ABSTRACT
Hemorrhoids are a common cause of rectal bleeding with a prevalence of 4 to 40% worldwide, varying in different geographical locations. The current treatment modality for 3rd degree hemorrhoids includes hemorrhoidectomy, but newer methods like rubber band ligation are rapidly gaining popularity. The purpose of our review was to establish if rubber band ligation can replace the traditional hemorrhoidectomy for the treatment of 3rd degree hemorrhoids.All databases were searched for relevant studies. A total of sixteen studies were included in the review. Current national and international literature points out that the results of rubber band ligation are comparable to hemorrhoidectomy and there are lesser complications associated with rubber band ligation.Reviewing the current recommendations, results, evidence and literature, our study recommends rubber band ligation as the treatment of choice for 3rd degree hemorrhoids
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Background: Laparoscopic Cholecystectomy is one of the most commonly performed routine operation in modern general surgery. All surgical specimens are routinely sent for histopathology. A wide spectrum of variations is seen under the microscope. Rarely, carcinoma is discovered on histopathological examination. The purpose of the article was to identify and elaborate the major histopathological findings of gallbladder after laparoscopic cholecystectomy in a tertiary health care hospital in Pakistan
Methods: This was a retrospective study and included histopathological specimens of gall bladder after cholecystectomy from February 2004 to April 2013. Data was analysed using MS Excel and SPSS 19.0
Results: Total number of cases: 8376, Chronic Cholecystitis: 7705, Acute or chronic cholecystitis with empyema, mucocele or gangrene: 554, Adenocarcinoma: 91, Adenomatous polyp: 3, Squamous cell carcinoma: 5, Papillary carcinoma: 3, Clear cell carcinoma: 4, Adenosquamous carcinoma: 2, Xanthogranulomatous changes: 54, Dysplasia: 13 and Cholesterosis: 1050
Conclusion: Considering the evidence from our study and the evidence from the literature reviewed, it can be concluded that prevalence of all kinds of gall bladder disease, benign or malignant including carcinoma is no different from the rest of the world. Routine histopathology of gall bladder can be omitted without compromising patient safety as proven and practiced by many centers across the globe
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Background: Needle stick injuries remains potential source of transmission of infections
Objective: To determine the prevalence of needle stick injuries among doctors and nurses working in Sheikh Zayed Hospital Rahim Yar Khan
Methodology: This cross sectional study was conducted from 1[st] June to 31[st] December 2014. All the nurses and medical officers who were listed in the medical superintendent office of the Sheikh Zayed Hospital Rahim Yar Khan were included in the study. A structured, self administered questionnaire was designed to describe the occurrence of needle-stick injuries among respondents. The questionnaire sought information about socio-demographic characteristics such as age, sex, marital status and years of experience. The questionnaire also included information about the frequency of being stuck by a needle or a sharp instrument while at work during the last six months. A yes/no response were used to assess whether the doctor/nurse reported the injury. The participants were asked about the reasons of needle stick injuries and how they managed the incident. Data analysis was performed using SPSS, version 17. The chi-square test was used to assess the association between duration of service and needle stick injuries
Results: Total of 308 health care workers [HCWs] participated in this study which included 173 medical officers and 135 nurses. About half of the medical officers were in the age category of 30 to 39 years while half of the nurses in 20 to 29 years of age. Among these HCWs 27.8% medical officers and 25.2% nurses had above 10 years of work experience. Needle stick injury was reported by 22.54% doctors and 37.78% nurses in the past six months and it was found significantly higher among nurses as compared to doctors [p=0.001]. Among perceived reasons of needle stick injuries the most frequently reported reason was workload [48.7% doctors, 56.9% nurses] followed by Recapping of needle [30,8% doctors, 21.6% nurses], hurriedness [12.8% doctors, 13.7% nurses] and non-cooperation of patient [7.7% doctors, 7.8% nurses]. After needle stick injury only 38.5% doctors and 25.5% nurses washed it with disinfectant. Duration of service was significantly associated with needle stick injury among doctors [p=0.000] and nurses [p=0.000]
Conclusion: In summary, we conclude that the frequency of Needle stick injury among Health Care Workers is high and duration of service was significantly associated with needle stilck injuries
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Background: Knowledge of breast feeding is essential among healthcare providers
Objective: To determine level of knowledge and practices of breastfeeding among nurses working in public sector pediatric and obstetric units of Bahawalpur City
Methodology: Study design: Cross sectional study. Place and Duration: Public sector hospitals of Bahawalpur City from 1 [st] June to 31[st] December 2013. All nurses working in Pediatric and Obstetrics departments for more than one month were included in the study after taking verbal consent. Information was collected through a structured questionnaire. Questions for assessing level of knowledge were feeding of colostrum, initiation of breastfeeding within half hour after delivery, duration of exclusive breastfeeding, total duration of breastfeeding, maximum interval between two feeds, continuation of breastfeeding during adverse health conditions of mother like fever, diabetes mellitus, hepatitis [B, C], active pulmonary tuberculosis and continuation of breastfeeding in adverse health conditions of children like, diarrhea, fever, respiratory tract infections and malnutrition. Practices of breastfeeding were evaluated among married nurses having one a live child of less than 2 years of age by asking breastfeeding her child currently, initiated breastfeeding within half hour after birth of her child, fed colostrum to infant or discarded, exclusively breastfed till age of 6 months and maximum interval between two feeds. Data was analyzed by using SPSS version 17. Scoring method was used to assess level of knowledge and practices of breastfeeding. One mark was given for correct answer and zero for incorrect. Knowledge was categorized into good if score was more than 70%, transitory if score between 50- 70% and below 50% were labeled as having poor knowledge
Results: Out of 13 aspects asked about knowledge of breastfeeding highest knowledge was found about continuation of breastfeeding if child is suffering from diarrhea [79.31%] followed by correct knowledge about feeding of colostrum [75.86%] and about exclusive breastfeeding for 6 months [68.10%]. The duration of service was directly related with level of knowledge [p=0.0000]. Our study revealed that 29.16% nurses initiated breastfeeding within half hour of delivery, 16.66% were breastfeeding her child currently, 12.5% Fed colostrum to her child and practices of exclusive breastfeeding till age of 6 months and correct interval between two feeds was not observed by any study participant
Conclusion: There was poor knowledge and lack of proper practices of breastfeeding among nurses
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Objective: To evaluate cases presenting with parathyroid tumors and the efficacy of treatments offered
Methods: Six cases presented with bony manifestations in mandible, femur, tibia and maxilla while one presented with an overt neck swelling. Renal calculi showed in one case. All cases were subjected to assessment of serum parathyroid hormone level and radionuleotide scan.Sonography was done in addition in two of the cases . In all cases parathyroid tumors were identified and subjected to exploratory parathyroid surgery, In addition bony pathologies were subjected to excisions of the lesions
Results: In all the cases serum parathyroid hormone levels were raised.MIBI scans picked parathyroid tumors in almost all the cases. Six of the excised tumors were parathyroid adenomas while one was adenocarcinoma. Additional surgeries done in these cases include excisions of mandibular growths, maxillectomy and osteotomies on tibia and femur. All were giant cell tumours.One case with adenocarcinoma expired. The other cases showed normalization of parathyroid hormone levels
Conclusion: Parathyroid adenoma is the common benign tumor of parathyroid gland usually presenting with exaggerated parathyroid hormone levels. Ultrasound scan screening with tc99 Sestamibi scanning are most helpful in establishing the diagnosis. Parathyroid surgery is safe in experienced hands and is the standard treatment modality to reverse the morbidity associated with pathologies. In all bony lesions with a doubtful clinical diagnosis screening for Parathyroid lesions is mandatory. Gross disfigurements, functional disabilities call for excision of bony lesions
Subject(s)
Humans , Female , Male , Middle Aged , Adult , Parathyroid Glands , Parathyroid Hormone , Adenoma , Disease ManagementABSTRACT
Background: Women empowerment has been identified significant effects on many aspects of human development
Objective: To assess the effect of education and duration of marriage on women empowerment at household level
Subjects and Methods: Study design: Cross sectional descriptive study. Study place: Model town, Bahawalpur. Study duration: From 1" January 2013 to 30th June 2013. Sample size: Expecting the female literacy rate 47% in a population with 5% precision and 95% level of confidence, calculated sample size was 378. Sampling technique: It was simple random sampling. Data collection and analysis: Data was collected by using pretested questionnaire and analyzed by using SPSS version 17. Women empowerment was measured by asking ten questions. Response of each question was divided into three categories and each category was scored as, Not at ail = 1, to some extent = 2 and to great extent = 3. The composite score of each respondent was 30. The women's empowerment on the basis of composite score was divided into three levels, the score in between 1-10 = low, 11 -20 - medium and from 21-30 was taken as high empowerment.
