Evaluation of anxiety during nasal pack removal in patients operated under local versus general anesthesia

Objective: To evaluate the anxiety experienced before, during and after conventional paraffin gauze nasal pack removal in patients operated under local versus general anesthesia

Study design: Comparative study

Place and duration of study: Department of ENT, Combined Military Hospital Sialkot and PAF Hospital Shorkot from July 2017 to June 2018

Material and methods: A total of 120 patients planned for Septoplasty were enrolled and divided into two groups. Sixty patients were to be operated under local anesthesia [Group A] while the other 60 were undergoing the same procedure under general anesthesia [Group B]. Conventional paraffin gauze nasal packing was done for 24 hours in all 120 patients. Hamilton Anxiety Rating Scale [HAM-A] was used to determine the patients' anxiety in both groups, 1 hour pre-operatively, immediately before and 1 hour after nasal pack removal

Results: The mean Hamilton Anxiety Scale assessment scores in both groups were of ‘mild' category. The highest scores in both groups were observed immediately before nasal pack removal, with a range of 15-18, while the lowest scores in both groups were documented one hour after pack removal with a range of 13-16. Anxiety level in patients operated under general anesthesia was slightly lower than patients administered local anesthesia mean score of 16.40 +/- 0.763 vs 17.21 +/- 0.666 [p<0.001]

Conclusion: Anxiety during nasal pack removal is mainly associated with prior pain experienced during nasal pack insertion. It is recommended that proper analgesia, adequate topical anesthesia, gentle insertion would make this process less distressing and will subsequently result in less anxiety at its removal

Clinical profile and short-term outcome of pediatric hyperleukocytic acute leukemia from a developing country

This study was conducted to determine the frequency, clinical profile, and short-term outcome of children with hyperleukocytosis at two pediatric oncology centers in Karachi. Of a total 1,045 patients, 13.97% [n=146] patients had hyperleukocytosis. Majority [61.7%, n=90] were under 10 years of age and 76% [n=146] were male. The symptom duration before diagnosis was more than 30 days in 49.3% [n=72]. The median WBC count was 181 x109/L [IQR=130.45- 298.3] and extreme hyperleukocytosis [>200 x109/L] was observed in 44.5% [n=65] patients. Majority [94.5%, n=138] of patients were diagnosed with acute lymphoblastic leukemia. One or more complications developed in 78% [n=114] of cases. Clinical and laboratory tumor lysis syndrome [TLS] was observed in 17.1% [n=25] and 39% [n=57] patients, respectively. Pulmonary and neurological complications related to leukostasis were noted in 9.5% [n=14] and 27.3% [n=40] of cases, respectively. Infectious complications occurred in 23.2% [n=34] patients. The case-specific mortality was 20.5% [n=30]. No mortality was related to early complications of hyperleukocytosis

Causes and adverse impact of physician burnout: a systematic review

Objective: To review the significant causes and effects of physician burnout in published literature

Methodology: A systematic review was conducted for searching published literature on the causes and effects of burnout in three online databases. Inclusion and exclusion criteria were developed for final selection of papers. The selected papers were critically appraised and thematic analysis was done to identify major themes related to physician burnout

Results: Thirty-one papers were finally selected among the 2,828 identified studies. The thematic analysis revealed demographic factors, e.g. age, gender, marital status, specialty and job position; and organizational factors, e.g. workload, interpersonal demands, job insecurity and lack of resources, as significant causes of burnout. The consequences of burnout included individual and organizational effects. The individual effects of burnout included physical health problems; while organizational effects included poor job performance, low organizational commitment, and turnover intentions

Conclusion: Burnout is a recognized workplace hazard in the healthcare sector. The individual characteristics of physicians and working environment within hospitals are contributory factors of burnout. Therefore, proactive interventions should be taken at individual and institutional levels for preventing physician burnout by improving the personal lifestyle of physician and working environment in hospitals

Diabetes mellitus type 2; pattern of dyslipidemias

Objective: The objective of this study is to determine the pattern dyslipidimia in patients of Type 2 diabetes mellitus

Study Design: Cross-sectional study

Place and Duration: This study was carried out in General Medicine department of Peoples Medical University and Hospital Nawabshah and Civil Hospital Karachi, from June 2011 to July 2012

