Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study / Terapia com imunomodulador ou vitrectomia para manejo de uveíte intermediária complicada: estudo clínico prospectivo e randomizado

ABSTRACT Purpose: To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis. Methods: This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings. Results: Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement. Conclusions: Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.

RESUMO Objetivo: Comparar os benefícios e efeitos co laterais da vitrectomia via pars plana com os da terapia imunomo duladora sistêmica em pacientes com uveíte intermediária complicada. Métodos: Estudo clínico prospectivo incluiu pacientes com uveíte intermediária recorrente que apresentaram melhora minima da acuidade visual, apesar das injeções perioculares de esteroides. Vinte pacientes foram randomizados para o grupo de vitrectomia via pars plana ou esteróide oral e ciclosporina A (10 olhos de 10 pacientes por grupo). O acompanhamento foi de 24 meses para estudar al te rações na acuidade visual, o escore da oftalmoscopia binocular indireta, a angiofluoresceinografia e achados na to mográfica de coerência óptica. Resultados: A acuidade visual (logaritmo do ângulo mínimo de resolução) melhorou significativamente de 0,71 para 0,42 (p=0,001) no grupo cirúrgico, enquanto melhorou de 0,68 para 0,43 (p=0,001) no grupo da terapia imunomoduladora. Sete pacientes (70%) no grupo cirúrgico ganharam ≥2 linhas e seis pacientes (60%) no grupo da terapia imunomoduladora ganharam ≥2 linhas (p=0,970). Os estudos de angiofluoresceinografia e tomografia de coerência óptica mostraram que seis dos sete pacientes da vitrectomia via pars plana que apresentaram edema macular cistóide melhoraram, enquanto dois pacientes com edema macular difuso não apresentaram melhora. No grupo da terapia imunomoduladora, três dos seis pacientes com edema macular cistoide não apresentaram melhora, enquanto dois pacientes com edema macular difuso melhoraram. Conclusões: A vitrectomia via pars plana e a terapia imunomoduladora resultaram em melhora significative da função visual dos pacientes com inflamação persistente secundária a uveíte intermediária crônica. Apesar desse sucesso, continua sendo necessário determinar as melhores indicações para o uso de cada modalidade. A terapia imunomoduladora foi bem sucedida no tratamento do edema macular difuso associado à uveíte intermediária crônica, enquanto a vitrectomia via pars plana não foi.

Assessment of knowledge, attitude and practice toward down syndrome in Jeddah City, Saudi Arabia 2016

Background: Down syndrome [DS] is a chromosomal disorder that results in intellectual disability and growth problems. The worldwide incidence of this syndrome is 1 in 1000 births and increases exponentially with the maternal age. People with DS usually have reduced life expectancy and suffer from mental retardation, heart problems, Alzheimer's disease among other complications. However, the severity of the disease differs from patient to patient. Perceptions of the disease and the public attitudes towards people with Down syndrome are very important in the inclusion of these people in the community and the supporting families

Objectives: to assess the level of awareness, attitude and practice toward Down syndrome in Jeddah city to identify barriers

Methods: a cross-sectional analytical questionnaire-based study among the general population of Jeddah city

Results: a total of 360 subjects answered the questionnaires. The mean age was 36 years, it ranged from 16 to 70, with 45.2% females and 43.7% male respondents. Of these, 67% had attended college, 5% had a postgraduate degree, 23.5% had completed high school, and 3.1% had basic school. The majority of participants had a high level of monthly income [38%]. The majority of subjects included in the research were [59.6%] married and [51.3%] were unemployed. Most subjects [338] had poor knowledge about Down syndrome and there was no association between the knowledge and demographics of participants except for education at the higher levels of education, the more significant association with good knowledge

Conclusion: The results of the present study reveal that the knowledge about the Down syndrome was poor among the studied population. Also, education significantly impacts the knowledge of Down syndrome, thus there is a need for providing the population and patients with the necessary information to improve their Down syndrome awareness

Three-port versus four-port laparoscopic cholecystectomy - a two years experience at combined military hospital Malir cantt Karachi

Objective: To compare the safety, outcome and advantages of three port laparoscopic cholecystectomy vs. four port laparoscopic cholecystectomy

