When the Disease is Known but the Patient is not. Outcome of 118 such Patients at a Tertiary Care Centre

Abstract This is a prospective study, carried out at the Department of Neurosurgery at M.B.G Hospital, R.N.T Medical College, Udaipur, Rajasthan (India). Many patients with history of trauma with head injury, whose identity cannot be ascertained, are admitted in our hospital. The management of these unattended patients from pre-hospital till discharge, rehabilitation or death is full of difficulties especially when surgical intervention has to be done. From March 16, 2015, until March 30, 2016, 118 consecutive patients unattended patients admitted in our department with history of head injury were enrolled in the study. Out of 118 patients, 107 (91%) were male, most were in the age group of 30-39 years. In majority of patients, 115 (97%) principal cause of head injury was road traffic accident. Majority of the patients 49 (41%) had Glasgow coma scale >13 on admission. Twenty three patients 23 (20%) died in hospital, 71 (60%) patients had good recovery. During the course of treatment identity of 115 patients was established and 92 (78%) patients, who survived were discharged to home. Three (3%) patients were shifted to destitute home. All discharged patients were followed at 1 month and 6 month interval. 78 (82%) & 76 (80%) patients showed good recovery (GOS) at 1 month & 6 month respectively. One patient expired at home within one month of discharge and 6 patients lost to follow up at 6 months.

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Outcome of surgically treated head injury in unattended patients at Neurosurgery Department in Tertiary Care Centre - an institutional study

Romanian Neurosurgery ◽

10.1515/romneu-2017-0039 ◽

2017 ◽

Vol 31 (2) ◽

pp. 233-239

Author(s):

Praveen Kumar Tripathi ◽

Vardan Kulshreshtha ◽

Gaurav Jaiswal ◽

Tarun Kumar Gupta

Keyword(s):

Head Injury ◽

Prospective Study ◽

Road Traffic ◽

Tertiary Care ◽

Neurosurgical Procedures ◽

Good Recovery ◽

Tertiary Care Centre ◽

Discharged Patients ◽

History Of ◽

A Prospective Study

Abstract This is a prospective study, carried out at our department. Many patients with history of trauma with head injury, whose identity cannot be ascertained, are admitted in our hospital. The management of these unattended patients from pre-hospital till discharge, rehabilitation or death is full of difficulties especially when surgical intervention has to be done. We conducted a prospective study by enrolling 11 consecutive unattended patients in whom neurosurgical procedures performed at our hospital. Out of 11 patients, 9 (82%) were male, most were in the age group of 21-30 years. The mean age was 30 years. Mean duration of hospital stay was 11.27 days. The cause of head injury was road traffic accident in all patients. Majority of the patients 10 (90%) had Glasgow coma scale less than 8 on admission. Two patients 2 (18%) died in hospital, 7 (63%) patients had good recovery. During the course of treatment identity of all 11 patients was established and 8 (72%) patients who survived were discharged to home. All discharged patients were followed at interval of 1 month and 3 months. Four (50%) & 5 (62%) patients showed good recovery (GOS) at 1 month & 3 month respectively

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Accidental tramadol ingestion in children admitted in tertiary care centre

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195200 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2661

Author(s):

Vadlakonda Sruthi ◽

Annaladasu Narendra

Keyword(s):

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Ventilatory Support ◽

Case Series ◽

Pediatric Intensive Care ◽

Hemodynamic Instability ◽

Tertiary Care Centre ◽

Medical College ◽

History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

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Magnitude of hypothyroidism among patients of cholelithiasis in a tertiary care centre in rural West Bengal: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20214374 ◽

2021 ◽

Vol 8 (11) ◽

pp. 3375

Author(s):

Jaganmoy Maji ◽

Debjyoti Mandal

Keyword(s):

Stone Formation ◽

Tertiary Care ◽

Gall Stone ◽

Sampling Technique ◽

Cross Sectional Study ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Medical College ◽

Elder Patients ◽

A Prospective Study

Background: Cholelithiasis is a common pathology of the gall bladder affecting about 10 to 15% of the adults in western countries and 2 to 29% in India. More than 80% of the patients with cholelithiasis are asymptomatic. Hypothyroidism may cause gall stone formation due to the hyperlipidemia, motility disorders affecting the bile duct and sphincter of Oddi.Methods: This was a descriptive cross-sectional study conducted at Department of Surgery, Bankura Sammilani Medical College and Hospital, Bankura from March 2019 to February 2020 for duration of one and half year. The sample size was 54 and consecutive non-probability sampling technique was used for the sampling. All the collected data were recorded in a pre-designed proforma and analyzed in MS excel.Results: Out of 54-patients with cholelithiasis, 28% patients were from the age group 45-54 years.40% patients were hypothyroid pre-dominantly females. Among 30-female patients 11 (26.82%) were hypothyroid and among 11-male patients 2 (15.38%) were hypothyroid. Hypothyroidism in male and female was statistically significant.Conclusions: This study was introduced to determine the relationship between hypothyroidism and cholelithiasis. It was concluded that hypothyroidism was more common in female, obese and elder patients. The gender distribution of the hypothyroidism in patients with cholelithiasis was statistically significant while all other variables were statistically not significant.

