Objective To identify the amputation rates and causative factors for failed revascularization leading to amputation in patients undergoing primary limb salvage procedures for lower-extremity vascular injuries. Methods This retrospective study was conducted at the vascular surgery department, Shaheed Mohtarma Benazir Bhutto (SMBB) Institute of Trauma, Karachi, Pakistan. The data were collected from hospital record using the non-probability sampling technique. Patients aged 17-70 years, undergoing primary revascularization during April 2016 to March 2021, were included in the study. Patients with crush injuries/non-salvageable limbs underwent primary amputation, isolated deep femoral artery or crural arteries (non-limb threatening) injuries, and non-traumatic injuries like intravenous drug-induced or iatrogenic injuries were excluded. The data analysis is done using SPSS Version 20.0 (IBM Corp., Armonk, NY, USA). A P-value of <0.05 was considered as significant. Results This study includes 56 patients of mean age 30.82 ± 9.29 years with male gender four times more affected than their counterpart. About 32% of patients were smokers, while 58% of patients had no co-morbidities. All patients presented with a mean time of 7.66 ± 1.69 hours of injury with an average of 1.14 arterial segments involved. The most frequent artery involved was popliteal artery (both above and below the knee), followed by superficial femoral artery injury constituting 50% and 26%, respectively, with arterial laceration and transection being common findings on exploration. Out of 56 patients, 27 (48.2%) had open fractures, 21 (37.5% ) closed fractures, and eight patients (14.3 % ) presented with dislocation as associated injuries. Following the procedure, secondary amputation was recorded in 18 (32.1%) patients. Thrombosis and infection were the leading causes of revascularization failure. Type of injury, segment of arterial injury, and associated bony injuries were associated with limb amputation. Conclusion Type and site of injury along with concomitant bony injuries are associated with major amputations after revascularization in lower-extremity arterial injuries.

The aim of this study was to assess the effects of ligation and excision of femoral artery pseudoaneurysm without revascularization in intravenous drug abusers presenting in the tertiary care center. MethodsThis was a retrospective study conducted at Shaheed Mohtarma Benazir Bhutto Institute, Karachi, Pakistan, and included 119 patients admitted for vascular injuries of the groin between June 2016 and June 2020. Data collected from the hospital's medical records included all intravenous drug addicts presented with mass near or at groin area only, while other pseudoaneurysm locations secondary to vascular trauma, arteriovenous fistula, and hemodialysis were excluded. SPSS Version 20.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. ResultsThis study included 119 patients, all of whom presented and admitted to the Accident and Emergency Department, with a mean age of about 32 years ± 11.34 years and a mean duration of addiction of 2.47 years ± 1.37 years. Males constituted 83.2% of the patients, while females constituted 16.8%. The left femoral artery was affected more commonly than the right femoral artery, with an average of 75.6% and 24.4%, respectively. The most common presentation was bleeding from ruptured pseudoaneurysm (76.5%) and oozing with pulsatile mass (17.6%), while infected pulsatile swelling and misdiagnosis were uncommon. After surgical intervention, limb salvage was 95.8%, whereas mortality and amputation rate were 2.5 % and 1.7%, respectively. ConclusionThe optimal management of femoral artery pseudoaneurysm in intravenous drug addicts is ligation and excision of the pseudoaneurysm without revascularization.

No abstract

Objective: To assess awareness about the role of lifestyle changes in the management of diabetes among diabetics. Patients and Methods: Settings: Diabetic clinics of Jinnah Postgraduate Medical Centre and Kidney Centre. Karachi. Study Period: From April 7, 2008 to August 31, 2008. Study Design: Cross Sectional. Sampling Technique: Convenient. Sample Size: 200 diabetic patients. Results: A total of 200 diabetics were interviewed. Their mean age was 48.8 years. Of these 92 (46%) were males and 108 (54%) were females. Diabetes was under control of 38% and 57% were taking regular treatment. Education sessions were attended by only 11%, counseling for lifestyle modification was done with 16%, 30% followed diet chart and 18% of the study participants were doing regular / irregular exercise. Majority of them (68%) needed social and family support to cop up the disease. Conclusions: There was a lack of awareness about the role of lifestyle changes in the management of diabetes among these diabetic patients. There is a need of health education programs for diabetics and general public.

BACKGROUND Pre-oxygenation with 100% oxygen is performed routinely before induction of anaesthesia. The purpose of pre-oxygenation is to increase the body oxygen stores and to replace nitrogen in the lungs by an equivalent volume of oxygen, thus delaying the onset of oxygen desaturation and hypoxemia during the apnoeic period following induction of anaesthesia. The objectives of this study were to compare the effects of varying periods of preoxygenation on intraoperative oxygen saturation and its hemodynamic effect. MATERIALS AND METHODS Sixty adults ASA I and II patients scheduled for surgery under general anaesthesia were divided into three groups according to method of pre-oxygenation. In Group 1 (n=20) patients were preoxygenated for 60 seconds, Group 2 (n=20) patients were pre-oxygenated for 120 seconds and Group 3 (n=20) patients were preoxygenated for three minutes of tidal volume breathing using oxygen flow of 6 Lmin-1. Following preoxygenation, face mask oxygenation was continued until the patient got relaxed and then trachea was intubated. Intraoperative saturation was measured using pulse oximetry after every 5 minutes along with other hemodynamic parameters. RESULTS The mean values of intraoperative oxygen saturation at 5 min, 10 min, 15 min and 20 min among three groups did not fall significantly and were statistically non-significant between the three groups (p value of > 0.05). Likewise, at different intervals of intraoperative stage like after 30 min, 45 min, 60 min, 75 min, 90 min, 105 minutes, the values remain same and statistically non-significant (p value> 0.05). Regarding vital parameters (heart rate, blood pressure, respiratory rate, oxygen saturation), there was non-significant difference between the three study groups (p value >0.05). CONCLUSION Rapid preoxygenation by one-minute and two-minutes, normal tidal volume breathing technique is equally efficient to three minutes of preoxygenation in healthy patients.