Harmonic Scalpel Hemorrhoidectomy Vs Milligan-Morgan Hemorrhoidectomy

Background: To compare Harmonic Scalpel Hemorrhoidectomy (HSH) with classical Milligan Morgan Hemorrhoidectomy (MMH) in terms of operation time and post-operative pain to establish effectiveness of this novel procedure.Methods: A total of 62 patients planned for excision hemorrhoidecotmy were randomly selected into HSH and MMH groups. Mean operation time was calculated during surgery and pain at time of first defecation was recorded on visual analog scale (VAS).Results: Mean VAS after surgery at time of first defecation was 4.32 (SD 0.909) in HSH group and 6.97 (SD 1.426) in MMH group (p value <0.000). Mean Operation time in HSH group was 18.13 (SD 3.956) minutes and that of MMH group was 22.90 (SD 4.901) minutes (P value <0.000).Conclusion: Harmonic Scalpel Hemorrhoidectomy is better than Milligan Morgan hemorrhoidectom

Role of Gum Chewing After Small Gut Anastomosis

This study was performed to access the effectiveness of gum chewing on gut motility in early postoperative period after small gut anastomosis in patients operated for reversal of ileostomy or ileocolostomy. Methods: This prospective, randomized trial was undertaken at Surgical Unit-I, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi from March 2016 to March 2018. 90 patients were randomly divided into two equal groups. All patients underwent small gut anastomosis after reversal of ileostomy or ileocolostomy. In group A (gum chewing group), patients were advised to chew gum, whereas group B (control group) patients did not received any gum for chewing and continued standard post-operative care. Both groups were kept NPO till 2nd post-operative day. After surgery, all patients were observed for onset of bowel sounds, time after surgery when flatus and stool were passed, time required for return of appetite and discharge from hospital. Patient satisfaction with postoperative course, incidence of anastomotic leak, wound infection and mortality was also recorded in both groups. Results : Statistically, group A and group B were similar in age, gender and type of procedure. There was significant difference between both groups for onset of bowel sounds, passage of first flatus, complaints of nausea and vomiting, appetite, duration of hospital stay and patient’s satisfaction level (P < 0.05). In Group A, 35 patients were satisfied whereas in group B, only 5 patients were happy with their postoperative course (P < 0.05). There was no statistically significant difference between groups for incidence of anastomotic leak, wound infection and mortality. Conclusion: It is safe and cost effective to advise gum chewing in patients undergoing small gut anastomosis for reducing duration of postoperative ileus and improving level of patient satisfaction about their postoperative course. Keywords: Postoperative ileus, Ileostomy, Anastomotic leak, Surgical site infection &nbsp

Efficacy of Aloe Vera Cream for Healing Diabetic Foot Ulcers

Background :To compare the efficacy of aloe vera cream with normal saline dressings for infected diabetic leg ulcers. Methods: In this randomized controlled trial 60 patients with infected ulcers on lower limbs were assigned into 2 groups by random sample collection using lottery method. Patients in Group A received aloe vera dressings and patients in Group B received saline soaked dressings daily and were advised to revisit after 8 days. Wound was assessed on the very first visit and then on the 8th day. Patients were assessed with reference to duration of diabetes, grade of ulcer, body mass index and efficacy of treatment. Results: Out of 60 patients, majority were females (53.33%). The efficacy of AVC (aloe vera) dressing was significantly higher than that of NSD (normal saline dressing). i.e. 100% vs 53.3%. (p-value = 0.000) Similar trend was observed for age, gender, BMI, Grade of ulcer and duration of diabetes (p = < 0.05) except for patients with 11-15 years of diabetes & obesity. Conclusion: Efficacy of Aloe vera is higher as compared to that of NSD for treating diabetic foot ulcers. Added advantage of Aloe vera is its cost effectiveness and minimal side effects

Comparison of Epinephrine and Salbutamol Nebulization in Acute Bronchiolitis in terms of mean change in RDAI Score

Objective: This study was conducted to compare epinephrine and salbutamol nebulization in emergency management of moderately ill children less than one and a half years old with bronchiolitis in terms of mean change in respiratory distress assessment instrument (RDAI) score. Materials and Methods: Randomized controlled design was selected in this trial at the Department of Pediatrics, KRL Hospital Islamabad, Pakistan from 24th April 2016 to 24th October 2016. Sixty children with acute bronchiolitis, having a moderate degree of illness (RDAI 8-15) were included in this study. Patient were randomly allocated into Group A (epinephrine = 0.1 mL/kg in concentration of 1:10000) and Group B (salbutamol = 0.15 mg/kg combined with 3 mL 0.9% normal saline). It was delivered by a nebulizer and a face mask with a continuous flow of 6 L/min at100% oxygen. Data was collected on a predesigned performa and assessed with reference to mean change in RDAI score. Results: The patients ' mean age in Group A and Group B were 10.57±4.22 and 11.63±3.14 months, respectively. The majority of the patients were males (56%). The mean RDAI score was insignificant between the two groups, both at baseline (11.57±2.21 in epinephrine group vs 11.3±2.14 in salbutamol group, p = 0.63) and 125 minutes (4.77±2.19 in Epinephrine group vs 5.43±1.69 in Salbutamol group, p = 0.19). However, when stratified according to age and gender, the mean RDAI score was found statistically significant among the 2-12 months age group (p = 0.0045) and female gender (p = 0.0052). Conclusion: Epinephrine and salbutamol have similar effects in acute bronchiolitis when compared with regards to mean change in RDAI score

Laparoscopic Splenectomy for Immune Thrombocytopenic Purpura (ITP)

Background: To determine the operating time, blood loss, postoperative rise in platelet count, need of conversion to open surgery, postoperative hospital stay and postoperative complications in ITP patients undergoing laparoscopic splenectomy.Methods: In this cross-sectional study patients diagnosed with ITP undergoing laparoscopic splenectomy were included. Patient characteristics regarding operating time, blood loss, postoperative hospital stay, conversion to open surgery, postoperative complications and postoperative rise in platelet count were analyzed..Results: Out of 23 patients, 9 were males and 14 were females. The mean age of the patients was 31±7 years. There was 1 conversion to open surgery. The mean operating time was 90±22 mins and mean blood loss 131±55 ml. 21 out of 23 (91.3%) patients showed a positive response of rise in platelet count after surgery. There was no postoperative complication in any patient. The mean postoperative hospital stay was 3±1 days.Conclusion: Laparoscopic splenectomy is associated with less operating time, postoperative hospital stay, blood loss, and postoperative complications. It produces an adequate postoperative rise in platelet count

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020