scholarly journals Clinical profile and outcome of pediatric surgical patients in a rural tertiary centre

2021 ◽  
Author(s):  
Sunil Pathak ◽  
R. V. Mhapsekar ◽  
Neeraj Gupta ◽  
Karthik Surabhi ◽  
Shruchi Bhargava ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Clinical Profile ◽  
Surgical Patients ◽  
Curative Therapy ◽  
Tertiary Centre ◽  
Number Of Patients ◽  
Important Means ◽  
Surgical Conditions ◽  
Time Of Admission ◽  
Surgical Condition

Background: Pediatric surgery is a sub-speciality involving the surgery of foetuses, infants, children and adolescents. Congenital malformations, trauma and childhood cancers are their three major concerns requiring the focus of their attention. Rural pediatric population in India still remains devoid of such facilities. Little is factually known about the burden of surgical disease globally. Surgical treatment is an essential component of basic medical care and an important means of providing preventive and curative therapy. Pediatrician has a significant role in caring for surgical patients. There is a need to know the spectrum of diseases that warrant admission into the pediatric surgical units. Current study was conducted to find out the clinical profile and immediate outcome of the various pediatric surgical conditions. Methods: This prospective observational study was conducted at Vadodara. All the patients 0-18 years, with surgical condition were enrolled in the study. Patients were followed from the time of admission to discharge.  All the clinical data from admission to discharge were recorded and analyzed.Results: Total 127 (3%) patients were enrolled in the study. Males were 93 (73.2%). One to 5 years 45 (35.4%) was the largest age group folowed by infants 23 (18.1%). Largest number of patients were from Gastro Intestinal Condition 52 (40.9%) and congenital causes forms 83 (65.35%) of admissions. Commonest congenital anomaly was inguinal hernia 23 (27.7%). Complications were recorded in 46 (36.22%) patients. The average duration of stay was 7.7 days. The 124 patients were discharged successfully.Conclusions: Surgical conditions are important part of pediatric and neonatal care. Management of congenital surgical condition is important to decrease infant and under five mortality and other comorbidities as well.

scholarly journals Effect of Neuromuscular Blockade on Intraoperative Respiratory Mechanics and Surgical Space Conditions during Robot-Assisted Radical Prostatectomy: A Prospective Randomized Controlled Trial

2021 ◽  
Vol 10 (21) ◽  
pp. 5090
Author(s):  
Chang-Hoon Koo ◽  
Insun Park ◽  
Sungmin Ahn ◽  
Sangchul Lee ◽  
Jung-Hee Ryu
Keyword(s):  
Radical Prostatectomy ◽  
Neuromuscular Blockade ◽  
Respiratory Mechanics ◽  
Controlled Trial ◽  
Peak Inspiratory Pressure ◽  
Robot Assisted ◽  
Co2 Insufflation ◽  
Number Of Patients ◽  
Surgical Conditions ◽  
Surgical Condition

The aim of this study was to investigate whether deep neuromuscular blockade (NMB) may affect intraoperative respiratory mechanics, surgical condition, and recovery profiles in patients undergoing robot-assisted radical prostatectomy (RARP). Patients were randomly assigned to the moderate or deep NMB groups. Pneumoperitoneum was maintained with carbon dioxide (CO2) insufflation at 15 mmHg during surgery. The primary outcome was peak inspiratory pressure (PIP) after CO2 insufflation. Mean airway pressure (Pmean) and dynamic lung compliance (Cdyn) were also recorded. The surgeon rated the surgical condition and surgical difficulty on a five-point scale (1 = extremely poor; 2 = poor; 3 = acceptable; 4 = good; 5 = optimal). Recovery profiles, such as pulmonary complications, pain scores, and recovery time, were recorded. We included 58 patients in this study. No significant differences were observed regarding intraoperative respiratory mechanics including PIP, Pmean and Cdyn, between the two groups. The number of patients with optimal surgical conditions was significantly higher in the deep than in the moderate NMB group (29 vs. 20, p = 0.014). We found no differences in recovery profiles. In conclusion, deep NMB had no significant effect on the intraoperative respiratory mechanics but resulted in optimal endoscopic surgical conditions during RARP compared with moderate NMB.

scholarly journals Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jean-Luc Fellahi ◽  
Emmanuel Futier ◽  
Camille Vaisse ◽  
Olivier Collange ◽  
Olivier Huet ◽  
...  
Keyword(s):  
High Risk ◽  
Fluid Therapy ◽  
Postoperative Morbidity ◽  
Large Body ◽  
Surgical Patients ◽  
Cardiac Output Monitoring ◽  
Routine Practice ◽  
Daily Routine ◽  
Hemodynamic Optimization ◽  
Number Of Patients

AbstractDespite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a “validity criteria checklist” before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients.