Results: Among the illiterate group only 8% women had high level of empowerment, in primary/middle group 33.3%, in third group [matric/intermediate] 53.4%, while in graduate or above group 80.3% respondents were highly empowered. Education was significantly associated with the women's empowerment at household level [p < 0.0000]. In a group of marriage duration < 5 years 16.3% women had high level of empowerment as compared to 15.7% in 6-10 year, 45% in 11-15 years and 53% in > 16 years category. Significant association was found between duration of marriage and women empowerment [p <0.0000]
Conclusion: There is significant association between the education, marriage duration and women's empowerment at household level
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Background: Chronic subdural hematoma [CSDH], a common type of intracranial hemorrhage and one of the most common clinical entities encountered in daily neurosurgical practice tends to occur in elderly patients
Objective: To determine the frequency and risk factors of chronic subdural hematoma recurrence after burr holes surgery
Patients and Methods: This descriptive cross sectional study was conducted in neurosurgery department Nishtar Hospital Multan from 1[st] January 2013 to 31[st] December 2013. All the patients diagnosed as CSDH, confirmed on computed tomography [CT] and treated by hematoma evacuation and drainage through cranial bur hole during the study duration were included in the study. Routine computed tomography [CT] was performed in all the patients, the day after the surgery, one week after the surgery, two months after the surgery and all the patients were followed up to three months after the surgery. Preoperative and postoperative CT findings were compared to calculate the recurrence rate. Data was entered and analyzed by using SPSS version 17. P-value = 0.05 was considered significant
Results: There were 72.64% male and 27.36% female patients. 78.31% patients were = 70 years age and 21.69% below 70 years. CT demonstrated CSDH as hypo dense to cerebral parenchyma in 49.05%, isodense in 29.24% and hyperdense in 21.71%. Recurrence of chronic subdural hematoma after the bur holes craniotomy was observed in 10.8% [12] patients. Major risk factors identified for recurrence were age = 70 years and re-expansion of the brain after the surgery
Conclusion: It is concluded that recurrence of chronic subdural hematoma after burr holes evacuation is directly related with age and re-expansion of the brain after surgery
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Background: Myopia is one of the preventable cause of visual impairment
Objective: Objective of this study was to determine the frequency and risk factors for myopia among children [6-12 years] visiting Ophthalmology outpatient department of Bahawal Victoria Hospital, Bahawalpur
Patients and Methods: It was cross sectional study conducted in Ophthalmology outpatient, department of Bahawal Victoria Hospital, Bahawalpur from 1[st] July, 2012 to 30[th] June 2013. After taking ethical approval from hospital ethical committee, all the children aged 6-12 years visiting Ophthalmology outpatient department, whose parents had endorsed informed written consent, were included in the study. After collecting personal detail of each participant, and noting risk factors from their parents by using questionnaire, the visual acuity of each child was checked by using Snellen's chart. The children having visual acuity less than 6/6 in at least one eye underwent refraction by using retinoscopy after 1% cyclopentolate eye drops had been instilled at least half an hour previously. Data was entered and analyzed by using SPSS version 17. Spherical equivalents equal to or more than -0.50 D in either eye was taken as myopic. Chi square test was applied to see any statistical difference if existed and p-value
Results: Out of total 2936 children, 57.93% were myopic. 32.86% children were in the age group of 6-8 years, 54.67% in 9-11 years and 12.47% were >/= 12 years of age. 67.37% children were females. Family history of myopia was positive in 65.8% children. The reading hours of 17.3% children were 8 hours per day in 6.48%. The duration of TV watching was 4 hours in 2.02% children. 60.72% of the children were spending their time in playing video games or using computer for 4 hours
Conclusion: There is strong association of myopia with near work and parental myopia
