scholarly journals Burden of isolated clavicle fractures at tertiary care healthcare centre: a look into registry

2020 ◽  
Vol 6 (3) ◽  
pp. 542
Author(s):  
Sruti Sharma ◽  
Vishal Kumar ◽  
Raman Sharma ◽  
Sameer Aggarwal
Keyword(s):  
Open Reduction ◽  
Clavicle Fracture ◽  
Tertiary Care ◽  
Trauma Centre ◽  
North India ◽  
Tertiary Level ◽  
Elderly Age ◽  
Number Of Patients ◽  
Clavicle Fractures ◽  
The Common

<p class="abstract"><strong>Background:</strong> Clavicle is one of the common bones to undergo fractures with incidence rate higher in second to third decade of one’s life as well as in elderly age. Management of these clavicle fractures have always been a subject of debate, where literature have been advocating both non-operative as well as operative methods.</p><p class="abstract"><strong>Methods:</strong> The present study was conceived to know the burden of these isolated clavicle fracture cases reporting to tertiary level healthcare institute of North India and to study about their management pattern.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the five years study duration (2014-2018), a total of 38 patients had reported to the trauma centre of the institute. Out of total, males had more preponderance 77% (29) and incidences were reported more in younger population. All patients were managed well by opting conservative measures, besides deformity had been reported in 2 (5.26%) patients. 3 (7.9%) patients had reported with complaints of pain, weakness while doing work, fatigue and pain when lying on the affected shoulder None of the patient was managed by open reduction and fixation.</p><p class="abstract"><strong>Conclusions:</strong> The present study concludes that the number of patients having isolated clavicle fracture are not contributing to any sort of burden at tertiary level institutes and are not even time consuming.</p>

scholarly journals Study of procalcitonin in neonatal sepsis with blood culture in suspected sepsis in North India

2021 ◽  
Vol 8 (7) ◽  
pp. 1241
Author(s):  
Munna Lal Jaipal ◽  
Ajit Kumar Shrivastava ◽  
Prema Ram Choudhary
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Tertiary Care ◽  
Clinical Signs ◽  
North India ◽  
Care Hospital ◽  
Negative Blood Culture ◽  
Suspected Sepsis ◽  
Cross Sectional ◽  
Number Of Patients

Background: Sepsis can occasionally be difficult to demonstrate, and its difference from non-infectious conditions in critically ill patients is often a challenge. Serum procalcitonin (PCT) assay is one of the biomarkers of sepsis. The aim of the study was to investigate the value of procalcitonin, in the early diagnosis of neonatal sepsis.Methods: A cross-sectional study was conducted at tertiary care hospital in New Delhi. It included all neonates with clinical signs of sepsis. The neonates were divided into two groups as sepsis, and healthy neonates. The PCT level was measured by using ELISA technique and compared between the two groups. Statistical analysis was performed using SPSS windows version 20.0 software.Results: In this study total number of patients included 350, out of which 175 were clinically suspected sepsis cases and 175 were healthy controls. 68 (39%) neonates were show positive blood culture and 107 (61%) neonates were representing negative blood culture report in study group. The mean serum value of PCT was significantly (p<0.001) higher in sepsis neonates. The serum PCT value was significantly increased in neonate’s sepsis with positive blood culture (p<0.001) and negative blood culture (p<0.001) as compared to healthy neonates.Conclusions: It is concluded from this study that the PCT assay was established to be a valuable biomarker of sepsis in this study. The assay might be performed and reported quickly and gave precious information before availability of culture results. This might assist in avoiding unnecessary antibiotic therapy.

scholarly journals Pattern of admissions, clinical course and short term outcome of patients admitted to an obstetric ICU of a tertiary care hospital of north India: a retrospective study

2018 ◽  
Vol 7 (5) ◽  
pp. 1749
Author(s):  
Waseeqa Nigeen ◽  
Saima Salam ◽  
Samina Ashraf ◽  
Abdus Sami Bhat
Keyword(s):  
Mortality Rate ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Spectrum Management ◽  
North India ◽  
Care Hospital ◽  
Care Giving ◽  
Obstetric Haemorrhage ◽  
Number Of Patients ◽  
The World

