Major flaws in technique of intramuscular injections

To identify the major flaws in technique of administering intramuscular injections by our health care professionals and to suggest improvements based upon a scientific study. Cross sectional [Jan-Feb, 2011].Place: Combined Military Hospital Sargodha, Pakistan Air Force Hospital Sargodha, Pakistan Air Force Hospital Mianwali. All staff involved in administration of IM injection to the patients. A detailed questionnaire was required to be filled in front of an observer and submitted. Injection sites were required to be marked on diagrams. The data were analyzed by SPSS 17. Major flaws were identified in the technique of administration of IMI

Intramuscular ceftriaxone as single dose treatment of acute otitis media

To evaluate single dose intramuscular ceftriaxone as an option for the treatment of acute otitis media [AOM]. To compare efficacy of single dose intramuscular ceftriaxone to 10 days treatment with amoxicillin-clavulanate combination. Prospective, randomized, double blind control study. Combined Military Hospital Muzaffarabad, Azad Kashmir, over a period of 02 years from October 2006 to September 2008. A total of 148 freshly diagnosed cases of AOM between ages 03months to 6 years were recruited and divided randomly into two equal groups of 74 each using random numbers table. Group I was administered oral amoxicillin-clavulanate in a dose of 45mg/kg/day in three divided doses along with single intramuscular shot of placebo. Group II was given a single shot of intramuscular ceftriaxone in a dose of 50mg/kg along with placebo syrup thrice a day for 10 days. Patients were reassessed at day 03 and 11. Ninety four point five percent of patients responded to amoxicillin-clavulanate whereas 95.9% responded to single dose IM ceftriaxone. No significant difference was noted between the two types of treatments in term of disease outcome. Single dose intramuscular ceftriaxone can be another option for the treatment of AOM especially in children/parents with poor compliance

Nasal hirudiniasis-an unusual cause of epistaxis

Common causes for unilateral nasal bleeding in adults are benign or malignant tumours, deviated nasal septum, nasal trauma and foreign bodies. Nasal leech infestation has not been identified as a cause of nasal bleeding in most of the textbooks of Ear Nose and Throat. Over 3 years, at Combined Military Hospital Muzaffarabad, and Combined Military Hospital Abbottabad, we have dealt with 38 such cases presenting with epistaxis where the cause was found to be leech infestation. A descriptive study was carried out at Combined Military Hospital Muzaffarabad and Combined Military Hospital Abbottabad over a period of 3 years. All patients whose epistaxis was due to leech infestation were included in the study regardless of age and sex. A total of 38 such cases presented with nasal Hirudiniasis as a cause of unilateral epistaxis. 29 were male and 09 female. All of the patients related their problem to the intake of fresh water of stream origin. The mean duration of symptoms was 12 weeks SD 3.0. It is concluded that nasal Hirudiniasis [nasal leech infestation] is a cause of unilateral epistaxis in areas like Muzaffarabad, Azad Kashmir and Abbottabad, where leeches are a common inhabitants of fresh water streams

Surgery in a temporary setup- sharing an experience of 16 months

Sharing an experience of surgery in a temporary set up. Descriptive study. This study was carried out at Combined Military Hospital Muzaffarabad after the earthquake of October 2005 over a period of 16 months. The workload that this hospital has managed over the period despite running under tents. The hospital was functioning under the temporary set up. Patients were earth quake victims requiring different surgical procedure. A total of 2887 major and 7471 minor surgical procedures pertaining to the specialty of General Surgery, Orthopedics, ENT, EYE and Gynecology were carried out over a period of 16 months. Though the load was comparable to any [C] class and most of the [B] class hospitals, despite being under tents, there was not a single case of post operative infection. The importance of single-use-only surgical disposables in the good management of surgical patients has also been highlighted. The basic sterilization techniques, if followed religiously stand good in preventing postoperative infection, even in compromised working condition

Total thyroidectomy as primary elective procedure in multinodular thyroid disease

