Pediatric appendicitis- five year experience at tertiary care pediatric surgery department: a cohort study

Background: Acute appendicitis is one of the most common abdominal surgical condition in pediatric population. It accounts for 1-8% of children presenting in pediatric surgical emergency. The aim of this study was to evaluate pediatric appendectomy in our department.Methods: It was a hospital based prospective cohort study spanning over a period of 5 years, where all diagnosed cases of pediatric appendicitis were enrolled. Demographic profile, clinical features and operative findings were analyzed. Patients were kept on regular follow-up and complications were noted.Results: During the study period 146 patients were enrolled for the study. Male: female ratio was 1:1. Maximum patients belonged to age group of 11-15 years (42%). Pain in abdomen and fever were the most common presenting symptoms. Tenderness in right iliac fossa was the most common clinical sign (89.72%) and inflamed appendix was the most common operative finding in the study (83.91%).Conclusions: The diagnosis of acute appendicitis is based on clinical examination. Atypical symptoms may lead to delay in the diagnosis and management. Imaging and lab investigations are supportive. Early recognition of symptoms, access to healthcare facility with a surgeon can significantly reduce the morbidity and complication rates in pediatric age group.

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Evaluation of Alvardo score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20172780 ◽

2017 ◽

Vol 4 (7) ◽

pp. 2276

Author(s):

Uday Kiran Mokati ◽

L. Hari Prasada Rao ◽

N. Siva Durgesh ◽

P. Avinash ◽

K. Baby Lakshmi ◽

...

Keyword(s):

Acute Appendicitis ◽

Iliac Fossa ◽

Ultra Sound ◽

Study Group ◽

Age Group ◽

Alvarado Score ◽

Female Ratio ◽

Group I ◽

Study Results ◽

Right Iliac Fossa Pain

Background: Acute appendicitis is a common cause of abdominal pain for which a prompt diagnosis is rewarded by a marked decrease in morbidity and mortality. Right Iliac fossa pain is the hallmark of acute appendicitis until proven otherwise. Decision making in a case of acute appendicitis may be difficult, especially for junior surgeons. Hence, we aimed at analysing the Alvarado Score in patients with right iliac fossa pain.Methods: A prospective study involving 120 patients with right iliac fossa pain attending KIMS casualty during May 2015- April 2016 were included in the study. Results: The least was in the age group of 56 to 65 years (2%). Out of 120 patients, 84 were males (70%) and 36 were female (30%). The male to female ratio was 1:0.4. Patients with Alvarado score 7-9 (Group I) includes 60 male and 26 females (71% of total study group). Alvarado score 5-6 (Group II) includes 17 males,19 female (22% of total study group). Alvarado score 1-4 (Group III) includes 7 males, and 1 female (7% of total study group). In patients of Group I, among 60 males, 51 were confirmed with acute appendicitis. Among 26 females, 19 were confirmed with acute appendicitis, with a positive appendicectomy rate of 81.3% and negative appendicectomy rate 19.7%. The numbers of patients were highest in the age group 15 to 25 years (38%) followed by 36 to 45 years (30%).Conclusions: The Modified Alvarado scoring system was found to be highly effective in the diagnosis of the acute appendicitis in men and can be widely used to avoid expensive time consuming and non-readily available additional investigations. However, this system was not very effective in women. Therefore, ultra sound examination of abdomen and pelvis and diagnostic laparoscopy are also advised to minimize the high false negative rate in women which excludes common pelvic pathology that mimic clinically acute appendicitis.

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Gastro intestinal perforations: an audit from a tertiary care teaching hospital, Mysore, India

International Surgery Journal ◽

10.18203/2349-2902.isj20184613 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3484

Author(s):

Shashikumar H. B. ◽

Madhu B. S. ◽

Shyama S.