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Background: Gestational diabetes mellitus [GDM] is associated with increased perinatal morbidity and mortality, along with maternal complications in future
Objective: The objective of this study was to determine the diagnostic accuracy of 50 gram oral glucose challenge test in the screening of gestational diabetes mellitus
Patients and Methods: It was cross sectional study conducted in obstetrics and gynecology outpatient department of Bahawal Victoria Hospital, Bahawalpur, from 1[st] March, 2013 to 31[st] October, 2013, to determine the diagnostic accuracy of 50 gram oral glucose challenge test in screening of gestational diabetes mellitus [GDM]. Sample size calculated for the study at 5% precision, 8% anticipated proportion of GDM and expecting the sensitivity and specificity as 95.3% and 48.6% respectively, from formula of sensitivity and specificity, was 416. Four hundred and sixteen primigravida and multigravida women of age 20-40 years with singleton pregnancy at 24-28 weeks of gestation visiting the obstetrics and gynecology outpatient department selected by non-probability convenient method were included in the study. 50 gram oral glucose in 250 ml of plain water was given to each participant, after one hour venous blood sample was withdrawn to measure serum glucose level and 140 mg/dl was taken as cut off value for labeling the patient as screen positive or negative. Regardless of the results of 50 gram oral glucose challenge test all the participants were further evaluated by oral glucose tolerance test [OGTT]. Before doing OGTT all the patients were advised to come in the morning with overnight fast of 8-12 hours [plain water was allowed]. After taking blood samples for fasting blood glucose level, 75 gram oral glucose was given and after two hours blood glucose level was measured again. Fasting blood glucose level >/=110mg/dl and after 2 hours of taking 75 gram oral glucose, serum level of >/=160mg/dl was taken as cut off values to label as test positive or negative. Data was entered and analyzed by using SPSS version 17. Accuracy of OGCT in terms of sensitivity, specificity, positive predictive value and negative predictive value was measured by assuming OGTT as gold standard test
Results: Gestational diabetes mellitus was recorded in 22.59% on OGCT. On OGTT 19.95% were found to have GDM. Sensitivity was calculated as 85.54%, specificity 93.03%, positive predictive value 75.53% and 96.27% negative predictive value
Conclusion: Our results suggest that 50 gm OGCT is a test with high accuracy and can be used as a screening test for GDM in all antenatal clinics
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To assess the knowledge and practice of preventive measures against dengue fever among medical students of Quaid-e-Azasm medical college and engineering students of Islamia university, Bahawalpur. Cross sectional descriptive study. September 2012 to December 2012. Quaid-e-Azam Medial College and Engineering wing of Islamia University Bahawalpur. Sample size calculated for study 8 by expecting prevalence of knowledge 78% in population of 1000 in each group with 5% margin of error and at 95% confidence interval was 263; by adding 10% response error sample became 290 for each population. Individuals for study were selected by simple random sampling and interviewed by using preformed questionnaire. Obtained data was analyzed by using SPSS version 11. For categorization of knowledge and preventive practices against dengue fever into good, satisfactory insufficient and poor scoring was done. knowledge of protective measures against dengue fever was found significantly better among medical than engineering group [p<.000]. Knowledge of personal protective measures against dengue fever was adequate i.e. more than 90% in both groups had knowledge. Knowledge regarding environmental protective measures as screening and spraying of rooms was adequate i.e. >85% while this knowledge with regard to covering of collected water, disposal of broken bottles and tins, daily change of water in room cooler and space spray was 50% or less. However, knowledge of biological control for mosquito breed with regard to use of snail was very poor i.e. 20% or less. As for as the practices of preventive measures were concerned both groups had no significant difference which were very poor in all aspects except screening of rooms which was more than 90%. There is dire need for improvement in both knowledge and practices of preventive measures against dengue fever among students and general population
