Relationship of sociodemographic factors with serum levels of vitamin D in a healthy population of Pakistan

Background: High prevalence of vitamin D deficiency has been reported from Pakistan. Association of sociodemographic factors with vitamin D status has received little attention in this region. Therefore, we embarked on investigating the relationship of sociodemographic factors with vitamin D levels in a healthy Pakistani population. Venous blood from 226 healthy participants [age range 19-69 years] was collected and analyzed for serum concentrations of 25[OH] vitamin D [25[OH]D] and other related biomarkers. Demographic characteristics of the study participants were collected. Vitamin D deficiency [25[OH]D levels less than 20 ng/ml] was found to be 75% in this cohort. Gender, sunlight exposure and monthly household income emerged as predictors of hypovitaminosis D. Mean serum 25[OH]D levels in the groups with monthly household income less than Pakistani Rupees [PKR] 20,000, between PKR 20,000-50,000 and above PKR 50,000 were found to be 11.0+/-7.5, 13.9+/-9.6 and16.9+/-11.7 ng/ml, respectively. Using logistic regression the odds of having vitamin D deficiency was 3.22 [95% CI, 1.65-6.28] in the group with household income less than PKR 50,000 per month compared to the group with household income more than PKR 50,000 per month when the model was adjusted for gender and exposure to sunlight. There is an association between household income and hypovitaminosis D in a healthy Pakistani population

Comparison of early oral feeding and conventional oral feeding in cases of elective intestinal stoma reversal in terms of number of days of nasogastric decompression and hospital stay

Objective: To compare the efficacy of early oral feeding and conventional oral feeding in elective intestinal stoma reversal in terms of mean number of days of NG tube out and hospital stay. Study Design: Randomized Controlled Trials. Settings: Surgical Units of Allied/DHQ hospitals Faisalabad. Duration of Study: 1 year duration from February 2014 to January 2015. Sampling Technique: Non-probability consecutive sampling

Methodology: 60 patients were selected from OPD. Patients were randomly allocated to two groups. All stomas were closed in single layer extramucosal seromuscular fashion, intraperitonealy. In post-operative period, patients in group I were allowed oral feed in early post-operative period [6-8 hours] after the surgery. Initially, oral liquids [30ml/hr] was given and patients were observed for nausea and vomiting. Oral feed was increased gradually with the response of the patient with semi-solid to solid diet on 1[st] or 2[nd] post-operative day. Patients in group II were started oral sips of liquids once they pass flatus or audible bowel sounds. At least two follow up visits were advised within two weeks of discharge of patients, 1[st] on the 7[th] day and 2[nd] on the 14[th] day, for removal of skin stitches

Results: Out of 60 patients 37 [61.7%] were males and 23 [38.3%] were females. Among the variables under the study, for both groups, the minimum total number of days of nasogastric decompression was 0 days and maximum total number of days of nasogastric decompression was 5 days with mean of 1.17 days and standard deviation of 1.33. In group 1, the mean of the total number of days of nasogastric decompression was 0.13 +/- 0.35 days and in group 2, the mean of the total number of days of nasogastric decompression was 2.20 +/- 1.13 days with p-value of 0.0001 for both the groups, the minimum total number of days of hospital stay was 3 days and the maximum was 9 days, with mean of 4.82 days and Std. Deviation of 1.70 days. In group 1, the mean of the total number of days of hospital stay was 3.37 +/- 0.61 days and in group 2 the mean of the total number of days of hospital stay was 6.27 +/- 1.08 days with p-value of 0.000

Conclusion: Early oral feeding in cases of elective intestinal stoma reversal is better than conventional oral feeding in terms of number of days of nasogastric decompression and hospital stay

Damage to recurrent laryngeal nerve [RLN] with and without exposure in thyroidectomy

Objectives: To determine damage of RLN with and without exposure during thyroidectomy. Study design: Randomized control study Sampling technique: Non-probability consecutive sampling. Sample size: 150 patients. Setting: Surgical units of Allied Hospital Faisalabad

