Strategic analysis of the obstetric and gynaecological internship in Sudan

The high expectations of the increasingly questioning society lays a great burden on the first line treating doctors in Sudan. This is particularly true in the obstetrics and gynaecology departments. The impact of training of the house-officer in surgical departments was not studied before in Sudan. To evaluate the gains in knowledge and skills of house-officers in the obstetrics and gynaecology departments as reflected by their activities and their opinions. A prospective cohort carried in the period from May 2011 through June 2011. The data was collected from 200 house-officers. Their activities and duties as formulated by their seniors and supervisors and gains in knowledge and skills were noted. All house-officers participated actively in the clinical diagnosis [history, physical examination and relevant investigations] and management of cases of antepartum and postpartum haemorrhages. Of them 186[93%] had duties not more than twice a week. However, 121[60.5%] shared training opportunities in units having seven or less peers. Also, 109[54.5%] had regular seminars and tutorials. In practice, 165[82.5%] performed evacuations, 158[79%] participated in normal deliveries, and 110[55%] were assisted in performing caesarean sections. The overall performance of house-officers in the department of obstetrics and gynaecology in Sudan is good. However, standards of training need to revisited to fill gabs in training if these young doctors are to be dispatched to rural hospital immediately after the internship period

Lingual, inferior alveolar and mylohyoid nerves sensory impairment following removal of mandibular third molars

The objectives of this study were to investigate the incidence of sensory impairment of the lingual, inferior alveolar and mylohyoid nerves following lower third molar removal and to compare the outcome with the results of other studies with the intention of implementing any change in the treatment protocol, if indicated and to predict the need for routine postoperative follow up and it's cost implications. A total of 2456 mandibular third molars were removed from 1275 patients of which 585 were operated under general anaesthesia and 690 received local anaesthesia with or without sedation. Of the 1275 patients, 58 [4.57%] experienced transient sensory impairment affecting single or a combination of the above nerves. Only 15 [1.18%] patients had anaesthetic impairment and the rest 43 [3.42%] patient's injury was paraesthetic in nature. All of these resolved completely during the period of study except one patient who suffered permanent impairment of the lingual nerve functions and this occurred in general anaesthetic group. No permanent sensory impairment was recorded for inferior alveolar and mylohyoid nerves. Surgical criteria and treatment justification with appropriate patient information sheet and the need for follow up is discussed

Management of pediatric HCV

Hepatitis C viral [HCV] infection is emerging as a challenge to the developing and affluent nations alike including the pediatric population. With universal pretransfusion screening for HCV, the major focus of pediatric HCV disease has shifted to the study of natural course and management of perinatally acquired HCV disease. In contrast to the favorable change of trend in the developed countries, sharing of contaminated needles and instruments, unprotected sex and occupational exposure continue to be a significant source of transmission in developing countries like Pakistan. Similarly, there is a lack of epidemiological data and a new sense of urgency in the healthcare community about the burden of the pediatric HCV disease for the local population in Pakistan. In general, the course of HCV infection is deceptively benign during childhood followed by complications during later life including hepatocellular carcinoma [HCC] and end stage liver disease. Interferon and more recently Pegylated-interferon [PEG-INF] with ribavirin has gained popularity as the treatment modalities in adults. However, there is lack of consensus guidelines for screening and management of HCV during childhood. Cost is an additional barrier to pharmacotherapy in developing countries. This review focuses on the natural history, diagnostic modalities and approach to the management of HCV in pediatric age group

Lichtenstien repair of inguinal hernia under local anaesthesia - day case surgery

This prospective study was carried on 250 patients to study the complication and recurrence rate associated with Lichtenstien repair of inguinal hernia in our clinical and socioeconomic settings. The cost effectiveness and return to work after surgery were the other outcome measures. Two hundred and fifty patients underwent mesh repair of inguinal hernia at two different centers over a period of two years. All the patients were operated under local anesthesia. A bolus dose of preoperative antibiotic was given intravenously. The patients were followed up for two years and their post operative course was assessed according to a prescribed proforma. The rate of minor complications was in the range of 11.8%. The recurrence rate was 1.2%.There was minimal pain and the procedure was cost effective in terms of operative cost and less economic loss due to early return to work. It is concluded that Lichtenstien repair as a day case is safe and effective procedure to be performed by a trained general surgeon under local anesthesia. The infection rate and the recurrence rate are low. The compliance and acceptability of the patient and ease of carrying out the procedure under local anesthesia by surgeon is acceptable. In our view this type of hernial repair is an appropriate method in district hospital and tehsial headquarter hospitals where provision of anaesthesia facilities are yet to be fully developed and hospitals cater a major hernial load due to elderly patients with background of farming professions being admitted. The patient can be sent home on same day after surgery