Keyword(s):

Surgical Procedure ◽

Dietary Habits ◽

Tertiary Care ◽

Patch Repair ◽

Age Group ◽

Hollow Viscus ◽

Care Teaching ◽

Presenting Symptoms ◽

Intestinal Perforations ◽

Hollow Viscus Perforation

Background: Peritonitis secondary to hollow viscus perforation is one of the most frequently encountered surgical emergencies in India. The objective of this study was to study the demographic and clinical profile of gastro intestinal perforations and surgical procedures done for the same in a tertiary care teaching hospital.Methods: This study was performed on 46 cases of hollow viscus perforation admitted in K. R. Hospital from January to June 2018. The presenting symptoms, age and sex profile, risk factors, site of perforation, the surgical procedure they underwent, post-operative complications were assessed and analyzed.Results: The most common age group affected was 21-30 years out of which 89.1 % were males. Gastric perforations were the most common type (56.5%) and jejunal perforations were the least common (6.5%). Abdominal pain was the main presenting symptom in all the cases. Fever was found to be a significant history in cases of ileal perforation (p=0.001) as was history of trauma in cases of jejunal perforation (p=0.001). Guarding, rigidity and air under the diaphragm were seen consistently in most cases. Graham’s patch repair was the most common surgical procedure performed. Ileostomy was the most common surgery done for ileal perforations. Wound infections were the most common post-operative complication observed and death occurred in 13% of cases mostly due to sepsis and cardio pulmonary complications.Conclusions: This study showed an increased incidence of perforation in younger age group which is alarming. The rise in the frequency of gastric perforations points towards an unhealthy lifestyle and dietary habits.

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A RETROGRADE STUDY OF MYIASIS IN A TERTIARY CARE CENTRE

10.36106/paripex/1504291 ◽

2020 ◽

pp. 3-5

Author(s):

Ayesha Goel ◽

Ritu Nigam

Keyword(s):

Oral Cavity ◽

Head And Neck ◽

Tertiary Care ◽

Personal Hygiene ◽

Intracranial Extension ◽

Atrophic Rhinitis ◽

Time Interval ◽

Age Group ◽

Predisposing Factor ◽

Female Ratio

Myiasis in head and neck region is a rare occurrence and is usually found in tropical countries like India. Poor hygiene, unsanitary living conditions, mental retardation, neglected wounds, diabetes mellitus and old age along with a warm and humid climate lay down a conducive environment for the larva of dipterous fly to infest humans. Maggots due to their tissue destructive properties can affect many regions in otolaryngorhinology like nasal cavity, ears, oral cavity, tracheostomy site ostoma, PNS, the skin and ulcerative lesions of head and neck. The burden of the disease lies in the fact that the complications range from minor tissue destruction, perforation of either the tympanic membrane, palate or septum, vertigo, angioedema to severe neurological manifestations, intracranial extension or rarely even death. Objective: To assess the commonly affected age group and gender infested by myiasis, it’s seasonal trend, socioeconomic status of the affected patients and the relationship of myiasis infestation with various predisposing factors. Methodology: Retrograde study was conducted on 95 patients of department of otorhinolaryngology. The study was done from January 2015 to October 2018 by collecting data of 3 years 10 months time interval and results tabulated. Ethical clearance was sort and patients consent obtained. Result: The most commonly affected age group was found to be elderly, in the 7th decade of life (56.84%). Females were more commonly affected than males consisting of 55 out of 95 cases (57.89%), with a male female ratio of 1:1.4. Majority of cases presented in the months of October-January, with a peak in November (32/95). Nasal myiasis was found to be more common (69 cases) in comparison to aural and oral cavity myiasis. The most common predisposing factor was found to be Atrophic Rhinitis in 66.7% cases. Conclusion : With awareness and improved personal hygiene a devastating disease like myiasis is easily preventable and curable.

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Cardiac Health Awareness Among Women Presenting for Routine Health Checkup at Tertiary Care Center: Time Trends Over 15 Years

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0039-1695652 ◽

2019 ◽

Vol 04 (02) ◽

pp. 079-084

Author(s):

Shibba Takkar Chhabra ◽

Gurleen Kaur ◽

Samir Kapoor ◽

Gagandeep Nagi ◽

Devanshi Kajal ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Treatment Modalities ◽

