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1.
J Ayub Med Coll Abbottabad ; 32(4): 470-475, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33225646

RESUMEN

BACKGROUND: Enhanced recovery after surgery (ERAS) is a perioperative bundle aimed to reduce surgical stress. Significant reductions in length of hospital stay and associated costs have been reported in multiple studies in all surgical specialties. Purpose of the study was to compare the effect of Enhanced recovery protocols vs. conventional care on perioperative length of hospital stay and cost per patient in a government funded hospital. METHODS: this randomized controlled trial was conducted in the department of General Surgery, unit B, Lady reading hospital, Peshawar from April to December 2018. One hundred and fifty patients were selected based on consecutive sampling. Random allocation into two groups of 75 (ERAS vs Conventional) was done based on computer generated numbers. Length of hospital stay and total direct costs were calculated. Frequency of Surgical site infections, readmissions and mortality was also recorded. Patient reported outcomes were recorded by Surgical Recovery Scale SRS. RESULTS: Patients in the Enhanced recovery group showed a significant reduction in length of hospital stay 28.9 hours in ERAS group vs 40.5 hours in Conventional care group (p<0.001). Total per patient cost was reduced in the ERAS group PKR 6804 in comparison to the conventional care PKR 7682 (p<0.001). Patient reported outcomes measured on Surgical Recovery Scale SRS on discharge, day 3 of discharge and day 10 of discharge showed no significant difference between the two groups. CONCLUSIONS: Enhanced recovery protocols demonstrated a reduction in length of perioperative hospital stay and total cost despite similar post discharge recovery scores on Surgical Recovery Scale SRS and no increase in readmissions.


Asunto(s)
Colecistectomía Laparoscópica , Recuperación Mejorada Después de la Cirugía , Costos de Hospital/estadística & datos numéricos , Colecistectomía Laparoscópica/economía , Colecistectomía Laparoscópica/métodos , Colecistectomía Laparoscópica/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/economía , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos
2.
Saudi J Gastroenterol ; 16(4): 247-52, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20871187

RESUMEN

BACKGROUND/AIM: To assess the prognostic indicators preoperatively presenting and influencing the mortality rate following esophagectomy for esophageal cancer. MATERIALS AND METHODS: This study was a retrospective cohort study, conducted at the Department of Surgery, Lady Reading Hospital, Peshawar, from 1 January 2003 till 31 December 2008. Group 1 included patients who had undergone sub-total esophagectomy and were alive at completion of 12 months; whereas Group 2 included those patients who died by the completion of 12 months. Data were recollected from the Data Bank. A list of variables common to all patients from both groups was categorized and subsequently all data related to each individual patient were placed and analyzed on the version 13.0 of SPSS R for Windows. RESULTS: Significant findings of a lower mean level of serum albumin from Group 2 were observed, whereas serum transferrin levels, also found lower in Group 2, were not statistically significant. Findings of serum pre-albumin, with a mean value of 16.12 mg/dl (P < 0.05) and Geansler's index for the evaluation of the presence of obstructive pulmonary disease prior to surgery showed a lower reading of mean ratio in Group 2. Anastamotic leak was not a common finding in the entire study. In most cases, the choice of conduit was the remodeled stomach. Nine patients from Group 2 were observed with evident leak on the fifth to seventh post-operative day following contrast swallow studies. This was statistically insignificant (P = 0.051) on multivariate analysis. CONCLUSION: Pre-operative variables including weight loss, low serum albumin and pre-albumin, Geansler's index, postoperative chylothorax, pleural effusion, and hospital stay, are predictive of mortality in patients who undergo esophagectomy for esophageal cancer.


