Diabetic foot ulcer; sequelae

Objective: The number of diabetic patients is increasing at a rapid rate1. Management of diabetic foot has been a challenge for medical professionals. This study was carried out to find the sequelae of diabetic foot ulcer management. Study design: Observational analytical study. Setting: Military Hospital, Combined Military Hospitals Rawalpindi and MIMC teaching Hospital, Mirpur [AJK]. Period: Sep 2009 to August 2013

Materials and methods: Total 310 patients were included in this study as outdoor and indoor cases. Out of these 184 were males and 126 were females. Age affected ranged from 20 years to 90 years. Average age was 50 years. Wagner's grading for diabetic foot ulcer was used as guideline for management

Results: Hyperglycemia was controlled in consultation with physicians in all these patients. Out of these 310patients 199 [64%] patients got their feet wounds healed on conservative management without amputation while 111[35.8%] patients had to undergo some amputation at some level

Conclusion: Diabetes mellitus, fore runner of so many diseases requires multidisciplinary approach. Well controlled diabetes mellitus, good feet hygiene, rational antibiotics in light of culture/sensitivity report and timely conservative or active surgical intervention produce good results in diabetic foot management

Comparison of post circumcision complications and wound healing in infants by conventional open method and bone-cutter method

The objective of this study is to compare the frequency of post circumcision complications like bleeding and infection along with wound healing in infants by conventional open method and the bone-cutter method. Randomized controlled trial. Combined Military Hospital and Military Hospital Rawalpindi, from March 2009 to March 2010. A total of 400 patients were included in the study that underwent circumcision. Patients were randomly allotted to either group A in whom the circumcision was done with conventional open technique [n = 200] or to group B, in whom circumcision was done with bone-cutter [n = 200]. Patients were followed up in the surgical OPD after 5 days for assessment and earlier in case of any complication. Outcomes were measured by absence or presence of infection, post operative bleeding and cosmetic acceptance by the parents. Comparison between the two groups showed that the bleeding rate was 8% in group A and 7% in group B [p = 0.704]. Infection rate was 6% in group A and 5% in group B [p = 0.661]. Delayed wound healing was seen in 4% of circumcisions in group A as opposed to 2% in group B [p = 0.241]. Complication is a part of any surgical procedure. So is the case with circumcision however no significant difference was found between the two procedures in terms of bleeding, infection, trauma to the glans and the cosmetic outcome

Circumcision by bone cutter-Is it safe?

Objective: To determine the frequency of complications observed in circumcisions performed using closed method and to ascertain its safety in relation to pediatric penile trauma

Study Design: Quasi-experimental study

Place and Duration of Study: Study was conducted in departments of surgery of combined military hospitals of Cherat, Khuzdar and Malir from Jan 2008 to Dec 2009

Patients and Methods: Two hundred and fifty patients were included through the outpatient department for elective circumcision. Male children from 1 week of age to 1 year were included, circumcision being performed for ritual purpose. Exclusion criteria was those male children having deranged coagulation profile, neonatal jaundice, congenital urogenital abnormalities and any other disease. Circumcision was performed using closed technique by bone cutter

Results: Out of the total 250 cases, the success rate of circumcision without any complication was recorded in 229 [91.6%] cases. The remaining 21 [8.4%] cases developed minor complications. Infection was recorded in 7 children [2.8%].Some degree of bleeding was observed in 10 [4%] cases which require change of dressing in 8 cases and haemostasis by application of stitches in 2 cases. Redo surgery was done in 4 [1.6%] cases for unsatisfactory cosmetic reasons. None of the patients in our study sustained trauma to glans

Conclusion: Although it is not a standard procedure, Close method of circumcision by bone cutter is an established and safe technique if it is performed by trained practitioners. We suggest that training workshops should be organized to adequately train all practitioners of circumcision on the safe methods available

Polio vaccination; knowledge, attitude, and practice in district Abbottabad, Khyber Pakhtunkhwa, Pakistan

To assess knowledge, attitude and practice [KAP] about poliomyelitis [polio] vaccination in District Abbottabad, province Khyber Pakhtunkhwa [KPK], Pakistan, to identify reasons of failure of polio vaccination/ eradication campaign and to make recommendations in the light of the study. District Abbottabad, province KPK, Pakistan including both urban and rural areas. Three months from 1st June to 31st August 2012. This cross-sectional descriptive explorative study was conducted in District Abbottabad, of province KPK, Pakistan. A structured questionnaire was submitted to people in the urban and rural population using convenient sampling. Out of 200, only 142 questionnaires were filled by interviewing parents and guardians of the children followed by focused group discussions with the community heads and the parents of the children. Majority [61.78%] of respondents were of low income category with the mean age of 31 years. Amongst those [75%] were earning Rs.7,000-12,000 per month. Literacy rate was low with 45.77%. Out of which 40.67% fathers and 59.33% mothers were illiterate. Therefore a few respondents were aware about the mode of transmission of polio. Majority [80%] said that polio could be prevented by polio drops and about 86% said that this vaccine had no side effects. About 45% respondents refused to cooperate with polio teams, and 28% respondents believed, that Abbottabad Operation had bad effect on anti-polio campaign. Regarding the use of boiled drinking water, 95.8% respondents knew that it was good for health. While only 4.20% were using boiled water for drinking. Advice of the health professionals [69.71%] and other family members [7.74%] was respected in making health care decisions, therefore it was an opportunity for the government to involve these persons as well as media men in conveying message to the community to achieve ultimate goal of polio free Pakistan. Unawareness among the population of District Abbottabad, especially the knowledge about the disease, mode of transmission and its prevention are the most deficient areas. Secondly misconceptions about the nature of polio drops, and religious misinterpretations in masses, created by general public and religious leaders, are the major obstacles in the real success of vaccination campaign

