scholarly journals Patterns and Severity of Injuries in Patients Following Physical Assault– A Medicolegal Aspects

2020 ◽  
Vol 2 (2) ◽  
pp. 16-20
Author(s):  
Archana Chaudhary ◽  
Srijana Kunwar ◽  
Samjhana Ghimire ◽  
Harihar Wasti
Keyword(s):  
Tertiary Care ◽  
Treatment Strategies ◽  
Point Of View ◽  
Physical Assault ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
Exact Test ◽  
Young Males ◽  
Far Eastern

Background and purpose: Physical assault (PA) is a common cause of mortality and morbidity throughout the world and the prevalence is still very high in underdeveloped and developing countries. With the objective to see the spectrum of injury following PA from the medico legal point of view, this study was design in a tertiary care centre at far eastern part of Nepal. Material and method: This is a prospective analytical study with non- probability consecutive sampling of physical assault cases presented in the emergency department over the duration of 4 months. All the patients who meet the inclusion criteria were collected in preformed proforma. Gender, types of weapons used for PA, location of external and internal injuries, various treatment strategies, and severity of injuries were presented in frequencies and percentage. Association of different age categories, gender and types of weapons used with severity of injuries were analysed using Chi square/ Fisher’s exact test wherever applicable. Result: There were total 99 patients presented with physical assault during the study period with mean age of presentation 31.69 (SD 13.38) Years with male (70%) predominance. Among various types of weapons used for PA; punches/ kicks were used in 50% of assaults followed by blunt heavy objects (35%) and sharp heavy weapons (14%). Location of the external injuries were more common in head and neck area . Obvious internal injuries were seen in 14% of the assaulted patients. Among all the case of PA, 42% patients needed some sort of surgical intervention during hospital stay. There were 9% cases of grievous injury and 6% had life threatening injuries. Conclusion: Physical assault is a common mode of injuries in eastern Nepal, where young males are more prone to such injuries. Violence are commonly carried out using fists, kicks and blunt objects. Severity of injuries is similar with all the types of weapons used.

Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

2021 ◽  
pp. 153857442110225
Author(s):  
Joel Mathew John ◽  
Vimalin Samuel ◽  
Dheepak Selvaraj ◽  
Prabhu Premkumar ◽  
Albert A Kota ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Interventional Procedure ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Multivariable Logistic Regression Analysis ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Exact Test ◽  
Institutional Review ◽  
Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

FACTORS CAUSING DELAY IN TIME TO DOOR AT EMERGENCY DEPARTMENT(ED) IN CASES OF ACUTE STROKE AND IT'S IMPACT ON OUTCOME AT TERTIARY CARE CENTRE

2020 ◽  
pp. 67-70
Author(s):  
Yogender Kumar Yadav ◽  
Dina J Shah ◽  
Jyoti B Sharma ◽  
Nalini Bala Pandey
Keyword(s):  
Acute Stroke ◽  
Average Length ◽  
Tertiary Care ◽  
Onset Time ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
End Points ◽  
Exact Test

