Comparison of Value per Operative Time between Primary and Revision Surgery for Adult Spinal Deformity: A Propensity Score-Matched Analysis

Methods@#Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥18 years who underwent surgery for spinal deformity between 2011 and 2019 were identified and included. To ensure a homogenous patient cohort, those who underwent anterior-only and concurrent anterior-posterior fusions were excluded. Propensity score matching analysis was performed, and Mann-Whitney U test, Pearson chi-square test, or Fisher’s exact test were used to compare matched cohorts as appropriate. @*Results@#A total of 326 patients who underwent revision surgery were matched with 206 primary surgery patients via propensity score matching. Demographic characteristics, comorbidities, preoperative laboratory values, and readmission and reoperation rates were not significantly different between groups. The revision surgery group had significantly higher mean RVUs per minute than that of the primary surgery group (0.331 vs. 0.249, p <0.001), as well as rates of morbidity and blood transfusion. @*Conclusions@#Compared to primary surgery, revision surgery for ASD is associated with significantly higher RVUs per minute and total RVUs and higher rates of 30-day morbidity and blood transfusions. Readmission and reoperation rates are similar between surgeries.

Unusual presentation of bone metastasis from hepatocellular carcinoma mimicking as breast lump

A 55-year female presented with left breast lump. Her sonomammography was unremarkable. Core biopsy showed it to be metastatic hepatocellular carcinoma [HCC]. Biphasic computerized tomography [CT] of liver confirmed presence of primary liver masses while CT chest showed involvement of left anterior chest wall, rather than primary breast mass. F18-Fluorodeoxyglucose [FDG] positron emission tomography CT [PET-CT] imaging confirmed primary liver tumor with bony metastases

Frequency of thymoma in thymectomy specimens in myasthenic patients

This study was carried out to determine the frequency of thymoma in different age groups and sexes in thymectomy specimens in Myasthenia Gravis patients. Observational study. The study was carried out in General Surgery Department at PIMS over a period of three years from 2009-2012. PIMS is a tertiary care centre where large population of Islamabad and Surrounding territory, including AJK, Gilgit Baltistan, Hazara division, Peshwar and nearby districts of Punjab gets treatment. A total of 30 patients selected at random, were included in this study. Patients were of different age groups, above 12 and under 52 years of either sex. Patients with poor medical control of disease with no contra indication for surgery. Patients with operable mediastinal mass [thymoma] were included. Generalized myasthenia gravis was diagnosed in patients. Pre-operative plasmaphoresis was carried out in all patients. Transsternal approach was used in all cases although now video assisted thoracoscopic thymectomy is becoming popular. Intraoperative findings were noted with emphasis on gross appearance and an information by histopathological report [frozen section]. In our study 17 % thymectomy specimens turned out to be Thymoma. Male to female ratio was 3:2. Age range was 12 years to 52 years. All patients undergoing thymectomy for Myasthenia Gravis don't have thymoma. Moreover all Thymomas are not associated with Myasthenia Gravis. Ages between 3[rd] to 5[th] decade are affected by thymoma and gender difference is very little

Assessment of antiphospholipid antibodies in women with recurrent miscarriage at GMMMC, Sukkur

Objective: To determine and analysis of Antiphospholipid Antibodies in women with RecurrentMiscarriage belongs to District Sukkur

Study Design:Cross-sectionals study

Place and Duration of Study: This study was conducted in the Ghulam Muhammad Mahar Medical College, Sukkur and women attending local health clinics enrolled in this study after taking their informed consent fromMay, 2012 to August2013

Materials and Methods: In this study 205 patients were taken. Patient's whole blood was collected by disposable syringes through vein puncture technique from cubital vein and maximum of 10 ml blood was taken. An aliquot of this blood [4 ml] was transferred in the EDTA containing tube. Immediately after collection plasma was separated and stored at -40 °C for the measurement of plasma Anti phospholipid and anticardiolipin antibodies level. 5 ml blood was drawn in plain tube and allowed to clot, and then serum was separated and used for blood cholesterol, HDL, LDL and Plasma lipid concentration