Methodology: With informed consent, study was conducted on two groups[75 in each group].Patients were distributed on alternate basis into group A and group B for thyroidectomy with and without identification of RLN respectively

Results: In group A 30[40%] patients were between 31-40 Years and 18[24%] between 41-50 Years. In group B 32[42.7%] were between 31-40 Years,13[17.3%] between 41-50 Years and 15[20%] between 50-60 Years. Mean of age was 38.5 +/- 10.9[standard deviation].In group A,28[37.3%] were male and 47[62.7%] females while in group B 25[33.3%] were males and 50 [66.7%] females. In group A 38[50.7%] patients were of MNG, 10 [13.3%] diffuse goiter, 7[9.3] solitary nodules, 13 [17.3%] suspicion of malignancy and 7[9.3%] malignanacy. In group B 33[44%] patients were having MNG, 15[20%] diffuse goiter, 10[13.3%] solitary nodule, 6[8%] suspicion of malignancy and 11[14.7%] malignant disease. In group A 39[52%] patients underwent STT, 20[26.7%] NTT, 10[13.3%] TT and 6[8%] hemi-thyroidectomy. In group B 35[46.7%] patients underwent STT, 21[28%] NTT, 12[16%] TT and 7 [9.3%] hemi-thyroidectomy. In group A 3 [4%] patients developed transient paralysis and 1[1.3%] permanent paralysis of RLN. In group B 7[9.3%] patients developed transient paralysis and 3[4%] permanent paralysis of RLN

Conclusion: Preservation of RLN is more likely with exposure and identification of RLN post-operatively

Outcome of stapled haemorrhoidectomy versus open milligan morgan haemorrhoidectomy at allied hospital

Objective: to compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's haemorrhoidectomy at Allied Hospital

Study Design: simple comparative study

Place of Study: Surgical Unit 1, Allied Hospital Faisalabad

Duration of Study: January 2011 to September 2012

Sample size: 50 patients

Material and Methods: fifty patients of 3rd and 4th degree hemorrhoids were selected for admission from the outpatient department. Patients with additional anal disease [e.g. fissure, abscess, fistula, ano-rectal cancer etc.] were excluded. Two groups of twenty five each were made. Group A for stapled haemorrhoidectomy and Group B for Milligan- Morgan haemorrhoidectomy [MMH]. The operative time was measured in minutes. Postoperative pain was assessed through visual analogue scale [VAS]. Bleeding was measured as mild, moderate and profuse. Other postoperative complications during hospital stay like urinary retention, anal stenosis etc. were noted. T-test, chi-square test and repeated measured analysis of variance were applied to compare the variables

Results: a majority of patients[combined in both groups] had third degree haemorrhoids. The mean length of operative time was found statistically insignificant between stapled and open groups [34 vs 36 minutes]. In Group A 23 [92%] patients were discharged in 24 hrs while 2 [8%] patients were discharged after 24 hrs. In Group B 9 [36%] patients were discharged in 24 hrs and 16 [64%] patients were discharged after 24 hrs. In group A 19 [76%] patients were having mild bleeding, 5 [20%] moderate bleeding and 1 [4%] profuse bleeding. In Group B 7 [28%] patients were having mild, 16 [64%] moderate and 2 [8%] profuse bleeding. In Group A 15 [60%] patients were having mild pain, 7 [28%] moderate and 3 [12%] severe pain on visual analogue scale. In Group B 4 [16%] patients were having mild pain, 15 [60%] moderate and 6 [24%] severe pain. The proportion of postoperative anal stenosis, prolapsed recurrence, persistent pain, recurrent bleeding and urinary retention was higher in MMH than stapled haemorrhoidectomy group

Conclusion: there was a significant difference between stapled haemorrhoidectomy and Milligan Morgan's for bleeding, pain and hospital stay. However the mean length of operative time was insignificantly different

Role of preloading with and without intramuscular ephedrine to prevent post spinal hypotension in elderly patients

