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

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.

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POSSUM and P-POSSUM Scoring in Hip Fracture Mortalities

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320931674 ◽

2020 ◽

Vol 11 ◽

pp. 215145932093167

Author(s):

William L. Johns ◽

Benjamin Strong ◽

Stephen Kates ◽

Nirav K. Patel

Keyword(s):

Hip Fracture ◽

High Risk ◽

Mortality Rate ◽

Clinical Decision Making ◽

Tertiary Care ◽

Significant Risk ◽

Screening Tools ◽

Morbidity And Mortality ◽

Mortality And Morbidity ◽

Operative Severity Score

Introduction: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) are general surgical tools used to efficiently assess mortality and morbidity risk. Data suggest that these tools can be used in hip fracture patients to predict morbidity and mortality; however, it is unclear what score indicates a significant risk on a case-by-case basis. We examined the POSSUM and P-POSSUM scores in a group of hip fracture mortalities in order to assess their accuracy in identification of similar high-risk patients. Materials and Methods: Retrospective analysis of all consecutive mortalities in hip fracture patients at a single tertiary care center over 2 years was performed. Patient medical records were examined for baseline demographics, fracture characteristics, surgical interventions, and cause of death. Twelve physiological and 6 operative variables were used to retrospectively calculate POSSUM and P-POSSUM scores at the time of injury. Results: Forty-seven hip fracture mortalities were reviewed. Median patient age was 88 years (range: 56-99). Overall, 68.1% (32) underwent surgical intervention. Mean predicted POSSUM morbidity and mortality rates were 73.9% (28%-99%) and 31.1% (5%-83%), respectively. The mean predicted P-POSSUM mortality rate was 26.4% (1%-91%) and 53.2% (25) had a P-POSSUM predicted mortality of >20%. Subgroup analysis demonstrated poor agreement between predicted mortality and observed mortality rate for POSSUM in operative (χ2 = 127.5, P < .00001) and nonoperative cohorts (χ2 = 14.6, P < .00001), in addition to P-POSSUM operative (χ2 = 101.9, P < .00001) and nonoperative (χ2 = 11.9, P < .00001) scoring. Discussion/Conclusion: Hip fracture patients are at significant risk of both morbidity and mortality. A reliable, replicable, and accurate tool to represent the expected risk of such complications could help facilitate clinical decision-making to determine the optimal level of care. Screening tools such as POSSUM and P-POSSUM have limitations in accurately identifying high-risk hip fracture patients.

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Study of antepartum hemorrhage and its maternal and perinatal outcome at a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212149 ◽

2021 ◽

Vol 10 (6) ◽

pp. 2210

Author(s):

Amruta R. Kulkarni ◽

Arti S. Shirsath

Keyword(s):

Maternal Mortality ◽

Perinatal Mortality ◽

Perinatal Outcome ◽

Placenta Previa ◽

Tertiary Care ◽

Care Hospital ◽

Mortality And Morbidity ◽

Antepartum Haemorrhage ◽

Medical College ◽

Abruptio Placenta

Background: Antepartum haemorrhages are defined as bleeding from or into the genital tract after the period of viability untill delivery of the fetus. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Objective of this study is to quantitate maternal morbidity, mortality and perinatal outcome in patients with APH at a tertiary care hospital.Methods: A retrospective observational study was carried out in the department of obstetrics and gynecology, Smt. Kashibai Navale medical college and general hospital, Pune. Patient information was obtained from the delivery records of 2018, 2019 and 2020. Patients presenting after the gestational age of 28 weeks with antepartum haemorrhage were included in the study.Results: Out of 100 cases of APH, abruptio placenta contributes to 60%, placenta previa to 37% and 3 cases were due to unknown cause. Overall maternal mortality was 3% and perinatal mortality was 23% in abruptio placentas compared to 13% in cases with placenta previa. Main cause of perinatal mortality was prematurity69%.Conclusions: Antepartum haemorrhage is one of the leading cause of perinatal mortality and morbidity. These cases should be deliverd at a centre with transfusion facility, NICU facility and by the obstetrician skilled in controlling intraoperative haemorrhage by stepwise devascularising sutures. Timely decision of uterine tamponade can also save few ceaserean hysterectomies.