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A PROSPECTIVE HISTOPATHOLOGICAL STUDY OF MENINGIOMAS IN A TERTIARY CARE CENTRE OF VIJAYAWADA

10.36106/gjra/9100428 ◽

2021 ◽

pp. 11-13

Author(s):

C.Bhanu Sree ◽

P. Annapurna ◽

M. Rajani

Keyword(s):

Surgical Resection ◽

Tertiary Care ◽

Histopathological Study ◽

Age Group ◽

Care Centre ◽

Tertiary Care Centre ◽

Medical College ◽

Histological Appearance ◽

Classi Cation ◽

A Prospective Study

Background: Meningiomas are neoplasms arising from the arachnoidal cap cells in the meningeal coverings of the spinal cord and brain. These are the most common benign intracranial tumours and account for about 13-26% of all primary brain neoplasms. These are generally benign neoplasms of adults most often seen in middle age, but about 10% are atypical or malignant. These neoplasms are graded by WHO as Grade I , II and III . Benign meningiomas can be cured by surgical resection where as higher grade meningiomas require radiotherapy after surgical resection as these higher grade meningiomas have greater recurrence and aggressive behavior. Aims and Objectives: To study the variants and histopathological spectrum of meningioma and prognosis of variants. Material & Methods: The present study is a prospective study conducted in the department of Pathology, Siddhartha medical college from June 2019-May 2020. During this study, 16 cases of meningiomas were diagnosed and reviewed. Result:In our study of 16 cases females were 62.5%. The most common age group is 41-60 yrs (68.75%). Most common variant was noted to be transitional meningioma followed by meningothelial meningioma. Out of the 16 cases, grade I were 81.25%. Conclusion: Meningiomas account for 28-30% of primary central nervous system tumors and unveil a heterogeneous histopathology. The histological appearance of meningioma determines the grading for the management of the various subtypes and also associated with patient's prognosis. Hence a continuous revision of histopathological classication systems is required to improve the diagnostic accuracy. Benign meningiomas are the most common type. From our study, we conclude that transitional meningioma is the most common benign variant.

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Epidemiologic Characteristics of Patients Presenting with Head Injury due to Road Traffic Accident and Factors Associated with Outcome: Experience of a Tertiary Care Center in Northern Kerala

Indian Journal of Neurosurgery ◽

10.1055/s-0039-1678468 ◽

2019 ◽

Vol 08 (01) ◽

pp. 039-046

Author(s):

Mandaka Rajeev ◽

Vattaparambil Shinihas ◽

Pankaj Chauhan

Keyword(s):

Road Traffic Accident ◽

Traffic Accident ◽

Alcohol Intake ◽

Road Traffic ◽

Care Center ◽

Tertiary Care ◽

Health Resources ◽

Medical College ◽

History Of ◽

Limited Health

Abstract Background In India, most factors related to road traffic accident (RTA) causation and outcome go improperly documented, and database regarding RTA-related traumatic brain injury (TBI) seems inadequate. Two-wheeler drivers form the largest segment of people affected by RTA. The socioeconomic and neurologic burden, imposed by TBI due to RTAs (largely preventable), is overwhelmingly significant, especially for a developing country like India. Materials and Methods Descriptive study involving patients, presenting to the casualty of Government Medical College, Kozhikode, Kerala, was performed, and various demographic features were analyzed. Usage of helmet and history of alcohol intake were also noted. Patients were evaluated according to their presenting Glasgow coma scale (GCS), investigated and either operated or managed conservatively, and their outcome was assessed with Glasgow outcome score (GOS) at 3 months. Results Bike drivers formed the single largest proportion of RTA victims (53.7%). Proportion of helmet users was 17.9%, whereas 21.9% were found with history of alcohol intake. There was a consistent trend toward a favorable outcome in patients with no alcohol intake (17.08% deaths compared with 34.07% patients with alcohol intake) and with helmet usage (14.55% compared with 22.18% in patients without helmet). However, the absolute contribution of these factors cannot be inferred. Conclusion Various factors related to RTA need evaluation for pooling and compilation of data at regional and national levels. Mandatory helmet laws and strict implementation and provision of subsidized helmets (standard, full coverage) will go a long way in reducing the burden on limited health resources.

