Durability and versatility of free lattismus dorsi muscle flap in leg defects in tertiary care hospital

Reconstruction of the legs and feet is challenging. Because of the composite tissue defects, inadequate and tight local tissues and poor circulation, soft tissue scarcity around the lower portion of the leg presents a significant challenge to the reconstructive surgeon. The aim of this study was to assess the outcome of free Lattismus dorsi (LD) muscle flap used for soft tissue reconstruction of leg defects. This prospective non-randomized study was conducted on 13 patients with leg defects of different causes attended emergency unit and outpatient clinic of plastic surgery department of plastic surgery and burn unit, Dhaka medical college hospital (DMCH) in the period between July 2017 and June 2018. Durability of coverage, flap success, infection and overall satisfaction were studied. The age distribution of the study population highest number of patients (46.15%) were in middle (31-40 years) age group whereas lowest are in older group (>51 years). Highest number of patients (84.61%) were standard myocutanous type of flap whereas lowest were in (15.31%) were chimeric flap and partial latissimus muscle flap. There were one case of total flap loss. Two patients had seroma formation among them one patient had partial necrosis. The outcome of reconstruction of n=13 patients 76.92% patients discharged with excellent recovery, (15.38%) patients discharged with good outcome, 1 (7.69%) patients had total flap loss. Flap is easy to dissect, anatomical variation is rare, long pedicle length which allow to anastomose with suitable recipient artery and finally donor morbidity is negligible.

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Fibroid uterus: Clinical presentation and surgical management in A Tertiary Care Hospital

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.01.4359 ◽

2021 ◽

Vol 28 (01) ◽

pp. 96-100

Author(s):

Saadia Bano ◽

Iram Aslam ◽

Tasneem Azhar ◽

Uzma Manzoor ◽

Uzma Shahzad ◽

...

Keyword(s):

Surgical Management ◽

Clinical Presentation ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Age Distribution ◽

Health Care Facilities ◽

Reproductive Age ◽

Care Hospital ◽

Fibroid Uterus ◽

Number Of Patients

This study was to evaluate the clinical presentation and management of fibroid uterus. Study Design: Retrospective Descriptive study. Setting: Independent University Hospital Faisalabad, which is a Tertiary Care Hospital providing health care facilities to poor socioeconomic group. Period: 1st May 2015 to 30th April 2017. Material & Methods: All patients with fibroid uterus who were admitted in gynae ward and operated. Patients having fibroid uterus with pregnancy and patients on medical management were excluded. Results: 56 patients of various ages included in study. The age distribution of patients was 20-70 years with a mean age of 45 years. Parity of patients range from 0-8, 58% were multiparous and 21% were nulliparous. The most common complaints of patients were menorrhagia 83% with anemia and dysmenorrheal 25%. Regarding management total abdominal hysterectomy was performed in 67% of patients preferably in with multiparity and myomectomy in 32% of total patients. Conclusion: Fibroid uterus is the most common benign tumor of reproductive age influencing fertility outcomes and general health of females. This study reinforces the fact that large number of patients requires surgical management because of its varied clinical presentations and often with failure of medical treatment.

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First and second wave of COVID-19: A comparative study of tertiary care hospitalized patients in Jalgaon, Maharashtra

MedPulse International Journal of Medicine ◽

10.26611/10111931 ◽

2021 ◽

Vol 19 (3) ◽

pp. 23-29

Author(s):

