scholarly journals Management of extra hepatic biliary obstruction, in a rural tertiary care hospital India

2021 ◽  
Vol 8 (9) ◽  
pp. 2711
Author(s):  
Divyanshu Joshi ◽  
Y. P. Monga ◽  
Shashank Mishra ◽  
Rani Bansal ◽  
Sachin Agrawal
Keyword(s):  
Biliary Obstruction ◽  
Tertiary Care Hospital ◽  
Open Cholecystectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Exploratory Laparotomy ◽  
Rural Setting ◽  
Care Hospital ◽  
Tube Drainage ◽  
T Tube

Background: Extra hepatic biliary obstruction (EHBO) is not a rare surgical problem; our experience in managing 36 patients over a period of two years at a tertiary care hospital in a rural setting in India. The objective was to study the etiology and clinical presentation of patients with EHBO, role of various investigative modalities and management strategies in these patients and their outcome.Methods: This was a prospective study conducted between September 2018 to August 2020 in the department of surgery in tertiary care center Subharti medical college (SMC) Meerut. Data was taken in a pre-formed performa and the results were tabulated and analyzed (descriptive analysis).Results: Out of 36 patients, 2 (5.5%) patients underwent choledochoduodenostomy, 1 (2.7%) exploratory laparotomy with CBD exploration with t tube drainage, 1 (2.7%) ERCP with pigtail drainage; 17(47.2%) ERCP (endoscopic retrograde cholangiopancreatography) followed by cholecystectomy, 1 (2.7%) open cholecystectomy with t tube drainage, 4 (11.1%) ERCP alone, 2 (5.5%) hepaticojejunostomy, 1 (2.7%) ERCP followed by diverticulectomy, 2 (5.5%) PTBD (percutaneous transhepatic biliary drainage) followed by a triple bypass surgery, 2 (5.5%) PTBD, 1 (2.7%) pylorus preserving pancreaticoduodenectomy, 1 (2.7%) ERCP with sphincterotomy, 1 (2.7%) PTBD followed by whipples procedure. Patients were followed up and 5 (13.8%) patients had recurrence of the disease.Conclusions: EHBO is a hepatobiliary surgical condition caused by both neoplastic and non-neoplastic etiology. Benign pathologies common in younger patients whereas neoplastic conditions in older age. Ultrasonography is the most common investigative modality followed by ERCP with PTBD/ENBD playing an important role in decompression of biliary obstruction as a palliative measure in advanced malignancies.

scholarly journals Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study

2020 ◽  
Vol 27 (4) ◽  
pp. E202043
Author(s):  
Aamir Hussain Hela ◽  
Haseeb Mohammad Khandwaw ◽  
Rahul Kumar ◽  
Mir Adnan Samad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Bile Duct ◽  
Surgical Site Infection ◽  
Tertiary Care Hospital ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Care Hospital ◽  
Site Infection ◽  
The Mean

Introduction: Laparoscopic cholecystectomy is the most commonly performed surgical procedure of digestive tract. It has replaced open cholecystectomy as gold standard treatment for cholelithiasis and inflammation of gallbladder.  It is estimated that approximately 90% of cholecystectomies in the  United States are performed using a laparoscopic approach.  The aim of this study was to evaluate the outcome of Laparoscopic cholecystectomy in context to its complications, morbidity and mortality in a tertiary care hospital.  Methods: This retrospective study was conducted on 1200 patients, who underwent laparoscopic cholecystectomies, during the period from January 2019 to December 2019, at Government Medical College Jammu J & K, India and necessary data was collected and reviewed. Results: In our study, a total of 1200 patients were studied including 216 males (18%) and 984 females (82%). The mean age of the patients was 43.35±8.61. The mean operative time in our study was 55.5±10.60 minutes with range of 45 – 90 minutes. Conversion rate was 2.6%. 2 patients were re-explored. Bile duct injury was found in 6 patients (0.5%).  Conclusions: Gallstone disease is a global health problem. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first choice of treatment for gallstones. Gall stone diseases is most frequently encountered in female population. The risk factors for conversion to open cholecystectomy include male gender, previous abdominal surgery, acute cholecystitis, dense adhesions and fibrosis in Calot’ s triangle, anatomical variations, advanced age, comorbidity, obesity, suspicion of common bile duct stones, jaundice, and decreased surgeon experience. The incidence of surgical site infection has significantly decreased in laparoscopic cholecystectomy compared to open cholecystectomy. In our study we could not find any case of surgical site infection.

scholarly journals Psychiatric Illnesses among the Patients Admitted for Self-poisoning in a Tertiary Care Hospital of Nepal