Age Group ◽

Tertiary Care Center ◽

Health Awareness ◽

Health Checkup ◽

Cardiac Health ◽

Presenting Symptoms ◽

The Past

Abstract Background Women have been thought to be protected against the perils of cardiovascular disease (CVD) till late in their lives. But the literature suggests quite the opposite with CVD being a major cause of death even in young women. In contrast, the lack of awareness among women is disheartening and needs to be addressed radically. Methods The study was designed and conducted as retrospective cohort at a tertiary care center. Data was collected from patients presenting for routine cardiac health checkup over the past 15 years. The parameters observed included age at presenting, symptoms and/or signs, plus area of residence or domicile. Results A total of 32,831 patients presented for routine cardiac health checkup, of which 9,211 (28.1%) patients were women and 23,620 (71.9%) were men. On 5 yearly cumulative assessment, the mean attendance of women was 28.1 ± 2.5% as compared with 71.9 ± 2.6% men. Trend observed over the past 15 years revealed little change in the number of women versus men presenting for cardiac health checkup annually. Statistical significance was seen at p < 0.01. Among the women presenting for the checkup, it was observed that most women were in the postmenopausal age group (42.8%), followed by perimenopausal age group (34.6%), and least in premenopausal age group (22.5%) during the timeline of the study. A similar trend was observed in the male attendance; the input of males being higher at all instances. Noteworthy were trends of urban women (69.6%) presenting for health checkup more often as compared with 30.4% visiting from rural residence. Conclusions Coronary artery disease (CAD) is not uncommon in female gender. It is accompanied by varying symptom presentation with high mortality. It is seen that cardiac health awareness is significantly lacking among women as compared with men. There are almost static trends observed over the past 15 years, especially in premenopausal age group and rural domicile. Corrective actions inclining toward campaigns and communication to distribute information on cardiac disease prevention and treatment modalities among women are needed to curb CAD. This may promote early detection of CAD leading to early interventions to promote a healthy heart among women. Recommendations and necessary actions steps for a woman oriented cardiac program are the need of the hour.

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Laryngeal Web in the Pediatric Population: Evaluation and Management

Otolaryngology ◽

10.1177/0194599819893985 ◽

2019 ◽

Vol 162 (2) ◽

pp. 234-240 ◽

Cited By ~ 1

Author(s):

Claire M. Lawlor ◽

Natasha D. Dombrowski ◽

Roger C. Nuss ◽

Reza Rahbar ◽

Sukgi S. Choi

Keyword(s):

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Case Series ◽

22Q11.2 Deletion Syndrome ◽

Deletion Syndrome ◽

Retrospective Case ◽

Presenting Symptoms ◽

Subglottic Extension ◽

Type 3

Objective To discuss the presentation, evaluation, and management of pediatric laryngeal web. Study Design Retrospective case series. Setting Single tertiary care center. Subjects All patients with laryngeal web at Boston Children’s Hospital in the past 22 years. Methods No exclusion criteria. Charts mined for age at presentation, presenting symptoms, degree/location of web, associated syndromes, number/type of surgical procedures, and postoperative outcomes. Results Thirty-seven patients were included (13 male, 24 female). Average age at diagnosis was 3.7 years (0-19.5 years). Mean follow-up was 4.4 years (range, 0-16.4 years). There were 26 congenital webs (70.2%) and 11 acquired webs (29.8%). Presenting symptoms were vocal (29 patients, 78.4%) and respiratory (22 patients, 60%). Underlying syndromes or synchronous airway lesions included the following: premature (n = 5), congenital heart disease (n = 18), subglottic stenosis (n = 5), 22q11.2 deletion syndrome (n = 10), and recurrent respiratory papillomatosis (n = 4). There were 20 type 1 webs, 6 type 2 webs, 8 type 3 webs, and 3 type 4 webs; 10 had subglottic extension of the laryngeal web. Twelve patients were managed conservatively with observation. Eighty-four interventions were performed: 18 open and 66 endoscopic (sharp division, 32; dilation, 33; mitomycin C, 14; laser, 5; keel, 6; triamcinolone injection, 8; stent, 15; removal of granulation tissue, 5). Tracheotomy was required in 11 patients, and 5 patients were decannulated. Voice improved in 12 patients, with respiratory symptoms in 12 patients. Web recurred in 17 patients. One patient died due to airway complications. Conclusions Pediatric laryngeal web is an uncommon but challenging lesion. Patients need to be evaluated for comorbid syndromes and synchronous airway lesions. Management includes open and endoscopic procedures. Procedures should be tailored to the child’s presentation.

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Soft tissue neoplasms: a clinicopathological study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204234 ◽

2020 ◽

Vol 8 (10) ◽

pp. 3591

Author(s):

Athulya Krishna Kumar K. T. ◽

Ariya S.

