Efficacy of tube Cecostomy in preventing post appendectomy fistula

Objective: This study was conducted to determine role of tube cecostomy in preventing fecal fistula formation after appendectomy in the patients with appendicular mass or abscess.Study design and Duration: It is a descriptive case series study. Study was started in July 2017 and it was completed in December 2017 comprising on 6 months duration.Setting: This study was conducted in surgical unit of Bahawal Victoria Hospital Bahawalpur, Pakistan.Patients and Methods: In this study 34 cases were included having appendicular mass or appendicular abscess. These cases were admitted in the ward via emergency department. Initially detailed history was taken and thorough examination was done. All necessary investigations were carried out to confirm the diagnosis. An inclusion criterion was formed on which basis only those cases were included in this study which presented with appendicular abscess or phlegmon formation. After investigations, which cases had other diagnosis, they were excluded from the study. All data of the patients in study group was documented properly. After taking anesthesia fitness these cases were operated and tube cecostomy was performed after appendectomy. These cases were retained in the ward for 4-6 days. Monitoring was done. Findings per operating were noted down. Complications during operation or after it were observed. Which cases developed any complication they were retained for more time and other cases were discharged on good antibiotics and they were called on follow-up after 10 days. Proper consent was taken from the patients for including their data in the study. Consent was also taken from the in charge of ward for conducting this study. Data was analyzed on Microsoft office and SPSS version 2017 and results were calculated in the form of frequencies and expressed in tables and graphs.      Results: Total 34 cases were studied. Ages of these cases was ranging from 15-50 years with mean age of 27.5 years. Minimum age of the patient was 15 years and maximum age reported was 46 years. Most of the cases were between 20-30 years age. During operation findings were gangrenous appendix in 14 cases, perforated appendix with abscess formation in 12 cases and in 8 cases there was perforated appendix without abscess formation which presented relatively earlier. Complications after tube cecostomy included leakage from pericatheter in 3 cases, early dislodgement of catheter occurred in one case and retained catheter in 2 cases. After removal of catheter fistula formation was not seen in any patient that indicated this method prevents fecal fistula formation and it is much safe method with less morbidity and early recovery. Post operative complications were seen in 6 cases and in rest of 28 cases no complications occurred. There were both male and female patients In this study accounting 22 males and 12 females.     Conclusion: After appendectomy for appendicular abscess or appendicular mass fecal fistula formation is much common, this can be prevented by tube cecostomy. It is a very effective procedure and simple to perform with good outcom

Treatment and outcomes of soft tissue sarcoma of groin, hip and thigh: A retrospective review from a tertiary care hospital

Objective: To study the frequency of the thigh, hip and groin soft tissue sarcomas and retrospectively analyse the management, treatment results, and outcomes of these uncommon malignant tumours, in a tertiary care hospital of the city of Karachi.Methodology: Data of soft tissue tumours registered from 2017-2018 was retrieved during January 2019 to March 2019 from Aga Khan University Hospital, Karachi bone and soft tissue tumour registry. A retrospective review was performed and all soft tissue tumour cases treated with surgical intervention (with adjuvant /neoadjuvant therapy) or palliative intention were included.Results: Total 119 cases of soft tissue tumours (STS) were identified out of which 85 were malignant cases (sarcomas) while 30 were benign. On presentation 84 (70.6%) were primary cases. On topographical distribution, there were 25 patients who had hip, groin and thigh sarcoma. Of these, 15 were males and 10 were females. As treatment, neo-adjuvant radiation was done in 4 (16%) patients and adjuvant chemo/radio therapy was given to 13 (52%) patients. Wide margin excision was performed in 19 (76%) patients and 4 (16%) had amputation. Reconstruction was offered to 3 (12%) patients. In post-surgical complications, 1 (4%) patient had wound infection. On final surgical histopathology, majority of the sarcomas were liposarcomas, myxofibrosarcoma, synovial sarcoma and Leiomyosarcoma. Post-surgery recurrence occurred in 7 (28%) patients. Overall survival was 76%.Conclusions: In treatment of soft tissue sarcoma, limb salvage is an achievable option and survival results are also good

Surgical education and training during the COVID-19 pandemic: Strategies and solutions for Pakistan

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during the pandemic. Hospitals\u27 implementation of shift schedules for rotations helps continue training while minimising risks. Moreover, examination boards and residency programmes must appropriately tailor their eligibility criteria and assessment processes to the current situation. Lastly, it is vital to safeguard trainees\u27 mental wellness during the pandemic and after by ensuring readily available professional psychological support when needed

The environment under the knife: A review of current eco-surgical strategies and recommendations for Pakistan

