Background/aim: Diabetic foot ulcers and related complications are a major cause of morbidity and hospital admissions. Our aim was to evaluate the risk factors associated with poor outcome in diabetic foot ulcers. Materials and methods:A prospective study was conducted on patients with diabetic foot ulceration attending the Madinah Teaching Hospital from June 2014 to December 2015. Potential risk factors and laboratory test results at presentation were recorded and their association with outcome (healing vs. amputation) was analyzed using IBM SPSS Statistics for Windows, Version 22.0.Results: In total, 112 patients were studied during our study period. The majority of the patients were male (60.7%) and aged 50 years and older (62.5%). Regarding the outcome, 68% healed completely, 27.7% underwent amputation, and 4.5% died during this period. Patient age of 50 and older, long duration of diabetes (>10 years), rural origin, and heel ulcers were significantly associated with poor outcome (P < 0.05). Conclusion:Patients with diabetes should have a detailed annual foot examination; those having risk factors for poor outcome require more frequent foot care, patient education, and early referral to tertiary care centers.
Objectives: Oncoplastic breast surgery (OBS) is a revolutionary approach for managing breast cancer. This manuscript aimed to assess the oncological and cosmetic outcomes of OBS in breast cancer. Study Design: Descriptive, prospective study. Setting: Department of Surgery, Madina Teaching Hospital, Faisalabad. Period: January 2018 to June 2019. Material & Methods: Females with invasive breast cancer having 5-6 cm tumour size, Locally advanced tumour after chemotherapy, single tumour and patients < 70 years were included; while patients with fixed tumours, high tumour to breast size ratio, multiple axillary lymph nodes, metastatic cancer & patient’s choice for mastectomy were excluded. Oncological outcome was assessed by; Margin involvement, time lag for chemotherapy, local recurrence and distant metastasis. Cosmetic outcome was detected by score given by patient and an independent surgeon. Results: Thirty two female patients underwent OBS. Mean age of patients was 46.56 yr (SD =10.23). Six patients (18.8%) had central tumors. 3 patients were post neoadjuvant chemotherapy. In 28 patients volume displacement (VD) surgery; while in 4 patients volume replacement (VR) using different flaps like LICAP flap were done. Oncological outcome showed positive margin in one case only, in all other cases clear margins were found. Chemotherapy start time varied from 3 to 8 weeks after surgery (Mean=31.3 days). Delayed time was associated with high BMI and diabetes (P<0.05). Local recurrence or distant metastasis was not noticed in any case. Majority of the patients and surgeon (90%) were satisfied with cosmetic outcome. Conclusion: Oncoplastic Breast surgery is a unique approach to conserve breast even in larger tumours without compromise on oncological principles and cosmesis.
Objective: To compare the effects of intraincisional and intraperitoneal infiltration of local anaesthetic to relieve early postoperative pain in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Department of Anaesthesia and Surgery, Madinah Teaching Hospital Faisalabad. Period: July 2017 to March 2018. Material & Methods: A sample of 100 patients with American Society of Anaesthesiologists Physical status (ASA) I and II, undergoing laparoscopic cholecystectomy were selected using simple random sampling technique. Patients were randomly assigned into groups A and B. Group A patients received intraperitoneal infiltration of 20 ml solution of 0.25% bupivacaine and group B patients received intraincisional infiltration of 20 ml solution of 0.25% bupivacaine. Results: Demographic characteristics were not significantly different in both groups. Our study showed that Group A patients had better pain relief as compared to group B patients. Visual analogue score (VAS) for pain relief at 0, 3,6,12 and 24 hours was statistically different in both groups. The requirement of rescue analgesia between group A and B was found to be12% and 38% which is statically significant (p value 0.003). Conclusion: intraperitoneal infiltration of Bupivacaine offers better postoperative pain relief after laparoscopic cholecystectomy and is associated with less analgesic requirement in early postoperative period.
Objective: To compare the efficacy of paramedian and midline approach for spinal block in elderly, in terms of success rate and number of attempts required by either approach. Study Design: Randomized Controlled Trial. Setting: Department of Anaesthesia, Madina Teaching Hospital Faisalabad. Period: January 2018 to December 2019. Material & Method: 120 elderly ASA I-III patients scheduled to undergo lower abdominal or limbs; general or orthopaedic surgery were randomly divided into two equal groups A and B of sixty patients. Patients were assigned into groups by lottery method. Group A patients were supposed to receive spinal block by midline approach while group B patients were planned to receive spinal block by paramedian approach. Results: It was observed that success rate was significantly high in group B, 98.3% as compared to group A, 80%, (p value 0.001). The number of attempts were significantly less in group B in comparison to group A (p-value 0.0001). Conclusion: The paramedian approach for spinal block in elderly patient’s offers ease of administration and a higher success rate as compared to midline approach.
ABSTRACT BACKGROUND & OBJECTIVE: Road traffic accidents are the ninth leading cause of death worldwide, contributing significantly to global disease burden. Emergency Medical services(EMS) play a role in minimizing the morbidity and mortality. Our objective was to determine the characteristics of injury pattern and causes encountered in Road Traffic crashes (RTCs) managed by 1122 in Faisalabad Pakistan andto access the outcome of these accidents. METHODOLOGY: All Road Traffic crashes and victims in Faisalabad city of Pakistan which were initially managed by Rescue 1122 between 2016 to 2019 were included in the study. Total sample size was 101995. It is descriptive cross-sectional study which includes patients of different ages, sex and motor-vehicles accidents having different injury sites. RESULTS: During the study period there were total 101995 RTCs victims to whom emergency medical services (EMS) were provided. Gender wise 80.73% male victims and 19.27% female victims. Major age groups were between 21-30 years (25.917%). The major risk factors of accidents were over-speeding (56.8%) followed by carelessness (18.32%), wrong turn (8.69%) , u-turn(5.84%) , one wheeling(0.008%), tyre burst (0.117%) and others(10.14%). The injuries frequently encountered are minor which accounts for (44.68%), Single fracture (23.25%), Multiple fracture (16.62%), Head injury (12.40%) and Spinal injury(3.03%). Outcome of RTCs in our study was alive & unstable (54.47%), alive & stable (44.7%) and dead (0.83%). CONCLUSION: This study showed that Road Traffic Accident are the major public health problem in our society and contributes markedly to high morbidity and mortality. Urgent Preventive measures including community education should be established to reduce the risk of their outcome.
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