scholarly journals Prophylactic antibiotics in patients with episiotomy following normal vaginal delivery: a randomised clinical trial

2019 ◽  
Vol 8 (10) ◽  
pp. 3846
Author(s):  
Nirav J. Garala ◽  
Sabnam S. Nambiar
Keyword(s):  
Clinical Trial ◽  
Hospital Stay ◽  
Vaginal Delivery ◽  
Randomised Clinical Trial ◽  
Prophylactic Antibiotics ◽  
Normal Vaginal Delivery ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B ◽  
Prolonged Hospital

Background: Postpartum  infectious  complications  following  normal  vaginal delivery  remains  a  cause  of   major  concern for  the  health  care professionals  due  to  higher  morbidity  and  mortality  and  prolonged hospital  stays  and  increased  healthcare  costs which makes us consider prophylactic use of antibiotics after normal vaginal delivery. On the other hand unjudicious use of antibiotics has led to widespread antibiotic resistance. Therefore this study was carried out to validate the use of prophylactic antibiotics in these patients and their role in prevention of puerperial pyrexia, wound infections and prolonged hospital stay.Methods: This Randomised clinical trial was conducted at KCHC-Kerala Co-operative Hospital Complex, Pariyaram, Kannur District, Kerala from 1st March 2012 to 30th April 2013. Eligible women were randomly assigned to group which does not receive prophylactic antibiotics (Group A) and group receiving prophylactic antibiotics (Group B). Patients in both the groups were examined every day till the patient was discharged from the hospital and observed for signs and symptoms of infected episiotomy wound, puerperial pyrexia and duration of hospital stay was noted.Results: Mean age in years was 25.6 for Group A and 26.2 for Group B. Mean gestational age in both the groups was 37.6 weeks. Mean duration of labour was 6.62 and 6.22 hours for Group A and B respectively. 6 subjects in Group A and 5 subjects in Group B had puerperial pyrexia. 3 Subjects in Group A and 2 subjects in Group B had wound infection. The mean duration of hospital stay for Group A was 4.18 with SD of 1.0 while mean hospital stay for Group B was 4.01 with SD of 1.1.Conclusions: By comparing subjects in both the groups with respect to puerperial pyrexia, wound infection and duration of hospital stay there was no statistical difference in any of the above criteria in both groups. Hence, in view of the risk of allergic reactions, toxicity and the selection of resistant strains the prophylactic administration of antibiotics does not seem to be justified in patients with episiotomy following vaginal delivery as per this study.

scholarly journals Comparison of In-Hospital Outcomes Between Patients With or Without Acute Kidney Injury Developed After Hospitalization Following Acute Coronary Syndrome

2020 ◽  
Vol 16 (1) ◽  
pp. 3-10
Author(s):  
Md Sajjad Safi ◽  
Msi Tipu Chowdhury ◽  
Tanjima Parvin ◽  
Khurshed Ahmed ◽  
Md Ashraf Uddin Sultana ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Cardiogenic Shock ◽  
Hospital Stay ◽  
Kidney Injury ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Hospital Stays ◽  
Group B