BACKGROUND: The effectiveness of stroke management is highly dependent on post onset time of treatment. The study hypothesized that perceptual, social and behavioral factors affect delay in seeking help after symptom onset and worsen the outcome and recovery. OBJECTIVE: To look at the causes of delay in arrival to denitive care hospital ED after symptoms of acute stoke and its impact on patient's clinical outcome. METHODS: An observational prospective study conducted on 63 patients with signs and symptoms of acute stroke (CPSS/NIHSS positive) reported to ED. Reasons for delay in arrival to ED observed. Patients divided into two groups, those who came within 4.5 hours of onset of acute stroke symptoms and those who came after 4.5 hours. Impact of delay on patient's outcome studied at time of discharge as primary end-points in terms of average length of stay (ALOS), complications and death. Secondary end-points evaluate in terms of improvement, deterioration and death within 30th day. Statistical analysis using Chi-square or Fisher's exact test applied to compare both the groups. Odds ratio with 95 % condence limit was also calculated. RESULTS: There were multiple overlapping causes of delay; most frequently was “rst went to physician who doesn't treat stroke (8; 38.1%) and non-availability of nearby stroke centre (8; 38.1%)”. Total 21 (33.34%) patients came after window period (4.5hours). Primary endpoints in terms of ALOS (8 days compared to 9 days, p=0.48), complications (OR=1.4, 95%CI:0.2-8.8, p=0.74) and death (OR=3, 95%CI:0.4-19.3, p=0.24) at time of discharge. Secondary endpoints in terms of improvement (OR=2.8, 95%CI:1.0-7.8, p=0.03), deterioration (OR=6.0, 95%CI:1.4-24.5, p=0.01) and death within 30 days (OR=1.2, 95%CI:0.2-5.5, p=0.81). CONCLUSION: Inadequate knowledge of stroke identication and management causes delay in arrival to hospital. This delay can cause signicant impact on patient outcome and recovery

scholarly journals Comparison of intravenous hydralazine and intravenous labetalol in the management of severe hypertensive disorders of pregnancy: a tertiary care centre study

2018 ◽  
Vol 7 (6) ◽  
pp. 2251
Author(s):  
Manvi Verma ◽  
Shashi Gupta ◽  
B. R. Bhagat ◽  
Aakanksha Mahajan ◽  
Baseerat Kaur
Keyword(s):  
Adverse Effects ◽  
Severe Hypertension ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
Categorical Variables ◽  
Tertiary Care Centre ◽  
Low Birth Weight Infants ◽  
Chi Square ◽  
Exact Test ◽  
Student’S T

Background: Severe hypertension in pregnancy (SBP ≥160 mmHg &/or DBP ≥ 110 mmHg) must be treated judiciously to prevent maternal and fetal complications. The study was conducted to compare the efficacy, adverse effects, maternal and fetal outcome between Hydralazine and Labetalol which are the most commonly used drugs for the purpose.Methods: In a prospective study, 130 pregnant patients each with severe hypertension presenting to SMGS Hospital Jammu were randomized in 2 groups and administered hydralazine or labetalol intravenously. The efficacy of the two drugs was measured in terms of number of doses required to obtain target BP and the timing to achieve the same. The incidence of adverse effects, maternal and fetal outcomes were also compared. Comparisons among the two groups was performed by using independent Student’s t test for normally distributed variables, Fishers’ exact test, and Pearson Chi Square test for categorical variables. The level of significance was set at p<0.05 for all analysis.Results: There was no statistical difference between the two drugs in terms of efficacy. Significantly more low-birth weight infants were born in the hydralazine group. Also, the adverse effects were significantly more in the hydralazine group.Conclusions: Both hydralazine and labetalol can be used to treat hypertensive emergencies of pregnancy but hydralazine is associated with more side effects.

scholarly journals A Single Institute Five-Year Surgical Experience with Chronic Subdural Hematoma: Analysis of 270 Consecutive Patients at a Tertiary Care Centre

2018 ◽  
Vol 32 (3) ◽  
pp. 473-482
Author(s):  
Gaurav Jaiswal ◽  
Vivek Kankane ◽  
Ashok Kumar ◽  
Pavan Kumar ◽  
Tarun Kumar Gupta
Keyword(s):  
Subdural Hematoma ◽  
Care Center ◽  
Tertiary Care ◽  
Treatment Strategies ◽  
Chronic Subdural Hematoma ◽  
Twist Drill ◽  
Surgical Experience ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Surgery Mortality

Abstract Chronic subdural hematoma (CSDH) is one of the very common surgically treatable neurosurgical entities. Still there is lack of uniformity in the management of CSDH amongst surgeons in terms of various treatment strategies and protocols. Burrhole drainage is the treatment modality of choice for an uncomplicated CSDH. Some recent trials support the use of drain to lessen the rate of recurrence. Twist drill craniostomy and craniotomy do also play a role in the management of CSDH. The current study is a retrospective analysis of 270 surgically treated patients with chronic subdural hematoma at a tertiary care center over a span of five years. The present study highlighted on rate of recurrence, re-surgery, mortality and morbidity.

