Comparision of efficacy of levocetirizine with montelukast and levocetirizine alone in persistent allergic rhinitis

To compare the efficacy of levocetirizine with montelukast and levocetirizine alone in patients with persistent allergic rhinitis in our setup. Patients with symptoms of AR attending ENT clinic were registered and divided into two groups based on drug given. Patients with odd numbers were included in group A receiving levocetirizine 5mg with montelukast 10mg once daily while patients with even numbers were included in group B receiving only levocetirizine 5mg once daily. Data was collected at visit 1 prior to medication, visit 2 one week after medication and visit 3 two weeks after medication. Medication history review, nasal symptom assessment and anterior rhinoscopy were done at each visit. Patients were evaluated for rhinorrhea, sneezing, nasal itching and nasal obstruction on a scale. Total symptom complex score [TSCS] was calculated by adding scores of all four variables under study using proforma. Lower the score more effective will be the drug. One hundred twenty four patients were included in study; 63 were male and 61 were female. TSCS was 9 -10 in 73.3% patients at visit 1 in levocetirizine + montelukast group that improved to 4-5 in 28.3% and 3- 4 in 65% patients at visit 2 and 3 respectively. Patients receiving levocetirizine alone had TSCS of 9 to 10 in 52.9% at visit 1 with an improvement to 3-4 in 9.4% and 49.1% at visit 2 and visit 3 respectively. Levocetirizine with montelukast is superior to levocetirizine alone in controlling overall symptoms of AR.

Surgical management of liver trauma

To compare the results of operative management of hepatic trauma treated with suture hepatorraphy alone and with suture hepatorraphy in combination with hepatotomy [resectional debridement with individual vessel suture ligation] spongston, and omental packing. Cross-sectional comparative study. The study was conducted at Bahawal Victoria Hospital Quaid-e-Azam Medical College Bahawalpur, from Jaunary 2007 to December 2010. A total of fifty patients were divided into two groups. Group A comprising 25 patients [50%], was treated with suture hepatorraphy alone while the Group B was treated with suture hepatorraphy in combination with hepatotomy, omental packing and spongston. Of the 50 patients of liver trauma mean age was 28.14 years [SD +/- 12.12y] and 94% were males. Sixty percent injuries were blunt in nature and 40% penetrating. Of penetrating trauma 75% were firearm injuries and 25% stab wounds. Right lobe was the site of injury in 56% of patients. Severity of injury was grade I in 14%, grade II in 40%, grade III in 36% and grade IV in 10% .Postoperative complications were sepsis in 24%, bile leak in 16% and recurrent hemorrhage in 24% of group A patients, whereas, in group B patients the sepsis was 8%, bile leak 8% and recurrent hemorrhage 4%. Mean hospital stay in group A was 26.44 days [SD +/- 13.56] while in group B it was 20.20 days [SD +/- 11.06]. In group A patients, the survival rate was 96% while it was 100% in group B. Once decided for Surgical management for blunt and penetrating liver trauma, suture hepatorraphy in combination with hepatotomy, omental packing and use of spongston for hemostasis had marginally better survival rate, reduced hospital stay and significantly fewer postoperative complications as compared to simple suture hepatorraphy

Acute cholecystitis; early versus interval cholecystectomy for a comparative study

Gallstones are common biliary pathology. The Vast majority of subjects are asymptomatic. About 0.2% of the population suffering from gallstones develop acute cholecystitis every year. In case of acute calculous cholecystitis, cholecystectomy can be performed early i.e during the same admission or interval i.e after 6 weeks of conservative management. To compare the early and interval cholecystectomy in acute calculous cholecystitis for morbidity, postoperative hospital stay, total hospital stay and complications. Study Design: Quasi-experimental study. Department of Surgery Bahawal Victoria Hospital Bahawalpur. Two year study from December 2007 to December 2009. Sixty patients fulfilling the inclusion criteria were selected for this study. The patients were divided into two groups. Group A patients were managed by early cholecystectomy and group B patients by interval cholecystectomy. Postoperatively patients were evaluated for postoperative hospital stay, total hospital stay and postoperative complications. The mean age of the patients in group A was 42.2 + 1 0.7 years and in group B was 42.2+ 1 0.7 years. The Male to female ratio was 1 :4 in both groups. The mean postoperative hospital stay in group A was 4.0+ 1 .Sdays and in group B was 3.8+ 1 .4 days. The mean total hospital stay in group A was 6.5 + 1 .7 days and in group B was 10.2 + 1 .3 days. The P value was less than 0.001, which was significant. In distribution of postoperative complications, in group A there were 1[3.3%] injury to biliary tree, 4[13.3%] wound infection, 1[3.3%] wound haematoma, 3 [10%] seroma and 1[3.3%] wound dehiscence. While in group B there were 1 [3.3%] injury to biliary tree, 3[10%] wound infection,2 [6.7%] wound haematoma, 2[6.7%] and no patient of wound dehiscence. Our study suggests that early cholecystectomy is a better treatment option than interval cholecystectomy because it has less total hospital stay, needs single hospital visit and has no risk of developing complications during wait for surgery