Results: In the current research of district Sukkur showed the highest frequency in age group of 26 to 35 years [Table 140]. In physical parameters, BMI, calories intake and maternal history of RM of patients and control subjects showed significant [p<0.05] difference. In present study the assessment of antiphospholipids antibodies [aPL] 1.95 % which were significantly different [p<0.05] than controls. Results of anticardiolipin antibodies [aCL] showed 2.43 % prevalence in patients with recurrentmiscarriage

Conclusion: The present study indicated that antiphospholipid antibodies and anticardiolipin antibodies were found an indipanded risk for recurrent miscarriage in population of Sukkur

Study to estimate the prevalence of malaria infection in Sukkur

The aim of the study to estimate the prevalence of malaria amongst the population with fever or history of fever at sukkur. Cross sectional study. This study conducted at laboratory Ghulam Mohammad Mahar Medical College Hospital Sukkur from January 2011 to December 2012. Total 1746 clinical suspected case of malaria were included in the study. Patients presenting with fever were screened, thick and thin blood films prepared on microscopic glass slide, stained with 5% Giemsa's stain. There were 344 cases below 11 years, 590 cases between 11 to 20 years.812 cases above 20 years. They were 960 males and 786 females, with male to female ratio 1.2:1 .The prevalence of plasmodium slide positivity was 7.9% [138/1746]. Among plasmodium slide positive, 60.5% [83/138] were positive for P.vivax and 39.5% [55/138] were positive for P. falciparum. Identification of malaria cases in early acute phase of disease is significant for proper curative treatment. Anti mosquito eradication measures should be taken for breeding places of vector with personal protection measures and awareness program for malaria should be initiated

Full length migration of plastic biliary stent into the left lobe of liver and its endoscopic retrieval

An elderly female was admitted with obstructive jaundice, secondary to an impacted 1.7 cm size stone in distal CBD. Cholangiogram obtained during ERCP revealed dilated biliary system with large, immobile stone at the lower end of CBD. A large size sphincterotomy was performed and stone extraction using biliary balloon / dormia basket attempted which was unsuccessful as the stone was impacted in distal CBD. Therefore, a plastic biliary stent of 9 cm/8.5 french size was inserted successfully to secure the biliary drainage. Patient improved clinically and discharged home on ursodeoxycholic acid. Four weeks later, she presented to emergency department with signs of cholangitis. An emergency ERCP was performed. The stent had migrated up completely into the left intra hepatic duct. In this session, the stone was extracted and biliary drainage secured. Migrated stent was removed later on by another ERCP procedure

Decompressive craniotomy and duraplasty in patients of traumatic bifrontal contusions

To find the outcome of bifrontal decompression craniotomy [DC] for the treatment of traumatic bifrontal contusions. Descriptive case series. Department of Neurosurgery Jinnah Postgraduate Medical Center [JPMC] Karachi, from January 2011 to March 2014. This study included patients with bifrontal contusions secondary to trauma admitted through A and E department, aged between 14 year to 60 year with confirmation on CT scan having Glasgow Coma Scale [GCS] scores between 6-12. Patients who were unfit for surgery or anesthesia and those with coagulation disorders, were excluded. Patients underwent bifrontal DC with evacuation of contusions followed by duraplasty. The age, gender, preoperative size of the contusion, GCS on admission, postoperative complications and Glasgow Outcome Scale [GOS] score after 6 months of surgery were recorded. This study was conducted on 50 patients. Trauma was the commonest type of injury in 43 [86%] cases. Mostly patients were males [84%]. Majority of patients were between 21 year and 40 year of age. The GCS score before surgery in these patients was 9 in 13 [26%] patients, 10 in 16 [32%] patients, 11 in 11 [22%] patients, 12 in 6 [12%] and 13 in 4 [8%] patients. The most common size of contusions was 4 and 5 cms, both on right and left side. Of these, none of the patients required reoperation. Three died after aspiration within the postoperative time span of day 5-7. Good recovery was seen in 40 [80%] patients, moderate disability in 6[12%], severe disability in 1 [2%], persistent vegetative state in 2 [4%] and death in 1 [2%] patient. This study showed feasibility and efficacy of DC in bifrontal brain contusions secondary to traumatic brain injury [TBI] with good outcome

Relationship of anemia with nutrition among pregnant women residing in urban slums of Taluka Qasimabad, district Hyderabad

Objective: To find out relationship of anemia with nutrition among pregnant women residing in urban slum areas of Taluka Qasimabad, District Hyderabad

Study design: A community based cross sectional descriptive study

Place and duration of study: Study was conducted in urban slum areas of Taluka Qasimabad, District Hyderabad from 1[st] March 2011 to 31[st] August 2011

Methodology: Two hundred and fifty [250] pregnant women during 2[nd] and 3[rd] trimester of pregnancy were included in the study. The qualitative data collected by filling questionnaire comprised of demographic information about woman, her family and about her diet. The quantitative data collected by assessing anemia by determining the hemoglobin level in the enrolled pregnant women

Results: Two hundred and fifty [250] pregnant women were included in the study. Two hundred and thirty three pregnant women were found anemic [93.2 %]. Majority of the women ie 70% presented with moderate anemia [hemoglobin level 7.0-9.9g /dl] while severe anemia [hemoglobin level <7 g/dl] was recorded in 5.2% pregnant women. While17.6% women presented with mild anemia [hemoglobin range 10.0-10.9g/dl]. Majority of the women in study population were not taking balanced diet i.e. 232 out of total 250 and all of them were anemic not taking balanced diet and statistically significant association was found between occurrence of anemia and unbalanced diet. [p= 0.00]

Conclusions: Our study showed a significant association between occurrence of anemia during pregnancy and unbalanced diet on the studied population

Screening for dengue virus infection at GMMMC hospital, Sukkur

Dengue is a severe arthropod borne viral disease characterized by fever, headache, retro - orbital pain, maculopapular rash, and thrombocytopenia. Disease is transmitted from one human to another by bite of infected Aedes aegypti mosquito. Disease now a days occurs in more than 100 countries worldwide. Study designed for screening suspected or probable cases to detect specific antibodies response in early stage of disease. Cross sectional study. This study was conducted at Ghulam Muhammad Mahar Medical College Hospital, Sukkur from October, 2010 to October, 2012. Patients presenting with fever, bleeding tendencies, maculopapular rash or fever with thrombocytopenia were screened as per WHO criteria for suspected dengue infection. Blood was collected after 4 - 5 days of onset of illness. The serologic test was performed by using rapid immunochromatographic assay detection of anti dengue immunoglobulin M [IgM] antibodies. 162 cases were screened for dengue infection. 16 [9.9%] patients were positive with anti-dengue IgM. 12 patients were male and 04 were female. Platelets count was observed below 100 x 10[3] cmm[3] in patients with dengue infection. Identification of dengue virus infection in early acute phase of disease is significant for morbidity and mortality screening of suspected cases and anti-mosquito eradication measures should be taken for breading sites of vector, mass education, and awareness programs may be initiated

Omphalomesenteric duct cyst in an omphalocele: a rare association

Omphalomesenteric duct [OMD] remnants and omphalocele are not infrequently seen in paediatric patients. In most of the cases, OMD remnant in an omphalocele is a Meckel's diverticulum; however rarely there may be other lesions. A one-day old male baby underwent surgery for omphalocele. At exploration a 10 x 12 cm cyst containing gut contents was found as the content of the omphalocele, with proximal and distal ileal loops running in continuity with it. Resection of the cyst with end to end primary gut anastomosis was done. Baby also had complex associated cardiac anomalies and died few days after surgery due to sepsis

Isolation of E-coli in UTI cases with malnutrition in children of distant rural area of Sukkur, Sindh

A cross-sectional study of isolation of Escherichia coli in urine culture of children and its correlation to childhood malnutrition induce microcytic hypochromic anaemia [I.D.A]. Cross Sectional Study. This study was carried out at the Biochemistry Department, GMMMC, Sukkur from 01.12.2011 to 31.05.2013. Study was carry out among the children under 05 [five] years of age. Number of children included in this study was 150. Structured questionnaire were use to obtain the required data. Laboratory investigation of blood, urine samples was performing by standard methods and anthropometric data also collected. The results showed that Escherichia coli positive children are 64.0%, 60.5% Childs has extremely low body weight, 43.6% shows stunting and 21.7% was wasting. This study showed that there is correlation between Urinary tract infection and malnutrition. So, energy yielding nutrients containing 8 - 10 essential amino acids, fates and minerals may be supplemented to less privileged patients of remote rural area of sukkur to enhance immune status

experience of open Anderson-Hynes pyeloplasty

To document the outcome of open Anderson-Hynes pyeloplasty for pelviureteric junction [PUJ] obstruction in terms of renal function and complications. Descriptive study. Department of Urology at Peoples University of Medical and Health Sciences for Women Hospital Shaheed Benazir Abad [Nawabshah] from 2007 to 2009. Thirty consecutive cases of pelviureteric junction obstruction were admitted. All patients underwent Anderson-Hynes open pyeloplasty. Complications and outcome were recorded. Most of our patients were male [n=25]. Majority belonged to age group 1-5 year [n=18]. Left side was affected in most of the cases [n=22]. Low incidence of postoperative accepted complications noted. Post operative outcome was excellent In relation to improved drainage and renal function. Anderson-Hynes pyeloplasty was safe, with low postoperative complication rate and better renal function preservation

Intravenous urogram as a first line investigation in comparison with ultrasound

The objective of was to evaluate the usefulness and efficacy of intravenous urogram in patients with urinary tract pathology detected on ultrasound and X-ray KUB. The duration of the study was from September 2007 to August 2009 and a total of 250 patients were included in this cross-sectional study by non probability purposive sampling technique. Ultrasound scans and intravenous urograms were conducted by/under direct supervision of consultant radiologist. Out of 254 patients, four were unable to complete the intravenous urogram due to reaction to the contrast medium; hence a total of 250 patients were included in the final study. There were 66 male and 184 female patients. Calculi [renal, ureteric and vesical] were seen in 139 patients, pefviureteric Junction obstruction in 9, double collecting system and/or ureter in 6, neurogenic bladder in 13, horseshoe/pancake kidney in 2, ectopic kidney in 1, ureterocele in 2, cystocele in 1 and bladder mass in 7 patients. In 14 patients, the tests conducted were inconclusive and further investigations were advised. 28 patients had no detectable urinary tract pathology on any of the diagnostic modality. Intravenous urogram should not be performed routinely as a first line investigation in every patient presenting with flank pain. However, in congenital anomalies, intravenous urograms are needed and should be performed after a preliminary ultrasound

Comparison of efficacy of thioridazine with clonidine acting through different mechanisms in acute opioid abstinence syndrome

To compare the efficacy, safety and tolerability of thioridazine with clonidine in patients with Acute opioid Abstinence Syndrome. This single blind comparative clinical trial was carried out at Department of Pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Center [JPMC], Karachi. Fifty two addicts were selected randomly and were grouped into, group-A to received thioridazine 100 mg/day and group -B to received clonidine 150mcg/day. All participants completed the treatment program and stayed in hospital for ten days. The efficacy safety and tolerability of thioridazine was scant, while clonidine showed statistically significant turn down in the objective signs of acute opioid abstinence syndrome. Clonidine had more powerful effects than thioridazine. While treating the withdrawal signs of opioid abstinence syndrome may possibly pointed out that over activation of norepinephrine is a major factor contributes to the commencement of opioid abstinence syndrome

Relationship between sialic acid and microvascular complications in type 2 diabetes mellitus

Serum total sialic acid is a marker of acute phase response. Elevated levels have also been associated with several risk factors for diabetic vascular disease. The objective of the study was to find out a relationship between sialic acid and metabolic variables in type 2 diabetic patients with and without microvascular complications. This study included 200 subjects of whom 50 were of diabetes mellitus with nephropathy, 50 patients of type 2 diabetes mellitus with retinopathy, 50 patients of type 2 diabetes without any complication and 50 healthy individuals without diabetes mellitus [control subjects]. The subjects aged 15 - 60 years were selected for study. Fasting venous blood samples were taken from all the 200 subjects. Simultaneously urine sample were also collected from each of them. All blood samples were analysed for fasting and postprandial glucose, total cholesterol, triglyceride [TG], low density lipoprotein [LDL], high density lipoprotein [HDL], creatinine, HbAIc on fully automated analyser. Serum and urine sialic acid along with microalbumin levels were also estimated. Serum total sialic acid concentrations were significantly higher among all diabetic subjects with or without complications compared to control subjects. In diabetic patients there was a significantly increasing trend of serum and urinary sialic acid with severity f nephropathy [p < 0.001] and with the degree of urinary albumin excretion [p < 0.001]. Elevated serum sialic acid concentrations were also associated with severel risk factors. The main finding of this study is that elevated serum and urinary sialic acid and microalbumin concentration were strongly related to the presence of microvascular complications like diabetic nephropathy and retinopathy and cardiovascular risk factors in type 2 diabetic patients

