assessment of postoperative levels of pain with reference to validated protocols at a hospital in Karachi Pakistan

Objective: The aim of study is to assess the postoperative levels of pain in accordance with established protocols

Method: The type of study is a hospital wide survey conducted from February 2014 to April 2014, at department of surgery and associated wards, at a tertiary care hospital in Karachi Pakistan. World Health Organization pain scoring system was used as a base to develop a questionnaire to assess the level of pain. The results were correlation with various other variables involved

Results: The study was conducted on 200 patients out of whom 38% [n=76] were males having mean age of 44.16 +/- 20 and 62% [n=124] were females having mean age of 36 +/- 14.5 years. Generally patients experiences mild pain [40%], moderate [39%] severe [16%] and no pain [5%] when recorded after 24 hours postoperatively. While after 48 hours the scores recorded for the same patients were as, mild [56%], moderate to severe [34%] and in the no pain group [10%] of patients were recorded

Conclusion: It is noted that absolute pain free surgeries are not possible at the moment, but with the use of latest advancements in the field of health sciences, post-operative pain can be minimized and should be the one of the prime goals for a good surgical outcome

Post Hemorrhoidectomy pain relief; outcome of Local Anesthesia

Background: The aim of my study is to evaluate post-operative pain relief on patients who had hemorrhoidectomy

Materials and Methods: 300 patients who had hemorrhoidectomy were divided equally in to three groups, according to anesthesia type, group 1 [local anesthesia and sedation], while spinal anesthesia was group 2 and general anesthesia was considered to be group 3. Pain relief, post-operative complications, hospital staying time were measured and compared between the three groups. Period: Study was performed between Jan 2012 to Dec 2014

Results: The study showed that patients who had local anesthesia infiltration and sedation a significant decrease of post-operative total pain scores at 6/12/18/24 hours of more than 50%,200/240/300/320 out of 1000 points in group II as compared to 420/500/540/580,700/680/660/660 in 3rd groups respectively. The total postoperative analgesia doses in the 3 groups were 120: 140: 180 respectively, total hospital staying time were 130: 210: 260 days, headache in the ratio of 0: 8: 1, urine retention in 0: 6: 1 patients, nausea and vomiting in 0: 1: 5 patients were reduced by 30 % P-value < 0.05. On the other hand, spinal anesthesia which is group 2 showed slight decline of patients numbers who had respiratory symptoms, hypotension and urticarial

Conclusion: Post-operative pain, analgesia, total cost, hospital staying time, nausea and vomiting have been significantly reduced by local anesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higher rate in post-operative urine retention, headache and hypotension compared to local anesthesia with sedation and general anesthesia. Respiratory symptoms, urticaria, were slightly reduced in local anesthesia with sedation compared to spinal and general anesthesia

Antibiotic resistance among clinical isolates of stenotrophomonas maltophilia at a teaching hospital in Riyadh, Saudi Arabia

Stenotrophomonas maltophilia has emerged as a significant pathogen in compromised patients, causing infections which are difficult to treat. This study was carried out to comprehend the recent trend of antimicrobial resistance among clinical isolates of S. maltophilia and suggest management guidance for patients in general and in our region in particular. A total of 222 clinical isolates were tested between Jan 2003 to Jun 2009 at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh Saudi Arabia. The organisms were identified as per standard guidelines. Final identification and minimum inhibitory concentration [MIC] was determined by using Microscan[registered]. S. maltophilia showed absolute resistance to Imipenem. In vitro, least resistance was observed against Cotrimoxazole [9.45%] followed by Ceftazidime [57.21%], Piperacillin/Tazobactam [60.82%], Ciprofloxacin [77.03%], Aztreonam [86.03%]. Gentamicin showed overall highest resistance [87.39%]. The crude mortality rate was 47%.Cotrimoxazole is still the most effective agent against S. maltophilia but, keeping in view the increasing resistance to first and second line drugs, there is an urgent need for an effective surveillance system. To discourage development of resistance and devise an effective empirical therapy, large scale study should be considered.

Anti-mycobacterial activity of garlic [Allium Sativum] against multi-drug resistant and non-multi-drug resistant Mycobacterium tuberculosis

Emergence of multi-drug resistant [MDR] and extensively drug resistant [XDR] TB throughout the developing world is very disturbing in the present scenario of TB management. There is a fundamental need to explore alternative anti-TB agents. Hence natural plants should be investigated to understand their antimicrobial properties and safety. Garlic [Allium sativum] is one of natural plant which possesses variety of biological properties like anti-tumor, anti-hyperlipedemic and anti-microbial etc. The present study was evaluated for antibacterial activity of garlic against non-MDR and MDR isolates of M. tuberculosis. A total of 20 clinical isolates of MTB including 15 MDR and 5 non-MDR were investigated. Ethanolic extract of garlic was prepared by maceration method. Minimum inhibitory concentration [MIC] was performed by using 7H9 middle brook broth dilution technique. MIC of garlic extract was ranged from 1 to 3 mg/ml; showing inhibitory effects of garlic against both non-MDR and MDR M. tuberculosis isolates. Alternate medicine practices with plant extracts including garlic should be considered to decrease the burden of drug resistance and cost in the management of diseases. The use of garlic against MDR-TB may be of great importance regarding public health