The healthcare sector at its core is based on the fundamentals belief to do no harm and bring about betterment in the lives of the people. Paradoxically, hospitals are one of the leading contributors to pollution, greenhouse gas (GHG) emissions and toxic waste material worldwide. Surgical care delivery is quite resource intensive, consuming significant amount of energy and equipment as well as producing large quantities of waste. With climate change being a global priority, it is crucial that hospitals re-evaluate the environmental impact of such practices. The current review was planned to identify areas of improvement in surgical care in terms of sustainability, as well as describe efficient and innovative strategies for hospitals in Pakistan to lessen their impact on the environment. The implementation of the 5 R\u27s strategy for surgical care (Reduce, Reuse, Recycle, Rethink and Research) as well as general measures to improve energy efficiency, waste management and inter-sectoral collaboration will provide significant benefits to the environment and advance efforts to creating a more sustainable future for surgical healthcare in Pakistan

Assessment of factors affecting quality of life in oral squamous cell carcinoma patients using university of washington quality of life questionnaire

Introduction Post-treatment Quality of Life (QOL) is considered an important outcome in cancer patients. A number of questionnaire tools have been designed for its assessment. University of Washington Quality of Life (UW QOL) questionnaire version four is a reliable tool for assessment of post-treatment QOL in oral squamous cell carcinoma (OSCC) patients. Our aim was to identify the post-treatment problems faced by OSCC patients and to assess the impact of clinical factors affecting post-treatment QOL by using UW QOL (version four) questionnaire. Methods The study was conducted on 59 patients with OSCC who were treated with curative intent at Patel Hospital, Karachi from August 2015 to September 2015. Patients were asked to fill the UW QOL questionnaire (version four) on their follow-up visit. Results Overall mean composite QOL score was 66.59 ± 16.98. Chewing and saliva (dryness of mouth) had the lowest scores (38.98 ± 37.2 and 56.78 ± 41.4, respectively) among all domains while pain and anxiety had the highest scores (80.93 ± 20.4 and 79.66 ± 29.8, respectively). Patients having tumors of the tongue, late stage (III and IV) tumors, and restricted mouth opening had significantly lower mean composite QOL scores. Patients with tongue tumors revealed significantly lower scores for pain, swallowing, mood, and anxiety. Patients with late-stage tumors showed significantly lower scores for chewing, swallowing, taste, saliva, appearance, anxiety, and recreation. Patients with restricted mouth opening had significantly lower scores for pain, speech, appearance, recreation, and anxiety domains. Conclusion Different clinical features have different impacts on QOL in terms of problems faced by the patients. Features having a significant effect should be identified, and measures focused on most relevant problems should be employed in order to improve the post-treatment QOL

Plagiarism in non-anglophone countries: A cross-sectional survey of researchers and journal editors

Background: Plagiarism is one of the most common violation of publication ethics, and it still remains an area with several misconceptions and uncertainties.Methods: This online cross-sectional survey was conducted to analyze plagiarism perceptions among researchers and journal editors, particularly from non-Anglophone countries.Results: Among 211 respondents (mean age 40 years; M:F, 0.85:1), 26 were scholarly journal editors and 70 were reviewers with a large representation from India (50, 24%), Turkey (28, 13%), Kazakhstan (25, 12%) and Ukraine (24, 11%). Rigid and outdated pre- and post-graduate education was considered as the origin of plagiarism by 63% of respondents. Paraphragiarism was the most commonly encountered type of plagiarism (145, 69%). Students (150, 71%), non-Anglophone researchers with poor English writing skills (117, 55%), and agents of commercial editing agencies (126, 60%) were thought to be prone to plagiarize. There was a significant disagreement on the legitimacy of text copying in scholarly articles, permitted plagiarism limit, and plagiarized text in methods section. More than half (165, 78%) recommended specifically designed courses for plagiarism detection and prevention, and 94.7% (200) thought that social media platforms may be deployed to educate and notify about plagiarism.Conclusion: Great variation exists in the understanding of plagiarism, potentially contributing to unethical publications and even retractions. Bridging the knowledge gap by arranging topical education and widely employing advanced anti-plagiarism software address this unmet need

Antecedents and Consequences of Student Loyalty in Higher Education

In the intense competition and financial uncertainty for higher educational institutions, student loyalty is an imperative and most essential factor for their ultimate survival and success. Student loyalty is a crucial measure for the success of institutions that are offering higher education with the sole aim of retaining students until their all educational necessities are met. The motivation of this research paper was lack of literature evidence when the antecedents and the consequences of student loyalty are being scrutinized, all on one single platform. Therefore, through this research paper, an attempt has been made to examine the causing roots that provoke loyalty in a student and to what extent it can be prolonged and at what point student loyalty is achieved completely. This study examined the existence of student loyalty derived from antecedents (perceived value, trust, corporate and brand image, student satisfaction and service quality) and consequences (word of mouth, retention, recommendation and commitment) in the context of higher education in Pakistan. A total of six business schools were selected, the data was collected using survey method. Several recommendations are made to the management of the higher educational institutions to ensure student loyalty among their students