An experience of mass administration of fractional dose inactivated polio vaccine through intradermal needle-free injectors in Karachi, Sindh, Pakistan.

BACKGROUND: Inactivated Polio Vaccine (IPV) campaign was conducted in February 2019 in Karachi where needle-free injectors were introduced for the administration of the fractional dose of IPV (fIPV) on a large scale. This study aimed to determine the impact of needle-free injectors on vaccination coverage. METHODS: In four towns of Karachi, fIPV was given using needle-free injectors "PharmaJet Tropis ID". Whereas, in six towns full dose of IPV was administered to children of 4-59 months of age. Cluster surveys through rapid convenience assessment method were conducted after the completion of vaccination activity. RESULTS: A total of 33,815 households' data was analyzed. Among these, 27,650 (82.8%) children were vaccinated. In fIPV areas, 85.3% of children were vaccinated compared to 79.5% in full dose IPV areas. A comparison of reasons for unvaccinated showed that 1.6% of parents do not give importance to vaccination in fIPV areas compared to 4.2% in full IPV areas (p-value < 0.0001). More children were not vaccinated due to fear of injection 1.8% in full IPV areas compared to 0.7% in fIPV areas (p-value < 0.0001). The source of campaign information shows that more frequent mobile miking 3.1% was observed in fIPV areas compared to 0.4% in full IPV areas (p-value < 0.0001). CONCLUSIONS: Our analysis supports the fractional dose of IPV in mass campaigns to achieve good vaccination coverage especially using needle-free injectors "PharmaJet Tropis ID" and vigorous social mobilization activities are expedient in accomplishing high coverage.

OUTCOME OF LAPAROSCOPIC TOTALLY EXTRAPERITONEAL HERNIOPLASTY FOR INGUINAL HERNIA.

BACKGROUND: Hernioplasty for Inguinal hernia is one of the commonest operations performed in general surgical wards. More recently, interest has waxed and waned regarding the minimally invasive approach to hernioplasty. This study was carried out to assess the management outcome of minimally invasive hernioplasty (Totally extra-peritoneal approach) as the treatment of choice for uncomplicated (incomplete and reducible) inguinal hernia. METHODS: In this quasi experimental study patients aged between 14-83 years who were otherwise fit and willing for total extra-peritoneal laparoscopic repair were recruited prospectively over a 10 month period. Thirty-seven such patients were operated and followed up in the hernia clinics. Six cases were later excluded for lack of proper follow-up. RESULTS: The typical patient was middle-aged male with right-sided inguinal hernia. Mean operating time was 53.3 minutes. No conversion was undertaken; however, there was one case of small bowel injury that went unrecognized on-table but necessitated subsequent laparotomy. Overall morbidity was 13.5%. Mean length of hospitalization was 2.89 days. Mean duration to normal routine life was 9.25 days. Overall, 70.9% of patients expressed satisfaction with the surgery. CONCLUSION: Totally extra-peritoneal mesh repair is a new and safe technique for hernioplasty with acceptable rates of morbidity and it is procedure of choice for recurrent and bilateral inguinal hernias and also used as alternate to open hernioplasty for uncomplicated (incomplete and reducible) inguinal herma.

Polydioxanone Versus Polypropylene Closure For Midline Abdominal Incisions.

BACKGROUND: Midline laparotomy is the most common technique of abdominal incisions because it is simple, provides adequate exposure to all four quadrants, and is rapid to open. A major problem after midline laparotomy remains the adequate technique of abdominal fascia closure. This study was conducted to see the role of Polydioxanone and Prolene for midline abdominal closure in terms of postoperative wound infection and wound pain. METHODS: This study was carried out at surgical unit II, Federal Government Services Hospital Islamabad. Patients were equally divided in two groups, i.e., A and B. Groups A and B patients undergone midline abdominal closure with Polydioxanone number 1 and Polypropylene number 1 sutures respectively. RESULTS: Total 620 patients were included in this study. Post-operative wound pain score according to Visual analogue scale (VAS) was compared in terms of no pain (0), mild pain (1-3), moderate pain (4-6), severe pain (7-9). In group A (Polydioxanone), the frequency and percentages of no, mild, moderate and severe pain were 101 (32.6%), 95 (30.6%), 81 (26.1%) and 33 (10.6%) respectively, where as in group B (polypropylene) it was 82 (26.5%), 43 (13.9%), 59 (19%) and 126 (40.6%) respectively. Similarly, the frequency and percentages of post-operative wound infection in group A (Polydioxanone) and group B (polypropylene) was 105 (33.9%) and 208 (67.1%) respectively. CONCLUSIONS: Polydioxanone results in less wound pain and wound infection when compared to Polypropylene.