efficacy of normal saline irrigation to prevent surgical site infection

The aim of the study was to evaluate the efficacy of normal saline irrigations to prevent surgical site infection [SSI]. A comparative study. The study was conducted at surgery and gynecology Dept CMH Chunian from 1[st] Jan 2012 to 1[st] Nov 2012. Two hundred clean surgical and gynecological cases were included in the study. Hundred cases which were randomly selected had their wound washed with warm normal saline for 60 sec and then mopped dry with clean swabs. Subcuticular Stitches were applied to all the 200 cases. The surgical wounds were examined on 3[rd] post operative day and then finally on 15[th] post operative day. Patients with wound infection developed pain at the operation site and fever on third post operative day. Wounds were examined for swelling, redness, discharge and stitch abscess. Routine investigations were done as per protocol. Wound swabs were taken for culture and sensitivity. The study was carried out on 200 clean cases [general and gynecological]. They were 130 females and 70 males. The 100 cases whose wounds were washed with normal saline only 1 patient developed wound infection while in the other group who did not had saline irrigations 8 patients out of 100 developed wound infection. The commonest infective organisms were staphylococcus aureus and the other organisms were streptococcus pyogenes, proteus, Klaebsiella, E coli and pseudomonas. No MRSA was detected. In our study washing the wound with warm normal saline for 60 seconds resulted in the wound being infection free. Wound infection is associated with delayed wound healing, prolonged hospital stay and increased economic pressure on the patient and on the state

Learning from errors in radiology to improve patient safety

To determine the views and practices of trainees and consultant radiologists about error reporting. Cross-sectional survey. Radiology trainees and consultant radiologists in four tertiary care hospitals in Karachi approached in the second quarter of 2011. Participants were enquired as to their grade, sub-specialty interest, whether they kept a recod/log of their errors [defined as a mistake that has management implications for the patient], number of errors they made in the last 12 months and the predominant type of error. They were also asked about the details of their department error meeting. All duty completed questionnaires were included in the study while the ones with incomplete information were excluded. A total of 100 radiologists participated in the survey. Of them 34 were consultants and 66 were trainees. They had a wide range of sub-specialty interest like CT, Ultrasound, etc. Out of the 100 responders, 49 kept a personal record/log of their errors. In response to the recall of approximate errors they made in the last 12 months. 73 [73%] of participants recorded a varied response with 1 - 5 errors mentioned by majority i.e. 47 [64.5%]. Most of the radiologists [97%] claimed receiving information about their errors through multiple sources like morbidity/mortality meetings, patients' follow-up, through colleagues and consultants. Perceptual error 66 [66%] were the predominant error type reported. Regular occurrence of error meetings and attending three or more error meetings in the last 12 months was reported by 35% participants. Majority among these described the atmosphere of these error meetings as informative and comfortable [n = 22, 62.8%]. It is of outmost importance to develop a culture of learning from mistakes by conducting error meetings and improving the process of recording and addressing errors to enhance patient safety

Combat trauma experience at forward treatment centre during Swat operation

To have an overview of combat trauma experience at Forward Treatment Centre during Swat Operation. Descriptive study. Forward Treatment Centre of a medical battalion in Swat from Jan 2009 to August 2009. All battle casualties of different age groups operated under general anaesthesia were included in the study. Surgeries performed under local anaesthesia were excluded. Relevant information was recorded in specially prepared proforma. Two hundred and sixty eight surgeries were performed under general anaesthesia over the course of eight months. Twenty two [8.2%] were officers, 12 [4.5%] JCOs and 234 [87.3%] were soldiers. Majority of the casualities were between 20 -30 years of age [86%]. 73.9% of the casualities reached Forward Treatment Centre within 4 hours while 3.3% reached after 24 hrs. Most of the patients sustained injuries due to bullets [50.7%] and splinters [39.9%]. Most of the patients were putting on bullet proof jackets at the time of injury and sustained injuries to the limbs [237/268, 88.4%]. Blood transfusion was carried out in 32 [11.9%] cases. Fifteen [5.6%] cases required less than two and 17 [6.3%] cases required more than two units of blood transfusion. Most of the casualities were sustained by younger age group and were caused by bullets and splinters. Majority of the injuries were sustained on the limbs and less on the chest and abdomen. Blood transfusion and timely evacuation to a Forward Treatment Centre providing effective trauma surgical care to combat casualities saved a number of lives

Percutaneous cholecystostomy [PC] in the management of acute cholecystitis in high risk patients