Background: Obstetric ICUs have become an important part of any tertiary care obstetric hospital. There have been studies in different parts of the world including India to determine the clinical spectrum, management and outcome of the patients admitted to these units. There have been a few studies on the subject from our part of the country, so we tried to carry out the said study. Our objective was to study indications of admissions, the pattern of complications, interventions required, and the maternal and fetal /neonatal outcome of the patients admitted in an obstetric ICU of our hospital.Methods: A retrospective descriptive study carried out at Lalla Ded hospital Srinagar, a tertiary care hospital of north India, between January 2017 and June 2017.Results: Fifty patients among 4890 obstetric admissions required ICU care giving an admission rate of 1.02%. Most of the patients fell in the age group of 26-30years (52%) followed by 31-35 years (24%).The most frequent indication for admission to ICU was pregnancy induced hypertension related eclampsia and preeclampsia which constituted about 44% (n=22) of the admissions. Obstetric haemorrhage was a close second and accounted for 34% (n=17) of the admissions. Mean ICU stay was 2.5±1 days. Four patients died giving a maternal mortality rate of 8% in this ICU. There were eleven fetal and neonatal deaths excluding ectopic pregnancy giving a fetal /neonatal mortality rate of 22%.Conclusions: Obstetric ICUs have become an important part of any tertiary care obstetric hospital. Significant number of patients get admitted and treated in these ICUs. In our part of the world majority of ICU admissions are because of eclampsia/preeclampsia and obstetric haemorrhage. Although a large number of mothers and their neonates get benefitted by way of admission to ICUs, a significant proportion of these mothers and their neonates die. There is a lot of scope of improvement in maternal and perinatal mortality. In addition to the importance of setting up of state of the art obstetric ICUs, the need for supervision of pregnancies, institutional deliveries, early detection of complications and early referral cannot be overemphasized. 

scholarly journals Two-year Functional Outcomes Of Operative Vs. Non-operative Treatment Of Completely Displaced Midshaft Clavicle Fractures In Adolescents: Results From A Prospective, Multicenter, Level 2 Study

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0042
Author(s):  
Benton E. Heyworth ◽  
Andrew T. Pennock ◽  
G. Ying Li ◽  
Leslie Kalish ◽  
Brittany Dragonetti ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Functional Outcomes ◽  
Clavicle Fracture ◽  
Tertiary Care ◽  
High Volume ◽  
Treatment Decisions ◽  
Fracture Pattern ◽  
Complication Rates ◽  
Patient Reported ◽  
Clavicle Fractures

Objectives: To investigate the two-year functional outcomes and complications following operative versus non-operative treatment of completely displaced midshaft clavicle fractures in adolescents. Methods: All patients 10-18 years-old treated for a midshaft clavicle fracture between August, 2013 and August, 2018 at one of 8 geographically diverse, high-volume, tertiary-care pediatric centers were enrolled, with independent treatment decisions determined by individual providers. The sub-population of patients with completely displaced fractures was prospectively followed for over 2 years. Clinical course, complications, validated patient-reported outcome measures (PROs), quality of life metrics, and satisfaction scores were analyzed. To address the ceiling effect of the PRO/satisfaction data following clavicle injuries, a priori thresholds for ‘suboptimal’ scores were established (ASES scores <90, QuickDASH scores >10, EQ-5D <0.80). According to ‘intention to treat’ statistical principles, one post-operative complication (and a subsequent secondary operation) was analyzed within the non-operative cohort, given that the patient represented a ‘crossover’ from the non-operative to the operative treatment group. Results: Of the 909 patients enrolled in the prospective study, 417 patients (45.9%) demonstrated completely displaced fractures and maintained enrollment over the study period, 277 (66%) of whom had reached two year follow up, and 151 of whom provided adequate PRO data, representing a 55% response rate. Of these patients, 55 (36%) underwent operative treatment, while 96 (64%) were treated non-operatively. Those treated surgically showed no difference in gender distribution (76% males,p=0.43), athletic participation (p=0.76), or fracture pattern (p=0.18), but were older (mean age 15.3 vs. 13.5 years, p<0.001) and had greater shortening (p<0.001) than those treated non-operatively. Within the subset with adequate complication data, listed in Figure 1, complications were less common in non-surgical than surgical patients (p=0.0003), but this difference did not reach significance when sensory deficits were excluded (p=0.17). There was no difference in secondary surgeries (p=0.43). While greater percentages of operative than non-operative patients reported suboptimal PRO/satisfaction scores (ASES: 15% vs. 5%, QuickDASH 11% vs 5%, satisfaction 11% vs. 5%), these differences did not reach significance (p=0.07, 0.20, 0.06, respectively). Conclusion: At eight large pediatric centers with many surgeons making independent treatment decisions, non-operative treatment of adolescent clavicle fractures demonstrated lower complication rates and similar satisfaction and functional outcomes.These data establish a comprehensive functional assessment of adolescents treated for clavicle fractures, which represents the epidemiological sub-population most affected by this condition. Unlike several adult studies demonstrating superiority in operative treatment, this adolescent study demonstrates equivalent function and fewer complications associated with non-operative treatment. [Table: see text]

