BackgroundThe diagnosis of abdominal tuberculosis is a major health challenge. Limited data are available to support the use of GeneXpert MTB/RIF in the diagnosis of abdominal tuberculosis. The current study is an analysis of the sensitivity and specificity of GeneXpert MTB/RIF for the diagnosis of abdominal tuberculosis, keeping histopathology as the gold standard.Materials and methodsA prospective study was conducted in Surgery Unit-I of Holy Family hospital in the year 2017. Data of 21 patients presenting with abdominal tuberculosis were collected. The samples collected were ascitic fluid for GeneXpert and acid-fast bacilli (AFB) and a tissue sample for histopathology, which included either the enlarged lymph nodes or the involved gut segment.ResultsOut of a total of 21 patients, 10 were male and 11 were female. The predominant age group was less than 30 years with 76.2% cases. Of the 21 samples analyzed, all were positive for tuberculosis (TB) by histopathology. GeneXpert was positive in six and negative in 15 patients. The sensitivity of GeneXpert was 28.57% and specificity was 0%. The positive predictive value was 100%. The diagnostic accuracy was found to be 28.57%.ConclusionIn our study, GeneXpert has shown poor sensitivity and specificity for the detection of abdominal TB from ascitic fluid samples. On the basis of this data, we lay stress on finding new tests and biomarkers for the rapid diagnosis of abdominal TB.
Background
Laparoscopic surgery is becoming the gold standard for most abdominal surgeries in recent times. Laparoscopic repair of perforated duodenal ulcer (PDU), however, is still an area of debate. The purpose of this study was to evaluate the safety and efficacy of laparoscopic repair of PDU versus open repair.
Methods
In this cross-sectional study, patients were consecutively sampled. Out of 101 patients with clinically diagnosed PDU, 36 patients underwent laparoscopic Graham patch repair and 65 underwent open Graham patch repair in a tertiary care academic hospital. Open repair was via upper midline incision, and laparoscopic repair by the three-port technique. The following stages were calculated: operative time, duration of postoperative analgesia, time taken to mobilize, and patient length of stay after the operation.
Results
The mean operative time was somewhat longer in the laparoscopy group compared to the open repair group (74.01 vs 56.17 minutes, respectively). Mean postoperative analgesia requirement, time taken to mobilize, and hospital stay were significantly shorter after laparoscopy than after open repair (1.21 days, 9.32 hours, and 3.12 days vs 3.83 days, 16.20 hours, and 4.85 days, respectively). Three patients (8%) in the laparoscopy group and 35 (54%) in the open repair group had postoperative complications.
Conclusions
Laparoscopic repair of PDU is a safe approach and better than open repair in terms of operative time with the right level of expertise only, postoperative analgesia requirement, mobilization, duration of hospital stay, and incidence of postoperative respiratory and wound complications.
In breast clinics worldwide, cyclical mastalgia is the commonest presenting complaint among patients of reproductive age. Non-pharmacological options are preferred mode of treatment due to their better side effect profile. This study compares the effectiveness of two such non-pharmacological options i.e. Vitamin E and Evening Primrose Oil. Study Design: Randomized controlled single blinded trial. Setting: Surgical Unit 1 Holy Family Hospital, Rawalpindi. Period: Six months from July to Dec 2017. Materials and Methods: Observing all scientific and ethical protocols. All non-pregnant and non-lactating females of reproductive age were included in study. Two groups A and B, of 190 patients each, were made. Group A received Vitamin E capsules 400 mg once daily whereas group B received evening primrose oil 500 mg capsules twice daily. After six months, mean reduction in pain scores in both groups was calculated using a t-test (p-value < 0.05 was considered significant). Results: Total number of 380 female patients (190 in each group) were enrolled in study for a period of 6 months. Mean age was 30.00+16.54 years. Mean score at presentation was 5.69+0.08 in vitamin E group and 5.66+0.8 in EPO group. After 6 months, score was 3.70+1.5 in vitamin E group and 4.78+1.47 in EPO group, which was statistically significant (p value < 0.05). Conclusion: Vitamin E, when taken for 6 months, is more effective than evening primrose oil in reducing pain in moderate cyclical mastalgia.
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