Background: Acute Kidney Injury (AKI), a common complication of acute coronary syndromes (ACS), is associated with higher mortality and longer hospital stays. ACS patients with renal impairment during hospitalization are associated with adverse in-hospital outcomes in the form of heart failure, cardiogenic shock, arrhythmia, dialysis requirement and mortality. Objective: To compare the in-hospital adverse outcomesof patients with ACS with or without AKI. Materials and Methods: This prospective comparative study was conducted in the Department of Cardiology, BSMMU, Dhaka, during the period of August 2017 to July 2018. A total of 70 eligible patients were included in this study of which 35 patients were included in group A (ACS with AKI) and 35 patients were included in group B (ACS without AKI). AKI was diagnosed, on the basis of increased serum creatinine level 0.3mg/dL from baseline within 48 hours after hospitalization. They were subjected to electrocardiography, blood test for serum creatinine (on admission, 12 hours, 48 hours and at the time of discharge), lipid profile, 2-D echocardiography along with serum troponin, CK MB and electrolytes. Results: It was observed that mean age was 58.0±8.5 years in group A and 55.6±12.3 years in group B. Heart failure was more common in group A than in Group B (74.3% vs 34.2% p=0.001 respectively) and arrhythmia was more common in group A than in Group B (100% vs 74.2% respectively). 7(20%) patients of group A required dialysis. The mean duration of hospital stay was significantly higher in Group A than in the Group B (9.4±2.3 vs 7.2±0.6; p=0.001) days. Multiple logistic regression analysis revealed that heart failure, cardiogenic shock, duration of hospital stay were found to be the independently significant predictors of outcome of the patients with AKI with odds ratio being 5.53 (p=0.001), 4.353 (p=0.001) and 6.92 (p=0.001) Conclusion: This study shows that, heart failure, cardiogenic shock, arrhythmia, dialysis requirement, were more common in the patients with AKI (group A) than in the patients without AKI (group B). The duration of hospital stays were longer in patients with AKI (group A) than in the patients without AKI (group B). Therefore, an important research target is the identification of high-risk patients with ACS experiencing AKI, thereby appropriate medication and follow-up should be implemented. University Heart Journal Vol. 16, No. 1, Jan 2020; 3-10

scholarly journals A comparative study of foot infections in diabetic and non-diabetic patients with reference to etiopathogenesis, clinical features and outcome

2020 ◽  
Vol 7 (5) ◽  
pp. 1496
Author(s):  
Venkata Reddy M. ◽  
Varun Deep K. ◽  
Inamdar P.
Keyword(s):  
Hospital Stay ◽  
Clinical Features ◽  
Diabetic Foot ◽  
Healing Process ◽  
Significant Proportion ◽  
Diabetic Patients ◽  
Group A ◽  
Wagner’S Grade ◽  
Group B ◽  
Prolonged Hospital

Background: Infections in the foot are more common with significant proportion of world’s population remaining bare foot, minor skin trauma is a frequent cause of local infection. The present study was conducted with an aim to study various foot infections and compare the findings in diabetic and non diabetic patients with reference to etiopathogenesis, clinical features, management, duration of hospital stay and outcome.Methods: The present study was conducted in Mamata General Hospital, Khammam, Telangana state from October 2016 to September 2018. A total of 50 cases were divided into 2 groups, Group A included 25 patients with diabetic foot infection and Group B included 25 patients with non diabetic foot infections.Results: In diabetics 6th decade and in non-diabetics 4th-6th decade was the most common age group presenting with foot infections. Cellulitis of the foot was the most common in both diabetics (40%) and non-diabetics (52%). Wagner’s grade 4 lesions were more common in diabetics (28%) than in non-diabetics (8%). The most common site of lesion in diabetics was dorsum (40%) and in non-diabetics was toes (40%). The incidence of neuropathy was significantly higher in diabetics (72%) than in non-diabetics (20%). Rate of amputation was high in diabetics (12%) compared to non-diabetics (8%). The average number days in a hospital stay in diabetics was 42.27 days and in non-diabetics it was 28.96 days.Conclusion: Diabetic patients have increased severity of infections, delayed healing process, need more active interventions. As compared to the non-diabetic patients, they do show high risk of amputations and prolonged hospital stay.

scholarly journals Comparison between Autologous Blood and Fibrin Glue for Adhering Conjunctival Autografts after Pterygium Excision- A Randomised Clinical Trial

2021 ◽  
Author(s):  
Mona Sune ◽  
Pradeep Sune
Keyword(s):  
Clinical Trial ◽  
Fibrin Glue ◽  
Autologous Blood ◽  
Randomised Clinical Trial ◽  
Mild Degree ◽  
Group A ◽  
Pterygium Surgery ◽  
Pterygium Excision ◽  
Group B

