scholarly journals A prospective observational study on feasibility of laparoscopic perforation repair in patients presenting with intestinal perforation at a tertiary care superspeciality hospital in Chhattisgarh

2020 ◽  
Vol 7 (5) ◽  
pp. 1597
Author(s):  
Deepak Taneja ◽  
Akash Gupta ◽  
Sandeep Dave ◽  
Siddharth Tamaskar
Keyword(s):  
Laparoscopic Repair ◽  
Bowel Perforation ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Suture Repair ◽  
High Morbidity ◽  
Care Hospital ◽  
Perioperative Morbidity ◽  
Male Predominance ◽  
Early Return

Background: Bowel perforation is one of the common emergencies faced by the surgeons in the developing world. It carries a high morbidity and mortality rate even today. In the present era, laparoscopy is being used as a better treatment alternative across the world. Various reports in literature are now available regarding the feasibility of laparoscopic repair of bowel perforation. The purpose of this study was to assess the feasibility of laparoscopic primary suture repair as the initial modality in treating a bowel perforation and to analyze the pattern of bowel perforation in relation to age, sex and etiology in Chhattisgarh state.Methods: This study included the data of relevant patients who got admitted in Ramkrishna Care Hospital Raipur from 1st October 2017 to 31st September 2019 (24 months).Results: Most commonly affected mean age group in this study was 39±15.82 years with male predominance. Statistically  significant findings in favour of laparoscopic repair in our study were early return of bowel activity, less incidence of surgical site infection, early return to work (less hospital stay), less post-operative pain as compared to open surgery (p<0.05).Conclusions: In this study it was found that laparoscopy in patients with bowel perforation who are hemodynamically stable and present early (<72 hours) to the hospital is feasible and safe and gives many benefits including reduction in perioperative morbidity and mortality. 

scholarly journals Early debridement with physiotherapy for prevention of postburn contracture of neck: a case series

2020 ◽  
Vol 7 (5) ◽  
pp. 1618
Author(s):  
Girish D. Bakhshi ◽  
Aditya B. Marathe ◽  
Chirag Kamat ◽  
Khadeija Hussain
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Neck Region ◽  
Late Presentation ◽  
Favourable Outcome ◽  
High Morbidity ◽  
Care Hospital ◽  
Thermal Burns ◽  
Early Return ◽  
Early Debridement

Hypertrophic scars and contractures are well known sequelae after burns. They result in high morbidity in severely burned patients who are surviving. Present case study was done to establish the usefulness of early debridement and physiotherapy in preventing these sequelae. Present study was conducted on patients admitted in a tertiary care hospital on patients with alleged history of thermal burns to neck and upper chest over a period of 6 months. These patients were subjected to early debridement, daily dressings and early neck physiotherapy. They were assessed for neck mobility and development of neck contracture. Three patients were studied, two had a favourable outcome due to adherence to above measures while one developed contracture due to her late presentation and non-compliance to early physiotherapy. Post burn contractures are common sequelae of thermal burns involving the neck region. Early Debridement, daily dressing of the raw areas with starting of early neck physiotherapy are important and prove beneficial in preventing neck contractures with early return to normal daily activity.

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

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

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

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

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

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

scholarly journals Trauma admissions among victims of domestic violence at a tertiary care hospital in north-western Tanzania: an urgent call to action

2015 ◽  
Vol 17 (4) ◽  
Author(s):  
Phillipo L. Chalya ◽  
Anthony N. Massinde ◽  
Albert Kihunrwa ◽  
Neema M Kayange ◽  
Kiyeti A. Hauli ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Physical Violence ◽  
Negative Impact ◽  
Tertiary Care ◽  
Soft Tissue Injuries ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Care Hospital ◽  
Severity Of Injury ◽  
North Western

Background: Despite the growing recognition of domestic violence as a public health and human rights concern, it remains rampant in developing countries and has a negative impact on the victim’s health. This study describes the injury characteristics and treatment outcome of trauma associated with domestic violence in north-western Tanzania.Methods: This was a descriptive prospective study of patients who were managed for domestic violence related trauma at Bugando Medical Centre in Mwanza, Tanzania from April 2009 to March 2014.Results: A total of 324 patients (M: F = 1: 10.6) were studied. Majority of the patients were in the second and third decades of life. The perpetrators were mainly husbands and ex-partners (55.5%). Suspecting sexual partner being unfaithful was the most common reason given by victims for domestic violence in 63.4% of cases. Blunt and sharp objects (56.8%) were the most common weapons used. Gunshot injuries were recorded in 0.6% of cases. The head/neck was commonly affected in 68.5%. Soft tissue injuries (77.8%) were the most frequent type of injuries. The majority of patients (65.4%) sustained mild injuries. Twenty-three (7.1%) patients were HIV positive. Surgical treatment was performed in only 34.6% of cases.  Complication rate was 26.8%. The median hospital stay was 12 days. Mortality rate was 6.5%. The main predictors of mortality were advanced age (> 60 years),  late presentation,  severity of injury, severe head injury, HIV seropositivity, low CD 4 count (<200 cells), surgical site infection (p<0.001). More than two-thirds of patients were lost to follow up.Conclusion: Domestic violence related trauma remains rampant in northwestern Tanzania and contributes significantly to high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of domestic physical violence is necessary to reduce the morbidity and mortality resulting from these injuries. 