scholarly journals Clinicoepidemiological profile of ear, nose, throat patients in outpatient clinic of tertiary health care facility in Punjab

2020 ◽  
Vol 7 (11) ◽  
pp. 4522
Author(s):  
Manish Munjal ◽  
Anurag Chowdhary ◽  
Harsimran Bhatti ◽  
Porshia Rishi ◽  
Nitika Tuli ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
General Medicine ◽  
Care Facility ◽  
Health Care Facility ◽  
Neck Surgery ◽  
North India ◽  
Care Hospital ◽  
Number Of Patients

Background: This study evaluated the profile of ailments in patients presenting to outpatient clinic of tertiary care hospital of North India that caters to ENT diseases in population of Punjab, Haryana, Himachal Pradesh and Jammu and Kashmir.Methods: A retrospective study was undertaken by analysing the medical records of patients managed at the department of otorhinolaryngology and head and neck surgery at the tertiary care hospital, Punjab from Jan 2018 to Dec 2018 and all essential data was collected.Results: Total no. of patients presenting to the ENT OPD during the period of assesment were 32,475.  49.30% were males and 50.70 % were females, respectively. 29.70% were children below 15 years. The number of patients presenting per month were 2706, with maximum no. of patients presenting in the month of August to November. Patients with ear diseases were 9280 (28.57%), Nose diseases were 11963 (36.83%), and throat diseases were 11232 (34.58%).Conclusions: This study showed that awareness of ENT ailments and visits for specialised treatment is on the rise rather than primary level treatment at local or general medicine or family physician level.

scholarly journals Profile and Management of Blepharoptosis Patients in North India - A Two-Year Study

2020 ◽  
Vol 7 (42) ◽  
pp. 2394-2398
Author(s):  
Neebha Anand ◽  
Jyoti Deswal ◽  
Ashok Kumar Khurana
Keyword(s):  
Psychosocial Development ◽  
Tertiary Care ◽  
Clinical Profile ◽  
North India ◽  
Successful Outcome ◽  
Care Hospital ◽  
Congenital Ptosis ◽  
Female Ratio ◽  
Number Of Patients ◽  
Sling Surgery