Yogita G Bavaskar ◽

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Clinical History ◽

Care Hospital ◽

Age Group ◽

Number Of Patients ◽

The Mean ◽

Collection Form ◽

Time Of Admission ◽

Second Wave

Background: Most of the countries including India have witnessed two or more waves of Covid 19 pandemic. The present study was conducted to compare the differences in clinico-demographic characteristics and outcomes of Covid 19 patients admitted in first and second wave of Covid 19 pandemic in a tertiary care hospital at Jalgaon, Maharashtra. Methods: A retrospective observational study was conducted at a tertiary care Dedicated Covid hospital for Covid 19 at Jalgaon, Maharashtra. All microbiologically proven corona positive patients were included in the study. The demographic records and clinical history was extracted from the case history sheets of the patients from first as well as second wave using standardized data collection form. Clinical outcome of the patients, i.e., development of complications, death or discharge was also recorded for each enrolled subject. Results: 3845 patients of Covid-19 admitted in the hospital during the first wave of epidemic and 2956 patients during second wave of the epidemic were included in the study. The mean age of patients admitted in the second wave was significantly lower as compared to first [48.77(15.31) years vs 50.23 (14.33) years, P<0.005]. There is increase in proportion of patients in the age group of < 15 years in second wave as compared to first wave (74/2956, 2.5% vs 52/3845, 1.3%). The number of patients requiring admission in ICU at the time of admission increased by 13% in second wave as compared to first wave. [827/2956 (28%) vs 577/3845(15%), P<0.0001]. More than half of the patients who got admitted for Covid 19 in first as well as second wave were having one or more comorbidities.But the proportion of the patients with previous co-morbities was significantly higher in second wave (1684/2956, 57% vs 1960/ 3845, 51%, P= 0.0004). The mortality was also higher in second wave (533/2956, 18.03% vs 541/3845, 14%, P=0.0004). Conclusions: The demographic, clinical characteristics and outcome of Covid 19 patients was different in first and second wave of pandemic with involvement of younger patients, increased rates of admission to ICU and more mortality in the second wave as compared to first wave of the pandemic.

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Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽

10.1161/circ.142.suppl_3.14747 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jamshed Ali ◽

Osman Faheem ◽

Pirbhat Shams ◽

ghufran adnan ◽

Maria Khan

Keyword(s):

Care Center ◽

Tertiary Care ◽

Electronic Record ◽

Medical Attention ◽

Care Hospital ◽

Record System ◽

Admission Rates ◽

Cardiovascular Morbidity And Mortality ◽

Number Of Patients ◽

The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

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ASSESSMENT OF LIVER FIBROSIS IN ALCOHOLIC PATIENTS BY USING FIBROSCAN IN A TERTIARY CARE HOSPITAL

10.36106/ijar/2004149 ◽

2021 ◽

pp. 43-47

Author(s):

Veenit Kumar Prasad ◽

Bapilal Bala ◽

Biswadev Basumazumder ◽

Achintya Narayan Ray

Keyword(s):

Liver Disease ◽

Alcoholic Liver Disease ◽

Transient Elastography ◽

Wide Spectrum ◽

Tertiary Care ◽

Disease Patient ◽

Liver Stiffness ◽

Care Hospital ◽

Non Invasive ◽

Number Of Patients

INTRODUCTION: Alcoholic liver disease is one of the major causes of premature deaths worldwide. Alcohol induced liver injury is the most prevalent cause of liver disease and effects 10% to 20% of population worldwide. Alcoholic liver disease comprises a wide spectrum of pathological changes ranging from steatosis, alcoholicsteato-hepatitis, Cirrhosis and nally hepatocellular carcinoma. Our aims in this study are to detect this change by non invasive method by liver broscan and its clinical implications. MATERIALS AND METHODS: Total 200 patients were taken for observational study, conducted at Coochbehar Government Medical college and hospital both outpatient department and indoor patients from May 2019 to January 2020. Liver stiffness was assessed by ultrasound based method of transient elastography using Fibroscan machine. Gradation of liver stiffness was expressed in kilopascals (KPa). RESULTS: Maximum number of patients of alcoholic liver disease were between 40 - 49 years of age (42.5%). Male patients is 87.5% and female patients 12.5%. distribution of Rural population is 36 % and Urban population is 64%. Majority of population85 patients (42.5%) had fatty liver and 40 patients (20%) have hepatomegaly, 41 patients (20.5%) had Coarse echotexture of liver parenchyma and 54 patients (27%) had Splenomegaly, 62 patients (31%) had Nodular liver and 62 patients. It is observed that 11 patients (5.5%) had Fibroscan score ≤7.5 and 47 patients (23.5%) had broscan score 7.6 -9.9 and 40 patients (20%) had broscan score 10-12.4, 36 patients (18 %) had broscan score 12.5 – 14.6 and 66 patients (33%) have broscan score ≥ 14.7. CONCLUSIONS: Transient Elastography (TE) is a newer non invasive assessment technique to detect the progression of brosis or brosis in alcoholic liver disease patient. Major advantage is it is noninvasive (costeffective) so that we can early detect progression of this cirrhosis and can give efforts to halt the disease progression.

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Cognitive and Functional Outcomes of Early Versus Delayed Cranioplasty after Decompressive Craniectomy

Indian Journal of Neurotrauma ◽

10.1055/s-0038-1671681 ◽

2018 ◽

Vol 15 (01) ◽

pp. 029-035

Author(s):

Arun Kumar ◽

Biswaranjan Nayak ◽

Krishnamurthy B. H ◽

Sushant Patro ◽

Abhijeet C. R ◽

...

