Comparison of wound healing with and without adjuvant topical oxygen therapy in infected diabetic wounds

Diabetes mellitus [D.M] is one of the main problems in health systems and a global public health threat that has increased dramatically over the past 2 decades. Patients with D.M are prone to multiple complications such as diabetic foot ulcer [DFU]. Despite of the advantages of debridement, adequate debridement must always precede the application of topical wound healing agents, dressings or wound closure techniques

Objective: The objective of the study was to compare the efficacy of adjuvant topical oxygen therapy with conventional methods and conventional methods alone in management of infected diabetic wounds

Study Design: Randomized Control Trial

Setting: Surgical Unit III, Allied Hospital, Faisalabad

Period: 4 months from March to June 2017

Methodology: A total of 120 cases included in this study were admitted either through OPD or emergency ward. Group A [Topical oxygen therapy was given along with conventional methods]. Group B [Only conventional methods of wound care were applied]. All patients were given single dose IV antibiotic half an hour before induction of anesthesia. All diabetic patients were administered regular insulin to control blood glucose levels. Good debridement was done, removing all dead tissue. Simple available cellophane bag applied, sterilized with antiseptic solution, tailored according to size of affected part used tapped on open side of body of patient like tourniquet. 100% oxygen was given in bag with routinely available oxygen cylinder exposing whole affected part of body or limb. Oxygen in chamber was given for maximum one and a half hour twice daily in one sitting for 7-10 days. Gram positive, gram negative and anaerobic cover was given with antibiotics. Wound was washed daily with normal saline. After clinical improvement patient was discharged and called for follow up at outdoor on weekly basis initially and then fortnightly for 6 months

Results: Mean age was calculated as 49.56+/-7.02 and 49.11+/-6.59years in group A and B respectively. 53.33% [n=32] in group A and 58.33% [n=35] in group B were males, while 46.67% [n=28] in group A and 41.67% [n=25] in group B were females. Comparison shows that 46.67% [n=28] in group A and 26.67% [n=16] in group B had efficacy; p value was calculated as 0.02 showing a significant difference

Conclusion: Efficacy of adjuvant topical oxygen therapy with conventional methods is significantly higher when compared with conventional methods alone in management of infected diabetic wounds

Intracranial tuberculomas: presenting symptoms and outcome with anti tuberculosis drugs treatment

Background: Tuberculosis is still common in developing countries, and sometimes involves central nervous system, proper diagnosis and early treatment effectively reduces the mortality and morbidity associated with this disease

Objective: Observe presenting symptoms and outcome on anti-tuberculosis drug treatment

Material and Methods: This prospective study was conducted in the Department of Neurosurgery in collaboration with Department of Pathology, Ayub Teaching Hospital Abbottabad from March 2010 to December 2016. 22 patients; 8 females and 14 males were studied for their signs and symptoms and outcome after anti-tuberculosis drug treatment

Results: The most common location of tuberculous lesions was supratentorium [81%] particularly in parietal lobe [50%] followed by frontal lobe [22.7%] and occipital lobe [18.2%]. 45% patients had prior history of tuberculosis. Headache was the predominant complaint [72.7%] followed by altered sensorium [31%], seizures [27.3%] and cranial nerve palsies [22.7%]. After 12 months of anti-tuberculosis treatment ATT, about 87% of patients had either resolved or regressed tuberculoma

Conclusion: Brain tuberculomas are benign lesions with" malignant" behavior. Early diagnosis and anti-tuberculosis drug treatment can effectively treat this lesion forever. So in developing countries like Pakistan, when there is cystic, nodular or multiple lesions, there should be suspicion for brain tuberculoma and work up should be done because of very good prognosis associated with anti-tuberculosis drug treatment

Complications of colostomy; frequency in a tertiary care hospital

Objective: To study the frequency and types of complications in colostomy patients. Study Design: Prospective cross sectional study. Setting: Department at Surgery, Fauji Foundation Hospital Rawalpindi. Period: 1[st] December 2009 to 30th November 2011

Material and Methods: A total of 104 consecutive patients who end up with colostomy due to any reason were included in the study

Results: It was noted that 52 patients had stoma due to malignancy and complications was noted in 40 patients. Same number of Patients operated for non-malignant disease i.e. 52. Complications noted in only 24 patients while 28 were without complications

Conclusions: The chances of complications in different type of stomas are much higher in case of malignancy. It is recommended that such operations are performed by senior surgeons in order to avoid post-operative morbidity and mortality

Percutaneous intervention for coronary bifurcations-our experience on 133 patients at army cardiac centre Lahore

To study the safety and efficacy [pre and post procedure outcomes] of stenting the main vessel [MV] with or without stenting the side branch [SB] in the treatment of coronary bifurcation lesions. In this retrospective analysis of 133 patients, operated between Oct 2009 and Sept 2010, true coronary bifurcation lesions using the registry at Army Cardiac Centre were analyzed. All angiograms and case notes were reviewed for sites of lesions, MADINA classification, angle of bifurcation, size of MV and of SB, number and type of stents used, total procedure and radiation time, and patient characteristics. In-hospital MACE events were recorded for all patients. Of the 133 cases, 120 [90.2%] underwent MV stenting alone, while 13[9.8%] underwent SB stenting as well. Drug Eluting Stent [DES] with minicrash technique was deployed in the majority of the latter cases. In hospital clinical follow up showed 2 NSTEMI in the SB stents [p=0.009] whereas no MACE event was recorded for MV stents alone. Stenting of only MV is safer, effective and economical than stenting of both MV and SB. Moreover contrast related risks and risks of radiation are much less with stenting the MV in the treatment of coronary bifurcation as compared to stenting of both MV and SB