Objective: To assess the role of white blood cell count (WBC) in the diagnosis of acute appendicitis and its relation to histopathological findings. Methodology: A descriptive cross sectional study was conducted at Aziz Fatimah Hospital Faisalabad. One hundred patients with acute appendicitis were encompassed in our work. Diagnosis was confirmed after careful clinical assessment aided with classical sign and symptoms. White Blood cell count of every patient was done from laboratory of our hospital. Specimen of appendix of every patient was sent for histopathology. In addition, pre-operative white blood cell count (WBC) was compared with postoperative histopathology reports to assess WBC count's significance in the identification of acute appendicitis. Results: Out of 100 cases, 63 were male, and 37 were females. Age of the patients was between 12 to 55 years, mean age being 20.9 years. Commonest age group was 17 to 30 years (n=73). The sensitivity and specificity of WBC count were calculated 27% and 43.75% respectively, while positive and negative predictive value was 71.87 and 10.1%, respectively. Mean ± SD of TLC of patients with normal and inflamed appendix was 10781±291.0 and 95908 ± 329.43respectively, this difference was not statistically different (p value=0.16). Neutrophils count was 66. 86% in patients with inflamed appendix and nearly equal to this 65.18% was noticed with normal appendix on histopathology (p value=0.15). Odd Ratio were insignificant showing WBCs are nor independent predictors of acute appendicitis (p value 0.30) Conclusion: White blood cell count is not a very good and reliable investigation for diagnosis of acute appendicitis. Patient can be having acute appendicitis with normal white blood cell count.
Objective: To assess the role of topical antibiotic (mertronidazole) in the treatment of acute anal fissure. Study Design: Randomized Control Trial. Setting: General Surgery Outpatient Department of Aziz Fatima Hospital. Period: January 2020 and March 2021. Material & Method: In this study, patients were divided into two groups randomly. Patients in Group 1 were given only 0.2% GTN ointment and those in Group 2 were given 0.2% GTN ointment and metronidazole cream. All patients’ VAS scores for pain and healing of fissure by examining the peri anal area, as well as any adverse effects of the drugs, were recorded and statistically compared. Patients demographic characteristics, such as age and gender, were recorded. All patients were physically examined at the end of weeks 2, 4, and 6 of treatment. All statistical data analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 23.0. Descriptive statistics were used for comparisons. t test, and chi-square test were used to assess independent samples. A p-value <0.05 was accepted as statistically significant. Results: There were 46 (92%) female and 4 (08%) male patients in Group 1 and 48 (96%) female and 2 (24%) male patients in Group 2. The mean ages of the patients were 35.4±3.7 years in Group 1 and 37.8±4.2 years in Group 2. The mean VAS scores of the patients at the time of presentation to the hospital (pretreatment) were 7.2±1.2 in Group 1 and 7.4±0.9 in Group 2 (p=0.058). The mean VAS scores of the patients at the end of week 2 were 4.6±0.8 in Group 1 and 4.2±0.9 in Group 2 (p=0.058). The mean VAS scores of the patients at the end of week 4 were 3.2±O.7 in Group 1 and 2.4±0.8 in Group 2 (p=0.00004). The mean VAS scores of the patients at the end of week 6 were 2.36+0.65 in Group 1 and 1.86±0.48 in Group 2 (p<0.00054). In Group 1, 6(12%) patients had recovery at week 4 and 26 (32%) patients at week 6 with no recovery seen in 18(36%) patients. In Group 2, 9 (18%) patients had recovery at week 2 and 33(66%) patients at week 4 with no recovery seen in 8(16%) patients. There was a statistically significant difference between these data (p=0.022). Conclusion: We have observed that topical metronidazole along with other traditional management is an fruitful, easy-to-use, safe, rapid and secure option that helps in further reducing pain associated with anal fissure and increasing the healing rate. It is also effective in preventing the anal fissure to become chronic.
