5 research outputs found

    Peripheral Vascular Disease “A Spectrum”

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    Background: To observe the spectrum of peripheralvascular disease presenting in a tertiary care hospital.Method: This observational, descriptive study wascarried out in Surgical Unit –I at Holy Family Hospital,Rawalpindi over a period of two years. All the patientspresenting with peripheral vascular disorders excludingacute vascular trauma patients, diabetics and varicoseveins patients were included in the study.Results: A total of 49 patients presented to the hospital.The male to female ratio was 2:1.The average age ofpresentation was 50.2 years. About 35% patients presentedwith occlusive disease, 18% with autoimmune disease and14% with embolism. The less common causes of peripheralvascular disorders included femoral pseudoaneurysms in8% patients and true aneurysms of iliac, popliteal andsubclavian arteries in 12% patients. Bilateral gangrene ofboth lower limbs was seen in 4% patients.Conclusion: Peripheral vascular disease is commonerin males and is mostly seen in the sixth decade of life.Atherosclerotic occlusive disease is the commonest causeof peripheral vascular disease followed by vasculitis,embolisms and aneurysms

    Status of Fruit Farming in Central Valley of Khyber Pakhtunkhwa

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    This retrospective study was conducted in four districts of Khyber Pakhtunkhwa namely Charsadda, Nowshera, Mardan and Peshawar during January February, 2013 to examine the status and factors affecting fruit orchards. A total of Sixty four fruit orchards growers were interviewed on the basis of land acquisition. Data indicates that farmer areas for citrus and planted Stone fruit such as peach, plum and apricot were declined in the last 10 years while the area under pear and loquat were increased. The study results also indicate that a number of factors were affecting fruit orchards. These problems were ranked as (1) diseases/insects, followed by (2) high price, (3) water shortage problem, (4) adulteration in inputs, (5) marketing problem and (6) non-availability of credit. It is concluded that various factors are responsible for the decline in production of fruit orchards. It is thus, recommended that agriculture department should regularly disseminate technical-know-how regarding improved fruit orchards management practices through training, field days and workshop and other awareness programmes for fruit orchards growers. The government should also keep check and balance on price and quality of inputs to encourage fruit orchard growers to increase their production

    Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

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    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)
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