Management of pediatric HCV

Hepatitis C viral [HCV] infection is emerging as a challenge to the developing and affluent nations alike including the pediatric population. With universal pretransfusion screening for HCV, the major focus of pediatric HCV disease has shifted to the study of natural course and management of perinatally acquired HCV disease. In contrast to the favorable change of trend in the developed countries, sharing of contaminated needles and instruments, unprotected sex and occupational exposure continue to be a significant source of transmission in developing countries like Pakistan. Similarly, there is a lack of epidemiological data and a new sense of urgency in the healthcare community about the burden of the pediatric HCV disease for the local population in Pakistan. In general, the course of HCV infection is deceptively benign during childhood followed by complications during later life including hepatocellular carcinoma [HCC] and end stage liver disease. Interferon and more recently Pegylated-interferon [PEG-INF] with ribavirin have gained popularity as the treatment modalities in adults. However, there is lack of consensus guidelines for screening and management of HCV during childhood. Cost is an additional barrier to pharmacotherapy in developing countries. This review focuses on the natural history, diagnostic modalities and approach to the management of HCV in pediatric age group

Extramucosal single layer interrupted intestinal anastomosis: a better alternative

To evaluate the technique of extra mucosal interrupted single layer intestinal anastomosis in different diseases where anastomosis is needed in different parts of gastrointestinal tract both in elective and emergency situations. Design: Prospective study. Place and Duration of Study: Surgical Unit 1 Jinnah Hospital Lahore, over a period of 2'/2 years from December 2000 to June 2003. Material and In this study 123 anastomosis were performed in 100 patients. All these patients were operated upon by the senior surgeons in the emergency/elective operating rooms. Single layer interrupted extramucosal anastomosis with vicryl 2/0 or 3/0 was done in all cases. Overall anastomotic leak was just 0.81%. Wound infection was observed in 6%, without any increase in morbidity and zero% mortality. Extramucosal single layer interrupted intestinal anastomosis is the safest technique both for the small and large bowel, with minimal possible complications

Fistulae in ano following anorectal abscesses

This study was carried out to determine whether primary fistulotomy should be performed at the time of incision and drainage of anorectal abscesses and what% age of patients would develop fistula-in-ano or recurrent abscess. The record of 77 patients was reviewed who underwent incision and drainage of anorectal abscesses. Out of 77 patients, thirteen [16%] developed recurrent abscesses and 26 [34%] developed persistent fistulain-ano, with combined recurrence rate of 51%. This supports the policy of fistulotomy in the second sitting especially to prevent any complications and also of the fact that 59% would not need it

Peripheral vascular injuries due to trauma: pims experience

Peripheral vascular injuries due to trauma are on the rise in Pakistan. Morbidity in the form of amputation is very high because of late presentation of the patients to a centre where facilities for vascular surgery are available. The purpose of this study was to identify the factors responsible for late presentation, and poor outcome of vascular repair in such cases. Clinical and operative details of 51 patients with peripheral vascular trauma, who underwent surgical intervention between 1994 to 1998 at PIMS, were reviewed. Type of injury, mode of presentation, time between injury and arrival to the hospital, methods of vascular repair, use of graft or vein, and outcome of the procedure were analyzed.Patients with late presentation, combined arterial and venous injuries involving the popliteal artery and its branches were associated with high amputation rate, There were 45 arterial and 6 isolated venous injuries. After surgical repair, 9 [17.5 percent] patients required amputation due to various reasons. Time is the key factor in determining the final outcome of vascular repair. The delay can be avoided by rapid transfer of such patients to a major hospital

Liechtenstein's repair

Inguinal hernia is a common surgical problem. In this study one hundred patients of inguinal hernia operated in our department from January 1991 to August 1992 are evaluated and hernioplasty using Gore Tex patch and prolene mesh is compared with various techniques of herniorrhaphy

Parenteral sulbactum and ampicillin in general surgery

Thirty six patients [24 males, 12 female; mean age 42 years] hospitalized to undergo incision and drainage for documented or suspected surgical infections were treated with a combination of sulbactam and ampicillin. Mean daily dose employed was 1.25 gm sulbactam and 2.5 gm ampicillin given intravenously for a mean treatment period of 10 days. A clinically satisfactory response [cured plus improved] was achieved in 78% of patients with a response rate of 100% in cases of non-perforated appendicitis, sepsis traumatic wound infections and cellulites. Ninety two percent of the pathogenic bacteria isolated from infecting sites in 11 patients, were found sensitive to sulbactam/ampicillin. Complete to partial elimination of bacteria was recorded at the end of study in 82% of these patients. The results of this study indicate that sulbactam/ampicillin is an effective and well tolerated agent for the treatment of surgical infections requiring parenteral antibiotic therapy

Fiab classification and its relationship with immunophenotype in acute lymphoblastic leukemia

Morphological characteristics of blast cells were studied in 55 patients with acute lymphoblastic leukaemia and classified according to the French-American British [FAB] criteria. Thirty nine [70.9%] patients had FAB L[1] morphology and 16 [29.1%] had L[2] morphology. No case with L[3] morphology was identified. FAB L[1] morphology was slightly more frequent in adults [73.7%] as compared to children [69.4%]. Immunological classification of all cases using monoclonal antibodies was performed. No relationship was observed between the immunophenotypes and FAB morphology. Common - ALL and T-ALL immunotypes were in the same proportion of patients with L[1] [75%] and L[2] [25%] morphology