Changing Trend in COVID 19 Pandemic, Orthopaedic Care, and Arthroplasty - A Prospective Study Conducted in Indira Gandhi Institute of Medical Sciences, an Apex Tertiary Centre of Bihar

2021 ◽  
Vol 8 (28) ◽  
pp. 2544-2550
Author(s):  
Janki Sharan Bhadani ◽  
Wasim Ahmed ◽  
Nishant Kashyap ◽  
Indrajeet Kumar ◽  
Santosh Kumar ◽  
...  
Keyword(s):  
Health Services ◽  
Prospective Study ◽  
Postoperative Complication ◽  
Readmission Rate ◽  
Operative Procedure ◽  
Operative Management ◽  
Medical Sciences ◽  
Orthopaedic Care ◽  
Primary Arthroplasty ◽  
Significant Difference

BACKGROUND The novel corona virus pandemic has a profound impact on health services throughout the world, which reflected the changing guidelines of different health societies in different time zones. We tried first to ensure the safety of our patients and surgical staff. Patient care priorities based on strict evidence-based management of a particular case and also COVID-19-adjusted governmentimposed restriction during the crisis. We aim to study postoperative complication after arthroplasty and readmission rate and compared the same with the prepandemic era. We also address our strategies, concerns, and regulatory barriers due to government-imposed lockdown, during initial surge of pandemic and also when restrictions were lifted. This study is unique in the way that there is no such study from Bihar, a state of developing country with scarcity of specialized health services. METHODS In this prospective study done in Indira Gandhi Institute Of Medical Sciences, Patna, Bihar between 1st December 2019 to 31st January 2021 (14 months duration). We have selected a subset of those patient who were admitted for primary arthroplasty of hip during the pandemic after lock down, and compared those with patient those underwent similar operative management before the lockdown period. RESULTS There was no significant difference in postoperative complication and readmission rate when compared with the pre-pandemic era. CONCLUSIONS There is no significant increase in risks of patient as well as operating surgeon before the pandemic and during the pandemic when the elective operative procedure (arthroplasty) was allowed. Communication, precautions, and proper preoperative planning remain essential part of management at each step of treatment. By following above mentioned standard operative procedure (SOP) chances of getting infection of COVID-19 is negligible from operative work. KEYWORDS COVID 19, SARS-CoV-2, Arthroplasty, Orthopaedics

scholarly journals Acute Appendicitis – A Benign Disease?

2008 ◽  
Vol 90 (4) ◽  
pp. 313-316 ◽  
Author(s):  
J Simpson ◽  
APR Samaraweera ◽  
RK Sara ◽  
DN Lobo
Keyword(s):  
Abdominal Pain ◽  
Postoperative Complications ◽  
Postoperative Complication ◽  
Operative Procedure ◽  
Admission Rate ◽  
University Teaching ◽  
Septic Complication ◽  
High Dependency ◽  
Significant Difference ◽  
Negative Appendicectomy

INTRODUCTION Appendicitis is the most common cause of the acute abdomen and can affect all age groups. Most patients recover quickly but a minority can suffer postoperative complications. This case-note review was undertaken to assess the frequency of these complications. PATIENTS AND METHODS Adult patients (> 16 years) undergoing an emergency appendicectomy at a University teaching hospital between February 2004 and January 2005 were identified from pathology records. Details of operative procedure, histology and postoperative complications were noted from the hospital case notes RESULTS A total of 199 patients with a median age of 31 years (range, 16–89 years) were identified. Of these, 58 (29%) patients experienced a postoperative complication. Eight (4%) patients were admitted to the surgical high dependency unit or intensive care unit postoperatively and there was one death (0.5%). Re-operation for a postoperative complication was required in 9 (4.5%) patients and there was a 13% re-admission rate (26 patients). Comparison between patients with histologically proven appendicitis (164 patients; 82%) and those patients having a negative appendicectomy (35 patients; 18%) showed no significant difference in the rate of complications as defined (43 of 164, 26% versus 15 of 35, 43%; P = 0.08). However, patients with positive histology were more likely to experience a septic complication (29 of 164, 18% versus 1 of 35, 3%; P = 0.028) and all re-operations came from this group. Despite this, patients with a negative appendicectomy were more likely to be re-admitted (12 of 35, 34% versus 14 of 164, 8.5%; P = 0.0002), predominantly with persistent abdominal pain. CONCLUSIONS Appendicectomy is associated with a significant morbidity. Patients with an inflamed appendix were more likely to experience a septic complication but re-admission was more common in patients with a histologically normal appendix because of unresolved abdominal pain.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

scholarly journals Evaluation of e-health (Seha) application: a cross-sectional study in Saudi Arabia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abeer Alharbi ◽  
Joharah Alzuwaed ◽  
Hind Qasem
Keyword(s):  
Saudi Arabia ◽  
Health Services ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Advanced Technology ◽  
Sectional Study ◽  
Cross Sectional ◽  
Technical Problems ◽  
Significant Difference ◽  
Ease Of Access

