Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3

Background: Postoperative pancreatic fistula (POPF) remains the most serious complication of Pancreaticoduodenectomy. ISGPF defined POPF in 2005 based on drain fluid amylase on or after day 3 and graded the severity. But as Grade A fistulas are not clinically relevant, most of the clinicians do not consider them as POPF. Hence exact incidence of POPF is not known. Our aim is to see weather drain fluid amylase on or after day 5 can define clinically relevant POPF better than day 3.Methods: Prospective study included all patients who underwent Pancreaticoduodenectomy during the period January 2013 to November 2016. Serum and Drain fluid amylase were analyzed on Day 3. Those who met criteria of POPF underwent repeat amylase on Day 5. These patients were divided into 2 groups. Group A includes patients whose Day 5 amylase normalized and Group B where elevated Amylase persisted. Outcomes were compared in 2 Groups in terms of clinically relevant POPF (CRF), DGE, Haemorrhage (PPH), hospital stay and 30 Days mortality. Results were analysed and p value <0.05 was considered significant.Results: On 110 patients, 44 (40%) met ISGPF criteria of POPF. Of 44, 36 (82%) had normalized Amylase on Day 5 (Group A). Only 8 (18%) had persistent elevated amylase (Group B). None in Group A had CRF, whereas in Group B, 6(75%) had CRF and 2(25%) had only biochemical leak (p<0.0001). DGE was significantly higher in Group B (87.5% vs. 33.3%; p=0.013). PPH was seen in only 1 patient (Group A). Duration of hospital stay and 30day mortality were similar.Conclusions: Drain fluid amylase levels on or after Day 5 defines clinically relevant POPF better than levels on or after day 3.

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LAPROSCOPIC CHOLECYSTECTOMY;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.04.3364 ◽

2019 ◽

Vol 26 (04) ◽

Author(s):

Muhammad Usman ◽

Kaiser Saleem ◽

Saddaqat Hayat

Keyword(s):

Hospital Stay ◽

Pain Score ◽

Tertiary Care ◽

P Value ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Group A ◽

Group B ◽

Surgical Unit ◽

Trial Setting

Objectives: Compare the efficacy in terms of mean pain score and mean duration of hospital stay in patients of symptomatic cholilithiasis undergoing laproscopic cholecystectomy with and without subhepatic drain insertion. Study Design: Randomized control trial. Setting: Surgical unit –iii of Allied Hospital Faisalabad which is tertiary care unit. Duration of Study: 20-02-2013 to 20-08-2013. Results: Out of 150 cases (75 cases in two groups), mean+sd was calculated as 44.74+ 6.57 years, 80%(n=60) in Group-A and 82.66%(n=62) in Group-B were female, post- operative hospital stay was recorded which shows 3.16+0.463 in group-a and 2.32+0.569 days in group-b and it shows statistically significant difference between the two groups, similarly, on comparison of post-operative abdominal pain score at 24 hours in both groups 2.266+1.062 in Group-A and 1.8+0.90 in Group-B pain on vas was recorded at 24 hours which shows significantly lower in Group-B patients by calculating p value as 0.002348. Conclusion: No subhepatic drain insertion after laproscopic cholecystectomy is better when compared to those with subhepatic drain insertion in terms of mean pain score and mean duration of hospital stay in days post operatively.

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A comparative study of suturing technique of intestine between extra-mucosal single layer interrupted and continuous all layers: a single center experience

International Surgery Journal ◽

10.18203/2349-2902.isj20213652 ◽

2021 ◽

Author(s):

Manoranjan Kar ◽

Somu Singhal ◽

Bismoy Mondal ◽

Arijit Roy

Keyword(s):