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Determinants of delayed vaccination among children under 2 years attending an immunisation clinic of a tertiary care hospital, Kolkata

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205010 ◽

2020 ◽

Vol 8 (12) ◽

pp. 4324

Author(s):

Nabanita Chakraborty ◽

Gautam Kumar Joardar

Keyword(s):

Maternal Education ◽

Tertiary Care ◽

Substantial Reduction ◽

Care Hospital ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Medical College ◽

Hindu Religion ◽

Effective Public Health ◽

Timely Administration

Background: Immunization is one of the most effective public health measures for disease prevention and when administered timely leads to substantial reduction in child mortality and morbidity. However, timely administration of vaccines remains neglected putting the children at risk of acquiring the infections. Methods: The study is a cross-sectional, observational study, conducted in the immunization clinic of KPC Medical College and Hospital from January to March 2019 among children below the age of 2 years. The sample size was 332. The mothers were interviewed with a pre-designed and pre-tested schedule regarding socio-demographic details and records were reviewed for scheduled date of immunization and to find any delay.Results: Total 33.7% children had some delay in receiving vaccines. The delay was found to be more in mothers <20 years of age, female children, children belonging to Hindu religion, children from joint family, children belonging to class 4 SES, children where maternal education is up to primary level and children with birth order≥3. Significant association was found between vaccine delay birth and order. (p<005). Sickness of the child accounted for 41% of the delays followed by both parents working, which accounted for 25.9% of delays.Conclusions: Delay in vaccination was found in approximately one-third of children. Thus more awareness generation is required among mothers regarding the timeliness of vaccinations and risk it poses on the children making them more susceptible to diseases in the period of delay.

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Feasibility of repeat surgery for pediatric brain tumors: an objective assessment of perioperative outcomes

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.8.peds12133 ◽

2012 ◽

Vol 10 (5) ◽

pp. 411-417 ◽

Cited By ~ 3

Author(s):

Aliasgar V. Moiyadi ◽

Prakash Shetty

Keyword(s):

Brain Tumors ◽

Tertiary Care ◽

Pediatric Brain Tumors ◽

Prior Treatment ◽

Morbidity And Mortality ◽

Perioperative Outcomes ◽

Repeat Surgery ◽

Systemic Complications ◽

Presenting Symptoms ◽

Pediatric Brain

Object Repeat surgery for pediatric brain tumors is gaining acceptance, with extent of resection an important predictor of outcome. However, repeat surgeries may be associated with increased morbidity. Few studies in the literature provide such outcomes objectively. The authors report on their experience with repeat surgery at a tertiary care neurooncology referral center in India. Methods A prospectively maintained database documented epidemiological, clinical, radiological, operative, and perioperative events. The authors analyzed 117 children (younger than 18 years of age) who had undergone various resective surgeries for brain tumors over a period of 5 years. Assessed end points included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Results The majority of children (48%) were between 3 and 10 years of age. Elevated intracranial pressure (70% of patients) and neurological deficits (60% of patients) were the commonest presenting symptoms. A significant proportion of patients (35%) had a poor Karnofsky Performance Scale score (≤ 70). Supratentorial procedures were performed in 58% of the patients. Most patients (72%) had large (> 4 cm) tumors. Fifty-eight patients (50%) had received prior treatment, surgery in 55. Neurological morbidity (worsening), regional complications, and systemic complications occurred in 27%, 32%, and 25% of patients overall, respectively. Overall morbidity was 44.4% (26.5% major), and perioperative mortality was 7.7%. Neurological worsening occurred more frequently in patients undergoing a first surgery (p = 0.038), whereas wound-related complications were more common in those undergoing reoperations (p = 0.00). Conclusions Pediatric patients had larger tumors and were more likely to present with a poor performance status, often after prior treatment, than their adult counterparts. Wound-related complications were higher in the previously treated subgroup; however, neurological complications were fewer, probably because of a favorable selection of patients. Despite the unavailability of advanced intraoperative aids, acceptable levels of overall morbidity and mortality could be achieved in repeat surgeries for pediatric brain tumors.

