Comparison of morbidity in rubber band ligation and milligan morgan hemorrhoidectomy

Background: Hemorrhoidectomy treatment has multiple options, depending on grade of disease

Objective: This study was conducted to compare the postoperative morbidity of rubber band ligation [RBL] and milligan morgan haemorrhoidectomy in terms of frequency of pain and bleeding in patients with third degree hemorrhoids

Material and Methods: This study was conducted in Department of Surgery, District Headquarter Hospital Faisalabad, affiliated with Punjab Medical College from 25[th] January, 2012 to 24[th] January, 2014. This study included 140 [70 in each group] patients of grade 3 hemorrhoids. Patients were randomly allocated into either the rubber band ligation [RBL] group or milligan morgan haemorrhoidectomy groups by using computer generated random number tables. Both groups were observed for the impact of these treatment modalities on post operative pain and bleeding

Results: In group A, 49 patients [70%] and in group B, 47 patients [67.2%] were male. Regarding postoperative pain, 2 patients [2.9%] of group A and 22 patients [31.4%] developed mild postoperative pain [p<0.001], 1 patient [1.4%] of group A and 31 patients [44.3%] of group B faced moderate postoperative pain [p<0.001], 1 patient [1.4%] of group A and 11 patients [15.7%] has severe postoperative pain [p=0.002]. In group A, 2 patients [2.9%] and in group B, 10 patients [14.3%] has mild postoperative bleeding, 1 patient [1.4%] in group A and 8 patients [11.4%] in group B developed severe postoperative bleeding

Conclusion: RBL is a reliable and safe procedure with minimum complications and morbidity after the procedure

Tetanus; still cannot be prevented, a three year retrospective study in DHQ hospital, Faisalabad

Tetanus still remains a major public health problem in Pakistan like in most other developing countries, with a high morbidity and mortality. To study the demographic profile the clinical profile, the outcome of the tetanus patients and effectiveness of tetanus immunization coverage in district Faisalabad. Retrospective record based study. Surgical unit-5 DHQ Hospital, Faisalabad from January 2010 to December 2012. All data of 198 patients of tetanus of any age and sex, diagnosed clinically was collected, compiled and analyzed from the Medical Records Department of the Hospital. Out of 198 patients of tetanus,138[69.7%] were males and 60[30.3%] were females. Their ages ranged from 1 to 85 years with a mean and a standard deviation respectively of 29.36 and 17.48 years.162 [81.8%] were from rural and36[18.2%] were from urban areas. 47[23.7%] patients were having prior immunization and151[76.3%] were not immunized. The most common presenting symptoms were trismus [47.5%], body stiffness [24.2%],fits[19.2%] and respiratory distress[9.1%]. 23[11.6%] patients were having mild disease,71[35.9%] patients were having moderate disease,71[35.9%] patients were having severe disease and 33[16.7%] were having very severe disease. Overall mortality rate was 41.4%. Respiratory failure was the most common cause of death and there was statistically significant association between mortality and increasing grades of disease. By making expanded programme of immunization [EPI] more effective and removing flaws from out-dated vaccination through incomplete vaccination. By improving awareness in public and complete vaccination through EPI program, we can reduce the incidence of tetanus

Never underestimate simple splenic cyst.

Although splenic involvement alone in hydatid disease is very rare, spleen is the third common organ involved in hydatid disease. It is endemic in cattle rearing areas but occurs worldwide. The rarity of splenic hydatid disease poses diagnostic challenge for clinicians. The case is presented as the investigation in the beginning which induced confusion among experienced clinicians but subsequently diagnosis of splenic hydatid cyst with peritoneal dissemination was confirmed by laparoscopy and histopathological examination. Hydatid disease of spleen should be considered in differential in every patient in endemic area with cystic lesion of spleen until proved otherwise as the hydatid cyst can present even as simple cyst without having classic serological and imaging features.