scholarly journals Antenatal umbilical cord coiling index as a predictor of pregnancy outcome

2021 ◽  
Vol 8 (3) ◽  
pp. 383-387
Author(s):  
Lopamudra B John ◽  
Takkellapati Aanandini ◽  
Setu Rathod
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Umbilical Cord ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Exact Test ◽  
Fischer Exact Test

: Fetal compromise as a major contributor to neonatal morbidity is of great concern for obstetricians. Antenatal risk assessment profiles are often insufficient in picking up these cases and hence need to be improved. Antenatal Umbilical cord Coiling Index (AUCI) is one such potential predictor which helps in identifying pregnant women who need close antepartum and intrapartum monitoring. It is determined by ultrasonogram antenatally and noted to be fixed throughout the pregnancy. This study aims at determining the association between AUCI and pregnancy outcome.: This was a hospital based prospective analytical study conducted in a tertiary care centre in Pondicherry from January 2019 to May 2020. 207 pregnant women were included in the study and Colour doppler was performed and AUCI was noted. Participants were followed until delivery and pregnancy outcomes were noted.: Chi square and Fischer exact test: In the present study, among 207 subjects, 166 had normal AUCI i.e., 0.41 to 0.61. Hypocoiling was noted in 20 (&#60; 0.41) and hypercoiling in 21(&#62;0.61) subjects. Hypocoiling was associated with hypertension and oligohydramnios in10% cases each. Nonreasssuring fetal (NRFHR) heart rate, meconium stained liquor and low APGAR values were present in 15, 20 and 10% cases respectively. Hypercoiling was associated with diabetes (10%), hypertension (5%), oligohydramnios (10%), polyhydramnios (5%), NRFHR (10%) and meconium stained liquor (5%). However, there was no statistical significance among the above mentioned parameters.

SPECTRUM OF HISTOPATHOLOGICAL LESIONS OF FEMALE GENITAL TRACT - STUDY IN A TERTIARY CARE CENTRE

2021 ◽  
pp. 19-21
Author(s):  
Naik Viraj R ◽  
Manjusha Jindal ◽  
Siddhi D. Naik
Keyword(s):  
Genital Tract ◽  
Malignant Tumors ◽  
Benign Lesion ◽  
Tertiary Care ◽  
Female Genital Tract ◽  
Screening Methods ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Histopathological Lesions ◽  
Female Genital

Introduction: (1) The female genital tract is constituted by the ovaries, fallopian tubes, uterus (body/corpus and cervix), vagina, and vulva. Female genital tract lesions can be benign or malignant. Our study was carried out to nd out the frequency of various histopathological lesions including neoplasms of female genital tract. Materials and Methods: Our study is retrospective conducted over 2 years period. Data was collected from case records of patients presenting to Goa Medical College and histopathology reports obtained from Dept of pathology. Data was represented in form of charts and tables. The analysis of statistical data of variables was done using SPSS software version 22. Signicance was calculated using chi square test. Value of p <0.05 was considered signicant. Results: Out of total 270 subjects studied, 229 were having benign lesions and 41 had malignant lesions.The mean age was 49.5 years. Leiomyoma was diagnosed in (40.58%) cases. In abnormalities of endometrium proliferative endometrium was seen in 37.6%. Chronic cervicitis was seen 78.74% cases. Among the ovarian lesions, 67.74% cases were simple follicular cysts. Cervical cancer was found in 73.17% cases followed by ovarian malignancies in 19.51 % cases, endometrial carcinoma in 4.87% cases and vulvar cancer in 2.44% cases. Among the malignant tumors (58.54%) cases were postmenopausal women. Conclusion: Microscopic assessment and clinico-pathological correlation of lesions is necessary as grossly identiable benign lesion may harbour a focus of malignancy. It aids to appropriate management in the postoperative period. A concerted effort should be done towards prevention of cancers, by creating awareness through health education in addition to implementation of screening methods.

