Seroprevalence of transfusion transmitted infections among different blood group donors at blood bank LUMHS, Hyderabad

Objectives: To study the prevalence of HBsAg, Anti-HCV, HIV, Syphilis and Malaria in blood donors

Methods: This is a cross sectional descriptive study, conducted at Blood bank and Transfusion center at Liaquat University of Medical and Health Sciences [LUMHS] Hyderabad, during the period from January, 2014 to June, 2015.A total of 4683 blood donors were screened for HBsAg, Anti-HCV and HIV on Architect 20001 [manufactured by Abbott], employing chemiluminescent microparticle immunoassay [CMIA]. For Syphilis, VDRL ICT kits were used and Malaria parasite was screen through MP slides. Blood grouping was performed by both forward and reverse methods

Results: This study showed a high frequency of HBsAg, VDRL and malaria positivity among the O-ve blood group donors, i.e. 3.70%, 9.25% and 0.61% respectively. Blood group B-ve individuals were commonly infected with HCV [12.5%] as compared with all other blood group donors. HIV is more commonly reported in A+ve blood group individuals. Blood group O+ve is more prevalent [37.41 %]

Conclusion: High frequency of HCV infection in blood donors advocates implementation of strict screening policy for donors and public awareness campaigns about preventive measures to reduce the spread of this infection as well as other transfusion transmissible infections

Functional adaptation of thyroid gland in postmenopausal women with and without diabetes

Background: Prevalence of thyroid disorders in general population and in patients suffering from diabetes mellitus is inconsistent in different populations. The combined effect of thyroid dysfunction and diabetes in postmenopausal age may have its specific adaptations from the normal set up. The thyroid profile can provide a link between thyroid and diabetic postmenopausal women of variable ages. The study was designed to compare Thyroid stimulating hormone [TSH], Total thyroxine [TT4], Total triiodothyronine [TT3], Free thyroxine [FT4] and Free triiodothyronine [FT3] in non-diabetic postmenopausal, diabetic postmenopausal and premenopausal non-diabetic females

Methods: A total of 78 females from Lahore, Pakistan were recruited for the study and were divided into three groups: diabetic postmenopausal [n=32], non-diabetic postmenopausal [n=33] and premenopausal non-diabetic [n=13]. Participant’s serum sample was collected after written informed consent and analyzed for the above mentioned thyroid parameters by using ELISA

Results: TT4 was significantly greater in diabetic post-menopausal as compared to premenopausal. In diabetic subjects TT3 and FT3 were significantly lower as compared to non-diabetic postmenopausal. Compared to diabetic postmenopausal subjects FT3 level was significantly greater in premenopausal subjects

Conclusion: Thyroid gland appears to adapt its function in postmenopausal diabetic and non-diabetics. However, studies on larger population are required for a clear picture

Early and late outcome of coronary artery bypass grafting surgery in patients with poor left ventricular function

Objective: our aim of study was to determine early and late outcomes of CABG in patients with poor left ventricular function. The CABG surgery is beneficial in patients who have poor left ventricular function manifested by an ejection fraction 30% or even less. These are the high risk patients but CABG surgery not only promotes their survival but also improve their functional status. They are easy victims of increased operative mortality and diminished long term survival

Methods: in our study we identified 63 patients who underwent CABG surgery despite poor LV function. Data was collected during their follow up visits or telephonic follow up conducted by us. We used pre op. IABP in 2[3.17%] patients. Among these 63 patients 36[57.14%] were documented as healthy and Stable, 9[14.29%] were expired during follow up and in 18[28.57%] follow up was not continued because 4[6.35%] have no contact numbers and 14[22.22%] phones were switched off. The average duration from 2008 to 2015 was taken to be 42.5 months approximately. Each patient necessarily received at least one IMA. : The surgical strategy included approach through median sternotomy. All cases were started as off-pump CABG. Elective conversion to on-pump CABG was done for cases not tolerating off-pump

Results: in this retrospective study we have analyzed the early and late outcomes of CABG in low EF group. Main findings of the study are an acceptable hospital mortality i.e. mortality rate among patients with EF <30% is 1.59% at our tertiary care center However, post-surgery complications prevailed.3 [4.7%] patients encountered deep wound infection and same ratio suffered renal failure. We observed the early outcomes i.e. in hospital mortality evaluated to be 1.58%. These results reflect improving results of surgery in this high risk group

Conclusion: our study demonstrated that all of our patients received at least one arterial graft i.e. internal mammary artery. The minimum standard set by STS is that at least 95% of the patients must receive internal mammary artery. This contributes to the survival benefit of the patients and also improves the quality of life and reduces reoperation rates. In this retrospective study we have analyzed the outcome of CABG in low EF group. Main findings of the study are acceptable hospital mortality. We concluded that acceptable morbidity and mortality rates prevailed among this high risk group at our tertiary care center. We believe that improvements in cardiac anesthesia, surgical technique, extracorporeal perfusion, perioperative care and postoperative management have contributed significantly to better outcomes

Is laparoscopic cholecystectomy a safe treatment option in empyema of gall bladder?