Methodology: This study consisted of seventy patients. Detailed history was taken from all the patients with special regard to increased thirst and frequent urination, increased hunger, weight loss, fatigue, blurred vision, slow-healing sores or frequent infections and an areas of darkened skin. Inclusion criteria were that all patients after counseling for study and taking written consent were included in this study >35 years of age with either sex admitted in general medicine ward through outpatient department and diagnosed as case of DM type 2 on the basis of history, clinical examination and investigations. Exclusion criteria included patients on dialysis, patients on lipid lowering agents, patients with acute complication of diabetes mellitus such as diabetic keto-acidosis, patients suffering from hypothyroidism, nephritic syndrome, type 1 DM and HTN, lacticacidosis and hypoglycemia. Results were prepared with the help of tables and graphs. Data was analyzed through SPSS software

Results: Out of 70 patients included in this study 46 were men [65.8%] and 24 patients were female [34.2%]; with male to female ratio of 1.9:1. There was wide variation of age ranging from a minimum of 35 year to 75 year. The mean age was 48.65+7.8 years. Mean total serum cholesterol was 196.04 +/- 44.02mg/dl, mean serum triglycerides was 193.04 +/- 108.64 mg/dl , mean high density lipoprotein 29.28 +/- 8.48mg/dl, mean low density lipoprotein 125.24 +/- 39.68mg/dl and mean very low density lipoprotein was 31.28 +/- 8.48 mg/dl. Total cholesterol was abnormal [>200mg/dl] in 56[80%] patients out of 70[ 21[87.5%] were females and 35 [76.1%] were males], Triglycerides was abnormal [>150mg/dl] in 62[88.5%] patients [ 22 [91.66 %] were females and 40 [86.95%] were males], high density lipoprotein was abnormal [< 35 mg/dl] in 51[72.8%] patients[ 18[75%] were females and 33[71.73%] were males], LDL was abnormal [>130 mg/dl] in 40[57.1%] patients [ 17 [70.83%] were females and 23[50%] were males] and VLDL was abnormal [> 30 mg/dl] in 47[67.14%] patients [19[79.16%] were females and 28[60.86%] were males]

Conclusions: We conclude that dyslipidemia is common among type 2 diabetic patients. Males are more prone to suffer from this complication. Patterns of dyslipidemia found more commonly were decreased HDL levels, increased LDL and Triglycerides levels. There is a need for early detection and treatment of this problem to prevent type 2 diabetic complications

Surgical treatment of vesicovaginal fistula; an audit of 69 cases

The aim of this study is to assess the outcome of patients undergoing repair of vesicovaginal fistula. This descriptive study which was conducted from May 2002 to March 2008 the Department of Urology Lady Reading Hospital Peshawar. A total of 69 patients with Vesicovaginal fistula were included in this study. A detailed history and physical examination with special emphasis on previous gynecological and obstetrical events was recorded. All these patients underwent routine investigations like HB%, CBC, Urianalysis, renal function test and viral profile with ultrasonography of the abdomen and pelvis. Intravenous Urography [IVU] was offered to those patients who had upper tract dilatation on ultrasonography. Preliminary cystoscopy and Vaginoscopy was performed in all patients to diagnose VVF and plan the surgical approach. The mean age was 39.07 [+10.031] years. Thirt eight [55%] patients developed fistula due to obstetrical reasons while 30 [43-47%] had gynaecological surgeries and only one patient developed fistula after radiotherapy. The average size of the fistula was 3.36 cm: Trans abdominal repair of fistula was done in 58 [84.1%] patients while 11 [15.9%] has transvaginal repair. Successful repair was achieved in 65 [93.7%] patients. Vesicovaginal fistula can be successfully managed surgically. Proper preoperative assessment of the patients is mandatory for selection of the surgical approach

Role of C-reactive protein in the diagnosis of sepsis in early infancy

Objecctives: To assess the role of serial C-reactive protein in the diagnosis of sepsis during the early period of infancy [<90 days]

Materials and Methods: This cross sectional study was conducted in the pediatrics Department of Shaikh Zayed Hospital [SZH], Lahore. The duration of study was 6 months from 1[st] July to 31[st] December 2010. Total 150 cases fulfilling the inclusion criteria were enrolled randomly in the study. Babies were divided in two groups: Group 1 -Healthy babies. Group II- Babies with sign and symptoms of sepsis. The first C-reactive protein and blood cultures were sent in all cases at the time of admission. Antibiotics were started in the suspected cases of sepsis. After 48 hours of admission, second sample of C-reactive protein was again sent in all cases

