Inter-Rater Reliability Of Objective Structured Long Examination Record.

BACKGROUND: Objective Structured Long Examination Record (OSLER) scale was introduced in 1997 by Gleeson to improve the long case examination. There is no psychometric evidence to support reliability of OSLER. This study was done to analyse inter-rater reliability of OSLER. METHODS: Two groups of examiners assessed 105 students in long case examination of their final professional examination, using OSLER scale. Group 1 was composed of actual examiners while Group 2 was mock examiners. Kappa statistic and intraclass correlation coefficient (ICC) were used on SPSS 23 to calculate reliability. RESULTS: Mean score awarded by actual examiners was 55.36 (SD=11.2) whereas mean score by mock examiners was 57.74 (SD=14.1). Cronbach's alpha was 0.586, Kappa was 0.019 whereas inter-rater reliability on ICC was 0.413. CONCLUSIONS: Although OSLER is a practical modification of long case examination with good validity, the scale needs to be more structured to improve its reliability.

LAPAROTOMY FOR PERITONITIS: PRIMARY OR DELAYED PRIMARY CLOSURE?

BACKGROUND: Although literature does not provide a level-1 evidence to support either method of closure, various studies have shown a reduced frequency of superficial surgical site infection with delayed primary closure (DPC) as opposed to primary closure (PC). Nevertheless, PC is still preferred by most. surgeons to avoid a second procedure. This study was conducted with the objective to compare the frequency of wound infection and duration of hospitalization among patients undergoing primary and delayed primary closure of the skin wound following laparotomy for peritonitis. METHODS: A randomized controlled trial comprising 70 patients: Thirty-five patients underwent PC (Group-A) and 35 DPC (Group-B). Frequency of wound infection during follow up period and duration of hospital stay was noted in both groups. RESULTS: In group-A, 18 (51.43%) patients showed wound infection while in group-B, it was 9 (25.71%) with p=0.027. Mean hospital stay recorded in group-A was 7.03 days±1.81, and for group-B, it was 6.34 days±4.14 (p=0.372). CONCLUSION: DPC for surgical wounds is better than PC technique as it decreases the frequency of wound infection during follow-up period without any significant increase in duration of hospital stay.

Hepatitis C--a risk factor for gallstone disease.

BACKGROUND: There is increasing evidence that chronic liver disease is one of the risk factors for gallstone disease. A few published studies have documented the link between Hepatitis C Virus (HCV) related chronic liver disease and increased incidence of gallstones but these studies did not exclude subjects with other risk factors like cirrhosis. This study aimed to establish an association between HCV infection and gallstones by excluding subjects with all other risk factors for gallstones. METHODS: This cross sectional study was carried out at four hospitals of Rawalpindi, Pakistan, over a period of 18 months. It included all cases referred for ultrasound scan of abdomen. A total of 2000 cases, were included in the study by consecutive, non-probability sampling. Anti-HCV antibody test was carried out in all subjects by ELISA and sonography was done to determine presence or absence of gallstones. RESULTS: Patients suffering from HCV had a significantly high percentage of gallstones as compared to seronegative subjects (p = 0.001). In seropositive group, more males had gallstones (p = < 0.001) and prevalence of gallstones was significantly high in younger population with age at or below 40 years (p = < 0.001). CONCLUSION: Risk of gallstone disease is increased in patients suffering from HCV infection. This association is more pronounced in males.

Teenage jejunoileal diverticulosis.

Presentation of jeujunoileal diverticulosis in young age is virtually unknown. It is associated with middle or old age. It is usually asymptomatic but may present with vague abdominal pain and episodic nausea, vomiting or diarrhoea. It can lead to complications like bleeding, perforation and obstruction. We had 3 cases of jejuno-ileal diverticulosis presenting in their teens. They had resection and anastomosis resulting in improved health.

Dehydration related abdominal pain (DRAP).

OBJECTIVE: To describe the frequency of dehydration as a medical cause of acute abdomen. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: The study was conducted at Combined Military Hospital, Malir Cantonment Karachi between March 1, 2000 to March 1, 2002. SUBJECTS AND METHODS: All the patients reporting with abdominal pain to the surgical outpatient department or the emergency department, were reviewed in the study. The clinical findings in all these cases were studied along with the mode of their management and outcome. RESULTS: Of all the patients presenting with abdominal pain, 303% (n=68) were suffering from dehydration related abdominal pain. They were predominantly males in a ratio of 8.7:1, mostly in the 2nd and 3rd decades of their lives. All these cases were suffering from acute or chronic dehydration were provisionally diagnosed by general practitioners as 'acute abdomen' and referred for surgical consultation. Associated symptoms included vomiting in 42.6% backache in 91.2%, headache in 95.6%, and pain in lower limbs in 97.1% of the cases. 83.8% required indoor management with intravenous fluids. All the patients became asymptomatic with rehydration therapy. CONCLUSION: Dehydration is a possible cause of severe abdominal pain. There is a need to educate the general public about the benefits of adequate fluid intake.

Skip lesions in intestinal tuberculosis.

A case of a young lady is presented having acute intestinal obstruction due to multiple, discrete strictures throughout the small intestine. Histopathology confirmed the diagnosis of tuberculosis. Anti-tuberculosis therapy was started which resulted in complete remission. Discrete skip strictures in small intestines are typically seen in Crohn's disease, and are unusual for tuberculosis.