Spectrum of surgical site infection on the surgical floor; Increasing resistance to routine antibiotics

Objective: To know the spectrum of surgical site infections in general surgical patients so that specific strategies can be developed to decrease the morbidity caused by these infections.Material and Methods: All the patients who underwent general surgical operations on an emergency basis at the surgical unit of the District headquarters teaching hospital Rawalpindi from 01-01-2016 to 31-12-2017 were evaluated for surgical site infections. Surgical site infections suspected clinically were confirmed by culture and sensitivity. Involved flora and their sensitivity to various antibiotics were also determined.Results: Among 2202 emergency operated patients, two hundred and thirty-seven patients (10.76%) had surgical site infection confirmed on culture and sensitivity (C/S) report. About sixty-five percent of patients were male. Of two hundred and thirty-seven positive patients, the twenty-nine patient underwent laparotomy for penetrating and blunt abdominal trauma. Staph aureus was present in one hundred and forty-five (79.67%) patients. E.coli was the commonest Gram-ve micro-organism (70.95%). Forty-six patients (19.40%) were sensitive to Cefoperazone sodium followed by twenty patients (8.43%) to Piperacillin sodium and twenty-one (8.86%) each to Amikacin and Linezolid.Conclusion: Surgical site infection causes a significant rise in morbidity on the surgical floor. Most of the causative microorganisms are becoming resistant to routine antibiotics. Sensitivity to the broader spectrum of antibiotics like Cefoperazone and Linezolid is increasing

Studies on antihyperlipidemic and endothelium modulatory activities of polyherbal formulation (POL4) and its ingredients in high fat diet-fed rats

A compound herbal formulation (POL4) is used traditionally in interior parts (Distt. Badin) of Sindh, Pakistan, for the treatment of metabolic disorders like diabetes and hyperlipidemia. This study is aimed to determine the effectiveness of POL4 and its ingredients in hyperlipidemia and associated endothelial dysfunction and hypertension. POL4 is composed of equal proportion of Nigella sativa, Cichorium intybus, Trigonella foenum graecum and Gymnema sylvestre mixed in powdered form. Chronic (6 to 7 weeks) administration of POL4 and its ingredients mixed in diet caused a notable attenuation in total cholesterol, low density lipoprotein cholesterol, triglycerides, atherogenic index, C-reactive protein and glucose, while it has increased high density lipoprotein levels. POL4 intervention markedly (p\u3c0.01) reduced systolic blood pressure in rats to 127±1.92 vs. 145.4±1.07 mm of Hg using tail-cuff method and significantly (p\u3c0.05) improved endothelium-dependent relaxation (75±2.88 vs. 82.75±1.22%) to acetylcholine in isolated aortae of rats in treatment groups using force transducer and PowerLab system. Similar activities were assessed on the part of ingredients of POL4. These findings indicate that POL4 and its ingredients possess antihyperlipidemic, endothelium-dependent modulatory and antihypertensive activities, thus providing an evidence to the vernacular use of POL4 in hyperlipidemia and hypertension

Comparison of Tzanakis and Alvarado scoring system in diagnosis of acute appendicitis, with Histopathology as gold standard

Objective: To determine the diagnostic accuracy of Tzanakis and Alvarado score for the diagnosis of acute appendicitis taking histopathology as the gold standard. Materials and Methods: It was a Cross-sectional validation study The study was carried out at the emergency department of RMC allied hospital Rawalpindi. The study was completed in eighteen months from 1st May 2016 till 30th Nov 2017. After approval from the ethical committee total of 420 patients fulfilling inclusion criteria from the emergency department of District head Quarter hospital, Rawalpindi was taken. Informed consent was taken from patients or their attendants, and their demographic information like name, age, sex, and address was obtained. Alvarado score and Tzanakis score were calculated (as per operational definition) at the time of admission of the patients. After surgery, the specimen appendix was sent for histopathology in the hospital lab.  The diagnosis of the acute appendix was based on a positive histological report which was verified by a pathologist. All the data was entered by a researcher who will collect the data by himself. Results: The mean age of patients in this study was 20.15±7.13 years with 218 (51.9%) males and 202 (48.1%) females. The mean Alvardo score was recorded as 7.22±1.58 with the mean Tzanakis score being 9.64±3.13. The histopathology for diagnosing appendicitis showed positive for 367 (87.4%) patients and negative for 53 (12.6%) patients. The sensitivity of Alvarado score for diagnosing appendicitis, keeping histopathology as the gold standard was 86.92%, specificity was 92.45%, Positive Predictive Value was 98.76%, and Negative Predictive Value was 50.52% and overall diagnostic accuracy was 87.62%. The sensitivity of the Tzanakis score for diagnosing appendicitis, keeping histopathology as the gold standard was 88.83%, specificity was 88.6%, Positive Predictive Value was 98.19%, Negative Predictive Value was 53.41% and overall diagnostic accuracy was 88.81%. Conclusion: The sensitivity of the Tzanakis score was high when compared to the Alvarado score. And specificity was high in the Alvarado score when compared to the Tzanakis score. Moreover, the overall diagnostic accuracy of the Tzanakis score was high when compared to the Alvarado score. SoTzanakis score can be utilized to predict appendix and in the future, we can avoid negative appendectomies

