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Background: We endeavored to analyze patients of subacute and chronic subdural hematomas studied in a 4-year period at the Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India., Methods: The study was a retrospective analysis of 1181 patients of subdural hematomas. Demographic characteristics, clinico-radiologic features, operative modalities, and outcome were studied. Acute subdural hematomas were excluded from the study., Results: The mean age was 60.4 ± 12.4 and males outnumbered females. Chronic subdural collections were more common than subacute subdural hematomas and left side predominated. Two burr holes with closed-system drainage was used in most patients. Incidence of postoperative seizures is very low. Overall recurrence rates were low; however, multilocular hematomas had the highest incidence of recurrence. Morbidity and mortality were 7.53% and 2.96%, respectively. Preoperative neurologic grade correlated with outcome., Conclusions: Subdural hematomas are common in elderly males. Preoperative neurologic grade dictates the outcome. Multilocular hematomas have a higher chance of recurrence. Craniotomy should be reserved for recurrent hematomas, and there may be a scope of craniotomy for multilocular chronic subdural hematomas at the outset. Antiepileptic prophylaxis is not routinely recommended., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: Appendicitis is the most common abdominal emergency usually requiring surgery in the pediatric age group. Diagnosis of acute appendicitis can at times be difficult, especially in children. A failure to diagnose can lead to a progression of disease with its associated morbidity and mortality. The authors used a modification of Alvarado scoring system which consists of eight variables and would provide an accurate guide to the preoperative diagnosis of acute appendicitis leading to proper and timely management., Methods: This was a prospective study conducted from Jan 2005 through Dec 2006 and included 90 consecutive patients with suspected acute appendicitis. They were given specific scores according to variables of scoring system and divided into 3 groups. Group III patients (score 7 or more) underwent surgery, group II (score 5-6) were admitted for close observation and group I (score 4 or less) were discharged home. Patients from group II with increased symptom intensity (score 7 or more) on re-evaluation underwent surgery. Diagnosis was confirmed by operative findings and histopathological examination. Reliability of scoring system was assessed by calculating negative appendicectomy rate and positive predictive value., Results: Out of total 90 patients, 73 patients underwent surgery and appendicitis was confirmed in 68 cases. The negative appendicectomy rate was 6.84%, perforation rate was 36.9%. Positive predictive value was 93.1%., Conclusions: Our scoring system is useful as a first line, rapid, reliable and economic way of early preoperative diagnosis of acute appendicitis in children and in reducing the incidence of negative appendicectomy rate.

HIV infection has attained extraordinary attention among surgeons and other health care workers as a potential source of occupational infection. Disease is usually blood-borne and transmissible, and due to the nature of surgical work, surgical community has become involved and is developing sterile surgical barriers, and improved surgical techniques and procedures.

Objective: To determine the significance of the Diagnosis to Delivery Interval (DDI) on perinatal outcome and maternal complications in patients with umbilical cord prolapse., Methods: This was a case series of 44 patients identified with "Umbilical cord prolapse" during a 10-year period at the Aga Khan University Hospital. Data was retrieved for gestational age, foetal presentation, DDI, incision to delivery time, delivery method, apgar score, birth weight and outcome, and maternal complications. The influence of DDI on perinatal mortality, apgar scores at 5 minutes, neonatal intensive care unit (NICU) admission and maternal complications resulting from mode of delivery with cord prolapse was assessed., Results: The hospital based incidence of cord prolapse was 1.4 per 1000 deliveries. The mean DDI was 18 minutes, with 64% of women delivering within this time. Of the 13 (29%) neonates transferred to NICU with < 7 apgar score at 5 minutes, 10/13 (76%) delivered within the mean DDI. There were 4 perinatal deaths, of which 2 were term pregnancies with birth asphyxia, whereas 2 were < or = 28 weeks. There was no statistically significant impact of DDI on 5-minute apgar scores, perinatal mortality, NICU admissions and maternal complications in patients with cord prolapse, Conclusions: DDI may not be the only critical determinant of neonatal outcome. Most neonates with poor apgar scores had DDI within the average time. Artificial rupture of membranes should be performed cautiously with preexisting CTG trace abnormalities. In-utero resuscitative measures may help reduce further cord compression and improve outcome.

Objective: To evaluate the effects of soluble fiber rich bread on lowering blood glucose, blood pressure and blood lipid levels., Design: An interventional study., Place and Duration of Study: The study was undertaken at Medical Unit III, Jinnah Postgraduate Medical Centre, Karachi. Duration of the project was one year (1997-1998)., Subjects and Methods: Twenty stable diabetics of both genders were included in this study. They were provided with this bread (test diet) to replace their usual breakfast bread and chapati for lunch and dinner. The intakes of other foods as well as medications were unchanged. Anthropometric measurements, fasting and 2 hours postprandial blood sugar, fasting serum cholesterol and triglyceride levels were recorded before and after 4 weeks of intervention. Blood sugar and blood pressure were checked every week. Quality of life was assessed subjectively with the help of questionnaire, which were asked before and after the end of the intervention., Results: Glycemic control, both fasting and postprandial, improved significantly during intervention. Satisfactory reduction of blood pressure as well as serum cholesterol and triglyceride level was also observed in these cases. The medicines reduced significantly and quality of life improved in all subjects. None of these subjects complained any gastrointestinal discomfort during their consumption of this bread for 4 weeks., Conclusion: The use of soluble fiber rich bread helps to control blood sugar, the hyperlipidemia, and blood pressure which are elevated in poorly controlled diabetics. Thus, integrated improvement will improve the quality of life, reduce the cost of drugs as well as help to avoid harmful effect of drugs.

Sixtynine patients (31 males and 38 females) above the age of 12 years undergoing surgery under general anaesthesia were selected for this study. Thirty percent males and 29% females were depleted, 55% and 37% males and females, respectively, were normal and 13% and 34% males and females, respectively, were obese as indicated by Body-mass index (BMI). Measurement of midarm-muscle-circumference (MAMC) indicated mild to moderate protein deficiency in 32% of the patients while triceps skinfold thickness (T.S.T) indicates mild to severe calorie deficiency in 68% males and 50% females. Dietary intake both pre and post operatively was unsatisfactory. Pre-operatively 26% of the females had Hb level below normal (less than 11 G%). Only 3-5% of the patients had protein and albumin level below normal (less than 3.5 G%). Post-operatively all the anthropometric measurements as well as serum protein and albumin levels decreased and BUN increased significantly indicating body catabolism. Post operative hospital stay was significantly more in undernourished patients.