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Maternal and Fetal Outcome in Eclampsia: A Study From Tertiary Care Hospital

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v15i2.22816 ◽

2017 ◽

Vol 15 (2) ◽

pp. 6-9

Author(s):

Husneyara Haque ◽

Kalpana Kumari Thapa

Keyword(s):

Early Recognition ◽

Tertiary Care ◽

Fetal Outcome ◽

Morbidity And Mortality ◽

Care Hospital ◽

Cross Sectional ◽

Factors Affecting ◽

Medical College ◽

Life Threatening ◽

Study Population

Introduction: Eclampsia is an acute and life-threatening complication of pregnancy associated with elevated maternal and fetal morbidity and mortality. This study was done with the aim to evaluate the maternal and fetal outcome in eclampsia patients and to observe various factors affecting its occurrence and outcome. Methods: A retrospective cross-sectional hospital based study carried out in Nepalgunj Medical College, Nepalgunj from January 2015 to December 2016. Details and data obtained from maternity register were analysed. All patients with eclampsia were included and fetomaternal outcomes measured in terms of complications. Simple descriptive statistical method was applied for analysis. Result: Out of 6056 pregnant women, 46 had eclampsia with the incidence of 7.59 per 1000 deliveries. 58.7% of study population belonged to age group of 21-30 years followed by 36.96% from age less than 20 years. 78.26% cases were unbooked. 73.91% eclamptic patients were primi gravida and 60.87% had gestational age less than 37 weeks. Half of pregnancies with eclampsia underwent ceasarian for delivery and 30.44% required ICU care. One third women developed eclampsia related complications and 2(4.35%) died. Common complications were atonic postpartum heamorrhage (15.21%), psychosis (8.71%) acute renal failure (4.35%). 60.86% newborn were preterm and 56.52% were low birth weight. In 50% newborn, Apgar score at 5 minutes was less than 7. Fetal death was 10.85%. Conclusion: Eclampsia continues to be one of the prime etiological factors for maternal and fetal morbidity and mortality. Therefore early recognition and proper management are vital to tackle this challenge.

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Ear, nose, throat foreign bodies: experience in the tribal population

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20163474 ◽

2016 ◽

Vol 2 (4) ◽

pp. 244

Author(s):

Surendra H. Gawarle ◽

Manoj Jondhale ◽

Prashant Keche

Keyword(s):

Foreign Bodies ◽

Emergency Services ◽

Tertiary Care ◽

Fish Bone ◽

Care Hospital ◽

Tribal Population ◽

Mortality And Morbidity ◽

Throat Region ◽

Medical College ◽

Tribal Region

Background: Foreign bodies (FB) in the ears, nose or throat are a common occurrence in otorhinolaryngology (ENT) emergency services. The management calls for prompt & precise intervention which in turn decreases the overall morbidity and mortality. The aim of the study was to study the age & gender distribution, modes of presentation, management & complications of various foreign bodies in patients attending emergency & ENT OPD.Methods: It is a prospective, interventional clinical study conducted in a tertiary Care Hospital – Shri Vasantrao Naik government medical college situated in tribal region of Yavatmal, Maharashtra. About 200 patients from the tribal population with foreign body in ear, nose & throat region from November 2012 to October 2014 were included in the study. Results: Out of 200 patients, the commonest location of FB was in ear with 103 patients (51.5%) followed by nose with 72 patients (36%) and throat 25 patients (12.5%). 203 FB were removed from 200 patients. Throat cases include digestive tract (21 cases) and tracheobronchial (4 cases) FB. Amongst the FB in throat the commonest was fish bone and the commonest site being cricopharynx. Seeds were the commonest FB in ear & nose. A greater proportion of cases - 109 (54.5%) were below 10 years of age.Conclusions: A great degree of suspicion, prompt diagnosis and timely intervention can reduce the overall mortality and morbidity associated with ear, nose and throat foreign bodies.

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Clinicoepidemiologic profile of patients with poisoning presenting to a tertiary care hospital; a one year preliminary descriptive study

Journal of Preventive Epidemiology ◽

10.34172/jpe.2020.15 ◽

2020 ◽

Vol 5 (1) ◽

pp. e15-e15

Author(s):

Amir Mohammad Kazemifar ◽

Seyed Mostafa Mirakbari ◽

Zohreh Yazdi ◽

Bita Bitazar ◽

Pouria Soleimani

Keyword(s):

Mortality Rate ◽

Tertiary Care ◽

Hospital Costs ◽

Health Resources ◽

Care Hospital ◽

Health Providers ◽

Cross Sectional ◽

Presenting Symptoms ◽

Spss Software ◽

One Year

Introduction: Poisoning is regarded as a matter of concern for health providers as the burden of health resources loss can be high. Since nature and diversity of poisoning are different among various regions around the country, this study was conducted to demonstrate type and reasons for poisonings in Qazvin province, Iran. Objectives: The aim of this study was to demonstrate the reason of toxic events as well as presenting symptoms and outcome of poisonings. Patients and Methods: This prospective, cross-sectional and hospital-based study was conducted during a one-year period. The patients recruited to the study were consecutive intoxicated cases presenting to the hospital with alleged poisoning. Relevant epidemiological and clinical data from patients were collected and then analyzed using SPSS software. Results: A total of 23161 patients were admitted to the hospital, out of which 766 (3.3%) intoxicated patients were enrolled in the study. Mean age was 29.8 years old. Females outnumbered males but difference was not significant. The majority of the poisonings were deliberate (95.2%). Main clinical features of poisoning were decreased consciousness (47.4%), followed by lethargy (38.1%) and nausea/vomiting (31.9%). The benzodiazepines were the predominant agent ingested by patients, followed by opioids. Mortality rate was found to be 1%. Conclusion: Although the majority of poisoning cases are deliberate, however according to the type of pharmaceuticals involved in the poisonings and low-mortality rate, it is believed that the occurrence of the toxic events in many cases arises from impulsive behaviors originated from minor familial conflicts and incompetent life skills. Improving mental health and efficient coping skills can contribute to the reduction of intentional poisonings which in turn reduces the burden of hospital costs.

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

Emergency Medicine International ◽

10.1155/2021/4818312 ◽

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.

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Maternal mortality assessment in a tertiary care hospital in Uttar Pradesh, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203862 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3814

Author(s):

Urvashi Barman Singh ◽

Shakti Jain ◽

Yashi Srivastava ◽

Manisha Gupta ◽

Meena Dayal

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Post Partum ◽

Tertiary Care ◽

Uttar Pradesh ◽

Care Hospital ◽

Maternal Deaths ◽

Maternal Mortality Rate ◽

Medical College ◽

Time Period

Background: Objective of this study was to calculate the maternal mortality rate in our hospital and to assess the epidemiological aspects and causes of maternal mortality to further analyse ways to reduce the maternal mortality rate (MMR).Methods: This was a retrospective analytical study done in the department of obstetrics and gynecology, MLN Medical College and District Women Hospital, Prayagraj over a time period of 10 years i.e., October 2009 to October 2019. Retrospective analysis and evaluation of the medical records and statistics was done to find out and collect specific causes of maternal deaths in the give time period.Results: There were 357 maternal deaths from October 2009 to October 2019. Maternal mortality rate in the study was calculated to be 498.42 per 1 lakh live births. Maximum deaths were in 21-30 years age group with multipara, unbooked and illiterate cases. Majority of the deaths reported were from direct causes of maternal mortality i.e., hemorrhage, hypertensive disorders and sepsis.Conclusions: In the selected hospitals, the mean maternal mortality rate in the study period was 498.42/100000 births. 71.4% had direct cause and 21.56% had indirect cause of maternal mortality several factors like regular antenatal visits, early identification of high-risk cases, timely referral, institutional deliveries, adequate post-partum care and follow-up can contribute to decrease the maternal mortality rate effectively.

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Identification of Maternal Risk Factor with Preterm LBW Babies in a Tertiary Care Hospital

TAJ Journal of Teachers Association ◽

10.3329/taj.v24i2.37511 ◽

2018 ◽

Vol 24 (2) ◽

pp. 95-100

Author(s):

MB Uddin ◽

S Yasmin ◽

M Sanaul Haque ◽

A Hossain ◽

KI Jahan

Keyword(s):

Risk Factors ◽

Tertiary Care ◽

Care Hospital ◽

College Hospital ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Maternal Risk ◽

Medical College ◽

Poor Nutritional Status ◽

Health Related

This study was aimed to identify risk factors of preterm LBW babies by following a cross sectional type of comparative study. This study was conducted at inpatient department of paediatrics of Rajshahi Medical College Hospital from January 2009 to December 2010. A total 150 preterm babies were included in this study. The mothers of the babies were studied to identify some selected risk factors. Maternal poor nutritional status (p<.001), low age at conception (p<.003), poor antenatal care (p<.001) and low level of education (p<.002) were found significant socio-economic risk factors. Maternal health related conditions like Antepartum haemorrhage (p<.001), Premature rupture of the membrane (p<.001), toxemia of pregnancy (p<.005), anaemia (p<.002) all were found as the significant contributors of preterm birth. This study might help to reduce the incidence of mortality and morbidity of preterm infants by providing information regarding risk factors.TAJ 2011; 24(2): 95-100

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