Study Design: Prospective descriptive study

Place and Duration of Study: The study was done at Combined Military Hospital Malir Cantt Karachi starting, from Mar 2013 to Oct 2015

Material and Methods: Total 200 patients who had undergone gall bladder removal laparospically were studied. Complication rate, duration of operation, insertion of 4th port, converting laparoscopic method to open, duration of hospital admission, early return to work and need of analgesics were studied in patients with three ports laparoscopic cholecystectomy [LC] vs. four ports LC

Results: A total of 200 patients who had removal gall bladder laparospically, three-port LC were performed in 117 [58.5%] patients and four-port LC was performed in 83 [41.5%] patient. There was no significant difference with respect to complication rate, converting to open technique and duration of operation were comparable to four ports LC. One patient required 4th port in left hypochondrium for liver retractor to retract enlarged left liver lobe

Conclusion: LC using thee ports can be performed safely when done by experts in this method. The said procedure has significant benefits over the conventional four-port method with respect to decreased use of pain killers and duration of hospital admission

Concurrent cisplatin-based chemoradiation in squamous cell carcinoma of cervix

Objective: to evaluate the efficacy of cisplatin-based concurrent chemoradiation in squamous cell carcinoma of cervix and the frequency of acute toxicity

Study Design: case series

Place and Duration of Study: department of Clinical Oncology, Karachi Institute of Radiotherapy and Nuclear Medicine [KIRAN], Karachi, from September 2010 to September 2011

Methodology: eighty patients with histologically proven squamous cell carcinoma of cervix were included. Patients were treated with concurrent chemoradiation. External beam radiation was delivered with 50 Gy whole pelvis along with 40 mg/m2 weekly cisplatin followed by brachytherapy three insertions of 6.5 Gy each, one week apart. Response to treatment was assessed using response evaluation criteria in solid tumours [RECIST] criteria at 4 weeks after treatment. Acute toxicity of chemoradiation was assessed using common toxicity criteria

Results: out of the 80 patients, 8 patients were lost to follow-up. Remaining 72 patients aged 28 - 65 years with mean age of 48.03 +/- 8.9 years. Forty-eight patients [66%] were in stage II-B, 5 [7%] were in stage III-A, 7 [10%] were in stage III-B, and 12 [17%] were in stage IV-A. Overall response to treatment was 92%, in which 39 [54%] had complete response, and 27 [38%] had partial response while 6 [8%] show progressive disease. About 70% patients had diarrhea, 61.2% patients developed vomiting, 45.8% patients had dermatitis, 43% patients had vaginal mucositis, 40.3% had anemia, 13.9% patients had neutropenia, 27.8% patients had dysuria, and 22.2% patients had proctitis

Conclusion: cisplatin-based concurrent chemoradiation is an effective treatment in locally advanced stage of cervical cancer with manageable toxicity

Perception of diabetic patients regarding basal bolus insulin injections and outcome of its use

Objective: To assess the perceptions regarding basal bolus insulin injections and the changes in blood glucose levels and glycosylated hemoglobin [HbA1c] before and after 3 months of such treatment in diabetic patients. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2014 to March 2015

Methodology: A total of 222 diabetic patients started on basal bolus insulin injection were enrolled and asked to answer 17 questions. Those with complications of diabetes were excluded. Fasting blood glucose [FBS], random blood glucose [RBS] and HbA1c levels were checked initially, and after 3 months of getting basal bolus insulin. Paired t-test and chi-square test were used for determining p-value with significance at p < 0.05

Results: Majority [n=217, 97.7%] of the patients were previously taking other insulins. Before starting this treatment, the mean FBS was 260.5 +/- 52.2 mg/dl, RBS was 385.5 +/- 47.61 mg/dl and HbA1c was 12.76 +/- 1.92%. After 3 months of treatment, FBS improved to 117.9 +/- 14.2 mg/dl, RBS was 156.7 +/- 17.09 mg/dl and HbA1c was 7.72 +/- 4.41% [p < 0.001]. Two hundred and sixteen [97.3%] patients believed that basal bolus insulin was started as their diabetes worsened; 157 [70.70%] thought that their blood glucose control would improve with the use of this form of insulin. One hundred and ninety four [87.4%] had fear of needle injections. Perceptions regarding hypoglycemia with this form of insulin were observed in 157 [70.7%]. One hundred and twenty seven [84.1%] of the females and 51 [71.8%] of the males thought that the basal bolus insulin regimen was too expensive [p=0.032]