Background: This study was conducted to evaluate results of earlycholecystectomy in acute cholecystitis in terms of procedural safety. Methods: In this study 50consecutive cases of acute cholecystitis who underwent early laparoscopic cholecystectomy(within 03 days of attack) were included. Patients with symptoms of more than 03 days durationor those with associated diseases were excluded. Evaluation of results was done by analyzingthe data in SPSS V-17. Results: Out of 50 patients operated 46 (92%) were female and 4 (8%)were male. Most of the patients were received within 24 hours after the onset of symptoms. Theage of patients ranged from 30-70 years with the median age of 45 years. Ultrasound revealedoedematous gall bladder with pericholecystic fluid in 38 (76%) patients. In 8 (16%) patients, gallbladder was small, shrunken and thick walled, there was empyema in 2 (4%) patients &mucocele with stone impacted at hartmann’s pouch in 2 (4%) patients. Average operation timewas 40 minutes. All patients were operated within 72 hours of onset of symptoms. Per operativelysevere inflammation was noted in 32 (64%) patients, adhesions with colon/stomach/omentum in10 (20%) patients, adhesions with CBD in 3 (6%) patients, distorted anatomy at Calot’s triangle in5 (10%) patients. 6 (12%) patients had bleeding from liver bed, but controlled with diathermy. In46 (92%) patients laparoscopic cholecystectomy was completed successfully. In 4 (8%) patients,laparoscopic procedure was converted to open cholecystectomy. Reasons of conversion wereacute cholecystitis with severe adhesions which caused bleeding in 2 (4%) patients, obscureanatomy of Calot's triangle in 2 (4%) patients. Post operatively, there was bile leak in 1 (2%)patient which was due to minor injury of CBD, which required re-exploration & suturing of defect.No patient developed post operative jaundice. There was no major bleed post operatively. 3 (6%)patients developed wound infection. Conclusions: Laparoscopic cholecystectomy is aneffective and safe technique of treating symptomatic gallstones even in cases of acutecholecystitis because of accelerated recovery couple with less postoperative pain and shorthospital stay.
BACKGROUND & OBJECTIVE: Neutrophil to lymphocyte ratio has an important role to predict the outcome of diabetic foot syndrome. The aim is to evaluate NTL ratio as a prognostic factor in diabetic foot syndrome and its importance in diabetic wounds. METHODOLOGY: Descriptive cross-sectional study was to evaluate NTL ratio for prognosis of DFS. All cases were assessed for smoking, body mass index, presence of wound, glycated hemoglobin level, peripheral limb ischemia and infection. Patients were examined for a period of 12 months to assess wound if it resulted in minor amputation (below the level of ankle), major amputations (below/above knee amputation), chronic wound or completely healed wound. Chi-Square test was applied for categorical data. RESULTS: Total 100 patients were included and 61% were smokers. Average BMI was 31.7 and 34.5 in males and females. Complete wound healing found in 18% cases after debridement and chronic wounds in 15% patients. Subjects had to undergo major (above ankle) 16% and minor (below ankle) 51% amputations. Mean NTL count was 3.5 in fully healed wounds, 4.3 in chronic wounds, 6.9 in major amputations, and 5.2 in minor amputations. As the p-value indicates, there is a significant relationship between healed wounds, minor amputations, Chronic wounds and major amputations and the NTL ratio. CONCLUSION: Results revealed NTL ratio has independent prognosis in DFS for anticipating wound upshot. NTL ratio has a significant link with healed wounds, minor amputations, and major amputations, as indicated by p-value.
Background: Thyroidectomy is one of the most difficult surgical procedures. The study aims to compare the thyroidectomy procedure with drain placement and without drain concerning the hospital stay, Postoperative complications, and pain assessment using a visual analog scale. Methods: A prospective comparative study was designed in the Department of otorhinolaryngology & Head Neck Surgery---removed for blind review----. A total of 117 patients were enrolled in the study from which 9 were excluded due to loss of follow-up. The patients were divided into two groups by using computer-generated randomized numbers containing sealed envelopes. Both groups contained 54 patients. Group A patients with a drain placed while group B contained patients without a drain. The patients with drain have a longer hospital stay and reported increased pain as compared to the patients with drainless thyroidectomy. Results: The mean age and standard deviation calculated for the patients enrolled in both groups after randomization was 13.28 42.5 and 12.18 43.9 in groups A and B respectively. The mean ages were statistically insignificant. However, Postoperative variables such as length of hospital stay and post-operative pain by visual analog scale were assessed. The hospital stays of the patients with a drain placed was found statistically significant with a P-value < 0.05 Postoperative pain assessed by visual analog scale was also significant having a P-value <0.05 for patients having stayed for 2 to 4 days. Conclusion: Placement of drain after thyroidectomy saves the patient from life-threatening complications but at the same time increases the post-operative pain on day one and increases the length of hospital stay of the patient. The routine practice of drain placement should be avoided unless there must be a risk of the development of hematoma or seroma.
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