scholarly journals Frequency, risk factors and materno-foetal outcomes among cases of Placenta previa at a tertiary care hospital: a two year study

2019 ◽  
Vol 8 (6) ◽  
pp. 2240
Author(s):  
Pamulaparthi Bindu Reddy ◽  
Gurram Swetha Reddy
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Tertiary Care Hospital ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Previous History ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Early Date

Background: Placenta previa refers to the presence of placental tissue that extends over the internal cervical os.  Placenta previa is linked to maternal hypovolemia, anaemia, and long hospital stay and with prematurity, low birth weight, low APGAR score in newborn. So it is very important to identify the condition at an early date to warn the condition thereby reducing the maternal and foetal morbidity and mortality. The present study was aimed to estimate the prevalence of PP, its associated predisposing risk factors and maternal morbidity, mortality and the perinatal outcome.Methods: A prospective observational study for two years was conducted at a tertiary care hospital. Pregnant mothers with >28 weeks of age with H/o ante partum haemorrhage were screened for placenta previa, confirmed by ultra sonography and included in the study. Clinical history, obstetric examination was done and followed up till the delivery. Maternal and foetal outcomes were recorded. Data analyzed by using SPSS version 20.Results: 1.4% incidence of PP was noted, mean age of group was 29.17±1.6 years. Age group of 21-30 years, multiparity Gravida 2-4, previous history of caesarean section and less number of ante natal checkups were significant risk factors and LSCS was most common outcome. Prematurity, low birth weight and APGAR <7 score for 1 minute was common foetal outcomes.Conclusions: Our study strongly suggests foetal surveillance programmes in cases of placenta previa. Measures should be made to bring awareness about PP, in urban slums and to increase medical checkups regularly. Making USG mandatory during every ANC and referral of cases of PP to tertiary care centres would definitely reduce the chances of morbidity and mortality.

Abstract 147: Hypertension-related Admission and Mortality at a Referral Hospital in Tanzania - A Call to Action

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Naomi Shike ◽  
Santosh Vardhana ◽  
Judith Briant ◽  
Robert Peck
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Tertiary Care ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
Hospital Death ◽  
Care Hospital ◽  
Common Cause ◽  
Related Disease ◽  
Reasonable Approach

Introduction The WHO has been increasingly emphasizing and calling for research on the vast unattended burden of non-communicable diseases in the developing world. Hypertension (HTN) in particular is thought to play a growing role in morbidity and mortality in these regions, but has yet to gain significant momentum in public health initiatives. Objective To determine what role HTN and comorbid diseases play in admission and mortality in Bugando Medical Center (BMC), a tertiary care hospital in Tanzania serving 13 million people. Methods We conducted a retrospective analysis of all patients admitted to the internal medicine service at BMC over 34 months between 2008 and 2011. Data on admission diagnoses and mortality had been collected prospectively by Tanzanian doctors in hand-written logs. For patients with heart failure or stroke, the ward logs specified if this was primarily related to hypertension or other risk factors. Data were copied into an Excel database and analyzed to determine the proportion of admissions and deaths primarily related to hypertension. Results In 34 months 8,037 patients were admitted and 1,508 died. HTN-related disease led to 1,997 admissions (25%), while HIV-related illness led to 2,076 (26%). Similarly, HTN led to 377 deaths (25%) and HIV to 579 (38%). HTN-related disease was second only to HIV-related disease as a cause of admission and death. Among hypertensives, the most common cause of admission was congestive heart failure (446; 27%) and of death was stroke (147; 49%). In non-hypertensives, HIV-related disease was the most common cause of both admission (2029; 32%) and death (566; 46%). Conclusions HTN-related disease was second only to HIV as a cause of admission to our hospital and in-hospital death. Better strategies for early diagnosis and treatment of HTN are desperately need in sub Saharan Africa to prevent this morbidity and mortality. Building HTN screening and treatment on top of the extensive infrastructure for HIV disease may be a reasonable approach.

Assessing the Severity of Acute Pancreatitis with CT Severity Index and Other Conventional Methods in a Tertiary Care Hospital in Tamil Nadu, India – A Comparative Cross-Sectional Study

2021 ◽  
Vol 8 (41) ◽  
pp. 3541-3546
Author(s):  
Jayaprakash Subramani ◽  
Rajesh Prabhu ◽  
Jagadeesapandian Palpandi
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Predictive Value ◽  
Tamil Nadu ◽  
Objective Assessment ◽  
Tertiary Care ◽  
Severity Index ◽  
Apache Ii ◽  
Care Hospital ◽  
Male Predominance