Conclusion: There were many misconceptions in patients who were started on basal bolus insulin. Marked improvement in blood glucose levels and HbA1c were observed after the use of this regimen

Comprehensive review on treatment of HIV

HIV or AIDS is a major threat for humanity in the world especially in developing countries. The causative factor of the syndrome is HIV, which infects and destroys one of the cellular components of the immune system, the T cells, causing deficiency in the immunological surveillance and ultimately leading to AIDS. According to WHO, around 35 million people were living with HIV in 2013 and since the start of epidemic 39 million people have died due to AIDS. Center for disease control and prevention estimated in 2014 that 1,201,100 people aged 13 and above were suffering from HIV infection Worldwide. The most effective approach is the highly active antiretroviral therapy [HAART] containing the combined use of drugs having different mechanisms of action. However, complete eradication of HIV from the body does not occur by HAART, but it lead to long term toxicity occurs and emerges as drug resistant. Despite the recent development of various new antiretroviral compounds, there is still a need to develop need to search for new alternatives which are equally efficient and less expensive as compared to the contemporary treatment available. This review provides an overview and a summary of herbal medicines for HIV infection and summarized the efficacy and medicinal use of different plants used in the treatment of HIV infection. The objective of this review is to enlighten the recent advances in the exploration of medicinal plants used for treatment of HIV/AIDS

Evaluation of antipyretic activity of some medicinal plants from Cholistan desert Pakistan

Traditional herbal healers "Hakims" use various plants of the Cholistan desert, Pakistan for treating a number of infectious and non-infectious diseases. However, there has never been a scientific validation of these plant-based therapeutics. We compared the antipyretic effect of Echinops echinatus, Alhagi maurorum, Fagonia cretica, Cymbopogon jwarancusa and Panicum turgidum in animal model. These plants were used to reduce E.coli lysate induced pyrexia in rabbits. There were five groups of rabbits having five rabbits in each group. Among these five groups, three received various doses of experimental treatment, paracetamol was given to fourth group known as positive control. The fifth group of animals served as negative control and received no treatment. Ethanol extracts of Fagonia cretica [500mg/kg], Panicum turgidum [500mg/kg and 750mg/kg], Alhagi maurorum [500 and 750mg/kg], Cymbopogon jwarancusa [250mg/kg] and Echinops echinatus [750mg/kg] showed significant antipyretic effects when compared with controls and experimental counterparts. These results revealed that ethanol extracts of the plants evaluated in this study have dose dependent antipyretic activity. Further detailed screening of these plant species is recommended

Spectrum of firearm fatalities in Larkana region

Objective: To determine frequency of firearm fatalities in Larkana region

Study Design: Descriptive study

Place and Duration of Study: The study was conducted at causality and department of forensic medicine and toxicology Chandka Medical College @ SMBBMU Larkana from 1[st] June 2013 to 31[st] May 2015

Materials and Methods: Out of 1870 dead bodies brought for autopsy at causality Chandka Medical College Hospital Larkana and those 357 [19%] cases were selected in whom death occurred due to firearm as mentioned in police inquest report and autopsy record conducted, with the permission of authorities data was collected and analyzed and cause of death was determined by external and internal examination of body

Results: Autopsy record shows that among 357 cases males with 309 [87%] were dominated on females with 48 [13%] with Male/Female ratio of 6:1. The victim ages range from 11 years to 70 years and with location of injuries as 127 [35.57%] on Chest, 92 [25.77%] on Head and Neck, 59 [16.52%] on Abdomen, 38 [10.64%] on Head and Chest, chest and abdomen 31 [8.68%] and 10 [2.82%] on limbs and other parts, with manner of homicide in majority [78.15%] of cases

Conclusion: The majority of victims were young males belonging to rural areas with rifled firearm injuries on Chest, and Head and Neck as a cause of death

Geriatric fractures: an experience at a tertiary care hospital

Objective: To find out demographics, mechanism of injury and bones involved so as to suggest preventive measures in geriatric population

Study design Retrospective case series

Place and Duration of study: Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital Lahore, from January 2015 to December 2015

