Paucity of trauma literature from a highly burdened developing country

Abstract Introduction: Trauma is the leading cause of death among a younger population not only in USA but in Pakistan as well. The high prevalence of disease should result in a larger amount of data and a larger number of publications resulting in the ability to explore improvements in the field. This study aimed to review the trauma literature generated from Pakistan. Methods: Journals indexed with PubMed from January 2010 to December 2014 were searched using the search term ‘‘Trauma AND Pakistan’’ filtering for relevant dates and human reports only. The abstracts and articles were reviewed by the authors to collect data on a proforma. Results: 114 articles were published from Pakistan during these five years; 64% of articles were published in international journals; 63% of articles were published in journals with an Impact Factor less than 1; 54% of articles were published from one of four provinces of Pakistan; 64% of articles provided Level 4 evidence whilst another 14% of articles provided Level 5 evidence on the topic; 55% of articles discussed epidemiology in non-representative populations. Conclusions: Trauma literature from Pakistan is not only lacking significantly in quantity but is also of poor quality and is unable to offer conclusions on a particular trauma subject. There is huge room for improvement in the upcoming years

Improving outcomes of emergency bowel surgery using NELA model

Objective: To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA).Study Design: An audit.Place & Duration of Study: Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014.Methodology: Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their first report. P-value for categorical variables was calculated using Chi-square tests.Results: Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantly more than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lacking in terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperative goal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients and review of elderly patients by MCOP specialist. Conclusion: This study helped in understanding the deficiencies in the care of patients undergoing emergency bowel surgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to do interventions in the deficient areas to improve care given to these patients and their outcomes with the limited resources of a developing country

Diagnostic accuracy of CT scan in staging resectable esophageal cancer

Abstract INTRODUCTION: CT scan is an important tool in staging of esophageal cancer. Survival can be improved by providing neoadjuvant treatment which depends on stage of esophageal cancer. So it is very important to stage the disease accurately. METHODS: The objective of this study is to determine diagnostic accuracy of CT scan to stage esophageal cancer. Ct scans of 62 patients included in the study were reviewed by a Consultant radiologist who was blinded to the final stage of tumour. Diagnosticaccuracy measured by comparing with histopathological staging. RESULTS: Accuracy, sensitivity and specificity of CT for T2 and T3 are 66%, 61%, 68% and 63%, 67%, 56% respectively. Accuracy, sensitivity and specificity of CT for presence of nodal disease are 65%, 59% and 75%. CONCLUSIONS: Ct scan alone has low diagnostic accuracy for staging Esophageal Cancer

30-day readmission rate and its causes in general surgical patients

Objective: To find out the 30-day readmission rate for different surgical procedures and determine the causes for readmissions. Study Design: An audit report. Place and duration of study: Department of Surgery, The Aga Khan University Hospital, Karachi, in the calendar year 2014. Methodology: Records were retrospectively reviewed for 30-day readmission rate and their cause in general surgical patients who underwent a general surgical procedure at The Aga Khan University Hospital, Karachi, in the year 2014. Results: Out of 217 (6.4%) readmissions in 3,387 patients, more than 50% unplanned readmissions were avoidable. The highest readmission rate was after placement of feeding tubes (28.5%). Conclusion: More than half of the readmissions could have been prevented by proper patient/attendant education, good communication and provision of nursing services to these patients beyond the hospital

Short term outcome and predictors of response to neoadjuvant treatment in rectal cancer

Abstract OBJECTIVE: To evaluate response to neoadjuvant chemoradiation in the treatment of rectal cancer and to see if it can be predicted whether a particular patient will benefit from such treatment. METHODS: The retrospective case series was done at the Aga Khan University Hospital, Karachi, and comprised data related to period from January 2005 to December 2014 of patients with rectal cancer who had received neoadjuvant treatment. They were divided into responders and non-responders on the basis of imaging. Pre-treatment factors were compared to identify differences in the two groups. SPSS 19 was used for statistical analysis. RESULTS: The median age of 35 patients whose records were studied was 44 years (interquartile range: 33-54). Response to neoadjuvant treatment was seen in 13(37%) patients with complete pathological response in 8(22.9%). There was no statistically significant difference in age, gender, pre-treatment tumour stage, tumour biology and distance from anal verge among the responders and the non-responders (p\u3e0.05 each)