Keyword(s):

Decompressive Craniectomy ◽

Functional Outcomes ◽

Tertiary Care ◽

Age Distribution ◽

Total Sample ◽

Individual Case ◽

Care Hospital ◽

Early Cranioplasty ◽

State Examination

Abstract Introduction Delay in doing cranioplasty (CP) after decompressive craniectomy (DC) may cause motor, cognitive, and language deficits. Studies show doing CP before developing such symptoms helps in improving the outcome. CP improves cerebrospinal fluid (CSF) dynamics and cerebral blood flow, which may lead to better cognitive and functional outcome. Objective The aim of the study was to assess cognitive and functional outcomes of early versus delayed cranioplasty (DCP) after DC. Methodology This was a prospective observational study on 42 patients aged over 16 years and up to 70 years, who had undergone CP after DC for severe traumatic brain injury in in-patient and outpatient department of neurosurgery at a tertiary care hospital in Bhubaneswar, Odisha, India from the period of March 01, 2016 to December 31, 2017. Cognitive and functional outcomes were compared in early and DCP groups in preoperative and follow-up period at 1 month, 3 months, and 6 months. Early cranioplasty (ECP) was within 2 months, and DCP was beyond 2 months. Results Total sample size under this study was 42; 21 in ECP and 21 in DCP group. Mean age was 41.40 ± 15.95 years. The age distribution was quite young with 38.1% in 30 to 49 age group and had very high proportion of males (85.7%). This analysis revealed that both the ECP and DCP groups have resulted in significant improvement in mini-mental state examination (MMSE) and Glasgow Outcome Scale Extended (GOSE) score after CP. But in the ECP group, there has been steady and significant improvement in MMSE and GOSE score at different follow-ups starting from postoperative 1 month in MMSE score and from 3 months up to 6 months in GOSE score. Conclusion Neurosurgeon should evaluate and carefully monitor each individual case and take up CP as early as possible with suitable indication.

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The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan: 2011-2016

Otolaryngology ◽

10.1177/0194599817725713 ◽

2017 ◽

Vol 157 (4) ◽

pp. 602-607 ◽

Cited By ~ 7

Author(s):

Alexander Lanigan ◽

Brentley Lindsey ◽

Stephen Maturo ◽

Joseph Brennan ◽

Adrienne Laury

Keyword(s):

Soft Tissue ◽

Tertiary Care ◽

Case Series ◽

Soft Tissue Injuries ◽

Published Data ◽

Care Hospital ◽

Neck Injuries ◽

Facial Fractures ◽

Tympanic Membrane Perforations ◽

Tissue Injuries

Objective Define the number and type of facial and penetrating neck injuries sustained in combat operations in Iraq and Afghanistan from 2011 to 2016. Compare recent injury trends to prior years of modern conflict. Study Design Case series with chart review. Setting Tertiary care hospital. Methods The Joint Theater Trauma Registry (JTTR) was queried for facial and neck injuries from Iraq and Afghanistan from June 2011 to May 2016. Injury patterns, severity, and patient demographics were analyzed and compared to previously published data from combat operations during January 2003 to May 2011. Results A total of 5312 discrete facial and neck injuries among 922 service members were identified. There were 3842 soft tissue injuries (72.3%) of the head/neck and 1469 (27.7%) facial fractures. Soft tissue injuries of the face/cheek (31.4%) and neck/larynx/trachea (18.8%) were most common. The most common facial fractures were of the orbit (26.3%) and maxilla/zygoma (25.1%). Injuries per month were highest in 2011 to 2012 and steadily declined through 2016. The percentage of nonbattle injuries trended up over time, ranging from 14.7% to 65%. Concurrent facial/neck soft tissue trauma or fracture was associated with an overall mortality rate of 2.44%. Comparison of our data to that previously published revealed no statistical difference in concurrent mortality (3.5%-2.2%, P = .053); an increase in orbital fractures ( P < .005), facial nerve injury ( P < .0005), and ear/tympanic membrane perforations ( P < .0005); and a decrease in mandible fractures ( P < .005). Conclusion Penetrating neck and facial injuries remain common in modern warfare. Assessing injury characteristics and trends supports continued improvements in battlefield protection and identifies areas requiring further intervention.