Frequency of dominant blood groups in medical students of Karachi

1. To assess the different blood groups, in students of DUHS. 2. To determine the dominant blood group in the students of DUHS. 3. To compare the results of present study with other cities of Pakistan and countries of the world. Cross-sectional study. This study was carried out on medical students of Sindh and Dow medical Colleges, [DUHS] Karachi from September 2000-2004. Sample size of 2300 was drawn by using convenient sampling method. Blood samples were collected by finger prick method. Data was collected and analyzed on SPSS version 16. Out of 2300 students group B was found to be the commonest [40%], group O [32%], group A [20%], group AB [08%].Rh positive [85%].The dominant being B+ in karachi as well in Pakistan, compared to O blood group in different countries of world. The study showed very little%[08] of blood [AB] groups among the medical students of Karachi; it generated an authentic data, which may serve a useful purpose for high transfusion demand to very emergent situations

comparative study of trans urethral resection versus trans urethral incision for small size obstructing prostate

To compare the results of transurethral resection of prostate [TURP] with transurethral incision of prostate [TUIP] for small size obstructing prostate. Comparative study. Department of Urology, Peoples University of Medical and Health Sciences for women Hospital Nawabshah, from 2008 to 2010. Patients were divided in TURP and TUIP groups with fifty patients in each. Patients of any age with small size [thirty grams or less] prostate needing surgical intervention were included. TURP was done with conventional technique. In TUIP two deep incisions were made at 5 and 7'O clock positions of the bladder neck using Collings knife. Pre-per and postoperative variables were observed and recorded. All patients were followed up to six months post operatively. A total of 100 patients were included in the study. Mean operative time was 12.4 minutes in TUIP and 22.6 minutes in TURP. Retrograde ejaculation and blood transfusions were less in TUIP than TURP. The improvement in maximum flow rate improved in both the groups. TUIP is as effective as TURP in achieving maximum flow rate but TUIP was superior in terms of shorter operative time, less retrograde ejaculation and less need of blood transfusion

Current pattern of mechanical intestinal obstruction in adults

To evaluate the current pattern of mechanical bowel obstruction in adults. Descriptive case series. Surgical unit III and IV Bolan medical college/ complex hospital Quetta, from June 2007 to July 2009. The criteria for diagnosis were on the basis of history, clinical findings, radiological examination, exploration of abdomen and histopathological confirmation in selected cases. A total of 252 surgically treated cases of mechanical bowel obstruction were included. Out of the total, 187 [74.2%] presented with acute and 65 [25.8%] with sub-acute intestinal obstruction. The mean age was 37.4 years with male to female ratio of 2:1. Abdominal tuberculosis was found in 77 [30.6%] patients. Among the other causes bands/adhesions were found in 57 patients [22.6%] and obstructed hernias in 44 patients [17.5%]. In 161 patients [64%] the intestinal obstruction was without gut compromise, while in 91 patients [36% strangulated bowel obstruction was present. Forty patients [15.9%] developed postoperative complications mainly wound sepsis and chest problems in the form of atelectasis and pneumonia. The mortality rate was 2.4% [n 6]

Results of separate anastomoses of multiple renal arteries with recipient external iliac artery in renal transplant surgery

