Outcome of Laproscopic Cholecystectomy in Acute Cholecystitis

Objective: To compare the outcome of early laparoscopic cholecystectomy in acute cholecytitis due to cholelithiasis as compared to interval cholecystectomy in terms of conversion rate, operative time and complications.Study design:  Descriptive studyPlace of study: Department of general surgery, Pakistan Atomic Energy Commission General Hospital, H-11/4 Islamabad.Duration of Study: January 2016 to June 2017.Methodology: Patients were divided into two groups. Group A had acute cholecystitis and were admitted through emergency room or surgical OPD and were operated in the same index admission on earliest possible list thus waiting time for surgery was one to four days approximately. While group B, had all elective cases, without any evidence of acute cholecystitis, mainly booked through OPD. All the patients included in both groups, were studied for initial diagnosis, duration of symptoms, duration of surgery, conversion to open cholecystectomy, per operative and post-operative complications and duration of hospital stay.Results: A total of 360 patients were operated in the hospital for cholelithiasis during the said period. Standard four ports were employed for the surgery. Group A (acute cholecystitis) had total 112 patients while group B (non-acute cholecystitis) had 248 patients. Of these 112 patients in group A, there were 77 males and 35 females.  In group B, there were 112 male and 248 female patients in group B. The mean operating time for group A was 64±13 min. whereas for group B the mean duration was 60± 12 min. The average amount of blood loss during surgery for group A was 45 ml ± 33 ml and for group B was 30ml + 20ml.Conclusion: Early laparoscopic Cholecystectomy, for acute cholecystitis is cost effective, has shorter total length of hospital stay and reduces the risk of repeat cholecystitis

Breast reconstruction at The Aga Khan University - a 10 year audit

Abstract Considering the high incidence of breast cancer and the subsequent need for a mastectomy, the number of patients having breastreconstruction remains relatively low the world over. Most studies from the west show that anywhere between 5% to around 50% of women proceed to reconstruction following a complete mastectomy. There is a great paucity of literature on the subject in Pakistan. Anecdotal and unofficial accounts would suggest that less than a fraction of 1% of women in Pakistan undergo reconstruction following a mastectomy.We reviewed our cases retrospectively over a 10 year study period from January 2005 to December 2014 with the objective to assess our results and to learn from them as well as to attempt to raise the profile of this important reconstructive manoeuver. Our numbers are low when compared internationally. However on a national level it would seem that the numbers currently exceed most institutions in the country. The overall results appear to be acceptable though the low numbers preclude definitive conclusions

Radial forearm free flap: A dynamic flap for single-staged multiple subunit reconstruction

We report the case of a middle aged patient with biopsy proven squamous cell carcinoma of buccal mucosa who presented to us in Aga Khan University Hospital Karachi in April, 2017 and required reconstruction of buccal mucosa, upper lip and lower lip. As per protocol of our institute the lesion was excised by the head and neck surgeon and the defect was reconstructed by our team. The defect was large comprising of buccal mucosa including the left oral commissure, upper lip and the lower lip. It was reconstructed via a free flap and a radial forearm free flap. A specially designed radial forearm free flap was harvested and used for reconstruction which resulted in a good aesthetic and functional outcome

Dissection and Dynamics of the Salary: The Case of Bangladeshi Private Tutors

The demand side of private supplementary tutoring has been and is being researched rigorously while the supply side of this globally spreading phenomenon is remaining unobserved comparatively. This paper attempts to unveil the factors lying behind the determination of wage or salary of the tutors agreed to be given by the households. A set of university students who provide private tuition were surveyed. The findings reveal that the type of institution of the tutees makes an immense influence on the salary of the tutors. If the tutees are students of such academic institutions where the medium of instruction is English, giving tuition to them in private, tutors are more likely to get a salary above the market average rate of that. Transportation cost is the other feature contributing to the increased likelihood of getting the above-average salary. Academic background of the tutors, devoted hours to tuition and the minimum level of expected salary have no vital control over manipulating the salary of the tutors. This paper, in another way, establishes the fact that affluent households spend more money on private tutoring than their counterparts. Keywords: Private Supplementary Tutoring, Shadow Education, Salary, English Medium, Private Tutor

Clinical Outcome of Cortical Venous Thrombosis in Stroke Patients at a Tertiary Care Hospital of Southern Punjab

Objective:  This study was determined to find out the clinical Outcome of Cortical Venous Thrombosis (CVT) in Stroke patients at a Tertiary Care Hospital of Southern Punjab. Material & Methods:  A total of 100 patients with cortical venous thrombosis were included in this descriptive case series study, which was conducted at Department of Neurology, Nishtar Hospital Multan. Outcome of patients in terms of partial recovery or complete recovery, any recurrence, any complication, indication for Surgery and any disability in terms of focal deficit, prolonged hospital stay and Mortality was followed. Results:  Our study included a total of 100 patients with cortical venous thrombosis (CVT), 35 (35%) were male and 65 (65%) were female patients with their mean age was 37.69 ± 16.52 years, ranging from 20 – 83 years (51.37 ± 17.44 in males versus 30.32 ± 10.15 years for females). Headache was noted in 80%, focal deficit in 57%, nerve palsy in 30%, coma in 22% and disability was noted in 35%. Partial recovery was noted in 65%, whereas complete recovery was noted in 35% while, complications were noted in 12 (12%) of these patients with CVT. Conclusion:  Cortical venous thrombosis was more prevalent in females in their younger age groups and it was associated with poor prognosis as high frequency of partial recovery was noted in our study. Keywords:  Cortical venous thrombosis, Stroke, headache, recovery, outcome

The use of folic acid in dengue: Has it any value?