Introduction: Fibrin glue is a biological tissue adhesive and acts on the principle of final stages of the coagulation cascade. The cost of commercially available products is very high and not affordable for the patients of low socio-economic strata. As an alternative, pterygium surgery was done using patient’s own blood to adhere the conjunctival autograft to scleral bed by the process of coagulation of fibrin from the oozing blood from the blood vessels under the flap. Aim: To compare autologous blood and fibrin glue for adhering conjunctival autografts after pterygium excision. Materials and Methods: It was a randomised clinical trial. Total 97 subjects with primary pterygium who visited the Ophthalmology Department were randomised into two groups. In group A (n=31), patients had undergone pterygium excision wherein conjunctival autograft was attached by fibrin glue. In group B (n=66) the graft was attached by autologous blood present on the scleral bed. Mean operative time for the procedures were compared. Follow- up was done for 12 months and all subjects were examined for postoperative pain, foreign body sensation, inflammation, graft stability and recurrence. Results: The mean age of patients in group A was 48.32±14.3 years (21-65 years), and in group B was 54.48±15.67 (23-74 years). Mean operating time in group A was 23.21±9.4 minutes and 13.7±4.3 minutes in group B, (p-value=0.001). Postoperative pain of mild degree was present in all the 31 (100%) subjects of group A. In group B, pain was absent in 32 (48.5%) and mild degree in 34 (51.5%) subjects. No recurrence was found in both the groups. Mean follow-up period was 11.4 months. Conclusion: This study concludes that autologous blood is a useful alternative method for graft attachment in pterygium surgery without the untoward complications related to fibrin glue.

scholarly journals Outcome of treatment of OPC poisoning patients with atropine or atropine plus pralidoxime

2018 ◽  
Vol 50 (1-2) ◽  
pp. 3-7 ◽  
Author(s):  
SM Kamal ◽  
Shamima Akhter ◽  
Sk Farid Uddin Ahmed ◽  
Poritosh Kumar Chowdhury ◽  
AKM Mamunur Rashid ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Respiratory Failure ◽  
Death Rate ◽  
Ventilatory Support ◽  
Intervention Group ◽  
Randomised Clinical Trial ◽  
Treated Group ◽  
Group A ◽  
The Difference ◽  
Group B

Background: Organophosphorus compound (OPC) poisoning is common in Bangladesh and management facility is not adequate in most hospitals. Both inj. Atropine and inj. Pralidoxime is used as antidote for the management of OPC poisoning, although there is controversy regarding benefit of inj. Pralidoxime.Objective: This randomised clinical trial was conducted to compare the outcome of OPC poisoning patients treated by inj. Atropine along with supportive measures and by inj. Atropine plus inj. Pralidoxime along with supportive measures . This study also evaluated the clinical profile of OPC poisoning patients.Methods: A total number of 109 patients, admitted in medicine ward in Khulna medical college hospital during one year period were included in this randomised clinical trial. The patients were divided into two groups according to alternate day of admission in the medicine wards. Forty nine patients of group A was treated by inj. atropine only along with other supportive measures required and group B of 60 patients was treated by inj. atropine plus inj. pralidoxime along with supportive measures.Results: 49 patients of group A was treated with atropine alone and 60 patients in group B was treated with atropine plus pralidoxime. Death rate was 14.28% in atropine treated group and 16.66% in atropine plus pralidoxime treated group (p=0.733). The difference in death rate is not statistically significant. Four (8.18%) patients from atropine treated group and 4 (6.67%) patients from pralidoxime intervention group developed respiratory failure and ventilatory support was given in ICU. These 8 patients recovered. But this difference in development of respiratory failure is not statistically significant (p=0.766). The difference of death rate between male and female (12.5% Vs 18.87%) is not also significant (p=0.360).Conclusion: This study reveals that pralidoxime provides no better outcome in the management of OPC poisoning patients.Bang Med J (Khulna) 2017; 50 : 3-7

scholarly journals Clinical and Ultrasonographic Evaluation of the Pelvic Floor in Primiparous Women after Normal Vaginal Delivery with Episiotomy and without Episiotomy

2020 ◽  
Vol 7 (1) ◽  
pp. 4-8
Author(s):  
Nora H. K. Elabady ◽  
◽  
Ahmed M. Awara ◽  
Amr M. El-Badry ◽  
Nareman El-Hamamy ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Vaginal Delivery ◽  
Levator Ani ◽  
Clinical Findings ◽  
University Hospital ◽  
Normal Vaginal Delivery ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Primiparous Women

