scholarly journals Heineke-Mikulicz pyloroplasty for isolated pyloric stricture caused by corrosive ingestion in children

2019 ◽  
Vol 36 (ICON-Suppl) ◽  
Author(s):  
Muhammad Aqil Soomro ◽  
Maryam Aftab ◽  
Maria Hasan ◽  
Hana Arbab
Keyword(s):  
Gastric Outlet Obstruction ◽  
Low Income ◽  
Tertiary Care ◽  
Outlet Obstruction ◽  
Low Income Countries ◽  
Care Hospital ◽  
Creative Commons ◽  
Pyloric Stricture ◽  
Special Supplement ◽  
Corrosive Ingestion

Corrosive ingestion in children is a common problem in low income countries. These agents cause injuries and later strictures of esophagus and stomach. Gastric outlet obstruction is known complication of acids and surgery is the mainstay of treatment. There are multitude of surgical options for these strictures depending on the involved segment of the stomach and experience of the surgeon. Here we present three cases of children who accidentally ingested acid stored in soda bottles and subsequently developed isolated pyloric strictures. These cases presented between August 2018 and April 2019 to our facility, a tertiary care hospital in Karachi, Pakistan. All three patients had an initial latent period of one to two weeks following corrosive ingestion, after which symptoms of gastric outlet obstruction appeared. Intraoperatively, all three had normal esophagus and antrum but scarred and strictured pylorus. Heineke-Mikulicz pyloroplasty was done in these cases without complications and the outcomes were satisfactory. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1714 How to cite this:Soomro MA, Aftab M, Hasan M, Arbab H. Heineke-Mikulicz pyloroplasty for isolated pyloric stricture caused by corrosive ingestion in children. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S87-S90.  doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1714 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.

scholarly journals The safety and efficacy of the trans-umbilical approach for pyloroplasty in the management of post-acid corrosive gastric outlet obstruction in children

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Essam A. Elhalaby ◽  
Nezar Abd Erouf Abo Halawa ◽  
Ismael E. Elhalaby ◽  
Dina Shawky ◽  
Hussam Hassan ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Esophageal Stricture ◽  
Surgical Techniques ◽  
Outlet Obstruction ◽  
Skin Incision ◽  
Definitive Treatment ◽  
Endoscopic Dilatation ◽  
Umbilical Incision ◽  
Pyloric Stricture ◽  
Corrosive Ingestion

Abstract Background Gastric outlet obstruction (GOO) may follow acid corrosive ingestion. Several surgical techniques have been reported after the failure of endoscopic dilatation. The aim of this study was to evaluate the feasibility and safety of Heinecke-Mikulicz pyloroplasty (HMP) through a circum-umbilical skin incision in children with pyloric stricture after accidental acid corrosive ingestion. Results Seven patients were males and 4 were females, their ages ranged from 17 months to 6 years at the time of definitive treatment. The surgery was completed successfully in all patients through the circum-umbilical incision. Vertical extension of skin incision was needed in one patient. The pylorus was grossly affected in 9 patients. Both pylorus and gastric antrum were involved in 2 patients. Nine patients had an excellent postoperative course with the cessation of vomiting and progressive weight gain. One patient developed postoperative recurrent stricture treated by gastrojejunostomy. Another patient with associated esophageal stricture responded to repeated endoscopic dilatation for the esophageal stricture and pyloroplasty for the pyloric stricture. No surgical site infection or wound dehiscence occurred in any patient. Conclusion Heinecke-Mikulicz pyloroplasty through a circum-umbilical approach is both feasible and safe in the majority of children with post-acid corrosive GOO. It is associated with satisfactory wound healing and excellent cosmetic outcome. Different techniques are recommended in cases of severe pyloric stricture associated with significant proximal gastric antral scarring.

scholarly journals Trends in trauma care before and after the introduction of ‘Mukhyamantri Santwana Harish Scheme’ in a tertiary care hospital at Kolar

