scholarly journals Laparoscopy superseding open appendectomy: a prospective view

2020 ◽  
Vol 7 (11) ◽  
pp. 3724
Author(s):  
Amol Deshpande ◽  
Shardul Khade
Keyword(s):  
Laparoscopic Appendectomy ◽  
Iliac Fossa ◽  
Tertiary Care ◽  
Open Appendectomy ◽  
Central India ◽  
Laparoscopic Group ◽  
P Value ◽  
Common Symptom ◽  
Care Hospital ◽  
Open Approach

Background: Appendicitis is the most common surgical disease with appendectomy being the traditional treatment of choice. Different operative procedures exist for appendectomy. The objectives of the study were to compare the efficiency of laparoscopic versus open appendectomy and to compare post-operative complications between laparoscopic and open appendectomy.Methods: This is a longitudinal study done from January 2018 till January 2020 in a tertiary care hospital of central India. A total of 400 operative patients were randomly selected and analysed with acute appendicitis (AA) as diagnosis. Sample size was randomized into two groups. Data was analysed with of open Epi version 2.3 and p value <0.05 was considered significant.Results: Most common symptom was pain in right iliac fossa (94.63%). 18.18% had perforation while 26.38% had inflamed appendix. Histopathological assessment showed that 8.3% and 2.87% had suppurative and gangrenous appendicitis respectively. 23.82% of the open cases reported with surgical site infection (SSI). No SSI were reported in the laparoscopic group. Post-op duration for open and laparoscopic appendectomy was 4.91±0.86 and 2.98±0.76 (p value=0.04150) and was found to be statistically significant.Conclusions: Open appendectomy is considered safe and effective but associated with complications such as ileus, intestinal obstruction, and wound sepsis. Laparoscopic appendectomy with high accuracy and low complication rate has emerged as the modus operandi and has superseded the open approach for treatment of AA.

scholarly journals Comparison between laparoscopic and open appendectomy in pregnant women

2017 ◽  
Vol 4 (5) ◽  
pp. 1623
Author(s):  
Subba Rao Dova ◽  
Sankara Rao Pagoti ◽  
Manoj Kumar Mannem
Keyword(s):  
Acute Appendicitis ◽  
Pregnant Women ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Fetal Loss ◽  
P Value ◽  
Open Approach ◽  
Open Procedure ◽  
Gestational Age At Delivery ◽  
Group 2

Background: Acute appendicitis is the most common indication for surgical emergency in normal patients and also in pregnant women. The objective of this study was to study the clinical significance of a laparoscopic over an open approach to appendicectomy pregnant population.Methods: Total 46 cases patients with acute appendicitis confirmed the diagnosis by clinical examination and ultrasonography. The patients were divided into two groups laparoscopic appendectomy (group 1) n=21 and Open appendectomy (group 2) n=25. We retrospectively analyzed the medical records to compare the 2 groups.Results: All the demographic details are not significant when compared with each other. Laparoscopic appendectomy is significantly i.e. <p-value <0.05 less time for operation, length of stay in hospital and complication when compared with open procedure. Time to first flatus, leucocyte and neutrophil ratio are not significantly when compared laparoscopic appendectomy and open appendectomy. Preterm delivery, birth weight, APGAR score, gestational age at delivery, delivery type, fetal loss and maternal death were not significant when compared laparoscopic appendectomy and open appendectomy.Conclusions: Laparoscopic procedure is safe and effective technique for the treatment of appendicitis during pregnancy with nearly similar rates of complications compared to open procedure. Laparoscopic appendectomy associated with shorter hospital stay, faster return to daily activities and shorter time to first flatus.

scholarly journals Epidemiological charactristics of acute hepatitis in tertiary care hospital.

