Primary cemented bipolar hemiarthroplasty by transtrochanteric approach in unstable intertrochanteric fractures

Background: The successful treatment of unstable intertrochanteric fractures of the femur in elderly patients is a challenge. Due to complications associated with internal fixation, primary hemiarthroplasty is increasingly becoming an alternative treatment to achieve early mobilisation. A transtrochanteric approach could potentially decrease the complications associated with primary hemiarthroplasty. Aim of the study is to document the postoperative outcome and complications associated with this treatment.Methods: In this retrospective study, all elderly patients with unstable trochanteric fractures, treated by primary hemiarthroplasty through a transtrochanteric approach, in a tertiary care centre, from September 2017 to December 2019, were enrolled. Their data from hospital records were analysed and results compared to literature.Results: 48 patients underwent the procedure. Average age was 85 years. One year mortality was 31.25%. Average duration of surgery is 85 min. 58.3% were ambulant at one year. One case of dislocation secondary to surgical site infection was present.Conclusions: Primary hemiarthroplasty as a primary treatment in this group of patients enables early mobilization and prevents complications associated with prolonged immobilization. Transtrochanteric approach reduces the duration of surgery. Achieving early ambulation is the key to successful treatment.

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Efficacy of bipolar hemiarthroplasty in the elderly people: a study in a tertiary care centre

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171573 ◽

2017 ◽

Vol 3 (3) ◽

pp. 396

Author(s):

G. Ramachandra Reddy ◽

P. N. Prasad

Keyword(s):

Elderly Patients ◽

Tertiary Care ◽

The Elderly ◽

Bipolar Hemiarthroplasty ◽

Common Complication ◽

Care Centre ◽

Tertiary Care Centre ◽

Type Iv ◽

Prosthetic Implant ◽

The Mean

Background: Intertrochanteric fractures are associated with severe displacement and comminution are very common among the elderly patients especially women. Hemiarthroplasty is a procedure, where the head of the femur is replaced with a prosthetic implant. This study was performed to evaluate the efficacy of the bipolar hemiarthroplasty among the elderly patients with intra capsular fractures.Methods: Bipolar hemiarthroplasty with or without cement was performed on 77 patients above the age of 60 years with femoral neck fractures.Results: Out of the 77 patients, 79.2% were females and 20.8% were males. The mean age of all the patients was 68.4 years. Type IV was found to be most common among the elderly. The outcome of the surgery was excellent in more than 75% of the cases. Only one patient had a poor outcome. The most common complication of the surgery was limb shortening in 5.2% patients followed by superficial infections in 2.6%. Conclusions: Bipolar hemiarthroplasty for the unstable hip fractures in the elderly has good results with early mobilizations and minimal complications. This ultimately affects the general health of the patients and reduces morbidity and mortality.

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Pattern of Ear Diseases among Paediatric ENT Patient: An Experience from Tertiary Care Centre, Pokhara, Nepal

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v32i2.5673 ◽

2012 ◽

Vol 32 (2) ◽

pp. 142-145 ◽

Cited By ~ 2

Author(s):

B Sigdel ◽

R Nepali

Keyword(s):

Tertiary Care ◽

Age Group ◽

Care Centre ◽

Tertiary Care Centre ◽

Suppurative Otitis Media ◽

Ear Diseases ◽

Paediatric Age ◽

One Year ◽

A Prospective Study ◽

Nose And Throat

Introduction: Ear diseases are common in children mainly due to altered anatomy of Eustachian tube which is straighter in children as compared to that in adults. However, the cause of hearing loss in children is more varied, including the etiologies. This study was done to find out the pattern of ear diseases in paediatric age group attending ear, nose and throat OPD in a tertiary care centre in Pokhara, Nepal. Materials and Methods: This is a prospective study done in paediatric patients attending ENT OPD over a period of one year from January 2010 to January 2011. The diagnoses were made on the basis of history and clinical examination. Results were expressed in numbers and percentages. Results: Out of 1632 Pediatric ENT patients, 944 had ear diseases, 59.2% were males and 40.8% females. Wax (33.4%) was the commonest diagnosis followed by Chronic suppurative otitis media (24.3%) and Acute ottitis media (13%). Conclusion: Ear diseases are most common condition in ENT OPD among paediatric age group. Wax, CSOM and ASOM were the three most common ear diseases. J. Nepal Paediatr. Soc. 32(2) 2012 142-145 doi: http://dx.doi.org/10.3126/jnps.v32i2.5673