Surgical site infection; effect of contamination and duration of surgical procedure

Introduction: Surgical site infections are responsible for increased treatment cost, prolonged hospital stay and increased morbidity on surgical floor. Increased level of per operative contamination and prolonged surgery increases the incidence of surgical site infections.Objective: To know the effect of contamination and duration of surgery on the incidence of surgical site infections in emergency surgical patients so that specific strategies can be developed to decrease the morbidity and mortality caused by these infections.Materials and Methods: All the patients who underwent general surgical operations on an emergency basis at the surgical unit-1 of the Benazir Bhutto Hospital Rawalpindi from 01-01-2019 to 31-12-2020 were evaluated for surgical site infections. The level of contamination per operatively and duration of surgery were documented. Surgical site infections suspected clinically were confirmed by culture and sensitivity.Results: Among 2202 emergency-operated patients, two hundred and thirty-seven patients (10.76%) had surgical site infection confirmed on culture and sensitivity (C/S) report. About sixty-five percent of patients were male. Of two hundred and thirty-seven positive patients, seventy (29.09%) patients underwent laparotomy for penetrating and blunt abdominal trauma. About fifty-eight percent of SSI patients had contaminated wounds per operatively. Operative time was one to three hours in about sixty-seven percent of SSI-positive patients. Staph aureus was present in one hundred and forty-five (79.67%) patients. E.coli was the most commonest Gram-ve micro-organism (70.95%).Conclusion: Surgical site infection causes a significant rise in morbidity on the surgical floor. Increased levels of contamination per operatively and prolonged operative time increase the incidence of SSI in emergency surgical operations

Comparison of Tzanakis and Alvarado scoring system in diagnosis of acute appendicitis, with Histopathology as gold standard

Objective: To determine the diagnostic accuracy of Tzanakis and Alvarado score for the diagnosis of acute appendicitis taking histopathology as the gold standard. Materials and Methods: It was a Cross-sectional validation study The study was carried out at the emergency department of RMC allied hospital Rawalpindi. The study was completed in eighteen months from 1st May 2016 till 30th Nov 2017. After approval from the ethical committee total of 420 patients fulfilling inclusion criteria from the emergency department of District head Quarter hospital, Rawalpindi was taken. Informed consent was taken from patients or their attendants, and their demographic information like name, age, sex, and address was obtained. Alvarado score and Tzanakis score were calculated (as per operational definition) at the time of admission of the patients. After surgery, the specimen appendix was sent for histopathology in the hospital lab.  The diagnosis of the acute appendix was based on a positive histological report which was verified by a pathologist. All the data was entered by a researcher who will collect the data by himself. Results: The mean age of patients in this study was 20.15±7.13 years with 218 (51.9%) males and 202 (48.1%) females. The mean Alvardo score was recorded as 7.22±1.58 with the mean Tzanakis score being 9.64±3.13. The histopathology for diagnosing appendicitis showed positive for 367 (87.4%) patients and negative for 53 (12.6%) patients. The sensitivity of Alvarado score for diagnosing appendicitis, keeping histopathology as the gold standard was 86.92%, specificity was 92.45%, Positive Predictive Value was 98.76%, and Negative Predictive Value was 50.52% and overall diagnostic accuracy was 87.62%. The sensitivity of the Tzanakis score for diagnosing appendicitis, keeping histopathology as the gold standard was 88.83%, specificity was 88.6%, Positive Predictive Value was 98.19%, Negative Predictive Value was 53.41% and overall diagnostic accuracy was 88.81%. Conclusion: The sensitivity of the Tzanakis score was high when compared to the Alvarado score. And specificity was high in the Alvarado score when compared to the Tzanakis score. Moreover, the overall diagnostic accuracy of the Tzanakis score was high when compared to the Alvarado score. SoTzanakis score can be utilized to predict appendix and in the future, we can avoid negative appendectomies