BACKGROUND Blepharoptosis is a relatively common form of eyelid malposition in both children and adults. Along with being a cosmetic blemish, ptosis is associated with high incidence of amblyopia, especially in young children with severe ptosis. This can have a negative impact on psychosocial development of a child. Hence, it becomes necessary for a general physician as well as for a general ophthalmologist sitting at a primary health care centre, to know the clinical profile of such patients. We wanted to study the demography, clinical presentation and management of blepharoptosis patients seen in our institute over a period of 2 years. METHODS 45 patients with ptosis who reported at our tertiary care hospital in North India from January 2017 to December 2018, were included in the study. Demographic data, clinico-etiological profile, management of ptosis including outcome of surgeries performed was analysed retrospectively. Data was presented as frequencies and mean ± standard deviation (SD). RESULTS The study comprised of a total of 45 patients. The mean age of presentation was 17.4 years. Maximum number of patients i.e. 17 (37.7 %) were from the age group 11 - 20 years. Male to female ratio was 2.75 : 1. Congenital ptosis was found to be the most common type seen in 36 (80 %) patients. Simple congenital ptosis (34 patients) being the commonest among congenital type. 4 (17.7 %) patients had aponeurotic ptosis. 3 (6.6 %) patients had neurogenic ptosis. Myogenic ptosis was seen in 2 (4.4 %) patients. Majority of our cases had severe degree of ptosis (57.7 %) and poor LPS action (46.6 %). LPS resection was done in 21 (46.6 %) patients, LPS reinsertion in 1 (2.2 %), sling surgery in 18 (40 %) and Fasanella Servat operation in 1 (2.2 %) patient. 2 (4.4 %) patients were medically managed and 2 (4.4 %) were kept under observation. The outcome of surgery was good in 28 (62.2 %) patients, fair in 7 (15.5 %) and poor in 6 (13.3 %) patients. Presence of amblyopia was noted in 21 patients i.e. 46.7 % of the total patients. Marcus Gunn Jaw winking phenomenon was elicited in 2 (4.4 %) patients. Bell’s phenomenon was found in 4 (8.8 %) patients. 5 (11.1 %) patients had exotropia, 3 (6.6 %) had hypotropia and 1 (2.2 %) patient had complete ophthalmoplegia. CONCLUSIONS The study highlights the demographics, clinical profile and management of congenital blepharoptosis patients seen at a centre of excellence in North India. The study is helpful for ophthalmologists in guiding diagnosis, evaluation and management of such patients and hence, long-term successful outcome of this disease. KEYWORDS Blepharoptosis, Levator Resection, Frontalis Sling Surgery

scholarly journals Pattern of hand injuries reported in a tertiary care setting of North India

2017 ◽  
Vol 5 (3) ◽  
pp. 880 ◽  
Author(s):  
Rishabh Gupta ◽  
Shavi Mahajan ◽  
Deepika Dewan ◽  
Rajat Gupta
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Hand Injuries ◽  
North India ◽  
Time Interval ◽  
Cross Sectional ◽  
Pattern Of Injury ◽  
Number Of Patients

Background: Hand injuries are very common in this industrialized world. Significant number of patients report every day to the emergency department with various patterns of hand injuries. It is important to understand these patterns in order to plan proper management and develop safety protocols aimed at preventing these injuries.Methods: The present cross sectional study was conducted among 150 patients presenting with Open hand injuries, in the OPD and emergency of Post Graduate Department of Orthopaedics, Government Medical College, Jammu over a period of one year from January 2010 to December 2010.Results: Out of 150 cases 131(87.33%) were males and 19 (12.67%) were females. The commonest age group affected was 21-30 years (34%) followed by 11-20 years (23%). Maximum injuries 90 (60%) occurred in the time interval from 4 pm to midnight. Majority of patients 67 (45%) sustained injury while at work.  Occupation-wise 37 (25%) patients were unskilled workers, mainly laborers, 35 (23%) were farmers, while the remainder belonged to various other professions. In this series machine injuries, assault and road traffic accidents accounted for most injuries, representing 61 (41%), 25 (17%) and 16 (11%) patients respectively. Traumatic amputation (30%) was the most common injury. The index (21%) and middle (21%) fingers were involved more commonly. Tendon injuries (31%) were more frequent than compound fractures (23%).  Conclusions: Hand trauma predominantly affects young males who have occupational exposure to different machines. A proper understanding of the pattern of injury will help in better management.