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

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.

Acute mastoiditis and intracranial complications in children

2021 ◽  
Vol 70 (4) ◽  
pp. 207-213
Author(s):  
Andrea Kaliariková ◽  
Klára Perceová ◽  
Jan Machač ◽  
Michal Jurajda ◽  
Milan Urík
Keyword(s):  
Streptococcus Pneumoniae ◽  
Patient Group ◽  
Clinical Manifestations ◽  
Aetiological Agent ◽  
Acute Mastoiditis ◽  
Average Value ◽  
Tertiary Centre ◽  
Number Of Patients ◽  
Intracranial Complications ◽  
Low Incidence

Objectives: Characterisation of clinical manifestations in children who had acute mastoiditis (AM) -related intracranial complications (ICCs) and to determine the incidence of ICCs in the study group. To define children with a higher risk of ICCs and gain new information on aetiological microbial agents of AM. Methods: A retrospective analysis of 137 paediatric patients with AM treated at a tertiary centre using standard dia­gnostic and therapeutic protocol between 2002 and 2019. Results: Altogether 137 patients with AM were hospitalised at our centre between 2002 and 2019. During this time, the occurrence of ICC in children with AM was low (n = 3, incidence 2.19%). Due to the low number of patients with ICC with AM in our patient group, we were unable to define a specific group of patients with a higher risk of ICC development in AM. Despite this fact, the average value and median of CRP were considerably higher in patients with AM-associated ICCs. The most frequent aetiological agent was Streptococcus pneumoniae. Conclusions: The low incidence of ICC in patients with AM in our patient group might be caused by routinely performed paracentesis in developed acute otitis, rational antibio­tic therapy and the good availability of an ENT specialist in the Czech Republic. The most common aetiological agent of AM was Streptococcus pneumoniae. Keywords: Streptococcus pneumoniae – acute mastoiditis – intracranial complications – aetiological agent – antibio­tic therapy – antromastoidectomy

Enterostomies for acute abdominal surgical condition in children: An experience in a developing country

2020 ◽  
pp. 1-4
Keyword(s):  
Damage Control ◽  
Intestinal Atresia ◽  
University Teaching ◽  
Salvage Procedure ◽  
State University ◽  
Female Ratio ◽  
Peritoneal Contamination ◽  
Surgical Conditions ◽  
Age Range ◽  
Surgical Condition

Background: Pediatric abdominal surgical condition that is complicated by gross peritoneal contamination may require enterostomy as a damage control or salvage procedure. Late presentations mostly seen in developing countries make creation of enterostomy a relatively common surgical procedure. The aim of this study was to evaluate the creation of enterostomy in children who presented with acute abdominal surgical conditions. Methods: This was a retrospective study of children that had enterostomy in the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu, Nigeria. Medical records of pediatric patients that had enterostomy over a 10-year period were assessed. Results: There were 32 cases of enterostomies performed during the study period. There were 25 males (78.1%) and 7 females (21.9%) with a male to female ratio of 3.6:1. The age range of the patients was 3 weeks to 180 months, with a median age of 96 months. There were 1 neonate (3.1%), 10 infants (31.3%) and 21 children (65.6%) older than 1 year. The primary diagnoses were typhoid intestinal perforation in 21 patients (65.6%), intussusception 10 (31.3%) and intestinal atresia 1 (3.1%). Ileostomy was performed in 31 patients (96.9%) and jejunostomy in 1 patient (3.1%). Enterostomy was created at the time of initial laparotomy (damage control) in 21 patients (65.6%) while 11 patients (34.4%) had their enterostomy as a salvage procedure at the time of re-exploration. Peristomal skin complication was the most common complication recorded in our patients. Mortality was 12.5%. Conclusion: Enterostomy is lifesaving in the management of acute abdominal surgical condition when there is gross peritoneal contamination in severely ill children. Proper surgical technique and electrolyte derangements are important considerations when enterostomies are created.

