Comparison of dietary intake and dietary requirement in post operative adult cardiac surgical patients in ICU

To estimate optimum energy and protein intake and to examine the differences in actual intake versus optimum protein and energy requirement during first three days of patients at surgical ITC of AFIC. A descriptive, cross sectional study was conducted by using purposive sampling technique. One hundred patients admitted in adult ITC of Armed Forces Institute of Cardiology and National Institute of Cardiovascular Diseases between periods of 10[th] July to 10[th] December 2013, fulfilling study criteria were included in study sample. Data was collected from hospital records [bedside charts] and food frequency questionnaire [FFQ]. Protein and energy intake on 1[st], 2[nd] and 3[rd] post operative day was calculated and compared with pre- calculated optimum protein and caloric requirement. Mean caloric intake on 1[st] post operative day was 583 k/cal, on 2[nd] post operative day 679 kcal and on 3[rd] post operative day was 820 k/cal which were 70%, 65% and 68% respectively less than the optimum requirement. Whereas mean protein intake was 13 grams on the 1[st] post operative day and 13.2 and 22.3 grams on the 2[nd] and 3[rd] day respectively which was 85%, 83% and 72% less respectively on first, second and third post operative day. The results suggest that the energy and protein intake of patients was below estimated requirements. Attention must be paid to malnutrition and nutrition in general in the hospital wards

Frequency of dysnatremia and dyskalemia in cardiac surgical intensive care unit

To determine the frequency of dysnatremia and dyskalemiain cardiac surgical intensive care unit patients and to identify the factors associated with the changes in potassium and sodium levels. Cross Sectional study. Cardiac surgical intensive care unit [ICU] of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from July 2013 to November 2013. Post-operative patients in cardiac surgical intensive care unit were selected through non probability convenient sampling. Demographic and clinical data was collected for all patients including: age, sex etc. Additionally, laboratory data such as potassium and sodium serum concentrations were recorded of day one of the first five post operative days. Out of 100 patients, 51% had dyskalemia, 33% had episodes of hypokalemia, and 19% had hyperkalemia. On the other hand 79% patients had dysnatremia, among them 71%had hyponatremia, and 8% had hypernatremia. Dyskalemia and dysnatremia are common problems in cardiac surgical ICU with higher frequency of hyponatremia as compared to hypernatremia, and hypokalemia as compared to hyperkalemia

Reduction in platelet count in post CABG patients with or without IABP- an experience at AFIC/NIHD Rawalpindi

To study the reduction in platelet count in patients after coronary artery bypass grafting having IABP placed peri operatively with and without IABP placed. Descriptive Study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases [AFIC/NIHD] from Jan 2012 to Dec 2013. All cases with intra-aortic balloon pump [IABP] placed peri operatively [coronary artery bypass grafting, CABG] during this time period were examined in detail. Only those patients who had a platelet count of 150,000 or more pre operatively were included in the study. Patients taking medicines pre operatively that lead to decrease in platelet count were excluded. Platelet counts of each patient were analyzed till the third post-operative day. One hundred and fifty patients were divided into two equal groups, group A without IABP and group B with IABP. Patients without IABP [group A] pre operatively had mean platelet count of 223.57 +/- 83.02, on first post op day the mean platelet count was 171.0 +/- 59.0 which was 76.48% of preoperative level, on second post op day the mean platelet count was 168.1 +/- 59.4 which was 75.20% of preoperative level and on third post op day the mean platelet count was 167.5 +/- 60.0 which was 74.95% of pre-operative level. Patients with IABP [group B], pre operatively had mean platelet count of 205.32 +/- 50.257, on first post op day the mean platelet count of 152.71 +/- 43.77 which was 74.37% of preoperative level, on second post op day the mean platelet count was 112.11 +/- 42.571 which was 54.60% of preoperative level and on third post op day the platelet count was 90.87 +/- 41.538 which was 44.25% of preoperative level. There was significant reduction in platelet count from the pre-operative level in both the groups. Reduction in platelet count in post CABG patients is similar in both the groups i.e. in whom IABP is and those patients who are not treated with IABP

Pattern of skin malignancies in patients presenting to dermatology department Hayatabad Medical Complex Peshawar

This study was conducted to determine the pattern of cutaneous malignancies among patients attending the skin out-patient department Hayatabad Medical Complex Peshawar. This was descriptive analysis of skin cancers carried from January 2011 to December 2011. Histologically diagnosed skin cancers were reviewed and analyzed according to age, gender, site of distribution and histological types. Hundred histologically diagnosed skin malignancies were reported during the period under review. Sixty cases [60%] were males and 40 cases [40%] females with a male to female ratio of 1.5:1. Age ranged from 22 years to 86 years. Mean age was 57.05 +/- 11.39 SD. Mean duration of disease in months were 16.78 +/- 9.07SD. Basal cell carcinoma [BCC] was the most common malignancy consisting of 32[32%] cases followed by Squamous cell carcinoma [SCC 18%] with 10 [10%] cases of melanoma and 9[9%] cases of Mycosis Fungoides. Actinic Keratosis, Kaposi's sarcoma, Bowen's disease, Dermatofibroma, Atypical fibroxanthoma constituted the remaining. The most common skin malignancy was BCC followed by SCC and melanoma. Larger studies should be conducted to ascertain the actual prevalence of skin tumors

audit of laparotomies; carried out in combined military hospital Panno Aqil over three years period

To make an audit of laparotomies carried out at Combined Military Hospital Pano Aqil over a three year period. Cross sectional, retrospective study. Study was carried out at surgical department of combined military hospital Panno Aqil over a period of three years from Jan 2009 to Dec 2011. Patients with significant intra-abdominal pathology presenting as acute abdomen and who underwent laparotomy were included in study. Patients were either electively admitted via outpatient department or through Accident and Emergency [A and E] department. Patient charts and records were used to collect data. All 174 patients underwent laparotomy. In [27.6%] cases, intestinal perforation was the underlying cause; gynaecological pathology was found in [21.2%] patients. In 19.5% cases blunt and penetrating abdominal trauma was the cause of acute abdomen. Acute intestinal obstruction was found in [21.3%], tumors were found in [7.9%] and miscellaneous causes were identified in [2.3%] cases. Laparotomies carried out at Combined Military Hospital Pano Aqil fulfilled the evidence based medicine criteria

Treatment of fractures in 15 cases of osteitis fibrosa cystica - hyperparathyroidism: a case series

To study retrospectively the results of treatment of cases of pathological fractures presenting with osteitis fibrosa cystica due to hyperparathyroidism. Records of cases of hyperparathyroidism treated for pathological fractures in the past seven years were reviewed to assess success of treatment by various modalities. All patients had been investigated for vitamin D deficiency, parathyroid levels, serum calcium and phosphate levels along with renal function tests. All X-rays were restudied for evidence of osteitis fibrosa cystica. Thirteen cases healed uneventfully, one died of unrelated reasons and one failure led to non union. All patients had received oral calcium supplements and injectable vitamin D for three months at least. There were no complications of this treatment regimen. Pathological fractures due to bone weakness caused by hyperparathyroidism can be treated by various treatment modalities supplemented by oral calcium and injectable vitamin D