Patterns of maxillofacial fractures treated in a tertiary care government hospital of Puducherry – A descriptive cross-sectional study

2021 ◽  
Vol 12 (4) ◽  
pp. 92-97
Author(s):  
Shanmugam Devakumari ◽  
Vijhayapriya Thanasekar ◽  
Nandini Biradar ◽  
Neil Dominic
Keyword(s):  
Open Reduction ◽  
Road Traffic ◽  
Demographic Data ◽  
Tertiary Care ◽  
Developed Countries ◽  
Maxillofacial Trauma ◽  
Epidemiological Surveillance ◽  
Facial Trauma ◽  
Maxillofacial Fractures ◽  
The Common

Background: Maxillofacial trauma is most common in both developing and developed countries. Descriptive studies from various parts of the world helps us in understanding the patterns of these injuries which in turn help in formulating tailor made prevention strategies for that particular geographic region. Aims and Objectives: The aim of this study is to assess the patterns of maxillofacial fractures treated in IGMC & RI in Puducherry from 2011-2018. The objectives are to find out the type of maxillofacial fractures treated, to estimate the demographic data of maxillofacial fracture victims and to assess the treatment modality used(Closed reduction /open reduction and internal fixation (ORIF). Materials and Methods: Data of surgically treated patients of maxillofacial fractures were retrieved, tabulated and analysed using SPSS software – 24 for descriptive and inferential statistics. Results: The estimated results clearly indicate that males were most commonly affected by maxillofacial trauma. The common age group is 20 to 30 years. The major contributing aetiology for trauma is RTA and the common fracture that was encountered was fracture mandible and the fractures were largely managed by open reduction. Conclusion: The results obtained are expected to greatly contribute for the planning of prevention actions and management in health, assistance practices to victims of facial trauma, epidemiological surveillance and road traffic rules.

scholarly journals Clinical study of central serous chorioretinopathy presenting in a tertiary care centre

2019 ◽  
Vol 7 (11) ◽  
pp. 4200
Author(s):  
Ramamani Dalai ◽  
Rajashree Rout ◽  
Manjula Pradhan ◽  
Prasanta Kumar Nanda
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Tertiary Care ◽  
Population Based ◽  
Tertiary Care Centre ◽  
Population Based Study ◽  
Medical College ◽  
Number Of Patients ◽  
Department Of Ophthalmology ◽  
Common Causes ◽  
The Common

Background: Central Serous chorioretinopathy (CSCR) is one of the common causes of visual handicap affecting young people of highly intellectual professionals at the peak of their career which can lead to irrecoverable loss of vision.Methods: The present prospective observational population-based study was conducted in the Department of Ophthalmology, S.C.B. Medical College, Cuttack, Odisha from October 2013 to September 2015. The total number of patients attended the Outpatient Department (OPD) during the study period were 1,83,199. Amongst which 123 patients diagnosed to have CSCR were selected for the present study.Results: Incidence of CSCR during in this study period was 0.06%. The age group most commonly affected was 31 to 40 years. Males were affected 7 times more commonly than females. Increased incidence was noticed in bank employees (21.1 %) and IT professionals (17.8%).Conclusions: There was increased incidence of the disease in people under stressful life condition.

scholarly journals CHANGES IN SUPERIOR DISPLACEMENT, ANGULATION, AND SHORTENING IN THE EARLY PHASE OF HEALING FOR COMPLETELY DISPLACED MIDSHAFT CLAVICLE FRACTURES IN ADOLESCENTS: RESULTS FROM A PROSPECTIVE, MULTICENTER STUDY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0003
Author(s):  
Andrew T. Pennock ◽  
Benton E Heyworth ◽  
Tracey Bastrom ◽  
Donald S. Bae ◽  
Michael T. Busch ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Clavicle Fracture ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Consecutive Series ◽  
Post Injury ◽  
Adolescent Patients ◽  
Text Figure ◽  
Clavicle Fractures ◽  
Multi Center Study