Pattern of combat casualties in war against terror among soldiers wearing body armor at CMH Peshawar

To determine the pattern of gun shot and explosive injuries in soldiers equipped with body armor and helmet. Descriptive study Combined Military Hospital Peshawar, from 1st June 2008 to 30th May 2010. All combat casualties received in 'Emergency reception' of Combined Military Hospital, Peshawar were included. Data was taken from the patient's medical charts and by personal evaluation and entered in a proforma. The variables used were age, use of helmet, cause of the injury, site of injury, Haemo-dynamic Status, conscious level, intensive care treatment duration, total hospital stay, return to work and mortality. A total of 516 combat casualties were received in 'Emergency reception' of Combined Military Hospital, Peshawar, Pakistan. All patients were males with a mean age of 31.22 +/- 7.858 years. Sixty nine percent [356] cases had injury due to splinters from Improvised Explosive Devices [IED] and 31% [160] had gunshot wounds. Seventy five percent [391] patients were haemodynamically stable while 24.2% [125] were unstable. Penetrating Extremity Injury [PEI] was the commonest injury [71.9%] followed by Penetrating Injury of Face or Neck [PNFI] in 12.0% [62], Penetrating Torso Injury [PTI] in 8.9% [46] and Penetrating Injury of Cranial Vault [PCI] in 7.2% [37]. Overall mortality was 64 [12.4%] IEDs have become the weapon of choice in gorilla warfare by the terrorists in addition to guns, bombs, and anti-personnel mines. The use of body armor has decreased the mortality but the morbidity in terms of limb injuries has increased

Pattern of injuries inflicted on troops fighting, on the western front

To determine the pattern of fatal and non fatal injuries in soldiers and officers during the present war on Western front. Descriptive study with partly retrospective data collection. The study was carried out at Combined Military Hospital [CMH] Peshawar, the tertiary care centre for Pakistan Armed Forces serving FATA and NWFP from March 2004 to May 2009. Data of non-fatal injuries was collected by noting down the wounds inflicted on injured soldiers and officers evacuated from forward areas while the record of non-fatal injuries was noted from the hospital papers prepared for each patient. Due to reasons of confidentiality the analyses is based on percentages only, while actual figures can be provided by the authors on appropriate security cleared requests. The Lethality Index [LI] of wounds, calculated by dividing the fatal injuries by the total injuries, was 18% during these six years. Out of the total fatal injuries in all six years highest number occurred in 2008 [40%] while LI was highest in 2005 [25%]. Only a small number of patients [1.86%], who were evacuated alive, died in the hospital. Fifty one percent soldiers received multiple [>two] fatal injuries. Head [46%] and Chest [44%] were the commonest sites of fatal injuries while limbs were the commonest sites of non-fatal injuries. Gun shot wounds were the commonest [68%] mode of fatal and non-fatal injuries. Head and chest injuries are the commonest sites of fatal injuries, while limbs injuries constituted the major portion of the non-fatal injuries indicating potential areas in need of improved protective

Comparison of 0.2 % glyceryl trinitrate and open lateral internal anal sphincterotomy in treatment of chronic anal fissures

To compare lateral internal sphincterotomy with 0.2 percent glyceryl trinitrate in the treatment of chronic anal fissure in terms of fissure healing and complications. Randomised Controlled Trials [RCT] Place and duration of the study: The study was of 6 months duration conducted at surgical unit Combined Military Hospital Rawalpindi from August 2006 to February 2007. Subjects and Seventy Patients were randomly assigned to two treatment groups. Group 1 was assigned to apply glyceryl trinitrate 0.2 percent paste while, in group 2 lateral internal sphincterotomy was done. Response to the treatment was assessed in terms of fissure healing and occurrence of complications. Follow up of the patients was carried out at the end of 2nd, 4th, and 6th week of treatment. In this study overall healing rate after 6 weeks with GTN was 71.4% and 100% with LIS [p< 0.001]. Conclusions: lateral internal sphincterotomy is better than GTN in fissure healing

Injuries and fatalities resulting from the 2005 south Asia earthquake. A hospital experience

The South Asia quake struck South Asia with its epicentre in Pakistan on 8[th] October 2005, originating from a previously recognized fault line but of unsuspecting magnitude of death and destruction. The Earthquake measured 7.6 on the Richter scale and caused massive loss of life and extensive damage to property never seen before in the history of Pakistan. Earthquake related admissions and deaths to one of the two major tertiary care hospitals receiving casualties from the quake zone from 8[th] October 2005 through 1[st] November 2005 were analysed. All medical data from the hospital records was reviewed for quake related injuries and information about pattern of injuries received and treatment administered. A total of 3128 earthquake related admissions were recorded in the hospital with 39 in-hospital deaths. Admission rates were approximately 2:1 by gender, males affected more. Earthquake related injuries are varied and multifactorial. Comprehensive surveillance and a well developed plan for all Medicare setups need to be in place and when actively rehearsed, can help lead to better management preparedness