Positivity of Lumbar Puncture for Acute Bacterial Meningitis among Children Presenting with First Febrile Seizure

OBJECTIVES: To determine the frequency of lumber puncture-proven acute bacterial meningitis among children with fever and seizures of first onset.METHODOLOGY From March 2020 to March 2021, a hospital-based descriptive cross-sectional study was conducted at the paediatrics department of Hayatabad Medical Complex Peshawar. The sample size for a total of 342 people was estimated using WHO software. The study included all children who had first-onset febrile seizures through OPD and the emergency department. All children underwent lumber punctures using a stringent aseptic procedure, and the hospital laboratory received the samples to look for bacterial meningitis. On a pre-made Proforma, details including name, age, and gender were entered. The gathered data were input into the computer for additional SPSS analysis (version 23).RESULTS Most individuals were male and were lies in the 21-40 months of age group. Mean weight and length/height were evaluated, respectively. The majority had a history of 6-10 days of disease duration. Bacterial meningitis was found significantly (p<0.05) associated with age, gender and neurological deficit, while non-significantly (p>0.05) associated with the duration of diseases.CONCLUSION All children between the ages of 6 months and 60 months who presented with episodes of fever and seizures were found to have a statistically significant (p<0.05) association found among bacterial meningitis and age groups

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Pattern of Pelvic Malignancies

Background: To determine the frequency of various gynaecological malignancies and to describe the age distribution, stage and clinical presentation of various gynaecological malignancies.Methods: In this descriptive study all patients with Gynecological malignancies were included in the study irrespective of the age and stage of the diseases.Patients with breast cancer associated with Pelvic Cancer were excluded from the study.Clinical data was collected from the patients by taking history and performing relevant examination and filling up the attached questionnaire/ performa.Results: There were 15 cases with ovarian cancer, nine of cervical cancer, three cases of endometrial cancer, two cases of vulvar cancer and one case of chorio carcinoma. Age of the patients with cervical cancer ranged from 45-67 years. Endometrial cancer presented at mean age of 56 years. In ovarian cancer age of patients ranged from 24-63 years. The mean age of patients with vulvar cancer was 72.5 years. The age of the patient with choriocarcinoma was 32 years. Weight loss, vaginal bleeding and discharge, menstrual irregularities, post menopausal bleeding were common clinical manifestations . Most of the patients, in all types, presented in late stages.Conclusion: Patients with gynecological malignancies have good prognosis, if cancer is detected at an early stage. Therefore efforts should be made to encourage women to seek medical advice at first abnormal symptom

The Correlation of Sexual Dysfunctions with Chronic Pelvic Pain

Background: To describe the correlation of sexual problems in patients presenting with chronic pelvic painMethods: In this descriptive study, female patients (n=100) sufferer of chronic pelvic pain were included . Their sexual behaviour was assessed by using the questionnaire of Derogatis Interview for Sexual Functioning- Self Report (DISF-SR). This questionnaire contains 5 items which were given scores. A total score was then calculatedResults: Patients presenting with chronic pelvic pain having sexual dysfunction were 71% compared with 29% who were sufferer of chronic pelvic pain but without sexual problems. Mean age, BMI and socioeconomic status (monthly family income) was 33. Mean total sexual functioning score of our study sample was 38.28 ± 3.54 while mean and standard deviation for sexual disorders were 9.04± 1.55, 7.12 ± 1.28, 11.23 ± 1.69 and 11.20 ± 1.89 for sexual arousal, behaviour, orgasm and sexual drive respectively.Conclusion: Patients with chronic pelvic pain have some degree of sexual dysfunction and they may suffer from various sexual disorders which need to be assessed so that measures should be undertaken to help these patients to cope with pain and sexual disorders and so they can live a healthy life

Frequency of Modic Changes in Degenerative Disc Disease on Magnetic Resonance Imaging of Lumbar Spine