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EVALUATE INTRAOPERATIVE VARIABLES AND POSTOPERATIVE OUTCOMES OF INTERTROCHANTERIC FRACTURES WITH VULNERABLE/ BROKEN LATERAL WALL MANAGED WITH SHORT AND LONG CEPHALOMEDULLARY NAIL

10.36106/gjra/5201498 ◽

2021 ◽

pp. 36-37

Author(s):

Rahul Kumar ◽

Wasim Ahmed ◽

Indrajeet Kumar

Keyword(s):

Blood Loss ◽

Functional Outcome ◽

Postoperative Outcomes ◽

Treatment Modalities ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Neck Shaft Angle ◽

Duration Of Surgery ◽

One Year ◽

Lateral Walls

Purpose: To evaluate intraoperative variables and postoperative outcomes of intertrochanteric fractures with vulnerable/broken lateral walls managed with short and long cephalomedullary nails. Materials & Methodology: Twenty prospective cases of patients treated with LCMN and twenty retrospective cases treated with SCMN were included in the study. Intraoperative variables compared were duration of surgery, blood loss during surgery, and surgeon's perception of surgery. Functional outcome was evaluated by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12 at one year. Radiological assessment were done at six months/one year to look for progress of fracture union, change in neck-shaft angle, and any signs of implant failure. Results: Duration of surgery (p<0.001), blood loss during surgery (p=0.002), and surgeon's perception of surgery (p=0.002) were signicantly more in the LCMN group. The LCMN group had a better functional outcome. HHS for the LCMN group was 89.15±9.53, and for the SCMN group it was 81.53±13.21 (p=0.021). PPMS for LCMN group was 8.85± 0.67 and for the SCMN group was 7.53±1.807 (p=0.005). There were four implant failures in the LCMN group compared to none in the SCMN group (p=0.036). Conclusion: Both SCMN and LCMN are effective treatment modalities for unstable intertrochanteric fractures with vulnerable/broken lateral walls. In the absence of more extensive study and long-term follow-up, the superiority of one implant over the other cannot be recommended.

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Type and mode of diagnosis of carcinoma lung in a tertiary care centre: one year experience

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174940 ◽

2017 ◽

Vol 5 (11) ◽

pp. 4891

Author(s):

Jayaprakash Balakrishnan ◽

Sindhu Nair Prasannakumari ◽

Ajith Achuthan ◽

John Mathew

Keyword(s):

Lung Cancer ◽

Cell Carcinoma ◽

Small Cell Carcinoma ◽

Tertiary Care ◽

Small Cell ◽

Common Type ◽

Ultra Sound ◽

Tertiary Care Centre ◽

Easy Method ◽

One Year

Background: Lung cancer is one of the commonest cancers and cause of cancer related deaths all over the world. The reported incidence of adenocarcinoma is increasing globally and now reported to be the most common type of lung cancer. A panel of investigations are used for the diagnosis of lung cancer. Hence a study was planned to find out the pattern of malignancy and the most appropriate investigation for diagnosis. Objective of present study was to find out the type of carcinoma lung and to find out the best and easy method for diagnosis of carcinoma lung in a tertiary care centre.Methods: A hospital based cross sectional study was conducted in one unit of the Department of Pulmonary Medicine, Government Medical college, Thiruvananthapuram for a period of one year.148 diagnosed cases of carcinoma lung were enrolled. The type and the methods used for diagnosis were analysed.Results: Adenocarcinoma was the commonest malignancy 57 (38.5%), followed by squamous cell carcinoma 44 (29.7%) and small cell carcinoma 10 (6.75%). Rest of the cases 37 (25%) include non small cell carcinoma, poorly differentiated carcinoma and lymphoma. Diagnosis was established by FNA Lung in 46 (31.1%) patients and bronchoscopy and biopsy in 41 (27.7%). Other methods include TBNA 12 (8.1%), lymph node FNA/biopsy 11 (7.4%), pleural fluid cytology 24 (16.2%), sputum cytology and tru cut biopsy 14 (9.5%).Conclusions: The most common type of lung malignancy in present study was adenocarcinoma. Ultra sound guided FNAC lung and bronchoscopy biopsy were the best methods in present study to confirm the diagnosis.