Asunto(s)
Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/sangre , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esofagectomía/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Pronóstico , Albúmina Sérica/análisis
3.
Saudi J Gastroenterol ; 16(1): 8-13, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20065567

RESUMEN

BACKGROUND/AIM: To compare outcomes of light and heavy weight mesh for repair of inguinal hernia. MATERIALS AND METHODS: This study was conducted at the Department of Surgery; Lady Reading Hospital, Peshawar from January 1, 2007 to December 31, 2008. Patients were divided into two groups based on the type of mesh implanted for inguinal hernia repair. Group 1 included patients in whom light weight composite (VyproII ) mesh is implanted: Group 2 included patients in whom polypropylene (Prolene R ) mesh is implanted. Data concerning the complications and post operative pain in the perioperative and postoperative period were collected and analyzed. Categorical data were presented as percentages with 95% confidence intervals and compared using a chi2 test and P 0.05 were considered significant. RESULTS: Following allocation and exclusion of violating cases, 111 patients in group 1 and 138 patients in group 2 were analyzed. The mean age in group 1 was 38.20 +/- 13.34 years and in group 2 was 39.55 +/- 13.70 (P = 0.434). In group 1, hematoma formation was observed in four cases (3.6%), while it was observed in six cases (4.2%) in group 2 (P = 0.766). During the entire study, ten patients in all developed urinary retention, three of which required transient catheterization. One year post operation, there was a recurrence in only five cases overall, while only two patients complained of pain (P = 0.826). CONCLUSION: The frequency of postoperative pain and complications in patients was similar in both groups.


Asunto(s)
Hernia Inguinal/cirugía , Mallas Quirúrgicas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Poliglactina 910/uso terapéutico , Polipropilenos/uso terapéutico , Recurrencia , Resultado del Tratamiento
4.
J Ayub Med Coll Abbottabad ; 22(2): 46-51, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-21702265

RESUMEN

BACKGROUND: Laparoscopic Cholecystectomy originally a minimal invasive surgical technique involving less hospital stay less economical burden decreased post op complication and early mobility. The objective was to analyse data of patients undergoing laparoscopic cholecystectomy at a surgical setup. METHODS: This study was conducted at the Department of Surgery, Lady Reading Hospital, Peshawar from 11th January 2006 till 10th January 2009. Patients aged above 14 year, presenting in the outpatient department with clinical and ultrasonographic evidence of cholecystitis and undergoing laparoscopic cholecystectomy were included in the study. The procedure performed was predominantly the four port technique for laparoscopic cholecystectomy. A proforma was prepared to collect preoperative, operative, and postoperative data. Operative data included the technique used and the difficulties ascertained during those procedures. Data was analysed using SPSS-13.0. RESULTS: Of 421 patients, 387 patients fulfilled the criteria for admission to undergo the procedure. The mean age of all patients was 38.6 +/- 7.1 year ranging from 16 years to 72 year with a male to female ratio of 1:8.09. During the first six months 57 patients underwent the procedure for which the mean operating time was 67.4 min. During the last six months the mean operating time was 39.1 +/- 8.9 minutes. The overall rate of conversion of laparoscopic cholecystectomy was 6.4%. In comparison the last six months of the study showed one case (1.16%) in 86 patients being converted to open cholecystectomy. The most common cause foe conversion of the laparoscopic procedure to an open cholecystectomy was dense adhesions making dissection of the triangle of Calot's difficult. In 73 cases (21.4%) the gall bladder was perforated during dissection of gall bladder from the gall bladder bed. CONCLUSION: The out comes of this study during the last six months is comparable to studies conducted at more experienced centres making laparoscopic more than just an early experience in this part of the world.


