Comparison between Pendant Positions versus Traditional Sitting Positions for Successful Spinal Puncture in Patients Undergoing Caesarean Deliveries

Aim: To determine the effectiveness among pendant position and traditional sitting position in term of successful spinal puncture in patients underwent caesarean deliveries. Study Design: Randomized control trial Place and Duration of Study: Department of Anaesthesia, Ghurki Trust Teaching Hospital, Lahore from 1st April 2020 to 31st March 2021. Methodology: One hundred and eighty patients were included. Patient’s detailed demographics were recorded after taking written consent. Patients were aged between 20-50 years. Patients were equally divided into two groups, group I had 90 patients underwent pendant position and group II had 90 patients and underwent for traditional sitting. Randomly one of two positions was performed with the L3-L4 interface in spinal puncture. Time for successful spinal puncture, number of needle to bone contacts and total number of attempts were calculated. Results: Mean age of the patients in group I was 27.6±17.04 years with mean BMI 24.25±2.63 kg/m2 and in group II, mean age was 29.23±14.24 years with mean BMI 26.55±6.36 kg/m2. Mean height of patients in group I was 2.6524±1.0054 meter and in group II was 2.6516±1.0042 meter. Weight of the patients in group I 63.48±22.13 kg and in group II was 65.46±17.19 kg. Success rate after first attempt in group I was 80 (94.44%) and group II was 72 (80%). For spinal needle insertion, fewer mean times was observed in group I 19.55±11.221 sec as compared to group II 28.14±18.226 sec. Number of needle to bone contacts was higher 66.7% in group I and in group II 40%. Number of attempt was less in group I as compared to group II. Conclusion: The pendant position in the pregnant women who had a caesarean sector was much better than the standard position in order to provide the 1st attempt of spinal puncture. Keywords: Caesarean, Spinal anaesthesia, Traditional sitting, Pendant position</jats:p

Comparison of Open vs Laparoscopic Cholecystectomy in patients of Cholelithiasis having Previous Abdominal Surgeries

Background: Most of the surgeons in our setups perform open cholecystectomy (OC) in patients of cholelithiasis having previous abdominal surgery. This is the era of laparoscopic and robotic surgery and laparoscopic cholecystectomy (LC) should be the preferred treatment for these patients as well. Aim: To observe the effect of previous abdominal surgeries on laparoscopic cholecystectomy. Study design: Randomized, controlled and multicenter experimental study. Place and duration of study: Department of Surgery, Central Park Teaching Hospital, Lahore, Noor Hospital, Kot Radha Kishan and Bilquees Hospital, Kasur from 1st January 2020 to 31st December 2021. Methodology: Fifty eight patients were allocated into 2 groups (29 in each group) not considering age and sex. Both types of surgeries were analyzed on the basis of operating time, post-operative pain (VAS) and complications. Complications were noted i.e. wound infection, bile leakage from cystic duct/CBD injury, gut injury and per operative bleeding). Type of previous surgery was also noted. Data of conversion to open cholecystectomy from laparoscopic cholecystectomy was also recorded. Results: Mean age of patients in group A was 45.99±13.42 years while mean age of patients in group B was 41.87±14.65 years and p-value 0.105. 75.2% patients in group A were female while 82.1% patients in group B were female (p-value 0.185). Operative time in group A was 45.51±8.32 minutes while operative time in group B was 70.33±13.40 minutes (p-value 0.001). VAS score was 7.34±1.80 in group A while it was 5.24±1.93 in group B (p-value 0.001). 4 patients (13.79%) in group A developed wound infection while 1 patient (3.45%) from group B developed wound infection (p-value 0.005). Bile leakage and gut injury were not seen in any of the patient from both groups. Peroperative bleeding (more than 50ml) was seen in 2 patients of group A (6.90%) while it was seen in 8 patients of group B (27.59%) p-value 0.001. Type of previous surgeries were 24 cases were of mesh hernioplasty (41.38%), 16 cases of herniorrhaphy (27.59%), 10 laparotomies for peritonitis/intestinal obstruction (17.24%) and 8 cases of laparotomies for gynecological problems (13.79%). No case of laparoscopic cholecystectomy was converted to open cholecystectomy. Conclusion: Laparoscopic cholecystectomy is a safe and excellent option in patients of cholelithiasis having previous abdominal surgery. Even though LC takes more time due to adhesions but this issue does not out weights the benefits of laparoscopic cholecystectomy over open cholecystectomy. Keywords: Laparoscopic cholecystectomy, Cholelithiasis</jats:p

Comparison of Clinical Outcome of Laparoscopic with Open Repair Surgery for Duodenal Ulcer Perforation

Objective: To determine the clinical outcome of laparoscopic versus open repair of perforated peptic ulcer. Study Design: Comparative analytical study Place and Duration of Study: Department of Surgery Ward-2, Jinnah Postgraduate Medical Centre Karachi from 1st March 2021 to 28th February 2022. Methodology: Fifty patients with duodenal ulcer perforation were divided into two equal groups and open surgery or laparoscopic was performed after clinical examination. Boeys score, Mannheim Peritonitis Index preoperatively and VAS scoring as post-operative was done. Results: There were more males than females within both groups with a mean age of 51.3±16.5 years in group I and 55.7±14.9 years in group II. The perforation size of group I was greater as 16.3±6.4 mm than group II patients which were 15.9±5.7 mm. The post-operative complications showed a high frequency of respiratory cardiovascular and surgical site complications with greater mortality rate in Group II A major decrease in pain score was recorded in laparoscopic group such as group I in comparison with open repair such as group II. Conclusion: Shorter hospitalization and less post-operative pain was observed in laparoscopic repair for perforated peptic ulcer as compared to open-repair surgery. Keywords: Peptic ulcer, Laparoscopy, Advantages, Disease management</jats:p