2013 ◽  
Vol 2 (1) ◽  
pp. 10-13 ◽  
Author(s):  
Ajay Risal ◽  
Pushpa Prasad Sharma ◽  
Rajkumar Karki
Keyword(s):  
Tertiary Care Hospital ◽  
Organophosphorus Compounds ◽  
Care Center ◽  
Tertiary Care ◽  
Psychiatric Evaluation ◽  
Care Hospital ◽  
Age Group ◽  
Psychiatric Illnesses ◽  
History Of ◽  
One Year

Background and Aims- Self-poisoning is the commonest mode of suicide in our part of the world. Patients attempting suicide by self-poisoning usually land up in the Emergency. They are admitted for management of medical complications and subsequently referred to Psychiatry for evaluation of possible Psychiatric illnesses. The aim of this study was to explore the patterns of psychiatric illnesses in the patients admitted for self-poisoning in a tertiary care center in Nepal. Methods- The study population included those patients who were admitted and being managed for self-poisoning and brought for psychiatric evaluation during the period of one year (1st June 2011- 30th June 2012) at Dhulikhel Hospital, Nepal. Each patient underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Details including sociodemographic data, psychiatric diagnosis, and treatment offered and outcome was tabulated and analyzed using SPSS-16. Results- Among the total patients (N=100), 43 were in the age group 21-40 years, median age being 27.5. There was almost equal gender distribution. Majority was of Mongolian ethnicity, homemaker by occupation and married. More than 90% were single-attempters, suicidal attempt using organophosphorus compounds. Almost 50% had depression; family dispute (19%) and marital disharmony (17%) were the most common psychosocial precipitant. Conclusion- Patients with history of self-poisoning are commonly brought to the Emergency Department of any tertiary care hospital. It is widely prevalent on younger age group. It is usually by the use of Organophosphorus compound in our setting and most commonly associated with depression. Hence, psychiatric care is essential for these patients. Journal of Advances in Internal Medicine 2013;02(01):10-13 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7630

Vancomycin Control Measures at a Tertiary-Care Hospital: Impact of Interventions on Volume and Patterns of use

1998 ◽  
Vol 19 (4) ◽  
pp. 248-253 ◽  
Author(s):  
Mary V. Singer ◽  
Rachel Haft ◽  
Tamar Barlam ◽  
Mark Aronson ◽  
Amy Shafer ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Information Systems ◽  
Control Measures ◽  
Prescribing Patterns ◽  
Care Hospital ◽  
Patterns Of Use ◽  
Before And After ◽  
Aggressive Interventions

ABSTRACTOBJECTIVE: Evaluate vancomycin prescribing patterns in a tertiary-care hospital before and after interventions to decrease vancomycin utilization.DESIGN: Before/after analysis of interventions to limit vancomycin use.SETTING: 420-bed academic tertiary-care center.INTERVENTIONS: Educational efforts began August 10, 1994, and involved lectures to medical house staff followed by mailings to all physicians and posting of guidelines for vancomycin use on hospital information systems. Active interventions began November 15, 1994, and included automatic stop orders for vancomycin at 72 hours, alerts attached to the medical record, and, for 2 weeks only, computer alerts to physicians following each vancomycin order. Parenteral vancomycin use was estimated from the hospital pharmacy database of all medication orders. Records of a random sample of 344 patients receiving van-comycin between May 1, 1994, and April 30, 1995, were reviewed for an indication meeting published guidelines.RESULTS: Vancomycin prescribing decreased by 22% following interventions, from 8.5 to 6.8 courses per 100 discharges (P<.05). The estimated proportion of van-comycin ordered for an indication meeting published guidelines was 36.6% overall, with no significant change following interventions. However, during the 2 weeks that computer alerts were in place, 60% of vancomycin use was for an approved indication.CONCLUSIONS: Parenteral vancomycin prescribing decreased significantly following interventions, but the majority of orders still were not for an indication meeting published guidelines. Further improvement in the appropriateness of vancomycin prescribing potentially could be accomplished by more aggressive interventions, such as computer alerts, or by targeting specific aspects of prescribing patterns.

scholarly journals Clinical Features, Outcomes, and Risk Factors of Bloodstream Infections due to Stenotrophomonas maltophilia in a Tertiary-Care Hospital of China: A Retrospective Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Yibing Chen ◽  
Jijiang Suo ◽  
Mingmei Du ◽  
Liangan Chen ◽  
Yunxi Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Drug Resistance ◽  
Clinical Features ◽  
Stenotrophomonas Maltophilia ◽  
Pathogenic Bacteria ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
T Tube