Methodology: This study included all patients of age greater than 50 year of either sex admitted through emergency or OPD having any type fracture. The data were taken from hospital database and included clinical, epidemiological and radiological records. The results were analyzed using SPSS version 17.0

Results: A total of 1215 patients were included in the study. Of these 880 [72.4%] were males and 335 [27.6%] females. Male to females ratio were 1.38:1 with mean age of 56.21 +/- 12.603 year. Most of them were between 51-60 year [n=629 - 51.77%]. Femoral fractures were the most common and the main mechanism of injury were fall followed by road traffic accidents

Conclusions: Femoral neck fractures were the most common fractures and mostly females were involved. Fall was the main mechanism of injury

Laparoscopic surgery in urology: an experience from a tertiary care center

Objective: To describe the results of laparoscopic procedures performed in a Urology unit of a tertiary care hospital

Study design: Case series

Place and Duration of study: Department of Urology Jinnah postgraduate Medical Centre Karachi, from March 2011 to February 2016

Methodology: Data of all planned laparoscopic surgeries were collected and analyzed for demographic information, laboratory reports, procedure details, operative time, duration of hospital stay, complications and follow up details. BAUS guidelines were used to learn laparoscopic skills. Data was analyzed using Statistical package for the social Sciences [SPSS, Version 20.0]

Results: There were total of 57 patients who underwent laparoscopic surgery. This included 48 males [84.21%], and 9 [15.7%] females. Mean age of patient was 30.37 +/- 12.01 year [Range 12-73 year]. The procedures performed included simple nephrectomy [n=13], ureterolithotomy [n=14], varicocelectomy [n=13], orchidopaxy [n=2]. There were 12 diagnostic procedures for non-palpable testes, one adrenalectomy, one radical cystectomy, and one vesico-vaginal fistula repair. Fifteen patients needed conversion to open surgery due to various reasons. Out of 42 successfully performed laparoscopic procedures 10 different complications were noted majority being Clavien Grade II, including blood transfusion in one patient

Conclusion: Laparoscopic surgery has a prolonged learning curve. The conversion rate in this study was 26.3%

Mobile phone intervention to improve diabetes care in rural areas of Pakistan: a randomized controlled trial

To determine the effect of mobile phone intervention on HbA1c in type-2 Diabetes Mellitus [DM] patients living in rural areas of Pakistan. Randomized controlled trial. Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2013 to June 2014. A total of 440 patients in intervention and control groups were enrolled. All patients between 18 - 70 years of age, residing in rural areas of Pakistan, HbA1c >/= 8.0% and having personal functional mobile phone were included. The intervention group patients were called directly on mobile phone after every 15 days for a period of 4 months. They were asked about the self- monitoring blood glucose, intake of medications, physical activity, healthy eating and were physically examined after 4 months. However, the control group was examined initially and after 4 months physically in the clinic and there were no mobile phone contacts with these patients. Patients in intervention group showed improvement [p < 0.001] in following diet plan from 17.3% at baseline to 43.6% at endline, however, the control group showed insignificant increase [p=0.522] from 13.6% at baseline to 15.9% at endline. Intervention group [RR = 2.71, 95% CI = 1.18 - 6.40] showed significant positive association with normalization of HbA1c levels. The relationship was adjusted for age, gender, socio-economic status, ethnicity, education, hypertension, medication, BMI, diet, LDL levels and physical activity. Dietary restriction and low LDL levels also showed significant associations with reduced HbA1c levels on multivariate analysis. Mobile phone technology in rural areas of Pakistan was helpful in lowering HbA1c levels in intervention group through direct communication with the diabetic patients. Lowering LDL and following diabetic diet plan can reduce HbA1c in these patients and help in preventing future complications

Presentations and outcome of thyroiditis from a tertiary care hospital of Karachi

Objective: To assess the clinical presentations and short-term outcomes of patients with thyroiditis presenting to a tertiary care hospital in Karachi, Pakistan

Study Design: Case series

Place and Duration of Study: Department of Endocrinology, Liaquat National Hospital, Karachi, from June 2014 to February 2015

Methodology: Patients between 18 and 70 years of age with acute onset of thyroiditis confirmed on thyroid scan or clinical judgment presenting to the outpatient services were included in the study. Pregnant females, psychiatric patients and patients having other chronic illnesses were excluded from the study

