Journal of Surgery Pakistan

Index

2025-03-03T06:31:23+00:00

Quality Assurance In Surgical Practice

2025-03-03T06:37:31+00:00

Quality assurance of the services that are meant for the clients is an integral part of ensuring the same has been delivered as expected according to a set standard.1 This is a systematic process and is usually discussed in context of the industry. The manufacturing industry standards are well developed across the globe. These are meant to assess the quality of the products produced. Standard operating protocols are developed to achieve this goal.2 This concept is equally applicable to the medical discipline. However, it is still not applied stringently across the globe mainly in the low income countries.3 ……………

Sensitivity and Specificity of Initial Lactate Level in Predicting 24-Hour Mortality in Multi-Trauma Patients in Comparison to Revised Trauma Score

2025-03-03T06:48:35+00:00

Objective

To compare the ability of serum lactate levels and Revised Trauma Score (RTS) in predicting 24-hours mortality in hemodynamically unstable multi-trauma patients.

Study design

Cross-sectional analytic study.

Place & Duration of study

Dr. Ruth K. M. Pfau Civil Hospital Karachi, from February 2022 to August 2022

Methods

A total of 222 patients of 18 to 75-years of age who presented in the Emergency Department with multi-trauma were enrolled. The outcome variables noted were lactate level, Revised Trauma Score and mortality. All the collected data were entered into SPSS version 20 and analyzed.

Results

The mean age of the patients was 40.67±12.5 years. There was a male preponderance (n=170 – 76.6%). The most common mechanism of injury was stabbing (n=80 - 36%). The 24-hours’ mortality among patients with multi-trauma was 6.8% (n=15) and the area under the curve of lactate levels and Revised Trauma Score in predicting 24-hours mortality were 0.497 and 0.451 respectively. The findings were statistically insignificant.

Conclusion

In patients with multi-trauma the lactate level and Revised Trauma Score were not reliable in predicting the 24-hours mortality.

Key words

Multi-trauma, Mortality, Lactate level, Revised Trauma Score.

Assessment of Diagnostic Accuracy of the Risk of Malignancy Index in Ovarian Masses with Histopathology as the Gold Standard

2025-03-03T07:04:42+00:00

Objective

To ascertain the diagnostic accuracy of Risk of Malignancy Index (RMI) for diagnosing malignant ovarian masses taking histopathology findings as gold standard.

Study design

Cross sectional validation study.

Place & Duration of study

Department of Obstetrics & Gynecology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from May 2022 to November 2022.

Methods

Women between 20-years to 60-years of age with ovarian masses were enrolled by non-probability consecutive sampling methods. Demographic data like age, duration of the lesion, size of the mass were noted. Risk of malignancy index was calculated in each patient and malignant ovarian mass were identified. Surgery was then performed and specimen sent for histopathology to document the nature of the ovarian mass. RMI results were compared with histopathology findings.

Results

A total of 141 women were included. The mean age of the patients was 43.22±8.39 years and mean duration of the disease 6.55±1.48 months. Majority of the women (n=71-51.06%) presented with < 6-months duration of disease. In 91 (64.54%) women size of the lesion was < 3 cm. The overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of RMI for diagnosing malignant ovarian masses taking histopathology findings as gold standard were 88.10%, 91.23%, 93.67%, 83.87% and 89.36% respectively.

Conclusion

The diagnostic accuracy of RMI was high and helped in making preoperative diagnosis for planning treatment and counseling of the patients.

Key words

Ovarian tumor, Risk of malignancy index, Diagnostic accuracy, Malignant tumors.

Association of Obesity With Complications of Acute Pancreatitis

2025-03-03T07:12:12+00:00

Objective

To determine the association between obesity and complications of acute pancreatitis including mortality, pancreatic necrosis and organ failure.

Study design

Cohort study.

Place & Duration of study

This prospective study was done in the Department of General Surgery, Jinnah Postgraduate Medical Center (JPMC) Karachi, from February 2024 to June 2024.

Methods

The study included 184 patients with acute pancreatitis. Patients were divided into obese and non-obese categories based on their BMI. There were 92 obese individuals with body mass index (BMI) > 30 kg/m² and 92 individuals who were non-obese. Clinical, physiological, and biochemical data were collected and analyzed to assess any statistically significant association.