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A PROSPECTIVE STUDY OF THE PATTERN OF USE OF ANTIMICROBIAL AGENTS IN SURGICAL PROPHYLAXIS IN A TERTIARY CARE CENTRE

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i1.15803 ◽

2016 ◽

Vol 9 (1) ◽

pp. 283

Author(s):

C. S. Brethis ◽

S. Thamizharasan ◽

S. A. Sridevi ◽

B. Kalaiselvi ◽

M. Balaji Singh ◽

...

Keyword(s):

Antimicrobial Agent ◽

Antimicrobial Agents ◽

Tertiary Care ◽

Cost Effective ◽

Surgical Prophylaxis ◽

Tertiary Care Centre ◽

Medical College ◽

The Mean ◽

A Prospective Study ◽

Induction Of Anaesthesia

Objective: To evaluate the most common class of antimicrobial agents used in surgical prophylaxis. To evaluate the timing, dosage, route and duration of use of antimicrobial agents in surgical prophylaxis.Methods: The study subjects were 214 patients who underwent general surgical procedures at Vinayaka Missions Kirupananda Variyar Medical College from July 2013 to June 2014. The use of antimicrobial agents was noted from the first dose of antibiotic given before the induction of anaesthesia. After surgery was completed the duration of antibiotic in the post-operative ward was noted. Results: Majority of the patients were males of age group 50-60 y and the most common surgical procedure was hernioplasty. Combination therapy with two antimicrobial agents was more preferred regimen 126 (58.9%). Among the antimicrobial agent's cefotaxime 114 (24.8%) was the most commonly prescribed drug and it was followed by metronidazole 121 (21.9%). ceftriaxone 60 (13.1%) was the third most commonly prescribed antimicrobial agent. The mean duration of prescription of antimicrobial agents in the present study was 4.78 d and the mean cost of drug treatment was 787.54 rupees. The cost-effective regimen was that of aminoglycosides and imidazole.Conclusion: The choice of antimicrobial agent was based on the local prevalence pattern of microorganisms. The intravenous administration of antibiotic prophylaxis immediately before or after the induction of anaesthesia is the most reliable method for ensuring effective serum concentration at the time of surgery. The antimicrobial agent chosen must cover all the most likely contaminating organisms.

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Pattern of Congenital Overt and Occult Pediatric Surgical Anomalies in a Tertiary Care Centre Over 5 Years

Galore International Journal of Health Sciences and Research ◽

10.52403/gijhsr.20211004 ◽

2021 ◽

Vol 6 (4) ◽

pp. 16-20

Author(s):

Sam Varkey ◽

Aravind C. S ◽

Reeti Rajan

Keyword(s):

Congenital Anomalies ◽

Pediatric Surgery ◽

Hospital Admissions ◽

Tertiary Care ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Low Socioeconomic ◽

Medical College ◽

Common System ◽

History Of

ongenital anomalies are important cause of infant and childhood deaths, chronic illness and disability. The proportion of deaths and disability due to congenital anomalies has increased, as deaths due to other diseases have decreased over the years due to better health care. Hence it is essential to have basic epidemiological information of these anomalies. This is a hospital based, cross-sectional, record based study, conducted in the Department of Pediatric Surgery, Govt. Medical College Thiruvananthapuram, Kerala. Sample size included 300 children below the age of 12years admitted in the department of pediatric surgery with various major congenital anomalies, over a period of 5 years. More than half of these children were admitted after infancy for treatment, male children were more compared to females. Majority of these children were from low socioeconomic group. Only in 5.6% cases there was a history of consanguineous marriage. In 7.33% there was family history of congenital anomalies. In 32% cases the anomalies were detected in the antenatal period. Most of the anomalies were isolated anomalies. Genitourinary system was the most common system to be involved followed by, gastrointestinal tract. 91.67% children underwent surgical treatment, and only 10.67% children had major complications in postoperative period. This study shows that congenital anomalies are a major cause of hospital admissions in children of all ages. Pattern of anomalies seen in various centers are different. Knowledge of the pattern of congenital anomalies may be useful in planning health services. Keywords: Congenital, Anomalies, Pediatric surgery.