Comparison of Laparoscopic and Open Appendectomy in Terms of Surgical Site Infection

Objective: To compare the laparoscopic and open appendectomy in terms of surgical site infection. Study Design: Retrospective study Place and Duration of Study: Department of Surgery Unit-2, Ghulam Muhammad Mahar Medical College Hospital Sukkur from 1st January 2019 to 31st December 2020. Methodology: One hundred patients who were further divided in two groups with 50 patients each were enrolled after clinical confirmation of appendicitis. Group A was operated through open surgery method while Group B was operated laparoscopically. The data regarding hospital stay, duration of surgery and surgical site infection through both techniques was compared and data analyzed. Results: The mean age of patients was 26.5±5.5 years males with a percentage of 76% where as only 24% of the study cases were females. Patients undergoing laparoscopy were having reduced prevalence of surgical site infection as 10% than who underwent open surgery. Among the 26.54% of reported co-morbidity cases as well, there were 65% those who has surgical site infection with open surgery protocol. Conclusion: Laparoscopic surgery technique is highly efficient in reducing surgical site infection in comparison to open surgery method. Keywords: Appendectomy, Open surgery, Laparoscopic, Surgical site infection</jats:p

Thyroid Gland Examination for Thyroid Nodule through Free Hand Fine Needle Aspiration Cytology (FNAC) Versus Ultrasound Guided Core Sampling

Objective: To compare the free hand fine needle aspiration cytology versus ultrasound guided core sampling for thyroid nodule examination in thyroid gland. Study Design: Retrospective study Place and Duration of Study: Department of Surgery Unit-2, Ghulam Muhammad Mahar Medical College Hospital Sukkur from 1st January 2016 to 31st December 2021. Methodology: One hundred patients were divided in two groups. Group A had 50 patients who undergo ultrasonography through Doppler scanning while Group B had equal number of 50 patients which underwent free hand fine needle aspiration cytology. The clinical details were noted and graded as un-satisfactory or lacking follicular cells or else having &lt;6 groups epithelial cells or having sufficient number of follicular cells. Results: The mean age was 31.5±11.8 years and majority of the patients were females 54% in comparison with 46% males. Insufficient cytopathologic cells were noticed in 18% US guided thyroidal nodule examination while similar insufficiency was seen in 44% fine needle aspiration cytology examination. The adequate cytopathological cells were noticed in 82% Ultrasounds while same was only seen in 56% fine needle aspiration cytology. Conclusion: Ultrasound guided core sampling has presented higher adequate cytology cases in comparison to free hand fine needle aspiration cytology cases. Key words: Fine needle aspiration cytology, Ultrasonography, Thyroid nodule</jats:p

Role of Metronidazole after Appendicectomy in Simple Cases of Acute Appendicitis

Background: Simple cases of acute appendicitis are usually dealt with appendicectomy and post-operative antibiotics. Causative organisms include both aerobes as well as anaerobes. The antibiotic spectrum to cover aerobes varies from hospital to hospital but the drug Metronidazole is used to cover anaerobes which is fairly common Aim: To determine the role of metronidazole after appendicectomy in simple cases of acute appendicitis Study design: Randomized, controlled, multicenter trial. Place and duration of study: Department of Surgery, Central Park Teaching Hospital Lahore, Noor Hospital, Kot Radha Kishan and Bilquees Hospital, Kasur from 1st January 2020 to 31st December 2021 Methodology: One hundred and thirty patients were included in the study divided into 2 groups (65 in each group). Inclusion criteria included all patients of simple acute appendicitis from age 13 to 70 years. Exclusion criteria were patients with complications of acute appendicitis. Patients receiving Metronidazole were allocated group A, while those not receiving this drug were allocated group B. Open appendicectomy was done in all cases. Variables of interest were post-operative wound infection, hospital stay and nausea/vomiting. Results: Mean age of patients of group A was 29.39±16.32 years while mean age of patients in group B was 34.18±18.05 years. 44.6% patients of group A were male and 55.4% were females. On the other hand 50.8% patients of group B were male and 49.2% were females. In group A, 6 patients got wound infection (9.2%) while 59 patients had uneventful recovery (90.8%). In group B, 4 patients got wound infection making it 6.2% while rest of the 61 patients had uneventful recovery (93.8%). The difference between the 2 groups was not statistically significant (p-value 0.11). Mean hospital stay in group A patients was 2.28±0.89 days while in group B it was 2.12±0.73 days. Conclusion: Metronidazole is an effective drug against anaerobes but in simple cases of non-perforated appendicitis this drug does not decreases the wound infection rate after appendicectomy. Keywords: Metronidazole, Appendicitis, Appendicectomy</jats:p

Gender based Differences in COVID-19 patients

Coronaviruses are a huge family of viruses that originate disease extending from the common cold tofurther fatal maladies. Objective: The study was conducted to determine the gender baseddifferences in COVID-19 patients. Methods: Study included total 150 participants visiting Departmentof Medicine, Mayo Hospital, Lahore, Pakistan. Data were collected through self-structured questionnaireusing non-probability convenient sampling. Prior written informed consents were taken from theparticipants. Ethical approval was taken from The University of Lahore, Lahore. Data were analyzedthrough SPSS version 25.0. Results: Results showed that among the comorbidities hypertension wasmost common in COVID-19 patients followed by diabetes mellitus, especially in females. Whereas renaldisorders and asthma were most reported in males. Analysis revealed that there was a significantassociation (p=0.001) between disease severity and gender. Conclusion: Study concluded that therewas significant association between gender and disease severity.Key words: COVID-19, gender based differences, comorbidities</jats:p