Asunto(s)
Colecistectomía Laparoscópica , Enfermedades de la Vesícula Biliar/cirugía , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Enfermedades de la Vesícula Biliar/etiología , Enfermedades de la Vesícula Biliar/patología , Humanos , Masculino , Persona de Mediana Edad , Pakistán , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
5.
Pacing Clin Electrophysiol ; 32(6): 711-6, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19545332

RESUMEN

BACKGROUND: We have observed contour changes of the barium-filled esophagus during atrial fibrillation (AF) ablation with cryo-energy delivered in direct proximity to the esophagus. OBJECTIVE: To evaluate the frequency, location, and severity of esophageal contour changes during cryo-energy application close to the esophagus. METHODS: We retrospectively analyzed cine-fluoroscopic images acquired during hybrid cryo-radiofrequency AF ablation in 100 consecutive patients with cryo-energy delivered only in direct proximity to the esophagus. RESULTS: Esophageal contour changes were observed in 28 (32%) of 89 patients (and 74 [6.2%] of 1,191 of all cryo applications). They were more frequent in the left common pulmonary vein (PV) (50%) and less so in the right common PV and the upper PVs (4-5%). The distance of the ablation catheter from the endoesophageal contour prior to cryo-energy applications associated with contour changes was 1.8 +/- 1.5 mm, which increased to 4.1 +/- 1.6 mm at the time of peak contour change (P < 0.001). The esophageal contour deformation was 2.3 +/- 0.9 mm. There were no apparent complications related to cryo-energy application for 3-4 minutes, even if associated with contour changes. CONCLUSION: Esophageal contour changes were observed in >6% of cryo applications in direct proximity to the esophagus (32% of patients) and were most frequent in the posterior aspect of the left common and right lower PV ostium when cryo-energy was delivered at a distance of

Asunto(s)
Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Criocirugía/efectos adversos , Esófago/diagnóstico por imagen , Esófago/lesiones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento
6.
J Ayub Med Coll Abbottabad ; 20(4): 22-5, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-19999196

RESUMEN

BACKGROUND: Breast Cancer is the commonest malignancy of females all over the world and second leading cause of death due to cancer among females. The aim of this Descriptive study was to see the various features of breast cancer in order to know the pattern of disease in the recent time. The study was conducted from Jan. 2007 to Dec. 2007 in Surgical C Unit, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan. METHODS: Study included all patients presenting to and admitted in Surgical C Unit LRH, with carcinoma of breast during the above mentioned period. Name, age, sex, other relevant data, history and examination findings and results of histopathology and other investigations were recorded. RESULTS: Total of 46 patients was included in the study, out of which there were 46 female and 1 male patients. Most common age group was 40-49 years with 14 patients, followed by 50-59 years with 12 patients. Most common type of carcinoma was infiltrating ductal carcinoma with no specific features with 38 patients. Other types included 2 infiltrating ductal carcinomas of papillary type, 1 mucinous type and 1 medullary type; 3 invasive lobular carcinomas, and 1 mixed lobular and ductal carcinoma. The disease was left sided in 24 cases, right sided in 20 cases while it was bilateral in 2 cases. Upper outer quadrant of the breast was most commonly involved (n = 26). There were 2 cases of stage I, 16 stage II, 20 stage III and 08 cases of stage IV disease. There were 2 cases of grade I, 16 grade II, and 28 cases of grade III. CONCLUSION: Carcinoma breast is still a common problem presenting at a young to middle age group with invasive ductal carcinoma being the commonest variant with a high grade and a late stage of presentation due to lack of screening and awareness programs.


Asunto(s)
Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Hospitales de Enseñanza/estadística & datos numéricos , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Adulto Joven
7.
J Ayub Med Coll Abbottabad ; 20(4): 29-33, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-19999198

