Role of Occiput Spinal Angle-A Novel Sonographic Index to predict the outcome of labour

Introduction: The attitude (relationship of head of a fetus to the cervical spine) in the first stage of labour has a significant impact on the outcome of labour. Deflexion of the fetal head is determined by digital vaginal examination during labour. However, different ultra-sonographic indexes have been developed to predict labour outcomes. Occiput spine angle (OSA) is a novel ultra-sonographic marker which can be used to predict operative delivery. Objective: To determine the effect of the occipital spinal angle measured through transabdominal ultrasound during the first stage of labour on the labour outcome. Materials and Methods: This prospective cross-sectional study was carried out at Department of Obstetrics and Gynecology Unit 2, Holy Family Hospital, Rawalpindi from June 2020 to Dec 2020 which included 380 low-risk pregnant women in the first active stage of labour. Occipital-spine angle (OSA) was defined as the angle formed by the fetal occiput and the cervical spine on the sagittal plane at the transabdominal ultrasound. For each case, the angle was calculated twice and independently by the 2 radiologists who were unaware of labour outcome to minimize intra and inter-observer error. Data were analyzed using SPSS version 23.0. P-value ≤ 0.05 was considered significant. Results: Incidence of operative delivery was 17.2%. A cut-off value of 1260125.50 of OSA had a sensitivity of 92.3% and specificity of 98.1% to predict operative delivery. Binary Logistic Regression showed that gestational age, OSA, and Head station are significant with the OR= 1.15, 0.711, and 0.32 respectively. Conclusion: OSA is a good predictor of operative delivery at a cut-off value of 1260. It should be determined at routine ultrasound booking during pregnancy. More studies should be conducted to highlight its importance. &nbsp

Residents’ Perception Of Surgical Theatre Educational Environment At Public Hospitals Of Rawalpindi - A Steem Survey

INTRODUCTION: The experience in the operation theatres is pivotal for surgical education. A measure of the educational environment in the operating room as perceived by residents would assist educators and trainees in gauging the quality of the learning occurring within their institute.     METHODS:  A cross-sectional survey using the surgical theatre educational environment measure (STEEM) 40-item inventory to measure theatre learning environment perception of surgery and allied residents in public sector hospitals of Rawalpindi. Internal reliability of the inventory was assessed using the Cronbach α coefficient. P≤ 0.05 was considered significant.   RESULTS:  107 respondents were included in the study. Mean score of the survey was 133.7± 20.2. No significant differences in perception were found among residents at different stages and gender, except in learning subscale of the inventory for both gender and residents and the teaching and training subscale among residents at different levels. The inventory showed a high internal consistency with a Cronbach α of 0.851.   CONCLUSION: Surgical training and education have still a long way to go in the public sector. Much needed collaborations with education specialist and senior surgeons is required. Interval collection of feedback and perceptions of the educational environment is also necessary

Spectrum of Breast Diseases in a Breast Clinic of a Tertiary Care Hospital

Background: To determine the pattern and clinical presentation of breast diseases in different age groups presenting to a breast clinic. Methods: It was a retrospective descriptive study which included all patients presenting to a breast clinic for three years. Age at presentation, symptoms, clinical features, investigations, operative findings and specimen reports were recorded and submitted for analysis. . Results: A total of 3568 patients were included. Mastalgia was the commonest findings (39.42%) followed by fibroadenoma(15.83%) and carcinoma of breast (12.61%). Pain in the breast was the commonest presenting symptom (40.38%). Lump in the breast was found in 22.84%, while pain and lump were present in 27.27% of patients. Among carcinoma breast, intra ductal carcinoma was the commonest (57.55%) followed by malignant phyllodes tumour (17.77%). Conclusion: Most common breast diseases presenting in our setting are mastalgia, fibroadenoma and breast carcinoma. Dedicated breast clinic in our public sector hospitals is need of time. It will help to create awareness about breast diseases among general public and will be a source to collect data about disease burden so that future policies can be streamline

Comparison of chest HRCT severity score in PCR positive and PCR negative clinically suspected COVID-19 Patients

Background: The limitations and false-negative results of Real-time Polymerase chain reaction (RT PCR) in diagnosing COVID-19 infection demand the need for imaging modalities such as chest HRCT to improve the diagnostic accuracy andassess the severity of the infection. Objectives: The study aimed to compare the chest HRCT severity scores in RT-PCR positive and negative cases of COVID-19. Methods: This cross-sectional study included 50 clinically suspected COVID-19 patients. Chest HRCT and PCR testing of all 50 patients were done and the chest HRCT severity scores for each lung and bronchopulmonary segments were compared in patients with positive and negative PCR results. Chi-square and Mann Whitney U test were used to assess differences among study variables. Results: Chest HRCT severity score was more in PCR negative patients than in those with PCR positive results . However, the difference was not significant (p=0.11). There was a significant association in severity scores of the anterior basal segment of the left lung (p=0.022) and posterior segment upper lobe of right lung (p=0.035) with PCR results. This association was insignificantfor other bronchopulmonary segments (p>0.05). Conclusion: CR negativity does not rule out infection in clinically suspected COVID-19 patients. The use of chest HRCT helps to determine the extent of lung damage in clinically suspected patients irrespective of PCR results. Guidelines that consider clinical symptoms, chest HRCT severity score and PCR results for a confirmed diagnosis of COVID-19 in suspected patientsare needed. Keywords: Chest High resolution computed tomography (HRCT); COVID-19; Polymerase Chain Reaction (PCR)

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparison of Wound Infection after Reversal of Loop Ileostomy in Linear versus Purse-String Skin Closure of Stoma Site

Introduction: Loop Ileostomy is a surgical procedure which is done to divert intestinal contents away from distal bowel to allow healing of the distal anastomosis and also for the relieve of obstruction in emergency situations. Reversal is done through local stoma site via linear closure technique as the standard procedure. Surgical site infection is the most commonly occurring & morbid complications of this technique and it can be reduced if closure is done by Purse string method.  The aim of this study was to determine the more effective method of the two in terms of post-op surgical site infection. Material & Methods: This Randomized Controlled Trial was conducted for six-month duration in Benazir Bhutto Hospital, Rawalpindi. Reversal patients presenting in outdoor-department were included and allocated randomly into either Purse-String closure group or linear skin closure group. Follow-up was done for thirty days and wound infection was identified by presence of purulent discharge from incision site. Organisms were isolated from fluid culture or tissue culture from the wound or abscess. Results: We included a total of 90 patients in this study. 45 patients were randomly alloted to each group. The two groups were matched for various entry parameters. Wound infection was observed among 27(60%) in the linear closure group whereas 12(26.7%) in the purse-string group developed wound infection. This difference was statistically significant. Conclusion: Given the low rate of associated wound infection, purse string closure of stoma reversal is recommended to be the preferred procedure for ileostomy reversal. Key words: Loop Ileostomy, Linear closure, Purse string closure, Wound infectio