Journal of Islamabad Medical & Dental College
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Comparison of Syringing of the Ear Wax with Plastic Disposable & Metallic Syringe
Get PDFObjective: Ear syringing is a very common procedure performed by both general physicians and Ear Nose and Throat specialists & consultants. To compare the effectiveness of plastic disposable and metallic syringes for removal of ear wax. Patients and Methods: This experimental study was conducted on one hundred patients, over a period of one year from January to December 2016. These patients were divided into two groups by odd and even serial numbers. Group-A included 50 patients who were treated by syringing with a plastic disposable syringe to remove their ear wax while Group-B consisted of 50 patients who were treated by syringing with a traditional Higginson metallic syringe for the removal of their ear wax. The discomfort score, cost, efficacy, safety, and complications were recorded and compared in patients of both groups. Results: Syringing with a plastic disposable syringe was more cost-effective, safer, lesser cumbersome and has less complications rate than syringing with a metallic syringe. However, the efficacy was similar in both types of procedures. Conclusion: Syringing of the ear with a plastic disposable syringe is safer, more feasible, economical but equally effective as compared to syringing with a metallic syringe
Laparoscopic Cholecystectomy with and without Vacuum Suction Drain
Get PDFObjective: To compare the frequency and severity of pain due to vacuum suction drain placement postoperatively, in patients of laparoscopic cholecystectomy. Patients and Methods: This randomized control trial study was carried out at surgical Unit PAEC General Hospital Islamabad from Jan 2015 to Dec 2016. In total two hundred and twenty cases of gallstone disease were registered who fulfilled the inclusion criteria. The cases were divided into two study groups by random number table. Patients’ in-group “A” underwent laparoscopic cholecystectomy with vacuum suction drain placement and those in-group “B” had cholecystectomy without vacuum suction drain. Results: At 24th hour, a total of 42 patients experienced no pain. Among these 11 were from group A and 31 were from group B. In 178 patients, pain was present (Group A = 109 and Group B = 79). Number of patients suffering from pain was significantly high in group A and severity of pain was also significantly higher in Group A (p-value = 0.002). Conclusion: Laparoscopic cholecystectomy without drain is better as compared to the one with drain, with less postoperative pain
Chronic Gallstone Disease Presenting as Cholecystoduodenal Fistula
Get PDFCholecystoduodenal fistula (CDF) is the most common cholecystoenteric fistula. It is a late complication of gallbladder disease with calculus and is mainly encountered in the elderly and females. We report the case of a 60 years’ female patient with cholecystoduodenal fistula and gallstones. She had recurrent attacks of abdominal pain with anorexia and vomiting. Ultrasound abdomen demonstrated air in the biliary system. Computed tomography abdomen revealed pnemobilia and CDF tract. We did cholecystectomy and repair of CDH tract through Modified Graham’s repair. This case report suggests the importance of knowing the biliary anatomy through pre-op Magnetic resonance cholongio pancreatography (MRCP) or MRI abdomen and planning definitive procedure for bilioenteric fistulas. The patient’s clinical features and operative management are presented and discussed with current literature
Motorcycle Accidents, A Real Burden & Challenge of Health Care System in Tertiary Care Hospital
Get PDFObjectives: To find out the incidence, modalities, reasons of injuries and existing burden of motorcycles trauma in the Orthopedics department, of a tertiary care Hospital. Patients and Methods: This study was performed among patients that presented to the department of orthopedic surgery unit II, via accident and emergency from 1st September 2015 to 1st December 2015. Patients of both gender, age above 11 years, presented in emergency calls of unit II were included in the study. All patients were initially managed as per “Advance Trauma and Life Support” principles in Emergency department of PIMS and later either discharged or admitted. Results: Total 973 patients were categorized into four major groups, including 709 road traffic accidents, 186 incidental traumas, 29 assaults and 49 miscellaneous injuries. Road traffic accidents which were 73% of a total number of cases had a major share in the data. Among these 709 patients of road traffic accidents, 71% cases were the motorcycle riders. Among all motorcycle accidents, 36% riders were between 16 years to 25 years of age and the most grievous trauma was seen in this age group. Regarding license holding age, only 34% people had a driving license while remaining all were without a license. Conclusions: The motorcycle trauma ranges from minor abrasions to the long live disability. It is a huge percentage among all types of trauma and casualties showing the burden on the health system and ultimately the families who would be end sufferers. Younger population is more prone to the grievous injuries that ultimately pertain for a long time or some of them would be living with the permanent disability
Anal Fissure Dilatation Outcome and Patient Satisfaction
Get PDFObjective: To study outcome and level of satisfaction in patients of chronic anal fissure in terms of pain control and healing of fissure. Patients and Methods: This descriptive study was conducted in Fauji Foundation Hospital Rawalpindi. Total of 100 patients who had anal fissure for more than 6 weeks and were refractory to treatment with GTN paste were included in this study. Anal dilation was done in all the patients. Satisfaction of patient was assessed on visual analogue scale at 48 hours, 3 weeks, 6 weeks and 6 months during OPD follow up. Results: Total 100 patients were included in the study. Among them (84%) were females, 16% were male. 3 weeks after dilatation, anal fissure was completely cured in 93% of patients. After 6 months, repetition of procedure was needed in 3% of patients. Conclusion: Anal dilatation is a simple and safe procedure to treat chronic anal fissur
Isolated Amoebic Abscess of Spleen
Get PDFAmoebic liver abscess is the most common extra intestinal manifestation of amebiasis. Amoebic abscess of spleen is a rare disease and cases of isolated abscess of spleen have rarely been reported in literature. We report a case of 52-year female, who presented with history of high grade fever, weight loss and malaise. Her ultrasound a showed a welldefined, thin-walled hypoechoic lesion in spleen and High Dose Contrast Enhanced Computer Tomography(CECT) abdomen revealed a well-defined cystic lesion within the spleen with thin enhancing rim. Ultrasound guided aspiration of splenic abscess was done and showed clusters of trophozoites in the wall of the cavity. She received treatment for amebiasis for one month and reported with resolution of symptoms. Post treatment repeat ultrasound also revealed resolution of abscess.  