Objective The aim of this prospective study is clinical and ultrasonographic evaluation of the pelvic floor in primiparous women after normal vaginal delivery with episiotomy and without episiotomy. Methods This is a cross-section study of primiparous women with a history of delivery at Tanta University Hospital from August 2018 to August 2019. The sample power was calculated based on avulsion (major and minor) in two groups (vaginal delivery with episiotomy and without episiotomy) of total forty-primiparous women with an interval after delivery (20 cases after normal vaginal delivery with episiotomy and 20 cases after normal vaginal delivery without episiotomy). Results Twenty-four hours of delivery there was a highly significant difference between group A (with episiotomy) and group B (without episiotomy) regarding to ultrasound abnormalities, degree of tear, blood loss, hemoglobin concentration and clinical findings, while no difference regarding levator ani weakness. Two months later from delivery there was no significant difference between group A and group B regarding to ultrasound abnormalities and levator ani weakness while there was a difference between the two groups in regarding with clinical findings. Conclusion Normal vaginal delivery without episiotomy in primiparous women is better than normal vaginal delivery with episiotomy as there is no perineal tenderness, no dyspareunia. Low incidence of urinary, rectal incontinence, tear and perineal infection.

scholarly journals Evaluation of the use of subcutaneous drains to prevent wound complications in abdominal surgeries

2018 ◽  
Vol 5 (4) ◽  
pp. 1368
Author(s):  
G. V. Manoharan ◽  
T. Sivakumar ◽  
M. Ashok Kumar
Keyword(s):  
Hospital Stay ◽  
Abdominal Wall ◽  
Subcutaneous Tissue ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Skin Closure ◽  
Abdominal Wall Closure ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B

Background: Wound complications like surgical site infections (SSI) and wound dehiscence are common following abdominal surgery for peritonitis. Drains have been used to remove collections from the early days of surgery. The use of drains to remove subcutaneous collections to prevent wound complications needs to be studied.Methods: Sixty patients who underwent surgery for peritonitis were selected for the study. 30 patients underwent conventional abdominal wall closure while the other 30 had suction drains inserted in the subcutaneous tissue. Wounds were observed for complications and time for healing.Results: The incidence of SSI was significantly less in Group A (23%) than in Group B (60%). Similarly, wound dehiscence occurred in 43% of SSI cases in Group A as against 89% of SSI cases in Group B, the difference of which was statistically significant. The mean duration of hospital stay was significantly less when subcutaneous suction drain was placed (9 days).Conclusions: Subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis when compared to conventional primary skin closure as it significantly reduces the incidence of SSI, wound dehiscence, wound secondary suturing and duration of hospital stay. 

Comparative Analysis of Early versus Late Enteral Feeding after Gastrointestinal Surgeries

2021 ◽  
Vol 15 (8) ◽  
pp. 2050-2053
Author(s):  
Amnah Ilyas Khan ◽  
Nazish Masood ◽  
Usman Ilyas ◽  
Zahra Raza ◽  
Jehangaiz Khan
Keyword(s):  
Enteral Nutrition ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Enteral Feeding ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Early Enteral Nutrition ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B