Bomb blast in a tertiary care hospital, the challenges faced during management of victims in a resource limited country

Abstract Introduction: A bomb blast in a hospital results in a many fold increase in the casualties. The affected health care in the region is the next challenge faced by the administration of the city. We discuss the challenges faced after a bomb blast in the civil hospital of Quetta, Pakistan on 8 August 2016. Methods: A retrospective review of the medical records of patients who were transferred by air to the Aga Khan University Hospital Karachi over a period of 86 h after the blast in Quetta. Results: Seventy-five patients were received in three separate waves; those received in the first wave were sicker than the following waves. Errors in triage and communication which could have been prevented were identified. Conclusion: Security of hospitals needs to be improved to avoid such incidents in future. The teams involved in the management of these incidents should be trained about triage and communication and its importance. There is need for designated trauma centers to take care of these incidents

Quality Of Life of Women, Pre- and Post-Operative Breast Cancer Surgery

Objective: To evaluate the Quality of Life (QoL) of women with breast cancer who came for treatment in surgery department before diagnosis and post-operative time period. Methodology: A prospective cohort study was conducted at General surgery Department, Islamabad Medical complex, NESCOM, from October 2021 to March 2022. Seventy four diagnosed breast cancer patients, above 18 years of age, who underwent surgical treatment (MRM and Axillary clearance), were selected. QoL was assessed with the help of EORTC QLQ C-30 and EORTC BR-23 questionnaire. Data was collected on opd follow up and through telephone. SPSS 20 was used to analyze the data and Wilcoxon test and Kruskal-Wallis test were performed. Results: The QoL assessed at pre and post operative stage showed positive results only in the future prospects and emotional function domain. Whereas, negative results were scored in rest of the domains, which are symptoms in the arm, body image, financial concerns, sexual pleasure, cognitive function and physical function. Conclusion: The need for a multidisciplinary approach for breast cancer patients is required regarding different dimensions that can improve their QoL

Endoscopic Endonasal Excision of Pituitary Tumors Using a Mono-nostril Technique

Objectives: The purpose of this study is to assess the effectiveness and advantage of endoscopic mono-nostril approach to the pituitary tumors.Materials and Methods: We analyzed 70 patients undergoing transsphenoidal mono-nostril excision of pituitary tumors from September, 2016 to March, 2018.Results: We operated 70 patients, out of which 51 were males and 19 were females; the age of the patients ranged from 15 years to 65 years.In our study, out of 70 patients, 61 (87.1%) patients had excellent results with total tumor resection, marked visual improvement, early discharge on the second post-operative day, resuming their daily activities within two weeks and recurrence free interval of 1 year. Nine (12.8%) of our patients had a partial excision of the tumor, whereby there was improvement of headaches in all of them while visual status remained at the pre-operative status. Five (7.1%) of our patients had a post-operative cerebral spinal fluid (CSF) rhinorrhea, 4 (5.7%) in total excision group and 1 (1.4%) in partial excision group. These patients of CSF leak were retained in hospital and their mean stay in hospital was 12 ? 4. Conclusion: We consider that endoscopic mono-nostril excision of the pituitary tumor is a relatively safer, effective, minimally invasive procedure; whereby there is a fast recovery, early discharge and good cosmetic results

Characterization of cowpea to harvest rainwater for wheat in semiarid conditions

Aim of study: A field experiment was executed, under rainfed conditions from 2014-15 to 2017-18, to study the role of cowpea (Vigna unguiculata L.) in rainwater harvesting to enhance the wheat (Triticum aestivum L.) yield.Area of study: Rain-fed area of Pothwar region, Punjab, Pakistan.Material and methods: We designed three treatments (T1: control; T2: cowpea grown after conventional tillage and incorporated into soil to act as “green manure”; and T3: grown without any tillage practice, cut with sickle and spread as “mulch”). The effect of these treatments on soil moisture conservation was studied against conventional farmer’s practice, wherein no host crop is grown before wheat sowing.Main results: Available soil water remained highest in T2 during first three years when sufficient rainfall was received contrary to fourth year with low rainfall. The results revealed that cowpea biomass of 15.2 t/ha and 13.72 t/ha, from T2 and T3 respectively, were produced during 2015 corresponding to 213 mm rainfall. Whereas, these quantities increased to 25.69 t/ha and 24.29 t/ha during 2017 with 387 mm of rainfall. The study revealed that net income from wheat crop under T2 was Rs 13000 and Rs 9000 per hectare higher than that of control during the first two years respectively. Contrarily, net income from T2 was found negative and benefit-cost ratio reduced to 0.79 when very low rainfall was received during the last year.Research highlights: Use of cowpea as green manure gave maximum net return if sufficient rainfall is received during decomposition of cowpea and hence recommended for in-situ rainwater harvesting

