LAPAROSCOPIC CHOLECYSTECTOMY: OUTCOME OF FIRST 202 CASES IN A DISTRICT HOSPITAL IN GILGIT.

BACKGROUND: The incidence of gall stone disease is on the rise in Gilgit Baltistan. The objectives of the study were to assess the outcome of laparoscopic cholecystectomy in terms of conversion rate and postoperative morbidity, in The Aga Khan Medical Centre Gilgit. METHODS: It was descriptive case series. All patients that underwent laparoscopic cholecystectomy between June 2009 to May 2014 were included. The data was collected prospectively. Demographic features, operative time, and hospital stay were studied. Postoperative complications were documented and evaluated according to outcome measures (bile duct injuries, morbidity, mortality, conversion rates, wound infections). RESULTS: A total of 202 consecutive patients were enrolled with a mean age of 49±15 years. There were 164 (81%) female and 38(19%.) male patients. Twenty nine (15%) patients had hypertension, 51 (25%) patients had diabetes mellitus as comorbid conditions. The mean operative time was 54±21 minutes. The operative time was longer in 52 (26%) patients. Three patients (1.5%) required conversion to open cholecystectomy due to obscured anatomy in the area of Calot's triangle, and empyema gallbladder. The mean hospital stay was 2±0.7 days. No common bile duct injury, solid organ or bowel injury occurred in this study. The mean follow up duration was 30±15 months. Postoperative complications include, port site infection in 8 (2%) patient, chest infection in 5 (2.4%) patients, and one (0.5%) patient had myocardial infarction. There was no mortality reported in this group of patients. CONCLUSION: Laparoscopic cholecystectomy is a safe procedure with advantages of decreased wound infection, less pain, decreased hospital stay, and early recovery.

Prevalence of antenatal depression: comparison between Pakistani and Canadian women.

OBJECTIVE: To study the prevalence and correlates of depression in pregnant women of different cultures. METHODS: We used a score of 13 or greater on the Edinburgh Postnatal Depression Scale (EPDS) to indicate depression status and logistic regression to determine its correlates in pregnant women from Northern Pakistan (n=128), Caucasian (n=128) and Aboriginal (n=128) women from Saskatchewan, Canada. RESULTS: A higher proportion of Pakistani women (48.4%) had depression compared to their Aboriginal (31.2%) and Caucasian (8.6%) counterparts. Depression was associated with poor physical health in all women; however, there were unique correlates of antenatal depression in each group: physical abuse in Pakistani women (AOR=4.40:95% CI, 1.15-16.85), sexual abuse in Aboriginal women (AOR=3.02:95% CI, 1.09-8.40), and low income in Caucasian women (AOR=5.74:95% CI, 1.04-31.78). CONCLUSION: Depression is a substantial public health problem among pregnant women, with women in Pakistan having a much higher burden of antenatal depression than their Canadian counterparts.

Carbohydrate intake and overweight and obesity among healthy adults.

BACKGROUND: Little is known about the dietary habits of people with optimal body weight in communities with high overweight and obesity prevalence. OBJECTIVE: To evaluate carbohydrate intake in relation to overweight and obesity in healthy, free-living adults. DESIGN: We used a cross-sectional analysis. SUBJECTS/SETTING: The Canadian Community Health Survey Cycle 2.2 is a cross-sectional survey of Canadians conducted in 2004-2005. There were 4,451 participants aged 18 years and older with anthropometric and dietary data and no comorbid conditions in this analysis. MAIN OUTCOME MEASURES: Outcome variables were body mass index (BMI; calculated as kg/m(2)) and overweight or obesity status (dichotomous) defined as BMI > or =25 compared with BMI <25 based on measured height and weight. Diet was evaluated by 24-hour dietary recall based on the Automated Multi-Pass Method. STATISTICAL ANALYSES PERFORMED: Weighted regression models with bootstrapping and cubic splines were used. Outcome variables were BMI and overweight or obesity, and predictors were daily nutrient intake. Adjustment for total energy intake, age, leisure time energy expenditure, sex, smoking, education, and income adequacy was performed. RESULTS: Risk of overweight and obesity was decreased in all quartiles of carbohydrate intake compared to the lowest intake category (multivariate odds ratio quartile 2=0.63; 95% confidence interval: 0.49 to 0.90; odds ratio quartile 3=0.58; 95% confidence interval: 0.41 to 0.82; odds ratio quartile 4=0.60; 95% confidence interval: 0.42 to 0.85). Spline analyses revealed lowest risk among those consuming 290 to 310 g/day carbohydrates. CONCLUSIONS: Consuming a low-carbohydrate (approximately <47% energy) diet is associated with greater likelihood of being overweight or obese among healthy, free-living adults. Lowest risk may be obtained by consuming 47% to 64% energy from carbohydrates.

Injuries and illnesses from wood framing in residential construction, Washington State, 1993-1999.

The construction industry is associated with high rates of work-related injury. We used workers compensation data to describe the injuries and illnesses, claim rates, and claim costs associated with wood framing activities in construction. From 1993 to 1999, there were 33,021 accepted state fund workers compensation claims with direct costs of over $197 million. The average annual claim rate was 45 per 100 full-time equivalent. Statistically significant downward trends were noted in claim rates for all injuries and illnesses, compensable time loss claims, eye and fall injuries. However, these trends were not statistically significantly different from those observed in all other construction risk classes combined. The information in this report can be used to guide prevention efforts and to evaluate the effectiveness of Washington state initiatives to reduce injury and illness rates in wood frame construction.