scholarly journals Post-CABG Deep Sternal Wound Infection: A Retrospective Comparative Analysis of Early versus Late Referral to a Plastic Surgery Unit in a Tertiary Care Center

2021 ◽  
Vol 54 (02) ◽  
pp. 157-162
Author(s):  
Parag B. Sahasrabudhe ◽  
Mugdha D. Pradhan ◽  
Nikhil Panse ◽  
Ranjit Jagtap
Keyword(s):  
Plastic Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
Total Duration ◽  
Median Sternotomy ◽  
Deep Sternal Wound Infection ◽  
Early Group ◽  
Early Referral ◽  
Late Group ◽  
Late Referral

Abstract Background Deep sternal wound infections (DSWI) following median sternotomy are initially treated by the cardiothoracic surgeons and are referred to a plastic surgical unit late in the course of time. Methods This is a retrospective review done in a tertiary care teaching institute from January 2005 to June 2018 and the data of 72 patients who had DSWI out of 4,214 patients who underwent median sternotomy for coronary artery bypass grafting (CABG) was collected with respect to the duration between CABG and presentation of DSWI as well as time of referral to a plastic surgery unit. We defined early referral as < or equal to 15 days from presentation and late referral as > 15 days. Both groups were compared with respect to multiple parameters as well as early and late postoperative course, postoperative complications, and mortality. Results The early group had 33 patients, while the late group had 39 patients. The number of procedures done by the cardiothoracic team before referral to the plastic surgery unit is significant (p = 0.002). The average duration from the presentation of DSWI to definitive surgery was found to be 16.58 days in the early group and 89.36 days in the late group. The rest of the variables that were compared in both the groups did not have significant differences. Conclusion There is no statistical difference between early and late referral to plastic surgery in terms of mortality and morbidity. Yet, early referrals could lead to highly significant reduction in total duration of hospital stay, wound healing, and costs. Early referral of post-CABG DSWIs to Plastic surgeons by the cardiothoracic surgeons is highly recommended.

scholarly journals Analysis of causes of maternal mortality in tertiary care center, 11 years study

2021 ◽  
Vol 10 (9) ◽  
pp. 3320
Author(s):  
Vandana R. Saravade ◽  
Munira Ansari ◽  
Ganesh Shinde
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Care Center ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Hepatitis Infection ◽  
Mortality Ratio ◽  
Late Referral ◽  
Timely Treatment

Background: Objectives to study the causes of maternal mortality and the complications leading to maternal death.Methods: A retrospective study of hospital records and death summaries of all maternal death over a period of 11 years from January 2008 to December 2018 was carried out at tertiary care hospital, Mumbai.Results: There were a total of 459 maternal death out of 36930 live birth giving maternal mortality rate mean maternal mortality ratio (MMR) of 1242 per 100000 live births. Unregistered and late referral account for maternal death. The majority of women were in 21-30 years age group in 20 to less than 37 weeks of pregnancy. The commonest cause of death was due to hepatitis infection 129 (28.1%), sepsis 52 (11.32%), PIH including eclampsia 46 (10.02%), cardiovascular diseases 33 (7.18%), haemorrhage 31 (6.75%), Kochs 31 (6.75%) and respiratory diseases 22 (4.79%).Conclusions: Maternal mortality can be reduced by identifying causes which are preventable and giving timely treatment.

scholarly journals Cardiac involvement in patients of dengue fever in reference to ECG and Echocardiography – A tertiary care center study

2020 ◽  
Vol 8 (6) ◽  
pp. 392-397
Author(s):  
Dr. Nitesh Sukhwani ◽  
◽  
Dr. Rohit Chhari ◽  
Keyword(s):  
Cardiac Involvement ◽  
Clinical Symptoms ◽  
Care Center ◽  
Tertiary Care ◽  
Total Duration ◽  
Clinical Manifestations ◽  
General Medicine ◽  
Research Centre ◽  
Metabolic Derangement ◽  
Multiple Organs

Introduction: Dengue rarely affects the heart but clinical symptoms of cardiac involvement mayrange greatly from silent illness to severe myocarditis resulting in death. Clinical features areasymptomatic and most are transient among patients with DF/DHF. Material and methods: It wasan observational study conducted at the Department of General Medicine, Peoples College of MedicalSciences and Research Centre, Bhopal. The total duration of the study was One and a half yearsfrom Dec 2018 to May 2020. All dengue patients presenting to People’s Hospital during one and halfyears from which data was collected using as per given proforma. Results: In the present studygroup of 58 patients, it was found that 49 patients (84.5%) have not shown any cardiacabnormalities and 9 patients have abnormal values (15.5%) but are not significant. It is also foundthat the incidence of cardiac manifestations was more common in DHF and dengue shock syndromewhich was 15.5% and 3.4%, respectively. Conclusion: Clinical manifestations of cardiacinvolvement can vary widely from silent disease to severe myocarditis resulting in death. Rhythmabnormalities, hypotension, arrhythmias, myocarditis, myocardial depression with symptoms ofheart failure and shock, and pericarditis have been reported. Involvement of multiple organs, as wellas the presence of metabolic derangement, can further confuse the picture.

scholarly journals Impact of Early Versus Late Diuretic Exposure on Metabolic Bone Disease and Growth in Premature Neonates

2018 ◽  
Vol 23 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Lucas E. Orth ◽  
Keliana L. O'Mara
Keyword(s):  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Diuretic Therapy ◽  
Tertiary Care ◽  
Early Group ◽  
Oxygen Requirement ◽  
Premature Neonates ◽  
Metabolic Bone ◽  
Late Group ◽  
Electrolyte Abnormalities

OBJECTIVES This study aimed to determine whether there are differences in the incidence of metabolic bone disease (MBD) between preterm neonates first exposed to diuretics prior to 2 weeks of life versus those exposed after 2 weeks. METHODS This study was a retrospective analysis of premature neonates born at a tertiary care center between 2011 and 2015 who received either furosemide or chlorothiazide. The primary outcome was incidence of MBD. Secondary outcomes included growth, electrolyte disturbances, oxygen requirement, and length of stay. RESULTS A total of 147 patients were included. Early initiation (n = 90) and late initiation (n = 57) arms were balanced with respect to birth weight and gestational age. There was no difference in incidence of MBD in the early group (76%) versus the late group (65%; p = 0.164). Stratification by cumulative dose showed incidence of 85% in patients receiving ≥8 mg/kg of furosemide, compared with 68% and 64% of those in the &lt;4 mg/kg and 4 to 7.9 mg/kg strata, respectively (p = 0.06). The early group experienced greater reductions in length-for-age growth during diuretic therapy (−70% versus −40%; p = 0.009). Electrolyte abnormalities were more prevalent in the early group. Although there was no difference in duration of mechanical ventilation, duration of supplemental oxygen requirement was reduced in the late group (75 versus 89 days; p = 0.003). CONCLUSIONS Timing of diuretic initiation did not affect incidence of MBD. Increased cumulative furosemide exposure may be associated with higher incidence. Patients first exposed to diuretics within 2 weeks of life are at higher risk for electrolyte abnormalities and reduced growth velocity.

scholarly journals Retrospective Analysis of Flap Based Management in Deep Sternal Wound Infection in a Tertiary Care Centre –A Single Centre Study

2021 ◽  
Vol 9 (2) ◽  
pp. 69-72
Author(s):  
Sartaj Guroo ◽  
Ajit Padhy ◽  
Khushwant Popli ◽  
Ridhika Munja ◽  
Navnita Kisko ◽  
...  
Keyword(s):  
Wound Infection ◽  
Heart Surgery ◽  
Tertiary Care ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Muscle Flap ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Flap Surgery ◽  
Fascial Flap

Aims: In this retrospective study we analyzed the outcomes of flap based management in deep sternal wound infection (DSWI). Materials & Methods: Patients, who had undergone open heart surgery through median sternotomy between September 2017 and March 2020 and had developed deep sternal infections, were retrospectively analyzed in this study. Few patients found to have DSWI were managed only by Negative Pressure Wound Therapy (NPWT) and few were managed by NPWT and Bipectoral musculo fascial flap cover. The outcomes in terms of mortality and readmission in the postoperative course were obtained from the records during subsequent follow ups in OPD for six months. Results: Out of 925 patients 11 patients (1.2%) had deep sternal wound infection There were six patients (n=6, 54.55%) who received NPWT where as five patients (n=5, 45.45 %) received flap surgery following NPWT. The patient who underwent Flap surgery had a longer postoperative stay than NPWT group (46.2+/- 22.21, C.I 95%) days Vs (25.5+/- 14.41, C.I 95%) days. However, the readmission due to recurrence of infection was seen only in NPWT group (n=3, 50%) with in the period of six months following discharge. One patient out of the three readmitted patients expired due to sepsis. Conclusion: NPWT followed by bipectoral muscle flap closure has a better surgical outcome than NPW alone in deep sternal wound infection in early postoperative period

scholarly journals Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan

2020 ◽  
Vol 36 (7) ◽  
Author(s):  
Usama Ahmed ◽  
Faraz Shafiq ◽  
Dileep Kumar ◽  
Khalid Ahsan ◽  
Waleed Bin Ghaffar ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Care Center ◽  
Tertiary Care ◽  
Total Duration ◽  
Anaesthetic Management ◽  
University Hospital ◽  
Neurophysiological Monitoring ◽  
Tertiary Care Center ◽  
Brain Simulation ◽  
Deep Brain

Objectives: To review anaesthesia related outcome, perioperative complications and overall length of stay (LOS) in hospital for patients who had deep brain stimulation (DBS). Methods: The study was retrospective review of patients medical records diagnosed with Parkinson disease (PD) and underwent DBS at The Aga Khan University Hospital, Karachi from 2017-2019. Data was reviewed from file notes and patient chart and recorded on predesigned Performa. Frequency and percentages were used to present the data. Results: All patients were anaesthetized using Sleep-Awake-Sleep technique (SAS). Dexmedetomidine was mainly used for conscious sedation. Bispectral index monitor (BIS) was used to monitor the depth of sedation, and kept between 70-85 during sedative phase. All patients had successful intraoperative neurological monitoring, stimulation, and placement of electrodes. Total duration of anesthesia varied significantly in between the patients. Maximum duration was 600 minutes. None of our patient had any intraoperative event related to anaesthetic management. Overall five patients had some adverse events during ward stay. Mean LOS in hospital was four days. Conclusion: Anaesthetic management of DBS is well-tolerated. It requires dedicated team. The SAS technique is excellent for intraoperative neurophysiological monitoring. Careful selection of sedative agents and monitoring depth of anaesthesia using BIS would be beneficial in terms of improving related outcomes. doi: https://doi.org/10.12669/pjms.36.7.2870 How to cite this:Ahmed U, Shafiq F, Kumar D, Ahsan K, Ghaffar W, Bari E. Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan. Pak J Med Sci. 2020;36(7):---------.  doi: https://doi.org/10.12669/pjms.36.7.2870 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Increased Incidence of Ophthalmologic Findings in Children With Concurrent Isolated Nonsyndromic Metopic Suture Abnormalities and Deformational Cranial Vault Asymmetry

2020 ◽  
pp. 105566562095473
Author(s):  
Laura Roider ◽  
Garrett Ungerer ◽  
Leslie Shock ◽  
Kristina Aldridge ◽  
Mohannad Al-Samarraie ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Patient Population ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Cranial Vault ◽  
Refractive Errors ◽  
Deformational Plagiocephaly ◽  
Metopic Suture

Objective: The purpose of this project was to study the incidence of ophthalmologic findings which are known to be risk factors for amblyopia in children who have coexisting metopic suture abnormalities and deformational plagiocephaly (DP) and brachycephaly (DB). Design: Institutional Review Board–approved retrospective study reviewing records of a consecutive cohort of children under 2 years of age with metopic suture abnormalities and cranial vault asymmetries seen in both the plastic surgery and ophthalmology clinics from 2007 to 2017. Setting: Institutional tertiary care center with all care in plastic surgery under the senior author and the standard of care accepted in pediatric ophthalmology under one of two ophthalmologists. Patients: After application of exclusion criteria, 76 children diagnosed with metopic suture abnormalities and DP/DB were included in the study. Patients with severe trigonocephaly, other suture involvement, syndromic diagnoses, and primary ocular disorders were excluded. Main Outcome Measures: Describe the incidences of refractive errors (astigmatism, hyperopia, and myopia), anisometropia, strabismus, and amblyopia within the study population. Results: In our patient population, the rates of amblyopia (17.1%) and strabismus (15.8%) are higher than the general pediatric population rates of 1.5% to 1.8% and 2.4% to 3.6%, respectively. Overall, 47.4% had significant refractive error: 28.9% with astigmatism, 15.8% with hyperopia, 5.3% with myopia, and 10.5% with anisometropia. Conclusions: In our patient population, children with coexisting metopic suture abnormalities and DP or DB had significant risk for amblyopia, strabismus, and refractive errors.

scholarly journals OUTCOMES AND SAFETY OF STERNAL CLOSURE USING NON-ABSORBABLE POLYESTER BRAIDED SUTURE: SINGLE TERTIARY CARE CENTER EXPERIENCE OF 5 YEARS.

2020 ◽  
pp. 1-3
Author(s):  
Manpal Loona ◽  
Rahul Bhushan ◽  
Vaibhav chugh ◽  
Narender S. Jhajhria ◽  
Vijay Grover ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Wound Complications ◽  
Sternal Dehiscence ◽  
Sternal Closure ◽  
Surgical Suture ◽  
Poly Ethylene

Introduction: Median sternotomy is done as regular practice in cardiac surgery, which can lead to morbidity and mortality after sternal closure. Inappropriate sternal closure can lead to sternal dehiscence, sternal wound infection and mediastinitis. Aim: Efficacy and outcomes of sternal closure in adults weighing 2.5 kgs to 50 kgs using non-absorbable polyester braided suture. Methods: Total of 1091 patients underwent standard median sternotomy, weighing between 2.5 kgs to 50 kgs had sternal closure using non absorbable, braided, sterile, surgical suture composed of Poly ethylene terephthalate [polyester]. A retrospective analysis was done to review outcomes and complications related to this sternal closure technique. Results: Nineteen patients developed superficial surgical site infection and sternal sinus were seen in eight patients, whereas one patient had sternal dehiscence during immediate post-operative period. No sternal sutures were broken during the sternal closure and no case of mediastinitis was seen. Follow-up analyses of patients were done for 6 months after open heart surgery. Conclusion: Sternal closure using non-absorbable polyester braided suture is a safe and effective method with very less chances of post sternal wound complications in patients weighing between 2.5 kgs to 50 kgs.

Sign in / Sign up

Export Citation Format

Share Document