Results: A total of 26 patients with thyroiditis attended the endocrine clinic. Mean age of patients was 41.2 +/- 11.12 years. There were 18 [69.2%] females. Clinical presentations were fever [65.4%], tender neck [23.1%], goiter [19.2%], localized tenderness in neck and palpable lymph nodes [26.9%]. Major symptoms reported were: sore throat [69.2%], weight loss [38.5%], upper respiratory tract infection, thyroid pain, tremor, sweating and fever of unknown origin in 26.9% cases. All the patients had raised Erythrocyte Sedimentation Rate [ESR]. Low Thyroid Stimulating Hormone [TSH] < 0.4 mlU/L was seen in 88.5% and 57.7% had raised Free T4 > 1.8 ng/dL. Complete recovery was seen in 88.5% patients while 11.5% had early hypothyroidism

Conclusion: Fever and sore throat were the main presenting features of thyroiditis patients. ESR was raised in all patients. A majority of patients had complete recovery with appropriate management; however, few cases developed hypothyroidism

Rare case of Spigelian Hernia, diagnosis and treatment

As it stands, Spigelian hernias are rare and generally overlooked or misdiagnosed. We report a case in which a Spigelian hernia presented to us as a painless abdominal swelling in a 39 year old obese female with no known co-morbids The hernia appeared as swelling in the right lower quadrant, which was non tender at the time of admission and showed no signs of strangulation. Diagnosis of the hernia was made on CT-scan and an open technique was adapted to repair it. The post op period was insignificant in the patient

Viability of costochondral graft in temporomandibular joint ankylosis

Temporomandibular joint [TMJ] ankylosis is a very distressing structural condition that causes severe facial disfigurement leading to pathopsychological stress. Impairment of speech, difficulty with mastication, rampant caries, poor oral hygiene, disturbances of facial growth and severely compromised airway are the leading consequences of TMJ ankylosis. Surgical intervention is the widely accepted treatment modality of TMJ ankylosis. Current study was performed on 30 patients for three years [2009-2012] department of Oral and Maxillofacial Surgery, Children Hospital and Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore and costochondral graft was used to treat mandibular ankylosis. 21 [70%] patients were males and were divided into age groups of 2-5, 6-12 and 13-18 years. Regarding the side of mandible involved in male patients, unilateral ankylosis was found in 15[50%] and bilateral ankylosis were found in 6[20%] patients. Similarly in female patients, unilateral ankylosis was found in 7[23%] and bilateral ankylosis was seen in 2[7%] patients. Regarding post-operative monitoring of graft, bone scintigraphy was performed one week after the surgery and then after 12 weeks and 16 weeks to assess the viability and uptake of costochondral graft. Tc.99m MDP bone scan was performed in supine position with intravenous administration of 370MBq one week after the placement of graft. Results showed that out of 30 patients, CCG graft was viable in 28[93%] while it was non-viable in 2[7%] patients

new natural gel of Fagonia indica Burm f. extract for the treatment of burn on rats

Fagonia indica Burm f. [Mushikka or white spine] is a plant distributed in the deserts of Asia and Africa and reported to be medicinal in the scientific literature as well as in the folk medicine. Earlier investigations, the authors isolated a number of bioactive constituents from the plant including flavonoids, sterols and tritepenoids; In addition its flavonoidal content was found remarkably high reaching 3% [calculated as flavonol on dry weight]. The present study is an attempt to formulate, characterize and evaluate a natural wound-healing gel preparation containing the crude plant extract. Three formulae [F1-F3] were prepared. The gel properties such as viscosity, swelling ratio, bio-adhesion, in vitro release, stability, microbiological studies, in vivo burn healing test on rats and histopathological features were assessed. The results of the in vitro evaluation and stability studies showed that F3 [0.5% [w/w] of plant extract in 4% [w/w] chitosan] was significantly [p<0.05] the superior compared to other formulations. Besides, from the in vivo burn healing and histological results, F3 enhanced the skin wound re-epithelialization and speed up the healing process compared to the conventional commercial product. Thus, the Fagonia extract loaded chitosan topical gel would be used successfully in burn wound care.

