2[nd] to 6[th] postoperative week group A patients had significantly less postoperative pain as compared to group B [p <0.05]
Conclusion: Laparoscopic TEP repair was safe with early hospital discharge and less postoperative pain
ABSTRACT
To describe the appropriate management of women with postmenopausal bleeding [PMB]. Descriptive study in one year [Jan - Dec, 2012]. All patients with postmenopausal bleeding in one year were investigated and managed. Basic investigation was trans-vaginal sonography. Those with endometrial thickness more than 4 mm were further investigated by dilatation and curettage, then management strategy was planned according to the cause. A total of 23 patients were presented with postmenopausal bleeding [endometrial thickness > 4 mm] during one year. Among them 11 case were having first episode and the remaining had recurrent bleeding. Endometrial hyperplasia [simple] was the common pathology [52%], in whom surgical management [hysterectomy] was performed in 60% cases. Three cases [13%] were managed with MIRENA [levonorgestrel releasing intrauterine system]. Two case were diagnosed as endometrial carcinoma. Both of them were having advanced stage and were referred to Shaukat Khanum Hospital Lahore. Trans-vaginal sonography can reliably asses thickness and morphology of endometrium, thus risk group can be identified. Endometrial hyperplasia is the major cause of PMB. Dilatation and curettage, can provide sufficient diagnostic accuracy. Hysterectomy remained the main management of PMB patients
ABSTRACT
Teenage pregnancy is pregnancy in a female under the age of 20 [when the pregnancy ends]. A pregnancy can take place as early as two weeks before menarche [the first menstrual period], which signals the possibility of fertility, but usually occurs after menarche. Aim of the present study was to find out the fetal and maternal outcome of teenage pregnancy. It is a descriptive study carried out in one year, in District teaching hospital of Gomal Medical College D. I. Khan, Pakistan. Patients with pregnancy and aging below 18 years presenting to Gynae unit were followed up since 1[st] antenatal visit to delivery. Patient with teenage pregnancy and presenting first time in labour were also included in the study. They were looked for associated medical problems. The main outcome measures were health of mother, mode of delivery, weight of the baby, neonatal nursery admission and postnatal complications of mother. There is marked increase in hospital admission of the teenage pregnancies in last 3 years, probably because ofIDPS from Waziristan. The most common medical problems found was anaemia [HB < 10 gm] which was 67%. In a total of 92% of them delivered through. Normal vaginal delivery which shows close relationship of smaller babies, and laxity of the pelvic structure. Fifty four percent of the babies were weighing in 2.5 -3 kg range