Results: The study was carried out in babies <90 days admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 [45.33%] culture proven cases of sepsis and 82 [54.67%] cases were culture negative. Escherichia coli was the most common organism isolated followed by Staphylococcus aureus. Males [63%] were predominant as compared to females [37%]. 80% were term babies while 20% were preterm. 75% babies were born by lower segment caesarian section, 15% were delivered at home while 10% were born at the private clinics. Early onset sepsis was seen in 39.33% of cases while late onset sepsis was seen in 60.67% cases. Mechanical ventilation was done in 10 babies [6.6%]. 97.4% babies survived and 2.6% babies expired. The sensitivity, specificity, PPV, NPV of C-reactive protein was 91.18%, 53.66%, 62% and 88% respectively at the time of admission. The CRP level was statistically different between the two group [p<0.001], at the time of admission and at 48 hours after admission

Conclusion: Babies during the early infancy period are susceptible of developing sepsis that may lead to potential consequences if not treated in proper time. Also babies may be over-treated and may have prolonged stay in the hospital if not properly investigated, which may itself be a burden to the family members and have a financial instability also. So keeping in mind all these factors, were performed a serial CRP test at admission and after 48 hours for treatment monitoring and observing the response. Sensitivity of C-reactive protein and negative predictive value was high in this study at the time of admission. So, serial monitoring of C-reactive protein is recommended for the monitoring treatment response

Analysis of intra ocular lens power estimation in patients admitted for cataract surgery

According to Pakistan National Blindness and Visual Impairment Survey, cataract accounts for 51.5% of blindness and visual impairment in Pakistan. In most of the camp and primary level facilities intra-ocular lenses are implanted without proper estimation. The purpose of this study was to know the common keratometric, axial length values, IOL powers and whether or not it is advisable to implant intraocular lenses without proper pre-operative assessment. It was a retrospective study conducted at Department of Ophthalmology, DHQ Teaching Hospital, D.I.Khan. Review of estimated power of IOL of 1000 admitted patients was done. Out of 1000 patients, 473[47.3%] were males and 527[52.7%] females. The youngest patient was 10 years while the oldest was 80. Maximum patients presented in 51-60 years age group. Only 25[2.5%] patients were below 20 years. The range of axial length was 19.50-28.0mm. 581[58.1%] patients were having axial length 22-23.50mm. Ten [1.0%] had axial length >/= 26mm and 6[0.6%] <20.0mm. The range of estimated IOL power by SRK II formula with 118.0A constant was 10-33D. Maximum patients, 140[14.0%] were having IOL power of 20.50D. 522[52.2%] patients were having IOL power 20-22.0D. Only 26[2.6%] patients had IOL power of /= 25D. The estimated power of IOL differs from patient to patient with a wide range of 10D to 33D. Therefore assessment of IOL power by proper keratomery and biometry is desirable for good post-operative vision

Pattern of change in the frequency of Helicobacter pylori with perforated duodenal ulcer

Peptic ulcers were believed to be caused by stress, dietary factors, and gastric acid, but the link between H. pylori and peptic ulcers was identified in 1983. To see the frequency of Helicobacter pylori infection in patients with perforated duodenal ulcer and advise eradication therapy in these patients. This cross sectional study was conducted in Surgical Unit Hayatabad Medical Complex, Peshawar, during January 2007-June 2008. A total of 50 cases were included in the study. All cases presenting to our unit with acute perforated duodenal ulcer were recruited. After resuscitation and baseline investigations, all underwent emergency laparotomy via upper midline incision, after thorough peritoneal lavage, the perforation margins were freshened and closed over an omental patch. Serum from every patient was tested for H. pylori and accordingly managed. Out of the 50 cases, 45 were males, and 5 were females. Age ranged from 20- 80 years old. All patients underwent emergency laparotomy. Postoperatively, all were started on PPI treatment and serum testing for H. pylori was done. Thirty-four [68%] turned out positive and 16 [32%] were found to be negative for H. pylori. There is still a high frequency of H. pylori infection in patients with perforated duodenal ulcer. But comparing these results with the various data available, there is a significant decline in H pylori positive perforated duodenal ulcer patients