Role Of Symptomatic Treatment In Comparison To Antibiotics In Uncomplicated Urinary Tract Infections.

BACKGROUND: Uncomplicated urinary tract infections (UTIs) are the most common bacterial infections among women presenting to primary care causing rapidly increasing strains of resistant bacteria to the growing antibiotic industry. Restricting antibiotics to necessary indications is the only solution. The objectives of the study were to compare the efficacy of symptomatic treatment vs antibiotic in patients with uncomplicated UTI, in terms of individual symptom score, i.e., frequency, urgency, dysuria, supra pubic pain scores and total symptoms scores. METHODS: A randomized control trial (RCT) in 100 women (15-50 years) with symptoms of urinary frequency, urgency, dysuria and pain supra pubic region, associated with uncomplicated UTI, at Urology department, AMI, Abbottabad. Two treatment strategies were compared in uncomplicated UTI patient). Patients were randomized to antibiotic or symptomatic treatment groups on consecutive non-probability basis (50 in each group) given for 05 days. Efficacy of medications was assessed by comparing pre and post treatment symptom scores along with the post treatment scores of both groups compared to see statistical significance of difference by independent samples t-test. RESULTS: There was a statistically significant difference in symptoms improvement in both treatment arms of all scores, i.e., p-value=0.000. Whereas only dysuria score was able to show a statistically significance of difference in post Rx scores comparison of both groups, p-value=0.004. CONCLUSIONS: Symptomatic treatment is not inferior to antibiotic treatment when proper patient selection is undertaken, resulting in decreased need for unnecessary antibiotics use.

Pattern of change in the frequency of Helicobacter pylori with perforated duodenal ulcer.

BACKGROUND: Peptic ulcers were believed to be caused by stress, dietary factors, and gastric acid, but the link between H. pylori and peptic ulcers was identified in 1983. To see the frequency of Helicobacter pylori infection in patients with perforated duodenal ulcer and advise eradication therapy in these patients. This cross sectional study was conducted in Surgical Unit Hayatabad Medical Complex, Peshawar, during January 2007-June 2008. METHODS: A total of 50 cases were included in the study. All cases presenting to our unit with acute perforated duodenal ulcer were recruited. After resuscitation and baseline investigations, all underwent emergency laparotomy via upper midline incision, after thorough peritoneal lavage, the perforation margins were freshened and closed over an omental patch. Serum from every patient was tested for H. pylori and accordingly managed. RESULTS: Out of the 50 cases, 45 were males, and 5 were females. Age ranged from 20- 80 years old. All patients underwent emergency laparotomy. Postoperatively, all were started on PPI treatment and serum testing for H. pylori was done. Thirty-four (68%) turned out positive and 16 (32%) were found to be negative for H. pylori. CONCLUSION: There is still a high frequency of H. pylori infection in patients with perforated duodenal ulcer. But comparing these results with the various data available, there is a significant decline in H. pylori positive perforated duodenal ulcer patients.

Penile fracture: experience at Ayub Teaching Hospital.

BACKGROUND: Penile fracture is a relatively rare traumatic rupture of the tunica albuginea of one or both corpora cavernosa of an erect penis. It is a real urological emergency which needs early assessment and surgical management. METHODS: Twelve (12) cases of penile fracture were reviewed from July, 1997 to July, 2007 in the Department of Urology, Ayub Teaching Hospital Abbottabad. All cases presented with classical history of penile fracture and the diagnosis was made on the basis of history and clinical examination only. RESULTS: All the patients underwent immediate surgical repair with well preserved potency and excellent overall results. CONCLUSION: Penile fracture has typical signs. Standard treatment consists of immediate surgical repair of penile fracture with a low incidence of late complications. Post op complications including urethral strictures and erectile dysfunction should be ruled out by regular follow-up.

Type 2 diabetes mellitus: how well controlled in our patients?

BACKGROUND: Type 2 Diabetes mellitus has reached epidemic proportions worldwide and Pakistan is no exception. This study was done to see the glycaemic control of our diabetic patients by estimating Glycosylated haemoglobin & Fasting blood glucose as poor control leads to significant complications causing enormous human suffering & socioeconomic burden. METHOD: This Cross-sectional study was conducted on Type 2 diabetic patients coming to medical OPD and medical B ward of Ayub Teaching Hospital between March-September 2007 fulfilling the inclusion criteria. RESULTS: Among 100 patients with type 2 diabetes forty two had HbA1c more than 7.5%, while seventy had fasting blood glucose more than 120 mg/dl. All patients with HbA1c more than 7.5% had increased fasting blood glucose. While thirty out of seventy patients with fasting blood glucose more than 120 mg/dl had HbA1c less than 7.5%. None of the patients with fasting blood glucose less than 120 mg/dl had HbA1c more than 7.5%. CONCLUSIONS: Significant number of patients (42%) had poor control of diabetes as revealed by HbA1c, with FBG showing poor control in even more patients, i.e., 70%. However their blood glucose estimation was not frequent enough as required. Blood glucose results can be spuriously high and may lead to frequent change/increase in the dose of hypoglycaemic medications. This can lead to poor compliance as well as psychological trauma to patients. HbA1c on the other hand is easy to interpret, reflects long term glycaemic control and cost effective. We recommend its more frequent use along with blood glucose for better glycaemic control and decreased chances of complications.

A survey of urinary bladder injuries in Abbottabad.

BACKGROUND: Injury of urinary bladder is not very uncommon. It has iatrogenic and non iatrogenic causes. This study was designed to determine the pattern, mode of diagnosis and management of urinary bladder injuries presenting at Ayub Teaching Hospital, Abbottabad. METHODS: Ten years hospital record of urinary bladder injuries reporting at Urology, Surgical and Gynaecology wards of Ayub Teaching Hospital, Abbottabad was analysed. The cause of injury, associated injuries, diagnostic method and management protocols were analyzed. RESULTS: During 10 years period 260 patients were treated for bladder injuries. The age range was from 5-75 years while there were more males than females. In 35% the injuries were due to RTA, in 20% by a fall from a height, in 10% by a gun shot wound and in the remaining 35% the injury was iatrogenic. Gynaecological procedures were the major cause for iatrogenic bladder injuries. CONCLUSIONS: Most of the bladder injuries seen at our hospital are due to road traffic accidents or iatrogenic causes. Both of these factors can be minimized by taking appropriate steps to improve road safety and operative procedure safety respectively.