Accuracy of references: comparison between two premier Pakistani medical journals.

OBJECTIVE: To compare two premier Pakistani medical journals for errors in references of original articles published in the year 2008. METHODS: All original articles of the Journal of Pakistan Medical Association and the Journal of the College of Physicians and Surgeons Pakistan published in 2008 were included in the study. References pertaining to journals were included in the study, whereas references pertaining to other sources such as books internet articles, websites and newspapers were excluded. Errors were categorised into author error, article title error, journal title error, year of publication error, volume error and page number error. The data was analysed through SPSS 16.0. RESULTS: References from 200 original articles (100 each from both journals) were evaluated. Only 19 (9.5%) articles were found to be free of error with no significant difference between the two journals. On evaluation of 3783 references, the overall reference error was found to be 1015 (26.8%): 531 (31%) in JPMA and 484 (23.4%) in JCPSP. The author error was the commonest error among these references (n = 490; 13%), followed by page error (n = 297; 7.9%), article title error (n = 222; 5.9%), and journal title error (n = 189; 5%). JCPSP had statistically significant more article errors, whereas JPMA had statistically significant more journal title and page errors. CONCLUSION: Reference errors constitute an avoidable but substantial lapse of medical literature. The magnitude of reference errors is much higher than expected.

Post thyroidectomy complications: the Hyderabad experience.

OBJECTIVE: Thyroidectomy is a very common surgical procedure worldwide and is performed by surgeons with varied training. The outcome and complication rates are largely dependent on surgeon's skill and experience, the extent of surgery, indication of surgery and number of thyroid surgeries performed at that particular centre. The objective of this study was to determine the frequency of postoperative complications after thyroid surgery in Hyderabad, Pakistan. STUDY DESIGN: It was a descriptive study and was carried out at 2 private hospitals including a teaching University Hospital over a period of 3 years from April 2005 to March 2008. PATIENTS AND METHODS: All patients with goitre, who underwent any sort of thyroid surgery, were included in this study. Patients' bio-data including name, age sex, clinical status of thyroid, thyroid function tests, ultrasound, fine needle aspiration cytology and operative procedure, findings, post operative complications and histopathology reports were recorded. Data were analysed using SPSS 16.0. RESULTS: The overall postoperative complication rate was 10.7%. Postoperative hypocalcaemia was the most frequent complication observed in 3.5% of all patients followed by recurrent laryngeal nerve (RLN) injury noted in 2.8% patients. The less common complications were bleeding, seroma formation and wound infection. Majority of these complications were associated with total thyroidectomy, male gender, and in patients with age more than 30 years. CONCLUSION: The commonest post thyroidectomy complication was hypocalcaemia. Male gender, old age, and extensive thyroid surgery were associated with increased complication rate.

Plastibell circumcision: a minor surgical procedure of major importance.

OBJECTIVE: To determine the number of days taken by the Plastibell to fall off after circumcision and the Plastibell impaction rate in various age groups. METHODS: This was a prospective cohort study of male babies who underwent circumcision using the Plastibell technique. Patients were followed up 1 week postoperatively as well as soon after the Plastibell had fallen off. RESULTS: Mean age was 14.3 months and mean weight 8.2kg at time of surgery. The average time taken for the Plastibell to fall off after circumcision for babies under 3 months was 8.7 days; this period gradually increased to 16.8 days for children over 5 years of age. The overall complication rate was 7.4%. Plastibell impaction was the commonest complication, encountered after 6.1% of procedures, and was managed by cutting the Plastibell. The impaction rate was only 2.3% for babies under 3 months, but gradually increased to 26.9% for children over 5 years. CONCLUSION: The time taken by the Plastibell to fall off spontaneously as well as the Plastibell impaction rate increases gradually with age. In view of the overall safety, comfort and absence of any long-term complication, this procedure justifies recommendation in all children aged under 1 year, but its use is debatable in older children.

