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Objective: To compare the efficacy of paramedian and midline approach for spinal block in elderly, in terms of success rate and number of attempts required by either approach. Study Design: Randomized Controlled Trial. Setting: Department of Anaesthesia, Madina Teaching Hospital Faisalabad. Period: January 2018 to December 2019. Material & Method: 120 elderly ASA I-III patients scheduled to undergo lower abdominal or limbs; general or orthopaedic surgery were randomly divided into two equal groups A and B of sixty patients. Patients were assigned into groups by lottery method. Group A patients were supposed to receive spinal block by midline approach while group B patients were planned to receive spinal block by paramedian approach. Results: It was observed that success rate was significantly high in group B, 98.3% as compared to group A, 80%, (p value 0.001). The number of attempts were significantly less in group B in comparison to group A (p-value 0.0001). Conclusion: The paramedian approach for spinal block in elderly patient's offers ease of administration and a higher success rate as compared to midline approach. [ABSTRACT FROM AUTHOR]

Background: In recent years different techniques for hemorrhoidectomy have been introduced. Ligasure hemorrhoidectomy is a new technique associated with minimum procedure related complications. Objective: To compare the surgical outcomes of ligasure and open conventional hemorrhoidectomy. Methods: 52 patients having 3rdor 4th degree hemorrhoids were included in the study. After randomly dividing the subjects into two groups, half of the cases were operated by ligasure and the other half by open hemorrhoidectomy. Surgical outcome of both the procedures was compared. Different parameters to assess the outcome were; per-operative and post-operative bleeding, procedure time, post-operative pain, retention of urine, fecal incontinence, anal stenosis, hospital stay and wound healing. Results: Intraoperative and post-operative bleeding was significantly decreased in patients with ligasure Hemorrhoidectomy (P-value <0.001 and 0.4164 respectively). Post-operative pain (P-value < 0.001) and frequency of urinary retention were also markedly low in comparison. Short procedure time (P value < 0.001) short hospital stay, and early wound healing (P value = 0.0278) were other advantages of ligasure surgery compared to conventional method. Conclusion: Ligasure hemorrhoidectomy leads to better results and less post-operative complications as compared to open conventional hemorrhoidectomy. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE: Laparoscopic cholecystectomy (LC) following Endoscopic retrograde cholangiopancreatography (ERCP) is associated with an increased risk of complications. ERCP is associated with increased incidence of complications during LC. Surgery may be performed in same anesthesia with ERCP or up to 6 weeks later. We aimed to determine the benefits of performing LC within 72hrs of ERCP. METHODOLOGY: After institutional ethical approval this prospective cross-sectional study was performed at Madinah Teaching Hospital Faisalabad from April 2019 to June 2020. By performing convenience sampling, all patients undergoing LC after uneventful ERCP in our hospital were included. Study population was divided based on interval between ERCP and Cholecystectomy; Group-A had LC within 72hrs of ERCP, Group B had LC in same hospital stay after 72hrs and Group-C patients were discharged after ERCP and readmitted for LC. Data was collected using custom designed questionnaire, tabulated using Microsoft Excel 2016 and subjected to statistical tests to compare outcomes. Primary outcome was incidence of complications, while operative time, hospital stay and cost were considered as secondary outcomes. p-value of <0.05 was considered significant. RESULTS: Total 75 patients were included in study, 32 in Group-A, 20 in Group-B and 23 in Group-C. Average age was 44.987 ± 14.819 and study population was predominantly female (86.67%). Complication rate, duration of hospital stay and average cost were less in Group. A as compared to other groups (p<0.05). Mean operative time in 3 groups was similar. CONCLUSION: LC within 72hrs after ERCP provides superior results in terms of fewer complications, shorter hospital stays and lesser cost. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE: Road traffic accidents are the ninth leading cause of death worldwide, contributing significantly to global disease burden. Emergency Medical services(EMS) play a role in minimizing the morbidity and mortality. Our objective was to determine the characteristics of injury pattern and causes encountered in Road Traffic crashes (RTCs) managed by 1122 in Faisalabad Pakistan and to access the outcome of these accidents. METHODOLOGY: All Road Traffic crashes and victims in Faisalabad city of Pakistan which were initially managed by Rescue 1122 between 2016 to 2019 were included in the study. Total sample size was 101995. It is descriptive cross-sectional study which includes patients of different ages, sex and motor-vehicles accidents having different injury sites. RESULTS: During the study period there were total 101995 RTCs victims to whom emergency medical services (EMS) were provided. Gender wise 80.73% male victims and 