To evaluate the efficacy of intramuscular ephedrine along with preloading in prevention of post Spinal hypotension in elderly patients. Randomized controlled trial. Department of Anaesthesia and Intensive Care Combined Military Hospital Peshawar, from 20[th] March 2007 to 20[th] March 2008. A total of 100 patients of ASA I and II were selected. The patients were randomly divided by random numbers table into two groups of 50 each. Group A was preloaded with ringer solution 15 ml/kg and intramuscular injection of 1 ml normal saline as placebo was given. Group B preloaded with 7.5 ml/kg and intramuscular injection of ephedrine 0.5 mg/kg was given. Heart rate and mean arterial pressure were monitored after the spinal blockade. Hypotension was treated with intravenous bolus of 5mg ephedrine and additional rapid infusion of lactated ringers. In group A, hypotension occurred in 30 [60%] patients as compared to group B, where hypotension occurred in 11 [22%] patients. In group A, ephedrine 10mg [2 boluses] were given in 14 [28%] patients, while in group B, ephedrine 5mg [1 bolus] was given in 11 [22%] patients. It is concluded from the results of this study that less preloading is required in intramuscular preloading along with intramuscular ephedrine is more effective in preventing patients after spinal anaesthesia as compared to preloading alone

Prevention of post spinal hypotension; comparison between preloading with and without intramuscular ephedrine in elderly patients undergoing inguinal hernia surgery

Objective of the study is to evaluate the efficacy of intramuscular ephedrine along with preloading in prevention of post spinal hypotension in elderly patients undergoing inguinal hernia surgery. This is a quasi experimental study. The study was conducted at the department of Anaesthesia and Intensive Care Combined Military Hospital, Peshawar over a period of one year. In a double-blind, randomized study, 80 elderly patients undergoing inguinal hernia surgery under spinal anaesthesia divided into two equal groups of A and B. Forty patients received i/m inj of ephedrine 45mg deep in the paravertebral muscles immediately after injection of bupivacaine, and 40 received an equal volume of saline. Patients in both groups were given the same volumes of fluid before anaesthesia. The incidence of hypotension [Systolic arterial pressure <90mmHg or <80% of baseline] were recorded. and incidence of fall in the heart rate was recorded. Systolic arterial pressure during the first 60 min after anaesthesia remained significantly more stable in the ephedrine-treated group, and there was also a significantly smaller number of patients in this group who had decreases in pressure of more than 30% of pre-block levels and fewer required rescue i.v. Ephedrine. An increase in heart rate or systolic pressure of > 20% from baseline was found in two patients in the ephedrine group and in one patient in the placebo group. We conclude that ephedrine 45mg administered in the paravertebral muscles immediately after plain bupivacaine spinal anaesthesia is a simple and effective means of reducing the incidence of hypotensive episodes in the elderly patient

Role of adjuvant topical oxygen therapy [Topox] versus conventional methods in the management of non- healing infected wounds

Objectives: To compare the role of adjuvant topical oxygen therapy versus conventional methods in the management of non-healing infected wounds

Study Design: Simple comparative study

Setting: The study was carried out in one year duration from January 2010 to December 2010 in Surgical unit-1 Allied Hospital Faisalabad

Sample Size: 60 patients

Methods: Total of 60 patients was divided into two groups. In one group [A] topical oxygen therapy was given along with conventional measures for management of wound. In second group [B] only conventional methods were used for wounds

Results: 60 cases included in this study,30 in group A and 30 in group B. From patients of group A, 16[53.3%] showed clinical improvement in first week and 25[83.3%] showed clinical improvement in second week. While in group B 5[17%] and 11[36.7%] showed clinical improvement in first and second week respectively.5[17%] patients in group A developed granulation tissue in first week and 19[63%] in second week. While in group B 2 [7%] developed granulation tissue in first week and 8[27%] in second week. From group A 10[33.3%] and 24[80%] patients showed complete wound healing in second and third months respectively. In group B 3[10%] patients showed complete wound healing in two months and 12[40%] in three months.1[3.3%]patient in group A deteriorated in first week and 2[7%] in second week.8[27%]patients from group B deteriorated in first week and 4[13.3]in second week