Keyword(s):

Soft Tissue ◽

Tertiary Care ◽

Common Type ◽

Soft Tissue Neoplasms ◽

Care Hospital ◽

Malignant Tumours ◽

Soft Tissue Tumours ◽

Female Ratio ◽

Presenting Symptoms ◽

Malignant Soft Tissue

Background: The current WHO classification has categorized soft tissue tumours into benign, malignant and so-called intermediate neoplasms. Soft tissue sarcoma comprises <1% of adult cancers. The aim of the study was to clinically correlate soft tissue neoplasms and study the histomorphological features of various malignant soft tissue tumors.Methods: This was a retrospective study conducted in a tertiary care hospital in Mangalore, India from January 2019 to June 2020. Clinical details of all cases of soft tissue neoplasms retrieved from the medical records of our institution. Data collected included age, gender, presenting symptoms, site and size of soft tissue neoplasms and clinical diagnosis. Pathological diagnosis of these tumours was made and details recorded.Results: A total of 113 cases of soft tissue neoplasms were collected. 94.4% benign and 18.6 %. malignant tumours were present. 77% cases presented with swelling whereas 23% presented with pain. Majority of benign soft tissue tumours were located in the trunk (36.9%) and the most common type was lipomas (66.38%). Malignant soft tissue tumours showed male to female ratio of 1.33:1. Most predilection was noted for the extremities (42.8%) and leiomyosarcomas were the most common type (38%).Conclusions: The incidence of malignant soft tissue tumours is rare. Majority of the cases were noted in the extremities. Leiomyosarcoma was the most common type, in our study. Lipomas were the most common benign soft tissue tumours, and majority of the benign tumours were located in the trunk.

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Clinical profile of tracheo-bronchial foreign body inhalation at tertiary care center

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203206 ◽

2020 ◽

Vol 6 (8) ◽

pp. 1520

Author(s):

Vivek Samor ◽

Vijay Kumar ◽

Deep Chand ◽

Gaurav Gupta ◽

Mamta . ◽

...

Keyword(s):

Foreign Body ◽

Early Recognition ◽

Main Bronchus ◽

Tertiary Care ◽

Clinical Profile ◽

Diagnostic Study ◽

Age Group ◽

X Ray ◽

Bronchial Foreign Body ◽

Chest X Ray

Background: Inhalation of foreign bodies can be life threatening and are common in paediatric age group with peak incidence in the age group of 1-3 years. The objectives were to study the clinical profile of foreign body (FB) inhalation and to study the complications of tracheo-bronchial foreign body and rigid bronchoscopy.Methods: A cross-sectional hospital based diagnostic study conducted for 1 year, done on 50 patients with FB inhalation, included consecutively in study after obtaining informed consent. Patients were assessed and interviewed for socio demographic details and examined using chest X-ray PA view, routine investigations and pre-anaesthetic evaluation. After all investigations a diagnostic bronchoscopy under general anaesthesia was performed to extract the foreign body. Data were analyzed through tables and diagrams and appropriate test of significance by Epi Info software. Results: Total 50 FB inhalation cases (up to 10 years) in which 40% presented within 5 days to 2 weeks after inhalation. 92% were presents with cough and on chest examination 88% found to had decreased air entry, 72% presents with decreased movement and dull percussion on affected side. 70% of patients had abnormal chest X-ray finding. Foreign body found were groundnut (44%) followed by supari (32%) mostly in right main bronchus. We observed 10% patients with pneumonia, 4% had granuloma and 2% had bronchospasm.Conclusions: Prevention is best, but early recognition remains a critical factor in the treatment of FB inhalation in children.

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Study of Trauma Profile and its Outcomes at a Tertiary Care Centre: A Cohort Study of 1000 Cases

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49103.15225 ◽

2021 ◽

Author(s):

Bhupinder Singh Walia ◽

Pankaj Dugg ◽

Kanwaldeep Singh Aulakh ◽

Sanjeev Sharma ◽

Venita Kapur

Keyword(s):

Cohort Study ◽

Mortality Rate ◽

Emergency Surgery ◽

Road Traffic ◽

Tertiary Care ◽

P Value ◽

Age Group ◽

Tertiary Care Centre ◽

Male Population ◽

Male Predominance

Introduction: Trauma has been the leading cause of mortality and morbidity. However, there are changes in pattern of trauma and their outcomes with time. Aim: To study the mode and nature of injury and mortality associated with trauma of head, chest and abdomen. Materials and Methods: A prospective cohort study was conducted on 1000 individuals that presented to emergency surgery ward from 2014 to 2019. Patients presented to emergency surgery of Government Medical College, Amritsar, Punjab, India were observed for various characteristics i.e., age group, mode of injury, site of injury, outcomes and management. Results: The mean age of patients was 33.91±16.29 years with significant male predominance (n=794, 79.4%) (p-value 0.00001). Road Traffic Injuries (RTIs) were the most common mode of trauma affecting 490 patients (49%). Head injury was the most common of all injuries (n=834). Overall mortality was 3.6% (n=36). Mortality was higher in males (p-value 0.00933) and mortality rate of 25% was seen in age group of 61-70 years. Conclusion: RTIs followed by assaults are the most common cause of trauma and it significantly affects young male population. However, mortality rate increases with increase in age group with higher rates in older age groups.