To find out the effectiveness and safety of laparoscopic cholecystectomy for treatment of empyema gallbladder. Quasi-experimental study. PNS Shifa Karachi and CMH Lahore, Pakistan from January 2010 to August 2013. Out of 493 patients who underwent laparoscopic cholecystectomy [LC] by a single consultant surgeon during the study period, 40 patients who had empyema gall bladder on laparoscopic findings were included in the study. All patients with diagnosis of acute cholecystitis [n=117] who had no pus present in gall bladder and patients with diagnosis of biliary colic or chronic cholelithiasis [n=336] were excluded from the study. Forty patients were diagnosed to have empyema gall bladder. LC was successfully completed in 39 patients [97.5%]. In one patient [2.5%] the procedure was converted to open cholecystectomy [OC] due to finding of cholecystoduodenal fistula on laparoscopy. Mean operating time was up to 58.62 +/- 26.33 minutes. Postoperative complications occurred in 3 [7.5%] of the operated patients. Mean duration of hospital stay was 1.7 +/- 2.09 days. One patient with co-morbidity of diabetes mellitus died of septicemia resulting in a mortality rate of 2.5%.In laparoscopy for empyema gallbladder the complications are related to the advanced disease process and not to the approach. In skilled hands, laparoscopic cholecystectomy can be performed successfully in patients with diagnosis of empyema gallbladder

Laparoscopic cholecystectomy in acute gallstone pancreatitis in index hospital admission: Feasibility and safety

Acute gallstone pancreatitis is quite common throughout the globe. Conventionally definitive cholecystectomy has been delayed in index hospital admission. Since the last decade timing of cholecystectomy is gradually shifting towards the earlier phase of disease and currently gallstone pancreatitis is being evaluated as a further indication for laparoscopic cholecystectomy. There is also great concern regarding compliance of patients for definitive surgery due to poverty, ignorance and illiteracy in developing countries. The aim of this study was to assess the feasibility and safety of laparoscopic cholecystectomy as a definitive treatment in patients with mild and resolving gall stone pancreatitis. This was a prospective study from July 2009 to June 2012. Patients were diagnosed by clinical examination, biochemical tests, ultrasonography and contrast enhanced CT. Patients with mild form of the disease [Ranson Score <3] and who showed clinical improvement were offered laparoscopic cholecystectomy in index hospital admission. Those who were unfit for surgery were referred for endoscopic sphincterotomy. Common bile duct stones were excluded preoperatively. A total of 38 patients were admitted with acute gallstone pancreatitis in the study period. The mean age of patients was 46.3 years with male to female ratio of 11727. 22 [57.8%] patients were selected for laparoscopic cholecystectomy and procedure was completed successfully. Ten [26.3%] patients were referred for ERCP and endoscopic sphincterotomy and 11 [28.9%] were managed by conservative treatment and went without any definitive treatment. Mean duration of time from onset of symptoms and laparoscopic cholecystectomy was 7 days [range 4-10]. Mean duration of operative time was 45 minutes and hospital stay was 7 days. There was no operative mortality. No major intra-operative or post-operative complication was recorded, two patients [9%] had minor complications. Laparoscopic cholecystectomy can be safely performed in selected cases of mild gallstone pancreatitis in order to prevent further attacks of acute pancreatitis and Other consequences Of d6l3y8[] treatment. Furthermore it resolves the problem of noncompliance of patients in third world countries where many patients are lost for definitive treatment

Fistula in ANO; presentation and postoperative outcome of the different surgical procedures in low type

This study was planned to find out the clinical presentation and postoperative outcome of different surgical procedure in low type in low fistula in Ano. Prospective observational study. Study was conducted in teaching hospital setting at LUMHS Jamshoro, Zia ud Din Teaching Hospital Karachi and DHQ JMC Teaching Hospital Charsadda. Liaquat University in Surgical Unit-1 Jamshoro from May 2010 to June 2012. One seventy cases of low type fistula in Ano with single external opening, irrespective of age and sex admitted in surgical unit-l, were examined. Mean age was 37 years, patient's rages from [15-60 years]. Patients having high type fistula in ano identified pre and per operatively excluded from the study. A detailed history physical examination including local examination of anorectum focusing on the level of internal opening. Investigation like fistulogram done in selected case. Fistulectomy and fistulotomy performed in all these cases and patient followed up minimum upto the 6 months time. Maximum Number of cases were seen in 3rd,4th, decade of life 50 [29.6%] and 64 [37%] respectively. Mean age was 37 ranges from 15 to 60 years. Out of 172 patients 142 [85.7%] male and 24 [14.3%] female. Male to female ratio was 6.1:1. Majority of patients one forty two [82%] presented with discharge. Discharge along with swelling in 132 [76.7%]. Hundred twelve [65%] underwent fistulectomy, 38 [22%] of the patients got fistulotomy and [12%] of patients underwent fistulectomy along with haemorrhoidectomy and fissurectomy. A total of 72 [41.4%] patients experience different post operative, surgical and anesthetic complications. Conclusions: Incidence of low type fistula in ano is higher in 3rd and 4th decade of life. The disease was found more common in male, discharge, pain, itching are common symptoms of low type fistula in ano. In low type fistula in ano fistulotomy is safe procedure. Post operative complications can be prevented by careful treatment efforts