Folic acid is used in dengue patients. Our study aims to compare the duration of recovery of thrombocytopenia in patients with dengue infection who received folic acid and those who did not. We retrospectively reviewed the medical records of adult patients admitted over six years with a diagnosis of dengue. Of 2216 patients, 1464 fulfilled the inclusion criteria. Group A were those patients who received folic acid and group B were those who did not. A total of 1322 (90.3%) patients received folic acid. The mean time period required for platelets to double the nadir was 1.7 (±2.2) days in both groups A and B ( P = 0.89). In conclusion, there is no significant difference in the recovery of thrombocytopenia in patients with dengue fever who received folic and those who did not receive folic acid

Comparison of Bupivacaine and Dexmedetomidine versus Bupivacaine Alone in Transversus Abdominis Plane Block for Post-Operative Analgesia

Objective: To study the effects of adding dexmedetomidine to bupivacaine in transverses abdominis plane block in comparison with using bupivacaine alone. Materials and Methods: This was a prospective comparative study that was conducted in the Anaesthesia Department, CMH, Lahore over a period of six months from 1st June 2020 to 30th November 2020. Fifty patients of the American Society of Anesthesiologist Class I and II with an age range between 40 to 60 years were divided into two groups. Group B received 20ml of 0.25% bupivacaine with 2ml of normal saline on each side in the transversus abdominis plane block while group BD was given 20ml of 0.25% bupivacaine with dexmedetomidine 0.5mcg/kg on each side (in a volume of 2ml). Post-operative pain was assessed with a visual analogue scale. Rescue analgesia was given when a score of greater than 3 was observed using this scale. Time to first rescue analgesia was noted. Total opioid consumption in the first 24 hours was also recorded. Patients were observed for postoperative hypotension and bradycardia.Results: The mean-time for the first dose of analgesia for group B and BD was 302.92 ± 24.01 and 419.28 ± 31.97 minutes respectively with a p-value of 0.001. The mean of the total consumption of opioids in 24 hours post-operatively for group B and BD was 14.20±2.36 and 10.40±1.38 mg respectively with a p-value of 0.001. Hypotension was not seen in any patient in either group. Only one patient developed bradycardia and he belonged to group BD. P-value was 0.327.Conclusion: The addition of dexmedetomidine to bupivacaine for transversus abdominis plane block for postoperative analgesia significantly prolongs the duration of analgesia and reduces the postoperative opioid requirements

Quality of Life in Patients with Stoma

Objective: To determine the quality of life of patients with stoma at tertiary care Hospital. Methodology: This prospective study has been conducted at the general surgery department, Pakistan Institute of Medical Sciences hospital Islamabad (PIMS). The study was conducted from September 2019 to February 2020. All the patients having age more than 12 years, underwent intestinal stoma formation and either gender were included for study. Patients were interviewed regarding their routine activities after stoma and the impact of it on their social life including working status, sexual activities and life satisfaction. All the information of patients including demographic data was documented via self-derived proforma. Analysis of data was done by SPSS version 20. Results: Total 46 patients were studied having a stoma and were interviewed regarding their quality of life. The patient's mean age was 44.93+6.78 years. Out of all 34.8% were working currently and rest of the patients were still on bed rest.  34.8% were satisfied with sexual life. 71.7% were depressed after stoma surgery and 52.2% were hopeful about their future. 63% were socialised with peoples as before, 58.7% replied that stoma has affected their recreational activities and 52.2% answered that they can’t travel in any way. However according to overall satisfaction, 32.6% of patients were disagreeing, 34.8% were agreeing and 30.4% were undecided. Conclusion: It was concluded that almost half of the patients were satisfied and they are performing social and daily life activities however almost half of the patients needed psychological, financial, and relative support. Key words: Stoma, Quality of lif

Versatility of the anterolateral thigh flap : an AKUH experience.

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-site morbidity. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised date from October 2012 to December 2015. Of the 75 patients in which anterolateral thigh flap was used for reconstruction, 6(8%) flaps did not survive. The overall flap survival was 69(92%). Anterolateral thigh flap was versatile enough to provide soft tissue coverage to defects of various soft tissue and bulk requirements. Adequate outcomes were achieved pertaining to the reconstruction of the soft tissue defects. Anterolateral thigh flap can be used to reconstruct soft tissue defects almost anywhere and almost of any complexity