RESUMO
Background: Perforation of peptic ulcer is a life threatening emergency and associated with increased surgical morbidity
Objective: To determine the risk factors of post postoperative complications in patients of perforated duodenal ulcer
Methodology: A cross sectional study was conducted at Surgical Department of Sheikh Zayed Hospital, Rahim Yar Khan and started on 12[th] February 2013 and completed in 6 months. Clinically, radiologically and surgically proven, 133 cases of the perforated peptic ulcer were included in the study through non probability consecutive sampling after taking informed consent. Possible predictors were recorded on admission as well as during surgery. Main outcome measures were postoperative complications which included respiratory tract infection, wound infection, and burst abdomen. Data was entered and analyzed by using SPSS version 14
Results: Age range of study subjects was 26-70 years. 80% of the patients were male and 20% female. 27.8% of the cases had clinical features of shock at presentation. Majority of the cases 65% presented within 48 hours. Smoking was noted in 51.9% of the cases. 74% had no associated medical illness. In 96% of the cases the size of perforation was less than 1 cm. Amount of peritoneal Spillage was greater than 1 liter in more than half patients [62%]. First part of the duodenum was the most common site of the perforation, which was present in 88% of the cases. Graham's omentopexy was done in 95% cases. 53 [40%] cases developed postoperative complications. 31 cases developed 1 complication each, 17 cases developed 2 complications each while 5 cases 3 complications each. The most common complication was respiratory tract infection which occurred in 26 patients [19.6%]. Most of the patients were discharged home between the 5 and 10 postoperative days. Those patients who presented in emergency after duration of 48 hours since onset of epigastric pain had very significant association with postoperative complication rate [p=0.0001]. Other factor which showed significant association was shock at presentation [p-value= 0.004]
Conclusion: Late presentation and presence of shock significantly influence the rate of development of post operative complications in patients of perforated duodenal ulcer. However, smoking and presence of medical illness failed to show significant association with postoperative complications
RESUMO
In June-July 2008 a non-governmental organization [NGO] in Jalalpur Jattan [JPJ], Gujrat, Pakistan arranged two voluntary HIV screening camps after numerous HIV-infected persons reported to their treatment center in Lahore; 88 [35.8%] of 246 persons screened in those camps were positive by rapid test. Intense media coverage made the residents of JPJ hostile to further inquiries. The Pakistan Field Epidemiology Training and Laboratory Training Program [FELTP] was requested by the Provincial AIDS Control Program to carry out an epidemiological investigation. HIV-positive persons or family members of patients who died of AIDS and consented to be interviewed during the period 15 December 2008 to 2 January 2009 were investigated. Enhanced contact tracing was done to identify additional cases. A structured questionnaire was used to collect data regarding clinical history, risk factors, and HIV knowledge and practices. The national HIV/STI Referral Laboratory collected blood samples for HIV serology and molecular studies independently following pre- and post-counseling. A total of 53 HIV-infected persons were investigated. Out of these, 47 [88.7%] were alive at the time of investigation and 27 [50.9%] of the cases were female with 6 children aged 10 years or less. Median age was 35 years [mean 34.7, range 3-70]. Most frequent symptoms were unexplained fever 42 [79.2%], diarrhea 34 [64.15%] and skin infections 27 [50.9%]; 13 [24.5%] had co-infection with tuberculosis [TB] and 10 [18.9%] with hepatitis [B or C]. Use of injections 51 [96.2%], dental procedures 21 [40%] and barber shop visits among males 18 [72%] were common risk factors. Extramarital sex was reported by 4 [9.4%]. Only 19 [35.8%] were aware that HIV can be sexually transmitted and 18 [34%] were aware of HIV transmission by blood transfusion. Phylogenetic analysis revealed HIV infection in this group was HIV-1 Subtype A, transmitted over a decade, and the situation is endemic rather than an outbreak. The investigation indicates high rates of HIV infection in JPJ. Unlike other studies from Pakistan, a high proportion of cases in females and children less than 10 years of age were observed. Socio-cultural norms and stigmatization limited in-depth investigation of sexual and behavioral practices and history of drug abuse. A shift of HIV infection from high-risk groups to the general population was seen and requires vigilant surveillance besides targeted health education, clinical management, lab facilities for diagnosis and monitoring, and voluntary counseling and testing services to limit disease spread