scholarly journals Surgical management and perioperative complications of peritonitis secondary to hollow viscus perforation in a tertiary care centre

2021 ◽  
Vol 8 (11) ◽  
pp. 3359
Author(s):  
Lokesh M. G. ◽  
S. Chandrashekar ◽  
Arundathi Raikar ◽  
Abhishek S. S.
Keyword(s):  
Perioperative Complications ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Threatening Condition ◽  
Hollow Viscus Perforation

Background: High mortality and morbidity is associated with peritonitis secondary to hollow viscus perforation, proving it a most common life threatening condition which needs emergency surgical care. Hence a proper evaluation was needed regarding appropriate management to have a better outcome, which was a challenge to operating surgeon.Methods: A serial study of 96 cases of peritonitis secondary to hollow viscus perforation was conducted at tertiary care centre, department of general surgery, Mysore medical college and research institute, Mysore, Karnataka from the period of August 2020 to July 2021. Data related to aetiology, surgical intervention and its peri-operative complications were noted. Appropriate statistical analyses were done to draw the inference.Results: Out of 96 cases studied, 74 were male, 22 were female with mean age of 45.53 years. Most common cause of peritonitis was GU perforation, followed by idiopathic, infective, malignancy, appendicular perforation and Trauma.Conclusions: Hollow viscus perforation being most common surgical emergencies, surgical outcomes and its related complications depends on age, general condition, site, co-morbidities and aetiologies.

scholarly journals Neonatal candidiasis: clinical spectrum and epidemiology in a tertiary care centre

2017 ◽  
Vol 4 (2) ◽  
pp. 438
Author(s):  
Bhavana Koppad ◽  
Kulkarni Poornima Prakash
Keyword(s):  
Candida Albicans ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Candida Guilliermondii ◽  
Clinical Spectrum ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Neonatal Candidiasis

Background: Candidial infections are a serious problem in neonatal intensive care units (NICU) which increases the mortality and morbidity in addition to increasing health care costs. Confirming the diagnosis by laboratory tests is difficult and a high index of suspicion is required. The objective of this study was to identify the clinical spectrum and epidemiology of neonatal candidiasis in a tertiary care NICU.Methods: The present study was carried out in the NICU of SDM medical college and hospital, Dharwad. All babies who were admitted to NICU and who had positive blood culture for Candida were included in the study. One year Data (1st December 2015 to 31st November 2016) was collected retrospectively from NICU case records. Statistical test used was chi square test.Results: Total admissions to the NICU during the study period were 2591. Blood cultures were positive in 132 babies. Among these, Candidial sepsis was noted in 39.39% (52) babies. Out of the 52 positive fungal cultures, 15 were Candida albicans, 35 were Candida non albicans and 2 were mixed cultures (Candida albicans and non albicans) showing an increasing incidence of non-albicans Candida infections. Among the non albicans Candida, Candida tropicalis and Candida guilliermondii were the predominant species (11 each) followed by Candida famata (6), Candida krusei (6) and Candida parapsilosis (3). Candidial sepsis was seen to be more common among preterm and low birth weight babies. Usage of antibiotics, Total parenteral nutrition (TPN) and mechanical ventilation were common risk factors noted in our study.Conclusions: Systemic Candidiasis is a disease of modern neonatal intensive care. It deserves urgent attention for its prevention as well as effective treatment in order to minimize neonatal morbidity and mortality.

scholarly journals Postoperative Neurological Complications after a Cranial Surgery: A Multicentre Prospective Observational Study