Evaluation and comparison of different brands of domperidone tablets available in Karachi, Pakistan

Domperidone is an anti-dopaminergic drug used for the treatment of nausea, vomiting and dyspepsia. It has also been used in Parkinson's disease. In this study, five different brands of Domeperidone tablets were selected from the local market for evaluation of their quality as the local market is occupied of many competitors for a single generic. The evaluation of Domperidone tablets was done using various pharmacopoeial and non-pharmacopoeial tests. All the test results fell within BP specified limits for all the selected brands i.e. the results for Brands A to E for weight variation, thickness and diameter were satisfactory and within limits. For Brands A to E, the results for hardness and friability were also satisfactory i.e. 4-10kg/cm2and 0.1-0.6% respectively. The results for Brands A to E for disintegration were 2-6 minutes; for dissolution and assay, the results were 89-92% and 95-99% respectively. The results of similarity factor [f[2]]also showed that all brands of Domperidone have comparative dissolution profiles

Evaluation of the technical specifications of computerized tomography scanners in Jazan

Good quality management for computerized Tomography [CT] scanners is essential to safe and efficient CT units, providing quality clinical images, maintaining patient and staff radiation doses as low as reasonably achievable. to evaluate the technical specifications of [CT] scanners in Jazan region in the period from 2011-2013. 13 CT scanners have been evaluated; 2 of them are in private sectors and the rest in public hospitals. The Technical specifications of CT scanners were assessed using template issued by ImPACT [Imaging Performance Assessment of CT scanners]. When comparing the 11 public scanners age with guidelines rules of European Coordination Committee of the Radiological and Electro medical Industries [ECCREI]; it showed that scanners of Jazan region are within lifecycle guidelines, the total cumulative number of scanners since 1984 to 2013 are 15 scanners, 4 of them were replaced and the rest under use, multi detector CT scanners replaced most of the single detector scanners. for public CT scanners ; results show that all of the scanners are 3rd generation, gantry bores are arranged between70-80cm, the x-ray tube inventory showed that there is no dual source CT scanner in the region and the anode storage heat capacity ranged from [3-8MHU] except Siemens 64slices and 20slices reached up to [30MHU]. All of scanners in the region are built in solid state, image reconstruction time display per second is ranged from 1-40slice/seconds, advance clinical application software are available among the scanners. Jazan region CT scanners have a high capability and their technical specifications are in a rapid pace in developments that impacting on performance which depends on trade-off between image quality and patient dose

To compare the frequency of superficial surgical site infection after laparoscopic versus open appendectomy

To compare the frequency of Superficial Surgical Site infection after laparoscopic versus open appendectomy. Randomized clinical trial study. This study was conducted at Surgical Department Jinnah Post Graduate Medical Centre Karachi and Dow University Hospital from August 2013 to January 2014. The source of data was patients admitted in emergency. Patients were selected on the basis of clinical features. The data was collected with the help of Performa attached. It included demographic data of the patient, presenting complaints, operative findings, Surgical site infection. Random patients were placed in two groups. Surgical site infection by observation of pain, redness, tenderness and purulent discharge from the wound. Patients included were of both gender and age above 13 years presented to emergency department diagnosed as acute appendicitis on the basis of history and examination and exclusion of under 12 years of age, appendicular mass, CLD, I.H.D, DM and renal failure. Out of 270 patients, 153[56.7%] patients were males and 117[43.3%] patients were female. In Present study the different operative findings with their distribution among gender are shown in table. In other findings three patients with ruptured ovarian cyst and one with Mackel's Diverticulitis in which procedure was converted to open and resection and anastomosis of small intestine was done. SSSI is found to associated with operative finding with a significant P value 0.001. Superficial Surgical Site Infection were observed in both procedure laparoscopic appendectomy allotted in 134 cases but four cases are converted to open procedure so they are excluded from the results. The reason for conversion in three cases was difficulty in mobilizing the appendix because of adhesion and in one case Mackel's Diverticulitis found which need open procedure for formal small intestine resection and anastomosis. Superficial Surgical Site Infection was observed in three cases of Laparoscopic appendectomy and in 15 cases of Open Appendectomy group with the P value 0.005. Laparoscopic appendectomy is a better choice because of its reduced frequency of SSSI when compared with open procedure. SSSI is an important complication