scholarly journals A Retrospective 05 Years Analysis of Operated Surgical Patients in Bangladesh Level II Hospital, UNMIL

2014 ◽  
Vol 9 (1) ◽  
pp. 14-18
Author(s):  
MB Uddin ◽  
MU Ahmed ◽  
MA Haque ◽  
MD Hussain ◽  
SME Hossain
Keyword(s):  
Surgical Care ◽  
Armed Forces ◽  
Published Data ◽  
Optimal Outcome ◽  
Level Ii ◽  
Number Of Patients ◽  
Minor Surgery ◽  
Surgical Conditions ◽  
Logistic Support ◽  
The Impact

Introduction: There is a paucity of published data on the type of surgical conditions that affect the UN personnel of different countries setup and the spectrum of surgical operations performed for these patients. Such information are necessary for assessing the impact of surgical conditions, both elective and emergency, on the health of UN peacekeepers from different races and nationalities and for setting priority to improve the surgical care. Objectives: To ascertain highest possible standard of surgical care to be ensured in an international arena for optimal outcome. Materials and methods: Five years retrospective study was carried out in Bangladesh level II hospital (BANMED), UNMIL located at Suakoko district of Liberia from April 2007 to April 2012 comprising of all major and minor surgical cases with different types of dressings done. Results: A total 83 major, 567 minor and 3924 dressings were done. The majority of operations were emergency cases of which 73.49% were of major and 78.30% were minor surgery. While 26.50% of major and 21.69% of minor surgery were elective cases. All were male patients in cases of major operations and 93.29% for minor cases as most of the peacekeepers were male personnel. The most frequent cases were acute appendicitis, inguinal hernia and polytrauma cases. Highest number of patients was 28 (33.73%) from 26-30 years age group. There were 3 minor postoperative complications with nil mortality rates. Conclusion: The surgical unit of a level-II hospital has to work in an adverse situation of a conflict area with various limitations. So it is very important to provide highest possible standard of surgical care to be ensured in terms of staff, equipments, logistic support and with a motivated surgical team in an international arena for optimal outcome. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18720 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 14-19

scholarly journals Seasonal variations in the occurrence of acute appendicitis and their relationship with the presence of fecaliths in children

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yao-Jen Hsu ◽  
Yu-Wei Fu ◽  
Taiwai Chin
Keyword(s):  
Acute Appendicitis ◽  
Medical Records ◽  
Laboratory Data ◽  
Lymphoid Hyperplasia ◽  
Clinical Findings ◽  
Number Of Patients ◽  
Computed Tomography Scans ◽  
Pathology Reports ◽  
Operative Notes ◽  
Surgical Condition

Abstract Background Acute appendicitis (AA) is the most common surgical condition in children. Although a higher incidence of AA in summer has been reported, the reason for this observation remains unclear. The purpose of this study was to compare the clinical findings of AA patients who underwent appendectomies during the summer months with those who underwent the procedure during the non-summer months. Methods The clinical data of 171 patients who underwent appendectomy from January 2013 to December 2016 were reviewed. The patients were divided into a summer group (from May to October) and a non-summer group (from November to April) based on the month when appendectomy was performed. All patients were under 18 years of age at the time of surgery. The medical records including laboratory data, computed tomography scans, pathology reports and operative notes were reviewed. Results The number of patients with AA was higher in the summer group than in the non-summer group (101 vs. 70 patients). No significant differences in the laboratory results between the two groups of patients were observed. The percentage of AA patients who presented with a fecalith was significantly lower in the summer group (33.6%) than in the non-summer group (55.7%). No significant differences in the incidence of appendiceal perforations and abscesses, as well as postoperative complications were observed between the two groups. Conclusions The percentage of AA patients with fecaliths in summer was lower than that in the non-summer months. The increase in the number of AA patients in summer may be due to the increased occurrence of lymphoid hyperplasia, which may be correlated with the yearly outbreak of enterovirus infection during this period.

scholarly journals Trends in Burn Injuries in Northern Israel During the COVID-19 Lockdown

2020 ◽  
Author(s):  
Dani Kruchevsky ◽  
Maher Arraf ◽  
Shir Levanon ◽  
Tal Capucha ◽  
Yitzchak Ramon ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Age Groups ◽  
Temporal Variations ◽  
Burn Injuries ◽  
Burn Patients ◽  
Outbreak Period ◽  
Number Of Patients ◽  
Study Results ◽  
Period Data ◽  
Spread Of Infection

