Frequency of raised C - reactive protein in the diagnosis of clinically suspected neonatal sepsis

Introduction: Despite increasing knowledge of pathophysiology and modern therapeutic approaches, the mortality and morbidity associated with Neonatal sepsis remains alarmingly high. Its clinical features are non-specific and can be confused with many other diseases. This study is done to find out some rapid and reliable diagnostic tool in early detection of neonatal sepsis, thereby allowing prompt management and treatment of suspected cases

Objective: To determine the frequency of raised C - reactive protein in the diagnosis of suspected neonatal sepsis. Study design: Cross sectional survey. Setting: neonatal unit of pediatric medicine department of Chaudhry Rehmat Ali Memorial Trust Hospital Lahore, Pakistan. Duration of study: Six months from 01-10-2012 to 31-03-2013. Sample size: The calculated sample size is 140 cases. Sampling technique: Non probability purposive sampling. Data collection procedure: Data was collected by taking the history and physical examination of cases admitted in neonatal unit. C reactive protein was checked at bedside through quick read commercially available kits. Data was analyzed through SPSS version 12 and entered in Proforma

Results: Majority of neonates in our study population; 66 among 84[79.4%] with early onset sepsis [with in first 3 days of life] and 48 among 56 [85.7%] with late onset sepsis [4 to 28 days] has raised C reactive level for i - e >/=6 mg%

Conclusion: CRP is a readily available, inexpensive, reliable and highly sensitive marker in detection of neonatal sepsis

Comparision of excision and primary [midline] closure with karydakis technique in the surgical treatment of pilonidal sinus

Pilonidal sinus is a common anorectal problem that occurs in the cleavage between the buttocks [natal cleft] and causes discomfort and embarrassment and absence from work for the sufferers. It typically affects young men and women. Numerous surgical procedures have been described but treatment failure and disease recurrence is common leading to considerable morbidity in these otherwise healthy patients

Objective: To compare the effectiveness of excision and primary closure with Karadykis Technique of cleft closure in the surgical treatment of pilonidal sinus

Materials and Methods: Setting: Department of Surgery, Ch. Rahmat Ali Memorial Hospital, Township, Lahore. Study Duration: 3 years [Jan 2009 to Dec 2011]

Sample Size: 40 patients, 20 in each group

Inclusion Criteria: All adult males and females with clinical diagnosis of chronic pilonidal sinus

Exclusion Criteria: Recurrent pilonidal sinus disease, acute pilonidal abscess

Results: Out of 40 patients, 35 [87.5%] were males and 5 [12.5%] were females. Age range was 16 to 35 years with mean age of 25.5 years. Group A consisted of 20 patients who underwent Excision and Primary closure while group B had 20 patients who underwent Karydakis Technique of cleft closure. The postoperative complications encountered in Group A were post operative pain, wound infection, numbness at the site of surgery and recurrence while in Group B, complications included post operative pain, hematoma/seroma formation, wound infection, wound dehiscence, numbness at the site of surgery and recurrence

Conclusion: Karadykis procedure is better than excision and primary midline closure in terms of less postoperative complications, reduced hospital stay and recurrence rate

Clip-closure of appendix stump

An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. Many studies show that the use of costly high tech instruments such as Endo-loops, Endo-GIA for transaction and closure of the appendiceal stump lowers the risk of infection. The Aim of this study was to evaluate the use of clips for closure of appendix stump as a safe and cost-effective method. Descriptive Study. Oct 2009 to Jun 2010. Shalamar Hospital, Lahore. Over a period of 9 months 36 patients were selected to have laparoscopic appendicectomy. All patients had stump closure by clips as used for cystic duct and cystic artery in laparoscopic cholecystectomy. No patient had Endo-loop or Endo-GIA for closure of stump. All patients had follow-up at one week and six weeks after discharge from hospital. There was no clinical evidence of surgical site infection or leak from appendicular stump by this method. There was no discomfort in handling this instrument both for surgeon and scrub nurse. The price of the clips used was 4.30 Euros as compared to 112.00 and 232.77 Euros for the Endo-loops and Endo-GIA respectively. This study shows that clips can be used for stump closure without any additional risk to patient. It is also cost- effective. So appendiceal stump closure using clips is very convenient, an easy, safe, and cost-effective procedure

Patient satisfaction and merging of small hospital

The first merging of small hospitals into a large one came into existence in January 2005 in county Louth. As a result the surgical departments of Louth county hospital Dundalk and Our lady of Lourdes hospital Drogheda Ireland were combined. Two hospitals are at less than half an hour drive and situated North-eastern region of Ireland. To assess the impact of joining two departments of surgery in two different hospitals along with the patient's reaction after such arrangements were made. review of literature. Louth County Hospital Dundalk Ireland. One year Following review of literature it was decided to explore the experience of patients who were treated in Louth County Hospital Dundalk one year after merging of two departments of surgery. Randomly 20% of patients treated in Louth County Hospital were included in a telephone survey. These patients were under care of all consultant surgeons. The patients were asked about their experience in Louth hospital. Also impact of joining surgical departments on waiting list was explored. Out of 1310 patients, 20% of patients treated in Louth Hospitals were included in the survey. The age of the patients varied from 15 to 67 years. 57% of the patients were female and the remainders were males. It was found that 93.5% of patients were happy to travel to Dundalk and 96.5% were satisfied with the facilities there as well. Furthermore 96% said that they would be happy to have surgery in Dundalk if they ever needed it in the future. 6% of patients were dissatisfied with services in Louth County Hospital, Dundalk. The improvement of quality processes in healthcare is of constant concern to communities throughout the world. The results have clearly demonstrated that restructuring of services can work well and be acceptable to patients once hospitals are prepared with relevant resources in place