Results

The mean age of the patients was 54.33±11.22 years and 54.24±13.20 years for obese and non-obese groups. Majority (n=99-53.8%) of our patients had moderate category of pancreatitis. The in-hospital mortality rate among obese patients diagnosed with acute pancreatitis was higher (n=14 - 15.2%) as compared to non-obese patients (n=3 - 3.3%). Moreover, in comparison to non-obese patients, pancreatic necrosis and organ failure were more frequently observed in obese patients (n=17 - 18.5%) and (n=44 - 47.8%) respectively. The relative risk of mortality and organ failure were significantly elevated among obese individuals than non obese patients (RR=1.763 and 1.601, respectively).

Conclusion

Obesity significantly correlates with worse outcomes in patients with acute pancreatitis, including higher mortality and organ failure rates. This highlights the importance of BMI as a significant predictor of complications

Key words

Pancreatitis, Respiratory distress syndrome, Multiple organ failure, Gallstones, Hospital mortality.

Role of Exercise In Prevention of Gestational Diabetes Mellitus Among Pregnant Women

2025-03-03T07:18:08+00:00

Objective

To find out role of exercise in pregnant women in prevention of gestational diabetes mellitus (GDM).

Study design

Comparative cohort study.

Place & Duration of study

Al-Tibri Medical College, Isra University Campus Karachi, from June 2022 to December 2022.

Methods

The participants were assigned to either Group A or Group B on their first visit after performing oral glucose tolerance test. Group A included pregnant women who were encouraged to engage in brisk exercise for thirty minutes three times a week. The brisk walk was defined as 100 steps per minute. Group B consisted of women who received standard prenatal care. All participants were evaluated every two weeks until they reached 28-week of gestation. Compliance was verified at each appointment. Data were recorded using a specially designed form. Chi square test was applied for statistical significance.

Results

A total 110 pregnant women filled/answered the questionnaire. The mean age of the pregnant women was 25.56±4.41 years. Of the total, 70 % women were between the age of 18-27 years. There was a significant difference between the number of women diagnosed with GDM between the two groups (Group A: n=1 - 0.9% versus Group B: n=10 - 9.1%) with p=0.009. No significant difference was found between the family history of diabetes mellitus, BMI, congenital abnormality or weight of the baby in past pregnancies.

Conclusion

A significant association was noted between physical exercises and frequency of GDM. Other variables studied like maternal age and BMI of pregnant women were found insignificant.

Key words

Exercise, Gestational diabetes mellitus, Pregnant women, Lifestyle modification.

Screening of Women For HIV, Hepatitis B and Hepatitis C in Antenatal Clinic

2025-03-03T07:24:04+00:00

Objective

To estimate the frequency of HIV, Hepatitis B, and Hepatitis C among women attending antenatal clinics in a low-income area.

Study design

Descriptive cross-sectional study.

Place & Duration of study

Antenatal clinic of United Medical and Dental College / Creek Hospital Karachi, from July 2023 to December 2023.

Methods

All women meeting the selection criteria were enrolled after taking informed consent. The blood samples (5 ml each) were obtained from all the participants and sent for the diagnosis of HIV, Hepatitis B, and Hepatitis C. For antibody/antigen detection, a positive result was defined by the presence of specific antibodies/antigen, as detected by electrochemiluminescence (ECL) immunoassay, with a threshold signal value of 0.9-1.0. For HIV antigen P-24 and antibody, Anti HIV1+Anti H1V2 were tested. Hepatitis B antigen and Hepatitis C antibody were also tested.

Results

This study enrolled 700 pregnant women with a mean age of 25.9±4.56 years. The mean age of their spouses was 30.6±5.87 years. The mean parity was 2.54±2.15 and a mean trimester duration of 4.21±2.36 months. Among the study participants one (0.1%) woman was diagnosed as having HIV, 14 (2.0%) Hepatitis C, and three (0.4%) with Hepatitis B.

Conclusion

A relatively low frequency of HIV and Hepatitis B were found in the pregnant women. However, Hepatitis C was notably high in this cohort of women.

Key words

HIV, Hepatitis C, Hepatitis B, Antenatal care.

A Child With Stray Bullet Injury To Sauer’s Danger Zone: An Unusual Presentation – A Case Report

2025-03-03T07:29:25+00:00

ABSTRACT

Celebratory firings are common in many countries. These may cause significant harm to the victims who accidently get injured by a stray bullet. We report a 10-year-old male child who got injured by a stray bullet while he was sleeping at the roof top. A single entry wound was found on anterior chest on right side in third intercostal space just to the right of sternum. His general condition gradually deteriorated and needed chest intubation and packed cells transfusion. He responded to the conservative management and discharged after improvement. He survived in spite of significant mechanism of injury involving the danger zone of chest where bullet penetrated the body.

Key words

Stray bullet injury, Thoracic trauma, Sauer’s Danger zone, Child.