Background: Despite of widespread belief, clinical studies and animal experiments have suggested that initiation of early feeding after surgery has many advantages. Present study was planned for comparing outcomes of early and late enteral feeding in patients who were undergoing gastrointestinal surgeries in our settings. This would help the surgeons to select better option for earlier recovery after surgery Objective: To compare the outcome of early versus late enteral feeding in patients undergoing gastrointestinal surgeries. Design: It was a randomized controlled trial. Study Settings: The study was conducted at Department of General Surgery, PIMS Islamabad for a period of six months w.e.f 20-12-2017 to 19-06-2018. Patients and Methods: A total of two hundred (n=200) patients of both gender between age 15-70 years, who had been scheduled for elective or emergency gastrointestinal surgery were enrolled in the study. Patients were randomized early (Group A, <24 hours after surgery) and late enteral feeding (Group B, <24 hours after surgery). Outcomes were estimated in terms of infection, anastomotic leak and duration of hospital stay in both groups. Results: Mean age of the patients was 36.8±11.2. There were total 85 females and 115 males with female to male ratio of 1:1.35. Mean duration of hospital stay was 2.62 days ± 0.71 in group A and it was 6.55 days ± 0.71 2.93SD in groups B (P=0.001). Wound infection rate (8% vs 33%, P=0.001) and anastomotic leak rate (0% vs 10%, P=0.001) was also significantly lower in group A when compared with group B. Conclusion: Initiation of early enteral feeding (within 24 hours post operatively) in patients undergoing gastrointestinal surgeries has an immediate advantage of caloric intake and results in faster recovery with fewer complications. Similar results are found in the literature. We recommend early initiation (within 24 hours after surgery) of enteral feeding in patients undergoing gastrointestinal surgeries. Keywords: Anostomotic leak, early enteral nutrition (EEN), late enteral nutrition (LEN).

Evaluation of the Effects of Lumbosacral Corset on the Patients with Chronic Non-specific Low Back Pain

2015 ◽  
Vol 26 (3) ◽  
pp. 65-69
Author(s):  
Md. Abdus Shakoor ◽  
Mohammad Tariqul Islam ◽  
Md. Muhibbur Rahman ◽  
Md. Shahidur Rahman ◽  
Md. Moyeenuzzaman
Keyword(s):  
Clinical Trial ◽  
Daily Living ◽  
Randomised Clinical Trial ◽  
Low Back ◽  
Physical Medicine ◽  
Group A ◽  
The Mean ◽  
Pre Treatment ◽  
Group B ◽  
Medical University

Abstract A randomised clinical trial was conducted in the Department of Physical Medicine & Rehabilitation (PMR), Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. A total of 81 patients having chronic LBP were included according to the selection criteria. Out of them, 31 (38.3%) were male and 50 (61.7 %) were female in a ratio of 1: 1.61. The mean age of the patients in study was 41.65 ± 8.41years. Female persons were affected in their earlier ages (between 30 and 45 years) than male. Most of the patients were housewives (54.3%). The patients were divided randomly into two groups by the way of lottery for the clinical trial. Group-A patients were treated with NSAIDs, activities of daily living instructions (ADLs) and lumbosacral corset and group-B patients were treated with NSAIDs and ADLs. The patients were followed up weekly for five weeks and significant improvement was recorded after the treatment in both the groups (p=0.001). In comparison between two groups, it was found that there was no significant improvement in pre-treatment, after 1st week and after 3rd week. A little bit improvement was found in group-A patients than group-B after 4th week (p= 0.06). But finally, there was significant improvement in group-A than group-B patients after 5th week (p=0.005). So, it may be concluded that both the treatment is effective for the patients with chronic non-specific LBP. But the patient may be more benefited if lumbosacral corset is used as an adjunct to NSAIDs.

scholarly journals 1124. Effects of Co-infection on the Severity, Response to Treatment and Duration of Hospital Stay in Patients with Clostridium difficile Infection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S336-S337
Author(s):  
Muhammad Shafiq ◽  
Hani Alturkmani ◽  
Yousaf Zafar ◽  
Vishal Mittal ◽  
Hafsa Lodhi ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Hospital Stay ◽  
Infection Group ◽  
P Values ◽  
Duration Of Hospital Stay ◽  
Potential Pathogen ◽  
Group A ◽  
Definition Of ◽  
Group B ◽  
Treatment Escalation

