Role of primary closure in the management of early cases of typhoid intestinal perforation, in our set up

To see the benefits of primary closure in typhoid intestinal perforation in early cases, regarding morbidity and mortality in KPK. Prospective study. Study was performed at teaching hospital of KMU-IMS, Kohat from March 2006 to March 2014. In this prospective study, we included 76 cases of single perforation of less than 24 hours in terminal ileum in typhoid fever patients, these patients had primary closure in 2 layers. Data was collected on a structured proforma. Patients' data included demography, clinical features, investigation post-operative complications, hospital stay and follow up. 76 cases were included in the study over 8 years. Mean age was 24 +/- 10.32 years with m:f ratio of 1:2.6. In 100 % cases pain abdomen, fever, tenderness in either right iliac fossa or generalized in the abdomen were observed. Widal test, Typhidot and blood culture was positive in 51 ,54 and 58 out of 76 patients in same order. Wound sepsis was a common post-operative complication 12/76 [15%] other post-operative complications were pulmonary infection, abdominal dehiscence, intra peritoneal abscesses and Intestinal haemorrhage. Mean duration of hospital stay was 13.34 +/- 4.20 days. Mortality was 1.3% Two layer primary closure is an effective procedure having good results. Both morbidity and mortality are low and associated with reasonable length of hospital admission

Treatment adherence and outcomes of antiretroviral agents in HIV positive patients

To describe the treatment outcomes in terms of adherence, outcomes and side effects of antiretroviral [ARV] agents. An observational study. Teaching Hospital of Khyber Medical University, Institute of Medical Sciences, Kohat, from February 2007 to December 2012. Human Immunodeficiency Virus [HIV] positive patients, taking 1[st] line ARV agents for at least 6 months were included. Adherence was calculated by self report on asking the number of doses missed in last 30 days. ARVs were provided on monthly basis. Adherence data was noted over a period of 6 months. ARVs outcomes were recorded in the form of adherence, CD4 count, functional status of the patient, change in weight, further transmission of the disease, number of hospital admissions and deaths. Adverse Drug Reactions [ARDs] to ARVs were assessed clinically and by laboratory markers. Mean and standard deviation were calculated for numerical variables while frequencies and percentages were calculated for categorical variables. Total number of patients included in this study were 107. Out of them, 66.4% were males and 33.6% were females. The mean age was 39.9 +/- 13.80 years. Patients taking AZT/3TC/NVP, AZT/3TC/EFZ, D4T/3TC/NVP, D4T/3TC/EFZ, TNF/3TC/NVP or EFZ were 49.5%, 22.4%, 10.3%, 4.7% and 13% respectively. Most adverse affects were observed in 10 days to 90 days of initiation of therapy. Rash was observed in 71 [66.4%] patients, anaemia in 4 [3.7%] patients while only one patient [0.93%] had nausea / vomiting. Thirty [28%] patients reported no side effects. Out of 107 patients, 98 [91.5%] were alive whereas 9 [8.4%] died at the end of the study period. Twelve patients had one hospital admission [11.21%] whereas 9 [8.4%] patients had two admissions during the study period. The first mean CD4 was 325.27 cells /mcL whereas mean last CD4 count was 389.86 cells/mcL. ARVs have very satisfactory outcomes in HIV/AIDS patients, provided they are started at proper stage of the disease. Treatment outcomes in this study are comparable with reported previously in developed countries