Retained foreign bodies; afterintraabdominalsurgery-acontinuing problem

[1] To look into clinical presentations of intra-abdominal foreign bodies; [2] To document surgical procedure performed. [3] To see measures for prevention. Observational case series. Bahawal Victoria Hospital Bahawalpur. Period: From 1 .06.07 to 31 .5.08. Eleven patients with retained having intra-abdominal foreign body were treated. Relevant history, clinical examination and necessary investigations were done. Exploratory laparotomy was done in 1 0 cases to remove the foreign body and in one case foreign body passed from the rectum without laparotomy. Out of 11 cases, 54.54% are males and 45.45% were females. Operated in emergency 81.81% and elective 18.18%. 90.91% were operated in periphery and 9.09% in the tertiary care centre. Clinical presentations were intestinal obstruction [27.27%], intraabdominal abscess [13.18%], Discharging sinus [18.18%], mass abdomen [18.18%], entero cutaneous fistula [9.09%], peritonitis [9.09%]. Exploratory laparotomy was done in 90.91%, to remove the foreign body and in 1 case passed per rectum. Retained foreign bodies presented as intestinal obstruction, abscess, sinus fistula mass, or peritonitis. It is avoidable iatrogenic surgical complication, mostly found in operations done in emergency and at peripheral hospitals. Exploratory laparotomy remains the mainstay of treatment to remove the intra-abdominal foreign body. Surgeon should be vigilant to avoid mishap by check on counting, tucking sponge, blackboard counting, examining abdomen, screening in suspicious case and claim for radio-opaque sponges. Referral system needs improvements for in time adequate treatment

Osteomyelitis of the foot in diabetic patients

To find out the proportion of osteomyelitis [grade -III] in patients of diabetic foot and their out-come and how can we decrease the amputation rate in these patients. DESIGN: A descriptive and observational study.PLACE AND DURATION OF STUDY: Patients with diabetic foot, admitted in Surgical Unit I, B.V.Hospital, Bahawalpur, from January 2000 to January 2003 Patients were assessed for prevalence and management of grade III diabetic foot especially with regard to incidence, age and sex group, clinical presentation and various surgical options. Necessary investigations including x-ray foot, ECG, serum urea and creatinine, pus culture and sensitivity were carried out. Diabetes was controlled on insulin on the basis of serum sugar and urine sugar chart. A total of 80 known diabetic patients were studied, out of these 58 were male and 22 female. In this study of 80 cases of diabetic foot, majority of patients [58.5%] were male in fifth and sixth decade of life. Male to female ratio was 2.8:1. Involvement of foot was usually confined to forefoot involving the big or little toe, with 66.6% osteomyelitis of distal phalanx. In majority of the cases [52.5%], patients presented with grade-III diabetic foot with bone involvement and in 22.5% of the cases with localized gangrenous [grade-IV] diabetic foot. History of penetrating trauma was present in 35% of cases followed by peripheral neuropathy in 30% of cases and corn and callosities in 15% of cases. Patients with grade-III diabetic foot were advised flouroquinolones and clindamycin regime was used in 50% of cases after c/s. In 25% of the cases flouroquinolone+MTZ were used with good response while in 6.25% of cases of septicemia, 3rd generation cephalosporins were used. Toe and ray amputations were done in 35% and 16.25% of cases respectively. Below knee amputation was performed in10%, above knee amputation in 2.5%, calcaneal resection in1.25%. Wound infection was the main complication in 25% of the cases. Once osteomyelitis is established, its' hard to treat and end result may be some kind of amputation. The basic principle of the management include early detection of diabetic foot, early control of infection, control of diabetes and wound care in the form of debridement. It is evident that early diagnosis demands a method of seeking the patients rather than waiting for the patients

