Surgical site infection; evaluation of causative organisms involved

Wound infection can be defined as invasion of organisms through tissues following a breakdown of local and systemic host defenses. The basic principles of wound care and antisepsis introduced during the past century improved surgery dramatically. Evaluation of causative organisms which evolved in the surgical site infection [elective abdominal surgery] at surgical unit of Liaquat university hospital Jamshoro. This prospective observational study was contains 103 patients undergoing elective, abdominal surgery were included in this study. Surgical wound categories i.e. clean, clean contaminated, were included. Prophylactic antibiotics were given in all cases. Primary closure of wounds was employed in all cases. Follow up period was 30 days postoperatively. All cases were evaluated for postoperative fever, redness and swelling of wound margins, collection and discharge of pus. Cultures were taken from all the cases with any of the above findings. The mean age of the patient was 37 years with male to female ratio of 1:5:1. The overall rate of wound infection was 13.04%. Most frequently involved pathogen was E.col 33.33% followed by Staph Aureus 20%, Klebsiella 20%, proteus 13.33%, Pseudomonas 6.66% and no organism was isolated in 6.66% cases. Most effective antibiotics were cephalosporins, quinolones and aminoglycosides' whereas septran, erythromycin and tetracycline's were ineffective. Surgical wound infections are quite common. Time of postoperative hospital stay was twice longer in infected case. Male sex, old age, anemia, longer duration of operation and wound class were significant risk factors. Most common organims are found in this study E-Coli, Kllebcella and Staph Aureus, these are mostly sensitive to cephalosporins, quinolones and aminoglycosides

Tetanus toxoid [TT-2] coverage and its associated socio-demographic factors among married women of reproductive age in urban and slum areas of hyderabad

Neonatal tetanus is vaccine preventable infection and a cause of neonatal mortality in our country. TT- vaccination of women at child bearing age can safeguard women and reduce neonatal mortality. To assess the TT-2 coverage among women at reproductive age in Hyderabad urban and slum areas. To determine the socio-demographic risk factors influencing the TT-vaccination coverage. A community based cross sectional study. This study was conducted in Hyderabad city areas [Gari Khata, Noorani Basti], Latifabad Unit No: 5, 11, 12 and Qasimabad [Phase I, Sehrish Nagar, Nasim Nagar] from 15[th] June-15[th] August 2014. 220 women of child bearing age were approached through convenience sampling. Questionnaire based interviews and examining the vaccination cards were study tools. Data comprised of categorical and continuous variables and was analyzed by SPSS Version 16. Categorical variables were analyzed by chi-square test; mean and standard deviation was calculated for continuous variables and were analyzed by applying student t-test. The p-value

vitro evaluation of mutagenicity of metformin and aspartame alone and in combination

To assess the Mutagenicity of Metformin and Aspartame in vitro. Observational/Analytical study This study was carried out at Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences Lahore from 1[st] Jan 2011 to Dec 2011. Ames Salmonella/ Microsome Mutagenicity Assay was used to check the mutagenic potential of test chemicals and control. The data was analyzed by using Statistical Package of Social Sciences. Metformin was found to be highly mutagenic against TA 100 and TA98 both in the presence and absence of metabolic activation system. The results were significant because there was 2 fold rise in number of revertants as compared to the negative control. Overall metformin exhibited more mutagenicity against TA 100 as compared to TA 98 strain of Salmonella Typhimurium. Aspartame showed significant rise in mutagenicity at l00microg/plate and 250microg/plate in dose dependant manner against TA 100 in presence of metabolic activation system. When combination doses of aspartame and metformin were studied, even those doses became mutagenic which were not mutagenic alone. The data advocates that combination doses showed significant additive effect [p < 0.05] in the intensity of mutagenic index as compared to the mutagenic index of metformin and aspartame alone. Both of these products alone and together may cause significant damage to the cells of body as well. Combination therapy of these products should be monitored closely