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Clinicoepidemiological Profile of Childhood Poisoning in the Pediatric Unit of a Tertiary Care Hospital in North India

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v29i630094 ◽

2019 ◽

pp. 1-8

Author(s):

Rahid Rasool Malla ◽

Khalid Kawoosa ◽

Meryem Juwhyreeyeh ◽

Riyaz Ahmed Malik ◽

Asif Ahmed ◽

...

Keyword(s):

Parental Education ◽

Pediatric Population ◽

Tertiary Care ◽

Age Groups ◽

Gastric Lavage ◽

North India ◽

Care Hospital ◽

Age Group ◽

College Hospital ◽

Childhood Poisoning

Background: This study was conducted to find out the pattern of poisoning cases among the pediatric population in Srinagar and its Northwestern suburbs and compare it with what occurs elsewhere in India. Thereby we aimed to provide practical knowledge in dealing with these pediatric patients. Methods: The hospital records of children between the ages of 0-19 years admitted to the pediatric emergency ward of SKIMS Medical College Hospital Srinagar with poisoning from July 2016 to June 2018 were evaluated. Results: A total of 154 cases of poisoning were admitted in the study period, of which 89(57%) were males and 69(43%) were females. In the 0-12 year age group the poisonings were mostly in boys (68.26%) and were accidental whereas in the 13-19 year age group poisonings were mostly in girls (64%) and due to suicidal attempts. Organophoshorus poisoning was the most commonly ingested poison across all age groups (44.8%) followed by rodenticides (16.23%), kerosene (13.63%) and medications (11.68%). Interventions mostly commonly done were gastric lavage, induced vomiting. Mortaliy was seen in 2 cases over 2 years (1.29%). Conclusion: Knowledge on epidemiological and clinical features of poisoning in children according to age groups, establishing safety standards for sale and storage of harmful chemicals, and parental education can help to decrease the burden of childhood poisoning.

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Epidemiology of fractures in indoor patients at a tertiary care centre in India: a study of 3000 cases

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214958 ◽

2021 ◽

Vol 8 (1) ◽

pp. 39

Author(s):

Mohan M. Desai ◽

Deven R. Kuruwa ◽

Easwar Elango ◽

Roshan Wade

Keyword(s):

Road Traffic ◽

Tertiary Care ◽

Age Groups ◽

Control Measures ◽

Age Group ◽

Care Centre ◽

Tertiary Care Centre ◽

Treatment Protocols ◽

Female Ratio ◽

Femur Fractures

Background: Implementing appropriate fracture control measures and treatment protocols is crucial to maximizing health and development gains. This requires an in depth understanding of age-specific, sex-specific and cause-specific injury patterns at the national and subnational levels. No such study on fracture epidemiology has been undertaken in the Indian population.Methods: Study was conducted in a tertiary care centre (KEM hospital, Mumbai) which is one of the highest volume trauma centres in the country. Data of 3000 patients was obtained from the medical records department for the year 2016-2019. Patients were segregated with respect to their genders and into three age groups. Etiology of fracture was noted, and fractures classified according to the anatomical area. Whether the patient received conservative or operative management was also recorded.Results: 43.83% of the fractures occurred in 18-50 years age group. 41.33% in the above 50 group and only 14.73% in the below 18 age group. Overall male to female ratio was 1.4: 1. Vehicular accident was the most common mode of injury (47.07%) followed by fall from height (21.03%). Proximal femur fractures were the most common accounting for 19.57% of all fractures followed by forearm (10.53%), tibia diaphysis (8.10%). Talus was the least common. 81.07% cases were managed operatively and 18.93% conserved.Conclusions: Our study highlights that Indian epidemiology is unique from our Western counterparts. Population affected is much younger, old age males are affected more than females. Lower limb fractures are more prevalent and road traffic accidents are responsible for almost half the fractures.

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