ABSTRACT
Objective: To have an audit of the outcome of laparoscopic cholecystectomy for acute cholecystitis at a tertiary care centre. Study Design: An observational study. Place and Duration of Study: Department of Surgery, Prime Teaching Hospital, Peshawar Medical College, Peshawar, KPK, Pakistan, from January 2011 to December 2015
Methodology: Patients with acute cholecystitis undergoing laparoscopic cholecystectomy were evaluated for conversion rate, morbidity and hospital stay. Early laparoscopic cholecystectomy was defined as done within the same hospital admission
Results: In 83 patients, male to female ratio was 1:1.6 with a median age of 46 years [IQR 15]. The median interval between the onset of symptoms and time of surgery was 5 days [IQR 3]. Majority of cases [80%] were performed after 72 hours of their presentation as acute cholecystitis. Conversion rate from laparoscopic to open cholecystectomy was 8.4% [7/83 cases], because of difficult dissection and unclear anatomy at the Calot's triangle. Median duration of hospital stay was 2 days [IQR 1]. Morbidity rate was 9.6% [8/83 cases], all occurring in late presentations; port-site infection being the commonest [n=6, 7%], followed by port-site hernia and post-cholecystectomy pancreatitis [n=1 each]
Conclusion: Laparoscopic cholecystectomy is quite safe in acute cholecystitis with a low conversion rate, bile duct injuries, and hospital stay
ABSTRACT
Screening of kidney diseases by urinalysis in school children has been approved in many parts of the world with inexpensive tools such as urinary dipsticks. In this study, we investigated the prevalence of hematuria in a large sample of 6 to 15-year-old school students in Makkah and Baha, Saudi Arabia. A total population of 12, 347 students in primary and middle schools in Makkah and Baha, Saudi Arabia, were investigated for hematuria during 2007. There were 7, 299 students in Makkah [5, 007 boys and 2, 292 girls] and the remaining 5, 048 were in Baha [2, 734 boys and 2, 314 girls], aged from 6 to 15 years old. All the studied children were apparently healthy and asymptomatic. Parents' consents were taken prior to the test. A random fresh mid-stream urine was collected to complete the urine analysis [by dipstick and microscopy] to detect microscopic hematuria, albuminuria or pus cells. Measurements of the height and weight were also done and blood pressure was measured for each student. Among the 12, 347 students screened and urine samples provided, 2, 745[22.23%] had hematuria, 1, 822 [14.76% of the total population] from Makkah and 923 [7.48%] from Baha. Analysis of the prevalence of hematuria in students in Makkah and Baha showed that there was a very highly significant difference between the two cities [P value = 0.0000] There were 842 students [7% of the total population] had positive hematuria and hypertension and 2, 678 students [22%] had negative hematuria and hypertension with a highly statistically significant difference between positive hematuria students and negative students in the prevalence of hypertension [P value = 0.0044]. Asymptomatic hematuria might be detected by the school screening program and should be considered as an inexpensive way for early management of some renal diseases
ABSTRACT
To determine the prevalence of hypercalciuria in primary and secondary school students. Prospective randomized study. Primary and secondary schools in Makkah and Baha, Saudi Arabia. Seven hundred ninety-six school-age children were included in a study from January 2007 to December 2007. Non-fasting random urine specimens were analyzed for calcium and creatinine concentrations. The mean ratio of urine calcium-creatinine [Ca/Cr] was 0.11; the range was 0.008 to 0.837. Non-fasting Ca/Cr ratios were significantly different between Makkah and Baha and between males and females in both cities. The Ca/Cr ratio was highest in 6-7 years-old students [mean, 0.14 +/- 0.01]. Seventy-eight [9.8%] students were hypercalciuric, 29 [3.6%] were from Makkah and 49 [6.2%] from Baha students. The prevalence of hypercalciuria differed with age. The study showed highly significant difference in prevalence of hypercalciuria between Makkah and Baha. A child's geographic area, age and ethnicity should be taken into consideration when assessing the urinary calcium creatinine ratios
Subject(s)
Humans , Female , Male , Prevalence , Child , SchoolsABSTRACT
The role of laparoscopic appendectomy is still not well defined in the literature. This study was conducted to evaluate the feasibility of laparoscopic appendectomy at a university hospital in a developing country. Patients undergoing laparoscopic appendectomy [LA] from August 2002 to August 2006 were identified. For each case, a control was selected from patients undergoing open appendectomy [OA] during the same year by systematic sampling. The groups were compared in terms of duration of surgery, requirement of narcotic analgesia, length of hospital stay, postoperative complications and the overall cost for each patient. A total of 68 patients underwent laparoscopic appendectomy during the study period. Median duration of surgery was 82 minutes in LA group and 70 minutes in OA group [P < 0.001]. Forty-five patients in LA group and 64 in OA group required narcotic analgesia [P < 0.001]. Median length of hospital stay [P = 0.672] and postoperative complications [P = 0.779] were comparable in both groups. Median cost of hospital stay was Pakistani Rupees [PKR] 47121/in LA group and PKR 39318/in OA group, the difference being significant [P = 0.001]. Laparoscopic appendectomy is feasible in developing countries with similar postoperative outcome and less requirement of narcotic analgesia. The duration of surgery and overall cost were significantly higher and efforts should be made to develop expertise and reduce operative time with resultant decrease in cost. Development of standardized protocols for discharge of patients from the hospital after LA may further reduce the cost and benefit patients in developing countries