Aim: To find out the frequency of perforated appendix among patients presenting with acute appendicitis. Study design: A cross-sectional study Place and Duration: This study was conducted at Sindh Employee Social Security Hospital Landhi Karachi, Pakistan from July 2020 to November 2021. Methodology: This study includes 205 patients. All the details like age, gender, and previous history associated with diabetes and fasting blood sugar were noted. The surgeries were performed by a single surgeon who detected the presence and absence of a perforated appendix. Results: Mean age of patients was 28 years with a standard deviation of ±13.63. A total of 64% of patients were male and 26% were female. About 11% of patients had perforated appendix after acute appendicitis. Conclusion: The frequency of perforated appendix in this study was 11% in patients undergoing appendectomy for acute appendicitis. Keywords: Appendicitis, perforated appendix, adults, prevalence
Aim: To examine the clinical characteristics of patients with acute appendicitis Study design: A cross-sectional study Place and Duration: This study was conducted at Liaquat University Hospital Jamshoro / Hyderabad from March 2021 to March 2022. Methodology: Presentstudy included 118 patients who went through emergency appendectomy for acute appendicitis. The study evaluated the patient's clinical profile who presented with acute appendicitis. A detailed history was taken, a clinical examination was performed, and tests such as a complete blood test and ultrasonography were performed. Patients of either gender, above 10 years of age, and with clinical diagnoses of acute appendicitis were incorporated in the study. Patients having an appendicular mass or right ureteric/renal colic were excluded from the study. Results: In the current study themean age of patients was 27.56 ± 9.8 years. Out of 118 patients, 71 (60.1%) were males, and 47 (39.83%) were females. We observed thepredominance of malesin the current study. Majority of the patients presented with complaints of right iliac fossa pain (98.3%) and migration of pain (67.8%). Nausea and anorexia were present in 86.4% of cases, and vomiting was present in 84.7% of cases.Tenderness was observed in right iliac fossa in all patients while Dunphy sign (59.3%), guarding (63.5%), rebound tenderness (69.4%), rigidity (5.9%), Psoas sign (45.7%), Rovsing sign (35.5%)and Obturator sign (21.1%). Conclusion: Males are more likely to have acute appendicitis than females between 10 and 30 years of age. The most common signs and symptoms were discomforts, anorexia, nausea/vomiting, and abdominal pain. Tenderness, guarding, and rebound tenderness were the most prevalent symptoms.
Objective: To analyse the effects of stretching the muscles of the shoulder before surgery on the functionality of the shoulder after the surgery of mastectomy Study design: An analytical cross-sectional study Place and Duration: This study was conducted at Bibi Asifa Bhutto Dental College SMBB Medical University CMC Teaching Hospital Larkana from January 2022 to June 2022. Methodology: All the patients included in the study had mastectomy. The participants were randomized to control groups and treatment groups. The participants in the treatment group were gone through static stretching with a range of motion. The control group did not undergo any stretching preoperatively and was given standard postoperative care. The Numeric Pain Rating Scale (NPRS), Groningen Activity Restriction Scale (GARS), and Universal Goniometer (UG) were used for the collection of the data on the first and third postoperative days. The data was analyzed in the IBM SPSS version 26. Results: A total of 20 patients were included in the study. Overall10 patients were allocated to the treatment group and 10 were allocated to the control group. The mean age of the patients was 47±11.86 years. A significant difference in the functionality, range of motion, pain, and Groningen Activity Restriction Scale scores for daily activities was seen in the treatment group (p<0.05)compared to the control group (p>0.05). However, the difference was not significant in external rotation and Groningen Activity Restriction Scale scores (p>0.05). Conclusion: Shoulder stretching before surgery is not only safe, but it is also effective in the reduction of functional restriction and pain after the mastectomy surgery. Keywords: Shoulder stretching, Pre-operative stretching, Mastectomy, Post-op shoulder function
