Predicting the prognosis of Conservative Treatment in Acute Cholecystitis using an Artificial Neural Network

Introduction: In majority of the cases clinicians usually choose the conservative mode of treatment as the first line of treatment in case of acute cholecystitis. But studies have shown that in most of the cases patients do not show any significant improvement and eventually are referred to cholecystectomy. This delay in referral catalyses complications like septic conditions and development of gangrenous cholecystitis. Computational structures like artificial neural networks are excellent tools for predicting outcomes apriori. So a neural network was employed to predict the prognosis of conservative treatment mode in cholecystitis and avoid the otherwise imminent complications. Materials and Methods: A neural network was developed and trained on clinically significant data from a set of 150 medical records pertaining to patients who presented themselves with diagnosis of acute cholecystitis at a tertiary care hospital.  The performance of the network was tested on this training set and a separate validation set comprising of data from 100 such patients. Results: The developed network demonstrated excellent prognostic capabilities with respect to the success/failure of conservative treatment in acute cholecystitis. Conclusion: A neural network can predict the outcome of conservative treatment in cholecystitis with significant accuracy and could prove to be an indispensable tool to clinicians

Comparison between topical bacitracin and neomycin with pyodine for prophylaxis against wound infection in appendicectomy

To compare the efficacy of prophylactic use of topical Bacitracin-Neomycin [Bivalek spray] with pyodine [solution] against wound infection in appendicectomy. Random control trial. Department of Surgery, Military Hospital Rawalpini, Pakistan. One year from 15 Jan, 2007 to 14 Jan 2008. A total of 100 patients of acute appendicitis who underwent appendicectomy. Patients were randomly allotted to either group A in which the post appendicectomy wound sepsis was managed by using Bacitracin-Neomycin [n=50] or to group B, in which wound was managed by using pyodine [n=50]. Outcomes were measured by absence or presence of oedema, discharge from the wound and erythema at wound site, wound dehiscence or fistula formation. Comparison between two groups revealed infection rate of 14% in group A and 8% in group B with no significant difference in wound infection [p value = 0.388]. Topical Bacitracin-Neomycin [Bivalek Spray] is equally effective as pyodine for prophylaxis against wound infection after appendicectomy

Biliary atresia: experience in a Military Hospital

The purpose of this case series is to determine the types of biliary atresias presenting to our department, options available to confirm the diagnosis with appropriate management and their results. A total of 12 patients with suspected biliary atresia presented to the Department of Paediatric Surgery at Military Hospital Rawalpindi. Out of them 11 patients underwent surgical intervention. Age of the patients ranged from 6 weeks to 16 weeks [mean age 68.80 days]. One patient was beyond the scope of biliary drainage. Out of 11 patients operated, operative cholangiography revealed patent extrahepatic biliary tree in 6 patients [55%], thus excluding biliary atresia. One patient [9%] had patency of distal biliary tree with proximal obliteration [Type B] and 4 patients [36%] had complete obliteration of extrahepatic ducts [Type A]. These 5 patients of biliary atresia [45%] underwent traditional Kasai portoenterostomy. Two patients [40%] were stable postoperatively, 2 patients [40%] had gradual deterioration after initial improvement, and 1 patient [20%] died in perioperative period

Role of strictureplasty in the management of tuberculous strictures of small intestine

To evaluate the outcome and assess the reliability of strictureplasty in the management of small intestinal strictures due to tuberculosis. A retrospective observational and descriptive study. PNS-Shifa, Karachi. Clinical data of cases of intestinal tuberculosis reporting over a period of five years-[Aug 1999-to-Aug 2004] was studied. Thirty patients with small intestinal tuberculosis who underwent strictureplasty alone or in combination with limited resection were selected for the study. In 20 cases [66.67%] the strictureplasty was performed in combination with limited resection. Remaining 10 cases [33.33%] were managed by strictureplasty alone. Anastomotic leakage with fistula formation occurred in 3 cases [10%], Burst abdomen occurred in 2 cases [6.67%]. Sub-diaphragmatic abscess formation occurred in 3 cases [10%]. On prolonged follow-up averaging two years, re-admission was required in 5 cases [16.67%]. Re exploration to relieve obstruction due to adhesions was required in 2 cases [6.67%]. Late incisional hernia was seen in 4 cases [13.33%]. There was no procedure related mortality. Strictureplasty is a simple, quick, and safe operative technique to manage tuberculous small intestinal strictures, in combination with limited resection or as a sole procedure

Role of FNA cytology in the management of carcinoma breast

To evaluate the utility and role of fine needle aspiration cytology [FNAC] in essential surgical management of carcinoma breast. Descriptive study. PNS Shifa, Karachi, Combined Military Hospital [CMH], Pannu Aqil and PNS Rahat from August 1998 to August 2003 [05 years]. Patients and The study included one hundred cases of carcinoma of breast-97 females and 3 males, confirmed on histopathological examination and surgically treated at PNS Shifa, CMH Pano Aqil and PNS Rahat. FNA cytology was the primary tool of investigation in all. The benefit of the procedure was evaluated considering the ease of the procedure, cost, safety, reliability as screening procedure and its effect on sparing the patients from excision or incision biopsy and thus additional anesthesia. Sensitivity of the procedure was 78%, specificity 100%, predictve value 100% and overall diagnostic accuracy 72%. Out of 78 cases, diagnosed as positive for malignancy on FNAC and later confirmed by histopathological examination, 58 underwent frozen section examination followed by definitive surgery [modified radical mastectomy]. Remaining 20 cases underwent additional core biopsy. Out of these, 12 cases underwent definitive surgery without frozen section and 8 patients underwent frozen section examination followed by definitive surgery. A single case required general anesthesia [GA] while the patients undergoing core biopsy required a local anesthesia [LA] as well. Cases remaining undiagnosed by FNA-cytology [22 cases] required either an excision biopsy [17 cases] or incision biopsy [5 cases] under GA followed by definitive surgery, thus requiring general anesthesia twice during the management. FNA-cytology can positively affect the surgical management of carcinoma breast. It can be utilized to select the patients for frozen section examination and can thus spare the patients from additional procedure of excision or incision biopsy under separate anesthesia. It may be adopted as a routine procedure in surgical outpatient

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