2018 ◽  
Vol 5 (5) ◽  
pp. 2072
Author(s):  
Vikas Sankar Kottareddygari ◽  
Vishwas S. ◽  
Praveen G. P. ◽  
Amal Abraham ◽  
Sreeramulu P. N.
Keyword(s):  
Critical Care ◽  
Low Income ◽  
Life Support ◽  
Road Traffic ◽  
Tertiary Care ◽  
Advanced Life Support ◽  
Low Income Countries ◽  
Care Hospital ◽  
Number Of Patients ◽  
Before And After

Background: Road traffic injuries (RTI) are responsible for 1.2 million global deaths and rank 9th as cause of death in both the high and low income countries. Polytrauma cases make the bulk of emergencies in our centre and the victims were previously given only first aid and critical care before being referred to a government aided institute for further management due to monetary issues. After the introduction of Mukhyamantri Santwana - 'Harish' Scheme (MSHS), all the patients are entitled for cashless treatment for the first 48 hoursand this improved the quality of care they received.Methods: All the polytrauma cases brought to the emergency and critical care department for a period of 7months before the introduction of MSHS (October 2015- April 2016) and for a period of 7 months from the introduction of MSHS (May 2016- November 2016) were studied retrospectively. Data on the number of patients referred, admitted and underwent intervention during the time periods were collected and compared.Results: The number of cases that were admitted and given intervention in our centre increased considerably and number of cases referred to other centres decreased after the introduction of MSHS.Conclusions: Introduction of MSHS lead to patients receiving more advanced life support and interventions as necessary. However this cannot be generalised to all the centres as data is still lacking. Multicentric studies need to be done in this aspect.

scholarly journals An observational study on usage of insulin and self-injection practises among patients with diabetes attending to Diabetic Centre and Medical outpatient clinics of a tertiary care hospital of Northern Sri Lanka

2020 ◽  
Author(s):  
Sathyasagaran Narayanapillai ◽  
Peranantharajah Thambipillai ◽  
Aravinthan Mahalingam ◽  
Rajeshkannan Nadarajah
Keyword(s):  
Sri Lanka ◽  
Injection Site ◽  
Low Income ◽  
Tertiary Care ◽  
Insulin Injection ◽  
Tertiary Hospital ◽  
Low Income Countries ◽  
Care Hospital ◽  
Premixed Insulin ◽  
Cross Sectional

Abstract Background: Prevalence of diabetes increasing world-wide particularly in low income countries. Management of diabetes sometimes requires insulin injection due to various reasons. Proper usage of insulin and injection techniques are important for diabetes control among who requires insulin. This study was aimed to assess current insulin practices and associated complications.Methods and material: This was a cross sectional study conducted among diabetes patients attended all medical clinics and Diabetic Centre in Jaffna teaching Hospital which is the only tertiary hospital in the Northern Sri Lanka in May 2020.Insulin practices retrieved by using interviewer administered questionnaire. Data was analyses by using SPSS 26.Results: Out of 360 patients 64.2% were female and mean age was 58.19 (12-89).Majority (61.9%) of them belongs to low income category and most (73.3%) of them using insulin more than 1 year. Main reason for the insulin initiation was oral hypoglycaemic failure (81.7%) and majority of them (80.0%) were using twice daily premixed insulin regime followed by daily basal insulin (11.4%) and basal bolus insulin (5.6%) regime. Most of the participants (81.4%) reported they do cleaning of the injection site before injection and 89.7% usually rotate the injection site. Approximately half of them (50.8%) inject themselves and majority use syringes (91.4%). Common injection site complications reported were skin changes (25%), followed by 15.3% persistent swelling (15.3%) and thinning of skin(7.8%). Angle of injection (P-0.039) and insulin regime (P<0.001) showed statistically significant association with skin changes.High proportion of participants 68.6% (95%CI: 63.7%-73.2%) experienced hypoglycaemia, using syringes 2.21 times (95%CI-1.05-4.64) more risk of compare to pen users and missing meals 2.22 times more risk of hypoglycaemic events (95%CI: 1.18-4.17). Majority of them reported reusing the needles for injection (83.6%) and 35% were disposing needle into common garbage pin.Conclusion: This study revealed significant gaps in current insulin practices from expected norm and hypoglycaemic events alarmingly high among participants. Exploring Continuous Glucose Monitoring Devices or flash monitoring can be a mitigation strategy and urgent attention from health professionals needed to improve the safe insulin practices.