Practice of surgeons regarding examination of pathological specimens in operating room.

BACKGROUND: The debate of routine versus selective submission of specimens for histopathology makes it important to know the present practice of surgeons. The objective of this study was to determine the proportion of general surgeons examining the gall bladder and appendix specimens in operating room before submission for histopathology. METHODS: This questionnaire based survey was conducted for the general surgeons working in the city of Hyderabad, Pakistan during May-June 2008. The data was entered and analysed in SPSS 11.0 software statistical program to determine the impact of designation, hospital category and experience on the responses of surgeons. RESULTS: Overall, 42 out of 47 qualified general surgeons working in Hyderabad, Pakistan responded the questionnaire. About 23.8% and 4.8% reported to be always examining gall bladder and appendix specimens respectively in operating room. About 66.7% and 40.5% reported to be submitting every gall bladder and appendix specimen respectively for histopathology. Lack of practice and poverty were reported as the common causes of not examining the specimen in operating room and not submitting every specimen for histopathology respectively. About 25.8% and 81.8% from public and private sector hospitals respectively reported to be submitting every appendix specimen for histopathology. About 88.2% and 52% of surgeons having experience of five years or less and experience of more than five years respectively reported to be submitting every gall bladder specimen for histopathology. CONCLUSIONS: There is widespread variation in the practice of general surgeons regarding operating room examination as well as submission of specimens for histopathology.

Indications and complications of tube thoracostomy performed by general surgeons.

The cross-sectional study conducted at the Isra University Hospital, Hyderabad was to determine the frequencies of various indications and complications of tube thoracostomy performed by general surgeons between February 2003 and January 2006. The data was analyzed and compared with other local and international studies. One hundred and five tube thoracostomies were performed over the above mentioned last three years. The most common indication for tube thoracostomy was tuberculous effusion (38/105, 36.1%). Most of the complications were categorized as positional complications and these occurred in about 9.5% (10/105) of the patients. Insertional complications occurred in 5.7% (6/105) of the patients whereas infective complication was noticed in only one patient. The most common complication was nonfunctioning of tube and this occurred in about 7.6% (8/105) of the patients. Tube thoracostomy is a relatively simple but invasive procedure and carries less risk of complications if performed carefully and cautiously.

Mortality in necrotizing fasciitis.

OBJECTIVE: The objective of this study was to determine the mortality rate in patients presenting with Necrotizing Fasciitis. This prospective study was conducted at ward 26, JPMC Karachi over a period of two years from March 2001 to Feb 2003. METHODS: All patients above the age of 12 years diagnosed to be having Necrotizing Fasciitis and admitted through the Accident and emergency department were included in this study. After resuscitation, the patients underwent the emergency exploration and aggressive surgical debridement. Post-operatively, the patients were managed in isolated section of the ward. The patients requiring grafting were referred to plastic surgery unit. The patients were followed up in outpatients department for about two years. RESULTS: Over all, 25 male and 5 female patients fulfilled the inclusion criteria and were included in this study. The common clinical manifestations include redness, swelling, discharging abscess, pain, fever, skin necrosis and foul smelling discharge etc. The most common predisposing factor was Diabetes mellitus whereas the most commonly involved site was perineum. All patients underwent aggressive and extensive surgical debridements. The common additional procedures included Skin grafting, Secondary suturing, Cystostomy and Orchidectomy. Bacteroides and E. coli were the main micro-organisms isolated in this study. Bacteroides was the most common microorganism isolated among the eight patients who died. CONCLUSION: Necrotizing Fasciitis is a potentially life threatening emergency condition and carries the mortality rate of about 26.6%. The major contributing factors to increase the mortality missed initially diagnosed, old age, diabetes mellitus truncal involvement and late presentation. Anorectal involvement of disease carry worse prognosis. Hyperbaric oxygen therapy and proper use of unprocessed honey reduced the mortality rate.