2021 ◽  
Vol 28 (7) ◽  
pp. 1039-1043
Author(s):  
Hafiz Mughees Ather ◽  
◽  
Arfan Mahmood ◽  
Affan Shahid ◽  
Mohammed Osama ◽  
...  
Keyword(s):  
Acute Hepatitis ◽  
Tertiary Care ◽  
Stable Condition ◽  
Water Source ◽  
Categorical Variables ◽  
P Value ◽  
Common Symptom ◽  
Care Hospital ◽  
Cross Sectional ◽  
Epidemiological Characteristics

Objective: To record the epidemiological, characteristics of Acute hepatitis patients. Study Design. Cross Sectional study. Setting: Government General Hospital Ghulam Muhammad Abad, Faisalabad. Period: March 2019 to 30th of September 2019. Material & Methods: A total of 92 patients included in the study. Patient’s epidemiological characteristics, symptoms and lab results were recorded during hospital stay. Categorical variables were analyzed using Chi-Square and Fissure Exact tests. P value of <0.05 was considered statistically significant. Results: 78% were male & 22% were female. Water source was 16% filtered water, 32% ground water & 52% was Government supplied water. Most common symptom was yellow sclera (100%), Dark urine (100%), Nausea, fatigue and anorexia (Each 87%), Vomiting (83%), Fever (73%), Right hypochondriac pain (70%), Body aches (66%) and headache was 61%. Among the risk factors other than water source, outside eating was present in 74% and tattooing was present in 5% while blood transfusion history and Ear/Nose piercing was 0%. All 92 patients discharged in stable condition (100%). Tests for determination of cause i.e HAV & HEV serology were ordered in each case. Conclusion: Young males were affected more commonly. Presentation of acute hepatitis varies in symptoms but mostly the disease is self-limiting and running a mild course without leading to liver failure. Most common risk factor was outside eating in unhygienic environment which should be avoided.

scholarly journals Clinico-demographic profile of deceased patients with coronavirus disease in a tertiary care centre of central India

2021 ◽  
Vol 8 (5) ◽  
pp. 2474
Author(s):  
Rupali A. Patle ◽  
Ashok R. Jadhao ◽  
Priya B. Dhengre ◽  
Manjusha A. Dhoble
Keyword(s):  
Clinical Characteristics ◽  
Tertiary Care ◽  
Case Fatality ◽  
Central India ◽  
Cross Sectional Study ◽  
Common Symptom ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
The Difference

Background: The covid pandemic started from Hubei, Wuhan in December 2020 then covered many other countries including India. Understanding the demographic and clinical characteristics of deceased COVID-19 patients could inform public health interventions focusing on preventing mortality due to COVID-19. The present study was done with the objective of studying the socio-demographic and clinical profile of deceased patients with coronavirus disease.Methods: This is a hospital based cross-sectional study on 1190 deceased patients of coronavirus disease in a tertiary care hospital of central India which is a dedicated covid hospital from 11 March 2020 to 28 February 2021. Socio-demographic and clinical characteristics of deceased patients were recorded.Results: Overall case fatality rate was 13.24%. Maximum number of deaths occurred in the month of August 2020 and September 2020 were 372 (31.26%) and 477 (40.08%). It was higher in the males 791 (66.47%) as compared to females 399 (33.53%), but the difference was not significant. The most common symptom was fever on hospitalization 924 (77.65%), followed by generalized weakness 771 (64.79%). 352 (29.58%) patients died within 24 hours of the admission to hospital. Hypertension and type 2 diabetes mellitus were the most prevalent morbidity in 557 (46.80%) and 357 (30.00%). It was found that 232 (19.50%) deceased patients had oxygen saturation less than 50% on admission.Conclusions: Higher age and presence of co-morbidities at the time of admission were significantly associated with mortality.

scholarly journals Knowledge, attitude and practices of pharmacovigilance among the postgraduate and undergraduate medical students in a tertiary care hospital in Central India

2017 ◽  
Vol 6 (5) ◽  
pp. 1127
Author(s):  
Mohit Kulmi ◽  
Pooja Reddy ◽  
Shilpi Dhakre ◽  
Meghna Shinde ◽  
Chhaya Goyal
Keyword(s):  
Current Knowledge ◽  
Tertiary Care ◽  
Central India ◽  
P Value ◽  
Care Hospital ◽  
Undergraduate Medical Students ◽  
Adr Reporting ◽  
The Mean ◽  
Positive Effect ◽  
One Way Anova