To evaluate the results of separate anastomoses of multiple arteries of the donor kidney with the external iliac artery of the recipient in renal transplant surgery. A descriptive study conducted at department of Urology and Renal Transplantation, Foundation University Medical College, Fauji Foundation Hospital, Rawalpindi and Hearts International Hospital, Rawalpindi from January 2005 to December 2007. Living voluntary kidney donors having multiple renal arteries as seen on preoperative screening. During regular renal transplant surgery, donors having multiple renal arteries as diagnosed on preoperative computerized tomographic renal angiography were selected for further study. Such kidneys from volunteer donors were harvested and no ex vivo bench surgery was performed to unit these multiple renal arteries. An arterial punch was used to make separate arteriotomies on the external iliac artery of the recipient and anastomoses of the multiple renal donor arteries were carried out separately with the external iliac artery in an end to side manner using 7/0 prolene suture. Of the fifty grafts harvested, 38 had two renal arteries arising from the aorta and reaching the renal hilum [Group I]. These were anastomosed separately to the external iliac artery. Nine grafts had triple renal arteries, two running to the hilum and one entering into the lower pole [Group II]. All these three arteries were anastomosed in an end to side manner with the external iliac artery. Three grafts had one main renal artery and a tiny upper polar cortical vessel incapable of anastomoses [Group III]. The small upper polar cortical artery was sacrificed and the main renal artery was anastomosed with the external iliac artery. One release of vascular clamps perfusion of the graft was observed. Diuresis of the graft was notices. Color Doppler study of the graft was carried out on third postoperative day. Serum creatinine of the recipient was determined on alternate days for one week, after a month and then regularly at three months interval for two years. Early and late vascular and urological complications were observed over a period of two years. A total of 50 kidneys with multiple renal arteries were harvested. On release of vascular clamps, reperfusion of all the allograft occurred within 5 to 75 seconds [mean: 30 seconds]. Diuresis from the graft started in 1/2 to 8 minutes [mean 3.5 minutes]. One of the recipients in Group I developed sudden decline of urine output 2 hours postoperatively and a color Doppler scan showed lack of perusion. On re-exploration a positional kink of the arteries was found which was corrected. Color doppler study on third postoperative day revealed normal perfusion of all the grafts. Serum creatinine of all the recipients steadily came down and reached normal values within a week. Serum creatinine levels remained within normal range over two years of follow-up. None of the patients developed postoperative hypertension or other vascular complications during the follow-up period. Three patients in Group I developed lymphocele requiring percutaneous aspiration. Two patients in Group II had wound infection. Performing separate anastomoses for multiple renal arteries of the donor with the external iliac artery of the recipients in renal transplant surgery is a safe, easy to perform and practical with minimal complications. The renal arterial anatomy of the donor kidney should be evaluated by the spiral computed tomographic angiography, prior to harvesting it in the host and this angiography should be available in all renal transplant surgery units

In vitro efficacy of piperacillin/sulbactam, piperacillin/ tazobactam and cefoperazone/sulbactam against clinical isolates of pseudomonas aeruginosa - a comparative study

To determine the in vitro efficacy of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam against clinical isolates of Pseudomonas aeruginosa. Cross-sectional study Department of Microbiology, Armed Forces Institute of Pathology from January 2010 to September 2010. A total of 287 isolates of Pseudomonas aeruginosa recovered from various clinical specimens were taken under consideration. Routine microbiological methods were used to identify the organism. Susceptibility of the isolates was carried out by modified Kirby-Bauer disc diffusion method against piperacillin 100/sulbactam 30 [SPR130micro g], cefoperazone 75/sulbactam 30 [SCF105micro g] and piperacillin 100/tazobactam 10 [TZP110micro g], according to the guidelines provided by Clinical and Laboratory Standards Institute [CLSI]. The highest numbers of Pseudomonas aeruginosa isolates were found in pus swabs, followed by urine and endobronchial washings. Seventy five percent of clinical isolates of P. aeruginosa were susceptible to tazobactam/piperacillin, 71% to piperacillin/sulbactam and 70% to cefoperazone/sulbactam. The difference between the susceptibility of isolates to these three antimicrobials was statistically not significant [p>0.05]. We conclude that there was very little difference in the antimicrobial susceptibility of P. aeruginosa to the three beta-lactam/beta-lactamase inhibitor combination drugs studied. Periodic susceptibility testing should be carried out over a period of two to three years, to detect the current resistance trends. Moreover, a rational strategy on the limited and prudent use of anti-Pseudomonal agents is urgently required