Goal-directed fluid therapy based on noninvasive cardiac output monitor reduces postoperative complications in elderly patients after gastrointestinal surgery: a randomized controlled trial

Objective: To observe the pre-Ramadan health seeking behavior, fasting trends, eating pattern and, sleep cycle in pregnant women

Methods: It is a cross-sectional observational study, from July to September 2017, conducted at Tertiary Care Hospital in Karachi. The tool used for data collection was interviewer based closed ended questionnaire, 279 pregnant women who fasted during Ramadan were included in the study

Results: One to ten days of fasting was observed by 85.7% [198] of women. About 72.4% [202] never consulted any doctor for pre-Ramadan advice regarding fasting in pregnancy. Pregnant women 81.7% [228] believed that fasting would not cause any harm to their unborn child, while 42.7% [119] of family members feared about the health of mother and unborn child. Seventy four percent [208] of respondents had a reduced sleep cycle of about 3-4 hours. The food items consumed at Sehri and Iftar were rich in carbohydrates and fats

Conclusions: Pre-Ramadan medical consultation regarding safety of fasting during pregnancy should be structured and customized for women and their families. Gaps in knowledge identified in this study may help healthcare professionals to address these issues

Diagnostic dilemma in broad ligament leiomyoma with cystic degeneration

Fibroids are smooth muscle benign tumors; most commonly arise from uterus but may also rise from extra uterine sites like broad ligament. This case report of broad ligament myoma with extensive cystic degeneration is presented for its rarity and diagnostic challenges as they mimic pelvic adenexal tumors. Mrs. X, 43 years old p[5+2], asymptomatic women with no co-morbids presented with mass in abdomen. The MRI showed mix attenuation mass of 19.7 x 16.8 x 13.7cms arising from right side of uterus extending up to epigastrium, with cystic and solid components and ascitic fluid. Resection of mass with abdominal hysterectomy with bilateral salphingo oophrectomy was done. No local or abdominal organ metastases were seen. Histopathology showed left broad ligament leiomyoma weighing 4000 grams with cystic degeneration. Huge broad ligament leiomyoma with cystic degeneration and abdominal ascites may cause diagnostic dilemma with ovarian malignancy. This differential diagnosis must be considered before surgery

Ramadan fasting related awareness, practices and experiences of a representative group of urban Pakistani diabetics

The main objective of this retrospective study was to observe Ramadan related awareness, practices and experiences of diabetic patients. It is expected that the outcome of this study would assist the healthcare professionals in providing effective fasting related guidance. A total number of 1050 diabetic patients were interviewed post Ramadan. Closed ended questionnaires were administered and responses were recorded by the trained data collectors. Out of 1050 subjects, 33% [n=350] were males and 67% were females [n=700]. About two third of the study participants monitored their blood glucose at home or at health care facilities. Frequency of monitoring blood glucose once a month was the most common pattern. During Ramadan blood glucose level was monitored by 70% of subjects. Majority of the subjects did their blood sugar 1-3 times in a month. Dosage of oral hypoglycemic/insulin was adjusted before Ramadan in 80.8% of the patients with diabetes who planned to fast. Overall 3.1% of subjects broke the fast due to hypoglycemia, while 75% of study population had never experienced symptoms of hypoglycemia during fasting. The majority of diabetic patients were fasting without any adverse events however 15-20% of them were at risk as they continued fasting without checking their blood sugar even when they felt hypoglycemia. Diabetic patients should be counseled about the symptoms of hypoglycemia during fasting and the option for breaking the fast in case of low blood sugar

assess the practices about initiation of oral maternal feeding after cesarean section under regional anesthesia

Cesarean Section [C-S] is one of the most commonly performed operations in the world.1 Diet and nutrition play a vital role in post operative recovery. The objective of the study was to assess the trends and practices about "Early Initiation of Oral Maternal Feeding after Cesarean Section [C-S] under Regional Anesthesia [RA]" and to analyze it in the context of evidence based medicine [EBM]. The study was a multi center cross sectional survey conducted from August 2009-September 2010. Closed ended self administered questionnaires were filled in by 398 respondents of obstetric specialty. In response to the questionnaire 31.3% of the study participants were in favor of early initiation of maternal feeding 2-4 hours; while 84.6% preferred to delay it up to 6-12 hours; 61.6% had the perception that early start of solid diet may lead to ileus and wound dehiscence; whereas 3.4% feared burst abdomen; while only 35.1% said that it would have no effect on wound. About 57% respondents said that early maternal ambulation after an uncomplicated C-S can help in early recovery, while 43% participants thought that it may lead to hypotension, giddiness and spinal headache. The responses of the participants regarding early initiation of maternal oral feeding after C-S under RA illustrate fears and old conventional trends rather than practices based on scientific evidence. Awareness programs and multi center clinical trials in the local context may change this practice and give them enough experience and confidence. The evidence shows that initiation of early oral maternal feeding [MF] results in greater maternal satisfaction, less gastro intestinal and wound complications and is also cost effective

Is it necessary to catheterize before caesarian section

To compare the intra- and postoperative complications with or without urethral catheterization in caesarian sections in terms of accidental cystotomy, urinary retention and urinary tract infection. Comparative Study. This study was conducted at Fatima Bai Hospital for one and half year period from June 2007 to December 2008. One hundred and twenty consecutive patients who underwent caesarian section were enrolled and randomly assigned into Group A [with catheterization] and Group B [without catheterization]. Main outcome measures were accidental bladder injury preoperatively [i.e. accidental cystotomy], urinary retention and urinary tract infection [>10 leucocytes on]. Urine Detailed Report. The SPSS version 11 was used to analyze data. Student t-test and chi-square test was used where appropriate. The significance level was set at p value < 0.05. Total 60 patients with Mean+SD age of 31.45 +/- 8.38 years included in group A while 60 patients with Mean+SD age of 29.83+8.53 years were included in group B. Accidental cystotomy was not noticed in both groups. Urinary catheterization when carried out preoperatively, had significantly higher rates of urinary tract infection [28.3%] as compared to women in whom preoperative catheterization was not performed [11.7%; p=0.022]. Same trend was observed in terms of urinary retention in both groups [p=0.047]. Practice of routine catheterization prior to Cesarean section needs to be reviewed skeptically as it is likely to increase the risk of urinary tract infections and retention in women postoperatively