Adipokine Serum visfatin level in pregnancy induced hypertension and uncomplicated pregnancy

Background and Objectives: Hypertensive disorder in pregnancy is the significant disease that badly affects the maternal and fetal prognosis and lead to higher mortality and morbidity in the prenatal period. Visfatin, potentially a new adipokine has emerged having high contribution in pathogenesis of preeclampsia. The objective of the study was to find the level of Visfatin in pregnancy induced hypertension and normal pregnant women

Methods: This study was carried out in tertiary care hospitals, Peshawar from March-October 2014. A total of 234 pregnant women [gestational age >20 weeks] were included in the study with distribution as Preeclampsia [PE=86], Eclampsia [E=74] and control [N=74]. Blood was taken for measuring Visfatin level by Enzyme Linked Immunosorbent Assay [ELISA] technique. SPSS version 19 was used for statistical analysis. Student's t test was performed to evaluate the mean differences in patients and control

Results: Serum level of visfatin was significantly higher in pregnancy induced hypertension when compared with control [P value <0.001]. Comparisons of mean value of visfatin with age group of 21-40 years, body mass index [BMI], primary parous and parity 2-4, gestational age of >36 weeks and both systolic and diastolic blood pressure were highly significant in pregnancy induced hypertension when compared with control [p value <0.001]

Conclusion: Pregnancy induced hypertensive women showed increased level of serum Visfatin than normal pregnant women

early experience of laproscopic cholecystectomy from K.M.C / civil hospital Khairpur Mir's

Objective: To see feasibility, per operative difficulties and overall results of lap: Cholecystectomy in our newly established minimal invasive surgical setup

Study Design: Randomized Descriptive study

Place and Duration of Study: This study was conducted in Surgical Department of newly established Khairpur Medical College/ Civil Hospital Khairpur Mir's from August 2014 to May 2015

Materials and Methods: The data of all the 100 patients with the diagnosis of gall stone disease was entered in specific proforma, who were admitted at K.M.C / Civil Hospital Khairpur Mir's. The consent for laproscopic procedure was taken prior to surgery. All the base line blood and radiological investigations were done. Cardiac and general anesthesia opinion were also taken. The procedure was carried out by conventional "four port" method on scheduled elective operation list

Results: In this study male to female ratio was 1:6.1 and mean age was 38.5 years. In 52 patients gall bladder was non inflamed and callot's triangle was clear but in 48 cases various kinds of abnormalities were present. In 40% cases operative technique was modified by different means. Conversion rate remained 09%. In 56 cases operative time was 40 mints, in remaining 44 patients it was beyond 40 mints. Post operatively 26 patients developed various minor and major complications. There was no mortality in our series

Conclusion: Lap: Cholecystectomy is safe and effective procedure, applicable to any general as well as teaching hospital. Over all our results are acceptable according to the national and international studies

Blast Injuries in Children and Adolescents

Objective: To find out pattern of injuries, treatment provided and outcome of blast injuries in children including adolescents

Study design: Case series

Place and duration of study: Department of Paediatric Surgery National Institute of Child Health [NICH] Karachi, August and October 2013

Methodology: Demographic data of the blast victims, nature of the blast, treatment received before arrival to NICH, injuries found and treated, complications and outcome in terms of discharge, referred or death was entered into a performa. Descriptive statistics were used to present data

Results: Two incidents occurred during the study period. A total of ten children and adolescents were injured. In incident 1, bomb blast occurred after a football match. The bomb was planted in motorbike and was detonated with remote control. In incident 2 blast occurred when extortionist hurled hand grenade into a clinic of a doctor. Victims received multiple injuries. Of the total three children needed chest intubation in ER after needle thoracentesis for life threatening tension pneumothorx. A total of five laparotomies and one laparoscopy were performed. Hollow viscera were involved both due to blast wave and penetrating missile. Small bowel was involved in most [n=4] and colon in two patients. No intraperitoneal breach was found in patient who underwent laparoscopy. One patient lost his eye sight while in one patient was found paraplegic at tertiary survey. No mortality occurred in this series

Conclusion: The pattern of blast injuries were not different from what is reported from other centers. An organized approach using ATLS protocol was found useful in managing victims. Hollow visceral injuries were found in most of the cases

Perforated appendicitis with massive intraperitoneal free air in a two month old baby

Peritonitis due to perforated appendix in infant is an uncommon condition which is not suspected preoperatively. A two month old male baby presented with bilious vomiting and huge abdominal distension. Signs of peritonitis were present on clinical examination. Xray abdomen showed massive intraperitoneal free air. At laparotomy perforated appendix was found. Appendectomy was done. Postoperative course was uneventful