Objective: Surgical site infections (SSIs) pose a continued problem to operating surgeons. It adds to the healthcare cost, increases morbidity and mortality and sometimes culminates in re-explorations. Rate of SSIs can be ameliorated by removing damaged or non-viable tissue, metabolic waste and wound exudates; this can be achieved by irrigation of surgical wound intraoperatively. Surgical wound irrigation can also be performed postoperatively. Even after giving prophylactic antibiotics and august aseptic measures, post-appendectomy wound infection remains soaring. The efficacy of povidone-io- dine on non-incised skin is well known but its application as an intraoperative irrigation solution in open surgical wounds is not a mundane practice. Likewise prophylactic irrigation with normal saline solution to prevent wound infection has also turned out to be effective in some studies. The objective of this study is to compare the percentage of superficial SSI post-appendectomy, with intraoperative irrigation of subcutaneous plane using 1% povidone-iodine solution versus normal saline. Methods: 200 cases of open appendectomy for acute appendicitis at Baqai Medical University, Kara- chi were randomly distributed into two arms. In group A, 0.9% Normal Saline was employed to irrigate subcutaneous tissue before skin closure while in group B irrigation with 1% diluted povidone-iodine solution was undertaken. The cases were assessed for infection in surgical wounds in line with Southampton wound grading system for five days after surgery and followed for thirty days. Results: Mean age of participants of this study was 18.65 years. There were 100 patients in both groups and the groups were not different statistically in terms of age, gender and operative findings. A total of 38 (19%) out of 200 patients had Southampton grade 2 and above, signifying wound infection. Out of these, 29 (29%) were from Group A and 9 (9%) from Group B (p=0.001). Conclusion: 1% diluted povidone-iodine irrigation of subcutaneous plane after appendectomy remark- ably lowers the rate of SSI when compared with normal saline irrigation.
Aim: To evaluate the quality of bowel preparations concerning the Boston Bowel Preparation Score (BBPS) and to analyze the administration, ease, palatability, and side effects of practices. Study design: Cross-sectional study Place and Duration: this study was conducted in Liaquat University of Medical and Health Sciences Jamshoro from October 2021 to March 2022 Methodology: The present study incorporated 132 patients who visited the hospital for a colonoscopy. Patients above 18 years of age were included, whereas patients with surgical procedures were excluded from the study. Participants were evaluated through pre-designed proforma for demography, dietary recommendations, side effects, procedure indications, bowel preparations, and patient ease of the bowel preparations. BBPS was used to access the bowel preparation. A score ≥ 5 was regarded as satisfactory. Results: Out of 132 patients, 73 (55.3%) were males. Seventy-one (53.8%) patients received Polyethylene glycol-based bowl preparation, and sixty-one (46.2%) patients received sodium phosphate-based preparation. Chronic constipation was the most typical cause of colonoscopy. Common side effects were vomiting (12.1%), nausea (1.5%), and bloating (3%). More than half of them responded that the preparations were palatable. A satisfaction rate of 80.3% was observed in patients with both preparations. BBPS of above five was observed in 109 (82.6%) patients. Conclusion: Polyethylene glycol and sodium phosphate preparations have been widely used in clinical practices for cleansing the colon. Sodium phosphate-based preparation was found more effective. Keywords: Bowel cleansing agents, Colonoscopy, Endoscopy, Polyethylene Glycol, Sodium phosphate.
Objective: To determine the frequency of metabolic syndrome and its associated factors in patients with biopsy proven breast cancer at tertiary care university hospitals of Karachi, Pakistan. Methods: This cross sectional study was conducted at the hospitals affiliated with Dow university of health sciences & Baqai medical university from January 2018 to September 2019.A total of 114women between 30 to 50 years of age presented to the out patients clinics and underwent triple assessment including detailed history &examination, radiological assessment and fine needle aspiration cytology for confirmation of breast cancer were included in the study after taking written informed consent. Along with the routine baseline investigations blood sugar for hyperglycemia&blood sample for lipid profile was taken in fasting from Dow Lab. Blood pressure of the patients was also checked along with the weight, height and waist measurements. The SPSS version 19 was applied to the data for description and analysis. Results: Mean age of the patients was 42.57 ±4.90 years. Stages of cancer showed that stage III was found in majority (n=50, 43.9%). Frequency of metabolic syndrome was observed in 44 (38.6%) of the patients. A significant association of metabolic syndrome with educational status (p-value <0.001), Hypertension (p-value <0.001), Central obesity (p-value <0.001), Fasting blood sugar levels (p-value <0.001), Triglyceride levels (p-value <0.001), High density lipoprotein levels (p-value <0.001), and different Stages of breast cancer (p-value 0.003) was observed. Conclusion: This study show that a significant number of patients with breast cancer are suffering from metabolic syndrome which is also correlates with the educational status of the patients.