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A PROSPECTIVE OBSERVATIONAL STUDY OF CLINICAL PROFILE IN ETIOLOGY OF ANEMIA IN ELDERLY-A HOSPITAL BASED STUDY IN A TERTIARY CARE CENTRE IN SOUTH INDIA

International Journal of Advanced Research ◽

10.21474/ijar01/13508 ◽

2021 ◽

Vol 9 (09) ◽

pp. 961-972

Author(s):

K. Shivaraju ◽

◽

Karanam Sai Arun ◽

Mandhala Saikrishna ◽

◽

...

Keyword(s):

Tertiary Care ◽

The Elderly ◽

Moderate Degree ◽

Care Hospital ◽

Tertiary Care Centre ◽

Total Study Population ◽

Study Population ◽

Poor Outcomes ◽

One Year ◽

Severe Degree

Background: Anemia is often considered as a normal physiological process that occurs with aging. but recently since past 2 decades anemia of any degree is being recognized as significant independent contributor to morbidity mortality and frailty in elderly patients. It is easy to overlook anemia in elderly as symptoms of anemia like fatigue, SOB etc are often attributed to aging process itself. many evidences accumulated states that anemia of any degree reflects poor health and increased vulnerability to poor outcomes. Materials and methods: This study was conducted in the department of internal medicine in a tertiary care hospital over a period of one year with sample size of 362 subjects satisfying the inclusion and exclusion criteria after taking the consent form. Results: Moderate degree anaemia was the commonest around, 65.6% followed by severe degree anemia 20.1%. Easy fatigability was the commonest symptom and pallor was the commonest sign of anaemia in elderly. Anemia is not always a consequence of aging. Anemia of unexplained etiology constituted 15.97% of total study population. Conclusion: Anaemia in elderly is a challenge and has to be approached in an organized manner for appropriate diagnosis and evaluation to look into its cause and plan management to improve the quality of life of the elderly persons.An effort should always be made to reach etiological diagnosis before instituting specific therapy.

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TO ANALYSE THE DEFERRAL INCIDENCE AND ITS PATTERN AMONG THE BLOOD DONORS IN A TERTIARY CARE CENTRE IN NORTH INDIA.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i8.445 ◽

2019 ◽

Vol 3 (8) ◽

Author(s):

Dr. Surbhi Jain

Keyword(s):

Blood Donor ◽

Blood Donors ◽

Blood Donation ◽

Selection Process ◽

Tertiary Care ◽

Clinical History ◽

North India ◽

Tertiary Care Centre ◽

One Year ◽

Donor Deferral

Background: Blood donor programme is vital to any transfusion service. This process of blood donation involves voluntary and non remunerated blood donors. The objective of donor screening is to minimize the chances of transmitting infectious agents to recipients. Material and Method: The study was conducted during one year duration from 2017-2018. A total of 700 donors are deferred against 9556 blood donors recruited on the basis of clinical history and brief medical examination in blood bank and voluntary blood donation camps. Donors were deferred temporarily or permanently. Result: Out of 700 deferred donors; 546 were voluntary and 154 were replacement blood donors. Male (601) outnumbered female (99). There were 682 temporary and 18 permanent deferral. Most common age group for deferral was 17-30 yrs (490). Common causes included anemia(142), on medication(108), underweight(83) and high blood pressure(72). Conclusion: Donor selection process is a most important preliminary step in blood banking and should follow stringent medical and regulatory rules. Studying and analysing the profile of blood donors will help to identify sections of the population which could be targeted to increase the pool of voluntary blood donors. Every attempt should be made to decrease the donor deferral keeping in view the safety of both donor and recipients. Keywords: Blood donor, Deferral, Voluntary, Temporary, Permanent.