Background. Stenotrophomonas maltophilia bacteremia (SMB) is the most perilous situation as compared to other types of S. maltophilia infection. The present study aimed to investigate the clinical features, distribution, drug resistance, and predictors of survival of SMB in a tertiary-care hospital of China. Methods. SMB that occurred in a tertiary-care hospital in Beijing, China, within 9 years (2010–2018) was investigated in a retrospective study. Demographics, incidence, commodities, drug resistance, mortality, as well as antibiotics administration were summarized according to the electronic medical records. The risk factors for survival were analyzed by Chi-square test, Kaplan–Meier curve and Cox regression. Results. A total of 76 episodes of SMB were analyzed. The overall incidence of SMB fluctuated from 3.4 to 15.4 episodes per 1000 admissions over 9 years. Malignancy was the most common comorbidity. High in vitro sensitivity was observed to minocycline (96.1%), levofloxacin (81.6%), and trimethoprim-sulfamethoxazole (89.5%). Central venous catheter (CVC) (p=0.004), mechanical ventilation (MV) (p=0.006), hemodialysis (p=0.024), and septic shock (p=0.016) were significantly different between survival and death group. The 30-day mortality was 34.2% within 30 days after confirmation of blood culture. Factors such as hemodialysis (OR 0.287, 95% CI: 0.084–0.977, p=0.046), T-tube (OR 0.160, 95% CI: 0.029–0.881, p=0.035), and septic shock (OR 0.234, 95% CI: 0.076–0.719, p=0.011) were associated with survival. Conclusions. S. maltophilia is the major nosocomial blood stream infectious pathogenic bacteria. Trimethoprim-sulfamethoxazole and minocycline are optimal antibiotics for the treatment of SMB. T-tube, hemodialysis, and septic shock were the risk factors associated with survival of SMB patients.

scholarly journals Clinico-etiological profile of childhood stroke in a Tertiary Care Hospital in Eastern India

2015 ◽  
Vol 06 (04) ◽  
pp. 515-519 ◽  
Author(s):  
Chaitali Patra ◽  
Shatanik Sarkar ◽  
Debasree Guha ◽  
Malay K. Dasgupta
Keyword(s):  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Geographical Location ◽  
Care Hospital ◽  
Childhood Stroke ◽  
Intracranial Infection ◽  
Radio Imaging ◽  
Common Etiology ◽  
Neurological Insult

ABSTRACT Background: The clinical pattern and etiology of stroke may vary over time or with geographical location. In Asian countries, specific etiology and outcome of childhood stroke have been rarely reported. Objective: To determine the clinical and etiological pattern of childhood stroke and their outcome in a Tertiary Care Center. Materials and Methods: This study was conducted in a Tertiary Care Hospital of Kolkata over a period of 3 years. All children from 6 months to 12 years, diagnosed as childhood stroke by radio-imaging were included in our study. Children presenting with paraplegia/paraparesis were excluded. Etiologies were determined on the basis of clinical examination, related blood investigations and radio-imaging findings. Data gathered from the stroke patients were entered into a preformed proforma and appropriate statistical analyses were done. Result: Most commonly found clinical presentation was hemiparesis (70.6%). Next in place was a seizure (61.8%) and alteration of consciousness (58.8%). The most common etiology of childhood stroke in our hospital was found to be an intracranial infection (41.2%), followed by vascular etiology. Stroke was ischemic in nature in 91.2% of cases. Among the clinical features, vomiting, alteration of sensorium, and fever were significantly (P < 0.01) more in infectious cases of stroke, but hemiparesis was significantly (P < 0.05) more common in noninfectious etiology. Most of the cases of noninfectious etiology (95%) completely recovered without any persistent neurodeficit or mortality. Conclusion: Intracranial infection is the commonest etiology of stroke in pediatric patients presenting at our hospital. Commonest type is an ischemic stroke. The most of the patients completely recovered from the acute neurological insult after proper and timely management.

scholarly journals Study of referral pattern for psychiatric evaluation in psychiatric OPD in a rural tertiary care hospital

KYAMC Journal ◽  
2013 ◽  
Vol 2 (1) ◽  
pp. 128-131
Author(s):  
Muhammad Abdul Kayum Shaikh ◽  
Md Zulfikar Ali ◽  
Md Saiful Islam ◽  
AKM Mokhlesuzzaman
Keyword(s):  
Somatoform Disorders ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Well Being ◽  
Rural Setting ◽  
Psychiatric Evaluation ◽  
Care Hospital ◽  
Major Depressive ◽  
Outpatient Departments ◽  
Level Hospital

Health includes both physical and psychological well being of an individual. There is strong chance that every physical illness has psychological component and in many cases psychological disorders present with somatic symptoms; so psychiatric referral is very important to the proper management of a patient. The aim of this study was to find out the pattern of referral from different outpatient departments in a tertiary level hospital in rural setting of Bangladesh. In this descriptive study total 237 patients were evaluated in 7 months period and most of the diagnoses were anxiety disorders (40%), major depressive disorder (35%) and somatoform disorders (17%). Departments of medicine (cardiology 34%, internal medicine 28% and neurology 26%) referred most of the patients than the surgical or gynecological departments.DOI: http://dx.doi.org/10.3329/kyamcj.v2i1.13517 KYAMC Journal Vol.2(1) 2011 pp.128-131

Sign in / Sign up

Export Citation Format

Share Document