Acute Appendicitis: Relationship of Total Leucocyte Count with Per-Operative Stage

Objective: To correlate total leucocyte count(TLC) with per-operative stage of acute appendicitis. Patients and Methods: This cross sectional study was conducted in department of surgery, Pakistan Institute of Medical Sciences (PIMS) from June 2016 to June 2017. A total 77 patients were included through consecutive sampling technique. Statistical Package for Social Sciences (SPSS) version 20 was used to analyze data. Results: A total of 77 patients were included in the study, among them 47 (61%) were males, and 30(39%) were females. Mean age was 22.25 ± 5.19 years. Mean TLC was 12,900 ± 4087 cells/µL Patients having acute appendicitis were labeled as, acute appendicitis stage I which included 59 (76.6%) patients, Gangrenous appendicitis was named as stage II which included 11 (14.3%) patients. Perforated appendicitis was labeled as Stage III in which 7 (9.1%) patients were inducted. In stage I, mean age was 21.89 ± 5.50 years and mean TLC was 12,344 ± 4162 cells/µl. In stage II, mean age was 22.36 ± 3.90 years and mean of total leukocyte count was 15,072 ± 3497 cells/µl. In stage III, mean age was 25.57 ± 3.50 years and mean leukocyte count was 14,214 ± 4141cells/µl (p-value >0.05). Conclusion: Significant statistical association was not found in patients in different stages of appendicitis with respect to TLC (p value >0.05), although patients in all stages had raised mean TLC with mean TLC highest in patients having stage II (Gangrenous appendicitis)

Commonly Occurring Bacteria in Diabetic Foot Infections and their Sensitivity to various Antibiotics

Background: Diabetic foot infections are a common cause of morbidity in type 1 & 2 Diabetes mellitus. The selection of appropriate empirical treatment is thus essential while treating such patients. The main objective of this study was to find out most prevalent bacteria and their sensitivity to various antibiotics in patients with diabetic foot infections.Material and Methods: This cross-sectional study was conducted in the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from January 2017 to December 2017. A total 118 patients were included through consecutive sampling technique. Samples were collected in the form of swab, pus or tissue material and were cultured on blood agar and microorganisms were identified using standard microbiological methods. Antimicrobial sensitivity was also checked. StatisticalPackage for Social Sciences (SPSS) version 22 was used to analyze data.Results: Out of 118 patients, 72% (n=85) were males while 28% (n=33) were females. Cultures of 105 patients were positive and most common organisms isolated were S. aureus (32.4%; n=34), E. coli (17.1%; n=18), P. aeruginosa (14.3%; n=15), Polymicrobials (14.3%; n=15) and K. pneumoniae (7.6%; n=8). Antibiotics to which organisms were most sensitive included Piperacillin/Tazobactam (69.5%; n=73), Imipenem (55.2%; n=58), Amikacin (43.8%; n=46), Vancomycin (40%; n=42) and Levofloxacin (38.1%; n=40).Conclusion: Most common organisms causing diabetic foot infections in our study were S. aureus, E. coli, P. aeruginosa, Polymicrobial and Klebsiella. Overall most sensitive antibiotics to these organisms included Piperacillin/Tazobactam, Imipenem,Amikacin, Vancomycin and Levofloxacin

An Experience of Surgical Management of Peripheral Vascular Injuries at Pakistan Institute of Medical Sciences, Islamabad

Background: Peripheral vascular trauma is fairly common and its repercussions lead to need for urgent management and multidisciplinary approach. We hereby evaluate the presentation, management and outcomes of peripheral vascular injuries presenting in a tertiary care hospital in Islamabad, Pakistan. Material and Methods: This was a prospective clinical study conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad Pakistan from January 2016 to June 2018. A total of 60 patients with vascular extremity trauma were included in the study. Initial assessment and resuscitation were done and patients with vascular injury were directly shifted to operating room for primary vascular repair (if defect size < 2 cm) or vein graft (great saphenous). Fractures and nerve injuries were also treated. Fasciotomies were performed where indicated. Post-operative monitoring of limb was done for palpable pulses, temperature and color changes. Collected data included age, gender, duration of injury, nature of injury, operative findings, other associated injuries, type of definitive repair, involvement of artery, complications including amputations, infections, re-exploration, ligation or death. Statistical Package for Social Sciences (SPSS) version 23 was used to analyze data. Results: Out of total 60 patients, 53 (88.3%) were males and 7 (11.7%) were females, with a mean age of 27.8±14.1 years. Most of the patients presented after 6 hours of trauma (n=36; 60%). Blunt trauma accounted for 37 (61.7%) while penetrating trauma was seen in 23 (38.3%) patients. Per operatively, 33 (55%) patients had intimal injury, 7 (11.7%) had partial tear and 20 (33.3%) had complete transection of artery. Primary repair was performed in 9 (15%) patients and reverse vein graft in 51 (85%) patients. Most commonly injured arteries were femoral (n=21; 35%), brachial (n=18; 30%) and popliteal (n=12; 20%) arteries, respectively. Amputations were significantly related to presentation of patients later than 6 hours (P=0.035). Conclusion: Patients who present with vascular trauma need an early diagnosis, referral and timely management in order to save both limb and life of patients with special concern for good quality of life and cost-effective management