Journal of Surgery Pakistan

Index

2025-05-14T09:11:58+00:00

Prioritizing Between Circulation and Airway in Trauma Patients: Reaching A Consensus

2025-05-14T09:18:45+00:00

Advanced Trauma Life Support® (ATLS) course, a benchmark training program for the treatment of an acutely injured patients, emphasize the use of a “common language”. This includes ABCDE approach in primary survey where life threatening injuries are treated by priority. The initial three alphabets; ABC are the key components of resuscitation. Airway is given precedence over all other conditions. This is because of likelihood of a multiply injured patient dying of airway obstruction rather than circulatory compromise. This traditional approach has continued till date although new evidence against this is also reported in literature.1………………

Usefulness of Boey Score In Predicting the Outcome In Patients With Perforated Peptic Ulcer Disease

2025-05-14T09:33:06+00:00

Objective

To evaluate the reliability of Boey scoring system in patients presenting with perforated peptic ulcer disease.

Study design

Prospective cohort study.

Place & Duration of study

Department of Surgery Bolan Medical College and Mohtarma Shaheed Benazir Bhutto General Hospital Quetta, from March 2023 to June 2024.

Methods

All patients with perforated peptic ulcer disease were prepared according to surgical protocol and laparotomy was done. A primary closure of perforation with Graham’s omentopexy were done followed by a copious peritoneal lavage. Patients were followed for 30-days after laparotomy for any complication. Boey score assessment was made which has three parameters. The score ranges from 0-3. The data were analyzed and receiver-operating characteristic (ROC) curve and area under curve (AUC) analysis were used to estimate the predictive ability of the Boey score in assessing the postoperative morbidity and mortality. Chi squire test was applied for significance.

Results

The study was conducted on 95 patients. There were 80 males and 15 females with M: F ratio of 5.3:1. The mean age was 39.4+14.3 years. Majority of the patients (n=72 - 75.6%) reached the tertiary care hospital after 24 hours and 90 (94.74%) were in the state of shock. Comorbid conditions were present in 32 (33.7%) patients. Forty-nine (51.6%) patients had a Boey score of 2, while 27 (28.4%) had a score of 3. The overall mortality was 12 (12.6%). It was more in patients who had score of 3 followed by Boey score 2. This was statistically significant with p< 0.001.

Conclusion

The Boey scoring system is simple and easy to use. It was found efficient in predicting the clinical outcome in patients with peptic ulcers perforation

Key words

Peptic ulcer, Perforation, Boey score, Morbidity, Mortality, Prognosis.

Effect of Early Versus Delayed Umbilical Cord Clamping On Neonatal Hemoglobin•

2025-05-15T05:25:56+00:00

Objective

To Compare the effect of early cord clamping (ECC) versus delayed cord clamping (DCC) on hemoglobin level at 6-hours after delivery on term neonates.

Study design

A cross sectional study.

Place & Duration of study

Department of Obstetrics and Gynaecology, Sir Syed Hospital Karachi, from July 2021 to January 2022.

Methods

Booked pregnant women who fulfilled the inclusion criteria were assigned into two groups of 30 each by random sampling. In group A cord was clamped at or <15 seconds (ECC) and in group B at 60 seconds (DCC) after delivery. Neonatal haemoglobin was evaluated at 6-hours after birth. For statistical significance student t test was applied. A p-value of <0.05 was considered as significant.

Results

A total of 60 pregnant women were included, 30 in ECC group A and 30 in DCC group B. The women in both the groups were comparable in terms of their age, parity, gestational age and hemoglobin levels. The mean age of group A women was 25.9+4.9 years and group B women 28.4+4.7 years. The neonatal haemoglobin was compared in two groups and the statistical difference was found significant (p=<0.001) in favour of group B.

Conclusion

Delayed cord clamping at birth increases the neonatal hemoglobin within a physiologic range and this intervention seems to increase the iron stores and reduce the rate of neonatal anemia.

Key words

Early cord clamping, Delayed cord clamping, Neonatal hemoglobin, Neonatal anemia.

Diagnostic Accuracy of Alvarado Score In Comparison With Raised C-Reactive Protein Levels For Acute Appendicitis

2025-05-15T05:35:25+00:00

Objective

To find out the diagnostic accuracy of Alvarado score in comparison with raised C-reactive protein (CRP) levels for acute appendicitis considering histopathological findings as gold standard.

Study design

Cross sectional study.

Place & Duration of study

Department of •Surgery Unit II, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from August 2022 to August 2024.

Methods

Patients of either gender above 12-years of age were included. A detailed history was taken and physical examination performed. C-reactive protein level estimation was done along-with CBC and urine D/R. All patients underwent surgery and appendectomy done. Specimen was sent for histopathology. Descriptive statistics were used to report quantitative data as mean with standard deviation and qualitative variables as frequency and percentages. Sensitivity, specificity, positive and negative predictive values with diagnostic accuracy were computed for Alvarado score and CRP level.