Abdominal tuberculosis: varied presentations

To study various clinical presentations and out come of management of abdominal tuberculosis. Prospective cross-sectional study. This study was conducted at the Surgical Unit-1 Ghulam Mohammad Maher Medical College Hospital Sukkur and Al-Khair Hospital Sukkur from January 2007 to December 2010. The 65 patients admitted throughout patient department and emergency with abdominal catastrophes. Ages ranged between 14 to 70 years. Out of 65 patients 37 were males and 28 were females. All the patients were evaluated with history, examination and investigations. 34 patients were operated and the resected tissue sent for histopathology to conform the diagnosis of tuberculosis. Out of 65 cases of abdominal tuberculosis, 37 were male and 28 female. The mean age was 30.9 years with SD 14.19 [range 14 to 70 years]. The mean duration of symptoms at presentation was 6 months [range 1 month to 24 months]. 35 [52.3%] out of 65 patients were admitted with different complications in which 10 [29.4%] presented with peritonitis due to gut perforation, 9 [26.5%] with sub-acute intestinal obstruction, 8 [23.5%] with abdominal mass, 5 [14.7%] with acute appendicitis and 2[5.9%] with umbilical fistula. Surgery was performed in all these patients, Stricturoplasty done in 13 [38.3%], Ileostomy in 8 [23.5%], resection anastomosis in 5[14.7%], Right Hemicolectomy in 5 [14.7%] and adhesionolysis and biopsy in 3 [8.8%] patients. Diagnosis in these patients was confirmed with biopsy. Morbidity and mortality in this group was 40.2% and 17.6% respectively. Early diagnosis of the abdominal tuberculosis is possible only by the specific investigations like PCR. As these are not available in the remote areas of Sindh so the general surgeons in the peripheral tertiary care hospitals have to face such patients with complications. Early diagnosis of ATB can be made by high index of clinical suspicion to symptoms of abdominal pain, weight loss, low grade fever and vague ill health of more than one month duration and refractory to conventional treatment associated with raised ESR, positive Montoux test. To above symptomatology if empirical ATT is started early many of the complications of ATB can be avoided

When to operate and abdominal gunshot wounds

Violence has become part and parcel of the daily routine of living, the prospective study of 86 patients, sustaining abdominal gunshot wounds was designed to evaluate the pattern, presentation and treatment outcome. Descriptive study. This study was conducted at the department of Surgery, Ghulam Muhammad Mahar Medical College Sukkur from January 2011 to January 2012. patients presenting with abdominal firearm wounds at accident and emergency department were included in this study, clinically all were evaluated, resuscitated and their findings were recorded on proforma. Patients with signs of acute abdomen [peritonitis]/ shock underwent midline emergency laparotomy, others having minimal or equivocal abdominal signs were selected for observation [non-operative management] group. Total number of patients included was 86, all were males, they belonged to age varying from 15-70 years. 54 [62.8%] were below the 40 years of age, in 44 [51.1%] cases instrument of attack used by assailant was pistol/shotgun, 45[52.3%] cases were victims of armed robbery, in 75 [87.2%] entrance wounds were present in anterior abdominal wall where as in 11[12.1%] were present posterirly, 67 [77.9%] underwent emergency laparotomy and 19 [22%] were observed initially. Two patients belonging to observation group showed failure, needed delayed laparotomy and both had positive laparotomy. Gunshot wounds of abdomen can be safely managed non-operatively, in the absence of abdominal tenderness haemodynamic instability or inevaluable factors as head injury and heavy intoxication. Success of non operative management depends upon continuous monitoring and frequent clinical examination

Comparison of fissurectomy vs lateral internal sphincterotomy in chronic anal fissure surgery

Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Although lateral internal sphincterotomy [LIS] is an effective treatment of chronic fissure in ano, it has the potential to cause serious complications, the most distressing of which is incontinence to flatus and fecal soiling. We proposed fissurectomy [F] as an alternative surgical treatment. Experimental and Comparative Study. This study was conducted at Surgical Department, Ghulam Mohammad Mahar Medical College Sukkur. One hundred twenty four patients, divided into two groups. Sixty patients underwent fissurectomy and 64 underwent lateral internal sphincterotomy. After a median follow-up of 18 months, we compared the results of the two procedures. In addition to frequent visits on a predetermined basis, a telephone inquiry into fissure recurrence and continence status was made. All patients in either group were pain-free and without bleeding within one week. In both groups, urinary retention was noted in two patients. Incontinence to flatus occurred in four patients [6.2%] in the LIS group, but no incontinence was noted in the F group. There were two patients [3.1%] with fissure recurrence in the LIS group, but no one in F group. No patient in either group was afflicted with anal stenosis or perianal infections. All wounds healed within 6 to 8 weeks. 58 patients [96.6%] in the F group and 56 [87.5%] in the LIS group reported satisfactory results. In surgical treatment of chronic anal fissures not responding to conservative management, fissurectomy may be a sphincter-sparing alternative and perhaps a preferable surgical technique