Immunohistochemical study of progesterone receptors in thyroid gland

To determine the progesterone receptor status in thyroid gland. This study was based on immunohistochemical staining of formalin fixed paraffin embedded tissues, for progesterone receptors, in 50 previously diagnosed cases of various thyroid lesions and surrounding normal thyroid tissue. Out of 50 cases, 8 were nodular goiter, 9 cases of adenoma, 19 papillary carcinoma, 10 follicular carcinoma and four cases were of medullary carcinoma. Surrounding normal tissue was available in 4 non-neoplastic and 21 neoplastic lesions. Overall male patients comprised 20% [10 cases] and females 80% [40 cases]. Although a wide range of lesions in both the sexes including wide age range were available, none of our cases were positively stained for progesterone receptors. In contrary to earlier reports by immunohistochemical method using monoclonal mouse anti-PR antibody clone PgR 636, on formalin-fixed paraffin embedded thyroid tissues, the progesterone receptors were not detectable in our human samples. The effect of progesterone on thyroid gland may be an indirect one

Epidemiologic triad of dog bite [a study of 81 cases]

Dog bite accounts for a significant number of traumatic injuries, which often needs medical treatment .Although agent, host and environment characteristics of dog bite have been well documented internationally but it is not done in Pakistan. A study was planed to find Agent, host and environment characteristics of dog bite in local population.The study setting was Emergency Department of Abbasi Shaheed Hospital. Patients were enrolled in July 2004,on a Performa designed to get different features of epidemiologic triad. Performa contain features of agents [type of animal, nature of attack and vaccination status of animal]host features [Age .gender, body part involved in bite and vaccination] environmental features [Time of bite and site of accident].Performa was filled by Doctors after interviewing each patient individually. Total 81 cases were registered in this study. Male were dominating with 80% [66] cases .Children and adolescent were the main target 65% [53] of the dog bite victims were less than 15 year of age .Mostly lower limbs were involved in the accident and it accounted for 68 % [55] cases.The highest frequency of dog bite were reported from Orangi town 31 % [25], a thickly populated area belonging to very low socioeconomic group

Brucellosis a case report

We present a case of 27-year-old multigravida presented to us with high-grade fever with rigors and pain and swelling in her right wrist joint two weeks after full term normal vaginal delivery. During the stay in hospital she had fairly sudden visual impairment. Considering multisystem involvement she was investigated and finally she turned out to be Brucellosis

case of pulmonary sarcoidosis, not tuberculosis

The case of sarcoidosis of the lungs is described in a 50 years old female who presented with symptoms similar to pulmonary tuberculosis. As she showed no improvement on anti-tubercular therapy, sarcoidosis was suspected and confirmed by endobronchial biopsy and she responded well to treatment

Coronary artery bypass grafing in young adults

Atherosclerotic coronary artery disease in younger patients is different than that in older age group. As a result Coronary Artery Bypass Grafting [CABG] among such patients carries other considerations. The purpose of this study was to document the early surgical results of patients under the age of 35 years, under going CABG in mixed Pakistani population. Secondly, to examine the etiological factors and the issues related to psychological, social and sexual disturbances after surgery. Finally, to recommend a strategy for future management. Methods. Hospital data of all the patients under the age of 35 years undergoing CABG from January 2001 to December 2002, at National Institute of Cardiovascular Diseases, Karachi, was scrutinized. Various parameters were compared with those of older patient population, reported by our centre, being taken as a control. A total of 87 patients underwent surgery, 82 were males and 5 were females. The age range from 21 to 35 years. Risk factors included family history of coronary Artery disease in 74%, smoking in 86%, familial hypercholesterolemia in 29%, diabetes mellitus in 59% and hypertension in 42%. There were two hospital deaths. Post-operative morbidity included cardiac [17%], pulmonary [10%], infections [6%] and renal [1%]. Conclusion-Short term results in this patient population were comparable to those of older age group. Psychosocial and sexual dysfunction were more prominent in this patient population. Now compliance for secondary prevention was more prevalent in this age group. An organized, multi disciplinary approach is required to tackle various issues of this age group

Prevalence of anti - hepatitis C antibodies and hepatitis B surface antigen in healthy male naval recruits.

Hepatitis B virus [HBV] and hepatitis C virus [HCV] are the commonest causes of chronic liver disease the world over including Pakistan. Various studies done in the past show wide variation in the results. Freshly inducted healthy recruits selected in Pakistan Navy were tested for hepatitis B surface antigen [HBsAg] and anti-hepatitis C antibodies [anti-HCV]. This study was carried out in PNS Shifa hospital Karachi. The prevalence of anti-HCV was 2.2% [95% CI:1.3-3.1%] and HBsAg was 3.2% [95% CI:2.1-4.3%]. There was variation in prevalence of anti-HCV and HBsAg in different cities. This study indicates that there is a considerable HBV and HCV threat to our population