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To find disinfection and sterilization practices of laryngoscope in different hospitals. Descriptive study. Combined Military Hospital Gujranwala, from Jan 2010 to Jan 2011. laryngoscope decontamination practices in different hospitals were evaluated in this study which was based on a telephonic structured questionnaires. Preset questions were asked on phone from operation room technicians of 50 different hospitals. For clarification and confirmation of procedure anesthesiologist of the hospital was contacted. Laryngoscope decontamination practices were asked as per questionnaire and data collected was recorded and analyzed. Results were documented and compared with studies regarding laryngoscope decontamination practices of different countries. Most exercised methods were manual decontamination with simple gauze [50%], alcohol gauze [11%] or tap water [27%]. The use of disposable blades and sheathing of blades was not practiced by any of the hospitals. Similarly chemical disinfectants were used rarely [2%]. Rinsing laryngoscopes with water [always 27%, sometime 23%] was very common while, autoclaving or sheathing of blades was not done in any of the hospital. The rate of different postoperative infections is on the increase in our hospitals and one likely contributing source in contaminated laryngoscopes. Lack of awareness and poor practices among health care professionals, over work and economic constraints are the major contributing factors which need to be controlled by adhering to international standards
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Humans , Laryngoscopes , Hospitals , Disinfection , Sterilization , Surveys and QuestionnairesABSTRACT
To find out utility of a modified method of creating pneumoperitoneum for laparoscopic surgery. Quasi-experimental study. Ziauddin Medical University Hospital and Kutiyana Memon Hospital, Karachi from September 2007 to March 2008. The modified method for the creation of pneumoperitoneum for laparoscopic surgeries was applied to all patients. Approximately 1.2 cm vertical incision was made below the umbilicus and subcutaneous fat separated by blunt dissection till the rectus sheath visualized. A small incision approximately 5 mm was made in the full thickness of linea alba without opening the peritoneum. An artery forcep was then introduced in the peritoneum to open it. Rate of success of the procedure, time from sub umbilical incision to insertion of telescope and complication / difficulty encountered during the procedure were recorded in the operative notes and pre designed proforma. Results of the present technique was analyzed and compared with published literature in terms of visceral injury and air leak. A total of 55 patients were included in this study. Scar of previous abdominal surgery was present in 16 patients. Mean time from skin incision to insertion of telescope was 55 seconds [ranging from 35 to 95 seconds]. Trocar insertion into extra-peritoneal space occurred in 6 patients. Withdrawl and re-insertion into peritoneal space was successful in all cases except in 2[3.63%] patients in whom procedure was converted to open technique. No bowel or visceral injury occurred during the procedure. Gas leakage was not encountered during entire surgical procedure in all the patients. This modified technique for the creation of pneumoperitoneum for laparoscopic surgery is safe, quick and without the use of any specialized or disposable instruments
Subject(s)
Humans , Male , Female , Laparoscopy/methods , Surgical InstrumentsABSTRACT
A 14 years female of Afghan origin reported with maxillofacial and tibia growths causing progressive deformities since nine months, both were giant cell tumours on histopathology. Serum calcium was normal, but the parathyroid hormone was exaggerated [678pg/ml]. Ultrasound indicated and Tc-99m Setamibi scan confirmed a left lower parathyroid lesion. A 4cm length mass was identified, removed and proved to be a parathyroid adenoma. Two weeks later a subtotal maxillectomy and six weeks later anterior wedge osteotomy of the tibia were carried out. Serum parathyroid hormone level normalized