Background: Adverse Drug Reactions (ADRs) are one of the underestimated causes of morbidity and mortality. Monitoring of these ADRs is at the core of any pharmacovigilance program. ADR monitoring suffers from lack of reporting from health care personnels. Unless we know the current knowledge, attitude and practices of the budding doctors it’s difficult to design corrective measures to improve reporting. The present study was designed to assess the knowledge, attitude and practices of pharmacovigilance and ADR reporting among undergraduate and postgraduate medical students.Methods: This was a questionnaire-based, observational study. The questionnaire had six questions each pertaining to knowledge, attitude and practices of pharmacovigilance and ADR reporting. Factors discouraging ADR reporting were also studied. Descriptive statistics were carried out and one-way ANOVA was applied to find the statistical difference between the groups.Results: A total of 288 subjects were approached for the study of which 229 agreed to participate. It was observed that the knowledge of the participants regarding ADR reporting and pharmacovigilance was satisfactory. 68% of respondents felt that educational programmes have a positive effect on ADR reporting. 15% of respondents admitted of having reported an ADR. The mean scores of knowledge, attitude and practices of ADR reporting were considerably higher in postgraduates as compared to undergraduates (p-value <0.05).Conclusions: The study concluded that participants of study were aware of the importance of ADR reporting but it did not reflect in their practices. There is a need to create awareness and to educate these future physicians about Pharmacovigilance.

scholarly journals Clinicopathological Analysis of Whipple’s Pancreaticoduodenectomy Specimens in a Tertiary Care Hospital with Special Emphasis on Grossing

2021 ◽  
Author(s):  
Ashima Nagesh Amin ◽  
Christol Blanch Moras ◽  
T Umashankar
Keyword(s):  
Lymph Node ◽  
Perineural Invasion ◽  
Tertiary Care ◽  
Clinicopathological Parameters ◽  
Lymph Node Status ◽  
P Value ◽  
Common Symptom ◽  
Care Hospital ◽  
Whipple’S Procedure ◽  
The Mean

Introduction: Pancreaticoduodenectomy (PD) is done for a myriad of tumours as well as inflammatory condition affecting the duodenum, common bile duct, ampulla of vater and the head of pancreas. The diagnostic accuracy of the histopathology report is largely determined by the preliminary meticulous gross examination of the specimen. Aim: To comprehensively analyse the clinicopathological parameters of Whipple’s specimen and thus evaluate the trends in indication of Whipple’s procedure in Southern India .Materials and Methods: This was an observational time bound descriptive study done in the Department of Pathology, Father Muller Medical College Hospital, Mangalore, Karnataka from May 2014 to April 2019 wherein histopathological and clinical data of all the patients who underwent Whipple’s procedure were retrieved and analysed. The gross specimens were retrieved from the museum and records were assessed for the type of grossing method employed. The H&E slides were reassessed for the tumour type, grade, margins, perineural and angioinvasion, lymph node status and staging. Immunohistochemical marker (CD 117) and cytochemical like Mucicarmine and Alcian blue were employed wherever required. Descriptive analysis of the data involved calculating percentage, mean, median and range. The p-value was calculated using Fischer-Exact test with statistical significance level at <0.05. Results: Total of 45 patients underwent Whipple’s procedure, of which 28 (62.2%) were males and 17 (37.8%) were females with a ratio of 1.6:1. The most common symptom was jaundice (33 cases-73.3%) followed by pain abdomen (7 cases-15.6%). The mean age was 56.2 years. The mean tumour size was 2.8 cm. Malignancy was seen in (43 cases- 95.6%). The others being, inflammatory lesions (2 cases-2.2%). The most common site of localisation of tumours was periampullary (16 cases-37.2%) followed by pancreatic head (15 cases-34.9%).The most common histological subtype was adenocarcinoma (40 cases-93%). There were two cases of grade 2 neuroendocrine tumours (2 cases-4.7%) and one case (2.3%) of malignant Gastrointestinal Stromal Tumour (GIST). Lymph node positivity was most commonly seen in pancreatic cancers (7 cases-46.7%) with a significant p-value of 0.001. Lymphovascular invasion were seen in 16 cases (37.2%) and perineural invasion in 23 cases (53.5%). The most common tumour stage was T2 (16 cases-37.2%) followed by T3 (12 cases-27.9%). Margins were free in most of the malignant tumours (37 cases-86.04%). Conclusion: Thorough gross inspection of the Whipple’s specimen along with sound knowledge of the anatomy of the region is of utmost importance. The present analysis showed that periampullary adenocarcinoma was the most common subtype, many of the cases being diagnosed at an advanced stage, emphasising on early diagnosis through clinicoradiological modalities and guided biopsies. A meticulous and careful evaluation of the Whipple’s specimen is a pre-requisite for accurate histopathological differentiation of tumours originating in this anatomical region. Subtyping the tumor,reporting margin clearance, lymphovascular and perineural invasion, also has prognostic implications. Whipple’s PD may rarely be done for non-neoplastic conditions like chronic pancreatitis.