Comparative Study ◽

Hospital Stay ◽

Intestinal Anastomosis ◽

Single Layer ◽

P Value ◽

Bowel Anastomosis ◽

Duration Of Hospital Stay ◽

Group A ◽

The Mean ◽

Group B

Background: Gastrointestinal anastomosis has been excited interest in our day to day surgical practice. We have compared efficacy, advantages, disadvantages, and complications following intestinal resection-anastomosis using extra-mucosal interrupted single layer suturing or continuous all layer suturing.Methods: This comparative study included 50 cases (either in emergency or elective undergoing bowel resection and anastomosis), comprising of 2 Groups (25 cases in each Group) between January 2019 to June 2021 at Midnapore Medical College and Hospital. Patients data, operative findings, duration of anastomosis and length of hospital stay, post-operative complications of all patients were followed till discharge.Results: Our comparative study have shown that- the mean duration for intestinal anastomosis in Group A (extra-mucosal interrupted single layer) and Group B (continuous all layers) were 21.43 minutes and 14.35 respectively. Considering duration of the anastomosis continuous all layers intestinal anastomosis appears to represent in shorter duration, anastomotic leak was noted in 3 patients (6%). Anastomotic leak was observed in 1 patient extra-mucosal interrupted single layer bowel anastomosis whereas two patients in the Group of continuous all layered bowel anastomosis had leak (p value 0.5-not significant) and the mean duration of hospital stay in the Group A and Group B were 7.32 days and 7.92 days respectively. (p value -insignificant).Conclusions: Duration required to perform a continuous all layer bowl anastomosis is lesser when compared to an extra-mucosal interrupted single layer intestinal anastomosis. There is no significant difference in complications, final outcome and duration of hospital stay between two Groups.

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Comparison of In-Hospital Outcomes Between Patients With or Without Acute Kidney Injury Developed After Hospitalization Following Acute Coronary Syndrome

University Heart Journal ◽

10.3329/uhj.v16i1.44815 ◽

2020 ◽

Vol 16 (1) ◽

pp. 3-10

Author(s):

Md Sajjad Safi ◽

Msi Tipu Chowdhury ◽

Tanjima Parvin ◽

Khurshed Ahmed ◽

Md Ashraf Uddin Sultana ◽

...

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Serum Creatinine ◽

Cardiogenic Shock ◽

Hospital Stay ◽

Kidney Injury ◽

Duration Of Hospital Stay ◽

Group A ◽

Hospital Stays ◽

Group B

Background: Acute Kidney Injury (AKI), a common complication of acute coronary syndromes (ACS), is associated with higher mortality and longer hospital stays. ACS patients with renal impairment during hospitalization are associated with adverse in-hospital outcomes in the form of heart failure, cardiogenic shock, arrhythmia, dialysis requirement and mortality. Objective: To compare the in-hospital adverse outcomesof patients with ACS with or without AKI. Materials and Methods: This prospective comparative study was conducted in the Department of Cardiology, BSMMU, Dhaka, during the period of August 2017 to July 2018. A total of 70 eligible patients were included in this study of which 35 patients were included in group A (ACS with AKI) and 35 patients were included in group B (ACS without AKI). AKI was diagnosed, on the basis of increased serum creatinine level 0.3mg/dL from baseline within 48 hours after hospitalization. They were subjected to electrocardiography, blood test for serum creatinine (on admission, 12 hours, 48 hours and at the time of discharge), lipid profile, 2-D echocardiography along with serum troponin, CK MB and electrolytes. Results: It was observed that mean age was 58.0±8.5 years in group A and 55.6±12.3 years in group B. Heart failure was more common in group A than in Group B (74.3% vs 34.2% p=0.001 respectively) and arrhythmia was more common in group A than in Group B (100% vs 74.2% respectively). 7(20%) patients of group A required dialysis. The mean duration of hospital stay was significantly higher in Group A than in the Group B (9.4±2.3 vs 7.2±0.6; p=0.001) days. Multiple logistic regression analysis revealed that heart failure, cardiogenic shock, duration of hospital stay were found to be the independently significant predictors of outcome of the patients with AKI with odds ratio being 5.53 (p=0.001), 4.353 (p=0.001) and 6.92 (p=0.001) Conclusion: This study shows that, heart failure, cardiogenic shock, arrhythmia, dialysis requirement, were more common in the patients with AKI (group A) than in the patients without AKI (group B). The duration of hospital stays were longer in patients with AKI (group A) than in the patients without AKI (group B). Therefore, an important research target is the identification of high-risk patients with ACS experiencing AKI, thereby appropriate medication and follow-up should be implemented. University Heart Journal Vol. 16, No. 1, Jan 2020; 3-10

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HEMORRHOIDECTOMY;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.09.879 ◽

2017 ◽

Vol 24 (09) ◽

pp. 1316-1321

Author(s):

Shibber Ahmed ◽

Ishtiaq Ahmad ◽

Humayun Amjid ◽

Aamir Furqan

Keyword(s):