Background: The triple-negative tumor is a high-risk tumor as a targeted therapy to these proteins is not possible with this type of cancer. Objective: To investigate the prognostic factors that can help in treatment selection in the triple-negative phenotype breast tumors Study design: A cross-sectional study Place and duration: This study was conducted at People's University of Medical and Health Sciences Nawabshah from Nov 2021 to Nov 2022 Methodology: The present study examined numerous cases of invasive carcinoma of the breast. The patients visited for follow-up for a long time and they were examined by tissue microarray. The series was stained through concurrent immune-histochemical prognostic panels. This was done to specify the subgroups of different types of breast cancer and for the identification of prognostic markers as well as the aggressive behavior of the tumors. Results: In the beginning, a total of 280 cases were included in the study, out of which 45 (16.07%) patients had triple-negative breast cancer. Most of these cancers were grade 3 carcinomas. A strong association was seen with pushing margins, development of recurrence, large size, poorer Nottingham Prognostic Index, and distant metastasis. Moreover, the association was also seen with loss of expression of E-cadherin and androgen receptors, basal phenotype, p53, EGFR, and P-cadherin. The size of the tumor, androgen receptors, and lymph node staging were the most valuable prognostic markers. Androgen receptor and size had prognostic significance in the tumor subgroup with lymph node-positive tumors. On the other hand, the basal phenotype was the only prognostic marker in the subgroup with lymph node-negative tumors. Some other parameters considered in the present study are histological grade, size of the tumor, age of the patient, and vascular invasion. Conclusion: The most significant markers identified were basal phenotype and androgen receptor. Also, tumor size and the status of the lymph node are quite significant in low-risk and high-risk patients while selecting surgical or non-surgical treatment for the triple-negative tumors Keywords: Triple-negative, breast tumor, prognostic markers, androgen receptors
Objective: The objective of this study was to find out whether Lateral Internal Sphincterotomy (LIS) can be carried out using Local Anaesthesia (LA) hence, lowering down the cost and anaesthesia related complications in patients without compromising operative easiness or final result.Methods: One hundred patients who were diagnosed clinically as anal fissure patients and were scheduled for LIS were randomly distributed into two treatment arms. Non-probability consecutive sampling approach was employed. In the first group, LIS was carried out using LA while in the second group LIS was performed in spinal anaesthesia (SA). Age, gender, BMI, procedure time, post-operative complications like pain, post-operative nausea and vomiting (PONV), bleeding, headache, incontinence, urinary retention and patient satisfaction were the main outcome variables which were studied.Results: Out of 100 patients who were treated with LIS, 50 of these patients had SA whereas, the rests of the 50 patients were given LA. We found no statistically significant difference in the post-operative pain, PONV, bleeding, incontinence, and overall patient satisfaction but duration of surgery and post-operative complications like headache and retention of urine were considerably less in the LA group. The difference between the two groups dictated that LIS under local anaesthesia (Group A) took 13.46 minutes (SEM 0.808) lesser than Group B which was statistically significant. But the Mean postoperative pain scores of patients in both groups were not significantly different on statistical analysis nor pain scores at 12 hours from surgery and 24 hours from surgery separately i-e 'p-value>0.05'Conclusions: LIS under LA is less time-intensive, safe and has a comparable patient satisfaction rate to SA. Besides, the advantage of significant cost benefit, duration of surgery, exemption of the requirement of an anaesthetist, and less post-operative headache and PONV, LA also shows no noteworthy difference in the post-operative complications in comparison with SA.
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