Babesia bovis in Large Ruminants in Pakistan - Molecular Detection and Haemato-Biochemical Alterations

Background: Babesiosis is endemic in Pakistan and is one of the most important bovine diseases that causes huge economic losses and high mortality in young animals. A hematobiochemical study was conducted to unveil the difference between diseased and healthy animals in selected districts i.e., Faisalabad (31° 25' 7.3740'' N and 73° 4' 44.7924'' E), Toba Tek Singh (30° 58' 9.7392'' N and 72° 27' 40.7484'' E) and Jhang (31° 16' 40.9656'' N and 72° 18' 42.3360'' E) of Punjab, Pakistan. Materials, Methods & Results: A total of 518 (Cattle = 360, Buffalo = 158) blood samples were collected. The samples were analyzed by polymerase chain reaction (PCR) targeting apocytochrome b-gene (Babesia bovis-gene) (CYTb) followed by haemato-biochemical analysis. Chi-square test for univariate analysis was used to analyze the data. In summer the PCR-based prevalence was 29.4 (53/180) and 24.05% (19/79) in cows and buffaloes, respectively. On the other hand, in winter results showed that 12.7 (23/180), 13.92 % (11/79) samples positive for Babesia genus from cows and buffaloes, respectively. The positive samples were further investigated for hematological and biochemical analysis. The results revealed that, the mean value of hematological parameters like RBCs, Hb, PCV, MCV and MCHC was significantly (P < 0.05) decreased in infected animals (cows and buffaloes) as compared to the non-infected ones. While the biochemical parameters like Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), cholesterol and Lactate dehydrogenase were significantly (P < 0.05) increased in infected animals as compared to healthy animals. This study is the first molecular and hematobiochemical evidence of Babesia bovis in dairy herds of Punjab province, Pakistan. Discussion: Bovine babesiosis is one of the important tick-borne diseases (TBD) affecting dairy industry. In bovines, among 3 Babesia species that cause the disease B. bovis is more pathogenic with high mortality and morbidity. Pakistan is situated in tropical and sub-tropical region where the humidity is high in some part of countries. This high humidity mostly favors the reproduction of the ticks thus higher prevalence of TBDs in this region. Initially the babesiosis was diagnosed by light microscopy using thin blood smear stained with Giemsa stain. Many studies verified that PCR is a more specific and sensitive tool than conventional techniques for the detection of carrier / asymptomatic ruminants. The haemato-biochemical profile is another valuable footprint to track the disease. Keeping in view the above-mentioned fact the present project has been planned to evaluate the haemato-biochemical alteration between health and Babesia infected cattle along with the molecular detection of Babesia species involved in bovine babesiosis. The mean values of haemato-biochemical parameters in clinically ill and healthy animals revealed that the mean values of hematological parameters like RBCs, Hb, PCV, and HCT were significantly decreased in diseased animals as compared to the healthy ones. All these might be due the fact that the parasite is intra-erythrocytic in nature and destruction of red blood cells results in significant (P < 0.05) decrease level of all the hematological parameters. The mean value of ALT in babesiosis infected cattle was significantly higher as compared to healthy cattle. The mean values of AST and LDH in babesiosis infected cows was significantly higher as compared to that in healthy cows. The elevation in liver enzymes in babesiosis may be due to the hepatic damage and lesions induced by the parasite during its multiplication in the blood followed by disturbed liver function. These enzymes are present in high concentrations in the muscles and liver. High level of these enzymes in the blood is indicator of organ necrosis or damage. Keywords: bovines, buffaloes, tick-borne diseases, babesiosis, liver enzymes, PCR