Incidence of burns and factors associated with their hospitalisation in Rawalpindi, Pakistan.

BACKGROUND: The burden of burns is largely underreported due to the lack of a surveillance system in Pakistan. The aim of our study was to determine the incidence of burns and factors associated with their hospitalisation in the city of Rawalpindi, Pakistan. METHODS: A prospective observational study from July 2007 to June 2008 was conducted. All the burn-related injury patients presenting to emergency departments (EDs) of the three public teaching hospitals in Rawalpindi city were included. A standard World Health Organization questionnaire was used to record the information about injury victims. RESULTS: A total of 1498 burned patients presented to EDs. Females accounted for 40% of the patients. The majority of patients were ≤ 46 years. Most of the burns occurred at home (79.2%). The overall incidence of burn-related injuries per 100,000 inhabitants was 76.3 for emergency visits, 17.0 for hospitalisation and 0.3 for ED deaths. Female patients (adjusted odds ratio (aOR)=1.49, 95% confidence interval (95% CI)=1.09, 2.06), intentional burns (aOR=5.25, 95% CI=2.17-12.74) and injuries at work (aOR=3.81, 95% CI=2.40, 6.07) and in a market area (aOR=2.25, 95% CI=1.36-3.74) were more likely to result in hospitalisation. CONCLUSION: Rawalpindi city has a significant burden of burns. These results showed that investigating further factors leading to burns at home and work could be useful for future safety education campaigns. Moreover, continuous surveillance is warranted to decrease burns in Pakistan.

Differences in reporting of violence and deliberate self harm related injuries to health and police authorities, Rawalpindi, Pakistan.

BACKGROUND: The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan. METHODS/PRINCIPAL FINDINGS: Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital's ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1016 intentional injury victims reported to police whereas 3012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46-64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7990, 95% CI: 7322-8565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4-30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101-1516), police reported 0.5% and ED reported 39.9% of them. CONCLUSION: In Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence.

Role of nasogastric intubation after small bowel anastomosis.

OBJECTIVE: To determine advantages and disadvantages of postoperative nasogastric intubation after small bowel anastomosis. STUDY DESIGN: Quasi experimental. PLACE AND DURATION OF STUDY: Surgical Unit-I, Holy Family Hospital, Rawalpindi, from December 2003 to December 2006. METHODOLOGY: A total of 112 patients, undergoing small bowel anastomosis were equally divided in group I and II with and without postoperative nasogastric intubation respectively. Variables compared were number of patients having episodes of vomiting, change in abdominal girth, the time for onset of bowel sounds, time to begin per oral fluids, length of hospitalization and postoperative complications. RESULTS: In group-I, nasogastric tube was removed on an average after 3.1 days. Average postoperative nasogastric output was 357, 154 and 64 ml/day for day 1, 2 and 3 respectively. There was no statistically significant difference between two groups in abdominal girth before and after operation, frequency of vomiting, time taken for onset of bowel sounds and start of oral sips after operation, frequency of wound infection, anastomotic leak and mortality (p>0.05). Length of postoperative hospital stay and frequency of postoperative respiratory complications were more in group-I as compared to group-II (p<0.05). CONCLUSION: Nasogastric decompression does not provide added advantage after small bowel anastomosis.

Endoscopic dilation of esophageal strictures.

OBJECTIVE: To review the experience of endoscopic dilation of esophageal strictures at a tertiary care hospital. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad January 1985 to January 2003. MATERIALS AND METHODS: Patients presenting with dysphagia who presented at our institution during the past 8 years were reviewed. Their etiology and the number of dilations required for improvement in dysphagia and follow up with any complications were reviewed. All procedures were performed with savary dilators using guide wire without fluoroscopy. RESULTS: A total of 369 patients were seen during this period and 583 procedures were performed. Two hundred thirty-five (63.7%) patients had peptic stricture, 123 (33.3%) had malignant strictures, 08 (2.2%) had non obstructive dysphagia and 6 (1.6%) had corrosive ingestions. The age ranged from 28-68 years. There were 254 (88.5%) males and 115 (31.2%) females. Sixty-seven (11.5%) procedures were performed as inpatient and 516 (88.5%) procedures were done as outpatient. Two to three attempts at dilatation were required to achieve satisfactory swallowing. There were no serious complication. Follow-up period was 6-8 weeks on an average. CONCLUSION: Most common esophageal stricture found in our practice were peptic strictures. Dilation with savary system was safe and effective and was able to relieve dysphagia in large number of patients. No fluoroscopic guidance was needed.