Management of diabetic foot infections

To determine the infecting agent in diabetic foot infection with the susceptibility pattern, and to evaluate the effect of wound infection, vasculopathy, neuropathy and control of diabetes mellitus on the outcome of the patients. Design: A descriptive and observational study. Place and Duration of Study: Patients with diabetic foot, admitted in Surgical Unit I, B.V. Hospital, Bahawalpur, from April 1999 to April 2000, were included in this study. Subjects and A total of 60 known diabetic patients were studied, out of these 47 were males and 13 females. They were assessed for angiopathy, neuropathy and extent of foot involvement. Necessary investigations, including x-ray foot, ECG, serum urea and creatinine, pus culture and sensitivity were carried out. Diabetes was controlled on insulin on the basis of serum sugar and urine sugar chart and treated accordingly. The most common age of foot involvement was between 40-70 years. Right side was involved more often than the left [67%: 37%]. Most of the infections were due to Staphylococcus [50%], Pseudomonas [25%] and Streptococci [8%]. Antibiotic was started based on sensitivity report. Fluoroquinolone plus clindamycin was used in 50%, fluoroquinolone plus metronidazole in 20% and amoxycillin/clavulanate in 23%. Most of the patients [61.7%] were in grade III or IV of Meggit Wagner classification of diabetic foot. Three patients [5%] were treated by below knee amputations while 1[1.7%] patient by above knee amputation. In twenty-four [40%] patients some form of toe amputation/ray amputation had to be done, while 32[53.3%] patients had complete healing of wound without any amputation. Mortality was 3.33%. All the 4 patients [6.7%] who presented late, having uncontrolled diabetes, with angiopathy [absent foot pulses], neuropathy, infection of the foot [grade III or above] resulted in major amputation sooner or later. The 32 patients [53.3%] having controlled diabetes mellitus with no angiopathy or neuropathy of the limb got well with antibiotic on culture and sensitivity, wound wash and debridement; and the limb was saved. In patients, having controlled diabetes mellitus and not having neuropathy and angiopathy, the wound infection is controlled early with good outcome

Obstructive jaundice; its morbidity and mortality, a study of 60 cases

A prospective study was performed in the department of surgery at Bahawal Victoria Hospital Bahawalpur from January 1996 to December 1998. A total of 60 cases were admitted with signs and symptoms of obstructive jaundice. Average age at presentation was 49 years, of which 58% were females. Seventy five percent of cases were due to malignancy. 92% cases of carcinoma of gallbladder were in females. Only biopsy was performed in 35% of cases, choledochoduodenostomy in 17% and cholecystojejunostomy in 10%. Postoperative mortality was 10% in this study. Maximum survival for carcinoma of pancreas was 2 years, for carcinoma of gallbladder 1 year, and for carcinoma CBD 3 months

Risk factors of carcinoma breast in younger age group females

A prospective study on carcinoma breast was carried out at Bahawal Victoria Hospital, Bahawalpur from July 1997 to June 2000 and a total of 75 cases were detected. Of these thirty patients [40 percent] work between age of 25-30 years, an uncommon age group. The common risk factors were absent; all belonged to poor socioeconomic group. Eighty percent of them were from rural area related to cultivation of cotton crop, where use of organophosphorus compounds as pesticides are common. Twenty [67 percent] presented with lump breast, 17 percent with ulceration and 13 percent had nipple discharge. Upper outer quadrant was involved in 23 percent, IOQ in 17 percent, IOQ in 13 percent and two quadrants in 27 percent. Duration of symptoms was less than six months in 60 percent of young patients. Most patients [90 percent] were in stage II and III at presentation. The tumor in these patients behaved aggressively. Intraductal carcinoma was found in 80 percent of patients

Transurethral resection for benign prostatic hyperplasia: an analysis of 200 cases

A prospective study was conducted in the Department of Surgery, Bahawal Victoria Hospital Bahawalpur, from January 1996 to June 1999 to evaluate the results of transurethral resection for benign prostatic hyperplasia [BPH] in 200 cases. Patients' ages ranged from 45 to 90 years with maximum incidence between 50 to 65 years. One hundred and forty patients [70 percent] presented with urinary retention and 30 patients [15 percent] presented with irritative symptoms. Post operative complications were, haematuria in 10, transient incontinence in 10 and clot retention in 5 patients. Mean hospital stay was 6.48 days, with overall mortality at 0.5 percent. Transurethral resection is an excellent, safe and cost effective procedure for BPH