Background: Progressive displacement of diaphyseal clavicle fractures has been observed in adult patients, at times necessitating a change from non-operative to operative treatment. Whether this occurs in adolescent patients has not been well investigated. Purpose: The purpose of this study was to assess the rate and extent of progressive clavicle fracture displacement in adolescent patients following injury and during the early stages of healing. Methods: This was an IRB approved multi-center study evaluating prospective data that had previously been collected as part of a larger study evaluating the functional outcomes of adolescent clavicle fractures. A consecutive series of completely displaced diaphyseal clavicle fractures in patients age 10-18 years treated at one of three tertiary care pediatric trauma centers were included; all of which had standardized imaging within 2 weeks of the date of injury and throughout the course of healing (5-20 weeks post-injury). Measurements of clavicle shortening, superior displacement, and angulation were performed using validated techniques. Progressive displacement and/or interval improvement in fracture alignment were noted, as well as the subsequent need for surgical intervention. Patient demographic and radiographic parameters were assessed as possible risk factors for interval displacement. Results: One hundred patients met the inclusion criteria. The mean shortening, superior displacement, and angulation at the time of injury were 24 mm, 15 mm, and 7°, respectively. At a mean of 10 weeks post-injury, the fracture alignment improved across all three measurements for the overall cohort, with mean improvements in shortening of 15%, superior displacement of 15%, and angulation of 21% (Figures 1,2,3) Using a clinical threshold of a change in shortening or displacement of 10 mm or angulation of 10 degrees, 21% of fractures improved, 4% worsened, and 75% remain unchanged. Patients with more severe fractures were more likely to have improved alignment than less displaced fractures (p<0.001). No patient underwent surgical intervention for progressive displacement. Conclusions: Significant early improvements in fracture alignment were observed in a substantial percentage of adolescent patients with completely displaced clavicle fractures. Among the most severely displaced fractures, a 20% improvement in shortening and 50% improvement in angulation was identified. In 4% of cases, increased displacement was observed, but this tended to be mild, and in no cases did it prompt surgical intervention. This finding indicates that the true final deformity after an adolescent clavicle fracture is commonly less than that present at the time of injury. Figures: [Figure: see text][Figure: see text][Figure: see text]

scholarly journals Study of Clinico-Aetiological Profile in Patients of Liver Cirrhosis in a Tertiary Care Hospital of North India

2021 ◽  
Vol 8 (19) ◽  
pp. 1373-1379
Author(s):  
Jasmine Kaur ◽  
Navjot Kaur ◽  
Hardeep Singh Deep ◽  
Gaurav Chopra ◽  
Gurjyot Nanda
Keyword(s):  
Liver Cirrhosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Meld Score ◽  
Control Measures ◽  
North India ◽  
Aetiological Factor ◽  
Care Hospital ◽  
Number Of Patients ◽  
Detailed Medical History

BACKGROUND Cirrhosis is a chronic disease of liver marked by degeneration of cells, inflammation and fibrous thickening of the tissue. It is a common cause of morbidity and mortality. Globally, the incidence of liver cirrhosis is on the rise. Therefore, the exact knowledge of aetiology, mode of clinical presentation, and pattern of development of complications of cirrhosis will help in optimal and costeffective control measures of this disease. We undertook this study to evaluate the cause and mode of presentation of patients with liver cirrhosis presenting in a tertiary care hospital of North India. We also wanted to determine biochemical changes in liver cirrhosis. METHODS This observational prospective study was conducted in the Department of Medicine over a period of one year, it included 122 cirrhotic patients of both sexes between 18 and 75 years irrespective of aetiology who fulfilled inclusion criteria. After detailed medical history and thorough physical examination, relevant laboratory investigations, ultrasound of abdomen, and upper GI endoscopy was done. Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease ( MELD) score was calculated. The recorded data was analysed statistically. RESULTS Out of 122 patients, 85.2 % were males and 14.8 % were females. Maximum number of patients 33.60 % were in 41 - 50 years of age. Alcohol was found to be the most common aetiological factor in 80.3 % patients. The most common presenting symptom was abdominal distension in 89.9 % patients. Various complications such as spontaneous bacterial peritonitis was present in 13.9 %, anaemia in 93.4 %, thrombocytopenia 75.4 %, deranged international normalized ratio (INR) 78.6 %, deranged renal function 45.9 %, hyponatremia in 35.2 % patients. Maximum number of patients 72.9 % were in CTP class C. 68 % patientshad MELD score > 14. CONCLUSIONS Males are mainly affected by liver cirrhosis due to excessive alcohol consumption therefore proper preventive measures have to be taken. The raised total leucocyte count (TLC), serum bilirubin, serum creatinine, decreased serum albumin, serum sodium and coagulopathy were found to be poor prognostic markers. KEYWORDS Cirrhosis, Aetiology, Complications, Prognosis

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