RESUMEN

BACKGROUND: To evaluate the early outcome of Lichtenstein's technique for repair of inguinal hernia using polypropylene mesh. METHODS: This was a descriptive study conducted over a period of twelve months from 1st July 2007 to 30th June 2008 in Surgical 'B' unit, Lady Reading Hospital, Peshawar. One hundred and twelve patients were received through the out patient department with diagnosis of inguinal hernia. Inclusion criteria was patients above the age of 18 years, reducible hernia, evidence of swelling in groin > 2 months. Exclusion criteria was age less than 18 years, chronic constipation, chronic cough, symptoms of prostatism, irreducible hernia, obstructed hernia, strangulated hernia and patients with diabetes mellitus. All the patients were subjected to inguinal mesh repair using the Lichtenstein technique with polypropylene mesh. RESULTS: Mean age of patients was 48.78 +/- 14.41 years. Sixty patients (53.6%) had right sided inguinal hernia while 46 patients (41.1%) had a left sided hernia and 6 patients (5.4%) had bilateral hernia. Sixty two patients (55.4%) had indirect hernia and 43 (38.4%) cases had direct hernia. Sixteen cases (14.3%) had previous history of surgery for hernia on the same side (recurrent hernia). Mild pain was observed in 53 cases (47.3%), moderate pain in 42 cases (37.5%), and severe pain in 17 cases (15.2%). Four patients (3.6%) in all developed a seroma Two patients (1.8%) developed a haematoma that required drainage. Three patients (2.7%) had a prolonged recovery and presented with abdominal distension. Five cases presented with infected wounds. CONCLUSION: Lichtenstein's technique of inguinal mesh repair is a safe and effective procedure but emerging trends anticipates the implementation of day case surgery.


Asunto(s)
Hernia Inguinal/cirugía , Mallas Quirúrgicas , Procedimientos Quirúrgicos Operativos/métodos , Adulto , Femenino , Humanos , Masculino , Resultado del Tratamiento
10.
Pacing Clin Electrophysiol ; 27(8): 1153-7, 2004 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-15305968

RESUMEN

This report describes two patients with sustained regular left atrial tachycardias originating from multiple pulmonary veins in the absence of clinical evidence of atrial fibrillation. The tachycardias were eliminated by activation map-guided pulmonary vein isolation. Stable sustained regular pulmonary vein tachycardias unassociated with atrial fibrillation are uncommon, and they belong to the spectrum of pulmonary vein arrhythmias that include the more common paroxysmal and unstable tachycardias engendering atrial fibrillation.


Asunto(s)
Venas Pulmonares/cirugía , Taquicardia Atrial Ectópica/cirugía , Adulto , Humanos , Masculino , Persona de Mediana Edad
11.
N Z Med J ; 115(1148): 72-5, 2002 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-11913937

RESUMEN

AIMS: To determine patterns of alcohol use and misuse among community-dwelling people aged 65 years and over in Christchurch and to assess how often this comes to medical attention. METHODS: A cross-sectional survey of alcohol use and misuse was conducted followed by a self-administered postal survey among non- respondents. General practitioners (GPs) of the respondents completed a self-administered questionnaire on patients' alcohol use and misuse. RESULTS: The response rate was 58% (141/243). The prevalence of hazardous alcohol consumption in the past twelve months (AUDIT cut-off score 8 or more) was 9.9% (95% CI = 4.9-14.9) and the prevalence of lifetime alcohol dependence using DSM-IV diagnostic criteria was 24.8% (95% CI = 17.6-32.0). Men were more likely than women to report lifetime dependency and current hazardous patterns. The response rate among GPs was 77.7% (108/139). None of the GPs identified or diagnosed alcohol problems in the past twelve months among this group and reported a history of alcohol problems in only four (4.0%) patients. Those with current hazardous patterns of alcohol use were twice as likely to be admitted to hospital (RR=2.4; 95% CI 1.2-5.1) but significantly less likely to visit their GPs in the previous twelve months (RR=0.55; 95% CI 0.7-1.1). CONCLUSION: A significant proportion of community-dwelling elderly people reported patterns of alcohol consumption that put them at risk of future damage to physical or mental health. Hazardous drinkers were less likely to visit their GPs and only in a few cases, were GPs aware of such potential problems.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , Concienciación , Médicos de Familia , Características de la Residencia , Factores de Edad , Anciano , Anciano de 80 o más Años , Alcoholismo/diagnóstico , Estudios Transversales , Femenino , Humanos , Masculino , Nueva Zelanda/epidemiología , Prevalencia
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