Causes and management out come of peritonitis

This retrospective study was conducted to study the different causes of peritonitis and to determine the surgical outcome. Retrospective study. This study was carried out at the Department of Surgery Peoples Medical College Hospital Nawabshah from 1[st] January 2001 to 31[st] December 2001. In this study of 51 patients of peritonitis admitted, out of them, 16 cases of typhoid ileal perforation, 8 cases of perforated duodenal Ulcer, 7 cases of tuberculosis of those 2 cases were of jujenal perforation and 5 cases of ileal perforation, 4 cases of perforated appendix, 4 cases of ruptured liver abscess, 2 cases of perforated neoplasms of those 1 case each with multiple ileal/ jujenal perforation due to lymphoma ,malignant caecal perforation, gastric perforation, jujenal perforation obstructive/strangulated, infective caecal perforation each, 2 cases of post operative peritonitis, 3 cases trauma, 2 cases of blunt abdominal trauma each developed peritonitis due to ileal and jejunal perforation, 1 case of gunshot injury causing peritonitis due to colon perforation, 2 cases of ruptured ovarian cyst associated with appendicitis. In our study, male to female ratio is 4:1. Maximum frequency was observed in 20-30 years age, whereas most of the patients ranged between 13 to 40 years. Surgical outcome of the peritonitis resulted poor in those cases who came late with hugely contaminated peritoneal cavity when operated. They developed post operative complications i.e. wound infection, septicemia, fecal fistula and longer hospital stays. 22 patient's outcome was poor and out of them 8 patients expired. The mean hospital stay was 23.0 +/- 17.7 days and the range was 67[3-110 days]

To assess the in vitro genotoxicity of metformin and aspartame alone and in combination

Metformin is a known oral antidiabetic agent belonging to the class of biguanides, widely prescribed for the treatment of type 2 Diabetes Mellitus [DM]. In this study the genotoxic potential of metformin was studied alone and in combination with an artificial sweetener aspartame as most of the diabetic patients utilized this low calorie sweetener to reduce their sugar consumption per day. Many complaints regarding its potential to cause DNA damage have been submitted to PDA. Experimental study. This study was carried out at the Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences Lahore from 1[st] Jan 2011 to Dec 2011. Peripheral Blood Lymphocytes were exposed to various concentrations of metformin, aspartame and their combination. DNA damage was checked by comet assay. The data was analyzed by using Analysis of Variance [ANOVA] by Statistical Package of Social Sciences SPSS Exhibited dose dependant rise in comet tail lengths. Moreover the data advocates that tail lengths of lymphocytes after exposure to aspartame were high as compared to metformin. When lymphocytes were exposed to combination of aspartame and metformin and DNA damage was checked by comet assay, the results were significantly different [p<0.05] as compared to metformin and aspartame alone. It can be concluded from the present study that aspartame is posing great genotoxic threat to the cells as compared to metformin and the combination is even more toxic to DNA, so the drug regime of diabetic patient must be closely monitored. There is further need of more studies in this regard

Current pattern and diagnosis of small bowel obstruction in the patients of rural areas

Objective of this study to determine the clinical presenting factors including diagnosis and risk factors of the patients those admitted with small bowel obstruction. Observational study. This study was carried out at the Departments of General Surgery, Peoples Medical University and Health Science Nawabshah and Isra University Hospital Hyderabad from March 2013 to Aug 2013. After admission detailed history, physical examination, ultrasound, X-ray abdomen erect and supine and all routine baseline laboratory investigations were carried out. CT scan was done in the selected patients. Final diagnosis was done by laparotomy which was attempted after thorough initial assessment and investigations. Total 50 patients were included in the study of the rural areas of the Sindh, from all of them male were in majority. On the clinical presenting features Nausea, Constipation and Abdominal pain were most common with the percentage of 92%, 80% and 78% while other presenting features as; Vomiting, Abdominal tenderness, Abdominal distension, Fever, Epigastrium pain, Rectal bleeding and Rebound tenderness were with the percentage of 40%, 42%, 22%, 38%, 30%, 16%, 10% and 26% respectively. On the diagnosis adhesion was found as most common. In the conclusion of this study adhesion found as most common and leading cause of small bowel obstruction

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

Correlation of advanced glycation end products [AGEs] with the level of alanine amino transferase [ALT] and aspartate amino transferase [AST] enzymes in chronic diabetic patients

