Usefulness of Timed Up and Go (TUG) Test for Prediction of Adverse Outcomes in Patients Undergoing Thoracolumbar Spine Surgery

Neurosurgery ◽  
2019 ◽  
Vol 86 (3) ◽  
pp. E273-E280
Author(s):  
Gregoris Komodikis ◽  
Vedavyas Gannamani ◽  
Sivaram Neppala ◽  
Michael Li ◽  
Geno J Merli ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Spine Surgery ◽  
Test Performance ◽  
Tertiary Care ◽  
Skilled Nursing Facility ◽  
Thoracolumbar Spine ◽  
Adverse Outcomes ◽  
Care Hospital ◽  
High Grade ◽  
Timed Up And Go

Abstract BACKGROUND Spine surgery rates have increased and the high postoperative morbidity in these patients result in increased costs. Consequently, it is essential to identify patients at risk of adverse outcomes. OBJECTIVE To assess whether preoperative Timed Up and Go (TUG) test performance can predict high-grade postoperative complications. METHODS A prospective cohort study of patients undergoing elective thoracolumbar spine surgery in a tertiary care hospital between 2017 and 2018. Patients were assessed preoperatively and assigned to the slow-TUG group if unable to perform or test performance time was ≥18.4 s. Primary outcome: high-grade postoperative complications. Secondary outcomes: overall complications, length of stay (LOS), discharge to healthcare facility, readmission and emergency department (ED) presentation. Patients were followed-up until 6 wk after surgery. RESULTS One hundred three patients (mean age 62.95 ± 10.97 yr) were enrolled. Slow-TUG group were more likely to be classified as American Society of Anaesthesiology (ASA) class 3 (74.1% vs 47.4%, P = .02), non-independent (25.9% vs 5.3%, P < .01), and frail (92.3% vs 42.1%, P < .01). TUG was an independent predictor of high-grade complications (adjusted odds ratio (OR): 4.97, 95% CI: 1.18-22.47), overall complications (OR: 3.77, 95% CI: 1.33-11.81), discharge to a skilled-nursing facility (OR: 3.2, 95% CI: 1.00-10.70), readmission within 6 wk of surgery (OR: 9.14, 95% CI: 2.39-41.26) and LOS (adjusted incident rate ratio (IRR): 1.45, 95% CI: 1.16-1.80). CONCLUSION Compared to traditional risk factors, TUG is an important predictor of adverse postoperative outcomes and may be used preoperatively to identify high-risk thoracolumbar surgery patients.

A STUDY OF THE MORPHOLOGY OF PLACENTA IN TERTIARY CARE HOSPITAL OF CENTRAL KARNATAKA, INDIA

2021 ◽  
pp. 51-53
Author(s):  
Saryu Sain ◽  
Tupakula Sharmila ◽  
Uttam Kumar ◽  
Anita Anita
Keyword(s):  
Tap Water ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Careful Examination ◽  
Minimum Length ◽  
Care Hospital ◽  
Dispersal Pattern ◽  
Medical College ◽  
Foetal Membranes ◽  
Morphology And Morphometry

Introduction: Placenta is a temporary structure, developed during Pregnancy and discarded at Parturition. Human Placenta is of Discoid and Haemo-Chorial type. It connects the foetus with the mother's womb. It is formed by the contribution of two Individuals - both Mother and Baby. At 1 term four- fth of Placenta is of foetal origin and one- fth is of maternal. Along with Amnion, Chorion, Allantois and Yolk sac, Placenta can also be considered as one of the foetal membranes, which acts as Nutritive and Protective to the developing Embryo. Method: - The present study was done on morphology and morphometry of 150 placentae carried at the Department of Anatomy, Basaveshwara Medical College & Hospital (BMCH), Chitradurga. The placentae were collected with prior ethical clearance and proper consent. Soon after the delivery the placental surface was washed thoroughly under running tap water which were then weighed, tagged and brought to the department of Anatomy, BMCH. The parameters like size, shape and attachment of umbilical cord were noted down. Gross examination was carried out according to the proforma. Result: - The maximum number of placentae belong to the range of 501-600 gms (38.7%). Least placental weight is recorded as 205 gms, showing dispersal pattern. The maximum recorded weight is 835 gms and the average being 491.4 gms. The majority of the placentae are discoid (63.3%). The minimum length recorded is 8.9 cms, maximum as 23.80 cms and the average being 18.3 cms. Conclusion: - Careful examination of Placenta can help in explaining adverse outcomes, their management in subsequent pregnancies and assessment of new born risk.

scholarly journals PITYRIASIS ROSEA MIMICKING POLYMORPHIC ERUPTIONS OF PREGNANCY

2017 ◽  
Vol 10 (10) ◽  
pp. 21
Author(s):  
Balaji Ommurugan ◽  
Amita Priya ◽  
Swaminathan Tambaram Natesh
Keyword(s):  
Pregnancy Outcomes ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
First Trimester ◽  
Adverse Outcomes ◽  
Unknown Etiology ◽  
Care Hospital ◽  
Pityriasis Rosea ◽  
Human Herpes Virus

ABSTRACTPityriasis Rosea is a self-limiting skin disorder of unknown etiology affecting women more than men. It is very rare in pregnancy and evidence shows conflicting reports on pregnancy outcomes related to Pityriasis Rosea. But however recent evidence says, pregnancy outcomes are not altered, although clinicians must monitor the patient throughout the gestation for adverse outcomes. Hence, we report a case of Pityriasis Rosea infection in a primigravida, in the first trimester and the follow up done in a tertiary care hospital in Southern India.KEYWORDSRASH, FIRST TRIMESTER, ANOMALY SCAN, HUMAN HERPES VIRUS

scholarly journals The Pattern of Day Case (Ambulatory) Percutaneous (PCNL): A Descriptive Retrospective Study from a Tertiary Care Hospital

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Rehan Fareed ◽  
Huma Shamim
Keyword(s):  
Retrospective Study ◽  
Tertiary Care ◽  
Ureteral Stones ◽  
Transfusion Rate ◽  
Care Hospital ◽  
High Grade ◽  
High Grade Fever ◽  
Access Methods ◽  
The Mean ◽  
Staghorn Stones

Background: Percutaneous nephrolithotomy (PCNL) has experienced remarkable development and alteration since it was first described in 1976 by Fernstorm et al. It has also experienced miniaturization of equipment, improvement in operative systems, and refining renal access methods leading to the achievement of maximum clearance of stone while causing minimal morbidity. For example, in endourological practice, when the patient is subjected to PCNL, he traditionally needs programmed inpatient admission, as part of their recovery, it is applicable as an outpatient method in properly selected cases. Objectives: We aimed at evaluating the safety and applicability of the outpatient PCNL procedure. Methods: This retrospective study was done on 210 cases of tubeless PCNL performed by a single urologist at our institute from January 2016 to January 2019. Patients’ mean age (134 males and 76 females) was 57 ± 11.8 years, and 7 patients aged 8 - 12 years. There were 71 pelvic or calyceal solitary stones, 62 non-complete staghorn stones, 17 ureteral stones, 32 renal + ureteric stones (simultaneous renal and ureteral stones) , and 28 complete staghorn stones. The average stone size was 3.5 ± 2.8 (range: 0.7 to 11.8 cm). Results: The mean operation duration was 85.0 ± 29.4 min, and the mean hospital stay was 21.7 ± 3.4 h. Out of 210 patients, 6 patients had longer stay due to high-grade fever and 3 patients due to severe pain, and also 7 patients refused discharge due to personal and social reasons. Our ambulatory PCNL rate was 97 % ( 194 out of 210). Within 72 h, 5 patients were readmitted due to high-grade fever, 3 patients due to haematuria, and 4 patients due to pain and dysuria, and all patients were discharged 2 - 4 days after conservative treatment. Thus, the readmission rate was 6.18% (12 cases were readmitted out of 194 cases). Patients showed a blood transfusion rate of 1.4 %. Also, 19 cases (9.02%) were found with post-operative fever, and no urosepsis was reported. No pulmonary complications and mortality were noted. No re-exploration was done, and no major leak was noted. The angio-embolization rate was 0.59%. We did not use HEMO-SEAL technology, cautery, or suture in the tracks. Conclusions: In conclusion, the outpatient PCNL procedure is an applicable and feasible procedure under selected criteria; however, more investigations using a larger sample size are needed.

Repair of Esophageal Atresia With Trache Esophageal Fistula Through Modified Transpleural Approach by Delivering Lung Out of Main Wound

2018 ◽  
Vol 32 (4) ◽  
pp. 106-111
Author(s):  
Pramod Kumar Mohanty ◽  
Pravat Kumar Majumdar ◽  
Hiranya Kishor Mohanty ◽  
Pradeep Kumar Jena ◽  
Prasant Kumar Tripathy ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Esophageal Atresia ◽  
Tertiary Care ◽  
Operation Time ◽  
Anastomotic Site ◽  
Care Hospital ◽  
Co Morbidity ◽  
Group 2 ◽  
Surgery Department ◽  
Approach Group

Objectives: To assess the morbidity, mortality, operation time, and postoperative complications in the present modified transpleural (MTP) approach with the conventional extrapleural (EP) approach in esophageal atresia (EA) with tracheoesophageal fistula (TEF). Design: Longitudinal randomized case control study. Setting: Pediatrics Surgery Department of a tertiary care hospital. Study period: November 2009 to December 2011. Participants: Neonates above 1.5 kg body weight with EA and TEF. Results: Sex ratio is 7:3 (male and female). In total, 40% had associate anomalies. Duration of operation in MTP approach from 90 to 110 min (mean duration 98.6 min) where as in EP approach from 120 to 130 min (mean duration 121.4 min). All 3(15% wound infections were in EP group. A total of 3 develops right sided pneumothorax with 2 in MTP and 1 in EP approach group. In total, 10% (2) in MTP approach group and 5% (1) in EP group expired. Leakage in anastomotic site was seen in 2(10%) each in both the groups. Six developed stricture, out of which 4 in EP group, 2 in MTP group. Conclusion: MTP approach is less time consuming, possess less hindrance during operation. Postoperative complications are comparable. Mortality is higher in MTP group than EP group, may be because of associated lethal co morbidity.

scholarly journals Impact of Fluoroquinolone Exposure Prior to Tuberculosis Diagnosis on Clinical Outcomes in Immunocompromised Patients

2016 ◽  
Vol 60 (7) ◽  
pp. 4005-4012 ◽  
Author(s):  
Ju Young Lee ◽  
Hyun Jung Lee ◽  
Yong Kyun Kim ◽  
Shinae Yu ◽  
Jiwon Jung ◽  
...  
Keyword(s):  
Median Time ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Care Hospital ◽  
Immunocompromised Patients ◽  
Tb Treatment ◽  
Significant Difference ◽  
Tuberculosis Diagnosis ◽  
The Difference

ABSTRACTThere have been concerns about an association of fluoroquinolone (FQ) use prior to tuberculosis (TB) diagnosis with adverse outcomes. However, FQ use might prevent clinical deterioration in missed TB patients, especially in those who are immunocompromised, until they receive definitive anti-TB treatment. All adult immunocompromised patients with smear-negative and culture-positive TB at a tertiary care hospital in Korea over a 2-year period were included in this study. Long-term FQ (≥7 days) use was defined as exposure to FQ for at least 7 days prior to TB diagnosis. A total of 194 patients were identified: 33 (17%) in the long-term FQ group and 161 (83%) in the comparator, including a short-term FQ group (n= 23), non-FQ group (n= 78), and a group receiving no antibiotics (n= 60). Patients in the long-term FQ group presented with atypical chest radiologic pattern more frequently than those in the comparator (77% [24/31] versus 46% [63/138];P= 0.001). The median time from mycobacterial test to positive mycobacterial culture appeared to be longer in the long-term FQ group (8.1 weeks versus 7.7 weeks;P= 0.09), although the difference was not statistically significant. Patients in the long-term FQ group were less likely to receive empirical anti-TB treatment (55% versus 74%;P= 0.03). The median time from mycobacterial test to anti-TB therapy was longer in the long-term FQ group (4.6 weeks versus 2.2 weeks;P< 0.001), but there was no significant difference in FQ resistance (0% versus 3%;P> 0.99) or in the 30-day (6% versus 6%;P> 0.99) or 90-day (12% versus 12%;P> 0.99) mortality rate between the two groups. FQ exposure (≥7 days) prior to TB diagnosis in immunocompromised patients appears not to be associated with adverse outcomes.

scholarly journals Incidence of various urothelial malignancy in patients undergoing transurethral resection of bladder tumour in tertiary care hospital

2020 ◽  
Vol 8 (1) ◽  
pp. 346
Author(s):  
Kamal Preet Kaur ◽  
Gurpreet Singh Bhangu ◽  
Darpan Bansal ◽  
Divya Julka
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
High Grade ◽  
Urothelial Malignancy ◽  
Papillary Urothelial Carcinoma

Background: Urinary bladder lesions are a great health concern as it lies among the top ten most common cancers in the world. These range from benign, harmless lesions that do not recur to life threatening tumors. The present study was undertaken to study incidence of various urothelial cancer in patients undergoing transurethral resection of bladder tumor in tertiary care hospital, as the treatment, follow up and prognosis is highly variable with different subtypes of bladder cancer.Methods: A hospital based descriptive cross-sectional study was conducted on all patients undergoing transurethral resection of bladder tumor from December 2018 to May 2020 in the Department of General Surgery of Sri Guru Ramdas Institute of Medical Sciences and Research, Amritsar. Based on World Health Organization (WHO) classification incidence of various urothelial malignancy was calculated.Results: Out of 80 patients with growth urinary bladder, 4 patients (5% of total patient) were diagnosed as case of papilloma, 26 patients (32.5% of total patients) were diagnosed as low grade papillary urothelial carcinoma, 50 patients (62.5% of total patients) were of high grade papillary urothelial carcinoma. There were no case of PUNLMP in our study.Conclusions: It can be concluded that majority of the patient undergoing transurethral resection of bladder tumor are diagnosed with high grade papillary carcinoma. 

scholarly journals Clinicopathological correlation of p63 in Urothelial Carcinoma: Immunohistochemical Study

2020 ◽  
Vol 7 (6) ◽  
pp. A269-274
Author(s):  
Rupinderjit Kaur ◽  
Mridu Manjari ◽  
Sanjay Piplani
Keyword(s):  
Urothelial Carcinoma ◽  
Tertiary Care ◽  
Staining Intensity ◽  
Good Prognosis ◽  
Health Concern ◽  
Low Grade ◽  
Care Hospital ◽  
High Grade ◽  
Female Ratio ◽  
Urothelial Carcinomas

Background: Urothelial cancer (UCa) poses a significant medical and public health concern in most parts of the world and is defined as a pan- urothelial disease in which entire urothelium of the renal pelvis to the urethra can undergo malignant transformation.  Bladder tumors account for 90–95% of urothelial carcinomas and are the most common urinary tract malignancy. It is three times less common in females. Methods: The study was conducted on 40 cases of Urothelial Carcinoma received as biopsy specimens in a tertiary care hospital. There were 20 cases each of low grade and high grade and after grading these were subjected to p63 expression. Result: 78% of the patients were from 50-75 year age group with Male to Female ratio being 4:1. Painless hematuria was most common complaint. The size varied from 0.5 to 7.2 cm. For P63, 38 (95%) cases showed positive p63 expression. Of which 20 cases were low grade and 18 (90%) were high grade papillary urothelial carcinomas. Of P63 positive cases 36 cases showed moderate to strong staining intensity whereas two cases showed mild staining intensity. The p63 expression decreased with grade and invasion. Conclusion:   P63 immunoexpression decreases with increasing grade of tumor as well as with invasion thus showing that its expression is related with good prognosis.

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