Background: To determine the frequency and distribution of endplate marrow signal intensity changes in patients with low back pain and to analyze their association with age and gender.Methods: In this cross sectional study patients of ages 27-75 years, who came for MRI of lumbar spine with low back pain or sciatica, were included. The patients with age <25 years and >70 years with history of back surgery, trauma and malignancy were excluded. Imaging was performed on a 1.5 Tesla power magnetic resonance imaging machine. The imaging protocol included T1-weighted and T2 weighted, fast spin echo (FSE) sagittal and axial images. The intervertebral discs were graded as normal, Grade 1, Grade 2, Grade 3 and endplate bone marrow (Modic) changes were classified in three types according to the definitions of Modic et al. Findings were localized by disc segment (L1—L2, L2—L3, L3—L4, L4—L5, and L5— S1) and whether they were in the superior or inferior endplate. Frequencies and percentage was presented for categorical variables like gender, type of Modic change, vertebral level and intervertebral disc degeneration.Results: Out of 177 patients 49.15% lumbar spine showed positive modic changes while in 50.85% changes were absent. Majority of the patients were between 31-40 years of age. Out of these 61.58% were male and 38.42% were female.Conclusion: Modic changes are found frequently on MRI of spine in patients with degenerative changes and are associated with history of back ache. It gives useful information regarding the severity of degenerative disk disease

Comparison of Hydrocolloid Dressings (Duoderm) with Povidone -Iodine Dressings in Diabetic Foot Ulcer.

Background : To compare effects of hydrocolloid dressings with povidone-iodine dressings in debrided diabetic foot regarding fast wound healing and reducing amputation.Methods: In this descriptive study patients with diabetic foot were enrolled. In-group A dressings was done with hydrocolloid while in-group B dressing was done with povidone –iodine. Wounds were assessed for depth ischemia classification. Vasculopathy, neuropathy and osteomyelitis were assessed. Parenteral antibiotics based on culture sensitivity were given. Insulin was used according to sliding scale. Split Thickness skin grafting was performed for all wounds > 5 cm if the wounds were found to be clean .Wounds < 5 cm in diameter were allowed to epithelize and heal without Split thickness skin graft. The total healing period was measured by the number of days from the date of initial debridement to the date of the Split thickness skin grafting or complete epithelization.Results: Mean number of days of healing by complete epithelization for group A (n= 70/140) were 40.87 ± 14 . days and mean number of days of healing by complete epithelization for group B patients were 47.16 ± 17.52 days (p- value < 0.05; significant).Conclusion: Hydrocolloid (duoderm) is a more effective and safe treatment in promoting wound healing in diabetic foot ulcer

Correlation between total leukocyte count (TLC) and c-reactive protein (CRP) in paediatric bronchiolitis patients

Objective: The primary objective of this study was to investigate the correlation between Total Leukocyte Count (TLC) and C-Reactive Protein (CRP) levels in paediatric bronchiolitis patients to assess the prognostic significance of these markers in disease severity and patient outcomes. Study Design: A retrospective correlational study was conducted using patient records from a six-month period to analyze the relationship between TLC and CRP levels in paediatric bronchiolitis patients. Study Setting: The study was conducted at different centres including Department of Paediatrics, Social Security MNCH Hospital, Dera Ghazi Khan, Punjab and Sahara Medical College Narowal, Punjab in the period from August, 2022 to January, 2023. Methods: Data of paediatric patients aged 1 month to 2 years diagnosed with bronchiolitis was extracted from electronic medical records. The study included patients with complete data on TLC and CRP levels. Pearson's correlation coefficient was used to determine the association between TLC and CRP levels, while logistic regression analysis was performed to identify potential predictors of disease severity. Results: The study found a significant positive correlation between TLC and CRP levels in paediatric bronchiolitis patients (p<0.05). Higher TLC and CRP levels were associated with increased disease severity and longer hospital stay.&nbsp

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice