scholarly journals Experience with Tetanus in a Tertiary Care Hospital in Sudan: A Retrospective Review

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Mumen Abdalazim Dafallah ◽  
Esraa Ahmed Ragab ◽  
Omer Ali Mohamed Ahmed Elawad
Keyword(s):  
Mortality Rate ◽  
Rural Areas ◽  
Tertiary Care ◽  
Cardiovascular Complications ◽  
Lower Limbs ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Care Hospital ◽  
Female Ratio ◽  
Central Sudan

Introduction. Tetanus is still a major health issue, especially in rural areas, and is associated with high morbidity and mortality rate. This study was conducted to describe the pattern of presentation and treatment outcome among adult patients infected with tetanus in our environment. Materials and Methods. This is a descriptive retrospective hospital-based study conducted in Wad Medani teaching hospital, central Sudan. A total of thirty-one patients were enrolled in this study in the period between January 2018 and December 2020. Results. Thirty-one patients were infected with tetanus during the study period. They were 23 (74.2%) males and 8 (25.8%) females with a male-to-female ratio of 2.875 : 1. Their ages ranged from 20 to 70 years, and most of them (48.4%) were free workers. Acute injuries were the most common portal of entry (64.51%), and commonly involved the lower limbs (48.38%). Lock jaw (54.8%), muscle spasm (51.6%), and neck pain and stiffness (45.2%) were the most common presentation. Supportive measures along with surgical toilet and debridement, human tetanus immunoglobulin, antibiotics, and muscle relaxants were initiated in all patients. The most common antibiotics used were Penicillin V and Ceftriaxone. A muscle relaxant was administered to aid in relieving the spasms. Complication rate was 61.29% and included pulmonary and cardiovascular complications. Fifteen patients died accounting for an overall mortality rate of 48.4%. Conclusions. Tetanus remains a disease with high morbidity and mortality. The unknown/incomplete vaccination status among study participants, inadequate management, and lack of equipped resources lead to a devastating outcome as in Sudan.

scholarly journals Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

2018 ◽  
Vol 7 (6) ◽  
pp. 2283
Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

scholarly journals A study to assess the clinical profile of patients with snake bites in a tertiary care hospital

2019 ◽  
Vol 6 (6) ◽  
pp. 1727
Author(s):  
Keshava Murthy M. R. ◽  
Aruna C. Ramesh
Keyword(s):  
Rural Areas ◽  
Primary Care Physicians ◽  
Tertiary Care ◽  
Snake Bite ◽  
Clinical Profile ◽  
Medical Emergency ◽  
High Morbidity ◽  
Care Hospital ◽  
Correct Treatment ◽  
Snake Bites

Background: Snakebite is a life-threatening medical emergency. It occurs frequently among rural people, especially those working in the fields. Most houses in rural areas of India are made of mud and have many crevices where rodents flourish. Delay in seeking medical aid or ignorance among primary care physicians about the correct treatment of snakebite is responsible for the high morbidity and mortality. Authors objective was to study the clinical profile of snake bite at a rural tertiary care centre.Methods: A hospital based cross sectional study was conducted at M S Rammaih Medical College Bangalore from   June 2017 to June 2018.  The incidence of Snake bite in Karnataka is 0.5% and at 95% confidence interval with Margin of error at 1% the estimated sample size was 197, but in this study author were able to collect data of 237 cases, hence all the cases were included in the study and analyzed.Results: Majority of the respondents were middle aged between 21-50 years. Around 63.3% of the respondents were male and nearly 56.2% were farmers. The incidence of snake bite of Cobra was seen in 8.9%, Krait 5.1% and viper 4.2%. Around 70% patients had no significant complications following hospitalization in our study. Around 20% had hematotoxic like ARF, DIC and local gangrene.Conclusions: Snakebite is one of the common hazards especially in rural setup as agriculture being the main occupation. Snake bite can present with various manifestations at bite sites, neurotoxicity, hematotoxicity.

scholarly journals Hypertensive disorder of pregnancy and its immediate outcome on neonates in a tertiary care hospital of Western Nepal

2019 ◽  
Vol 8 (6) ◽  
pp. 1343
Author(s):  
Badri Kumar Gupta ◽  
Amit Kumar Shrivastava ◽  
Laxmi Shrestha
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Care Hospital ◽  
Early Management ◽  
Female Ratio ◽  
Hypertensive Disorder Of Pregnancy

Background: Hypertensive disorders in pregnancy remain a major cause of maternal and neonatal morbidity and mortality worldwide. This study prospectively examined the immediate neonatal outcome of women with maternal hypertensive disorder of pregnancy (HPD).Methods: This is a prospective study conducted at NICU in Universal College of Medical Sciences Hospital over a period from 2nd February 2018 to 1st February 2019. Fifty-two mothers and their newborn were selected. Mothers with gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension and chronic hypertension were included.Results: Mean maternal age was 26.4 years. Mean gestational age was 34±4 weeks. 38 were male and 24 were female with male: female ratio 1.72:1. Thirty seven (71.2%) mothers needed lower uterine caesarian section, fourteen (26.9%) mothers delivered NVD and one (1.9%) forceps delivery. Low birth weight (<2.5kg) babies were 25 (48.1%%), very low birth weight (<1.5kg) were 9 (17.3%) and normal weight were 18 (34.3%). Intrauterine growth retardation (IUGR) were 18(30%). Perinatal asphyxia 10 (19.2%) were most common cause of admission, other cause of admission were sepsis and prematurity.Conclusions: Eclampsia is still a common and serious complication of pregnancy. Proper antenatal care, detection of preeclampsia with early management and timely referral of high risk patient, administered of MgSO4 in correct doses and properly timed caesarean section in selected cases would reduce the incidence of eclampsia associated maternal and perinatal morbidity and mortality in our facility.

scholarly journals Whipple's pancreaticoduodenectomy: perioperative outcomes in a tertiary care hospital in Dhaka, Bangladesh

2021 ◽  
Vol 9 (3) ◽  
pp. 696
Author(s):  
A. B. M. Bayezid Hossain ◽  
Sadia Afroz ◽  
M. Tasnimul Khair Shovon ◽  
Nabila Anjuman ◽  
Mitul Chackraborty
Keyword(s):  
Mortality Rate ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Perioperative Outcomes ◽  
Care Hospital ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Presenting Symptoms ◽  
Critical Care Management ◽  
Considerable Morbidity

Background: Pancreaticoduodenectomy is one of the most complex surgery with significant mortality and morbidity. Though the mortality rate has steadily improved, morbidity continues to be high. The aim of this study was to demonstrate the perioperative outcome following this procedure at our hospital.Methods: This retrospective study was conducted in the department of Surgery, Sir Salimullah medical college and Mitford hospital from July 2018 to December 2019. A total of 29 patients who undergone pancreaticoduodenectomy were included in the study. Preoperative, intra-operative and post-operative data were analyzed with emphasis on the morbidity and mortality rates. None of the operated patients received any types of neoadjuvant therapy.Results: Out of 29 patients who underwent PD, 18 (62.1%) were male and 11 (37.9%) were female with a median age of 53.7 years. The most common (34.5%) age group of the patients were 51-60 years. Jaundice was the commonest (89.7%) presenting symptoms followed by anorexia (75.9%) and abdominal pain (48.3%). Overall complications occurred in 37.9% patients, including wound infections (31.0%) and post-operative pancreatic fistula (6.9%). The post-operative mortality rate was 6.9%.Conclusions: PD still causes considerable morbidity and mortality. With careful patient selection, adequate preoperative preparation, surgical technique, excellent critical care management PD can be performed safely. At our center we have a reasonable volume and our data are comparable to literature data. 

scholarly journals Spectrum of soft tissue lesions in upper and lower extremities on fine needle aspiration cytology: A three years’ experience from Western Indian population

2021 ◽  
Vol 6 (4) ◽  
pp. 301-306
Author(s):  
Sneha Sisodiya ◽  
Vaishali P Gaikwad ◽  
Leena Naik
Keyword(s):  
Soft Tissue ◽  
Wide Spectrum ◽  
Tertiary Care ◽  
Tendon Sheath ◽  
Lower Limbs ◽  
Care Hospital ◽  
Predictive Diagnosis ◽  
Soft Tissue Neoplasm ◽  
Female Ratio ◽  
Soft Tissue Lesions

Soft tissue lesions have a wide spectrum which includes non- neoplastic, benign & malignant lesions. FNAC act as preliminary diagnostic tool providing a predictive diagnosis of a benign or malignant soft tissue neoplasm and thus helps for further intervention. This study discusses the spectrum of FNAC of soft tissue lesions in upper and lower limbs.All cytology smears of soft tissue lesions from both upper and lower limbs were included over a period of three years at tertiary care hospital. The most common age group was 31 to 40 years with male to female ratio being 1.3:1. The spectrum included broadly neoplastic (65.7%) & non-neoplastic (34.3%) cases. The neoplasms were further divided as benign (42.8 %), malignant (18.6%) and suspicious for neoplasm (4.3%) whereas (34.3 %) were non-neoplastic lesions. The most common lesion was giant cell tumor (GCT) of tendon sheath. The most common site was hand (24%) followed by feet (22.5%). FNAC of soft tissue lesions is useful for differentiating various lesions and neoplasms in extremities so as to help patients in further management.

scholarly journals Etiology & Outcome of Acute kidney Injury in Intensive Care Unit Settings of a Tertiary Care Hospital

2020 ◽  
Vol 4 (2) ◽  
pp. 01-05
Author(s):  
Hassan Mumtaz
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Risk Factor ◽  
Intensive Care ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Care Hospital

Introduction: Acute kidney injury (AKI) is defined as a rapid loss of kidney function occurring over few hours or days. In intensive care unit settings, acute kidney injury (AKI) is a very prevalent condition as most of the patients who are admitted in intensive care units are critically ill. The incidence of acute kidney injury is increasing throughout the world mainly because of aging population and co morbidities which are associated with aging. In intensive care unit settings, the incidence of AKI may reach up to 67%. Though AKI effects depend on clinical situation yet associated with high morbidity and mortality. The rationale of this study is that, as acute kidney is one of major factors contributing in mortality and morbidity of ICU patients, this study will be helpful in identifying important risk factor for development of acute kidney injury in ICU settings, leading to its early detection and thus decreasing associated morbidity and mortality. Objective: To determine the frequency of etiology and outcome of acute kidney injury in medical intensive care unit of KRL Hospital. Setting: Medical ICU, KRL Hospital, Islamabad. Duration: six months from 17th May 2017 to 17th November 2017. Study design: Descriptive case series. Material and method: In this study 118 patients were observed. After screening and application of exclusion criteria, a total of 118 patients who were fulfilling the inclusion criteria were selected as the study sample and were included in the final analysis regarding prevalence of risk factors associated with AKI and the outcome associated with AKI. AKI was further classified using acute kidney injury network (AKIN) classification system. Patient age, gender, serum creatinine, etiology and outcome in form of recovery or mortality was recorded. Results: Overall incidence of AKI in ICU settings in this study was 37.8% (n=118). Out of 118 patients who had AKI, 59.3% (n=70) were male, whereas 40.7% (n=48) were females. Most common risk factor associated with development of AKI was sepsis secondary to infectious illnesses and 39% (n=46) of the patients who developed AKI were suffering from infectious illnesses. Gastrointestinal, drugs and cardiac causes constitutes the 32.2 % (n=38), 18.6% (n=22) and 10.2% (n=12) respectively of the AKI in ICU settings. In terms of outcome, mortality rate in patients with AKI was significantly higher as compared to patients without AKI(P =<0.001) and 56.8%(n=67) of the patients who had AKI died during their ICU stay as compared to 30.4%(n=59) in patients without AKI. Conclusion: Our study concludes that the frequency of etiology including infectious causes was 39%, cardiac pathology 10%, GI causes 32%, drugs was 19% and mortality was 56.8% in patients with acute kidney injury.

scholarly journals Blunt abdomen trauma: a study of 50 cases

2018 ◽  
Vol 5 (5) ◽  
pp. 1763
Author(s):  
Hardik J. Solanki ◽  
Himanshu R. Patel
Keyword(s):  
Mortality Rate ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Morbidity And Mortality ◽  
Urethral Injury ◽  
Care Hospital ◽  
Road Traffic Accidents ◽  
Female Ratio

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Identification of serious intra-abdominal pathology is often challenging; many injuries may not manifest during the initial assessment and treatment period.Methods: This study was conducted on 50 patients of blunt abdominal trauma admitted in a Tertiary Care Hospital, Including All patients with blunt abdominal trauma and Patients of all age groups.Results: In present study age group affected was 11 to 20 years and 41 to 50 years (20% each). Next group was 21 to 30 years (18%), male: female ratio was 2.8:1, most common mode of injury was road traffic accidents. Incidence of road traffic accidents was 48%. In study 2 patients out of 3 patients expired due to late presentation, liver injured (34%), followed by spleen (16%). Other injuries were small intestine and mesentery (14%), Urethral injury (12%) and muscular hematoma (8%), clinical presentation was abdominal pain (90). Extremity fractures 14% of cases, postoperative complication of respiratory infections (50%). Wound infection was 25% of patients. 2 patients who died suffered postoperative complications. Mortality rate (40%) in hemodynamically unstable patients than in hemodynamically stable patients (3%), Survival rate 94% while mortality rate 6%.Conclusions: Morbidity and mortality can be prevented by timely initial resuscitation and correct diagnosis as well as management (operative or non-operative) which depend on patient’s hemodynamic stability and findings of imaging studies.

scholarly journals Clinical spectrum and out comes of snake bite patients admitted in a tertiary care hospital , A prospective observational hospital based study

JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Sameer Anand ◽  
Owais Ahmed ◽  
Vijay Kundal
Keyword(s):  
Clinical Features ◽  
Rural Areas ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Snake Bite ◽  
World Health ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Female Ratio ◽  
Snake Bites

Background: Snakebite is a major public health problem and its prevalence is high in India. Insufficient epidemiological data and global neglect of this condition prompted the World Health organization to recognize it as a ‘‘neglected tropical disease’’ Objective: To study demographic characteristics of snakebite victims, to see clinical symptoms of bite and outcomes of snakebite. Methods: A prospective observational hospital-based study carried out from November 2016 to October 2017, in patients with a history of snakebite. Results:Total 300 patients were included in this study,170 (56.67%) were bitten by heamotoxic snakes and 130 (43.33%) were bitten by neurotoxic snakes. Majority of patients  were in the age group of 20-39 years  ( n=153; 51%). Men outnumbered women( n=190; 63.33%), with male to female ratio of 1.7: 1. Higher incidence of snake bite was found in July – September (n=135;45.00 %) followed by April to June( n=124; 41.33%).Majority of patients were farmers in rural areas ( n=242; 80.80%).Out of 300 patients,80required ICU care.In patients with neuroparalytic snake bites, clinical features were; ptosis (n=126; 96.92%),ophthalmoplegia  (n=98; 75.38%),respiratory paralysis (n=60; 46.15%),bulbar weakness ( n=74; 56.92%) andabdomen pain(n=25; 19.23%).Clinical features in patients of haemotoxic snake bites were ; bleeding from bite site(n=110; 65.29%) , cellulitis(n=100; 58.82%), gum bleed(n=53; 31.18%), ecchymosis(n=49; 28.82%),epistaxis(n=27; 15.82%),gastrointestinal bleeding(n=25; 14.71%) andhaemoptysis(n=19; 11.18%). Complications  observed  were  acute kidney injury ( n=62; 20.67%) , respiratory failure ( n=51; 17.00%) , DIC( n=7; 2.33%) and  ARDS( n=5; 1.67%) . Out of 170 hemotoxic snake bite patients, 157 (92.35%)  patients  recovered  and 13 (7.65%) patients  died and out of 130 neurotoxic snake bites, 124 (95.39%) patients  recovered and 6 (4.61%)  patients   died, overall mortality was 6.3%. In our study, bite to needle time  was less than 1 hour in 47 patients (15.66%), less than  6 hrs in 120 patients (40%) and more than 24 hours in 45 (15%). Conclusion: Snakebite is common in adult males between 20 to 50 years and the commonest site is the lower limb. The majority of the victims are farmers who work in fields. A maximum number of cases presented within 1-6 hours of bite using a tourniquet on the affected limb as first aid. The complications and mortality of snakebite are high.

scholarly journals STUDY OF MATERNAL MORTALITY IN A TERTIARY CARE CENTRE

2020 ◽  
pp. 30-32
Author(s):  
Anamika Anamika ◽  
Amrita Sharan
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Health Workers ◽  
Tertiary Care ◽  
World Health ◽  
Care Hospital ◽  
Contributing Factors ◽  
Tertiary Care Centre ◽  
Maternal Mortality Rate

BACKGROUND Maternal death or maternal mortality is defined by the World Health Organisation (WHO) as the “death of a women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” AIMS AND OBJECTIVES 1. To study the causes of maternal mortality, 2. To identify the deficits to decrease the current rate of maternal mortality. MATERIALS AND METHODS This was a retrospective study done by analyzing hospital records of maternal mortality occurring in the department of obstetrics and gynaecology of a tertiary care hospital of Bihar from January 2019 to December 2019. RESULTS A total of 126 deaths occurred in this period of 1 year. The total number of live births was 5568 in this year making the maternal mortality rate (MMR) to be 2262.93. This may be due to the fact that being a referral institute most of the cases were referred from the peripheries. 76.19% of the women were referred from outside. The most common age group to be affected was 20 to 29 years (79.36%). Multiparous women were more affected than primiparous women (61.9% V/s 38.10%). The most common cause of maternal mortality was eclampsia seen in 26.98% cases followed by PPH seen in 22.22% cases, anemia in 8.73%, medical complications in 7.94% cases , APH in 7.14% cases , rupture uterus in 7.14% cases. The most common type of delay was type 1 and 2. More number of women were from rural areas. More number of women were illiterates. Most of the women had no ANC. CONCLUSION Illiteracy, poverty, lack of knowledge, delayed referrals, lack of ANC are major contributing factors causing such high maternal mortality rate. Health education, strengthening of peripheral health care and availability of trained health workers and essential drugs should be enforced.

scholarly journals Analysis of enteric ileal perforation: a prospective study in a tertiary care hospital

2017 ◽  
Vol 4 (3) ◽  
pp. 899
Author(s):  
Prabu Shankar S. ◽  
Sudarshan P.B. ◽  
Sundaravadanan B.S.
Keyword(s):  
Prospective Study ◽  
Tertiary Care ◽  
Wound Dehiscence ◽  
Fecal Fistula ◽  
High Morbidity ◽  
Care Hospital ◽  
Female Ratio ◽  
Ileal Perforation ◽  
Delay In Diagnosis ◽  
A Prospective Study

Background: Intestinal perforation as a complication of enteric fever is still a serious problem in developing nations. Enteric ileal perforation is associated with high morbidity and mortality and many patients present in a severe toxic state because of delay in diagnosis and late presentation to hospital.Methods: A prospective study was conducted to assess the prognostic factors in enteric ileal perforation. Observations were made regarding symptoms, signs, duration of illness and presentation of patients to the hospital after acute episode. Per operative findings regarding site, size and number of perforations were recorded. Operative procedures were simple closure, ileostomy, or resection of diseased segment including right hemicolectomy done for associated caecal perforation and entero enteric anastomosis. Post-operative complications like wound infection, wound dehiscence, residual abscess, faecal fistula and deaths were documented.Results: There were 50 enteric ileal perforation cases with a age range of 13-80 with a mean age of 30.7. Male: female ratio was 11: 1. 85% of patients presented within 48 hrs of onset of symptoms of perforation and there is significant mortality in patients who presented more than 48 hrs of onset of symptoms of perforation (57.14%). Mortality was high in multiple perforation group (40%) and also higher incidences of fecal fistula and wound dehiscence.Conclusions: Age and sex have no bearing on the outcome. Perforation presentation interval, delay in surgery, number of perforations are important prognostic markers for typhoid ileal perforation. 

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