Cytopenias With Traditional Therapy of Hepatitis C in Pakistani Population

Objective: To find out the frequency of blood cytopenias among the relapsers, non-responders and responders to traditional therapy of Hepatitis C in a tertiary care hospital of Rawalpindi, Pakistan.Study Design:Cross sectional descriptive study.Place and Duration of Study: Hematology and Gastroenterology departments of Military Hospital, Rawalpindi, for a period of one year, from August 2014 to July 2015.Methodology:After six months of treatment with conventional interferons and ribavirin 5mL blood was obtained in EDTA bottles from responders, relapsers and non-responders in laboratory, and was analyzed using Hematology Analyzer sysmex KX-21. The hemoglobin levels, total leukocyte counts and platelet counts were measured. The results were entered into SPSS 16 and the analysis for descriptive statistics was applied for finding out the frequencies.Results: A total of 380 patients were studied, out of which 204 were non-responders, 52 were responders and 121 were relapsers. Ninety eight patients [25.9%] had anemia, 12 [3.2%] had leukopenia and 48 [12.7%] had thrombocytopenia. Among non-responders, 56 [27.5%] had anemia, 7 [3.4%] had leukopoenia and 31 [15.2%] had thrombocytopenia. Among responders, 16 [30.8%] had anemia, 2 [3.8%] had leukopoenia and 4 [7.7%] had thrombocytopenia. Among relapsers, 26 [21.5%] had anemia, 3[2.5%] had leukopoenia and 13 [10.7%] had thrombocytopenia.Conclusions:Anemia is most common among relapsers, non-responders and responders, while leukopenia is least commonly seen.  Thrombocytopoenia occurs more commonly among non-responders and least commonly among responders

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Cytopenias With Traditional Therapy of Hepatitis C in Pakistani Population

Objective:&nbsp;To find out the frequency of blood cytopenias among the relapsers, non-responders and responders to traditional therapy of Hepatitis C in a tertiary care hospital of Rawalpindi, Pakistan.Study Design:Cross sectional descriptive study.Place and Duration of Study:&nbsp;Hematology and Gastroenterology departments of Military Hospital, Rawalpindi, for a period of one year, from August 2014 to July 2015.Methodology:After six months of treatment with conventional interferons and ribavirin 5mL blood was obtained in EDTA bottles from responders, relapsers and non-responders in laboratory, and was analyzed using Hematology Analyzer sysmex KX-21. The hemoglobin levels, total leukocyte counts and platelet counts were measured. The results were entered into SPSS 16 and the analysis for descriptive statistics was applied for finding out the frequencies.Results:&nbsp;A total of 380 patients were studied, out of which 204 were non-responders, 52 were responders and 121 were relapsers. Ninety eight patients [25.9%] had anemia, 12 [3.2%] had leukopenia and 48 [12.7%] had thrombocytopenia. Among non-responders, 56 [27.5%] had anemia, 7 [3.4%] had leukopoenia and 31 [15.2%] had thrombocytopenia. Among responders, 16 [30.8%] had anemia, 2 [3.8%] had leukopoenia and 4 [7.7%] had thrombocytopenia. Among relapsers, 26 [21.5%] had anemia, 3[2.5%] had leukopoenia and 13 [10.7%] had thrombocytopenia.Conclusions:Anemia is most common among relapsers, non-responders and responders, while leukopenia is least commonly seen.&nbsp; Thrombocytopoenia occurs more commonly among non-responders and least commonly among responders

Postoperative Complications in Carcinoma Gall Bladder: A Tertiary Care Hospital Experience

Introduction: Gallbladder cancer is more common than any other part of the biliary system. Accounting between 2% and 3% of all cholecystectomies. Aims &Objectives: To analyze different postoperative complications in various stages of operated gall bladder carcinoma. Place and duration of study: Army Liver Transplant Unit (A.L.T.U.) Pak Emirates Military Hospital Rawalpindi (P.E.M.H.), from November 2020 to April 2022. Material & Methods: This cross-sectional descriptive study looked at all patients diagnosed with gallbladder cancer before surgery or who were subsequently found to have benign gallbladder cancer presenting with intra-luminal lesions and localized or diffuse wall thickening amenable to surgical treatment. A sequential sampling method was used to select the patients. A proforma was developed to streamline the data collection process. The patient's gallbladder cancer was staged using the A.J.C.C.'s Eighth Edition staging system, and the degree of complications was classified using the Clavien-Dindo system. Data was entered and analysed using SPSS version 23. Results: A total of 27 patients were included in the study, with male to female ratio of 1:3; and a mean age of 50.1 ± 4.7 years (range 25-70 years). Six patients were in Stage-1 of whom only 1 (3.7%) developed grade – I complication; 9 patients were in Stage-2, out of which 2 (7.4%) developed grade – II complications; 6 patients were in Stage-3, out of which 2 (7.4%) patients developed grade – III and 1 (4.7%) patient developed grade-II postoperative complications. Six (22.2%) were in Stage-4 and underwent curative resection, where no patient developed postoperative complications. Conclusion: Surgery remains a solitary curative option for gall bladder carcinoma, and when patients are selected carefully, postoperative complications after radical surgery are not very high. Moreover, as the stage of the disease increases, so does the complication grade

Parents’ behaviour toward antibiotic self-medication in children and incidence of resistance: a cross-sectional study from Punjab, Pakistan

Background. Antibiotic resistance is mostly brought about through antibiotic self-medication, which is a common issue in impoverished countries. The most at-risk group is children, while there is no protection evidence released for them. Due to a lack of proper knowledge, parents often inappropriately administer antibiotics to their children. Objectives. The current study aims to evaluate the parents’ knowledge of antibiotic use and their knowledge of the medical conditions for which self-medication is used. Material and methods. A cross-sectional descriptive study was carried out in parents. Parents’ direct interviews and self-administered questionnaires were used to gather the data. Descriptive analysis and chi-square tests were performed to determine the significance of these findings using IBM SPSS Statistics version 22. Results. There were 1,034 individuals who self-medicated their children in total. Male participants outnumbered female participants by a small margin. In the past 12 months, 88.6% of parents gave antibiotics to their children. Pharmacy advice and past prescriptions were the main causes of this behaviour, whilst cough, fever and tooth discomfort were the conditions for which antibiotics were prescribed. Throughout the course, 45.5% of patients changed antibiotics on their own. Conclusions. The findings of this study underscore the urgent need to address the issue of self-medication of antibiotics in children, emphasising the potential harm it can cause. Parents often resort to self-medication without a proper understanding of the underlying causes of their children’s illnesses, relying on antibiotics as a panacea. To mitigate this practice and protect the well-being of children, it is imperative to implement a multifaceted approach involving regulatory measures and educational initiatives beyond the scope of pharmacist interventions

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially