Combined Military Hospital Rawalpindi Research Articles

Perioperative Outcomes after Elective Laparoscopic Cholecystectomy in High Risk Patients

Background: The global population is aging, leading to an increased incidence of acute cholecystitis and associated complications in the elderly. While laparoscopic cholecystectomy is the gold standard for treating acute cholecystitis, its safety and outcomes in high-risk, elderly patients with comorbidities are not well-documented. Objective: To compare postoperative complications, hospital stay duration, and nursing care requirements between high-risk elderly patients undergoing tube cholecystostomy versus early elective laparoscopic cholecystectomy for acute cholecystitis. Methods: This cross-sectional comparative study was conducted at Combined Military Hospital Rawalpindi from July 2021 to January 2022. A total of 70 patients aged 40-80 years and classified as ASA 3 or 4 were included. Patients were divided into two groups: Group 1 (n=35) underwent tube cholecystostomy followed by interval cholecystectomy after six weeks; Group 2 (n=35) underwent early elective laparoscopic cholecystectomy within 72 hours of admission. Data on hospital stay, postoperative complications, and nursing care were collected and analyzed using SPSS version 25.0. Quantitative data were presented as mean ± standard deviation (SD), and qualitative data as frequency and percentage. Independent t-tests were applied, with a p-value of less than 0.05 considered statistically significant. Results: In Group 1, 91% of patients had a hospital stay of less than 5 days compared to 11% in Group 2 (p=0.000). Group 1 had 94% of patients nursed in the ward/HDU, while 94% of Group 2 required ICU care (p=0.000). Postoperative complications were significantly lower in Group 1, with 97% having no complications compared to 34% in Group 2 (p=0.000). Only 3% of Group 1 required multidisciplinary team management versus 66% in Group 2. Conclusion: Tube cholecystostomy is a safer and more effective initial management strategy for high-risk elderly patients with acute cholecystitis, leading to shorter hospital stays, less intensive postoperative care, and fewer complications compared to early elective laparoscopic cholecystectomy.

Outcomes of Septal Surgery with Nasal Packing Versus Quilting Sutures

Background: Septoplasty is a common surgical procedure used to correct a deviated nasal septum, which can cause nasal obstruction and impact respiratory function. Postoperative management traditionally includes nasal packing to prevent complications such as bleeding and hematoma, although it can be associated with discomfort and other complications. Quilting sutures have been proposed as an alternative technique to reduce these issues. Objective: To compare the postoperative outcomes of nasal packing versus quilting sutures in patients undergoing septoplasty. Methods: This prospective comparative cross-sectional study was conducted at the ENT unit of Combined Military Hospital Rawalpindi, Pakistan, after obtaining ethical approval. The sample size comprised 384 patients, with 192 in the nasal packing group and 192 in the quilting sutures group. Inclusion criteria included patients aged 18 to 70 years undergoing elective nasal septoplasty. Exclusion criteria were patients with nasal polyps, allergic rhinitis, diabetes, coagulation disorders, septal flap tears, those unfit for surgery, and those undergoing combined septoplasty and turbinate intervention. Patients were randomly assigned to either nasal packing or quilting sutures groups. Baseline characteristics, including age, gender, and BMI, were documented. Postoperative assessments were conducted at 48 hours, 1 week, and 3 months, evaluating pain using a visual analogue scale (VAS), bleeding, epiphora, dyspnea, hematoma, and adhesions. Data analysis was performed using SPSS version 26.0, with quantitative data represented as mean ± standard deviation and qualitative data as percentages and frequencies. Statistical significance was determined using chi-square and unpaired two-tailed Student’s t-tests, with p < 0.05 considered significant. Results: The mean age of participants was 34.37 ± 6.95 years. Gender distribution included 256 males (66.7%) and 128 females (33.3%). At 48 hours postoperatively, the nasal packing group had a higher mean pain score (5.96 ± 1.39) compared to the quilting sutures group (2.03 ± 1.05) (p < 0.001). Bleeding was more significant in the quilting sutures group (1.82 ± 0.60) than in the nasal packing group (1.27 ± 0.45) (p < 0.001). Epiphora and dyspnea were more common in the nasal packing group, with 48 patients (25%) and 81 patients (42.2%), respectively, compared to 8 patients (4.2%) and 6 patients (3.1%) in the quilting sutures group (p < 0.001). Hematoma occurrence was low and not significantly different between the groups. After 1 week, pain scores remained higher in the nasal packing group (1.45 ± 1.12) compared to the quilting sutures group (0.58 ± 0.79) (p < 0.001). At 3 months, pain scores were still higher in the nasal packing group (1.45 ± 1.12) compared to the quilting sutures group (0.58 ± 0.80) (p < 0.001), with no significant difference in adhesion formation. Conclusion: Quilting sutures resulted in lower postoperative pain and fewer complications compared to nasal packing in patients undergoing septoplasty, despite a slightly higher risk of bleeding. These findings suggest that quilting sutures may be a preferable alternative to nasal packing for postoperative management in septoplasty.

Comparative Efficacy of Goserelin vs. Leuprolide in Advanced Prostate Cancer in Patients Undergoing Androgen Deprivation Therapy

Comparative Efficacy of Goserelin vs. Leuprolide in Advanced Prostate Cancer in Patients Undergoing Androgen Deprivation Therapy

Frequency of 17p Deletion in Chronic Lymphocytic Leukemia Patients Presenting to Combined Military Hospital Rawalpindi

Frequency of 17p Deletion in Chronic Lymphocytic Leukemia Patients Presenting to Combined Military Hospital Rawalpindi

The Factors Impacting Decision-Making for Breast Reconstruction in Women Following Mastectomy: A Cross-Sectional Study

OBJECTIVES This study aimed to assess the Factors Impacting Decision-Making for Breast Reconstruction in Women Following Mastectomy in Combined Military Hospital, Rawalpindi METHODOLOGY This prospective cross-sectional study was conducted at a specialized Breast Clinic in the Combined Military Hospital Rawalpindi from January to June 2023. The sampling technique was non-probability sampling. A total of 56 female patients between the ages of 20-70 years with a histological diagnosis of carcinoma breast and undergoing mastectomy as part of their breast cancer therapy were included in the study. Patients who had metastatic cancer or connective tissue disorder were excluded from the study. After getting informed written consent, data was collected from patients. A semi-structured questionnaire was used as a study tool. Data was presented in the form of tables. RESULTSThe surgical preference of 56 patients was studied. Only 11(19.6%) patients opted for breast reconstruction. A total of 45(80.4%) patients refused to undergo BR. Several factors affecting the decision not to have BR were identified. They included fear of recurrence in 07 (15.5%) patients, long surgical procedures in 06 (13.3%), lack of concern regarding body image in 11(24.4%), financial issues in 13 (28.8%) patients, unsatisfactory results of breast reconstruction in 8 (17.7%) patients who had lack of trust in plastic surgeon regarding their post reconstruction breast shape. CONCLUSION This study laid the conceptual groundwork that factors like fear of recurrence, long surgical procedures, disregard for body image, poverty, and plastic surgeon distrust negatively influence the likelihood of having post-mastectomy breast reconstruction (PMBR). Methods: From January 2023 to June 2023, this cross-sectional study, carried out at a specialized Breast Clinic in the Combined Military Hospital Rawalpindi, sought to explore surgical preferences for breast reconstruction (BR) among breast carcinoma patients undergoing mastectomy and to identify factors influencing these decisions. 42 patients in all were enrolled, 8 of them selected breast reconstruction while 34 did not. The decision-making process was influenced by a number of issues, such as worry about recurrence, worries about time-consuming surgical procedures, and disregard for body image, financial limitations, and previous unsuccessful reconstructive results. Results: 28 patients had right-sided disease, 13 had left-sided cancer, and 1 had bilateral involvement, according to disease features. Furthermore, 25 individuals had N0 disease, while 17 had N1 disease, according to nodal staging. Six patients had sentinel lymph node biopsy (SLNB), two underwent axillary lymph node dissection (ALND), five chose upfront surgery, and three underwent neoadjuvant therapy before surgery, demonstrating the range of the surgical methods used. Conclusion: This study provides insightful information about the complex decision-making process involving breast reconstruction in individuals with breast cancer. The identified characteristics give healthcare professionals a framework on which to build strategies that guarantee patients receive educated and individualized care, thereby improving patient happiness and quality of life in general. Key words: breast, tumor, surgery, lymph node, reconstruction, aesthetic

Analgesic efficacy of Ultrasound-Guided Caudal Block versus Pudendal Nerve Block in BRAKA - I Repair for Paediatric Hypospadias

Objective: To compare the efficacy of ultrasound-guided caudal versus pudendal nerve block analgesia in paediatric patients undergoing hypospadias. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Rawalpindi, Pakistan from Mar to Sep 2022. Methodology: Paediatric patients with ages ranging from 4-12 years with ASA Grade I/II planned for hypospadias repair were included. Sixty-eight patients were divided into Group-C (caudal block) and Group-P (pudendal nerve block), after randomization. Group-C patients received ultrasound-guided caudal block while pudendal nerve blockade was performed under ultrasound guidance in Group- P. Demographic variables, requirement of rescue analgesics, CHEOPS scoring at 0, 1, 2,6 and 12 hours, and complications in the intraoperative period were recorded. Results: Pain scores at the 6th and 12th hour were significantly reduced in Group-P compared to Group-C. Requirement of analgesia was lesser in Group P 01(2.9%) compared to 11(32.3%) in Group C with a p-value of 0.006. Out of 34 patients in Group-C 07(20.6%), patients encountered complications compared to Group-P, which had no complications. Conclusion: Ultrasound-guided pudendal nerve block is superior to caudal block in providing adequate perioperative analgesia with fewer complications and decreased requirement of additional analgesic supplements.

Response Of Bortezomib, Cyclophosphamide And Dexamethasone Induction Chemotherapy In Multiple Myeloma Patients Presenting To Combined Military Hospital Rawalpindi

Objective: To determine the response rate and tolerability of Bortezomib, Cyclophosphamide and Dexamethasone (VCD) induction therapy in multiple myeloma patients. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Oncology, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2020. Methodology: Patients of either gender aged >20-65 years, newly diagnosed cases of multiple myeloma, Durie-Salmon stage II/III, were included. Patients were given Bortezomib, Cyclophosphamide and Dexamethasone induction therapy for a 21-day cycle. Response rate and tolerability were measured. Results: A total of 147 patients were included in the study. There were 75(51%) male and 72(49%) female.The overall response rate was seen in 93(63.3%) patients, complete response was seen in 30(20.4%), and partial response was seen in 63(42.9%) patients. The overall response rate was significantly associated with age, myeloma type, and Karnofsky's performance status (p-value<0.001). Conclusion: The novel sequential 3-drug combination of Bortezomib, Cyclophosphamide and Dexamethasone is safe and well tolerated for multiple myeloma patients. The results of the current study increase evidence of a moderately high response rate with Bortezomib, Cyclophosphamide and Dexamethasone induction therapy.

Presentation Of Post Cholecystectomy Bile Duct Injuries In A Tertiary Care Hospital

Introduction:The occurrence of iatrogenic bile duct injuries is few, however potentially linked to life-threatening complications, particularly following the advent of laparoscopic cholecystectomy. Aims &Objectives: To evaluate the presentation of post-cholecystectomy bile duct injuries in a tertiary care hospital. Place and Duration of Study: This study was done in the Department of General Surgery at Combined Military Hospital Rawalpindi from Nov 2020 to Dec 2021. Material &Methods: This cross-sectional study was conducted on 15 subjects with post-cholecystectomy bile duct injuries.All the patients who presented to the emergency department and outdoor were included in the study and had post-cholecystectomy CBD injuries. Laparoscopic and open BDI were classified according to Strasberg classification. In descriptive statistics, mean, and standard deviation was used, and in qualitative analysis, frequency and percentages were calculated with the help of the SPSS 23 version, a p-value of? 0.05 was considered significant. Results: In our study, 5 (33.3 %) males and 10 (66.7 %) were females, with a mean age of 47.27 ± 4.79. The presentation on the admission of patients was as follows, 3 (20.0 %) patients had biloma, 4 (26.7 %) had jaundice, 2 (13.3 %) had abdominal pain, 1 (6.7 %) had external biliary fistula, 3 (20.0 %) had Biliary peritonitis and 2 (13.3 %) had a fever. Conclusion: The most common consequence of cholecystectomy was complete resolution, but bile leak and major duct damage cause considerable morbidity, death, and healthcare expenditures. Better outcome was achieved when a nonprimary and skilled hepatobiliary surgeon repaired severe bile duct damage.

THE PATTERN OF WHEEL SPOKE INJURY TREATED AT COMBINED MILITARY HOSPITAL RAWALPINDI

This research investigated the characteristics and patterns of wheel spoke injuries treated at Combined Military Hospital Rawalpindi. The study was conducted at Combined Military Hospital Rawalpindi, a prominent healthcare facility in Rawalpindi, Pakistan, providing medical services to military personnel and civilians. The research analyzed data gathered over a year regarding wheel spoke injuries. A random sample of eighty-two patients was selected, and data was collected on demographic information, injury specifics, clinical presentations, treatments, and outcome measures to provide a quantitative analysis. The study's results showed that the average time elapsed from injury to presentation was 6 hours. Most injuries occurred on the right foot (37 patients) and were associated with the rear wheel (34 patients). Injuries to the lateral aspect of the ankle were common (73%), with the posterior ankle being the most frequent site (n=30). Soft-tissue injuries were classified into grades 0, 1, 2, and 3, with changes in grading noted in some cases. Patients with grade 0 or 1 injuries healed faster (mean 28 days) than those with grade 2 or 3 (mean 40 days). Eight patients had associated fractures, all healed without complications with a mean healing time of 18 days. The study concluded that wheel spoke injuries are common and are often found near the Achilles tendon. Injury classification is critical for treatment decisions and predicting prognosis. Monitoring for infection and necrosis within 48 hours is vital due to poor vascularity. Customized treatment approaches, including below-knee back splints, ankle foot orthoses, and debridement, are recommended based on injury characteristics.

Outcome of Surfactant-Administration in Neonates with “Meconium-Aspiration-Syndrome”

Background: Combined Military Hospital in Rawalpindi, surfactant treatment to newborns with meconium aspiration syndrome (MAS) was studied for its effectiveness. 100 newborns with MAS who underwent surfactant treatment between [30 June] 2021 and [30 July] 2022 were a part of this prospective trial. Mortality, the need for oxygen, the demand for mechanical ventilation, and the duration of hospital stay were the main outcome measures. The frequency of pneumothoraxes used as the secondary outcome indicator. The study's findings demonstrated that the administration of surfactants considerably decreased mortality [03%] vs [10%] oxygen consumption [50%] vs. [71%], the need for mechanical breathing [20%] vs. [45%], and hospital stay [05-06] days vs. [08-05] days. Additionally, there was a considerable reduction in the incidence of pneumothorax [10%] vs. [15%]. These results imply that the use of surfactants might lessen the mortality and morbidity linked to MAS in newborns. Aim: Combined Military Hospital Rawalpindi's newborns with meconium aspiration syndrome (MAS) were the subject of this research to determine the effects of surfactant treatment. It evaluated both the treatment's main and secondary results. Methods: The Department of Neonatology at the Combined Military Hospital in Rawalpindi performed this prospective research on a sample of hundred newborns with MAS who underwent surfactant treatment between [June 30], 2021, and [July 30] 2022. Mortality, the need for oxygen, the demand for mechanical ventilation, and the duration of hospital stay were the main outcome measures. The frequency of pneumothoraxes used as the secondary outcome indicator. Results: The study's findings demonstrated that the administration of surfactants considerably decreased mortality [03%] vs [10%], oxygen consumption [50%] vs [71%], the need for mechanical breathing [20%] vs [45%] and hospital stay [5-6 days] vs [8-5 days]. Additionally, there was a considerable reduction in the incidence of pneumothorax (10% vs. 15%). Conclusion: the use of surfactants might lessen the mortality and morbidity linked to MAS in newborns. Keywords: Surfactant, Neonates, Results, Meconium Aspiration Syndrome

ANALGESIC EFFICACY OF ULTRASOUND GUIDED BILATERAL SUBCOSTAL TRANSVERSUS ABDOMINIS MUSCLE PLANE BLOCK AND PORT SITE INFILTRATION WITH BUPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY

Objective: To evaluate the postoperative analgesic efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane block in comparison to port-site local anesthetic infiltration in patients undergoing elective lapa­roscopic cholecystectomy. Methodology: It was a Quasi experimental study, conducted in Combined Military Hospital Rawalpindi, over 6 months, from 13/4/21 till 13/10/2021. Patients numbering 92 of both genders fulfilling inclusion criteria were incorporated and placed into 2 groups equally. Group O (n=46) underwent ultrasound guided bilateral subcostal transversus abdominis plane block using 0.25% bupivacaine with volume dosage of 0.4ml/kg divided by 2, one part for each side. In Group-P (n=46) total dose of bupivacaine (0.25%, volume dose of 0.4ml/kg) was divided by total number of ports used and one portion was infiltrated at each port-site at the completion stage of surgery. Post-operative pain score, quantity of post-operative analgesia and patient satisfaction scores were calculated. Results: Mean tramadol usage in Group-O was 109.56 ± 15.04 mg compared with 155.21 ± 22.18 mg of Group-P (p value <0.001 for both). Visual Analog pain scores were lesser in Group-O all the times. Patient satis­faction scores were 3.30 ± 0.66 and 2.71 ± 0.98 for Group-O and Group-P respectively. Conclusion: Ultrasound guided subcostal Transversus abdominis plane block is effective in contributing to post-operative analgesia following laparoscopic cholecystectomy and is superior to port site infiltration. It decreas­es pain scores, post-operative analgesia requirement and increments patient satisfaction compared with port-site infiltration.

Comparison of Cervical Lymph Nodes Dissection for Excisional Biopsy “Simple Dissection Technique vs. Improvised Loop Traction Technique”

Aim: To compare improvised loop traction dissection with simple dissection technique for lymph node excisional biopsy of cervical region Study design: Cohort study. Place: Combined Military Hospital Rawalpindi, Abbottabad, Multan & Peshawar. Duration: September 2013 – January 2022. Methodology: cervical region Lymph nodes with intact architecture more than 1 centimeter were considered for this study while lymph nodes of the cervical region with distorted architecture and size <1cm were not included in this study. Among 530 patients, two dissection techniques (simple and improvised loop) were adopted. The lymph nodes to be removed were detected with palpation or through ultrasound and imaging such as computed tomography (CT). An open biopsy surgical procedure with or without modification was adopted. In the first group-I (n=206), Lymph node dissection was continued with the conventional technique, and in the group (n=324) lymph node was inserted with a silk suture for traction as the loop is adopted. The post-procedural assessment was for the difficulty level of dissection was done. Results: Among 530 Patients (Male=76.03%: Female=23.96%), the mean age in years of the patient was simple dissection technique n=206(range=20-69 mean 39) and loop techniques n=324(mean 41 and range 21-66). On average, 19.30 minutes for loop improvised and structural preservation was 69.75% (226), while rupture with the simple technique was observed in about 18(8.7%). The dissection time was less among patients with improvised loop technique and architectural preservation. Conclusions: Inserting silk suture as a double loop reduces duration and facilitates dissection in preserving architecture of lymph node sample Keywords: improvised loop technique, griping& holding, preserved architecture

The Outcome of Obesity in Pregnancy: A Cross-Sectional Study

Objective: To find out fetal and maternal outcomes among obese pregnant females.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Gynaecology and Obstetrics, Combined Military Hospital Rawalpindi, from Jun 2020 to Jun 2021.
 Methodology: A total of 124 pregnant obese women (BMI more than 30kg/m2), gestational age between 13-24 months, having fasting blood glucose and blood pressure within normal limits were enrolled in the study and were subsequently followed throughout pregnancy upon antenatal visits scheduled as per guidelines. Participants with diabetes mellitus or hypertension,above 40 years of age, family or previous history of gestational diabetes, and pre-eclampsia were also excluded from the study. Fetal and maternal outcomes were noted.
 Results: One hundred and twenty-four (124) pregnant obese women were enrolled in the study with a mean age of 33.7±4.1 years (21 -38 years). Out of which, 86(69.4%) had cesarean section primarily due to pre-eclampsia, prolonged or dysfunctional labour causing fetal distress. There were 8 cases of miscarriage and 3 cases of stillbirth. 26(21.0%) women presented with gestational diabetes mellitus, 31(25.0%) with pre-eclampsia and 12(9.7%) developed both conditions. There were 7(5.6%) participants who delivered babies with macrosomia, 1(0.8%) anencephaly, 3(2.4%) congenital deafness and 1(0.8%) cleft lip.
 Conclusion: Obesity in pregnancy can lead to serious maternal and fetal outcomes ranging from abortions to neonatal anomalies and fetal death. A high index of suspicion is required to diagnose and manage these difficult conditions.

Variations in Lipid Profile During Critical Illness

Objective: To determine to mean change in levels of Triglycerides (TG), Total cholesterol (TC), High-Density Lipoprotein Cholesterol (HDL-C), and low-density lipoprotein (LDL-C) in critically ill patients at admission,18 hours and 42 hours after admission.
 Study Design: Cross-sectional study
 Place and Duration of Study: Department of Chemical Pathology & Endocrinology, Armed Forces Institute of Pathology Rawalpindi (AFIP), in collaboration with Military Hospital Rawalpindi (MH), Combined Military Hospital Rawalpindi (CMH) and Armed Forces Institute of Cardiology Rawalpindi (AFIC) Pakistan, from Mar to Sep 2016.
 Methodology: A total of Fifty patients admitted to intensive care units of MH, CMH and AFIC for coronary artery disease(CAD), sepsis, burns and cancer were included in the study. Patients on lipid-lowering drugs and post-surgery patients were excluded.TC, HDL-C, LDL-C and TG were analysed on ADVIA 1800 (SIEMENS, Germany).
 Results: Fifty patients were included with mean age of 48.12±2.26 years. Parametric analyses revealed significant increase in serum TG levels during hospitalization in critically ill patients in various disease groups (Mean±SD at admission, 18 hours and 42 hours): TG (CNS disorders 1.35±0.18, 1.78±0.24 and 1.22±0.17; CVS 1.92±0.21, 2.15±0.28 ,2.32 ±0.20; sepsis 1.55±0.18,1.38+0.24,1.54+0.17; malignancies 1.24±0.31, 1.28+0.42,1.35+0.30; renal disorders 1.39+0.35,1.82+0.47,1.08+0.33; (p<0.05). TC decreased in sepsis, CVS and cancer patients while increasing in CNS and renal disorders. HDL-C and LDL-C decreased in all diseases as an acute stress response.
 Conclusions: During critical illness, TG and LDL-C may change significantly; therefore, they should be monitored and interpreted with extreme care if requested to be performed within the course of the disease.

Osteoporosis/Osteopenia in Post-Menopausal Breast Cancer Patients Receiving Hormonal Therapy

Objective: To analyze the presence of osteoporosis and osteopenia in post-menopausal breast cancer patients receiving hormonal therapy.
 Study Design: Comparative Cross-sectional Study.
 Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021.
 Methodology: This study was conducted on 200 post-menopausal female breast cancer patients who had been taking Aromatase inhibitors for more than six months. All the study participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to measure bone mineral density. As a result, they were classified as having osteoporosis or osteopenia based on bone mineral density. In addition, age, duration of therapy, tumour stage and molecular subtypes of breast cancer were correlated with the presence of osteopenia/osteoporosis in the study participants.
 Results: A total of 200 post-menopausal patients with breast cancer using hormonal therapy for more than six months were included in the final analysis. The mean age of the patients was 56.331 ± 6.744 years. In addition, 55 (22.5%) patients had normal bone mineral density, 92 (46%) had osteopenia, while 53 (26.5%) had osteoporosis on a dual-energy X-ray absorp- tiometry (DEXA) scan. Molecular subtypes of the tumour, the advancing age of patients and the long duration of hormonal therapy were statistically significantly associated with the presence of osteopenia/osteoporosis (p-value <0.05) in our study participants.
 Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking hormonal therapy showed the presence of osteopenia and osteoporosis. Molecular subtyping, the advanced age of patients and the long duration of hormonal therapy significantly predicted.........

Complete Blood Count in Preoperative Assessment of Acute Appendicitis -A Different Aspect

Objective: To study the role of neutrophils to lymphocytes ratio in predicting the severity of acute appendicitis among patients managed at tertiary care hospital.
 Study design: Cross-sectional study.
 Place and Duration of Study: Department of Surgery Combined Military Hospital Rawalpindi, from Jan to Jun 2021.
 Methodology: Three hundred patients diagnosed with acute appendicitis by a consultant surgeon were included in the study. The neutrophil to lymphocyte ratio was calculated at the time of diagnosis. The severity of the appendix was assessed at the time of surgery and graded between grades 0 and IV, depending upon the gross clinical findings. The severity grade of acute appendicitis and other factors was associated with the neutrophil-to-lymphocytes ratio in all the patients.
 Results: Out of 300 operated patients with the clinical diagnosis of acute appendicitis, 169 (56.3%) were males, while 131 (43.7%) were females. The mean age of the study participants was 31.21 ± 2.127 years. Based on severity, 60 (20%) had grade 0, 100 (33.3%) had Grade-I, 86 (28.7%) had Grade-2, 35 (11.7%) had Grade-III, while 19 (6.3%) had a Grade-IV appendicitis. 192 (64%) had neutrophil-to-lymphocyte ratio < 4.6 while 108 (36%) had more than 4.6. Chi-square test revealed that severity of acute appendicitis and raised C-reactive protein had a statistically significant correlation with raised neutrophil to lymphocyte ratio (p-value<0.05).
 Conclusion: Neutrophil to lymphocyte ratio was significantly raised in patients presenting with acute appendicitis. Raised C reactive protein and high grade of appendicitis were found significantly more in patients with raised neutrophil to....

Discordance of Diagnostic Core Biopsy and Final Histopathology Performed after Surgical Resection of Breast Cancer

Objective: To determine the frequency of discordance of receptor status in our breast cancer patients, find out its causes, and suggest remedial measures.
 Study Design: Retrospective longitudinal study.
 Place and Duration of Study: Breast clinic and Radiation Oncology Department of Combined Military Hospital Rawalpindi Pakistan from Jan 2018 to Nov 2021.
 Methodology: Estrogen Receptor, Progesterone Receptor and Her2 Neu status differences between diagnostic tru-cut biopsy and surgical specimen were compared.
 Results: Receptor status between initial core biopsy and final histopathology of 63 patients were compared. Discordance rates of 05 (7.90%), 13 (20.60%) and 12 (19%) were noted for Estrogen receptor, progesterone receptor and Her2, respectively. The highest discordance noted was for the progesterone receptor, followed by the HER2 receptor and the Estrogen receptor.
 Conclusion: The highest discordance noted was for the progesterone receptor, followed by the HER2 receptor and the Estrogen receptor. Further studies are required to know more about the causes of receptor status discordance, its impact on treatment decisions and its impact on disease progression and survival.

Knowledge and Attitude Towards Sexual Practices During Pregnancy

Objective: To explore the knowledge, attitude and sexual practices among pregnant women reporting to a tertiary care hospital
 Study Design: Cross-sectional analytical study.
 Place and Duration of Study: Antenatal clinic of Obstetrics & Gynaecology Department, Combined Military Hospital Rawalpindi Pakistan, from Jan to Jun 2020.
 Methodology: Three hundred and seventy women who attended the antenatal clinic during the study period were interviewed. The responses to chosen preferences were recorded on a structured questionnaire.
 Results: The majority of participants believed that intercourse could be done throughout pregnancy, it does not result in complications, and improves marital relationships. However, it was difficult due to the changed physical appearance, but it was not unpleasant for the husband. Only 51.1% of participants agreed to decreased libido. 77.6%, 71.6% and 75.4% were of the opinion that it was not prohibited in religion, neither influence baby nor labour respectively.
 Conclusion: Most pregnant women maintain sexual activity during pregnancy. The majority had adequate knowledge and a positive attitude.

Ewing Sarcoma of Chest Wall: Analysis of 19 Patients

Objective: To share the short and long term outcomes of the patients having Ewing Sarcoma of the chest wall.
 Study Design: Prospective longitudinal study.
 Place and Duration of Study: Thoracic Departments of Combined Military Hospital Rawalpindi, Combined Military Hospital Lahore and Combined Military Hospital Multan from Jan 2010 to Jun 2020.
 Methodology: In total, 19 patients were enrolled. Inclusion criteria were physiologically fit patients for one-lung ventilation with proven true-cut histopathology. Exclusion criteria were poor performance status and non-compliance to chemotherapy.
 Results: Out of 19 cases, 13 males (68.42%) and six females (31.58%) patients. The age range was from 8 to 29 years, with a mean age of 17.6 + 4.16 years. The most common symptom was palpable mass 19, followed by chest pain 8 and one patient presented with fungating mass. All patients showed partial response to neo-adjuvant chemotherapy as per RECIST criteria. Following resection and confirmation of negative margins, primary reconstruction was done. The soft tissue coverage was provided using Latissimus Dorsi Muscle Flap in 16 Cases (84.21%) and in 03 patients (15.79%) Rectus Abdominis muscle was used. Post operatively, less than 02 blood transfusions were needed in six patients. There was no post-operative ventilatory support required, and mortality was zero.
 Conclusion: Ewing Sarcoma of the chest wall is a rare tumour in the adult population. An excellent outcome can be achieved through early diagnosis, meticulous surgical technique and good teamwork in a multi-disciplinary setting.

Comparison of Outcomes Following Syndactyly Release with Grafts and Without Grafts

Objective: To compare the results of syndactyly release with or without graft in patients with simple syndactyly of hand.
 Study Design: Prospective comparative study.
 Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital Rawalpindi Pakistan, from Jul 2017 to Jun 2019
 Methodology: Forty-five patients with simple syndactyly were included in this study. Group-1 had 20 patients whose syndactyly was released without using a skin graft. Group-2 had 25 patients whose soft tissue was covered with a fullthickness skin graft between the flaps post syndactyly release. Both groups were compared based on operative time, wound healing time, and when physiotherapy was started post operatively.
 Results: The results of our study showed that the mean operative time for the first group was 47.1 ± 4.5 minutes (range 35-60 minutes) and for the second group 90.5 ± 10.0 minutes (range 72-108 minutes) with a p-value <0.001. The wound healing time for the first group was 15.2 ± 1.3 days (12-18 days’ range) and for the second group was 22.5 ± 5.1 days (range 14-30 days) with a p-value <0.001. Post-operative physiotherapy was started earlier in the first group with an average of 20.6 ± 1.3 days (18-22 days’ range) as compared to the second group whose average time of the start of physiotherapy was 27.7 ± 4.4 days (range 20- 35 days) with p-value <0.001.
 Conclusion: Syndactyly release without a skin graft has a lesser operative time, early wound healing and an earlier start of physiotherapy than syndactyly release with......