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Commonest modes of presentation of bone and soft tissue tumors at sarcoma services of A Tertiary Care Hospital of KPK.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.12.4478 ◽

2020 ◽

Vol 27 (12) ◽

pp. 2744-2748

Author(s):

Muhammad Ibrahim ◽

Zeeshan Khan ◽

Muhammad Saeed ◽

Israr Ahmad ◽

Salik Kashif ◽

...

Keyword(s):

Health Care Professionals ◽

Tertiary Care ◽

Sampling Technique ◽

Signs And Symptoms ◽

Soft Tissue Tumors ◽

Care Hospital ◽

Duration Of Symptoms ◽

Mode Of Presentation ◽

Number Of Patients ◽

Delays In Diagnosis

Objectives: The aim of this study is to assess the commonest mode of presentation at our sarcoma unit and the duration from onset of symptoms till presentation. Study Design: Retrospectively study. Setting: Sarcoma Unit of Hayatabad Medical Complex, Peshawar. Period: June 2016 to December 2019. Material & Methods: Two hundred and eighty two patients were included in this study of which 172 patients were male and 110 were female. Sample size was calculated through non-probability consecutive sampling technique. Results: Average age of patients presenting to us was 30.2years (±18.5) ranging from 3years to 83years. Highest numbers of patients fell into the age group category of 11-20years i.e. 94 (33.33%). The average duration of symptoms among our patients was 19.6 months (±26.09) ranging from 0.1months (3 days) to 168 months (14years). Highest number of patients fell into the 7months-12months category i.e. 86 patients (30.5%). The commonest mode of presentation among our patients was painful lump i.e. 128(45.3%) while patients presenting with painless lump were 57(20.2%) and those presenting with only pain were 28(9.9%). Conclusion: The study concluded that there is a need of greater awareness amount general population and health care professionals regarding red flag signs and symptoms in order to avoid the delays in diagnosis which may leads to poor prognosis.

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Aerobic bacteriological profile and antimicrobial susceptibility pattern of pus isolates from tertiary care hospital in India

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10473 ◽

2018 ◽

Vol 12 (10) ◽

pp. 842-848

Author(s):

Sukanya Sudhaharan ◽

Padmaja Kanne ◽

Padmasri Chavali ◽

Lakshmi Vemu

Keyword(s):

Antimicrobial Susceptibility ◽

Antibiotic Susceptibility ◽

Tertiary Care ◽

Care Hospital ◽

Tissue Samples ◽

Gram Negative ◽

Antimicrobial Susceptibility Pattern ◽

Bacteriological Profile ◽

Number Of Patients ◽

Antibiotic Susceptibility Patterns

Introduction: Pyogenic infections are an important cause of sepsis. These infections are difficult to treat because of the pathogens with increasing antibiotic resistance. It is important to know the pathogens causing the infections and its antibiotic susceptibility for proper management of the patients. Methodology: A retrospective analysis of 1428 culture positive pus and tissue samples received in the department of microbiology from various departments in the hospital between January 2012 to 2017 was performed. Data regarding the pathogen isolated and its antimicrobial susceptibility were collected and analyzed. The specimens were primarily processed, as per standard methods. Identification and susceptibility testing was done using the Vitek-2C system. Results: Among the samples males outnumbered females (M: F-2.5:1) and the median age was 47 years. The total number of patients were 1428 with total number of isolates being 1525 as in our study monomicrobial infections were seen in 93.2% (1331/1428) patients whereas combined infections with growth of two pathogens in 6.8% (97/1428). Gram-negative bacilli were isolated in 68.3% (1042/1525). Among the Gram-negative bacilli Escherichia coli was the major pathogen isolated (38.6%, 403/1042). Gram positive organisms were isolated in 31.6% (483/1525) of cases and Staphylococcus aureus was the predominant organism isolated (91.7%, 443/483). Rare pathogens like Burkholderia pseudomallei in 3 patients and Nocardia in one patient were also isolated. Conclusion: This study emphasizes to understand the common organisms isolated from wound infections and it helps in empirical treatment of patients based on antibiotic susceptibility patterns.

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Management Strategy of Patients Attending at Epilepsy Clinic in a Tertiary Care Hospital of Bangladesh

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i1.48005 ◽

2020 ◽

Vol 6 (1) ◽

pp. 3-8

Author(s):

Mohammad Sayeed Hassan ◽

Md Shafikul Islam Khan ◽

Paritosh Kumar Sarkar ◽

Anwar Israil ◽

Ferdous Ara ◽

...