19.27% female victims. Major age groups were between 21-30 years (25.917%). The major risk factors of accidents were over-speeding (56.8%) followed by carelessness (18.32%), wrong turn (8.69%) ,u-turn(5.84%) ,one wheeling(0.008%), tyre burst (0.117%) and others(10.14%). The injuries frequently encountered are minor which accounts for (44.68%), Single fracture (23.25%), Multiple fracture (16.62%), Head injury (12.40%) and Spinal injury(3.03%). Outcome of RTCs in our study was alive & unstable (54.47%), alive & stable (44.7%) and dead (0.83%). CONCLUSION: This study showed that Road Traffic Accident are the major public health problem in our society and contributes markedly to high morbidity and mortality. Urgent Preventive measures including community education should be established to reduce the risk of their outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to find a better prophylaxis against postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy. STUDY DESIGN: A randomized control study was carried out for comparison. SETTING & DURATION: This study was conducted at department of anaesthesia and intensive care, Madinah Teaching Hospital, Faisalabad from January 2015 to July 2015. SAMPLE SIZE: The study population consisted of 90 ASA I & II status patients undergoing laparoscopic cholecystectomy under general anaesthesia. METHODS: The patients were randomly divided into three groups A, B and C. Group A patients were to receive prophylactic Dexamethasone, group B patients were to receive both Ondansetron and Dexamethasone and group C patients were to receive Ondansetron preoperatively. Postoperative nausea and vomiting was recorded and compared between three groups in PACU (Post anaesthesia care unit) for one hour and surgical ward for 23 hours respectively. RESULTS: It was observed that group B (combined Dexamethasone and Ondansetron group) patients had significantly less postoperative nausea and vomiting as well as less requirement for rescue antiemetics postoperatively as compared to group A (Dexamethasone group) and C (Ondansetron group) patients. The frequency of nausea and vomiting was 0% and 3.3% in group B as compared to 30% and 30% in group A and 16.7% and 23.3% in group C respectively. Rescue antiemetics were used in 6.7% patients in group B as compared to 40% patients in group A and 23.3% patients in group C. CONCLUSION: It is concluded that combined Dexamethasone and Ondansetron offer effective prophylaxis against postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy as compared to Dexamethasone and Ondansetron alone. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the results of Limberg's flap procedure in pilonidal sinus in terms of procedural safety and complications. STUDY DESIGN: A prospective analytical study. PLACE AND DURATION OF STUDY: Study was conducted in surgical department of Madinah Teaching Hospital Faisalabad for one and a half year. METHODALOGY: In this study 50 consecutive patients of pilonidal sinus who underwent Limberg flap procedure were included. After discharged from ward follow up visit was done on weekly basis for 1st month and monthly for next six month. RESULTS: Out of 50 patients operated 47 (94%) were male and 3 (6%) were female (table 1). The age of patients ranged from 20-40 years with the median age of 25 years. All were operated electively after preparing for anesthesia. Rhomboid excision with Limberg flap reconstruction was done (Fig. 1-4). All were followed in outdoor after discharged from ward. Morbidity developed in 3 patients (infection in one, one having wound seroma formation and only one came with recurrence (table 2). Not a single patient were having flap necrosis or wound dehiscence. Almost all patients were pain free and all of them returned to work after treatment for their complication. The average hospital stay was 4-5 days and returned to work was after 15 days. CONCLUSION: Limberg Flap reconstruction with rhomboid excision technique of treating sacrococcygeal pilonidal sinus is beneficial in chronic cases with minimal recovery time and early return to work. [ABSTRACT FROM AUTHOR]

Background/aim: Diabetic foot ulcers and related complications are a major cause of morbidity and hospital admissions. Our aim was to evaluate the risk factors associated with poor outcome in diabetic foot ulcers., Materials and Methods: A prospective study was conducted on patients with diabetic foot ulceration attending the Madinah Teaching Hospital from June 2014 to December 2015. Potential risk factors and laboratory test results at presentation were recorded and their association with outcome (healing vs. amputation) was analyzed using IBM SPSS Statistics for Windows, Version 22.0., Results: In total, 112 patients were studied during our study period. The majority of the patients were male (60.7%) and aged 50 years and older (62.5%). Regarding the outcome, 68% healed completely, 27.7% underwent amputation, and 4.5% died during this period. Patient age of 50 and older, long duration of diabetes (>10 years), rural origin, and heel ulcers were significantly associated with poor outcome (P < 0.05)., Conclusion: Patients with diabetes should have a detailed annual foot examination; those having risk factors for poor outcome require more frequent foot care, patient education, and early referral to tertiary care centers.