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Biomedical subjects

K M Pal

Publications and source records attributed to K M Pal.

10 recordsLinked to original sources
PubMed2001

Continuous quality assessment; development of a simple computer based model for audit.

OBJECTIVE: Accurate assessment of quality of care is a fundamental first step in the process of quality improvement. The vast amount of data generated in a hospital mandates some form of computerization for management of information. We describe a locally developed simple computer based program to access relevant information from a hospital patient management network. The objective was to reduce the amount of manual work involved for busy clinicians attempting to audit quality of care. METHODS: A single surgical procedure, Laparoscopic Cholecystectomy was chosen. Quality indicators were identified by literature review as conversion rate from laparoscopic to open cholecystectomy and length of hospital stay (LOS). A simple query was developed to extract the required information from hospital database. Commercially available spreadsheet software (Microsoft Excel) was used to calculate the rates. Outliers were defined as LOS more than 1 standard deviation from the mean. The second part of the study involved a manual review of case notes to validate the program and determine the causes for deviation from the mean. RESULTS: The program was able to access and process data as planned. In a one-year period from March 1997 to February 1998, two hundred and thirty one laparoscopic cholecystectomies were attempted. Twenty-three were converted to open procedures given a conversion rate of 9.96%. On manual review of case notes no false positives or false negatives were found. The reasons for conversion were similar to those described in the literature. The mean length of stay for laparoscopic cholecystectomy was 3.39 days and 7.17 days for converted cases. The commonest reason for delay in discharge was noted to be non-availability of elective operating time. CONCLUSION: We have successfully developed and used a simple computer based program to access information stored in hospital patient management systems. Quality of care indicators identified from literature were used as standards. Outliers with respect to these were reviewed in detail to identify causes for deviation. The program was validated by manual review.

Computer Simulation↗
PubMed2001

Diagnostic issues in abdominal tuberculosis.

OBJECTIVE: To analyze the modes of presentation and diagnostic issues in the management of abdominal tuberculosis at a tertiary care hospital in a developing country, where most of the established diagnostic modalities are available. SETTING: The Aga Khan University Hospital, Karachi. METHODS: This study is a retrospective review of medical records of all inpatients, diagnosed to have abdominal tuberculosis, from January 1991 to December 1997. The data was collected and particularly analyzed for spectrum of presentation and role of various diagnostic modalities. Of special interest was the sub-group of patients, who after all investigations did not have a firm diagnosis. Following a literature review recommendations have been developed for empiric antituberculous therapy in such patients. RESULTS: A total of 135 patients were diagnosed to have abdominal tuberculosis with a mean age of 34 years and a male to female ratio of 1:2. Ninety-six (71%) patients presented with chronic abdominal symptoms, while 39 (29%) presented as an acute surgical emergency mandating exploratory laparotomy. A tissue-based diagnosis was established in 95 (70.30%) patients, while radiological diagnosis was made in 30 (22.2%) patients. In 10 (7.4%) patients all investigations undertaken could not reveal a final diagnosis; these were treated empirically on the basis of a strong clinical suspicion. CONCLUSION: The diagnosis of abdominal tuberculosis can be made confidently in most of the cases. There may be a small group of patients where diagnosis cannot be made despite appropriate investigations and a therapeutic trial of ATT may be considered with close monitoring according to a pre-fixed protocol.

Abdomen↗
PubMed1998

Appendicitis: a continuing challenge.

Acute appendicitis is a common surgical emergency in urban setting, of a developing country. The computerised hospital patient database at Aga Khan University Hospital, Karachi, was utilised to obtain records of all adults with a histologically proven diagnosis of acute appendicitis. A review of patients treated over a 18 month period was undertaken. One hundred and three appendicectomies were performed for acute appendicitis during this period. The diagnosis was clinical in all cases. Investigations like leucocyte count and lower abdominal ultrasound scan were used to improve diagnostic accuracy without a clear advantage. A number of routine investigations like, haemoglobin estimation and urea, creatinine, electrolyte measurements, did not provide additional information. The duration of antibiotic treatment in acute simple appendicitis was empiric and could be reduced to a single preoperative dose. Peritoneal fluid culture studies had a poor yield (26%) and results were not found to effect management in acute simple appendicitis. The routine use of Ampicillin in all cases of bacterial peritonitis needs re-evaluation, as a high incidence (73%) of resistance was seen. Studies to define the role and duration of treatment, with a single antibiotic, in acute simple appendicitis should be undertaken. Acute appendicitis is probably the most frequently considered surgical differential diagnosis at any hospital dealing with acute surgical conditions. The established treatment continues to be surgical removal of the inflamed organ. The diagnosis and decision to operate both are accepted to be based on clinical judgement, though a number of investigative manoeuvres have been described to reduce the negative appendicectomy rate. Other areas of debate are the number and length of antibiotic treatment and use of bacterial culture studies in cases of simple acute appendicitis. To analyse present practice and identify areas for study and change, a retrospective study was undertaken at Aga Khan University Hospital (AKUH), Karachi.

Acute Disease↗
PubMed1998

Preoperative work up: are the requirements different in a developing country?

In developing countries there is a tendency to advocate routine testing in asymptomatic healthy patients to identify undocumented significant medical conditions. A retrospective review of pre- operative laboratory investigations undertaken in patients attending the General Surgical department was performed. Three hundred and twenty patients case notes were reviewed, patients were selected on the basis of common general surgical procedures. Two hundred and sixteen patients (67.5%) did not have any associated medical illness on history and physical examination. Analysis of laboratory results showed that 42/216 (19.4%) had low hemoglobin. An abnormal chest X-ray was the next common abnormality 11/103 (10.6%). Mild hypokalemia (> 3 mEq/L) was seen in 6/123 (4.8%) and a raised blood sugar level was seen in 1/113 (0.88%) patients. Only one patient with hemoglobin of 4.8 gm/dL needed preoperative intervention, the rest of the abnormalities did not effect the treatment plan or outcome. The results were in general agreement with other studies except for the high proportion of low hemoglobin seen in the female population. It is suggested that a thorough history and physical examination is a reliable and inexpensive preoperative screening tool. Guidelines for pre-operative investigations in American Society of Anesthesiologists Grade I (ASA I) patients are suggested.

Adolescent↗
PubMedDate not supplied

Scrotal suppuration following appendicitis.

Inguinoscrotal sepsis following intraperitoneal infection is a recognised but infrequent complication. Incidence of this condition seems to have decreased because of the routine use of broad spectrum antibiotics. It is believed that a persistent communication between the peritoneal cavity and scrotum, in the form of a patent tunic vaginalis, is needed for this complication. There may or may not be an associated hernia. Intrascrotal sepsis can lead to testicular loss from vascular thrombosis. The treatment of choice is early operative drainage.

Appendicitis↗
PubMedDate not supplied

Metastatic malignant melanoma of maxillary gingiva. A case report.

Malignant melanoma of the oral cavity can be primary or secondary due to metastasis from distant site. Incidence of oral cavity by metastasis of melanoma is 1.85%. Most common oral sites involved are tongue, buccal mucosa and parotid gland. Oral lesions occur as a part of disseminated disease during the advanced stages and has poor prognosis. An unusual case of metastatic malignant melanoma of the maxillary gingiva is reported.

Biopsy↗