Abstract Background The Ministry of Health in Saudi Arabia is expanding the country’s telemedicine services by using advanced technology in health services. In doing so, an e-health application (app), Seha, was introduced in 2018 that allows individuals to have face-to-face visual medical consultations with their doctors on their smartphones. Objective This study evaluated the effectiveness of the app in improving healthcare delivery by ensuring patient satisfaction with the care given, increasing access to care, and improving efficiency in the healthcare system. Methods A cross-sectional study design was used to assess the perceptions of users of the Seha app and non-users who continued with traditional health services. The data were collected using an online survey via Google Forms between June 2020 and September 2020. Independent t tests and chi-square (χ2) tests were conducted to answer the research questions. Results There was a significant difference between users and non-users in terms of ease of access to health services (t =  − 9.38, p < 0.05), with app users having a higher mean score (4.19 ± 0.91) than non-users (3.41 ± 1.00); satisfaction with health services (t =  − 6.33, p < 0.05), with users having a higher mean score (3.96 ± 0.91) than non-users (3.45 ± 0.94); and efficiency (only one visit needed for treatment) (t =  − 3.20, p < 0.05), with users having a higher mean score (3.71 ± 0.93) than non-users (3.45 ± 0.93). There were significant associations between the use of the Seha app and age (χ2 = 8.79, p < 0.05), gender (χ2 = 22.19, p < 0.05), region (χ2 = 19.74, p < 0.05), and occupation (χ2 = 22.05, p < 0.05). There were significant relationships between the three items (on access, satisfaction, and efficiency) and experiencing technical issues (t = 4.47, t = 8.11, and t = 3.24, respectively, p < 0.05), with users who faced technical problems having significantly lower mean scores for all three items. Conclusion This study provided evidence that the Seha app improved the delivery of healthcare in Saudi Arabia. Users of the app had a better health experience in terms of their perceived ease of access to healthcare services; their satisfaction with healthcare services; and the efficiency of the system, measured by the number of required doctor visits. Other factors that appeared to influence the use of the app included age, gender, usual source of care, and technical difficulties.

scholarly journals Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 734
Author(s):  
Ivona Djordjevic ◽  
Dragoljub Zivanovic ◽  
Ivana Budic ◽  
Ana Kostic ◽  
Danijela Djeric
Keyword(s):  
Splenic Abscess ◽  
Operative Management ◽  
High Energy ◽  
Significant Difference ◽  
Injury Grade ◽  
Grade Ii ◽  
The Mean ◽  
Non Operative Management ◽  
Grade Iii

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.

scholarly journals Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110308
Author(s):  
Andrew Platt ◽  
Mostafa H. El Dafrawy ◽  
Michael J. Lee ◽  
Martin H. Herman ◽  
Edwin Ramos
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Gunshot Wounds ◽  
Operative Management ◽  
Operative Intervention ◽  
Lumbosacral Spine ◽  
Random Effects Model ◽  
Significant Difference

Study Design: Systematic review and meta-analysis. Objectives: Indications for surgical decompression of gunshot wounds to the lumbosacral spine are controversial and based on limited data. Methods: A systematic review of literature was conducted to identify studies that directly compare neurologic outcomes following operative and non-operative management of gunshot wounds to the lumbosacral spine. Studies were evaluated for degree of neurologic improvement, complications, and antibiotic usage. An odds ratio and 95% confidence interval were calculated for dichotomous outcomes which were then pooled by random-effects model meta-analysis. Results: Five studies were included that met inclusion criteria. The total rate of neurologic improvement was 72.3% following surgical intervention and 61.7% following non-operative intervention. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 1.07; 95% CI 0.45, 2.53; P = 0.88). In civilian only studies, a random-effects model meta-analysis failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 0.75; 95% CI 0.21, 2.72; P = 0.66). Meta-analysis further failed to show a statistically significant difference in the rate of neurologic improvement between patients with either complete (OR 4.13; 95% CI 0.55, 30.80; P = 0.17) or incomplete (OR 0.38; 95% CI 0.10, 1.52; P = 0.17) neurologic injuries who underwent surgical and non-operative intervention. There were no significant differences in the number of infections and other complications between patients who underwent surgical and non-operative intervention. Conclusions: There were no statistically significant differences in the rate of neurologic improvement between those who underwent surgical or non-operative intervention. Further research is necessary to determine if surgical intervention for gunshot wounds to the lumbosacral spine, including in the case of retained bullet within the spinal canal, is efficacious.

scholarly journals Gender Determination by Linear Dimension of Permanent Canine: An Odontometric Analysis

2014 ◽  
Vol 2 (1) ◽  
pp. 23-27
Author(s):  
B Sharma ◽  
N Balaji ◽  
MK Sumathi
Keyword(s):  
Sexual Dimorphism ◽  
Sex Determination ◽  
Linear Dimension ◽  
Medical Sciences ◽  
Medical College ◽  
Type Iv ◽  
Racial Background ◽  
Significant Difference ◽  
Natural Change ◽  
The Individual