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Study of benign neck swellings of anterior neck triangle at a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192709 ◽

2019 ◽

Vol 5 (4) ◽

pp. 941 ◽

Cited By ~ 1

Author(s):

Pradipkumar Digambar Khokle ◽

Vinod Tukaram Kandakure ◽

Ujjwala Madhukar Kolekar

Keyword(s):

Tertiary Care ◽

Surgical Excision ◽

Lateral Neck ◽

Neck Swelling ◽

Thyroglossal Cyst ◽

Tertiary Care Centre ◽

Medical College ◽

Wide Range ◽

Thyroid Swelling ◽

A Prospective Study

Background: Tumors of the neck are interesting to surgeons especially because of the complex neck anatomy and difficult differential diagnosis. The aim is to study different types of neck swellings i.e. thyroid swelling, salivary gland swelling, other neck swellings such as thyroglossal cyst, branchial cyst, lymphangioma and also the miscellaneous and rare lumps in the neck. The study also discusses their age and sex-wise distribution, clinical features, presentation, diagnostic modalities and treatment.Methods: This is a prospective study, conducted at our institute Government Medical College, Latur from June 2017 to May 2018 for a duration of one year. Results: A total of 57 patients were studied during this period. Out of the 57 patients, 47 of them were midline swellings (82.45%) and 10 among them were lateral neck swellings (17.55%). People over a wide range of age group between 5-60 years were affected. Midline neck swelling were more common than lateral neck swellings.Conclusions: Among the midline benign neck swellings, thyroid swelling was found to be the commonest followed by thyroglossal cyst. Thyroid swellings occur more commonly in the females than males. Ultrasound guided FNAC is the most common, effective and safe investigation that aids in the diagnosis. Treatment of choice for benign, non-inflammatory and non-malignant neck swelling is mostly surgical excision rather than medical management.

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Profile of chest injuries in a tertiary care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20200809 ◽

2020 ◽

Vol 7 (3) ◽

pp. 714

Author(s):

Rajesh K. Jegoda

Keyword(s):

Chest Trauma ◽

Road Traffic ◽

Tertiary Care ◽

Clinical History ◽

Blunt Injury ◽

Trauma Patients ◽

Care Centre ◽

Tertiary Care Centre ◽

Chest Injuries ◽

A Prospective Study

Background: Trauma is a major cause of mortality worldwide. This study is aimed at the patterns of chest trauma, their presentation and the outcome of management.Methods: A prospective study of trauma patients admitted to a tertiary care centre was carried out the clinical history, physical examination and outcome of management recorded in a predesigned proforma were analysed with SPSS 15 and the patients were followed up in the surgical department.Results: A total of 638 patients were admitted. 57 patents were identified with chest trauma, 43 (75%) were males and 14 (24.56%) were females. The age range was from 3-78 years and the most affected age was in the range of 20 to 39 years. Blunt injury constituted 82.4% while road traffic accident was responsible for 70.1%. The average time taken between accident and admission was 11 hours 12 minutes while the average duration of hospital stay was 11 days. The injury pattern mainly included rib fracture and hemopneumothorax. The mortality rate was 1.75%.Conclusions: Most patients arriving at the hospital survived, requiring general resuscitation or simple tube thoracostomy with few complications. Mortalities from trauma and cause of death at the site of accident are often not accounted for due to non-presentation to the hospital and lack of autopsy for those who present.

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Study of bacteriological profile and sensitivity to various drugs in a case of wound dehiscence in tertiary care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20190569 ◽

2019 ◽

Vol 6 (3) ◽

pp. 724

Author(s):

Shashank Shekhar Tripathi ◽

Ankur Tripathi ◽

Rahul Singh ◽

Himansha Pandey

Keyword(s):

Surgical Procedures ◽

Surgical Complication ◽

Tertiary Care ◽

Wound Dehiscence ◽

Tertiary Care Centre ◽

Medical College ◽

Elective Surgical Procedures ◽

One Year ◽

A Prospective Study ◽

Prolonged Hospital

Background: Surgical wound infection is a common post-operative complication causing significant post-operative morbidity and mortality, prolonged hospital stays and adds between 10-20% to hospital cost.Methods: This is a prospective study conducted in Department of General Surgery and Department of Microbiology, M.L.N. Medical College and Swaroop Rani Nehru Hospital, Allahabad. The study group comprised of all patients who underwent surgery during the period from October 2017 to September 2018 and were diagnosed with postoperative surgical site infection and wound dehiscence.Results: A total of 1640 patients were followed during one year of study. 540 (32.92%) patients were operated as emergency cases while 1100 (67.08%) were operated as elective cases.Conclusions: Wound dehiscence is a common surgical complication occurring in about 6.5% of surgical procedures. Emergency operative procedures are associated with higher incidence (16.67%) of wound dehiscence as compared to elective surgical procedures (1.67%). Male gender is more commonly associated with wound dehiscence especially in case of emergency surgical procedures with male to female ration of 1.67:1.Incidence of wound dehiscence increases with increasing age being maximum in older age group. Malnutrition is the most common risk factor present in surgical patients predisposing to wound dehiscence.

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