Surgical site infection; effect of contamination and duration of surgical procedure

Introduction: Surgical site infections are responsible for increased treatment cost, prolonged hospital stay and increased morbidity on surgical floor. Increased level of per operative contamination and prolonged surgery increases the incidence of surgical site infections.Objective: To know the effect of contamination and duration of surgery on the incidence of surgical site infections in emergency surgical patients so that specific strategies can be developed to decrease the morbidity and mortality caused by these infections.Materials and Methods: All the patients who underwent general surgical operations on an emergency basis at the surgical unit-1 of the Benazir Bhutto Hospital Rawalpindi from 01-01-2019 to 31-12-2020 were evaluated for surgical site infections. The level of contamination per operatively and duration of surgery were documented. Surgical site infections suspected clinically were confirmed by culture and sensitivity.Results: Among 2202 emergency-operated patients, two hundred and thirty-seven patients (10.76%) had surgical site infection confirmed on culture and sensitivity (C/S) report. About sixty-five percent of patients were male. Of two hundred and thirty-seven positive patients, seventy (29.09%) patients underwent laparotomy for penetrating and blunt abdominal trauma. About fifty-eight percent of SSI patients had contaminated wounds per operatively. Operative time was one to three hours in about sixty-seven percent of SSI-positive patients. Staph aureus was present in one hundred and forty-five (79.67%) patients. E.coli was the most commonest Gram-ve micro-organism (70.95%).Conclusion: Surgical site infection causes a significant rise in morbidity on the surgical floor. Increased levels of contamination per operatively and prolonged operative time increase the incidence of SSI in emergency surgical operations

Successful completion of pregnancy after mustard procedure for transposition of great arteries: A rare case from the developing world

Surgical repair of transposition of great arteries has undergone various evolutionary changes over the years. The initial of these treatment options was atrial septectomy followed by atrial switch and the current preferred treatment option is arterial switch operation worldwide. Due to various reasons, like lack of medical and surgical expertise atrial switch operation was commonly in practice in developing countries until few years back. Pregnancy in a patient with history of atrial switch operation poses a unique haemodynamic challenge. We report the case of a successful pregnancy in a 26 years old lady who had undergone Mustard repair surgery in the past in Pakistan

Policy on SMEs in Pakistan:: Relationship between Entrepreneurial Orientation, Firm Performance and Ownership Structure

To strengthen growth of SMEs in Pakistan, it is important for the policy makers to understand some significant related variables. For instance, Entrepreneurial Orientation (EO) is one such variable which can affect the performance of any business substantially; however, it is debatable if some of its dimensions do not affect the firm performance. This research investigates the relationship among the EO dimensions, firms’ performance and ownership structure. In this study, the collection of data was done by using a self-administered questionnaire survey using a 5-point Likert scale and Statistical Package for social sciences (SPSS) version 24. The findings revealed that EO has a statistically significant effect on firms’ performance and when checked individually for each dimension of the EO, it was clear that results for innovation were statistically insignificant, because innovation needs certain time and specific environmental conditions to yield significant results, whereas results for risk-seeking, proactive approach, autonomy, aggressive attitude, and competitive spirit were statistically significant and positively linked with the firms’ performance. The findings of this research reveal that ownership structure does play a significant moderating role on the relationship between performance of the firm and EO dimensions (Innovativeness, Proactiveness and competitive Energy) while Ownership structure doesn't play any significant moderating role between firm performance and few other EO dimensions (risk-attitude, autonomy and aggressiveness). Keywords:     Public Policy, Entrepreneurial Orientation, Firm Performance, Ownership Structure, Small & Medium Enterprises (SMEs), Pakista