BACKGROUND Acute pancreatitis is not uncommon in surgical practice with variable clinical presentation. Because of its potential notable catastrophic complications, it is mandatory to assess the severity at the earliest. In recent times, the decision making in the management is quite difficult due to its complications and outcome. So, an objective assessment of severity based on clinical and laboratory scoring verses computed tomography (CT) severity is still debate, hence the need for study. The purpose of this study was to compare the efficiency of CT severity index verses APACHE II and Ranson criteria in predicting the severity of acute pancreatitis. METHODS A total number of 36 consecutive cases of acute pancreatitis who were admitted between January 2013 and December 2014 in Apollo Specialty Hospitals – Madurai were included in the study. Written informed consent was obtained from all study participants. RESULTS In our study, out of 36 patients, 30 (83.33 %) were males and 6 (16.66 %) were females. The sex distribution shows a clear male predominance. Most of the patients in the present study belonged to the middle age group. Alcohol was the most common cause accounting for 41.7 % of the cases followed by the billiary pathology. CT severity index was the superior tool for prediction of the prognosis and early complications. CONCLUSIONS When using contrast enhanced computed tomography, it was found that there was a significant correlation between the development of organ failure and severity of pancreatitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ranson and acute physiology and chronic health evaluation – II (APACHE II) at 48 hours of admission with acute pancreatitis does not correlate in determining the severity of acute pancreatitis. KEYWORDS Acute Pancreatitis, Severity Markers, CT Severity Index

AEROBIC BACTERIOLOGICAL PROFILE WITH ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF PUS SAMPLES AT A TERTIARY CARE HOSPITAL IN JAIPUR

2021 ◽  
pp. 65-67
Author(s):  
Hemendra K Sharma ◽  
Niketa Gupta ◽  
Mahesh Yadav ◽  
Aruna Vyas ◽  
Rajni Sharma
Keyword(s):  
Antimicrobial Susceptibility ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Diffusion Method ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Gram Positive ◽  
Gram Negative ◽  
Inappropriate Use ◽  
Antimicrobial Susceptibility Pattern

Background: Pyogenic infections can be caused by various microorganisms and may co-exist as poly microbial infections which require antibiotic therapy. The inappropriate use of antibiotics has led to major problems of MDRO's contributing to morbidity and mortality. Even though the bacteriological prole of pus samples in many studies remain the same, antimicrobial susceptibility pattern of these isolates has shown a lot of variation. This study was conducted to assess bacteriological prole of pus samples and their antimicrobial susceptibility pattern Materials and Methods:Aretrospective study was carried out from April to June 2021. 540 pus culture aerobic bacterial isolates were included. The samples were cultured on Blood and MacConkey agar. After aerobic incubation at 37oC for 18-24 hrs, organisms were identied by conventional bacteriology methods as per laboratory protocol and antimicrobial susceptibility was tested by Kirby Bauer disc diffusion method as per CLSI 2020 guideline. Results: Out of 540 pus isolates , 452(83.7%)were gram negative bacili and 88(16.3%) were gram positive cocci Pseudomonas spp. 173(31.9%), was most common gram negative isolate while S.. aureus 66(12.19%) was most common Gram positive isolate. Most of gram negative isolates were susceptible to Imipenem and Polymyxin and gram positive isolates to vancomycin and linezolid . Conclusion: To combat resistance irrational use of antibiotics should be avoided. Also regular surveillance helps in implementing better therapeutic strategies to reduce morbidity and mortality

scholarly journals Clinical Presentation of Preterm Neonates with Intraventricular Hemorrhage: Experience in a Tertiary Care Hospital in Dhaka

2017 ◽  
Vol 7 (3) ◽  
pp. 194-197
Author(s):  
Tasnima Ahmed ◽  
Abdul Baki ◽  
Tahmina Begum ◽  
Nazmun Nahar
Keyword(s):  
Clinical Features ◽  
Intraventricular Hemorrhage ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Morbidity And Mortality ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Care Hospital ◽  
One Year

Background: Intraventricular hemorrhage (IVH) is common among preterm infants as many of them survive with the advancements in neonatal care. Severe IVH may lead to significant morbidity and mortality. The objective of our study is to find out the significant clinical signs of IVH in preterm neonate for early detection by ultrasonography.Methods: This prospective observational study was done in special care baby unit (SCABU), Bangladesh Institute of Research & rehabilitation of Diabetic, Endocrine & metabolic Disorder (BIRDEM) for a period of one year. Eighty five preterm neonates were included in this study. Clinical features of IVH like- convulsion, lethargy, irritability, bulged fontanelle, recurrent apnea, sudden onset of respiratory distress, sudden pallor and bradycardia were observed. Cranial ultrasound studies were done within 7 days of life in all cases to identify IVH.Result: Mean gestational age of these neonates was 31.31(±2.2) weeks & mean birth weight was 1413.42 (±330.55) gm. Among 85 preterm neonates 21(24.7%) developed IVH, confirmed by ultrasonography of brain. Clinical features like convulsion, bulged fontanel, repeated apnea & sudden pallor were significantly present in IVH group.Conclusion: Intraventricular Hemorrhage constitutes an important cause of morbidity and mortality in neonate. This study showed that clinical features like convulsion, bulged fontanel and sudden pallor had a significant relationship with intraventricular hemorrhage which will help for its early detection.Birdem Med J 2017; 7(3): 194-197

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