Surgical site infections in general surgical wards at a tertiary care hospital

Surgical site infections are important cause of morbidity and mortality in admitted patients world over. To determine the pattern of surgical site infections in General Surgical ward of a tertiary care hospital. Analytical cross-sectional study conducted at Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad for two years from January 2010 to December 2011. All cases were admitted in surgical ward with various surgical problems either as elective or emergency cases who developed wound infection later were included in the study. Cases of wound infection operated elsewhere, diabetic foot, and abscesses were excluded. Data collected included age, gender, primary diagnosis, mode of admission, comorbid factors, type and duration of surgery, expertise of the surgeon, use of antibiotics and hospital stay. After operation, wound was examined for evidence of infection from third post-op day onward. Any discharge was submitted for bacteriological examination. The wounds were followed till healed. A total of 1913 patients underwent surgery, including 983 cases [51.5 %] operated as elective and 932[48.5 %] as emergency. Postoperative wound infections occurred in 165 cases giving an overall incidence of infection in 8.6% cases. Infection rate in elective cases was lower [4.6%] than that in the emergency [12.7%] cases. Sixty one patients [37%] developed minor infection or stitch abscess, 104[63%] has frank suppuration requiring opening and drainage of wound; while 5[3%] cases developed deep seated infection of intra-abdominal spaces. E. coli was the commonest bacteria for wound infection [39%]. Post operative wound infection rate was 8.6%. The infection was significantly higher in cases who underwent emergency surgery and E. coli was the commonest pathogen to cause infection

comparative analysis of in-hospital left ventricular function in patients with successful or unsuccessful streptokinase thrombolysis following acute myocardial infarction

To compare in-hospital left ventricular function in patients with unsuccessful and successful thrombolysis presenting with acute myocardial infarction treated with streptokinase. This comparative study was conducted at department of Cardiology, Lady Reading Hospital Peshawar, from October 2006 to October 2007. Two hundred patients with first acute myocardial infarction were divided into two groups: group A [successful thrombolysis] and group B [unsuccessful thrombolysis], using ECG criteria. To determine Left Ventricular Function, 2-D Echo was used. Group A included 136 [68%] patients and group B included 64 [32%] patients. Impaired left ventricular function was found in 41 [30.1%] patients in group A and 41 [64.1%] patients in group B [p< 0.001]. Left ventricular failure was present in 31 [22.8%] patients of group A and 30 [46.9%] patients of group B [p=0.001]. Cardiogenic shock was diagnosed in 2 [1.5%] patients in group A and 6 [9.4%] patients in group B [p-0.008]. Presence of LVF is strongly associated with unsuccessful thrombolytic therapy in this group of patients

Assessment of left ventricular systolic and diastolic function by tissue doppler imaging after acute myocardial infarction

Objective: To evaluate left ventricular systolic and diastolic function by Tissue Doppler imaging after acute myocardial infarction. Methods: It was a hospital based, prospective descriptive study, from 1st July 2010 to 31st Dec. 2010. Total of 200 patients having acute myocardial infarction underwent detailed tissue Doppler imaging [TDI] echocardiographic examination for evaluation of left ventricular systolic and diastolic function on day 3, in echocardiographic section of Govt. Lady Reading Hospital, Peshawar. Peak systolic [Sm], peak early diastolic [Em] and peak late diastolic [Am] velocities were recorded at 4 different sites of the mitral annulus. The ejection fraction and pulse wave TDI diastolic parameters were also recorded. Using SPSS version 16 data was analysed, frequencies and Mean +/- SD were determined for categorical and numerical variables, respectively. A p-value =0.05 was considered significant. Results: Total study sample was 200 patients having acute myocardial infarction [MI]. The sample was divided into 4 groups, i.e., anterior MI, inferior MI, septal MI, and lateral MI. There were 122 men and 78 women and the mean age was 42 +/- 5 SD. There was a marked reduction in Sm velocity at mitral annulus, especially at the infarction sites. The mean peak systolic velocity from 4 mitral annulus sites was well correlated with ejection fraction [p=0.0001]. Similar to systolic velocities, Em velocity was also reduced, especially at the infarction sites. The mean peak early diastolic velocity from 4 mitral annulus sites was well correlated with ejection fraction [p=0.0001]. The mean Em velocity was correlated well with isovolumic relaxation time [IVRT]. There was no correlation between mean Em velocity and deceleration time [DT]. Conclusion: Tissue Doppler Imaging is a reliable, accurate and easily reproducible modality of echocardiography. The reduced peak systolic velocity and reduced peak early diastolic velocity seems to be an expression of regionally reduced systolic and diastolic functions, respectively. While the reduced mean systolic velocity and reduced mean early diastolic velocity from 4 mitral annulus sites are expressions of globally reduced systolic and diastolic functions, respectively and were correlated well with the ejection fraction. Keywords: Tissue Doppler imaging, ejection fraction, peak systolic velocity, peak early diastolic velocity, deceleration time, isovolumic relaxation time