Reasons for conversion from laparoscopic to open cholecystectomy

To determine the frequency and reasons of conversion of laparoscopic cholecystectomy [LC] to open cholecystectomy [OC]. This prospective study was carried out in the Surgical unit III, Peoples Medical College Hospital from April 2006 to October 2009 male and female] were included in the study, all were evaluated fully preoperatively in respect to disease and general fitness of the patient for surgery and counseled regarding possibility of conversion from LC to OC. 6 patients [8.8%] were converted to open procedure. Obscure anatomy of Calot's triangle, bleeding and bile duct injury were common reasons of conversion. Even in difficult cases LC is a safe procedure with low incidence of conversion and complications in hands of experienced laparoscopic surgeon, where as junior surgeons being in learning curve are less confident and skillful, so are prone to more complications. Therefore they are advised to convert to open procedure earlier according to the criteria laid down, before complication occurs

Colostomy in children: indications and complications

To determine the indication and frequency of complications occurring with construction of colostomy in children. This descriptive study was conducted at Paediatric Surgery department of PMC Hospital and at Mumtaz Medical Center [Pvt.] Nawab Shah, from April 2008 to December 2009. All patients who required colostomy as the part of management were included in this study. The patients who were operated upon previously or elsewhere and were referred after having colostomy, were excluded. In all patients loop colostomy was performed. Complications after colostomy construction were noted on a proforma. Thirty- seven colostomies were created in 36 patients. Sigmoid loop colostomies were 51.35%, Right and left transverse colostomies in 24.32% each. All patients were operated due to congenital anomalies. Twenty-eight patients had anorectal malformation and 8 Hirschsprung's disease. Common Complications related to stoma were excoriation of skin 58.82% and prolapse of stoma [50%]. Anaemia due to chronic blood loss was seen in 53.33% of patients. Transverse loop colostomy had higher number of complications / problems as compared with sigmoid loop colostomy. Five [13.88%] patients died [Three because of septicaemiae, one because of high grade fever at home, and one died on 2nd of PSARP, the cause could not be ascertained. Construction of colostomy in paediatric patients carries high frequency of complications and requires careful technique. A sigmoid loop colostomy is an ideal as it has minimal complications. Stoma care clinic and enterostomal therapist can be helpful in educating families for stoma care and to decrease the incidence of complications

Knowledge and attitude of patients towards hepatitis B and C

To assess the level of knowledge and attitude of patients towards Hepatitis B and C in a public sector hospital, especially with reference to educational level. Descriptive and cross sectional study, from April to August 2006. Surgical Unit-I, Nawabshah Medical College Hospital, Nawabshah. All patients admitted in Surgical Unit-I NMCH, during the study period. Data was collected on a preformed questionnaire. Results were compiled and compared with national and international literature. During the study period 500 admitted patients were asked questions regarding Hepatitis B and C. Amongst them 280 were males and 220 females. Only 10% males and 5.9% females were educated beyond primary level, and 20.4% males and 10% females to primary level, while 76% were illiterate. Patients educated beyond primary level had more knowledge than illiterate persons about the condition, especially regarding the cause, organ of involvement prevalence in society, presentation, and vaccination for Hepatitis B. One alarming thing found in this study was lack of knowledge about risk factors, especially amongst illiterate persons. There was also lack of responsibility and poor attitude of even educated persons towards the treatment of these diseases. Both literate and illiterate persons were following customs of community and relying on homeopathic or herbal medicines for their treatment. There is a significant lack of knowledge and poor attitude of people towards Hepatitis B and Hepatitis C in this area

audit of peripheral lymphadenopathy

To evaluate the causes of Peripheral Lymphadenopathy. A descriptive and cross sectional study conducted from July 2004 to June 2006. Department of Surgery and Pathology, Nawabshah Medical College and Hospital, Nawabshah. A total of 116 patients with Peripheral Lymphadenopathy. The patients were evaluated for outcome parameters in relation to age, sex. Site and specific cause of peripheral lymphadenopathy. A total of 116 patients including 64 [55.17%] females and 52[44.82%] males were evaluated for peripheral lymphadenopathy. Their ages ranged between nine months to 70 years with a mean age of 27.14 years; majority belonged to the age group 11 to 20 years. Forty seven [40.51%] patients had cervical lymph nodes enlargement, 42 [36.20%] mesenteric, 24 [20.86%] axillary and 3 [2.85%] inguinal nodes enlargement. Tuberculosis and malignancy were the main causes of lymphadenopathy with an incidence of 53.44% and 13.79% respectively. Nine [7.75%] cases had acute lymphadenitis and 27 [23.25%] reactive hyperplasia, while in tow [1.72%] cases no pathology was detected. Peripheral Lymphadenopathy without any obvious cause presents a diagnostic dilemma