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Abstract 13123: Early Mobilization of Older Adults in the Cardiac Intensive Care Unit

Circulation ◽

10.1161/circ.142.suppl_3.13123 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Michael Goldfarb ◽

Koorosh Semsar-kazerooni ◽

Jose Morais ◽

Diana Dima

Keyword(s):

Older Adults ◽

Tertiary Care ◽

Multivariable Analysis ◽

Intervention Group ◽

Length Of Hospital Stay ◽

Early Mobilization ◽

Hospital Death ◽

Healthcare Team ◽

Tertiary Care Centre ◽

Discharge Home

Background: Early mobilization (EM) is beneficial in general critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods: Consecutive admissions of adults ≥ 80 years old to a cardiac ICU at an academic tertiary care centre before (January to December 2017) and after (February 2018 to June 2019) implementation of a structured nurse-driven EM program. Mobility was measured using the validated Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk > 50 feet). The primary outcome was discharge home. Results: There were 412 patients included (N=234, intervention; N=178, preintervention). There was no difference in mean age between groups (overall mean age 86.3±4.8 years old) or sex (overall female N=215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prior to hospitalization and in 209 patients (89.3%) on admission. Nearly half of patients undergoing EM (N=107; 45.7%) improved their LOF by ≥1 during cardiac ICU stay. Mobilization occurred during nearly all opportunities (838/850; 98.6%) and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2%]) and transient (N=5). There were no falls, line dislodgements, or healthcare team injuries). Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4% vs. 65.7%, P=0.047, respectively) and had a lower rate of in-hospital death (6.4% vs. 14.6%, P=0.006, respectively). There was no difference in length of hospital stay or re-admission. In the multivariable analysis, predictors of discharge home were younger age, heart failure, and higher prehospital LOF. Outcomes were similar in adults ≥ age 90. Conclusion: EM is safe in older adults in the cardiac ICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.

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Relationship between travel time to primary and tertiary care centres and survival in glioblastoma: the NHS Grampian experience.

Neuro-Oncology ◽

10.1093/neuonc/noz167.076 ◽

2019 ◽

Vol 21 (Supplement_4) ◽

pp. iv17-iv17

Author(s):

Damjan Veljanoski ◽

Raphae Barlas ◽

Aimun Jamjoom ◽

Phyo Myint

Keyword(s):

Travel Time ◽

Cohort Analysis ◽

Tertiary Care ◽

Healthcare Facility ◽

Tertiary Care Centre ◽

Logistic Regression Models ◽

Retrospective Cohort Analysis ◽

Treatment Type ◽

One Year ◽

The Uk

Abstract Background Studies have demonstrated a distance-decay effect, whereby patients who live further away from their healthcare facility have poorer health outcomes. The geographical catchment area served by the neurosurgical unit in Aberdeen, Grampian region, Scotland is one of the largest in the UK. We aimed to examine the relationship between travel time as a proxy of distance travelled, and survival outcome for glioblastoma. Methods We conducted a retrospective, cohort analysis of patients with glioblastoma referred for treatment from January 2009 to December 2018. Travel time was calculated from the patients’ home to their general practitioner (GP) and to the neurosurgical unit. Logistic regression models were constructed to estimate survival at three, six and 12 months, as well as treatment within 62 days of GP referral, and within 31 days of diagnosis controlling for age, sex and treatment type. Results There were 195 patients (mean age (SD) 64.4 ± 12.9 years)57.9% were men, 65.1% were treated surgically, and 48.2% were alive after one year. Longer time travelled to GP, but not to tertiary care centre, was associated with reduced odds of mortality at three months (OR 0.88 95%CI 0.79–0.98; p=0.005) and six months (OR 0.92 95%CI 0.85–0.99; p=0.01), for each incremental increase in one minute. Conclusions Patients with glioblastoma with longer travel times to their GP were more likely to be alive at three months and six months. Further work is required to identify other factors, including degrees of socio-economic deprivation and rurality, which may influence this finding.

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