Objective of this study is to find Correlation of Advanced Glycation End products [AGEs] with the level of Alanine amino transferase [ALT] and Aspartate amino transferase [AST] enzymes in chronic diabetic patients. Case Control Study. This study was conducted at the laboratory of Department of Biochemistry, University of Agriculture, Faisalabad from December 2009 to May 2010. For this study blood samples were collected from Pakistan Institute of Medical Sciences, Islamabad. In the present study, the level of protein glycation in human serum samples of healthy older and young control subjects [n = 20], and diabetic patients [n=45], were investigated. The patients were selected on clinical grounds from Pakistan Institute of Medical Sciences. Serum AGEs were found to be significantly [P<0.001] increased in diabetic patients as compared to healthy older subjects and control subjects. However, no significant difference was found in the level of AST and ALT in diabetic patients and control group. The AGEs distribution in these groups reveals the hypothesis that the advanced glycation process might play a role in the development of liver diseases, but in this study no correlation has been found in level of glycation and such liver damage which could result in decreased or increased formation of AST and ALT. no study have been found regarding level of glycation and level of AST and ALT in diabetic patients. From this study we conclude that no correlation is present in level of glycation and level of AST and ALT in blood in diabetes. Since, there is no effect of AGE formation on production of ALT and AST in liver

Relationship between religious orientation and depression

The present study is aimed at exploring relationship between religious orientation and depression. Cross-sectional study. This study was conduted out at Clinical Psychology, FG Post Graduate College Wah cantt from March 2011 to May 2011. The study included samples of 100 individuals from normal population of Wah Cantt. The educational level of participants ranged from intermediate level to post graduate. Religious orientation scale and Zung self rating scale of depression were used to measure the relationship between religious orientation and depression. The present research project was designed to explore relationship between Religious Orientation and Depression. For this first of all Alpha reliability of religious orientation and depression scales were computed. Descriptive Statistics were measured for both scales. Our finding suggests that religious orientation is negatively correlated with depression

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

Frequency and type of stroke in hypertensive patients

To describe the frequency and type of stroke in hypertensive patients Descriptive study. This study was conducted in the carried out in the Department of Medicine [ICU] at Peoples Medical College / Hospital Nawabshah, from 1[st] September 2008 to 28th February 2009. A total of 100 patients were admitted to the ICU of medicine department. Relevant investigations like CT Scan brain, ECG and routine investigations like blood CP, Serum cholesterol and random blood sugar were done. Data was retrieved from the files on a structured performa. 65 were male and 35 female with ratio of 1.8:1. Mean age was 60.58 +/- 4.25 years for male and 59.22 +/- 3.25 for female. Ischemic stroke were 73% cases while 27% cases were recurrent hemorrhagic stroke. In ischemic stroke uncrossed hemiplegia occurred in 69[94.5%] cases and crossed hemiplegia occurred in 4[5.5%] cases while all hemorrhagic stroke patients suffered from uncrossed hemiplegia [100%]. Frequency of ischemic stroke was more common then hemorrhagic stroke in hypertensive patients

comparative study of percutaneous suprapubic cystolitholapaxy versus open cystolithotomy in children

To compare the outcome of percutaneous suprapubic cystolitholapaxy with open cystolithotomy in children. Comparative study. Department of Urology and Surgery, Peoples Medical College Hospital Nawabshah, from 2004 to 2007. Hundred patients [87 boys and 13 girls], from 1 to 10 years of age were enrolled in the study. The size of stones ranged from 8mm to 25mm. Patients were divided in two equal groups A and B. Group A submitted for percutaneous suprapubic cystolitholapaxy and group B for open cystolithotomy. The procedure was done under spinal and caudal anesthesia with intravenous sedation. To compare the outcome of percutaneous suprapubic cystolitholapaxy with open cystolithotomy Postoperative complications noted in group A patients included transient hematuria in 2 cases [p 0.495]. Operative time in group A was 10 to 15 minutes while in group B it was 25 to 40 minutes [p 0.0005]. Urinary leakage [n=2 - p 0.495] and wound infection [n=3 - p 0.242] were observed in group B. Duration of catheter placement was 2-3 days in group A, while 5 to 7 days in group B [p 0.0005]. Hospital stay of group A was 2-3 days while 5-7 days in group B [p 0.0005]. All patients became stone free. Percutaneous suprapubic cystolitholapaxy is an efficient, safe, minimally invasive and cost effective method