Abstract Coronavirus disease 2019 obliged many countries to apply lockdown policies to contain the spread of infection. The restrictions in Israel included limitations on movement, reduction of working capacity, and closure of the educational system. The present study focused on patients treated at a referral center for burns in northern Israel. Their goal was to investigate temporal variations in burn injuries during this period. Data were retrospectively extracted from the medical records of burn patients treated at our hospital between March 14, 2020 and April 20, 2020 (ie, the period of aggravated lockdown). Data from this period were compared with that from paralleling periods between 2017 and 2019. During the lockdown and paralleling periods, 178 patients were treated for burn injuries, of whom 44% were under 18. Although no restrictions were enforced during the virus outbreak period with regard to seeking medical care, we noticed a decrease in the number of patients admitted to the emergency room for all reasons. Of particular interest was a 66% decrease in the number of adult burn patients (P &lt; .0001). Meanwhile, among the pediatric population, no significant decrease was observed. Nonetheless, subgroups with higher susceptibility to burn injuries included children aged 2 to 5 years (56.3% vs 23.8%, P = .016) and female patients from all pediatric age groups (57.1% vs 25%, P = .027). These findings may be explained by the presumably busier kitchen and dining areas during the lockdown. Overall, the study results can assist with building a stronger understanding of varying burn injuries and with developing educational and preventive strategies.

Pulmonary regurgitation after percutaneous balloon valvoplasty for isolated pulmonary valvar stenosis in childhood

2003 ◽  
Vol 13 (5) ◽  
pp. 444-450 ◽  
Author(s):  
Louisa K. H. Poon ◽  
Samuel Menahem
Keyword(s):  
Pulmonary Valve ◽  
Statistical Significance ◽  
Pulmonary Regurgitation ◽  
Systolic Pressure ◽  
Subsequent Development ◽  
Tertiary Centre ◽  
Percutaneous Balloon ◽  
Number Of Patients ◽  
Pulmonary Valvar Stenosis

Objectives: A retrospective study was undertaken to determine the degree of pulmonary regurgitation following percutaneous balloon valvoplasty for isolated pulmonary valvar stenosis. Background: Percutaneous balloon valvoplasty is the recognised treatment of choice in pulmonary valvar stenosis with effective relief of gradient. Few studies have reviewed the degree of pulmonary regurgitation after the balloon valvoplasty. Methods: We reviewed all patients with isolated pulmonary valvar stenosis undergoing percutaneous balloon valvoplasty at a tertiary centre between December 1984 and August 1996. Those with an associated haemodynamically insignificant atrial septal defect or patent oval foramen were also included. Their medical records, echocardiograms and angiograms were studied. Colour flow Doppler was used as a semi-quantitative way of assessing the pulmonary incompetence. Results: Over the period of review, 57 procedures had been performed in 49 patients. The median age at the time of the procedure was 1.08 years, with a range from 0.01 to 13.3 years. The median period of follow-up was 5.64 years, with a range from 3.00 to 14.26 years. Immediately following the dilation of the pulmonary valve, the peak-to-peak instantaneous systolic pressure gradient was significantly reduced. Seven patients required a second dilation of the valve. Their median age at the first valvoplasty, at 0.49 year, was significantly lower than those who required only one procedure, at a median of 1.50 years. Following the valvoplasty, mild pulmonary incompetence was noted in 26 out of 42 patients the day after the procedure, but only 7% had moderate incompetence. On follow-up, there was an increase in the number of patients with moderate to severe pulmonary incompetence, from 7% to 29%. Those patients in whom the procedure was performed at a younger age had more significant pulmonary incompetence. Neither the initial gradient across the pulmonary valve, nor the size of the balloon used, were related with statistical significance to the subsequent development of pulmonary incompetence. Conclusions: The majority of the patients with congenital isolated pulmonary valvar stenosis had only a mild increase in the degree of pulmonary incompetence following a single pulmonary valvoplasty. Patients who required the procedure early in life were more likely to develop significant pulmonary incompetence. The ratio of the size of the balloon to the diameter of the valve did not significantly affect the outcome. We suggest that those patients who had more severe stenosis because of a more abnormal pulmonary valve, and hence required early intervention, were more likely to develop greater pulmonary incompetence after the valvoplasty.

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