2020 ◽  
Author(s):  
Ramesh J. Venkatapura ◽  
Surya K. Dubey ◽  
Nidhi Panda ◽  
Dhritiman Chakrabarti ◽  
Sudhir Venkataramaiah ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Tertiary Care ◽  
Neurological Complications ◽  
Vascular Pathology ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Exact Test ◽  
Cranial Surgery

Abstract Background  Cranial surgery is associated with multiple postoperative complications varying from simple nausea and vomiting to devastating complications such as stroke and death. This multicentre collaborative effort was envisioned to collect observational data regarding postoperative complications in cranial surgeries among the Indian population. The aim of this study was to describe the postoperative neurological complications occurring within the first 24 hours after surgery and to identify the predictive factors. Methods Data was collected from three participating tertiary care academic institutions. The study was prospective, observational, multicentre design with data collected over a period of two months or 100 cases, whichever is earlier, from each participating institute. A predesigned Microsoft excel sheet was distributed among all three centers to maintain uniformity. All patients aged 18 years and above of both sexes undergoing elective or emergency craniotomies were included in the study. The postoperative neurological complications (within 24 hours) assessed were: (1) Neurological deficit (ND) defined as new focal neurological motor deficit relative to preoperative status. (2) Sensorium deterioration (SD) defined as reduction in Glasgow coma score (GCS) by 2 or more points compared with preoperative GCS. (4) Postoperative seizures (SZs) defined as any seizure activity. All possible variables associated with the above neurological complications were tested using Chi-square/Fisher exact test or Mann–Whitney U test. The predictors, which were statistically significant at p < 0.2, were entered into a multiple logistic regression model. Alpha error of 5% was taken as significant. Results Data from three institutions was collected with a total of 279 cases. In total, there were 53 (19%) neurological complications. There were 28 patients with new postoperative NDs (10.04%), 24 patients had SD (8.6%), and 17 patients had seizures (6.1%). Neurological deficits were significantly less in institution 2. Diagnosis of traumatic brain injury (TBI) was associated with very low risk of ND, and vascular pathology was associated with higher chance of a ND. The duration of anesthesia was found to be significantly predictive of SD (OR/CI = 1.01 / 1–1.02). None of the factors were predictive of PS. Conclusion The incidences of postoperative ND, SD and postoperative seizures were 10%, 8.6%, and 6.1%, respectively. Studies with a much larger sample size are required for a better and detailed analysis of these complications.

scholarly journals Peripartum Hysterectomy in a Teaching Hospital in India

2013 ◽  
Vol 4 (1) ◽  
pp. 5-9
Author(s):  
Swati Agrawal ◽  
Reena Yadav ◽  
Chitra Raghunandan ◽  
Shilpa Dhingra ◽  
Harvinder Kaur
Keyword(s):  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Medical Sciences ◽  
Tertiary Care Centre ◽  
Maternal Deaths ◽  
Mortality And Morbidity ◽  
Maternal Characteristics ◽  
Peripartum Hysterectomy ◽  
Characteristics Method ◽  
Life Saving

Objectives: To find the incidence and clinical implications of peripartum hysterectomy in a tertiary care centre of India. Methods: A retrospective study of all cases of caesarean and postpartum hysterectomy between January 2006 and December 2011. Maternal characteristics, method of delivery, indications for hysterectomy and complications were reviewed. Results: The rate of peripartum hysterectomy was 0.47:1000 deliveries. Most were operative deliveries. The main indications were placenta accreta (38.88%), massive atonic PPH (36.11%) and uterine rupture (22.22%). Half the hysterectomies were subtotal while the rest were total. Maternal morbidity was high and there were seven maternal deaths (19.44%). All deaths were in patients brought in a critical condition to the hospital after massive blood loss. Conclusion: Peripartum hysterectomy is potentially a life saving procedure but the mortality and morbidity is high, especially if performed late when the hemodynamic instability has already set in. DOI: http://dx.doi.org/10.3126/ajms.v4i1.6967 Asian Journal of Medical Sciences 4(2013) 5-9

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