Multinodular goitre is one of the commonest thyroid diseases encountered in the practice of surgery. The most common surgery being performed for multinodular goitre is subtotal thyroidectomy. Total thyroidectomy is designed to remove all of the thyroid tissue. The objective of this study was to evaluate total thyroidectomy as a primary elective procedure for treatment of multinodular thyroid disease. This descriptive study was carried out at Combined Military Hospital Rawalpindi from June 2003 to September 2006. 88 patients of multinodular thyroid disease were included. Patients having evidence of recurrent laryngeal nerve damage, recurrent goitre, evidence of altered parathyroid functions or evidence of malignancy were excluded. All patients underwent total thyroidectomy by the same team of surgeons and the patients were closely followed up for postoperative complications especially in terms of recurrent laryngeal nerve damage and hypocalcaemic tetany. No major postoperative complication was noted. Only 1 patient [1.14%] developed unilateral recurrent laryngeal nerve damage and 2 patients [2.27%] developed transient hypocalcaemia that recovered quickly. Total thyroidectomy as a primary elective procedure in multinodular thyroid disease is a safe option and it removes the disease process completely, lowers local recurrence rates and avoids the substantial risks of reoperative surgery

Office management of benign paroxysmal positional vertigo with Epley's maneuver

The underlying cause of benign paroxysmal positional vertigo is free floating endolymph particles [otoconia displaced from the otolithic membrane of the utricle] in the posterior semicircular canal. Particle repositioning techniques are one of the effective method of treatment. The purpose of the study was to determine the effectiveness of Epley's maneuver against expectant treatment and to find out if this treatment should be used more frequently than watchful waiting for the treatment of BPPV. This study was carried out at outpatient clinic, departments of ENT, Combined Military hospital Rawalpindi and PNS Shifa hospital Karachi over a three years period from Jan, 2002 to Jan, 2005. Based upon history and Dix-hallpike testing 44 patients diagnosed as benign paroxysmal positional vertigo were collected by convenient sampling from these hospital's outpatient departments and divided by non probability convenience into two groups of 22 each. The control group [group A] was given placebo and the test group [group B] received single treatment by Epley's maneuver in the OPD. The results were analyzed at the end of one and two weeks by history taking and Dix-hallpike testing. Computer software SPSS version 10 was used. At the end of week one 14 [63.63%] patients of group B were symptom free and 2 [9.1%] patients was much better as compared to the control group where only 1 [4.5%] patient reported as symptom free and another 5 [22.7%] reported as much better. At the end of second week out of those treated by Epley's maneuver 16 [72.7%] reported as symptom free and another 2 [9.1%] as much better whereas 4 [18.2%] patients reported no improvement at all. In the control group only 4 [18.2%] patients reported as symptom free, 3 [13.6%] as much better, 6 [27.3%] as better and 9 [40.9%] reported no change in the symptoms. Chi square test was applied and the value of p came out to be 0.001 and 0.002 at week one and week two respectively. It was concluded that Epley's maneuver is a much better form of management for benign paroxysmal positional vertigo

Anaesthetic management of mass casualties-what should be the drug of choice?

Based on the experience of earthquake 8[th] October 2005 choice of best anaesthetic management for mass casualties was determined. Patients were subjected to all types of anaesthesia and then best out of these came out to be ketamine. One month. A total of 180 patients were anaesthetized by different methods during one month after earthquake. Out of 120 patients 80 received general, 74 ketamine, 22 spinal and 4 regional anaesthesia. 41% who received ketamine anaesthesia showed uneventful recovery without any complication. It is concluded that ketamine alone can be used very safely in case of mass casualties as also recommended in literature

Co2 laser treatment of benign laryngeal diseases

To determine the effectiveness of carbon dioxide laser surgery in the treatment of benign laryngeal diseases and to determine its advantages over conventional surgery. Quasi-experimental interventional study. The study was conducted in Combined Military Hospital Rawalpindi from January 2000 to January 2002. The study was carried out on 105 patients with freshly diagnosed benign laryngeal pathologies i.e. vocal cord nodules, vocal cord polyps, laryngeal papillomatosis, vocal cord paralysis, laryngeal web and stenosis; selected by convenience sampling from ENT OPD Combined Military Hospital Rawalpindi and divided into two groups of 50 each [patient fallout = 05]. One group was treated by carbon dioxide laser [Laser opmilas carbon dioxide 50 medical system] and the other was treated by conventional surgical techniques. Data collection was carried out by means of a questionnaire and the outcome was compared in terms of disease control, hospital stay, complications and cost of the treatment. Computer software SPSS version 10.0 was used for data analysis; t-test was used for hospital stay and Chi square test was applied for the other variables. It was noted that surgery with CO[2] laser resulted in a comparatively better disease control, the hospital stay was much lesser as was the rate of complications and the cost of treatment was also much reduced as compared to conventional surgery. Laser surgery is a better option for the treatment of benign laryngeal pathologies as compared to conventional surgical techniques