Browsing by Author "S, Khan"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
Publication Comparative study of three antimicrobial drugs protocol (Ceftriaxone, Gentamicin/Amikacin and Metronidazole) versus two antimicrobial drugs protocol (Ceftriaxone and Metronidazole) in cases of intra-abdominal sepsis(Kathmandu University, 2005) S, Khan; DK, Gupta; DN, KhanBackground: Treatment of intra-abdominal sepsis with antibacterial drugs should be initiated as soon as possible diagnosis is made before surgery and continued in the post operative period, unless required to be changed (when there is no satisfactory clinical response). The ideal agent (s) and duration of therapy remains somewhat controversial. However, early experimental and subsequent clinical studies have indicated that the spectrum of chosen antibacterial activity must encompass both colonic aerobes and anaerobes including B. fragilis. There are a number of multi drug protocols that are used to treat intra-abdominal septic conditions. Empiric use of these protocols not only adds toxicity to already ill patient but therapy becomes costly and utilizes human resource, unnecessarily. Aim of study: To study the clinical efficacy of the treatment of intra-abdominal sepsis with protocol –A (Ceftriaxone, Metronidazole and aminoglycoside) versus protocol –B. (Ceftriaxone and Metronidazole). Material and methods: This is a prospective randomized study conducted at NGMC, Nepalgunj, Nepal (2003- 2004) on the patient attending for the treatment of intra -abdominal sepsis. Patients included in this study were of inflammation, obstruction with or without gangrene and perforation of appendix, small bowel and large bowel with localized or generalized peritonitis. These patients were managed surgically by- appendicectomy, closure of perforation, resection and anastomosis (R&A) and resection and proximal colostomy. Patients of large bowel obstruction without gangrene and small bowel gangrene were managed by R&A. These patients had significant faecal spillage at the surgical site as well as in the peritoneum. At the end of operation peritoneum and surgical site of all cases were washed with saline and povidone-iodine solution. They were put on one of the two protocols for post-operative treatment. A total 59 patients were included in this study. 32 cases were treated with protocol- A and rest 27 cases were treated with protocol- B. These cases were selected randomly for this study. Their outcome was compiled and compared under following headings: postoperative recovery, postoperative pyrexia, wound infection and dehiscence, anastomotic leak, residual abscess and cost of therapy. Statistical analysis: Statistical analysis was done with the help of Chi square test. Result: Of the 59 patients, 32 were randomized to group I, 27 to group II. These groups were comparable in age, weight, sex and duration of therapy. Uneventful recovery was noted in 87.5 % (28/32) in -group I where as in 70.37% (19 /27) in-group II. Complications were observed in 12.5% in-group I where as 29.63 % in-group II. 10 patients in-group I where as 7 patients in -group II had surgical site infections (SSIs). All of these had superficial wound infection with/or without dehiscence of small portion of wound. A single case of residual abscess and anastomotic leak was observed. Postoperative pyrexia was noted in 8 patients in-group I where as in 6 patients in-group II. In pyrexia, temperature ranged from 99-104 0F. Finally except one case, rest of the cases recovered. On follow up after 3weeks, the cases recovered were doing well. Conclusion: At least three conclusions can be drawn from this study. Firstly protocol A is equally effective as protocol B. Secondly; it appears that combining aminoglycoside with Ceftriaxone therapeutically has no significant (P=0.09) benefit over Ceftriaxone alone. Finally protocol A is less expensive in terms of total therapy than protocol B and can be used without fear even in subnormal functioning kidney. Key Words: Comparative Study, Antimicrobial Drugs, Protocol, Intra-abdominal SepsisPublication Evaluation of hyperbilirubinemia in acute inflammation of appendix: A prospective study of 45 cases(Kathmandu University, 2006) S, KhanBackground: Hyperbilirubinemia is the result of imbalance between production and excretion of bilirubin by the liver. It may be because of hepatocellular, cholestatic or haemolytic diseases. Liver receives blood mainly through portal venous system, which receives blood from abdominal organs. Portal blood carries nutrients and other substances absorbed from gut including bacteria and its product (toxins). In small percentage, even in normal healthy people, bacteria are found in portal blood. It is commonly cleared by detoxification and immunological action of reticuloendothelial (RES) system of liver that act as first line defence in clearing toxic substances, bacteria and it's products. But when bacterial load overwhelms the Kuffer cell function, may cause dysfunction or damage to the hepatocytes (liver parenchyma). It reflects, rise in serum bilirubin (SB) alone or in combination with liver enzymes depending upon the type, severity and site of lesion. Recently, another substance known as Cytokines e.g. IL-6, Tumour necrosis factor (TNF), have also been labelled to be responsible for depressed excretory function of liver and may lead to increase in SB level without rise in liver enzymes. Aim: To evaluate hyperbilirubinemia associated in acute inflammation of appendix (acute appendicitis and its complication). Material and methods: This is a prospective study conducted at NGMC Teaching hospital Nepalgunj, Nepal during Oct.2004-Oct.2005. 45 Consecutive cases of acute appendicitis admitted in surgical unit III, were recruited for this study. Clinically suspected cases were subjected to investigations to confirm the diagnosis. Investigations included total leucocytes count, differential leucocytes count, urine analysis and ultrasound. These cases were also subjected to routine liver function tests. Subsequently these cases were operated and clinical diagnosis was confirmed per– operatively and post operatively by histopathological examination of the specimen. Their clinical and investigative data were compiled and analyzed and following observations were obtained. Routine liver function test results were compared with laboratory reference values given in Table- 1, 2 and 3. Inclusion Criteria: Case with acute appendicitis and its complication with test negative for HBSAg and no past history of jaundice. Exclusion Criteria: Case with acute appendicitis and its complication with test positive for HBSAg and /or past history of jaundice. Results: Total number cases were 45. Of 45, 25 were males and 20 were females. Their age ranged from 11years to 60 years. The average was 27.2 years. Duration of symptoms ranged from 5 hours to maximum 9 days. Among 45 cases diagnosed as acute appendicitis clinically (preoperatively), per operatively, 36 cases had inflamed appendix, 3 cases had gangrene, 5 cases had perforation with peritonitis (4 localized and 1 generalized peritonitis) and only a single case was noted to be of normal appendix (Table 4). Liver function tests (LFT) analysis revealed following results, Among 45 cases, SB was raised in 39cases where as 6 cases had normal SB level. The raised SB ranged from 1.2 mg/dL to 8.4 mg/dL. The average level of SB was 2.38 mg/dL. All the cases had indirect fraction of SB above 15%. (Table 4). The rise in SB was without concomitant much rise in liver enzymes. Conclusion: Following conclusion can be drawn from the present study. Firstly, There was Hyperbilirubinemia in 86.6% of the patients of acute inflammation of appendix (i.e. acute appendicitis and its complications). Secondly, Raised SB ranged from 1.2mg/dL - 8.4 mg/dL. Thirdly, The rise in SB was mixed in type (both indirect and direct). Finally, The hyperbiliubinemia was intra hepatic cholestatic in type due either to abnormality in permeability of hepatocyte or ductular membrane enzyme inhibition as the liver enzymes were not much elevated. Key words: Acute Inflammation of Appendix, Acute appendicitis, Hyperbilirubinemia, Serum bilirubinPublication Prospective study of pattern of breast diseases at Nepalgunj Medical College (NGMC), Nepal(Kathmandu University, 2003) S, Khan; AK, Kapoor; IU, Khan; GB, Shrestha; P, SinghIntroduction: Patients of breast diseases of female are very common cases attending surgical out patient department for treatment at NGMC, Banke, Nepal. Objectives: To find out the magnitude of the breast diseases, its frequency distribution in different age group among the patients attending surgical OPD for surgical consultation. Material and method: This is a prospective study conducted at NGMC, Nepalgunj, Nepal. Patients attending surgical OPD for one or another breast problem were included. They were assessed clinically and their diagnosis was confirmed by cytological (FNAC) or histopathological (biopsy) examination. Then they were subjected to appropriate treatment. It must be mentioned at the outset that no clinical mammography could be done in the case of this study as these facilities are not available at NGMC. Results: 264 cases of breast disease were diagnosed. This includes 232 female and 32 male patients. The ratio between benign and malignant lesions was 13.6:1. The benign breast diseases (BBD) were the commonest lesions of the breast found in this study (93.2%) whereas malignant lesion was infrequent (6.8%). Among BBD, the commonest lesion was fibroadenoma (32.57%) followed by breast abscess (24.19%), Aberration of Normal Development and Involution (ANDI) which was 16.63% and gynecomastia (11.34%). 18 cases (6.80%) were of malignant lesion. This includes 16 female and 2 male cases. The common ages for BBD were, 20-40 years for fibroadenoma, 15-40 years for breast abscess, 18-40 years for ANDI and 10-19, 50- 59 for gynecomastia respectively, whereas carcinoma breast was common in the age group of forties and fifties. Conclusion: We conclude from this study that BBD were the most frequent breast lesion. Among the BBD fibroadenoma was the commonest lesion. Breast carcinoma cases were less frequent and reached to the hospital in very late stage of the disease. Keywords : Benign Breast Diseases (BBD), fibroadenoma, breast abscesses, gynecomastia, ANDI, breast cancer, juvenile adenofibroma (JAF).Publication Retrospective analysis of abdominal surgeries at Nepalgunj Medical College (NGMC), Nepalgunj, Nepal: 2 year’s experience(Kathmandu University, 2004) S, Khan; IU, Khan; S, Aslam; A, HaqueBackground: Abdominal surgeries are the commonest major operations that are performed in the department of surgery. Aim: To find out the different causes of emergency and elective abdominal surgeries at Nepalgunj Medical College Teaching Hospital (NGMCTH) Nepalgunj, Nepal. Material and method: This is a retrospective study conducted in the department of surgery at NGMCTH Nepalgunj, Nepal, over a period of 2 years (2001-2003). The patients included in this study were drawn from Banke, Bardiya, Kailali, Kanchanpur, Surkhet, Dang, Dailake, and Tikapur. They belong to both sexes and different age groups. All the records of these patients under went laparotomy for elective as well as emergency conditions were included in this study. The data were analyzed; tabulated and following results were obtained. Results: The commonest cause of emergency laparotomies were peritonitis (peptic ulcer, enteric and appendicular perforations) whereas, the commonest cause of elective laparotomies were chronic cholecystitis with cholelithiasis followed by chronic appendicitis and pyloric obstruction. Conclusion: Over all, cholecystectomy for cholecystitis with cholelithiasis was the commonest operation, which was done in last two years. This disease may be because of excessive use of saturated animal fat and vegetable oil. Peritonitis was the 2 nd commonest cause of abdominal surgery. Among the causes of peritonitis, peptic ulcer perforations were the frequent followed by enteric and appendicular perforations. Appendicitis was the 3rd commonest cause of abdominal surgery. Nepal, being a Hindu country, people consume excessive amount of meat, and possibly due to this, the disease of the appendix was very high as compared to other Asian countries where people live on bulk cellulose diet. Key words: Abdominal surgery, Emergency laparotomy, Elective laparotomy, Peritonitis, Intestinal obstruction, Appendicitis.