scholarly journals Spectrum and outcome of gastric outlet obstruction in a tertiary care hospital

2018 ◽  
Vol 5 (11) ◽  
pp. 3467
Author(s):  
Sachin V. ◽  
Ravya R. S. ◽  
Sunil Kumar V.
Keyword(s):  
Gastric Outlet Obstruction ◽  
General Surgery ◽  
Disease Incidence ◽  
Tertiary Care ◽  
Outlet Obstruction ◽  
Care Hospital ◽  
Duodenal Ulcers ◽  
Predominant Symptom ◽  
Changing Trends ◽  
Clinical Scenarios

Background: Gastric Outlet Obstruction is a disorder wherein there is an obstruction in the opening of the stomach (Pylorus), blocking the entrance of ingested food coming from the stomach to the duodenum. Gastric Outlet Obstruction is the one of the most common clinical scenarios encountered in general surgery. Pyloric obstruction occurs in 2-4% of patients with chronic duodenal ulcer and it is described by Sir James Walton as “the stomach you can hear, the stomach you can feel and the stomach you can see”. Predominant cause for Gastric Outlet Obstruction has changed substantially with identification of H. Pylori and the use of proton pump inhibitor. In this study the various aspects and management of Gastric Outlet Obstruction are analysed.Methods: This prospective cohort study of 18 months duration was conducted among 50 patients in the department of general surgery from August 2016 to February 2018. The study population included patients presenting with gastric outlet obstruction in the deparment of general surgery who are treated on in-patient basis. An elaborate study of these cases was done and data pertaining to history, clinical features, investigations, management and follow up collected in a structured proforma.Results: Of the 50 cases of gastric outlet obstruction, 30 patients were diagnosed carcinoma pylorus and 17 of them were found to have cicatrising ulcer. Remaining 3 patients had other causes attributed to the presentation. The age incidence of the patients in this study ranged from 20 to 70 years with a mean age of 45.2 years. Majority of patients were manual labourers. 70% of the study subjects were smokers and 60% consumes alcohol. Vomiting and abdominal pain were the predominant symptom with recorded loss of weight in 35 cases.Conclusions: Gastric outlet obstruction is a common presentation of malignancy and cicactrising duodenal ulcers. However there has been changing trends in the pattern of disease incidence in view of changing trends in management and investigation modalities.

scholarly journals Pyloric stricture after corrosive ingestion in children: an attempt to address the optimum management of this rarity

2021 ◽  
Vol 8 (10) ◽  
pp. 1730
Author(s):  
Amit Kumar Jadhav ◽  
Goutam Chakraborty ◽  
Nidhi Sugandhi ◽  
Sameer Kant Acharya
Keyword(s):  
Gastric Outlet Obstruction ◽  
Excellent Result ◽  
Outlet Obstruction ◽  
Contrast Study ◽  
Long Term Outcome ◽  
Billroth I ◽  
Number Of Patients ◽  
Pyloric Stricture ◽  
Corrosive Ingestion

Corrosive ingestion in pediatric population can have devastating consequences. Pyloric stricture which is a rarer complication has not been discussed in details in existing literature. Whereas the presentation is more or less similar, a “case specific” approach may be required for the best outcome. We analyzed our series of eight patients to formulate a suitable approach to its management. This was a prospective observational study in the department of Pediatric Surgery in a tertiary health care centre in central India. Eight (n=8) patients with corrosive injuries exclusive to the pyloric antrum were analyzed with respect to the corrosive ingested, symptomatology, nutritional status, investigation findings, surgery undertaken and follow up. Total number of patients in our study were eight. Male -7 and female-1, mean age of 6.8 years, ranging from 4 and 10 years, most common agent was acid, ingested accidentally. Period of development of gastric outlet obstruction was 23 days, range between 11 days and 33 days. Initially presented with odynophagia but later developed features of gastric outlet obstruction. Procedure performed were Heineke Mickulicz pyloroplasty and Billroth I gastroduodenostomy with FJ depending on the intra operative findings. No significant post operative complications were encountered on follow up, all the patients had improved general condition and gained adequate weight. No re do surgeries were performed. Corrosive injury of the UGI tract is not uncommon in children. Pyloric stricture as a complication is relatively rare. Parents may seek consultation late only after the child has lost reasonable amount of weight. UGI Endoscopy and UGI contrast study are indispensable to evaluate the severity of damage and formulate the optimum plan of surgery. Early surgical intervention gives excellent result. Both Pyloroplasty and Billroth I anastomosis are safe with low morbidity and excellent long term outcome.

Distribution of MR-CoNS in the clinical staffs of tertiary care hospital

2021 ◽  
Vol 7 (2) ◽  
pp. 100-102
Author(s):  
Sonu S. Ahirwar ◽  
Prabhat Jatav ◽  
Kirti Kushwaha
Keyword(s):  
Low Income ◽  
Nasal Swab ◽  
Tertiary Care Hospital ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Automated System ◽  
Diffusion Method ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
Vitek 2

Methicillin-resistant coagulase-negative staphylococci (MR-CoNS) associated infection is a growing concern in healthcare settings now a day. MR-CoNS are the main infectious agents of the hospital acquired infection. Clinical staffs to patients transmission of resistant strains have caused a rapid increase in the prevalence of antimicrobial resistance in recent years. Growing rate of antimicrobial resistant against available antibiotics of MR-CoNS is a developing problem in low income or lower middle income counties. This study was conducted to determine the occurrence MR-CoNS isolated from different clinical staffs of tertiary care hospital. This prospective study conducted in clinical staffs, nasal swab were collected from all the participants. Screening of CoNS were done on the basis of cultural, morphological and biochemical tests, identification and AST analysis done by VITEK-2 automated system. Methicillin resistance pattern was checked by VITEK-2 and Kirby-Bauer disc diffusion method according to CLSI guideline. A total of 129 nasal swab samples were collected from clinical staffs, of which n=81 isolates (85.6%) were CoNS. Among n=81 CoNS, (48.12%) , (41.97%) , (7.4%) and (2.4%) were reported. Out of n=81 CoNS isolates, n=26 were conformed as MR-CoNS. Maximum methicillin resistance were reported in 53.48% (14/26), 42.30% (11/26), 3.84% (1/26) and 0% (0/26). Theoccurrence rate of MR-CoNS are higher (20.6%) in the healthcare workers and most of the methicillin resistant-CoNS isolates shows high level of resistance against widely used antibiotics but all the isolates susceptible against vancomycin.

scholarly journals Trends and causes of maternal mortality in a tertiary care hospital over five years: 2013-2017

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Sonia Rafiq ◽  
Wajeeha Syed ◽  
Simi Fayaz Ghaffar
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Creative Commons ◽  
Increased Risk ◽  
Mortality Ratio ◽  
Public Health Challenge

Background and Objective: Maternal death measurement is essential to a country’s wellbeing and development status. In emerging countries like Pakistan, it remains an intimidating and failed public health challenge. Objectives of our audit were to estimate trends and causes of maternal demise in Lady Reading Hospital, Peshawar, Pakistan. Methods: Between January 2013 to December 2017, a retrospective study was carried out at Medical Teaching Institute, Lady Reading Hospital, Peshawar. A structured proforma was used to collect data from the medical records. To detect trends in mother demise maternal mortality ratio was calculated for each year and for all five years, Spss version 23 was used for data analysis. Results: In the five-year periods 134 deaths were recorded. The maternal mortality during the study period was 431/100,000 live births. An unstable trend in mortality with two crowning periods in 2013 and 2017 was observed. Hemorrhage persisted as the foremost cause of maternal death over the five years period, accounting for 47.76% deaths followed by hypertension, accounting for 25.37% deaths. An increased risk of 35.08% was observed among women aged 25-29 years, followed by 26.11% in 20-24 years and 23.88% in >30 years. Conclusion: There is a decreasing trend of maternal death from 2013 to 2016 but a slight increase was noted in 2017. Hemorrhage was the top cause responsible for the maternal death. doi: https://doi.org/10.12669/pjms.35.4.1091 How to cite this:Rafiq S, Syed W, Ghaffar SF. Trends and causes of maternal mortality in a tertiary care hospital over five years: 2013-2017. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.1091 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.

scholarly journals Outcome of Acute Burn Injuries in a Tertiary Care Centre of Kathmandu Nepal

2020 ◽  
Vol 42 (2) ◽  
pp. 33-36
Author(s):  
Manish Devkota ◽  
Samit Sharma ◽  
Sangam Rayamajhi ◽  
Jayan M Shrestha ◽  
Ishwar Lohani
Keyword(s):  
Low Income ◽  
Surgical Intervention ◽  
Burn Injury ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Low Income Countries ◽  
Female Population ◽  
Partial Thickness Burn ◽  
Flame Burn

Introduction Burn injuries are associated with higher morbidity and mortality especially in middle and low-income countries. The objective of the study is to assess the outcome of acute burn injuries in a tertiary care center of Kathmandu, Nepal. MethodsThis is a descriptive cross-sectional study of the clinical data of acute burn patients admitted from January 2016-December 2018. ResultsOut of 124 patients with burn injuries, there were more females (n=65, 52.4 %) than males (n=59, 47.6%). Flame burn was the most common mode of injury (n=71,57.3 %) followed by scald (n=22,17.7 %). Thirty-eight (30.6%) patients arrived to hospital on the same day of injury. The average time required to reach our hospital was 24 hours. The most frequently involved site was lower extremities (n=40, 32.26%) followed by upper extremities (n=33, 26.62%). Total body surface area (TBSA) involved in the burn injury ranges from 10% to 50% with a median of 15%. Hospital stay was 14 to 58 days with a median of 17 days. Partial thickness burn was seen in 114 (91.94%) patients whereas 10 (8.06%) patients had full thickness burn. Surgical intervention was needed in 71 (57.26%) patients. Among 71 patients, 12 patients underwent surgery twice. Fifty-two (41.94%) patients were managed conservatively. The mortality rate was 4.03%. ConclusionAdult female population is at high risk for burn injuries mostly due to flame burn. Delay in reaching care has also contributed for poor outcome of burn injuries. Majority of burn injury patients needed surgical intervention and hence improvement in surgical aspects can lead to better outcome of burn injuries.Keywords:

scholarly journals Impact of pregnancy on cancer survival: Experience at a tertiary care hospital

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Dur-e- Shahwar ◽  
Sheikh Irfan Ahmed ◽  
Zaheena Shamsul Islam ◽  
Lumaan Sheikh
Keyword(s):  
Overall Survival ◽  
Cancer Survival ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Gestational Trophoblastic Disease ◽  
University Hospital ◽  
Care Hospital ◽  
Creative Commons ◽  
Hematological Cancers ◽  
Expectant Mothers

Objectives: To assess the overall survival of pregnant women diagnosed with cancer during pregnancy or became pregnant thereafter. Methods: A retrospective medical record review of 90 patients who were diagnosed with cancer when pregnant or who became pregnant thereafter between 1996 and 2015 in Aga Khan University Hospital, Karachi. Results: A total of 90 patients were analyzed. The malignancies that expectant mothers had were, breast cancer 38 (42.2%), hematological cancers 29 (32.2%), brain cancer 10 (11.1%), and other malignancies 13 (14.4%) that included thyroid cancers, gestational trophoblastic disease and synovial tumor of foot. We observed only four deaths out of 90 patients and mean survival time in pregnant patients with malignancies was 17.98 years [CI 16.35-19.31]. Conclusions: The diagnosis of most cancer types before or during pregnancy does not influence on overall survival of patients. doi: https://doi.org/10.12669/pjms.37.2.3525 How to cite this:Dur-e-Shahwar, Irfan S, Islam ZS, Sheikh L. Impact of pregnancy on cancer survival: Experience at a tertiary care hospital. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3525 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.

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