Conclusion: Use of TOPOX along with conventional method is more safe and effective in the management of nonhealing infected wound than conventional methods alone

Frequency of helicobacter pylori in patients with upper G.I symptoms

Our study aimed to determine the frequency of H pylori infection in our local population. 100 sequential patients undergoing upper gastrointestinal endoscopy were tested for the presence of H pylori infection by the urease test. All patients were tested for the presence of H pylori regardless of endoscopic findings. Of 100 patients, 39 were male and 61 were female. Patients age ranged from 13 years to 85 years, mean age being 39.9 years. Positive endoscopic findings were detected in 32% cases. 65% cases [42 female, 23 male] tested positive for H pylori infection. Of those who tested positive, 20 patients [30.7%] had significant upper Gl pathology detected. Of patients who were negative for H pylori infection, 12 [34.28%] had significant upper Gl pathology detected. Of a total of 61 female patients undergoing endoscopy, 68.8% tested positive for infection with H pylori, whereas 58.9% of the male patients test positive. Of 100 patients, 47 were aged 40 or above of which 55.3% were H pylori positive; 53 patients were below 40 years of age and of them, 75.3% were H pylori positive. We conclude that significant proportion of Pakistani population harbours H. Pylori and due consideration should be given to H. Pylori status of a person presenting with diseases with strong link with this organism

Incidence of spontaneous bacterial peritonitis in liver cirrhosis, the causative organisms and antibiotic sensitivity

To find out the incidence of spontaneous bacterial peritonitis in patients with liver cirrhosis having ascites, the causative organisms and their antibiotic sensitivity. This study was conducted in Medical Ward of Khyber Teaching Hospital, Peshawar from 1st June 2001 to 31 of March 2003. Patients having liver cirrhosis confirmed previously by histopathology and now presenting with fever with or without chills, abdominal discomfort, increasing abdominal distension, confusion and hepatic encephalopathy, were included. A total of 200 patients were studied. Out of 200 patients included, spontaneous bacterial peritonitis [SBP] was present in 102 patients. Classical SBP was present in 38.23%; Culture Negative Neutrocytic Ascites [CNNA] was present in 57.84% while Bacterascites was present in 03.92% of patients. E Coli was isolated in 58.13%, Streptococcus pneumoniae in 18.60%, Staphylococcus auras in 09.13%, Klebsiella in 09.13% and Acinetobacter in 04.65%. Out of 102 cases of SBP, blood cultures were positive in 21.56%, urine cultures in 15.68% and throat swabs in 10.78% of patients. E Coli was again the commonest organism isolated from blood cultures. All the organisms were sensitive to 3rd generation cephalosporins, and quinolones. Spontaneous bacterial peritonitis is quite a common complication of liver cirrhosis with ascites. Patients usually present with abdominal pain, abdominal tenderness, fever with or without rigors, jaundice, and hepatic encephalopathy. E Coli is the commonest organism followed by streptococcal pnaemoniae. Quinolones and 3rd generation cephalosporins are 100% effective in the management of spontaneous bacterial peritonitis

Review of 100 cases of falciparum malaria.

The rising incidence of falciparum malaria with its attending high morbidity and mortality in the last one and a half decade, coincident with the heavy influx of Afghan refugees especially in the North West frontier province, has been a matter of great concern to us. Hence, we embarked on this study to evaluate the presentation of falciparum malaria, to rationalize the treatment strategies abreast with current literature and to study the increasing drug resistance and drug effectiveness. The findings revealed that fever was present in 100% followed by headache in 95%, jaundice in 54%, herpes labialis in 46%, cerebral malaria in 26%, uraemia in 19% and blackwater fever in 5% of the patients. Out of 45 females seen 26 were pregnant. Five patients died. Chloroquine resistance was observed in 38%, amodiaquine resistance in 17%, and sulphadoxine+pyrimethamine [Fansidar] resistance in 14% of patients. The most effective drug was quinine. The second most effective drug was mefloquine