Comparison of the Efficacy of Postoperative Diclofenac Suppository with Intramuscular Diclofenac in Children Undergoing Inguinal Hernia Surgery
Get PDFObjective: To compare the analgesic effect of postoperative Diclofenac suppository with intramuscular Diclofenac in children undergoing inguinal hernia surgery. Patients and Methods: This cross-sectional study was conducted at Paeds Surgery Department of Services Hospital Lahore, from August 2016 to March 2017. A total of 160 patients were included in the study and were divided into two groups, one receiving diclofenac suppository (Group DS) and the other group DI which received intramuscular diclofenac injection. Numerical variables like age and weight were analyzed statistically by taking their mean and standard deviation while the outcome variable like the severity of pain was categorized as no pain, mild, moderate and severe pain in frequency percentage at 0, 2 and 4 hours’ interval. Results: Total 160 patients were divided into 2 groups equally, 80 in each (DS & DI). There was no significant difference in the efficacy of diclofenac suppository and diclofenac intramuscular when calculated at 0, 2 and 4 hours’ interval. When Chi-Square was applied to determine the association, it was observed that pain severity was significantly associated with age. However, the association of pain severity with weight and with time intervals in two groups was not statistically significant. Conclusion: There was no significant difference between the postoperative analgesic effect of either suppository or intramuscular diclofenac but suppository route has an advantage over intramuscular in that it is easier and safer, less prone to injury, easy to administer and has a longer duration of action, especially preferable in pediatric patients
Surgical Audit of Patients at a Tertiary Care Hospital
Get PDFObjective: Analysis of various cases admitted to surgical unit of Pakistan Institute of Medical Sciences (PIMS), Islamabad. Patients and Methods: This cross-sectional study was conducted from Jan 2016 – Dec 2016 at Department of General Surgery, PIMS Islamabad. The record of all the cases admitted in Surgical Unit II during the year 2016 was reviewed. All data was collected on a specially designed performa that included basic information of patients like demographics characters, mode of admission i.e. emergency, outpatient department, referred or transferred from another unit, management i.e. operation or conservative treatment, the outcome of management i.e. discharge, referred or death, and the presence of co-morbidities. Data was recorded and analyzed by using SPSS version 20. Results: Total number of admissions during the study period was 822, out of these 54.3% (n=447) were males and 45.60% (n=375) were females. The mean age of the patients was 35.9. The Record showed that 33.09% procedures were performed in an emergency while 66.91% were elective. Among these appendicectomy was the commonest emergency procedure while cholecystectomy was the commonest elective procedure. Majority of patients (94.89%) were discharged with full recovery and there were 19 (2.31%) deaths. Conclusion: Most patients were managed by surgery elective. Cholecystectomy being the most common elective procedure followed by breast surgeries and Appendicectomy was the most common operation performed in emergency. In Pakistan, there is a need for Surgical Audit in our hospitals for proper planning and betterment of health care system of the country. It is recommended to start computerized audit and sharing of patient’s database
Cerebellar Tubercular Abscess
Get PDFTubercular brain abscess is an uncommon lesion and tubercular cerebellar abscess is rarely reported. Almost all case reports of tuberculous abscess are described in HIVinfected or immunocompromised patients. We report a case of presented with an immunocompetent patient who was diagnosed with probable tuberculous brain abscess of the cerebellum. She complained of headache, neck pain and unsteadiness of gait since two months and associated diplopia on clinical examination. She did not have any history of pulmonary tuberculosis. Diagnosis was made by CT scan/MRI of brain. She responded well to anti tuberculous treatment and her symptoms resolved without any surgical intervention
Scurvy “in the Land of Citrus Fruits”
Get PDFNutritional deficiencies including scurvy are still prevalent in developing countries though not as common as they once were. Vitamin C deficiency has varied presentations including musculoskeletal problems, skin manifestations and bleeding tendency. We report a case of a five years old developmentally normal child who presented with debilitating bone pains and inability to walk. Overall clinical and radiological features were suggestive of scurvy. Treatment with vitamin C resulted in significant improvement.