To determine the role of ultrasound -guided percutaneous cholecystostomy [PC] regarding complications and outcome in the management of acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management. Observational case series. The study was carried out at The Aga Khan University Hospital, Karachi, from January 2003 to December 2007. The study included patients admitted with acute cholecystitis considered unfit for immediate surgery but not responding to conservative management. Percutaneous cholecystostomy was conducted under ultrasound guidance. The studied variables included patients' demographics, co-morbid, ultrasound findings of biliary tree, indication for percutaneous cholecystostomy, its route, complication during or after procedure, patient's clinical outcome [upto 48 hours] and 30 days follow-up. Those with incomplete medical record and follow-up were excluded. Data were analyzed and results compiled using SPSS 16.0 version. Mean and standard deviation for quantitative variable like age was derived. Proportions were computed for complications and patient's clinical outcome. Forty one patients with complete medical record were studied including 15 [37%] males and 26 [63%] females. Mean age was 65 +/- 13.5 years. Indications for PC included calculus cholecystitis in 25, acalculous cholecystitis in 10, empyema in 04 and gallbladder perforation in 02 patients. No complication was seen during or after procedure in 31 [75%] patients. Complications occurred in 10 [25%] patients including vagal reaction, pain during procedure, tube blockage, catheter dislodgement and bile leakage. Favourable clinical response [improvement in clinical symptoms] was noted in 34 [83%] patients. Seven [17%] patients did not show any improvement in clinical condition after the procedure. On 30 days follow-up, 9 patients had undergone cholecystectomy, 5 [12%] patients expired due to underlying clinical conditions and the rest were settled without requiring an immediate cholecystectomy. There was no direct procedure-related mortality. Imaging guided PC is a safe and effective procedure for immediate management of non-resolving acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management

Pattern of harmful practices towards the newborn in a Pakistani community

To assess the pattern of harmful practices which can affect the neonatal mortality in our community. It was a cross-sectional study based on recall of child birth and rearing events by the respondents. Place and Duration of the Study: The study was carried out in Union Council 45 [UC 45] of Rawalpindi District, which had a population of 25000 people with mostly low income families living on either side of Nalla Lai. The survey was carried out 20th July to 20th September 2006. One hundred mothers were interviewed. A questionnaire was used to identify these practices in an urban setting. It was found that many harmful neonatal practices were prevalent in the study population most common being the powder sprinkling on the baby [94%], removal of vernix caseosa [81%], pre-lacteal feeding [79%], unhygienic cord practices [74%], and application of contaminated Surma [73%]. Moreover mothers are mostly unaware of the consequences of their practices, however, they were found receptive and eager to know whether their practices were beneficial or not. The study highlights that many harmful neonatal practices are prevalent in the society. Larger study is required to determine the quantum effect of traditional harmful neonatal practices to the newborn mortality in order to prioritize our actions and develop strategies

Accidental poisoning in children: frequency and outcome of the cases at a military hospital

To determine the frequency of accidental poisoning by various agents and their associated outcome in children. Descriptive Study. The study was carried out in emergency department at PNS Shifa hospital Karachi, from January 2007 to December 2008. A total of 200 patients reported with accidental poisoning during the study period. Detailed history and examination regarding the nature of poisoning was taken. Relevant investigations for purpose of diagnosis were carried out. Mortality and morbidity was noted on predesigned proforma. Total 200 patients were admitted with accidental poisoning during the study period. 155[77.5%] of patients belonged to less than 5 year age group. Most frequently ingested poison was kerosene oil [51%], followed by insecticides [17.5%], Oral route was involved in majority of cases 194[97%]. Complications were observed in 6% of cases, Pneumonia was the most frequently occurring complication in 8 [4%] cases of kerosene oil ingestion, followed by seizures in 2 [1%] cases of insecticide ingestion. No mortality was reported in this study. Acute childhood poisoning is a significant public health problem affecting mainly toddlers. Main substances responsible for acute poisoning are Kerosene oil, insecticides, bleach and drugs

Malignant phyllodes tumour as an intracystic growth with osteosarcomatous differentiation

Phyllodes tumour is an uncommon fibro epithelial tumour of breast that often presents clinically as a rapidly enlarging lump. On mammography it appears as a soft tissue density well circumscribed mass. Ultrasound shows it to be a solid hypoechoic mass with small cystic spaces. A case of malignant phyllodes tumour with an atypical appearance of intracystic tumour on sonography is reported with pertinent imaging features and histopathological diagnostic criteria. The tumour had undergone osteosarcomatous differentiation

Follicular carcinoma thyroid in pendred syndrome

Pendred syndrome is a rare inherited disorder of bilateral sensorineural deafness with goitre. Presence of follicular carcinoma thyroid makes it even rarer. A case of a young girl is described with the features of Pendred syndrome and euthyroid state. Follicular carcinoma of thyroid was detected on histopathology requiring re-tailoring of the management