Results

A total of 369 patients were included. Mean age of the patients was 41.90 ±8.82 years. There were 216 males and 153 females. Alvarado score had a sensitivity of 85.7%, specificity 83%, positive predictive value 62.4%, negative predictive value 94.6%, and diagnostic accuracy 83.7%. CRP levels had sensitivity of 59.3%, specificity 88.8%, positive predictive value 63.5%, negative predictive value 86.6%, diagnostic accuracy of 81.5%.

Conclusion

Alvarado score had a better diagnostic accuracy in comparison with CRP levels.

Key words

Acute appendicitis, Alvarado score, CRP level, Diagnostic accuracy.

Severity of Iron Deficiency Anemia In Pregnancy With Fetomaternal Outcomes

2025-05-15T05:42:02+00:00

Objective

To find the severity of iron deficiency anemia in pregnancy along-with fetomaternal outcomes.

Study design

Cross sectional study.

Place & Duration of study

Department of Obstetrics and Gynecology Unit I, Shaikh Zayad Women's Hospital Larkana, from March 2023 to September 2023.

Methods

Pregnant women were selected through non-probability purposive sampling. Detailed history was taken and clinical examination performed. Nutritional status was assessed and dietary habits were inquired in particular. Hemoglobin, serum ferritin and total iron binding capacity levels were estimated. Gestational period was monitored for any maternal and fetal complications. Delivery related events and status of the newborns were also noted. Statistical analysis of the data were done to report the outcomes as frequencies and percentages and their relationship with the severity of anemia.

Results

A total of 100 pregnant women were included. The age of the participants was between 18 to 40-years. Forty-one (41%) women were between 26 to 30-years of age. Majority (n=63 – 63%) of the women belonged to the low socioeconomic group and had rural background (n=62 – 62%). Seventy-four (74%) women had moderate anemia. Twenty-five (25%) women had low ferritin levels (5- 10 mg/ L) while 40% had moderate levels (10-50 mg/ L). A total of 56% women had cesarean delivery, 16% experienced postpartum hemorrhage, and 12% developed cardiac failure. There were 20% intrauterine deaths and 8% maternal deaths in this series. In addition, 12% neonatal deaths occurred.

Conclusion

The iron deficiency anemia had huge effect on pregnancy, labor and newborns as gestational period was difficult to manage and delivery was challenging with poor maternal and fetal outcome. A large number on newborns also died.

Key words

Anemia, Pregnancy, Postpartum hemorrhage, Ferritin level, Maternal mortality.

Pattern of Neonatal Surgical Admissions and Outcome of the Surgeries

2025-05-15T06:06:22+00:00

Objective

To evaluate the pattern of neonatal surgical admissions and outcomes of surgeries.

Study design

Retrospective descriptive case series.

Place & Duration of study

Neonatal Intensive Care Unit (NICU), King Fahad Hospital, Al-Baha, Saudi Arabia, from May 2021 to May 2023.

Methods

The medical records of neonates admitted with surgical congenital anomalies were analysed for the pattern of diseases and the outcome of the treatment provided at a tertiary care hospital. Variables analyzed included demographic data, surgical details, complications, and follow-up. SPSS v28 was used with descriptive statistics to summarize key findings.

ResultsA total of 41 neonates were managed. There was a slight female preponderance (n=24 - 58.5%). All patients were Saudi nationals. The mean age of the patients was 26.6±8.3 days and 27 (65.9%) were preterm births. Mean birth weight was 2.47±0.79 kg. There were 14 (34.1%) low birth weight babies. The common surgical conditions included anorectal malformations (n=12 - 29.3%), necrotizing enterocolitis (n=6 - 14.6%), and hypertrophic pyloric stenosis (n=6 - 14.6%). Common surgeries were anoplasty (14.7%) and pyloromyotomy (14.6%). The mean age at surgery was 16.24 days. Postoperative complications occurred in 4.9%. The mortality rate was 17.1%, primarily due to necrotizing enterocolitis. The mean hospital stay was 29.12 days, and 9.8% required additional surgical intervention.

Conclusion

The mortality rate was high due to babies who developed necrotizing enterocolitis.

Key words

Neonatal surgery, Necrotizing enterocolitis, Surgical outcome, Anorectal malformations.

Infantile Appendicitis: A Case Report

2025-05-15T06:34:32+00:00

Infantile appendicitis is an uncommon condition. It often presents with atypical symptoms that mimic other conditions like gastroenteritis, respiratory tract infection, and sometimes sepsis. Delay in diagnosis or fail to diagnose in timely manner can lead to complications with prolong hospitalization. At times mortality can occur. In this study a 4-month old infant is reported who had acute appendicitis but presented with the symptoms of gastroenteritis. Infant underwent appendectomy with smooth postoperative recovery. Clinical vigilance and timely diagnosis can reduce the risk of complications in infants with acute appendicitis.

Key words

Infant, Appendicitis, Atypical symptoms, Diagnosis.