Hospital Stay ◽

Severe Pain ◽

Conventional Technique ◽

Categorical Variables ◽

P Value ◽

Chi Square ◽

Post Operative Pain ◽

Group A ◽

And Gender ◽

Group B

Objectives: Is to compare outcomes in terms of mean post-operative pain andhospital stay between stapled versus conventional hemorrhoidectomy. Hypothesis: There isa difference in mean post-operative pain and hospital stay between stapled and conventionalhemorrhoidectomy, stapled technique is better than conventional technique. Study Design:Randomized control trial. Setting: Department of General Surgery Bakhtawar Amin MemorialHospital Multan. Period: February 2016 February 2017. Methodology: A total number of 60patients enrolled in the study, both genders. Statistical software SPSS ver.23 was used toanalyze the data. Mean and SD were calculated and presented for numerical variables likeduration of hemorrhoids, age and pain score while frequencies and percentage were calculatedand presented for categorical variables like ender and grade of hemorrhoids. Independent t-testand chi square test were applied to see effect modification. P value ≤0.05 was considered assignificant. Results: Total number of 60 (100%) patients in the study, 32 (53.3%) were maleand 28 (46.7 %) were female. Mean hospital stay in group A was 1.63 ± 0.71 and in groupB means duration of hospital stay was 1.73 ± 0.74. A P value was 0.001. On stratification ofdata it is concluded that in group A 9 patients have no pain 6 have mild and 6 have moderatepain and 5 patients have severe pain, similarly in group B, 3 patients have no pain 2 have mildpain 1 have moderate pain and no patient have severe pain. P value for male patients was2.65. Conclusion: This study confirms that stapled hemorrhoidectomy is associated with lesspostoperative pain with no effect of age and gender on outcome.

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Comparison of early versus late enteral feeding following gut anastomosis.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.12.4355 ◽

2020 ◽

Vol 27 (12) ◽

pp. 2548-2552

Author(s):

Zohra Jabeen ◽

Ramlah Ghazanfor ◽

Muhammad Usman Akram ◽

Sara Malik ◽

Maham Tariq ◽

...

Keyword(s):

Hospital Stay ◽

Enteral Feeding ◽

Oral Feeding ◽

P Value ◽

Age Group ◽

Bowel Sounds ◽

Early Oral Feeding ◽

Group A ◽

Group B ◽

Mean Time

Objectives: To compare early feeding versus late enteral feeding following gut anastomosis in term of hospital stay. Study Design: Prospective Randomized Control study. Setting: Surgical Unit 1, Holy Family Hospital, Rawalpindi. Period: April to October 2017. Material & Methods: All patients, excluding paediatric age group (n= 60) undergoing emergency or non-emergency gut resection with primary anastomosis were incorporated. Two strata were devised. Group A (n=30) received early enteral feeding starting at 12th post-operative hours in form of 100-150ml fluid thrice daily. Group B endured being Nil per oral for 72hrs. Both groups were correlated for timing of return of bowel sounds and timespan of hospital stay. P value < 0.05 was considered noteworthy. Results: Overall 60 patients with 30 in each group were incorporated. They were predominantly males (55%) and belonged to middle age group (Group A=31.73+10.78 years; Group B= 36.00+10.53 years). Mean time for return of bowel sounds in both the groups was 24.40+5.88 hours and 35.20+10.88 hours respectively, which was striking (p value <0.05). Mean length of hospital stay in both the groups was also noteworthy i.e. 5.23+0.72 days and 6.40+1.67 days respectively. Conclusion: In the wake of gut anastomosis, early oral feeding at 12hours is superior to delayed oral feeding after 72hours, in terms of mean time for return of bowel sounds and period of hospital stay.

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Comparison of 4% Topical Hydroquinone versus Combination of Oral Tranexamic Acid and 4% Topical Hydroquinone in the Treatment of Epidermal Melasma

10.53350/pjmhs2115103406 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3406-3409

Author(s):

Sarah Riaz ◽

Najia Ahmed ◽

Ayesha Anwar ◽

Moizza Tahir ◽

Farrah Yousaf ◽

...

Keyword(s):

Tranexamic Acid ◽

Topical Therapy ◽

Military Hospital ◽

Ethical Review ◽

P Value ◽

Treatment Groups ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Better Than

Objective: comparison of efficacy of topical 4% hydroquinone monotherapy with combination of oral tranexamic acid and topical 4% hydroquinone in the treatment of epidermal melasma Study design: Quasi experimental study Study period and place: Dermatology OPD, Pak Emirates Military Hospital Rawalpindi from July 2018 to January 2019. Methodology: Total 80 patients presenting with epidermal melasma were selected from outdoor patient department after applying the inclusion criteria and consent was taken from selected patients. Study was started after getting permission from hospital ethical review board. Two treatment groups were made after dividing patients by using alternate method. Treatment with topical 4% hydroquinone alone was started for group A patients and combination of capsule tranexamic acid (250 mg two times a day) along with topical 4% hydroquinone were started for group B patients for the next 6 months. Evaluation of patients through detailed history, clinical and wood’s light examination before starting therapy and after of 24 weeks of treatment was done for both groups. Efficacy of treatment was assessed via Modified MASI score. Results: Hydroquinone monotherapy was effective in 21 (52.5%) patients among group A while in group B patients, combination treatment i.e. oral tranexamic acid and topical hydroquinone, was effective in 31 (77.5%) patients (p value= 0.01). Conclusion: Effectiveness of Hydroquinone 4% topical therapy combined with oral tranexamic acid for epidermal melasma is better than topical 4% hydroquinone alone. Key words: Epidermal melasma, oral tranexamic acid, topical 4% hydroquinone.

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Postoperative recovery; Stapled Hemorrhoidopexy versus Conventional haemorrhoidectomy.

The Professional Medical Journal ◽

10.29309/tpmj/2019.27.01.4098 ◽

2020 ◽

Vol 27 (01) ◽

pp. 166-171

Author(s):

Ashar Ahmad Khan ◽

Tania Mahar ◽

Muhammad Kashif Adnan ◽

Abdul Rasheed Surahio ◽

Abdul Manan ◽

...

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Postoperative Recovery ◽

Stapled Hemorrhoidopexy ◽

Anal Stenosis ◽

P Value ◽

Group A ◽

Conventional Haemorrhoidectomy ◽

Group B

Conventional haemorrhoidectomy, a usual procedure for hemorrhoids in our set up have many short and long term complications. Some patients complained pain many weeks after surgery and are unable to do their routine work. Anal stenosis and recurrence are long term issues. There is need for some other procedure which can decrease postoperative pain and hospital stay. Objectives: To compare the postoperative recovery between stapled hemorrhoidopexy and conventional hemorrhoidectomy. Study Design: Randomized Clinical trial. Setting: Surgery Department of Nishtar Medical University Multan. Period: from 01-01-2018 to 31-12-2018. Material & Methods: Randomly 02 equal groups of the patients, A and B were made. Stapled hemorrhoidopexy (SH) and conventional haemorrhoidectomy was done in group A and B respectively. SPSS version 20 used for data analysis. Mean and standard deviation were used for quantitative variables including postoperative pain, age and hospital stay. Independent Student t test used for comparison of hospital stay and postoperative pain. Effect modifier including gender, age, duration and grade of hemorrhoids were controlled by stratification and Chi square test was applied. P value less than 0.05 was taken as significant. Results: Out of 60 patients, 32 were males and 28 females. In Group A (Stapled Hemorrhoidopexy), mean age was 37.37 + 6.36 years and 39.17 + 5.53 years in Group-B. Postoperative pain in Group A was 3.60 + 1.27 and 6.03 + 1.73 in Group B. Postoperative pain was significantly high in Group B (CH) and P value =0.000. Mean hospital stay was 0.90 + 0.48 days in Group A and 1.87 + 0.57 days in Group B with P value= 0.000. Conclusion: Stapled hemorrhoidopexy is associated with shorter hospital stay and decrease postoperative pain irrespective of age, sex and grade of the hemorrhoids.

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Comparison of 3% saline and 0.9% normal saline nebulization as diluent in children with bronchiolitis

Journal of the Pakistan Medical Association ◽

10.47391/jpma.569 ◽

2020 ◽

pp. 1-10

Author(s):

Shobha Sapkota ◽

Ammara Kaleem ◽

Suffura Huma ◽

Muhammad Aleem Ud-Din ◽

Shabbir Ahmad ◽

...

Keyword(s):

Sodium Chloride ◽

Prospective Study ◽

Hospital Stay ◽

Normal Saline ◽

Saline Solution ◽

Length Of Hospital Stay ◽

Group A ◽

Key Words 3 ◽

Group B ◽

Mean Time

Abstract Objective: To compare the outcome in terms of mean time to disappearance of cough, wheezing, crackles and length of hospital stay in patients treated with sodium chloride 3% with sodium chloride 0.9% as nebulisation diluent in children for suffering from bronchiolitis. Methods: The prospective study was conducted at the Department of Paediatric Medicine Sheikh Zayed Hospital, Lahore, Pakistan, from November 2014 to April 2015, and comprised children aged between 6 weeks and 24 months having bronchiolitis. Group A received 3% sodium chloride and Group B received 0.9% of the same solution. Duration of cough, wheezing, crackles and duration of stay at hospital were compared between the groups. Data was analysed using SPSS 17. Results: Of the 100 patients, there were 50(50%) in Group A with a mean age of 7.17±4.46, and as many in Group B with a mean age of 6.6±3.74. Overall, there were 55(55%) boys and 45(45%) girls. Mean cough and wheezing remission time as well as length of hospital stay was significantly different between the groups (p<0.05). Conclusion: In children having bronchiolitis, 3% saline as nebuliser solution was found to be more effective than 0.9% saline solution. Key Words: 3% saline solution, Bronchiolitis, Wheezing, Crepitations, Hospital stay.