Background and objectives: Identification, an aspect of forensic anthropology, is the recognition of an individual based on the physical characteristics unique to the individual. Among the four main attributes i.e. gender, age, stature and ethnic or racial background of an individual’s biological identity, sex determination is usually the first step in the human identification process. Teeth can be used as a means of sex determination as teeth are resistant to post-mortem degradation and survive deliberate, accidental or natural change. This study was carried out with an objective to determine the sexual dimorphism of maxillary and mandibular canine by linear tooth diameter for permanent dentition in Moradabad population. Material and Methods: A total number of 40 subjects (20 Males and 20 Females) were included in this study. After obtaining an informed written consent, alginate impression was taken with help of perforated impression trays and study models were prepared with type IV dental stone. Linear (MD, BL, Crown Height) were taken with digital vernier caliper. Results: It was observed that males’ shows more mean linear crown diameter as compared to females. Also, the mesiodistal and buccolingual measurement shows statistically significant difference for all canines, being higher for males than females. Conclusion: The present study has expressed sexual dimorphism of permanent canine using Student’s test and indicate that linear dimension of maxillary canine can be used for sexual diamorphism with accuracy along with other accepted procedure for sex determination. DOI: http://dx.doi.org/10.3126/jmcjms.v2i1.11392   Janaki Medical College Journal of Medical Sciences (2014) Vol. 2 (1): 23-27

scholarly journals Tumor Tissue MIR92a and Plasma MIRs21 and 29a as Predictive Biomarkers Associated with Clinicopathological Features and Surgical Resection in a Prospective Study on Colorectal Cancer Patients

2020 ◽  
Vol 9 (8) ◽  
pp. 2509
Author(s):  
Masahiro Fukada ◽  
Nobuhisa Matsuhashi ◽  
Takao Takahashi ◽  
Nobuhiko Sugito ◽  
Kazuki Heishima ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prospective Study ◽  
Surgical Resection ◽  
Tumor Tissue ◽  
Lymphatic Invasion ◽  
Clinicopathological Features ◽  
Stage Iii ◽  
Sample Type ◽  
Significant Difference ◽  
A Prospective Study

Cancer-related microRNAs (miRNAs) are emerging as non-invasive biomarkers for colorectal cancer (CRC). This study aimed to analyze the correlation between the levels of tissue and plasma miRNAs and clinicopathological characteristics and surgical resection. This study was a prospective study of CRC patients who underwent surgery. Forty-four sample pairs of tissue and plasma were analyzed. The miRNA levels were evaluated by RT-qPCR. The level of tumor tissue MIR92a showed a significant difference in CRC with lymph node metastasis, stage ≥ III, and high lymphatic invasion. In preoperative plasma, there were significant differences in CRC with stage ≥ III (MIR29a) and perineural invasion (MIR21). In multivariate analysis of lymphatic invasion, the levels of both preoperative plasma MIR29a and tumor tissue MIR92a showed significant differences. Furthermore, in cases with higher plasma miRNA level, the levels of plasma MIRs21 and 29a were significantly decreased after the operation. In this study, there were significant differences in miRNAs levels with respect to the sample type, clinicopathological features, and surgical resection. The levels of tumor tissue MIR92a and preoperative plasma MIR29a may have the potential as a biomarker for prognosis. The plasma MIRs21 and 29a level has the potential to be a predictive biomarker for treatment efficacy.

scholarly journals Traumatic Liver Injury in Hong Kong: The Management Strategy and Outcome

2009 ◽  
Vol 16 (4) ◽  
pp. 208-216 ◽  
Author(s):  
CN Chong ◽  
YS Cheung ◽  
KF Lee ◽  
TH Rainer ◽  
BSP Lai
Keyword(s):  
Hong Kong ◽  
Liver Injury ◽  
Hospital Stay ◽  
Injury Severity ◽  
Road Traffic ◽  
Demographic Data ◽  
Operative Management ◽  
Concomitant Injuries ◽  
Significant Difference ◽  
Non Operative Management

Introduction Management of liver injury is challenging and evolving. The aim of this article is to review the outcome of traumatic liver injury in Chinese people in Hong Kong. Materials & methods Records of 40 patients with hepatic injury who received treatment at the Prince of Wales Hospital between December 2000 and May 2005 were reviewed. Demographic data, severity of liver injury, Injury Severity Score (ISS), haemodynamic status and Glasgow Coma Scale (GCS) score on admission, investigations made, concomitant injuries, management scheme, and outcome of patients were analysed. Results There were 23 male and 17 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (65%). Half of the patients were treated by non-operative management (NOM). None of them required surgery during subsequent management. Patients in the operative management (OM) group had a significantly higher ISS (p=0.026), but there was no significant difference in the mortality rate between the OM and NOM groups. Patients with stable haemodynamic status and who were treated non-operatively had a significantly shorter hospital stay (p=0.006). High grade liver injury (OR=8.0, 95% CI=1.2 to 53.8, p=0.03) and ISS greater than 25 (OR=21.6, 95% CI=2.0 to 225.3, p=0.01) were independent risk factors for mortality on multivariate analysis. Conclusions Non-operative management of liver injury can be safely accomplished in haemodynamically stable patients, with the possible benefit of a shorter hospital stay.

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