Keyword(s):

Partial Seizure ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Partial Epilepsy ◽

Absence Seizure ◽

Care Hospital ◽

Cross Sectional ◽

Tonic Seizure ◽

Number Of Patients ◽

Generalized Epilepsy

Background: Epilepsy is a neuronal disorder that is observed globally but still it is not explored very well in most parts of the world. Objective: The aim of our study was to determine the types of epilepsies along with their treatment strategies among patients attending the outdoor epilepsy clinic in a referral tertiary care hospital. Methodology: This cross sectional study was carried out from the records of weekly epilepsy clinic of Department of Neurology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from January 2018 to August 2019. Data were collected through a predesigned questionnaire containing information about demography, clinical features, EEG and imaging findings and treatment of patients. Results: A total number of 1832 patients were recruited. There was a male (55.3%) and urban (61.1%) predominance. Most (75.1%) of the patients were young (age range from 10 to 29 years). A large number of patients were student (44.4%) and 24.2% were unemployed. The duration of epilepsy in most patients were less than 5 years (40.7%). 58.3% patients took various forms of indigenous treatment prior to attending this clinic. 54.7% patients had no comorbid illness. EEG was abnormal in 34.5% patients of which 24.4% had focal abnormality and 10.1% had generalized epileptic discharge. In brain imaging (CT/MRI) only 16.4% showed abnormal findings. 49.5% patients were suffering from generalized epilepsy whereas 44.6% had partial epilepsy. Among the generalized epilepsy group, most of them had generalized tonic clonic seizure (GTCS) (75.4%), while 8.9% had absence seizure and 7.9% had tonic seizure. In partial epilepsy group, the majority were secondary generalized seizure (74.7%), followed by complex partial seizure (CPS) (18.7%) and simple partial seizure (6.6%).42.7% patients got single antiepileptic drug whereas 37.4% patients received dual drug. Polytherapy (three or more drugs) were prescribed in 14% patients. Valproic acid was the highest prescribed drug (29.3%) either as monotherapy or in combination. Carbamazepine (27.4%) was the second common drug followed by Levetiracetam (15.1%). Conclusion: Epilepsy affects almost all groups of the society. Most of the patients remain seizure-free with judicious anti-epileptic drugs. Therefore, more effort is needed for early accurate diagnosis and appropriate treatment of epilepsy Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 3-8

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Cerebral Venous Thrombosis Case Series at a Tertiary Care Hospital: Exploring Treatment Safety and Efficacy of Direct Oral Anticoagulants

Blood ◽

10.1182/blood-2019-128406 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3658-3658

Author(s):

Mohammed Abdullah Alsheef ◽

Mukhtar Alomar ◽

Abdul Rehman Z. Zaidi ◽

Ghaydaa Juma Kullab ◽

Mohammed AlHazzaa ◽

...

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Tertiary Care ◽

Case Series ◽

Case Report Form ◽

Care Hospital ◽

Safety And Efficacy ◽

Number Of Patients

Background: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults and children. Initial treatment with heparin followed by wafarin is the mainstay of treatment. Only insufficient experience is available for direct oral anticoagulants (DOACs). Aims: The study aims to demonstrate the efficacy and safety of DOACs such as (Rivaroxaban and Dabigatran) in patients with objectively confirmed CVT. Methods: Data of 46 cases of CVT collected using a standardized case report form. Inclusion criteria were patients diagnosed with CVT, confirmed by CT or MRI imaging. Results: The total number of patients was 46 (9 males and 37 females). The mean age of the patients was 35.2± 5 years. The most common clinical manifestations among our patients were headache followed by seizure. 52% of cases were unprovoked, while 48% were provoked by pregnancy and oral contraceptive pills. Superior sagittal sinus (55%) and transverse sinus (44.9%) were the most common sites. Involvement of more than three venous sinuses was 34.8%. Thrombophilic abnormality was detected in 21.7% of patients. Initiation of anticoagulation (AC) was mostly low molecular weight heparin (LMWH) (80%), followed by unfractionated heparin (UFH) (17.7%) and fondaparinex (2%). Maintenance AC with Rivaroxaban after heparin (LMWH/UFH) was in 63% of our patients, the rest were switched from Warfarin to Rivaroxaban (34.8%), and one was treated by Dabigatran (2%). CVT recurrence was observed in one patient. Major bleeding (according to ISTH criteria) was not reported in our case series. Conclusions: DOACs demonstrated good safety and efficacy profile and can potentially replace warfarin in CVT patients. Disclosures No relevant conflicts of interest to declare.

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