An audit of secondary peritonitis at a tertiary care university hospital of Sindh, Pakistan

Introduction

Indications for repair of abdominal hernia are well established and widely diffused. Controversies still exist about the indication in using the different prosthetic materials and principally about the biological ones.

Material and methods

In February 2012, the Italian Biological Prosthesis Work-Group (IBPWG), counting a background of 264 biologic implants, met in Bergamo (Italy) for 1-day meeting with the aim to elaborate a decisional model on biological prosthesis use in abdominal surgery.

Results

A diagram to simplify the decisional process in using biologics has been elaborated.

Conclusion

The present score represents a first attempt to combine scientific knowledge and clinical expertise in order to offer precise indications about the kind of biological mesh to use.     

Impact of ethnic variation and residential segregation on long-term survival following myocardial perfusion SPECT

Background

Ethnic characteristics of a neighborhood may impact upon all-cause mortality (ACM). It is not known whether this consideration remains a risk modifier among those being evaluated for CAD.

Methods

6,477 pts (60?±?13?years, male 38%) residing in NYC with normal or abnormal stress SPECT studies were assessed for ACM during a mean follow-up of 9?±?3.8?years. Baseline CAD risk factors and ethnic characteristics of patient neighborhoods were considered. Zip-codes with >70% of one ethnicity was considered to be predominant of that ethnicity.

Results

There were 573 (20%) Hispanics (HS), 765 (27%) African-Americans (AA), and 250 (30%) Caucasians (CC) residing in areas >70% of their own ethnicity. Compared to CC, the risk for ACM was lower in HS (hazard ratio (HR) 0.68, 95% CI 0.57-0.8, P?<?.0001) and similar among AA (HR 1.1, 95% CI 0.95-1.41, P?=?.2). Among HS, there was a lower ACM among those residing in HS areas compared to those residing in a non-HS areas (HR 0.7 95% CI 0.56-0.9, P?=?.03) despite a lower median household income ($27,838?±?3,328 vs $37,751?±?17,036; P?<?.0001). This survival difference was not seen in CC and AA.

Conclusion

Among patients referred for nuclear SPECT studies for suspected CAD, HS ethnicity was an independent predictor of a favorable prognosis. Among HS, the ethnic characteristic of patients?? neighborhoods was an independent predictor of ACM. These results imply that ethnic social support is a potentially powerful modifier of patient outcomes among certain patient groups.     

Post-traumatic near-complete aseptic necrosis of the maxilla: a case report and review of the literature

Osteonecrosis of the mandible and the maxilla is known; however, aseptic necrosis of the maxilla after traumatic fracture is hardly reported. This case aims to help clinicians realize the need to closely follow up and treat such patients with trauma as it can lead to osteonecrosis of the bone and cause difficulty in daily activities. We have also carried out a thorough review of the literature to give a concise understanding of all disease processes that may lead to osteonecrosis of the maxilla. Such an article has not previously been published.     

Accuracy of 64-slice multidetector computed tomography scan in detection of the point of transition of small bowel obstruction

Purpose  

To determine the accuracy of 64-slice multidetector computed tomography scans in detecting the point of transition of small bowel obstruction by using surgical findings as the gold standard.     

Hepatitis B and C prevalence among the high risk groups of Pakistani population. A cross sectional study

Background

Microbiology reference laboratories are critical in the development of high-quality clinical and public health services. In Belgium, the reference laboratories performed their activities on a voluntary basis and lacked a legal status.

Methods

Pathogens or groups of pathogens necessitating a national reference center (NRC) were prioritized based on diagnostic and epidemiologic relevance. Terms of reference for each of these pathogens were developed.

Results

Recently, 40 NRCs for different pathogens or groups of pathogens have been installed in Belgium to fulfill the following core functions: offering reference diagnostics, collecting reference materials, sharing information and scientific advice, participating in national and international networks, collaborating with research workgroups, and contributing to surveillance activities.

Conclusions

These NRCs are important focal points of the national and international network in public health microbiology.     

Opinions of women from deprived communities on national tobacco control measures in England

Objective: To ascertain the perceptions of women from deprived communities on national tobacco control measures in England.

Methods: A qualitative study of 11 women, smokers and ex-smokers, from disadvantaged areas, who had used the National Health Service (NHS) Stop Smoking Service. Data were collected through a focus group and semi-structured interviews, and subjected to thematic analysis.

Results: The ban on smoking in confined public places was perceived as an effective measure for tobacco control. Methods to restrict accessibility – including removing point-of-sale displays, raising the price, and preventing sales in certain places – were perceived as effective techniques to deter smoking initiation and prevent triggering temptation to smoke for someone motivated to quit, but not helpful to change attitudes or behaviors among current smokers. Women felt desensitized to health warnings used on tobacco products. Public health campaigns with gain-framed messages were more likely to engage smokers to want to quit. Of the loss-framed messages, participants felt that focusing on personal appearance and children was effective.

Conclusions: Strategies that are tailored to attitudes and beliefs among women smokers should consider gain-framed messages and messages that focused on the effects to appearance and children to promote cessation and prevent relapse.     

Prevalence of diabetic retinopathy in rural Pakistan: A population based cross-sectional study

Purpose:To estimate the prevalence of diabetic retinopathy (DR), an emerging cause of sight threat and blindness from a large rural population in Pakistan.Methods:This was a population-based cross-sectional study. We selected a rural district of Matiari Sindh Province in Pakistan, where we selected all the health facilities and their attached Lady Health Workers (LHWs)/Lady Health Supervisors (LHSs). These female health workers were trained to identify high-risk diabetic individuals in their catchment areas using pre-defined criteria and to refer them to the nearest health facilities for screening and testing random blood sugar (BSR). Adults of 18 years or above, male or female, were included in the study for DM and DR screening. Ophthalmic examination was conducted by the optometrists on those who had BSR level >180 mg/dl for the evidence of DR. Identified DR patients were referred to a linked tertiary-level ophthalmology institute for their free DR treatment.Results:Of the identified and referred 24,463 participants, 23,999 were tested for BSR and 2,331 (9.74%) were found to be high-risk patients (BSR >180 mg/dl) and had ophthalmic examination conducted. Of these, 563 had clinically established DR, a prevalence of 24.2% (95% CI, 22–26%). Significantly more DR patients (228, 40.5%) were found in the age group >60 years, with more among female (327, 58.1%) with DR.Conclusion:DR is highly prevalent in the Pakistani rural population. The establishment of an integrated approach within the health care system could decrease the burden of DR in Pakistan.