scholarly journals EP.WE.334Value of including CT chest in the management of acute abdominal emergencies: Experience during first wave of COVID-19 pandemic at a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Maitreyi Patel ◽  
Jennifer Jebamani ◽  
Shrabani Das Mohapatra
Keyword(s):  
Acute Abdomen ◽  
Surgical Management ◽  
District General Hospital ◽  
P Value ◽  
Rt Pcr ◽  
Microsoft Excel ◽  
Surgical Guidance ◽  
Patient Demographics ◽  
Abdominal Emergencies ◽  
Ct Features

Abstract Aims The aim of this retrospective study was to assess the incidence of positive findings on CT chest in patients presenting with acute abdomen, who underwent CT thorax as part of the Intercollegiate General Surgical Guidance on COVID-19 during the first wave. To correlate CT chest findings with confirmed cases on RT-PCR; and to determine its influence on surgical management of abdominal emergencies. Methods A retrospective observational study of adult emergency surgical referrals (excluding trauma) for acute abdomen over a ten week period was performed. COVID changes on CT Chest were categorized as per the BSTI CT reporting criteria. Patient demographics, COVID RT-PCR, management and outcome were recorded. Statistical analysis was performed using Microsoft Excel with p value significant at ≤ 0.05. Results Of the 160 patients included, only 111(69.38%) had COVID RT-PCR. Of 24 (15%) patients with CT chest features of COVID, 45.83% demonstrated classic/probable CT features of COVID of which 36.36% had positive RT PCR. 54.17% had indeterminate pattern and none tested positive for COVID. There was a significant association between positive CT abdomen with normal CT chest findings (p = 0.03). Of 25 (15.63%) patients with normal CT abdomen, 7(28%) had CT features of COVID. Only 43(34.4%) patients needed surgical intervention of which 18.6% had COVID changes on CT, confirmed by positive RT PCR in 12.5%. Conclusions CT chest as an additional investigation modality in acute abdomen had clinically helped in triaging of patients to appropriate specialties but did not influence emergency surgical management.

scholarly journals 1200 Management of Supracondylar Fractures at a District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Erotocritou ◽  
M Antar ◽  
A Abdulkarim
Keyword(s):  
District General Hospital ◽  
Supracondylar Fracture ◽  
P Value ◽  
Type I ◽  
Electronic Patient Records ◽  
Supracondylar Fractures ◽  
Microsoft Excel ◽  
Exclusion Criteria ◽  
Type Iv ◽  
K Wires

Abstract Aim The aims of the study were to identify supracondylar fracture cases, identify any differences in management between the pre- and post-COVID period, as well as compare local management to BOAST guidelines. Method Cases were retrospectively identified using electronic patient records, imaging, theatre records and clinic letters. Cases were identified between 1st of December 2019 – 30th December 2020. The Pre-COVID period was defined as before 15th of March 2020. The Post-COVID period was defined as after 15th of March 2020. Inclusion criteria: any paediatric supracondylar fracture requiring conservative or surgical management. Exclusion criteria: any adult cases. Data analysis and graphics were produced on Microsoft Excel. Results A total of 22 cases were identified. Time to operation Pre-COVID: 1 day vs Post-COVID 2 days (p < 0.05). Only 30% of cases had good neurovascular status documentation. Using the Gartland Classficiation – Type I:2, Type II:10, Type III:9, Type IV:1. Type of Fixation – MUA: 3, K-wires: 18, Plate and screws: 1. All Type I fractures were treated with K-wires. Cast duration for MUA 4 weeks vs K-wire 5 weeks (p-value< 0.05). Only 2/22 cases were referred to physiotherapy, whilst only 1 case required revision surgery. Conclusions MUA was not the treatment of choice for Type I fractures against BOAST guidelines. MUA offered a shorter duration in cast compared to K-wires. There was a statistically significant increase in time to operation between the Pre-COVID to Post-COVID Period. There is a need for better documentation for neurovascular status.

HUBUNGAN ANTARA UMUR IBU DAN JARAK KEHAMILAN DENGAN KEJADIAN PERDARAHAN POSTPARTUM DI RUANG KEBIDANAN RSUD KOTA PRABUMULIH TAHUN 2016

2019 ◽  
Vol 7 (2) ◽  
Author(s):  
Desti Widya Astuti Desti Widya Astuti
Keyword(s):  
General Hospital ◽  
Post Partum ◽  
District General Hospital ◽  
Study Data ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Significance Level ◽  
Chi Square Test ◽  
Post Partum Bleeding

ABSTRAK   Berdasarkan data di RSUD Kota Prabumulih bahwa terdapat peningkatan jumlah kejadian perdarahan post partum, tahun 2014 sebanyak 178 orang, tahun 2015 sebanyak 246 orang dan tahun 2016 sebanyak 151 orang. Penelitian ini bertujuan untuk mengetahui hubungan umur ibu dan jarak kehamilan terhadap kejadian perdarahan post partum di RSUD Kota Prabumulih Tahun 2016. Penelitian ini merupakan penelitian analitik dengan rancangan cross sectional. Populasi yang digunakan adalah semua ibu bersalin di RSUD Kota Prabumulih, sebanyak 1.296 ibu bersalin dan 306 sampel. Pengambilan sampel dengan mengunakan random sampling, analisa data menggunakan analisa univariat dan bivariat dengan menggunakan uji statistik chi-square dengan derajat kemaknaan 0,05. Hasil penelitian ini menunjukan bahwa dari 288 ibu bersalin terdapat 151 yang mengalami perdarahan post partum sebagian besar adalah ibu dengan umur resiko tinggi sebanyak 43 orang  (40,9%) dan ibu dengan jarak kehamilan resiko tinggi sebanyak 21 orang (17,3%). Hasil uju chi-square umur didapatkan p.value 0,000 < α 0,05 dan uji chi-square untuk jarak kehamilan didapatkan p.value 0,000 < α 0,05. Maka ada hubungan umur ibu dan jarak kehamilan terhadap kejadian perdarahan post partum di RSUD Kota Prabumulih Tahun 2016. ABSTRACK   Based on the data at District General Hospital (RSUD) Prabumulih, there was increasing of post-partum bleeding, in 2014, there were 178 people. In 2015, there were 246 people. And in 2016, there were 151 people. The purpose of the study was to know relationship between maternal mother and the distance and old post-partum bleedingat District General Hospital (RSUD) Prabumulih in 2013. The study was analytic researchwith cross sectional design. Population thas was used in the study was all maternal mother ar District General Hospital (RSUD) Prabumulih. It was about 1.296 maternal mother and from 306. Random sampilng was done in the study, data analyses used univariate and bivariate analyses by using chi-square statistic test with significance level 0,05. The study result showed that from 306 maternal mother, there were 151 mother who experienced old post-partum bleeding, the large of that was high maternal mother 43 people  (40,9%) and mother age high distance 21 people (17,3%). The result of chi-square test was p value 0,000 < α 0,05 and chi-square test for age was p value 0,000 < α 0,05. It meant that there was relationship between maternal mother and the distance and of post-partum bleeding at District General Hospital (RSUD) Prabumulih in 2016.

The Protective Effect of Metformin against Oxandrolone-Induced Infertility in Male Rats

2020 ◽  
Vol 26 ◽  
Author(s):  
Abdulqader Fadhil Abed ◽  
Yazun Bashir Jarrar ◽  
Hamzeh J Al-Ameer ◽  
Wajdy Al-Awaida ◽  
Su-Jun Lee
Keyword(s):  
Gene Expression ◽  
Male Infertility ◽  
Protective Effect ◽  
Histological Examination ◽  
Sperm Count ◽  
Serum Testosterone ◽  
Male Rats ◽  
P Value ◽  
Protective Effects ◽  
Rt Pcr

Background: Oxandrolone is a synthetic testosterone analogue that is widely used among bodybuilders and athletes. However, oxandrolone causes male infertility. Recently, it was found that metformin reduces the risk of infertility associated with diabetes mellitus. Aim: This study aimed to investigate the protective effects of metformin against oxandrolone-induced infertility in male rats. Methods: Rats continuously received one of four treatments (n=7) over 14 days: control DMSO administration, oxandrolone administration, metformin administration, or co-administration of oxandrolone and metformin. Doses were equivalent to those used for human treatment. Subsequently, testicular and blood samples were collected for morphological, biochemical, and histological examination. In addition, gene expression of the testosterone synthesizing enzyme CYP11A1 was analyzed in the testes using RT-PCR. Results: Oxandrolone administration induced male infertility by significantly reducing relative weights of testes by 48%, sperm count by 82%, and serum testosterone levels by 96% (ANOVA, P value < 0.05). In addition, histological examination determined that oxandrolone caused spermatogenic arrest which was associated with 2-fold downregulation of testicular CYP11A1 gene expression. However, co-administration of metformin with oxandrolone significantly ameliorated toxicological alterations induced by oxandrolone exposure (ANOVA, P value < 0.05). Conclusion: Metformin administration protected against oxandrolone-induced infertility in male rats. Further clinical studies are needed to confirm the protective effect of metformin against oxandrolone-induced infertility among athletes.

The Role of Nutritional Access in Malnourished Elderly Undergoing Major Surgery for Acute Abdomen: A Propensity Score-Matched Analysis

2020 ◽  
pp. 000313482097371
Author(s):  
Shekhar Gogna ◽  
David Samson ◽  
James Choi ◽  
Jorge Con ◽  
Kartik Prabhakaran ◽  
...  
Keyword(s):  
Propensity Score ◽  
Abdominal Surgery ◽  
Acute Abdomen ◽  
Anastomotic Dehiscence ◽  
The Elderly ◽  
Major Surgery ◽  
P Value ◽  
Gastrointestinal Complications ◽  
Group I

Background About 50% of the elderly undergoing emergency abdominal surgery are malnourished. The role of timely surgical nutritional access in this group of patients is unknown. Methods We analyzed the National Inpatient Sample database from 2009 through the first three-quarters of 2015 of patients aged ≥65 years who were malnourished and underwent major abdominal surgery for the acute abdomen within the first 2 days of hospital admission. Results Of 3 246 721 patients analyzed, 4311 patients met inclusion criteria. Of these, only 507 (11.8%) patients had surgical nutritional access (gastrostomy or jejunostomy) (group I), while 3804 patients (88.2%) did not (group II). In the propensity score-matched population, there were 482 patients in each group. The patients in group I had lower odds of mortality and postoperative gastrointestinal complications (paralytic ileus, anastomotic dehiscence, and intestinal fistulae) ( P-value <.01, respectively). Discussion Elderly who receive surgical nutritional access have lower rates of gastrointestinal complications and mortality.

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = &lt;.001), and more often missed grade 1 (&lt; 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

scholarly journals The Level of Knowledge and Awareness About Sex and Reproductive Health Among Adolescents in Kashmir

2021 ◽  
pp. 263183182198992
Author(s):  
Mohmad Iqbal
Keyword(s):  
Reproductive Health ◽  
Human Body ◽  
Sexual And Reproductive Health ◽  
P Value ◽  
Kashmir Valley ◽  
Microsoft Excel ◽  
Statistical Tool ◽  
Body Experiences ◽  
Level Of Knowledge ◽  
Time Awareness

Background: A human body keeps changing physiologically, biologically, and psychologically from birth to death. There is always a change in all human faculties. But adolescence is a phase earmarked where a human body experiences drastic changes among all these faculties. And any such bodily change carrying baggage of shame, insecurity, stigma, and concealment demands on-time awareness and intervention. Aim: The aim of the study is to understand the knowledge and level of awareness regarding sexual and reproductive health among the school-going adolescents of Kashmir Valley where majority of the population belongs to Muslim conservative culture. Methodology: Due to COVID-19 lockdown, the inability of access to schools and children gave the researcher the opportunity to utilize the alternate places and a total of 550 students from classes 8, 9, and 10 were selected for the purpose. The permission was sought from the respective teachers and then the parents. The sample was a combination of boys and girls, students from both private and government-run schools. The researcher collected the data and it was tabulated systematically and analyzed using Microsoft Excel. P value was evaluated by using an application “P Value: A Statistical Tool” from Play Store. Results and Conclusion: The results depicted that higher the level of class, more the knowledge they had about the matter. Girls had a little knowledge about sexual and reproductive health than boys. This study felt a dire need of educating both parents and adolescent boys and girls regarding sexual health. The shame does not lie in educating the children but in the mishaps that may result due to unawareness about the same.

SP5.1.7 What did we miss? A 5 - year retrospective cohort study calculating the endoscopy miss rate for UGI cancers in a Scottish district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
M Rashid ◽  
D Clyde ◽  
P J Driscoll ◽  
H Jafferbhoy
Keyword(s):  
General Hospital ◽  
Meta Analysis ◽  
District General Hospital ◽  
Quality Standard ◽  
Health Records ◽  
Male Predominance ◽  
Patient Demographics ◽  
Reporting Tool ◽  
Age Range ◽  
Upper Gastrointestinal

Abstract Aims Despite the widespread use of endoscopy, upper gastrointestinal (UGI) cancers still present at an advanced stage. As survival is closely linked to stage and time of diagnosis, failure to detect subtle precancerous changes at endoscopy may compound poor prognoses. This study calculates the miss rate of UGI cancer over a 5-year period at a district general hospital. Methods All patients diagnosed with UGI cancer between January 2015 - December 2019 were identified from a prospectively collected cancer registry. Electronic health records and Unisoft GI reporting tool were used to identify patient demographics and previous UGI endoscopies. ‘Missed cancers’ were defined as patients who had a normal endoscopy within 3 years of their cancer diagnosis. Results The median age at diagnosis was 72.2 years (age range 24 - 98, n = 408) with a male predominance of 2:1 (66.6% male vs 33.4% female) in keeping with UK statistics. Within this 5 year study period, there were 22 missed cancers (5.4%, n = 408). A year by year break down shows miss rate in 2015 of 3% ( 3,n=100), 2016 of 4.2% (5,n=120), 2017 5.5% (5,n=91), 2018 6.4% (6,n=94) and most recently in 2019 3.2% (3,n=94). Conclusions In 2014, a meta-analysis by S.Menon et al recorded a miss rate of 11.3%. More recently published UK studies report miss rates between 6% - 7.3%, more in keeping with our local rate of 5.4%. Further assessment is required to assess whether the 2017 BSG and AUGIS UGI endoscopy quality standard statement will improve this rate.

SP3.2.10 Establishing an Emergency Surgical Ambulatory Care (ESAC) pathway for acute laparoscopic cholecystectomies: a single centre experience from a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Neil Donald ◽  
Lavanya Varatharajan ◽  
Kumaran Ratnasingham ◽  
Shashi Irukulla
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Ambulatory Care ◽  
Operating Time ◽  
District General Hospital ◽  
Gallstone Pancreatitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Patient Demographics ◽  
Day Range ◽  
Cost Efficiencies

Abstract Aims Early laparoscopic cholecystectomy is the gold standard for acute cholecystitis and gallstone pancreatitis. In order to deliver this service, a local Emergency Surgical Ambulatory Care (ESAC) pathway with a dedicated ESAC theatre list was established. The aim of this audit was to determine whether ESAC was associated with (1) improved length of stay and (2) cost efficiencies. Methods Consecutive patients who underwent an emergency laparoscopic cholecystectomy between October 2018 to October 2019 were identified. Data related to patient demographics, operating time, complications length of stay (LOS), reason for inpatient stay and re-admissions were collected. A dedicated ESAC service was introduced in July 2020. Outcomes were re-audited (July – December 2020). Results Prior to the introduction of ESAC, 142 patients (42% male, mean age 51 years (range 14 -82 years)) underwent an acute cholecystectomy, of which 13% were discharged on the same day. Median pre-operative LOS was 2 days (range 0-12 days) and median post-operative LOS was 1 day (range 1-16 days). Following the introduction of ESAC, 78 patients (32% male, mean age 49 years (range 22 – 89 years)) underwent an acute cholecystectomy, of which 76% were discharged on the same day and 90% within 1 day. Median pre-operative LOS was 0 days (range 0 to 7 days) and median post-operative LOS was 0 days (range 0-16 days). Conclusions Our results show that the introduction of a dedicated ESAC pathway improved both pre- and post-operative LOS. This subsequently saves approximately £80,000 per annum in hospital bed days.

scholarly journals Single-operator cholangioscopy for diagnosis of cholangioadenoma (bile duct adenoma) and its potential impact on surgical management

2018 ◽  
Vol 06 (11) ◽  
pp. E1312-E1316 ◽  
Author(s):  
John Eccles ◽  
Aducio Thiesen ◽  
Gurpal Sandha
Keyword(s):  
Bile Duct ◽  
Surgical Management ◽  
Liver Enzymes ◽  
Clinical Indication ◽  
Targeted Biopsy ◽  
Patient Demographics ◽  
Single Operator ◽  
Potential Impact ◽  
Per Oral

Abstract Background and study aims Cholangioadenoma is not recognized commonly and is often only diagnosed on surgical specimens. Direct per oral single-operator cholangioscopy (SOC) allows characterization of common bile duct (CBD) lesions through direct visualization and directed forceps biopsies with potential for impacting surgical management decisions. This is a retrospective review of all SOC cases diagnosed with cholangioadenoma. Patient demographics and outcomes were recorded. Three patients (all male), average age 68 years (range 62 – 76 years), were identified to have a cholangioadenoma. The clinical indication for SOC was deranged liver enzymes with a dilated CBD and a CBD abnormality identified on biliary imaging. The site of cholangioadenoma was proximal, mid and distal CBD, respectively. All patients had a successful SOC with targeted biopsy-proven diagnosis. One patient had a synchronous cholangiocarcinoma and underwent palliative stenting whereas the other two patients underwent appropriate curative resection based on cholangioadenoma location. We conclude that SOC is safe and effective for diagnosis of cholangioadenoma and has potential impact on decisions for surgical management.

scholarly journals Factors Associated With Intraoperative Conversion to Total Thyroidectomy in Benign Goiters

2019 ◽  
Vol 2 (1) ◽  
pp. 105-109
Author(s):  
Samuel Olatoke ◽  
Olayide Agodirin ◽  
Ganiyu Rahman ◽  
Benjamin Bolaji ◽  
Habeeb Olufemi
Keyword(s):  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Degenerative Changes ◽  
P Value ◽  
Receiver Operator Curve ◽  
Factors Associated ◽  
Patient Demographics ◽  
Partial Thyroidectomy ◽  
Intraoperative Conversion ◽  
Operator Curve

Background: Decision to undertake total thyroidectomy when gross inspection of the gland raises suspicion of widespread degenerative changes is often intraoperative. Knowing the factors associated with intraoperative conversion to total thyroidectomy may assist preoperative counselling. This study describes the probability of conversion to total thyroidectomy and factors associated with con-version among patients hitherto planned for partial thyroidectomy. Methods: We reviewed 191 records and extracted data on patient demographics, the pre-operative radiograph findings, the weight of excised gland and the operation performed. Descriptive and inferential statistics were performed. Receiver operator curve was used to assess for cut-off point. P-value was set at 0.05. Results: A total of 191 records was reviewed consisting of 181 females (94.8% 95% CI 90.6-97.5) and 10 males (5.2%, 95%CI 2.5-9.4). Only nodular goiters required conversion to total thyroidectomy. The over-all probability of total thyroidectomy was 11%(95% CI 7.0-16.3). The probability of total thyroidectomy in female was 10.5%(95% CI 6.4-16.9) while in male was 20%(95% CI2.5-55.6). The probability of total thyroidectomy in a female with nodular goiter was 8.1%(95% CI 4.8-13.5), compared to 28.6%(95% CI 3.7-71) in males. The risk of total thyroidectomy was associated with the weight of the excised gland. Conclusion: Only nodular goiters required intraoperative conversion to total thyroidecto-my and the probability of conversion was higher in males.

Sign in / Sign up

Export Citation Format

Share Document