Laparoscopic management of adnexal masses in admitted patients at tertiary care centre, Bhilai, Chhattisgarh, India

Background: Laparoscopy is most widely accepted procedure in gynaecological cases both for diagnostic and operative purposes. It is associated with early recovery, shorter hospital stay and significant patient satisfaction. This study has been conducted to evaluate the effectiveness and safety of laparoscopy in the management of adnexal masses. Our Primary aim was to find out indications, intraoperative findings and different interventions to deal with adnexal mass. The objective of the study was to determine laparoscopic management of adnexal mass in all women attending Obstetrics and Gynaecology department, Shanakaracharya Institute of Medical Science, Bhilai, Chhattisgarh.Methods: This is a retrospective record-based observational study conducted over a period of one year from March 2020 to March 2021 after getting approval from the institutional ethical committee. Patients diagnosed with adnexal mass were evaluated and data was collected and analyzed.Results: Of the 130 cases of adnexal mass admitted in the hospital during the period under review, 43 cases (33%) were diagnosed as ovarian cyst among which simple cystic ovarian cyst was found to be most common etiology followed by ectopic pregnancy (41 cases). Majority of cases were managed laparoscopically with a good success rate, better outcome and short hospital stay. Conversion rate to laparotomy was 3.8% mainly seen in cases with complex ovarian mass or dense adhesions.Conclusions: Diagnosis of adnexal mass is important and it may affect females of any age group. Laparoscopy is a better approach to deal with adnexal masses (except malignancy) as it has better paronamic vision with less complications, less post-operative pain, shorter hospital stay. Careful patient selection should also be taken into account. Current study is an overview in favor of laparoscopic management of adnexal mass.

Download Full-text

Prevalence of Extended-Spectrum β-Lactamase and Antimicrobial Susceptibility Pattern of Clinical Isolates of Pseudomonas in Tertiary Care Centre of Kutch

Journal of Advances in Microbiology ◽

10.9734/jamb/2021/v21i530350 ◽

2021 ◽

pp. 45-49

Author(s):

Krupali Kothari ◽

Dolly Solanki

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Susceptibility ◽

Tertiary Care ◽

Medical Science ◽

Clinical Samples ◽

Zone Of Inhibition ◽

Tertiary Care Centre ◽

Antibiotic Policy ◽

Antimicrobial Susceptibility Pattern ◽

One Year

Aim: The current research was performed with an aim to discover the prevalence of ESBL producing P. aeruginosa and also to provide as a direct for doctors administration subjects by executing suitable infection control events as well as inventing an efficient antibiotic policy. Materials and Methods: The current research was performed in the Department of Microbiology at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat over a period for one year. All 250 isolates of Pseudomonas aeruginosa acquired from different clinical samples established in microbiology laboratory from IPD & OPD were incorporated in the research. Different clinical specimens established in our laboratory were coursed and Pseudomonas aeruginosa was recognized as apiece normal microbiological method. All isolates were subjected for ESBL screening test. Antimicrobial susceptibility test was performed by Kirby. Results: Highest samples established from middle age group (30- 50). Out of 250 isolates, 177 (70.7%) isolates of Pseudomonas aeruginosa demonstrated zone of inhibition≤ 22 mm for Ceftazidime. All ESBL positive Pseudomonas aeruginosa isolates demonstrated elevated confrontation to ciprofloxacin 43 (91.04%), Gentamicin 34 (72.3%) and tobramycin 33 (70.21%). Conclusion: The majority of isolates were from hospitalized subjects which point out additional probability of their nosocomial predominance.

Download Full-text

Retroperitoneal laparoscopic adrenalectomy: its role in the management of adrenal tumour and tertiary care centre experience

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200769 ◽

2020 ◽

Vol 8 (3) ◽

pp. 993

Author(s):

Avinash Pratap Singh Thakur ◽

G. Venugopal ◽

Darsan S.

Keyword(s):

Hospital Stay ◽

Laparoscopic Adrenalectomy ◽

Conversion Rate ◽

Operative Time ◽

Tertiary Care ◽

Adrenal Tumour ◽

Transperitoneal Approach ◽

Tertiary Care Centre ◽

Early Recovery ◽

Excellent Outcome

Background: Laparoscopic adrenalectomy for adrenal tumour has gained increased popularity worldwide. To decrease the complications of commonly used transperitoneal approach, by not entering into peritoneal cavity the retroperitoneal laparoscopic adrenalectomy (RLA) has developed. It has several advantages over the transperitoneal approach and associated with reduced morbidity and excellent outcome. The objective of this study was to report our experience with RLA for treatment of adrenal tumour.Methods: The study was done from August 2014 and December 2017, data of 44 patients who underwent RLA for adrenal tumour in the institute were retrospectively reviewed. Patient’s demographical, clinical, diagnostic and procedural data were recorded. All patients were assessed by history, physical examinations, laboratory values with biochemical marker test and imaging by computed tomography/magnetic resonance imaging. Treatment outcome was assessed in terms of operative time, haemoglobin drop, conversion rate, hospital stay and complications.Results: In 44 adrenalectomy, 24 men and 20 women, with a mean age of 47.0±8.9 years were enrolled. Mean body mass index was 23.5±2.2 kg/m2. Right adrenal tumour was seen in 26 cases and left in 18 cases. Mean adrenal mass size was 2.6±0.85 cm. Mean operative time was 109.1±21.16 minutes, mean haemoglobin drop was 0.47±0.26 gram/L. Conversion to open surgery was necessary in 2 patients. Mean postoperative hospital stay was 4.0±0.91 days. Recovery time mean value was 12.18±1.7 days postoperatively. In final histopathology result adenoma was most prevalent (25 cases) and myelolipoma was least (1 case). Conclusions: RLA appears to be safe and effective alternative to transperitoneal adrenalectomy for moderate size adrenal tumour in particular less than 6 cm. It is associated with less blood loss, shorter hospitalization, low conversion rate, fewer complications and early recovery. RLA offers an alternative method for treating adrenal tumour with improved surgical outcomes.

Download Full-text

A prospective observational study on the effectiveness of risk of malignancy index score (RMI 3) in a tertiary care centre in Eastern India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i5.29548 ◽

2020 ◽

Vol 11 (5) ◽

pp. 54-60

Author(s):

Apurba Mandal ◽

Shibram Chattopadhyay ◽

Sushanta Mondal ◽

Arunava Biswas

Keyword(s):

Ovarian Cancer ◽

Adnexal Mass ◽

Malignant Tumors ◽

Histopathological Examination ◽

Tertiary Care ◽

Ca 125 ◽

Tertiary Care Centre ◽

Gynecology And Obstetrics ◽

Risk Of Malignancy ◽

Malignant Lesions

Background: Adnexal mass is a common presentation in today’s gynecological practice. The incidence of ovarian cancer is increasing day by day and diagnosis is often difficult to be made pre operatively with inadequate surgical exploration is a regular occurrence. Aims and Objectives: To assess and validate the importance of RMI-3 score as pre-operative diagnostic tool of differentiating benign from malignant adnexal mass for starting first line therapy of ovarian cancer and to find out the incidences of ovarian malignancy among study population. Material and Methods: The study was conducted in the Department of Gynecology and Obstetrics on (n=115) patients attending GOPD and indoor with adnexal mass fulfilling the inclusion and exclusion criteria using purposive sampling technique. All the selected cases underwent ultrasonography and serum CA- 125 level estimation necessary for calculating RMI score. A score of >200 was taken as suggestive of malignancy and confirmatory diagnosis was performed by histopathological examination obtained from staging laparotomy of adnexal mass. The individual scores were then correlated with final outcomes with statistical analyses. Results: The study revealed benign ovarian tumors are more under 50 years (78.46%) and patients with normal BMI are diagnosed with maximum of malignancy (n = 28). History of tubal ligation carried less risk of malignancy (p<0.0001). Histologically malignant tumors found mostly in 71.4% postmenopausal group whereas 94.1% benign pathology were present in perimenopausal group and there is no association found between parity and histopathology (p=0.058). Bilateral (p=0.013), multilocular (p=0.000) tumors with solid areas (p<0.0001) and thick papillary projections (p<0.0001) had statistically significant association with malignant lesions. RMI score (>200) had more efficacy than serum CA-125 level (>46) in differentiating malignant lesions from benign one in terms of specificity (96% vs 83.87%) and positive predictive value (95% vs 79.17%). Conclusions: RMI-3 score is a simple, reliable and effective tool in differentiating benign from malignant adnexal masses thereby help in quick referral and management of cases with increase chances of survival of the patients.

Download Full-text

Pattern of Ear Diseases among Paediatric ENT Patient: An Experience from Tertiary Care Centre, Pokhara, Nepal

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v32i2.5673 ◽

2012 ◽

Vol 32 (2) ◽

pp. 142-145 ◽

Cited By ~ 2

Author(s):

B Sigdel ◽

R Nepali

Keyword(s):

Tertiary Care ◽

Age Group ◽

Care Centre ◽

Tertiary Care Centre ◽

Suppurative Otitis Media ◽

Ear Diseases ◽

Paediatric Age ◽

One Year ◽

A Prospective Study ◽

Nose And Throat

Introduction: Ear diseases are common in children mainly due to altered anatomy of Eustachian tube which is straighter in children as compared to that in adults. However, the cause of hearing loss in children is more varied, including the etiologies. This study was done to find out the pattern of ear diseases in paediatric age group attending ear, nose and throat OPD in a tertiary care centre in Pokhara, Nepal. Materials and Methods: This is a prospective study done in paediatric patients attending ENT OPD over a period of one year from January 2010 to January 2011. The diagnoses were made on the basis of history and clinical examination. Results were expressed in numbers and percentages. Results: Out of 1632 Pediatric ENT patients, 944 had ear diseases, 59.2% were males and 40.8% females. Wax (33.4%) was the commonest diagnosis followed by Chronic suppurative otitis media (24.3%) and Acute ottitis media (13%). Conclusion: Ear diseases are most common condition in ENT OPD among paediatric age group. Wax, CSOM and ASOM were the three most common ear diseases. J. Nepal Paediatr. Soc. 32(2) 2012 142-145 doi: http://dx.doi.org/10.3126/jnps.v32i2.5673

Download Full-text

Study of incidence and prevalence of hypokalemic periodic paralysis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20190928 ◽

2019 ◽

Vol 7 (3) ◽

pp. 810

Author(s):

Ajith Dungdung ◽

Vishwanath Malkappa Jalawadi ◽

Upendra Prasad Yadav

Keyword(s):

Tertiary Care ◽

Medical Science ◽

Periodic Paralysis ◽

High Carbohydrate Diet ◽

Strenuous Exercise ◽

Hypokalemic Periodic Paralysis ◽

Tertiary Care Centre ◽

Carbohydrate Diet ◽

High Carbohydrate ◽

History Of

Background: Hypokalemic periodic paralysis (HPP) is a rare autosomal dominant channelopathy characterised by muscle weakness or paralysis when there is a fall of potassium level in the blood. In individuals with mutation, attack begins during adolescents and most commonly occurs after sleep on awakening, rest after strenuous exercise, high carbohydrate diet and meal with high sodium content. This study was conducted to analyse the age of incidence and prevalence of HPP with various clinical presentations, diagnosis and its effective treatment.Methods: A retrospective analysis of 50 patients of Hypokalemic periodic paralysis was analysed in tertiary care centre “Rajendra institute of medical science” Ranchi, Jharkhand, India, with reference to its clinical presentation, age of incidence and prevalence with laboratory parameters and treatment outcomes.Results: Incidence of attack is more common in men between 26-35 years of age. Sudden onset of flaccid quadriparesis was the most common presentation with history of high carbohydrate diet on the background of strenuous work during summer season. Around 60% had similar history of attacks in the past and most of the patients had serum potassium levels between 2.1-3.0mEq/L. Electrocardiography (ECG) abnormalities associated with hypokalemia had been observed in 90% of patients, and also significant clinical, biochemical changes have been observed as well.Conclusions: Early diagnosis not only helps in definitive management with potassium replacement, but also prevents patient going for life threatening respiratory failure. Patients recover completely without any clinical sequelae. Therefore, it is imperative for physicians, particularly those working in acute care settings, to be aware of this condition. Further management depends on the cause, frequency of attacks, severity of symptoms and the duration of the illness.

Download Full-text

Type and mode of diagnosis of carcinoma lung in a tertiary care centre: one year experience

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174940 ◽

2017 ◽

Vol 5 (11) ◽

pp. 4891

Author(s):

Jayaprakash Balakrishnan ◽

Sindhu Nair Prasannakumari ◽

Ajith Achuthan ◽

John Mathew

Keyword(s):

Lung Cancer ◽

Cell Carcinoma ◽

Small Cell Carcinoma ◽

Tertiary Care ◽

Small Cell ◽

Common Type ◽

Ultra Sound ◽

Tertiary Care Centre ◽

Easy Method ◽

One Year

Background: Lung cancer is one of the commonest cancers and cause of cancer related deaths all over the world. The reported incidence of adenocarcinoma is increasing globally and now reported to be the most common type of lung cancer. A panel of investigations are used for the diagnosis of lung cancer. Hence a study was planned to find out the pattern of malignancy and the most appropriate investigation for diagnosis. Objective of present study was to find out the type of carcinoma lung and to find out the best and easy method for diagnosis of carcinoma lung in a tertiary care centre.Methods: A hospital based cross sectional study was conducted in one unit of the Department of Pulmonary Medicine, Government Medical college, Thiruvananthapuram for a period of one year.148 diagnosed cases of carcinoma lung were enrolled. The type and the methods used for diagnosis were analysed.Results: Adenocarcinoma was the commonest malignancy 57 (38.5%), followed by squamous cell carcinoma 44 (29.7%) and small cell carcinoma 10 (6.75%). Rest of the cases 37 (25%) include non small cell carcinoma, poorly differentiated carcinoma and lymphoma. Diagnosis was established by FNA Lung in 46 (31.1%) patients and bronchoscopy and biopsy in 41 (27.7%). Other methods include TBNA 12 (8.1%), lymph node FNA/biopsy 11 (7.4%), pleural fluid cytology 24 (16.2%), sputum cytology and tru cut biopsy 14 (9.5%).Conclusions: The most common type of lung malignancy in present study was adenocarcinoma. Ultra sound guided FNAC lung and bronchoscopy biopsy were the best methods in present study to confirm the diagnosis.

Download Full-text

A PROSPECTIVE OBSERVATIONAL STUDY OF CLINICAL PROFILE IN ETIOLOGY OF ANEMIA IN ELDERLY-A HOSPITAL BASED STUDY IN A TERTIARY CARE CENTRE IN SOUTH INDIA

International Journal of Advanced Research ◽

10.21474/ijar01/13508 ◽

2021 ◽

Vol 9 (09) ◽

pp. 961-972

Author(s):

K. Shivaraju ◽

◽

Karanam Sai Arun ◽

Mandhala Saikrishna ◽

◽

...

Keyword(s):

Tertiary Care ◽

The Elderly ◽

Moderate Degree ◽

Care Hospital ◽

Tertiary Care Centre ◽

Total Study Population ◽

Study Population ◽

Poor Outcomes ◽

One Year ◽

Severe Degree

Background: Anemia is often considered as a normal physiological process that occurs with aging. but recently since past 2 decades anemia of any degree is being recognized as significant independent contributor to morbidity mortality and frailty in elderly patients. It is easy to overlook anemia in elderly as symptoms of anemia like fatigue, SOB etc are often attributed to aging process itself. many evidences accumulated states that anemia of any degree reflects poor health and increased vulnerability to poor outcomes. Materials and methods: This study was conducted in the department of internal medicine in a tertiary care hospital over a period of one year with sample size of 362 subjects satisfying the inclusion and exclusion criteria after taking the consent form. Results: Moderate degree anaemia was the commonest around, 65.6% followed by severe degree anemia 20.1%. Easy fatigability was the commonest symptom and pallor was the commonest sign of anaemia in elderly. Anemia is not always a consequence of aging. Anemia of unexplained etiology constituted 15.97% of total study population. Conclusion: Anaemia in elderly is a challenge and has to be approached in an organized manner for appropriate diagnosis and evaluation to look into its cause and plan management to improve the quality of life of the elderly persons.An effort should always be made to reach etiological diagnosis before instituting specific therapy.

Download Full-text

Retrograde Intrarenal surgery- Our experience

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.19 ◽

2020 ◽

Vol 3 (1) ◽

pp. 88-92

Author(s):

Nand Kumar B. Madhekar ◽

A. Nischal Prasad

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Tertiary Care ◽

Renal Stones ◽

Tertiary Care Centre ◽

Renal Surgery ◽

Retrograde Intrarenal Surgery ◽

Residual Stone ◽

Stone Clearance ◽

Residual Stones

Background: RIRS has become an important treatment option for kidney stones in pediatric patients with the development of new-generation ureteroscopy and holmium laser. The present study was conducted to assess cases of retrograde intrarenal surgery. Subjects and Methods: The present study was conducted in a tertiary care centre over a period of one year on 120 cases of retrograde intra renal surgery (RIRS) performed in both genders. Renal stone location and stone clearance, laterality, stone size, operative time, hematuria, postoperative pain & fever, urosepsis, hospital stay, residual stones and need of an adjunctive procedure to achieve residual stone clearance. Results: Out of 120 patients, males were 70 and females were 50. Stones were detected in upper calyx in 50 cases, middle calyx in 40, lower calyx in 20 and pelvis in 10 cases. The mean size of stones was 8.1 mm, operative time was 62.1 minutes, hospital stay was 3.6 days, clinically insignificant radiological fragments were seen in 35 cases and residual stones were seen in 20 cases. Maximum cases of CIRF were seen in middle calyx (15) and residual stones were seen in lower calyx (7). The difference was significant (P< 0.05). Common complications were fever in 7, hematuria in 3, flank pain in 4 and urosepsis in 2 cases. Conclusion: Authors found that retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal stones.

Download Full-text

Primary cemented bipolar hemiarthroplasty by transtrochanteric approach in unstable intertrochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212362 ◽

2021 ◽

Author(s):

Thomas Angelo Skariah ◽

Koshy George ◽

Deny Mathew ◽

James C. George ◽

Samuel Chittaranjan

Keyword(s):

Elderly Patients ◽

Successful Treatment ◽

Tertiary Care ◽

Postoperative Outcome ◽

Early Mobilization ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Tertiary Care Centre ◽

Duration Of Surgery ◽

One Year

Background: The successful treatment of unstable intertrochanteric fractures of the femur in elderly patients is a challenge. Due to complications associated with internal fixation, primary hemiarthroplasty is increasingly becoming an alternative treatment to achieve early mobilisation. A transtrochanteric approach could potentially decrease the complications associated with primary hemiarthroplasty. Aim of the study is to document the postoperative outcome and complications associated with this treatment.Methods: In this retrospective study, all elderly patients with unstable trochanteric fractures, treated by primary hemiarthroplasty through a transtrochanteric approach, in a tertiary care centre, from September 2017 to December 2019, were enrolled. Their data from hospital records were analysed and results compared to literature.Results: 48 patients underwent the procedure. Average age was 85 years. One year mortality was 31.25%. Average duration of surgery is 85 min. 58.3% were ambulant at one year. One case of dislocation secondary to surgical site infection was present.Conclusions: Primary hemiarthroplasty as a primary treatment in this group of patients enables early mobilization and prevents complications associated with prolonged immobilization. Transtrochanteric approach reduces the duration of surgery. Achieving early ambulation is the key to successful treatment.

Download Full-text

CLINICAL PROFILE AND MANAGEMENT OF PATIENTS OF AMOEBIC LIVER ABSCESS IN A TERTIARY CARE CENTRE

10.36106/ijsr/5406508 ◽

2020 ◽

pp. 5-7

Author(s):

Rakesh Mishra ◽

Debabrata Banerjee ◽

Debarshi Jana

Keyword(s):

Drug Treatment ◽

Liver Abscess ◽

Tertiary Care ◽

Clinical Manifestations ◽

Needle Aspiration ◽

Intestinal Disease ◽

Amoebic Liver Abscess ◽

Treatment Modalities ◽

Tertiary Care Centre ◽

Early Recovery

Introduction: Amoebiasis is caused by the protozoan Entamoeba histolytica. Most infections are asymptomatic; clinical manifestations include amoebic dysentery and extra intestinal disease. Amoebic liver abscess is the most common extraintestinal manifestation of amoebiasis. Amoebae establish hepatic infection by ascending the portal venous system. Aim: To study various aspects of Amoebic Liver Abscess like demographic profiles, clinical presentations, association with intestinal disease, radiological and laboratory findings, treatment modalities and complications. Materials and Methods: A hospital based prospective observational study was performed in the Department of Internal Medicine, Command Hospital (Eastern Command), Kolkata, from Jan 2018 to Jun 2019. All confirmed cases of amoebic liver abscess above the age of 18 years admitted in Command Hospital (EC) were included in this study. The patient were then subsequently followed up for 01 year with USG abdomen every 03 monthly. Results: Total 40 patients of Amoebic Liver Abscess with age more than 18 year were enrolled in the study. The age ranged from 26 to 70 years (mean age 46.2 year). Male patients were dominated over female. 80.0 % were from rural background. About 55% patients were addicted to alcohol & 25.0 % were known diabetics at presentation. In all, 07 (17.5%) patients with abscess size of 6 cm to 10 cm (Vol> 300 cc) were treated by needle aspiration and drug therapy. Remaining 17(42.5%) patients with abscess size more than 10 cm were treated with pigtail drainage and drug. Conclusion: There is significant advantage of pigtail drainage with drug treatment over needle aspiration with drug and only with drug treatment in terms of decrease in lesion size and early recovery.

Download Full-text