iosr-JDMS   Volume-10 ~ Issue-3

Abstract: Amputation is greatly feared in developing countries, often due to it psycho-social effect on patients perception in public. Secondly cultural background and thirdly due to the economic burden on the family towards welfare and support ,due to scarce social and public welfare services. Despite these long term effect, amputation is still carried out for most absolute indication due to the presence of these etiological causes persisting in our environment. Considering these facts ,we deem it necessary and pertinent to review the common indications for surgically treated amputation and refashioning in our environment as well as the necessary epidemiology .

Keywords: Diabetes, Amputation, Aetio-pathologic

[1]. Solagberu B. A. The scope of amputations in a Nigerian teaching hospital. Afr J Med, Med Sci 2001; 30(3): 225-7.
[2]. Thanni L. O., Tade A. O. Extremity amputation in Nigeria - a review of indications and mortality. Surgeon. 2007; 5(4): 213- 7
[3]. Olasehinde A. A.,Oginni L. M., Bankole J. O., Adegbehingbe, Oluwadiya K. S. Indications for amputation in Ile-Ife, Nigeria. Niger J Med 2002; 11(3): 118-21
[4]. Ekere A. A.The scope of extremity amputations in a private hospital in South South region of Nigeria. Niger J Med 2003; 12(4): 225-8
[5]. Dada A A, Awoyomi B O. Is the trend of amputation in Nigeria changing? A review of 51 consecutives cases seen at Federal medical centre Ebute Metta, Lagos, Nigeria. Niger Med J 2010;51:167-9
[6]. Ogunlade S. O., Alonge T. O., Omololu A. B. et al . major limb amputation in Ibadan. Afr J Med Med Sci. 2002; 31(4): 333-6
[7]. Obalum D. C., Okeke G. C. Lower limb amputations at a Nigerian private tertiary hospital West Afr J Med 2009; 28(1): 24-7
[8]. Yinusa W., Ugbeye M. E. Problems of amputation surgery in a developing Country. Int Orthop. 2003; 27(2): 121-4.
[9]. Abbas A. D., Musa A. M. Changing pattern for extremity amputations in University of Maiduguri Teaching Hospital, Nigeria. Niger J Med 2007; 16(4): 330 -3.

Abstract: Background: Operation notes are necessarily a vital part of good note keeping in clinical surgery as they are useful tools in patients management. They are also useful in research, audit of procedures and a sine qua non should medico-legal dispute arise. Ideally operation notes should be written by operating surgeon. This article assesses the quality of operation notes in a young teaching hospital. Method: A total of 99 operation notes were randomly selected from a list of surgical operations between July 2008 and June 2010 of a young teaching Hospital. The operation notes were assessed for expected parameters of a standard operative note against the background of hospital templates and published protocol derived from Good surgical practice by the Royal college of surgeons, Edinburgh, 2008. Available components in the written notes were tabulated. Result: Results showed that all the operative notes were incomplete for all parameters. Deficiencies ranged from 1% for written operative procedure to as high as 96% for tolerance. Other deficiencies were at rates of ;5,7,10, 29, 45, 56 and 58 percentages for name of patient, name of surgeon, admission number, indications, blood loss and positioning respectively. Conclusion. Regular audit of operation notes should be carried out and medical personnel should be properly trained concerning writing of operation notes in a legible, comprehensible and briefly way with the goal of achieving best medical practice.

Keywords: Operation notes, assessment, audit, medico-legal.

[1]. Shah S, Dangol B, Kumari S, Guragain R P. An audit of Operative note at TUTH. Nepalese Journal of Ent, head and neck surgery , Vol 2,No2,issue 2 July-Dec 2011
[2]. General Medical council, Good Medical Practice, GMC 2011
[3]. Lefter LP,Walter SR, Dewhurst F and Turner RWL.An Audit of operative notes:facts and ways to improve.ANZ J.Surg.2008;78:800-2
[4]. Bastia BK.Litigation suits in Otorhinolaryngology, areas of concern, Indian Journal of otolaryngology and head and neck surgery 2006:58;1;370-3.

Abstract: Objective Identifying and prioritizing factors which help in predicting risk of Coronary artery Disease(CAD) in diabetics could play an important role in prevention and early treatment of coronary events. This study was done to find the association of anthropometric obesity indices with Coronary artery Disease (CAD) in type 2 diabetics and to compare the relative importance among the indices. Methods Type 2 Diabetic males on treatment since last 10 years and more than 50 years of age were included.. Subjects with history of hypertension and smoking were also included. The total sample size was 150 individuals with 94 diabetics with CAD as cases and 56 diabetics without CAD as controls. The anthropometric variables were- Body Mass Index(BMI), Waist Circumference(WC), Waist Hip Ratio(WHR), Waist Height Ratio(WHtR) and Conicity Index(CI). Fasting blood glucose(FBG) , HBA1C, Total cholesterol(TCho) and Triglyceride levels(TGL) were also estimated. Correlation coefficient and odds ratio was done for all parameters. Chi square was done for categorical variables. Results. Among anthropometric indices waist height ratio and waist circumference had the greatest predictive value for CAD in diabetics. The odds ratio for BMI was also slightly significant. Waist hip ratio and conicity index were not significant. Among non anthropometric risk factors duration of diabetes , smoking, hypertension and triglycerides showed significant impact on the outcome of CAD.

Key words: anthropometric variables, Coronary artery disease (CAD), diabetics, obesity indices, waist Height ratio , waist hip ratio.

[1]. International Diabetes Federation. IDF Diabetes Atlas, 5th edn. Brussels, Belgium: International Diabetes Federation, 2011. Available from http://www.idf.org/diabetesatlas.

[2]. Sandeep Chopra, Soumia Peter. Screening for coronary artery disease in patients with type 2 diabetes mellitus: An evidence-based review. Indian J Endocrinol Metab. 2012 Jan-Feb; 16(1): 94–101.

[3]. Harald J. Schneider, Nele Friedrich, Jens Klotsche,Lars Pieper, Matthias Nauck, Ulrich John, et al. The Predictive Value of Different Measures of Obesity for Incident Cardiovascular Events and Mortality. The Journal of Clinical Endocrinology & Metabolism. 2010 April1;95(4):1777-1785.

[4]. Chin-Hsiao Tseng. Waist-to-height Ratio and Coronary Artery Disease in Taiwanese Type 2 Diabetic Patients. Obesity .2008; 16 (12): 2754–2759.

[5]. Salim Yusuf, Steven Hawken, Stephanie Ôunpuu, Leonelo Bautista, Maria Grazia Franzosi, Patrick Commerford etal. Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. Lancet. 2005Nov; 366: 1640–49.

[6]. Lawrence de Koning,, Anwar T. Merchant,, Janice Pogue and Sonia S. Anand. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. European Heart Journal.2007; 28: 850–856.

[7]. Meerjady Sabrina Flora, Cgn Mascie-Taylor, Mahmudur Rahman . Conicity index of adult Bangladeshi population and their socio-demographic characteristics. ibrahim med. coll. j. 2009; 3(1): 1-8

[8]. Sarah Choi, Edwin Tan. Anthropometric measures and lipid CHD risk factors in Korean Immigrants with Type 2 Diabetes.J Cardiovasc Nurs. 2011 Sep-Oct; 26(5): 414–422.

[9]. Waist Circumference and Waist-Hip Ratio .Report of a WHO Expert Consultation Geneva, 8–11 December 2008. Available from http://whqlibdoc.who.int/publications/2011/9789241501491_eng.pdf.

[10]. Chamukuttan Snehalatha,Vijay Viswanathan,Ambady Ramachandran. Cutoff Values for Normal Anthropometric Variables in Asian Indian Adults Diabetes Care. 2003; 26:1380–1384.

Abstract: A 19year old primigravida with 12 weeks gestation was admitted in our hospital with bleeding per vagina (PV). She also complained of dyspnea, fatigue, chest pain. Her x-ray chest PA view showed evidence of pneumothorax. Emergency Inter costal drainage (ICD) was placed. . After 24 hours she was posted for dilatation and curettage. General Anaesthesia was administered using injection1 mg butorphanol , 100 mg propofol and 20 mg atracurium. Airway was secured with size 3 laryngeal mask airway (LMA). At the end of the procedure patient was reversed with neostigmine and glycopyrolate and shifted to MICU without any complication

Key words: Dilatation and Curettage, General Anaesthesia,Pneumothorax.Inter costal drainage,Thoracotomy

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