Biliary bypass surgery - Analysis of indications and outcome of different procedures

This study reports the indications and outcome of various biliary bypass surgical procedures from a single centre over a period of 10 years. This is a prospective observational study conducted over a period of 10 years [January 2001-december 2010]. A total of 1500 patients were included, who underwent pancreatico-biliary surgery due to common bile duct [CBD] stones, congenital anomalies of biliary tree, unoperable pancreatico-biliary malignancies, CBD strictures and cases who developed iatrogenic biliary injuries during cholecystectomy [both open and laproscopic] during this period of time. The patients who required biliary bypass surgery were further analysed for indications and outcome. Out of 1500 patients 83 [5.53%] required biliary bypass surgical procedures. The CBD stones were observed as the most common indication [25.3%], followed by CBD injuries after open [10.84%] or laproscopic-cholecystectomy [14.46%], carcinoma head of pancreas [12.05%] and CBD obstruction [14.46%] either due to CBD strictures or unknown distal obstruction. Roux-en-Y-hepatico-jejunostomy [26.51%] was the most frequently performed procedure, followed by choledochoduodenostomy and Roux-en-Y choledocho-jejunostomy [i.e. 25.3% and 12.05% respectively]. Roux-en-Y biliary bypass procedure was observed to be associated with better outcome in terms of rate of complications as well duration of hospital stay. Biliary bypass surgical procedures are the better options to restore the continuity of biliary system in patients with iatrogenic biliary tree injuries and un-operable pancreatico-biliary malignancy. Roux-en-Y biliary bypass procedure is safe and problem solving method in these cases

Factors responsible for prolonged postoperative hospital stay after laparoscopic cholecystectomy

To identify various factors which prolong post-operative hospital stay after laparoscopic cholecystectomy. This is an observational prospective study conducted at a teaching hospital over a period of five years [Jan 2005-Dec 2010] and includes 580 patients of symptomatic cholelithiasis, admitted and treated by laparoscopic surgery. All patients were observed from 1st postoperative day to date of discharge and different operative, postoperative and patient related variables were recorded on a proforma which were found responsible for an unduly prolonged post-operative stay in the hospital. The duration decided for short stay was 48 hours and duration more than that was considered as prolonged stay. Out of 580 patients, 187 [32.24%] had prolonged stay extending from 3-28 days. Majority of patients presented in 4[th] and 5[th] decade [60.52%] with pain in right hypochondrium [58.79%] and pain in right hypochondrium combined with pain in epigastrium [27.6%] as main clinical features. Twenty eight variables were identified comprising of 10 patients related [15.86%], 12 surgery related [16.55%] and 6 post-surgery related [16.38%] which contributed to prolong the hospital stay. Patients having co morbid conditions, difficult operative procedure and major postoperative complications were main factors for prolonged stay. The prolonged post-operative hospital stay can be reduced by careful pre-operative assessment, meticulous surgery and proper post-operative management

Comparative study of conventional open versus laparoscopic cholecystectomy for symptomatic cholelithiasis

To compare the results of conventional open with laparoscopic cholecystectomy regarding their operative time and postoperative parameters. This is a comparative study of 400 patients of cholelithiasis operated for either open or Laparoscopic cholecystectomy during five years from January 2004 to December 2008. The cases were compared for operative time and various postoperative parameters in order to assess the advantages and disadvantages of each procedure. The patients were divided into two groups; group OC for open and group LC for laparoscopic cholecystectomy, each comprising of 200 cases. The operative time was longer in OC than LC patients with mean operative time of 54.16 +/- 11.94 minutes in OC and 46.89 +/- 14.83 minutes in LC group [P<0.001]. The overall frequency of postoperative complications was relatively high in OC group 50.5% as compared to LC [37%] including all minor and major problems with combined morbidity of 43.75% [P<0.001]. The mean hospital stay was shorter in LC group as compared to OC group i.e. 3.02 +/- 1.75 [range 1-5] days versus 5.56 +/- 9.8 [range 4-10] days respectively. Return to normal work was also significantly shorter in LC group i.e. 18.06 +/- 5.16days [range 1-4 weeks] as compared to 31.61 +/- 7.6 days [range 3-6 weeks] in OC group with p value <0.001. The laparoscopic cholecystectomy is superior to open cholecystectomy due to short operative time, early mobilization and fast recovery, less postoperative pain and complications, short hospital stay and early return to work