Frequency of hyperuricemia in patients with ischemic heart disease

To determine the frequency of hyperuricemia, as a risk factor, in patients with ischemic heart disease in our setup. This prospective and observational study was carried out in the Departments of cardiology, medical unit III and pathology, Peoples Medical College and Hospital, Nawabshah from 15[th] January 2007 to 15[th] July 2007. Fifty patients, of any age and of either sex, diagnosed on ECG as ischemic heart disease [IHD] were selected and compared with serum uric acid [SUA] levels and age, sex, approximately body mass index [BMI] matched healthy controls. SUA was measured on 3[rd] day of admission by using enzyme uricase method on CLINIKON photometer 5010. Hyperuricemia was found in 27 out of 50 IHD patients and in 5 out of 50 controls; therefore a highly significant association was observed. Mean SUA level was 7.21 +/- 2.14 in patients with ischemic heart disease and 5.38 +/- 1.26 was found in healthy control subject. The difference between these two means was highly significant [P<0.0001]. Hyperuncemia significantly associates with IHD. It does not cause t IHD, neither is an independent risk factor but it only accelerates the process of atherosclerosis which can worsen the preexisting IHD

Experience with spinal instrumentation for tuberculosis spine at PMCH Nawabshah

Spinal column is the common site of skeletal tuberculosis. Anteriorly there are three varieties: Paradiscal, Centrosomatic and Anterior Longitudinal. Extra-osseous involvement causes paravertebral abscess, epidural abscess or involvement of ligaments. The purpose of this study is to identify the frequency, presenting features, diagnostic tests and outcome of decompression and stabilization of tuberculous spondylitis. This study was conducted in Peoples Medical College, Nawabshah. All cases of spinal tuberculosis treated surgically were included. Admission criteria for these patients were advanced form of spinal tuberculosis, presenting with progressive deformity, neurological deficit, intractable pain, large paraspinal abscess or posterior element involvement. Over a period of 5 years, we had operated upon 248 cases of tuberculous spondylitis. Females dominated [1.91 times]. Bulk of series belonged to younger age group less than 40 years. Majorities of them had pain, neurological deficit and gibbus deformity. Surgery was performed to decompress the cord, apply a bony strut graft and stabilize with instrumentation. Thoracic region was commonly involved. Anterior approach was preferred because most of times anterior elements were involved. Webb Morley instrumentation system was used in majority of cases from D4 to L4. At the end of 6 months postoperatively pain relief was observed in 94.9% and neurological [motor] improvement in 92.2% cases. In this series we have observed that in our part of the world tuberculosis of spine is commonly seen in females and younger age group. Anterior decompression and stabilization is helpful in segmental rigid fixation of spine, pain relief deformity correction and early neurological recovery

Isolation and seroprevalence of avian influenzavirus [H9N2] at Islamabad/Rawalpindi

The aim of this study was to isolate and evaluate the seroprevalence of avian influenza virus [AIV] infection in chicken in Pakistan with special reference to its serotype/H9N2. Laboratory based prospective. This study was carried out at department of Biological Sciences, Quaid-e-Azam University Islamabad and National Agricultural Research Centre Islamabad Pakistan from 2000 to 2001. The human virological aspects were dealt by AF Institute of Pathology, Rawalpindi. The chicken flocks studied belonged to different poultry farms located at Islamabad/Rawalpindi area. For the isolation of avian influenza virus, lungs and trachea specimens were processed to prepare virus inoculum and inoculated in 9-day old embryonated eggs via allantoic route. For identification of virus, haemagglutination test and immunofluorescent antibody test [IFA] were used. Serological analysis was done by Agar Gel Precipitation Test [AGPT], Haemagglutination [HA] and Haemagglutination inhibition test [HI]. This study was divided into two parts; firstly the sera of chicken with history of respiratory tract infection were tested for the presence of antibodies against H9N2 virus. Such chicken were found to have seroconverted against H9N2. Secondly, it was aimed to isolate virus from kidneys, lungs and trachea of infected birds by growing virus in 9 days old chick embryos. Out of 40 clinical samples, 9 isolates of AIV were recovered and typed serologically as serotype H9N2. In this scenario, the presence of H9N2 in poultry in the country poses a continuous threat for the emergence of more pathogenic strains of human influenza virus. For this purpose there is a constant need to carry out surveillance for influenza viruses both in birds and humans in the country