scholarly journals APPENDICECTOMY;

2012 ◽  
Vol 19 (01) ◽  
pp. 001-005
Author(s):  
JAHANGIR SARWAR KHAN ◽  
UMAR FAROOQ ◽  
HAMID HASSAN
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Open Appendectomy ◽  
Length Of Hospital Stay ◽  
Laparoscopic Group ◽  
P Value ◽  
Pain Scores ◽  
Post Operative Pain

Objective: The objective of this study was to compare length of hospital stay, pain scores and the rate of wound infectionsbetween laparoscopic and open appendectomy. Design: Randomized Controlled trial. Place and Duration of study: This study wasconducted in surgical unit I Holy Family hospital, Rawalpindi from 1st June 2009 to 31st May 2010. Patients and methods: The patients weredivided into open and laparoscopy groups and their age, sex, time of discharge, pain scores and wound infection rates were compared andanalyzed. Results: Total of 160 patients were included in the study, 80 in each group. There were 58% male and 42% female patients. Mean agewas 22.78 years (±6.2).Post operative pain scores were significantly less in the laparoscopic group (p<0.05). The length of hospital stay in opengroup was 35.10 hrs (±5.4) hours and in the laparoscopic group was 38.70(4.8) hrs with a p value of 0.592.Wound infection was 0.037% in openand 0.025% in the laparoscopic group. Conclusions: Laparoscopic appendectomy is superior in terms of less morbidity and shorter postoperative hospital stay in the setting of an overworked tertiary care surgical floor of a Pakistani hospital.

Clinical Profile Of Hepatocellular Carcinoma-Experience At A Tertiary Care Hospital

2021 ◽  
Vol 10 (02) ◽  
pp. 106-110
Author(s):  
Rafi ud din ◽  
Fauzia Anjum ◽  
Abdul Latif Khattak ◽  
Rao Saad Ali Khan ◽  
Khawar Shabbir ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Abdominal Pain ◽  
Performance Status ◽  
Tertiary Care ◽  
Military Hospital ◽  
Vascular Involvement ◽  
P Value ◽  
Common Symptom ◽  
Care Hospital ◽  
Co Morbidity