Abstract Background According to the multicenter evaluation of the FilmArray® multiplex gastrointestinal (GI) panel for etiologic diagnosis of infectious gastroenteritis, the GI panel detected at least one potential pathogen in 53.5% of the stool specimens that were collected. Out of the positive samples, 31.5% tested positive for more than one potential pathogen. The samples that were co-infected showed that Clostridium difficile infection (CDI) was present in 53.4% of them. This lead to the idea of our project to determine whether the presence of another GI infection affects CDI outcomes in terms of severity, treatment escalation, duration of hospital stay and recurrence. Methods Inclusion criteria: 18-year-old and above patients. Exclusion criteria are GI panel performed on outpatient basis, presence of any co-founder that had independent effect on the outcomes such as end-stage renal disease, cirrhosis, presence of non-GI infection (pneumonia, urinary tract infection, osteomyelitis etc.), and recurrent CDI. Out of the 2,576 GI panels performed from January 1, 2015 until December 31, 2016; only 235 patients were selected for retrospective chart review based on the above criteria. Out of 235 patients, 38 patients had co-infection (CDI + another GI infection = Group A) and reminder had only CDI (Group B). Chi-square test, Fisher’s exact test (for severity, treatment escalation and recurrence) and Independent T-test (for duration of hospital stay) were used to compare Group A with Group B. Alpha criterion was 0.05. Results The P-values for each outcome are given below: (a) 0.16 for severity according to definition of American College of Gastroenterology. (b) 0.77 for severity according to definition of Infectious Disease Society of America. (c) 0.23 for treatment escalation. (d) 0.41 for duration of hospital stay. (e) 0.49 for CDI recurrence. Conclusion All the resulted P-values are greater than 0.05. These results are suggestive of the fact that presence of another GI infection does not affect the outcomes for CDI in terms of severity, treatment escalation, duration of hospital stay, and recurrence. As there were only 38 patients in co-infection group, it limits the ability to determine the effect of individual infectious agent on the outcomes of CDI. Disclosures All authors: No reported disclosures.

scholarly journals Clinical Outcome of Posterior Fossa Tumor Surgery Without Preoperative Ventriculo-peritoneal Shunt

1970 ◽  
Vol 40 (1) ◽  
pp. 43-47 ◽  
Author(s):  
MR Islam ◽  
KMT Islam ◽  
M Hossain ◽  
MH Rashid ◽  
S Dhakhal ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Posterior Fossa ◽  
Final Outcome ◽  
Posterior Fossa Tumor ◽  
Tumor Surgery ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B ◽  
Ventriculo Peritoneal Shunt

The aim of the study was to assess the clinical outcome of surgically treated patients with posterior fossa tumor with hydrocephalus with symptoms and sings of raised intracranial pressure without pre-operative ventriculo-peritoneal shunt by comparing two groups (one group-with pre-operative ventriculo-peritoneal shunt and other group-without preoperative ventriculo-peritoneal shunt) in respect to complications, duration of hospital stay and final outcome at 1 month post-operative follow up. This clinical study was carried out at the department of neurosurgery, BSMMU from November 2008 to April 2010 on patients with posterior fossa tumor with hydrocephalus with symptoms and signs of raised intracranial pressure (ICP) who underwent surgery without preoperative ventriculo-peritoneal shunt. A total of 32 patients were included in this study. Patients were divided into two groups, control group (group-A) underwent ventriculoperitoneal shunt prior to tumor surgery and experimental group (group-B) were not treated with ventriculo-peritoneal shunt prior to tumor surgery. Both groups were followed up during hospital stay and after 1 month of tumor resection. Clinical studies include analysis of the following parameters: i) duration of hospital stay, ii) post-operative complications include cerebrospinal fluid leakage, pseudomeningocele, seizure, meningitis, and shunt blockage and, iii) final outcome at 1 month follow up in modified karnofsky performance scale. We also observed whether or not, use of ventriculo-peritoneal shunt to drain cerebrospinal fluid was useful and safe. The mean duration of hospital stay were 95.1±12.6 days with ranged from 70 to 120 days and 71.5±12.6 days ranged from 36 to 88 days in group-A and group-B respectively. The majority of the patients had no complications in both group, which were 12(70.6%) and 9 (60.0%) in group A and group B respectively. Final outcome at 1 month follow up in modified karnofsky performance scale in both groups were similar. DOI: http://dx.doi.org/10.3329/bmj.v40i1.9963 BMJ 2011; 40(1): 43-47

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