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COMPARISON OF EFFICACY OF TRANEXAMIC ACID 10 MG/KG AND 15 MG/KG IN REDUCING BLEEDING AND TRANSFUSIONS IN TOTAL KNEE ARTHROPLASTY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2019.v12i3.31006 ◽

2019 ◽

pp. 535-538

Author(s):

HIMA R NAMBIAR ◽

SHAILA S KAMATH

Keyword(s):

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Hospital Stay ◽

Knee Arthroplasty ◽

P Value ◽

Duration Of Hospital Stay ◽

Institutional Ethics ◽

Number Of Patients ◽

Total Knee ◽

Group B

Objective: The objective of this study was to compare the efficacy of tranexamic acid 10 mg/kg and 15 mg/kg in reducing bleeding and transfusions in total knee arthroplasty. Methods: After approval from the Institutional Ethics Committee, KMC, Mangaluru, 88 patients fulfilling the inclusion criteria of this study undergoing total knee replacements were informed of the study details and consent was obtained for the same. They were randomized into two groups using computer-generated block randomization, i.e., Group A and Group B, and were administered tranexamic acid 10 mg/kg and 15 mg/kg intravenously, respectively. Intraoperatively, hemodynamic parameters were noted. Postoperatively, hemoglobin levels were assessed on days 1 and 3. Transfusions, thromboembolic complications, and duration of hospital stay were noted. Results: Of the 88 participants of the trial, 44 in Groups A and B each, there were no significant differences in the parameters observed in this study such as intraoperative hemodynamic changes, post-operative fall in hemoglobin on day 3, number of patients requiring transfusions, number of thromboembolic events, and duration of hospital stay. A significant p-value was observed in the fall in hemoglobin in the post-operative day 3 (p=0.043). Conclusion: About 15 mg/kg tranexamic acid proved to have a lesser fall in hemoglobin on day 3 postoperatively when compared to the 10 mg/kg group. However, the fall of hemoglobin on day 3 was statistically significant and warranted a blood transfusion in two patients in the 10 mg/kg group but did not prolong their hospital stay.

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Outcome of thyroid lobectomies undergone with and without drains

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203438 ◽

2020 ◽

Vol 8 (8) ◽

pp. 2919

Author(s):

Sahrish Bachani ◽

Shahid N. Memon ◽

Muhammad R. Pathan ◽

Rehmat Sehrish Shah ◽

Aneeta Kumari ◽

...

Keyword(s):

Hospital Stay ◽

Wound Infection ◽

Pain Score ◽

Thyroid Nodules ◽

University Hospital ◽

P Value ◽

Thyroid Lobectomy ◽

Significant Difference ◽

Group A ◽

Group B

Background: Thyroid lobectomy is a common operative technique of management of benign solitary thyroid nodules in which drains are used routinely. Objective of this study to compare the outcome of thyroid lobectomies undergone with and without drains in patients of benign solitary thyroid nodules.Methods: A comparative cross-sectional research was completed on 98 patients of benign solitary thyroid nodules at surgery department of Liaquat University Hospital Jamshoro. Patients having age of 18-60 years underwent thyroid lobectomies were included and distributed in two groups A and B. Group A includes thyroid lobectomies with drain and Group B without drain. Postoperative outcomes including pain score assessed via visual analog score (VAS), hospital stay and complications including wound infection, seroma and hematoma.Results: Out of 98 cases, 49 underwent thyroid lobectomy with drain and 49 without a drain. Females patients were in majority in group A 42 (85.7%) and also in group B 47 (95.9%). No significant difference (p-value=0.674) was in mean age of group A 30.8±10.2 years and group B 31.8±12.2 years. Higher mean with significant difference (p-value=0.001) was in pain score of group A 5.61±1.25 as compared to group B 3.55±0.70. No significant difference was in complications; seroma 1 (2.04%) vs 5 (10.20%), hematoma 1 (2.04%) vs 1 (2.04%) and infection 3 (6.12%) vs 0 (0.0%) in group A and B respectively. Higher mean with significant difference (p-value=0.001) was in hospital stay of group A 2.40±1.57 days as compared to group B 1.42±0.54 days. No significant difference (p-value=0.748) was in overall rate of complications in group A 5 (10.20%) and B 6 (12.24%).Conclusions: Thyroid lobectomy with drain is not effective in lowering the postoperative complications whereas enhanced the risk of postoperative pain, wound infection and duration of hospital stay as compared to thyroid lobectomy without a drain.

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