Objective: To determine the characteristics of Hepatocellular carcinoma (HCC) in patients visiting PEMH Rawalpindi. Study Design and Setting: Cross-sectional Study conducted at Department of Gastroenterology/hepatology in Pak Emirates Military Hospital Rawalpindi (PEMH) from Oct 2015 to Jan 2018. Methodology: In this study total 100 patients, with HCC of both genders were included. All the cases were discussed in multidisciplinary team (MDT) meetings which were held once every week. A decision on the best possible management for the given case was arrived at in the MDT meeting. All the relevant features of each case were recorded in the Performa. Descriptive statistics were used to calculate mean, standard deviation and frequencies for gender, various presenting features, co-morbidities and clinical features. Data was analyzed on SPSS version 21. P value <0.05 was considered as statistically significant. Results: Sixty seven men and 33 women with HCC were included in this study with a mean age of 58.23 years. The abdominal pain was the most common symptom present in 66 (66%) patients. Edema was seen in 30 (30%) and palpable splenomegaly in 26(26%). Diabetes mellitus was the most common co-morbidity found in 20(20%) patients. HCV was the commonest cause of HCC present in 79(79%) patients. Vascular involvement was seen in 15 (15%) patients. Most (62%) patients had a single HCC lesion and most belonged to Child –Pugh class A (68%) and BCLC stage B (42%). ECOG performance status was good in most patients with 49% patients scoring 0. The AFP levels were raised in 58 (58%) of the patients. Conclusion: HCV was the most common underlying etiology. Most of the patients were asymptomatic at the time of diagnosis. Majority of subjects reported with the complaint of abdominal pain and had no underlying co morbidity. The metastasis was negative in majority of cases

scholarly journals The management of appendicular abscesses in a Tunisian Tertiary Care Hospital

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Atef Mejri ◽  
Khaoula Arfaoui ◽  
Mohamed Ali Mseddi ◽  
Mohamed Ben Slima ◽  
Sarra Saad ◽  
...  
Keyword(s):  
Iliac Fossa ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Case Series ◽  
Laparoscopic Approach ◽  
Ileocecal Resection ◽  
Common Symptom ◽  
Care Hospital ◽  
Palpable Mass ◽  
The Right

Abstract Background This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management. Methods This descriptive retrospective study was carried out over 3 years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi2 test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05. Results The mean age was 40.51 years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients, open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection. The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6 months (4–24 weeks) and was uneventful. Conclusion Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively.

Sero-Prevalence of Parvovirus B 19 Infection Among HIV Positive Patients Attending Tertiary Care Hospital in Central India

2017 ◽  
Vol 01 (04) ◽  
pp. 127-132
Author(s):  
Bhushan Shrikhande ◽  
Meena Mishra ◽  
Mohiuddin Qazi ◽  
Arvind Kurhade ◽  
Chandrashekhar Unakal ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Central India ◽  
Hiv Positive ◽  
Care Hospital ◽  
Parvovirus B 19

Causes of Epilepsy in Elderly Patients Presenting in a Tertiary Care Hospital of Karachi

2020 ◽  
Keyword(s):  
Elderly Patients ◽  
Cerebrovascular Disease ◽  
Neurodegenerative Disorder ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Traumatic Head Injury ◽  
Keywords Epilepsy ◽  
College Hospital ◽  
Cross Sectional

Background: Epilepsy is fairly a frequent occurrence in the elderly. It is commonly diagnosed after the episode of two or more unprovoked seizures. Unprovoked seizures in elderly are recurrent rather than younger individuals. This study was designed to estimate the concrete burden of frequent causes of epilepsy. Methods: A descriptive cross-sectional study with a total of 153 patients diagnosed case of epilepsy were included in this study at Jinnah Medical College Hospital from February 2018-August 2018. Mean was calculated for age, duration of disease of the patients. Causes of epilepsy, gender, and education was calculated and presented as percentages. Electrolyte readings were taken i.e., Sodium, Calcium and Magnesium levels and imaging was planned to rule out stroke, primary neurodegenerative disorders and tumors. Post stratification Chi square test was applied and p-value less than or equal to 0.05 was considered significant. Results: The mean age of the patients was 63.91±5.68 years and mean duration of the disease was 4.61± 1.07 months. The common causes of epilepsy were found to be cerebrovascular disease 56.9%, cryptogenic 54.2%, neurodegenerative disorder 20.3%, traumatic head injury 11.8%, metabolic abnormalities or electrolyte disturbances 10.5% and brain tumor 7.8%. Conclusion: Elderly patients with first seizure should present to a facility designed in a way that neurologist, cardiologist, rehabilitation and geriatrics work together to identify and treat the condition in a better way. Keywords: Epilepsy; Seizures; Cerebrovascular Disease; Neurodegenerative Disorder.

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