Objective: To explore the perceptions about COVID – 19 disease among patients admitted in Isolation ward and to improve management ideas. Methodology: This qualitative cross sectional interview based study was conducted at Isolation ward, Pakistan Institute of Medical Sciences Islamabad from April to June 2020. Patients who were reported positive for SARS COV-2 through nasopharyngeal or oropharyngeal swabs and were admitted for at least one day in isolation ward, were included in the study. Patients who were too ill to talk for the interview and those who could not survive the disease were excluded. After taking informed consent and following the standard operating procedures (SOPs) of Corona Isolation ward; data was obtained by conducting in depth interviews arranged as per patients’ convenience on mobile calls. Data was analyzed using Narrative Analysis. Themes were delineated and organized to groups for understanding. Results: Twenty two patients participated with the mean age of 34.64±7.26 years. Majority of the patients had anxiety and fear for the COVID-19 disease however also were hopeful to face it. The delineated themes were anxiety & depression, fear, hopefulness & moving forward, health facilities & related issues, living in isolation and physiological disturbances like sleep, appetite, smoking or addiction, exercise. Conclusion: Covid-19 patients depict mixed perceptions while admitted in Isolation ward and this provide us an insight to this catastrophic illness. Their experiences help the health authorities to address this issue.
The potential for laparoscopic entry to cause serious injury is real. However, when the written records of laparoscopic entry was audited against the Middlesbrough consensus guidelines in a large teaching hospital, there were wide variations in the documentation of safety techniques. A standard proforma was created to facilitate the documentation of techniques.
Objective: To determine the accuracy of ultrasound in predicting difficult laproscopic cholecystectomy,keeping preoperative findings as gold standard. Methodology: A cross sectional study was conducted from July 2018 to January 2019 at Pakistan Institute of Medical Sciences Islamabad. Adult patients wih cholelithiasis were included in the study by consecutive sampling, who underwent laproscopic cholecystectomy. Preoperative ultrasound parameters such as gallbladder wall thickness, size and number of gall stones, contracted gall bladder and pericholecystic fluid were studied. Intraoperative difficulty of laproscopic cholecystectomy was determined by criteria as procedure time more than 60 minutes, dissection at Calot's triangle more than 30 minutes and tear of gall bladder Results: A total of 150 patients were included with mean age of 41.4 ± 9.9 years . There were 29 (19.3%) males and 121 (80.7%) were female. Male to Female ratio was 1:4, preoperative ultrasonography findings such as gallbladder wall thickness > 4mm ,size of stone >1cm impacted gall stone , contracted gallbladder and presence of pericholicystic fluid were significantly associated with difficult laproscopic cholycytectomy (p value=0.001) Conclusion: In majority of patients, preoperative ultrasonography is found as good predictor of difficult laproscopic cholycystectomy and should be used as a screening procedures.
Menorrhagia and dysfunctional uterine bleeding are com-mon indications for referral to a gynecologist. One in 20 women aged 30-49 will consult her general practitioner every year com-plaining of heavy uterine bleeding. Over 70,000 hysterecto-mies are performed annually in the UK with menorrhagia being the commonest indication. In up to 30% of these cases the uterus is anatomically normal. To these women, heavy uterine bleed-ing brings considerable stress and disruption to their social, domestic and professional lives. In the UK, the cost of primary care prescriptions for the treatment of menorrhagia was esti-mated in 1998 to be around £7 million. Gynecologists have looked at less radical but effective alternatives to hysterectomy for the treatment of heavy uterine bleeding. While the MISTLE-TOE* audit had demonstrated a pivotal role for less extreme yet successful interventions than hysterectomy for the treatment of bleeding problems, there were some setbacks. Special skills are needed to perform rollerball and diathermy loop resections of the endometrium. As well as the risk of serious intra-opera-tive complications the techniques are relatively time consum-ing to perform. In the MISTLETOE audit there were two direct deaths as a consequence of the procedure and 1.26% of patients required emergency surgery. This review looks at two new in-terventions available for clinical use, in the short term they have both proven to be successful and safe in the management of heavy uterine bleeding. Individually, they offer distinct advan-tages in the successful treatment of heavy uterine bleeding with-out the disadvantages of major surgery or medical treatment. They are both relatively easy to learn and do not require ad-vanced hysteroscopic skills. A major step forward is the suit-ability for outpatient setting.
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